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<1>
Accession Number
2013735907
Title
Clinical outcomes of leadless pacemaker: A systematic review.
Source
Minerva Cardiology and Angiology. 69 (3) (pp 346-357), 2021. Date of
Publication: June 2021.
Author
Oliveira S.F.; Carvalho M.M.; Adao L.; Nunes J.P.
Institution
(Oliveira, Carvalho, Nunes) Faculty of Medicine, University of Porto,
Porto, Portugal
(Carvalho, Adao, Nunes) Sao Joao University Hospital, Porto, Portugal
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Transvenous pacemakers are associated with a significant
amount of complications. Leadless pacemakers (LP) are emerging as an
alternative to conventional devices. This article provides a systematic
review of patient eligibility, safety and clinical outcomes of the LP
devices. EVIDENCE ACQUISITION: A systematic search for articles describing
the use of LP was conducted. Out of two databases, 24 articles were
included in the qualitative analysis. These articles comprised a total of
4739 patients, with followup times of 1-38 months. Further information was
obtained from 10 more studies. EVIDENCE SYNTHESIS: From a population of
4739 patients included in the qualitative analysis, 4670 LP were implanted
with success (98.5%). A total of 248 complications were described (5.23%)
during the follow-up. The most common were pacing issues such as elevated
thresholds, dislodgements or battery failure (68 patients), events at the
femoral access site such as hemorrhage, hematoma or pseudoaneurysms (64
patients) and procedure related cardiac injuries such as cardiac
perforation, tamponade or pericardial effusion (47 patients). There were
360 deaths during the follow-up and 11 were described as procedure or
device related. Four studies presented the strategy of using a combined
approach of atrioventricular node ablation (AVNA) and LP implantation.
<br/>CONCLUSION(S): Leadless pacemakers seem to have a relatively low
complication rate. These devices may be a good option in patients with an
indication for single-chamber pacing, in patients with conditions
precluding conventional transvenous pacemaker implantations. Studies
directly comparing LP and transvenous pacemakers and data on longer
follow-up periods are needed.<br/>Copyright &#xa9; 2020 EDIZIONI MINERVA
MEDICA

<2>
Accession Number
2013418745
Title
Surgery for lung cancer: postoperative changes and complications-what the
Radiologist needs to know.
Source
Insights into Imaging. 12 (1) (no pagination), 2021. Article Number: 116.
Date of Publication: December 2021.
Author
Burel J.; El Ayoubi M.; Baste J.-M.; Garnier M.; Montagne F.; Dacher
J.-N.; Demeyere M.
Institution
(Burel, Garnier, Dacher, Demeyere) Service de Radiologie, Hopital
Charles-Nicolle, CHU de Rouen, 37 boulevard Gambetta, Rouen, France
(El Ayoubi, Baste, Montagne) Service de Chirurgie Thoracique, Hopital
Charles-Nicolle, CHU de Rouen, 37 boulevard Gambetta, Rouen, France
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Imaging findings after thoracic surgery can be misleading. Knowledge of
the normal post-operative anatomy helps the radiologist to recognise
life-threatening complications and conversely not to wrongly evoke a
complication in cases of trivial post-operative abnormalities. In this
educational article, we reviewed the expected patterns after thoracic
surgery including sublobar resection, lobectomy, pneumonectomy and related
techniques. Imaging aspects of frequent and less common complications and
their typical imaging features are then presented.<br/>Copyright &#xa9;
2021, The Author(s).

<3>
Accession Number
2013401149
Title
Comparison between bicycle ergometric interval and continuous training in
patients early after coronary artery bypass grafting: A prospective,
randomized study.
Source
SAGE Open Medicine. 9 (no pagination), 2021. Date of Publication: 2021.
Author
Reer M.; Rauschenberg S.; Hottenrott K.; Schwesig R.; Heinze V.; Huta D.;
Schwark N.; Schlitt A.
Institution
(Reer, Heinze, Huta, Schlitt) Paracelsus-Harz Clinic, Quedlinburg, Germany
(Rauschenberg, Schwark, Schlitt) Martin-Luther University
Halle-Wittenberg, Halle (Saale), Germany
(Hottenrott) Institute of Sports Science, Martin-Luther-University
Halle-Wittenberg, Halle (Saale), Germany
(Schwesig) Department of Orthopedic and Trauma Surgery,
Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
Publisher
SAGE Publications Ltd
Abstract
Objectives: Continuous and interval training have previously been compared
in patients with cardiac diseases. However, data comparing the safety and
effectiveness of the two exercise methods are lacking in patients early
after coronary artery bypass grafting. <br/>Method(s): In all, 120
patients were prospectively randomized in a 1:1 fashion approximately 17
days after coronary artery bypass grafting to an interval group or
continuous group. All patients participated in bicycle ergometric training
six times/week for 20 min each during a 3-week inpatient rehabilitation
program. The combined primary endpoint was safety as defined by incidence
of scar pain and cardiac events related to the exercise intervention.
Secondary outcomes included the effect of the interventions on parameters
such as heart rate and peak power output. <br/>Result(s): Four patients
(12.1%) in the interval group reported pain on the saphenectomy scar as a
result of the training intervention in comparison to six patients (20.0%)
in the continuous group (chi² (1, n = 63) = 0.73, p = 0.393).
No cardiac events were related to exercise intervention. No effect on
heart rate was found during the intervention, nor was a difference
observed between the groups. Peak power output, as one of the analyzed
markers, improved significantly in both groups, but no differences were
found between groups. <br/>Conclusion(s): Ergometry training performed as
interval or continuous training was safe and effective regarding increase
in physical fitness early after coronary artery bypass grafting in an
inpatient rehabilitation setting, with no differences observed between the
groups.<br/>Copyright &#xa9; The Author(s) 2021.

<4>
Accession Number
2011519086
Title
Cerebral blood flow impairment and cognitive decline in heart failure.
Source
Brain and Behavior. 11 (6) (no pagination), 2021. Article Number: e02176.
Date of Publication: June 2021.
Author
Ovsenik A.; Podbregar M.; Fabjan A.
Institution
(Ovsenik) Faculty of Medicine, University of Ljubljana, Ljubljana,
Slovenia
(Ovsenik) Department of Cardiology, University Medical Centre Ljubljana,
Ljubljana, Slovenia
(Podbregar) Faculty of Medicine, Department for Internal Medicine,
University of Ljubljana, Ljubljana, Slovenia
(Podbregar) Department of Intensive care, General Hospital Celje, Celje,
Slovenia
(Fabjan) Faculty of Medicine, Institute for Physiology, University of
Ljubljana, Ljubljana, Slovenia
(Fabjan) Department of Vascular Neurology and Intensive Care, Neurological
Clinic, University Medical Centre Ljubljana, Ljubljana, Slovenia
Publisher
John Wiley and Sons Ltd
Abstract
Background and Purpose: Cognitive decline is an important contributor to
disability in patients with chronic heart failure, affecting 25%-50% of
patients. The aim of this review is to stress the importance of
understanding pathophysiological mechanisms of heart failure involved in
cognitive decline. <br/>Method(s): An extensive PubMed search was
conducted for the literature on the basic mechanisms of cerebral blood
flow regulation, the effect of cardiac dysfunction on cerebral blood flow,
and possible mechanisms underlying the association between cardiac
dysfunction and cognitive decline. <br/>Result(s): Published literature
supports the thesis that cardiac dysfunction leads to cerebral blood flow
impairment and predisposes to cognitive decline. One of the postulated
mechanisms underlying cognitive decline in chronic heart failure is
chronic regional hypoperfusion of critical brain areas. Cognitive function
may be further compromised by microvascular damage due to cardiovascular
risk factors. Furthermore, it is implied that cerebral blood flow
assessment could enable early recognition of patients at risk and help
guide appropriate therapeutic strategies. <br/>Conclusion(s):
Interdisciplinary knowledge in the fields of neurology and cardiology is
essential to clarify heart and brain interconnections in chronic heart
failure. Understanding and identifying the basic neuropathophysiological
changes in chronic heart failure could help with developing methods for
early recognition of patients at risk, followed by institution of
therapeutic actions to prevent or decrease cognitive
decline.<br/>Copyright &#xa9; 2021 The Authors. Brain and Behavior
published by Wiley Periodicals LLC

<5>
Accession Number
633876046
Title
Incidence and prevalence of pressure injury in adult cardiac patients
admitted to intensive care: A systematic review and meta-analysis.
Source
International journal of nursing studies. 114 (pp 103826), 2021. Date of
Publication: 01 Feb 2021.
Author
Fulbrook P.; Mbuzi V.; Miles S.
Institution
(Fulbrook) Nursing Research and Practice Development Centre, The Prince
Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane,
Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine,
Australian Catholic University, Brisbane, Australia; Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
(Mbuzi) Nursing Research and Practice Development Centre, The Prince
Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane,
Queensland 4032, Australia; Adult Intensive Care Services, The Prince
Charles Hospital, Brisbane, Australia
(Miles) Nursing Research and Practice Development Centre, The Prince
Charles Hospital, Level 5 Clinical Sciences Building, Chermside, Brisbane,
Queensland 4032, Australia; School of Nursing, Midwifery and Paramedicine,
Australian Catholic University, Brisbane, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pressure injury is recognised as an adverse event occurring in
healthcare settings. Patients in intensive care are at high risk of
developing a pressure injury. Cardiac patients are also among those at
higher risk. <br/>OBJECTIVE(S): To systematically assess the incidence and
prevalence of pressure injury in adult cardiac patients admitted to
intensive care. DESIGN: Systematic review and meta-analysis of incidence
and prevalence REVIEW METHODS: Articles published in English between 2009
and 2018, reporting pressure injury as a primary outcome were selected
based on inclusion criteria. Two authors assessed study bias and extracted
data, with a third reviewer as arbitrator. A random effects meta-analysis
was conducted. Sub-group meta-analyses were conducted to investigate
potential causes of heterogeneity. <br/>RESULT(S): Fifteen studies met the
criteria for inclusion in the systematic review, of which 14 were
incidence studies. Heterogeneity was significant and there was large
observed variance between studies. The 95% confidence interval of
cumulative incidence across all 14 studies, with an overall sample size of
6371, was 9.8-25.6%. In 11 studies that included all-stage pressure injury
the 95% confidence interval was 8.3-28.3%. In seven studies in which Stage
1 pressure injury was excluded, the 95% confidence interval was 5.8-22.7%.
In the single prevalence study included, which excluded Stage 1 pressure
injury, prevalence was 8.8%. <br/>CONCLUSION(S): The incidence of pressure
injury in cardiac intensive care patients was similar to that found in
general intensive care patients. However, our results suggest that the
incidence may be significantly higher in cardiac surgical patients
admitted to intensive care. There were significant differences across the
various studies in the ways in which data were collected and reported.
Further well-designed studies are required to better understand incidence
in this population, using standardised methods of data collection and
reporting.<br/>Copyright &#xa9; 2020. Published by Elsevier Ltd.

<6>
Accession Number
634061522
Title
Comparison of Reusable Models in Pericardiocentesis Simulation Training.
Source
Annals of the Academy of Medicine, Singapore. 49 (12) (pp 971-977), 2020.
Date of Publication: 01 Dec 2020.
Author
Lin Z.; Soh C.H.W.; Chua M.T.; Lin J.; Ho C.J.Y.; Lee J.Y.H.; Shen F.Y.T.;
Yau Y.W.; Kuan W.S.
Institution
(Lin) Emergency Medicine Department, National University Hospital,
National University Health System, Singapore
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Pericardiocentesis is a potentially life-saving procedure.
We compared two low-cost models-an agar-based model and a novel model,
Centesys-in terms of ultrasound image quality and realism, effectiveness
of the model, and learners' confidence and satisfaction after training.
<br/>METHOD(S): In this pilot randomised 2x2 crossover trial stratified by
physician seniority, participants were assigned to undergo
pericardiocentesis training either with the agar-based or Centesys model
first, followed by the other model. Participants were asked to rate their
confidence in performing ultrasound-guided pericardiocentesis, clarity and
realism of cardiac structures on ultrasound imaging, and satisfaction on a
7-point Likert scale before and after training with each model.
<br/>RESULT(S): Twenty participants with median postgraduate year of 4
(interquartile range [IQR] 3.75-6) years were recruited. Pre-training,
participants rated themselves a median score of 2.5 (IQR 2-4) for level of
confidence in performing pericardiocentesis, which improved to 5 (IQR 4-6)
post-training with Centesys (P=0.007). Centesys was recognised to be more
realistic in simulating cardiac anatomy on ultrasound (median 5 [IQR 4-5]
versus 3.5 [IQR 3-4], P=0.002) than the agar-based model. There was
greater satisfaction with Centesys (median 5 [IQR 5-6] versus 4 [IQR
3.75-4], P<0.001). All 20 participants achieved successful insertion of a
pericardial drain into the simulated pericardial sac with Centesys.
<br/>CONCLUSION(S): Centesys achieved greater learner satisfaction as
compared to the agar-based model, and was an effective tool for teaching
ultrasound-guided pericardiocentesis and drain insertion.

<7>
Accession Number
632732833
Title
The effectiveness of aromatherapy on preoperative anxiety in adults: A
systematic review and meta-analysis of randomized controlled trials.
Source
International journal of nursing studies. 111 (pp 103747), 2020. Date of
Publication: 01 Nov 2020.
Author
Guo P.; Li P.; Zhang X.; Liu N.; Wang J.; Yang S.; Yu L.; Zhang W.
Institution
(Guo, Zhang, Liu, Wang, Yang, Yu, Zhang) School of Nursing, Jilin
University, No. 965 Xinjiang, Street, Changchun, Jilin Province 130021,
China
(Li) Second Hospital of Jilin University, Changchun, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Preoperative anxiety is very common in adults awaiting all
types of surgical procedures, which can interfere with the start and
completion of surgery and increase the risk of postoperative
complications. In this context, many researchers and clinical
practitioners have attempted to use aromatherapy to help adults reduce
preoperative anxiety. <br/>OBJECTIVE(S): To investigate systematically the
efficacy of aromatherapy on preoperative anxiety in adults. DESIGN: A
systematic review and meta-analysis of randomized controlled trials was
undertaken. DATA SOURCES: PubMed, Embase, Cochrane Library, Web of
Science, PsycINFO and CINAHL were comprehensively searched from their
inception to June 2020. REVIEW METHODS: Studies on the use of aromatherapy
for treating preoperative anxiety in adults were included. Two reviewers
assessed the risk of bias of the included studies independently using the
Cochrane Collaboration 'Risk of Bias' tool. Overall meta-analysis and five
subgroup analyses regarding the type of control, the type of aroma
preparations, delivery mode, session length and surgery type were
performed using RevMan 5.3. The Higgins' I2 (%) statistic was used to
measure heterogeneity. A funnel plot and Egger's test were used to
evaluate publication bias. <br/>RESULT(S): Twenty studies comprising 1717
participants were included. The meta-analysis indicated that aromatherapy
could significantly ameliorate preoperative anxiety (standard mean
difference=-0.57, 95% confidence interval [-0.75, -0.39], p<0.00001) for
adults awaiting surgical procedures, compared to placebo control,
conventional care and no intervention. The subgroup analysis based on the
surgery type showed that aromatherapy had a great improvement on
preoperative anxiety for patients awaiting cardiac surgery and relatively
low-risk surgery. Lavender oil, citrus species preparations and rose oil
were the three most commonly used aroma preparations that could
significantly improve preoperative anxiety. Most delivery modes of
aromatherapy, including inhalation, massage, and oral administration, were
effective. Moreover, short length (<=20 min per session) aromatherapy
showed a better effect on preoperative anxiety (mean difference=-5.84, 95%
confidence interval [-8.09, -3.59], p<0.00001) than aromatherapy lasting
more than 20-minutes per session (mean difference=-2.15, 95% confidence
interval [-3.81, -0.49], p = 0.01). <br/>CONCLUSION(S): Aromatherapy is an
effective intervention for reducing preoperative anxiety in adults.
Short-length aromatherapy inhalation seems to be more worthy of being
recommended in clinical settings. More well-designed randomized controlled
trials containing a wider range of surgical types and participants from
more countries are needed to verify our findings before we can make strong
recommendations.<br/>Copyright &#xa9; 2020. Published by Elsevier Ltd.

<8>
Accession Number
2013443761
Title
A retrospective study of coronary artery bypass grafting with low-thermal
plasma dissection device compared to conventional monopolar
electrosurgery.
Source
Brazilian Journal of Cardiovascular Surgery. 36 (3) (pp 379-387), 2021.
Date of Publication: 2021.
Author
Uysal D.; Ibrisim E.
Institution
(Uysal, Ibrisim) Department of Cardiovascular Surgery, Suleyman Demirel
Universitesi Tip Fakultesi, Isparta, Turkey
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: The objective of this study is to compare the effects of
conventional monopolar electrosurgery (CMES) and low-thermal plasma
kinetic cautery (PKC) on complications such as bleeding, abnormal wound
healing, pain, and drainage in patients who underwent on-pump coronary
artery bypass grafting (CABG). <br/>Method(s): This retrospective clinical
study included 258 patients undergoing CABG; the patients were randomized
to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients'
clinical data were examined retrospectively for biochemical variables,
postoperative drainage, post-surgery erythrocyte suspension transfusion
count, surgical site pain examined with visual analogue scale (VAS), and
wound healing. Two-sided P-value > 0.05 was considered as statistically
significant. <br/>Result(s): The median post-surgery erythrocyte
suspension transfusion number was significantly lower with PKC compared to
CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative
drain output and time until removal of drain tubes were significantly
lower with PKC compared to CMES (300+/-113 vs. 547+/-192 and 1.95+/-1.5
vs. 2.44+/-1.8; P<0.001 and P=0.025, respectively). Mean VAS score for
spontaneous and cough-induced pain were significantly lower with PKC
compared to CMES (1.98+/-1.51 vs. 3.94+/- 2.09 and 3.76+/-1.46 vs.
5.6+/-1.92; P<0.001 for both comparisons). Reoperation due to bleeding was
significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001).
<br/>Conclusion(s): Use of PKC during CABG considerably reduces
postoperative drainage, need for blood transfusion, reoperation due to
bleeding, and postoperative pain. PCK appears to be a good alternative to
CMES for CABG.<br/>Copyright &#xa9; 2021, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<9>
Accession Number
2013443694
Title
Impact of COVID-19 pandemic in a pediatric and congenital cardiovascular
surgery program in Brazil.
Source
Brazilian Journal of Cardiovascular Surgery. 36 (3) (pp 289-294), 2021.
Date of Publication: 2021.
Author
Miana L.A.; Manuel V.; Caneo L.F.; Strabelli T.M.V.; Arita E.T.; Monteiro
R.; Jatene M.B.; Jatene F.B.
Institution
(Miana, Manuel, Caneo, Arita, Monteiro, Jatene, Jatene) Division of
Cardiovascular Surgery, Instituto do Coracao (InCor), Hospital das
Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao
Paulo, Brazil
(Strabelli) Infection Control Unit, Instituto do Coracao (InCor), Hospital
das Clinicas, Facul-dade de Medicina, Universidade de Sao Paulo, Sao
Paulo, Sao Paulo, Brazil
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) has negatively
impacted healthcare services worldwide. We hypothesized that the pandemic
would affect our case mix and mortality. Our objective was to study this
impact. <br/>Method(s): We retrospectively studied all patients who
underwent congenital heart surgeries from March 21^st to August
21^st in 2019 and 2020 using the institutional electronic
database. We compared demographic data, preoperative and postoperative
length of stay (LOS), risk stratification using Risk Adjustment for
Congenital Heart Surgery (RACHS) classification and outcomes in both
periods. <br/>Result(s): We observed a 66.7% decrease in our surgical
volume (285 x 95 patients). Patients operated in the pre-pandemic period
were older (911.3 [174.8-5953.8] days-old) compared to the pandemic period
(275 days-old; P<0.05). When the case mix was compared between periods,
the percentage of neonatal surgery was increased in the pandemic era (8% x
21.1%; P<0.05), and the number of RACHS 1-2 surgeries decreased
significantly (60.7 x 27.4%; P<0.05). Preoperative LOS was increased in
the pandemic period (1.2 x 7 days; P=0.001). There was no significant
increment in mortality (P=0.1). Two patients tested positive for COVID-19
in the postoperative period and both died. <br/>Conclusion(s): Our program
observed a sudden decrease in surgical volume and a consequent increase in
surgical complexity. There was a non-significant increment in
mortality.<br/>Copyright &#xa9; 2021, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<10>
Accession Number
2014052666
Title
Colchicine in Patients With Chronic Coronary Disease in Relation to Prior
Acute Coronary Syndrome.
Source
Journal of the American College of Cardiology. 78 (9) (pp 859-866), 2021.
Date of Publication: 31 Aug 2021.
Author
Opstal T.S.J.; Fiolet A.T.L.; van Broekhoven A.; Eikelboom J.W.; Duyvendak
M.; van Beek E.A.; den Hartog F.; Budgeon C.A.; Bax W.A.; Tijssen J.G.P.;
El Messaoudi S.; Nidorf S.M.; Xu X.F.; Ireland M.A.; Latchem D.; Whelan
A.; Hendriks R.; Salkani P.; Tan I.W.; Thompson A.G.; Morton A.M.;
Hockings B.E.; Thompson P.L.; King B.; Cornel J.H.; Bakker-Lohmeijer H.;
Mosterd A.; Bunschoten P.; The S.H.K.; van der Kooi S.; Lenderink T.;
Lardinois R.G.J.L.; Hoogslag P.A.M.; de Vos A.; Jerzewski A.; Jansen S.;
Nierop P.R.; van der Knaap M.; Swart H.P.; Kingma R.; Schaap J.; Blom
L.B.; Kuijper A.F.M.; Bayraktar-Verver E.; van Hessen M.W.J.; Engelen
W.C.T.C.; van Eck J.W.M.; van der Ven-Elzebroek N.; van Hal J.M.C.; Drost
I.M.J.; den Hartog F.R.; van Wijk D.; van Beek E.; van der Horst C.;
Bartels G.L.; Hendriks M.; de Nooijer C.; Welten C.; Ronner E.; Dijkshoorn
A.; Prins F.J.; Rutten R.N.A.; Beele D.P.W.; Hendriks I.; van der Sluis
A.; Badings E.A.; Westendorp I.C.D.; Melein A.; Romer T.J.; Bruines P.;
van de Wal R.; Leenders - van Lieshout I.; Hemels M.E.W.; Meinen-Werner
K.; de Groot M.R.; Post G.; Mulder M.W.C.; Stuij S.; van Nes E.; Luyten
P.; Plomp J.; Veldmeijer S.V.; Asselman M.J.; Scholtus P.A.
Institution
(Opstal, van Broekhoven, El Messaoudi, Cornel) Department of Cardiology,
Radboud University Medical Center, Nijmegen, Netherlands
(Opstal, Cornel) Department of Cardiology, Northwest Clinics, Alkmaar,
Netherlands
(Fiolet) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Fiolet, Mosterd, Cornel) Dutch Network for Cardiovascular Research,
Utrecht, Netherlands
(Mosterd) Department of Cardiology, Meander Medical Center, Amersfoort,
Netherlands
(Eikelboom) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Nidorf, Thompson) Heart and Vascular Research Institute of Western
Australia, Sir Charles Gairdner Hospital, Perth, Western Australia,
Australia
(Nidorf) GenesisCare Western Australia, Perth, Western Australia,
Australia
(Thompson) Harry Perkins Institute of Medical Research, Perth, Western
Australia, Australia
(Thompson, Budgeon) University of Western Australia, Perth, Western
Australia, Australia
(Duyvendak) Department of Clinical Pharmacy, Antonius Hospital Sneek,
Sneek, Netherlands
(Duyvendak) Pharmacy D&A Research, Sneek, Netherlands
(van Eck) Department of Cardiology, Jeroen Bosch Hospital,
's-Hertogenbosch, Netherlands
(van Beek) Department of Cardiology, St Jansdal Hospital, Harderwijk,
Netherlands
(den Hartog) Department of Cardiology, Gelderse Vallei Hospital, Ede,
Netherlands
(Bax) Department of Internal Medicine, Northwest Clinics, Alkmaar,
Netherlands
(Tijssen) Department of Cardiology, Amsterdam University Medical Center,
Amsterdam, Netherlands
(Tijssen) Cardialysis BV, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Colchicine reduces risk of cardiovascular events in patients
post-myocardial infarction and in patients with chronic coronary disease.
It remains unclear whether this effect is related to the time of onset of
treatment following an acute coronary syndrome (ACS). <br/>Objective(s):
This study investigates risk for major adverse cardiovascular events in
relation to history and timing of prior ACS, to determine whether the
benefits of colchicine are consistent independent of prior ACS status.
<br/>Method(s): The LoDoCo2 (Low-Dose Colchicine 2) trial randomly
allocated patients with chronic coronary disease to colchicine 0.5 mg once
daily or placebo. The rate of the composite of cardiovascular death,
spontaneous myocardial infarction, ischemic stroke, or ischemia-driven
coronary revascularization was compared between patients with no prior,
recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS;
interaction between ACS status and colchicine treatment effect was
assessed. <br/>Result(s): In 5,522 randomized patients, risk of the
primary endpoint was independent of prior ACS status. Colchicine
consistently reduced the primary endpoint in patients with no prior ACS
(incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR]:
0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4
vs 3.3 events per 100 person-years; HR: 0.75; 95% CI: 0.51-1.10), remote
ACS (incidence: 1.8 vs 3.2 events per 100 person-years, HR: 0.55; 95% CI:
0.37-0.82), and very remote ACS (incidence: 3.0 vs 4.3 events per 100
person-years, HR: 0.70; 95% CI: 0.51-0.96) (P for interaction = 0.59).
<br/>Conclusion(s): The benefits of colchicine are consistent irrespective
of history and timing of prior ACS. (The LoDoCo2 Trial: Low Dose
Colchicine for secondary prevention of cardiovascular disease [LoDoCo2]
ACTRN12614000093684)<br/>Copyright &#xa9; 2021 American College of
Cardiology Foundation

<11>
Accession Number
2014072515
Title
Effects of inorganic nitrate on ischaemia-reperfusion injury after
coronary artery bypass surgery.
Source
British Journal of Anaesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Eriksson K.E.; Eidhagen F.; Liska J.; Franco-Cereceda A.; Lundberg J.O.;
Weitzberg E.
Institution
(Eriksson, Eidhagen, Lundberg, Weitzberg) Department of Physiology and
Pharmacology, Karolinska Institutet, Stockholm, Sweden
(Eriksson, Weitzberg) Department of Perioperative Medicine and Intensive
Care, Karolinska University Hospital, Stockholm, Sweden
(Eidhagen) Stockholm Center for Spine Surgery (RKC), Stockholm, Sweden
(Liska, Franco-Cereceda) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Liska, Franco-Cereceda) Department of Cardiothoracic Surgery, Karolinska
University Hospital, Stockholm, Sweden
Publisher
Elsevier Ltd
Abstract
Background: Nitric oxide (NO) is an important signalling molecule in the
cardiovascular system with protective properties in ischaemia-reperfusion
injury. Inorganic nitrate, an oxidation product of endogenous NO
production and a constituent in our diet, can be recycled back to
bioactive NO. We investigated if preoperative administration of inorganic
nitrate could reduce troponin T release and other plasma markers of injury
to the heart, liver, kidney, and brain in patients undergoing cardiac
surgery. <br/>Method(s): This single-centre, randomised, double-blind,
placebo-controlled trial included 82 patients undergoing coronary artery
bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mgx2)
or placebo (NaCl) were administered before surgery. Biomarkers of
ischaemia-reperfusion injury and plasma nitrate and nitrite were collected
before and up to 72 h after surgery. Troponin T release was our predefined
primary endpoint and biomarkers of renal, liver, and brain injury were
secondary endpoints. <br/>Result(s): Plasma concentrations of nitrate and
nitrite were elevated in nitrate-treated patients compared with placebo.
The 72-h release of troponin T did not differ between groups. Other plasma
biomarkers of organ injury were also similar between groups. Blood loss
was not a predefined outcome parameter, but perioperative bleeding was 18%
less in nitrate-treated patients compared with controls.
<br/>Conclusion(s): Preoperative administration of inorganic nitrate did
not influence troponin T release or other plasma biomarkers of organ
injury in cardiac surgery. Clinical trial registration:
NCT01348971.<br/>Copyright &#xa9; 2021 The Authors

