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<1>
Accession Number
629340931
Title
Impact of surgical aortic root enlargement on the outcomes of aortic valve
replacement: A meta-analysis of 13 174 patients.
Source
Interactive Cardiovascular and Thoracic Surgery. 29 (1) (pp 74-82), 2019.
Date of Publication: 01 Jul 2019.
Author
Sa M.P.B.O.; Carvalho M.M.B.; Filho D.C.S.; Cavalcanti L.R.P.; Diniz
R.G.S.; Rayol S.C.; Soares A.M.M.N.; de Araujoe Sa F.B.C.; Menezes A.M.;
Clavel M.-A.; Pibarot P.; Lima R.C.
Institution
(Sa, Cavalcanti, Diniz, Rayol, Soares, de Araujoe Sa, Menezes, Lima)
Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco - PROCAPE, Recife, Brazil
(Sa, Carvalho, Filho, Cavalcanti, Diniz, Rayol, Soares, de Araujoe Sa,
Menezes, Lima) University of Pernambuco - UPE, Recife, Brazil
(Sa, Carvalho, Filho, Lima) Faculty of Medical Sciences and Biological
Sciences Instituite - FCM/ICB, Recife, Brazil
(Clavel, Pibarot) Institut Universitaire de Cardiologie e de Pneumologie
du Quebec, Quebec City, QC, Canada
Publisher
Oxford University Press
Abstract
OBJECTIVES: This study sought to evaluate the impact of surgical aortic
root enlargement (ARE) on the perioperative outcomes of aortic valve
replacement (AVR). METHOD(S): Databases were searched for studies
published until April 2018 to carry out a systematic review followed by
meta-analysis of results. RESULT(S): The search yielded 1468 studies
for inclusion. Of these, 10 articles were analysed and their data
extracted. A total of 13 174 patients (AVR with ARE: 2819 patients; AVR
without ARE: 10 355 patients) were included from studies published from
2002 to 2018. The total rate of ARE was 21.4%, varying in the studies from
5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)]
for perioperative mortality showed a statistically significant difference
between the groups (among 10 studies), with a higher risk in the 'AVR with
ARE' group (OR 1.506, 95% CI 1.209-1.875; P < 0.001), but not when
adjusted for isolated AVR + ARE without any concomitant procedures such as
mitral valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95%
CI 0.968-2.726; P = 0.066-among 6 studies). The 'AVR with ARE' group
showed an overall lower risk of significant patient-prosthesis mismatch
among 9 studies (OR 0.472, 95% CI 0.295-0.756; P = 0.002) and a higher
overall difference in means of indexed effective orifice area among 10
studies (random-effect model: 0.06 cm2/m2, 95% CI
0.029-0.103; P < 0.001). CONCLUSION(S): Surgical ARE seems to be
associated with increased perioperative mortality but with lower risk of
patient-prosthesis mismatch. Copyright © The Author(s) 2019.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<2>
Accession Number
626366127
Title
Right minithoracotomy versus median sternotomy for reoperative mitral
valve surgery: A systematic review and meta-analysis of observational
studies.
Source
European Journal of Cardio-thoracic Surgery. 54 (5) (pp 817-825), 2018.
Date of Publication: 01 Nov 2018.
Author
Daemen J.H.T.; Heuts S.; Olsthoorn J.R.; Maessen J.G.; Nia P.S.
Institution
(Heuts, Maessen, Nia) Faculty of Health, Medicine and Life Sciences,
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Daemen, Heuts, Olsthoorn, Maessen, Nia) Department of Cardiothoracic
Surgery, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25,
Maastricht 6229 HX, Netherlands
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Reoperative mitral valve surgery (MVS) through a median sternotomy
(ST-MVS) can be particularly challenging due to dense adhesions and is
known to carry a substantial risk of injuries to vascular structures.
These injuries occur in 7-9% of cases and are associated with increased
mortality rates. A valid alternative that could avoid the risks associated
with redo ST-MVS is the right anterolateral minithoracotomy (MT-MVS)
approach. The aim of this study was to quantify the effects of MT-MVS
compared with those of ST-MVS on morbidity and mortality among patients
who underwent prior cardiac surgery through a sternotomy. The MEDLINE and
EMBASE databases were searched through 1 November 2017. Data regarding
mortality, stroke, reoperation for bleeding and length of hospital stay
were extracted and submitted to a meta-analysis using random effects
modelling and the I2-test for heterogeneity. Six retrospective
observational studies were included, enrolling a total of 777 patients. In
a pooled analysis, MT-MVS demonstrated reduced mortality rates compared to
a standard sternotomy [odds ratio (OR) 0.41, 95% confidence interval (CI)
0.18-0.96; P = 0.04]. MT-MVS was, moreover, associated with reduced length
of hospital stay [difference between the means was -3.81, 95% CI -5.53 to
-2.08; P < 0.0001) and reoperation for bleeding (OR 0.32, 95% CI
0.10-0.99; P = 0.0488). The incidence of stroke was similar (OR 1.51, 95%
CI 0.65-3.54; P = 0.34), all in the absence of heterogeneity. In
conclusion, reoperative minimally invasive MVS through a minithoracotomy
is a safe alternative to standard sternotomy, with reduced mortality
rates, length of hospital stay and reoperations for bleeding and a
comparable risk of stroke. However, because the existing literature
provided limited, low-quality evidence, more methodologically rigorous
randomized controlled trials are needed. Copyright © The
Author(s) 2018.

<3>
Accession Number
614959242
Title
Prospective randomized comparison of clinical and angiographic outcomes
between everolimus-eluting vs. zotarolimus-eluting stents for treatment of
coronary restenosis in drug-eluting stents:Intravascular ultrasound
volumetric analysis (RESTENT-ISR trial).
Source
European Heart Journal. 37 (45) (pp 3409-3418), 2016. Date of Publication:
01 Dec 2016.
Author
Hong S.J.; Ahn C.M.; Kim B.-K.; Ko Y.-G.; Hur S.-H.; Yu C.W.; Lee S.-J.;
Choi C.U.; Kim J.S.; Yoon J.S.; Hong Y.J.; Choi J.-W.; Choi S.-H.; Jang
Y.; Lim D.-S.
Institution
(Hong, Ahn, Yu, Lim) Department of Cardiology, Cardiovascular Center,
Korea University Anam Hospital, 126-1, 5ka, Anam-dong, Sungbuk-ku, Seoul
136-705, South Korea
(Ahn, Kim, Ko, Jang) Severance Cardiovascular Hospital, Yonsei University,
50-1, Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea
(Hur) Keimyung University Dongsan Medical Center, 56 Dalseong-Ro, Jung-Gu,
Daegu 700-712, South Korea
(Lee) Soonchunhyang University Medical Center, 23-20, Byeongmyeong-dong,
Dongnam-gu, Cheonan, Chungcheongnam-do 31151, South Korea
(Choi) Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul
08308, South Korea
(Kim) Sejong General Hospital, Sosabon-dong, Sosa-gu, Bucheon-si,
Gyeonggi-do 14754, South Korea
(Yoon) Yonsei University Wonju College of Medicine, Wonju Christian
Hospital, 20 Ilsan-ro, Wonju, Gangwon-do, Wonju 220-701, South Korea
(Hong) Chonnam National University Hospital, 77 Yongbong-ro, Buk-gu,
Gwangju 500-757, South Korea
(Choi) Eulji General Hospital, 68 Hangeulbiseok-Ro, Nowon-Gu, Seoul 01830,
South Korea
(Choi) Samsung Medical Center, Sungkyunkwan University School of Medicine,
81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
Publisher
Oxford University Press
Abstract
Aims At present no proven standard treatment for drug-eluting stent (DES)
restenosis is available, and the efficacy and safety of everolimus-eluting
stent (EES) and zotarolimus-eluting stent (ZES) for DES restenosis are
limited. The purpose of this prospective, randomized 9-month intracoronary
ultrasound (IVUS) and 3-year clinical follow-up study was to compare the
effects of EESs and ZESs on neointima volume and major adverse
cardiovascular events (MACEs) such as death, myocardial infarction (MI),
target lesion revascularization (TLR) and stent thrombosis in DES
restenosis patients. Methods and results Patients were eligible for this
study if they were between 40 and 75 years old with in-stent
restenosis>50% by quantitative coronary angiographic analysis in DES or
within 5mm of the stent edges with signs of ischaemia. Eligible patients
(n=304, 146 women and 158 men) were randomly assigned to receive either
EES (158 patients) or ZES (146 patients). The primary endpoint of the
study was to compare neointima volume between the EES and ZES groups at
the 9-month follow-up IVUS. MACEs, including death, non-fatal MI, stent
thrombosis and the need for repeated TLR within 3 years, were noted. The
9-month angiographic and IVUS follow-up showed no significant differences
in late lumen loss (0.4060.56 vs. 0.4560.61 mm, P=0.57, respectively) and
neointima volume (0.5160.48 vs. 0.5660.54mm3/1 mm, P=0.47, respectively)
in the EES and the ZES groups. Composite MACEs such as death, MI, stent
thrombosis and TLR during 3-year follow-up were comparable between the two
groups [15.8% (n=25) in the EES group and 22.6% (n=33) in the ZES group,
P=0.276], independent of de novo DES type, sex, age, body mass index,
presence of diabetes, hypertension and dyslipidaemia. Conclusions Patients
with first- and second-generation DES restenosis, both EES and ZES
implantation were effective and safe in reducing neointima volume and late
loss with a comparable rate of MACEs independent of cardiovascular risk
factors. Copyright © 2016 The Author All rights reserved.

<4>
Accession Number
606124408
Title
Statin pretreatment and risk of in-hospital atrial fibrillation among
patients undergoing cardiac surgery: A collaborative meta-analysis of 11
randomized controlled trials.
Source
Europace. 17 (6) (pp 855-863), 2015. Date of Publication: 01 Jun 2015.
Author
Patti G.; Bennett R.; Seshasai S.R.K.; Cannon C.P.; Cavallari I.; Chello
M.; Nusca A.; Mega S.; Caorsi C.; Spadaccio C.; Keun On Y.; Mannacio V.;
Berkan O.; Yilmaz M.B.; Katrancioglu N.; Ji Q.; Kourliouros A.; Baran C.;
Pasceri V.; Akar A.R.; Kaski J.C.; Di Sciascio G.; Ray K.K.
Institution
(Patti, Cavallari, Chello, Nusca, Mega, Di Sciascio) Department of
Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
(Bennett, Seshasai, Kaski, Ray) Cardiovascular Sciences Research Centre,
St George's University of London, Cranmer Terrace, London SW170RE, United
Kingdom
(Cannon) Cardiovascular Division, Harvard Medical School, Brigham and
Women's Hospital, Boston, MA, United States
(Caorsi) Cardiovascular Department, Clinica Las Condes, Hospital Clinico
de la Fuerza Aerea de Chile, Las Condes, Chile
(Spadaccio) Cardiovascular Diseases and Cardiac Surgery Departments,
University Hospital UZ Leuven, Leuven, Belgium
(Spadaccio) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Genk,
Belgium
(Keun On) Department of Medicine, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea
(Mannacio) Department of Cardiac Surgery, University of Naples Federico
II, Naples, Italy
(Berkan) Department of Cardiovascular Surgery, Cumhuriyet University
School of Medicine, Sivas, Turkey
(Yilmaz, Katrancioglu) Department of Cardiology, Cumhuriyet University
School of Medicine, Sivas, Turkey
(Ji) Department of Thoracic Cardiovascular Surgery, Tongji University,
Tongji Hospital, Shanghai, China
(Kourliouros) Department of Cardiothoracic Surgery, King's College
Hospital, London, United Kingdom
(Baran, Akar) Department of Cardiovascular Surgery, Heart Center, Ankara
University School of Medicine, Dikimevi, Turkey
(Pasceri) Interventional Cardiology, San Filippo Neri Hospital of Rome,
Rome, Italy
Publisher
Oxford University Press
Abstract
Aims Statin pretreatment in patients undergoing cardiac surgery is
understood to prevent postoperative atrial fibrillation (AF). However,
this is based on observational and limited randomized trial evidence,
resulting in uncertainty about any genuine anti-arrhythmic benefits of
these agents in this setting.We therefore aimed to quantify precisely the
association between statin pretreatment and postoperative AF among
patients undergoing cardiac surgery. Methods and results A detailed search
of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012)was
conducted, followed by a review of the reference lists of published
studies and correspondence with trial investigators to obtain
individual-participant data for meta-analysis. Evidence was combined
across prospective, randomized clinical trials that compared the risk of
postoperative AF among individuals randomized to statin pretreatment or
placebo/control medication before elective cardiac surgery. Postoperative
AF was defined as episodes of AF lasting >=5 min. Overall, 1105
participants from 11 trials were included; of them, 552 received statin
therapy preoperatively. Postoperative AF occurred in 19% of these
participants when compared with 36% of those not treated with statins
(odds ratio 0.41, 95% confidence interval 0.31-0.54, P < 0.00001, using a
random-effects model). Atrial fibrillation prevention by statin
pretreatmentwas consistent across different subgroups. Conclusion
Short-term statin pretreatment may reduce the risk of postoperative AF
among patients undergoing cardiac surgery. Copyright © The Author
2015. All rights reserved.

<5>
Accession Number
606175972
Title
Transcatheter heart valve failure: A systematic review.
Source
European Heart Journal. 36 (21) (pp 1306-1327), 2015. Date of Publication:
01 Jun 2015.
Author
Mylotte D.; Andalib A.; Theriault-Lauzier P.; Dorfmeister M.; Girgis M.;
Alharbi W.; Chetrit M.; Galatas C.; Mamane S.; Sebag I.; Buithieu J.;
Bilodeau L.; De Varennes B.; Lachapelle K.; Lange R.; Martucci G.; Virmani
R.; Piazza N.
Institution
(Mylotte, Andalib, Theriault-Lauzier, Girgis, Alharbi, Chetrit, Galatas,
Mamane, Buithieu, Bilodeau, Martucci, Piazza) Department of Interventional
Cardiology, McGill University Health Centre, Montreal, QC, Canada
(Mylotte) Department of Cardiology, Galway University Hospital, Galway,
Ireland
(Dorfmeister, Lange, Piazza) Department of Cardiac Surgery, German Heart
Center, Munich, Germany
(Sebag) Department of Cardiology, Mortimer Davis, Jewish General Hospital,
Montreal, QC, Canada
(De Varennes, Lachapelle) Department of Cardiovascular Surgery, McGill
University Health Centre, Montreal, QC, Canada
(Virmani) CVPath Institute, Gaithersburg, MD, United States
Publisher
Oxford University Press
Abstract
Aims A comprehensive description of transcatheter heart valve (THV)
failure has not been performed. We undertook a systematic review to
investigate the aetiology, diagnosis, management, and outcomes of THV
failure. Methods and results The systematic review was performed in
accordance with the PRISMA guidelines using EMBASE, MEDLINE, and Scopus.
Between December 2002 and March 2014, 70 publications reported 87
individual cases of transcatheter aortic valve implantation (TAVI)
failure. Similar to surgical bioprosthetic heart valve failure, we
observed cases of prosthetic valve endocarditis (PVE) (n = 34), structural
valve failure (n = 13), and THV thrombosis (n = 15). The microbiological
profile of THV PVE was similar to surgical PVE, though one-quarter had
satellite mitral valve endocarditis, and surgical intervention was
required in 40% (75% survival). Structural valve failure occurred most
frequently due to leaflet calcification and was predominantly treated by
redo-THV (60%). Transcatheter heart valve thrombosis occurred at a mean
9+7 months post-implantation and was successfully treated by prolonged
anticoagulation in three-quarters of cases. Twonovel causes of THV
failurewere identified: lateTHVembolization (n = 18); and THV compression
(n = 7) following cardiopulmonary resuscitation (CPR). These failure modes
have not been reported in the surgical literature. Potential risk factors
for late THV embolization include low prosthesis implantation, THV
undersizing/underexpansion, bicuspid, and non-calcified anatomy.
Transcatheter heart valve embolization mandated surgery in 80% of
patients. Transcatheter heart valve compression was noted at post-mortem
in most cases. Conclusion Transcatheter heart valves are susceptible to
failure modes typical to those of surgical bioprostheses and unique to
their specific design. Transcatheter heart valve compression and late
embolization represent complications previously unreported in the surgical
literature. Copyright © The Author 2014.

<6>
Accession Number
372153520
Title
Varespladib and cardiovascular events in patients with an acute coronary
syndrome: The VISTA-16 randomized clinical trial.
Source
JAMA - Journal of the American Medical Association. 311 (3) (pp 252-262),
2014. Date of Publication: 15 Jan 2014.
Author
Nicholls S.J.; Kastelein J.J.P.; Schwartz G.G.; Bash D.; Rosenson R.S.;
Cavender M.A.; Brennan D.M.; Koenig W.; Jukema J.W.; Nambi V.; Wright
R.S.; Menon V.; Lincoff A.M.; Nissen S.E.; Hennekens C.; Brown W.V.;
DeMets D.; Pfeffer M.; Roleau J.; Abraham J.; Gebel J.; Huff C.; Katzan
I.; Shishehbor M.; Rassi A.; Uchino K.; Vest A.; Zishiri E.; Heckman M.J.;
Balog C.; Dart A.; Amerena J.; Prasad C.; Farshid A.; Gunalingam B.;
Thompson P.; Collins N.; Arstall M.; van Gaal W.; Aroney C.; Mahar L.;
Youssef G.; Horowitz J.; Anand D.; Rodes-Cabau J.; Polasek P.; Lai C.;
Huynh T.; Hubacek J.; Kokis A.; Paradis J.M.; Mukherjee A.; Senaratne M.;
Constance C.; Gosselin G.; Lavi S.; Parker J.; Zadra R.; Abramson B.;
Della-Siega A.; Spinar J.; Pudil R.; Motovska Z.; Maly M.; Hutyra M.;
Pleva L.; Mayer O.; Semenka J.; Klimovic T.; Horak D.; Cervinka P.; Klimsa
Z.; Hulinsky V.; Reichert P.; Monhart Z.; Rotterova H.; Kobulia B.;
Shaburishvili T.; Mamatsashvili M.; Chapidze G.; Chumburidze V.;
Megreladze I.; Khintibidze I.; Leithauser B.; Voehringer H.F.; Wachter R.;
Nogai K.; Lapp H.; Haltern G.; Gielen S.; Dorsel T.; Mollmann H.;
Stellbrink C.; Hengstenberg C.; Dengler T.; Heuer H.; Kreuzer J.; Leschke
M.; Mudra H.; Werner N.; Braun-Dullaeus R.; Rosenberg M.; Frey N.;
Strasser R.; Genth-Zotz S.; Kiss R.; Nagy A.; Kovacs Z.; Csapo K.; Edes
I.; Sereg M.; Vertes A.; Ronaszeki A.; Kancz S.; Benczur B.; Polgar P.;
Muller G.; Simonyi G.; Dezsi C.; Merkely B.; Dinnyes J.; Lupkovics G.;
Kahali D.; Banker D.; Trivedi S.; Rajput R.; Premchand R.; Dani S.;
Vadaganelli P.; Gupta S.; Chandra S.; Fulwani M.; Chawla K.; Parikh K.;
Prati F.; Speciale G.; Valgimigli M.; Suriano P.; Berni A.; Sangiorgi G.;
Fineschi M.; Merenda R.; Marenzi G.; Berti S.; Corrada E.; Cuccia C.;
Testa R.; Moretti L.; Mennuni M.; Biasucci L.M.; Lioy E.; Auguadro C.;
Magagnini E.; Fedele F.; Piscione F.; Azar R.; Trip M.D.; Liem A.; den
Hartoog M.; Lenderink T.; van de Wetering M.L.; Lok D.; Oei F.; Tans J.G.;
Ilmer B.; Keijzers M.; Monraats P.; Kedhi E.; Breedveld R.W.; Herrman J.;
van Wijk L.; Ronner E.; Nierop P.; Bosschaert M.; Hermans W.; Doevendans
P.; Troquay R.; van der Heijden R.; Veen G.; Bokern M.J.; Bronzwaer P.N.;
Kie S.H.; Den Hartog F.; Elliott J.; Wilkins G.; Hart H.; Devlin G.;
Harding S.; Ponikowski P.; Madej A.; Kochmanski M.; Witkowski A.; Pluta
W.; Bronisz M.; Kornacewicz-Jach Z.; Wysokinski A.; Ujda M.; Drozdz J.;
Derlaga B.; Gessek J.; Dabrowski M.; Miekus P.; Kozlowski A.; Gniot J.;
Musial W.; Dobrzycki S.; Rynkiewicz A.; Psuja P.; Rekosz J.; Drzewiecki
A.; Kuznetsov V.; Gordeev I.; Goloshchekin B.; Markov V.; Barbarich V.;
Belenky D.; Mikhin V.; Volkova E.; Timofeev A.; Ermoshkina L.; Barbarash
O.; Klein G.; Libis R.; Vishnevsky A.; Linev K.; Khaisheva L.; Ruda M.;
Dovgalevskiy Y.; Shvarts Y.; Zateyshchikov D.; Kostenko V.; Shalnev V.;
Simanenkov V.; Arkhipov M.; Ovcharenko E.; Guseva G.; Akhunova S.; Ortiz
A.I.; Navarro M.J.; Romero A.J.; Goya I.L.; Penaranda A.S.; Cendon A.A.;
Rubio A.M.; Zubiri J.J.; Soriano F.R.; Sanz R.R.; Genis A.B.; Lago V.N.;
Fernandez J.D.; Romo A.I.; Franco S.N.; Martin I.H.; Montero J.S.; Martin
Mde M.; Gonzalez M.J.; Antolin J.M.; Areses E.L.; Miranda J.M.;
Alonso-Pulpon L.; Esquivias G.B.; Jarne E.F.; Cortes J.M.; Perez M.B.;
Gormaz C.L.; Alegret J.M.; Nava J.S.; Ingelmo J.M.; Urbano R.H.; Sanmartin
M.; Katerenchuk O.; Vakaliuk I.; Karpenko O.; Prokhorov O.; Koval O.;
Faynyk A.; Kopytsya M.; Karpenko Y.; Kraiz I.; Feskov O.; Rudenko L.;
Kozhukhov S.; Goloborodko B.; Rivera E.; Broadwater S.; Crowley S.; Vijay
N.; Goswami R.; Ferrier L.; Blanchard A.; McCullum K.; Chernick R.;
Bertolet B.; Battaglia J.; Richardson J.; Lochridge S.; Lieberman S.;
Amkieh A.; Cavender J.B.; Denning S.; Treasure C.; Kmetzo J.; Stillabower
M.; Brilakis E.; Acheatel R.; Kukuy E.; Ashchi M.; Skelding K.; Martin L.;
Gillespie E.; French W.; Pollock S.; Polk D.; Black R.; Drenning D.;
Anderson J.; Sanz M.; Korban E.; Wiley M.; Rezkalla S.; Minisi A.; Shah
A.; Silverman P.; Amlani M.; Eaton G.; Brown A.; Jay D.; Loussararian A.;
Lamas G.; Lauer M.; Williams J.; Asfour A.; Runquist L.; Robertson R.;
Blonder R.; Davies C.; Downes T.; Chronos N.; Marso S.; Haldis T.; Eich
D.; Ahmed M.; East C.; MacDonald L.; Seigel P.; White M.; Camp A.; Kleiman
N.; Burtt D.; Strain J.; Go B.; Henry P.; Sultan P.; Delafontaine P.;
Kashou H.; Lambert C.; Movahed M.; Saucedo J.; Thadani U.; Chandrashekhar
Y.; Lu D.; Chandna H.; Mann J.; Ramaswamy G.; Browne K.; Janik M.; Cannon
K.; Tolerico P.
Institution
(Nicholls) South Australian Health and Medical Research Institute,
University of Adelaide, Adelaide, SA, Australia
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Schwartz) Veterans Affairs Medical Center, University of Colorado,
Denver, CO, United States
(Bash, Brennan, Menon, Lincoff, Nissen) Cleveland Clinic Coordinating
Center for Clinical Research, Cleveland, OH, United States
(Rosenson) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(Cavender) Brigham and Women's Hospital, Boston, MA, United States
(Koenig) University of Ulm Medical Center, Ulm, Germany
(Jukema) Leiden University Medical Center, Leiden, Netherlands
(Jukema) Interuniversity Cardiology Institute of the Netherlands, Utrecht,
Netherlands
(Nambi) Michael E. DeBakey Veterans Affairs Hospital, Baylor College of
Medicine, Houston, TX, United States
(Wright) Mayo Clinic, Rochester, MN, United States
Publisher
American Medical Association (E-mail: smcleod@itsa.ucsf.edu)
Abstract
IMPORTANCE: Secretory phospholipase A<inf>2</inf> (sPLA<inf>2</inf>)
generates bioactive phospholipid products implicated in atherosclerosis.
The sPLA<inf>2</inf> inhibitor varespladib has favorable effects on lipid
and inflammatory markers; however, its effect on cardiovascular outcomes
is unknown. OBJECTIVE(S): To determine the effects of
sPLA<inf>2</inf> inhibition with varespladib on cardiovascular outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter
trial at 362 academic and community hospitals in Europe, Australia, New
Zealand, India, and North America of 5145 patients randomized within 96
hours of presentation of an acute coronary syndrome (ACS) to either
varespladib (n = 2572) or placebo (n = 2573) with enrollment between June
1, 2010, and March 7, 2012 (study termination on March 9, 2012).
INTERVENTIONS: Participants were randomized to receive varespladib (500
mg) or placebo daily for 16 weeks, in addition to atorvastatin and other
established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy
measurewas a composite of cardiovascular mortality, nonfatal myocardial
infarction (MI), nonfatal stroke, or unstable angina with evidence of
ischemia requiring hospitalization at 16 weeks. Six-month survival status
was also evaluated. RESULT(S): At a prespecified interim analysis,
including 212 primary end point events, the independent data and safety
monitoring board recommended termination of the trial for futility and
possible harm. The primary end point occurred in 136 patients (6.1%)
treated with varespladib compared with 109 patients (5.1%) treated with
placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08).
Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47
[2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite
secondary end point of cardiovascular mortality, MI, and stroke was
observed in 107 patients (4.6%) in the varespladib group and 79 patients
(3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04).
CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did
not reduce the risk of recurrent cardiovascular events and significantly
increased the risk of MI. The sPLA<inf>2</inf> inhibition with varespladib
may be harmful and is not a useful strategy to reduce adverse
cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov
Identifier: NCT01130246. Copyright 2014 American Medical Association. All
rights reserved.

