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<1>
Accession Number
2005781545
Title
Sarcopenia in Patients Undergoing Transcatheter Aortic Valve Implantation
(TAVI): A Systematic Review of the Literature.
Source
Journal of Nutrition, Health and Aging. 25 (1) (pp 64-70), 2021. Date of
Publication: January 2021.
Author
Bertschi D.; Kiss C.M.; Schoenenberger A.W.; Stuck A.E.; Kressig R.W.
Institution
(Bertschi, Kiss, Kressig) University Department of Geriatric Medicine
FELIX PLATTER, Burgfelderstrasse 101, Basel 4055, Switzerland
(Bertschi, Schoenenberger, Stuck) Department of Geriatrics, Inselspital,
Bern University Hospital, and University of Bern, Bern, Switzerland
Publisher
Serdi-Editions
Abstract
Background: In older patients, sarcopenia is a prevalent disease
associated with negative outcomes. Sarcopenia has been investigated in
patients undergoing transcatheter aortic valve implantation (TAVI), but
the criteria for diagnosis of the disease are heterogeneous. This
systematic review of the current literature aims to evaluate the
prevalence of sarcopenia in patients undergoing TAVI and to analyse the
impact of sarcopenia on clinical outcomes. Method(s): A comprehensive
search of the literature has been performed in electronic databases from
the date of initiation until March 2020. Using a pre-defined search
strategy, we identified studies assessing skeletal muscle mass, muscle
quality and muscle function as measures for sarcopenia in patients
undergoing TAVI. We evaluated how sarcopenia affects the outcomes
mortality at >=1 year, prolonged length of hospital stay, and functional
decline. Result(s): We identified 18 observational studies, enrolling
a total number of 9'513 patients. For assessment of skeletal muscle mass,
all included studies used data from computed tomography. Cutoff points for
definition of low muscle mass were heterogeneous, and prevalence of
sarcopenia varied between 21.0% and 70.2%. In uni- or multivariate
regression analysis of different studies, low muscle mass was found to be
a significant predictor of mortality, prolonged length of hospital stay,
and functional decline. No interventional study was identified measuring
the effect of nutritional or physiotherapy interventions on sarcopenia in
TAVI patients. Conclusion(s): Sarcopenia is highly prevalent among
patients undergoing TAVI, and negatively affects important outcomes. Early
diagnosis of this condition might allow a timely start of nutritional and
physiotherapy interventions to prevent negative outcomes in TAVI
patients. Copyright © 2020, Serdi and Springer-Verlag
International SAS, part of Springer Nature.

<2>
Accession Number
2004769897
Title
Predictive Value for Outcome and Evolution of Geriatric Parameters after
Transcatheter Aortic Valve Implantation.
Source
Journal of Nutrition, Health and Aging. 24 (6) (pp 598-605), 2020. Date of
Publication: 01 Jun 2020.
Author
Roca F.; Durand E.; Eltchaninoff H.; Chassagne P.
Institution
(Roca, Chassagne) Department of Geriatric medicine, Rouen University
Hospital, Rouen F 76000, France
(Durand, Eltchaninoff) Department of Cardiology, Rouen University
Hospital, FHU REMOD-VHF, Rouen F 76000, France
(Roca) Service de Medecine Geriatrique, CHU de Rouen, Rouen Cedex 76031,
France
Publisher
Serdi-Editions
Abstract
Objectives: To identify parameters of comprehensive geriatric assessment
(CGA) CGA including ABCDEF score, a multidomain frailty assessment,
associated with poor outcome after TAVI and to assess the evolution of CGA
parameters at 6-months follow-up. Design(s): One-year monocentric
prospective cohort study. Setting(s): Departments of geriatric
medicine and cardiology in Rouen University Hospital, Normandy, France.
 Participant(s): All patients over 70, selected for TAVI by a
multidisciplinary "heart team". Measurements: 8-areas CGA was performed
before TAVI and at 6-months follow-up. Poor outcome was defined as
decrease in 1 BADL or unplanned readmission at 6 months or death within
the first year after TAVI. Geriatric characteristics associated with poor
outcome were assessed by logistic regression with surgical scores as
bivariable. Geriatric characteristics were compared between baseline and
6-months follow-up. Result(s): 114 patients (mean age 85.8+/-5.3
years) were included. Mean EuroSCORE was 19.1+/-10.6%. Poor outcome
occurred in 57(50.0%) patients. Loss of one BADL (OR: 1.66,
95CI[1.11-2.48]), decrease in IADL (OR: 1.41, 95CI[1.14-1.74]), in
plasmatic albumin (OR: 1.10, 95CI[1.01-1.20]), in MMSe (OR: 1.13,
95CI[1.02-1.26]), low walking speed (OR: 1.53, 95CI[1.01-2.33]) and ABCDEF
score >=2 (OR: 1.63, 95CI[1.09-2.42]) were independently associated with
poor outcome. In survivors with complete follow-up (n=80), most geriatric
parameters were maintained 6 months after TAVI, but IADL decreased
(5.6+/-1.9 to 4.9+/-2.2, p<0.001). MMSe increased in patients with
previous cognitive impairments whereas it decreased in those without
(p<0.001). Conclusion(s): CGA parameters are independently associated
with poor outcome after TAVI. These parameters, but IADL, are maintained
at 6 months and course of the MMSe depends on previous cognitive
status. Copyright © 2020, Serdi and Springer-Verlag International
SAS, part of Springer Nature.

<3>
Accession Number
2007517241
Title
Comparison between the effect of aromatherapy with lavender and damask
rose on sleep quality in patients undergoing coronary artery bypass graft
surgery: A randomized clinical trial.
Source
ARYA Atherosclerosis. 17 (1) (no pagination), 2021. Article Number: 2064.
Date of Publication: 15 Jan 2021.
Author
Emami-Sigaroudi A.; Salari A.; Nourisaeed A.; Ahmadnia Z.; Ashouri A.;
Modallalkar S.S.; Javadzadeh-Moghtader A.; Parvinroo S.; Dadkhah-Tirani H.
Institution
(Emami-Sigaroudi, Salari, Nourisaeed, Ahmadnia, Modallalkar,
Javadzadeh-Moghtader, Parvinroo, Dadkhah-Tirani) Cardiovascular Diseases
Research Center AND Department of Cardiology, Heshmat Hospital, School of
Medicine, Guilan University of Medical Sciences, Rasht, Iran, Islamic
Republic of
(Ashouri) Research Center of Health and Environment AND Department of
Health Education and Promotion, School of Health, Guilan University of
Medical Sciences, Rasht, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS)
Abstract
BACKGROUND: Numerous studies have investigated the effect of lavender and
damask rose aromatherapy on sleep quality. There is, however, little
research to compare the impact of them over each other. The aim of current
study was to compare the effect of aromatherapy with lavender and damask
rose on sleep quality in patients after coronary artery bypass graft
(CABG) surgery in Guilan Province, Iran, in 2017-2018. METHOD(S): In
this randomized clinical trial (RCT) study, 97 patients undergoing CABG
were randomly assigned to intervention or control groups. In the
intervention groups, the patients were asked by the researcher to inhale
the lavender or damask rose randomly every night for 5 consecutive nights
at 22:00. The control group received routine nursing care in compliance
with the hospital procedure. Data were obtained by demographic-clinical
and Beck Depression Inventory (BDI) questionnaires. To analyze the data,
chi-square test, t-test, Kruskal-Wallis test, and Wilcoxon test were used.
 RESULT(S): During the 5-night intervention period, despite a relative
improvement of sleep quality in intervention groups compared to the
control group, none of the two aromatherapies had a statistically
significant effect on any of delayed sleep (P = 0.514), sleep duration (P
= 0.839), sleep efficiency (P = 0.067), sleep disturbances (P = 0.061),
and daily functional disorders (P = 0.114) except for subjective sleep
quality (P = 0.016) and use of sleep medications (P = 0.031).
 CONCLUSION(S): Using both aromatherapies with lavender and damask
rose indicated positive effects on sleep quality of the CABG patients, but
we could not find a superiority over each other. Copyright ©
2021, Isfahan University of Medical Sciences(IUMS). All rights reserved.

<4>
Accession Number
635011044
Title
Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve
Disease-A Systematic Review of the Literature.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 629227. Date of Publication: 24 Mar 2021.
Author
Cave D.G.W.; Panayiotou H.; Bissell M.M.
Institution
(Cave, Panayiotou, Bissell) Department of Biomedical Imaging Science,
Leeds Institute of Cardiovascular and Metabolic Medicine, University of
Leeds, Leeds, United Kingdom
Publisher
Frontiers Media S.A.
Abstract
Bicuspid aortic valve (BAV) disease presents a unique management challenge
both pre- and post-operatively. 4D flow MRI offers multiple tools for the
assessment of the thoracic aorta in aortic valve disease. In particular,
its assessment of flow patterns and wall shear stress have led to new
understandings around the mechanisms of aneurysm development in BAV
disease. Novel parameters have now been developed that have the potential
to predict pathological aortic dilatation and may help to risk stratify
BAV patients in future. This systematic review analyses the current 4D
flow MRI literature after aortic valve and/or ascending aortic replacement
in bicuspid aortic valve disease. 4D flow MRI has also identified distinct
challenges posed by this cohort at the time of valve replacement compared
to standard management of tri-leaflet disorders, and may help tailor the
type and timing of replacement. Eccentric pathological flow patterns seen
after bioprosthetic valve implantation, but not with mechanical
prostheses, might be an important future consideration in intervention
planning. 4D flow MRI also has promising potential in supporting the
development of artificial valve prostheses and aortic conduits with more
physiological flow patterns. © Copyright © 2021 Cave,
Panayiotou and Bissell.

<5>
Accession Number
635009794
Title
Radiation-Induced Vascular Disease-A State-of-the-Art Review.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 652761. Date of Publication: 30 Mar 2021.
Author
Yang E.H.; Marmagkiolis K.; Balanescu D.V.; Hakeem A.; Donisan T.; Finch
W.; Virmani R.; Herrman J.; Cilingiroglu M.; Grines C.L.; Toutouzas K.;
Iliescu C.
Institution
(Yang, Finch) Cardio-Oncology Program, Division of Cardiology, Department
of Medicine, University of California, Los Angeles, Los Angeles, CA,
United States
(Marmagkiolis) Hospital Corporation of America Northside Hospital, St.
Petersburg, FL, United States
(Balanescu, Donisan) Department of Internal Medicine, Beaumont Hospital,
Royal Oak, MI, United States
(Hakeem) Division of Cardiovascular Diseases & Hypertension, Robert Wood
Johnson Medical School, New Brunswick, NJ, United States
(Virmani) CVPath Institute, Gaithersburg, MD, United States
(Herrman) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Cilingiroglu, Iliescu) Department of Cardiology, The University of Texas
MD Anderson Cancer Center, Houston, TX, United States
(Cilingiroglu) University of Hawaii John Burns School of Medicine,
Honolulu, HI, United States
(Grines) Cardiovascular Institute, Northside Hospital, Atlanta, GA, United
States
(Toutouzas) Athens Medical School, Hippokration General Hospital, Athens,
Greece
Publisher
Frontiers Media S.A.
Abstract
Since the 1990s, there has been a steady increase in the number of cancer
survivors to an estimated 17 million in 2019 in the US alone. Radiation
therapy today is applied to a variety of malignancies and over 50% of
cancer patients. The effects of ionizing radiation on cardiac structure
and function, so-called radiation-induced heart disease (RIHD), have been
extensively studied. We review the available published data on the
mechanisms and manifestations of RIHD, with a focus on vascular disease,
as well as proposed strategies for its prevention, screening, diagnosis,
and management. © Copyright © 2021 Yang, Marmagkiolis,
Balanescu, Hakeem, Donisan, Finch, Virmani, Herrman, Cilingiroglu, Grines,
Toutouzas and Iliescu.

<6>
Accession Number
2011117206
Title
Systematic Review of Minimally Invasive Surgery for Mitral Valve Infective
Endocarditis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 16 (3) (pp 244-248), 2021. Date of Publication: May 2021.
Author
Shih E.; Squiers J.J.; DiMaio J.M.
Institution
(Shih, Squiers, DiMaio) Baylor Scott White Research Institute, The Heart
Hospital Baylor Plano, Plano, TX, United States
(Shih, Squiers) Department of Surgery, Baylor University Medical Center,
Dallas, TX, United States
(DiMaio) Department of Cardiothoracic Surgery, The Heart Hospital, Plano,
TX, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: The scope of application of minimally invasive mitral valve
surgery is expanding. However, the safety and efficacy of minimally
invasive mitral valve surgery in the setting of infective endocarditis is
not well known. We sought to identify the best evidence available to
support a minimally invasive surgical approach for mitral valve infective
endocarditis. Method(s): A systematic review of minimally invasive
mitral valve surgery for infective endocarditis was conducted according to
the Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA) guidelines. Result(s): A total of 6 manuscripts describing
271 patients were identified. Mean age was 60.4 +/- 14.9 years old, and
60.1% patients were male. Mean EuroSCORE II was 24.6 +/- 23.2. Mitral
valve repair was achieved in 32.4% of cases. The average in-hospital
mortality was 9.4%, and average length of hospital stay was 21.6 days.
Survival was 89.1% at 30 days, and 1-year survival was 79.3%. Rate of
conversion to sternotomy was 1.8%. Postoperative complications included:
6.9% postoperative bleeding, 9.3% new postoperative dialysis, 2.3%
postoperative stroke, and 3.4% recurrence of endocarditis. Reoperation
over the long-term was required in 9.3% of cases. Conclusion(s):
Minimally invasive mitral valve surgery for infective endocarditis has
acceptable perioperative morbidity as well as short- and intermediate-term
mortality at experienced centers. Minimally invasive mitral valve surgery
may be an acceptable alternative approach to infective endocarditis and
warrants further study. Copyright © The Author(s) 2021.

<7>
Accession Number
2005033251
Title
Comparison of infective endocarditis risk between balloon and
self-expandable valves following transcatheter aortic valve replacement:
systematic review and meta-analysis.
Source
Cardiovascular Intervention and Therapeutics. 36 (3) (pp 363-374), 2021.
Date of Publication: July 2021.
Author
Prasitlumkum N.; Thangjui S.; Leesutipornchai T.; Kewcharoen J.;
Limpruttidham N.; Pai R.G.
Institution
(Prasitlumkum, Kewcharoen, Limpruttidham) University of Hawaii Internal
Medicine Residency Program, 1356 Lusitana St, Honolulu, HI 96813, United
States
(Thangjui, Leesutipornchai) Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
(Pai) Department of Cardiology, University of California Riverside,
Riverside, CA, United States
Publisher
Springer Japan
Abstract
This study aimed to compare incidence of IE between BE and SE valves by
performing a systematic review and meta-analysis of the literature. We
comprehensively searched the databases of MEDLINE and EMBASE from
inception to November 2019. Included studies were published observational
studies that compared the risk of IE among patients undergoing TAVR
employing BE versus SE valves, using the random-effects to calculate risk
ratios and 95% confidence intervals (CIs).Ten cohort studies from April
2013 to November 2019 were included in this meta-analysis involving 13,478
subjects (6289 SE and 7189 BE types). Our study showed no statistical
difference in IE rates between each type of valves (pooled OR 0.96, 95%
CI: 0.68-1.35, p = 0.801 with I2 = 14.7%). There was no difference in IE
rate between BE and SE valves following TAVR. Further studies are
warranted to confirm our findings. Copyright © 2020, Japanese
Association of Cardiovascular Intervention and Therapeutics.

<8>
Accession Number
635388020
Title
Inhalational versus intravenous anesthetics during one lung ventilation in
elective thoracic surgeries: A narrative review.
Source
Saudi Journal of Anaesthesia. 15 (3) (pp 312-323), 2021. Date of
Publication: July-September 2021.
Author
Parab S.; Gaikwad S.; Majeti S.
Institution
(Parab, Gaikwad, Majeti) Department of Anesthesiology Critical Care and
Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Maharashtra,
Mumbai, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
The anesthesia regimen used during one lung ventilation (OLV) carry the
potential to affect intra-operative course and post-operative outcomes, by
its effects on pulmonary vasculature and alveolar inflammation. This
narrative review aims to understand the pathophysiology of acute lung
injury during one lung ventilation, and to study the effects of
inhalational versus intravenous anaesthetics on intraoperative and
post-operative outcomes, following thoracic surgery. For this purpose, we
independently searched 'PubMed', 'Google Scholar' and 'Cochrane Central'
databases to find out randomized controlled trials (RCTs), in English
language, which compared the effects of intravenous versus inhalational
anaesthetics on intraoperative and post-operative outcomes, in elective
thoracic surgeries, in human beings. In total, 38 RCTs were included in
this review. Salient results of the review are- Propofol reduced
intraoperative shunt and maintained better intraoperative oxygenation than
inhalational agents. However, use of modern inhalational anaesthetics
during OLV reduced alveolar inflammation significantly, as compared to
propofol. Regarding post-operative complications, the evidence is not
conclusive enough but slightly in favour of inhalational anaesthetics.
Thus, we conclude that modern inhalational anaesthetics, by their virtue
of better anti-inflammatory properties, exhibit lung protective effects
and hence, seem to be safe for maintenance of anesthesia during OLV in
elective thoracic surgeries. Further research is required to establish the
safety of these agents with respect to long term post-operative outcomes
like cancer recurrence. Copyright © 2021 Saudi Journal of
Anesthesia Published by Wolters Kluwer - Medknow.

<9>
Accession Number
2013299104
Title
Potential causes of paraplegia after coronary artery bypass grafting: A
literature review.
Source
Heart Surgery Forum. 24 (30) (pp E487-E492), 2021. Date of Publication: 11
May 2021.
Author
Cheng Z.; Xu J.; Guo Y.
Institution
(Cheng, Guo) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Sichuan, Chengdu, China
(Xu) Department of Cardiology, first hospital of Lanzhou University,
Gansu, Lanzhou, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Paraplegia is an unpredictable neurologic complication after coronary
artery bypass grafting (CABG) surgery. It is rare but fatal, and the
mechanism still is unclear. We aimed to make a summary of the possible
causes of paraplegia after CABG. Pubmed database was searched from January
1, 1978 to December 31, 2019, and 14 studies were finally included.
Paraplegia after CABG is a multifactorial consequence, but spinal cord
ischemia is the key pathological factor to postoperative
paraplegia. Copyright © 2021 Forum Multimedia Publishing, LLC

<10>
Accession Number
2013301210
Title
Safety of Direct Oral Anticoagulants Compared to Warfarin for Atrial
Fibrillation after Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Hage A.; Dolan D.P.; Nasr V.G.; Castelo-Branco L.; Motta-Calderon D.;
Ghandour H.; Hage F.; Papatheodorou S.; Chu M.W.A.
Institution
(Hage, Dolan, Nasr, Castelo-Branco, Motta-Calderon, Hage, Papatheodorou)
Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,
United States
(Hage, Hage, Chu) Division of Cardiac Surgery, Western University, London,
ON, Canada
(Dolan) Division of Thoracic Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Nasr) Division of Cardiac Anesthesia, Department of Anesthesiology,
Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA,
United States
(Castelo-Branco) Neuroscience, Neuromodulation Center, Spaulding
Rehabilitation Hospital, Boston, MA, United States
(Motta-Calderon) Division of General Internal Medicine, Brigham and
Women's Hospital, Boston, MA, United States
(Ghandour) Global Surgery, Harvard Medical School, Boston, MA, United
States
Publisher
W.B. Saunders
Abstract
The evidence for use of direct oral anticoagulants (DOACs) in the
management of post-operative cardiac surgery atrial fibrillation is
limited and mostly founded on clinical trials that excluded this patient
population. We performed a systematic review and meta-analysis of clinical
trials and observational studies to evaluate the hypothesis that DOACs are
safe compared to warfarin for the anticoagulation of patients with
post-operative cardiac surgery atrial fibrillation. We searched PubMed,
EMBASE, Web of Science, clinicaltrials.gov, and the Cochrane Library for
clinical trials and observational studies comparing DOAC with warfarin in
patients >=18 years old who had post-cardiac surgery atrial fibrillation.
Primary outcomes included stroke, systemic embolization, bleeding, and
mortality. We performed a random-effects meta-analysis of all outcomes.
The meta-analysis for the primary outcomes showed significantly lower risk
of stroke with DOAC use (6 studies, 7143 patients, RR 0.64; 95% CI
0.50-0.81, I2: 0.0%) compared to warfarin, a trend towards
lower risk of systemic embolization (4 studies, 7289 patients, RR 0.64,
95% CI 0.41-1.01, I2: 31.99%) and similar risks of bleeding (14
studies, 10182 patients, RR 0.91; 95% CI 0.74-1.10, I2: 26.6%)
and mortality (12 studies, 9843 patients, relative risk [RR] 1.01; 95% CI
0.74-1.37, I2: 26.5%). Current evidence suggests that DOACs,
compared to warfarin, in the management of atrial fibrillation after
cardiac surgery is associated with lower risk of stroke and a strong trend
for lower risk of systemic embolization, and no evidence of increased risk
for hospital readmission, bleeding and mortality. Copyright ©
2021 Elsevier Inc.

<11>
Accession Number
2013264659
Title
Comparison of SYNTAX score strata effects of percutaneous and surgical
revascularization trials: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Gaudino M.; Hameed I.; Di Franco A.; Naik A.; Demetres M.; Biondi-Zoccai
G.; Bangalore S.
Institution
(Gaudino, Hameed, Di Franco, Naik) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
(Hameed) Section of Cardiac Surgery, Yale University School of Medicine,
New Haven, Conn, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Bangalore) New York University Grossman School of Medicine, New York, New
York, NY, United States
Publisher
Mosby Inc.
Abstract
Objectives: The evidence supporting the use of the Synergy Between
Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)
score for risk stratification is controversial. We performed a systematic
review and meta-analysis of all the randomized controlled trials comparing
percutaneous coronary intervention versus coronary artery bypass grafting
that reported their outcomes stratified by SYNTAX score, focusing on
between-strata comparisons. Method(s): A systematic review of
MEDLINE, EMBASE, Cochrane Library databases was performed. Incidence rate
ratios were pooled with a random effect model. Between-group statistical
heterogeneity according to accepted SYNTAX score tertiles was computed in
the main analysis. Ratios of incidence rate ratios were computed to
appraise between-strata effect, as sensitivity analysis. Primary and
secondary outcomes were major adverse cardiac and cerebrovascular events
and all-cause mortality, respectively. Separate sub-analyses were
performed for left main and multivessel disease. Result(s): From 425
citations, 6 trials were eventually included (8269 patients [4134
percutaneous coronary interventions, 4135 coronary artery bypass
graftings]; mean follow-up: 6.2 years [range: 3.8-10]). Overall,
percutaneous coronary intervention was associated with a significant
increase in major adverse cardiac and cerebrovascular events (incidence
rate ratio, 1.39, 95% confidence interval, 1.27-1.51) and nonsignificant
increase in all-cause mortality (incidence rate ratio, 1.17, 95%
confidence interval, 0.98-1.40). There was no significant statistical
heterogeneity of treatment effect by SYNTAX score for major adverse
cardiac and cerebrovascular events or mortality (P = .40 and P = .34,
respectively). Results were consistent also for patients with left main
and multivessel disease (major adverse cardiac and cerebrovascular events:
P = .85 in left main, P = .78 in multivessel disease 0.78; mortality: P =
.12 in left main; P = .34 in multivessel disease). Results of analysis
based on ratios of incidence rate ratios were consistent with the main
analysis. Conclusion(s): No significant association was found between
SYNTAX score and the comparative effectiveness of percutaneous coronary
intervention and coronary artery bypass grafting. These findings have
implications for clinical practice, future guidelines, and the design of
percutaneous coronary intervention versus coronary artery bypass grafting
trials. Copyright © 2021 The American Association for Thoracic
Surgery

<12>
Accession Number
2012931208
Title
COVID-19 in heart transplant recipients during February-August 2020: A
systematic review.
Source
Clinical Transplantation. (no pagination), 2021. Date of Publication:
2021.
Author
Diaz-Arocutipa C.; Carvallo-Castaneda D.; Luis-Ybanez O.; Pariona M.;
Rivas-Lasarte M.; Alvarez-Garcia J.
Institution
(Diaz-Arocutipa) Vicerrectorado de Investigacion, Universidad San Ignacio
de Loyola, Lima, Peru
(Diaz-Arocutipa) Programa de Atencion Domiciliaria (PADOMI) - EsSalud,
Lima, Peru
(Diaz-Arocutipa, Carvallo-Castaneda, Luis-Ybanez) Asociacion para el
Desarrollo de la Investigacion Estudiantil en Ciencias de la Salud
(ADIECS), Lima, Peru
(Carvallo-Castaneda) Puesto de Salud Pacaycasa, Ministerio de Salud,
Ayacucho, Peru
(Luis-Ybanez) Facultad de Medicina de San Fernando, Universidad Nacional
Mayor de San Marcos, Lima, Peru
(Pariona) Departamento de Cardiologia, Hospital Nacional Edgardo
Rebagliati Martins, Lima, Peru
(Rivas-Lasarte) Unidad de Insuficiencia Cardiaca Avanzada y Trasplante
Cardiaco, Hospital Universitario Puerta de Hierro, Madrid, Spain
(Rivas-Lasarte, Alvarez-Garcia) Centro de Investigacion Biomedica en Red
de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
(Alvarez-Garcia) Unidad de Insuficiencia Cardiaca Avanzada. Servicio de
Cardiologia del Hospital Universitario Ramon y Cajal, Madrid, Spain
(Alvarez-Garcia) Universidad Autonoma de Barcelona, Barcelona, Spain
Publisher
Blackwell Publishing Ltd
Abstract
The coronavirus disease 2019 (COVID-19) pandemic represents a major
concern in immunosuppressed patients such as heart transplant recipients.
Therefore, we performed a systematic review to summarize the clinical
features, treatment, and outcomes of heart transplant recipients with
COVID-19. We searched electronic databases from inception to January 11,
2021. Thirty-nine articles (22 case reports and 17 cohorts) involving 415
patients were included. The mean age was 59.9 +/- 15.7 years and 77% of
patients were men. In cohort studies including outpatients and inpatients,
the hospitalization rate was 77%. The most common symptoms were fever
(70%) and cough (67%). Inflammatory biomarkers (C-reactive protein and
procalcitonin) were above the normal range. Forty-eight percent of
patients presented with severe or critical COVID-19. Hydroxychloroquine
(54%), azithromycin (14%), and lopinavir/ritonavir (14%) were the most
commonly used drugs. Forty-nine percent of patients discontinued the
baseline regimen of antimetabolites. In contrast, 59% and 73% continued
the same regimen of calcineurin inhibitors and corticosteroids,
respectively. Short-term mortality among cohorts limited to inpatients was
25%. Our review suggests that heart transplant recipients with COVID-19
exhibited similar demographic and clinical features to the general
population. However, the prognosis was poor in these
patients. Copyright © 2021 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<13>
Accession Number
2012909324
Title
Glycaemic stability and length of stay: Tight versus conventional
intraoperative glycaemic control protocols among patients with diabetes
mellitus undergoing coronary artery bypass graft surgery.
Source
International Journal of Clinical Practice. (no pagination), 2021. Date of
Publication: 2021.
Author
Hayajneh A.A.; Hweidi I.M.; Zytoon A.M.
Institution
(Hayajneh) Adult Health-Nursing Department, Faculty of Nursing, Jordan
University of Science and Technology, Irbid, Jordan
(Hweidi) School of Nursing, Adult Health Nursing Department, Jordan
University of Science and Technology, Irbid, Jordan
(Zytoon) Adult Health Nursing Department, Jordan University of Science and
Technology, Irbid, Jordan
Publisher
Blackwell Publishing Ltd
Abstract
Background: Intraoperative glycaemic stability and control among patients
with diabetes mellitus (DM) undergoing coronary artery bypass grafting
(CABG) surgery have been a major concern. The current study aimed to
compare the effect of tight glycaemic control and conventional glycaemic
control on glycaemic stability and length of stay (LOS) among diabetic
patients undergoing CABG surgery. Method(s): This study utilised a
randomised control trial design among a convenience sample of 144
patients. Participants were randomly assigned to either the tight or
conventional glycaemic control groups. The repeated measures analysis of
variance (ANOVA) test and an independent samples t test were used to
assess the variations in blood glucose (BG) level and LOS based on insulin
therapy type. Result(s): Patients who received the tight glycaemic
control protocol had significantly more consistent and lower mean
intraoperative BG levels than did patients who received the conventional
glycaemic control protocol. No statistically significant differences in
hospital LOS in days were identified between the two groups.
 Conclusion(s): Healthcare providers, including physicians and nurses,
should consider using tight glycaemic control therapy among patients
undergoing coronary artery bypass graft (CABG) surgery. This may lead to
increased BG level consistency and stability and lower mean intraoperative
BG level across time. Copyright © 2021 John Wiley & Sons Ltd

<14>
Accession Number
635393823
Title
Urinary metabolic profile and stone composition in kidney stone formers
with and without heart disease.
Source
Journal of nephrology. (no pagination), 2021. Date of Publication: 21 Jun
2021.
Author
Bargagli M.; Moochhala S.; Robertson W.G.; Gambaro G.; Lombardi G.; Unwin
R.J.; Ferraro P.M.
Institution
(Bargagli, Ferraro) U.O.S. Terapia Conservativa della Malattia Renale
Cronica, U.O.C. Nefrologia, Fondazione Policlinico Universitario A.
Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Largo Agostino
Gemelli 8, Rome 00168, Italy
(Moochhala, Robertson, Unwin) Department of Renal Medicine, Royal Free
Campus Medical School ,University College Hospital, London, United Kingdom
(Robertson) Nuffield Department of Surgical Sciences, University of
Oxford, Oxford, United Kingdom
(Gambaro, Lombardi) Renal Unit, Division of Nephrology and Dialysis,
Department of Medicine, University of Verona, Verona, Italy
(Ferraro) Dipartimento Universitario di Medicina e Chirurgia
Traslazionale, Universita Cattolica del Sacro Cuore, Rome, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Kidney stone disease seems to be associated with an increased
risk of incident cardiovascular outcomes; the aim of this study is to
identify differences in 24-h urine excretory profiles and stone
composition among stone formers with and without cardiovascular disease
(CVD). METHOD(S): Data from patients attending the Department of
Renal Medicine's metabolic stone clinic from 1995 to 2012 were reviewed.
The sample was divided according to the presence or absence of CVD
(myocardial infarction, angina, coronary revascularization, or surgery for
calcified heart valves). Univariable and multivariable regression models,
adjusted for age, sex, BMI, hypertension, diabetes, eGFR, plasma
bicarbonate and potential renal acid load of foods were used to
investigate differences across groups. RESULT(S): 1826 patients had
available data for 24-h urine analysis. Among these, 108 (5.9%) had a
history of CVD. Those with CVD were older, have higher prevalence of
hypertension and diabetes and lower eGFR. Univariable analysis showed that
patients with CVD had significantly lower 24-h urinary excretions for
citrate (2.4 vs 2.6 mmol/24 h, p = 0.04), magnesium (3.9 vs 4.2 mmol/24 h,
p = 0.03) and urinary pH (6.1 vs 6.2, p = 0.02). After adjustment for
confounders, differences in urinary citrate and magnesium excretions
remained significant. No differences in the probability of stone formation
or stone compositions were found. CONCLUSION(S): Stone formers with
CVD have lower renal alkali excretion, possibly suggesting higher acid
retention in stone formers with cardiovascular comorbidities. Randomized
clinical trials including medications and a controlled diet design are
needed to confirm the results presented here.

<15>
Accession Number
635393806
Title
Recruitment maneuvers in patients undergoing thoracic surgery: a
meta-analysis.
Source
General thoracic and cardiovascular surgery. (no pagination), 2021. Date
of Publication: 21 Jun 2021.
Author
Hu M.-C.; Yang Y.-L.; Chen T.-T.; Chen J.-T.; Tiong T.-Y.; Tam K.-W.
Institution
(Hu, Chen) Graduate Institute of Clinical Medicine, College of Medicine,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Hu, Chen) Division of Pulmonary Medicine, Department of Internal
Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City,
Taiwan (Republic of China)
(Yang) School of Respiratory Therapy, College of Medicine, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Yang) Department of Respiratory Therapy, Landseed International Hospital,
Taoyuan, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical
University, New Taipei City, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Tiong) Division of Thoracic Surgery, Department of Surgery, Shuang Ho
Hospital, Taipei Medical University, New Taipei City, Taiwan (Republic of
China)
(Tam) Division of General Surgery, Department of Surgery, Shuang Ho
Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe
District, New Taipei City, 23561, Taiwan
(Tam) Division of General Surgery, Department of Surgery, School of
Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Tam) Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan (Republic
of China)
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Pulmonary atelectasis is a common postoperative complication
that may lead to intrapulmonary shunt, refractory hypoxemia, and
respiratory distress. Recruitment maneuvers may relieve pulmonary
atelectasis in patients undergoing thoracic surgery. This meta-analysis of
randomized controlled trials (RCTs) is to evaluate the effectiveness and
safety of recruitment maneuvers in patients undergoing thoracic surgery.
 METHOD(S): We performed a literature search on the PubMed, Embase,
and Cochrane Library databases and the ClinicalTrials.gov registry for
trials published before April 2021. We investigated postoperative
pulmonary atelectasis incidence, intrapulmonary shunt fraction, static
lung compliance, and mean arterial pressure. RESULT(S): Six RCTs
involving 526 patients were reviewed. Patients receiving a recruitment
maneuver exhibited a significant decrease in intrapulmonary shunt fraction
[weighted mean difference (WMD)-0.02, 95% CI-0.03 to-0.01], improved
static lung compliance (WMD 2.16; 95% CI 1.14-3.18), and PaO2/FIO2 ratio
(WMD 31.31; 95% CI 12.11-50.52) without a significant difference in mean
arterial pressure (WMD-0.64; 95% CI-4.92 to 3.64). The incidence pulmonary
atelectasis favored recruitment maneuver group, but was not statistically
significant (RR 0.55; 95% CI 0.27-1.12). CONCLUSION(S): Recruitment
maneuvers may be a viable treatment for reducing intra-pulmonary shunt and
improving static lung compliance and PaO2/FIO2 ratio without the
disturbance of hemodynamics in patients undergoing thoracic surgery.