<12>
Accession Number
2014071891
Title
Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From
Pathogenesis to Management: A Case Report Based Systematic Review.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
100933. Date of Publication: 2021.
Author
Kermani-Alghoraishi M.; Pouramini A.; Kafi F.; Khosravi A.
Institution
(Kermani-Alghoraishi, Pouramini) Interventional Cardiology Research
Center, Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Kafi, Khosravi) Hypertension Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
Mosby Inc.
Abstract
The Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) created a
global pandemic that continues to this day. In addition to pulmonary
symptoms, the virus can have destructive effects on other organs,
especially the heart. For example, large pericardial effusion has been
observed as a critical and life-threatening finding in Coronavirus disease
of 2019 (COVID-19) patients. In this case report based systematic review,
we review the reports of moderate to severe pericardial effusion
associated with tamponade physiology. Direct cardiomyocyte and pericardium
invasion, inflammation and cytokine storms and oxidative stress due to
acute respiratory distress syndrome, are the pathogenesis of this
phenomenon. The results showed that the manifestations of this finding are
variable. Pericardial effusion can be seen as a delayed complication,
accompanied by myocarditis or pericarditis, isolated, or with acute
respiratory distress syndrome. In most patients, emergency percutaneous
pericardiocentesis was performed, and fluid analysis was often exudative
in 3 pattern of hemorrhagic, serous, and serosanguinous. Medical treatment
and follow-up are recommended, especially in cases of
pericarditis.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<13>
Accession Number
2014071889
Title
Maintenance of Serum Potassium Levels >=3.6 mEq/L Versus >=4.5 mEq/L After
Isolated Elective Coronary Artery Bypass Grafting and the Incidence of
New-Onset Atrial Fibrillation: Pilot and Feasibility Study Results.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Campbell N.G.; Allen E.; Montgomery H.; Aron J.; Canter R.R.; Dodd M.;
Sanders J.; Sturgess J.; Elbourne D.; O'Brien B.
Institution
(Campbell) Division of Cardiovascular Sciences, School of Medical
Sciences, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
(Campbell) Wythenshawe Hospital, Manchester University Foundation NHS
Trust, Manchester, United Kingdom
(Allen, Canter, Dodd, Sturgess, Elbourne) Clinical Trials Unit, London
School of Hygiene & Tropical Medicine, London, United Kingdom
(Montgomery) UCL Division of Medicine and Institute for Sport, Exercise,
and Health, London, United Kingdom
(Aron) St. George's Hospital, London, United Kingdom
(Sanders, O'Brien) St. Bartholomew's Hospital, Barts Health NHS Trust,
West Smithfield, London, United Kingdom
(O'Brien) German Heart Center, Department of Cardiac Anesthesiology and
Intensive Care Medicine, Berlin, Germany
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Charite Berlin, Berlin, Germany
(O'Brien) Outcomes Research Consortium, Cleveland, OH, United States
Publisher
W.B. Saunders
Abstract
Objective: Serum potassium levels frequently are maintained at high levels
(>=4.5 mEq/L) to prevent atrial fibrillation after cardiac surgery
(AFACS), with limited evidence. Before undertaking a noninferiority
randomized controlled trial to investigate the noninferiority of
maintaining levels >=3.6 mEq/L compared with this strategy, the authors
wanted to assess the feasibility, acceptability, and safety of recruiting
for such a trial. <br/>Design(s): Pilot and feasibility study of full
trial protocol. <br/>Setting(s): Two university tertiary-care hospitals.
<br/>Participant(s): A total of 160 individuals undergoing first-time
elective isolated coronary artery bypass grafting. <br/>Intervention(s):
Randomization (1:1) to protocols aiming to maintain serum potassium at
either >=3.6 mEq/L or >=4.5 mEq/L after arrival in the postoperative care
facility and for 120 hours or until discharge from the hospital or AFACS
occurred, whichever happened first. <br/>Measurements and Main Results:
Primary outcomes: (1) whether it was possible to recruit and randomize 160
patients for six months (estimated 20% of those eligible); (2) maintaining
supplementation protocol violation rate <=10% (defined as potassium
supplementation being inappropriately administered or withheld according
to treatment allocation after a serum potassium measurement); and (3)
retaining 28-day follow-up rates >=90% after surgery. Between August 2017
and April 2018, 723 patients were screened and 160 (22%) were recruited.
Potassium protocol violation rate = 9.8%. Follow-up rate at 28 days =
94.3%. Data on planned outcomes for the full trial also were collected.
<br/>Conclusion(s): It is feasible to recruit and randomize patients to a
study assessing the impact of maintaining serum potassium concentrations
at either >=3.6 mEq/L or >=4.5 mEq/L on the incidence of
AFACS.<br/>Copyright &#xa9; 2021

<14>
Accession Number
2013796114
Title
Meta-analysis of Surgical Left Atrial Appendage Occlusion During Cardiac
Surgery.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Mohamed M.M.G.; Faisaluddin M.; Kheiri B.; Osman M.
Institution
(Mohamed) Internal Medicine Department, SSM Health St. Mary's Hospital,
St. Louis, MO, United States
(Faisaluddin) Internal Medicine Department, Rochester General Hospital,
Rochester, NY, United States
(Kheiri) Knight Cardiovascular Institute, Oregon Health & Science
University, Portland, OR, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV, United States
Publisher
Elsevier Inc.

<15>
Accession Number
2013462912
Title
Pseudomeningocele-a rare complication following thoracic spinal
decompression surgery: clinical features, treatment guidelines, technical
notes, and evaluation of results.
Source
International Orthopaedics. (no pagination), 2021. Date of Publication:
2021.
Author
Wang L.; Yang X.; Wang H.; Chen Z.; Sun C.; Li W.
Institution
(Wang, Yang, Wang, Chen, Sun, Li) Department of Orthopaedics, Peking
University Third Hospital, Haidian District, 49 North Garden Road, Beijing
100191, China
(Wang, Yang, Wang, Chen, Sun, Li) Engineering Research Center of Bone and
Joint Precision Medicine, Beijing, China
(Wang, Yang, Wang, Chen, Sun, Li) Beijing Key Laboratory of Spinal Disease
Research, Beijing, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Pseudomeningocele (PMC) is a rare complication following thoracic
spinal decompression surgery. The aim of this study is to assess the
clinical features and treatment of PMC and provide the technical notes
with revision surgery. <br/>Method(s): Between January 2010 and December
2019, patients who developed PMC after posterior thoracic surgery were
enrolled. An additional 25 patients who suffered cerebrospinal fluid
leakage (CSFL) but did not develop PMC in the same period were randomly
selected. General data, intra-operative factors, CSFL position, cost,
modified Japanese Orthopaedic Association (mJOA) scores, patient
satisfaction, and clinical features were recorded and compared between the
two groups. <br/>Result(s): Eighteen patients were diagnosed with PMC
after thoracic spinal surgery. The average length, width, and depth were
16.25 +/- 5.73 cm, 6.96 +/- 3.61 cm and 4.39 +/- 2.2 cm, respectively. The
most common symptom was neurological deficits following incision problems
and headache. Compared with the control group, the PMC group showed a
longer duration of initial surgery, greater estimated blood loss, an
increased rate of CSFL on the ventral side, reduced mJOA scores, and lower
patient satisfaction at the final follow-up. <br/>Conclusion(s): PMC is a
rare complication of thoracic surgery with an incidence of 1.12%. PMC
typically occurs at the upper and lower thoracic spine, resulting in
increased health care costs, poorer neurological recovery, and a lower
rate of patient satisfaction. The management of PMC should be
individualized depending on diagnosis time and symptoms.<br/>Copyright
&#xa9; 2021, SICOT aisbl.

<16>
Accession Number
635735911
Title
Device Profile of the VEST for External Support of SVG Coronary Artery
Bypass Grafting: Historical Development, Current Status and Future
Directions.
Source
Expert review of medical devices. (no pagination), 2021. Date of
Publication: 27 Jul 2021.
Author
Goldstein D.J.
Institution
(Goldstein) Montefiore Medical Center - Cardiothoracic Surgery, Bainbridge
Ave MAP Building, 5th Fl Bronx, NY, United States
Publisher
NLM (Medline)
Abstract
A search for strategies to address saphenous vein graft (SVG) failure -
the main factor limiting the long-term success of coronary bypass grafting
- has led to trialing of external stenting technologies. AREAS COVERED:
The manuscript covers historical development and current status of
external scaffolding for the treatment of SVG intimal hyperplasia.
Comprehensive literature review and personal communication with VGS
leadership, the developer of the VEST device, served as the sources.
EXPERT OPINION: If the external scaffolding concept proves to be
successful in mitigating the intimal hyperplasia inherent to arterialized
saphenous vein conduits, it could have a dramatic impact on the recurrence
of anginal symptoms, the need for repeat revascularization, and the
incidence of myocardial infarction following CABG surgery. These laudable
sequelae could ultimately convey significant public health repercussions
by reducing healthcare resource use and improving the long-term survival
and quality of life of CABG recipients.

<17>
Accession Number
2010942033
Title
Venous outcomes at 1 year after using the femoral vein as a conduit for
passage of percutaneous femoropopliteal bypass.
Source
Journal of Vascular Surgery: Venous and Lymphatic Disorders. 9 (5) (pp
1266-1272.e3), 2021. Date of Publication: September 2021.
Author
Schneider P.A.; Krievins D.K.; Halena G.; Schmidt A.; Lyden S.; Lee V.; Hu
M.; Adelman M.
Institution
(Schneider) Division of Vascular and Endovascular Surgery, University of
California, San Francisco, Calif, United States
(Krievins) Division of Vascular Surgery, Department of Surgery, P.
Stradins Clinical University Hospital, Riga, Latvia
(Halena) Department of Vascular Surgery, Medical University of Gdansk,
Gdansk, Poland
(Schmidt) Department of Angiology, University Hospital Leipzig, Leipzig,
Germany
(Lyden) Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH,
United States
(Lee, Hu, Adelman) Syntactx, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: The DETOUR 1 study was performed to assess the safety of the
femoral vein as a "pass through" conduit for covered stent placement
during fully percutaneous femoropopliteal bypass, also known as the DETOUR
procedure. <br/>Method(s): At eight participating centers in this
prospective, single-arm, international trial, 78 patients (82
femoropopliteal lesions) were enrolled. All patients had patent femoral
veins measuring >=10 mm in diameter at baseline. The DETOUR procedure
involved delivery of a series of TORUS stent grafts, deployed from
contralateral common femoral artery access, to the ipsilateral proximal
superficial femoral artery, with entry into the femoral vein and re-entry
into the arterial vasculature at the above-the-knee popliteal artery. The
TORUS stent grafts are deployed in an overlapping configuration as an
arterial-arterial conduit. Due to this novel transvenous approach, we
assessed specific considerations related to the venous system to analyze
the risk of risk of venous thromboembolic complications. Symptomatic deep
vein thrombosis, nonocclusive material associated with the graft such as
benign endovenous graft-associated material, pulmonary embolism, Venous
Clinical Severity Score (VCSS) and Villalta scores, and luminal occupancy
by the stent graft were assessed as the ratio of cross-sectional areas of
the stent graft to the native vein at baseline and 1 year after the
procedure. <br/>Result(s): A duplicate femoral vein was present in 20.7%
of cases. The majority of patients (86.8%) had a femoral vein luminal area
preservation of >=55%. Thirty-two patients experienced an increase in the
vein diameter over time after the procedure, but this pattern of venous
remodeling was not uniform. The patients who had a compensatory increase
in the vein diameter had a smaller average baseline vein diameter compared
with the patients who did not have a compensatory increase in vein
diameter (P = .0414). Only two patients (2.4%) developed ipsilateral
symptomatic deep vein thrombosis) through 1 year of follow-up. There were
no pulmonary embolism in any patient in the series. The overall VCSS and
Villata scores did not change during follow-up. Mean VCSS and Villata were
0.8 +/- 1.4 and 0.5 +/- 1.1 at 1 year, compared with 0.6 +/- 1.0 and 0.4
+/- 0.9 at baseline, respectively. <br/>Conclusion(s): As a percutaneous
alternative to open surgical bypass for complex femoropopliteal peripheral
arterial disease, the transvenous bypass has a low rate of deep venous
thrombotic and obstructive complications. Cross-sectional vein area is
preserved, and in some patients, the compensatory vein diameter increases
with time, supporting the feasibility and safety of using the lower
extremity deep venous system as a pass-through conduit for the DETOUR
percutaneous femoropopliteal bypass. Trial Registration:
NCT02471638.<br/>Copyright &#xa9; 2021 Society for Vascular Surgery

<18>
Accession Number
2010920415
Title
Mortality in patients with cardiogenic shock supported with VA ECMO: A
systematic review and meta-analysis evaluating the impact of etiology on
29,289 patients.
Source
Journal of Heart and Lung Transplantation. 40 (4) (pp 260-268), 2021. Date
of Publication: April 2021.
Author
Alba A.C.; Foroutan F.; Buchan T.A.; Alvarez J.; Kinsella A.; Clark K.;
Zhu A.; Lau K.; McGuinty C.; Aleksova N.; Francis T.; Stanimirovic A.;
Vishram-Nielsen J.; Malik A.; Ross H.J.; Fan E.; Rac V.E.; Rao V.; Billia
F.
Institution
(Alba, Foroutan, Buchan, Alvarez, Kinsella, Clark, Zhu, Lau, McGuinty,
Aleksova, Vishram-Nielsen, Malik, Ross, Rac, Rao, Billia) Ted Rogers
Center of Excellence, Peter Munk Cardiac Centre, Toronto, ON, Canada
(Francis, Stanimirovic) Toronto Health Economics and Technology Assessment
(THETA) Collaborative, Institute of Health Policy, Management and
Evaluation, Dalla Lana School of Public Health
(Fan) Interdepartmental Division of Critical Care Medicine, University of
Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is
associated with variable outcomes. In this meta-analysis, we evaluated the
mortality after VA ECMO across multiple etiologies of cardiogenic shock
(CS). <br/>METHOD(S): In June 2019, we performed a systematic search
selecting observational studies with >=10 adult patients reporting on
short-term mortality (30-day or mortality at discharge) after initiation
of VA ECMO by CS etiology published after 2009. We performed meta-analyses
using random effect models and used metaregression to evaluate mortality
across CS etiology. <br/>RESULT(S): We included 306 studies (29,289
patients): 25 studies on after heart transplantation (HTx) (771 patients),
13 on myocarditis (906 patients), 33 on decompensated heart failure (HF)
(3,567 patients), 64 on after cardiotomy shock (8,231 patients), 10 on
pulmonary embolism (PE) (221 patients), 80 on acute myocardial infarction
(AMI) (7,774 patients), and 113 on after cardiac arrest [CA] (7,814
patients). With moderate certainty on effect estimates, we observed
significantly different mortality estimates for various etiologies (p <
0.001), which is not explained by differences in age and sex across
studies: 35% (95% CI: 29-42) for after HTx, 40% (95% CI: 33-46) for
myocarditis, 53% (95% CI: 46-59) for HF, 52% (95% CI: 38-66) for PE, 59%
(95% CI: 56-63) for cardiotomy, 60% (95% CI: 57-64) for AMI, 64% (95% CI:
59-69) for post-in-hospital CA, and 76% (95% CI: 69-82) for
post-out-of-hospital CA. Univariable metaregression showed that variation
in mortality estimates within etiology group was partially explained by
population age, proportion of females, left ventricle venting, and CA.
<br/>CONCLUSION(S): Using an overall estimate of mortality for patients
with CS requiring VA ECMO is inadequate given the differential outcomes by
etiology. To further refine patient selection and management to improve
outcomes, additional studies evaluating patient characteristics impacting
outcomes by specific CS etiology are needed.<br/>Copyright &#xa9; 2021
International Society for Heart and Lung Transplantation

<19>
Accession Number
2013292614
Title
Feasibility and efficacy of cryoneurolysis analgesia in robotic-assisted
thoracoscopic surgery (CARTS): a pilot study.
Source
Journal of Robotic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Tung J.; Patel R.; Rajwani T.; Han S.; Hanson N.; Sternbach J.; Hubka M.
Institution
(Tung, Patel, Rajwani, Han, Hanson, Sternbach, Hubka) Virginia Mason
Medical Center, Virginia Mason Hospital, Seattle, WA, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Opioid therapy has been the mainstay therapy of post-operative pain
management in thoracic surgery patients. With the high incidence of
chronic pain in thoracic surgery patients and adverse effects of opioids,
we examined the safety and efficacy of cryoneurolysis as an adjunct for
narcotic-free pain management in robotic-assisted thoracoscopic
lobectomies. Ten consecutive patients undergoing robotic-assisted
(DaVinci) pulmonary resection and cryoneurolysis were compared to ten
patients managed without intraoperative cryoneurolysis. All patients
received multimodal pain regimen including paravertebral blocks as per our
institutional enhanced recovery pathway. Patients with chronic pain and
chronic opioid use were excluded. We compared inpatient and outpatient
opioid consumption measured in morphine equivalents (mme), incidence of
opioid-free outpatient recovery, and adverse events. The two groups did
not differ significantly in terms of baseline demographics. Both inpatient
(88.13 vs 26.92 mme) and outpatient (118.5 vs 34.5 mme) use of narcotics
were significantly lower in the cryoneurolysis group (p < 0.05) with seven
of ten patients receiving cryoneurolysis able to recover without the use
of opioids in the outpatient setting, compared to two in the control
group. One patient reported post-operative neuralgia in each
cryoneurolysis and control group. There were no readmissions in either
group and mean length of stay was identical at 1.7 days in control group
and 1.1 days in experimental group (p = 0.33). The use of intraoperative
intercostal cryoneurolysis may safely reduce the utilization of outpatient
opioids in patients undergoing robotic-assisted thoracoscopic surgery. A
randomized controlled trial is warranted to validate these findings in a
larger cohort of patients.<br/>Copyright &#xa9; 2021, The Author(s), under
exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

<20>
Accession Number
2013284437
Title
Albumin use in bleeding cardiac surgical patients and associated patient
outcomes.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Hanley C.; Callum J.; McCluskey S.; Karkouti K.; Bartoszko J.
Institution
(Hanley) Department of Anesthesia, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre, Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Kingston, ON, Canada
(Karkouti, Bartoszko) Department of Anesthesia and Pain Management,
Toronto General Hospital - University Health Network, Sinai Health System,
Women's College Hospital, University of Toronto, 200 Elizabeth Street,
3EN-464, Toronto, ON M5G 2C4, Canada
(McCluskey, Karkouti, Bartoszko) Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Health Network, Toronto,
ON, Canada
(McCluskey, Karkouti) Institute of Health Policy Management and
Evaluation, University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: Albumin solution is a colloid used for resuscitation in cardiac
surgical patients, but it is unclear if it offers advantages over
crystalloids. We examined current clinical practice across 11 cardiac
surgical centres and the association of albumin with outcomes in a cohort
of bleeding cardiac surgical patients. <br/>Method(s): This was a post hoc
analysis of data from the Effect of Fibrinogen Concentrate vs
Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery
(FIBRES) trial. Multivariable regression models adjusted for demographic
and surgical characteristics were used to examine predictors of early
albumin administration (within the initial 24 perioperative hours), late
albumin administration (from 24 hr to seven days after cardiopulmonary
bypass), and the association of albumin use with 28-day acute kidney
injury, mortality, and length of hospital and intensive care unit (ICU)
stay. <br/>Result(s): Of the 735 patients included, 525 (71%) received
albumin, ranging from 4.8% to 97.4% of patients across institutions, with
475 (64.6%) receiving albumin early (5% or 25% solution). In the adjusted
models, female sex and preoperative hospital admission were associated
with early use, while heart failure, female sex, bleeding severity, older
age, and prior albumin use were predictors of later administration. Early
albumin use was not associated with differences in acute kidney injury
(adjusted odds ratio [aOR] 1.77; 95% confidence interval [CI], 0.96 to
3.27; P = 0.07), mortality (aOR 1.66; 95% CI, 0.99 to 2.78; P = 0.05), or
length of ICU stay (P = 0.11) or hospital stay (P = 0.67).
<br/>Conclusion(s): Albumin use is common but highly variable within and
across sites. Albumin use was not associated with improved outcomes. High
quality randomized controlled trials should clarify its role in cardiac
surgical patients.<br/>Copyright &#xa9; 2021, Canadian Anesthesiologists'
Society.

<21>
Accession Number
2013281926
Title
Comparison of dopamine versus norepinephrine in circulatory shock after
cardiac surgery: A randomized controlled trial.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Lim J.Y.; Park S.J.; Kim H.J.; Choo S.J.; Chung C.H.; Lee J.W.; Park
D.-W.; Kim J.B.
Institution
(Lim) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Park, Kim, Choo, Chung, Lee, Kim) Department of Thoracic and
Cardiovascular Surgery, Asan Medical Center, University of Ulsan College
of Medicine, Seoul, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Anam Hospital,
University of Korea College of Medicine, Seoul, South Korea
(Park) Department of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim of the Study: Although dopamine and norepinephrine are
recommended as first-line agents in the treatment of shock, it is unclear
which is the optimal vasoactive inotropic agent (VIA) to manage
postcardiotomy circulatory shock. This single-center, randomized clinical
trial aimed to investigate the efficacy and safety of dopamine versus
norepinephrine in postcardiotomy circulatory shock. <br/>Method(s): We
randomly assigned the patients with postcardiotomy circulatory shock to
receive either dopamine or norepinephrine. When shock persisted despite
the dose of 20 mug/kg/min of dopamine or the dose of 0.2 mug/kg/min of
norepinephrine, epinephrine or vasopressin could be added. The primary
endpoint was new-onset tachyarrhythmic event during drug infusion.
Secondary endpoints included requirement of additional VIAs, postoperative
complications, and all-cause mortality within 30 days of drug initiation.
<br/>Result(s): At the planned interim analysis of 100 patients, the
boundary for the benefit of norepinephrine has been crossed, and the study
was stopped early. Excluding two patients withdrawing a consent, 48
patients were assigned to dopamine and 50 patients to norepinephrine.
New-onset tachyarrhythmic event occurred in 12 (25%) patients in the
dopamine and one (2%) patient in the norepinephrine group (p =.009). The
requirement for additional VIAs was more common in the dopamine group (p
<.001). Other secondary endpoints were similar between groups.
<br/>Conclusion(s): Despite the limited study subjects with early
determination, in patients with postcardiotomy circulatory shock, dopamine
as a first-line vasopressor was associated with higher tachyarrhythmic
events and greater need for additional VIAs compared with
norepinephrine.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<22>
Accession Number
2013281853
Title
Network meta-analysis of treatment strategies in patients with coronary
artery disease and low left ventricular ejection fraction.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yokoyama Y.; Fukuhara S.; Mori M.; Noguchi M.; Takagi H.; Briasoulis A.;
Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
(Mori) Division of Cardiac Surgery, Yale School of Medicine, New Haven,
CT, United States
(Noguchi) Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical
Center, Urayasu, Japan
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Cardiology, Heart failure and Transplantation,
University of Iowa, Iowa City, IA, United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York City, NY, United States
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein Medical College, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The optimal treatment strategy in patients with coronary artery
disease (CAD) and low left ventricular ejection fraction (LVEF) remains
controversial. Herein, we conducted a network meta-analysis comparing
coronary artery bypass graft (CABG), percutaneous coronary intervention
(PCI), and optimal medical therapy (OMT) in patients with CAD and low
LVEF. <br/>Method(s): MEDLINE and EMBASE were searched through March, 2021
to identify randomized controlled trials (RCTs) and propensity-score
matched (PSM) studies comparing CABG, PCI, and OMT. We extracted hazard
ratios (HRs) of the outcomes. <br/>Result(s): A total of three RCTs and 10
PSM trials were identified, yielding a total of 18,855 patients with CAD
with low EF who were treated with CABG (n = 9241), PCI (n = 8771), or OMT
(n = 1003). All-cause mortality was significantly lower in patients with
CABG compared with those with PCI or OMT (HR [95% confidence interval
(CI)] = 0.72 [0.62-0.82], p <.001, HR [95% CI] = 0.65 [0.51-0.82], p
=.004, respectively), while no difference was observed between PCI and
OMT. The rates of MI were significantly lower in patients treated with
CABG compared to those treated with PCI or OMT. However, the subgroup
analysis by limiting the PCI group to patients who received drug-eluting
stent (DES) showed similar all-cause mortality between CABG and PCI, while
both CABG and PCI were associated with lower all-cause mortality compared
with OMT. Concluion: The present study demonstrated that CABG was the
appropriate treatment strategy in patients with CAD and low LVEF. Further
long-term trials were warranted to investigate outcomes of PCI with DES
compared with CABG.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC.

<23>
Accession Number
635727987
Title
Iron supplementation for patients undergoing cardiac surgery: a protocol
for a systematic review and meta-analysis of randomized controlled trials.
Source
CMAJ open. 9 (2) (pp E623-E626), 2021. Date of Publication: 01 Apr 2021.
Author
Cameron M.J.; Al Kharusi L.; Gosselin A.; Baradari P.G.; Chirico A.;
Amar-Zifkin A.; Yang S.S.
Institution
(Cameron, Al Kharusi, Gosselin, Baradari, Chirico, Amar-Zifkin, Yang)
Faculty of Medicine (Cameron, Gosselin, Gholipour Baradari, Chirico,
Yang), McGill University; Department of Anesthesia (Cameron, Al Kharusi,
Yang), McGill University; Department of Anesthesia (Cameron, Yang), Jewish
General Hospital; McGill University Health Centre Medical Libraries
(Amar-Zifkin), Montreal, Que
Publisher
NLM (Medline)
Abstract
BACKGROUND: Iron administration has been evaluated in several randomized
controlled trials for the potential of increasing baseline hemoglobin
values and decreasing the incidence of red blood cell transfusion during
cardiac surgery. We describe the protocol for a study aiming to evaluate
the efficacy and safety of perioperative iron administration in patients
undergoing cardiac surgery. <br/>METHOD(S): We will search MEDLINE,
Embase, the Cochrane Central Register of Controlled Trials and the Web of
Science, from inception to Nov. 19, 2020, for randomized controlled trials
in any language evaluating the perioperative administration of iron in
adult patients undergoing cardiac surgery; we will also include the first
50 results from Google Scholar. The primary outcome will be the incidence
of red blood cell transfusion from the study intervention time until 8
weeks postoperatively. The secondary outcomes will be the number of red
blood cell units transfused; change in ferritin level, reticulocyte count
and hemoglobin concentration after iron administration; and adverse
events. We will assess the risk of bias with the Cochrane Collaboration
Risk of Bias Tool, and will analyze the primary and secondary outcomes
using a random-effects model. INTERPRETATION: This study will summarize
the current evidence about perioperative iron administration in patients
undergoing cardiac surgery, help determine whether this intervention
should be included in enhanced-recovery protocols, and shape future
research if needed. The final manuscript will be submitted to a
peer-reviewed journal. TRIAL REGISTRATION: PROSPERO no.
CRD42020161927.<br/>Copyright &#xa9; 2021 CMA Joule Inc. or its licensors.