<7>
Accession Number
372905812
Title
Avoiding the clamp during off-pump coronary artery bypass reduces cerebral
embolic events: Results of a prospective randomized trial.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (1) (pp 12-16), 2012.
Date of Publication: 01 Jan 2012.
Author
El Zayat H.; Puskas J.D.; Hwang S.; Thourani V.H.; Lattouf O.M.; Kilgo P.;
Halkos M.E.
Institution
(El Zayat, Puskas, Thourani, Lattouf, Kilgo, Halkos) Division of
Cardiothoracic Surgery, Emory University School of Medicine, Clinical
Research Unit, Atlanta, GA, United States
(Hwang) Department of Radiology, Emory University School of Medicine,
Atlanta, GA, United States
Publisher
Oxford University Press
Abstract
The purpose of this study was to determine whether a clampless
facilitating device (CFD) to perform proximal aortocoronary anastomoses
would result in a lower incidence of cerebral embolic events compared with
a partial clamping strategy during off-pump coronary artery bypass
(OPCAB). After epiaortic ultrasound confirmed the mild aortic disease
(Grades I and II), 57 patients were randomly assigned to have proximal
anastomoses using a partial-occluding clamp (CL, n = 28) or a CFD
[Heartstring (HS), n = 29] (Maquet Cardiovascular LLC, San Jose, CA).
Solid and gaseous emboli in the middle cerebral arteries were detected
using transcranial Doppler ultrasonography. The mean number of proximal
anastomoses was similar between groups 1.93 +/- 0.72 (CL) and 1.72 +/-
0.70 (HS) (P = 0.28). The mean number of gaseous plus solid emboli was
greater in the CL group than the HS group (90.0 +/- 64.0 vs. 50.8 +/-
36.6, P = 0.01). Emboli were fewest in patients undergoing HS anastomoses
using the suction device. The number of intraoperative cerebral emboli was
proportional to the number of proximal anastomoses in the HS groups, but
independent of the number of proximal anastomoses in the CL groups. Among
patients with a low burden of aortic atherosclerosis, partial clamping of
the ascending aorta during OPCAB was associated with more cerebral embolic
events compared with an anastomosis with a CFD. © 2011 The Author
2011. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<8>
Accession Number
366057978
Title
Neither moxifloxacin nor cefuroxime produces significant attenuation of
inflammatory mediator release in patients exposed to cardiopulmonary
bypass: A randomized controlled trial.
Source
Journal of Antimicrobial Chemotherapy. 67 (1) (pp 230-233), 2012. Date of
Publication: 01 Jan 2012.
Author
Wiesner G.; Braun S.L.; Gruber M.; Gertler R.; Lange R.; Tassani P.;
Martin K.
Institution
(Wiesner, Gertler, Tassani, Martin) Institute of Anaesthesiology, German
Heart Centre Munich, Lazarettstr.36, D-80636 Munich, Germany
(Braun) Institute of Laboratory Medicine, German Heart Centre Munich,
Lazarettstr. 36, D-80636 Munich, Germany
(Gruber) Department of Anaesthesiology, University of Regensburg,
Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany
(Lange) Department of Cardiovascular Surgery, German Heart Centre Munich,
Lazarettstr 36, D-80636 Munich, Germany
Publisher
Oxford University Press
Abstract
Objectives: In vitro and experimental studies in animals have established
the anti-inflammatory effects of moxifloxacin. Cardiopulmonary bypass
(CPB) leads to an inflammatory response. The aim of this study was to
assess whether the inflammatory cytokine response to CPB is reduced with a
perioperative antibiotic prophylaxis, either moxifloxacin or cefuroxime
(the standard prophylaxis). Patients and Methods: Twenty-eight
patients scheduled for elective coronary artery bypass grafting with CPB
were randomly assigned to receive either moxifloxacin or cefuroxime as the
perioperative antibiotic prophylaxis. Interleukin (IL)-6, -8, -10 and
tumour necrosis factor-alpha (TNF-alpha) serum concentrations were
determined at eight time points before and after CPB. Result(s): In
both groups, all cytokine concentrations significantly increased after the
start of CPB. There were no statistically significant differences between
the moxifloxacin and cefuroxime groups at any point; IL-6 concentrations
[median (interquartile range)] 240 min after CPB, the primary endpoint,
were 364 (192-598) and 465 (325-906) pg/mL (P=0.323), respectively.
 Conclusion(s): Neither moxifloxacin nor cefuroxime produced
significant attenuation of the inflammatory cytokine response to CPB. The
reasons why moxifloxacin did not have significant anti-inflammatory
effects in this unique clinical situation may be: (i) the inflammatory
response to CPB may be different from that of infectious disease states
that were used to establish the immunomodulatory effects of moxifloxacin;
and (ii) a single intravenous dose, which was used in this investigation,
may not lead to high enough plasma and intracellular concentrations.
©The Author 2011. Published by Oxford University Press on behalf of
the British Society for Antimicrobial Chemotherapy. All rights reserved.

<9>
Accession Number
2010403630
Title
Myocardial Protection in Adult Cardiac Surgery With del Nido Versus Blood
Cardioplegia: A Systematic Review and Meta-Analysis.
Source
Heart Lung and Circulation. 30 (5) (pp 642-655), 2021. Date of
Publication: May 2021.
Author
Misra S.; Srinivasan A.; Jena S.S.; Bellapukonda S.
Institution
(Misra, Jena, Bellapukonda) Department of Anesthesiology and Critical
Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar,
Odisha, India
(Srinivasan) Department of Pharmacology, All India Institute of Medical
Sciences (AIIMS), Bhubaneswar, Odisha, India
Publisher
Elsevier Ltd
Abstract
Background: Myocardial protection in adult cardiac surgery is commonly
achieved with either multidose blood cardioplegia or single-dose del Nido
crystalloid cardioplegia. Aim(s): The aim of this systematic review
and meta-analysis was to compare the outcomes of del Nido cardioplegia
versus blood cardioplegia in adult cardiac surgery. Method(s): All
English-language articles were searched in MEDLINE (PubMed), the Cochrane
Central Register of Controlled Trials (CENTRAL), and Google Scholar up to
March 2020, to identify randomised control trials, prospective
observational studies, and retrospective analyses (with or without
propensity matching) reporting any or all of the primary and secondary
endpoints. The primary endpoint was all-cause mortality. Secondary
endpoints included cardiopulmonary bypass (CPB) and aortic cross-clamp
(AoX) time; cardioplegia volume; need for defibrillation after AoX
release; intraoperative glucose; postoperative myocardial enzyme release;
postoperative left ventricular ejection fraction (LVEF); incidence of
postoperative acute kidney injury (AKI), atrial fibrillation (AF), stroke,
and low cardiac output syndrome (LCOS); postoperative blood transfusion;
duration of mechanical ventilation; and length of intensive care unit
(ICU) and hospital stay. Result(s): Twenty-nine (29) studies were
included. There was no difference in the primary outcome of mortality
between the two groups (odds ratio [OR], 1.18; 95% confidence interval
[CI], 0.82-1.72 [p=0.37]). del Nido cardioplegia was associated with
significantly shorter CPB (mean difference [MD], -7.42 minutes; 95% CI,
-12.53 to -2.31 [p=0.004]) and AoX times (MD, -6.39 minutes; 95% CI,
-10.30 to -2.48 [p=0.001]), and lower cardioplegia volumes. Significantly
fewer patients required defibrillation after AoX release in the del Nido
group. Intraoperative glucose homeostasis was better preserved in the del
Nido group. Postoperative cardiac troponin T release and the number of
patients needing transfusions were less in the del Nido group. No
differences were seen in postoperative LVEF, or in the incidence of AKI,
stroke, AF, and LCOS. Duration of mechanical ventilation, and length of
ICU and hospital stay were similar. Conclusion(s): Although this
meta-analysis failed to find any mortality benefits with del Nido
cardioplegia, significant benefits were seen in a number of intraoperative
and postoperative variables. del Nido cardioplegia is a safe and
favourable alternative to blood cardioplegia in adult cardiac
surgery. Copyright © 2020 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<10>
Accession Number
2007626899
Title
Patient survival in severe low-flow, low-gradient aortic stenosis after
aortic valve replacement or conservative management.
Source
Journal of Cardiac Surgery. 36 (3) (pp 1030-1039), 2021. Date of
Publication: March 2021.
Author
Micali L.R.; Algargoosh S.; Parise O.; Parise G.; Matteucci F.; de Jong
M.; Ioanna Moula A.; Tetta C.; Gelsomino S.
Institution
(Micali, Algargoosh, Parise, Parise, Matteucci, de Jong, Ioanna Moula,
Tetta, Gelsomino) Department of Cardiothoracic Surgery, Cardiovascular
Research Institute Maastricht University, Maastricht, Netherlands
Publisher
Blackwell Publishing Inc.
Abstract
Background and aim: Classical and paradoxical low-flow, low-gradient
(LFLG) aortic stenosis (AS) are the most challenging subtypes of AS. The
current therapeutic options are aortic valve replacement (AVR) and
conservative management: AVR promotes long-term survival but is invasive,
while conservative management yields a poor prognosis but is noninvasive
since it uses no aortic valve replacement (noAVR). The present
meta-analysis investigated the rate of survival of patients with LFLG AS
undergoing either AVR or noAVR interventions. Method(s): The
meta-analysis compared the outcomes of AVR with those of noAVR in terms of
patient survival. In both groups, a meta-regression was conducted to
investigate the impact on patient survival of the left ventricular
ejection fraction (LVEF), either preserved (paradoxical LFLG AS) or
reduced (classical LFLG AS). Result(s): The relative risk of survival
between the AVR and noAVR groups was 1.99 [1.40, 2.82] (p =.0001),
suggesting that survival tends to be better in AVR patients than in noAVR
patients. The meta-regression revealed that a reduced LVEF may be related
to a higher survival in AVR patients when compared to a preserved LVEF (p
=.04). Finally, the analysis indicated that LVEF seems not to be
prognostic of survival in noAVR patients (p =.18). Conclusion(s):
Patients with LFLG AS have better survival if they undergo AVR. In AVR
patients, reduced LVEF rather than preserved LVEF is related to better
survival, whereas there seems to be no difference in prognostic value
between reduced and preserved LVEF in noAVR patients. Copyright ©
2020 The Authors. Journal of Renal Care published by Wiley Periodicals LLC

<11>
Accession Number
2005605020
Title
The effect of erythropoietin administration on the serum level of ykl-40,
pro-bnp and il-6 in coronary surgery patients.
Source
Iranian Journal of Pharmaceutical Research. 19 (3) (pp 430-439), 2020.
Date of Publication: 2020.
Author
Foroughi M.; Mohammadi Z.; Tehrani M.M.; Bakhtiari M.; Dabbagh A.;
Molahoseini M.H.
Institution
(Foroughi, Mohammadi, Tehrani) Cardiovascular Research Center, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bakhtiari) Clinical Research and Development Center, Shahid Modarres
Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Dabbagh) Anesthesiology Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Molahoseini) Department of Immunology, School of Medicine, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Iranian Journal of Pharmaceutical Research
Abstract
Cardiopulmonary bypass and aortic clamping evokes the obligatory global
myocardial ischemia and dysfunction with a significant inflammatory
response. The discrepancy about cardioprotective effects of erythropoietin
still exist. The aim of this study was to assess the clinical
immunomodulatory effects of Erythropoietin (EPO) on serum inflammatory
biomarkers (YKL-40, IL-6) and cardiac biomarkers, (pro-BNP, CK-MB and
troponin). In this randomized double blind clinical trial, 132 patients
admitted for elective coronary surgery with Cardiopulmonary Bypass (CPB)
were randomly assigned in one of three groups: 1-group EPO-A (n = 35)
infusion of 300 IU/Kg EPO after anesthesia induction and before undergoing
CPB; 2-group EPO-CPB (n = 31) the same intervention during CPB; 3-placebo
group (n = 66) saline infusion in the same volume. Cardiac enzymes and
serum biomarkers were measured at intervals. There was a sharp increase in
serum YKL-40 with a 24 h delay after CPB in all groups without significant
difference. The increase in serum IL-6 was significant in EPO-CPB group
compared with both other groups (p = 0.001 and p = 0.001, respectively).
Serum pro-BNP reached maximum level 24 h after operation in all groups; in
group A significantly less than others (p = 0.008). CK-MB increased
significantly in all groups (p < 0.001), less prominently in CPB-A group
(p = 0.03). EPO administration before induced ischemia may be
cardioprotective in terms of cardiac biomarkers in patients undergoing
CABG with CPB. Copyright © 2020, Iranian Journal of
Pharmaceutical Research. All rights reserved.

<12>
Accession Number
2010977348
Title
Ticagrelor-based antiplatelet regimens in patients treated with coronary
artery bypass grafting: A meta-analysis of randomized controlled trials.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 520-528), 2020.
Date of Publication: 01 Mar 2020.
Author
Von Scheidt M.; Bongiovanni D.; Tebbe U.; Nowak B.; Stritzke J.; Zhao Q.;
Zhu Y.; Kastrati A.; Cassese S.; Schunkert H.
Institution
(Von Scheidt, Kastrati, Cassese, Schunkert) Klinik fur Herz- und
Kreislauferkrankungen, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Munich, Germany
(Von Scheidt, Bongiovanni, Kastrati, Schunkert) DZHK (German Center for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Bongiovanni) Medical Department i, Cardiology, Klinikum Rechts der Isar,
Technical University, Munich, Germany
(Tebbe) Department of Cardiology, Angiology, and Intensive Care Medicine,
District Hospital Lippe-Detmold, Detmold, Germany
(Nowak) CCB, Cardiovascular Center Bethanien, Frankfurt, Germany
(Stritzke) Lanserhof Sylt, Marienstein Privatklinik, List, Germany
(Zhao, Zhu) Ruijin Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The optimal antiplatelet strategy in patients undergoing CABG
remains unclear. This is the first meta-analysis investigating the
clinical outcomes associated with ticagrelor-based antiplatelet regimens
in patients receiving CABG. METHOD(S): Relevant scientific databases
were searched for studies investigating antiplatelet regimens after CABG
from inception until April 1, 2019. Studies which randomly assigned CABG
patients to either ticagrelor-based or control antiplatelet regimens were
eligible. The primary outcome of this analysis was all-cause death. The
main secondary outcome was MI. Other outcomes of interest were cardiac
death, major adverse cardiac events, stroke and bleeding. This study is
registered with PROSPERO, number CRD42019122192. RESULT(S): Five
trials comprising 3996 patients (2002 assigned to ticagrelor-based and
1994 to control antiplatelet regimens) were eligible for quantitative
synthesis. The median follow-up was 12 months. Control antiplatelet
regimens consisted of either aspirin or clopidogrel or both. As compared
to control, ticagrelor-based regimens reduced the risk of all-cause death
[0.61 (0.43-0.87); P = 0.007], cardiac death [0.58 (0.39-0.86); P = 0.007]
and major adverse cardiac events [0.79 (0.63-0.98); P = 0.03], without
difference in the risk of MI [0.76 (0.50-1.18); P = 0.22], stroke [0.99
(0.56-1.78); P = 0.98] or bleeding [1.04 (0.95-1.14); P = 0.41]. There was
a treatment effect modification for the primary outcome associated with
trials enrolling predominantly patients with acute coronary syndrome (P
for interaction = 0.038). CONCLUSION(S): In patients receiving CABG,
ticagrelor-based regimens reduce mortality and major adverse cardiac
events without excess bleeding risk as compared with aspirin monotherapy
or the combination of aspirin and clopidogrel. The benefit of
ticagrelor-based regimens is more relevant in those studies enrolling
predominantly patients with acute coronary syndrome. These findings
require further confirmation in randomized trials focused on this subset
of patients and powered for clinical outcomes. Copyright © 2019
The Author(s) 2019. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<13>
Accession Number
2010977345
Title
Mini-extracorporeal circulation surgery produces less inflammation than
off-pump coronary surgery.
Source
European Journal of Cardio-thoracic Surgery. 57 (3) (pp 496-503), 2020.
Date of Publication: 01 Mar 2020.
Author
Permanyer E.; Munoz-Guijosa C.; Padro J.-M.; Ginel A.; Montiel J.;
Sanchez-Quesada J.L.; Vila L.; Camacho M.
Institution
(Permanyer) Department of Cardiac Surgery, Quironsalud Teknon Heart
Institute, Barcelona, Spain
(Permanyer, Padro, Ginel, Montiel) Department of Cardiac Surgery, Hospital
de la Santa Creu i Sant Pau, Research Institute Hospital Sant Pau, IIB
Sant Pau, Barcelona, Spain
(Munoz-Guijosa) Department of Cardiac Surgery, University Hospital Germans
Trias i Pujol, Badalona, Spain
(Sanchez-Quesada) Cardiovascular Research Group, CIBERDEM, Research
Institute Hospital Sant Pau, IIB Sant Pau, Barcelona, Spain
(Vila, Camacho) Laboratory of Angiology, Vascular Biology and
Inflammation, Research Institute Hospital Sant Pau, IIB Sant Pau,
Barcelona, Spain
(Camacho) Genomics of Complex Diseases, Research Institute Hospital Sant
Pau, IIB Sant Pau, Barcelona, Spain
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Both off-pump coronary artery bypass grafting surgery (OPCABG)
and mini-extracorporeal circulation (MECC) have been associated with lower
morbidity and mortality and less inflammation than conventional
cardiopulmonary bypass. However, studies comparing the 2 techniques are
scarce and the results are controversial. We compared the clinical
outcomes and inflammatory response of low-risk patients undergoing
coronary bypass grafting with MECC versus OPCABG. METHOD(S): We
conducted a prospective, randomized study in patients undergoing coronary
heart surgery. Two hundred and thirty consecutive low-risk patients were
randomly assigned to either receive OPCABG (n = 117) or MECC (n = 113).
Clinical outcomes and postoperative biochemical results were analysed in
both groups. We also analysed 19 circulating inflammatory markers in a
subgroup of 40 patients at 4 perioperative time points. The area under the
curve for each marker was calculated to monitor differences in the
inflammatory response. RESULT(S): No significant differences were
found between groups regarding perioperative clinical complications and no
deaths occurred during the trial. Plasma levels in 9 of the 19
inflammatory markers were undetectable or showed no temporal variation, 3
were higher in the MECC group [interleukin (IL)-10, macrophage
inflammatory protein-1beta and epidermal growth factor] and 7 were higher
in the OPCABG group (growth regulator oncogene, IL-6, IL-8, soluble CD40
ligand, monocyte chemoattractant protein-1, monocyte chemoattractant
protein-3 and tumour necrosis factor-alpha). Differences in 2
proinflammatory cytokines, IL-6 and monocyte chemoattractant protein 1,
between the 2 surgical procedures were statistically significant.
 CONCLUSION(S): No clinical differences were observed between in
low-risk patients undergoing MECC or OPCABG surgery, but OPCABG was
associated with an increased release of proinflammatory cytokines compared
with MECC. Studies in larger cohorts and in patients at higher risk are
needed to confirm these findings. Clinical trial registration number:
NCT02118025. Copyright © 2019 The Author(s) 2019. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<14>
Accession Number
2006875919
Title
Systematic review of the evaluation and management of coronary
pseudoaneurysm after stent implantation.
Source
Catheterization and Cardiovascular Interventions. 98 (1) (pp 107-116),
2021. Date of Publication: 01 Jul 2021.
Author
Hassan A.; Uretsky B.F.; Vargas Estrada A.M.; Hassan R.; Al-Hawwas M.;
Agarwal S.K.
Institution
(Hassan, Uretsky, Al-Hawwas, Agarwal) Department of Internal Medicine,
University of Arkansas for Medical Sciences, Little Rock, AR, United
States
(Uretsky, Al-Hawwas, Agarwal) Department of Internal Medicine, Central
Arkansas Veterans Health System, Little Rock, AR, United States
(Vargas Estrada) Department of Internal Medicine, Mercy Hospital, Fort
Smith, AR, United States
(Hassan) Department of Internal Medicine, Advocate Illinois Masonic
Medical Center, Chicago, IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Pseudoaneurysm (PSA) formation is a rare but well-known complication of
coronary stenting. It develops after a procedural perforation disrupts the
integrity of the vessel wall but is contained by a single wall layer,
usually pericardium, extravascular thrombosis and later fibrosis. Medical
literature of PSA consists primarily of case reports. A systematic review
of pseudoaneurysm after coronary stenting was performed to summarize its
presentation, diagnostic imaging modalities, natural history, and
management approaches. Clinical presentations range from asymptomatic to
hemodynamic collapse, size from small to "giant," and treatment approaches
from surgical or percutaneous exclusion to "watchful waiting" and imaging
surveillance. Based on current information, a management algorithm is
provided recommending urgent to emergent exclusion for symptomatic PSA,
elective exclusion for large and giant PSA, and "watchful waiting" and
periodic imaging surveillance for small to moderate sized
PSA. Copyright © 2020 Wiley Periodicals LLC.

<15>
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.

<16>
Accession Number
2012314866
Title
Percutaneous coronary intervention versus coronary artery bypass grafting
in patients with coronary heart disease and type 2 diabetes mellitus:
Cumulative meta-analysis.
Source
Clinical Cardiology. 44 (7) (pp 899-906), 2021. Date of Publication: July
2021.
Author
Xie Q.; Huang J.; Zhu K.; Chen Q.
Institution
(Xie, Zhu, Chen) Department of Cardiology, Zhuzhou Central Hospital,
Zhuzhou, China
(Huang) Department of Cardiology, Liling Traditional Chinese Medicine
Hospital, Zhuzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Previous meta-analyses showed that coronary artery bypass grafting (CABG)
has lower all-cause mortality than percutaneous coronary intervention
(PCI) for the management of coronary heart disease (CHD), but the
long-term outcomes were not analyzed thoroughly in patients with type 2
diabetes mellitus (T2DM). To perform a meta-analysis of randomized
controlled trials (RCTs) to explore the long-term effectiveness between
CABG and PCI in patients with T2DM and study the temporal trends using a
cumulative meta-analysis. PubMed, Embase, Cochrane library, and Clinical
Trials Registry for eligible RCTs published up to September 2020. The
outcomes were all-cause death, cardiac death, myocardial infarction,
repeat revascularization, and stroke. Nine RCTs and 4566 patients were
included. CABG resulted in better outcomes than PCI in terms of all-cause
death (RR = 1.41, 95%CI: 1.22-1.63, p < 0.001), cardiac death (RR = 1.56,
95%CI: 1.25-1.95, p < 0.001), and repeat revascularization (RR = 2.68,
95%CI: 1.86-3.85, p < 0.001), but with difference regarding the occurrence
of myocardial infarction (RR = 1.20, 95%CI: 0.78-1.85, p = 0.414), while
PCI was associated with better outcomes in terms of stroke occurrence (RR
= 0.51, 95%CI: 0.34-0.77, p = 0.001). The cumulative meta-analysis for
all-cause death showed that the differences between CABG and PCI started
to be significant at 3 years of follow-up, while the difference became
significant at 5 years for cardiac death. In patients with CHD and T2DM,
CABG results in better outcomes than PCI in terms of all-cause death,
cardiac mortality, and repeat revascularization, while PCI had better
outcomes in terms of stroke. The differences are mainly observed over the
long-term follow-up. Copyright © 2021 The Authors. Clinical
Cardiology published by Wiley Periodicals LLC.

<17>
Accession Number
2011498754
Title
Native Aortic Root Thrombosis After Norwood Palliation for Hypoplastic
Left Heart Syndrome.
Source
Annals of Thoracic Surgery. 112 (1) (pp 147-154), 2021. Date of
Publication: July 2021.
Author
Rajab T.K.; Mitchell M.B.
Institution
(Rajab) Section of Pediatric Cardiothoracic Surgery, Medical University of
South Carolina, Charleston, SC, United States
(Mitchell) Section of Congenital Cardiac Surgery, University of Colorado,
Aurora, CO, United States
Publisher
Elsevier Inc.
Abstract
Background: Norwood palliation for hypoplastic left heart syndrome
typically results in retrograde perfusion of the native aortic root. This
may predispose to native aortic root thrombosis (NART). Method(s):
Patients who underwent stage 1 Norwood palliation at Children's Hospital
Colorado between 2003 and 2019 were retrospectively reviewed for NART.
Additional patients were identified by a systematic literature review.
Patient factors, operative details, presentation, diagnostic methods,
treatments, and outcomes were analyzed. Result(s): Three patients
with NART were identified among 241 patients who had undergone stage 1
Norwood palliation at Children's Hospital Colorado (mean follow-up, 48
months). A fourth patient identified at Children's Hospital Colorado had
undergone stage 1 palliation elsewhere. The systematic literature review
identified 12 additional patients. Among the 16 patients, patients
presented with new arrhythmias (38% [n = 6]), evidence of ischemia (31% [n
= 5]), incidentally (19% [n = 3]), inability to wean from postoperative
support (6% [n = 1]), and cardiac arrest (6% [n = 1). The diagnosis was
made by transthoracic echocardiography (TTE) in 50% (n = 8),
transesophageal echocardiography in 19% (n = 3), cardiac catheterization
in 25% (n = 4), and cardiac computed tomography in 6% (n = 1).
Importantly, 44% (n = 7) of patients were missed by TTE and subsequently
diagnosed by other methods. Treatment strategies were surgical
thrombectomy in 38% (n = 6), anticoagulation alone in 38% (n = 6), direct
catheter thrombolysis in 19% (n = 3), and systemic thrombolysis in 6% (n =
1). The rate of mortality or transplant listing was 44% (n = 7).
 Conclusion(s): NART is an underappreciated complication of Norwood
palliation with high mortality. There should be a high index of suspicion
for NART in patients after Norwood palliation with an unexplained
complicated clinical course. Importantly, NART is frequently missed by
TTE. Copyright © 2021 The Society of Thoracic Surgeons

<18>
Accession Number
2010173236
Title
Cardiovascular events in patients undergoing hip fracture surgery treated
with remote ischaemic preconditioning: 1-year follow-up of a randomised
clinical trial.
Source
Anaesthesia. 76 (8) (pp 1042-1050), 2021. Date of Publication: August
2021.
Author
Ekeloef S.; Koyuncu S.; Holst-Knudsen J.; Gundel O.; Meyhoff C.S.;
Homilius M.; Stilling M.; Ekeloef P.; Munster A.M.B.; Mathiesen O.;
Gogenur I.
Institution
(Ekeloef, Gogenur) Center for Surgical Science, Department of Surgery,
Zealand University Hospital, Koege, Denmark
(Koyuncu, Holst-Knudsen, Mathiesen) Centre for Anaesthesiological
Research, Department of Anaesthesiology, Zealand University Hospital,
Koege, Denmark
(Gundel, Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg
and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Homilius, Stilling) Department of Orthopaedic Surgery, University Clinic
for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro,
Denmark
(Ekeloef) Department of Anaesthesiology, Regional Hospital West Jutland,
Holstebro, Denmark
(Munster) Unit for Thrombosis Research, Department of Clinical
Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
Publisher
Blackwell Publishing Ltd
Abstract
Remote ischaemic preconditioning reduces the risk of myocardial injury
within 4 days of hip fracture surgery. We aimed to investigate the effect
of remote ischaemic preconditioning on the incidence of major adverse
cardiovascular events 1 year after hip fracture surgery. We performed a
phase-2, multicentre, randomised, observer-blinded, clinical trial between
February 2015 and September 2017. We studied patients aged >= 45 years
with a hip fracture and a minimum of one cardiovascular risk factor.
Patients were allocated randomly to remote ischaemic preconditioning
applied just before surgery or no treatment (control group). Remote
ischaemic preconditioning was performed on the upper arm with a tourniquet
in four cycles of 5 min ischaemia and 5 min reperfusion. Primary outcome
was the occurrence of major adverse cardiovascular events within 1 year of
surgery. A total of 316 patients were allocated randomly to the remote
ischaemic preconditioning group and 309 patients to the control group.
Major adverse cardiovascular events occurred in 43 patients (13.6%) in the
remote ischaemic preconditioning group compared with 51 patients (16.5%)
in the control group (adjusted hazard ratio (95%CI) 0.83 (0.55-1.25); p =
0.37). Fewer patients in the remote ischaemic preconditioning group had a
myocardial infarction (11 (3.5%) vs. 22 (7.1%); hazard ratio (95%CI) 0.48
(CI 0.23-1.00); p = 0.04). Remote ischaemic preconditioning did not reduce
the occurrence of major adverse cardiovascular events within 1 year of hip
fracture surgery. The effect of remote ischaemic preconditioning on
clinical cardiovascular outcomes in non-cardiac surgery needs confirmation
in appropriately powered randomised clinical trials. Copyright ©
2021 Association of Anaesthetists.