<16>
Accession Number
635393393
Title
Is hybrid coronary revascularization really beneficial in the long term?.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 21 Jun 2021.
Author
Wang C.; Li P.; Zhang F.; Li J.; Kong Q.
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This analysis aimed to compare both short- and long-term
outcomes of hybrid coronary revascularization (HCR) with different
techniques and coronary artery bypass grafting (CABG). METHOD(S):
Twenty-three studies were included, covering 10 468 different patients,
among whom 2403 patients underwent HCR with either simultaneous or staged
method and 8065 patients underwent CABG. RESULT(S): Compared with
CABG, HCR had a statistically significant lower risk of stroke [odds ratio
(OR) = 0.55, P=0.049], major adverse cardiac and cerebrovascular events
(OR=0.69, P=0.024) and blood transfusion (BT) (OR=0.39, P<0.001), whereas
no significant differences were detected in mortality, myocardial
infarction and repeat revascularization. A network meta-analysis showed
that simultaneous HCR had significantly better outcomes in stroke
(OR=0.24, P=0.01) and major adverse cardiac and cerebrovascular events
(OR=0.29, P<0.001), and staged HCR had a significantly better outcome in
BT (OR = 0.31, P<0.001). According to the frequentist statistic results,
simultaneous HCR had the highest probability of being the best treatment
in terms of mortality (84%), stroke (97%), myocardial infarction (88%) and
major adverse cardiac and cerebrovascular events (99%), whereas staged HCR
had the highest probability of being the best in postoperative repeat
revascularization (59%) and BT (83%). However, long-term results showed no
significant difference between the HCR and CABG techniques.
 CONCLUSION(S): HCR appears to be a feasible option for multivessel
coronary artery disease patients. Compared to traditional CABG, HCR had
lower risk of adverse events in the short term, but in the long term,
survival rate and freedom from major adverse cardiac and cerebrovascular
events rate were similar between groups. Copyright © The
Author(s) 2021. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<17>
Accession Number
2010324642
Title
Ivabradine plus conventional treatment vs conventional treatment alone in
reducing the mean heart rate in heart transplant recipients: A randomized
clinical trial.
Source
Clinical Transplantation. 35 (4) (no pagination), 2021. Article Number:
e14227. Date of Publication: April 2021.
Author
dos Santos C.C.; Rossi Neto J.M.; Finger M.A.; Timerman A.; Contreras C.;
Chaccur P.
Institution
(dos Santos, Rossi Neto, Finger, Timerman, Contreras, Chaccur) Instituto
Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
Publisher
Blackwell Publishing Ltd
Abstract
The absence of afferent nerves for heart rate (HR) regulation leaves the
transplanted heart under the influence of its internal and hormonal
control. The HR of heart transplantation (HTx) recipients varies from to
90-110 bpm, indicating a lack of vagal parasympathetic tone. We
hypothesized that the reduction in mean HR using an If-channel antagonist
(ivabradine) could be effective and safe in HTx recipients. The primary
objective of this open-label randomized clinical trial was to compare the
mean HR at 3, 6, 12, 18, 24, 30, and 36 months after randomization between
an ivabradine plus conventional treatment group (IG) and conventional
treatment alone group (CG). The secondary objectives were reduction in
mortality, graft dysfunction, and ventricular mass. All patients were
randomized between 1 and 12 months after HTx. Ivabradine started at
randomization. Of the 35 patients, 54.28% were in the CG and 45.72% in the
IG. There were no significant between-group differences in demographics.
Over time, the HR differences between the groups became significant (P
<.01). There were no significant between-group differences in mortality,
graft dysfunction, and ventricular mass. We conclude that ivabradine could
effectively and consistently reduce the HR in HTx
recipients. Copyright © 2021 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd

<18>
Accession Number
635010164
Title
Impact of Serum Uric Acid Lowering and Contemporary Uric Acid-Lowering
Therapies on Cardiovascular Outcomes: A Systematic Review and
Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 641062. Date of Publication: 23 Mar 2021.
Author
Ying H.; Yuan H.; Tang X.; Guo W.; Jiang R.; Jiang C.
Institution
(Ying, Tang, Guo, Jiang, Jiang) Key Laboratory of Cardiovascular
Intervention and Regenerative Medicine of Zhejiang Province, Department of
Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of
Medicine, Hangzhou, China
(Yuan) Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang
University School of Medicine, Hangzhou, China
Publisher
Frontiers Media S.A.
Abstract
Objective: This study aimed to evaluate the potential association between
uric acid (UA) lowering and cardiovascular risk reduction among
UA-lowering therapies in adults. Method(s): A systematic search for
randomized controlled trials (RCTs) was conducted according to the
protocol pre-registered in PROSPERO (No. CRD42020199259). We search for
RCTs in PubMed, Embase, Web of Science, the Cochrane Library, and
ClinicalTrials.gov up to July 1, 2020. A meta-analysis was performed using
a fixed- or random-effects model. Result(s): In total, 30 studies
involving 18,585 hyperuricaemic patients were included. Xanthine oxidase
inhibitor (XOI) therapy produced a 6.0% reduction in relative risk (RR)
for major adverse cardiovascular events (MACEs). The use of febuxostat was
associated with a higher risk of cardiovascular events (CVEs) (RR: 1.09,
95% CI 0.998-1.19, I2 = 0.0%), but the difference was not
statistically significant. Allopurinol treatment was associated with a
lower CVE risk (RR: 0.61, 95% CI 0.46-0.80, I2 = 21.0%). Among
the UA-lowering therapies, the drug treatments were associated with
all-cause mortality (RR: 1.20, 95% CI 1.02-1.41, I2 = 0.0%).
The subgroup with a UA endpoint <7 mg/dl was not associated with a higher
CVE risk (RR: 0.57, 95% CI 0.35-0.92, I2 = 0.0%), and in the
subgroup with a UA endpoint <5 mg/dl group, a lower risk of CVEs was not
observed (RR: 0.99, 95% CI 0.69-1.44, I2 = 0.0%).
 Conclusion(s): UA reduction caused by XOIs reduced the incidence of
MACEs. UA-lowering medicines were associated with changes in all-cause
mortality but not cardiovascular outcomes. The lower UA endpoint was not
associated with reduced cardiovascular risk. © Copyright ©
2021 Ying, Yuan, Tang, Guo, Jiang and Jiang.

<19>
Accession Number
2007504155
Title
AviteneTM microfibrillar collagen hemostat for adjunctive hemostasis in
surgical procedures: A systematic literature review.
Source
Medical Devices: Evidence and Research. 14 (pp 155-163), 2021. Date of
Publication: 2021.
Author
Cziperle D.J.
Institution
(Cziperle) Ann B. Barshinger Cancer Institute, Lancaster, PA, United
States
Publisher
Dove Medical Press Ltd
Abstract
Adequate hemostasis during surgical procedures is essential for successful
patient outcomes and reduced healthcare resource utilization. Topical
hemostatic agents can act as catalysts for the clotting cascade or as a
scaffold to promote platelet activation or aggregation. Although an
ever-increasing number of topical absorbable hemostatic agents are now
available for perioperative use, health care providers are disadvantaged
by the lack of comparative data on feasibility, clinical effectiveness,
advantages, and limitations of each in specific surgical settings. This
knowledge is important for appropriate product choice when patient
characteristics, type of surgical procedure, type of bleeding, and product
availability may differ widely. This manuscript provides the first
comprehensive overview of AviteneTM Microfibrillar Collagen Hemostat
(MCH), a bovine collagen-based absorbable hemostat that has been widely
used for over four decades in the United States and abroad. MCH is
indicated as an adjunct to hemostasis across a broad spectrum of surgical
specialties and has been shown to achieve hemostasis with positive patient
outcomes and a favorable safety profile in many applications, including
hepatic, orthopedic, splenic, oral, and otolaryngologic surgery. Although
published clinical data regarding the use of MCH in cardiovascular surgery
is limited, evidence suggests moderate use in this specialty. The
information contained in this systematic review will help health care
providers understand the clinical use and effectiveness of the product to
determine appropriate use in differing bleeding scenarios across multiple
surgical specialties. Future studies may include comparative functional
and cost analyses to explore the economic advantages of using absorbable
hemostatic agents compared with each other or with conventional techniques
of hemostasis, when appropriate. Copyright © 2021 Cziperle.

<20>
Accession Number
2012346800
Title
Perioperative liberal versus restrictive fluid strategies and
postoperative outcomes: a systematic review and metanalysis on
randomised-controlled trials in major abdominal elective surgery.
Source
Critical Care. 25 (1) (no pagination), 2021. Article Number: 205. Date of
Publication: December 2021.
Author
Messina A.; Robba C.; Calabro L.; Zambelli D.; Iannuzzi F.; Molinari E.;
Scarano S.; Battaglini D.; Baggiani M.; De Mattei G.; Saderi L.; Sotgiu
G.; Pelosi P.; Cecconi M.
Institution
(Messina, Calabro, Zambelli, Cecconi) Department of Anaesthesia and
Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS,
Via Alessandro Manzoni, 56, Rozzano, MI 20089, Italy
(Messina, Cecconi) Department of Biomedical Sciences, Humanitas
University, Pieve Emanuele, MI, Italy
(Robba, Iannuzzi, Molinari, Scarano, Battaglini, Pelosi) Anaesthesia and
Intensive Care, IRCCS for Oncology and Neuroscience, San Martino
Policlinico Hospital, Genoa, Italy
(Iannuzzi, Molinari, Scarano, Pelosi) Department of Surgical Sciences and
Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
(Baggiani) Anesthesia and Intensive Care Medicine, Maggiore Della Carita
University Hospital, Novara, Italy
(De Mattei) Anesthesia and Intensive Care Medicine, Azienda Sanitaria
Universitaria Integrata Udine, Udine, Italy
(Saderi, Sotgiu) Clinical Epidemiology and Medical Statistics Unit,
Department of Medical, Surgical and Experimental, University of Sassari,
Sassari, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative complications impact on early and long-term
patients' outcome. Appropriate perioperative fluid management is pivotal
in this context; however, the most effective perioperative fluid
management is still unclear. The enhanced recovery after surgery pathways
recommend a perioperative zero-balance, whereas recent findings suggest a
more liberal approach could be beneficial. We conducted this trial to
address the impact of restrictive vs. liberal fluid approaches on overall
postoperative complications and mortality. Method(s): Systematic
review and meta-analysis, including randomised controlled trials (RCTs).
We performed a systematic literature search using MEDLINE (via Ovid),
EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register
databases, published from 1 January 2000 to 31 December 2019. We included
RCTs enrolling adult patients undergoing elective abdominal surgery and
comparing the use of restrictive/liberal approaches enrolling at least 15
patients in each subgroup. Studies involving cardiac, non-elective
surgery, paediatric or obstetric surgeries were excluded. Result(s):
After full-text examination, the metanalysis finally included 18 studies
and 5567 patients randomised to restrictive (2786 patients; 50.0%) or
liberal approaches (2780 patients; 50.0%). We found no difference in the
occurrence of severe postoperative complications between restrictive and
liberal subgroups [risk difference (95% CI) = 0.009 (- 0.02; 0.04); p
value = 0.62; I<inf>2</inf> (95% CI) = 38.6% (0-66.9%)]. This result was
confirmed also in the subgroup of five studies having a low overall risk
of bias. The liberal approach was associated with lower overall renal
major events, as compared to the restrictive [risk difference (95% CI) =
0.06 (0.02-0.09); p value = 0.001]. We found no difference in either early
(p value = 0.33) or late (p value = 0.22) postoperative mortality between
restrictive and liberal subgroups Conclusion(s): In major abdominal
elective surgery perioperative, the choice between liberal or restrictive
approach did not affect overall major postoperative complications or
mortality. In a subgroup analysis, a liberal as compared to a restrictive
perioperative fluid policy was associated with lower overall complication
renal major events, as compared to the restrictive. Trial Registration:
CRD42020218059; Registration: February 2020,
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059. Copyright © 2021, The Author(s).

<21>
Accession Number
2011901063
Title
Incidence and impact of primary graft dysfunction in adult heart
transplant recipients: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 40 (7) (pp 642-651), 2021. Date
of Publication: July 2021.
Author
Buchan T.A.; Moayedi Y.; Truby L.K.; Guyatt G.; Posada J.D.; Ross H.J.;
Khush K.K.; Alba A.C.; Foroutan F.
Institution
(Buchan, Moayedi, Posada, Ross, Alba, Foroutan) Peter Munk Cardiac Center,
Toronto General Hospital-University Health Network, Toronto, Canada
(Buchan, Guyatt, Foroutan) Department of Health Research Methods,
Evidence, and Impact, McMaster University, Ontario, Canada
(Truby) Division of Cardiology, Department of Medicine, Duke University
Medical Center, North Carolina, United States
(Khush) Division of Cardiovascular Medicine, Department of Medicine,
Stanford University, California, United States
Publisher
Elsevier Inc.
Abstract
Purpose: Primary graft dysfunction (PGD) is a leading cause of early
mortality after heart transplant (HTx). To identify PGD incidence and
impact on mortality, and to elucidate risk factors for PGD, we
systematically reviewed studies using the ISHLT 2014 Consensus Report
definition and reporting the incidence of PGD in adult HTx recipients.
 Method(s): We conducted a systematic search in January 2020 including
studies reporting the incidence of PGD in adult HTx recipients. We used a
random effects model to pool the incidence of PGD among HTx recipients
and, for each PGD severity, the mortality rate among those who developed
PGD. For prognostic factors evaluated in >=2 studies, we used random
effects meta-analyses to pool the adjusted odds ratios for development of
PGD. The GRADE framework informed our certainty in the evidence.
 Result(s): Of 148 publications identified, 36 observational studies
proved eligible. With moderate certainty, we observed pooled incidences of
3.5%, 6.6%, 7.7%, and 1.6% and 1-year mortality rates of 15%, 21%, 41%,
and 35% for mild, moderate, severe and isolated right ventricular-PGD,
respectively. Donor factors (female sex, and undersized), recipient
factors (creatinine, and pre-HTx use of amiodarone, and temporary or
durable mechanical support), and prolonged ischemic time proved associated
with PGD post-HTx. Conclusion(s): Our review suggests that the
incidence of PGD may be low but its risk of mortality high, increasing
with PGD severity. Prognostic factors, including undersized donor,
recipient use of amiodarone pre-HTx and recipient creatinine may guide
future studies in exploring donor and/or recipient selection and risk
mitigation strategies. Copyright © 2021 International Society for
Heart and Lung Transplantation

<22>
Accession Number
2011733667
Title
Effect of a smartphone-based intervention on secondary prevention
medication prescriptions after coronary artery bypass graft surgery: The
MISSION-1 randomized controlled trial.
Source
American Heart Journal. 237 (pp 79-89), 2021. Date of Publication: July
2021.
Author
Qu J.; Du J.; Rao C.; Chen S.; Gu D.; Li J.; Zhang H.; Zhao Y.; Hu S.;
Zheng Z.
Institution
(Qu, Du, Rao, Chen, Gu, Li, Zhang, Zhao, Hu, Zheng) National Clinical
Research Center for Cardiovascular, Diseases, State Key Laboratory of
Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular
Diseases, Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China
(Qu, Du, Rao, Gu, Zhang, Hu, Zheng) Department of Cardiovascular Surgery,
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences, Peking Union Medical College, Beijing, China
(Chen) Information Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Du) Department of Cardiothoracic Surgery, Shenzhen Children's Hospital,
Shenzhen, China
Publisher
Mosby Inc.
Abstract
Background: Studies found that patients who underwent coronary artery
bypass grafting (CABG) often fail to receive optimal evidence-based
secondary prevention medications. We evaluated the effectiveness of a
smartphone-based quality improvement effort on improving the prescription
of medical therapies. Method(s): In this cluster-randomized
controlled trial, 60 hospitals were randomized to a control arm (n = 30)
or to an intervention arm using smartphone-based multifaceted quality
improvement interventions (n = 30). The primary outcome was the
prescription of statin. The secondary outcomes were prescription of
beta-blocker, angiotensin-converting enzyme inhibitor, or angiotensin
receptor blocker (ACE inhibitor or ARB), and optimal medical therapy for
eligible patients. Result(s): Between June 1, 2015 and September 15,
2016, a total of 10,006 CABG patients were enrolled (5,653 in 26
intervention and 4,353 in 29 control hospitals, 5 hospitals withdrew).
Statin prescribing rate was 87.8% in the intervention arm and 84.4% in the
control arm. We saw no evidence of an effect of intervention on statin
prescribing in the intention-to-treat analysis (odds ratio [OR], 1.31; 95%
confidence interval (CI), 0.68-2.54; P = .43) or in key patient subsets.
The prescription rates of ACE inhibitor or ARB and optimal medical therapy
were comparable between study groups, while beta-blocker was more often
prescribed in the intervention arm. Post hoc analysis demonstrated a
greater increase in statin prescribing rate over time in the intervention
arm. Conclusion(s): A smartphone-based quality improvement
intervention compared with usual care did not increase statin prescribing
for patients who received CABG. New studies focusing on the best practice
of this technique may be warranted. Copyright © 2021 Elsevier
Inc.

<23>
Accession Number
2013221273
Title
Operator preference and determinants of size selection when additional
intermediate-size aortic transcatheter heart valves are made available.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Kawashima H.; Serruys P.W.; Mylotte D.; Rosseel L.; Amat-Santos I.J.; Rao
R.S.; Onuma Y.; Wijns W.; Abdel-Wahab M.; Baumbach A.; Soliman O.
Institution
(Kawashima, Serruys, Mylotte, Rosseel, Onuma, Wijns, Soliman) Department
of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB
Corelab and Center for Research and Imaging, Galway, Ireland
(Kawashima) Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(Serruys, Soliman) CURAM, the SFI Research Centre for Medical Devices,
Galway, Ireland
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Amat-Santos) CIBERCV, Hospital Clinico Universitario, Valladolid, Spain
(Rao) RHL Heart center, Rajasthan Hospital, Jaipur, India
(Abdel-Wahab) Heart Center Leipzig at University of Leipzig and Leipzig
Heart Institute, Leipzig, Germany
(Baumbach) William Harvey Research Institute, Queen Mary University of
London, and Barts Heart Centre, London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Appropriate size selection of transcatheter heart valves
(THVs) is fundamental to reduce transcatheter aortic valve implantation
(TAVI) related complications, particularly paravalvular aortic
regurgitation, new permanent pacemaker implantation, and annular rupture.
We sought to investigate the frequency of operator selection of
intermediate-size balloon-expandable Myval THVs (Meril Life Sciences Pvt.
Ltd., India) for TAVI in a real-world dataset. Method(s): In this
retrospective survey of patients treated with TAVI using the Myval THV,
20, 23, 26, and 29 mm are conventional-size THVs, 21.5, 24.5 and 27.5 mm
are intermediate-size THVs, and 30.5 and 32 mm are extra-large THVs.
Operator size selection for implantation was based on multislice computed
tomography (MSCT) derived aortic-root dimensions. Result(s): A total
of 1115 patients underwent Myval THV implantation in 27 countries
worldwide. The Myval intermediate-size THVs were used in 468 (42.0%)
patients. MSCT data were available in 562 patients. There was no
statistical difference between the Intermediate/Upsized and Appropriately
sized groups or Intermediate/Downsized and Appropriately sized groups in
terms of different variables measured with MSCT except for annular
dimensions and degree of calcification. Conclusion(s):
Intermediate-size Myval balloon-expandable THVs are used in nearly half of
all cases in contemporary real-world TAVI practice, addressing the unmet
need of TAVI operators for a more calibrated THV choice. Our hypothesis
should be tested in randomized prospective studies currently initiated in
Europe, including clinical outcomes of patients treated with both
conventional- and intermediate-size THVs. Copyright © 2021 The
Authors

<24>
Accession Number
2013142659
Title
Association of Pain With Atrial Fibrillation and Delirium After Cardiac
Surgery: A DECADE Sub-Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Ince I.; Chiu A.; Sagir A.; Chahar P.; Lin J.; Douglas A.; Adi A.; Fang
J.; Mao G.; Turan A.
Institution
(Ince, Chiu, Chahar, Fang, Turan) Department of Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
(Ince) Anesthesiology Clinical Research Office, Ataturk University,
Erzurum, Turkey
(Sagir, Chahar, Turan) Department of General Anesthesia, Cleveland Clinic,
Cleveland, OH, United States
(Lin, Douglas, Adi) Department of Cardiovascular Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Mao) Department Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to evaluate the effects of postoperative pain
on the incidence of atrial fibrillation and delirium in patients having
surgery with cardiopulmonary bypass (CPB). Design(s): Post hoc
analysis of the (An investigator-initiated, multicentre, double-blind
trial (ClinicalTrials NCT02004613) (DECADE)), a randomized,
placebo-controlled trial. Setting(s): Tertiary, academic hospital.
 Participant(s): Six hundred five adults from the DECADE enrolled at
Cleveland Clinic Main Campus, who had had surgery with CPB.
 Intervention(s): Dexmedetomidine versus placebo started before
surgical incision and postoperatively was maintained until 24 hours.
Measurements: Primary outcomes were atrial fibrillation, diagnosed by
clinicians in the intensive care unit (ICU), presence of delirium assessed
with the Confusion Assessment Method for the ICU, data on pain scores, and
opioid consumption, occurring between ICU admission and the earlier of
postoperative day five or hospital discharge. Result(s):
Postoperative pain levels were similar among patients with or without
atrial fibrillation. Two hundred six (34%) patients had atrial
fibrillation and ninety-two (15%) had delirium before hospital discharge
within the first five postoperative days. The risk of atrial fibrillation
was not significantly different between groups (hazard ratio: 1.09; 97.5%
confidence interval [CI]: 0.99, 1.20, p = 0.039); there were no
associations between postoperative pain and the risk of postoperative
delirium (hazard ratio: 0.96; 97.5% CI: 0.84-1.11; p = 0.57).
Postoperative opioid consumption was neither significantly associated with
postoperative atrial fibrillation nor delirium. Conclusion(s): Atrial
fibrillation and delirium was not associated with pain after cardiac
surgery. Opioid use was not associated with atrial fibrillation and
delirium. Because both atrial fibrillation and delirium have a
multifactorial nature, further studies should be focused on other
plausible mechanisms. Copyright © 2021

<25>
Accession Number
2013142657
Title
Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery
Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A
Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Abdelbaser I.; Mageed N.A.; Elmorsy M.M.; Elfayoumy S.I.
Institution
(Abdelbaser, Mageed, Elmorsy) Department of Anesthesia and Surgical
Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Elfayoumy) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Portsaid University, Portsaid, Egypt
Publisher
W.B. Saunders
Abstract
Objective: The objective of the present study was to compare
ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery
catheterization in neonates and infants undergoing cardiac surgery.
 Design(s): A single-center, prospective, randomized, single-blinded,
controlled study. Setting(s): This study was conducted in the
operating room and intensive care unit of the division of cardiac surgery,
Mansoura University Children's Hospital, Egypt. Participant(s):
Ninety neonates and infants undergoing elective cardiac surgery were
enrolled in this study and randomly allocated to ultrasound-guided LAX and
SAX groups. Intervention(s): Ultrasound-guided femoral artery
catheterization was done using either LAX (in-plane) or SAX (out-of-plane)
technique. Measurements and Main Results: The primary outcome measure
was the rate of a successful first puncture. The secondary outcome
measures were the rates of mechanical complications, failure rate, time to
a successful first, second, and third puncture, total time of
catheterization, and imaging time. The first puncture success rate was
significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than
in the SAX group (25 of 41, 60.9%). The mean time to a successful first
puncture was significantly shorter (p < 0.001) in the LAX group (153.1 +/-
30.1 seconds) than in the SAX group (227.2 +/- 48.8 seconds). The total
catheterization time was significantly shorter in the LAX group than in
the SAX group. There was no significant difference in the rate of
complication. Conclusion(s): With a single experienced operator
performing the ultrasound-guided femoral artery cannulation, the LAX
technique resulted in a higher first puncture success rate and shorter
time to cannulation than the SAX technique. Copyright © 2021
Elsevier Inc.

<26>
Accession Number
2012846140
Title
Preoperative proteinuria may be a risk factor for postoperative acute
kidney injury:a meta-analysis.
Source
Renal Failure. 43 (1) (pp 958-967), 2021. Date of Publication: 2021.
Author
Huang D.-D.; Li Y.-Y.; Fan Z.; Wu Y.-G.
Institution
(Huang, Li, Fan, Wu) Department of Nephropathy, The First Affiliated
Hospital, Anhui Medical University, Hefei, Anhui, China
Publisher
Taylor and Francis Ltd.
Abstract
Objective: To investigate the relationship between preoperative
proteinuria and postoperative acute kidney injury (AKI). Method(s):
We performed a search on databases included PubMed, Embase, the Cochrane
Library, and Web of Science, from December 2009 to September 2020. Data
extracted from eligible studies were synthesized to calculate the odds
ratio (OR) and 95% confidence interval (CI). A fixed or random effects
model was applied to calculate the pooled OR based on heterogeneity
through the included studies. Result(s): This meta-analysis of 11
observational studies included 203,987 participants, of whom 21,621
patients suffered from postoperative AKI and 182,366 patients did not
suffer from postoperative AKI. The combined results demonstrated that
preoperative proteinuria is an independent risk factor for postoperative
AKI (adjusted OR = 1.65, 95%CI:1.44-1.89, p < 0.001). Subgroup analysis
showed that both preoperative mild proteinuria (adjusted OR = 1.30,
95%CI:1.24-1.36, p < 0.001) and preoperative heavy proteinuria (adjusted
OR = 1.93, 95%CI:1.65-2.27, p < 0.001) were independent risk factors for
postoperative AKI. The heterogeneity was combined because its values were
lower. Further subgroup analysis found that preoperative proteinuria
measured using dipstick was an independent risk factor for postoperative
AKI (adjusted OR = 1.48, 95%CI:1.37-1.60, p < 0.001). Finally,
preoperative proteinuria was an independent risk factor for postoperative
AKI in the non-cardiac surgery group (adjusted OR = 2.06, 95%CI:1.31-3.24,
p = 0.002) and cardiac surgery group (adjusted OR = 1.69, 95%CI:1.39-2.06,
p < 0.001) Conclusion(s): Preoperative proteinuria is an independent
risk factor for postoperative AKI and in instances when proteinuria is
detected using dipsticks. Copyright © 2021 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<27>
Accession Number
2013284280
Title
2018 Evidence Base of Patient Blood Management - Recommendations from the
First International Consensus Conference, Frankfurt/Main, Germany.
Source
Blood. Conference: 61st ASH Annual Meeting. Orlando United States. 134
(Supplement 1) (pp 4982), 2019. Date of Publication: 13 Nov 2019.
Author
Mueller M.M.; van Remoortel H.; Meybohm P.; Aranko K.; Murphy M.; Carson
J.L.; Seifried E.
Institution
(Mueller) German Red Cross Blood Transfusion Service Frankfurt/Main,
Germany, Frankfurt, Germany
(van Remoortel) Centre for Evidence-Based Practice (CEBaP), Belgian Red
Cross, Mechelen, Belgium
(Meybohm) University Hospital Frankfurt, Frankfurt, Germany
(Aranko) European Blood Alliance, Amsterdam, Netherlands
(Aranko) Finnish Red Cross Blood Service, Helsinki, Finland
(Murphy) NHSBT, Oxford, United Kingdom
(Carson) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Seifried) Institute Frankfurt, Baden-Wurttemberg-Hessen gGmbH Institut
Frankfurt, Frankfurt am Main, Germany
Publisher
Elsevier B.V.
Abstract
Introduction: The analysis of published clinical trial results is
essential for the evidence base of patient blood management (PBM). In
addition, an evidence-based way of developing guidelines and
recommendation is indispensable for high quality patient-centred
hemotherapy. The international Consensus Conference (ICC) was set up in
order to develop evidence-based clinical and research recommendations for
preoperative anemia, red blood cell (RBC) transfusion thresholds in adult
patients and implementation of PBM programmes. Method(s): An
international scientific committee (SC) defined 17
population-intervention-comparison-outcome (PICO) questions for the three
topics preoperative anemia, red blood cell (RBC) transfusion thresholds in
adult patients and implementation of PBM. From these 17 PICO questions,
literature search was conducted in four biomedical databases. Several
meta-analyses, forest plots, the GRADE methodology (= grading of
recommendations, assessment, development and evaluation), GRADEpro, the
open source online database for GRADE as well as the Evidence-to-Decision
(EtD) framework were used in order to keep the development of
recommendations as evidence-based and transparent as possible. Three
expert panels (EP) consisting of clinicians, scientists, nurses, patient
representatives and methodologists were established and used the methods
described above in order to develop recommendations driven by published
evidence. Result(s): Out of more than 17,500 literature citations,
data from 145 studies (63 randomised trials including more than 23,000
patients (pts.) & 82 observational studies including more than 4 million
pts.) was incorporated into the final analysis. The expert panel for
preoperative anemia developed 4 clinical and 3 research recommendations. A
strong recommendation advocates for early detection and management of
preoperative anemia before major elective surgery. For RBC transfusion
thresholds, 4 clinical and 6 research recommendations came out of the
process. Two strong clinical recommendations for PBC transfusion
thresholds advocate a hemoglobin level (hb) of < 7 g/dL for critical ill,
but clinical stable adult intensive care patients independent of septic
shock and < 7.5 g/dL for adults undergoing cardiac surgery. For
implementation of PBM programmes, 2 clinical and 3 research
recommendations were defined. Research recommendations define open fields
in PBM and try to initiate additional studies in order to answer still
open questions. Conclusion(s): This is the first ICC for PBM defining
the evidence base for three clinically important hemotherapy topics. The
relative paucity of strong evidence in current PBM literature underscores
the ongoing struggle to a.) find internationally accepted definitions e.g.
for anemia and b.) execute internationally planned meaningful multicentre
trials in the still open fields of PBM. The clinical recommendations found
here however should be considered and accepted in clinical practice.
Disclosures: Seifried: Medac: Other: BSD owns IP and is contract
manufacturer; Uniqure BV: Research Funding. Copyright © 2019
American Society of Hematology

<28>
[Use Link to view the full text]
Accession Number
635378614
Title
Left ventricular mass reduction and hypertrophy regression following renal
artery revascularization: Ameta-analysis.
Source
Journal of Hypertension. 39 (1) (pp 4-11), 2021. Date of Publication:
January 2021.
Author
Cuspidi C.; Tadic M.; Sala C.; Quarti-Trevano F.; Gherbesi E.; Mancia G.;
Grassi G.
Institution
(Cuspidi, Quarti-Trevano, Mancia, Grassi) Department of Medicine and
Surgery, University of Milano-Bicocca, Italy
(Cuspidi) Clinical Research Unit, Istituto Auxologico Italiano, Milan,
Italy
(Tadic) Department of Cardiology, University Hospital 'Dr Dragisa Misovic
- Dedinje', Belgrade, Serbia
(Sala, Gherbesi) Department of Clinical Sciences and Community Health,
University of Milano and Fondazione Ospedale Maggiore Irccs Policlinico di
Milano, Milan, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Aim: Few echocardiographic studies have focused on regression of left
ventricular hypertrophy (LVH) in patients with renal artery stenosis after
revascularization, with inconsistent results. We performed a systematic
metaanalysis of these studies in order to offer a comprehensive
information on this topic. Method(s): The PubMed, OVID-MEDLINE, and
Cochrane library databases were analyzed to search English-language
articles published from 1 January 1990 up to 31 March 2020. Studies were
identified by crossing the following terms: 'renal artery stenosis',
'renovascular hypertension', 'fibromuscular dysplasia', 'renal artery
stenting', 'renal artery surgery' with 'cardiac damage', 'hypertensive
heart disease' 'left ventricular mass', 'left ventricular hypertrophy',
'echocardiography'. Result(s): A total of 726 hypertensive patients
with renal artery stenosis (mean age 61 years, 64% men, 98% treated, 10%
with fibromuscular dysplasia) were included in 13 studies. Baseline and
postintervention pooled mean LVM values were 220+/-15 and 203+/-19 g,
respectively (SMD -0.24+/-0.06, CI -0.37 to -0.21, P<0.0001);
corresponding values for LV mass index were 129.0+/-6 and 115+/-7 g/m2,
respectively (SMD -0.28+/-0.04, CI -0.36 to 0.21, P<0.0001). Renal
revascularization was associated with a 40% lower risk of LVH. This trend
was accompanied by a reduction in the number of antihypertensive drugs
(SMD -0.27+/-0.04, CI -0.37 to 0.17, P<0.0001). Conclusion(s): The
present meta-analysis suggests that renal artery revascularization added
to antihypertensive therapy promotes a favourable effect on LV structure,
as reflected by a significant decrease in absolute and indexed LV mass
index as well by a lower risk of LVH. Limitations include: High prevalence
of modest renal artery stenosis (>=50%); small sample of fibromuscular
dysplasia; lack of randomized design of most studies. Copyright ©
2021 Lippincott Williams and Wilkins. All rights reserved.

<29>
Accession Number
635379449
Title
Extreme Cooling Rates in Avalanche Victims Case Report and Narrative
Review.
Source
High Altitude Medicine and Biology. 22 (2) (pp 235-240), 2021. Date of
Publication: June 2021.
Author
Mittermair C.; Foidl E.; Wallner B.; Brugger H.; Paal P.
Institution
(Mittermair) Department of Surgery, Hospitallers Brothers Hospital,
Paracelsus Medical University, Salzburg, Austria
(Foidl) Department of Anaesthesiology and Intensive Care Medicine,
Kufstein Hospital, Kufstein, Austria
(Wallner) Department of Anaesthesiology and General Intensive Care
Medicine, Medical University of Innsbruck, Innsbruck, Austria
(Wallner, Brugger) Institute of Mountain Emergency Medicine, Eurac
Research, Bolzano, Italy
(Brugger, Paal) International Commission of Mountain Emergency Medicine
(ICAR MEDCOM), Kloten, Switzerland
(Paal) Department of Anaesthesiology and Intensive Care Medicine,
Hospitallers Brothers Hospital, Paracelsus Medical University, Salzburg,
Austria
Publisher
Mary Ann Liebert Inc.
Abstract
Mittermair, Christof, Eva Foidl, Bernd Wallner, Hermann Brugger, and Peter
Paal. Extreme cooling rates in avalanche victims case report and narrative
review. High Alt Med Biol. 22 235-240, 2021. Background We report a
25-year-old female backcountry skier who was buried by an avalanche during
ascent. A cooling rate of 8.5degreeC/h from burial to hospital is the
fastest reported in a person with persistent circulation. Methods A case
report according to the CARE guidelines is presented. A literature search
with the keywords "avalanche"AND "hypothermia"was performed and yielded 96
results, and the last update was on October 25, 2020. A narrative review
complements this work. Results A literature search revealed four avalanche
patients with extreme cooling rates (>5degree/h). References of included
articles were searched for further relevant studies. Nineteen additional
pertinent articles were included. Overall, 32 studies were included in
this work. Discussion An avalanche patient cools in different phases, and
every phase may have different cooling rates (1) during burial, (2) with
postburial exposure on-site, and (3) during transport. It is important to
measure the core temperature correctly, ideally with an esophageal probe.
Contributing factors to fast cooling are sweating, impaired consciousness,
no shivering, wearing thin monolayer clothing and head and hands
uncovered, an air pocket, and development of hypercapnia, being slender.
Conclusions Rescuers should be prepared to encounter severely hypothermic
subjects (<30degreeC) even after burials of <60 minutes. Subjects rescued
from an avalanche may cool extremely fast the more contributing factors
for rapid cooling exist. After avalanche burial (>=60 minutes) and
unwitnessed cardiac arrest, chances of neurologically intact survival are
small and depend on rapid cooling and onset of severe hypothermia
(<30degreeC) before hypoxia-induced cardiac arrest. © Copyright
2021, 2021 Mary Ann Liebert, Inc., publishers 2021.

