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<1>
Accession Number
604680808
Title
Clinical benefits of aortic cross-clamping versus limb remote ischemic
preconditioning in coronary artery bypass grafting with cardiopulmonary
bypass: a meta-analysis of randomized controlled trials.
Source
The Journal of surgical research. 193 (1) (pp 52-68), 2015. Date of
Publication: 01 Jan 2015.
Author
Deng Q.-W.; Xia Z.-Q.; Qiu Y.-X.; Wu Y.; Liu J.-X.; Li C.; Liu K.-X.
Institution
(Deng) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Xia) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Qiu) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Wu) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Liu) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Li) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China
(Liu) Department of Anesthesiology, The First Affiliated Hospital, Sun
Yat-Sen University, Guangzhou, China. Electronic address:
liukexuan705@163.com
Abstract
BACKGROUND: We assessed whether aortic cross-clamping or limb remote
ischemic preconditioning improved postoperative outcomes, reduced
myocardial injury and incidences of postoperative complications in
patients undergoing on-pump coronary artery bypass grafting (CABG).
MATERIALS AND METHODS: PubMed, EMBASE, the Cochrane Library, and
ClinicalTrials databases were searched for studies comparing the effects
of ischemic preconditioning with no preconditioning in adult patients
undergoing on-pump CABG. The primary end points were mechanical
ventilation time, the length of stay in intensive care unit and hospital,
whereas the secondary end points were peak values of myocardial biomarkers
and postoperative complications. Mean differences were estimated for the
primary end points, as well as standard mean differences and odds ratios
for the secondary end points.
CONCLUSIONS: Cardiac surgeons could consider aortic cross-clamping or limb
remote ischemic preconditioning to reduce myocardial injury during CABG.
Moreover, aortic cross-clamping preconditioning is associated with a
decreased risk of postoperative respiratory failure and cardiac
arrhythmia.
RESULTS: A total of 29 randomized controlled trials with 1791 patients
were included. Compared with control group, aortic cross-clamping
preconditioning reduced mechanical ventilation time (mean difference [95%
confidence interval {CI}]) (-5.59 h [-9.21 to -1.96]), whereas limb remote
ischemic preconditioning was not associated with improvement of
postoperative outcomes. For myocardial biomarkers, both aortic
cross-clamping and limb remote ischemic preconditioning reduced peak
values of myocardial biomarkers (standard mean difference [95% CI]) (-0.48
[-0.81 to -0.14]; -0.19 [-0.36 to -0.02], respectively). Subgroup analysis
showed that aortic cross-clamping preconditioning protocols with ischemia
episodes <5 min did reduce the release of biomarkers (-0.69 [-1.04 to
-0.34]) but those with 5 min ischemia episodes elevated them (0.40
[0.04-0.75]). Cardiovascular, cerebrovascular, renal, and intestinal
complications were reported, and aortic cross-clamping preconditioning
seemed to reduce the incidences of cardiac arrhythmia (odds ratio [95%
CI]) (0.46 [0.27-0.80], P = 0.006). Copyright © 2015 Elsevier
Inc. All rights reserved.

<2>
Accession Number
635745611
Title
Various Kinds of Functional Digestive Tract Reconstruction Methods After
Proximal Gastrectomy.
Source
Frontiers in Oncology. 11 (no pagination), 2021. Article Number: 685717.
Date of Publication: 03 Aug 2021.
Author
Lu S.; Ma F.; Zhang Z.; Peng L.; Yang W.; Chai J.; Liu C.; Ge F.; Ji S.;
Luo S.; Chen X.; Hua Y.
Institution
(Lu, Ma, Zhang, Peng, Yang, Chai, Liu, Ge, Ji, Hua) Department of General
Surgery, Tumor Hospital of Zhengzhou University, Zhengzhou, China
(Luo, Chen) Department of Medical Oncology, The Affiliated Tumor Hospital
of Zhengzhou University, Zhengzhou, China
Publisher
Frontiers Media S.A.
Abstract
The incidence of proximal gastric cancer has shown a rising trend in
recent years. Surgery is still the main way to cure proximal gastric
cancer. Total gastrectomy with D2 lymph node dissection was considered to
be the standard procedure for proximal gastric cancer in the past several
decades. However, in recent years, many studies have confirmed that
proximal gastrectomy can preserve part of the stomach function and can
result in a better quality of life of the patient than total gastrectomy.
Therefore, proximal gastrectomy is increasingly used in patients with
proximal gastric cancer. Unfortunately, there are some concerns after
proximal gastrectomy with traditional esophagogastrostomy. For example,
the incidence of reflux esophagitis in patients who underwent proximal
gastrectomy with traditional esophagogastrostomy is significantly higher
than those patients who underwent total gastrectomy. To solve those
problems, various functional digestive tract reconstruction methods after
proximal gastrectomy have been proposed gradually. In order to provide
some help for clinical treatment, in this article, we reviewed relevant
literature and new clinical developments to compare various kinds of
functional digestive tract reconstruction methods after proximal
gastrectomy mainly from perioperative outcomes, postoperative quality of
life and survival outcomes aspects. After comparison and discussion, we
drew the conclusion that various functional reconstruction methods have
their own advantages and disadvantages; large scale high-level clinical
studies are needed to choose an ideal reconstruction method in the future.
Besides, in clinical practice, surgeons should consider the condition of
the patient for individualized selection of the most appropriate
reconstruction method. © Copyright © 2021 Lu, Ma, Zhang,
Peng, Yang, Chai, Liu, Ge, Ji, Luo, Chen and Hua.

<3>
Accession Number
635169532
Title
Levothyroxine Treatment and Cardiovascular Outcomes in Older People With
Subclinical Hypothyroidism: Pooled Individual Results of Two Randomised
Controlled Trials.
Source
Frontiers in Endocrinology. 12 (no pagination), 2021. Article Number:
674841. Date of Publication: 20 May 2021.
Author
Zijlstra L.E.; Jukema J.W.; Westendorp R.G.J.; Du Puy R.S.; Poortvliet
R.K.E.; Kearney P.M.; O'Keeffe L.; Dekkers O.M.; Blum M.R.; Rodondi N.;
Collet T.-H.; Quinn T.J.; Sattar N.; Stott D.J.; Trompet S.; den Elzen
W.P.J.; Gussekloo J.; Mooijaart S.P.
Institution
(Zijlstra, Jukema, Trompet) Department of Cardiology, Leiden University
Medical Center, Leiden, Netherlands
(Westendorp) Department of Public Health, University of Copenha, en,
Copenhagen, Denmark
(Westendorp) Center for Healthy Aging, University of Copenhagen,
Copenhagen, Denmark
(Du Puy, Poortvliet, Gussekloo) Department of Public Health and Primary
Care, Leiden University Medical Center, Leiden, Netherlands
(Kearney, O'Keeffe) School of Public Health, University College Cork,
Cork, Ireland
(Dekkers) Department of Endocrinology and Metabolic Disorders, Leiden
University Medical Center, Leiden, Netherlands
(Blum, Rodondi) Department of General Internal Medicine, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Blum, Rodondi) Institute of Primary Health Care (BIHAM), University of
Bern, Bern, Switzerland
(Collet) Service of Endocrinology, Diabetology, Nutrition and Therapeutic
Education, Geneva University Hospitals, Geneva, Switzerland
(Quinn) The Academic Section of Geriatric Medicine, Institute of
Cardiovascular and Medical Sciences, University of Glasgow, Glasgow,
United Kingdom
(Sattar) BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine,
Glasgow, United Kingdom
(Stott) Institute of Cardiovascular and Medical Sciences, College of
Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow,
United Kingdom
(Trompet, Gussekloo, Mooijaart) Department of Internal Medicine, Section
of Gerontology and Geriatrics, Leiden University Medical Center, Leiden,
Netherlands
(den Elzen) Department of Clinical Chemistry and Laboratory Medicine,
Leiden University Medical Center, Leiden, Netherlands
(Mooijaart) Institute for Evidence-based Medicine in Old Age (IEMO),
Leiden, Netherlands
Publisher
Frontiers Media S.A.
Abstract
Background: The cardiovascular effects of treating older adults with
subclinical hypothyroidism (SCH) are uncertain. Although concerns have
been raised regarding a potential increase in cardiovascular side effects
from thyroid hormone replacement, undertreatment may also increase the
risk of cardiovascular events, especially for patients with cardiovascular
disease (CVD). Objective(s): To determine the effects of
levothyroxine treatment on cardiovascular outcomes in older adults with
SCH. Method(s): Combined data of two parallel randomised double-blind
placebo-controlled trials TRUST (Thyroid hormone Replacement for Untreated
older adults with Subclinical hypothyroidism - a randomised placebo
controlled Trial) and IEMO80+ (the Institute for Evidence-Based Medicine
in Old Age 80-plus thyroid trial) were analysed as one-stage individual
participant data. Participants aged >=65 years for TRUST (n=737) and >=80
years for IEMO80+ (n=105) with SCH, defined by elevated TSH with fT4
within the reference range, were included. Participants were randomly
assigned to receive placebo or levothyroxine, with titration of the dose
until TSH level was within the reference range. Cardiovascular events and
cardiovascular side effects of overtreatment (new-onset atrial
fibrillation and heart failure) were investigated, including stratified
analyses according to CVD history and age. Result(s): The median
[IQR] age was 75.0 [69.7-81.1] years, and 448 participants (53.2%) were
women. The mean TSH was 6.38+/- SD 5.7 mIU/L at baseline and decreased at
1 year to 5.66 +/- 3.3 mIU/L in the placebo group, compared with 3.66 +/-
2.1 mIU/L in the levothyroxine group (p<0.001), at a median dose of 50
mug. Levothyroxine did not significantly change the risk of any of the
prespecified cardiovascular outcomes, including cardiovascular events (HR
0.74 [0.41-1.25]), atrial fibrillation (HR 0.69 [0.32-1.52]), or heart
failure (0.41 [0.13-1.35]), or all-cause mortality (HR 1.28 [0.54-3.03]),
irrespective of history of CVD and age. Conclusion(s): Treatment with
levothyroxine did not significantly change the risk of cardiovascular
outcomes in older adults with subclinical hypothyroidism, irrespective of
a history of cardiovascular disease and age. Clinical Trial Registration:
[ClinicalTrials.gov], identifier [NCT01660126] (TRUST); Netherlands Trial
Register: NTR3851 (IEMO80+). © Copyright © 2021 Zijlstra,
Jukema, Westendorp, Du Puy, Poortvliet, Kearney, O'Keeffe, Dekkers, Blum,
Rodondi, Collet, Quinn, Sattar, Stott, Trompet, den Elzen, Gussekloo and
Mooijaart.

<4>
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). 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. 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. Copyright © 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<5>
Accession Number
2013141700
Title
Optimal protamine dosing after cardiopulmonary bypass: The PRODOSE
adaptive randomised controlled trial.
Source
PLoS Medicine. 18 (6) (no pagination), 2021. Article Number: e1003658.
Date of Publication: June 2021.
Author
Miles L.F.; Burt C.; Arrowsmith J.; McKie M.A.; Villar S.S.; Govender P.;
Shaylor R.; Tan Z.; De Silva R.; Falter F.
Institution
(Miles, Shaylor) Department of Critical Care, The University of Melbourne,
Melbourne, Australia
(Miles) Department of Anaesthesia, Austin Health, Melbourne, Australia
(Burt, Arrowsmith, Govender, Tan, Falter) Department of Anaesthesia and
Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge,
United Kingdom
(McKie, Villar) MRC Biostatistics Unit, School of Clinical Medicine,
University of Cambridge, Cambridge, United Kingdom
(De Silva) Department of Surgery, Royal Papworth Hospital NHS Foundation
Trust, Cambridge, United Kingdom
Publisher
Public Library of Science
Abstract
Background The dose of protamine required following cardiopulmonary bypass
(CPB) is often determined by the dose of heparin required pre-CPB,
expressed as a fixed ratio. Dosing based on mathematical models of heparin
clearance is postulated to improve protamine dosing precision and
coagulation. We hypothesised that protamine dosing based on a
2-compartment model would improve thromboelastography (TAU :
PleasenotethattheabbreviationTEGhasbeenintroducedforthromboelastographyint
hesentenceWehypothesisedthatprotaminedosing::::EG) parameters and reduce
the dose of protamine administered, relative to a fixed ratio. Methods and
findings We undertook a 2-stage, adaptive randomised controlled trial,
allocating 228 participants to receive protamine dosed according to a
mathematical model of heparin clearance or a fixed ratio of 1 mg of
protamine for every 100 IU of heparin required to establish
anticoagulation pre-CPB. A planned, blinded interim analysis was
undertaken after the recruitment of 50% of the study cohort. Following
this, the randomisation ratio was adapted from 1:1 to 1:1.33 to increase
recruitment to the superior arm while maintaining study power. At the
conclusion of trial recruitment, we had randomised 121 patients to the
intervention arm and 107 patients to the control arm. The primary endpoint
was kaolin TEG r-time measured 3 minutes after protamine administration at
the end of CPB. Secondary endpoints included ratio of kaolin TEG r-time
pre-CPB to the same metric following protamine administration, requirement
for allogeneic red cell transfusion, intercostal catheter drainage at 4
hours postoperatively, and the requirement for reoperation due to
bleeding. The trial was listed on a clinical trial registry
(ClinicalTrials.gov Identifier: NCT03532594). Participants were recruited
between April 2018 and August 2019. Those in the intervention/ model group
had a shorter mean kaolin r-time (6.58 [SD 2.50] vs. 8.08 [SD 3.98]
minutes; p = 0.0016) post-CPB. The post-protamine thromboelastogram of the
model group was closer to pre-CPB parameters (median pre-CPB to
post-protamine kaolin r-time ratio 0.96 [IQR 0.78-1.14] vs. 0.75 [IQR
0.57-0.99]; p < 0.001). We found no evidence of a difference in median
mediastinal/pleural drainage at 4 hours postoperatively (140 [IQR 75-245]
vs. 135 [IQR 94-222] mL; p = 0.85) or requirement (as a binary outcome)
for packed red blood cell transfusion at 24 hours postoperatively (19
[15.8%] vs. 14 [13.1%] p = 0.69). Those in the model group had a lower
median protamine dose (180 [IQR 160-210] vs. 280 [IQR 250-300] mg; p <
0.001). Important limitations of this study include an unblinded design
and lack of generalisability to certain populations deliberately excluded
from the study (specifically children, patients with a total body weight
>120 kg, and patients requiring therapeutic hypothermia to <28degreeC).
Conclusions Using a mathematical model to guide protamine dosing in
patients following CPB improved TEG r-time and reduced the dose
administered relative to a fixed ratio. No differences were detected in
postoperative mediastinal/pleural drainage or red blood cell transfusion
requirement in our cohort of low-risk patients. Copyright © 2021
Miles 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.