<19>
[Use Link to view the full text]
Accession Number
635313996
Title
Association of smoking with postoperative atrial fibrillation in patients
with cardiac surgery: A PRISMA-compliant article.
Source
Medicine. 100 (23) (pp e26179), 2021. Date of Publication: 11 Jun 2021.
Author
Wan Q.; Li S.; Hu J.
Institution
(Wan, Hu) Jiangxi Provincial People's Hospital Affiliated to Nanchang
University, Nanchang of Jiangxi
(Li) Second Clinical Medical College of Nanchang University, Nanchang,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cigarette smoking is an important modifiable risk factor for
incident atrial fibrillation. However, the impact of smoking on
postoperative atrial fibrillation in patients undergoing cardiac surgery
remains controversial. We performed this meta-analysis to explore the
association of smoking with postoperative atrial fibrillation in patients
with cardiac surgery. METHOD(S): We systematically searched 2
computer-based databases (PubMed and EMBASE) up to July 2019 for all
relevant studies. A random-effects model was selected to pool the odds
ratios (ORs) and 95% confidence intervals (CIs). In this meta-analysis,
the protocol and reporting of the results were based on the Preferred
Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)
statement. RESULT(S): A total of 36 studies were included in this
meta-analysis. Overall, smoking was not associated with an increased risk
of postoperative atrial fibrillation in patients undergoing cardiac
surgery (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.79-1.02).
The corresponding results were stable in the subgroup analyses.
Specifically, smoking was not associated with an increased risk of
postoperative atrial fibrillation regardless of the type of cardiac
surgery: coronary artery bypass grafting (OR = 0.91; 95% CI 0.77-1.07),
valve surgery (OR = 0.15; 95% CI 0.01-1.56), and coronary artery bypass
grafting+valve surgery (OR = 0.91; 95% CI 0.70-1.18). CONCLUSION(S):
Based on currently published studies, smoking was not associated with an
increased risk of postoperative atrial fibrillation in patients undergoing
cardiac surgery. Copyright © 2021 the Author(s). Published by
Wolters Kluwer Health, Inc.

<20>
Accession Number
634894429
Title
Risk factors of postoperative delirium after cardiac surgery: a
meta-analysis.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 113), 2021. Date of
Publication: 26 Apr 2021.
Author
Chen H.; Mo L.; Hu H.; Ou Y.; Luo J.
Institution
(Chen) Education and Training Department, First Affiliated Hospital of
University of South China, Hengyang, China
(Mo, Luo) Department of Cardiothoracic Surgery, First Affiliated Hospital
of University of South China, Hengyang, China
(Hu) Nursing Department, First Affiliated Hospital of University of South
China, Hengyang, China
(Ou) Nursing Department, First Affiliated Hospital of University of South
China, Hengyang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium is a frequent event after cardiac
surgery. This meta-analysis aimed to identify relevant risk factors.
 METHOD(S): In this meta-analysis, all original researches regarding
patients undergoing mixed types of cardiac surgery (excluding
transcatheter procedures) and postoperative delirium were evaluated for
inclusion. On July 28th 2020, we searched PubMed, Embase, Web of Science
and Scopus. Data about name of first author, year of publication,
inclusion and exclusion criteria, research design, setting, method of
delirium assessment, incidence of delirium, odds ratio (OR) and
corresponding 95% confidence interval (CI) of risk factors, and other
information relevant was collected. OR and 95% CI were used as metrics for
summarized results. Random effects model was applied. RESULT(S):
Fourteen reports were included with a total sample size of 13,286. The
incidence of delirium ranged from 4.1 to 54.9%. Eight risk factors were
identified including aging, diabetes, preoperative depression, mild
cognitive impairment, carotid artery stenosis, NYHA functional class III
or IV, time of mechanical ventilation and length of intensive care unit
stay. CONCLUSION(S): In this study several risk factors associated
with postoperative delirium after cardiac surgery were identified.
Utilizing the information may allow us to identifying patients at high
risk of developing postoperative delirium prior to delirium onset.

<21>
Accession Number
635428853
Title
Relation of insulin treatment for type 2 diabetes to the risk of major
adverse cardiovascular events after acute coronary syndrome: an analysis
of the BETonMACE randomized clinical trial.
Source
Cardiovascular diabetology. 20 (1) (pp 125), 2021. Date of Publication: 22
Jun 2021.
Author
Schwartz G.G.; Nicholls S.J.; Toth P.P.; Sweeney M.; Halliday C.;
Johansson J.O.; Wong N.C.W.; Kulikowski E.; Kalantar-Zadeh K.; Ginsberg
H.N.; Ray K.K.
Institution
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, 1700 N. Wheeling St. (Cardiology 111B), CO, Aurora 80045, United
States
(Nicholls) Victorian Heart Institute, Monash University, Melbourne,
Australia
(Toth) Cicarrone Center for the Prevention of Cardiovascular Disease,
Johns Hopkins University School of Medicine, MD, Baltimore, United States
(Toth) CGH Medical Center Sterling, Sterling, United States
(Sweeney, Halliday, Johansson, Wong, Kulikowski) Resverlogix Corporation,
AB, Calgary, Canada
(Kalantar-Zadeh) Division of Nephrology and Hypertension, University of
California Irvine, Orange, CA, USA
(Ginsberg) Department of Medicine, Vagelos College of Physicians and
Surgeons, Columbia University, NY, NY, United States
(Ray) Imperial Centre for Cardiovascular Disease Prevention, Imperial
College, London, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: In stable patients with type 2 diabetes (T2D), insulin
treatment is associated with elevated risk for major adverse
cardiovascular events (MACE). Patients with acute coronary syndrome (ACS)
and T2D are at particularly high risk for recurrent MACE despite
evidence-based therapies. It is uncertain to what extent this risk is
further magnified in patients with recent ACS who are treated with
insulin. We examined the relationship of insulin use to risk of MACE and
modification of that risk by apabetalone, a bromodomain and extra-terminal
(BET) protein inhibitor. METHOD(S): The analysis utilized data from
the BETonMACE phase 3 trial that compared apabetalone to placebo in
patients with T2D, low HDL cholesterol, andACS. The primary MACE outcome
(cardiovascular death, myocardial infarction, or stroke) was examined
according to insulin treatment and assigned study treatment. Multivariable
Cox regression was used to determine whether insulin use was independently
associated with the risk of MACE. RESULT(S): Among 2418 patients
followed for median 26.5 months, 829 (34.2%) were treated with insulin.
Despite high utilization of evidence-based treatments including coronary
revascularization, intensive statin treatment, and dual antiplatelet
therapy, the 3-year incidence of MACE in the placebo group was elevated
among insulin-treated patients (20.4%) compared to those not-treated with
insulin (12.8%, P=0.0001). Insulin treatment remained strongly associated
with the risk of MACE (HR 2.10, 95% CI 1.42-3.10, P=0.0002) after
adjustment for demographic, clinical, and treatment variables. Apabetalone
had a consistent, favorable effect on MACE in insulin-treated and not
insulin-treated patients. CONCLUSION(S): Insulin-treated patients
with T2D, low HDL cholesterol, and ACS are at high risk for recurrent MACE
despite the use of evidence-based, contemporary therapies. A strong
association of insulin treatment with risk of MACE persists after
adjustment for other characteristics associated with MACE. There is unmet
need for additional treatments to mitigate this risk. Trial registration
ClinicalTrials.gov NCT02586155, registered October 26, 2015.

<22>
Accession Number
635428530
Title
Effects of bilateral Pecto-intercostal Fascial Block for perioperative
pain management in patients undergoing open cardiac surgery: a prospective
randomized study.
Source
BMC anesthesiology. 21 (1) (pp 175), 2021. Date of Publication: 22 Jun
2021.
Author
Zhang Y.; Gong H.; Zhan B.; Chen S.
Institution
(Zhang, Gong, Chen) Department of Anesthesiology, First Affiliated
Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang,
Jiangxi 330006, China
(Zhan) Department of cardiology, second Affiliated Hospital of Nanchang
University, NO.1 minde Street, Nanchang, Jiangxi 330006, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Open cardiac surgical patients may experience severe acute
poststernotomy pain. The ultrasound-guided Pecto-intercostal Fascial Block
(PIFB) can cover anterior branches of intercostal nerves from T2 to T6.
The aim of this study was to investigate the effect of bilateral PIFB in
patients undergoing open cardiac surgery. METHOD(S): A group of 108
patients were randomly allocated to either receive bilateral PIFB (PIFB
group) or no nerve block (SALI group). The primary endpoint was
postoperative pain. The secondary outcome measures included intraoperative
and postoperative sufentanil and parecoxib consumption, time to
extubation, time to first feces, length of stay in the ICU and the length
of hospital stay. Insulin, glucose, insulin resistance and interleukin
(IL)-6 at 1, 2, 3days after surgery were mearsured. The homeostasis model
assessment (HOMA-IR) was used to measure perioperative insulin resistance.
 RESULT(S): The PIFB group reported significantly less sufentanil and
parecoxib consumption than the SALI group. Compared to the PIFB group, the
SALI group had higher Numerical Rating Scale (NRS) pain scores at 24h
after operation both at rest and during coughing. The time to extubation,
length of stay in the ICU and length of hospital stay were significantly
decreased in the PIFB group compared with the SALI group. The PIFB group
had a lower insulin, glucose, IL-6, HOMA-IR level than the SALI group
3days after surgery. CONCLUSION(S): Bilateral PIFB provides effective
analgesia and accelerates recovery in patients undergoing open cardiac
surgery. TRIAL REGISTRATION: This study was registered in the Chinese
Clinical Trial Registry ( ChiCTR 2000030609 ) on 08/03/2020.

<23>
Accession Number
2007669944
Title
Effects of sevoflurane and desflurane on microcirculation during
non-cardiac surgery.
Source
Kuwait Medical Journal. 53 (2) (pp 173-178), 2021. Date of Publication:
June 2021.
Author
Cil H.; Kilicaslan B.; Cizmeci E.A.; Kanbak M.; Ince C.
Institution
(Cil, Kilicaslan, Cizmeci, Kanbak) Department of Anesthesiology and
Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
(Cil) Department of Anesthesia and Perioperative Care, University of
California San Francisco, San Francisco, CA, United States
(Ince) Department of Intensive Care, Erasmus Medical Center University
Hospital, Rotterdam, Netherlands
Publisher
Kuwait Medical Association
Abstract
Objectives: Assessment of microcirculation is thought to be a surrogate of
tissue perfusion and anesthetic drugs are known to alter the
microcirculation in cardiac surgery patients, but their effects in less
complicated non-cardiac surgery remain unknown. Our aim is to investigate
the effects of sevoflurane and desflurane on the microcirculation
parameters during non-cardiac surgery. Design(s): Prospective cohort
study Setting: Hacettepe University Medical Faculty and Hospital Subjects:
Patients with American Society of Anesthesiologists (ASA) score of I-II
who underwent >=2 hours of non-cardiac surgery were randomly divided into
two groups: sevoflurane (n=20) and desflurane (n=19).
 Intervention(s): Sevoflurane or desflurane Main Outcome
Measure(s): Demographic, hemodynamic (heart rate, mean arterial pressure)
and laboratory parameters (hematocrit, hemoglobin, urea and creatinine)
were measured. Microcirculation imaging was performed by using side stream
dark field imaging. Result(s): There were no statistical differences
in demographic, hemodynamic and laboratory parameters between groups. In
the sevoflurane group, the proportion of perfused vessel (PPV) was
slightly increased at the second hour intraoperatively compared to the
post-induction period in small vessels (94.7% vs 93%, P=.036), but other
parameters (microvascular flow index, total vascular density and perfused
vascular density) were comparable in both measurement periods. In the
desflurane group, all microcirculation parameters were comparable between
post-induction period and second hour intraoperatively.
 Conclusion(s): Sevoflurane anesthesia slightly increases the PPV in
small vessels, whereas desflurane has no effect on microcirculation
parameters in ASA I-II non-cardiac surgery patients. Neither sevoflurane
nor desflurane have major effects on microcirculation in this patient
population. Copyright © 2021, Kuwait Medical Association. All
rights reserved.

<24>
Accession Number
2013389127
Title
The effects of radiotherapy after thoracic and laparoscopic surgery on
patients with esophageal cancer and on their prognoses.
Source
American Journal of Translational Research. 13 (6) (pp 6446-6456), 2021.
Date of Publication: 2021.
Author
Gao Y.; Kang M.; Niu L.; Xu L.; Xie X.; Chen D.; Zhu L.; Wang F.
Institution
(Gao, Kang, Niu, Xu, Xie, Chen, Zhu, Wang) Department of Radiation
Oncology, Anhui Medical University, Anhui Province, Hefei, China
Publisher
E-Century Publishing Corporation
Abstract
Objective: This paper aimed to explore the effects of radiotherapy after
thoracic and laparoscopic surgery (TLS) in patients with esophageal cancer
and on their prognoses. Method(s): Altogether 118 patients with
esophageal cancer diagnosed in our hospital were recruited as the study
cohort and randomly divided into a postoperative radiotherapy group (59
cases) and a postoperative chemotherapy group (59 cases). All the patients
were treated with TLS. In addition to the TLS, the patients in the
postoperative radiotherapy group underwent radiotherapy, and the patients
in the postoperative chemotherapy group were administered cisplatin and
5-fluorouracil (PF) chemotherapy. Before the treatment and at 6 months
after the treatment, the serum carbohydrate antigen 199 (CA199),
carbohydrate antigen 153 (CA153), and carcinoembryonic antigen (CEA)
levels were measured using immunity transmission turbidity (ITT). The
expression levels of Bax and Bcl-2 in the peripheral blood mononuclear
cells (PBMCs) were measured using Western blot (WB). The CD4+,
CD8+ and CD3+ levels in the peripheral venous blood
were measured using a flow cytometer. The two groups were compared in
terms of their effective treatment rates, their incidences of
complications, and their postoperative survival rates. Result(s):
After the treatment, the serum CEA, CA153, and CA199 levels in the
postoperative radiotherapy group were significantly lower than they were
in the postoperative chemotherapy group (P<0.05). After the treatment, the
expression level of Bcl-2 was significantly lower in the postoperative
radiotherapy group, but the Bax expression level was significantly higher
in the postoperative radiotherapy group (P<0.05). After the treatment,
there were no statistically significant differences in the
CD4+, CD3+ or CD8+ levels between the two
groups (P>0.05). After the treatment, the overall response rate (ORR) and
the total incidence of adverse reactions were significantly higher in the
postoperative radiotherapy group (P<0.05). After the treatment, the
1-year, 3-year, and 5-year survival rates were significantly elevated in
the postoperative radiotherapy group (P<0.05). Conclusion(s):
Compared with the esophageal cancer patients treated with chemotherapy
after TLS, the serum CA153, CA199, and CEA levels were significantly
improved in the patients treated with radiotherapy. The Bcl-2 and Bax
levels in the PBMCs tended close to normal. Therefore, undergoing
radiotherapy after TLS is markedly effective in prolonging patients'
survival times and improving their prognoses. Copyright © 2021
E-Century Publishing Corporation. All rights reserved.

<25>
Accession Number
2013019807
Title
Factor VIII inhibitor bypass activity (FEIBA) for the reduction of
transfusion in cardiac surgery: a randomized, double-blind,
placebo-controlled, pilot trial.
Source
Pilot and Feasibility Studies. 7 (1) (no pagination), 2021. Article
Number: 137. Date of Publication: December 2021.
Author
Sera V.A.; Stevens A.E.; Song H.K.; Rodriguez V.M.; Tibayan F.A.;
Treggiari M.M.
Institution
(Sera, Treggiari) Department of Anesthesiology and Perioperative Medicine,
Oregon Health & Science University, Portland, OR, United States
(Stevens) Department of Anesthesiology, Kaiser Permanente, Portland, OR,
United States
(Song, Tibayan) Department of Cardiothoracic Surgery, Oregon Health &
Science University, Portland, OR, United States
(Rodriguez) Department of Surgery, Division of Cardiothoracic Surgery, UC
Davis Vascular Center, Davis, CA, United States
(Treggiari) Department of Anesthesiology, Yale University, 333 Cedar
Street, TMP-3, New Haven, CT, United States
Publisher
BioMed Central Ltd
Abstract
Background: Uncontrolled bleeding after cardiac surgery can be
life-threatening. Factor eight inhibitor bypassing activity (FEIBA) is a
prothrombin complex concentrate empirically used as rescue therapy for
correction of refractory bleeding diathesis post-cardiopulmonary bypass
(CPB). FEIBA used as rescue therapy for bleeding diathesis after CPB has
been associated with a low incidence of complications and a reduction in
transfusion requirement and re-exploration. The feasibility and efficacy
of early administration of FEIBA after the termination of CPB have not
been studied in a prospective randomized trial. Method(s): We
designed a small randomized, double-blinded, placebo-controlled pilot
trial to determine the feasibility of a larger trial testing the
hypothesis that FEIBA decreases transfusion requirements after CPB. The
study was designed to evaluate the feasibility of a larger pivotal trial
to determine the effectiveness of FEIBA in reducing the total volume of
blood products transfused perioperatively, and its safety profile. Study
participants were adult patients undergoing elective major aortic
cardiovascular surgery at a tertiary referral hospital, who were equally
randomized to receive a single dose of either FEIBA or matched placebo
intraoperatively at the end of CPB. Result(s): Twenty patients were
screened and 12 were randomized and included in the analysis. Protocol
adherence was high, and all patients received the study drug per
intention-to-treat except one patient. There were no protocol deviations
or events of unblinding, and adverse events were not different between
groups. Patients in the FEIBA group were older and more likely to be
female and had higher BMI, lower hematocrit, and longer hypothermic
circulatory arrest. There were no differences in post-randomization blood
product transfusions (difference FEIBA vs. placebo -899 mL; 95% CI -5206
to 3409) or in the administration of open-label FEIBA. Conclusion(s):
This pilot trial confirmed the adequacy of the trial design that involved
the early, blinded administration of FEIBA, by demonstrating excellent
protocol adherence. We conclude that a larger trial establishing the
effectiveness of early prothrombin complex concentrate administration to
reduce the use of blood products in the setting of high-risk cardiac
surgery is feasible. Trial registration: ClinicalTrials.gov, NCT02577614.
Registered 16 October 2015 Copyright © 2021, The Author(s).

<26>
Accession Number
2012859511
Title
Effect of intrapartum oxygen on the rate of cesarean delivery: a
meta-analysis.
Source
American Journal of Obstetrics and Gynecology MFM. 3 (4) (no pagination),
2021. Article Number: 100374. Date of Publication: July 2021.
Author
Burd J.; Quist-Nelson J.; Moors S.; Raghuraman N.; Aly H.; Berghella V.
Institution
(Burd) Department of Obstetrics and Gynecology, Thomas Jefferson
University Hospital, Philadelphia, PA, United States
(Quist-Nelson, Berghella) Division of Maternal-Fetal Medicine, Department
of Obstetrics and Gynecology, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
(Moors) Department of Obstetrics and Gynecology, St. Antonius Hospital,
Utrecht, Netherlands
(Raghuraman) Department of Obstetrics and Gynecology, Washington
University School of Medicine in St. Louis, St. Louis, MO, United States
(Aly) Department of Neonatology, Cleveland Clinic Children's Hospital,
Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
OBJECTIVE: This study aimed to determine if maternal intrapartum
administration of oxygen altered the rate of cesarean delivery compared
with room air. DATA SOURCES: This study was a systematic review and
meta-analysis of randomized controlled trials. Searches were performed in
MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central
Register of Controlled Trials using a combination of key words related to
"pregnant patients," "labor," "oxygen," "fetus," "newborn," and pregnancy
outcomes from database inception until April 2020. The study was
registered in PROSPERO (registration number CRD42020162110). STUDY
ELIGIBILITY CRITERIA: The inclusion criteria were randomized controlled
trials of maternal administration of oxygen compared with room air in
labor. The exclusion criteria were quasi-randomized trials and oxygen
administered for planned cesarean deliveries. The primary outcome was the
rate of cesarean delivery. Secondary maternal and neonatal outcomes,
including cord gas values, were analyzed. METHOD(S): The Cochrane
Handbook guidelines were used to assess bias in trials. To calculate the
relative risk or mean differences with confidence intervals, a
random-effects model was employed. Subgroup analyses were performed for
women who received oxygen for nonreassuring fetal heart rate monitoring or
prophylactically. RESULT(S): Five randomized controlled trials,
including 768 women, were included in the meta-analysis, 3 using
prophylactic oxygen and 2 using oxygen for nonreassuring fetal heart rate
monitoring. The risk of bias was generally considered low. There was no
statistically significant difference in the rate of cesarean delivery
between patients administered oxygen and patients provided room air (16 of
365 [4.4%] vs 11 of 379 [2.9%]; risk ratio 1.5; 95% confidence interval,
0.7-3.3). In addition, there were no statistically significant differencs
in the rates of cesarean delivery for nonreassuring fetal heart rate
monitoring, operative vaginal deliveries, Apgar scores of <7, neonatal
intensive care unit admissions, or cord blood gas values. There were no
statistically significant difference when analyzing oxygen for
nonreassuring fetal heart rate monitoring alone or prophylactic oxygen
alone. Data regarding FHT is mixed, with one study suggesting an
improvement and three suggesting no change. CONCLUSION(S): Maternal
intrapartum oxygen administration was not associated with any differences
in the rate of cesarean delivery or any secondary outcomes compared with
room air overall and in the subgroups of therapeutic (for nonreassuring
fetal heart rate monitoring) or prophylactic administration in this
meta-analysis. Large randomized controlled trials are necessary to further
examine any possible benefits or harms of oxygen administration in labor,
particularly for nonreassuring fetal heart rate monitoring. Copyright
© 2021 Elsevier Inc.

