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<1>
Accession Number
2005987890
Title
Asymmetric dimethylarginine predicts perioperative cardiovascular
complications in patients undergoing medium-to-high risk non-cardiac
surgery.
Source
Journal of International Medical Research. 48 (8) (no pagination), 2020.
Date of Publication: August 2020.
Author
Appel D.; Boger R.; Windolph J.; Heinze G.; Goetz A.E.; Hannemann J.
Institution
(Appel, Heinze, Goetz) University Medical Center Hamburg-Eppendorf,
Department of Anesthesiology, Hamburg, DE, Germany
(Boger, Windolph, Hannemann) University Medical Center Hamburg-Eppendorf,
Institute of Clinical Pharmacology and Toxicology, Hamburg, DE, Germany
Publisher
SAGE Publications Ltd
Abstract
Objectives: Perioperative cardiovascular events remain an important factor
that affects surgery outcome. We assessed if asymmetric dimethylarginine
(ADMA), an endogenous inhibitor of nitric oxide synthesis, predicts
perioperative risk, and if pre-operative supplementation with
L-arginine/L-citrulline improves the plasma L-arginine/ADMA ratio.
<br/>Method(s): In this prospective study, planned thoracic and/or
abdominal surgery patients were randomized to receive
L-arginine/L-citrulline (5 g/day) or placebo 1 to 5 days before surgery.
We measured perioperative plasma ADMA and L-arginine levels. The primary
outcome was a 30-day combined cardiovascular endpoint. <br/>Result(s):
Among 269 patients, 23 (8.6%) experienced a major adverse cardiovascular
event. ADMA and C-reactive protein were significantly associated with the
incidence of cardiovascular complications in the multivariable-adjusted
analysis. The L-arginine plasma concentration was significantly higher on
the day of surgery with L-arginine/L-citrulline supplementation compared
with placebo. In patients with high pre-operative ADMA, there was a
non-significant trend towards reduced incidence of the primary endpoint
with L-arginine/L-citrulline supplementation (six vs. nine events).
<br/>Conclusion(s): ADMA is a predictor of major adverse cardiovascular
complications in the perioperative period for patients who are undergoing
major abdominal and/or thoracic surgery. Supplementation with
L-arginine/L-citrulline increased the L-arginine plasma concentration,
enhanced the L-arginine/ADMA ratio, and induced a trend towards fewer
perioperative events.<br/>Copyright &#xa9; The Author(s) 2020.

<2>
Accession Number
614678286
Title
A modified Cox maze IV procedure: A simpler technique for the surgical
treatment of atrial fibrillation.
Source
Interactive Cardiovascular and Thoracic Surgery. 23 (6) (pp 856-860),
2016. Date of Publication: December 2016.
Author
Shi J.; Bai Z.-X.; Zhang B.-G.; Ren W.-J.; Guo Y.-Q.
Institution
(Shi, Bai, Zhang, Ren, Guo) Department of Cardiovascular Surgery, West
China Hospital, Sichuan University, Chengdu, Sichuan, China
Publisher
Oxford University Press
Abstract
OBJECTIVES: To determine the effectiveness of a simplified surgical
treatment method for atrial fibrillation (AF). <br/>METHOD(S): Between
September 2012 and October 2013, 120 patients (mean age, 52.3 +/- 8.8
years) underwent valve surgery and concomitant bipolar radiofrequency
ablation for the treatment of AF. Patients were randomized to a Cox maze
IV procedure (CMP-IV) group (n = 60) or a modified CMP-IV (MCMP-IV) group
(n = 60). Freedom from AF was defined as freedom from any left atrial
arrhythmia lasting <30 s and no requirement of antiarrhythmic drugs after
6 months. Data were recorded at postoperative follow-up examinations,
which were scheduled at 1, 3, 6 and 12 months, and annually thereafter.
<br/>RESULT(S): No ablation-related complications occurred in either
group. The mean ablation time was longer in the CMP-IV group than in the
MCMP-IV group (18.5 +/- 1.7 vs 16.6 +/- 1.6 min, P < 0.001). The mean
follow-up time was 32.4 +/- 3.6 months (range, 26-39 months). Freedom from
AF tended to be higher, but not significantly so, among the MCMP-IV group
than among the CMP-IV group over the entire follow-up period.
<br/>CONCLUSION(S): The MCMP-IV is an effective surgical procedure for the
treatment of AF. In certain patients, such as those with anatomic
variations of the pulmonary veins, the MCMP-IV is simpler than the CMP-IV.
CLINICAL TRIALS REGISTRATION ID: ChiCTR-TRC-12002742.<br/>Copyright &#xa9;
The Author 2016. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<3>
Accession Number
604281230
Title
Ischaemic heart disease during pregnancy or post-partum: Systematic review
and case series.
Source
Netherlands Heart Journal. 23 (5) (pp 249-257), 2015. Date of Publication:
May 2015.
Author
Lameijer H.; Kampman M.A.M.; Oudijk M.A.; Pieper P.G.
Institution
(Lameijer, Kampman, Pieper) Department of Cardiology, University Medical
Centre Groningen, University of Groningen, Hanzeplein 1, Groningen 9700
RB, Netherlands
(Lameijer) Department of Emergency Medicine, University Medical Centre
Groningen, University of Groningen, Groningen, Netherlands
(Kampman) The Netherlands Heart Institute (ICIN), Utrecht, Netherlands
(Oudijk) Department of Obstetrics, University Medical Centre Utrecht,
University of Utrecht, Utrecht, Netherlands
Publisher
Bohn Stafleu van Loghum
Abstract
The risk of manifestations of ischaemic heart disease (IHD) in fertile
women is elevated during pregnancy and the post-partum period. With
increasing maternal age and a higher prevalence of cardiac risk factors,
the incidence of IHD during pregnancy is rising. However, information in
the literature is scarce. We therefore performed a retrospective cohort
study and systematically reviewed the overall (1975-2013) and contemporary
(2005-2013) literature concerning IHD presenting during pregnancy or in
the post-partum period. We report two cases of IHD with atypical
presentation during pregnancy or post-partum. In our review, we describe
146 pregnancies, including 57 contemporary cases (2005-2013). Risk factors
for IHD were present in 80 %. Of the cases of IHD, 71 % manifested in the
third trimester or the post-partum period, and 95 % presented with chest
pain. The main cause was coronary dissection (35 %), or thrombus/emboli
(35 %) in the more contemporary group. Maternal mortality was 8 % (6 % in
the contemporary group), and the main cardiac complication was ventricular
tachycardia (n = 17). Premature delivery rate was 56 %, and caesarean
section was performed in 57 %. Perinatal mortality was 4 %. In conclusion,
IHD during pregnancy or in the post-partum period has high maternal
mortality and morbidity rates. Also, premature delivery and perinatal
mortality rates are high.<br/>Copyright &#xa9; The Author(s) 2015.

<4>
Accession Number
600590850
Title
Effective Risk Stratification of Patients on the Basis of Myocardial
Perfusion SPECT Is Dependent on Appropriate Patient Selection.
Source
Current Cardiology Reports. 17 (1) (no pagination), 2015. Date of
Publication: January 2015.
Author
Alexander S.; Doukky R.
Institution
(Alexander, Doukky) Division of Cardiology, Rush University Medical
Center, Chicago, IL, United States
(Doukky) Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, 1901 W. Harrison St., Chicago, IL 60612, United States
Publisher
Current Medicine Group LLC 1
Abstract
Myocardial perfusion imaging (MPI) with single-photon emission computed
tomography (SPECT) is commonly used in risk assessment, as an abnormal
scan predicts a multifold increase in cardiac risk. Recent studies have
showed that application of the appropriate use criteria (AUC) sharpens the
prognostic value of SPECT-MPI, while inappropriate use is clinically
ineffective and may lead to unnecessary downstream invasive testing and
revascularization procedures. In this review, we will discuss recent
literature examining the impact of appropriate use on the prognostic value
of SPECT-MPI and downstream decision-making. We will also discuss the
implications of appropriate use on cost-effectiveness of
MPI.<br/>Copyright &#xa9; 2014, Springer Science+Business Media New York.

<5>
Accession Number
52228033
Title
Clinical profile and outcome of patients with severe aortic stenosis at
high surgical risk: Single-center prospective evaluation according to
treatment assignment.
Source
Catheterization and Cardiovascular Interventions. 81 (5) (pp 871-881),
2013. Date of Publication: April 2013.
Author
Dvir D.; Sagie A.; Porat E.; Assali A.; Shapira Y.; Vaknin-Assa H.; Shafir
G.; Bental T.; Nevzorov R.; Battler A.; Kornowski R.
Institution
(Dvir, Sagie, Assali, Shapira, Vaknin-Assa, Bental, Nevzorov, Battler,
Kornowski) Department of Cardiology, Tel Aviv University, Rabin Medical
Center, Petach Tikva 49100, Israel
(Porat) Department of Cadiothoracic Surgery, Rabin Medical Center, Petach
Tikva, Tel Aviv University, Tel Aviv, Israel
(Shafir) Department of Radiology, Rabin Medical Center, Petach Tikva, Tel
Aviv University, Tel Aviv, Israel
Publisher
John Wiley and Sons Inc
Abstract
Background: The study sought to assess the clinical profile, outcome, and
predictors for mortality of ''real-world'' high-risk severe aortic
stenosis patients according to the mode of treatment assigned.
<br/>Method(s): Patients were referred to a dedicated clinic for
meticulous screening and multidisciplinary team assessment and 343 were
finally assigned treatment (age 81.3 +/- 7.2 years, 42.3% men):
transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN or
CoreValve device, 100 (29.2%); surgical aortic valve replacement (SAVR),
61 (17.8%); balloon valvuloplasty (as definitive therapy), 27 (7.9%);
medication only, 155 (45.2%). No patient was lost to follow-up.
<br/>Result(s): The balloon valvuloplasty group had a significantly higher
1-month mortality rate (18.5%) than the TAVR group (3%, P = 0.006) and
medical therapy group (3.9%; P = 0.004), without significant difference
from the SAVR group (11.5%, P = 0.5). Oneyear cumulative survival was
significantly higher in the TAVR group (92%) than in the other groups
(SAVR 71%, balloon valvuloplasty 61.5%, medication 65%; all P > 0.001).
Among survivors, 1-year rates of high functional class (NYHA I/II) were as
follows: TAVR, 84.6%; SAVR, 63.3%; balloon valvuloplasty, 18.2%;
medication, 21.4% (TAVR vs. SAVR, P = 0.04; SAVR vs. balloon valvuloplasty
or medical therapy, P = 0.01). On multivariate regression analysis, renal
failure (hazard ratio [HR] = 5.3, P > 0.001), not performing TAVR (HR =
4.9, P > 0.001), and pulmonary pressure (10 mm Hg, HR = 1.2, P = 0.02)
were independent predictors of 1-year mortality. <br/>Conclusion(s): TAVR,
performed in carefully selected high-risk patients, is associated with an
excellent survival rate and high functional class. Patients treated with
another of the available modalities, including SAVR, had a worse outcome,
regardless of which alternative treatment they receive. &#xa9; 2012 Wiley
Periodicals, Inc.

<6>
Accession Number
611310900
Title
Is stereotactic ablative radiotherapy equivalent to sublobar resection in
high-risk surgical patients with Stage I non-small-cell lung cancer?.
Source
Interactive Cardiovascular and Thoracic Surgery. 17 (5) (pp 845-853),
2013. Date of Publication: November 2013.
Author
Mahmood S.; Bilal H.; Faivre-Finn C.; Shah R.
Institution
(Mahmood) Royal Oldham Hospital, Oldham, Lancashire, United Kingdom
(Bilal, Shah) Department of Cardiothoracic Surgery, University Hospital
South Manchester, Wythenshawe, Manchester M239LT, United Kingdom
(Faivre-Finn) Department of Clinical Oncology, Christie Hospital NHS
Trust, Withington, Manchester, 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 stereotactic ablative
radiotherapy equivalent to sublobar resection in high-risk surgical
patients with Stage I non-small cell lung cancer?'. Altogether over 318
papers were found, of which 18 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. Stereotactic ablative radiotherapy (SABR) and
sublobar resection (SLR) offer clear survival benefit in the treatment of
early-stage non-small-cell lung cancer (NSCLC) in high-risk patients
unsuitable for lobectomy and SABR has shown good results in medically
operable patients. No randomized data are available comparing SLR and
SABR, and therefore, data from prospective studies were compared. Overall
survival at 1 year was similar between patients treated with SABR and SLR
(81-85.7 vs 92%); however, overall 3-year survival was higher following
SLR (87.1 vs 45.1- 57.1%). There was no statistically significant
difference in local recurrence in patients treated with SABR compared with
SLR (3.5-14.5 vs 4.8-20%). Both treatment modalities are associated with
complications. Fatigue (31-32.6%), pneumonitis (2.1-12.5%) and chest wall
pain (3.1-12%) were common following SABR; however, serious grade 3 and 4
toxicity were rare. Morbidity following SLR was reported between 7.3 and
33.7%. Thirty-day mortality following SABR was 0%, while predicted 30-day
mortality following a lung resection, using the thoracoscore predictive
model ranges between 1 and 2.6%. Treatment for early-stage NSCLC should be
tailored to individual patients. SABR is an acceptable alternative to SLR
in high-risk patients but comparative data are required.

<7>
Accession Number
634902948
Title
Fluid Balance in the Critically Ill Child Section: "How Bad Is Fluid in
Neonates?".
Source
Frontiers in Pediatrics. 9 (no pagination), 2021. Article Number: 651458.
Date of Publication: 20 Apr 2021.
Author
Rutledge A.; Murphy H.J.; Harer M.W.; Jetton J.G.
Institution
(Rutledge, Murphy) Department of Pediatrics, Medical University of South
Carolina, Charleston, SC, United States
(Harer) Department of Pediatrics (Neonatology), University of Wisconsin,
Madison, WI, United States
(Jetton) Stead Family Department of Pediatrics (Nephrology), University of
Iowa Health Care, Iowa City, IA, United States
Publisher
Frontiers Media S.A.
Abstract
Fluid overload (FO) in neonates is understudied, and its management
requires nuanced care and an understanding of the complexity of neonatal
fluid dynamics. Recent studies suggest neonates are susceptible to
developing FO, and neonatal fluid balance is impacted by multiple factors
including functional renal immaturity in the newborn period, physiologic
postnatal diuresis and weight loss, and pathologies that require fluid
administration. FO also has a deleterious impact on other organ systems,
particularly the lung, and appears to impact survival. However, assessing
fluid balance in the postnatal period can be challenging, particularly in
extremely low birth weight infants (ELBWs), given the confounding role of
maternal serum creatinine (Scr), physiologic weight changes, insensible
losses that can be difficult to quantify, and difficulty in obtaining
accurate intake and output measurements given mixed diaper output.
Although significant FO may be an indication for kidney replacement
therapy (KRT) in older children and adults, KRT may not be technically
feasible in the smallest infants and much remains to be learned about
optimal KRT utilization in neonates. This article, though not a
meta-analysis or systematic review, presents a comprehensive review of the
current evidence describing the effects of FO on outcomes in neonates and
highlights areas where additional research is needed.<br/>&#xa9; Copyright
&#xa9; 2021 Rutledge, Murphy, Harer and Jetton.

<8>
Accession Number
2008438618
Title
Association Between Revascularization and Quality of Life in Patients With
Coronary Chronic Total Occlusions: A Systematic Review.
Source
Cardiovascular Revascularization Medicine. 25 (pp 47-54), 2021. Date of
Publication: April 2021.
Author
Abuzeid W.; Zivkovic N.; Elbaz-Greener G.; Yaranton B.; Patel V.; Strauss
B.; Wijeysundera H.C.
Institution
(Abuzeid, Zivkovic, Elbaz-Greener, Yaranton, Patel, Strauss, Wijeysundera)
Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences
Centre, University of Toronto, ON, Canada
(Abuzeid) Division of Cardiology, Kingston Health Sciences Center, Queen's
University, ON, Canada
(Wijeysundera) Institute of Health Policy, Management and Evaluation,
University of Toronto, ON, Canada
(Wijeysundera) Institute for Clinical Evaluative Sciences (ICES), ON,
Canada
Publisher
Elsevier Inc.
Abstract
Background: Percutaneous revascularization of coronary chronic total
occlusions (CTO) has increased due to advances in technology and operator
expertise. Quality of life (QoL) remains an important but understudied
outcome following CTO revascularization. Our aim is to conduct a
systematic review of the impact of CTO revascularization on QoL.
<br/>Method(s): We searched three databases (Ovid MEDLINE, EMBASE, EBM
reviews) from January 1st, 1990 to May 17th, 2020. Studies reporting on
the following QoL metrics post CTO revascularization were included: QoL
subscale of the Seattle Angina Questionnaire (SAQ-QoL). The ROBINS-I tool
and Cochrane risk of bias tool were used to critically assess for risk of
bias. <br/>Result(s): We identified 1476 articles, of which 21 articles
met inclusion criteria. Three categories of studies were identified with
distinct patient populations. In the first category (1 study), CTO
patients treated with either PCI or CABG compared to medical therapy had a
significant improvement in SAQ-QoL compared to baseline (PCI 54.2 to 74.3;
CABG 56.1 to 78.0; p < 0.05). In the second category (1 study), CTO
patients compared to non-CTO patients had similar improvements in SAQ-QoL
post PCI (CTO baseline 53.2 to 80.3; non-CTO baseline 56.5 to 80.6; p <
0.05). Finally, a third category with only CTO patients treated with PCI
to the CTO vessel included 19 studies, all of which on average showed a
significant improvement in SAQ-QoL post successful PCI, compared to
non-successful PCI. <br/>Conclusion(s): Despite the limited literature,
revascularization of CTO vessel was generally associated with improvement
in QoL. Brief summary: Quality of life (QoL) is an important but
understudied outcome following CTO revascularization. We conducted a
systematic review of the impact of CTO revascularization on QoL. Despite
the limitations of a lack of enough randomized control trials and the
small number of studies, our systematic review highlights a trend of
improvement in QoL indices after revascularization of CTO.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<9>
Accession Number
2011114851
Title
Music Intervention in Pain Relief of Cardiovascular Patients in Cardiac
Procedures: A Systematic Review and Meta-analysis.
Source
Pain Medicine (United States). 21 (11) (pp 3055-3065), 2020. Date of
Publication: 2020.
Author
Wang Y.; Wei J.; Guan X.; Zhang Y.; Zhang N.; Mao M.; Du W.; Ren Y.; Shen
H.; Liu P.
Institution
(Wang, Guan, Zhang, Zhang, Zhang, Mao, Du, Ren, Shen, Liu) Longhua
Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai,
China
(Wang, Guan, Zhang, Mao, Shen) Shanghai University of Traditional Chinese
Medicine, Shanghai, China
(Wei) Shanghai Xuhui Central Hospital, Shanghai, China
Publisher
Oxford University Press
Abstract
Background. Numerous meta-analyses have been conducted on music and pain,
but no studies have investigated music and cardiac procedural pain.
Objective. To assess the effects of music intervention on pain in cardiac
procedures in the published randomized controlled trials. Methods. This
study was conducted according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses guidelines. All the included
randomized controlled studies were published between 1999 and 2016.
Studies were obtained from electronic databases or by hand-searching of
related journals and reference lists. The main outcome was pain intensity,
and the secondary outcomes were vital signs such as heart rate,
respiration rate, systolic blood pressure, and diastolic blood pressure.
Risk of bias of the included studies was evaluated according to the
Cochrane Collaboration guidelines. Results. Analysis of 14 studies
indicated that music interventions had statistically significant effects
on decreasing pain scales (mean deviation [MD] = -1.84), heart rate (MD =
-2.62), respiration rate (MD = -2.57), systolic blood pressure (MD =
-5.11), and diastolic blood pressure (MD = 0.44). The subgroup analysis
method was used in all five outcomes. Conclusions. Considering all the
possible benefits, music intervention may provide an effective complement
for the relief of cardiac procedural pain.<br/>Copyright &#xa9; The
Author(s) 2020. Published by Oxford University Press on behalf of the
American Academy of Pain Medicine.

<10>
Accession Number
2011090474
Title
Early results from a prospective, single-arm European trial on
decellularized allografts for aortic valve replacement: The ARISE study
and ARISE registry data.
Source
European Journal of Cardio-thoracic Surgery. 58 (5) (pp 1045-1053), 2020.
Date of Publication: 2020.
Author
Horke A.; Tudorache I.; Laufer G.; Andreas M.; Pomar J.L.; Pereda D.;
Quintana E.; Sitges M.; Meyns B.; Rega F.; Hazekamp M.; Hubler M.;
Schmiady M.; Pepper J.; Rosendahl U.; Lichtenberg A.; Akhyari P.; Boethig
D.; Bobylev D.; Avsar M.; Cebotari S.; Haverich A.; Sarikouch S.
Institution
(Horke, Tudorache, Boethig, Bobylev, Avsar, Cebotari, Haverich, Sarikouch)
Department for Cardiothoracic, Transplant, and Vascular Surgery, Hannover
Medical School, Hannover, Germany
(Laufer, Andreas) Department of Cardiac Surgery, Medical University of
Vienna, Vienna, Austria
(Pomar, Pereda, Quintana, Sitges) Department of Cardiovascular Surgery,
Hospital Clinico de Barcelona, Barcelona, Spain
(Pomar, Pereda, Quintana, Sitges) Department of Cardiology, Hospital
Clinico de Barcelona, Barcelona, Spain
(Meyns, Rega) Department of Cardiac Surgery, Katholieke Universiteit
Leuven, Leuven, Belgium
(Hazekamp) Department of Cardiothoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Hubler, Schmiady) Division of Congenital Cardiovascular Surgery,
University Children's Hospital, Zurich, Switzerland
(Pepper, Rosendahl) Department of Cardiovascular Surgery, Royal Brompton
and Harefield NHS Foundation Trust, London, United Kingdom
(Lichtenberg, Akhyari) Department for Cardiovascular Surgery,
Heinrich-Heine University, Dusseldorf, Germany
(Akhyari) European Homograft Bank, Clinique Saint-Jean, Brussels, Belgium
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Decellularized aortic homografts (DAH) may provide an
additional aortic valve replacement option for young patients due to their
potential to overcome the high early failure rate of conventional
allogenic and xenogenic aortic valve prostheses. <br/>METHOD(S): A
prospective, European Union-funded, single-arm, multicentre, safety study
was conducted in 8 centres evaluating non-cryopreserved DAH for aortic
valve replacement. <br/>RESULT(S): One hundred and forty-four patients (99
male) were prospectively enrolled between October 2015 and October 2018,
mean age 33.6 +/- 20.8 years; 45% had undergone previous cardiac
operations. Mean implanted DAH diameter 22.6 +/- 2.4 mm and mean durations
for the operation, cardiopulmonary bypass and cross-clamp were 341 +/-
140, 174 +/- 80 and 126 +/- 43 min, respectively. There were 2 early
deaths (1 LCA thrombus on day 3 and 1 ventricular arrhythmia 5 h postop)
and 1 late death due to endocarditis 4 months postoperatively, resulting
in a total mortality of 2.08%. One pacemaker implantation was necessary
and 1 DAH was successfully repaired after 6 weeks for early regurgitation
following subcoronary implantation. All other DAH were implanted as a
free-standing root. After a mean follow-up of 1.54 +/- 0.81 years, the
primary efficacy end points peak gradient (mean 11.8 +/- 7.5 mmHg) and
regurgitation (mean 0.42 +/- 0.49, grade 0-3) were excellent. At 2.5
years, freedom from explantation/endocarditis/bleeding/stroke was 98.4 +/-
1.1%/99.4 +/- 0.6%/99.1 +/- 0.9%/99.2 +/- 0.8%, respectively, with results
almost identical to those in an age-matched Ross operation cohort of 212
patients (mean age 34 years) despite DAH patients having undergone >2 more
previous procedures. <br/>CONCLUSION(S): The initial results of the
prospective multicentre ARISE trial show DAH to be safe for aortic valve
replacement with excellent haemodynamics in the short follow-up
period.<br/>Copyright &#xa9; The Author(s) 2020.

<11>
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. 154 (pp 78-85), 2021. Date of Publication:
01 Sep 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

<12>
Accession Number
2013237238
Title
Efficacy and safety of cerebral embolic protection systems during
transcatheter aortic valve replacement: a review of current clinical
findings.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2021. Date of
Publication: 2021.
Author
Sato Y.; Kawakami R.; Sakamoto A.; Cornelissen A.; Mori M.; Kawai K.;
Ghosh S.; Romero M.E.; Kolodgie F.D.; Virmani R.; Finn A.V.
Institution
(Sato, Kawakami, Sakamoto, Cornelissen, Mori, Kawai, Ghosh, Romero,
Kolodgie, Virmani, Finn) CVPath Institute, Gaithersburg, MD, United States
(Finn) University of Maryland, School of Medicine, Baltimore, MD, United
States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Cerebrovascular events are one of the most serious
consequences after transcatheter aortic valve replacement (TAVR). More
than half of the cerebrovascular events following TAVR are due to
procedure-related emboli. Embolic protection devices (EPDs) have the
potential to decrease cerebrovascular events during TAVR procedure.
However, randomized controlled trials (RCTs) have not conclusively
determined if EPDs are effective, likely because of small number of
patients enrolled. However, meta-analyses and propensity-matched analyses
from large registries have shown efficacy and suggest the importance of
EPDs in prevention of stroke during TAVR and perhaps other structural
heart procedures. Areas covered: This review will focus on clinical and
histopathologic studies examining the efficacy, safety, and
histopathologic device capture findings in the presence and absence of
EPDs during TAVR procedures. Expert opinion: Clinical studies have not
conclusively determined the efficacy of EPDs. Current ongoing large-scale
RCT (PROTECTED TAVR [NCT04149535]) has the potential to prove their
efficacy. Histopathological evaluation of debris captured by EPDs
contributes to our understanding of the mechanisms of TAVR
procedure-related embolic events and suggests the importance of preventing
cerebral embolization of debris released during this and other structural
heart procedures.<br/>Copyright &#xa9; 2021 Informa UK Limited, trading as
Taylor & Francis Group.

<13>
Accession Number
2013157768
Title
Del Nido cardioplegia for myocardial protection in adult cardiac surgery:
a systematic review and update meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Zhai K.; Cheng X.; Zhang P.; Wei S.; Huang J.; Wu X.; Gao B.; Li Y.
Institution
(Zhai, Cheng, Zhang, Wei, Huang, Wu, Gao, Li) Department of Cardiac
Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou,
China
(Zhai, Cheng, Zhang, Wei, Huang, Li) Laboratory of Extracorporeal Life
Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou,
China
Publisher
SAGE Publications Ltd
Abstract
Objective: Although the application of del Nido cardioplegia solution
(DNC) in adult cardiac surgery is accumulating, the feasibility and safety
of this myocardial protection strategy in adults remains controversial. We
aimed to update our previous meta-analysis to determine the myocardial
protective effect of DNC versus conventional cardioplegia (CC) in adult
cardiac surgery. <br/>Method(s): A comprehensive literature search was
performed using PubMed, EMBASE, the Cochrane Library, and International
Clinical Trials Registry Platform databases through November 2020.
<br/>Result(s): Thirty-seven observational studies and four randomized
controlled trials (RCTs) including 21,779 patients were identified. The
DNC group was associated with decreased postoperative cardiac enzymes
[troponin T (cTnT) and creatine kinase-MB (CK-MB)] [standardized mean
differences (SMD): -0.59, 95% confidence interval (CI): -0.99 to -0.19, p
= 0.004], cardiopulmonary bypass (CPB) time (MD: -9.31, 95% CI: -13.10 to
-5.51, p < 0.00001), aortic cross-clamp (ACC) time (MD: -7.20, 95% CI:
-10.31 to -4.09, p < 0.00001), and cardioplegia volume (SMD: -1.95, 95%
CI: -2.46 to -1.44, p < 0.00001). Intraoperative defibrillation
requirement was less in the DNC group [relative risk (RR): 0.50, 95% CI:
0.33 to 0.75, p = 0.0007]. The pooled analysis revealed no significant
difference in operative mortality among the patients assigned to DNC and
those undergoing CC. <br/>Conclusion(s): In adult cardiac surgery,
compared to CC, myocardial protection used with DNC yield similar or
better short-term clinical outcomes. More high-quality trials and RCTs
reflecting long-term follow-up morbidity and mortality are required in the
future to confirm these findings.<br/>Copyright &#xa9; The Author(s) 2021.

<14>
Accession Number
635491700
Title
Impact on quality of life from multimodality treatment for lung cancer: A
randomised controlled feasibility trial of surgery versus no surgery as
part of multimodality treatment in potentially resectable stage III-N2
NSCLC (the PIONEER trial).
Source
BMJ Open Respiratory Research. 8 (1) (no pagination), 2021. Article
Number: e000846. Date of Publication: 15 Jul 2021.
Author
Taylor S.; Yorke J.; Tsim S.; Navani N.; Baldwin D.; Woolhouse I.; Edwards
J.; Grundy S.; Robson J.; Rhodes S.; Gomes F.; Blackhall F.; Faivre-Finn
C.; Evison M.
Institution
(Taylor, Yorke, Gomes) Christie Patient Centred Research, The Christie NHS
Foundation Trust, Manchester, United Kingdom
(Taylor, Yorke) School of Nursing, Midwifery and Social Work, University
of Manchester, Manchester, United Kingdom
(Tsim) Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital,
Glasgow, United Kingdom
(Tsim) Institute of Cancer Sciences, University of Glasgow, Glasgow,
United Kingdom
(Navani) Lungs for Living Research Centre, University College London and
Department of Thoracic Medicine, University College London Hospital,
London, United Kingdom
(Baldwin) Respiratory Medicine Unit, David Evans Research Centre,
Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire,
United Kingdom
(Woolhouse) Department of Respiratory Medicine, University Hospitals
Birmingham NHS Foundation Trust, Birmingham, United Kingdom
(Edwards) Department of Cardiothoracic Surgery, Sheffield Teaching
Hospitals NHS Foundation Trust, Sheffield, Sheffield, United Kingdom
(Grundy) Respiratory Medicine, Salford Royal NHS Foundation Trust,
Salford, United Kingdom
(Robson) Leeds Teaching Hospital Trusts, Leeds, United Kingdom
(Rhodes, Blackhall, Faivre-Finn) University of Manchester, Manchester,
United Kingdom
(Gomes) Medical Oncology Department, The Christie NHS Foundation Trust,
Manchester, United Kingdom
(Blackhall, Faivre-Finn) The Christie NHS Foundation Trust, Manchester,
United Kingdom
(Evison) Lung Cancer and Thoracic Surgery Directorate, Wythenshawe
Hospital, Manchester University NHS Foundation Trust, Manchester, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction Optimal treatment for potentially resectable' stage III-N2
non-small cell lung cancer (NSCLC) requires multimodality treatment: local
treatment (surgery or radiotherapy) and systemic anticancer therapy. There
is no clear evidence of superiority for survival between the two
approaches and little research has explored quality of life (QOL). This
study will inform the design of a phase III randomised trial of surgery
versus no surgery as part of multimodality treatment for stage III-N2
NSCLC with QOL as a primary outcome. Methods and analysis Patient
participants will be randomised to receive multimodality treatment (1)
with surgery OR (2) without surgery. The Quintet Recruitment Intervention
will be used to maximise recruitment. Eligible patients will have
potentially resectable' N2 NSCLC and have received a multidisciplinary
team recommendation for multimodality treatment. Sixty-six patients and
their carers will be recruited from 8 UK centres. Patient/carer QOL
questionnaires will be administered at baseline, weeks 6, 9, 12 and month
6. Semistructured interviews will be conducted. Quantitative data will be
analysed descriptively and qualitative data will be analysed using
framework analysis. Ethics and dissemination Ethical approval has been
obtained. Results will be disseminated via publications, national bodies
and networks, and patient and public involvement groups. Trial
registration NCT04540757 <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.

<15>
Accession Number
635340070
Title
Outcome of mitral valve repair or replacement for non-ischemic mitral
regurgitation: a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 175), 2021. Date of
Publication: 15 Jun 2021.
Author
Fan Q.; Li X.; Cao G.; Yu P.; Zhang F.
Institution
(Fan, Li, Cao) Department of Cardiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Hubei Province
430022, China
(Fan) Department of Nephrology, Wuhan HanKou Hospital, Hubei Province
430012, China
(Li) Department of Cardiology, People's Hospital of Jianghan University,
Wuhan 43003, China
(Yu) Key Laboratory of Metallurgical Equipment and Control Technology,
Wuhan University of Science and Technology, Hubei Province 430081, China
(Zhang) Department of Cardiology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Hubei Province 430022,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Mitral regurgitation (MR) is a rather common valvular heart
disease. The aim of this systematic review and meta-analysis was to
compare the outcomes, and complications of mitral valve (MV) replacement
with surgical MV repair of non-ischemic MR (NIMR) METHODS: MEDLINE,
EMBASE, and the Cochrane Central Register of Controlled Trials were
searched until October, 2020. Studies were eligible for inclusion if they
included patients with MR and reported early (30-day or in-hospital) or
late all-cause mortality. For each study, data on all-cause mortality and
incidence of reoperation and operative complications in both groups were
used to generate odds ratios (ORs) or hazard ratios (HRs). This study is
registered with PROSPERO, CRD42018089608. <br/>RESULT(S): The literature
search yielded 4834 studies, of which 20 studies, including a total of
21,898 patients with NIMR, were included. The pooled analysis showed that
lower age, less female inclusion and incident of hypertension,
significantly higher rates of diabetes and atrial fibrillation in the MV
replacement group than MV repair group. No significant differences in the
rates of pre-operative left ventricle ejection fraction (LVEF) and heart
failure were observed between groups. The number of patients in the MV
repair group was lower than in the MV replacement group. We found that
there were significantly increased risks of mortality associated with
replacement of MR. Moreover, the rate of re-operation and post-operative
MR in the MV repair group was lower than in the MV replacement group.
<br/>CONCLUSION(S): In patients with NIMR, MV repair achieves higher
survival and leads to fewer complications than surgical MV replacement. In
light of these results, we suggest that MV repair surgery should be a
priority for NIMR patients.