<6>
Accession Number
2012937751
Title
Therapeutic application of fibrinogen in spine surgery: A review article.
Source
International Journal of Spine Surgery. 15 (3) (pp 549-561), 2021. Date of
Publication: 01 Jun 2021.
Author
BARIMANI B.; MOISAN P.; SANTAGUIDA C.; WEBER M.
Institution
(BARIMANI, MOISAN) Division of Orthopedic Surgery, McGill University,
Montreal, QC, Canada
(SANTAGUIDA) Department of Neurology and Neurosurgery, McGill University,
Montreal, QC, Canada
(WEBER) Department of Surgery, McGill University, Montreal, QC, Canada
(WEBER) Montreal General Hospital, Montreal, QC, Canada
Publisher
ISASS
Abstract
Background: The aim of this review is to investigate current uses of
fibrinogen as a tool to reduce operative and postoperative blood loss in
different surgical fields especially orthopedic spine surgery. This is a
systematic review. Method(s): MEDLINE (via Ovid 1946 to June 1, 2020)
and Embase (via Ovid 1947 to June 1, 2020) were searched using the
keywords "fibrinogen", "surgery", and "spine"for relevant studies. The
search strategy used text words and relevant indexing to identify articles
discussing the use of fibrinogen to control surgical blood loss.
 Result(s): The original literature search yielded 407 articles from
which 68 duplications were removed. Three hundred thirty-nine abstracts
and titles were screened. Results were separated by surgical specialties.
 Conclusion(s): Multiple studies have looked at the role of fibrinogen
for acute bleeding in the operative setting. The current evidence
regarding the use of fibrinogen concentrate in spine surgery is promising
but limited, even though this is a field with the potential for severe
hemorrhage. Further trials are required to understand the utility of
fibrinogen concentrate as a first-line therapy in spine surgery and to
understand the importance of target fibrinogen levels and subsequent
dosing and administration to allow recommendations to be made in this
field. Copyright © 2021 ISASS.

<7>
Accession Number
2007707700
Title
Comparison of neural network and logistic regression for dementia
prediction: Results from the preadvise trial.
Source
Journal of Gerontology and Geriatrics. 69 (2) (pp 137-146), 2021. Date of
Publication: June 2021.
Author
Ding X.; Schmitt F.; Kryscio R.; Charnigo R.
Institution
(Ding) Western Kentucky University, Department of Public Health, Bowling
Green, KY, United States
(Kryscio, Charnigo) University of Kentucky, Department of Statistics,
Lexington, KY, United States
(Schmitt, Kryscio) University of Kentucky, SandersBrown Center on Aging,
Lexington, KY, United States
(Schmitt) University of Kentucky, Department of Neurology, Lexington, KY,
United States
(Kryscio, Charnigo) University of Kentucky, Department of Biostatistics,
Lexington, KY, United States
Publisher
Pacini Editore S.p.A./AU-CNS
Abstract
Objective. Two systematic reviews suggest that current parametric
predictive models are not recommended for use in population dementia
diagnostic screening. This study was to compare predictive performance
between logistic regression (conventional method) and neural network
(non-conventional method). Method. Neural network analysis was performed
through the R package "Neuralnet" by using the same covariates as the
logistic regression model. Results. Results show that neural network had a
slightly apparently better predictive performance (area under curve (AUC):
0.732 neural network vs. 0.725 logistic regression). Neural network
performed similarly as logistic regression. Furthermore, logistic
regression confirmed that the interaction effect among covariates, which
elucidated from neural network. Conclusions. Neural network performed
slightly apparently better than logistic regression, and it is able to
elucidate complicated relationships among covariates. Copyright ©
by Societa Italiana di Gerontologia e Geriatria (SIGG).

<8>
Accession Number
633760146
Title
Effect of ultrasound-guided-pressure-controlled ventilation on
intraoperative blood gas and ventilatory parameters during thoracic
surgery.
Source
Indian Journal of Anaesthesia. 64 (12) (pp 1047-1053), 2020. Date of
Publication: December 2020.
Author
Ghosh D.; Jain G.; Agarwal A.; Govil N.
Institution
(Ghosh, Jain, Agarwal, Govil) Department of Anaesthesiology and Critical
Care, All India Institute of Medical Sciences, Virbhadra Marg, Rishikesh,
Uttarakhand 249203, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Identifying an ideal intraoperative ventilation
strategy remains an area of research. We evaluated the effect of
ultrasound-guided-pressure-controlled ventilation (UG-PCV) on the
blood-gas and ventilatory parameters, during both two-lung ventilation
(TLV) and one-lung ventilation (OLV) for thoracic surgery of unilateral
pulmonary disease, compared with volume-targeted PCV (VT-PCV).
 Method(s): In a prospective, parallel-group and double-blinded
design, 40 consecutive patients were randomised into two groups. Group A:
Received VT-PCV at a tidal volume (TV) of 9 mL/kg for TLV and 5 mL/kg for
OLV; group B: Received UG-PCV at an inspiratory pressure (2 cmH2O
increments every 15 s) targeted to achieve the alveolar aeration at the
base of the dependent lung (ultrasound-guided), for both TLV/OLV,
respectively. Primary outcome included arterial oxygen partial pressure
(PaO2) measured at baseline before anaesthesia induction (T1), at 30 min
immediately before conversion from TLV to OLV (T2), at 30 min on OLV (T3)
and before terminating OLV at the end of surgery (T4). Statistical tool
included Mann-Whitney test. Result(s): The PaO2 (mmHg) was
significantly higher in group B (374.5 +/- 25.9, 321.7 +/- 35.2 and 357.0
+/- 24.7) as compared to group A (353.3 +/- 38.1, 272.6 +/- 37.9 and 295.3
+/- 40.1), at T2, T3 and T4, respectively. The acid-base status remained
preserved in group B, while gradual respiratory acidosis was observed in
group A. The bicarbonate levels remained uniform in all patients. The TV
and airway pressures were marginally higher in group B, with no
intraoperative complications. Conclusion(s): The UG-PCV mode offered
better oxygenation, homogenous acid-base balance and individualised
alveolar ventilation for thoracic surgery. Copyright © 2020
Indian Journal of Anaesthesia.

<9>
Accession Number
633760138
Title
A randomised controlled comparison of serratus anterior plane, pectoral
nerves and intercostal nerve block for post-thoracotomy analgesia in adult
cardiac surgery.
Source
Indian Journal of Anaesthesia. 64 (12) (pp 1018-1024), 2020. Date of
Publication: December 2020.
Author
Magoon R.; Kaushal B.; Chauhan S.; Bhoi D.; Bisoi A.; Khan M.
Institution
(Magoon, Kaushal, Chauhan) Department of Cardiac Anaesthesia, Cardio and
Neurosciences Center, New Delhi, India
(Bhoi) Department of Anaesthesiology, Pain Medicine and Critical Care, New
Delhi, India
(Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio and
Neurosciences Center, New Delhi, India
(Khan) Department of Biostatistics, AIIMS, New Delhi, India
(Kaushal) Department of Anaesthesia, Gandhi Medical College and Hamidia
Hospital, Bhopal, Madhya Pradesh 462001, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background and Aims: Enhanced recovery after cardiac surgery is centred
around multimodal analgesia which is becoming increasingly feasible with
the advent of safer regional analgesic techniques such as fascial plane
blocks. We designed this prospective, single-blind, randomised controlled
study to compare the efficacy of serratus anterior plane block (SAPB),
pectoral nerves (Pecs) II block, and intercostal nerve block (ICNB) for
post-thoracotomy analgesia in cardiac surgery. Method(s): 100 adults
posted for cardiac surgery through a thoracotomy were randomly allocated
to one of the three groups: SAPB, Pecs II or, ICNB wherein the patients
received 2.5 mg/kg of 0.5% ropivacaine for ultrasound-guided block after
completion of surgery. Postoperatively, intravenous (IV) paracetamol was
used for multimodal and fentanyl was employed as rescue analgesia. Visual
analogue scale (VAS) was evaluated at 2, 4, 6, 8, 10 and 12 hours
post-extubation. Result(s): The early mean VAS scores at 2, 4 and 6
hours were comparable in the 3 groups. The late mean VAS (8, 10 and 12
hours) was significantly lower in the SAPB and Pecs II group compared with
that of the ICNB group (P value <0.05). The cumulative rescue fentanyl
dose was significantly higher in ICNB group compared to SAPB and Pecs II
group (P value <0.001). The SAPB group had the highest time to 1st rescue
analgesic requirement in contrast to the other groups. Conclusion(s):
SAPB and Pecs II blocks are simple single-shot effective alternatives to
ICNB with a prolonged analgesic duration following thoracotomy and can
potentially enhance pain-free recovery after cardiac
surgery. Copyright © 2020 Indian Journal of Anaesthesia.

<10>
Accession Number
635252249
Title
The Optimising Cardiac Surgery ouTcOmes in People with diabeteS (OCTOPuS)
randomised controlled trial to evaluate an outpatient pre-cardiac surgery
diabetes management intervention: A study protocol.
Source
BMJ Open. 11 (6) (no pagination), 2021. Article Number: 050919. Date of
Publication: 09 Jun 2021.
Author
Holt R.I.G.; Dritsakis G.; Barnard-Kelly K.; Thorne K.; Whitehead A.;
Cohen L.; Dixon E.; Patel M.; Newland-Jones P.; Green M.; Partridge H.;
Luthra S.; Ohri S.; Salhiyyah K.; Lord J.; Niven J.; Cook A.
Institution
(Holt) Human Development and Health, Faculty of Medicine, University of
Southampton, Southampton, United Kingdom
(Holt) Southampton National Institute for Health Research, Biomedical
Research Centre, University Hospital, Southampton Nhs Foundation Trust,
Southampton, United Kingdom
(Dritsakis, Thorne, Whitehead, Dixon) Clinical Trial Units, University of
Southampton, Southampton, United Kingdom
(Barnard-Kelly, Cohen) Barnard Health - Health Psychology Research,
Fareham, United Kingdom
(Patel, Newland-Jones, Green) Department of Diabetes and Endocrinology,
University Hospital Southampton, Southampton, Hampshire, United Kingdom
(Partridge) Diabetes and Endocrinology, Royal Bournemouth and Christchurch
Hospitals Nhs Foundation Trust, Bournemouth, Bournemouth, United Kingdom
(Luthra, Ohri) Division of Cardiac Surgery, Wessex Cardiothoracic Centre,
University Hospital Southampton, Southampton, Hampshire, United Kingdom
(Salhiyyah) Middle East University, Amman, Jordan
(Lord) Southampton Health Technology Assessments Centre, University of
Southampton, Southampton, Hampshire, United Kingdom
(Niven) Patient Representative, Southampton, United Kingdom
(Cook) Wessex Institute, University of Southampton, Southampton,
Hampshire, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction Cardiothoracic surgical outcomes are poorer in people with
diabetes compared with those without diabetes. There are two important
uncertainties in the management of people with diabetes undergoing major
surgery: (1) how to improve diabetes management in the weeks leading up to
an elective procedure and (2) whether that improved management leads to
better postoperative outcomes. We previously demonstrated the feasibility
of delivering the Optimising Cardiac Surgery ouTcOmes in People with
diabeteS (OCTOPuS) intervention, an outpatient intervention delivered by
diabetes healthcare professionals for people with suboptimally managed
diabetes over 8-12 weeks before elective cardiac surgery. The present
study will assess the clinical and cost-effectiveness of the intervention
in cardiothoracic centres across the UK. Methods and analysis A
multicentre, parallel group, single-blinded 1:1 individually randomised
trial comparing time from surgery until clinically fit for discharge in
adults with suboptimally managed type 1 diabetes or type 2 diabetes
undergoing elective surgery between the OCTOPuS intervention and usual
care (primary endpoint). Secondary endpoints will include actual time from
surgery to discharge from hospital; days alive and either out of hospital
or judged as clinically fit for discharge; mortality; time on intensive
therapy unit (ITU)/ventilator; infections; acute myocardial infarction;
change in weight; effect on postoperative renal function and incidence of
acute kidney injury; change in HbA 1c; frequency and severity of
self-reported hypoglycaemia; operations permanently cancelled for
suboptimal glycaemic levels; cost-effectiveness; psychosocial
questionnaires. The target sample size will be 426 recruited across
approximately 15 sites. The primary analysis will be conducted on an
intention-to-treat population. A two-sided p value of 0.05 or less will be
used to declare statistical significance for all analyses and results will
be presented with 95% CIs. Ethics and dissemination The trial was approved
by the South Central-Hampshire A Research Ethics Committee (20/SC/0271).
Results will be disseminated through conferences, scientific journals,
newsletters, magazines and social media. Trial registration number
ISRCTN10170306. Copyright ©

