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<1>
Accession Number
362453996
Title
The effect of ulinastatin on postoperative blood loss in patients
undergoing open heart surgery with cardiopulmonary bypass.
Source
Journal of International Medical Research. 39 (4) (pp 1201-1210), 2011.
Date of Publication: August 2011.
Author
Song J.E.; Kang W.S.; Kim D.K.; Yoon T.G.; Kim T.Y.; Bang Y.-S.; Kim S.H.
Institution
(Song, Kang, Kim, Yoon, Kim, Kim) Department of Anaesthesiology and Pain
Medicine, Konkuk University School of Medicine, Seoul, South Korea
(Bang) Department of Anaesthesiology and Pain Medicine, CHA Bundang
Medical Centre, CHA University, Seongnam, South Korea
Publisher
SAGE Publications Ltd
Abstract
This prospective, randomized, doubleblind study evaluated the effect of
ulinastatin on postoperative blood loss and transfusion requirements of
patients undergoing open-heart surgery with cardiopulmonary bypass (CPB)
and aortic cross-clamping (ACC). CPB and ACC produce variable systemic
inflammatory reactions that are associated with multiorgan dysfunction via
leucocytes, especially polymorphonuclear neutrophils (PMNs). PMNs increase
blood loss and transfusion requirements. Ulinastatin, a urinary trypsin
inhibitor, inhibits PMN activity and reduces the systemic inflammatory
response. Patients received either 5000 U/kg ulinastatin or the equivalent
volume of normal saline (control group) before ACC. Postoperative blood
loss and transfusion requirements were recorded. Duration of intubation
and length of stay in the intensive care unit (ICU) were also noted. There
were no statistically significant between-group differences in
postoperative blood loss and transfusion requirements. Ulinastatin caused
a non-significant decrease in duration of intubation. Patients who
received ulinastatin had significantly shorter ICU stays than control
patients. &#xa9; 2011 Field House Publishing LLP.

<2>
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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2021 The Author(s)
2021. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
2007163541
Title
Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A
Meta-analysis.
Source
Pediatric Cardiology. 42 (2) (pp 225-233), 2021. Date of Publication:
February 2021.
Author
Farias J.S.; Villarreal E.G.; Flores S.; Mastropietro C.W.; Vogel M.;
Schulz K.; Culichia C.; Iliopoulos I.D.; Bronicki R.A.; Loomba R.S.
Institution
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Flores, Bronicki) Texas Children's Hospital, Houston, TX, United States
(Flores, Bronicki) Baylor College of Medicine, Houston, TX, United States
(Mastropietro) Riley's Children's Health, Indianapolis, IN, United States
(Mastropietro) Indiana University School of Medicine, Indianapolis, IN,
United States
(Vogel, Schulz, Culichia, Loomba) Chicago Medical School/Rosalind Franklin
University of Medicine and Science, North Chicago, IL, United States
(Vogel, Schulz, Culichia, Loomba) Advocate Children's Heart
Institute/Advocate Children's Hospital, Oak Lawn, IL, United States
(Iliopoulos) Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
(Villarreal) Department of Pediatrics, Tecnologico de Monterrey, Escuela
de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Publisher
Springer
Abstract
Vasopressin has been used to augment blood pressure; however,
cardiovascular effects after cardiac surgery have not been well
established. The primary objective of this study was to survey the current
literature and quantify the pooled effect of vasopressin on hemodynamic
parameters in children after pediatric cardiac surgery. A systematic
review was conducted to identify studies characterizing the hemodynamic
effects of vasopressin after pediatric cardiac surgery. Studies were
assessed and those of satisfactory quality with pre- and post-vasopressin
hemodynamics for each patient were included in the final analyses. 6
studies with 160 patients were included for endpoints during the first 2 h
of infusions. Patients who received vasopressin infusion had greater mean,
systolic, and diastolic blood pressures and lower heart rates at 2 h after
initiation. 8 studies with 338 patients were included for the effects at
24 h. Patients who received vasopressin infusion had lower central venous
pressures and decreased lactate concentrations 24 h after initiation. A
subset analysis for children with functionally univentricular hearts found
significant decrease in inotrope score and central venous pressure. A
subset analysis for neonates found significant decrease in inotrope score
and fluid balance. Vasopressin leads to decrease in heart rate and
increase in blood pressure in the first 2 h of initiation. Later effects
include decrease in inotrope score, central venous pressure, fluid
balance, and in lactate within the first 24 h. Findings vary in neonates
and in those with functionally univentricular hearts although beneficial
effects are noted in both.<br/>Copyright &#xa9; 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<4>
Accession Number
635461696
Title
Acute pain after serratus anterior plane or thoracic paravertebral blocks
for video-assisted thoracoscopic surgery: A noninferiority randomised
trial.
Source
European journal of anaesthesiology. 38 (Supplement 2) (pp S97-S105),
2021. Date of Publication: 01 Aug 2021.
Author
Qiu Y.; Wu J.; Huang Q.; Lu Y.; Xu M.; Mascha E.J.; Yang D.; Ince I.;
Sessler D.I.
Institution
(Qiu) From the Department of Anesthesiology, Shanghai Chest Hospital,
Shanghai Jiao Tong University, Shanghai, China (YQ, JW, QH, YL, MX), the
Department of Outcomes Research, Anesthesiology Institute, Cleveland
Clinic (YQ, EJM, DY, II, DIS), the Outcomes Research Consortium (JW), the
Department of Quantitative Health Sciences, Cleveland Clinic, Ohio, USA
(EJM, DY), the Department of Anesthesiology and Reanimation, Ataturk
University School of Medicine, Anaesthesiology Clinical Research Office,
Erzurum, Turkey (II)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Serratus anterior plane blocks (SAPBs) and thoracic
paravertebral blocks (TPVBs) can both be used for video-assisted thoracic
surgery. However, it remains unknown whether the analgesic efficacy of a
SAPB is comparable to that of a TPVB. <br/>OBJECTIVE(S): We tested the
primary hypothesis that SAPBs provide noninferior analgesia compared with
TPVBs for video-assisted thoracic surgery. DESIGN: A noninferiority
randomised trial. SETTING: Shanghai Chest Hospital, between August 2018
and November 2018. PATIENTS: Ninety patients scheduled for video-assisted
thoracic lobectomy or segmentectomy were randomised. Patients were
excluded if they were unable to perform the visual analogue pain scale, or
surgery was converted to thoracotomy. INTERVENTIONS: Blocks were performed
after induction of general anaesthesia. The three groups were
paravertebral blocks (n = 30); serratus anterior plane blocks (n = 29);
and general anaesthesia alone (n = 30). PRIMARY OUTCOME MEASURES: Visual
analogue pain scores (0 to 10 cm) at rest and while coughing, and
Prince-Henry pain scores (0 to 4 points) were used to assess postoperative
analgesia at 2, 24 and 48 h after surgery. We assessed the noninferiority
of SAPBs with TPVBs on all three primary pain outcomes using a delta of 1
cm or one point as appropriate. <br/>RESULT(S): The mean difference (95%
confidence intervals) in visual analogue scores between the SAPBs and
TPVBs was -0.04 (-0.10 to 0.03) cm at rest, -0.22 (-0.43 to -0.01) cm
during coughing and -0.10 (-0.25 to 0.05) for Prince-Henry pain scores. As
the upper limit of the confidence intervals were less than 1 (all P <
0.001), noninferiority was claimed for all three primary outcomes.
Compared with general anaesthesia alone, the VAS scores at rest and while
coughing, and the Prince-Henry pain scores for the two blocks were
significantly lower during the initial 2 h after surgery.
<br/>CONCLUSION(S): Serratus anterior plane blocks are quicker and easier
to perform than paravertebral blocks and provide comparable analgesia in
patients having video-assisted thoracic surgery. Both blocks provided
analgesia that was superior to general anaesthesia alone during the
initial 2 h after surgery. TRIAL REGISTRATION: Chinese Clinical Trial
Registry, identifier: ChiCTR1800017671.<br/>Copyright &#xa9; 2021 European
Society of Anaesthesiology and Intensive Care. Unauthorized reproduction
of this article is prohibited.

<5>
Accession Number
2013264659
Title
Comparison of SYNTAX score strata effects of percutaneous and surgical
revascularization trials: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Gaudino M.; Hameed I.; Di Franco A.; Naik A.; Demetres M.; Biondi-Zoccai
G.; Bangalore S.
Institution
(Gaudino, Hameed, Di Franco, Naik) Department of Cardiothoracic Surgery,
Weill Cornell Medicine, New York, NY, United States
(Hameed) Section of Cardiac Surgery, Yale University School of Medicine,
New Haven, Conn, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, New York, NY, United States
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University of Rome, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Napoli, Italy
(Bangalore) New York University Grossman School of Medicine, New York, New
York, NY, United States
Publisher
Mosby Inc.
Abstract
Objectives: The evidence supporting the use of the Synergy Between
Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)
score for risk stratification is controversial. We performed a systematic
review and meta-analysis of all the randomized controlled trials comparing
percutaneous coronary intervention versus coronary artery bypass grafting
that reported their outcomes stratified by SYNTAX score, focusing on
between-strata comparisons. <br/>Method(s): A systematic review of
MEDLINE, EMBASE, Cochrane Library databases was performed. Incidence rate
ratios were pooled with a random effect model. Between-group statistical
heterogeneity according to accepted SYNTAX score tertiles was computed in
the main analysis. Ratios of incidence rate ratios were computed to
appraise between-strata effect, as sensitivity analysis. Primary and
secondary outcomes were major adverse cardiac and cerebrovascular events
and all-cause mortality, respectively. Separate sub-analyses were
performed for left main and multivessel disease. <br/>Result(s): From 425
citations, 6 trials were eventually included (8269 patients [4134
percutaneous coronary interventions, 4135 coronary artery bypass
graftings]; mean follow-up: 6.2 years [range: 3.8-10]). Overall,
percutaneous coronary intervention was associated with a significant
increase in major adverse cardiac and cerebrovascular events (incidence
rate ratio, 1.39, 95% confidence interval, 1.27-1.51) and nonsignificant
increase in all-cause mortality (incidence rate ratio, 1.17, 95%
confidence interval, 0.98-1.40). There was no significant statistical
heterogeneity of treatment effect by SYNTAX score for major adverse
cardiac and cerebrovascular events or mortality (P = .40 and P = .34,
respectively). Results were consistent also for patients with left main
and multivessel disease (major adverse cardiac and cerebrovascular events:
P = .85 in left main, P = .78 in multivessel disease 0.78; mortality: P =
.12 in left main; P = .34 in multivessel disease). Results of analysis
based on ratios of incidence rate ratios were consistent with the main
analysis. <br/>Conclusion(s): No significant association was found between
SYNTAX score and the comparative effectiveness of percutaneous coronary
intervention and coronary artery bypass grafting. These findings have
implications for clinical practice, future guidelines, and the design of
percutaneous coronary intervention versus coronary artery bypass grafting
trials.<br/>Copyright &#xa9; 2021 The American Association for Thoracic
Surgery

<6>
Accession Number
2013262856
Title
Implantable cardioverter defibrillators in left ventricular assist device
patients: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Rorris F.-P.; Antonopoulos C.N.; Kyriakopoulos C.P.; Drakos S.G.; Charitos
C.
Institution
(Rorris, Antonopoulos, Charitos) Department of Thoracic and Cardiovascular
Surgery, Evangelismos General Hospital, Athens, Greece
(Kyriakopoulos, Drakos) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Utah Health & School of Medicine, Salt
Lake City, UT, United States
Publisher
Elsevier Inc.
Abstract
Implantable cardioverter-defibrillators (ICDs) remain the standard of care
in advanced heart failure with reduced ejection fraction patients for the
prevention of sudden cardiac death. However, current guidelines remain
conflicting with respect to the use of ICDs in patients supported with a
continuous flow left ventricular assist device (CF-LVAD). The current
review adhered to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Studies comparing the use of ICD in patients
with CF-LVADs were included. The 2 primary outcomes studied were all-cause
mortality, and a successful bridge to heart transplantation. We calculated
pooled odds ratios (ORs) with 95% confidence intervals (CIs). We also
compared baseline characteristics between US and European studies, for
CF-LVAD patients with an ICD. Among all studies, the use of an ICD was not
associated with all-cause mortality in patients with CF-LVADs (OR: 0.85,
95% CIs: 0.64-1.12, p = 0.24). The presence of an ICD was associated with
a trend towards increased likelihood of successful bridge to heart
transplantation (OR: 1.12, 95% CI: 1.0-1.3, p = 0.06). A subgroup analysis
of studies published by European centers revealed a significant decrease
in pooled mortality (OR: 0.58, 95% CI: 0.4-0.83, p = 0.003) with the use
of ICD, contrary to an increase in pooled mortality among studies
published by US centers (OR: 1.2, 95% CI 1.02-1.33, p = 0.025). Moreover,
we identified significant differences in baseline characteristics such as
bridge to transplantation rate, Interagency Registry for Mechanically
Assisted Circulatory Support profiles, and use of an intra-aortic balloon
pump or extracorporeal membrane oxygenation preoperatively, between the US
and European populations. While this meta-analysis did not show an overall
survival benefit with the use of an ICD in CF-LVAD patients, it revealed
significant differences in the derived benefit, in distinct patient
populations. This might reflect differences in baseline patient
characteristics and warrants further investigation.<br/>Copyright &#xa9;
2021 International Society for Heart and Lung Transplantation

<7>
Accession Number
2013245614
Title
Impact of preoperative glycometabolic status on outcomes in cardiac
surgery: Systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Corazzari C.; Matteucci M.; Kolodziejczak M.; Kowalewski M.; Formenti
A.M.; Giustina A.; Beghi C.; Barili F.; Lorusso R.
Institution
(Corazzari, Matteucci, Kowalewski, Lorusso) Department of Cardiothoracic
Surgery, Heart and Vascular Centre, Maastricht University Medical Centre,
Maastricht, Netherlands
(Corazzari, Matteucci, Beghi) Department of Surgical and Morphological
Sciences, Circolo Hospital, University of Insubria, Varese, Italy
(Kolodziejczak) Department of Anaesthesiology and Intensive Care,
Collegium Medicum Nicolaus Copernicus University, Antoni Jurasz University
Hospital No. 1, Bydgoszcz, Poland
(Kolodziejczak) Yale Cardiovascular Research Group, Yale School of
Medicine, New Haven, Conn, United States
(Kowalewski) Department of Cardiac Surgery, Central Clinical Hospital of
the Ministry of Interior, Centre of Postgraduate Medical Education,
Warsaw, Poland
(Kowalewski) Thoracic Research Centre, Collegium Medicum Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
(Formenti, Giustina) Institute of Endocrine and Metabolic Sciences, San
Raffaele Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
(Barili) Cardiac Surgery Unit, S. Croce Hospital, Cuneo, Italy
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
Mosby Inc.
Abstract
Background: Historically, impaired glucose metabolism has been associated
with early and late complicated clinical outcomes after cardiac surgery;
however, such a condition is not specific to subjects with diabetes
mellitus and involves a larger patient population. <br/>Method(s):
Databases were screened (January 2000 to December 2020) to identify
eligible articles; studies that evaluated the association between
preoperative metabolic status, as assessed by glycosylated hemoglobin
levels and clinical outcomes, were considered. The studies were stratified
in thresholds by baseline glycosylated hemoglobin level (lower vs higher).
<br/>Result(s): Thirty studies, involving 34,650 patients, were included
in the review. In a meta-analysis stratified by glycosylated hemoglobin
levels, early mortality was numerically reduced in each threshold
comparison and yielded the highest reductions when less than 5.5% versus
greater than 5.5% glycosylated hemoglobin levels were compared (risk
ratio, 0.39; 95% confidence interval, 0.18-0.84; P = .02). Comparing
higher glycosylated hemoglobin threshold values yielded comparable
results. Late mortality was reduced with lower levels of glycosylated
hemoglobin. Low preoperative glycosylated hemoglobin was associated with
the lowest risk of sternal wound infections (risk ratio, 0.50; 95%
confidence interval, 0.32-0.80; P = .003 and risk ratio, 0.53; 95%
confidence interval, 0.39-0.70; P < .0001) for comparisons of less than
7.5% versus greater than 7.5% and less than 7.0% versus greater than 7.0%
glycosylated hemoglobin thresholds, respectively. Additionally, levels of
glycosylated hemoglobin lower than 7% were associated with reduced
hospital stay, lower risk of stroke/transient ischemic attack (risk ratio
0.53; 95% confidence interval, 0.39-0.70; P < .0001), and acute kidney
injury (risk ratio, 0.65; 95% confidence interval, 0.54-0.79; P < .0001).
<br/>Conclusion(s): Lower levels of glycosylated hemoglobin in patients
undergoing cardiac surgery are associated with a lower risk of early and
late mortality, as well as in the incidence of postoperative acute kidney
injury, neurologic complications, and wound infection, compared with
higher levels.<br/>Copyright &#xa9; 2021 The Authors

<8>
Accession Number
2012392225
Title
Delirium and depression in cardiac surgery: A comprehensive review of risk
factors, pathophysiology, and management.
Source
Journal of Cardiac Surgery. 36 (8) (pp 2876-2889), 2021. Date of
Publication: August 2021.
Author
FatehiHassanabad A.; Bahrami N.; Novick R.J.; Ali I.S.
Institution
(Fatehi Hassanabad, Novick, Ali) Section of Cardiac Surgery, Department of
Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular
Institute, Calgary, AB, Canada
(Bahrami) Department of Medicine, Department of Medicine, Cumming School
of Medicine, Calgary, AB, Canada
Publisher
Blackwell Publishing Inc.
Abstract
Background: Mental health and wellbeing continue to gain more attention as
they are inextricably associated with clinical outcomes, particularly
quality of life. Many medical ailments and major surgeries affect
patients' mental health, including depression and delirium. <br/>Aim(s):
The objective of this manuscript was to comprehensively review and
critically examine the literature pertaining to cardiac surgery,
depression, and delirium. <br/>Method(s): This is a narrative review
article. We performed our search analysis by using the following key
words: "Cardiac Surgery", "Depression", "Delirium", "Clinical outcomes",
and "Mental Health". Search analysis was done on MedLine PubMed, accessing
indexed peer-reviewed publications. <br/>Result(s): Cardiac Surgery is a
life-altering intervention indicated to improve morbidity and mortality in
patients with cardiovascular diseases. Psychiatric conditions before and
after cardiac surgery worsen patient prognosis and increase mortality
rate. Specifically, preoperative depression increases postoperative
depression and is associated with impaired functional status, slow
physical recovery, and an increased readmission rate. <br/>Discussion(s):
Although the exact pathophysiology between depression and cardiovascular
disease (CVD) is unknown, several pathways have been implicated. Unmanaged
depression can also lead to other psychological conditions such as
delirium. Like depression, the exact association between delirium and CVD
is not well understood, but believed to be multifactorial.
<br/>Conclusion(s): Herein, we provide a comprehensive review of the links
between depression, delirium, and cardiovascular surgery. We critically
examine the current data that pertains to the pathophysiology of these
debilitating mental health issues in the context of cardiac surgery.
Finally, we summarize the various treatment options available for managing
depression and delirium in the cardiac surgery patient
population.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<9>
Accession Number
635462486
Title
The effect of phased written health education combined with healthy diet
on the quality of life of patients after heart valve replacement.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 183), 2021. Date of
Publication: 25 Jun 2021.
Author
Li D.; Liu P.; Zhang H.; Wang L.
Institution
(Li, Liu, Zhang) Department of Cardiac Surgery, First Hospital of Hebei
Medical University, Shijiazhuang, China
(Wang) Functional Division, Fourth Hospital of Hebei Medical University,
No.169 Tianshan Street ,Yuhua District, Shijiazhuang, Hebei 050000, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: To observe the effect of phased written health education
combined with healthy diet on the quality of life of patients after heart
valve replacement. <br/>METHOD(S): One hundred-thirty patients who
underwent heart valve replacement surgery in our hospital from January
2018 to January 2020 were enrolled as the research subjects. They were
randomly divided into study group (65 patients, phased written health
education combined with health Diet) and control group (65 cases, routine
health education). The drug compliance and the degree of anticoagulant
drugs knowledge were compared between the two groups in the first and
second stage rehabilitation and the recovery stage. The health behavior
ability and quality of life at different phases were also observed.
<br/>RESULT(S): During the first and the second stage rehabilitation, and
the recovery stage, the drug compliance of the study group was superior to
that of the control group, with statistical significance (P<0.05).
Meanwhile, the knowledge of anticoagulant drugs in the study group was
better than that in the control group, with statistical significance
(P<0.05). Before intervention, there was no significant difference in
health behavior ability and quality of life between the two groups
(P>0.05). The healthy behavior ability of study group for each stage was
superior to the control group, the difference was significant (P<0.05).
The healthy behavior ability and quality of life showed the same results
with statistical significance (P<0.05). <br/>CONCLUSION(S): The use of
phased written health education combined with healthy diet in patients
after heart valve replacement can effectively improve patients' medication
compliance, anticoagulant drugs knowledge, healthy behavior ability and
quality of life at different stages, and is worthy of clinical
application.

<10>
Accession Number
635462260
Title
Frailty and pre-frailty in cardiac surgery: a systematic review and
meta-analysis of 66,448 patients.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 184), 2021. Date of
Publication: 25 Jun 2021.
Author
Lee J.A.; Yanagawa B.; An K.R.; Arora R.C.; Verma S.; Friedrich J.O.
Institution
(Lee, Yanagawa, An, Verma) Division of Cardiac Surgery, University of
Toronto, ON, 30 Bond Street ,8th Floor ,Bond Wing, Toronto M5B 1W8, Canada
(Arora) Department of Surgery, Max Rady College of Medicine, University of
Manitoba, Winnipeg, MB, Canada
(Friedrich) Critical Care, St Michael's Hospital, University of Toronto,
Toronto, ON, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: The burden of frailty on cardiac surgical outcomes is
incompletely understood. Here we perform a systematic review and
meta-analysis of studies comparing frail versus pre-frail versus non-frail
patients following cardiac surgery. <br/>METHOD(S): We searched MEDLINE
and EMBASE databases until July 2018 for studies comparing cardiac surgery
outcomes in "frail", "pre-frail" and "non-frail" patients. Data was
extracted in duplicate. Primary outcome was operative mortality.
<br/>RESULT(S): There were 19 observational studies with 66,448 patients.
Frail patients were more likely female (risk ratio [RR]1.7;
95%CI:1.5-1.9), older (mean difference: 2.4; 95%CI:1.3-3.5years older)
with greater comorbidities and higher STS-PROM. Frailty (RR2.35;
95%CI:1.57-3.51; p<0.0001) and pre-frailty (RR2.03; 95%CI:1.52-2.70;
p<0.00001) were associated with increased operative mortality compared
with non-frail patients. Frailty was also associated with greater risk of
prolonged hospital stay (RR1.83; 95%CI:1.61-2.08; p<0.0001) and
intermediate care facility discharge (RR2.71; 95%CI:1.45-5.05; p=0.002).
Frail (Hazard Ratio [HR]3.27; 95%CI:1.93-5.55; p<0.0001) and pre-frail
patients (HR2.30; 95%CI:1.29-4.09; p=0.005) had worse mid-term mortality
(median follow-up 1years [range 0.5-4years]). After adjustment for
baseline imbalances, frailty was still associated with greater operative
mortality (odds ratio [OR]1.97; 95%CI:1.51-2.57; p<0.00001), intermediate
care facility discharge (OR4.61; 95%CI:2.78-7.66; p< 0.00001) and midterm
mortality (HR1.37; 95%CI:1.03-1.83; p=0.03). <br/>CONCLUSION(S): In
patients undergoing cardiac surgery, frailty and pre-frailty were
associated with 2-fold and 1.5-fold greater adjusted operative mortality,
respectively, greater adjusted perioperative complications and frailty was
associated with almost 5-fold risk of non-home discharge. Burden of
frailty and pre-frailty on cardiac surgical outcomes.

<11>
Accession Number
2007743564
Title
Efficacy of intraoperative hemodynamic optimization using flotrac/ev1000
platform for early goal-directed therapy to improve postoperative outcomes
in patients undergoing coronary artery bypass graft with cardiopulmonary
bypass: A randomized controlled trial.
Source
Medical Devices: Evidence and Research. 14 (pp 201-209), 2021. Date of
Publication: 2021.
Author
Tribuddharat S.; Sathitkarnmanee T.; Ngamsangsirisup K.; Nongnuang K.
Institution
(Tribuddharat, Sathitkarnmanee, Ngamsangsirisup) Department of
Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen
40002, Thailand
(Nongnuang) Phramongkutklao Hospital, Bangkok 10400, Thailand
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Early goal-directed therapy (EGDT) using the FloTrac system
reportedly improved postoperative outcomes among high-risk patients
undergoing non-cardiac surgery. This study's objective was to evaluate the
FloTrac/EV1000 platform's efficacy for improving postoperative outcomes in
cardiac surgery. <br/>Patients and Methods: Eighty-six adults undergoing
coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2
tertiary referral centers were randomized to the EGDT or Control group.
The Control group was managed with standard care to achieve the following
goals: mean arterial pressure 65-90 mmHg; central venous pressure 8-12
mmHg; urine output >=0.5 mL.kg^-1.h-1; oxygen saturation >95%;
and hematocrit 26-30%. The EGDT group was managed to reach similar goals
using information from the FloTrac/EV1000 monitor. The targets were stroke
volume variation <13%; stroke volume index 33-65 mL.beat^-1.m-2;
cardiac index 2.2-4.0 L.min^-1.m-2; and systemic vascular
resistance index 1600-2500 dynes.s.cm^-5.m-2. <br/>Result(s):
The intensive care unit (ICU) stay of the EGDT group was significantly
shorter (mean difference -29.5 h; 95% CI -17.2 to -41.8, P < 0.001). The
mechanical ventilation time was also shorter in the EGDT group (mean
difference -11.3 h; 95% CI -2.7 to -19.9, P = 0.011). The hospital LOS was
shorter in the EGDT group (mean difference -1.1 d; 95% CI -0.1 to -2.1, P
= 0.038). <br/>Conclusion(s): EGDT using FloTrac/EV1000 can be applied in
CABG with CPB to improve postoperative outcomes.<br/>Copyright &#xa9; 2021
Tribuddharat et al.

<12>
Accession Number
635452340
Title
Effect of the oXiris membrane on microcirculation after cardiac surgery
under cardiopulmonary bypass: Study protocol for a randomised controlled
trial (OXICARD Study).
Source
BMJ Open. 11 (7) (no pagination), 2021. Article Number: e044424. Date of
Publication: 09 Jul 2021.
Author
Abou-Arab O.; Huette P.; Haye G.; Guilbart M.; Touati G.; Diouf M.; Beyls
C.; Dupont H.; Mahjoub Y.
Institution
(Abou-Arab, Huette, Haye, Guilbart, Beyls, Dupont, Mahjoub) Anesthesiology
and Critical Care, CHU Amiens-Picardie, Amiens, France
(Touati) Cardiac Surgery Department, CHU Amiens-Picardie, Amiens, France
(Diouf) Statistic Department, CHU Amiens-Picardie, Amiens, France
Publisher
BMJ Publishing Group
Abstract
Cytokine storm and endotoxin release during cardiac surgery with
cardiopulmonary bypass (CPB) have been related to vasoplegic shock and
organ dysfunction. We hypothesised that early (during CPB) cytokine
adsorption with oXiris membrane for patients at high risk of inflammatory
syndrome following cardiac surgery may improve microcirculation,
endothelial function and outcomes. The Oxicard trial is a prospective,
monocentric trial, randomising 70 patients scheduled for cardiac surgery.
The inclusion criterion is patients aged more than 18 years old undergoing
elective cardiac surgery under CPB with an expected CPB time >90 min
(double valve replacement or valve replacement plus coronary arterial
bypass graft). Patients will be allocated to the intervention group (n=35)
or the control group (n=35). In the intervention group, oXiris membrane
will be used on the Prismaflex device (Baxter) at blood pump flow of 450
mL/min during cardiac surgery under CPB. In the control group, cardiac
surgery under CPB will be conducted as usual without oXiris membrane. An
intention-to-treat analysis will be performed. The primary endpoint will
be the microcirculatory flow index measured by sublingual microcirculation
device at day 1 following cardiac surgery. The secondary endpoints will be
other microcirculation variables at CPB end, 6 hours after CPB, at day 1
and at day 2. We also aim to evaluate the occurrence of major
cardiovascular and cerebral events (eg, myocardial infarction, stroke,
ischaemic mesenteric, resuscitated cardiac arrest, acute kidney injury)
within the first 30 days. Cumulative catecholamine use, intensive care
unit length of stay, endothelium glycocalyx shedding parameters
(syndecan-1, heparan-sulfate and hyaluronic acid), inflammatory cytokines
(tumour necrosis factor (TNF) alpha, interleukin 1 (IL1) beta, IL 10, IL
6, lipopolysaccharide, endothelin) and endothelial permeability biomarkers
(angiopoietin 1, angiopoietin 2, Tie2 soluble receptor and Vascular
Endothelial Growth Factor (VEGF) will also be evaluated. Ethical approval
has been obtained from the Institutional Review Board of the University
Hospital of Amiens (registration number ID RDB: 2019-A02437-50 in February
2020). Results of the study will be disseminated via peer-reviewed
publications and presentations at national and international conferences.
NCT04201119.<br/>Copyright &#xa9; Author(s) (or their employer(s)) 2021.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<13>
Accession Number
2013096483
Title
Optimal treatment strategies for coronary artery disease in patients with
advanced kidney disease: a meta-analysis.
Source
Therapeutic Advances in Chronic Disease. 12 (no pagination), 2021. Date of
Publication: 2021.
Author
Yong J.; Tian J.; Zhao X.; Yang X.; Xing H.; He Y.; Song X.
Institution
(Yong, Tian, Zhao, Yang, Xing) Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing, China
(He) Department of Radiology, Beijing Friendship Hospital, Capital Medical
University, Yongan Road 95, Beijing City 100050, China
(Song) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Chaoyang District, Anzhen Road No. 2, Beijing City 100029,
China
Publisher
SAGE Publications Ltd
Abstract
Background: Coronary artery disease (CAD) is the leading cause of death in
advanced kidney disease. However, its best treatment has not been
determined. <br/>Method(s): We searched PubMed and Cochrane databases and
scanned references to related articles. Studies comparing the different
treatments for patients with CAD and advanced CKD (estimated glomerular
filtration rate <30 ml/min/1.73 m² or dialysis) were selected.
The primary result was all-cause death, classified according to the
follow-up time: short-term (<1 month), medium-term (1 month-1 year), and
long-term (>1 year). <br/>Result(s): A total of 32 studies were selected
to enroll 84,498 patients with advanced kidney disease. Compared with
medical therapy (MT) alone, percutaneous coronary intervention (PCI) was
associated with low risk of short-, medium-term and long-term all-cause
death (more than 3 years). For AMI patients, compared with MT, PCI was not
associated with low risk of short- and medium-term all-cause death. For
non-AMI patients, compared with MT, PCI was associated with low risk of
long-term mortality (more than 3 years). Compared with MT, coronary artery
bypass surgery (CABG) had no significant advantages in each follow-up
period of all-cause death. Compared with PCI, CABG was associated with a
high risk of short-term death, but low risk of long-term death: 1-3 years;
more than 3 years. CABG could also reduce the risk of long-term risk of
cardiac death, major adverse cardiovascular events (MACEs), myocardial
infarction (MI), and repeat revascularization. <br/>Conclusion(s): In
patients with advanced kidney disease and CAD, PCI reduced the risk of
short-, medium- and long- term (more than 3 years) all-cause death
compared with MT. Compared with PCI, CABG was associated with a high risk
of short-term death and a low risk of long-term death and adverse
events.<br/>Copyright &#xa9; The Author(s), 2021.