<16>
Accession Number
635099724
Title
A randomized evaluation of the TriGuardTM HDH cerebral embolic protection
device to Reduce the Impact of Cerebral Embolic LEsions after
TransCatheter Aortic Valve ImplanTation: the REFLECT I trial.
Source
European heart journal. 42 (27) (pp 2670-2679), 2021. Date of Publication:
15 Jul 2021.
Author
Lansky A.J.; Makkar R.; Nazif T.; Messe S.; Forrest J.; Sharma R.; Schofer
J.; Linke A.; Brown D.; Dhoble A.; Horwitz P.; Zang M.; DeMarco F.;
Rajagopal V.; Dwyer M.G.; Zivadinov R.; Stella P.; Rovin J.; Parise H.;
Kodali S.; Baumbach A.; Moses J.
Institution
(Lansky, Forrest, Parise, Baumbach) Division of Cardiology, Yale School of
Medicine, CT 06510, 135 College Street, New Haven, United States
(Lansky, Baumbach) Barts Heart Centre, London and Queen Mary University of
London, London, United Kingdom
(Makkar) Cedar Sinai Medical Center, Los Angeles, CA, USA
(Nazif, Kodali, Moses) College of Physicians and Surgeons, Columbia
University, NY, NY, United States
(Messe) Department of Neurology, Hospital of the University of
Pennsylvania, PA, Philadelphia, United States
(Sharma) Division of Cardiology, Stanford University, Stanford, CA, USA
(Schofer) Hamburg University Cardiovascular Center, DE, Hamburg, Germany
(Linke) University Hospital Dresden Heart Center, Dresden,DE
(Brown) Heart Hospital Baylor, TX, Plano, United States
(Dhoble) University of Texas Health Science Center, TX, Houston, United
States
(Horwitz) University of Iowa Carver College of Medicine, IA, Iowa City,
United States
(Zang) Swedish Medical Center, Seattle, WA, USA
(DeMarco) San Donato, Milan, Italy
(Rajagopal) Piedmont Heart Institute, Atlanta, United States
(Dwyer, Zivadinov) Buffalo Neuroimaging Analysis Center, Department of
Neurology, State University of New York at Buffalo, Buffalo, NY, USA
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Rovin) BayCare Health System, FL, Clearwater, United States
Publisher
NLM (Medline)
Abstract
AIMS : The REFLECT I trial investigated the safety and effectiveness of
the TriGuardTM HDH (TG) cerebral embolic deflection device in patients
undergoing transcatheter aortic valve replacement (TAVR). METHODS AND
RESULTS : This prospective, multicentre, single-blind, 2:1 randomized (TG
vs. no TG) study aimed to enrol up to 375 patients, including up to 90
roll-in patients. The primary combined safety endpoint (VARC-2 defined
early safety) at 30days was compared with a performance goal. The primary
efficacy endpoint was a hierarchical composite of (i) all-cause mortality
or any stroke at 30days, (ii) National Institutes of Health Stroke Scale
(NIHSS) worsening at 2-5days or Montreal Cognitive Assessment worsening at
30days, and (iii) total volume of cerebral ischaemic lesions detected by
diffusion-weighted magnetic resonance imaging at 2-5days. Cumulative
scores were compared between treatment groups using the
Finkelstein-Schoenfeld method. A total of 258 of the planned, 375 patients
(68.8%) were enrolled (54 roll-in and 204 randomized). The primary safety
outcome was met compared with the performance goal (21.8% vs. 35%,
P<0.0001). The primary hierarchical efficacy endpoint was not met (mean
efficacy score, higher is better: -5.3+/-99.8 TG vs. 11.8+/-96.4 control,
P=0.31). Covert central nervous system injury was numerically lower with
TG both in-hospital (46.1% vs. 60.3%, P=0.0698) and at 5days (61.7 vs.
76.2%, P=0.054) compared with controls. CONCLUSION : REFLECT I
demonstrated that TG cerebral protection during TAVR was safe in
comparison with historical TAVR data but did not meet the predefined
effectiveness endpoint compared with unprotected TAVR
controls.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2021. For
permissions, please email: journals.permissions@oup.com.

<17>
Accession Number
634169065
Title
Patient values and preferences on valve replacement for aortic stenosis: A
systematic review.
Source
Heart. 107 (16) (pp 1289-1295), 2021. Date of Publication: 01 Aug 2021.
Author
Heen A.F.; Lytvyn L.; Shapiro M.; Guyatt G.H.; Siemieniuk R.A.C.; Zhang
Y.; Manja V.; Vandvik P.O.; Agoritsas T.
Institution
(Heen) Department of Medicine, Innlandet Hospital Trust Gjovik Hospital,
Brumunddal, Norway
(Lytvyn, Guyatt, Siemieniuk, Zhang, Agoritsas) Department of Health
Research Methods, Evidence, and Impact, McMaster University Faculty of
Health Sciences, Hamilton, ON, Canada
(Shapiro) ChicagoILUnited States
(Manja) Department of Surgery, University of California Davis, Sacramento,
CA, United States
(Manja) Department of Medicine, Veterans Affairs Northern California
Health Care System, Mather, CA, United States
(Vandvik) Institute of Health and Society, University of Oslo, Oslo,
Norway
(Agoritsas) Division of General Internal Medicine, Department of Medicine,
University Hospitals of Geneva, Geneva, Switzerland
Publisher
BMJ Publishing Group
Abstract
The review aims to summarise evidence addressing patients' values,
preferences and practical issues on deciding between transcatheter aortic
valve insertion (TAVI) and surgical aortic valve replacement (SAVR) for
aortic stenosis. We searched databases and grey literature until June
2020. We included studies of adults with aortic stenosis eliciting values
and preferences about treatment, excluding medical management or
palliative care. Qualitative findings were synthesised using thematic
analysis, and quantitative findings were narratively described. Evidence
certainty was assessed using CERQual (Confidence in the Evidence from
Reviews of Qualitative Research) and GRADE (Grading of Recommendations
Assessment, Development and Evaluation). We included eight studies.
Findings ranged from low to very low certainty. Most studies only
addressed TAVI. Studies addressing both TAVI and SAVR reported on factors
affecting patients' decision-making along with treatment effectiveness,
instead of trade-offs between procedures. Willingness to accept risk
varied considerably. To improve their health status, participants were
willing to accept higher mortality risk than current evidence suggests for
either procedure. No study explicitly addressed valve reintervention, and
one study reported variability in willingness to accept shorter duration
of known effectiveness of TAVI compared with SAVR. The most common themes
were desire for symptom relief and improved function. Participants
preferred minimally invasive procedures with shorter hospital stay and
recovery. The current body of evidence on patients' values, preferences
and practical issues related to aortic stenosis management is of
suboptimal rigour and reports widely disparate results regarding patients'
perceptions. These findings emphasise the need for higher quality studies
to inform clinical practice guidelines and the central importance of
shared decision-making to individualise care fitted to each patient.
<br/>Copyright &#xa9; 2021 BMJ Publishing Group. All rights reserved.

<18>
Accession Number
2013853207
Title
The Fares Study: A Multicenter, Randomized, Active-Control, Pragmatic,
Phase 2 Pilot Study Comparing Prothrombin Complex Concentrate Versus
Frozen Plasma in Bleeding Adult Cardiac Surgical Patients.
Source
Blood. Conference: 62nd ASH Annual Meeting. Virtual, Online. 136
(Supplement 1) (pp 28-29), 2020. Date of Publication: 05 Nov 2020.
Author
Karkouti K.; Callum J.L.
Institution
(Karkouti) Department of Anesthesiology and Pain Medicine, Toronto General
Hospital, University Health Network, University of Toronto, Toronto,
Canada
(Callum) Department of Laboratory Medicine and Pathobiology, University of
Toronto, Toronto, Canada
(Callum) Sunnybrook Health Sciences Centre, Toronto, Canada
Publisher
Elsevier B.V.
Abstract
[Formula presented] Introduction: Coagulopathic bleeding is a frequent
complication of cardiac surgery and can lead to excessive blood loss,
blood product transfusion, and bleeding-related complications. Hemostatic
management in bleeding surgical patients is evolving towards targeted
therapy with purified products undergoing pathogen reduction technology.
Unlike frozen plasma (FP), purified prothrombin complex concentrates
(PCCs) do not require ABO blood type matching or thawing, are
pathogen-reduced, and are associated with a lower risk of
transfusion-associated circulatory overload and transfusion-related acute
lung injury. The FARES study will compare the efficacy and safety of PCC
(Octaplex; Octapharma) versus FP in bleeding cardiac surgical patients
with confirmed or suspected coagulopathy. Preliminary non-randomized
studies suggest PCC may be superior to plasma for management of bleeding
after cardiac surgery. <br/>Method(s): The randomized, active-control,
single-blinded, pragmatic, investigator-initiated, Phase 2 FARES pilot
study will enrolled 120 bleeding adult cardiac surgery patients requiring
coagulation factor replacement from two hospitals to achieve 100 treated
patients. The study outline is shown in Figure 1. Patients were randomized
to PCC or FP, with two weight-based doses, for management of bleeding
where coagulation factor deficiency is known or suspected (patients over
50 kg were transfused either 2000 IU of PCC or 4 units of plasma; patients
under 50 kg were transfused 1500 IU of PCC or 3 units of plasma). Required
second doses will be given according to randomization group allocation,
but all patients will receive FP for their third and any subsequent doses.
The primary endpoint is hemostatic effectiveness and transfusion
requirements. Adverse events will be recorded from the beginning of
surgery. <br/>Result(s): The study commenced in September of 2019 and
completed enrollment of the last patient in June of 2020. Results were
monitored and overseen by the Independent Data and Safety Monitoring
Committee. The database will be locked in August 2020 after 28 day
follow-up is complete for all patients. Statistical analysis plan is
complete. The results will inform a definitive, pragmatic, multi-center
trial to determine if PCCs can replace plasma for the management of
coagulopathy in the bleeding cardiac surgery patient. <br/>Conclusion(s):
This study will determine the feasibility, and inform the design and
primary outcome parameter, of a definitive Phase 3 trial comparing the
efficacy and safety of PCC versus FP in bleeding cardiac surgical patients
requiring coagulation factor replacement. The pilot study results will
also be used in sample size calculations and to aid detection of any
safety issues. [Formula presented] Disclosures: Karkouti: Octapharma:
Research Funding; Canadian blood services: Research Funding. Callum:
Canadian Blood Services: Research Funding; Octapharma: Research Funding.
OffLabel Disclosure: Coagulation factor replacement with Prothrmobin
Complex Concentrates (off-label in the USA and on label in
Canada/Europe)<br/>Copyright &#xa9; 2020 American Society of Hematology

<19>
Accession Number
2013849150
Title
Reduction in Absolute Involved Free Light Chain and Difference between
Involved and Uninvolved Free Light Chain Is Associated with Prolonged
Major Organ Deterioration Progression-Free Survival in Patients with Newly
Diagnosed AL Amyloidosis Receiving Bortezomib, Cyclophosphamide, and
Dexamethasone with or without Daratumumab: Results from Andromeda.
Source
Blood. Conference: 62nd ASH Annual Meeting. Virtual, Online. 136
(Supplement 1) (pp 48-50), 2020. Date of Publication: 05 Nov 2020.
Author
Comenzo R.L.; Kastritis E.; Palladini G.; Minnema M.C.; Wechalekar A.D.;
Jaccard A.; Sanchorawala V.; Lee H.C.; Gibbs S.D.; Mollee P.; Venner C.P.;
Lu J.; Schonland S.; Gatt M.; Suzuki K.; Kim K.; Cibeira M.T.; Beksac M.;
Libby E.; Valent J.; Hungria V.T.M.; Wong S.W.; Rosenzweig M.; Bumma N.;
Chauveau D.; Dimopoulos M.A.; Tran N.; Qin X.; Vasey S.Y.; Tromp B.; Weiss
B.M.; Vermeulen J.; Merlini G.
Institution
(Comenzo) Division of Hematology/Oncology, John C. Davis Myeloma and
Amyloid Program, Tufts Medical Center, Boston, MA, United States
(Kastritis) Department of Clinical Therapeutics, National and Kapodistrian
University of Athens, School of Medicine, ATHENS, Greece
(Palladini) Amyloidosis Research and Treatment Center, Fondazione IRCCS
Policlinico San Matteo, Department of Molecular Medicine, University of
Pavia, Pavia, Italy
(Minnema) Department of Hematology, UMC Utrecht, Utrecht, Netherlands
(Wechalekar) University College London, London, United Kingdom
(Jaccard) Centre Hospitalier Universitaire and Reference Center for AL
Amyloidosis, Limoges, France
(Sanchorawala) Amyloidosis Center, Boston University School of Medicine,
Boston, MA, United States
(Lee) Department of Lymphoma and Myeloma, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Gibbs) The Victorian and Tasmanian Amyloidosis Service, Department of
Haematology, Monash University Easter Health Clinical School, Melbourne,
Australia
(Mollee) Department of Haematology, Princess Alexandra Hospital, Brisbane,
Australia
(Venner) Cross Cancer Institute, University of Alberta, Edmonton, Canada
(Lu) Peking University People's Hospital, Peking University Institute of
Hematology, National Clinical Research Center for Hematologic Disease,
Collaborative Innovation Center of Hematology, Beijing, China
(Schonland) Medical Department V, Amyloidosis Center, Heidelberg
University Hospital, Heidelberg, Germany
(Gatt) Department of Hematology, Hadassah-Hebrew University Medical
Center-, Jerusalem, Israel
(Suzuki) Japanese Red Cross Medical Center, Department of Hematology,
Tokyo, Japan
(Kim) Division of Hematology-Oncology, Department of Medicine, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, South
Korea
(Cibeira) Hospital Clinic of Barcelona, Barcelona, Spain
(Beksac) Cebeci Yerleskesi Dikimevi, Ankara, Turkey
(Libby) Division of Medical Oncology, Department of Medicine, University
of Washington, Seattle, WA, United States
(Valent) Department of Hematology and Medical Oncology, Taussig Cancer
Institute, Cleveland Clinic, Cleveland, OH, United States
(Hungria) Sao Germano Clinic, Sao Paulo, Brazil
(Wong) Tufts Medical Center, San Francisco, CA, United States
(Rosenzweig) Department of Hematology and Hematopoietic Cell
Transplantation, Judy and Bernard Briskin Center for Multiple Myeloma
Research, City of Hope, Duarte, CA, United States
(Bumma) Division of Hematology, Department of Internal Medicine, The Ohio
State University Comprehensive Cancer Center, Columbus, OH, United States
(Chauveau) CHU de Toulouse-Hopital Rangueil, Toulouse, France
(Dimopoulos) University of Athens School of Medicine, KIFISIA, Greece
(Tran) Janssen Research & Development, LLC, Los Angeles, CA, United States
(Qin, Vasey, Weiss) Janssen Research & Development, LLC, Spring House, PA,
United States
(Tromp, Vermeulen) Janssen Research & Development, LLC, Leiden,
Netherlands
(Merlini) Amyloidosis Research and Treatment Center, Fondazione IRCCS
Policlinico San Matteo, Department of Molecular Medicine, University of
Pavia, Pavia, Italy
Publisher
Elsevier B.V.
Abstract
Background: Systemic AL amyloidosis is characterized by the deposition of
insoluble amyloid fibrils produced by light chains synthesized by clonal
CD38⁺ plasma cells. Combining daratumumab (DARA) with
bortezomib, cyclophosphamide, and dexamethasone (VCd) has demonstrated
significantly improved outcomes in patients with AL amyloidosis. The
classification of hematologic complete response (CR) in this disease is
evolving, and the absolute reduction of the involved free light chain
(iFLC) and the difference between iFLC and uninvolved free light chain
(dFLC) are being recognized as very meaningful endpoints. Here, we present
results from the ANDROMEDA study (NCT03201965) to demonstrate the impact
of achieving deep reductions of iFLC and dFLC on major organ deterioration
progression-free survival (MOD-PFS), a novel, key secondary endpoint in
this study. <br/>Method(s): Key eligibility criteria included newly
diagnosed AL amyloidosis with measurable hematologic disease (serum
monoclonal protein >=0.5 g/dL by protein electrophoresis or serum free
light chain >=5.0 mg/dL with an abnormal kappa:lambda ratio or dFLC >=50
mg/L), >=1 involved organ, cardiac stage I-IIIA, eGFR >=20 mL/min, and
absence of symptomatic multiple myeloma. Patients were randomized (1:1) to
receive DARA-VCd or VCd alone. All patients received bortezomib (1.3
mg/m² subcutaneous [SC] weekly), cyclophosphamide (300
mg/m² oral [PO] or intravenous [IV] weekly), and dexamethasone
(20-40 mg PO or IV weekly) for six 28-day cycles. DARA SC (1800 mg,
co-formulated with recombinant human hyaluronidase PH20 in 15 mL) was
administered by injection weekly in Cycles 1-2, every other week in Cycles
3-6, and every 4 weeks thereafter for up to 24 cycles. Disease evaluations
occurred every 4 weeks (Cycles 1-6) and every 8 weeks (after Cycle 7)
until major organ deterioration, death, end of study, or withdrawal. The
primary endpoint was overall (ie, at any time) hematologic CR rate,
defined here as normalization of FLC levels and ratio (FLCr) and negative
serum and urine immunofixation, confirmed at a subsequent visit;
normalization of uninvolved FLC level and FLCr were not required if
iFLC<upper limit of normal.^1-2 The following criteria for deep
hematological response were evaluated: iFLC <=20 mg/L regardless of
FLCr³ and dFLC<10 regardless of FLCr.⁴ MOD-PFS is a
composite endpoint defined as any one of the following events (whichever
comes first): death; cardiac deterioration (requiring cardiac transplant,
left ventricular assist device or intra-aortic balloon pump); end stage
renal disease requiring hemodialysis or renal transplant; or hematologic
progression per consensus guidelines.¹ Analyses of deep
hematological responses were performed on the intent-to-treat analysis
set; patients without a baseline assessment or post-baseline assessment
were considered non-responders. Descriptive statistics were used to
summarize overall response rates. Kaplan-Meier curves were plotted for
MOD-PFS by hematologic response status. <br/>Result(s): A total of 388
patients were randomized to receive DARA-VCd (n=195) or VCd alone (n=193).
Baseline characteristics were well balanced between treatment groups. The
median age was 64 years and 65% of patients had >=2 organs involved. The
proportions of patients with heart and kidney involvement were 71% and
59%, respectively, and the proportions of patients with cardiac stage I,
II, and IIIA were 23%, 40%, and 37%, respectively. The median duration of
treatment was 9.6 months for DARA-VCd and 5.3 months for VCd. Median
follow-up was 11.4 months (range, 0.03-21.3+). The rates of deep
hematological responses by all criteria strongly favored the DARA-VCd
treatment arm (Table). MOD-PFS was longer in patients achieving deep
hematological responses by all criteria (Figure). In addition, the
corresponding MOD-PFS was similar regardless of the hematological response
criteria used. <br/>Conclusion(s): Regardless of the criteria used, the
addition of DARA to VCd increased the rates of deep hematologic responses
in patients with newly diagnosed AL amyloidosis, which, in turn, was
associated with prolonged MOD-PFS. These results support the benefit of
DARA in this patient population. References 1. Comenzo RL, et al.
Leukemia. 2012;26(11):2317-25 2. Sidana S, et al. Leukemia.
2019;34(5):1472-75 3. Muchtar E, et al. Leukemia. 2019;33(3):790-94 4.
Manwani R, et al. Blood. 2019;134(25):2271-2280 [Formula presented]
Disclosures: Comenzo: Amgen: Consultancy; Sanofi: Consultancy; Prothena:
Consultancy, Research Funding; Janssen: Consultancy, Research Funding;
Unum: Consultancy; Karyopharm: Consultancy, Research Funding; Takeda:
Consultancy, Research Funding; Caleum: Consultancy. Kastritis: Pfizer:
Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding;
Genesis Pharma: Consultancy, Honoraria; Janssen: Consultancy, Honoraria,
Research Funding; Takeda: Consultancy, Honoraria. Palladini: Celgene:
Other: Travel support; Jannsen Cilag: Honoraria, Other. Minnema: Celgene:
Other: travel support, Research Funding; Kite, a Gilead Company: Speakers
Bureau; Amgen: Consultancy; Servier: Consultancy. Wechalekar: Caelum:
Other: Advisory; Janssen: Honoraria, Other: Advisory; Takeda: Honoraria,
Other: Travel; Celgene: Honoraria. Jaccard: Celgene: Honoraria, Other:
A.J. has served in a consulting or advisory role for Janssen and has
received honoraria from, received research funding from, and had travel,
accommodations, or other expenses paid for or reimbursed by Celgene.,
Research Funding; Janssen: Consultancy, Honoraria, Other: A.J. has served
in a consulting or advisory role for Janssen and has received honoraria
from, received research funding from, and had travel, accommodations, or
other expenses paid for or reimbursed by Janssen., Research Funding.
Sanchorawala: Proclara: Other: advisory board; Abbvie: Other: advisory
board; UpToDate: Patents & Royalties; Regeneron: Other: advisory board;
Caleum: Other: advisory board; Janssen: Research Funding; Takeda: Research
Funding; Celgene: Research Funding; Prothena: Research Funding; Caelum:
Research Funding; Oncopeptide: Research Funding. Lee: Janssen:
Consultancy, Research Funding; Takeda: Consultancy, Research Funding;
Genentech: Consultancy; GlaxoSmithKline: Consultancy, Research Funding;
Sanofi: Consultancy; Daiichi Sankyo: Research Funding; Regeneron: Research
Funding; Genentech: Consultancy; Celgene: Consultancy, Research Funding;
Amgen: Consultancy, Research Funding. Gibbs: Janssen, BMS/Celgene, Amgen,
Takeda, Pfizer, Caelum, Abbvie and Eidos: Membership on an entity's Board
of Directors or advisory committees. Mollee: Janssen: Membership on an
entity's Board of Directors or advisory committees, Research Funding;
BMS/Celgene: Membership on an entity's Board of Directors or advisory
committees; Amgen: Membership on an entity's Board of Directors or
advisory committees; Takeda: Membership on an entity's Board of Directors
or advisory committees; Pfizer: Membership on an entity's Board of
Directors or advisory committees; Caelum: Membership on an entity's Board
of Directors or advisory committees. Venner: Celgene, Amgen: Research
Funding; Janssen, BMS/Celgene, Sanofi, Takeda, Amgen: Honoraria.
Schonland: Janssen, Prothena, Takeda: Honoraria, Other: travel support to
meetings, Research Funding. Suzuki: Takeda, Amgen, Janssen and Celgene:
Consultancy; Bristol-Myers Squibb, Celgene and Amgen: Research Funding;
Takeda, Celgene, ONO, Amgen, Novartis, Sanofi, Bristol-Myers Squibb,
AbbVie and Janssen: Honoraria. Kim: Amgen, BMS, Janssen, Sanofi, Takeda:
Consultancy, Honoraria, Research Funding. Cibeira: Janssen, Akcea
Therapeutics: Honoraria, Membership on an entity's Board of Directors or
advisory committees; Janssen, Celgene, Amgen: Honoraria, Other:
Educational lectures. Beksac: Deva: Membership on an entity's Board of
Directors or advisory committees, Speakers Bureau; Celgene: Membership on
an entity's Board of Directors or advisory committees, Speakers Bureau;
Takeda: Membership on an entity's Board of Directors or advisory
committees, Speakers Bureau; Sanofi: Speakers Bureau; Amgen: Membership on
an entity's Board of Directors or advisory committees, Speakers Bureau;
Janssen&janssen: Membership on an entity's Board of Directors or advisory
committees, Speakers Bureau. Valent: Amgen Inc.: Other: Teaching, Speakers
Bureau; Takeda Pharmaceuticals: Other: Teaching, Speakers Bureau; Celgene:
Other: Teaching, Speakers Bureau. Wong: Fortis: Research Funding; GSK:
Research Funding; Amgen: Consultancy; Janssen: Research Funding; Roche:
Research Funding; Bristol Myers Squibb: Research Funding; Sanofi:
Membership on an entity's Board of Directors or advisory committees.
Rosenzweig: Janssen: Speakers Bureau. Bumma: Sanofi: Speakers Bureau;
Amgen: Speakers Bureau. Dimopoulos: BMS: Consultancy, Membership on an
entity's Board of Directors or advisory committees, Other: Personal fees;
Janssen: Consultancy, Honoraria, Membership on an entity's Board of
Directors or advisory committees, Other: Personal fees, Research Funding,
Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an
entity's Board of Directors or advisory committees, Other: Personal fees,
Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's
Board of Directors or advisory committees, Other: Personal fees, Research
Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Membership on an
entity's Board of Directors or advisory committees, Other: Personal fees,
Research Funding, Speakers Bureau. Tran: Janssen: Current Employment,
Current equity holder in publicly-traded company. Qin: Janssen: Current
Employment. Vasey: Janssen Research & Development: Current Employment,
Current equity holder in publicly-traded company. Tromp: Janssen: Current
Employment, Current equity holder in publicly-traded company. Weiss:
Janssen: Current Employment, Current equity holder in publicly-traded
company. Vermeulen: Janssen: Current Employment, Current equity holder in
publicly-traded company.<br/>Copyright &#xa9; 2020 American Society of
Hematology

<20>
Accession Number
2013846371
Title
Parental Post-traumatic Stress and Healthcare Use in Infants with Complex
Cardiac Defects.
Source
Journal of Pediatrics. (no pagination), 2021. Date of Publication: 2021.
Author
Golfenshtein N.; Hanlon A.L.; Lozano A.J.; Srulovici E.; Lisanti A.J.; Cui
N.; Medoff-Cooper B.
Institution
(Golfenshtein, Srulovici) Department of Nursing, University of Haifa,
Haifa, Israel
(Hanlon, Lozano) Center for Biostatistics and Health Data Science,
Virginia Tech, Roanoke, VA, United States
(Lisanti) Center for Pediatric Nursing Research & Evidence-Based Practice,
Children's Hospital of Philadelphia, Philadelphia, PA, United States
(Cui) School of Nursing & Rehabilitation, Shandong University, Jinan,
Shandong Province, China
(Medoff-Cooper) University of Pennsylvania, School of Nursing,
Philadelphia, PA, United States
(Medoff-Cooper) Children's Hospital of Philadelphia, Philadelphia, PA,
United States
Publisher
Mosby Inc.
Abstract
Objective: To examine the associations between post-traumatic stress of
parents of infants with complex congenital heart defects and their
healthcare use for their infants during the early months of life. Study
design: The current study is a secondary data analysis from a randomized
controlled trial in which 216 parent-infant dyads were recruited from 3
cardiac intensive care units of large pediatric centers in Northeastern
America. The current sample included 153 dyads with post-traumatic stress
data at hospital discharge and at 4-months' follow-up. Poisson regressions
were used to estimate the effect of post-traumatic stress change scores on
number of emergency department (ED) visits, unscheduled cardiologist
visits, and unscheduled pediatrician visits outcomes. <br/>Result(s):
Infants whose parents gained post-traumatic stress disorder over the study
period were at increased risk for ED visits and unscheduled cardiologist
visits. Increased symptom severity predicted more unscheduled cardiologist
visits and more unscheduled pediatrician visits. Increased symptom
clusters (avoidance, arousal, re-experiencing) predicted more ED visits,
more unscheduled cardiologist visits, and more unscheduled pediatrician
visits. <br/>Conclusion(s): Parents of infants with cardiac conditions may
experience post-traumatic stress following cardiac surgery, which can be
linked to greater healthcare use. Findings highlight the importance of
screening and treating post-traumatic stress to preserve parental mental
health and prevent adverse outcomes.<br/>Copyright &#xa9; 2021 Elsevier
Inc.

<21>
Accession Number
2013836987
Title
Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and
Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications:
A Systematic Review and Meta-Analysis.
Source
Respiration. (no pagination), 2021. Date of Publication: 2021.
Author
Sullivan K.A.; Churchill I.F.; Hylton D.A.; Hanna W.C.
Institution
(Sullivan, Churchill, Hylton, Hanna) Department of Health Research
Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
(Sullivan, Churchill, Hylton, Hanna) Division of Thoracic Surgery, St.
Joseph's Healthcare Hamilton, Hamilton, ON, Canada
Publisher
S. Karger AG
Abstract
Background: Currently, consensus on the effectiveness of incentive
spirometry (IS) following cardiac, thoracic, and upper abdominal surgery
has been based on randomized controlled trials (RCTs) and systematic
reviews of lower methodological quality. To improve the quality of the
research and to account for the effects of IS following thoracic surgery,
in addition to cardiac and upper abdominal surgery, we performed a
meta-analysis with thorough application of the Grading of Recommendations
Assessment, Development and Evaluation scoring system and extensive
reference to the Cochrane Handbook for Systematic Reviews of
Interventions. <br/>Objective(s): The objective of this study was to
determine, with rigorous methodology, whether IS for adult patients (18
years of age or older) undergoing cardiac, thoracic, or upper abdominal
surgery significantly reduces30-day post-operative pulmonary complications
(PPCs), 30-day mortality, and length of hospital stay (LHS) when compared
to other rehabilitation strategies. <br/>Method(s): The literature was
searched using Cochrane Central Register of Controlled Trials, MEDLINE,
EMBASE, CINAHL, and Web of Science for RCTs between the databases'
inception and March 2019. A random-effect model was selected to calculate
risk ratios (RRs) with 95% confidence intervals (CIs). <br/>Result(s):
Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or
upper abdominal surgery were included. By comparing the use of IS to other
chest rehabilitation strategies, we found that IS alone did not
significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88-1.13) or 30-day
mortality (RR = 0.73, 95% CI: 0.42-1.25). Likewise, there was no
difference in LHS (mean difference =-0.17,95% CI:-0.65 to 0.30) between IS
and the other rehabilitation strategies. None of the included trials
significantly impacted the sensitivity analysis and publication bias was
not detected. <br/>Conclusion(s): This meta-analysis showed that IS alone
likely results in little to no reduction in the number of adult patients
with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and
upper abdominal surgery.<br/>Copyright &#xa9; 2021 S. Karger AG. All
rights reserved.

<22>
Accession Number
2013823033
Title
Association between individual surgeon volume and outcome in mitral valve
surgery: A systematic review.
Source
Journal of Thoracic Disease. 13 (7) (pp 4500-4510), 2021. Date of
Publication: July 2021.
Author
Akmaz B.; van Kuijk S.M.J.; Nia P.S.
Institution
(Akmaz) Faculty of Health Medicine and Life Sciences, Maastricht
University, Maastricht, Netherlands
(Akmaz, Nia) Department of Cardiothoracic Surgery, Maastricht University
Medical Centre, Maastricht, Netherlands
(van Kuijk) Department of Clinical Epidemiology and Medical Technology
Assessment (KEMTA), Maastricht University Medical Center (MUMC+),
Maastricht, Netherlands
Publisher
AME Publishing Company
Abstract
Background: Surgeon volume has been identified as a possible factor that
influences outcomes in mitral valve (MV) surgery. The aim of this study
was to systematically review all published studies on the association
between individual surgeon volume and outcome in MV surgery.
<br/>Method(s): PubMed was searched last on 19 November 2020. The
reporting of this systematic review was done in accordance with PRISMA
guidelines. Manuscripts were eligible when these studied individual
surgeon volumes and its association with repair rate, mortality or
reoperation. The methodological quality of the studies was assessed with
the Newcastle-Ottawa Scale (NOS). Absolute numbers and percentages of the
outcome measures, odds ratios (ORs), P values and threshold values
regarding surgeon volume were collected. <br/>Result(s): A total of 7
retrospective cohort studies were included in the qualitative analysis
with total of 158488 patients. Definitions of surgeon volumes were found
to be heterogenic and therefore pooling of data was not possible. Surgeon
volume was significantly associated with repair rate (OR =1.25-5.5) and
mortality (OR =0.46-0.84 and OR =1.50-2.27 depending on the reference
group). Regarding reoperation, results were not consistent and did not
always show a significant lower reoperation rate when surgeon volume
increased. A mean threshold of minimally 30 MV surgeries per year was
found. <br/>Discussion(s): Higher surgeon volume is significantly
associated with improved outcomes of repair rate and mortality. MV should
preferentially be performed by high-volume surgeons and centralization of
MV surgery might be necessary.<br/>Copyright &#xa9; 2021 AME Publishing
Company. All rights reserved.