<11>
Accession Number
2013443696
Title
Blood mRNA expression profiles of autophagy, apoptosis, and hypoxia
markers on blood cardioplegia and custodiol cardioplegia groups.
Source
Brazilian Journal of Cardiovascular Surgery. 36 (3) (pp 331-337), 2021.
Date of Publication: 2021.
Author
Elcik D.; Tuncay A.; Sener E.F.; Taheri S.; Tahtasakal R.; Mehmetbeyoglu
E.; Gunes I.; Emirogullari O.N.
Institution
(Elcik) Department of Cardiology, Erciyes University Medical Faculty,
Kayseri, Turkey
(Tuncay, Emirogullari) Department of Cardiovascular Surgery, Erciyes
University Medical Faculty, Kayseri, Turkey
(Sener, Taheri, Tahtasakal, Mehmetbeyoglu) Department of Medical Biology,
Erciyes University Medical Faculty, Kayseri, Turkey
(Sener, Taheri, Tahtasakal, Mehmetbeyoglu) Erciyes University, Genome and
Stem Cell Center (GENKOK), Kayseri, Turkey
(Gunes) Department of Anesthesiology and Reanimation, Erciyes University
Medical Faculty, Kayseri, Turkey
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Blood cardioplegia (BC) and Custodiol cardioplegia (CC) have
been used for a long time in open heart surgery and are highly effective
solutions. The most controversial issue among these two is whether there
is any difference between them regarding myocardial damage after ischemia
surgery. In this study, autophagy, apoptosis, and hypoxia markers were
investigated and that way we evaluated the differences between BC and CC
patients. Method(s): A total of 30 patients were included in this
study, using two different cardioplegic solutions. Three different whole
blood samples of the patients were taken from a central vein
(preoperatively, immediately postoperatively, and one day after surgery).
Total ribonucleic acid was extracted from these samples. Quantitative
real-time polymerase chain reaction was performed, and changes in gene
expression were determined by the 2-Ct method of relative quantification.
 Result(s): In the CC group, Beclin gene expression level was found to
be higher and this difference was statistically significant (P=0.0024).
Similarly, cysteine-aspartic acid protease (caspase) 9 and
hypoxia-inducible factor 1alpha messenger ribonucleic acid (mRNA) gene
expression level increased and were significantly different in the CC
group. In the BC group, Beclin and microtubule-associated protein light
chain 3 expressions were higher in the samples taken one day after
surgery. Caspases 3 and 8 gene expressions were significantly different in
the BC group. Conclusion(s): As a result of the analysis performed
between the two cardioplegia groups, it has been shown that CC harms the
myocardium more than BC at the level of mRNA expression of related
markers. Copyright © 2021, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<12>
Accession Number
2011344578
Title
Incidence and risk factors for major bleeding among patients undergoing
percutaneous coronary intervention: Findings from the Norwegian Coronary
Stent Trial (NORSTENT).
Source
PLoS ONE. 16 (3 March) (no pagination), 2021. Article Number: e0247358.
Date of Publication: March 2021.
Author
Samuelsen P.-J.; Eggen A.E.; Steigen T.; Wilsgaard T.; Kristensen A.;
Skogsholm A.; Holme E.; van den Heuvel C.; Nordrehaug J.E.; Bendz B.;
Nilsen D.W.T.; Bonaa K.H.
Institution
(Samuelsen) Regional Medicines Information and Pharmacovigilance Centre
(RELIS), University Hospital of North Norway, Tromso, Norway
(Samuelsen, Eggen, Wilsgaard) Department of Community Medicine, UiT The
Arctic University of Norway, Tromso, Norway
(Steigen, Kristensen, Skogsholm, Holme, van den Heuvel) Department of
Cardiology, University Hospital of North Norway, Tromso, Norway
(Steigen) Cardiovascular Diseases Research Group, UiT The Arctic
University of Norway, Tromso, Norway
(Nordrehaug, Nilsen) Department of Clinical Science, University of Bergen,
Bergen, Norway
(Bendz) Department of Cardiology, Rikshospitalet, Oslo University
Hospital, Oslo, Norway
(Bendz) Faculty of Medicine, Institute of Clinical Medicine, University of
Oslo, Oslo, Norway
(Nilsen) Department of Cardiology, Stavanger University Hospital,
Stavanger, Norway
(Bonaa) Clinic for Heart Disease, St. Olav's University Hospital,
Trondheim, Norway
(Bonaa) Department of Circulation and Medical Imaging, Norwegian
University of Science and Technology, Trondheim, Norway
Publisher
Public Library of Science
Abstract
Introduction Bleeding is a concern after percutaneous coronary
intervention (PCI) and subsequent dual antiplatelet therapy (DAPT). We
herein report the incidence and risk factors for major bleeding in the
Norwegian Coronary Stent Trial (NORSTENT). Materials and methods NORSTENT
was a randomized, double blind, pragmatic trial among patients with acute
coronary syndrome or stable coronary disease undergoing PCI during
2008-11. The patients (N = 9,013) were randomized to receive either a
drug-eluting stent or a bare-metal stent, and were treated with at least
nine months of DAPT. The patients were followed for a median of five
years, with Bleeding Academic Research Consortium (BARC) 3-5 major
bleeding as one of the safety endpoints. We estimated cumulative incidence
of major bleeding by a competing risks model and risk factors through
cause-specific Cox models. Results The 12-month cumulative incidence of
major bleeding was 2.3%. Independent risk factors for major bleeding were
chronic kidney disease, low bodyweight (< 60 kilograms), diabetes
mellitus, and advanced age (> 80 years). A myocardial infarction (MI) or
PCI during followup increased the risk of major bleeding (HR = 1.67, 95%
CI 1-29-2.15). Conclusions The 12-month cumulative incidence of major
bleeding in NORSTENT was higher than reported in previous, explanatory
trials. This analysis strengthens the role of chronic kidney disease,
advanced age, and low bodyweight as risk factors for major bleeding among
patients receiving DAPT after PCI. The presence of diabetes mellitus or
recurrent MI among patients is furthermore a signal of increased bleeding
risk. Copyright: © 2021 Samuelsen 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.

<13>
Accession Number
2010173164
Title
Parental experiences of their infant's hospital admission undergoing
cardiac surgery: A systematic review.
Source
Acta Paediatrica, International Journal of Paediatrics. 110 (6) (pp
1730-1740), 2021. Date of Publication: June 2021.
Author
de Man M.A.C.P.; Segers E.W.; Schappin R.; van der Leeden K.; Wosten-van
Asperen R.M.; Breur H.; de Weerth C.; van den Hoogen A.
Institution
(de Man, Segers, van der Leeden, Wosten-van Asperen, Breur, van den
Hoogen) Wilhelmina Children's Hospital, University Medical Centre Utrecht,
Utrecht, Netherlands
(Schappin) Department of Development and Education of Youth in Diverse
Societies, Utrecht University, Utrecht, Netherlands
(de Weerth) Donders Institute for Brain, Cognition and Behaviour, Radboud
University Medical Center, Nijmegen, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Aim: To explore parents' experiences of parenting a child hospitalised
with congenital heart disease (CHD) and undergoing surgery.
 Method(s): Five electronic databases were systematically searched for
articles describing the experiences of parents with a child with a CHD. A
thematic analysis approach was used to identify the most common themes.
 Result(s): A total of 188 articles were identified. Eight studies
were included in the review. Four themes emerged, including balancing the
parental role, experiencing anticipatory grief, decreasing parental stress
using coping strategies and professional support. Conclusion(s):
Having a child with CHD undergoing heart surgery is a stressful experience
due to, among other things, the different situation-related parenting role
during the hospital stay and feelings of anticipatory grief. Healthcare
professionals in the PICU have an essential role in supporting parents and
understanding the needs that are crucial for the parents in order to
provide better support and reduce stress and anxiety. More qualitative
research regarding the pathway from the prenatal diagnosis through the
early childhood period is warranted. Copyright © 2021 The
Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of
Foundation Acta Paediatrica

<14>
Accession Number
2012302542
Title
Is it better to take that antihypertensive at night?.
Source
Journal of Family Practice. 69 (7) (pp 362-364), 2020. Date of
Publication: September 2020.
Author
Dickman M.; Marshall B.; Meisenheimer E.S.
Institution
(Dickman, Marshall, Meisenheimer) Madigan Family Medicine Residency, Joint
Base Lewis-McChord, WA, United States
Publisher
Frontline Medical Communications

<15>
Accession Number
2013639910
Title
Impact of Diabetes on Outcomes After Transcatheter Mitral Valve Repair in
Heart Failure: COAPT Trial.
Source
JACC: Heart Failure. 9 (8) (pp 559-567), 2021. Date of Publication: August
2021.
Author
Shahim B.; Ben-Yehuda O.; Chen S.; Redfors B.; Madhavan M.V.; Kar S.; Lim
D.S.; Asch F.M.; Weissman N.J.; Cohen D.J.; Arnold S.V.; Liu M.;
Lindenfeld J.; Abraham W.T.; Mack M.J.; Stone G.W.
Institution
(Shahim, Ben-Yehuda, Chen, Redfors, Madhavan, Cohen, Liu, Stone) Clinical
Trials Center, Cardiovascular Research Foundation, New York, NY, United
States
(Ben-Yehuda, Chen, Redfors, Madhavan) NewYork-Presbyterian
Hospital/Columbia University Irving Medical Center, New York, NY, United
States
(Ben-Yehuda) Division of Cardiology, University of California San Diego,
San Diego, CA, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, Bakersfield, CA, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville, VA,
United States
(Asch, Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Asch, Weissman) Georgetown University, Washington, DC, United States
(Cohen) St. Francis Hospital, Roslyn, NY, United States
(Arnold) University of Missouri-Kansas City School of Medicine, Kansas
City, MO, United States
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, the Ohio State University,
Columbus, OH, United States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: This paper sought to determine whether diabetes influences the
outcomes of transcatheter mitral valve repair (TMVr) in patients with
heart failure (HF) and secondary mitral regurgitation (SMR).
 Background(s): Diabetes is associated with worse outcomes in patients
with HF. Method(s): The COAPT (Cardiovascular Outcomes Assessment of
the MitraClip Percutaneous Therapy for Heart Failure Patients With
functional Mitral Regurgitation) trial randomized HF patients with 3+ or
4+ SMR to MitraClip plus guideline-directed medical therapy (GDMT) versus
GDMT alone. Two-year outcomes were evaluated in patients with versus
without diabetes. Result(s): Of 614 patients, 229 (37.3%) had
diabetes. Diabetic patients had higher 2-year rates of death than those
without diabetes (40.8% vs 32.3%, respectively; adjusted P = 0.04) and
tended to have higher rates of HF hospitalization (HFH) (HFH: 50.1% vs
43.0%, respectively; adjusted P = 0.07). TMVr reduced the 2-year rate of
death consistently in patients with (30.3% vs 49.9%, respectively;
adjusted HR: 0.51; 95% CI: 0.32 to 0.81) and without (27.0% vs 38.3%,
respectively; adjusted HR: 0.57; 95% CI: 0.39-0.84) diabetes
(P<inf>interaction</inf> = 0.72). TMVr also consistently reduced the
2-year rates of HFH in patients with (32.2% vs 54.8%, respectively;
adjusted HR: 0.41; 95% CI: 0.28-0.58) and without (41.5% vs 59.0%,
respectively; adjusted HR: 0.54: 95% CI 0.35-0.82) diabetes
(P<inf>interaction</inf> = 0.33). Greater movements in quality-of-life
(QOL) and exercise capacity occurred with TMVr than with GDMT alone,
regardless of diabetic status. Conclusion(s): Among HF patients with
severe SMR in the COAPT trial, those with diabetes had a worse prognosis.
Nonetheless, diabetic and nondiabetic patients had consistent reductions
in the 2-year rates of death and HFH and improvements in QOL and
functional capacity following TMVr treatment using the MitraClip than with
maintenance on GDMT alone. (Cardiovascular Outcomes Assessment of the
MitraClip Percutaneous Therapy for Heart Failure Patients With Functional
Mitral Regurgitation [COAPT]; NCT01626079) Copyright © 2021
American College of Cardiology Foundation

<16>
Accession Number
635795773
Title
Subacute endocarditis following dental work in an immunocompetent patient:
From toothache to heartbreak.
Source
Journal of General Internal Medicine. Conference: 2021 Annual Meeting of
the Society of General Internal Medicine, SGIM 2021. Virtual. 36 (SUPPL 1)
(pp S272), 2021. Date of Publication: 2021.
Author
Foglia R.; Schwabe-Warf D.; Kota K.J.
Institution
(Schwabe-Warf, Kota) Internal Medicine, Rutgers Robert Wood Johnson
Medical School New Brunswick, New Brunswick, NJ, United States
(Foglia) Rutgers Robert Wood Johnson Medical School, Piscataway, NJ,
United States
Publisher
Springer New York LLC
Abstract
LEARNING OBJECTIVE #1: Recognize the clinical manifestations of subacute
endocarditis. LEARNING OBJECTIVE #2: Recognize mitral valve prolapse as a
risk factor for endocarditis. CASE: A 51-year-old perimenopausal female
with known mitral valve prolapse (MVP) presented to care due to worsening
fatigue in the setting of newonset anemia. The patient had a failed root
canal in July and a repeat procedure in September, receiving clindamycin
prophylaxis both times. She reported myalgias, anorexia with 30-pound
weight loss, fatigue, chills, drenching sweats, and lower extremity
weakness. On admission she was afebrile, tachycardic to 118, normotensive,
breathing well on room air. Physical exam was significant for a 3/6
holosystolic murmur greatest at the apex radiating to the axilla and
diffuse, mild weakness. Labs revealed WBC 14.1k/uL and hemoglobin 8.4
g/dL, characterized as anemia of chronic disease; she was up-to-date with
cancer screenings, and had a negative HIV titer and rheumatologic workup.
TTE demonstrated a 1.5 cm x 1.5 cm vegetation on the mitral valve. Blood
cultures grew Haemophilus parainfluenzae, fulfilling Duke's criteria for
subacute infective endocarditis (IE); later imaging revealed acute
asymptomatic occlusion of the right subclavian and axillary arteries. She
was treated with ceftriaxone monotherapy and underwent mitral valve
replacement. IMPACT/DISCUSSION: IE is defined as acute or subacute based
on the rate of progression and, at times, the underlying pathogen.
Diagnosis of IE is often difficult given its varied presentations and
nonspecific laboratory abnormalities. History of invasive procedures with
the potential for bacteremia, such as dental procedures, and preexisting
valvular pathology are important risk factors. Currently, the 2017 ACC/AHA
guidelines do not recommend antibiotic prophylaxis for those with mitral
valve prolapse. The primary indications for IE prophylaxis are a history
of IE or prosthetic cardiac valves; this evidence is rated as Class IIA,
LOE C-LD. These guidelines are largely based on the low prevalence of IE
and estimates that antibiotic prophylaxis prevents less than 10% of cases.
However, IE can have a one-year mortality of up to 25%, which should
affect risk-benefit calculations. As well, a 2018 Journal of the American
College of Cardiology case control study by Zegri-Reiriz et al showed that
patients with MVP had rates of IE over three times higher than other
high-risk groups (e.g., prosthetic valves). This suggests that mitral
valve prolapse should be reclassified from a medium-risk to a high-risk
condition. To make definitive recommendations, a randomized clinical
trialnever before undertakenwould be necessary. CONCLUSION(S): IE can
have a wide presentation and can masquerade with features of rheumatologic
or malignant processes. IE should always be considered in patients with
nonspecific complaints, especially after recent dental work or in the
setting of valvular pathology. MVP should be considered an important risk
factor for IE, especially when considering antibiotic prophylaxis.