<24>
Accession Number
2013997842
Title
A randomized evaluation of the TriGuardTM HDH cerebral embolic protection
device to Reduce the Impact of Cerebral Embolic LEsions after
TransCatheter Aortic Valve Implan Tation: The REFLECT I trial.
Source
European Heart Journal. 42 (27) (pp 2670-2679), 2021. Date of Publication:
14 Jul 2021.
Author
Lansky A.J.; Makkar R.; Nazif T.; Messe S.; Forrest J.; Sharma R.; Schofer
J.; Linke A.; Brown D.; Dhoble A.; Horwitz P.; Zang M.; Demarco F.;
Rajagopal V.; Dwyer M.G.; Zivadinov R.; Stella P.; Rovin J.; Parise H.;
Kodali S.; Baumbach A.; Moses J.
Institution
(Lansky, Forrest, Parise, Baumbach) Division of Cardiology, Yale School of
Medicine, 135 College Street, New Haven, CT 06510, United States
(Lansky, Baumbach) Barts Heart Centre, London and Queen Mary University of
London, London, United Kingdom
(Makkar) Cedar Sinai Medical Center, Los Angeles, CA, United States
(Nazif, Kodali, Moses) College of Physicians and Surgeons, Columbia
University, New York, NY, United States
(Messe) Department of Neurology, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Sharma) Division of Cardiology, Stanford University, Stanford, CA, United
States
(Schofer) Hamburg University Cardiovascular Center, Hamburg, Germany
(Linke) University Hospital Dresden Heart Center, Dresden, Germany
(Brown) Heart Hospital Baylor, Plano, TX, United States
(Dhoble) University of Texas Health Science Center, Houston, TX, United
States
(Horwitz) University of Iowa Carver College of Medicine, Iowa City, IA,
United States
(Zang) Swedish Medical Center, Seattle, WA, United States
(Demarco) San Donato, Milan, Italy
(Rajagopal) Piedmont Heart Institute, Atlanta, GA, United States
(Dwyer, Zivadinov) Buffalo Neuroimaging Analysis Center, Department of
Neurology, State University of New York at Buffalo, Buffalo, NY, United
States
(Stella) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Rovin) BayCare Health System, Clearwater, FL, United States
Publisher
Oxford University Press
Abstract
Aims: The REFLECT I trial investigated the safety and effectiveness of the
TriGuardTM HDH (TG) cerebral embolic deflection device in patients
undergoing transcatheter aortic valve replacement (TAVR). <br/>Methods and
Results: This prospective, multicentre, single-blind, 2:1 randomized (TG
vs. no TG) study aimed to enrol up to 375 patients, including up to 90
roll-in patients. The primary combined safety endpoint (VARC-2 defined
early safety) at 30 days was compared with a performance goal. The primary
efficacy endpoint was a hierarchical composite of (i) all-cause mortality
or any stroke at 30 days, (ii) National Institutes of Health Stroke Scale
(NIHSS) worsening at 2-5 days or Montreal Cognitive Assessment worsening
at 30 days, and (iii) total volume of cerebral ischaemic lesions detected
by diffusion-weighted magnetic resonance imaging at 2-5 days. Cumulative
scores were compared between treatment groups using the
Finkelstein-Schoenfeld method. A total of 258 of the planned, 375 patients
(68.8%) were enrolled (54 roll-in and 204 randomized). The primary safety
outcome was met compared with the performance goal (21.8% vs. 35%, P <
0.0001). The primary hierarchical efficacy endpoint was not met (mean
efficacy score, higher is better: -5.3 +/- 99.8 TG vs. 11.8 +/- 96.4
control, P = 0.31). Covert central nervous system injury was numerically
lower with TG both in-hospital (46.1% vs. 60.3%, P = 0.0698) and at 5 days
(61.7 vs. 76.2%, P = 0.054) compared with controls. <br/>Conclusion(s):
REFLECT I demonstrated that TG cerebral protection during TAVR was safe in
comparison with historical TAVR data but did not meet the predefined
effectiveness endpoint compared with unprotected TAVR
controls.<br/>Copyright &#xa9; 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<25>
Accession Number
2014071056
Title
New internet-based warfarin anticoagulation management approach after
mechanical heart valve replacement: Prospective, multicenter, randomized
controlled trial.
Source
Journal of Medical Internet Research. 23 (8) (no pagination), 2021.
Article Number: e29529. Date of Publication: August 2021.
Author
Zhu Z.; Li C.; Shen J.; Wu K.; Liu K.; Zhang F.; Zhang Z.; Li Y.; Han J.;
Qin Y.; Yang Y.; Fan G.; Ding Z.; Xu D.; Chen Y.; Zheng Y.; Zheng Z.; Meng
X.; Zhang H.
Institution
(Zhu, Shen, Wu, Li, Liu, Zhang, Zhang, Li, Han, Qin, Meng, Zhang)
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Zhu) Ludwig Maximilian University of Munich, Munich, Germany
(Li) Renal Division, Department of Medicine IV, Ludwig Maximilian
University of Munich, Munich, Germany
(Zhang) Department of Cardiovascular Surgery, Beijing Luhe Hospital,
Capital Medical University, Beijing, China
(Yang, Xu) Department of Cardiovascular Surgery, Beijing Xuanwu Hospital,
Beijing, China
(Fan, Chen) Department of Cardiovascular Surgery, Peking University
People's Hospital, Beijing, China
(Zhang) Department of Cardiovascular Surgery, PLA General Hospital,
Beijing, China
(Ding, Zheng) Department of Pharmacy, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Zheng) Department of Cardiovascular Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
Publisher
JMIR Publications Inc.
Abstract
Background: Mechanical heart valve replacement (MHVR) is an effective
method for the treatment of severe heart valve disease; however, it
subjects patient to lifelong warfarin therapy after MHVR with the
attendant risk of bleeding and thrombosis. Whether internet-based warfarin
management reduces complications and improves patient quality of life
remains unknown. <br/>Objective(s): This study aimed to compare the
effects of internet-based warfarin management and the conventional
approach in patients who received MHVR in order to provide evidence
regarding alternative strategies for long-term anticoagulation.
<br/>Method(s): This was a prospective, multicenter, randomized,
open-label, controlled clinical trial with a 1-year follow-up. Patients
who needed long-term warfarin anticoagulation after MHVR were enrolled and
then randomly divided into conventional and internet-based management
groups. The percentage of time in the therapeutic range (TTR) was used as
the primary outcome, while bleeding, thrombosis, and other events were the
secondary outcomes. <br/>Result(s): A total of 721 patients were enrolled.
The baseline characteristics did not reach statistical differences between
the 2 groups, suggesting the random assignment was successful. As a
result, the internet-based group showed a significantly higher TTR (mean
0.53, SD 0.24 vs mean 0.46, SD 0.21; P<.001) and fraction of time in the
therapeutic range (mean 0.48, SD 0.22 vs mean 0.42, SD 0.19; P<.001) than
did those in the conventional group. Furthermore, as expected, the
anticoagulation complications, including the bleeding and embolic events
had a lower frequency in the internet-based group than in the conventional
group (6.94% vs 12.74%; P=.01). Logistic regression showed that
internet-based management increased the TTR by 7% (odds ratio [OR] 1.07,
95% CI 1.05-1.09; P<.001) and reduced the bleeding and embolic risk by 6%
(OR 0.94, 95% CI 0.92-0.96; P=.01). Moreover, low TTR was found to be a
risk factor for bleeding and embolic events (OR 0.87, 95% CI 0.83-0.91;
P=.005). <br/>Conclusion(s): The internet-based warfarin management is
superior to the conventional method, as it can reduce the anticoagulation
complications in patients who receive long-term warfarin anticoagulation
after MHVR.<br/>Copyright &#xa9;Zhihui Zhu, Chenyu Li, Jinglun Shen,
Kaisheng Wu, Yuehuan Li, Kun Liu, Fan Zhang, Zhenhua Zhang, Yan Li, Jie
Han, Ying Qin, Yu Yang, Guangpu Fan, Huajun Zhang, Zheng Ding, Dong Xu, Yu
Chen, Yingli Zheng, Zhe Zheng, Xu Meng, Haibo Zhang.

<26>
Accession Number
2014072382
Title
Perioperative Neutrophil-Lymphocyte Ratio Predicts Mortality After Cardiac
Surgery: Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Perry L.A.; Liu Z.; Loth J.; Penny-Dimri J.C.; Plummer M.; Segal R.; Smith
J.
Institution
(Perry, Liu, Loth, Segal) Department of Anaesthesia, Royal Melbourne
Hospital, Parkville, Australia
(Penny-Dimri, Smith) Department of Surgery, Monash University, Clayton,
Australia
(Penny-Dimri, Smith) School of Clinical Sciences, Monash Health, Clayton,
Australia
(Plummer) Intensive Care Unit, Royal Melbourne Hospital, Parkville,
Australia
(Plummer) Department of Critical Care, University of Melbourne, Parkville,
Australia
(Segal) Department of Medicine, University of Melbourne, Parkville,
Australia
Publisher
W.B. Saunders
Abstract
Objectives: Neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker
that has been evaluated across a variety of surgical disciplines and is
widely predictive of poor postoperative outcome, but its value in cardiac
surgery is unclear. The authors did this systematic review and
meta-analysis to determine the impact of elevated perioperative NLR on
survival after cardiac surgery. <br/>Design(s): Systematic review and
meta-analysis of study-level data. <br/>Setting(s): Multiple hospitals
involved in an international pool of studies. <br/>Participant(s): Adults
undergoing cardiac surgery. <br/>Intervention(s): None. <br/>Measurements
and Main Results: The authors searched multiple databases from inception
until November 2020. They generated summary hazard ratios (HR) and odds
ratios (OR) for the association of elevated preoperative NLR with
long-term and short-term mortality following cardiac surgery. They
separately reported on elevated postoperative NLR. Between-study
heterogeneity was explored using metaregression. The authors included 12
studies involving 13,262 patients undergoing cardiac surgery. Elevated
preoperative NLR was associated with worse long-term (>30 days) (hazard
ratio [HR] 1.56; 95% CI [confidence interval], 1.18-2.06; 8 studies) and
short-term (<30 days) mortality (OR 3.18; 95% CI, 1.90-5.30; 7 studies).
One study reported the association of elevated postoperative NLR with
long-term mortality (HR 8.58; 95% CI, 2.55-28.85). There was considerable
between-study heterogeneity for the analysis of long-term mortality
(I² statistic 94.39%), which mostly was explained by
study-level variables, such as the number of variables adjusted for by
included studies and how many of these significantly increased the risk of
long-term mortality, high risk of bias, and number of study centers, as
well as participant level factors, such as average participant age and
hypertension prevalence. <br/>Conclusion(s): Perioperative NLR is an
independent predictor of short-term and long-term postoperative mortality
following cardiac surgery. Further research is required to determine which
patient-level factors modify the prognostic value of NLR and to evaluate
its role in routine clinical practice.<br/>Copyright &#xa9; 2021 Elsevier
Inc.

<27>
Accession Number
624755353
Title
Repetitive levosimendan infusions for patients with advanced chronic heart
failure in the vulnerable post-discharge period.
Source
ESC Heart Failure. 6 (1) (pp 174-181), 2019. Date of Publication: February
2019.
Author
Polzl G.; Allipour Birgani S.; Comin-Colet J.; Delgado J.F.; Fedele F.;
Garcia-Gonzales M.J.; Gustafsson F.; Masip J.; Papp Z.; Stork S.; Ulmer
H.; Vrtovec B.; Wikstrom G.; Altenberger J.
Institution
(Polzl, Allipour Birgani) Department of Internal Medicine III, Medical
University Innsbruck, Innsbruck, Austria
(Comin-Colet) Department of Cardiology, Bellvitge University Hospital and
IDIBELL, University of Barcelona Hospitalet de Llobregat, Barcelona, Spain
(Delgado) Department of Cardiology, University Hospital 12 de Octubre,
CIBERCV, Madrid, Spain
(Fedele) Department of Cardiovascular, Respiratory, Nephrology,
Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome,
Italy
(Garcia-Gonzales) Department of Cardiology, University Hospital Canarias,
San Cristobal de La Laguna, Tenerife, Spain
(Gustafsson) Department of Cardiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Masip) Intensive Care Department, Consorci Sanitari Integral, University
of Barcelona, Barcelona, Spain
(Masip) Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain
(Papp) Department of Cardiology, Division of Clinical Physiology, Faculty
of Medicine, University of Debrecen, Debrecen, Hungary
(Stork) Department of Internal Medicine and Comprehensive Heart Failure
Center, University Hospital Wurzburg, Wurzburg, Germany
(Ulmer) Department for Medical Statistics, Informatics and Health
Economics, Medical University Innsbruck, Innsbruck, Austria
(Vrtovec) Department of Cardiology, University Medical Center Ljubljana,
Ljubljana, Slovenia
(Wikstrom) Department of Cardiology, Institute of Medical Sciences,
Uppsala University Hospital, Uppsala, Sweden
(Altenberger) Cardiac Rehabilitation Center Grossgmain,
Pensionsversicherungsanstalt, Teaching Hospital of Paracelsus Medical
Private University, Salzburg, Austria
Publisher
Wiley-Blackwell
Abstract
Hospitalization for acute heart failure (HF) is associated with a
substantial morbidity burden and with associated healthcare costs and an
increased mortality risk. However, few if any major medical innovations
have been witnessed in this area in recent times. Levosimendan is a
first-in-class calcium sensitizer and potassium channel opener indicated
for the management of acute HF. Experience in several clinical studies has
indicated that administration of intravenous levosimendan in intermittent
cycles may reduce hospitalization and mortality rates in patients with
advanced HF; however, none of those trials were designed or powered to
give conclusive insights into that possibility. This paper describes the
rationale and protocol of LeoDOR (levosimendan infusions for patients with
advanced chronic heart failure), a randomized, double-blind,
placebo-controlled, international, multicentre trial that will explore the
efficacy and safety of intermittent levosimendan therapy, in addition to
optimized standard therapy, in patients following hospitalization for
acute HF. Salient features of LeoDOR include the use of two treatment
regimens, in order to evaluate the effects of different schedules and
doses of levosimendan during a 12 week treatment phase, and the use of a
global rank primary endpoint, in which all patients are ranked across
three hierarchical groups ranging from time to death or urgent heart
transplantation or implantation of a ventricular assist device to time to
rehospitalization and, lastly, time-averaged proportional change in
N-terminal pro-brain natriuretic peptide. Secondary endpoints include
changes in HF symptoms and functional status at 14 weeks.<br/>Copyright
&#xa9; 2018 The Authors. ESC Heart Failure published by John Wiley & Sons
Ltd on behalf of the European Society of Cardiology.

<28>
Accession Number
624632544
Title
Heart transplantation for infective endocarditis: Viable option for a
limited few?.
Source
Transplant Infectious Disease. 21 (1) (no pagination), 2019. Article
Number: e13006. Date of Publication: February 2019.
Author
Murphy K.M.; Vikram H.R.
Institution
(Murphy) Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ,
United States
(Vikram) Division of Infectious Diseases, Mayo Clinic, Phoenix, AZ, United
States
Publisher
John Wiley and Sons Inc
Abstract
Active infection in the recipient is considered a relative
contraindication for solid organ transplantation. However, heart
transplantation (HT) can be curative in patients with ventricular assist
device infections. For patients with infective endocarditis (IE), valve
replacement is part of the management strategy based on emergent, acute,
or elective indications. HT has been utilized as an uncommon and sporadic
treatment option for carefully selected patients with refractory or
recurrent IE after all other surgical treatment options have been
exhausted or are not feasible. Herein, we review 19 published cases of IE
in whom HT was undertaken in the setting of ongoing active infection with
reported good outcomes. We attempt to propose general criteria for HT in
the setting of IE and discuss challenges and hurdles that clinicians might
encounter when considering HT for active IE in the absence of robust data
or clearly defined criteria.<br/>Copyright &#xa9; 2018 John Wiley & Sons
A/S. Published by John Wiley & Sons Ltd

<29>
Accession Number
2014049674
Title
Leg wound complications: A comparison between endoscopic and open
saphenous vein harvesting techniques.
Source
Heart Surgery Forum. 24 (4) (pp E604-E610), 2021. Date of Publication: 26
Jul 2021.
Author
Mubarak Y.; Abdeljawad A.
Institution
(Mubarak) Cardiothoracic Surgery Department, Minia University, Egypt
(Mubarak) Madinah Cardiac Center, KSA, Saudi Arabia
(Abdeljawad) Cardiothoracic Surgery Department, Cairo University, Egypt
(Abdeljawad) Clinical of Cardiothoracic and Vascular Surgery, Stadtisches
Klinikum Braunschweig, Germany
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: The most common conduit for coronary artery bypass graft
(CABG) surgery is saphenous vein graft (SVG). There are two techniques for
SVG harvesting: open and endoscopic. Our aim is to evaluate clinical
results of endoscopic versus open SVG harvesting. Nowadays, endoscopic
vein harvesting (EVH) has become prevalent because of reduced
complications with more patient satisfaction. <br/>Objective(s): We
designed and performed a prospective randomized cohort study of patients
undergoing CABG to compare the results of open versus endoscopic
harvesting technique. <br/>Method(s): Patients who underwent elective CABG
at our hospitals were divided into two groups, during the period of
January 2019 to March 2021. The EVH group (50 patients) underwent
endoscopic technique compared with the open vein harvesting (OVH) group
(50 patients) that was underwent open surgical incision for great
saphenous vein (GSV) harvesting. The two groups demographically were
similar and received identical management. Leg wound was evaluated at
discharge, two weeks, and four weeks for evidence of any complications.
Early outcomes were recorded, including infection, gaped wound and
surgical re-suture, degree of pain, level of cosmetic satisfaction, and
early mobilization. <br/>Result(s): In the EVH group, harvesting time
increased, and incision closure time decreased in comparison with OVH. The
hospital stay was 5.5 +/- 2.4 days in the EVH group versus 9.5 +/- 2.7
days in the OVH group. Leg wound complications were significantly reduced
in the EVH group in comparison with the OVH group. <br/>Conclusion(s):
Endoscopic vein harvesting technique reduced leg wound complications.
Conveniently, patients also were cosmetically satisfied.<br/>Copyright
&#xa9; 2021 Forum Multimedia Publishing LLC. All rights reserved.

<30>
Accession Number
2014049663
Title
CD133+ stem cell therapy effects on myocardial regeneration through
increased vascular endothelial growth factor correlate with cardiac
magnetic resonance imaging results in coronary artery bypass graft surgery
patients with low ejection fraction.
Source
Heart Surgery Forum. 24 (4) (pp E670-E674), 2021. Date of Publication: 29
Jul 2021.
Author
Soetisna T.W.
Institution
(Soetisna) Department of Cardiothoracic and Vascular Surgery, National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Stem cell implantation has become a promising therapy for
heart failure due to coronary heart disease (CHD). CD133+ stem cell
therapy, together with increases of vascular endothelial growth factor
(VEGF) and other growth hormones, can induce myocardial repair.
<br/>Objective(s): To prove that VEGF plays a role in cardiac
regeneration. <br/>Method(s): Twenty-six patients with CHD and ejection
fractions <35% from Harapan Kita Heart and Vascular Center, Jakarta,
Indonesia, from 2016 to 2018 were randomized into 2 groups. The treatment
group underwent coronary artery bypass graft (CABG) + CD133+ implantation,
and the control group underwent CABG only. Six months later, perfusion and
myocardial function were assessed by ejection fraction, wall motion score
index (WMSI), ventricular dimensions, and scar size using cardiovascular
magnetic resonance imaging. VEGF was assessed with enzyme-linked
immunosorbent assay. <br/>Result(s): There was significant improvement in
ejection fraction (8.69% +/- 9.49% versus 1.43% +/- 7.87%, P = .04), WMSI
(0.51 +/- 0.48 versus -0.01 +/- 0.21, P = .003), and scar size (25.46 +/-
12.91 versus 27.32 +/- 12.92 mm, P = .047) and a significant increase in
blood VEGF levels (61.05 +/- 63.01 versus 19.88 +/- 33.78 pg/mL, P = .01).
Improvements in perfusion defects (13.69 +/- 5.03 versus 11.53 +/- 5.81 P
= .32) and ventricular dimensions (-27.59 +/- 84.48 versus -19.08 +/-
36.79 mm, P = .06) were not statistically significant. <br/>Conclusion(s):
CD133+ stem cell implantation improves myocardial function. The increase
in VEGF levels is expected to continue improving restoration of myocardial
function when myocardial perfusion improvement is still not
optimal.<br/>Copyright &#xa9; 2021 Forum Multimedia Publishing LLC. All
rights reserved.

<31>
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). <br/>Method(s): Pubmed, Embase, and Cochrane
Trials databases were searched for randomized controlled trials (RCTs)
comparing the rhythm outcome of AF patients undergoing pulmonary vein
isolation (PVI), left atrial Maze (LAM), bi-atrial Maze (BAM), or no
ablation during concomitant cardiac surgery. An NMA was conducted to
explore the difference of over 1 year AF freedom as well as risks for
early mortality and permanent pacemaker implantation (PPMI).
<br/>Result(s): A total of 2031 patients of 19 RCTs were included. PVI,
LAM, and BAM (OR [95% Cr.I]: 5.02 [2.72, 10.02], 7.97 [4.93, 14.29], 8.29
[4.90, 14.86], p <.05) demonstrated higher freedom of AF compared with no
ablation, however, no significant difference of rhythm outcome was found
among the three ablation strategies based on the random-effects model. BAM
was associated with an increase in early mortality when compared with no
ablation (OR [95% Cr.I]: 4.08 [1.23, 17.30], p <.05), while none of the
remaining comparisons reached statistical difference in terms of early
mortality and PPMI. <br/>Conclusion(s): Bi-atrial ablation is not superior
to left atrial ablation strategies in reducing AF recurrence for
un-selected surgical patients. BAM has a higher risk of early mortality
than no ablation, but no difference was found between bi-atrial and left
atrial ablation in regard to early mortality and PPMI based on the current
evidence.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<32>
Accession Number
2010730025
Title
Current clinical applications of speckle tracking echocardiography for
assessment of left atrial function.
Source
Journal of Echocardiography. 19 (3) (pp 129-140), 2021. Date of
Publication: September 2021.
Author
Yuda S.
Institution
(Yuda) Department of Cardiology, Teine Keijinkai Hospital, 1-jo, 12-chome,
Maeda, Teine-ku, Sapporo 006-8555, Japan
Publisher
Springer Japan
Abstract
Two-dimensional speckle tracking echocardiography (2D-STE) enables
assessment of left atrial (LA) function with better reproducibility and
less load dependence than those with conventional methods. Data regarding
LA functions determined by 2D-STE in patients with various cardiovascular
diseases have recently been accumulating. LA strain has emerged as a novel
parameter with the potential of improving the diagnostic accuracy of left
ventricular diastolic dysfunction and the prognostic value in patients
with heart failure and stroke. Furthermore, LA dysfunction determined by
2D STE can provide incremental prognostic information to conventional
echocardiographic parameters in patients with cardiovascular diseases.
Hence, 2D-STE appears to be a promising technique for diagnosis and
therapeutic decision-making. Data regarding LA functions determined by
three-dimensional speckle tracking echocardiography (3D-STE) have also
been accumulating. Here, I review recent studies, especially those
published after 2016, on clinical applications of LA function assessed by
2D-STE and 3D-STE and summarize the remaining problems to be solved for
improving the clinical utility of these techniques.<br/>Copyright &#xa9;
2021, Japanese Society of Echocardiography.

<33>
Accession Number
2007674554
Title
New or Worsened Mitral Regurgitation After Surgical Aortic Valve
Replacement: A Systematic Review.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 25 (3) (pp 173-184),
2021. Date of Publication: September 2021.
Author
Kumar N.; Kumar J.E.; Hussain N.; Gorelik L.; Essandoh M.K.; Whitson B.A.;
Bhatt A.M.; Flores A.S.; Hachem A.; Sawyer T.R.; Iyer M.H.
Institution
(Kumar, Kumar, Hussain, Gorelik, Essandoh, Bhatt, Flores, Iyer) Department
of Anesthesiology, The Ohio State University Wexner Medical Center,
Columbus, OH, United States
(Kumar) The Ohio State University College of Medicine, Columbus, OH,
United States
(Whitson) Division of Cardiac Surgery, Department of Surgery, The Ohio
State University Wexner Medical Center, OH, United States
(Hachem, Sawyer) Central Michigan University College of Medicine, Mt.
Pleasant, MI, United States
Publisher
SAGE Publications Inc.
Abstract
Background: New or worsened mitral regurgitation (MR) is an uncommon yet
serious complication after surgical aortic valve replacement (SAVR). While
there have been numerous reports of its occurrence, there is little
consensus regarding its presentation and management. This systematic
review summarizes the evidence in the current literature surrounding new
or worsened MR after SAVR and analyzes its potential implications.
<br/>Method(s): Databases were examined for all articles and abstracts
reporting on new or worsened MR after SAVR. Data collected included number
of patients studied; patient characteristics; incidences of new or
worsened MR; timing of diagnosis; and treatment. <br/>Result(s):
Thirty-six full-text citations were included in this review. The
prevalence of new or worsened MR after SAVR was 8.4%. Sixteen percent of
new MR occurrences were from an organic etiology, and 83% of new MR
occurrences were that of a functional etiology. Most diagnoses were made
in the late or unspecified postoperative period using echocardiography
(range: 0 minutes to 18 years postoperatively). While no patients died
from this complication, 7.7% of patients (16 out of 207) required emergent
procedural re-intervention. <br/>Conclusion(s): This systematic review
underscores the importance of identifying new or worsened MR following
SAVR and accurate scoring of MR severity to guide treatment. It also
outlines the associated clinical measures commonly documented following
this complication, and the usefulness of transesophageal echocardiography
for the detection of significant MR. These results reflect the current,
limited state of the literature on this topic and warrant further
investigation into MR detection and management strategies in SAVR
patients.<br/>Copyright &#xa9; The Author(s) 2020.

<34>
Accession Number
635462486
Title
The effect of phased written health education combined with healthy diet
on the quality of life of patients after heart valve replacement.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 183), 2021. Date of
Publication: 25 Jun 2021.
Author
Li D.; Liu P.; Zhang H.; Wang L.
Institution
(Li, Liu, Zhang) Department of Cardiac Surgery, First Hospital of Hebei
Medical University, Shijiazhuang, China
(Wang) Functional Division, Fourth Hospital of Hebei Medical University,
No.169 Tianshan Street ,Yuhua District, Shijiazhuang, Hebei 050000, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: To observe the effect of phased written health education
combined with healthy diet on the quality of life of patients after heart
valve replacement. <br/>METHOD(S): One hundred-thirty patients who
underwent heart valve replacement surgery in our hospital from January
2018 to January 2020 were enrolled as the research subjects. They were
randomly divided into study group (65 patients, phased written health
education combined with health Diet) and control group (65 cases, routine
health education). The drug compliance and the degree of anticoagulant
drugs knowledge were compared between the two groups in the first and
second stage rehabilitation and the recovery stage. The health behavior
ability and quality of life at different phases were also observed.
<br/>RESULT(S): During the first and the second stage rehabilitation, and
the recovery stage, the drug compliance of the study group was superior to
that of the control group, with statistical significance (P<0.05).
Meanwhile, the knowledge of anticoagulant drugs in the study group was
better than that in the control group, with statistical significance
(P<0.05). Before intervention, there was no significant difference in
health behavior ability and quality of life between the two groups
(P>0.05). The healthy behavior ability of study group for each stage was
superior to the control group, the difference was significant (P<0.05).
The healthy behavior ability and quality of life showed the same results
with statistical significance (P<0.05). <br/>CONCLUSION(S): The use of
phased written health education combined with healthy diet in patients
after heart valve replacement can effectively improve patients' medication
compliance, anticoagulant drugs knowledge, healthy behavior ability and
quality of life at different stages, and is worthy of clinical
application.

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

<36>
Accession Number
2014037106
Title
The Effects of Ischemic Preconditioning Supplementation on Endothelial
Function: A Systematic Review and Meta-Analysis.
Source
Evidence-based Complementary and Alternative Medicine. 2021 (no
pagination), 2021. Article Number: 6690691. Date of Publication: 2021.
Author
Gu X.; Liu Z.; Gao S.; Ma L.; Chen J.; Lu A.; Wang Z.; Wang B.; Li Y.
Institution
(Gu, Wang) Second Affiliated Hospital, Tianjin University of Traditional
Chinese Medicine, Tianjin, China
(Liu, Gao, Ma, Chen, Wang, Lu, Wang, Li) Tianjin University of Traditional
Chinese Medicine, Tianjin, China
Publisher
Hindawi Limited
Abstract
Objective. Ischemic preconditioning (IPC) has gradually been promoted in
clinical practice to lower the risk of cardiovascular surgery and
postoperative complications. We investigated the role of IPC on vascular
endothelial function and the relationship between IPC, flow-mediated
dilation (FMD), and brachial artery diameter (BAD). Methods. Systematic
searches were conducted in PubMed, Medline, Cochrane Library, Embase, and
Scopus databases from their inception to March 20, 2020. This research
included randomized controlled trials (RCTs) with adults, and the values
of FMD and BAD were considered as the primary outcomes. Ten studies
comprising 292 participants were included in the meta-analysis. Results.
Regarding FMD, we observed beneficial effects of IPC on endothelial
function (standardized mean difference (SMD): 1.82; 95% confidence
interval (CI): 0.64, 3.01; p<0.001; I2 = 89.9%). However, the available
evidence did not indicate that IPC affected BAD (SMD: 0.08; 95% CI: -0.03,
0.18; p>0.05; I2 = 76.5%). Conclusions. Our meta-analysis indicated a
significant effect of IPC on the endothelial function of the blood
vessels, affecting FMD but not BAD.<br/>Copyright &#xa9; 2021 Xufang Gu et
al.