<23>
Accession Number
2013827114
Title
Global longitudinal strain as a prognostic marker in cardiac
resynchronisation therapy: A systematic review.
Source
IJC Heart and Vasculature. 35 (no pagination), 2021. Article Number:
100849. Date of Publication: August 2021.
Author
Appadurai V.; D'Elia N.; Mew T.; Tomlinson S.; Chan J.; Hamilton-Craig C.;
Scalia G.M.
Institution
(Appadurai, Mew, Tomlinson, Chan, Hamilton-Craig, Scalia) Department of
Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
(Appadurai, Mew, Tomlinson, Hamilton-Craig, Scalia) School of Medicine,
The University of Queensland, St Lucia, Australia
(D'Elia) The Alfred Hospital, Melbourne, Victoria, Australia
(D'Elia) Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
(Chan, Hamilton-Craig) School of Medicine, Griffith University, Gold
Coast, Australia
Publisher
Elsevier Ireland Ltd
Abstract
Purpose: Cardiac resynchronisation therapy (CRT) has proven mortality
benefits for heart failure patients with moderate to severe systolic left
ventricular dysfunction and evidence of a left bundle branch block.
Determining responders to this therapy can be difficult due to the
presence of myocardial fibrosis and scar. Left ventricular global
longitudinal strain (LV GLS) is a robust and sensitive measure of
myocardial function and fibrosis that has significant prognostic value for
a plethora of cardiac pathologies. Our aim was to perform a systematic
review of the value of LV GLS for predicting outcomes in patients
undergoing CRT. <br/>Method(s): A systematic review of the literature was
conducted according to the Preferred Reporting Items for Systematic
reviews and Meta-Analyses (PRISMA) protocol for reporting on systematic
reviews and meta-analyses. An electronic search of all English, adult
publications in EMBASE, MEDLINE/PubMed and the Cochrane Database of
Systematic reviews was undertaken. <br/>Result(s): The search yielded, 9
studies that included 3,981 patients with symptomatic heart failure,
undergoing CRT implantation with LV GLS utilised as a predictor of
all-cause mortality, cardiovascular death, rehospitalisation, LVAD
implantation/ heart transplantation or left ventricular reverse
remodelling. Significant heterogeneity was observed in study outcome
measures, included populations, LV-GLS cut-offs and follow-up definitions,
resulting in the inability to reliably conduct a meta-analyses. Overall,
pre-CRT LV GLS was found to be a predictor of outcome post CRT insertion.
<br/>Conclusion(s): In conclusion, all studies implied that incrementally
abnormal baseline LV GLS pre-CRT implantation was associated with a long
term poorer outcome.<br/>Copyright &#xa9; 2021 The Authors

<24>
Accession Number
2013823009
Title
Predictors and nomogram models for postoperative headache in patients
undergoing heart valve surgery.
Source
Journal of Thoracic Disease. 13 (7) (pp 4236-4249), 2021. Date of
Publication: July 2021.
Author
Wang D.; Huang X.; Wang H.; Le S.; Du X.
Institution
(Wang, Huang, Wang, Le, Du) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Publisher
AME Publishing Company
Abstract
Background: Headache is a frequent complication after cardiac surgery.
However, studies on the risk factors of postoperative headache (POH) are
rare. The purpose of this study was to identify independent risk factors
for POH in patients undergoing heart valve surgery (HVS) and to develop
and validate risk prediction models. <br/>Method(s): Consecutive patients
undergoing open HVS from 2016 to 2019 were enrolled in this study.
Patients were randomly assigned to training and validation sets at a 2:1
ratio. Univariate and multivariate analysis were applied to identify
independent predictors for POH in the training set. A nomogram predicting
POH was developed based on these factors, and was validated in the
independent validation set. <br/>Result(s): POH developed in 1,061 of the
3,853 patients (27.5%). The overall mortality was 2.9%, and it was
significantly higher in patients with POH (4.3% versus 2.4%, P<0.001). In
the training set, six independent predictors were identified by
multivariate analysis, including female, smoking history, hypertension,
headache history, left ventricular ejection fraction, and cardiopulmonary
bypass time. The model demonstrated good discrimination in both the
training (c-index: 0.811) and validation sets (c-index: 0.814), and
calibration was assessed by visual inspection. A second nomogram was also
constructed including only preoperative predictors, with good
discrimination (c-index: 0.792) and calibration. The decision and clinical
impact curves of the models showed good clinical utility.
<br/>Conclusion(s): We developed and validated two risk prediction models
for POH in patients undergoing HVS. The models may have clinical utility
in individualized risk assessment and preventive
interventions.<br/>Copyright &#xa9; 2021 AME Publishing Company. All
rights reserved.

<25>
Accession Number
2013823004
Title
Beating-heart on-pump coronary artery bypass grafting vs. off-pump
coronary artery bypass grafting: A systematic review and meta-analysis.
Source
Journal of Thoracic Disease. 13 (7) (pp 4185-4194), 2021. Date of
Publication: July 2021.
Author
Jiang Y.; Xu L.; Liu Y.; Deng B.; Dong N.; Chen S.
Institution
(Jiang, Xu, Dong, Chen) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Liu, Deng) First Clinical College, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
Publisher
AME Publishing Company
Abstract
Background: Beating-heart on-pump coronary artery bypass grafting (CABG),
otherwise known as BH-ONCAB, can reduce myocardial injury by preserving
native coronary blood flow while maintaining hemodynamic stability by the
effective support of cardiopulmonary bypass (CPB). This study aimed to
identify whether BH-ONCAB confers a survival, mortality, or morbidity
benefit over off-pump CABG (OPCAB). <br/>Method(s): A systematic
literature review identified 18 studies incorporating 5,615 patients
(1,548 BH-ONCAB and 4,067 OPCAB cases) who satisfied the inclusion
criteria. Outcome measures were meta-analyzed using random-effects
modeling. Between-study heterogeneity was investigated through quality
assessment and risk of bias analysis. <br/>Result(s): The results
demonstrated comparable early mortality and long-term survival between
BH-ONCAB and OPCAB coronary revascularization with no significant
statistical differences. The incidences of stroke, renal failure, blood
loss, and arrhythmias were significantly higher in patients who underwent
BH-ONCAB than patients who underwent OPCAB. However, BH-ONCAB conferred
lower rates of incomplete revascularization and greater numbers of distal
anastomoses. <br/>Conclusion(s): BH-ONCAB is a safe and comparable
alternative to OPCAB in terms of early mortality and late survival.
BH-ONCAB may confer particular advantages in preventing incomplete
revascularization and allowing more distal anastomoses compared to OPCAB.
However, BH-ONCAB was associated with more postoperative complications due
to the use of CPB. Future work should focus on larger matched studies and
multicenter randomized controlled trials to optimize our surgical
revascularization strategies.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<26>
Accession Number
2013823003
Title
On-pump beating heart versus conventional on-pump coronary artery bypass
grafting on clinical outcomes: A meta-analysis.
Source
Journal of Thoracic Disease. 13 (7) (pp 4169-4184), 2021. Date of
Publication: July 2021.
Author
Wang C.; Jiang Y.; Jiang X.; Chen S.
Institution
(Wang, Jiang, Jiang, Chen) Department of Cardiovascular Surgery and Heart
transplantation, Union Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
Publisher
AME Publishing Company
Abstract
Background: A hybrid surgery method, on-pump beating heart coronary artery
bypass graft (ON-BH CABG), is supposed to be a promising technology for
coronary artery revascularization. Here, we conducted a comprehensive
meta-analysis of the data derived from published studies on ON-BH CABG and
conventional on-pump coronary artery bypass graft (C-CABG) to compare
their short-term and long-term clinical outcomes. <br/>Method(s): We
searched major electronic databases and 24 studies incorporating 6,862
patients (1,847 ON-BH CABG and 5,015 C-CABG) were included eventually, and
9 studies of them were focusing on high-risk patients. <br/>Result(s):
Compared with ON-BH CABG, C-CABG was associated with a higher risk in
early mortality [odds ratio (OR), 1.45; 95% confidence interval (CI), 1.09
to 1.93; P=0.01], myocardial infarction (MI) (OR, 2.60; 95% CI, 1.41 to
4.78; P<0.01), low output syndrome (LOS) (OR, 2.56; 95% CI, 1.55 to 4.23;
P<0.01), renal failure (OR, 1.84; 95% CI, 1.38 to 2.44; P<0.01). In
contrast, there was no significant difference in long-term survival
[hazard ratio (HR), 1.08; 95% CI, 0.81 to 1.43; P=0.60]. In systematic
analysis of the studies in high-risk patients, ON-BH CABG showed a lower
risk in terms of early mortality, intra-aortic balloon pump (IABP) usage,
renal failure, hemodialysis, MI and pulmonary complication. No significant
difference was observed in the long-term survival between ON-BH CABG and
C-CABG. <br/>Conclusion(s): With experienced and adept surgical team and
mature ON-BH technology, ON-BH CABG may reduce the risk of postoperative
death and complications in some patients. It might be an attractive
alternative for high-risk patient populations.<br/>Copyright &#xa9; 2021
AME Publishing Company. All rights reserved.

<27>
Accession Number
2013826394
Title
Acute kidney injury following transcatheter edge-to-edge mitral valve
repair: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Doulamis I.P.; Tzani A.; Kampaktsis P.N.; Kaneko T.; Tang G.H.L.
Institution
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Kampaktsis) Division of Cardiology, New York University Langone Medical
Center, NY, United States
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Aim of this study was to perform a systematic review a
meta-analysis of the literature in order to identify predictors of acute
kidney injury (AKI) in patients with mitral regurgitation (MR) undergoing
transcatheter edge-to-edge repair (TEER) and assess its effect on
in-hospital outcomes and mortality. Although iodinated contrast is not
typically used in TEER, these patients are still at risk for developing
AKI. <br/>Method(s): Studies reporting on the effect of incident AKI on
mortality following TEER for MR were included. Random-effects
meta-analysis was performed, comparing clinical outcomes between the
patients with or without incident AKI. <br/>Result(s): Six studies
including a total of 2057 patients (377 AKI and 1680 No-AKI) were included
and analyzed. AKI was significantly associated with 30-day mortality after
TEER (Odds ratio (OR): 8.06; 95% CI: 3.20, 20.30, p < 0.01; I²
= 18.4%) and all-cause mortality over a mean follow-up time of 30 months
(Hazard ratio (HR): 2.48; 95% CI: 1.89, 3.24, p < 0.01; I² =
23.7%). AKI after TEER was associated with prolonged hospitalization (Mean
difference (in days): 1.41; 95% CI: 0.52, 2.31, p < 0.01; I² =
82.4%). Stage 4 chronic kidney disease (CKD), device failure and history
of chronic obstructive pulmonary disease (COPD) were significant
predictors of AKI following TEER (CKD stage 4: OR: 2.38; 95% CI: 1.18,
4.78, p = 0.02; I² = 0.0%; Device failure: OR: 3.15; 95% CI:
1.94, 5.12, p < 0.01; I² = 0.0%; COPD: OR: 1.92; 95% CI: 1.16,
3.17; I² = 26.7%). <br/>Conclusion(s): Our findings highlight
the renal vulnerability of the TEER population to renal injury and the
associated deterioration in clinical outcomes and survival.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<28>
Accession Number
2013795145
Title
Coronary Artery Bypass Grafting Transit Time Flow Measurement: Graft
Patency and Clinical Outcomes.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Quin J.A.; Noubani M.; Rove J.Y.; Krstacic J.E.; Hattler B.; Collins J.F.;
Grover F.L.; Almassi G.H.; Shroyer A.L.
Institution
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Quin) Harvard Medical School, Boston, MA, United States
(Noubani, Krstacic, Shroyer) Northport VA Medical Center, Northport, NY,
United States
(Noubani, Krstacic, Shroyer) Stony Brook University, Stony Brook, New
York, United States
(Rove, Hattler, Grover) Rocky Mountain Regional VA Medical Center, Aurora,
CO, United States
(Rove, Grover) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado School of Medicine, Aurora, CO, United States
(Hattler) Division of Cardiology, Department of Medicine, University of
Colorado School of Medicine, Aurora, CO, United States
(Collins) VA Cooperative Studies Program, Perry Point, MD, United States
(Almassi) Clement J. Zablocki VA Medical Center, Milwaukee, WI, United
States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
Publisher
Elsevier Inc.
Abstract
Background: This subanalysis of the Randomized On-Off Bypass (ROOBY) trial
examined transit time flow measurement (TTFM) use and its impact on graft
patency and long-term clinical outcomes after coronary artery bypass graft
surgery. <br/>Method(s): Use of TTFM for ROOBY centers and surgeons was
assessed. Comparative patient outcomes based on TTFM use included 1-year
graft patency and 1-year and 5-year major adverse cardiac events:
all-cause mortality, nonfatal myocardial infarction, and revascularization
(percutaneous coronary intervention or repeat coronary artery bypass graft
surgery). <br/>Result(s): Transit time flow measurement was used in 1067
patients (TTFM group) and not used in 501 patients (non-TTFM group); of
the TTFM group, median percentage TTFM use was 79% (interquartile range,
41% to 98%) among 18 Veterans Affairs Medical Centers, and 74%
(interquartile range, 13% to 98%) among 48 surgeons. Patients were
comparable in age (63 +/- 8.5 years TTFM vs 62 +/- 8 years non-TTFM, P =
.30) and estimated 30-day mortality risk (1.8 +/- 1.7 TTFM vs 1.9
non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988
grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM
assessed grafts (P < .01). Fewer TTFM patients had an occluded graft (29%,
vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients,
5-year major adverse cardiac event rates were 30% vs 25% (P = .06).
Individual component rates were 14% vs 11% for death (P = .06), 12% vs
8.8% for myocardial infarction (P = .07), and 13% vs 12% for
revascularization (P = .62). <br/>Conclusion(s): The association of TTFM
use with graft patency and clinical outcome is uncertain. Future
randomized studies that account for patient risk factors and practice
variation would help address this knowledge gap.<br/>Copyright &#xa9; 2021
The Society of Thoracic Surgeons

<29>
Accession Number
2013320320
Title
Cost-Consequence Analysis of Using Cangrelor in High Angiographic Risk
Percutaneous Coronary Intervention Patients: A US Hospital Perspective.
Source
American Journal of Cardiovascular Drugs. (no pagination), 2021. Date of
Publication: 2021.
Author
Jensen I.S.; Wu E.; Cyr P.L.; Claussen M.; Winkler T.; Salahuddin K.;
Prats J.; Mahaffey K.W.; Gibson C.M.; Steg P.G.; Stone G.W.; Bhatt D.L.
Institution
(Jensen, Wu, Cyr) Precision Health Economics, 133 Federal Street, 10th
floor, Boston, MA 02110, United States
(Cyr) University of North Carolina at Charlotte, College of Health and
Human Services, Charlotte, NC, United States
(Claussen, Winkler, Salahuddin) Chiesi, Inc., Cary, NC, United States
(Prats) Elysis, CarlisleMAUnited States
(Mahaffey) Department of Medicine, Stanford Center for Clinical Research,
Stanford, CA, United States
(Gibson) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Steg) Universite de Paris, Assistance Publique-Hopitaux de Paris, Hopital
Bichat, INSERM U-1148, Paris, France
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, and the Cardiovascular Research
Foundation, New York, NY, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, and
Harvard Medical School, Boston, MA, United States
Publisher
Adis
Abstract
Objectives: The objective of this study was to evaluate a US hospital's
cost implications and outcomes of cangrelor use in percutaneous coronary
intervention (PCI) patients with two or more angiographic high-risk
features (HRFs), including avoidance of oral P2Y<inf>12</inf> inhibitor
pretreatment in patients requiring cardiac surgery. Intravenous cangrelor
provides direct, immediate onset and rapid-offset P2Y<inf>12</inf>
inhibition, which may reduce the necessity for oral P2Y<inf>12</inf>
pretreatment. <br/>Method(s): A decision analytic model was developed,
estimating the annual impact over 3 years of cangrelor availability.
Ischemic and bleeding events (48 h) from randomized clinical trial data
were extrapolated to 30 days. Event costs were from the CHAMPION PHOENIX
Economics substudy. Rates of coronary artery disease (CAD) presentation,
PCI, oral P2Y<inf>12</inf> pretreatment, and inpatient hospitalization
costs were from published literature and clinical experts. Scenario
analyses evaluated the impact of cangrelor availability on potential
reduced P2Y<inf>12</inf> pretreatment rates by 50-100%. Drug costs were
2019 wholesale acquisition costs and, where necessary, all costs were
adjusted to 2019 dollars. <br/>Result(s): In a hospital treating 1000 CAD
PCI inpatients annually, increasing cangrelor use from 11 to 32% resulted
in a reduction in 48-h ischemic events/year by 5.7%, while bleeding events
increased by 2.9%. Total costs of $1,135,472 declined 12.8%, with a 50%
reduction in P2Y<inf>12</inf> pretreatment or 30% with no pretreatment.
Savings were driven by a decrease in ischemic events, decrease in
glycoprotein IIb/IIIa inhibitor use, and less need for and shorter oral
P2Y<inf>12</inf> inhibitor washout period for surgery patients.
<br/>Conclusion(s): Use of cangrelor in patients with two or more
angiographic HRFs may improve outcomes and lower hospital budgets, mainly
from avoiding surgery delays necessitated by oral P2Y<inf>12</inf>
inhibitor pretreatment.<br/>Copyright &#xa9; 2021, The Author(s).

<30>
Accession Number
2013151631
Title
Simultaneous Left Ventricular Aneurysm and Ventricular Septal Rupture
Complicating Delayed STEMI Presentation: A Case-Based Review of Post-MI
Mechanical Complications Amid the COVID-19 Pandemic.
Source
Journal of Investigative Medicine High Impact Case Reports. 9 (no
pagination), 2021. Date of Publication: 2021.
Author
Goraya M.H.N.; Kalsoom S.; Almas T.; Amin M.K.; Hussain N.; Awan J.R.;
Ehtesham M.; Niaz M.A.; Virk H.U.H.; Filby S.J.
Institution
(Goraya) Services Institute of Medical Sciences, Lahore, Pakistan
(Kalsoom) Conemaugh Memorial Medical Center, Johnstown, PA, United States
(Almas, Ehtesham, Niaz) Royal College of Surgeons in Ireland, Dublin,
Ireland
(Amin) Texas Tech University Health Sciences Center, Amarillo, TX, United
States
(Hussain) Banner-University Medical Center, Tucson, AZ, United States
(Awan) University Hospital Limerick, Limerick, Ireland
(Virk, Filby) University Hospitals Cleveland Medical Center, Cleveland,
OH, United States
Publisher
SAGE Publications Ltd
Abstract
Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an
unprecedented increase in public avoidance of hospitals predominantly
driven by fear of contracting the virus. Recent publications highlight a
re-emergence of rare post-myocardial infarction complications. While
mechanical complications are infrequent in the era of primary percutaneous
coronary intervention, they are associated with high mortality rates. The
concurrent occurrence of mechanical complications such as left ventricular
aneurysm and ventricular septal rupture is an extremely rare entity. We
hereby delineate a unique case of a 53-year-old Caucasian male who
underwent successful concomitant closure of a ventricular septal rupture,
left ventricular aneurysmectomy, and 3-vessel coronary artery bypass
grafting. Due to a delayed initial presentation owing to the patient's
fear of contracting COVID-19, the surgery was carried out 3 months after
the myocardial infarction. His postoperative evaluation confirmed normal
contractility of the left ventricle and complete closure of the
ventricular septal rupture. Six months postoperatively, the patient
continues to do well. We also present a literature review of the
mechanical complications following delayed presentation of myocardial
infarction amid the COVID-19 pandemic. This article illustrates that
clinicians should remain cognizant of these extremely rare but potentially
lethal collateral effects during the ongoing global public-health
challenge. Furthermore, it highlights a significant concern regarding the
delay in first medical contact due to the reluctance of patients to visit
the hospital during the COVID-19 pandemic.<br/>Copyright &#xa9; 2021
American Federation for Medical Research.

<31>
Accession Number
606451584
Title
The effects of intraoperative dexamethasone on left atrial function and
postoperative atrial fibrillation in cardiac surgical patients.
Source
Netherlands Heart Journal. 23 (3) (pp 168-173), 2015. Date of Publication:
March 2015.
Author
Jacob K.A.; Dieleman J.M.; Nathoe H.M.; Van Osch D.; De Waal E.E.C.;
Cramer M.J.; Kluin J.; Van Dijk D.
Institution
(Jacob, Dieleman, De Waal, Van Dijk) Department of Anesthesiology and
Intensive Care, University Medical Center Utrecht, Mail Stop F.06.149, PO
Box 85500, Utrecht 3508, Netherlands
(Jacob, Kluin) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Nathoe, Van Osch, Cramer) Department of Cardiology, University Medical
Center Utrecht, Utrecht, Netherlands
Publisher
Bohn Stafleu van Loghum
Abstract
Postoperative new-onset atrial fibrillation (PNAF) is very common after
cardiac surgery and postoperative inflammation may contribute to PNAF by
inducing atrial dysfunction. Corticosteroids reduce inflammation and may
thus reduce atrial dysfunction and PNAF development. This study aimed to
determine whether dexamethasone protects against left atrial dysfunction
and PNAF in cardiac surgical patients. Cardiac surgical patients were
randomised to a single dose of dexamethasone (1 mg.kg^-1) or
placebo after inducing anaesthesia. Transoesophageal echocardiography was
performed in patients before and after surgery. Primary outcome was left
atrial total ejection fraction (LA-TEF) after sternal closure; secondary
outcomes included left atrial diameter and PNAF. 62 patients were
included. Baseline characteristics were well balanced. Postoperative
LA-TEF was 36.4%in the dexamethasone group and 40.2 % in the placebo group
(difference -3.8 %; 95 % confidence interval (CI) -9.0 to 1.4 %; P= 0.15).
Postoperative left atrial diameter was 4.6 and 4.3 cm, respectively
(difference 0.3; 95 % CI -0.2 to 0.7; P=0.19). The incidence of PNAF was
30 % in the dexamethasone group and 39 % in the placebo group (P = 0.47).
Intraoperative high-dose dexamethasone did not protect against
postoperative left atrial dysfunction and did not reduce the risk of PNAF
in cardiac surgical patients.<br/>Copyright &#xa9; The Author(s) 2015.

<32>
Accession Number
369203050
Title
Prophylactic intraaortic balloon pumping in high-risk cardiac surgery
patients.
Source
Medizinische Klinik - Intensivmedizin und Notfallmedizin. 106 (2) (pp
125-131), 2011. Date of Publication: October 2011.
Author
Metz D.; Stiller M.; Silber R.-E.; Kroll H.; Hofmann H.-S.; Diez C.
Institution
(Metz) Klinik fur Herz-, Thorax- und Gefaschirurgie, MediClin Herzzentrum
Coswig, Coswig, Germany
(Stiller, Silber) Klinik fur Herz- und Thoraxchirurgie,
Universitatsklinikum Halle (Saale), Halle, Germany
(Kroll) Klinik fur Anasthesiologie, Universitatsklinikum Halle (Saale),
Halle, Germany
(Hofmann) Abteilung fur Thoraxchirurgie, Universitatsklinikum Regensburg,
Regensburg, Germany
(Diez) Klinik fur Herz-, Thorax- und herznahe Gefaschirurgie,
Universitatsklinikum Regensburg, Franz-Josef-Straus-Allee 11, 93052
Regensburg, Germany
Publisher
Springer-Verlag
Abstract
Background: We examined the impact of prophylactic IABP insertion in
EuroSCORE-stratified high-risk cardiac surgery patients with a score >=8.
<br/>Material(s) and Method(s): A randomized trial with 104 patients
either without prophylactic IABP insertion (group A, n=52) or with IABP
(group B, n=52) was conducted. The primary endpoint was 30-day mortality.
<br/>Result(s): The median age of the patients was 74 years and 43% of
participants were females. The 30-day mortality did not differ between
group A (17.3%) and group B (13.4%; p=0.78). The median hospital stay was
14 days in both groups. Intra- and postoperative IABP support was required
by 13 patients (21%) in group A. The median ventilation time (14 hours
versus 13 hours), median catecholamine dose, frequency of
dialysis-dependent acute renal failure (28% versus 18%), cardiac indices,
and frequency of a low cardiac output syndrome (26% versus 25%) did not
significantly differ between groups. <br/>Conclusion(s): Prophylactic
preoperative IABP insertion in EuroSCORE-stratified high-risk patients is
not associated with decreased 30-day mortality. &#xa9; 2011 Urban & Vogel,
Muenchen.

<33>
Accession Number
2007157422
Title
Rivaroxaban Versus Warfarin in Patients with Mechanical Heart Valves:
Open-Label, Proof-of-Concept trial-The RIWA study.
Source
American Journal of Cardiovascular Drugs. 21 (3) (pp 363-371), 2021. Date
of Publication: May 2021.
Author
Duraes A.R.; de Souza Lima Bitar Y.; Schonhofen I.S.; Travassos K.S.O.;
Pereira L.V.; Filho J.A.L.; Neto M.G.; Junior R.A.; Roever L.
Institution
(Duraes, Neto, Junior) PPGMS/Federal University of Bahia, UFBA, Bahia,
Salvador, Brazil
(Duraes, de Souza Lima Bitar, Junior) Medical School, Federal University
of Bahia, FAMEB/UFBA, Largo do Terreiro de Jesus, XV de Novembro Square,
s/n, Salvador, Bahia CEP 40026-010, Brazil
(Schonhofen, Filho) General Hospital Roberto Santos/SUS-Bahia, Salvador,
Bahia, Brazil
(Travassos) Bahiana School of Medicine and Public Health, EBMSP, Salvador,
Bahia, Brazil
(Pereira) Nursing School, Federal University of Bahia, UFBA, Salvador,
Bahia, Brazil
(Roever) Federal University of Uberlandia, Minas Gerais, Uberlandia, Minas
Gerais, Brazil
Publisher
Adis
Abstract
Background and Purpose: To date, vitamin K antagonists are the only
available oral anticoagulants in patients with mechanical heart valves. In
this way, we developed a pilot trial with rivaroxaban. <br/>Method(s): The
RIWA study was a proof-of-concept, open-label, randomized clinical trial
and was designed to assess the incidence of thromboembolic and bleeding
events of the rivaroxaban-based strategy (15 mg twice daily) in comparison
to dose-adjusted warfarin. Patients were randomly assigned in a 1:1 ratio
and were followed prospectively for 90 days. <br/>Result(s): A total of 72
patients were enrolled in the present study. Of these, 44 patients were
randomized: 23 patients were allocated to the rivaroxaban group and 21 to
the warfarin group. After 90 days of follow-up, the primary outcome
occurred in one patient (4.3%) in the rivaroxaban group and three patients
(14.3%) in the warfarin group (risk ratio [RR] 0.27; 95% confidence
interval [CI] 0.02-2.85; P = 0.25). Minor bleeding (without
discontinuation of medical therapy) occurred in six patients (26.1%) in
the rivaroxaban group versus six patients (28.6%) in the warfarin group
(RR 0.88; 95% CI 0.23-3.32; P = 0.85). One patient in the warfarin group
died from myocardial infarction. No cases of hemorrhagic stroke, valve
thrombosis, peripheral embolic events, or new intracardiac thrombus were
related in both groups. <br/>Conclusion(s): In this pilot study,
rivaroxaban 15 mg twice daily had thromboembolic and bleeding events
similar to warfarin in patients with mechanical heart valves. These data
confirm the authors' proof-of-concept and suggest that a larger trial with
a similar design is not unreasonable. ClinicalTrial.gov identifier:
NCT03566303.<br/>Copyright &#xa9; 2020, Springer Nature Switzerland AG.

<34>
Accession Number
634608358
Title
Erythropoietin in Lupus: Unanticipated Immune Modulating Effects of a
Kidney Hormone.
Source
Frontiers in Immunology. 12 (no pagination), 2021. Article Number: 639370.
Date of Publication: 16 Mar 2021.
Author
Eswarappa M.; Cantarelli C.; Cravedi P.
Institution
(Eswarappa, Cravedi) Department of Medicine, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Cantarelli) UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma,
Parma, Italy
Publisher
Frontiers Media S.A.
Abstract
Systemic lupus erythematosus (SLE) is a multiorgan autoimmune disease with
variable clinical presentation, typically characterized by a
relapsing-remitting course. SLE has a multifactorial pathogenesis
including genetic, environmental, and hormonal factors that lead to loss
of tolerance against self-antigens and autoantibody production. Mortality
in SLE patients remains significantly higher than in the general
population, in part because of the limited efficacy of available
treatments and the associated toxicities. Therefore, novel targeted
therapies are urgently needed to improve the outcomes of affected
individuals. Erythropoietin (EPO), a kidney-produced hormone that promotes
red blood cell production in response to hypoxia, has lately been shown to
also possess non-erythropoietic properties, including immunomodulatory
effects. In various models of autoimmune diseases, EPO limits cell
apoptosis and favors cell clearance, while reducing proinflammatory
cytokines and promoting the induction of regulatory T cells. Notably, EPO
has been shown to reduce autoimmune response and decrease disease severity
in mouse models of SLE. Herein, we review EPO's non-erythropoietic
effects, with a special focus on immune modulating effects in SLE and its
potential clinical utility.<br/>&#xa9; Copyright &#xa9; 2021 Eswarappa,
Cantarelli and Cravedi.

<35>
Accession Number
2011907138
Title
Congenital heart disease-associated liver disease: A narrative review.
Source
Cardiovascular Diagnosis and Therapy. 11 (2) (pp 577-590), 2021. Date of
Publication: April 2021.
Author
Reiter F.P.; Hadjamu N.J.; Nagdyman N.; Zachoval R.; Mayerle J.; de Toni
E.N.; Kaemmerer H.; Denk G.
Institution
(Reiter, Mayerle, de Toni, Denk) Department of Medicine II, University
Hospital, LMU Munich, Munich, Germany
(Hadjamu) Department of Cardiology and Vascular Medicine, West German
Heart and Vascular Center, University Hospital Essen, Essen, Germany
(Nagdyman, Kaemmerer) Department of Congenital Heart Disease and Pediatric
Cardiology, German Heart Center Munich, Technical University Munich,
Munich, Germany
(Zachoval, Denk) Transplantation Center Munich, University Hospital, LMU
Munich, Munich, Germany
Publisher
AME Publishing Company
Abstract
Congenital heart diseases (CHD) can be associated with liver dysfunction.
The cause for liver impairment can result out of a wide spectrum of
different causes, including liver congestion, hypoxemia or low cardiac
output. Fortunately, most CHD show a good long-term outcome from a cardiac
perspective, but great attention should be paid on non-cardiac health
problems that develop frequently in patients suffering from CHD. The
treatment of liver dysfunction in CHD requires a close multidisciplinary
management in a vulnerable patient collective. Unfortunately, structured
recommendations on the management of liver dysfunction in patients with
CHD are scarce. The objective of this review is to provide insights on the
pathophysiology and etiologies of liver dysfunction as one of the most
relevant non-cardiac problems related to CHD. Furthermore, we advise here
on the management of liver disease in CHD with special attention on
assessment of liver dysfunction, management of portal hypertension as well
as on surveillance and management of hepatocellular carcinoma (HCC). A
multidisciplinary perspective may help to optimize morbidity and mortality
in the long-term course in these patients. However, as evidence is low in
many aspects, we encourage the scientific community to perform prospective
studies to gain more insights in the treatment of liver dysfunction in
patients with CHD.<br/>Copyright &#xa9; Cardiovascular Diagnosis and
Therapy. All rights reserved.

<36>
Accession Number
2011535552
Title
Anesthetic management of peripartum cardiomyopathy.
Source
Minerva Anestesiologica. 87 (3) (pp 334-340), 2021. Date of Publication:
March 2021.
Author
TURNBULL D.
Institution
(TURNBULL) Royal Hallamshire Hospital, Sheffield, United Kingdom
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare idiopathic
cardiomyopathy frequently presenting with heart failure secondary to left
ventricular systolic dysfunction towards the end of pregnancy or in the
months following delivery. Within the published literature, there are case
reports extolling the safety of both regional and general anesthetic
interventions in PPCM. However, there is an absence of high-quality
evidence to define a suitable paradigm for peri-operative care. In the
absence of a large prospective case series or clinical trials, the
synthesis of clinical data from published case reports provides an
opportunity to distil published clinical data and explore the effect of
clinical interventions. EVIDENCEACQUISITION: Asystematic search of English
articles English language case reports published between 1986 and 2020
within multiple databases. Clinical data was extracted and aggregated into
a database for analysis. EVIDENCE SYNTHESIS: Gestational hypertension and
pre-eclampsia were pre-partum risk factors. 403 case reports provided 466
individual cases from 48 countries. Neither regional nor general
anesthetic interventions in the peripartum period have a discernible
impact on the outcome of patients with PPCM. Rapid unpredictable
deterioration in the peripartum period, requiring mechanical cardiac
support or heart transplantation is described. The mortality of PPCM is
5-6%. <br/>CONCLUSION(S): Patients with PPCM are at risk of rapid
unpredictable decline. Management within specialist centers should be
considered. Although the data is unsuitable to provide a comprehensive
paradigm for the anesthetic and critical care management of PPCM, the
observations provide a direction for future clinical audits and
trials.<br/>Copyright &#xa9; 2021 Edizioni Minerva Medica. All rights
reserved.