<17>
Accession Number
2013506743
Title
Direct-acting oral anticoagulants versus warfarin in relation to risk of
gastrointestinal bleeding: A systematic review and meta-analysis of
randomized controlled trials.
Source
Annals of Gastroenterology. 34 (5) (pp 651-659), 2021. Date of
Publication: 2021.
Author
Aloysius M.M.; Perisetti A.; Goyal H.; Boregowda U.; Jecmenica M.;
Cheryala M.; Bajaj A.; Milekic B.; Babic M.; Bansal P.; Enders G.H.
Institution
(Aloysius, Goyal, Jecmenica, Cheryala, Milekic, Babic) Department of
Internal Medicine, The Wright Center for Graduate Medical Education, PA,
United States
(Aloysius, Bansal) Geisinger Commonwealth School of Medicine, PA, United
States
(Perisetti) Department of Gastroenterology and Hepatology, University of
Arkansas for Medical Sciences, Little Rock, AR, United States
(Goyal) Mercer University School of Medicine, GA, United States
(Boregowda) Department of Internal Medicine, Bassett Medical Center, NY,
United States
(Bajaj) Monument Health Heart and Vasular Institute, SD, United States
(Bansal, Enders) Department of Gastroenterology, Commonwealth Health
Regional Hospital of Scranton, PA, United States
Publisher
Hellenic Society of Gastroenterology
Abstract
Background Direct-acting oral anticoagulants (DOACs) are increasingly
used, with studies showing a lower risk of gastrointestinal bleeding
(GIB), but overall data for GIB risk remains debatable. The objective was
to assess non-fatal and fatal GIB risk in patients on DOACs compared with
warfarin from randomized clinical trials (RCTs). Methods RCTs comparing
warfarin and DOACs for various indications (atrial fibrillation,
thromboembolism, insertion of mechanical heart valves) were included. The
primary endpoint was any GIB event. Other clinical events, such as fatal
GIB, and effects of age (<=60 years or older), time in therapeutic range
for warfarin, and choice of individual DOACs on GIB risk, were also
assessed. Results 14 RCTs were included, comprising 87,407 participants
(DOACs n=46,223, warfarin control n=41,184). The risk of GIB with DOACs
was similar to that of warfarin (relative risk [RR] 1.04, 95% confidence
interval [CI] 0.85-1.27). Compared with warfarin, rivaroxaban (RR 1.23,
95%CI 1.03-1.48) and dabigatran (RR 1.38, 95%CI 1.12-1.71) had a higher
risk of any GIB, whereas fatal GIB risk was lower in the DOACs group (RR
0.36, 95%CI 0.15-0.82). The risk of DOAC-related fatal GIB was lower in
patients aged <=60 years and in those with poor coagulation control (RR
0.39, 95%CI 0.15-0.98). Conclusions DOACs compared with warfarin have a
lower risk of fatal GIB, especially in those aged <60 years and those with
poor coagulation control. However, the risk of GIB was comparable with
warfarin and DOACs, except for rivaroxaban and dabigatran. Copyright
© 2021 Hellenic Society of Gastroenterology.

<18>
Accession Number
2014212360
Title
Quantitative angiographic assessment of aortic regurgitation after
transcatheter implantation of the venus A-valve: Comparison with other
self-expanding valves and impact of a learning curve in a single Chinese
center.
Source
Global Heart. 16 (1) (no pagination), 2021. Article Number: 54. Date of
Publication: 2021.
Author
Wang R.; Kawashima H.; Mylotte D.; Rosseel L.; Gao C.; Aben J.-P.;
Abdelshafy M.; Onuma Y.; Yang J.; Soliman O.; Tao L.; Serruys P.W.
Institution
(Wang, Gao, Tao) Department of Cardiology, Xijing Hospital, Xi'an, China
(Wang, Kawashima, Mylotte, Rosseel, Gao, Abdelshafy, Onuma, Soliman,
Serruys) Department of Cardiology, National University of Ireland, Galway
(NUIG), Galway and CORRIB Research Center for Advanced Imaging and Core
Laboratory, Ireland
(Wang, Gao) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(Kawashima) Amsterdam UMC, University of Amsterdam, Heart Center,
Department of Clinical and Experimental Cardiology, Amsterdam
Cardiovascular Sciences, Amsterdam, Netherlands
(Aben) Pie Medical Imaging, Maastricht, Netherlands
(Yang) Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, China
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Ubiquity Press
Abstract
Objectives: We aimed to compare the quantitative angiographic aortic
regurgitation (AR) into the left ventricular out flow tract (LVOT-AR) of
five different types of transcatheter self-expanding valves and to
investigate the impact of the learning curve on post-TAVR AR.
 Background(s): Quantitative video densitometric aortography is an
objective, accurate, and reproducible tool for assessment of AR following
TAVR. Methods and Results: This retrospective academic core-lab
analysis, analyzed 1150 consecutive cine aortograms performed immediately
post-TAVR. Quantitative angiographic AR of post-procedural aortography in
181 consecutive patients, who underwent TAVR with the Venus A-valve in a
single Chinese center, were compared to the results of Evolut Pro, Evolut
R, CoreValve, (Medtronic, Dublin, Ireland) and Acurate Neo (Boston
Scientific, Massachusetts, US) transcatheter heart valves (THVs), from a
previously published pooled database. Among the 181 aortograms of patients
treated with the Venus A-Valve, 113 (62.4%) were analyzable for
quantitative assessment of AR. The mean LVOT-AR was 8.9% +/- 10.0% with
14.2% of patients having moderate or severe AR in the Venus A-valve group.
No significant difference in mean LVOT-AR was observed between Evolut Pro,
Evolut R, Acurate Neo, and Venus A-valve. The incidence of LVOT-AR >17%,
which correlates with echocardiographic derived >= moderate AR, with the
Evolut Pro was lower than with the Venus A-valve (5.3% vs. 14.2%, p =
0.034), but was not different from the Evolut R (5.3% vs. 8.8%, p =
0.612), or the Acurate Neo (5.3% vs. 11.3% p = 0.16) systems. A landmark
analysis after recruitment of the first half of patients treated with the
Venus A valve (N = 56), showed a significantly lower mean LVOT-AR in the
second half of the series (11.3% +/- 11.9% vs. 6.5% +/- 7.1%, p = 0.011).
The incidence of LVOT-AR >17% in the latest 57 cases was also numerically
lower (7.0% vs. 21.4%, p = 0.857) and compared favorably with the best in
class of the self-expanding valves. Conclusion(s): The Venus A-valve
has comparable mean LVOT-AR to other self-expanding valves but has a
higher rate of moderate or severe AR than the Evolut Pro THV. However,
after completion of a learning phase, results improved and compared
favorably with the best in class of the commercially available
self-expanding valves. These findings should be confirmed in prospective
randomized comparisons of AR between different THVs. Copyright ©
2021 The Author(s). This is an open-access article distributed under the
terms of the Creative Commons Attribution 4.0 International License (CC-BY
4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited. See
http://creativecommons.org/licenses/by/4.0/.

<19>
Accession Number
366426254
Title
Modeling the effects of bivalirudin in cardiac surgical patients.
Source
Conference proceedings : ... Annual International Conference of the IEEE
Engineering in Medicine and Biology Society. IEEE Engineering in Medicine
and Biology Society. Conference. (pp 120-123), 2011. Date of Publication:
2011.
Author
Edrich T.; Frendl G.; Rawn J.D.; Paschalidis Y.
Institution
(Edrich) Department of Anesthesia, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Boston, MA 02115, United States
Abstract
Bivalirudin is direct thrombin inhibitor used in patients with
heparin-induced thrombocytopenia. A pharmacokinetic and--dynamic model
that predicts the partial thromboplastin time (PTT) based on the past
infusion rates of bivalirudin following dose adjustment would be useful to
guide optimal therapy. In this retrospective study we randomized 132
patients to a derivation and a validation cohort, and tested two models.
The first model is a single-state linear model; the other incorporates a
non-linear element to account for renal elimination of bivalirudin. Both
models predicted PTT changes equally well with root-mean squared errors of
15 to 16 seconds (Pearson correlation coefficients for both were 0.67).
Intra- and inter-individual variability of response to bivalirudin was
significant. Although a high percentage of patients had moderate to severe
renal dysfunction at one point during the bivalirudin infusion, the
non-linear model that incorporates variable renal clearance of drug did
not perform better than the linear model. This finding persisted even in
the subgroup analysis of patients with moderate and low estimated
glomerular filtration rates.

<20>
Accession Number
2012040728
Title
Effect of dexmedetomidine on perioperative hemodynamics and myocardial
protection in thoracoscopic-assisted thoracic surgery.
Source
Medical Science Monitor. 27 (no pagination), 2021. Article Number:
e929949. Date of Publication: April 2021.
Author
Li H.; Liu J.; Shi H.
Institution
(Li, Liu, Shi) Department of Anesthesiology, Shanghai Pulmonary Hospital,
Shanghai, China
Publisher
International Scientific Information, Inc.
Abstract
Background: This study aimed to clarify the protective role of
dexmedetomidine in thoracoscopic-assisted thoracic surgery (TATS),
including control of the intraoperative heart rate, blood pressure, and
myocardial injury markers. Material/Methods: The patients who underwent
TATS were divided into 2 equal groups: the dexmedetomidine group
(dexmedetomidine pumped at 0.5 microg/kg for >10 min before the
administration of anesthesia and at 0.5 microg/kg in the maintenance
period) and the control group (pumped normal saline for >10 min before the
administration of anesthesia). The data recorded for each patient were
heart rate (preoperative, maximum intraoperative, and minimum
intraoperative), systolic and diastolic blood pressure, intraoperative
hemodynamic data, and intraoperative cardiovascular drugs administered. An
enzyme-linked immunosorbent assay was performed to assess the
postoperative levels of cardiac troponin I (cTnI), creatine kinase
isoenzyme, myoglobin, and N-terminal pro-B-type natriuretic peptide
(NT-proBNP). Result(s): There were no significant differences in the
age, sex, body height, body weight, American Society of Anesthesiologists
classification grade, resection mode, operation time, ejection fraction,
basal heart rate, and systolic and diastolic blood pressure of the 2
groups. In the dexmedetomidine group, the patients' maximum intraoperative
heart rate and diastolic pressure decreased, and the postoperative
hospital stay period was shorter. The postoperative peripheral blood test
for the dexmedetomidine group showed higher NT-proBNP levels and lower
cTnI levels. Conclusion(s): Preoperative administration of
dexmedetomidine can benefit hemodynamic stability, protect the
cardiovascular system in the intraoperative and postoperative periods, and
shorten postoperative hospitalization. Copyright © 2021
International Scientific Information, Inc.. All rights reserved.

<21>
Accession Number
2013353695
Title
Myocardial protective and anti-inflammatory effects of dexmedetomidine in
patients undergoing cardiovascular surgery with cardiopulmonary bypass: a
systematic review and meta-analysis.
Source
Journal of Anesthesia. (no pagination), 2021. Date of Publication: 2021.
Author
Chen M.; Li X.; Mu G.
Institution
(Chen, Li) Department of Anesthesiology, Shehong People's Hospital, NO.
19, Guanghan road, Shehong, Sichuan 629200, China
(Mu) Department of Anesthesiology, Zigong Fourth People's Hospital,
Zigong, Sichuan, China
Publisher
Springer Japan
Abstract
Cardiopulmonary bypass (CPB) technology provides potential for cardiac
surgery, but it is followed by myocardial injury and inflammation related
to ischemia-reperfusion. This meta-analysis aimed to systematically
evaluate the cardioprotective effect of dexmedetomidine on cardiac surgery
under CPB and its effect on accompanied inflammation. PubMed, Cochrane
Library, EMBASE and Web of Science databases were comprehensively searched
for all randomized controlled trials (RCTs) published before April 1st,
2021 that explored the application of dexmedetomidine in cardiac surgery.
Compared with the control group (group C), the concentrations of CK-MB in
the perioperative period and cTn-I at 12 h and 24 h after operation in
dexmedetomidine group (group D) were significantly decreased (P < 0.05).
In addition, in group D, the levels of interleukin-6 at 24 h after
operation, tumor necrosis factor-a at the 12 h and 24 h after operation
were significantly decreased (P < 0.05). At the same time, the length of
Intensive Care Unit stay in group D was significantly shorter than group C
(P < 0.05). However, there was no significant difference in interleukin-10
level, C reactive protein level, the time on ventilator and length of
hospital stay between the two groups (P > 0.05). The application of
dexmedetomidine in cardiac surgery with CPB can reduce CK-MB and cTn-I
concentration and interleukin-6, tumor necrosis factor-alpha levels to a
certain extent and shorten the length of Intensive Care Unit stay, but it
has no significant effect on IL-10 level, C reactive protein level, the
time on ventilator and length of hospital stay. Copyright © 2021,
Japanese Society of Anesthesiologists.

<22>
Accession Number
2011668736
Title
Low-temperature electrocautery reduces adverse effects from secondary
cardiac implantable electronic device procedures: Insights from the
WRAP-IT trial.
Source
Heart Rhythm. 18 (7) (pp 1142-1150), 2021. Date of Publication: July 2021.
Author
Mittal S.; Wilkoff B.L.; Poole J.E.; Kennergren C.; Wright D.J.; Berman
B.J.; Riggio D.; Sholevar D.P.; Martinez-Arraras J.; Moubarak J.B.;
Schaller R.D.; Love J.C.; Pickett R.A.; Philippon F.; Eldadah Z.; Lande
J.D.; Lexcen D.R.; Holbrook R.; Tarakji K.G.
Institution
(Mittal) Valley Health System, Ridgewood, NJ, United States
(Wilkoff, Tarakji) Cleveland Clinic, Cleveland, OH, United States
(Poole) University of Washington School of Medicine, Seattle, WA, United
States
(Kennergren) Sahlgrenska University Hospital, Goteborg, Sweden, Sweden
(Wright) Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
(Berman) Chula Vista Cardiac Center, Chula Vista, CA, United States
(Riggio) Arizona Arrhythmia Consultants, Scottsdale, AZ, United States
(Sholevar) Virtua Health System, Camden, NJ, United States
(Martinez-Arraras) Amarrillo Heart Group, Amarillo, TX, United States
(Moubarak) Hamot Medical Center, Erie, PA, United States
(Schaller) University of Pennsylvania, Philadelphia, PA, United States
(Love) Maine Medical Center, Portland, ME, United States
(Pickett) Saint Thomas Research Institute, LLC Thomas, Nashville, TN,
United States
(Philippon) Institut Universitaire de Cardiologie et de Pneumologie de
Quebec (IUCPQ), Quebec, Canada
(Eldadah) MedStar Heart and Vascular Institute, Washington, DC, United
States
(Lande, Lexcen, Holbrook) Medtronic, Mounds View, MN, United States
Publisher
Elsevier B.V.
Abstract
Background: Cardiac device procedures require tissue dissection to free
existing device lead(s). Common techniques include blunt dissection,
standard electrocautery, and low-temperature electrocautery (PlasmaBlade,
Medtronic); however, data on the type of electrosurgical tool used and the
development of procedure- or lead-related adverse events are limited.
 Objective(s): The purpose of this study was to determine whether
standard or low-temperature electrocautery impacts the development of an
adverse event. Method(s): We evaluated patients enrolled in WRAP-IT
(Worldwide Randomized Antibiotic EnveloPe Infection PrevenTion Trial)
undergoing cardiac implantable electronic device (CIED) revision, upgrade,
or replacement. All adverse events were adjudicated by an independent
physician committee. Data were analyzed using Cox proportional hazard
regression modeling. Result(s): In total, 5641 patients underwent
device revision/upgrade/replacement. Electrocautery was used in 5205
patients (92.3%) (mean age 70.6 +/- 12.7 years; 28.8% female), and
low-temperature electrocautery was used in 1866 patients (35.9%). Compared
to standard electrocautery, low-temperature electrocautery was associated
with a 23% reduction in the incidence of a procedure- or lead-related
adverse event through 3 years of follow up (hazard ratio [HR] 0.77; 95%
confidence interval [CI] 0.65-0.91; P = .002). After controlling for the
number of active leads, degree of capsulectomy, degree of lead dissection,
and renal dysfunction, low-temperature electrocautery was associated with
a 32% lower risk of lead-related adverse events (HR 0.68; 95% CI
0.52-0.89; P = .004). These effects were consistent across a spectrum of
lead-related adverse event types. Conclusion(s): This study
represents one of the largest assessments of electrocautery use in
patients undergoing CIED revision, upgrade, or replacement procedures.
Compared to standard electrocautery, low-temperature electrocautery
significantly reduces adverse effects from these procedures. Copyright
© 2021 Heart Rhythm Society

<23>
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. 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. 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.
 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. Copyright © 2021 by
Daedalus Enterprises.