<30>
Accession Number
2013256222
Title
On pump versus off pump coronary artery bypass grafting in patients with
left ventricular dysfunction - A comparative study at Rajiv Gandhi govt.
general hospital.
Source
Journal International Medical Sciences Academy. 34 (1) (pp 60-62), 2021.
Date of Publication: 2021.
Author
Raj G.J.; Anand P.
Institution
(Raj) Institute of Cardiovascular & Thoracic Surgery, Rajiv Gandhi Govt.
General Hospital. & MMC, Tamil Nadu, Chennai, India
(Anand) Dept. of Cardiovascular & Thoracic Surgery, Rajiv Gandhi Govt.
General Hospital. & MMC., Tamil Nadu, Chennai, India
Publisher
International Medical Sciences Academy
Abstract
This study is a non randomized observational study in patients with
coronary artery disease and Left Ventricular Dysfunction admitted in the
department of Cardio Thoracic surgery at Rajiv Gandhi Govt. Hospital
between September 2018 to January 2020. Patients with Ejection Fraction of
less than 55% and coronary artery disease were taken up for study after
explaining the proposed surgery, line of management, post op management
and adherence to medication after surgery. Of the 81 patients taken up for
study, 42 were operated on-pump and 39 off pump. The decision of onpump or
off-pump was made by the surgeon, on table after examining the coronaries,
feasibility of the procedure and haemodynamics of the patient. All
patients were operated under general anesthesia, through midline
sternotomy, conduits used were Internal thoracic artery, saphenous venous
grafts. For on pump surgeries, CPB was established by cannulating Aorta
and right Atrium, with mild hypothermia using roller pump, non-pulsatile
flow and mean arterial pressure 60 mm hg, cold blood CP. Stabilizing the
heart was done with Octopus generic stabilizer and starfish apex
stabilizer. ITA and venous grafts distal anastamosis were done with 8-0
prolene, grafts 7-0. Proximal anastamosis were done with 6-0 prolene. post
op management was done in intensive care unit. Post discharge patients
were advised regular follow up. The study aims at finding 1. Epidemiology
of coronary artery disease with Left ventricular dysfunction in the local
population 2. Comparing the outcome of on pump and off pump CABG in
patients with Left ventricular dysfunction. 3. Complications following
surgery. 4. Analyze and compare the advantages and disadvantages of on
pump versus off pump surgeries. 5. To analyze improvement in EF following
surgery. Pre-op, operative a post op data was collected and analyzed and
documented. Copyright © 2021 International Medical Sciences
Academy. All rights reserved.

<31>
Accession Number
2013252477
Title
Impact of Surgical and Transcatheter Aortic Valve Replacement in
Low-Gradient Aortic Stenosis: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14 (13) (pp 1481-1492), 2021. Date of
Publication: 12 Jul 2021.
Author
Ueyama H.; Kuno T.; Harrington M.; Takagi H.; Krishnamoorthy P.; Sharma
S.K.; Kini A.; Lerakis S.
Institution
(Ueyama, Kuno, Harrington) Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United
States
(Ueyama, Krishnamoorthy, Sharma, Kini, Lerakis) Division of Cardiology,
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York,
NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the impact of aortic valve
replacement (AVR) on survival in patients with each subclass of
low-gradient (LG) aortic stenosis (AS) and to compare outcomes following
surgical AVR (SAVR) and transcatheter AVR (TAVR). Background(s): LG
severe AS encompasses a wide variety of pathophysiology, including
classical low-flow, LG (LF-LG), paradoxical LF-LG, and normal-flow, LG
(NF-LG) AS, and uncertainty exists regarding the impact of AVR on each
subclass of LG AS. Method(s): PubMed and Embase were queried through
October 2020 to identify studies comparing survival with different
management strategies (SAVR, TAVR, and conservative) in patients with LG
AS. Pairwise meta-analysis comparing AVR versus conservative management
and network meta-analysis comparing SAVR versus TAVR versus conservative
management were performed. Result(s): Thirty-two studies with a total
of 6,515 patients and a median follow-up time of 24.2 months
(interquartile range: 36.5 months) were included. AVR was associated with
a significant decrease in all-cause mortality in classical LF-LG (hazard
ratio [HR]: 0.42; 95% confidence interval [CI]: 0.36 to 0.48), paradoxical
LF-LG (HR: 0.41; 95% CI: 0.29 to 0.57), and NF-LG (HR: 0.41; 95% CI: 0.27
to 0.62) AS compared with conservative management. SAVR and TAVR were each
associated with a decrease in all-cause mortality in classical LF-LG (HR:
0.46 [95% CI: 0.38 to 0.55] and 0.49 [95% CI: 0.37 to 0.64],
respectively), paradoxical LF-LG (HR: 0.42 [95% CI: 0.28 to 0.65] and 0.42
[95% CI: 0.25 to 0.72], respectively), and NF-LG (HR: 0.40 [95% CI: 0.21
to 0.77] and 0.46 [95% CI: 0.26 to 0.84], respectively) AS compared with
conservative management. No significant difference was observed between
SAVR and TAVR. Conclusion(s): In all subclasses of LG AS, AVR was
associated with a significant decrease in all-cause mortality regardless
of surgical or transcatheter approach. Copyright © 2021 American
College of Cardiology Foundation

<32>
Accession Number
2007618184
Title
Role of concomitant coronary artery bypass grafting in valve surgery for
infective endocarditis.
Source
Journal of Clinical Medicine. 10 (13) (no pagination), 2021. Article
Number: 2867. Date of Publication: 01 Jul 2021.
Author
Diab M.; Lehmann T.; Weber C.; Petrov G.; Luehr M.; Akhyari P.; Tugtekin
S.-M.; Schulze P.C.; Franz M.; Misfeld M.; Borger M.A.; Matschke K.;
Wahlers T.; Lichtenberg A.; Hagl C.; Doenst T.
Institution
(Diab, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital-Friedrich Schiller University of Jena, Jena 07747, Germany
(Lehmann) Center of Clinical Studies, Jena University Hospital-Friedrich
Schiller University of Jena, Jena 07747, Germany
(Weber, Luehr, Wahlers) Department of Cardiothoracic Surgery, Heart Center
of the University of Cologne, Colonge 50937, Germany
(Petrov, Akhyari, Lichtenberg) Department of Cardiothoracic Surgery,
Heinrich-Heine-University Duesseldorf, Duesseldof 40225, Germany
(Tugtekin, Matschke) Department of Cardiac Surgery, Heart Center Dresden,
Dresden 01307, Germany
(Schulze, Franz) Department of Internal Medicine I, Jena University
Hospital-Friedrich Schiller University of Jena, Jena 07747, Germany
(Misfeld) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney 2050, Australia
(Misfeld, Borger) Department of Cardiac Surgery, Heart Center Leipzig,
Leipzig 04289, Germany
(Hagl) Department of Cardiac Surgery, Ludwig Maximilian University Munich,
Munich 80539, Germany
Publisher
MDPI AG
Abstract
Background: It is current practice to perform concomitant coronary artery
bypass grafting (CABG) in patients with infective endocarditis (IE) who
have relevant coronary artery disease (CAD). However, CABG may add
complexity to the operation. We aimed to investigate the impact of
concomitant CABG on perioperative outcomes in patients undergoing surgery
for IE. Method(s): We retrospectively used data of surgically treated
IE patients between 1994 and 2018 in six German cardiac surgery centers.
We performed inverse probability weighting (IPW), multivariable
adjust-ment, chi-square analysis, and Kaplan-Meier survival estimates.
 Result(s): CAD was reported in 1242/4917 (25%) patients. Among them,
527 received concomitant CABG. After adjustment for basal characteristics
between CABG and no-CABG patients using IPW, concomitant CABG was
associated with higher postoperative stroke (26% vs. 21%, p = 0.003) and a
trend towards higher postoperative hemodialysis (29% vs. 25%, p = 0.052).
Thirty-day mortality was similar in both groups (24% vs. 23%, p = 0.370).
Multivariate Cox regression analysis after IPW showed that CABG was not
associated with better long-term survival (HR: 1.00, 95% CI: 0.82-1.23, p
= 0.998). Conclusion(s): In endocarditis patients with CAD, adding
CABG to valve surgery may be associated with a higher likelihood of
postoperative stroke without adding long-term survival benefits.
Therefore, in the absence of critical CAD, concomitant CABG may be omitted
without impacting outcome. The results are limited due to a lack of data
on the severity of CAD, and therefore there is a need for a randomized
trial. Copyright © 2021 by the authorsLicensee MDPI, Basel,
Switzerland.

<33>
[Use Link to view the full text]
Accession Number
635378718
Title
Appropriate therapy for patients with stable ischemic heart disease: A
review of literature and the implication of the International Study of
Comparative Effectiveness with Medical and Invasive Approaches trial.
Source
Current Opinion in Cardiology. 35 (6) (pp 658-663), 2020. Date of
Publication: November 2020.
Author
Guo M.H.; Nantsios A.; Ruel M.
Institution
(Guo, Nantsios, Ruel) Division of Cardiac Surgery, University of Ottawa
Heart Institute, Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review The aim of this review is to review the current
literature on the management of stable ischemic heart disease in light of
findings from the International Study of Comparative Effectiveness with
Medical and Invasive Approaches (ISCHEMIA) trial. Recent findings Compared
with optimal medical therapy, coronary artery bypass grafting (CABG) has
been shown to improve survival and incidence of myocardial infarction in
patients with stable ischemic heart disease whereas percutaneous coronary
intervention (PCI) has not. The ISCHEMIA trial compared an initial
conservative management strategy with optimal medical therapy with an
initial invasive strategy with coronary angiogram followed by
revascularization and found no difference in survival and myocardial
infarction between the two groups. However, the trial was conducted under
the assumption that patients would be referred to the most efficacious
revascularization therapy; it was apparent that CABG was underutilized in
many appropriate patients in the ISCHEMIA trial. The study highlighted the
importance of optimizing medical therapy in stable ischemic heart disease
(SIHD) patients but does not answer whether revascularization or
conservative management is better for patients with SIHD. Summary Optimal
medical therapy is an important element and should be included in the
Heart Team discussion, and also applied after revascularization from PCI
or CABG. Cardiac surgeons need to continue to advocate for the appropriate
use of CABG based on the current available evidence. Copyright ©
2020 Wolters Kluwer Health, Inc. All rights reserved.

<34>
[Use Link to view the full text]
Accession Number
635378352
Title
Current state of noninvasive, continuous monitoring modalities in
pediatric anesthesiology.
Source
Current Opinion in Anaesthesiology. 33 (6) (pp 781-787), 2020. Date of
Publication: December 2020.
Author
Wijk J.J.V.; Weber F.; Stolker R.J.; Staals L.M.
Institution
(Wijk, Weber, Staals) Department of Anesthesiology, ErasmusMC Sophia
Children's Hospital, Rotterdam, Netherlands
(Stolker) Department of Anesthesiology, University Medical Center
Rotterdam, Erasmus Mc, Rotterdam, Netherlands
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review The last decades, anesthesia has become safer, partly
due to developments in monitoring. Advanced monitoring of children under
anesthesia is challenging, due to lack of evidence, validity and size
constraints. Most measured parameters are proxies for end organ function,
in which an anesthesiologist is actually interested. Ideally, monitoring
should be continuous, noninvasive and accurate. This present review
summarizes the current literature on noninvasive monitoring in noncardiac
pediatric anesthesia. Recent findings For cardiac output (CO) monitoring,
bolus thermodilution is still considered the gold standard. New
noninvasive techniques based on bioimpedance and pulse contour analysis
are promising, but require more refining in accuracy of CO values in
children. Near-infrared spectroscopy is most commonly used in cardiac
surgery despite there being no consensus on safety margins. Its place in
noncardiac anesthesia has yet to be determined. Transcutaneous
measurements of blood gases are used mainly in the neonatal intensive care
unit, and is finding its way to the pediatric operation theatre.
Especially CO2 measurements are accurate and useful. Summary New
techniques are available to assess a child's hemodynamic and respiratory
status while under anesthesia. These new monitors can be used as
complementary tools together with standard monitoring in children, to
further improve perioperative safety. Copyright_2020 The Author(s).
Published by Wolters Kluwer Health, Inc.

<35>
Accession Number
635378130
Title
Tranexamic Acid in Neuroanesthesia and Neurocritical Care: Time for Its
Critical Appraisal.
Source
Journal of Neuroanaesthesiology and Critical Care. 6 (3) (pp 257-266),
2019. Article Number: JNACC1900159. Date of Publication: 01 Sep 2019.
Author
Hooda B.; Muthuchellappan R.
Institution
(Hooda) Department of Anaesthesiology and Critical Care, Army Hospital
Research and Referral, New Delhi 110010, India
(Muthuchellappan) Department of Neuroanaesthesia and Neurocritical Care,
National Institute of Mental Health and Neurosciences (NIMHANS),
Bengaluru, Karnataka, India
Publisher
Georg Thieme Verlag
Abstract
There is a renewed interest in the use of antifibrinolytics, especially
tranexamic acid (TxA), in varied clinical settings such as trauma,
perioperative bleeding, cardiac surgery, and multilevel spine
instrumentation procedures. Because of its prothrombotic potential, the
use of TxA in neurosurgical disorders has not gained popularity since this
subset of the population is more prone to developing thromboembolic
complications. However, recent studies have shown that TxA reduces blood
loss, reduces the need for allogeneic blood transfusion, and is associated
with minimal side effects. In this narrative review, Google Scholar,
PubMed, and EMBASE databases were searched to identify publications
relevant to the current use of TxA in varied neurosurgical and critical
care settings. These publications were analyzed, and a summary of the
findings and the role of future research on this drug are presented in
this review. Copyright © 2019 Indian Society of
Neuroanaesthesiology and Critical Care.

<36>
Accession Number
2013262856
Title
Implantable cardioverter defibrillators in left ventricular assist device
patients: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Rorris F.-P.; Antonopoulos C.N.; Kyriakopoulos C.P.; Drakos S.G.; Charitos
C.
Institution
(Rorris, Antonopoulos, Charitos) Department of Thoracic and Cardiovascular
Surgery, Evangelismos General Hospital, Athens, Greece
(Kyriakopoulos, Drakos) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Utah Health & School of Medicine, Salt
Lake City, UT, United States
Publisher
Elsevier Inc.
Abstract
Implantable cardioverter-defibrillators (ICDs) remain the standard of care
in advanced heart failure with reduced ejection fraction patients for the
prevention of sudden cardiac death. However, current guidelines remain
conflicting with respect to the use of ICDs in patients supported with a
continuous flow left ventricular assist device (CF-LVAD). The current
review adhered to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Studies comparing the use of ICD in patients
with CF-LVADs were included. The 2 primary outcomes studied were all-cause
mortality, and a successful bridge to heart transplantation. We calculated
pooled odds ratios (ORs) with 95% confidence intervals (CIs). We also
compared baseline characteristics between US and European studies, for
CF-LVAD patients with an ICD. Among all studies, the use of an ICD was not
associated with all-cause mortality in patients with CF-LVADs (OR: 0.85,
95% CIs: 0.64-1.12, p = 0.24). The presence of an ICD was associated with
a trend towards increased likelihood of successful bridge to heart
transplantation (OR: 1.12, 95% CI: 1.0-1.3, p = 0.06). A subgroup analysis
of studies published by European centers revealed a significant decrease
in pooled mortality (OR: 0.58, 95% CI: 0.4-0.83, p = 0.003) with the use
of ICD, contrary to an increase in pooled mortality among studies
published by US centers (OR: 1.2, 95% CI 1.02-1.33, p = 0.025). Moreover,
we identified significant differences in baseline characteristics such as
bridge to transplantation rate, Interagency Registry for Mechanically
Assisted Circulatory Support profiles, and use of an intra-aortic balloon
pump or extracorporeal membrane oxygenation preoperatively, between the US
and European populations. While this meta-analysis did not show an overall
survival benefit with the use of an ICD in CF-LVAD patients, it revealed
significant differences in the derived benefit, in distinct patient
populations. This might reflect differences in baseline patient
characteristics and warrants further investigation. Copyright ©
2021 International Society for Heart and Lung Transplantation

<37>
Accession Number
635384521
Title
Antiplatelet therapy after transcatheter aortic valve implantation: a
systematic review and meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 20 Jun 2021.
Author
Costa G.F.; Costa M.; Goncalves L.; Teixeira R.
Institution
(Costa, Costa, Goncalves, Teixeira) Servico de Cardiologia, Centro
Hospitalar e Universitario de Coimbra, Coimbra, Portugal
(Goncalves, Teixeira) Faculdade de Medicina da Universidade de Coimbra,
Coimbra, Portugal
(Goncalves, Teixeira) Coimbra Institute for Clinical and Biomedical
Research (iCBR), Coimbra, Portugal
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to compare antithrombotic regimens
after transcatheter aortic valve implantation (TAVI) in patients without
an indication for long-term anticoagulation. TAVI is a safe and effective
approach for patients with symptomatic severe aortic stenosis and an
intermediate-to-high surgical risk. Nevertheless, the antithrombotic
regimen after procedure remains controversial. METHOD(S): We
systematically searched PubMed, Embase and Cochrane databases for
interventional studies comparing single antiplatelet therapy with double
antiplatelet therapy after TAVI. A meta-analysis was carried out to
compare thrombotic and bleeding events between both strategies.
 RESULT(S): Four randomized clinical trials were included comprising a
total of 1085 patients. Our meta-analysis revealed a higher odds ratio
(OR) of major bleeding events (pooled OR 2.45, 95% confidence interval
(CI) 1.29-4.67; P < 0.01; I2 = 0%) and minor bleeding (pooled OR 1.73, 95%
CI 1.12-2.66; P = 0.01; I2 = 0%) for the double antiplatelet therapy group
compared with the single antiplatelet therapy group. There was no
difference between groups in the risk of stroke (pooled OR 1.04, 95% CI
0.58-1.86; P = 0.91; I2 = 0%), myocardial infarction (pooled OR 2.10, 95%
CI 0.75-5.84; P = 0.16, I2 = 0%) and all-cause mortality (pooled OR 1.07,
95% CI 0.63-1.86; P = 0.08; I2 = 0%) after TAVI. CONCLUSION(S): Our
pooled analysis suggests that for patients who underwent TAVI, double
antiplatelet therapy compared with single antiplatelet therapy alone
increased the risk of bleeding without reducing mortality and ischaemic
events. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<38>
Accession Number
2010297934
Title
Remote ischemic preconditioning in patients undergoing coronary bypass
grafting following acute coronary syndrome without ST elevation.
Source
Vojnosanitetski Pregled. 77 (10) (pp 1017-1023), 2020. Date of
Publication: 2020.
Author
Milicic M.; Soldatovic I.; Nezic D.; Jovic M.; Stojkovic V.M.; Vukovic P.;
Milojevic P.
Institution
(Milicic, Nezic, Stojkovic, Vukovic, Milojevic) University of Belgrade,
Faculty of Medicine, Dedinje Cardiovascular Institute, Department of
Cardiac Surgery, Serbia
(Jovic) Department of Anesthesia, Belgrade, Serbia
(Soldatovic) University of Belgrade, Faculty of Medicine, Department of
Medical Statistics and Informatics, Belgrade, Serbia
Publisher
Inst. Sci. inf., Univ. Defence in Belgrade
Abstract
Background/Aim. A protection of heart and other organs from
ischemic-reperfusion injuries can be provided by remote ischemic
preconditioning (RIPC) by brief episodes of ischemia and reperfusion in
distant tissues. The aim of this study was to assess effects of RIPC on
early outcomes in patients underwent coronary bypass surgery (CABG)
following acute coronary syndrome without persistent ST segment elevation
(NSTEMI ACS). Methods. This trial included 42 patients randomized into two
groups: the group 1 received RIPC and the group 2 was without RIPC
(control group). Pre-, intra- and postoperative parameters were compared
but primary endpoint was myocardial injury reflected as value of troponin
I measured preoperatively and 1, 6, 12, 24, 48 and 72 h postoperatively.
The secondary endpoints were hemodynamic parameters, blood loss, intensive
care unit stay, mortality etc. Results. The groups 1 and 2 were similar in
preoperative characteristics including age, New York Heart Association
(NYHA) class, EuroSCORE II, left ventricular ejection fraction. The only
significant difference between groups was for triple vessel coronary
disease with dominance in the RIPC group [20 (100%) vs. 17 (77.3%), p =
0.049]. Cardiopulmonary bypass time [mean (+/- standard deviation): 83.0
(22.9) vs. 67.0 (17.4) minutes, p = 0.015], cross clamp time [57.9 (15.4)
vs. 44.3 (14.3) minutes, p = 0.005] and number of conduits [median
(25-75th percentile): 23.5(3-4) vs. 3(2-3), p = 0.002] were different.
Other intra- and postoperative variables did not differ between groups.
There were no differences in C reactive protein levels and postoperative
hemodynamic parameters. Average troponin values in all time points
revealed no significant differences between groups (p0h = 0.740, p1h =
0.212, p6h = 0.504, p12h = 0.597, p24h = 0.562, p48h = 0.465 and p72h =
0.715, respectively). Furthermore, there were no significant differences
in adverse events, hospital stay and mortality between groups. Conclusion.
Treatment with RIPC during CABG following NSTEMI ACS did not provide
better myocardial protection and hemodynamics characteristics but further
larger randomized studies are needed t. prove its real
value. Copyright © 2020 Inst. Sci. inf., Univ. Defence in
Belgrade. All rights reserved.

<39>
Accession Number
2012088895
Title
Aortic valve replacement vs. balloon-expandable and self-expandable
transcatheter implantation: A network meta-analysis.
Source
International Journal of Cardiology. 337 (pp 90-98), 2021. Date of
Publication: 15 Aug 2021.
Author
D'Ascenzo F.; Bruno F.; Baldetti L.; De Filippo O.; Marengo G.; Breviario
S.; Melillo F.; Thyregod H.G.H.; Thiele H.; Sondergaard L.; Popma J.J.;
Kodali S.; Franchin L.; Annaratone M.; Marruncheddu L.; Gallone G.; Crimi
G.; La Torre M.; Rinaldi M.; Omede P.; Conrotto F.; Salizzoni S.; De
Ferrari G.M.
Institution
(D'Ascenzo, Bruno, De Filippo, Marengo, Breviario, Franchin, Gallone,
Omede, Conrotto, De Ferrari) Division of Cardiology, Cardiovascular and
Thoracic Department, Citta della Salute e della Scienza Hospital and
University of Turin, Italy
(Baldetti) Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific
Institute, Italy
(Melillo) Unit of echocardiography, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Thyregod) Departments of cardiothoracic and cardiology, Rigshospitalet,
Copenhagen University Hospital, Denmark
(Thiele) Heart Center Leipzig, University of Leipzig, Germany
(Sondergaard, Popma) Beth Israel Deaconess Boston, United States
(Kodali) Columbia University Medical Center (SKK), United States
(Annaratone) Politecnico di Torino, Turin, Italy
(Marruncheddu) Department of Clinical Internal, Anesthesiological and
Cardiovascular Science, Sapienza University of Rome, Rome, Italy
(Crimi) Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(La Torre, Rinaldi, Salizzoni) Division of Cardiosurgery, Cardiovascular
and Thoracic Department, Citta della Salute e della Scienza Hospital and
University of Turin, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Recently, observational data have raised concerns about
safety of selfexpandable (SE) compared to balloon-expandable (BE) valves
in TAVI, although potentially limited by patient selection bias. Methods.
All Randomized Controlled Trials (RCTs) comparing BE vs. SE TAVI or/and
vs. aortic valve replacement (AVR) were included and compared through
Network Meta Analysis (NMA). All-cause and cardiovascular (CV) mortality
were the primary endpoints, stroke, rates of permanent pacemaker
implantation (PPI), moderate/severe paravalvular leak (PVL) and
reintervention were the secondary endpoints. Results We obtained data from
11 RCTs, encompassing 9752 patients. After one and two years, no
significant differences for allcause and CV mortality were observed.
Compared to surgical bioprostheses, both BE and SE TAVI reduced the risk
of acute kidney injury (OR 0.42; CI 95% 0.30-0.60 and OR 0.44; CI 95%
0.32-0.60), new-onset atrial fibrillation (OR 0.24; CI 95% 0.14-0.42 and
OR 0.21; CI 95% 0.13-0.34) and major bleedings (OR 0.32; CI 95% 0.16-0.65
and OR 0.47; CI 95% 0.25-0.89). The BE prostheses reduced the risk of
moderate/severe PVL at 30-day (OR 0.31; CI 95% 0.17-0.55) and of PPI both
at 30-day (OR 0.51; CI 95% 0.33-0.79) and 1 year (OR 0.40; CI 95%
0.30-0.55) as compared to SE TAVI. Conclusions A TAVI strategy,
independently from BE or SE prostheses, offers a midterm survival
comparable to AVR. The BE prostheses are associated with a reduction of
PPI and PVL compared to SE prostheses without any differences in all-cause
and CV mortality during two years of follow up. PROSPERO ID
CRD42020182407. Copyright © 2021 Elsevier B.V.

<40>
[Use Link to view the full text]
Accession Number
632870677
Title
Meta-Analysis of Perioperative Stroke and Mortality in CABG Patients With
Carotid Stenosis.
Source
The neurologist. 25 (5) (pp 113-116), 2020. Date of Publication: 01 Sep
2020.
Author
Roy P.; Brahme I.; Reddy R.P.; Wechsler L.; Gleason T.; Thirumala P.D.
Institution
(Roy, Brahme, Reddy, Thirumala) Departments of Neurological Surgery
(Wechsler, Gleason) Cardiothoracic Surgery
(Thirumala) Neurology, University of Pittsburgh Medical Center,
Pittsburgh, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass grafting (CABG) is a proven approach in
the treatment of coronary heart disease, but the surgery has several
complications, including stroke and death. Though it has been established
that perioperative stroke is associated with higher rates of long-term
mortality, the relationship between stroke and mortality in the
perioperative period has not yet been systematically examined.
 METHOD(S): Online databases of peer-reviewed literature were searched
to retrieve articles concerning mortality and stroke after CABG in
patients with carotid stenosis. Six studies (n=3786) were included for
analysis. This study was conducted at a single University hospital system,
University of Pittsburgh Medical Center, on patients who underwent CABG.
The data obtained from peer-reviewed literature originated from several
sources, primarily single institution hospitals. RESULT(S):
Consistent with current literature, the incidence of stroke in CABG
patients with significant carotid stenosis was 2.1%. Data were further
analyzed to generate a summary odds ratio of stroke-related mortality
after CABG, which showed that patients who died within 30 days of CABG
were 7.3 times more likely to have had a perioperative stroke (95%
confidence interval, 4.1-13.2). The 30-day mortality rate among
perioperative stroke victims was 14.4% versus 2.3% for nonstroke patients.
 CONCLUSION(S): Together, these data suggest an association between
stroke and mortality in the perioperative period in patients undergoing
CABG, demonstrating a need for improved monitoring, screening, and
treatment of stroke before, during, and shortly after surgery.

<41>
Accession Number
2013282179
Title
Characteristics and Financial Impact of Potentially Inappropriate Platelet
Transfusion in the Inpatient Hospital Setting.
Source
Blood. Conference: 61st ASH Annual Meeting. Orlando United States. 134
(Supplement 1) (pp 2096), 2019. Date of Publication: 13 Nov 2019.
Author
Mou E.; Murphy C.; Hom J.; Shieh L.; Shah N.
Institution
(Mou, Murphy, Hom, Shieh, Shah) Stanford Health Care, Stanford, CA, United
States
Publisher
Elsevier B.V.
Abstract
[Formula presented] Introduction Platelets are transfused prophylactically
to prevent hemorrhage in a variety of patient populations. However,
guidelines indicate that prophylactic platelet transfusions in patients
with platelet counts above 50k/uL are usually not indicated, with notable
exceptions including those undergoing neurological or cardiac bypass
surgery. Common minor procedures such as paracentesis, central line
placement, and lumbar puncture have been safely performed at platelet
counts below 50k/uL. Despite this evidence, our institution incurred
approximately 10 million dollars (USD) in direct platelet costs in 2017,
with nearly 40% of platelet transfusions are occurring when the patient's
platelet count exceeded 50k/uL. Given the significant financial impact of,
and potential adverse effects associated with inappropriate platelet
transfusion, we implemented a best practice advisory (BPA) in our
electronic medical record (EMR) in order to better characterize patterns
of platelet transfusion orders in patients with platelet counts >50k/uL.
Methods An EMR-embedded BPA was activated in the inpatient hospital
setting of a large, tertiary care academic medical center on May 1, 2019,
and triggered whenever a platelet transfusion order was placed on an
admitted patient whose most recent documented platelet count was >50k/ul.
To inform the comparative impact of BPA alerts on provider behavior,
alerts were randomized at the patient level to trigger either in standard
or silent fashion. For standard alerts, the BPA appeared on-screen,
informing the provider that their platelet transfusion order was
potentially inappropriate and citing supportive evidence. Providers had
the option of following or overriding the alert (Figure 1). In case of
alert override, a pre-specified or free text justification was requested.
Pre-specified options included upcoming neurosurgery, cardiac bypass
surgery, known qualitative platelet defects, or patients taking
antiplatelet drugs. Charge data were based on charges for platelet
transfusion orders as listed in the hospital charge master. Results From
May 1, 2019 to July 30, 2019, the alert fired 181 times (Figure 2). Alerts
were silently triggered in 64 (35%) cases. Of the 117 active alerts, 23
(20%) were followed and 94 (80%) were overridden. The most common reasons
for alert override included prophylactic transfusions ahead of non-cardiac
and non-neurosurgical operations (18%), upcoming cardiac bypass surgery
(18%), qualitative platelet defects (12%), active central nervous system
(CNS) bleeding (12%), and active non-CNS bleeding (7%). The estimated cost
savings associated with followed alerts was $18,170 USD. Discussion Our
BPA was effective in reducing instances of platelet transfusion orders by
20% over a three-month period, translating to an estimated annual savings
of nearly $70,000 USD in hospital charges. Conversely, the 80% alert
override rate indicates that platelet transfusion in patients with
platelet counts >50k/uL remains common, occurring in a variety of
contexts. Potentially appropriate reasons for platelet transfusions
included orders in the setting of cardiovascular bypass surgery, active
CNS bleeding, or qualitative platelet defects, representing circumstances
in which platelet thresholds are often set higher than 50k/uL.
Alternatively, 25% of alert overrides occurred in potentially
inappropriate contexts, including patients undergoing
non-cardiovascular/non-neurosurgical procedures and patients with non-CNS
active bleeding, settings where routinely targeting a platelet threshold
>50k/uL is not supported by evidence. As a result of our study's
randomized design, future directions include comparative analyses between
patient care encounters in which alerts were silently versus visibly
triggered, allowing for rigorous determination as to whether providers'
interaction with our BPA influences subsequent rates of potentially
inappropriate platelet utilization as compared to a control group.
Overall, our findings show that platelets are frequently ordered in
potentially inappropriate settings, and that reducing these orders imparts
significant financial savings. These results provide an impetus for
interventions directed at educating providers on appropriate platelet
ordering practices, in order to further reduce unnecessary expenditures
and optimize patient care. [Formula presented] Disclosures: No relevant
conflicts of interest to declare. Copyright © 2019 American
Society of Hematology

<42>
Accession Number
2013223266
Title
Maximum 24-Hour Platelet Count Fall Rate As a Predictor of HIT.
Source
Blood. Conference: 61st ASH Annual Meeting. Orlando United States. 134
(Supplement 1) (pp 1072), 2019. Date of Publication: 13 Nov 2019.
Author
Lefler D.S.; Cuker A.; Pishko A.M.
Institution
(Lefler) Department of Medicine, University of Pennsylvania, Philadelphia,
PA, United States
(Lefler) Department of Medicine, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Cuker) Department of Medicine and Department of Pathology & Laboratory
Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
(Pishko) Hospital of University of Pennsylvania, Conshohocken, PA, United
States
Publisher
Elsevier B.V.
Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a high-stakes
diagnosis. A delay in initiation of appropriate therapy is associated with
a 6.1% daily incidence of thrombosis, amputation, and death (Greinacher et
al, Blood 2000). However, misdiagnosis exposes patients without HIT to
alternative anticoagulants and their attendant risk of major bleeding.
Although a meta-analysis showed that the negative predictive value (NPV)
of a low-probability 4Ts score is 99.8%, the positive predictive value
(PPV) of the 4Ts score is limited. This is particularly true among
individuals with an intermediate-probability score, in whom the PPV is
only 14% (Cuker et al. Blood 2012). It has been observed that
immune-mediated causes of thrombocytopenia result in a more precipitous
fall in the platelet count than other common causes of hospital-acquired
thrombocytopenia (e.g. infection, disseminated intravascular coagulation,
drug-induced myelosuppression). Nevertheless, the pace of platelet count
fall is not currently captured in the 4Ts score or other clinical
prediction models for HIT. We hypothesized that rapidity of the platelet
count fall could help to discriminate HIT status among patients with an
intermediate probability 4Ts score. Method(s): In a cohort of 292
patients with suspected HIT and prospectively calculated 4Ts scores, we
identified patients with an intermediate 4Ts score (4 or 5). Patients were
classified as HIT-positive or HIT-negative by an independent panel of HIT
experts as previously described (Pishko et al. Blood Advances 2018). We
compared the frequency of scores in each of the 4Ts score categories
between HIT-positive and-HIT negative patients using Chi-square analysis.
For each day from hospital admission to day of HIT laboratory testing, we
extracted the first measured platelet count, exposure to heparin, and
platelet transfusions. We also extracted the dates of the following events
of interest, as they may be associated with an immediate fall in platelet
count: cardiovascular surgery, initiation of extracorporeal membrane
oxygenation, intra-aortic balloon pump placement, Impella device
placement, and left ventricular assist device implantation. Two reviewers
reviewed the platelet count and clinical data for each patient to
determine the day on which the platelet count began to decline, excluding
platelet count falls 24 hours following one of the aforementioned events
of interest. From this date, we calculated the change in platelet count
per each 24-hour timeframe, expressed as a percentage of the previous
day's platelet count. For each subject, we identified the maximum
percentage decrease in platelet count in a 24-hour period
(Fall<inf>max</inf>). We then compared the Fall<inf>max</inf> between
HIT-positive and HIT-negative subjects using the Wilcoxon-rank sum test.
We assessed the operating characteristics of Fall<inf>max</inf> for the
diagnosis of HIT at different cut-offs. We selected a cut-off that
maximized specificity of the metric while maintaining a sensitivity of
>=95%. Result(s): Among 292 patients, 158 (54.1%) had a 4Ts score of
4 or 5. Twenty-two (13.9%) were HIT-positive and 136 (86.1%) were
HIT-negative. Patient characteristics are listed in table 1. No single
item in the 4Ts score exhibited a significant relationship with HIT
diagnosis (table 2). The median Fall<inf>max</inf> was 49.6% (IQR
42.3-58.9) in HIT-positive patients and 38.5% (IQR 27.8-50.4) in
HIT-negative patients (p=0.009). At a Fall<inf>max</inf> cut off of >=
30%, the sensitivity and specificity of this measure for the diagnosis of
HIT was 95.5% (95% CI 77.2%-99.9%) and 29.4% (95% CI 21.9%-37.8%),
respectively (table 3). 29.4% (40/136) of the HIT-negative patients had a
Fall<inf>max</inf> below this cut-off versus only 2.4% (1/22) HIT-positive
patients. Conclusion(s): The maximum percentage decrease in platelet
count within 24-hours (Fall<inf>max</inf>) was significantly higher in
HIT-positive versus HIT-negative patients. A Fall<inf>max</inf> >= 30% may
be a useful metric to discriminate HIT positivity among patients with an
intermediate 4Ts score. In this cohort, nearly 30% of HIT negative
patients did not meet this cut-off and thus may have been spared
alternative anticoagulant exposure. The rapidity of platelet count fall
holds promise as a marker for improving the PPV of the 4Ts score, though
it requires further evaluation and external validation. [Formula
presented] Disclosures: Cuker: Synergy: Consultancy; Alexion: Other:
Institutional funding on author's behalf; Bayer: Other: Institutional
funding on author's behalf; Novo Nordisk: Other: Institutional funding on
author's behalf; Pfizer: Other: Institutional funding on author's behalf;
Spark: Other: Institutional funding on author's behalf. Pishko: Novo
Nordisk: Research Funding; Sanofi Genzyme: Research Funding. Copyright
© 2019 American Society of Hematology

<43>
Accession Number
2007596409
Title
Recurrence of cardiac defects among siblings: Could this pose an urgent
need for genetic and chromosomal analysis? case report and review of
literature.
Source
Current Pediatric Research. 25 (4) (pp 590-593), 2021. Date of
Publication: 2021.
Author
Chinawa J.M.; Ujunwa F.A.; Aronu A.E.; Chinawa A.T.; Maduka N.C.; Obidike
E.O.
Institution
(Chinawa, Ujunwa, Aronu) Department of Paediatrics, College of Medicine,
University of Nigeria, Enugu Campus, Nsukka, Enugu, Nigeria
(Chinawa, Maduka, Obidike) Department of Community medicine, Enugu State
University, College of medicine, Nsukka, Enugu, Nigeria
Publisher
Scientific Publishers of India
Abstract
Background: Current trends in chromosomal analysis and genetic assay for
cardiac anomalies have led to arising need for genetic cardiologists and
counsellors. Objective(s): We present series of four cases that
showed a very strong demand and need for genetic testing and counselling.
Results/Case Presentation: We report four cases of congenital familial
disease, each pair consists of siblings with both congenital and acquired
heart diseases. The first pair arise from same parents, both males, 8
years and 5 years respectively with both presenting with anomaly from
cono-truncal origin. The elder brother has pulmonary stenosis and the
younger had truncus arteriosus. The former had surgery and was doing well
but the former awaits surgery. The second pair arise from same biological
parent. Both are females, 8 years and 6 years old respectively, both had
cardiomyopathy, they are now awaiting cardiac transplant. Regrettably,
none of the familial cases had any genetic assay or counselling because of
lack of funds and facilities. Conclusion(s): From these cases, it is
very expedient to include genetic counselling and chromosomal analysis as
part of our daily practice in our locale. Indications such as the presence
of a syndromic phenotype, growth delays and a family history of cardiac
lesion could be a tell-tale sign for genetic analysis. Copyright
© 2021, Scientific Publishers of India. All rights reserved.

