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<1>
Accession Number
620160644
Title
Intramyocardial dissecting hematoma: Two case reports and a meta-analysis
of the literature.
Source
Echocardiography. 35 (2) (pp 260-266), 2018. Date of Publication: February
2018.
Author
Leitman M.; Tyomkin V.; Sternik L.; Copel L.; Goitein O.; Vered Z.
Institution
(Tyomkin, Vered) Department of Cardiology, Assaf Harofeh Medical Center,
Zerifin, Israel
(Leitman, Sternik, Copel, Goitein, Vered) Sackler School of Medicine, Tel
Aviv University, Zerifin, Israel
(Sternik) Department of Cardiac Surgery, Sheba Medical Center, Tel
Hashomer, Israel
(Copel) Department of Radiology, Assaf Harofeh Medical Center, Zerifin,
Israel
(Goitein) Department of Radiology, Sheba Medical Center, Tel Hashomer,
Israel
Publisher
Blackwell Publishing Inc.
Abstract
Until recently, diagnosis of intramyocardial dissecting hematoma (IDH) was
performed during necropsy or at surgery. During the recent years,
echocardiography has permitted clinical suspicion, which usually needed
confirmation with magnetic resonance imaging (MRI). In this study, we
tried to define clinical and imaging features of IDH and predictors of
mortality. We searched the literature for proven cases of IDH and analyzed
them together with 2 of our cases. A total of 40 cases of IDH (2 our
original and 38 literature cases) were included. Mean age was 60. In 32
cases, IDH was a complication of myocardial infarction (MI), in 66%
anterior, a mean time from symptoms to diagnosis was 9 days. Thirty-eight
% underwent surgery. In-hospital mortality was 23%. Multivariate analysis
showed that the strongest independent predictor of mortality (42%) was EF
< 35%; in patients with age >60, mortality risk was 44%; and in the
presence of MI or late diagnosis (>24 hours since symptoms started),
mortality risk was 50%. In summary, IDH is a diagnostic challenge. A high
level of suspicion is needed for prompt diagnosis. Management of these
patients is based on individual clinical and imaging parameters. Low EF,
age > 60, and late diagnosis, all are predictors of in-hospital
mortality. Copyright © 2018 Wiley Periodicals, Inc.

<2>
Accession Number
618389896
Title
Percutaneous coronary intervention vs. coronary artery bypass grafting for
left main revascularization: An updated meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 3 (3) (pp
173-182), 2017. Date of Publication: 01 Jul 2017.
Author
Bajaj N.S.; Patel N.; Kalra R.; Marogil P.; Bhardwaj A.; Arora G.; Arora
P.
Institution
(Bajaj) Division of Cardiovascular Medicine, Department of Radiology,
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United
States
(Bajaj, Patel, Bhardwaj, Arora, Arora) Division of Cardiovascular
Diseases, Department of Medicine, University of Alabama at Birmingham,
1900 University Boulevard Birmingham, AL 35233, United States
(Kalra) Cardiovascular Division, University of Minnesota, 420 Delaware St
SE, Minneapolis, MN 55455, United States
(Marogil) Department of Internal Medicine, Brookwood Baptist Health, 2010
Brookwood Medical Center Drive Birmingham, AL 35209, United States
(Arora) Section of Cardiology, Birmingham Veterans Affairs Medical Center,
700 19th St S, Birmingham, AL 35233, United States
Publisher
Oxford University Press
Abstract
Aims The optimal revascularization strategy for left main coronary artery
disease (LMD) remains controversial, especially with two recent randomized
controlled trials showing conflicting results. We sought to address this
controversy with our analysis. Methods and results Comprehensive
literature search was performed. We compared percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) for LMD
revascularization using standard meta-analytic techniques. A 21% higher
risk of long-term major adverse cardiac and cerebrovascular event [MACCE;
composite of death, myocardial infarction (MI), stroke, and repeat
revascularization] was observed in patients undergoing PCI in comparison
with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05-1.40].
This risk was driven by higher rate of repeat revascularization in those
undergoing PCI (RR 1.61, 95% CI 1.34-1.95). On the contrary, MACCE rates
at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI
0.39-0.76), which was driven by lower rates of stroke in the PCI arm (RR
0.41, 95% CI 0.17-0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI
0.08-0.59) in the PCI arm were balanced by higher repeat revascularization
rates in those undergoing PCI (RR 1.78, 95% CI 1.33-2.37), resulting in a
clinical equipoise in MACCE rates between the two revascularization
strategies. There was no difference in death or MI between PCI when
compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI
for LMD revascularization vary over time. Therefore, individualized
decisions need to be made for LMD revascularization using the heart team
approach. Copyright © 2017 The Author.

<3>
Accession Number
2011027173
Title
Ablative radiosurgery for cardiac arrhythmias - A systematic review.
Source
Cancer/Radiotherapie. 25 (4) (pp 373-379), 2021. Date of Publication: June
2021.
Author
Munshi A.
Institution
(Munshi) Department of Radiation Oncology, Manipal Hospitals, Dwarka, New
Delhi, India
Publisher
Elsevier Masson s.r.l.
Abstract
Stereotactic body radiotherapy (SBRT) is a high precision technique that
is commonly used for malignant lesions in lung, liver, pancreas and spine.
Recent reports suggest promise in use of SBRT as a tool in atrial and
ventricular cardiac arrhythmias. The present systematic review deals with
the use of SBRT technology for this novel indication. A PubMed search was
done for articles published between 1990 and 2020. All original articles,
case reports, case series of treated patients were included in the
analyses. Out of the 55 articles in PubMed search, our search found 1
phase I/II clinical case series, 3 clinical case reports, 3 animal studies
and 4 dosimetric studies related to cardiac SBRT for arrythmias. All
studies used a uniform cardiac dose of 25 Gy. The available preclinical,
dosimetric and clinical studies have suggested that SBRT for cardiac
arrhythmias could become a potential alternative in suitable patients.
Cardiac and radiation oncology community await further data and experience
in this modality, including safety and outcomes. Copyright © 2021
Societe francaise de radiotherapie oncologique (SFRO)

<4>
Accession Number
2011020683
Title
Survival outcomes and adverse events in patients with chronic kidney
disease after coronary artery bypass grafting and percutaneous coronary
intervention: a meta-analysis of propensity score-matching studies.
Source
Renal Failure. 43 (1) (pp 606-616), 2021. Date of Publication: 2021.
Author
Yang Y.-G.; Li N.; Chen M.-H.
Institution
(Yang, Chen) Department of Intensive Care Medicine, The Second Affiliated
Hospital of Guangxi Medical University, Nanning, China
(Li) Guangxi Medical University, Nanning, China
Publisher
Taylor and Francis Ltd.
Abstract
Background: The present meta-analysis of propensity score-matching studies
aimed to compare the long-term survival outcomes and adverse events
associated with coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI) in patients with chronic kidney disease (CKD).
 Method(s): Electronic databases were searched for studies comparing
CABG and PCI in patients with CKD. The search period extended to 13
February 2021. The primary outcome was all-cause mortality, and the
secondary endpoints included myocardial infarction, revascularization, and
stroke. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence
intervals (CIs) were used to express the pooled effect. Study quality was
assessed using the Newcastle-Ottawa scale. The analyses were performed
using RevMan 5.3. Result(s): Thirteen studies involving 18,005
patients were included in the meta-analysis. Long-term mortality risk was
significantly lower in the CABG group than in the PCI group (HR: 0.76, 95%
CI: 0.70-0.83, p <.001), and similar results were observed in the subgroup
analysis of patients undergoing dialysis and for different estimated
glomerular filtration rate ranges. The incidence rates of myocardial
infarction (OR: 0.25, 95% CI: 0.12-0.54, p <.001) and revascularization
(OR: 0.17, 95% CI: 0.08-0.35, p <.001) were lower in the CABG group than
in the PCI group, although there were no significant differences in the
incidence of stroke between the two groups (OR: 1.24; 95% CI: 0.89-1.73, p
>.05). Subgroup analysis among patients on dialysis yielded similar
results. Conclusion(s): Our propensity score matching analysis
revealed that, based on long-term follow-up outcomes, CABG remains
superior to PCI in patients with CKD. Copyright © 2021 The
Author(s). Published by Informa UK Limited, trading as Taylor & Francis
Group.

<5>
Accession Number
2012226707
Title
Risk factors for recurrence of atrial fibrillation.
Source
Anatolian Journal of Cardiology. 25 (5) (pp 338-345), 2021. Date of
Publication: May 2021.
Author
Kisheva A.; Yotov Y.
Institution
(Kisheva, Yotov) First Department of Internal Medicine, Medical University
Varna, Varna, Bulgaria
Publisher
Turkish Society of Cardiology
Abstract
Objective: Atrial fibrillation (AF) is a progressive disease, associated
with increased risk of mortality, stroke, heart failure, and worsens
quality of life. There is a high incidence of AF recurrence despite the
treatment. The aim of the study was to assess the time to recurrence of AF
after sinus rhythm restoration with electrical or pharmacological
cardioversion and to identify the risk factors. Method(s): This study
included 101 patients with AF (56% females) at a mean age of 68.02+/-7
years, after sinus rhythm restoration in a clinical observation of 1-year
placebo-controlled treatment with spironolactone (1:1). The patients were
analyzed on the basis of AF recurrence, hospitalization, demographic
parameters, comorbidities, embolic risk, and value of biomarker galectin-3
(Gal-3). Result(s): The average number of AF recurrences was1.62 per
patient per year. The median time of occurrence of at least one new
episode was 48 days, 95% confidence interval (CI) 14.24-81.76. Female
patients experienced significantly more recurrences than male-53.3% vs.
28.6% hazard ration (HR) =1.76, 95% CI 1.02-3.03, p=0.036. The recurrences
were more common with increased age, although not significantly. Patients
with arterial hypertension had a threefold risk of recurrences than those
without hypertension (p=0.025), independently of the treatment.
CHA2DS2-VASc score was significantly associated with AF recurrent
episodes. Patients with gout had a twofold increased risk, without
statistical significance (p=0.15). There was no difference in the AF
episodes according to treatment with spironolactone. The levels of Gal-3
did not affect the number of AF recurrences (p=0.9). Conclusion(s):
AF is associated with frequent recurrences after restoration of sinus
rhythm in the majority of the patients. Most of them occurred within the
first 3 months. Female sex, arterial hypertension, and CHA2DS2-VASc score
were significant predictors of AF recurrence. Spironolactone did not
reduce AF recurrences. Copyright © 2021 Turkish Society of
Cardiology. All rights reserved.

<6>
Accession Number
2006892880
Title
Three-Year Outcomes From the LIBERTY 360 Study of Endovascular
Interventions for Peripheral Artery Disease Stratified by Rutherford
Category.
Source
Journal of Endovascular Therapy. 28 (2) (pp 262-274), 2021. Date of
Publication: April 2021.
Author
Giannopoulos S.; Mustapha J.; Gray W.A.; Ansel G.; Adams G.; Secemsky
E.A.; Armstrong E.J.
Institution
(Giannopoulos, Armstrong) Division of Cardiology, Rocky Mountain Regional
VA Medical Center, University of Colorado, Denver, CO, United States
(Mustapha) Advanced Cardiac and Vascular Centers for Amputation
Prevention, Grand Rapids, MI, United States
(Gray) Lankenau Heart Institute/Main Line Health, Philadelphia, PA, United
States
(Ansel) OhioHealth Heart and Vascular Physicians, Columbus, OH, United
States
(Adams) Department of Cardiology, North Carolina Heart and Vascular, Rex
Hospital, UNC School of Medicine, Raleigh, NC, United States
(Secemsky) Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA, United States
Publisher
SAGE Publications Inc.
Abstract
Purpose: To report the 3-year results of the LIBERTY 360 study, which
investigated outcomes of endovascular treatment of symptomatic peripheral
artery disease (PAD). Material(s) and Method(s): The LIBERTY trial
(ClinicalTrials.gov identifier NCT01855412) was a prospective,
observational, core laboratory-assessed, multicenter study of endovascular
interventions enrolling >1200 participants treated at 51 sites. Data from
1189 patients were stratified according to Rutherford category (RC) and
analyzed [RC 2-3 (n=500), RC 4-5 (n=589), and RC 6 (n=100)]. The primary
outcomes were major amputation of the target limb and all-cause death;
secondary outcomes were target vessel revascularization (TVR) or target
lesion revascularization (TLR); major adverse events (MAEs; death within
30 days, TVR or TLR, and major amputation); death or major amputation
combined; and change in self-reported quality of life (QoL) measures
(VascuQol-25). The Kaplan-Meier (KM) method was employed to estimate the
outcomes; estimates are presented with the 95% confidence intervals (CI).
Predictors of 3-year MAE, death, TVR, and major amputation were analyzed
using Cox proportional hazard regression modeling. Result(s): The
36-month KM survival rates were 86.0% in RC 2-3, 79.8% in RC 4-5, and
62.0% in RC 6 groups. The KM estimates of freedom from major amputation at
36 months were 98.5% in RC 2-3, 94.0% in RC 4-5, and 79.9% in RC 6. The
36-month KM estimates for freedom from TVR/TLR were 71.1% in RC 2-3, 64.2%
in RC 4-5 and 61.9% in RC 6 groups. Patients with claudication at baseline
were at lower risk for MAEs compared with RC 4-5 and RC 6 patients during
the 36-month follow-up. Vascular QoL improved from baseline and persisted
up to 36 months in all patients. Conclusion(s): Endovascular therapy
is a viable treatment option for patients with symptomatic PAD, with
sustained improved quality of life in both claudicants and patients with
chronic limb-threatening ischemia. These results provide important point
estimates for midterm outcomes after modern endovascular interventions for
PAD. Copyright © The Author(s) 2020.

<7>
Accession Number
634334139
Title
Invasive versus medically managed acute coronary syndromes with prior
bypass (CABG-ACS): Insights into the registry versus randomised trial
populations.
Source
Open Heart. 8 (1) (no pagination), 2021. Article Number: e001453. Date of
Publication: 26 Feb 2021.
Author
Lee M.M.Y.; Petrie M.C.; Rocchiccioli P.; Simpson J.; Jackson C.E.;
Corcoran D.S.; Mangion K.; Brown A.; Cialdella P.; Sidik N.P.; McEntegart
M.B.; Shaukat A.; Rae A.P.; Hood S.H.M.; Peat E.E.; Findlay I.N.; Murphy
C.L.; Cormack A.J.; Bukov N.B.; Balachandran K.P.; Ford I.; Wu O.;
McConnachie A.; Barry S.J.E.; Berry C.
Institution
(Lee, Petrie, Simpson, Jackson, Corcoran, Mangion, Sidik, McEntegart, Rae,
Hood, Berry) Institute of Cardiovascular and Medical Sciences, University
of Glasgow, Glasgow, United Kingdom
(Lee, Petrie, Rocchiccioli, Simpson, Jackson, Corcoran, Mangion,
Cialdella, Sidik, McEntegart, Shaukat, Hood, Peat, Berry) West of Scotland
Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, United
Kingdom
(Lee, Petrie, Rocchiccioli, Shaukat, Rae) Cardiology, Glasgow Royal
Infirmary, Glasgow, United Kingdom
(Lee, Jackson, Brown, McEntegart, Berry) Cardiology, Western Infirmary,
Glasgow, United Kingdom
(Lee, Hood, Peat, Findlay, Murphy, Cormack) Cardiology, Royal Alexandra
Hospital, Paisley, United Kingdom
(Bukov, Balachandran) Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Ford, McConnachie) Robertson Centre for Biostatistics, University of
Glasgow, Glasgow, United Kingdom
(Wu) Health Economics and Health Technology Assessment, University of
Glasgow, Glasgow, United Kingdom
(Barry) Department of Mathematics and Statistics, University of
Strathclyde, Glasgow, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background Coronary artery bypass graft (CABG) patients are
under-represented in acute coronary syndrome (ACS) trials. We compared
characteristics and outcomes for patients who did and did not participate
in a randomised trial of invasive versus non-invasive management
(CABG-ACS). Methods ACS patients with prior CABG in four hospitals were
randomised to invasive or non-invasive management. Non-randomised patients
entered a registry. Primary efficacy (composite of all-cause mortality,
rehospitalisation for refractory ischaemia/angina, myocardial infarction
(MI), heart failure) and safety outcomes (composite of bleeding, stroke,
procedure-related MI, worsening renal function) were independently
adjudicated. Results Of 217 patients screened, 84 (39%) screenfailed, of
whom 24 (29%) did not consent and 60 (71%) were ineligible. Of 133 (61%)
eligible, 60 (mean+/-SD age, 71+/-9 years, 72% male) entered the trial and
73 (age, 72+/-10 years, 73% male) entered a registry (preferences:
physician (79%), patient (38%), both (21%)). Compared with trial
participants, registry patients had more valve disease, lower haemoglobin,
worse New York Heart Association class and higher frailty. At baseline,
invasive management was performed in 52% and 49% trial and registry
patients, respectively, of whom 32% and 36% had percutaneous coronary
intervention at baseline, respectively (p=0.800). After 2 years follow-up
(694 (median, IQR 558-841) days), primary efficacy (43% trial vs 49%
registry (HR 1.14, 95% CI 0.69 to 1.89)) and safety outcomes (28% trial vs
22% registry (HR 0.74, 95% CI 0.37 to 1.46)) were similar. EuroQol was
lower in registry patients at 1 year. Conclusions Compared with trial
participants, registry participants had excess morbidity, but longer-term
outcomes were similar. Trial registration number
NCT01895751. Copyright © 2021 BMJ Publishing Group. All rights
reserved.

<8>
Accession Number
2008500329
Title
Critical Review and Meta-Analysis of Postoperative Sedation after Adult
Cardiac Surgery: Dexmedetomidine Versus Propofol.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1134-1142),
2021. Date of Publication: April 2021.
Author
Abowali H.A.; Paganini M.; Enten G.; Elbadawi A.; Camporesi E.M.
Institution
(Abowali, Paganini, Enten, Camporesi) Team Health Research Institute,
Tampa General Hospital, Tampa, FL, United States
(Elbadawi) University of Texas Medical Branch, Galveston, TX, United
States
Publisher
W.B. Saunders
Abstract
Objective: To evaluate reports from the published literature of all
randomized clinical trials (RCT) comparing postoperative sedation with
dexmedetomidine versus propofol in adult patients, after open cardiac
surgery. Design(s): A computerized search on Medline, EMBASE, Web of
Science, and Agency for Healthcare Research and Quality databases was
completed through June 2020. Meta-analysis of all published RCT comparing
dexmedetomidine versus propofol utilization in the postoperative phase,
using the standard Preferred Reporting Items for Systematic Reviews and
Meta-Analyses checklist. Setting(s): Assemblage and critical
discussion of 11 RCTs comparing postoperative sedation from standard
published reports from 2003 to 2019. Participant(s): The study
comprised 1,184 patients and analyzed critical discussion of time-based
parameters (time to extubation, intensive care unit length of stay, and
hospital length of stay) and nontime-dependent factors (delirium,
bradycardia, and hypotension). Measurements and Main Results: Time to
extubation was significantly reduced in the dexmedetomidine group
(standardized mean difference [SMD] = -0.70, 95% confidence interval [CI]
-0.98 to -0.42, p < 0.001); however, no difference in mechanical
ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.).
Dexmedetomidine significantly reduced the intensive care unit length of
stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not
translate into a reduced hospital length of stay (SMD = -1.13, 95% CI
-2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium
was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06,
N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p =
0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were
reported with propofol. Conclusion(s): Despite the ICU time
advantages afforded by dexmedetomidine over propofol, the former did not
seem to contribute to an overall reduction in hospital length of stay or
improvement in postoperative outcomes of heart valve surgery and CABG
patients. Copyright © 2020

<9>
Accession Number
2007883556
Title
Sublingual Sufentanil Tablet System Versus Continuous Morphine Infusion
for Postoperative Analgesia in Cardiac Surgery Patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (4) (pp 1125-1133),
2021. Date of Publication: April 2021.
Author
Van Tittelboom V.; Poelaert R.; Malbrain M.L.N.G.; La Meir M.; Staessens
K.; Poelaert J.
Institution
(Van Tittelboom, Poelaert) Department of Anesthesiology and Perioperative
Medicine, UZ Brussels, Jette, Belgium
(Malbrain) Department of Intensive Care, UZ Brussels, Faculty of Medicine
and Pharmacy, Jette, Belgium
(La Meir) Department of Cardiac Surgery, UZ Brussels, Faculty of Medicine
and Pharmacy, Jette, Belgium
(Staessens) Department of Perfusion, UZ Brussels, Jette, Belgium
(Poelaert) Department of Anesthesiology and Perioperative Medicine, UZ
Brussels, Faculty of Medicine and Pharmacy, Jette, Belgium
Publisher
W.B. Saunders
Abstract
Objective(s): To assess the effectiveness and side effects of a
patient-controlled sublingual sufentanil tablet system for postoperative
analgesia after cardiac surgery and to compare it to a nurse-controlled
continuous morphine infusion. Design(s): Prospective, open-label,
randomized controlled trial. Setting(s): Single university academic
center. Participant(s): Adult patients undergoing cardiac surgery,
which included a sternotomy. Intervention(s): Sublingual sufentanil
tablet system versus nurse-controlled continuous morphine infusion.
 Measurements and Main Results: A total of 483 cardiac surgery
patients were screened for eligibility, of whom 64 patients completed the
study. No statistically significant differences were found for baseline
characteristics between both groups. All mean numeric rating scale (NRS)
pain scores from after extubation until intensive care unit discharge were
<=3 in both groups. The cumulative mean NRS pain score from 24 hours after
extubation (primary outcome) (t = hours after extubation) was
significantly different in favor of the morphine group: (t = 0-24) (0.8
[0.7] v 1.3 [0.8]; p = 0.006). Later cumulative mean pain scores were also
in favor of the morphine group: (t = 24-48) (0.2 [0.3] v 0.6 [0.5]; p =
0.001) and (t = 48-63) (0.0 [0.0] v 0.1 [0.2]; p = 0.013). The cumulative
opioid dose (in milligrams intravenous morphine equivalents) was
significantly higher in the morphine group compared with the sublingual
sufentanil group (241.94 [218.73] v 39.84 [21.96]; p = 0.0001). No
differences were found for the incidences of postoperative nausea and
vomiting, sedation, hypoventilation, bradycardia, or hypotension between
both groups (secondary outcomes). Conclusion(s): Despite resulting in
statistically significantly higher pain scores, a patient-controlled
sublingual sufentanil tablet system offers adequate analgesia after
cardiac surgery and reduces opioid consumption when compared with
continuous morphine infusion. Copyright © 2020 Elsevier Inc.

<10>
Accession Number
2007541471
Title
Surgical Strategy for Intravenous Cardiac Leiomyomatosis.
Source
Heart Lung and Circulation. 30 (2) (pp 240-246), 2021. Date of
Publication: February 2021.
Author
Deng Y.; Dong S.; Song B.
Institution
(Deng, Dong, Song) Department of Cardiovascular Surgery, The First
Hospital of Lanzhou University, Gansu Province, China
Publisher
Elsevier Ltd
Abstract
Intravenous-cardiac leiomyomatosis (IVCL) is a rare, histologically benign
but biologically aggressive tumour. Accurate diagnosis and appropriate
treatment choices are important for prognosis. The best surgical approach
remains unclear owing to limited evidence. This study aimed to assess
surgical strategies for treating IVCL and to propose individualised
surgical strategies. We searched PubMed, Web of Science, and the Cochrane
Library to identify case reports and case series published in English over
the last 10 years. Two (2) reviewers independently screened the literature
according to the inclusion and exclusion criteria, and subsequently
extracted data. One hundred and ten (110) cases were included. According
to our analysis, IV cardiac leiomyomatosis is most common in the fifth
decade, and the mean age at detection is 45.71+/-7.67 years. Most patients
had undergone previous hysterectomy/myomectomy, or had a co-existing
uterine leiomyoma when admitted. The most common clinical presentations
were dyspnoea, palpitation, pelvic mass, and leg oedema. More patients
benefited more from one-stage surgery. Seventy-eight per cent (78%) of
cases experienced a surgical approach of thoracic and abdominal incisions.
Extractions of IVCL were varied. Eighty-seven (87) patients experienced
cardiopulmonary bypass and deep hypothermic circulatory arrest was
performed on 64.4% of them. Total hysterectomy and bilateral oophorectomy,
together with pelvic leiomyoma excision, were done in 76.0% of patients.
Overall, surgical strategies for IVCL are varied; the optimal strategy
required consideration of multiple factors. Complete resection is
recommended for both single- and two-stage operations. Once complete
resection is achieved, recurrence is rare. Copyright © 2020
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<11>
Accession Number
2006113334
Title
Etiology and management of pediatric intestinal failure: Focus on the
non-digestive causes.
Source
Nutrients. 13 (3) (pp 1-18), 2021. Article Number: 786. Date of
Publication: March 2021.
Author
Diamanti A.; Calvitti G.; Martinelli D.; Santariga E.; Capriati T.;
Bolasco G.; Iughetti L.; Pujia A.; Knafelz D.; Maggiore G.
Institution
(Diamanti, Capriati, Bolasco, Knafelz, Maggiore) Hepatology
Gastroenterology and Nutrition Unit, "Bambino Gesu" Children Hospital,
Rome 00165, Italy
(Calvitti, Iughetti) Pediatric Unit, Department of Medical and Surgical
Sciences for Mothers, Children and Adults, University of Modena and Reggio
Emilia, Modena 41121, Italy
(Martinelli) Metabolic Diseases Unit, "Bambino Gesu" Children Hospital,
Rome 00165, Italy
(Santariga, Pujia) Clinical Nutrition Unit, Department of Medical and
Surgical Sciences, University Magna Graecia, Catanzaro 88100, Italy
(Maggiore) Medical Sciences Department, Ferrara University, Ferrara 44121,
Italy
Publisher
MDPI AG
Abstract
Background: Intestinal failure (IF) is defined as reduction in functioning
gut mass below the minimal amount necessary for adequate digestion and
absorption. In most cases, IF results from intrinsic diseases of the
gastrointestinal tract (digestive IF) (DIF); few cases arise from
digestive vascular components, gut annexed (liver and pancreas) and
extra-digestive organs or from systemic diseases (non-digestive IF)
(NDIF). The present review revised etiology and treatments of DIF and
NDIF, with special focus on the pathophysiological mechanisms, whereby
NDIF develops. Method(s): We performed a comprehensive search of
published literature from January 2010 to the present by selecting the
following search strings: "intestinal failure" OR "home parenteral
nutrition" OR "short bowel syndrome" OR "chronic pseudo-obstruction" OR
"chronic intestinal pseudo-obstruction" OR "autoimmune enteropathy" OR
"long-term parenteral nutrition". Result(s): We collected overall
1656 patients with well-documented etiology of IF: 1419 with DIF (86%) and
237 with NDIF (14%), 55% males and 45% females. Among DIF cases, 66% had
SBS and among NDIF cases 90% had malabsorption/maldigestion.
 Conclusion(s): The improved availability of diagnostic and
therapeutic tools has increased prevalence and life expectancy of rare and
severe diseases responsible for IF. The present review greatly expands the
spectrum of knowledge on the pathophysiological mechanisms through which
the diseases not strictly affecting the intestine can cause IF. In view of
the rarity of the majority of pediatric IF diseases, the development of IF
Registries is strongly required; in fact, through information flow within
the network, the Registries could improve IF knowledge and
management. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<12>
Accession Number
2008508174
Title
Thoracic aortic surgery: Status and upcoming novelties.
Source
Minerva Cardioangiologica. 68 (5) (pp 518-531), 2020. Date of Publication:
October 2020.
Author
Spadaccio C.; Hu H.; Li C.; Qiaq Z.; Ge Y.; Tie Z.; Zhu J.; Moon M.R.;
Dantqn M.; Sun L.; Gaudinq M.F.
Institution
(Spadaccio) Institute of Cardiovascular and Medical Sciences, University
of Glasgow, Glasgow, United Kingdom
(Spadaccio) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Spadaccio, Hu, Li, Qiaq, Ge, Tie, Zhu, Sun) Department of Cardiovascular
Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital
Medical University, Beijing Institute of Heart Lung and Blood Vessel
Diseases, Beijing Engineering Research Centre for Vascular Prostheses,
Beijing, China
(Moon) School of Medicine, Washington University, St Louis, MI, United
States
(Dantqn) Department of Cardiac Surgery, Scottish Pediatric Cardiac
Services, Royal Hospital for Children, Glasgow, United Kingdom
(Gaudinq) Department of Cardiothoracic Surgery Weill Cornell Medicine, New
York - Presbyterian Hospital, NY, United States
Publisher
Edizioni Minerva Medica
Abstract
Several novel technological developments and surgical approaches have
characterized the field of aortic surgery in the recent decade. The
progressive introduction of endovascular procedures, minimally invasive
surgical techniques and hybrid approaches have changed the practice in
aortic surgery and generated new trends and questions. Also, the
advancements in the manufacturing of tissue engineered vascular grafts as
substitutes for aortic replacements are enlightening new avenues in the
treatment of aortic disease. This review will provide an overview of the
current novel perspectives, debates and trends in major thoracic aortic
surgery. Copyright © 2020 EDIZIONI MINERVA MEDICA

<13>
Accession Number
2008340287
Title
Effect of Retrograde Autologous Blood Priming of Cardiopulmonary Bypass on
Hemodynamic Parameters and Pulmonary Mechanics in Pediatric Cardiac
Surgery: A Randomized Clinical Study.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33 (2) (pp 505-512),
2021. Date of Publication: Summer 2021.
Author
Singab H.; Gamal M.A.; Refaey R.; Al-Taher W.
Institution
(Singab, Gamal, Refaey) Cardiothoracic Surgery Department, Ain Shams
University Faculty of Medicine, Ain Shams University Hospitals, Cairo,
Egypt
(Al-Taher) Anesthesia and Intensive Care Department, Ain Shams University
Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
The present study aimed to assess the impact of retrograde autologous
priming (RAP) on hemodynamics and pulmonary mechanics in children
subjected to cardiothoracic surgery. This prospective randomized study
analyzed the clinical records of 124 children with risk adjustment in
congenital heart surgery-1 left to right lesions subjected to cardiac
surgery. They comprised 64 patients in RAP group and 60 patients in the
conventional priming group. The preoperative, intraoperative and
postoperative data of the studied patients were reported. The outcome
measures included hematocrit (Hct) value, blood gases, lung mechanics
parameters, transfusion needs, ICU stay, postoperative complications and
mortality. Preoperatively, there were no significant differences between
the studied groups regarding the demographic data, underlying lesions,
laboratory data, blood gases and pulmonary mechanics parameters.
Intraoperatively, RAP group patients had significantly lower amount of
blood loss, less frequent need to packed red blood cells (RBC)s
transfusion and better Hct values when compared with the control group.
Postoperatively, RAP group patients had significantly higher Hct% at ICU
arrival, significantly better pulmonary mechanics parameters and
significantly shorter duration on mechanical ventilation. RAP in children
older than 12 months subjected to cardiac surgery for risk adjustment in
congenital heart surgery-1 left to right lesions is associated with less
transfusion needs and better pulmonary mechanics. Copyright ©
2020 Elsevier Inc.

<14>
Accession Number
2007316070
Title
Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve
Replacement: A Meta-analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33 (2) (pp 316-325),
2021. Date of Publication: Summer 2021.
Author
Sa M.P.B.O.; Zhigalov K.; Cavalcanti L.R.P.; Escorel Neto A.C.; Rayol
S.C.; Weymann A.; Ruhparwar A.; Lima R.C.
Institution
(Sa, Cavalcanti, Escorel Neto, Rayol, Lima) Division of Cardiovascular
Surgery of Pronto Socorro Cardiologico de Pernambuco - PROCAPE, Recife,
Brazil
(Sa, Cavalcanti, Escorel Neto, Rayol, Lima) University of Pernambuco -
UPE, Recife, Brazil
(Sa, Lima) Nucleus of Postgraduate and Research in Health Sciences of
Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB,
Recife, Brazil
(Zhigalov, Weymann, Ruhparwar) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center Essen, University Hospital
of Essen, University Duisburg-Essen, Essen, Germany
Publisher
W.B. Saunders
Abstract
We sought to evaluate the impact of surgical aortic annulus enlargement
(ARE) on the perioperative outcomes of surgical aortic valve replacement.
Databases were searched for articles published by October 2019 in order to
carry out a systematic review followed by meta-analysis. Thirteen studies
with 40,447 patients (aortic valve replacement [AVR] with aortic annulus
enlargement [AAE]: 4686 patients; AVR without AAE: 35,761 patients) were
included. The total rate of AAE was 11.6%, ranging from 4.1%-28.1%. The
overall unadjusted odds ratio (OR) (95% confidence interval [CI]) for
operative mortality showed a statistically significant difference between
the groups, with higher risk in the "AVR with AAE" group (OR 1.388; 95% CI
1.049-1.836, P < 0.001), but not for isolated AVR+AAE (OR 1.341; 95% CI
0.920-1.956, P = 0.127) and also not in matched populations (OR 1.003; 95%
CI 0.773-1.300, P = 0.984). The "AVR with AAE" group showed an overall
lower risk of significant patient-prosthesis mismatch (PPM) (OR 0.567; 95%
CI 0.376-0.854, P = 0.007) and a higher overall difference in means of
indexed effective orifice area (iEOA) (random effect model: 0.058
cm2/m2; 95% CI 0.024-0.092, P < 0.001). The overall
ORs for myocardial infarction, stroke, complete heart block/permanent
pacemaker implantation and reoperation for bleeding showed no
statistically significant difference between the groups. AAE is a useful
adjunct to AVR, but the benefit of reduced PPM must be balanced against a
possibly higher risk of perioperative mortality. Copyright © 2020
Elsevier Inc.

<15>
Accession Number
2012120935
Title
Risk factors associated with longer stays in cardiovascular surgical
intensive care unit after CABG.
Source
Journal of the Formosan Medical Association. (no pagination), 2021. Date
of Publication: 2021.
Author
Kao K.-D.; Lee S.-Y.K.C.; Liu C.-Y.; Chou N.-K.
Institution
(Kao) Department of Nursing, National Taiwan University Hospital, Taiwan
(Republic of China)
(Kao, Lee) School of Nursing, National Taipei University of Nursing and
Health Sciences, Taiwan (Republic of China)
(Liu) Department of Speech Language Pathology and Audiology, National
Taipei University of Nursing and Health Sciences, Taiwan (Republic of
China)
(Chou) Department of Cardiovascular Surgery, National Taiwan University
Hospital, Taiwan (Republic of China)
Publisher
Elsevier B.V.
Abstract
Background/Purpose: Monitoring ICU length of stay (LOS) after CABG and
examining its risk factors can guide initiatives on the improvement of
care. But few have evaluated this issue to include personal and clinical
factors, and demands of ICU care. This study applied Donabedian model to
identify risk factors for longer ICU stays after CABG. Lifestyle, clinical
factors during and after CABG, TISS were viewed as structure factors, and
infection and organ failures during ICU did as process factors.
 Method(s): This retrospective cohort study used data via medical
records at a medical center. A stratified randomized sample of 230 adults
from a cohort of 690 isolated CABGs was to reflect the rate of 34.7%
longer than 3-day-ICU LOS. The sample comprised of longer-stay group (n =
150) and shorter-stay group (n = 80). Result(s): Hierarchical
logistic regression analysis revealed that potential signs of infection
(3-day average WBC higher than 10,000/muL, OR: 3.41 and the body
temperature higher than 38 degreeC, OR:5.67) and acute renal failure (OR:
8.97) remained as the most significant predicted factors of stay longer
than 3 ICU days. Along with higher TISS score within 24 hours (OR:1.06),
structure factors of female gender (OR:4.16) smoking(OR: 4.87), higher CCI
before surgery(OR:1.49), bypass during CABG (OR:3.51) had higher odds of
risk to stay longer. Conclusion(s): Further quality improvement
initiatives to shorten ICU stay after CABG may include the promotion of a
smoking cessation program in clinical practice, and better management of
the manpower allocation, infection control and renal
failure. Copyright © 2021

<16>
Accession Number
2011864963
Title
When to Consider Deferral of Surgery in Acute Type A Aortic Dissection: A
Review.
Source
Annals of Thoracic Surgery. 111 (6) (pp 1754-1762), 2021. Date of
Publication: June 2021.
Author
Sabe A.A.; Percy E.D.; Kaneko T.; Plichta R.P.; Hughes G.C.
Institution
(Sabe, Percy, Kaneko) Division of Cardiac Surgery, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Plichta, Hughes) Division of Cardiovascular and Thoracic Surgery, Duke
University Medical Center, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Background: Acute type A aortic dissection (ATAAD) is a surgical emergency
with an operative mortality of up to 30%, a rate that has not changed
meaningfully in more than 2 decades. A growing body of research has
highlighted several comorbidities and presenting factors in which delay or
permanent deferral of surgery may be considered; however, modern
comprehensive summative reviews are lacking. The urgency and timing of
this review are underscored by significant challenges in resource use
posed by the coronavirus disease 2019 (COVID-19) pandemic. This review
provides an update on the current understanding of risk assessment,
surgical candidacy, and operative timing in patients with ATAAD.
 Method(s): A literature search was conducted through PubMed and
Embase databases to identify relevant studies relating to risk assessment
in ATAAD. Articles were selected by group consensus on the basis of
quality and relevance. Result(s): Several patient factors have been
identified that increase risk in ATAAD repair. In particular, frailty,
advanced age, previous cardiac surgery, and use of novel anticoagulant
medications have been studied. The understanding of malperfusion syndromes
has also expanded significantly, including recommendations for surgical
delay. Finally, approaches to triage have been significantly influenced by
resource limitations related to the ongoing COVID-19 pandemic. Although
medical management remains a reasonable option in carefully selected
patients at prohibitive risk for open surgery, endovascular therapies for
treatment of ATAAD are rapidly evolving. Conclusion(s): Early
surgical repair remains the preferred treatment for most patients with
ATAAD. However, improvements in risk stratification should guide
appropriate delay or permanent deferral of surgery in select
individuals. Copyright © 2021 The Society of Thoracic Surgeons

<17>
Accession Number
2011797455
Title
Effect of Availability of Transcatheter Aortic-Valve Implantation on
Survival for all Patients With Severe Aortic Stenosis.
Source
American Journal of Cardiology. 149 (pp 72-77), 2021. Date of Publication:
15 Jun 2021.
Author
Chao A.; Picard M.H.; Passeri J.J.; Cui J.; Nethery R.C.; Wasfy J.H.
Institution
(Chao) Department of Biostatistics, Yale School of Public Health, New
Haven, CT, United States
(Picard, Passeri, Cui, Wasfy) Cardiology Division, Department of Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Nethery) Department of Biostatistics, Harvard T.H. Chan School of Public
Health, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Clinical outcomes for the overall severe aortic stenosis (AS) patient
population are not well described because those medically managed are not
included in procedural registries, and AS severity is not identifiable
from administrative data. We aim to assess whether transcatheter aortic
valve implantation (TAVI) availability has been associated with overall
changes in survival for the whole AS patient population. This is important
because patients with AS in real-world practice may differ from those
included in randomized controlled trials, potentially attenuating the
purported treatment efficacy estimated in trials. Classic severe AS
patients (mean gradient >=40 mmHg) were identified from an
echocardiography database. Survival was defined as time since severe AS
diagnosis until death. We first compared survival among all patients
before and after TAVI availability in 2008. To further understand
mechanism, we then assessed whether any survival changes were attributable
to TAVI with extended Cox regression models comparing survival among TAVI,
surgical aortic valve replacement, and medically managed patients. 3663
classic severe AS patients were included in the study. Median survival
years for all patients were greater during the TAVI-era than Pre-TAVI-era
(>11.5 vs 6.8, 5-year-HR = 0.8, time-varying effect p <0.0001), and
increased median survival was greatest for patients age 65 to74 (>11.5 vs
9.5, 5-year-HR = 0.7, time-varying effect p = 0.045). TAVI patients age 65
to 74 had the lowest risk of death compared to medically managed patients
(HR = 0.2, 95% CI = [0.1, 0.3], p <0.0001). In conclusion, in the
TAVI-era, overall survival for patients with severe AS has doubled. This
improvement is most marked for patients 65 to 74 years of
age. Copyright © 2021 Elsevier Inc.

<18>
Accession Number
2011616143
Title
Transcatheter aortic valve implantation in low-risk patients: A case of
rational over exuberance. The time is not now.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2021. Date of
Publication: 2021.
Author
Navaratnarajah M.; Luthra S.; Ohri S.
Institution
(Navaratnarajah, Luthra, Ohri) Department of Cardiac Surgery, Southampton
University Hospital, Southampton, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background: Review of evidence and concerns, relating to extension of
transcatheter aortic valve implantation usage to low-risk patients.
 Method(s): Comprehensive literature review was conducted identifying
articles relating to transcatheter aortic valve implantation.
 Result(s): Transcatheter aortic valve implantation is effective in
patients with aortic stenosis. Currently, long-term durability and
cost-effectiveness are unproven, anticoagulation requirement undefined,
permanent pacemaker implantation and paravalvular leak rates higher than
following surgical aortic valve replacement. Conclusion(s): Current
evidence supporting transcatheter aortic valve implantation usage in
low-risk patients is insufficient. Extending use now, to this large young
patient population is premature, and should be delayed. Copyright
© The Author(s) 2021.