<14>
Accession Number
2013136537
Title
Vasoplegic syndrome after cardiovascular surgery: A review of
pathophysiology and outcome-oriented therapeutic management.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Datt V.; Wadhhwa R.; Sharma V.; Virmani S.; Minhas H.S.; Malik S.
Institution
(Datt, Wadhhwa, Sharma, Virmani, Minhas, Malik) Department of Cardiac
Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital
[GIPMER], New Delhi, India
Publisher
Blackwell Publishing Inc.
Abstract
Background: Vasoplegic syndrome (VPS) is defined as systemic hypotension
due to profound vasodilatation and loss of systemic vascular resistance
(SVR), despite normal or increased cardiac index, and characterized by
inadequate response to standard doses of vasopressors, and increased
morbidity and mortality. It occurs in 9%-44% of cardiac surgery patients
after cardiopulmonary bypass (CPB). The underlying pathophysiology
following CPB consists of resistance to vasopressors (inactivation of
Ca²⁺ voltage gated channels) on the one hand and excessive
activation of vasodilators (SIRS, iNOS, and low AVP) on the other. Use of
angiotensin-converting enzyme inhibitor (ACE-I), calcium channel blockers,
amiodarone, heparin, low cardiac reserve (EF < 35%), symptomatic
congestive heart failure, and diabetes mellitus are the perioperative risk
factors for VPS after cardiac surgery in adults. Till date, there is no
consensus about the outcome-oriented therapeutic management of VPS.
Vasopressors such as norepinephrine (NE; 0.025-0.2 microg/kg/min) and
vasopressin (0.06 U/min or 6 U/h median dose) are the first choice for the
treatment. The adjuvant therapy (hydrocortisone, calcium, vitamin C, and
thiamine) and rescue therapy (methylene blue [MB] and hydroxocobalamin)
are also considered when perfusion goals (meanarterial pressure [MAP] >
60-70 mmHg) are not achieved with nor-epinephrine and/or vasopressin.
<br/>Aim(s): The aims of this systematic review are to collect all the
clinically relevant data to describe the VPS, its potential risk factors,
pathophysiology after CPB, and to assess the efficacy, safety, and outcome
of the therapeutic management with catecholamine and non-catecholamine
vasopressors employed for refractory vasoplegia after cardiac surgery.
Also, to elucidate the current and practical approach for management of
VPS after cardiac surgery. <br/>Material(s) and Method(s): "PubMed,"
"Google," and "Medline" weresearched, and over 150 recent relevant
articles including RCTs, clinical studies, meta-analysis, reviews, case
reports, case series and Cochrane data were analyzed for this systematic
review. The filter was applied specificallyusing key words like VPS after
cardiac surgery, perioperative VPS following CPB, morbidity, and mortality
in VPS after cardiac surgery, vasopressors for VPS that improve outcomes,
VPS after valve surgery, VPS after CABG surgery, VPS following complex
congenital cardiac anomalies corrective surgery, rescue therapy for VPS,
adjuvant therapy for VPS, definition of VPS, outcome in VPS after cardiac
surgery, etiopathology of VPS following CPB. This review did not require
any ethical approval or consent from the patients. <br/>Result(s): Despite
the recent advances in therapy, the mortality remains as high as 30%-50%.
NE has been recommended the most frequent used vasopressor for VPS. It
restores and maintain the MAP and provides the outcome benefits.
Vasopressin rescue therapy is an alternative approach, if catecholamines
and fluid infusions fail to improve hemodynamics. It effectively increases
vascular tone and lowers CO, and significantly decreases the 30 days
mortality. Hence, suggested a first-line vasopressor agent in postcardiac
surgery VPS. Terlipressin (1.3mug/kg/h), a longer acting and more specific
vasoconstrictor prevents the development of VPS after CPB in patients
treated with ACE-I. MB significantly reduces morbidity and mortality of
VPS. The Preoperative MB (1%, 2mg/kg/30min, 1h before surgery)
administration in high risk (on ACE-I) patients for VPS undergoing CABG
surgery, provides 100% protection against VPS, and early of MB
significantly reduces operative mortality, and recommended as a rescue
therapy for VPS. Hydroxocobalamin (5 g) has been recommended as a rescue
agent in VPS refractory to multiple vasopressors. A combination of
ascorbic acid (6 g), hydrocortisone (200 mg/day), and thiamine (400
mg/day) as an adjuvant therapy significantly reduces the vasopressors
requirement, and provides mortality and morbidity benefits.
<br/>Conclusion(s): Currently, the VPS is frequently encountered (9%-40%)
in cardiac surgical patients with predisposing patient-specific risk
factors and combined with inflammatory response to CPB. Multidrug therapy
(NE, MB, AVP, ATII, terlipressin, hydroxocobalamin) targeting multiple
receptor systems is recommended in refractory VPS. A combination of high
dosage of ascorbic acid, hydrocortisone and thiamine has been used
successfully as adjunctive therapyto restore the MAP. We also advocate for
the early use of multiagent vasopressors therapy and catecholamine sparing
adjunctive agents to restore the systemic perfusion pressure with a goal
of preventing the progressive refractory VPS.<br/>Copyright &#xa9; 2021
Wiley Periodicals LLC

<15>
Accession Number
2013110474
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. (no pagination), 2021. Date of
Publication: 2021.
Author
Tu M.-Y.; Hong S.; Lu J.; Liu Y.-H.; Deng M.
Institution
(Tu, Hong, Liu, Deng) Department of Anesthesiology, Huashan Hospital of
Fudan University, Shanghai, China
(Lu) Department of Anesthesiology, Huashan Hospital North Affiliated to
Fudan University, Shanghai, China
Publisher
Blackwell Publishing Ltd
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
protocolised fluid delivery. The efficacy of strict BP management for
preventing postoperative AKI in non-cardiac surgery patients was assessed
by a meta-analysis. <br/>Method(s): We systematically retrieved randomised
controlled trials (RCTs) and 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.
<br/>Result(s): Five RCTs, comprising 1485 patients, were included in the
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). <br/>Conclusion(s): Strict BP
management is significantly more effective than conventional therapy for
the prevention of postoperative AKI. Supranormal target of intraoperative
BP management may be considered a more appealing option for the prevention
of AKI.<br/>Copyright &#xa9; 2021 John Wiley & Sons Ltd

<16>
Accession Number
635468146
Title
Neuromuscular and Clinical Recovery in Thoracic Surgical Patients Reversed
with Neostigmine or Sugammadex.
Source
Anesthesia and Analgesia. (pp 435-444), 2021. Date of Publication: 2021.
Author
Murphy G.S.; Avram M.J.; Greenberg S.B.; Bilimoria S.; Benson J.; Maher
C.E.; Teister K.J.; Szokol J.W.
Institution
(Murphy, Greenberg, Bilimoria, Benson, Maher, Teister, Szokol) Department
of Anesthesiology, NorthShore University HealthSystem, University of
Chicago Pritzker, School of Medicine, Evanston, IL, United States
(Avram) Department of Anesthesiology, Northwestern University Feinberg,
School of Medicine, Chicago, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Patients undergoing thoracoscopic procedures may be at
high-risk for incomplete neuromuscular recovery and associated
complications. The aim of this clinical investigation was to assess the
incidence of postoperative residual neuromuscular blockade in adult
thoracic surgical patients administered neostigmine or sugammadex when
optimal dosing and reversal strategies for these agents were used. The
effect of choice of reversal agent on hypoxemic events and signs and
symptoms of muscle weakness were also determined. Additionally, operative
conditions in each group were graded by surgeons performing the
procedures. <br/>METHOD(S): Two hundred patients undergoing thoracoscopic
surgical procedures were enrolled in this nonrandomized controlled trial.
One hundred consecutive patients maintained at moderate levels of
neuromuscular blockade were reversed with neostigmine (neostigmine group)
followed by 100 consecutive patients given sugammadex to antagonize deeper
levels of neuromuscular blockade (sugammadex group). Anesthetic and
neuromuscular management were standardized. Surgeons rated operative
conditions at the conclusion of the procedure on a 4-point scale (grade 1
= excellent to grade 4 = poor). Train-of-four ratios were measured
immediately before extubation and at PACU admission (primary outcomes).
Postoperatively, patients were assessed for adverse respiratory events and
11 signs and 16 symptoms of muscle weakness. <br/>RESULT(S): The 2 groups
were similar in intraoperative management characteristics. The percentage
of patients with residual neuromuscular blockade, defined as a normalized
train-of-four ratio <0.9, was significantly greater in the neostigmine
group than the sugammadex group at both tracheal extubation (80% vs 6%,
respectively, P <.0001) and PACU admission (61% vs 1%, respectively, P
<.0001). Patients in the neostigmine group had less optimal operative
conditions (median score 2 [good] versus 1 [excellent] in the sugammadex
group; P <.0001), and more symptoms of muscle weakness were present in
these subjects (median number [interquartile range] 4 [1-8] vs 1 [0-2] in
the sugammadex group, P <.0001). No differences between groups in adverse
airway events were observed. <br/>CONCLUSION(S): Despite the application
of strategies documented to reduce the risk of residual neuromuscular
blockade, a high percentage of thoracoscopic patients whose neuromuscular
blockade was reversed with neostigmine were admitted to the PACU with
clinical evidence of residual paralysis. In contrast, muscle weakness was
rarely observed in patients whose neuromuscular blockade was antagonized
with sugammadex.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<17>
Accession Number
2005221304
Title
Extrapolation of Survival Benefits in Patients with Transthyretin Amyloid
Cardiomyopathy Receiving Tafamidis: Analysis of the Tafamidis in
Transthyretin Cardiomyopathy Clinical Trial.
Source
Cardiology and Therapy. 9 (2) (pp 535-540), 2020. Date of Publication: 01
Dec 2020.
Author
Li B.; Alvir J.; Stewart M.
Institution
(Li, Alvir) Pfizer, New York, NY, United States
(Stewart) Pfizer, Groton, CT, United States
Publisher
Adis
Abstract
Introduction: In the Tafamidis in Transthyretin Cardiomyopathy Clinical
Trial (ATTR-ACT; ClinicalTrials.gov number NCT01994889), tafamidis reduced
the risk of all-cause mortality in patients with transthyretin amyloid
cardiomyopathy (ATTR-CM) by 30% versus placebo. Median overall survival
was not achieved in either treatment arm (57.1 and 70.5% of patients in
the placebo and tafamidis groups, respectively, survived at 30 months),
limiting assessment of the potential survival benefits of treatment.
<br/>Method(s): A survival extrapolation analysis was conducted following
technical support guidelines from the National Institute for Health and
Care Excellence. Multiple models (i.e., exponential, Weibull, gamma,
log-logistic, log-normal, Gompertz, generalized gamma, and generalized F)
were applied to systematically fit different candidate curves to existing
patient-level data from the 30-month treatment period in ATTR-ACT. The
relative goodness-of-fit for each candidate curve was then tested by
Akaike's and Bayesian information criteria to select a single model that
was fitted to the placebo and pooled tafamidis treatment arms.
<br/>Result(s): A gamma distribution was selected as best fitting model
and fitted to both treatment arms. The resulting estimated median overall
survival was 35.16 months for placebo and 52.64 months for tafamidis
(difference 17.48 months). <br/>Conclusion(s): This extrapolation of
survival data from ATTR-ACT further supports the efficacy of tafamidis in
patients with ATTR-CM. Owing to the limitations of this analysis, these
survival estimates should be interpreted with caution; however, they are
consistent with recently presented findings from a combined analysis of
data from ATTR-ACT and interim data from an ongoing long-term extension
study (median follow-up 36 months; ClinicalTrials.gov number NCT02791230).
Trial Registration: ClinicalTrials.gov: NCT01994889.<br/>Copyright &#xa9;
2020, The Author(s).

<18>
Accession Number
2004937022
Title
Mitraclip Plus Medical Therapy Versus Medical Therapy Alone for Functional
Mitral Regurgitation: A Meta-Analysis.
Source
Cardiology and Therapy. 9 (1) (pp 5-17), 2020. Date of Publication: 01 Jun
2020.
Author
Goel S.; Pasam R.T.; Wats K.; Chava S.; Gotesman J.; Sharma A.; Malik
B.A.; Ayzenberg S.; Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Gidwani) Department of Cardiology, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Pasam, Wats, Chava, Gotesman, Malik, Ayzenberg, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, New York,
NY, United States
(Sharma) Division of Cardiology, Gundersen Health System, La Crosse, WI,
United States
(Sharma) Institute of Cardiovascular Science and Technology, New York, NY,
United States
Publisher
Adis
Abstract
Introduction: The purpose of this meta-analysis is to compare the efficacy
of MitraClip plus medical therapy versus medical therapy alone in patients
with functional mitral regurgitation (FMR). FMR caused by left ventricular
dysfunction is associated with poor prognosis. Whether MitraClip improves
clinical outcomes in this patient population remains controversial.
<br/>Method(s): We conducted an electronic database search of PubMed,
CINAHL, Cochrane Central, Scopus, Google Scholar, and Web of Science
databases for randomized control trials (RCTs) and observational studies
with propensity score matching (PSM) that compared MitraClip plus medical
therapy with medical therapy alone for patients with FMR and reported on
subsequent mortality, heart failure re-hospitalization, and other outcomes
of interest. Event rates were compared using a random-effects model with
odds ratio as the effect size. <br/>Result(s): Five studies (n = 1513;
MitraClip = 796, medical therapy = 717) were included in the final
analysis. MitraClip plus medical therapy compared to medical therapy alone
was associated with a significant reduction in overall mortality (OR =
0.66, 95% CI = 0.44-0.99, P = 0.04) and heart failure (HF)
re-hospitalization rates (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (OR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (OR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the MitraClip
group. No effect was observed on cardiac mortality (P = 0.42) between the
two groups. <br/>Conclusion(s): MitraClip plus medical therapy improves
overall mortality and reduces HF re-hospitalization rates compared to
medical therapy alone in patients with FMR.<br/>Copyright &#xa9; 2019, The
Author(s).

<19>
Accession Number
622467924
Title
Clinical Acceptability Of Trimetazidine Modified-Release 80 mg Once Daily
Versus Trimetazidine Modified-Release 35 mg Twice Daily In Stable Angina
Pectoris.
Source
Cardiology and Therapy. 7 (1) (pp 61-70), 2018. Date of Publication: 01
Jun 2018.
Author
Pozdnyakov Y.M.; Uskov V.L.; Gon-charenko I.I.; Prasolova T.P.; Guseva
V.G.; Shinkar A.S.; Samsonova S.M.; Vikhrova I.V.; Kuz'kina S.A.; Mitina
L.V.; Timofeeva I.V.; Archakova T.M.; Kovaleva N.Y.; Romanova E.A.; Tivon
Y.V.; Antonova Y.N.; Kurganova O.B.; Davydova N.N.; Klyuchantseva O.V.;
Popovskaya Y.V.; Kharitonova E.I.; Kuzmina T.N.; Buzmakova K.V.; Kaplenko
L.I.; Pospelova N.V.; Stepanova A.Y.; Kol-basheva N.A.; Krasnova G.M.;
Pal'vin-skaya A.Y.; Toloknova V.A.; Bikmullina R.F.; Gainullina A.A.;
Kedrina E.V.; Mikhailova S.A.; Nabiullina T.A.; Nizamova A.F.; Uskova
A.A.; Yushkova A.E.; Andreeva O.V.; Fedotova G.V.; Besser-geneva O.L.;
Gavrilyuk D.D.; Ehalo N.V.; Zlo-bina M.V.; Zhemartseva E.Y.; Markushina
I.A.; Pavlovets V.P.; Sobolenko A.A.; Apanovich I.E.; Kireeva N.V.;
Maksimova I.V.; Butz T.V.; Pavlova I.A.; Bachurina S.N.; Orlyachenko S.V.;
Zaitseva T.V.; Beznogova V.F.; Litsis N.N.; Novozhenina A.Y.; Abramyan
L.L.; Adamyan M.M.; Askerko S.N.; Bolmosov A.N.; Vasilieva I.N.; Volodova
S.I.; Grishko P.V.; Zherebetskaya E.S.; Zemlyanaya N.S.; Klysh-nikova
L.N.; Kononchik E.I.; Kuznetsova N.A.; Kuz'minova I.A.; Marmurova I.V.;
Mikhailova R.Y.; Mordovina I.P.; Nazarkina O.V.; Per-epechko A.P.;
Pivovarova N.G.; Potapova T.P.; Prokofiev D.A.; Proniushkina N.E.;
Savelieva E.V.; A Semovskikh N.; Timonenkova L.D.; Fomin V.V.; Furman
O.A.; Tsutsieva R.M.; Chibrikina M.V.; Shoshina I.N.; Yashchenko P.;
Bocharova T.I.; Demya-nenko O.L.; Zhukova L.B.; Melnikov A.Y.; Mer-kulieva
I.A.; Tyasina E.I.; Pakholkova N.S.; Rogozina S.V.; Chugunova I.V.;
Brazhnik M.L.; Guseva Y.V.; Anisimova A.N.; Kuzeyina S.S.; Kulakhmetova
R.G.; Petrova I.S.; Ignatyeva I.A.; Morozova T.A.; Ryb-nikova N.V.;
Gritsenko I.I.; Kondratskaya O.V.; Shishkin A.V.; Gogleva N.N.; Kulipanova
V.M.; Mitrofanova S.V.; Parada E.V.; Svistunova S.Y.; Sergeeva T.M.;
Kryukova V.V.; Suprun T.N.; Fedorova E.M.; Shnor O.F.; Mitroshina T.N.;
Shemetova T.S.; Val'kevich L.P.; Varnikova S.N.; Ivanova E.A.; Shlykova
O.N.; Guryanova I.R.; Zheltova V.L.; Bulygina E.D.; Gorskaya E.V.; Kosenko
L.V.; Musaeva F.K.; Fedorchenko M.Y.; Harish V.I.; Serbarinova O.M.;
Yatsenya Y.A.; Golubev M.N.; Kopaev D.E.; Miludina L.A.; Polischuk L.V.;
Shilintseva O.A.; Krylova L.M.; Vasilik M.V.; Zotov D.D.; Kalishevich
N.B.; Kachmazova L.I.; Kontorikova S.G.; Mamoshko T.A.; Osnovin S.A.;
Timosh-enko (Schmalz) I.O.; Kashina A.N.; Kiryanova O.G.; Kotova L.E.;
Kuvshinova L.E.; Ulyanova I.M.; Shevelo O.F.; Kir-eeva I.B.; Korohova
L.V.; Lisunova T.I.; Medvedeva E.V.; Matvienko T.E.; Shovgaryan S.L.;
Nebolsina T.F.; Mikusheva M.A.; Misharin N.N.; Kutaliya T.O.; Chernova
V.N.; Yanina Y.A.; Permyakova O.V.; Skurikhina N.N.; Goldinova L.M.;
Pri-khodko T.N.; Myshyakova A.G.; Akhmerova E.Z.; Zaitseva K.V.; Ozerchuk
A.A.; Polyakova I.M.; Rodionova; Safiullina I.D.; Arsentieva I.N.; Volkova
O.O.; Kondrina I.N.; Kharlova T.E.; Grigorieva T.L.; Kurtmulaeva K.V.;
Rogozina O.M.
Institution
(Pozdnyakov) Moscow Regional Cardiology Centre, Zhukovsky, Russian
Federation
Publisher
Springer Healthcare
Abstract
Introduction: Trimetazidine (TMZ) is an anti-ischemic metabolic agent that
has been shown to be efficacious in angina treatment, both in monotherapy
and in combination. A new formulation of TMZ modified-release (MR) 80 mg
was developed, which is to be taken once daily (od), instead of twice
daily (bid) for the currently available TMZ MR 35 mg, with the aim of
simplifying the medication regimen. <br/>Method(s): The present study was
an international, multicenter, randomized, double-blind, parallel-group
phase III study with a 12-week treatment period. The safety of TMZ MR 80
mg once daily was assessed compared to TMZ MR 35 mg twice daily, in
patients previously treated successfully by the latter. Emergent adverse
events (EAEs), biological parameters, vital signs, 12-lead resting ECG
(electrocardiogram) and Canadian Cardiovascular Society (CCS)
classification were recorded. <br/>Result(s): One-hundred and sixty-five
patients previously diagnosed with stable angina pectoris on treatment
were randomized to receive either TMZ MR 80 mg od or TMZ MR 35 mg bid. In
the TMZ MR 80 mg group, fewer patients had >= 1 EAE (17.1 vs. 22.9% in the
TMZ MR 35 mg group). Serious EAEs were reported by three patients in each
group. No EAE required dose modification, withdrawal, or temporary
interruption of study treatments. Vital signs, 12-lead ECG, and laboratory
parameters did not change. No worsening in CCS classes was observed with
either treatment. <br/>Conclusion(s): TMZ MR 80 mg od and TMZ MR 35 mg bid
have similar safety profiles. This new once-daily formulation could
improve patient compliance with therapy, thereby enhancing clinical
benefit. Trial Registration: ISRCTN registry, ISRCTN 84362208.
<br/>Funding(s): Institut de Recherches Internationales Servier and
Servier, Moscow, Russian Federation. Plain Language Summary: Plain
language summary available for this article.<br/>Copyright &#xa9; 2018,
The Author(s).

<20>
Accession Number
619397142
Title
Treatment of Stable Angina with a New Fixed-Dose Combination of Ivabradine
and Metoprolol: Effectiveness and Tolerability in Routine Clinical
Practice.
Source
Cardiology and Therapy. 6 (2) (pp 239-249), 2017. Date of Publication: 01
Dec 2017.
Author
Divchev D.; Stockl G.
Institution
(Divchev) Department of Cardiology and Angiology, University Hospital
Marburg, Baldingerstrasse, Marburg 35043, Germany
(Stockl) Department of Medical Affairs, Servier Deutschland GmbH, Munich,
Germany
Publisher
Springer Healthcare
Abstract
Introduction: In this prospective, multicenter, observational cohort
study, the effectiveness and tolerability of the first fixed-dose
combination (FDC) formulation of the selective heart rate reducing agent
ivabradine and the beta-blocker metoprolol was evaluated in stable angina
pectoris (AP) patients in a clinical practice setting. <br/>Method(s):
Stable AP outpatients received a FDC of ivabradine and metoprolol (b.i.d.)
for 4 months, in addition to cardiovascular standard therapy. Resting
heart rate (HR), number of angina attacks, short-acting nitrate
consumption, severity of symptoms (assessed by patient judgment and
documented by CCS score) and tolerability were documented. Medication
adherence was assessed by a modified four-item Morisky questionnaire.
Descriptive statistics were performed on all data. <br/>Result(s): A total
of 747 stable AP patients (mean age, 66.4 years, 62% male, 50% and 31%
with previous PCI and myocardial infarction, respectively) were included.
Apart from ivabradine and beta-blockers as free combination, most
frequently used concomitant standard medications at baseline were aspirin
(68%), statins (71%), ACEI/AT1-blockers (76%), diuretics (35%), and
calcium antagonists (15%). Highly prevalent comorbidities were
hypertension (86%), hyperlipidemia (65%), and diabetes (35%). After 4
months, switch to treatment with the FDC was associated with a significant
reduction in mean HR by 10 bpm. Proportion of patients with >= 1 angina
attacks/week decreased from 38 to 7%. Patients in CCS class 1 increased
(25 to 63%), while they decreased in CCS class 3 (19 to 5%). Medication
adherence was also significantly improved (p < 0.001 for all changes from
baseline). Mostly mild adverse events were documented in 5.4% of patients.
<br/>Conclusion(s): In these stable AP patients in a real-life setting,
treatment with a FDC of ivabradine and metoprolol was associated with
reduced HR and angina symptoms, while exercise capacity (CCS score) was
improved. These effects may be mainly mediated by the increased medication
adherence of patients observed with use of the FDC formulation.
<br/>Funding(s): Servier Trial registration number:
ISRCTN51906157.<br/>Copyright &#xa9; 2017, The Author(s).

<21>
Accession Number
616464043
Title
Improvement of Subjective Well-Being by Ranolazine in Patients with
Chronic Angina and Known Myocardial Ischemia (IMWELL Study).
Source
Cardiology and Therapy. 6 (1) (pp 81-88), 2017. Date of Publication: 01
Jun 2017.
Author
Bavry A.A.; Park K.E.; Choi C.Y.; Mahmoud A.N.; Wen X.; Elgendy I.Y.
Institution
(Bavry, Park, Choi, Mahmoud, Wen, Elgendy) Department of Medicine,
University of Florida, Gainesville, FL, United States
(Bavry, Park, Choi) North Florida/South Georgia Veterans Health System,
Gainesville, FL, United States
(Wen) Health Outcomes, College of Pharmacy, University of Rhode Island,
Kingston, RI, United States
Publisher
Springer Healthcare
Abstract
Introduction: We aimed to assess if ranolazine would improve angina
symptoms among patients with documented myocardial ischemia.
<br/>Method(s): Eligible subjects had chronic stable angina and at least
one coronary stenosis with fractional flow reserve (FFR) <=0.80 or at
least one chronic total occlusion (CTO) without attempted
revascularization. Subjects were randomized to oral ranolazine 500 mg
twice daily for 1 week, then ranolazine 1000 mg twice daily for 15 weeks
versus matching placebo. The primary end point was change in angina at 16
weeks as assessed by the Seattle Angina Questionnaire (SAQ).
<br/>Result(s): Between September 2014 and January 2016, 25 subjects were
randomized to ranolazine versus 25 to placebo. The most common reason for
eligibility was CTO (72%), while the remainder had myocardial ischemia
documented by low FFR. The mean FFR was 0.57 +/- 0.12. Sixty-eight percent
of subjects were on two or more anti-angina medications at baseline. Study
medication was discontinued in 32% (eight of 25) of the ranolazine group
versus 36% (nine of 25) of the placebo group. By intention-to-treat, 46
subjects had baseline and follow-up SAQ data completed. Ranolazine was not
associated with an improvement in angina compared with placebo at 16
weeks. The results were similar among 33 subjects that completed study
medication. The incidence of ischemia-driven hospitalization or
catheterization was 12% (three of 25) of the ranolazine group versus 20%
(five of 25) in the placebo group (p > 0.05). <br/>Conclusion(s): In
subjects with chronic stable angina and documented myocardial ischemia,
ranolazine did not improve angina symptoms at 16 weeks. <br/>Funding(s):
Gilead. Clinical trial registration: The study was registered at
ClinicalTrials.gov (NCT02265796).<br/>Copyright &#xa9; 2016, The
Author(s).

<22>
Accession Number
616464036
Title
A Randomized Trial to Assess the Contribution of a Novel Thorax Support
Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.
Source
Cardiology and Therapy. 6 (1) (pp 41-51), 2017. Date of Publication: 01
Jun 2017.
Author
Caimmi P.P.; Sabbatini M.; Kapetanakis E.I.; Cantone S.; Ferraz M.V.;
Cannas M.; Tesler U.F.
Institution
(Caimmi) Department of Cardiac Surgery, University Hospital of Novara
"Maggiore della Carita", Novara, Italy
(Caimmi, Cannas) Department of Science Health, UPO University, Novara,
Italy
(Caimmi, Tesler) "Policlinico di Monza" Hospital Group, Department Cardiac
Surgery, San Gaudenzio Clinic, Novara, Italy
(Sabbatini) Department of Science and Innovation Technology, UPO
University, Alessandria, Italy
(Kapetanakis) Department of Thoracic Surgery, "Sotiria" Chest Diseases
Hospital of Athens, Athens, Greece
(Cantone) "Policlinico di Monza" Health Care Group, Department Cardiac
Anaestehsiology, San Gaudenzio Clinic, Novara, Italy
(Ferraz) Department of Cardiac Surgery, Beneficencia Portouguesa Hospital,
Piracicaba, Brazil
Publisher
Springer Healthcare
Abstract
Objectives: Mechanical complications of median sternotomy may cause
significant morbidity and mortality in cardiac surgical patients. This
study was aimed at assessing the role of Posthorax support vest (Epple,
Inc., Vienna, Austria) in the prevention of sternal complications and the
improvement of anatomical healing in patients at high risk for mechanical
sternal dehiscence after cardiac surgery by mean of median sternotomy.
<br/>Method(s): A prospective, randomized, study was performed and 310
patients with predisposing factors for sternal dehiscence after sternotomy
for cardiac surgery were included. The patients were divided into two
groups: patients who received the Posthorax support vest after surgery,
and patients who did not. Primary variables assessed included the
incidence of mechanical sternal complications, the quality of sternal
healing, the rate of re-operation, the duration of hospitalization, rate
and duration of hospital, re-admission for sternal complications.
Secondary variables assessed were the post-operative pain, the number of
requests for supplemental analgesia and the quality of life measured by
means of the EQ-5D format. <br/>Result(s): Patients using vest
demonstrated a lower incidence of mechanical sternal complications, a
better anatomical sternum healing, lower hospital stay, no re-operations
for sternal dehiscence before discharge and lower re-admissions for
mechanical sternal complication. In addition, patients using a vest
reported a better quality of life with better freedom from limitations in
mobility, self-care, and pain. <br/>Conclusion(s): Our findings
demonstrate that the use of the Posthorax vest reduces post-sternotomy
mechanical complications and improves the healing of the sternotomy, the
clinical course, and the post-operative quality of life.<br/>Copyright
&#xa9; 2016, The Author(s).

<23>
Accession Number
608459567
Title
Safety and feasibility of a novel adjustable mitral annuloplasty ring: A
multicentre European experience.
Source
European Journal of Cardio-thoracic Surgery. 49 (1) (pp 249-254), 2016.
Date of Publication: January 2016.
Author
Andreas M.; Doll N.; Livesey S.; Castella M.; Kocher A.; Casselman F.;
Voth V.; Bannister C.; Palacios J.F.E.; Pereda D.; Laufer G.; Czesla M.
Institution
(Andreas, Kocher, Laufer) Department of Surgery, Division of Cardiac
Surgery, Medical University of Vienna, Vienna, Austria
(Doll, Voth, Czesla) Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
(Livesey, Bannister) Department of Cardiothoracic Surgery, Southampton
General Hospital, Southampton, United Kingdom
(Castella, Palacios, Pereda) Department of Cardiovascular Surgery,
Institut Clinic del Torax, Hospital Clinic, University of Barcelona,
Barcelona, Spain
(Casselman) Department of Cardiovascular and Thoracic Surgery, OLV Clinic,
Aalst, Belgium
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Recurrent mitral regurgitation is a significant problem after
mitral valve repair in patients with functional valve disease. We report
the safety and feasibility of a novel adjustable mitral annuloplasty
device that permits downsizing of the anterior-posterior diameter late
after initial surgery. <br/>METHOD(S): In this multicentre,
non-randomized, observational register, patients with moderate or severe
mitral regurgitation undergoing surgical mitral valve repair with the
MiCardia EnCorSQTM Mitral Valve Repair system were evaluated. Patient
characteristics, operative specifications and results as well as
postoperative follow-up were collected for all five centres.
<br/>RESULT(S): Ninety-four patients with a median age of 71 (64-75) years
(EuroSCORE II 6.7 +/- 6.3; 66% male, 48% ischaemic MR, 37% dilated
cardiomyopathy and 15% degenerative disease) were included. Operative
mortality was 1% and the 1-year survival was 93%. Ring adjustment was
attempted in 12 patients at a mean interval of 9 +/- 6 months after
surgery. In three of these attempts, a technical failure occurred. In 1
patient, mitral regurgitation was reduced two grades, in 2 patients mitral
regurgitation was reduced one grade and in 6 patients, mitral
regurgitation did not change significantly. The mean grade of mitral
regurgitation changed from 2.9 +/- 0.9 to 2.1 +/- 0.7 (P = 0.02). Five
patients were reoperated after 11 +/- 9 months (Ring dehiscence: 2; failed
adjustment: 3). <br/>CONCLUSION(S): We conclude that this device may
provide an additional treatment option in patients with functional mitral
regurgitation, who are at risk for reoperation due to recurrent mitral
regurgitation. Clinical results in this complex disease were ambiguous and
patient selection seems to be a crucial step for this device. Further
trials are required to estimate the clinical value of this therapeutic
concept.<br/>Copyright &#xa9; The Author 2015.

<24>
Accession Number
614667158
Title
Does prophylactic ligation of the thoracic duct reduce chylothorax rates
in patients undergoing oesophagectomy? A systematic review and
meta-Analysis.
Source
European Journal of Cardio-thoracic Surgery. 50 (6) (pp 1019-1024), 2016.
Date of Publication: December 2016.
Author
Crucitti P.; Mangiameli G.; Petitti T.; Condoluci A.; Rocco R.; Gallo
I.F.; Longo F.; Rocco G.
Institution
(Crucitti, Mangiameli, Condoluci, Rocco, Gallo, Longo) Section of Thoracic
Surgery, Department of Vascular Surgery, Campus Bio-Medico University of
Rome, Rome, Italy
(Petitti) Department of Public Health, Hygiene and Statistics, Campus
Bio-Medico University of Rome, Rome, Italy
(Rocco) Department of Thoracic Surgery and Oncology, Division of Thoracic
Surgery, Istituto Nazionale Tumori, IRCCS, Fondazione Pascale, Napoli,
Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
A systematic review of English and non-English articles using OVID MEDLINE
(1980-2014) was performed to evaluate the potential value of prophylactic
ligation of the thoracic duct in preventing chylous leakage after
oesophagectomy for cancer. Search terms included [Oesophagectomy OR
esophagectomy] AND [chylothorax] AND [thoracic duct ligation]. Only those
papers that directly compared the incidence of chylothorax in patients who
underwent prophylactic ligation [ligation group (LG)] with that in those
who had conservative treatment were selected [preservation group (PG)];
all the articles presenting original data and supplying sufficient
information on the chylothorax rate after oesophagectomy were included.
Independent extraction of articles was performed by two authors using
predefined data fields, including study quality indicators. The PRISMA
guidelines were carefully adhered to. A total of 5254 subjects were
included in the 7 clinical studies examined into the current
meta-analysis. Of these, 2179 patients underwent prophylactic ligature of
the thoracic duct (LG group) and 3075 had preservation of the thoracic
duct (PG group). A significant difference in terms of chylothorax rate
[odd ratios (ORs) 0.47 in favour of LG, 95% confidence interval (CI)
0.27-0.80] was noted between the LG group and the PG group. According to
our meta-analysis and taking into account-specific caveats, prophylactic
ligation of the thoracic duct could be considered as an effective
preventative measure to reduce the incidence of postoperative
chylothorax.<br/>Copyright &#xa9; The Author 2016.

<25>
Accession Number
600867302
Title
Effects of levosimendan for low cardiac output syndrome in critically ill
patients: systematic review with meta-analysis and trial sequential
analysis.
Source
Intensive Care Medicine. 41 (2) (pp 203-221), 2015. Date of Publication:
February 2015.
Author
Koster G.; Wetterslev J.; Gluud C.; Zijlstra J.G.; Scheeren T.W.L.; van
der Horst I.C.C.; Keus F.
Institution
(Koster, Zijlstra, van der Horst, Keus) Department of Critical Care,
University of Groningen, University Medical Centre Groningen, P.O. Box
30.001, Groningen 9700 RB, Netherlands
(Wetterslev, Gluud) The Copenhagen Trial Unit (CTU), Centre for Clinical
Intervention Research, Department 7812, Rigshospitalet, Copenhagen
University Hospital, Copenhagen 2100, Denmark
(Scheeren) Department of Anaesthesiology, University of Groningen,
University Medical Centre Groningen, Groningen, Netherlands
Publisher
Springer Verlag
Abstract
Purpose: To assess the benefits and harms of levosimendan for low cardiac
output syndrome in critically ill patients.
Methods: We conducted a systematic review with meta-analyses and trial
sequential analyses (TSA) of randomised clinical trials comparing
levosimendan with any type of control. Two reviewers independently
assessed studies for inclusion. The Cochrane Collaboration methodology was
used. Random-effects risk ratios (RR) and 95 % confidence intervals (CI)
were derived for the principal primary outcome mortality at maximal
follow-up.
Results: A total of 88 trials were included in the systematic review and
49 trials (6,688 patients) in the meta-analysis. One trial had low risk of
bias and nine trials (2,490 patients) were considered lower risk of bias.
Trials compared levosimendan with placebo, control interventions, and
other inotropes. Pooling all trials including heterogenous populations was
considered inappropriate. Pooled analysis of 30 trials including
critically ill patients not having cardiac surgery showed an association
between levosimendan and mortality (RR 0.83, TSA-adjusted 95 % CI
0.59-0.97), while trials with lower risk of bias showed no significant
difference (RR 0.83, TSA-adjusted 95 % CI 0.48-1.55). Conventional
meta-analysis of all 14 trials including cardiac surgery patients showed
an association, while lower risk of bias trials showed no association
between levosimendan and mortality (RR 0.52, 95 % CI 0.37-0.73 versus RR
1.02, 95 % CI 0.48-2.16).
Conclusions: The available evidence is inconclusive whether or not
levosimendan may have a beneficial effect on mortality due to risks of
systematic errors and random errors. Further well-designed randomised
trials are needed.<br/>Copyright &#xa9; 2014, Springer-Verlag Berlin
Heidelberg and ESICM.

<26>
Accession Number
601111717
Title
Ivabradine Versus Beta-Blockers in Patients with Conduction Abnormalities
or Left Ventricular Dysfunction Undergoing Cardiac Surgery.
Source
Cardiology and Therapy. 3 (1-2) (pp 13-26), 2013. Date of Publication:
2013.
Author
Iliuta L.; Rac-Albu M.
Institution
(Iliuta, Rac-Albu) "Carol Davila" University of Medicine and Pharmacy,
Bucharest, Romania
Publisher
Springer Healthcare
Abstract
Introduction: In patients with conduction abnormalities or left ventricle
(LV) dysfunction the use of beta-blockers for post cardiac surgery rhythm
control is difficult and controversial, with a paucity of information
about other drugs such ivabradine used postoperatively. The objective of
this study was to compare the efficacy and safety of ivabradine versus
metoprolol used perioperatively in cardiac surgery patients with
conduction abnormalities or LV systolic dysfunction.
Methods: This was an open-label, randomized clinical trial enrolling 527
patients with conduction abnormalities or LV systolic dysfunction
undergoing coronary artery bypass grafting or valvular replacement,
randomized to take ivabradine or metoprolol, or metoprolol plus
ivabradine. The primary endpoints were the composites of 30-day mortality,
in-hospital atrial fibrillation (AF), in-hospital three-degree
atrioventricular block and need for pacing, in-hospital worsening heart
failure (HF; safety endpoints), duration of hospital stay and
immobilization and the above endpoint plus in-hospital bradycardia,
gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy
plus safety endpoint).
Results: Heart rate reduction and prevention of postoperative AF or
tachyarrhythmia with combined therapy was more effective than with
metoprolol or ivabradine alone during the immediate postoperative
management of cardiac surgery patients. In the Ivabradine group, the
frequency of early postoperative pacing and HF worsening was smaller than
in the Metoprolol group and in combined therapy group. The frequency of
primary combined endpoint was lower in the combined Ivabradine +
Metoprolol group compared with the monotherapy groups.
Conclusion: Considering efficacy and safety, the cardiac rhythm reduction
after open heart surgery in patients with conduction abnormalities or LV
dysfunction with ivabradine plus metoprolol emerged as the best treatment
in this trial.<br/>Copyright &#xa9; 2013, The Author(s).

<27>
Accession Number
2010595418
Title
Recurrent spontaneous coronary artery dissection.
Source
Expert Review of Cardiovascular Therapy. 19 (3) (pp 201-210), 2021. Date
of Publication: 2021.
Author
Kok S.N.; Tweet M.S.
Institution
(Kok) Division of General Internal Medicine, Department of Medicine, Mayo
Clinic College of Medicine and Science, Rochester, MN, United States
(Tweet) Department of Cardiovascular Diseases, Mayo Clinic College of
Medicine and Science, Rochester, MN, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Spontaneous coronary artery dissection (SCAD) is a cause of
non-atherosclerotic acute coronary syndrome and sudden cardiac death that
predominantly impacts young and middle-aged women. In addition to the
challenges of acute SCAD including arrhythmias, heart failure, and
recurrent chest pain, de novo recurrent SCAD occurs in 5-29% of patients.
Recurrent SCAD presents both a psychological burden and a significant
cardiac risk to patients. Research regarding SCAD recurrence risk has been
growing and can guide providers and patients alike. Areas covered: This
review provides up-to-date information about many aspects of SCAD with a
focus on SCAD recurrence. PubMed articles were reviewed through October
2020, with particular focus on clinical studies and original research. The
resulting literature was scrutinized for information on SCAD recurrence.
SCAD-associated conditions, genetic data, clinical characteristics,
medications, and aspects of post-SCAD care are summarized. Expert Opinion:
SCAD recurrence poses a concerning risk for patients with SCAD. Conditions
such as hypertension and severe coronary tortuosity may be associated with
recurrence. More research is needed to further elucidate risk factors for
recurrence and clarify interventions, such as beta blocker therapy, that
may reduce recurrence risk.<br/>Copyright &#xa9; 2021 Informa UK Limited,
trading as Taylor & Francis Group.