<44>
Accession Number
626953543
Title
Postoperative analgesia with ropivacaine and dexmedetomidine for
ultrasound-guided fascia iliaca compartment block after arthroscopic knee
surgery.
Source
Saudi Journal of Anaesthesia. 13 (2) (pp 100-105), 2019. Date of
Publication: April-June 2019.
Author
Li Y.; Geng J.; Wen L.; Chen J.; Wu Z.
Institution
(Li, Geng, Wen, Chen, Wu) Department of Anesthesiology, Jiangyin Hospital,
Affiliated to Southeast University Medical School, No. 163, Shoushan Road,
Chengjiang District, Jiangyin City, Jiangsu Province, China
Publisher
Wolters Kluwer Medknow Publications
Abstract
Objective: The objective of this study is to evaluate the postoperative
analgesic effect of a combination of ropivacaine and dexmedetomidine for
ultrasound-guided fascia iliaca compartment block (FICB) after knee
arthroscopy. Material(s) and Method(s): Forty patients scheduled for
knee arthroscopy were randomized to receive either 30 ml of 0.25%
ropivacaine alone (Group A, n = 20) or combined with dexmedetomidine 1
mug/kg (Group B, n = 20). Pain intensity was evaluated using the visual
analogue scale (VAS), at rest and during activity at 4, 6, 8, 12, and 24 h
after surgery. Level of consciousness was evaluated using the Ramsay
sedation score. Time to first analgesic request after surgery, the dose of
analgesic used in the first 24 h after surgery, variation of heart rate,
and adverse reactions were also recorded. Result(s): VAS scores at 6
and 12 h after surgery were significantly lower in Group B compared to
Group A (P < 0.05). No significant difference was observed in the Ramsay
sedation score or time to first analgesic request after surgery (P >
0.05). The total dose of analgesic used in the first 24 h after surgery
was higher in Group A than in Group B. The incidence of bradycardia was
higher in Group B compared to Group A. No adverse reactions were observed
in either group. Conclusion(s): FICB with a combination of
ropivacaine and dexmedetomidine resulted in significant reduction of VAS
scores with lower postoperative analgesic requirement after arthroscopic
knee surgery. No adverse reactions or complications were noted except for
lower heart rate in Group B patients. Copyright © 2019 Saudi
Journal of Anesthesia Published by Wolters Kluwer - Medknow.

<45>
Accession Number
626113997
Title
Comparison of propofol versus sevoflurane on the outcomes of patients
undergoing cardiac surgery with cardiopulmonary bypass.
Source
Acta Medica Mediterranea. 35 (1) (pp 369-372), 2019. Date of Publication:
2019.
Author
Tang S.; Yang F.; Zhang K.; Chen W.; Xie T.
Institution
(Tang) Department of Anesthesiology, Renmin Hospital of Wuhan University,
Wuhan, Hubei Province 430060, China
(Yang) Department of Clinical Oncology, Taihe Hospital, Hubei University
of Medicine, Shiyan, Hubei 442000, China
(Xie) Department of Anesthesiology, Jingzhou Central Hospital, Second
Clinical Medical College, Yangtze University, Jingzhou, Hubei 434020,
China
(Chen) Department of Anesthesiology, first people's hospital of Jingzhou,
first Clinical Medical College, Yangtze University, Jingzhou, Hubei
434020, China
Publisher
A. CARBONE Editore
Abstract
Objective: To compare the effects of propofol versus sevoflurane on the
outcomes of patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). Method(s): 110 patients who underwent cardiac surgery
with CPB from January 2015 to June 2017 in our hospital were randomly
divided into 2 groups (n=55): A group in which anesthesia was maintained
with sevoflurane and B group in which anesthesia was maintained with
propofol. MMSE score before and after operation, perioperative laboratory
index, the incidence of postoperative cognitive dysfunction (POCD) and the
incidence of adverse events between two groups were compared.
 Result(s): MMSE score was significantly higher in B group than in A
group after anesthesia (p<0.05). Serum levels of brain injury markers
neuron-specific enolase, S100beta and matrix metalloproteinase 9 were
significantly lower in B group than in A group (p<0.05). POCD incidence at
12 h and 24 h after operation was significantly lower in B group than in A
group (p<0.05). There was no significant difference in the incidence of
low cardiac output and thoracotomy bleeding between two groups.
 Conclusion(s): Compared with sevoflurane, the use of propofol during
cardiac surgery with CPB can efficiently improve postoperative cognitive
function without increasing the risk of adverse reactions. Copyright
© 2019 A. CARBONE Editore. All rights reserved.

<46>
Accession Number
625764782
Title
Cardiovascular risk reduction with icosapent ethyl for
hypertriglyceridemia.
Source
New England Journal of Medicine. 380 (1) (pp 11-22), 2019. Date of
Publication: 03 Jan 2019.
Author
Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson T.A.; Ketchum
S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Granowitz C.; Tardif J.-C.;
Ballantyne C.M.
Institution
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, 75 Francis St., Boston, MA 02115, United States
(Steg) FACT (French Alliance for Cardiovascular Trials), Departement
Hospitalo-Universitaire FIRE (Fibrose, Inflammation, and Remodeling),
Assistance Publique-Hopitaux de Paris, Hopital Bichat, Universite
Paris-Diderot, INSERM Unite 1148, Paris, France
(Steg) National Heart and Lung Institute, Imperial College, Royal Brompton
Hospital, London, United Kingdom
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, MD, United States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Ketchum, Doyle, Juliano, Jiao, Granowitz) Amarin Pharma, Bedminster, NJ,
United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine, Center
for Cardiovascular Disease Prevention, Methodist De-Bakey Heart and
Vascular Center, Houston, TX, United States
Publisher
Massachussetts Medical Society
Abstract
Background: Patients with elevated triglyceride levels are at increased
risk for ischemic events. Icosapent ethyl, a highly purified
eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data
are needed to determine its effects on ischemic events. Method(s): We
performed a multicenter, randomized, double-blind, placebo-controlled
trial involving patients with established cardiovascular disease or with
diabetes and other risk factors, who had been receiving statin therapy and
who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52
to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of
41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients
were randomly assigned to receive 2 g of icosapent ethyl twice daily
(total daily dose, 4 g) or placebo. The primary end point was a composite
of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina. The key secondary end
point was a composite of cardiovascular death, nonfatal myocardial
infarction, or nonfatal stroke. Result(s): A total of 8179 patients
were enrolled (70.7% for secondary prevention of cardiovascular events)
and were followed for a median of 4.9 years. A primary end-point event
occurred in 17.2% of the patients in the icosapent ethyl group, as
compared with 22.0% of the patients in the placebo group (hazard ratio,
0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the
corresponding rates of the key secondary end point were 11.2% and 14.8%
(hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of
additional ischemic end points, as assessed according to a prespecified
hierarchical schema, were significantly lower in the icosapent ethyl group
than in the placebo group, including the rate of cardiovascular death
(4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P = 0.03). A
larger percentage of patients in the icosapent ethyl group than in the
placebo group were hospitalized for atrial fibrillation or flutter (3.1%
vs. 2.1%, P = 0.004). Serious bleeding events occurred in 2.7% of the
patients in the icosapent ethyl group and in 2.1% in the placebo group (P
= 0.06). Conclusion(s): Among patients with elevated triglyceride
levels despite the use of statins, the risk of ischemic events, including
cardiovascular death, was significantly lower among those who received 2 g
of icosapent ethyl twice daily than among those who received
placebo. Copyright © 2018 Massachusetts Medical Society.

<47>
Accession Number
625379048
Title
Application of different anesthetic methods in coronary artery bypass
grafting and the effect on postoperative outcome.
Source
Experimental and Therapeutic Medicine. 17 (1) (pp 695-700), 2019. Date of
Publication: January 2019.
Author
Shi Y.; Wang W.
Institution
(Shi) Department of Cardiac Surgery, Jining No. 1 People's Hospital,
Jining, Shandong 272000, China
(Wang) Department of Anesthesiology, Jining No. 1 People's Hospital,
Jining, Shandong 272000, China
Publisher
Spandidos Publications
Abstract
Application of different anesthetic methods in coronary artery bypass
grafting and its effect on postoperative outcome were explored.
Ninety-four patients undergoing coronary artery bypass grafting in Jining
No. 1 People's Hospital from March 2017 to February 2018 were randomly
divided into the control and observation groups. The control group was
anesthetized by fentanyl and propofol. The observation group was
anesthetized by sevoflurane combined anesthesia. The mean heart rates
(HR), mean arterial pressure (MAP), systemic vascular resistance index
(SVRI) and cardiac index (CI) in the two groups were compared. The levels
of beta endorphin (beta-EP) and malondialdehyde (MDA) in patients were
examined. Adverse reactions in the two groups were compared. The
enzyme-linked immunosorbent assay (ELISA) was used to detect the changes
of serum inflammatory factors. The prognosis of the two groups was
analyzed and compared. MoCA and MMSE scale were used to evaluate
postoperative cognitive function in the two groups. The levels of beta-EP
and MDA in the two groups during operation were higher than those before
operation (P<0.05). On the third, fifth and seventh day after operation,
the CRP, TNF-alpha and IL-6 levels of the two groups increased
significantly compared to those before operation (P<0.05). The eating time
and out of bed time in the observation group were significantly earlier
than those in the control group, and the length of stay in the observation
group was significantly shorter than that in the control group (P<0.05).
On the first day after operation, the scores of MoCA and MMSE in the
observation group were better than those in the control group (P<0.05).
The two different anesthetic methods can maintain the perioperative
hemodynamic stability of coronary artery bypass patients, but sevoflurane
intravenous-inhalation combined anesthesia can effectively. Copyright
© 2019, Spandidos Publications. All rights reserved.

<48>
Accession Number
2002500123
Title
Clinical Efficacy of a Medical Centre- and Home-based Cardiac
Rehabilitation Program for Patients With Coronary Heart Disease after
Coronary Bypass Graft Surgery.
Source
Archives of Medical Research. 50 (3) (pp 122-132), 2019. Date of
Publication: April 2019.
Author
Aronov D.; Bubnova M.; Iosseliani D.; Orekhov A.
Institution
(Aronov, Bubnova) Federal State Institution "National Medical Research
Center for Preventive Medicine", Petroverigskiy lane 10, Moscow, Russian
Federation
(Iosseliani) Center for Interventional Cardioangiology, I.M. Sechenov
First Moscow State Medical University, 8-2, Trubetskaya St., Moscow,
Russian Federation
(Orekhov) Laboratory of Angiopathology, Institute of General Pathology and
Pathophysiology, Moscow, Russian Federation
(Orekhov) Institute for Atherosclerosis Research, Skolkovo Innovative
Center, Moscow, Russian Federation
(Orekhov) Institute of Human Morphology, Moscow, Russian Federation
Publisher
Elsevier Inc.
Abstract
Background: Rehabilitation measures are crucial for maintaining clinical
benefits of coronary artery bypass grafting (CABG) surgery. We evaluated
the clinical efficacy of a medical centre- and home-based cardiac
rehabilitation (CR) for patients after CABG in an out-patient setting.
 Method(s): The study included 36 male patients 3-8 weeks after CABG
that were randomly assigned to either study or control group. Patients
from the study group performed a 60 min excercise in controlled setting 3
times a week for 4 months followed by home-based excercise later on, while
patients from the control group only received a recommendation to perform
the excercise at home in an uncontrolled setting. Total duration of the
follow-up was 12 months. Result(s): Physical endurance in the study
group increased by 32.6% (p <0.05) in comparison to baseline after 4
months, and was maintained at this level after 12 months, while in the
control group, an improvement of 9.8% (p <0.05) was observed after 12
months. Moreover, patients from the study group demonstrated a stable
level of such risk factors as blood total and low-density lipoprotein
cholesterol, while in the control group, these parameters increased by
10.2% (p < 0.05) and 15.6% (p < 0.05) respectively by the end of
follow-up. Controlled medical centre-based exercise resulted in
improvement of patients' quality of life and reduction of cardiovascular
complications (11.1% against 39.2% in the control group).
 Conclusion(s): The integral (medical centre and home-based) stage III
CR program after CABG helped reducing cardiovascular risk factors, and
improved clinical parameters and functional capacity of
patients. Copyright © 2019 IMSS

<49>
Accession Number
2002496894
Title
Effectiveness of acupressure on bio-physiological parameters in
mediosternotomy patients.
Source
International Journal of Research in Pharmaceutical Sciences. 10 (3) (pp
2082-2089), 2019. Date of Publication: 2019.
Author
Pritha L.; Valliammal S.; Goothy S.K.; Vijayaraghavan R.
Institution
(Pritha) Sri SathyaSai Institute of Higher Medical Sciences, College of
Nursing, EPIP Area, Bangalore, India
(Valliammal) NIMHANS college of nursing, NIMHANS, Bangalore, India
(Goothy) Department of Physiology, Vishnu Dental College, Bhimavaram,
Andhra Pradesh, India
(Vijayaraghavan) Saveetha Institute of Medical and Technical Sciences,
Chennai, Tamil Nadu, India
Publisher
J. K. Welfare and Pharmascope Foundation
Abstract
Acupressure is one of the emerging alternative therapies for the
management of the pain, anxiety and other physiological indexes. The
present study was conducted at Sri Sathya Sai Institute of Higher Medical
Sciences, Whitefiield, Bangalore. A total of twenty male and female
patients those who undergo open-heart surgery via median sternotomy were
part of the study after obtaining the written informed consent. After
recording the demographic data, the participants were randomly grouped
into control and intervention groups using random numbers generated by
computer with 10 participants in each group. The intervention will be
provided at PC6 acupressure point, situated on the inner side of the
forearm, three fiingers below the wrist joint, three times a day (6 am, 12
noon, 6 pm). There was a signifiicant decrease in the heart rate and blood
pressure and a signifiicant increase in the partial pressure of oxygen.
Further, there was a decrease in the serum troponin T levels. The study
support implementation of the acupressure Copyright © 2019, J. K.
Welfare and Pharmascope Foundation. All rights reserved.

<50>
Accession Number
2002384577
Title
Comparison of effects of propofol versus sevoflurane for patients
undergoing cardiopulmonary bypass cardiac surgery.
Source
Pakistan Journal of Medical Sciences. 35 (4) (pp 1072-1075), 2019. Date of
Publication: July-August 2019.
Author
Tang S.; Huang W.; Zhang K.; Chen W.; Xie T.
Institution
(Tang) Department of Anesthesiology, Renmin Hospital of Wuhan University,
Wuhan, Hubei Province 430060, China
(Huang) Department of Neurology, Taihe Hospital Hubei University of
Medicine, Shiyan, Hubei 442000, China
(Zhang, Xie) Department of Anesthesiology, Jingzhou Central Hospital,
Second Clinical Medical College, Yangtze University, Jingzhou, Hubei
434020, China
(Chen) Department of Anesthesiology, The first people's hospital of
Jingzhou, The first Clinical Medical College, Yangtze University,
Jingzhou, Hubei 434020, China
Publisher
Professional Medical Publications
Abstract
Objective: To compare the effects of propofol versus sevoflurane on the
outcomes of patients undergoing cardiac surgery with cardiopulmonary
bypass (CPB). Method(s): A total of 110 patients undergoing cardiac
surgery with CPB in our hospital from January 2015 to June 2017 were
randomly divided into 2 groups (n=55): Group A, in which anesthesia was
maintained with sevoflurane, and Group B, in which anesthesia was
maintained with propofol. The MMSE score before and after operation,
perioperative laboratory index, incidence of postoperative cognitive
dysfunction (POCD) and incidence of adverse events between the two groups
were compared. Result(s): The MMSE score was significantly higher in
Group B than in Group A after anesthesia (p<0.05). Serum levels of the
brain injury markers neuron-specific enolase, S100B and matrix
metalloproteinase 9 were significantly lower in Group B than in Group A
(p<0.05). POCD incidence at 12 hour and 24 hour after operation was
significantly lower in Group B than in Group A (p<0.05). There were no
significant differences in the incidence of low cardiac output and
thoracotomy bleeding between two groups. Conclusion(s): Compared with
sevoflurane, the use of propofol during cardiac surgery with CPB can
efficiently improve postoperative cognitive function without increasing
the risk of adverse reactions. Copyright © 2019, Professional
Medical Publications. All rights reserved.

<51>
Accession Number
2002329809
Title
Bisoprolol versus corticosteroid and bisoprolol combination for prevention
of atrial fibrillation after on-pump coronary artery bypass graft surgery.
Source
Open Anesthesia Journal. 13 (1) (pp 18-24), 2019. Date of Publication:
2019.
Author
Mahrose R.; Elsayed A.M.; Elshorbagy M.S.
Institution
(Mahrose, Elsayed, Elshorbagy) Department of Anesthesiology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
Abstract
Background: The most common cardiac arrhythmia that happens after on-pump
Coronary Artery Bypass Graft (CABG) surgery is Atrial Fibrillation (AF).
It is combined with several postoperative complications such as increased
incidence of stroke, increased hospital stay and increased costs.
 Objective(s): The aim of this study was to look for safe, effective,
reliable and well tolerated tools for the prevention of atrial
fibrillation after on pump coronary artery bypass surgery. Patients
and Methods: The study enclosed 176 patients (the age ranges from 40 to 79
years) and scheduled for elective on-pump CABG operations without
concomitant procedures. The patients were selected randomly into two equal
groups. Group (A) in which bisoprolol was used to prevent atrial
fibrillation after surgery. Group (B) in which bisoprolol and
hydrocortisone were used for prevention of atrial fibrillation after
surgery. For each patient, the following data were collected: gender,
preoperative diseases, cardiopulmonary bypass time, intraoperative cross
clamp time, Left internal mammary Artery usage, incidence of postoperative
atrial fibrillation, death, myocardial infarction chest infection and
C-reactive protein amount in plasma. Result(s): There was a
statistically significant decrease in the occurrence of atrial
fibrillation in group (B) when compared to corresponding values in group
(A). Also, group (B) showed a statistically significant decrease in length
of hospital stay in comparison to group (A). C-reactive protein
concentrations on the 1st and 2nd postoperative days
were lower significantly in group (B) than in group (A). There were no
statistically significant differences between both groups regarding
gender, preoperative diseases, cardiorespiratory bypass time,
intraoperative cross clamp time, Left internal mammary artery usage,
death, myocardial infarction and chest infection. Conclusion(s): This
study demonstrated that using bisoprolol and hydrocortisone combination
showed greater benefit than the use of bisoprolol only for prevention of
postoperative AF after on-pump coronary artery bypass graft
surgery. Copyright © 2019 Mahrose et al.

<52>
Accession Number
2002159713
Title
Protective effect of dexmedetomidine combined with ulinastatin on
myocardium in patients undergoing valve replacement.
Source
Farmacia. 67 (3) (pp 437-441), 2019. Date of Publication: 2019.
Author
Zhan Y.; Zhang H.; Han Z.
Institution
(Zhan, Zhang) Department of Anesthesiology, The Third Affiliated Hospital
of Qiqihar Medical University, Qiqihar City 161000, China
(Han) Department of Cardiothoracic Surgery, The Third Affiliated Hospital
of Qiqihar Medical University, Qiqihar City 161000, China
Publisher
Romanian Society for Pharmaceutical Sciences
Abstract
The aim of the study was to evaluate the myocardial protective effect of
dexmedetomidine (Dex) combined with ulinastatin in patients undergoing
heart valve replacement (HVR). Thirty-six patients undergoing
cardiopulmonary bypass (CPB) were randomly divided into control group
(group C), Dex group (group D), ulinastatin group (group U), and Dex
combined with ulinastatin group (group B), 9 patients per group.
Hemodynamic changes were monitored in all patients. From each patient 3 mL
of blood was collected from the internal jugular vein at 30 minutes after
anaesthesia induction, 30 minutes after rewarming, 30 minutes, 4 hours and
24 hours after stopping anaesthesia. The concentrations of tumour necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), plasma S100beta protein
and malondialdehyde (MDA) were measured. The results showed that there was
no significant difference in regional arterial blood pressure, central
venous blood pressure, heart rate and oxygen saturation between the four
groups (p > 0.05). The concentrations of TNF-alpha, IL-6, MDA and S100beta
in blood had no significant difference immediately after anaesthesia
induction (p> 0.05); 30 minutes after anaesthesia induction, 30 minutes
after rewarming, 30 minutes, 4 hours and 24 hours after stopping
anaesthesia, the concentration of TNF-alpha, IL-6, MDA and S100beta in
group D and U were significantly lower than those in group C, while those
in group B were significantly lower than those in groups D and U (p <
0.05). In conclusion, Dex combined with ulinastatin can alleviate
myocardial injury in patients undergoing cardiopulmonary bypass valve
replacement, and has good myocardial protection, superior to the
dexmedetomidine or ulinastatin alone. Copyright © 2019, Romanian
Society for Pharmaceutical Sciences. All rights reserved.

<53>
Accession Number
2001967121
Title
Long-term comparison of ethyl icosapentate vs. Omega-3-acid ethyl in
patients with cardiovascular disease and hypertriglyceridemia (DEFAT
Trial).
Source
Circulation Journal. 83 (6) (pp 1368-1376), 2019. Date of Publication:
2019.
Author
Sezai A.; Unosawa S.; Taoka M.; Osaka S.; Obata K.; Kanno S.; Sekino H.;
Tanaka M.
Institution
(Sezai, Taoka, Osaka, Tanaka) Department of Cardiovascular Surgery, Nihon
University School of Medicine, Japan
(Obata, Kanno, Sekino) Sekino Hospital, Tokyo, Japan
Publisher
Japanese Circulation Society
Abstract
Background: Numerous studies have demonstrated a reduction in
cardiovascular events when the low-density lipoprotein cholesterol (LDL)
level is decreased by statin therapy. However, despite good control of
LDL, cardiovascular events may increase if the triglyceride (TG) level is
high. We conducted a long-term comparison of treatment of
hypertriglyceridemia with ethyl icosapentate (EPA) vs. omega-3-acid ethyl
(EPA+docosahexaenoic acid [DHA]). Methods and Results: Cardiac
surgery patients with hypertriglyceridemia were randomized to an EPA group
(1.8 g t.i.d.) or an EPA+DHA group (2 g s.i.d.) and observed for 3 years.
The primary endpoints were the serum TG level and its percent change.
Secondary endpoints included lipid markers, fatty acid parameters, serum
creatinine, cystatin-C, oxidized LDL, high-sensitivity C-reactive protein,
and MACCE. An interview to assess study drug adherence was conducted 6
months after completing the study. TG levels were significantly lower in
the EPA+DHA group than in the EPA group. Levels of remnant-like
particles-cholesterol, oxidized LDL, and cystatin-C were also
significantly lower in the EPA+DHA group than in the EPA group. Compliance
with treatment was significantly worse in the EPA group.
 Conclusion(s): Better results were obtained in the EPA+DHA group, but
more patients showed poor compliance with treatment in the EPA group,
making detailed comparison of the 2 groups difficult. Even so, TG were
reduced while EPA and DHA levels were increased in the EPA+DHA group,
together with a reduction in oxidative stress and remnant-like
particles-cholesterol. Decreased compliance with medication in the EPA
group significantly affected the results of this study, clearly indicating
the importance of good compliance. Copyright © 2019, Japanese
Circulation Society. All rights reserved.

<54>
Accession Number
2001922604
Title
Pacemaker Implantation After Mitral Valve Surgery With Atrial Fibrillation
Ablation.
Source
Journal of the American College of Cardiology. 73 (19) (pp 2427-2435),
2019. Date of Publication: 21 May 2019.
Author
DeRose J.J.; Mancini D.M.; Chang H.L.; Argenziano M.; Dagenais F.;
Ailawadi G.; Perrault L.P.; Parides M.K.; Taddei-Peters W.C.; Mack M.J.;
Glower D.D.; Yerokun B.A.; Atluri P.; Mullen J.C.; Puskas J.D.; O'Sullivan
K.; Sledz N.M.; Tremblay H.; Moquete E.; Ferket B.S.; Moskowitz A.J.;
Iribarne A.; Gelijns A.C.; O'Gara P.T.; Blackstone E.H.; Gillinov A.M.;
Miller M.A.; Buxton D.; Connolly A.; Geller N.L.; Gordon D.; Jeffries
N.O.; Lee A.; Moy C.S.; Gombos I.K.; Ralph J.; Weisel R.; Gardner T.J.;
Rose E.A.; Ascheim D.D.; Bagiella E.; Chang H.; Chase M.; Dobrev E.;
Goldfarb S.; Gupta L.; Kirkwood K.; Levitan R.; Overbey J.; Santos M.;
Weglinski M.; Williams P.; Wood C.; Ye X.; Mack M.; Adame T.; Settele N.;
Adams J.; Ryan W.; Smith R.L.; Grayburn P.; Chen F.Y.; Nohria A.; Cohn L.;
Shekar P.; Aranki S.; Couper G.; Davidson M.; Bolman R.M.; Burgess A.;
Conboy D.; Blackwell R.; Kerzner R.; Banbury M.; Squire A.M.; Lytle B.;
Mihaljevic T.; Lackner P.; Berroteran L.; Dolney D.; Fleming S.; Palumbo
R.; Whitman C.; Sankovic K.; Sweeney D.K.; Pattakos G.; Williams M.;
Goldsmith L.; Smith C.R.; Naka Y.; Stewart A.; Schwartz A.; Bell D.; Van
Patten D.; Sreekanth S.; Smith P.K.; Alexander J.H.; Milano C.A.; Mathew
J.P.; Harrison J.K.; Welsh S.; Ferguson T.B.; Kypson A.P.; Rodriguez E.;
Harris M.; Akers B.; O'Neal A.; Thourani V.H.; Guyton R.; Baer J.; Baio
K.; Neill A.A.; Voisine P.; Senechal M.; O'Connor K.; Dussault G.;
Ballivian T.; Keilani S.; Michler R.E.; D'Alessandro D.A.; Goldstein D.J.;
Bello R.; Jakobleff W.; Garcia M.; Taub C.; Spevack D.; Swayze R.; Sookraj
N.; Basmadjian A.-J.; Bouchard D.; Carrier M.; Cartier R.; Pellerin M.;
Tanguay J.F.; El-Hamamsy I.; Denault A.; Lacharite J.; Robichaud S.; Adams
D.H.; Varghese R.; Mandel-Portnoy Y.; Horvath K.A.; Corcoran P.C.;
Siegenthaler M.P.; Murphy M.; Iraola M.; Greenberg A.; Sai-Sudhakar C.;
Hasan A.; McDavid A.; Kinn B.; Choy J.; Meyer S.; Kuurstra E.; Gammie
J.S.; DeFilippi C.R.; Gaetani D.T.; Young C.A.; Beach D.; Collins J.;
Bolling S.F.; Pagani F.D.; Bloem C.; Acker M.A.; Woo Y.J.; Mayer M.L.;
Bavaria J.E.; Szeto W.Y.; Margulies K.; Keane M.; Glassberg H.; Jagasia
D.; Kirkpatrick J.; Kron I.L.; Johnston K.; Dent J.M.; Kern J.; Keim J.;
Burks S.; Gahring K.; Mangi A.; Akar J.; Yuh D.; Wilson L.; Bull D.A.;
Desvigne-Nickens P.; Dixon D.O.; Haigney M.; Holubkov R.; Jacobs A.;
Miller F.; Murkin J.M.; Spertus J.; Wechsler A.S.; Sellke F.; McDonald
C.L.; Byington R.; Dickert N.; Ikonomidis J.S.; Williams D.O.; Yancy C.W.;
Canty J.M.; Fang J.C.; Giannetti N.; Richenbacher W.; Rao V.; Furie K.L.;
Miller R.; Pinney S.; Roberts W.C.; Walsh M.N.; Hung J.; Zeng X.; Couderc
J.-P.; Balda D.; Bowen W.; Wilson M.; Schering A.
Institution
(DeRose, Parides) Department of Cardiothoracic Surgery, Montefiore Medical
Center/Albert Einstein College of Medicine, New York, NY, United States
(Mancini, Chang, O'Sullivan, Sledz, Moquete, Ferket, Moskowitz, Gelijns)
International Center for Health Outcomes and Innovation Research
(InCHOIR), the Department of Population Health Science and Policy, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Argenziano) Division of Cardiothoracic Surgery, Department of Surgery,
College of Physicians and Surgeons, Columbia University, New York, NY,
United States
(Dagenais, Tremblay) Department of Surgery, Institut de Cardiologie et
Pneumologie de Quebec, Quebec, Canada
(Ailawadi) Section of Adult Cardiac Surgery, University of Virginia,
Charlottesville, VA, United States
(Perrault) Department of Surgery, Montreal Heart Institute, Quebec,
Quebec, Canada
(Taddei-Peters) Division of Cardiovascular Sciences, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, MD, United
States
(Mack) Cardiovascular Surgery, Baylor Scott and White Health, Plano, TX,
United States
(Glower, Yerokun) Department of Surgery, Duke University Medical Center,
Durham, NC, United States
(Atluri) Department of Surgery, University of Pennsylvania, Philadelphia,
PA, United States
(Mullen) Division of Cardiac Surgery, University of Alberta, Edmonton,
Alberta, Canada
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Heart at Saint
Luke's, New York, NY, United States
(Iribarne) Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center,
Lebanon, NH, United States
(O'Gara) Cardiovascular Division, Brigham and Women's Hospital, Boston,
MA, United States
(Blackstone, Gillinov) Department of Thoracic and Cardiovascular Surgery,
Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background: The incidence of permanent pacemaker (PPM)implantation is
higher following mitral valve surgery (MVS)with ablation for atrial
fibrillation (AF)compared with MVS alone. Objective(s): This study
identified risk factors and outcomes associated with PPM implantation in a
randomized trial that evaluated ablation for AF in patients who underwent
MVS. Method(s): A total of 243 patients with AF and without previous
PPM placement were randomly assigned to MVS alone (n = 117)or MVS +
ablation (n = 126). Patients in the ablation group were further randomized
to pulmonary vein isolation (PVI)(n = 62)or the biatrial maze procedure (n
= 64). Using competing risk models, this study examined the association
among PPM and baseline and operative risk factors, and the effect of PPM
on time to discharge, readmissions, and 1-year mortality. Result(s):
Thirty-five patients received a PPM within the first year (14.4%), 29
(83%)underwent implantation during the index hospitalization. The
frequency of PPM implantation was 7.7% in patients randomized to MVS
alone, 16.1% in MVS + PVI, and 25% in MVS + biatrial maze. The indications
for PPM were similar among patients who underwent MVS with and without
ablation. Ablation, multivalve surgery, and New York Heart Association
functional (NYHA)functional class III/IV were independent risk factors for
PPM implantation. Length of stay post-surgery was longer in patients who
received PPMs, but it was not significant when adjusted for randomization
assignment (MVS vs. ablation)and age (hazard ratio [HR]: 0.81; 95%
confidence interval [CI]: 0.61 to 1.08; p = 0.14). PPM implantation did
not increase 30-day readmission rate (HR: 1.43; 95% CI: 0.50 to 4.05; p =
0.50). The need for PPM was associated with a higher risk of 1-year
mortality (HR: 3.21; 95% CI: 1.01 to 10.17; p = 0.05)after adjustment for
randomization assignment, age, and NYHA functional class.
 Conclusion(s): AF ablation, multivalve surgery, and NYHA functional
class III/IV were associated with an increased risk for permanent pacing.
PPM implantation following MVS was associated with a significant increase
in 1-year mortality. (Surgical Ablation Versus No Surgical Ablation for
Patients With Atrial Fibrillation Undergoing Mitral Valve Surgery;
NCT00903370) Copyright © 2019 American College of Cardiology
Foundation

<55>
Accession Number
2001846943
Title
Computed tomography quantitative volume imaging guides postoperative
nursing of patients with lung cancer.
Source
Journal of Medical Imaging and Health Informatics. 9 (5) (pp 945-950),
2019. Date of Publication: June 2019.
Author
Zhou L.; Ye J.; Wu W.; Wang J.
Institution
(Zhou, Ye, Wu, Wang) Department of Cardiothoracic Surgery, Second People's
Hospital of Wuhu, Anhui 241000, China
Publisher
American Scientific Publishers
Abstract
Objective: The evaluation of pulmonary function after operation is useful
for the choice of treatment plan. The aim of this study is to explore the
guiding role of computed tomography (CT) quantitative volume imaging in
postoperative nursing of patients with lung cancer. Method(s): Sixty
patients with lung cancer treated by thoracic surgery were selected.
Before and 3 months after operation, the lung volume was measured by CT
quantitative volume imaging technology and lung function was examined. The
correlation between CT lung volume and lung function was evaluated. All
patients were randomly divided into observation and control group. The
patients in observation group were given targeted nursing according to the
predicted results of preoperative CT quantitative volume imaging. The
patients in control group were given routine nursing, and the prognosis
was compared between two groups. Result(s): The highest correlation
coefficient between the measured data and the preoperative pulmonary
function was 0.92, and the correlation coefficient between the predicted
pulmonary function and the measured pulmonary function was 0.95. Compared
with the control group, the incidence of cardiopulmonary complications,
hospitalization time and hospitalization expenses in the observation group
were reduced, and the difference was statistically significant (P <0.05).
 Conclusion(s): The CT quantitative volume imaging can predict the
pulmonary function of patients with lung cancer after operation. Targeted
nursing after operation guided by this quantitative measurement technology
can promote the rehabilitation of patients. Copyright © 2019
American Scientific Publishers.