<24>
Accession Number
635791723
Title
Nurse-based secondary preventive follow-up by telephone reduced recurrence
of cardiovascular events: a randomised controlled trial.
Source
Scientific reports. 11 (1) (pp 15628), 2021. Date of Publication: 02 Aug
2021.
Author
Irewall A.-L.; Ulvenstam A.; Graipe A.; Ogren J.; Mooe T.
Institution
(Irewall, Ulvenstam, Graipe, Ogren, Mooe) Department of Public Health and
Clinical Medicine, Ostersund ,Umea University, Umea, Sweden
Publisher
NLM (Medline)
Abstract
Enhanced follow-up is needed to improve the results of secondary
preventive care in patients with established cardiovascular disease. We
examined the effect of long-term, nurse-based, secondary preventive
follow-up by telephone on the recurrence of cardiovascular events. Open,
randomised, controlled trial with two parallel groups. Between 1 January
2010 and 31 December 2014, consecutive patients (n=1890) admitted to
hospital due to stroke, transient ischaemic attack (TIA), or acute
coronary syndrome (ACS) were included. Participants were randomised (1:1)
to nurse-based telephone follow-up (intervention, n=944) or usual care
(control, n=946) and followed until 31 December 2017. The primary endpoint
was a composite of stroke, myocardial infarction, cardiac
revascularisation, and cardiovascular death. The individual components of
the primary endpoint, TIA, and all-cause mortality were analysed as
secondary endpoints. The assessment of outcome events was blinded to study
group assignment. After a mean follow-up of 4.5 years, 22.7% (n=214) of
patients in the intervention group and 27.1% (n=256) in the control group
reached the primary composite endpoint (HR 0.81, 95% CI 0.68-0.97; ARR
4.4%, 95% CI 0.5-8.3). Secondary endpoints did not differ significantly
between groups. Nurse-based secondary preventive follow-up by telephone
reduced the recurrence of cardiovascular events during long-term
follow-up. Copyright © 2021. The Author(s).

<25>
Accession Number
2014156935
Title
Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical
Therapy for Mitral Regurgitation in Heart Failure.
Source
JACC: Heart Failure. 9 (9) (pp 674-683), 2021. Date of Publication:
September 2021.
Author
Kosmidou I.; Lindenfeld J.; Abraham W.T.; Rinaldi M.J.; Kapadia S.R.;
Rajagopal V.; Sarembock I.J.; Brieke A.; Gaba P.; Rogers J.H.; Shahim B.;
Redfors B.; Zhang Z.; Mack M.J.; Stone G.W.
Institution
(Kosmidou, Gaba, Redfors) NewYork-Presbyterian Hospital/Columbia
University Irving Medical Center, New York, NY, United States
(Kosmidou, Shahim, Redfors, Zhang, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Rinaldi) Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC,
United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Rajagopal) Piedmont Hospital, Atlanta, GA, United States
(Sarembock) The Christ Hospital and Lindner Clinical Research Center,
Cincinnati, OH, United States
(Brieke) University Of Colorado Hospital, Aurora, CO, United States
(Rogers) UC Davis Medical Center, Davis, CA, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to assess the sex-specific outcomes in
patients with heart failure (HF) with 3+ and 4+ secondary mitral
regurgitation (SMR) treated with transcatheter mitral valve repair (TMVr)
plus guideline-directed medical therapy (GDMT) versus GDMT alone in the
COAPT trial. Background(s): The impact of sex in patients with HF and
severe SMR treated with TMVr with the MitraClip compared with GDMT alone
is unknown. Method(s): Patients were randomized 1:1 to TMVr versus
GDMT alone. Two-year outcomes were examined according to sex.
 Result(s): Among 614 patients, 221 (36.0%) were women. Women were
younger than men and had fewer comorbidities, but reduced quality of life
and functional capacity at baseline. In a joint frailty model accounting
for the competing risk of death, the 2-year cumulative incidence of the
primary endpoint of all HF hospitalizations (HFH) was higher in men
compared with women treated with GDMT alone. However, the relative
reduction in HFHs with TMVr was greater in men (HR: 0.43; 95% CI:
0.34-0.54) than women (HR: 0.78; 95% CI: 0.57-1.05)
(P<inf>interaction</inf> = 0.002). A significant interaction between TMVr
versus GDMT alone treatment and time was present for all HFHs in women
(HR: 0.57; 95% CI: 0.39-0.84, and HR: 1.39; 95% CI: 0.83-2.33 between 0-1
year and 1-2 years after randomization, respectively,
P<inf>interaction</inf> = 0.007) but not in men (HR: 0.48; 95% CI:
0.36-0.64, and HR: 0.33; 95% CI: 0.21-0.51; P<inf>interaction</inf> =
0.16). Female sex was independently associated with a lower adjusted risk
of death at 2 years (HR: 0.64; 95% CI: 0.46-0.90; P = 0.011). TMVr
consistently reduced 2-year mortality compared with GDMT alone,
irrespective of sex (P<inf>interaction</inf> = 0.99). Conclusion(s):
In the COAPT trial, TMVr with the MitraClip resulted in improved clinical
outcomes compared with GDMT alone, irrespective of sex. However, the
impact of TMVr in reducing HFH was less pronounced in women compared with
men beyond the first year after treatment. (Cardiovascular Outcomes
Assessment of the MitraClip Percutaneous Therapy for Heart Failure
Patients With Functional Mitral Regurgitation [The COAPT Tria] [COAPT];
NCT01626079) Copyright © 2021 American College of Cardiology
Foundation

<26>
Accession Number
2014194547
Title
Effect of live oud music on physiological and psychological parameters in
patients undergoing cardiac surgery.
Source
Global Cardiology Science and Practice. 2019 (2) (no pagination), 2019.
Article Number: 17. Date of Publication: 2019.
Author
Luis M.; Doss R.; Zayed B.; Yacoub M.
Institution
(Luis, Doss, Yacoub) Aswan Heart Centre, Aswan, Egypt
(Zayed) Music and Art therapist, Ellenhorn, MA, United States
Publisher
HBKU Press
Abstract
Background. Music therapy has emerged as a promising evidence-based
adjuvant method of intervention. This study aims to assess the effect of
live oud music on physiological and psychological parameters in patients
undergoing cardiac surgery, pre- and post-operatively. Methods. Twelve
patients undergoing cardiac operations were randomly allocated into either
intervention group or control group, six patients in each group. Patients
in the intervention group listened to 20 minutes of improvised and
personally customized live oud music before and after surgery while
patients in the control group heard the normal hospital sounds. While
anxiety scores were assessed preoperatively, vital signs and pain scores
were assessed postoperatively together with serum levels of cortisol,
which was used as a surrogate marker of the stress response. Results. In
the intervention group, pain scores and respiratory rates showed
statistically significant reduction after listening to music (P values of
0.043 and 0.034 respectively). Additionally, heart rates, anxiety scores
and serum cortisol levels showed borderline significant reduction in
patients who listened to music with P values, 0.063, 0.066 and 0.068
respectively. These changes were not found in the control group.
Conclusions. This preliminary study suggests a role of live oud music
therapy in decreasing stress response of the patients undergoing cardiac
surgery, in addition to its positive effects on pain perception and
anxiety scores. Copyright © 2019 The Author(s).

<27>
Accession Number
2014191694
Title
Meta-analysis of transcatheter aortic valve implantation versus surgical
aortic valve replacement in patients at low surgical risk.
Source
EuroIntervention. 15 (12) (pp E1047-E1056), 2019. Date of Publication:
December 2019.
Author
Witberg G.; Landes U.; Lador A.; Yahav D.; Kornowski R.
Institution
(Witberg, Landes, Lador, Kornowski) Department of Cardiology, Rabin
Medical Center, Petach-Tikva, Israel
(Witberg, Landes, Lador, Yahav, Kornowski) Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
(Yahav) Infectious Diseases Unit, Rabin Medical Center, Petach-Tikva,
Israel
Publisher
Europa Group
Abstract
Aims: Although transcatheter aortic valve implantation (TAVI) is
officially indicated for severe aortic stenosis (AS) patients at
intermediate or higher surgical risk, the procedure is now increasingly
being performed in patients who are at low surgical risk. Data on the
benefit of TAVI in this patient population are limited. We therefore aimed
to perform an updated meta-analysis of all published randomised controlled
trials (RCTs) and propensity score-matched studies comparing TAVI versus
surgical aortic valve replacement (SAVR) in patients at low surgical risk.
 Methods and Results: We conducted a systematic review and
meta-analysis of RCTs and observational studies with propensity score
matching (PSM) of TAVI versus SAVR in patients who are at low surgical
risk (mean STS score <4% and/or logistic EuroSCORE <10%). The primary
outcome was mortality (examined at 30 days, one year and the longest
available follow-up). The secondary outcomes included procedural
complications. Nine studies (n=6,124) were included. TAVI was associated
with a numerically, but not statistically, significant reduced mortality
at 30 days (1.45% vs 2.1%, p=0.05), and similar mortality at one year
(5.1% vs 5.0%, p=0.74) and a median of two years (10.8% vs 9.8%, p=0.15).
For both time points, there was significant heterogeneity between RCT/PSM
studies, with the former suggesting survival advantage for TAVI and the
latter for SAVR. In terms of periprocedural complications, TAVI was
associated with reduced risk for stroke, bleeding and renal failure and an
increase in vascular complications and pacemaker implantation.
 Conclusion(s): In patients who are at low surgical risk, TAVI seems
to be associated with equivalent mortality up to a median follow-up of two
years compared to SAVR. More data are required before TAVI can be
routinely considered as an alternative to SAVR in low-risk patients.
 Copyright © Europa Digital & Publishing 2019.

<28>
Accession Number
2014191686
Title
Multicentre propensity-matched comparison of transcatheter aortic valve
implantation using the ACURATE TA/neo selfexpanding versus the SAPIEN 3
balloon-expandable prosthesis.
Source
EuroIntervention. 15 (10) (pp 884-891), 2019. Date of Publication:
November 2019.
Author
Barth S.; Reents W.; Zacher M.; Kerber S.; Diegeler A.; Schieffer B.;
Schreiber M.; Lauer B.; Kuntze T.; Dahmer M.; Hamm C.; Hamm K.
Institution
(Barth, Kerber, Hamm) Department of Cardiology, Cardiovascular Center Bad
Neustadt, Bad Neustadt a.d. Saale, Germany
(Reents, Zacher, Diegeler) Department of Cardiac Surgery, Cardiovascular
Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
(Schieffer) Department of Cardiology, Philipps University of Marburg,
Marburg, Germany
(Schreiber, Lauer) Department of Cardiology, Zentralklinik Bad Berka, Bad
Berka, Germany
(Kuntze) Department of Cardiac Surgery, Zentralklinik Bad Berka, Bad
Berka, Germany
(Dahmer, Hamm) Department of Internal Medicine I, Division of Cardiology,
University of Giessen, Giessen, Germany
Publisher
Europa Group
Abstract
Aims: In the absence of randomised data, we aimed to compare the
transapical ACURATE and transfemoral ACURATE neo with the SAPIEN 3
prosthesis using propensity matching. Methods and Results: From 2012
to 2016, 1,306 patients at three German centres received either the
ACURATE/ACURATE neo prosthesis (n=591) or the SAPIEN 3 prosthesis (n=715).
Through nearest neighbour matching with exact allocation for access route
and centre, pairs of 329 patients (250 transfemoral, 79 transapical) per
group were determined. Patients were 81 years old on average and had a
logistic EuroSCORE I of 19%. Predilatation and post-dilatation were more
frequent in the ACURATE group (97.6% versus 52.1%, p<0.001 for
predilatation and 40.4% versus 11.6%, p<0.001 for post-dilatation), but
rapid pacing for implantation was used less frequently (37.1% versus
98.2%, p<0.001). More-thanmild aortic regurgitation at postoperative
echocardiography was 12.0% for the ACURATE group and 3.1% for the SAPIEN
group, p<=0.001). More-than-mild aortic regurgitation in the ACURATE group
differed amongst the centres with 6.0% (3/50) in centre A, 34.1% (29/85)
in centre B and 3.4% (6/181) in centre C. Patients in the ACURATE group
less frequently had pacemaker implantation compared to the SAPIEN 3 group
(11.9% versus 18.5%, p=0.020), 30-day mortality was 4.6% versus 2.1%,
respectively, p=0.134, and one-year survival was 83.1% (95% CI: 77.6-87.4)
versus 88.8% (95% CI: 84.0-92.2). Conclusion(s): In this propensity
score analysis, patients treated with the transapical ACURATE or
transfemoral ACURATE neo prosthesis less frequently had pacemakers at 30
days but had more aortic regurgitation and lower one-year
survival. Copyright © 2019 Pensoft Publishers. All rights
reserved.