<19>
Accession Number
2011614145
Title
Testing the feasibility of operationalizing a prospective, randomized
trial with remote cardiac safety EKG monitoring during a pandemic.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2021. Date of Publication: 2021.
Author
Liu H.H.; Ezekowitz M.D.; Columbo M.; Khan O.; Martin J.; Spahr J.; Yaron
D.; Cushinotto L.; Kapelusznik L.
Institution
(Liu, Ezekowitz, Columbo, Martin, Kapelusznik) Department of Medicine,
Bryn Mawr Hospital, Bryn Mawr, PA, United States
(Ezekowitz) The Sidney Kimmel Medical College, Philadelphia, PA, United
States
(Khan) Lankenau Internal Medicine Residency Program, Lankenau Hospital,
Main Line Health System, Wynnewood, PA, United States
(Spahr) LewesDEUnited States
(Yaron) Bryn Mawr Family Practice Residency, Bryn Mawr Hospital, Bryn
Mawr, PA, United States
(Cushinotto) Department of Pharmacy, Bryn Mawr Hospital, Bryn Mawr, PA,
United States
Publisher
Springer
Abstract
Background: The coronavirus SARS-CoV-2 is highly contagious.
Hydroxychloroquine (HCQ) has in vitro activity against SARS-CoV-2. The FDA
authorized emergency use of HCQ against COVID-19. HCQ may have
dose-related cardiotoxicity. This clinical trial received ethical approval
on May 15, 2020, operationalized in June to evaluate a low prophylaxis
dose of HCQ (200mg BID) in household contacts of COVID-19-positive
patients without physical contact between investigators and participants.
It represents the first report of the FDA approved 6-lead EKGs with a
smartphone KardiaMobile 6L application. Method(s): To reach a sample
size of 170, household members were contacted by telephone, emailed
consent forms with electronic signature capability, and randomized 2:1 to
HCQ or observation for 10 days with follow-up of 14 days. Home saliva PCR
tests recorded COVID status on days 1 and 14. Symptoms and 6-lead EKGs
were obtained daily. Result(s): Fifty-one participants were
randomized with 42 evaluable at day 14. Remote monitoring of 407 EKGs
revealed no QTc prolongation or other ECG changes in either group. At time
of consent, no participants were symptomatic or COVID+. On days 1 and 14,
COVID tests were positive in 4 and 2 in the HCQ group and 4 and 0 in the
observation group. No tests converted to positive. There were no deaths or
hospitalizations. Conclusion(s): A clinical trial without personal
contact, rapidly initiated and operationalized to exclude cardiac toxicity
using daily remote 6-lead EKG monitoring, is feasible. Of 407 EKGs from 42
participants, there was no evidence of cardiac toxicity. Clinical trial
registration: Clinicaltrials.gov: NCT04652648 registration date: December
3, 2020 Copyright © 2021, Springer Science+Business Media, LLC,
part of Springer Nature.

<20>
Accession Number
2011602419
Title
Biomarkers of acute kidney injury in pediatric cardiac surgery.
Source
Pediatric Nephrology. (no pagination), 2021. Date of Publication: 2021.
Author
Cavalcante C.T.M.B.; Cavalcante M.B.; Castello Branco K.M.P.; Chan T.;
Maia I.C.L.; Pompeu R.G.; de Oliveira Telles A.C.; Brito A.K.M.; Liborio
A.B.
Institution
(Cavalcante, Castello Branco, Maia, Pompeu, de Oliveira Telles, Brito)
Pediatric Cardiac Center of the Messejana Hospital Dr. Carlos Alberto
Studart Gomes, Fortaleza, CE, Brazil
(Cavalcante) Department of Pediatrics, Fortaleza University (UNIFOR), Av.
Washington Soares, 1321 - Edson Queiroz, CEP, Fortaleza, CE 60811-905,
Brazil
(Cavalcante) Department of Obstetrics and Gynecology, Fortaleza University
(UNIFOR), Av. Washington Soares, 1321 - Edson Queiroz, CEP, Fortaleza, CE
60811-905, Brazil
(Chan) The Heart Center, Seattle Children's Hospital, University of
Washington, Seattle, WA, United States
(Cavalcante, Liborio) Medical Sciences Postgraduate Program, Fortaleza
University (UNIFOR), Av. Washington Soares, 1321 - Edson Queiroz, CEP,
Fortaleza, CE 60811-905, Brazil
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Acute kidney injury (AKI) is characterized by a sudden decrease in kidney
function. Children with congenital heart disease are a special group at
risk of developing AKI. We performed a systematic review of the literature
to search for studies reporting the usefulness of novel urine, serum, and
plasma biomarkers in the diagnosis and progression of AKI and their
association with clinical outcomes in children undergoing pediatric
cardiac surgery. In thirty studies, we analyzed the capacity to predict
AKI and poor outcomes of five biomarkers: Cystatin C, Neutrophil
gelatinase-associated lipocalin, Interleukin-18, Kidney injury molecule-1,
and Liver fatty acid-binding protein. In conclusion, we suggest the need
for further meta-analyses with the availability of additional
studies. Copyright © 2021, IPNA.

<21>
Accession Number
2011498911
Title
Predicting Readmission to Intensive Care After Cardiac Surgery Within
Index Hospitalization: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2166-2179),
2021. Date of Publication: July 2021.
Author
Kimani L.; Howitt S.; Tennyson C.; Templeton R.; McCollum C.; Grant S.W.
Institution
(Kimani, Howitt, McCollum, Grant) Division of Cardiovascular Sciences,
University of Manchester, ERC, Manchester University Hospital Foundation
Trust, Manchester, United Kingdom
(Howitt, Templeton) Department of Cardiothoracic Anaesthesia and Critical
Care, Wythenshawe Hospital, Manchester University Hospital Foundation
Trust, Manchester, United Kingdom
(Tennyson) Department of Cardiothoracic Surgery, Blackpool Victoria
Hospital, Blackpool, United Kingdom
Publisher
W.B. Saunders
Abstract
Readmission to the cardiac intensive care unit after cardiac surgery has
significant implications for both patients and healthcare providers.
Identifying patients at risk of readmission potentially could improve
outcomes. The objective of this systematic review was to identify risk
factors and clinical prediction models for readmission within a single
hospitalization to intensive care after cardiac surgery. PubMed, MEDLINE,
and EMBASE databases were searched to identify candidate articles. Only
studies that used multivariate analyses to identify independent predictors
were included. There were 25 studies and five risk prediction models
identified. The overall rate of readmission pooled across the included
studies was 4.9%. In all 25 studies, in-hospital mortality and duration of
hospital stay were higher in patients who experienced readmission.
Recurring predictors for readmission were preoperative renal failure, age
>70, diabetes, chronic obstructive pulmonary disease, preoperative left
ventricular ejection fraction <30%, type and urgency of surgery, prolonged
cardiopulmonary bypass time, prolonged postoperative ventilation,
postoperative anemia, and neurologic dysfunction. The majority of
readmissions occurred due to respiratory and cardiac complications. Four
models were identified for predicting readmission, with one external
validation study. As all models developed to date had limitations, further
work on larger datasets is required to develop clinically useful models to
identify patients at risk of readmission to the cardiac intensive care
unit after cardiac surgery. Copyright © 2021 Elsevier Inc.

<22>
Accession Number
2010619115
Title
A Risk Score for Adults With Congenital Heart Disease Undergoing Heart
Transplantation.
Source
Annals of Thoracic Surgery. 111 (6) (pp 2033-2040), 2021. Date of
Publication: June 2021.
Author
Seese L.; Morell V.O.; Viegas M.; Keebler M.; Hickey G.; Wang Y.; Kilic A.
Institution
(Seese, Wang, Kilic) Division of Cardiac Surgery, University of Pittsburgh
Medical Center, Pittsburgh, PA, United States
(Morell, Viegas) Division of Congenital Heart Surgery, Children's Hospital
of Pittsburgh, Pittsburgh, PA, United States
(Keebler, Hickey) Division of Cardiology, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
Publisher
Elsevier Inc.
Abstract
Background: This study derived and validated a risk score for 1-year
mortality in patients with adult congenital heart disease (ACHD)
undergoing orthotopic heart transplantation (OHT). Method(s): The
United Network for Organ Sharing registry identified patients with ACHD
(>=18 years of age) who underwent OHT between 1987 and 2018. The primary
outcome was 1-year mortality. Associated covariates (univariate P < .2)
were entered into a multivariable logistic regression model. Variable
inclusion in the model was assessed by improvement in the McFadden
pseudo-R2, likelihood ratio test, and C-index. A risk score was
created using the absolute magnitude of the odds ratios from the
derivation cohort, and its ability to predict 1-year mortality was tested
in the validation cohort. Result(s): A total of 1388 recipients were
randomly divided into derivation (66.7%, n = 950) and validation (33.3%, n
= 438) cohorts. A 13-point risk score incorporating 4 pretransplant
variables (age, dialysis dependence, serum bilirubin level, and mechanical
ventilation) was created. The predicted 1-year mortality ranged from 14.6%
(0 points) to 49.9% (13 points) (P < .001). In weighted regression
analysis, there was a strong correlation between predicted 1-year
mortality and observed 1-year mortality in the validation cohort (r =
0.85, P < .001). Logistic regression also demonstrated a significant
association (odds ratio, 1.18; 95% confidence interval, 1.1-1.3; P =
.004). The Brier score of the composite score in the validation cohort was
0.14. Kaplan-Meier analysis demonstrated that risk scores of 4 points or
higher portended worse survival at 1-year posttransplant (P < .001).
 Conclusion(s): This 13-point risk score for ACHD is predictive of
mortality within 1 year after OHT and has potential utilization in
improving recipient selection for OHT in adult patients with
CHD. Copyright © 2021 The Society of Thoracic Surgeons

<23>
Accession Number
2010510251
Title
Double-lumen endotracheal tubes and bronchial blockers exhibit similar
lung collapse physiology during lung isolation.
Source
Canadian Journal of Anesthesia. 68 (6) (pp 791-800), 2021. Date of
Publication: June 2021.
Author
Moreault O.; Couture E.J.; Provencher S.; Somma J.; Lohser J.; Ugalde
P.A.; Lemieux J.; Lellouche F.; Bussieres J.S.
Institution
(Moreault, Couture, Lemieux, Lellouche, Bussieres) Department of
Anesthesiology and Critical Care, Universite Laval, Quebec City, QC,
Canada
(Provencher, Ugalde) Department of Respirology and Thoracic Surgery,
Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec
City, QC, Canada
(Moreault, Couture, Somma, Lemieux, Lellouche, Bussieres) Department of
Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de
Quebec - Universite Laval, 2725, Chemin Sainte-Foy, Quebec City, QC G1V
4G5, Canada
(Lohser) Department of Anesthesiology, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, BC, Canada
(Lellouche) Research Center, Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec City, QC, Canada
Publisher
Springer
Abstract
Purpose: Double-lumen endotracheal tubes (DL-ETT) and bronchial blockers
(BB) are frequently used to allow one-lung ventilation (OLV) during
video-assisted thoracic surgery (VATS). Recently, faster lung collapse has
been documented with a BB than with a DL-ETT. The physiologic mechanisms
behind this faster collapse remained unknown. We aimed to measure ambient
air absorption (V<inf>resorb</inf>) and intra-bronchial pressure
(P<inf>airway</inf>) into the non-ventilated lung during OLV using DL-ETT
and BB. Method(s): Patients undergoing VATS and OLV for lung
resection were randomly assigned to have measurements made of
V<inf>resorb</inf> or P<inf>airway</inf> within the non-ventilated lung
using either a DL-ETT or BB. Result(s): Thirty-nine patients were
included in the analyses. The mean (standard error of the mean [SEM])
V<inf>resorb</inf> was similar in the DL-ETT and BB groups [504 (85) vs
630 (86) mL, respectively; mean difference, 126; 95% confidence interval
[CI], -128 to 380; P = 0.31]. The mean (SEM) P<inf>airway</inf> became
progressively negative in the non-ventilated lung in both the DL-ETT and
the BB groups reaching [-20 (5) and -31 (10) cmH<inf>2</inf>O,
respectively; mean difference, -11; 95% CI, -34 to 12; P = 0.44] at the
time of the pleural opening. Conclusion(s): During OLV before pleural
opening, entrainment of ambient air into the non-ventilated lung occurs
when the lumen of the lung isolation device is kept open. This phenomenon
is prevented by occluding the lumen of the isolation device before pleural
opening, resulting in a progressive build-up of negative pressure in the
non-ventilated lung. Future clinical studies are needed to confirm these
physiologic results and their impact on lung collapse and operative
outcomes. Trial registration: www.clinicaltrials.gov (NCT02919267);
registered 28 September 2016. Copyright © 2021, Canadian
Anesthesiologists' Society.

<24>
Accession Number
2010447866
Title
Postoperative hemodynamics after high spinal block with or without
intrathecal morphine in cardiac surgical patients: a randomized-controlled
trial.
Source
Canadian Journal of Anesthesia. 68 (6) (pp 825-834), 2021. Date of
Publication: June 2021.
Author
Bhat I.; Arya V.K.; Mandal B.; Jayant A.; Dutta V.; Rana S.S.
Institution
(Bhat, Arya, Mandal) Department of Anaesthesiology and Intensive Care,
Post Graduate Institute of Medical Education and Research, Chandigarh,
India
(Arya, Dutta) Department of Anesthesiology, Perioperative and Pain
Medicine, Max Rady College of Medicine, University of Manitoba, St.
Boniface Hosptial, Winnipeg, MB, Canada
(Jayant) Department of Anaesthesiology and Critical Care Medicine, Amrita
Institute of Medical Sciences, Kochi, India
(Rana) Department of Cardiothoracic and Vascular Surgery, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
Springer
Abstract
Purpose: There is some evidence for the use of intrathecal morphine as a
means to provide prolonged analgesia in selective cardiac surgical
patients; however, the hemodynamic effects of intrathecal morphine are not
well defined. This study was designed to study the effect of intrathecal
morphine on hemodynamic parameters in cardiac surgery patients.
 Method(s): In a prospective, double-blind study, 100 adult cardiac
surgical patients were randomized to receive either intrathecal 40 mg of
0.5% hyperbaric bupivacaine alone (intrathecal bupivacaine [ITB] group, n
= 50) or intrathecal 250 microg of morphine added to 40 mg of 0.5%
bupivacaine (intrathecal bupivacaine and morphine [ITBM] group, n = 50).
Hemodynamic data, pain scores, rescue analgesic use, spirometry, and
vasopressor use were recorded every four hours after surgery for 48 hr.
The primary outcome was the incidence of vasoplegia in each group, which
was defined as a cardiac index > 2.2 L.min-1.m-2
with the requirement of vasopressors to maintain the mean arterial
pressure > 60 mmHg with the hemodynamic episode lasting > four hours.
 Result(s): Eighty-seven patients were analyzed (ITB group, n = 42,
and ITBM group, n =45). The incidence of vasoplegia was higher in the ITBM
group than in the ITB group [14 (31%) vs 5 (12%), respectively; relative
risk, 2.6; 95% confidence interval [CI], 1.0 to 6.6; P = 0.04]. The mean
(standard deviation [SD]) duration of vasoplegia was significantly longer
in the ITBM group than in the ITB group [8.9 (3.0) hr vs 4.3 (0.4) hr,
respectively; difference in means, 4.6; 95% CI, 3.7 to 5.5; P < 0.001].
 Conclusion(s): Intrathecal morphine added to bupivacaine for high
spinal anesthesia increases the incidence and duration of vasoplegia in
cardiac surgery patients. Trial registration: www.clinicaltrials.gov
(NCT02825056); registered 19 June 2016. Copyright © 2021,
Canadian Anesthesiologists' Society.

<25>
Accession Number
2012240295
Title
Cervical intramedullary recurrent Ewing sarcoma after 10-year disease-free
survival in an adult: a case report and review of literature.
Source
Spinal Cord Series and Cases. 7 (1) (no pagination), 2021. Article Number:
45. Date of Publication: December 2021.
Author
Fukushima K.; Tsuji O.; Suzuki S.; Nori S.; Nagoshi N.; Okada E.; Yagi M.;
Emoto K.; Nakayama R.; Watanabe K.; Nakamura M.; Matsumoto M.
Institution
(Fukushima, Tsuji, Suzuki, Nori, Nagoshi, Okada, Yagi, Nakayama, Watanabe,
Nakamura, Matsumoto) Department of Orthopaedic Surgery, Keio University
School of Medicine, Tokyo, Japan
(Emoto) Division of Diagnostic Pathology, Keio University School of
Medicine, Tokyo, Japan
Publisher
Springer Nature
Abstract
Introduction: Intramedullary metastasis of Ewing sarcoma is extremely
rare. Here, we report an adult case of cervical intramedullary recurrent
Ewing sarcoma after a 10-year disease-free survival after the initial
surgery for a thoracic lesion. Case presentation: A 39-year-old man with a
history of surgery and chemoradiotherapy for thoracic Ewing sarcoma ten
years ago presented with neck pain and incomplete motor paralysis in the
right upper extremity, which had suddenly appeared three months before.
Cervical magnetic resonance imaging revealed a tear-drop-shaped
intramedullary lesion at the C3 level accompanied by diffuse edematous
change. Because of the rapid progression of his myelopathy, he underwent
surgery for this intramedullary lesion. Intraoperatively, the tumor
exhibited an orangish exophytic appearance. The unclearness of the tumor
boundary compelled us to perform a partial resection. The histopathology
showed the tumor comprised small round atypical cells with
immunoreactivity for Nkx2.2 and CD99, diagnosing a metastatic Ewing
sarcoma. Postoperatively, although his myelopathy improved transiently and
adjuvant chemotherapy radiation was undergone, he died of cranial
dissemination of the tumor two months and a half later.
 Discussion(s): To our knowledge, 31 cases of primary and only 4 cases
of recurrent intramedullary spinal Ewing sarcoma have been reported to
date; however, this is the first case of recurrent intramedullary Ewing
sarcoma with a 10-year disease-free survival. Sadly, the prognosis of the
current case was extremely poor. There is no clear treatment guideline for
recurrent intramedullary Ewing sarcoma because of its rarity, and further
collection of similar cases would be required. Copyright © 2021,
The Author(s), under exclusive licence to International Spinal Cord
Society.

<26>
Accession Number
2007343922
Title
Infective endocarditis by yersinia species: A systematic review.
Source
Tropical Medicine and Infectious Disease. 6 (1) (no pagination), 2021.
Article Number: 19. Date of Publication: March 2021.
Author
Ioannou P.; Vougiouklakis G.; Baliou S.; Miliara E.; Kofteridis D.P.
Institution
(Ioannou, Vougiouklakis, Miliara, Kofteridis) Department of Internal
Medicine & Infectious Diseases, University Hospital of Heraklion,
Heraklion, Crete 71110, Greece
(Baliou) National Hellenic Research Foundation, Athens 11635, Greece
Publisher
MDPI AG
Abstract
Yersinia spp. are non-spore-forming Gram-negative bacilli. They comprise
only three species known to cause disease in humans, namely Y. pestis, Y.
enterocolitica and Y. pseudotuberculosis. Since infective endocarditis
(IE) is rarely caused by Yersinia, the management of these infections can
be problematic due to the lack of experience. The purpose of this study
was to systematically review all published cases of IE by Yersinia species
in the literature. A systematic review of PubMed, Scopus and Cochrane
Library (through 1 November 2020) for studies providing epidemiological,
clinical and microbiological information as well as data on treatment and
outcomes of IE caused by Yersinia species was performed. A total of 12
studies, containing data of 12 patients, were included. A prosthetic valve
was present in 17% of patients. The mitral valve was the most commonly
infected site, followed by the aortic valve. Fever, sepsis and embolic
phenomena were common clinical signs, followed by heart failure.
Aminoglycosides, cephalosporins and quinolones were the most commonly used
antimicrobials. Clinical cure was noted in 83%, while overall mortality
was 17%. This systematic review describes IE by Yersinia and provides
information on patients' epidemiology, clinical signs and the related
therapeutic strategies and outcomes. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<27>
Accession Number
635124114
Title
Protocol for a randomised controlled trial for Treatment in Thoracic
Aortic Aneurysm: Surgery versus Surveillance (TITAN: SvS).
Source
BMJ Open. 11 (5) (no pagination), 2021. Article Number: e052070. Date of
Publication: 26 May 2021.
Author
Guo M.H.; Appoo J.J.; Wells G.A.; Chu M.; Ouzounian M.; Fortier J.;
Boodhwani M.
Institution
(Guo, Fortier, Boodhwani) Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Appoo) Cardiac Surgery, University of Calgary, Calgary, AB, Canada
(Wells) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
(Wells) Cardiovascular Research Methods Centre, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Chu) Cardiac Surgery, Western University Schulich School of Medicine and
Dentistry, London, ON, Canada
(Ouzounian) Cardiac Surgery, University Health Network, Toronto, ON,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Ascending thoracic aortic aneurysm (ATAA) is an asymptomatic
condition that can lead to catastrophic events of rupture or dissection.
Current guidelines are based on limited retrospective data and recommend
surgical intervention for ATAA with a diameter of greater or equal to 5.5
cm. Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance is
the first prospective, multicentre, randomised controlled trial that
compares outcomes of patients undergoing early elective ascending aortic
surgery to patients undergoing medical surveillance. Methods and analysis
Patients between the ages of 18 and 80 with an asymptomatic ATAA between
5.0 cm and 5.4 cm in diameter are eligible for randomisation to early
surgery or surveillance. Patients in the surgery group will be followed at
1 month after discharge, then annually for a minimum of 2 years and up to
5 years. Patients in the surveillance group will be followed annually from
their index clinic visit for a minimum of 2 years and up to 5 years. The
primary outcome is all-cause mortality at follow-up. A sample size of 618
subjects (309 in each group) will achieve an 80% power at a 0.047
significance level. Ethics and dissemination This study has received
Ottawa Health Science Network Research Ethics Board approval (Protocol
20180007-01H), which was most recently updated on 25 November 2020. The
Research Ethics Board have granted approval to the study at 14
participating institutions, including the Ottawa Health Science Network
Research Ethics Board. On completion of data analysis, the result of the
trial will be presented at national and international conferences, and
published in relevant journals, regardless of the finding of the trial.
Trial registration number NCT03536312. Copyright © 2021 BMJ
Publishing Group. All rights reserved.

<28>
Accession Number
635160837
Title
In patients undergoing coronary artery bypass grafting is
semi-skeletonization superior to pedicled harvesting of the left internal
mammary artery?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 25 May 2021.
Author
Maskell P.; Berks M.; Vibhishanan J.; Harky A.
Institution
(Maskell) Department of Surgery, Cambridge University NHS Foundation
Trust, Cambridge, United Kingdom
(Berks, Vibhishanan) School of Clinical Medicine, University of Cambridge,
Cambridge, United Kingdom
(Harky) Department of Cardiothoracic surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Liverpool Centre of Cardiovascular Science, University of
Liverpool and 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 undergoing
coronary artery bypass grafting is semi-skeletonized harvesting superior
to pedicled harvesting of the left internal mammary artery (LIMA) in terms
of conduit length, flow, rate of sternal wound infections and
post-operative bleeding?'. Altogether, 235 papers were found using the
reported search, of which 5 represented the best evidence to answer the
clinical question. Three studies were cohort studies and 2 were randomized
controlled trials. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. One randomized controlled trial showed superiority
with semi-skeletonized harvesting in terms of conduit length (P<0.001),
flow (P=0.004) and diastolic filling (P=0.005). Three studies included
data on surgical wound infections/mediastinitis, all of which reported
n=0. One randomized controlled trial and 3 cohort studies reported that
semi-skeletonized harvesting reduced postoperative bleeding. No studies
reported a statistically significant difference in operative time. This
review suggests that semi-skeletonized harvesting could possibly be
associated with favourable outcomes when compared to pedicled harvesting
with respect to graft length and flow, and lower postoperative bleeding,
without increasing operative time; although there is insufficient data to
compare sternal wound infections or long-term outcomes. In conclusion, the
limited evidence base prevents robust informed decision-making when
comparing both techniques. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<29>
Accession Number
635159634
Title
Rationale and design of the intravenous iron for treatment of anemia
before cardiac surgery (ITACS) trial.
Source
American heart journal. (no pagination), 2021. Date of Publication: 22 May
2021.
Author
Myles P.S.; Richards T.; Klein A.; Smith J.; Wood E.M.; Heritier S.;
McGiffin D.; Zavarsek S.; Symons J.; McQuilten Z.K.; Baker R.A.; Karkouti
K.; Wallace S.
Institution
(Myles, Symons, Wallace) Department of Anaesthesiology and Perioperative
Medicine, Alfred Hospital, Melbourne, Victoria, Australia; Department of
Anaesthesiology and Perioperative Medicine, Monash University, Melbourne,
Victoria, Australia
(Richards) Department of Anaesthesiology and Perioperative Medicine,
Monash University, Melbourne, Victoria, Australia; Department of Surgery,
University of Western Australia, Australia
(Klein) Department of Anaesthesiology and Perioperative Medicine, Monash
University, Melbourne, Victoria, Australia; Department of Anaesthesia and
Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
(Smith) Department of Cardiothoracic Surgery, Monash Health, Clayton,
Victoria, Australia; Department of Surgery, Monash University, Clayton,
Victoria, Australia
(Wood, McQuilten) Department of Clinical Haematology, Monash Health and
University, Clayton, Victoria, Australia; School of Public Health and
Preventive Medicine, Monash University; Melbourne, Victoria, Australia
(Heritier) School of Public Health and Preventive Medicine, Monash
University; Melbourne, Victoria, Australia
(McGiffin) Department of Cardiothoracic Surgery, Alfred Hospital,
Melbourne, VIC, Australia
(Zavarsek) Deakin Health Economics, Institute for Health Transformation,
Faculty of Health, Deakin University, Burwood, VIC, Australia
(Baker) Cardiothoracic Quality and Outcomes, SALHN Perfusion Service,
Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
(Karkouti) Department of Anesthesia and Pain Medicine, University of
Toronto, Toronto, Canada
Publisher
NLM (Medline)
Abstract
Background Approximately 20-30% of patients awaiting cardiac surgery are
anemic. Anemia increases the likelihood of requiring a red cell
transfusion and is associated with increased complications, intensive care
and hospital stay following surgery. Iron deficiency is the commonest
cause of anemia and preoperative intravenous (IV) iron therapy thus may
improve anemia and therefore patient outcome following cardiac surgery. We
have initiated the ITACS Trial to test the hypothesis that in patients
with anemia awaiting elective cardiac surgery, IV iron will reduce
complications and facilitate recovery after surgery. Methods ITACS is a
1000-patient, international randomized trial in patients with anemia
undergoing elective cardiac surgery. The patients, health care providers,
data collectors, and statistician are blinded to whether patients receive
IV iron 1000 mg, or placebo, at 1-26 weeks before their planned date of
surgery. The primary endpoint is the number of days alive and at home up
to 90 days after surgery. Results To date, ITACS has enrolled 615 patients
in 30 hospitals in 9 countries. Patient mean (SD) age is 66 (12) years,
63% are male, with a mean (SD) hemoglobin at baseline of 118 (12) g/L; 40%
have evidence (ferritin <100 ng/mL and/or transferrin saturation <25%)
suggestive of iron deficiency. Most (59%) patients have undergone coronary
artery surgery with or without valve surgery. Conclusions The ITACS Trial
will be the largest study yet conducted to ascertain the benefits and
risks of IV iron administration in anemic patients awaiting cardiac
surgery. Copyright © 2021. Published by Elsevier Inc.

<30>
Accession Number
635156624
Title
Efficacy and safety of sulforaphane for treatment of mild to moderate
depression in patients with history of cardiac interventions: A
randomized, double-blind, placebo-controlled clinical trial.
Source
Psychiatry and clinical neurosciences. (no pagination), 2021. Date of
Publication: 25 May 2021.
Author
Ghazizadeh-Hashemi F.; Bagheri S.; Ashraf-Ganjouei A.; Moradi K.;
Shahmansouri N.; Mehrpooya M.; Noorbala A.-A.; Akhondzadeh S.
Institution
(Ghazizadeh-Hashemi, Shahmansouri, Noorbala) Psychosomatic Research
Center, Imam Hospital, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bagheri, Ashraf-Ganjouei, Moradi, Akhondzadeh) Psychiatric Research
Center, Roozbeh Psychiatric Hospital, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mehrpooya) Cardiovascular Ward, Imam Hospital, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
AIM: Depression has been recognized as one of the disorders associated
with cardiac interventions such as percutaneous coronary intervention
(PCI) or coronary artery bypass graft surgery (CABG). In the present
study, we evaluated the efficacy and safety of sulforaphane in treatment
of depression induced by cardiac interventions. METHOD(S): After
initial screening, 66 patients with previous history of at least one
cardiac intervention and current mild to moderate depression were randomly
assigned to two parallel groups receiving either sulforaphane (n = 33) or
placebo (n = 33) for 6 successive weeks. Efficacy was assessed using the
Hamilton Rating Scale for Depression (HAM-D) at baseline and week 2, 4,
and 6. Safety of the treatments were checked during the trial period.
 RESULT(S): Sixty participants completed the clinical trial (n = 30 in
each group). Baseline demographic and clinical parameters were all similar
among groups. Repeated measures analysis indicated that the sulforaphane
group exhibited greater improvement in HAM-D scores throughout the trial
(p<0.001). Response to treatment (>=50% reduction in the HAM-D score) rate
was higher in the sulforaphane group at trial endpoint (30% versus 6.67%,
p = 0.042). Remission (HAM-D score<=7) rate was also higher in the
sulforaphane group; however, the difference was not significant (23.33%
versus 3.33%, p = 0.052). Finally, no significant difference was observed
between the two groups in terms of frequency of side effects.
 CONCLUSION(S): Sulforaphane could safely improve depressive symptoms
induced by cardiac interventions. Further clinical trials with larger
sample sizes and longer follow-up periods are warranted to confirm our
results. This article is protected by copyright. All rights reserved.

<31>
Accession Number
635154689
Title
Routine Postsurgical Anesthesia Visit to Improve 30-Day Morbidity and
Mortality: A Multicenter, Stepped-Wedge Cluster Randomized Interventional
Study (the TRACE Study).
Source
Annals of surgery. (no pagination), 2021. Date of Publication: 24 May
2021.
Author
Buhre W.F.F.A.; Boer C.; Boer D.K.; Stolze A.; Posthuma L.M.; Smit-Fun
V.M.; van Kuijk S.; Noordzij P.G.; Rinia M.; Hering J.-P.; Veld B.'.;
Scheffer G.-J.; Dirksen C.; Boermeester M.; Bonjer J.; Dejong C.; Hollmann
M.W.; Breel J.S.; van den Brink I.; van Dijk F.; Geurts J.; Glas W.; van
Gorp R.; Jwair A.; Koca F.; Lange I.; Preckel B.; van Roy J.P.; Theunissen
M.; Wensing A.G.C.L.; Werger A.
Institution
(Buhre) Department of Anesthesiology and Pain Medicine, Maastricht
University Medical Centre+, Maastricht, The Netherlands Department of
Anesthesiology, Amsterdam University Medical Centre, VU University,
Amsterdam, The Netherlands Department of Anesthesiology, Amsterdam
University Medical Centre, University of Amsterdam, Amsterdam, The
Netherlands Department of Anesthesiology, St. Antonius Nieuwegein,
Nieuwegein, The Netherlands Department of Anesthesiology, Rijnstate
Hospital, Arnhem, The Netherlands Department of Anesthesiology and
Operations, Dijklander Hospital, Hoorn, The Netherlands Department of
Anesthesiology and Pain Management, Medical Centre Haaglanden, The Hague
Department of Anesthesiology, Pain and Palliative Medicine, Radboud
University Medical Centre, Nijmegen, The Netherlands Department of
Surgery, Amsterdam University Medical Centre, University of Amsterdam,
Amsterdam, The Netherlands Department of Surgery, Amsterdam University
Medical Centre, VU University, Amsterdam, The Netherlands Department of
Surgery, Maastricht University Medical Centre +, Maastricht, The
Netherlands Department of Clinical Epidemiology and Medical Technology
Assessment, Maastricht University Medical Centre +, Maastricht, the
Netherlands Care and Public Health Research Institute CAPHRI, Maastricht
University, Maastricht, the Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To study the impact of a standardized postoperative anesthesia
visit on 30-day mortality in medium to high-risk elective surgical
patients. BACKGROUND: Postoperative complications are the leading cause of
perioperative morbidity and mortality. While modified early warning scores
(MEWS) were instituted to monitor vital functions and improve
postoperative outcome, we hypothesized that complementary anesthesia
expertise is needed to adequately identify early deterioration.
 METHOD(S): In a prospective, multicenter, stepped-wedge cluster
randomized interventional study in nine academic and non-academic
hospitals in the Netherlands, we studied the impact of adding standardized
postoperative anesthesia visits on day one and three to routine use of
MEWS in 5473 patients undergoing elective non-cardiac surgery. Primary
outcome was 30-day mortality. Secondary outcomes included: incidence of
postoperative complications, length of hospital stay and intensive care
unit (ICU) admission. RESULT(S): Patients were enrolled between
October 2016 and August 2018. Informed consent was obtained from 5473
patients of which 5190 were eligible for statistical analyses, 2490 in the
control and 2700 in the intervention group. Thirty-day mortality was 0.56%
(n = 14) in the control and 0.44% (n = 12) in the intervention group (odds
ratio 0.74, 95%confidence interval 0.34-1.62). Incidence of postoperative
complications did not differ between groups except for renal complications
which was higher in the control group (1.7% (n = 41) vs. 1.0% (n = 27), p
= 0.014). Median length of hospital stay did not differ significantly
between groups. During the post-anesthesia visits, for 16% (n = 437) and
11% (n = 293) of patients recommendations were given on day one and three,
respectively, of which 67% (n = 293) and 69% (n = 202) were followed up.
 CONCLUSION(S): The combination of MEWS and a postoperative anesthesia
visit did not reduce 30-day mortality. Whether a postoperative anesthesia
visit with strong adherence to the recommendations provided and in a
high-risk population might have a stronger impact on postoperative
mortality remains to be determined. TRIAL REGISTRATION: Netherlands Trial
Registration, NTR5506/ NL5249,
https://www.trialregister.nl/trial/5249. Copyright © 2021 Wolters
Kluwer Health, Inc. All rights reserved.

<32>
[Use Link to view the full text]
Accession Number
635152167
Title
Phrenic Nerve Block at the Azygos Vein Level Versus Sham Block for
Ipsilateral Shoulder Pain after Video-Assisted Thoracoscopic Surgery: A
Randomized Controlled Trial.
Source
Anesthesia and Analgesia. (pp 1594-1602), 2021. Date of Publication: 2021.
Author
Kimura Kuroiwa K.; Shiko Y.; Kawasaki Y.; Aoki Y.; Nishizawa M.; Ide S.;
Miura K.; Kobayashi N.; Sehmbi H.
Institution
(Kimura Kuroiwa, Nishizawa, Ide) Department of Anesthesia, Nagano Red
Cross Hospital, Wakasato 5-22-1, Nagano 380-8582, Japan
(Shiko) Department of Biostatistics, Clinical Research Center, Chiba
University Hospital, Chiba, Japan
(Kawasaki) Department of Biostatistics, Japanese Red Cross College of
Nursing, Tokyo, Japan
(Aoki) Department of Anesthesiology and Intensive Care, Hamamatsu
University, School of Medicine, Hamamatsu, Japan
(Miura, Kobayashi) Department of Thoracic Surgery, Nagano Red Cross
Hospital, Nagano, Japan
(Sehmbi) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre, Western University, London, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Ipsilateral shoulder pain (ISP) is a common problem after
pulmonary surgery. We hypothesized that phrenic nerve block (PNB) at the
azygos vein level, near the location of the surgical operation, would be
effective for reducing ISP. Our primary aim was to assess the effect of
PNB on postoperative ISP, following video-assisted thoracic surgery
(VATS). METHOD(S): This prospective, randomized, patient-blinded,
single-institution trial was registered at the University Hospital Medical
Information Network (UMIN000030464). Enrolled patients had been scheduled
for VATS under general anesthesia with epidural analgesia. Patients were
randomly allocated to receive infiltration of the ipsilateral phrenic
nerve at the azygos vein level with either 10 mL of 0.375% ropivacaine
(PNB group) or 0.9% saline (control group) before chest closure.
Postoperative ISP was assessed using a numerical rating scale (NRS, 0-10)
at rest at 2, 4, 8, 16, and 24 hours. The incidence of ISP was defined as
the proportion of patients who reported an NRS score of >=1 at least once
within 24 hours after surgery. In the primary analysis, the proportion of
patients with ISP was compared between PNB and control groups using the
chi2 test. NRS values of ISP and postoperative incision pain within 24
hours were investigated, as was the frequency of postoperative analgesic
use. Incision pain was assessed using an NRS at the time of ISP
assessment. Finally, the incidence of postoperative nausea and vomiting
and shoulder movement disorders were also evaluated. RESULT(S):
Eighty-five patients were included, and their data were analyzed. These
patients were randomly assigned to either PNB group (n = 42) or control
group (n = 43). There were no clinically relevant differences in
demographic and surgical profiles between the groups. There was no
significant difference in the incidence of ISP (the control group 20/43
[46.5%] versus the PNB group 14/42 [33.3%]; P =.215). The severity of ISP
was lower in the PNB group than in the control group (linear mixed-effects
model, the main effect of treatment [groups]: P <.001). There were no
significant differences between groups in terms of postoperative incision
pain. The frequency of postoperative analgesic use was significantly
higher in the control group (Wilcoxon rank sum test, P <.001).
Postoperative nausea and vomiting did not significantly differ between the
2 groups. There were no changes in the range of shoulder joint movement.
 CONCLUSION(S): Azygos vein level PNB did not significantly affect the
incidence of ISP after VATS. Copyright © 2020 The Author(s).
Published by Wolters Kluwer Health, Inc.

<33>
Accession Number
627898630
Title
Do patients who require re-exploration for bleeding have inferior outcomes
following cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 613-618),
2019. Date of Publication: 01 Apr 2019.
Author
Ali J.M.; Wallwork K.; Moorjani N.
Institution
(Ali, Wallwork, Moorjani) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge CB23 3RE, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: Do patients who require
return to theatre (RTT) for bleeding have inferior outcomes following
cardiac surgery? Altogether, 598 papers were found using the reported
search, of which 8 represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
are tabulated. In summary, patients who bleed following cardiac surgery
and then RTT have increased mortality and experience greater morbidity,
including neurological, respiratory and renal complications, which result
in increased length of intensive care unit stay and hospital stay. It is
not easy to dissect the relative contribution of the blood loss and
consequent haemodynamic instability, the RTT and the increased blood
product consumption to the inferior outcomes observed, as there is
evidence that each is important. However, several studies have
demonstrated RTT to be an independent predictor of morbidity and
mortality, even when controlling for amount of transfusion. Patients who
bleed and RTT beyond 12 h postoperatively appear to have the poorest
outcomes, suggesting that the decision to RTT should not be delayed if
there are concerns over significant bleeding, to ensure the best patient
outcomes. Copyright © 2018 The Author(s).

<34>
Accession Number
624329304
Title
Comparison of graft patency following coronary artery bypass grafting in
the left versus the right coronary artery systems: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 54 (2) (pp 221-228), 2018.
Date of Publication: 01 Aug 2018.
Author
Pinho-Gomes A.-C.; Azevedo L.; Antoniades C.; Taggart D.P.
Institution
(Pinho-Gomes, Taggart) Department of Cardiac Surgery, Oxford University
Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX39DU, United
Kingdom
(Azevedo) Department of Community Medicine, Information and Health
Decision Sciences, Faculty of Medicine, Center for Health Technology and
Services Research, University of Porto, Porto, Portugal
(Antoniades, Taggart) Division of Cardiovascular Medicine, University of
Oxford, Oxford, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Although coronary artery bypass grafting has been the standard of care for
patients with complex coronary artery disease for over 50 years, the
evolution of graft patency over time in the left versus the right coronary
systems remains poorly documented. This systematic review and
meta-analysis aimed to characterize the evolution of graft patency over
time comparing the left (excluding left anterior descending artery) and
right coronary systems, with an emphasis on the comparison of venous
versus arterial grafts and symptomatic versus asymptomatic patients. We
searched the Cochrane Central Register of Controlled Trials (CENTRAL) and
MEDLINE from inception to August 2016. We also searched clinical trials
registers and reference lists of relevant studies. We included randomized
clinical trials and observational studies comparing graft patency in the
left versus the right coronary systems. Our outcome was graft patency
defined as a binary variable according to whether grafts were reported as
patent or failed at the time of angiogram. Data collection and analysis
were performed according to the methodological recommendations of the
Cochrane Collaboration. From a total 2275 papers, 52 studies were included
in the qualitative analysis and 48 studies (including 36 006 grafts) in
the meta-analysis. There was a 3.3% significant difference between the
left-sided and rightsided graft patency, and the difference appeared to
increase over time. Furthermore, patency of arterial grafts was higher in
the left coronary system, while venous grafts performed similarly
irrespective of the coronary circulation. Symptom recurrence also seemed
related to a higher failure rate in the right coronary circulation.
However, the high degree of heterogeneity precluded drawing definite
conclusions. This metaanalysis suggested that graft patency might be
better for left-sided vessels and that this difference might be driven by
the better performance of arterial grafts in the left coronary system.
However, evidence currently available is limited, and further research is
warranted to understand whether certain grafts achieve better patency in
the right versus the left coronary circulations. Copyright © 2018
The Author(s).