<56>
Accession Number
2001733875
Title
Bypass Surgery or Stenting for Left Main Coronary Artery Disease in
Patients With Diabetes.
Source
Journal of the American College of Cardiology. 73 (13) (pp 1616-1628),
2019. Date of Publication: 9 April 2019.
Author
Milojevic M.; Serruys P.W.; Sabik J.F.; Kandzari D.E.; Schampaert E.; van
Boven A.J.; Horkay F.; Ungi I.; Mansour S.; Banning A.P.; Taggart D.P.;
Sabate M.; Gershlick A.H.; Bochenek A.; Pomar J.; Lembo N.J.; Noiseux N.;
Puskas J.D.; Crowley A.; Kosmidou I.; Mehran R.; Ben-Yehuda O.; Genereux
P.; Pocock S.J.; Simonton C.A.; Stone G.W.; Kappetein A.P.
Institution
(Milojevic, Kappetein) Erasmus Medical Center, Rotterdam, Netherlands
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Sabik) UH Cleveland Medical Center, Cleveland, OH, United States
(Kandzari) Piedmont Heart Institute, Atlanta, Georgia
(Schampaert, Genereux) Hopital du Sacre-Coeur de Montreal, Montreal,
Quebec, Canada
(van Boven) Medical Center Leeuwarden, Leeuwarden, Netherlands
(Horkay) Semmelweis University, Budapest, Hungary
(Ungi) University of Szeged, Szeged, Hungary
(Mansour, Noiseux) Centre Hospitalier de l'Universite de Montreal,
Montreal, Quebec, Canada
(Banning, Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Sabate, Pomar) Hospital Clinic, Barcelona, Spain
(Gershlick) Glenfield Hospital, Leicester, United Kingdom
(Bochenek) American Heart of Poland, Katowice, Poland
(Lembo, Kosmidou, Ben-Yehuda, Stone) NewYork-Presbyterian
Hospital/Columbia University Medical Center, New York, NY, United States
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Crowley, Kosmidou, Mehran, Ben-Yehuda, Genereux, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, NY, United States
(Mehran) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
(Simonton) Abbott Vascular, Santa Clara, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: The randomized EXCEL (Evaluation of XIENCE versus Coronary
Artery Bypass Surgery for Effectiveness of Left Main Revascularization)
trial reported a similar rate of the 3-year composite primary endpoint of
death, myocardial infarction (MI), or stroke in patients with left main
coronary artery disease (LMCAD) and site-assessed low or intermediate
SYNTAX scores treated with percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG). Whether these results are
consistent in high-risk patients with diabetes, who have fared relatively
better with CABG in most prior trials, is unknown. Objective(s): In
this pre-specified subgroup analysis from the EXCEL trial, the authors
sought to examine the effect of diabetes in patients with LMCAD treated
with PCI versus CABG. Method(s): Patients (N = 1,905) with LMCAD and
site-assessed low or intermediate CAD complexity (SYNTAX scores <=32) were
randomized 1:1 to PCI with everolimus-eluting stents versus CABG,
stratified by the presence of diabetes. The primary endpoint was the rate
of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were
examined in patients with (n = 554) and without (n = 1,350) diabetes.
 Result(s): The 3-year composite primary endpoint was significantly
higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p
< 0.001). The rate of the 3-year primary endpoint was similar after
treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%,
respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p
= 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard
ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause
death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p =
0.046), although no significant interaction was present between diabetes
status and treatment for all-cause death (p = 0.22) or other endpoints,
including the 3-year primary endpoint (p = 0.82) or the major secondary
endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI,
stroke, or ischemia-driven revascularization at 3 years (p = 0.65).
 Conclusion(s): In the EXCEL trial, the relative 30-day and 3-year
outcomes of PCI with everolimus-eluting stents versus CABG were consistent
in diabetic and nondiabetic patients with LMCAD and site-assessed low or
intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery
Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL];
NCT01205776) Copyright © 2019

<57>
Accession Number
2001678673
Title
Effect of continuous nursing intervention on rehabilitation after coronary
artery bypass grafting in elderly patients with coronary heart disease.
Source
Acta Medica Mediterranea. 35 (pp 467-473), 2019. Date of Publication:
2019.
Author
Zhao G.
Institution
(Zhao) Operating Room, Zhongnan Hospital of Wuhan University, Wuhan City
430071, China
Publisher
A. CARBONE Editore
Abstract
Objective: To explore the effect of continuous nursing on the
rehabilitation of elderly patients with coronary artery disease who had
undergone non-stop coronary artery bypass grafting; to discuss the
feasibility and effectiveness of health education and postoperative
guidance after coronary artery bypass grafting for patients through
continuous nursing and routine nursing and comparing the results; to know
the feasibility of different nursing methods in clinical practice.
 Method(s): 72 elderly patients with coronary artery disease who
underwent non-stop coronary artery bypass grafting were selected and
divided into control group and intervention group by random number table
method, and each group had 36 cases. The control group received routine
outpatient visits, while the intervention group adopted continuous
nursing. Two groups of elderly patients with coronary heart disease were
observed and compared for a year, to understand the rehabilitation of two
groups of patients undergoing coronary artery bypass surgery, and to
explore and analyze the effect of continuous nursing intervention on the
rehabilitation of elderly coronary heart disease patients after coronary
artery bypass grafting. Result(s): 1. By comparing and analyzing the
scores of social functional defects screening scale (SDSS) after
intervention in two groups, the total score of the intervention group was
significantly lower than that of the control group; 2. Through the
comparison and analysis of the scores of Chinese cardiovascular patients'
quality questionnaire (CCQQ) before and after the intervention of two
groups of patients, it was found that the quality of life of the patients
in the intervention group was improved; 3. By comparing the complications
of two groups of patients, it was found that the intervention group was
significantly lower than the control group. Conclusion(s): the
continuous nursing mode can improve the cognitive ability of the patients
after the operation, improve the quality of life of the elderly patients
after operation, and can effectively reduce the incidence of postoperative
complications. It is feasible to take continuous nursing in clinical
practice. Copyright © 2019 A. CARBONE Editore. All Rights
Reserved.

<58>
Accession Number
2001633868
Title
Puerarin pre-conditioning on the expression levels of CK-MB, cTnI and
inflammatory factors in patients undergoing cardiac valve replacement.
Source
Experimental and Therapeutic Medicine. 17 (4) (pp 2598-2602), 2019. Date
of Publication: April 2019.
Author
Zhou Y.; Liu L.; Gao C.; Liu N.; Fa X.
Institution
(Zhou, Liu, Gao, Liu, Fa) Department of Cardiovascular Surgery, The Second
Affiliated Hospital oZhengzhou University, Zhengzhou, Henan 450014, China
Publisher
Spandidos Publications
Abstract
Effect of puerarin preconditioning on the expression levels of nuclear
factor kappaB (NF-kappaB), interleukin 6 (IL-6), interleukin 8 (IL-8),
troponin I (cTnI), and creatine kinase isoenzyme MB (CK-MB) in the
neutrophils of patients undergoing cardiac valve replacement under
cardiopulmonary bypass (CPB) was evaluated. We enrolled 50 patients
scheduled for cardiac valve replacement and assigned them randomly divided
into either a puerarin or a control group. Puerarin was dissolved in 10 ml
normal saline before CPB, and administered by intravenous infusion to
patients in the puerarin group. The control group was administered an
equivalent amount of saline. We used flow cytometry to determine the
expression levels of NF-kappaB, IL-6 and IL-8 in neutrophils and an auto
chemistry analyzer to determine the serum levels of cTnI and CK-MB before
anesthesia induction (T0), 30 min after aortic declamping (T1), 4 h after
aortic declamping (T2), and 8 h after aortic declamping (T3). We found the
mean serum cTnI and CK-MB levels of the puerarin group tended to decrease
with time. The positive rates of NF-kappaB, IL-6 and IL-8 at different
time-points were lower in patients of the puerarin group than in those of
the control group (and the differences at T3 were statistically
significant). The clinical manifestations of patients in the puerarin
group after operation were better than those in the control group
(P<0.05). We found that the expression levels of NF-kappaB, IL-6 and IL-8
were positively correlated with the levels of CK-MB and cTnI (P<0.05).
Puerarin preconditioning can reduce the NF-kappaB activation and the
overexpression of IL-6 and IL-8 in neutrophils, and it inhibits the
release of myocardial enzyme cTnI and. Copyright © 2019,
Spandidos Publications. All rights reserved.

<59>
Accession Number
2001506953
Title
Sevoflurane, propofol and carvedilol block myocardial protection by limb
remote ischemic preconditioning.
Source
International Journal of Molecular Sciences. 20 (2) (no pagination), 2019.
Article Number: 269. Date of Publication: 02 Jan 2019.
Author
Cho Y.J.; Nam K.; Kim T.K.; Choi S.W.; Kim S.J.; Hausenloy D.J.; Jeon Y.
Institution
(Cho, Nam, Kim, Jeon) Department of Anesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul National University College of
Medicine, Seoul 03080, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae
Medical Center, Seoul 07061, South Korea
(Choi, Kim) Department of Physiology, Department of Biomedical Sciences,
Seoul National University College of Medicine, Seoul 03080, South Korea
(Choi) Department of Stem Cell Biology, School of Medicine, Konkuk
University, Seoul 05029, South Korea
(Hausenloy) Duke-National University of Singapore Medical School,
Singapore 169857, Singapore
(Hausenloy) Hatter Cardiovascular Institute, Institute of Cardiovascular
Science, University College of London, London WC1E 6HX, United Kingdom
(Hausenloy) Tecnologico de Monterrey, Centro de Biotecnologica-FEMSA,
Nuevo Leon 64849, Mexico
(Hausenloy) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore 119228, Singapore
(Hausenloy) The National Institute of Health Research, University College
London Hospitals, Biomedical Research Centre, London W1T 7DN, United
Kingdom
(Hausenloy) National Heart Research Institute Singapore, National Heart
Centre, Singapore 169609, Singapore
Publisher
MDPI AG
Abstract
The effects of remote ischemic preconditioning (RIPC) in cardiac surgery
have been inconsistent. We investigated whether anesthesia or
beta-blockers interfere with RIPC cardioprotection. Fifty patients
undergoing cardiac surgery were randomized to receive limb RIPC (four
cycles of 5-min of upper arm cuff inflation/deflation) in the awake state
(no-anesthesia; n = 17), or under sevoflurane (n = 17) or propofol (n =
16) anesthesia. In a separate crossover study, 11 healthy volunteers
received either carvedilol or no medication prior to RIPC. Plasma
dialysates were obtained and perfused through an isolated male
Sprague-Dawley rat heart subjected to 30-min ischemia/60-min reperfusion,
following which myocardial infarct (MI) size was determined. In the
cardiac surgery study, pre-RIPC MI sizes were similar among the groups
(39.7 +/- 4.5% no-anesthesia, 38.9 +/- 5.3% sevoflurane, and 38.6 +/- 3.6%
propofol). However, post-RIPC MI size was reduced in the no-anesthesia
group (27.5 +/- 8.0%; p < 0.001), but not in the anesthesia groups (35.7
+/- 6.9% sevoflurane and 35.8 +/- 5.8% propofol). In the healthy volunteer
study, there was a reduction in MI size with RIPC in the no-carvedilol
group (41.7 +/- 4.3% to 30.6 +/- 8.5%; p < 0.0001), but not in the
carvedilol group (41.0 +/- 4.0% to 39.6 +/- 5.6%; p = 0.452). We found
that the cardioprotective effects of limb RIPC were abolished under
propofol or sevoflurane anesthesia and in the presence of carvedilol
therapy. Copyright © 2019 by the authors. Licensee MDPI, Basel,
Switzerland.

<60>
Accession Number
2001284374
Title
Impact of remote ischemic preconditioning preceding coronary artery bypass
grafting on inducing neuroprotection.
Source
Journal of Thoracic and Cardiovascular Surgery. 157 (4) (pp 1466-1476.e3),
2019. Date of Publication: April 2019.
Author
Gasparovic H.; Kopjar T.; Anticevic A.; Rados M.; Malojcic B.; Ivancan V.;
Fabijanic T.; Cikes M.; Milicic D.; Gasparovic V.; Biocina B.
Institution
(Gasparovic, Kopjar, Ivancan, Fabijanic, Biocina) Department of Cardiac
Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb,
Croatia
(Rados) Department of Radiology, University Hospital Center Zagreb,
University of Zagreb, Zagreb, Croatia
(Malojcic) Department of Neurology, University Hospital Center Zagreb,
University of Zagreb, Zagreb, Croatia
(Cikes, Milicic, Gasparovic) Departments of Cardiology and Internal
Medicine, University Hospital Center Zagreb, University of Zagreb, Zagreb,
Croatia
(Rados) Center of Excellence for Basic, Clinical and Translational
Neuroscience, Croatian Institute for Brain Research, School of Medicine,
University of Zagreb, Zagreb, Croatia
(Anticevic) Departments of Psychiatry and Psychology, Yale University
School of Medicine, New Haven, Conn, United States
Publisher
Mosby Inc.
Abstract
Background: Neurological complications after coronary artery bypass
grafting (CABG) reduce quality of life, increase mortality, and inflate
resource utilization. The risk of postoperative neurological complications
parallels the increasing risk burden of the contemporary patient
population. We evaluated the efficacy of remote ischemic preconditioning
(RIPC) on inducing neuroprotection. Method(s): Seventy patients
undergoing first-time CABG were randomly assigned to RIPC or a sham
procedure. Structural brain magnetic resonance imaging (MRI) was
complemented with functional connectivity MRI to gain a whole-brain global
connectivity analysis. Paired neurocognitive and MRI data were acquired
pre- and postoperatively. The primary end point was a composite of new
ischemic brain lesions and neurocognitive impairment. Secondary end points
included brain connectivity profiles, pooled ischemic volumes, and
individual components of the primary outcome. The Shapiro-Wilk test was
used to determine whether a data set followed a normal distribution. The
Fisher exact test was used to calculate the measures of association for
categorical variables, whereas continuous data were tested with either the
Mann-Whitney U test or the Student t test. Result(s): There was no
between-group difference in the incidence of the primary end point (9
[27%] in the RIPC group vs 8 [24%] in the control group, odds ratio, 1.17
[95% confidence interval, 0.34-4.06]; P = 1.0). Although RIPC did not
reduce the incidence of brain ischemia (8/33 [24%] vs 7/33 [21%]; P =
1.0), the pooled ischemic volume was lower in the RIPC group (157
[interquartile range, 125-231] vs 777 [interquartile range, 564-965]
mm3; P =.004). Postoperative neurocognition was marginally
superior in the RIPC group as evidenced by a lower absolute number of
abnormal neurocognitive tests in the RIPC group (7/99 [7%] vs 16/99 [16%];
odds ratio, 0.40 [95% confidence interval, 0.14-1.09]; P =.074). Robust
reductions of functional connectivity profiles for the associative
thalamus were documented in both groups, irrespective of RIPC (RIPC group,
t = 3.31; P <.01; and the control group, t = 3.52; P <.01).
 Conclusion(s): Silent brain ischemia occurs frequently after CABG.
RIPC did not reduce the incidence of the primary outcome. However, RIPC
significantly reduced the pooled volume of ischemic brain lesions. Surgery
adversely affected global brain connectivity, with RIPC conferring no
demonstrable protection. The association of RIPC with superior
neurocognitive test scores failed to cross the threshold for
significance. Copyright © 2018

<61>
Accession Number
628387140
Title
Effects of stretching exercises on upper crossed syndrome in women after a
coronary artery bypass graft.
Source
Crescent Journal of Medical and Biological Sciences. 6 (3) (pp 350-354),
2019. Date of Publication: 2019.
Author
Dehdilani M.; Gol M.K.; Hashemzadeh K.
Institution
(Dehdilani) Department of Anesthesiology, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Gol) Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz,
Iran, Islamic Republic of
(Hashemzadeh) Department of Heart Surgery, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
Publisher
Aras Part Medical International Press
Abstract
Objectives: Upper crossed syndrome (UCS) can exert adverse effects on
rehabilitation after a coronary artery bypass graft (CABG). Hence, the
present study aimed to investigate the effects of stretching exercises on
UCS in women undergoing CABG. Material(s) and Method(s): The present
quasi-experimental study was carried out on 30 women in Shahid Madani
hospital of Tabriz, Iran. According to a similar study, the participants
were selected through a convenience sampling method and randomly assigned
to two groups of A and B. Those in group A participated in an 8-week
intervention of stretching exercises (3 sessions per week) in accordance
with the existing protocol. The data were statistically analyzed using
analysis of covariance, the dependent t test, and the Wilcoxon test at the
significance level of 0.05. Result(s): The results indicated a
significant difference between the two groups in terms of kyphosis angle
(P=0.001) and forward head angle (P=0.019) after the intervention. The
data analysis also showed that stretching exercises had no significant
effect on the improvement of angles of left and right shoulders (P=0.109
and P=0.111) respectively. Conclusion(s): The study findings suggest
that corrective and stretching exercises might improve head forward
posture and kyphosis angle, but do not affect shoulder
angle. Copyright © 2019 The Author(s).

<62>
Accession Number
628283744
Title
Effects of remote ischemic preconditioning in patients undergoing off-pump
coronary artery bypass graft surgery.
Source
Frontiers in Physiology. 10 (APR) (no pagination), 2019. Article Number:
495. Date of Publication: 2019.
Author
Wang H.; Lyu Y.; Liao Q.; Jin L.; Xu L.; Hu Y.; Yu Y.; Guo K.
Institution
(Wang, Liao, Jin, Xu, Hu, Yu, Guo) Department of Anesthesiology, Zhongshan
Hospital, Fudan University, Shanghai, China
(Lyu) Department of Anesthesiology, Yunnan Baoshan Anli Hospital, Baoshan,
China
Publisher
Frontiers Media S.A.
Abstract
Purpose: This study aimed to evaluate effects of remote ischemic
preconditioning (RIPC) on myocardial injury in patients undergoing
off-pump coronary artery bypass graft surgery (OPCABG). Method(s):
Sixty-five patients scheduled for the OPCABG were randomly assigned to
control (n = 32) or RIPC group (n = 33). All patients received general
anesthesia. Before the surgical incision, RIPC was induced on an upper
limb with repeated 5-min ischemia and 5-min reperfusion for four times.
Blood samples were collected from right internal jugular vein. Plasma
levels of IL-6, IL-8, IL-10, TNF-alpha, cTnT, HFABP, IMA, and MDA were
detected at pre-operatively and 0, 6, 18, 24, 48, 72, and 120 h after the
surgery. Left internal mammary artery (LIMA) and great saphenous vein
(GSV) was cut into 2-3 mm for Western blot analysis of Hif-1alpha.
 Result(s): In the present study, RIPC treatment significantly reduced
plasma levels of cardiac troponin T (p < 0.05), heart-type fatty acid
binding protein (p < 0.05), ischemia modified albumin (p < 0.05),
malondialdehyde (p < 0.05), as well as plasma levels of pro-inflammatory
cytokines including IL-6, IL-8, and TNF-alpha (P < 0.05, respectively).
RIPC treatment significantly increased hypoxia-inducible factor-1alpha (p
< 0.05) expression as well. Mechanical ventilation time for postoperative
patients was shortened in RIPC group than those in control group (17.4 +/-
3.8 h vs. 19.7 +/- 2.9 h, respectively, p < 0.05). Conclusion(s):
RIPC by upper limb ischemia shortens mechanical ventilation time in
patients undergoing OPCABG. RIPC treatment reduces postoperative
myocardial enzyme expression and pro-inflammatory cytokine production.
RIPC is a protective therapeutic approach in the coronary artery bypass
graft surgery. Copyright © 2019 Frontiers Media S.A. All Rights
Reserved.

<63>
Accession Number
627605350
Title
Intramuscular stimulation as a novel alternative method of pain management
after thoracic surgery.
Source
Journal of Thoracic Disease. 11 (4) (pp 1528-1535), 2019. Date of
Publication: 01 Apr 2019.
Author
Moon D.H.; Park J.; Kang D.-Y.; Lee H.S.; Lee S.
Institution
(Moon, Lee) Department of Thoracic and Cardiovascular Surgery, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, South
Korea
(Park) Department of Rehabilitation Medicine, Gangnam Severance Hospital,
Rehabilitation Institute of Neuromuscular Disease, Yonsei University
College of Medicine, Seoul, South Korea
(Kang) Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung
Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Lee) Biostatics Collaboration Unit, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
AME Publishing Company
Abstract
Background: The purpose of this study was to determine whether electrical
twitch-obtaining intramuscular stimulation (ETOIMS) can be an alternative
to intravenous patient-controlled analgesia (IV-PCA) for postoperative
pain management in pneumothorax patients undergoing single-port
video-assisted thoracoscopic surgery (VATS). Method(s): This
preliminary prospective randomized study was conducted between March 2017
and July 2017. A total of 26 patients undergoing single-port VATS were
randomly assigned to two groups: the ETOIMS group (n=12), which received
intramuscular stimulation prior to chest tube insertion toward the end of
procedure, and the IV-PCA group (n=14), which received continuous infusion
of fentanyl with a basal rate of 10 mug/mL/h. To measure postoperative
pain, visual analogue scale (VAS; range, 0-10) was used as the primary
endpoint. Result(s): Baseline characteristics were not different
between the two groups. According to the linear mixed model, there was
statistical difference in the serial VAS score between the two groups
(P=0.007). The ETOIMS group showed a significantly lower VAS score
compared with the IV-PCA group, especially at postoperatively hour 8, day
1, and day 2. Conclusion(s): We showed that ETOIMS may be a safe,
effective, and simple alternative for pain management after single-port
VATS. Copyright © Journal of Thoracic Disease. All rights
reserved.

<64>
Accession Number
627212858
Title
Terlipressin versus norepinephrine to prevent milrinone-induced systemic
vascular hypotension in cardiac surgery patient with pulmonary
hypertension.
Source
Annals of Cardiac Anaesthesia. 22 (2) (pp 136-142), 2019. Date of
Publication: April-June 2019.
Author
Abdelazziz M.; Abdelhamid H.
Institution
(Abdelazziz, Abdelhamid) Department of Anesthesia, Ain Shams University,
116 el Hegaz Street, Heliopolis, Cairo, Egypt
Publisher
Wolters Kluwer Medknow Publications
Abstract
Introduction: Milrinone at inotropic doses requires the addition of a
vasoconstrictive drug. We hypothesized that terlipressin use could
selectively recover the systemic vascular hypotension induced by milrinone
without increasing the pulmonary vascular resistance (PVR) and mean
pulmonary artery pressure (MPAP) as norepinephrine in cardiac surgery
patients. Patients and Methods: Patients with pulmonary hypertension
were enrolled in this study. At the start of rewarming a milrinone 25
mug/kg bolus over 10 min followed by infusion at the rate of 0.25
mug/kg/min. Just after the loading dose of milrinone, the patients were
randomized to receive norepinephrine infusion at a dose of 0.1 mug/kg/min
(norepinephrine group) or terlipressin infusion at a dose of 2 mug/kg/h
(terlipressin group). Heart rate, mean arterial blood pressure (MAP),
central venous pressure, MPAP, systemic vascular resistance (SVR), PVR,
cardiac output were measured after induction of anesthesia, after loading
dose of milrinone, during skin closure, and in the intensive care unit
till 24 h. Result(s): Milrinone decreased MAP (from 79.56 +/- 4.5 to
55.21 +/- 2.1 and from 78.46 +/- 3.3 to 54.11 +/- 1.1) and decreased the
MPAP (from 59.5 +/- 3.5 to 25.4 +/- 2.6 and from 61.3 +/- 5.2 to 25.1 +/-
2.3) in both groups. After norepinephrine, there was an increase in the
MAP which is comparable to terlipressin group (P > 0.05). Terlipressin
group shows a significant lower MPAP than norepinephrine group (24.5 +/-
1.4 at skin closure vs. 43.3 +/- 2.1, than 20.3 +/- 2.1 at 24 h vs. 39.8
+/- 3.8 postoperatively). There is a comparable increase in the SVR in
both group, PVR showed a significant increase in the norepinephrine group
compared to the terlipressin group (240.5 +/- 23 vs. 140.6 +/- 13 at skin
closure than 190.3 +/- 32 vs. 120.3 +/- 10 at 24 h postoperatively).
 Conclusion(s): The use of terlipressin after milrinone will reverse
systemic hypotension with lesser effect on the pulmonary artery
pressure. Copyright © 2019 Medknow Publications. All rights
reserved.

<65>
[Use Link to view the full text]
Accession Number
628563098
Title
High-speed rotational atherectomy versus modified balloons prior to
drug-eluting stent implantation in severely calcified coronary lesions:
The randomized prepare-CALC trial.
Source
Circulation: Cardiovascular Interventions. 11 (10) (no pagination), 2018.
Article Number: e007415. Date of Publication: 2018.
Author
Abdel-Wahab M.; Toelg R.; Byrne R.A.; Geist V.; El-Mawardy M.; Allali A.;
Rheude T.; Robinson D.R.; Abdelghani M.; Sulimov D.S.; Kastrati A.;
Richardt G.
Institution
(Abdel-Wahab, Sulimov) Department of Cardiology, Heart Center Leipzig,
Leipzig University Hospital, Strumpellstrase 39, Leipzig 04289, Germany
(Abdel-Wahab, Toelg, Geist, Allali, Abdelghani, Sulimov, Richardt)
Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg,
Germany
(Toelg, Byrne, Kastrati) Department of Cardiology, Deutsches Herzzentrum
Munchen, Technical University of Munich, Germany
(Byrne, Kastrati) German Center for Cardiovascular Research, Partner site
Munich Heart Alliance, Germany
(El-Mawardy) Department of Cardiology, Vivantes Wenckebach Hospital,
Berlin, Germany
(Robinson) Department of Mathematics, University of Sussex, Brighton,
United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Balloon dilatation or debulking seems to be essential to allow
successful stent implantation in calcified coronary lesions. Compared with
standard balloon predilatation, debulking using high-speed rotational
atherectomy (RA) is associated with higher initial procedural success
albeit with higher in-stent late lumen loss at intermediate-term
follow-up. Whether modified (scoring or cutting) balloons (MB) could
achieve similar procedural success compared with RA is not known. In
addition, whether new-generation drug-eluting stents could counterbalance
the excessive neointimal proliferation triggered by RA remains to be
determined. METHODS AND RESULTS: We randomly assigned patients with
documented myocardial ischemia and severely calcified native coronary
lesions undergoing percutaneous coronary intervention to a strategy of
lesion preparation using MB or RA followed by drug-eluting stent
implantation. Stenting was performed using a third-generation
sirolimus-eluting stent with a bioabsorbable polymer. The trial had 2
primary end points: strategy success (defined as successful stent delivery
and expansion with attainment of <20% in-stent residual stenosis in the
presence of TIMI [Thrombolysis in Myocardial Infarction] 3 flow without
crossover or stent failure; powered for superiority) and in-stent late
lumen loss at 9 months (powered for noninferiority). Two hundred patients
were enrolled at 2 centers in Germany (n=100 in each treatment group). The
mean age of the study population was 74.9+/-7.0 years; 76% were men, and
33.5% had diabetes mellitus. Strategy success was significantly more
common in the RA group (81% versus 98%; relative risk of failure with an
MB- versus RA-based strategy, 9.5; 95% CI, 2.3-39.7; P=0.0001), but mean
fluoroscopy time was longer (19.6+/-13.4 versus 23.9+/-12.2 minutes;
P=0.03). At 9 months, mean in-stent late lumen loss was 0.16+/-0.39 mm in
the MB group and 0.22+/-0.40 mm in the RA group (P=0.21, P=0.02 for
noninferiority). Target lesion revascularization (7% versus 2%; P=0.17),
definite or probable stent thrombosis (0% versus 0%; P=1.00), and target
vessel failure (8% versus 6%; P=0.78) were low and not significantly
different between the MB and RA groups. CONCLUSION(S): Lesion
preparation with upfront RA before drug-eluting stent implantation is
feasible in nearly all patients with severely calcified coronary lesions,
is more commonly successful as a primary strategy compared with MB, and is
not associated with excessive late lumen loss. A strategy of provisional
MB remains feasible, safe, and effective as long as bailout RA is readily
available and may offer the advantages of compatibility with smaller sized
catheters and less irradiation. Both strategies are associated with
excellent clinical outcome at 9 months. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT02502851. Copyright © 2018 American Heart Association, Inc.

<66>
Accession Number
625048080
Title
Goal-directed fluid therapy based on noninvasive cardiac output monitor
reduces postoperative complications in elderly patients after
gastrointestinal surgery: A randomized controlled trial.
Source
Pakistan Journal of Medical Sciences. 34 (6) (pp 1320-1325), 2018. Date of
Publication: November-December 2018.
Author
Yin K.; Ding J.; Wu Y.; Peng M.
Institution
(Yin, Ding, Wu, Peng) Department of Anesthesiology, Yongchuan Hospital of
Chongqing Medical University, Chongqing 402160, China
Publisher
Professional Medical Publications
Abstract
Objective: Goal-directed fluid therapy (GDFT) was associated with improved
outcomes after surgery. Noninvasive Cardiac Output Monitoring (NICOM) has
proved to be a good choice for guiding GDFT. This study evaluated the
effect of GDFT based on NICOM on prognosis in elderly patients undergoing
resection of gastrointestinal tumor. Method(s): Fifty patients
scheduled for elective laparoscopic radical resection for stomach, colon
or rectal cancer in Yongchuan Hospital of Chongqing Medical University
between November 2014 and December 2015 were included and randomly divided
into two groups: conventional fluid therapy (group C, n=25) and
goal-directed fluid therapy (group G, n=25). The primary outcome was
moderate or severe postoperative complications within 30 days.
 Result(s): Finally, 45 patients successfully completed the study
(group G, n=22; group C, n=23). There were no difference of the duration
of surgery, the requirement of vasoactive agents and the bleeding volume
between two groups (P>0.05). Total fluids infused were 2956+/-629 ml
(group C) and 2259+/-454 ml (group G) (P<0.05), while the requirement of
colloid was increased in group G (1103+/-285ml vs 855+/-226ml) (P<0.05).
The MAP and the mean CI were higher in group G (P<0.05). Compared with
group C, the time when the patients passed the flatus and the length of
hospital stay after operation were shortened in group G (12.6+/-2.4 day
vs17.2+/-2.6 day), the incidence of postoperative complications were
significantly lower in group G (P<0.05). Conclusion(s): Goal-directed
fluid therapy based on NICOM was significantly associated with improvement
of prognosis in elderly patients undergoing resection of gastrointestinal
tumor which reduced postoperative complications. Copyright ©
2018, Professional Medical Publications. All rights reserved.

<67>
Accession Number
624758469
Title
Effects of dexmedetomidine on postoperative cognitive function in patients
undergoing coronary artery bypass grafting.
Source
Experimental and Therapeutic Medicine. 16 (6) (pp 4685-4689), 2018. Date
of Publication: December 2018.
Author
Gong Z.; Li J.; Zhong Y.; Guan X.; Huang A.; Ma L.
Institution
(Gong, Li, Zhong, Guan, Huang, Ma) Department of Anesthesiology, The
People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi
530021, China
Publisher
Spandidos Publications
Abstract
Effects of dexmedetomidine on postoperative cognitive function in patients
undergoing coronary artery bypass grafting were investigated. Eighty
patients undergoing systemic anesthesia with extracorporeal coronary
artery bypass grafting in The People's Hospital of Guangxi Zhuang
Autonomous Region from January 2015 to August 2017 were selected and
randomly divided into the observation group (n=40) and control group
(n=40). The two groups were treated with dexmedetomidine and equal volume
of normal saline, respectively. Moreover, safety indexes including EEG
bispectral index (BIS) at 30 min before induction of anesthesia (T0),
immediately after intubation (T1), when incision was made (T2), when chest
was closed (T3), when operation was completed (T4) and at 6 h after
operation (T5), intraoperative circulatory system-related complications,
cortisol, epinephrine and norepinephrine levels at the end of surgery as
well as anesthesia recovery time and postoperative mechanical ventilation
time were recorded and compared. All the patients were followed up for 1
week. Mini-mental state examination (MMSE) and Montreal cognitive
assessment (MoCA) were administered at 1, 3 and 7 days after operation,
and the incidence of intraoperative awareness and postoperative cognitive
dysfunction was recorded. BIS value in the observation group was lower
than that in the control group (P<0.05) at T1-T4 time points, and the BIS
value in the observation group was higher than that in the control group
(P<0.05) at T5. Incidence rates of intraoperative arrhythmia, hypertension
and hypotension in the observation group was significantly lower than
those in the control group (P<0.05). At the end of operation, levels of
cortisol, epinephrine and norepinephrine in the observation group were
significantly lower than those in the control group (P<0.05). Anesthesia
recovery time and postoperative mechanical ventilation time in the
observation group was significantly shorter than the time in the control
group (P<0.05). MMSE and MoCA scores of the observation group were better
than those of the control group (P<0.05). The incidence of cognitive
impairment and postoperative cognitive impairment in the observation group
was significantly lower than those in the control group (P<0.05).
Therefore, it is concluded that dexmedetomidine can effectively reduce the
incidence of postoperative cognitive impairment in patients undergoing
coronary artery bypass grafting, and it is of high safety for circulatory
function. Copyright © 2018, Spandidos Publications. All rights
reserved.