<29>
Accession Number
2014191638
Title
Does an occluded rca affect prognosis in patients undergoing pci or cabg
for left main coronary artery disease? analysis from the excel trial.
Source
EuroIntervention. 15 (6) (pp E531-E538), 2019. Date of Publication: August
2019.
Author
Chen S.; Karmpaliotis D.; Redfors B.; Shlofmitz E.; Ben-Yehuda O.; Crowley
A.; Mehdipoor G.; Puskas J.D.; Kandzari D.E.; Banning A.P.; Morice M.-C.;
Taggart D.P.; Sabik III J.F.; Serruys P.W.; Kappetein A.P.; Stone G.W.
Institution
(Chen, Karmpaliotis, Redfors, Shlofmitz, Ben-Yehuda, Crowley, Mehdipoor,
Stone) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, United States
(Karmpaliotis, Shlofmitz, Ben-Yehuda, Stone) NewYork-Presbyterian
Hospital, Columbia University Medical Center, New York, NY, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Puskas) Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY,
United States
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Banning, Taggart) John Radcliffe Hospital, Oxford, United Kingdom
(Morice) Hopital prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Sabik III) Department of Surgery, UH Cleveland Medical Center, Cleveland,
OH, United States
(Serruys) Imperial College of Science, Technology and Medicine, London,
United Kingdom
(Kappetein) Thoraxcenter, Erasmus MC, Rotterdam, Netherlands
Publisher
Europa Group
Abstract
Aims: The impact of an occluded right coronary artery (RCA) in patients
with left main coronary artery disease (LMCAD) undergoing
revascularisation is unknown. We compared outcomes for patients with LMCAD
randomised to percutaneous coronary intervention (PCI) or coronary artery
bypass grafting (CABG) according to the presence of an occluded RCA in the
EXCEL trial. Methods and Results: The EXCEL trial randomised 1,905
patients with LMCAD and SYNTAX scores <=32 to PCI with everolimus-eluting
stents versus CABG. Patients were categorised according to whether they
had an occluded RCA at baseline, and their outcomes were examined using
multivariable Cox proportional hazards regression. The primary endpoint
was a composite of death, stroke, or myocardial infarction at three years.
Among 1,753 patients with a dominant RCA by core laboratory analysis, the
RCA was occluded in 130 (7.4%) at baseline. PCI was attempted in 34 of 65
patients with an occluded RCA (52.3%) and was successful in 27 (79.4% of
those attempted; 41.5% of all RCAs recanalised). The RCA was bypassed in
42 of 65 patients with an occluded RCA (64.6%; p=0.0008 versus PCI). The
three-year absolute and relative rates of the primary endpoint were
similar between PCI and CABG, in patients with or without an occluded RCA
(pinteraction=0.92). Conclusion(s): In the EXCEL trial, the presence
of an occluded RCA at baseline did not confer a worse three-year prognosis
in patients undergoing revascularisation for LMCAD and did not affect the
relative outcomes of PCI versus CABG in this high-risk patient cohort.
 Copyright © Europa Digital & Publishing 2019.

<30>
Accession Number
2014154113
Title
Acute and Chronic Kidney Disease Following Congenital Heart Surgery: A
Review.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Khuong J.N.; Wilson T.G.; Iyengar A.J.; d'Udekem Y.
Institution
(Khuong, Wilson, Iyengar) Heart Research Group, Murdoch Children's
Research Institute, Melbourne, Australia
(Khuong, Wilson, Iyengar) Department of Paediatrics, Faculty of Medicine,
University of Melbourne, Melbourne, Australia
(d'Udekem) Division of Cardiac Surgery, Children's National Hospital,
Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: There is an increasing prevalence of chronic kidney disease in
the population of adults currently living with congenital heart disease. A
considerable proportion of children who undergo congenital heart surgery
experience postoperative acute kidney injury. Whether there is an
association between acute kidney injury after cardiac surgery in childhood
and development of chronic kidney disease is unclear. Method(s):
Three electronic databases were searched to capture relevant studies
exploring the relationship between acute kidney injury after congenital
heart surgery in children and progression to chronic kidney disease.
 Result(s): A literature search identified a total of 212 research
articles, 7 of which were selected for in-depth review.
 Conclusion(s): There is a likely association between acute kidney
injury in children undergoing congenital heart surgery and progression to
chronic kidney disease. Research should be developed to mitigate factors
contributing to postoperative acute kidney injury in neonates, infants,
and children undergoing cardiac surgery. Better targeted follow-up
protocols to monitor renal function in children undergoing cardiac surgery
should be implemented. A universal definition for acute kidney injury and
chronic kidney disease is needed to improve detection and research in this
field. Copyright © 2021

<31>
Accession Number
635787580
Title
Incidence and Clinical Significance of Worsening Tricuspid Regurgitation
following Surgical or Transcatheter Aortic Valve Replacement: Analysis
from the PARTNER IIA Trial.
Source
Circulation: Cardiovascular Interventions. (no pagination), 2021. Article
Number: e010437. Date of Publication: 2021.
Author
Cremer P.C.; Wang T.K.M.; Rodriguez L.L.; Lindman B.R.; Zhang Y.; Zajarias
A.; Hahn R.T.; Lerakis S.; Malaisrie S.C.; Douglas P.S.; Pibarot P.;
Svensson L.G.; Kapadia S.; Leon M.B.; Jaber W.A.
Institution
(Cremer, Wang, Rodriguez, Jaber) Section of Cardiovascular Imaging,
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic
Institute, Cleveland Clinic, OH, United States
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Zhang, Hahn, Leon) Cardiovascular Research Foundation, NY, United States
(Zajarias) Washington University, School of Medicine, St. Louis, MO,
United States
(Hahn, Leon) Structural Heart and Valve Center, NewYork-Presbyterian
Hospital, Columbia University Medical Center, NY, United States
(Lerakis) Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, NY, United States
(Malaisrie) Division of Cardiac Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
(Douglas) Duke Clinical Research Institute, Duke University Medical
Center, Durham, NC, United States
(Pibarot) Department of Medicine, Universite Laval, Quebec, QC, Canada
(Svensson, Kapadia) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, OH, United States
(Jaber) Department of Cardiovascular Medicine, Cleveland Clinic, OH,
United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Aortic valve replacement (AVR) is recommended for severe
symptomatic aortic stenosis. However, the incidence of worsening tricuspid
regurgitation (TR) following transcatheter compared with surgical AVR
(TAVR, SAVR), and the impact of worsening TR on outcomes, is ill-defined.
Accordingly, among patients randomized to TAVR or SAVR, we describe the
differential incidence of worsening TR and its association with survival.
 Method(s): From the PARTNER IIA trial (Placement of Aortic
Transcatheter Valves IIA), 1334 patients were included with baseline and
30-day postprocedure core-lab echocardiograms. Worsening TR was defined as
deterioration of >=1 grade from baseline to 30 days. Outcomes included
cardiovascular and all-cause death between 30 days and 2 years.
Multivariable logistic regression was performed to identify associations
with worsening TR; survival analyses were performed to assess associations
with mortality. Result(s): Worsening TR occurred in 17.3% (125/721)
of TAVR and 27.0% (165/611) of SAVR patients. On multivariable analysis,
SAVR (odds ratio, 2.09 [95% CI, 1.40-3.11]), female sex (odds ratio, 2.22
[95% CI, 1.44-3.42]), atrial fibrillation (odds ratio, 1.61 [95% CI,
1.03-2.51]), and right ventricular enlargement (odds ratio, 2.25 [95% CI,
1.17-4.31]) were associated with worsening TR. Cardiovascular and
all-cause death occurred in 9.0% (26/290) and 17.9% (52/290) of patients
with worsening TR, compared with 4.8% (50/1042) and 10.9% (114/1042)
without worsening TR, respectively. In patients with worsening TR,
cardiovascular and all-cause death were similar in TAVR compared with
SAVR, (hazard ratio, 1.09 [95% CI, 0.55-2.16]) and (hazard ratio, 1.07
[95% CI, 0.62-1.87]), respectively. After adjustment, worsening TR was
independently associated with cardiovascular (hazard ratio, 3.62 [95% CI,
2.08-6.29]) and all-cause death (hazard ratio, 2.11 [95% CI, 1.37-3.27]).
 Conclusion(s): Worsening TR is associated with female sex, atrial
fibrillation, right ventricular enlargement, and SAVR. Regardless of mode
of AVR, worsening TR is similarly associated with a poor prognosis. Future
studies should focus on whether preventing or treating worsening TR
improves outcomes. Registration: URL: https://www.clinicaltrials.gov;
Unique identifier: NCT01314313. Copyright © 2021 Georg Thieme
Verlag. All rights reserved.

<32>
Accession Number
635784626
Title
Sex differences in outcomes after coronary artery bypass grafting: a
pooled analysis of individual patient data.
Source
European heart journal. (no pagination), 2021. Date of Publication: 02 Aug
2021.
Author
Gaudino M.; Di Franco A.; Alexander J.H.; Bakaeen F.; Egorova N.;
Kurlansky P.; Boening A.; Chikwe J.; Demetres M.; Devereaux P.J.; Diegeler
A.; Dimagli A.; Flather M.; Hameed I.; Lamy A.; Lawton J.S.; Reents W.;
Robinson N.B.; Audisio K.; Rahouma M.; Serruys P.W.; Hara H.; Taggart
D.P.; Girardi L.N.; Fremes S.E.; Benedetto U.
Institution
(Gaudino, Di Franco, Hameed, Robinson, Audisio, Rahouma, Girardi)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East
68th Street, NY, NY 10065, United States
(Alexander) Department of Medicine, Division of Cardiology, Duke Clinical
Research Institute, Duke University Medical Center, 40 Duke Medicine Cir,
Durham, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Carnegie Ave, Cleveland, OH 44103, USA
(Egorova) Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, NY, NY 10029, United
States
(Kurlansky) Department of Surgery, Center for Innovation and Outcomes
Research, Columbia University Medical Center, 622 W 168th St, NY, NY
10032, United States
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Ludwigstrase 23, Germany
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA
90048, USA
(Demetres) Weill Cornell Medicine, Samuel J. Wood Library and C.V. Starr
Biomedical Information Center525 East 68th Street, NY, NY 10065, United
States
(Devereaux, Lamy) Population Health Research Institute, McMaster
University, 1280 Main St W, Hamilton ON L8S 4L8, Canada
(Diegeler, Reents) Department Cardiac Surgery, Cardiovascular Center Bad
Neustadt/Saale, Germany
(Dimagli, Benedetto) Bristol Heart Institute, University of Bristol,
Terrell St, Bristol BS2 8ED, United Kingdom
(Flather) Research and Development Unit, Norfolk and Norwich University
Hospitals NHS Foundation Trust, Colney Ln, Norwich NR4 7UY, United Kingdom
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
(Serruys, Hara) Department of Cardiology, National University of Ireland,
University Rd, Galway, Ireland
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, Oxford OX1 2JD, United Kingdom
(Fremes) Schulich Heart Centre Sunnybrook Health Sciences Centre,
University of Toronto, Hospital Road, Toronto, Canada
Publisher
NLM (Medline)
Abstract
AIMS: Data suggest that women have worse outcomes than men after coronary
artery bypass grafting (CABG), but results have been inconsistent across
studies. Due to the large differences in baseline characteristics between
sexes, suboptimal risk adjustment due to low-quality data may be the
reason for the observed differences. To overcome this limitation, we
undertook a systematic review and pooled analysis of high-quality
individual patient data from large CABG trials to compare the adjusted
outcomes of women and men. METHODS AND RESULTS: The primary outcome was a
composite of all-cause mortality, myocardial infarction (MI), stroke, and
repeat revascularization (major adverse cardiac and cerebrovascular
events, MACCE). The secondary outcome was all-cause mortality.
Multivariable mixed-effect Cox regression was used. Four trials involving
13193 patients (10479 males; 2714 females) were included. Over 5years of
follow-up, women had a significantly higher risk of MACCE [adjusted hazard
ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.21; P=0.004] but
similar mortality (adjusted HR 1.03, 95% CI 0.94-1.14; P=0.51) compared to
men. Women had higher incidence of MI (adjusted HR 1.30, 95% CI 1.11-1.52)
and repeat revascularization (adjusted HR 1.22, 95% CI 1.04-1.43) but not
stroke (adjusted HR 1.17, 95% CI 0.90-1.52). The difference in MACCE
between sexes was not significant in patients 75years and older. The use
of off-pump surgery and multiple arterial grafting did not modify the
difference between sexes. CONCLUSION(S): Women have worse outcomes
than men in the first 5years after CABG. This difference is not
significant in patients aged over 75years and is not affected by the
surgical technique. Copyright Published on behalf of the European
Society of Cardiology. All rights reserved. © The Author(s) 2021. For
permissions, please email: journals.permissions@oup.com.

<33>
Accession Number
635783677
Title
Patients with Atrial Fibrillation Undergoing Cardiac Surgery: No Left
Atrial Appendage Shall Remain Untouched
WhitlockRPBelley-CoteEPPaparellaDet al. Left atrial appendage occlusion
during cardiac surgery to prevent strokeN Engl J Med2021; 384: 2081-2091.
DOI: 10.1056/NEJMoa2101897.
Source
Innovations (Philadelphia, Pa.). (pp 15569845211032139), 2021. Date of
Publication: 01 Aug 2021.
Author
Whitlock R.P.; Belley-Cote E.P.
Institution
(Whitlock, Belley-Cote) 3710 McMaster University, Hamilton, Canada
(Whitlock, Belley-Cote) Hamilton Health Sciences, Hamilton, Canada
(Whitlock, Belley-Cote) Population Health Research Institute, Hamilton,
Canada
Publisher
NLM (Medline)
Abstract
The Left Atrial Appendage Occlusion Study III randomized 4,811 patients
with atrial fibrillation and a CHA2DS2VASc score >=2 undergoing cardiac
surgery to surgical left atrial appendage occlusion or no occlusion. At a
mean follow-up of 3.8 years, stroke or systemic embolism was reduced by
33% in the occlusion group with no evidence of early or late adverse
effects. This review discusses the implication of these findings.