<37>
Accession Number
634315512
Title
Major infections after blood transfusion in isolated coronary artery
bypass surgery patients: A meta-analysis.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. San Diego, CA United States. 136 (SUPPL 1) (pp 25),
2020. Date of Publication: November 2020.
Author
Mosalem O.; Kherallah S.; Mujer M.; Agarwal P.; Varghese M.T.; Elshafie
A.; Garces C.C.; Abdelsamia M.; Rayamajhi S.
Publisher
American Society of Hematology
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.

<38>
Accession Number
634314696
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 American Society of Hematology Annual Meeting and
Exposition, ASH 2020. San Diego, CA United States. 136 (SUPPL 1) (pp 6-7),
2020. Date of Publication: November 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.
Publisher
American Society of Hematology
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. <br/>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. <br/>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). <br/>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.

<39>
Accession Number
634311490
Title
The fares study: A multicenter, randomized, active-control, pragmatic,
phase 2 pilot study comparing prothrombin complex concentrate versus
frozen plasma in bleeding adult cardiac surgical patients.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. San Diego, CA United States. 136 (SUPPL 1) (pp
28-29), 2020. Date of Publication: November 2020.
Author
Karkouti K.; Callum J.L.
Publisher
American Society of Hematology
Abstract
Introduction: Coagulopathic bleeding is a frequent complication of cardiac
surgery and can lead to excessive blood loss, blood product transfusion,
and bleeding-related complications. Hemostatic management in bleeding
surgical patients is evolving towards targeted therapy with purified
products undergoing pathogen reduction technology. Unlike frozen plasma
(FP), purified prothrombin complex concentrates (PCCs) do not require ABO
blood type matching or thawing, are pathogen-reduced, and are associated
with a lower risk of transfusion-associated circulatory overload and
transfusion-related acute lung injury. The FARES study will compare the
efficacy and safety of PCC (Octaplex; Octapharma) versus FP in bleeding
cardiac surgical patients with confirmed or suspected coagulopathy.
Preliminary non-randomized studies suggest PCC may be superior to plasma
for management of bleeding after cardiac surgery. <br/>Method(s): The
randomized, active-control, single-blinded, pragmatic,
investigator-initiated, Phase 2 FARES pilot study will enrolled 120
bleeding adult cardiac surgery patients requiring coagulation factor
replacement from two hospitals to achieve 100 treated patients. The study
outline is shown in Figure 1. Patients were randomized to PCC or FP, with
two weight-based doses, for management of bleeding where coagulation
factor deficiency is known or suspected (patients over 50 kg were
transfused either 2000 IU of PCC or 4 units of plasma; patients under 50
kg were transfused 1500 IU of PCC or 3 units of plasma). Required second
doses will be given according to randomization group allocation, but all
patients will receive FP for their third and any subsequent doses. The
primary endpoint is hemostatic effectiveness and transfusion requirements.
Adverse events will be recorded from the beginning of surgery.
<br/>Result(s): The study commenced in September of 2019 and completed
enrollment of the last patient in June of 2020. Results were monitored and
overseen by the Independent Data and Safety Monitoring Committee. The
database will be locked in August 2020 after 28 day follow-up is complete
for all patients. Statistical analysis plan is complete. The results will
inform a definitive, pragmatic, multi-center trial to determine if PCCs
can replace plasma for the management of coagulopathy in the bleeding
cardiac surgery patient. <br/>Conclusion(s): This study will determine the
feasibility, and inform the design and primary outcome parameter, of a
definitive Phase 3 trial comparing the efficacy and safety of PCC versus
FP in bleeding cardiac surgical patients requiring coagulation factor
replacement. The pilot study results will also be used in sample size
calculations and to aid detection of any safety issues.

<40>
Accession Number
634309649
Title
Reduction in absolute involved free light chain and difference between
involved and uninvolved free light chain is associated with prolonged
major organ deterioration progression-free survival in patients with newly
diagnosed AL amyloidosis receiving bortezomib, cyclophosphamide, and
dexamethasone with or without daratumumab: Results from ANDROMEDA.
Source
Blood. Conference: 62nd American Society of Hematology Annual Meeting and
Exposition, ASH 2020. San Diego, CA United States. 136 (SUPPL 1) (pp
48-50), 2020. Date of Publication: November 2020.
Author
Comenzo R.L.; Kastritis E.; Palladini G.; Minnema M.C.; Wechalekar A.D.;
Jaccard A.; Sanchorawala V.; Lee H.C.; Gibbs S.D.; Mollee P.; Venner C.P.;
Lu J.; Schonland S.; Gatt M.; Suzuki K.; Kim K.; Cibeira M.T.; Beksac M.;
Libby E.; Valent J.; Hungria V.T.M.; Wong S.W.; Rosenzweig M.; Bumma N.;
Chauveau D.; Dimopoulos M.A.; Tran N.; Qin X.; Vasey S.Y.; Tromp B.; Weiss
B.M.; Vermeulen J.; Merlini G.
Publisher
American Society of Hematology
Abstract
Background: Systemic AL amyloidosis is characterized by the deposition of
insoluble amyloid fibrils produced by light chains synthesized by clonal
CD38⁺ plasma cells. Combining daratumumab (DARA) with
bortezomib, cyclophosphamide, and dexamethasone (VCd) has demonstrated
significantly improved outcomes in patients with AL amyloidosis. The
classification of hematologic complete response (CR) in this disease is
evolving, and the absolute reduction of the involved free light chain
(iFLC) and the difference between iFLC and uninvolved free light chain
(dFLC) are being recognized as very meaningful endpoints. Here, we present
results from the ANDROMEDA study (NCT03201965) to demonstrate the impact
of achieving deep reductions of iFLC and dFLC on major organ deterioration
progression-free survival (MOD-PFS), a novel, key secondary endpoint in
this study. <br/>Method(s): Key eligibility criteria included newly
diagnosed AL amyloidosis with measurable hematologic disease (serum
monoclonal protein >=0.5 g/dL by protein electrophoresis or serum free
light chain >=5.0 mg/dL with an abnormal kappa:lambda ratio or dFLC >=50
mg/L), >=1 involved organ, cardiac stage I-IIIA, eGFR >=20 mL/min, and
absence of symptomatic multiple myeloma. Patients were randomized (1:1) to
receive DARA-VCd or VCd alone. All patients received bortezomib (1.3
mg/m² subcutaneous [SC] weekly), cyclophosphamide (300
mg/m² oral [PO] or intravenous [IV] weekly), and dexamethasone
(20-40 mg PO or IV weekly) for six 28-day cycles. DARA SC (1800 mg,
co-formulated with recombinant human hyaluronidase PH20 in 15 mL) was
administered by injection weekly in Cycles 1-2, every other week in Cycles
3-6, and every 4 weeks thereafter for up to 24 cycles. Disease evaluations
occurred every 4 weeks (Cycles 1-6) and every 8 weeks (after Cycle 7)
until major organ deterioration, death, end of study, or withdrawal. The
primary endpoint was overall (ie, at any time) hematologic CR rate,
defined here as normalization of FLC levels and ratio (FLCr) and negative
serum and urine immunofixation, confirmed at a subsequent visit;
normalization of uninvolved FLC level and FLCr were not required if
iFLC<upper limit of normal.^1-2 The following criteria for deep
hematological response were evaluated: iFLC <=20 mg/L regardless of
FLCr³ and dFLC<10 regardless of FLCr.⁴ MOD-PFS is a
composite endpoint defined as any one of the following events (whichever
comes first): death; cardiac deterioration (requiring cardiac transplant,
left ventricular assist device or intra-aortic balloon pump); end stage
renal disease requiring hemodialysis or renal transplant; or hematologic
progression per consensus guidelines.¹ Analyses of deep
hematological responses were performed on the intent-to-treat analysis
set; patients without a baseline assessment or post-baseline assessment
were considered non-responders. Descriptive statistics were used to
summarize overall response rates. Kaplan-Meier curves were plotted for
MOD-PFS by hematologic response status. <br/>Result(s): A total of 388
patients were randomized to receive DARA-VCd (n=195) or VCd alone (n=193).
Baseline characteristics were well balanced between treatment groups. The
median age was 64 years and 65% of patients had >=2 organs involved. The
proportions of patients with heart and kidney involvement were 71% and
59%, respectively, and the proportions of patients with cardiac stage I,
II, and IIIA were 23%, 40%, and 37%, respectively. The median duration of
treatment was 9.6 months for DARA-VCd and 5.3 months for VCd. Median
follow-up was 11.4 months (range, 0.03-21.3+). The rates of deep
hematological responses by all criteria strongly favored the DARA-VCd
treatment arm (Table). MOD-PFS was longer in patients achieving deep
hematological responses by all criteria (Figure). In addition, the
corresponding MOD-PFS was similar regardless of the hematological response
criteria used. <br/>Conclusion(s): Regardless of the criteria used, the
addition of DARA to VCd increased the rates of deep hematologic responses
in patients with newly diagnosed AL amyloidosis, which, in turn, was
associated with prolonged MOD-PFS. These results support the benefit of
DARA in this patient population.

<41>
Accession Number
624224548
Title
Zero-Balance Ultrafiltration of Priming Blood Attenuates Procalcitonin and
Improves the Respiratory Function in Infants After Cardiopulmonary Bypass:
A Randomized Controlled Trial.
Source
Artificial Organs. 43 (2) (pp 167-172), 2019. Date of Publication:
February 2019.
Author
Gholampour Dehaki M.; Niknam S.; Azarfarin R.; Bakhshandeh H.; Mahdavi M.
Institution
(Gholampour Dehaki, Niknam, Azarfarin, Bakhshandeh, Mahdavi) Rajaie
Cardiovascular, Medical & Research Center-Perfusion, Tehran Province,
Tehran, Iran, Islamic Republic of
Publisher
John Wiley and Sons Inc
Abstract
Blood priming is needed for cardiopulmonary bypass (CPB) in neonates and
infants to avoid exceeding hemodilution; however, transfusion-related
inflammation affects post-CPB outcomes in infant open-heart surgery.
Procalcitonin, a newly detected inflammatory moderator and a sensitive
parameter for predicting pulmonary dysfunction secondary to CPB, rises
after CPB. We hypothesized that the hemofiltration of priming blood before
CPB might decrease inflammatory mediators in the blood and post-CPB
inflammatory replications, thereby improving the respiratory function
after CPB in infants. Sixty infants with a weight below 10 kg were divided
randomly into two equal groups of CPB with the zero-balance
ultrafiltration (Z-BUF) of priming blood and CPB without it. The
procalcitonin level was measured before anesthesia, after admission to the
intensive care unit (ICU), and 24 h afterward. The respiratory index and
pulmonary compliance were measured after anesthesia, at the end of CPB,
and 2 h after admission to the ICU. Additionally, time to extubation was
recorded. The Z-BUF of priming blood maintained electrolytes within a
physiologic level, and procalcitonin had a slighter rise in the Z-BUF
Group at 24 h after admission to the ICU (P = 0.05). The respiratory index
was decreased in the Z-BUF Group, but the difference with the control
group did not reach statistical significance (P > 0.05). The change in
pulmonary compliance was significantly increased in the cyanotic patients
in the intervention group, but there was no significant difference between
the two groups. The time to extubation and the ICU stay were shorter in
the Z-BUF Group (P < 0.05). A positive correlation was found between the
peak procalcitonin concentration and the time to extubation directly and
pulmonary compliance reversely. These results suggest that the Z-BUF of
priming blood may have some beneficial clinical effects such as improved
respiratory function and attenuated procalcitonin.<br/>Copyright &#xa9;
2018 International Center for Artificial Organs and Transplantation and
Wiley Periodicals, Inc.

<42>
Accession Number
2007712626
Title
Optimal strategy for side branch treatment in patients with left main
coronary bifurcation lesions.
Source
Revista Espanola de Cardiologia. 74 (8) (pp 691-699), 2021. Date of
Publication: August 2021.
Author
Kim J.; Lee J.M.; Park T.K.; Yang J.H.; Hahn J.-Y.; Choi J.-H.; Choi
S.-H.; Seung K.B.; Hur S.-H.; Rha S.-W.; Kim J.-H.; Choi R.K.; Oh J.H.;
Kim H.-S.; Lee S.-H.; Park J.-S.; Jeon D.W.; Jeong M.H.; Lee J.-H.; Lee
S.Y.; Park W.-J.; Song Y.B.; Gwon H.-C.
Institution
(Kim, Lee, Park, Yang, Hahn, Choi, Choi, Song, Gwon) Division of
Cardiology, Department of Internal Medicine, Heart Vascular Stroke
Institute, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seul, South Korea
(Seung) Division of Cardiology, Seoul St. Mary's Hospital, Catholic
University of Korea, Seul, South Korea
(Hur) Division of Cardiology, Keimyung University Dongsan Medical Center,
Daegu, South Korea
(Rha) Division of Cardiology, Korea University Guro Hospital, Seul, South
Korea
(Kim) Division of Cardiology, Pusan National University Yangsan Hospital,
Pusan, South Korea
(Choi) Division of Cardiology, Mediplex Sejong Hospital, Incheon, South
Korea
(Oh) Division of Cardiology, Samsung Changwon Hospital, Sungkyunkwan
University School of Medicine, Changwon, South Korea
(Kim) Division of Cardiology, Seoul National University Hospital, Seul,
South Korea
(Lee) Division of Cardiology, Yonsei University Wonju Christian Hospital,
Wonju, South Korea
(Park) Division of Cardiology, Yeungnam University Medical Center, Daegu,
South Korea
(Lee) Division of Cardiology, Inje University Ilsan Paik Hospital, Ilsan,
South Korea
(Jeon) Division of Cardiology, National Health Insurance Service Ilsan
Hospital, Ilsan, South Korea
(Jeong) Division of Cardiology, Chonnam National University Hospital,
Gwangju, South Korea
(Lee) Division of Cardiology, Chungnam National University Hospital,
Daejeon, South Korea
(Lee) Division of Cardiology, Chungbuk National University Hospital,
Cheongju, South Korea
(Park) Division of Cardiology, Hallym University Sacred Heart Hospital,
Anyang, South Korea
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: There are no guidelines regarding the most
appropriate approach for provisional side branch (SB) intervention in left
main (LM) bifurcation lesions. <br/>Method(s): The present prospective,
randomized, open-label, multicenter trial compared conservative vs
aggressive strategies for provisional SB intervention during LM
bifurcation treatment. Although the trial was designed to enroll 700
patients, it was prematurely terminated due to slow enrollment. For 160
non-true bifurcation lesions, a 1-stent technique without kissing balloon
inflation was applied in the conservative strategy, whereas a 1-stent
technique with mandatory kissing balloon inflation was applied in the
aggressive strategy. For 46 true bifurcation lesions, a stepwise approach
was applied in the conservative strategy (after main vessel stenting, SB
ballooning when residual stenosis > 75%; then, SB stenting if residual
stenosis > 50% or there was a dissection). An elective 2-stent technique
was applied in the aggressive strategy. The primary outcome was a 1-year
target lesion failure (TLF) composite of cardiac death, myocardial
infarction, or target lesion revascularization. <br/>Result(s): Among
non-true bifurcation lesions, the conservative strategy group used a
smaller amount of contrast dye than the aggressive strategy group. There
were no significant differences in 1-year TLF between the 2 strategies
among non-true bifurcation lesions (6.5% vs 4.9%; HR, 1.31; 95%CI,
0.35-4.88; P = .687) and true bifurcation lesions (17.6% vs 21.7%; HR,
0.76; 95%CI, 0.20-2.83; P = .683). <br/>Conclusion(s): In patients with a
LM bifurcation lesion, conservative and aggressive strategies for a
provisional SB approach have similar 1-year TLF rates.<br/>Copyright
&#xa9; 2020 Sociedad Espanola de Cardiologia

<43>
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. <br/>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.
<br/>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.
<br/>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. <br/>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.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC.

<44>
Accession Number
2006128502
Title
Cardiac graft assessment in the era of machine perfusion: Current and
future biomarkers.
Source
Journal of the American Heart Association. 10 (4) (pp 1-29), 2021. Article
Number: e018966. Date of Publication: 16 Feb 2021.
Author
Bona M.; Wyss R.K.; Arnold M.; Mendez-Carmona N.; Sanz M.N.; Gunsch D.;
Barile L.; Carrel T.P.; Longnus S.L.
Institution
(Bona, Wyss, Arnold, Mendez-Carmona, Sanz, Carrel, Longnus) Department of
Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern,
Switzerland
(Bona, Wyss, Arnold, Mendez-Carmona, Sanz, Carrel, Longnus) Department for
BioMedical Research, University of Bern, Switzerland
(Gunsch) Department of Anesthesiology and Pain Medicine/Institute for
Diagnostic, Interventional and Paediatric Radiology, Bern University
Hospital, Inselspital, University of Bern, Switzerland
(Barile) Laboratory for Cardiovascular Theranostics, Cardiocentro Ticino
Foundation and Faculty of Biomedical Sciences, Universita Svizzera
Italiana, Lugano, Switzerland
Publisher
American Heart Association Inc.
Abstract
Heart transplantation remains the treatment of reference for patients
experiencing end-stage heart failure; unfortu-nately, graft availability
through conventional donation after brain death is insufficient to meet
the demand. Use of extended-criteria donors or donation after circulatory
death has emerged to increase organ availability; however, clinical
protocols require optimization to limit or prevent damage in hearts
possessing greater susceptibility to injury than conventional grafts. The
emergence of cardiac ex situ machine perfusion not only facilitates the
use of extended-criteria donor and donation after circulatory death hearts
through the avoidance of potentially damaging ischemia during graft
storage and transport, it also opens the door to multiple opportunities
for more sensitive monitoring of graft quality. With this review, we aim
to bring to-gether the current knowledge of biomarkers that hold
particular promise for cardiac graft evaluation to improve precision and
reliability in the identification of hearts for transplantation, thereby
facilitating the safe increase in graft availability. Information about
the utility of potential biomarkers was categorized into 5 themes: (1)
functional, (2) metabolic, (3) hormone/prohormone, (4) cellular
damage/death, and (5) inflammatory markers. Several promising biomarkers
are identified, and recommendations for potential improvements to current
clinical protocols are provided.<br/>Copyright &#xa9; 2021 The Authors.

<45>
[Use Link to view the full text]
Accession Number
635024963
Title
A meta-analysis of the diagnostic accuracy of chest ultrasound for the
diagnosis of occult penetrating cardiac injuries in hemodynamically stable
patients with penetrating thoracic trauma.
Source
Journal of Trauma and Acute Care Surgery. 90 (2) (pp 388-395), 2021. Date
of Publication: 2021.
Author
Manzano-Nunez R.; Gomez A.; Espitia D.; Sierra-Ruiz M.; Gonzalez J.;
Rodriguez-Narvaez J.G.; Castillo A.C.; Gonzalez A.; Orjuela J.;
Orozco-Martin V.; Bernal F.; Giron F.; Rios A.C.; Carranza P.;
Gonzalez-Hadad A.; Garcia-Perdomo H.A.; Garcia A.F.
Institution
(Manzano-Nunez, Espitia, Gonzalez, Rodriguez-Narvaez, Castillo, Gonzalez,
Orjuela, Orozco-Martin, Bernal, Giron) Mederi Hospital Universitario Mayor
(Manzano-Nunez, Espitia, Gonzalez, Rodriguez-Narvaez, Castillo, Gonzalez,
Orjuela, Orozco-Martin, Bernal, Giron) Escuela de Medicina y Ciencias de
la Salud, Universidad del Rosario, Bogota, DC, Colombia
(Gomez, Sierra-Ruiz) Fundacion Valle del Lili, Clinical Research Center,
Cali, Colombia
(Rios, Carranza) Hospital Occidente de Kennedy, Bogota, DC, Colombia
(Gonzalez-Hadad, Garcia-Perdomo) Seccion de Urologia, Departamento de
Cirugia, Universidad del Valle
(Garcia) Department of Surgery, Fundacion Valle del Lili, Cali, Colombia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We performed a systematic review (SR) and meta-analysis (MA)
to determine the diagnostic accuracy of chest ultrasound (US) compared
with a pericardial window (PW) for the diagnosis of occult penetrating
cardiac injuries in hemodynamically stable patients with penetrating
thoracic trauma. <br/>Method(s): A literature search in five databases
identified relevant articles for inclusion in this SR and MA. Studies were
eligible if they evaluated the diagnostic accuracy of chest US, compared
with a PW, for the diagnosis of occult penetrating cardiac injuries in
hemodynamically stable patients presenting with penetrating thoracic
trauma. Two investigators independently assessed articles for inclusion
and exclusion criteria and selected studies for final analysis.
Methodological quality was evaluated using Quality Assessment of
Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test
accuracy within the bivariate mixed-effects logistic regression modeling
framework. <br/>Result(s): We included five studies in our SR and MA.
These studies included a total of 556 trauma patients. The MA found that,
compared with PW, the US was 79% sensitive and 92% specific for detecting
occult penetrating cardiac injuries in hemodynamically stable patients.
The presence of a concomitant left hemothorax was frequent in patients
with false-negative results. <br/>Conclusion(s): This SR and MA found
that, compared with PW, US was 79% sensitive and 92% specific for
detecting occult penetrating cardiac injuries in hemodynamically stable
patients with penetrating thoracic trauma. Caution interpretation of
pericardial US results is suggested in the presence of left hemothorax. In
these cases, a second diagnostic test should be performed. LEVEL OF
EVIDENCE Systematic Review and Meta-analysis, level II.<br/>Copyright
&#xa9; 2021 Wolters Kluwer Health, Inc. All rights reserved.

<46>
Accession Number
2011436560
Title
The Surgeon's Role in Cardiogenic Shock.
Source
Current Heart Failure Reports. 18 (4) (pp 240-251), 2021. Date of
Publication: August 2021.
Author
Sperry A.E.; Williams M.; Atluri P.; Szeto W.Y.; Cevasco M.; Bermudez
C.A.; Acker M.A.; Ibrahim M.
Institution
(Sperry, Williams, Atluri, Szeto, Cevasco, Bermudez, Acker, Ibrahim)
Division of Cardiovascular Surgery, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
Publisher
Springer
Abstract
Purpose of Review: Cardiogenic shock represents a very challenging patient
population due to the undifferentiated pathologies presenting as
cardiogenic shock, difficult decision-making, prognostication, and
ever-expanding support options. The role of cardiac surgeons on this team
is evolving. Recent Findings: The implementation of a shock team is
associated with improved outcomes in patients with cardiogenic shock.
Early deployment of mechanical circulatory support devices may allow an
opportunity to rescue these patients. <br/>Summary: Cardiothoracic
surgeons are a critical component of the shock team who can deploy timely
mechanical support and surgical intervention in selected patients for
optimal outcomes.<br/>Copyright &#xa9; 2021, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<47>
Accession Number
2013331580
Title
Effect of intravenous lidocaine on serum interleukin-17 after
video-assisted thoracic surgery for non-small-cell lung cancer: A
randomized, double-blind, placebo-controlled trial.
Source
Drug Design, Development and Therapy. 15 (pp 3379-3390), 2021. Date of
Publication: 2021.
Author
Hou Y.-H.; Shi W.-C.; Cai S.; Liu H.; Zheng Z.; Qi F.-W.; Li C.; Feng
X.-M.; Peng K.; Ji F.-H.
Institution
(Hou, Cai, Peng, Ji) Department of Anesthesiology, First Affiliated
Hospital of Soochow University, Jiangsu, Suzhou, China
(Shi, Zheng, Qi) Department of Anesthesiology, Taicang First People's
Hospital, Taicang Affiliated Hospital of Soochow University, Jiangsu,
Taicang, China
(Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health, Sacramento, CA, United States
(Li) Department of Thoracic Surgery, First Affiliated Hospital of Soochow
University, Jiangsu, Suzhou, China
(Feng) Department of Anesthesiology, University of Utah health, Salt Lake
City, UT, United States
(Feng) Intermountain Medical Center, Salt Lake City, UT, United States
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Surgical stress promotes tumor metastasis. Interleukin (IL)-17
plays a pivotal role in cancer progression, and high IL-17 expression
predicts poor prognosis of non-small-cell lung cancer (NSCLC). Lidocaine
may exert tumor-inhibiting effects. We hypothesize that intravenous
lidocaine attenuates surgical stress and reduces serum IL-17 levels during
video-assisted thoracic surgery (VATS) for NSCLC. <br/>Method(s): This
randomized, double-blind, placebo-controlled trial included 60 early-stage
NSCLC patients undergoing VATS, into a lidocaine group (n = 30;
intravenous lidocaine bolus 1.0 mg/kg, and 1.0 mg/kg/h until the end of
surgery) or a normal saline control group (n = 30). The primary outcome
was serum IL-17 level at 24 hours postoperatively. The secondary outcomes
included serum IL-17 level at the time of post-anesthesia care unit (PACU)
discharge, serum cortisol level at PACU discharge and postoperative 24
hours, pain scores (0-10) from PACU discharge to 48 hours postoperatively,
incidences of postoperative nausea and vomiting, dizziness, and arrhythmia
during 0-48 hours postoperatively, and 30-day mortality. Long-term
outcomes included chemotherapy, cancer recurrence, and mortality.
<br/>Result(s): The lidocaine group had lower serum IL-17 at 24 hours
postoperatively compared with the control group (23.0 +/- 5.8 pg/mL vs
27.3 +/- 8.2 pg/mL, difference [95% CI] = -4.3 [-8.4 to -0.2] pg/mL; P =
0.038). The lidocaine group also had reduced serum IL-17 (difference [95%
CI] = -4.6 [-8.7 to -0.5] pg/mL), serum cortisol (difference [95% CI] =
-37 [-73 to -2] ng/mL), and pain scores (difference [95% CI] = -0.7 [-1.3
to -0.1] points) at PACU discharge. During a median follow-up of 10 (IQR,
9-13) months, 2 patients in the lidocaine group and 6 patients in the
control group received chemotherapy, one patient in the control group had
cancer recurrence, and no death event occurred. <br/>Conclusion(s):
Intravenous lidocaine was associated with reduced serum IL-17 and cortisol
following VATS procedures in early-stage NSCLC patients. Trial
Registration: ChiCTR2000030629.<br/>Copyright &#xa9; 2021 Hou et al.