<28>
Accession Number
2007586544
Title
Catheter ablation for atrial fibrillation in patients with end-stage heart
failure and eligibility for heart transplantation.
Source
ESC Heart Failure. 8 (2) (pp 1666-1674), 2021. Date of Publication: April
2021.
Author
Sohns C.; Marrouche N.F.; Costard-Jackle A.; Sossalla S.; Bergau L.;
Schramm R.; Fuchs U.; Omran H.; Rubarth K.; Dumitrescu D.; Konietschke F.;
Rudolph V.; Gummert J.; Sommer P.; Fox H.
Institution
(Sohns, Bergau, Sommer) Clinic for Electrophysiology, Herz- und
Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Marrouche) Tulane Research Innovation for Arrhythmia Discoveries (TRIAD),
Heart and Vascular Institute, Tulane University School of Medicine, New
Orleans, LA, United States
(Costard-Jackle, Schramm, Fuchs, Omran, Gummert, Fox) Clinic for Thoracic
and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW,
Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
(Sossalla) Department of Internal Medicine II, Cardiology, Pneumology,
Intensive Care, University Hospital Regensburg, Regensburg, Germany
(Rubarth, Konietschke) Department of Biometry and Clinical Epidemiology,
University Medical Center Berlin Charite, Berlin, Germany
(Dumitrescu, Rudolph) Clinic for General and Interventional
Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universitat
Bochum, Bad Oeynhausen, Germany
(Costard-Jackle, Dumitrescu, Rudolph, Gummert, Sommer, Fox) Heart Failure
Department, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad
Oeynhausen, Germany
Publisher
John Wiley and Sons Inc
Abstract
Aims: Timely referrals for transplantation and left ventricular assist
device (LVAD) play a key role in favourable outcomes in patients with
advanced heart failure (HF). The purpose of the Catheter Ablation for
atrial fibrillation in patientS with end-sTage heart faiLure and
Eligibility for Heart Transplantation (CASTLE-HTx) trial is to test the
hypothesis that atrial fibrillation (AF) ablation has beneficial effects
on mortality and morbidity during 'waiting time' for heart transplantation
(HTx) or to prolong the time span until LVAD implantation. <br/>Methods
and Results: CASTLE-HTx is a randomized evaluation of ablative treatment
of AF in patients with severe left ventricular dysfunction who are
candidates and eligible for HTx. The primary endpoint is the composite of
all-cause mortality, worsening of HF requiring a high urgent
transplantation, or LVAD implantation. The secondary study endpoints are
all-cause mortality, cardiovascular mortality, cerebrovascular accidents,
worsening of HF requiring unplanned hospitalization, AF burden reduction,
unplanned hospitalization due to cardiovascular reason, all-cause
hospitalization, quality of life, number of delivered implantable
cardioverter defibrillator therapies, time to first implantable
cardioverter defibrillator therapy, number of device-detected ventricular
tachycardia/ventricular fibrillation episodes, left ventricular function,
exercise tolerance, and percentage of right ventricular pacing.
Ventricular myocardial tissue will be obtained from patients who will
undergo LVAD implantation or HTx to assess the effect of catheter ablation
on human HF myocardium. CASTLE-HTx will randomize 194 patients over a
minimum time period of 2 years. <br/>Conclusion(s): CASTLE-HTx will
determine if AF ablation has beneficial effects on mortality in patients
with end-stage HF who are eligible for HTx.<br/>Copyright &#xa9; 2020 The
Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of
European Society of Cardiology

<29>
Accession Number
2011155961
Title
Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on
Lower Urinary Tract Symptoms in Males.
Source
Obesity Surgery. 31 (7) (pp 3151-3158), 2021. Date of Publication: July
2021.
Author
Stefanova I.; Currie A.C.; Newton R.C.; Albon L.; Slater G.; Birnie A.;
Hawkins W.; Pring C.
Institution
(Stefanova) Department of General Surgery, East Surrey Hospital, Redhill,
United Kingdom
(Currie) Department of Bariatric Surgery, Ashford and St Peters Hospital
Trust, Guildford Street, Chertsey KT16 0PZ, United Kingdom
(Newton, Slater, Hawkins, Pring) Department of Bariatric Surgery, St
Richard's Hospital, Chichester, United Kingdom
(Albon) Department of Bariatric Surgery and Diabetes, St Richard's
Hospital, Chichester, United Kingdom
(Birnie) Department of Urology, St Richard's Hospital, Chichester, United
Kingdom
Publisher
Springer
Abstract
Background: Obesity is a chronic disease with multisystem morbidity. There
are multiple studies reporting the effect of bariatric surgery on
cardiovascular and metabolic disease, but few examine its impact on lower
urinary tract symptoms. This article aims to perform a systematic review
with meta-analysis, to determine the effects of bariatric surgery on lower
urinary tract symptoms in male patients. <br/>Method(s): Medline, Embase,
conference proceedings, and reference lists were searched for studies
reporting the quantitative measurement of lower urinary tract symptoms
score pre- and postweight loss surgery. The primary outcome was
International Prostate Symptom Score (IPSS) before and after bariatric
surgery. Secondary outcomes were changed in body mass index (BMI) and
total body weight (TBW). Weighted mean differences (MD) were calculated
for continuous outcomes. <br/>Result(s): Seven studies were included in
the analysis of 334 patients undergoing bariatric surgery. Mean study
follow-up was between 3 and 36 months. IPSS score ranged from 3-12.7
preoperatively and 1.9-6.9 postoperatively. There was a statistically
significant improvement in the IPSS score following bariatric surgery (MD
2.82, 95% CI 0.96 to 4.69, p=0.003). Bariatric surgery also resulted in
statistically significant reduction of BMI and TBW. <br/>Conclusion(s):
Bariatric surgery produces a significant improvement on lower urinary
tract symptoms in men with obesity. This may be due to improvement of
insulin sensitivity, testosterone levels or lipid profile associated with
weight loss. Graphical abstract: [Figure not available: see
fulltext.].<br/>Copyright &#xa9; 2021, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<30>
Accession Number
2012090479
Title
Influenza Vaccination Blunts the Inflammatory Response in Patients
Undergoing Cardiopulmonary Bypass.
Source
Annals of Thoracic Surgery. 111 (6) (pp 1923-1930), 2021. Date of
Publication: June 2021.
Author
Atoui R.; Ebrahim F.; Saroka K.; Mireau J.; McElhaney J.E.; Hare G.M.T.
Institution
(Atoui) Division of Cardiac Surgery, Health Sciences North, Northern
Ontario School of Medicine, Sudbury, ON, Canada
(Ebrahim) Department of Anesthesia, Hamilton Health Sciences, McMaster
University, Hamilton, ON, Canada
(Ebrahim, Hare) Department of Anesthesia, St Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(Saroka) Laurentian University, Sudbury, ON, Canada
(Mireau) Department of Anesthesia, Health Sciences North, Northern Ontario
School of Medicine, Sudbury, ON, Canada
(McElhaney) Health Sciences North Research Institute, Sudbury, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Coronary artery bypass grafting with cardiopulmonary bypass
(CPB) induces an inflammatory reaction that is associated with
postoperative complications. Influenza vaccination has been shown to
decrease cardiovascular morbidity in patients with cardiovascular disease,
possibly via its anti-inflammatory properties. We hypothesize that
influenza vaccination would attenuate the inflammatory reaction after CPB.
<br/>Method(s): Thirty patients undergoing coronary artery bypass grafting
were blindly randomized to receive the influenza vaccine (group I, n = 15)
or a placebo (group II, n = 15) preoperatively. Serum samples of
proinflammatory mediators (interleukin-6, interleukin-8, tumor necrosis
factor, C-reactive protein) as well as the anti-inflammatory
interleukin-10 were collected at different time points perioperatively.
Assessment of myocardial dysfunction was investigated by measuring
hemodynamic data, echocardiographic data, and troponin levels. Other
clinical outcomes were collected prospectively. <br/>Result(s):
Proinflammatory cytokine levels were significantly reduced in the
treatment group vs the placebo group (interleukin-6 [157.4 pg/dL vs 256
pg/dL, P =.043], interleukin-8 [65.03 pg/dL vs 118.56 pg/dL, P =.025], and
tumor necrosis factor [12.05 pg/dL vs 20.8 pg/dL, P =.003]). These
differences were observed at the end of CPB and persisted for 2 days
postoperatively. Interestingly, the level of the anti-inflammatory marker
interleukin-10 was significantly higher in group I (83.3 pg/dL vs 15.15
pg/dL, P =.008). Evidence of improved myocardial protection was observed
in group I, as reflected by troponin measurements postoperatively (6020.2
pg/dL vs 12,098.01 pg/dL, P =.052). <br/>Conclusion(s): Influenza
vaccination attenuates the inflammatory response to CPB as reflected by a
reduction in the level of troponin and proinflammatory mediators and an
increase in the anti-inflammatory cytokine interleukin-10.<br/>Copyright
&#xa9; 2021 The Society of Thoracic Surgeons

<31>
Accession Number
634189689
Title
Comparison of major bleeding in patients with acute coronary syndrome that
underwent coronary artery bypass grafting treated with clopidogrel or
ticagrelor: A systematic review and meta-analysis.
Source
F1000Research. 9 (no pagination), 2020. Article Number: 99. Date of
Publication: 2020.
Author
Tamara F.; Heriansyah T.; Pikir B.S.; Fajar J.K.; Rohman M.S.; Purnamasari
Y.; Ilmawan M.; Mahdi B.A.; Mahendra A.I.; Mazen M.; Yamin M.
Institution
(Rohman) Brawijaya Cardiovascular Research Center, Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya, Malang, East Java 65145, Indonesia
(Purnamasari, Ilmawan) Faculty of Medicine, Universitas Brawijaya, Malang,
East Java 65145, Indonesia
(Mahdi) Department of Internal Medicine, Faculty of Medicine, Universitas
Airlangga, Surabaya, East Java 60115, Indonesia
(Tamara, Fajar, Mahendra, Mazen) Brawijaya Internal Medicine Research
Center, Department of Internal Medicine, Faculty of Medicine, Universitas
Brawijaya, Malang, East Java 65145, Indonesia
(Heriansyah) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh 23111, Indonesia
(Yamin) Division of Cardiovascular Medicine, Department of Internal
Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Jakarta
16424, Indonesia
(Pikir) Department of Cardiology and Vascular Medicine, Faculty of
Medicine, Universitas Airlangga, Surabaya, East Java 60115, Indonesia
Publisher
F1000 Research Ltd
Abstract
Background: There is controversy among physicians regarding the use of
dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients
treated with coronary artery bypass grafting (CABG). Moreover, the
evidence of previous studies about this topic remained inconclusive. This
study aimed to perform a meta-analysis concerning the relation between the
risk of major bleeding and the use of different DAPT (clopidogrel or
ticagrelor) in ACS patients treated with CABG. <br/>Method(s): A
meta-analysis was conducted during March to October 2019. Searches were
carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor
covariate in our present study was DAPT (clopidogrel or ticagrelor), and
the outcome measure was the risk of major bleeding. Sub-group analysis was
also performed, where data were classified into pre- and post-CABG.
Furthermore, to determine the correlation and effect estimation, data were
analyzed using fixed or random effect model. <br/>Result(s): A total of 13
studies consisting 34,015 patients treated with clopidogrel and 32,661
patients treated with ticagrelor was included in our study. Our pooled
calculation revealed that the incidence of major bleeding was not
different significantly between clopidogrel and ticagrelor. In pre- and
post-CABG sub-groups, our results also found no significant difference in
major bleeding incidence between clopidogrel and ticagrelor groups.
<br/>Conclusion(s): Our meta-analysis clarifies that clopidogrel, compared
to ticagrelor, or vice versa, is not associated with the risk of major
bleeding in ACS patients treated with CABG.<br/>Copyright &#xa9; 2020
Rohman MS et al.

<32>
Accession Number
2013299104
Title
Potential causes of paraplegia after coronary artery bypass grafting: A
literature review.
Source
Heart Surgery Forum. 24 (30) (pp E487-E492), 2021. Date of Publication: 11
May 2021.
Author
Cheng Z.; Xu J.; Guo Y.
Institution
(Cheng, Guo) Department of Cardiovascular Surgery, West China Hospital,
Sichuan University, Sichuan, Chengdu, China
(Xu) Department of Cardiology, first hospital of Lanzhou University,
Gansu, Lanzhou, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Paraplegia is an unpredictable neurologic complication after coronary
artery bypass grafting (CABG) surgery. It is rare but fatal, and the
mechanism still is unclear. We aimed to make a summary of the possible
causes of paraplegia after CABG. Pubmed database was searched from January
1, 1978 to December 31, 2019, and 14 studies were finally included.
Paraplegia after CABG is a multifactorial consequence, but spinal cord
ischemia is the key pathological factor to postoperative
paraplegia.<br/>Copyright &#xa9; 2021 Forum Multimedia Publishing, LLC

<33>
Accession Number
2011578414
Title
Outcomes of surgical treatment for carcinoid heart disease: A systematic
review and meta-analysis.
Source
Surgery (United States). 170 (2) (pp 390-396), 2021. Date of Publication:
August 2021.
Author
O'Malley T.J.; Jimenez D.C.; Saxena A.; Weber M.P.; Samuels L.E.;
Entwistle J.W.; Guy T.S.; Massey H.T.; Morris R.J.; Tchantchaleishvili V.
Institution
(O'Malley, Jimenez, Saxena, Weber, Samuels, Entwistle, Guy, Massey,
Morris, Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
Publisher
Mosby Inc.
Abstract
Background: Carcinoid heart disease (CaHD) develops from vasoactive
substances released by neuroendocrine tumors, which can cause significant
patient morbidity and mortality without surgical intervention. We
performed a systematic review and meta-analysis to elucidate granular
perioperative details and long-term outcomes in these patients.
<br/>Method(s): Electronic search of Ovid, Scopus, Cumulative Index of
Nursing and Allied Health Literature, and Cochrane Controlled Trials
Register was performed to examine surgical treatment of carcinoid disease.
Nine articles comprising 416 patients were selected. Study-level data were
extracted and pooled for meta-analysis. <br/>Result(s): Mean patient age
was 63 years (95% confidence interval, 57-70) with 53% (95% confidence
interval, 46-61) of patients being male. In addition, 75% (95% confidence
interval, 54-96) of neuroendocrine tumors originated from the small bowel
or colon and 98% (95% confidence interval, 93-100) had liver metastases.
Right heart failure was present in 48% (95% confidence interval, 14-81).
Moderate or severe regurgitation was present in 97% (95% confidence
interval, 95-99) of tricuspid and 72% (95% confidence interval, 58-83) of
pulmonary valves. In addition, 99% (95% confidence interval, 98-100) of
tricuspid and 59% (95% confidence interval, 38-79) of pulmonary valves
were replaced. Bioprosthetic valves were used in 80% (95% confidence
interval, 68-93) of tricuspid positions. Mean hospital duration of stay
was 16 days (95% confidence interval, 7-25). Thirty-day mortality was 9%
(95% confidence interval, 6-12). Mean follow-up was 25 months (95%
confidence interval, 11-39). Median survival was 3 years (95% confidence
interval, 2.5-3.5). <br/>Conclusion(s): For patients >18 years of age,
surgical treatment of carcinoid heart disease can be performed with a
reasonable safety profile. However, overall survival appears to have
ongoing effects of the primary disease.<br/>Copyright &#xa9; 2021

<34>
Accession Number
2005258746
Title
Anticoagulation and amiodarone for new atrial fibrillation after coronary
artery bypass grafting: Prescription patterns and 30-day outcomes in the
United States and Canada.
Source
Journal of Thoracic and Cardiovascular Surgery. 162 (2) (pp 616-624.e3),
2021. Date of Publication: August 2021.
Author
Matos J.D.; McIlvaine S.; Grau-Sepulveda M.; Jawitz O.K.; Brennan J.M.;
Khabbaz K.R.; Sellke F.W.; Yeh R.; Zimetbaum P.
Institution
(Matos, McIlvaine, Yeh, Zimetbaum) Division of Cardiology, Department of
Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA, United States
(Grau-Sepulveda, Jawitz, Brennan) Duke Clinical Research Institute,
Durham, NC, United States
(Khabbaz) Department of Cardiac Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, MA, United States
(Sellke) Department of Cardiothoracic Surgery, Brown Medical School and
Lifespan Hospitals, Providence, RI, United States
(Yeh, Zimetbaum) Smith Center for Cardiovascular Outcomes Research, Beth
Israel Deaconess Medical Center, Boston, MA, United States
Publisher
Mosby Inc.
Abstract
Objective: We sought to elucidate national practice patterns regarding
anticoagulation and antiarrhythmic medication use at discharge and examine
short-term patient outcomes. <br/>Method(s): In this retrospective cohort
study, we analyzed the data of patients from the Society of Thoracic
Surgeons Adult Cardiac Surgery Database from July 2011 to June 2018 who
underwent first-time isolated coronary artery bypass graft surgery (CABG)
and developed new post-CABG atrial fibrillation (AF) without significant
complications. In total, 166,747 patients met study criteria. We examined
30-day outcomes. <br/>Result(s): In total, 166,747 patients were analyzed
and divided into 4 groups based on discharge medications: amiodarone with
or without anticoagulation, anticoagulation alone, and neither.
Demographic characteristics were similar among the 4 groups. In total,
25.7% of patients were discharged on anticoagulation with an average
CHA<inf>2</inf>DS<inf>2</inf>-VASc score of 3.2 +/- 1.3. Anticoagulation
use at discharge was not associated with lower 30-day stroke readmissions
(adjusted odds ratio [AOR], 0.87; 95% confidence interval [CI], 0.65-1.16;
P = .35). Adjusted 30-day readmissions for major bleeding were
significantly more common in anticoagulated patients (AOR, 4.30; 95% CI,
3.69-5.03; P < .0001). Among those discharged off anticoagulation, there
was no significant difference in adjusted 30-day stroke rates based on
amiodarone use at discharge (AOR, 1.19; 95% CI, 0.85-1.66; P = .31).
<br/>Conclusion(s): Post-CABG anticoagulation for new AF is associated
with increased bleeding and no difference in stroke at 30 days.
Prospective randomized studies are needed to formalize safe and
efficacious short- and long-term management strategies.<br/>Copyright
&#xa9; 2020 The American Association for Thoracic Surgery

<35>
Accession Number
2007792290
Title
Effects of mediterranean diet or low-fat diet on blood fatty acids in
patients with coronary heart disease. A randomized intervention study.
Source
Nutrients. 13 (7) (no pagination), 2021. Article Number: 2389. Date of
Publication: July 2021.
Author
Giroli M.G.; Werba J.P.; Rise P.; Porro B.; Sala A.; Amato M.; Tremoli E.;
Bonomi A.; Veglia F.
Institution
(Giroli, Werba, Porro, Amato, Tremoli, Bonomi, Veglia) Centro Cardiologico
Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
(Rise, Sala) Department of Pharmaceutical Sciences, University of Milan,
Via Balzaretti, 9, Milan 20133, Italy
(Sala) IRIB Consiglio Nazionale delle Ricerche, Via Ugo la Malfa, 153,
Palermo 90146, Italy
(Tremoli) Maria Cecilia Hospital, Via Corriera, 1, Cotignola 48033, Italy
Publisher
MDPI AG
Abstract
The Mediterranean diet (MD) prevents cardiovascular disease by different
putative mech-anisms, including modifications in the blood fatty acid (FA)
profile. Polytherapy for secondary cardiovascular prevention might mask
the effect of MD on the FA profile. This study was aimed to assess whether
MD, in comparison with a low-fat diet (LFD), favorably modifies the blood
FA profile in patients with coronary heart disease (CHD) on polytherapy.
One hundred and twenty patients with a recent history of coronary
stenting, randomized to MD or to LFD, completed 3 months of this
open-label dietary intervention study. Diet Mediterranean-ness was
evaluated using the Mediterranean Diet Adherence Screener (MeDAS) score.
Both diets significantly reduced saturated FA (p < 0.01). Putative
favorable changes in total n-3 FA (p = 0.03) and eicosapentaenoic acid
plus docosahexaenoic acid (EPA + DHA; p = 0.04) were significantly larger
with MD than with LFD. At 3 months, in the whole cohort, the MeDAS score
correlated inversely with palmitic acid (R = -0.21, p = 0.02), and with
palmitoleic acid (R = -0.32, p = 0.007), and positively with total n-3 FA
(R = 0.19, p = 0.03), EPA (R = 0.28, p = 0.002), and EPA + DHA (R = 0.21,
p = 0.02). In CHD patients on polytherapy, both MD and LFD shift FA blood
composition towards a healthier profile, with a more favorable effect of
MD on omega-3 levels.<br/>Copyright &#xa9; 2021 by the authors. Licensee
MDPI, Basel, Switzerland.

<36>
Accession Number
635462584
Title
Effect of Perioperative Intravenous iron Supplementation for Complex
Cardiac Surgery on Transfusion Requirements: A Randomized, Double-Blinded
Placebo-Controlled Trial.
Source
Annals of surgery. (no pagination), 2021. Date of Publication: 18 Jun
2021.
Author
Song J.W.; Soh S.; Shim J.-K.; Lee S.; Lee S.H.; Kim H.B.; Kim M.-Y.; Kwak
Y.L.
Institution
(Song) Department of Anesthesiology and Pain Medicine Anesthesia and Pain
Research Institute Department of Thoracic and Cardiovascular Surgery,
Yonsei University College of Medicine, 50 Yonsei-ro ,Seodaemun-gu, Seoul
03722, South Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We investigated whether routine perioperative intravenous iron
replenishment reduces the requirement for packed erythrocytes (pRBC)
transfusion. SUMMARY BACKGROUND DATA: Patients undergoing complex cardiac
surgery are at high risk of developing postoperative iron deficiency
anemia, thus requiring transfusion, which is associated with adverse
outcomes. <br/>METHOD(S): Patients were randomized to receive either
ferric derisomaltose 20 mg/kg (n = 103) or placebo (n = 101) twice during
the perioperative period: 3 days before and after the surgery. The primary
endpoint was the proportion of patients who received pRBC transfusion
until postoperative day (POD) 10. Hemoglobin, reticulocyte count, serum
iron profile, hepcidin, and erythropoietin were serially measured.
<br/>RESULT(S): pRBC was transfused in 60.4% and 57.2% of patients in the
control and iron group, respectively (P = 0.651). Hemoglobin concentration
at 3 weeks postoperatively was higher in the iron group than in the
control group (11.6 +/- 1.5 g/dl vs. 10.9 +/- 1.4 g/dl, P < 0.001). The
iron group showed higher reticulocyte count (205 [150-267]x103/mul vs. 164
[122-207]x103/mul, P = 0.003) at POD 10. Transferrin saturation and serum
ferritin were significantly increased in the iron group than in the
control group (P < 0.001). Serum hepcidin was higher in the iron group
than in the control group at POD 3 (106.3 [42.9-115.9] ng/ml vs. 39.3
[33.3-43.6] ng/ml, P < 0.001). Erythropoietin concentration increased
postoperatively in both groups (P = 0.003), with no between-group
difference. <br/>CONCLUSION(S): Intravenous iron supplementation during
index hospitalization for complex cardiac surgery did not minimize pRBC
transfusion despite replenished iron store and augmented erythropoiesis,
which may be attributed to enhanced hepcidin expression.<br/>Copyright
&#xa9; 2021 Wolters Kluwer Health, Inc. All rights reserved.

<37>
Accession Number
2003394770
Title
Fetal heart rate monitoring in nonobstetric surgery: a systematic review
of the evidence.
Source
American Journal of Obstetrics and Gynecology MFM. 1 (4) (no pagination),
2019. Article Number: 100048. Date of Publication: November 2019.
Author
Higgins M.F.; Pollard L.; McGuinness S.K.; Kingdom J.C.
Institution
(Higgins, Kingdom) Maternal Fetal Medicine, Mount Sinai Hospital, Toronto,
ON, Canada
(Higgins) Perinatal Research Center, Obstetrics and Gynaecology, School of
Medicine and Medical Sciences, University College Dublin, National
Maternity Hospital, Dublin, Ireland
(Pollard) Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
(McGuinness) Department of Anaesthesia, St. Vincent's University Hospital,
Dublin, Ireland
(Kingdom) Obstetrics and Gynaecology, University of Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Objective: Concern for fetal well-being during maternal nonobstetric
surgery may result in obstetricians and other maternity care providers
being asked to perform intraoperative fetal heart rate (FHR) monitoring.
We systematically reviewed the evidence regarding the use of FHR
monitoring during nonobstetric surgery after potential fetal viability
(>22 weeks gestational age), and examined the FHR patterns and outcomes
reported. Data sources: A systematic review of the evidence was performed.
Sources included databases (MEDLINE, EMBASE, Cochrane, and CENTRAL), hand
searching, guidelines, conference proceedings, and literature reviews.
Online searching was performed to include literature published from 1966
to May 2019. Study eligibility criteria: All studies reviewing care of
pregnant women undergoing nonobstetric surgery where FHR monitoring was
performed intraoperatively. Data were extracted from appropriate full-text
articles using a data abstraction form. Study appraisal and synthesis:
Case reports and case series only were identified. A total of 74 cases
were reviewed, encompassing maternal general surgery (n = 41,
cardiovascular surgery (n = 13) and neurosurgery/orthopedics (n = 20).
Median gestational age at time of maternal surgery was 30 weeks (range,
22-36 weeks). In 41 cases, findings of FHR monitoring were not reported.
Abnormal tracings were observed in 29 cases, as either reduced variability
(n = 13) or fetal bradycardia (n = 17). All but 3 bradycardias reported
occurred during maternal cardiac surgery involving aortic clamping and
cardiopulmonary bypass. In 1 case, FHR monitoring was not possible because
of a surgical pneumoperitoneum; there was 1 fetal tachycardia associated
with maternal pyrexia, and three cases in which FHR monitoring was deemed
stable or normal. Three preterm infants were delivered simultaneously at
the time of general surgery as a result of FHR abnormalities (at 30, 33,
and 34 weeks respectively), 2 as a result of fetal bradycardia and 1
because of protracted reduced variablity. <br/>Conclusion(s): The evidence
for intraoperative fetal monitoring is based on case reports and cases
series. Maternal cardiac surgery involving cardiopulmonary bypass commonly
results in fetal bradycardia, which may be challenging to interpret.
Obstetricians should be aware of FHR pattern changes in response to
anesthesia and surgery that do not justify iatrogenic preterm cesarean
delivery.<br/>Copyright &#xa9; 2019 Elsevier Inc.

<38>
Accession Number
602764547
Title
New Clinical Trials in Acute and Recurrent Pericarditis.
Source
Current Cardiology Reports. 17 (4) (pp 1-7), 2015. Date of Publication:
April 2015.
Author
Imazio M.
Institution
(Imazio) Cardiology Department, Maria Vittoria Hospital and University of
Torino, Via Luigi Cibrario 72, Torino 10141, Italy
Publisher
Current Medicine Group LLC 1
Abstract
Clinical trials in the last decade have improved the quality of evidence
to support preventive medical strategies to reduce the risk of recurrences
after pericarditis. There are essentially three main strategies: (1) to
use full anti-inflammatory doses for the treatment of each attack of
pericarditis till symptoms resolution and normalization of markers of
inflammation (i.e., C-reactive protein); (2) to limit the use of
corticosteroids and, if used, to use low to moderate doses (i.e.,
prednisone 0.2 to 0.5 mg/kg/day or equivalent) followed by slow tapering;
and (3) to add colchicine to improve the response to conventional
anti-inflammatory therapies and reduce the risk of recurrences.
Recommended regimens include weight-adjusted doses (i.e., 0.5-0.6 mg twice
daily for patients weighing >70 kg or 0.5-0.6 mg once daily for patients
weighing <=70 kg for 3 months for acute pericarditis and 6 months for
recurrences) without a loading dose to improve patients' compliance. Using
these doses and appropriate selection of patients (e.g. to avoid severe
renal impairment or adjust doses according to comorbid conditions and
concomitant therapies), the drug is well tolerated, may cause reversible
gastrointestinal intolerance (mainly diarrhea) in about 8 to 10 % of cases
but has no severe side effects.<br/>Copyright &#xa9; 2015, Springer
Science+Business Media New York.

<39>
Accession Number
366299938
Title
Oral beta-glucan reduces infarction size and improves regional contractile
function in a porcine ischaemia/reperfusion model.
Source
European Journal of Cardio-thoracic Surgery. 41 (4) (pp 919-925), 2012.
Date of Publication: April 2012.
Author
Aarsaether E.; Straumbotn E.; Rosner A.; Busund R.
Institution
(Aarsaether, Rosner, Busund) Department of Cardiothoracic and Vascular
Surgery, University Hospital of North Norway, Tromso, Norway
(Straumbotn, Rosner, Busund) Department of Clinical Medicine, Faculty of
Health Sciences, University of Tromso, Tromso, Norway
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: We previously reported a cardioprotective effect of oral
beta-glucan in patients who underwent coronary artery bypass grafting. The
present study was conducted to determine whether oral beta-glucan could
reduce myocardial infarction size and whether these changes would be
reflected by better preservation of contractile indices measured by
speckle tracking echocardiography (STE). <br/>Method(s): Fourteen pigs
were randomized to receive oral beta-glucan 50 mg/kg (n = 7) or placebo
(control, n = 7) 10 days before they were anaesthetized and subjected to 1
h clamping of the left anterior descending coronary artery followed by
reperfusion for 3 h. Longitudinal strain, circumferential strain and
radial strain were assessed by STE after 3 h of reperfusion. Infarction
size and area at risk were determined by Evans blue and
2,3,5-triphenyltetrazolium chloride staining. <br/>Result(s): Pretreatment
with beta-glucan reduced the infarct area/area at risk ratio by 36% (P <
0.05) and the total necrotic area of the left ventricle by 37% (P < 0.05)
compared with controls. Viable myocardium at risk was 30% higher in the
beta-glucan vs. control group (P < 0.05). Anterior apical strain values
for beta-glucan vs. control were -4.7 +/- 9.4 vs. 5.9 +/- 6.1% (P < 0.05)
for longitudinal strain, -14.7 +/- 6.6 vs. -7.7 +/- 4.3 (P < 0.05) for
circumferential strain, 15.1 +/- 7.7 vs. 7.1 +/- 11.8 (ns) for radial
strain. <br/>Conclusion(s): Oral beta-glucan pretreatment reduces
infarction size and improves regional contractile function in a porcine
ischaemia/reperfusion model. &#xa9; The Author 2012. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<40>
Accession Number
2005887822
Title
Reverse remodeling after percutaneous transluminal septal myocardial
ablation in severe but asymptomatic LVOT obstruction (RASTA) study:
Rationale and design of transcatheter septal reduction in asymptomatic
patients with severe hypertrophic obstructive cardiomyopathy.
Source
Catheterization and Cardiovascular Interventions. 97 (3) (pp 488-492),
2021. Date of Publication: 15 Feb 2021.
Author
Arslan F.; Akdim F.; ten Berg J.M.
Institution
(Arslan, Akdim, ten Berg) Department of Cardiology, St. Antonius Hospital
Nieuwegein, Nieuwegein, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Objectives: The aim of this study is to evaluate the impact of
percutaneous transluminal septal myocardial ablation (PTSMA) on remodeling
in asymptomatic patients with hypertrophic obstructive cardiomyopathy
(HOCM) and severe left ventricular outflow tract (LVOT) obstruction.
<br/>Background(s): Symptoms justify invasive treatment in HOCM patients
with LVOT obstruction. Adverse structural and functional changes
(remodeling) in the heart occur preceding heart failure and sudden cardiac
death. Early invasive treatment in asymptomatic patients may reverse
adverse remodeling to the same extent as in symptomatic patients.
<br/>Method(s): Reverse remodeling after PTSMA in severe but asymptomatic
LVOT obstruction (RASTA) study is a prospective single-blind randomized
trial (ClinicalTrials.gov number: NCT04230551). Ten asymptomatic HOCM
patients with an exertional LVOT gradient >=50 mmHg (or >30 mmHg in rest)
are randomized 1:1 to PTSMA versus conservative therapy, in the absence of
mitral valve disease or other indications for cardiac surgery. Five
symptomatic (reference group) will undergo PTSMA according to the current
guidelines. <br/>Result(s): Remodeling is assessed using extensive cardiac
imaging with transthoracic echocardiography and late gadolinium
enhancement cardiac magnetic resonance at baseline and during follow-up at
1, 12, and 24 months. Extracellular volume fraction, global, and regional
strain analysis, geometry, pressure gradients and changes in
four-dimensional velocity mapping are primary parameters to study
(reversal of) adverse remodeling. <br/>Conclusion(s): The RASTA study
gives insight in cardiac remodeling that may occur in asymptomatic
patients after PTSMA. It will provide arguments whether to pursue (or not)
a larger trial with clinical endpoints in asymptomatic HOCM patients with
severe LVOT obstruction.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC

<41>
Accession Number
2011078704
Title
Anesthesia Management for Pediatrics with Congenital Heart Diseases Who
Undergo Cardiac Catheterization in China.
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 8861461. Date of Publication: 2021.
Author
Xie C.-M.; Yao Y.-T.
Institution
(Xie) Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital,
Affiliated Cardiovascular Hospital, Kunming Medical University, Kunming
650000, China
(Yao) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of
Medical Sciences, Beijing 10037, China
Publisher
Hindawi Limited
Abstract
Objectives. The goal of this study was to summarize anesthesia management
for pediatrics with congenital heart diseases who undergo cardiac
catheterization procedure in China. Methods. The relevant articles were
identified through computerized searches in the CNKI, Wanfang, VIP, and
PubMed databases through May 2020, using different combinations of
keywords: "congenital heart
diseases,""pediatric,""children,""anesthesia,""cardiac
catheterization,""interventional therapy,""interventional
treatment,""interventional examination,"and "computed tomography."Results.
The database searches identified 48 potentially qualified articles, of
which 25 (9,738 patients in total) were determined to be eligible and
included. The authors collect data from the article information.
Anesthesia methods included endotracheal intubation or laryngeal mask
ventilation general anesthesia, monitored anesthesia care, and combined
with sacral canal block. Anesthesia-related complications occurred in
7.41% of the patients and included dysphoria, respiratory depression,
nausea, vomiting, cough, increased respiratory secretion, and airway
obstruction. The incidence of procedure-related complications was 12.14%,
of which the most common were arrhythmia and hypotension. Conclusions. For
pediatric patients with congenital heart diseases who undergo cardiac
catheterization procedures in China, arrhythmia and hypotension are the
most common procedure-related complications. Monitored anesthesia care is
the commonly used anesthesia methods, and dysphoria, cough, nausea,
vomiting, and respiratory depression are frequent complications associated
with anesthesia.<br/>Copyright &#xa9; 2021 Chun-Mei Xie and Yun-Tai Yao.