<34>
[Use Link to view the full text]
Accession Number
604690985
Title
Cost-effectiveness of percutaneous coronary intervention with drug-eluting
stents versus bypass surgery for patients with 3-vessel or left main
coronary artery disease: final results from the Synergy Between
Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)
trial.
Source
Circulation. 130 (14) (pp 1146-1157), 2014. Date of Publication: 30 Sep
2014.
Author
Cohen D.J.; Osnabrugge R.L.; Magnuson E.A.; Wang K.; Li H.;
Chinnakondepalli K.; Pinto D.; Abdallah M.S.; Vilain K.A.; Morice M.-C.;
Dawkins K.D.; Kappetein A.P.; Mohr F.W.; Serruys P.W.
Institution
(Cohen) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.). dcohen@saint-lukes.org
(Osnabrugge) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Magnuson) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Wang) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Li) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Chinnakondepalli) From Saint Luke's Mid America Heart Institute,
University of Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M.,
K.W., H.L., K.C.); Erasmus University Medical Center, Rotterdam, The
Netherlands (R.L.O., A.P.K., P.W.S.); Harvard School of Public Health,
Boston, MA (D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.);
Boston Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat
Leipzig, Leipzig, Germany (F.W.M.)
(Pinto) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Abdallah) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Vilain) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Morice) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Dawkins) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Kappetein) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Mohr) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
(Serruys) From Saint Luke's Mid America Heart Institute, University of
Missouri-Kansas City, Kansas City (D.J.C., R.L.O., E.A.M., K.W., H.L.,
K.C.); Erasmus University Medical Center, Rotterdam, The Netherlands
(R.L.O., A.P.K., P.W.S.); Harvard School of Public Health, Boston, MA
(D.P.); Institut Jacques Cartier, Massy, France (M.-C.M.); Boston
Scientific, Natick, MA (K.D.D.); and Herzzentrum Universitat Leipzig,
Leipzig, Germany (F.W.M.)
Abstract
BACKGROUND: The Synergy Between Percutaneous Coronary Intervention With
TAXUS and Cardiac Surgery (SYNTAX) trial demonstrated that in patients
with 3-vessel or left main coronary artery disease, coronary artery bypass
graft surgery (CABG) was associated with a lower rate of cardiovascular
death, myocardial infarction, stroke, or repeat revascularization compared
with percutaneous coronary revascularization with drug-eluting stents
(DES-PCI)). The long-term cost-effectiveness of these strategies is
unknown.
METHODS AND RESULTS: Between 2005 and 2007, 1800 patients with left main
or 3-vessel coronary artery disease were randomized to CABG (n=897) or
DES-PCI (n=903). Costs were assessed from a US perspective, and health
state utilities were evaluated with the EuroQOL questionnaire. A
patient-level microsimulation model based on the 5-year in-trial data was
used to extrapolate costs, life expectancy, and quality-adjusted life
expectancy over a lifetime horizon. Although initial procedural costs were
$3415 per patient lower with CABG, total hospitalization costs were $10
036 per patient higher. Over the next 5 years, follow-up costs were higher
with DES-PCI as a result of more frequent hospitalizations,
revascularization procedures, and higher medication costs. Over a lifetime
horizon, CABG remained more costly than DES-PCI, but the incremental
cost-effectiveness ratio was favorable ($16 537 per quality-adjusted
life-year gained) and remained <$20 000 per quality-adjusted life-year in
most bootstrap replicates. Results were consistent across a wide range of
assumptions about the long-term effect of CABG versus DES-PCI on events
and costs. In patients with left main disease or a SYNTAX score <=22,
however, DES-PCI was economically dominant compared with CABG, although
these findings were less certain.
CONCLUSIONS: For most patients with 3-vessel or left main coronary artery
disease, CABG is a clinically and economically attractive
revascularization strategy compared with DES-PCI. However, among patients
with less complex disease, DES-PCI may be preferred on both clinical and
economic grounds.
CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique
identifier: NCT00114972. Copyright © 2014 American Heart
Association, Inc.

<35>
Accession Number
2011486117
Title
European Resuscitation Council Guidelines 2021: Executive summary.
Source
Resuscitation. 161 (pp 1-60), 2021. Date of Publication: April 2021.
Author
Perkins G.D.; Graesner J.-T.; Semeraro F.; Olasveengen T.; Soar J.; Lott
C.; Van de Voorde P.; Madar J.; Zideman D.; Mentzelopoulos S.; Bossaert
L.; Greif R.; Monsieurs K.; Svavarsdottir H.; Nolan J.P.
Institution
(Perkins, Nolan) Warwick Clinical Trials Unit, Warwick Medical School,
University of Warwick, Coventry CV4 7AL, United Kingdom
(Perkins) University Hospitals Birmingham, Birmingham B9 5SS, United
Kingdom
(Graesner) University Hospital Schleswig-Holstein, Institute for Emergency
Medicine, Kiel, Germany
(Semeraro) Department of Anaesthesia, Intensive Care and Emergency Medical
Services, Maggiore Hospital, Bologna, Italy
(Olasveengen) Department of Anesthesiology, Oslo University Hospital and
Institute of Clinical Medicine, University of Oslo, Norway
(Soar) Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB,
United Kingdom
(Lott) Department of Anesthesiology, University Medical Center, Johannes
Gutenberg-University Mainz, Germany
(Van de Voorde) Department of Emergency Medicine, Faculty of Medicine
Ghent University, Ghent, Belgium
(Van de Voorde) EMS Dispatch Center, East-West Flanders, Federal
Department of Health, Belgium
(Madar) Department of Neonatology, University Hospitals Plymouth,
Plymouth, United Kingdom
(Zideman) Thames Valley Air Ambulance, Stokenchurch, United Kingdom
(Mentzelopoulos) National and Kapodistrian University of Athens Medical
School, Athens, Greece
(Bossaert) University of Antwerp, Antwerp, Belgium
(Greif) Department of Anaesthesiology and Pain Medicine, Bern University
Hospital, University of Bern, Bern, Switzerland
(Greif) School of Medicine, Sigmund Freud University Vienna, Vienna,
Austria
(Monsieurs) Department of Emergency Medicine, Antwerp University Hospital
and University of Antwerp, Belgium
(Svavarsdottir) Akureyri Hospital, Akureyri, Iceland
(Svavarsdottir) University of Akureyri, Akureyri, Iceland
(Nolan) Royal United Hospital, Bath BA1 3NG, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Informed by a series of systematic reviews, scoping reviews and evidence
updates from the International Liaison Committee on Resuscitation, the
2021 European Resuscitation Council Guidelines present the most up to date
evidence-based guidelines for the practice of resuscitation across Europe.
The guidelines cover the epidemiology of cardiac arrest; the role that
systems play in saving lives, adult basic life support, adult advanced
life support, resuscitation in special circumstances, post resuscitation
care, first aid, neonatal life support, paediatric life support, ethics
and education. Copyright © 2021

<36>
Accession Number
631867997
Title
Efficacy of Evolocumab on Cardiovascular Outcomes in Patients with Recent
Myocardial Infarction: A Prespecified Secondary Analysis from the FOURIER
Trial.
Source
JAMA Cardiology. 5 (8) (pp 952-957), 2020. Date of Publication: August
2020.
Author
Gencer B.; MacH F.; Murphy S.A.; De Ferrari G.M.; Huber K.; Lewis B.S.;
Ferreira J.; Kurtz C.E.; Wang H.; Honarpour N.; Keech A.C.; Sever P.S.;
Pedersen T.R.; Sabatine M.S.; Giugliano R.P.
Institution
(Gencer, Murphy, Sabatine, Giugliano) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, 60 Fenwood Rd, Hale Building, Boston, MA 02115, United States
(Gencer, MacH) Cardiology Division, Geneva University Hospitals, Geneva,
Switzerland
(De Ferrari) Division of Cardiology Citta della Salute e della Scienza,
Department of Medical Sciences, University of Torino, Turin, Italy
(Huber) Department of Medicine, Cardiology and Intensive Care Medicine and
Sigmund, Freud University, Medical School, Vienna, Austria
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Ferreira) Hospital de Santa Cruz, Lisbon, Portugal
(Kurtz, Wang, Honarpour) Amgen, Thousand Oaks, CA, United States
(Keech) Sydney Medical School, National Health and Medical Research
Council Clinical Trials Centre, University of Sydney, Sydney, Australia
(Sever) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Pedersen) Oslo University Hospital, Ulleval and Medical Faculty,
University of Oslo, Oslo, Norway
Publisher
American Medical Association
Abstract
Importance: The 2018 American Heart Association/American College of
Cardiology Multisociety Guideline on the Management of Blood Cholesterol
identified patients with recent (past 12 months) myocardial infarction
(MI) as very high risk, in whom a PCSK9 inhibitor is reasonable to add to
maximally tolerated statin combined with ezetimibe if their low-density
lipoprotein cholesterol level is 70 mg/dL or greater or non-high-density
lipoprotein cholesterol level is 100 mg/dL or greater. Objective(s):
To examine the clinical efficacy of evolocumab in patients with recent MI.
 Design, Setting, and Participant(s): This was a prespecified
secondary analysis of the Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial, in which
27 564 patients with atherosclerotic cardiovascular disease treated with a
statin were randomized to evolocumab vs placebo. Patients with prior MI
with a known date (n = 22320) were stratified as having a recent MI
(within 12 months of randomization) or a remote MI (more than 12 months
prior to randomization). Per protocol, patients with MI within 4 weeks
prior to randomization were excluded from the FOURIER trial. Data were
collected from February 2013 to November 2016, and data were analyzed from
May 2019 to February 2020. Main Outcomes and Measures: The primary
composite end point was cardiovascular death, MI, stroke, hospitalization
for unstable angina, or coronary revascularization. The key secondary
composite end point was cardiovascular death, MI, or stroke.
 Result(s): Of 22320 included patients, 17516 (78.5%) were male, and
the mean (SD) age was 62.2 (9.0) years. Compared with 16609 patients with
a remote MI, 5711 patients with a recent MI were younger and more likely
to be treated with high-intensity statin (77.3% [4415] vs 69.3% [11506]).
In the placebo arm, the 3-year Kaplan-Meier rate for the primary end point
was 17.2% in patients with recent MI compared with 14.4% in those with
remote MI (adjusted HR, 1.45; 95% CI, 1.29-1.64; P <.001). Similarly, the
3-year Kaplan-Meier rates for the key secondary end point was also higher
in those with recent MI (10.9% vs 9.5%; adjusted HR, 1.45; 95% CI,
1.24-1.69; P <.001). In patients with a recent MI, evolocumab reduced the
risk of the primary and key secondary end points by 19% (hazard ratio
[HR], 0.81; 95% CI, 0.70-0.93) and 25% (HR, 0.75; 95% CI, 0.62-0.91),
respectively. In patients with a remote MI, evolocumab reduced the risk of
the primary and key secondary end points by 8% (HR, 0.92; 95% CI,
0.84-1.01; P for interaction =.13) and 15% (HR, 0.85; 95% CI, 0.76-0.96; P
for interaction =.24), respectively. Given the higher event rates in
patients with a recent MI, the absolute risk reductions over 3 years with
evolocumab were 3.7% in those with recent MI vs 1.1% in those with remote
MI for the primary end point and 3.2% vs 1.3%, respectively, for the key
secondary end point. Conclusions and Relevance: Patients with a
recent MI were at higher risk of cardiovascular events and tended to
experience greater absolute risk reductions with evolocumab than those
with remote MIs. These findings support the concept in US and European
guidelines to aggressively lower low-density lipoprotein cholesterol
levels in very high-risk patients, such as those with a recent MI. Trial
Registration: ClinicalTrials.gov Identifier: NCT01764633. Copyright
© 2020 American Medical Association. All rights reserved.

<37>
Accession Number
635300755
Title
Iatrogenic immune-mediated neuropathies: Diagnostic, epidemiological and
mechanistic uncertainties for causality and implications for clinical
practice.
Source
Journal of Neurology, Neurosurgery and Psychiatry. 92 (9) (pp 975-982),
2021. Date of Publication: 01 Sep 2021.
Author
Goedee H.S.; Attarian S.; Kuntzer T.; Van den Bergh P.; Rajabally Y.A.
Institution
(Goedee) Department of Neurology and Neurosurgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Attarian) Service de Neurologie, Hopital La Timone, Marseille, France
(Kuntzer) Service of Neurology, Lausanne University Hospital (CHUV),
Lausanne, Switzerland
(Van den Bergh) Centre de Reference Neuromusculaire, Cliniques
Universitaires St-Luc, Brussels, Belgium
(Rajabally) Inflammatory Neuropathy Clinic, University Hospitals
Birmingham NHS Foundation Trust, Birmingham, United Kingdom
(Rajabally) Aston Medical School, Aston University, Birmingham, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Acute and chronic immune-mediated neuropathies have been widely reported
with medical intervention. Although causal relationship may be uncertain
in many cases, a variety of drugs, several vaccination types, surgical
procedures and bone marrow transplants have been reported as possible
cause or trigger of a putative immune-mediated response resulting in acute
and chronic neuropathies. We conducted a systematic review of the
literature from 1966 to 2020 on reported cases of possible iatrogenic
immune-mediated neuropathies. We determined in each case the likelihood of
causality based on frequency of the association, focusing primarily on
clinical presentation and disease course as well as available ancillary
investigations (electrophysiology, blood and cerebrospinal fluid and
neuropathology). The response to immunotherapy and issue of re-exposure
were also evaluated. We also considered hypothesised mechanisms of onset
of immune-mediated neuropathy in the specific iatrogenic context. We
believe that a likely causal relationship exists for only few drugs,
mainly antitumour necrosis factor alpha agents and immune checkpoint
inhibitors, but remains largely unsubstantiated for most other suggested
iatrogenic causes. Unfortunately, given the lack of an accurate diagnostic
biomarker for most immune-mediated neuropathies, clinical assessment will
often override ancillary investigations, resulting in lower levels of
certainty that may continue to cast serious doubts on reliability of their
diagnosis. Consequently, future reports of suspected cases should collect
and exhaustively assess all relevant data. At the current time, besides
lack of evidence for causality, the practical implications on management
of suspected cases is extremely limited and therapeutic decisions appear
likely no different to those made in non-iatrogenic cases. Copyright
© Author(s) (or their employer(s)) 2021. No commercial re-use. See
rights and permissions. Published by BMJ.