<27>
Accession Number
2013403946
Title
Activation of the innate immune response and organ injury after cardiac
surgery: a systematic review and meta-analysis of randomised trials and
analysis of individual patient data from randomised and non-randomised
studies.
Source
British Journal of Anaesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Abbasciano R.G.; Lai F.Y.; Roman M.A.; Rizzello A.; Pathak S.; Ramzi J.;
Lucarelli C.; Layton G.R.; Kumar T.; Wozniak M.J.; Eagle-Hemming B.;
Akowuah E.; Rogers C.A.; Angelini G.D.; Murphy G.J.
Institution
(Abbasciano, Lai, Roman, Rizzello, Pathak, Kumar, Wozniak, Eagle-Hemming,
Murphy) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Ramzi) Leicester Medical School, University of Leicester, Leicester,
United Kingdom
(Lucarelli) Department of Cardiac Surgery, University of Verona, Verona,
Italy
(Layton) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Akowuah) South Tees Hospitals NHS Foundation Trust, Middlesbrough, United
Kingdom
(Rogers) Clinical Trials and Evaluation Unit, Bristol Trials Centre,
University of Bristol, Bristol, UK, United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol, UK,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: It is unclear whether the innate immune response represents a
therapeutic target for organ protection strategies in cardiac surgery.
 Method(s): A systematic review of trials of interventions targeting
the inflammatory response to cardiac surgery reporting treatment effects
on both innate immune system cytokines and organ injury was performed. The
protocol was registered at the International Prospective Register of
Systematic Reviews: CRD42020187239. Searches of the Cochrane Central
Register of Controlled Trials, MEDLINE, and Embase were performed.
Random-effects meta-analyses were used for the primary analysis. A
separate analysis of individual patient data from six studies (n=785)
explored sources of heterogeneity for treatment effects on cytokine
levels. Result(s): Searches to May 2020 identified 251 trials
evaluating 24 interventions with 20 582 participants for inclusion. Most
trials had important limitations. Methodological limitations of the
included trials and heterogeneity of the treatment effects on cytokine
levels between trials limited interpretation. The primary analysis
demonstrated inconsistency in the direction of the treatment effects on
innate immunity and organ failure or death between interventions. Analyses
restricted to important subgroups or trials with fewer limitations showed
similar results. Meta-regression, pooling available data from all trials,
demonstrated no association between the direction of the treatment effects
on inflammatory cytokines and organ injury or death. The analysis of
individual patient data demonstrated heterogeneity in the association
between the cytokine response and organ injury after cardiac surgery for
people >75 yr old and those with some chronic diseases.
 Conclusion(s): The certainty of the evidence for a causal
relationship between innate immune system activation and organ injury
after cardiac surgery is low. Copyright © 2021 British Journal of
Anaesthesia

<28>
Accession Number
2013221298
Title
Ross Operation in Neonates: A Meta-analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Rajab T.K.; Zorrilla-Vaca A.; Kavarana M.N.; Mokashi S.; Sainathan S.
Institution
(Rajab, Kavarana) Section of Pediatric Cardiothoracic Surgery, Department
of Surgery, Medical University of South Carolina, Charleston, SC, United
States
(Zorrilla-Vaca) Department of Anesthesiology and Perioperative Medicine,
University of Texas MD Anderson Cancer Center, Houston, TX, United States
(Mokashi) Division of Cardiac Surgery, Department of Surgery, Creighton
University, Omaha, NE, United States
(Sainathan) Section of Pediatric Cardiac Surgery, Department of Surgery,
University of North Carolina, Chapel Hill, NC, United States
Publisher
Elsevier Inc.
Abstract
Background: The Ross operation is the preferred treatment for aortic valve
replacement in children. However previous studies indicate that outcomes
in neonates are poor. This meta-analysis examines the pooled outcomes of
the Ross operation in neonates. Method(s): Four major databases
(PubMed/MEDLINE, EMBASE, Scopus, and ScienceDirect) were searched from
inception until May 1, 2020 for studies describing outcomes of the Ross
operation in neonates. The primary outcome was early mortality, and
secondary outcomes were late mortality and mechanical support.
Random-effects models were used to account for possible heterogeneity
between studies, and continuity corrections were used to include zero
total event trials. Result(s): Eighteen studies comprising outcomes
data on 181 neonates were included in the analysis. Meta-analysis showed a
pooled early mortality rate of 24% (95% confidence interval, 12%-38%;
I2 = 52%, P for heterogeneity = .01). Meta-regression analysis
showed that more recently published studies reported significantly worse
early mortality (P = .03). The pooled incidence of postoperative
mechanical support was 15% (95% confidence interval, 5%-28%; I2
= 28%, P for heterogeneity = .22). No evidence of publication bias was
found according to Egger's test (bias coefficient = 0.21, P = .57).
 Conclusion(s): The neonatal Ross operation carries a high early
mortality rate. The treatment of unrepairable aortic valves in neonates
remains an unsolved problem in congenital cardiac surgery. Copyright
© 2021

<29>
Accession Number
635420202
Title
Effect of strict intraoperative blood pressure management strategy on
postoperative acute kidney injury in non-cardiac surgery: a meta-analysis
of randomised controlled trials.
Source
International journal of clinical practice. (pp e14570), 2021. Date of
Publication: 24 Jun 2021.
Author
Tu M.; Hong S.; Lu J.; Liu Y.; Deng M.
Institution
(Tu, Hong, Liu, Deng) Department of Anesthesiology, Huashan Hospital of
Fudan University
(Lu) Department of Anesthesiology, Huashan Hospital North Affiliated to
Fudan University, Shanghai, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute kidney injury (AKI) is one of the most serious
perioperative complications. 20% to 40% of high-risk patients who undergo
non-cardiac surgery have AKI and those with AKI are eight-times more
likely to die within 30 days after surgery. It may be related to
intraoperative hypotension, which is mainly caused by vasodilatory and
cardiodepressant effects of anaesthesia, and/or hypovolemia. Strict
intraoperative blood pressure management strategy (strict BP management)
is a potential option to prevent postoperative AKI. This strategy refers
to additional administration of vasoactive agents under the premise of a
protocolized fluid delivery. The efficacy of strict BP management for
preventing postoperative AKI in non-cardiac surgery patients was assessed
by a meta-analysis. METHOD(S): We systematically retrieved randomised
controlled trials (RCTs) compared strict BP management with conventional
therapy control on effect of postoperative AKI in non-cardiac surgery
patients, which were published on PubMed, EMBASE, Cochrane library, and
Web of Science databases before October 5, 2020. Ultimately, a
meta-analysis of all RCTs eligible for inclusion criteria was performed.
 RESULT(S): Five RCTs, comprising 1485 patients, were included inthe
meta-analysis. Strict BP management was associated with a reduced
incidence of postoperative AKI [relative risk (RR) = 0.73, 95% confidence
interval (CI) 0.58-0.92, P = .007]. No significant difference was found
between strict BP management group and conventional therapy control in
mortality at longest follow-up available (RR = 0.92, 95% CI 0.68-1.25, P =
.60). In the subset analysis, the studies using supranormal BP management
target was significantly lower in the incidence of postoperative AKI (RR =
0.65, 95% CI 0.51-0.82, P = .0003) CONCLUSION(S): Strict BP
management is significantly more effective than conventional therapy for
the prevention of postoperative AKI. Supranormal target of intraoperative
blood pressure management may be considered a more appealing option for
the prevention of AKI. Copyright This article is protected by
copyright. All rights reserved.

<30>
Accession Number
2007173473
Title
Efficacy of dexmedetomidine versus morphine as an adjunct to bupivacaine
in caudal anesthesia for pediatric thoracic surgeries: A randomized
controlled trial.
Source
Anesthesiology and Pain Medicine. 11 (2) (no pagination), 2021. Article
Number: e112296. Date of Publication: April 2021.
Author
Ismail A.A.; Hamza H.M.; Gado A.A.
Institution
(Ismail, Hamza, Gado) Lecturer of Anesthesia and Pain Management,
Anesthesia Department, Faculty of Medicine, Cairo University, Egypt
Publisher
Kowsar Medical Institute
Abstract
Background: Caudal anesthesia is an effective method of pain management,
which can be successfully employed to minimize post-thoracotomy pain in
pediatric patients. However, its main disadvantage is the short
postoperative analgesic period, which can be prolonged by the concurrent
administration of one of many adjuvants. Objective(s): This
prospective randomized, blinded study aimed to compare the efficacy of
dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal
anesthesia for thoracic surgeries in pediatric patients. Method(s):
Fifty patients were randomly allocated into two equal groups. To achieve
caudal epidural block anesthesia, the patients in group M (n = 25) were
administered morphine and bupivacaine, while group D (n = 25) received a
mixture of dexmedetomidine and bupivacaine. The primary outcome of this
study was the postoperative analgesic duration achieved. The secondary
outcomes included morphine administration in the first 24 hours following
caudal block anesthesia, the face, legs, activity, cry, consolability
(FLACC) scale scores, and adverse effects, including vomiting, itching,
bradycardia, hypotension, and respiratory depression. Result(s): The
results showed that patients who had received dexmedetomidine achieved a
longer postoperative analgesia as compared to those who had received
morphine (P < 0.001). Postoperatively, the heart rate, blood pressure,
pain score, and mean consumption of morphine were lower in group D as
compared to the group M. There was no significant difference in the
adverse effects between the two groups. Conclusion(s): The use of
dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during
pediatric thoracic surgeries induced better and prolonged postoperative
analgesia as compared to morphine. Copyright © 2021, Author(s).

<31>
Accession Number
2010145568
Title
Colchicine Use in Acute Coronary Syndromes: An Update.
Source
Angiology. 72 (6) (pp 503-510), 2021. Date of Publication: July 2021.
Author
Tapoi L.; Benchea L.; Siriopol D.; Kanbay M.; Covic A.
Institution
(Tapoi, Benchea) Cardiovascular Diseases Institute "Prof. Dr. George I.M.
Georgescu,", Iasi, Romania
(Siriopol, Covic) Grigore T. Popa, University of Medicine and Pharmacy,
Iasi, Romania
(Siriopol, Covic) Nephrology Department, Dialysis and Renal Transplant
Center, "Dr. C.I. Parhon" University Hospital, Iasi, Romania
(Kanbay) Department of Medicine, Division of Nephrology, Koc University
School of Medicine, Istanbul, Turkey
Publisher
SAGE Publications Inc.
Abstract
Coronary artery disease is the leading cause of death worldwide, and its
main pathological substrate is represented by atherosclerosis.
Inflammation is a major promoter of the atherosclerotic process and is
involved in both the initiation and progression of atherosclerosis, as
well as in the occurrence of fatal complications. Until the present
moment, Colchicine Cardiovascular Outcomes Trial is the largest trial to
demonstrate a major benefit of low-dose colchicine on major adverse
cardiac events in patients with recent myocardial infarction (MI), but the
mechanisms behind this relation are not completely known. The purpose of
this review is to emphasize the possible pathways through which colchicine
improves the clinical outcomes in the acute setting of acute coronary
syndromes by referring to the results of the studies published in the past
5 years. Aside from its stated systemic anti-inflammatory effect,
colchicine could be a valuable addition to the therapeutic approach of
acute MI by reducing the infarct size, stabilizing the coronary plaque, as
well as reducing platelet aggregation. Moreover, colchicine may improve
endothelial function, reduce the transcoronary release of cytokines, and
prevent a rise in inflammatory markers after percutaneous coronary
intervention, thus diminishing the residual inflammatory
risk. Copyright © The Author(s) 2021.

<32>
Accession Number
2010968539
Title
Optical coherence tomography-guided coronary stent implantation compared
to angiography: A multicentre randomised trial in PCI - Design and
rationale of ILUMIEN IV: OPTIMAL PCI.
Source
EuroIntervention. 16 (13) (pp 1092-1099), 2021. Date of Publication: 2021.
Author
Ali Z.A.; Landmesser U.; Galougahi K.K.; Maehara A.; Matsumura M.;
Shlofmitz R.A.; Guagliumi G.; Price M.J.; Hill J.M.; Akasaka T.; Prati F.;
Bezerra H.G.; Wijns W.; Mintz G.S.; Ben-Yehuda O.; McGreevy R.J.; Zhang
Z.; Rapoza R.J.; West N.E.J.; Stone G.W.
Institution
(Ali, Galougahi, Maehara, Ben-Yehuda) Center for Interventional Vascular
Therapy, Division of Cardiology, NewYork-Presbyterian Hospital, Columbia
University Irving Medical Center, New York, NY, United States
(Ali, Galougahi, Maehara, Matsumura, Mintz, Ben-Yehuda, Stone) Clinical
Trials Center, Cardiovascular Research Foundation, New York, NY, United
States
(Ali, Shlofmitz) St. Francis Hospital, Roslyn, NY, United States
(Landmesser) Department of Cardiology, Charite-University Medicine Berlin,
Berlin, Germany
(Landmesser) Berlin Institute of Health, Berlin, Germany
(Landmesser) German Centre for Cardiovascular Research, Berlin, Germany
(Guagliumi) Ospedale Papa Giovanni XXIII, Bergamo, Italy
(Price) Division of Cardiovascular Diseases, Scripps Clinic, San diego,
CA, United States
(Hill) Royal Brompton Hospital, London, United Kingdom
(Akasaka) Wakayama Medical University, Wakayama, Japan
(Prati) San Giovanni Hospital and CLI Foundation, Rome, Italy
(Bezerra) Harrington Heart and Vascular Institute, University Hospitals
Cleveland Medical Center, Cleveland, OH, United States
(Wijns) Lambe Institute for Translational Research, NUI Galway, Galway,
Ireland
(Wijns) Saolta University Healthcare Group, Galway, Ireland
(McGreevy, Zhang, Rapoza, West) Abbott Vascular, Santa Clara, CA, United
States
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Publisher
Europa Group
Abstract
Aims: Randomised trials have demonstrated improvement in clinical outcomes
with intravascular ultrasound (IVUS)-guided percutaneous coronary
intervention (PCI) compared with angiography-guided PCI. The ILUMIEN III
trial demonstrated non-inferiority of an optical coherence tomography
(OCT)- versus IVUS-guided PCI strategy in achieving similar post-PCI lumen
dimensions. ILUMIEN IV is a large-scale, multicentre, randomised trial
designed to demonstrate the superiority of OCT- versus angiography-guided
stent implantation in patients with high-risk clinical characteristics
(diabetes) and/or complex angiographic lesions in achieving larger
post-PCI lumen dimensions and improving clinical outcomes. Methods
and Results: ILUMIEN IV is a prospective, single-blind clinical
investigation that will randomise between 2,490 and 3,656 patients using
an adaptive design to OCT-guided versus angiography-guided coronary stent
implantation in a 1:1 ratio. The primary endpoints are: (1) post-PCI
minimal stent area assessed by OCT in each randomised arm, and (2) target
vessel failure, the composite of cardiac death, target vessel myocardial
infarction, or ischaemia-driven target vessel revascularisation. Clinical
follow-up will continue for up to two years. The trial is currently
enrolling, and the principal results are expected in 2022.
 Conclusion(s): The large-scale ILUMIEN IV randomised controlled trial
will evaluate the effectiveness of OCT-guided versus angiography-guided
PCI in improving post-PCI lumen dimensions and clinical outcomes in
patients with diabetes and/or with complex coronary lesions. Trial
registration: NCT03507777 Copyright © Europa Digital & Publishing
2021. All rights reserved.

<33>
Accession Number
2012109122
Title
High-flow nasal cannula vs. Incentive spirometer after cardiac surgery: A
randomized controlled trial.
Source
Journal of the Medical Association of Thailand. 104 (5) (pp 794-801),
2021. Date of Publication: May 2021.
Author
Pibul W.; Kocharunjitt W.; Foofuengmonkolkit K.
Institution
(Pibul, Kocharunjitt, Foofuengmonkolkit) Cardiovascular Thoracic Surgery
Unit, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
Publisher
Medical Association of Thailand
Abstract
Background: Respiratory care after cardiac surgery is a challenging area
of medical treatment. High-flow nasal oxygen cannula (HFNC) may be used
for reducing the reintubation rate. Objective(s): The present study
aimed to compare the use of HFNC with that of an incentive spirometer (IS)
with respect to the reintubation rates in patients after cardiac surgery.
 Material(s) and Method(s): The authors conducted a prospective
randomized controlled trial of 67 cardiac surgery patients. The HFNC group
received the HFNC immediately after extubation performed within 24 hours,
and the IS group received the IS with breathing exercises. Reintubation,
length of intensive care unit, length of hospital stay, ratio of arterial
partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2),
partial pressure of carbon dioxide (PaCO2), and peak expiratory flow rate
(PEFR) were analyzed and compared. Result(s): The reintubation rate
was higher in the HFNC group, but the difference was not statistically
significant (p=0.054). Hypoxia was the most common cause of intervention
failure at 29.4% and 24.2% in the HFNC and IS groups, respectively. Four
(11.8%) reintubated patients in the HFNC group later progressed to
hospital-Acquired pneumonia, which resulted in longer hospital stays
(p=0.010). The PaO2/FiO2 ratio and PEFR decreased by 33.5% and 62.5%,
respectively, on postoperative day 1 and improved the following day. The
PaCO2 was within the normal limits in both groups. Conclusion(s):
Compared to IS, prophylactic HFNC 24 hours after cardiac surgery increased
the reintubation rate, but not significantly. The decision to administer
prophylactic HFNC support after extubation in cardiac surgery patients
should be contemplated on an individual basis. Trial registration: This
trial is registered at clinicaltrials.in.th, Thai Clinical Trials
Registry, TCTR20180201001. Copyright © 2021 Medical Association
of Thailand. All rights reserved.

<34>
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

<35>
Accession Number
2012394341
Title
Indirect impact of the COVID-19 pandemic on hospitalisations for
cardiometabolic conditions and their management: A systematic review.
Source
Primary Care Diabetes. 15 (4) (pp 653-681), 2021. Date of Publication:
August 2021.
Author
Seidu S.; Kunutsor S.K.; Cos X.; Khunti K.
Institution
(Seidu, Khunti) Leicester Real World Evidence Unit, Diabetes Research
Centre, University of Leicester, UK, United Kingdom
(Kunutsor) National Institute for Health Research Bristol Biomedical
Research Centre, University Hospitals Bristol and Weston NHS Foundation
Trust and the University of Bristol, Bristol, UK, United Kingdom
(Kunutsor) Musculoskeletal Research Unit, Translational Health Sciences,
Bristol Medical School, University of Bristol, Learning & Research
Building (Level 1), Southmead Hospital, Bristol, UK BS10 5NB, United
Kingdom
(Cos) DAP_Cat Research Group, Gerencia Territorial Barcelona Ciutat,
Institut Catala de la Salut, Foundation University Institute for Primary
Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Publisher
Elsevier Ltd
Abstract
Background: The Coronavirus disease 2019 (COVID-19) pandemic has led to a
dramatic crisis in health care systems worldwide. These may have
significant implications for the management of cardiometabolic diseases.
We conducted a systematic review of published evidence to assess the
indirect impact of the COVID-19 pandemic on hospitalisations for
cardiovascular diseases and their management. Method(s): Studies that
evaluated volume of hospitalisations for cardiometabolic conditions and
their management with comparisons between the COVID-19 and pre-COVID
periods were identified from MEDLINE, Embase and the reference list of
relevant studies from January 2020 to 25 February 2021. Result(s): We
identified 103 observational studies, with most studies assessing
hospitalisations for acute cardiovascular conditions such as acute
coronary syndrome, ischemic strokes and heart failure. About 89% of
studies reported a decline in hospitalisations during the pandemic
compared to pre-pandemic times, with reductions ranging from 20.2 to 73%.
Severe presentation, less utilization of cardiovascular procedures, and
longer patient- and healthcare-related delays were common during the
pandemic. Most studies reported shorter length of hospital stay during the
pandemic than before the pandemic (1-8 vs 2-12 days) or no difference in
length of stay. Most studies reported no change in in-hospital mortality
among hospitalised patients. Conclusion(s): Clinical care of patients
for acute cardiovascular conditions, their management and outcomes have
been adversely impacted by the COVID-19 pandemic. Patients should be
educated via population-wide approaches on the need for timely medical
contact and health systems should put strategies in place to provide
timely care to patients at high risk. Systematic review registration:
PROSPERO 2021: CRD42021236102 Copyright © 2021 Primary Care
Diabetes Europe

<36>
Accession Number
2011631697
Title
Meta-Analysis Comparing Valve in Valve Transcatheter Mitral Valve
Replacement Versus Redo Surgical Mitral Valve Replacement for Degenerating
Bioprosthetic Valves.
Source
American Journal of Cardiology. 149 (pp 155-156), 2021. Date of
Publication: 15 Jun 2021.
Author
Zahid S.; Ullah W.; Khan M.U.; Sarvepalli D.; Inayat A.; Salman F.; Khan
M.Z.
Institution
(Zahid) Rochester General Hospital, NY, United States
(Ullah) Abington Jefferson, PA, United States
(Khan, Khan) West Virginia University, WV, United States
(Sarvepalli) Gunter Medical College, India
(Inayat) Sisters of Charity Hospital, NY, United States
(Salman) St. Vincent Medical Center, Toledo, OH, United States
Publisher
Elsevier Inc.

<37>
Accession Number
2011540551
Title
Meta-analysis of minimalist versus standard care approach for
transcatheter aortic valve replacement.
Source
Expert Review of Cardiovascular Therapy. 19 (6) (pp 565-574), 2021. Date
of Publication: 2021.
Author
Qureshi W.T.; Kundu A.; Mir T.; Khan A.; Anwaruddin S.; Sattar Y.; Ogunsua
A.; Dutta A.; Majeed C.N.; Walker J.; Kakouros N.
Institution
(Qureshi, Kundu, Khan, Ogunsua, Kakouros) Division of Cardiovascular
Medicine, University of Massachusetts Medical School, Worcester, MA,
United States
(Mir) Department of Internal Medicine, Detroit Medical Centre, Wayne State
University, Detroit, United States
(Anwaruddin) Division of Cardiovascular Medicine, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
(Sattar) Department of Internal Medicine, Icahn School of Medicine at
Mount, Sinai Elmhurst Hospital, Queens, NY, United States
(Dutta) Department of Critical Care Medicine, Memorial Sloan Kettering,
NY, United States
(Majeed) Department of Internal Medicine, Section on Hospital Medicine,
Wake Forest School of Medicine, Winston-Salem, NC, United States
(Walker) Division of Cardiothoracic Surgery, University of Massachusetts
Medical School, Worcester, MA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: The change in practice of transcatheter aortic valve
replacement (TAVR) to a minimalist approach is a debate. Method(s):
Online database search for studies that compared the minimalist approach
with the standard approach for TAVR were searched from inception through
September 2020. We calculated pooled odds ratios (ORs) and 95% confidence
intervals (CIs) using the fixed or random-effects model. Result(s): A
total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and
standard TAVR; 1,814) were included. Compared to standard approach, there
were no significant differences in in-hospital mortality, 30-day
mortality, or hospital readmissions. However, there was a reduced risk of
acute kidney injury (OR0.49;95%CI0.27-0.89), major bleeding
(OR0.21;95%CI0.12-0.38) and major vascular complications
(OR0.60,95%CI0.39-0.91) associated with the minimalist TAVR group. There
was comparatively shorter hospital length of stay (mean difference
-2.41;95%CI-2.99,-1.83) days, procedural time (mean difference
-43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference
-2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference
-26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group.
 Conclusion(s): This meta-analysis demonstrated potential benefits of
the minimalist TAVR approach over the standard approach regarding some
adverse clinical outcomes as well as procedural outcomes without
significant differences in mortality or readmission rates. Copyright
© 2021 Informa UK Limited, trading as Taylor & Francis Group.

<38>
Accession Number
634929808
Title
Antifibrinolytics reduces blood loss in thoracic surgery: a systematic
review and meta-analysis.
Source
ANZ journal of surgery. 91 (6) (pp 1251-1259), 2021. Date of Publication:
01 Jun 2021.
Author
Leow L.; Ng J.; Luo H.D.; Choong A.M.T.L.; Mithiran H.; Kofidis T.; Tam
J.K.C.
Institution
(Leow, Luo, Choong, Mithiran, Kofidis, Tam) Department of Cardiac,
Thoracic and Vascular Surgery, National University Heart Centre Singapore,
National University Hospital Singapore, Singapore
(Ng) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Choong, Tam) Department of Surgery, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore
(Choong) Cardiovascular Research Institute, National University of
Singapore, Singapore
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose of this systematic review is to evaluate the
efficacy of antifibrinolytics in non-cardiac thoracic surgery.
 METHOD(S): We searched for all randomized controlled trials on this
topic. A set of strict inclusion and exclusion criteria was developed. Six
studies were meta-analysed together then in subgroups of topical
tranexamic acid and intravenous aprotinin. We compared postoperative chest
drain output, transfusions requirements and duration of hospital stay
where available to determine the efficacy of topical tranexamic acid or
intravenous aprotinin in reducing blood loss. RESULT(S): The use of
antifibrinolytics reduces 24-h chest drain output (-290.21mL [-524.75,
-55.66], P =0.02, I2 =98%), red blood cell transfusion requirements
(-1.27units [-2.24, -0.30], P =0.01, I2 =100%) and shortened duration of
hospital stay (-1.81days [-3.25, -0.36], P =0.01, I2 =96%). The subgroup
analysis also supported this trend. CONCLUSION(S): We conclude that
the use of antifibrinolytics appears to reduce postoperative blood loss by
reducing chest drain output, transfusion requirements and length of stay
after thoracic surgery. Copyright © 2021 Royal Australasian
College of Surgeons.

<39>
Accession Number
635396863
Title
Efficacy and Safety of Antifibrinolytic Drugs in Pediatric Surgery: A
Systematic Review.
Source
Seminars in Thrombosis and Hemostasis. 47 (5) (pp 538-568), 2021. Date of
Publication: 01 Jul 2021.
Author
Hovgesen N.T.; Larsen J.B.; Fenger-Eriksen C.; Hansen A.K.; Hvas A.-M.
Institution
(Hovgesen, Larsen, Hvas) Thrombosis and Hemostasis Research Unit,
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus,
Denmark
(Fenger-Eriksen) Department of Anesthesiology, Aarhus University Hospital,
Aarhus, Denmark
(Hansen) Neonatal Intensive Care Unit, Department of Pediatrics and
Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
(Hvas) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Publisher
Thieme Medical Publishers, Inc.
Abstract
Antifibrinolytic drugs are used to reduce blood loss and subsequent
transfusions during surgery and following trauma, but the optimal dosing
regimen in the pediatric population is still unresolved. The aim of this
systematic review was to evaluate efficacy and safety of antifibrinolytic
drugs in pediatric surgery and trauma to determine the optimal dosing
regimen. A literature search was performed in PubMed, Embase, Cochrane,
and Web of Science on May 3, 2020. We included randomized controlled
studies investigating the effect of tranexamic acid (TXA), aprotinin, and
epsilon-aminocaproic acid, in terms of reducing blood loss, blood
transfusions, reoperations, and rebleeds in pediatric patients aged 0 to
18 years undergoing cardiac surgery, noncardiac surgery, or trauma. Fifty
randomized controlled trials (RCTs) were included; 28 RCTs investigated
cardiac surgery and 22 investigated noncardiac surgery. No RCTs regarding
trauma met the inclusion criteria. All antifibrinolytic drugs reduced
postoperative blood loss and transfusions when used in pediatric surgery.
The dosing regimen varied between studies, but similar effect sizes were
found in terms of reduced blood loss regardless of the cumulative dose
used. Few studies found adverse events, and no difference in incidence or
type of adverse events was seen between the antifibrinolytic and the
placebo group. In conclusion, use of antifibrinolytics is efficient and
safe in children undergoing surgery. We propose TXA as the drug of choice
based on its level of evidence and safety profile; we recommend a dosing
regimen composed of a loading dose of 10 to 15 mg/kg prior to surgery
followed by 1 to 5 mg/kg/h as continuous infusion throughout
surgery. Copyright © 2021 SPIE. All rights reserved.