<42>
Accession Number
2011048377
Title
Treatment and outcome of plastic bronchitis in single ventricle patients:
A systematic review.
Source
Interactive Cardiovascular and Thoracic Surgery. 30 (6) (pp 846-853),
2021. Date of Publication: 2021.
Author
Harteveld L.M.; Blom N.A.; Hazekamp M.G.; Ten Harkel A.D.J.
Institution
(Harteveld, Blom, Hazekamp, Ten Harkel) Centre for Congenital Heart
Disease Amsterdam-Leiden, Leiden, Netherlands
(Blom, Ten Harkel) Department of Paediatric Cardiology, Leiden University
Medical Centre, Leiden, Netherlands
(Blom) Department of Paediatric Cardiology, Amsterdam University Medical
Centre, Academic Medical Centre, Amsterdam, Netherlands
(Hazekamp) Department of Cardiothoracic Surgery, Leiden University Medical
Centre, Leiden, Netherlands
Publisher
Oxford University Press
Abstract
Plastic bronchitis (PB) is a life-threatening complication in single
ventricle (SV) patients of which the exact pathophysiology, outcome and
optimal treatment are still unclear. This study aims to systematically
review the literature to give insight into the characteristics, outcome
and management options of SV patients with PB. A systematic review was
conducted, using the electronic database PubMed to find records published
up to August 2018, describing SV patients and PB in which characteristics,
treatment and/or outcome were adequately described per case. A total of
577 records were screened of which 73 had sufficient data describing 133
SV cases with PB. Most cases had completed a Fontan palliation (n = 126)
with a median interval between Fontan completion and diagnosis of PB of
18.4 months (Q1-Q3 5.0-36.3). Overall mortality was 15.2% and was
associated with the diagnosis of PB within 12 months after Fontan
palliation (5-year survival of 56.1% <_12 months vs 94.8% >12 months, P =
0.002) and a higher age at Fontan completion (47.4 months for
non-survivors vs 36.0 months for survivors, P = 0.015). Most patients
received a combination therapy from 3 different treatment strategies, i.e.
therapy for relief of airway obstruction, anti-inflammatory treatment and
treatment to improve haemodynamics of the Fontan physiology (55.1%). In
conclusion, SV patients who are diagnosed with PB within 12 months after
Fontan palliation have a higher risk of mortality. Moreover, most cases
received a combination therapy consisting of all 3 treatment
strategies.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<43>
Accession Number
2007934675
Title
Bempedoic acid safety analysis: Pooled data from four phase 3 clinical
trials.
Source
Journal of Clinical Lipidology. 14 (5) (pp 649-659.e6), 2020. Date of
Publication: 01 Sep 2020.
Author
Bays H.E.; Banach M.; Catapano A.L.; Duell P.B.; Gotto A.M.; Laufs U.;
Leiter L.A.; Mancini G.B.J.; Ray K.K.; Bloedon L.T.; Sasiela W.J.; Ye Z.;
Ballantyne C.M.
Institution
(Bays) Louisville Metabolic and Atherosclerosis Research Center,
Louisville, KY, United States
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland
(Catapano) Department of Pharmacological and Biomolecular Sciences,
University of Milan and Multimedica IRCCS, Milan, Italy
(Duell) Center for Preventive Cardiology, Knight Cardiovascular Institute,
Oregon Health & Science University, Portland, OR, United States
(Gotto) Houston Methodist Research Institute, Houston, TX, United States
(Gotto) Weill Cornell Medicine, New York, NY, United States
(Laufs) Klinik und Poliklinik fur Kardiologie, Universitatsklinikum
Leipzig, Leipzig, Germany
(Leiter) Division of Endocrinology & Metabolism, Li Ka Shing Knowledge
Institute, St. Michael's Hospital, University of Toronto, Toronto, ON,
Canada
(Mancini) Division of Cardiology, University of British Columbia,
Vancouver, BC, Canada
(Ray) Department of Primary Care and Public Health, Imperial Centre for
Cardiovascular Disease Prevention, Imperial College London, London, United
Kingdom
(Bloedon, Sasiela, Ye) Esperion Therapeutics, Inc., Ann Arbor, MI, United
States
(Ballantyne) Department of Medicine, Baylor College of Medicine, Houston,
TX, United States
Publisher
Elsevier Ltd
Abstract
Background: An ongoing need exists for safe and effective lipid-lowering
therapies (LLTs) for patients unable to achieve desired lipid levels with
current treatment options. <br/>Objective(s): The objective of this study
was to describe the safety profile of bempedoic acid, an oral,
first-in-class, adenosine triphosphate (ATP)-citrate lyase inhibitor that
significantly reduces low-density lipoprotein cholesterol (LDL-C) levels
by 17.4%-28.5% vs placebo. <br/>Method(s): This was a pooled analysis of
four phase 3, randomized (2:1), double-blind, placebo-controlled studies
in patients with hypercholesterolemia who required additional LDL-C
lowering, despite stable maximally-tolerated LLT. Patients received 180 mg
of bempedoic acid (n = 2424) or placebo (n = 1197) once daily for 12 to 52
weeks. Assessments included treatment-emergent adverse events (TEAEs) and
clinical laboratory tests. <br/>Result(s): Of 3621 patients (the median
drug exposure: 363 days), exposure-adjusted TEAE rates were 87.1/100 and
82.9/100 person-years (PY) for bempedoic acid and placebo, respectively.
No single TEAE influenced the difference in rates. TEAEs leading to
discontinuation occurred at rates of 13.4/100 and 8.9/100 PY for bempedoic
acid vs placebo, with the most common cause being myalgia, which occurred
less frequently with bempedoic acid vs placebo (1.5/100 vs 2.0/100 PY).
Rates of myalgia and muscle weakness were comparable vs placebo. Bempedoic
acid was associated with mild increases in blood urea nitrogen,
creatinine, and uric acid and decreases in hemoglobin. These laboratory
abnormalities were apparent by week 4, stable over time, and reversible
after treatment cessation. Gout incidence was 1.6/100 vs 0.5/100 PY in the
bempedoic acid vs placebo groups. New-onset diabetes/hyperglycemia
occurred less frequently with bempedoic acid vs placebo (4.7/100 vs
6.4/100 PY). The safety profile was consistent across subgroups.
<br/>Conclusion(s): Bempedoic acid is generally safe and well tolerated
among patients with hypercholesterolemia who require additional
LLT.<br/>Copyright &#xa9; 2020 National Lipid Association

<44>
Accession Number
2006052740
Title
Clinical outcomes after transcatheter aortic valve replacement in South
America: A centre-level systematic review and meta-analysis of
observational data.
Source
Journal of Evaluation in Clinical Practice. 27 (4) (pp 785-798), 2021.
Date of Publication: August 2021.
Author
Boissonnet C.P.; Giorgi M.A.; Carosella L.; Brescacin C.; Pissinis J.;
Guetta J.N.
Institution
(Boissonnet, Giorgi, Guetta) Health Economics and Technology Assessment
Unit, Instituto Universitario CEMIC, Centro de Educacion Medica e
Investigaciones Clinicas "Norberto Quirno" (CEMIC), Buenos Aires,
Argentina
(Boissonnet, Giorgi, Guetta) Cardiology Section, Department of Internal
Medicine, Centro de Educacion Medica e Investigaciones Clinicas "Norberto
Quirno" (CEMIC), Buenos Aires, Argentina
(Giorgi) Department of Pharmacology, Instituto Universitario CEMIC, Buenos
Aires, Argentina
(Carosella, Brescacin, Pissinis) Department of Internal Medicine, Centro
de Educacion Medica e Investigaciones Clinicas "Norberto Quirno" (CEMIC),
Buenos Aires, Argentina
Publisher
Blackwell Publishing Ltd
Abstract
Objectives: To estimate in-hospital and 30-day outcomes after
transcatheter aortic valve replacement (TAVR) in South America through a
systematic review and meta-analysis of observational data. <br/>Method(s):
We comprehensively searched for papers published in peer-reviewed medical
journals and for abstracts presented in medical conferences of the region
from 1 September 2008, through 29 June 2020, using predefined criteria. We
included single-centre studies on TAVR populations with >=10 patients from
South America reporting any in-hospital or 30-day clinical outcome.
<br/>Result(s): Fifty-five cohorts from seven countries, pooling 3001
patients, were included in a random-effects meta-analysis. Self-expandable
prostheses were the most frequently implanted. Pooled estimate of
procedure success by VARC2 criteria was 90.0% (95%CI 81.8%-94.7%;
I² 75.0%). The pooled estimate rates of the outcomes were as
follow: post-procedure moderate or severe aortic regurgitation, 9.7%
(95%CI 6.0%-15.4%; I² 65.4%), in-hospital cardiac tamponade,
4.0% (95%CI 2.5%-6.6%; I² 0%), in-hospital stroke, 4.1% (95%CI
2.9%-5.7%; I² 0%), in-hospital major vascular complication,
7.8% (95%CI 5.2%-11.5%; I² 22.3%), in-hospital permanent
pacemaker implantation, 19.4% (95%CI 15.9%-23.4%; I² 53.8%),
in-hospital mortality, 8.0% (95%CI 6.7%-9.6%; I² 0%), and
30-day mortality, 9.7% (95%CI 7.9%-11.8%; I² 26.4%).
<br/>Conclusion(s): As compared with published international registries,
the overall results of TAVR in South America seemed underrated.
Significant heterogeneity was observed in procedural success, pacemaker
requirement, and post-procedure moderate or severe aortic regurgitation.
This study provides a real-life framework for the analysis of the
performance of this technology in the region, intended to be a starting
point for quality improvement.<br/>Copyright &#xa9; 2020 John Wiley & Sons
Ltd

<45>
Accession Number
634322374
Title
Providing Epidemiological Data in Lumbar Spine Imaging Reports Did Not
Affect Subsequent Utilization of Spine Procedures: Secondary Outcomes from
a Stepped-Wedge Randomized Controlled Trial.
Source
Pain medicine (Malden, Mass.). 22 (6) (pp 1272-1280), 2021. Date of
Publication: 04 Jun 2021.
Author
Suri P.; Meier E.N.; Gold L.S.; Marcum Z.A.; Johnston S.K.; James K.T.;
Bresnahan B.W.; O'Reilly M.; Turner J.A.; Kallmes D.F.; Sherman K.J.; Deyo
R.A.; Luetmer P.H.; Avins A.L.; Griffith B.; Heagerty P.J.; Rundell S.D.;
Jarvik J.G.; Friedly J.L.
Institution
(Suri, Meier, Gold, Johnston, James, O'Reilly, Turner, Heagerty, Rundell,
Jarvik, Friedly) Clinical Learning, Evidence, Research Center, University
of Washington, Seattle, WA, United States
(Suri, Turner, Rundell, Friedly) Department of Rehabilitation Medicine,
University of Washington, Seattle, WA, United States
(Suri) Seattle Epidemiologic Research and Information Center, VA Puget
Sound Health Care System, Seattle, WA, United States
(Suri) Rehabilitation Care Services, VA Puget Sound Health Care System,
Seattle, WA, United States
(Meier, Heagerty) Department of Biostatistics, University of Washington,
Seattle, WA, United States
(Gold, Johnston, James, Bresnahan, O'Reilly, Jarvik) Department of
Radiology, School of Medicine, University of Washington, Seattle, WA,
United States
(Marcum) Department of Pharmacy, School of Pharmacy, University of
Washington, Seattle, WA, United States
(Turner) Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle, WA, United States
(Kallmes, Luetmer) Department of Radiology, Mayo Clinic, Rochester, MN,
United States
(Sherman) SeattleWAUnited States
(Deyo) Departments of Family Medicine and Internal Medicine, Oregon Health
& Science University, Portland, Oregon, USA
(Avins) Division of Research (ALA), Kaiser Permanente Northern California,
Oakland, CA, United States
(Griffith) Department of Radiology, Henry Ford Hospital, Detroit, MI,
United States
(Jarvik) Department of Neurological Surgery, University of Washington,
Seattle, WA, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the effect of inserting epidemiological information
into lumbar spine imaging reports on subsequent nonsurgical and surgical
procedures involving the thoracolumbosacral spine and sacroiliac joints.
DESIGN: Analysis of secondary outcomes from the Lumbar Imaging with
Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized trial.
SETTING: Primary care clinics within four integrated health care systems
in the United States. SUBJECTS: 238,886 patients >=18years of age who
received lumbar diagnostic imaging between 2013 and 2016. <br/>METHOD(S):
Clinics were randomized to receive text containing age- and
modality-specific epidemiological benchmarks indicating the prevalence of
common spine imaging findings in people without low back pain, inserted
into lumbar spine imaging reports (the "LIRE intervention"). The study
outcomes were receiving 1) any nonsurgical lumbosacral or sacroiliac spine
procedure (lumbosacral epidural steroid injection, facet joint injection,
or facet joint radiofrequency ablation; or sacroiliac joint injection) or
2) any surgical procedure involving the lumbar, sacral, or thoracic spine
(decompression surgery or spinal fusion or other spine surgery).
<br/>RESULT(S): The LIRE intervention was not significantly associated
with subsequent utilization of nonsurgical lumbosacral or sacroiliac spine
procedures (odds ratio [OR]=1.01, 95% confidence interval [CI] 0.93-1.09;
P=0.79) or any surgical procedure (OR=0.99, 95 CI 0.91-1.07; P=0.74)
involving the lumbar, sacral, or thoracic spine. The intervention was also
not significantly associated with any individual spine procedure.
<br/>CONCLUSION(S): Inserting epidemiological text into spine imaging
reports had no effect on nonsurgical or surgical procedure utilization
among patients receiving lumbar diagnostic imaging.<br/>Copyright &#xa9;
The Author(s) 2021. Published by Oxford University Press on behalf of the
American Academy of Pain Medicine. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.

<46>
Accession Number
2013035474
Title
Pharmacodynamic Effects of Pre-Hospital Administered Crushed Prasugrel in
Patients With ST-Segment Elevation Myocardial Infarction.
Source
JACC: Cardiovascular Interventions. 14 (12) (pp 1323-1333), 2021. Date of
Publication: 28 Jun 2021.
Author
Vogel R.F.; Delewi R.; Angiolillo D.J.; Wilschut J.M.; Lemmert M.E.;
Diletti R.; van Vliet R.; van der Waarden N.W.P.L.; Nuis R.-J.; Paradies
V.; Alexopoulos D.; Zijlstra F.; Montalescot G.; Krucoff M.W.; van Mieghem
N.M.; Smits P.C.; Vlachojannis G.J.
Institution
(Vogel, Vlachojannis) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Delewi) Department of Cardiology, Amsterdam University Medical Center,
Amsterdam, Netherlands
(Angiolillo) Department of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Wilschut, Lemmert, Diletti, Nuis, Zijlstra, van Mieghem) Department of
Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
(Lemmert) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(van Vliet, Paradies, Smits, Vlachojannis) Department of Cardiology,
Maasstad Hospital, Rotterdam, Netherlands
(van der Waarden) Emergency Medical Service, AmbulanceZorg
Rotterdam-Rijnmond, Barendrecht, Netherlands
(Alexopoulos) Department of Cardiology, National and Kapodistrian
University of Athens Medical School, Attikon University Hospital, Athens,
Greece
(Montalescot) Department of Cardiology, ACTION Group, Groupe Hospitalier
Pitie-Salpetriere Hospital (Assistance Publique-Hopitaux de Paris),
Sorbonne University, Paris, France
(Krucoff) Department of Cardiology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to compare the pharmacodynamic effects of
pre-hospitally administered P2Y<inf>12</inf> inhibitor prasugrel in
crushed versus integral tablet formulation in patients with ST-segment
elevation myocardial infarction (STEMI) undergoing primary percutaneous
coronary intervention (pPCI). <br/>Background(s): Early dual antiplatelet
therapy is recommended in STEMI patients. Yet, onset of oral
P2Y<inf>12</inf> inhibitor effect is delayed and varies according to
formulation administered. <br/>Method(s): The COMPARE CRUSH (Comparison of
Pre-hospital Crushed Versus Uncrushed Prasugrel Tablets in Patients With
STEMI Undergoing Primary Percutaneous Coronary Interventions) trial
randomized patients with suspected STEMI to crushed or integral prasugrel
60-mg loading dose in the ambulance. Pharmacodynamic measurements were
performed at 4 time points: before antiplatelet treatment, at the
beginning and end of pPCI, and 4 h after study treatment onset. The
primary endpoint was high platelet reactivity at the end of pPCI. The
secondary endpoint was impact of platelet reactivity status on markers of
coronary reperfusion. <br/>Result(s): A total of 441 patients were
included. In patients with crushed prasugrel, the occurrence of high
platelet reactivity at the end of pPCI was reduced by almost one-half
(crushed 34.7% vs. uncrushed 61.6%; odds ratio [OR] = 0.33; 95% confidence
interval [CI] = 0.22 to 0.50; p < 0.01). Platelet reactivity <150
P2Y<inf>12</inf> reactivity units at the beginning of coronary angiography
correlated with improved Thrombolysis In Myocardial Infarction flow grade
3 in the infarct artery pre-pPCI (OR: 1.78; 95% CI: 1.08 to 2.94; p =
0.02) but not ST-segment resolution (OR: 0.80; 95% CI: 0.48 to 1.34; p =
0.40). <br/>Conclusion(s): Oral administration of crushed compared with
integral prasugrel significantly improves platelet inhibition during the
acute phase in STEMI patients undergoing pPCI. However, a considerable
number of patients still exhibit inadequate platelet inhibition at the end
of pPCI, suggesting the need for alternative agents to bridge the gap in
platelet inhibition.<br/>Copyright &#xa9; 2021 American College of
Cardiology Foundation

<47>
Accession Number
2011638305
Title
Bilateral transversus thoracis muscle plane block provides effective
analgesia and enhances recovery after open cardiac surgery.
Source
Journal of Cardiac Surgery. 36 (8) (pp 2818-2823), 2021. Date of
Publication: August 2021.
Author
Zhang Y.; Li X.; Chen S.
Institution
(Zhang, Chen) Department of Anesthesiology, First Affiliated Hospital of
Nanchang University, Nanchang, Jiangxi, China
(Li) Department of Nursing, The first Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
Publisher
Blackwell Publishing Inc.
Abstract
Background: The mid-sternum is the main source of pain after open cardiac
surgery. The aim of this study was to investigate the effect of bilateral
transversus thoracis muscle plane (TTMP) blocks on open cardiac surgery.
<br/>Method(s): Sixty patients were randomly divided into two groups:
bilateral TTMP blocks (TP group) or no nerve block (CO group). The primary
endpoint was perioperative sufentanil consumption. The secondary outcome
measures included postoperative pain, flurbiprofen axetil administration,
quality of sleep after extubation, time to extubation, time to the return
of gastrointestinal function, time to drain removal, the Intensive Care
Unit (ICU) stay time, and hospital stay. <br/>Result(s): The TP group
reported significantly less sufentanil and flurbiprofen axetil consumption
than the CO group. The CO group had higher Numerical Rating Scale (NRS)
pain scores at 1, 2, 6, 12, and 24 h after extubation both at rest and
during movement than the TP groups. Compared with the CO group,time to
extubation, time to the first bowel movement, ICU stay time, and hospital
stay were significantly decreased in the TP group. The TP group was rated
as better in the quality of the two nights of sleep after extubation.
<br/>Conclusion(s): Bilateral TTMP blocks can provide good perioperative
analgesia for patients undergoing open cardiac surgery and promote
postoperative recovery.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<48>
Accession Number
2011547428
Title
Effects of Colchicine on Cardiovascular Outcomes in Patients with Coronary
Artery Disease: A Systematic Review and One-Stage and Two-Stage
Meta-Analysis of Randomized-Controlled Trials.
Source
High Blood Pressure and Cardiovascular Prevention. 28 (4) (pp 343-354),
2021. Date of Publication: July 2021.
Author
Teo Y.N.; Teo Y.H.; Syn N.L.; Goh M.W.; Yoong C.S.Y.; Lee C.-H.; Chan
M.Y.-Y.; Chai P.; Yeo T.-C.; Sia C.-H.
Institution
(Teo, Teo, Syn, Goh, Yoong, Lee, Chan, Chai, Yeo, Sia) Department of
Medicine, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore
(Lee, Chan, Chai, Yeo, Sia) Department of Cardiology, National University
Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9,
Singapore 119228, Singapore
Publisher
Adis
Abstract
Aim: Colchicine has received emerging interest due to its cardiovascular
benefits in patients with coronary artery disease (CAD). We conducted a
one-stage meta-analysis of reconstructed individual patient data (IPD)
from randomized-controlled trials to summarize the effects of colchicine
on cardiovascular outcomes in patients with CAD. <br/>Method(s): Four
databases (PubMed, Embase, Cochrane, SCOPUS) were searched for articles
published from inception to 30th September 2020, examining the effect of
colchicine on cardiovascular outcomes in patients with CAD, yielding 10
randomized-controlled trials with a combined cohort of 12,781 patients.
IPD was reconstructed from Kaplan-Meier curves published in 3 studies and
analysed using the shared-frailty Cox model. Aggregate data meta-analysis
of all 10 studies was performed for outcomes unsuitable for IPD
reconstruction. <br/>Result(s): In patients receiving colchicine compared
to placebo, one-stage meta-analysis demonstrated a hazard ratio of 0.70
(95% CI 0.61-0.80) for the composite outcome of cardiovascular death,
non-fatal myocardial infarction, non-fatal stroke, and urgent
hospitalization for angina requiring coronary revascularization. Aggregate
data meta-analysis demonstrated a significant reduction in hazard rate for
stroke (HR 0.45; 95% CI 0.27-0.75) and urgent revascularization (HR 0.59;
95% CI 0.38-0.91); and a relative risk reduction for myocardial infarction
(RR 0.72; 95% CI of 0.52-1.00) and post-operative atrial fibrillation (RR
0.64; 95% CI 0.48-0.86). <br/>Conclusion(s): Given the significant
benefits of colchicine demonstrated on IPD, and its consistent benefits
when analyzed using aggregate data meta-analysis, we propose that
colchicine may be considered as an additional pharmacological adjunct to
the first line therapy for patients with coronary artery
disease.<br/>Copyright &#xa9; 2021, Italian Society of Hypertension.

<49>
Accession Number
2011519161
Title
Risk factors for Takotsubo syndrome following cardiac surgery: A
case-control study.
Source
Journal of Cardiac Surgery. 36 (8) (pp 2767-2773), 2021. Date of
Publication: August 2021.
Author
Kim Y.S.; Lim J.Y.
Institution
(Kim) Departments of Thoracic and Cardiovascular Surgery, Keimyung
University Dongsan Hospital, Daegu, South Korea
(Lim) Departments of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, The Catholic University of Korea College of Medicine, Seoul,
South Korea
Publisher
Blackwell Publishing Inc.
Abstract
Objective: Takotsubo syndrome following cardiac surgery is a rare
occurrence. However, early diagnosis is essential to prevent treatment
which could increase the left ventricular outflow tract pressure gradient
in patients with Takotsubo syndrome, and lead to cardiogenic shock.
Therefore, our study aimed to identify the incidence of Takotsubo syndrome
after cardiopulmonary bypass and the associated risk factors and
prognosis. <br/>Method(s): We retrospectively studied 5773 patients who
underwent cardiopulmonary bypass between February 2007 and July 2017.
Among these, Takotsubo syndrome was diagnosed in 52 (0.9%). To evaluate
the risk factors for Takotsubo syndrome, 104 of the remaining 5721 patient
were randomly selected as the control group (1:2 ratio). Univariate and
multivariate logistic regression analyses were used for risk factor
analysis. <br/>Result(s): Majority of patients (69.2%) in the Takotsubo
syndrome group underwent mitral valve surgery, compared with 32.7% in the
control group. The following risk factors of Takotsubo syndrome were
identified: atrio-ventricular valve surgery (odds ratio (OR) 10.5; 95%
confidence interval (CI), 2.6-42.5; p = 0.001); and the immediate
postoperative use of epinephrine (OR, 3.3; 95% CI, 1.0-10.7; p = 0.05) and
dobutamine (OR, 4.8; 95% CI, 1.72-13.3; p = 0.003). Hypertension was a
significant protective factor against Takotsubo syndrome following cardiac
surgery (OR, 0.22; 95% CI, 0.06-0.73; p = 0.01). <br/>Conclusion(s):
Takotsubo syndrome following cardiac surgery is rare. Immediate
postoperative use of epinephrine and doputamine, as well as
atrio-ventricular valve surgery were factors associated with the
development of Takotsubo syndrome.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC

<50>
Accession Number
2010719472
Title
Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After
Cardiac Surgery.
Source
Clinical Pharmacokinetics. 60 (7) (pp 907-919), 2021. Date of Publication:
July 2021.
Author
Valtola A.; Laakso M.; Hakomaki H.; Anderson B.J.; Kokki H.; Ranta V.-P.;
Rinne V.; Kokki M.
Institution
(Valtola, Laakso) Heart Centre, Kuopio University Hospital, Kuopio,
Finland
(Laakso, Kokki) School of Medicine, University of Eastern Finland, Kuopio,
Finland
(Hakomaki, Ranta) School of Pharmacy, University of Eastern Finland,
Kuopio, Finland
(Rinne) Admescope Ltd, Oulu, Finland
(Anderson) Department of Anaesthesiology, University of Auckland,
Auckland, New Zealand
(Kokki) Department of Anaesthesia and Intensive Care, Kuopio University
Hospital, KYS, PO Box 100, Kuopio 70029, Finland
Publisher
Adis
Abstract
Background: Cardiac bypass surgery patients have early postoperative
interventions that elicit breakthrough pain. We evaluated the use of
intranasal fentanyl for breakthrough pain management in these patients.
<br/>Method(s): Multimodal analgesia (paracetamol 1 g three times a day,
oxycodone 2-3 mg boluses with a patient-controlled intravenous pump) was
used in 16 patients (age 49-70 years, weight 59-129 kg) after cardiac
bypass surgery. Intranasal fentanyl 100 microg or 200 microg was used to
manage breakthrough pain on the first and third postoperative mornings in
a randomised order. Blood samples were collected for up to 3 h after
fentanyl administration, pain was assessed with a numeric rating scale of
0-10. Plasma fentanyl concentration was assayed using liquid
chromatography-mass spectrometry. Body composition was measured with a
bioelectrical impedance device. <br/>Result(s): Bioavailability of
intranasal fentanyl was high (77%), absorption half-time short (< 2 min)
and an analgesic plasma concentration >= 0.5 ng/mL was achieved in 31 of
32 administrations. Fentanyl exposure correlated inversely with skeletal
muscle mass and total body water. Fentanyl analgesia was effective both on
the first postoperative morning with chest pleural tube removal and during
physiotherapy on the third postoperative morning. The median time of
subsequent oxycodone administration was 1.1 h after intranasal fentanyl
100 microg and 2.1 h after intranasal fentanyl 200 microg, despite similar
oxycodone concentrations (median 13.8, range 5.2-35 ng/mL) in both
fentanyl dose groups. <br/>Conclusion(s): Intranasal fentanyl 100 microg
provided rapid-onset analgesia within 10 min and is an appropriate
starting dose for incidental breakthrough pain in the first 3
postoperative days after cardiac bypass surgery. Clinical Trial
Registration: EudraCT Number: 2018-001280-22.<br/>Copyright &#xa9; 2021,
The Author(s).

<51>
Accession Number
2013487181
Title
Stroke Severity in Transcatheter Aortic Valve Implantation Versus Surgical
Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Journal of Stroke and Cerebrovascular Diseases. 30 (9) (no pagination),
2021. Article Number: 105927. Date of Publication: September 2021.
Author
Synnott P.; Murphy R.P.; Judge C.; Costello M.; Reddin C.; Dennehy K.;
Loughlin E.; Smyth A.; Mylotte D.; O'Donnell M.J.; Canavan M.
Institution
(Synnott, Murphy, Judge, Costello, Reddin, Dennehy, Loughlin, Smyth,
Mylotte, O'Donnell, Canavan) HRB-Clinical Research Facility, NUI Galway,
Galway, Ireland
(Judge) Translational Medical Device Lab, NUI Galway, Galway, Ireland
(Judge) Wellcome Trust - HRB, Irish Clinical Academic Training, Ireland
Publisher
W.B. Saunders
Abstract
Objectives: An assessment of the comparative incidence of fatal or
disabling stroke may influence choice of intervention for patients with
severe aortic stenosis. We explored whether transcatheter aortic valve
implantation (TAVI) is associated with a lower incidence of fatal or
disabling stroke, compared to surgical aortic valve replacement (SAVR).
<br/>Material(s) and Method(s): We classified stroke into two categories;
fatal or disabling, or non-disabling, and completed meta-analyses for
each. We explored randomised controlled trials to assess the effect
publication year, predicted operative risk, and route of TAVI access.
<br/>Result(s): There was no difference between treatment groups per 100
person years of follow up for disabling or non-disabling stroke outcomes.
In a stratified analysis by year of publication, there was a lower rate of
fatal or disabling stroke with TAVI in trials published after 2015,
compared to those published in 2015 or before (p-interaction = 0.01 at 30
days). Higher proportions of transfemoral route access (>90%), more common
in recent trials, were associated with a lower rate of fatal or disabling
stroke (p-interaction = 0.03 at 30 days). Lower average surgical risk
scores were associated with lower rates of fatal or disabling stroke (p =
0.02 at 30 days). <br/>Conclusion(s): We found that treatment of aortic
stenosis with TAVI compared with SAVR was not associated with an overall
reduced risk in fatal or disabling stroke. Subgroup analyses suggested a
lower risk of fatal or disabling stroke with TAVI in situations which
reflect contemporary practice.<br/>Copyright &#xa9; 2021 The Authors

<52>
Accession Number
2013461821
Title
Relationship between REM sleep behavior disorder and depression and
anxiety and night eating syndrome.
Source
Progress in Nutrition. 23 (2) (no pagination), 2021. Article Number:
10130. Date of Publication: 07 Feb 2021.
Author
Canturk R.G.Y.; Comert I.T.; Ugras S.; Akcan G.; Salkim D.I.; Tutkun E.;
Yukseloglu E.H.
Institution
(Canturk) Istanbul Arel University, Institute of Social Sciences, Clinical
Psychology, Istanbul, Turkey
(Comert) Fatih Sultan Mehmet University, Psychology Department, Istanbul,
Turkey
(Ugras, Salkim, Yukseloglu) Istanbul University- Cerrahpasa Institute of
Forensic Sciences and Legal Medicine, Istanbul, Turkey
(Akcan) Bartin University, Faculty of Literature, Appliied Psychology
Department, Bartin, Turkey
(Tutkun) Bursa Uludag University, Faculty of Sport Science, Bursa, Turkey
Publisher
Mattioli 1885
Abstract
The purpose of this study is to reveal the risk of depression and anxiety
disorders and night eating syndrome in individuals with REM sleep behavior
disorder and to determine the relationship between them. Intermittent
awakening from sleep to sleep or accompanied by physical movements that
could injure itself is defined as REM sleep behavior disorder. Ethical
committee approval of the study taken from T.R. Istanbul Arel University.
The sample of the study was analyzed by 47 people from T.R. Ministry of
Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research
Hospital, 39 people from T.R. Ministry of Health Sultan Abdul Hamid Khan
Training and Research Hospital, 28 people from the T.R. Ministry of
Health, Okmeydani Training and Research Hospital were included in the
study. Total of 108 data randomly selected were included in the study as
control group. It can be said that the REM sleep behavior disorder was low
(13-0=13/3=4,33; 0-4,33: low; 4,34-8,66: intermediate; 8,67-13,00: high).
There was a positive and significant relationship between REM sleep
behavior disorder scores and anxiety (r =.43; p <.05) and depression (r
=.56; p <.05) scores. The participants with high REM sleep behavior
disorders have high anxiety and depression symptoms.<br/>Copyright &#xa9;
2021 Mattioli 1885. All rights reserved.

<53>
Accession Number
2012931815
Title
Meta-analysis of AKI to CKD transition in perioperative patients.
Source
Perioperative Medicine. 10 (1) (no pagination), 2021. Article Number: 24.
Date of Publication: December 2021.
Author
M. Abdala P.; Swanson E.A.; P. Hutchens M.
Institution
(M. Abdala, P. Hutchens) Anesthesiology & Perioperative Medicine, Oregon
Health & Science University, Portland, OR, United States
(Swanson) Medical Scientist Training Program, Oregon Health & Science
University, Portland, OR, United States
(P. Hutchens) Portland Veterans Affairs Medical Center, Operative Care
Division, 3710 SW US Veterans Hospital Road, Portland, OR 97239, United
States
Publisher
BioMed Central Ltd
Abstract
Background: Recent research shows AKI increases the risk of incident CKD.
We hypothesized that perioperative AKI may confer increased risk of
subsequent CKD compared to nonperioperative AKI. <br/>Method(s): A MEDLINE
search was performed for "AKI, CKD, chronic renal insufficiency, surgery,
and perioperative" and related terms yielded 5209 articles. One thousand
sixty-five relevant studies were reviewed. One thousand six were excluded
because they were review, animal, or pediatric studies. Fifty-nine studies
underwent full manuscript review by two independent evaluators. Seventeen
met all inclusion criteria and underwent analysis. Two-by-two tables were
constructed from AKI +/- and CKD +/- data. The R package metafor was
employed to determine odds ratio (OR), and a random-effects model was used
to calculate weighted ORs. Leave-1-out, funnel analysis, and structured
analysis were used to estimate effects of study heterogeneity and bias.
<br/>Result(s): Nonperioperative studies included studies of oncology,
percutaneous coronary intervention, and myocardial infarction patients.
Perioperative studies comprised patients from cardiac surgery, vascular
surgery, and burns. There was significant heterogeneity, but risk of bias
was overall assessed as low. The OR for AKI versus non-AKI patients
developing CKD in all studies was 4.31 (95% CI 3.01-6.17; p < 0.01).
Nonperioperative subjects demonstrated OR 3.32 for developing CKD compared
to non-AKI patients (95% CI 2.06-5.34; p < 0.01) while perioperative
patients demonstrated OR 5.20 (95% CI 3.12-8.66; p < 0.01) for the same
event. <br/>Conclusion(s): We conclude that studies conducted in
perioperative and nonperioperative patient populations suggest similar
risk of development of CKD after AKI.<br/>Copyright &#xa9; 2021, The
Author(s).

<54>
Accession Number
2012297646
Title
Meta-analysis of the Safety and Efficacy of the Sentinel Cerebral
Protection System in Transcatheter Aortic Valve Implantation.
Source
American Journal of Cardiology. 152 (pp 169-170), 2021. Date of
Publication: 01 Aug 2021.
Author
Radwan Y.; Al-abcha A.; Salam M.F.; Khor S.Y.; Prasad R.M.; Elshafie A.;
Abela G.
Institution
(Radwan, Al-abcha, Salam, Khor, Prasad, Elshafie) Department of Internal
Medicine, Michigan State University, East Lansing, MI, United States
(Abela) Department of Cardiology, Michigan State University, East Lansing,
MI, United States
Publisher
Elsevier Inc.