<48>
Accession Number
2013307350
Title
Dose approach matter? A meta-analysis of outcomes following transfemoral
versus transapical transcatheter aortic valve replacement.
Source
BMC Cardiovascular Disorders. 21 (1) (no pagination), 2021. Article
Number: 358. Date of Publication: December 2021.
Author
Guo R.; Xie M.; Yim W.Y.; Wu W.; Jiang W.; Wang Y.; Hu X.
Institution
(Guo, Xie, Yim, Wang, Hu) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, 1277# Jiefang Avenue, Wuhan 430022, China
(Wu) Department of Gastroenterology, Zhongnan Hospital, Wuhan University,
Wuhan, China
(Jiang) Department of Gastroenterology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
Publisher
BioMed Central Ltd
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has gained
increasing acceptance for patients with aortic disease. Both transfemoral
(TF-TAVR) and transapical (TA-TAVR) approach were widely adopted while
their performances are limited to a few studies with controversial
results. This meta-analysis aimed to compare the mortality and morbidity
of complications between TF- versus TA-TAVR based on the latest data.
<br/>Method(s): Electronic databases were searched until April 2021. RCTs
and observational studies comparing the outcomes between TF-TAVR versus
TA-TAVR patients were included. Heterogeneity assumption was assessed by
an I² test. The pooled odds ratios(OR) or mean differences with
corresponding 95% confidence intervals (CI) were used to evaluate the
difference for each end point using a fixed-effect model or random-effect
model based on I² test. <br/>Result(s): The meta-analysis
included 1 RCT and 20 observational studies, enrolling 19,520 patients
(TF-TAVR, n = 11,986 and TA-TAVR, n = 7,534). Compared with TA-TAVR,
TF-TAVR patients showed significantly lower rate of postoperative
in-hospital death (OR = 0.67, 95% CI 0.59-0.77, P < 0.001) and 1-year
death (OR = 0.53, 95% CI 0.41-0.69, P < 0.001). Incidence of major
bleeding and acute kidney injury were lower and length of hospital stay
was shorter, whereas those of permanent pacemaker and major vascular
complication were higher in TF-TAVR patients. There were no significant
differences between TF-TAVR versus TA-TAVR for stroke and mid-term
mortality. <br/>Conclusion(s): There were fewer early deaths in patients
with transfemoral approach, whereas the number of mid-term deaths and
stroke was not significantly different between two approaches. TF-TAVR was
associated with lower risk of bleeding, acute kidney injury as well as
shorter in-hospital stay, but higher incidence of vascular complication
and permanent pacemaker implantation.<br/>Copyright &#xa9; 2021, The
Author(s).

<49>
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. <br/>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.
<br/>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. <br/>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.<br/>Copyright
&#xa9; 2021 The Authors Psychiatry and Clinical Neurosciences &#xa9; 2021
Japanese Society of Psychiatry and Neurology

<50>
Accession Number
2013003564
Title
New-Onset Cancer in the HF Population: Epidemiology, Pathophysiology, and
Clinical Management.
Source
Current Heart Failure Reports. 18 (4) (pp 191-199), 2021. Date of
Publication: August 2021.
Author
Cuomo A.; Paudice F.; D'Angelo G.; Perrotta G.; Carannante A.; Attanasio
U.; Iengo M.; Fiore F.; Tocchetti C.G.; Mercurio V.; Pirozzi F.
Institution
(Cuomo, Paudice, D'Angelo, Perrotta, Carannante, Attanasio, Iengo, Fiore,
Tocchetti, Mercurio, Pirozzi) Department of Translational Medical
Sciences, Federico II University, Naples, Italy
(Tocchetti) Interdepartmental Center of Clinical and Translational
Sciences (CIRCET), Federico II University, Naples, Italy
(Tocchetti) Interdepartmental Hypertension Research Center (CIRIAPA),
Federico II University, Naples, Italy
Publisher
Springer
Abstract
Purpose of Review: Oncological treatments are known to induce cardiac
toxicity, but the impact of new-onset cancer in patients with pre-existing
HF remains unknown. This review focuses on the epidemiology,
pathophysiological mechanisms, and clinical implications of HF patients
who develop malignancies. Recent Findings: Novel findings suggest that HF
and cancer, beside common risk factors, are deeply linked by shared
pathophysiological mechanisms. In particular, HF itself may enhance
carcinogenesis by producing pro-inflammatory cytokines, and it has been
suggested that neurohormonal activation, commonly associated with the
failing heart, might play a pivotal role in promoting neoplastic
transformation. <br/>Summary: The risk of malignancies seems to be higher
in HF patients compared to the general population, probably due to shared
risk factors and common pathophysiological pathways. Additionally,
management of these patients represents a challenge for clinicians,
considering that the co-existence of these diseases significantly worsens
patients' prognosis and negatively affects therapeutic options for both
diseases.<br/>Copyright &#xa9; 2021, The Author(s).

<51>
Accession Number
2011832117
Title
Ablation strategies for arrhythmogenic right ventricular cardiomyopathy: A
systematic review and meta-analysis.
Source
Journal of Geriatric Cardiology. 17 (11) (pp 694-703), 2020. Date of
Publication: 2020.
Author
Shen L.-S.; Liu L.-M.; Zheng L.-H.; Hu F.; Hu Z.-C.; Liu S.-Y.; Guo J.-R.;
Bhagat K.K.; Yao Y.
Institution
(Shen, Liu, Zheng, Hu, Hu, Liu, Yao) Arrhythmia Center, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Guo) Arrhythmia Center, Yunnan Fuwai Cardiovascular Hospital, Kunming,
China
(Bhagat) Eternal hospital, Jaipur, Rajasthan, India
Publisher
Science Press
Abstract
Background Catheter ablation for ventricular tachycardia (VT) in patients
with arrhythmogenic right ventricular cardiomyopathy (ARVC) has
significantly evolved over the past decade. However, different ablation
strategies showed inconsistency in acute and long-term outcomes. Methods
We searched the databases of Medline, Embase and Cochrane Library through
October 17, 2019 for studies describing the clinical outcomes of VT
ablation in ARVC. Data including VT recurrence, all-cause mortality, acute
procedural efficacy and major procedural complications were extracted. A
meta-analysis with trial sequential analysis was further performed in
comparative studies of endo-epicardial versus endocardial-only ablation.
Results A total of 24 studies with 717 participants were enrolled. The
literatures of epicardial ablation were mainly published after 2010 with
total ICD implantation of 73.7%, acute efficacy of 89.8%, major
complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%,
all-cause mortality of 1.1% and heart transplantation of 0.6%.
Meta-analysis of 10 comparative studies revealed that compared with
endocardial-only approach, epicardial ablation significantly decreased VT
recurrence (OR: 0.50; 95% CI: 0.30-0.85; P = 0.010), but somehow increased
major procedural complications (OR: 4.64; 95% CI: 1.28-16.92; P = 0.02),
with not evident improvement of acute efficacy (OR: 2.74; 95% CI:
0.98-7.65; P = 0.051) or all-cause mortality (OR: 0.87; 95% CI: 0.09-8.31;
P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and
effective. Epicardial ablation is associated with better long-term VT
freedom, but with more major complications and unremarkable survival or
acute efficacy benefit.<br/>Copyright &#xa9; 2020 JGC All rights reserved;
www.jgc301.com

<52>
Accession Number
2011783427
Title
Echocardiographic RV-E/e' for predicting right atrial pressure: A review.
Source
Echo Research and Practice. 7 (4) (pp R11-R20), 2020. Date of Publication:
December 2020.
Author
Fletcher A.J.; Robinson S.; Rana B.S.
Institution
(Fletcher) Department of Cardiac Physiology, Royal Papworth Hospital NHS
Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
(Robinson) Department of Cardiac Investigations, North West Anglia NHS
Foundation Trust, Peterborough City Hospital, Bretton Gate, Peterborough,
United Kingdom
(Rana) Department of Cardiology, Imperial College London NHS Foundation
Trust, London, United Kingdom
Publisher
BioScientifica Ltd.
Abstract
Right atrial pressure (RAP) is a key cardiac parameter of diagnostic and
prognostic significance, yet current two-dimensional echocardiographic
methods are inadequate for the accurate estimation of this haemodynamic
marker. Right-heart trans-tricuspid Doppler and tissue Doppler
echocardiographic techniques can be combined to calculate the right
ventricular (RV) E/e' ratio - a reflection of RV filling pressure which is
a surrogate of RAP. A systematic search was undertaken which found
seventeen articles that compared invasively measured RAP with RV-E/e'
estimated RAP. Results commonly concerned pulmonary hypertension or
advanced heart failure/transplantation populations. Reported receiver
operating characteristic analyses showed reasonable diagnostic ability of
RV-E/e' for estimating RAP in patients with coronary artery disease and RV
systolic dysfunction. The diagnostic ability of RV-E/e' was generally poor
in studies of paediatrics, heart failure and mitral stenosis, whilst
results were equivocal in other diseases. Bland-Altman analyses showed
good accuracy but poor precision of RV-E/e' for estimating RAP, but were
limited by only being reported in seven out of seventeen articles. This
suggests that RV-E/e' may be useful at a population level but not at an
individual level for clinical decision making. Very little evidence was
found about how atrial fibrillation may affect the estimation of RAP from
RV-E/e', nor about the independent prognostic ability of RV-E/e' .
Recommended areas for future research concerning RV-E/e' include;
non-sinus rhythm, valvular heart disease, short and long term prognostic
ability, and validation over a wide range of RAP.<br/>Copyright &#xa9;
2021 The authors.

<53>
Accession Number
2013279605
Title
Comparative clinical efficacy of novel bidirectional cannula in cardiac
surgery via peripheral cannulation for cardiopulmonary bypass.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Gunaydin S.; Babaroglu S.; Budak A.B.; Sayin B.; Cayhan V.; Ozisik K.
Institution
(Gunaydin, Babaroglu, Budak, Ozisik) Department of Cardiovascular Surgery,
Ankara City Hospital, University of Health Sciences, Ankara, Turkey
(Sayin, Cayhan) Department of Radiology, Ankara City Hospital, University
of Health Sciences, Ankara, Turkey
Publisher
SAGE Publications Ltd
Abstract
Objectives: The aim of this study is to evaluate the safety and efficacy
of the novel bidirectional cannula that ensures stable distal perfusion
compared to conventional cannula in patients undergoing femoral arterial
cannulation for cardiopulmonary bypass (CPB). <br/>Method(s): During a
1-year period, 64 patients undergoing surgery via peripheral cannulation
were prospectively randomized to receive 19 F bidirectional (BiflowTM,
LivaNova, Italy) or 19 F conventional (HLS Peripheral cannula, Getinge
GroupTM, Germany) cannula with 6 F downstream line (BicakcilarTM, Turkey)
for femoral artery cannulation. The primary outcome included the efficacy
(adequacy of antegrade/retrograde comparative flow via cannula measured by
doppler ultrasonography) and the secondary outcome was the safety
(early/late complications and adverse events). <br/>Result(s): Percent
flow (distal/proximal) after cannulation measured by doppler
ultrasonography was significantly better in study group (33.1 +/- 5
ml/min) versus downstream cannula (16.1 +/- 4, p = 0.012). SpO<inf>2</inf>
measured by near infrared spectroscopy (NIRS) also demonstrated
significantly better saturation in distal calf of the cannulated leg in
bidirectional cannula group (67.5% +/- 10% vs 52.5 +/- 8, p = 0.04). The
incidence of serious adverse events was seroma on femoral region (one
patient), superficial wound infection (one patient), pseudo-hematoma (two
patients) in bidirectional cannula group and in-hospital femoral
embolectomy/artery repair (two patients), superficial wound infection
(three patients), cannulation site hematoma (three patients) in
conventional cannula group. <br/>Conclusion(s): This study demonstrates
that in patients undergoing femoral arterial cannulation for CPB during
cardiac surgery, the use of a novel bidirectional cannula is safe and easy
to insert and provides stable distal perfusion of the cannulated
limb.<br/>Copyright &#xa9; The Author(s) 2021.

<54>
Accession Number
2011294536
Title
Ascorbic Acid in the Acute Care Setting.
Source
Journal of Parenteral and Enteral Nutrition. 45 (5) (pp 874-881), 2021.
Date of Publication: July 2021.
Author
Kressin C.; Pandya K.; Woodward B.M.; Donaldson C.; Flannery A.H.
Institution
(Kressin, Pandya, Woodward, Donaldson, Flannery) Acute Care Pharmacy
Services, University of Kentucky HealthCare, Lexington, KY, United States
(Flannery) Department of Pharmacy Practice and Science, University of
Kentucky College of Pharmacy, Lexington, KY, United States
Publisher
John Wiley and Sons Inc
Abstract
Ascorbic acid (AA) is an essential nutrient with many physiologic roles
not limited to the prevention of scurvy. Beyond its role as a supplement,
it has gained popularity in the acute care setting as an inexpensive
medication for a variety of conditions. Because of limitations with
absorption of oral formulations and reduced serum concentrations observed
in acute illness, intravenous (IV) administration, and higher doses, may
be needed to produce the desired serum concentrations for a particular
indication. Following a PubMed search, we reviewed published studies
relevant to AA in the acute care setting and summarized the results in a
narrative review. In the acute care setting, AA may be used for improved
wound healing, improved organ function in sepsis and acute respiratory
distress syndrome, faster resolution of vasoplegic shock after cardiac
surgery, reduction of resuscitative fluids in severe burn injury, and as
an adjunctive analgesic, among other uses. Each indication differs in its
level of evidence supporting exogenous administration of AA, but overall,
AA was not commonly associated with adverse effects in the identified
studies. Use of AA remains an active area of clinical investigation for
various indications in the acute care patient population.<br/>Copyright
&#xa9; 2021 American Society for Parenteral and Enteral Nutrition

<55>
Accession Number
635697439
Title
LDL-cholesterol lowering with evolocumab, and outcomes according to age
and sex in patients in the FOURIER Trial.
Source
European journal of preventive cardiology. 28 (8) (pp 805-812), 2021. Date
of Publication: 23 Jul 2021.
Author
Sever P.; Gouni-Berthold I.; Keech A.; Giugliano R.; Pedersen T.R.; Im K.;
Wang H.; Knusel B.; Sabatine M.S.; O'Donoghue M.L.
Institution
(Sever) National Heart and Lung Institute, Imperial College London, United
Kingdom
(Gouni-Berthold) Polyclinic for Endocrinology, Diabetes and Preventive
Medicine, University of Cologne, Germany
(Keech) NHMRC Clinical Trials Centre, University of Sydney, Australia
(Giugliano, Im, Sabatine, O'Donoghue) TIMI Study Group, Brigham and
Women's Hospital and Harvard Medical School, United States
(Pedersen) Centre for Preventive Medicine, Ulleval University Hospital,
Norway
(Wang, Knusel) Clinical Development, Amgen Inc., United States
Publisher
NLM (Medline)
Abstract
AIMS: Some trials have reported diminished efficacy for statins in the
elderly, and in women compared with men. We examined the efficacy and
safety of evolocumab by patient age and sex in the FOURIER trial, the
first major cardiovascular outcome trial of a PCSK9 inhibitor. METHODS AND
RESULTS: FOURIER was a randomised, double blind trial, comparing
evolocumab with placebo in 27,564 patients with atherosclerotic
cardiovascular disease receiving statin therapy (median follow-up 2.2
years). The primary endpoint was cardiovascular death, myocardial
infarction, stroke, hospitalisation for unstable angina or coronary
revascularisation. Cox proportional hazards models were used to assess the
efficacy of evolocumab versus placebo stratified by quartiles of patient
age and by sex. There were small variations in the cardiovascular event
rate across the age range (for the primary endpoint, Kaplan-Meier at 3
years 15.6%, >69 years, vs. 15.1%, <=56 years, P=0.45); however, the
relative efficacy of evolocumab was consistent regardless of patient age
(for the primary endpoint (Q1 hazard ratio, 95% confidence interval) 0.83,
0.72-0.96, Q2 0.88, 0.76-1.01, Q3 0.82, 0.71-0.95, Q4 0.86, 0.74-1.00;
Pinteraction=0.91), and the key secondary endpoint (cardiovascular death,
myocardial infarction, stroke) (Q1 0.74 (0.61-0.89), Q2 0.83 (0.69-1.00),
Q3 0.78 (0.65-0.94), Q4 0.82 (0.69-0.98)); Pinteraction=0.81). Women had a
lower primary endpoint rate than men (Kaplan-Meier at 3 years 12.5 vs.
15.3%, respectively, P<0.001). Relative risk reductions in the primary
endpoint and key secondary endpoint were similar in women (0.81
(0.69-0.95) and 0.74 (0.61-0.90), respectively) compared with men (0.86
(0.80-0.94) and 0.81 (0.73-0.90), respectively), Pinteraction=0.48 and
0.44, respectively. Adverse events were more common in women and with
increasing age but, with the exception of injection site reactions, there
were no important significant differences reported by those assigned
evolocumab versus placebo. <br/>CONCLUSION(S): The efficacy and safety of
evolocumab are similar throughout a broad range of ages and in both men
and women.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2020. For
permissions, please email: journals.permissions@oup.com.

<56>
Accession Number
635019332
Title
Effect of Recruitment Maneuvers and PEEP on Respiratory Failure After
Cardiothoracic Surgery in Obese Subjects: A Randomized Controlled Trial.
Source
Respiratory care. 66 (8) (pp 1306-1314), 2021. Date of Publication: 01 Aug
2021.
Author
Amaru P.; Delannoy B.; Genty T.; Desebbe O.; Laverdure F.;
Rezaiguia-Delclaux S.; Stephan F.
Institution
(Amaru, Genty) Cardiothoracic ICU, Department of Anesthesiology and ICU,
Hopital Marie Lannelongue, Le Plessis Robinson, France
(Delannoy, Desebbe, Rezaiguia-Delclaux) Anesthesiology, Clinique de la
Sauvegarde, Lyon, France
(Laverdure) Anesthesiology, Department of Anesthesiology and ICU, Hopital
Marie Lannelongue, Le Plessis Robinson, France
(Stephan) Cardiothoracic ICU, Department of Anesthesiology and ICU,
Hopital Marie Lannelongue, Le Plessis Robinson, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: Obesity may increase the risk of respiratory failure after
cardiothoracic surgery. A recruitment maneuver followed by PEEP might
decrease the risk of respiratory failure in obese subjects. We
hypothesized that the routine use after heart surgery of a recruitment
maneuver followed by high or low PEEP level would decrease the frequency
of respiratory failure in obese subjects. <br/>METHOD(S): In a pragmatic,
randomized controlled trial, we assigned obese subjects (ie, with body
mass index [BMI] >= 30 kg/m2) in the immediate postoperative period of
cardiothoracic surgery to either volume control ventilation with 5 cm H2O
of PEEP (control group) or a recruitment maneuver followed by 5 or 10 cm
H2O of PEEP in the intervention arms (RM5 and RM10 groups, respectively).
The primary outcome was the proportion of subjects with postextubation
respiratory failure, defined as the need for re-intubation, bi-level
positive airway pressure, or high-flow nasal cannula within the first 48
h. <br/>RESULT(S): The study included 192 subjects: 65 in the control
group (BMI 33.5 +/- 3.2 kg/m2), 66 in the RM5 group (BMI 34.5 +/- 3.2
kg/m2, and 61 in RM10 group (BMI 33.8 +/- 4.8 kg/m2). Postextubation
respiratory failure occurred in 14 subjects in the control group (21.5%
[95% CI 13.3-35.3]), 21 subjects in the RM5 group (31.8% [95% CI
21.2-44.6]), and 9 subjects in the RM10 group (14.7% [95% CI 7.4-26.7]) (P
= .07). The recruitment maneuver was stopped prematurely due to severe
hypotension in 8 (12.1%) RM5 subjects and in 4 (6.6%) RM10 subjects (P =
.28). There were no significant differences between the 3 groups for the
frequencies of atelectasis, pneumonia, and death in the ICU.
<br/>CONCLUSION(S): The routine use after heart surgery of a recruitment
maneuver followed by 5 or 10 cm H2O of PEEP did not decrease the frequency
of respiratory failure in obese subjects. A recruitment maneuver followed
by 5 cm H2O of PEEP is inappropriate.<br/>Copyright &#xa9; 2021 by
Daedalus Enterprises.

<57>
Accession Number
634600813
Title
A comparison of two different management plans for patients requiring both
carotid endarterectomy and coronary artery bypass grafting.
Source
Cardiovascular journal of Africa. 32 (3) (pp 129-132), 2021. Date of
Publication: 01 May 2021.
Author
Ecevit A.N.; Karaca O.G.; Kalender M.; Bekmezci M.; Sungur M.A.; Darcin
O.T.
Institution
(Ecevit) Bilkent City Hospital, Yuksek Ihtisas Cardiovascular Surgery
Hospital, Ankara, Turkey
(Karaca) Department of Cardiovascular Surgery, Medical Faculty of Duzce
University, Duzce, Turkey
(Kalender) Department of Cardiovascular Surgery, Derince Training and
Research Hospital, Kocaeli, Turkey
(Bekmezci) Dr Ali Kemal Belviranli Obstetric and Gynecology Hospital,
Konya, Turkey
(Sungur) Department of Biostatistics and Medical Informatics, Medical
Faculty of Duzce University, Duzce, Turkey
(Darcin) Department of Cardiovascular Surgery, Antalya Training and
Research Hospital, Antalya, Turkey
Publisher
NLM (Medline)
Abstract
BACKGROUND: Carotid endarterectomy (CEA) is a prophylactic operation that
is used to mitigate the risk of stroke caused by embolism of
atherosclerotic plaques in the carotid bifurcation. Previously, the large,
multicentre, randomised, controlled GALA study found no significant
differences in clinical outcomes between patients treated using general or
local anaesthesia. While this study provided important insights into
disease outcomes based on treatment modalities, it did not answer
questions regarding the safety of CEA under local anaesthesia in patients
at high risk for cardiovascular complications. Here, we examined the use
of two different management plans in patients requiring both carotid
endarterectomy and coronary artery bypass grafting (CABG), in terms of
their effects on hospital mortality. <br/>METHOD(S): Thirty-four patients
consecutively operated on in our cardiovascular department were included
in this analysis. The patients were divided into two groups based on the
anaesthetic management plan. The first group consisted of patients who
underwent CEA and CABG under general anaesthesia in the same session (GA
group); the second group consisted of patients who initially underwent CEA
under cervical block anaesthesia followed by CABG under general
anaesthesia in a separate session (CB-GA group). These two groups were
compared in terms of postoperative complications and hospital mortality.
<br/>RESULT(S): The incidence of postoperative myocardial infarction was
higher in the CB-GA group, with four patients experiencing postoperative
myocardial infarction, compared to no patients in the GA group.
<br/>CONCLUSION(S): For patients requiring CEA and CABG, performing both
operations under general anaesthesia in the same session was safer than
initially performing CEA under cervical block anaesthesia followed by CABG
under general anaesthesia.

<58>
Accession Number
2014002708
Title
P57. A double blind, randomized controlled, prospective trial assessing
the effectiveness of oral corticoids in the treatment of symptomatic
lumbar stenosis.
Source
Spine Journal. Conference: Proceedings of the 36th Annual Meeting of the
North American Spine Society. Boston Convention and Exhibition Center,
Boston United States. 21 (9 Supplement) (pp S167-S168), 2021. Date of
Publication: September 2021.
Author
Rodrigues L.C.L.; Pereira N.A.N.J.; Nakao R.; Navarro F.A.
Institution
(Rodrigues) Sao PaloSPBrazil
(Pereira) Santa Marcelina School of Medicina, Sao Paulo, SP, Brazil
(Nakao) Hospital Santa Marcelina Itaquera, Sao Paulo, Itaquera, Brazil
(Navarro) Sao Caetano Do Sul, Sao Paulo, Brazil
Publisher
Elsevier Inc.
Abstract
BACKGROUND CONTEXT: Corticoids have potent anti-inflammatory effects,
which may help in relieving pain and dysfunction associated with lumbar
stenosis. We assessed the effectiveness of a decreasing-dose regimen of
oral corticoids in the treatment of lumbar canal stenosis in a
prospective, double-blind, randomized, placebo-controlled trial. PURPOSE:
Because spinal stenosis most frequently affects the elderly, a patient
group with a high surgical complication rate, an oral regimen can
dramatically improve overall treatment safety. To this end, we assessed
the efficacy of oral corticoids for the treatment of lumbar canal
stenosis. STUDY DESIGN/SETTING: This prospective, double-blind, randomized
controlled study was approved by the institutional research ethics
committee. Sixty-one patients were electronically randomized to the drug
treatment or placebo control group. Opaque envelopes were used to ensure
the secrecy of the allocation. The drug treatment group was administered
corticoids at 1 mg/kg/day with a one-third dose reduction per week. The
control group was administered placebo for the same period. All patients
were assessed at four time points during the study: baseline (T0), at the
end of treatment (week 3, T3), and at 6 and 12 weeks after study
initiation (T6 and T12, respectively). All patients were permitted
paracetamol (750-mg tablets) up to 3 times a day as a rescue analgesic.
Total paracetamol intake and response were also assessed. The patient and
the assessor were blinded to treatment. PATIENT SAMPLE: All patients were
assessed by the following instruments: the Short Form (SF)-36 Health
Survey, the Roland-Morris Questionnaire, the 6-min walk test, a 10-cm
visual analog scale (VAS) for pain, and a 5-point Likert-type scale ("much
better", "slightly better", "unchanged", "slightly worse", and "much
worse"). The Likert scale was not applied for the initial assessment (T0).
OUTCOME MEASURES: The sample size was chosen to yield a statistical power
of 80% and a significance of 5% when comparing VAS scores between groups,
assuming a group standard deviation of 2 cm and a minimum mean intergroup
difference of 2 cm. We used Student's t-test to compare continuous
variables with a homogenous distribution across groups. Generalized linear
models (MLGs) and unbalanced 2-factor ANOVA were used to test the temporal
effect of medication and interaction between the test period and
medication. Tukey's test was used for 2 by 2 comparisons between time
period and medication for the measurement points. Pearson's correlation
analyses were performed to assess the relationships among clinical
variables. In all statistical tests, P-values of <5% were considered
statistically significant. <br/>METHOD(S): Inclusion criteria were the
presence of claudication within less than 100 m and the presence of at
least two of the following lower limb symptoms: pain, weakness, burning,
tingling (associated with or independent of lower back pain), and a
vertebral canal area of <100 mm2 in at least one of the levels assessed
(L3/L4, L4/L5, L5/S1) by the Hamanishi technique [9].The exclusion
criteria were as follows: decompensated diabetes mellitus, systemic
hypertension, decompensated cardiopathy, systemic diseases affecting the
lower limbs, neuromuscular diseases, use of corticoids in the past 3
months, previous lumbar or thoracic surgeries, cognitive deficits that
compromise the capacity to understand or interpret the questionnaires,
spondylolisthesis (except degenerative), degenerative scoliosis with a
Cobb angle of >10degree, degenerative pathologies in the hip or knee that
can interfere with gait, and a history of total or partial arthroplasty in
the hip and/or knee joint.The canal area was calculated on the basis of
maximum anteroposterior (b) and mediolateral {1.5 [EN] (a) diameters
measured by the computer program Osirix (2011) {3.4 [EN] using magnetic
resonance imaging (MRI). After calculating these values, they were
individually divided by 2 and multiplied by pi (PI), with pi = 3.14:Area =
(a/2) x (b/2) x pi x constant, where the constant is 0.8 when the canal is
circular, 0.7 when the canal is elliptical, 0.6 in the presence of
facetary compression, and 0.5 when the compression is caused by the disc
and facets. <br/>RESULT(S): All 61 eligible patients, including 31 in the
corticoid group and 30 in the placebo group, completed the study. There
were no group differences in female: male ratio and there were no
significant differences in height and weight between groups for the males
and females. There was no significant difference in the use of paracetamol
as a rescue analgesic between groups over the 21-day drug/placebo
administration period. The Roland-Morris questionnaire was administered at
baseline (T0), after the 3-week drug/placebo trial (T3), and at 6 and 12
weeks after study initiation (T6, T12). The scores suggested a slight
improvement in the corticoid group at the beginning of treatment; however,
they were not significantly different from those for the placebo group. In
fact, no significant differences in total scores were observed within or
between groups for any individual assessment period. The VAS scores for
pain suggested a mild improvement in both groups at T3, as indicated by
the lower scores compared with those at baseline (T0); however, these
scores increased thereafter, with no significant change across test
periods in either group. The 6-min walk test, performed according to the
American Thoracic Society standards on a 22-m track with patients walking
as fast as possible, also showed no significant improvement in both
groups. In fact, the total distance travelled by the corticoid group
decreased by approximately 40-50 m between T3 and T6 and T12 (Table 2).
Because this assessment depends on muscular structure, the male and female
subgroups were separately compared; this analysis also indicated no
benefit of corticoids (not shown). The SF-36 questionnaire assesses
current health conditions, with higher values corresponding to a better
condition. The SF-36 scores for our patients suggested modest differences
in some of the eight domains during the study period; however, the final
values at T6 and T12 were similar between groups. Separate comparisons by
gender also did not reveal significant differences in condition between
groups (not shown). The Likert-type scale, wherein patients were
instructed to document how they were feeling after treatment (much better,
slightly better, unchanged, slightly worse, or much worse) also indicated
no significant benefits of corticoids (not shown). Because the results
were very similar, we compared the results of the different assessment
instruments. There were no significant differences among instruments,
which confirmed the results of the study and the reliability of the
instruments in question. The body mass index (BMI) of patients correlated
with the Roland-Morris Questionnaire findings; in other words, patients
with a greater body weight, regardless of the group, gave more unfavorable
answers. This indicated that obese patients with lumbar canal stenosis are
more symptomatic. <br/>CONCLUSION(S): This placebo-controlled study
indicates that a tapering regimen of oral corticoids, starting at 1 mg/kg
daily, is not effective in the treatment of lumbar canal stenosis. We
found no direct correlation between the degree of stenosis on MRI and
symptom severity or quality of life as revealed by the Roland-Morris
Questionnaire and SF-36. Lumbar stenosis at L4/L5 is more symptomatic
compared with stenoses at the other evaluated levels. BMI was directly
associated with the degree of limitation and inversely associated with
quality of life. FDA DEVICE/DRUG STATUS: This abstract does not discuss or
include any applicable devices or drugs.<br/>Copyright &#xa9; 2021