<37>
Accession Number
2013716626
Title
Determinants of atrial fibrillation after cardiac surgery.
Source
Reviews in Cardiovascular Medicine. 22 (2) (pp 329-341), 2021. Date of
Publication: 30 Jun 2021.
Author
Qureshi M.; Ahmed A.; Massie V.; Marshall E.; Harky A.
Institution
(Qureshi, Ahmed, Massie, Marshall) School of Medicine, University of
Liverpool, Cedar House, Ashton Street, Liverpool L69 3GE, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool L14 3PE, United Kingdom
Publisher
IMR Press Limited
Abstract
Post-operative Atrial fibrillation (POAF) is a common complication post
cardiac surgery. It can result in detrimental short- and long-term
outcomes due to the increased risk of stroke, cardiac arrest and
congestive heart failure in addition to prolonged intensive care and total
hospital stay raising the overall healthcare cost. Accurately identifying
predictors and biomarkers for POAF ensures that patients at greatest risk
can be given the appropriate prophylactic measures; resources can be
distributed to the groups who are most in need and where they will gain
the optimum effect. Commonly recurring predictors can be investigated
further to unveil the pathophysiology behind POAF, which has yet to be
fully understood. This literature review aims to examine relevant studies
on the proposed predictors of POAF: increased age, gender, history of
atrial fibrillation, hypertension, cardiopulmonary bypass time and the use
of beta blockers amongst others. This paper will discuss the significance
of both the well-known and newfound risk factors to consolidate the areas
that require further exploration in order to highlight those at risk and
to unravel the mechanism behind POAF.<br/>Copyright &#xa9; 2021 The
Author(s). Published by IMR Press.

<38>
Accession Number
2013627977
Title
Efficacy and safety of dexmedetomidine in maintaining hemodynamic
stability in pediatric cardiac surgery: a systematic review and
meta-analysis.
Source
Jornal de Pediatria. (no pagination), 2021. Date of Publication: 2021.
Author
Wang Q.; Chen C.; Wang L.
Institution
(Wang, Chen) Hainan Women and Children's Medical Center, Department of
Anesthesiology, Haikou, China
(Wang) The First Hospital of Hebei Medical University, Department of
Anesthesiology, Shijiazhuang, China
Publisher
Elsevier Editora Ltda
Abstract
Objectives: Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic
receptor agonist, which is the main sedative in the intensive care unit.
This study aims to investigate the effectiveness and adverse events of DEX
in maintaining hemodynamic stability in pediatric cardiac surgery.
Sources: Databases such as PubMed, Cochrane, Web of Science, WANFANG STATA
and China National Knowledge Infrastructure were searched for articles
about the application of DEX in maintaining hemodynamic stability during
and after pediatric cardiac surgery up to 18th Feb. 2021. Only randomized
controlled trials were included and random-effects model meta-analysis was
applied to calculate the standardized mean deviation (SMD), odds ratio
(OR) and 95% confidence interval (CI). Summary of the findings: Fifteen
articles were included for this meta-analysis, and 9 articles for
qualitative analysis. The results showed that preoperative prophylaxis and
postoperative recovery of DEX in pediatric patients undergoing cardiac
surgery were effective in maintaining systolic blood pressure (SBP), mean
arterial pressure (MAP), diastolic blood pressure (DBP) and reducing heart
rate (HR) (SBP: SMD = -0.35,95% CI: -0.72, 0.01; MAP: SMD = -0.83, 95% CI:
-1.87,0.21; DBP: SMD = -0.79,95% CI: -1.66,0.08; HR: SMD = -1.71,95% CI:
-2.29, -1.13). In addition, the frequency of Junctional Ectopic
Tachycardia in the DEX treatment group was lower than that in the placebo
group. <br/>Conclusion(s): The application of DEX for preoperative
prophylaxis and postoperative recovery in pediatric cardiac surgery
patients are effective in maintaining hemodynamic stability, and the
clinical dose of DEX is not significantly related to the occurrence of
pediatric adverse events which may be related to individual
differences.<br/>Copyright &#xa9; 2021 Sociedade Brasileira de Pediatria

<39>
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.

<40>
Accession Number
2013135232
Title
Effectiveness of cervicothoracic and thoracic manual physical therapy in
managing upper quarter disorders-a systematic review.
Source
Journal of Manual and Manipulative Therapy. (no pagination), 2021. Date of
Publication: 2021.
Author
Schenk R.; Donaldson M.; Parent-Nichols J.; Wilhelm M.; Wright A.; Cleland
J.A.
Institution
(Schenk, Donaldson, Parent-Nichols, Wilhelm, Wright, Cleland) Department
of Public Health and Community Medicine, Program in Physical Therapy,
Tufts University School of Medicine, Boston, MA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Study Design: Systematic review. <br/>Background(s): Physical therapists
often use cervicothoracic and thoracic manual techniques to treat
musculoskeletal disorders of the upper quarter,however, the overall
effectiveness of this approach remains to be elucidated.
<br/>Objective(s): This systematic review explored studies that examined
the short- and long-term effectiveness of manual physical therapy directed
at the cervicothoracic and thoracic region in the management of upper
quarter musculoskeletal conditions. <br/>Method(s): The electronic
databases MEDLINE, AMED, CINAHL, and Embase were searched from their
inception through 30 October 2020. Eligible clinical trials included those
where human subjects treated with cervicothoracic and/or thoracic manual
procedures were compared with a control group or other interventions. The
methodological quality of individual studies was assessed using the PEDro
scale. <br/>Result(s): The initial search returned 950 individual
articles. After the screening of titles and abstracts, full texts were
reviewed by two authors, with 14 articles determined to be eligible for
inclusion. PEDro scores ranged from 66 to 10 (out of a maximum score of
10). In the immediate to 52-week follow-up period, studies provided
limited evidence that cervicothoracic and thoracic manual physical therapy
may reduce pain and improve function when compared to control/sham or
other treatments. <br/>Conclusion(s): Evidence provides some support for
the short-termeffectiveness of cervicothoracic and thoracic manual
physical therapy in reducing pain and improving function in people
experiencing upper quarter musculoskeletal disorders. Evidence is lacking
for long-term effectiveness as only two studies explored outcomes beyond
26 weeks and this was for patient-perceived improvement. Prospero ID:
CRD42020219456.<br/>Copyright &#xa9; 2021 Informa UK Limited, trading as
Taylor & Francis Group.

<41>
Accession Number
2013073925
Title
Predictors of permanent pacemaker implantation in patients undergoing
transcatheter aortic valve replacement-a systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 10 (14) (no pagination), 2021.
Article Number: e020906. Date of Publication: 20 Jul 2021.
Author
Ullah W.; Zahid S.; Zaidi S.R.; Sarvepalli D.; Haq S.; Roomi S.; Mukhtar
M.; Khan M.A.; Gowda S.N.; Ruggiero N.; Vishnevsky A.; Fischman D.L.
Institution
(Ullah, Ruggiero, Vishnevsky, Fischman) Thomas Jefferson University
Hospitals, Philadelphia, PA, United States
(Zahid) Rochester General Hospital, Rochester, NY, United States
(Zaidi) St. Mary Mercy Livonia, Livonia, MI, United States
(Sarvepalli) Guntur Medical College, Guntur, India
(Haq, Roomi) Abington Jefferson Health, Abington, PA, United States
(Mukhtar) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Khan) Texas Tech University Health Sciences Center, Amarillo, TX, United
States
(Gowda) University of South Dakota, Vermillion, SD, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: As transcatheter aortic valve replacement (TAVR) technology
expands to healthy and lower-risk populations, the burden and predictors
of procedure-related complications including the need for permanent
pacemaker (PPM) implantation needs to be identified. METHODS AND RESULTS:
Digital databases were systematically searched to identify studies
reporting the incidence of PPM implantation after TAVR. A random-and
fixed-effects model was used to calculate unadjusted odds ratios (OR) for
all predictors. A total of 78 studies, recruiting 31 261 patients were
included in the final analysis. Overall, 6212 patients required a PPM,
with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%.
The pooled estimates on a random-effects model indicated significantly
higher odds of post-TAVR PPM implantation for men (OR, 1.16; 95% CI,
1.04-1.28); for patients with baseline mobitz type-1 second-degree
atrioventricular block (OR, 3.13; 95% CI, 1.64-5.93), left anterior
hemiblock (OR, 1.43; 95% CI, 1.09-1.86), bifascicular block (OR, 2.59; 95%
CI, 1.52-4.42), right bundle-branch block (OR, 2.48; 95% CI, 2.17-2.83),
and for periprocedural atriorventricular block (OR, 4.17; 95% CI,
2.69-6.46). The mechanically expandable valves had 1.44 (95% CI,
1.18-1.76), while self-expandable valves had 1.93 (95% CI, 1.42-2.63) fold
higher odds of PPM requirement compared with self-expandable and
balloon-expandable valves, respectively. <br/>CONCLUSION(S): Male sex,
baseline atrioventricular conduction delays, intraprocedural
atrioventricular block, and use of mechanically expandable and
self-expanding prosthesis served as positive predictors of PPM
implantation in patients undergoing TAVR.<br/>Copyright &#xa9; 2021 The
Authors. Published on behalf of the American Heart Association, Inc., by
Wiley.

<42>
Accession Number
2005219447
Title
Efficacy of statin treatment based on cardiovascular outcomes in elderly
patients: a standard meta-analysis and Bayesian network analysis.
Source
Journal of International Medical Research. 48 (6) (no pagination), 2020.
Date of Publication: June 2020.
Author
Zhai C.; Hou K.; Li R.; Hu Y.; Zhang J.; Zhang Y.; Wang L.; Zhang R.; Cong
H.
Institution
(Zhai, Hou, Cong) School of Medicine, Nankai University, Tianjin, China
(Zhai, Hou, Hu, Zhang, Zhang, Wang, Zhang, Cong) Department of Cardiology,
Tianjin Chest Hospital, Tianjin, China
(Li) Department of Internal Medicine, Tianjin GongAn Hospital, Tianjin,
China
Publisher
SAGE Publications Ltd
Abstract
Objective: Statins have been shown to be beneficial for the prevention of
cardiovascular events. In elderly individuals, the efficacy of statins
remains controversial and the comparative effect of statins has not been
assessed. <br/>Method(s): MEDLINE, Embase, and the Cochrane Central
database were searched for randomized controlled trials that assessed
statins in older patients. <br/>Result(s): Seventeen trials were analyzed.
When used for secondary prevention, statins were associated with reduced
risk of cardiovascular events, all-cause mortality, cardiovascular
mortality, revascularization, and stroke. When used for primary
prevention, statins reduced the risk of myocardial infarction and
revascularization, but did not significantly affect other outcomes. A
modest difference between pharmaceutical statin products was found, and
high-quality evidence indicated that intensive atorvastatin had the
greatest benefits for secondary prevention. <br/>Conclusion(s): In
secondary prevention, evidence strongly suggests that statins are
associated with a reduction in the risk of all-cause mortality,
cardiovascular events, cardiovascular mortality, and revascularization.
However, differences in the effects of various statins do not appear to
have significant effects on therapy in secondary prevention for the
elderly.<br/>Copyright &#xa9; The Author(s) 2020.

<43>
Accession Number
2004244391
Title
Invasive haemodynamics in de novo everolimus vs. calcineurin inhibitor
heart transplant recipients.
Source
ESC Heart Failure. 7 (2) (pp 567-576), 2020. Date of Publication: 01 Apr
2020.
Author
Bergh N.; Gude E.; Bartfay S.-E.; K Andreassen A.; Arora S.; Dahlberg P.;
Dellgren G.; Gullestad L.; Gustafsson F.; Karasson K.; Radegran G.;
Bollano E.; Andersson B.
Institution
(Bergh, Bartfay, Dahlberg, Bollano, Andersson) Department of Cardiology,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Bergh, Bartfay, Dahlberg, Karasson, Bollano) Institute of Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
(Gude, K Andreassen, Arora, Gullestad) Department of Cardiology, Oslo
University Hospital Rikshospitalet, Oslo, Norway
(Gustafsson) Department of Cardiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Radegran) The Section for Heart Failure and Valvular Disease, VO Heart
and Lung Medicine, Skane University Hospital, Lund, Sweden
(Dellgren, Radegran) Department of Clinical Sciences, Lund University,
Lund, SwedenTransplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(K Andreassen, Arora, Gullestad) KG Jebsen Center for Cardiac Research,
University of Oslo, Oslo, Norway
(K Andreassen, Arora, Gullestad) Center for Heart Failure Research, Oslo
University Hospital, Oslo, Norway
(Gullestad) Faculty of Medicine, University of Oslo, Oslo, Norway
Publisher
Wiley-Blackwell
Abstract
Aims: Invasive haemodynamic profiles at rest and during exercise after
heart transplantation (HTx) have never been described in a randomized
trial where de novo everolimus (EVR)-based therapy with early calcineurin
inhibitor (CNI) withdrawal has been compared with conventional CNI
treatment. We report central invasive haemodynamic parameters at rest and
exercise during a 3 year follow-up after HTx in a sub-study of the
SCandiavian Heart transplant Everolimus De novo stUdy with earLy
calcineurin inhibitor avoidancE trial. We hypothesized that the
nephroprotective properties, the less development of cardiac allograft
vasculopathy (CAV), and the antifibrotic properties of EVR, in comparison
with CNI-based immunosuppression, would demonstrate favourable invasive
haemodynamic profiles in patients at rest and during exercise.
<br/>Methods and Results: Ninety of 115 HTx recipients randomized to EVR
or CNI treatment performed right heart catheterization at rest and 68
performed right heart catheterization at exercise up to 3 years after HTx.
Haemodynamic profiles were compared between EVR and CNI treatment groups.
Resting haemodynamics improved in both groups from pre-HTx to the first
follow-up at 7-11 weeks post-HTx and thereafter remained unchanged up to 3
years of follow-up. During follow-up, cardiac reserve during exercise
increased with higher levels of maximum heart rate (118 to 148 b.p.m., P <
0.001), mean arterial pressure (103 to 128 mmHg, P < 0.001), and cardiac
output (10.3 to 12.2 l/min, P < 0.001). No significant differences in
haemodynamic parameters were observed between the EVR and CNI groups at
rest or exercise. Isolated post-capillary pulmonary hypertension (mean
pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure
>= 15 mmHg, and pulmonary vascular resistance <3) were measured in 11% of
the patients at 7-11 weeks, 5% at 12 months, and 6% at 36 months after
HTx. The EVR group had significantly better kidney function (76 mL/min/1
vs. 60 mL/min/1, P < 0.001) and reduced CAV (P < 0.01) but an increased
rate of early biopsy-proven treated rejections (21.2% vs 5.7%, P < 0.01)
compared with the CNI group at any time point. The differences in renal
function, CAV, or early biopsy-proven treated acute rejections were not
associated with altered haemodynamics. <br/>Conclusion(s): De novo EVR
treatment with early CNI withdrawal compared with conventional CNI therapy
did not result in differences in haemodynamics at rest or during exercise
up to 3 years after HTx despite significant differences in renal function,
reduced CAV, and number of early biopsy-proven treated
rejections.<br/>Copyright &#xa9; 2020 The Authors. ESC Heart Failure
published by John Wiley & Sons Ltd on behalf of the European Society of
Cardiology

<44>
Accession Number
610172560
Title
Tooth loss is independently associated with poor outcomes in stable
coronary heart disease.
Source
European Journal of Preventive Cardiology. 23 (8) (pp 839-846), 2016. Date
of Publication: May 2015.
Author
Vedin O.; Hagstrom E.; Budaj A.; Denchev S.; Harrington R.A.; Koenig W.;
Soffer J.; Sritara P.; Stebbins A.; Stewart R.H.A.; Swart H.P.; Viigimaa
M.; Vinereanu D.; Wallentin L.; White H.D.; Held C.
Institution
(Vedin, Hagstrom, Wallentin, White, Held) Department of Medical Sciences,
Cardiology, Uppsala University, Uppsala, Sweden
(Vedin, Hagstrom, Wallentin) Uppsala Clinical Research Center, Uppsala
University, Uppsala, Sweden
(Budaj) Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
(Denchev) Clinic of Cardiology, Medical Institute of Ministry of Interior,
Sofia, Bulgaria
(Harrington) Department of Medicine, Stanford University, Stanford, CA,
United States
(Koenig) Department of Internal Medicine II-Cardiology, University of Ulm
Medical Center, Ulm, Germany
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Germany
(Koenig) DZHK (German Centre for Cardiovascular Research), Partner Site
Munich Heart Alliance, Munich, Germany
(Soffer) Metabolic Pathways and Cardiovascular Therapeutic Area,
GlaxoSmithKline, PA, United States
(Sritara) Department of Medicine, Faculty of Medicine, Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
(Stebbins) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Stewart) Green Lane Cardiovascular Service, Auckland City Hospital,
University of Auckland, Auckland, New Zealand
(Swart) Department of Cardioresearch, Antonius Ziekenhuis Sneek,
Netherlands
(Viigimaa) Tallinn University of Technology, North Estonia Medical Centre,
Tallinn, Estonia
(Vinereanu) University of Medicine and Pharmacy Carol Davila, University
and Emergency Hospital, Bucharest, Romania
Publisher
SAGE Publications Inc.
Abstract
Objective We investigated associations between self-reported tooth loss
and cardiovascular outcomes in a global stable coronary heart disease
cohort. Methods We examined 15,456 patients from 39 countries with stable
coronary heart disease (prior myocardial infarction, prior
revascularisation or multivessel coronary heart disease) in the STABILITY
trial. At baseline, patients reported number of teeth (26-32 (all), 20-25,
15-19, 1-14 and no teeth) and were followed for 3.7 years. Cox regression
models adjusted for cardiovascular risk factors and socioeconomic status,
determined associations between tooth loss level (26-32 teeth: lowest
level; no teeth: highest level) and cardiovascular outcomes. Results After
adjustment, every increase in tooth loss level was associated with an
increased risk of the primary outcome, the composite of cardiovascular
death, non-fatal myocardial infarction and non-fatal stroke (hazard ratio
1.06; 95% confidence interval 1.02-1.10), cardiovascular death (1.17;
1.10-1.24), all-cause death (1.16; 1.11-1.22) and non-fatal or fatal
stroke (1.14; 1.04-1.24), but not with non-fatal or fatal myocardial
infarction (0.99; 0.94-1.05). Having no teeth, compared to 26-32 teeth,
entailed a significantly higher risk of the primary outcome (1.27 (1.08,
1.49)), cardiovascular death (1.85 (1.45, 2.37), all-cause death (1.81
(1.50, 2.20)) and stroke (1.67 (1.15, 2.39)). Conclusions In this large
global cohort of patients with coronary heart disease, self-reported tooth
loss predicted adverse cardiovascular outcomes and all-cause death
independent of cardiovascular risk factors and socioeconomic
status.<br/>Copyright &#xa9; 2015 European Society of Cardiology.

<45>
Accession Number
622047939
Title
The causative agents in infective endocarditis: A systematic review
comprising 33,214 cases.
Source
European Journal of Clinical Microbiology and Infectious Diseases. 35 (8)
(pp 1227-1245), 2016. Date of Publication: August 2016.
Author
Vogkou C.T.; Vlachogiannis N.I.; Palaiodimos L.; Kousoulis A.A.
Institution
(Vogkou, Vlachogiannis, Palaiodimos, Kousoulis) AthensGreece
(Vogkou, Vlachogiannis) School of Medicine, National and Kapodistrian
University of Athens, Athens, Greece
(Palaiodimos) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine, Bronx, NY, United States
(Kousoulis) Faculty of Epidemiology and Population Health, London School
of Hygiene and Tropical Medicine, London, United Kingdom
Publisher
Springer Verlag
Abstract
Infective endocarditis (IE) incidence remains high with considerable
fatality rates; guidelines for prophylaxis against IE are currently under
review in some settings which highlights the importance of maintaining
up-to-date epidemiological estimates about the most common microbial
causes. The objective of this systematic review, following PRISMA
guidelines, was to identify the most common microbial causes of IE in
recent years. Medline was searched from January 1, 2003 to March 31, 2013
for all articles containing the term "in-fective endocarditis". All
relevant studies reporting diagnostic results were included. Special
patient subpopula-tions were assessed separately. A total of 105 studies
were included, from 36 countries, with available data on a total of 33,214
cases. Staphylococcus aureus was found to be the most common
microorganism, being the most frequent in 54.3 % of studies (N = 57) (and
in 55.4 % of studies using Duke's criteria for diagnosis [ N = 51]. Vi r i
dans gr oup st r ept ococci (VGS), coagulase-negative staphylococci
(CoNS), Enterococcus spp and Streptococcus bovis were among the most
common causes. S. aureus was the most common pathogen in almost all
population subgroups; however, this was not the case in patients with
implantable devices, prosthetic valves, or immunocompromised non-HIV, as
well as in the sub-group from Asia, emphasizing that a global
one-size-fits-all approach to the management of suspected IE is not
appropriate. This review provides an evidence-based map of the most common
causative agents of IE, highlighting S. aureus as the leading cause in the
21st century. The changing epidemiology of IE in some patient sub-groups
in the last decade and the very high number of microbiologically
undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and
diagnostic strategies.<br/>Copyright &#xa9; Springer-Verlag Berlin
Heidelberg 2016.

<46>
Accession Number
600131270
Title
Gender differences in patients with cardiogenic shock complicating
myocardial infarction: a substudy of the IABP-SHOCK II-trial.
Source
Clinical Research in Cardiology. 104 (1) (pp 71-78), 2015. Date of
Publication: January 2014.
Author
Fengler K.; Fuernau G.; Desch S.; Eitel I.; Neumann F.-J.; Olbrich H.-G.;
de Waha A.; de Waha S.; Richardt G.; Hennersdorf M.; Empen K.; Hambrecht
R.; Fuhrmann J.; Bohm M.; Poess J.; Strasser R.; Schneider S.; Schuler G.;
Werdan K.; Zeymer U.; Thiele H.
Institution
(Fengler, Fuernau, Schuler) Department of Internal Medicine, Cardiology,
University of Leipzig, Heart Center, Strumpellstrase 39, Leipzig 04289,
Germany
(Desch, Eitel, Poess, Thiele) Department of Internal Medicine II,
University of Lubeck, Lubeck, Germany
(Neumann) Department of Cardiology, University of Freiburg, Bad Krozingen
Heart Center, Bad Krozingen, Germany
(Olbrich) Department of Internal Medicine I, Hospital Langen, Langen,
Germany
(de Waha) Department of Cardiology, German Heart Center Munich, Munich,
Germany
(de Waha, Richardt) Department of Cardiology, Angiology, Bad Segeberg
Heart Center, Bad Segeberg, Germany
(Hennersdorf) Department of Internal Medicine I, Klinikum am
Gesundbrunnen, Heilbronn, Germany
(Empen) Department of Internal Medicine B, University of Greifswald,
Greifswald, Germany
(Hambrecht) Department of Cardiology, Angiology, Klinikum links der Weser,
Bremen, Germany
(Fuhrmann) Department of Cardiology, Zentralklinik Bad Berka, Bad Berka,
Germany
(Bohm) Department of Internal Medicine III, University of Homburg,
Homburg, Saar, Germany
(Strasser) Department of Internal Medicine, Cardiology, University of
Dresden, Heart Center, Dresden, Germany
(Schneider, Zeymer) Institut fur Herzinfarktforschung, Ludwigshafen,
Germany
(Werdan) Department of Internal Medicine III, Martin-Luther-University
Halle-Wittenberg, Halle, Saale, Germany
Publisher
Dr. Dietrich Steinkopff Verlag GmbH and Co. KG
Abstract
Background: Cardiogenic shock (CS) complicating acute myocardial
infarction (AMI) is associated with high mortality. Previous studies
regarding gender-specific differences in CS are conflicting and there are
insufficient data for the presence of gender-associated differences in the
contemporary percutaneous coronary intervention era. Aim of this study was
therefore to investigate gender-specific differences in a large cohort of
AMI patients with CS undergoing contemporary treatment.
Methods: In the randomized Intra-aortic Balloon Pump in Cardiogenic Shock
II (IABP-SHOCK II) trial, 600 patients with CS complicating AMI undergoing
early revascularization were assigned to therapy with or without
intra-aortic balloon pump. We compared sex-specific differences in these
patients with regard to baseline and procedural characteristics as well as
short- and long-term clinical outcome.
Results: Of 600 patients 187 (31 %) were female. Women were significantly
older than men and had a significantly lower systolic and diastolic blood
pressure at presentation (p < 0.05 for all). Diabetes mellitus and
hypertension were more frequent in women, whereas smoking was more
frequent in men (p < 0.05 for all). Women showed a higher mortality within
the first day after randomization (p = 0.004). However, after
multivariable adjustment this numerical difference was no longer
statistically significant. No gender-related differences in clinical
outcome were observed after 1, 6 and 12 months of follow-up.
Conclusion: In this large-scale multicenter study in patients with CS
complicating AMI, women had a worse-risk profile in comparison to men. No
significant gender-related differences in treatment as well as short- and
long-term outcome were observed.<br/>Copyright &#xa9; 2014,
Springer-Verlag Berlin Heidelberg.

<47>
Accession Number
606305848
Title
Multicentre double-blind randomized controlled trial of perhexiline as a
metabolic modulator to augment myocardial protection in patients with left
ventricular hypertrophy undergoing cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 48 (3) (pp 354-362), 2015.
Date of Publication: September 2015.
Author
Senanayake E.L.; Howell N.J.; Ranasinghe A.M.; Drury N.E.; Freemantle N.;
Frenneaux M.; Oelofse T.; Green D.; Wilson I.C.; Rooney S.J.; Mascaro J.;
Graham T.R.; Bhudia S.; Lewis M.; Pagano D.
Institution
(Senanayake, Howell, Ranasinghe, Drury, Wilson, Rooney, Mascaro, Graham,
Pagano) Department of Cardiothoracic Surgery, University Hospitals
Birmingham NHS FT, Birmingham, United Kingdom
(Senanayake, Howell, Ranasinghe) School of Clinical and Experimental
Medicine, University of Birmingham, Birmingham, United Kingdom
(Freemantle) Department of Primary Care and Population Health, University
College London, London, United Kingdom
(Frenneaux) School of Medicine, University of Aberdeen, Aberdeen, United
Kingdom
(Oelofse, Green) Department of Cardiothoracic Anaesthesia, Queen Elizabeth
Hospital Birmingham, Birmingham, United Kingdom
(Bhudia) Department of Cardiothoracic Surgery, University Hospital
Coventry and Warwickshire, Coventry, United Kingdom
(Lewis) Department of Cardiothoracic Surgery, Royal Sussex County
Hospital, Brighton, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Patients undergoing cardiac surgery require adequate
myocardial protection. Manipulating myocardial metabolism may improve the
extent of myocardial protection. Perhexiline has been shown to be an
effective anti-anginal agent due to its metabolic modulation properties by
inhibiting the uptake of free fatty acids into the mitochondrion, and
thereby promoting a more efficient carbohydrate- driven myocardial
metabolism. Metabolic modulation may augment myocardial protection,
particularly in patients with left ventricular hypertrophy (LVH) known to
have a deranged metabolic state and are at risk of poor postoperative
outcomes. This study aimed to evaluate the role of perhexiline as an
adjunct in myocardial protection in patients with LVH secondary to aortic
stenosis (AS), undergoing an aortic valve replacement (AVR).
<br/>METHOD(S): In a multicentre double-blind randomized controlled trial
of patients with AS undergoing AVR +/- coronary artery bypass graft
surgery, patients were randomized to preoperative oral therapy with either
perhexiline or placebo. The primary end point was incidence of inotrope
use to improve haemodynamic performance due to a low cardiac output state
during the first 6 h of reperfusion, judged by a blinded end points
committee. Secondary outcome measures included haemodynamic measurements,
electrocardiographic and biochemical markers of new myocardial injury and
clinical safety outcome measures. <br/>RESULT(S): The trial was halted
early on the advice of the Data Safety and Monitoring Board. Sixty-two
patients were randomized to perhexiline and 65 to placebo. Of these, 112
(54 perhexiline and 48 placebo) patients received the intervention,
remained in the trial at the time of the operation and were analysed. Of
110 patients who achieved the primary end point, 30 patients (16
perhexiline and 14 placebo) had inotropes started appropriately; there was
no difference in the incidence of inotrope usage OR of 1.65 [confidence
interval (CI): 0.67- 4.06] P = 0.28. There was no difference in myocardial
injury as evidenced by electrocardiogram odds ratio (OR) of 0.36 (CI:
0.07-1.97) P = 0.24 or postoperative troponin release. Gross secondary
outcome measures were comparable between the groups. <br/>CONCLUSION(S):
Perhexiline as a metabolic modulator to enhance standard myocardial
protection does not provide an additional benefit in haemodynamic
performance or attenuate myocardial injury in the hypertrophied heart
secondary to AS. The role of perhexiline in cardiac surgery is
limited.<br/>Copyright &#xa9; The Author 2015. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery.

<48>
Accession Number
601954193
Title
Sodium bicarbonate infusion for prevention of acute kidney injury: No
evidence for superior benefit, but risk for harm?.
Source
International Urology and Nephrology. 47 (2) (pp 321-326), 2015. Date of
Publication: February 2014.
Author
Schiffl H.
Institution
(Schiffl) Department of Internal Medicine IV, University Hospital Munich,
Munich, Germany
(Schiffl) KfH Renal Centre Munich Laim, Munich, Germany
Publisher
Kluwer Academic Publishers
Abstract
The best "treatment" of acute kidney injury (AKI) is prevention. Patients
who are at high risk of AKI should have an assessment of their volume
status and receive appropriate volume expansion. The most effective type
of intravenous fluid remains unclear. Innumerable studies have compared
sodium bicarbonate and isotonic saline and have combined fluid hydration
with pharmacological interventions, particularly N-acetyl-cysteine.
However, abundant systematic reviews and meta-analyses have provided
conflicting conclusions and have recognized a significant degree of
heterogeneity between studies and publication bias. Most studies comparing
intravenous sodium bicarbonate and saline were small. They often enrolled
patients with a low risk for AKI, yielding low serious events (renal
replacement therapy), and used different protocols for administration of
fluids. Based on current literature, intravenous sodium bicarbonate does
not seem to be more efficient than saline for the prevention of
contrast-media-induced AKI, cardiac surgery-associated AKI, pigment
nephropathy or septic AKI. However, some cohort studies or prospective
randomized trials did track and report serious adverse events, such as
higher rates of AKI or higher in-hospital mortality. At present, it should
be concluded that the use of intravenous sodium bicarbonate administration
to prevent AKI should be evaluated further in multicenter randomized
double-blind trials rather than adopted into routine clinical
practice.<br/>Copyright &#xa9; 2014, Springer Science+Business Media
Dordrecht.

<49>
Accession Number
603859353
Title
A 2-year follow-up of oxidative stress levels in patients with ST-segment
elevation myocardial infarction: A subanalysis of the ALPS-AMI study.
Source
Angiology. 66 (3) (pp 271-277), 2015. Date of Publication: March 2015.
Author
Abe N.; Kashima Y.; Izawa A.; Motoki H.; Ebisawa S.; Miyashita Y.; Imamura
H.; Ikeda U.
Institution
(Abe, Kashima, Izawa, Motoki, Miyashita, Imamura, Ikeda) Department of
Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1
Asahi, Matsumoto, Nagano 390-0802, Japan
(Ebisawa) Department of Emergency and Intensive Care Medicine, Shinshu
University School of Medicine, Nagano, Japan
Publisher
SAGE Publications Inc.
Abstract
We sought to determine whether serial measurements of oxidative stress
levels could serve as a predictive marker for cardiovascular (CV) events
in patients with ST-segment elevation myocardial infarction (STEMI).
Biological antioxidant potential (BAP) levels were measured at admission
and at 6, 12, and 24 months in 69 patients with STEMI. The CV events
abruptly increased 6 to 10 months after successful percutaneous coronary
intervention in patients with STEMI, and the 6-month BAP levels were
significantly lower in patients with CV events (2456 mumol/L
[interquartile range: 2237-2615 mumol/L]) than in those without (2849
mumol/L [2575-2987 mumol/L], P <.001). A decreased 6-month BAP level was
an independent and significant predictor of long-term CV events (hazard
ratio = 2.45; 95% confidence intervals 1.10-5.78; P =.04). Our findings
suggest that serial changes in antioxidant capacity, assessed by BAP
levels, may serve as a predictive marker for CV events after
STEMI.<br/>Copyright &#xa9; The Author(s) 2014.