<35>
Accession Number
2005145452
Title
Transcatheter aortic valve replacement in patients with a history of
cancer: Periprocedural and long-term outcomes.
Source
Catheterization and Cardiovascular Interventions. 97 (1) (pp 157-164),
2021. Date of Publication: 01 Jan 2021.
Author
Murphy A.C.; Koshy A.N.; Cameron W.; Horrigan M.; Kearney L.; Yeo B.;
Farouque O.; Yudi M.B.
Institution
(Murphy, Koshy, Cameron, Horrigan, Kearney, Farouque, Yudi) Department of
Cardiology, Austin Health, Melbourne, VIC, Australia
(Murphy, Koshy, Kearney, Farouque, Yudi) Department of Medicine, The
University of Melbourne, Melbourne, VIC, Australia
(Yeo) Department of Oncology, The Olivia Newton-John Cancer and Wellness
Centre, Melbourne, VIC, Australia
Publisher
John Wiley and Sons Inc
Abstract
Background: A history of cancer is incorporated into the surgical risk
assessment of patients undergoing surgical aortic valve replacement
through the Society for Thoracic Surgeons score. However, the prognostic
significance of cancer in patients treated with transcatheter aortic valve
replacement (TAVR) is unclear. As the cancer survivorship population
increases, it is imperative to establish the efficacy and safety of TAVR
in patients with severe symptomatic aortic stenosis (AS) and a history of
malignancy. Objective(s): The primary goal of this study was to
assess the periprocedural outcomes and long-term mortality in patients
with a history of cancer undergoing TAVR. Method(s): A systematic
review of PubMed, MEDLINE, and EMBASE was conducted to identify studies
reporting outcomes in patients with a history of malignancy undergoing
TAVR. A meta-analysis was performed using a random-effects model with a
primary outcome of all-cause mortality and cardiac mortality at the
longest follow-up. On secondary analyses, procedural safety was assessed.
 Result(s): A total of 13 observational studies with 10,916 patients
were identified in the systematic review. Seven studies including 6,323
patients were included in the quantitative analysis. Short-term mortality
(relative risk [RR] 0.61, 95%CI 0.36-1.01; p =.06) and long-term all-cause
mortality (RR 1.24, 95%CI 0.95-1.63; p =.11) were not significantly
different when comparing patients with and without a history of cancer. No
significant difference in the rate of periprocedural complications
including stroke, bleeding, acute kidney injury, and pacemaker
implantation was noted. Conclusion(s): In patients with severe AS
undergoing TAVR, a history of cancer was not associated with adverse short
or long-term survival. Based on these findings, TAVR should be considered
in all patients with severe symptomatic AS, irrespective of their history
of malignancy. Copyright © 2020 Wiley Periodicals LLC.

<36>
Accession Number
2011815556
Title
Low Tidal Volume Mechanical Ventilation Against No Ventilation During
Cardiopulmonary Bypass in Heart Surgery (MECANO): A Randomized Controlled
Trial.
Source
Chest. 159 (5) (pp 1843-1853), 2021. Date of Publication: May 2021.
Author
Nguyen L.S.; Estagnasie P.; Merzoug M.; Brusset A.; Law Koune J.-D.;
Aubert S.; Waldmann T.; Naudin C.; Grinda J.-M.; Gibert H.; Squara P.
Institution
(Nguyen, Estagnasie, Brusset, Squara) Critical Care Department, CMC
Ambroise Pare, Neuilly-sur-Seine, France
(Nguyen, Estagnasie, Merzoug, Brusset, Law Koune, Aubert, Waldmann,
Naudin, Grinda, Gibert, Squara) Research & Innovation Department, CMC
Ambroise Pare, Neuilly-sur-Seine, France
(Law Koune, Gibert) Anesthesiology Department, CMC Ambroise Pare,
Neuilly-sur-Seine, France
(Aubert, Waldmann, Grinda) Cardiothoracic Surgery Department, CMC Ambroise
Pare, Neuilly-sur-Seine, France
Publisher
Elsevier Inc.
Abstract
Background: Postoperative pulmonary complications are common after cardiac
surgery and have been related to lung collapse during cardiopulmonary
bypass (CPB). No consensus exists regarding the effects of maintaining
mechanical ventilation during CPB to decrease these complications.
Research Question: To determine whether maintaining low-tidal ventilation
(3 mL/kg 5 times/min, with positive end expiratory pressure of 5 cm
H<inf>2</inf>O) during CPB (ventilation strategy) was superior to a
resting-lung strategy with no ventilation (no ventilation strategy)
regarding postoperative pulmonary complications, including mortality.
Study Design and Methods: In a randomized controlled trial, patients
undergoing cardiac surgery at a single center from May 2017 through August
2019 were randomized to the ventilation or no ventilation strategy during
CPB (1:1 ratio). Apart from the CPB phase, perioperative ventilation
procedures were standardized. Result(s): The study included 1,501
patients (mean age, 68.8 +/- 10.3 years; 1,152 (76.7%) men; mean EuroSCORE
II, 2.3 +/- 2.7). Seven hundred fifty-six patients were in the ventilation
strategy group, and no differences existed in baseline characteristics and
types of procedures between the two groups. An intention-to-treat analysis
yielded no significant difference between the ventilation and no
ventilation groups regarding incidence of the primary composite outcome
combining death, early respiratory failure, ventilation support beyond day
2, and reintubation, with 112 of 756 patients (14.8%) in the ventilation
group vs 133 of 745 patients (17.9%) in the no ventilation group (OR,
0.80; 95% CI, 0.61-1.05; P =.11). Strict per-protocol analyses of 1,338
patients (89.1%) with equally distributed preoperative characteristics
yielded similar results (OR, 0.81; 95% CI, 0.60-1.09; P =.16). Post hoc
analysis of the subgroup who underwent isolated coronary artery bypass
graft procedures (n = 725) showed that the ventilation strategy was
superior to the no ventilation strategy regarding the primary outcome (OR,
0.56; 95% CI, 0.37-0.84; P =.005). Interpretation(s): Among patients
undergoing cardiac surgery with CPB, continuation of low tidal volume
ventilation was not superior to no ventilation during CPB with respect to
postoperative complications, including death, early respiratory failure,
ventilation support beyond day 2, and reintubation. Trial Registry:
ClinicalTrials.gov; No.: NCT03098524; URL:
www.clinicaltrials.gov Copyright © 2020 American College of Chest
Physicians

<37>
Accession Number
2012114963
Title
External stenting and disease progression in saphenous vein grafts two
years after coronary artery bypass grafting: A multicenter randomized
trial.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Taggart D.P.; Gavrilov Y.; Krasopoulos G.; Rajakaruna C.; Zacharias J.; De
Silva R.; Channon K.M.; Gehrig T.; Donovan T.J.; Friedrich I.; Benedetto
U.; Vohra H.; Bittar M.N.; Bose A.; Berman M.; Kharbanda R.; Paraforos A.;
Ladyshenskij L.; Bonaros N.; Schachner T.; Sandner S.; Angleitner P.;
Bolotin G.; Jacobs S.; Thielmann M.; Wendt D.; Choi Y.-H.; Liakopoulos O.;
Ohri S.; Lipey A.
Institution
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
John Radcliffe Hospital, Oxford, United Kingdom
(Gavrilov) TechnoSTAT Ltd, Raanana, Israel
(Krasopoulos) Oxford University Hospitals NHS Foundation Trust, Oxford,
United Kingdom
(Rajakaruna, Benedetto, Vohra) Department of Cardiothoracic Surgery,
University Hospitals Bristol, Bristol, United Kingdom
(Zacharias, Bittar, Bose) Department of Cardiothoracic Surgery, Blackpool
Victoria Hospital, Blackpool, United Kingdom
(De Silva, Berman) Department of Cardiothoracic Surgery, Papworth
Hospital, Cambridge, United Kingdom
(Channon, Kharbanda) Department of Cardiovascular Medicine, University of
Oxford, John Radcliffe Hospital, Oxford, United Kingdom
(Gehrig, Donovan, Friedrich, Paraforos) Herzzentrum Trier, Krankenhaus der
Barmherzigen Bruder, Trier, Germany
(Ladyshenskij) Department of Cardiothoracic Surgery, Immanuel Klinikum
Bernau Herzzentrum Brandenburg, Bernau bei Berlin, Brandenburg, Germany
(Bonaros, Schachner) Department of Cardiothoracic Surgery, Medical
University of Innsbruck, Innsbruck, Austria
(Sandner, Angleitner) Department of Cardiothoracic Surgery, Medizinische
Universitat Wien, Wien, Vienna, Austria
(Bolotin) Department of Cardiothoracic Surgery, Rambam Medical Center,
Haifa, Israel
(Jacobs) Department of Cardiothoracic Surgery, German Heart Centre Berlin,
Berlin, Germany
(Thielmann, Wendt) Department of Cardiothoracic Surgery, West-German Heart
and Vascular Center Essen, University Hospital Essen, Essen, Germany
(Choi, Liakopoulos) Department of Cardiac Surgery, Kerckhoff Heart Center,
Bad Nauheim, Germany
(Choi, Liakopoulos) Justus-Liebig-University Giesen, Campus Kerckhoff, Bad
Nauheim, Germany
(Choi, Liakopoulos) German Center for Cardiovascular Research (DZHK),
Partner Site Rhine Main, Frankfurt/Main, Germany
(Choi, Liakopoulos) Department of Cardiothoracic Surgery, Uniklinik Koln,
Koln, Germany
(Ohri) Department of Cardiothoracic Surgery, University Hospital
Southampton, Southampton, United Kingdom
(Lipey) Department of Cardiothoracic Surgery, Sheba Medical Center, Ramat
Gan, Israel
Publisher
Mosby Inc.
Abstract
Objectives: Little data exist regarding the potential of external stents
to mitigate long-term disease progression in saphenous vein grafts. We
investigated the effect of external stents on the progression of saphenous
vein graft disease. Method(s): A total of 184 patients undergoing
isolated coronary artery bypass grafting, using an internal thoracic
artery graft and at least 2 additional saphenous vein grafts, were
enrolled in 14 European centers. One saphenous vein graft was randomized
to an external stent, and 1 nonstented saphenous vein graft served as the
control. The primary end point was the saphenous vein graft Fitzgibbon
patency scale assessed by angiography, and the secondary end point was
saphenous vein graft intimal hyperplasia assessed by intravascular
ultrasound in a prespecified subgroup at 2 years. Result(s):
Angiography was completed in 128 patients and intravascular ultrasound in
the entire prespecified cohort (n = 51) at 2 years. Overall patency rates
were similar between stented and nonstented saphenous vein grafts (78.3%
vs 82.2%, P =.43). However, the Fitzgibbon patency scale was significantly
improved in stented versus nonstented saphenous vein grafts, with
Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8%
versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P
=.03). Fitzgibbon patency scale was inversely related to saphenous vein
graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III
saphenous vein grafts having an average minimal lumen diameter of 2.62 mm,
1.98 mm, and 1.32 mm, respectively (P <.05). Externally stented saphenous
vein grafts also showed significant reductions in mean intimal hyperplasia
area (22.5%; P <.001) and thickness (23.5%; P <.001). Conclusion(s):
Two years after coronary artery bypass grafting, external stenting
improves Fitzgibbon patency scales of saphenous vein grafts and
significantly reduces intimal hyperplasia area and thickness. Whether this
will eventually lead to improved long-term patency is still
unknown. Copyright © 2021 The Authors

<38>
[Use Link to view the full text]
Accession Number
2010149718
Title
A review of indications and comorbidities in which warfarin may be the
preferred oral anticoagulant.
Source
Journal of Clinical Pharmacy and Therapeutics. 46 (3) (pp 560-570), 2021.
Date of Publication: June 2021.
Author
Wadsworth D.; Sullivan E.; Jacky T.; Sprague T.; Feinman H.; Kim J.
Institution
(Wadsworth, Sullivan, Jacky, Sprague, Feinman) The University of North
Carolina Eshelman School of Pharmacy, Chapel Hill, NC, United States
(Kim) Cone Health Department of Internal Medicine, Greensboro, NC, United
States
Publisher
Blackwell Publishing Ltd
Abstract
What is known and objective: Direct oral anticoagulants (DOACs) are
increasingly prescribed instead of warfarin for chronic anticoagulation
for ease of dosing, fewer interactions, and less stringent monitoring.
However, it is important to consider indications and comorbidities for
which warfarin is still the preferred anticoagulant. This review aims to
capture these clinical scenarios in which warfarin may still be preferred
over DOACs. Method(s): We undertook a comprehensive literature search
using the PubMed database. Key search terms were based on DOAC clinical
trial exclusion criteria, as well as indications and conditions in which
the use of DOACs for anticoagulation has suggested harm. Society
guidelines and tertiary literature were used to inform expert opinion
where necessary. Studies were included if they investigated the use of
DOACs or warfarin in the identified indications or conditions. Results and
Discussion: Currently, evidence for the use of warfarin over DOACs for
anticoagulation is strongest for patients with prosthetic valves,
antiphospholipid syndrome, or a high risk of gastrointestinal bleeding.
For several clinical situations, including mitral stenosis, obesity,
altered gastrointestinal anatomy, pulmonary arterial hypertension, renal
or hepatic impairment, and left ventricular thrombus, evidence is lacking
but may eventually support the use of DOACs. Depending on indication and
condition, appropriateness of DOAC use may vary by agent. What is new and
conclusion: New evidence continues to support new indications and
conditions in which DOACs may be appropriate to use for anticoagulation.
There are key clinical scenarios, however, in which emerging literature
continues to support warfarin as the preferred
anticoagulant. Copyright © 2021 John Wiley & Sons Ltd

<39>
Accession Number
631480743
Title
Indirect comparison of the efficacy and safety of alirocumab and
evolocumab: a systematic review and network meta-analysis.
Source
European heart journal. Cardiovascular pharmacotherapy. 7 (3) (pp
225-235), 2021. Date of Publication: 23 May 2021.
Author
Guedeney P.; Sorrentino S.; Giustino G.; Chapelle C.; Laporte S.; Claessen
B.E.; Ollier E.; Camaj A.; Kalkman D.N.; Vogel B.; De Rosa S.; Indolfi C.;
Lattuca B.; Zeitouni M.; Kerneis M.; Silvain J.; Collet J.-P.; Mehran R.;
Montalescot G.
Institution
(Guedeney, Vogel, Lattuca, Zeitouni, Kerneis, Silvain, Collet,
Montalescot) Department of Cardiology, Sorbonne Universite, ACTION study
group, Institut de Cardiologie, Pitie Salpetriere Hospital (AP-HP), Paris,
France
(Guedeney, Sorrentino, Giustino, Claessen, Camaj, Kalkman, Mehran)
Department of Interventional Cardiovascular Research and Clinical Trials,
Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, NY, NY, United States
(Sorrentino, De Rosa, Indolfi) Division of Cardiology, Department of
Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
(Chapelle, Laporte, Ollier) Unite de Recherche Clinique Innovation et
Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
(Kalkman) Department of Clinical and Experimental Cardiology, University
of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences,
Meibergdreef 9, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Although alirocumab and evolocumab have both been associated with
improved outcomes in patients with dyslipidaemia or established
atherosclerotic cardiovascular disease, data on their respective
performances are scarce. This study aimed at providing an indirect
comparison of the efficacy and safety of alirocumab vs. evolocumab.
METHODS AND RESULTS: We conducted a systematic review and network
meta-analysis of randomized trials comparing alirocumab or evolocumab to
placebo with consistent background lipid-lowering therapy up to November
2018. We estimated the relative risk (RR) and the 95% confidence intervals
(CIs) using fixed-effect model in a frequentist pairwise and network
meta-analytic approach. A total of 30 trials, enrolling 59 026 patients
were included. Eligibility criteria varied significantly across trials
evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab
was associated with a significant reduction in all-cause death (RR 0.80,
95% CI 0.66-0.97) but not in cardiovascular death (RR 0.83, 95% CI
0.65-1.05). This study did not find any significant differences in
myocardial infarction (RR 1.15, 95% CI 0.99-1.34), stroke (RR 0.96, 95% CI
0.71-1.28), or coronary revascularization (RR 1.13, 95% CI 0.99-1.29)
between the two agents. Alirocumab was associated with a 27% increased
risk of injection site reaction compared to evolocumab; however, no
significant differences were found in terms of treatment discontinuations,
systemic allergic reaction, neurocognitive events, ophthalmologic events,
or new-onset of or worsening of pre-existing diabetes. CONCLUSION(S):
Alirocumab and evolocumab share a similar safety profile except for
injection site reaction. No significant differences were observed across
the efficacy endpoints, except for all-cause death, which may be related
to the heterogeneity of the studied populations treated with the two
drugs. Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. © The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<40>
Accession Number
633148945
Title
Influenza Vaccination Blunts the Inflammatory Response in Patients
Undergoing Cardiopulmonary Bypass.
Source
The Annals of thoracic surgery. 111 (6) (pp 1923-1930), 2021. Date of
Publication: 01 Jun 2021.
Author
Atoui R.; Ebrahim F.; Saroka K.; Mireau J.; McElhaney J.E.; Hare G.M.T.
Institution
(Atoui) Division of Cardiac Surgery, Health Sciences North, Northern
Ontario School of Medicine, Sudbury, ON, Canada
(Ebrahim) Department of Anesthesia, Hamilton Health Sciences, McMaster
University, Hamilton, Ontario, Canada; Department of Anesthesia, St
Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
(Saroka) Laurentian University, Sudbury, ON, Canada
(Mireau) Department of Anesthesia, Health Sciences North, Northern Ontario
School of Medicine, Sudbury, ON, Canada
(McElhaney) Health Sciences North Research Institute, Sudbury, ON, Canada
(Hare) Department of Anesthesia, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass grafting with cardiopulmonary bypass
(CPB) induces an inflammatory reaction that is associated with
postoperative complications. Influenza vaccination has been shown to
decrease cardiovascular morbidity in patients with cardiovascular disease,
possibly via its anti-inflammatory properties. We hypothesize that
influenza vaccination would attenuate the inflammatory reaction after CPB.
 METHOD(S): Thirty patients undergoing coronary artery bypass grafting
were blindly randomized to receive the influenza vaccine (group I, n = 15)
or a placebo (group II, n = 15) preoperatively. Serum samples of
proinflammatory mediators (interleukin-6, interleukin-8, tumor necrosis
factor, C-reactive protein) as well as the anti-inflammatory
interleukin-10 were collected at different time points perioperatively.
Assessment of myocardial dysfunction was investigated by measuring
hemodynamic data, echocardiographic data, and troponin levels. Other
clinical outcomes were collected prospectively. RESULT(S):
Proinflammatory cytokine levels were significantly reduced in the
treatment group vs the placebo group (interleukin-6 [157.4 pg/dL vs 256
pg/dL, P = .043], interleukin-8 [65.03 pg/dL vs 118.56 pg/dL, P = .025],
and tumor necrosis factor [12.05 pg/dL vs 20.8 pg/dL, P = .003]). These
differences were observed at the end of CPB and persisted for 2 days
postoperatively. Interestingly, the level of the anti-inflammatory marker
interleukin-10 was significantly higher in group I (83.3 pg/dL vs 15.15
pg/dL, P = .008). Evidence of improved myocardial protection was observed
in group I, as reflected by troponin measurements postoperatively (6020.2
pg/dL vs 12,098.01 pg/dL, P = .052). CONCLUSION(S): Influenza
vaccination attenuates the inflammatory response to CPB as reflected by a
reduction in the level of troponin and proinflammatory mediators and an
increase in the anti-inflammatory cytokine interleukin-10. Copyright
© 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc.
All rights reserved.

<41>
Accession Number
633884353
Title
Post-operative pain following cardiac implantable electronic device
implantation: insights from the BRUISE CONTROL trials.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. 23 (5)
(pp 748-756), 2021. Date of Publication: 21 May 2021.
Author
Nair G.M.; Birnie D.H.; Sumner G.L.; Krahn A.D.; Healey J.S.; Nery P.B.;
Kalfon E.; Verma A.; Ayala-Paredes F.; Coutu B.; Becker G.; Philippon F.;
Eikelboom J.; Sandhu R.K.; Sapp J.; Leather R.; Yung D.; Thibault B.;
Simpson C.S.; Ahmad K.; Sturmer M.; Kavanagh K.; Crystal E.; Wells G.A.;
Essebag V.
Institution
(Nair, Birnie, Nery, Wells) Arrhythmia Service, Division of Cardiology,
University of Ottawa Heart Institute, Ottawa ON K1Y 4W7, Canada
(Sumner, Sandhu, Kavanagh) Department of Medicine, University of Calgary,
Libin Cardiovascular Institute, AB, Calgary, Canada
(Krahn) Department of Medicine, University of British Columbia, Vancouver,
Canada
(Healey, Eikelboom) Division of Cardiology, Department of Medicine,
McMaster University, Hamilton Health Sciences, Population Health Research
Institute, ON, Hamilton, Canada
(Kalfon) Department of Medicine, Galilee Medical Center, Israel
(Verma) Department of Medicine, Southlake Regional Health Center,
University of Toronto, ON, Toronto, Canada
(Ayala-Paredes) Department of Medicine, Universite de Sherbrooke, QC,
Sherbrooke, Canada
(Coutu) Department of Medicine, Centre Hospitalier de l'Universite de
Montreal, Hopital Hotel-Dieu, QC, Montreal, Canada
(Becker) Department of Medicine, McGill University Health Center, QC,
Montreal, Canada
(Philippon) Department of Medicine, Quebec Heart Institute, Sainte-Foy,
QC, Canada
(Sapp) Department of Medicine, QEII Health Sciences Centre, Halifax, NS,
Canada
(Leather, Yung) Scarborough Health Network, University of Toronto, ON,
Toronto, Canada
(Thibault) Division of Cardiology, Department of Medicine, QC, Canada
(Simpson) Department of Medicine, Queen's University, ON, Kingston, Canada
(Ahmad) Department of Medicine, University of Toronto, ON, Toronto, Canada
(Sturmer, Essebag) Division of Cardiology, Department of Medicine,
University of Calgary, Libin Cardiovascular Institute, AB, Calgary, Canada
(Crystal) Department of Medicine, Sunnybrook Health Sciences Center,
University of Toronto, ON, Toronto, Canada
Publisher
NLM (Medline)
Abstract
AIMS : Post-operative pain following cardiac implantable electronic device
(CIED) insertion is associated with patient dissatisfaction, emotional
distress, and emergency department visits. We sought to identify factors
associated with post-operative pain and develop a prediction score for
post-operative pain. METHODS AND RESULTS : All patients from the BRUISE
CONTROL-1 and 2 trials were included in this analysis. A validated Visual
Analogue Scale (VAS) was used to assess the severity of pain related to
CIED implant procedures. Patients were asked to grade the most severe
post-operative pain, average post-operative pain, and pain on the day of
the first post-operative clinic. Multivariable regression analyses were
performed to identify predictors of significant post-operative pain and to
develop a pain-prediction score. A total of 1308 patients were included.
Multivariable regression analysis found that the presence of
post-operative clinically significant haematoma {CSH; P value < 0.001;
odds ratio (OR) 3.82 [95% confidence interval (CI): 2.37-6.16]}, de novo
CIED implantation [P value < 0.001; OR 1.90 (95% CI: 1.47-2.46)], female
sex [P value < 0.001; OR 1.61 (95% CI: 1.22-2.12)], younger age [<65years;
P value < 0.001; OR 1.54 (95% CI: 1.14-2.10)], and lower body mass index
[<20kg/m2; P value < 0.05; OR 2.05 (95% CI: 0.98-4.28)] demonstrated
strong and independent associations with increased post-operative pain. An
11-point post-operative pain prediction score was developed using the
data. CONCLUSION : Our study has identified multiple predictors of
post-operative pain after CIED insertion. We have developed a prediction
score for post-operative pain that can be used to identify individuals at
risk of experiencing significant post-operative pain. Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. © The Author(s) 2020. For permissions, please email:
journals.permissions@oup.com.

<42>
Accession Number
635149007
Title
Systematic review of prospective studies focused on regionalization of
care in surgical oncology.
Source
Updates in surgery. (no pagination), 2021. Date of Publication: 24 May
2021.
Author
Goel S.; Symer M.M.; Alzghari T.; Nelson B.B.; Yeo H.L.
Institution
(Goel) Department of Surgery, Weill Cornell Medical College, NY, NY,
United States
(Goel) Department of Surgical Oncology, Department of Healthcare Policy,
Weill Cornell Medicine, 525 E 68th St, NY, NY 10065, United States
(Symer, Alzghari, Yeo) Department of Surgery, Weill Cornell Medical
College, NY, NY, United States
(Nelson) Clinical and Systems Librarian, Weill Cornell Medical College,
NY, NY, United States
(Yeo) Department of Surgical Oncology, Department of Healthcare Policy,
Weill Cornell Medicine, 525 E 68th St, NY, NY 10065, United States
Publisher
NLM (Medline)
Abstract
To perform a systematic review of studies prospectively analyzing the
impact of regionalization of complex surgical oncology care on patient
outcomes. High volume care of complex surgical oncology patients has been
repeatedly associated with improved outcomes. Most studies, however, are
retrospective and have not prospectively accounted for confounders such as
financial ability and social support. Four electronic databases (Ovid
MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), and EBSCHOHost) were
searched from inception until August 25, 2018. Two authors independently
reviewed 5887 references, with a third independent reviewer acting as
arbitrator when needed. Data extracted from 11 articles that met inclusion
criteria. Risk of bias assessments conducted using MINORS criteria for the
non-randomized, observational studies, and the Cochrane tool for the
randomized-controlled trial. Of the 11 studies selected, we found 7
historically-controlled trials, two retrospective cohort studies with
prospective data collection, one prospective study, and one
randomized-controlled trial. 73% of studies were from Northern Europe, 18%
from Ontario, Canada, and 9% from England. Pancreatic surgery accounted
for 36% of studies, followed by gynecologic oncology (27%), thoracic
surgery (18%), and dermatologic surgery (9%). The studies reported varying
outcome parameters, but all showed improvement post-regionalization.
Included studies featured poor-to-fair risk of bias. 11 studies indicated
improved outcomes following regionalization of surgical oncology, but most
exhibit poor methodological rigor. Prospective evidence for the
regionalization of surgical oncology is lacking. More research addressing
patient access to care and specialist availability is needed to understand
the shortcomings of centralization.

<43>
Accession Number
635143445
Title
Thoracic Bone Mineral Density measured by Quantitative Computed Tomography
in Patients undergoing Spine Surgery.
Source
The spine journal : official journal of the North American Spine Society.
(no pagination), 2021. Date of Publication: 19 May 2021.
Author
Salzmann S.N.; Okano I.; Jones C.; Basile E.; Iuso A.; Zhu J.; Reisener
M.-J.; Chiapparelli E.; Shue J.; Carrino J.A.; Girardi F.P.; Cammisa F.P.;
Sama A.A.; Hughes A.P.
Institution
(Salzmann, Okano, Jones, Basile, Iuso, Zhu, Reisener, Chiapparelli, Shue,
Carrino, Girardi, Cammisa, Sama, Hughes) Spine Care Institute, Hospital
for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York,
NY 10021, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND CONTEXT: The thoracic spine is a common location for vertebral
fractures as well as instrumentation failure after long spinal fusion
procedures. The association between those complications and bone mineral
density (BMD) are well recognized. Due to the overlying sternum and ribs
in the thoracic spine, projectional BMD assessment tools such as dual
energy x-ray absorptiometry (DXA) are limited to the lumbar spine.
Quantitative computed tomography circumvents several shortcomings of DXA
and allows for level-specific BMD measurements. Studies comprehensively
quantifying BMD of the entire thoracic spine in patients undergoing spine
surgery are limited. PURPOSE: The objective of this study was: 1) to
assess the reliability of thoracic QCT measurements, 2) to determine
possible level-specific BMD variation throughout the thoracic spine and 3)
to assess the correlation between BMDs of the T1-T12 spinal levels. STUDY
DESIGN/SETTING: Cross-sectional observation study. PATIENT SAMPLE:
Patients undergoing spine surgery from 2016-2020 at a single, academic
institution with available preoperative CT imaging of the thoracic spine
were included in this study. OUTCOME MEASURES: The outcome measure was BMD
measured by QCT. METHOD(S): Patients undergoing spine surgery from
2016-2020 at a single, academic institution with available preoperative CT
imaging of the thoracic spine were included in this study. Subjects with
previous instrumentation at any thoracic level, concurrent vertebral
fractures, a Cobb angle of more than 20 degrees, or incomplete thoracic
spine CT imaging were excluded. Asynchronous quantitative computed
tomography (QCT) measurements of T1-T12 were performed. To assess inter-
and intra-observer reliability, a validation study was performed on 120
vertebrae in 10 randomly selected patients. The interclass correlation
coefficient (ICC) was calculated. A pairwise comparison of BMD was
conducted and correlations between each thoracic level were evaluated. The
statistical significance level was set at p<0.05. RESULT(S): 60
patients (men, 51.7%) met inclusion criteria. The study population was 90%
Caucasian with a mean age of 62.2 years and a mean BMI of 30.2 kg/m2. The
inter- and intra-observer reliability of the thoracic QCT measurements was
excellent (ICC of 0.97 and 0.97, respectively). The trabecular BMD was
highest in the upper thoracic spine and decreased in the caudal direction
(T1=182.3 mg/cm3, T2=168.1 mg/cm3, T3=163.5 mg/cm3, T4=164.7 mg/cm3,
T5=161.4 mg/cm3, T6=152.5 mg/cm3, T7=143.5 mg/cm3, T8=141.3 mg/cm3,
T9=143.5 mg/cm3, T10=145.1 mg/cm3, T11=145.3 mg/cm3, T12=133.6 mg/cm3).
The BMD of all thoracic levels cranial to T6 was statistically higher than
the BMD of all levels caudal to T6 (p < 0.001). Nonetheless, significant
correlations in BMD among all measured thoracic levels were observed, with
a Pearson's correlation coefficient ranging from 0.74 to 0.97.
 CONCLUSION(S): There is significant regional BMD variation in the
thoracic spine depending on spinal level. This BMD variation might
contribute to several clinically relevant phenomena. First, vertebral
fractures occur most commonly at the thoracolumbar junction including T12.
In addition to mechanical reasons, these fractures might be partially
attributed to thoracic BMD that is lowest at T12. Second, the optimal
upper instrumented vertebra (UIV) for stopping long fusions to the sacrum
and pelvis is controversial. The BMD of surgically relevant upper thoracic
stopping points (T2-T4) was significantly higher than the BMD of lower
thoracic stopping points (T10-T12). Besides stress concentration at the
relatively mobile lower thoracic segments, the low BMD at these levels
might contribute to previously suggested higher rates of junctional
failures with short fusions. Copyright © 2021. Published by
Elsevier Inc.

<44>
Accession Number
635142103
Title
2-Year Outcomes for Transcatheter Repair in Patients With Mitral
Regurgitation From the CLASP Study.
Source
JACC. Cardiovascular interventions. (no pagination), 2021. Date of
Publication: 07 May 2021.
Author
Szerlip M.; Spargias K.S.; Makkar R.; Kar S.; Kipperman R.M.; O'Neill
W.W.; Ng M.K.C.; Smith R.L.; Fam N.P.; Rinaldi M.J.; Raffel O.C.; Walters
D.L.; Levisay J.; Montorfano M.; Latib A.; Carroll J.D.; Nickenig G.;
Windecker S.; Marcoff L.; Cohen G.N.; Schafer U.; Webb J.G.; Lim D.S.
Institution
(Szerlip, Smith) Department of Cardiology, Baylor Scott and White The
Heart Hospital Plano, Plano, TX, United States
(Spargias) Department of Cardiology, Hygeia Hospital, Athens, Greece
(Makkar) Department of Interventional Cardiology, Cedars-Sinai Medical
Center, Los Angeles, CA, United States
(Kar) Department of Cardiology, Los Robles Regional Medical Center,
Thousand Oaks, CA, United States
(Kipperman, Marcoff) Department of Cardiology, Atlantic Health System
Morristown Medical Center, Morristown, NJ, United States
(O'Neill) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
(Ng) Department of Interventional Cardiology, Royal Prince Alfred
Hospital, Camperdown, NSW, Australia
(Fam) Department of Cardiology, St. Michael's Hospital, Toronto, ON,
Canada
(Rinaldi) Department of Interventional Cardiology, Sanger Heart and
Vascular Institute, Charlotte, North Carolina, USA
(Raffel, Walters) Department of Interventional Cardiology, Prince Charles
Hospital, QLD, Australia
(Levisay) Department of Interventional Cardiology, NorthShore University
Health System, Evanston Hospital, Evanston, IL, United States
(Montorfano) Department of Interventional Cardiology, San Raffaele
Institute, Milan, Italy
(Latib) Department of Interventional Cardiology, Montefiore Medical
Center, Bronx, NY, United States
(Carroll) Department of Interventional Cardiology, University of Colorado,
Aurora, CO, United States
(Nickenig) Department of Internal Medicine, University Hospital Bonn,
Bonn, Germany
(Windecker) Department of Cardiology, Bern University Hospital, Bern,
Switzerland
(Cohen) Department of Cardiac Surgery, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Schafer) Department of Internal Medicine, Marienkrankenhaus, Hamburg,
Germany
(Webb) Department of Interventional Cardiology, St. Paul's Hospital,
Vancouver, BC, Canada
(Lim) Department of Cardiovascular Medicine, University of Virginia Health
System Hospital, Charlottesville, VA, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The study reports 2-year outcomes from the multicenter,
prospective, single-arm CLASP study with functional mitral regurgitation
(FMR) and degenerative MR (DMR) analysis. BACKGROUND: Transcatheter repair
is a favorable option to treat MR. Long-term prognostic impact of the
PASCAL transcatheter valve repair system in patients with clinically
significant MR remains to be established. METHOD(S): Patients had
clinically significant MR >=3+ as evaluated by the echocardiographic core
laboratory and were deemed candidates for transcatheter repair by the
heart team. Assessments were performed by clinical events committee to 1
year (site-reported thereafter) and core laboratory to 2 years.
 RESULT(S): A total of 124 patients (69% FMR, 31% DMR) were enrolled
with a mean age of 75 years, 56% were male, 60% were New York Heart
Association functional class III to IVa, and 100% had MR >=3+. At 2 years,
Kaplan-Meier estimates showed 80% survival (72% FMR, 94% DMR) and 84%
freedom from heart failure (HF) hospitalization (78% FMR, 97% DMR), with
85% reduction in annualized HF hospitalization rate (81% FMR, 98% DMR). MR
<=1+ was achieved in 78% of patients (84% FMR, 71% DMR) and MR <=2+ was
achieved in 97% (95% FMR, 100% DMR) (all p < 0.001). Left ventricular
end-diastolic volume decreased by 33 ml (p < 0.001); 93% of patients were
in New York Heart Association functional class I to II (p < 0.001).
 CONCLUSION(S): The PASCAL repair system demonstrated sustained
favorable outcomes at 2 years in FMR and DMR patients. Results showed high
survival and freedom from HF rehospitalization rates with a significantly
reduced annualized HF hospitalization rate. Durable MR reduction was
achieved with evidence of left ventricular reverse remodeling and
significant improvement in functional status. The CLASP IID/IIF randomized
pivotal trial is ongoing. Copyright © 2021 American College of
Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

<45>
Accession Number
2011637871
Title
Tool-tissue forces in surgery: A systematic review.
Source
Annals of Medicine and Surgery. 65 (no pagination), 2021. Article Number:
102268. Date of Publication: May 2021.
Author
Golahmadi A.K.; Khan D.Z.; Mylonas G.P.; Marcus H.J.
Institution
(Golahmadi) Imperial College London School of Medicine, London, United
Kingdom
(Golahmadi, Mylonas) HARMS Laboratory, The Hamlyn Centre, Department of
Surgery & Cancer, Imperial College London, London, United Kingdom
(Khan, Marcus) National Hospital for Neurology and Neurosurgery, London,
United Kingdom
(Khan, Marcus) Wellcome/EPSRC Centre for Interventional and Surgical
Sciences, University College London, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Excessive tool-tissue interaction forces often result in
tissue damage and intraoperative complications, while insufficient forces
prevent the completion of the task. This review sought to explore the
tool-tissue interaction forces exerted by instruments during surgery
across different specialities, tissues, manoeuvres and experience levels.
 Material(s) and Method(s): A PRISMA-guided systematic review was
carried out using Embase, Medline and Web of Science databases.
 Result(s): Of 462 articles screened, 45 studies discussing surgical
tool-tissue forces were included. The studies were categorized into 9
different specialities with the mean of average forces lowest for
ophthalmology (0.04N) and highest for orthopaedic surgery (210N). Nervous
tissue required the least amount of force to manipulate (mean of average:
0.4N), whilst connective tissue (including bone) required the most (mean
of average: 45.8). For manoeuvres, drilling recorded the highest forces
(mean of average: 14N), whilst sharp dissection recorded the lowest (mean
of average: 0.03N). When comparing differences in the mean of average
forces between groups, novices exerted 22.7% more force than experts, and
presence of a feedback mechanism (e.g. audio) reduced exerted forces by
47.9%. Conclusion(s): The measurement of tool-tissue forces is a
novel but rapidly expanding field. The range of forces applied varies
according to surgical speciality, tissue, manoeuvre, operator experience
and feedback provided. Knowledge of the safe range of surgical forces will
improve surgical safety whilst maintaining effectiveness. Measuring forces
during surgery may provide an objective metric for training and
assessment. Development of smart instruments, robotics and integrated
feedback systems will facilitate this. Copyright © 2021

<46>
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.

<47>
Accession Number
2005414717
Title
Effect of pre-existing left bundle branch block on post-procedural
outcomes of transcatheter aortic valve replacement: A meta-analysis of
comparative studies.
Source
American Journal of Cardiovascular Disease. 10 (4) (pp 294-300), 2020.
Article Number: AJCD0113732. Date of Publication: 2020.
Author
Shoar S.; Batra S.; Gulraiz A.; Ikram W.; Javed M.; Hosseini F.; Naderan
M.; Shoar N.; John J.; Modukuru V.R.; Sharma S.K.
Institution
(Shoar) Department of Clinical Research, ScientificWriting Corporation,
Houston, TX, United States
(Batra) Department of Internal Medicine, Dow University of Health
Sciences, Karachi, Pakistan
(Gulraiz) Department of Medicine, Nishtar Medical University, Multan,
Pakistan
(Ikram, Javed) Department of Medicine, Lahore Medical and Dental College,
Lahore, Pakistan
(Hosseini) Faculty of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Naderan) Faculty of Medicine, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Shoar) Faculty of Medicine, Kashan University of Medical Sciences,
Kashan, Iran, Islamic Republic of
(John) Department of Medicine, Dr. Somervell C.S.I. Medical College and
Hospital, Trivandrum, Karakonam, Kerala, India
(Modukuru) Department of Surgery, Metropolitan Hospital, New York College
of Medicine, Manhattan, NY, United States
(Sharma) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, NY, United States
Publisher
E-Century Publishing Corporation
Abstract
Background: As an established procedure for patients with aortic valve
stenosis and a high surgical risk profile, transcatheter aortic valve
replacement (TAVR) can be associated with conductance abnormalities.
However, data regarding the impact of pre-existing left bundle branch
block (LBBB) on post-TAVR outcome is scarce. Objective(s): We
conducted this meta-analysis to pool available data in the literature on
the impact of pre-existing LBBB on the clinical outcomes of patients
undergoing TAVR. Method(s): We queried Medline/PubMed, Scopus, and
Cochrane Library to identify comparative studies of patients with and
without a pre-existing LBBB undergoing TAVR for aortic stenosis. Risk
ratio (RR) and the corresponding 95% confidence interval (95% CI) were
estimated to measure the effect of pre-existing LBBB on developing
post-procedure stroke, permanent pacemaker implantation (PPM), or
moderate/severe aortic regurgitation (AR). Result(s): Data of three
clinical trials encompassing 4,668 patients undergoing TAVR were included
in this meta-analysis. Patients with pre-existing LBBB prior to TAVR had
an increased risk of developing moderate/severe AR (RR = 1.04 [0.79-1.37];
P = 0.77), stroke (RR = 1.72 [0.61-4.85]; P = 0.31), and a need for PPM
implantation (RR = 4.43 [0.43-45.64]; P = 0.21) following TAVR.
 Conclusion(s): Preexisting LBBB seems to increase the risk of
developing stroke, aortic regurgitation, and the need for a permanent
pacemaker implantation. However, due to scarcity of data and high
heterogeneity among the current studies, further clinical trials are
warranted. Copyright © 2020, E-Century Publishing Corporation.
All rights reserved.