<59>
Accession Number
635709305
Title
Case series of patients with cholesterol crystal embolism syndrome that
mimics systemic vasculitis.
Source
Annals of the Rheumatic Diseases. Conference: European Congress of
Rheumatology, EULAR 2021. Virtual. 80 (SUPPL 1) (pp 1227), 2021. Date of
Publication: June 2021.
Author
Ouyang Z.M.; Zeng W.C.; Wei X.N.; Zheng D.H.; Lin J.; Li Q.H.; Dai L.; Mo
Y.
Institution
(Ouyang, Zeng, Wei, Zheng, Lin, Li, Dai, Mo) Sun Yat-Sen Memorial
Hospital, Sun Yat-Sen University, Department of Rheumatology, Guangzhou,
China
Publisher
BMJ Publishing Group
Abstract
Background: Cholesterol crystal embolism (CCE) syndrome is a multisystemic
disorder caused by small arteries cholesterol crystal emboli subsequent to
small pieces of atheromatous plaques from the aorta or other major
arteries break off. CCE is often overlooked because it mimics symptoms of
systemic vasculitis due to its clinical characteristics such as ulceration
and gangrene of toes, livedo reticularis, renal insufficiency. Acute
inflammatory reactants such as ESR, CRP may elevate in CCE patients since
the cholesterol crystals trigger a foreign-body inflammatory reaction
around the arterioles. <br/>Objective(s): This study aimed to explore the
clinical characteristics of CCE patients, to make rheumatologists learn
more about this disease. <br/>Method(s): Peer-reviewed articles in the
electronic databases Medline, PubMed, Science Citation Index, China
Biomedical Literature Database (CBM), China Journal Full Text Database
(CNKI), and WANFANG Data were searched using the terms cholesterol crystal
embolism syndrome, cholesterol embolism, atherosclerotic embolism,
atherosclerotic nephropathy, or CCE. Only articles or case reports
containing detailed medical records of CCE patients were included. We also
included CCE patients in our department. <br/>Result(s): A 66-year-old
male CCE patient presented with multiple ulceration and gangrene of toes
and heels (Figure 1), subacute renal insufficiency, and elevated CRP and
ESR. This patient had been considered as suspected systemic vasculitis and
was referred to our rheumatology department. Another 39 Chinese CCE
patients from the above databases were qualified for analysis. Among these
40 patients, 87.5% (35/40) were male and the mean age was 68+/-6 years.
The most common involved was kidney and 90% (36/40) of patients presenting
with renal insufficiency including the progressive increase of serum
creatinine, hematuria, proteinuria, or sudden (or sharp) aggravation of
hypertension. Next common involved was skin that occurred in 87.5% (35/40)
of patients, especially in the toes and heels. For skin manifestations,
blue toe syndrome occurred in 82.5% (33/40) of patients, ulceration or
gangrene in 25% (10/40), and livedo reticularis in 15% (6/40).
Additionally, 12.5% (5/40) showed ocular involvement such as visual
impairment and visual field defect. In 2 patients, embolized cholesterol
crystal in retinal arteries that is called Hollenhorst plaques was
detected by fundoscopy. There were 62.5% (25/40) of patients having
elevated CRP or ESR. The positive rate for skin or subcutaneous biopsies
was 58% (11/19) and for kidney biopsies was 100% (6/6). The precipitating
factors preceding the occurrence of classical symptoms such as blue toe
syndrome, livedo reticularis and/or subacute renal insufficiency is
important for CCE diagnosis especially for patients who had
contraindications or were intolerant to biopsy. The precipitating factors
include endovascular intervention (80%), vascular surgery (5%), and
anticoagulant or thrombolytic therapy (2.5%). Only 12.5% (5/40) of
patients were spontaneous and didn't have any predisposing factors.
General interventions of CCE included statins (82.5%), antiplatelets
(32.5%), and dialysis (32.5%). Twelve patients (30%) received
glucocorticoids and 75% (9/12) of them renal function improved and
ulceration healed (Figure 1). Among 36 patients who presented with renal
insufficiency, the renal function returned to normal after treatment in 2
patients (5.6%), but 27 patients (75%) still showed abnormal renal
function even though somewhat improved, and 7 patients (19.4%) needed
renal replacement therapy or dialysis for maintenance. <br/>Conclusion(s):
This study reported CCE patients had high prevalence of renal
insufficiency, blue toe syndrome, and ulceration or gangrene of toes, as
well as elevated CRP or ESR, thus rheumatologists should be alert to this
disease as one of the differential diagnosis of systemic vasculitis,
especially for elderly patients with evidence of atherosclerosis who
undergo a recent cardiovascular procedure.

<60>
Accession Number
2014012598
Title
Effect of electroencephalography-guided anesthesia on neurocognitive
disorders in elderly patients undergoing major non-cardiac surgery: A
trial protocol the POEGEA trial (POncd Elderly GEneral Anesthesia).
Source
PLoS ONE. 16 (8 August) (no pagination), 2021. Article Number: e0255852.
Date of Publication: August 2021.
Author
Morisson L.; Laferriere-Langlois P.; Carrier F.M.; Page G.; Godbout C.;
Fortier L.-P.; Ogez D.; Letourneau G.; Jarry S.; Denault A.; Fortier A.;
Guertin M.-C.; Verdonck O.; Richebe P.
Institution
(Morisson, Laferriere-Langlois, Godbout, Fortier, Ogez, Verdonck, Richebe)
Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont
Hospital - CIUSSS de L'Est de l'Ile de Montreal, Universite de Montreal,
Montreal, QC, Canada
(Laferriere-Langlois, Carrier, Page, Godbout, Fortier, Ogez, Denault,
Verdonck, Richebe) Department of Anesthesiology and Pain Medicine,
Universite de Montreal, Quebec, Canada
(Carrier) Department of Anesthesiology, Department of Medicine, Critical
Care Division, Centre Hospitalier de l'Universite de Montreal (CHUM),
Universite de Montreal, Montreal, QC, Canada
(Carrier, Page) Research Center of the CHUM (Centre Hospitalier de
l'Universite de Montreal), Universite de Montreal, Montreal, QC, Canada
(Page) Department of Psychology, Universite de Montreal, Montreal, QC,
Canada
(Godbout, Fortier, Ogez, Letourneau, Verdonck, Richebe) Research Center,
CIUSSS de L'Est de l'Ile de Montreal, Universite de Montreal, Montreal,
QC, Canada
(Jarry, Denault) Department of Anesthesiology, Montreal Heart Institute,
Montreal, QC, Canada
(Fortier, Guertin) Department of Statistics, Montreal Health Innovations
Coordinating Center (MHICC), Montreal, QC, Canada
Publisher
Public Library of Science
Abstract
Introduction The number of elderly patients undergoing major surgery is
rapidly increasing. They are particularly at risk of developing
postoperative neurocognitive disorders (NCD). Earlier studies suggested
that processed electroencephalographic (EEG) monitors may reduce the
incidence of postoperative NCD. However, none of these studies controlled
for intraoperative nociception levels or personalized blood pressure
targets. Their results remain unclear if the reduction in the incidence of
postoperative NCD relates to avoidance of any electroencephalographic
pattern suggesting excessive anesthesia depth. Objective The objective of
this trial is to investigate-in patients > 70 years old undergoing major
non-cardiac surgery-the effect of EEG-guided anesthesia on postoperative
NCD while controlling for intraoperative nociception, personalized blood
pressure targets, and using detailed information provided by the EEG
monitor (including burst suppression ratio, density spectral array, and
raw EEG waveform). Material and methods This prospective, randomized,
controlled trial will be conducted in a single Canadian university
hospital. Patients > 70 years old undergoing elective major non-cardiac
surgery will be included in the trial. The administration of sevoflurane
will be adjusted to maintain a BIS index value between 40 and 60, to keep
a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any
suppression time and a spectrogram with most of the EEG wave frequency
within the alpha, theta, and delta frequencies in the EEG-guided group. In
the control group, sevoflurane will be administered to achieve an
age-adjusted minimum alveolar concentration of [0.8-1.2]. In both groups,
a nociception monitor will guide intraoperative opioid administration,
individual blood pressure targets will be used, and cerebral oximetry used
to tailor intraoperative hemodynamic management. The primary endpoint will
be the incidence of NCD at postoperative day 1, as evaluated by the
Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the
incidence of postoperative NCD at different time points and the evaluation
of cognitive trajectories up to 90 days after surgery among EEG-guided and
control groups.<br/>Copyright &#xa9; 2021 Morisson 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.

<61>
Accession Number
2013997721
Title
The independent reduction in mortality associated with guideline-directed
medical therapy in patients with coronary artery disease and heart failure
with reduced ejection fraction.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 7 (4) (pp
416-421), 2021. Date of Publication: 01 Oct 2021.
Author
Wolfe N.K.; Mitchell J.D.; Brown D.L.
Institution
(Wolfe, Mitchell, Brown) Department of Medicine, Cardiovascular Division,
Washington University School of Medicine, 660 S. Euclid Ave, Campus Box
8086, St. Louis, MO 63110, United States
Publisher
Oxford University Press
Abstract
Aims: Guideline-directed medical therapy (GDMT) is underutilized in
patients with coronary artery disease (CAD). However, there are no studies
evaluating the impact of GDMT adherence on mortality among patients with
CAD and heart failure with reduced ejection fraction (HFrEF). We sought to
investigate the association of GDMT adherence with long-term mortality in
patients with CAD and HFrEF. <br/>Methods and Results: Surgical Treatment
for Ischaemic Heart Failure (STICH) was a trial of patients with an left
ventricular ejection fraction <=35% and CAD amenable to coronary artery
bypass graft surgery (CABG) who were randomized to CABG plus medical
therapy (N = 610) or medical therapy alone (N = 602). Median follow-up
time was 9.8 years. We defined GDMT for the treatment of CAD and HFrEF as
the combination of at least one antiplatelet drug, a statin, a
beta-blocker, and an angiotensin-converting enzyme inhibitor or
angiotensin receptor blocker. The primary outcome was all-cause mortality.
Assessment of the independent association between GDMT and mortality was
performed using multivariable Cox regression with GDMT as a time-dependent
covariate. In the CABG arm, 63.6% of patients were on GDMT throughout the
study period compared to 66.5% of patients in the medical therapy arm (P =
0.3). GDMT was independently associated with a significant reduction in
mortality (hazard ratio 0.65, 95% confidence interval 0.56-0.76; P <
0.001). <br/>Conclusion(s): GDMT is associated with reduced mortality in
patients with CAD and HFrEF independent of revascularization with CABG.
Strategies to improve GDMT adherence in this population are needed to
maximize survival. <br/>Copyright &#xa9; 2020 Published on behalf of the
European Society of Cardiology.

<62>
Accession Number
2013408491
Title
Tranexamic acid for the prevention and treatment of bleeding in surgery,
trauma and bleeding disorders: a narrative review.
Source
Thrombosis Journal. 19 (1) (no pagination), 2021. Article Number: 54. Date
of Publication: December 2021.
Author
Ockerman A.; Vanassche T.; Garip M.; Vandenbriele C.; Engelen M.M.;
Martens J.; Politis C.; Jacobs R.; Verhamme P.
Institution
(Ockerman, Garip, Martens, Politis, Jacobs) Department of Imaging and
Pathology, KU Leuven, OMFS-IMPATH Research Group, Leuven, Belgium
(Ockerman, Garip, Martens, Politis, Jacobs) Department of Oral &
Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
(Vanassche, Vandenbriele, Engelen, Verhamme) Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium
(Jacobs) Department of Dental Medicine, Karolinska Institutet, Stockholm,
Sweden
Publisher
BioMed Central Ltd
Abstract
Objectives: We review the evidence for tranexamic acid (TXA) for the
treatment and prevention of bleeding caused by surgery, trauma and
bleeding disorders. We highlight therapeutic areas where evidence is
lacking and discuss safety issues, particularly the concern regarding
thrombotic complications. <br/>Method(s): An electronic search was
performed in PubMed and the Cochrane Library to identify clinical trials,
safety reports and review articles. <br/>Finding(s): TXA reduces bleeding
in patients with menorrhagia, and in patients undergoing caesarian
section, myomectomy, hysterectomy, orthopedic surgery, cardiac surgery,
orthognathic surgery, rhinoplasty, and prostate surgery. For dental
extractions in patients with bleeding disorders or taking antithrombotic
drugs, as well as in cases of idiopathic epistaxis, tonsillectomy, liver
transplantation and resection, nephrolithotomy, skin cancer surgery, burn
wounds and skin grafting, there is moderate evidence that TXA is effective
for reducing bleeding. TXA was not effective in reducing bleeding in
traumatic brain injury and upper and lower gastrointestinal bleeding. TXA
reduces mortality in patients suffering from trauma and postpartum
hemorrhage. For many of these indications, there is no consensus about the
optimal TXA dose. With certain dosages and with certain indications TXA
can cause harm, such as an increased risk of seizures after high TXA doses
with brain injury and cardiac surgery, and an increased mortality after
delayed administration of TXA for trauma events or postpartum hemorrhage.
Whereas most trials did not signal an increased risk for thrombotic
events, some trials reported an increased rate of thrombotic complications
with the use of TXA for gastro-intestinal bleeding and trauma.
<br/>Conclusion(s): TXA has well-documented beneficial effects in many
clinical indications. Identifying these indications and the optimal dose
and timing to minimize risk of seizures or thromboembolic events is work
in progress.<br/>Copyright &#xa9; 2021, The Author(s).

<63>
Accession Number
2013444661
Title
The clinical utility of 2-deoxy-2-[¹⁸F]fluoro-d-glucose
positron emission tomography in guiding myocardial revascularisation.
Source
Clinical and Translational Imaging. (no pagination), 2021. Date of
Publication: 2021.
Author
Mpanya D.; Ayeni A.; More S.; Hadebe B.; Sathekge M.; Tsabedze N.
Institution
(Mpanya, Tsabedze) Division of Cardiology, Department of Internal
Medicine, School of Clinical Medicine, Faculty of Health Sciences,
Charlotte Maxeke Johannesburg Academic Hospital, University of the
Witwatersrand, Johannesburg, 17 Jubilee Road, Parktown, Johannesburg,
Gauteng 2193, South Africa
(Ayeni) Division of Clinical Associates/Family Medicine, Department of
Family Medicine and Primary Care, School of Clinical Medicine, Faculty of
Health Sciences, University of the Witwatersrand, Johannesburg,
Johannesburg, South Africa
(Ayeni, More) Division of Nuclear Medicine, Department of Radiation
Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town,
South Africa
(Hadebe) Department of Nuclear Medicine, School of Clinical Medicine,
Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South
Africa
(Sathekge) Department of Nuclear Medicine, University of Pretoria and
Steve Biko Academic Hospital, Pretoria, South Africa
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: Current myocardial revascularisation guidelines recommend
that patients with acute coronary syndromes be timeously revascularised.
Despite these class I recommendations, immediate access to timeous
revascularisation is often not achievable in low- and middle-income
countries (LMIC) and remote regions in high-income countries (HIC). Many
patients present late outside of the therapeutic window for
guideline-recommended interventions.
2-Deoxy-2-[¹⁸F]fluoro-d-glucose (2-[¹⁸F]FDG) is a
radiopharmaceutical agent used to identify cardiac regions with viable or
hibernating myocardium. Viable myocytes with impaired contraction may
recover their contractility with successful myocardial revascularisation.
However, there are conflicting hard outcomes data on patients with
hibernating myocardium who are subsequently revascularised. Whether this
management strategy results in improved major adverse cardiovascular
events remains uncertain. <br/>Method(s): In this narrative review, we
will critically appraise the existing body of evidence on whether using
2-[¹⁸F]FDG positron emission tomography (PET) in guiding
myocardial revascularisation leads to compelling clinical outcomes or not.
Furthermore, we will discuss possible reasons for the lack of differences
in patient outcomes. <br/>Result(s): A few randomised controlled trials
have challenged the concept of viability testing with
2-[¹⁸F]FDG PET. One trial demonstrated that a reduction in
mortality could be observed if PET recommendations are followed.
<br/>Conclusion(s): The current evidence is insufficient for clinicians in
LMIC or remote areas in HIC without access to catheterisation laboratories
to refrain from referring patients for viability imaging.<br/>Copyright
&#xa9; 2021, Italian Association of Nuclear Medicine and Molecular
Imaging.

<64>
Accession Number
2013410248
Title
Direct oral anticoagulants in patients with atrial fibrillation and
bioprosthetic valve replacement: A meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Lacy S.C.; Saint Croix G.R.; Porter K.; Latib A.; Beohar N.
Institution
(Lacy) Loyola University Medical Center, Maywood, IL, United States
(Saint Croix, Beohar) Columbia University Division of Cardiology at Mount
Sinai Medical Center, Miami Beach, FL, United States
(Porter) Jackson Memorial Hospital/University of Miami Hospital, Miami,
FL, United States
(Latib) Montefiore Medical Center, Albert Einstein College of Medicine,
New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This systematic review and meta-analysis compares direct oral
anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients
with atrial fibrillation and bioprosthetic valve replacement or repair
(BVR). <br/>Background(s): The optimal anticoagulation therapy for
patients with atrial fibrillation and a history of bioprosthetic valve
replacement or repair (BVR) is not well understood. <br/>Method(s): We
performed a systematic literature review to identify clinical studies that
compared anticoagulation therapies for patients with atrial fibrillation
and BVR. The primary outcomes of stroke, major bleeding, and mortality
were reported as random effects risk ratio (RR) with 95% confidence
interval. No prior ethical approval was required since all data is public.
<br/>Result(s): Our search yielded 101 potential studies. We included six
studies reporting on 1911 patients. There was a lower risk of stroke and
major bleeding in patients with atrial fibrillation after BVR treated with
DOACs when compared to VKAs with risk ratios of 0.44 (95% CI 0.24-0.82, p
< 0.01) and 0.53 (95% CI 0.34-0.83, p < 0.01), respectively. There was no
statistically significant difference in mortality between patients with
atrial fibrillation after BVR treated with DOACs compared to patients
treated with VKAs with a risk ratio of 1.12 (95% CI 0.73-1.74, p = 0.60).
<br/>Conclusion(s): This systematic review and meta-analysis suggests that
DOACs are superior to VKAs with respect to stroke and major bleeding in
patients with atrial fibrillation and BVR.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC.

<65>
Accession Number
635697169
Title
The global outbreak of Mycobacterium chimaera infections in cardiac
surgery - A systematic review of whole genome sequencing studies and joint
analysis.
Source
Clinical microbiology and infection : the official publication of the
European Society of Clinical Microbiology and Infectious Diseases. (no
pagination), 2021. Date of Publication: 20 Jul 2021.
Author
Schreiber P.W.; Kohl T.A.; Kuster S.P.; Niemann S.; Sax H.
Institution
(Schreiber, Kuster, Sax) Division of Infectious Diseases and Hospital
Epidemiology, University Hospital Zurich, University of Zurich, Zurich,
Switzerland
(Kohl, Niemann) Molecular and Experimental Mycobacteriology,
Forschungszentrum Borstel, Leibniz-Zentrum fur Medizin und
Biowissenschaften, Borstel; German Center for Infection Research (DZIF),
Partner Site Hamburg-Lubeck-Borstel-Riems, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: With increasing dimensions of the international cardiac
surgery-associated Mycobacterium chimaera outbreak the hypothesis of a
point source arose. <br/>OBJECTIVE(S): We aimed to review the published
evidence of clonality among cardiac surgery-associated M. chimaera
isolates evaluated by whole genome sequencing (WGS) and to perform an
integrative genomic analysis of available genome data. DATA SOURCES: We
searched PubMed and EMBASE for studies applying WGS on cardiac
surgery-associated M. chimaera isolates. STUDY ELIGIBILITY CRITERIA: We
included studies that applied WGS on more than a single M. chimaera
isolate. <br/>METHOD(S): Two authors independently extracted data from
included studies. Available genome data from published studies were
subjected to a joint analysis. <br/>RESULT(S): Of 121 identified articles,
nine studies were included. M. chimaera isolates from LivaNova
heater-cooler devices (HCDs) had a high level of genetic similarity, but
were genetically distant from isolates from HCDs produced by other
manufacturers. With exception of a single (11.1%) study, the remaining
eight (89.9%) studies reported a high level of genetic proximity between
the majority of M. chimaera isolates derived from cardiac
surgery-associated patients and LivaNova HCDs. In-depth analysis revealed
involvement of three distinct M. chimaera subgroups in the outbreak (1.1,
1.8, 2.1), with 1.1 suggested as causative of the outbreak. Samples taken
at the LivaNova production site supported contamination with strains of
subgroups 1.1 and 1.8. In the combined analysis of 526 publicly available
WGS datasets, nearly all isolates from cardiac surgery-associated patients
contained strain 1.1 (50/52, 96.2%), and at least one of the outbreak
strains was found in almost all LivaNova HCDs (241/257, 93.8%), with
strain 1.1 in particular present in 198/257 (77.0%). <br/>CONCLUSION(S):
HCD contamination during production seems plausible as predominant point
source for the global M. chimaera outbreak. While HCDs can be contaminated
with mixed populations, M. chimaera strains of the subgroup 1.1 caused
most infections.<br/>Copyright &#xa9; 2021. Published by Elsevier Ltd.

<66>
Accession Number
620697056
Title
Cognitive Outcomes After Transcatheter Aortic Valve Implantation: A
Metaanalysis.
Source
Journal of the American Geriatrics Society. 66 (2) (pp 254-262), 2018.
Date of Publication: February 2018.
Author
Khan M.M.; Herrmann N.; Gallagher D.; Gandell D.; Fremes S.E.;
Wijeysundera H.C.; Radhakrishnan S.; Sun Y.R.; Lanctot K.L.
Institution
(Khan, Herrmann, Sun, Lanctot) Neuropsychopharmacology Research Group,
Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto,
ON, Canada
(Khan, Sun, Lanctot) Department of Pharmacology and Toxicology, University
of Toronto, Toronto, ON, Canada
(Herrmann, Gallagher, Lanctot) Department of Psychiatry, Sunnybrook Health
Sciences Centre and University of Toronto, Toronto, ON, Canada
(Gandell) Department of Geriatric Medicine, Sunnybrook Health Sciences
Centre, Toronto, ON, Canada
(Fremes, Wijeysundera, Radhakrishnan) Schulich Heart Centre, Sunnybrook
Health Sciences Centre, Toronto, ON, Canada
Abstract
Objectives: To quantitatively summarize changes in cognitive performance
in individuals with severe aortic stenosis undergoing transcatheter aortic
valve implantation (TAVI). <br/>Design(s): Metaanalysis.
<br/>Participant(s): Individuals undergoing TAVI (N = 1,065 (48.5% male)
from 18 studies, average age >=80). Measurements: The MEDLINE, EMBASE, and
Cochrane Central databases were searched for original peer-reviewed
reports assessing cognitive performance using standardized cognitive tests
before and after TAVI. Data were extracted for cognitive scores before
TAVI; perioperatively (within 7 days after TAVI); 1, 3, and 6 months after
TAVI, and 12 to 34 months after TAVI (over the long term). Standardized
mean differences (SMDs) were generated using random-effects models for
changes in cognition at each time point. Metaregression analyses were
conducted to assess the association between population and procedural
characteristics and cognitive outcomes. Risk of bias was assessed.
<br/>Result(s): There were no significant changes from baseline in
perioperative cognitive performance (SMD = 0.05, 95% confidence interval
(CI) = -0.08-0.18; z = 0.75, P =.46), although overall cognitive
performance had improved significantly 1 month after TAVI (SMD = -0.33,
95% CI = -0.50 to -0.16; z = 3.83, P <.001). There were no differences in
cognitive performance 3 and 6 months after TAVI or over the long term.
Cognitive outcomes were not associated with any covariates in regression
analyses. <br/>Conclusion(s): Cognitive performance is preserved after
TAVI, suggesting TAVI is not detrimental to cognition.<br/>&#xa9; 2017,
Copyright the Authors Journal compilation &#xa9; 2017, The American
Geriatrics Society

<67>
Accession Number
2011180639
Title
Platelet Reactivity in Patients With Acute Coronary Syndromes Awaiting
Surgical Revascularization.
Source
Journal of the American College of Cardiology. 77 (10) (pp 1277-1286),
2021. Date of Publication: 16 Mar 2021.
Author
Nakashima C.A.K.; Dallan L.A.O.; Lisboa L.A.F.; Jatene F.B.; Hajjar L.A.;
Soeiro A.M.; Furtado R.H.M.; Dalcoquio T.F.; Baracioli L.M.; Lima F.G.;
Giraldez R.R.C.V.; Silva B.A.; Costa M.S.S.; Strunz C.M.C.; Dallan L.R.P.;
Barbosa C.J.D.G.; Britto F.A.B.; Farkouh M.E.; Gurbel P.A.; Nicolau J.C.
Institution
(Nakashima, Dallan, Lisboa, Jatene, Hajjar, Soeiro, Furtado, Dalcoquio,
Baracioli, Lima, Giraldez, Silva, Costa, Strunz, Dallan, Nicolau)
Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Furtado) Hospital Israelita Albert Einstein, Sao Paulo, Brazil
(Barbosa) Hospital do Coracao do Brasil, Brasilia, Brazil
(Britto, Farkouh) Hospital das Clinicas, Faculdade de Medicina,
Universidade Federal de Uberlandia, Minas Gerais, Brazil
(Britto, Farkouh) Peter Munk Cardiac Centre and Heart and Stroke Richard
Lewar Centre, University of Toronto, Toronto, ON, Canada
(Gurbel) Sinai Center for Thrombosis Research and Drug Development, Sinai
Hospital of Baltimore, Baltimore, MD, United States
Publisher
Elsevier Inc.
Abstract
Background: Dual antiplatelet therapy is recommended for patients with
acute coronary syndromes (ACS). Approximately 10% to 15% of these patients
will undergo coronary artery bypass graft (CABG) surgery for index events,
and current guidelines recommend stopping clopidogrel at least 5 days
before CABG. This waiting time has clinical and economic implications.
<br/>Objective(s): This study aimed to evaluate if a platelet
reactivity-based strategy is noninferior to standard of care for 24-h
post-CABG bleeding. <br/>Method(s): In this randomized, open label
noninferiority trial, 190 patients admitted with ACS with indications for
CABG and on aspirin and P2Y<inf>12</inf> receptor inhibitors, were
assigned to either control group, P2Y<inf>12</inf> receptor inhibitor
withdrawn 5 to 7 days before CABG, or intervention group, daily
measurements of platelet reactivity by Multiplate analyzer (Roche
Diagnostics GmbH, Vienna, Austria) with CABG planned the next working day
after platelet reactivity normalization (pre-defined as >=46 aggregation
units). <br/>Result(s): Within the first 24 h of CABG, the median chest
tube drainage was 350 ml (interquartile range [IQR]: 250 to 475 ml) and
350 ml (IQR: 255 to 500 ml) in the intervention and control groups,
respectively (p for noninferiority <0.001). The median waiting period
between the decision to undergo CABG and the procedure was 112 h (IQR: 66
to 142 h) and 136 h (IQR: 112 to 161 h) (p < 0.001), respectively. In the
intention-to-treat analysis, a 6.4% decrease in the median in-hospital
expenses was observed in the intervention group (p = 0.014), with 11.2%
decrease in the analysis per protocol (p = 0.003). <br/>Conclusion(s): A
strategy based on platelet reactivity-guided is noninferior to the
standard of care in patients with ACS awaiting CABG regarding
peri-operative bleeding, significantly shortens the waiting time to CABG,
and decreases hospital expenses. (Evaluation of Platelet Aggregability in
the Release of CABG in Patients With ACS With DAPT;
NCT02516267)<br/>Copyright &#xa9; 2021 American College of Cardiology
Foundation