<55>
Accession Number
2013469863
Title
Comparison of Ticagrelor Versus Clopidogrel on Cerebrovascular
Microembolic Events and Platelet Inhibition during Transcatheter Aortic
Valve Implantation.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Vavuranakis M.A.; Kalantzis C.; Voudris V.; Kosmas E.; Kalogeras K.;
Katsianos E.; Oikonomou E.; Siasos G.; Aznaouridis K.; Toutouzas K.;
Stasinopoulou M.; Tountopoulou A.; Bei E.; Moldovan C.M.; Vrachatis D.;
Iakovou I.; Papaioannou T.G.; Tousoulis D.; Leucker T.M.; Vavuranakis M.
Institution
(Vavuranakis, Kalantzis, Kalogeras, Oikonomou, Siasos, Aznaouridis,
Toutouzas, Bei, Moldovan, Papaioannou, Tousoulis, Vavuranakis) Department
of Cardiology, National and Kapodistrian University of Athens,
Hippokration Hospital, Athens, Greece
(Voudris, Kosmas, Iakovou) Onassis Cardiac Surgery Center, Kallithea,
Greece
(Kalogeras, Katsianos, Oikonomou, Siasos, Vavuranakis) Department of
Cardiology, National and Kapodistrian University of Athens, Sotiria
Hospital, Athens, Greece
(Stasinopoulou) Agios Savvas - Anticancer Hospital, Athens, Greece
(Tountopoulou) Aiginiteio University Hospital, Athens, Greece
(Vrachatis) General Hospital of Athens "G. Gennimatas", Athens, Greece
(Vavuranakis, Leucker) Division of Cardiology, Department of Medicine,
Johns Hopkins University School of Medicine, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
The impact of the antiplatelet regimen and the extent of associated
platelet inhibition on cerebrovascular microembolic events during
transcatheter aortic valve implantation (TAVI) are unknown. Our aim was to
evaluate the effects of ticagrelor versus clopidogrel and of platelet
inhibition on the number of cerebrovascular microembolic events in
patients undergoing TAVI. Patients scheduled for TAVI were randomized
previous to the procedure to either aspirin and ticagrelor or to aspirin
and clopidogrel. Platelet inhibition was expressed in P2Y12 reaction units
(PRU) and percentage of inhibition. High intensity transient signals
(HITS) were assessed with transcranial Doppler (TCD). Safety outcomes were
recorded according to the VARC-2 definitions. Among 90 patients
randomized, 6 had an inadequate TCD signal. The total number of procedural
HITS was lower in the ticagrelor group (416.5 [324.8, 484.2]) (42
patients) than in the clopidogrel group (723.5 [471.5, 875.0]) (42
patients), p <0.001. After adjusting for the duration of the procedure,
diabetes, extra-cardiac arteriopathy, BMI, hypertension, aortic valve
calcium content, procedural ACT, and pre-implantation balloon
valvuloplasty, patients on ticagrelor had on average 256.8 (95% CI:
[-335.7, -176.5]) fewer total procedural HITS than patients on
clopidogrel. Platelet inhibition was greater with ticagrelor 26 [10, 74.5]
PRU than with clopidogrel 207.5 (120 to 236.2) PRU, p <0.001, and
correlated significantly with procedural HITS (r = 0.5, p <0.05). In
conclusion, ticagrelor resulted in fewer procedural HITS, compared with
clopidogrel, in patients undergoing TAVI, while achieving greater platelet
inhibition.<br/>Copyright &#xa9; 2021

<56>
Accession Number
2013342741
Title
Comparison between intraoperative bleeding score and ROTEM measurements to
assess coagulopathy during major pediatric surgery.
Source
Transfusion and Apheresis Science. (no pagination), 2021. Article Number:
103191. Date of Publication: 2021.
Author
Restin T.; Schmugge M.; Cushing M.M.; Haas T.
Institution
(Restin) Newborn Research Zurich, Department of Neonatology, University
hospital Zurich, Zurich, Switzerland
(Restin) Institute of Physiology, Zurich Center for Integrative Human
Physiology, University of Zurich, Zurich, Switzerland
(Schmugge) Department of Hematology, Zurich University Children's
Hospital, Zurich, Switzerland
(Schmugge, Haas) Children's Research Center, University Children's
Hospital of Zurich, Zurich, Switzerland
(Cushing) Department of Pathology and Laboratory Medicine, Weill Cornell
Medical College, New York, NY, United States
(Haas) Department of Anesthesia, Zurich University Children's Hospital,
Zurich, Switzerland
Publisher
Elsevier Ltd
Abstract
Purpose: Intraoperative bleeding should be regularly assessed visually to
guide coagulation management. Whereas viscoelastic testing with ROTEM
measurement has been proven to be useful in detecting coagulopathies, the
visual assessment is not standardized. This study therefore aims to
compare a standardized visual assessment with ROTEM results.
<br/>Method(s): A 5-point bleeding score was created and applied in a
recently published randomized controlled trial in major pediatric
non-cardiac surgery. This score assesses overall bleeding tendency and the
occurrence of diffuse bleeding, aqueous bleeding, bleeding outside the
operative field, and the ability to control bleeding. Validity of this
score was tested by post hoc comparison to the results of simultaneously
performed ROTEM measurements. <br/>Result(s): Signs of coagulopathic
bleeding were assessed at 183 time points. Mild to moderate bleeding
intensity was judged at 103 time points, in 42 % abnormal ROTEM traces
were obtained simultaneously. When severe bleeding was scored, abnormal
ROTEM values occurred in 58 %, and FIBTEM-values were significantly lower
than in the "no bleeding group". Altogether, the correlation between
bleeding score and ROTEM measurements was not significant.
<br/>Conclusion(s): The standardized visual assessment did not correlate
well with ROTEM measurements, suggesting that it is not useful to detect
coagulopathy. Trial registry number: ClinicalTrials.gov identifier No.
NCT01487837.<br/>Copyright &#xa9; 2021

<57>
Accession Number
626300338
Title
Prospective, randomized trial of bioresorbable scaffolds vs.
everolimus-eluting stents in patients undergoing coronary stenting for
myocardial infarction: The Intracoronary Scaffold Assessment a Randomized
evaluation of Absorb in Myocardial Infarction (ISAR-Absorb MI) trial.
Source
European Heart Journal. 40 (2) (pp 167-176), 2019. Date of Publication: 07
Jan 2019.
Author
Byrne R.A.; Alfonso F.; Schneider S.; Maeng M.; Wiebe J.; Kretov E.;
Bradaric C.; Rai H.; Cuesta J.; Rivero F.; Hoppmann P.; Schlichtenmaier
J.; Christiansen E.H.; Cassese S.; Joner M.; Schunkert H.; Laugwitz K.-L.;
Kastrati A.
Institution
(Byrne, Wiebe, Rai, Cassese, Joner, Schunkert, Kastrati) Department of
Cardiovascular Diseases, Deutsches Herzzentrum Munchen, Technische
Universitat Munchen, Lazarettstrasse 36, Munich, Germany
(Byrne, Joner, Schunkert, Laugwitz, Kastrati) DZHK (German Centre for
Cardiovascular Research), Partner Site Munich Heart Alliance, Munich,
Germany
(Alfonso, Cuesta, Rivero) Cardiac Department, Hospital Universitario de la
Princesa Madrid, Madrid, Spain
(Schneider, Bradaric, Hoppmann, Schlichtenmaier, Laugwitz) Clinic and
Policlinic Internal Medicine i (Cardiology and Angiology), Klinikum Rechts
der Isar, Technische Universitat Munchen, Munich, Germany
(Maeng, Christiansen) Department of Cardiology, Aarhus University
Hospital, Aarhus, Denmark
(Kretov) E.N. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
Publisher
Oxford University Press
Abstract
Aims Bioresorbable scaffolds (BRS) provide short-Term coronary artery
scaffolding and drug delivery. Although prior trials showed a higher rate
of device failure compared with conventional drug-eluting stents (DES),
only a single trial investigated patients undergoing percutaneous coronary
intervention (PCI) for acute myocardial infarction (MI). We aimed to
compare outcomes with BRS vs. DES in patients undergoing PCI for MI.
Methods and results We did a prospective, randomized, multicentre,
non-inferiority, clinical trial of everolimus-eluting BRS vs. durable
polymer everolimus-eluting stents (EES) in patients with acute MI.
Patients were eligible for enrolment if they presented with ST-elevation
MI, or non-ST-elevation MI with thrombosis visual at angiography and were
randomly allocated to treatment with BRS or EES in 2:1 proportion.
Angiographic follow-up was scheduled at 6-8 months and clinical follow-up
was done at 12 months. The primary endpoint was percentage diameter
stenosis in-segment at follow-up. A total of 262 patients were enrolled
and were allocated to BRS (n = 173) or EES (n = 89). Angiographic
follow-up was available for 213 (81.3%) patients. Mean diameter stenosis
was 24.6 +/- 12.2% with BRS vs. 27.3 +/- 11.7% with EES (mean
difference-2.7%, upper limit of one-sided 97.5% confidence limit 0.7%,
prespecified margin of non-inferiority 5%, Pnon-inferiority <0.001). The
rate of the device-oriented composite of cardiac death/target vessel
MI/target lesion revascularization [BRS: 12 (7.0%) vs. EES: 6 (6.7%),
hazard ratio (HR) 1.04, 95% confidence interval (CI) 0.39-2.78] and
definite/probable stent thrombosis [3 (1.7%) vs. 2 (2.3%), HR 0.76, 95% CI
0.13-4.56] were comparable in both groups. Conclusion In patients
undergoing PCI for acute MI BRS were non-inferior to EES for percentage
diameter stenosis at angiographic follow-up. Rates of clinical events were
comparable between the treatment groups, although the study was not
powered to detect differences in clinical outcomes. Clinical trial
registration The trial was registered at www.clinicaltrials.gov
(NCT01942070).<br/>Copyright &#xa9; The Author(s) 2018.

<58>
Accession Number
627895167
Title
Is systematic lymph node dissection mandatory or is sampling adequate in
patients with stage I non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 550-554),
2019. Date of Publication: 01 Apr 2019.
Author
Mitsos S.; Panagiotopoulos N.; Patrini D.; George R.S.
Institution
(Mitsos, Panagiotopoulos, Patrini, George) Thoracic Surgery Department,
University College London Hospitals, NHS Foundation Trust, London, United
Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Is systematic lymph node
dissection (SLND) mandatory or is sampling adequate in stage I
non-small-cell lung cancer (NSCLC)? Two hundred and eleven papers were
identified, of which 12 papers represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and the results of
these papers are tabulated. There are 7 retrospective cohort reviews, 3
meta-analyses and 2 randomized controlled clinical trials (RCTs) to answer
the clinical question. Four of the 7 retrospective studies demonstrated
that the total number of resected lymph nodes and the number of lymph node
stations sampled affected the accuracy of staging in patients with
early-stage NSCLC and had an impact on overall survival and disease-free
survival. Two RCTs, 1 meta-analysis and 1 cohort study revealed no
significant benefit in overall survival and disease-free survival in
patients undergoing SLND. One meta-analysis, which contained only 1 RCT,
revealed significantly better 3- and 5-year survival with SLND. One
further metaanalysis revealed improved survival with SLND in cohort
studies but no significant difference in the 4 RCTs included. Two further
studies identified specific subgroups of patients in whom LN sampling
could be justified and SLND avoided. We conclude that there is no
significant difference in the recurrence rate when performing either SLND
or LN sampling in patients with stage I NSCLC. While retrospective cohort
studies implied survival benefit with SLND, this was not borne out in RCTs
and meta-analyses. However, there may be a potential survival benefit for
patients who are upstaged by SLND identifying mediastinal nodal
involvement.<br/>Copyright &#xa9; 2018 The Author.

<59>
Accession Number
627895115
Title
Does the 'non-intubated' anaesthetic technique offer any advantage for
patients undergoing pulmonary lobectomy?.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (4) (pp 555-558),
2019. Date of Publication: 01 Apr 2019.
Author
Ali J.M.; Volpi S.; Kaul P.; Aresu G.
Institution
(Ali, Volpi, Kaul, Aresu) Department of Cardiothoracic Surgery, Royal
Papworth Hospital, Cambridge, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiothoracic surgery was written according to a
structured protocol. The question addressed was: Do patients undergoing
pulmonary lobectomy using the non-intubated anaesthetic technique have
superior clinical outcomes? Altogether, 324 papers were found using the
reported search, of which 5 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. The nonintubated anaesthetic technique can be safely
used in patients undergoing video-assisted thoracic surgery lobectomy. Low
conversion rates to intubation are reported, and conversion has been
safely managed with no associated morbidity or mortality reported. The
technique has not been shown to impact on the incidence of postoperative
complications. However, studies consistently demonstrate improved
postoperative outcomes in terms of recovery from anaesthesia permitting
earlier oral intake and mobilization which is associated with a reduced
length of hospital stay.<br/>Copyright &#xa9; The Author(s) 2018.

<60>
Accession Number
627837035
Title
Myectomy with mitral valve repair versus replacement in adult patients
with hypertrophic obstructive cardiomyopathy: a systematic review and
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 28 (3) (pp 465-472),
2019. Date of Publication: 01 Mar 2019.
Author
Afanasyev A.; Bogachev-Prokophiev A.; Lenko E.; Sharifulin R.; Ovcharov
M.; Kozmin D.; Karaskov A.
Institution
(Afanasyev, Bogachev-Prokophiev, Lenko, Sharifulin, Ovcharov, Karaskov)
National Medical Research Center, Rechkunovsky St. 15, Novosibirsk 630055,
Russian Federation
(Kozmin) Cardiac surgery department, Federal Center for Cardiovascular
Surgery, Astrakhan, Russian Federation
Publisher
Oxford University Press
Abstract
We evaluated the differences in mitral valve (MV) plasty (MVP) and MV
replacement (MVR) with respect to death, postoperative MV dysfunction,
reoperation rates and thromboembolic events (DFRE) in patients with
hypertrophic obstructive cardiomyopathy and systolic anterior motion of
the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We
followed the Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines, searching PubMed, Cochrane library and
ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM &
MR after MVP/MVR. We used a risk of bias assessment tool for
non-randomized studies, and analyses were performed using Cochrane Review
Manager 5.3.5 for I² statistics, funnel plots and forest plot
and the generic inverse variance method for hazard ratios (HRs). We
developed qualitative and quantitative syntheses of 35 and 23 studies,
respectively, including levels of evidence of 1=2/3/4/5 = 3/1/11/11/9 and
1=2/3/4/5 = 0/1/11/11/0, respectively, from January 1980 to August 2017. A
statistically significant difference between MVP and MVR favoured MVP for
the prevention of DFRE in patients with HOCM & MR, on the basis of a
significant reduction of the HR for DFRE: HR = 0.68 (0.57, 0.82),
I² = 68% (P = 0.002). The findings were as follows: (i) MVP
should be the first-line treatment in patients with HOCM & MR (accuracy
LEVEL A) and (ii) MVR may be harmful if it is used as the first-line
treatment (accuracy LEVEL A).<br/>Copyright &#xa9; The Author(s) 2018.

<61>
Accession Number
629252216
Title
Remote ischaemic preconditioning in isolated aortic valve and coronary
artery bypass surgery: A randomized trial.
Source
European Journal of Cardio-thoracic Surgery. 55 (5) (pp 905-912), 2019.
Date of Publication: 01 May 2019.
Author
Moscarelli M.; Fiorentino F.; Suleiman M.-S.; Emanueli C.; Reeves B.C.;
Punjabi P.P.; Angelini G.D.
Institution
(Moscarelli, Suleiman, Reeves, Angelini) Faculty of Health Sciences,
Bristol Heart Institute, Bristol Medical School, University of Bristol,
Level 7, Bristol Royal Infirmary, Marlborough St, Bristol BS28HW, United
Kingdom
(Fiorentino, Emanueli, Punjabi) Imperial College, National Heart and Lung
Institute, London, United Kingdom
(Moscarelli) GVM Care and Research, Anthea Hospital, Bari, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: This trial was designed and patients were recruited at a time
when the benefits of remote ischaemic preconditioning during open-heart
surgery were still controversial. We focused on a homogeneous patient
population undergoing either isolated aortic valve replacement or coronary
artery bypass grafting (CABG) surgery by investigating cardiac injury,
metabolic stress and inflammatory response. <br/>METHOD(S): A 2-centre
randomized controlled trial recruited a total of 124 patients between
February 2013 and April 2015. Of them, 64 patients underwent CABG and 60
patients underwent aortic valve replacement. Patients were randomized to
either sham or preconditioning. Remote ischaemic preconditioning was
applied following anaesthesia and before sternotomy. Myocardial injury and
inflammatory response were assessed by serially measuring cardiac troponin
I, and interleukin-6, 8, 10 and the tumour necrosis factor (TNF-alpha).
Biopsies from the left and the right ventricles were harvested after
ischaemic reperfusion injury for nucleotides analysis. <br/>RESULT(S):
Application of remote ischaemic preconditioning did not alter the degree
of troponin I release, levels of inflammatory markers and cardiac
energetics in both the CABG and the aortic valve replacement groups.
<br/>CONCLUSION(S): Preconditioning did not confer any additional
cardioprotection in terms of reducing the levels of troponin I and
inflammatory markers and preserving left and right ventricle energy
metabolites in patients undergoing isolated CABG or aortic valve surgery.
Clinical trial registration number: International Standard Randomized
Controlled Trial Number (ISRCTN) registry ID 33084113 (doi:
10.1186/ISRCTN33084113) and UK controlled randomized trial number (UKCRN)
registry ID 13672.<br/>Copyright &#xa9; 2018 The Author(s). Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<62>
Accession Number
625233900
Title
How to treat severe symptomatic structural valve deterioration of aortic
surgical bioprosthesis: Transcatheter valve-in-valve implantation or redo
valve surgery?.
Source
European Journal of Cardio-thoracic Surgery. 54 (6) (pp 1-9), 2018. Date
of Publication: 01 Dec 2018.
Author
Attias D.; Nejjari M.; Nappi F.; Dreyfus J.; Eleid M.F.; Rihal C.S.
Institution
(Attias, Nejjari, Dreyfus) Department of Cardiology, Centre Cardiologique
du Nord, 32-36 rue des Moulins Gemeaux, Saint Denis 93200, France
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint
Denis, France
(Eleid, Rihal) Department of Cardiovascular Diseases and Cardiovascular
Surgery, Mayo Clinic, Rochester, MN, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The optimal management of aortic surgical bioprosthesis presenting with
severe symptomatic structural valve deterioration is currently a matter of
debate. Over the past 20 years, the number of implanted bioprostheses
worldwide has been rapidly increasing at the expense of mechanical
prostheses. A large proportion of patients, however, will require
intervention for bioprosthesis structural valve deterioration. Current
options for older patients who often have severe comorbidities include
either transcatheter valve-in-valve (TVIV) implantation or redo valve
surgery. The emergence of TVIV implantation, which is perceived to be less
invasive than redo valve surgery, offers an effective alternative to
surgery for these patients with proven safety and efficacy in high-risk
patient groups including elderly and frail patients. A potential caveat to
this strategy is that results of long-term follow-up after TVIV
implantation are limited. Redo surgery is sometimes preferable, especially
for young patients with a smaller-sized aortic bioprosthesis. With the
emergence of TVIV implantation and the long experience of redo valve
surgery, we currently have 2 complementary treatment modalities, allowing
a tailor-made and patient-orientated intervention. In the heart team, the
decision-making should be based on several factors including type of
bioprosthesis failure, age, comorbidities, operative risk, anatomical
factors, anticipated risks and benefits of each alternative, patient's
choice and local experience. The aim of this review is to provide a
framework for individualized optimal treatment strategies in patients with
failed aortic surgical bioprosthesis.<br/>Copyright &#xa9; The Author(s)
2018.

<63>
Accession Number
624440895
Title
Non-invasive screening for coronary artery disease in asymptomatic
diabetic patients: A systematic review and meta-analysis of randomised
controlled trials.
Source
European Heart Journal Cardiovascular Imaging. 19 (8) (pp 838-846), 2018.
Date of Publication: 01 Aug 2018.
Author
Clerc O.F.; Fuchs T.A.; Stehli J.; Benz D.C.; Grani C.; Messerli M.;
Giannopoulos A.A.; Buechel R.R.; Luscher T.F.; Pazhenkottil A.P.; Kaufmann
P.A.; Gaemperli O.
Institution
(Clerc, Fuchs, Stehli, Benz, Grani, Messerli, Giannopoulos, Buechel,
Luscher, Pazhenkottil, Kaufmann, Gaemperli) University Heart Centre,
University Hospital Zurich, Raemistrasse 100, Zurich CH-8091, Switzerland
Publisher
Oxford University Press
Abstract
It is unclear whether non-invasive screening of asymptomatic diabetic
patients for coronary artery disease (CAD) may improve cardiac outcomes.
Thus, we performed a systematic literature review and meta-analysis of
randomised controlled trials (RCT's) on this topic. We searched
appropriate RCT's in five online databases (PubMed/MEDLINE, Cochrane
Library, Embase, Scopus, and Web of Science) from January 2000 to November
2017 and in 41 recent reviews. Two investigators independently extracted
and assessed study data using standardised forms. Additional unpublished
data were obtained from trial authors. The primary endpoint 'any cardiac
event' was a composite of cardiac death, non-fatal myocardial infarction
(MI), unstable angina (UA), or heart failure (HF) hospitalisation. We
performed a meta-analysis of relative risks (RRs) with 95% confidence
intervals (CI) using the Mantel-Haenszel method. We included five RCT's
with 3299 patients, of which 189 (5.7%) experienced any cardiac event on
follow-up (weighted mean 4.1 years). Non-invasive CAD screening
significantly reduced any cardiac event by 27% [RR 0.73 (95% CI
0.55-0.97), P = 0.028, number needed to screen 56]. This result was driven
by important, albeit non-significant decreases in non-fatal MI [RR 0.65
(95% CI 0.41-1.02), P = 0.062] and HF hospitalisation [RR 0.61 (95% CI
0.33-1.10), P = 0.100]. Non-invasive CAD screening did not significantly
affect cardiac death [RR 0.92 (95% CI 0.53-1.60), P = 0.77] and UA [RR
0.73 (95% CI 0.41-1.31), P = 0.29]. Compared with the standard care,
non-invasive CAD screening reduced cardiac events by 27% in asymptomatic
diabetic patients, largely through reductions in non-fatal MIs, and HF
hospitalisations. The present results justify larger, appropriately
powered trials to potentially revisit current
recommendations.<br/>Copyright Published on behalf of the European Society
of Cardiology. All rights reserved. VC The Author(s) 2018.

<64>
Accession Number
624430159
Title
Enhanced recovery after surgery pathway for patients undergoing cardiac
surgery: A randomized clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 54 (3) (pp 491-497), 2018.
Date of Publication: 01 Sep 2018.
Author
Li M.; Zhang J.; Gan T.J.; Qin G.; Wang L.; Zhu M.; Zhang Z.; Pan Y.; Ye
Z.; Zhang F.; Chen X.; Lin G.; Huang L.; Luo W.; Guo Q.; Wang E.
Institution
(Li, Zhang, Qin, Wang, Zhu, Zhang, Pan, Ye, Zhang, Guo, Wang) Department
of Anaesthesiology, Xiangya Hospital, Central South University, Changsha,
Hunan 410008, China
(Gan) Department of Anesthesiology, Stony Brook University, Stony Brook,
NY, United States
(Chen, Lin, Huang, Luo) Department of Cardiovascular Surgery, Xiangya
Hospital, Central South University, Changsha, Hunan, China
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Enhanced recovery after surgery (ERAS) pathways have not been
reported in cardiac surgery. The aim of this study was to evaluate the
clinical effectiveness and safety profile of ERAS pathways compared with
routine care for patients undergoing cardiac valvular surgery.
<br/>METHOD(S): A randomized clinical trial was conducted between July
2015 and November 2016. A total of 226 patients who underwent elective
valvular surgery were randomly assigned to the ERAS pathway or routine
care (control) group. The ERAS protocol consisted of an evidence-based
systematic optimization approach for managing perioperative patients. The
control group received routine care. The primary end-point was readiness
for hospital discharge. The secondary outcomes were duration of intensive
care unit (ICU) stay, length of postoperative vasoactive drug support,
duration of mechanical ventilation, time to first bowel movement, removal
of surgical drain, overall medical costs and complication rate.
<br/>RESULT(S): Postoperative time to readiness for discharge was
significantly shorter in the ERAS group (6.0 (2.014.0) days) than the
control group (7.0 (4.016.0) days, P = 0.01), and the duration of ICU stay
and duration of mechanical ventilation were significantly shorter in the
ERAS group (20.9 (13.569.3) h, 7.2 (0.022.3) h, respectively) than the
control group (22.0 (13.4212.3) h, P = 0.001; 8.8 (3.744.9) h,
respectively; P < 0.0001). The overall treatment cost of the ERAS group
(69202 (52089123823) CNY) was significantly lower than that of the control
group (77058 (51390144290) CNY, P = 0.002). <br/>CONCLUSION(S): ERAS
pathways reduce the length of ICU and hospital stay, postoperative
complications and cost for patients undergoing cardiac surgery. Clinical
trial registration: ClinicalTrials.gov: NCT02479581.<br/>Copyright &#xa9;
2018 The Author(s).

<65>
Accession Number
624399324
Title
Does oesophageal stenosis have any impact on survival of oesophageal
cancer patients?.
Source
Interactive Cardiovascular and Thoracic Surgery. 27 (3) (pp 384-386),
2018. Date of Publication: 01 Sep 2018.
Author
Deng H.-Y.; Li G.; Luo J.
Institution
(Deng) Lung Cancer Center, West China Hospital, Sichuan University, No. 37
Guoxue Alley, Chengdu, Sichuan 610041, China
(Deng, Li, Luo) Department of Thoracic Surgery, West China Hospital,
Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does oesophageal stenosis
have any impact on survival of oesophageal cancer patients?'. A total of
542 papers were found using the reported search, of which 8 cohort studies
represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers are tabulated.
Most of these studies defined stenosis as failure to cross the tumour at
endoscopic ultrasonography. Seven studies demonstrated that oesophageal
cancer patients with stenosis had significantly poorer survival than those
without, while 2 studies found that oesophageal stenosis was also a
predictor of poor recurrence-free survival. We conclude that oesophageal
stenosis is a predictor of poor prognosis in patients with oesophageal
cancer.<br/>Copyright &#xa9; 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<66>
Accession Number
619305019
Title
Postoperative bleeding in coronary artery bypass patients on double
antiplatelet therapy: Predictive value of preoperative aggregometry.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 901-908), 2017.
Date of Publication: 01 Nov 2017.
Author
Della Corte A.; Bancone C.; Spadafora A.; Borrelli M.; Galdieri N.;
Quintiliano S.N.; Bifulco O.; de Feo M.
Institution
(Della Corte, Bancone, Spadafora, Borrelli, Galdieri, Quintiliano,
Bifulco, de Feo) Department of Cardiothoracic Sciences, Second University
of Naples, Unit of Cardiac Surgery of the Monaldi Hospital, Naples, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: We tested the possible value of routine aggregometry testing
for bleeding prediction following coronary artery bypass grafting in
patients who received preoperative double antiplatelet therapy.
<br/>METHOD(S): In 226 patients undergoing on-pump isolated coronary
artery bypass grafting, aggregometry [adenosine diphosphate (ADP) test and
ASPI test] was always prospectively performed by Multiplate analyser
immediately before surgery. We assessed the differences in postoperative
bleeding according to the type of double antiplatelet therapy
[acetylsalicylic acid plus clopidogrel (ASA+C), or plus ticagrelor
(ASA+T)], duration of clopidogrel/ticagrelor withdrawal (0-3 days or >= 4
days) and results of aggregometry tests. Multivariable predictors of blood
losses were sought by linear regressions (drainage amount at 6, 12 and 24
postoperative hours) and logistic regression (increased bleeding: 75th
percentile of blood losses at 6 h, i.e. >450 ml). <br/>RESULT(S): Overall,
postoperative blood losses did not significantly differ between treatment
groups (median at 6 h: ASA + C = 335 ml, ASA + T = 300 ml, P = 0.21). With
longer withdrawal interval, higher rates of patients with normal
ADP-related platelet function were observed in both groups (ASA + C: P =
0.04; ASA + T: P = 0.006) but only in the ASA + T group were blood losses
significantly smaller at all 3 time points. Bleeders (>450 ml at 6 h) were
significantly less frequent among patients with ADP test showing recovered
platelet function (ASA + T: P = 0.002; ASA + C: P = 0.053). The
correlation between ADP test result and blood losses amount was stronger
in the ASA + T group (e.g. at 6 h: r = -0.6; P < 0.001). In multivariable
analyses, the ADP test result independently predicted postoperative
bleeding in the ASA + T group and the ASPI test in the ASA + C group.
<br/>CONCLUSION(S): Aggregometry can help in predicting postoperative
bleeding in double antiplatelet therapy patients undergoing coronary
artery bypass grafting.<br/>Copyright &#xa9; The Author 2017. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<67>
Accession Number
619305011
Title
The German aortic valve score II.
Source
European Journal of Cardio-thoracic Surgery. 52 (5) (pp 881-887), 2017.
Date of Publication: 01 Nov 2017.
Author
Schiller W.; Barnewold L.; Kazmaier T.; Beckmann A.; Masseli F.; Welz A.;
Szecsenyi J.; Heller G.
Institution
(Schiller, Masseli, Welz) Department of Cardiac Surgery, University of
Bonn, Bonn, Germany
(Barnewold, Kazmaier, Szecsenyi) AQUA-Institut fur angewandte
Qualitatsforderung, Forschung im Gesundheitswesen GmbH, Gottingen, Germany
(Beckmann) Department of Cardiac and Vascular Surgery, Heart Center
Duisburg, Duisburg, Germany
(Heller) IQTIG-Institut fur Qualitatssicherung, Transparenz im
Gesundheitswesen, Berlin, Germany
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The German Aortic Valve Score (GAVS) was developed for
national quality assurance regarding the in-hospital mortality rate of
patients following isolated aortic valve replacement. The goal of this
work was the recalibration of the GAVS in the context of increased numbers
of transcatheter aortic valve implantations. <br/>METHOD(S): In 2011 and
2012, 36 183 cases were documented who had either surgical aortic valve
replacement or transcatheter aortic valve implantation (45%). All cases
were randomly assigned to the study or to the validation group. All items
of the data set were checked for significance by developing a
multiregression risk model using iterative backward elimination.
Calibration was ascertained using the Hosmer-Lemeshow method. To define
the quality of discrimination, the area under the receiver operating
characteristic curve (C-statistic) was calculated. <br/>RESULT(S): The
randomized study cohort comprised 18 054 patients. After modelling with
multiple regression algorithms, 18 of the initial 28 risk factors entered
the risk model. When applied to the validation group, the newly developed
GAVS II showed good calibration with a P-value of 0.411 in the
Hosmer-Lemeshow test and good discrimination with a C-statistic of 0.741.
<br/>CONCLUSION(S): The GAVS II is a new risk model that is applicable to
cohorts having surgical aortic valve replacement or transcatheter aortic
valve implantation procedures.<br/>Copyright &#xa9; The Author 2017.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<68>
Accession Number
614959240
Title
Culotte stenting vs. TAP stenting for treatment of de-novo coronary
bifurcation lesions with the need for side-branch stenting: The
Bifurcations Bad Krozingen (BBK) II angiographic trial.
Source
European Heart Journal. 37 (45) (pp 3399-3405), 2016. Date of Publication:
01 Dec 2016.
Author
Ferenc M.; Gick M.; Comberg T.; Rothe J.; Valina C.; Toma A.; Loffelhardt
N.; Hochholzer W.; Riede F.; Kienzle R.-P.; Achtari A.; Neumann F.-J.
Institution
(Ferenc, Gick, Comberg, Rothe, Valina, Toma, Loffelhardt, Hochholzer,
Riede, Kienzle, Achtari, Neumann) Division of Cardiology and Angiology II,
University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Publisher
Oxford University Press
Abstract
Aims In percutaneous coronary intervention for de-novo coronary
bifurcation lesions, the optimal technique for provisional side-branch
stenting is still a matter of debate. We tested whether in this setting
culotte stenting reduces the incidence of restenosis as compared with
T-and-protrusion (TAP) stenting. Methods and Results This trial included
300 patients with a coronary bifurcation lesion requiring a side-branch
stent. Patients were randomly assigned to culotte stenting or TAP stenting
using drug-eluting stents in a 1:1 fashion. Primary endpoint was maximal
per cent diameter stenosis of the bifurcation lesion at 9-month
angiographic follow-up. As clinical endpoints we assessed target lesion
re-intervention (TLR) and target lesion failure (composite of cardiac
death, target vessel myocardial infarction, and TLR). Angiographic
follow-up was available in 91% of the patients. After culotte stenting,
the maximum per cent diameter stenosis in the treated bifurcation lesion
was 21620% as compared with 27625% after TAP stenting (P=0.038). The
respective corresponding binary restenosis rates were 6.5 and 17%
(P=0.006). The 1-year incidence of TLR was 6.0% after culotte stenting vs.
12.0% after T-stenting (P=0.069). Target lesion failure occurred in 6.7%
of the culotte group and in 12.0% of the TAP group (P=0.11). Only one
patient of the culotte group incurred a definite stent thrombosis during
1-year follow-up. Conclusions Compared with the TAP stenting, culotte
stenting was associated with a significantly lower incidence of
angiographic restenosis.<br/>Copyright &#xa9; 2016 The Author All rights
reserved.

<69>
Accession Number
614959238
Title
Ten-year clinical outcomes of first-generation drug-eluting stents: The
Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary
Revascularization (SIRTAX) VERY LATE trial.
Source
European Heart Journal. 37 (45) (pp 3386-3395), 2016. Date of Publication:
01 Dec 2016.
Author
Yamaji K.; Raber L.; Zanchin T.; Spitzer E.; Zanchin C.; Pilgrim T.;
Stortecky S.; Moschovitis A.; Billinger M.; Schonenberger C.; Eberli F.;
Juni P.; Luscher T.F.; Heg D.; Windecker S.
Institution
(Yamaji, Raber, Zanchin, Spitzer, Zanchin, Pilgrim, Stortecky,
Moschovitis, Billinger, Schonenberger, Windecker) Department of
Cardiology, Bern University Hospital, Bern 3010, Switzerland
(Eberli) Department of Cardiology, Triemlispital, Zurich, Switzerland
(Juni) Applied Health Research Centre (AHRC), Department of Medicine and
Institute of Health Policy, Management and Evaluation, University of
Toronto, Toronto, ON, Canada
(Luscher) Department of Cardiology, University Hospital Zurich, Zurich,
Switzerland
(Heg) Institute of Social and Preventive Medicine and Clinical Trials
Unit, University of Bern, Bern, Switzerland
Publisher
Oxford University Press
Abstract
Aims Compared with bare metal stents, first-generation drug-eluting stents
(DES) are associated with an increased risk of late restenosis and stent
thrombosis (ST). Whether this risk continues or attenuates during
long-term follow-up remains unknown. Methods and results We extended the
follow-up of 1012 patients [sirolimus-eluting stent (SES): N=503 and
paclitaxel-eluting stent (PES): N=509] included in the all-comers,
randomized Sirolimus-Eluting vs. Paclitaxel-Eluting Stents for Coronary
Revascularization (SIRTAX) trial to 10 years. Follow-up was complete in
895 patients (88.4%) at 10 years. At 1, 5, and 10 years of follow-up,
rates of ischaemia-driven target lesion revascularization (ID-TLR) were
8.1%, 14.6% and 17.7%, respectively, and rates of ST were 1.9%, 4.5% and
5.6%, respectively. The annual risks of ID-TLR and definite ST were
significantly higher between 1 and 5 years as compared with the 5- to
10-year period [ID-TLR: 1.8% vs. 0.7%/year, hazard ratio (HR) 0.36, 95%
confidence intervals (95% CI) 0.21-0.62, P<0.001; definite ST: 0.67% vs.
0.23%/year, HR 0.31, 95% CI 0.13-0.75, P=0.01]. The attenuation of the
risk of ID-TLR and ST beyond 5 years was independent of age. Major adverse
events (cardiac death, myocardial infarction, and ID-TLR) occurred in
33.7% of SES- and 33.8% of PES-treated patients (P=0.72). Conclusions
During long-term follow-up through 10 years, the annual risks of ID-TLR
and definite ST significantly decreased beyond 5 years after
first-generation DES implantation. These findings may have important
implications for secondary prevention after percutaneous coronary
intervention with first-generation DES including long-term antiplatelet
therapy.<br/>Copyright &#xa9; 2016 The Author All rights reserved.

<70>
Accession Number
614942113
Title
Impact of high-sensitivity cardiac troponin on use of coronary
angiography, cardiac stress testing, and time to discharge in suspected
acute myocardial infarction.
Source
European Heart Journal. 37 (44) (pp 3324-3332a), 2016. Date of
Publication: 21 Nov 2016.
Author
Twerenbold R.; Jaeger C.; Gimenez M.R.; Wildi K.; Reichlin T.;
Nestelberger T.; Boeddinghaus J.; Grimm K.; Puelacher C.; Moehring B.;
Pretre G.; Schaerli N.; Campodarve I.; Rentsch K.; Steuer S.; Osswald S.;
Mueller C.
Institution
(Twerenbold, Jaeger, Gimenez, Wildi, Reichlin, Nestelberger, Boeddinghaus,
Grimm, Puelacher, Moehring, Pretre, Schaerli, Osswald, Mueller) Department
of Cardiology, University Hospital Basel, Petersgraben 4, Basel CH-4031,
Switzerland
(Twerenbold, Jaeger, Gimenez, Wildi, Reichlin, Nestelberger, Boeddinghaus,
Grimm, Puelacher, Moehring, Pretre, Schaerli, Osswald, Mueller)
Cardiovascular Research Institute Basel (CRIB), University Hospital Basel,
Basel, Switzerland
(Campodarve) Servicio de Urgencias y Medicina Interna, Hospital Del Mar,
Barcelona, Spain
(Rentsch) Laboratory Medicine, University Hospital Basel, Basel,
Switzerland
(Steuer) Emergency Department, Kantonsspital Luzern, Luzern, Switzerland
Publisher
Oxford University Press
Abstract
Aims: High-sensitivity cardiac troponin (hs-cTn) assays provide higher
diagnostic accuracy for acute myocardial infarction (AMI) when compared
with conventional assays, but may result in increased use of unnecessary
coronary angiographies due to their increased detection of cardiomyocyte
injury in conditions other than AMI. <br/>Methods and Results: We
evaluated the impact of the clinical introduction of high-sensitivity
cardiac troponin T (hs-cTnT) on the use of coronary angiography, stress
testing, and time to discharge in 2544 patients presenting with symptoms
suggestive of AMI to the emergency department (ED) within a multicentre
study either before (1455 patients) or after (1089 patients) hscTnT
introduction. Acute myocardial infarction was more often the clinical
discharge diagnosis after hs-cTnT introduction (10 vs. 14%, P < 0.001),
while unstable angina less often the clinical discharge diagnosis (14 vs.
9%, P = 0.007). The rate of coronary angiography was similar before and
after the introduction of hs-cTnT (23 vs. 23%, P = 0.092), as was the
percentage of coronary angiographies showing no stenosis (11 vs. 7%, P =
0.361). In contrast, the use of stress testing was substantially reduced
from 29 to 19% (P < 0.001). In outpatients, median time to discharge from
the ED decreased by 79 min (P < 0.001). Mean total costs decreased by 20%
in outpatients after the introduction of hs-cTnT (P = 0.002).
<br/>Conclusion(s): The clinical introduction of hs-cTn does not lead to
an increased or inappropriate use of coronary angiography. Introduction of
hs-cTn is associated with an improved rule-out process and thereby reduces
the need for stress testing and time to discharge.<br/>Copyright &#xa9;
The Author 2016.