<40>
Accession Number
635396061
Title
Rationale and Design of Assessing the Effectiveness of Short-Term Low-Dose
Lithium Therapy in Averting Cardiac Surgery-Associated Acute Kidney
Injury: A Randomized, Double Blinded, Placebo Controlled Pilot Trial.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 639402.
Date of Publication: 14 Jun 2021.
Author
Sharif S.; Chen B.; Brewster P.; Chen T.; Dworkin L.; Gong R.
Institution
(Sharif) Division of Critical Care Medicine, St Francis Hospital, New
York, NY, United States
(Sharif, Chen, Dworkin, Gong) Division of Kidney Disease and Hypertension,
Department of Medicine, Rhode Island Hospital, Brown University School of
Medicine, Providence, RI, United States
(Chen, Brewster, Dworkin, Gong) Division of Nephrology, Department of
Medicine, University of Toledo Medical Center, Toledo, OH, United States
(Chen) Department of Mathematics and Statistics, The University of Toledo,
Toledo, OH, United States
Publisher
Frontiers Media S.A.
Abstract
Background: Burgeoning pre-clinical evidence suggests that therapeutic
targeting of glycogen synthase kinase 3beta (GSK3beta), a convergence
point of multiple cellular protective signaling pathways, confers a
beneficial effect on acute kidney injury (AKI) in experimental models.
However, it remains unknown if GSK3beta inhibition likewise mitigates AKI
in humans. Cardiac surgery associated acute kidney injury (CSA-AKI) poses
a significant challenge for clinicians and currently the only treatment
available is general supportive measures. Lithium, an FDA approved mood
stabilizer, is the best-known GSK3beta inhibitor and has been safely used
for over half a century as the first line regimen to treat bipolar
affective disorders. This study attempts to examine the effectiveness of
short term low dose lithium on CSA-AKI in human patients. Methods/Design:
This is a single center, prospective, randomized, double blinded, placebo
controlled pilot study on patients undergoing cardiac surgery with
cardiopulmonary bypass. Patients will be randomized to receive a small
dose of lithium or placebo treatment for three consecutive days. Renal
function will be measured via creatinine as well as novel AKI biomarkers.
The primary outcome is incidence of AKI according to Acute Kidney Injury
Network (AKIN) criteria, and secondary outcomes include receipt of new
dialysis, days on dialysis, days on mechanical ventilation, infections
within 1 month of surgery, and death within 90 days of surgery.
 Discussion(s): As a standard selective inhibitor of GSK3beta, lithium
has been shown to exert a beneficial effect on tissue repair and
regeneration upon acute injury in multiple organ systems, including the
central nervous system and hematopoietic system. In experimental AKI,
lithium at small doses is able to ameliorate AKI and promote kidney
repair. Successful completion of this study will help to assess the
effectiveness of lithium in CSA-AKI and could potentially pave the way for
large-scale randomized trials to thoroughly evaluate the efficacy of this
novel regimen for preventing AKI after cardiac surgery. Trial
Registration: This study was registered prospectively on the 17th February
2017 at ClinicalTrials.gov (NCT03056248,
https://clinicaltrials.gov/ct2/show/NCT03056248?term=NCT03056248&draw=2&ra
nk=1). © Copyright © 2021 Sharif, Chen, Brewster, Chen,
Dworkin and Gong.

<41>
Accession Number
2013365395
Title
Prognostic models for mortality after cardiac surgery in patients with
infective endocarditis: a systematic review and aggregation of prediction
models.
Source
Clinical Microbiology and Infection. (no pagination), 2021. Date of
Publication: 2021.
Author
Fernandez-Felix B.M.; Barca L.V.; Garcia-Esquinas E.; Correa-Perez A.;
Fernandez-Hidalgo N.; Muriel A.; Lopez-Alcalde J.; Alvarez-Diaz N.; Pijoan
J.I.; Ribera A.; Elorza E.N.; Munoz P.; Farinas M.D.C.; Goenaga M.A.;
Zamora J.
Institution
(Fernandez-Felix, Correa-Perez, Muriel, Lopez-Alcalde, Zamora) Clinical
Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid,
Spain
(Fernandez-Felix, Garcia-Esquinas, Muriel, Lopez-Alcalde, Pijoan, Ribera,
Zamora) CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
(Barca) Department of Cardiovascular Surgery, Fundacion Jimenez Diaz
University Hospital, Madrid, Spain
(Garcia-Esquinas) Department of Preventive Medicine and Public Health,
School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
(Garcia-Esquinas) IdiPaz (Hospital Universitario La Paz-Universidad
Autonoma de Madrid), Madrid, Spain
(Correa-Perez, Lopez-Alcalde) Faculty of Medicine, Universidad Francisco
de Vitoria, Madrid, Spain
(Fernandez-Hidalgo) Servei de Malalties Infeccioses, Hospital Universitari
Vall d'Hebron, Barcelona, Spain
(Fernandez-Hidalgo) Red Espanola de Investigacion en Patologia Infecciosa
(REIPI), Instituto de Salud Carlos III, Madrid, Spain
(Lopez-Alcalde) Institute for Complementary and Integrative Medicine,
University Hospital Zurich and University of Zurich, Zurich, Switzerland
(Alvarez-Diaz) Medical Library, Hospital Universitario Ramon y Cajal
(IRYCIS), Madrid, Madrid, Spain
(Pijoan) Hospital Universitario Cruces/OSI EEC, Barakaldo, Spain
(Pijoan) Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
(Ribera) Cardiovascular Epidemiology and Research Unit, Hospital
Universitari Vall d'Hebron, Barcelona, Spain
(Elorza) Department of Infectology, Hospital Universitario Ramon y Cajal
(IRYCIS), Madrid, Spain
(Munoz) Clinical Microbiology and Infectious Diseases Service, Hospital
General Universitario Gregorio Maranon, Instituto de Investigacion
Sanitaria Gregorio Maranon, CIBER Enfermedades Respiratorias-CIBERES,
Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
(Farinas) Infectious Diseases Service, Hospital Universitario Marques de
Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
(Goenaga) Infectious Diseases Service, Hospital Universitario Donostia,
IIS Biodonostia, OSI Donostialdea, San Sebastian, Spain
(Zamora) WHO Collaborating Centre for Global Women's Health, Institute of
Metabolism and Systems Research, University of Birmingham, Birmingham,
United Kingdom
Publisher
Elsevier B.V.
Abstract
Background: There are several prognostic models to estimate the risk of
mortality after surgery for active infective endocarditis (IE). However,
these models incorporate different predictors and their performance is
uncertain. Objective(s): We systematically reviewed and critically
appraised all available prediction models of postoperative mortality in
patients undergoing surgery for IE, and aggregated them into a meta-model.
Data sources: We searched Medline and EMBASE databases from inception to
June 2020. Study eligibility criteria: We included studies that developed
or updated a prognostic model of postoperative mortality in patient with
IE. Method(s): We assessed the risk of bias of the models using
PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated
them into an aggregate meta-model based on stacked regressions and
optimized it for a nationwide registry of IE patients. The meta-model
performance was assessed using bootstrap validation methods and adjusted
for optimism. Result(s): We identified 11 prognostic models for
postoperative mortality. Eight models had a high risk of bias. The
meta-model included weighted predictors from the remaining three models
(EndoSCORE, specific ES-I and specific ES-II), which were not rated as
high risk of bias and provided full model equations. Additionally, two
variables (age and infectious agent) that had been modelled differently
across studies, were estimated based on the nationwide registry. The
performance of the meta-model was better than the original three models,
with the corresponding performance measures: C-statistics 0.79 (95% CI
0.76-0.82), calibration slope 0.98 (95% CI 0.86-1.13) and
calibration-in-the-large -0.05 (95% CI -0.20 to 0.11). Conclusion(s):
The meta-model outperformed published models and showed a robust
predictive capacity for predicting the individualized risk of
postoperative mortality in patients with IE. Protocol Registration:
PROSPERO (registration number CRD42020192602). Copyright © 2021
European Society of Clinical Microbiology and Infectious Diseases

<42>
Accession Number
635420563
Title
Bi-atrial or left atrial ablation of atrial fibrillation during
concomitant cardiac surgery: A Bayesian network meta-analysis of
randomized controlled trials.
Source
Journal of cardiovascular electrophysiology. (no pagination), 2021. Date
of Publication: 23 Jun 2021.
Author
Guo Q.; Yan F.; Ouyang P.; Xie Z.; Wang H.; Yang W.; Pan X.
Institution
(Guo, Ouyang, Pan) Department of Cardiac Surgery, Yunnan Fuwai
Cardiovascular Hospital, Kunming Medical University, Kunming, China
(Guo, Wang) Department of Cardiovascular Surgery, First Affiliated
Hospital of Kunming Medical University, Kunming, China
(Guo, Yan, Xie, Wang, Yang) School of Pharmaceutical Science and Yunnan
Key Laboratory of Pharmacology for Natural Products, Kunming Medical
University, Kunming, China
(Yan) Department of Ophthalmology, First Affiliated Hospital of Kunming
Medical University, Kunming, China
(Xie) Department of Cardiology, Yunnan Fuwai Cardiovascular Hospital,
Kunming Medical University, Kunming, China
(Pan) Department of Structural Heart Disease, National Center for
Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical
Sciences & Peking Union Medical College, Beijing, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Surgical ablation of atrial fibrillation (AF) has became a
routine procedure during concomitant cardiac surgery, however, the
extension of lesion sets remained controversial. We sought to compare the
relative benefit and risk of different lesion sets through a Bayesian
network meta-analysis (NMA). METHOD(S): Pubmed, Embase and Cochrane
Trials databases were searched for randomized controlled trials (RCTs)
comparing the rhythm outcome of AF patients undergoing pulmonary vein
isolation (PVI), left atrial Maze (LAM), bi-atrial Maze (BAM) or no
ablation during concomitant cardiac surgery. A NMA was conducted to
explore the difference of over 1 year AF freedom as well as risks for
early mortality and permanent pacemaker implantation (PPMI).
 RESULT(S): 2031 patients of 19 RCTs were included. PVI, LAM and BAM
(O.R. [95% Cr.I]: 5.02[2.72, 10.02], 7.97[4.93, 14.29], 8.29[4.90, 14.86],
P<0.05) demonstrated higher freedom of AF compared with no ablation,
however, no significant difference of rhythm outcome was found among the
three ablation strategies based on random-effects model. BAM was
associated with a increase of early mortality when compared with no
ablation (O.R. [95% Cr.I]: 4.08[1.23, 17.30], P<0.05), while none of the
remaining comparisons reached statistically difference in terms of early
mortality and PPMI. CONCLUSION(S): Bi-atrial ablation is not superior
than left atrial ablation strategies in reducing AF recurrence for
un-selected surgical patients. BAM have higher risk of early mortality
than no ablation, but no difference was found between bi-atrial and left
atrial ablation in regards to early mortality and PPMI based on the
current evidence. This article is protected by copyright. All rights
reserved.

<43>
Accession Number
635420441
Title
Safety and Efficacy of Left Atrial Appendage Closure Using an Epicardial
Suture Snaring Device: Systematic Review and Current Status.
Source
Journal of cardiovascular electrophysiology. (no pagination), 2021. Date
of Publication: 23 Jun 2021.
Author
Sabzwari S.R.A.; Mehta N.A.; Garg L.; Racharla L.; Kurtz E.; Afzal M.R.;
Turagam M.K.; Lakkireddy D.
Institution
(Sabzwari) Department of Electrophysiology, University of Colorado, CO,
Aurora, United States
(Mehta, Racharla) Department of Cardiology, Lehigh Valley Health Network,
PA, Allentown, United States
(Garg) Department of Electrophysiology, Hospital of the University of
Pennsylvania, PA
(Kurtz) Department of Internal Medicine, Lehigh Valley Health Network, PA,
Allentown, United States
(Afzal) Department of Electrophysiology, Ohio State University, Columbus,
OH
(Turagam) Department of Electrophysiology, The Mount Sinai Hospital, New
York City, NY
(Lakkireddy) Department of Electrophysiology, Overland Park Regional
Medical Center, Overland Park
Publisher
NLM (Medline)
Abstract
BACKGROUND: The LARIAT epicardial suture snaring device has been fraught
with technical challenges and procedural complications. Over time,
technique modification and improved operator experience have helped
overcome many of these challenges. METHODS AND RESULTS: Studies reporting
left atrial appendage epicardial closure over a 12 year period from
2009-2020 were evaluated. The primary efficacy outcome evaluated was left
atrial appendage closure with residual flow <=1 mm. Safety outcomes
evaluated were periprocedural and long term complications after device
placement. Nine studies consisting of 1,430 patients were included in this
analysis, of which 1,386 (97%) underwent successful device placement. The
mean age was 69.3 years, with a mean CHADS2 -VASC score of 3.78. Primary
efficacy end point was achieved in 95.8% patients immediately after device
placement, and in 92.8% patients on long term follow-up. Early procedural
complications consisted of pericardial effusion 5.6%, cardiac perforation
2.7%, pericarditis 2.6%, and need for open heart surgery 1.5%. Long term
complications included an all-cause mortality of 2.3%, stroke 1.5%, and
left atrial appendage thrombus 2.3%. Reduced complications were noted
using micropuncture needles (2.20% vs 10.14%; P<0.0001), a longer duration
pericardial drainage, and use of anti-inflammatory medications (1.58% vs
8.4%). Oral anticoagulation use decreased substantially from 44.7% to
22.9% post device implantation, and to 8.5% on last clinical follow up.
 CONCLUSION(S): The LARIAT device is effective in epicardial closure
of the left atrial appendage. Improvement in device techniques such as use
of micropuncture needle, prophylactic colchicine, and maintenance of a
pericardial drain have helped improve safety over time. This article is
protected by copyright. All rights reserved.

<44>
Accession Number
635420350
Title
Aortic valve myxoma - A systematic review of published cases.
Source
International journal of clinical practice. (pp e14566), 2021. Date of
Publication: 24 Jun 2021.
Author
Sachdeva S.; Desai R.; Shamim S.; Gandhi Z.; Shrivastava A.; Patel D.;
Uzair Lodhi M.; Raina J.; Itare V.; Mahmood A.; Sachdeva R.; Kumar G.
Institution
(Sachdeva) Section of Cardiovascular Medicine, Department of Medicine,
Boston University School Of Medicine, MA, United States
(Desai, Sachdeva, Kumar) Division of Cardiology, Atlanta VA Medical
Center, Decatur, United States
(Shamim) Internal Medicine, AIM Medical Center, Snellville, United States
(Gandhi) Department of Medicine, C.U. Shah Medical College, Surendranagar,
Gujarat, India
(Shrivastava) Department of Pediatrics, Children's Hospital of Michigan,
Detroit Medical Center, MI, Detroit, United States
(Patel) Department of Internal Medicine, Texas Tech University Health
Sciences Center El Paso, TX, United States
(Uzair Lodhi, Mahmood) Department of Internal Medicine, Eastern Idaho
Regional Medical Center, ID, Idaho Falls, United States
(Raina, Itare) Department of Internal Medicine, Brookdale University
Hospital and Medical Center, NY, United States
(Sachdeva) Division of Cardiology, Morehouse School of Medicine, Atlanta,
United States
(Sachdeva) Division of Cardiology, Medical College of Georgia, Augusta,
United States
(Kumar) Division of Cardiology, Emory University School of Medicine,
Atlanta, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aortic valve myxoma is the rarest location of the most common
primary tumor of cardiac origin. Due to the paucity of data, there is
little known about their clinical presentation, diagnosis and
complications. METHOD(S): PUBMED, EMBASE, SCOPUS and WEB OF SCIENCE
were systematically searched to identify all published cases of aortic
valve myxoma through October 2020. Descriptive statistics were used to
report the data. RESULT(S): Aortic valve myxomas were more prevalent
in young (mean age 41 years) male (75%) patients. It most commonly
involved the right coronary cusp (50%). Cerebrovascular events (25%),
dyspnea(18.8%), and distal embolization(18.8%) were found to be the most
frequent complications. Echocardiography remains the diagnostic modality
of choice in all cases, histopathology is used for confirmation. Most
cases were treated with surgical excision (94%); concomitant aortic valve
repair and mechanical aortic valve replacement were performed in 25% and
37.5% cases respectively. Sudden cardiac death was noted in one patient.
 CONCLUSION(S): Aortic valve myxomas are more often than not
discovered in the context of embolic phenomenon or dyspnea. The most
feared complication is stroke, although mortality remains low in
surgically managed cases. Copyright This article is protected by
copyright. All rights reserved.

<45>
Accession Number
635414391
Title
Incidence of Herpes Zoster in Adult Solid Organ Transplant Recipients: A
Meta-analysis and Comprehensive Review.
Source
Transplant infectious disease : an official journal of the Transplantation
Society. (pp e13674), 2021. Date of Publication: 21 Jun 2021.
Author
Kwon D.E.; Lee H.S.; Lee K.H.; La Y.; Han S.H.; Song Y.G.
Institution
(Kwon, Lee, La, Han, Song) Division of Infectious Disease, Department of
Internal Medicine, Yonsei University College of Medicine, Seoul, South
Korea
(Lee) Biostatistics Collaboration Unit, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Chronic immunosuppressive therapy in solid organ transplant
(SOT) recipients can trigger latent varicella zoster virus reactivation
even in those with stable graft function. The inactivated herpes zoster
(HZ) vaccine can be effective in preventing post-transplant HZ, which can
cause severe neuralgia or disseminated disease. This meta-analysis aims to
assess the incidences of HZ across transplant organs in SOT recipients.
 METHOD(S): We included 12 observational studies (6560 recipients)
from a PubMed and EMBASE search of articles through October 2019 and
collected data from single-center dating from January 2001 to December
2017 (3498 recipients). The pooled HZ incidence and its differences
between subgroups was obtained from random-effect models and meta-analysis
of variance tests using R package. RESULT(S): The overall pooled
crude incidence was 9.1% (95% confidence interval [CI], 7.6-10.8%). The
pooled incidence was similar between sexes but significantly different
between transplanted organs (P < 0.001). Heart transplants (HT) (n=644)
had the highest pooled incidence with 15.2% (95% CI, 12.7-18.2%), followed
by lung transplants (LTX) (n=780) with 11.0% (8.3-14.4%). Kidney
transplants (n=5435) had the lowest incidence of 6.7 (5.1-8.8%). The
meta-regression analysis revealed that HZ development had a relationship
with past graft rejection (P = 0.024). CONCLUSION(S): This data
supports the need for subunit HZ vaccination in SOT recipients with a high
risk for HZ, especially HT and LTX recipients, without respect to the late
post-transplant period. Copyright This article is protected by
copyright. All rights reserved.

<46>
[Use Link to view the full text]
Accession Number
2007517294
Title
Complete revascularization of stable stemi patients offers a significant
benefit if done during the index pci, but not if it's done as a staged
procedure.
Source
International Journal of General Medicine. 14 (pp 2239-2248), 2021. Date
of Publication: 2021.
Author
Cerrud-Rodriguez R.C.; Rashid S.M.I.; Wiley K.A.; Gonzalez M.; Kosmacheva
V.A.; Castillero-Norato I.; Rivera C.; Villablanca P.; Wiley J.
Institution
(Cerrud-Rodriguez, Rashid, Wiley, Gonzalez, Kosmacheva, Rivera, Wiley)
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical
Center, Albert Einstein College of Medicine, Bronx, NY, United States
(Castillero-Norato) Facultad de Medicina, Universidad de Panama, Campus
Octavio Mendez Pereira, Panama City, Panama
(Villablanca) Department of Medicine, Division of Cardiology, Henry Ford
Hospital, Detroit, MI, United States
Publisher
Dove Medical Press Ltd
Abstract
Background: Complete revascularization (CR) of hemodynamically stable
STEMI improves outcomes when compared to culprit-only PCI. However, the
optimal timing for CR (CR during index PCI [iCR] versus staged PCI [sCR])
is unknown. sCR is defined as revascularization of non-culprit lesions not
done during the index procedure (mean 31.5+/-24.6 days after STEMI). Our
goal was to determine whether iCR was the superior strategy when compared
to sCR. Method(s): A systematic review of Medline, Cochrane, and
Embase was performed for RCTs reporting outcomes of stable STEMI patients
who had undergone CR. Only RCTs with a clearly defined timing of CR, for
the classification into iCR and sCR, and a follow-up of at least 12 months
were included. Seven RCTs comprising 6647 patients (mean age:62.9+/-1.4
years, male sex:79.4%) met these criteria and were included.
 Result(s): After a mean follow-up of 25.1+/-9.4 months, iCR was
associated with a significant reduction in cardiovascular mortality (risk
ratio [RR] 0.48, 95% confidence interval [CI] 0.26-0.90, p=0.02, relative
risk reduction [RRR] 52%) and non-fatal reinfarctions (RR 0.42, 95% CI
0.25-0.70, p=0.001, RRR: 58%). sCR showed a significant reduction in
non-fatal reinfarctions only (RR 0.68, 95% CI 0.54-0.85, p=0.0008, RRR:
32%). There was no difference in the safety outcome of contrast-induced
nephropathy between groups. Conclusion(s): iCR of stable STEMI
patients is associated with a significant reduction in cardiovascular
death and a trend towards reduction in all-cause mortality. These benefits
are not seen in sCR. Both strategies are associated with a reduction in
non-fatal reinfarctions. Copyright © 2021 Cerrud-Rodriguez et al.

<47>
Accession Number
2011014770
Title
The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane
Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (8) (pp 2483-2495),
2021. Date of Publication: August 2021.
Author
Kaddoura R.; Omar A.S.; Ibrahim M.I.M.; Alkhulaifi A.; Lorusso R.;
Elsherbini H.; Soliman O.; Caliskan K.
Institution
(Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical
Corporation, Doha, Qatar
(Omar, Alkhulaifi) Department of Cardiothoracic Surgery/Cardiac Anesthesia
& ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
(Ibrahim) Faculty of Pharmacy, Qatar University, Doha, Qatar
(Lorusso) Maastricht University Medical Centre (MUMC) Cardiovascular
Research Institute, Maastricht (CARIM) Maastricht University, Roterdam,
Netherlands
(Elsherbini) Cardiology, Erasmus University Medical Center, Roterdam,
Netherlands
(Soliman) National University of Ireland Galway, Galway, Ireland
(Caliskan) Cardiology, Erasmus University Medical Center, Roterdam,
Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)
provides a temporary support system for patients with cardiogenic shock
refractory to conventional medical therapies. It has been reported that
levosimendan may facilitate VA-ECMO weaning and improve survival. The
primary objective of this review was to examine the effect of levosimendan
use on VA-ECMO weaning and mortality in critically ill patients on
VA-ECMO. Design(s): MEDLINE, EMBASE, and CENTRAL were searched. A
pair of reviewers identified eligible clinical trials. Two reviewers
extracted data and independently assessed the risk of bias. A
random-effect model was used to combine data. The primary outcome was the
success of weaning from VA-ECMO. Measurements and Main Results: Seven
studies of observational design, including a total of 630 patients, were
selected in the final analysis. The sample size ranged from ten-to-240
patients, with a mean age between 53 and 65 years, and more than half of
them underwent cardiac surgeries. The VA-ECMO durations varied between
four and 11.6 days. Overall, levosimendan use was significantly associated
with successful weaning compared with control (odds ratio [OR] 2.89, 95%
CI, 1.53-5.46; p<inf>overall effect</inf> = 0.001); I2 = 49%).
For survival, six studies (n = 617) were included in the meta-analysis
involving 326 patients in the levosimendan group and 291 in the comparator
group. Pooled results showed a significantly higher survival rate in the
levosimendan group (OR 0.46, 95% CI, 0.30-0.71; p<inf>overall effect</inf>
= 0.0004; I2 = 20%). Conclusion(s): Levosimendan therapy
was significantly associated with successful weaning and survival benefit
in patients with cardiogenic or postcardiotomy shock needing VA-ECMO
support for severe cardiocirculatory compromise. To date, there is limited
literature and absence of evidence from randomized trials addressing the
use of levosimendan in VA-ECMO weaning. This study may be considered a
hypothesis-generating research for randomized controlled trials to confirm
its findings. Copyright © 2021 The Authors

<48>
Accession Number
2010573225
Title
A Randomized Comparison of Positional Stability: The EZ-Blocker Versus
Left-Sided Double-Lumen Endobronchial Tubes in Adult Patients Undergoing
Thoracic Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (8) (pp 2319-2325),
2021. Date of Publication: August 2021.
Author
Morris B.N.; Fernando R.J.; Garner C.R.; Johnson S.D.; Gardner J.C.;
Marchant B.E.; Johnson K.N.; Harris H.M.; Russell G.B.; Wudel L.J.;
Templeton T.W.
Institution
(Morris, Fernando, Garner, Johnson, Gardner, Marchant, Johnson, Harris,
Russell, Templeton) Department of Anesthesiology, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Wudel) Department of Cardiothoracic Surgery, Wake Forest School of
Medicine, Winston-Salem, NC, United States
(Russell) Division of Public Health Sciences\Department of Biostatistics
and Data Science
Publisher
W.B. Saunders
Abstract
Objective: To assess if there is a difference in the repositioning rate of
the EZ-Blocker versus a left-sided double-lumen endobronchial tube (DLT)
in patients undergoing thoracic surgery and one-lung ventilation.
 Design(s): Prospective, randomized. Setting(s): Single center,
university hospital. Participant(s): One hundred sixty-three thoracic
surgery patients. Intervention(s): Patients were randomized to either
EZ-Blocker or a DLT. Measurements and Main Results: The primary
outcome was positional stability of either the EZ-Blocker or a left-sided
double-lumen endobronchial tube, defined as the number of repositionings
per hour of surgery and one-lung ventilation. Secondary outcomes included
an ordinal isolation score from 1 to 3, in which 1 was poor, up to 3,
which represented excellent isolation, and a visual analog postoperative
sore throat score (0-100) on postoperative days (POD) one and two. Rate of
repositionings per hour during one-lung ventilation and surgical
manipulation in left-sided cases was similar between the two devices: 0.08
+/- 0.15 v 0.11 +/- 0.3 (p = 0.72). In right-sided cases, the rate of
repositioning was higher in the EZ-Blocker group compared with DLT: 0.38
+/- 0.65 v 0.09 +/- 0.21 (p = 0.03). Overall, mean isolation scores for
the EZ-Blocker versus the DLT were 2.76 v 2.92 (p = 0.04) in left-sided
cases and 2.70 v 2.83 (p = 0.22) in right-sided cases. Median sore throat
scores for left sided cases were 0 v 5 (p = 0.13) POD one and 0 v 5 (p =
0.006) POD two for the EZ-Blocker and left-sided DLT, respectively.
 Conclusion(s): For right-sided procedures, the positional stability
of the EZ-Blocker is inferior to a DLT. In left-sided cases, the rate of
repositioning for the EZ-Blocker and DLT are not statistically
different. Copyright © 2020 Elsevier Inc.