<68>
Accession Number
2013682146
Title
Efficacy of Erector Spinae Plane Block for Analgesia in Thoracic Surgery:
A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Koo C.-H.; Lee H.-T.; Na H.-S.; Ryu J.-H.; Shin H.-J.
Institution
(Koo, Lee, Na, Ryu, Shin) Department of Anesthesiology & Pain Medicine,
Seoul National University Bundang Hospital, Seongnam, South Korea
(Ryu) Department of Anesthesiology & Pain Medicine, Seoul National
University College of Medicine, Seoul, South Korea
Publisher
W.B. Saunders
Abstract
Objective: The objective of this study was to determine whether erector
spinae plane block (ESPB) can provide an effective analgesia for managing
pain after thoracic surgery and compare the efficacy of ESPB with that of
other regional analgesic techniques. <br/>Design(s): Systematic review and
meta-analysis of randomized controlled trials. <br/>Setting(s): PubMed,
EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science were searched.
<br/>Participant(s): Patients undergoing thoracic surgeries.
<br/>Intervention(s): Erector spinae plane block with local anesthetics
for postoperative analgesia. Measurement and Main Results: Seventeen
studies, including 1,092 patients, were included in the final analysis.
Erector spinae plane block reduced 24-hour postoperative opioid
consumption (mean difference [MD] -17.49, 95% CI -26.87 to -8.12), pain
score at rest (MD -0.82, 95% CI -1.31 to -0.33), and pain score at
movement (MD -0.77, 95% CI -1.20 to -0.3) compared to no block. Compared
with other regional blocks, various results have been observed. Although
statistical results showed that ESPB is inferior to thoracic paravertebral
block and intercostal nerve block and superior to serratus anterior plan
block in postoperative analgesia, clinical differences remain unclear. The
incidence of hematoma was lower in the ESPB group than in the other groups
(odds ratio 0.19, 95% CI 0.05-0.73). <br/>Conclusion(s): Erector spinae
plane block may provide effective analgesia after thoracic surgery.
Compared with other techniques, it is a safer method, without clinically
important differences, for postoperative pain control. Therefore, ESPB may
be considered as a valuable option for postoperative pain management after
thoracic surgery.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<69>
Accession Number
634775646
Title
Depression as a predictor of postoperative delirium after cardiac surgery:
a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 371-379),
2021. Date of Publication: 08 Apr 2021.
Author
Falk A.; Kahlin J.; Nymark C.; Hultgren R.; Stenman M.
Institution
(Falk, Hultgren, Stenman) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Falk, Kahlin, Stenman) Perioperative Medicine and Intensive Care
Function, Karolinska University Hospital, Stockholm, Sweden
(Kahlin) Department of Physiology and Pharmacology, Karolinska Institutet,
Stockholm, Sweden
(Nymark) Department of Neurobiology, Care Sciences and Society, Karolinska
Institutet, Stockholm, Sweden
(Nymark, Hultgren) Heart and Vascular Theme, Karolinska University
Hospital, Stockholm, Sweden
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Depression is common in patients with cardiac disease. The
importance of preoperative depression for development of postoperative
delirium (POD) following cardiac surgery is not well known. The aim is to
provide a summary estimate of depression as a predictor of POD following
cardiac surgery. <br/>METHOD(S): Systematic search of MEDLINE, EMBASE,
Cochrane Library, Web of Science Core Collection and Psycinfo (Ovid) was
performed from inception to October 2019, including cohort studies
reporting odds ratios (ORs) and 95% confidence intervals (CIs) for POD
following cardiac surgery in patients with preoperative depression
compared to patients without depression. ORs and 95% CIs for POD were
calculated using random-effects meta-analyses. Subgroup and sensitivity
analyses were performed. <br/>RESULT(S): Seven studies were included with
a combined study population of 2066 patients. The pooled prevalence of POD
in the combined study population was 26% and preoperative depression was
present in ~9% of the total study population. All studies showed a
positive association between preoperative depression and POD; and in 5
studies, the association was statistically significant. Patients with
depression had a pooled OR of 2.31 (95% CI 1.37-3.90) for POD.
<br/>CONCLUSION(S): This systematic review and meta-analysis confirm the
findings that the previous association between preoperative depression and
increased risk for developing POD reported for other patient groups is
found also in cardiac surgery. Depression screening prior to cardiac
surgery may be effective in identifying patients at higher risk for
POD.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<70>
Accession Number
634775575
Title
Comparison of early postoperative cytokine changes in patients undergoing
intubated and non-intubated thoracic surgery: a randomized controlled
trial.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 343-350),
2021. Date of Publication: 08 Apr 2021.
Author
Jeon J.; Sung S.; Moon Y.; Koo J.; Hyun K.; Han K.; Hwang W.
Institution
(Jeon) Department of Anesthesia and Pain Medicine, Eunpyeong St. Mary's
Hospital, College of Medicine, Catholic University of Korea, Seoul, South
Korea
(Sung) Department of Thoracic and Cardiovascular Surgery, Ewha Womans
University Seoul Hospital, Seoul, South Korea
(Moon) Department of Thoracic and Cardiovascular Surgery, Eunpyeong St.
Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul,
South Korea
(Koo, Hwang) Department of Anesthesia and Pain Medicine, Seoul St. Mary's
Hospital, College of Medicine, Catholic University of Korea, Seoul, South
Korea
(Hyun) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, Catholic University of Korea, Seoul, South
Korea
(Han) Department of Statistics and Actuarial Science, Soongsil University,
Seoul, South Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The inflammatory response after surgery is associated with
patient prognosis. Patients who undergo thoracic surgery exhibit a
profound systemic inflammatory response due to the surgical procedures
used and application of one-lung ventilation. The aim of this study was to
compare perioperative inflammatory changes in patients after intubated and
non-intubated thoracic surgery for primary lung cancer resection.
<br/>METHOD(S): This prospective randomized controlled study included
forty patients who underwent surgical resection for stage I non-small-cell
lung cancer. Blood samples for cytokine analysis were collected just
before induction, at 1 and 24h after surgery. Levels of the
pro-inflammatory cytokine and anti-inflammatory cytokines were measured
using quantitative sandwich enzyme immunoassay kits. <br/>RESULT(S): The
basal values of cytokines were comparable between 2 groups. Within each
group, the postoperative levels of interleukin (IL)-1, IL-6 and tumour
necrosis factor-alpha increased, while those of IL-4 and IL-10 did not
change significantly. The levels of IL-6 and tumour necrosis factor-alpha
were significantly lower in group NI at 1 and 24h postoperatively. Other
cytokines did not differ in both groups during postoperative period. The
IL-6/IL-10 ratio at 1h after surgery was lower in non-intubated patients
than in intubated patients, but there was no difference at 24h after
surgery. <br/>CONCLUSION(S): Non-intubated thoracic surgery may attenuate
the early inflammatory cytokine changes following major resection for
primary lung cancer compared with intubated conventional surgery. CLINICAL
TRIAL REGISTRATION: ClinicalTrials.gov registry number
NCT04007354.<br/>Copyright &#xa9; The Author(s) 2020. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<71>
Accession Number
633507094
Title
Mitral valve surgery after a failed MitraClip procedure.
Source
Interactive cardiovascular and thoracic surgery. 32 (3) (pp 380-385),
2021. Date of Publication: 08 Apr 2021.
Author
Melillo F.; Baldetti L.; Beneduce A.; Agricola E.; Margonato A.; Godino C.
Institution
(Melillo, Baldetti, Beneduce, Agricola, Margonato, Godino)
Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
(Agricola, Margonato) Vita-Salute San Raffaele University, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Among patients undergoing transcatheter mitral valve repair
with the MitraClip device, a relevant proportion (2-6%) requires open
mitral valve surgery within 1year after unsuccessful clip implantation.
The goal of this review is to pool data from different reports to provide
a comprehensive overview of mitral valve surgery outcomes after the
MitraClip procedure and estimate in-hospital and follow-up mortality.
<br/>METHOD(S): All published clinical studies reporting on surgical
intervention for a failed MitraClip procedure were evaluated for inclusion
in this meta-analysis. The primary study outcome was in-hospital
mortality. Secondary outcomes were in-hospital adverse events and
follow-up mortality. Pooled estimate rates and 95% confidence intervals
(CIs) of study outcomes were calculated using a DerSimionian-Laird binary
random-effects model. To assess heterogeneity across studies, we used the
Cochrane Q statistic to compute I2 values. <br/>RESULT(S): Overall, 20
reports were included, comprising 172 patients. Mean age was 70.5years
(95% CI 67.2-73.7years). The underlying mitral valve disease was
functional mitral regurgitation in 50% and degenerative mitral
regurgitation in 49% of cases. The indication for surgery was persistent
or recurrent mitral regurgitation (grade >2) in 93% of patients, whereas
6% of patients presented with mitral stenosis. At the time of the
operation, 80% of patients presented in New York Heart Association
functional class III-IV. Despite favourable intraoperative results,
in-hospital mortality was 15%. The rate of periprocedural cerebrovascular
accidents was 6%. At a mean follow-up of 12months, all-cause death was
26.5%. Mitral valve replacement was most commonly required because the
possibility of valve repair was jeopardized, likely due to severe valve
injury after clip implantation. <br/>CONCLUSION(S): Surgical intervention
after failed transcatheter mitral valve intervention is burdened by high
in-hospital and 1-year mortality, which reflects reflecting the high-risk
baseline profile of the patients. Mitral valve replacement is usually
required due to leaflet injury.<br/>Copyright &#xa9; The Author(s) 2020.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<72>
Accession Number
2013237238
Title
Efficacy and safety of cerebral embolic protection systems during
transcatheter aortic valve replacement: a review of current clinical
findings.
Source
Expert Review of Cardiovascular Therapy. 19 (8) (pp 725-737), 2021. Date
of Publication: 2021.
Author
Sato Y.; Kawakami R.; Sakamoto A.; Cornelissen A.; Mori M.; Kawai K.;
Ghosh S.; Romero M.E.; Kolodgie F.D.; Virmani R.; Finn A.V.
Institution
(Sato, Kawakami, Sakamoto, Cornelissen, Mori, Kawai, Ghosh, Romero,
Kolodgie, Virmani, Finn) CVPath Institute, Gaithersburg, MD, United States
(Finn) University of Maryland, School of Medicine, Baltimore, MD, United
States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Cerebrovascular events are one of the most serious
consequences after transcatheter aortic valve replacement (TAVR). More
than half of the cerebrovascular events following TAVR are due to
procedure-related emboli. Embolic protection devices (EPDs) have the
potential to decrease cerebrovascular events during TAVR procedure.
However, randomized controlled trials (RCTs) have not conclusively
determined if EPDs are effective, likely because of small number of
patients enrolled. However, meta-analyses and propensity-matched analyses
from large registries have shown efficacy and suggest the importance of
EPDs in prevention of stroke during TAVR and perhaps other structural
heart procedures. Areas covered: This review will focus on clinical and
histopathologic studies examining the efficacy, safety, and
histopathologic device capture findings in the presence and absence of
EPDs during TAVR procedures. Expert opinion: Clinical studies have not
conclusively determined the efficacy of EPDs. Current ongoing large-scale
RCT (PROTECTED TAVR [NCT04149535]) has the potential to prove their
efficacy. Histopathological evaluation of debris captured by EPDs
contributes to our understanding of the mechanisms of TAVR
procedure-related embolic events and suggests the importance of preventing
cerebral embolization of debris released during this and other structural
heart procedures.<br/>Copyright &#xa9; 2021 Informa UK Limited, trading as
Taylor & Francis Group.

<73>
Accession Number
2012285227
Title
Clinical anatomy of the lumbar sinuvertebral nerve with regard to
discogenic low back pain and review of literature.
Source
European Spine Journal. (no pagination), 2021. Date of Publication: 2021.
Author
Quinones S.; Konschake M.; Aguilar L.L.; Simon C.; Aragones P.; Hernandez
L.M.; Abramovic A.; Tubbs S.R.; Bouzad J.; Valderrama-Canales F.J.;
Vazquez T.; Sanudo J.
Institution
(Quinones, Aragones, Bouzad, Valderrama-Canales, Vazquez, Sanudo)
Department of Anatomy and Embryology, Faculty of Medicine, Universidad
Complutense de Madrid, Madrid, Spain
(Konschake, Abramovic) Department of Anatomy, Histology and Embryology,
Institute of Clinical and Functional Anatomy, Medical University of
Innsbruck (MUI), Mullerstr. 59, Innsbruck 6020, Austria
(Aguilar) Unidad de Columna. Servicio de COT., Hospital Plato., Barcelona,
Spain
(Simon) Computer Science and Statistics, URJC., Madrid, Spain
(Simon) Instituto Universitario de Evaluacion Sanitaria, UCM, Madrid,
Spain
(Aragones) Department of Orthopedics. Hospital, Universitario Santa
Cristina, Madrid, Spain
(Hernandez) Human Anatomy and Embryology Unit, Department of Surgery,
Medical and Social Sciences, Scholl of Medicine and Health Sciences,
University of Alcala, UAH, Alcala de Henares, Madrid, Spain
(Abramovic) Department of Neurosurgery, Medical University of Innsbruck
(MUI), Innsbruck, Austria
(Tubbs) Department of Neurosurgery, Tulane University School of Medicine,
New Orleans, LA, United States
(Tubbs) Department of Neurology, Tulane University School of Medicine, New
Orleans, LA, United States
(Tubbs) Department of Surgery, Tulane University School of Medicine, New
Orleans, LA, United States
(Tubbs) Department of Structural and Cellular Biology, Tulane University
School of Medicine, New Orleans, LA, United States
(Tubbs) Department of Neurosurgery and Ochsner Neuroscience Institute,
Ochsner Health System, New Orleans, LA, United States
(Tubbs) Department of Anatomical Sciences, School of Medicine, St.
George's University, West Indies, Grenada
(Tubbs) University of Queensland, Brisbane, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Lumbar discogenic diffuse pain is still not understood. Authors
describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor
studies are rare and controversial. Therefore, the aim was to revisit the
origin, course and distribution in a body-donor study. <br/>Method(s): Six
lumbar blocks (3 female, 3 male) aged between 59 and 94 years were
dissected. After removal of the back muscles, lamina, dura mater and cauda
equina, the anterior vertebral venous plexus, spinal artery and SVN were
exposed and evaluated. <br/>Result(s): 43 nerves out of 48 levels could be
evaluated. The origin of the SVN was constituted by two roots: a somatic
and a sympathetic branch arising from the rami communicantes. In 4/48
intervertebral canals studied (8.3%), we found two SVN at the same level.
In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The
SVN had a recurrent course below the inferior vertebral notch; in the
vertebral canal it showed different patterns: ascending branch (31/43,
72.1%), common branch diverging into two branches (10/43, 23.3%), double
ascending branch (1/43, 2.3%) finalizing two levels above and a descending
branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral
connections with another SVN. The distribution ended in the middle of the
vertebral body supplying adjacent structures. <br/>Conclusion(s): A
thorough understanding of the anatomy of the SVN might lead to significant
benefits in therapy of discogenic low back pain. We suggest blocking the
SVN at the level of the inferior vertebral notch of two adjacent segments.
Level of evidence I: Diagnostic: individual cross-sectional studies with
consistently applied reference standard and blinding<br/>Copyright &#xa9;
2021, The Author(s).

<74>
Accession Number
2010569545
Title
Ocular complications of perioperative anesthesia: a review.
Source
Graefe's Archive for Clinical and Experimental Ophthalmology. 259 (8) (pp
2069-2083), 2021. Date of Publication: August 2021.
Author
Singh R.B.; Khera T.; Ly V.; Saini C.; Cho W.; Shergill S.; Singh K.P.;
Agarwal A.
Institution
(Singh, Saini, Cho) Massachusetts Eye and Ear, Department of
Ophthalmology, Harvard Medical School, Boston, MA 02114, United States
(Singh) Department of Ophthalmology, Leiden University Medical Center,
Leiden, ZA 2333, Netherlands
(Khera) Department of Anesthesia, Critical Care and Pain Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215,
United States
(Ly) University of Arkansas for Medical Sciences, Little Rock, AR 72205,
United States
(Shergill) Department of Anesthesiology, Yale School of Medicine, New
Haven, CT 06510, United States
(Singh) Dayanand Medical College & Hospital, Ludhiana 141001, India
(Agarwal) Advanced Eye Center, Department of Ophthalmology, Post Graduate
Institute of Medical Education and Research (PGIMER), Sector 12,
Chandigarh 160012, India
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Ocular complications associated with anesthesia in ocular and non-ocular
surgeries are rare adverse events which may present with clinical
presentations vacillating between easily treatable corneal abrasions to
more serious complication such as irreversible bilateral vision loss. In
this review, we outline the different techniques of anesthetic delivery in
ocular surgeries and highlight the incidence and etiologies of associated
injuries. The changes in vision in non-ocular surgeries are mistaken for
residual sedation or anesthetics, therefore require high clinical
suspicion on part of the treating ophthalmologists, to ensure early
diagnosis, adequate and swift management especially in surgeries such as
cardiac, spine, head and neck, and some orthopedic procedures, that have a
comparatively higher incidence of ocular complications. In this article,
we review the literature for reports on the clinical incidence of
different ocular complications associated with anesthesia in non-ocular
surgeries and outline the current understanding of pathophysiological
processes associated with these adverse events.<br/>Copyright &#xa9; 2021,
The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of
Springer Nature.

<75>
Accession Number
2007840140
Title
Cardiomyopathies: An overview.
Source
International Journal of Molecular Sciences. 22 (14) (no pagination),
2021. Article Number: 7722. Date of Publication: 02 Jul 2021.
Author
Ciarambino T.; Menna G.; Sansone G.; Giordano M.
Institution
(Ciarambino) Internal Emergency Department, Hospital of Marcianise, ASL,
Caserta 81037, Italy
(Menna, Sansone, Giordano) Department of Medical Science, University of
Campania, L. Vanvitelli, Naples 81100, Italy
Publisher
MDPI AG
Abstract
Background: Cardiomyopathies are a heterogeneous group of pathologies
characterized by structural and functional alterations of the heart.
<br/>Aim(s): The purpose of this narrative review is to focus on the most
important cardiomyopathies and their epidemiology, diagnosis, and
manage-ment. <br/>Method(s): Clinical trials were identified by Pubmed
until 30 March 2021. The search keywords were "cardiomyopathies, sudden
cardiac arrest, dilated cardiomyopathy (DCM), hypertrophic car-diomyopathy
(HCM), restrictive cardiomyopathy, arrhythmogenic cardiomyopathy (ARCV),
tako-tsubo syndrome". <br/>Result(s): Hypertrophic cardiomyopathy (HCM) is
the most common primary car-diomyopathy, with a prevalence of 1:500
persons. Dilated cardiomyopathy (DCM) has a prevalence of 1:2500 and is
the leading indication for heart transplantation. Restrictive
cardiomyopathy (RCM) is the least common of the major cardiomyopathies,
representing 2% to 5% of cases. Arrhythmogenic cardiomyopathy (ARCV) is a
pathology characterized by the substitution of the myocardium by
fibrofatty tissue. Takotsubo cardiomyopathy is defined as an abrupt onset
of left ventricular dysfunction in response to severe emotional or
physiologic stress. <br/>Conclusion(s): In particular, it has been
reported that HCM is the most important cause of sudden death on the
athletic field in the United States. It is needless to say how important
it is to know which changes in the heart due to physical activity are
normal, and when they are pathological.<br/>Copyright &#xa9; 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<76>
Accession Number
2013735904
Title
Meta-analysis of impact of renin-angiotensin system inhibitors on survival
after transcatheter aortic valve implantation.
Source
Minerva Cardiology and Angiology. 69 (3) (pp 299-309), 2021. Date of
Publication: June 2021.
Author
Takagi H.; Kuno T.; Hari Y.; Nakashima K.; Yokoyama Y.; Ueyama H.; Ando T.
Institution
(Takagi, Hari, Nakashima) Shizuoka Medical Center, Department of
Cardiovascular Surgery, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno, Ueyama) Department of Medicine, Mount Sinai Beth Israel Medical
Center, New York, NY, United States
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA, United
States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital, Columbia University Medical Center, New
York, NY, United States
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: To determine whether renin-angiotensin system inhibitor
(RASI) prescription is associated with better survival after transcatheter
aortic valve implantation (TAVI), we performed the first meta-analysis of
currently available studies. EVIDENCE ACQUISITION: To identify all studies
reporting impact of RASI prescription on survival after TAVI, we searched
PubMed, Web of Science, Google Scholar, etc. through October 2019. We
extracted adjusted (if unavailable, unadjusted) hazard ratios (HRs) with
their confidence intervals (CIs) of midterm (up to >=6-month) all-cause
mortality for RASI prescription from each study and combined
study-specific estimates using inverse variance-weighted averages of
logarithmic HRs in the random-effects model. EVIDENCE SYNTHESIS: We
identified 13 eligible studies with a total of 26,132 TAVI patients and
included them in the present meta-analysis. None was a randomized
controlled trial, 5 were observational studies comparing patients with
versus without RASI prescription (including 3 propensity score matched
studies), and 8 were observational studies investigating RASI prescription
as one of covariates. The primary meta-analysis of all studies
demonstrated that RASI prescription was associated with significantly
lower midterm mortality (HR=0.83; 95% CI: 0.76 to 0.92; P=0.0002).
Although we identified significant funnel plot asymmetry (P=0.036 by the
rank correlation test) suggesting publication bias, correcting for it
using the trim-and-fill method did not substantially alter the result
favoring RASI prescription (corrected HR=0.85; 95% CI: 0.76 to 0.95;
P=0.004). <br/>CONCLUSION(S): RASI prescription may be associated with
better midterm survival after TAVI.<br/>Copyright &#xa9; 2020 EDIZIONI
MINERVA MEDICA

<77>
Accession Number
635650594
Title
Milrinone as compared with dobutamine in the treatment of cardiogenic
shock.
Source
New England Journal of Medicine. 385 (6) (pp 516-525), 2021. Date of
Publication: 05 Aug 2021.
Author
Mathew R.; Di Santo P.; Jung R.G.; Marbach J.A.; Hutson J.; Simard T.;
Ramirez F.D.; Harnett D.T.; Merdad A.; Almufleh A.; Weng W.; Abdel-Razek
O.; Fernando S.M.; Kyeremanteng K.; Bernick J.; Wells G.A.; Chan V.;
Froeschl M.; Labinaz M.; Le May M.R.; Russo J.J.; Hibbert B.
Institution
(Mathew, Di Santo, Jung, Marbach, Hutson, Simard, Ramirez, Harnett,
Abdel-Razek, Froeschl, Labinaz, Le May, Russo, Hibbert) The CAPITAL
Research Group, Division of Cardiology, Canada
(Bernick, Wells) The Cardiovascular Research Methods Centre, Canada
(Chan) The Division of Cardiac Surgery, Canada
(Mathew, Di Santo, Jung, Hutson, Harnett, Weng, Abdel-Razek, Fernando,
Kyeremanteng, Froeschl, Labinaz, Le May, Russo, Hibbert) University of
Ottawa Heart Institute, The Faculty of Medicine, Canada
(Mathew, Hutson, Fernando, Kyeremanteng) The Division of Critical Care,
Department of Medicine, Canada
(Di Santo) The School of Epidemiology and Public Health, Canada
(Jung, Simard, Hibbert) The Department of Cellular and Molecular Medicine,
Canada
(Merdad) University of Ottawa, Ottawa, Canada
(Almufleh) The Division of Cardiology, University of British Columbia,
Vancouver, Canada
(Marbach) The Division of Critical Care, Tufts Medical Center, Boston,
United States
(Simard) The Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Ramirez) Hopital Cardiologique du Haut Leveque, Centre Hospitalier
Universitaire Bordeaux, Bordeaux-Pessac, France
(Ramirez) LIRYC (l'Institut de Rythmologie et Modelisation Cardiaque),
Bordeaux-Pessac, France
(Merdad) The Division of Cardiology, University of Toronto, Toronto,
Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Cardiogenic shock is associated with substantial morbidity and
mortality. Although inotropic support is a mainstay of medical therapy for
cardiogenic shock, little evidence exists to guide the selection of
inotropic agents in clinical practice. METHODS We randomly assigned
patients with cardiogenic shock to receive milrinone or dobutamine in a
double-blind fashion. The primary outcome was a composite of in-hospital
death from any cause, resuscitated cardiac arrest, receipt of a cardiac
transplant or mechanical circulatory support, nonfatal myocardial
infarction, transient ischemic attack or stroke diagnosed by a
neurologist, or initiation of renal replacement therapy. Secondary
outcomes included the individual components of the primary composite
outcome. RESULTS A total of 192 participants (96 in each group) were
enrolled. The treatment groups did not differ significantly with respect
to the primary outcome; a primary outcome event occurred in 47
participants (49%) in the milrinone group and in 52 participants (54%) in
the dobutamine group (relative risk, 0.90; 95% confidence interval [CI],
0.69 to 1.19; P = 0.47). There were also no significant differences
between the groups with respect to secondary outcomes, including
in-hospital death (37% and 43% of the participants, respectively; relative
risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%;
hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical
circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to
1.71), or initiation of renal replacement therapy (22% and 17%; hazard
ratio, 1.39; 95% CI, 0.73 to 2.67). CONCLUSIONS In patients with
cardiogenic shock, no significant difference between milrinone and
dobutamine was found with respect to the primary composite outcome or
important secondary outcomes. (Funded by the Innovation Fund of the
Alternative Funding Plan for the Academic Health Sciences Centres of
Ontario; ClinicalTrials.gov number, NCT03207165.) <br/>Copyright &#xa9;
2021 Massachusetts Medical Society.

<78>
Accession Number
635624059
Title
Heart failure in pregnancy: What is the long-term impact of pregnancy on
cardiac function? A tertiary care centre experience and systematic review.
Source
Open Heart. 8 (2) (no pagination), 2021. Article Number: e001587. Date of
Publication: 03 Aug 2021.
Author
Dodeja A.K.; Siegel F.; Dodd K.; Ma'ayeh M.; Mehta L.S.; Fuchs M.M.; Rood
K.M.; Mah M.L.; Bradley E.A.
Institution
(Dodeja, Mah) Division of Cardiology, Nationwide Children's Hospital,
Columbus, OH, United States
(Dodeja, Dodd, Mehta, Bradley) Department of Internal Medicine, Division
of Cardiovascular Medicine, The Ohio State University, Columbus, OH,
United States
(Siegel) The Ohio State University College of Medicine, Columbus, OH,
United States
(Ma'ayeh, Rood) Department of Obstetrics and Gynecology, Division of
Maternal Fetal Medicine, The Ohio State University, Columbus, OH, United
States
(Fuchs) Mayo Clinic Division of Cardiovascular Diseases, Rochester, MN,
United States
Publisher
BMJ Publishing Group
Abstract
Background Women with cardiomyopathy (CM) are often advised against
pregnancy due to risk for major adverse cardiovascular events (MACE).
However, the impact of CM subtype on maternal MACE is not understood, and
so we sought to evaluate the influence of CM phenotype on maternal
outcomes, as well as the effect on immediate and late left ventricular
function. Methods We evaluated all pregnant women in our high-risk
maternal cardiovascular programme (2009-2019). Composite maternal MACE
included: death, inotrope use, left ventricular assist device, orthotopic
heart transplant and/or escalation in transplant listing status, acute
decompensated heart failure and sustained ventricular arrhythmia. Results
Among 875 women followed, 32 had CM (29+/-7 years old, left ventricular
ejection fraction (LVEF) 41%+/-12%): 3 ischaemic CM (ICM), 10 peripartum
CM (PPCM) and 19 non-ICM (NICM). MACE events occurred in 6 (18%) women
(PPCM: 2 (33%), NICM: 4 (67%)). There was no difference in LVEF at
baseline, however, women with MACE had significantly lower LVEF both early
(LVEF: 27+/-5% vs. 41+/-2%, p<0.05) and late post partum (LVEF: 28+/-5%
vs. 44+/-2%, p<0.01). Conclusions In this contemporary cohort of women
with CM, maternal MACE rates were lower than previously reported, and were
less common in PPCM as compared with ICM and NICM. Heart function in women
with MACE was negatively impacted immediately after delivery and in late
postpartum follow-up, suggesting that pregnancy itself likely has
influence on future left ventricular function in women with underlying CM.
<br/>Copyright &#xa9; 2021 A.D.A.C.. All rights reserved.