<68>
Accession Number
623399844
Title
Lund exhaust on hemodynamic parameters and inflammatory mediators in
patients undergoing cardiac valve replacement under cardiopulmonary
bypass.
Source
Experimental and Therapeutic Medicine. 16 (3) (pp 1747-1752), 2018. Date
of Publication: September 2018.
Author
Zhu J.; Zhang W.; Shen G.; Yu X.; Guo J.; Zhong T.
Institution
(Zhu, Yu, Zhong) Department of Anesthesiology, Sir Run Run Shaw Hospital
of Zhejiang University, Hangzhou, Zhejiang 310016, China
(Zhang, Guo) Heart Center, Sir Run Run Shaw Hospital of Zhejiang
University, Hangzhou, Zhejiang 310016, China
(Shen) Out-patient Department, Sir Run Run Shaw Hospital of Zhejiang
University, Hangzhou, Zhejiang 310016, China
Publisher
Spandidos Publications
Abstract
The effect of Lund exhaust technique on hemodynamics and inflammatory
mediators in patients undergoing cardiac valve replacement under
cardiopulmonary bypass was evaluated. A total of 60 patients with heart
disease undergoing elective heart valve replacement under elective
cardiopulmonary bypass were randomly divided into Lund exhaust group
(group A) and control group (group B), with 30 patients in each group.
Group A underwent Lund exhaust during cardiopulmonary bypass, while group
B was identical to group A except for not using the Lund exhaust technique
during cardiopulmonary bypass. The hemodynamic parameters at different
time-points showed that the indexes of MAP, PASP, CO, CI, PCWP, CVP and
SVR in T<inf>1</inf>, T<inf>2</inf>, T<inf>3</inf> and T<inf>4</inf>
moments between group A and group B were statistically significant
(p<0.05). There was no statistical significance in IL-6, IL-8, IL-10,
TNF-alpha and TIMP-1 between group A and group B patients at the T0 moment
(p>0.05). The levels of IL-6, IL-8, IL-10, TNF-alpha and TIMP-1 in group B
patients at T<inf>1</inf>, T<inf>2</inf>, T<inf>3</inf> and T<inf>4</inf>
moments were statistically significant compared with those in group A
(p<0.05). The IL-6, IL-8, TNF-alpha indexes of group B patients were
statistically significant at the T<inf>5</inf> moment compared with those
in group A (p<0.05). The IL-10 and TIMP-1 of two groups were not
statistically significant at the T<inf>5</inf> moment. The operating time,
CPB time, aortic clamp time, intraoperative blood loss, postoperative tube
time, ICU stay time, hospital stay time and pulmonary infection of
patients in group A were significantly less than those in group B. In
conclusion, Lund exhaust technology can significantly reduce the
fluctuation of hemodynamics, decrease the expression of inflammatory
factors, improve lung function, and is conducive to the rehabilitation of
patients. Copyright © 2018, Spandidos Publications. All rights
reserved.

<69>
Accession Number
623313983
Title
Efficacy of bilateral pectoralis nerve block for ultrafast tracking and
postoperative pain management in cardiac surgery.
Source
Annals of Cardiac Anaesthesia. 21 (3) (pp 333-338), 2018. Date of
Publication: July-September 2018.
Author
Kumar K.N.; Kalyane R.N.; Singh N.G.; Nagaraja P.S.; Krishna M.; Babu B.;
Varadaraju R.; Sathish N.; Manjunatha N.
Institution
(Kumar, Singh, Nagaraja, Krishna, Babu, Sathish, Manjunatha) Departments
of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular
Sciences and Research, Bengaluru, Karnataka 560 069, India
(Kalyane, Varadaraju) Cardiaothoracic and Vascular Surgery, Sri Jayadeva
Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka,
India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Good postoperative analgesia in cardiac surgical patients
helps in early recovery and ambulation. An alternative to parenteral,
paravertebral, and thoracic epidural analgesia can be pectoralis nerve
(Pecs) block, which is novel, less invasive regional analgesic technique.
 Aim(s): We hypothesized that Pecs block would provide superior
postoperative analgesia for patients undergoing cardiac surgery through
midline sternotomy compared to parenteral analgesia. Material(s) and
Method(s): Forty adult patients between the age groups of 25 and 65 years
undergoing coronary artery bypass grafting or valve surgeries through
midline sternotomy under general anesthesia were enrolled in the study.
Patients were randomly allocated into two groups with 20 in each group.
Group 1 patients did not receive Pecs block, whereas Group 2 patients
received bilateral Pecs block postoperatively. Patients were extubated
once they fulfilled extubation criteria. Ventilator duration was recorded.
Patients were interrogated for pain by visual analog scale (VAS) scoring
at rest and cough. Inspiratory flow rate was assessed using incentive
spirometry. Result(s): Pecs group patients required lesser duration
of ventilator support (P < 0.0001) in comparison to control group. Pain
scores at rest and cough were significantly low in Pecs group at 0, 3, 6,
12, and 18 h from extubation (P < 0.05). At 24 h, VAS scores were
comparable between two groups. Peak inspiratory flow rates were higher in
Pecs group as compared to control group at 0, 3, 6, 12, 18, and 24 h (P <
0.05). Thirty-four episodes of rescue analgesia were given in control
group, whereas in Pecs group, there were only four episodes of rescue
analgesia. Conclusion(s): Pecs block is technically simple and
effective technique and can be used as part of multimodal analgesia in
postoperative cardiac surgical patients for better patient comfort and
outcome. Copyright © 2018 Medknow Publications. All rights
reserved.

<70>
Accession Number
2001599105
Title
Comparison of the effect of fibrinogen concentrate with fresh frozen
plasma (FFP) in management of hypofibrinogenemic bleeding after congenital
cardiac surgeries: A clinical trial study.
Source
ARYA Atherosclerosis. 14 (6) (pp 248-253), 2018. Date of Publication:
2018.
Author
Masoumi G.; Mardani D.; Musavian M.; Bigdelian H.
Institution
(Masoumi) Department of Anesthesiology, Isfahan Cardiovascular Research
Center, Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Mardani) Chamran Cardiovascular Medical & Research Center, School of
Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
(Musavian) School of Medicine, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Bigdelian) Department of Surgery, Cardiac Rehabilitation Research Center,
Cardiovascular Research Institute, Isfahan University of Medical Sciences,
Isfahan, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS)
Abstract
BACKGROUND: Hypofibrinogenemia is an independent factor of excessive
bleeding after congenital cardiac surgeries. Fresh frozen plasma (FFP) and
fibrinogen concentrate are examples of recommended products for management
of hypofibrinogenemic bleedings. Unfortunately, there is no study to
compare these treatments in pediatric cardiac surgeries. Therefore, this
study aimed to compare the effect of fibrinogen concentrate with FFP on
postoperative bleeding and clinical outcome after congenital cardiac
surgeries in pediatric population. METHOD(S): Phis prospective
clinical trial study was carried out on 90 consecutive pediatric patients
who underwent congenital cardiac surgeries. The eligible pediatrics who
met our study criteria, randomly received FFP (10 ml/kg) or fibrinogen
concentrate (70 mg/kg) to assess postoperative bleeding and blood-products
requirements. RESULT(S): Each of FFP and fibrinogen concentrate
significantly reduced total chest tube drainage (CTD) at 3, 6, 12, and 24
postoperative hours (P = 0.04). The analysis of time*intervention revealed
that our intervention (fibrinogen group) significantly reduced CTD more (P
= 0.01). Moreover, fibrinogen group had a significantly higher plasma
fibrinogen level in first 24 hours (P = 0.02). CONCLUSION(S):
Nowadays, both of fibrinogen concentrate and FFP product are widely used
for management of hypofibrinogenic bleedings after cardiac surgeries.
According to our results, we concluded that although the both product had
a comparable effect on management of hypofibrinogenemic bleeding in
pediatrics undergoing congenital cardiac surgeries, choosing better
product depended on general condition of patients such as their body fluid
status. Copyright © 2018, Isfahan University of Medical
Sciences(IUMS). All rights reserved

<71>
Accession Number
625574201
Title
Comparing the conventional 15 cm and the C-length approaches for central
venous catheter placement.
Source
Journal of Cardiovascular and Thoracic Research. 10 (4) (pp 221-226),
2018. Date of Publication: 2018.
Author
Jarineshin H.; Sharifi M.; Kashani S.
Institution
(Jarineshin, Sharifi, Kashani) Anesthesiology, Critical Care and Pain
Management Research Center, Hormozgan University of Medical Sciences,
Bandar Abbas, Iran, Islamic Republic of
Publisher
Tabriz University of Medical Sciences
Abstract
Introduction: The present guidelines recommend placing the catheter tip in
the superior vena cava (SVC) above the pericardial cephalic reflection.
The aim of this study was to compare the accuracy of two different
approaches in locating the tip of the Central venous catheter (CVC) at the
suggested vascular zone. Method(s): This was an interventional study
on two hundred patients undergoing Coronary artery bypass surgery (CABG)
operation who required a central venous cannulation. They were randomly
assigned into two groups. in the first group catheter placement was
applied through using the conventional 15 cm method. in the second group a
C-length method was applied for measuring the depth of catheter tip
placement from the preoperative chest radiographs. For statistical
analysis Chi-square test and T-test were used. Result(s): in the
first group (15 cm) 100% of the patients had their catheters placed below
the C-line (Carina line) and the average distance between the catheter tip
and the C-line was +4.22+/-2.10 cm. in the second (C-Length) group 52% of
the catheters were below C-line with an average distance of +0.77+/-0.5
cm. There was a meaningful difference between the two groups in respect to
the catheter location depth and zone of placement (P<0.001).
 Conclusion(s): The C-Length approach in comparison to the
conventional 15 cm approach resulted in a considerable higher number of
catheters above the recommended C-line, thus it can provide a more
reliable and safe mode for CVC placement in the SVC. Copyright ©
2018 The Author (s).

<72>
Accession Number
606175950
Title
Telemedicine-guided, very low-dose international normalized ratio
self-control in patients with mechanical heart valve implants.
Source
European Heart Journal. 36 (21) (pp 1297-1305), 2015. Date of Publication:
01 Jun 2015.
Author
Koertke H.; Zittermann A.; Wagner O.; Secer S.; Huth C.; Sciangula A.;
Saggau W.; Sack F.-U.; Ennker J.; Cremer J.; Musumeci F.; Gummert J.F.
Institution
(Koertke, Zittermann, Secer, Gummert) Clinic for Thoracic and
Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia,
Ruhr University Bochum, Bad Oeynhausen, Germany
(Koertke, Wagner, Secer) Institute of Applied Telemedicine, Heart and
Diabetes Center North Rhine-Westphalia, Ruhr University Bochum,
Georgstr.11, Bad Oeynhausen 32545, Germany
(Huth) Clinic for Thoracic and Cardiovascular Surgery, Otto von Guericke
University Magdeburg, Magdeburg, Germany
(Sciangula) Hospital Santa Anna, Catanzaro, Italy
(Saggau, Sack) Academic City Hospital, Ludwigshafen, Germany
(Ennker) Mediclin Heart Institute Lahr/Baden, University Witten-Herdecke,
Faculty of Health, School of Medicine, Lahr, Germany
(Cremer) Clinic for Cardiac and Vascular Surgery,
Christain-Albrechts-University Kiel, Kiel, Germany
(Musumeci) Azienda Ospedaliera S. Camillo Forlani, Roma, Italy
Publisher
Oxford University Press
Abstract
Aim To study in patients performing international normalized ratio (INR)
self-control the efficacy and safety of an INR target range of 1.6-2.1 for
aortic valve replacement (AVR) and 2.0-2.5 for mitral valve replacement
(MVR) or double valve replacement (DVR). Methods and results In total,
1304 patients undergoing AVR, 189 undergoing MVR and 78 undergoing DVR
were randomly assigned to low-dose INR self-control (LOW group) (INR
target range, AVR: 1.8-2.8; MVR/DVR: 2.5-3.5) or very low-dose INR
self-control once a week (VLO group) and twice a week (VLT group) (INR
target range, AVR: 1.6-2.1; MVR/DVR: 2.0-2.5), with electronically guided
transfer of INR values.We compared grade III complications (major bleeding
and thrombotic events; primary end-points) and overall mortality
(secondary end-point) across the three treatment groups. Findings Two-year
freedom frombleedings in the LOW, VLO, and VLTgroupswas 96.3, 98.6, and
99.1%, respectively (P = 0.008). The corresponding values for thrombotic
eventswere 99.0, 99.8, and 98.9%, respectively (P = 0.258). The
risk-adjusted composite of grade III complicationswas in the per-protocol
population (reference: LOW-dose group) as follows: hazard ratio = 0.307
(95% CI: 0.102-0.926; P = 0.036) for the VLO group and = 0.241 (95% CI:
0.070-0.836; P = 0.025) for the VLT group. The corresponding values of
2-year mortality were = 1.685 (95% CI: 0.473-5.996; P = 0.421) for the VLO
group and = 4.70 (95% CI: 1.62-13.60; P = 0.004) for the VLT group.
Conclusion Telemedicine-guided very low-dose INR self-control is
comparable with low-dose INR in thrombotic risk, and is superior in
bleeding risk.Weekly testing is sufficient. Given the small number of MVR
and DVR patients, results are only valid for AVR patients. Copyright
© The Author 2014.

<73>
Accession Number
52299281
Title
Paclitaxel-coated balloon with bare-metal stenting in patients with
chronic total occlusions in native coronary arteries.
Source
Catheterization and Cardiovascular Interventions. 81 (5) (pp 793-799),
2013. Date of Publication: April 2013.
Author
Wohrle J.; Werner G.S.
Institution
(Wohrle) Department of Internal Medicine II, University of Ulm,
Albert-Einstein-Allee 23, 89081 Ulm, Germany
(Werner) Medizinische Klinik i, Klinikum Darmstadt GmbH, Darmstadt,
Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We sought to evaluate the efficacy and safety of
paclitaxel-coated balloon plus bare-metal stenting (BMS) in chronic total
occlusions (CTOs). Background(s): Drugeluting stent implantation
after recanalization of CTOs is limited by the occurrence of restenosis
and risk for late stent thromboses. Method(s): In this prospective,
bicenter trial we treated 48 patients after successful chronic total
occlusion (CTO) recanalization in a native coronary artery with
paclitaxel-coated balloon plus BMS. Patients were matched according to
stent length, reference diameter, and diabetes mellitus with 48 patients
treated with Taxus stent implantation. Dual antiplatelet therapy was
prescribed for 6 months. Angiographic (clinical) follow-up was obtained
after 6 (12) months. Primary endpoint was in-stent late lumen loss.
 Result(s): There was no difference in patient baseline
characteristics or procedural results. Stent length was 59.7 +/- 32.4 mm
(16-151 mm) for paclitaxel-coated balloon plus BMS versus 56.2 +/- 25.9 mm
(16-132 mm) for Taxus stent. Late loss was statistically not different
within the stent with 0.64 +/- 0.69 mm versus 0.43 +/- 0.64 mm (difference
0.20 mm, 95% confidence interval 20.07 to 0.47, P = 0.14) and at the
occlusion site with 0.33 +/- 0.69 mm versus 0.26 +/- 0.70 mm,
respectively. Restenosis rate was 27.7% compared with 20.8% (P 5 0.44) and
the combined clinical endpoint (cardiac death, myocardial infarction
attributed to the target vessel, target lesion revascularization) was
14.6% versus 18.8% (P 5 0.58), respectively. Conclusion(s): In
conclusion, for patients with complex CTOs in native coronary arteries the
use of paclitaxel-coated balloon after bare-metal stenting was associated
with similar clinical results and a nonsignificantly higher in-stent late
loss compared with a matched population with paclitaxel-eluting stent
implantation (ClinicalTrials.gov NCT00670436). © 2012 Wiley
Periodicals, Inc.

<74>
Accession Number
368386123
Title
Comparison of real-world clinical outcomes between Cypher- and
Taxus-eluting stents: The GARA-GARA study.
Source
Cardiovascular Intervention and Therapeutics. 26 (3) (pp 202-208), 2011.
Date of Publication: September 2011.
Author
Fukumoto A.; Otsuji S.; Takiuchi S.; Ikushima M.; Asano K.; Terasoma K.;
Hasegawa K.; Yabuki M.; Higashino Y.
Institution
(Fukumoto, Otsuji, Takiuchi, Ikushima, Asano, Terasoma, Hasegawa, Yabuki,
Higashino) Department of Cardiology, Higashi Takarazuka Satoh Hospital,
2-1 Nagao-cho, Takarazuka, Hyogo, 665-0873, Japan
Publisher
Springer Japan
Abstract
To evaluate real-world outcomes of PCI in unselected individuals using
sirolimus-eluting (SESs) or paclitaxel-eluting stents (PESs) in a
single-center randomized trial. Eight hundred consecutive patients (919
lesions) with coronary artery disease were randomized to receive SES or
PES implantation. In-hospital, mid-term, and 1-year clinical and
angiographical outcomes in both groups were compared. MACEs were defined
as cardiac death, myocardial infarction, CABG and target vessel
revascularization (TLR). Follow-up angiography was performed in 80. 7% of
patients. The baseline clinical characteristics were similar in both
groups. Pre- and postprocedural reference vessel diameter, minimum length
diameter, and diameter stenosis (%DS) were similar in both groups, as was
incidence of in-hospital and mid-term MACEs. SESs significantly reduced
the risk of TLR, compared with PESs (SES = 5. 5%, PES = 10. 5%). The
superiority of SESs for TLR was also demonstrated with regard to small
vessel lesions (stent diameter <2. 5 mm) (SES = 6. 0%, PES = 15. 9%),
whereas larger vessel (stent diameter >2. 5 mm) lesions did not differ
between groups (SES = 5. 3%, PES = 8. 4%). The safety and efficacy of both
DESs were nearly equivalent. SESs, however, were superior to PESs in
reducing mid-term TLR, particularly in the small vessel lesion subsets.
© 2011 Japanese Association of Cardiovascular Intervention and
Therapeutics.

<75>
Accession Number
2010889863
Title
Extracorporeal Cardiopulmonary Resuscitation for Refractory
Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized
Feasibility Trial of Expedited Out-of-Hospital Transport.
Source
Annals of Emergency Medicine. 78 (1) (pp 92-101), 2021. Date of
Publication: July 2021.
Author
Hsu C.H.; Meurer W.J.; Domeier R.; Fowler J.; Whitmore S.P.; Bassin B.S.;
Gunnerson K.J.; Haft J.W.; Lynch W.R.; Nallamothu B.K.; Havey R.A.;
Kidwell K.M.; Stacey W.C.; Silbergleit R.; Bartlett R.H.; Neumar R.W.
Institution
(Hsu, Meurer, Domeier, Fowler, Whitmore, Bassin, Gunnerson, Havey,
Silbergleit, Neumar) Department of Emergency Medicine, University of
Michigan Medical School, Ann Arbor, MI, United States
(Hsu, Meurer, Bassin, Gunnerson, Neumar) Michigan Center for Integrative
Research in Critical Care, University of Michigan Medical School, Ann
Arbor, MI, United States
(Hsu, Bartlett) Department of Surgery, University of Michigan Medical
School, Ann Arbor, MI, United States
(Meurer) Department of Neurology, University of Michigan Medical School,
Ann Arbor, MI, United States
(Domeier) Saint Joseph Hospital, University of Michigan Medical School,
Ann Arbor, MI, United States
(Haft, Lynch) Department of Cardiac Surgery, University of Michigan
Medical School, Ann Arbor, MI, United States
(Nallamothu) Department of Internal Medicine, Division of Cardiovascular
Medicine, University of Michigan Medical School, Ann Arbor, MI, United
States
(Kidwell) Department of Biostatistics, University of Michigan Medical
School, Ann Arbor, MI, United States
(Stacey, Bartlett, Neumar) Extracorporeal Life Support Laboratory,
University of Michigan Medical School, Ann Arbor, MI, United States
Publisher
Mosby Inc.
Abstract
Study objective: Outcomes of extracorporeal cardiopulmonary resuscitation
(ECPR) for out-of-hospital cardiac arrest depend on time to therapy
initiation. We hypothesize that it would be feasible to select refractory
out-of-hospital cardiac arrest patients for expedited transport based on
real-time estimates of the 911 call to the emergency department (ED)
arrival interval, and for emergency physicians to rapidly initiate ECPR in
eligible patients. Method(s): In a 2-tiered emergency medical service
with an ECPR-capable primary destination hospital, adults with refractory
shockable or witnessed out-of-hospital cardiac arrest were randomized 4:1
to expedited transport or standard care if the predicted 911 call to ED
arrival interval was less than or equal to 30 minutes. The primary
outcomes were the proportion of subjects with 911 call to ED arrival less
than or equal to 30 minutes and ED arrival to ECPR flow less than or equal
to 30 minutes. Result(s): Of 151 out-of-hospital cardiac arrest 911
calls, 15 subjects (10%) were enrolled. Five of 12 subjects randomized to
expedited transport had an ED arrival time of less than or equal to 30
minutes (overall mean 32.5 minutes [SD 7.1]), and 5 were eligible for and
treated with ECPR. Three of 5 ECPR-treated subjects had flow initiated in
less than or equal to 30 minutes of ED arrival (overall mean 32.4 minutes
[SD 10.9]). No subject in either group survived with a good neurologic
outcome. Conclusion(s): The Extracorporeal Cardiopulmonary
Resuscitation for Refractory Out-of-Hospital Cardiac Arrest trial did not
meet predefined feasibility outcomes for selecting out-of-hospital cardiac
arrest patients for expedited transport and initiating ECPR in the ED.
Additional research is needed to improve the accuracy of predicting the
911 call to ED arrival interval, optimize patient selection, and reduce
the ED arrival to ECPR flow interval. Copyright © 2020 American
College of Emergency Physicians

<76>
Accession Number
2010146811
Title
Effect of Single-Injection Thoracic Paravertebral Block via the
Intrathoracic Approach for Analgesia After Single-Port Video-Assisted
Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial.
Source
Pain and Therapy. 10 (1) (pp 433-442), 2021. Date of Publication: June
2021.
Author
Hu L.; Xu X.; Tian H.; He J.
Institution
(Hu, Xu) Department of Anesthesiology, Ningbo Medical Center Lihuili
Hospital, Ningbo, China
(Tian, He) Department of Thoracic Surgery, Ningbo Medical Center Lihuili
Hospital, Ningbo, China
Publisher
Adis
Abstract
Introduction: Pain is still severe after single-port video-assisted
thoracoscopic (SPVAT) lung wedge resection. We observed the effect of
single-injection thoracic paravertebral block (TPB) via the intrathoracic
approach for analgesia after SPVAT lung wedge resection. Method(s):
Sixty patients undergoing SPVAT lung wedge resection were randomly divided
into a control group and an observation group. All patients underwent TPB
via the intrathoracic approach at the T4 level with a scalp needle before
closing the chest. The patients in the observation group received 20 ml
0.375% ropivacaine at the T4 level, and the patients in the control group
received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic
(PCIA) pump with sufentanil was attached to all patients after surgery.
The sufentanil consumption and number of PCIA presses in the first 24 h
after surgery were recorded. The visual analogue scale (VAS) scores
(during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h
after surgery. The incidence of adverse reactions after surgery were
recorded. Result(s): The sufentanil consumption in the observation
group was significantly lower than that in the control group (34.2 +/- 1.9
microg vs. 52.3 +/- 2.3 microg; P < 0.001). The VAS score at 6, 12, and 24
h after surgery, the incidence of adverse reactions after surgery in the
observation group were significantly lower than those in the control group
(all P < 0.05). The number of PCIA presses in the observation group was
significantly lower than that in the control group [0 (0-0) times vs. 3
(2-4) times, P < 0.001]. Conclusion(s): Single-injection TPB via the
intrathoracic approach under thoracoscopic direct vision is easy to
perform and can effectively alleviate postoperative pain after SPVAT lung
wedge resection, with fewer adverse reactions. Trial Registration:
ChiCTR2000034726. Copyright © 2021, The Author(s).

<77>
Accession Number
2010040348
Title
Reducing the dose of neuromuscular blocking agents with adjuncts: a
systematic review and meta-analysis.
Source
British Journal of Anaesthesia. 126 (3) (pp 608-621), 2021. Date of
Publication: March 2021.
Author
Weber V.; Abbott T.E.F.; Ackland G.L.
Institution
(Weber, Abbott, Ackland) Queen Mary University of London, Barts and the
London School of Medicine and Dentistry, London, United Kingdom
(Abbott, Ackland) William Harvey Research Institute, Queen Mary University
of London, London, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Acute global shortages of neuromuscular blocking agents (NMBA)
threaten to impact adversely on perioperative and critical care. The use
of pharmacological adjuncts may reduce NMBA dose. However, the magnitude
of any putative effects remains unclear. Method(s): We conducted a
systematic review and meta-analysis of RCTs. We searched Medline, Embase,
Web of Science, and Cochrane Database (1970-2020) for RCTs comparing use
of pharmacological adjuncts for NMBAs. We excluded RCTs not reporting
perioperative NMBA dose. The primary outcome was total NMBA dose used to
achieve a clinically acceptable depth of neuromuscular block. We assessed
the quality of evidence using the GRADE (Grades of Recommendation,
Assessment, Development, and Evaluation) criteria. Data are presented as
the standardised mean difference (SMD); I2 indicates percentage
of variance attributable to heterogeneity. Result(s): From 3082
records, the full texts of 159 trials were retrieved. Thirty-one
perioperative RCTs met the inclusion criteria for meta-analysis (n=1962).
No studies were conducted in critically ill patients. Reduction in NMBA
dose was associated with use of magnesium (SMD: -1.10 [-1.44 to -0.76],
P<0.001; I2=85%; GRADE=moderate), dexmedetomidine (SMD: -0.89
[-1.55 to -0.22]; P=0.009; I2=87%; GRADE=low), and clonidine
(SMD: -0.67 [-1.13 to -0.22]; P=0.004; I2=0%; GRADE=low) but
not lidocaine (SMD: -0.46 [-1.01 to -0.09]; P=0.10; I2=68%;
GRADE=moderate). Meta-analyses for nicardipine, diltiazem, and
dexamethasone were not possible owing to the low numbers of studies. We
estimated that 30-50 mg kg-1 magnesium preoperatively (8-15 mg
kg h-1 intraoperatively) reduces rocuronium dose by 25.5%
(inter-quartile range, 14.7-31). Conclusion(s): Magnesium,
dexmedetomidine, and clonidine may confer a clinically relevant sparing
effect on the required dose of neuromuscular block ing drugs in the
perioperative setting. Systematic review registration: PROSPERO:
CRD42020183969. Copyright © 2020 British Journal of Anaesthesia

<78>
Accession Number
635310813
Title
Randomized comparison between bare-metal stent plus colchicine versus
drug-eluting stent alone in prevention of clinical adverse events after
percutaneous coronary intervention.
Source
Future Cardiology. 17 (4) (pp 539-547), 2021. Date of Publication: July
2021.
Author
Correa-Sadouet C.; Matias Rodriguez-Granillo A.; Gallardo C.; Mieres J.;
Fontana L.; Curotto M.V.; Wainer P.; Allende N.G.; Fernandez-Pereira C.; M
Vetulli H.; De La Hoz R.P.; Kastrati A.; Rodriguez A.E.
Institution
(Correa-Sadouet, Matias Rodriguez-Granillo, Gallardo, Fontana, Curotto, M
Vetulli) Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos
Aires, Argentina
(Matias Rodriguez-Granillo, Mieres, Fernandez-Pereira, Rodriguez)
Interventional Cardiology Department, Sanatorio Otamendi, Ciudad de Buenos
Aires, Argentina
(Matias Rodriguez-Granillo, Mieres, Fernandez-Pereira, Rodriguez) Centro
de Estudios en Cardiologia Intervencionista, Ciudad de Buenos Aires,
Argentina
(Wainer) Internal Medicine Department, Sanatorio Otamendi, Ciudad de
Buenos Aires, Argentina
(Allende) Cardiology Department, Clinica IMA, Adrogue, Provincia de Buenos
Aires, Argentina
(De La Hoz) Cardiology Department, Hospital de Clinicas Jose de San
Martin, Ciudad de Buenos Aires, Argentina
(Kastrati) Deutsches Herzzentrum Munich, Germany
Publisher
Future Medicine Ltd.
Abstract
The use of colchicine is associated with a significant reduction of
cardiac adverse events in patients with coronary artery disease. Past
small randomized trials with oral immunosuppressive or anti-inflammatory
therapies have demonstrated a reduction of adverse clinical events after
bare metal stent implantation. The potential role of adjunctive colchicine
after bare-metal stent implantation, compared with drug-eluting stent
alone, is unknown. The primary end point of the study will be to compare
cost-effectiveness at 1 year of follow-up of coronary intervention with
bare-metal stent implantation plus 1 mg of colchicine during 3 months
versus percutaneous coronary intervention with drug-eluting stent
implantation alone. ClinicalTrials.gov identifier: NCT04382443</ext-link.
Colchicine is an anti-inflammatory drug used to reduce the chance of heart
attacks in patients with heart disease. The use of stents - small tubes
inserted into blood vessels to keep them open - in this group of people is
well known, and several small clinical trials have been carried out to
investigate this. Our trial aims to assess if there is a role for using
colchicine after inserting a stent, compared with using stents that
release drugs themselves (drug-eluting stents), to reduce side effects and
complications of cardiac procedures. Our primary objective will be to
demonstrate that this drug, combined with the old metallic stent designs,
will prevent future complications in comparison with the latest generation
of drug-eluting stents. Copyright © 2020 Future Medicine Ltd.

<79>
Accession Number
634603085
Title
P2Y12 inhibitor monotherapy after coronary stenting according to type of
P2Y12 inhibitor.
Source
Heart. 107 (13) (pp 1077-1083), 2021. Date of Publication: 01 Jul 2021.
Author
Kim J.; Jang W.J.; Lee W.S.; Choi K.H.; Lee J.M.; Park T.K.; Yang J.H.;
Choi J.-H.; Song Y.B.; Choi S.-H.; Gwon H.-C.; Lee S.H.; Oh J.-H.; Chun
W.J.; Park Y.H.; Im E.-S.; Jeong J.-O.; Cho B.R.; Oh S.K.; Yun K.H.; Cho
D.-K.; Lee J.-Y.; Koh Y.-Y.; Bae J.-W.; Choi J.W.; Yoon H.J.; Lee S.U.;
Cho J.H.; Choi W.G.; Rha S.-W.; Hahn J.-Y.
Institution
(Kim, Choi, Lee, Park, Yang, Choi, Song, Choi, Gwon, Lee, Hahn) Division
of Cardiology, Department of Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Jang) Division of Cardiology, Department of Internal Medicine, Ewha
Womans University College of Medicine Seoul Hospital, Seoul, South Korea
(Lee) Department of Cardiology, Chung-Ang University Hospital, Seoul,
South Korea
(Oh, Chun, Park) Department of Cardiology, Samsung Changwon Hospital,
Sungkyunkwan University School of Medicine, Seoul, South Korea
(Im) Division of Cardiology, Dongsuwon General Hospital, Suwon, South
Korea
(Jeong) Department of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Cho) Department of Cardiology, Kangwon National University Hospital,
Chuncheon, South Korea
(Oh, Yun) Department of Cardiology, Wonkwang University Hospital, Iksan,
South Korea
(Cho) Department of Cardiology, Myongji Hospital, Goyang, South Korea
(Lee) Department of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Koh) Department of Cardiology, Chosun University Hospital, Gwangju, South
Korea
(Bae) Division of Cardiology, Department of Internal Medicine, Chungbuk
National University Hospital, Cheongju, South Korea
(Choi) Division of Cardiology, Seoul Eulji Hospital, Eulji University
College of Medicine, Seoul, South Korea
(Yoon) Department of Cardiology, Keimyung University Dongsan Medical
Center, Daegu, South Korea
(Lee) Department of Cardiology, Kwangju Christian Hospital, Gwangju, South
Korea
(Cho) Division of Cardiology, Saint Carollo Hospital, Suncheon, South
Korea
(Choi) Department of Cardiology, Konkuk University Chungju Hospital,
Chungju, South Korea
(Rha) Department of Cardiology, Korea University Guro Hospital, Seoul,
South Korea
Publisher
BMJ Publishing Group
Abstract
Objective To compare P2Y12 inhibitor monotherapy after 3-month dual
antiplatelet therapy (DAPT) with 12-month DAPT according to the type of
P2Y12 inhibitor in patients undergoing percutaneous coronary intervention
(PCI). Methods The Smart Angioplasty Research Team: Comparison Between
P2Y12 Antagonist Monotherapy vs Dual Antiplatelet Therapy in Patients
Undergoing Implantation of Coronary Drug-Eluting Stents (SMART-CHOICE)
randomised trial compared 3-month DAPT followed by P2Y12 inhibitor
monotherapy with 12-month DAPT. In this trial, 2993 patients undergoing
successful PCI with drug-eluting stent were enrolled in Korea. As a
prespecified analysis, P2Y12 inhibitor monotherapy after 3-month DAPT
versus 12-month DAPT were compared among patients receiving clopidogrel
and those receiving potent P2Y12 inhibitor (ticagrelor or prasugrel),
respectively. The primary endpoint was a composite of all-cause death,
myocardial infarction or stroke at 12 months after the index procedure.
Results Among 2993 patients (mean age 64 years), 58.2% presented with
acute coronary syndrome. Clopidogrel was prescribed in 2312 patients
(77.2%) and a potent P2Y12 inhibitor in 681 (22.8%). There were no
significant differences in the primary endpoint between the P2Y12
inhibitor monotherapy group and the DAPT group among patients receiving
clopidogrel (3.0% vs 3.0%; HR: 1.02; 95% CI 0.64 to 1.65; p=0.93) as well
as among patients receiving potent P2Y12 inhibitors (2.4% vs 0.7%; HR:
3.37; 95% CI 0.77 to 14.78; p=0.11; interaction p=0.1). Among patients
receiving clopidogrel, P2Y12 inhibitor monotherapy compared with DAPT
showed consistent treatment effects across various subgroups for the
primary endpoint. Among patients receiving potent P2Y12 inhibitors, the
rate of bleeding (Bleeding Academic Research Consortium types 2- 5) was
significantly lower in the P2Y12 inhibitor monotherapy group than in the
DAPT group (1.5% vs 5.0%; HR: 0.33; 95% CI 0.12 to 0.87; p=0.03).
Conclusions Compared with 12-month DAPT, clopidogrel monotherapy after
3-month DAPT showed comparable cardiovascular outcomes in patients
undergoing PCI. Trial registration number NCT02079194. Copyright
©

<80>
Accession Number
634492746
Title
Newer Volatile Anesthetic Agents in Cardiac Anesthesia: Review of
Literature.
Source
Journal of Cardiac Critical Care. 5 (1) (pp 54-59), 2021. Article Number:
JCCC20110005. Date of Publication: 01 Jan 2021.
Author
Mandke A.; Sarkar M.; Deshpande C.; Maheshwari A.; Kumar B.; Bhavani M.;
Varma S.; Shah H.; Bhanu L.; Khanderkar S.; Ganpathy K.; Soni K.; Nebu R.;
Saxena G.
Institution
(Mandke) Department of Cardiac Anaesthesia, Kokilaben Dhirubhai Ambani
Hospital, Mumbai, Maharashtra, India
(Sarkar) Department of Anaesthesia, Dnyandeo Yashwantrao Patil Hospital,
Mumbai, Maharashtra, India
(Deshpande) Department of Anaesthesia BYL, Nair Ch. Hospital, Mumbai,
Maharashtra, India
(Maheshwari) Department of Cardiac Anaesthesia, Sir Ganga Ram Hospital,
New Delhi, India
(Kumar) Department of Cardiac Anaesthesia, PGIMER, Chandigarh, India
(Bhavani) Department of Anaesthesia, Madras Medical College, Tamil Nadu,
Chennai, India
(Varma) Department of Cardiac Anaesthesia, MGM, Healthcare, Tamil Nadu,
Chennai, India
(Shah) Department of Cardiac Anaesthesia, Narayana Hrudyalaya, Gujrat,
Ahmedabad, India
(Bhanu) Department of Anaesthesia, Gandhi Medical College, Hyderabad,
Telangana, India
(Khanderkar) Department of Cardiac Anaesthesia, KDA, Mumbai, Maharashtra,
India
(Ganpathy) Department of Anaesthesia, Apollo Hospitals, Tamil Nadu,
Chennai, India
(Soni) Department of Anaesthesia, Apollo Hospital Bhat, Gujarat,
Ahmedabad, India
(Nebu) Department of Cardiac Anaesthesia, KEM Hospital, Maharashtra,
Mumbai, India
(Saxena) Medical Division Affairs, Baxter India, DLF Cyber City Phase 2,
Haryana, Gurgaon 122002, India
Publisher
Thieme India
Abstract
Myocardial protection with volatile anesthetic agents have been suggested
by multiple studies. These studies, however, are scattered and are often
limited to a particular aspect of cardiac anesthesia. Older inhalational
agents like halothane is known to cause significant hepatic damage in
patients undergoing long duration surgeries while isoflurane is known to
have marked vasodilating properties that also affects the coronary
arteries leading to coronary steal phenomenon. Additionally, newer agents,
like sevoflurane and desflurane, have shown more prominent
cardioprotective effects than older agents. We searched ScholarOne,
Medline, Embase, and the Cochrane Central Register of Controlled Trials
(CENTRAL) in the Cochrane Library. The medical subject headings (MeSH)
terms anaesthesia, inhalational, anaesthesia, intravenous, or TIVA, and
Cardiac anaesthesia or Cardiac Surgery were used. Additional studies were
identified by review of the reference sections of all eligible studies.
The aim of this review article is to bring together the evidences with
newer inhalational agents and provide a holistic view of their benefits
and shortcomings in cardiac anesthesia. Copyright © 2021 Thieme
India. All rights reserved.