<49>
Accession Number
2008566461
Title
The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain
After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (8) (pp 2438-2446),
2021. Date of Publication: August 2021.
Author
Xu Z.; Dai S.-H.; Jiang J.-L.; He L.-L.; Zheng J.-Q.; Yu H.
Institution
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) Department of Anesthesiology, West
China Hospital, Sichuan University, Chengdu, China
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) The Research Units of West China
(2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Sternal incisions can generate persistent and intense
post-sternotomy pain. Propofol has been shown to improve postoperative
analgesia, but the preventive effect on persistent pain after cardiac
surgery is unknown. The hypothesis of the present study was that
intraoperative propofol-based anesthesia compared with volatile anesthesia
could reduce the risk of chronic pain after cardiac surgery.
 Design(s): A single-center, two-arm, patient-and-evaluator-blinded,
randomized controlled trial. Setting(s): A single major urban
teaching and university hospital. Patient(s): Five-hundred adult
patients undergoing cardiac surgery via sternotomy randomly were assigned.
With six withdrawals from the study and five from surgery, 244 in the
total intravenous anesthesia group and 245 in the volatile group were
included in the modified intention-to-treat analysis.
 Intervention(s): Patients randomly were assigned to receive either
propofol-based total intravenous anesthesia or volatile anesthesia during
surgery. Measurements and Main Results: The primary outcomes were the
incidence of pain at three, six, and 12 months after surgery defined as
pain score >0 on the numeric rating scale. The secondary outcomes included
acute pain, opioid use during the first 72 hours after surgery, and
quality of life. The use of propofol did not significantly affect chronic
pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence
interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%,
difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v
20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with
volatile anesthetics. Furthermore, there were no differences in acute pain
score; morphine-equivalent consumption during the first 72 hours; and
quality of life at three, six, and 12 months after surgery.
 Conclusion(s): Intraoperative administration of propofol did not
reduce persistent pain after cardiac surgery compared with volatile
anesthetics. Copyright © 2020 Elsevier Inc.

<50>
Accession Number
2007883469
Title
Combined Cardiothoracic Surgery and Liver Transplantation Versus Isolated
Liver Transplantation.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (8) (pp 2363-2369),
2021. Date of Publication: August 2021.
Author
Bui C.C.M.; Tanner C.; Nguyen-Buckley C.; Scovotti J.; Wray C.; Xia V.W.
Institution
(Bui, Tanner, Nguyen-Buckley, Scovotti, Wray, Xia) Department of
Anesthesiology and Perioperative Medicine, David Geffen School of Medicine
at UCLA, Los Angeles, CA, United States
Publisher
W.B. Saunders
Abstract
Objective: Combined cardiothoracic surgery and liver transplantation
(cCSLT) recently increasingly has been used. Despite that, liver
transplant immediately after cardiothoracic surgery has not been
well-characterized. The authors aimed to compare perioperative management
and postoperative outcomes between patients undergoing cCSLT and isolated
liver transplantation (iLT). Design(s): A retrospective study.
 Setting(s): University tertiary medical center. Participant(s):
Twenty-five cCSLT patients and 1091 iLT patients at a single institution
from 2010 to 2017. Intervention(s): Twenty-five cCSLT patients were
compared with 100 randomly selected and 100 propensity-matched iLT
patients. Measurements and Main Results: All cCSLT patients underwent
comprehensive preoperative evaluation by a multidisciplinary team. Of 25
cardiothoracic surgeries, heart transplant (n = 9) was most common,
followed by coronary artery bypass grafting (n = 5) and lung transplant (n
= 3). Intraoperative management of cCSLT was provided by 2 separate teams,
one for cardiothoracic surgery and one for liver transplantation. Patients
undergoing cCSLT often required cardiopulmonary bypass, an intra-aortic
balloon pump, extracorporeal membrane oxygenation, or cardiac
pharmacologic therapies and, additionally, needed more interventions
including antifibrinolytic administration, venovenous bypass, massive
blood transfusion, and platelet transfusions compared with iLT patients.
Ninety-day survival rates were similar in the cCSLT (100%) and iLT groups
(random iLT 87% and matched iLT 93%, log-rank test p = 0.089).
 Conclusion(s): Despite having end-stage liver disease and advanced
cardiothoracic disorders and experiencing a complex intraoperative course,
cCSLT patients had comparable 90-day survival to iLT patients.
Comprehensive planning before transplant, optimal patient/donor selection,
the multiple-team model, and meticulous intraoperative management are
critical to the success of cCSLT. Copyright © 2020 Elsevier Inc.

<51>
Accession Number
634017057
Title
Chest keloids: effect of surgical excision and adjuvant radiotherapy on
recurrence, a systematic review and meta-analysis.
Source
ANZ journal of surgery. 91 (6) (pp 1104-1109), 2021. Date of Publication:
01 Jun 2021.
Author
Miles O.J.; Zhou J.; Paleri S.; Fua T.; Ramakrishnan A.
Institution
(Miles) Department of Plastic and Reconstructive Surgery, St Vincent's
Hospital Melbourne, VIC, Australia
(Zhou) Department of Plastic and Reconstructive Surgery, Alfred Hospital
Melbourne, Melbourne, VIC, Australia
(Paleri) Department of Cardiology, St Vincent's Hospital Melbourne, VIC,
Australia
(Fua) Department of Radiation Oncology, Peter MacCallum Cancer Centre,
Melbourne, VIC, Australia
(Ramakrishnan) Department of Plastic and Reconstructive Surgery, Royal
Melbourne Hospital, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Chest keloids are a difficult sub-group of scars to treat,
likely secondary to the high wound tension in the area that promotes
excessive fibroblast proliferation and collagen deposition. Excision and
adjuvant radiotherapy has been demonstrated as an efficacious treatment
for keloids in general, but no meta-analysis exists to support the claims
for chest keloids. This study aims to identify the rate of recurrence
after surgical resection and radiotherapy on patients with chest keloids.
 METHOD(S): A search was performed using Embase, MEDLINE, Pubmed and
Cochrane database on 22 December 2018 for terms 'radiotherapy', 'keloid'
and 'chest'. Papers included met a prospectively designed inclusion
criteria assessed by multiple investigators. RESULT(S): Twelve
studies, including 1 randomized controlled trial, were included for a
total of 400 patients with a chest keloid scar managed with surgical
excision and adjuvant radiotherapy. Overall pooled-estimate of recurrence
rate was 22% (95% CI 12-32%). Meta-regression did not demonstrate a
significant effect for method of wound closure, type of radiotherapy,
radiotherapy dose (BED10 ) and study type. CONCLUSION(S): Excision
and adjuvant radiotherapy represents an effective method of treatment for
chest keloids, however sufficient prospective data, including randomized
controlled trials, did not yet exist to support these findings. Further
studies with sufficient sub-group analysis for keloid location are
required to add to the pool of literature that can be added to this
meta-analysis. Copyright © 2021 Royal Australasian College of
Surgeons.

<52>
Accession Number
2007658702
Title
NGS of micrornas involved in cardioprotection induced by sevoflurane
compared to propofol in myocardial revascularization surgery: The
ACDHUVV-16 clinical trial.
Source
Current Medicinal Chemistry. 28 (20) (pp 4074-4086), 2021. Date of
Publication: 2021.
Author
Guerrero Orriach J.L.; Escalona Belmonte J.J.; Aliaga M.R.; Fernandez
A.R.; Rodriguez Capitan M.J.; Munoz G.Q.; Ponferrada A.R.; Torres J.A.;
Santiago-Fernandez C.; Gonzalez E.M.; Navarro M.R.; Bautista R.; Maldonado
J.G.; Garrido-Sanchez L.; Manas J.C.
Institution
(Guerrero Orriach, Escalona Belmonte, Aliaga, Fernandez, Rodriguez
Capitan, Munoz, Ponferrada, Navarro, Manas) Department of
Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Malaga,
Spain
(Guerrero Orriach, Escalona Belmonte, Aliaga, Fernandez, Rodriguez
Capitan, Munoz, Ponferrada, Santiago-Fernandez, Navarro, Garrido-Sanchez,
Manas) Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga,
Spain
(Torres, Santiago-Fernandez, Garrido-Sanchez) Unidad de Gestion Clinica de
Endocrino-logia y Nutricion, Hospital Universitario Virgen de la Victoria,
Malaga, Spain
(Gonzalez) Department of Anesthesia, Hospital Universitario, Sanitas La
Moraleja, Spain
(Bautista, Maldonado) Genomic and Ultrasecuenciation. Supercomputacion y
Bioinnovacion Center, Malaga University, Malaga, Spain
(Garrido-Sanchez) CIBER Fisiopatologia de la Obesidad y
Nu-tricion-CIBEROBN, Instituto de Salud, Carlos III, Spain
Publisher
Bentham Science Publishers
Abstract
Background: Numerous studies have demonstrated that halogenated agents
elicit myocardial conditioning effects when administered perioperatively
in cardiac surgery. Recent evidence has been pub-lished on the benefits of
maintaining exposure to halogenated agents during the early postoperative
pe-riod. The enzymatic mechanisms by which this beneficial effect is
exerted were explained recently. Objective(s): Our study was
performed to investigate whether this phenomenon is mediated by either the
activation or suppression of miRNAs targeted by halogenated anesthetics.
 Method(s): A double-blind, two-stage trial was conducted. The results
of the first stage of the trial are pre-sented in this paper. The sample
was composed of patients undergoing off-pump myocardial revasculari-zation
surgery. Patients were randomized to receive either sevoflurane [S] or
propofol [P] during the in-traoperative and early postoperative period
(during the first six hours after the intervention). Hemodynam-ics (heart
rate, blood pressure, central venous pressure, cardiac index, systolic
volume index, LVEF) and myocardial enzymes (troponin I) were monitored at
six hour intervals during the first 48 hours. In the first stage of the
trial, blood was drawn for gene sequencing from eight patients (four per
group) at baseline and at 24 h. In the second stage of the study, a qPCR
analysis was performed of the miRNAs identified as significant by gene
sequencing. Levels of cardioprotective enzymes (serine/threonine protein
kinase (Akt), tumor necrosis factor alpha (TNFalpha), extracellular
regulated protein kinase (ERK 1/2), and caspase 3) were measured to assess
their role in myocardial conditioning pathways. The purpose was to
identify the miRNAs that play a major role in myocardial conditioning
induced by halogenated agents. Concentrations of cardioprotective enzymes
were higher in patients who received sevoflurane than the patients who
were administered propofol. Result(s): NGS differences were observed
between baseline and 24-h values in the two study groups. In group P,
miRNA 197-3p was overexpressed, whereas miRNAs 4443 and 1294, 708-3p were
underex-pressed. In group S, miRNAs 615-3p, 4466, 29, 937-3p, 636, 197-3P,
184, 4685, 296-3p, 147b, 3199, 6815, 1294 and 3176 were underexpressed;
whereas 708-3p was overexpressed. qPCR showed significant variations in
miRNAs 197-3p, 4443, 708-3p and 1294 in the P group, and in miRNAs 937-3p,
636, 197-3p, 296-3p and 708-3p in the S group. Conclusion(s): In the
P Group, changes in the expression of some miRNAs were associated with
lower concentrations of the enzymes involved in myocardial pre-and
postconditioning. In contrast, in Group S, variations in miRNAs were
associated with the activation of mediators of anesthetic-induced pre-and
post-conditioning, a reduction in cell apoptosis, and a decrease in
caspase and TnBF alpha concentrations. Changes in these miRNAs were
associated with better prognosis in patients with ischemic heart disease.
The main limitation of this study will be overcome in the second stage of
the trial, where the specific role of each miRNA will be
determined. Copyright © 2021 Bentham Science Publishers.

<53>
Accession Number
2013370492
Title
Ultrasound-guided infraclavicular axillary vein cannulation: - Is it a
good alternative to internal jugular vein cannulation in pediatric cardiac
surgery?.
Source
Anestezi Dergisi. 29 (1) (pp 32-39), 2021. Date of Publication: 2021.
Author
Elbaser I.I.A.; Abdelmageed N.A.; El-Morsy M.
Institution
(Elbaser, Abdelmageed, El-Morsy) Department of Anesthesia and Surgical
Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Publisher
Anestezi Dergisi
Abstract
Objective: This study was designed to compare the rates of successful
first attempt and mechanical complications between internal jugular vein
(IJV) and axillary vein (AXV) cannulation. Method(s): This
prospective, randomized, comparative, controlled study included 220
pediatric patients with age range 1 to 12 years scheduled for cardiac
surgery. Patients were allocated into 2 equal groups as IJV and AXV
groups. The rates of successful first, second and third puncture attempts
and the mechanical complications (arterial puncture, pneumothorax,
catheter occlusion, catheter malposition, nerve injury) were investigated.
 Result(s): There was no statistically significant difference
(p=0.053) in the first skin puncture success rates in both groups (AXV
group 80% and IJV group 68%). There were no significant differences
regarding the second and third skin puncture success rates. The incidence
rates of failed vein punctures were similar in IJV (3%) and AXV (2%)
groups. The vein puncture and catheter insertion times and the rates.
Arterial puncture, pneumothorax and catheter malposition were similar in
IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). The
rates of catheter occlusion with sternal retraction were significantly
higher (p=0.029) in AXV than IJV group (6% vs 0%). Postoperative phrenic
(IJV group) or brachial plexus nerve injury (AXV group) was not developed
in any patient. Conclusion(s): Ultrasound-guided cannulation of both
infraclavicular AXV and IJV were similarly associated with high success
rates and low incidence of mechanical complications. © Copyright
Anesthesiology and Reanimation Specialists' Society. This journal
published by Logos Medical Publishing. Licenced by Creative Commons
Attribution 4.0 International (CC)

<54>
Accession Number
2013347744
Title
Apixaban versus PhenpRocoumon: Oral AntiCoagulation plus antiplatelet
tHerapy in patients with Acute Coronary Syndrome and Atrial Fibrillation
(APPROACH-ACS-AF): Rationale and design of the prospective randomized
parallel-group, open-label, blinded-endpoint, superiority,
multicenter-trial of a triple therapy versus a dual therapy in patients
with Atrial Fibrillation and Acute Coronary Syndrome undergoing coronary
stenting.
Source
IJC Heart and Vasculature. 35 (no pagination), 2021. Article Number:
100810. Date of Publication: August 2021.
Author
Riesinger L.; Strobl C.; Leistner D.M.; Gori T.; Akin I.; Mehr M.; Kellnar
A.; Mahabadi A.A.; Bogossian H.; Block M.; Edelmann F.; Sarafoff N.;
Sibbing D.; Ince H.; Rassaf T.; Mansmann U.; Mehilli J.; Kaab S.;
Hausleiter J.; Massberg S.; Wakili R.
Institution
(Riesinger, Strobl, Mehr, Kellnar, Sarafoff, Sibbing, Mehilli, Kaab,
Hausleiter, Massberg, Wakili) Department of Medicine I, University
Hospital Munich, Campus Grosshadern, Ludwig-Maximilians-University Munich
(LMU Munich), Munich, Germany
(Riesinger, Strobl, Mehr, Kellnar, Sibbing, Mehilli, Kaab, Hausleiter,
Massberg, Wakili) DZHK (German Centre for Cardiovascular Research),
Partner Site Munich Heart Alliance, Munich 80802, Germany
(Riesinger, Mahabadi, Rassaf, Wakili) Department of Cardiology and
Vascular Medicine, West-German Heart and Vascular Center Essen, University
Hospital Essen, University Duisburg-Essen, Essen, Germany
(Leistner) Department of Cardiology, Charite University of Medicine,
Berlin, Campus Benjamin Franklin, Germany and Berlin Institute of Health
(BIH), Berlin 10117, Germany
(Leistner, Edelmann) DZHK (German Center for Cardiovascular Research),
Partner Site Berlin, Germany
(Gori) Center for Cardiology, Cardiology 1, Universitatsmedizin Mainz,
Mainz, Germany
(Gori) DZHK (German Center for Cardiovascular Research), Partner Site
Rhine-Main, Germany
(Akin) First Department of Medicine, Faculty of Medicine Mannheim,
University Medical Centre Mannheim (UMM), University of Heidelberg,
Germany
(Akin) DZHK (German Center for Cardiovascular Research), Partner Site
Heidelberg/Mannheim, Germany
(Bogossian) Markische Kliniken GmbH, Klinikum Ludenscheid, Ludenscheid,
Germany
(Bogossian) Department of Cardiology, University Witten/Herdecke, Witten,
Germany
(Block) Department of Cardiology, Augustinum Hospital, Munich, Germany
(Edelmann) Department of Internal Medicine and Cardiology, Charite
University Hospital (Campus Virchow Klinikum), Berlin, Germany
(Ince) Department of Cardiology, Rostock University Medical Center,
Rostock, Germany
(Mansmann) Department of Medical Information Processing, Biometry and
Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU Munich),
Munich, Germany
(Mehilli) Department of Medicine I, Landshut-Achdorf Hospital, Landshut,
Germany
Publisher
Elsevier Ireland Ltd
Abstract
Background: A regimen of dual (DAT) vs. triple (TAT) antithrombotic
therapy reduces bleeding in patients with atrial fibrillation (AF)
undergoing percutaneous coronary intervention (PCI). However, recent
evidence suggests that DAT may be associated with an increased ischemic
risk. This raises the question whether DAT rather than TAT should be
recommended to AF patients that undergo PCI for acute coronary syndrome
(ACS), carrying a particularly high risk of both bleeding and ischemic
events, studied only as subgroups of previous trials. Methods and design:
The APPROACH-ACS-AF-(DZHK-7) trial is a multicenter prospective,
randomized, open-label, blinded endpoint (PROBE) trial which will include
patients presenting with an ACS managed by PCI and requiring oral
anticoagulation (OAC) due to AF. The trial will test, whether a
DAT-regimen comprising clopidogrel plus the non-Vitamin-K-antagonist oral
anticoagulant (NOAC) apixaban is superior to a TAT-regimen of
vitamin-K-antagonist (VKA) plus dual anti-platelet therapy (APT) with
respect to bleeding. A total of 400 patients will be randomized 1:1 to a
control-arm with guideline-recommended TAT with VKA plus clopidogrel and
acetylsalicylic-acid and a study arm receiving DAT comprising apixaban
plus clopidogrel. Patients will be followed-up for 6 months. The primary
endpoint of the study is the cumulative incidence of BARC type >=2
bleeding, secondary endpoints include a composite clinical ischemic
outcome and net clinical outcome. Conclusion(s): APPROACH-ACS-AF is
the first trial dedicated to ACS patients, testing whether in terms of
bleeding a DAT with NOAC is superior to a TAT regimen with VKA in
high-risk ACS patients with AF. Copyright © 2021 The Authors

<55>
Accession Number
2013342291
Title
Cerebral oximetry and preventing neurological complication post-cardiac
surgery: A systematic review.
Source
European Journal of Cardio-thoracic Surgery. 59 (6) (pp 1144-1154), 2021.
Date of Publication: 01 Jun 2021.
Author
Semrau J.S.; Motamed M.; Ross-White A.; Boyd J.G.
Institution
(Semrau, Boyd) Centre for Neuroscience Studies, Queen's University,
Kingston, ON, Canada
(Motamed) School of Medicine, Faculty of Health Sciences, Queen's
University, Kingston, ON, Canada
(Ross-White) Library Services, Queen's University, Kingston, ON, Canada
(Boyd) Kingston Health Sciences Centre, Kingston, ON, Canada
(Boyd) Department of Critical Care, Faculty of Health Sciences, Queen's
University, Kingston, ON, Canada
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: This systematic review aims to provide an up-To-date summary
of the current literature examining the relationship between
intraoperative regional cerebral oxygen saturation and neurological
complications after cardiac surgery. METHOD(S): Observational and
interventional studies investigating the link between regional cerebral
oxygen saturation and postoperative delirium, cognitive dysfunction and
stroke were included. After database searching and study screening, study
characteristics and major findings were extracted. RESULT(S):
Twenty-seven studies were identified. Of the observational studies (n =
17), 8 reported that regional cerebral oxygen desaturations were
significantly associated with neurological complications after cardiac
surgery. Of the interventional studies (n = 10), 3 provided evidence for
monitoring cerebral oximetry during cardiac surgery as a means of reducing
incidence of postoperative cognitive dysfunction or stroke. There was
significant heterogeneity in the tools and rigor used to diagnose
neurological complications. CONCLUSION(S): Studies to date show an
inconsistent relationship between regional cerebral oxygen saturation and
neurological outcomes after cardiac surgery, and lack of clear benefit of
targeting cerebral oximetry to minimize neurological complications.
Standardized assessments, definitions of impairment and desaturation
thresholds will help determine the benefits of cerebral oximetry
monitoring during cardiac surgery. Copyright © 2021 The
Author(s) 2021. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<56>
Accession Number
2011599741
Title
26th Cardiovascular Summit TCTAP 2021.
Source
Journal of the American College of Cardiology. Conference: 26th
Cardiovascular Summit Transcatheter Cardiovascular Therapeutics Asia
Pacific (TCTAP). Virtual, Online. 77 (14 Supplement) (pp E1-E263), 2021.
Date of Publication: 13 Apr 2021.
Author
Anonymous
Publisher
Elsevier Inc.
Abstract
The proceedings contains 175 papers. The topics discussed include: TCTAP
A-001 Optimal Strategy for Antiplatelet Therapy After Coronary
Drug-eluting Stent Implantation in High-risk "TWILIGHT-Like" Patients with
Diabetes Mellitus;TCTAP A-002 Limitation of Angiographic Parameters in
Predicting Residual Ischemia After Drug-eluting Stent Implantation;TCTAP
A-003 Prosthesis Geometrical Predictors of Leaflet Thrombosis following
Transcatheter Aortic Valve Replacement with Intra-annular Prostheses;TCTAP
A-004 Effectiveness of Intracoronary Eptifibatide Bolus Only on Myocardial
Perfusion During Primary Percutaneous Coronary Intervention in Patient
Presented with ST-Segment Elevation Myocardial Infarction: A Real-World
Evidence;TCTAP A-005 Effects of Age and Sex on Outcomes After Percutaneous
Coronary Intervention or Coronary Artery Bypass Grafting in Non-ST-Segment
Elevation Acute Coronary Syndrome Patients with Triple-vessel
Disease;TCTAP A-006 The Optimal Percutaneous Coronary Intervention
Strategy for Patients with ST-segment Elevation Myocardial Infarction and
Multivessel Coronary Artery Disease: A Pairwise and Network Meta-analysis
of Randomized Trials;TCTAP A-007 Transradial Versus Transfemoral Access in
STEMI Patients Undergoing Rescue Percutaneous Coronary Intervention Post
Fibrinolytic Therapy: A 10-year Contemporary National Centre
Experience;TCTAP A-008 Urinary Alpha1-microglobulin as a Novel Predictor
for In-hospital All-cause Mortality in Patients with ST-Segment Elevation
Myocardial Infarction;TCTAP A-009 Clinical Impact of Direct Rotational
Atherectomy in Patients with Complex Coronary Artery Lesions;TCTAP A-010
Different Strategies in Thrombus Management in ST-Segment Elevation
Myocardial Infarction: Is Thrombosuction No Longer Relevant?;TCTAP A-011
Strategy in Management of Heavily Calcified Coronary Vessels - A
Case-series of the Use of Shockwave Coronary Intravascular
Lithotripsy;TCTAP A-012 The Real World Usage of Rota Floppy Vs. Rota Extra
Support Wire in Asia;TCTAP A-016 Intrahospital and Long-term Outcomes
After True Bifurcation Stenting;TCTAP C-006 High Thrombus Burden of Right
Coronary Artery

<57>
Accession Number
2010851895
Title
2021 Canadian Women's Heart Health Summit.
Source
Canadian Journal of Cardiology. Conference: 2021 Canadian Women's Heart
Health Summit. Virtual, Online. 37 (2) (pp A1-A10), 2021. Date of
Publication: February 2021.
Author
Anonymous
Publisher
Elsevier Inc.
Abstract
The proceedings contains 63 papers. The topics discussed include:
Increased mortality and intervention delay in female patients with severe
aortic stenosis and reduced ejection fraction undergoing aortic valve
replacement;Sex differences in depressive symptoms upon entry to cardiac
rehabilitation: a sex- age- and diagnosis matched cohort;The effect of sex
on vascular function during acute stress;The use of placenta pathology to
identify women at high-risk of cardiovascular disease following
preeclampsia;Women in cardiovascular medicine and science in Canada:
challenges successes and opportunities for change;A case study: "health
shocks can be isolating; peer support is key";Addressing sex and gender
inequities in health research: sex and gender-based analysis and reporting
(SGBAR);An innovative approach to support women with postural orthostatic
tachycardia syndrome (POTS);An integrated mixed methods systematic review
to summarize research evidence related to self-management programs for
women with cardiac pain;Association between the NEDD4L rs4149601 single
nucleotide polymorphism and early onset essential hypertension in
Caucasian females: a case-control study;Cannabis use and tobacco quit
rates in a cohort of female patients participating in a tobacco cessation
program;Cardiac rehabilitation is not associated with better psychological
health in women treated with percutaneous coronary intervention;Cardiac
tele-rehabilitation programs: a study of women participation in rural
settings;Clinical phenotype & outcomes of women who develop severe
hypertension in pregnancy 2020;Complexity of acute care journey of females
with heart failure following hospitalization;Development and evaluation of
online learning modules for family medicine residents: hypertensive
disorders in pregnancy and physical activity in pregnancy;Do Sex Hormones
Mediate the Effect of Gender on Acute Coronary Syndrome
Outcomes?;Exploring gender-based differences in exercise self-efficacy
post-stroke: preliminary findings