<71>
Accession Number
608566129
Title
Management strategies in patients affected by chronic total occlusions:
Results from the Italian Registry of Chronic Total Occlusions.
Source
European Heart Journal. 36 (45) (pp 3189-3198a), 2015. Date of
Publication: 01 Dec 2015.
Author
Tomasello S.D.; Boukhris M.; Giubilato S.; Marza F.; Garbo R.;
Contegiacomo G.; Marzocchi A.; Niccoli G.; Gagnor A.; Varbella F.;
Desideri A.; Rubartelli P.; Cioppa A.; Baralis G.; Galassi A.R.
Institution
(Tomasello, Boukhris, Giubilato, Marza, Galassi) Ospedale Cannizz Aro,
Universita di Catania, Via Antonello da Messina 75, Acicastello, Catania
95021, Italy
(Garbo) Ospedale G. Bosco, Torino, Italy
(Contegiacomo) Casa di Cura S. Maria, Bari, Italy
(Marzocchi) Policlinico S. Orsola Malpigli, Bologna, Italy
(Niccoli) Ospedale Policlinico Gemelli, Roma, Italy
(Gagnor, Varbella) Ospedale Degli Infermi, Rivoli, Italy
(Desideri) Ospedale S. Giacomo, Castelfranco, Veneto Genova, Italy
(Rubartelli) Ospedale Villa Scassi, Genova, Italy
(Cioppa) Casa di Cura Montevergine, Mercogliano, Italy
(Baralis) Ospedale S. Croce e Carle, Cuneo, Italy
(Boukhris) Faculty of Medicine of Tunis, University Tunis El Manar,
Tunisia
Publisher
Oxford University Press
Abstract
Background Through contemporary literature, the optimal strategy to manage
coronary chronic total occlusions (CTOs) remains under debate. Objectives
The aim of the Italian Registry of Chronic Total Occlusions (IRCTO) was to
provide data on prevalence, characteristics, and outcome of CTO patients
according to the management strategy. Methods The IRCTO is a prospective
real world multicentre registry enrolling patients showing at least one
CTO. Clinical and angiographic data were collected independently from the
therapeutic strategy [optimal medical therapy (MT), percutaneous coronary
intervention (PCI), or coronary artery bypass grafting (CABG)]; a
comparative 1-year clinical followup was performed. Results A total of
1777 patients were enrolled for an overall CTO prevalence of 13.3%. The
adopted therapeutic strategies were as follows: MT in 826 patients
(46.5%), PCI in 776 patients (43.7%), and CABG in the remaining 175
patients (9.8%). At 1-year follow-up, patients undergoing PCI showed lower
rate of major adverse cardiac and cerebrovascular events (MACCE) (2.6% vs.
8.2% and vs. 6.9%; P < 0.001 and P < 0.01) and cardiac death (1.4% vs.
4.7% and vs. 6.3%; P < 0.001 and P < 0.001) in comparison with those
treated with MT and CABG, respectively. After propensity scorematching
analysis, patients treated with PCI showed lower incidence of cardiac
death (1.5 vs. 4.4%; P < 0.001), acute myocardial infarction (1.1 vs.
2.9%; P = 0.03), and re-hospitalization (2.3 vs. 4.4% P = 0.04) in
comparison with those managed by MT. Conclusions Our data showed how CTO
PCI might significantly improve the survival and decrease MACCE occurrence
at 1 year follow-up in comparison with MT and/or CABG.<br/>Copyright
&#xa9; 2015 The Author.

<72>
Accession Number
608566081
Title
Deferral vs. performance of percutaneous coronary intervention of
functionally non-significant coronary stenosis: 15-year follow-up of the
DEFER trial.
Source
European Heart Journal. 36 (45) (pp 3182-3188), 2015. Date of Publication:
01 Dec 2015.
Author
Zimmermann F.M.; Ferrara A.; Johnson N.P.; Van Nunen L.X.; Escaned J.;
Albertsson P.; Erbel R.; Legrand V.; Gwon H.-C.; Remkes W.S.; Stella P.R.;
Van Schaardenburgh P.; Jan Willem Bech G.; De Bruyne B.; Pijls N.H.J.
Institution
(Zimmermann, Van Nunen, Pijls) Department of Cardiology, Catharina
Hospital Eindhoven, Michelangelolaan 2, Eindhoven 5623 EJ, Netherlands
(Ferrara, De Bruyne) Cardiovascular Center, Aalst, Belgium
(Johnson) Weatherhead PET Center for Preventing and Reversing
Atherosclerosis, Division of Cardiology, Department of Medicine,
University of Texas Medical, School and Memorial Hermann Hospital,
Houston, TX, United States
(Van Nunen, Pijls) Department of Biomedical Engineering, Eindhoven
University of Technology, Eindhoven, Netherlands
(Escaned) Hospital Clinico San Carlos, Faculty of Medicine, Complutense
University of Madrid, Centro Nacional de Investigaciones Cardiovasculares
Carlos III (CNIC), Madrid, Spain
(Albertsson) Department of Cardiology, Sahlgrenska University Hospital
Gothenburg, Sweden
(Erbel) Department of Cardiology, West-German Heart and Vascular Centre,
University Hospital of Essen, Essen, Germany
(Legrand) Department of Cardiology, University Hospital of Liege, Liege,
Belgium
(Gwon) Division of Cardiology, Cardiac and Vascular Center, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Remkes) Department of Cardiology, Isala Klinieken, Zwolle, Netherlands
(Stella) Department of Interventional Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
(Van Schaardenburgh) Department of Cardiology, VieCuri, Venlo, Netherlands
(Jan Willem Bech) Department of Cardiology, HagaZiekenhuis, The Hague,
Netherlands
(Jan Willem Bech) Reinier de Graaf Groep, Delft, Netherlands
Publisher
Oxford University Press
Abstract
Aims Stenting an angiographically intermediate but functionally
non-significant stenosis is controversial. Nevertheless, it has been
questioned if deferral of a functionally non-significant lesion on the
basis of fractional flow reserve (FFR) measurement, is safe, especially on
the long term. Five-year follow-up of the DEFER trial showed that outcome
after deferral of percutaneous coronary intervention (PCI) of an
intermediate coronary stenosis based on FFR = 0.75 is excellent and was
not improved by stenting. The aim of this study was to investigate the
validity of this position on the very long term. Met hods and resul ts In
325 patients scheduled for PCI of an intermediate stenosis, FFR was
measured just before the planned intervention. If FFR was = 0.75, patients
were randomly assigned to deferral (Defer group; n = 91) or performance
(Perform group; n = 90) of PCI. If FFR was, 0.75, PCI was performed as
planned (Reference group; n = 144). Clinical follow-up was 15 years. There
were no differences in baseline clinical characteristics between the
randomized groups. Complete 15-year follow-up was obtained in 92% of
patients. After 15 years of follow-up, the rate of death was not different
between the three groups: 33.0% in the Defer group, 31.1% in the Perform
group, and 36.1% in the Reference group (Defer vs. Perform, RR 1.06, 95%
CI: 0.69 1.62, P = 0.79). The rate of myocardial infarction was
significantly lower in the Defer group (2.2%) compared with the Perform
group (10.0%), RR 0.22, 95% CI: 0.05 0.99, P = 0.03. Conclusion Deferral
of PCI of a functionally non-significant stenosis is associated with a
favourable very long-term follow-up without signs of late 'catch-up'
phenomenon.<br/>Copyright &#xa9; 2015 The Author.

<73>
Accession Number
606305847
Title
Outcomes of mitral valve repair compared with replacement in patients
undergoing concomitant aortic valve surgery: A meta-analysis of
observational studies.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 347-353), 2015.
Date of Publication: 01 Sep 2015.
Author
Saurav A.; Alla V.M.; Kaushik M.; Hunter C.C.; Mooss A.V.
Institution
(Saurav, Alla, Kaushik, Hunter, Mooss) Division of Cardiology, Creighton
University Medical Center, Omaha, NE, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Long-term superiority of mitral valve (MV) repair compared with
replacement is well established in degenerative MV disease. In rheumatic
heart disease, its advantages are unclear and it is often performed in
conjunction with aortic valve (AV) replacement. Herein, we performed a
systematic review and meta-analysis comparing outcomes of MV repair vs
replacement in patients undergoing concomitant AV replacement. PubMed,
Cochrane and Web of Science databases were searched up to 25 January 2014
for English language studies comparing outcomes of MV repair vs
replacement in patients undergoing simultaneous AV replacement. Data of
selected studies were extracted. Study quality, publication bias and
heterogeneity were assessed. Analysis was performed using a random effects
model (meta-analysis of observational studies in epidemiology
recommendation). A total of 1202 abstracts/titles were screened. Of these,
20 were selected for full text review and 8 studies (3924 patients) were
included in the final analysis: 1255 underwent MV repair and 2669
underwent replacement. Late outcome data were available in seven studies
(cumulative follow-up: 15 654 patient-years). The early (in hospital and
up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95%
confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days
post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were
significantly lower in the MV repair group compared with the MV
replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P
= 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI:
0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI:
0.49-1.57, P = 0.659) were found to be comparable between the two groups.
In a separate analysis of studies with exclusively rheumatic patients (n =
1106), the early as well as late mortality benefit of MV repair was lost
(RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P
= 0.199, respectively), whereas the MV reoperation rate became
significantly higher (RR: 5.10, 95% CI: 1.62- 16.05, P = 0.005) with MV
repair. In patients undergoing concomitant mitral and AV surgery, MV
repair is associated with improved early and late survival without any
increased risk for mitral valve reoperation. However, in patients with
rheumatic heart disease MV repair does not impart any survival advantage
while the risk forMV reoperation remains significantly
higher.<br/>Copyright &#xa9; The Author 2015. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<74>
Accession Number
606122978
Title
A comparison of cardiac computerized tomography and exercise stress
electrocardiogramtest for the investigation of stable chest pain: The
clinical results of the CAPP randomized prospective trial.
Source
European Heart Journal Cardiovascular Imaging. 16 (4) (pp 441-448), 2015.
Date of Publication: 01 Apr 2015.
Author
McKavanagh P.; Lusk L.; Ball P.A.; Verghis R.M.; Agus A.M.; Trinick T.R.;
Duly E.; Walls G.M.; Stevenson M.; James B.; Hamilton A.; Harbinson M.T.;
Donnelly P.M.
Institution
(McKavanagh, Lusk, Ball, Trinick, Duly, Walls, James, Hamilton, Donnelly)
Cardiology Department, Ulster Hospital, South Eastern Health and Social
Care Trust, Upper Newtownards Road, Dundonald, Belfast BT16 1RH, United
Kingdom
(McKavanagh, Harbinson, Donnelly) Centre for Vision and Vascular Science,
Institute of Clinical Science A, Queen's University Belfast, Royal
Victoria Hospital Belfast, Belfast BT126BA, United Kingdom
(Verghis, Agus, Stevenson) Northern Ireland Clinical Trials Unit,
Education and Research Centre, Royal Hospitals, Belfast BT12 6BA, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims To determine the symptomatic and prognostic differences resulting
from a novel diagnostic pathway based on cardiac computerized tomography
(CT) compared with the traditional exercise stress electrocardiography
test (EST) in stable chest pain patients. Methods and results A
prospective randomized controlled trial compared selected patient outcomes
in EST and cardiac CT coronary angiography groups. Five hundred patients
with troponin-negative stable chest pain and without known coronary artery
disease were recruited. Patients completed the Seattle Angina
Questionnaires (SAQ) at baseline, 3, and 12 months to assess angina
symptoms. Patients were also followed for management strategies and
clinical events. Over the year 12 patients withdrew, resulting in 245 in
the EST cohort and 243 in the CT cohort. There was no significant
difference in baseline demographics. The CT arm had a statistical
difference in angina stability and quality-of-life domains of the SAQ at 3
and12 months, suggesting less angina compared with the EST arm. In the CT
arm, there was more significant disease identified and more
revascularizations. Significantly, more inconclusive results were seen in
the EST arm with a higher number of additional investigations ordered.
There was also a longer mean time to management. There were no differences
in major adverse cardiac events between the cohorts. At 1 year in the EST
arm, there were more Accident and Emergency (A&E) attendances and cardiac
admission. Conclusion Cardiac CTas an index investigation for stable chest
pain improved angina symptoms and resulted in fewer investigations and
re-hospitalizations compared with EST. Clinical trial registration
http://www.controlled-trials.com/ISRCTN52480460.<br/>Copyright &#xa9; The
Author 2015.

<75>
[Use Link to view the full text]
Accession Number
612062665
Title
Echocardiographic findings in simple and complex patent foramen ovale
before and after transcatheter closure.
Source
European Heart Journal Cardiovascular Imaging. 15 (12) (pp 1377-1385),
2014. Date of Publication: 01 Dec 2014.
Author
Vitarelli A.; Mangieri E.; Capotosto L.; Tanzilli G.; D'Angeli I.; Toni
D.; Azzano A.; Ricci S.; Placanica A.; Rinaldi E.; Mukred K.; Placanica
G.; Ashurov R.
Institution
(Vitarelli, Mangieri, Capotosto, Tanzilli, D'Angeli, Toni, Azzano, Ricci,
Placanica, Rinaldi, Mukred, Placanica, Ashurov) Sapienza University, Via
Lima 35, Rome 00198, Italy
Publisher
Oxford University Press
Abstract
Aims Percutaneous closure of patent foramen ovale (PFO) in cryptogenic
cerebrovascular events is an alternative to medical therapy. The
interpretation of residual shunts after implantation of different devices
for PFO with different morphologies is controversial. Methods and results
Transcatheter PFO closurewas performed in 123 patients with a history of
>=1 paradoxical embolism using three different devices: Amplatzer (n =
46), Figulla Occlutech (n = 41), and Atriasept Cardia (n = 36). Fifty-six
patients presented with simple PFO and 67 patients had complex
morphologies. All patients were studied with contrast enhanced
transesophageal echocardiography (TEE) before interventional procedure and
thereafter at 1 and 6 months and every 6-12 months in case of incomplete
closure. Definite closure was confirmed in at least two consecutive TEE
studies. Various PFO morphologies were identified by TEE before device
implantation. The device size to PFO diameter ratio was significantly
increased in patients with complex PFO compared with those patients with a
simple PFO morphology (P < 0.05). The difference between the closure rate
of S-PFO and C-PFO concerning each device type was significant (Amplatzer
P = 0.0027, Figulla P = 0.0043, and Atriasept P < 0.01). The mean
follow-up period was 3.4 years (median 2.7 years) with a cerebrovascular
re-event rate of 2.4% per year. In three patients, thrombi were detected
in the 6-month TEE controls and resolved after medical therapy. In three
other patients, the implantation of an adjunctive device was necessary for
residual shunt. Conclusion In our series of patients, the closure rate was
dependent on PFO morphology more than occluder size and type. An
adjunctive device was implanted in selected cases. Published on behalf of
the European Society of Cardiology. All rights reserved.<br/>Copyright
&#xa9;The Author 2014.

<76>
Accession Number
370289534
Title
Coronary artery bypass graft surgery vs percutaneous interventions in
coronary revascularization: A systematic review.
Source
JAMA - Journal of the American Medical Association. 310 (19) (pp
2086-2095), 2013. Date of Publication: 20 Nov 2013.
Author
Deb S.; Wijeysundera H.C.; Ko D.T.; Tsubota H.; Hill S.; Fremes S.E.
Institution
(Deb, Wijeysundera, Ko, Tsubota, Hill, Fremes) Schulich Heart Centre,
Division of Cardiology and Cardiac Surgery, Sunnybrook Health Sciences
Centre, Toronto, ON, Canada
(Deb, Wijeysundera, Ko, Fremes) Institute of Health Policy Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(Wijeysundera, Ko) Institute for Clinical Evaluative Sciences, Toronto,
ON, Canada
Publisher
American Medical Association
Abstract
IMPORTANCE: Ischemic heart disease is the leading cause of death globally.
Coronary artery bypass graft (CABG) surgery and percutaneous coronary
intervention (PCI) are the revascularization options for ischemic heart
disease. However, the choice of the most appropriate revascularization
modality is controversial in some patient subgroups. <br/>OBJECTIVE(S): To
summarize the current evidence comparing the effectiveness of CABG surgery
and PCI in patients with unprotected left main disease (ULMD, in which
there is >50% left main coronary stenosis without protective bypass
grafts), multivessel coronary artery disease (CAD), diabetes, or left
ventricular dysfunction (LVD). EVIDENCE REVIEW: A search of OvidSP
MEDLINE, EMBASE, and Cochrane databases between January 2007 and June
2013, limited to randomized clinical trials (RCTs) and meta-analysis of
trials and/or observational studies comparing CABG surgery with PCI was
performed. Bibliographies of relevant studies were also searched.
Mortality and major adverse cardiac and cerebrovascular events (MACCE,
defined as all-cause mortality, myocardial infarction, stroke, and repeat
revascularization) were reported wherever possible. FINDINGS: Thirteen
RCTs and 5 meta-analyses were included. CABG surgery should be recommended
in patients with ULMD, multivessel CAD, or LVD, if the severity of
coronary disease is deemed to be complex (SYNTAX >22) due to lower cardiac
events associated with CABG surgery. In cases in which coronary disease is
less complex (SYNTAX <=22) and/or the patient is a higher surgical risk,
PCI should be considered. For patients with diabetes and multivessel CAD,
CABG surgery should be recommended as standard therapy irrespective of the
severity of coronary anatomy, given improved long-term survival and lower
cardiac events (5-year MACCE, 18.7% for CABG surgery vs 26.6% for PCI; P =
.005). Overall, the incidence of repeat revascularization is higher after
PCI, whereas stroke is higher after CABG surgery. Current literature
emphasizes the importance of a heart-team approach that should consider
coronary anatomy, patient characteristics, and local expertise in
revascularization options. Literature pertaining to revascularization
options in LVD is scarce predominantly due to LVD being an exclusion
factor in most studies. CONCLUSIONS AND RELEVANCE: Both CABG surgery and
PCI are reasonable options for patients with advanced CAD. Patients with
diabetes generally have better outcomes with CABG surgery than PCI. In
cases of ULMD, multivessel CAD, or LVD, CABG surgery should be favored in
patients with complex coronary lesions and anatomy and PCI in less
complicated coronary disease or deemed a high surgical risk. A heart-team
approach should evaluate coronary disease complexity, patient
comorbidities, patient preferences, and local expertise. Copyright 2013
American Medical Association. All rights reserved.

<77>
Accession Number
368321689
Title
Extended heart failure clinic follow-up in low-risk patients: A randomized
clinical trial (NorthStar).
Source
European Heart Journal. 34 (6) (pp 432-442), 2013. Date of Publication: 07
Feb 2013.
Author
Schou M.; Gustafsson F.; Videbaek L.; Tuxen C.; Keller N.; Handberg J.;
Sejr Knudsen A.; Espersen G.; Markenvard J.; Egstrup K.; Ulriksen H.;
Hildebrandt P.R.
Institution
(Schou, Tuxen, Hildebrandt) Department of Cardiology and Endocrinology,
Frederiksberg University Hospital, DK-2000 Frderiksberg, Denmark
(Schou, Gustafsson) Department of Cardiology, Heart Centre,
Rigshospitalet, Blegdamsvej 2, DK-2100 Copenhagen, Denmark
(Videbaek) Department of Cardiology, Odense University Hospital, DK-5000
Odense C, Denmark
(Keller) Department of Cardiology, Herlev University Hospital, DK-2730
Herlev, Denmark
(Handberg) Department of Cardiology and Endocrinology, Hillerod University
Hospital, DK-3400 Hillerod, Denmark
(Sejr Knudsen) Department of Cardiology, Vejle University Hospital,
DK-7100 Vejle, Denmark
(Espersen) Department of Cardiology, Aalborg University Hospital, DK-9000
Aalborg, Denmark
(Markenvard) Department of Internal Medicine, Fredericia County Hospital,
DK-7000 Fredericia, Denmark
(Egstrup) Department of Internal Medicine, Funen University Hospital,
DK-5700 Svendborg, Denmark
(Ulriksen) Department of Internal Medicine, Skive County Hospital, DK-7800
Skive, Denmark
Publisher
Oxford University Press
Abstract
BackgroundOutpatient follow-up in specialized heart failure clinics (HFCs)
is recommended by current guidelines and implemented in most European
countries, but the optimal duration of HFC programmes has not been
established. Nor is it known whether all or only high-risk patients, e.g.
identified by NT-proBNP, might benefit from an extended HFC
follow-up.Methods and resultsIn a multi-centre setting, we randomly
assigned 921 clinically stable systolic heart failure (HF) outpatients on
optimal medical therapy to undergo either an extended follow-up in the HFC
(n = 461) or referral back to their general practitioner (GP) (n = 460).
The primary composite endpoint was death or a cardiovascular admission.
Secondary endpoints included mortality, an HF admission, quality of life,
number of days admitted, and number of admissions. The median age of the
patients was 69 years; 23% were females; the median left ventricular
ejection fraction was 0.30; and the median NT-proBNP was 801 pg/mL; 89%
were in NYHA class I-II. The median follow-up was 2.5 years. Time-to-event
did not differ between groups (HFC vs. GP) (HR: 1.17, 95% CI: 0.95-1.45, P
= 0.149). The two groups did not differ with respect to any of the
secondary endpoints at the follow-up (P> 0.05 for all). In high-risk
patients identified by NT-proBNP >=1000 pg/mL, no benefit from HFC
follow-up was found (P = 0.721).ConclusionIrrespective of the level of
NT-proBNP stable HF patients on optimal medical therapy do not benefit
from long-term follow-up in a specialized HFC in a publicly funded
universal access healthcare system. Heart failure patients on optimal
medical therapy with mild or moderate symptoms are safely managed by their
personal GP.Trial Registration: www.Centerwatch.com: 173491 (NorthStar).
&#xa9; The Author 2012.

<78>
Accession Number
366300019
Title
Adverse effects of fibrin sealants in thoracic surgery: The safety of a
new fibrin sealant: Multicentre, randomized, controlled, clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 657-662), 2012.
Date of Publication: 01 Mar 2012.
Author
Cardillo G.; Carleo F.; Carbone L.; De Massimi A.R.; Lococo A.; Santini
P.F.; Janni A.; Gonfiotti A.
Institution
(Cardillo, Carleo, Carbone, De Massimi) Unit of Thoracic Surgery, Carlo
Forlanini Hospital, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
(Lococo) Unit of Thoracic Surgery, Pescara General Hospital, Pescara,
Italy
(Santini, Janni, Gonfiotti) Unit of Thoracic Surgery, Careggi Hospital,
Florence, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: The safety of fibrin sealants (FS) has been questioned in the
light of recent reports of adverse effects. We evaluated the safety of a
new FS in a randomized controlled trial (RCT). <br/>Method(s):
Multicentre, open-label Phase II/III RCT to evaluate the safety of the new
FS. The trial was approved by the Ethic Committee of each three
participatingCentre. FS includes two components (component 1: fibrinogen;
component 2: thrombin), each of them subjected to two viralinactivation
procedures. Out of 200 screened patients, 185 eligible patients (49
females, 136 males), aged between 18 and 75 years, undergoing major
thoracic surgery were randomized to receive FS (#91 patients) as an
adjuvant for air leak control or no treatment (#94 patients, control
group). Safety variables were: percentage of subjects with adverse
eventsassociated with the therapy; formation of antibodies against bovine
aprotinin; vital signs (blood pressure, body temperature, heart and
respiratory rate); laboratory parameters. <br/>Result(s): Overall
operative mortality was 3.2% (6/185), 1.1% in the FS group and 5.3% in the
control group, respectively. Twenty patients (22%) had adverse events in
the FS group and 22 (23.4%) in the control group. Atrial fibrillation
(five patients in the FS group and four in the control group) and
hyperpyrexia (five and seven patients, respectively, in the two groups)
were the most common adverse events. No patient reported thromboembolic
events (pulmonary embolism or deep vein thrombosis) during the in hospital
stay or within 1 month from discharge. None of the adverse events was
considered as treatment related. The formation of bovine aprotinin
antibodies was reported in a total of 34 patients (37.4%) in the FS group
and was not related to any adverse effect. <br/>Conclusion(s): The present
RCT did not show any increased risk of adverse events, and of surgical
complications, related to the use of the new FS. &#xa9; The Author 2011.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<79>
Accession Number
366299993
Title
The use of pre-operative brain natriuretic peptides as a predictor of
adverse outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 525-534), 2012.
Date of Publication: March 2012.
Author
Litton E.; Ho K.W.
Institution
(Litton, Ho) Department of Intensive Care Medicine, Royal Perth Hospital,
Perth, WA, Australia
(Litton) School of Medicine and Pharmacology, University of Western
Australia, Perth, WA, Australia
(Ho) School of Population Health, University of Western Australia, Perth,
WA, Australia
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The objective of this systematic review was to assess whether
pre-operative brain natriuretic peptide (BNP) and N-terminal pro-B-type
natriuretic peptide (NT pro-BNP) are independent predictors of adverse
outcomes after cardiac surgery. MEDLINE, Embase and the Cochrane
Controlled Trials Register databases were searched. Eligible studies
included observational or randomized control trials measuring natriuretic
peptide concentrations before induction of anaesthesia for cardiac
surgery. Two investigators independently extracted the data and assessed
the validity of the included studies. The predictive ability of
pre-operative BNP or NT pro-BNP on mortality, post-operative atrial
fibrillation (AF) and intra-aortic balloon pump (IABP) requirement was
meta-analysed. The association between BNP or NT pro-BNP and other
outcomes was systematically summarized. A total of 4933 patients from 22
studies were considered in the systematic review. Ten studies with one or
more outcomes of interest were included in the meta-analyses. The strength
of association between pre-operative natriuretic peptide levels and
adverse outcomes after surgery was variable, as was the size and quality
of the included studies. The summary areas under the receiver operating
characteristic curve for mortality, post-operative AF and post-operative
IABP requirement were 0.61 (95% confidence interval [CI] 0.51-0.70), 0.61
(95% CI 0.58-0.64) and 0.81 (95% CI 0.73-0.89), respectively. With the
limited data available, the associations between pre-operative natriuretic
peptide levels and adverse outcomes after cardiac surgery were moderate.
Future studies should assess whether pre-operative natriuretic peptides
can provide additional independent predictive information to
well-validated prognostic scores of cardiac surgery. &#xa9; The Author
2011. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<80>
Accession Number
366299905
Title
Performance of the original EuroSCORE.
Source
European Journal of Cardio-thoracic Surgery. 41 (4) (pp 746-754), 2012.
Date of Publication: April 2012.
Author
Siregar S.; Groenwold R.H.H.; de Heer F.; Bots M.L.; van der Graaf Y.; van
Herwerden L.A.
Institution
(Siregar, de Heer, van Herwerden) Department of Cardio-Thoracic Surgery,
Heart and Lungs Division, University Medical Center Utrecht, Utrecht,
Netherlands
(Siregar, Groenwold, Bots, van der Graaf) Julius Center for Health
Sciences and Primary Care, University Medical Center Utrecht, Utrecht,
Netherlands
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
The European system for cardiac operative risk evaluation (EuroSCORE) is a
commonly used risk score for operative mortality following cardiac
surgery. We aimed to conduct a systematic review of the performance of the
additive and logistic EuroSCORE. A literature search resulted in 67
articles. Studies applying the EuroSCORE on patients undergoing cardiac
surgery and which reported early mortality were included. Weighted
meta-regression showed that the EuroSCORE overestimated mortality.
However, this performance depended on the risk profile of patients: in
high-risk patients, the additive model actually underestimated mortality.
Discriminative performance was good. Given the poor predictive
performance, the EuroSCORE may not be suitable as a tool for patient
selection nor for benchmarking. &#xa9; The Author 2012. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<81>
Accession Number
372905816
Title
What is the optimal timing for surgery in infective endocarditis with
cerebrovascular complications?.
Source
Interactive Cardiovascular and Thoracic Surgery. 14 (1) (pp 72-80), 2012.
Date of Publication: 01 Jan 2012.
Author
Rossi M.; Gallo A.; Joseph De Silva R.; Sayeed R.
Institution
(Rossi, Gallo, Joseph De Silva, Sayeed) Department of Cardio-thoracic
Surgery, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
Publisher
Oxford University Press
Abstract
Neurologic dysfunction complicates the course of 10-40% of left-side
infective endocarditis (IE). In right-sided IE, instead, when systemic
emboli occur, paradoxical embolism should be considered. The spectrum of
neurologic events includes embolic cerebrovascular complication (CVC),
intracranial haemorrhage, ruptured mycotic aneurysm, transient ischaemic
attack (TIA), meningitis, encephalopathy and brain abscess.
Cardiopulmonary bypass might exacerbate neurological deficits due to:
heparinization and secondary cerebral haemorrhage; hypotension and
cerebral oedema in areas of the disrupted blood brain barrier. A best
evidence topic was written according to a structured protocol. The
question addressed was, whether there is an optimal timing for surgery in
IE with CVCs. One hundred papers were found using the reported search
criteria, and out of these 20 papers, provided the best evidence to answer
the clinical question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results were tabulated. We found that evidence is conflicting because of
lack of controlled studies. The optimal timing for the valve replacement
depends on the type of neurological complication and the urgency of the
operation. The new 2009 Guidelines on the prevention, diagnosis, and
treatment of infective endocarditis (IE) recommend a multidisciplinary
approach and to wait for 1-2 weeks of antibiotics treatment before
performing cardiac surgery. However, early surgery is indicated in: heart
failure (class 1 B), uncontrolled infection (class 1 B) and prevention of
embolic events (class 1B/C). After a stroke, surgery should not be delayed
as long as coma is absent and cerebral haemorrhage has been excluded by
cranial CT (class IIa level B). After a TIA or a silent cerebral embolism,
surgery is recommended without delay (class 1 level B). In intracranial
haemorrhage (ICH), surgery must be postponed for at least 1 month (class 1
level C). Surgery for prosthetic valve endocarditis (PVE) follows the
general principles outlined for native valve IE. Every patient should have
a repeated head CT scan immediately before the operation to rule out a
preoperative haemorrhagic transformation of a brain infarction. The
presence of a haematoma warrants neurosurgical consultation and
consideration of cerebral angiography to rule out a mycotic aneurysm.
&#xa9; 2011 The Author 2011. Published by Oxford University Press on
behalf of the European Association for Cardio-Thoracic Surgery. All rights
reserved.

<82>
Accession Number
2010968538
Title
Outcomes of optical coherence tomography compared with intravascular
ultrasound and with angiography to guide coronary stent implantation:
One-year results from the ILUMIEN III: OPTIMIZE PCI trial.
Source
EuroIntervention. 16 (13) (pp 1085-1091), 2021. Date of Publication: 2021.
Author
Ali Z.A.; Galougahi K.K.; Maehara A.; Shlofmitz R.A.; Fabbiocchi F.;
Guagliumi G.; Alfonso F.; Akasaka T.; Matsumura M.; Mintz G.S.; Ben-Yehuda
O.; Zhang Z.; Rapoza R.J.; West N.E.J.; Stone G.W.
Institution
(Ali, Maehara, Ben-Yehuda) Center for Interventional Vascular Therapy,
Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University
Medical Center, New York, NY, United States
(Ali, Maehara, Matsumura, Mintz, Ben-Yehuda, Stone) Clinical Trials
Center, Cardiovascular Research Foundation, New York, NY, United States
(Ali, Shlofmitz) St. Francis Hospital, Roslyn, New York, NY, United States
(Galougahi) Royal Prince Alfred Hospital, University of Sydney, Sydney,
Australia
(Fabbiocchi) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Guagliumi) Cardiovascular Department, Ospedale Papa Giovanni XXIII,
Bergamo, Italy
(Alfonso) Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Madrid,
Spain
(Akasaka) Wakayama Medical University, Wakayama, Japan
(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
(Ali) Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New
York, NY 10019, United States
Publisher
Europa Group
Abstract
Aims: In the ILUMIEN III trial, among 450 randomised patients with
non-complex lesions undergoing percutaneous coronary intervention (PCI),
optical coherence tomography (OCT) guidance led to greater stent expansion
than angiography guidance, similar minimal stent area compared to both
intravascular ultrasound (IVUS) guidance and angiography guidance, and
lower rates of uncorrected dissection and malapposition than both IVUS
guidance and angiography guidance. Whether these differences impact on
clinical outcomes is unknown. The aim of the present study was to report
the 12-month clinical follow-up data from the ILUMIEN III study.
<br/>Methods and Results: OCT-guided PCI, using an external elastic
lamina-based protocol, was compared to operator-directed IVUS-guided or
angiography-guided PCI. Target lesion failure (TLF) and major adverse
cardiovascular events (MACE) at 12 months were adjudicated by a blinded
clinical events committee. There were no significant differences in the
rates of TLF (2.0% OCT, 3.7% IVUS, 1.4% angiography), MACE (9.8% OCT, 9.1%
IVUS, 7.9% angiography), or any of the individual components of these
outcomes among the groups. No independent predictors of 12-month
stent-related clinical events were identified from final OCT.
<br/>Conclusion(s): In this underpowered study, OCT-guided PCI of
non-complex lesions did not show a statistical difference in clinical
outcomes at 12 months compared with IVUS or angiography guidance. An
appropriately powered trial, including only complex patients and lesions,
is underway to substantiate the potential clinical benefit of OCT-guided
PCI. Trial registration: NCT02471586<br/>Copyright &#xa9; Europa Digital &
Publishing 2021. All rights reserved.

<83>
Accession Number
635315199
Title
Airway Pressure Release Ventilation Mode Improves Circulatory and
Respiratory Function in Patients After Cardiopulmonary Bypass, a
Randomized Trial.
Source
Frontiers in Physiology. 12 (no pagination), 2021. Article Number: 684927.
Date of Publication: 03 Jun 2021.
Author
Ge H.; Lin L.; Xu Y.; Xu P.; Duan K.; Pan Q.; Ying K.
Institution
(Ge, Xu, Xu, Duan) Department of Respiratory Care, Regional Medical
Center, National Institute of Respiratory Diseases, Sir Run Run Shaw
Hospital, School of Medicine, Zhejiang University, Hangzhou, China
(Lin) Department of Critical Care Medicine, Sir Run Run Shaw Hospital,
School of Medicine, Zhejiang University, Hangzhou, China
(Pan) College of Information Engineering, Zhejiang University of
Technology, Hangzhou, China
(Ying) Department of Respiratory and Critical Care, Regional Medical
Center, National Institute of Respiratory Diseases, Sir Run Run Shaw
Hospital, School of Medicine, Zhejiang University, Hangzhou, China
Publisher
Frontiers Media S.A.
Abstract
Importance: Postoperative pulmonary complications and cardiovascular
complications are major causes of morbidity, mortality, and resource
utilization in cardiac surgery patients. <br/>Objective(s): To investigate
the effects of airway pressure release ventilation (APRV) on respiration
and hemodynamics in post cardiac surgery patients. <br/>Main Outcomes and
Measures: A single-center randomized control trial was performed. In
total, 138 patients undergoing cardiopulmonary bypass were prospectively
screened. Ultimately 39 patients met the inclusion criteria and were
randomized into two groups: 19 patients were managed with pressure control
ventilation (PCV) and 20 patients were managed with APRV. Respiratory
mechanics after 4 h, hemodynamics within the first day, and Chest
radiograph score (CRS) and blood gasses within the first three days were
recorded and compared. <br/>Result(s): A higher cardiac index (3.1 +/- 0.7
vs. 2.8 +/- 0.8 Lmin^-1m²; p < 0.05), and shock
volume index (35.4 +/- 9.2 vs. 33.1 +/- 9.7 ml m^-2; p < 0.05)
were also observed in the APRV group after 4 h as well as within the first
day (p < 0.05). Compared to the PCV group, the PaO2/FiO<inf>2</inf> was
significantly higher after 4 h in patients of APRV group (340 +/- 97 vs.
301 +/- 82, p < 0.05) and within the first three days (p < 0.05) in the
APRV group. CRS revealed less overall lung injury in the APRV group (p <
0.001). The duration of mechanical ventilation and ICU length of stay were
not significantly (p = 0.248 and 0.424, respectively). <br/>Conclusions
and Relevance: Compared to PCV, APRV may be associated with increased
cardiac output improved oxygenation, and decreased lung injury in
postoperative cardiac surgery patients.<br/>&#xa9; Copyright &#xa9; 2021
Ge, Lin, Xu, Xu, Duan, Pan and Ying.