<50>
Accession Number
52978572
Title
Effect of trimetazidine on recurrent angina pectoris and left ventricular
structure in elderly multivessel coronary heart disease patients with
diabetes mellitus after drug-eluting stent implantation: A single-centre,
prospective, randomized, double-blind study at 2-year follow-up.
Source
Clinical Drug Investigation. 34 (4) (pp 251-258), 2014. Date of
Publication: April 2014.
Author
Xu X.; Zhang W.; Zhou Y.; Zhao Y.; Liu Y.; Shi D.; Zhou Z.; Ma H.; Wang
Z.; Yu M.; Ma Q.; Gao F.; Shen H.; Zhang J.
Institution
(Xu, Zhang, Zhou, Zhao, Liu, Shi, Zhou, Ma, Wang, Yu, Ma, Gao, Shen,
Zhang) Department of Cardiology, Beijing An Zhen Hospital, Capital Medical
University, Anzhenli Avenue, Chao Yang District, Beijing 100029, China
Publisher
Springer International Publishing
Abstract
Background and Objective: Trimetazidine has been shown to improve angina
pectoris and left ventricular (LV) function in diabetic patients with
ischaemic cardiomyopathy. The objective of this study was to evaluate the
effects of trimetazidine on recurrent angina pectoris and LV structure
after drug-eluting stent (DES) implantation in elderly multivessel
coronary heart disease (CHD) patients with diabetes mellitus (DM) and a
left ventricular ejection fraction (LVEF) of >=50 %. <br/>Method(s): This
was a single-centre, prospective, randomized, double-blind evaluation
study. Between January 2010 and September 2010, 700 CHD patients with DM
who were aged >=65 years and undergoing coronary angiography at An Zhen
Hospital (Beijing, China) were recruited and prospectively randomized to
receive trimetazidine (20 mg three times daily) or placebo after DES
implantation as an addition to conventional CHD treatment. The primary end
points were the incidence of recurrent angina pectoris and measures of
various echocardiographic parameters, which included LVEF. <br/>Result(s):
At 2-year follow-up, patients in the trimetazidine group (n = 255) showed
significant improvements in the incidence (P = 0.024) and severity of
angina pectoris, compared with the control group, as well as silent
myocardial ischaemia (P = 0.009) and angina pectoris-free survival (P =
0.011). LV function and structure in trimetazidine-treated patients were
relatively stable at 2-year follow-up, while they deteriorated in the
control group (n = 255) with a significant difference between groups (all
P < 0.01). The E peak to A peak (E/A) ratio in trimetazidine-treated
patients and in the control group decreased after 2 years; the E/A ratio
in trimetazidine-treated patients was slightly better than that in the
control group, without a significant difference (P = 0.170). There was no
significant difference in event-free survival for the composite end point
including death, myocardial infarction, cerebrovascular accident (P =
0.422) and subsequent revascularization (P = 0.073). <br/>Conclusion(s):
Adjunctive therapy with trimetazidine after DES implantation can have a
beneficial effect on recurrent angina pectoris as well as LV function and
structure in elderly multivessel CHD patients with DM. &#xa9; 2014
Springer International Publishing Switzerland.

<51>
Accession Number
373646287
Title
Sirolimus Immunoprophylaxis and Renal Histological Changes in Long-Term
Cardiac Transplant Recipients: A Pilot Study.
Source
Annals of Pharmacotherapy. 48 (7) (pp 837-846), 2014. Date of Publication:
July 2014.
Author
White M.; Boucher A.; Dandavino R.; Fortier A.; Pelletier G.B.; Racine N.;
Ducharme A.; de Denus S.; Carrier M.; Collette S.
Institution
(White, Pelletier, Racine, Ducharme, de Denus, Carrier) Montreal Heart
Institute, Universite de Montreal, Montreal, Canada
(Boucher, Dandavino, Collette) Hopital Maisonneuve-Rosemont, Universite de
Montreal, Montreal, Canada
(Fortier) Montreal Heart Institute Coordinating Center, Montreal, Canada
Publisher
SAGE Publications Inc.
Abstract
Background: The effects of sirolimus (SIR), as a substitution for
calcineurin inhibitor (CNI) immunoprophylaxis, on renal function in
very-long-term cardiac transplant recipients have been a matter of
controversy. <br/>Objective(s): To assess the impacts of SIR as a
substitution for CNI on renal function up to 24 months in long-term
cardiac recipients as well as the renal histological changes in patients
with suspected CNI-induced nephrotoxicity. <br/>Method(s): A total of 23
cardiac transplant recipients aged 57.7 +/- 11.2 years, 91 months
post-cardiac transplantation were recruited; 15 patients were randomized
to CNI-free immune suppression with SIR, and 8 patients were allocated to
continue their CNI regimens. Serum creatinine and calculated serum
creatinine clearance were measured at prespecified time points up to 24
months. Renal structure and function were assessed by renal biopsies,
renal ultrasound, and magnetic resonance imaging at baseline.
<br/>Result(s): There were no significant changes in creatinine clearance
during the course of the study in patients treated with SIR. However,
SIR-treated patients exhibited a significant decrease in 24-hours and
nighttime systolic and diastolic blood pressures. Typical findings of
significant hypertensive renal disease were detected in 9 of the 11 (82%)
patients. Features of chronic CNI toxicity were detected in 6 (55%)
patients. <br/>Conclusion(s): There is a very high rate of hypertensive
renal disease concomitantly with some degree of CNI toxicity in long-term
cardiac transplant recipients with renal dysfunction. This very high rate
of hypertension-related disease may limit the impact of SIR on improving
renal function long term following cardiac transplantation. &#xa9; The
Author(s) 2014.

<52>
Accession Number
52756201
Title
Safety and effects of two red blood cell transfusion strategies in
pediatric cardiac surgery patients: A randomized controlled trial.
Source
Intensive Care Medicine. 39 (11) (pp 2011-2019), 2013. Date of
Publication: November 2013.
Author
De Gast-Bakker D.H.; De Wilde R.B.P.; Hazekamp M.G.; Sojak V.; Zwaginga
J.J.; Wolterbeek R.; De Jonge E.; Gesink-Van Der Veer B.J.
Institution
(De Gast-Bakker, De Wilde, De Jonge, Gesink-Van Der Veer) Pediatric
Intensive Care Unit, Leiden University Medical Center, Leiden, Netherlands
(Hazekamp, Sojak) Department of Cardiothoracic Surgery, Leiden University
Medical Center, Leiden, Netherlands
(Zwaginga) Center for Clinical Transfusion Research, Sanquin Research,
Leiden, Netherlands
(Zwaginga) Department of Immuno-hematology and Blood Transfusion, Leiden
University Medical Center, Leiden, Netherlands
(Wolterbeek) Department of Medical Statistics and Bioinformatics, Leiden
University Medical Center, Leiden, Netherlands
(De Wilde) Albinusdreef 2, 2300 RC Leiden, Netherlands
Publisher
Springer Verlag
Abstract
Objective: To investigate the safety and effects of a restrictive red
blood cell (RBC) transfusion strategy in pediatric cardiac surgery
patients. <br/>Design(s): Randomized controlled trial. <br/>Setting(s):
Pediatric ICU in an academic tertiary care center, Leiden University
Medical Center, Leiden, The Netherlands. <br/>Patient(s): One hundred
seven patients with non-cyanotic congenital heart defects between 6 weeks
and 6 years of age. One hundred three patients underwent corrective
surgery on cardiopulmonary bypass. <br/>Intervention(s): Prior to surgery
patients were randomly assigned to one of two groups with specific RBC
transfusion thresholds: Hb 10.8 g/dl (6.8 mmol/l) and Hb 8.0 g/dl (5.0
mmol/l). Measurements: Length of stay in hospital (primary outcome),
length of stay in PICU, duration of ventilation (secondary outcome),
incidence of adverse events and complications related to randomization
(intention to treat analysis). <br/>Result(s): In the restrictive
transfusion group, mean volume of transfused RBC was 186 (+/-70) ml per
patient and in the liberal transfusion group 258 (+/-87) ml per patient,
(95 % CI 40.6-104.6), p < 0.001. Length of hospital stay was shorter in
patients with a restrictive RBC transfusion strategy: Median 8 (IQR 7-11)
vs. 9 (IQR 7-14) days, p = 0.047. All other outcome measures and incidence
of adverse effects were equal in both RBC transfusion groups. Cost of
blood products for the liberal transfusion group was 438.35 (+/-203.39)
vs. 316.27 (+/-189.96) euros (95 % CI 46.61-197.51) per patient in the
restrictive transfusion group, p = 0.002. <br/>Conclusion(s): For patients
with a non-cyanotic congenital heart defect undergoing elective cardiac
surgery, a restrictive RBC transfusion policy (threshold of Hb 8.0 g/dl)
during the entire perioperative period is safe, leads to a shorter
hospital stay and is less expensive. &#xa9; 2013 Springer-Verlag Berlin
Heidelberg and ESICM.

<53>
Accession Number
52722505
Title
Safety of off-label erythropoiesis stimulating agents in critically ill
patients: A meta-analysis.
Source
Intensive Care Medicine. 39 (11) (pp 1896-1908), 2013. Date of
Publication: November 2013.
Author
Mesgarpour B.; Heidinger B.H.; Schwameis M.; Kienbacher C.; Walsh C.;
Schmitz S.; Herkner H.
Institution
(Mesgarpour, Heidinger, Schwameis, Kienbacher, Herkner) Department of
Emergency Medicine, General Hospital, Medical University of Vienna,
Wahringer Gurtel 18-20, 1090 Vienna, Austria
(Mesgarpour, Schwameis) Department of Clinical Pharmacology, Medical
University of Vienna, Vienna, Austria
(Walsh) Department of Statistics, Trinity College Dublin, Dublin, Ireland
(Schmitz) Department of Pharmacology and Therapeutics, Trinity College
Dublin, Dublin, Ireland
Publisher
Springer Verlag
Abstract
Purpose: Erythropoiesis stimulating agents (ESAs) are used to treat anemia
in critically ill patients. This indication is off-label, because it is
not licensed by regulatory authorities. Recently ESAs were suspected to
harm critically ill patients. Our objective was to assess the safety of
ESAs in off-label indications in critically ill patients. <br/>Method(s):
Eleven databases were searched up to April 2012. We considered randomized
controlled trials (RCTs) and controlled observational studies in any
language that compared off-label ESAs treatment with other effective
interventions, placebo or no treatment in critically ill patients. Two
authors independently screened and evaluated retrieved records, extracted
data and assessed risk of bias and quality of reporting. <br/>Result(s):
We used frequentist and Bayesian models to combine studies, and performed
sensitivity and subgroup analyses. From 12,888 citations, we included 48
studies (34 RCTs; 14 observational), involving 944,856 participants. Harm
reporting was of medium to low quality. There was no statistically
significant increased risk of adverse events in general, serious adverse
events, the most frequently reported adverse events, and death in
critically ill patients treated with ESAs. These results were robust
against risk of bias and analysis methods. There is evidence that ESAs
increase the risk of clinically relevant thrombotic vascular events, and
there is some less certain evidence that ESAs might increase the risk for
venous thromboembolism. <br/>Conclusion(s): In critically ill patients,
administration of ESAs is associated with a significant increase in
clinically relevant thrombotic vascular events but not with other
frequently reported adverse events and death. &#xa9; 2013 Springer-Verlag
Berlin Heidelberg and ESICM.

<54>
Accession Number
364610680
Title
Early mitral valve repair versus watchful waiting in patients with severe
asymptomatic organic mitral regurgitation; rationale and design of the
Dutch AMR trial, a multicenter, randomised trial.
Source
Netherlands Heart Journal. 20 (3) (pp 94-101), 2012. Date of Publication:
March 2012.
Author
Tietge W.J.; de Heer L.M.; van Hessen M.W.J.; Jansen R.; Bots M.L.; van
Gilst W.; Schalij M.; Klautz R.J.M.; van den Brink R.B.A.; van Herwerden
L.A.; Doevendans P.A.; Chamuleau S.A.J.; Kluin J.
Institution
(Tietge, Jansen, Doevendans, Chamuleau) Department of Cardiology, UMC
Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
(de Heer, van Herwerden, Kluin) Department of Cardiothoracic Surgery, UMC
Utrecht, Utrecht, Netherlands
(van Hessen) WCN, Utrecht, Netherlands
(Bots) Julius Center Utrecht, Utrecht, Netherlands
(van Gilst) ICIN, Utrecht, Netherlands
(Schalij) Department of Cardiology, LUMC, Leiden, Netherlands
(Klautz) Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
(van den Brink) Department of Cardiology, AMC Amsterdam, Amsterdam,
Netherlands
Publisher
Bohn Stafleu van Loghum
Abstract
Background Asymptomatic severe mitral valve (MV) regurgitation with
preserved left ventricular function is a challenging clinical entity as
data on the recommended treatment strategy for these patients are scarce
and conflicting. For asymptomatic patients, no randomised trial has been
performed for objectivising the best treatment strategy. Methods The Dutch
AMR (Asymptomatic Mitral Regurgitation) trial is a multicenter,
prospective, randomised trial comparing early MV repair versus watchful
waiting in asymptomatic patients with severe organic MV regurgitation. A
total of 250 asymptomatic patients (18-70 years) with preserved left
ventricular function will be included. Intervention will be either
watchful waiting or MV surgery. Follow-up will be 5 years. Primary outcome
measures are all-cause mortality and a composite endpoint of
cardiovascular mortality, congestive heart failure, and hospitalization
for non-fatal cardiovascular and cerebrovascular events. Secondary outcome
measures are total costs, cost-effectiveness, quality of life,
echocardiographic and cardiac magnetic resonance parameters, exercise
tests, asymptomatic atrial fibrillation and brain natriuretic peptide
levels. Additionally, the complication rate in the surgery group and rate
of surgery in the watchful waiting group will be determined. Implications
The DutchAMR trial will be the first multicenter randomised trial on this
topic. We anticipate that the results of this study are highly needed to
elucidate the best treatment strategy and that this may prove to be an
international landmark study. &#xa9; Springer Media / Bohn Stafleu van
Loghum 2012.

<55>
Accession Number
361711248
Title
Heat shock proteins and myocardial protection during cardiopulmonary
bypass.
Source
Journal of International Medical Research. 39 (2) (pp 499-507), 2011. Date
of Publication: April 2011.
Author
Yavuz S.; Kasap M.; Parlar H.; Agirbas H.; Torol S.; Kanli A.; Hosten T.;
Kanko M.; Berki T.
Institution
(Yavuz, Parlar, Agirbas, Kanko, Berki) Department of Cardiovascular
Surgery, School of Medicine, Kocaeli University, Baki Komsuoglu Avenue,
Campus of Umuttepe, Turkey
(Kasap, Torol, Kanli) Department of Medical Biology, School of Medicine,
Kocaeli University, Kocaeli, Turkey
(Hosten) Department of Anaesthesiology, School of Medicine, Kocaeli
University, Kocaeli, Turkey
Publisher
SAGE Publications Ltd
Abstract
This prospective randomized study investigated the effects of two
different cardioplegia techniques on myocardial heat shock protein 70
(HSP70) mRNA levels. Patients undergoing elective coronary artery bypass
grafting with cardiopulmonary bypass (CPB) were divided into two equal
groups. All patients received the same anaesthesia. Myocardial
preservation was achieved by delivering intermittent antegrade isothermic
blood cardioplegia in one group and antegrade plus continuous retrograde
isothermic blood cardioplegia in the other. Biopsies for measurement of
HSP70 mRNA levels were taken from the right atria before surgical
manipulation of the heart, and later from the same place following CPB.
HSP70 mRNA levels were evaluated using quantitative real-time reverse
transcription-polymerase chain reaction. Crossing-point values for HSP70
and beta-actin were used to evaluate up-regulation. There was a
significant increase in HSP70 mRNA levels in response to CPB in both
groups, but no significant between-group difference in HSP70
up-regulation. Further investigation is required to evaluate the
correlation between the level of HSP induction and the degree of
myocardial protection in more heterogeneous groups of patients. &#xa9;
2011 Field House Publishing LLP.

<56>
Accession Number
2010933537
Title
Coronary artery bypass graft surgery versus stenting for patients with
chronic kidney disease and complex coronary artery disease: a systematic
review and meta-analysis.
Source
Therapeutic Advances in Chronic Disease. 12 (no pagination), 2021. Date of
Publication: 2021.
Author
Cui K.; Liu H.; Yuan F.; Xu F.; Zhang M.; Wang W.; Zhang D.; Tian J.; Lyu
S.; Dou K.
Institution
(Cui) Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beijing, China
(Liu, Yuan, Xu, Zhang, Zhang, Wang, Zhang, Tian) Department of Cardiology,
Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of
Heart, Lung and Blood Vessel Diseases, Beijing, China
(Lyu) Department of Cardiology, Beijing Anzhen Hospital, Capital Medical
University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2
Anzhen Road, Chaoyang District, Beijing 100029, China
(Dou) Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, No. 167, Beilishi Road, Xicheng District, Beijing 100037,
China
Publisher
SAGE Publications Ltd
Abstract
Background: The relative role of coronary artery bypass grafting (CABG)
and percutaneous coronary intervention (PCI) with stent implantation in
patients with chronic kidney disease (CKD) and complex coronary artery
disease (CAD) remains debatable due to the lack of randomized controlled
trials (RCTs). We therefore performed this meta-analysis to compare the
outcomes of the two strategies in CKD patients with multivessel and/or
left main disease. <br/>Method(s): Electronic databases including PubMed,
EMBASE and Cochrane Library were comprehensively searched to identify the
eligible subgroup analysis of RCTs and propensity-matched registries. The
primary endpoint was all-cause mortality during the longest follow-up.
<br/>Result(s): Five subgroup analyses of RCTs and six propensity-matched
registries involving 26,441 patients were analyzed. Overall, the strategy
of CABG was associated with lower risks of long-term mortality [odds ratio
(OR) 0.83, 95% confidence interval (CI) 0.74-0.93], myocardial infarction
(OR, 0.41; 95% CI, 0.27-0.62), and repeat revascularization (OR, 0.25; 95%
CI, 0.16-0.39) compared with PCI in CKD patients with complex CAD.
However, CABG was slightly associated with higher risk of stroke than PCI
(OR, 1.33; 95% CI, 1.00-1.77). Nonetheless, the higher stroke risk in the
CABG group no longer existed during long-term follow-up (OR, 0.92; 95% CI,
0.37-2.25) (>3 years). <br/>Conclusion(s): This meta-analysis supports the
current guideline advising CABG for patients with CKD and complex CAD. At
the expense of slightly increased risk of stroke, CABG reduces the
incidences of long-term all-cause death, myocardial infarction and repeat
revascularization compared with PCI.<br/>Copyright &#xa9; The Author(s),
2021.

<57>
Accession Number
635550297
Title
A prospective study on use of thrive (transnasal humidified rapid
insufflation ventilatory exchange) versus conventional nasal oxygenation
following extubation of adult cardiac surgical patients.
Source
Annals of Cardiac Anaesthesia. 24 (3) (pp 353-357), 2021. Date of
Publication: July-September 2021.
Author
Burra V.; Putta G.; Prasad S.; Manjunath V.
Institution
(Burra) Department of Cardiac Anesthesia, SRM Institute of Medical
Sciences, Chennai, India
(Putta) Department of Anesthesia, Apollo Institute of Medical Sciences and
Research, Andhra Pradesh, Chittor, India
(Prasad, Manjunath) Department of Anesthesia, Sri Jayadeva Institute of
Cardiovascular Sciences and Research, Karnataka, Bangalore, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Postoperative pulmonary complications in cardiac surgery
increase mortality and morbidity. High flow nasal cannula oxygen therapy
(HFNC) is one of the preventive measures to reduce the incidence of lung
complications. HFNC can decrease dyspnea and improve physiologic
parameters after extubation, including respiratory rate and heart rate,
compared with conventional oxygen therapy. In this study, we evaluated the
role of THRIVE (Transnasal Humidified Rapid Insufflation Ventilatory
Exchange) after extubation. Methodology: We prospectively randomized 60
adults aged between 18 and 65 years undergoing elective cardiac surgery to
either High flow oxygen therapy using THRIVE (Group A) or conventional
nasal cannula (group B). Arterial paO2, paCO2, pH at three points of time
i.e., 1, 2, 4 hrs after extubation were evaluated using arterial blood gas
analysis. Ventilation duration, the incidence of reintubation, sedation
score, mortality, and other complications were also assessed.
<br/>Result(s): Thirty adults in each group had comparable patient
characteristics. There was a statistically significant decline in
paCO<inf>2</inf>in group A at 1, 2, 4 hrs post extubation (P = 0.022,
0.02, <0.001) with a significant increase in oxygenation (P < 0.001) when
compared to group B.ICU stay duration was similar between two groups. No
complications were noted in both groups. <br/>Conclusion(s): THRIVE is
safe to use following extubation in adult cardiac surgical
patients.<br/>Copyright &#xa9; 2021 Wolters Kluwer Medknow Publications.
All rights reserved.

<58>
Accession Number
635550240
Title
Volatile anesthetic preconditioning modulates oxidative stress and nitric
oxide in patients undergoing coronary artery bypass grafting.
Source
Annals of Cardiac Anaesthesia. 24 (3) (pp 319-326), 2021. Date of
Publication: July-September 2021.
Author
Dharmalingam S.; Amirtharaj G.; Ramachandran A.; Korula M.
Institution
(Dharmalingam, Korula) Department of Anaesthesiology, Division of
Gastrointestinal Sciences, Christian Medical College, Ida Scudder Road,
Tamil Nadu, Vellore, India
(Amirtharaj, Ramachandran) The Wellcome Trust Research Laboratory,
Division of Gastrointestinal Sciences, Christian Medical College, Ida
Scudder Road, Tamil Nadu, Vellore, India
(Ramachandran) Department of Pharmacology, Toxicology and Therapeutics,
University of Kansas Medical Center, Kansas City, KS 66160, United States
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Myocardial preconditioning using volatile anesthetics such as
isoflurane and sevoflurane have beneficial effects in decreasing morbidity
in cardiac surgical patients. Studies in animal models have indicated that
reactive oxygen and nitrogen species probably play a role in mediating
these effects. However, data from human studies are scarce and the
differential effect of sevoflurane vs. isoflurane on reactive oxygen
species (ROS) and reactive nitrogen species (RNS) has not been studied
extensively. <br/>Material(s) and Method(s): Randomized clinical control
trial comparing preconditioning effects of volatile agents isoflurane and
sevoflurane when administered during coronary artery bypass surgeries on
cardiopulmonary bypass (CPB). Serum samples were collected at 3 time
points before induction, after cross clamp release and one hour after
separation from CPB. Levels of oxidative stress markers and nitric oxide
were analyzed in these samples. <br/>Result(s): Hemodynamic indices,
cardio-pulmonary bypass duration, and ICU stay were similar between the
groups. CKMB values 12 hours post-op were decreased in majority of
patients in the sevoflurane group compared to isoflurane. Serum
malondialdehyde and nitrate levels were lower with sevoflurane (P < 0.05)
when compared to the isoflurane group, but no significant differences in
protein carbonyl content or protein thiol content were evident between the
2 groups. Sevoflurane also prevented the decrease in total thiols during
later stages of surgery. <br/>Conclusion(s): Volatile anesthetics,
isoflurane and sevoflurane modulate oxidative and nitrosative stress
during CABG. Between the two pre-conditioning agents, isoflurane seems to
provide better protection during the pre-bypass period, while sevoflurane
provides protection during both pre- as well as post-bypass
period.<br/>Copyright &#xa9; 2021 Wolters Kluwer Medknow Publications. All
rights reserved.

<59>
Accession Number
635550227
Title
Comparison of postoperative delirium within 24 hours between ketamine and
propofol infusion during cardiopulmonary bypass machine: A randomized
controlled trial.
Source
Annals of Cardiac Anaesthesia. 24 (3) (pp 294-301), 2021. Date of
Publication: July-September 2021.
Author
Siripoonyothai S.; Sindhvananda W.
Institution
(Siripoonyothai) Department of Anesthesiology, Phramongkutklao Hospital,
315 Ratchawithi Rd., Thung Phaya Thai, Rajadevi, Thailand
(Sindhvananda) Department of Anesthesiology, Faculty of Medicine,
Chulalongkorn University, Rama IV, Bangkok, Thailand
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Postoperative delirium (POD) is a common complication in
cardiac surgery especially in elderly population which can lead to a delay
of weaning from ventilator and extubation. Cardiopulmonary bypass
(CPB)-induced inflammation is related to POD. Anti-inflammatory effect of
anesthetic agent might attenuate POD. <br/>Aim(s): The present study was
primarily aimed to compare within-24-h POD between ketamine-based
anesthesia and propofol-based anesthesia during CPB. The secondary
objective was to identify risk factors associated with within-24-h POD.
Setting and Design: Our study was a randomized controlled trial in
patients undergoing cardiac surgery with CPB. Enrolling patients were aged
>65 years, and able to comprehensive communication. Exclusion criteria
were aortic surgery, cognitive disorders, cerebrovascular and carotid
disease, and positive result of preoperative CAM-ICU. <br/>Material(s) and
Method(s): Patients were randomly assigned to group Ketamine infusion of 1
mg/kg/h and group Propofol infusion of 1.5-6 mg/kg/h during CPB. POD was
evaluated by validated Thai version CAM-ICU at 8-24 hour after ICU
arrival. Statistics: Chi-square, Fisher exact and t-test tests, univariate
analysis and multivariate logistic regression were utilized.
<br/>Result(s): Total 82 patients entered this study and 64 patients
remained after exclusion (Group Ketamine = 32 and Group Propofol = 32).
Within-24-h POD were 31.25% and 56.25% (P = 0.04) and mean arterial
pressure (MAP) were 71.45 and 65.53 mmHg (P = 0.01) respectively in
Ketamine and Propofol group. Postoperative leukocytosis was a significant
risk to POD (adjusted OR 124.5). <br/>Conclusion(s): With limitations of
the study, prevention of 24-h POD in general by ketamine was inconclusive.
In comparison with propofol, ketamine leaded to less events of 24-h POD
and kept higher MAP. Severity of postoperative inflammation was a
significant prediction of 24-h POD.<br/>Copyright &#xa9; 2021 Wolters
Kluwer Medknow Publications. All rights reserved.

<60>
Accession Number
635012586
Title
A prospective randomized clinical study of perioperative oral thyroid
hormone treatment for children undergoing surgery for congenital heart
diseases.
Source
Annals of Pediatric Cardiology. 14 (2) (pp 170-177), 2021. Date of
Publication: April-June 2021.
Author
Kumar A.; Tiwari N.; Ramamurthy H.; Kumar V.; Kumar G.
Institution
(Kumar) Department of Cardiothoracic Anaesthesia, Army Hospital RandR, New
Delhi, India
(Tiwari) Department of Cardiothoracic Surgery, Army Hospital RandR, New
Delhi, India
(Ramamurthy, Kumar) Department of Pediatric Cardiology and Grown Up
Congenital Heart Diseases, Army Hospital RandR, New Delhi, India
(Kumar) Department of Pediatric Cardiothoracic Surgery, Fortis Escorts
Heart Institute, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Context : Thyroid hormone deficiency is known to occur after cardiac
surgery and known as nonthyroid illness (NTI). The beneficial role
perioperative thyroid hormone supplementation in children has been
debatable more so with oral supplementation. Aims : The aim is to evaluate
the role of pre-operative oral thyroid hormone therapy in preventing NTI.
To assess its effect on post-operative thyroid hormone levels, hemodynamic
parameters, and cardiac function of infants and small children undergoing
pediatric cardiac surgery. Settings and Design : Prospective randomized,
double-blinded controlled trial at a tertiary level pediatric
cardiothoracic center. Materials and Methods : Sixty-five children aged
under 18 months undergoing corrective surgeries on cardiopulmonary bypass
were included. Patients were randomized into two equal groups: placebo
group (given placebo) and thyroxine group (given thyroxine tablet 10
mug/kg) orally once a day starting on the preoperative evening till the
fifth postoperative day. The postoperative hemodynamics, inotropic
requirement, ventilatory requirement, and cardiac function on
echocardiography were observed. Statistical Tests : Shapiro-Wilk test,
Mann-Whitney/t-test, Chi-square test, ANOVA with Tukey correction were
used. Results : Serum triiodothyronine and thyroxine levels
postoperatively were significantly higher in the thyroxine group than in
the placebo group. There was no significant difference in left ventricular
ejection fraction, hemodynamic variables, extubation time, and length of
intensive care unit (ICU) stay between the two groups. Conclusions : In
infants and small children undergoing corrective cardiac surgery,
perioperative oral thyroid hormone therapy reduces the severity of
postoperative NTI. It increases the serum level of thyroid hormones but
the therapy does not translate to better hemodynamics, reduced inotropic
requirement, reduced ventilatory requirement, improved myocardial function
or reduced ICU stay when compared to placebo.<br/>Copyright &#xa9; 2021
Wolters Kluwer Medknow Publications. All rights reserved.

<61>
Accession Number
2008450792
Title
Feasibility, safety and outcome of inguinal hernia repair under spinal
versus general anesthesia in preterm and term infants.
Source
Journal of Pediatric Surgery. 56 (5) (pp 1057-1061), 2021. Date of
Publication: May 2021.
Author
Ceccanti S.; Cervellone A.; Pesce M.V.; Cozzi D.A.
Institution
(Ceccanti, Cervellone, Cozzi) Pediatric Surgery Unit, Sapienza University
of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy
(Pesce) Department of Anesthesia and Critical Care Medicine, Sapienza
University of Rome, Azienda Policlinico Umberto I, Rome, RM 00161, Italy
Publisher
W.B. Saunders
Abstract
Background: Inguinal hernia repair (IHR) is a common operation in preterm
and term infants. Recently, spinal anesthesia (SA) has been proposed as an
alternative to avoid exposure to general anesthesia (GA) during early
life. The aim of this study was to compare surgical outcomes of open IHR
performed under SA versus GA in neonates and infants, and to detect
criteria to predict the success or failure of SA. <br/>Material(s) and
Method(s): This is a 6-year, single center, nonrandomized interventional
study (2013-2019). SA was performed with 0.5% bupivacaine. GA was given
using propofol, fentanyl, sevoflurane, and laryngeal mask. Patient
demographics, operative time, intraoperative events related to surgery or
anesthesia, and complications were analyzed at short and long-term
follow-up. <br/>Result(s): 68 infants (78 IHR) and 37 infants (44 IHR)
received SA and GA at the discretion of the anesthesiologist,
respectively. SA failure rate was 9%, and positively correlated with
weight at surgery (p = 0.001; r<inf>p</inf> = 0.38). Conversion from SA to
GA occurred in 4 (6%) patients owing to prolonged operative time (43.75
+/- 4.8 vs 23.02 +/- 11.3 min; p = 0.0006). There were no differences
regarding operative time and intra- and postoperative complications among
the two groups at mean follow-up of 18.53 +/- 21.9 months.
<br/>Conclusion(s): This pilot study confirms that SA is safe, effective
and not detrimental to surgical outcome of neonates and infants undergoing
IHR. Additionally, it may help further define what patients may have a
successful SA. Our experience suggests that SA is especially suitable in
infants weighing < 4000 g, and conversion to GA correlates with prolonged
operative time. <br/>Level of Evidence: Level II.<br/>Copyright &#xa9;
2020 Elsevier Inc.

<62>
Accession Number
2013625946
Title
CRYO lipolysis versus cold laser on lipid profile and body composition in
women with central obesity.
Source
Turkish Journal of Physiotherapy and Rehabilitation. 32 (3) (pp
9287-9293), 2021. Date of Publication: 2021.
Author
Al-Agamy N.N.; Al-Nahas N.G.; Obay H.E.
Institution
(Al-Agamy) Cairo University Working in El-Mabara Hospital Mit-Ghamr,
Dakahleya, Egypt
(Al-Nahas, Obay) Department of Physical Therapy for Cardiovascular
Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo
University, Egypt
Publisher
Turkish Physiotherapy Association
Abstract
Purpose: The purpose of this study is to compare the effect of CRYO
lipolysis and cold laser on body composition and lipid profile in women
with central obesity. <br/>Method(s): Sixty women patient with central
obesity their ages ranged from 35 to45 years old they was received from
outpatient clinic of ALMABARA hospital on Mit-Ghamr. Dakahlia. their BMI
was between 30 kg/m² to 39.9 kg\m² considered class1
and class11 obesity with dyslipidaemia with waist circumference more than
88 cm .they were assigned into two groups equal in number Group A: thirty
patient received CRYO lipolysis on the abdomen for 35 to 45 minutes (1
session every 3 weeks) for three months and Group B: thirty patient
received cold laser on the abdomen for 35 to 45 minutes (2 sessions\week)
below the umbilicus for 3 months evaluated by: a) In body device (in body
120) was used for measuring weight,BMI, body composition, fat mass, fat
free mass, water, segmental fat and segmental lean pre and post treatment
of both groups b) Unstretchable tape Was used to measure height and waist
circumference pre and post treatment c) Laboratory analysi Serum analysis.
for estimation of serum lipid (cholesterol, triglycerides,LDL-C,HDL-C).pre
and post treatment. <br/>Result(s): Statistical analysis revealed that
CRYO lipolysis(gruopA) has significant effect on triglycerides (decreased
9.02%), on high density lipoprotein (increased 9.97%), waist circumference
(decreased 7.28%) on abdominal fat (decreased 10.7%). In cold
laser(groupB) there was a significant decrease in Triglycerides level
(18%) on high density lipoprotein (increased 10.2%) Waist Circumference
(WC) (decreased 9.38%) abdominal fat (decreased 4.52%) and no significant
difference between groups. <br/>Conclusion(s):cryo lipolysis and cold
laser can be used to improve lipid profile as well as decrease of the
waist circumference and abdominal fat in women with abdominal
obesity.<br/>Copyright &#xa9; 2021 Turkish Physiotherapy Association. All
rights reserved.

<63>
Accession Number
2013196155
Title
Effects of bilateral Pecto-intercostal Fascial Block for perioperative
pain management in patients undergoing open cardiac surgery: a prospective
randomized study.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 175.
Date of Publication: December 2021.
Author
Zhang Y.; Gong H.; Zhan B.; Chen S.
Institution
(Zhang, Gong, Chen) Department of Anesthesiology, First Affiliated
Hospital of Nanchang University, 17 Yong wai zheng Street, Nanchang,
Jiangxi 330006, China
(Zhan) Department of cardiology, The second Affiliated Hospital of
Nanchang University, NO.1 minde Street, Nanchang, Jiangxi 330006, China
Publisher
BioMed Central Ltd
Abstract
Background: Open cardiac surgical patients may experience severe acute
poststernotomy pain. The ultrasound-guided Pecto-intercostal Fascial Block
(PIFB) can cover anterior branches of intercostal nerves from T2 to T6.
The aim of this study was to investigate the effect of bilateral PIFB in
patients undergoing open cardiac surgery. <br/>Method(s): A group of 108
patients were randomly allocated to either receive bilateral PIFB (PIFB
group) or no nerve block (SALI group). The primary endpoint was
postoperative pain. The secondary outcome measures included intraoperative
and postoperative sufentanil and parecoxib consumption, time to
extubation, time to first feces, length of stay in the ICU and the length
of hospital stay. Insulin, glucose, insulin resistance and interleukin
(IL)-6 at 1, 2, 3 days after surgery were mearsured. The homeostasis model
assessment (HOMA-IR) was used to measure perioperative insulin resistance.
<br/>Result(s): The PIFB group reported significantly less sufentanil and
parecoxib consumption than the SALI group. Compared to the PIFB group, the
SALI group had higher Numerical Rating Scale (NRS) pain scores at 24 h
after operation both at rest and during coughing. The time to extubation,
length of stay in the ICU and length of hospital stay were significantly
decreased in the PIFB group compared with the SALI group. The PIFB group
had a lower insulin, glucose, IL-6, HOMA-IR level than the SALI group 3
days after surgery. <br/>Conclusion(s): Bilateral PIFB provides effective
analgesia and accelerates recovery in patients undergoing open cardiac
surgery. Trial registration: This study was registered in the Chinese
Clinical Trial Registry (ChiCTR 2000030609) on 08/03/2020.<br/>Copyright
&#xa9; 2021, The Author(s).

<64>
Accession Number
2012070201
Title
Dexmedetomidine for heart arrhythmia prevention in coronary artery bypass
surgery patients.
Source
Medical Forum Monthly. 32 (2) (pp 147-151), 2021. Date of Publication:
February 2021.
Author
Siddiq S.; Imran-Ul-Hassan S.; Hasnain Z.; Awan K.; Ikram M.; Saleem J.
Institution
(Siddiq) Department of Anesthesia, Services Hospital, Lahore, Pakistan
(Imran-Ul-Hassan, Hasnain, Awan, Ikram, Saleem) Department of Anesthesia,
Punjab Institute of Cardiology, Lahore, Pakistan
Publisher
Medical Forum Monthly
Abstract
Objective: The aim of this study was to compare the incidence of various
types of cardiac arrhythmias between the two groups of CABG cardiac
surgery treated peri operatively with dexmedetomidine with those treated
with placebo in the department of cardiac surgery, Punjab Institute of
Cardiology, Lahore, Pakistan. <br/>Study Design: Randomized controlled
trial study. Place and Duration of Study: This study was conducted at the
Department of Cardiac Surgery and Anesthesia, Punjab Institute of
Cardiology, Lahore from January 2020 to June 2020. <br/>Material(s) and
Method(s): Patients of elective cardiac surgery were enrolled and divided
into two groups. As per the inclusion criteria step in the research
proposal all the patients undergoing off-pump CABG surgery of ASA class II
and III, with age of 35 to 75 years having ejection fraction (EF) of >35%
were enrolled. Patients in the trial group or DEX group was given 0.5
mcg/kg/h of dexmedetomidine during the induction process and later on an
infusion was started at a dose of 0.5 mcg/kg/h till the completion of the
surgery even till the shifting of the patient in the High risk units.The
frequency of atrial fibrillation and other types of arrhythmias was
documented and compared with the two groups using chi square test. Data
was stratified for age and gender, post-stratified chi square test was
applied to see the effect of these variables on the outcome variable.
P<0.05 was taken significant. <br/>Result(s): A total of 60 cases (30 in
each group) fulfilling the selection criteria were enrolled to compare the
incidence of various types of cardiac arrhythmias between the two groups
of CABG cardiac surgery treated peri-operatively with dexmedetomidine with
those treated with placebo. Patients treated with DEX had an overall lower
incidence of various types of arrhythmias. Most common arrhythmia was
ventricular tachycardia and premature ventricular contractions.
<br/>Conclusion(s): With the use of dexmedetomidine as a sedative and
adjuvant of general anesthesia drugs, the incidence of various
tachyarrhythmia is decreased during cardiac surgery and in the
post-operative period; but the decrease in the incidence was not
statistically significant for all types of arrhythmias.<br/>Copyright
&#xa9; 2021 Medical Forum Monthly. All rights reserved.

<65>
Accession Number
2012070200
Title
Effect of peri-operative dexmedetomidine on incidence of delirium in
elderly patients after cardiac surgery.
Source
Medical Forum Monthly. 32 (2) (pp 142-146), 2021. Date of Publication:
February 2021.
Author
Imran-Ul-Hassan S.; Hasnain Z.; Awan K.; Liaquat M.; Ikram M.; Saleem J.
Institution
(Imran-Ul-Hassan, Hasnain, Awan, Liaquat, Ikram, Saleem) Department of
Anesthesia, Punjab Institute of Cardiology, Lahore, Pakistan
Publisher
Medical Forum Monthly
Abstract
Objective: The aim of this study was to compare the frequency of delirium
in patients of elective cardiac surgery treated peri operatively with
dexmedetomidine with those treated with midazolam. <br/>Study Design:
Randomized controlled trial study. Place and Duration of Study: This study
was conducted at the Department of cardiac surgery, Punjab Institute of
Cardiology, Lahore, Pakistan from July, 2020 till December, 2020.
<br/>Material(s) and Method(s): Dexmedetomidine was given to half of the
patients included in the study and other drug was taken as a controlled
drug, Midazolam.The objective of this study was to compare the frequency
of delirium in patients of elective cardiac surgery treated with peri
operatively with dexmedetomidine with those treated with midazolam
prei-operatively. Delirium was assessed using the scale - MMSE Scoring
scale. Mini-Mental State Examination (MMSE) Score is of total 30 score.
Patients were asked some questions in the form of an interview and 1 mark
was given for each correct answer. Any patient with a score of less than
24 was labeled as having a cognitive impairment or delirium.
<br/>Result(s): The comparison of frequency of deliriumin patients of
cardiac surgery treated with perioperative dexmedetomidine vs midazolam
was done, 8.57% (n=2) in Dexmedetomidine group and 22.86%(n=8) in
midazolam group were found with delirium, p value was 0.04.
<br/>Conclusion(s): Delirium is a stressful complication observed in the
post-operative period. With the use of dexmedetomidine along with the
induction of general anesthesia, the chances of post-operative delirium
can be reduced. This trial should be done on a larger scale documenting
the effects of DEX on all the parameters monitored during the general
anesthesia.<br/>Copyright &#xa9; 2021 Medical Forum Monthly. All rights
reserved.

<66>
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.

<67>
Accession Number
2011535562
Title
Comparison of dynamic needle tip positioning versus conventional long-axis
in-plane techniques for ultrasound-guided internal jugular venous
catheterization: A randomized controlled trial.
Source
Minerva Anestesiologica. 87 (3) (pp 294-301), 2021. Date of Publication:
March 2021.
Author
LEE S.; CHANG J.-E.; OH Y.; YANG H.-J.; BAE J.; CHO Y.-J.; JEON Y.; NAM
K.; KIM T.-K.
Institution
(LEE, OH, YANG, BAE, CHO, JEON, NAM) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University,
College of Medicine, Seoul, South Korea
(CHANG, OH, YANG, KIM) Department of Anesthesiology and Pain Medicine,
Seoul Metropolitan Government, Seoul National University, Boramae Medical
Center, College of Medicine, Seoul, South Korea
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: Continuous visualization of the needle tip is essential for
successful ultrasound-guided central venous catheterization, and the
dynamic needle tip positioning (DNTP) technique enables it. The aim of
this randomized, dual-center trial was to compare the first-attempt
success rate of ultrasound-guided internal jugular catheterization between
the DNTP and conventional long-axis in-plane (LAX-IP) techniques.
<br/>METHOD(S): Patients undergoing cardiac surgery at two tertiary
teaching hospitals were randomly allocated to either the DNTP or LAX-IP
group. Internal jugular venous catheterization was performed by four
anesthesiologists. The primary outcome was the first-attempt success rate
of central venous catheterization. Procedural time and complications
related to catheterization were compared as secondary outcomes.
<br/>RESULT(S): In total, 142 patients were analysed. The first-attempt
success rate was significantly higher in the DNTP group (59/72, 81.9%)
than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence
interval 1.09-5.15; P=0.028). In addition, the needle was redirected less
frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural
time was comparable between the groups. No significant differences were
observed in complications related to catheterization, including posterior
wall puncture, carotid artery puncture, or hematoma. <br/>CONCLUSION(S):
The DNTP technique resulted in a significantly higher success rate on the
first attempt at internal jugular venous catheterization and required less
frequent redirection of the needle during the procedure than the
conventional LAX-IP technique.<br/>Copyright &#xa9; 2021 Edizioni Minerva
Medica. All rights reserved.

<68>
Accession Number
2011098227
Title
Personalized antiplatelet therapy guided by a novel detection of platelet
aggregation function in stable coronary artery disease patients undergoing
percutaneous coronary intervention: A randomized controlled clinical
trial.
Source
European Heart Journal - Cardiovascular Pharmacotherapy. 6 (4) (pp
211-221), 2020. Date of Publication: 2020.
Author
Zheng Y.-Y.; Wu T.-T.; Yang Y.; Hou X.-G.; Gao Y.; Chen Y.; Yang Y.-N.; Li
X.-M.; Ma X.; Ma Y.-T.; Xie X.
Institution
(Zheng, Wu, Yang, Hou, Chen, Yang, Li, Ma, Ma, Xie) Department of
Cardiology, Hospital of Xinjiang Medical University, No. 137, Liyushan
Road, Urumqi 830054, China
(Zheng) Department of Cardiology, Hospital of Zhengzhou University, Key
Laboratory of Cardiac Injury and Repair of Henan Province, No. 1, Jianshe
Road, Zhengzhou 450002, China
(Gao) Department of Cadre Ward, Hospital of Xinjiang Medical University,
No. 137, Liyushan Road, Urumqi 830054, China
Publisher
Oxford University Press
Abstract
Aims A number of studies have attempted to demonstrate the benefits
associated with personalized antiplatelet therapy guided by platelet
function testing, which has led to disappointing findings. In this study,
we used a new platelet function test to guide antiplatelet therapy in
stable coronary artery disease (CAD) patients after percutaneous coronary
intervention (PCI). Methods and results In the present randomized
controlled trial, a total of 2237 patients with stable CAD undergoing PCI
were randomly chosen to be administered personalized antiplatelet therapy
(personalized group; n = 1123) or standard antiplatelet treatment
(standard group; n = 1114). The patients in the standard therapy group,
without detecting the platelet aggregation rate, were administered a 75
mg/day clopidogrel maintenance dosage plus 100 mg/day of aspirin for at
least 6 months after the procedure. For the patients in the personalized
therapy group, the antiplatelet strategy was performed according to the
maximum aggregation rate (MAR), determined using a novel platelet
analyser, PL-12. If MAR 55%, 90 mg ticagrelor was administered twice daily
plus 100 mg/day of aspirin after PCI. If MAR 55%, 75 mg/day clopidogrel
plus 100 mg/day of aspirin was administered after PCI. The primary
endpoint was net clinical adverse events, which were a composite of
cardiac death, myocardial infarction, stroke, stent thrombosis, urgent
revascularization, and bleeding [Bleeding Academic Research Consortium
(BARC) definitions, Type 2, 3, or 5], in the 180-day period after
randomization. The primary endpoint was reached in 58 patients in the
personalized group, compared with 85 patients in the standard group [5.1%
vs. 7.5%, hazard ratio (HR) 0.678, 95% confidence interval (CI)
0.486-0.947, P = 0.023], on intention-To-Treat analysis. We also found
that the net clinical adverse events (including ischaemic and bleeding
events) were significantly reduced in the personalized group at 30 days
after PCI compared to the standard group (1.5% vs. 3.0%, HR 0.510, 95% CI
0.284-0.915, P = 0.020). We did not find a significant difference in major
bleeding events at either the 30-day (0.5% vs. 0.3%, P = 0.322) or the
180-day follow-up (2.1% vs. 1.6%, P = 0.364) between the two groups.
Conclusion The present study suggests that personalized antiplatelet
therapy according to MAR can significantly improve the net clinical
benefit 180 days after PCI.<br/>Copyright &#xa9; 2020 Oxford University
Press. All rights reserved.

<69>
Accession Number
2013682337
Title
Prognostic relevance of exercise testing in hypertrophic cardiomyopathy. A
systematic review.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Rodrigues T.; Raposo S.C.; Brito D.; Lopes L.R.
Institution
(Rodrigues, Brito) Cardiology Department, Centro Hospitalar Universitario
Lisboa Norte, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal
(Rodrigues, Brito, Lopes) CAML, CCUL, Lisbon School of Medicine,
Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal
(Raposo) Unidade de Saude Familiar Reynaldo dos Santos, Agrupamento de
Centros de Saude Estuario do Tejo, Administracao Regional de Saude Lisboa
e Vale do Tejo, Portugal
(Raposo) Lisbon School of Medicine, Universidade de Lisboa, Lisboa,
Portugal
(Lopes) Barts Heart Centre, St. Bartholomew's Hospital, London, United
Kingdom
(Lopes) Centre for Heart Muscle Disease, Institute of Cardiovascular
Science, University College London, London, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cardiopulmonary exercise test (CPET) is indicated as part of
the assessment in hypertrophic cardiomyopathy (HCM) patients and stress
echocardiography is often used to assess symptoms. However, the role of
exercise testing for prognostic stratification in HCM is still not
established. <br/>Aim(s): To systematically review the evidence on the
role of exercise testing for prognostic stratification in hypertrophic
cardiomyopathy. <br/>Method(s): A systematic review was conducted for
eligible publications, between 2010 and 2020, that included evaluation of
outcomes and prognosis. In these studies, patients underwent exercise
echocardiography and/or cardiopulmonary exercise testing, performed
according to predefined protocols. Diverse parameters were assessed in
order to determine which were relevant for the prognosis. Analyzed
outcomes included death from any cause, sudden cardiac death (SCD) and
equivalents, cardiovascular death, heart failure requiring hospitalization
or progression to New York Heart Association classes III or IV, cardiac
transplantation, non-sustained ventricular tachycardia, stroke, myocardial
infarction and invasive septal reduction therapy. <br/>Result(s): Eighteen
publications were included, corresponding to a total of 7525 patients. The
mean follow-up period varied between 1 and 8 years. The main findings of
these studies revealed that the major predictors of outcomes were abnormal
heart rate recovery, abnormal blood pressure response exercise induced
wall motion abnormalities, lower peak VO2, higher VE/VCO2, and pulmonary
hypertension/exercise-induced pulmonary hypertension. <br/>Conclusion(s):
Although most studies concluded that exercise test results are useful to
determine prognosis in HCM, further investigation is needed regarding
whether it adds independent value to the current risk stratification
strategies.<br/>Copyright &#xa9; 2021 The Author(s)

<70>
Accession Number
2013682146
Title
Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery:
A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Koo C.-H.; Lee H.-T.; Na H.-S.; Ryu J.-H.; Shin H.-J.
Institution
(Koo, Lee, Na, Ryu, Shin) Department of Anesthesiology & Pain Medicine,
Seoul National University Bundang Hospital, Seongnam, South Korea
(Ryu) Department of Anesthesiology & Pain Medicine, Seoul National
University College of Medicine, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: The objective of this study was to determine whether erector
spinae plane block (ESPB) can provide an effective analgesia for managing
pain after thoracic surgery and compare the efficacy of ESPB with that of
other regional analgesic techniques. <br/>Design(s): Systematic review and
meta-analysis of randomized controlled trials. <br/>Setting(s): PubMed,
EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched.
<br/>Participant(s): Patients undergoing thoracic surgeries.
<br/>Intervention(s): Erector spinae plane block with local anesthetics
for postoperative analgesia. Measurement and Main Results: Seventeen
studies, including 1,092 patients, were included in the final analysis.
Erector spinae plane block reduced 24-hour postoperative opioid
consumption (mean difference [MD] -17.49, 95% CI -26.87 to -8.12), pain
score at rest (MD -0.82, 95% CI -1.31 to -0.33), and pain score at
movement (MD -0.77, 95% CI -1.20 to -0.3) compared to no block. Compared
with other regional blocks, various results have been observed. Although
statistical results showed that ESPB is inferior to thoracic paravertebral
block and intercostal nerve block and superior to serratus anterior plan
block in postoperative analgesia, clinical differences remain unclear. The
incidence of hematoma was lower in the ESPB group than in the other groups
(odds ratio 0.19, 95% CI 0.05-0.73). <br/>Conclusion(s): Erector spinae
plane block may provide effective analgesia after thoracic surgery.
Compared with other techniques, it is a safer method, without clinically
important differences, for postoperative pain control. Therefore, ESPB may
be considered as a valuable option for postoperative pain management after
thoracic surgery.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<71>
Accession Number
2013593990
Title
Transcatheter aortic valve replacement in low-risk bicuspid and tricuspid
patients: Meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Medranda G.A.; Rogers T.; Doros G.; Zhang C.; Case B.C.; Yerasi C.; Shults
C.C.; Waksman R.
Institution
(Medranda, Rogers, Doros, Zhang, Case, Yerasi, Waksman) Section of
Interventional Cardiology, MedStar Washington Hospital Center, Washington,
DC, United States
(Rogers) Cardiovascular Branch, Division of Intramural Research, National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda,
MD, United States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital
Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: Most pivotal transcatheter aortic valve replacement (TAVR)
trials have excluded patients with bicuspid aortic stenosis (AS). This
study compared TAVR in low-risk patients with bicuspid AS to those with
tricuspid AS, incorporating data from prospective trials. <br/>Method(s):
We selected prospective US low-risk TAVR trials containing a bicuspid arm
for this meta-analysis, examining outcomes at 30 days. Study results were
pooled using a hierarchical Bayesian random-effects model. <br/>Result(s):
Included were 3 Food and Drug Administration (FDA)-approved
investigational device exemption (IDE) trials that enrolled a total of
1810 low-risk patients with symptomatic severe AS for TAVR. We compared
380 bicuspid patients with 1430 tricuspid patients. Event rates at 30 days
overall were low, with similar mortality (odds ratio [OR], 0.38; 95%
credible interval [CrI]: 0.08, 1.78; I², 0%), non-disabling
stroke (OR, 0.45; 95% CrI: 0.15, 1.07; I², 9%), and permanent
pacemaker implantation (OR, 0.86; 95% CrI: 0.41, 1.47; I²,
59%). There were statistically significant differences in disabling stroke
(OR, 0.16; 95% CrI: 0.01, 0.90; I², NA) and coronary
obstruction (OR, 0.21; 95% CrI: 0.05, 0.91) that disappeared after
sensitivity analysis by adding a single event to the tricuspid arm.
Hemodynamics were similar at 30 days. <br/>Conclusion(s): Preliminary data
from the FDA-approved IDE trials of low-risk patients with bicuspid AS
undergoing TAVR demonstrated 30-day outcomes comparable to low-risk
tricuspid patients, except for a trend toward higher stroke in bicuspid
patients. Randomized trials are warranted to reassure the safety and
long-term outcome of TAVR in patients with severe bicuspid
AS.<br/>Copyright &#xa9; 2021

<72>
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

<73>
Accession Number
2013147668
Title
Pericarditis as a manifestation of IgG4-related disease.
Source
Rheumatology International. (no pagination), 2021. Date of Publication:
2021.
Author
Doumen M.; Vankelecom B.; Westhovens R.; Michiels S.
Institution
(Doumen, Westhovens) Department of Development and Regeneration, Skeletal
Biology and Engineering Research Centre, KU Leuven, ON IV Herestraat
49-bus 805, Leuven 3000, Belgium
(Doumen, Westhovens) Rheumatology, University Hospitals Leuven, Leuven,
Belgium
(Vankelecom) Cardiology, Imelda Hospital, Bonheiden, Belgium
(Michiels) Rheumatology, Imelda Hospital, Bonheiden, Belgium
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
IgG4-related disease (IgG4-RD) is a systemic, immune-mediated
fibro-inflammatory disease that can affect virtually every organ system.
It is usually insidious in onset and often mimics malignant or other
inflammatory disorders. Diagnosis frequently requires a combination of
clinical, serological, radiographic, and histopathological features,
including increased serum-IgG4 levels and tissue infiltration of
IgG4-positive plasma cells with associated fibrosis. Unlike more
frequently affected sites, including the hepatobiliary system, salivary
glands and retroperitoneum, pericardial involvement of IgG4-RD has only
rarely been described. We report the case of a 76-year-old woman
presenting with refractory pericarditis and imminent cardiac tamponade,
successfully treated with therapeutic pericardiectomy. A diagnosis of
IgG4-RD was made based on elevated serum-IgG4 levels and the presence of
typical pericardial histopathological findings, meeting all 3 of the 2011
comprehensive diagnostic criteria for IgG4-RD. Following pericardiectomy,
the patient remained in remission without a need for glucocorticoids or
additional immunosuppressive therapy. Adding to this case, we reviewed the
literature for previously described cases of IgG4-RD presenting with
pericarditis and described their characteristics and the available
treatment options. Our case-based literature review provides a clear
overview of the diagnostic process for IgG4-RD and the need to apply
classification criteria with the necessary caution, particularly in the
case of rare disease manifestations, including pericarditis.<br/>Copyright
&#xa9; 2021, The Author(s), under exclusive licence to Springer-Verlag
GmbH Germany, part of Springer Nature.

<74>
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
John Wiley and Sons 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

<75>
Accession Number
2010832647
Title
Percutaneous coronary intervention in saphenous vein grafts after coronary
artery bypass grafting: a systematic review and meta-analysis.
Source
Scandinavian Cardiovascular Journal. 55 (4) (pp 245-253), 2021. Date of
Publication: 2021.
Author
Ferrari G.; Geijer H.; Cao Y.; Souza D.; Samano N.
Institution
(Ferrari, Samano) Department of Cardiothoracic and Vascular Surgery and
University Health Care Research Center, Faculty of Medicine and Health,
Orebro University, Orebro, Sweden
(Geijer) Department of Radiology, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Cao) Clinical Epidemiology and Biostatistics, School of Medical Sciences,
Orebro University, Orebro, Sweden
(Souza) Department of Cardiothoracic and Vascular Surgery, Faculty of
Medicine and Health, Orebro University, Orebro, Sweden
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: To investigate the results of percutaneous coronary
intervention (PCI) in saphenous vein grafts after coronary artery bypass
grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were
searched for relevant articles published between 1 January 2000 and 29
February 2020. The PICO (population, intervention, comparison, outcome)
model was applied in constructing the clinical question. Two independent
researchers performed the literature search. Thirty-six articles were
identified and subjected to a quality assessment. The primary outcomes of
the meta-analysis were long-term in-stent restenosis and long-term major
adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95%
CI: 4.2-14.7%) and MACE was 35.3% (95% CI: 27-43.7%) at mean time 2.7 +/-
1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%;
95% CI: 2.9-12.5%), 30-day MACE (4.3%; 95% CI: 2.5-6.1%), and 1-year MACE
(15.5%; 95% CI: 11.7-19.3%). The use of drug-eluting stents resulted in
better outcomes at least in term of in-stent restenosis, while the benefit
of using embolic protection devices was questionable. Conclusions. PCI of
a stenosed or occluded saphenous vein graft is a challenge for
interventional cardiologists, and is still associated with relatively high
rates of restenosis, MACE, and procedural failure. All efforts to enhance
the results are warranted, including improved quality of the venous grafts
used during CABG.<br/>Copyright &#xa9; 2021 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<76>
Accession Number
2013307575
Title
Preoperative walking recommendation for non-cardiac surgery patients to
reduce the length of hospital stay: a randomized control trial.
Source
BMC Sports Science, Medicine and Rehabilitation. 13 (1) (no pagination),
2021. Article Number: 80. Date of Publication: December 2021.
Author
Cortes O.L.; Herrera-Galindo M.; Becerra C.; Rincon-Roncancio M.;
Povea-Combariza C.; Esparza-Bohorquez M.
Institution
(Cortes) Research Unit and Nursing Department, Fundacion
Cardioinfantil-Instituto de Cardiologia, Cl. 163a #13B-60, Bogota D.C,
Colombia
(Herrera-Galindo) Faculty of Health Sciences, Universidad Autonoma de
Bucaramanga, Avenida 42 No 48-11PBX, Bucaramanga, Colombia
(Becerra) Nursing Department, Fundacion Cardioinfantil-Instituto de
Cardiologia, Cl. 163a #13B-60, Bogota D.C, Colombia
(Rincon-Roncancio) Cardiovascular Rehabilitation Department, Fundacion
Cardioinfantil-Instituto de Cardiologia, Cl. 163a #13B-60, Bogota D.C,
Colombia
(Povea-Combariza) Faculty of Medicine, Universidad Nacional de Colombia,
Cra 45, Bogota D.C, Colombia
(Esparza-Bohorquez) Nursing Department, Fundacion Oftalmologica de
Santander-Clinica Carlos Ardila Lulle, FOSCAL, Calle 155A No23-60,
Floridablanca, Colombia
Publisher
BioMed Central Ltd
Abstract
Background: Even though the importance of preparing patients for a
surgical event is recognized, there are still gaps about the benefit of
improving functional capacity by walking during the waiting time among
patients scheduled for non-cardiac surgery. The aim of this study was to
evaluate the impact of pre-surgical walking in-hospital length of stay,
early ambulation, and the appearance of complications after surgery among
patients scheduled for non-cardiac surgery. <br/>Method(s): A two-arm,
single- blinded randomized controlled trial was developed from May 2016 to
August 2017. Eligible outpatients scheduled for non-cardiac surgery,
capable of walking, were randomized (2:1 ratio) to receive a prescription
of walking 150 min/week during the whole pre-surgical waiting time (n =
249) or conventional care (n = 119). The primary outcome was the
difference in hospital length of stay, and secondary results were time to
first ambulation during hospitalization, description of ischemic events
during hospitalization and after six months of hospital discharge, and the
walking continuation. We performed an intention to treat analysis and
compared length of stay between both groups by Kaplan-Meier estimator
(log-rank test). <br/>Result(s): There were no significant differences in
the length of hospital stay between both groups (log-rank test p = 0.367)
and no differences in the first ambulation time during hospitalization
(log-rank test p = 0.299). Similar rates of postoperative complications
were observed in both groups, but patients in the intervention group
continued to practice walking six months after discharge (p < 0.001).
<br/>Conclusion(s): Our study is the first clinical trial evaluating the
impact of walking before non-cardiac surgery in the length of stay, early
ambulation, and complications after surgery. Prescription of walking for
patients before non-cardiac surgery had no significant effect in reducing
the length of stay, and early ambulation. The results become a crucial
element for further investigation. Trial registration: PAMP-Phase2 was
registered in ClinicalTrials.gov NCT03213496 on July 11,
2017.<br/>Copyright &#xa9; 2021, The Author(s).

<77>
Accession Number
2013307350
Title
Dose approach matter? A meta-analysis of outcomes following transfemoral
versus transapical transcatheter aortic valve replacement.
Source
BMC Cardiovascular Disorders. 21 (1) (no pagination), 2021. Article
Number: 358. Date of Publication: December 2021.
Author
Guo R.; Xie M.; Yim W.Y.; Wu W.; Jiang W.; Wang Y.; Hu X.
Institution
(Guo, Xie, Yim, Wang, Hu) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, 1277# Jiefang Avenue, Wuhan 430022, China
(Wu) Department of Gastroenterology, Zhongnan Hospital, Wuhan University,
Wuhan, China
(Jiang) Department of Gastroenterology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
Publisher
BioMed Central Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has gained
increasing acceptance for patients with aortic disease. Both transfemoral
(TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while
their performances are limited to a few studies with controversial
results. This meta-analysis aimed to compare the mortality and morbidity
of complications between TF- versus TA-TAVR based on the latest data.
<br/>Method(s): Electronic databases were searched until April 2021. RCTs
and observational studies comparing the outcomes between TF-TAVR versus
TA-TAVR patients were included. Heterogeneity assumption was assessed by
an I² test. The pooled odds ratios(OR) or mean differences with
corresponding 95% confidence intervals (CI) were used to evaluate the
difference for each end point using a fixed-effect model or random-effect
model based on I² test. <br/>Result(s): The meta-analysis
included 1 RCT and 20 observational studies, enrolling 19,520 patients
(TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR,
TF-TAVR patients showed significantly lower rate of postoperative
in-hospital death (OR = 0.67, 95% CI 0.59-0.77, P < 0.001) and 1-year
death (OR = 0.53, 95% CI 0.41-0.69, P < 0.001). Incidence of major
bleeding and acute kidney injury were lower and length of hospital stay
was shorter, whereas those of permanent pacemaker and major vascular
complication were higher in TF-TAVR patients. There were no significant
differences between TF-TAVR versus TA-TAVR for stroke and mid-term
mortality. <br/>Conclusion(s): There were fewer early deaths in patients
with transfemoral approach, whereas the number of mid-term deaths and
stroke was not significantly different between two approaches. TF-TAVR was
associated with lower risk of bleeding, acute kidney injury as well as
shorter in-hospital stay, but higher incidence of vascular complication
and permanent pacemaker implantation.<br/>Copyright &#xa9; 2021, The
Author(s).

<78>
Accession Number
2013091735
Title
Neurally-adjusted ventilatory assist (NAVA) versus pneumatically
synchronized ventilation modes in children admitted to PICU.
Source
Journal of Clinical Medicine. 10 (15) (no pagination), 2021. Article
Number: 3393. Date of Publication: 01 Aug 2021.
Author
Sugunan P.; Hosheh O.; Garcia Cusco M.; Mildner R.
Institution
(Sugunan, Hosheh, Mildner) Paediatric Intensive Care Unit, Birmingham
Children's Hospital, Birmingham B4 6NH, United Kingdom
(Garcia Cusco) Paediatric Intensive Care Unit, Royal Bristol Children's
Hospital, Bristol BS 2 8BJ, United Kingdom
Publisher
MDPI AG
Abstract
Traditionally, invasively ventilated children in the paediatric intensive
care unit (PICU) are weaned using pneumatically-triggered ventilation
modes with a fixed level of assist. The best weaning mode is currently not
known. Neurally adjusted ventilatory assist (NAVA), a newer weaning mode,
uses the electrical activity of the diaphragm (Edi) to synchronise
ventilator support proportionally to the patient's respiratory drive. We
aimed to perform a systematic literature review to assess the effect of
NAVA on clinical outcomes in invasively ventilated children with
nonneonatal lung disease. Three studies (n = 285) were included for
analysis. One randomised controlled trial (RCT) of all comers showed a
significant reduction in PICU length of stay and sedative use. A cohort
study of acute respiratory distress syndrome (ARDS) patients (n = 30)
showed a significantly shorter duration of ventilation and improved
sedation with the use of NAVA. A cohort study of children recovering from
cardiac surgery (n = 75) showed significantly higher extubation success,
shorter duration of ventilation and PICU length of stay, and a reduction
in sedative use. Our systematic review presents weak evidence that NAVA
may shorten the duration of ventilation and PICU length of stay, and
reduce the requirement of sedatives. However, further RCTs are required to
more fully assess the effect of NAVA on clinical outcomes and treatment
costs in ventilated children.<br/>Copyright &#xa9; 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<79>
Accession Number
2013091729
Title
Should we monitor glucose and biomarkers in diabetics over heart surgery?.
Source
Journal of Clinical Medicine. 10 (15) (no pagination), 2021. Article
Number: 3399. Date of Publication: 01 Aug 2021.
Author
Golukhova E.Z.; Lifanova L.S.; Pugovkina Y.V.; Grigoryan M.V.; Bulaeva
N.I.
Institution
(Golukhova, Lifanova, Pugovkina, Grigoryan, Bulaeva) Cardiology
Department, Bakulev National Medical Research Center of Cardiovascular
Surgery, Roublyevskoe Shosse 135, Moscow 121552, Russian Federation
Publisher
MDPI AG
Abstract
Hyperglycemia is associated with adverse outcomes after coronary artery
bypass grafting (CABG). While there is a consensus that blood glucose
control may benefit patients undergoing CABG, the role of biomarkers,
optimal method, and duration of such monitoring are still unclear. The aim
of this study is to define the efficacy of a continuous glucose monitoring
system (CGMS) and link it to pro-inflammatory biomarkers while on insulin
pump therapy in diabetic patients undergoing CABG. We prospectively
assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing
isolated CABG. In diabetics, CGMS was connected to an insulin pump for
precise glucose control. On top of conventional biomarkers (HbA1C, lipid
profile), high sensitive C-reactive protein (hs-CRP), Regulated upon
Activation Normal T cell Expressed and presumably Secreted (RANTES), and
leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1
year after CABG. Overall, CGMS revealed high glucose independently from
underlying diabetes during first 48 h following CABG but was higher (p <
0.05) in diabetics. The insulin pump improved glycemic control over early
follow-up (72 h) post-CABG. There were no hypoglycemic episodes in
patients on insulin pump therapy and those receiving bolus insulin
therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in
patients on insulin pump therapy compared to patients prescribed bolus
insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and
RANTES levels were lower in patients with T2DM on insulin pump therapy
compared to patients prescribed bolus insulin therapy in the early
postoperative period (p < 0.05). It is most likely due to the fact that
insulin pump therapy decreases systemic inflammatory response. Further
controlled trials should assess whether CGMS improves outcomes after
cardiac surgery.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<80>
Accession Number
2013811485
Title
Trends, Predictors and In-Hospital Outcomes of the Next Day Discharge
Approach After Transcatheter Mitral Valve Repair.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Grant J.K.; Vincent L.; Ebner B.; Singh H.; Maning J.; Rubin P.;
Olorunfemi O.; Colombo R.; Braghiroli J.; De Marchena E.
Institution
(Grant, Vincent, Ebner, Singh, Maning, Rubin) Department of Internal
Medicine, University of Miami Miller School of Medicine/Jackson Memorial
Hospital, Florida 33136, United States
(Olorunfemi, Colombo, Braghiroli) Department of Medicine, Cardiovascular
Division, Jackson Memorial Hospital
(De Marchena) Department of Medicine, Cardiovascular Division, University
of Miami Miller School of Medicine
Publisher
Elsevier Inc.
Abstract
Early discharge strategies are associated with lower cost and resource
utilization during hospitalization, as such we sought to evaluate trends,
predictors and outcomes of the next day discharge (NDD) approach after
transcatheter mitral valve repair (TMVR) procedures with the MitraClip
device. The National Inpatient Sample (NIS) was queried between 2013 and
2018 for patients undergoing TMVR using the International Classification
of Diseases (ICD) 9 procedure code '3597' and ICD-10 procedure code
'02UG3JZ'. Patients undergoing TMVR were stratified into two groups,
determined by hospital length of stay (LOS) [<=1 day, NDD versus >1-day,
non-NDD]. Overall, 22,035 patients underwent TMVR with 35.7% (n = 7,870)
belonging to the NDD group (mean age 78.1 +/- 9.7 years, women 45%). From
2013 to 2018, the proportion of patients being discharged using the NDD
approach trended upward from 18.3% to 46.0%. Amongst demographic and
social factors, female sex, black race, and low median household income
were predictive of non-NDD (p <0.05 for all). Amongst clinical factors,
anemia, iron deficiency anemia, major depressive disorder,
thrombocytopenia, obesity and end stage renal disease were some predictors
of non-NDD (p <0.05 for all). In the non-NDD group there was a downward
trend of pooled post-procedure complications, post procedure cardiogenic
shock, vascular complications, acute kidney injury, mechanical circulatory
support use, acute respiratory distress and postoperative ischemic stroke
and (p for trend <0.001 for all). Despite the overall downward trend,
complications began increasing in 2017-18. In conclusion, these trends may
reflect improving operator experience, advancement in vascular access
device closures and techniques, and prioritization of decreasing length of
stay. Ideally, the feasibility and safety of this approach should be
confirmed in larger-sized multicenter, randomized trials.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<81>
Accession Number
2013292614
Title
Feasibility and efficacy of cryoneurolysis analgesia in robotic-assisted
thoracoscopic surgery (CARTS): a pilot study.
Source
Journal of Robotic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Tung J.; Patel R.; Rajwani T.; Han S.; Hanson N.; Sternbach J.; Hubka M.
Institution
(Tung, Patel, Rajwani, Han, Hanson, Sternbach, Hubka) Virginia Mason
Medical Center, Virginia Mason Hospital, Seattle, WA, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Opioid therapy has been the mainstay therapy of post-operative pain
management in thoracic surgery patients. With the high incidence of
chronic pain in thoracic surgery patients and adverse effects of opioids,
we examined the safety and efficacy of cryoneurolysis as an adjunct for
narcotic-free pain management in robotic-assisted thoracoscopic
lobectomies. Ten consecutive patients undergoing robotic-assisted
(DaVinci) pulmonary resection and cryoneurolysis were compared to ten
patients managed without intraoperative cryoneurolysis. All patients
received multimodal pain regimen including paravertebral blocks as per our
institutional enhanced recovery pathway. Patients with chronic pain and
chronic opioid use were excluded. We compared inpatient and outpatient
opioid consumption measured in morphine equivalents (mme), incidence of
opioid-free outpatient recovery, and adverse events. The two groups did
not differ significantly in terms of baseline demographics. Both inpatient
(88.13 vs 26.92 mme) and outpatient (118.5 vs 34.5 mme) use of narcotics
were significantly lower in the cryoneurolysis group (p < 0.05) with seven
of ten patients receiving cryoneurolysis able to recover without the use
of opioids in the outpatient setting, compared to two in the control
group. One patient reported post-operative neuralgia in each
cryoneurolysis and control group. There were no readmissions in either
group and mean length of stay was identical at 1.7 days in control group
and 1.1 days in experimental group (p = 0.33). The use of intraoperative
intercostal cryoneurolysis may safely reduce the utilization of outpatient
opioids in patients undergoing robotic-assisted thoracoscopic surgery. A
randomized controlled trial is warranted to validate these findings in a
larger cohort of patients.<br/>Copyright &#xa9; 2021, The Author(s), under
exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

<82>
Accession Number
2013284437
Title
Albumin use in bleeding cardiac surgical patients and associated patient
outcomes.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Hanley C.; Callum J.; McCluskey S.; Karkouti K.; Bartoszko J.
Institution
(Hanley) Department of Anesthesia, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre, Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Kingston, ON, Canada
(Karkouti, Bartoszko) Department of Anesthesia and Pain Management,
Toronto General Hospital - University Health Network, Sinai Health System,
Women's College Hospital, University of Toronto, 200 Elizabeth Street,
3EN-464, Toronto, ON M5G 2C4, Canada
(McCluskey, Karkouti, Bartoszko) Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Health Network, Toronto,
ON, Canada
(McCluskey, Karkouti) Institute of Health Policy Management and
Evaluation, University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: Albumin solution is a colloid used for resuscitation in cardiac
surgical patients, but it is unclear if it offers advantages over
crystalloids. We examined current clinical practice across 11 cardiac
surgical centres and the association of albumin with outcomes in a cohort
of bleeding cardiac surgical patients. <br/>Method(s): This was a post hoc
analysis of data from the Effect of Fibrinogen Concentrate vs
Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery
(FIBRES) trial. Multivariable regression models adjusted for demographic
and surgical characteristics were used to examine predictors of early
albumin administration (within the initial 24 perioperative hours), late
albumin administration (from 24 hr to seven days after cardiopulmonary
bypass), and the association of albumin use with 28-day acute kidney
injury, mortality, and length of hospital and intensive care unit (ICU)
stay. <br/>Result(s): Of the 735 patients included, 525 (71%) received
albumin, ranging from 4.8% to 97.4% of patients across institutions, with
475 (64.6%) receiving albumin early (5% or 25% solution). In the adjusted
models, female sex and preoperative hospital admission were associated
with early use, while heart failure, female sex, bleeding severity, older
age, and prior albumin use were predictors of later administration. Early
albumin use was not associated with differences in acute kidney injury
(adjusted odds ratio [aOR] 1.77; 95% confidence interval [CI], 0.96 to
3.27; P = 0.07), mortality (aOR 1.66; 95% CI, 0.99 to 2.78; P = 0.05), or
length of ICU stay (P = 0.11) or hospital stay (P = 0.67).
<br/>Conclusion(s): Albumin use is common but highly variable within and
across sites. Albumin use was not associated with improved outcomes. High
quality randomized controlled trials should clarify its role in cardiac
surgical patients.<br/>Copyright &#xa9; 2021, Canadian Anesthesiologists'
Society.

<83>
Accession Number
611333849
Title
Serial changes in longitudinal graft function and implications of acute
cellular graft rejections during the first year after heart
transplantation.
Source
European Heart Journal Cardiovascular Imaging. 17 (2) (pp 184-193), 2016.
Date of Publication: February 2016.
Author
Clemmensen T.S.; Logstrup B.B.; Eiskjaer H.; Poulsen S.H.
Institution
(Clemmensen, Logstrup, Eiskjaer, Poulsen) Department of Cardiology, Aarhus
University Hospital, Brendstrupgardsvej 100, Skejby 8200, Denmark
Publisher
Oxford University Press
Abstract
Aims The aim of this prospective study was to use left ventricular global
longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of
graft function in relation to acute cellular rejection (ACR) during the
first year after heart transplantation (HTX). Methods and results The
study population consisted of 36 patients undergoingHTXfrom November 2010
until October 2013. Patients were followed by comprehensive
echocardiography and biopsies at 2weeks and 1, 3, 6, and 12 months after
HTX. ACRs were classified based on the ISHLT classification (0R-3R).
Patientswere divided into two groups according to the presence of one or
more episodes of biopsy proven >=grade 2R ACR during follow-up.We found
that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were
significantly related to ACR burden in a linear regression model. The
absolute difference in LV-GLS between patients in the ACR group (-14.4%)
and patients in the ACR-free group (-16.8%) was -2.4% (P<0.01) 12 months
after HTX. In the ACR group, patients' LV-GLS did not improve between 1
and 12 months, whereas an improvement of 22.9% was seen in the ACR-free
group in this period (P<0.01). The two groups appeared not to differ in
terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE
was 15.3+/-2.8 mm in the ACR-free group vs. 13.2+/-2.1 mm ACR group,
P<0.05, 12 months after HTX. Conclusion Gradual improvement of
longitudinal LV and RV function was seen within the first year after HTX,
but the degree of recovery was strongly influenced by ACR
episodes.<br/>Copyright &#xa9; The Author 2015. Published on behalf of the
European Society of Cardiology. All rights reserved.

<84>
Accession Number
609626697
Title
Predictors of exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure: A meta-regression
analysis.
Source
European Journal of Preventive Cardiology. 23 (7) (pp 683-693), 2016. Date
of Publication: May 2015.
Author
Uddin J.; Zwisler A.-D.; Lewinter C.; Moniruzzaman M.; Lund K.; Tang L.H.;
Taylor R.S.
Institution
(Uddin) Department of Cardiac Surgery, Ibrahim Cardiac Hospital and
Research Institute, Bangladesh
(Uddin, Zwisler, Taylor) National Institute of Public Health, University
of Southern Denmark, Denmark
(Lewinter) Department of Cardiology, Vejle Hospital, Vejle, Denmark
(Moniruzzaman) Non-communicable Disease Unit, World Health Organization
(WHO), Country Office for Bangladesh, Dhaka, Bangladesh
(Lund) Department of Physiotherapy and Occupational Therapy, Holbaek
Hospital, Denmark
(Tang) Heart Centre, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark
(Tang) CopenRehab, Section of Social Medicine, Department of Public
Health, University of Copenhagen, Denmark
(Tang) Bachelor's Degree Programme in Physiotherapy, Dept. of
Rehabilitation and Nutrition, Faculty of Health and Technology,
Metropolitan University College, Copenhagen, Denmark
(Taylor) Department of Health Services Research, Institute of Health
Research, University of Exeter Medical School, South Cloisters, St Lukes
Campus, Heavitree Road, Exeter EX1 2LU, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background The aim of this study was to undertake a comprehensive
assessment of the patient, intervention and trial-level factors that may
predict exercise capacity following exercise-based rehabilitation in
patients with coronary heart disease and heart failure. Design
Meta-analysis and meta-regression analysis. Methods Randomized controlled
trials of exercise-based rehabilitation were identified from three
published systematic reviews. Exercise capacity was pooled across trials
using random effects meta-analysis, and meta-regression used to examine
the association between exercise capacity and a range of patient (e.g.
age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias)
factors. Results 55 trials (61 exercise-control comparisons, 7553
patients) were included. Following exercise-based rehabilitation compared
to control, overall exercise capacity was on average 0.95 (95% CI:
0.76-1.41) standard deviation units higher, and in trials reporting
maximum oxygen uptake (VO<inf>2</inf>max) was 3.3 ml/kg.min^-1
(95% CI: 2.6-4.0) higher. There was evidence of a high level of
statistical heterogeneity across trials (I² statistic > 50%).
In multivariable meta-regression analysis, only exercise intervention
intensity was found to be significantly associated with VO<inf>2</inf>max
(P = 0.04); those trials with the highest average exercise intensity had
the largest mean post-rehabilitation VO<inf>2</inf>max compared to
control. Conclusions We found considerable heterogeneity across randomized
controlled trials in the magnitude of improvement in exercise capacity
following exercise-based rehabilitation compared to control among patients
with coronary heart disease or heart failure. Whilst higher exercise
intensities were associated with a greater level of post-rehabilitation
exercise capacity, there was no strong evidence to support other
intervention, patient or trial factors to be predictive.<br/>Copyright
&#xa9; The European Society of Cardiology 2015.

<85>
Accession Number
600175789
Title
Role of Pre-procedural C-reactive Protein Level in the Prediction of Major
Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary
Intervention: a Meta-analysisof Longitudinal Studies.
Source
Inflammation. 38 (1) (pp 159-169), 2015. Date of Publication: February
2014.
Author
Bibek S.-B.; Xie Y.; Gao J.-J.; Wang Z.; Wang J.-F.; Geng D.-F.
Institution
(Bibek) Department of Cardiology, Shahid Gangalal National Heart Center,
Kathmandu, Nepal
(Xie, Gao, Wang, Geng) Department of Cardiology, Sun Yat-sen Memorial
Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou
510120, China
(Wang) Department of Anesthesiology, Sun Yat-sen Memorial Hospital,
Guangzhou 510120, China
(Xie, Gao, Wang, Geng) Guangdong Province Key Laboratory of Arrhythmia and
Electrophysiology, Sun Yat-sen University, Guangzhou 510120, China
Publisher
Springer Science and Business Media, LLC
Abstract
Numerous studies have reported the relation between pre-procedural
C-reactive protein (CRP) levels and the risk of major adverse cardiac
events (MACEs) in patients undergoing percutaneous coronary intervention
(PCI). However, the results across the studies were inconsistent. The aim
of this study was to evaluate the predictive effect of pre-procedural CRP
levels and the risk of MACEs in patients undergoing PCI. Longitudinal
studies on the association between pre-procedural CRP levels and MACEs
were identified by electronic and manual searches. Summary risk ratios
(RRs) and 95 % confidence intervals (CI) were calculated employing an
inverse variance random-effects model irrespective of between-study
heterogeneity. Thirty-three studies involving 34,367 patients with 4119
MACEs were included in this study. High CRP level was associated with
increased incidences of MACEs, all-cause death, myocardial infarction,
coronary revascularization, and clinical restenosis, with pooled RRs of
1.97 (95 % CI, 1.65, 2.35), 2.88 (95 % CI, 2.15, 3.86), 1.81 (95 % CI,
1.48, 2.21), 1.31 (95 % CI, 1.11, 1.56), and 1.45 (95 % CI, 1.07, 1.96),
respectively. Dose-response analysis showed that every 1 mg/L increment in
pre-procedural serum CRP level was associated with a significant 12 %
increase in the risk of MACEs. In spite of heterogeneity across the
included studies, this meta-analysis suggests that pre-procedural serum
CRP level is a valuable predictor of MACEs in patients undergoing
PCI.<br/>Copyright &#xa9; 2014, Springer Science+Business Media New York.

<86>
Accession Number
608383546
Title
Prognosis following acute coronary syndromes according to prior coronary
artery bypass grafting: Meta-analysis.
Source
European Heart Journal: Acute Cardiovascular Care. 4 (6) (pp 518-527),
2015. Date of Publication: December 2015.
Author
Teixeira R.; Vieira M.J.; Ribeiro M.A.; Goncalves L.; Gersh B.J.
Institution
(Teixeira, Ribeiro) Departamento de Medicina, Servico de Cardiologia,
Hospital Beatriz Angelo, Loures, Portugal
(Teixeira, Vieira, Goncalves) Universidade de Coimbra, Coimbra, Portugal
(Goncalves) Servico de Cardiologia, Centro Hospitalar e Universitario de
Coimbra, Hospital Geral, Coimbra, Portugal
(Gersh) Division of Cardiovascular Disease and Internal Medicine, Mayo
Clinic, Rochester, United States
Publisher
SAGE Publications Inc.
Abstract
Purpose: Conduct a meta-analysis to study the prognostic influence of a
previous coronary artery bypass grafting (CABG) in patients admitted for
an acute coronary syndrome (ACS). <br/>Method(s): A systematic review of
the literature was performed using electronic reference databases through
January 2013 (MEDLINE, Cochrane Library, Web of Knowledge, Google Scholar
and references cited in other studies). Studies in which ACS outcomes with
a previous history of CABG were compared with ACS outcomes with no history
of previous CABG were considered for inclusion. The main endpoints of
interest were mortality and non-fatal acute myocardial infarction. Data
was aggregated at three follow-up times using random-effects meta-analysis
models. <br/>Result(s): Twenty-four studies were included which provided
387,181 patients for analysis. Previous CABG ACS patients were older, more
diabetic and had a more frequent history of a previous myocardial
infarction. Pooled in-hospital mortality was higher for the previous CABG
ACS patients (OR 1.22 [1.04-1.44], p<0.01, I² 88%). The pooled
adjusted OR showed no significant differences for the two groups (adjusted
OR 1.13 [0.93-1.37], p=0.22, I² 92%). Previous CABG ACS patient
had a higher pooled 30-day mortality (OR 1.28 [1.05-1.55], p=0.02,
I² 74%); a higher non-adjusted (OR 1.61 [1.38-1.88], p<0.01,
I² 70%) and adjusted (adjusted OR 1.37 [1.15-1.65], p<0.01,
I² 0%) long-term mortality. Both the in-hospital and the
long-term re-infarction rates were higher for the previous CABG ACS
patients. <br/>Conclusion(s): According to our data, ACS patients with
previous CABG history had a higher risk for short- and longterm adverse
events.<br/>Copyright &#xa9; The European Society of Cardiology 2014.

<87>
Accession Number
2011263068
Title
Is there a role for ECMO-facilitated resuscitation for the management of
out-of-hospital cardiac arrest (OHCA) with refractory ventricular
fibrillation (VF)?.
Source
Canadian Journal of Emergency Medicine. 23 (4) (pp 460-462), 2021. Date of
Publication: July 2021.
Author
Cheskes L.; Cheskes S.; McLeod S.
Institution
(Cheskes) Department of Emergency Medicine, The Ottawa Hospital,
University of Ottawa, 1053 Carling Ave, Ottawa, ON K1Y4E9, Canada
(McLeod) Schwartz/Reisman Emergency Medicine Institute, Sinai Health,
Toronto, ON, Canada
(Cheskes, McLeod) Division of Emergency Medicine, Department of Family and
Community Medicine, University of Toronto, Toronto, ON, Canada
(Cheskes) Sunnybrook Centre for Prehospital Medicine, Li Ka Shing
Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada
Publisher
Springer Nature

<88>
Accession Number
2013627775
Title
The effects of high-intensity interval training, Nordic walking and
moderate-to-vigorous intensity continuous training on functional capacity,
depression and quality of life in patients with coronary artery disease
enrolled in cardiac rehabilitation: A randomized controlled trial (CRX
study).
Source
Progress in Cardiovascular Diseases. (no pagination), 2021. Date of
Publication: 2021.
Author
Reed J.L.; Terada T.; Cotie L.M.; Tulloch H.E.; Leenen F.H.; Mistura M.;
Hans H.; Wang H.-W.; Vidal-Almela S.; Reid R.D.; Pipe A.L.
Institution
(Reed, Terada, Mistura, Hans, Vidal-Almela) Exercise Physiology and
Cardiovascular Health Lab, University of Ottawa Heart Institute, 40 Ruskin
Street, Ottawa, ON K1Y 4W7, Canada
(Reed) School of Epidemiology and Public Health, Faculty of Medicine,
University of Ottawa, Canada
(Reed, Vidal-Almela) School of Human Kinetics, Faculty of Health Sciences,
University of Ottawa, Canada
(Reed, Terada, Cotie, Tulloch, Mistura, Hans, Vidal-Almela, Reid, Pipe)
Division of Cardiac Prevention and Rehabilitation, University of Ottawa
Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Tulloch, Leenen, Reid, Pipe) School of Medicine, Faculty of Medicine,
University of Ottawa, Ottawa, Canada
(Leenen, Wang) Brain and Heart Research Group, University of Ottawa Heart
Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Vidal-Almela) Institut du savoir Montfort, Hopital Montfort, Ottawa,
Canada
Publisher
W.B. Saunders
Abstract
Background: Coronary artery disease (CAD) patients undergoing
revascularization procedures often experience ongoing, diminished
functional capacity, high rates of depression and markedly low quality of
life (QoL). In CAD patients, studies have demonstrated that high-intensity
interval training (HIIT) is superior to traditional moderate-to-vigorous
intensity continuous training (MICT) for improving functional capacity,
whereas no differences between Nordic walking (NW) and MICT have been
observed. Mental health is equally as important as physical health, yet
few studies have examined the impact of HIIT and NW on depression and QoL.
The purpose of this randomized controlled trial (RCT) was to compare the
effects of 12 weeks of HIIT, NW and MICT on functional capacity in CAD
patients. The effects on depression severity, brain-derived neurotrophic
factor (BDNF) and QoL were also examined. <br/>Method(s): CAD patients who
underwent coronary revascularization procedures were randomly assigned to:
(1) HIIT (4 x 4-min of high-intensity work periods at 85%-95% peak heart
rate [HR]), (2) NW (resting HR [RHR] + 20-40 bpm), or (3) MICT (RHR +
20-40 bpm) twice weekly for 12 weeks. Functional capacity (six-min walk
test [6MWT]), depression (Beck Depression Inventory-II [BDI-II]), BDNF
(from a blood sample), and general (Short-Form 36 [SF-36]) and
disease-specific (HeartQoL) QoL were measured at baseline and follow-up.
Linear mixed-effects models for repeated measures were used to test the
effects of time, group and time x group interactions. <br/>Result(s): N =
135 CAD patients (aged 61 +/- 7 years; male: 85%) participated. A
significant time x group interaction (p = 0.042) showed greater increases
in 6MWT distance (m) for NW (77.2 +/- 60.9) than HIIT (51.4 +/- 47.8) and
MICT (48.3 +/- 47.3). BDI-II significantly improved (HIIT: -1.4 +/- 3.7,
NW: -1.6 +/- 4.0, MICT: -2.3 +/- 6.0 points, main effect of time: p <
0.001) whereas BDNF concentrations did not change (HIIT: -2.5 +/- 9.6, NW:
-0.4 +/- 7.7, MICT: -1.2 +/- 6.4 ng/mL, main effect of time: p > 0.05).
Significant improvements in SF-36 and HeartQoL values were observed (main
effects of time: p < 0.05). HIIT, NW and MICT participants attended 17.7
+/- 7.5, 18.3 +/- 8.0 and 16.1 +/- 7.3 of the 24 exercise sessions,
respectively (p = 0.387). <br/>Conclusion(s): All exercise programmes
(HIIT, NW, MICT) were well attended, safe and beneficial in improving
physical and mental health for CAD patients. NW was, however,
statistically and clinically superior in increasing functional capacity, a
predictor of future cardiovascular events.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<89>
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.

<90>
Accession Number
2013687871
Title
B-PO05-146 DIRECT ORAL ANTICOAGULANTS ARE SAFE AND EFFECTIVE IN PATIENTS
WITH ATRIAL FIBRILLATION AND BIOPROSTHETIC VALVES, A META-ANALYSIS.
Source
Heart Rhythm. Conference: Heart Rhythm 2021. Boston United States. 18 (8
Supplement) (pp S431), 2021. Date of Publication: August 2021.
Author
Ruzieh M.; Wolbrette D.L.; Naccarelli G.V.
Publisher
Elsevier B.V.
Abstract
Background: Long-term oral anticoagulation is recommended for patients
with atrial fibrillation and bioprosthetic valves. Nonetheless, there is
uncertainty whether direct oral anticoagulants (DOACs) are safe and
effective in this population. <br/>Objective(s): To assess the safety and
efficacy of DOACs compared to warfarin in patients with atrial
fibrillation and bioprosthetic valves. <br/>Method(s): We searched PubMed
for relevant studies. The risk ratio (RR) of clinical outcomes was
calculated using the Mantel Haenszel random effect model. A two-sided p
value of < 0.05 was considered statistically significant. <br/>Result(s):
Six studies met out inclusion criteria. There were 2701 patient-year in
the DOACs arm and 7743 patient-year in the warfarin arm. There was no
significant difference in the rate of ischemic stroke (RR: 0.60, 95% CI:
0.25 - 1.41), all-cause mortality (RR: 0.80, 95% CI: 0.62 - 1.02), or
cardiovascular death (RR: 0.81, 95% CI: 0.40 - 1.64) between DOACs and
warfarin. Major bleeding was similar between both treatment arms (RR:
0.61, 95% CI: 0.35 - 1.06). However, intracranial bleed and hemorrhagic
stroke were significantly reduced with DOACs use (RR: 0.46, 95% CI: 0.24 -
0.87), figure. <br/>Conclusion(s): DOACs are safe in patients with atrial
fibrillation and bioprosthetic valves. Future large-scale studies are
warranted to confirm this observation. [Formula presented]<br/>Copyright
&#xa9; 2021

<91>
Accession Number
2012273243
Title
Aortic Valve Replacement Using Stented or Sutureless Prosthesis via Either
Full-Sternotomy or a Minimally Invasive Approach: A Metwork Meta-analysis.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S24), 2021. Date of
Publication: January 2021.
Author
Woldendorp K.; Doyle M.; Bannon P.; Yan T.
Institution
(Woldendorp, Doyle, Bannon, Yan) Royal Prince Alfred Hospital, Sydney,
NSW, Australia
Publisher
Elsevier Ltd
Abstract
Purpose: In the era of transcatheter aortic valve replacement (TAVI), new
technologies such as sutureless prosthetic valves and access via
minimally-invasive incisions reduce surgical trauma for patients
undergoing surgical aortic valve replacement (SAVR). Whether a reduction
in cardiopulmonary bypass and aortic cross-clamp times or avoiding
complete sternotomy offer improved early postoperative outcomes is
unknown. <br/>Method(s): Electronic databases were searched for studies
comparing outcomes for full-sternotomy AVR (SAVR), minimally-invasive AVR
(MiAVR), sutureless AVR (SuAVR) via full-sternotomy, or minimally-invasive
SuAVR (MiSuAVR). Early postoperative outcomes and follow-up data were
included in a Bayesian network meta-analysis. <br/>Result(s): Twenty-two
studies with 6,643 patients were identified. A signal towards reduced
early mortality, stroke, bleeding complications, sternal infections, and
acute kidney injury was noted in both sutureless and minimally invasive
techniques. Cardiopulmonary bypass and cross-clamp times were shorter for
sutureless procedures with right anterior thoracotomy having the largest
reduction compared to SAVR (mean difference: -31 and -29 mins,
respectively). Postoperative ventilation time was also shorter for
sutureless procedures with hemi-sternotomy showing the greatest reduction
(mean difference: -7.1 hrs). Minimally invasive and sutureless procedures
had lower rates of new postoperative atrial fibrillation (POAF): MiSuAVR
vs SAVR, OR: 0.52, 95% CI: 0.32-0.85 and MiAVR vs SAVR, OR: 0.74, 95% CI:
0.61-0.89; and MiSuAVR demonstrated a shorter ICU LOS (mean difference:
-0.6 days, 95% CI: (-)0.75-(-)0.16). Late mortality was 12.8% in the
full-sternotomy group and 4.5% in the minimally invasive cohort. Valve
related reoperations occurred in 2.7% of patients who had a stented
prosthesis via minimal access surgery and 0.9% who received a sutureless
prosthesis, however neither result was statistically significant.
<br/>Conclusion(s): Minimally invasive and sutureless techniques
demonstrate equivalent early postoperative outcomes to full sternotomy AVR
and may reduce ventilation time, ICU LOS and POAF burden.<br/>Copyright
&#xa9; 2021

<92>
Accession Number
2012271091
Title
Sternalock360 Plate and Band Sternal Fixation Versus Conventional Wire
Fixation RCT After Cardiac Surgery.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S22), 2021. Date of
Publication: January 2021.
Author
Royse A.; El-Ansary D.; Hoang W.; Tivendale L.; Canty D.; Yang Y.; Boggett
S.; Broad D.; Royse C.
Institution
(Royse, El-Ansary, Hoang, Tivendale, Canty, Yang, Boggett, Broad, Royse)
The University of Melbourne, Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Purpose: Good sternal healing requires minimisation of bony edge movement.
However, activities such as coughing exert considerable force on the chest
wall. Measurements at rest, such as X-rays fail to measure dynamic sternal
edge displacement, whereas real-time ultrasound imaging accurately detects
sternal edge motion. The aim was to compare the sternal micro-motion of
conventional wire cerclage with a plate and banding closure system.
<br/>Method(s): In this prospective trial, patients undergoing coronary or
valvular surgery were randomised to sternal closure with conventional
figure of 8 wire cerclage (Wires) or a novel band and plate system,
Sternalock360 (Plates). Primary outcome was sternal edge motion of <=2mm
in <=2 of 4 sternal sites examined at 6 weeks postoperative. Secondary
outcomes included sternal motion, postoperative quality of recovery score
and persistent pain at 12 weeks. <br/>Result(s): Of 50 patients (26
plates, 24 wires), two patients died and one withdrew consent, leaving 25
plates and 22 wires for analysis. Operations were 37 coronary, 5 valve and
8 combined coronary and valve procedures. At 6 weeks, sternal motion was
less for plates than wires (4% vs 32%, p=0.018). Agreement between
observers was high, kappa=0.850. At 12 weeks, the sternal motion was less
for plates (0% vs 25%, p=0.016). At 12 weeks, return to baseline
postoperative recovery score was similar (54% vs 33%, p=0.144) but
persistent pain was lower for plates (8% vs 33%, p=0.035).
<br/>Conclusion(s): Micromotion at 6 and 12 weeks after sternotomy was
less for sternal band and plates than for wire cerclage, with reduced
persistent pain.<br/>Copyright &#xa9; 2021

<93>
Accession Number
2012271080
Title
Sternal Micromotion During Early Weighted Upper Limb Exercise Following
Median Sternotomy: An Interim Analysis of the SAFE-ARMS Study.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S16), 2021. Date of
Publication: January 2021.
Author
Pengelly J.; Royse C.; Royse A.; El-Ansary D.; Williams G.; Bryant A.
Institution
(Pengelly, Royse, Royse, El-Ansary, Williams, Bryant) Swinburne University
of Technology, Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Background: Sternal precautions that limit the use of the upper limb and
trunk remain routine after cardiac surgery via median sternotomy, despite
evidence to support active upper limb movements. This study address a gap
by investigating sternal micromotion during upper limb resistance
exercises in the early post-operative period. <br/>Method(s): Eight males
following median sternotomy (72.9+/-6.9 years) have participated in the
resistance arm of a pilot randomised controlled trial to date. Six upper
limb exercises (seated row, shoulder pulldown, shoulder press, bicep curl,
triceps dip and lateral raise) were assessed at 2, 8 and 14 weeks
postoperatively. Sternal edge motion in the lateral (coronal plane) and
anterior-posterior (sagittal plane) directions was measured using
real-time ultrasound at the mid and lower sternum, at 6cm and 10cm from
the sternal notch. Maximal pain was recorded during exercise, using a
Numeric Rating Scale (0-10). <br/>Result(s): Maximum sternal micromotion
occurred in the coronal plane during the biceps curl 0.7+/-1.0mm
(-0.5-1.9), triceps dip 1.0+/-0.8mm (-0.4-1.7), shoulder press 0.8+/-
0.8mm (-0.2-1.8), lateral raise 0.8+/-0.7mm (-0.4-1.7) and seated row
0.8+/-0.7mm (-0.2-1.8). Maximum sternal micromotion occurred in the
sagittal plane for the shoulder pulldown -0.9+/-0.4mm (-0.2-1.6),
indicative of a reduction in sternal separation from rest. Pain at rest
was 0/10 at 2 weeks, 0/10 at 8 weeks and 0/10 at 14 weeks. No increase in
sternal pain was reported for any upper limb movements at any time-period.
<br/>Conclusion(s): Interim analysis of early upper limb resistance
exercise demonstrates safety and feasibility with respect to sternal
micromotion and pain.<br/>Copyright &#xa9; 2021

<94>
Accession Number
2012271075
Title
Enhanced Recovery After Surgery (ERAS) Pathway for Cardiac Surgery: The
First Australian Experience.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S14), 2021. Date of
Publication: January 2021.
Author
Marchand K.; Aguirre V.; Worthington M.; Chew D.; Fitton V.; Cullen H.
Institution
(Marchand, Aguirre, Worthington, Chew, Fitton, Cullen) Royal Adelaide
Hospital, Adelaide, SA, Australia
Publisher
Elsevier Ltd
Abstract
Introduction: The use of ERAS pathways has previously being proven to
improve care in multiple surgical specialties. It is however a new concept
in cardiac surgery where it can facilitate a patient centred and
standardised perioperative care. Unfortunately, their applicability in
real life clinical scenarios is impacted by multiple factors, including
clinician/health staff adherence, changing knowledge and consensus
differences of the multidisciplinary team. ERAS pathways are a combination
of evidence-based guidelines, clinical protocols and best practice rules,
design to reduce physiological and psychological stress in surgical
patients as well as achieve a rapid recovery. They reduce morbidity,
length of stay and enhance a cost-effective, satisfactory relationship
between the surgical patient and the health team. <br/>Method(s): A 5
stages project protocol was formulated: Stage 1-Literature review; Stage
2- Formation of pathway team and review of current protocols; Stage
3-Elaboration of pathway; Stage 4-Introduction of the pathway; and Stage
5-Evaluation: Statistical analysis and presentation of results.
<br/>Result(s): In Stage 1 of the project, a comprehensive literature
review was conducted. Eight relevant publications were found and appraised
for further use in Stages 2 and 3 of the project. The evidence of the
reviewed publications supports the benefits of ERAS pathways in patient
recovery, measured by shorter lengths of stay, shorter intubation times,
decrease readmission rates and a perceived decrease in medical and
surgical complications. During Stage 2, we identified and reviewed a total
of 20 protocols which are currently being used in the elaboration of an
ERAS pathway which will be presented at the meeting to invite Australian
cardiothoracic units to be part of the first Australian ERAS
trial.<br/>Copyright &#xa9; 2021

<95>
Accession Number
2012270884
Title
Evaluation of the ACS-NSQIP Surgical Risk Calculator as a Predictor of
Postoperative Complications After Cardiac Surgery.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S44), 2021. Date of
Publication: January 2021.
Author
Dutta S.; Vo T.; Iyer A.; Mundy J.
Institution
(Dutta, Vo, Iyer, Mundy) Princess Alexandra Hospital, Brisbane, Qld,
Australia
Publisher
Elsevier Ltd
Abstract
Purpose: To evaluate the ability of the American College of Surgeons
National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk
calculator in predicting post-operative complications in cardiac surgical
patients. <br/>Method(s): One-hundred patients who underwent cardiac
procedures at the Princess Alexandra Hospital (Brisbane, Australia) from
January 2013 to January 2014 were randomly selected. Patient information
according to the requirements of the ACS-NSQIP was obtained and entered
into the online calculator. Predictive risk of serious complication, any
complication, pneumonia, cardiac complications, surgical site infection,
urinary tract infection, venous thromboembolism, renal failure, sepsis,
readmission, return to surgery and death were compared to actual patient
outcomes following surgery. <br/>Result(s): Of the 100 cases, 28 were
female and 72 were male. Median age for the female group was 64.7 years
and 61.9 years for the male group. Median post-operative length of stay
was 5 days (range, 4 to 47). The Hosmer-Lemeshow Goodness Of Fit test
suggested that the ACS-NSQIP calculated values demonstrated reasonable fit
to the data. However a small sample size meant further evaluation using
receiver operating characteristic curves (c-statistic) was required. The
ACS-NSQIP calculator performed best for predicting renal failure
(c-statistic=0.92, p<0.001) but did not accurately predict most
complications - including a summary index representing any complication
(c-statistic=0.44, p=0.947). <br/>Conclusion(s): It appears that the
ACS-NSQIP calculator performed worse in cardiac surgical patients than
what has been reported in the general surgical population. Further
evaluation with a larger population size is needed to confirm this early
finding.<br/>Copyright &#xa9; 2021

<96>
Accession Number
2012270880
Title
Is Pre-Operative Neutrophil Lymphocyte Ratio an Important Predictor of
Adverse Events Following Cardiac Surgery?.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S6), 2021. Date of
Publication: January 2021.
Author
Florisson D.; Debono J.; Conte S.; Dimitriou J.
Institution
(Florisson, Debono, Conte, Dimitriou) St Vincent's Hospital Melbourne,
Melbourne, Vic, Australia
Publisher
Elsevier Ltd
Abstract
Purpose: A best evidence topic was written according to a structured
protocol to answer the following question: "Is pre-operative neutrophil
lymphocyte ratio an important predictor of adverse events following
cardiac surgery?" Methods: A literature search of major databases was
conducted and revealed over 36 papers, of which 13 represented the best
evidence to answer the clinical question; reference lists were also
searched manually. <br/>Result(s): Available data from these studies
demonstrate that a high pre-operative neutrophil lymphocyte ratio (NLR) in
patients undergoing cardiac surgery was associated with higher
post-operative cardiovascular mortality (p<0.001), all-cause mortality
(p<0.001) and an increased risk of 5-year mortality in patients with high
NLR who underwent on-pump coronary artery bypass grafting (CABG) vs
off-pump CABG (p<0.001) High pre-operative NLR was also associated with an
increased risk of post-operative acute kidney injury (p=0.001) and
saphenous vein graft stenosis/occlusion (p=0.001). Three studies
investigated atrial fibrillation and two of these, including a large
meta-analysis, demonstrated an increased risk of post-operative atrial
fibrillation in patients with a high pre-operative NLR (p<0.001); however,
one study demonstrated no difference (p=0.164). In two papers where
adverse events (AE) were combined, a high pre-operative NRL was associated
with a higher incidence of AE (0.001-0.007). High post-operative NLR was
also associated with an increased risk of delirium (p=0.001) and post
peri-cardiotomy syndrome (p=0.01). <br/>Conclusion(s): High pre-operative
NLR in patients undergoing cardiac surgery is associated with an increased
risk of morbidity and mortality. NLR is readily available and easy to
calculate, and the inclusion of NLR in pre-operative risk stratification
in cardiac surgery patients may assist in predicting adverse outcomes and
preventing them.<br/>Copyright &#xa9; 2021

<97>
Accession Number
2012270878
Title
Cardiac Prehabilitation: A Home-Based Program.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S10), 2021. Date of
Publication: January 2021.
Author
Stamp N.; McCann M.; Maiorana A.; Ngui A.; Quested E.; Ntomanis N.; Litton
E.; Thorgersen-Ntonami C.
Institution
(Stamp, McCann, Maiorana, Ngui, Quested, Ntomanis, Litton,
Thorgersen-Ntonami) Fiona Stanley Hospital, Perth, WA, Australia
Publisher
Elsevier Ltd
Abstract
Purpose: The care of patients undergoing cardiac surgery is becoming more
complex, owing to increased burdens of comorbid disease, frailty,
psychosocial issues and complex pathology. Cardiac rehabilitation is a
well-established way to improve the outcomes of patients after a cardiac
event or cardiac surgery but is a highly reactive approach. Cardiac
prehabilitation on the other hand is proactive and evidence suggests that
improving aerobic conditioning, respiratory muscle training, lifestyle
modification, diabetic control and sleep may improve outcomes. There are
however barriers to implementing these changes which may be overcome with
a carefully designed program. <br/>Method(s): All adult patients
undergoing cardiac surgery electively with a minimum wait period of
4-weeks prior to surgery will be recruited in absence of exclusion
criteria. They will be randomised to the intervention or conventional
care. The intervention is a multidisciplinary led (cardiac surgery,
anaesthesia, intensive care, exercise physiology, psychology and nursing)
intervention that is a home-based walking program. Subjects will be
recruited on the day of their first appointment and all face-to-face
follow-ups will be done at the same time as pre-existing appointments to
minimise cost to patient and hospital. Patients will be provided with an
accelerometer wearable device (FitBit) to measure exercise and provided
with motivational support and information via social media (a closed
Facebook group) and text messaging. Geographical concerns have been
alleviated by the use of a home-based program and have applicability to
Australian populations with rural and remote patients. <br/>Result(s):
Primary outcomes are Days Alive Out of Hospital at 90 days and length of
stay. Secondary outcomes include cost of stay, cardiometabolic markers,
motivation to exercise, quality of life, attendance at cardiac
rehabilitation. <br/>Conclusion(s): The optimal cardiac prehabiliation
program remains unclear but whatever it looks like, a low-cost, home-based
and scalable program has promising applicability to Australian patients.
Specifically targeting modifiable perioperative risk factors may reduce
adverse outcomes after surgery.<br/>Copyright &#xa9; 2021

<98>
Accession Number
2012270866
Title
Renal Effects of Procaine vs. Lignocaine Containing Modified Melbourne
Formula Cardioplegia.
Source
Heart Lung and Circulation. Conference: ANZSCTS Annual Scientific Meeting
2019. Hobart Australia. 30 (Supplement 1) (pp S48), 2021. Date of
Publication: January 2021.
Author
Balachandran V.; Dittmer J.; Bayly M.; Armarego S.; Zhou X.; Mejia R.;
Singh T.; James A.; Seah P.
Institution
(Balachandran, Dittmer, Bayly, Armarego, Zhou, Mejia, Singh, James, Seah)
John Hunter Hospital, Newcastle, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Hyperkalaemic cardioplegia remains the gold standard for providing swift,
reliable cardiac arrest. However, the depolarising range of cardioplegic
solutions are not without side-effects. We present the findings of a
prospective, randomised trial with two versions of a modified Melbourne
Solution cardioplegia-one containing procaine and the other lignocaine,
with specific emphasis on the renal effects
post-operatively.<br/>Copyright &#xa9; 2021

<99>
Accession Number
2013009866
Title
Cardiorespiratory parameters in intermittent positive pressure ventilation
versus spontaneous ventilation in under one-year-old pediatrics: A
randomized trial.
Source
Iranian Journal of Pediatrics. 31 (3) (no pagination), 2021. Article
Number: e109382. Date of Publication: 2021.
Author
Zare A.; Ghanbari A.; Nasiri A.; Nooralishahi B.; Arani H.Z.
Institution
(Zare, Ghanbari, Nasiri, Arani) Young Researchers and Elite Club, Tehran
Medical Sciences, Islamic Azad University, Tehran, Iran, Islamic Republic
of
(Nooralishahi) Department of Anesthesia, Children's Medical Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Background: Cardiac catheterization is a useful method for determining the
anatomy and pressure in cardiac vessels and chambers. The use of
anesthesia methods with minimal hemodynamic and respiratory effects can
increase diagnostic accuracy. <br/>Objective(s): Since there are a few
exclusive pediatric angiography centers, scarce studies have been done in
this area. Accordingly, this study determined the effects of intermittent
positive pressure ventilation (IPPV) versus spontaneous ventilation on
cardiorespiratory parameters in less than one-year-old pediatric patients
undergoing angiography with general anesthesia. <br/>Method(s): In this
interventional study that was performed as a double-blind, randomized
clinical trial, 60 children younger than one year were enrolled. The
pulmonary, renal, hepatic, and metabolic background diseases, previous
cardiac and thoracic surgery, requiring over two ketamine doses, and
receiving sedative or anti-convulsant therapeutics were excluded. The
patients were randomly assigned to two groups, including IPPV and
spontaneous ventilation. Their vital signs were also recorded before and
after anesthesia induction and needling, as well as during measurements of
pulmonary parameters and systemic blood pressure. All measurements were
done by a single operator using the same device for each variable.
<br/>Result(s): It was seen that SPO<inf>2</inf>, as well as
PCO<inf>2</inf> after anesthesia had significant alterations among the
study variables. Nausea and vomiting, pain, and agitation were not
different across the groups (P-value > 0.05). <br/>Conclusion(s): In this
study, we found that IPPV and spontaneous ventilation have the same
effects on respiration. Both techniques can be used in children with
different cardiovascular catheterization conditions to increase accuracy
and reduce alterations in cardiopulmonary parameters.<br/>Copyright &#xa9;
2021, Author(s).

<100>
Accession Number
635574374
Title
A randomized control led study comparing CMAC video laryngoscope and
Macintosh laryngoscope for insertion of double lumen tube in patients
undergoing elective thoracotomy.
Source
Journal of Anaesthesiology Clinical Pharmacology. 37 (2) (pp 266-271),
2021. Date of Publication: April-June 2021.
Author
Mathew A.; Chandy J.; Punnoose J.; Gnanamuthu B.R.; Jeyseelan L.;
Sahajanandan R.
Institution
(Mathew, Chandy, Punnoose, Sahajanandan) Department of Anaesthesia,
Christian Medical College, Tamil Nadu, Vellore, India
(Gnanamuthu) Department of CTVS, Christian Medical College, Tamil Nadu,
Vellore, India
(Jeyseelan) Department of Biostatistics, Christian Medical College, Tamil
Nadu, Vellore, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Double lumen tube (DLT) insertion for isolation of
lung during thoracic surgery is challenging and is associated with
considerable airway trauma. The advent of video laryngoscopy has
revolutionized the management of difficult airway. Use of video
laryngoscopy may reduce the time to intubate for DLTs even in patients
with normal airway. <br/>Material(s) and Method(s): A total of 87 ASA 1-3
adults, scheduled to undergo elective thoracotomy, requiring a DLT were
randomly allocated to videolaryngoscope (CMAC) arm or Macintosh
laryngoscope arm. It was on open label study, and only the patient was
blinded. The primary objective of this study was to compare the mean time
taken for DLT intubation with CMAC (Mac 3) and Macintosh laryngoscope
blade and the secondary objectives included the hemodynamic response to
intubation, the level of difficulty using the intubation difficulty scale
(IDS), and complications associated with intubation.Data was analysed
using the statistical software SPSS (version 18.0). <br/>Result(s): The
time taken for intubation was not significantly different (42.8 +/- 14.8 s
for CMAC and 42.5 +/- 11.5 s for Macintosh laryngoscope P -0.908). The
CMAC video laryngoscope was associated with an improved laryngoscopy grade
(Grade I in 81.8% with CMAC and in 46.5% with Macintosh), less pressure
applied on the tongue, and less external laryngeal pressure required.
Hemodynamic responses to intubation were similar in both groups.
<br/>Conclusion(s): Macintosh blade is as good as CMAC (mac 3) blade to
facilitate DLT intubation in adult patients with no anticipated airway
difficulty, however CMAC was superior as it offers better laryngoscopic
view, needed less force, and fewer external laryngeal manipulations.
<br/>Copyright &#xa9; 2021 Journal of Anaesthesiology Clinical
Pharmacology <br/> Published by Wolters Kluwer - Medknow.

<101>
Accession Number
2013749991
Title
Inhibition of platelet aggregation after coronary stenting in patients
receiving oral anticoagulation.
Source
Deutsches Arzteblatt International. 118 (22) (pp 379-388), 2021. Date of
Publication: 04 Jun 2021.
Author
Genz C.; Braun-Dullaeus R.C.
Institution
(Genz, Braun-Dullaeus) Department of Internal Medicine, Division of
Cardiology and Angiology, University Hospital Magdeburg, Germany
Publisher
Deutscher Arzte-Verlag GmbH
Abstract
Background: Approximately 18% of patients with atrial fibrillation undergo
a percutaneous coronary intervention (PCI) to treat coronary heart
disease. Pharmacological anticoagulation in patients with atrial
fibrillation and PCI involves a trade-off of potential ischemic and
hemorrhagic complications. <br/>Method(s): This review is based on
pertinent publications that were retrieved by a selective literature
search, including current guidelines and recommendations. <br/>Result(s):
Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a
P2Y12 inhibitor protects against stent thrombosis, but not against thrombo
- embolic stroke. In contrast, oral anticoagulation does provide effective
prevention against stroke during atrial fibrillation. Combining DAPT with
oral anticoagulation (triple therapy) over the long term, as has been
recommended to date, carries an elevated risk of hemorrhage. In a
randomized controlled trial, 44% of patients with atrial fibrillation
receiving triple therapy sustained a hemorrhagic event, compared to 19.4%
of patients receiving dual therapy. A meta-analysis has shown that
clinically relevant hemorrhage is less common under combined treatment
with one of the new oral anticoagulants (NOAC) and a single antiplatelet
drug than under triple therapy including a vitamin K antagonist (hazard
ratio, 0.56; 95% confidence interval 0.39; 0.80]), but no significant
difference was found with respect to stent thrombosis, myocardial
infarction, or overall mortality. <br/>Conclusion(s): After coronary stent
implantation, dual therapy with a NOAC and a P2Y12 inhibitor is
recommended, subsequent to triple therapy given only during the
peri-interventional period.<br/>Copyright &#xa9; 2021 Deutscher
Arzte-Verlag GmbH. All rights reserved.

<102>
Accession Number
2013736275
Title
The impact of post-operative atrial fibrillation on outcomes in coronary
artery bypass graft and combined procedures.
Source
Journal of Geriatric Cardiology. 18 (5) (pp 319-326), 2021. Date of
Publication: May 2021.
Author
Chau Y.-L.A.; Yoo J.W.; Yuen H.C.; Waleed K.B.; Chang D.; Liu T.; Liu
F.Z.; Tse G.; Lee S.; Li K.H.C.
Institution
(Chau, Yoo) Faculty of Pharmaceutical Sciences, University of British
Columbia, BC, Canada
(Yuen) Department of Medicine and Geriatrics, Princess Margaret Hospital,
Hong Kong
(Waleed) Department of Cardiology, Fuwai Hospital, Chinese Academy of
Medical Sciences Shenzhen, Shenzhen, China
(Waleed) Institute of Biomedicine and Biotechnology, Shenzhen Institutes
of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(Chang) Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
(Liu, Tse) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, The Second Hospital of Tianjin Medical University, Tianjin,
China
(Liu) Department of Cardiology, Guangdong Cardiovascular Institute,
Guangdong Provincial People's Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
(Tse) Faculty of Health and Medical Sciences, University of Surrey,
Guildford GU2 7AL, United Kingdom
(Lee) Cardiovascular Analytics Group, Laboratory of Cardiovascular
Physiology, Hong Kong, Hong Kong
(Li) Arrowe Park Acute Stroke Unit, Wirral University, Teaching Hospital,
NHS Foundation Trust, Wirral, United Kingdom
Publisher
Science Press
Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is a common yet
understudied clinical issue after coronary artery bypass graft (CABG)
leading to higher mortality rates and stroke. This systematic review and
meta-analysis evaluated the rates of adverse outcomes between patients
with and without POAF in patients treated with CABG or combined
procedures. METHODS The search period was from the beginning of PubMed and
Embase to May 18^th, 2020 with no language restrictions. The
inclusion criteria were: (1) studies comparing new onset atrial
fibrillation before or after revascularization vs. no new onset AF before
or after revascularization. The outcomes assessed included all-cause
mortality, cardiac death, cerebral vascular accident (CVA), myocardial
infarction (MI), repeated revascularization, major adverse cardiac event
(MACE), and major adverse cardiac and cerebrovascular events (MACCEs).
RESULTS Of the 7,279 entries screened, 11 studies comprising of 57,384
patients were included. Compared to non-POAF, POAF was significantly
associated with higher risk of all-cause mortality (Risk Ratio (RR) =
1.58; 95% Confidence Interval (CI): 1.42-1.76, P < 0.00001) with
accompanying high level of heterogeneity (I² = 62%).
Conclusions Patients with POAF after CABG or combined procedures are at an
increased risk of all-cause mortality or CVAs. Therefore, POAF after such
procedures should be closely monitored and treated judiciously to minimize
risk of further complications. While there are studies on POAF versus no
POAF on outcomes, the heterogeneity suggests that further studies are
needed.<br/>Copyright &#xa9; 2021 JGC All rights reserved; www.jgc301.com

<103>
Accession Number
2013281926
Title
Comparison of dopamine versus norepinephrine in circulatory shock after
cardiac surgery: A randomized controlled trial.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Lim J.Y.; Park S.J.; Kim H.J.; Choo S.J.; Chung C.H.; Lee J.W.; Park
D.-W.; Kim J.B.
Institution
(Lim) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Park, Kim, Choo, Chung, Lee, Kim) Department of Thoracic and
Cardiovascular Surgery, Asan Medical Center, University of Ulsan College
of Medicine, Seoul, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Anam Hospital,
University of Korea College of Medicine, Seoul, South Korea
(Park) Department of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim of the Study: Although dopamine and norepinephrine are
recommended as first-line agents in the treatment of shock, it is unclear
which is the optimal vasoactive inotropic agent (VIA) to manage
postcardiotomy circulatory shock. This single-center, randomized clinical
trial aimed to investigate the efficacy and safety of dopamine versus
norepinephrine in postcardiotomy circulatory shock. <br/>Method(s): We
randomly assigned the patients with postcardiotomy circulatory shock to
receive either dopamine or norepinephrine. When shock persisted despite
the dose of 20 mug/kg/min of dopamine or the dose of 0.2 mug/kg/min of
norepinephrine, epinephrine or vasopressin could be added. The primary
endpoint was new-onset tachyarrhythmic event during drug infusion.
Secondary endpoints included requirement of additional VIAs, postoperative
complications, and all-cause mortality within 30 days of drug initiation.
<br/>Result(s): At the planned interim analysis of 100 patients, the
boundary for the benefit of norepinephrine has been crossed, and the study
was stopped early. Excluding two patients withdrawing a consent, 48
patients were assigned to dopamine and 50 patients to norepinephrine.
New-onset tachyarrhythmic event occurred in 12 (25%) patients in the
dopamine and one (2%) patient in the norepinephrine group (p =.009). The
requirement for additional VIAs was more common in the dopamine group (p
<.001). Other secondary endpoints were similar between groups.
<br/>Conclusion(s): Despite the limited study subjects with early
determination, in patients with postcardiotomy circulatory shock, dopamine
as a first-line vasopressor was associated with higher tachyarrhythmic
events and greater need for additional VIAs compared with
norepinephrine.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<104>
Accession Number
2013281853
Title
Network meta-analysis of treatment strategies in patients with coronary
artery disease and low left ventricular ejection fraction.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yokoyama Y.; Fukuhara S.; Mori M.; Noguchi M.; Takagi H.; Briasoulis A.;
Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
(Mori) Division of Cardiac Surgery, Yale School of Medicine, New Haven,
CT, United States
(Noguchi) Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical
Center, Urayasu, Japan
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Cardiology, Heart failure and Transplantation,
University of Iowa, Iowa City, IA, United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York City, NY, United States
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein Medical College, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The optimal treatment strategy in patients with coronary artery
disease (CAD) and low left ventricular ejection fraction (LVEF) remains
controversial. Herein, we conducted a network meta-analysis comparing
coronary artery bypass graft (CABG), percutaneous coronary intervention
(PCI), and optimal medical therapy (OMT) in patients with CAD and low
LVEF. <br/>Method(s): MEDLINE and EMBASE were searched through March, 2021
to identify randomized controlled trials (RCTs) and propensity-score
matched (PSM) studies comparing CABG, PCI, and OMT. We extracted hazard
ratios (HRs) of the outcomes. <br/>Result(s): A total of three RCTs and 10
PSM trials were identified, yielding a total of 18,855 patients with CAD
with low EF who were treated with CABG (n = 9241), PCI (n = 8771), or OMT
(n = 1003). All-cause mortality was significantly lower in patients with
CABG compared with those with PCI or OMT (HR [95% confidence interval
(CI)] = 0.72 [0.62-0.82], p <.001, HR [95% CI] = 0.65 [0.51-0.82], p
=.004, respectively), while no difference was observed between PCI and
OMT. The rates of MI were significantly lower in patients treated with
CABG compared to those treated with PCI or OMT. However, the subgroup
analysis by limiting the PCI group to patients who received drug-eluting
stent (DES) showed similar all-cause mortality between CABG and PCI, while
both CABG and PCI were associated with lower all-cause mortality compared
with OMT. Concluion: The present study demonstrated that CABG was the
appropriate treatment strategy in patients with CAD and low LVEF. Further
long-term trials were warranted to investigate outcomes of PCI with DES
compared with CABG.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC.

<105>
Accession Number
635568725
Title
A Retrospective Study of Coronary Artery Bypass Grafting with Low-Thermal
Plasma Dissection Device Compared to Conventional Monopolar
Electrosurgery.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2021. Date
of Publication: 07 Jul 2021.
Author
Uysal D.; Ibrisim E.
Institution
(Uysal, Ibrisim) Department of Cardiovascular Surgery, Suleyman Demirel
Universitesi Tip Fakultesi, Isparta, Turkey
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The objective of this study is to compare the effects of
conventional monopolar electrosurgery (CMES) and low-thermal plasma
kinetic cautery (PKC) on complications such as bleeding, abnormal wound
healing, pain, and drainage in patients who underwent on-pump coronary
artery bypass grafting (CABG). <br/>METHOD(S): This retrospective clinical
study included 258 patients undergoing CABG; the patients were randomized
to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients'
clinical data were examined retrospectively for biochemical variables,
postoperative drainage, post-surgery erythrocyte suspension transfusion
count, surgical site pain examined with visual analogue scale (VAS), and
wound healing. Two-sided P-value > 0.05 was considered as statistically
significant. <br/>RESULT(S): The median post-surgery erythrocyte
suspension transfusion number was significantly lower with PKC compared to
CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative
drain output and time until removal of drain tubes were significantly
lower with PKC compared to CMES (300+/-113 vs. 547+/-192 and 1.95+/-1.5
vs. 2.44+/-1.8; P<0.001 and P=0.025, respectively). Mean VAS score for
spontaneous and cough-induced pain were significantly lower with PKC
compared to CMES (1.98+/-1.51 vs. 3.94+/- 2.09 and 3.76+/-1.46 vs.
5.6+/-1.92; P<0.001 for both comparisons). Reoperation due to bleeding was
significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001).
<br/>CONCLUSION(S): Use of PKC during CABG considerably reduces
postoperative drainage, need for blood transfusion, reoperation due to
bleeding, and postoperative pain. PCK appears to be a good alternative to
CMES for CABG.

<106>
Accession Number
635568701
Title
Video-Assisted Thoracoscopy For Penetrating Cardiac Box Injury in Stable
Patients.
Source
Brazilian journal of cardiovascular surgery. (no pagination), 2021. Date
of Publication: 07 Jul 2021.
Author
Vinck E.E.; Angel E.P.; Barrios R.V.; Martinez S.I.; Arias C.A.; Garzon
J.C.; Ebels T.; Alzate S.A.; Fernandez A.
Institution
(Vinck) Department of Cardiovascular Surgery, Cardio VID Clinic -
Pontifical Bolivarian University, Medellin, Colombia
(Angel) Department of Surgery, Pontificia Universidad Javeriana, Bogota,
Colombia
(Barrios, Martinez, Fernandez) Department of Thoracic Surgery, El Bosque
University, Bogota, Colombia
(Arias) Department of Cardiovascular Surgery, Central Military Hospital,
Bogota, Colombia
(Garzon) Department of Thoracic Surgery; Fundacion Cardioinfantil, Bogota,
Colombia
(Ebels) Department of Cardio-thoracic Surgery, University Medical Center
Groningen, Groningen, Netherlands
(Alzate) Department of Cardiovascular Surgery, Fundacion Clinica Shaio,
Bogota, Colombia
Publisher
NLM (Medline)
Abstract
INTRODUCTION: In high-volume trauma centers, especially in developing
countries, penetrating cardiac box injuries are frequent. Although many
aspects of penetrating chest injuries have been well established,
video-assisted thoracoscopy is still finding its place in cardiac box
trauma and algorithmic approaches are still lacking. The purpose of this
manuscript is to provide a streamlined recommendation for penetrating
cardiac box injury in stable patients. <br/>METHOD(S): Literature review
was carried out using PubMed/ MEDLINE and Google Scholar databases to
identify articles describing the characteristics and concepts of
penetrating cardiac box trauma, including the characteristics of
tamponade, cardiac ultrasound, indications and techniques of pericardial
windows and, especially, the role of video-assisted thoracoscopy in stable
patients. <br/>RESULT(S): Penetrating cardiac box injuries, whether by
stab or gunshot wounds, require rapid surgical consultation. Unstable
patients require immediate open surgery, however, determining which stable
patients should be taken to thoracoscopic surgery is still controversial.
Here, the classification of penetrating cardiac box injury used in
Colombia is detailed, as well as the algorithmic approach to these types
of trauma. <br/>CONCLUSION(S): Although open surgery is mandatory in
unstable patients with penetrating cardiac box injuries, a more
conservative and minimally invasive approach may be undertaken in stable
patients. As rapid decision-making is critical in the trauma bay, surgeons
working in high-volume trauma centers should expose themselves to
thoracoscopy and always consider this possibility in the setting of
penetrating cardiac box injuries in stable patients, always in the context
of an experienced trauma team.

<107>
Accession Number
635566190
Title
Utilization, costs, and outcomes of conscious sedation versus general
anesthesia for transcatheter aortic valve replacement.
Source
Circulation: Cardiovascular Interventions. (pp 742-750), 2021. Date of
Publication: 2021.
Author
Herrmann H.C.; Cohen D.J.; Hahn R.T.; Babaliaros V.C.; Yu X.; Makkar R.;
McCabe J.; Szerlip M.; Kapadia S.; Russo M.; Malaisrie S.C.; Webb J.G.;
Szeto W.Y.; Kodali S.; Thourani V.H.; Mack M.J.; Leon M.B.
Institution
(Herrmann, Szeto) Perelman School of Medicine, The University of
Pennsylvania, Philadelphia, PA, United States
(Cohen) Cardiovascular Research Foundation, New York, NY, United States
(Hahn, Kodali, Leon) Columbia University Medical Center, New York, NY,
United States
(Babaliaros) Emory University, Atlanta, GA, United States
(Yu) Edwards Lifesciences, Inc, Irvine, CA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(McCabe) University of Washington, Seattle, WA, United States
(Szerlip, Mack) Baylor Scott and White Health, Plano, TX, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Russo) Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
(Malaisrie) Northwestern University Hospital, Chicago, IL, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: The potential advantages for conscious sedation (CS) as
compared to general anesthesia (GA) have not been evaluated in studies
with core laboratory echocardiographic assessments and monitored end
points. We compared CS versus GA for SAPIEN 3 transcatheter aortic valve
replacement in patients at intermediate- and low-surgical risk.
<br/>METHOD(S): This analysis included patients in the PARTNER 2
(Placement of Aortic Transcatheter Valve Trial) intermediate-risk registry
and the PARTNER 3 randomized low-risk study. CS was compared to GA with
respect to death, stroke, bleeding, paravalvular regurgitation, length of
stay, and costs. Outcomes were assessed by a core echocardiographic
laboratory, and clinical events were independently adjudicated.
<br/>RESULT(S): Baseline characteristics were similar between the CS and
GA groups. Postprocedure hospital length of stay was significantly shorter
for CS versus GA both in intermediate-risk patients (4.4+/-0.2 and
5.2+/-0.2 days, respectively, P<0.01) and low-risk patients (2.7+/-0.1 and
3.4+/-0.2 days, respectively, P<0.001). There were no significant
differences between CA and GA patients in either the 30-day or 1-year
rates of death, stroke, rehospitalization, or paravalvular aortic
regurgitation >=moderate. In the intermediate-risk cohort, adjusted 30-day
health care costs were $3833 lower per patient in the CS group.
<br/>CONCLUSION(S): The selective use of CS is associated with shorter
procedure times, shorter intensive care unit and hospital length of stay,
lower costs, and no difference in clinical outcomes to 1 year, including
>=moderate paravalvular regurgitation. Our data demonstrate similar safety
profiles with both approaches and support the continued use of CS for most
patients undergoing the procedure.<br/>Copyright &#xa9; 2021 American
Heart Association, Inc.