<48>
Accession Number
631655743
Title
Dexmedetomidine versus propofol for prolonged sedation in critically ill
trauma and surgical patients.
Source
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and
Ireland. 19 (3) (pp 129-134), 2021. Date of Publication: 01 Jun 2021.
Author
Winings N.A.; Daley B.J.; Bollig R.W.; Roberts R.F.; Radtke J.; Heidel
R.E.; Taylor J.E.; McMillen J.C.
Institution
(Winings) 1924 Alcoa Highway, Box 41, Department of Pharmacy, The
University of Tennessee Medical Center Knoxville, Tennessee, 37920 USA
(Daley, Bollig, Roberts, Radtke, Taylor) 1924 Alcoa Highway, Box U-11,
Department of Surgery, Division of Trauma & Critical Care Surgery the
University of Tennessee Medical Center, Knoxville, TN, 37920 USA
(Heidel) University of Tennessee Graduate School of Medicine, TN, 1924
Alcoa Highway, Knoxville 37920, United States
(McMillen) 1924 Alcoa Highway, Box 41, Department of Pharmacy, The
University of Tennessee Medical Center Knoxville, Tennessee, 37920 USA.
Electronic address: jc.mcmil@gmail.com
Publisher
NLM (Medline)
Abstract
BACKGROUND: and Purpose: Currently, dexmedetomidine versus propofol has
primarily been studied in medical and cardiac surgery patients with
outcomes indicating safe and effective sedation. The purpose of this study
was to assess the efficacy of dexmedetomidine versus propofol for
prolonged sedation in trauma and surgical patients. METHOD(S): This
was a single-center prospective study conducted in the Trauma/Surgical
Intensive Care Unit (ICU) at a Level I academic trauma center. It included
patients 18 years of age or older requiring mechanical ventilation who
were randomly assigned based on unit bed location to receive either
dexmedetomidine or propofol. The primary outcome was duration of
mechanical ventilation. Secondary outcomes included mortality; proportion
of time in target sedation; incidence of delirium, hypotension, and
bradycardia; and ICU and hospital length of stay (LOS). RESULT(S): A
total of 57 patients were included. Baseline characteristics were similar
between groups. There was no significant difference in duration of
mechanical ventilation (median [IQR]) between the dexmedetomidine
(78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There
was no difference between groups in ICU mortality, ICU and hospital LOS,
or incidence of delirium. Safety outcomes were also similar. Patients in
the dexmedetomidine group spent a significantly greater percentage of time
in target sedation (98[8] %) compared to propofol group (92[10] %; p =
0.02). CONCLUSION(S): Our results suggest that, similar to medical
and cardiac surgery patients, dexmedetomidine and propofol are safe and
effective sedation agents in critically ill trauma and surgical patients;
however, dexmedetomidine achieves target sedation better than propofol for
this specific population. Copyright © 2020 Royal College of
Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College
of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

<49>
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

<50>
Accession Number
2011566749
Title
Does the Nuss procedure for treating pectus excavatum compromise the long
term internal mammary artery flow? A systematic review.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Elsayed H.H.; Ahmed T.A.; Hassaballa A.S.; Sharkawy H.Y.
Institution
(Elsayed) Thoracic Surgery Department, Faculty of Medicine, Ain Shams
University, Cairo, Egypt
(Ahmed, Hassaballa, Sharkawy) Cardiothoracic Surgery Department, Ain Shams
University, Cairo, Egypt
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: The Nuss procedure is the most common procedure used to
treat patients with pectus excavatum. The effect of the Nuss bars on the
long-term internal mammary artery flow (IMA) is not well studied. This
could have an impact on patients requiring a coronary artery bypass
grafting surgery after the Nuss procedure. We performed a systematic
review to study the impact of the Nuss bars on the IMA long term flow.
 Method(s): A Medline search from January 1990 to August 2020 was
performed using [Nuss OR thoracoscopic pectus OR minimally invasive
pectus] AND [Internal mammary OR Internal thoracic OR IMA OR ITA]. English
language papers only were included. This trial was registered with
PROSPERO under registration number CRD42021234010. Result(s): A total
of 48 papers were identified using the reported search, of which three
represented the best evidence to answer the clinical question. One study
looked at the IMA flow via computed tomography (CT)-angiography on the
10th postoperative day after the Nuss procedure and found 15 out of 34
patients (44%) to have abnormal IMA blood flow but with no clinical
consequences. Two studies looked at the IMA flow after removal of the
Nuss-bar. The first study utilized CT-angiography on the 5th postoperative
day after Nuss-bar removal and found four out of the six patients studied
(67%) to have abnormal flow. The last study was composed of 19 patients
and looked at IMA flow during the presence of the Nuss-bars and after its
removal utilizing Doppler-angiography. It found 11 out of 19 patients
(58%) to have abnormal blood flow with the bars in place. After removal of
the bars, only two patients (10%) were found to have unilateral IMA
obstructed flow. Conclusion(s): In patients undergoing the Nuss
procedure for management of pectus excavatum, the internal mammary artery
flow is compromised in 44%-58% of patients with the bar in situ. When
these patients are assessed 10 days following removal of the bar, some
reversal of compromised IMA flow is evident. However, in up to 67% of
patients, abnormal IMA flow remains. Further studies are required to
determine whether this abnormal flow is permanent, which will require
examining patients at longer follow-up intervals. Patients undergoing
coronary artery bypass grafting who have a history of a Nuss procedure
should receive preoperative IMA imaging. Copyright © 2021 Wiley
Periodicals LLC

<51>
Accession Number
635098994
Title
Takayasu's arteritis presenting as acute myocardial infarction: Case
series and review of literature.
Source
Cardiology in the Young. (no pagination), 2021. Date of Publication: 2021.
Author
Wilson L.; Chandran A.; Fudge J.C.; Moguillansky D.; Thatayatikom A.;
Philip J.; Jacobs J.P.; Bleiweis M.; Elder M.; Gupta D.
Institution
(Wilson, Chandran, Fudge, Moguillansky, Philip, Jacobs, Bleiweis, Gupta)
Congenital Heart Center, Department of Paediatrics, University of Florida,
Gainesville, FL, United States
(Thatayatikom, Elder) Division of Allergy, Immunology and Rheumatology,
Department of Paediatrics, University of Florida, Gainesville, FL, United
States
(Jacobs, Bleiweis) Division of Cardiovascular Surgery, Department of
Surgery, University of Florida, Gainesville, FL, United States
Publisher
Cambridge University Press
Abstract
This series describes three adolescent females who presented with chest
pain and ventricular dysfunction related to acute coronary ischemia
secondary to Takayasu's arteritis with varied courses of disease
progression leading to a diverse range of therapies including cardiac
transplantation. While Takayasu's arteritis is rare in childhood, it
should be strongly considered in any adolescent female presenting with
systemic inflammation and chest pain consistent with myocardial
infarction. A high index of suspicion can lead to early detection and
aggressive management of the underlying vasculitis reducing associated
morbidity and mortality. The purpose of this report is to describe the
challenges in the clinical diagnosis and management of Takayasu's
arteritis with myocardial infarction. We also seek to enhance awareness
about unique presentations of Takayasu's arteritis within the paediatric
community. Copyright © The Author(s), 2021. Published by
Cambridge University Press.

<52>
Accession Number
635131073
Title
Subxiphoid incisional hernias post median sternotomy: A literature review.
Source
British Journal of Surgery. Conference: ASiT x MedAll Surgical Summit
2020. Virtual. 108 (SUPPL 2) (pp ii79), 2021. Date of Publication: May
2021.
Author
Chan J.; Oo S.
Institution
(Chan) University of Bristol, Bristol, United Kingdom
(Oo) Musgrove Park Hospital, Taunton, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Subxiphoid incisional hernias are one of the complications
following a median sternotomy, a surgical procedure to provide access to
the mediastinum. Incidence has been reported between 1-4%, although the
true incidence is not well known due to its asymptomatic nature.
 Method(s): A comprehensive search was performed on multiple sites.
Keywords included "incisional hernia OR Subxiphoid hernia" AND "Median
sternotomy OR Cardiac Surgery OR Coronary artery bypass graft OR
Transplant OR Valve replacement". Articles up to 1st of August 2020 were
included in this study. Result(s): 8 articles were included in the
study, with a total number of 132 patient identified. The incidence ranged
from 0.81% to 3.44%. There was a mixture of repair method and follow up
period reported. Recurrence post-repair ranged from 10% to 43%.
 Conclusion(s): Subxiphoid incisional hernias are rare, however,
remain challenging to manage. A mixture of open and laparoscopic
techniques was reported with a mixed recurrence or failure rate. Further
work should be done with a large patient cohort comparing both the open
and laparoscopic technique.

<53>
Accession Number
635130936
Title
Tool-tissue forces in surgery: A systematic review.
Source
British Journal of Surgery. Conference: ASiT x MedAll Surgical Summit
2020. Virtual. 108 (SUPPL 2) (pp ii7-ii8), 2021. Date of Publication: May
2021.
Author
Khan D.Z.; Kafai Golahmadi A.; Mylonas G.; Marcus H.
Institution
(Khan, Marcus) Wellcome / EPSRC Centre for Interventional and Surgical
Sciences, University College London, London, United Kingdom
(Khan, Marcus) National Hospital for Neurology and Neurosurgery, London,
United Kingdom
(Kafai Golahmadi) Imperial College London, School of Medicine, London,
United Kingdom
(Kafai Golahmadi, Mylonas) HARMS Laboratory,The Hamlyn Centre, Department
of Surgery and Cancer, Imperial College London, London, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Excessive tool-tissue interaction forces in surgery may
result in tissue damage and intraoperative complications, while
insufficient forces prevent the completion of the task. Method(s): A
systematic review of studies exploring tool-tissue forces applied during
surgery was performed in accordance with PRISMA guidelines.
 Result(s): 45 studies discussing tool-tissue forces during surgical
procedures or tasks were included. Mean forces per speciality were as
follows: ophthalmology (0.04N), vascular (0.7N), neurosurgery (0.68N),
cardiothoracic surgery (1.5N), general surgery (4.7N), otorhinolaryngology
(8.5N), obstetrics & gynaecology (mean 8.7N), urology (9.8N) and
orthopaedic surgery (210N). Senior surgeons applied 25% less force than
novice surgeons, and feedback (haptic, visual or audio) reduced force
application by 40% - across specialities and tasks. Nervous tissue
required the least amount of force to manipulate (0.4N, n=17), followed by
epithelial (3.8N, n=18), muscle (4.1N, n=4) and connective tissue (45.8,
n=10). For manoeuvres, retraction-with-grasping recorded the highest
forces (3.65N, n=13), whilst vessel clamping recorded the lowest (0.5N,
n=2). Conclusion(s): The measurement of tool-tissue forces is a novel
but rapidly expanding field. Knowledge of the safe range of surgical
forces will improve surgical safety whilst maintaining effectiveness.
Measuring surgical forces may provide an objective metric for training and
assessment. Development of smart instruments, robotics and integrated
feedback systems will facilitate this.

<54>
Accession Number
635130795
Title
Concomitant surgical atrial fibrillation ablation follow-up against
best-practice standards at a tertiary cardiac surgery centre in Brighton.
Source
British Journal of Surgery. Conference: ASiT x MedAll Surgical Summit
2020. Virtual. 108 (SUPPL 2) (pp ii97), 2021. Date of Publication: May
2021.
Author
Singh S.; Hussain A.; Kugan G.; Lewis M.
Institution
(Singh, Hussain, Kugan, Lewis) Royal Sussex County Hospital, Brighton,
United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Best-practice as per JCTVS 2006 meta-analysis recommends
following patients who undergo concomitant surgical Atrial Fibrillation
(AF) ablation at 3-months, 1, 2 and 3 years to ensure AF resolution. A
dedicated nurse-led arrythmia clinic managed these patients at Royal
Sussex County Hospital (RSCH), Brighton but was relinquished. Follow-up
was incorporated into routine cardiothoracic/cardiology clinics. This
audit compares current practice at RSCH against best-practice (JCTVS).
 Method(s): Patients who underwent surgical AF ablation between
2016-2017 at RSCH notes were interrogated for demographic, clinical and
outcome data. Survival, freedom from AF at 3-years and post-operative
anticoagulation/rate-control medications at follow-up data were extracted.
 Result(s): Sixty-two patients underwent surgical AF ablation; 21 were
followed up locally at RSCH and included in the final analysis. 53% had
post-surgical AF resolution. At 3-years, 48% were free from AF; all
patients survived. Only 38% patients had 4 follow-up appointments as per
best-practice standards. 62% and 66% continued anticoagulation and
rate-control medications, respectively. Conclusion(s): Best-practice
standards were poorly met. Patients inappropriately followed-up could
incur severe AF-related complications including longer hospital stay,
treatment and poorer quality of life. A nurse-led arrhythmia clinic can
prevent AF-related hospital admissions and sequalae by ensuring
cost-effective review, optimal anticoagulation, and rate/rhythm control.

<55>
Accession Number
635130773
Title
Acute type a aortic dissection in-hours vs out-of-hours: A systematic
review and meta-analysis.
Source
British Journal of Surgery. Conference: ASiT x MedAll Surgical Summit
2020. Virtual. 108 (SUPPL 2) (pp ii6), 2021. Date of Publication: May
2021.
Author
Toh S.; Yew D.C.M.; Choong J.J.; Chong T.L.; Harky A.
Institution
(Toh, Harky) University of Liverpool, Liverpool, United Kingdom
(Yew, Choong, Chong) Monash University, Kuala Lumpur, Malaysia
(Harky) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Acute type A aortic dissection (ATAAD) is a life-threatening
medical emergency requiring immediate surgical intervention. We sought to
compare clinical outcomes in patients with ATAAD that undergone surgical
repair during in-hours (IH) versus out-of-hours (OOH). Method(s):
Electronic database search at PubMed, Ovid, Scopus, Cochrane and Embase
was performed from inception till March 2020. Primary outcomes were 30-day
mortality, stroke, and re-operation for bleeding; secondary outcomes were
previous cardiac surgery and total arch replacement. Result(s): Six
articles with a total of 3,744 patients met the inclusion criteria.
Re-operation for bleeding and stroke rate were similar, with 18% in IH vs
23% in OOH (RR 0.89, 95% CI [0.73, 1.08], p=0.24), and 12% in IH vs 13% in
OOH (RR 0.83, 95% CI [0.66, 1.03], p=0.09) respectively. 30-day mortality
was significantly lower in IH (26%) vs 24% in OOH (RR 0.81, 95% CI [0.72,
0.90], p=0.0001). Previous cardiac surgery was higher in IH (5%) vs 4% in
OOH patients (p=0.005). Total arch replacement were similar in both
cohorts, 29% in IH vs 32% in OOH (RR 0.96, 95% CI [0.89, 1.04], p=0.37).
 Conclusion(s): ATAAD operation during IH and OOH have comparable
clinical outcomes. Therefore, operating on such cases should be decided on
clinical priority without delay.

<56>
Accession Number
635130541
Title
Preclosure of large bore venous access sites in patients undergoing
transcatheter mitral replacement and repair.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions, SCAI
2021. Virtual. 97 (SUPPL 1) (pp S65-S66), 2021. Date of Publication: April
2021.
Author
Mohammed M.; Lemor A.; Nona P.; o'Neill B.; Frisoli T.; Lee J.; O'Neill
W.W.; Wang D.D.; Eng M.H.; Villablanca P.
Institution
(Mohammed, Lemor, Nona, o'Neill, Lee, Wang, Eng, Villablanca) Henry Ford
Health System, United States
(Frisoli, O'Neill) Henry Ford Hospital, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Patients requiring transcatheter mitral valve repair (TMVr)
and replacement (TMVR) interventions require large bore venous access
(LBVA). Clinical outcome data on the use of suturemediated devices for
LBVA site closure are limited. We aim to report on the efficacy and safety
of LBVA preclosure with PercloseTM (Abbott Vascular Devices, CA)
suture-mediated device use following TMVr and TMVR. Method(s): This
is a retrospective cohort study in a large academic center. 354
consecutive high-risk patients with mitral valvular heart disease
underwent TMVr (n=287) with MitraClip and TMVR (n=67) with Edwards Sapien
Valves between 2012 and 2019. LBVA was required for those cases with the
largest being 26 French sheath and smallest 16 French sheath.
Complications were recorded and analyzed in those cases using and excel
sheet. Result(s): All patients underwent preclosure of LBVA except
for one that underwent manual hemostasis. There were no closure device
failures. None of the cases required surgical repair of the access site
following venous preclose. Two cases had large hematomas (>6 cm) following
Perclose in each group. Six cases had small hematomas (<6cm and >2cm) with
3 in each group. There was one major bleeding using MVARC 2 definition
(retroperitoneal bleed from arterial puncture) unrelated to the venous
closure. Transfusion related to vascular access complication was required
in 5 cases. There were 2 immediate acute deep venous thromboses
post-procedure; one of which occurred after preclosure. There were no
arteriovenous malformations, pseudoaneurysms or access site infections
reported following Perclose. Conclusion(s): Proglide preclosure
technique is a feasible and safe alternative approach to achieve
hemostasis after removal of LBVA sheaths in patients undergoing TMVr and
TMVR. Randomized trials are needed to compare suture-mediated versus other
modalities of hemostasis.

<57>
Accession Number
635130508
Title
Thirty-day outcomes of left ventricular pacing during transcatheter aortic
valve implantation: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions, SCAI
2021. Virtual. 97 (SUPPL 1) (pp S91), 2021. Date of Publication: April
2021.
Author
Bansal R.; Torres R.N.C.; Thandra A.; Ponamgi S.; Reddy A.K.; Alla V.M.
Institution
(Bansal, Thandra, Ponamgi, Reddy) CHI Health Creighton University Medical
Center, United States
(Torres) CHI Health Creighton University Medical Center -Bergan Mercy,
United States
(Alla) Creighton University, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Rapid pacing via the right ventricular (RV) pacing is used
during transcatheter aortic valve replacement (TAVR). Pacing via
retrograde left ventricular (LV) guidewire can be used alternatively. We
conducted a meta-analysis to determine outcomes of LV pacing during TAVR.
 Method(s): PubMed, Google scholar and Cochrane databases were
searched for all studies reporting outcomes for patients undergoing TAVR
with LV guidewire pacing. Outcomes of interest were procedural success
(valve deployment), 30-day all-cause mortality, pacemaker implantation,
pericardial tamponade, vascular complications and stroke. Pooled incidence
with corresponding 95% confidence intervals (CIs) were calculated using
random-effects model. Result(s): Six studies met the inclusion
criteria with a total of 697 patients. Mean procedure duration was 64.5
+/-15.3 minutes, with a procedural success rate of 96 % (95% CI
0.87-0.99). Pooled incidence of 30-day all-cause mortality was 3% (95% CI
0.02-0.05). 30-day pooled rates of pacemaker implantation, pericardial
tamponade, vascular complications and stroke were 13% (95% CI 0.08-0.19),
1% (95% CI 0.00-0.04), 6% (95% CI 0.03-0.10), and 3% (95% CI 0.02-0.06)
respectively. [Figure 1] Conclusion(s): The results of our study
suggest that pacing via the LV guidewire has a very high procedural
success rate. Overall complication rates were low with the use of LV
pacing wire and therefore may serve as an alternate to right ventricular
pacing, eliminating the need for venous access during TAVR.

<58>
Accession Number
635130460
Title
Comparison by meta-analysis of 10-year outcomes of percutaneous coronary
intervention versus coronary artery bypass grafting in patients with
unprotected left main coronary artery disease.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions, SCAI
2021. Virtual. 97 (SUPPL 1) (pp S47), 2021. Date of Publication: April
2021.
Author
Khan M.R.; Hamzeh I.; Birnbaum Y.; Alam M.
Institution
(Khan) McLaren Flint, Michigan State University, United States
(Hamzeh, Birnbaum, Alam) Baylor College of Medicine, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: Data comparing very long-term outcomes of unprotected left
main coronary artery (ULMCA) revascularization with Percutaneous Coronary
Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) is scarce
and is continuing to evolve. Method(s): We performed aggregate data
meta-analyses of clinical outcomes [all-cause mortality, stroke, non-fatal
myocardial infarction (MI), repeat revascularization and a composite of
death, MI and stroke (MACCE)] in studies reporting a minimum of 10-year
follow-up. An extensive literature search (to January 20, 2021) identified
5 studies (2 randomized, 3 observational). Effect size for individual
clinical outcomes were estimated with odds ratio (OR) and 95% confidence
intervals (CI) using a random-effects model. Result(s): A total of
4,000 patients were included in this analysis. Baseline demographic and
clinical characteristics were comparable between the two groups. At the
longest available follow-up, patients in the PCI and CABG groups were
comparable in terms of all-cause mortality (OR 0.95, CI 0.81-1.12), MACCE
(OR 0.98, CI 0.83-1.16), stroke (OR 0.73, CI 0.36-1.49), non-fatal MI (OR
1.19, CI 0.72-1.97) but higher rates of repeat revascularization (OR 2.48,
CI 1.15-5.35) (Table 1). Conclusion(s): At a very long-term
follow-up, PCI and CABG have a comparable mortality, risk of stroke,
non-fatal MI and MACCE. PCI, however, is associated with an increased risk
of repeat revascularization.

<59>
Accession Number
635130454
Title
Plug-based manta vs suture-based proglide for vascular closure after
transfemoral transcatheter aortic valve implantation (TF-TAVI)-a meta
analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions, SCAI
2021. Virtual. 97 (SUPPL 1) (pp S80), 2021. Date of Publication: April
2021.
Author
Razzack A.A.; Emara A.; Elkhouly A.; Hassan S.A.; Garimella V.; Garimella
R.; Pothuru S.; Theja Reddy K.; Sattar Y.
Institution
(Razzack, Garimella) Dr. NTR University of Health Sciences, India
(Emara, Elkhouly) Alexandria Faculty of Medicine, Egypt
(Hassan) University of Louisville, United States
(Garimella) Howard University, School of Medicine, United States
(Pothuru) Ascension via Christi Hospital, United States
(Theja Reddy) UHS Southern California Medical Education, Consortium
Internal Medicine Residency program, United States
(Sattar) NYC Health + Hospitals/Elmhurst, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: -Access site vascular and bleeding complications are a major
concern in transfemoral transfemoral aortic valve implantation (TF-TAVI).
The efficacy and safety of the novel MANTA relative to ProGlide remains
unknown. Method(s): -Electronic databases ( PubMed, Embase, Scopus,
Cochrane) were searched from inception to December 28th, 2020. Unadjusted
odds ratios (OR) were calculated from dichotomous data using Mantel
Haenszel (M-H) random-effects with statistical significance to be
considered if the confidence interval excludes 1 and p<0.05. The primary
outcome of interest was a composite of major and minor vascular
complications. Secondary outcomes included clinically relevant bleeding.
 Result(s): -A total of four studies with 895 participants (ProGlide=
406; MANTA=395) were included. Mean age was 80.7 and 80.4 in the ProGlide
and MANTA groups respectively. Average follow-up period was 30days. There
was no significant difference in the primary endpoint of vascular
complications (RR 0.79, 95% CI 0.39-1.60; p=0.52; I2=61)and the
secondary endpoint of bleeding complications (RR 1.08, 95% CI 0.65-1.80;
p=0.76; I2=56) between MANTA and ProGlide . Conclusion(s):
-Plug-based MANTA vascular closure device was not superior to suture-based
ProGlide closure in TF-TAVI for prevention of vascular and bleeding
complications.

<60>
Accession Number
635130448
Title
Valve in valve trancatheter mitral valve replacement (viv TMVR) vs. redo
surgical mitral valve replacement (SMVR) for degenerating bioprosthetic
valves-A Meta-Analysis.
Source
Catheterization and Cardiovascular Interventions. Conference: Society for
Cardiovascular Angiography and Interventions Scientific Sessions, SCAI
2021. Virtual. 97 (SUPPL 1) (pp S79), 2021. Date of Publication: April
2021.
Author
Zahid S.; Inayat A.; Khan S.; Sarvepalli D.; Gilani A.; Ullah W.; Khan
M.Z.; Khan M.U.; Balla S.; Alraies M.C.
Institution
(Zahid) Rochester General Hospital, United States
(Inayat) Sisters of Charity Hospital Catholic Health, United States
(Khan) St Vincent Hospital, United States
(Sarvepalli) Gunter Medical College, India
(Gilani) Khyber Girls Medical College, Pakistan
(Ullah) Abington Jefferson Health, United States
(Khan, Khan, Balla) West Virginia University, School of Medicine, United
States
(Alraies) Detroit Medical Center Heart Hospital, United States
Publisher
John Wiley and Sons Inc.
Abstract
Background: The data on outcomes for ViV TMVR vs. redo SMVR for
degenerating bioprosthetic valves remains limited. Method(s): The
Pubmed, cochrane database and embase were queried for relevant articles.
Data was analyzed using a random-effect model to calculate unadjusted odds
ratio (OR). Result(s): A total of 260 patients, 132 in the ViV TMVR
group and 128 in the redo SMVR group were included in the analysis. The
ViV TMVR group had older patients with higher mean age compared to redo
SMVR group (76.5+/-9 vs.66.1+/-10,p=<0.01). The comorbidity burden was
greater in the TMVR group with higher proportion of patients having
diabetes(22% vs. 12%,p=0.03), hypertension (68% vs. 52%,p=0.01) and
dyslipidemia (57% vs.37%,p=<0.01) for ViV TMVR vs. Redo SMVR respectively.
On pooled analysis, the major adverse cardiovascular events (OR: 0.40, 95%
CI 0.24-0.66,p=<0.01) and major bleeding (OR: 0.40, 95% CI
0.17-0.95,p=0.04) were significantly lower for patients undergoing ViV
TMVR compared to redo SMVR group respectively. However the odds for
mortality (OR: 0.60, 95% CI 0.22-1.68,p=0.33) and stroke (OR: 0.30, 95% CI
0.07-1.27,p=0.68) were found comparable between the two groups. The
hospital length of stay (LOS) was significantly lower for ViV TMVR when
compared to redo SMVR group (7.9+/- 5.2 vs. 11.9 +/- 6.5, p=<0.01).
 Conclusion(s): ViV TMVR has a better safety profile with lower odds
of MACE and major bleeding when compared to redo SMVR for degenerating
bioprosthetic valves. In terms of resource utilization, ViV TMVR has a
significantly shorter hospital stay compared to conventional surgery.

<61>
Accession Number
635128586
Title
Pediatric incisional negative pressure wound therapy for poket
complications involving cardiac implantable electronic devices.
Source
Journal of Wound Care. Conference: 5th Congress of World Union of Wound
Healing Societies, WUWHS 2016. Florence Italy. 26 (SUPPL 6) (pp 154),
2017. Date of Publication: 2017.
Author
Ciprandi G.; Filippelli S.; Zama M.; Crucianelli S.; Amodeo A.
Institution
(Ciprandi, Zama, Crucianelli) Division of Plastic and Maxillofacial
Surgery, Department of Surgery, Bambino Gesu' Children's Hospital, Irccs,
Rome, Italy
(Filippelli, Amodeo) Division of Cardiothoracic Surgery, Bambino Gesu'
Children's Hospital, Irccs, Rome, Italy
Publisher
MA Healthcare Ltd
Abstract
BACKGROUND AND AIMS: Use of incisional NPWT (iNPWT) has been shown to
actively manage clean closed surgical incision. The use of iNPWT has been
reported in a variety of risk conditions. Cardiac pokets could symbolize
the essence of a high risk wound, often complicated by a surgical
dehiscence or infection. The aim of this study is to prove the
effectiveness of the iNPWT in a small group of 11 consecutive pediatric
patients affected by a complicated poket allocating a cardiac implantable
electronic device. METHOD(S): This is a monocentric retrospective
observational study. The full charts of 11 children (average age 12,4yrs)
were rewieved. All children showed a dehiscent and infected poket at
various degrees treated with a conservative closed approach using iNPWT.
Results. All children recovered from their local infection, 9 showed a
salvage of the poket: in 3 children we used rotational flaps and a
subsequent immediate application of the iNPWT on the closed incisional
suture. In two cases the iNPWT was used as a bridge for sterilizing the
deep Surgical Site Infection (SSI's) with a following partial removal of
the device but on a sterile bed, showing hypergranulating tissues.
 CONCLUSION(S): The management of deep SSI's has been challenging over
the years, particularly in children affected by congenital or acquired
impaired immunity. Randomized, controlled studies of NPWT for closed
incisions in orthopedic settings have shown the global impact on reducing
wound infection and dehiscence. In our experience the application of iNPWT
was useful in treating residual seromas and with the aim of consolidating
the abdominal wall layers. Its major role was played in preventing,
controlling and caring local infection sometimes responsible for the lost
of devices. iNPWT improves wound outcomes after cardiothoracic surgery in
pediatric patients and should be routinely considered as a daily cost
saving practice.

<62>
Accession Number
635128260
Title
Pressure ulcer-mean arterial pressure (PU-MAP).
Source
Journal of Wound Care. Conference: 5th Congress of World Union of Wound
Healing Societies, WUWHS 2016. Florence Italy. 26 (SUPPL 6) (pp 429),
2017. Date of Publication: 2017.
Author
Langvad A.
Publisher
MA Healthcare Ltd
Abstract
BACKGROUND A research project "How to prevent patients developing pressure
ulcer (PU) when undergoing cardio-thoracic surgery" concluded that
sseveral factors influence the development of pressure ulcers
intraoperatively. Especially the extrinsic factors, which are the external
factors the patient is exposed to during the operation, increase the risk
of PU. The extrinsic factor hypotension was not covered by this project.
Few studies examine the correlation between low mean arterial pressure
(MAP) (> 60 mmHG) during perfusion and development of pressure ulcers.
Several studies show a correlation between MAP and development / healing
of pressure ulcers in intubated patients in ICU (Park 2014). This is
supported by a retrospective study including 347 patients. In this study
it was found that patients, who developed pressure ulcers, had a MAP that
was lower than the patients, who did not develop pressure ulcers (Cox
2011). A descriptive, comparative study with 40 patients showed that MAP
of 36-75 mmHg triggered a low Braden score, but not a significantly
pressure ulcer development (Pender et al 2005). To investigate the
extrinsic factor hypotension we initiated the study "Pressure Ulcer- Mean
Arterial Pressure" (PU-MAP) as an understudy to "the PPCI trial"
(perfusion - pressure - cerebral - infarction trial). This study included
patients undergoing cardiac surgery. Patients were randomized to a MAP
pressure of 70-80 mmHg during perfusion in the intervention group and a
MAP higher or equal to 40 mmHg in the control group. AIM To investigate
whether there is a correlation between a MAP higher or equal to 40 mmHg or
a MAP of 70 - 80 mmHg during cardiac surgical procedures on perfusion and
the development of pressure ulcers METHODS Randomized controlled blinded
patient single center study with two parallel groups, 1: 1 ratio
Allocation and stratification for age and surgery type. Pressure ulcers
are recorded in the intervention and control group: *Preoperative in the
operating theatre. *Postoperative before the patient is transferred to the
ICU. *On the first postoperative day in ICU before the patient transferred
to the ward. *4On the fourth postoperative day in the ward RESULTS Results
of the study are being analyzed based on the following questions: *did
patients develop pressure ulcers in the postoperative period *is there a
coherence between the development of pressure ulcers and intervention with
MAP 70 - 80 mmHg compared to a MAP higher or equal to 40 mmHg In order to
identify other factors that might influence the development of pressure
ulcers in this study the following parameters, will be included in the
analysis of data. *Type of operation *Length of operation *Demographic
data *DM *Already known pressure ulcers.

<63>
Accession Number
2012222165
Title
Lobe-specific lymph node dissection in stage IA non-small-cell lung
cancer: A retrospective cohort study.
Source
European Journal of Cardio-thoracic Surgery. 59 (4) (pp 783-790), 2021.
Date of Publication: 01 Apr 2021.
Author
Abughararah T.Z.; Jeong Y.H.; Alabbood F.; Chong Y.; Yun J.K.; Lee G.D.;
Choi S.; Kim H.R.; Kim Y.-H.; Kim D.K.; Park S.-I.
Institution
(Abughararah, Jeong, Alabbood, Chong, Yun, Lee, Choi, Kim, Kim, Kim, Park)
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center,
University of Ulsan, College of Medicine, Seoul 05505, South Korea
(Abughararah) Department of Thoracic Surgery, Prince Mohammed Bin
Abdulaziz Hospital, MNGHA, King Abdullah International Medical Research
Center, Riyadh, Saudi Arabia
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: To investigate lymph node (LN) metastasis according to tumour
location and assess the impact of lobe-specific LN dissection on survival
in stage IA non-small-cell lung cancer (NSCLC). METHOD(S): We
retrospectively analysed the data of patients with clinical stage IA NSCLC
treated with lobectomy and systematic LN dissection at Asan Medical Center
(Seoul, Korea) between June 2005 and April 2017. Patients who received
neoadjuvant therapy had multiple primary tumours or missed the follow-up
during the first postoperative year were excluded. The patients were
divided into five groups according to involved lung lobes: Right upper
lobe (RUL), right middle lobe (RML), right lower lobe (RLL), left upper
lobe (LUL) and left lower lobe (LLL), which were further divided into
subgroups according to LN station metastasis. Overall survival (OS) and
the incidence of metastasis were calculated for each subgroup. Efficacy
indices (EIs) were calculated to determine the correlation between each
lung lobe and LN station, and the impact of the dissection of these
stations on survival. RESULT(S): A total of 1202 patients were
analysed. The 5-year OS in the RUL, RML, RLL, LUL and LLL groups was 74%,
88%, 78%, 80% and 75%, respectively. The incidence of single LN station
metastasis was 11%, 10%, 10%, 16% and 14%, respectively. The lobe-specific
LNs for RUL, RML, RLL, LUL and LLL were stations 2/3/4, 4/7, 2/4/7, 4/5/6
and 6/7/9, respectively. Moreover, the LN stations with high EIs for RUL,
RML, RLL, LUL and LLL were 4, 7, 7, 5 and 7, respectively. In the RUL
group, the incidence of metastasis to stations 2, 3 and 4 was 2.3%, 0.5%
and 7.6%, and the EI was 0.8, 0.3 and 4.3, respectively. In RML, the
incidence of metastasis to stations 4 and 7 was 4% and 6%, and the EI was
1.3 and 2.4, respectively. In RLL, the incidence of metastasis to stations
2, 4 and 7 was 4.4%, 5.6% and 8.3%, and the EI was 1.3, 1.4 and 3.3,
respectively. In LUL, the incidence of metastasis to stations 4, 5 and 6
was 1.4%, 11.8% and 2.5%, and the EI was 0.4, 7.1 and 0.5, respectively.
In LLL, the incidence of metastasis to stations 6, 7 and 9 was 1.1%, 5.7%
and 1.7%, and the EI was 0.6, 2.3 and 0.5, respectively. Furthermore, the
OS of patients with lobe-specific LN metastasis was statistically
significantly different from that of the non-lobe-specific LN metastasis
group with P-values of 0.001 for RUL, 0.002 for RML, 0.002 for RLL, 0.001
for LUL and 0.003 for LLL. CONCLUSION(S): Our findings support the
use of lobe-specific LN dissection in stage IA NSCLC. When LN stations
with high EI were negative, LN metastasis in other stations was unlikely.
The incidence of LN metastasis beyond lobe-specific LN stations was
&sim;1% in all subgroups. Dissection of non-lobe-specific LNs may not
improve the OS; however, prospective randomized controlled trials are
needed to modify the standard approach. © 2020 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved. Copyright ©
2021 European Association for Cardio-Thoracic Surgery. All rights
reserved.

<64>
Accession Number
2012222159
Title
Long-term and short-term outcomes of robot-versus video-assisted anatomic
lung resection in lung cancer: A systematic review and meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 59 (4) (pp 732-740), 2021.
Date of Publication: 01 Apr 2021.
Author
Wu H.; Jin R.; Yang S.; Park B.J.; Li H.
Institution
(Wu, Jin, Yang, Li) Department of Thoracic Surgery, Ruijin Hospital,
Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
(Park) Thoracic Service, Department of Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Minimally invasive thoracic surgery has evolved with the
introduction of robotic platforms. This study aimed to compare the
long-term and short-term outcomes of the robot-assisted thoracic surgery
(RATS) and video-assisted thoracic surgery (VATS) for anatomic lung
resection. METHOD(S): We searched published studies that investigated
RATS and VATS in anatomic lung resection. Long-term outcomes (disease-free
survival and overall survival) and short-term outcomes (30-day mortality,
postoperative complications, conversion rate to open surgery and lymph
node upstaging) were extracted. The features were compared and tested as
hazard ratios (HRs) and odds ratios (ORs) at a 95% confidence interval
(CI). RESULT(S): Twenty-five studies with 50 404 patients (7135 for
RATS and 43 269 for VATS) were included. The RATS group had a longer
disease-free survival than the VATS group (HR: 0.76; 95% CI: 0.59-0.97; P
= 0.03), and the overall survival showed a similar trend but was not
statistically significant (HR: 0.77; 95% CI: 0.57-1.05; P = 0.10). The
RATS group showed a significantly lower 30-day mortality (OR: 0.55; 95%
CI: 0.38-0.81; P = 0.002). No significant difference was found in
postoperative complications (OR: 1.01; 95% CI: 0.87-1.16; P = 0.94), the
conversion rate to open surgery (OR: 0.92; 95% CI: 0.56-1.52; P = 0.75)
and lymph node upstaging (OR: 0.89; 95% CI: 0.52-1.54; P = 0.68).
 CONCLUSION(S): RATS has comparable short-term outcomes and potential
long-term survival benefits for anatomic lung resection compared with
VATS. © 2020 The Author(s). Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved. Copyright © 2021 European Association for
Cardio-Thoracic Surgery. All rights reserved.

<65>
Accession Number
2011670422
Title
Transfusion Strategies for Pediatric Cardiac Surgery: A Meta-Analysis and
Trial Sequential Analysis.
Source
Pediatric Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Duan Z.X.; Chen D.X.; Yang B.Z.; Zhang X.Q.
Institution
(Duan, Zhang) Department of Anesthesiology, Yuncheng Central Hospital,
Yuncheng, Shanxi 044000, China
(Chen) Department of Anesthesiology, West China Hospital, Sichuan
University, No. 37 Wainan Guoxue Rd, Chengdu, Sichuan 610041, China
(Yang) Department of Anesthesiology, First Hospital of Shanxi Medical
University, Taiyuan, Shanxi 030001, China
Publisher
Springer
Abstract
This study aimed to compare the effects of restrictive and liberal red
blood cell (RBC) transfusion strategies on pediatric patients undergoing
cardiac surgery, including cyanotic and non-cyanotic children. A
literature search of the MEDLINE, EMBASE, PubMed, and the Cochrane Library
database was conducted. Meta-analyses were carried out comparing
restrictive and liberal transfusion strategies. Subgroup analyses were
performed based on the basis of cyanotic status. Five randomized
controlled trials with a total of 497 children were included. There was no
significant difference in the risk of in-hospital mortality between the
two transfusion strategies (risk ratio 1.21; 95% confidence interval 0.49
to 2.99; P = 0.68). The trial sequential analysis suggested that the
current meta-analysis had an absence of evidence for in-hospital
mortality, and the data were insufficient. Moreover, no significant
differences existed between groups in terms of risk of infection, blood
loss, duration of mechanical ventilation, pediatric intensive care unit
(PICU) stay duration, or hospital stay duration. Cyanotic children treated
with a liberal transfusion strategy had a shorter ventilator duration, but
the transfusion strategy did not affect in-hospital mortality, infection,
hospital stay, or PICU stay duration. On the basis of the available data,
our analysis indicates that a liberal transfusion strategy did not lead to
a better outcomes, but the data are extremely sparse, which highlights the
need for clearer transfusion guidelines specific to this specific
population. Trial registration number CRD42018102283. Copyright ©
2021, The Author(s), under exclusive licence to Springer Science+Business
Media, LLC, part of Springer Nature.

<66>
Accession Number
2011638305
Title
Bilateral transversus thoracis muscle plane block provides effective
analgesia and enhances recovery after open cardiac surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Zhang Y.; Li X.; Chen S.
Institution
(Zhang, Chen) Department of Anesthesiology, First Affiliated Hospital of
Nanchang University, Nanchang, Jiangxi, China
(Li) Department of Nursing, The first Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Publisher
Blackwell Publishing Inc.
Abstract
Background: The mid-sternum is the main source of pain after open cardiac
surgery. The aim of this study was to investigate the effect of bilateral
transversus thoracis muscle plane (TTMP) blocks on open cardiac surgery.
 Method(s): Sixty patients were randomly divided into two groups:
bilateral TTMP blocks (TP group) or no nerve block (CO group). The primary
endpoint was perioperative sufentanil consumption. The secondary outcome
measures included postoperative pain, flurbiprofen axetil administration,
quality of sleep after extubation, time to extubation, time to the return
of gastrointestinal function, time to drain removal, the Intensive Care
Unit (ICU) stay time, and hospital stay. Result(s): The TP group
reported significantly less sufentanil and flurbiprofen axetil consumption
than the CO group. The CO group had higher Numerical Rating Scale (NRS)
pain scores at 1, 2, 6, 12, and 24 h after extubation both at rest and
during movement than the TP groups. Compared with the CO group,time to
extubation, time to the first bowel movement, ICU stay time, and hospital
stay were significantly decreased in the TP group. The TP group was rated
as better in the quality of the two nights of sleep after extubation.
 Conclusion(s): Bilateral TTMP blocks can provide good perioperative
analgesia for patients undergoing open cardiac surgery and promote
postoperative recovery. Copyright © 2021 Wiley Periodicals LLC

<67>
Accession Number
635134636
Title
Frailty as a Predictor of Postoperative Outcomes in Invasive Cardiac
Surgery: A Systematic Review of Literature.
Source
The Journal of cardiovascular nursing. (no pagination), 2021. Date of
Publication: 19 May 2021.
Author
Peeler A.; Moser C.; Gleason K.T.; Davidson P.M.
Institution
(Peeler) Maryland. Chandler Moser, Maryland. Patricia M. Davidson, MEd, RN
Johns Hopkins School of Nursing, Baltimore, MD, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Frailty is a syndrome characterized by increased vulnerability
and reduced ability to maintain homeostasis after stressful events that
results in an increased risk for poor outcomes. Frailty screening could
potentially be valuable in cardiac surgery risk assessment. The purpose of
this review is to evaluate the current literature linking multicomponent
frailty assessment and invasive cardiac surgery outcomes. METHOD(S):
We searched PubMed, EMBASE, and CINAHL; 1887 articles met the search
criteria, and each was independently reviewed by 2 reviewers.
 RESULT(S): The 19 eligible studies assessed 52 291 subjects using 17
different frailty measurements. The most commonly used instruments were
the Fried Frailty Phenotype and the Clinical Frailty Scale. Between 9% and
61% of participants were found to be frail in each study. All 19 studies
included mortality as an outcome, 12 included surgical complications, 12
included hospital length of stay, 3 included quality of life, and 2
included functional status. Nine found statistically significant
differences in survival between frail and nonfrail patients, 6 of 12 found
that frail patients had a longer length of stay, 4 of 12 found that frail
patients were more likely to experience major complications, and 2 of 2
found that frail patients were more likely to have a decrease in
functional status. CONCLUSION(S): Although some studies lacked power,
the majority confirmed that frail patients are more likely to experience
poor outcomes. Further research is needed to determine which frailty
measure provides the best predictive validity and to identify
interventions to mitigate the risks that major cardiac surgery poses to
frail patients. Copyright © 2021 Wolters Kluwer Health, Inc. All
rights reserved.