<84>
Accession Number
2011857898
Title
Current Management of Acute Pulmonary Embolism.
Source
Current Surgery Reports. 9 (6) (no pagination), 2021. Article Number: 16.
Date of Publication: June 2021.
Author
Madathil R.J.; Anagnostakos J.; Pereira G.; Hall M.; Cires-Drouet R.
Institution
(Madathil, Cires-Drouet) Department of Surgery, Division of Cardiac
Surgery, University of Maryland, Baltimore, MD, United States
(Anagnostakos, Pereira, Hall) Department of Surgery, Division of Vascular
Surgery, University of Maryland, Baltimore, MD, United States
Publisher
Springer
Abstract
Purpose of Review: The purpose of this review article is to analyze the
current information about diagnosis, prognosis, treatment, and
interventional therapies regarding pulmonary embolism (PE) treatment. In
addition to review the outcomes obtained by pulmonary embolism response
teams. Recent Findings: Several important contributions in the PE
management have been recently published. New scoring systems, such as the
PERC rule and YEARS, are used to effectively rule out PE; and
stratification scores such as Bova and Hestia were validated. New evidence
was favorable to support the use of direct oral anticoagulants in morbidly
obese and end-stage renal disease patients; although, not in patients with
antiphospholipid antibody syndrome. New studies of catheter-based
thrombectomy for acute PE were also published. However, a new statement
from the American Heart Association criticizes the lack of randomized
trials to support the use of catheter-based interventions in acute PE.
Contributions about the cardiopulmonary support in massive PE patients,
including ventilation techniques, vasopressors, inhaled pulmonary
vasodilators and extracorporeal membrane oxygenation are available.
Finally, the advantages and disadvantages of the impact of Pulmonary
Embolism Response Teams in the care of acute PE patients. <br/>Summary:
Nearly all aspects in the diagnosis, prognosis and care of PE are
evolving. In this article, we discuss the epidemiology, diagnosis, risk
stratification, and therapeutic approaches to PE. We provide additional
focus on advanced therapeutic strategies such as catheter-based
interventions, surgical approaches, and cardiopulmonary support. The
impact of a multidisciplinary team approach to PE management is also
discussed.<br/>Copyright &#xa9; 2021, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<85>
Accession Number
2011719130
Title
3D CT airway evaluation-guided intraluminal placement of endobronchial
blocker in pediatric patients: a randomized controlled study.
Source
Translational Pediatrics. 10 (3) (pp 625-634), 2021. Date of Publication:
March 2021.
Author
Xu Y.; Li L.; Hou J.; Zhang N.; Zeng M.; Qiu Q.; Liang Y.; Wei W.; Tan Y.
Institution
(Xu, Zhang, Zeng, Qiu, Wei, Tan) Department of Anesthesiology, Guangzhou
Women and Children's Medical Center, Guangzhou Medical University,
Guangzhou, China
(Li) Department of Pediatric Surgery, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
(Hou) Department of Radiology, Guangzhou Women and Children's Medical
Center, Guangzhou Medical University, Guangzhou, China
(Liang) Pediatric Intensive Care Unit, Guangzhou Women and Children's
Medical Center, Guangzhou Medical University, Guangzhou, China
Publisher
AME Publishing Company
Abstract
Background: The aim of the present study was to propose a new approach for
3D computed tomography (CT) airway evaluation-guided endobronchial blocker
placement in pediatric patients, and to determine its efficiency in
clinical application. <br/>Method(s): A total of 127 pediatric patients
aged 0.5-3 years who were scheduled for elective thoracic surgery using
one-lung ventilation (OLV) were randomized into the bronchoscopy (BRO)
group and the CT group. The degree of lung collapse, postoperative airway
mucosal injury, pulmonary infection within 72 h after surgery, and
hoarseness after tracheal extubation; duration of postoperative mechanical
ventilation, intensive care unit (ICU) stay and hospitalization; success
rate of first blocker positioning; and required time and repositioning for
successful blocker placement were compared between the 2 groups.
<br/>Result(s): The degree of lung collapse, postoperative airway mucosal
injury, pulmonary infection within 72 h after surgery, and hoarseness
after tracheal extubation; duration of postoperative mechanical
ventilation, ICU stay and hospitalization; success rate of first blocker
positioning; and required time and repositioning for successful blocker
placement were similar between the 2 groups (all P>0.05).
<br/>Conclusion(s): For pediatric patients undergoing surgery with OLV,
preoperative 3D CT airway evaluation could be used to guide endobronchial
blocker placement, with a blocking efficiency similar to that of
BRO-guided blocker placement.<br/>Copyright &#xa9; 2021 AME Publishing
Company. All rights reserved.

<86>
Accession Number
2007668342
Title
Use of direct-acting oral anticoagulants in solid organ transplantation: A
systematic review.
Source
Pharmacotherapy. 41 (1) (pp 28-43), 2021. Date of Publication: January
2021.
Author
Bixby A.L.; Lichvar A.B.; Salerno D.; Park J.M.
Institution
(Bixby) Department of Pharmacy Services, University of Hospitals Cleveland
Medical Center, Cleveland, OH, United States
(Lichvar) Department of Pharmacy Practice, University of Illinois at
Chicago College of Pharmacy, Chicago, IL, United States
(Lichvar) Department of Surgery, University of Illinois at Chicago College
of Medicine, Chicago, IL, United States
(Salerno) Department of Pharmacy, NewYork-Presbyterian Hospital, New York,
NY, United States
(Park) Department of Clinical Pharmacy, College of Pharmacy, University of
Michigan, Ann Arbor, MI, United States
(Park) Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI,
United States
Publisher
Pharmacotherapy Publications Inc.
Abstract
The use of direct-acting oral anticoagulants (DOACs) has increased
secondary to the mounting evidence for comparable efficacy and potentially
superior safety to vitamin K antagonists (VKAs) in the general population.
However, insufficient data regarding DOAC use in solid organ transplant
(SOT) recipients and numerous pharmacokinetic and pharmacodynamic
considerations limit their use in this highly selected patient population.
A systematic review of recent clinical evidence on the safety and efficacy
of DOACs compared to VKAs in SOT recipients was conducted. Additional
considerations including transplant-specific strategies for DOAC reversal
and common pharmacokinetic/pharmacodynamic concerns were also reviewed.
Although current evidence is limited to single-center retrospective
analyses, DOACs, especially apixaban, appear to be a safe and effective
alternative to VKAs for SOT recipients with stable graft function and
without drug-drug interactions. Reliable data on DOAC reversal at the time
of transplant surgery are lacking, and clinicians should consider
idarucizumab, andexanet alfa, and other non-specific reversal agents on an
individual patient basis. There is no evidence supporting deviations from
the Food and Drug Administration labeling recommendations for DOAC dosing
in the setting of drug-drug interactions, obesity, and renal function,
especially in patients on hemodialysis.<br/>Copyright &#xa9; 2020
Pharmacotherapy Publications, Inc.

<87>
[Use Link to view the full text]
Accession Number
2007567606
Title
Left Ventricular Thrombus Therapy With Direct Oral Anticoagulants Versus
Vitamin K Antagonists: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 26 (3) (pp
233-243), 2021. Date of Publication: May 2021.
Author
Saleiro C.; Lopes J.; De Campos D.; Puga L.; Costa M.; Goncalves L.;
Teixeira R.
Institution
(Saleiro, Lopes, De Campos, Puga, Costa, Goncalves, Teixeira) Servico de
Cardiologia, Centro Hospitalar e Universitario de Coimbra, Coimbra,
Portugal
(Goncalves, Teixeira) Coimbra Institute for Clinical and Biomedical
Research (iCBR), Coimbra, Portugal
(Goncalves, Teixeira) Faculdade de Medicina da Universidade de Coimbra,
Coimbra, Portugal
Publisher
SAGE Publications Ltd
Abstract
Background: Current guidelines recommend vitamin K antagonists (VKAs) for
left ventricular thrombus (LVT) resolution. Direct oral anticoagulants
(DOACs) are increasingly evaluated as alternatives to the standard of care
in anticoagulation. <br/>Method(s): We performed a systematic review and
meta-analysis to assess the use of DOACs vs VKAs for LVT treatment. The
occurrence of LVT resolution, systemic embolism (SE) or stroke, and
bleeding events were compared during follow-up using random-effects
analysis. <br/>Result(s): The 5 included studies were all observational (a
total of 828 patients). Of these, 284 patients (34%) were treated with
DOACs, and 544 (66%) treated with VKAs. Thrombus resolution was similar
for both methods (pooled odds ratio [OR], 0.91; 95% CI, 0.47-1.75;
I² = 63%; P =.78). The incidence of SE or stroke was also
similar (pooled OR, 1.59; 95% CI, 0.85-2.97; I² = 0%; P =.14).
Clinically relevant bleeding incidence was similar for both groups (pooled
OR, 0.66; 95% CI, 0.31-1.40; I² = 0%; P =.28), although all
bleeding events were less frequent in the DOAC group (pooled OR, 0.49; 95%
CI, 0.26-0.90; I² = 0%; P =.02). <br/>Conclusion(s): Our
systematic review and meta-analysis suggests DOACs were as effective as
VKAs for LVT resolution, with a similar risk of systemic embolism/stroke
and clinically relevant bleeding. These results, obtained from
observational studies, are not definitive and hence randomized controlled
trials are needed. Nevertheless, our analysis identifies key experimental
features required in future studies.<br/>Copyright &#xa9; The Author(s)
2020.

<88>
[Use Link to view the full text]
Accession Number
2007517290
Title
The short-term patency rate of a saphenous vein bridge using the no-touch
technique in off-pump coronary artery bypass grafting in vein harvesting.
Source
International Journal of General Medicine. 14 (pp 2281-2288), 2021. Date
of Publication: 2021.
Author
Zhao T.-Y.; Bu J.-Q.; Gu J.-J.; Liu Y.; Zhang W.-L.; Chen Z.-Y.
Institution
(Zhao, Bu, Gu, Liu, Zhang, Chen) Department of Cardiac Surgery, The Second
Hospital of Hebei Medical University, Shijiazhuang 050000, China
Publisher
Dove Medical Press Ltd
Abstract
Objective: This study aimed to examine the short-term effect of the
no-touch technique on the patency rate of a great saphenous vein (GSV)
bridge used during off-pump coronary artery bypass grafting (OPCABG).
<br/>Method(s): Between June 2018 and September 2020, 140 patients
undergoing OPCABG, with grafts obtained from the GSV using the "no-touch"
technique or the left internal mammary artery (LIMA), were enrolled in
this study. The early clinical results and short-term patency rate of the
OPCABG were evaluated at a three-month follow-up by comparing the patency
rate of the LIMA bridge and the GSV bridge obtained by the no-touch
technique. This study also analyzed the impacts of the postoperative
complications of the lower limbs and the distribution area of diseased
vessels on the patency rate of a GSV bridge obtained by the no-touch
technique at an early stage. <br/>Result(s): No perioperative death or
adverse cardiovascular or cerebrovascular events occurred in the 140
patients undergoing OPCABG. The difference in the early patency rate
between the GSV bridge obtained by the no-touch technique and the LIMA
bridge was not statistically significant (95.9% vs 97.1%, p = 0.501).
There was no significant difference in the patency rate between an
end-to-side anastomosed venous bridge and a LIMA bridge (95.0% [248/261]
vs 97.1% [136/140], p = 0.314). The overall patency rate of a no-touch
vein bridge in the right coronary artery region was lower than it was in
the left coronary artery region (93.8% [165/176] vs 97.9% [183/187], p =
0.049). <br/>Conclusion(s): The no-touch technique may improve the early
patency rate of a GSV bridge, and its effect is similar to that of a LIMA
bridge.<br/>Copyright &#xa9; 2021 Zhao et al.

<89>
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.<br/>Copyright: &#xa9; 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.

<90>
Accession Number
2011560159
Title
Cardiovascular safety of febuxostat compared to allopurinol for the
treatment of gout: A systematic and meta-analysis.
Source
Clinical Cardiology. 44 (7) (pp 907-916), 2021. Date of Publication: July
2021.
Author
Gao L.; Wang B.; Pan Y.; Lu Y.; Cheng R.
Institution
(Gao, Wang, Pan, Lu, Cheng) Department of Comprehensive Surgery, General
Hospital of Chinese People's Liberation Army & National Clinical Research
Center for Geriatric Disease, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
The cardiovascular safety of febuxostat compared to allopurinol for the
treatment of gout remains equivocal. Febuxostat had a better safety
outcome compared with allopurinol. In this systematic review and
meta-analysis, we searched MEDLINE and Embase for articles published
between March 1, 2000 and April 4, 2021, without any language
restrictions. We did a systematic review and meta-analysis of included
clinical trials to evaluate the cardiovascular safety of febuxostat
compared to allopurinol for treatment of chronic gout. Two reviewers
independently selected studies, assessed study quality, and extracted
data. Risk ratios were calculated with random effects and were reported
with corresponding 95% confidence intervals (CI). From 240 potentially
relevant citations, 224 papers were excluded; 16 studies were ultimately
included in the analysis. Febuxostat had a better safety outcome compared
with allopurinol,which was the composite of urgent coronary
revascularization (OR: 0.84, 95% CI: 0.77-0.90, p <.0001) and stroke (OR:
0.87, 95% CI: 0.79-0.97, p =.009). However, that difference was not found
in nonfatal myocardial infarction (OR: 0.99, 95% CI: 0.80-1.22, p =.91),
cardiovascular related mortality (OR: 0.98, 95% CI: 0.69-1.38, p =.89) and
all-cause mortality (OR: 0.93, 95% CI: 0.75-1.15, p =.52). No significant
differences in cardiovascular related mortality and all-cause mortality
were observed across any subgroup. This meta-analysis adds new evidence
regarding the cardiovascular safety of febuxostat in patients. Initiation
of febuxostat in patients was not associated with an increased risk of
death or serious cardiovascular related adverse events compared with
allopurinol.<br/>Copyright &#xa9; 2021 The Authors. Clinical Cardiology
published by Wiley Periodicals LLC.

<91>
Accession Number
634039587
Title
Tranexamic acid rapidly inhibits fibrinolysis, yet transiently enhances
plasmin generation in vivo.
Source
Blood coagulation & fibrinolysis : an international journal in haemostasis
and thrombosis. 32 (3) (pp 172-179), 2021. Date of Publication: 01 Apr
2021.
Author
Draxler D.F.; Zahra S.; Goncalves I.; Tran H.; Hanafi G.; Ho H.; Keragala
C.B.; Ilich A.; Key N.S.; Myles P.S.; Medcalf R.L.
Institution
(Draxler, Zahra, Goncalves, Tran, Hanafi, Ho, Keragala, Medcalf)
Australian Centre for Blood Diseases, Monash University, Melbourne, VIC,
Australia
(Ilich, Key) Division of Hematology and Blood Research Center, Department
of Medicine, University of North Carolina, Chapel Hill, NC, United States
(Myles) Department of Anaesthesiology and Perioperative Medicine, Alfred
Hospital
(Myles) Department of Anaesthesiology and Perioperative Medicine, Monash
University, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
Tranexamic acid (TXA) is a lysine analogue that inhibits plasmin
generation and has been used for decades as an antifibrinolytic agent to
reduce bleeding. Recent reports have indicated that TXA can paradoxically
promote plasmin generation. Blood was obtained from 41 cardiac surgical
patients randomly assigned to TXA or placebo before start of surgery
(preOP), at the end of surgery (EOS), then again on postoperative day 1
(POD-1) as well as POD-3. Plasma levels of tissue-type plasminogen
activator (t-PA), urokinase (u-PA), the plasmin-antiplasmin (PAP) complex,
as well as t-PA and u-PA-induced clot lysis assays were then determined.
Clot lysis and PAP complex levels were also assessed in healthy volunteers
before and at various time points after taking 1 g TXA orally. Surgery
induced an increase in circulating t-PA, yet not u-PA at EOS. t-PA levels
were unaffected by TXA; however, u-PA levels were significantly reduced in
patients on POD-3. t-PA and u-PA-induced clot lysis were both inhibited in
plasma from TXA-treated patients. In contrast, PAP complex formation,
representing plasmin generation, was unexpectedly enhanced in the plasma
of patients administered TXA at the EOS time point. In healthy volunteers,
oral TXA effectively blocked fibrinolysis within 30 min and blockade was
sustained for 8 h. However, TXA also increased PAP levels in volunteers 4
h after administration. Our findings demonstrate that TXA can actually
augment PAP complex formation, consistent with an increase in plasmin
generation in vivo despite the fact that it blocks fibrinolysis within 30
min. This may have unanticipated consequences in vivo.<br/>Copyright
&#xa9; 2021 Wolters Kluwer Health, Inc. All rights reserved.

<92>
Accession Number
635435636
Title
A randomized parallel design trial of the efficacy and safety of
tranexamic acid, dexmedetomidine and nitroglycerin in controlling
intraoperative bleeding and improving surgical field quality during
septorhinoplasty under general anesthesia.
Source
Medical Gas Research. 11 (4) (pp 131-137), 2021. Date of Publication: 01
Oct 2021.
Author
Modir H.; Moshiri E.; Naseri N.; Faraji F.; Almasi-Hashiani A.
Institution
(Modir, Moshiri) Departments of Anesthesiology and Critical Care, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Naseri) Department of Otorhinolaryngology, Arak University of Medical
Sciences, Arak, Iran, Islamic Republic of
(Faraji) Students Research Committee, Arak University of Medical Sciences,
Arak, Iran, Islamic Republic of
(Almasi-Hashiani) Department of Epidemiology, School of Health, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications
Abstract
In this blinded clinical trial, we attempted to compare the efficacy and
safety of administering tranexamic acid, dexmedetomidine and nitroglycerin
in preventing intraoperative bleeding and improving the quality of the
surgical field during septorhinoplasty under general anesthesia. A total
of 105 patients scheduled for septorhinoplasty were enrolled and randomly
assigned into three groups based on the balanced-block randomization
method. First group received 1 mug/kg intravenous injection
dexmedetomidine, second group received 10 mg/kg intravenous injection
tranexamic acid and third group received 0.5 mug/kg nitroglycerin,
intravenously. The study sample was composed of 105 participants with the
total mean age of 25.85 +/- 6.52 years, and 59.05% of participants were
female and the mean of body mass index was 24.34 +/- 2.57
kg/m². The results showed that there was no statistically
significant difference in terms of arterial oxygen saturation, mean
arterial pressure, heart rate, bleeding rate, duration of surgery, and
surgeon satisfaction among the three groups; however, there was a
significant difference in the extubation time, recovery time and the dose
of administered propofol among the three groups. Dexmedetomidine reduced
the dose of administered propofol while increasing the extubation time and
recovery time. In the tranexamic acid group compared with the other two
groups, the recovery time was shorter. However, all the three drugs could
reduce intraoperative bleeding and lead to surgeon satisfaction. It can be
concluded that all these three drugs can be utilized to control bleeding
and improve the quality of the surgical field but the ultimate decision
lies with the anesthesiologist's judgment and the conditions of the
patient. The study protocol was registered in the Iranian Registry of
Clinical Trials (registration No. IRCT20141209020258N121) on September 24,
2019 and it was ethically approved by the Ethical Committee of Arak
University of Medical Sciences (approval No. IR.ARAKMU.REC.1397.355) on
February 24, 2019. Modir Hesameddin 1 Departments of Anesthesiology and
Critical Care, Arak University of Medical Sciences, Arak Moshiri Esmail 2
Departments of Anesthesiology and Critical Care, Arak University of
Medical Sciences, Arak Naseri Narges 3 Department of Otorhinolaryngology,
Arak University of Medical Sciences, Arak Faraji Fatemeh 4 Students
Research Committee, Arak University of Medical Sciences, Arak
Almasi-Hashiani Amir 5 Department of Epidemiology, School of Health, Arak
University of Medical Sciences, Arak H1. Ofo E, Singh A, Marais J.
Steroids in rhinoplasty: a survey of current UK otolaryngologists'
practice. J Laryngol Otol. 2006;120:108-112. Blackwell KE, Ross DA, Kapur
P, Calcaterra TC. Propofol for maintenance of general anesthesia: a
technique to limit blood loss during endoscopic sinus surgery. Am J
Otolaryngol. 1993;14:262-266. Brull R, Macfarlane AJR, Chan VWS. Spinal,
epidural and caudal anesthesia. In: Miller R, ed. Miller's Anesthesia.
Churchill Livingstone: Elsvier; 2015:1684-1720. Ducloy-Bouthors AS, Jude
B, Duhamel A, et al. High-dose tranexamic acid reduces blood loss in
postpartum haemorrhage. Crit Care. 2011;15:R117. Taksaudom N, Siwachat S,
Tantraworasin A. Additional effects of topical tranexamic acid in on-pump
cardiac surgery. Asian Cardiovasc Thorac Ann. 2017;25:24-30. Kumsar S,
Dirim A, Toksoz S, Saglam HS, Adsan O. Tranexamic acid decreases blood
loss during transurethral resection of the prostate (TUR -P). Cent
European J Urol. 2011;64:156-158. Dobrovolsky AB, Titaeva EV. The
fibrinolysis system: regulation of activity and physiologic functions of
its main components. Biochemistry (Mosc). 2002;67:99-108. McCormack PL.
Tranexamic acid: a review of its use in the treatment of
hyperfibrinolysis. Drugs. 2012;72:585-617. Nielsen JD, Gram J, Fabrin K,
Holm-Nielsen A, Jespersen J. Lack of correlation between blood
fibrinolysis and the immediate or post-operative blood loss in
transurethral resection of the prostate. Br J Urol. 1997;80:105-110.
Sethna NF, Zurakowski D, Brustowicz RM, Bacsik J, Sullivan LJ, Shapiro F.
Tranexamic acid reduces intraoperative blood loss in pediatric patients
undergoing scoliosis surgery. Anesthesiology. 2005;102:727-732. Wong J, El
Beheiry H, Rampersaud YR, et al. Tranexamic Acid reduces perioperative
blood loss in adult patients having spinal fusion surgery. Anesth Analg.
2008;107:1479-1486. Mayur G, Purvi P, Ashoo G, Pankaj D. Efficacy of
tranexamic acid in decreasing blood loss during and after cesarean
section: A randomized case controlled prospective study. J Obstet Gynecol
India. 2007;57:227-230. Alimian M, Mohseni M. The effect of intravenous
tranexamic acid on blood loss and surgical field quality during endoscopic
sinus surgery: a placebo-controlled clinical trial. J Clin Anesth.
2011;23:611-615. White PF. The changing role of non-opioid analgesic
techniques in the management of postoperative pain. Anesth Analg.
2005;101:S5-22. Rezaee M, Safavi M, Monabati M. Complete guide to
anesthesia drugs. Tehran: Jame-e-Negar Publishing House. 2013. Guven DG,
Demiraran Y, Sezen G, Kepek O, Iskender A. Evaluation of outcomes in
patients given dexmedetomidine in functional endoscopic sinus surgery. Ann
Otol Rhinol Laryngol. 2011;120:586-592. Praveen DV, Pushparani A, Anand K,
Balachandran S, Umadevi. Comparison of dexmedetomidine with
nitroglycerinefor hypotensive anaesthesia in functional endoscopic sinus
surgery. Indian J Clin Anaesth. 2016;3:376-388. Modares M, Rahnama P. Side
effects of glyceryl trinitrate ointment for primary dysmenorrhea: a
randomized clinical trial. Tehran Univ Med J. 2008;65:61-66. Hadavi MR,
Zarei Y, Tarogh S. Comparison of effects of labetalol and nitroglycerine
on intraoperative blood loss and surgical field quality in rhinoplasty
surgery. World J Plast Surg. 2015;4:60-65. Srivastava U, Dupargude AB,
Kumar D, Joshi K, Gupta A. Controlled hypotension for functional
endoscopic sinus surgery: comparison of esmolol and nitroglycerine. Indian
J Otolaryngol Head Neck Surg. 2013;65:440-444. Mayhew D, Mendonca V,
Murthy BVS. A review of ASA physical status - historical perspectives and
modern developments. Anaesthesia. 2019;74:373-379. Fromme GA, MacKenzie
RA, Gould AB, Jr., Lund BA, Offord KP. Controlled hypotension for
orthognathic surgery. Anesth Analg. 1986;65:683-686. Bayram A, Ulgey A,
Gunes I, et al. Comparison between magnesium sulfate and dexmedetomidine
in controlled hypotension during functional endoscopic sinus surgery. Rev
Bras Anestesiol. 2015;65:61-67. Berenjian S, Hassani V, Farhadi M, Zaman
B, Alimian M. Comparing the effect of tranexamic acid and dexmedetomidine
on bleeding during rhinoplasty. J Anesthesiol Pain. 2017;7:36-43. Eghbal
A, Modir H, Moshiri E, Khalili M, Barsari F, Mohammadbeigi A. Hypotensive
effect of labetalol and dexmedetomidine blood loss and surgical conditions
in functional endoscopic sinus surgery: A double-blind randomized clinical
trial. Formos J Surg. 2018;51:98-104. Modir H, Modir A, Rezaei O,
Mohammadbeigi A. Comparing remifentanil, magnesium sulfate, and
dexmedetomidine for intraoperative hypotension and bleeding and
postoperative recovery in endoscopic sinus surgery and
tympanomastoidectomy. Med Gas Res. 2018;8:42-47. Moshiri E, Modir H, Yazdi
B, Susanabadi A, Salehjafari N. Comparison of the effects of propofol and
dexmedetomidine on controlled hypotension and bleeding during endoscopic
sinus surgery. Ann Trop Med Public Health. 2017;10:721. Ghavimi MA, Taheri
Talesh K, Ghoreishizadeh A, Chavoshzadeh MA, Zarandi A. Efficacy of
tranexamic acid on side effects of rhinoplasty: A randomized double-blind
study. J Craniomaxillofac Surg. 2017;45:897-902. Sankar D, Krishnan R,
Veerabahu M, Vikraman B. Evaluation of the efficacy of tranexamic acid on
blood loss in orthognathic surgery. A prospective, randomized clinical
study. Int J Oral Maxillofac Surg. 2012;41:713-717. Ghodraty M, Khatibi A,
Rokhtabnak F, Maleki M, Parsa F. Comparing labetalol and nitroglycerine on
inducing controlled hypotension and intraoperative blood loss in
rhinoplasty: a single-blinded clinical trial. Anesth Pain Med.
2017;7:e13677. Jalali MM, Moosavi S, Fatemi S, Banan RA. Comparison
between dexamethasone and tranexamic acid on postoperative edema and
ecchymosis after rhinoplasty operation. J Guilan Univ Med Sci.
2012;21:72-77. Ayoglu H, Yapakci O, Ugur MB, et al. Effectiveness of
dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty
operations. J Clin Anesth. 2008;20:437-441.<br/>Copyright &#xa9; 2021 BMJ
Publishing Group. All rights reserved.

<93>
Accession Number
2013475881
Title
Exploring the Operative Strategy for Secondary Mitral Regurgitation: A
Systematic Review.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
3466813. Date of Publication: 2021.
Author
Nappi F.; Singh S.S.A.; Bellomo F.; Nappi P.; Chello C.; Iervolino A.;
Chello M.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Singh) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Bellomo, Nappi) Department of Clinical and Experimental Medicine,
University of Messina, Italy
(Chello) Regenerative Medicine, Universita Campus Bio-Medico di Roma, Rome
00128, Italy
(Iervolino) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCSS, Italy
(Chello) Cardiovascular Surgery, Universita Campus Bio-Medico di Roma,
Rome 00128, Italy
Publisher
Hindawi Limited
Abstract
Background. Mitral valve disease surgery is an evolving field with
multiple possible interventions. There is an increasing body of evidence
regarding the optimal strategy in secondary mitral regurgitation where the
pathology lies within the ventricle. We conducted a systematic review to
identify the benefits and limitations of each surgical option. Methods. A
systematic review of the literature was performed to identify pertinent
randomized controlled trials (RCTs), propensity-matched observational
series, and meta-analyses which were considered initially and followed by
unmatched observational series using the MEDLINE, Ovid EMBASE, and
Cochrane Library. Results. We identified 6 different strategies for
treating secondary mitral valve regurgitation: mitral valve replacement,
restrictive mitral annuloplasty, surgical revascularization (with and
without mitral annuloplasty), subvalvular procedures (papillary muscle
approximation, papillary muscle relocation, ring and string procedure),
and procedures directly targeting the mitral valve (edge-to-edge repair
and anterior leaflet enlargement) alongside transcatheter heart valve
therapy. We also highlighted the role of left ventricular assist devices
in the management of this condition. The benefits and limitations of each
intervention are highlighted. Conclusion. There is currently no unanimous
and shared strategy for the optimal treatment of patients with secondary
IMR. The management of patients with secondary mitral regurgitation must
be entrusted to a multidisciplinary Heart Team to ensure ideal
intervention and patient matching for the best outcomes.<br/>Copyright
&#xa9; 2021 Francesco Nappi et al.

<94>
Accession Number
2013446865
Title
Thoracic bone mineral density measured by quantitative computed tomography
in patients undergoing spine surgery.
Source
Spine Journal. (no pagination), 2021. Date of Publication: 2021.
Author
Salzmann S.N.; Okano I.; Jones C.; Basile E.; Iuso A.; Zhu J.; Reisener
M.-J.; Chiapparelli E.; Shue J.; Carrino J.A.; Girardi F.P.; Cammisa F.P.;
Sama A.A.; Hughes A.P.
Institution
(Salzmann, Okano, Jones, Basile, Iuso, Zhu, Reisener, Chiapparelli, Shue,
Carrino, Girardi, Cammisa, Sama, Hughes) Spine Care Institute, Hospital
for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York,
NY 10021, United States
Publisher
Elsevier Inc.
Abstract
BACKGROUND CONTEXT: The thoracic spine is a common location for vertebral
fractures as well as instrumentation failure after long spinal fusion
procedures. The association between those complications and bone mineral
density (BMD) are well recognized. Due to the overlying sternum and ribs
in the thoracic spine, projectional BMD assessment tools such as dual
energy x-ray absorptiometry (DXA) are limited to the lumbar spine.
Quantitative computed tomography circumvents several shortcomings of DXA
and allows for level-specific BMD measurements. Studies comprehensively
quantifying BMD of the entire thoracic spine in patients undergoing spine
surgery are limited. PURPOSE: The objective of this study was: (1) to
assess the reliability of thoracic QCT measurements, (2) to determine
possible level-specific BMD variation throughout the thoracic spine and
(3) to assess the correlation between BMDs of the T1-T12 spinal levels.
STUDY DESIGN/SETTING: Cross-sectional observation study. PATIENT SAMPLE:
Patients undergoing spine surgery from 2016-2020 at a single, academic
institution with available preoperative CT imaging of the thoracic spine
were included in this study. OUTCOME MEASURES: The outcome measure was BMD
measured by QCT. <br/>METHOD(S): Patients undergoing spine surgery from
2016-2020 at a single, academic institution with available preoperative CT
imaging of the thoracic spine were included in this study. Subjects with
previous instrumentation at any thoracic level, concurrent vertebral
fractures, a Cobb angle of more than 20 degrees, or incomplete thoracic
spine CT imaging were excluded. Asynchronous quantitative computed
tomography (QCT) measurements of T1-T12 were performed. To assess inter-
and intra-observer reliability, a validation study was performed on 120
vertebrae in 10 randomly selected patients. The interclass correlation
coefficient (ICC) was calculated. A pairwise comparison of BMD was
conducted and correlations between each thoracic level were evaluated. The
statistical significance level was set at p<.05. <br/>RESULT(S): 60
patients (men, 51.7%) met inclusion criteria. The study population was 90%
Caucasian with a mean age of 62.2 years and a mean BMI of 30.2
kg/m². The inter- and intra-observer reliability of the
thoracic QCT measurements was excellent (ICC of 0.97 and 0.97,
respectively). The trabecular BMD was highest in the upper thoracic spine
and decreased in the caudal direction (T1 = 182.3 mg/cm³, T2 =
168.1 mg/cm³, T3 = 163.5 mg/cm³, T4 = 164.7
mg/cm³, T5 = 161.4 mg/cm³, T6 = 152.5
mg/cm³, T7 = 143.5 mg/cm³, T8 = 141.3
mg/cm³, T9 = 143.5 mg/cm³, T10 = 145.1
mg/cm³, T11 = 145.3 mg/cm³, T12 = 133.6
mg/cm³). The BMD of all thoracic levels cranial to T6 was
statistically higher than the BMD of all levels caudal to T6 (p < .001).
Nonetheless, significant correlations in BMD among all measured thoracic
levels were observed, with a Pearson's correlation coefficient ranging
from 0.74 to 0.97. <br/>CONCLUSION(S): There is significant regional BMD
variation in the thoracic spine depending on spinal level. This BMD
variation might contribute to several clinically relevant phenomena.
First, vertebral fractures occur most commonly at the thoracolumbar
junction including T12. In addition to mechanical reasons, these fractures
might be partially attributed to thoracic BMD that is lowest at T12.
Second, the optimal upper instrumented vertebra (UIV) for stopping long
fusions to the sacrum and pelvis is controversial. The BMD of surgically
relevant upper thoracic stopping points (T2-T4) was significantly higher
than the BMD of lower thoracic stopping points (T10-T12). Besides stress
concentration at the relatively mobile lower thoracic segments, the low
BMD at these levels might contribute to previously suggested higher rates
of junctional failures with short fusions.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<95>
Accession Number
2013014534
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: 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, Kunming, China
Publisher
Blackwell Publishing Inc.
Abstract
Objective: Surgical ablation of atrial fibrillation (AF) has become a
routine procedure during concomitant cardiac surgery, however, the
extension of lesion sets remain controversial. We sought to compare the
relative benefit and risk of different lesion sets through a Bayesian
network meta-analysis (NMA). <br/>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. An 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).
<br/>Result(s): A total of 2031 patients of 19 RCTs were included. PVI,
LAM, and BAM (OR [95% Cr.I]: 5.02 [2.72, 10.02], 7.97 [4.93, 14.29], 8.29
[4.90, 14.86], p <.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 the random-effects model. BAM
was associated with an increase in early mortality when compared with no
ablation (OR [95% Cr.I]: 4.08 [1.23, 17.30], p <.05), while none of the
remaining comparisons reached statistical difference in terms of early
mortality and PPMI. <br/>Conclusion(s): Bi-atrial ablation is not superior
to left atrial ablation strategies in reducing AF recurrence for
un-selected surgical patients. BAM has a higher risk of early mortality
than no ablation, but no difference was found between bi-atrial and left
atrial ablation in regard to early mortality and PPMI based on the current
evidence.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC.