<81>
Accession Number
631481731
Title
Agreement between the Schedule for the Evaluation of Individual Quality of
Life-Direct Weighting (SEIQoL-DW) interview and a paper-administered
adaption.
Source
BMC medical research methodology. 20 (1) (pp 80), 2020. Date of
Publication: 10 Apr 2020.
Author
Burckhardt M.; Fleischer S.; Berg A.
Institution
(Burckhardt, Fleischer, Berg) Institute of Health and Nursing Science,
Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale),
Germany
(Burckhardt) SRH University of Applied Health Sciences, Gera, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: The Schedule for the Evaluation of Individual Quality of
Life-Direct Weighting (SEIQoL-DW) is a prevalent face-to-face interview
method for measuring quality of life by integrating respondent-generated
dimensions. To apply this method in clinical trials, a paper-administered
alternative would be of interest. Therefore, our study aimed to analyze
the agreement between the SEIQoL-DW and a paper questionnaire version
(SEIQoL-PF/G). METHOD(S): In a crossover design, both measures were
completed in a random sequence. 104 patients at a heart surgery hospital
in Germany were randomly assigned to receive either the SEIQoL-DW or the
SEIQoL-PF/G as the first measurement in the sequence. Patients were
approached on their earliest stable day after surgery. The average time
between both measurements was 1 day (mean 1.3; SD 0.8). Agreement
regarding the indices, ratings, and weightings of nominated life areas
(cues) was explored using Bland-Altman plots with 95% limits of agreement
(LoA). Agreement of the SEIQoL indices was defined as acceptable if the
LoA did not exceed a threshold of 10 scale points. Data from n=99 patients
were included in the agreement analysis. RESULT(S): Both measures led
to similarly nominated cues. The most frequently nominated cues were
"physical health" and "family". In the Bland-Altman plot, the indices
showed a mean of differences of 2 points (95% CI, -1 to 6). The upper LoA
showed a difference of 36 points (95% CI, 30 to 42), and the lower LoA
showed a difference of -31 points (95% CI, -37 to -26). Thus, the LoAs and
confidence intervals exceeded the predefined threshold. The Bland-Altman
plots for the cue levels and cue weights showed similar results. The
SEIQoL-PF/G version showed a tendency for equal weighting of cues, while
the weighting procedure of the SEIQoL-DW led to greater variability.
 CONCLUSION(S): For cardiac surgery patients, use of the current
version of the SEIQoL-PF/G as a substitute for the SEIQoL-DW is not
recommended. The current questionnaire weighting method seems to be unable
to distinguish weighting for different cues. Therefore, the further design
of a weighting method without interviewer support as a paper-administered
measure of individual quality of life is desirable.

<82>
Accession Number
635363238
Title
Pacing leads in transcatheter tricuspid valve.
Source
Europace. Conference: Annual Congress of the European Heart Rhythm
Association, EHRA 2021. Online. 23 (SUPPL 3) (pp iii526), 2021. Date of
Publication: May 2021.
Author
Santos H.; Santos M.; Miranda H.; Almeida I.; Paula S.; Figueiredo M.;
Neto M.; Sa C.; Chin J.; Almeida S.; Sousa C.; Almeida L.
Institution
(Santos, Santos, Miranda, Almeida, Paula, Figueiredo, Neto, Sa, Chin,
Almeida, Sousa, Almeida) Hospital N.S. Rosario, Cardiology, Barreiro,
Portugal
Publisher
Oxford University Press
Abstract
Background: Transcatheter therapy of bioprothesis in tricuspid position
and the native tricuspid valve are a growing field in interventional
cardiology. Yet, the presence of pacing leads can demand a different
approach. We performed a systemic review of this topic to understand the
risks and the potential impact on the pacing leads. Objective(s):
Review the evidence regarding the efficacy and safety of pacing leads with
the transcatheter tricuspid valve implantation. Method(s): A systemic
research on MEDLINE and PUBMED with two the following terms 'transvenous
pacing', 'transcatheter valve', 'transcatheter tricuspid', 'transvalvular
leads', 'tricuspid valve-in-valve' and 'transvalvular pacemaker'. 120
results were identified. However, just 5 papers were selected since are
the only ones that described the implantation of a transcatheter tricuspid
valve in patients with pacing leads and had some follow up, yet one of the
papers lacks data and was excluded. The majority of papers reported the
success of the procedure yet without a follow-up or the potentials
complications on the pacing leads. Result(s): Four studies were
selected, including a total of 33 patients. The studies were performed
with different techniques and procedures, as well as the reports regarding
the echocardiogram and pacing data before the procedure and during the
follow-up. Mean age 59.51 years old, 78.78% were female, 72.72% had NYHA
class >= III, 21.21% was hospitalized in the previous 6 months, 21.21% had
acute or chronic renal insufficiency, 18.18% had cirrhosis or liver
disease, 51.52% had other prosthetic valves and 12.12 had history of
endocarditis. Acquired etiology for tricuspid valve disease in 63.64%,
atrial fibrillation in 60.60%, 78.79% had a tricuspid bioprosthetic valve,
one patient had a catheter valve and the rest had a ring with or without
homograft valve. 60.60% had moderate or severe tricuspid regurgitation and
15.15% had mixed tricuspid regurgitation and stenosis, with a mean
tricuspid valve gradient of 7.22 mmHg. SAPIEN transcatheter valve was used
in 78.79% and Melody valve in the rest. The transcatheter tricuspid
implantation was a success in 32 patients, without any interference in the
pacing leads. Of them, the follow-up period was diverse and heterogeneous
with a mean of 13.51 months, a mean tricuspid valve gradient of 5.00 mmHg,
and a register of 3 death without any relationship with the transcatheter
valve or pacing complications. Was reported three complications during the
follow-up regarding the pacing leads, two patients had a marked increase
in the right ventricle leads impedance and stimulation threshold and one
patient developed a right ventricle lead fracture. Conclusion(s):
9.28% of the patients submitted to transcatheter tricuspid valve had
pacing lead complications. Considering the small sample, further
investigation regarding the impact of this procedure in the pacing leads
is required for a clear assessment.

<83>
Accession Number
635363168
Title
Does cardiac arrhythmia surgery improve a patient's quality of life? a
systematic review and meta-analysis.
Source
Europace. Conference: Annual Congress of the European Heart Rhythm
Association, EHRA 2021. Online. 23 (SUPPL 3) (pp iii289), 2021. Date of
Publication: May 2021.
Author
Van Der Heijden C.A.J.; Bidar E.; Vos R.; Maessen J.; Athanasiou T.;
Maesen B.
Institution
(Van Der Heijden) Maastricht University Medical Centre (MUMC+),
Cardiothoracic Surgery, Maastricht, Netherlands
(Bidar, Maessen, Maesen) Maastricht University Medical Centre (MUMC+),
Cardiothoracic surgery and Cardiovascular Research Institute Maastricht
(CARIM), Maastricht, Netherlands
(Vos) Maastricht University, Methodology and Statistics, Maastricht,
Netherlands
(Athanasiou) Imperial college of London, Cardiothoracic surgery, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Background: Although one-year success of arrhythmia surgery for atrial
fibrillation (AF) has long been defined as freedom from supraventricular
tachyarrhythmia, patient-reported quality of life (QOL) has become
increasingly important. Purpose(s): We aimed to analyze current
evidence of QOL following both concomitant and stand-alone arrhythmia
surgery for AF. Method(s): Studies reporting on QOL of patients
undergoing arrhythmia surgery for AF, stand-alone or concomitant, who
provided essential data for the analysis, were included in this systematic
review. A meta-analysis was performed on inter-study heterogeneity of
changes in QOL in 9 of 12 included studies who used the Short-Form (SF) 36
tool. The metric standardized mean difference (SMD) was used to compare
one year outcomes with baseline scores per variable of the SF-36 QOL
questionnaire (total patients n = 545). Finally, meta-regression based on
rhythm outcome after one year and add-on arrhythmia surgery as covariate
were performed. Result(s): QOL scores improved one year after
surgical ablation for AF, evaluated by several questionnaires. In
standalone arrhythmia procedures, meta-regression showed a significant
improvement between the QOL and the procedural effectiveness after one
year (Physical Functioning p = 0.015, Role Physical p = 0.006, General
Health p = 0.002, Social Functioning p = 0.043. Forest plot Physical
Functioning: SMD = 1.105; heterogeneity: I2=90.6%, p < 0.001).
While this association was also suggested in concomitant procedures, only
the variable Physical Role demonstrated a significant improvement when
comparing QOL of cardiac surgery with and without add-on surgical AF
ablation (p = 0.037). Conclusion(s): Arrhythmia surgery for AF
improves QOL. Both in standalone and concomitant procedures, the
improvement in QOL seems to be related to the procedural effectiveness to
maintain sinus rhythm after 12 months.

<84>
Accession Number
635363106
Title
Steroid use for recovery of advanced atrioventricular block immediately
after valvular surgery (Survival): A randomized clinical trial.
Source
Europace. Conference: Annual Congress of the European Heart Rhythm
Association, EHRA 2021. Online. 23 (SUPPL 3) (pp iii359), 2021. Date of
Publication: May 2021.
Author
Masoudkabir F.; Ghodsi S.; Hosseini Z.; Davarpasand T.; Haj Hossein
Talasaz A.; Jalali A.; Bagheri J.
Institution
(Masoudkabir, Ghodsi, Hosseini, Davarpasand, Haj Hossein Talasaz, Jalali,
Bagheri) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
Publisher
Oxford University Press
Abstract
Background: Limited inconsistent evidence support use of steroids in
recovery of atrioventricular block (AVB) after trans-catheter aortic valve
implantation. However, there is no study to examine the efficacy of
steroids in recovery of high-grade AVB following valvular surgery.
 Purpose(s): To assess the effect of high-dose dexamethasone on
recovery of advanced AVB following valvular heart surgery. Method(s):
In this randomized controlled trial, patients with advanced postoperative
AVB (either Mobitz type II or third degree) were randomly assigned to
receive either dexamethasone (0.4 mg /kg, maximum 30 mg /day in three
divided doses) intravenously for three days or conservative care only.
Primary endpoint was recovery rate in day five since randomization.
Secondary endpoints were recovery rate in day 7 and day 10, cumulative AVB
time, PPM implantation rate, length of stay in critical care units, and
post-operative major adverse events (MAE) during one month. We defined MAE
as composite of all-cause mortality, all-type infections, major bleeding,
prolonged sternal dehiscence, new stroke, postoperative MI, complicated
uncontrolled hyperglycemia and readmission for decompensated heart
failure. Result(s): We enrolled 139 subjects (48.9% male) with mean
age of 59.9 years who were randomly allocated to intervention group (n=
69) and control group (n= 70). Dexamethasone led to higher recovery rates
at day 5 (82.6% vs. 62.9%, P= 0.009) and day 7 (88.4% vs. 61.4%, P<
0.0001) respectively. Random 24-hours ECG Holter monitoring of patients at
day 5 revealed the same results and confirmed the superiority of
dexamethasone for recovery of AVB (80.5% vs 61.2%, respectively, P =
0.024). Although this benefit ceased at day 10 (83.05 vs 78.6 %, P =
0.547), Generalized Estimating Equation analysis for recovery over 10 days
favored intervention (odds ratio: 2.56, 95% CI: 1.27- 5.15, P = 0.008).
Median cumulative AVB time was shorter in dexamethasone group compared to
control group (41 hours vs 64 hours, P = 0.044). PPM implantation rates
were similar between the dexamethasone and control groups (15.9% vs 17.1
%, respectively, P = 0.849). Median length of stay in ICU (10 days vs 12
days, P= 0.03) and MAE (17.4 % vs 25.7%, P = 0.133) tended to be lower
with dexamethasone. Conclusion(s): Our findings suggest that
dexamethasone may serve as a safe and effective medication to improve
recovery of advanced AVB after valvular surgery. Further studies are
needed to confirm these findings, particularly regarding subsequent PPM
implantation rate.

<85>
Accession Number
635362876
Title
A Case of Recurrent Serratia Marcescens Endocarditis in Native and
Bioprosthetic Mitral Valves.
Source
ASAIO Journal. Conference: Annual Conference of the American Society for
Artificial Internal Organs, ASAIO 2021. Washington DC United States. 67
(SUPPL 2) (pp 119), 2021. Date of Publication: June 2021.
Author
Ramparas T.; Tirupathi R.; Subedi B.H.; Rabaan A.
Institution
(Ramparas) Xavier University School of Medicine (XUSOM), Oranjestad, Aruba
(Tirupathi, Subedi) Penn State University School of Medicine, Hershey, PA,
United States
(Rabaan) Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare,
Dhahran, Saudi Arabia
Publisher
Lippincott Williams and Wilkins
Abstract
Study: Serratia marcescens is a known cause of native valve endocarditis
(NVE). It is an uncommon cause of infectious endocarditis (IE), and can be
challenging to treat. We describe a case of a recrudescence of S.
marcescens IE in a bioprosthetic mitral valve 3 months after valve
replacement surgery for NVE. We explore the challenges of treating S.
marcescens in an intravenous drug use (IVDU) patient. Method(s):
Clinical management of a 41 year old Caucasian female with an IVDU history
who was diagnosed with S. marcescens NVE in December 2019, treated with
antibiotics and mitral valve replacement but developed S. marcescens
prosthetic valve endocarditis (PVE), was documented over the course of her
multiple hospitalizations and compiled into a case report. We conducted a
systematic search of PubMed, Sciencedirect and Google scholar for articles
on S. marcescens IE. We extracted and synthesized data on circumstances,
treatment and patient outcomes and tabulated our findings to explore
antibiotic resistance in the context of our patient. Our search included
the following terms within the title, abstract and author keywords:
"Serratia marcescens", "infective endocarditis", "recurrence", "IVDU" and
"prosthetic mitral valves". We had no start date or country requirements
and limited our search to papers in English. Our search included case
reports, case series, original studies and letters of correspondence
reporting small clinical studies. Result(s): Following multiple
courses of treatment including 6 weeks of Cefepime, mitral valve
replacement and tricuspid annuloplasty with 4 weeks of Ciprofloxacin and
Gentamicin post-MVR, 6 weeks inpatient treatment with Ciprofloxacin and
Ertapenem and finally 6 weeks of oral Ciprofloxacin, the patient passed
away. Our literature review explored Serratia's ability to affect
left-sided heart valves, its virulence, antibiotic sensitivity and
difficulty to treat in PVE in IVDU patients given the current opioid
crisis.

<86>
Accession Number
635362645
Title
Sternasafe or Pillow: A Randomized Trial for Pain Management Following
Median Sternotomy.
Source
ASAIO Journal. Conference: Annual Conference of the American Society for
Artificial Internal Organs, ASAIO 2021. Washington DC United States. 67
(SUPPL 2) (pp 95), 2021. Date of Publication: June 2021.
Author
Nowak A.; Coleman C.H.; Cruz J.; Hoang R.; Cohen W.; Simone P.; Jang Y.;
Lupo S.; Ota T.; Jeevanandam V.; Combs P.
Institution
(Nowak, Coleman, Cruz, Hoang, Simone, Jang, Lupo, Ota, Jeevanandam, Combs)
Cardiac and Thoracic Surgery, University of Chicago, Chicago, IL, United
States
(Cohen) Perelman School of Medicine, University of Pennsylvania,
Philadelphia, PA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Study: Patients who undergo median sternotomy are often advised to use
pillows for extra support to their sternum when engaging in high pressure
movements such as coughing or deep breathing. However, there is concern
regarding the effectiveness of this solution and the ability for patients
to consistently utilize the pillow. The Sternasafe support device, an
elastic band continuously worn circumferentially around the thorax, has
been offered as a potential replacement. We compare pain levels in
post-operative cardiac surgery patients who utilized either a standard
pillow or the novel SternaSafe support device. Method(s): A parallel,
randomized, open-label trial with 1:1 allocation compared pain management
among cardiac surgery patients using a standard pillow or SternaSafe
support device. Resting pain levels (0-10 with zero being no pain) were
recorded pre-operatively, one day post-operatively, and in each of the
subsequent four weeks. A P-value <0.05 was considered statistically
significant. Result(s): Twenty-eight patients met inclusion criteria.
There were no significant differences in demographics or comorbidities
between groups. While reported pain was less in the Sternasafe group at
all post-operative timepoints, only post-operative day +30 reached
statistical significance (p=0.041) (Table 1). Reduced patient reported
pain on post-operative day +1 only approached statistical significance
(p=0.061), likely due to small sample size. Expanded trials should be
conducted to further assess SternaSafe efficacy and patient satisfaction.

<87>
Accession Number
2013208752
Title
The Effect of Rhythmic Breathing on the Severity of Sternotomy Pain after
Coronary Artery Bypass Graft Surgery: A Randomized Controlled Clinical
Trial.
Source
Evidence-based Complementary and Alternative Medicine. 2021 (no
pagination), 2021. Article Number: 9933876. Date of Publication: 2021.
Author
Babamohamadi H.; Karkeabadi M.; Ebrahimian A.
Institution
(Babamohamadi, Ebrahimian) Nursing Care Research Center, Semnan University
of Medical Sciences, Semnan 3513138111, Iran, Islamic Republic of
(Babamohamadi) Department of Nursing, Faculty of Nursing and Midwifery,
Semnan University of Medical Sciences, Semnan 3513138111, Iran, Islamic
Republic of
(Karkeabadi) Student Research Committee, Semnan University of Medical
Sciences, Semnan 3513138111, Iran, Islamic Republic of
(Ebrahimian) Emergency Medicine Group, School of Medicine, Qom University
of Medical Sciences, Qom Muq.ac.ir, Iran, Islamic Republic of
Publisher
Hindawi Limited
Abstract
Background. Moderate-to-severe pain is reported in up to 75% of the
patients in the first 48 hours after cardiac surgery. Evidence suggests
that distraction is an effective nursing intervention for controlling
short-term and transient pain. Distraction can be achieved by various
techniques, including progressive muscle relaxation, meditation, and
rhythmic breathing (RB). The present research aimed at evaluating the
impacts of RB on the severity of sternotomy pain after Coronary Artery
Bypass Graft (CABG). Methods. This randomized, controlled clinical trial
was conducted on 60 patients after CABG surgery at the open-heart surgery
Intensive Care Unit (ICU) of Kowsar Hospital, affiliated to Semnan
University of Medical Sciences in Semnan, Iran. The patients were selected
through convenience sampling and randomly assigned to two groups,
including (1) intervention or RB and (2) control groups. RB was performed
in the intervention group every 12 hours (9 a.m. and 9 p.m.) for three
consecutive days after the surgery. The control group received only
routine care for pain control (opioid analgesics) with no additional
interventions. The severity of pain was measured every day in both groups
of patients before and after the interventions using the Visual Analog
Scale (VAS). Results. The mean postintervention pain scores were
significantly different from the mean preintervention scores in the
intervention group (p < 0.05). The changes in the mean pain score in the
intervention group were also significantly different from the
corresponding changes in the controls (p < 0.05). Conclusion. Based on the
results, the severity of pain after the intervention was significantly
lower in the RB group compared to the control. RB was found to be an
effective technique for reducing the patients' pain and is therefore
recommended as a post-CABG pain control technique. Iranian Registry of
Clinical Trials: this trial is clinically registered with
IRCT20120109008665N7, registered 3 September 2018. Copyright ©
2021 Hassan Babamohamadi et al.

<88>
Accession Number
2013204599
Title
Is there a predictive value of hemoglobin a1c for complications of cardiac
surgery?.
Source
Journal of the College of Physicians and Surgeons Pakistan. 31 (6) (pp
686-693), 2021. Date of Publication: June 2021.
Author
Ozturk S.; Kayacoglu I.; Sensoz Y.; Ozcelik S.; Arslan Y.; Ozturk I.
Institution
(Ozturk) Department of Cardiovascular Surgery, Goztepe Education and
Research Hospital, Istanbul, Turkey
(Ozturk, Kayacoglu, Sensoz, Ozcelik, Arslan) Department of Anesthesiology,
Goztepe Education and Research Hospital, Istanbul, Turkey
Publisher
College of Physicians and Surgeons Pakistan
Abstract
Objective: To investigate the effect of preoperative hemoglobin A1c levels
for the complications of cardiac surgery. Study Design:
Meta-analysis. Place of Study: Siyami Ersek Chest and Cardiovascular
Surgery Education and Research Hospital, Istanbul, Turkey. Methodology:
PubMed, Scopus, Web of Science and Ovid electronic databases were used.
The studies were included the recorded preoperative levels of hemoglobin
A1C and postoperative complications developed after cardiac surgery.
Results of the studies were evaluated, based on either random or fixed
effect model, according to presence of heterogeneity (I2>25%).
 Result(s): In total, 2,312 articles were obtained. After reviewing
the articles, 33 articles covering 3500 patients meeting the inclusion
criteria were included. The results pointed out that there was a
relationship between preoperative hemoglobin A1c levels and mediastinitis,
stroke, pneumonia, sepsis, renal failure and mortality. Heterogeneity was
observed for myocardial infarction, atrial fibrillation and multiorgan
failure (I2 >25%). Conclusion(s): Preoperative hemoglobin A1C levels
were associated with development of mediastinitis, stroke, pneumonia,
sepsis, renal failure and mortality after cardiac surgery. Copyright
© 2021 College of Physicians and Surgeons Pakistan. All rights
reserved.

<89>
Accession Number
2013245614
Title
Impact of preoperative glycometabolic status on outcomes in cardiac
surgery: Systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Corazzari C.; Matteucci M.; Kolodziejczak M.; Kowalewski M.; Formenti
A.M.; Giustina A.; Beghi C.; Barili F.; Lorusso R.
Institution
(Corazzari, Matteucci, Kowalewski, Lorusso) Department of Cardiothoracic
Surgery, Heart and Vascular Centre, Maastricht University Medical Centre,
Maastricht, Netherlands
(Corazzari, Matteucci, Beghi) Department of Surgical and Morphological
Sciences, Circolo Hospital, University of Insubria, Varese, Italy
(Kolodziejczak) Department of Anaesthesiology and Intensive Care,
Collegium Medicum Nicolaus Copernicus University, Antoni Jurasz University
Hospital No. 1, Bydgoszcz, Poland
(Kolodziejczak) Yale Cardiovascular Research Group, Yale School of
Medicine, New Haven, Conn, United States
(Kowalewski) Department of Cardiac Surgery, Central Clinical Hospital of
the Ministry of Interior, Centre of Postgraduate Medical Education,
Warsaw, Poland
(Kowalewski) Thoracic Research Centre, Collegium Medicum Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
(Formenti, Giustina) Institute of Endocrine and Metabolic Sciences, San
Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
(Barili) Cardiac Surgery Unit, S. Croce Hospital, Cuneo, Italy
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
Mosby Inc.
Abstract
Background: Historically, impaired glucose metabolism has been associated
with early and late complicated clinical outcomes after cardiac surgery;
however, such a condition is not specific to subjects with diabetes
mellitus and involves a larger patient population. Method(s):
Databases were screened (January 2000 to December 2020) to identify
eligible articles; studies that evaluated the association between
preoperative metabolic status, as assessed by glycosylated hemoglobin
levels and clinical outcomes, were considered. The studies were stratified
in thresholds by baseline glycosylated hemoglobin level (lower vs higher).
 Result(s): Thirty studies, involving 34,650 patients, were included
in the review. In a meta-analysis stratified by glycosylated hemoglobin
levels, early mortality was numerically reduced in each threshold
comparison and yielded the highest reductions when less than 5.5% versus
greater than 5.5% glycosylated hemoglobin levels were compared (risk
ratio, 0.39; 95% confidence interval, 0.18-0.84; P = .02). Comparing
higher glycosylated hemoglobin threshold values yielded comparable
results. Late mortality was reduced with lower levels of glycosylated
hemoglobin. Low preoperative glycosylated hemoglobin was associated with
the lowest risk of sternal wound infections (risk ratio, 0.50; 95%
confidence interval, 0.32-0.80; P = .003 and risk ratio, 0.53; 95%
confidence interval, 0.39-0.70; P < .0001) for comparisons of less than
7.5% versus greater than 7.5% and less than 7.0% versus greater than 7.0%
glycosylated hemoglobin thresholds, respectively. Additionally, levels of
glycosylated hemoglobin lower than 7% were associated with reduced
hospital stay, lower risk of stroke/transient ischemic attack (risk ratio
0.53; 95% confidence interval, 0.39-0.70; P < .0001), and acute kidney
injury (risk ratio, 0.65; 95% confidence interval, 0.54-0.79; P < .0001).
 Conclusion(s): Lower levels of glycosylated hemoglobin in patients
undergoing cardiac surgery are associated with a lower risk of early and
late mortality, as well as in the incidence of postoperative acute kidney
injury, neurologic complications, and wound infection, compared with
higher levels. Copyright © 2021 The Authors

<90>
Accession Number
2012871355
Title
Update on surgical repair in functional mitral regurgitation.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Hu J.; Lee A.P.W.; Wei X.; Cheng Z.-Y.; Ho A.M.H.; Wan S.
Institution
(Hu) Department of Cardiovascular Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
(Lee) Division of Cardiology, Prince of Wales Hospital, The Chinese
University of Hong Kong, Hong Kong
(Wei) Department of Cardiothoracic and Vascular Surgery, Tongji Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
(Cheng) Department of Cardiovascular Surgery, Fuwai Central China
Cardiovascular Hospital, Zhengzhou, China
(Ho) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Queen's University, Kingston, ON, Canada
(Wan) Division of Cardiothoracic Surgery, Department of Surgery, The
Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
Publisher
Blackwell Publishing Inc.
Abstract
Background: Functional mitral regurgitation (FMR) is common in patients
with myocardial infarction or dilated cardiomyopathy, and portends a poor
prognosis despite guideline-directed medical therapy (GDMT). Surgical or
transcatheter mitral repair for FMR from recent randomized clinical trials
showed disappointing or conflicting results. Aim(s): To provide an
update on the role of surgical repair in the management of FMR.
 Material(s) and Method(s): A literature search was conducted
utilizing PubMed, Ovid, Web of Science, Embase, and Cochrane Library. The
search terms included secondary/FMR, ischemic mitral regurgitation, mitral
repair, mitral replacement, mitral annuloplasty, transcatheter mitral
repair, and percutaneous mitral repair. Randomized clinical trials over
the past decade were the particular focus of the current review.
 Result(s): Recent data underlined the complexity and poor prognosis
of FMR. GDMT and cardiac resynchronization, when indicated, should always
be applied. Accurate assessment of the interplay between ventricular
geometry and mitral valve function is essential to differentiate
proportionate FMR from the disproportionate subgroup, which could be
helpful in selecting appropriate transcatheter intervention strategies.
Surgical repair, most commonly performed with an undersized ring
annuloplasty, remains controversial. Adjunctive valvular or subvalvular
repair techniques are evolving and may produce improved results in
selected FMR patients. Conclusion(s): FMR resulted from complex
valve-ventricular interaction and remodeling. Distinguishing proportionate
FMR from disproportionate FMR is important in exploring their underlying
mechanisms and to guide medical treatment with surgical or transcatheter
interventions. Further studies are warranted to confirm the clinical
benefit of appropriate surgical repair in selected FMR
patients. Copyright © 2021 Wiley Periodicals LLC

<91>
Accession Number
2012856107
Title
The Better Option of Revascularization in Complex Coronary Artery Disease
Patients Complicate With Chronic Kidney Disease: A Review and
Meta-Analysis.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
100886. Date of Publication: 2021.
Author
Chen X.; Zhang X.; Yan Y.; Wang G.
Institution
(Chen, Wang) Department of Emergency, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
(Zhang, Yan) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
Publisher
Mosby Inc.
Abstract
The treatment of complex coronary artery disease (CAD) combined with
chronic kidney disease (CKD) faces great challenges. We thus did a
systematic review and meta-analysis to assess the effect of percutaneous
coronary intervention (PCI) and coronary artery bypass graft (CABG). We
systematically searched PubMed, Embase, Cochrane Library and other
relevant articles refer to reference. Our main endpoints were main adverse
cardiovascular and cerebrovascular events (MACCE), all cause death,
myocardial infarction (MI), repeat revascularization and stoke. 24 studies
were included in our analysis. Compared with PCI, CABG improved outcomes
such as MACCE (Odds Ratio [OR] 1.75; 95%CI 1.26-2.42), all cause death (OR
1.13; 95%CI 1.00-1.28), repeat revascularization (OR 4.24; 95%CI
3.29-5.47) and MI (OR 2.16; 95%CI 1.59-2.91), but stoke (OR 0.84, 95%CI
0.61-1.17). CABG shows absolute advantage in complex CAD complicated with
CKD and ESRD patients than stent implantation in the long-term
following-up. Copyright © 2021 Elsevier Inc.

<92>
[Use Link to view the full text]
Accession Number
635359153
Title
Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A
Scientific Statement from the American Heart Association.
Source
Circulation. (pp E1088-E1114), 2021. Date of Publication: 2021.
Author
Shroff G.R.; Bangalore S.; Bhave N.M.; Chang T.I.; Garcia S.; Mathew R.O.;
Rangaswami J.; Ternacle J.; Thourani V.H.; Pibarot P.
Publisher
Lippincott Williams and Wilkins
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a
clinical challenge. Aortic stenosis is more prevalent and progresses more
rapidly and unpredictably in CKD, and the presence of CKD is associated
with worse short-term and long-term outcomes after aortic valve
replacement. Because patients with advanced CKD and end-stage kidney
disease have been excluded from randomized trials, clinicians need to make
complex management decisions in this population that are based on
retrospective and observational evidence. This statement summarizes the
epidemiological and pathophysiological characteristics of aortic stenosis
in the context of CKD, evaluates the nuances and prognostic information
provided by noninvasive cardiovascular imaging with echocardiography and
advanced imaging techniques, and outlines the special risks in this
population. Furthermore, this statement provides a critical review of the
existing literature pertaining to clinical outcomes of surgical versus
transcatheter aortic valve replacement in this high-risk population to
help guide clinical decision making in the choice of aortic valve
replacement and specific prosthesis. Finally, this statement provides an
approach to the perioperative management of these patients, with special
attention to a multidisciplinary heart-kidney collaborative team-based
approach. Copyright © 2021 Lippincott Williams and Wilkins. All
rights reserved.