<58>
Accession Number
2001998265
Title
Systematic review and consensus definitions for the Standardised Endpoints
in Perioperative Medicine initiative: clinical indicators.
Source
British Journal of Anaesthesia. 123 (2) (pp 228-237), 2019. Date of
Publication: 01 Aug 2019.
Author
Bampoe S.; Cook T.; Fleisher L.A.; Grocott M.P.W.; Neuman M.; Story D.;
Myles P.S.; Biccard B.; Blazeby J.; Boney O.; Chan M.; Diouf E.; Kalkman
C.; Kurz A.; Moonesinghe R.; Wijeysundera D.; Gan T.J.; Peyton P.; Sessler
D.; Tramer M.; Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.;
Botti M.; Haller G.; Gruen R.; Evered L.; Scott D.; Silbert B.; van Dijk
D.; Grocott H.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Beattie S.;
Landoni G.; Leslie K.; Howell S.; Nagele P.; Richards T.; Lamy A.; Lalu
M.; Pearse R.; Mythen M.; Canet J.; Moller A.; Gin T.; Schultz M.; Pelosi
P.; Gabreu M.; Futier E.; Creagh-Brown B.; Abbott T.; Klein A.; Corcoran
T.; Jamie Cooper D.; Dieleman S.; McIlroy D.; Bellomo R.; Shaw A.; Prowle
J.; Karkouti K.; Billings J.; Mazer D.; Jayarajah M.; Murphy M.; Bartoszko
J.; Sneyd R.; Morris S.; George R.; Shulman M.; Lane-Fall M.; Nilsson U.;
Stevenson N.; Cooper J.D.J.; van Klei W.; Cabrini L.; Miller T.; Pace N.;
Jackson S.; Buggy D.; Short T.; Riedel B.; Gottumukkala V.; Alkhaffaf B.;
Johnson M.
Institution
(Haller) Department of Anaesthesiology, Geneva University Hospitals,
Geneva, Switzerland
(Haller, Myles) Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
(Bampoe) Centre for Perioperative Medicine, University College London,
United Kingdom
(Cook) Department of Anaesthesia and Intensive Care, Royal United
Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
(Fleisher, Neuman) Departments of Anesthesiology and Critical Care and
Medicine, Perelman School of Medicine of the University of Pennsylvania,
Philadelphia, PA, United States
(Grocott) Integrative Physiology and Critical Illness Group, Clinical and
Experimental Sciences, Faculty of Medicine, University Hospital
Southampton, Southampton, United Kingdom
(Grocott) Anaesthesia, Perioperative and Critical Care Research Group,
Southampton NIHR Biomedical Research Centre, University Hospital
Southampton, Southampton, United Kingdom
(Story) Centre for Integrated Critical Care, University of Melbourne,
Melbourne, Australia
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, Australia
Publisher
Elsevier Ltd
Abstract
Background: Clinical indicators are powerful tools to quantify the safety
and quality of patient care. Their validity is often unclear and
definitions extremely heterogeneous. As part of the International
Standardised Endpoints in Perioperative Medicine (StEP) initiative, this
study aimed to derive a set of standardised and valid clinical outcome
indicators for use in perioperative clinical trials. Method(s): We
identified clinical indicators via a systematic review of the anaesthesia
and perioperative medicine literature (PubMed/OVID, EMBASE, and Cochrane
Library). We performed a three-stage Delphi consensus-gaining process that
involved 54 clinician-researchers worldwide. Indicators were first
shortlisted and the most suitable definitions for evaluation of quality
and safety interventions determined. Indicators were then assessed for
validity, reliability, feasibility, and clarity. Result(s): We
identified 167 clinical outcome indicators. Participation in the three
Delphi rounds was 100% (n=13), 68% (n=54), and 85% (n= 6), respectively. A
final list of eight outcome indicators was generated: surgical site
infection at 30 days, stroke within 30 days of surgery, death within 30
days of coronary artery bypass grafting, death within 30 days of surgery,
admission to the intensive care unit within 14 days of surgery,
readmission to hospital within 30 days of surgery, and length of hospital
stay (with or without in-hospital mortality). They were rated by the
majority of experts as valid, reliable, easy to use, and clearly defined.
 Conclusion(s): These clinical indicators can be confidently used as
endpoints in clinical trials measuring quality, safety, and improvement in
perioperative care. Registration: PROSPERO 2016 CRD42016042102
(http://www.crd.york.ac.uk/PROSPERO/display_record.php?
ID=CRD42016042102). Copyright © 2019 British Journal of
Anaesthesia

<59>
Accession Number
362101727
Title
Blood gases response to different breathing modalities in phase i of
cardiac rehabilitation program after coronary artery bypass graft.
Source
European Journal of General Medicine. 8 (2) (pp 85-91), 2011. Date of
Publication: 2011.
Author
El-Kader S.M.A.
Institution
(El-Kader) Cairo University, Faculty of Physical Therapy, Physical Therapy
of Cardiopulmonary Disorders and Geriatrics, Egypt
Publisher
TIP ARASTIRMALARI DERNEGI
Abstract
Aim: One major cause of postoperative respiratory complications is
pulmonary atelectasis. Atelectasis and the associated loss of functional
alveolar units has been recognized as a major pathophysiological mechanism
responsible for postoperative hypoxemia after coronary artery bypass graft
(CABG). The aim of this study was to determine which therapeutic breathing
method from incentive spirometry (IS), non-invasive intermittent positive
pressure breathing (IPPB) and continuous positive airway pressure
breathing (CPAP) in addition to postoperative pulmonary physiotherapy
obtain the best improvement in blood gases in phase I of cardiac
rehabilitation program after CABG. Method(s): Thirty six patients of
both sexes who underwent CABG divided into three groups. Group (A)
received breathing training with IS (5 minutes 5 times per day) in
addition the chest physiotherapy program for patients after CABG and Group
(B) received breathing training with CPAP (10 cmH2O for 15 minutes once
daily) in addition to the chest physiotherapy program for patients after
CABG., where Group(C) received breathing training with IPPB (maximum 15
cmH2O for 15 minutes once daily) in addition to the chest physiotherapy
program for patients after CABG. Measurements of blood gases were done
before the study in the first post operative day and repeated at the end
of the study in the tenth postoperative day. Result(s): Blood gases
were improved in all groups in addition to a significant difference
between IS & CPAP and IS & IPPB groups. Where there was no significant
difference between CPAP & IPPB groups. Conclusion(s): Incentive
spirometry in addition to the usual respiratory physical therapy is
recommended for patients in phase I of cardiac rehabilitation program
after CABG.

<60>
Accession Number
359759346
Title
Prospective observational study for perioperative volume replacement with
6% HES 130/0,42, 4% gelatin and 6% HES 200/0,5 in cardiac surgery.
Source
European Journal of Medical Research. 15 (9) (pp 383-389), 2010. Date of
Publication: 24 Sep 2010.
Author
Winterhalter M.; Malinski P.; Danzeisen O.; Sixt S.; Monaca E.; Juttner
T.; Peiper M.; Kienbaum R.; Koester A.; Rahe-Meyer N.
Institution
(Winterhalter, Danzeisen, Sixt, Monaca, Juttner, Kienbaum, Koester)
University of Dusseldorf, Dept. of Anaesthesiology, Moorenstr.5, 40225
Dusseldorf, Germany
(Malinski, Rahe-Meyer) Department of Anaesthesiology, Hannover Medical
School, Germany
(Peiper) Department of Surgery, University of Dusseldorf, Germany
Publisher
BioMed Central Ltd
Abstract
Background: The constantly growing amount of different kinds of colloid
fluids necessitates comparative investigations with regards to the safety
and effectivity in clinical use of these preparations. Hence we compared
three colloid fluids in an observational study. The objective was the
exploration of the influence of these three colloids on blood coagulation,
hemody-namics and renal function of the cardiac surgical patient.
 Method(s): We included 90 patients undergoing an elective open-heart
surgery with the use of the heart-lung machine and observed them
consecutively. Group 1 [gelatin 4% (n = 30)], Group 2 [HES 200/0,5 (n =
30)] and Group 3 [HES 130/0,42 (n = 30)]. We measured the perioperative
volume replacement, the administration of blood- and coagulation-products,
the application of catecholamines, the renal function, blood gas and the
platelet aggregation using multiplate electrode analyzer (Multiplate,
Dynabyte medical, Munich, Germany). Result(s): The gelatin-group
needed significantly more norepinephrine than the HES 130/0.42 group. The
responsible surgeon considered the blood coagulation in the HES 200/0.5
group most frequently as impaired. Furthermore we saw a significant
decrease in platelet function in the HES 200/0.5 group when performing the
multiplate-analysis (ADP-and COL-test). HES 130/0.4 as well as gelatin 4%
showed no significant change in platelet function. The gelatin-group and
the HES 200/0.5 needed significantly more aprotinine than the HES 130/0.4
group. We saw no significant difference with regards to administration of
blood and coagulation products between the three groups. The urinary
excretion during the intervention was significantly higher in the HES
200/0.5 group and in the gelatin group than in the HES 130/0.4 group.
 Conclusion(s): Our results confirm the lower stabilizing effect of
gelatin on circulation during fluid resuscitation. The blood coagulation
was mostly impaired due to HES 200/0.5 confirmed by the
multiplate-analysis as well as by different clinical findings. © I.
Holzapfel Publishers 2010.

<61>
Accession Number
2010710351
Title
Human glycocalyx shedding: Systematic review and critical appraisal.
Source
Acta Anaesthesiologica Scandinavica. 65 (5) (pp 590-606), 2021. Date of
Publication: May 2021.
Author
Hahn R.G.; Patel V.; Dull R.O.
Institution
(Hahn) Research Unit, Sodertalje Hospital, Sodertalje, Sweden
(Hahn) Karolinska Institute at Danderyds Hospital (KIDS), Stockholm,
Sweden
(Patel) Department of Internal Medicine, Northwestern Medicine McHenry
Hospital, McHenry, IL, United States
(Dull) Department of Anesthesiology, Pathology, Physiology, Surgery,
University of Arizona, College of Medicine, Tucson, AZ, United States
Publisher
Blackwell Munksgaard
Abstract
Background: The number of studies measuring breakdown products of the
glycocalyx in plasma has increased rapidly during the past decade. The
purpose of the present systematic review was to assess the current
knowledge concerning the association between plasma concentrations of
glycocalyx components and structural assessment of the endothelium.
 Method(s): We performed a literature review of Pubmed to determine
which glycocalyx components change in a wide variety of human diseases and
conditions. We also searched for evidence of a relationship between plasma
concentrations and the thickness of the endothelial glycocalyx layer as
obtained by imaging methods. Result(s): Out of 3,454 publications, we
identified 228 that met our inclusion criteria. The vast majority
demonstrate an increase in plasma glycocalyx products. Sepsis and trauma
are most frequently studied, and comprise approximately 40 publications.
They usually report 3-4-foldt increased levels of glycocalyx degradation
products, most commonly of syndecan-1. Surgery shows a variable picture.
Cardiac surgery and transplantations are most likely to involve elevations
of glycocalyx degradation products. Structural assessment using imaging
methods show thinning of the endothelial glycocalyx layer in
cardiovascular conditions and during major surgery, but thinning does not
always correlate with the plasma concentrations of glycocalyx products.
The few structural assessments performed do not currently support that
capillary permeability is increased when the plasma levels of glycocalyx
fragments in plasma are increased. Conclusion(s): Shedding of
glycocalyx components is a ubiquitous process that occurs during both
acute and chronic inflammation with no sensitivity or specificity for a
specific disease or condition. Copyright © 2021 The Authors. Acta
Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on
behalf of Acta Anaesthesiologica Scandinavica Foundation.

<62>
Accession Number
2010392523
Title
Short term outcomes after transcatheter mitral valve repair.
Source
International Journal of Cardiology. 327 (pp 163-169), 2021. Date of
Publication: 15 Mar 2021.
Author
Tripathi B.; Sawant A.C.; Sharma P.; Tandon V.; Patel T.; Klein J.;
Pershad A.
Institution
(Tripathi, Sawant, Sharma, Tandon, Pershad) University of Arizona College
of Medicine, Phoenix, AZ, United States
(Patel) Advent Health East Orlando, Orlando, FL, United States
(Klein) Heart & Vascular Center of Arizona, Phoenix, AZ, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Outcome data following transcatheter mitral valve repair
(TMVR) with the MITRACLIP device are scarce outside the pivotal randomized
controlled trials. Method(s): The Nationwide Readmission Data base
(NRD) was utilized for years 2013-2017 to identify the study population.
Thirty-day readmission pattern, in-hospital complications, causes of
readmissions, and multivariate predictors for readmission, complications
and mortality were explored. Result(s): We noted a total of 14,647
index admissions related to MITRACLIP of which 48% of procedures were
performed at high volume centers (Annual hospital volume >= 25). A total
of 15% of patients were readmitted within 30 days of discharge most
frequently due to cardiac causes. Approximately 33% of patients were
discharged within 24 h of the procedure. The in-hospital mortality rate
was 2.8% and in-hospital complication rate was 14.6%. The most common
complications were cardiac complications (8.2%), bleeding related
complications (5.9%) and vascular complications (0.65%). On multivariate
modeling, female sex, CHF, Atrial fibrillation, prior PCI, COPD, CKD,
transfer to skilled nursing facility, length of stay >=2 days were
associated with a high risk of readmission. Additionally, coagulopathy,
chronic kidney disease and lengthier hospital stays were associated with
high risk of complication or death. Conclusion(s): The 30-day
readmission rate following commercial treatment with the MITRACLIP device
is 15%. Half of these admission were from a cardiac etiology. Heart
failure, atrial arrhythmias and clip related complications round out the
top 3 cardiac reasons for readmission. There was no impact of hospital
size, teaching status or case volume on mortality and in hospital
complication rates. Copyright © 2020 Elsevier B.V.

<63>
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.

<64>
Accession Number
2005875485
Title
Early aspirin discontinuation after coronary stenting: A systematic review
and meta-analysis.
Source
Journal of the American Heart Association. 10 (2) (pp 1-10), 2021. Article
Number: e018304. Date of Publication: 2021.
Author
Wiebe J.; Ndrepepa G.; Kufner S.; Lahmann A.L.; Xhepa E.; Kuna C.; Voll
F.; Gosetti R.; Laugwitz K.-L.; Joner M.; Kastrati A.; Cassese S.
Institution
(Wiebe, Ndrepepa, Kufner, Lahmann, Xhepa, Kuna, Voll, Joner, Kastrati,
Cassese) Klinik fur Herz- und Kreislauferkrankungen, Deutsches Herzzentrum
Munchen, Technische Universitat Munchen, Munich, Germany
(Gosetti, Laugwitz) Medizinische Klinik, Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
(Laugwitz, Joner, Kastrati) DZHK (German Centre for Cardiovascular
Research), partner site Munich Heart Alliance, Munich, Germany
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The clinical impact of early aspirin discontinuation compared
with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous
coronary intervention with stenting remains poorly studied. We
investigated the clinical outcomes of patients assigned to either early
aspirin discontinuation or DAPT after percutaneous coronary intervention
with stenting. METHODS AND RESULTS: We performed a meta-analysis of
aggregate data from randomized clinical trials enrolling participants
receiving a percutaneous coronary intervention with stenting and assigned
to either early aspirin discontinuation or DAPT. Scientific databases were
searched from inception through March 30, 2020. Trial-level hazard ratios
(HRs) and 95% CIs were pooled using a random effects model with inverse
variance weighting. The primary outcome was all-cause death. Secondary
outcomes were myocardial infarction, stent thrombosis, stroke, and major
bleeding. Overall, 36 206 participants were allocated to either early
aspirin discontinuation (experimental therapy, n=18 088) or DAPT (control
therapy, n=18 118) in 7 trials. Median follow-up was 12 months. All-cause
death occurred in 2.5% of patients assigned to experimental and 2.9% of
patients assigned control therapy (hazard ratio [HR], 0.91, 95% CI,
0.75-1.11; P=0.37). Overall, patients treated with experimental versus
control therapy showed no significant difference in terms of myocardial
infarction (HR, 1.02 [0.85-1.22], P=0.81), stent thrombosis (HR, 1.02
[0.87-1.20], P=0.83), or stroke (HR, 1.01 [0.68-1.49], P=0.96). However,
the risk for major bleeding (HR, 0.58 [0.43-0.77], P<0.01) was
significantly reduced by experimental as compared with control therapy.
 CONCLUSION(S): In patients treated with percutaneous coronary
intervention and stenting, assigned to a strategy of early aspirin
discontinuation versus DAPT, the risk of death and ischemic events is not
significantly different but the risk of bleeding is lower. Copyright
© 2021 The Authors.

<65>
Accession Number
2012114667
Title
Long-Term Renal Outcomes in Children With Acute Kidney Injury Post Cardiac
Surgery.
Source
Kidney International Reports. 6 (7) (pp 1850-1857), 2021. Date of
Publication: July 2021.
Author
Sethi S.K.; Sharma R.; Gupta A.; Tibrewal A.; Akole R.; Dhir R.; Soni K.;
Bansal S.B.; Jha P.K.; Bhan A.; Kher V.; Raina R.
Institution
(Sethi, Dhir, Soni) Department of Pediatric Nephrology, Kidney Institute,
Medanta - The Medicity, Gurgaon, Haryana, India
(Sharma, Akole) Pediatric Cardiac Intensive Care, Medanta - The Medicity,
Gurgaon, Haryana, India
(Gupta) Department of Biochemistry, Aster Clinical Lab, Bangalore, India
(Tibrewal, Raina) Department of Nephrology, Akron's Children Hospital,
Akron, OH, United States
(Bansal, Jha, Kher) Kidney Institute, Medanta, The Medicity Hospital,
Gurgaon, Haryana, India
(Bhan) CTVS, Medanta - The Medicity, Gurgaon, Haryana, India
Publisher
Elsevier Inc.
Abstract
Introduction: The long-term renal outcomes of survivors of pediatric acute
kidney injury (AKI) are varied within the current literature, and we aim
to establish long-term renal outcomes for pediatric patients after cardiac
surgery. We studied long-term renal outcomes and markers of kidney injury
in pediatric patients after congenital cardiac surgery. Method(s): In
a prospective case-control observational study (the Renal Outcomes in
Children with acute Kidney injury post cardiac Surgery [ROCKS] trial) we
reviewed all children who underwent cardiac surgery on cardiopulmonary
bypass (December 2010-2017). Result(s): During the study period, 2035
patients underwent cardiac surgery, of whom 9.8% developed AKI
postoperatively. Forty-four patients who had postoperative AKI had a
long-term follow-up, met our inclusion criteria, and were compared with 49
control subjects. We conducted a univariate analysis of reported
parameters. At a median follow-up of 41 months, the cases had
significantly higher urine levels of neutrophil gelatinase-associated
lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1
(KIM-1). The biomarkers remained higher after adjusting for the urine
creatinine, and the ratio of urine KIM-1/urine creatinine was
significantly higher among cases. None of the patients had proteinuria or
hypertension on follow-up. The presence of AKI, AKI stage, and younger age
were not associated with the occurrence of low glomerular filtration rate
(GFR) at follow-up. Conclusion(s): Urinary biomarker abnormalities
persist years after a congenital cardiac surgery in children, who may have
a low GFR on follow-up. The presence of AKI, AKI stage, and younger age at
surgery are not associated with the occurrence of low GFR at follow-up.
Children with a higher surgical complexity score have lower GFR on
follow-up. Copyright © 2021

<66>
Accession Number
2010778684
Title
Impact of chronic obstructive pulmonary disease on 10-year mortality after
percutaneous coronary intervention and bypass surgery for complex coronary
artery disease: insights from the SYNTAX Extended Survival study.
Source
Clinical Research in Cardiology. 110 (7) (pp 1083-1095), 2021. Date of
Publication: July 2021.
Author
Wang R.; Tomaniak M.; Takahashi K.; Gao C.; Kawashima H.; Hara H.; Ono M.;
van Klaveren D.; van Geuns R.-J.; Morice M.-C.; Davierwala P.M.; Mack
M.J.; Witkowski A.; Curzen N.; Berti S.; Burzotta F.; James S.; Kappetein
A.P.; Head S.J.; Thuijs D.J.F.M.; Mohr F.W.; Holmes D.R.; Tao L.; Onuma
Y.; Serruys P.W.
Institution
(Wang, Gao, Tao) Department of Cardiology, Xijing Hospital, Xi'an, China
(Wang, Gao, Kawashima, Hara, Ono, Onuma, Serruys) Department of
Cardiology, National University of Ireland, Galway (NUIG), P.O. University
Road, Galway H91 TK33, Ireland
(Wang, Gao, van Geuns) Department of Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Tomaniak) First Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Tomaniak) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Takahashi, Kawashima, Hara, Ono) Department of Cardiology, Amsterdam
Universities Medical Centers, Location Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(van Klaveren) Department of Public Health, Erasmus University Medical
Center, Rotterdam, Netherlands
(van Klaveren) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, United States
(Morice) ICPS Ramsay-Generale de Sante, Massy, France
(Davierwala, Mohr) Department of Cardiac Surgery, Heart Centre Leipzig,
Leipzig, Germany
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Witkowski) Department of Interventional Cardiology and Angiology,
National Institute of Cardiology, Warsaw, Poland
(Curzen) Cardiology Department, University Hospital Southampton,
Southampton, United Kingdom
(Berti) Cardiology Department, Heart Hospital-Fondazione C.N.R. Reg.
Toscana G. Monasterio, Massa, Italy
(Burzotta) Institute of Cardiology, Fondazione Policlinico Universitario
Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
(James) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Serruys) Erasmus University Medical Center, Rotterdam, Netherlands
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: To evaluate the impact of chronic obstructive pulmonary disease
(COPD) on 10-year all-cause death and the treatment effect of CABG versus
PCI on 10-year all-cause death in patients with three-vessel disease (3VD)
and/or left main coronary artery disease (LMCAD) and COPD. Method(s):
Patients were stratified according to COPD status and compared with regard
to clinical outcomes. Ten-year all-cause death was examined according to
the presence of COPD and the revascularization strategy. Result(s):
COPD status was available for all randomized 1800 patients, of whom, 154
had COPD (8.6%) at the time of randomization. Regardless of the
revascularization strategy, patients with COPD had a higher risk of
10-year all-cause death, compared with those without COPD (43.1% vs.
24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56-2.64; p
< 0.001). Among patients with COPD, CABG appeared to have a slightly lower
risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR:
0.96; 95% CI: 0.59-1.56, p = 0.858), whereas among those without COPD,
CABG had a significantly lower risk of 10-year all-cause death (22.7% vs.
27.1%; HR: 0.81; 95% CI: 0.67-0.99, p = 0.041). There was no significant
differential treatment effect of CABG versus PCI on 10-year all-cause
death between patients with and without COPD (p<inf>interaction</inf> =
0.544). Conclusion(s): COPD was associated with a higher risk of
10-year all-cause death after revascularization for complex coronary
artery disease. The presence of COPD did not significantly modify the
beneficial effect of CABG versus PCI on 10-year all-cause death. Trial
registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX
Extended Survival: ClinicalTrials.gov reference: NCT03417050 Graphic
abstract: [Figure not available: see fulltext.] Copyright © 2021,
The Author(s).

<67>
Accession Number
615411557
Title
Feasibility, safety, and efficacy of transcatheter aortic valve
replacement without balloon predilation: A systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 90 (5) (pp 839-850),
2017. Date of Publication: November 2017.
Author
Auffret V.; Regueiro A.; Campelo-Parada F.; Del Trigo M.; Chiche O.;
Chamandi C.; Puri R.; Rodes-Cabau J.
Institution
(Auffret, Regueiro, Campelo-Parada, Del Trigo, Chiche, Chamandi, Puri,
Rodes-Cabau) Quebec Heart & Lung Institute, Laval University, Quebec City,
QC, Canada
(Auffret) Signal and Image Processing Laboratory, Rennes 1 University,
Rennes, France
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To evaluate the feasibility, safety, and efficacy of direct
transcatheter aortic valve replacement (TAVR), that is, TAVR without
balloon predilation (BPD), by performing a systematic review and
meta-analysis of available evidence. Background(s): Avoiding BPD
during TAVR was shown to be feasible in previous studies but the risks and
benefits of this technique are unknown owing to the limited number of
patients included in these studies. Method(s): We performed a
systematic search for studies comparing direct TAVR vs TAVR performed with
BPD. Crude risk ratios (RRs) or mean differences and 95% confidence
intervals (CI) for each endpoint were calculated using random effects
models. Result(s): Twenty studies including 3586 patients (1606
undergoing direct TAVR) were selected for the analysis. Mean device
success with direct TAVR was 88% with <5% of bail-out techniques. There
were no differences between direct and BPD-TAVR in short-term (in-hospital
or 30-day) mortality (RR: 1.06; 95% CI: 0.78-1.43) or cerebrovascular
events (RR: 0.92; 95% CI: 0.58-1.46). Direct TAVR associated with reduced
moderate or severe paravalvular leak post-TAVR (RR: 0.59; 95% CI:
0.36-0.98) but not with a reduced risk of permanent pacemaker implantation
(RR: 0.85, 95% CI: 0.71-1.02). A slight increase in postdilation was
observed in direct transfemoral-TAVR recipients (RR: 1.2; 95% CI:
1.00-1.44). Conclusion(s): Direct TAVR is feasible and safe. However,
given the unadjusted nature of our results, uncertainties remain regarding
the independent effect of direct TAVR on outcomes post-TAVR. Randomized
studies are warranted to determine the potential benefits of direct
TAVR. Copyright © 2017 Wiley Periodicals, Inc.

<68>
Accession Number
2013350156
Title
Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic
review and meta-analysis.
Source
PLoS ONE. 16 (6 June) (no pagination), 2021. Article Number: e0253581.
Date of Publication: June 2021.
Author
Liaw J.; Walker B.; Hall L.; Gorton S.; White A.V.; Heal C.
Institution
(Liaw, Walker, Hall, Heal) College of Medicine and Dentistry, James Cook
University, Mackay, QLD, Australia
(Gorton, White) College of Medicine and Dentistry, James Cook University,
Townsville, QLD, Australia
Publisher
Public Library of Science
Abstract
Purpose Associations between rheumatic heart disease (RHD) in pregnancy
and fetal outcomes are relatively unknown. This study aimed to review
rates and predictors of major adverse fetal outcomes of RHD in pregnancy.
Methods Medline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and
WHOICTRP databases were searched for studies that reported rates of
adverse perinatal events in women with RHD during pregnancy. Outcomes
included preterm birth, intra-uterine growth restriction (IUGR), low-birth
weight (LBW), perinatal death and percutaneous balloon mitral
valvuloplasty intervention. Meta-analysis of fetal events by the New-York
Heart Association (NYHA) heart failure classification, and the
Mitral-valve Area (MVA) severity score was performed with unadjusted
random effects models and heterogeneity of risk ratios (RR) was assessed
with the I2 statistic. Quality of evidence was evaluated using
the GRADE approach. The study was registered in PROSPERO (CRD42020161529).
Findings The search identified 5949 non-duplicate records of which 136
full-text articles were assessed for eligibility and 22 studies included,
11 studies were eligible for meta-analyses. In 3928 pregnancies, high
rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR
(6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA
III/IV pre-pregnancy was associated with higher rates of preterm birth (5
studies, RR 2.86, 95%CI 1.54-5.33), and perinatal death (6 studies, RR
3.23, 1.92-5.44). Moderate /severe mitral stenosis (MS) was associated
with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02-4.11)
and IUGR (3 studies, RR 2.46, 95%CI 1.02-5.95). Interpretation RHD during
pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV
and moderate/severe MS in particular may predict poor
prognosis. Copyright: © 2021 Liaw et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<69>
Accession Number
2013349874
Title
Surgical treatment of spinal arachnoid web: Report of two cases and
literature review.
Source
Surgical Neurology International. 12 (no pagination), 2021. Article
Number: A13. Date of Publication: 2021.
Author
Rodrigues A.B.; Rodrigues D.B.; Queiroz J.W.M.; Laube K.A.C.; Braga
M.C.M.; Kita W.S.; De Luna A.A.A.N.F.; De Souza R.W.; Netto R.H.D.
Institution
(Rodrigues, Rodrigues, Queiroz, Laube, Braga, Kita, De Luna, De Souza,
Netto) Department of Neurosurgery, Santa Marcelina Hospital, Sao Paulo,
Brazil
Publisher
Scientific Scholar
Abstract
Background: Arachnoid webs (AWs) can cause cord compression and
syringomyelia in the thoracic spine. Here, we describe two patients who
underwent operative treatment for AW and reviewed the literature. Case
Description: Two patients underwent surgical treatment for thoracic AW.
Both presented with spastic gait and numbness in the lower extremities. On
MR, these lesions exhibited the "scalpel" sign (i.e. due to the
accumulation of cerebrospinal fluid on the dorsal aspect of the spinal
cord). Operative intervention, consisting of fenestration and web
resection, resulted in symptom resolution. Conclusion(s): Thoracic
AWs are rare lesions that should be considered among the differential
diagnosis of spinal compressive syndromes. Surgical fenestration and
resection of the AW correct the flow dynamics allowing for full symptoms
resolution. Copyright © 2021 Scientific Scholar. All rights
reserved.