<79>
Accession Number
2013997714
Title
Management of aortic stenosis: A systematic review of clinical practice
guidelines and recommendations.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 7 (4) (pp
340-353), 2021. Date of Publication: 01 Oct 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, United
Kingdom
(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, Malmo 205 02, Sweden
(Ricci) Department of Cardiology, Casa di Cura Villa Serena, Citta
Sant'Angelo, Pescara 65013, 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, Heol Maes Eglwys, 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, MN
55902, United States
Publisher
Oxford University Press
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. <br/>Copyright &#xa9; 2021 Published on behalf of
the European Society of Cardiology. All rights reserved.

<80>
Accession Number
2013735912
Title
Long-term outcomes of percutaneous or surgical treatment in left main
disease.
Source
Minerva Cardiology and Angiology. 69 (3) (pp 313-321), 2021. Date of
Publication: June 2021.
Author
Chiabrando J.G.; Vescovo G.M.; Lombardi M.; Del Buono M.G.; Romeo F.J.;
Berrocal D.H.; Guzman L.; Biondi-Zoccai G.; Abbate A.
Institution
(Chiabrando, Romeo, Berrocal) Interventional Cardiology Service, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina
(Chiabrando) Health Science Statistics Applied Laboratory (LEACS),
Department of Pharmacology and Toxicology, School of Medicine, University
of Buenos Aires, Buenos Aires, Argentina
(Vescovo) Department of Cardiac Thoracic, Vascular Sciences and Public
Health, University of Padua, Padua, Italy
(Lombardi, Del Buono, Abbate) VCU Pauley Heart Center, Virginia
Commonwealth University, Richmond, VA, United States
(Lombardi, Del Buono) Department of Cardiovascular and Thoracic Sciences,
Sacred Heart Catholic University, Rome, Italy
(Guzman) Wake Forest University, Winston-Salem, NC, United States
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Long-term efficacy and safety of either surgical or
percutaneous treatment left main coronary artery disease treatment is
lacking. EVIDENCE ACQUISITION: We conducted a systematic review and
meta-analysis of the most updated randomized clinical trials that compared
the efficacy of coronary artery bypass surgery (CABG) or percutaneous
coronary intervention (PCI) for the Left Main Coronary Artery (LMCA)
disease. It was also conducted a systematic search of PubMed, Google
Scholar, reference lists of relevant articles, and Medline. The search
utilized the following terms: "left main PCI versus CABG," "drug-eluting
stents," "bypass surgery" and "left main stenting." The search of articles
compatible with our inclusion and exclusion criteria was performed from
inception through April 2020 and returned a combined total of 304
articles. EVIDENCE SYNTHESIS: We identified 6 studies, providing data on
5812 patients. The mean follow-up was 6.7 years. PCI was associated with
an increased risk of major vascular events (MACE) (IRR 1.24, 95% CI
[1.03-1.67], P<0.01), and coronary revascularization (IRR 1.69, 95% CI
[1.42-2.03], P<0.01) compared to CABG. Furthermore, all-cause death, MI
and stroke events were not statistically different between the two
therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24],
P=0.47, IRR 1.35, 95% CI [0.84-2.16], P=0.03 and IRR 0.66, 95% CI
[0.43-1.01], P=0.05, respectively). <br/>CONCLUSION(S): LMCA PCI has an
overall same survival compared to CABG in the long term follow-up.
Nevertheless, MACE and revascularization events were more frequent in PCI
compared to CABG.<br/>Copyright &#xa9; 2020 EDIZIONI MINERVA MEDICA

<81>
Accession Number
2013331794
Title
Atrial fibrillation ablation in heart failure patients.
Source
Journal of Clinical Medicine. 10 (16) (no pagination), 2021. Article
Number: 3512. Date of Publication: 02 Aug 2021.
Author
Derndorfer M.; Chen S.; Purerfellner H.
Institution
(Derndorfer, Purerfellner) Ordensklinikum Linz Elisabethinen, Interne
II/Kardiologie und Interne Intensivmedizin, Fadingerstrase 1, Linz 4020,
Austria
(Chen) Cardioangiologisches Centrum Bethanien (CCB), Kardiologie,
Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches
Lehrkrankenhaus der Goethe-Universitat Frankfurt am Main, Frankfurt am
Main 60431, Germany
Publisher
MDPI AG
Abstract
Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each
other, as each can be either the cause of or the result of the other.
Successfully treating one of the two entities means laying the basis for
treating the other one as well. Management of patients with AF and HF can
be challenging and should primarily adhere to available guidelines.
Concerning AF, medication is limited and causes many side effects, leading
to low medical adherence. Several smaller studies, summarized in a big
meta-analysis, provide evidence that ablation of AF in HF patients is
crucial for improving quality of life, reducing HF hospitalizations, and
reducing death, provided the LVEF is at least 25% or higher. In advanced
HF, alternative treatment options (including assist devices, heart
transplant) might still be the better option. Early rhythm control should
be taken into consideration, as there is evidence that it is associated
with better cardiovascular outcome.<br/>Copyright &#xa9; 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<82>
Accession Number
2013402253
Title
The Use of Corticosteroids for Cardiopulmonary Bypass in Adults.
Source
Current Anesthesiology Reports. (no pagination), 2021. Date of
Publication: 2021.
Author
Perchermeier S.; Tassani-Prell P.
Institution
(Perchermeier, Tassani-Prell) Institute of Anesthesiology, German Heart
Center, Technical University of Munich, Lazarettstr. 36, Munich D-80636,
Germany
Publisher
Springer
Abstract
Purpose of Review: Cardiopulmonary bypass for on-pump cardiac surgery
induces a systemic inflammation that may contribute to postoperative major
complications. To reduce this inflammatory response in patients undergoing
heart surgery, the perioperative use of anti-inflammatory corticosteroids
has long been recommended to improve clinical outcomes. However, the
efficacy and safety of steroids remain still unclear. Recent Findings: We
reviewed recent published literature, including the large clinical trials
DECS and SIRS and the two meta-analysis by Dvirnik et al. (2018) and Ng et
al. (2020), on mortality and major postoperative complications, such as
myocardial complications, atrial fibrillation, stroke, pulmonary adverse
events, length of ICU and hospital stay, renal failure, and infection.
<br/>Summary: The perioperative application of corticosteroids did not
improve mortality rates beyond standard care or other secondary outcomes,
such as myocardial infarction, stroke, renal failure, and infection. The
observed increased risk of myocardial damage in patients receiving
corticosteroids in the SIRS trial is mainly related to the author-defined
CK-MB threshold as indicator for early myocardial injury. Interestingly,
the use of steroids may have some beneficial effects on secondary
outcomes: they significantly decreased the risk of respiratory failure and
pneumonia and shortened the length of ICU and hospital stay, but the
mechanism involved in pulmonary injury is multifactorial and it is
difficult to evaluate this result. Patients receiving steroids did not
have a decreased incidence of atrial fibrillation shown by the two large
trials unlike some previous small sample size trials have
demonstrated.<br/>Copyright &#xa9; 2021, The Author(s).

<83>
Accession Number
2013401953
Title
Effects of remote ischemic postconditioning on HIF-1alpha and other
markers in on-pump cardiac surgery.
Source
General Thoracic and Cardiovascular Surgery. (no pagination), 2021. Date
of Publication: 2021.
Author
Garcia-de-la-Asuncion J.; Moreno T.; Duca A.; Garcia-del-Olmo N.;
Perez-Griera J.; Belda J.; Soro M.; Garcia-del-Olmo E.
Institution
(Garcia-de-la-Asuncion, Moreno, Duca, Belda, Soro) Department of
Anaesthesiology and Critical Care, Hospital Clinico Universitario,
Instituto de Investigacion Sanitaria-INCLIVA, Valencia, Spain
(Garcia-del-Olmo) Department of General Surgery, Hospital Lluis Alcanyis,
Xativa, Spain
(Perez-Griera) Laboratory of Biochemistry, Hospital Clinico Universitario,
Instituto de Investigacion Sanitaria-INCLIVA, Valencia, Spain
(Garcia-del-Olmo) Department of Thoracic Surgery, Consorcio Hospital
General Universitario, Valencia, Spain
Publisher
Springer Japan
Abstract
Background: There is a lack of data about the effects of remote ischemic
postconditioning (RIPostC) on hypoxia-inducible factor-1alpha (HIF-1alpha)
plasma levels after on-pump cardiac surgery (OPCS). This study aimed to
measure the effects of RIPostC on postoperative HIF-1alpha plasma levels,
cardiac markers and arterial oxygenation in patients undergoing OPCS.
<br/>Method(s): This single-centre randomized, double blind, controlled
trial, enrolled 70 patients (35 control and 35 RIPostC). RIPostC was
performed by 3 cycles (5 min of ischemia followed by 5 min of reperfusion)
administered in upper arm immediately after the pump period. The primary
outcome was to measure HIF-1alpha plasma levels: before surgery (T0), and
2 h (T1), 8 h (T2), 24 h (T3), 36 h (T4) and 48 h (T5) after RIPostC. As
secondary endpoint, Troponin T, CK-MB, CPK plasma levels and
PaO<inf>2</inf>/FiO<inf>2</inf> ratio were measured. <br/>Result(s):
HIF-1alpha plasma levels were increased at T1-T3 compared to T0 in both
groups (P < 0.001). In the RIPostC group HIF-1alpha increased compared to
the control group: differences between means (95% CI) were 0.034
(0.006-0.06) P = 0.019 at T1; 0.041 (0.013-0.069) P = 0.005 at T2; and
0.021 (0.001-0.042) P = 0.045 at T3. PaO<inf>2</inf>/FiO<inf>2</inf> was
higher in the RIPostC group than in the control group: at T3, T4 and T5.
Moreover, Troponin T, CK-MB and CPK values decreased in the RIPostC group
compared to the control group. <br/>Conclusion(s): HIF-1alpha plasma
levels increased in control patients during for at least 36 h after OPCS.
RIPostC resulted in even higher HIF-1alpha levels during at least the
first 24 h and improved arterial oxygenation and cardiac
markers.<br/>Copyright &#xa9; 2021, The Japanese Association for Thoracic
Surgery.

<84>
Accession Number
2013387147
Title
The role of viscoelastic testing in assessing peri-interventional platelet
function and coagulation.
Source
Platelets. (no pagination), 2021. Date of Publication: 2021.
Author
Tantry U.S.; Hartmann J.; Neal M.D.; Schoechl H.; Bliden K.P.; Agarwal S.;
Mason D.; Dias J.D.; Mahla E.; Gurbel P.A.
Institution
(Tantry, Bliden, Gurbel) Sinai Center for Thrombosis Research and Drug
Development, Sinai Hospital of Baltimore, Baltimore, MD, United States
(Hartmann, Mason, Dias) Medical Affairs and Clinical Development,
Haemonetics Corporation, Boston, MA, United States
(Neal) Department of General Surgery, The University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Schoechl) Department of Anesthesiology and Intensive Care Medicine, AUVA
Trauma Centre Salzburg, Academic Teaching Hospital, Paracelsus Medical
University, Salzburg, Austria
(Schoechl) AUVA Trauma Research Centre, Ludwig Boltzmann Institute for
Experimental and Clinical Traumatology, Vienna, Austria
(Agarwal) Department of Anaesthesia, Manchester University Foundation
Trust, Manchester, United Kingdom
(Mahla) Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Graz, Graz, Austria
Publisher
Taylor and Francis Ltd.
Abstract
We carried out a literature search in MEDLINE (PubMed) and EMBASE
literature databases to provide a concise review of the role of
viscoelastic testing in assessing peri-interventional platelet function
and coagulation. The search identified 130 articles that were relevant for
the review, covering the basic science of VHA and VHA in clinical settings
including cardiac surgery, cardiology, neurology, trauma, non-cardiac
surgery, obstetrics, liver disease, and COVID-19. Evidence from these
articles is used to describe the important role of VHAs and platelet
function testing in various peri-interventional setups. VHAs can help us
to comprehensively assess the contribution of platelets and coagulation
dynamics to clotting at the site-of-care much faster than standard
laboratory measures. In addition to standard coagulation tests, VHAs are
beneficial in reducing allogeneic transfusion requirements and bleeding,
in predicting ischemic events, and improving outcomes in several
peri-interventional care settings. Further focused studies are needed to
confirm their utility in the peri-interventional case.<br/>Copyright
&#xa9; 2021 The Author(s). Published with license by Taylor & Francis
Group, LLC.

<85>
Accession Number
2013385714
Title
Infective endocarditis by Enterobacter cloacae: a systematic review and
meta-analysis.
Source
Journal of Chemotherapy. (no pagination), 2021. Date of Publication: 2021.
Author
Ioannou P.; Vamvoukaki R.; Kofteridis D.P.
Institution
(Ioannou, Vamvoukaki, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete,
Greece
Publisher
Taylor and Francis Ltd.
Abstract
Enterobacter species are Gram-negative, non-spore-forming, facultative
anaerobes typically motile due to the presence of peritrichous flagella.
E. cloacae, the species responsible for the majority of Enterobacter
infections in humans, is part of the intestinal microbiota and may cause
infection in patients that have previously received antimicrobial therapy
or who have been admitted to the Intensive Care Unit. E. cloacae may cause
several infections, such as pneumonia, urinary tract, skin and soft tissue
and intravascular infections. Infective Endocarditis (IE) is a rare
disease with notable morbidity and mortality. Even though IE is rarely
caused by E. cloacae, these infections can be problematic due to the
relative lack of experience in their management. The purpose of this study
was to systematically review all published cases of IE by E. cloacae in
the literature. A systematic review of PubMed, Scopus and Cochrane library
(through 14^th November 2020) for studies providing
epidemiological, clinical, microbiological as well as treatment data and
outcomes of IE by E. cloacae was performed. A total of 20 studies,
containing data of 20 patients, were included. A prosthetic valve was
present in 27.8%. Mitral valve was the commonest infected site, followed
by aortic valve. Diagnosis was facilitated by transthoracic and
transesophageal echocardiography in 38.5% each, while the diagnosis was
set at autopsy in 10%. Fever, sepsis, shock and immunologic phenomena were
the most common clinical presentations, followed by heart failure.
Aminoglycosides, cephalosporins and carbapenems were the most common
antimicrobials used. Clinical cure was noted in 75%, while overall
mortality was 30%. Development of shock and treatment with the combination
of piperacillin with tazobactam were associated with overall
mortality.<br/>Copyright &#xa9; 2021 Edizioni Scientifi che per
l'Informazione su Farmaci e Terapia.

<86>
Accession Number
2013379362
Title
Revascularization versus medical therapy in patients aged 80 and older
with stable ischemic heart disease.
Source
Journal of the American Geriatrics Society. (no pagination), 2021. Date of
Publication: 2021.
Author
Phan D.Q.; Zadegan R.; Lee M.-S.
Institution
(Phan, Zadegan) Regional Cardiac Catheterization Lab, Kaiser Permanente
Southern California, Los Angeles, CA, United States
(Lee) Department of Cardiology, Kaiser Permanente Los Angeles Medical
Center, Los Angeles, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Older patients are underrepresented in landmark randomized
trials for stable ischemic heart disease (SIHD). Therefore, we sought to
evaluate the benefits of revascularization in patients >=80 years old with
SIHD. <br/>Method(s): Retrospective study of patients undergoing invasive
coronary angiography (ICA) for SIHD between 2009 and 2019. Patients were
grouped according to treatment: revascularization (percutaneous coronary
intervention [PCI] or coronary artery bypass grafting [CABG]) versus
initial medical therapy alone. Inverse probability of treatment weighting
(IPTW)-adjusted Cox proportional hazard regression analyses were
performed. Outcomes evaluated were all-cause mortality, non-fatal
myocardial infarction (MI), and repeat revascularization. <br/>Result(s):
A total of 1015 patients (median age 83.0, interquartile range [IQR]
81.3-85.2 years; 29% female) underwent ICA for SIHD. Of these, 557 (55%)
were treated with revascularization and 458 (45%) with initial medical
therapy alone. Baseline characteristics were well balanced after IPTW
adjustment. At median follow-up of 3.5 years (IQR 1.7-5.9 years), there
were no differences in all-cause mortality and non-fatal MI between
treatment groups; but there was an increased need for repeat
revascularization (IPTW adjusted hazard ratio 2.22, 95% confidence
interval 1.53-3.22) with revascularization. Separately comparing PCI or
CABG alone versus medical therapy yielded similar results; as well as in
subgroup analysis (except for patients >=90 years old and those without
prior CABG). <br/>Conclusion(s): There were no differences in all-cause
mortality and non-fatal MI with invasive revascularization (either PCI or
CABG) versus medical therapy alone in patients >=80 years old with SIHD.
Large randomized trials focusing on older patients are warranted to guide
clinical practice in this growing population.<br/>Copyright &#xa9; 2021
The American Geriatrics Society.

<87>
Accession Number
2013338112
Title
Right Anterolateral Thoracotomy Versus Sternotomy for Resection of Benign
Atrial Masses: A Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2021. Date of Publication: 2021.
Author
Olsthoorn J.R.; Daemen J.H.T.; de Loos E.R.; ter Woorst J.F.; van Straten
A.H.M.; Maessen J.G.; Sardari Nia P.; Heuts S.
Institution
(Olsthoorn, ter Woorst, van Straten) Department of Cardiothoracic Surgery,
Catharina Ziekenhuis Eindhoven, Netherlands
(Daemen, de Loos) Department of Surgery, Division of General Thoracic
Surgery, Zuyderland Medical Center, Heerlen, Netherlands
(Maessen, Sardari Nia, Heuts) Department of Cardiothoracic Surgery,
Maastricht University Medical Center, Netherlands
Publisher
SAGE Publications Ltd
Abstract
Objective: Primary benign cardiac tumors are rare disease entity that
predominantly originate from the atria. Benign masses can induce heart
failure, arrhythmia, or thromboembolic events. Therefore, surgical
excision is often indicated. Current guidelines on the preferred
approaches for resection (i.e., median sternotomy [MST] or right
anterolateral thoracotomy [RAT]) are lacking. The aim of the current
meta-analysis was to evaluate all studies comparing RAT to MST for
excision of benign atrial masses in terms of safety, efficacy, and
complications. <br/>Method(s): The PubMed and EMBASE databases were
searched through 9 June 2020. Data regarding mortality, complications,
recurrence, ICU stay, and length of hospital stay were extracted and
submitted to meta-analysis using random effects modelling. Heterogeneity
was assessed by the I² test. <br/>Result(s): Four retrospective
observational studies were included, including 196 patients (RAT n = 97,
MST n = 99). Mortality was 0% in both groups. Recurrence was <1% in the
RAT group and 0% in the MST group. Complication rate tended to be lower in
favor of the RAT group. Furthermore, RAT was associated with lower length
of ICU stay (-17.7 hr, P = 0.01) and hospital stay (-4.0 days, P < 0.001).
No significant differences in cardiopulmonary bypass (P = 0.09) and
cross-clamp times (P = 0.15) were observed. <br/>Conclusion(s): The RAT
approach is as safe and effective as MST for the excision of benign atrial
masses. Moreover, RAT is associated with a reduced complication rate and a
reduced duration of hospitalization and could be considered as the
preferred approach in anatomically suitable patients.<br/>Copyright &#xa9;
The Author(s) 2021.

<88>
Accession Number
635696516
Title
Does lung cancer screening with low-dose computerized tomography improve
survival?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 23 Jul 2021.
Author
Manuel L.; Fong L.S.; Ly T.; Meredith G.
Institution
(Manuel, Ly, Meredith) Department of Cardiothoracic Surgery, Westmead
Hospital, Sydney, Australia
(Manuel, Fong) Department of Cardiothoracic Surgery, Prince of Wales
Hospital, Sydney, Australia
Publisher
NLM (Medline)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'Does lung cancer
screening with low-dose computerised tomography (LDCT) improve survival?'
More than 963 papers were found, of which 8 randomized control trials and
1 meta-analysis represented the best evidence to answer the clinical
question. The authors, journal, date and country of publication, patient
group studied, study type, relevant outcomes and results of these papers
were tabulated. The majority of studies trended towards greater incidence
of early lung cancer detection, and subsequent curative treatment, in the
LDCT screening populations with appropriately powered randomized control
trials (NELSON and NLST) demonstrating survival benefits of >20% in lung
cancer-specific mortality. However, this reduction must be evaluated
against the potential harms associated with screening, including
complications from diagnostic procedures, and costs of overdiagnosis, as
evidenced in several studies. We conclude that in high-risk populations,
lung cancer screening with LDCT results in earlier detection of low-stage
cancers and improved survival when compared to usual clinical care or
screening with a chest X-ray.<br/>Copyright &#xa9; The Author(s) 2021.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<89>
Accession Number
635687859
Title
Recommendations of the Society of Thoracic Surgery and the Section of
Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia,
Resuscitation and Pain Therapy, for patients undergoing lung surgery
included in an intensified recovery program.
Source
Revista espanola de anestesiologia y reanimacion. (no pagination), 2021.
Date of Publication: 19 Jul 2021.
Author
Garutti I.; Cabanero A.; Vicente R.; Sanchez D.; Granell M.; Fraile C.A.;
Real Navacerrada M.; Novoa N.; Sanchez-Pedrosa G.; Congregado M.; Gomez
A.; Minana E.; Pineiro P.; Cruz P.; de la Gala F.; Quero F.; Huerta L.J.;
Rodriguez M.; Jimenez E.; Puente-Maestu L.; Aragon S.; Osorio-Salazar E.;
Sitges M.; Lopez Maldonado M.D.; Rios F.T.; Morales J.E.; Callejas R.;
Gonzalez-Bardancas S.; Botella S.; Cortes M.; Yepes M.J.; Iranzo R.; Sayas
J.
Institution
(Garutti) Servicio de Anestesia y Reanimacion, Hospital General
Universitario Gregorio Maranon, Madrid, Espana; Departamento de
Farmacologia y Toxicologia, Facultad de Medicina, Universidad Complutense
de Madrid, Madrid, Espana
(Cabanero) Servicio de Cirugia Toracica, Hospital Universitario Ramon y
Cajal, Madrid, Spain
(Vicente, Lopez Maldonado, Rios, Botella) Servicio de Anestesia y
Reanimacion, Hospital La Fe, Valencia, Spain
(Sanchez) Servicio de Cirugia Toracica, Hospital Clinic, Barcelona, Spain
(Granell, Morales) Servicio de Anestesia y Reanimacion, Hospital General,
Valencia, Spain
(Fraile) Servicio de Cirugia Toracica, Hospital Universitari Arnau de
Vilanova, Lleida, Spain
(Real Navacerrada, Cortes) Servicio de Anestesia y Reanimacion, Hospital
Universitario 12 de Octubre, Madrid, Spain
(Novoa) Servicio de Cirugia Toracica, Complejo Asistencial Universitario
de Salamanca (CAUS), Instituto de Investigacion Biomedica de Salamanca
(IBSAL), Salamanca, Spain
(Sanchez-Pedrosa, Pineiro, Cruz, de la Gala) Servicio de Anestesia y
Reanimacion, Hospital General Universitario Gregorio Maranon, Madrid,
Spain
(Congregado) Servicio de Cirugia Toracica, Hospital Virgen de la Macarena,
Sevilla, Spain
(Gomez) Unitat de Rehabilitacio Cardiorespiratoria, Hospital Universitari
Vall d'Hebron, Barcelona, Spain
(Minana) Servicio de Anestesia y Reanimacion, Hospital de La Ribera,
Alzira, Valencia, Spain
(Quero) Servicio de Cirugia Toracica, Hospital Universitario Virgen de las
Nieves, Granada, Spain
(Huerta) Servicio de Cirugia Toracica, Hospital General Universitario
Gregorio Maranon, Madrid, Spain
(Rodriguez) Servicio de Cirugia Toracica, Clinica Universidad de Navarra,
Madrid, Spain
(Jimenez) Hospital Universitario de A Coruna, Spain
(Puente-Maestu, Sayas) Servicio de Neumologia, Hospital General
Universitario Gregorio Maranon, Facultad de Medicina, Universidad
Complutense de Madrid, Madrid, Spain
(Aragon, Callejas) Servicio de Anestesia, Reanimacion y Tratamiento del
Dolor, Hospital Clinico Universitario, Valencia, Spain
(Osorio-Salazar) Servicio de Anestesia y Reanimacion, Hospital
Universitari Arnau de Vilanova, Lleida, Spain
(Sitges) Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
(Gonzalez-Bardancas) Servicio de Anestesia y Reanimacion, Complejo
Hospitalario Universitario A Coruna, Spain
(Yepes) Servicio de Anestesia y Reanimacion, Clinica Universidad de
Navarra, Navarra, Pamplona, Espana
(Iranzo) Servicio de Anestesia y Reanimacion, Hospital Universitario
Puerta de Hierro, Majadahonda, Madrid, Spain
Publisher
NLM (Medline)

<90>
Accession Number
635686269
Title
Cardiac Surgery 2020 Reviewed.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2021. Date of
Publication: 2021.
Author
Doenst T.; Caldonazo T.; Schneider U.; Moschovas A.; Tkebuchava S.;
Safarov R.; Diab M.; Farber G.; Kirov H.
Institution
(Doenst, Caldonazo, Schneider, Moschovas, Tkebuchava, Safarov, Diab,
Farber, Kirov) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Jena, Germany
(Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University of Jena, Am Klinikum 1, Jena 07747, Germany
Publisher
Georg Thieme Verlag
Abstract
In 2020, nearly 30,000 published references appeared in the PubMed for the
search term cardiac surgery. While SARS-CoV-2 affected the number of
surgical procedures, it did not affect outcomes reporting. Using the
PRISMA approach, we selected relevant publications and prepared a
results-oriented summary. We reviewed primarily the fields of coronary and
conventional valve surgery and their overlap with interventional
alternatives. The coronary field started with a discussion on trial data
value and their interpretation. Registry comparisons of coronary artery
bypass surgery (CABG) and percutaneous coronary intervention confirmed
outcomes for severe coronary artery disease and advanced comorbidities
with CABG. Multiple arterial grafting was best. In aortic valve surgery,
meta-analyses of randomized trials report that transcatheter aortic valve
implantation may provide a short-term advantage but long-term survival may
be better with classic aortic valve replacement (AVR). Minimally invasive
AVR and decellularized homografts emerged as hopeful techniques. In mitral
and tricuspid valve surgery, excellent perioperative and long-term
outcomes were presented for structural mitral regurgitation. For both,
coronary and valve surgery, outcomes are strongly dependent on surgeon
expertise. Kidney disease increases perioperative risk, but does not limit
the surgical treatment effect. Finally, a cursory look is thrown on
aortic, transplant, and assist-device surgery with a glimpse into the
current stand of xenotransplantation. As in recent years, this article
summarizes publications perceived as important by us. It does not expect
to be complete and cannot be free of individual interpretation. We aimed
to provide up-to-date information for decision-making and patient
information.<br/>Copyright &#xa9; 2021 Cambridge University Press. All
rights reserved.