<93>
Accession Number
635358125
Title
Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in
Coronary Artery Bypass Surgery: A Post Hoc Analysis from the COMPASS
Trial.
Source
JAMA Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Lamy A.; Browne A.; Sheth T.; Zheng Z.; Dagenais F.; Noiseux N.; Chen X.;
Bakeen F.G.; Brtko M.; Stevens L.-M.; Alboom M.; Lee S.F.; Copland I.;
Salim Y.; Eikelboom J.
Institution
(Lamy, Browne, Sheth, Lee, Copland, Salim, Eikelboom) Population Health
Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
(Lamy, Alboom) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Lamy, Lee, Salim) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada
(Sheth, Salim, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Zheng) Department of Cardiovascular Surgery, Fuwai Hospital, Beijing,
China
(Dagenais) Department of Cardiac Surgery, Quebec Heart and Lung Institute,
Laval University, Quebec City, QC, Canada
(Noiseux, Stevens) Department of Cardiac Surgery, Centre Hospitalier,
L'Universite de Montreal, Montreal, QC, Canada
(Chen) Department of Thoracic and Cardiovascular Surgery, Nanjing First
Hospital, Nanjing Medical University, Nanjing, China
(Bakeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Brtko) Department of Cardiac Surgery, Fakultni Nemocnice Hradec Kralove,
Hradec Kralove, Kralovehradecky, Czechia
Publisher
American Medical Association
Abstract
Importance: The relative safety and patency of skeletonized vs pedicled
internal mammary artery grafts in patients undergoing coronary artery
bypass graft (CABG) surgery are unknown. Objective(s): To investigate
the association of skeletonized vs pedicled harvesting with internal
mammary artery graft patency and clinical outcomes 1 year after CABG
surgery. Design, Setting, and Participant(s): This study was a post
hoc analysis of the multicenter, randomized, double-blind,
placebo-controlled Cardiovascular Outcomes for People Using
Anticoagulation Strategies (COMPASS) clinical trial, which enrolled 27 395
patients from 602 centers in 33 countries from March 2013 through May
2016. Eligibility criteria for the trial included CABG surgery for
coronary artery disease with at least 2 grafts implanted and an estimated
glomerular filtration rate of at least 30 mL/min. A total of 1002 of 1448
patients were randomized to the CABG arm of the COMPASS trial and
underwent skeletonized (282 [28.1%]) or pedicled (720 [71.9%]) internal
mammary artery harvesting. The patients had evaluable angiography results
1 year after surgery. Data were analyzed from October 11, 2019, to May 14,
2020. Intervention(s): Patients underwent graft harvesting with
either the pedicled technique or skeletonized technique. Main
Outcomes and Measures: The primary outcome was graft occlusion 1 year
after CABG surgery, as assessed by computed tomography angiography.
 Result(s): A total of 1002 patients underwent skeletonized (282
[28.1%]; mean [SD] age, 65.9 [8.1] years; 229 men [81.2%]; 194 White
patients [68.8%]) or pedicled (720 [71.9%]; mean [SD] age, 64.8 [7.6]
years; 603 men [83.8%]; 455 White patients [63.2%]) internal mammary
artery harvesting. Rates of internal mammary artery graft occlusion 1 year
after CABG surgery were higher in the skeletonized group than in the
pedicled group (33 of 344 [9.6%] vs 30 of 764 [3.9%]; graft-level adjusted
odds ratio, 2.41; 95% CI, 1.39-4.20; P =.002), including the left internal
mammary artery to left anterior descending artery (21 of 289 [7.3%] vs 25
of 725 [3.4%]; graft-level adjusted odds ratio, 2.10; 95% CI, 1.14-3.88, P
=.02). After a mean follow-up of 23 months, skeletonized graft harvesting
was also associated with a higher rate of major adverse cardiovascular
events (20 [7.1%] vs 15 [2.1%]; adjusted hazard ratio, 3.19; 95% CI,
1.53-6.67; P =.002) and repeated revascularization (14 [5.0%] vs 10
[1.4%]; adjusted hazard ratio, 2.75; 95% CI, 1.10-6.88; P =.03).
 Conclusions and Relevance: This post hoc analysis of the COMPASS
randomized clinical trial found that harvesting of the internal mammary
artery during CABG surgery using a skeletonized technique was associated
with a higher rate of graft occlusion and worse clinical outcomes than the
traditional pedicled technique. Future randomized clinical trials are
needed to establish the safety and patency of the skeletonized technique.
Trial Registration: ClinicalTrials.gov Identifier:
NCT01776424. Copyright © 2021 American Medical Association. All
rights reserved.

<94>
Accession Number
2011486117
Title
European Resuscitation Council Guidelines 2021: Executive summary.
Source
Resuscitation. 161 (pp 1-60), 2021. Date of Publication: April 2021.
Author
Perkins G.D.; Graesner J.-T.; Semeraro F.; Olasveengen T.; Soar J.; Lott
C.; Van de Voorde P.; Madar J.; Zideman D.; Mentzelopoulos S.; Bossaert
L.; Greif R.; Monsieurs K.; Svavarsdottir H.; Nolan J.P.
Institution
(Perkins, Nolan) Warwick Clinical Trials Unit, Warwick Medical School,
University of Warwick, Coventry CV4 7AL, United Kingdom
(Perkins) University Hospitals Birmingham, Birmingham B9 5SS, United
Kingdom
(Graesner) University Hospital Schleswig-Holstein, Institute for Emergency
Medicine, Kiel, Germany
(Semeraro) Department of Anaesthesia, Intensive Care and Emergency Medical
Services, Maggiore Hospital, Bologna, Italy
(Olasveengen) Department of Anesthesiology, Oslo University Hospital and
Institute of Clinical Medicine, University of Oslo, Norway
(Soar) Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB,
United Kingdom
(Lott) Department of Anesthesiology, University Medical Center, Johannes
Gutenberg-University Mainz, Germany
(Van de Voorde) Department of Emergency Medicine, Faculty of Medicine
Ghent University, Ghent, Belgium
(Van de Voorde) EMS Dispatch Center, East-West Flanders, Federal
Department of Health, Belgium
(Madar) Department of Neonatology, University Hospitals Plymouth,
Plymouth, United Kingdom
(Zideman) Thames Valley Air Ambulance, Stokenchurch, United Kingdom
(Mentzelopoulos) National and Kapodistrian University of Athens Medical
School, Athens, Greece
(Bossaert) University of Antwerp, Antwerp, Belgium
(Greif) Department of Anaesthesiology and Pain Medicine, Bern University
Hospital, University of Bern, Bern, Switzerland
(Greif) School of Medicine, Sigmund Freud University Vienna, Vienna,
Austria
(Monsieurs) Department of Emergency Medicine, Antwerp University Hospital
and University of Antwerp, Belgium
(Svavarsdottir) Akureyri Hospital, Akureyri, Iceland
(Svavarsdottir) University of Akureyri, Akureyri, Iceland
(Nolan) Royal United Hospital, Bath BA1 3NG, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Informed by a series of systematic reviews, scoping reviews and evidence
updates from the International Liaison Committee on Resuscitation, the
2021 European Resuscitation Council Guidelines present the most up to date
evidence-based guidelines for the practice of resuscitation across Europe.
The guidelines cover the epidemiology of cardiac arrest; the role that
systems play in saving lives, adult basic life support, adult advanced
life support, resuscitation in special circumstances, post resuscitation
care, first aid, neonatal life support, paediatric life support, ethics
and education. Copyright © 2021

<95>
Accession Number
634996226
Title
Effect of intravenous application of nicorandil on area of myocardial
infarction in patients with STEMI during the perioperative stage of PCI.
Source
Clinical Hemorheology and Microcirculation. 77 (4) (pp 411-423), 2021.
Date of Publication: 2021.
Author
Wang Z.-D.; Li H.; Liu M.; Li P.; Chen J.; Liang X.-W.; Zhu X.-Z.; Liao W.
Institution
(Wang, Li, Liu, Li, Chen, Liang, Zhu, Liao) Department of Cardiology,
Yulin First People's Hospital, Sixth Affiliated Hospital of Guangxi
Medical University, Yulin, Guangxi, China
Publisher
IOS Press BV
Abstract
OBJECTIVE: The aim of the present study was to evaluate the effectiveness
and safety of nicorandil in improving the area of myocardial infarction in
patients with acute myocardial infarction (AMI). METHOD(S): One
hundred and twenty patients with acute ST-segment elevation myocardial
infarction (STEMI) admitted to our hospital between December 1, 2018 and
December 31, 2019 were selected and randomly allocated to the experimental
group (group A, n=60) and the control group (group B, n=60). In the
experimental group, an infusion of nicorandil was given intravenously
before the first balloon dilation or 1 minute before the stent placement,
and with the completion of the infusion, nicorandil maintenance infusion
was given. In the control group, only balloon dilation and stent placement
were undertaken. RESULT(S): The postoperative peak levels of
myoglobin, creatine kinase isoform and hypersensitive troponin T were
significantly lower in group A than in group B (p<0.05). Moreover, the
left ventricular ejection fraction (LVEF) on the 180th day post operation
was substantially greater in group A than in group B (p<0.01), and the
area of myocardial infarction was significantly smaller in patients in
group A than those in group B on the 180th day post operation (p<0.01). In
terms of the safety, there were no statistically significant differences
in the incidence of slow flow/no reflow, malignant arrhythmias, and
hypotension within 24 hours post operation between the two groups
(p>0.05), and no major adverse cardiovascular event (MACE) occurred in
either group during the postoperative follow-up period of 180 days
(p>0.05). CONCLUSION(S): Intravenous administration of nicorandil in
patients with STEMI during the perioperative percutaneous coronary
intervention (PCI) period was effective in reducing the area of myocardial
infarction and myocardial injury without increasing the incidence of
malignant arrhythmias, hypotension, or composite cardiovascular events
during the drug administration period. Copyright © 2021-IOS
Press. All rights reserved.

<96>
Accession Number
2007329936
Title
Intravenous albumin for mitigating hypotension and augmenting
ultrafiltration during kidney replacement therapy.
Source
Clinical Journal of the American Society of Nephrology. 16 (5) (pp
820-828), 2021. Date of Publication: 08 May 2021.
Author
Hryciw N.; Joannidis M.; Hiremath S.; Callum J.; Clark E.G.
Institution
(Hryciw) Department of Medicine, University of Ottawa, Ottawa, ON, Canada
(Joannidis) Division of Intensive Care and Emergency Medicine, Department
of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
(Hiremath, Clark) Division of Nephrology, Department of Medicine,
University of Ottawa and the Ottawa Hospital Research Institute, Ottawa,
ON, Canada
(Callum) Department of Laboratory Medicine and Molecular Diagnostics,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Callum) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, ON, Canada
Publisher
American Society of Nephrology
Abstract
Among its many functions, owing to its oversized effect on colloid oncotic
pressure, intravascular albumin helps preserve the effective circulatory
volume. Hypoalbuminemia is common in hospitalized patients and is found
especially frequently in patients who require KRT either for AKI or as
maintenance hemodialysis. In such patients, hypoalbuminemia is strongly
associated with morbidity, intradialytic hypotension, and mortality.
Intravenous albumin may be administered in an effort to prevent or treat
hypotension or to augment fluid removal, but this practice is
controversial. Theoretically, intravenous albumin administration might
prevent or treat hypotension by promoting plasma refilling in response to
ultrafiltration. However, clinical trials have demonstrated that albumin
administration is not nearly as effective a volume expander as might be
assumed according to its oncotic properties. Although intravenous albumin
is generally considered to be safe, it is also very expensive. In
addition, there are potential risks to using it to prevent or treat
intradialytic hypotension. Some recent studies have suggested that
hyperoncotic albumin solutions may precipitate or worsen AKI in patients
with sepsis or shock; however, the overall evidence supporting this effect
is weak. In this review, we explore the theoretical benefits and risks of
using intravenous albumin to mitigate intradialytic hypotension and/or
enhance ultrafiltration and summarize the current evidence relating to
this practice. This includes studies relevant to its use in patients on
maintenance hemodialysis and critically ill patients with AKI who require
KRT in the intensive care unit. Despite evidence of its frequent use and
high costs, at present, there are minimal data that support the routine
use of intravenous albumin during KRT. As such, adequately powered trials
to evaluate the efficacy of intravenous albumin in this setting are
clearly needed. Copyright © 2021 by the American Society of
Nephrology.

<97>
Accession Number
2012252203
Title
Formula for safe insertion depth of a pulmonary artery catheter.
Source
British Journal of Anaesthesia. 127 (1) (pp e25-e27), 2021. Date of
Publication: July 2021.
Author
Walz R.; Roth S.; Hollmann M.W.; Huhn R.
Institution
(Walz, Roth, Huhn) Department of Anesthesiology, Medical Faculty and
University Hospital Dusseldorf, Heinrich-Heine-University Dusseldorf,
Dusseldorf, Germany
(Hollmann) Department of Anesthesiology, Amsterdam University Medical
Center, Amsterdam, Netherlands
Publisher
Elsevier Ltd

<98>
Accession Number
2011834961
Title
Comparison of the analgesic effect of quadratus lumborum block and
epidural block in open uterine surgery: A randomized controlled trial.
Source
Minerva Anestesiologica. 87 (4) (pp 414-422), 2021. Date of Publication:
April 2021.
Author
She H.; Jiang P.; Zhu J.; Zhou Y.; Wang Y.; Kan M.; Wu J.
Institution
(She, Jiang, Zhu, Wang, Kan, Wu) Department of Anesthesiology, Affiliated
Hospital of Jiangsu University, Zhenjiang, China
(Zhou) Department of Surgery, Affiliated Hospital of Jiangsu University,
Zhenjiang, China
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Effective regional analgesia during open surgery could reduce
opioid consumption and enhance early recovery. We compared the effects of
the newly developed quadratus lumborum block (QLB) and the traditional
epidural block (EB) in open uterine surgery. METHOD(S): In this
randomized controlled trial, we included patients scheduled for elective
open uterine surgery during May - September 30, 2019. Patients received
QLB or EB for perioperative pain relief before general anesthesia.
Perioperative opioid consumption, and numeric rating scale (NRS: 0-10)
pain scores after surgery, heart rate (HR), mean arterial pressure (MAP),
ephedrine and urapidil use during surgery, lower limb muscle strength,
timing of first flatus and defecation, nausea, vomiting, and other
complications within 24 h post-surgery, were the primary and secondary
outcomes, respectively. RESULT(S): Data of 72 (86%; 36/group) of 83
eligible patients were analyzed. Remifentanil consumption during surgery
was higher in the QLB than in the EB group, while cumulative sufentanil
consumption within 24 h post-surgery was similar between both groups. NRS
pain scores at rest and during activity were higher at 1 h post-surgery,
and MAP was higher at 5-, 15-, and 30-min postincision in the QLB than in
the EB group; HR was similar between groups. Lower ephedrine requirements,
higher lower limb muscle strength at 1 h post-surgery, and lower nausea
incidence were observed in the QLB group. CONCLUSION(S): QLB produces
a less intense but longer block and fewer side effects in the first 24 h
after open uterine surgery than those produced by EB. Copyright ©
2021 Edizioni Minerva Medica. All rights reserved.

<99>
Accession Number
2011733341
Title
An interactive pain application (MServ) improves postoperative pain
management.
Source
Pain Research and Management. 2021 (no pagination), 2021. Article Number:
8898170. Date of Publication: 2021.
Author
Gordon-Williams R.; Trigo A.; Bassett P.; Williams A.; Cone S.; Lees M.;
Brandner B.
Institution
(Gordon-Williams, Trigo, Cone, Brandner) University College London
Hospitals NHS Foundation Trust, Department of Anaesthesia, London NW1 2BU,
United Kingdom
(Bassett) Stats Consultancy Ltd., 40 Longwood Lane, Amersham, Bucks HP7
9EN, United Kingdom
(Williams) University College London, Clinical, Educational and Health
Psychology, Gower St, London WC1E 6BT, United Kingdom
(Lees) Barts Health NHS Trust, Department of Cardiothoracic Anaesthesia,
London EC1A 7BE, United Kingdom
Publisher
Hindawi Limited
Abstract
Background. Most patients have moderate or severe pain after surgery.
Opioids are the cornerstone of treating severe pain after surgery but
cause problems when continued long after discharge. We investigated the
efficacy of multifunction pain management software (MServ) in improving
postoperative pain control and reducing opioid prescription at discharge.
Methods. We recruited 234 patients to a prospective cohort study into
sequential groups in a nonrandomised manner, one day after major thoracic
or urological surgery. Group 1 received standard care (SC, n = 102), group
2 were given a multifunctional device that fed back to the nursing staff
alone (DN, n = 66), and group 3 were given the same device that fed back
to both the nursing staff and the acute pain team (DNPT, n = 66).
Patient-reported pain scores at 24 and 48 hours and patient-reported time
in severe pain, medications, and satisfaction were recorded on trial
discharge. Findings. Odds of having poor pain control (>1 on 0-4 pain
scale) were calculated between standard care (SC) and device groups (DN
and DNPT). Patients with a device were significantly less likely to have
poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report
time in severe pain at 48 hours (OR 0.62, 95% CI 0.47-0.80). Patients with
a device were three times less likely to be prescribed strong opioids on
discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth
device designed for pain management, rather than standard care, reduced
the incidence of poor pain control in the postoperative period and reduced
opioid prescription on discharge from hospital. Copyright © 2021
Richard Gordon-Williams et al.

<100>
Accession Number
2010583967
Title
Impact of Myocardial Scar on Prognostic Implication of Secondary Mitral
Regurgitation in Heart Failure.
Source
JACC: Cardiovascular Imaging. 14 (4) (pp 812-822), 2021. Date of
Publication: April 2021.
Author
Tayal B.; Debs D.; Nabi F.; Malahfji M.; Little S.H.; Reardon M.; Zoghbi
W.; Kleiman N.; Shah D.J.
Institution
(Tayal, Debs, Nabi, Malahfji, Little, Reardon, Zoghbi, Kleiman, Shah)
Houston Methodist DeBakey Heart and Vascular Center, Division of
Cardiovascular Imaging, Houston, TX, United States
(Tayal) Aalborg University Hospital, Department of Cardiology, Aalborg,
Denmark
Publisher
Elsevier Inc.
Abstract
Objectives: The objective of the present study was to use cardiovascular
magnetic resonance (CMR) to examine the natural history of secondary MR
severity and the implication of left ventricular (LV) scar on its
prognostic significance. Background(s): There is a need for further
understanding of the prognostic implication of secondary mitral
regurgitation (MR) given the heterogeneous findings of the 2 recent
randomized trials on percutaneous mitral intervention in patients with
secondary MR. Method(s): Patients with heart failure were enrolled
into a prospective observational registry between 2008 and 2019. Outcomes
were a composite of all-cause death, heart transplantation, or LV assist
device implantation at follow-up. CMR was used to quantify the mitral
regurgitation volume and mitral regurgitation fraction (MRF) along with
scar burden utilizing late gadolinium enhancement. Patients were
categorized into 4 subgroups based on presence and tertiles of scar
extent: no scar, limited scar (scar burden 1% to 4%), intermediate scar
(scar burden 5% to 20%), and extensive scar (scar burden >20%).
 Result(s): Among patients (n = 441) included in the study (age 59 +/-
14 years, 43% with ischemic etiology), 85 (19%) experienced an adverse
event. MRF >=30% was associated with increased risk of events among the
study group (hazard ratio: 1.74; 95% confidence interval: 1.10 to 2.76; p
= 0.02). When stratified by presence or absence of scar, MRF >=30% was
associated with events only among patients with scar (hazard ratio: 1.67;
95% confidence interval: 1.02 to 2.76; p = 0.04) but not among patients
without scar. On further classification of patients with scar, the
prognostic significance of secondary MR was observed primarily among
patients with intermediate scar burden. Conclusion(s): The natural
history of secondary MR is complex, and outcomes are affected by severity
of MR and vary depending upon the extent of scar. (DeBakey Cardiovascular
Magnetic Resonance Study [DEBAKEY-CMR]; NCT04281823) Copyright ©
2021 American College of Cardiology Foundation

<101>
Accession Number
2012996323
Title
Percutaneous versus Surgical Intervention for Severe Aortic Valve
Stenosis: A Systematic Review.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
3973924. Date of Publication: 2021.
Author
Iervolino A.; Singh S.S.A.; Nappi P.; Bellomo F.; Nappi F.
Institution
(Iervolino) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCSS, Italy
(Singh) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Nappi, Bellomo) Department of Clinical and Experimental Medicine,
University of Messina, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
Publisher
Hindawi Limited
Abstract
Aortic stenosis is a disease that is increasing in prevalence and
manifests as decreased cardiac output, which if left untreated can result
in heart failure and ultimately death. It is primarily a disease of the
elderly who often have multiple comorbidities. The advent of transcatheter
aortic valve therapies has changed the way we treat these conditions.
However, long-term results of these therapies remain uncertain. Recently,
there has been an increasing number of studies examining the role of both
surgical aortic valve replacement and transcatheter aortic valve
replacement. We therefore performed a systematic review using Ovid
MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched
papers published between January 1, 2007, and to date using the following
terms: "aortic valve stenosis,""aortic valve operation,"and "transcatheter
aortic valve therapy."Both strategies in aortic stenosis treatment
highlighted specific indications alongside the pitfalls such as structural
valve degeneration and valve thrombosis which have a bearing on clinical
outcomes. We propose some recommendations to help clinicians in the
decision-making process as technological improvements make both surgical
and transcatheter therapies viable options for patients with aortic
stenosis. Finally, we assess the role of finite element analysis in
patient selection for aortic valve replacement. THVT and AVR-S are both
useful tools in the armamentarium against aortic stenosis. The decision
between the two treatment strategies should be best guided by a strong
robust evidence base, ideally with a long-term follow-up. This is best
performed by the heart team with the patient as the center of the
discussion. Copyright © 2021 Adelaide Iervolino et al.

<102>
Accession Number
2012844249
Title
Modular minimally invasive extracorporeal circulation ensures perfusion
safety and technical feasibility in cardiac surgery; a systematic review
of the literature.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Anastasiadis K.; Antonitsis P.; Asteriou C.; Deliopoulos A.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Asteriou, Deliopoulos, Argiriadou)
Cardiothoracic Department, School of Medicine, Aristotle University of
Thessaloniki, Thessaloniki, Greece
Publisher
SAGE Publications Ltd
Abstract
Introduction: Despite extensive evidence that shows clinical of
superiority of MiECC, worldwide penetration remains low due to concerns
regarding air handling and volume management in the context of a closed
system. The purpose of this study is to thoroughly investigate perfusion
safety and technical feasibility of performing all cardiac surgical
procedures with modular (hybrid) MiECC, as experienced from the
perfusionist's perspective. Method(s): We retrospectively reviewed
perfusion charts of consecutive adult patients undergoing all types of
elective, urgent, and emergency cardiac surgery under modular MiECC. The
primary outcome measure was perfusion safety and technical feasibility, as
evidenced in the need for conversion from a closed to an open circuit. A
systematic review of the literature was conducted aiming to ultimately
clarify whether there are any safety issues regarding MiECC technology.
 Result(s): We challenged modular MiECC use in a series of 403
consecutive patients of whom a significant proportion (111/403; 28%)
underwent complex surgery including reoperations (4%), emergency repair of
acute type A aortic dissection and composite aortic surgery (1.7%).
Technical success rate was 100%. Conversion to an open circuit was
required in 18/396 patients (4.5%), excluding procedures performed under
circulatory arrest. Open configuration accounted for 40% +/- 21% of total
procedural perfusion time and was related to significant hemodilution and
increase in peak lactate levels. Systematic review revealed that safety of
the procedure challenged originated from a single report, while no
clinical adverse event related to MiECC was identified.
 Conclusion(s): Use of modular MiECC secures safety and ensures
technical feasibility in all cardiac surgical procedures. It represents a
type III active closed system, while its stand-by component is reserved
for a small (<5%) proportion of procedures and for a partial procedural
time. Thus, it eliminates any safety concern regarding air handling and
volume management, while it overcomes any unexpected intraoperative
scenario. Copyright © The Author(s) 2021.

<103>
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. 151 (pp 25-29), 2021. Date of Publication:
15 Jul 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, Georgia
(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.

<104>
Accession Number
635292235
Title
P2Y12 inhibitor monotherapy or dual antiplatelet therapy after coronary
revascularisation: Individual patient level meta-analysis of randomised
controlled trials.
Source
The BMJ. 373 (no pagination), 2021. Article Number: n1332. Date of
Publication: 16 Jun 2021.
Author
Valgimigli M.; Gragnano F.; Branca M.; Franzone A.; Baber U.; Jang Y.;
Kimura T.; Hahn J.-Y.; Zhao Q.; Windecker S.; Gibson C.M.; Kim B.-K.;
Watanabe H.; Song Y.B.; Zhu Y.; Vranckx P.; Mehta S.; Hong S.-J.; Ando K.;
Gwon H.-C.; Serruys P.W.; Dangas G.D.; McFadden E.P.; Angiolillo D.J.; Heg
D.; Juni P.; Mehran R.
Institution
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Lugano, Switzerland
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Gragnano) Department of Translational Medical Sciences, University of
Campania Luigi Vanvitelli, Caserta, Italy
(Branca, Heg) Clinical Trials Unit, Bern, Switzerland
(Franzone) Department of Advanced Biomedical Sciences, University of
Naples Federico II, Naples, Italy
(Baber, Dangas, Mehran) Icahn School of Medicine at Mount Sinai, New York,
NY, United States
(Jang, Kim, Hong) Severance Cardiovascular Hospital, Yonsei University
College of Medicine, Seoul, South Korea
(Kimura, Watanabe) Department of Cardiovascular Medicine, Kyoto
University, Graduate School of Medicine, Kyoto, Japan
(Hahn, Song, Gwon) Heart Vascular Stroke Institute, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
(Zhao, Zhu) Department of Cardiovascular Surgery, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Gibson) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Belgium
(Mehta) Department of Medicine, McMaster University, Hamilton, ON, Canada
(Mehta) Hamilton Health Sciences, Hamilton, ON, Canada
(Ando) Kokura Memorial Hospital, Department of Cardiology, Kitakyushu,
Japan
(Serruys) Department of Cardiology, National University of Ireland Galway,
Galway, Ireland
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(McFadden) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(McFadden) Department of Cardiology, Cork University Hospital, Cork,
Ireland
(Angiolillo) Division of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute,
Department of Medicine, St Michael's Hospital, University of Toronto,
Toronto, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Objective To assess the risks and benefits of P2Y 12 inhibitor monotherapy
compared with dual antiplatelet therapy (DAPT) and whether these
associations are modified by patients' characteristics. Design Individual
patient level meta-analysis of randomised controlled trials. Data sources
Searches were conducted in Ovid Medline, Embase, and three websites
(www.tctmd.com, www.escardio.org, www.acc.org/cardiosourceplus) from
inception to 16 July 2020. The primary authors provided individual
participant data. Eligibility criteria Randomised controlled trials
comparing effects of oral P2Y 12 monotherapy and DAPT on centrally
adjudicated endpoints after coronary revascularisation in patients without
an indication for oral anticoagulation. Main outcome measures The primary
outcome was a composite of all cause death, myocardial infarction, and
stroke, tested for non-inferiority against a margin of 1.15 for the hazard
ratio. The key safety endpoint was Bleeding Academic Research Consortium
(BARC) type 3 or type 5 bleeding. Results The meta-analysis included data
from six trials, including 24 096 patients. The primary outcome occurred
in 283 (2.95%) patients with P2Y 12 inhibitor monotherapy and 315 (3.27%)
with DAPT in the per protocol population (hazard ratio 0.93, 95%
confidence interval 0.79 to 1.09; P=0.005 for non-inferiority; P=0.38 for
superiority; tau 2 =0.00) and in 303 (2.94%) with P2Y 12 inhibitor
monotherapy and 338 (3.36%) with DAPT in the intention to treat population
(0.90, 0.77 to 1.05; P=0.18 for superiority; tau 2 =0.00). The treatment
effect was consistent across all subgroups, except for sex (P for
interaction=0.02), suggesting that P2Y 12 inhibitor monotherapy lowers the
risk of the primary ischaemic endpoint in women (hazard ratio 0.64, 0.46
to 0.89) but not in men (1.00, 0.83 to 1.19). The risk of bleeding was
lower with P2Y 12 inhibitor monotherapy than with DAPT (97 (0.89%) v 197
(1.83%); hazard ratio 0.49, 0.39 to 0.63; P<0.001; tau 2 =0.03), which was
consistent across subgroups, except for type of P2Y 12 inhibitor (P for
interaction=0.02), suggesting greater benefit when a newer P2Y 12
inhibitor rather than clopidogrel was part of the DAPT regimen.
Conclusions P2Y 12 inhibitor monotherapy was associated with a similar
risk of death, myocardial infarction, or stroke, with evidence that this
association may be modified by sex, and a lower bleeding risk compared
with DAPT. Copyright © 2019 Author(s). Published by BMJ.

<105>
Accession Number
635343240
Title
Empagliflozin reduces the total burden of cardiovascular events including
recurrent events in the EMPA-REG OUTCOME trial.
Source
Diabetologie und Stoffwechsel. Conference: Diabetes Kongress 2021 - 55.
Jahrestagung der DDG. Online. 16 (SUPPL 1) (pp S51), 2021. Date of
Publication: 2021.
Author
Autoren Fitchett D.; Inzucchi S.E.; Zinman B.; Wanner C.; Anker S.D.;
Pocock S.; Kaspers S.; George J.T.; Johansen O.E.; Jamal W.; Hantel S.;
Lund S.S.
Institution
(Autoren Fitchett) Institut University of Toronto, St Michael's Hospital,
Division of Cardiology, Toronto, ON, Canada
(Inzucchi) Yale University School of Medicine, Section of Endocrinology,
New Haven, CT, United States
(Zinman) University of Toronto, Mount Sinai Hospital, Lunenfeld-Tanenbaum
Research Institute, Toronto, ON, Canada
(Wanner) Wurzburg University Clinic, Department of Internal Medicine I,
Wurzburg, Germany
(Anker) Charite-Universitatsmedizin Berlin, Department of Cardiology
(CVK), Berlin, Germany
(Pocock) London School of Hygiene and Tropical Medicine, Department of
Medical Statistics, London, United Kingdom
(Kaspers, George, Jamal, Lund) Boehringer Ingelheim International GmbH,
CardioMetabolism and Respiratory, Ingelheim, Germany
(Johansen) Boehringer Ingelheim Norway KS, Medicine, Asker, Norway
(Hantel) Boehringer Ingelheim Pharma GmbH and Co. KG, Department
Biostatistics and Data Sciences, Biberach an der Ris, Germany
Publisher
Georg Thieme Verlag
Abstract
Introduction In EMPA-REG OUTCOME, empagliflozin (EMPA) reduced the risk of
major adverse cardiovascular (CV) events (MACE), CV mortality and
hospitalization for heart failure (HHF) in analyses of first events in
patients with type 2 diabetes (T2D) and atherosclerotic CV disease
(ASCVD). We assessed the effect of EMPA on the total burden of CV events.
Methods Patients were randomized to EMPA 10 mg, EMPA 25 mg, or placebo. We
assessed the effects of EMPA pooled vs placebo on any (first plus
recurrent) adjudicated CV event (composite of myocardial infarction (MI),
stroke, coronary revascularization (CR), hospitalization for unstable
angina, transient ischemic attack, HHF, and CV death) using a negative
binomial model. Results Among 7,020 treated patients (mean [SD] age 63 [9]
years), there were 2,142 total adjudicated CV events, most frequently CR
(585), MI (421), and HHF (321). EMPA reduced the risk of total adjudicated
CV events by 24% vs placebo (event rate ratio (95% CI): 0.76 (0.67, 0.87),
p < 0.0001). Risk reductions were driven predominantly by reductions in
HHF (0.58 (0.42, 0.81), p=0.0012), MI (0.79 (0.620, 0.998), p=0.0486), and
CV death (0.62 (0.50, 0.78), p < 0.0001). The estimated number of total CV
events prevented with EMPA was 414.4, and the number of patients needed to
treat over 3 years to prevent one event was 10.2 (6.6, 22.7). Conclusions
EMPA produced a sizeable risk reduction in the total burden of any
adjudicated CV outcome, including HHF, MI and CV death, in patients with
T2D and ASCVD.

<106>
Accession Number
2013161500
Title
Use of tropical vancomycin in decreasing the incidence of surgical site
infection in open heart surgery.
Source
Pakistan Journal of Medical and Health Sciences. 15 (5) (pp 968-970),
2021. Date of Publication: May 2021.
Author
Mahmood M.M.; Ahmad A.; Rehman W.
Institution
(Mahmood, Ahmad, Rehman) Department of Cardiothoracic Surgery, Shaikh
Zayed Hospital, Lahore, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Aim: To study the effect of vancomycin tropically in decreasing the
incidence of sternal wound infection in patients undergoing open cardiac
surgery. Study design: Randomized controlled trial Place and duration:
Department of Cardiovascular & Thoracic Surgery Sheikh Zayed Hospital
Lahore from 1st January 2019 to 31st July 2020. Method(s): A total of
180 male and female planned for elective open heart surgery is selected
for this research work. All patients age is between 40 and 70 years and
these patients are bifurcated in two groups. In Group I there are 90
patients in which vancomycin is used on the sternal edges, while in Group
II there are 90 patients in which only normal saline wash is used at the
time of sternal approximation. At the end incidence of sternal wound
infection is monitored to establish the benefits of tropical vancomycin.
 Result(s): One hundred and thirty three (73.89%) were males and 47
(26.11%) were females. Topical vancomycin group has decreased rate of
superficial and deep sternal wound infections as compared to the patients
in which topical vancomycin is not applied (2.22% vs 6.67%) and (1.11% vs
4.4%). Conclusion(s): Application of vancomycin tropically at
surgical site at the time of closure of sternum in conjunction with
prophylactic use of antibiotics reduces wound infection in open heart
surgery. Copyright © 2021 Lahore Medical And Dental College. All
rights reserved.

<107>
Accession Number
2012853506
Title
Pedicled or skeletonized bilateral internal mammary artery harvesting - a
meta- analysis and trial sequential analysis.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2021. Date of
Publication: 2021.
Author
Iddawela S.; Mellor S.L.; Zahra S.A.; Khare Y.; Harky A.
Institution
(Iddawela) Department of General Surgery, University Hospitals Birmingham,
Birmingham, United Kingdom
(Mellor) College of Medical and Dental Sciences, University of Birmingham,
Birmingham, United Kingdom
(Zahra, Khare) Department of Medicine, St George's, University of London,
London, United Kingdom
(Harky) Department of Cardio-thoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Faculty of Life Sciences, University of Liverpool, Liverpool,
United Kingdom
Publisher
Taylor and Francis Ltd.
Abstract
Objective: There is varying evidence on the role of skeletonization of
internal mammary artery in reducing the risk of sternal wound infections
and ischemia following bilateral internal mammary artery grafting.
Post-operative clinical outcomes of skeletonized bilateral internal
mammary artery versus pedicled bilateral internal mammary artery
harvesting in patients undergoing coronary artery bypass surgery were
compared. Method(s): A comprehensive electronic search was conducted
using MEDLINE, Scopus, EMBASE, Cochrane database and Google Scholar from
inception until 15 June 2020. All studies directly comparing skeletonized
and pedicled bilateral internal mammary artery harvesting were included.
Meta-analysis and trial sequential analysis were conducted.
 Result(s): Nine studies (one randomized controlled trial and eight
observational studies) consisting of 3649 patients (2050 patients with
skeletonized bilateral internal mammary artery grafting and 1599 patients
with pedicled bilateral internal mammary artery grafting) were included.
Pooled effects analysis and trial sequential analysis reported
significantly lower risk of sternal wound infection with skeletonized
bilateral internal mammary artery harvesting (OR 0.27, 95% CI 0.20-0.51, p
< 0.00001). Conclusion(s): Skeletonization reduces the risk of
sternal wound infections by preserving vasculature as much as possible.
This facilitates its use in patients at high risk of sternal wound
infection. Copyright © 2021 Informa UK Limited, trading as Taylor
& Francis Group.

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