<68>
Accession Number
635125223
Title
Saphenous vein harvesting techniques for coronary artery bypass grafting:
a systematic review and meta-analysis.
Source
Coronary artery disease. (no pagination), 2021. Date of Publication: 18
May 2021.
Author
Vuong N.L.; Elfaituri M.K.; Eldoadoa M.; Karimzadeh S.; Mokhtar M.A.; Eid
P.S.; Nam N.H.; Mostafa M.R.; Radwan I.; Zaki M.M.M.; Al Khudari R.;
Kassem M.; Huy N.T.
Institution
(Vuong) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine Department of Medical Statistics and Informatics, Faculty of
Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho
Chi Minh City, Vietnam Online Research Club
(http://www.onlineresearchclub.org), School of Tropical Medicine and
Global Health, Nagasaki University, Nagasaki, Japan Faculty of Medicine -
University of Tripoli, Tripoli, Libya Milton Keynes University Hospital,
Milton Keynes, UK School of Medicine, Sabzevar University of Medical
Sciences, Sabzevar, Iran Faculty of Medicine, Sohag University, Sohag
Faculty of Medicine, Ain Shams University, Cairo, Egypt Division of
Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of
Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
School of Medicine, Tanta University, Tanta Faculty of Clinical Pharmacy,
Fayoum university, Fayoum, Egypt Pediatric Department, Children's
University Hospital, Damascus University, Damascus, Syria Department of
Medical Oncology, The Ohio State University Wexner Medical Center,
Columbus, Ohio, USA School of Tropical Medicine and Global Health,
Nagasaki University, Nagasaki, Japan
Publisher
NLM (Medline)
Abstract
The great saphenous vein (GSV) graft remains a frequently used conduit for
coronary artery bypass graft (CABG) surgery. The optimal technique for GSV
harvesting has been the subject of on-going controversy. We therefore
sought to conduct a systematic review and meta-analysis of all available
GSV harvesting techniques in CABG. A systematic search of 12 electronic
databases was performed to identify all randomized controlled trials
(RCTs) of any GSV harvesting technique, including conventional vein
harvesting (CVH), no-touch, standard bridging technique (SBT) and
endoscopic vein harvesting (EVH) techniques. We investigated safety and
long-term efficacy outcomes. All outcomes were analyzed using the
frequentist network meta-analysis. A total of 6480 patients from 34 RCTs
were included. For safety outcomes, EVH reduced 91% and 77% risk of wound
infection compared to no-touch and CVH, respectively. EVH and SBT also
significantly reduced the risk of sensibility disorder and postoperative
pain. The techniques were not significantly different regarding long-term
efficacy outcomes, including mortality, myocardial infarction and graft
patency. For GSV harvesting for CABG, EVH techniques are the most
favorable, but in case of using an open technique, no-touch is more
recommended than CVH. More effective and safer procedures should be
investigated for GSV harvesting in CABG. Copyright © 2021 Wolters
Kluwer Health, Inc. All rights reserved.

<69>
Accession Number
635122597
Title
Impact of renin-angiotensin system inhibitors after revascularization of
patients with left main coronary artery disease.
Source
Coronary artery disease. (no pagination), 2021. Date of Publication: 18
May 2021.
Author
Chen S.; Redfors B.; Serruys P.W.; Pieter Kappetein A.; Crowley A.;
Ben-Yehuda O.; Srdanovic I.; Lembo N.J.; Brown W.M.; Sabik J.F.; Stone
G.W.
Institution
(Chen) Clinical Trials Center, Cardiovascular Research Foundation
NewYork-Presbyterian Hospital/Columbia University Irving Medical Center,
New York, USA Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden Department of Cardiology, National University of
Ireland Galway (NUIG), Galway, Ireland Department of Cardiology, Imperial
College of London, London, UK Thoraxcenter, Erasmus MC, Rotterdam, the
Netherlands Division of Cardiology, University of California - San Diego,
San Diego, California, USA Piedmont Heart Institute, Atlanta, Georgia
Department of Surgery, UH Cleveland Medical Center, Cleveland, Ohio The
Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of
Medicine at Mount Sinai, New York, USA
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is a paucity of data regarding the effect of inhibition
of the renin-angiotensin system on outcomes after percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG). We sought
to examine long-term outcomes of patients with left main coronary disease
(LMCAD) randomized to PCI with fluoropolymer-based cobalt-chromium
everolimus-eluting stents or CABG according to treatment at discharge with
angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor
blockers (ARB) in the large-scale, multicenter, randomized EXCEL trial.
 METHOD(S): EXCEL randomized 1905 patients with LMCAD of low and
intermediate anatomical complexity (visually-assessed SYNTAX score <=32)
to PCI (n=948) versus CABG (n=957). Patients were categorized according to
whether they were treated with ACEI/ARB at discharge; their outcomes from
discharge to 5years were examined using multivariable logistic regression
with an offset for follow-up time. RESULT(S): Among 1775 patients
discharged alive with known ACEI/ARB treatment status, 896 (50.5%) were
treated with one of these agents. Among those treated with ACEI/ARB, the
5-year rate of all-cause death was similar after PCI or CABG (10.7% versus
9.8% respectively, adjOR, 0.94; 95% CI, 0.56-1.57) in contrast to patients
not treated with ACEI/ARB (15.0% versus 7.8%, respectively, adjOR, 2.20;
95% CI, 1.32-3.67) (Pinteraction=0.02). Significant interactions between
treatment arm (PCI versus CABG) and ACEI/ARB treatment status were also
found for cardiovascular death (Pinteraction=0.03), ischemia-driven
revascularization (Pinteraction=0.03), target vessel revascularization
(Pinteraction=0.007) and target vessel failure (Pinteraction=0.0009).
 CONCLUSION(S): In the EXCEL trial, the postdischarge rates of death
and revascularization after 5years were similar after PCI and CABG in
patients with LMCAD treated with ACEI/ARB at discharge. In contrast, event
rates were higher after PCI versus CABG in those not so
treated. Copyright © 2021 Wolters Kluwer Health, Inc. All rights
reserved.

<70>
Accession Number
635122076
Title
White blood cell count and clinical outcomes after left main coronary
artery revascularization: insights from the EXCEL trial.
Source
Coronary artery disease. (no pagination), 2021. Date of Publication: 18
May 2021.
Author
Claessen B.E.; Ben-Yehuda O.; Mehran R.; Sorrentino S.; Guedeney P.; Chen
S.; Dressler O.; Kini A.S.; Sharma S.K.; Mansour S.; Noiseux N.; Li D.;
Kappetein A.P.; Sabik J.F.; Serruys P.W.; Stone G.W.
Institution
(Claessen) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai Clinical Trials Center, Cardiovascular
Research Foundation Center for Interventional Vascular Therapy, Division
of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving
Medical Center, New York, USA Division of Cardiology, University of
California - San Diego, San Diego, California, USA Centre Hospitalier de
l'Universite de Montreal, Montreal, Quebec, Canada Erasmus Medical Center,
Rotterdam, the Netherlands Department of Surgery, UH Cleveland Medical
Center, Cleveland, Ohio, USA Department of Cardiology, National University
of Ireland Galway (NUIG), Galway, Ireland Imperial College of London,
London, UK
Publisher
NLM (Medline)
Abstract
BACKGROUND: Prior studies have reported an association between elevated
white blood cell count (WBCc) and worse clinical outcomes after coronary
artery bypass grafting (CABG) and percutaneous coronary intervention
(PCI). We assessed the prognostic impact of WBCc in patients undergoing
revascularization for left main coronary artery disease (LMCAD).
 METHOD(S): In Evaluation of XIENCE Versus Coronary Artery Bypass
Surgery for Effectiveness of Left Main Revascularization (EXCEL), 1905
patients with LMCAD and low or intermediate SYNTAX scores were randomized
to PCI with everolimus-eluting stents versus CABG. The 1895 patients with
baseline WBCc available were grouped in tertiles of WBCc (mean 5.6+/-0.8,
7.5+/-0.5, and 10.1+/-1.6x109/L). RESULT(S): Five-year rates of the
primary endpoint (death, myocardial infarction or stroke) were similar
across increasing WBCc tertiles (21.2, 18.9, and 21.6%; P=0.46).
Individual components of the primary endpoint, Bleeding Academic Research
Consortium (BARC) 3-5 bleeding, stent thrombosis or graft occlusion and
ischemia-driven revascularization were all similar across WBCc tertiles.
By multivariable analysis, WBCc as a continuous variable was not an
independent predictor of adverse events (hazard radio per 1x109/L: 1.02;
95% CI, 0.97-1.08; P=0.43). Results were consistent in the PCI and CABG
arms individually. CONCLUSION(S): There was no association between
baseline WBCc and 30-day or 5-year clinical outcomes after PCI or CABG.
The absence of a clear incremental increase in events with increasing WBCc
in the current analysis indicates that WBCc should not routinely be used
as a prognostic marker or to guide revascularization decisions in patients
with LMCAD. Copyright © 2021 Wolters Kluwer Health, Inc. All
rights reserved.

<71>
Accession Number
631555441
Title
Patient care without borders: A systematic review of medical and surgical
tourism.
Source
Journal of Travel Medicine. 26 (6) (no pagination), 2019. Date of
Publication: 02 Sep 2019.
Author
Foley B.M.; Haglin J.M.; Tanzer J.R.; Eltorai A.E.M.
Institution
(Foley, Haglin) Mayo Clinic Alix School of Medicine, Scottsdale, AZ 85054,
United States
(Tanzer) University of Rhode Island, United States
(Eltorai) Warren Alpert Medical School of Brown University, Providence, RI
02903, United States
Publisher
Oxford University Press
Abstract
Background: Medical tourism (MT) is an increasingly utilized modality for
acquiring medical treatment for patients globally. This review assimilates
the current literature regarding MT, with particular focus on the
applications, ethics and economics. Method(s): A systematic review of
MEDLINE and PubMed Central databases for publications relating to MT from
2005 to 2018 yielded 43 articles for this review. Result(s): Patients
seeking elective bariatric, cosmetic and orthopedic surgery abroad are
motivated by significantly lower costs, all-inclusive vacation packages
and reduced wait times. Complication rates as high as 56% include
infection, poor aesthetic and functional outcome and adverse
cardiovascular events. Cross-border reproductive care has steadily
increased due to less restrictive policies in select countries; however,
the depth of research on outcomes and quality of care is abysmal. Stem
cell therapy promise treatments that are often not well researched and
offer minimal evidence of efficacy, yet patients are drawn to treatment
through anecdotal advertisements and a last sense of hope. Transplant
surgery sought to decrease wait times carries many of the similar
aforementioned risks and may contribute to the practice of organ
trafficking in countries with high rates of poverty. Patients and
countries alike are motivated by a plethora of factors to engage in the MT
industry but may be doing so without accurate knowledge of the quality,
safety or potential for economic gain. Safety is of utmost importance to
prevent surgical complications and the spread of treatment-resistant
bacteria. Conclusion(s): MT is growing in popularity and complexity.
The lack of standardization in its definition and regulation leads to
difficulty in epidemiologic and economic analysis and ethical issues of
informed consent and health equity. The findings of this review may be
used by the stakeholders of MT, including patients and providers, to
enhance informed decision-making and quality of care. Copyright ©
2019 International Society of Travel Medicine 2019. Published by Oxford
University Press. All rights reserved.

<72>
Accession Number
365978765
Title
Meta-analysis: Lowering LDL-C levels using statins reduces major vascular
events regardless of baseline risk.
Source
Annals of Internal Medicine. 157 (8) (pp JC4-JC2), 2012. Date of
Publication: 16 Oct 2012.
Author
Anonymous
Publisher
American College of Physicians

<73>
Accession Number
2006784432
Title
Effect of propofol in cardioplegia solution on biomarkers of myocardial
injury in coronary artery bypass grafting surgery: A randomized
double-blind clinical trial.
Source
Journal of Health and Translational Medicine. 24 (1) (pp 30-36), 2021.
Date of Publication: 2021.
Author
Reza J.; Gholam A.H.; Reza K.; Hojatollah N.; Elham A.; Zahra E.
Institution
(Reza, Gholam, Hojatollah, Elham, Zahra) Anesthesiology and Critical Care
Research Center, Shiraz University of Medical Science, Shiraz, Iran,
Islamic Republic of
(Reza) Health Human Resources Research Center, Department of Health in
Disasters and Emergencies, School of Management and Information Sciences,
Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Faculty of Medicine, University of Malaya
Abstract
Introduction: Coronary artery bypass graft (CABG) surgery with
cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to
the development of myocardial damage and dysfunction. It is assumed that
propofol, a general anesthetic agent, has a protective role against
oxidative stress. The aim of this study was to evaluate the effect of
propofol on myocardial protection when added to cardioplegic solution in
patients undergoing CABG. Method(s): In this prospective and
double-blind RCT study, 120 patients undergoing CABG surgery were randomly
assigned into two equal groups. In one group, we added 1200 microg/min
(ultimate dose 4 microg/ml) propofol to cardioplegic solution and in the
control group, an equal volume of normal saline was added to cardioplegic
solution. Serum levels of CPK-MB and Troponin I were checked at four time
points, including: just after induction (T1) as baseline, after chest
closure (T2), 6 hours after arrival to ICU (T3) and 24 hours after ICU
admission (T4). Result(s): Cardiac enzyme levels had significant
increase over time in both groups (p-value <0.05). It was observed that
the enzyme levels in the propofol group increased less compared with the
control group; however, this difference was not significant. Both groups
were also similar in incidence of post-operative arrhythmia and need for
use of IABP. Conclusion(s): Adding a dose of 1200 microg/min
(ultimate dose 4 microg/mL) propofol to cardioplegia solution does not
have an effect on CPK-MB & troponin I level. Copyright © 2021,
Faculty of Medicine, University of Malaya. All rights reserved.

<74>
Accession Number
2007324947
Title
The spectrum of lupus myocarditis: from asymptomatic forms to cardiogenic
shock.
Source
Heart Failure Reviews. 26 (3) (pp 553-560), 2021. Date of Publication: May
2021.
Author
Guglin M.; Smith C.; Rao R.
Institution
(Guglin, Smith, Rao) Indiana University School of Medicine, Krannert
Institute of Cardiology, 1801 Senate Blvd Suite 2000, Indianapolis, IN
46202, United States
Publisher
Springer
Abstract
Lupus myocarditis is a serious, potentially deadly disease. When it
presents as an acute or fulminant myocarditis in a patient without an
established diagnosis of lupus, lupus as an etiology of the condition is
not commonly suspected. Meanwhile, it has a distinct treatment which may
be lifesaving. Review of the literature can shed more light as current
management is mostly based on clinical experience and case reports rather
than randomized control trials. In this review we are discussing this
diagnostic entity, focusing on cardiogenic shock as a manifestation of
lupus myocarditis, and discussing management including aggressive
immunosuppression, mechanical circulatory support, and cardiac
transplantation. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<75>
Accession Number
2010364402
Title
Secondary Prevention Medications Post Coronary Artery Bypass Grafting
Surgery-A Literature Review.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 26 (4) (pp
310-320), 2021. Date of Publication: July 2021.
Author
Dimitriadis S.; Qian E.; Irvine A.; Harky A.
Institution
(Dimitriadis, Qian, Irvine) Medical Sciences Division, University of
Oxford, Oxford, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Secondary prevention after coronary artery bypass graft (CABG) surgery is
imperative in slowing the progression of atherosclerosis in both native
and grafted vessels. Aspirin and statins remain the key medications for
all patients without significant contraindications. The evidence for dual
antiplatelet therapy with clopidogrel is less convincing, but there is
hope for newer antiplatelet agents, such as ticagrelor. Meanwhile,
beta-blockers and angiotensin converting enzyme inhibitors might only
offer benefits to specific sub-groups. Post-CABG patients appear to have
different medication needs to the general cardiovascular patient and
respond differently. In this review, we cover the drug regimens proposed
by recent guidelines and the evidence behind their use. Assessing the
evidence behind these recommendations, we find that there is an unmet need
in some areas for robust population-specific evidence. We hope that future
research will address this gap. Copyright © The Author(s) 2021.

<76>
Accession Number
2011851787
Title
Highly sensitive serum cardiac troponin T and cardiovascular events in
patients with systemic lupus erythematosus (TROPOPLUS study).
Source
Rheumatology (United Kingdom). 60 (3) (pp 1210-1215), 2021. Date of
Publication: 01 Mar 2021.
Author
Chezel J.; Costedoat-Chalumeau N.; Laouenan C.; Rouzaud D.;
Chenevier-Gobeaux C.; Le Guern V.; Mathian A.; Belhadi D.; De Almeida
Chaves S.; Duhaut P.; Fain O.; Galicier L.; Ghillani-Dalbin P.; Kahn J.E.;
Morel N.; Perard L.; Pha M.; Saidoune F.; Sarrot-Reynauld F.; Aumaitre O.;
Chasset F.; Limal N.; Desmurs-Clavel H.; Ackermann F.; Amoura Z.; Papo T.;
Sacre K.
Institution
(Chezel, Rouzaud, Saidoune, Papo, Sacre) Departement de Medecine Interne,
Hopital Bichat, Assistance Publique Hopitaux de Paris (APHP), Institut
national de la sante et de la recherche medicale (INSERM), U1149,
Universite de Paris, 46 Rue Henri Huchard, Paris 75018, France
(Costedoat-Chalumeau, Le Guern, Morel) Departement de Medecine Interne,
Hopital Cochin, Centre de Reference Maladies Auto-immunes et Systemiques
Rares, APHP, Universite de Paris, CRESS, INSERM, INRA, France
(Laouenan, Belhadi) Departement d'Epidemiologie et de Recherche Clinique,
Hopital Bichat, France
(Chenevier-Gobeaux) Service de Diagnostic Biologique Automatise,
Departement medico-universitaire BioPhyGen, Hopital Cochin, APHP,
Universite de Paris, Paris, France
(Mathian, Pha, Amoura) Departement de Medecine Interne 2, French National
Referral Center for Systemic Lupus Erythematosus, Antiphospholipid
Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier
Pitie-Salpetriere, APHP, Sorbonne Universite, Paris, France
(De Almeida Chaves) Departement de Medecine Interne, Hopital Purpan,
Centre Hospitalo-Universitaire (CHU) de Toulouse, Toulouse, France
(Duhaut) Departement de Medecine Interne, Hopital Amiens Nord, CHU
d'Amiens, Amiens, France
(Fain) Departement de Medecine Interne, Hopital Saint Antoine, APHP,
Universite Pierre et Marie Curie, Paris, France
(Galicier) Departement d'Immunologie Clinique, Hopital Saint Louis, APHP,
Universite de Paris, Paris, France
(Ghillani-Dalbin) Departement de Immunologie, Hopital Pitie-Salpetriere,
APHP, Universite Pierre et Marie Curie, Paris, France
(Kahn) Departement de Medecine Interne, Hopital Ambroise Pare, APHP,
Universite de Versailles-Saint-Quentin en Yvelines, Versailles, France
(Perard) Departement de Medecine Interne, Hopital St Joseph St Luc, Lyon,
France
(Sarrot-Reynauld) Departement de medecine interne, Hopital Michallon, CHU
de Grenoble Alpes, Grenoble, France
(Aumaitre) Departement de medecine interne, Hopital Gabriel-Montpied, CHU
de Clermont-Ferrand, Clermont-Ferrand, France
(Chasset) Departement de medecine interne, Hopital Tenon, APHP Universite
Pierre et Marie Curie, Paris, France
(Limal) Departement de medecine interne, Hopital Henri Mondor, APHP
Universite Paris-Est Creteil, Paris, France
(Desmurs-Clavel) Departement de medecine interne, Hopital Edouard Herriot,
Hospices Civils de Lyon, Lyon, France
(Ackermann) Departement de medecine interne, Hopital Foch, Suresnes,
France
Publisher
Oxford University Press
Abstract
Objective: Identification of biological markers able to better stratify
cardiovascular risks in SLE patients is needed. We aimed to determine
whether serum cardiac troponin T (cTnT) levels measured with a highly
sensitive assay [high sensitivity cTnT (HS-cTnT)] may predict
cardiovascular events (CVEs) in SLE. Method(s): All SLE patients
included between 2007 and 2010 in the randomized, double-blind,
placebo-controlled, multicentre PLUS trial were screened. Patients with no
past history of CVE at inclusion and a follow-up period of >20 months were
analysed. HS-cTnT concentration was measured using the
electrochemiluminescence method on serum collected at PLUS inclusion. The
primary outcome was the incident CVE. Factors associated with the primary
outcome were identified and multivariate analysis was performed.
 Result(s): Overall, 442 SLE patients (of the 573 included in the PLUS
study) were analysed for the primary outcome with a median follow up of
110 (interquartile range: 99-120) months. Among them, 29 (6.6%)
experienced at least one CVE that occurred at a median of 67
(interquartile range: 31-91) months after inclusion. Six out of 29
patients had more than one CVE. In the multivariate analysis,
dyslipidaemia, age and HS-cTnT were associated with the occurrence of CVE.
Kaplan-Meier analysis showed that a concentration of HS-cTnT > 4.27 ng/l
at inclusion increased by 2.7 [hazard ratio 2.7 (95% CI: 1.3, 5.6), P
=0.0083] the risk of CVE in SLE. Conclusion(s): HS-cTnT measured in
serum is the first identified biomarker independently associated with
incident CVE in SLE patients. Copyright © 2020 The Author(s).
Published by Oxford University Press on behalf of the British Society for
Rheumatology. All rights reserved.

<77>
Accession Number
2011565949
Title
Efficacy and safety of percutaneous mitral balloon valvotomy in patients
with mitral stenosis: A systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 33 (no pagination), 2021. Article Number:
100765. Date of Publication: April 2021.
Author
Abu Rmilah A.A.; Tahboub M.A.; Alkurashi A.K.; Jaber S.A.; Yagmour A.H.;
Al-Souri D.; Lewis B.R.; Nkomo V.T.; Erwin P.J.; Reeder G.S.
Institution
(Abu Rmilah, Tahboub) William J. von Liebig Center for Transplantation and
Clinical, Regeneration Mayo Clinic, Rochester, MN, United States
(Abu Rmilah, Alkurashi, Nkomo, Reeder) Department of Cardiovascular
Medicine, Mayo Clinic, Rochester, MN, United States
(Jaber) Department of Internal Medicine, Al Hamadi Hospital, Riyadh, Saudi
Arabia
(Yagmour) Al Quds University School of Medicine, Palestine
(Al-Souri) Department of Internal Medicine, Med Star Washington Hospital
Center, Washington DC, United States
(Lewis) Department of Biomedical Statistics and Informatics, Mayo Clinic,
Rochester, MN, United States
(Erwin) Department of Library Services, Mayo Clinic, Rochester, MN, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Aims: Percutaneous mitral balloon valvotomy PMBV is an acceptable
alternative to Mitral valve surgery for patients with mitral stenosis. The
purpose of this study was to explore the immediate results of PMBV with
respect to echocardiographic changes, outcomes, and complications, using a
meta-analysis approach. Method(s): MEDLINE, and EMBASE databases were
searched (01/2012 to 10/2018) for original research articles regarding the
efficacy and safety of PMBV. Two reviewers independently screened
references for inclusion and abstracted data including article details and
echocardiographic parameters before and 24-72 h after PMBV, follow-up
duration, and acute complications. Disagreements were resolved by third
adjudicator. Quality of all included studies was evaluated using the
Newcastle-Ottawa Scale NOS. Result(s): 44/990 references met the
inclusion criteria representing 6537 patients. Our findings suggest that
PMBV leads to a significant increase in MVA (MD = 0.81 cm2;
0.76-0.87, p < 0.00001), LVEDP (MD = 1.89 mmHg; 0.52-3.26, p = 0.007),
LVEDV EDV (MD = 5.81 ml; 2.65-8.97, p = 0.0003) and decrease in MPG (MD =
-7.96 mmHg; -8.73 to -7.20, p < 0.00001), LAP (MD = -10.09 mmHg; -11.06 to
-9.12, p < 0.00001), and SPAP (MD = -15.55 mmHg; -17.92 to -13.18, p <
0.00001). On short term basis, the pooled overall incidence estimates of
repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV
stroke, and systemic thromboembolism were 0.5%, 2%, 1.4%, 0.4%, and 0.7%%
respectively. On long term basis, the pooled overall incidence estimates
of repeat PMBV, mitral valve surgery, post-PMBV severe MR, and post-PMBV
stroke, systemic thromboembolism were 5%, 11.5%, 5.5%, 2.7%, and 1.7%
respectively Conclusion(s): PMBV represents a successful approach for
patients with mitral stenosis as evidenced by improvement in
echocardiographic parameters and low rate of complications. Copyright
© 2021

<78>
Accession Number
2011510249
Title
Virtual reality vs. Kalinox for management of pain in intensive care unit
after cardiac surgery: a randomized study.
Source
Annals of Intensive Care. 11 (1) (no pagination), 2021. Article Number:
74. Date of Publication: December 2021.
Author
Laghlam D.; Naudin C.; Coroyer L.; Aidan V.; Malvy J.; Rahoual G.;
Estagnasie P.; Squara P.
Institution
(Laghlam, Coroyer, Aidan, Malvy, Rahoual, Estagnasie, Squara) Department
of Cardiology and Critical Care, CERIC, Clinique Ambroise Pare, 27
boulevard Victor Hugo, Neuilly-sur-Seine 92200, France
(Naudin) Department of Clinical Research, Clinique Ambroise Pare, 27
boulevard Victor Hugo, Neuilly-sur-Seine 92200, France
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: The management of pain and anxiety remains a challenge in
the intensive care unit. By distracting patients, virtual reality (VR) may
have a role in painful procedures. We compared VR vs. an inhaled equimolar
mixture of N<inf>2</inf>O and O<inf>2</inf> (Kalinox) for pain and anxiety
management during the removal of chest drains after cardiac surgery.
 Method(s): Prospective, non-inferiority, open-label study. Patients
were randomized, for Kalinox or VR session during drain removal. The
analgesia/nociception index (ANI) was monitored during the procedure for
objective assessment of pain and anxiety. The primary endpoint was the
DELTAANI (ANI<inf>min</inf> - ANI<inf>0</inf>) during the procedure, based
on ANIm (average on 4 min). We prespecified VR as non-inferior to Kalinox
with a margin of 3 points. Self-reported pain and anxiety were also
analysed using numeric rate scale (NRS). Result(s): 200 patients were
included, 99 in the VR group and 101 in the Kalinox group; 90 patients
were analysed in both groups in per-protocol analysis. The median age was
68.0 years [60.0-74.8]. The DELTAANI was - 15.1 +/- 12.9 in the Kalinox
group and - 15.7 +/- 11.6 in the VR group (NS). The mean difference was,
therefore, - 0.6 [- 3.6 to 2.4], including the non-inferiority margin of
3. Patients in the VR group had a significantly higher pain NRS scale
immediately after the drain removal, 5.0 [3.0-7.0] vs. 3.0 [2.0-6.0], p =
0.009, but no difference 10 min after. NRS of anxiety did not differ
between the two groups. Conclusion(s): Based on the ANI, the current
study showed that VR did not reach the statistical requirements for a
proven non-inferiority vs. Kalinox in managing pain and anxiety during
chest drain removal. Moreover, VR was less effective based on NRS. More
studies are needed to determine if VR might have a place in the overall
approach to pain and anxiety in intensive care units. Trial registration
NCT, NCT03956264. Registered 20 May 2019,
https://clinicaltrials.gov/ct2/show/NCT03956264. Copyright ©
2021, The Author(s).

<79>
Accession Number
2011264781
Title
Longitudinal assessment of preoperative dexamethasone administration on
cognitive function after cardiac surgery: a 4-year follow-up of a
randomized controlled trial.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 129.
Date of Publication: December 2021.
Author
Glumac S.; Kardum G.; Sodic L.; Bulat C.; Covic I.; Carev M.; Karanovic N.
Institution
(Glumac, Carev, Karanovic) Department of Anesthesiology and Intensive
Care, University Hospital of Split, Spinciceva 1, Split 21000, Croatia
(Kardum) Department of Psychology, Faculty of Humanities and Social
Sciences, University of Split, Split, Croatia
(Sodic) Department of Neurology, University Hospital of Split, Split,
Croatia
(Bulat) Department of Cardiac Surgery, University Hospital of Split,
Split, Croatia
(Covic) School of Medicine, University of Split, Split, Croatia
(Carev, Karanovic) Department of Anesthesiology and Intensive Medicine,
School of Medicine, University of Split, Split, Croatia
Publisher
BioMed Central Ltd
Abstract
Background: The pathogenesis of postoperative cognitive decline (POCD) is
still poorly understood; however, the inflammatory response to surgical
procedures seems likely to be involved. In addition, our recent randomized
controlled trial showed that perioperative corticosteroid treatment may
ameliorate early POCD after cardiac surgery. To assess the long-term
effect of dexamethasone administration on cognitive function, we conducted
a 4-year follow-up. Method(s): The patients were randomized to
receive a single intravenous bolus of 0.1 mg kg- 1
dexamethasone or placebo 10 h before elective cardiac surgery. The
endpoint in both groups was POCD incidence on the 6th day and four years
postoperatively. Result(s): Of the 161 patients analyzed previously,
the current follow-up included 116 patients. Compared to the 62 patients
in the placebo group, the 54 patients in the dexamethasone group showed a
lower incidence of POCD on the 6th day (relative risk (RR), 0.510; 95 %
confidence interval (CI), 0.241 to 1.079; p = 0.067, time interval also
analyzed previously) and four years (RR, 0.459; 95 % CI, 0.192 to 1.100; p
= 0.068) after cardiac surgery. The change in cognitive status between the
two postoperative measurements was not significant (p = 0.010) among the
patients in the dexamethasone group, in contrast to patients in the
placebo group (p = 0.673). Conclusion(s): Although statistical
significance was not reached in the current study, the prophylactic
administration of dexamethasone seems to be useful to prevent POCD
development following cardiac surgery. However, further large multicenter
research is needed to confirm these directions. Trial registration:
ClinicalTrials.gov identifier: NCT02767713 (10/05/2016). Copyright
© 2021, The Author(s).

<80>
Accession Number
2007174470
Title
Safety and Effectiveness of Del Nido Cardioplegia in Comparison to
Blood-Based St. Thomas Cardioplegia in Congenital Heart Surgeries: A
Prospective Randomized Controlled Study.
Source
World Journal for Pediatric and Congenital Heart Surgery. 11 (6) (pp
720-726), 2020. Date of Publication: November 2020.
Author
Haranal M.; Chin H.C.; Sivalingam S.; Raja N.; Mohammad Shaffie M.S.;
Namasiwayam T.K.; Fadleen M.; Fakhri N.
Institution
(Haranal, Chin, Sivalingam) Department of Pediatric Cardiac Surgery,
National Heart Institute, Kuala Lumpur, Malaysia
(Raja, Mohammad Shaffie, Namasiwayam) Department of Cardiac Anesthesia,
National Heart Institute, Kuala Lumpur, Malaysia
(Fadleen) Department of Perfusion Sciences, National Heart Institute,
Kuala Lumpur, Malaysia
(Fakhri) Department of Clinical Research, National Heart Institute, Kuala
Lumpur, Malaysia
Publisher
SAGE Publications Inc.
Abstract
Background: To compare the safety and effectiveness of del Nido
cardioplegia with blood-based St Thomas Hospital (BSTH) cardioplegia in
myocardial protection in congenital heart surgery. Method(s): It is a
prospective, open-labeled, randomized controlled study conducted at
National Heart Institute, Kuala Lumpur from July 2018 to July 2019. All
patients with simple and complex congenital heart diseases (CHD) with good
left ventricular function (left ventricular ejection fraction [LVEF] >50%)
were included while those with LVEF <50% were excluded. A total of 100
patients were randomized into two groups of 50 each receiving either del
Nido or BSTH cardioplegia. Primary end points were the spontaneous return
of activity following aortic cross-clamp release and ventricular function
between two groups. Secondary end point was myocardial injury as assessed
by troponin T levels. Result(s): Cardiopulmonary bypass and aortic
cross-clamp time, return of spontaneous cardiac activity following the
aortic cross-clamp release, the duration of mechanical ventilation, and
intensive care unit stay were comparable between two groups. Statistically
significant difference was seen in the amount and number of cardioplegia
doses delivered (P <.001). The hemodilution was significantly less in the
del Nido complex CHD group compared to BSTH cardioplegia (P =.001) but no
difference in blood usage (P =.36). The myocardial injury was lesser
(lower troponin T release) with del Nido compared to BSTH cardioplegia (P
=.6). Conclusion(s): Our study showed that both del Nido and BSTH
cardioplegia are comparable in terms of myocardial protection. However,
single, less frequent, and lesser volume of del Nido cardioplegia makes it
more suitable for complex repair. Copyright © The Author(s) 2020.

<81>
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.

<82>
Accession Number
2012058387
Title
Surgical Risk Scoring in TAVR: Still Needed? A Metaregression Analysis.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
100875. Date of Publication: 2021.
Author
Baro R.; Cura F.; Belardi J.; Brugaletta S.; Lamelas P.
Institution
(Baro, Cura, Belardi, Lamelas) Instituto Cardiovascular de Buenos Aires,
Buenos Aires, Argentina
(Brugaletta) Clinic Cardiovascular Institute, Hospital Clinic, IDIBAPS,
Barcelona, Spain
(Lamelas) Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada
Publisher
Mosby Inc.
Abstract
Several randomized controlled trials evaluating the effectiveness of
transcatheter aortic valve replacement (TAVR) against surgical aortic
valve replacement have been published to date. The fact that higher risk
populations were implemented first does not necessarily mean that they
benefit more from a TAVR procedure. We performed meta-analysis of the 8
randomized clinical trials performing TAVR for both mortality and stroke
outcomes. Meta-regression was used to evaluate the association between
mean surgical risk using the Society of Thoracic Surgeons (STS) score and
hazard ratio observed in each of the trials. Overall, TAVR was associated
with a significant reduction of both mortality and stroke across the whole
spectrum of patients enrolled, with no evidence of significant
heterogeneity. Metaregression analysis does not suggest a statistically
significant association between STS score and hazard ratio for both
mortality and stroke. This observation suggests reconsidering the use of
risk scores to prioritize TAVR utilization in higher risk patients, while
more focus should be done on patient's life expectancy related to TAVR
durability. Copyright © 2021 Elsevier Inc.

<83>
Accession Number
2011560159
Title
Cardiovascular safety of febuxostat compared to allopurinol for the
treatment of gout: A systematic and meta-analysis.
Source
Clinical Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Gao L.; Wang B.; Pan Y.; Lu Y.; Cheng R.
Institution
(Gao, Wang, Pan, Lu, Cheng) Department of Comprehensive Surgery, General
Hospital of Chinese People's Liberation Army & National Clinical Research
Center for Geriatric Disease, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
The cardiovascular safety of febuxostat compared to allopurinol for the
treatment of gout remains equivocal. Febuxostat had a better safety
outcome compared with allopurinol. In this systematic review and
meta-analysis, we searched MEDLINE and Embase for articles published
between March 1, 2000 and April 4, 2021, without any language
restrictions. We did a systematic review and meta-analysis of included
clinical trials to evaluate the cardiovascular safety of febuxostat
compared to allopurinol for treatment of chronic gout. Two reviewers
independently selected studies, assessed study quality, and extracted
data. Risk ratios were calculated with random effects and were reported
with corresponding 95% confidence intervals (CI). From 240 potentially
relevant citations, 224 papers were excluded; 16 studies were ultimately
included in the analysis. Febuxostat had a better safety outcome compared
with allopurinol,which was the composite of urgent coronary
revascularization (OR: 0.84, 95% CI: 0.77-0.90, p <.0001) and stroke (OR:
0.87, 95% CI: 0.79-0.97, p =.009). However, that difference was not found
in nonfatal myocardial infarction (OR: 0.99, 95% CI: 0.80-1.22, p =.91),
cardiovascular related mortality (OR: 0.98, 95% CI: 0.69-1.38, p =.89) and
all-cause mortality (OR: 0.93, 95% CI: 0.75-1.15, p =.52). No significant
differences in cardiovascular related mortality and all-cause mortality
were observed across any subgroup. This meta-analysis adds new evidence
regarding the cardiovascular safety of febuxostat in patients. Initiation
of febuxostat in patients was not associated with an increased risk of
death or serious cardiovascular related adverse events compared with
allopurinol. Copyright © 2021 The Authors. Clinical Cardiology
published by Wiley Periodicals LLC.

<84>
Accession Number
2011216217
Title
Potential Renoprotective Strategies in Adult Cardiac Surgery: A Survey of
Society of Cardiovascular Anesthesiologists Members to Explore the
Rationale and Beliefs Driving Current Clinical Decision-Making.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2043-2051),
2021. Date of Publication: July 2021.
Author
McIlroy D.R.; Roman B.; Billings F.T.; Bollen B.A.; Fox A.; Geube M.; Liu
H.; Shore-Lesserson L.; Zarbock A.; Shaw A.D.
Institution
(McIlroy, Billings) Vanderbilt University Medical Center, Nashville, TN,
United States
(McIlroy) Monash University, Commercial Road, Melbourne, Victoria,
Australia
(Roman) Ochsner Medical Center, New Orleans, LA, United States
(Bollen) Missoula Anesthesiology and The International Heart Institute of
Montana, Missoula, MT, United States
(Fox) UT Southwestern Medical Center, Dallas, TX, United States
(Geube) Cleveland Clinic, Cleveland, OH, United States
(Liu) University of California Davis Health, Sacramento, CA, United States
(Shore-Lesserson) Zucker School of Medicine at Hofstra Northwell,
Manhasset, NY, United States
(Zarbock) University Hospital Munster, Munster, Germany
(Shaw) University of Alberta, Edmonton, AB, Canada
Publisher
W.B. Saunders
Abstract
Objectives: The authors sought to (1) characterize the rationale
underpinning anesthesiologists' use of various perioperative strategies
hypothesized to affect renal function in adult patients undergoing cardiac
surgery, (2) characterize existing belief about the quality of evidence
addressing the renal impact of these strategies, and (3) identify
potentially renoprotective strategies for which anesthesiologists would
most value a detailed, evidence-based review. Design(s): Survey of
perioperative practice in adult patients undergoing cardiac surgery.
 Setting(s): Online survey. Participant(s): Members of the
Society of Cardiovascular Anesthesiologists (SCA). Intervention(s):
None. Measurements & Main Results: The survey was distributed to more than
2,000 SCA members and completed in whole or in part by 202 respondents.
Selection of target intraoperative blood pressure (and relative
hypotension avoidance) was the strategy most frequently reported to
reflect belief about its potential renal effect (79%; 95% CI: 72-85). Most
respondents believed the evidence supporting an effect on renal injury of
intraoperative target blood pressure during cardiac surgery was of high or
moderate quality. Other factors, including a specific nonrenal rationale,
surgeon preference, department- or institution-level decisions, tradition,
or habit, also frequently were reported to affect decision making across
queried strategies. Potential renoprotective strategies most frequently
requested for inclusion in a subsequent detailed, evidence-based review
were intraoperative target blood pressure and choice of vasopressor agent
to achieve target pressure. Conclusion(s): A large number of
perioperative strategies are believed to variably affect renal injury in
adult patients undergoing cardiac surgery, with wide variation in
perceived quality of evidence for a renal effect of these
strategies. Copyright © 2021 Elsevier Inc.

<85>
Accession Number
2010964702
Title
Lung Injury After Neonatal Congenital Cardiac Surgery Is Mild and
Modifiable by Corticosteroids.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2100-2107),
2021. Date of Publication: July 2021.
Author
Kaskinen A.K.; Keski-Nisula J.; Martelius L.; Moilanen E.; Hamalainen M.;
Rautiainen P.; Andersson S.; Pitkanen-Argillander O.M.
Institution
(Kaskinen) Division of Pediatric Nephrology and Transplantation,
Children's Hospital and Pediatric Research Center, Helsinki University
Hospital and University of Helsinki, Helsinki, Finland
(Keski-Nisula, Rautiainen) Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Hospital and University of
Helsinki, Helsinki, Finland
(Martelius) Department of Radiology, HUS Medical Imaging Center,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Moilanen, Hamalainen) The Immunopharmacology Research Group, Faculty of
Medicine and Health Technology, Tampere University and Tampere University
Hospital, Tampere, Finland
(Andersson) Children's Hospital and Pediatric Research Center, Helsinki
University Hospital and Helsinki University, Helsinki, Finland
(Pitkanen-Argillander) Division of Pediatric Cardiology, Children's
Hospital, Helsinki University Hospital and University of Helsinki,
Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objectives: The present study was performed to determine whether lung
injury manifests as lung edema in neonates after congenital cardiac
surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates
postoperative lung injury in neonates after congenital cardiac surgery.
 Design(s): A supplementary report of a randomized, double-blinded,
placebo-controlled clinical trial. Setting(s): A pediatric tertiary
university hospital. Participant(s): Forty neonates (age <=28 days)
undergoing congenital cardiac surgery with cardiopulmonary bypass.
 Intervention(s): After anesthesia induction, patients were assigned
randomly to receive intravenously either 2 mg/kg methylprednisolone or
placebo b, which was followed by hydrocortisone or placebo bolus six hours
after weaning from CPB for five days as follows: 0.2 mg/kg/h for 48 hours,
0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24
hours. Measurements and Main Results: The chest radiography lung
edema score was lower in the SDC than in the placebo group on the first
postoperative day (POD one) (p = 0.03) and on PODs two and three (p =
0.03). Furthermore, a modest increase in the edema score of 0.9 was noted
in the placebo group, whereas the edema score remained at the preoperative
level in the SDC group. Postoperative dynamic respiratory system
compliance was higher in the SDC group until POD three (p < 0.01).
However, postoperative oxygenation; length of mechanical ventilation; and
tracheal aspirate biomarkers of inflammation and oxidative stress, namely
interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no
differences between the groups. Conclusion(s): The SDC regimen
reduced the development of mild and likely clinically insignificant
radiographic lung edema and improved postoperative dynamic respiratory
system compliance without adverse events, but it failed to improve
postoperative oxygenation and length of mechanical
ventilation. Copyright © 2021 The Authors

<86>
Accession Number
2010583880
Title
Paravalvular Regurgitation According to Transcatheter Aortic Valve
Prosthesis Type: Insights From the Randomized SOLVE-TAVI Trial.
Source
JACC: Cardiovascular Imaging. 14 (6) (pp 1277-1279), 2021. Date of
Publication: June 2021.
Author
Stachel G.; Abdel-Wahab M.; de Waha-Thiele S.; Desch S.; Feistritzer
H.-J.; Kitamura M.; Eitel I.; Kurz T.; Thiele H.
Publisher
Elsevier Inc.

<87>
Accession Number
2008417122
Title
Combined Use of Rotational Thromboelastometry (Rotem) and Platelet
Impedance Aggregometry (Multiplate Analyzer) in Cyanotic and Acyanotic
Infants and Children Undergoing Cardiac Surgery With Cardiopulmonary
Bypass: Subgroup Analysis of a Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2115-2123),
2021. Date of Publication: July 2021.
Author
Dieu A.; Van Regemorter V.; Detaille T.; Houtekie L.; Eeckhoudt S.;
Khalifa C.; Kahn D.; Clement De Clety S.; Poncelet A.; Momeni M.
Institution
(Dieu, Van Regemorter, Khalifa, Kahn, Momeni) Department of
Anesthesiology, Cliniques Universitaires Saint Luc, Universite Catholique
de Louvain, Brussels, Belgium
(Detaille, Houtekie, Clement De Clety) Department of Pediatric Intensive
Care Unit, Cliniques Universitaires Saint Luc, Universite Catholique de
Louvain, Brussels, Belgium
(Eeckhoudt) Department of Hematology, Laboratoires des Hopitaux
Universitaires de Bruxelles, Universite Libre de Bruxelles, Brussels,
Belgium
(Poncelet) Department of Cardiac Surgery, Cliniques Universitaires Saint
Luc, Universite Catholique de Louvain, Brussels, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: Few studies have investigated the Multiplate platelet function
analyzer in pediatrics. The authors evaluated Multiplate combined with
Rotem in terms of guiding platelet transfusion after pediatric cardiac
surgery with cardiopulmonary bypass (CPB). The authors further compared
coagulation parameters between cyanotic and acyanotic patients.
 Design(s): Subgroup analysis of a randomized clinical trial.
 Setting(s): Tertiary hospital. Participant(s): Patients weighing
between seven and 15 kg. Intervention(s): None. Measurements and
Main Results: Rotem and Multiplate tests were performed (1) after
anesthesia induction, (2) upon CPB separation, and (3) upon intensive care
unit arrival. Among a total of 59 subjects, 9 patients required platelet
transfusion. In multivariate linear regression, analysis EXTEM maximum
clot firmness upon CPB separation was associated with the volume of
transfused platelets (regression coefficient = -0.348 [95% confidence
interval -1.006 to -0.028]; p = 0.039). No such association was found for
the Multiplate test. Acyanotic and cyanotic heart disease were present in
32 and 27 children, respectively. There were no significant differences
between these two groups in terms of platelet count and function.
Postoperative blood loss was significantly higher in the cyanotic group
compared with the acyanotic arm (p = 0.015; difference [95% confidence
interval -2.40 {-4.20 to -0.60}]). There were no differences between
groups regarding transfusion of allogeneic blood products.
 Conclusion(s): This study showed that Rotem, but not Multiplate
results, were associated with platelet transfusion in pediatric cardiac
surgery with no intake of platelet inhibitors. The usefulness of combining
these tests in platelet transfusion decision-making needs to be evaluated
in larger populations. Copyright © 2020 Elsevier Inc.

<88>
Accession Number
2007957209
Title
Is preoperative balloon aortic valvuloplasty of interest for severe aortic
stenosis in hip fracture surgery?.
Source
Injury. 52 (6) (pp 1438-1444), 2021. Date of Publication: June 2021.
Author
Ferre F.; Viarnes M.; Martin C.; Bosch L.; Bouisset F.; Lhermusier T.;
Reina N.; Lairez O.; Minville V.
Institution
(Ferre, Viarnes, Martin, Bosch, Minville) Centre Hospitalier Universitaire
de Toulouse Purpan, Place du Dr Baylac, TSA 40 031, Toulouse 31059, France
(Bouisset, Lhermusier, Lairez) Cardiologie, pole cardiovasculaire et
metabolique, CHU Rangueil, Toulouse, France
(Reina) Departement de chirurgie Orthopedique et Traumatologique, Hopital
Pierre-Paul Riquet, CHU Purpan, Toulouse, France
Publisher
Elsevier Ltd
Abstract
Purpose: In elderly patients, the discovery and management of a severe
aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent
and controversial issue. The objective of this study was to evaluate
preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip
fracture surgery. Method(s): We conducted an observational,
monocentric, retrospective study from 2011 to 2018. Survival (30-day,
90-day and 180-day mortality) and the occurrence of perioperative
complications were analyzed and compared between control (i.e. no BAV
prior to surgery) and preoperative BAV groups in patients with hip
fracture surgery and a formal transthoracic echocardiographic diagnosis of
severe AS (aortic valve area < 1 cm2). Patients' allocation to the
intervention and control groups was after a discussion between
cardiologist, anesthesiologist and the surgeon. Result(s): Among the
8506 patients who underwent hip fracture surgery, 29 patients in the
control group and 30 patients in the BAV group were finally included.
Kaplan-Meier survival analysis demonstrated a significant decrease in
mortality in the BAV group (p=0.014) despite an increase in median time to
operation of about 48 hours (p<0.0001). Multivariate analysis (stepwise
logistic regression) showed that postoperative delirium (OR [95%CI]: 17.5
[1.8-168]; p=0.013) and postoperative acute congestive heart failure (OR
[95%CI]: 59.4 [5.0-711.1]; p=0.0013) were predictive factors of 30-day
mortality with an area under ROC curve of 0.90 (95%CI: 0.80-0.97;
p<0.0001). Conclusion(s): preoperative BAV for severe AS could reduce
the mortality of hip fracture patients despite an increase in time to
operation. This improved survival could be linked to the decrease in
cardiologic and neurologic adverse events. A larger prospective randomized
study is necessary before generalizing our results. Copyright ©
2020

<89>
[Use Link to view the full text]
Accession Number
632428581
Title
Effects of Different Doses of Remote Ischemic Preconditioning on Kidney
Damage Among Patients Undergoing Cardiac Surgery: A Single-Center
Mechanistic Randomized Controlled Trial.
Source
Critical care medicine. 48 (8) (pp e690-e697), 2020. Date of Publication:
01 Aug 2020.
Author
Meersch M.; Kullmar M.; Pavenstadt H.; Rossaint J.; Kellum J.A.; Martens
S.; Klausmeyer P.; Schmidt E.A.; Kerschke L.; Zarbock A.
Institution
(Meersch, Kullmar, Rossaint, Klausmeyer, Schmidt, Zarbock) Department of
Anaesthesiology, Intensive Care Medicine and Pain Medicine, University
Hospital Munster, Munster, Germany
(Pavenstadt) Department of Medicine, Division D, Nephrology, University
Hospital Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, United States
(Martens) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Kerschke) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We have previously shown that remote ischemic preconditioning
reduces acute kidney injury (acute kidney injury) in high-risk patients
undergoing cardiopulmonary bypass and that the protective effect is
confined to patients who exhibit an increased urinary tissue inhibitor of
metalloproteinases-2 and insulin-like growth factor-binding protein 7 in
response to remote ischemic preconditioning. The purpose of this study was
to determine the optimal intensity of remote ischemic preconditioning to
induce required [tissue inhibitor of metalloproteinases-2]*[insulin-like
growth factor-binding protein 7] changes and further explore mechanisms of
remote ischemic preconditioning. DESIGN: Observational and randomized
controlled, double-blind clinical trial. SETTING: University Hospital of
Muenster, Germany. PATIENTS: High-risk patients undergoing cardiac surgery
as defined by the Cleveland Clinic Foundation Score. INTERVENTIONS: In the
interventional part, patients were randomized to receive either one of
four different remote ischemic preconditioning doses (3x5min, 3x7min,
3x10min remote ischemic preconditioning, or 3x5min remote ischemic
preconditioning + 2x10min remote ischemic preconditioning in
nonresponders) or sham-remote ischemic preconditioning (control).
MEASUREMENTS AND MAIN RESULTS: The primary endpoint of the interventional
part was change in urinary [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7]
between pre- and postintervention. To examine secondary objectives
including acute kidney injury incidence, we included an observational
cohort. A total of 180 patients were included in the trial (n = 80
observational and n = 100 randomized controlled part [20 patients/group]).
The mean age was 69.3 years (10.5 yr), 119 were men (66.1%). Absolute
changes in [tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] were significantly higher in all remote ischemic
preconditioning groups when compared with controls (p < 0.01). Although we
did not observe a dose-response relationship on absolute changes in
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] across the four different remote ischemic
preconditioning groups, in the 15 patients failing to respond to the
lowest dose, nine (60%) responded to a subsequent treatment at a higher
intensity. Compared with controls, fewer patients receiving remote
ischemic preconditioning developed acute kidney injury within 72 hours
after surgery as defined by both Kidney Disease: Improving Global Outcomes
criteria (30/80 [37.5%] vs 61/100 [61.0%]; p = 0.003). CONCLUSION(S):
All doses of remote ischemic preconditioning significantly increased
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] and significantly decreased acute kidney injury
compared with controls. High-dose remote ischemic preconditioning could
stimulate [tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] increases in patients refractory to low-dose
remote ischemic preconditioning.

<90>
Accession Number
2012198011
Title
The relationship between preoperative serum vitamin D deficiency and
postoperative atrial fibrillation: A systematic review and metaanalysis.
Source
Journal of Cardiovascular and Thoracic Research. 13 (2) (pp 102-108),
2021. Date of Publication: May 2021.
Author
Rahimi M.; Taban-Sadeghi M.; Nikniaz L.; Pashazadeh F.
Institution
(Rahimi) Student Research Committee, Cardiovascular Research Center,
Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Rahimi, Taban-Sadeghi) Cardiovascular Research Center, Tabriz University
of Medical Sciences, Tabriz, Iran, Islamic Republic of
(Nikniaz) Tabriz Health Services Management Research Center, Health
Management and Safety Promotion Research Institute, Tabriz University of
Medical Sciences, Tabriz, Iran, Islamic Republic of
(Pashazadeh) Research Center for Evidence-based Medicine, Iranian EBM
Centre: A Joanna Briggs Institute (JBI) Centre of Excellence, Faculty of
Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Publisher
Tabriz University of Medical Sciences
Abstract
Postoperative atrial fibrillation (POAF) is the most common arrhythmia
seen in the first days following cardiac surgeries. Recently, there is a
growing discussion regarding the link between vitamin D deficiency and
POAF development. This systematic review and meta-analysis of the
observational studies aimed at evaluating the association between
preoperative vitamin D deficiency and Postoperative atrial fibrillation.
In this study, using PubMed, Scopus, Google Scholar, EMBASE, Web of
Science, and Cochrane Libraries, we searched for records published before
July 2020. Two reviewers screened for studies that examined the
relationship between preoperative vitamin D levels and the generation of
POAF. Data regarding study design, patient characteristics, definition of
atrial fibrillation (AF), type of surgery, vitamin D levels, and
measurement methods were extracted. Five studies were included in the
meta-analysis. Our primary analysis showed a significant relationship
between preoperative levels of vitamin D and POAF development (mean
differences (MD) = -2.851, 95% confidence interval (CI) =-5.506 to -0.195;
P value = 0.035). Our meta-analysis suggested serum vitamin D deficiency
is associated with an increased risk of POAF development. Further large
scale interventional studies are needed to explore whether vitamin D
supplementation will prevent POAF. Copyright © 2021 The
Author(s).

<91>
Accession Number
2012180036
Title
Survival of patients with acute pulmonary embolism treated with
venoarterial extracorporeal membrane oxygenation: A systematic review and
meta-analysis.
Source
Journal of Critical Care. 64 (pp 245-254), 2021. Date of Publication:
August 2021.
Author
Karami M.; Mandigers L.; Miranda D.D.R.; Rietdijk W.J.R.; Binnekade J.M.;
Knijn D.C.M.; Lagrand W.K.; den Uil C.A.; Henriques J.P.S.; Vlaar A.P.J.
Institution
(Karami, Henriques) Heart Center, Department of Cardiology, Amsterdam
Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Mandigers, Miranda, Rietdijk, den Uil) Department of Intensive Care
Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
(Binnekade, Knijn, Lagrand, Vlaar) Department of Intensive Care Medicine,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(den Uil) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Background: To examine whether venoarterial extracorporeal membrane
oxygenation (VA-ECMO) improves survival of patients with acute pulmonary
embolism (PE). Method(s): Following the PRISMA guidelines, a
systematic search was conducted up to August 2019 of the databases:
PubMed/MEDLINE, EMBASE and Cochrane. All studies reporting the survival of
adult patients with acute PE treated with VA-ECMO and including four
patients or more were included. Exclusion criteria were: correspondences,
reviews and studies in absence of a full text, written in other languages
than English or Dutch, or dating before 1980. Short-term (hospital or
30-day) survival data were pooled and presented with relative risks (RR)
and 95% confidence intervals (95% CI). Also, the following pre-defined
factors were evaluated for their association with survival in VA-ECMO
treated patients: age > 60 years, male sex, pre-ECMO cardiac arrest,
surgical embolectomy, catheter directed therapy, systemic thrombolysis,
and VA-ECMO as single therapy. Result(s): A total of 29 observational
studies were included (N = 1947 patients: VA-ECMO N = 1138 and control N =
809). There was no difference in short-term survival between VA-ECMO
treated patients and control patients (RR 0.91, 95% CI 0.71-1.16). In
acute PE patients undergoing VA-ECMO, age > 60 years was associated with
lower survival (RR 0.72, 95% CI 0.52-0.99), surgical embolectomy was
associated with higher survival (RR 1.96, 95% CI 1.39-2.76) and pre-ECMO
cardiac arrest showed a trend toward lower survival (RR 0.88, 95% CI
0.77-1.01). The other evaluated factors were not associated with a
difference in survival. Conclusion(s): At present, there is
insufficient evidence that VA-ECMO treatment improves short-term survival
of acute PE patients. Low quality evidence suggest that VA-ECMO patients
aged <=60 years or who received SE have higher survival rates. Considering
the limited evidence derived from the present data, this study emphasizes
the need for prospective studies. Protocol Registration: PROSPERO
CRD42019120370. Copyright © 2021 The Authors

<92>
Accession Number
2012221939
Title
Reduction in acute kidney injury post cardiac surgery using balanced
forced diuresis: A randomized, controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 59 (3) (pp 562-569), 2021.
Date of Publication: 01 Mar 2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Cardiothoracic Surgeon, American Hospital, Dubai, United Arab
Emirates
(Giri) Cardiothoracic Anaesthesiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Wrigley) Interventional Cardiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Specialist Registrar Cardiothoracic Surgery, Heart
and Lung Centre, Wolverhampton, United Kingdom
(Sharman) Research and Development Department, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Beare) Senior Clinical Perfusionist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nevill) Statistics, Faculty of Education, Health and Wellbeing,
University of Wolverhampton, Wolverhampton, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Our goal was to investigate the efficacy of balanced forced
diuresis in reducing the rate of acute kidney injury (AKI) in cardiac
surgical patients requiring cardiopulmonary bypass (CPB), using the
RenalGuard (RG) system. METHOD(S): Patients at risk of developing AKI
(history of diabetes and/or anaemia; estimated glomerular filtration rate
20-60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5)
were randomized to the RG system group (n = 110) or managed according to
current practice (control = 110). The primary end point was the
development of AKI within the first 3 postoperative days as defined by the
RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal
disease) criteria. RESULT(S): There were no significant differences
in preoperative and intraoperative characteristics between the 2 groups.
Postoperative AKI rates were significantly lower in the RG system group
compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025].
This effect persisted even after controlling for a number of potential
confounders (odds ratio 2.82, 95% confidence interval 1.20-6.60; P =
0.017) when assessed by binary logistic regression analysis. The mean
volumes of urine produced during surgery and within the first 24 h
postoperatively were significantly higher in the RG system group (P <
0.001). There were no significant differences in the incidence of blood
transfusions, atrial fibrillation and infections and in the median
duration of intensive care unit stays between the groups. The number
needed to treat with the RG system to prevent AKI was 9 patients (95%
confidence interval 6.0-19.2). CONCLUSION(S): In patients at risk for
AKI who had cardiac surgery with CPB, the RS RG system significantly
reduced the incidence of AKI and can be used safely and reproducibly.
Larger studies are required to confirm cost benefits. Clinical trial
registration number: NCT02974946. Copyright © 2020 The Author(s)
2020. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery.

<93>
Accession Number
2012216147
Title
Meta-Analysis of Duration of Dual Antiplatelet Therapy in Acute Coronary
Syndrome Treated With Coronary Stenting.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Knijnik L.; Fernandes M.; Rivera M.; Cardoso R.; Goyal A.; Liberman H.;
Sperling L.S.; McDaniel M.C.
Institution
(Knijnik) Division of Medicine, University of Miami, Miami, FL, United
States
(Fernandes, Goyal, Liberman, Sperling, McDaniel) Division of Cardiology,
Emory University, Atlanta, Georgia, United States
(Rivera) Division of Cardiology, Washington University-Saint Louis, St.
Louis, MO, United States
(Cardoso) Division of Cardiology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
We aimed to evaluate if a shorter course of DAPT followed by P2Y12
inhibitor monotherapy is as effective as a 12-month course with fewer
bleeding events. PubMed, Scopus, and Cochrane Central were searched for
randomized controlled trials of ACS patients comparing dual antiplatelet
therapy (DAPT) for 1 to 3 months followed by a P2Y12 inhibitor to 12-month
DAPT. Quality assessment was performed with the Cochrane Collaboration
risk of bias assessment tool. Five randomized clinical trials were
included, with a total of 18,046 participants. Antiplatelet strategies
were aspirin and P2Y12 inhibitor for 12 months compared with aspirin and
P2Y12 inhibitor for 1 to 3 months followed by P212 inhibitor alone.
Patients randomized to 1 to 3 months of DAPT followed by P2Y12 inhibitor
monotherapy had lower rates of major bleeding (1.42% vs 2.53%; OR 0.53;
95% CI 0.42-0.67; p < 0.001; I2 = 0%) and all-cause mortality
(1.00% vs 1.42%; OR 0.71; 95% CI 0.53-0.95; p = 0.02; I2=0%)
with similar major adverse cardiac events (MACE) (2.66% vs 3.11%; OR 0.86;
95% CI 0.71 - 1.03; p = 0.10; I2 = 0 %) compared to 12 months
of DAPT. In conclusion, shorter course of DAPT for 1 to 3 months followed
by P2Y12 inhibitor monotherapy reduces major bleeding and all course
mortality without increasing major adverse cardiac events compared with
traditional DAPT for 12 months. Copyright © 2021 Elsevier Inc.

<94>
Accession Number
635106864
Title
Fungal Infection in Burn Patents: A Review of 36 Case Reports.
Source
Annals of plastic surgery. 86 (4S Suppl 4) (pp S463-S467), 2021. Date of
Publication: 01 Jun 2021.
Author
Tu Y.; Lineaweaver W.C.; Breland A.; Zhang F.
Institution
(Lineaweaver, Breland, Zhang) Joseph M. Still Burn and Reconstruction
Center, MS, Jackson, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aims of this study were to review recent fungal infection
case reports published, evaluate the treatment regimens and clinical
outcomes, and provide recommendations for future management.
 METHOD(S): A review of case reports published over the last decade
was conducted. PubMed was searched to collect the relevant citations using
a combination of the key words ("burn," "burned," "burns," "fungal,"
"fungi," and "fungus") in title or abstract. Case series, reviews,
guidelines, and experimental and non-English studies were excluded.
Statistical analyses were performed using Microsoft Excel 2019.
 RESULT(S): A total of 36 case reports encompassing a total of 44 burn
patients with fungal infection were included in the final analysis.
Ablative surgeries, including surgical excision, debridement, skin graft,
vitrectomy, teeth extraction, valve replacement, or amputation, were
performed in 38 cases after the suspicion or identification of fungal
infection. Twenty-nine of them were eventually discharged, yielding a
survival rate of 76.3%. In the remaining 6 cases, ablative surgery was not
mentioned and 3 of them eventually died, yielding a survival rate of 50%.
The total mortality was 27.27%. Among the 12 death cases, 1 was infected
with Candida albicans, 1 with non-albicans Candida, 2 with Aspergillus
spp, 2 with Fusarium spp, 4 with Zygomycetes, and 2 with other fungal
species. CONCLUSION(S): The overall mortality of fungal wound
infection is still high in burn patients around the world, especially
those infected with non-Candida species. Early diagnosis of fungal
infection, early initiation of appropriate antifungal therapy, and
effective surgical intervention are key measures to improve the treatment
effect and reduce the mortality of fungal infection in burn
patients. Copyright © 2021 Wolters Kluwer Health, Inc. All rights
reserved.

<95>
[Use Link to view the full text]
Accession Number
635121840
Title
Application of 3D printing technology combined with PBL teaching model in
teaching clinical nursing in congenital heart surgery: A case-control
study.
Source
Medicine. 100 (20) (pp e25918), 2021. Date of Publication: 21 May 2021.
Author
Tan H.; Huang E.; Deng X.; Ouyang S.
Institution
(Tan, Huang, Ouyang) Department of Cardiovascular Surgery, The Second
Xiangya Hospital of Central South University, Changsha 410000, Hunan
Province, China; Clinical Nursing Teaching and Research Section, The
Second Xiangya Hospital, Central South University
(Deng) Heart Center, Hunan Children's Hospital, Changsha, China
Publisher
NLM (Medline)
Abstract
ABSTRACT: We aimed to explore the application of three-dimensional (3D)
printing technology with problem-based learning (PBL) teaching model in
clinical nursing education of congenital heart surgery, and to further
improve the teaching quality of clinical nursing in congenital heart
surgery. In this study, a total of 132 trainees of clinical nursing in
congenital heart surgery from a grade-A tertiary hospital in 2019 were
selected and randomly divided into 3D printing group or traditional group.
The 3D printing group was taught with 3D printed heart models combined
with PBL teaching technique, while the traditional group used conventional
teaching aids combined with PBL technique for teaching. After the teaching
process, the 2 groups of nursing students were assessed and surveyed
separately to evaluate the results. Compared to the traditional group, the
theoretical scores, clinical nursing thinking ability, self-evaluation for
comprehensive ability, and teaching satisfaction from the questionnaires
filled by the 3D printing group were all higher than the traditional
group. The difference was found to be statistically significant (P < .05).
Our study has shown the 3D printing technology combined with the PBL
teaching technique in the clinical nursing teaching of congenital heart
surgery achieved good results. Copyright © 2021 the Author(s).
Published by Wolters Kluwer Health, Inc.

<96>
Accession Number
2012048877
Title
Evolution of technology in replacement of heart valves: Transcatheter
aortic valves, a revolution for management of valvular heart diseases.
Source
Health Policy and Technology. 10 (2) (no pagination), 2021. Article
Number: 100512. Date of Publication: June 2021.
Author
Coccia M.
Institution
(Coccia) CNR - National Research Council of Italy, Collegio Carlo Alberto,
Via Real Collegio, Moncalieri, Torino 30-10024, Italy
Publisher
Elsevier B.V.
Abstract
Objectives: The goal of this study is to analyze the evolution of
technology in artificial heart valves for solving the problem of aortic
stenosis (a narrowing of the aortic valve opening) that is one of the most
common valvular heart diseases in society. In particular, this study
explains the evolution of new technology of transcatheter aortic valve
implantation (TAVI) compared to surgical aortic valve replacement (SAVR).
 Method(s): Data of Scopus (2020) based scientific products and
patents that have in title, abstract or keywords the following terms:
"transcatheter aortic valve implantation (TAVI)" or "surgical aortic valve
replacement (SAVR)". The evolution of technology is analyzed with a model,
which shows how TAVI technique is substituting established technique of
SAVR in cardiology. The relationships are investigated with loglinear
models using ordinary least squares method for estimating the unknown
parameters. Statistical analyses are performed with the Statistics
Software SPSS 26. Result(s): Statistical analyses reveal that TAVI,
with its growing scientific and technological production, is expected to
be a dominant technology in future for the treatment of aortic stenosis in
society. In fact, the scientific production of TAVI has a coefficient of
growth in function of time equal to 0.39(P<.001) compared to a coefficient
for SAVR that is 0.10(P<.001). Statistical analyses with patent production
confirm these results. Findings hint at general properties of the
evolutionary behavior of this medical technology: 1) TAVI has a
disproportionate growth in scientific products and patents compared to
SAVR; 2) TAVI has a growing scientific and technological production driven
by major and minor technological advances to solve consequential problems
to treat valvular heart diseases; 3) learning via diffusion and diffusion
by learning are driving forces underlying the development and adoption of
TAVI in cardiology. Conclusion(s): TAVI, introduced in 2002, is
growing in terms of scientific production and innovative activity to
revolutionize the management of aortic stenosis in cardiology with
important implications of health management based on improved
cost-effectiveness of this new technology and better efficiency in
healthcare of people. Copyright © 2021 Fellowship of Postgraduate
Medicine

<97>
Accession Number
2007339890
Title
Donor heart preservation with hydrogen sulfide: A systematic review and
meta-analysis.
Source
International Journal of Molecular Sciences. 22 (11) (no pagination),
2021. Article Number: 5737. Date of Publication: 01 Jun 2021.
Author
Ertugrul I.A.; van Suylen V.; Damman K.; de Koning M.-S.L.Y.; van Goor H.;
Erasmus M.E.
Institution
(Ertugrul, van Suylen, Erasmus) University Medical Centre Groningen,
Department of Cardiothoracic Surgery, University of Groningen, Groningen
9700 RB, Netherlands
(Damman, de Koning) University Medical Centre Groningen, Department of
Cardiology, University of Groningen, Groningen 9700 RB, Netherlands
(van Goor) University Medical Centre Groningen, Department of Pathology
and Medical Biology, University of Groningen, Groningen 9700 RB,
Netherlands
Publisher
MDPI AG
Abstract
Preclinical studies have shown that postconditioning with hydrogen sulfide
(H<inf>2</inf>S) exerts cardioprotective effects against myocardial
ischemia-reperfusion injury (IRI). The aim of this study was to appraise
the current evidence of the cardioprotective effects of H<inf>2</inf>S
against IRI in order to explore the future implementation of
H<inf>2</inf>S in clinical cardiac transplantation. The current literature
on H<inf>2</inf>S postconditioning in the setting of global myocardial
ischemia was systematically reviewed and analyzed, performing
meta-analyses. A literature search of the electronic databases Medline,
Embase and Cinahl identified 1835 studies that were subjected to our
pre-defined inclusion criteria. Sixteen studies were considered eligible
for inclusion. Postconditioning with H<inf>2</inf>S showed significant
robust effects with regard to limiting infarct size (standardized mean
difference (SMD) = -4.12, 95% CI [-5.53--2.71], p < 0.00001). Furthermore,
H<inf>2</inf>S postconditioning consistently resulted in a significantly
lower release of cardiac injury markers, lower levels of oxidative stress
and improved cardiac function. Postconditioning with slow-releasing
H<inf>2</inf>S donors offers a valuable opportunity for novel therapies
within cardiac preservation for transplantation. Before clinical
implication, studies evaluating the long-term effects of H<inf>2</inf>S
treatment and effects of H<inf>2</inf>S treatment in large animal studies
are warranted. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<98>
Accession Number
2007317674
Title
Aortic annular sizing using novel software in three-dimensional
transesophageal echocardiography for transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Diagnostics. 11 (5) (no pagination), 2021. Article Number: 751. Date of
Publication: 22 Apr 2021.
Author
Mork C.; Wei M.; Jiang W.; Ren J.; Ran H.
Institution
(Mork, Wei, Jiang, Ren, Ran) Department of Ultrasound, The Second
Affiliated Hospital of Chongqing Medical University, Chongqing 400010,
China
(Jiang, Ren, Ran) Chongqing Key Laboratory of Ultrasound Molecular
Imaging, Chongqing 400010, China
Publisher
MDPI AG
Abstract
(1) Background: We performed this study to evaluate the agreement between
novel automated software of three-dimensional transesophageal
echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for
aortic annular measurements of preprocedural transcatheter aor-tic valve
replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and
Cochrane Library (Wiley) databases were systematically searched for
studies that compared 3D-TEE and MDCT as the reference standard for aortic
annular measurement of the following parameters: annular area, annular
perimeter, area derived-diameter, perimeter derived-diameter, maximum and
minimum diameter. Meta-analytic methods were utilized to determine the
pooled correlations and mean differences between 3D-TEE and MDCT.
Heterogeneity and publication bias were also assessed. Meta-regression
analyses were performed based on the potential factors affecting the
correlation of aortic annular area; (3) Results: A total of 889 patients
from 10 studies were included in the meta-analysis. Pooled correlation
coefficients between 3D-TEE and MDCT of annulus area, perimeter, area
derived-diameter, perimeter derived-diameter, maximum and minimum diameter
measurements were strong 0.89 (95% CI: 0.84-0.92), 0.88 (95% CI:
0.83-0.92), 0.87 (95% CI: 0.77-0.93), 0.87 (95% CI: 0.77-0.93), 0.79 (95%
CI: 0.64-0.87), and 0.75 (95% CI: 0.61-0.84) (Overall p < 0.0001),
respectively. Pooled mean differences between 3D-TEE and MDCT of annulus
area, perimeter, area derived-diameter, perimeter derived-diameter,
maximum and minimum diameter measurements were -20.01 mm2 ((95%
CI: -35.37 to -0.64), p = 0.011), -2.31 mm ((95% CI: -3.31 to -1.31), p <
0.0001), -0.22 mm ((95% CI: -0.73 to 0.29), p = 0.40), -0.47 mm ((95% CI:
-1.06 to 0.12), p = 0.12), -1.36 mm ((95% CI: -2.43 to -0.30), p = 0.012),
and 0.31 mm ((95% CI: -0.15 to 0.77), p = 0.18), respectively. There were
no statistically significant associations with the baseline patient
characteristics of sex, age, left ventricular ejection fraction, mean
transaortic gradient, and aortic valve area to the correlation between
3D-TEE and MDCT for aortic annular area sizing; (4) Conclusion(s):
The present study implies that 3D-TEE using novel software tools,
automatically analysis, is feasible to MDCT for annulus sizing in clinical
practice. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<99>
Accession Number
635123488
Title
The Effectiveness of the Transitional Care Program Among People Awaiting
Coronary Artery Bypass Graft Surgery: A Randomized Control Trial.
Source
Journal of nursing scholarship : an official publication of Sigma Theta
Tau International Honor Society of Nursing. (no pagination), 2021. Date of
Publication: 19 May 2021.
Author
Yuroong A.; Asdornwised U.; Pinyopasakul W.; Wongkornrat W.; Chansatitporn
N.
Institution
(Yuroong) PhD Candidate, Faculty of Nursing, Ramathibodi School of
Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
Bangkok, Thailand
(Asdornwised, Pinyopasakul) Faculty of Nursing, Mahidol University,
Bangkok, Thailand
(Wongkornrat) Cardiothoracic Division, Department of Surgery, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Chansatitporn) Department of Biostatistics, Faculty of Public Health,
Mahidol University, Bangkok, Thailand
Publisher
NLM (Medline)
Abstract
PURPOSE: This study examined the effectiveness of the Transitional Care
Program (TCP) on the anxiety, depression, cardiac self-efficacy, number of
hospitalizations, and satisfaction with care among people awaiting
elective coronary artery bypass graft (CABG) surgery. DESIGN: The study
design was a randomized controlled trial. METHOD(S): The participants
with coronary artery disease who met the study criteria (n = 104) were
randomly assigned to the intervention group (n = 52) receiving the TCP
plus routine care, or the control group (n = 52) receiving routine care
only. The TCP, developed based on the Transitional Care Model, comprised
hospital discharge planning and six weekly home telephone follow-ups to
provide health education, counseling, monitoring, and emotional support
tailored to the individual's needs. Data were collected at baseline, and
then at weeks 1, 6, and 8 after program enrollment. Data were analyzed
using descriptive statistics, repeated-measures analysis of variance, and
the Z test. FINDINGS: The intervention group had lower anxiety and
depression than did the control group at weeks 1, 6, and 8 after program
enrollment. At weeks 6 and 8, the intervention group exhibited higher
cardiac self-efficacy and satisfaction with care than the control group.
Further, the intervention group had a significantly lower number of
hospitalizations than the control group at week 8. CONCLUSION(S): The
TCP can reduce anxiety, depression, and number of hospitalizations, while
increasing cardiac self-efficacy and satisfaction with care among people
awaiting CABG. CLINICAL RELEVANCE: Nurses are in a pivotal position to
make care transitions safer. Provision of discharge education and regular
telephone contacts could enhance positive outcomes regarding patients
awaiting elective cardiac surgery. Copyright © 2021 Sigma Theta
Tau International.

<100>
Accession Number
635108025
Title
Cardiac mortality in patients randomised to elective coronary
revascularisation plus medical therapy or medical therapy alone: a
systematic review and meta-analysis.
Source
European heart journal. (no pagination), 2021. Date of Publication: 18 May
2021.
Author
Navarese E.P.; Lansky A.J.; Kereiakes D.J.; Kubica J.; Gurbel P.A.; Gorog
D.A.; Valgimigli M.; Curzen N.; Kandzari D.E.; Bonaca M.P.; Brouwer M.;
Uminska J.; Jaguszewski M.J.; Raggi P.; Waksman R.; Leon M.B.; Wijns W.;
Andreotti F.
Institution
(Navarese, Kubica) Interventional Cardiology and Cardiovascular Medicine
Research, Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Navarese, Raggi) Faculty of Medicine, University of Alberta, Edmonton,
Canada
(Navarese, Kubica) SIRIO MEDICINE research network, Poland
(Lansky) Yale University School of Medicine, CT, New Haven, United States
(Kereiakes) Christ Hospital and Lindner Research Center, Cincinnati, OH,
USA
(Gurbel) Sinai Center for Thrombosis Research and Drug Development, Sinai
Hospital of Baltimore, MD, Baltimore, United States
(Gorog) Faculty of Medicine, National Heart and Lung Institute, Imperial
College, London, United Kingdom
(Gorog) Cardiology Department, East and North Hertfordshire NHS Trust,
Stevenage, United Kingdom
(Valgimigli) Department of Cardiology, Inselspital Universitatsspital,
Bern, Switzerland
(Curzen) University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Curzen) University of Southampton, Southampton, United Kingdom
(Kandzari) Department of Interventional Cardiology, Piedmont Heart
Institute, Atlanta, United States
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
United States
(Brouwer) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Uminska) Department of Geriatrics, Nicolaus Copernicus University,
Bydgoszcz, Poland
(Jaguszewski) 1st Department of Cardiology, Medical University of Gdansk,
Gdansk, Poland
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, DC, WA, United States
(Leon) Division of Cardiovascular Medicine, Columbia University Irving
Medical Center, NY, NY, United States
(Leon) Cardiovascular Research Foundation, NY, NY, United States
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland Galway and Saolta University Healthcare Group,
Galway, Ireland
(Andreotti) Direzione Scientifica, Fondazione Policlinico Universitario
Gemelli IRCCS, Rome, Italy
(Andreotti) Cardiovascular Medicine, Catholic University Medical School,
Rome, Italy
Publisher
NLM (Medline)
Abstract
AIMS: The value of elective coronary revascularisation plus medical
therapy over medical therapy alone in managing stable patients with
coronary artery disease is debated. We reviewed all trials comparing the
two strategies in this population. METHODS AND RESULTS: From inception
through November 2020, MEDLINE, EMBASE, Google Scholar, and other
databases were searched for randomised trials comparing revascularisation
against medical therapy alone in clinically stable coronary artery disease
patients. Treatment effects were measured by rate ratios (RRs) with 95%
confidence intervals, using random-effects models. Cardiac mortality was
the pre-specified primary endpoint. Spontaneous myocardial infarction (MI)
and its association with cardiac mortality were secondary endpoints.
Further endpoints included all-cause mortality, any MI, and stroke.
Longest follow-up data were abstracted. The study is registered with
PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients
(10 023 randomised to revascularisation plus medical therapy and 9783 to
medical therapy alone) were included. Compared with medical therapy alone,
revascularisation yielded a lower risk of cardiac death [RR 0.79
(0.67-0.93), P<0.01] and spontaneous MI [RR 0.74 (0.64-0.86), P<0.01]. By
meta-regression, the cardiac death risk reduction after revascularisation,
compared with medical therapy alone, was linearly associated with
follow-up duration [RR per 4-year follow-up: 0.81 (0.69-0.96), P=0.008],
spontaneous MI absolute difference (P=0.01) and percentage of multivessel
disease at baseline (P=0.004). Trial sequential and sensitivity analyses
confirmed the reliability of the cardiac mortality findings. All-cause
mortality [0.94 (0.87-1.01), P=0.11], any MI (P=0.14), and stroke risk
(P=0.30) did not differ significantly between strategies.
 CONCLUSION(S): In stable coronary artery disease patients,
randomisation to elective coronary revascularisation plus medical therapy
led to reduced cardiac mortality compared with medical therapy alone. The
cardiac survival benefit after revascularisation improved with longer
follow-up times and was associated with fewer spontaneous
MIs. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<101>
Accession Number
635102707
Title
A pooled analysis of pacemaker implantation after Perceval sutureless
aortic valve replacement.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 14 May 2021.
Author
Moscarelli M.; Santarpino G.; Athanasiou T.; Mastroroberto P.; Fattouch
K.; Nasso G.; Speziale G.
Institution
(Moscarelli, Nasso, Speziale) Department of Cardiovascular Surgery, Anthea
Hospital, GVM Care & Research, Bari, Italy
(Moscarelli, Athanasiou) Imperial College, NHLI, Hammersmith Hospital,
London, United Kingdom
(Santarpino, Mastroroberto) Department of Clinical and Experimental
Medicine, Magna Graecia University, Catanzaro, Italy
(Santarpino) Department of Cardiac Surgery, Paracelsus Medical University,
Nuremberg, Germany
(Fattouch) Department of Cardiovascular Surgery, Maria Eleonora Hospital,
GVM Care & Research, Palermo, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We performed a literature meta-analysis to estimate the rate
of pacemaker implantation after Perceval sutureless aortic valve
replacement. METHOD(S): Pertinent articles were identified from the
PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible
studies reported the de novo incidence of postoperative pacemaker
implantation after Perceval valve surgery. Among 394 articles retrieved,
26 studies including 9492 patients met the inclusion criteria.
 RESULT(S): The pooled event rate for postoperative pacemaker
implantation was 7% [95% confidence interval (CI) 6-9%]; however,
significant heterogeneity was observed across studies. In a sub-analysis,
there was no difference between the rates of pacemaker implantation
calculated from multicentre and registry studies (8 studies, 6845
patients; 7%, 95% CI 5-10%) and single-centre studies (18 studies, 2647
patients; 7%, 95% CI 5-9%; P=0.75). Implantation rates were similar in
high-volume studies (16 studies, 9121 patients; 7%, 95% CI 5-8%) than in
low-volume studies (10 studies, 371 patients; pooled rate: 7%, 95% CI
4-14%; P=0.5). Postoperative pacemaker implantation rates tended to
decrease over time. CONCLUSION(S): With a pooled event rate of 7%,
postoperative pacemaker implantation remains an important limitation of
Perceval sutureless valve surgery, although we observed a degree of
variability across included studies. The resultant findings provide a
useful estimate for physicians and patients and can serve as a benchmark
for future comparative studies. PROSPERO REGISTRATION NUMBER:
CRD42020188397. Copyright © The Author(s) 2021. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<102>
Accession Number
635102481
Title
Risk factors for persistent pain after breast and thoracic surgeries: a
systematic literature review and meta-analysis.
Source
Pain. (no pagination), 2021. Date of Publication: 05 Apr 2021.
Author
Lim J.; Chen D.; McNicol E.; Sharma L.; Varaday G.; Sharma A.; Wilson E.;
Wright-Yatsko T.; Yaeger L.; Gilron I.; Finnerup N.B.; Haroutounian S.
Institution
(Lim) Saint Louis University School of Medicine, St. Louis, MO, United
States University of Sydney School of Medicine, Sydney, Australia MCPHS
University, Boston, MA, United States Department of Anesthesiology,
Washington University in St. Louis School of Medicine, St. Louis, MO,
United States Becker Medical Library, Washington University in St. Louis
School of Medicine, St. Louis, MO, United States Departments of
Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences,
Centre for Neuroscience Studies, and School of Policy Studies, Queen's
University, Kingston, Ontario, Canada Department of Clinical Medicine,
Danish Pain Research Center, Aarhus University, Aarhus, Denmark
Publisher
NLM (Medline)
Abstract
ABSTRACT: Persistent postsurgical pain (PPSP) is common after breast and
thoracic surgeries. Understanding which risk factors consistently
contribute to PPSP will allow clinicians to apply preventive strategies,
as they emerge, to high-risk patients. The objective of this work was to
systematically review and meta-analyze the literature on risk factors of
PPSP after breast and thoracic surgeries. A systematic literature search
using Ovid Medline, Cochrane Central Register of Controlled Trials,
Cumulative Index to Nursing and Allied Health Literature, Embase,
PsycINFO, and Scopus databases was conducted. Study screening with
inclusion and exclusion criteria, data extraction, and risk of bias
assessment was performed independently by 2 authors. The data for each
surgical group were analyzed separately and meta-analyzed where possible.
The literature search yielded 5584 articles, and data from 126 breast
surgery and 143 thoracic surgery articles were considered for
meta-analysis. In breast surgery, younger age, higher body mass index,
anxiety, depression, diabetes, smoking, preoperative pain, moderate to
severe acute postoperative pain, reoperation, radiotherapy, and axillary
lymph node dissection were the main factors associated with higher risk of
PPSP. In thoracic surgery, younger age, female sex, hypertension,
preoperative pain, moderate to severe acute postoperative pain, surgical
approach, major procedure, and wound complications were associated with
PPSP. This systematic review demonstrated certain consistent risk factors
of PPSP after breast and thoracic surgeries, as well as identified
research gaps. Understanding the factors that increase susceptibility to
PPSP can help selectively allocate resources to optimize perioperative
care in high-risk patients and help develop targeted, risk-stratified
interventions for PPSP prevention. Copyright © 2021 International
Association for the Study of Pain.