<70>
Accession Number
2013342302
Title
Novel risk score for predicting recurrence of atrial fibrillation after
the Cryo-Maze procedure.
Source
European Journal of Cardio-thoracic Surgery. 59 (6) (pp 1218-1225), 2021.
Date of Publication: 01 Jun 2021.
Author
Kakuta T.; Fukushima S.; Minami K.; Saito T.; Kawamoto N.; Tadokoro N.;
Ikuta A.; Kobayashi J.; Fujita T.
Institution
(Kakuta, Fukushima, Saito, Kawamoto, Tadokoro, Ikuta, Kobayashi, Fujita)
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular
Research Center, Suita, Osaka, Japan
(Minami) Department of Surgical Intensive Care, National Cerebral and
Cardiovascular Research Center, Suita, Osaka, Japan
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A predictive model for atrial fibrillation recurrence and the rate of
freedom from atrial fibrillation recurrence by each score OBJECTIVES: This
study aimed to develop a novel risk score model for quantitative
prediction of the rate of atrial fibrillation (AF) recurrence after the
Cryo-Maze procedure in patients with persistent AF. METHOD(S): We
enrolled 450 consecutive patients who underwent the Cryo-Maze procedure
for persistent AF concomitant with other cardiac procedures in our
institute between 2001 and 2019. We randomly divided the cohort into two
groups. We derived a model in a 'development cohort' (270 patients; 60%)
and validated it in a 'test cohort' (180 patients; 40%) by receiver
operating characteristic curve analysis. RESULT(S): The median
follow-up was 5.2 (interquartile range: 2.0-9.9) years. The 1-, 5-, 10-
and 15-year rates of freedom from AF recurrence in the entire cohort were
91.4%, 83.5%, 76.2% and 57.1%, respectively. Risk factors for AF
recurrence examined by logistic regression analysis included F-wave
voltage in V1 < 0.2 mV, preoperative AF duration >5 years and left atrial
volume index >100 ml/m2. Points were assigned to each risk factor
according to its odds ratio. A novel risk score model was developed using
these three variables and age, with a range up to 10 points. High score
(>7) predicted high rates of AF recurrence after the Cryo-Maze procedure.
The area under the receiver operating characteristic curve of the novel
risk model score was 0.78 (95% confidence interval: 0.65-0.91) in the test
cohort. CONCLUSION(S): Use of the Cryo-Maze procedure should be
carefully considered in patients with a higher model score because of a
higher risk of AF recurrence. Copyright © 2021 The Author(s)
2021. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<71>
Accession Number
2013342731
Title
Variability and reproducibility of the SYNTAX score for triple-vessel
disease.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Basman C.; Levine E.; Tejpal A.; Thampi S.; Rashid U.; Barry R.; Stoffels
G.; Kliger C.A.; Coplan N.; Patel N.; Scheinerman S.J.; Singh V.P.
Institution
(Basman, Levine, Tejpal, Thampi, Rashid, Barry, Stoffels, Kliger, Coplan,
Patel, Scheinerman, Singh) Department of Cardiothoracic Surgery and
Cardiovascular Medicine, Lenox Hill Heart and Lung, Northwell Health
System, 130 East 77th Street, Black Hall 4th floor, New York, NY 10075,
United States
(Basman, Rashid, Singh) Department of Cardiovascular Medicine, Northern
Westchester Hospital, Northwell Health System, 400 E. Main St, Mt Kisco,
NY 10549, United States
Publisher
Elsevier Inc.
Abstract
Background: The SYNTAX score (SX) is an angiographic grading system to
determine the burden and complexity of coronary artery disease (CAD) and
to guide operators as to the appropriateness of percutaneous coronary
intervention (PCI) vs coronary artery bypass grafting (CABG). However,
variability of the SX may exist since the assessment relies on individual
clinicians to visually interpret lesion severity and characteristics. We
therefore aimed to assess SX variability and reproducibility among
interpreting physicians. Method(s): Fifty patient angiograms were
randomly selected from a registry of patients with multi-vessel CAD
(treated with PCI or CABG) completed at our institution during the years
2011-2018. Each angiogram was evaluated by 6 clinicians on 2 separate
occasions (minimum 8 weeks between occasions) for a total of 600 SX. Our
goal was to evaluate both inter- and intra- observer reliability of SX
scores. Variation in both raw score as well as risk classification (low,
intermediate or high SX) was observed. Inter- and intra-observer
reliability were assessed using the intra-class correlation coefficient
(ICC), Cohen's weighted Kappa, and Fleiss' Kappa. Result(s): SYNTAX
scores on both assessments and across all 6 cardiologists had a mean score
of 25.3. On the first assessment, the ICC for the inter-observer
reliability of SX scores was 0.61 (95% CI: 0.50, 0.73). Across the 6
observers, only 16% of angiograms were classified in the same risk
classification by all observers. 34% of angiograms had less than a
majority agreement (3 or less observers) on risk classification. The
weighted Kappa for intra-observer reliability of risk classification
scores ranged from 0.30 to 0.81. Across the 6 observers, the proportion of
angiograms classified as the same risk classification between each
observer's 1st and 2nd assessment ranged from 46% to 84%.
 Conclusion(s): This study shows a wide inter- and intra- user
variability in calculating SX. Our data indicates a significant limitation
in using the SX to guide revascularization strategies. Further studies are
needed to determine more reliable ways to quantitate burden of
CAD. Copyright © 2021 Elsevier Inc.

<72>
Accession Number
2013012935
Title
Efficacy and safety of sulforaphane for treatment of mild to moderate
depression in patients with history of cardiac interventions: A
randomized, double-blind, placebo-controlled clinical trial.
Source
Psychiatry and Clinical Neurosciences. (no pagination), 2021. Date of
Publication: 2021.
Author
Ghazizadeh-Hashemi F.; Bagheri S.; Ashraf-Ganjouei A.; Moradi K.;
Shahmansouri N.; Mehrpooya M.; Noorbala A.-A.; Akhondzadeh S.
Institution
(Ghazizadeh-Hashemi, Shahmansouri, Noorbala) Psychosomatic Research
Center, Imam Hospital, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bagheri, Ashraf-Ganjouei, Moradi, Akhondzadeh) Psychiatric Research
Center, Roozbeh Psychiatric Hospital, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mehrpooya) Cardiovascular Ward, Imam Hospital, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Blackwell Publishing
Abstract
Aim: Depression has been recognized as one of the disorders associated
with cardiac interventions such as percutaneous coronary intervention
(PCI) or coronary artery bypass graft surgery (CABG). In the present
study, we evaluated the efficacy and safety of sulforaphane in treatment
of depression induced by cardiac interventions. Method(s): After
initial screening, 66 patients with previous history of at least one
cardiac intervention and current mild to moderate depression were randomly
assigned to two parallel groups receiving either sulforaphane (n = 33) or
placebo (n = 33) for six successive weeks. Efficacy was assessed using the
Hamilton Rating Scale for Depression (HAM-D) at baseline and week 2, 4,
and 6. Safety of the treatments was checked during the trial period.
 Result(s): Sixty participants completed the clinical trial (n = 30 in
each group). Baseline demographic and clinical parameters were all similar
among groups. Repeated measures analysis indicated that the sulforaphane
group exhibited greater improvement in HAM-D scores throughout the trial
(P < 0.001). Response to treatment (>=50% reduction in the HAM-D score)
rate was higher in the sulforaphane group at trial endpoint (30% vs 6.67%,
P = 0.042). Remission (HAM-D score <= 7) rate was also higher in the
sulforaphane group; however, the difference was not significant (23.33% vs
3.33%, P = 0.052). Finally, no significant difference was observed between
the two groups in terms of frequency of side effects. Conclusion(s):
Sulforaphane could safely improve depressive symptoms induced by cardiac
interventions. Further clinical trials with larger sample sizes and longer
follow-up periods are warranted to confirm our results. Copyright
© 2021 The Authors Psychiatry and Clinical Neurosciences © 2021
Japanese Society of Psychiatry and Neurology

<73>
Accession Number
2011661723
Title
Tailored anaesthesia for thoracoscopic surgery promoting enhanced
recovery: The state of the art.
Source
Anaesthesia Critical Care and Pain Medicine. 40 (2) (no pagination), 2021.
Article Number: 100846. Date of Publication: April 2021.
Author
Elsayed H.H.; Moharram A.A.
Institution
(Elsayed) Thoracic Surgery Department, Ain Shams University, Cairo, Egypt
(Moharram) Department of Anaesthesia, Intensive Care and Pain Management,
Ain Shams University, Cairo, Egypt
Publisher
Elsevier Masson s.r.l.
Abstract
Purpose of the review: The current review focuses on precise anaesthesia
for video-assisted thoracoscopic surgery (VATS) with the goal of enhanced
recovery. The main aim of an enhanced recovery program after thoracic
surgery is to reduce postoperative stress response, protect from
postoperative pulmonary complications, give hospitals a better financial
option and improve overall patient outcome. This can ultimately reduce
hospital stay and increase patient satisfaction. With advances in
endoscopic, robotic and endovascular techniques, video-assisted
thoracoscopic surgery (VATS) can be performed in a minimally invasive way
in managing most pulmonary, pleural and mediastinal diseases. As a
minimally invasive technique, video-assisted thoracoscopic surgery (VATS)
represents an important element of enhanced recovery program in thoracic
surgery as it can achieve most of its goals. Anaesthetic management during
preoperative, intraoperative and postoperative period is essential for the
establishment of a successful enhanced recovery program. In the era of
enhanced recovery protocols, non-intubated thoracoscopic procedures
present a step forward. This article focuses on the key anaesthetic
elements of the enhanced recovery program during all phases of
thoracoscopic surgery. Having reviewed recent literature, a systematic
review of literature will highlight successful ERAS protocols published
for thoracoscopic surgery. Copyright © 2021 Societe francaise
d'anesthesie et de reanimation (Sfar)

<74>
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.

<75>
Accession Number
635009851
Title
Clinical Insights Into Heritable Cardiomyopathies.
Source
Frontiers in Genetics. 12 (no pagination), 2021. Article Number: 663450.
Date of Publication: 28 Apr 2021.
Author
Martinez H.R.; Beasley G.S.; Miller N.; Goldberg J.F.; Jefferies J.L.
Institution
(Martinez, Beasley, Miller, Goldberg) The Heart Institute, Le Bonheur
Children's Hospital, The University of Tennessee Health Science Center,
Memphis, TN, United States
(Jefferies) The Cardiovascular Institute, The University of Tennessee
Health Science Center, Memphis, TN, United States
Publisher
Frontiers Media S.A.
Abstract
Cardiomyopathies (CMs) encompass a heterogeneous group of structural and
functional abnormalities of the myocardium. The phenotypic characteristics
of these myocardial diseases range from silent to symptomatic heart
failure, to sudden cardiac death due to malignant tachycardias. These
diseases represent a leading cause of cardiovascular morbidity, cardiac
transplantation, and death. Since the discovery of the first locus
associated with hypertrophic cardiomyopathy 30 years ago, multiple loci
and molecular mechanisms have been associated with these cardiomyopathy
phenotypes. Conversely, the disparity between the ever-growing landscape
of cardiovascular genetics and the lack of awareness in this field
noticeably demonstrates the necessity to update training curricula and
educational pathways. This review summarizes the current understanding of
heritable CMs, including the most common pathogenic gene variants
associated with the morpho-functional types of cardiomyopathies: dilated,
hypertrophic, arrhythmogenic, non-compaction, and restrictive. Increased
understanding of the genetic/phenotypic associations of these heritable
diseases would facilitate risk stratification to leveraging appropriate
surveillance and management, and it would additionally provide
identification of family members at risk of avoidable cardiovascular
morbidity and mortality. © Copyright © 2021 Martinez,
Beasley, Miller, Goldberg and Jefferies.

<76>
Accession Number
634097123
Title
Effect of redundant clinical trials from mainland China evaluating statins
in patients with coronary artery disease: Cross sectional study.
Source
The BMJ. 372 (no pagination), 2021. Article Number: n48. Date of
Publication: 02 Feb 2021.
Author
Jia Y.; Wen J.; Qureshi R.; Ehrhardt S.; Celentano D.D.; Wei X.; Rosman
L.; Wen Y.; Robinson K.A.
Institution
(Jia, Robinson) Department of Medicine, School of Medicine, Johns Hopkins
University, 1830 East Monument Street, Baltimore, MD 21287, United States
(Wen, Qureshi, Ehrhardt, Celentano) Department of Epidemiology, Bloomberg
School of Public Health, Johns Hopkins University, Baltimore, MD, United
States
(Wei) Department of Cardiology, Virginia Commonwealth University,
Richmond, VA, United States
(Rosman) Welch Medical Library, Johns Hopkins University, Baltimore, MD,
United States
(Wen) Division of Nephrology, School of Medicine, Johns Hopkins
University, Baltimore, MD, United States
Publisher
BMJ Publishing Group
Abstract
Objective To identify redundant clinical trials evaluating statin
treatment in patients with coronary artery disease from mainland China,
and to estimate the number of extra major adverse cardiac events (MACEs)
experienced by participants not treated with statins in those trials.
Design Cross sectional study. Setting 2577 randomized clinical trials
comparing statin treatment with placebo or no treatment in patients with
coronary artery disease from mainland China, searched from bibliographic
databases to December 2019. Participants 250 810 patients with any type of
coronary artery disease who were enrolled in the 2577 randomized clinical
trials. Main outcome measures Redundant clinical trials were defined as
randomized clinical trials that initiated or continued recruiting after
2008 (ie, one year after statin treatment was strongly recommended by
clinical practice guidelines). The primary outcome is the number of extra
MACEs that were attributable to the deprivation of statins among patients
in the control groups of redundant clinical trials-that is, the number of
extra MACEs that could have been prevented if patients were given statins.
Cumulative meta-analyses were also conducted to establish the time points
when statins were shown to have a statistically significant effect on
coronary artery disease. Results 2045 redundant clinical trials were
identified published between 2008 and 2019, comprising 101 486 patients in
the control groups not treated with statins for 24 638 person years. 3470
(95% confidence interval 3230 to 3619) extra MACEs were reported,
including 559 (95% confidence interval 506 to 612) deaths, 973 (95%
confidence interval 897 to 1052) patients with new or recurrent myocardial
infarction, 161 (132 to 190) patients with stroke, 83 (58 to 105) patients
requiring revascularization, 398 (352 to 448) patients with heart failure,
1197 (1110 to 1282) patients with recurrent or deteriorated angina
pectoris, and 99 (95% confidence interval 69 to 129) unspecified MACEs.
Conclusions Of more than 2000 redundant clinical trials on statins in
patients with coronary artery disease identified from mainland China, an
extra 3000 MACEs, including nearly 600 deaths, were experienced by
participants not treated with statins in these trials. The scale of
redundancy necessitates urgent reform to protect patients. Copyright
© 2021 BMJ Publishing Group. All rights reserved.

<77>
Accession Number
2006711257
Title
Supplementation with octacosanol affects the level of pcsk9 and restore
its physiologic relation with ldl-c in patients on chronic statin therapy.
Source
Nutrients. 13 (3) (pp 1-12), 2021. Article Number: 903. Date of
Publication: March 2021.
Author
Ciric M.Z.; Ostojic M.; Baralic I.; Kotur-Stevuljevic J.; Djordjevic B.I.;
Markovic S.; Zivkovic S.; Stankovic I.
Institution
(Ciric, Djordjevic, Stankovic) Department of Bromatology, Faculty of
Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade 11221,
Serbia
(Ostojic) Faculty of Medicine, University of Belgrade, 6 Dr Subotica
Street, Belgrade 11000, Serbia
(Ostojic) Institute for Cardiovascular Diseases "Dedinje", Milana Tepica
1, Belgrade 11000, Serbia
(Ostojic) Department of Cardiology, University Clinical Centre of the
Republic of Srpska, Banja Luka 78000, Bosnia and Herzegovina
(Ostojic) Medical Faculty, University of Banja Luka, Banja Luka 78000,
Bosnia and Herzegovina
(Baralic, Markovic, Zivkovic) Department of Pharmacy, Zvezdara University
Medical Center, Dimitrija Tucovica 161, Belgrade 11000, Serbia
(Kotur-Stevuljevic) Department of Medical Biochemistry, Faculty of
Pharmacy, University of Belgrade, Vojvode Stepe 450, Belgrade 11221,
Serbia
Publisher
MDPI AG
Abstract
Dietary supplementation with sugar cane derivates may modulate low-density
lipopro-tein cholesterol (LDL-C) and proprotein convertase
subtilisin/kexin type 9 (PCSK9) levels. The pur-pose of this study was to
determine if dietary supplement (DS), containing Octacosanol (20 mg) and
vitamin K2 (45 microg), could restore the disrupted physiologic relation
between LDL-C and serum PCSK9. Double-blind, randomized,
placebo-controlled, single-center study including 87 patients on chronic
atorvastatin therapy was conducted. Eighty-seven patients were randomized
to receive DS (n = 42) or placebo (n = 45), and followed for 13 weeks.
Serum PCSK9 levels, lipid parameters and their relationship were the main
efficacy endpoints. The absolute levels of PCSK9 and LDL-C were not
significantly different from baseline to 13 weeks. However, physiologic
correlation between % change of PCSK9 and % change of LDL-C levels was
normalized only in the group of patients treated with DS (r = 0.409, p =
0.012). This study shows that DS can restore statin disrupted physiologic
positive correlation between PCSK9 and LDL-C. Elevated PCSK9 level is an
independent risk factor so controlling its rise by statins may be
important in prevention of cardiovascular events. Copyright ©
2021 by the authors. Li-censee MDPI, Basel, Switzerland.

<78>
Accession Number
2010449457
Title
Meta-analysis of Direct Oral Anticoagulants in Patients With Atrial
Fibrillation and Bioprosthetic Valves.
Source
American Journal of Cardiology. 142 (pp 140-141), 2021. Date of
Publication: 01 Mar 2021.
Author
Kheiri B.; Przybylowicz R.; Simpson T.F.; Alhamoud H.; Osman M.; Dalouk
K.; Nazer B.; Henrikson C.A.; Stecker E.
Institution
(Kheiri, Przybylowicz, Simpson, Dalouk, Nazer, Henrikson, Stecker) Knight
Cardiovascular Institute, Oregon Health & Science University, Portland,
OR, United States
(Alhamoud, Osman) Division of Cardiology, West Virginia University School
of Medicine, Morgantown, WV, United States
Publisher
Elsevier Inc.

<79>
Accession Number
2010234505
Title
Efficacy of Trimetazidine in Limiting Periprocedural Myocardial Injury in
Patients Undergoing Percutaneous Coronary Intervention: A Systematic
Review and Meta-Analysis.
Source
Angiology. 72 (6) (pp 511-523), 2021. Date of Publication: July 2021.
Author
Wang C.; Chen W.; Yu M.; Yang P.
Institution
(Wang, Chen, Yu, Yang) Department of Cardiology, China-Japan Union
Hospital of Jilin University, Changchun, Jilin, China
(Wang, Chen) Jilin Provincial Precision Medicine Key Laboratory for
Cardiovascular Genetic Diagnosis, Jilin, China
(Wang, Yu, Yang) Jilin Provincial Engineering Laboratory for Endothelial
Function and Genetic Diagnosis of Cardiovascular Disease, Jilin, China
(Chen, Yu) Jilin Provincial Cardiovascular Research Institute, Jilin,
China
(Yang) Jilin Provincial Molecular Biology Research Center for Precision
Medicine of Major Cardiovascular Disease, Jilin, China
Publisher
SAGE Publications Inc.
Abstract
We systematically searched the literature to assess the efficacy of
trimetazidine in reducing periprocedural myocardial injury and improving
postoperative left ventricular ejection fraction (LVEF) in patients with
coronary artery disease (CAD) undergoing percutaneous coronary
intervention (PCI). An electronic search was conducted based on the
PubMed, Ovid, Scopus, Springer, CENTRAL, and Google Scholar databases; 14
randomized controlled trials (RCTs) were included. Our meta-analysis
showed a significant reduction in cardiac troponin I (cTnI) levels with
trimetazidine compared with controls (P <.00001) but not in serum creatine
kinase-myocardial band levels (P =.49). There were significantly reduced
odds of ischemic ST-T segment changes with trimetazidine (P =.0.03) but
lack of significant difference in the incidence of anginal attacks between
the 2 groups (P =.10). Results also suggest significantly higher LVEF with
trimetazidine compared with controls (P <.00001). Meta-regression analysis
indicated no influence of duration of trimetazidine therapy on cTnI
levels. The administration of preprocedure trimetazidine may have a role
in reducing periprocedural myocardial injury in patients with CAD
undergoing PCI. Evidence also suggests that postoperative trimetazidine
may improve LVEF in the short term. Lack of high-quality trials and the
heterogeneity of studies limit the ability of our analysis to draw strong
conclusions. Further well-designed RCTs are required to supplement current
evidence. Copyright © The Author(s) 2021.

<80>
Accession Number
2007629295
Title
Pedicled versus skeletonized internal thoracic artery grafts: a randomized
trial.
Source
Asian Cardiovascular and Thoracic Annals. 29 (6) (pp 490-497), 2021. Date
of Publication: July 2021.
Author
Dreifaldt M.; Samano N.; Geijer H.; Liden M.; Bodin L.; Souza D.
Institution
(Dreifaldt, Souza) Department of Cardiovascular and Thoracic Surgery,
School of Medical Sciences, Orebro University, Orebro, Sweden
(Samano) Department of Cardiothoracic and Vascular Surgery, and University
Health Care Research Center, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Geijer, Liden) Department of Radiology, School of Medical Sciences,
Orebro University, Orebro, Sweden
(Bodin) Institute of Environmental Medicine, Unit of Intervention and
Implementation Research, Karolinska Institute, Stockholm, Sweden
Publisher
SAGE Publications Inc.
Abstract
Objective: Concerns have been raised regarding whether skeletonization of
the internal thoracic artery could damage the graft and thereby reduces
its patency. The objective of this study was to compare patency rates at
mid- and long-term follow-up between pedicled and skeletonized left
internal thoracic artery grafts. Method(s): This randomized
controlled trial included 109 patients undergoing coronary artery bypass
surgery. The patients were assigned to receive either one pedicled or one
skeletonized left internal thoracic artery graft to the left anterior
descending artery. Follow-up was performed at 3 years with conventional
angiography, and at 8 years with computed tomography angiography.
Differences between patency rates were analyzed with Fisher's exact test
and a generalized linear model. Result(s): The patency rates for
pedicled and skeletonized left internal thoracic artery grafts were 46/48
(95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%)
versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in
patency rates for pedicled and skeletonized grafts was 5.4% (95%
confidence interval: -4.2-14.5) at 3 years and 2.8% (95% confidence
interval: -9.9-14.1) at 8 years. All failed grafts, except for one with a
localized stenosis, were anastomosed to native coronary arteries with a
stenosis less than 70%. Three patients suffered sternal wound infections
(two in the pedicled group, one in the skeletonized group).
 Conclusion(s): The skeletonization technique can be used without
jeopardizing the patency of the left internal thoracic artery. The most
important factor in graft failure was target artery stenosis below
70%. Copyright © The Author(s) 2020.

<81>
Accession Number
2013314383
Title
Influence of frailty on outcome in older patients undergoing non-cardiac
surgery - A systematic review and meta-analysis.
Source
Aging and Disease. 11 (5) (pp 1276-1290), 2020. Date of Publication: 2020.
Author
Tjeertes E.K.M.; Van Fessem J.M.K.; Mattace-Raso F.U.S.; Hoofwijk A.G.M.;
Stolker R.J.; Hoeks S.E.
Institution
(Tjeertes, Van Fessem, Stolker, Hoeks) Department of Anesthesiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands
(Mattace-Raso) Department of Internal Medicine, Division of Geriatric
Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
(Hoofwijk) Department of Surgery, Zuyderland Medical Center, Geleen,
Netherlands
Publisher
International Society on Aging and Disease
Abstract
Frailty is increasingly recognized as a better predictor of adverse
postoperative events than chronological age. The objective of this review
was to systematically evaluate the effect of frailty on postoperative
morbidity and mortality. Studies were included if patients underwent
non-cardiac surgery and if frailty was measured by a validated instrument
using physical, cognitive and functional domains. A systematic search was
performed using EMBASE, MEDLINE, Web of Science, CENTRAL and PubMed from
1990 - 2017. Methodological quality was assessed using an assessment tool
for prognosis studies. Outcomes were 30-day mortality and complications,
one-year mortality, postoperative delirium and discharge location.
Meta-analyses using random effect models were performed and presented as
pooled risk ratios with confidence intervals and prediction intervals. We
included 56 studies involving 1.106.653 patients. Eleven frailty
assessment tools were used. Frailty increases risk of 30-day mortality (31
studies, 673.387 patients, risk ratio 3.71 [95% CI 2.89-4.77] (PI
1.38-9.97; I2=95%) and 30-day complications (37 studies, 627.991 patients,
RR 2.39 [95% CI 2.02-2.83). Risk of 1-year mortality was threefold higher
(six studies, 341.769 patients, RR 3.40 [95% CI 2.42-4.77]). Four studies
(N=438) reported on postoperative delirium. Meta-analysis showed a
significant increased risk (RR 2.13 [95% CI 1.23-3.67). Finally, frail
patients had a higher risk of institutionalization (10 studies, RR 2.30
[95% CI 1.81-2.92]). Frailty is strongly associated with risk of
postoperative complications, delirium, institutionalization and mortality.
Preoperative assessment of frailty can be used as a tool for patients and
doctors to decide who benefits from surgery and who doesn't. Copyright
© 2019 Tjeertes EKM, et al.

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