<96>
Accession Number
629252212
Title
Mid-term results of a randomized trial of tricuspid annuloplasty for
less-than-severe functional tricuspid regurgitation at the time of mitral
valve surgery.
Source
European Journal of Cardio-thoracic Surgery. 55 (5) (pp 851-858), 2019.
Date of Publication: 01 May 2019.
Author
Pettinari M.; De Kerchove L.; Lazam S.; Pasquet A.; Gerber B.;
Vanoverschelde J.-L.; El-Khoury G.
Institution
(Pettinari) Cardiac Surgery Department, Ziekenhuis Oost Limburg, Schiepse
Bos 6, Genk 3600, Belgium
(De Kerchove, El-Khoury) Cardiac Surgery Department, Universitair Clinique
St. Luc, Brussel, Belgium
(Lazam, Pasquet, Gerber, Vanoverschelde) Cardiology Department,
Universitair Clinique St. Luc, Brussel, Belgium
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The optimal management of functional tricuspid regurgitation
(FTR) in the setting of mitral valve operations remains controversial. The
current practice is both centre specific and surgeon specific with
guidelines based on non-randomized data. A prospective randomized trial
was performed to evaluate the worth of less-than-severe FTR repair during
mitral valve procedures. <br/>METHOD(S): A single-centre randomized study
was designed to allocate patients with less-than-severe FTR undergoing
mitral valve surgery to be prophylactically treated with or without
tricuspid valve annuloplasty (TVP-or TVP+). These patients were analysed
using longitudinal cardiopulmonary exercise capacity, echocardiographic
follow-up and cardiac magnetic resonance. The primary outcome was freedom
from more than or equal to moderate tricuspid regurgitation with vena
contracta >=4 mm. Secondary outcomes were maximal oxygen uptake and right
ventricular (RV) dimension and function. <br/>RESULT(S): A total of 53
patients were allocated to receive concomitant TVP+, and 53 patients were
treated conservatively (TVP-). At 5 years, tricuspid regurgitation was
observed to be greater than mild in 10 patients in the TVP-group and no
patients in the TVP+ group (P < 0.01). Maximal oxygen uptake, RV basal
diameter, end-diastolic diameter and end-systolic diameter and fractional
area changes were similar in both groups. Cardiac magnetic resonance
confirmed no differences in RV end-diastolic volume, RV end-systolic
volume and RV ejection fraction. <br/>CONCLUSION(S): This single-centre
prospective randomized trial demonstrated that prophylactic tricuspid
annuloplasty irrespective of annular dilatation at the time of mitral
surgery reduced the recurrence of moderate or severe FTR at 5-year
follow-up and reduced the pulmonary pressure. Nevertheless, the functional
capacity, the RV function and the RV dimension remained
similar.<br/>Copyright &#xa9; 2018 The Author(s). Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<97>
Accession Number
608791355
Title
Multicentre, randomized, double-blind trial of intracoronary autologous
mononuclear bone marrow cell injection in non-ischaemic dilated
cardiomyopathy (the dilated cardiomyopathy arm of the MiHeart study).
Source
European Heart Journal. 36 (42) (pp 2898-2904), 2015. Date of Publication:
07 Nov 2015.
Author
Martino H.; Brofman P.; Greco O.; Bueno R.; Bodanese L.; Clausell N.;
Maldonado J.A.; Mill J.; Braile D.; Moraes J.; Silva S.; Bozza A.; Santos
B.; De Carvalho A.C.
Institution
(Martino, Bozza, Santos, De Carvalho) Instituto Nacionalde Cardiologia,
Rua das Laranjeiras, 374/50 andar (PesquisaClinica), Rio de Janeiro, RJ
CEP 22240-006, Brazil
(Brofman) Santa Casa de Misericordiado Parana, Curitiba, Brazil
(Greco) Instituto de Molestias Cardiovasculares, Sao Jose do Rio Preto,
Brazil
(Bueno) Universidade Federal do Parana, Curitiba, Brazil
(Bodanese) Pontificia Universidade Catolica do Rio Grande do Sul, Porto
Alegre, Brazil
(Clausell) Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
(Maldonado) Universidade Federal do Amazonas, Manaus, Brazil
(Mill) Universidade Federal do Espirito Santo, Vitoria, Brazil
(Braile) Instituto Domingo Braile, Sao Jose do Rio Preto, Brazil
(Moraes) Hospital Agamenon Magalhaes, Recife, Brazil
(Silva) Hospital Pro-Cardiaco, Rio de Janeiro, Brazil
Publisher
Oxford University Press
Abstract
Aims: Pre-clinical and few clinical studies suggest that transplantation
of autologous bone marrow mononuclear cells (BMNC) improves heart function
in dilated cardiomyopathies. Our objective was to determine if
intracoronary injection of autologous BMNC improves the left ventricular
ejection fraction (LVEF) of patients with non-ischaemic dilated
cardiomyopathy (NIDCM). <br/>Methods and Results: This study was a
multicentre, randomized, double-blind, placebo controlled trial with a
follow-up of 12 months. Patients with NIDCM and LVEF <35% were recruited
at heart failure ambulatories in specialized hospitals around Brazil. One
hundred and sixty subjects were randomized to intracoronary injection of
BMNC or placebo (1:1). The primary endpoint was the difference in change
of LVEF between BMNC and placebo groups as determined by echocardiography.
One hundred and fifteen patients completed the study. Left ventricular
ejection fraction decreased from 24.0% (21.6-26.3) to 19.9% (15.4-24.4) in
the BMNC group and from 24.3% (22.1-26.5) to 22.1% (17.4-26.8) in the
placebo group. There were no significant differences in changes between
cell and placebo groups for left ventricular systolic and diastolic
volumes and ejection fraction. Mortality rate was 20.37% in placebo and
21.31% in BMNC. <br/>Conclusion(s): Intracoronary injection of autologous
BMNC does not improve left ventricular function in patients with
NIDCM.<br/>Copyright &#xa9; The Author 2015.

<98>
Accession Number
606438346
Title
Does preoperative statin therapy prevent postoperative atrial fibrillation
in patients undergoing cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 20 (3) (pp 422-428),
2015. Date of Publication: 01 Mar 2015.
Author
Goh S.L.; Yap K.H.; Chua K.C.; Chao V.T.T.
Institution
(Goh) Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney,
NSW 2050, Australia
(Yap, Chua, Chao) Department of Cardiothoracic Surgery, National Heart
Centre, Singapore General Hospital, Singapore, Singapore
Publisher
Oxford University Press
Abstract
Best evidence topic was written according to a structured protocol. The
question addressed was: does preoperative statin therapy prevent
postoperative atrial fibrillation (AF) in patients undergoing cardiac
surgery? There were 445 papers found using the reported search. From
these, 12 represented the best evidence to answer the clinical question.
The authors, journal, date and country of publication, patient group
studied, study type, relevant outcomes and results of these papers are
tabulated. This paper includes three systematic reviews with
meta-analysis, five randomized controlled trials and four retrospective
studies. All the papers compared either all or some of the following
postoperative complications: mortality, morbidity, AF, length of hospital
stay (intensive care unit and hospital) and inflammatory markers. The
largest study in this paper includes a systematic review of 91 491
patients that showed a reduction in postoperative AF with preoperative
statin therapy (OR = 0.71, 95% CI 0.61-0.82, P <0.0001). However, the
durations (3 days to 2 months preoperatively), doses and types of
preoperative statin differed between these papers. Although the majority
of studies (10 of 12) support the use of statins preoperatively, 2 studies
found no association between preoperative statin therapy and the reduction
of postoperative AF. In conclusion, the available evidence suggests that
preoperative statin therapy in patients undergoing elective cardiac
surgery is associated with the following: (1) a lower incidence and risk
of developing postoperative AF, (2) reduced stroke, (3) a shorter hospital
stay and (4) reduced levels of inflammatory markers postoperatively.
However, while the evidence supports the use of statins preoperatively,
the optimal duration, dose and type of statin cannot be concluded from
this review.<br/>Copyright &#xa9; The Author 2014. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<99>
Accession Number
606305851
Title
Morphological and functional consequences of transradial coronary
angiography on the radial artery: Implications for its use as a bypass
conduit.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 370-374), 2015.
Date of Publication: 01 Sep 2015.
Author
Gaudino M.; Leone A.; Lupascu A.; Toesca A.; Mazza A.; Ponziani F.R.;
Flore R.; Tondi P.; Massetti M.
Institution
(Gaudino, Leone, Mazza, Massetti) Department of Cardiovascular Science,
Catholic University, Rome, Italy
(Lupascu, Ponziani, Flore, Tondi) Department of Angiology, Catholic
University, Rome, Italy
(Toesca) Department of Human Anatomy, Catholic University, Rome, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: To assess the degree of damage to the radial artery (RA) in
coronary artery bypass grafting (CABG) patients who underwent preoperative
transradial coronary angiography (RA-CA). <br/>METHOD(S): From May 2012 to
October 2013, 50 consecutive CABG patients who underwent RA-CA were
prospectively enrolled in the study. All patients underwent echo-Doppler
evaluation of the RA of the catheterized arm; the contralateral RA was
used as control. The distal segment of the RA was submitted to
immunohistochemical assessment of endothelial integrity. Patients were
divided in three groups according to the time interval from angiography to
evaluation: <=24 h, >24 h to <7 days and >=7 days. <br/>RESULT(S):
Baseline RA median diameters were 0.25 +/- 0.04 cm in the cannulated arm
and 0.22 +/- 0.04 cm in the non-cannulated arm (P = 0.01). The
flow-mediated dilatation (FMD) in the RA in the catheterized arm and in
the control arm were 11.6 +/- 7.9 and 14.2 +/- 8.9 (P = 0.01),
respectively. A statistically significant correlation was found between
FMD of the catheterized RA and the time from RA-CA (Pearson's r = 0.348).
Linear regression analysis confirmed that the FMD of the catheterized RA
was dependent on days elapsed from the procedure (P = 0.032; OR 1.11, CI
0.009-0.203). Immunohistochemical evaluation showed extensive endothelial
lesion in all examined RAs, with a trend towards reduction of the damage
with time. Endothelial function and integrity of the cannulated arm did
not reach those of the control arm in any of the study patients.
<br/>CONCLUSION(S): RA-CA produces extensive damage to the RA. The lesions
tend to heal with time but incomplete recovery of endothelial integrity
and function is still present more than 30 days after the procedure. After
RA-CA, the cannulated RA should not be used for CABG.<br/>Copyright &#xa9;
The Author 2015. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery.

<100>
Accession Number
372831414
Title
Comparison of balloon-expandable vs self-expandable valves in patients
undergoing transcatheter aortic valve replacement: The CHOICE randomized
clinical trial.
Source
JAMA - Journal of the American Medical Association. 311 (15) (pp
1503-1514), 2014. Date of Publication: 16 Apr 2014.
Author
Abdel-Wahab M.; Mehilli J.; Frerker C.; Neumann F.-J.; Kurz T.; Tolg R.;
Zachow D.; Guerra E.; Massberg S.; Schafer U.; El-Mawardy M.; Richardt G.
Institution
(Abdel-Wahab, Tolg, El-Mawardy, Richardt) Heart Center, Segeberger
Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel and
Hamburg, Am Kurpark 1, 23795 Bad Segeberg, Germany
(Mehilli, Massberg) Munich University Clinic, Munich, Germany
(Frerker, Schafer) Cardiology Department, Asklepios Clinic St. Georg,
Hamburg, Germany
(Neumann) University Heart Center Freiburg-Bad Krozingen, Bad Krozingen,
Germany
(Kurz) Cardiology Department, Lubeck University Hospital, Lubeck, Germany
(Zachow) Radiology Department, Segeberger Kliniken, Bad Segeberg, Germany
(Guerra) Intracoronary Stenting and Antithrombosis Research Center,
Munich, Germany
(Schafer) Cardiology Department, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
Publisher
American Medical Association
Abstract
IMPORTANCE: Transcatheter aortic valve replacement (TAVR) is an effective
treatment option for high-risk patients with severe aortic stenosis.
Different from surgery, transcatheter deployment of valves requires either
a balloon-expandable or self-expandable system. A randomized comparison of
these 2 systems has not been performed. <br/>OBJECTIVE(S): To determine
whether the balloon-expandable device is associated with a better success
rate than the self-expandable device. DESIGN, SETTING, AND PATIENTS: The
CHOICE studywas an investigator-initiated trial in high-risk patients with
severe aortic stenosis and an anatomy suitable for the transfemoral TAVR
procedure. One hundred twenty-one patients were randomly assigned to
receive a balloon-expandable valve (Edwards Sapien XT) and 120 were
assigned to receive a self-expandable valve (Medtronic CoreValve).
Patients were enrolled between March 2012 and December 2013 at 5 centers
in Germany. INTERVENTIONS: Transfemoral TAVR with a balloon-expandable or
self-expandable device. MAIN OUTCOMES AND MEASURES: The primary end
pointwas device success, which is a composite end point including
successful vascular access and deployment of the device and retrieval of
the delivery system, correct position of the device, intended performance
of the heart valve without moderate or severe regurgitation, and only 1
valve implanted in the proper anatomical location. Secondary end points
included cardiovascular mortality, bleeding and vascular complications,
postprocedural pacemaker placement, and a combined safety end point at 30
days, including all-cause mortality, major stroke, and other serious
complications. <br/>RESULT(S): Device success occurred in 116 of 121
patients (95.9%) in the balloon-expandable valve group and 93 of 120
patients (77.5%) in the self-expandable valve group (relative risk [RR],
1.24, 95%CI, 1.12-1.37, P < .001). This was attributed to a significantly
lower frequency of residual more-than-mild aortic regurgitation (4.1%vs
18.3%; RR, 0.23; 95%CI, 0.09-0.58; P < .001) and the less frequent need
for implanting more than 1 valve (0.8%vs 5.8%, P = .03) in the
balloon-expandable valve group. Cardiovascular mortality at 30 days was
4.1% in the balloon-expandable valve group and 4.3%in the self-expandable
valve group (RR, 0.97; 95% CI, 0.29-3.25; P = .99). Bleeding and vascular
complications were not significantly different, and the combined safety
end point occurred in 18.2%of those in the balloon-expandable valve group
and 23.1%of the self-expandable valve group (RR, 0.79; 95%CI, 0.48-1.30; P
= .42). Placement of a new permanent pacemaker was less frequent in the
balloon-expandable valve group (17.3%vs 37.6%, P = .001). CONCLUSIONS AND
RELEVANCE: Among patients with high-risk aortic stenosis undergoing TAVR,
the use of a balloon-expandable valve resulted in a greater rate of device
success than use of a self-expandable valve. TRIAL REGISTRATION:
clinicaltrials.gov Identifier: NCT01645202. Copyright 2014 American
Medical Association. All rights reserved.

<101>
Accession Number
366300003
Title
Randomized comparison between mild and moderate hypothermic
cardiopulmonary bypass for neonatal arterial switch operation.
Source
European Journal of Cardio-thoracic Surgery. 41 (3) (pp 581-586), 2012.
Date of Publication: March 2012.
Author
Aydemir N.; Harmanda B.; Karac A.R.; Erdem A.; Yurtseven N.; Sasmaze A.;
Yekeler I.
Institution
(Aydemir, Harmanda, Karac, Sasmaze, Yekeler) Department of Pediatric
Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Training and
Research Hospital, Istanbul, Turkey
(Erdem) Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and
Cardiovascular Training and Research Hospital, Istanbul, Turkey
(Yurtseven) Department of Anesthesiology and Reanimation, Dr. Siyami Ersek
Thoracic and Cardiovascular Training and Research Hospital, Istanbul,
Turkey
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: To compare neonates receiving arterial switch operation (ASO)
either with mild or moderate hypothermic cardiopulmonary bypass.
<br/>Method(s): Forty neonates undergoing ASO were randomized to receive
either mild (Mi>32degreeC, n=20) or moderate (Mo>26degreeC, n=20)
hypothermic cardiopulmonary bypass (CPB) between April 2007 and June 2010.
All patients were diagnosed with simple transposition of the great
arteries. Mean age (Mi: 8.32 +/-4.5 days, Mo: 7.54 +/-5.0 days, P=0.21)
and body weight were similar in both groups (Mi: 3.64 +/- 0.91 kg, Mo:
3.73 +/- 0.84 kg, P=0.14). Follow-up was 3.1 +/- 2.5 years for all
patients. <br/>Result(s): Lowest perioperative rectal temperature was
33.5+/- 1.4degreeC (Mi) versus 28.2+/-2.1degreeC (Mo) (P<0.001). All
patients safely weaned from CPB required lower doses of dopamine (Mi: 5.1
+/-2.4 mug/kg min, Mo: 6.5 +/-2.1 mu/kg min, P=0.04), dobutamine (Mi: 7.2
+/- 2.5 mug/kg min, Mo: 8.6+/-2.4mu/kg min, P=0.04) and adrenalin (Mi:
0.02 +/- 0.02 mug/kg min, Mo: 0.05 +/-0.03 mu/kg min, P=0.03) in mild
hypothermia group. Intraoperative blood transfusion (Mi: 190 +/-58 ml, Mo:
230 +/-24 ml, P=0.03) and postoperative lactate levels (Mi: 2.7 +/-0.9
mmol/l, Mo: 3.1 +/-2.2 mmol/l, P=0.02) were lower under mild hypothermia.
Secondary chest closure was performed in 30% (Mi) versus 35% (Mo)
(P=0.65). Duration of inotropic support (Mi: 7 (4-11) days, Mo: 11 (7-15)
days, P=0.03), time to extubation (Mi: 108 (88-128) h, Mo: 128 (102-210)
h, P=0.04), lengths of intensive care unit (ICU) stay (Mi: 9 (5-14) days,
Mo: 12 (10-18) days, P=0.04) and hospital stay (Mi: 19 (10-29) days, Mo:
23 (15-37) days, P=0.04) were significantly shorter under mild
hypothermia. Two-year freedom from reoperation was 100% for both the
groups. <br/>Conclusion(s): The ASO under mild hypothermia seemed to be
beneficial for pulmonary recovery, need for inotropic support and length
of ICU and hospital stay. No worse early-or intermediate-term effects of
mild hypothermia were found. &#xa9; The Author 2011. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<102>
Accession Number
2004650982
Title
Exercise-based cardiac rehabilitation and parasympathetic function in
patients with coronary artery disease: a systematic review and
meta-analysis.
Source
Clinical Autonomic Research. 31 (2) (pp 187-203), 2021. Date of
Publication: April 2021.
Author
Manresa-Rocamora A.; Ribeiro F.; Sarabia J.M.; Ibias J.; Oliveira N.L.;
Vera-Garcia F.J.; Moya-Ramon M.
Institution
(Manresa-Rocamora, Sarabia, Vera-Garcia, Moya-Ramon) Sport Research
Centre, Miguel Hernandez University, Avenida de la Universidad s/n, Elche
03202, Spain
(Ribeiro) School of Health Sciences and Institute of Biomedicine-iBiMED,
University of Aveiro, Building 30, Agras do Crasto-Campus Universita rio
de Santiago, Aveiro 3810-193, Portugal
(Sarabia, Moya-Ramon) Department of Sport Sciences, Miguel Hernandez
University, Elche, Institute for Health and Biomedical Research
(ISABIAL-FISABIO Foundation), Alicante, Spain
(Ibias) Department of Behavioral Sciences and Methodology, Faculty of
Psychology, National Distance Education University (UNED), Juan del Rosal
10, Madrid 28040, Spain
(Oliveira) National Institute of Science and Technology for Health
Technology Assessment (IATS/HCPA) and Exercise Pathophysiology Laboratory,
Hospital de Clinicas de Porto Alegre, Clinical Research Center, Rua Ramiro
Barcelos 2350, Porto Alegre, RS, Brazil
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: The effects of exercise-based cardiac rehabilitation (CR) on
parasympathetic modulation are controversial. This systematic review and
meta-analysis aims to (a) determine the effect of exercise-based CR on
heart-rate-derived indices associated with cardiac parasympathetic
modulation in resting and post-exercise conditions in coronary artery
disease (CAD) patients and (b) identify the possible moderator variables
of the effect of exercise-based CR on parasympathetic modulation.
<br/>Method(s): We searched CENTRAL and Web of Science up to November 2018
for the following terms: adult CAD patients, controlled exercise-based CR
interventions and parasympathetic modulation measured in resting
(vagal-related heart rate variability [HRV] indices of the root mean
square of the differences in successive in RR interval [RMSSD] and high
frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and
post-intervention. We estimated a random-effects model of standardised
mean difference (SMD) and mean difference (MD) for vagal-related HRV
indices and HRR, respectively. We assessed the influence of categorical
and continuous variables. <br/>Result(s): The overall effect size showed
significant differences in RMSSD (SMD<inf>+</inf> = 0.30; 95% confidence
interval [CI] = 0.12-0.49) and HRR (MD<inf>+</inf> = 5.35; 95% CI =
4.08-6.61 bpm) in favour of the exercise-based CR group. The overall
effect size showed no differences in HF between groups (SMD<inf>+</inf> =
0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical
significance, with high heterogeneity for HF (p < 0.001; I² =
70%) and HRR (p < 0.001; I² = 85%). Analysis of the moderator
variables showed that the effect on HRR is greater in young patients (p =
0.008) and patients treated with percutaneous intervention (p = 0.020).
<br/>Conclusion(s): Exercise-based CR improves the post-exercise
parasympathetic function, with greater effects in younger CAD patients and
in those who were revascularised with percutaneous intervention. The
effects on resting parasympathetic function are more controversial due to
methodological inconsistencies in measuring HRV, with the use of RMSSD
recommended instead of HF because its results show higher consistency.
Future studies involving women, focusing on methodological issues, and
performing other training methods are needed to increase our knowledge
about this topic.<br/>Copyright &#xa9; 2020, Springer-Verlag GmbH Germany,
part of Springer Nature.

<103>
Accession Number
2006936024
Title
Effect of perioperative intravenous lidocaine on the incidence of
short-term cognitive function after noncardiac surgery: A meta-analysis
based on randomized controlled trials.
Source
Brain and Behavior. 10 (12) (no pagination), 2020. Article Number: e01875.
Date of Publication: December 2020.
Author
Huang X.; Sun Y.; Lin D.; Wei C.; Wu A.
Institution
(Huang, Lin, Wei, Wu) Anesthesia Department of Beijing Chao-Yang Hospital,
Beijing, China
(Sun) Pharmacy Department of Beijing Chao-Yang Hospital, Beijing, China
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: Postoperative cognitive dysfunction is a debilitating
postoperative complication. The perioperative neuroprotective effect of
lidocaine has conflicting results. <br/>Method(s): In this qualitative
review of randomized controlled clinical trials on the perioperative use
of lidocaine, we report the effects of intravenous lidocaine on brain
function after noncardiac surgery. Studies were identified from PubMed,
MEDLINE, and Cochrane Central Register. <br/>Result(s): Of the 453
retrieved studies, 4 randomized trials were included. No significant
association between the use of lidocaine postoperative cognitive states
was found (risk ratio 0.67; 95% CI -0.02 to 1.36; I²89%; p
=.06). <br/>Conclusion(s): Current evidence cannot suggest that
perioperative intravenous use of lidocaine has pharmacological brain
neuroprotection after noncardiac surgery. All the included studies were
small-scale research, and the total number of participants was small; the
results should be interpreted with caution.<br/>Copyright &#xa9; 2020 The
Authors. Brain and Behavior published by Wiley Periodicals LLC.

<104>
Accession Number
628375022
Title
Role of coronary angiography in patients with a non-diagnostic
electrocardiogram following out of hospital cardiac arrest: Rationale and
design of the multicentre randomized controlled COUPE trial.
Source
European Heart Journal: Acute Cardiovascular Care. 9 (4_suppl) (pp
S131-S137), 2020. Date of Publication: November 2020.
Author
Viana-Tejedor A.; Ariza-Sole A.; Martinez-Selles M.; Mena M.J.; Vila M.;
Garcia C.; Garcia Acuna J.M.; Baneras J.; Garcia Rubira J.C.; Perez P.J.;
Querol C.T.; Pastor G.; Andrea R.; Osorio P.L.; Alonso N.; Martinez C.;
Perez Rodriguez M.; Noriega F.J.; Ferrera C.; Salinas P.; Gil I.N.; Ortiz
A.F.; Macaya C.
Institution
(Viana-Tejedor, Noriega, Ferrera, Salinas, Gil, Ortiz, Macaya) Cardiology
Department, Hospital Clinico San Carlos, Instituto de Investigacion
Sanitaria Hospital Clinico San Carlos (IdISSC), Madrid, Spain
(Ariza-Sole) Cardiology Department, Hospital Universitari de Bellvitge,
Barcelona, Spain
(Martinez-Selles) Cardiology Department, Hospital General Universitario
Gregorio Maranon, CIBERCV, Universidad Complutense, Universidad Europea,
Madrid, Spain
(Mena) Cardiology Department, Hospital Universitario Ramon y Cajal,
Madrid, Spain
(Vila) Cardiology Department, Fundacio Institut de Recerca de l'Hospital
de la Santa Creu i Sant Pau, Barcelona, Spain
(Garcia) Cardiology Department, Hospital Universitari Germans Trias i
Pujol, CIBERCV, Barcelona, Spain
(Garcia Acuna) Cardiology Department, Hospital Universitario de Santiago
de Compostela, CIBERCV, Spain
(Baneras) Cardiology Department, Hospital Universitario Vall d'Hebron,
CIBERCV, Barcelona, Spain
(Garcia Rubira) Cardiology Department, Hospital Virgen de la Macarena,
Seville, Spain
(Perez) Cardiology Department, Hospital Universitario de Canarias,
Tenerife, Spain
(Querol) Cardiology Department, Hospital Universitari Arnau de Vilanova,
Lleida - IRBLL, Lleida, Spain
(Pastor) Cardiology Department, Hospital Clinico Universitario de
Valladolid, CIBERCV, Valladolid, Spain
(Andrea) Instituto Cardiovascular, Hospital Clinic, IDIBAPS, Universidad
de Barcelona, Institut de Investigacions Mediques Pi i Sunyer, Spain
(Osorio) Cardiology Department, Institut d Investigacion Biomedica Dr,
Josep Trueta de Girona, CIBERCV, Girona, Spain
(Alonso) Cardiology Department, Hospital Universitario de Leon, Spain
(Martinez) Intensive Care Medicine Department, Hospital Universitario
Principe de Asturias, Madrid, Spain
(Perez Rodriguez) Cardiology Department. Hospital, Universitari de
Tarragona Joan XXIII. Tarragona, Spain
Publisher
SAGE Publications Inc.
Abstract
Background: Coronary artery disease (CAD) is a major cause of
out-of-hospital cardiac arrest (OHCA). The role of emergency coronary
angiography (CAG) and percutaneous coronary intervention (PCI) following
cardiac arrest in patients without ST-segment elevation myocardial
infarction (STEMI) remains unclear. <br/>Aim(s): We aim to assess whether
emergency CAG and PCI, when indicated, will improve survival with good
neurological outcome in post-OHCA patients without STEMI who remain
comatose. <br/>Method(s): COUPE is a prospective, multicentre and
randomized controlled clinical trial. A total of 166 survivors of OHCA
without STEMI will be included. Potentially non-cardiac aetiology of the
cardiac arrest will be ruled out prior to randomization. Randomization
will be 1:1 for emergency (within 2 h) or deferred (performed before
discharge) CAG. Both groups will receive routine care in the intensive
cardiac care unit, including therapeutic hypothermia. The primary efficacy
endpoint is a composite of in-hospital survival free of severe dependence,
which will be evaluated using the Cerebral Performance Category Scale. The
safety endpoint will be a composite of major adverse cardiac events
including death, reinfarction, bleeding and ventricular arrhythmias.
<br/>Conclusion(s): This study will assess the efficacy of an emergency
CAG versus a deferred one in OHCA patients without STEMI in terms of
survival and neurological impairment.<br/>Copyright &#xa9; The European
Society of Cardiology 2019.

<105>
Accession Number
627964740
Title
Engaging hospitalized patients with personalized health information: a
randomized trial of an inpatient portal.
Source
Journal of the American Medical Informatics Association. 26 (2) (pp
115-123), 2019. Date of Publication: 01 Feb 2019.
Author
Creber R.M.M.; Grossman L.V.; Ryan B.; Qian M.; Polubriaginof F.C.G.;
Restaino S.; Bakken S.; Hripcsak G.; Vawdrey D.K.
Institution
(Creber) Department of Healthcare Policy and Research, Division of Health
Informatics, Weill Cornell Medicine, New York, NY, United States
(Grossman, Polubriaginof, Hripcsak, Vawdrey) Department of Biomedical
Informatics, Columbia University, New York, NY, United States
(Ryan, Polubriaginof, Vawdrey) Value Institute at NewYork-Presbyterian
Hospital/Department of Biomedical Informatics, Columbia University, 622
West 168th St., New York, NY 10032, United States
(Qian) Department of Biostatistics, Columbia University, New York, NY,
United States
(Restaino) Columbia University Medical Center, New York, NY, United States
(Bakken) Department of Biomedical Informatics, School of Nursing, Data
Science Institute, Columbia University, New York, NY, United States
Publisher
Oxford University Press
Abstract
Objective: To determine the effects of an inpatient portal intervention on
patient activation, patient satisfaction, patient engagement with health
information, and 30-day hospital readmissions. Methods and Materials: From
March 2014 to May 2017, we enrolled 426 English-or Spanish-speaking
patients from 2 cardiac medical-surgical units at an urban academic
medical center. Patients were randomized to 1 of 3 groups: 1) usual care,
2) tablet with general Internet access (tablet-only), and 3) tablet with
an inpatient portal. The primary study outcome was patient activation
(Patient Activation Measure-13). Secondary outcomes included all-cause
readmission within 30 days, patient satisfaction, and patient engagement
with health information. <br/>Result(s): There was no evidence of a
difference in patient activation among patients assigned to the inpatient
portal intervention compared to usual care or the tablet-only group.
Patients in the inpatient portal group had lower 30-day hospital
readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P0.044).
There was evidence of a difference in patient engagement with health
information between the inpatient portal and tabletonly group, including
looking up health information online (89.6% vs. 51.8%; P<0.001).
Healthcare providers reported that patients found the portal useful and
that the portal did not negatively impact healthcare delivery.
<br/>Conclusion(s): Access to an inpatient portal did not significantly
improve patient activation, but it was associated with looking up health
information online and with a lower 30-day hospital readmission rate.
These results illustrate benefit of providing hospitalized patients with
real-time access to their electronic health record data while in the
hospital.<br/>Copyright &#xa9; The Author(s) 2018.

<106>
Accession Number
620129078
Title
Mechanical aortic valve replacement in non-elderly adults: Meta-analysis
and microsimulation.
Source
European Heart Journal. 38 (45) (pp 3370-3377), 2017. Date of Publication:
01 Dec 2017.
Author
Korteland N.M.; Etnel J.R.G.; Arabkhani B.; Mokhles M.M.; Mohamad A.;
Roos-Hesselink J.W.; Bogers A.J.J.C.; Takkenberg J.J.M.
Institution
(Korteland, Etnel, Arabkhani, Mokhles, Bogers, Takkenberg) Department of
Cardiothoracic Surgery, Erasmus MC, PO Box 2040, Rotterdam 3000 CA,
Netherlands
(Mohamad) Department of Radiology, Erasmus MC, PO Box 2040, Rotterdam 3000
CA, Netherlands
(Roos-Hesselink) Department of Cardiothoracic Cardiology, Erasmus MC, PO
Box 2040, Rotterdam 3000 CA, Netherlands
Publisher
Oxford University Press
Abstract
Aims To support decision-making regarding prosthetic valve selection in
non-elderly adults, we aim to provide a detailed overview of outcome after
contemporary mechanical aortic valve replacement (AVR). Methods and
results A systematic review was conducted for papers reporting clinical
outcome after AVR with bileaflet mechanical valves with a mean patient age
>=18 and <=55 years, published between 1 January 1995 and 31 December
2015. Through meta-analysis outcomes were pooled and entered into a
microsimulation model to calculate (event-free) life expectancy and
lifetime event risk. Twenty-nine publications, encompassing a total of
5728 patients with 32 515 patient-years of follow-up (pooled mean
follow-up: 5.7 years), were included. Pooled mean age at surgery was 48.0
years. Pooled early mortality risk was 3.15% (95% confidence interval
(CI):2.37-4.23), late mortality rate was 1.55%/year (95%CI:1.25-1.92);
38.7% of late deaths were valve-related. Pooled thromboembolism rate was
0.90%/year (95%CI:0.68-1.21), major bleeding 0.85%/year (95%CI:0.65-1.12),
nonstructural valve dysfunction 0.39%/year (95%CI:0.21-0.76), endocarditis
0.41%/year (95%CI:0.29-0.57), valve thrombosis 0.14%/year
(95%CI:0.08-0.25), structural valve deterioration 0.00%/year (zero events
observed), and reintervention 0.51%/year (95%CI:0.37-0.71), mostly due to
nonstructural valve dysfunction and endocarditis. For a 45-year-old, for
example, this translated to an estimated life expectancy of 19 years
(general population: 34 years) and lifetime risks of thromboembolism,
bleeding and reintervention of 18%, 15%, and 10%, respectively. Conclusion
This study demonstrates that outcome after mechanical AVR in non-elderly
adults is characterized by suboptimal survival and considerable lifetime
risk of anticoagulation-related complications, but also reoperation.
Non-elderly adult patients who are facing prosthetic valve selection are
entitled to conveyance of evidence-based estimates of the risks and
benefits of both mechanical and biological valve options in a shared
decision-making process.<br/>Copyright &#xa9; 2017 The Author.

<107>
Accession Number
2013409262
Title
Therapeutic effects of ulinastatin on postoperative complications and
cognitive function in elderly patients with esophageal cancer after
thoracic laparoscopic surgery.
Source
Tropical Journal of Pharmaceutical Research. 20 (6) (pp 1285-1291), 2021.
Date of Publication: 2021.
Author
Yuan P.; Wang Y.; Jin C.; Wang D.
Institution
(Yuan, Jin, Wang) Department of Thoracic Surgery, First People's Hospital,
Jinan, China
(Wang) Department of Geriatrics, Fifth People's Hospital, Qingdao, China
Publisher
University of Benin
Abstract
Purpose: To investigate the therapeutic effect of ulinastatin on
postoperative complications and cognitive function in elderly patients
with esophageal cancer after thoracic laparoscopic surgery.
<br/>Method(s): A total of 100 elderly in-patients with esophageal cancer
who had undergone thoracic laparoscopic surgery from April 2019 to
December 2020 were selected and randomly assigned to control and study
groups. Patients in control group received conventional treatment, while
those in the study group were administered ulinastatin. The two groups
were compared with respect to response, incidence of postoperative
complications, Mini-Mental State Examination (MMSE) cognitive function
score, Barthel Index (BI) scores; preoperative, intraoperative, 12-h and
24-h post-surgery levels of IL-1beta and IL-6; levels of CD3⁺,
CD4⁺ and CD8⁺, as well as duration of surgery and
waking time. <br/>Result(s): Response, MMSE score, BI index, and levels of
CD3⁺, CD4⁺ and CD8⁺ in the study group
were significantly higher than those in the control group (p < 0.05).
Incidence of postoperative complications, and expression levels of
IL-1beta and IL-6 12 h and 24 h after surgery in the study group were
lower than the corresponding control levels (p < 0.05). There were no
significant differences in duration of operation and waking time between
the two groups (p > 0.05). <br/>Conclusion(s): Ulinastatin significantly
reduces postoperative complications, and also improves cognitive function
in elderly patients with esophageal cancer after thoracic laparoscopic
surgery. This finding is of great significance in the treatment of these
patients.<br/>Copyright &#xa9; Pharmacotherapy Group, Faculty of Pharmacy,
University of Benin, Benin City, 300001 Nigeria.

<108>
Accession Number
2013079809
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: 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,
Aurora, CO, United States
(Mehta, Racharla) Department of Cardiology, Lehigh Valley Health Network,
Allentown, PA, United States
(Garg) Department of Electrophysiology, Hospital of the University of
Pennsylvania, PA, United States
(Kurtz) Department of Internal Medicine, Lehigh Valley Health Network,
Allentown, PA, United States
(Afzal) Department of Electrophysiology, Ohio State University, Columbus,
OH, United States
(Turagam) Department of Electrophysiology, The Mount Sinai Hospital, New
York City, NY, United States
(Lakkireddy) Department of Electrophysiology, Overland Park Regional
Medical Center, Overland Park, KS, United States
Publisher
Blackwell Publishing Inc.
Abstract
Introduction: 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. <br/>Methods and Results: Studies
reporting left atrial appendage epicardial closure over a 12-year period
from 2009 to 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 1430 patients were included
in this analysis, of which 1386 (97%) underwent successful device
placement. The mean age was 69.3 years, with a mean CHADS<inf>2</inf>-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 consisted of all-cause
mortality 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 <.0001), a longer duration pericardial drainage, and use of
anti-inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use
decreased from 44.7% to 22.9% post device implantation, and to 8.5% on
last clinical follow up. <br/>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.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC