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

<2>
Accession Number
2012750073
Title
Economic assessment of traditional surgical valve replacement versus use
of transfemoral intervention in degenerative aortic stenosis.
Source
Minerva Medica. 112 (3) (pp 372-383), 2021. Date of Publication: June
2021.
Author
Edlinger C.; Krizanic F.; Butter C.; Bannehr M.; Neuss M.; Fejzic D.;
Hoppe U.C.; Lichtenauer M.
Institution
(Edlinger, Butter, Bannehr, Neuss) Department of Cardiology, Heart Center
Brandenburg, Berlin, Germany
(Edlinger, Butter, Bannehr, Neuss) Brandenburg Medical School (MHB)
"Theodor Fontane,", Neuruppin, Germany
(Edlinger, Fejzic, Hoppe, Lichtenauer) Department of Cardiology, Clinic of
Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg,
Austria
(Krizanic) Department of Cardiology, Caritas Clinic Pankow Berlin, Berlin,
Germany
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The aim of this study was to provide an economic assessment
of interventional vs. surgical aortic valve replacement in the context of
cost-effectiveness. Aortic stenosis represents the most common form of
degenerative valvular heart diseases. As life expectancy increases, an
even emerging prevalence is expected. Over decades, surgical replacement
was considered as the method of choice. Up to one third of the patients
were not eligible for surgery, as their estimated peri-operative risk was
too high. In the early 2000s a catheter-based technique has been
developed, being an alternative treatment option for patients, considered
to be inoperable. EVIDENCEACQUISITION: Asystematic analysis of current
literature was performed from September 2018 to December 2018. All
suitable data in the field was obtained from Pubmed and Google/Google
scholar. The search terms "TAVI AND costs," "TAVR and costs" and "aortic
valve replacement AND costs" was entered in the search field, showing an
overall amount of 317 publications. In a next step all obtained
publications were screened by expert hand selection. EVIDENCESYNTHESIS:
Recently the Food and Drug Association (FDA) approved transcatheter aortic
valve replacement (TAVR) in the low-risk setting. Nevertheless, concerns
on the higher price remain. We performed an analysis of current literature
on aortic stenosis and economic aspects. Out of 322 screened publications,
7 studies were found eligible by expert hand selection. Based on the
predefined payment readiness of the analyzed healthcare system, TAVR
appeared to have a slightly better cost effectiveness. Initial results
within the early era seemed to be inconsistent. Recent publications
showed, TAVRmight be of more cost effectiveness when using the newest
generation devices and a profound clinical experience is guaranteed.
 CONCLUSION(S): We assume, that TAVRwill not only be the method of
choice for the treatment of aortic stenosis in many patients. As the
valves are getting cheaper, TAVRmight even be superior to conventional
heart surgery from an economic point of view. Copyright © 2020
EDIZIONI MINERVA MEDICA

<3>
Accession Number
634745591
Title
Secundum atrial septal defects transcatheter closure versus surgery in
adulthood: A 2000-2020 systematic review and meta-analysis of
intrahospital outcomes.
Source
Cardiology in the Young. 31 (4) (pp 541-546), 2021. Date of Publication:
April 2021.
Author
Rigatelli G.; Zuin M.; Roncon L.; Nanjiundappa A.
Institution
(Rigatelli, Roncon) Division of Cardiology, Rovigo General Hospital,
Rovigo, Italy
(Zuin) Department of Translational Medicine, University of Ferrara,
Ferrara, Italy
(Nanjiundappa) Center of Vascular Excellence, West Virginia University
Medical School, Charlstone, WV, United States
Publisher
Cambridge University Press
Abstract
Technologically, advances in both transcatheter and surgical techniques
have been continuing in the past 20 years, but an updated comprehensive
comparison in device-based versus surgery in adults in terms of incidence
of in-hospital mortality, perioperative stroke, and atrial fibrillation
onset is still lacking. We investigate the performance of transcatheter
device-based closure compared to surgical techniques by a systematic
review and meta-analysis of the last 20 years literature data.
 Material(s) and Method(s): The analysis was conducted following the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement. Literature search was performed based on Cochrane
Library, Embase, PubMed, and Google Scholar to locate articles published
between January 2000 and October 2020, regarding the comparison between
short-term outcome and post-procedural complications of atrial septal
defect patients receiving transcatheter or surgical closure. The primary
outcome was the comparison of in-hospital mortality from all causes
between patients treated with transcatheter closure or cardiac. Secondary
outcomes were the onset of post-procedural atrial fibrillation or
perioperative stroke. Result(s): A total of 2360 patients were
included of which 1393 [mean age 47.6 years, 952 females (68.3%)] and 967
[mean age 40.3 years, 693 females (71.6%)] received a transcatheter
device-based and surgery closure, respectively. In-hospital mortality [OR
0.16 (95% CI (0.66-0.44)), p = 0.0003, I2 = 0%], perioperative stroke [OR
0.51 (95% CI (0.31-0.84)), p = 0.003, I2 = 79%], and post-procedural
atrial fibrillation [OR 0.14 (95% CI (0.03-0.61)), p = 0.009, I2 = 0%]
significantly favoured transcatheter device-based closure
 Conclusion(s): Transcatheter atrial septal defect closure resulted
safer in terms of in-hospital mortality, perioperative stroke, and
post-procedural atrial fibrillation compared to traditional
surgery. Copyright © 2021 Cambridge University Press. All rights
reserved.

<4>
Accession Number
2011302817
Title
Effect of treatment of peripheral arterial disease on the onset of
anaerobic exercise during cardiopulmonary exercise testing.
Source
Physiological Reports. 9 (7) (no pagination), 2021. Article Number:
e14815. Date of Publication: April 2021.
Author
Barkat M.; Key A.; Ali T.; Walker P.; Duffy N.; Snellgrove J.; Torella F.
Institution
(Barkat, Snellgrove, Torella) Liverpool Vascular and Endovascular Service,
Liverpool University Hospitals NHS Foundation Trust, Liverpool, United
Kingdom
(Barkat) Institute of Ageing and Chronic Disease, University of Liverpool,
Liverpool, United Kingdom
(Key, Walker, Duffy) Department of Respiratory Medicine, Liverpool
University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
(Ali, Walker, Torella) Faculty of Health and Life Sciences, University of
Liverpool, Liverpool, United Kingdom
(Torella) School of Physical Sciences, University of Liverpool, Liverpool,
United Kingdom
(Torella) Liverpool Centre for Cardiovascular Science, Liverpool, United
Kingdom
Publisher
American Physiological Society
Abstract
Objective: Cardiopulmonary exercise testing (CPET) is often used to assess
pre-operative fitness in elderly patients, in whom peripheral arterial
disease (PAD) is highly prevalent, but may affect the results of CPET by
early lactate release due to muscle ischemia. This study investigated the
effect revascularization of PAD on oxygen delivery (VO<inf>2</inf>) during
CPET. Method(s): We conducted a prospective cohort study of 30
patients, who underwent CPET before and after treatment of ilio-femoral
PAD. The primary outcome measure was difference in VO<inf>2</inf> at the
lactate threshold (LT) before and after revascularization. Secondary
outcome measures were the relationship between change in VO<inf>2</inf> at
LT and peak exercise and change in ankle-brachial index (ABI)
differential. Result(s): The study was approved by the North
West-Lancaster Research and Ethics committee (reference 15/NW/0801) and
registered in clinicaltrial.gov (reference NCT02657278). As specified in
the study protocol, 30 patients were recruited but only 20 (15 men), with
a mean age of 62 years, completed pre- and post-treatment CPETs. Twelve
patients demonstrated an improvement in VO<inf>2</inf> at LT after
revascularization, but the difference did not achieve statistical
significance (mean difference (95% CI) = 1.43 (-0.21 to 3.08) ml/kg/min;
(p = 0.085). There was, however, a significant improvement in
VO<inf>2</inf>, VE/CO<inf>2</inf>, workload and Borg breathlessness and
leg fatigue score at peak exercise after revascularization. There was no
significant correlation between change in VO<inf>2</inf> at LT (r = -0.11,
p = 0.65) or change in VO<inf>2</inf> at peak and ABI differential (r =
-0.14, p = 0.55). Conclusion(s): Revascularization of PAD led to
significant improvement in multiple peak/maximal exercise parameters
within a few weeks and without exercise training. We were unable to
demonstrate a statistically significant improvement in VO<inf>2</inf> at
LT albeit in a majority of subjects this exceeded what we pre-defined as
clinically significant. Copyright © 2021 The Authors.
Physiological Reports published by Wiley Periodicals LLC on behalf of The
Physiological Society and the American Physiological Society

<5>
Accession Number
2007825121
Title
Surgical aortic mitral curtain replacement: Systematic review and
metanalysis of early and long-term results.
Source
Journal of Clinical Medicine. 10 (14) (no pagination), 2021. Article
Number: 3163. Date of Publication: 02 Jul 2021.
Author
Giambuzzi I.; Bonalumi G.; Di Mauro M.; Roberto M.; Corona S.; Alamanni
F.; Zanobini M.
Institution
(Giambuzzi, Bonalumi, Roberto, Corona, Alamanni, Zanobini) IRCCS Centro
Cardiologico Monzino, Department of Cardiovascular Surgery, Milan 20100,
Italy
(Giambuzzi, Corona, Alamanni) DISCCO Department, University of Milan,
Milan 20100, Italy
(Di Mauro) Heart and Vascular Centre, Cardio-Thoracic Surgery Unit,
Maastricht University Medical Centre (MUMC), 9 Cardiovascular Research
Institute Maastricht (CARIM), Maastricht 6221, Netherlands
Publisher
MDPI AG
Abstract
The Commando procedure is challenging, and aims to replace the mitral
valve, the aortic valve and the aortic mitral curtain, when the latter is
severely affected by pathological processes (such as infective
endocarditis or massive calcification). Given the high complexity, it is
seldomly performed. We aim to review the literature on early
(hospitalization and up to 30 days) and long-term (at least 3 years of
follow-up) results. Bibliographical research was performed on PubMed and
Cochrane with a dedicated string. Papers regarding double valve
replacement or repair in the con-text of aortic mitral curtain disease
were included. The metaprop function was used to assess early survival and
complications (pacemaker implantation, stroke and bleeding). Nine papers
(540 pa-tients, median follow-up 41 (IQR 24.5-51.5) months) were included
in the study. Pooled proportion of early mortality, stroke, pacemaker
implant and REDO for bleeding were, respectively 16.2%, 7.8%, 25.1% and
13.1%. The long-term survival rate ranged from 50% to 92.2%. Freedom from
re-intervention was as high as 90.9% when the endocarditis was not the
first etiology and 78.6% in case of valvular infection (one author had
100%). Freedom from IE recurrences reached 85% at 10 years. Despite the
high mortality, the rates of re-intervention and infective endocarditis
recurrences following the Commando procedure are satisfactory and confirm
the need for an aggressive strategy to improve long-term
outcomes. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<6>
Accession Number
634154677
Title
Aortic valve neocuspidization with autologous pericardium in adult
patients: UK experience and meta-analytic comparison with other aortic
valve substitutes.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. 60 (1) (pp 34-46), 2021.
Date of Publication: 14 Jul 2021.
Author
Benedetto U.; Sinha S.; Dimagli A.; Dixon L.; Stoica S.; Cocomello L.;
Quarto C.; Angelini G.D.; Dandekar U.; Caputo M.
Institution
(Benedetto, Sinha, Dimagli, Dixon, Stoica, Cocomello, Angelini, Caputo)
Bristol Heart Institute, Translational Health Sciences, University of
Bristol, Bristol, United Kingdom
(Quarto) Department of Cardiothoracic Surgery, Royal Brompton Harefield
NHS Trust, London, United Kingdom
(Dandekar) Department of Cardiothoracic Surgery, University Hospital
Coventry Warwickshire NHS Trust, West Midlands, Coventry, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: We sought to provide further evidence on the safety and
efficacy of aortic valve neocuspidization (AVNeo) using autologous
pericardium in adult patients with aortic valve disease by reporting
clinical and echocardiographic results from the first UK experience and
performing a meta-analytic comparison with other biological valve
substitutes. METHOD(S): We reported clinical and echocardiographic
outcomes of 55 patients (mean age 58+/-15years) undergoing AVNeo with
autologous pericardium in 2 UK centres from 2018 to 2020. These results
were included in a meta-analytic comparison between series on AVNeo (7
studies, 1205 patients, mean weighted follow-up 3.6years) versus Trifecta
(10 studies, 8705 patients, 3.8years), Magna Ease (3 studies, 3137
patients, 4.1years), Freedom Solo (4 studies, 1869 patients, 4.4years),
Freestyle (4 studies, 4307 patients, 7years), Mitroflow (4 studies, 4760
patients, 4.1years) and autograft aortic valve (7 papers, 3839 patients,
9.1years). RESULT(S): In the present series no patients required
intraoperative conversion. After mean follow-up of 12.5+/-0.9months, 3
patients presented with endocarditis and 1 required reintervention. The
remaining patients had absent or mild aortic valve insufficiency with very
low peak and mean transvalvular gradients (16+/-3.7 and 9+/-2.2mmHg,
respectively). Meta-analytic estimates showed non-significant difference
between AVNeo and all but Magna Ease valves with regards to structural
valve degeneration, reintervention and endocarditis. When compared Magna
Ease valve, AVNeo and other valve substitutes showed an excess of
valve-related events. CONCLUSION(S): AVNeo is safe, associated with
excellent haemodynamic profile. Its midterm risk of valve-related events
is comparable to most biological valve substitutes. Magna Ease is
potentially the best biological choice as far as risk of reintervention is
concerned. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<7>
Accession Number
2013639223
Title
Meta-computational techniques' for managing spare data: An application in
off-pump heart surgery.
Source
Computer Methods and Programs in Biomedicine. 208 (no pagination), 2021.
Article Number: 106267. Date of Publication: September 2021.
Author
Lai H.; Khan Y.A.; Abbas S.Z.; Chammam W.
Institution
(Lai) School of Information Engineering, Huanghuai University. China
(Khan, Abbas) Department of Mathematics and Statistics, Hazara University
Mansehra, Pakistan
(Chammam) Department of Mathematics, College of Science Al-Zulfi, Majmaah
University, PO Box 66, Al-Majmaah 11952, Saudi Arabia
Publisher
Elsevier Ireland Ltd
Abstract
Background and Objectives: This research looked at the key considerations
to remember when selecting a model for working with sparse data. In the
presence of sparse evidence, it proposes ideal conditions for conducting
meta-analysis. Method(s): Monte Carlo simulations were used to
produce study results, and three forms of continuity correction were used
in the research. Besides, meta-analytical approaches were used to measure
the cumulative effect of treatment and estimate each method's efficiency.
A clinical trial in off-pump surgery met the main objectives of this
research. Meta-analysis methods were used to determine the outcome of
postoperative risk results. After that, with a total population of 3030,
Monte Carlo simulations were used to produce research data to run fixed
and random-effect models with three continuity correction forms. The type
of consistency adjustment used, group imbalances, statistical analysis
used, and variance values between studies all affect meta-analytical
methods' results. Result(s): MSE values for balanced groups are
normally zero. While the Arc-sine variation approach does a decent job of
coping with inconsistent results on the effect of treatment, it has
concerns with boundary estimates of variance between tests. Furthermore,
using continuity correction methods introduces bias and imprecise
medication outcome calculations. The spectrum of statistical analysis,
such as fixed effects and random effects, can be inferred as completely
based on data in samples. The sensitivity analysis of correction decisions
could increase the reliability of meta-analysis approaches by enabling
researchers to analyze various effect estimation findings.
 Conclusion(s): This research study can be expanded upon by
identifying alternative approaches to continuity correction methods and
resolving boundary estimate problems. The range of statistical analysis,
such as fixed effects and random effects, can be entirely dependent on the
samples' type of data. The sensitivity analysis of correction decisions
could improve the efficiency of meta-analysis methods by allowing
researchers to investigate a wide range of effect estimation
results. Copyright © 2021

<8>
Accession Number
2013533004
Title
Percutaneous Coronary Revascularization: JACC Historical Breakthroughs in
Perspective.
Source
Journal of the American College of Cardiology. 78 (4) (pp 384-407), 2021.
Date of Publication: 27 Jul 2021.
Author
Serruys P.W.; Ono M.; Garg S.; Hara H.; Kawashima H.; Pompilio G.;
Andreini D.; Holmes D.R.; Onuma Y.; King III S.B.
Institution
(Serruys, Ono, Hara, Kawashima, Onuma) Department of Cardiology, National
University of Ireland, Galway (NUIG), Galway, Ireland
(Serruys, Ono, Hara, Kawashima, Onuma) CURAM-SFI Centre for Research in
Medical Devices, Galway, Ireland
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Ono, Hara, Kawashima) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Pompilio, Andreini) Centro Cardiologico Monzino, IRCCS, Milan, Italy
(Pompilio) Department of Biomedical, Surgical and Dental Sciences,
University of Milan, Milan, Italy
(Andreini) Department of Clinical Sciences and Community Health,
University of Milan, Milan, Italy
(Holmes) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
MN, United States
(King III) Division of Cardiology, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
Publisher
Elsevier Inc.
Abstract
Over the last 4 decades, percutaneous coronary intervention has evolved
dramatically and is now an acceptable treatment option for patients with
advanced coronary artery disease. However, trialists have struggled to
establish the respective roles for percutaneous coronary intervention and
coronary artery bypass graft surgery, especially in patients with
multivessel disease and unprotected left-main stem coronary artery
disease. Several pivotal trials and meta-analyses comparing these 2
revascularization strategies have enabled the relative merits of each
technique to be established with regard to the type of ischemic syndrome,
the coronary anatomy, and the patient's overall comorbidity. Precision
medicine with individualized prognosis is emerging as an important method
of selecting treatment. However, the never-ending advancement of
technology, in conjunction with the emergence of novel pharmacological
agents, will in the future continue to force us to reconsider the evolving
question: "Which treatment strategy is better and for which
patient?" Copyright © 2021 American College of Cardiology
Foundation

<9>
Accession Number
2013491396
Title
Postoperative Atrial Fibrillation or Flutter Following Transcatheter or
Surgical Aortic Valve Replacement: PARTNER 3 Trial.
Source
JACC: Cardiovascular Interventions. 14 (14) (pp 1565-1574), 2021. Date of
Publication: 26 Jul 2021.
Author
Shahim B.; Malaisrie S.C.; George I.; Thourani V.H.; Biviano A.B.; Russo
M.; Brown D.L.; Babaliaros V.; Guyton R.A.; Kodali S.K.; Nazif T.M.;
Kapadia S.; Pibarot P.; McCabe J.M.; Williams M.; Genereux P.; Lu M.; Yu
X.; Alu M.; Webb J.G.; Mack M.J.; Leon M.B.; Kosmidou I.
Institution
(Shahim, Alu, Leon, Kosmidou) Cardiovascular Research Foundation, New
York, NY, United States
(Malaisrie) Division of Cardiac Surgery, Northwestern University, Chicago,
IL, United States
(George, Biviano, Kodali, Nazif, Alu, Leon, Kosmidou) NewYork-Presbyterian
Hospital/Columbia University Irving Medical Center, New York, NY, United
States
(Thourani) Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta,
GA, United States
(Russo) Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical
School, New Brunswick, NJ, United States
(Brown, Mack) Baylor Scott & White Health, Plano, TX, United States
(Babaliaros, Guyton) Emory University Medical Center, Atlanta, GA, United
States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Pibarot) Quebec Heart and Lung Institute, Laval University, Quebec, QC,
Canada
(McCabe) University of Washington, Seattle, WA, United States
(Williams) NYU Langone Medical Center, New York, NY, United States
(Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center,
Morristown, NJ, United States
(Lu, Yu) Edwards Lifesciences, Irvine, CA, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the incidence and
prognostic impact of early and late postoperative atrial fibrillation or
flutter (POAF) in patients with severe aortic stenosis (AS) treated with
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR). Background(s): There is an ongoing controversy
regarding the incidence, recurrence rate, and prognostic impact of early
(in-hospital) POAF and late (postdischarge) POAF in patients with AS
undergoing TAVR or SAVR. Method(s): In the PARTNER (Placement of
Aortic Transcatheter Valve) 3 trial, patients with severe AS at low
surgical risk were randomized to TAVR or SAVR. Analyses were performed in
the as-treated population excluding patients with preexistent atrial
fibrillation or flutter. Result(s): Among 781 patients included in
the analysis, early POAF occurred in 152 (19.5%) (18 of 415 [4.3%] and 134
of 366 [36.6%] following TAVR and SAVR, respectively). Following
discharge, 58 new or recurrent late POAF events occurred within 1 year
following the index procedure in 55 of 781 patients (7.0%). Early POAF was
not an independent predictor of late POAF following discharge (odds ratio:
1.04; 95% CI: 0.52-2.08; P = 0.90). Following adjustment, early POAF was
not an independent predictor of the composite outcome of death, stroke, or
rehospitalization (hazard ratio: 1.10; 95% CI: 0.64-1.92; P = 0.72),
whereas late POAF was associated with an increased adjusted risk for the
composite outcome (hazard ratio: 8.90; 95% CI: 5.02-15.74; P < 0.0001),
irrespective of treatment modality. Conclusion(s): In the PARTNER 3
trial, early POAF was more frequent following SAVR compared with TAVR.
Late POAF, but not early POAF, was significantly associated with worse
outcomes at 2 years, irrespective of treatment modality. Copyright
© 2021 The Authors

<10>
Accession Number
2013147120
Title
Incidence, Predictors, and Outcomes of Patients Discharged Home Versus
Other Medical Facility After Transcatheter or Surgical Aortic Valve
Replacement.
Source
Structural Heart. 5 (4) (pp 392-400), 2021. Date of Publication: 2021.
Author
Shreenivas S.; Lilly S.; Kodali S.; Thourani V.H.; Mack M.J.; Cohen D.J.;
Arnold S.V.; Zhang Y.; Leon M.B.; Kereiakes D.J.
Institution
(Shreenivas, Kereiakes) The Christ Hospital, Cincinnati, OH, United States
(Lilly) Ohio State University Medical Center, Columbus, OH, United States
(Kodali, Leon) Columbia University Medical Center/NewYork-Presbyterian
Hospital, New York, NY, United States
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Cohen, Zhang, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Cohen) St. Francis Hospital, Roslyn, NY, United States
(Arnold) University of Missouri-Kansas City, Kansas City, MO, United
States
(Arnold) Saint Luke's MidAmerica Heart Institute, Kansas City, MO, United
States
Publisher
Taylor and Francis Ltd.
Abstract
Background: Discharge patterns for patients following treatment of aortic
stenosis with transcatheter (TAVR) or surgical aortic valve replacement
(SAVR) are poorly defined and could impact long-term clinical outcomes.
This study considers incidence, predictors, and outcomes of patients
discharged home versus to another medical facility after either treatment.
 Method(s): This is a retrospective analysis of the multicenter
randomized PARTNER 2 trial of transcatheter versus surgical aortic valve
replacement and associated registries. All patients who received either
therapy and survived until discharge were included in two separate
analyses: one for patients receiving TAVR and one for patients receiving
SAVR. The primary outcome was 2-year mortality after discharge home versus
other medical facility. Also, a model was developed to predict discharge
patterns following TAVR or SAVR. Result(s): Of 4,312 patients who
underwent TAVR, 22% (n = 958) were discharged to other medical facilities;
916 patients underwent SAVR and 52.4% (n = 480) were discharged to other
medical facilities. Two-year mortality for patients undergoing aortic
valve replacement and discharged to other medical facility versus home was
36.6% vs 18.0% after TAVR (p < 0.0001) and 19.7% vs 11.1% (p < 0.001)
after SAVR. Patients discharged to another medical facility had worse
quality of life and were more likely to be readmitted after either
procedure. Conclusion(s): After adjusting for risk factors that may
relate to discharge location and death, discharge to other medical
facility is associated with increased mortality and worse quality of life
at 2 years following TAVR or SAVR treatment of aortic
stenosis. Copyright © 2021 Cardiovascular Research Foundation.

<11>
Accession Number
2011418092
Title
The use of semi-compliant versus non-compliant balloon systems for
predilatation during the implantation of self-expandable transcatheter
aortic valves: Data from the VIenna CardioThOracic Aortic Valve RegistrY
(VICTORY).
Source
European Journal of Clinical Investigation. 51 (9) (no pagination), 2021.
Article Number: e13570. Date of Publication: September 2021.
Author
Mach M.; Szalkiewicz P.; Poschner T.; Hasan W.; Andreas M.; Winkler B.;
Hasimbegovic E.; Steinkellner T.; Strouhal A.; Adlbrecht C.; Delle-Karth
G.; Grabenwoger M.
Institution
(Mach, Szalkiewicz, Poschner, Andreas, Hasimbegovic) Department of Cardiac
Surgery, Medical University of Vienna - Vienna General Hospital, Vienna,
Austria
(Mach, Szalkiewicz, Winkler, Grabenwoger) Heart Team Vienna, Department of
Cardio-Vascular Surgery, Clinic Floridsdorf and the Karl Landsteiner
Institute for Cardio-Vascular Research, Vienna, Austria
(Hasan) Faculty of Medicine, Imperial College London, London, United
Kingdom
(Hasimbegovic) Division of Cardiology, Department of Internal Medicine II,
Medical University of Vienna - Vienna General Hospital, Vienna, Austria
(Steinkellner) Division of Anatomy, Center of Anatomy and Cell Biology,
Medical University of Vienna - Vienna General Hospital, Vienna, Austria
(Strouhal, Adlbrecht, Delle-Karth) Department of Cardiology, Clinic
Floridsdorf and the Karl Landsteiner Institute for Cardiovascular and
Critical Care Research, Vienna, Austria
(Adlbrecht) Imed19-privat, private clinical research center, Vienna,
Austria
(Grabenwoger) Medical faculty, Sigmund Freud University, Vienna, Austria
Publisher
John Wiley and Sons Inc
Abstract
Background: This study aimed to evaluate the differences in outcome
arising from the use of semi-compliant (SCB) versus non-compliant balloon
(NCB) systems for predilatation during self-expanding transcatheter aortic
valve replacement (TAVR). Method(s): 251 TAVR procedures with the
implantation of self-expanding valves after predilatation were analyzed.
SCB systems were used in 166 and NCB systems in 85 patients. The primary
endpoint was defined as device success, a composite endpoint comprising
the absence of procedural mortality, correct valve positioning, adequate
valve performance and the absence of more than a mild paravalvular leak.
The secondary endpoints were chosen in accordance with the valve academic
research consortium (VARC-2) endpoint definitions. Result(s): No
significant differences were observed with regard to procedural device
success between the SCB- and NCB cohort (SCB: 142 [85.5%%] vs. NCB: 77
[90.6%]; P =.257). There was a notable difference between the rates of
conversion to open surgery and the postdilatation rate, both of which were
higher for the NCB group (SCB: 1 [0.6%] vs. NCB: 4 [5.1%]; P =.042; SCB:
30 [18.1%] vs. NCB: 34 [40%]; P <.001). In a multivariate logistic
regression analysis, the use of semi-compliant balloon systems for
predilatation was associated with a lower risk for postdilatation (OR:
0.296; 95% CI: 0.149-0.588) and conversion to open surgery (OR: 0.205; 95%
CI: 0.085-0.493; P =.001) but not for device success. Conclusion(s):
While the balloon compliance did not affect the procedural mortality,
device success or the rate of paravalvular leakage, the use of
semi-compliant balloons for predilatation during TAVR should be
investigated in larger randomized trials in the light of the lower rates
of postdilatation and conversion to open surgery compared to their
non-compliant counterparts. Copyright © 2021 The Authors.
European Journal of Clinical Investigation published by John Wiley & Sons
Ltd on behalf of Stichting European Society for Clinical Investigation
Journal Foundation

<12>
Accession Number
2007588917
Title
Self-expanding transcatheter aortic valve infolding: Current evidence,
diagnosis, and management.
Source
Catheterization and Cardiovascular Interventions. 98 (2) (pp E299-E305),
2021. Date of Publication: 01 Aug 2021.
Author
Ancona M.B.; Beneduce A.; Romano V.; Buzzatti N.; Russo F.; Bellini B.;
Ferri L.A.; Agricola E.; Landoni G.; Scandroglio A.M.; Chieffo A.;
Montorfano M.
Institution
(Ancona, Beneduce, Romano, Russo, Bellini, Ferri, Chieffo, Montorfano)
Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Buzzatti) Cardiac Surgery Unit, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Agricola) Echocardiography Unit, IRCCS San Raffaele Scientific Institute,
Milan, Italy
(Landoni, Scandroglio) Anesthesia and Intensive Care Department, IRCCS San
Raffaele Scientific Institute, Milan, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: Prosthetic valve infolding is a rare but severe complication
of transcatheter aortic valve implantation (TAVI) with self-expanding
valves. However, currently available clinical data are limited and
fragmented. Objective(s): This report aims to provide a comprehensive
overview of this complication focusing on predisposing factors, clinical
presentation, diagnostic findings, treatment and clinical outcomes.
 Method(s): A systematic review of the literature was performed to
identify cases of infolding occurring during TAVI with self-expanding
valves published until August 2020. These data were pooled with all the
retrospectively identified infolding cases occurred at San Raffaele
Scientific Institute between December 2014 and August 2020.
 Result(s): A total of 34 cases were included. Among patients with
available data, 38% received a first-generation CoreValve, and 62% a
second-generation Evolut R (82%) or Evolut PRO (18%). Infolding occurred
mostly with >=29-mm valves (94%). Predisposing factors included
resheathing of a second-generation valve (82%), heavy calcification of the
native valve (65%), lack of predilatation (16%), Sievers type-1 bicuspid
aortic valve (11%), and improper valve loading (5%). Infolding resulted in
severe PVL causing hemodynamic instability (29%) or cardiac arrest (12%).
Postdilatation was the treatment strategy in 68%, while prosthesis
replacement with a new device in 23% of cases. Device success rate was
82%. Death and stroke occurred in 3% and 12% of cases. Conclusion(s):
Prosthetic valve infolding is typically observed after resheathing of a
large-size self-expanding TAVI. When infolding is timely diagnosed,
prosthesis removal and replacement should be pursued. Further studies are
required to precisely define predisposing factors to prevent this
complication. Copyright © 2020 Wiley Periodicals LLC.

<13>
Accession Number
2013387311
Title
Derivation and validation of a model to predict acute kidney injury
following cardiac surgery in patients with normal renal function.
Source
Renal Failure. 43 (1) (pp 1205-1213), 2021. Date of Publication: 2021.
Author
Hu P.; Mo Z.; Chen Y.; Wu Y.; Song L.; Zhang L.; Li Z.; Fu L.; Liang H.;
Tao Y.; Liu S.; Ye Z.; Liang X.
Institution
(Hu) Division of Nephrology, The Affiliated Yixing Hospital of Jiangsu
University, Yixing, China
(Hu, Chen, Wu, Song, Zhang, Li, Fu, Liang, Tao, Liu, Ye, Liang) Division
of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy
of Medical Sciences, Guangzhou, China
(Hu, Mo, Liang) The Second School of Clinical Medicine, Southern Medical
University, Guangzhou, China
Publisher
Taylor and Francis Ltd.
Abstract
Background: The study aimed to construct a clinical model based on
preoperative data for predicting acute kidney injury (AKI) following
cardiac surgery in patients with normal renal function. Method(s): A
total of 22,348 consecutive patients with normal renal function undergoing
cardiac surgery were enrolled. Among them, 15,701 were randomly selected
for the training group and the remaining for the validation group. To
develop a model visualized as a nomogram for predicting AKI, logistic
regression was performed with variables selected using least absolute
shrinkage and selection operator regression. The discrimination,
calibration, and clinical value of the model were evaluated.
 Result(s): The incidence of AKI was 25.2% in the training group. The
new model consisted of nine preoperative variables, including age, male
gender, left ventricular ejection fraction, hypertension, hemoglobin, uric
acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and
non-steroidal anti-inflammatory drug within 1 week before surgery. The
model had a good performance in the validation group. The discrimination
was good with an area under the receiver operating characteristic curve of
0.740 (95% confidence interval, 0.726-0.753). The calibration plot
indicated excellent agreement between the model prediction and actual
observations. Decision curve analysis also showed that the model was
clinically useful. Conclusion(s): The new model was constructed based
on nine easily available preoperative clinical data characteristics for
predicting AKI following cardiac surgery in patients with normal kidney
function, which may help treatment decision-making, and rational
utilization of medical resources. Copyright © 2021 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<14>
Accession Number
2013321579
Title
Analgesic effect of butorphanol during castration in donkeys under total
intravenous anaesthesia.
Source
Animals. 11 (8) (no pagination), 2021. Article Number: 2346. Date of
Publication: August 2021.
Author
Stratico P.; Carluccio A.; Varasano V.; Guerri G.; Suriano R.; Robbe D.;
Cerasoli I.; Petrizzi L.
Institution
(Stratico, Carluccio, Varasano, Guerri, Suriano, Robbe, Petrizzi) Faculty
of Veterinary Medicine, University of Teramo, Localita Piano D'Accio,
Teramo 64100, Italy
(Cerasoli) Clinica Veterinaria Borghesiana, Via di Vermicino 96, Roma
00133, Italy
Publisher
MDPI AG
Abstract
Pain management is necessary for all surgical procedures. Little
scientific evidence about drug efficacy in donkeys is available. The aim
of this study was to evaluate the analgesic effect of butorphanol in
donkeys undergoing orchiectomy under total intravenous anaesthesia with
guaifenesin-ketamine-detomidine. A randomized blinded prospective clinical
trial (Protocol n. 2021/0000338), was carried out on 18 clinically healthy
donkeys undergoing bilateral orchiectomy. Patients were assigned to Group
D (n = 8) or Group DB (n = 10) if receiving intravenous detomidine or
detomidine-butorphanol respectively, before induction of general
anaesthesia with ketaminediazepam. Intraoperative muscle relaxation,
nystagmus, palpebral reflex, heart and respiratory rate, and non-invasive
blood pressure were evaluated every 2 min; time to prepare the patient,
duration of surgery and anaesthesia and recovery score were recorded.
Group D had significantly longer surgical time, higher heart rate, higher
systolic and mean blood pressure (p < 0.05; repeated measure ANOVA),
increased muscle rigidity and expression of palpebral reflex (p < 0.05;
Mann-Whitney U test) than group DB. Top-ups with thiopental were
statistically higher in Group D. Butorphanol and detomidine together
produced a more stable anaesthetic plan. The low dosage of opioid and
alpha-2-agonists and reduced rescue anaesthesia are responsible for a
safer and more superficial anaesthesia, which is mandatory under field
conditions. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<15>
Accession Number
635678636
Title
Protamine sulfate during transcatheter aortic valve implantation (PS TAVI)
- a single-center, single-blind, randomized placebo-controlled trial.
Source
Kardiologia polska. (no pagination), 2021. Date of Publication: 22 Jul
2021.
Author
Zbronski K.; Grodecki K.; Gozdowska R.; Ostrowska E.; Wysinska J.; Rymuza
B.; Scislo P.; Wilimski R.; Kochman J.; Filipiak K.J.; Opolski G.; Huczek
Z.
Institution
(Zbronski, Grodecki, Gozdowska, Ostrowska, Wysinska, Rymuza, Scislo,
Kochman, Filipiak, Opolski, Huczek) 1st Department of Cardiology, Medical
University of Warsaw, Warszawa, Poland
(Wilimski) Department of Cardiac Surgery, Medical University of Warsaw,
Warszawa, Poland
Publisher
NLM (Medline)
Abstract
BACKGROUND: Bleeding complications after transcatheter aortic valve
implantation (TAVI) negatively affect the post-procedural prognosis.
Routine use of protamine sulfate (PS) to reverse unfractionated heparin
after TAVI was never assessed in a randomized controlled trial. AIMS: The
aim of this study was to assess the impact of PS on bleeding complications
after TAVI. METHOD(S): Between December 2016 and July 2020 311
patients qualified to TAVI in one academic center were screened. Patients
that met the inclusion criteria were randomized to either PS or normal
saline administration at the moment of optimal valve deployment. Baseline,
procedural and follow-up data up to 30 days were collected and analyzed.
The primary endpoint (PE) was a composite of life-threatening and major
bleeding according to Valve Academic Research Consortium within 48 hours
after the procedure. RESULT(S): Overall, 100 patients (48 males,
median age 82 years) met the inclusion criteria and were included in the
study. Forty-seven subjects (47%) were randomized to PS. The primary
endpoint occurred in the 29% of the study population. Despite a
numerically lower rates of PE in patients randomized to PS, a statistical
significance was not reached (21% in the PS group and 36% in the placebo
group; odds ratio [OR], 0.48; 95% confidence intervals [CI] 0.2-1.2; P =
0.11). There were no significant differences in secondary endpoints.
 CONCLUSION(S): Routine protamine sulfate administration did not
significantly decrease the rate of major and life-threatening bleeding
complications after TAVI. Larger studies are required to assess the impact
of routine PS use.

<16>
Accession Number
626112800
Title
Systematic review to assess the possibility of return of cerebral and
cardiac activity after normothermic regional perfusion for donors after
circulatory death.
Source
British Journal of Surgery. 106 (3) (pp 174-180), 2019. Date of
Publication: February 2019.
Author
Shapey I.M.; Summers A.; Augustine T.; van Dellen D.
Institution
(Shapey, Summers, Augustine, van Dellen) Faculty of Biology, Medicine and
Health, University of Manchester, Manchester, United Kingdom
(Shapey, Summers, Augustine, van Dellen) Department of Renal and
Pancreatic Transplantation, Manchester Royal Infirmary, Manchester
University NHS Foundation Trust, Manchester, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Normothermic regional perfusion (NRP) is a novel technique
that aids organ recovery from donors after circulatory death (DCDs).
However, ethical concerns exist regarding the potential return of
spontaneous cerebral and cardiac activity (ROSCCA). This study aimed to
determine the likelihood of ROSCCA in NRP-DCDs of abdominal organs.
 Method(s): Extracorporeal cardiopulmonary resuscitation (ECPR) for
refractory out-of-hospital cardiac arrest (OOHCA) was identified as a
comparator for NRP-DCDs and as a validation cohort. A systematic search
identified all articles relating to NRP-DCDs and ECPR-OOHCA. Rates of
ROSCCA and survival outcomes (ECPR-OOHCA only) were recorded and analysed
according to the duration of no perfusion. Result(s): In NRP-DCDs, 12
of 410 articles identified by database searching were eligible for
inclusion. There were no instances of ROSCCA recorded among 493 donors. In
ECPR-OOHCA, eight of 947 screened articles were eligible for inclusion
(254 patients). Where the absence of perfusion exceeded 5 min in
ECPR-OOHCA, there were no survivors with a favourable neurological
outcome. Conclusion(s): ROSCCA is unlikely following commencement of
NRP and has not occurred to date. Strict observance of the 5-min interval
following asystole provides satisfactory assurance that ROSCCA will not
occur following NRP. Copyright © 2019 The Authors. BJS published
by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

<17>
Accession Number
626066430
Title
Pharmacokinetics of tacrolimus granules in pediatric de novo liver,
kidney, and heart transplantation: The OPTION study.
Source
Pediatric Transplantation. 23 (1) (no pagination), 2019. Article Number:
e13328. Date of Publication: February 2019.
Author
Webb N.J.A.; Baumann U.; Camino M.; Frauca E.; Undre N.; Garcia-Guereta
L.; Tonshoff B.; Reding R.; Rubik J.; Di-Filippo S.; Deschenes G.
Institution
(Webb) Department of Paediatric Nephrology and NIHR/Wellcome Trust
Manchester Clinical Research Facility, University of Manchester,
Manchester Academic Health Science Centre, Royal Manchester Children's
Hospital, Manchester, United Kingdom
(Baumann) Division of Paediatric Gastroenterology and Hepatology,
Children's Hospital, Hannover Medical School, Hannover, Germany
(Camino) Hospital Universitario Gregorio Maranon, Madrid, Spain
(Frauca) Hospital Universitario La Paz, Madrid, Spain
(Undre) Astellas Pharma EMEA, Chertsey, Surrey, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Tacrolimus granules were developed for patients who are unable to swallow
capsules. Therapeutic drug monitoring (TDM) is required to optimize
efficacy and safety, which is based on C<inf>trough</inf> for tacrolimus
capsules. Pharmacokinetic (PK) data for tacrolimus granules are required
to establish the basis for TDM in those who are unable to swallow
capsules. In this phase IV study (NCT01371331) of children undergoing
liver, kidney, or heart transplantation, patients received tacrolimus
granules 0.15 mg/kg twice daily; first dose was administered within 24
hours of reperfusion. PK analysis samples were collected after
reperfusion, after first dose of tacrolimus (Day 1), and at steady state
(Day 7; >4 days stable dose). Of the 52 transplant recipients enrolled, 38
had two evaluable PK profiles. Mean AUC<inf>tau</inf> after first dose of
tacrolimus was 211, 97, and 224 hour*ng/mL in liver, kidney, and heart
transplant recipients, respectively; corresponding mean AUC<inf>tau</inf>
at steady state was 195, 208, and 165 hour*ng/mL. C<inf>trough</inf> and
AUC<inf>tau</inf> were positively correlated after first dose of
tacrolimus and at steady state (Pearson's coefficients: r = 0.81 and r =
0.87, respectively). This study demonstrated that C<inf>trough</inf> is a
reliable marker for TDM in pediatric transplant recipients treated with
tacrolimus granules, consistent with TDM for other tacrolimus
formulations. Copyright © 2019 John Wiley & Sons A/S. Published
by John Wiley & Sons Ltd

<18>
Accession Number
619323234
Title
The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in
paediatric cardiac surgery: a prospective, randomised trial.
Source
Anaesthesia. 73 (2) (pp 205-215), 2018. Date of Publication: February
2018.
Author
Oh H.-W.; Lee J.-H.; Kim H.-C.; Kim E.-H.; Song I.-K.; Kim H.-S.; Kim
J.-T.
Institution
(Oh) Department of Anaesthesiology and Pain Medicine, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
South Korea
(Lee, Kim, Kim, Kim) Department of Anaesthesiology and Pain Medicine,
Seoul National University Hospital, Seoul, South Korea
(Kim) Department of Anaesthesiology and Pain Medicine, Dongsan Medical
Centre, Keimyung University College of Medicine, Daegu, South Korea
(Song) Department of Anaesthesiology and Pain Medicine, Asan Medical
Centre, University of Ulsan College of Medicine, Seoul, South Korea
Abstract
We have evaluated the effect of a colloid solution on acute kidney injury
in paediatric cardiac surgery. A total of 195 patients were ramdomly
divided into an hydroxyethyl starch group and a control group. In the
starch group, 6% hydroxyethyl starch 130/0.4 (Volulyte) was
used as the primary fluid for volume resuscitation but was limited to 30
ml.kg-1. In the control group, only crystalloid fluid was used
during the peri-operative period. The incidence of acute kidney injury,
peri-operative transfusion, clinical outcomes and laboratory data were
compared. The incidence of acute kidney injury determined by Paediatric
Risk, Injury, Failure, Loss, End-stage renal disease (pRIFLE) and Acute
Kidney Injury Network (AKIN) criteria were no different between the two
groups (starch group 40.8% vs. control group 30.0%; p = 0.150 using
pRIFLE; 19.6% vs. 21.1% respectively, p = 0.602 using AKIN). There were no
differences in clinical outcomes such as mortality, major adverse events,
intensive care unit stay or duration of mechanical ventilation. Clotting
time as measured using rotational thromboelastometry (ROTEM) was
prolonged, and clot firmness after 10 min and maximal clot firmness were
shorter in the starch group compared with the control group after sternal
closure. There was no difference in transfusion between the two groups.
Patients with acute kidney injury had worse clinical courses than those
without acute kidney injury. We conclude that intra-operative use of 6%
hydroxyethyl starch 130/0.4 up to 30 ml.kg-1 was not associated
with postoperative acute kidney injury in paediatric cardiac
patients. Copyright © 2017 The Association of Anaesthetists of
Great Britain and Ireland

<19>
Accession Number
618763459
Title
Randomized comparison of balloon aortic valvuloplasty performed with or
without rapid cardiac pacing: The pacing versus no pacing (PNP) study.
Source
Journal of Interventional Cardiology. 31 (1) (pp 51-59), 2018. Date of
Publication: February 2018.
Author
Dall'Ara G.; Marzocchi A.; Taglieri N.; Moretti C.; Rodino G.; Chiarabelli
M.; Bottoni P.; Marrozzini C.; Sabattini M.R.; Bacchi-Reggiani M.-L.;
Rapezzi C.; Saia F.
Institution
(Dall'Ara, Marzocchi, Taglieri, Moretti, Rodino, Chiarabelli, Bottoni,
Marrozzini, Sabattini, Bacchi-Reggiani, Rapezzi, Saia) Cardiology Unit,
Cardio-Thoraco-Vascular Department, University Hospital of Bologna,
Policlinico S. Orsola-Malpighi, Bologna, Italy
(Dall'Ara) Dottorato di ricerca XXXdegreeciclo, Scienze
Cardio-Nefro-Toraciche, University of Bologna, Bologna, Italy
Publisher
Blackwell Publishing Inc.
Abstract
Objectives: To compare the effectiveness and safety of balloon aortic
valvuloplasty (BAV) performed with or without rapid ventricular pacing
(RP). Background(s): BAV technique is poorly standardized.
 Method(s): One hundred consecutive patients were randomly assigned
1:1 between BAV performed with or without RP. Exclusion criteria were an
immediate indication for surgical or transcatheter aortic valve
replacement, presentation in cardiogenic shock or pulmonary edema
refractory to medical stabilization. Result(s): There were 51
patients in the BAV group performed with RP, 49 in the BAV group without
RP (noRP). Procedural success (50% hemodynamic gradient reduction) was
achieved in 37.3% and 55.1%, respectively (P = 0.16). Fewer people in the
noRP group complained of poor tolerance to the procedure (16% vs 41%). The
primary efficacy endpoint, a 50% reduction in the mean echocardiographic
trans-aortic gradient, was met in 21/49 patients in the noRP group
compared to 20/51 in the RP (42.9% vs 39.2%; P = 0.84). No significant
difference between the groups was observed in the primary safety endpoint,
a 30-day composite of death, myocardial infarction, stroke, acute aortic
regurgitation, and BARC bleeding >=3 (8.2% noRP vs 13.7%; P = 0.53). The
noRP group required fewer bailout temporary pacemakers (P = 0.048) and had
a lower incidence of moderate/severe renal function worsening (4.1% vs
17.6%; P = 0.052). Conclusion(s): Rapid ventricular pacing did not
influence BAV efficacy or safety and tolerance was slightly
worse. Copyright © 2017, Wiley Periodicals, Inc.

<20>
Accession Number
2011978959
Title
Mechanical Circulatory Support as a Bridge to Definitive Treatment in
Post-Infarction Ventricular Septal Rupture.
Source
JACC: Cardiovascular Interventions. 14 (10) (pp 1053-1066), 2021. Date of
Publication: 24 May 2021.
Author
Ronco D.; Matteucci M.; Ravaux J.M.; Marra S.; Torchio F.; Corazzari C.;
Massimi G.; Beghi C.; Maessen J.; Lorusso R.
Institution
(Ronco, Matteucci, Ravaux, Torchio, Corazzari, Massimi, Maessen, Lorusso)
Department of Cardiothoracic Surgery, Heart and Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
(Ronco, Matteucci, Torchio, Corazzari, Massimi, Beghi) Department of
Medicine and Surgery, Circolo Hospital, University of Insubria, Varese,
Italy
(Marra) Humanitas Clinical and Research Center-IRCCS, Scientific
Documentation Center, Rozzano, Milan, Italy
(Marra) Humanitas University, Department of Biomedical Sciences, Pieve
Emanuele, Milan, Italy
(Lorusso) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Publisher
Elsevier Inc.
Abstract
Ventricular septal rupture (VSR) represents a rare complication of acute
myocardial infarction, often presenting with cardiogenic shock and
associated with high in-hospital mortality despite prompt intervention.
Although immediate surgery is recommended for patients who cannot be
effectively stabilized, the ideal timing of intervention remains
controversial. Mechanical circulatory support (MCS) may allow hemodynamic
stabilization and delay definitive treatment even in critical patients.
However, the interactions between MCS and VSR pathophysiology as well as
potentially related adverse effects remain unclear. A systematic review
was performed, from 2000 onward, to identify reports describing MCS types,
effects, complications, and outcomes in the pre-operative VSR-related
setting. One hundred eleven studies (2,440 patients) were included. Most
patients had well-known negative predictors (e.g., cardiogenic shock,
inferior infarction). Almost all patients had intra-aortic balloon pumps,
with additional MCS adopted in 129 patients (77.5% being venoarterial
extracorporeal membrane oxygenation). Mean MCS bridging time was 6 days
(range: 0 to 23 days). In-hospital mortality was 50.4%, with the lowest
mortality rate in the extracorporeal membrane oxygenation group (29.2%).
MCS may enhance hemodynamic stabilization and delayed VSR treatment.
However, the actual effects and interaction of the MCS-VSR association
should be carefully assessed to avoid further complications or incorrect
MCS-VSR coupling. Copyright © 2021 American College of Cardiology
Foundation

<21>
Accession Number
2013014534
Title
Bi-atrial or left atrial ablation of atrial fibrillation during
concomitant cardiac surgery: A Bayesian network meta-analysis of
randomized controlled trials.
Source
Journal of Cardiovascular Electrophysiology. 32 (8) (pp 2316-2328), 2021.
Date of Publication: August 2021.
Author
Guo Q.; Yan F.; Ouyang P.; Xie Z.; Wang H.; Yang W.; Pan X.
Institution
(Guo, Ouyang, Pan) Department of Cardiac Surgery, Yunnan Fuwai
Cardiovascular Hospital, Kunming Medical University, Kunming, China
(Guo, Wang) Department of Cardiovascular Surgery, First Affiliated
Hospital of Kunming Medical University, Kunming, China
(Guo, Yan, Xie, Wang, Yang) School of Pharmaceutical Science and Yunnan
Key Laboratory of Pharmacology for Natural Products, Kunming Medical
University, Kunming, China
(Yan) Department of Ophthalmology, First Affiliated Hospital of Kunming
Medical University, Kunming, China
(Xie) Department of Cardiology, Yunnan Fuwai Cardiovascular Hospital,
Kunming Medical University, Kunming, China
(Pan) Department of Structural Heart Disease, National Center for
Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical
Sciences & Peking Union Medical College, Kunming, China
Publisher
John Wiley and Sons Inc
Abstract
Objective: Surgical ablation of atrial fibrillation (AF) has become a
routine procedure during concomitant cardiac surgery, however, the
extension of lesion sets remain controversial. We sought to compare the
relative benefit and risk of different lesion sets through a Bayesian
network meta-analysis (NMA). Method(s): Pubmed, Embase, and Cochrane
Trials databases were searched for randomized controlled trials (RCTs)
comparing the rhythm outcome of AF patients undergoing pulmonary vein
isolation (PVI), left atrial Maze (LAM), bi-atrial Maze (BAM), or no
ablation during concomitant cardiac surgery. An NMA was conducted to
explore the difference of over 1 year AF freedom as well as risks for
early mortality and permanent pacemaker implantation (PPMI).
 Result(s): A total of 2031 patients of 19 RCTs were included. PVI,
LAM, and BAM (OR [95% Cr.I]: 5.02 [2.72, 10.02], 7.97 [4.93, 14.29], 8.29
[4.90, 14.86], p <.05) demonstrated higher freedom of AF compared with no
ablation, however, no significant difference of rhythm outcome was found
among the three ablation strategies based on the random-effects model. BAM
was associated with an increase in early mortality when compared with no
ablation (OR [95% Cr.I]: 4.08 [1.23, 17.30], p <.05), while none of the
remaining comparisons reached statistical difference in terms of early
mortality and PPMI. Conclusion(s): Bi-atrial ablation is not superior
to left atrial ablation strategies in reducing AF recurrence for
un-selected surgical patients. BAM has a higher risk of early mortality
than no ablation, but no difference was found between bi-atrial and left
atrial ablation in regard to early mortality and PPMI based on the current
evidence. Copyright © 2021 Wiley Periodicals LLC

<22>
Accession Number
2012310704
Title
Evaluation of respiratory and peripheral muscle training in individuals
undergoing myocardial revascularization.
Source
Journal of Cardiac Surgery. 36 (9) (pp 3166-3173), 2021. Date of
Publication: September 2021.
Author
de Aquino T.N.; de Faria Rosseto S.; Lucio Vaz J.; de Faria Cordeiro Alves
C.; Vidigal F.D.C.; Galdino G.
Institution
(de Aquino, de Faria Rosseto, Lucio Vaz, Galdino) Department of Motricity
Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
(de Aquino, de Faria Rosseto, Lucio Vaz, de Faria Cordeiro Alves)
Department of Rehabilitation and Cardiology of Hospital Santa Lucia, Pocos
de Caldas, Minas Gerais, Brazil
(Vidigal) Department of Nutrition, Federal University of Alfenas, Alfenas,
Minas Gerais, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To investigate the effect of peripheral muscle strength
training (PMT) and respiratory muscle strength training (RMT) muscle
strength training associated with conventional physical therapy on the
respiratory muscle strength, functional capacity, and quality of life in
the immediate postoperative period of patients undergoing coronary artery
bypass graft (CABG). Method(s): This was a randomized controlled
trial. Eighty-three patients undergoing CABG were divided into two groups:
Intervention group, patients that received PMT and RMT associated with
conventional physical therapy, one session a day for 5 days; control
group, patients that received conventional physical therapy, one session a
day for 5 days. All patients had respiratory muscle strength, peripheral
muscle strength, functional capacity, and quality of life evaluated by
manovacuometry, dynamometry, 6-min walking test, and 36-item Short-Form
Health Survey Questionnaire, respectively, before and 5 days after CABG.
 Result(s): Both groups showed a significantly reduced respiratory
muscle strength after CABG; however, in the intervention group, the
inspiratory muscle strength reduction was lower (confidence interval [CI]
95%: 2.29 [1.9; 27.54]). The quality of live domains for pain (CI 95%:
3.08 [5.21; 24.97]) and vitality perception (CI 95%: 2.51 [2.12; 19.53])
worsened in the control and improved in the intervention group (pain: CI
95%: 1.19 [-3.38; 13.09]; vitality CI 95%: 0.07 [-6.55; 7.04]). Both
groups showed reduced functional capacity and expiratory muscle strength
after CABG. Conclusion(s): Conventional physical therapy combined
with PMT and RMT may reduce inspiratory muscle strength loss and improve
pain and vitality perception in the immediate postoperative period after
CABG. Copyright © 2021 Wiley Periodicals LLC

<23>
Accession Number
2011022301
Title
Randomized, placebo-controlled trial of orally administered vitamin K1 for
warfarin-associated coagulopathy in Chinese patients with mechanical heart
valves.
Source
European Journal of Clinical Pharmacology. 77 (9) (pp 1333-1339), 2021.
Date of Publication: September 2021.
Author
Zhang H.; Li M.; Ao X.-L.; Dong Y.-J.; Dong L.
Institution
(Zhang, Li, Dong) Department of Cardiovascular Surgery, West China
Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041,
China
(Ao) Department of Ultrasound, West China Hospital of Sichuan University,
Chengdu, China
(Dong) Department of Thoracic Neoplasm, West China Hospital of Sichuan
University, Chengdu, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Warfarin-associated coagulopathy commonly occurs in patients
undergoing treatment with this anticoagulant. This trial aimed to
determine the efficacy of using low-dose orally administered vitamin
K<inf>1</inf> to lower international normalized ratio (INR) values into
the target range in a cohort of Chinese patients with mechanical heart
valves. Method(s): This was a double-blind, placebo-controlled,
randomized trial. Chinese patients with mechanical heart valves who were
undergoing warfarin treatment and who had INR values from 4.0 to 10.0
without bleeding were the subjects of this study. These patients were
randomized into two treatment groups and were orally administered either
vitamin K<inf>1</inf> (2.5 mg) or placebo. Warfarin was discontinued in
both groups until INR values were <= 2.5. INR values on the day following
treatment were the primary study outcome, with INR values on the following
days and adverse clinical events over a 3-month follow-up serving as
secondary study outcomes. Result(s): In total, 80 patients were
enrolled in the present study, and 40 patients each were assigned to the
placebo and vitamin K1 treatment groups. Patients administered vitamin
K<inf>1</inf> exhibited a quick reduction in INR values relative to
patients administered placebo (29 of 40 [72.5%] vs. 0 of 44 [0%] patients
exhibiting INR values from 1.5-2.5 on the day following treatment,
respectively, p = 0.000). Lower bleeding incidence was observed among
patients administered vitamin K<inf>1</inf> relative to those administered
placebo during follow-up (4 [10%] vs. 12 [30%] patients, respectively, p =
0.045). There were no instances of thromboembolic complications or
warfarin resistance in either group. Conclusion(s): Low-dose oral
vitamin K<inf>1</inf> can be effectively administered to Chinese patients
with mechanical heart valves taking warfarin to rapidly reduce elevated
INR values. Copyright © 2021, The Author(s), under exclusive
licence to Springer-Verlag GmbH Germany, part of Springer Nature.

<24>
Accession Number
634667273
Title
Efficacy and safety of low-dose colchicine in patients with coronary
disease: a systematic review and meta-analysis of randomized trials.
Source
European heart journal. 42 (28) (pp 2765-2775), 2021. Date of Publication:
21 Jul 2021.
Author
Fiolet A.T.L.; Opstal T.S.J.; Mosterd A.; Eikelboom J.W.; Jolly S.S.;
Keech A.C.; Kelly P.; Tong D.C.; Layland J.; Nidorf S.M.; Thompson P.L.;
Budgeon C.; Tijssen J.G.P.; Cornel J.H.
Institution
(Fiolet) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Fiolet, Mosterd, Cornel) Dutch Network for Cardiovascular Research (WCN),
Utrecht, Netherlands
(Opstal, Cornel) Department of Cardiology, Northwest Clinics, Alkmaar,
Netherlands
(Opstal, Cornel) Department of Cardiology, Radboud University Medical
Centre, Nijmegen, Netherlands
(Mosterd) Department of Cardiology, Meander Medical Centre, Amersfoort,
Netherlands
(Mosterd) Julius Centre for Health Sciences and Primary Care, Utrecht
University Medical Centre, Utrecht, Netherlands
(Eikelboom) Department of Medicine, McMaster University, ON, Hamilton,
Canada
(Jolly) Division of Cardiology, Department of Medicine, Population Health
Research Institute, McMaster University, ON, Hamilton, Canada
(Keech) Sydney Medical School, National Health and Medical Research
Council (NHMRC) Clinical Trials Centre, University of Sydney, Australia
(Kelly) Mater University and Health Research Board (HRB) Stroke Clinical
Trials Network Ireland, University College Dublin, Ireland
(Tong, Layland) Cardiology, Department of Medicine, Peninsula Health,
Peninsula Clinical School, Central Clinical School, Monash University,
VIC, Australia
(Tong, Layland) Department of Cardiology, St. Vincent's Hospital
Melbourne, VIC, Australia
(Layland) Peninsula Clinical School, Central Clinical School, Monash
University, VIC, Australia
(Nidorf, Thompson) Heart and Vascular Research Institute of Western
Australia, Perth, Australia
(Nidorf) GenesisCare Western Australia, Perth, Australia
(Thompson) Sir Charles Gairdner Hospital, Perth, Australia
(Thompson, Budgeon) School of Population and Global Health, University of
Western Australia, Perth, Australia
(Tijssen) Department of Cardiology, Amsterdam University Medical Centre,
Amsterdam, Netherlands
(Tijssen) Cardialysis BV, Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Recent randomized trials demonstrated a benefit of low-dose
colchicine added to guideline-based treatment in patients with recent
myocardial infarction or chronic coronary disease. We performed a
systematic review and meta-analysis to obtain best estimates of the
effects of colchicine on major adverse cardiovascular events (MACE).
METHODS AND RESULTS: We searched the literature for randomized clinical
trials of long-term colchicine in patients with atherosclerosis published
up to 1 September 2020. The primary efficacy endpoint was MACE, the
composite of myocardial infarction, stroke, or cardiovascular death. We
combined the results of five trials that included 11 816 patients. The
primary endpoint occurred in 578 patients. Colchicine reduced the risk for
the primary endpoint by 25% [relative risk (RR) 0.75, 95% confidence
interval (CI) 0.61-0.92; P=0.005], myocardial infarction by 22% (RR 0.78,
95% CI 0.64-0.94; P=0.010), stroke by 46% (RR 0.54, 95% CI 0.34-0.86;
P=0.009), and coronary revascularization by 23% (RR 0.77, 95% CI
0.66-0.90; P<0.001). We observed no difference in all-cause death (RR
1.08, 95% CI 0.71-1.62; P=0.73), with a lower incidence of cardiovascular
death (RR 0.82, 95% CI 0.55-1.23; P=0.34) counterbalanced by a higher
incidence of non-cardiovascular death (RR 1.38, 95% CI 0.99-1.92;
P=0.060). CONCLUSION(S): Our meta-analysis indicates that low-dose
colchicine reduced the risk of MACE as well as that of myocardial
infarction, stroke, and the need for coronary revascularization in a broad
spectrum of patients with coronary disease. There was no difference in
all-cause mortality and fewer cardiovascular deaths were counterbalanced
by more non-cardiovascular deaths. Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. © The
Author(s) 2021. For permissions, please email:
journals.permissions@oup.com.

<25>
Accession Number
634636694
Title
Management of aortic stenosis: a systematic review of clinical practice
guidelines and recommendations.
Source
European heart journal. Quality of care & clinical outcomes. 7 (4) (pp
340-353), 2021. Date of Publication: 21 Jul 2021.
Author
Khanji M.Y.; Ricci F.; Galusko V.; Sekar B.; Chahal C.A.A.; Ceriello L.;
Gallina S.; Kennon S.; Awad W.I.; Ionescu A.
Institution
(Khanji) Department of Cardiology, Newham University Hospital, Barts
Health NHS Trust, Glen Road, London E13 8SL, United Kingdom
(Khanji, Chahal, Kennon, Awad) Department of Cardiology, Barts Heart
Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
(Khanji) NIHR Barts Biomedical Research Centre, William Harvey Research
Institute, Queen Mary University of London, London EC1A 7BE, United
Kingdom
(Ricci, Ceriello, Gallina) Department of Neuroscience, Imaging and
Clinical Sciences, Institute of Advanced Biomedical Technologies,
"G.d'Annunzio" University, Chieti 66100, Italy
(Ricci) Department of Clinical Sciences, Lund University, Jan Waldenstroms
gata 35, 205 02 Malmo, Sweden
(Ricci) Department of Cardiology, Casa di Cura Villa Serena, 65013 Citta
Sant'Angelo, Pescara, Italy
(Galusko) Department of Cardiology, King's College Hospital, Denmark Hill,
London SE5 9RS, United Kingdom
(Sekar, Ionescu) Department of Cardiology, Morriston Cardiac Regional
Centre, Swansea Bay Health Board, Swansea SA6 6NL, United Kingdom
(Chahal) Department of Cardiology, University of Pennsylvania, 3400 Spruce
St, Philadelphia PA 19104, United States
(Chahal) Department of Cardiovascular Diseases, Mayo Clinic, Rochester,
United States
Publisher
NLM (Medline)
Abstract
Multiple guidelines exist for the management of aortic stenosis (AS). We
systematically reviewed current guidelines and recommendations, developed
by national or international medical organizations, on management of AS to
aid clinical decision-making. Publications in MEDLINE and EMBASE between 1
June 2010 and 15 January 2021 were identified. Additionally, the
International Guideline Library, National Guideline Clearinghouse,
National Library for Health Guidelines Finder, Canadian Medical
Association Clinical Practice Guidelines Infobase, and websites of
relevant organizations were searched. Two reviewers independently screened
titles and abstracts. Two reviewers assessed rigour of guideline
development and extracted the recommendations. Of the seven guidelines and
recommendations retrieved, five showed considerable rigour of development.
Those rigourously developed, agreed on the definition of severe AS and
diverse haemodynamic phenotypes, indications and contraindications for
intervention in symptomatic severe AS, surveillance intervals in
asymptomatic severe AS, and the importance of multidisciplinary teams
(MDTs) and shared decision-making. Discrepancies exist in age and surgical
risk cut-offs for recommending surgical aortic valve replacement (SAVR)
vs. transcatheter aortic valve implantation (TAVI), the use of biomarkers
and complementary multimodality imaging for decision-making in
asymptomatic patients and surveillance intervals for non-severe AS.
Contemporary guidelines for AS management agree on the importance of MDT
involvement and shared decision-making for individualized treatment and
unanimously indicate valve replacement in severe, symptomatic AS.
Discrepancies exist in thresholds for age and procedural risk used in
choosing between SAVR and TAVI, role of biomarkers and complementary
imaging modalities to define AS severity and risk of progression in
asymptomatic patients. Copyright Published on behalf of the European
Society of Cardiology. All rights reserved. © The Author(s) 2021. For
permissions, please email: journals.permissions@oup.com.

<26>
Accession Number
633289188
Title
Reiki protocol for preoperative anxiety, depression, and well-being: a
non-randomized controlled trial.
Source
Revista da Escola de Enfermagem da U S P. 54 (pp e03630), 2020. Date of
Publication: 2020.
Author
Santos C.B.R.D.; Gomes E.T.; Bezerra S.M.M.D.S.; Puschel V.A.A.
Institution
(Santos, Bezerra) Universidade de Pernambuco, PE, Recife, Brazil
(Gomes, Puschel) Universidade de Sao Paulo, Escola de Enfermagem, Sao
Paulo, Brazil
Publisher
NLM (Medline)

<27>
Accession Number
2013952781
Title
25983 Rates of individual and composite cardiovascular events through 5
years of tildrakizumab exposure in 2 phase 3 clinical trials.
Source
Journal of the American Academy of Dermatology. Conference: 2021 AAD VMX
Vertual Meeting. Virtual, Online. 85 (3 Supplement) (pp AB78), 2021. Date
of Publication: September 2021.
Author
Trickett C.; Gniadecki R.; West D.T.; Mendelsohn A.M.; Rozzo S.J.; Dhawan
S.
Institution
(Trickett) University of Texas Southwestern Medical Center, Dallas, TX,
United States
(Trickett) University of North Texas Health Science Center, Fort Worth,
TX, United States
(Gniadecki) Division of Dermatology, University of Alberta, Edmonton, AB,
Canada
(West) Spectrum Dermatology, Scottsdale, AZ, United States
(Mendelsohn, Rozzo) Sun Pharmaceuticals, Inc., Princeton, NJ, United
States
(Dhawan) Center for Dermatology Cosmetic & Laser Surgery, Milpitas, CA,
United States
(Dhawan) Department of Dermatology, Stanford University, Stanford, CA,
United States
(Dhawan) and Center for Dermatology Clinical Research, Inc., Fremont, CA,
United States
Publisher
Mosby Inc.
Abstract
Introduction: Over 3 years of treatment with tildrakizumab, an
anti-interleukin-23p19 monoclonal antibody approved for treatment of
plaque psoriasis, confirmed cardiovascular events were uncommon. Here, we
present rates of cardiovascular events for up to 5 years in patients
receiving tildrakizumab. Method(s): reSURFACE 1 and 2
(NCT01722331/NCT01729754) were 3-part, double-blind, randomized,
controlled trials with long-term extensions evaluating tildrakizumab
monotherapy every 12 weeks in adults with moderate to severe chronic
plaque psoriasis. This post hoc analysis reports exposure-adjusted
incidence rates (EAIR) of positively adjudicated cardiovascular events,
including individual and composite major adverse cardiovascular events
(MACE), as cumulative incidence per 100 patient years (PY) exposure to
tildrakizumab 100 and 200 mg. Result(s): In reSURFACE 1/2, 256/381
and 269/349 patients receiving tildrakizumab 100 and 200 mg entered the
extensions and received tildrakizumab for a mean 237.4/227.7 and
265.0/226.1 weeks, respectively. Total exposure was 1164.8/1671.3 and
1365.8/1567.5 PY for tildrakizumab 100 and 200 mg, respectively, in
reSURFACE 1/2. In reSURFACE 1/2, EAIR of cardiac events, cerebrovascular
events, and peripheral venous events were 0.2/0.2, 0.5/0.1, and 0.1/0.1
for tildrakizumab 100 mg and 0.3/0.6, 0.4/0.1, and 0.2/0.1 for
tildrakizumab 200 mg. In reSURFACE 1/2, EAIR of MACE (nonfatal myocardial
infarction and stroke, cardiovascular death) and extended MACE (including
unstable angina, coronary revascularization, and resuscitated cardiac
arrest) were both 0.5/0.3 for tildrakizumab 100 mg and 0.4/0.6 and 0.7/0.6
for tildrakizumab 200 mg. Conclusion(s): In reSURFACE 1/2, EAIR of
individual and composite cardiovascular events were low and similar
between tildrakizumab doses for up to 5 years. Copyright © 2021

<28>
Accession Number
2013910721
Title
The usefulness of professional foot and wound care on post-saphenectomy
surgical site complications in patients undergoing coronary artery bypass
grafting.
Source
European Journal of Cardiovascular Medicine. 6 (1) (pp 591-595), 2020.
Date of Publication: 2020.
Author
Acikel M.E.T.; Isci E.T.; Divarci N.
Institution
(Acikel) University of Health Sciences, Haseki Training and Research
Hospital, Cardiac Surgery Clinic, Istanbul, Turkey
(Isci) Biruni University Hospital, Department of Esthetic and Plastic
Surgery Clinic, Istanbul, Turkey
(Divarci) Biruni University Hospital, Department of Podiatry, Istanbul,
Turkey
Publisher
Healthcare Bulletin
Abstract
Background: Venous vessel removal during coronary artery bypass grafting
may cause undesired problems such as pain and skin infection in the
surgical site. Objective(s): To investigate the usefulness of
professional foot and wound care on the healing of saphenectomy surgical
site in patients undergoing coronary artery bypass grafting (CABG).
 Method(s): The present prospective study was conducted among 574
patients (>18 years) undergoing CABG with great saphenous vein harvesting,
between May 2017 and May 2018. The patients were randomly divided into two
groups based on the foot care into professional foot care group (PFCG) and
the standard foot care group (SFCG) with 287 patients each. Postoperative
surgical site complications were assessed on the first, second, third,
fourth day, 1 week and 1 month interval. Result(s): The Mean age of
patients in PFCG and SFCG groups was 59.71 +/-9.9 and 60.34 +/-11.22,
respectively. Rate of Postoperative complications decreased on the follow
up examinations in PFCG group as compared to SFCG group. A significant
difference in the incidence of complications was observed on the fourth
day (p=0.004) and after 1 month (p=0.029) of surgery between 2 groups. No
significant correlation was determined between the length of the removed
saphenous vein, number of arteries anastomosed and the post-saphenectomy
complication rate at the first, second, third, and fourth days, at the
first week, and first month in both groups except in PFCG where
significant association was noted on the third postoperative day.
 Conclusion(s): Postoperative limb care by professional foot
specialist decreases the postoperative complications in the surgical
site. Copyright © 2020 Healthcare Bulletin. All rights reserved.

<29>
Accession Number
2013930263
Title
Impact of Corticosteroids on Cardiopulmonary Bypass Induced Inflammation
in Children: A Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Bronicki R.A.; Flores S.; Loomba R.S.; Checchia P.A.; Pollak U.;
Villarreal E.G.; Nickerson P.; Graham E.M.
Institution
(Bronicki, Flores, Checchia, Villarreal, Nickerson) Department of
Pediatrics, Baylor College of Medicine, Section of Critical Care Medicine
and Cardiology, Texas Children's Hospital, Houston, TX, United States
(Loomba) Department of Pediatrics, Chicago Medical School, Section of
Cardiology, Advocate Children's Hospital, Oak Lawn, IL, United States
(Pollak) Department of Pediatrics, Hebrew University-Hadassah Medical
School, Hebrew University of Jerusalem, Hadassah Hebrew University Medical
Center, Jerusalem, Israel
(Villarreal) Tecnologico de Monterrey, Escuela de Medicina y Ciencias de
la Salud, Nuevo Leon, Monterrey, Mexico, Mexico
(Graham) Department of Pediatrics, Medical University of South Carolina,
Section of Cardiology, Medical University of South Carolina, Charleston,
SC, United States
Publisher
Elsevier Inc.
Abstract
Background: Corticosteroids suppress the inflammatory response to
cardiopulmonary bypass in children undergoing cardiac surgery. What is
less clear is the impact of corticosteroids on the postoperative course.
 Method(s): A systematic review and meta-analysis was made of
prospective randomized blinded placebo-controlled trials of pediatric
patients who received corticosteroids or saline placebo before surgery was
performed. Ten studies met inclusion criteria for a total of 768 patients.
In a prespecified subgroup analysis, studies that either were limited to
The Society of Thoracic Surgeons-European Association for Cardio-Thoracic
Surgery congenital heart surgery mortality categories 1 and 2 or excluded
neonates were eliminated and a secondary analysis was conducted, which
consisted of seven studies and 555 patients. Result(s):
Corticosteroids were associated with a significant improvement in fluid
balance at 24 and 36 hours after surgery, with a mean difference of -15.2
mL/kg (95% confidence interval, 25.3 to -5.1 mL/kg; P < .01) and -5.7
mL/kg (95% confidence interval, -9.8 to -1.6 mL/kg; P < .01),
respectively. Corticosteroids had no impact on the incidence of infection
or mortality. With the secondary analysis, corticosteroids were associated
with a trend toward significance in shortening the duration of mechanical
ventilation (mean difference -0.7 days; 95% confidence interval, -1.7 to
0.1; P = .08). Conclusion(s): Corticosteroids were found to have a
favorable impact on postoperative fluid balance and may be associated with
shortening the duration of mechanical ventilation. Although
corticosteroids had no impact on mortality, they may be beneficial
particularly for neonates and patients undergoing highly complex
surgery. Copyright © 2021

<30>
Accession Number
2007122403
Title
Effect of preoperative respiratory rehabilitation in patients undergoing
cardiac surgery.
Source
Acta Clinica Croatica. 59 (4) (pp 597-604), 2020. Date of Publication:
2020.
Author
Nejkov S.; Bokan-Mirkovic V.; Dukic-Macut N.; Vukovic M.
Institution
(Nejkov, Bokan-Mirkovic, Vukovic) Clinical Center of Montenegro,
Department of Physical Medicine and Rehabilitation, Podgorica, Serbia
(Bokan-Mirkovic, Vukovic) Faculty of Medicine, University of Montenegro,
Podgorica, Serbia
(Dukic-Macut) Faculty of Medicine, University of Prishtina, Kosovska,
Mitrovica, Serbia
Publisher
Dr. Mladen Stojanovic University Hospital
Abstract
The aim of the study was to evaluate the effects of preoperative
respiratory rehabilitation on functional capacity, length of stay in
intensive care unit (ICU), duration of mechanical ventilation (MV) and
total hospitalization, as well as to estimate arterial blood gas (ABG)
values in patients undergoing cardiac surgery. Nineteen patients were
included in the randomized observational study, divided into two groups:
group A (intervention) and B (control). Preoperative and postoperative
rehabilitation was performed in group A, and only postoperative
rehabilitation in group B. Rehabilitation was carried out according to a
predefined protocol. We used ABG to evaluate respiratory function,
two-minute walk test (2MWT) and sit-to-stand test to assess functional
capacity. The following data were obtained from medical documentation:
duration of MV, length of stay at ICU, occurrence of postoperative
pulmonary complications, and length of total hospitalization in both
groups. Significant between-group difference was found for the length of
total hospitalization and duration of MV (p<0.05 both). Analysis of the
mean values of 2MWT on the last day of hospitalization (p=0.005),
sit-to-stand test before surgery (p=0.022) and on the last day of
hospitalization (p=0.008) showed statistically significant differences.
The length of hospital stay significantly corre-lated with preoperative
rehabilitation in group A (r=0.885; p<0.0001). There was no difference in
ABG parameters between the groups. The study showed that preoperative
respiratory rehabilitation had an effect on reducing duration of MV and
length of total hospitalization, and improved functional
capacity. Copyright © 2020, Dr. Mladen Stojanovic University
Hospital. All rights reserved.

<31>
Accession Number
2012856107
Title
The Better Option of Revascularization in Complex Coronary Artery Disease
Patients Complicate With Chronic Kidney Disease: A Review and
Meta-Analysis.
Source
Current Problems in Cardiology. 46 (9) (no pagination), 2021. Article
Number: 100886. Date of Publication: September 2021.
Author
Chen X.; Zhang X.; Yan Y.; Wang G.
Institution
(Chen, Wang) Department of Emergency, Beijing Friendship Hospital, Capital
Medical University, Beijing, China
(Zhang, Yan) Department of Cardiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
Publisher
Mosby Inc.
Abstract
The treatment of complex coronary artery disease (CAD) combined with
chronic kidney disease (CKD) faces great challenges. We thus did a
systematic review and meta-analysis to assess the effect of percutaneous
coronary intervention (PCI) and coronary artery bypass graft (CABG). We
systematically searched PubMed, Embase, Cochrane Library and other
relevant articles refer to reference. Our main endpoints were main adverse
cardiovascular and cerebrovascular events (MACCE), all cause death,
myocardial infarction (MI), repeat revascularization and stoke. 24 studies
were included in our analysis. Compared with PCI, CABG improved outcomes
such as MACCE (Odds Ratio [OR] 1.75; 95%CI 1.26-2.42), all cause death (OR
1.13; 95%CI 1.00-1.28), repeat revascularization (OR 4.24; 95%CI
3.29-5.47) and MI (OR 2.16; 95%CI 1.59-2.91), but stoke (OR 0.84, 95%CI
0.61-1.17). CABG shows absolute advantage in complex CAD complicated with
CKD and ESRD patients than stent implantation in the long-term
following-up. Copyright © 2021 Elsevier Inc.

<32>
Accession Number
2006119034
Title
Coronary Artery Bypass Grafting Versus Percutaneous Coronary Intervention
in Patients with Left Ventricular Systolic Dysfunction.
Source
Cardiovascular Drugs and Therapy. 35 (3) (pp 575-585), 2021. Date of
Publication: June 2021.
Author
Khan M.R.; Kayani W.T.; Pelton J.; Ansari A.; Paniagua D.; Khalid U.;
Denktas A.; Changezi H.U.; Munir A.; Jimenez E.; Alam M.; Jneid H.
Institution
(Khan, Changezi, Munir) Division of Cardiology, McLaren-Flint/Michigan
State University, Flint, MI, United States
(Kayani, Pelton, Ansari, Paniagua, Khalid, Denktas, Alam, Jneid) Section
of Cardiology, Department of Internal Medicine, Baylor College of
Medicine, Houston, TX 77030, United States
(Khalid, Jimenez, Jneid) Division of Cardiology, Michael E. DeBakey
Veterans Affairs Medical Center, Houston, TX 77030, United States
(Jimenez) Division of Cardiothoracic Surgery, Michael E. DeBakey Veterans
Affairs Medical Center, Houston, TX, United States
Publisher
Springer
Abstract
Purpose: There is a paucity of comparative data examining the optimal
revascularization strategy in patients with left ventricular systolic
dysfunction (LVD). Method(s): We performed an aggregate data
meta-analysis of clinical outcomes comparing percutaneous coronary
intervention (PCI) versus coronary artery bypass (CABG) in patients with
LVD (left ventricle ejection fraction (LVEF) of <= 40%), using the random
effects model. Effects size is reported as odds ratio (OR) and a 95%
confidence interval. Outcomes included all-cause mortality, myocardial
infarction, stroke, repeat revascularization, and a composite of major
adverse cardiac and cerebrovascular events (MACCE) at 30-day, 3-year, and
long-term (6.3 +/- 0.9 years) follow-ups. Seventeen studies (16
observational, 1 randomized) and 18,599 patients (CABG 9651; PCI 8948)
were included. Result(s): PCI and CABG had comparable all-cause
mortality at 30 days (OR 0.78, 95% CI 0.49-1.23) and 3 years (OR 1.05, 95%
CI 0.91-1.21); however, PCI was associated with increased long-term
morality after a mean follow-up of 6.3 +/- 0.9 years (31.6% vs. 24.3%, OR
1.41, 95% CI 1.21-1.64). A similar mortality trend was observed in the
subgroup of patients with EF <= 35%. PCI had a higher rate of repeat
revascularization at 3-year and long-term follow-ups. The long-term rates
of stroke and MI were comparable. PCI, on the other hand, had lower rates
of stroke at 30-day and 3-year follow-ups. Conclusion(s): CABG was
associated with lower rates of long-term mortality and revascularization
but higher rate of upfront stroke in patients with LVD. However, the data
included consisted predominantly of observational studies, highlighting
the paucity and need for randomized trials. Copyright © 2020,
Springer Science+Business Media, LLC, part of Springer Nature.

<33>
Accession Number
2010759709
Title
Determinants of acute kidney injury after cardiac surgery: A systematic
review.
Source
Reviews in Cardiovascular Medicine. 21 (4) (pp 601-610), 2020. Date of
Publication: December 2020.
Author
Tinica G.; Brinza C.; Covic A.; Popa I.V.; Tarus A.; Bacusca A.E.; Burlacu
A.
Institution
(Tinica, Brinza, Tarus, Bacusca) Department of Cardiovascular Surgery,
Cardiovascular Diseases Institute, Iasi 700503, Romania
(Tinica, Brinza, Covic, Popa, Tarus, Bacusca, Burlacu) Grigore T. Popa,
University of Medicine, Iasi 700115, Romania
(Covic) Nephrology Clinic, Dialysis, Renal Transplant Center, 'C.I.
Parhon' Hospital, Iasi 700507, Romania
(Burlacu) Department of Interventional Cardiology, Cardiovascular Diseases
Institute, Iasi 700503, Romania
Publisher
IMR Press Limited
Abstract
Acute kidney injury following cardiac surgery (CS-AKI) represents a severe
postoperative complication, negatively impacting short-term and long-term
mortality. Due to the lack of a specific treatment, effective prevention
remains the most powerful tool to overcome the CS-AKI burden. Improving
the preventive strategies is possible by establishing appropriate
preoperative risk profiles. Various clinical models were proposed as a
means to assist physicians in stratifying the risk of CS-AKI. However,
these models are used for predicting severe forms of CS-AKI, while their
predictive power for mild forms is insufficient. Our paper represents the
first systematic approach to review all proposed preoperative risk factors
and their predictive power. Our strategy is the starting point for
selecting and comparing the predictive elements to be integrated into
future risk models. Heart failure, chronic hyperglycemia, anemia, obesity,
preoperative exposure to nephrotoxic drugs or contrast media,
inflammation, proteinuria, and pre-existing kidney disease were
systematically reviewed and were found to be associated with an increased
risk of postoperative CS-AKI. As no externally validated and universally
accepted risk models currently exist, the clinical judgment and a good
knowledge of the preoperative risk factors in the light of new evidence
may help personalize preoperative risk profiles as the cornerstone of
prevention measures. Copyright © 2020 Tinica et al. Published by
IMR Press.

<34>
Accession Number
2013356278
Title
Treating symptoms and reversing remodelling: clinical and
echocardiographic 1-year outcomes with percutaneous mitral annuloplasty
for mild to moderate secondary mitral regurgitation.
Source
European Journal of Heart Failure. (no pagination), 2021. Date of
Publication: 2021.
Author
Witte K.K.; Kaye D.M.; Lipiecki J.; Siminiak T.; Goldberg S.L.; von
Bardeleben R.S.; Sievert H.; Levy W.C.; Starling R.C.
Institution
(Witte) Department of Internal Medicine I, University Clinic, RWTH Aachen
University, Aachen, Germany
(Kaye) Department of Cardiology, Alfred Hospital, Melbourne, Australia
(Lipiecki) Clinique Pole Sante Republique, Clermont Ferrand, France
(Siminiak) HCP Medical Center, Poznan University of Medical Sciences,
Poznan, Poland
(Goldberg) Tyler Heart Institute at Community Hospital of the Monterey
Peninsula, Monterey, CA, United States
(Goldberg) Cardiac Dimensions, Kirkland, WA, United States
(von Bardeleben) Department of Cardiology, University Medical Centre
Mainz, Mainz, Germany
(Sievert) CardioVascular Center Sankt Katherinen, Frankfurt, Germany
(Sievert) Anglia Ruskin University, Chelmsford, United Kingdom
(Levy) Advanced Heart Failure, Division of Cardiology, University of
Washington Heart Institute, Seattle, WA, United States
(Starling) Section of Heart Failure and Cardiac Transplant Medicine,
Kaufman Center for Heart Failure Treatment and Recovery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Ltd
Abstract
Aims: To determine the effects of percutaneous mitral annuloplasty on
symptoms, walk distance and left ventricular (LV) structure and function
in patients with mild or moderate secondary mitral regurgitation (SMR).
 Methods and Results: This was a pooled analysis of patients (n = 68)
who, despite guideline-directed medical therapy had symptomatic heart
failure (HF) with mild (n = 25) or moderate (n = 43) SMR treated with
percutaneous mitral annuloplasty as part of the TITAN, TITAN II, or
REDUCE-FMR trials. Primary outcomes were changes in symptoms, 6-min walk
distance, and quality of life assessed by the Kansas City Cardiomyopathy
Questionnaire (KCCQ) after 1 year. Secondary analyses included changes in
LV structure and function. At 1 year, New York Heart Association class
status was maintained (48%) or improved (46%) in most patients, mean KCCQ
scores increased from baseline by 10 units [95% confidence interval (CI) 3
to17; P < 0.01] and mean 6-min walk test distance increased by 34 m (95%
CI 12 to 57; P < 0.01). SMR grade improved in 25% of patients and was
maintained in 58% of patients with changes in mean regurgitant volume of
-7 mL (95% CI -11 to -3; P < 0.001), vena contracta -0.11 cm (95% CI -0.20
to -0.02; P < 0.05), and effective regurgitant orifice area -0.03
cm2 (95% CI -0.06 to -0.01; P < 0.05). There were
non-significant improvements in LV ejection fraction and volumes. Survival
over 1 year was 89% with no difference between mild (96%) and moderate
(86%) SMR (log-rank P = 0.22). Progression-free survival was 70% (82% in
mild vs. 63% in moderate SMR; P = 0.16). Freedom from HF hospitalization
was 73% (87% in mild SMR vs. 66% in moderate SMR; P = 0.07).
 Conclusion(s): Among patients with symptomatic HF and mild or
moderate SMR on guideline-directed medical therapy, percutaneous mitral
annuloplasty was associated with improvements in symptoms, SMR, a
stabilization of LV structure and function, and high survival
rates. Copyright © 2021 The Authors. European Journal of Heart
Failure published by John Wiley & Sons Ltd on behalf of European Society
of Cardiology.

<35>
Accession Number
2013079809
Title
Safety and efficacy of left atrial appendage closure using an epicardial
suture snaring device: Systematic review and current status.
Source
Journal of Cardiovascular Electrophysiology. 32 (8) (pp 2189-2198), 2021.
Date of Publication: August 2021.
Author
Sabzwari S.R.A.; Mehta N.A.; Garg L.; Racharla L.; Kurtz E.; Afzal M.R.;
Turagam M.K.; Lakkireddy D.
Institution
(Sabzwari) Department of Electrophysiology, University of Colorado,
Aurora, CO, United States
(Mehta, Racharla) Department of Cardiology, Lehigh Valley Health Network,
Allentown, PA, United States
(Garg) Department of Electrophysiology, Hospital of the University of
Pennsylvania, PA, United States
(Kurtz) Department of Internal Medicine, Lehigh Valley Health Network,
Allentown, PA, United States
(Afzal) Department of Electrophysiology, Ohio State University, Columbus,
OH, United States
(Turagam) Department of Electrophysiology, The Mount Sinai Hospital, New
York City, NY, United States
(Lakkireddy) Department of Electrophysiology, Overland Park Regional
Medical Center, Overland Park, KS, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: The LARIAT epicardial suture snaring device has been fraught
with technical challenges and procedural complications. Over time,
technique modification and improved operator experience have helped
overcome many of these challenges. Methods and Results: Studies
reporting left atrial appendage epicardial closure over a 12-year period
from 2009 to 2020 were evaluated. The primary efficacy outcome evaluated
was left atrial appendage closure with residual flow <=1 mm. Safety
outcomes evaluated were periprocedural and long term complications after
device placement. Nine studies consisting of 1430 patients were included
in this analysis, of which 1386 (97%) underwent successful device
placement. The mean age was 69.3 years, with a mean CHADS<inf>2</inf>-VASC
score of 3.78. Primary efficacy end point was achieved in 95.8% patients
immediately after device placement, and in 92.8% patients on long term
follow-up. Early procedural complications consisted of pericardial
effusion 5.6%, cardiac perforation 2.7%, pericarditis 2.6%, and need for
open heart surgery 1.5%. Long term complications consisted of all-cause
mortality 2.3%, stroke 1.5%, and left atrial appendage thrombus 2.3%.
Reduced complications were noted using micropuncture needles (2.20% vs.
10.14%; p <.0001), a longer duration pericardial drainage, and use of
anti-inflammatory medications (1.58% vs. 8.4%). Oral anticoagulation use
decreased from 44.7% to 22.9% post device implantation, and to 8.5% on
last clinical follow up. Conclusion(s): The LARIAT device is
effective in epicardial closure of the left atrial appendage. Improvement
in device techniques such as use of micropuncture needle, prophylactic
colchicine, and maintenance of a pericardial drain have helped improve
safety over time. Copyright © 2021 Wiley Periodicals LLC

<36>
Accession Number
2013012935
Title
Efficacy and safety of sulforaphane for treatment of mild to moderate
depression in patients with history of cardiac interventions: A
randomized, double-blind, placebo-controlled clinical trial.
Source
Psychiatry and Clinical Neurosciences. 75 (8) (pp 250-255), 2021. Date of
Publication: August 2021.
Author
Ghazizadeh-Hashemi F.; Bagheri S.; Ashraf-Ganjouei A.; Moradi K.;
Shahmansouri N.; Mehrpooya M.; Noorbala A.-A.; Akhondzadeh S.
Institution
(Ghazizadeh-Hashemi, Shahmansouri, Noorbala) Psychosomatic Research
Center, Imam Hospital, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bagheri, Ashraf-Ganjouei, Moradi, Akhondzadeh) Psychiatric Research
Center, Roozbeh Psychiatric Hospital, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mehrpooya) Cardiovascular Ward, Imam Hospital, Tehran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc
Abstract
Aim: Depression has been recognized as one of the disorders associated
with cardiac interventions such as percutaneous coronary intervention
(PCI) or coronary artery bypass graft surgery (CABG). In the present
study, we evaluated the efficacy and safety of sulforaphane in treatment
of depression induced by cardiac interventions. Method(s): After
initial screening, 66 patients with previous history of at least one
cardiac intervention and current mild to moderate depression were randomly
assigned to two parallel groups receiving either sulforaphane (n = 33) or
placebo (n = 33) for six successive weeks. Efficacy was assessed using the
Hamilton Rating Scale for Depression (HAM-D) at baseline and week 2, 4,
and 6. Safety of the treatments was checked during the trial period.
 Result(s): Sixty participants completed the clinical trial (n = 30 in
each group). Baseline demographic and clinical parameters were all similar
among groups. Repeated measures analysis indicated that the sulforaphane
group exhibited greater improvement in HAM-D scores throughout the trial
(P < 0.001). Response to treatment (>=50% reduction in the HAM-D score)
rate was higher in the sulforaphane group at trial endpoint (30% vs 6.67%,
P = 0.042). Remission (HAM-D score <= 7) rate was also higher in the
sulforaphane group; however, the difference was not significant (23.33% vs
3.33%, P = 0.052). Finally, no significant difference was observed between
the two groups in terms of frequency of side effects. Conclusion(s):
Sulforaphane could safely improve depressive symptoms induced by cardiac
interventions. Further clinical trials with larger sample sizes and longer
follow-up periods are warranted to confirm our results. Copyright
© 2021 The Authors Psychiatry and Clinical Neurosciences © 2021
Japanese Society of Psychiatry and Neurology

<37>
Accession Number
2012853506
Title
Pedicled or skeletonized bilateral internal mammary artery harvesting - a
meta- analysis and trial sequential analysis.
Source
Expert Review of Cardiovascular Therapy. 19 (7) (pp 647-654), 2021. Date
of Publication: 2021.
Author
Iddawela S.; Mellor S.L.; Zahra S.A.; Khare Y.; Harky A.
Institution
(Iddawela) Department of General Surgery, University Hospitals Birmingham,
Birmingham, United Kingdom
(Mellor) College of Medical and Dental Sciences, University of Birmingham,
Birmingham, United Kingdom
(Zahra, Khare) Department of Medicine, St George's, University of London,
London, United Kingdom
(Harky) Department of Cardio-thoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Faculty of Life Sciences, University of Liverpool, Liverpool,
United Kingdom
Publisher
Taylor and Francis Ltd.
Abstract
Objective: There is varying evidence on the role of skeletonization of
internal mammary artery in reducing the risk of sternal wound infections
and ischemia following bilateral internal mammary artery grafting.
Post-operative clinical outcomes of skeletonized bilateral internal
mammary artery versus pedicled bilateral internal mammary artery
harvesting in patients undergoing coronary artery bypass surgery were
compared. Method(s): A comprehensive electronic search was conducted
using MEDLINE, Scopus, EMBASE, Cochrane database and Google Scholar from
inception until 15 June 2020. All studies directly comparing skeletonized
and pedicled bilateral internal mammary artery harvesting were included.
Meta-analysis and trial sequential analysis were conducted.
 Result(s): Nine studies (one randomized controlled trial and eight
observational studies) consisting of 3649 patients (2050 patients with
skeletonized bilateral internal mammary artery grafting and 1599 patients
with pedicled bilateral internal mammary artery grafting) were included.
Pooled effects analysis and trial sequential analysis reported
significantly lower risk of sternal wound infection with skeletonized
bilateral internal mammary artery harvesting (OR 0.27, 95% CI 0.20-0.51, p
< 0.00001). Conclusion(s): Skeletonization reduces the risk of
sternal wound infections by preserving vasculature as much as possible.
This facilitates its use in patients at high risk of sternal wound
infection. Copyright © 2021 Informa UK Limited, trading as Taylor
& Francis Group.

<38>
Accession Number
2012507977
Title
Heparin-induced thrombocytopenia: Construction of a pretest diagnostic
score derived from the analysis of a prospective multinational database,
with internal validation.
Source
Journal of Thrombosis and Haemostasis. 19 (8) (pp 1959-1972), 2021. Date
of Publication: August 2021.
Author
Tardy-Poncet B.; de Maistre E.; Pouplard C.; Presles E.; Alhenc-Gelas M.;
Lasne D.; Horellou M.-H.; Mouton C.; Serre-Sapin A.; Bauters A.; Nguyen
P.; Mullier F.; Perrin J.; Le Gal G.; Morange P.-E.; Grunebaum L.;
Lillo-Le Louet A.; Elalamy I.; Gruel Y.; Greinacher A.; Lecompte T.; Tardy
B.
Institution
(Tardy-Poncet, Presles, Tardy) CIC 1408, Inserm U1059 SAINBIOSE, F-Crin
INNOVTE, Universite de Lyon, Saint-Etienne, France
(de Maistre) Hemostasis Unit, CHU Dijon, Dijon, France
(Pouplard, Gruel) Division of Hematology - Hemostasis, University Hospital
of Tours, Tours, France
(Alhenc-Gelas) Hemostasis Unit, Hopital Europeen Georges Pompidou, AP-HP,
Paris, France
(Lasne) Hemostasis Unit, Hopital Necker, AP-HP, Paris, France
(Lasne) Universite Paris Sud Paris Saclay, Inserm U1176, Le
Kremlin-Bicetre, France
(Horellou) Hematology Laboratory Unit, Hopital Universitaire Paris-centre,
Paris, France
(Mouton) Hemostasis Unit, CHU Bordeaux, Bordeaux, France
(Serre-Sapin) Hemostasis Unit, CHU Clermont-Ferrand, Clermont-Ferrand,
France
(Bauters) Hemostasis Unit, CHU Lille, Lille, France
(Nguyen) Hemostasis Unit, CHU Reims, Reims, France
(Mullier) Namur Thrombosis and Hemostasis Center, Hematology Laboratory,
Universite catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
(Perrin) Hemostasis Unit, CHU Nancy, Nancy, France
(Le Gal) Department of Medicine, University of Ottawa, Ottawa Hospital
Research Institute, Thrombosis Research Group, Ottawa, ON, Canada
(Morange) C2VN, Aix Marseille University, INSERM, INRA; Laboratory of
Hematology, La Timone Hospital, Assistance Publique des Hopitaux de
Marseille, Marseille, France
(Grunebaum) Laboratory of Hematology, CHU Strasbourg, Strasbourg, France
(Lillo-Le Louet) Pharmacovigilance Center, Georges Pompidou European
Hospital, AP-HP, Paris, France
(Elalamy) Hematology and Thrombosis Center, Tenon University Hospital,
INSERM UMRS 938, Sorbonne University, Paris, France
(Greinacher) Institut fuer Immunologie und Transfusionsmedizin,
Universitaetsmedizin Greifswald, Greifswald, Germany
(Lecompte) Department of Medicine, Geneva University Hospitals, and Geneva
Platelet Group (GpG), Faculty of Medicine, University of Geneva, Geneva,
Switzerland
Publisher
John Wiley and Sons Inc
Abstract
Background: Diagnosis of heparin-induced thrombocytopenia (HIT) requires
pretest probability assessment and dedicated laboratory assays.
 Objective(s): To develop a pretest score for HIT. Design(s):
Observational; analysis of prospectively collected data of hospitalized
patients suspected with HIT (ClinicalTrials.gov NCT00748839).
 Setting(s): Thirty-one tertiary hospitals in France, Switzerland, and
Belgium. Patient(s): Patients tested for HIT antibodies (2280
evaluable), randomly allocated to derivation and validation cohorts.
Measurements: Independent adjudicators diagnosed HIT based on the
prospectively collected data and serotonin release assay results.
 Result(s): Heparin-induced thrombocytopenia was diagnosed in 234
(14.7%) and 99 (14.5%) patients in the two cohorts. Eight features were
associated with HIT (in brackets, points assigned for score calculation of
the score): unfractionated heparin (1); therapeutic-dose heparin (1);
cardiopulmonary bypass (cardiac surgery) (2); major trauma (3); 5- to
21-day interval from anticoagulation initiation to suspicion of HIT (4);
>=40% decrease in platelet count over <=6 days (3); thrombotic event,
arterial (3) or venous (3). The C-statistic was 0.79 (95% CI, 0.76-0.82).
In the validation cohort, the area under the receiver operating
characteristic curve was 0.77 (95% CI, 0.74-0.80). Three groups of scores
were defined; HIT prevalence reached almost 30% in the high-probability
group. Limitation(s): The performance of the score may depend on
settings and practices. Conclusion(s): The objective,
easy-to-collect, clinical features of HIT we evidenced were incorporated
into a pretest score, which may guide clinical decisions regarding
diagnostic testing and anticoagulation. Copyright © 2021
International Society on Thrombosis and Haemostasis

<39>
Accession Number
2011882500
Title
Ivabradine Versus Amiodarone in the Management of Postoperative Junctional
Ectopic Tachycardia: A Randomized, Open-Label, Noninferiority Study.
Source
JACC: Clinical Electrophysiology. 7 (8) (pp 1052-1060), 2021. Date of
Publication: August 2021.
Author
Arvind B.; Kothari S.S.; Juneja R.; Saxena A.; Ramakrishnan S.; Gupta
S.K.; Chowdhury U.K.; Devagourou V.; Talwar S.; Hote M.P.; Rajashekar P.;
Sahu M.K.; Singh S.P.
Institution
(Arvind, Kothari, Juneja, Saxena, Ramakrishnan, Gupta) Department of
Cardiology, All India Institute of Medical Sciences, New Delhi, India
(Chowdhury, Devagourou, Talwar, Hote, Rajashekar, Sahu, Singh) Department
of Cardiothoracic and Vascular Surgery, All India Institute of Medical
Sciences, New Delhi, India
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to compare the efficacy of ivabradine and
amiodarone in the management of postoperative junctional ectopic
tachycardia (JET) after cardiac surgery in children. Background(s):
JET is a serious arrhythmia occurring in children after cardiac surgery
and requires aggressive management. Amiodarone has been conventionally
used in its treatment. Recent studies have reported the utility of
ivabradine in this regard. Method(s): In this open-label randomized
controlled trial, 94 children (age <=18 years) who developed postoperative
JET were allocated to receive either amiodarone or ivabradine. The primary
endpoint was restoration of normal sinus rhythm. Result(s): Sinus
rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone
group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean
difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to
11.5%). The median (interquartile range) time taken to achieve sinus
rhythm conversion was similar in both the groups: 21.5 (17-30.2) hours
versus 22 (13.4-38.5) hours (p = 0.36)]. The time taken to rate control of
JET was significantly less in the amiodarone group: median 7.0 (5.5-9.5)
hours versus 8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse
events were observed in the ivabradine group. Conclusion(s): Oral
ivabradine is not inferior to intravenous amiodarone in converting
postoperative JET to sinus rhythm. There was no difference in time taken
to sinus rhythm conversion between the groups, although the rate control
was earlier in patients who received amiodarone. Monotherapy with
ivabradine may be considered as an alternative to amiodarone in the
management of postoperative JET. (Comparison of Two Drugs, Ivabradine and
Amiodarone, in the Management of Junctional Ectopic Tachycardia, an
Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo
Cardiac Surgery: CTRI/2018/08/015182) Copyright © 2021 American
College of Cardiology Foundation

<40>
Accession Number
2010298979
Title
Association between intra-operative cardiac arrest and country Human
Development Index status: a systematic review with meta-regression
analysis and meta-analysis of observational studies*.
Source
Anaesthesia. 76 (9) (pp 1259-1273), 2021. Date of Publication: September
2021.
Author
Braz L.G.; Einav S.; Heesen M.A.; Betini M.; Corrente J.E.; Pacchioni M.;
Cury J.B.; Braz M.G.; Braz J.R.C.
Institution
(Braz, Pacchioni, Cury, Braz, Braz) Anaesthesia Cardiac Arrest and
Mortality Study Commission, Department of Surgical Specialties and
Anaesthesiology, Botucatu Medical School, Sao Paulo State University -
UNESP, Botucatu, Brazil
(Einav) Shaare Zedek Medical Centre, Jerusalem, Israel
(Einav) Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem,
Israel
(Heesen) Department of Anaesthesia, Kantonsspital Baden, Baden,
Switzerland
(Betini) Technical Division of Library and Documentation, Institute of
Biosciences, Sao Paulo State University - UNESP, Botucatu, Brazil
(Corrente) Department of Biostatistics, Institute of Biosciences, Sao
Paulo State University - UNESP, Botucatu, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Intra-operative cardiac arrests differ from most in-hospital cardiac
arrests because they reflect not only the patient's condition but also the
quality of surgery and anaesthesia care provided. We assessed the
relationship between intra-operative cardiac arrest rates and country
Human Development Index (HDI), and the changes occurring in these rates
over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science,
CINAHL and SciELO from inception to 29 January 2020. For the global
population, rates of intra-operative cardiac arrest and baseline ASA
physical status were extracted. Intra-operative cardiac arrest rates were
analysed by time, country HDI status and ASA physical status using
meta-regression analysis. Proportional meta-analysis was performed to
compare intra-operative cardiac arrest rates and ASA physical status in
low- vs. high-HDI countries and in two time periods. Eighty-two studies
from 25 countries with more than 29 million anaesthetic procedures were
included. Intra-operative cardiac arrest rates were inversely correlated
with country HDI (p = 0.0001); they decreased over time only in high-HDI
countries (p = 0.040) and increased with increasing ASA physical status (p
< 0.0001). Baseline ASA physical status did not change in high-HDI
countries (p = 0.106), while it decreased over time in low-HDI countries
(p = 0.040). In high-HDI countries, intra-operative cardiac arrest rates
(per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59-13.16)
pre-1990 to 5.17 (95%CI 4.42-5.97) in 1990-2020 (p = 0.013). During the
same time periods, no improvement was observed in the intra-operative
cardiac arrest rates in low-HDI countries (p = 0.498). Odds ratios of
intra-operative cardiac arrest rates in ASA 3-5 patients were 8.48 (95%CI
1.67-42.99) times higher in low-HDI countries than in high-HDI countries
(p = 0.0098). Intra-operative cardiac arrest rates are related to
country-HDI and decreased over time only in high-HDI countries. The
widening gap in these rates between low- and high-HDI countries needs to
be addressed globally. Copyright © 2021 Association of
Anaesthetists

<41>
Accession Number
2010177224
Title
Update in carcinoid heart disease - the heart of the matter.
Source
Reviews in Endocrine and Metabolic Disorders. 22 (3) (pp 553-561), 2021.
Date of Publication: September 2021.
Author
Oleinikov K.; Korach A.; Planer D.; Gilon D.; Grozinsky-Glasberg S.
Institution
(Oleinikov, Grozinsky-Glasberg) Neuroendocrine Tumor Unit, Endocrinology
and Metabolism Department, Division of Medicine, Hadassah-Hebrew
University Medical Center, P.O.B. 12000, Jerusalem 91120, Israel
(Oleinikov, Korach, Planer, Gilon, Grozinsky-Glasberg) ENETS Center of
Excellence, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
(Korach) Department of Cardiothoracic Surgery, Hadassah-Hebrew University
Medical Center, Jerusalem, Israel
(Planer, Gilon) Department of Cardiology, Hadassah-Hebrew University
Medical Center, Jerusalem, Israel
Publisher
Springer
Abstract
Carcinoid heart disease (CHD) is a paraneoplastic cardiac manifestation
occurring in patients with carcinoid syndrome (CS) and advanced
neuroendocrine malignancy. In about 20-40% of patients with CS, chronic
exposure to tumor-released circulating vasoactive peptides typically
results in right-sided valvular fibrosis leading to valve dysfunction and
right heart failure. CHD remains a significant cause of morbidity and
mortality. The management of patients with CHD is complex, as both the
systemic malignant disease and the heart involvement have to be addressed.
Early diagnosis and timely surgical intervention in selected patients are
of utmost importance and offer a survival benefit. In patients with
advanced carcinoid heart disease, valve replacement surgery is the most
effective option to alleviate cardiac symptoms and contribute to survival
outcomes. A collaboration of a multidisciplinary team in centers with
experience is required to provide optimal patient management. Here, we
review the current literature regarding CHD presentation, pathophysiology,
diagnostic tools, and available treatment strategies. Copyright ©
2021, The Author(s), under exclusive licence to Springer Science+Business
Media, LLC part of Springer Nature.

<42>
Accession Number
635470436
Title
From Other Journals: A Review of Recent Articles by Our Editorial Team.
Source
Pediatric cardiology. 42 (6) (pp 1235-1240), 2021. Date of Publication: 01
Aug 2021.
Author
Alsaied T.; Ashfaq A.
Institution
(Alsaied) Heart Institute, Pittsburgh Children's Hospital Medical Center,
PA, 4401 Penn Avenue, Pittsburgh, United States
(Alsaied) Department of Pediatrics, University of Pittsburgh, PA,
Pittsburgh, United States
(Ashfaq) Heart Institute, Johns Hopkins All Children's All Children's
Hospital, FL, St. Petersburg, United States
Publisher
NLM (Medline)
Abstract
In this review, we provide a brief description of recently published
articles addressing topics relevant to pediatric cardiologists. Our hope
is to provide a summary of the latest articles published recently in other
journals in our field. The articles reviewed in this manuscript address
(1) long-term fate of the truncal valve, (2) comparison of combined
heart-liver vs heart-only transplantation in pediatric and young adult
Fontan recipients showing non-inferior survival of heart-liver transplant
in a small sample, (3) impact of palliation strategy on interstage feeding
and somatic growth for infants with ductal-dependent pulmonary blood flow
showing no difference in growth between ductal stenting and
Blalock-Taussig shunt, (4) biventricular repair in interrupted aortic arch
and ventricular septal defect with a small left ventricular outflow tract,
(5) a randomized controlled trial comparing controlled reoxygenation and
standard cardiopulmonary bypass in pediatric cardiac surgery, and (6)
tricuspid valve and right ventricular function throughout the hybrid
palliation strategy for hypoplastic left heart syndrome and
variants. Copyright © 2021. The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<43>
Accession Number
633533102
Title
Positive expiratory pressure in postoperative cardiac patients in
intensive care: A randomized controlled trial.
Source
Clinical rehabilitation. 35 (5) (pp 681-691), 2021. Date of Publication:
01 May 2021.
Author
Pieczkoski S.M.; de Oliveira A.L.; Haeffner M.P.; Azambuja A.C.M.; Sbruzzi
G.
Institution
(Pieczkoski, Azambuja, Sbruzzi) Postgraduate Program in Human Movement
Sciences, Universidade Federal do Rio Grande do Sul, RS, Porto Alegre,
Brazil
(de Oliveira, Sbruzzi) Physiotherapy Course, Universidade Federal do Rio
Grande do Sul, RS, Porto Alegre, Brazil
(Haeffner, Sbruzzi) Hospital de Clinicas de Porto Alegre, RS, Porto
Alegre, Brazil
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate effectiveness of positive expiratory pressure
blow-bottle device compared to expiratory positive airway pressure and
conventional physiotherapy on pulmonary function in postoperative cardiac
surgery patients in intensive care unit. DESIGN: A randomized controlled
trial. SETTINGS: Tertiary care. SUBJECTS: 48 patients (16 in each group;
aged 64.5+/-9.1years, 38 male) submitted to cardiac surgery.
INTERVENTIONS: Patients were randomized into conventional physiotherapy
(G1), positive expiratory pressure blow-bottle device (G2) or expiratory
positive airway pressure, both associated with conventional physiotherapy
(G3). G2 and G3performed three sets of 10 repetitions in each session for
each technique. MAIN MEASURES: Pulmonary function (primary); respiratory
muscle strength, radiological changes, pulmonary complications, length of
intensive care unit and hospital stay (secondary) assessed preoperatively
and on the 3rd postoperative day. RESULT(S): Pulmonary function
(except for forced expiratory volume in one second/ forced vital capacity
% predicted) and respiratory muscle strength showed significant reduction
from the preoperative to the 3rd postoperative in all groups (P<0.001),
with no difference between groups (P>0.05). Regarding radiological
changes, length of intensive care unit stay and length of hospital stay,
there was no significant difference between groups (P>0.05).
 CONCLUSION(S): Both positive expiratory pressure techniques
associated with conventional physiotherapy were similar, but there was no
difference regarding the use of positive expiratory pressure compared to
conventional physiotherapy. CLINICAL TRIAL REGISTRATION NUMBER:
NCT03639974.https://clinicaltrials.gov/ct2/show/NCT03639974.

<44>
Accession Number
634748825
Title
Cognitive Outcomes after DEXmedetomidine sedation in cardiac surgery:
CODEX randomised controlled trial protocol.
Source
BMJ Open. 11 (4) (no pagination), 2021. Article Number: e046851. Date of
Publication: 13 Apr 2021.
Author
Choi S.; Jerath A.; Jones P.; Avramescu S.; Djaiani G.; Syed S.; Saha T.;
Kaustov L.; Kiss A.; D'Aragon F.; Hedlin P.; Rajamohan R.; Couture E.J.;
Singh A.; Mapplebeck J.C.S.; Wong S.; Orser B.A.
Institution
(Choi, Jerath, Kaustov, Singh, Mapplebeck, Wong, Orser) Department of
Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Choi, Jerath, Avramescu, Djaiani, Wong, Orser) Department of
Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University
of Toronto, Toronto, ON, Canada
(Jones) Department of Anesthsia and Perioperative Medicine, University of
Western Ontario, London, ON, Canada
(Avramescu) Department of Anesthesia, Humber River Hospital, Toronto, ON,
Canada
(Djaiani) Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Syed) Department of Anesthesia, McMaster University, Hamilton, ON, Canada
(Saha) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Kiss) Sunnybrook Research Institute, Toronto, ON, Canada
(D'Aragon) Department d'anesthesiologie, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Hedlin) Department of Anesthesiology, Perioperative Medicine and Pain
Management, University of Saskatchewan, Saskatoon, SK, Canada
(Rajamohan) Department of Anesthesiology, Pharmacology and Therapeutics,
The University of British Columbia, Vancouver, BC, Canada
(Couture) Department of Anesthesiology and Cardiac Surgical Intensive Care
Division, Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Orser) Department of Physiology, University of Toronto, Toronto, ON,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Older patients undergoing cardiac surgery carry the highest
risk for developing major postoperative neurocognitive disorder
(postoperative NCD or P-NCD) with up to 25% incidence 3 months after
surgery. P-NCD is associated with significant morbidity, mortality, loss
of independence, premature retirement and increased healthcare costs. This
multicentre randomised trial is investigating the efficacy of
postoperative dexmedetomidine sedation in reducing the incidence of major
P-NCD after cardiac surgery compared with standard protocols. CODEX will
be the largest interventional trial with major P-NCD as the primary
outcome. Methods and analysis CODEX is recruiting patients >=60 years old,
undergoing elective cardiac surgery and without pre-existing major
cognitive dysfunction or dementia. Eligible participants are randomised to
receive postoperative dexmedetomidine or standard institutional sedation
protocols in the intensive care unit. Baseline preoperative cognitive
function is assessed with the computer-based Cogstate Brief Battery. The
primary outcome, major P-NCD, 3 months after surgery is defined as a
decrease in cognitive function >=1.96 SD below age-matched, non-operative
controls. Secondary outcomes include delirium, major P-NCD at 6/12 months,
depressive symptoms, mild P-NCD and quality of surgical recovery at 3/6/12
months. The specific diagnostic criteria used in this protocol are
consistent with the recommendations for clinical assessment and management
of NCD from the Nomenclature Consensus Working Group on perioperative
cognitive changes. Intention-to-treat analysis will compare major P-NCD at
3 months between study groups. Ethics and dissemination CODEX was approved
by Sunnybrook Health Sciences Centre Research Ethics Board (REB) (Project
ID 1743). This will be the first multicentre, randomised controlled trial
to assess the efficacy of a pharmacological intervention to reduce the
incidence of major P-NCD after cardiac surgery in patients >=60 years old.
Dissemination of the study results will include briefings of key findings
and interpretation, conference presentations and peer-reviewed
publications. Copyright © 2021 Author(s).

<45>
Accession Number
634739748
Title
Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or
Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older
Patients: Study Protocol for a Multicenter Randomized Controlled Trial.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 654700.
Date of Publication: 30 Mar 2021.
Author
Yang Y.-F.; Zhu Y.-J.; Long Y.-Q.; Liu H.-Y.; Shan X.-S.; Feng X.-M.; Peng
K.; Ji F.-H.
Institution
(Yang, Zhu, Long, Liu, Shan, Peng, Ji) Department of Anesthesiology, First
Affiliated Hospital of Soochow University, Suzhou, China
(Feng) Department of Anesthesiology, University of Utah Health, Salt Lake
City, UT, United States
Publisher
Frontiers Media S.A.
Abstract
Background: Older hypertensive adults are at increased risk for
postoperative morbidity and mortality. As first line antihypertensive drug
therapy, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin
receptor blockers (ARBs) have many beneficial effects. However, the use of
ACEIs/ARBs in the perioperative period remains controversial. This study
aims to determine the effects of withholding vs. continuing ACEIs/ARBs
before non-cardiac surgery on perioperative hypotension and postoperative
outcomes in older patients. Method(s): In this multicenter,
randomized, double-blind, placebo-controlled trial, a total of 2036
patients aged 60-80 years undergoing non-cardiac surgical procedures will
be randomly assigned, in a 1:1 ratio, to receive oral ACEIs/ARBs (the
ACEIs/ARBs continued group) or inactive placebos (the ACEIs/ARBs withheld
group) on the morning of surgery. For both groups, the ACEIs/ARBs will be
continued from the first postoperative day. The primary outcome measure is
the incidence of perioperative hypotensive events, defined as mean blood
pressure (MBP) < 65 mmHg or >=30% reduction in MBP from baseline during
surgery and in a post-anesthesia care unit. The secondary outcomes include
duration of perioperative hypotension, intraoperative use of fluids and
vasopressors, hypotensive events within postoperative 3 days, and
perioperative neurocognitive disorders, major adverse cardiocerebral
events (a composite outcome of stroke, coma, myocardial infarction, heart
block, and cardiac arrest), and mortality within 30 days after surgery.
 Discussion(s): The results of this trial will offer an evidence-based
perioperative ACEIs/ARBs therapy for older hypertensive adults undergoing
non-cardiac surgery. Study Registration: This study is approved by the
Medical Ethics Committee of The First Affiliated Hospital of Soochow
University (Approval No. 2020-077-1) and by the institutional ethics
review board of each participating center. This protocol is registered at
the Chinese Clinical Trials Registry (ChiCTR2000039376). ©
Copyright © 2021 Yang, Zhu, Long, Liu, Shan, Feng, Peng and Ji.

<46>
Accession Number
634735973
Title
The effect of lavender aromatherapy on sleep quality and physiological
indicators in patients after cabg surgery: A clinical trial study.
Source
Indian Journal of Critical Care Medicine. 25 (4) (pp 429-434), 2021. Date
of Publication: April 2021.
Author
Davari H.; Ebrahimian A.; Rezayei S.; Tourdeh M.
Institution
(Davari) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Ebrahimian) Department of Medical Emergencies, School of Medicine, Qom
University of Medical Sciences, Qom, Iran, Islamic Republic of
(Ebrahimian) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Rezayei) Student Research Committee, Nursing School, Semnan University of
Medical Sciences, Semnan, Iran, Islamic Republic of
(Tourdeh) Department of Anaesthesia, Paramedic School, Qom University of
Medical Sciences, Qom, Iran, Islamic Republic of
Publisher
Jaypee Brothers Medical Publishers (P) Ltd
Abstract
Background: Sleep disorders occur in the first days after heart surgery.
One of the major causes of sleep disorders after coronary artery bypass
graft (CABG) is subsequent changes in physiological indicators, such as
systolic blood pressure (BP), respiratory rate (RR), saturation of oxygen
(O2), and heart rate (RR). This study is aimed to determine the effect of
lavender aromatherapy on patients' sleep quality and physiological
indicators after CABG. Patients and Methods: This study was a
randomized clinical trial. Patients after CABG surgery were randomly
allocated into the lavender and distilled water groups. Patients in the
intervention group inhaled lavender while those in the control group
inhaled distilled water for 10 hours. Sleep quality and physiological
postoperative data were collected for 3 days. Data were analyzed using
repeated measurement test, sample t-test, and chi-square test.
 Result(s): Repeated measurement test showed no significant difference
between the lavender and distilled water groups in terms of systolic BP,
RR, O2 saturation, HR, and body temperature after matching the effect of
time and its interactive effect with the intervention (p > 0.05). This
test revealed a significant difference between the lavender and distilled
water groups in terms of sleep quality (p < 0.001), such that the sleep
quality was higher in the lavender group. Conclusion(s): Lavender
aromatherapy can increase patients' sleep quality after CABG surgery.
However, it cannot completely treat sleep disorders in such patients.
Furthermore, aromatherapy with lavender does not affect the physiological
parameters, such as HR, BP, RR, and O2 saturation. Copyright ©
Jaypee Brothers Medical Publishers.

<47>
Accession Number
2013333897
Title
Invited commentary: A prospective randomized trial on parents' disease
knowledge and quality of life. Shall WeChat about telehealth?.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Stevens R.M.; Chilingerian J.; Mulinari L.; Sun J.; Throckmorton A.;
Latifi R.
Institution
(Stevens, Sun) Division of Pediatric Cardiac Surgery, Pediatric Cardiac
Surgery, St. Christopher's Hospital for Children, Drexel University
College of Medicine, Philadelphia, PA, United States
(Chilingerian) The Heller School for Social Policy and Management,
Brandeis University, Waltham, MA, United States
(Chilingerian) Adjunct of Public Health and Community Medicine, Tufts
School of Medicine, Tufts University, Boston, MA, United States
(Mulinari) DeWitt Daughtry Family Department of Surgery, University of
Miami Leonard Miller School of Medicine, Holtz Children's Hospital,
Jackson Memorial Hospital, Miami, FL, United States
(Throckmorton) School of Biomedical Engineering, Drexel University,
Philadelphia, PA, United States
(Latifi) Department of Surgery, New York Medical College, School of
Medicine, West Chester Medical Center, Valhalla, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
WeChat and access to wireless communication may offer a continuum of care
following medical and surgical intervention. This cardiac surgery research
study evaluates the process of parental education and social support
following pediatric cardiac surgery utilizing standard of care compared to
telehealth. Copyright © 2021 Wiley Periodicals LLC

<48>
Accession Number
635654838
Title
Plasma and Lung Tissue Pharmacokinetics of Ceftaroline Fosamil in Patients
Undergoing Cardiac Surgery with Cardiopulmonary Bypass: An in-vivo
Microdialysis Study.
Source
Antimicrobial agents and chemotherapy. (pp AAC0067921), 2021. Date of
Publication: 19 Jul 2021.
Author
Edlinger-Stanger M.; Al Jalali V.; Andreas M.; Jager W.; Bohmdorfer M.;
Zeitlinger M.; Hutschala D.
Institution
(Edlinger-Stanger, Hutschala) Medical University of Vienna, Department of
Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac
Thoracic Vascular Anesthesia and Intensive Care Medicine, Wahringer Gurtel
18-20, Vienna 1090, Austria
(Al Jalali, Zeitlinger) Medical University of Vienna, Department of
Clinical Pharmacology, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Andreas) Medical University of Vienna, Department of Surgery, Division of
Cardiac Surgery, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Jager, Bohmdorfer) University of Vienna, Department of Pharmaceutical
Chemistry, Althanstrase 14 (UZA II), Vienna 1090, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: Ceftaroline fosamil, a 5th generation cephalosporin antibiotic
with activity against MRSA, is currently approved for the treatment of
pneumonia and complicated skin and soft tissue infections. However,
pharmacokinetic data on free lung tissue concentrations in critical
patient populations are lacking. OBJECTIVE(S): The aim of this study
was to evaluate the pharmacokinetics of the high-dose regimen of
ceftaroline in plasma and lung tissue in cardiac surgery patients during
intermittent and continuous administration. MATERIALS AND METHODS: 9
patients undergoing elective cardiac surgery on cardiopulmonary bypass
were included in this study and randomly assigned to intermittent or
continuous administration. 1800mg ceftaroline fosamil were administered
intravenously as either 600mg over 2h q8h (intermittent group) or 600mg
over 2h (loading dose) and 1200mg over 22h (continuous group).
Interstitial lung tissue concentrations were measured by in-vivo
microdialysis. Relevant pharmacokinetic parameters were calculated for
each group. RESULT(S): Plasma exposure during intermittent and
continuous administration were comparable to previously published studies
and did not differ significantly between both groups. In-vivo
microdialysis demonstrated reliable and adequate penetration of
ceftaroline into lung tissue during intermittent and continuous
administration. The AUCSS 0-8 and AUCtissue/plasma ratio were
descriptively higher in the continuous group. Continuous administration of
ceftaroline fosamil achieved significantly higher fT4x>MIC than
intermittent administration for pathogens with a minimal inhibitory
concentration of 1mg/L. CONCLUSION(S): Ceftaroline showed adequate
penetration into interstitial lung tissue of critically ill patients
undergoing major cardiothoracic surgery, supporting its use for pneumonia
caused by susceptible pathogens.

<49>
[Use Link to view the full text]
Accession Number
634773715
Title
Reduction in Revascularization with Icosapent Ethyl: Insights from
REDUCE-IT Revascularization Analyses.
Source
Circulation. (pp 33-44), 2021. Article Number: 050276. Date of
Publication: 2021.
Author
Peterson B.E.; Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson
T.A.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz C.;
Gibson C.M.; Pinto D.; Giugliano R.P.; Budoff M.J.; Tardif J.-C.; Verma
S.; Ballantyne C.M.
Institution
(Peterson, Bhatt, Giugliano) Interventional Cardiovascular Programs,
Brigham and Women's Hospital, Heart and Vascular Center, Department of
Medicine, Harvard Medical School, 75 Francis St, Boston, MA 02115, United
States
(Steg) Universite de Paris, AP-HP (Assistance Publique-Hopitaux de Paris),
Hopital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM
U-1148, France
(Miller) Department of Medicine, University of Maryland, School of
Medicine, Baltimore, United States
(Brinton) Utah Lipid Center, Salt Lake City, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University, School of Medicine, Atlanta, GA, United
States
(Ketchum, Juliano, Jiao, Doyle, Granowitz) Amarin Pharma, Inc (Amarin),
Bridgewater, NJ, United States
(Gibson, Pinto) Baim Clinical Research Institute, Boston, MA, United
States
(Budoff) David Geffen School of Medicine, Lundquist Institute, Torrance,
CA, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Verma) Division of Cardiac Surgery, St Michael's Hospital, University of
Toronto, ON, Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine, Center
for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with elevated triglycerides despite statin therapy
have increased risk for ischemic events, including coronary
revascularizations. Method(s): REDUCE-IT (The Reduction of
Cardiovascular Events with Icosapent Ethyl-Intervention Trial), a
multicenter, double-blind, placebo-controlled trial, randomly assigned
statin-treated patients with elevated triglycerides (135-499 mg/dL),
controlled low-density lipoprotein (41-100 mg/dL), and either established
cardiovascular disease or diabetes plus other risk factors to receive
icosapent ethyl 4 g/d or placebo. The primary and key secondary composite
end points were significantly reduced. Prespecified analyses examined all
coronary revascularizations, recurrent revascularizations, and
revascularization subtypes. Result(s): A total of 8179 randomly
assigned patients were followed for 4.9 years (median). First
revascularizations were reduced to 9.2% (22.5/1000 patient-years) with
icosapent ethyl versus 13.3% (33.7/1000 patient-years) with placebo
(hazard ratio, 0.66 [95% CI, 0.58-0.76]; P<0.0001; number needed to treat
for 4.9 years=24); similar reductions were observed in total (first and
subsequent) revascularizations (negative binomial rate ratio, 0.64 [95%
CI, 0.56-0.74]; P<0.0001), and across elective, urgent, and emergent
revascularizations. Icosapent ethyl significantly reduced percutaneous
coronary intervention (hazard ratio, 0.68 [95% CI, 0.59-0.79]; P<0.0001)
and coronary artery bypass grafting (hazard ratio, 0.61 [95% CI,
0.45-0.81]; P=0.0005). Conclusion(s): Icosapent ethyl reduced the
need for first and subsequent coronary revascularizations in
statin-treated patients with elevated triglycerides and increased
cardiovascular risk. To our knowledge, icosapent ethyl is the first
non-low-density lipoprotein-lowering treatment that has been shown to
reduce coronary artery bypass grafting in a blinded, randomized trial.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT01492361. Copyright © 2020 The Authors. Circulation is
published on behalf of the American Heart Association, Inc.

<50>
Accession Number
634773631
Title
Myocardial Ischemia in the Management of Chronic Coronary Artery Disease:
Past and Present.
Source
Circulation: Cardiovascular Imaging. (no pagination), 2021. Article
Number: e011615. Date of Publication: 2021.
Author
Gibbons R.J.
Institution
(Gibbons) Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St.
SW, Rochester, MN 55905-0001, United States
Publisher
Lippincott Williams and Wilkins
Abstract
For many years, stress-induced myocardial ischemia has been considered
important in the management of chronic coronary artery disease. Early
evidence focused on the exercise ECG and the Duke treadmill score. In the
1970s, randomized clinical trials, which compared coronary artery bypass
surgery to medical therapy, enrolled patients who were very different from
contemporary practice and had inconsistent results. Surgery appeared to be
of greatest benefit in high-risk patients defined by anatomy (such as left
main disease) or stress-induced ischemia. However, randomized clinical
trials of revascularization versus contemporary medical therapy over the
past 20 years have been surprisingly negative. Nuclear cardiology
substudies from these trials reported inconsistent results. Two
observational studies from a single-center provided the best evidence for
the use of stress-induced ischemia to identify patients who were most
likely to benefit from revascularization. The recently completed ISCHEMIA
trial (International Study of Comparative Health Effectiveness With
Medical and Invasive Approaches) was designed to test the hypothesis that
revascularization would improve outcomes in patients with moderate-severe
ischemia on stress testing. Unfortunately, 14.2% of the randomized
patients had either mild or no ischemia on core lab review. Nearly
one-quarter of the patients were randomized on the basis of an exercise
ECG without imaging. The negative results of the trial reflect the
long-term population decline in coronary artery disease and abnormal
stress tests, as well as improvements in patient outcome due to optimal
medical therapy. Topics requiring further research are presented. The
implications of the trial for the use of both stress imaging and coronary
computed tomography angiography in clinical practice are
examined. Copyright © 2021 Lippincott Williams and Wilkins. All
rights reserved.

<51>
Accession Number
634773548
Title
Randomized Trial of Aspirin Versus Warfarin after Transcatheter Aortic
Valve Replacement in Low-Risk Patients.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2021. Article
Number: e009983. Date of Publication: 2021.
Author
Rogers T.; Shults C.; Torguson R.; Shea C.; Parikh P.; Bilfinger T.; Cocke
T.; Brizzio M.E.; Levitt R.; Hahn C.; Hanna N.; Comas G.; Mahoney P.;
Newton J.; Buchbinder M.; Moreno R.; Zhang C.; Craig P.; Asch F.M.;
Weissman G.; Garcia-Garcia H.M.; Ben-Dor I.; Satler L.F.; Waksman R.
Institution
(Rogers, Torguson, Shea, Zhang, Craig, Ben-Dor, Satler, Waksman) Section
of Interventional Cardiology, MedStar Washington Hospital Center, WA,
United States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital
Center, WA, United States
(Asch) MedStar Health Research Institute, MedStar Washington Hospital
Center, WA, United States
(Weissman, Garcia-Garcia) Department of Cardiology, MedStar Washington
Hospital Center, WA, United States
(Rogers) Cardiovascular Branch, Division of Intramural Research, National
Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda,
MD, United States
(Parikh) Department of Cardiology, Stony Brook University Hospital, NY,
United States
(Bilfinger) Department of Cardiothoracic Surgery, Stony Brook University
Hospital, NY, United States
(Cocke) Department of Cardiology, The Valley Hospital, Ridgewood, NJ,
United States
(Brizzio) Department of Cardiothoracic Surgery, The Valley Hospital,
Ridgewood, NJ, United States
(Levitt) Henrico Cardiology Associates, Hca Virginia Health System, United
States
(Hahn) Cardiothoracic Surgical Associates - Richmond, Hca Virginia Health
System, United States
(Hanna) Department of Cardiology, St. John Health System, Tulsa, OK,
United States
(Comas) Department of Cardiothoracic Surgery, St. John Health System,
Tulsa, OK, United States
(Mahoney) Department of Cardiology, Sentara Norfolk General Hospital, VA,
United States
(Newton) Department of Cardiothoracic Surgery, Sentara Norfolk General
Hospital, VA, United States
(Buchbinder) Department of Cardiology, Foundation for Cardiovascular
Medicine, San Diego, CA, United States
(Moreno) Department of Cardiothoracic Surgery, Foundation for
Cardiovascular Medicine, San Diego, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimal antithrombotic regimen after transcatheter aortic
valve replacement remains unclear. Method(s): In this randomized
open-label study, low-risk patients undergoing transfemoral transcatheter
aortic valve replacement at 7 centers in the United States were randomized
1:1 to low-dose aspirin or warfarin plus low-dose aspirin for 30 days.
Patients who could not be randomized were enrolled in a separate registry.
Computed tomography or transesophageal echocardiography was performed at
30 days. The primary effectiveness end point was a composite of the
following at 30 days: hypoattenuated leaflet thickening, at least
moderately reduced leaflet motion, hemodynamic dysfunction (mean aortic
valve gradient >=20 mm Hg, effective orifice area <=1.0 cm2,
dimensionless valve index <0.35, or moderate or severe aortic
regurgitation), stroke, or transient ischemic attack. Result(s):
Between July 2018 and October 2019, 94 patients were randomly assigned, 50
to aspirin and 44 to warfarin plus aspirin, and 30 were enrolled into the
registry. In the intention-to-treat analysis of the randomized cohort, the
composite primary effectiveness end point was met in 26.5% for aspirin
versus 7.0% for warfarin plus aspirin (P=0.014; odds ratio, 4.8 [95% CI,
1.3-18.3]). The rate of hypoattenuated leaflet thickening was 16.3% for
aspirin versus 4.7% for warfarin plus aspirin (P=0.07; odds ratio, 4.0
[95% CI, 0.8-20.0]). There was no excess bleeding at 30 days with
anticoagulation. In the as-treated analysis of pooled randomized and
registry cohorts, the rate of hypoattenuated leaflet thickening was 16.7%
for aspirin versus 3.1% for warfarin plus aspirin (P=0.011; odds ratio,
6.3 [95% CI, 1.3-30.6]). Conclusion(s): In low-risk transcatheter
aortic valve replacement patients, anticoagulation with warfarin may
prevent transcatheter heart valve dysfunction in the short term without
excess bleeding. Registration: URL: https://www.clinicaltrials.gov. Unique
identifier: NCT03557242. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<52>
Accession Number
625728509
Title
B-type natriuretic peptide is associated with remodeling and exercise
capacity after transcatheter aortic valve replacement for aortic stenosis.
Source
Clinical Cardiology. 42 (2) (pp 270-276), 2019. Date of Publication:
February 2019.
Author
Sato K.; Kumar A.; Krishnaswamy A.; Mick S.; Desai M.Y.; Griffin B.P.;
Kapadia S.R.; Popovic Z.B.
Institution
(Sato, Kumar, Krishnaswamy, Mick, Desai, Griffin, Kapadia, Popovic)
Department of Cardiovascular Medicine, Heart and Vascular Institute,
Cleveland Clinic, Cleveland, OH, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: We aimed to assess longitudinal changes of B-type natriuretic
peptide (BNP) in aortic stenosis (AS) patients treated by transcatheter
aortic valve replacement (TAVR). Method(s): From our TAVR database,
we identified 193 consecutive patients with severe symptomatic AS who
underwent TAVR and were prospectively followed using serial BNP levels and
echocardiography. Patients were divided into subgroups according to type
of left ventricular (LV) remodeling as having normal LV mass and relative
wall thickness, or showing concentric remodeling (CR), concentric
hypertrophy (CH), and eccentric hypertrophy (EH). Result(s): At
baseline, 30 patients (16%) had EH, 115 (60%) had CH, 37 (19%) had CR, and
11 (6%) had normal LV geometry. After TAVR, BNP decreased in the first 30
days, with further improvement during follow-up. Patients with EH had
higher BNP at baseline (P < 0.01) and a greater subsequent decrease (P <
0.001). During the median follow-up of 1331 days (interquartile range:
632-1678), 119 (62%) patients died. BNP showed a time-dependent
association with all-cause mortality both in a univariable (hazards ratio
[HR] 1.24, 95% confidence interval [CI]: 1.04-1.47, P = 0.017), and in a
multivariable model with Society of Thoracic Surgeons score and baseline
BNP forced into the analysis (HR 1.32, 95% CI: 1.001-1.73, P = 0.049).
Elevated BNP was associated with a larger LV end-diastolic volume index (P
< 0.001) and shorter 6-minute walk test distance (P = 0.013) throughout
follow-up. Conclusion(s): In patients with AS, BNP was associated
with LV remodeling phenotypes and functional status before and after TAVR.
Elevated BNP levels were associated with poor prognosis. Copyright
© 2018 The Authors. Clinical Cardiology published by Wiley
Periodicals, Inc.

<53>
Accession Number
2010753168
Title
The role of cryoprecipitate in human and canine transfusion medicine.
Source
Journal of Veterinary Emergency and Critical Care. 31 (2) (pp 204-214),
2021. Date of Publication: March/April 2021.
Author
Prittie J.
Institution
(Prittie) Department of Emergency and Critical Care, Animal Medical
Center, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: To evaluate the current role of cryoprecipitate in human and
canine transfusion medicine. Data sources: Human and veterinary scientific
reviews and original studies found using PubMed and CAB Abstract search
engines were reviewed. Human data synthesis: In the human critical care
setting, cryoprecipitate is predominantly used for fibrinogen
replenishment in bleeding patients with acute traumatic coagulopathy.
Other coagulopathic patient cohorts for whom cryoprecipitate is
recommended include those undergoing cardiovascular or obstetric
procedures or patients bleeding from advanced liver disease. Preferential
selection of cryoprecipitate versus fibrinogen concentrate (when
available) is currently being investigated. Also a matter of ongoing
debate is whether to administer this product as part of a fixed-dose
massive hemorrhage protocol or to incorporate it into a goal-directed
transfusion algorithm applied to the individual bleeding patient.
Veterinary data synthesis: Although there are sporadic reports of the use
of cryoprecipitate in dogs with heritable coagulopathies, there are few to
no data pertaining to its use in acquired hypofibrinogenemic states. Low
fibrinogen in dogs (as in people) has been documented with acute traumatic
coagulopathy, advanced liver disease, and disseminated intravascular
coagulation. Bleeding secondary to these hypocoagulable states may be
amenable to cryoprecipitate therapy. Indications for preferential
selection of cryoprecipitate (versus fresh frozen plasma) remain to be
determined. Conclusion(s): In the United States, cryoprecipitate
remains the standard of care for fibrinogen replenishment in the bleeding
human trauma patient. Its preferential selection for this purpose is the
subject of several ongoing human clinical trials. Timely incorporation of
cryoprecipitate into the transfusion protocol of the individual bleeding
patient with hypofibrinogenemia may conserve blood products, mitigate
adverse transfusion-related events, and improve patient outcomes.
Cryoprecipitate is readily available, effective, and safe for use in dogs.
The role of this blood product in clinical canine patients with acquired
coagulopathy remains unknown. Copyright © Veterinary Emergency
and Critical Care Society 2021

<54>
Accession Number
2008599306
Title
Clinical Outcomes Following Urgent vs. Elective Percutaneous Mitral Valve
Repair.
Source
Cardiovascular Revascularization Medicine. 26 (pp 6-11), 2021. Date of
Publication: May 2021.
Author
Benito-Gonzalez T.; Estevez-Loureiro R.; del Castillo S.; Minguito-Carazo
C.; Garrote-Coloma C.; Alonso-Rodriguez D.; Tundidor-Sanz E.;
Rodriguez-Santamarta M.; Perez de Prado A.; Ramon C.C.; Lopez-Benito M.;
Gualis J.; Fernandez-Vazquez F.
Institution
(Benito-Gonzalez, Estevez-Loureiro, del Castillo, Minguito-Carazo,
Garrote-Coloma, Alonso-Rodriguez, Tundidor-Sanz, Rodriguez-Santamarta,
Perez de Prado, Ramon, Lopez-Benito, Fernandez-Vazquez) Department of
Cardiology, University Hospital of Leon, Leon, Spain
(Gualis) Department of Cardiovascular Surgery, University Hospital of
Leon, Leon, Spain
Publisher
Elsevier Inc.
Abstract
Aim: To examine procedural and clinical outcomes among patients undergoing
percutaneous mitral valve repair (PMVR) within an admission for
acute-decompensated heart failure (ADHF). Methods and Results:
Prospective registry of all consecutive patients with symptomatic mitral
regurgitation (MR) grade 3+ or 4+ who underwent PMVR our centre and
classified in 2 groups: elective group and urgent PMVR group (within the
index admission for ADHF). Echocardiographic, procedural and clinical
outcomes were compared between groups. 85 patients (median age 77.0
[67.8-83.4] years, 64.7% male) were treated within the recruitment period.
Among them, 17 (20%) underwent urgent MitraClip. Urgent PMVR were at a
higher risk for conventional surgery (p = 0.002) and had worse estimated
prognosis according to HF risk scores (p < 0.001). Overall technical
success was 100%, without differences between groups. At 30 days, no
differences were found in mortality, MR reduction and in NYHA functional
improvement between groups. Cumulative estimated survival free from
all-cause death was 92.9% (82.4% vs. 95.6%), 89.4% (82.4% vs. 91.1%),
76.3% (82.4 vs. 74.9%) at 6 months, 1-year and 2-years, respectively, with
no significant differences between urgent or elective PMVR (p = 0.769).
 Conclusion(s): MitraClip implantation can be considered as an urgent
therapy during admission for ADHF. Copyright © 2020 Elsevier Inc.

<55>
Accession Number
2008354259
Title
Skeletonized or Pedicled Harvesting of Left Internal Mammary Artery: A
Systematic Review and Meta-analysis.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33 (1) (pp 10-18), 2021.
Date of Publication: Spring 2021.
Author
Kusu-Orkar T.-E.; Kermali M.; Masharani K.; Noshirwani A.; MacCarthy-Ofosu
B.; Oguamanam N.; Bin Saeid J.; Muir A.D.; Harky A.
Institution
(Kusu-Orkar) Department of Surgery, Pilgrim Hospital, Boston, United
Kingdom
(Kermali) Faculty of Medicine, St. George's, University of London, London,
United Kingdom
(Masharani, Noshirwani, MacCarthy-Ofosu, Bin Saeid, Muir, Harky)
Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
(Oguamanam) Department of Cardiothoracic Surgery, Barts Heart Centre, St.
Bartholomew's Hospital, London, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
W.B. Saunders
Abstract
We sought to compare clinical outcomes in skeletonized versus pedicled
left internal mammary artery (LIMA) grafts in elective coronary artery
bypass grafting through a systematic review and meta-analysis. A
comprehensive electronic literature search of PubMed, Ovid, Embase, and
Scopus was conducted from inception to January 2020. Only short-term (30
days) studies which compared both techniques have been included in our
analysis. Primary outcomes were post anastomosis flow rate and sternal
wound infection rate (SWI); secondary outcomes were conduit length, acute
myocardial infarction and 30-day mortality. Thirteen articles with a total
of 6222 patients met the inclusion criteria. Except for the prevalence of
diabetes mellitus being significantly lower in the skeletonized cohort
(odds ratio [OR] 0.77 95% confidence interval [CI] [0.61, 0.97], P =
0.03), there were no differences in the preoperative demographics between
the 2 groups. The skeletonized LIMA conduit was significantly longer when
compared to the pedicled conduit (weighted mean difference -2.64 cm 95% CI
[-3.71, -1.56], P < 0.0001). SWI rates were not significantly different in
the skeletonized versus pedicled LIMA group (OR 0.71 95% CI [0.47, 1.06],
P = 0.10). New onset of acute myocardial infarction and 30-day mortality
rate was similar in the 2 groups (OR 1.04 and 0.97, respectively, P > 0.05
in both). The postanastomoses flow rate was higher in skeletonized LIMA
(Weighted Mean Difference -11.51 mL/min 95% CI [-20.54, -2.49], P < 0.01).
Harvesting the LIMA using the skeletonized technique is associated with
higher postanastomosis flow rates and longer conduit lengths; with no
difference in SWI and mortality rates when compared to the pedicled
technique. We suggest that this technique should be adopted, particularly
for BITA harvesting. However, further research is needed to provide
clearer indications for both methods. Copyright © 2020 Elsevier
Inc.

<56>
Accession Number
2013252477
Title
Impact of Surgical and Transcatheter Aortic Valve Replacement in
Low-Gradient Aortic Stenosis: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14 (13) (pp 1481-1492), 2021. Date of
Publication: 12 Jul 2021.
Author
Ueyama H.; Kuno T.; Harrington M.; Takagi H.; Krishnamoorthy P.; Sharma
S.K.; Kini A.; Lerakis S.
Institution
(Ueyama, Kuno, Harrington) Department of Medicine, Icahn School of
Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, United
States
(Ueyama, Krishnamoorthy, Sharma, Kini, Lerakis) Division of Cardiology,
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York,
NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the impact of aortic valve
replacement (AVR) on survival in patients with each subclass of
low-gradient (LG) aortic stenosis (AS) and to compare outcomes following
surgical AVR (SAVR) and transcatheter AVR (TAVR). Background(s): LG
severe AS encompasses a wide variety of pathophysiology, including
classical low-flow, LG (LF-LG), paradoxical LF-LG, and normal-flow, LG
(NF-LG) AS, and uncertainty exists regarding the impact of AVR on each
subclass of LG AS. Method(s): PubMed and Embase were queried through
October 2020 to identify studies comparing survival with different
management strategies (SAVR, TAVR, and conservative) in patients with LG
AS. Pairwise meta-analysis comparing AVR versus conservative management
and network meta-analysis comparing SAVR versus TAVR versus conservative
management were performed. Result(s): Thirty-two studies with a total
of 6,515 patients and a median follow-up time of 24.2 months
(interquartile range: 36.5 months) were included. AVR was associated with
a significant decrease in all-cause mortality in classical LF-LG (hazard
ratio [HR]: 0.42; 95% confidence interval [CI]: 0.36 to 0.48), paradoxical
LF-LG (HR: 0.41; 95% CI: 0.29 to 0.57), and NF-LG (HR: 0.41; 95% CI: 0.27
to 0.62) AS compared with conservative management. SAVR and TAVR were each
associated with a decrease in all-cause mortality in classical LF-LG (HR:
0.46 [95% CI: 0.38 to 0.55] and 0.49 [95% CI: 0.37 to 0.64],
respectively), paradoxical LF-LG (HR: 0.42 [95% CI: 0.28 to 0.65] and 0.42
[95% CI: 0.25 to 0.72], respectively), and NF-LG (HR: 0.40 [95% CI: 0.21
to 0.77] and 0.46 [95% CI: 0.26 to 0.84], respectively) AS compared with
conservative management. No significant difference was observed between
SAVR and TAVR. Conclusion(s): In all subclasses of LG AS, AVR was
associated with a significant decrease in all-cause mortality regardless
of surgical or transcatheter approach. Copyright © 2021 American
College of Cardiology Foundation

<57>
Accession Number
2011216966
Title
Editor's Choice - Early and Late Outcomes after Transcarotid
Revascularisation for Internal Carotid Artery Stenosis: A Systematic
Review and Meta-Analysis.
Source
European Journal of Vascular and Endovascular Surgery. 61 (5) (pp
725-738), 2021. Date of Publication: May 2021.
Author
Galyfos G.C.; Tsoutsas I.; Konstantopoulos T.; Galanopoulos G.; Sigala F.;
Filis K.; Papavassiliou V.
Institution
(Galyfos, Sigala, Filis) Vascular Surgery Unit, First Department of
Propedeutic Surgery, National and Kapodistrian University of Athens,
Hippocration Hospital, Athens, Greece
(Tsoutsas, Konstantopoulos, Galanopoulos, Papavassiliou) Vascular Surgery
Department, Sismanogleio General Hospital, Athens, Greece
Publisher
W.B. Saunders Ltd
Abstract
Objective: Transcarotid/transcervical revascularisation (TCAR) is an
alternative to carotid endarterectomy (CEA) and transfemoral carotid
stenting (tfCAS). This review aimed to evaluate pooled data on patients
undergoing TCAR. Data sources: Medline, Embase, Scopus, and Cochrane
Library databases were used. Review methods: This systematic review was
conducted under Systematic Reviews and Meta-Analysis guidelines. Eligible
studies (published online up to September 2020) reported 30 day mortality
and stroke/transient ischaemic attack (TIA) rates in patients undergoing
TCAR. Data were pooled in a random effects model and weight of effect for
each study was also reported. Quality of studies was evaluated according
to Newcastle - Ottawa scale. Result(s): Eighteen studies (three low,
seven medium, and eight high quality) included 4 852 patients (4 867 TCAR
procedures). The pooled 30 day mortality rate was 0.7% (n = 32) (95%
confidence interval [CI] 0.5 - 1.0), 30 day stroke rate 1.4% (n = 62) (95%
CI 1.0 - 1.7), and 30 day stroke/TIA rate 2.0% (n = 92) (95% CI 1.4 -
2.7). Pooled technical success was 97.6% (95% CI 95.9 - 98.8). The cranial
nerve injury rate was 1.2% (95% CI 0.7 - 1.9) (n = 14; data from 10
studies) while the early myocardial infarction (MI) rate was 0.4% (95% CI
0.2 - 0.6) (n = 16; data from 17 studies). The haematoma/bleeding rate was
3.4% (95% CI 1.7 - 5.8) (n = 135; data from 10 studies), with one third of
these cases needing drainage or intervention. Within a follow up of 3 - 40
months the restenosis rate was 4% (95% CI 0.1 - 13.1) (data from nine
studies; n = 64/530 patients) and death/stroke rate 4.5% (95% CI 1.8 -
8.4) (data from five studies; n = 184/3 742 patients). Symptomatic
patients had a higher risk of early stroke/TIA than asymptomatic patients
(2.5% vs. 1.2%; odds ratio 1.99; 95% CI 1.01 - 3.92); p =.046; data from
eight studies). Conclusion(s): TCAR is associated with promising
early and late outcomes, with symptomatic patients having a higher risk of
early cerebrovascular events. More prospective comparative studies are
needed in order to verify TCAR as an established alternative treatment
technique. Copyright © 2021 European Society for Vascular Surgery

<58>
Accession Number
2011822367
Title
Applications of Head-Mounted Displays and Smart Glasses in Vascular
Surgery.
Source
Annals of Vascular Surgery. 75 (pp 497-512), 2021. Date of Publication:
August 2021.
Author
Lareyre F.; Chaudhuri A.; Adam C.; Carrier M.; Mialhe C.; Raffort J.
Institution
(Lareyre) Department of Vascular Surgery, Hospital of
Antibes-Juan-les-Pins, France
(Lareyre, Raffort) Universite Cote d'Azur, CHU, Inserm U1065, Nice C3M,
France
(Chaudhuri) Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire
Hospitals NHS Foundation Trust, Bedford, United Kingdom
(Adam, Carrier) Laboratory of Applied Mathematics and Computer Science
(MICS), CentraleSupelec, Universite Paris-Saclay, France
(Mialhe) Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco,
Monaco
(Raffort) Clinical Chemistry, Laboratory, University Hospital of Nice,
France
Publisher
Elsevier Inc.
Abstract
Objectives: Advances in virtual, augmented and mixed reality have led to
the development of wearable technologies including head mounted displays
(HMD) and smart glasses. While there is a growing interest on their
potential applications in health, only a few studies have addressed so far
their use in vascular surgery. The aim of this review was to summarize the
fundamental notions associated with these technologies and to discuss
potential applications and current limits for their use in vascular
surgery. Method(s): A comprehensive literature review was performed
to introduce the fundamental concepts and provide an overview of
applications of HMD and smart glasses in surgery. Result(s): HMD and
smart glasses demonstrated a potential interest for the education of
surgeons including anatomical teaching, surgical training, teaching and
telementoring. Applications for pre-surgical planning have been developed
in general and cardiac surgery and could be transposed for a use in
vascular surgery. The use of wearable technologies in the operating room
has also been investigated in both general and cardiovascular surgery and
demonstrated its potential interest for image-guided surgery and data
collection. Conclusion(s): Studies performed so far represent a proof
of concept of the interest of HMD and smart glasses in vascular surgery
for education of surgeons and for surgical practice. Although these
technologies exhibited encouraging results for applications in vascular
surgery, technical improvements and further clinical research in large
series are required before hoping using them in daily clinical
practice. Copyright © 2021

<59>
Accession Number
2011555600
Title
Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus
On-Pump Techniques in a Large Cohort of Patients.
Source
Heart Lung and Circulation. 30 (9) (pp 1281-1291), 2021. Date of
Publication: September 2021.
Author
Tzoumas A.; Giannopoulos S.; Kakargias F.; Kokkinidis D.G.; Giannakoulas
G.; Faillace R.T.; Bakoyiannis C.; Doulamis I.P.; Avgerinos D.V.
Institution
(Tzoumas, Kakargias) Aristotle University of Thessaloniki, Thessaloniki,
Greece
(Giannopoulos) Division of Cardiology, Rocky Mountain Regional VA Medical
Center, University of Colorado, Denver, CO, United States
(Kokkinidis, Faillace) Department of Medicine, Jacobi Medical Center,
Albert Einstein College of Medicine, Bronx, NY, United States
(Giannakoulas) Department of Cardiology, Aristotle University of
Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
(Bakoyiannis) First Department of Surgery, National and Kapodistrian
University of Athens, Laikon General Hospital, Athens, Greece
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Avgerinos) Department of Cardiothoracic Surgery, Weill Cornell Medicine,
New York Presbyterian, New York, NY, United States
Publisher
Elsevier Ltd
Abstract
Background: Redo coronary artery bypass grafting (CABG) can be performed
with either the off-pump (OPCAB) or the on-pump (ONCAB) technique.
 Method(s): Following the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety
and efficacy of OPCAB versus ONCAB redo CABG. Result(s): Twenty-three
(23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245).
Off-pump CABG significantly reduced the risk of perioperative death
(defined as in-hospital or 30-day death rate), myocardial infarction,
atrial fibrillation, and acute kidney injury. The two treatment approaches
were comparable regarding 30-day stroke and late all-cause mortality.
 Conclusion(s): Off-pump redo CABG resulted in lower perioperative
death and periprocedural complication rates. No difference was observed in
perioperative stroke rates and long-term survival between the two
techniques. Copyright © 2021 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<60>
Accession Number
2013854623
Title
Post-Transplant Lymphoproliferative Disorder after Heart Transplant in the
Pediatric Population: A Systematic Review.
Source
Blood. Conference: 62nd ASH Annual Meeting. Virtual, Online. 136
(Supplement 1) (pp 37), 2020. Date of Publication: 05 Nov 2020.
Author
Haider M.Z.; Taqi M.; Mirza H.M.; Zamani Z.; Shahid H.; Abdullah S.M.;
Sami K.N.; Irfan A.; Kumar D.; Javed S.; Kiran F.; Anwer F.
Institution
(Haider, Zamani, Shahid, Abdullah) King Edward Medical University, Lahore,
Pakistan
(Taqi) Mayo Hospital, Lahore, Pakistan
(Mirza) Beth Israel Deaconess Medical Center/Harvard Medical School,
Boston, MA, Boston, MA, United States
(Sami) Services Institute Of Medical Sciences, Lahore, Pakistan
(Irfan) University of Missouri Kansas City, Kansas City, United States
(Kumar) Jinnah Postgraduate Medical Center, Karachi, Pakistan
(Javed) Department of Internal Medicine, Allama Iqbal Medical College,
Lahore, Pakistan
(Kiran) Sindh institute of urology and transplantation, Karachi, Pakistan
(Anwer) Department of Hematology & Medical Oncology, Cleveland Clinic
Taussig Cancer Institute, Moreland Hills, OH, United States
Publisher
Elsevier B.V.
Abstract
Background: Post-transplant lymphoproliferative disorder (PTLD) is a
B-cell proliferation disorder that results from disruption in the
physiological mechanisms for proliferation in an immunocompromised host
after a solid organ transplant. Our study aims to review the demographic
characteristics and clinical outcomes after transplantation. We also aim
to study the role of immunosuppression induction therapy, the effect of
PTLD on survival, and the effective chemotherapy used for B-cell disorders
leading to improved survival. Method(s): Following the PRISMA
guideline, we performed a comprehensive literature search on PubMed,
Cochrane Library, Embase, and clinicaltrials.gov from the past decade on
May 04, 2020. We used the MeSH terms of organ transplantation and
lymphoproliferative disorders. 1741 articles were screened. We excluded
all case reports, case series, pre-clinical trials, review articles, and
meta-analysis and included three cohort studies and one prospective
multicentric study. We extracted the data for baseline characteristics,
the reason for transplantation, recipient & donor EBV status,
immunosuppression used, type & stage of PTLD, organ system involved,
duration between transplant and PTLD diagnosis, treatment, response to
therapy, adverse effects of therapy and mortality. Result(s): We
studied 9617 patients in the included four studies, out of which 499
patients developed PTLD. Data in these studies was collected over the last
20-26 years. Median follow-up of patients since transplant was 3-9 years
(average 7.5y). Table 1 The age of the patients ranged from 3-18 years
with a male: female gender ratio of 48:52% and around 50% of the patients
were seronegative to EBV pretransplant. The following drugs were used for
immunosuppression: cyclosporin, tacrolimus, azathioprine, mycophenolate,
interleukin 2 receptor antagonist (basiliximab), corticosteroids,
anti-thymocyte globulins(ATG). Kindel et al. narrated that the development
of eosinophilic oesophagitis may be a marker for the development of
PTLD.Gajarski et al. concluded that Post-transplant Immunosuppressive
induction therapy with cytolytic drugs (e.g OKT3 monoclonal antibody, ATG,
thymoglobulin Basiliximab and daclizumab), lowers the rate of PTLD, graft
rejections, and early infections in post-transplant patients as compared
patients who did not receive induction therapy. This depends upon the type
of induction e.g OKT3 monoclonal antibody was associated with increased
PTLDs and graft rejection, while Thymoglobulin/IL-2R antagonists
demonstrated to decrease both the outcomes. Claire et al. described that
overall mortality is decreasing due to the ongoing better understanding of
pathophysiology and treatment options related to solid organ transplant.
The mortality of the post-transplant congenital heart disease group was
higher as compared to the cardiomyopathy group due to high comorbidities
and surgical complications. The study by Christopher et al. showed that
EBV seronegativity before transplant is associated with an increased risk
of PTLD. PTLD is associated with lower survival rates as compared to
non-PTLD groups. Conclusion(s): Our review illustrates that
pretransplant seronegativity, OKT3 monoclonal antibody, and the
development of eosinophilic esophagitis during the immunosuppressive
regime increase the risk of PTLD. This study demonstrates that with a
better understanding of PTLD and tumor behavior, the all-cause mortality
rates are falling significantly. PTLD is one of the leading causes of
mortality in post-transplant patients. However, the immunosuppressive
induction therapy, absence of eosinophilic esophagitis,
thymoglobulin/IL-2R antagonists improve survival and outcomes in the
post-transplant patient in terms of graft rejection, graft failure, and
development of PTLD. [Formula presented] Disclosures: Anwer: Incyte,
Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas
Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research
Funding, Speakers Bureau. Copyright © 2020 American Society of
Hematology

<61>
Accession Number
2013850831
Title
Major Infections after Blood Transfusion in Isolated Coronary Artery
Bypass Surgery Patients: A Meta-Analysis.
Source
Blood. Conference: 62nd ASH Annual Meeting. Virtual, Online. 136
(Supplement 1) (pp 25), 2020. Date of Publication: 05 Nov 2020.
Author
Mosalem O.; Kherallah S.; Mujer M.; Agarwal P.; Treasa Varghese M.;
Elshafie A.; Garces C.C.; Abdelsamia M.; Rayamajhi S.
Institution
(Mosalem, Rayamajhi) Department of Medicine, Michigan State University,
East Lansing, MI, United States
(Mosalem) Department of Medicine, Sparrow health system, Lansing, MI,
United States
(Kherallah, Agarwal, Treasa Varghese, Elshafie, Garces) Michigan State
University, East Lansing, MI, United States
(Mujer) Department of medicine, Michigan State University / Sparrow
Hospital, East Lansing, MI
(Abdelsamia) Department of medicine, Michigan State University, East
Lansing, MI, United States
Publisher
Elsevier B.V.
Abstract
BACKGROUND Blood transfusion in patients undergoing coronary artery bypass
surgery (CABG) remains high despite advances in perioperative blood
conservation. Several studies have shown poorer clinical outcomes in
isolated CABG patients who receive blood products, including an increased
rate of renal failure, non-fatal myocardial infarction, and death. Our
study sought to determine the impact of blood transfusion on sternal wound
infections and other major infections in patients who undergo isolated
CABG. METHODS We performed a systematic search using PubMed, Google
Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without language
restriction until May 15, 2020. A random-effects model was utilized to
calculate risk ratio (RR) and mean difference (MD) with 95% confidence
interval (CI). RESULTS In patients undergoing isolated CABG, sternal wound
infections [RR 1.73 (95% CI: 1.35 to 2.20; p<0.0001)] and overall major
infections [RR 1.70 (95% CI: 1.39 to 2.08; p<0.0001)] were significantly
higher in those who received a periprocedural blood transfusion.
Thirty-day mortality was lower in patients who did not receive any
transfusion [RR 2.46 (95% CI: 1.09-5.56;p=0.03)]. The test of
heterogeneity was low for clinical outcomes aside from 30-day mortality.
CONCLUSION Periprocedural blood transfusion is associated with an
increased risk of sternal wound infections and major infections and higher
30-day mortality in patients who undergo isolated CABG [Formula presented]
Disclosures: No relevant conflicts of interest to declare. Copyright
© 2020 American Society of Hematology

<62>
Accession Number
2013916866
Title
The emergency department evaluation and management of massive hemoptysis.
Source
American Journal of Emergency Medicine. 50 (pp 148-155), 2021. Date of
Publication: December 2021.
Author
Atchinson P.R.A.; Hatton C.J.; Roginski M.A.; Backer E.D.; Long B.; Lentz
S.A.
Institution
(Atchinson, Roginski) Department of Emergency Medicine, Geisel School of
Medicine at Dartmouth, Hanover, NH, United States
(Hatton, Backer) Dartmouth-Hitchcock Medical Center, Section of Critical
Care Medicine, Department of Medicine, Geisel School of Medicine at
Dartmouth, Hanover, NH, United States
(Long) Department of Emergency Medicine, Brooke Army Medical Center, San
Antonio, TX, United States
(Lentz) Division of Emergency Medicine and Pulmonary Disease and Critical
Care Medicine, The University of Vermont Larner College of Medicine,
Burlington, VT, United States
Publisher
W.B. Saunders
Abstract
Introduction: Massive hemoptysis is a life-threatening emergency that
requires rapid evaluation and management. Recognition of this deadly
condition, knowledge of the initial resuscitation and diagnostic
evaluation, and communication with consultants capable of definitive
management are key to successful treatment. Objective(s): The
objective of this narrative review is to provide an evidence-based review
on the management of massive hemoptysis for the emergency clinician.
 Discussion(s): Rapid diagnosis and management of life-threatening
hemoptysis is key to patient survival. The majority of cases arise from
the bronchial arterial system, which is under systemic blood pressure.
Initial management includes patient and airway stabilization, reversal of
coagulopathy, and identification of the source of bleeding using computed
tomography angiogram. Bronchial artery embolization with interventional
radiology has become the mainstay of treatment; however, unstable patients
may require advanced bronchoscopic procedures to treat or temporize while
additional information and treatment can be directed at the underlying
pathology. Conclusion(s): Massive hemoptysis is a life-threatening
condition that emergency clinicians must be prepared to manage. Emergency
clinicians should focus their management on immediate resuscitation,
airway preservation often including intubation and isolation of the
non-bleeding lung, and coordination of definitive management with
available consultants including interventional radiology, interventional
pulmonology, and thoracic surgery. Copyright © 2021 Elsevier Inc.

<63>
Accession Number
2013912430
Title
Rate Versus Rhythm Control in Heart Failure Patients with Post-Operative
Atrial Fibrillation After Cardiac Surgery.
Source
Journal of Cardiac Failure. 27 (8) (pp 915-919), 2021. Date of
Publication: August 2021.
Author
Yang E.; Spragg D.; Schulman S.; Gilotra N.A.; Kilic A.; Salenger R.;
Whitman G.; Metkus T.S.
Institution
(Yang, Spragg, Schulman, Gilotra, Metkus) Division of Cardiology,
Department of Medicine, Johns Hopkins University School of Medicine,
Baltimore, MD, United States
(Kilic, Whitman, Metkus) Division of Cardiovascular Surgery, Department of
Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,
United States
(Salenger) Division of Cardiac Surgery, Department of Surgery, University
of Maryland School of Medicine, Baltimore, MD, United States
Publisher
Elsevier B.V.
Abstract
Background: Whether rhythm control for post-operative atrial fibrillation
after cardiac surgery (POAF) is superior to rate control in patients with
heart failure or systolic dysfunction (HF) is not known. Method(s):
We performed a post-hoc analysis of a trial by the Cardiothoracic Surgical
Trials Network, which randomized patients with POAF after cardiac surgery
to rate control or rhythm control with amiodarone/cardioversion. We
assessed subgroups of trial participants defined by heart
failure/cardiomyopathy history or left ventricular ejection fraction
(LVEF) < 50%. We conducted a stratified analysis in patients with and
without HF to explore outcomes of rhythm versus rate control strategy.
 Result(s): Of 523 subjects with POAF after cardiac surgery, 131 (25%)
had HF. 49% of HF patients were randomized to rhythm control. In HF
patients, rhythm control was associated with less atrial fibrillation
within the first 7 days. There were no differences in rhythm at 30- and
60-day follow-up. In the HF group, there were significantly more subjects
with AF < 48 hours in the rhythm control group compared to rate control
group- 68.8% compared to 46.3%, P=0.009. By comparison, in the non-HF
stratum, 54.4% of the rate control group had AF < 48 hours compared to
63.5% of the rhythm control group (P=0.067).), though there was no
significant interaction of heart failure with cardiac rhythm at 7 days
(Pinteraction 0.16). Conclusion(s): Rhythm control for HF patients
with POAF after cardiac surgery increases early restoration of sinus
rhythm. Rate and rhythm control are both reasonable for HF patients with
AF after cardiac surgery Copyright © 2021 Elsevier Inc.

<64>
Accession Number
635639022
Title
Comparison of analgesic efficacy of the conventional approach and
mid-transverse process to pleura approach of the paravertebral block in
video-assisted thoracoscopy surgeries: A randomised controlled trial.
Source
Indian Journal of Anaesthesia. 65 (7) (pp 512-518), 2021. Date of
Publication: July 2021.
Author
Swathi K.; Kamal M.; Kumar M.; Kumar R.; Chhabr S.; Bhatia P.
Institution
(Swathi, Kamal, Kumar, Chhabr, Bhatia) Department of Anaesthesiology and
Critical Care, All India Institute of Medical Sciences, Jodhpur,
Rajasthan, India
(Kumar) Department of Anaesthesiology, Critical Care and Pain Medicine,
All India Institute of Medical Sciences, New Delhi, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: The paravertebral block (PVB) is an effective
alternative to thoracic epidural analgesia for post-operative analgesia in
thoracic surgeries. Despite the use of ultrasound in PVB, the search for a
safer approach continues. This study was conducted to compare the
analgesic efficacy of conventional and mid-transverse process to the
pleura (MTP) approach of the PVB. Method(s): Forty patients aged
between 18-60 years, posted for video-assisted thoracoscopic surgery, were
enroled for this study. Patients were randomised into two groups using a
random number table, and group allocation was done by the sealed opaque
envelope method. One group received PVB by conventional approach (group
CP). In contrast, patients in the other group (group MP) received PVB by
the mid-transverse process to pleura (MTP) approach before induction of
general anaesthesia under ultrasound guidance. The study's primary aim was
to compare analgesic consumption in the first 24 hours. Secondary aims
were comparing the Visual Analogue Scale (VAS) score, block performance
time, dermatomal spread, haemodynamic parameters such as heart rate (HR),
oxygen saturation (SpO<inf>2</inf>), and non-invasive blood pressure
(NIBP), patient satisfaction scores, and complications observed. Data were
analysed using Statistical Package for the Social Sciences version 23.
 Result(s): Demographic parameters, block performance time, and
dermatomal distribution were comparable in both groups. We did not find
any statistical difference in the analgesic consumption in the first 24
hours (P = 0.38), VAS at rest or on movement, complication rates, and
patient satisfaction scores between the groups. Conclusion(s): The
MTP approach of the PVB is as effective as the conventional thoracic
paravertebral approach for post-operative analgesia in video-assisted
thoracoscopic surgeries. Copyright © 2021 Wolters Kluwer Medknow
Publications. All rights reserved.

<65>
Accession Number
634748820
Title
Association between postsurgical pain and heart rate variability: Protocol
for a scoping review.
Source
BMJ Open. 11 (4) (no pagination), 2021. Article Number: e044949. Date of
Publication: 13 Apr 2021.
Author
So V.; Klar G.; Leitch J.; Mcgillion M.; Devereaux P.J.; Arellano R.;
Parlow J.; Gilron I.
Institution
(So, Klar, Leitch, Arellano, Parlow, Gilron) Anesthesiology and
Perioperative Medicine, Queen's University, Kingston, ON, Canada
(Mcgillion) School of Nursing, Faculty of Health Sciences, McMaster
University, Hamilton, ON, Canada
(Devereaux) Division of Cardiology, Medicine, McMaster University Faculty
of Health Sciences, Hamilton, ON, Canada
(Parlow) Departments of Biomedical and Molecular Sciences, Queen's
University Faculty of Health Sciences, Kingston, ON, Canada
(Gilron) Departments of Biomedical and Molecular Sciences, Centre for
Neuroscience Studies, Queen's University Faculty of Health Sciences,
Kingston, ON, Canada
(Gilron) School of Policy Studies, Queen's University, Kingston, ON,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Surgical interventions can elicit neuroendocrine responses
and sympathovagal imbalance, ultimately affecting cardiac autonomic
function. Cardiac complications account for 30% of postoperative
complications and are the leading cause of morbidity and mortality
following non-cardiac surgery. One cardiovascular parameter, heart rate
variability (HRV), has been found to be predictive of postoperative
morbidity and mortality. HRV is defined as variation in time intervals
between heartbeats and is affected by cardiac autonomic balance.
Furthermore, altered HRV has been shown to predict cardiovascular events
in non-surgical settings. In multiple studies, experimentally induced pain
in healthy humans leads to reduced HRV suggesting a causal relationship.
In a different studies, chronic pain has been associated with altered HRV,
however, in the setting of clinical pain conditions, it remains unclear
how much HRV impairment is due to pain itself versus autonomic changes
related to analgesia. We aim to review the available evidence describing
the association between postsurgical pain and HRV alterations in the early
postoperative period. Methods and analysis We will conduct a scoping
review of relevant studies using detailed searches of MEDLINE and EMBASE,
in accordance with the Preferred Reporting Items for Systematic Reviews
and Meta-Analysis. Included studies will involve participants undergoing
non-cardiac surgery and investigate outcomes of (1) measures of pain
intensity; (2) measures of HRV and (3) statistical assessment of
association between #1 and #2. As secondary review outcomes included
studies will also be examined for other cardiovascular events and for
their attempts to control for analgesic treatment and presurgical HRV
differences among treatment groups in the analysis. This work aims to
synthesise available evidence to inform future research questions related
to postsurgical pain and cardiac complications. Ethics and dissemination
Ethics review and approval is not required for this review. The results
will be submitted for publication in peer-reviewed journals.
 Copyright © 2021 Author(s).

<66>
Accession Number
2013896255
Title
Analogy of Del Nido and conventional cardioplegia in patients undergoing
isolated mitral valve replacement surgery: A single-center retrospective
study.
Source
Clinical Epidemiology and Global Health. 12 (no pagination), 2021. Article
Number: 100829. Date of Publication: 01 Oct 2021.
Author
Rai G.; Chandrababu R.; Sevagur Kamath G.; Pai B S.
Institution
(Rai, Sevagur Kamath) Department of Cardiovascular & Thoracic Surgery,
Kasturba Medical College, Manipal Academy of Higher Education, Manipal,
Karnataka 576104, India
(Chandrababu) Department of Medical Surgical Nursing, Sri Ramachandra
Faculty of Nursing, Sri Ramachandra Institute of Higher Education and
Research, Porur, Chennai 600116, India
(Pai B) Department of Perfusion Technology, Manipal College of Health
Professions, Manipal Academy of Higher Education, Manipal, Karnataka
576104, India
Publisher
Elsevier B.V.
Abstract
Objective: The objective of this study was to assess the postoperative
outcomes after utilizing the Del Nido cardioplegia as compared to
conventional cardioplegia, in patients undergoing isolated mitral valve
replacement surgery. Method(s): This was a single-center
retrospective study conducted with the data from 80 patients with mitral
valve disease, who underwent cardiopulmonary bypass. The outcome
assessments of the Del Nido group (n = 40) was compared with that of the
non-Del Nido group (n = 40). Various time factors were analyzed as end
points that included cardiopulmonary bypass time aortic cross clamp time,
duration of mechanical ventilation, need for postoperative inotropic
support, volume of packed red blood cells (RBCs) transfusion, length of
ICU and hospital stay, among others. Result(s): The current study
showed that the mean cardiopulmonary bypass time and aortic cross-clamp
time were significantly shorter in the Del Nido group when compared to the
non-Del Nido group (P < 0.05). The mean number of packed red blood cell
pints administered in the Del Nido group was fewer than the non-Del Nido
group (P < 0.05). No significant differences found in other outcome
measures. Conclusion(s): The use of the Del Nido cardioplegia
technique did significantly reduce the aortic cross-clamping time and
cardio-pulmonary bypass time. The present study did also show a marked
reduction in the amount of packed RBCs transfusion in the Del Nido group
as compared to non-Del Nido conventional cardioplegia. Rigorous,
adequately scrutinized randomized control trials are required to reiterate
these findings in-order to enable us to extrapolate their benefits to a
larger population. Copyright © 2021 The Authors

<67>
Accession Number
2013353695
Title
Myocardial protective and anti-inflammatory effects of dexmedetomidine in
patients undergoing cardiovascular surgery with cardiopulmonary bypass: a
systematic review and meta-analysis.
Source
Journal of Anesthesia. (no pagination), 2021. Date of Publication: 2021.
Author
Chen M.; Li X.; Mu G.
Institution
(Chen, Li) Department of Anesthesiology, Shehong People's Hospital, NO.
19, Guanghan road, Shehong, Sichuan 629200, China
(Mu) Department of Anesthesiology, Zigong Fourth People's Hospital,
Zigong, Sichuan, China
Publisher
Springer Japan
Abstract
Cardiopulmonary bypass (CPB) technology provides potential for cardiac
surgery, but it is followed by myocardial injury and inflammation related
to ischemia-reperfusion. This meta-analysis aimed to systematically
evaluate the cardioprotective effect of dexmedetomidine on cardiac surgery
under CPB and its effect on accompanied inflammation. PubMed, Cochrane
Library, EMBASE and Web of Science databases were comprehensively searched
for all randomized controlled trials (RCTs) published before April 1st,
2021 that explored the application of dexmedetomidine in cardiac surgery.
Compared with the control group (group C), the concentrations of CK-MB in
the perioperative period and cTn-I at 12 h and 24 h after operation in
dexmedetomidine group (group D) were significantly decreased (P < 0.05).
In addition, in group D, the levels of interleukin-6 at 24 h after
operation, tumor necrosis factor-a at the 12 h and 24 h after operation
were significantly decreased (P < 0.05). At the same time, the length of
Intensive Care Unit stay in group D was significantly shorter than group C
(P < 0.05). However, there was no significant difference in interleukin-10
level, C reactive protein level, the time on ventilator and length of
hospital stay between the two groups (P > 0.05). The application of
dexmedetomidine in cardiac surgery with CPB can reduce CK-MB and cTn-I
concentration and interleukin-6, tumor necrosis factor-alpha levels to a
certain extent and shorten the length of Intensive Care Unit stay, but it
has no significant effect on IL-10 level, C reactive protein level, the
time on ventilator and length of hospital stay. Copyright © 2021,
Japanese Society of Anesthesiologists.

<68>
Accession Number
635635561
Title
The short- and long-term effects of dietary patterns on cardiometabolic
health in adults aged 65 years or older: a systematic review.
Source
Nutrition reviews. (no pagination), 2021. Date of Publication: 17 Jul
2021.
Author
Luong R.; Ribeiro R.V.; Cunningham J.; Chen S.; Hirani V.
Institution
(Luong, Ribeiro, Cunningham, Chen, Hirani) R. Luong, R. Ribeiro, S. Chen,
V. Hirani are with the School of Life and Environmental Sciences, Charles
Perkins Centre, University of Sydney, NSW, Australia
Publisher
NLM (Medline)
Abstract
CONTEXT: Cardiometabolic diseases are leading causes of death and
morbidity. Aging increases the risk of disease development. Diet has
protective and causal effects on cardiometabolic health.
 OBJECTIVE(S): To consolidate the current evidence on the short- and
long-term effects of dietary patterns on cardiometabolic health in adults
aged >=65years. DATA SOURCES: The Medline, Embase, Cochrane Central
Register of Controlled Trials, Cochrane Database of Systematic Reviews,
Database of Abstracts of Reviews of Effects, Cumulative Index to Nursing
and Allied Health Literature, Web of Science, Scopus, Global Health, and
Pre-Medline databases, along with ClinicalTrials.gov and the World Health
Organization International Clinical Trials Registry Platform were
searched. DATA EXTRACTION: A total of 40042 records were identified.
Quality assessment involved using the revised Cochrane risk-of-bias tool
for randomized trials and Joanna Briggs Institute checklists. The
certainty of evidence was assessed using Grading of Recommendations,
Assessment, Development, and Evaluation. RESULT(S): Thirteen articles
were included (n = 5 cohort studies and n = 3 randomized controlled
trials). The low-fat dietary pattern reduced adiposity; however, no
effects were evident for hypertension incidence, composite coronary heart
disease incidence (including myocardial infarction, coronary heart
disease, and coronary revascularization), high-density lipoprotein
cholesterol level, and increased blood pressure in the long term. The
Mediterranean dietary pattern resulted in reduced triglyceride levels and
systolic blood pressure, and had no effects on diastolic blood pressure
and glucose in the short term. Other dietary patterns had inconclusive
effects. CONCLUSION(S): The Mediterranean dietary pattern showed the
most benefits without harm on cardiometabolic health in older adults. The
current body of evidence is small, indicating the need for more research
to confirm these findings at a high certainty of evidence, and to include
dietary patterns combined with other dietary components, subgroups with
cardiometabolic disease or risk factors, longer follow-up, and outcomes
that have not yet been investigated. Studies including these factors may
help identify the most effective dietary pattern for cardiometabolic
health benefits in older adults, to inform future guidelines. SYSTEMATIC
REVIEW REGISTRATION: PROSPERO registration no.
CRD42020141400. Copyright © The Author(s) 2021. Published by
Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<69>
[Use Link to view the full text]
Accession Number
634780040
Title
Closure of Iatrogenic Atrial Septal Defect after Transcatheter Mitral
Valve Repair: The Randomized MITHRAS Trial.
Source
Circulation. (pp 292-294), 2021. Date of Publication: 2021.
Author
Lurz P.; Unterhuber M.; Rommel K.-P.; Kresoja K.-P.; Kister T.; Besler C.;
Fengler K.; Sandri M.; Daehnert I.; Thiele H.; Von Roeder M.; Blazek S.
Institution
(Lurz, Unterhuber, Rommel, Kresoja, Kister, Besler, Fengler, Sandri,
Thiele, Von Roeder, Blazek) Department of Internal Medicine/Cardiology,
Heart Center Leipzig at Leipzig University, Germany
(Daehnert) Department of Pediatric Cardiology, Heart Center Leipzig at
Leipzig University, Germany
(Daehnert) Leipzig Heart Institute, Germany
Publisher
Lippincott Williams and Wilkins

<70>
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.
 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. Conclusion(s): THRIVE is
safe to use following extubation in adult cardiac surgical
patients. Copyright © 2021 Wolters Kluwer Medknow Publications.
All rights reserved.

<71>
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. 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. 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. 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. Copyright © 2021 Wolters Kluwer Medknow Publications. All
rights reserved.

<72>
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. 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. 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.
 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). 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. Copyright © 2021 Wolters
Kluwer Medknow Publications. All rights reserved.

<73>
Accession Number
2012041488
Title
Incidence, Risk Factors, and Outcomes of Perioperative Atrial Fibrillation
following Noncardiothoracic Surgery: A Systematic Review and
Meta-Regression Analysis of Observational Studies.
Source
Anesthesiology Research and Practice. 2021 (no pagination), 2021. Article
Number: 5527199. Date of Publication: 2021.
Author
Subramani Y.; El Tohamy O.; Jalali D.; Nagappa M.; Yang H.; Fayad A.
Institution
(Subramani, Nagappa, Yang, Fayad) Department of Anesthesia and
Perioperative Medicine, London Health Sciences Centre and St. Joseph
Health Care, Western University, Schulich School of Medicine and
Dentistry, London, ON, Canada
(El Tohamy, Jalali) Department of Medical Sciences, Western University,
London, ON, Canada
Publisher
Hindawi Limited
Abstract
Background. Atrial fibrillation (AF) occurs in 16-30% of patients after
cardiac and thoracic surgery and can lead to serious complications like
hypoperfusion of vital organs, pulmonary edema, and myocardial infarction.
The evidence on risk factors and complications associated with
perioperative AF after noncardiothoracic surgery is limited. Methods. The
primary objective was to determine demographic and clinical risk factors
for new-onset atrial fibrillation associated with noncardiothoracic
surgery. A secondary aim was to identify the incidence and odds of
perioperative complications associated with the new-onset atrial
fibrillation. A systematic search within multiple databases was conducted
for studies that explicitly reported on new-onset atrial fibrillation
after noncardiothoracic surgery. We reported data on demographics,
comorbidities, and perioperative complications as mean difference (MD) or
odds ratios (OR) and corresponding 95% confidence interval (CI) using
random effects models. A two-sided P value of less than 0.05 was
considered significant. We performed meta-regression and sensitivity
analysis of various subgroups to confirm the inference of our findings.
Results. Eleven studies reporting on 121,517 patients were included, of
whom 2,944 developed perioperative AF (incidence rate: 3.7%; 95% CI: 2.3%
- 6.2%). Advanced age (AF group versus control group: 69.36 +/- 10.5
versus 64.37 +/- 9.53 years; MD: 4.06; 95% CI: 1.67 - 6.44; P=0.0009),
male gender (52.85% versus 43.59%; OR: 1.08; 95% CI: 0.54 to 1.62; I2:
84%; P<0.0001), preoperative hypertension (60.42% versus 56.51%; OR: 1.15;
95% CI: 1.08 to 1.23; I2: 0%; P<0.00001), diabetes mellitus (22.6% versus
23.04%; OR: 0.97; 95% CI: 0.89 to 1.05; I2: 0; P<0.00001), and cardiac
disease (30.64% versus 8.49%; OR: 2.3; 95% CI: 0.28 to 4.31; I2: 93%;
P=0.03) were found to be significant predictors for perioperative AF. The
AF group was at increased odds of developing postoperative cardiac
complications (34.1% versus 5%; OR: 5.44; 95% CI: 0.49 to 10.39; I2: 82%;
P=0.03), postoperative stroke (0.5% versus 0.1%; OR: 3; 95% CI: 0.65 to
5.35; I2: 0%; P=0.01), and mortality (7.40% versus 1.92%; OR: 3.58; 95%
CI: 0.14 to 7.02; I2: 0%; P=0.04). Study quality assessment by
meta-regression and sensitivity analysis of the various subgroups did not
affect the final inference of the results. Conclusion. We identified
advanced age, male gender, preoperative hypertension, diabetes mellitus,
and cardiac disease as important risk factors for perioperative atrial
fibrillation. The atrial fibrillation group was at increased odds for
postoperative cardiac complications, stroke, and higher mortality,
emphasizing the need for risk stratification and close
monitoring. Copyright © 2021 Yamini Subramani et al.

<74>
Accession Number
2010583128
Title
Uniportal and three-portal video-assisted thoracic surgery pulmonary
lobectomy for early-stage lung cancer (UNIT trial): study protocol of a
single-center randomized trial.
Source
Trials. 22 (1) (no pagination), 2021. Article Number: 163. Date of
Publication: December 2021.
Author
Mendogni P.; Mazzucco A.; Palleschi A.; Rosso L.; Righi I.; Carrinola R.;
Damarco F.; Privitera E.; Fumagalli J.; Bonitta G.; Nosotti M.; Tosi D.
Institution
(Mendogni, Mazzucco, Palleschi, Rosso, Righi, Carrinola, Damarco,
Privitera, Bonitta, Nosotti, Tosi) Thoracic Surgery and Lung Transplant
Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico,
University of Milan, Via Francesco Sforza 35, Milan, Italy
(Fumagalli) Department of Anesthesia and Critical Care, Fondazione IRCCS
Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
(Nosotti) Department of Pathophysiology and Transplantation, Universita
degli Studi di Milano, Milan, Italy
Publisher
BioMed Central Ltd
Abstract
Background: Video-assisted thoracoscopic surgery (VATS) lobectomy is
currently the recommended approach for treating early-stage non-small cell
lung cancer (NSCLC). Different VATS approaches have been proposed so far,
and the actual advantages of one technique over the other are still under
debate. The aim of our study is to compare postoperative pain and
analgesic drug consumption in uniportal VATS and triportal VATS for
pulmonary lobectomy in early-stage lung cancer patients. Method(s):
This study is a single-center, prospective, two-arm, parallel-group,
randomized controlled trial. It is designed to compare uniportal
video-assisted thoracic surgery (u-VATS) and three-port video-assisted
thoracic surgery (t-VATS) in terms of postoperative pain. The trial will
enroll 120 patients with a 1:1 randomization. The primary outcome is the
assessment of analgesic drug consumption. Secondary outcomes are
postoperative pain measurement, evaluation of postoperative pulmonary
function, and metabolic recovery after pulmonary lobectomy.
 Discussion(s): The choice of which VATS approach to adopt for
treating patients undergoing pulmonary resection mostly depends on the
surgeon's preferences; therefore, it is hard to prove whether one VATS
technique is superior to the other. Moreover, postoperative analgesic
protocols vary consistently among different centers. To date, only a few
studies have evaluated the effects of the most popular VATS techniques.
There is no evidence about the difference between multiport VATS and
u-VATS in terms of postoperative pain. We hope that the results of our
trial will provide valuable information on the outcomes of these different
surgical approaches. Trial registration: ClinicalTrials.gov NCT03240250.
Registered on 07 August 2017; retrospectively registered. Copyright
© 2021, The Author(s).

<75>
Accession Number
633784819
Title
A six-week inspiratory muscle training and aerobic exercise improves
respiratory muscle strength and exercise capacity in lung cancer patients
after video-assisted thoracoscopic surgery: A randomized controlled trial.
Source
Clinical rehabilitation. 35 (6) (pp 840-850), 2021. Date of Publication:
01 Jun 2021.
Author
Liu J.-F.; Kuo N.-Y.; Fang T.-P.; Chen J.-O.; Lu H.-I.; Lin H.-L.
Institution
(Liu, Fang, Lin) Department of Respiratory Care, Chang Gung University of
Science and Technology, Chiayi, Taiwan (Republic of China)
(Liu, Kuo) Department of Respiratory Therapy, Chang Gung Memorial
Hospital-Kaohsiung Medical Center and Chang Gung University College of
Medicine, Kaohsiung, Taiwan (Republic of China)
(Fang, Lin) Department of Respiratory Therapy, Chiai Chang Gung Memorial
Hospital, Chiayi, Taiwan (Republic of China)
(Chen) Department of Nursing, Tajen University, Pingtung, Taiwan (Republic
of China)
(Lu) Division of Thoracic and Cardiovascular Surgery, Department of
Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University
College of Medicine Kaohsiung, Kaohsiung, Taiwan (Republic of China)
(Lin) Department of Respiratory Therapy, Chang Gung University, Taoyuan,
Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the postoperative outcomes of inspiratory muscle
training and aerobic exercise, along with standard care, on lung cancer
patients undergoing video-assisted thoracoscopic surgery (VATS). DESIGN: A
parallel-group, single-blind randomized clinical trial. SETTING: Thoracic
surgery ward and outpatient clinic in a teaching hospital. SUBJECTS:
Overall 63 patients underwent VATS were randomly assigned to a triaging
(TG, n=32) or control group (CG, n=31). A total of 54 patients (TG, n=26;
CG, n=28) completed the study. INTERVENTION: TG: six-week threshold
inspiratory muscle training and aerobic exercise. CG: standard care. MAIN
MEASURES: Maximum inspiratory pressure (PImax), maximum expiratory
pressure (PEmax) lung expansion volume, and 6-min walking test (6MWT) were
performed on the day of chest tube removal (baseline), and 2, 6, and
12weeks postoperatively. RESULT(S): The TG showed significant
improvement in PImax at week 6 (71.6+/-34.9 vs. 94.3+/-32.8cmH2O,
P=0.018), PEmax at week 2 (70.9+/-24.3 vs. 90.9+/-28.2cmH2O, P=0.015) and
week 12 (76.1+/-20.2 vs. 98.6+/-35.3cmH2O, P=0.012), the lung expansion
volume at week 2 (1080+/-433 vs 1457+/-624mL, P=0.02) and week 12
(1200+/-387 vs 1885+/-678mL, P<0.001), in addition to the 6MWT at week 2
(332+/-78 vs 412+/-74m, P=0.002), week 6 (360+/-70 vs 419+/-60m, P=0.007)
and week 12 (360+/-58 vs 402+/-65m, P=0.036). CONCLUSION(S): A six
weeks of inspiratory muscle training and aerobic exercise had improved
respiratory muscle strength and aerobic exercise postoperatively in lung
cancer patients after VATS as early as 2weeks.

<76>
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. 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. 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). 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. 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. Copyright © 2021 S. Karger AG. All
rights reserved.

<77>
Accession Number
2013626947
Title
Intravenous versus inhalational maintenance of anesthesia for quality of
recovery in adult patients undergoing non-cardiac surgery: A systematic
review with meta-analysis and trial sequential analysis.
Source
PLoS ONE. 16 (7 July) (no pagination), 2021. Article Number: e0254271.
Date of Publication: July 2021.
Author
Shui M.; Xue Z.; Miao X.; Wei C.; Wu A.
Institution
(Shui, Xue, Miao, Wei, Wu) Department of Anesthesiology, Beijing Chaoyang
Hospital, Capital Medical University, Beijing, China
Publisher
Public Library of Science
Abstract
Background Intravenous and inhalational agents are commonly used in
general anesthesia. However, it is still controversial which technique is
superior for the quality of postoperative recovery. This meta-analysis
aimed at comparing impact of total intravenous anesthesia (TIVA) versus
inhalational maintenance of anesthesia on the quality of recovery in
patients undergoing non-cardiac surgery. Methods We systematically
searched EMBASE, PubMed, and Cochrane library for randomized controlled
trials (RCTs), with no language or publication status restriction. Two
authors independently performed data extraction and assessed risk of bias.
The outcomes were expressed as mean difference (MD) with 95% confidence
interval (CI) based on a random-effect model. We performed trial
sequential analysis (TSA) for total QoR-40 scores and calculated the
required information size (RIS) to correct the increased type I error.
Results A total of 156 records were identified, and 9 RCTs consisting of
922 patients were reviewed and included in the meta-analysis. It revealed
a significant increase in total QoR-40 score on the day of surgery with
TIVA (MD, 5.91 points; 95% CI, 2.14 to 9.68 points; P = 0.002;
I2 = 0.0%). The main improvement was in four dimensions,
including "physical comfort", "emotional status", "psychological support"
and "physical independence". There was no significant difference between
groups in total QoR-40 score (P = 0.120) or scores of each dimension on
POD1. The TSA showed that the estimated required information size for
total QoR-40 scores was not surpassed by recovered evidence in our
meta-analysis. And the adjusted Z-curves did not cross the conventional
boundary and the TSA monitoring boundary. Conclusion Low-certainty
evidence suggests that propofol-based TIVA may improve the QoR-40 score on
the day of surgery. But more evidence is needed for a firm conclusion and
clinical significance. Copyright © 2021 Shui et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<78>
Accession Number
2013177737
Title
Angiotensin-converting enzyme inhibitor for post-transcatheter aortic
valve implantation patients: study protocol for a multicenter randomized,
open-label blinded endpoint control trial.
Source
Trials. 22 (1) (no pagination), 2021. Article Number: 462. Date of
Publication: December 2021.
Author
Liao Y.B.; Xia C.; Cheng Y.; Li Q.; Wei X.; Ou Y.; Chen F.; Li Y.; Liu Q.;
Xiong T.; Zhao Z.; Peng Y.; Wei J.; Feng Y.; Chen M.
Institution
(Liao, Xia, Cheng, Li, Wei, Ou, Chen, Li, Liu, Xiong, Zhao, Peng, Wei,
Feng, Chen) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
BioMed Central Ltd
Abstract
Background: With the expanded utilization of transcatheter aortic valve
implantation (TAVI) to younger and lower surgical risk patients with
severe aortic stenosis (AS), optimal medical therapy after TAVI procedure
has become the main concern. Renin-angiotensin system inhibitors (RASi)
are widely utilized in the area of cardiovascular disease including heart
failure and myocardial infarction and revealed the ability to reverse left
ventricular (LV) remodeling. Interests have, thus, been drawn in
investigating whether the prescription of RASi after the TAVI procedure
can prevent or reverse cardiac remodeling and improve long-term clinical
outcomes. No recommendation regarding the prescription of RASi after TAVI
is proposed yet due to the lack of evidence from randomized controlled
trials, especially in the Chinese population. We, therefore, designed this
randomized controlled trial to explore the effect of adding fosinopril to
standard care in patients who underwent a successful TAVI procedure on the
LV remodeling. Method(s): A total of 200 post-TAVI patients from
seven academic hospitals across China will be recruited and randomized
with a ratio of 1:1 to receive standard care or standard care plus
fosinopril. Follow-up visits will take place at 30 days, 3 months, 6
months, 12 months, and 24 months from randomization to assess the clinical
symptoms, any adverse events, cardiac function, and quality of life.
Cardiac magnetic resonance will be performed at baseline and repeated at
the 24-month follow-up visit to assess LV remodeling. Discussion(s):
This study will provide evidence regarding medical therapy for AS patients
who underwent TAVI and filling the gap in the Chinese population. Trial
registration: Chinese Clinical Trial Registry ChiCTR2100042266. Registered
on 17 January 2021. Copyright © 2021, The Author(s).

<79>
Accession Number
2013158667
Title
The use of diflunisal for transthyretin cardiac amyloidosis: a review.
Source
Heart Failure Reviews. (no pagination), 2021. Date of Publication: 2021.
Author
Ibrahim M.; Saint Croix G.R.; Lacy S.; Fattouh M.; Barillas-Lara M.I.;
Behrooz L.; Mechanic O.
Institution
(Ibrahim, Behrooz) Department Medicine, Division of Cardiovascular
Medicine, Boston University Hospital, 801 Massachusetts Avenue Suite 400,
Boston, MA 02118, United States
(Saint Croix, Mechanic) Division of Cardiology At Mount Sinai Medical
Center, Columbia University, 4300 Alton Rd, Miami Beach, FL 33140, United
States
(Lacy) Department of Medicine, University of Miami Miller School of
Medicine, 1120 NW 14th Street, Clinical Research Building, Miami, FL
33136, United States
(Fattouh, Barillas-Lara) Department of Internal Medicine Boston Medical
Center, Boston University School of Medicine, 72 East Concord St, Boston,
MA 02118, United States
Publisher
Springer
Abstract
Transthyretin cardiac amyloidosis (ATTR-CM) is caused by the accumulation
of misfolded transthyretin (TTR) protein in the myocardium. Diflunisal, an
agent that stabilizes TTR, has been used as an off-label therapeutic for
ATTR-CM. Given limited data surrounding the use of diflunisal, a
systematic review of the literature is warranted. We searched the PubMed,
MEDLINE, and Embase databases for studies that reported on the use of
diflunisal therapy for patients with ATTR-CM. We included English language
studies which assessed the effect of diflunisal in adult patients with
ATTR-CM who received diflunisal as primary treatment and reported clinical
outcomes with emphasis on studies that noted the safety and efficacy of
diflunisal in cardiac manifestations of ATTR amyloidosis. We excluded
studies which did not use diflunisal therapy or used diflunisal therapy
for non-cardiac manifestations of TTR amyloidosis. We also excluded case
reports, abstracts, oral presentations, and studies with fewer than 10
subjects. Our search yielded 316 records, and we included 6 studies
reporting on 400 patients. Non-comparative single-arm small non-randomized
trials for diflunisal comprised 4 of the included studies. The 2 studies
that compared diflunisal versus no treatment found improvements in TTR
concentration, left atrial volume index, cardiac troponin I, and global
longitudinal strain. Overall, diflunisal use was associated with decreased
mortality and number of orthotopic heart transplant in ATTR-CM patients.
Although a smaller number of patients had to stop treatment due to
gastrointestinal side effects and transient renal dysfunction, there were
no severe reactions reported in the studies included in our review. This
systematic review supports the use of diflunisal for ATTR-CM. Additional
long-term analyses and randomized clinical trials are needed to confirm
these results. Copyright © 2021, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<80>
Accession Number
635550224
Title
Is airway pressure release ventilation, a better primary mode of
post-operative ventilation for adult patients undergoing open heart
surgery? A prospective randomised study.
Source
Annals of Cardiac Anaesthesia. 24 (3) (pp 288-293), 2021. Date of
Publication: July-September 2021.
Author
Manjunath V.; Reddy B.; Prasad S.
Institution
(Manjunath, Reddy, Prasad) Department of Cardiac Anaesthesia, Sri Jayadeva
Institute of Cardiovascular Sciences and Research, Karnataka, Bangalore,
India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Context: Cardiopulmonary bypass (CPB) induced acute lung injury is
accounted for most of the post-operative pulmonary dysfunction which leads
to decreased compliance and hypoxemia. Airway Pressure Release Ventilation
(APRV) as compared to other modes of ventilation has shown to improve gas
exchange in Acute lung injury (ALI)/Acute respiratory distress syndrome
(ARDS) lungs. Aim(s): We hypothesized APRV as a better primary mode
of postoperative ventilation in adult post-cardiac surgery patients.
Methodology: The study included 90 postoperative surgical patients, which
were randomized into three groups: SIMV-PC(P), APRV(A), and SIMV-VC(V)
with 30 patients in each group. Subjects and Methods: Lung compliance and
serial arterial blood gas were assessed at regular intervals.
PaO<inf>2</inf>/FiO<inf>2</inf>ratio (a measure of oxygenation) and lung
compliance were used as an indirect indicator for improvement in lung
function. Hemodynamic parameters were closely observed for all the
patients. Statistical Analysis Used: Statistical analysis was done using
'R' software. Result(s): There was a statistically significant
improvement in PaO2/FiO2 ratio in the APRV group as compared to other
groups. There was also an improvement in lung compliance after 6 h of
ventilation and lesser duration of ventilation in the APRV group. However,
it was not statistically significant. Conclusion(s): Our study
suggests that APRV can be a useful alternative primary mode of ventilation
to improve lung compliance and oxygenation in adult post-cardiac surgical
patients. Copyright © 2021 Wolters Kluwer Medknow Publications.
All rights reserved.

<81>
Accession Number
2013855513
Title
Rapid and Deep Hematologic Responses Are Associated with Improved Major
Organ Deterioration Progression-Free Survival in Newly Diagnosed AL
Amyloidosis: Results from Andromeda.
Source
Blood. Conference: 62nd ASH Annual Meeting. Virtual, Online. 136
(Supplement 1) (pp 6-7), 2020. Date of Publication: 05 Nov 2020.
Author
Wechalekar A.D.; Palladini G.; Merlini G.; Comenzo R.L.; Jaccard A.; Tran
N.; Pei H.; Vasey S.Y.; Tromp B.; Weiss B.M.; Vermeulen J.; Kastritis E.
Institution
(Wechalekar) University College London, London, United Kingdom
(Palladini, Merlini) Amyloidosis Research and Treatment Center, Fondazione
IRCCS Policlinico San Matteo, Department of Molecular Medicine, University
of Pavia, Pavia, Italy
(Comenzo) Division of Hematology/Oncology, John C. Davis Myeloma and
Amyloid Program, Tufts Medical Center, Boston, MA, United States
(Jaccard) Centre Hospitalier Universitaire and Reference Center for AL
Amyloidosis, Limoges, France
(Tran) Janssen Research & Development, LLC, Los Angeles, CA, United States
(Pei) Janssen Research & Development, LLC, Titusville, NJ, United States
(Vasey, Weiss) Janssen Research & Development, LLC, Spring House, PA,
United States
(Tromp, Vermeulen) Janssen Research & Development, LLC, Leiden,
Netherlands
(Kastritis) Department of Clinical Therapeutics, National and Kapodistrian
University of Athens, School of Medicine, ATHENS, Greece
Publisher
Elsevier B.V.
Abstract
Background: As immunoglobulin light chains present in AL amyloidosis are
considered to be toxic to involved organs, especially the heart, rapid and
deep hematologic remission with reduction of these light chains with
frontline therapy may be crucial to improving long-term clinical outcomes.
ANDROMEDA (NCT03201965) is the first phase 3 study in this patient
population to evaluate major organ deterioration progression-free survival
(MOD-PFS), a composite endpoint of time to end-stage cardiac disease
(requiring cardiac transplant, left ventricular assist device, or
intra-aortic balloon pump); end-stage renal disease (requiring
hemodialysis or renal transplant); hematologic progression per consensus
guidelines1; and death. Here, we report the impact of early and
deep hematologic responses on MOD-PFS. Method(s): ANDROMEDA is a
randomized, open-label, active-controlled phase 3 study of patients with
newly diagnosed AL amyloidosis who received cyclophosphamide, bortezomib,
and dexamethasone (VCd) +/- daratumumab subcutaneous (DARA SC; DARA 1800
mg coformulated with recombinant human hyaluronidase PH20 in 15 mL). Key
eligibility criteria were newly diagnosed AL amyloidosis with measurable
hematologic disease, >=1 involved organ, cardiac stage I-IIIA, eGFR >=20
mL/min, and absence of symptomatic multiple myeloma. Disease evaluations
occurred every 4 weeks during Cycles 1-6. Hematologic responses were
adjudicated by an Independent Review Committee. Landmark analyses for
response were performed at 1 and 3 months (+/- 7 days). Analyses of
hematologic responses and MOD-PFS were performed on the intent-to-treat
analysis set. Patients without a baseline or post-baseline assessment were
censored at randomization for the MOD-PFS analysis. Hazard ratios and
corresponding 95% confidence intervals were estimated based on Cox
proportional hazard model. Result(s): A total of 388 patients were
randomized to DARA-VCd (n=195) or VCd alone (n=193). Baseline
characteristics were well balanced between groups. The proportions of
patients with heart and kidney involvement were 71% and 59%, respectively.
Median follow-up was 11.4 months (range, 0.03-21.3+). For the 1- and
3-month landmark analysis, hematologic response was available for 356 and
289 patients, respectively. Hematologic response rates by treatment group
at 1 and 3 months are shown in the Table. MOD-PFS was longer in patients
with complete response (CR)/very good partial response (VGPR) at 1 and 3
months vs patients with lower levels of response (Figure). CR/VGPR at 1
and 3 months was associated with reduced risk of death or major organ
deterioration in a multivariate analysis adjusting for baseline difference
between involved and uninvolved free light chains and cardiac stage, (HR:
0.399, P=0.0006 and HR: 0.262, P=0.0003, respectively). At 1 and 3 months,
cardiac and renal response rates were higher in those who achieved early
and deep hematologic responses (CR and VGPR). Conclusion(s): CR/VGPR
at 1 and 3 months was associated with a reduced risk of major organ
deterioration and death in patients with newly diagnosed AL amyloidosis.
These data confirm that initial therapy that achieves rapid and deep
hematological responses is essential to improving long-term outcomes in AL
amyloidosis. Reference 1. Comenzo RL, et al. Leukemia. 2012;26(11):2317-25
[Formula presented] Disclosures: Wechalekar: Janssen: Honoraria, Other:
Advisory; Caelum: Other: Advisory; Celgene: Honoraria; Takeda: Honoraria,
Other: Travel. Palladini: Celgene: Other: Travel support; Jannsen Cilag:
Honoraria, Other. Comenzo: Caleum: Consultancy; Unum: Consultancy; Sanofi:
Consultancy; Takeda: Consultancy, Research Funding; Amgen: Consultancy;
Karyopharm: Consultancy, Research Funding; Janssen: Consultancy, Research
Funding; Prothena: Consultancy, Research Funding. 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. Tran: Janssen: Current Employment, Current equity holder
in publicly-traded company. Pei: Janssen: Current Employment, Current
equity holder in publicly-traded company. 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. Kastritis:
Pfizer: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Janssen:
Consultancy, Honoraria, Research Funding; Genesis Pharma: Consultancy,
Honoraria; Amgen: Consultancy, Honoraria, Research Funding. Copyright
© 2020 American Society of Hematology

<82>
[Use Link to view the full text]
Accession Number
635625527
Title
The noninferiority of transcatheter aortic valve implantation compared to
surgical aortic valve replacement for severe aortic disease: Evidence
based on 16 randomized controlled trials.
Source
Medicine. 100 (28) (pp e26556), 2021. Date of Publication: 16 Jul 2021.
Author
Zhao P.-Y.; Wang Y.-H.; Liu R.-S.; Zhu J.-H.; Wu J.-Y.; Song B.
Institution
(Zhao, Liu, Song) Department of Cardiovascular Surgery, Lanzhou University
First Affiliated Hospital, Lanzhou, China
(Wang, Zhu, Wu) Department of Cardiovascular Surgery, Qinghai University
Affiliated Hospital, China
(Wang, Zhu, Wu) Medical College of Qinghai University, Qinghai University,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Currently, transcatheter aortic valve implantation (TAVI) as
an effective and convenient intervention has been adopted extensively for
patients with severe aortic disease. However, the efficacy and safety of
TAVI have not yet been well evaluated and its noninferiority compared with
traditional surgical aortic valve replacement (sAVR) still lack sufficient
evidence. This meta-analysis was designed to comprehensively compare the
noninferiority of TAVI with sAVR for patients with severe aortic disease.
 METHOD(S): A systematic search of PubMed, Embase, Cochrane Library,
and Web of Science up to October 1, 2020 was conducted for relevant
studies that comparing TAVI and sAVR in the treatment of severe aortic
disease. The primary outcomes were early, midterm and long term mortality.
The secondary outcomes included early complications and other late
outcomes. Two reviewers assessed trial quality and extracted the data
independently. All statistical analyzes were performed using the standard
statistical procedures provided in Review Manager 5.2. RESULT(S): A
total of 16 studies including 14394 patients were identified. There was no
difference in 30-day, 1-year, 2-year, and 5-year all-cause or
cardiovascular mortality as well as stroke between TAVI and sAVR.
Regarding to the 30-day outcomes, compared with sAVR, TAVI experienced a
significantly lower incidence of myocardial infarction (risk ratio [RR]
0.62; 95% confidence interval [CI] 0.40-0.97; 5441 pts), cardiogenic shock
(RR 0.34; 95% CI 0.19-0.59; 1936 pts), acute kidney injury (AKI) > stage 2
(RR 0.37; 95% CI 0.25-0.54; 5371 pts), and new-onset atrial fibrillation
(NOAF) (RR 0.29; 95% CI 0.24-0.35; 5371 pts) respectively, but higher
incidence of permanent pacemaker implantation (RR 3.16; 95% CI 1.61-6.21;
5441 pts) and major vascular complications (RR 2.22; 95% CI 1.14-4.32;
5371 pts). Regarding to the 1- and 2-year outcomes, compared with sAVR,
TAVI experienced a significantly lower incidence of NOAF, but higher
incidence of neurological events, transient ischemic attacks (TIA),
permanent pacemaker and major vascular complications respectively.
Regarding to the 5-year outcomes, compared with sAVR, TAVI experienced a
significantly lower incidence of NOAF, but higher incidence of TIA and
reintervention respectively. CONCLUSION(S): Our analysis shows that
TAVI was equal to sAVR in early, midterm and long term mortality for
patients with severe aortic disease. In addition, TAVI may be favorable in
reducing the incidence of both early, midterm and long term NOAF. However,
pooled results showed superiority of sAVR in reducing permanent pacemaker
implantation, neurological events, TIA, major vascular complications and
reintervention. Copyright © 2021 the Author(s). Published by
Wolters Kluwer Health, Inc.

<83>
[Use Link to view the full text]
Accession Number
635625390
Title
Comparison of postprocedural new-onset atrial fibrillation between
transcatheter and surgical aortic valve replacement: A systematic review
and meta-analysis based on 16 randomized controlled trials.
Source
Medicine. 100 (28) (pp e26613), 2021. Date of Publication: 16 Jul 2021.
Author
Ding Y.; Wan M.; Zhang H.; Wang C.; Dai Z.
Institution
(Ding, Zhang, Wang, Dai) Medical Department
(Wan) Outpatient Department, Zhebei Mingzhou hospital, Huzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Presently, transcatheter aortic valve replacement (TAVR) as an
effective and convenient intervention has been adopted extensively for
patients with severe aortic disease. However, after surgical aortic valve
replacement (SAVR) and TAVR, the incidence of new-onset atrial
fibrillation (NOAF) is prevalently found. This meta-analysis was designed
to comprehensively compare the incidence of NOAF at different times after
TAVR and SAVR for patients with severe aortic disease. METHOD(S): A
systematic search of PubMed, Embase, Cochrane Library, and Web of Science
up to October 1, 2020 was conducted for relevant studies that comparing
TAVR and SAVR in the treatment of severe aortic disease. The primary
outcomes were the incidence of NOAF with early, midterm and long term
follow-up. The secondary outcomes included permanent pacemaker (PM)
implantation, myocardial infarction (MI), cardiogenic shock, as well as
mortality and other complications. Two reviewers assessed trial quality
and extracted the data independently. All statistical analyses were
performed using the standard statistical procedures provided in Review
Manager 5.2. RESULT(S): A total of 16 studies including 13,310
patients were identified. The pooled results indicated that, compared with
SAVR, TAVR experienced a significantly lower incidence of
30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk
ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23-0.41; 5725 pts),
0.30 (95% CI 0.24-0.39; 6321 pts), 0.48 (95% CI 0.38-0.61; 3441 pts), and
0.45 (95% CI 0.37-0.55; 2268 pts) respectively. In addition, TAVR showed
lower incidence of MI (RR 0.62; 95% CI 0.40-0.97) and cardiogenic shock
(RR 0.34; 95% CI 0.19-0.59), but higher incidence of permanent PM (RR
3.16; 95% CI 1.61-6.21) and major vascular complications (RR 2.22; 95% CI
1.14-4.32) at 30-day/in-hospital. At 1- and 2-year after procedure,
compared with SAVR, TAVR experienced a significantly higher incidence of
neurological events, transient ischemic attacks (TIA), permanent PM, and
major vascular complications, respectively. At 5-year after procedure,
compared with SAVR, TAVR experienced a significantly higher incidence of
TIA and re-intervention respectively. There was no difference in 30-day,
1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well
as stroke between TAVR and SAVR. CONCLUSION(S): Our analysis showed
that TAVR was superior to SAVR in decreasing the both short and long term
postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long
term mortality. In addition, TAVR showed lower incidence of
30-day/in-hospital MI and cardiogenic shock after procedure. However,
pooled results showed that TAVR was inferior to SAVR in reducing permanent
pacemaker implantation, neurological events, TIA, major vascular
complications, and re-intervention. Copyright © 2021 the
Author(s). Published by Wolters Kluwer Health, Inc.

<84>
[Use Link to view the full text]
Accession Number
635624811
Title
Individualized positive end-expiratory pressure (PEEP) during one-lung
ventilation for prevention of postoperative pulmonary complications in
patients undergoing thoracic surgery: A meta-analysis.
Source
Medicine. 100 (28) (pp e26638), 2021. Date of Publication: 16 Jul 2021.
Author
Li P.; Kang X.; Miao M.; Zhang J.
Institution
(Li) Department of Anesthesia and Perioperative Medicine, Zhengzhou
University People's Hospital, Henan Provincial People's Hospital,
Zhengzhou, Henan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Positive end-expiratory pressure (PEEP) is an important part
of the lung protection strategies for one-lung ventilation (OLV). However,
a fixed PEEP value is not suitable for all patients. Our objective was to
determine the prevention of individualized PEEP on postoperative
complications in patients undergoing one-lung ventilation. METHOD(S):
We searched the PubMed, Embase, and Cochrane and performed a meta-analysis
to compare the effect of individual PEEP vs fixed PEEP during single lung
ventilation on postoperative pulmonary complications. Our primary outcome
was the occurrence of postoperative pulmonary complications during
follow-up. Secondary outcomes included the partial pressure of arterial
oxygen and oxygenation index during one-lung ventilation. RESULT(S):
Eight studies examining 849 patients were included in this review. The
rate of postoperative pulmonary complications was reduced in the
individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37-0.73; P =
.0001). The partial pressure of arterial oxygen during the OLV in the
individualized PEEP group was higher with a mean difference 34.20 mm Hg
(95% CI: 8.92-59.48; P = .0004). Similarly, the individualized PEEP group
had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21-70.92; P <
.0001). CONCLUSION(S): Individualized PEEP setting during one-lung
ventilation in patients undergoing thoracic surgery was associated with
fewer postoperative pulmonary complications and better perioperative
oxygenation. Copyright © 2021 the Author(s). Published by Wolters
Kluwer Health, Inc.

<85>
Accession Number
2013894802
Title
Comparison of outcomes of direct-acting oral anticoagulants vs. vitamin K
antagonists in patients with bioprosthetic heart valves or valve repair: A
systematic review and meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 25 (15) (pp
5006-5017), 2021. Date of Publication: 2021.
Author
Tang L.-L.; Liang S.-W.; Shi H.-L.; Ye J.-J.
Institution
(Tang, Liang, Shi, Ye) Department of Pharmacy, XinChang County Hospital of
Traditional Chinese Medicine, Zhejiang Province, Shaoxing, China
Publisher
Verduci Editore s.r.l
Abstract
OBJECTIVE: To compare the outcomes between direct-acting oral
anticoagulants and vitamin K antagonists, particularly for risk of stroke
and bleeding, among patients with atrial fibrillation (AF) and
bioprosthetic heart valve replacement or repair. MATERIALS AND METHODS: A
systematic search was conducted in the PubMed, Scopus, Cochrane Database
of Systematic Reviews and Google scholar databases. Studies that were done
in patients with AF who underwent bioprosthetic heart valve replacement or
repair and that compared the outcomes between the use of direct-acting
oral anticoagulants (DOACs) and vitamin K antagonists were eligible for
inclusion. Studies that were preferably randomized controlled trials or
adopted a cohort approach or retrospective data-based studies were
considered for inclusion. The strength of association was presented in the
form of pooled hazards risk (HR). Statistical analysis was done using
STATA version 16.0. RESULT(S): A total of 8 articles were included in
the meta-analysis. There were no significant differences in the risk of
"all-cause stroke" [HR 0.72, 95% CI: 0.39, 1.34] and ischemic stroke [HR
0.79, 95% CI: 0.49, 1.29] between the two groups. The risk of "any
bleeding" [HR 0.74, 95% CI: 0.64, 0.87], major bleeding [HR 0.60, 95% CI:
0.42, 0.86] and intra-cranial bleeding [HR 0.54, 95% CI: 0.36, 0.81] was
much lower in those that received DOAC compared to warfarin. Compared to
those receiving warfarin, those on DOACs had substantially reduced risk of
any clinical thromboembolic events [HR 0.52, 95% CI: 0.39, 0.70]. No
significant differences were noted for all-cause mortality [HR 0.88, 95%
CI: 0.74, 1.05], cardiovascular events/myocardial infarction (MI) [HR
0.58, 95% CI: 0.33, 1.04] and and readmission rates [HR 0.85, 95% CI:
0.62, 1.18]. CONCLUSION(S): Findings suggest that the use DOACs in
patients with AF with bioprosthetic valve replacement or repair is
comparatively better than vitamin K antagonists in reducing the risk of
bleeding and thrombo-embolic events. Future studies with a randomized
design and larger sample sizes are needed to further substantiate these
findings. Copyright © 2021 Verduci Editore s.r.l. All rights
reserved.

<86>
Accession Number
634683462
Title
Percutaneous transluminal rotational atherectomy for coronary artery
disease.
Source
Cochrane Database of Systematic Reviews. 2021 (4) (no pagination), 2012.
Article Number: CD003334. Date of Publication: 12 Dec 2012.
Author
Wasiak J.; Law J.; Watson P.; Spinks A.
Institution
(Wasiak) Department of Pediatrics, University of Melbourne, Melbourne,
Australia
(Law) The Royal Melbourne Hospital, Melbourne, Australia
(Watson) Victorian Adult Burns Service and School of Public Health and
Preventative Medicine, Monash University, The Alfred Hospital, Melbourne,
Australia
(Spinks) School of Medicine, Griffith University, Meadowbrook, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Background: This is an update of the review on 'Percutaneous transluminal
rotational atherectomy for coronary artery disease' first published in The
Cochrane Library Issue 4, 2003. Percutaneous transluminal coronary
rotational atherectomy (PTCRA) debulks atherosclerotic plaque from
coronary arteries using an abrasive burr. On rotation, the burr
selectively removes hard tissue. PTCRA has been used both as an
alternative to and in conjunction with balloon angioplasty to open up
blocked coronary arteries. Its ongoing effectiveness and safety compared
with other modes of removing atherosclerotic plaques is reviewed.
 Objective(s): To assess the effects of PTCRA for coronary artery
disease in patients with non-complex and complex lesions (e.g. ostial,
long or diffuse lesions or those arising from in-stent re-stenosis) of the
coronary arteries. Search Method(s): For the original review, we
searched the Heart Group Specialised Register; The Cochrane Library to
Issue 2, 2001; and MEDLINE, CINAHL, EMBASE and Current Contents to
December 2002 and reviewed reference lists for relevant articles. For the
current review, we searched the same registries from 2002 to 2012 and
reviewed reference lists for relevant articles. Selection Criteria:
We included randomised and quasi-randomised controlled trials of PTCRA
compared with placebo, no treatment or another intervention and excluded
cross-over trials. Data Collection and Analysis: Two review authors
independently extracted data and assessed the risk of bias of the studies
identified. Data were extracted independently by two review authors. We
asked authors of trials to provide information when missing data were
encountered. Statistical summaries used risk ratios (RR) and weighted mean
differences. Main Result(s): We included 12 trials enrolling 3474
patients. The overall risk of bias was unclear for the majority of
articles due to a lack of reported data; however, the authors determined
that this would be unlikely to impact negatively as most data outcomes
were objective (e.g. death vs. no death). There was no evidence of the
effectiveness in improving patient outcomes of PTCRA in non-complex
lesions. In complex lesions, there were no statistically significant
differences in re-stenosis rates at six months (RR 1.05; 95% confidence
interval (CI) 0.83 to 1.33) and at one year (RR 1.21; 95% CI 0.95 to 1.55)
in those receiving PTCRA with adjunctive balloon angioplasty (PTCA)
(PTCRA/PTCA) compared to those receiving PTCA alone. Morphological
characteristics distinguishing complex lesions have not been examined in
parallel-arm randomised controlled trials. The evidence for the
effectiveness of PTCRA in in-stent re-stenosis is unclear. Compared to
angioplasty alone, PTCRA/PTCA did not result in a statistically
significant increase in the risk of major adverse cardiac events
(myocardial infarction (MI), emergency cardiac surgery or death) during
the in-hospital period (RR 1.27; 95% CI 0.86 to 1.90). Compared to
angioplasty, PTCRA was associated with nine times the risk of an
angiographically detectable vascular spasm (RR 9.23; 95% CI 4.61 to
18.47), four times the risk of perforation (RR 4.28; 95% CI 0.92 to 19.83)
and about twice the risk of transient vessel occlusions (RR 2.49; 95% CI
1.25 to 4.99) while angiographic dissections (RR 0.48; 95% CI 0.34 to
0.68) and stents used as a bailout procedure (RR 0.29; 95% CI 0.09 to
0.87) were less common. Authors' conclusions: When conventional PTCA is
feasible, PTCRA appears to confer no additional benefits. There is limited
published evidence and no long-term data to support the routine use of
PTCRA in in-stent re-stenosis. Compared to angioplasty alone, PTCRA/PTCA
did not result in a higher incidence of major adverse cardiac events, but
patients were more likely to experience vascular spasm, perforation and
transient vessel occlusion. In certain circumstances (e.g. patients
ineligible for cardiac surgery, those with architecturally complex
lesions, or those with lesions that fail PTCA), PTCRA may achieve
satisfactory re-vascularisation in subsequent procedures. Copyright
© 2012 The Cochrane Collaboration. Published by John Wiley & Sons,
Ltd.

<87>
Accession Number
634683465
Title
Pre-operative intra aortic balloon pumps in patients undergoing coronary
artery bypass grafting.
Source
Cochrane Database of Systematic Reviews. 2021 (4) (no pagination), 2011.
Article Number: CD004472. Date of Publication: 19 Jan 2011.
Author
Theologou T.; Bashir M.; Rengarajan A.; Khan O.; Spyt T.; Richens D.;
Field M.
Institution
(Theologou) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
(Bashir) Queen Elizabeth Hospital, University Hospital Birmingham,
Birmingham, United Kingdom
(Rengarajan) Department of Cardiothoracic Surgery, Nothern General
Hospital, Sheffield, United Kingdom
(Khan) Department of Cardiothoracic Surgery, Nottingham City Hospital,
Nottingham, United Kingdom
(Spyt) Department of Cardiac Surgery, Glenfield Hospital, Leicester,
United Kingdom
(Richens) Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham
City Hospital, Nottingham, United Kingdom
(Field) Department of Cardiothoracic Surgery, The Liverpool Heart and
Chest Hospital, Liverpool, United Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: The intra aortic balloon pump (IABP) is a mechanical assist
device which improves cardiac function in high risk cardiac patients. The
device has a well-established place in algorithms for managing low cardiac
output following cardiac surgery. There is increasing evidence that
certain cardiac surgery patients benefit from a period of preoperative
augmentation with the intra aortic balloon pump. Objective(s): To
determine the effect of the preoperative intra aortic balloon pump on
mortality and morbidity in a number of different patients groups
undergoing coronary artery bypass grafting. Search Method(s): The
Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane
Library (Issue 3, 2009), MEDLINE (2000 to October 2013), EMBASE (1998 to
October 2013), BIOSIS previews (1969 to October 2013) and ISI Proceedings
(1990 to October 2013) were searched. References and ongoing registers of
studies were checked. No language restrictions were applied.
 Selection Criteria: Randomised controlled trials (RCTs) of any size
or length were included. Data Collection and Analysis: Papers were
assessed for inclusion by two authors independently and differences were
settled by consensus with a third author. Date are presented in the form
of odds ratios (OR) and 95% confidence intervals (CI). Main
Result(s): Six trials were included (five on-pump and one off-pump). This
update adds the results of one further trial. Data from a total of 255
patients were included in the meta-analysis of mortality outcomes; all
on-pump. Generally, the patients were considered as "high risk" and 132
were treated preoperatively with IABP and 123 served as controls. There
were four hospital deaths in the intervention arm and 23 in the
non-intervention arm (OR 0.18, 95% CI 0.08 to 0.41; P<0.0001). In a
subgroup analysis, low cardiac index (<2.0 L/min/m2) was noted
in 21 out of 105 patients in the treatment arm and 59 patients out of 88
in the non-treatment arm (OR 0.14, 95% CI: 0.08 to 0.25; P<0.00001). An
off-pump versus on-pump analysis was not possible due to the limited
number of off-pump studies. However a single well-conducted RCT suggested
favourable effect of the preoperative IABP in off-pump patients. Authors'
conclusions: Evidence suggests that preoperative IABP may have a
beneficial effect on mortality and morbidity in specific high risk patient
groups undergoing coronary artery bypass grafting, however there are many
problems with the quality, validity and generalisability of the trials.
However, the available evidence is not robust enough to extend the use of
IABP to truly elective, high risk patients. Defining more precisely which
patient groups may benefit would be the challenge for the
future. Copyright © 2011 The Cochrane Collaboration. Published by
John Wiley & Sons, Ltd.

<88>
Accession Number
635629740
Title
Incidence and Clinical Significance of Worsening Tricuspid Regurgitation
Following Surgical or Transcatheter Aortic Valve Replacement: Analysis
From the PARTNER IIA Trial.
Source
Circulation. Cardiovascular interventions. (pp
CIRCINTERVENTIONS120010437), 2021. Date of Publication: 16 Jul 2021.
Author
Cremer P.C.; Wang T.K.M.; Rodriguez L.L.; Lindman B.R.; Zhang Y.; Zajarias
A.; Hahn R.T.; Lerakis S.; Malaisrie S.C.; Douglas P.S.; Pibarot P.;
Svensson L.G.; Kapadia S.; Leon M.B.; Jaber W.A.
Institution
(Cremer, Wang, Rodriguez, Jaber) Section of Cardiovascular Imaging,
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic
Institute, Cleveland Clinic, L.L.R.
(Lindman) Structural Heart & Valve Center, Vanderbilt University Medical
Center, Nashville, United States
(Zhang, Hahn, Leon) Cardiovascular Research Foundation, R.T.H.
(Zajarias) Washington University School of Medicine, St. Louis, United
States
(Hahn, Leon) Structural Heart & Valve Center, NewYork-Presbyterian
Hospital/Columbia University Medical Center
(Lerakis) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai
(Malaisrie) Division of Cardiac Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Mexico
(Douglas) Duke Clinical Research Institute and Duke University Medical
Center, Durham
(Pibarot) Department of Medicine, Universite Laval, QC, QC
(Svensson, Kapadia) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic
(Jaber) Department of Cardiovascular Medicine, Cleveland Clinic
Publisher
NLM (Medline)
Abstract
BACKGROUND: Aortic valve replacement (AVR) is recommended for severe
symptomatic aortic stenosis. However, the incidence of worsening tricuspid
regurgitation (TR) following transcatheter compared with surgical AVR
(TAVR, SAVR), and the impact of worsening TR on outcomes, is ill-defined.
Accordingly, among patients randomized to TAVR or SAVR, we describe the
differential incidence of worsening TR and its association with survival.
 METHOD(S): From the PARTNER IIA trial (Placement of Aortic
Transcatheter Valves IIA), 1334 patients were included with baseline and
30-day postprocedure core-lab echocardiograms. Worsening TR was defined as
deterioration of >=1 grade from baseline to 30 days. Outcomes included
cardiovascular and all-cause death between 30 days and 2 years.
Multivariable logistic regression was performed to identify associations
with worsening TR; survival analyses were performed to assess associations
with mortality. RESULT(S): Worsening TR occurred in 17.3% (125/721)
of TAVR and 27.0% (165/611) of SAVR patients. On multivariable analysis,
SAVR (odds ratio, 2.09 [95% CI, 1.40-3.11]), female sex (odds ratio, 2.22
[95% CI, 1.44-3.42]), atrial fibrillation (odds ratio, 1.61 [95% CI,
1.03-2.51]), and right ventricular enlargement (odds ratio, 2.25 [95% CI,
1.17-4.31]) were associated with worsening TR. Cardiovascular and
all-cause death occurred in 9.0% (26/290) and 17.9% (52/290) of patients
with worsening TR, compared with 4.8% (50/1042) and 10.9% (114/1042)
without worsening TR, respectively. In patients with worsening TR,
cardiovascular and all-cause death were similar in TAVR compared with
SAVR, (hazard ratio, 1.09 [95% CI, 0.55-2.16]) and (hazard ratio, 1.07
[95% CI, 0.62-1.87]), respectively. After adjustment, worsening TR was
independently associated with cardiovascular (hazard ratio, 3.62 [95% CI,
2.08-6.29]) and all-cause death (hazard ratio, 2.11 [95% CI, 1.37-3.27]).
 CONCLUSION(S): Worsening TR is associated with female sex, atrial
fibrillation, right ventricular enlargement, and SAVR. Regardless of mode
of AVR, worsening TR is similarly associated with a poor prognosis. Future
studies should focus on whether preventing or treating worsening TR
improves outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov;
Unique identifier: NCT01314313.

<89>
Accession Number
635626986
Title
Low dose intraoperative ketamine infusion with multilevel paravertebral
block for pain after video-assisted thoracic surgery: a
randomized-controlled study.
Source
Annals of palliative medicine. (no pagination), 2021. Date of Publication:
06 Jul 2021.
Author
Suksompong S.; Chaikittisilpa N.; Wanchiange S.; Poolsuppasit S.;
Thongcharoen P.; Limratana P.
Institution
(Suksompong, Chaikittisilpa, Wanchiange, Poolsuppasit, Limratana)
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital,
Mahidol University, Bangkok, Thailand
(Thongcharoen) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative low-dose ketamine infusion has been reported to
be an effective adjuvant to opioids for postoperative pain control without
major side effects, but it has not been tested in videoassisted thoracic
surgery (VATS). The aim of this study was to examine the effect of
low-dose intraoperative intravenous ketamine infusion on 24-hour morphine
requirement and acute postoperative pain following VATS for lung
resection. METHOD(S): This study was a single center, randomized,
double-blind, placebo-controlled study. Thirtytwo patients undergoing
elective VATS for lung resection in a university hospital were included.
Patients were randomly allocated (1:1 ratio) to receive either
intraoperative low-dose ketamine (0.2 mg/kg/h) or normal saline infusion
starting from intubation to the beginning of chest closure. All patients
received multilevel thoracic paravertebral block (TPVB) and morphine was
administered postoperatively via the patient-controlled analgesia pump
using the same protocol. Time to first analgesia, postoperative cumulative
morphine doses at 10, 30 minutes, and the consecutive 1, 2, 6, 12, 18, and
24 hours were recorded. Pain intensity during rest and deep breathing were
also assessed by numeric rating scale (NRS) score at 1- and 24-hour
postoperatively. RESULT(S): There was no significant difference in
median (P25, P75) cumulative 24-hour morphine requirement between the
ketamine and the control groups [15 (5.5, 29.5) vs. 22.5 (15.3, 40.8) mg,
P=0.090]. Patients in ketamine group had significantly longer median pain
free time than the control group (27 vs. 2 minutes, P=0.006). No
difference in overall NRS score at rest or during deep breathing at 1- and
24-hour postoperatively was demonstrated (P=0.861). CONCLUSION(S):
Intraoperative low dose ketamine infusion in addition to TPVB does not
reduce postoperative morphine consumption or pain intensity but may
prolong pain free time in patients undergoing VATS for lung resection.

<90>
Accession Number
635626689
Title
Transcatheter versus surgical aortic valve replacement in aortic stenosis
patients with advanced chronic kidney disease: a systematic review and
meta-analysis.
Source
Annals of palliative medicine. (no pagination), 2021. Date of Publication:
01 Jul 2021.
Author
Wei S.; Zhang P.; Zhai K.; Wang S.; Wang W.; Tian Y.; Liu D.; Li Y.
Institution
(Wei, Zhang, Zhai, Wang, Wang, Tian, Liu) Department of Cardiac Surgery,
Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
(Li) Department of Cardiac Surgery, Lanzhou University Second Hospital,
Lanzhou University, Lanzhou, China; Laboratory of Extracorporeal Life
Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been
increasingly used in all levels of risk patients, which is less invasive
and has fewer complications. However, the benefits of transcatheter and
surgical methods of aortic valve replacement remain controversial for
aortic stenosis (AS) patients with advanced chronic kidney disease (stage
3-5). METHOD(S): We comprehensively searched PubMed, Embase, the
Cochrane Library, and the International Clinical Trials Registry Platform
(ICTRP) from January 2000 to October 2020 and performed a systematic
review to evaluate the two techniques. Two investigators independently
conducted the literature searches, study eligibility assessment, and data
extraction in duplicate. RESULT(S): Compared to surgical aortic valve
replacement (SAVR), TAVR had lower risk of in-hospital mortality [odds
ratio (OR): 0.53; 95% confidence interval (CI): 0.36-0.78; P=0.001], lower
stroke rate (OR: 0.68; 95% CI: 0.47-0.96; P=0.03), lower risk of acute
kidney injury (AKI) (OR: 0.42; 95% CI: 0.34-0.52; P<0.00001) and AKI
requiring dialysis (OR: 0.65; 95% CI: 0.58-0.73; P<0.00001), lower rate of
bleeding (OR: 0.35; 95% CI: 0.31-0.38; P<0.00001) and blood transfusion
(OR: 0.41; 95% CI: 0.32-0.52; P<0.00001), lower infection rate (OR: 0.23;
95% CI: 0.13-0.38; P<0.00001), lower risk of atrial fibrillation (AF) (OR:
0.37; 95% CI: 0.17-0.79; P=0.01) and cardiac tamponade (OR: 0.53; 95% CI:
0.37-0.75; P=0.0003), shorter ICU stay [weighted mean difference (WMD):
-2.55; 95% CI: -4.13 to -0.98; P=0.002] and hospital stay (WMD: -7.06; 95%
CI: -8.41 to -5.71; P<0.00001). DISCUSSION: TAVR is a safe, efficient, and
feasible technique for AS patients with advanced CKD and probably a better
solution for its advantage in reducing in-hospital mortality,
postoperative complications, ICU, and hospital stay.

<91>
Accession Number
635626590
Title
The incidence, risk factors, and prognosis of postoperative
hyperbilirubinemia after cardiac surgery: a systematic review and
meta-analysis.
Source
Annals of palliative medicine. (no pagination), 2021. Date of Publication:
30 Jun 2021.
Author
Bai M.; Zhang W.; Sun S.; Chen X.
Institution
(Chen, Bai, Zhang, Sun) Department of Nephrology, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
(Chen) Department of Nephrology, Xijing Hospital, The Fourth Military
Medical University, Xi'an, China; State Key Laboratory of Kidney Disease,
Department of Nephrology, Chinese People's Liberation Army General
Hospital and Military Medical Postgraduate College, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose of the present systematic review was to evaluate
the incidence, risk factors, and outcome of hyperbilirubinemia after
cardiac surgery. METHOD(S): The Population, Interventions,
Comparators, Outcomes, and Study design (PICOS) framework was employed to
develop the search strategy, and the findings are reported in accordance
with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. PubMed, Embase, and the Cochrane Library
were systematically searched for studies that provided data on the
incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac
surgery patients from January 1960 to May 2020. Publication bias was
graphically explored through funnel plots, and the Newcastle-Ottawa
quality assessment scale (NOS) was used to evaluate the quality of the
included studies. RESULT(S): Ten studies with 6,100 patients were
included in our systematic review. The pooled incidence of
hyperbilirubinemia was 23% [95% confidence interval (CI), 0.13-0.32].
Preoperative factors, including right atrial pressure [mean difference
(MD), 4.65; 95% CI, 4.43-4.88], total bilirubin (TB) concentration (MD,
0.72; 95% CI, 0.65-0.79), alkaline phosphatase (MD, 27.38; 95% CI,
12.94-41.82), and alanine aminotransferase (MD, 12.02; 95% CI,
10.73-13.31), and intraoperative factors, including cardiopulmonary bypass
(CPB) time (MD, 1.57; 95% CI, 0.52-2.63), aortic cross-clamping (ACC) time
(MD, 11.82; 95% CI, 9.50-14.14), and the amount of blood transfused (MD,
3.77; 95% CI, 0.68-6.85), were the most robust risk factors for
hyperbilirubinemia after cardiac surgery. Additionally, postoperative
hyperbilirubinemia was associated with increased in-hospital mortality
[odds ratio (OR), 9.9; 95% CI, 5.00-19.60, P<0.0001]. DISCUSSION:
Hyperbilirubinemia was common and was associated with increased
in-hospital mortality. Preoperative high right atrial pressure, high TB
concentration, prolonged CPB and ACC time, and a large amount of blood
transfused were the commonly observed risk factors for postoperative
hyperbilirubinemia in cardiac surgery patients. Addressing these risk
factors may be helpful to lower the occurrence of postoperative
hyperbilirubinemia.

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