<103>
Accession Number
635099800
Title
Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke.
Source
The New England journal of medicine. (no pagination), 2021. Date of
Publication: 15 May 2021.
Author
Whitlock R.P.; Belley-Cote E.P.; Paparella D.; Healey J.S.; Brady K.;
Sharma M.; Reents W.; Budera P.; Baddour A.J.; Fila P.; Devereaux P.J.;
Bogachev-Prokophiev A.; Boening A.; Teoh K.H.T.; Tagarakis G.I.; Slaughter
M.S.; Royse A.G.; McGuinness S.; Alings M.; Punjabi P.P.; Mazer C.D.;
Folkeringa R.J.; Colli A.; Avezum A.; Nakamya J.; Balasubramanian K.;
Vincent J.; Voisine P.; Lamy A.; Yusuf S.; Connolly S.J.
Institution
(Whitlock, Belley-Cote, Paparella, Healey, Brady, Sharma, Reents, Budera,
Baddour, Fila, Devereaux, Bogachev-Prokophiev, Boening, Teoh, Tagarakis,
Slaughter, Royse, McGuinness, Alings, Punjabi, Mazer, Folkeringa, Colli,
Avezum, Nakamya, Balasubramanian, Vincent, Voisine, Lamy, Yusuf, Connolly)
From McMaster University (R.P.W., E.P.B.-C., J.S.H., M.S., P.J.D., J.N.,
K. Balasubramanian, A.L., S.Y., S.J.C.), Hamilton Health Sciences (R.P.W.,
E.P.B.-C., J.S.H., K. Brady, M.S., P.J.D., J.V., A.L., S.Y., S.J.C.), and
the Population Health Research Institute (R.P.W., E.P.B.-C., J.S.H., K.
Brady, M.S., P.J.D., J.N., K. Balasubramanian, J.V., A.L., S.Y., S.J.C.),
Hamilton, ON, Southlake Regional Health Centre, Newmarket, ON (K.H.T.T.),
the University of Toronto and Li Ka Shing Knowledge Institute of St.
Michael's Hospital, Toronto (C.D.M.), and Quebec Heart and Lung Institute,
Quebec, QC (P.V.) - all in Canada; University of Foggia, Foggia (D.P.),
Santa Maria Hospital, Gruppo Villa Maria Care and Research, Bari (D.P.),
and the University of Pisa, Pisa (A.C.) - all in Italy; Rhon-Klinikum
Campus Bad Neustadt, Bad Neustadt (W.R.), and University Hospital Giessen,
Giessen (A.B.) - both in Germany; the Institute for Clinical and
Experimental Medicine, Prague (P.B.), and the Center of Cardiovascular
Surgery and Transplantation, Brno (P.F.) - both in the Czech Republic; "G.
Papanikolaou" Hospital (A.J.B.) and Aristotle University of Thessaloniki
(G.I.T.) - both in Thessaloniki, Greece; E. Meshalkin National Medical
Research Center, Novosibirsk, Russia (A.B.-P.); the University of
Louisville, Louisville, KY (M.S.S.); the University of Melbourne and Royal
Melbourne Hospital, Melbourne, VIC, Australia (A.G.R.); Auckland City
Hospital, Auckland, New Zealand (S.M.); Amphia Ziekenhuis, Breda (M.A.),
and Medical Center Leeuwarden, Leeuwarden (R.J.F.) - both in the
Netherlands; the National Heart and Lung Institute, Imperial College
London, London (P.P.P.); and the International Research Center, Hospital
Alemao Oswaldo Cruz, Sao Paulo (A.A.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Surgical occlusion of the left atrial appendage has been
hypothesized to prevent ischemic stroke in patients with atrial
fibrillation, but this has not been proved. The procedure can be performed
during cardiac surgery undertaken for other reasons. METHOD(S): We
conducted a multicenter, randomized trial involving participants with
atrial fibrillation and a CHA2DS2-VASc score of at least 2 (on a scale
from 0 to 9, with higher scores indicating greater risk of stroke) who
were scheduled to undergo cardiac surgery for another indication. The
participants were randomly assigned to undergo or not undergo occlusion of
the left atrial appendage during surgery; all the participants were
expected to receive usual care, including oral anticoagulation, during
follow-up. The primary outcome was the occurrence of ischemic stroke
(including transient ischemic attack with positive neuroimaging) or
systemic embolism. The participants, research personnel, and primary care
physicians (other than the surgeons) were unaware of the trial-group
assignments. RESULT(S): The primary analysis population included 2379
participants in the occlusion group and 2391 in the no-occlusion group,
with a mean age of 71 years and a mean CHA2DS2-VASc score of 4.2. The
participants were followed for a mean of 3.8 years. A total of 92.1% of
the participants received the assigned procedure, and at 3 years, 76.8% of
the participants continued to receive oral anticoagulation. Stroke or
systemic embolism occurred in 114 participants (4.8%) in the occlusion
group and in 168 (7.0%) in the no-occlusion group (hazard ratio, 0.67; 95%
confidence interval, 0.53 to 0.85; P=0.001). The incidence of
perioperative bleeding, heart failure, or death did not differ
significantly between the trial groups. CONCLUSION(S): Among
participants with atrial fibrillation who had undergone cardiac surgery,
most of whom continued to receive ongoing antithrombotic therapy, the risk
of ischemic stroke or systemic embolism was lower with concomitant left
atrial appendage occlusion performed during the surgery than without it.
(Funded by the Canadian Institutes of Health Research and others; LAAOS
III ClinicalTrials.gov number, NCT01561651.). Copyright © 2021
Massachusetts Medical Society.

<104>
Accession Number
635099724
Title
A randomized evaluation of the TriGuardTM HDH cerebral embolic protection
device to Reduce the Impact of Cerebral Embolic LEsions after
TransCatheter Aortic Valve ImplanTation: the REFLECT I trial.
Source
European heart journal. (no pagination), 2021. Date of Publication: 17 May
2021.
Author
Lansky A.J.; Makkar R.; Nazif T.; Messe S.; Forrest J.; Sharma R.; Schofer
J.; Linke A.; Brown D.; Dhoble A.; Horwitz P.; Zang M.; DeMarco F.;
Rajagopal V.; Dwyer M.G.; Zivadinov R.; Stella P.; Rovin J.; Parise H.;
Kodali S.; Baumbach A.; Moses J.
Institution
(Lansky, Forrest, Parise, Baumbach) Division of Cardiology, Yale School of
Medicine, CT 06510, 135 College Street, New Haven, United States
(Lansky, Baumbach) Barts Heart Centre, London and Queen Mary University of
London, London, United Kingdom
(Makkar) Cedar Sinai Medical Center, Los Angeles, CA, USA
(Nazif, Kodali, Moses) College of Physicians and Surgeons, Columbia
University, NY, NY, United States
(Messe) Department of Neurology, Hospital of the University of
Pennsylvania, Philadelphia, United States
(Sharma) Division of Cardiology, Stanford University, Stanford, CA, USA
(Schofer) Hamburg University Cardiovascular Center, DE, Hamburg, Germany
(Linke) University Hospital Dresden Heart Center, Dresden,DE
(Brown) Heart Hospital Baylor, TX, Plano, United States
(Dhoble) University of Texas Health Science Center, TX, Houston, United
States
(Horwitz) University of Iowa Carver College of Medicine, IA, Iowa City,
United States
(Zang) Swedish Medical Center, Seattle, WA, USA
(DeMarco) San Donato, Milan, Italy
(Rajagopal) Piedmont Heart Institute, Atlanta, United States
(Dwyer, Zivadinov) Buffalo Neuroimaging Analysis Center, Department of
Neurology, State University of New York at Buffalo, Buffalo, NY, USA
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Rovin) BayCare Health System, FL, Clearwater, United States
Publisher
NLM (Medline)
Abstract
AIMS : The REFLECT I trial investigated the safety and effectiveness of
the TriGuardTM HDH (TG) cerebral embolic deflection device in patients
undergoing transcatheter aortic valve replacement (TAVR). METHODS AND
RESULTS : This prospective, multicentre, single-blind, 2:1 randomized (TG
vs. no TG) study aimed to enrol up to 375 patients, including up to 90
roll-in patients. The primary combined safety endpoint (VARC-2 defined
early safety) at 30days was compared with a performance goal. The primary
efficacy endpoint was a hierarchical composite of (i) all-cause mortality
or any stroke at 30days, (ii) National Institutes of Health Stroke Scale
(NIHSS) worsening at 2-5days or Montreal Cognitive Assessment worsening at
30days, and (iii) total volume of cerebral ischaemic lesions detected by
diffusion-weighted magnetic resonance imaging at 2-5days. Cumulative
scores were compared between treatment groups using the
Finkelstein-Schoenfeld method. A total of 258 of the planned, 375 patients
(68.8%) were enrolled (54 roll-in and 204 randomized). The primary safety
outcome was met compared with the performance goal (21.8% vs. 35%,
P<0.0001). The primary hierarchical efficacy endpoint was not met (mean
efficacy score, higher is better: -5.3+/-99.8 TG vs. 11.8+/-96.4 control,
P=0.31). Covert central nervous system injury was numerically lower with
TG both in-hospital (46.1% vs. 60.3%, P=0.0698) and at 5days (61.7 vs.
76.2%, P=0.054) compared with controls. CONCLUSION : REFLECT I
demonstrated that TG cerebral protection during TAVR was safe in
comparison with historical TAVR data but did not meet the predefined
effectiveness endpoint compared with unprotected TAVR
controls. 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.

<105>
Accession Number
635097174
Title
Association between Achieved omega-3 Fatty Acid Levels and Major Adverse
Cardiovascular Outcomes in Patients with High Cardiovascular Risk: A
Secondary Analysis of the STRENGTH Trial.
Source
JAMA Cardiology. (no pagination), 2021. Article Number: 1157. Date of
Publication: 2021.
Author
Nissen S.E.; Lincoff A.M.; Wolski K.; Ballantyne C.M.; Kastelein J.J.P.;
Ridker P.M.; Ray K.K.; McGuire D.K.; Mozaffarian D.; Koenig W.; Davidson
M.H.; Garcia M.; Katona B.G.; Himmelmann A.; Loss L.E.; Poole M.; Menon
V.; Nicholls S.J.
Institution
(Nissen, Lincoff, Wolski, Garcia, Menon) Cleveland Clinic Coordinating
Center for Clinical Research, Department of Cardiovascular Medicine,
Cleveland Clinic, Cleveland, OH, United States
(Ballantyne) Baylor College of Medicine, Houston, TX, United States
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Ridker) Center for Cardiovascular Disease Prevention, Harvard Medical
School, Boston, MA, United States
(Ray) Imperial College of London, London, United Kingdom
(McGuire) University of Texas, Southwestern Medical Center, Dallas, United
States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
DZHK (German Centre for Cardiovascular Research) Munich Heart Alliance,
Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Ulm, Germany
(Davidson) University of Chicago, Chicago, IL, United States
(Katona, Loss) AstraZeneca BioPharmaceuticals RandD, Late-stage
Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD, United
States
(Himmelmann, Poole) AstraZeneca BioPharmaceuticals RandD, Late-stage
Development, Cardiovascular, Renal and Metabolic, Gothenburg, Sweden
(Nicholls) Monash Cardiovascular Research Centre, Melbourne, VIC,
Australia
Publisher
American Medical Association
Abstract
Importance: In patients treated with omega-3 fatty acids, it remains
uncertain whether achieved levels of eicosapentaenoic acid (EPA) or
docosahexaenoic acid (DHA) are associated with cardiovascular outcomes.
 Objective(s): To determine the association between plasma levels of
EPA and DHA and cardiovascular outcomes in a trial of omega-3 fatty acids
compared with corn oil placebo. Design, Setting, and Participant(s):
A double-blind, multicenter trial enrolled patients at high cardiovascular
risk with elevated triglyceride levels and low levels of high-density
lipoprotein cholesterol at 675 centers (enrollment from October 30, 2014,
to June 14, 2017; study termination January 8, 2020; last visit May 14,
2020). Intervention(s): Participants were randomized to receive 4 g
daily of omega-3 carboxylic acid (CA) or an inert comparator, corn oil.
 Main Outcomes and Measures: The primary prespecified end point was a
composite of cardiovascular death, nonfatal myocardial infarction,
nonfatal stroke, coronary revascularization, or unstable angina requiring
hospitalization. The primary outcome measure was the hazard ratio,
adjusted for baseline characteristics, for patients treated with the
omega-3 CA compared with corn oil for the top tertile of achieved EPA and
DHA plasma levels 12 months after randomization. Result(s): Of the
13078 total participants, 6539 (50%) were randomized to receive omega-3 CA
and 6539 (50%) randomized to corn oil. omega-3 Fatty acid levels were
available at both baseline and 12 months after randomization in 10382
participants (5175 omega-3 CA patients [49.8%] and 5207 corn oil-treated
patients [50.2%]; mean [SD] age, 62.5 [8.9] years, 3588 [34.6%] were
women, 9025 [86.9%] were White, and 7285 [70.2%] had type 2 diabetes). The
median plasma levels at 12 months in omega-3 CA patients were 89 mug/mL
(interquartile range [IQR], 46-131 mug/mL) for EPA and 91 mug/mL (IQR,
71-114 mug/mL) for DHA with top tertile levels of 151 mug/mL (IQR, 132-181
mug/mL) and 118 mug/mL (IQR, 102-143 mug/mL), respectively. Compared with
corn oil, the adjusted hazard ratios for the highest tertile of achieved
plasma levels were 0.98 (95% CI, 0.83-1.16; P =.81) for EPA, and 1.02 (95%
CI, 0.86-1.20; P =.85 for DHA. Sensitivity analyses based on changes in
plasma and red blood cell levels of EPA and DHA and primary and secondary
prevention subgroups showed similar results. Conclusions and
Relevance: Among patients treated with omega-3 CA, the highest achieved
tertiles of EPA and DHA were associated with neither benefit nor harm in
patients at high cardiovascular risk. Trial Registration:
ClinicalTrials.gov Identifier: NCT02104817. Copyright © 2021
American Medical Association. All rights reserved.

<106>
Accession Number
2006014845
Title
Serum glycated albumin predicts all-cause mortality in dialysis patients
with diabetes mellitus: meta-analysis and systematic review of a
predictive biomarker.
Source
Acta Diabetologica. 58 (1) (pp 81-91), 2021. Date of Publication: January
2021.
Author
Copur S.; Siriopol D.; Afsar B.; Comert M.C.; Uzunkopru G.; Sag A.A.;
Ortiz A.; Covic A.; van Raalte D.H.; Cherney D.Z.; Rossing P.; Kanbay M.
Institution
(Copur, Comert, Uzunkopru) Department of Medicine, Koc University School
of Medicine, Istanbul, Turkey
(Siriopol, Covic) Department of Nephrology, Grigore T. Popa' University of
Medicine, Iasi, Romania
(Afsar) Department of Medicine, Division of Nephrology, Suleyman Demirel
University School of Medicine, Isparta, Turkey
(Sag) Division of Vascular and Interventional Radiology, Department of
Radiology, Duke University Medical Center, Durham, NC, United States
(Ortiz) Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz,
Universidad Autonoma de Madrid, Avd. Reyes Catolicos 2, Madrid 28040,
Spain
(van Raalte) Diabetes Center, Department of Internal Medicine, Amsterdam
University Medical Center, Loaction VUMC, Amsterdam, Netherlands
(Cherney) Toronto General Hospital Research Institute, UHN, Toronto,
Canada
(Cherney) Departments of Physiology and Pharmacology and Toxicology,
University of Toronto, Toronto, ON, Canada
(Rossing) Steno Diabetes Center Copenhagen, Copenhagen Denmark and
University of Copenhagen, Copenhagen, Denmark
(Kanbay) Department of Medicine, Division of Nephrology, Koc University
School of Medicine, Istanbul 34010, Turkey
Publisher
Springer-Verlag Italia s.r.l.
Abstract
Background and Aim: HbA1c, the traditional and current gold standard
biomarker guiding diabetic management, has been scrutinized for low
predictive value for patients with chronic kidney disease due to variables
affecting erythrocyte number and turnover. Glycated albumin, the precursor
to advanced glycation end products, reflects glycemic status over the
preceding 2-3 week period and already outperforms HbA1c for glycemic
monitoring. Our aim was to establish whether serum GA can be further used
to predict mortality risk in dialysis patients with diabetes mellitus (DM)
Methods: We did systematic review of the literature in PubMed/Medline, Web
of Science, Embase (Elsevier) and the Cochrane Central Register of
Controlled Trials (Wiley) up to and including February 2020.
 Result(s): This meta-analysis included 25,932 dialysis patients
across 12 studies with maximum follow-up of 11 years. Higher GA levels
were associated with the risk of all-cause mortality in dialysis patients
with DM (HR 1.02, 95% CI 1.01 to 1.03, P < 0.001) irrespective of the type
of dialysis, whereas higher GA was not associated with cardiovascular
mortality (HR 1.03, 95% CI 0.99 to 1.06, P = 0.15) and cardiovascular
events (both fatal and non-fatal) (HR 1.03, 95% CI 0.97 to 1.09, P = 0.31)
in dialysis patients with DM. Conclusion(s): Serum glycated albumin
predicts all-cause mortality risk in dialysis patients with DM. The
endpoints of cardiovascular mortality and cardiovascular events trended
similarly, but did not reach significance at the current sample
size. Copyright © 2020, Springer-Verlag Italia S.r.l., part of
Springer Nature.

<107>
Accession Number
2006900253
Title
Comparison of drug-eluting stent and plain old balloon angioplasty after
rotational atherectomy in severe calcified and large coronary.
Source
International Heart Journal. 62 (2) (pp 264-273), 2021. Date of
Publication: 2021.
Author
Dong H.; Hachinohe D.; Nie Z.; Kashima Y.; Luo J.; Haraguchi T.; Shitan
H.; Watanabe T.; Tadano Y.; Kaneko U.; Sugie T.; Kobayashi K.; Kanno D.;
Enomoto M.; Sato K.; Fujita T.
Institution
(Dong, Luo) Department of Cardiology, Guangdong Cardiovascular Institute,
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention,
Guangdong Provincial People's Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
(Dong, Hachinohe, Kashima, Haraguchi, Shitan, Watanabe, Tadano, Kaneko,
Sugie, Kobayashi, Kanno, Enomoto, Sato, Fujita) Sapporo Heart Center,
Sapporo Cardio Vascular Clinic, Sapporo, Japan
(Nie) Department of Epidemiology, Guangdong Cardiovascular Institute,
Guangdong Provincial People's Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
Publisher
International Heart Journal Association
Abstract
Drug-eluting stent (DES) is well known to be effective in severely
calcified lesion after rotational atherectomy (ROTA). However, there are
still some situations when stents should be avoided and plain old balloon
angioplasty (POBA) should be the preferred option. The present study aims
to explore whether POBA is comparably effective to DES in large and
calcified coronary pretreated by ROTA in clinical outcomes. Consecutive
patients treated for severely calcified lesions in the large (>=3 mm)
coronary using ROTA + DES or ROTA + POBA were retrospectively analyzed.
The major adverse cardiac events (MACE), including all-cause/cardiac death
and target lesion revascularization (TLR) at 1 year and 2 years
posttreatment, were compared between groups using the Cox regression
analysis to identify independent predictors of TLR and MACE. The analysis
included 285 cases in the ROTA + DES group and 47 cases in the ROTA + POBA
group, without relevant differences in clinical baseline characteristics.
Of note, lesion length was greater in the ROTA + DES group (37.2 versus
19.3 mm, P < 0.001); the ROTA + DES group had a higher rate of chronic
total occlusion (CTO) lesions, with 8.4%, and the ROTA + POBA group had
none. The inhospital/30-day mortality rate (5.3%, ROTA + DES; 6.4%, ROTA +
POBA) and the 12- and 24-month all-cause/cardiac mortality rate (9.3%,
ROTA + DES; 7.7%, ROTA + POBA) were not significantly different between
the two groups. TLR rates were not significantly different between the two
groups at 12 (4.6%, ROTA + DES; 4.3%, ROTA + POBA) and 24 (5.3%, ROTA +
DES; 6.4%, ROTA + POBA) months. Outcomes were comparable for ROTA + DES
and ROTA + POBA in severely calcified large coronary artery intervention
with respect to midterm death or TLR rate, especially for short lesion of
< 20 mm. Copyright © 2021, International Heart Journal
Association. All rights reserved.

<108>
Accession Number
633970755
Title
Polypill with or without aspirin in persons without cardiovascular
disease.
Source
New England Journal of Medicine. 384 (3) (pp 216-228), 2021. Date of
Publication: 21 Jan 2021.
Author
Yusuf S.; Joseph P.; Dans A.; Gao P.; Teo K.; Xavier D.; Lopez-Jaramillo
P.; Yusoff K.; Santoso A.; Gamra H.; Talukder S.; Christou C.; Girish P.;
Yeates K.; Xavier F.; Dagenais G.; Rocha C.; McCready T.; Tyrwhitt J.;
Bosch J.; Pais P.
Institution
(Yusuf, Joseph, Gao, Teo, Christou, McCready, Tyrwhitt, Bosch) Population
Health Research Institute, McMaster University, Hamilton Health Sciences,
237 Barton St. E., Hamilton, ON L8L2X2, Canada
(Yeates) Queen's University, Kingston, ON, Canada
(Dagenais) Universite Laval Institut, Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada
(Dans) University of the Philippines, Manila, Philippines
(Xavier, Girish, Xavier, Pais) St. John's Medical College, Bangalore,
India
(Lopez-Jaramillo, Rocha) Fundacion Oftalmologica de Santander, Universidad
de Santander, Bucaramanga, Colombia
(Yusoff) Universiti Teknologi MARA, Selayang, Selangor, Malaysia
(Santoso) UCSI University, Cheras, Kuala Lumpur, Malaysia
(Gamra) Universitas Indonesia, National Cardiovascular Center, Jakarta,
Indonesia
(Talukder) Fattouma Bourguiba Hospital, University of Monastir, Monastir,
Tunisia
(Talukder) Eminence, Dhaka, Bangladesh
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND A polypill comprising statins, multiple blood-pressure-lowering
drugs, and aspirin has been proposed to reduce the risk of cardiovascular
disease. METHODS Using a 2-by-2-by-2 factorial design, we randomly
assigned participants without cardiovascular disease who had an elevated
INTERHEART Risk Score to receive a polypill (containing 40 mg of
simvastatin, 100 mg of atenolol, 25 mg of hydrochlorothiazide, and 10 mg
of ramipril) or placebo daily, aspirin (75 mg) or placebo daily, and
vitamin D or placebo monthly. We report here the outcomes for the polypill
alone as compared with matching placebo, for aspirin alone as compared
with matching placebo, and for the polypill plus aspirin as compared with
double placebo. For the polypill-alone and polypill-plus-aspirin
comparisons, the primary outcome was death from cardiovascular causes,
myocardial infarction, stroke, resuscitated cardiac arrest, heart failure,
or revascularization. For the aspirin comparison, the primary outcome was
death from cardiovascular causes, myocardial infarction, or stroke. Safety
was also assessed. RESULTS A total of 5713 participants underwent
randomization, and the mean follow-up was 4.6 years. The low-density
lipoprotein cholesterol level was lower by approximately 19 mg per
deciliter and systolic blood pressure was lower by approximately 5.8 mm Hg
with the polypill and with combination therapy than with placebo. The
primary outcome for the polypill comparison occurred in 126 participants
(4.4%) in the polypill group and in 157 (5.5%) in the placebo group
(hazard ratio, 0.79; 95% confidence interval [CI], 0.63 to 1.00). The
primary outcome for the aspirin comparison occurred in 116 participants
(4.1%) in the aspirin group and in 134 (4.7%) in the placebo group (hazard
ratio, 0.86; 95% CI, 0.67 to 1.10). The primary outcome for the
polypill-plus-aspirin comparison occurred in 59 participants (4.1%) in the
combined-treatment group and in 83 (5.8%) in the doubleplacebo group
(hazard ratio, 0.69; 95% CI, 0.50 to 0.97). The incidence of hypotension
or dizziness was higher in groups that received the polypill than in their
respective placebo groups. CONCLUSIONS Combined treatment with a polypill
plus aspirin led to a lower incidence of cardiovascular events than did
placebo among participants without cardiovascular disease who were at
intermediate cardiovascular risk. Copyright © 2020 Massachusetts
Medical Society.

<109>
Accession Number
2011576670
Title
Concomitant endocarditis and spondylodiscitis due to coagulase-negative
Staphylococci and a review of the literature.
Source
IDCases. 24 (no pagination), 2021. Article Number: e01100. Date of
Publication: January 2021.
Author
Houkes K.M.G.; Mudde S.E.; Constantinescu A.A.; Verkaik N.J.; Yusuf E.
Institution
(Houkes, Mudde, Verkaik, Yusuf) Department of Medical Microbiology and
Infectious Diseases, Erasmus University Medical Center, Rotterdam,
Netherlands
(Constantinescu) Department of Cardiology, Thorax Center, Erasmus
University Medical Center, Rotterdam, Netherlands
Publisher
Elsevier Ltd
Abstract
Background: Coagulase-negative staphylococci (CoNS) are part of the normal
skin flora. Although CoNS are generally considered as low pathogenic
microorganisms, they can cause serious infections, particularly in the
context of foreign body material. Case report: Here we present two cases
of concomitant infectious endocarditis and spondylodiscitis; one caused by
S. epidermidis, the other by S. haemolyticus. Additionally, we reviewed
the literature for previously reported cases of concomitant endocarditis
and spondylodiscitis due to CoNS. Conclusion(s): In patients with
back pain and a cardiac device in situ, CoNS should be considered as
causative pathogens for possible endocarditis and/or spondylodiscitis, and
should not be regarded as contamination. Copyright © 2021 The
Author(s)

<110>
Accession Number
2011411474
Title
Oral Pregabalin in Cardiac Surgery: A Systematic Review and Meta-Analysis
of Randomized Controlled Trials.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
8835891. Date of Publication: 2021.
Author
Wang X.-X.; Dai J.; Hu X.-G.; Zhou A.-G.; Pan D.-B.
Institution
(Wang, Dai, Zhou, Pan) Department of Anesthesiology, First People's
Hospital of Changde City, Changde, Hunan, China
(Hu) Department of Anesthesiology, Taoyuan County People's Hospital,
Changde, Hunan, China
Publisher
Hindawi Limited
Abstract
Background. Pregabalin has received wide clinical attention as a new type
of analgesic. We undertake a systematic review and meta-analysis to
evaluate the effect of pregabalin on postoperative pain in patients
undergoing cardiac surgery. Methods. We searched PubMed, Embase, and
Cochrane Library (from inception to July 2020) for eligible studies. The
primary outcomes were the total morphine consumption at 24 h. A secondary
outcome was intraoperative fentanyl consumption, extubation time
postoperative, and length of stay in hospital. We calculated pooled
weighted mean difference (WMD) or odds ratio (OR) and 95% CIs using
random- or fixed-effects models. Results. Seven trials involving 463
patients were listed. Meta-analysis showed that the total morphine
consumption at 24 h in the pregabalin group was significantly less than
the control group (WMD: -5.44, 95% CI: -10.42-0.46, P=0.03). We found that
there is no significant difference between the two groups in
intraoperative fentanyl consumption. Compared with the control group, the
length of stay in hospital in the pregabalin group was significantly
shorter (WMD = -0.87, 95% CI: -1.42-0.32, P=0.002). And we found that
there were no significant differences between the two groups in extubation
time (WMD: 17.24, 95% CI: -24.36-58.84, P=0.42). Conclusions. Oral
pregabalin for cardiac surgery patients can effectively reduce the
patient's 24-hour morphine consumption after surgery, shorten the
patient's hospital stay, and is more conducive to early postoperative
recovery. Copyright © 2021 Xian-xue Wang et al.

<111>
Accession Number
2011411462
Title
The Efficacy of Percutaneous Patent Foramen Ovale Closure on Migraine: A
Meta-Analysis of Randomized Controlled Trials and Observational Studies.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
6643266. Date of Publication: 2021.
Author
Zhang Q.-Q.; Lu J.-J.; Yan M.-Y.; Hu X.-W.; Qin Y.-R.; Wang D.-P.; Jiang
J.-H.; Fang Q.; Zhao H.-R.
Institution
(Zhang, Lu, Yan, Hu, Qin, Wang, Jiang, Fang, Zhao) Department of
Neurology, The First Affiliated Hospital, Soochow University, Suzhou
215006, China
Publisher
Hindawi Limited
Abstract
Objectives. Whether patent foramen ovale (PFO) closure is effective on
migraine is controversial. This article was aimed at assessing the
efficacy of PFO closure on migraine based on randomized controlled trials
(RCTs) and observational studies. Methods. We searched PubMed, Embase, and
Cochrane databases up to October 2020 evaluating PFO closure versus
control in patients with migraine, then conducted a meta-analysis of all
RCTs and observational studies, respectively. The main outcomes were (1)
respond rate: complete cessation of migraine; (2) reduction in the
frequency of migraine attacks per month; and (3) reduction in migraine
days per month. Results. Seven studies (3 RCTs and 4 observational
studies), containing 887 migraine patients, were identified. (1) The
respond rate of PFO closure on migraine was significantly higher than
control group both in RCT subgroup and observational studies subgroup (OR
3.86, 95% CI 1.35-11.04, P=0.01 in RCTs; OR 8.28, 95% CI 2.31-29.67,
P=0.001 in observational studies). (2) Reduction in frequency of migraine
attacks was higher in PFO closure group compared with control group in the
RCT subgroup analysis (mean difference MD=0.57, 95% CI 0.23-0.90,
P=0.0009). (3) Reduction in migraine days was also higher in PFO closure
group compared with control group in the RCT subgroup analysis (MD=1.33,
95% CI 0.35-2.31, P=0.008). Conclusions. PFO closure might be suitable for
migraine patients, especially for migraine with aura, by cessation of
migraine headaches or reducing migraine attacks and migraine
days. Copyright © 2021 Quan-Quan Zhang et al.

<112>
Accession Number
2010818355
Title
Use of Pre- And Intensified Postprocedural Physiotherapy in Patients with
Symptomatic Aortic Stenosis Undergoing Transcatheter Aortic Valve
Replacement Study (the 4P-TAVR Study).
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 8894223. Date of Publication: 2021.
Author
Weber M.; Klein U.; Weigert A.; Schiller W.; Bayley-Ezziddin V.; Wirtz
D.C.; Welz A.; Werner N.; Grube E.; Nickenig G.; Sinning J.-M.; Ghanem A.
Institution
(Weber, Klein, Weigert, Werner, Grube, Nickenig, Sinning, Ghanem)
Department of Medicine II, Heart Center Bonn, University Hospital Bonn,
Bonn, Germany
(Schiller, Welz) Department of Cardiac Surgery, Heart Center Bonn,
University Hospital Bonn, Bonn, Germany
(Bayley-Ezziddin, Wirtz) Clinic for Orthopedics and Trauma Surgery,
University Hospital Bonn, Bonn, Germany
Publisher
Hindawi Limited
Abstract
Background. Physiotherapy prior to open-heart surgery lowers the rate of
pneumonia and length of the hospital stay. Pneumonia is a major
contributor to short-term mortality following transcatheter aortic valve
replacement (TAVR). Hence, we hypothesized that pre- and intensified
postprocedural physiotherapy in patients undergoing TAVR might impact the
net functional and clinical outcome. Methods and Results. The 4P-TAVR
study was a prospective, monocentric, randomized trial. The study was
designed to compare the efficacy and safety of intensified periprocedural
physiotherapy including inspiratory muscle training versus standard
postprocedural physiotherapy. Patients were randomized in a 1: 1 fashion.
108 patients were included and followed up for 90 days after TAVR. While
patients in group A (control group: 50 patients, age: 81.7 +/- 5.0 years,
52% male) did not receive physiotherapy prior to TAVR, group B
(intervention group: 58 patients, age: 82.2 +/- 5.82 years, 47% male)
participated in intensive physiotherapy. Compared to the control group,
patients in the interventional group showed a lower incidence of
postinterventional pneumonia (10 [20.0%] vs. 3 [5.1%], p=0.016) and had a
3-day shorter mean hospital stay (13.5 +/- 6.1 days vs. 10.1 +/- 4.7 days,
p=0.02). The primary composite endpoint of mortality and rehospitalization
was not different between the groups. Conclusion. Intensified
physiotherapy is safe and has positive effects on clinical outcomes up to
90 days after TAVR but has no impact on the primary combined endpoint of
mortality and rehospitalization. Longer follow-up, a multicenter design,
and a higher number of subjects are needed to confirm these preliminary
results. This trial is registered with DRKS00017239. Copyright ©
2021 M. Weber et al.

<113>
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.

<114>
[Use Link to view the full text]
Accession Number
626861401
Title
Effectiveness of Discharge Education With the Teach-Back Method on 30-Day
Readmission: A Systematic Review.
Source
Journal of patient safety. 17 (4) (pp 305-310), 2021. Date of Publication:
01 Jun 2021.
Author
Oh E.G.; Lee H.J.; Yang Y.L.; Kim Y.M.
Institution
(Oh) From the College of Nursing, .Mo-Im Kim Nursing Research Institute,
.Yonsei Evidence Based Nursing Center of Korea: A Joanna Briggs Institute
Center of Excellence, Yonsei University
(Lee, Yang) College of Nursing, .Mo-Im Kim Nursing Research Institute,
Yonsei University
(Kim) College of Nursing, Graduate School, Yonsei University, Seoul, South
Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Teach-back methods are reported to improve patient outcomes by
encouraging patient understanding and participation and are increasingly
being used in various clinical settings. This study attempts to identify
the effectiveness of discharge education using the teach-back method on
30-day readmission. METHOD(S): MEDLINE, CINAHL, Embase, The Cochrane
Library, and Web of Science were used to search experimental studies. The
search terms were "discharged patient," "teach-back," and "30-day
readmission" published in English up until July 2017. Two trained
reviewers performed a critical appraisal of retrieved studies using the
Risk of Bias Assessment tool for Nonrandomized Studies. Data were analyzed
using Cochrane Review Manager (Revman) software 5.2. RESULT(S): A
total of five studies were analyzed (3 studies on heart failure, 1 study
on total joint replacement, and 1 study on a coronary artery bypass
graft). The main content of the teach-back education was to confirm and
reinforce the patients' comprehension of health-related information. Among
the five studies, three studies were included in the meta-analysis. The
odds ratio of 30-day readmission for discharge education with the
teach-back method and usual care was 0.55 (95% confidence interval,
0.34-0.91; P = 0.02). The I2 score was 0%, which means that the analyzed
studies are homogeneous. CONCLUSION(S): The results indicate that
discharge education with the teach-back method resulted in a 45% reduction
in 30-day readmission. However, only a few studies were included in the
analysis, and they showed a high risk of selection bias. Therefore, we
suggest that well-designed randomized controlled trials be
conducted. Copyright © 2019 Wolters Kluwer Health, Inc. All
rights reserved.

<115>
Accession Number
635050033
Title
Single-dose intravenous ketorolac for acute postoperative pain in adults.
Source
Cochrane Database of Systematic Reviews. 2021 (5) (no pagination), 2021.
Article Number: CD013263. Date of Publication: 17 May 2021.
Author
McNicol E.D.; Ferguson M.C.; Schumann R.
Institution
(McNicol) Department of Anesthesiology and Perioperative Medicine, Tufts
Medical Center, Boston, MA, United States
(Ferguson) Pharmacy Practice, Southern Illinois University Edwardsville,
Edwardsville, IL, United States
(Schumann) Department of Anesthesia, Critical Care and Pain Medicine, VA
Boston Healthcare System, West Roxbury, MA, United States
Publisher
John Wiley and Sons Ltd
Abstract
Background: Postoperative pain is common and may be severe. Postoperative
administration of non-steroidal anti-inflammatory drugs (NSAIDs) reduces
patient opioid requirements and, in turn, may reduce the incidence and
severity of opioid-induced adverse events (AEs). Objective(s): To
assess the analgesic efficacy and adverse effects of single-dose
intravenous ketorolac, compared with placebo or an active comparator, for
moderate to severe postoperative pain in adults. Search Method(s): We
searched the following databases without language restrictions: CENTRAL,
MEDLINE, Embase and LILACS on 20 April 2020. We checked clinical trials
registers and reference lists of retrieved articles for additional
studies. Selection Criteria: Randomized double-blind trials that
compared a single postoperative dose of intravenous ketorolac with placebo
or another active treatment, for treating acute postoperative pain in
adults following any surgery. Data Collection and Analysis: We used
standard methodological procedures expected by Cochrane. Our primary
outcome was the number of participants in each arm achieving at least 50%
pain relief over a four- and six-hour period.Our secondary outcomes were
time to and number of participants using rescue medication; withdrawals
due to lack of efficacy, adverse events (AEs), and for any other cause;
and number of participants experiencing any AE, serious AEs (SAEs), and
NSAID-related or opioid-related AEs.For subgroup analysis, we planned to
analyze different doses of parenteral ketorolac separately and to analyze
results based on the type of surgery performed.We assessed the certainty
of evidence using GRADE. Main Result(s): We included 12 studies,
involving 1905 participants undergoing various surgeries
(pelvic/abdominal, dental, and orthopedic), with 17 to 83 participants
receiving intravenous ketorolac in each study. Mean study population ages
ranged from 22.5 years to 67.4 years. Most studies administered a dose of
ketorolac of 30 mg; one study assessed 15 mg, and another administered 60
mg. Most studies had an unclear risk of bias for some domains,
particularly allocation concealment and blinding, and a high risk of bias
due to small sample size. The overall certainty of evidence for each
outcome ranged from very low to moderate. Reasons for downgrading
certainty included serious study limitations, inconsistency and
imprecision. Ketorolac versus placebo. Very low-certainty evidence from
eight studies (658 participants) suggests that ketorolac results in a
large increase in the number of participants achieving at least 50% pain
relief over four hours compared to placebo, but the evidence is very
uncertain (risk ratio (RR) 2.81, 95% confidence interval (CI) 1.80 to
4.37). The number needed to treat for one additional participant to
benefit (NNTB) was 2.4 (95% CI 1.8 to 3.7). Low-certainty evidence from 10
studies (914 participants) demonstrates that ketorolac may result in a
large increase in the number of participants achieving at least 50% pain
relief over six hours compared to placebo (RR 3.26, 95% CI 1.93 to 5.51).
The NNTB was 2.5 (95% CI 1.9 to 3.7). Among secondary outcomes, for time
to rescue medication, moderate-certainty evidence comparing intravenous
ketorolac versus placebo demonstrated a mean median of 271 minutes for
ketorolac versus 104 minutes for placebo (6 studies, 633 participants).
For the number of participants using rescue medication, very low-certainty
evidence from five studies (417 participants) compared ketorolac with
placebo. The RR was 0.60 (95% CI 0.36 to 1.00), that is, it did not
demonstrate a difference between groups. Ketorolac probably results in a
slight increase in total adverse event rates compared with placebo (74%
versus 65%; 8 studies, 810 participants; RR 1.09, 95% CI 1.00 to 1.19;
number needed to treat for an additional harmful event (NNTH) 16.7, 95% CI
8.3 to infinite, moderate-certainty evidence). Serious AEs were rare.
Low-certainty evidence from eight studies (703 participants) did not
demonstrate a difference in rates between ketorolac and placebo (RR 0.62,
95% CI 0.13 to 3.03). Ketorolac versus NSAIDs Ketorolac was compared to
parecoxib in four studies and diclofenac in two studies. For our primary
outcome, over both four and six hours there was no evidence of a
difference between intravenous ketorolac and another NSAID (low-certainty
and moderate-certainty evidence, respectively). Over four hours, four
studies (337 participants) produced an RR of 1.04 (95% CI 0.89 to 1.21)
and over six hours, six studies (603 participants) produced an RR of 1.06
(95% CI 0.95 to 1.19). For time to rescue medication, low-certainty
evidence from four studies (427 participants) suggested that participants
receiving ketorolac waited an extra 35 minutes (mean median 331 minutes
versus 296 minutes). For the number of participants using rescue
medication, very low-certainty evidence from three studies (260
participants) compared ketorolac with another NSAID. The RR was 0.90 (95%
CI 0.58 to 1.40), that is, there may be little or no difference between
groups. Ketorolac probably results in a slight increase in total adverse
event rates compared with another NSAID (76% versus 68%, 5 studies, 516
participants; RR 1.11, 95% CI 1.00 to 1.23; NNTH 12.5, 95% CI 6.7 to
infinite, moderate-certainty evidence). Serious AEs were rare.
Low-certainty evidence from five studies (530 participants) did not
demonstrate a difference in rates between ketorolac and another NSAID (RR
3.18, 95% CI 0.13 to 76.99). Only one of the five studies reported a
single serious AE. Authors' conclusions: The amount and certainty of
evidence for the use of intravenous ketorolac as a treatment for
postoperative pain varies across efficacy and safety outcomes and amongst
comparators, from very low to moderate. The available evidence indicates
that postoperative intravenous ketorolac administration may offer
substantial pain relief for most patients, but further research may impact
this estimate. Adverse events appear to occur at a slightly higher rate in
comparison to placebo and to other NSAIDs. Insufficient information is
available to assess whether intravenous ketorolac has a different rate of
gastrointestinal or surgical-site bleeding, renal dysfunction, or
cardiovascular events versus other NSAIDs. There was a lack of studies in
cardiovascular surgeries and in elderly populations who may be at
increased risk for adverse events. Copyright © 2021 The Cochrane
Collaboration. Published by John Wiley & Sons, Ltd.

<116>
Accession Number
632887828
Title
Systematic review of perioperative mortality risk prediction models for
adults undergoing inpatient non-cardiac surgery.
Source
ANZ journal of surgery. 91 (5) (pp 860-870), 2021. Date of Publication: 01
May 2021.
Author
Reilly J.R.; Gabbe B.J.; Brown W.A.; Hodgson C.L.; Myles P.S.
Institution
(Reilly, Myles) Department of Anaesthesiology and Perioperative Medicine,
Alfred Health, Melbourne, VIC, Australia
(Reilly, Myles) Department of Anaesthesia and Perioperative Medicine,
Monash University, Melbourne, VIC, Australia
(Gabbe, Hodgson) School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Brown) Department of Surgery, Alfred Health, Melbourne, VIC, Australia
(Brown) Department of Surgery, Monash University, Melbourne, VIC,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Risk prediction tools can be used in the perioperative setting
to identify high-risk patients who may benefit from increased surveillance
and monitoring in the postoperative period, to aid shared decision-making,
and to benchmark risk-adjusted hospital performance. We evaluated
perioperative risk prediction tools relevant to an Australian context.
 METHOD(S): A systematic review of perioperative mortality risk
prediction tools used for adults undergoing inpatient noncardiac surgery,
published between 2011 and 2019 (following an earlier systematic review).
We searched Medline via OVID using medical subject headings consistent
with the three main areas of risk, surgery and mortality/morbidity. A
similar search was conducted in Embase. Tools predicting morbidity but not
mortality were excluded, as were those predicting a composite outcome that
did not report predictive performance for mortality separately. Tools were
also excluded if they were specifically designed for use in cardiac or
other highly specialized surgery, emergency surgery, paediatrics or
elderly patients. RESULT(S): Literature search identified 2568
studies for screening, of which 19 studies identified 21 risk prediction
tools for inclusion. CONCLUSION(S): Four tools are candidates for
adapting in the Australian context, including the Surgical Mortality
Probability Model (SMPM), Preoperative Score to Predict Postoperative
Mortality (POSPOM), Surgical Outcome Risk Tool (SORT) and NZRISK. SORT has
similar predictive performance to POSPOM, using only six variables instead
of 17, contains all variables of the SMPM, and the original model
developed in the UK has already been successfully adapted in New Zealand
as NZRISK. Collecting the SORT and NZRISK variables in a national surgical
outcomes study in Australia would present an opportunity to simultaneously
investigate three of our four shortlisted models and to develop a locally
valid perioperative mortality risk prediction model with high predictive
performance. Copyright © 2020 Royal Australasian College of
Surgeons.

<117>
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. 31 (5) (pp 699-706), 2021. Date of Publication:
May 2021.
Author
Foote H.P.; Hornik C.P.; Hill K.D.; Rotta A.T.; Chamberlain R.; Thompson
E.J.
Institution
(Foote, Hornik, Hill, Rotta, Chamberlain, Thompson) Department of
Pediatrics, Duke University School of Medicine, Durham, NC, 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
© 2021 Cambridge University Press. All rights reserved.

<118>
Accession Number
634826093
Title
A systematic review of the evidence supporting post-operative medication
use in congenital heart disease.
Source
Cardiology in the Young. 31 (5) (pp 707-733), 2021. Date of Publication:
May 2021.
Author
Thompson E.J.; Foote H.P.; King C.E.; Ciociola E.C.; Leung D.; Rotta A.T.;
Hill K.D.; Cohen-Wolkowiez M.; Hornik C.P.
Institution
(Thompson, Foote, King, Rotta, Hill, Cohen-Wolkowiez, Hornik) Department
of Pediatrics, Duke University School of Medicine, Durham, NC, United
States
(Ciociola, Hill, Cohen-Wolkowiez, Hornik) Duke Clinical Research
Institute, Duke University School of Medicine, Durham, NC, United States
(Leung) Department of Pediatrics, University of North Carolina at Chapel
Hill, Chapel Hill, NC, United States
Publisher
Cambridge University Press
Abstract
Background: Targeted drug development efforts in patients with CHD are
needed to standardise care, improve outcomes, and limit adverse events in
the post-operative period. To identify major gaps in knowledge that can be
addressed by drug development efforts and provide a rationale for current
clinical practice, this review evaluates the evidence behind the most
common medication classes used in the post-operative care of children with
CHD undergoing cardiac surgery with cardiopulmonary bypass.
 Method(s): We systematically searched PubMed and EMBASE from 2000 to
2019 using a controlled vocabulary and keywords related to diuretics,
vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation
system medications, antiarrhythmics, steroids, and other endocrine drugs.
We included studies of drugs given post-operatively to children with CHD
undergoing repair or palliation with cardiopulmonary bypass.
 Result(s): We identified a total of 127 studies with 51,573 total
children across medication classes. Most studies were retrospective
cohorts at single centres. There is significant age- and disease-related
variability in drug disposition, efficacy, and safety. Conclusion(s):
In this study, we discovered major gaps in knowledge for each medication
class and identified areas for future research. Advances in data
collection through electronic health records, novel trial methods, and
collaboration can aid drug development efforts in standardising care,
improving outcomes, and limiting adverse events in the post-operative
period. Copyright © 2021 Cambridge University Press. All rights
reserved.

<119>
Accession Number
2012106162
Title
REVeAL-HF: Design and Rationale of a Pragmatic Randomized Controlled Trial
Embedded Within Routine Clinical Practice.
Source
JACC: Heart Failure. 9 (6) (pp 409-419), 2021. Date of Publication: June
2021.
Author
Ahmad T.; Yamamoto Y.; Biswas A.; Ghazi L.; Martin M.; Simonov M.; Hsiao
A.; Kashyap N.; Velazquez E.J.; Desai N.R.; Wilson F.P.
Institution
(Ahmad, Velazquez, Desai) Section of Cardiovascular Medicine, Yale
University School of Medicine, New Haven, CT, United States
(Ahmad, Yamamoto, Biswas, Ghazi, Martin, Desai, Wilson) Clinical and
Translational Research Accelerator, Yale University School of Medicine,
New Haven, CT, United States
(Simonov, Hsiao, Kashyap) Joint Data Analytics Team, Yale University
School of Medicine, New Haven, CT, United States
(Wilson) Section of Nephrology, Yale University School of Medicine, New
Haven, CT, United States
Publisher
Elsevier Inc.
Abstract
Heart failure (HF) is one of the most common causes of hospitalization in
the United States and carries a significant risk of morbidity and
mortality. Use of evidence-based interventions may improve outcomes, but
their use is encumbered in part by limitations in accurate
prognostication. The REVeAL-HF (Risk EValuation And its Impact on ClinicAL
Decision Making and Outcomes in Heart Failure) trial is the first to
definitively evaluate the impact of knowledge about prognosis on clinical
decision making and patient outcomes. The REVeAL-HF trial is a pragmatic,
completely electronic, randomized controlled trial that has completed
enrollment of 3,124 adults hospitalized for HF, defined as having an
N-terminal pro-B-type natriuretic peptide level of >500 pg/ml and
receiving intravenous diuretic agents within 24 h of admission. Patients
randomized to the intervention had their risk of 1-year mortality
generated with information in the electronic health record and presented
to their providers, who had the option to give feedback on their
impression of this risk assessment. The authors are examining the impact
of this information on clinical decision-making (use of HF
pharmacotherapies, referral to electrophysiology, palliative care
referral, and referral for advanced therapies like heart transplantation
or mechanical circulatory support) and patient outcomes (length of stay,
post-discharge 30-day rehospitalizations, and 1-year mortality). The
REVeAL-HF trial will definitively examine whether knowledge about
prognosis in HF has an impact on clinical decision making and patient
outcomes. It will also examine the relationship between calculated,
perceived, and real risk of mortality in this patient population. (Risk
EValuation And Its Impact on ClinicAL Decision Making and Outcomes in
Heart Failure [REVeAL-HF]; NCT03845660). Copyright © 2021

<120>
Accession Number
2012105710
Title
Percutaneous Mitral Valve Annuloplasty in Patients With Secondary Mitral
Regurgitation and Severe Left Ventricular Enlargement.
Source
JACC: Heart Failure. 9 (6) (pp 453-462), 2021. Date of Publication: June
2021.
Author
Anker S.D.; Starling R.C.; Khan M.S.; Friede T.; Filippatos G.; Lindenfeld
J.; Stephan von Bardeleben R.; Coats A.J.S.; Butler J.
Institution
(Anker) Department of Cardiology, German Centre for Cardiovascular
Research partner site Berlin, Charite Universitatsmedizin Berlin, Berlin,
Germany
(Anker) Berlin Institute of Health Center for Regenerative Therapies,
German Centre for Cardiovascular Research, partner site Berlin, Charite
Universitatsmedizin Berlin, Berlin, Germany
(Starling) Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland,
OH, United States
(Starling) Heart, Vascular and Thoracic Institute, Cleveland Clinic,
Cleveland, OH, United States
(Khan, Butler) Department of Medicine, University of Mississippi School of
Medicine, Jackson, MS, United States
(Friede) Department of Medical Statistics, University Medical Center
Gottingen, Gottingen, Germany
(Friede) Department of Medical Statistics, German Center of Cardiovascular
Research, partner site Gottingen, Gottingen, Germany
(Filippatos) Department of Cardiology, University Hospital Attikon,
National and Kapodistrian University of Athens School of Medicine, Athens,
Greece
(Lindenfeld) Heart Failure and Transplantation Section, Vanderbilt Heart
and Vascular Institute, Nashville, TN, United States
(Stephan von Bardeleben) Department of Cardiology I, Heart Valve Center,
Universitatsmedizin Mainz, Mainz, Germany
(Coats) Department of Cardiology, Monash University Australia and
University of Warwick, Warwick, United Kingdom
(Coats) Department of Medical Sciences, Centre for Clinical and Basic
Research, IRCCS San Raffaele Pisana, Rome, Italy
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to determine the effect of percutaneous
mitral valve annuloplasty with the Carillon device versus
guideline-directed medical therapy (GDMT) alone in patients with secondary
mitral regurgitation (MR) and severe left ventricular (LV) enlargement.
 Background(s): The clinical impact of the Carillon device in patients
with severe LV dilation is not well established. Method(s): This is a
pooled analysis involving 3 prospective trials (TITAN [Transcatheter
Implantation of Carillon Mitral Annuloplasty Device], TITAN II, and REDUCE
FMR [CARILLON Mitral Contour System for Reducing Functional Mitral
Regurgitation] trials) in which patients with functional MR and severe LV
enlargement (LV end-diastolic diameter >65 mm) were treated with GDMT and
the Carillon device versus GDMT alone. Key outcomes of this analysis were
changes over 1 year of follow-up in mitral valve and LV echocardiographic
parameters, functional outcome, quality of life, mortality, and heart
failure hospitalization (HFH). Result(s): A total of 95 patients (67
in the Carillon group, 28 in the GDMT group) with severe LV enlargement
were included. In the Carillon group, all mitral valve and LV morphology
parameters were significantly improved at 1 year. Regurgitant volume
decreased by 12 ml (p < 0.001), MR grade decreased by 0.6 U (p < 0.001),
LV end-diastolic volume decreased by 25 cm3 (p = 0.005), and LV
end-systolic volume decreased by 21 cm3 (p = 0.01). Significant
functional improvement differences were also noted between the Carillon
group and the GDMT group including an improvement of Kansas City
Cardiomyopathy Questionnaire score (15 +/- 4 vs. 6 +/- 6; p = 0.03). The
incidence of HFH was 29.9% versus 50.0% and the cumulative rate of HFH was
0.43 versus 0.75 (p < 0.001). Conclusion(s): In patients with
functional MR and severe LV enlargement, the Carillon device improved
mitral valve function, LV morphology, and functional outcome compared with
patients receiving GDMT only. Preoperative LV dimension should not be a
limiting factor when evaluating patient eligibility or anticipated
response to therapy with the Carillon device. Copyright © 2021
American College of Cardiology Foundation

<121>
Accession Number
2011573713
Title
Mitochondrial transplantation therapy for ischemia reperfusion injury: a
systematic review of animal and human studies.
Source
Journal of Translational Medicine. 19 (1) (no pagination), 2021. Article
Number: 214. Date of Publication: December 2021.
Author
Hayashida K.; Takegawa R.; Shoaib M.; Aoki T.; Choudhary R.C.; Kuschner
C.E.; Nishikimi M.; Miyara S.J.; Rolston D.M.; Guevara S.; Kim J.;
Shinozaki K.; Molmenti E.P.; Becker L.B.
Institution
(Hayashida, Takegawa, Shoaib, Aoki, Choudhary, Kuschner, Nishikimi,
Miyara, Kim, Shinozaki, Becker) The Feinstein Institutes for Medical
Research, Northwell Health System, 350 Community Drive, Manhasset, NY,
United States
(Hayashida, Takegawa, Shoaib, Aoki, Choudhary, Kuschner, Nishikimi,
Miyara, Rolston, Kim, Shinozaki, Becker) Department of Emergency Medicine,
North Shore University Hospital, Northwell Health System, 350 Community
Dr, Manhasset, NY 11030, United States
(Shoaib, Kuschner, Rolston, Kim, Shinozaki, Molmenti, Becker) Zucker
School of Medicine At Hofstra/Northwell, New York, NY, United States
(Guevara, Molmenti) Department of Surgery, Northwell Health, Manhasset,
NY, United States
Publisher
BioMed Central Ltd
Abstract
Background: Mitochondria are essential organelles that provide energy for
cellular functions, participate in cellular signaling and growth, and
facilitate cell death. Based on their multifactorial roles, mitochondria
are also critical in the progression of critical illnesses.
Transplantation of mitochondria has been reported as a potential promising
approach to treat critical illnesses, particularly ischemia reperfusion
injury (IRI). However, a systematic review of the relevant literature has
not been conducted to date. Here, we systematically reviewed the animal
and human studies relevant to IRI to summarize the evidence for
mitochondrial transplantation. Method(s): We searched MEDLINE, the
Cochrane library, and Embase and performed a systematic review of
mitochondrial transplantation for IRI in both preclinical and clinical
studies. We developed a search strategy using a combination of keywords
and Medical Subject Heading/Emtree terms. Studies including cell-mediated
transfer of mitochondria as a transfer method were excluded. Data were
extracted to a tailored template, and data synthesis was descriptive
because the data were not suitable for meta-analysis. Result(s):
Overall, we identified 20 animal studies and two human studies. Among
animal studies, 14 (70%) studies focused on either brain or heart IRI.
Both autograft and allograft mitochondrial transplantation were used in 17
(85%) animal studies. The designs of the animal studies were heterogeneous
in terms of the route of administration, timing of transplantation, and
dosage used. Twelve (60%) studies were performed in a blinded manner. All
animal studies reported that mitochondrial transplantation markedly
mitigated IRI in the target tissues, but there was variation in biological
biomarkers and pathological changes. The human studies were conducted with
a single-arm, unblinded design, in which autologous mitochondrial
transplantation was applied to pediatric patients who required
extracorporeal membrane oxygenation (ECMO) for IRI-associated myocardial
dysfunction after cardiac surgery. Conclusion(s): The evidence
gathered from our systematic review supports the potential beneficial
effects of mitochondrial transplantation after IRI, but its clinical
translation remains limited. Further investigations are thus required to
explore the mechanisms of action and patient outcomes in critical settings
after mitochondrial transplantation. Systematic review registration The
study was registered at UMIN under the registration number
UMIN000043347. Copyright © 2021, The Author(s).

<122>
Accession Number
2011547428
Title
Effects of Colchicine on Cardiovascular Outcomes in Patients with Coronary
Artery Disease: A Systematic Review and One-Stage and Two-Stage
Meta-Analysis of Randomized-Controlled Trials.
Source
High Blood Pressure and Cardiovascular Prevention. (no pagination), 2021.
Date of Publication: 2021.
Author
Teo Y.N.; Teo Y.H.; Syn N.L.; Goh M.W.; Yoong C.S.Y.; Lee C.-H.; Chan
M.Y.-Y.; Chai P.; Yeo T.-C.; Sia C.-H.
Institution
(Teo, Teo, Syn, Goh, Yoong, Lee, Chan, Chai, Yeo, Sia) Department of
Medicine, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Lee, Chan, Chai, Yeo, Sia) Department of Cardiology, National University
Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9,
Singapore 119228, Singapore
Publisher
Adis
Abstract
Aim: Colchicine has received emerging interest due to its cardiovascular
benefits in patients with coronary artery disease (CAD). We conducted a
one-stage meta-analysis of reconstructed individual patient data (IPD)
from randomized-controlled trials to summarize the effects of colchicine
on cardiovascular outcomes in patients with CAD. Method(s): Four
databases (PubMed, Embase, Cochrane, SCOPUS) were searched for articles
published from inception to 30th September 2020, examining the effect of
colchicine on cardiovascular outcomes in patients with CAD, yielding 10
randomized-controlled trials with a combined cohort of 12,781 patients.
IPD was reconstructed from Kaplan-Meier curves published in 3 studies and
analysed using the shared-frailty Cox model. Aggregate data meta-analysis
of all 10 studies was performed for outcomes unsuitable for IPD
reconstruction. Result(s): In patients receiving colchicine compared
to placebo, one-stage meta-analysis demonstrated a hazard ratio of 0.70
(95% CI 0.61-0.80) for the composite outcome of cardiovascular death,
non-fatal myocardial infarction, non-fatal stroke, and urgent
hospitalization for angina requiring coronary revascularization. Aggregate
data meta-analysis demonstrated a significant reduction in hazard rate for
stroke (HR 0.45; 95% CI 0.27-0.75) and urgent revascularization (HR 0.59;
95% CI 0.38-0.91); and a relative risk reduction for myocardial infarction
(RR 0.72; 95% CI of 0.52-1.00) and post-operative atrial fibrillation (RR
0.64; 95% CI 0.48-0.86). Conclusion(s): Given the significant
benefits of colchicine demonstrated on IPD, and its consistent benefits
when analyzed using aggregate data meta-analysis, we propose that
colchicine may be considered as an additional pharmacological adjunct to
the first line therapy for patients with coronary artery
disease. Copyright © 2021, Italian Society of Hypertension.

<123>
Accession Number
2011540294
Title
Real world coronary artery ostia full accessibility after last generation
transcatheter aortic valve implantation.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2021. Date of
Publication: 2021.
Author
Rigatelli G.; Zuin M.; Roncon L.; Nanjiundappa A.; Daggubati R.
Institution
(Rigatelli, Roncon) Division of Cardiology, Rovigo General Hospital,
Rovigo, Italy
(Zuin) Department of Translational Medicine, Section of Internal and
CardioRespiratory Medicine, University of Ferrara, Ferrara, Italy
(Nanjiundappa) Center of Vascular Excellence, West Virginia University
Medical School, Charlstone, United States
(Daggubati) West Virginia University School of Medicine, Heart and
Vascular Institute, Morgantown, United States
Publisher
SAGE Publications Inc.
Abstract
Aim: We evaluate, performing a pooled meta-analysis, the current coronary
artery accessibility rate in transcatheter aortic valve implantation
(TAVI) patients during the follow-up. Full coronary artery accessibility
after TAVI has not been adequately addressed by the current literature.
 Method(s): According to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines, data on coronary artery access were
obtained from the ratio between in the full coronary engagement (n) and
the number of coronary angiography and/or percutaneous coronary
intervention (N). Data were synthesized using random-effects
meta-analyses. Result(s): Out of 7048 TAVI patients, 276 (3.9%) (mean
age 76.8 years, 111 (40.2%) females) were analysed. Full coronary artery
accessibility for coronary angiographies and percutaneous coronary
interventions were obtained in 83.0% (95% confidence interval (CI):
0.66-0.92, p = 0.001, I2: 88.2%) and 96.0% (95% CI: 0.90-0.98,
p < 0.0001, I2: 0) of cases (p for difference <.0.001). Left
coronary artery (n = 219) was easily fully engaged compared to the right
one (90.9% (95% CI: 0.80-0.96, p < 0.0001, I2: 58.4% and 82.0%
(95% CI: 0.60-0.93, p = 0.006, I2: 83.2%), respectively, (p for
difference < 0.001). Using age as moderator variable, meta-regression
revealed a positive and negative correlation with coronary artery
accessibility in patients treated with Sapien-Edwards (p = 0.008) and
CoreValve (p = 0.010) platforms, respectively. Conversely, a negative
correlation (p = 0.01) was found between coronary artery accessibility and
mean time after Sapien-Edwards platform implantation (p = 0.01).
 Conclusion(s): Full coronary artery accessibility during coronary
angiographies and/or percutaneous coronary interventions results
suboptimal for both coronary artery ostia and worse for right compared to
left coronary artery after TAVI. Copyright © The Author(s) 2021.

<124>
Accession Number
2011521006
Title
The use of minimal fluoroscopy for cardiac electrophysiology procedures: A
meta-analysis and review of the literature.
Source
Clinical Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Chiang L.L.W.; Li C.; Hong K.L.; Hui W.S.; Beh S.Y.; Gong M.; Liu T.; Li
G.; Xia Y.; Ho J.; Roever L.; Duong S.; Huang G.; Tse G.; Baranchuk A.;
Glover B.M.
Institution
(Chiang) Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong
Kong
(Li, Tse) Department of Medicine and Therapeutics, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Li, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Li, Hui, Beh) Faculty of Medicine, Newcastle University, Newcastle,
United Kingdom
(Hong, Duong, Huang, Glover) Division of Cardiology, University of
Toronto, Toronto, ON, Canada
(Gong, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Ho) Department of Anaesthesia and Intensive care, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Roever) Federal University of Uberlandia, Department of Clinical
Research, Uberlandia, Minas Gerais, Brazil
(Baranchuk) Division of Cardiology, Kingston General Hospital, Queen's
University, Kingston, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Conventional catheter ablation involves prolonged exposure to
ionizing radiation, potentially leading to detrimental health effects.
Minimal fluoroscopy (MF) represents a safer alternative, which should be
explored. Data on the safety and efficacy of this technique are limited.
Hypothesis: Our hypothesis is that MF is of equal efficacy and safety to
conventional catheter ablation with the use of fluoroscopy by performing a
meta-analysis of both randomized controlled trials (RCTs) and real-world
registry studies. Method(s): Pubmed and Embase were searched from
their inception to July 2020 for RCTs, cohort and observational studies
that assessed the outcomes of catheter ablation using a MF technique
versus the conventional approach. Result(s): Fifteen studies
involving 3795 patients were included in this meta-analysis. There was a
significant reduction in fluoroscopy and procedural time with no
difference in acute success (odds ratio [OR]:0.74, 95% CI: 0.50-1.10, p
=.14), long-term success (OR:0.92, 95% CI: 0.65-1.31, p =.38), arrhythmia
recurrence (OR:1.24, 95% CI: 0.75-2.06, p =.97) or rate of complications.
(OR:0.83, 95% CI: 0.46-1.48, p =.65). Additionally sub-group analysis for
those undergoing catheter ablation for atrial fibrillation (AF) did not
demonstrate a difference in success or complication rates (OR:0.86, 95%
CI: 0.30-2.42, p =.77). Multivariate meta-regression did not identify the
presence of moderator variables. Conclusion(s): This updated
meta-analysis demonstrated an overall reduction in procedural and
fluoroscopy time for those undergoing a minimal fluoroscopic approach.
There was no significant difference in either acute or chronic success
rates or complications between a MF approach and conventional approach for
the management of all arrhythmias including those undergoing catheter
ablation for AF. Copyright © 2021 The Authors. Clinical
Cardiology published by Wiley Periodicals LLC.

<125>
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

<126>
Accession Number
2010173164
Title
Parental experiences of their infant's hospital admission undergoing
cardiac surgery: A systematic review.
Source
Acta Paediatrica, International Journal of Paediatrics. 110 (6) (pp
1730-1740), 2021. Date of Publication: June 2021.
Author
de Man M.A.C.P.; Segers E.W.; Schappin R.; van der Leeden K.; Wosten-van
Asperen R.M.; Breur H.; de Weerth C.; van den Hoogen A.
Institution
(de Man, Segers, van der Leeden, Wosten-van Asperen, Breur, van den
Hoogen) Wilhelmina Children's Hospital, University Medical Centre Utrecht,
Utrecht, Netherlands
(Schappin) Department of Development and Education of Youth in Diverse
Societies, Utrecht University, Utrecht, Netherlands
(de Weerth) Donders Institute for Brain, Cognition and Behaviour, Radboud
University Medical Center, Nijmegen, Netherlands
Publisher
Blackwell Publishing Ltd
Abstract
Aim: To explore parents' experiences of parenting a child hospitalised
with congenital heart disease (CHD) and undergoing surgery.
 Method(s): Five electronic databases were systematically searched for
articles describing the experiences of parents with a child with a CHD. A
thematic analysis approach was used to identify the most common themes.
 Result(s): A total of 188 articles were identified. Eight studies
were included in the review. Four themes emerged, including balancing the
parental role, experiencing anticipatory grief, decreasing parental stress
using coping strategies and professional support. Conclusion(s):
Having a child with CHD undergoing heart surgery is a stressful experience
due to, among other things, the different situation-related parenting role
during the hospital stay and feelings of anticipatory grief. Healthcare
professionals in the PICU have an essential role in supporting parents and
understanding the needs that are crucial for the parents in order to
provide better support and reduce stress and anxiety. More qualitative
research regarding the pathway from the prenatal diagnosis through the
early childhood period is warranted. Copyright © 2021 The
Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of
Foundation Acta Paediatrica

<127>
Accession Number
628237732
Title
Music therapy following cardiac surgery-is it an effective method to
reduce pain and anxiety?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (5) (pp 722-727),
2019. Date of Publication: 01 May 2019.
Author
Grafton-Clarke C.; Grace L.; Harky A.
Institution
(Grafton-Clarke) School of Medicine, University of Liverpool, Liverpool,
United Kingdom
(Grace) Department of Cardiac Surgery, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Harky) Department of Vascular Surgery, Countess of Chester Hospital,
Chester, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In patients undergoing
cardiac surgery, is postoperative music therapy effective in reducing pain
and anxiety? Altogether, 153 papers were found using the reported search
method, of which 7 represented the best evidence to answer the clinical
question. Six of the included studies were randomized trials, with 1
further non-randomized trial. The specific music protocols utilized widely
varied, ranging from 1 short session on day 1 postoperatively to multiple
sessions per day over a 72-h period. Most therapies involved music of a
relaxing type, typically between 50 and 60 dB. All 7 studies reported on
pain, with 4 demonstrating significant differences in pain score; however,
3 of these were not associated with reduction in analgesia requirements.
Five studies reported on anxiety, with 2 demonstrating a statistically
significant improvement in levels of anxiety. These results need to be
contextualized by the small number of participants within each study and
the heterogeneity in the therapy protocols utilized. The current best
available evidence fails to support the benefits of music therapy as an
effective non-pharmacological option in reducing pain and anxiety
following open-heart surgery. While there is scarce evidence demonstrating
efficacy, the current literature contains very small-sample-sized studies
in utilizing music therapy protocols which in turn have wide range of
variability in terms of duration, frequency, timing in the postoperative
period and specific choice of music utilized in each
protocol. Copyright © 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<128>
Accession Number
635100962
Title
Postoperative outcomes for Indigenous Peoples in Canada: a systematic
review.
Source
CMAJ : Canadian Medical Association journal = journal de l'Association
medicale canadienne. 193 (20) (pp E713-E722), 2021. Date of Publication:
17 May 2021.
Author
McVicar J.A.; Poon A.; Caron N.R.; Bould M.D.; Nickerson J.W.; Ahmad N.;
Kimmaliardjuk D.M.; Sheffield C.; Champion C.; McIsaac D.I.
Institution
(McVicar, Poon, Caron, Bould, Ahmad, Kimmaliardjuk, Sheffield, Champion,
McIsaac) Departments of Anesthesiology and Pain Medicine (McVicar, Poon,
Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine
(Ahmad, during the conduct of the study); Centre for Health Law, Policy
and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital
(McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern
Ontario (Bould); Bruyere Research Institute (Nickerson), Ottawa, Ont.;
Department of Surgery and Northern Medical Program (Caron), University of
British Columbia, Prince George, BC; Centre for Excellence in Indigenous
Health (Caron), University of British Columbia, Vancouver, BC; Department
of Anesthesiology and Pain Medicine (Ahmad, at time of writing),
University of Toronto, Toronto, Ont.; Qikiqtani General Hospital
(Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry
Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of
Medicine, Sudbury, Ont
(Nickerson) Departments of Anesthesiology and Pain Medicine (McVicar,
Poon, Bould, McIsaac) and of Surgery (Kimmaliardjuk), Faculty of Medicine
(Ahmad, during the conduct of the study); Centre for Health Law, Policy
and Ethics (Nickerson), University of Ottawa; The Ottawa Hospital
(McVicar, Poon, Kimmaliardjuk, McIsaac); Children's Hospital of Eastern
Ontario (Bould); Bruyere Research Institute (Nickerson), Ottawa, Ont.;
Department of Surgery and Northern Medical Program (Caron), University of
British Columbia, Prince George, BC; Centre for Excellence in Indigenous
Health (Caron), University of British Columbia, Vancouver, BC; Department
of Anesthesiology and Pain Medicine (Ahmad, at time of writing),
University of Toronto, Toronto, Ont.; Qikiqtani General Hospital
(Sheffield), Iqaluit, NU; West Parry Sound Health Centre (Champion), Parry
Sound, Ont.; Department of Surgery (Champion), Northern Ontario School of
Medicine, Sudbury, Ont. jmcvicar@toh.ca
Publisher
NLM (Medline)
Abstract
BACKGROUND: Substantial health inequities exist for Indigenous Peoples in
Canada. The remote and distributed population of Canada presents unique
challenges for access to and use of surgery. To date, the surgical outcome
data for Indigenous Peoples in Canada have not been synthesized.
 METHOD(S): We searched 4 databases to identify studies comparing
surgical outcomes and utilization rates of adults of First Nations, Inuit
or Metis identity with non-Indigenous people in Canada. Independent
reviewers completed all stages in duplicate. Our primary outcome was
mortality; secondary outcomes included utilization rates of surgical
procedures, complications and hospital length of stay. We performed
meta-analysis of the primary outcome using random effects models. We
assessed risk of bias using the ROBINS-I tool. RESULT(S):
Twenty-eight studies were reviewed involving 1 976 258 participants (10.2%
Indigenous). No studies specifically addressed Inuit or Metis populations.
Four studies, including 7 cohorts, contributed adjusted mortality data for
7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher
rate of death after surgery than non-Indigenous patients (pooled hazard
ratio 1.30, 95% CI 1.09-1.54; I2 = 81%). Complications were also higher
for Indigenous Peoples, including infectious complications (adjusted OR
1.63, 95% CI 1.13-2.34) and pneumonia (OR 2.24, 95% CI 1.58-3.19). Rates
of various surgical procedures were lower, including rates of renal
transplant, joint replacement, cardiac surgery and cesarean delivery.
INTERPRETATION: The currently available data on postoperative outcomes and
surgery utilization rates for Indigenous Peoples in Canada are limited and
of poor quality. Available data suggest that Indigenous Peoples have
higher rates of death and adverse events after surgery, while also
encountering barriers accessing surgical procedures. These findings
suggest a need for substantial re-evaluation of surgical care for
Indigenous Peoples in Canada to ensure equitable access and to improve
outcomes. PROTOCOL REGISTRATION: PROSPERO-CRD42018098757. Copyright
© 2021 CMA Joule Inc. or its licensors.

<129>
Accession Number
2007324281
Title
Influence of internal thoracic artery harvesting on sternal osteoblastic
activity and perfusion.
Source
Diagnostics. 10 (11) (no pagination), 2020. Article Number: 921. Date of
Publication: November 2020.
Author
Mamchur S.; Vecherskii Y.; Chichkova T.
Institution
(Mamchur, Chichkova) Department of Cardiovascular Surgery, Research
Institute for Complex Issues of Cardiovascular Diseases, Kemerovo 650002,
Russian Federation
(Vecherskii) Department of Cardiovascular Surgery, Research Institute of
Cardiology, Tomsk 634012, Russian Federation
Publisher
MDPI AG
Abstract
The purpose of this study was to assess the sternal osteoblastic activity
and perfusion in the early period after a coronary artery bypass graft
(CABG) using single-photon emission computed tomography (SPECT) and
three-phasic dynamic scintigraphy (3PDS) with 99mTc methylene
diphosphonate (MDP). Method(s): The study group consisted of 57 male
patients that were 57.3 +/- 6.6 years of age. Thirty-six of them were
randomized into two groups: in group I (n = 18), the internal thoracic
artery (ITA) was skeletonized, and in group II (n = 18), the ITA was
pedicled. All the patients in groups I and II underwent an off-pump CABG
using 1.7 +/- 0.3 grafts, including one anastomosis of the ITA to the left
anterior descending coronary artery. The control group III (n = 21)
consisted of patients that underwent mitral valve repair surgery, in whom
the sternotomy without the ITA harvesting was performed. The 3PDS and
SPECT of the thorax with 99mTc MDP were performed 2 weeks after surgery.
 Result(s): The sternal phosphates uptake in group I was approximately
twice as high as in group II and approximately 1.5 times higher than in
group III (p < 0.05). The MDP uptake asymmetry after the ITA
skeletonization was the same as in the group with both intact ITAs. In
contrast, after the pedicled ITA harvesting, the osteoblastic activity of
the ipsilateral side of the sternum was lower than in the contralateral
one. There was no statistically significant difference in scintillation
count in the xiphoid process between groups I and II (p > 0.05); however,
we observed a significant difference in the manubrium and body (p < 0.05).
 Conclusion(s): The main factor that improved the sternal perfusion
after a CABG was the preservation of branches supplying the sternum using
the skeletonization technique of ITA harvesting. Copyright © 2020
by the authors. Licensee MDPI, Basel, Switzerland.

<130>
Accession Number
635086361
Title
Efficacy of parasternal block to decrease intraoperative opioid use in
coronary artery bypass surgery via sternotomy: A randomized controlled
trial.
Source
Regional Anesthesia and Pain Medicine. (no pagination), 2021. Article
Number: 102207. Date of Publication: 2021.
Author
Bloc S.; Perot B.P.; Gibert H.; Law Koune J.-D.; Burg Y.; Leclerc D.;
Vuitton A.-S.; De La Jonquiere C.; Luka M.; Waldmann T.; Vistarini N.;
Aubert S.; Menager M.M.; Merzoug M.; Naudin C.; Squara P.
Institution
(Bloc, Gibert, Law Koune, Burg, Leclerc, Vuitton, De La Jonquiere)
Anesthesiology Department, CMC Ambroise Pare, Neuilly-sur-Seine 92200,
France
(Bloc, Merzoug, Naudin, Squara) Clinical Research Department, CMC Ambroise
Pare, Neuilly-sur-Seine, France
(Perot, Luka, Menager) Laboratory of Inflammatory Responses and
Transcriptomic Networks in Diseases, Imagine Institute, INSERM UMR 1163,
ATIP-Avenir Team, Universite de Paris, Paris, France
(Waldmann, Vistarini, Aubert) Cardiac Surgery Department, CMC Ambroise
Pare, Neuilly-sur-Seine, France
(Squara) Critical Care Medicine Department, CMC Ambroise Pare,
Neuilly-sur-Seine, France
Publisher
BMJ Publishing Group
Abstract
Objective: This study aims to assess the effect of a preoperative
parasternal plane block (PSB) on opioid consumption required to maintain
hemodynamic stability during sternotomy for coronary artery bypass graft
surgery. Method(s): This double-blind, randomized, placebo-controlled
trial prospectively enrolled 35 patients scheduled for coronary artery
bypass graft surgery under general anesthesia with propofol and
remifentanil. Patients were randomized to receive preoperative PSB using
either ropivacaine (PSB group) or saline solution (placebo group) (1:1
ratio). The primary endpoint was the maximal effect-site concentration of
remifentanil required to maintain heart rate and blood pressure within the
recommended ranges during sternotomy. Result(s): Median maximum
concentration of remifentanil necessary to maintain adequate hemodynamic
status during sternotomy was significantly reduced in PSB group (4.2
(2.5-6.0) ng/mL) compared with placebo group (7.0 (5.2-8.0) ng/mL)
(p=0.02). Mean maximum concentration of propofol used to control depth of
anesthesia was also reduced (3.9+/-1.1 mug/mL vs 5.0+/-1.5 mug/mL, PSB vs
placebo, respectively; p=0.02). This reduction in propofol consumption
during sternotomy enabled a more adequate level of sedation to be
maintained in patients (minimum patient state index was 11.7+/-8.7 in
placebo group and 18.3+/-6.8 in PSB group; p=0.02). PSB reduced
postoperative inflammatory response by limiting concentrations of
proinflammatory cytokines IL-8, IL-18, IL-23, IL-33 and MCP-1 measured in
the first 7-day after surgery (p<0.05). Conclusion(s): Preoperative
PSB reduced the maximum concentrations of remifentanil and propofol
required to maintain hemodynamic stability and depth of anesthesia during
sternotomy. Trial registration number: NCT03734159. Sebastien Bloc,
M.D.1,2; Brieuc P. Perot, Ph.D.3; Hadrien Gibert, M.D.1; Jean-Dominique
Law Koune, M.D.1; Yannick Burg, M.D.1; Didier Leclerc, M.D.1; Anne-Sophie
Vuitton, M.D.1; Christophe De La Jonquiere, M.D.1; Marine Luka, L.S.3;
Thierry Waldmann, M.D.4; Nicolas Vistarini, M.D.4; Stephane Aubert, M.D.4;
Mickael M. Menager, Ph.D.3; Messaouda Merzoug, Ph.D.2; Cecile Naudin,
Ph.D.2; Pierre Squara, M.D.2,5 Copyright © American Society of
Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights
and permissions. Published by BMJ.

<131>
Accession Number
635102759
Title
Role of pre-operative transthoracic echocardiography in predicting
post-operative atrial fibrillation after cardiac surgery: a systematic
review of the literature and meta-analysis.
Source
Europace : European pacing, arrhythmias, and cardiac electrophysiology :
journal of the working groups on cardiac pacing, arrhythmias, and cardiac
cellular electrophysiology of the European Society of Cardiology. (no
pagination), 2021. Date of Publication: 17 May 2021.
Author
Kawczynski M.J.; Gilbers M.; Van De Walle S.; Schalla S.; Crijns H.J.;
Maessen J.G.; Schotten U.; Maesen B.; Bidar E.
Institution
(Kawczynski, Gilbers, Van De Walle, Maessen, Maesen, Bidar) Department of
Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University
Medical Centre, HX Maastricht 6229, Netherlands
(Kawczynski, Gilbers, Maessen, Schotten, Maesen, Bidar) Department of
Physiology, Maastricht University, Maastricht, Netherlands
(Schalla, Crijns) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
(Schalla, Crijns) Department of Cardiology, Heart and Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
(Schalla) Department of Radiology, Maastricht University Medical Centre,
Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: This systematic review and meta-analysis aims to evaluate the role
of pre-operative transthoracic echocardiography in predicting
post-operative atrial fibrillation (POAF) after cardiac surgery. METHODS
AND RESULTS: Electronic databases were searched for studies reporting on
pre-operative echocardiographic predictors of POAF in PubMed, Cochrane
library, and Embase. A meta-analysis of echocardiographic predictors of
POAF that were identified by at least five different publications was
performed. Forty-three publications were included in this systematic
review. Echocardiographic predictors for POAF included surrogate
parameters for total atrial conduction time (TACT), structural cardiac
changes, and functional disturbances. Meta-analysis showed that prolonged
pre-operative PA-TDI interval [5 studies, Cohen's d=1.4, 95% confidence
interval (CI) 0.9-1.9], increased left atrial volume indexed for body
surface area (LAVI) (23 studies, Cohen's d=0.8, 95% CI 0.6-1.0), and
reduced peak atrial longitudinal strain (PALS) (5 studies, Cohen's d=1.4,
95% CI 1.0-1.8), were associated with POAF incidence. Left atrial volume
indexed for body surface was the most important predicting factor in
patients without a history of AF. These parameters remained important
predictors of POAF in heterogeneous populations with variable age and
comorbidities such as coronary artery disease and valvular disease.
 CONCLUSION(S): This meta-analysis shows that increased TACT,
increased LAVI, and reduced PALS are valuable parameters for predicting
POAF in the early post-operative phase in a large variety of
patients. 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.

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