<38>
Accession Number
635124114
Title
Protocol for a randomised controlled trial for Treatment in Thoracic
Aortic Aneurysm: Surgery versus Surveillance (TITAN: SvS).
Source
BMJ Open. 11 (5) (no pagination), 2021. Article Number: e052070. Date of
Publication: 26 May 2021.
Author
Guo M.H.; Appoo J.J.; Wells G.A.; Chu M.; Ouzounian M.; Fortier J.;
Boodhwani M.
Institution
(Guo, Fortier, Boodhwani) Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Appoo) Cardiac Surgery, University of Calgary, Calgary, AB, Canada
(Wells) School of Epidemiology and Public Health, University of Ottawa,
Ottawa, ON, Canada
(Wells) Cardiovascular Research Methods Centre, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Chu) Cardiac Surgery, Western University Schulich School of Medicine and
Dentistry, London, ON, Canada
(Ouzounian) Cardiac Surgery, University Health Network, Toronto, ON,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Ascending thoracic aortic aneurysm (ATAA) is an asymptomatic
condition that can lead to catastrophic events of rupture or dissection.
Current guidelines are based on limited retrospective data and recommend
surgical intervention for ATAA with a diameter of greater or equal to 5.5
cm. Treatment in Thoracic Aortic Aneurysm: Surgery versus Surveillance is
the first prospective, multicentre, randomised controlled trial that
compares outcomes of patients undergoing early elective ascending aortic
surgery to patients undergoing medical surveillance. Methods and analysis
Patients between the ages of 18 and 80 with an asymptomatic ATAA between
5.0 cm and 5.4 cm in diameter are eligible for randomisation to early
surgery or surveillance. Patients in the surgery group will be followed at
1 month after discharge, then annually for a minimum of 2 years and up to
5 years. Patients in the surveillance group will be followed annually from
their index clinic visit for a minimum of 2 years and up to 5 years. The
primary outcome is all-cause mortality at follow-up. A sample size of 618
subjects (309 in each group) will achieve an 80% power at a 0.047
significance level. Ethics and dissemination This study has received
Ottawa Health Science Network Research Ethics Board approval (Protocol
20180007-01H), which was most recently updated on 25 November 2020. The
Research Ethics Board have granted approval to the study at 14
participating institutions, including the Ottawa Health Science Network
Research Ethics Board. On completion of data analysis, the result of the
trial will be presented at national and international conferences, and
published in relevant journals, regardless of the finding of the trial.
Trial registration number NCT03536312. Copyright © 2021 BMJ
Publishing Group. All rights reserved.

<39>
Accession Number
2008417122
Title
Combined Use of Rotational Thromboelastometry (Rotem) and Platelet
Impedance Aggregometry (Multiplate Analyzer) in Cyanotic and Acyanotic
Infants and Children Undergoing Cardiac Surgery With Cardiopulmonary
Bypass: Subgroup Analysis of a Randomized Clinical Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2115-2123),
2021. Date of Publication: July 2021.
Author
Dieu A.; Van Regemorter V.; Detaille T.; Houtekie L.; Eeckhoudt S.;
Khalifa C.; Kahn D.; Clement De Clety S.; Poncelet A.; Momeni M.
Institution
(Dieu, Van Regemorter, Khalifa, Kahn, Momeni) Department of
Anesthesiology, Cliniques Universitaires Saint Luc, Universite Catholique
de Louvain, Brussels, Belgium
(Detaille, Houtekie, Clement De Clety) Department of Pediatric Intensive
Care Unit, Cliniques Universitaires Saint Luc, Universite Catholique de
Louvain, Brussels, Belgium
(Eeckhoudt) Department of Hematology, Laboratoires des Hopitaux
Universitaires de Bruxelles, Universite Libre de Bruxelles, Brussels,
Belgium
(Poncelet) Department of Cardiac Surgery, Cliniques Universitaires Saint
Luc, Universite Catholique de Louvain, Brussels, Belgium
Publisher
W.B. Saunders
Abstract
Objectives: Few studies have investigated the Multiplate platelet function
analyzer in pediatrics. The authors evaluated Multiplate combined with
Rotem in terms of guiding platelet transfusion after pediatric cardiac
surgery with cardiopulmonary bypass (CPB). The authors further compared
coagulation parameters between cyanotic and acyanotic patients.
 Design(s): Subgroup analysis of a randomized clinical trial.
 Setting(s): Tertiary hospital. Participant(s): Patients weighing
between seven and 15 kg. Intervention(s): None. Measurements and
Main Results: Rotem and Multiplate tests were performed (1) after
anesthesia induction, (2) upon CPB separation, and (3) upon intensive care
unit arrival. Among a total of 59 subjects, 9 patients required platelet
transfusion. In multivariate linear regression, analysis EXTEM maximum
clot firmness upon CPB separation was associated with the volume of
transfused platelets (regression coefficient = -0.348 [95% confidence
interval -1.006 to -0.028]; p = 0.039). No such association was found for
the Multiplate test. Acyanotic and cyanotic heart disease were present in
32 and 27 children, respectively. There were no significant differences
between these two groups in terms of platelet count and function.
Postoperative blood loss was significantly higher in the cyanotic group
compared with the acyanotic arm (p = 0.015; difference [95% confidence
interval -2.40 {-4.20 to -0.60}]). There were no differences between
groups regarding transfusion of allogeneic blood products.
 Conclusion(s): This study showed that Rotem, but not Multiplate
results, were associated with platelet transfusion in pediatric cardiac
surgery with no intake of platelet inhibitors. The usefulness of combining
these tests in platelet transfusion decision-making needs to be evaluated
in larger populations. Copyright © 2020 Elsevier Inc.

<40>
Accession Number
2010964702
Title
Lung Injury After Neonatal Congenital Cardiac Surgery Is Mild and
Modifiable by Corticosteroids.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2100-2107),
2021. Date of Publication: July 2021.
Author
Kaskinen A.K.; Keski-Nisula J.; Martelius L.; Moilanen E.; Hamalainen M.;
Rautiainen P.; Andersson S.; Pitkanen-Argillander O.M.
Institution
(Kaskinen) Division of Pediatric Nephrology and Transplantation,
Children's Hospital and Pediatric Research Center, Helsinki University
Hospital and University of Helsinki, Helsinki, Finland
(Keski-Nisula, Rautiainen) Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Hospital and University of
Helsinki, Helsinki, Finland
(Martelius) Department of Radiology, HUS Medical Imaging Center,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
(Moilanen, Hamalainen) The Immunopharmacology Research Group, Faculty of
Medicine and Health Technology, Tampere University and Tampere University
Hospital, Tampere, Finland
(Andersson) Children's Hospital and Pediatric Research Center, Helsinki
University Hospital and Helsinki University, Helsinki, Finland
(Pitkanen-Argillander) Division of Pediatric Cardiology, Children's
Hospital, Helsinki University Hospital and University of Helsinki,
Helsinki, Finland
Publisher
W.B. Saunders
Abstract
Objectives: The present study was performed to determine whether lung
injury manifests as lung edema in neonates after congenital cardiac
surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates
postoperative lung injury in neonates after congenital cardiac surgery.
 Design(s): A supplementary report of a randomized, double-blinded,
placebo-controlled clinical trial. Setting(s): A pediatric tertiary
university hospital. Participant(s): Forty neonates (age <=28 days)
undergoing congenital cardiac surgery with cardiopulmonary bypass.
 Intervention(s): After anesthesia induction, patients were assigned
randomly to receive intravenously either 2 mg/kg methylprednisolone or
placebo b, which was followed by hydrocortisone or placebo bolus six hours
after weaning from CPB for five days as follows: 0.2 mg/kg/h for 48 hours,
0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24
hours. Measurements and Main Results: The chest radiography lung
edema score was lower in the SDC than in the placebo group on the first
postoperative day (POD one) (p = 0.03) and on PODs two and three (p =
0.03). Furthermore, a modest increase in the edema score of 0.9 was noted
in the placebo group, whereas the edema score remained at the preoperative
level in the SDC group. Postoperative dynamic respiratory system
compliance was higher in the SDC group until POD three (p < 0.01).
However, postoperative oxygenation; length of mechanical ventilation; and
tracheal aspirate biomarkers of inflammation and oxidative stress, namely
interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no
differences between the groups. Conclusion(s): The SDC regimen
reduced the development of mild and likely clinically insignificant
radiographic lung edema and improved postoperative dynamic respiratory
system compliance without adverse events, but it failed to improve
postoperative oxygenation and length of mechanical
ventilation. Copyright © 2021 The Authors

<41>
Accession Number
2013826394
Title
Acute kidney injury following transcatheter edge-to-edge mitral valve
repair: A systematic review and meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Doulamis I.P.; Tzani A.; Kampaktsis P.N.; Kaneko T.; Tang G.H.L.
Institution
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Tzani) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Kampaktsis) Division of Cardiology, New York University Langone Medical
Center, NY, United States
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Tang) Department of Cardiovascular Surgery, Mount Sinai Health System,
New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Aim of this study was to perform a systematic review a
meta-analysis of the literature in order to identify predictors of acute
kidney injury (AKI) in patients with mitral regurgitation (MR) undergoing
transcatheter edge-to-edge repair (TEER) and assess its effect on
in-hospital outcomes and mortality. Although iodinated contrast is not
typically used in TEER, these patients are still at risk for developing
AKI. Method(s): Studies reporting on the effect of incident AKI on
mortality following TEER for MR were included. Random-effects
meta-analysis was performed, comparing clinical outcomes between the
patients with or without incident AKI. Result(s): Six studies
including a total of 2057 patients (377 AKI and 1680 No-AKI) were included
and analyzed. AKI was significantly associated with 30-day mortality after
TEER (Odds ratio (OR): 8.06; 95% CI: 3.20, 20.30, p < 0.01; I2
= 18.4%) and all-cause mortality over a mean follow-up time of 30 months
(Hazard ratio (HR): 2.48; 95% CI: 1.89, 3.24, p < 0.01; I2 =
23.7%). AKI after TEER was associated with prolonged hospitalization (Mean
difference (in days): 1.41; 95% CI: 0.52, 2.31, p < 0.01; I2 =
82.4%). Stage 4 chronic kidney disease (CKD), device failure and history
of chronic obstructive pulmonary disease (COPD) were significant
predictors of AKI following TEER (CKD stage 4: OR: 2.38; 95% CI: 1.18,
4.78, p = 0.02; I2 = 0.0%; Device failure: OR: 3.15; 95% CI:
1.94, 5.12, p < 0.01; I2 = 0.0%; COPD: OR: 1.92; 95% CI: 1.16,
3.17; I2 = 26.7%). Conclusion(s): Our findings highlight
the renal vulnerability of the TEER population to renal injury and the
associated deterioration in clinical outcomes and survival. Copyright
© 2021 Elsevier Inc.

<42>
Accession Number
2013811485
Title
Trends, Predictors and In-Hospital Outcomes of the Next Day Discharge
Approach After Transcatheter Mitral Valve Repair.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Grant J.K.; Vincent L.; Ebner B.; Singh H.; Maning J.; Rubin P.;
Olorunfemi O.; Colombo R.; Braghiroli J.; De Marchena E.
Institution
(Grant, Vincent, Ebner, Singh, Maning, Rubin) Department of Internal
Medicine, University of Miami Miller School of Medicine/Jackson Memorial
Hospital, Florida 33136, United States
(Olorunfemi, Colombo, Braghiroli) Department of Medicine, Cardiovascular
Division, Jackson Memorial Hospital
(De Marchena) Department of Medicine, Cardiovascular Division, University
of Miami Miller School of Medicine
Publisher
Elsevier Inc.
Abstract
Early discharge strategies are associated with lower cost and resource
utilization during hospitalization, as such we sought to evaluate trends,
predictors and outcomes of the next day discharge (NDD) approach after
transcatheter mitral valve repair (TMVR) procedures with the MitraClip
device. The National Inpatient Sample (NIS) was queried between 2013 and
2018 for patients undergoing TMVR using the International Classification
of Diseases (ICD) 9 procedure code '3597' and ICD-10 procedure code
'02UG3JZ'. Patients undergoing TMVR were stratified into two groups,
determined by hospital length of stay (LOS) [<=1 day, NDD versus >1-day,
non-NDD]. Overall, 22,035 patients underwent TMVR with 35.7% (n = 7,870)
belonging to the NDD group (mean age 78.1 +/- 9.7 years, women 45%). From
2013 to 2018, the proportion of patients being discharged using the NDD
approach trended upward from 18.3% to 46.0%. Amongst demographic and
social factors, female sex, black race, and low median household income
were predictive of non-NDD (p <0.05 for all). Amongst clinical factors,
anemia, iron deficiency anemia, major depressive disorder,
thrombocytopenia, obesity and end stage renal disease were some predictors
of non-NDD (p <0.05 for all). In the non-NDD group there was a downward
trend of pooled post-procedure complications, post procedure cardiogenic
shock, vascular complications, acute kidney injury, mechanical circulatory
support use, acute respiratory distress and postoperative ischemic stroke
and (p for trend <0.001 for all). Despite the overall downward trend,
complications began increasing in 2017-18. In conclusion, these trends may
reflect improving operator experience, advancement in vascular access
device closures and techniques, and prioritization of decreasing length of
stay. Ideally, the feasibility and safety of this approach should be
confirmed in larger-sized multicenter, randomized trials. Copyright
© 2021 Elsevier Inc.

<43>
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. 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. 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. 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. Copyright ©
The Author(s) 2021.

<44>
Accession Number
2013333897
Title
Invited commentary: A prospective randomized trial on parents' disease
knowledge and quality of life. Shall WeChat about telehealth?.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Stevens R.M.; Chilingerian J.; Mulinari L.; Sun J.; Throckmorton A.;
Latifi R.
Institution
(Stevens, Sun) Division of Pediatric Cardiac Surgery, Pediatric Cardiac
Surgery, St. Christopher's Hospital for Children, Drexel University
College of Medicine, Philadelphia, PA, United States
(Chilingerian) The Heller School for Social Policy and Management,
Brandeis University, Waltham, MA, United States
(Chilingerian) Adjunct of Public Health and Community Medicine, Tufts
School of Medicine, Tufts University, Boston, MA, United States
(Mulinari) DeWitt Daughtry Family Department of Surgery, University of
Miami Leonard Miller School of Medicine, Holtz Children's Hospital,
Jackson Memorial Hospital, Miami, FL, United States
(Throckmorton) School of Biomedical Engineering, Drexel University,
Philadelphia, PA, United States
(Latifi) Department of Surgery, New York Medical College, School of
Medicine, West Chester Medical Center, Valhalla, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
WeChat and access to wireless communication may offer a continuum of care
following medical and surgical intervention. This cardiac surgery research
study evaluates the process of parental education and social support
following pediatric cardiac surgery utilizing standard of care compared to
telehealth. Copyright © 2021 Wiley Periodicals LLC

<45>
Accession Number
635236819
Title
Retrograde autologous priming during cardiopulmonary bypass reduces blood
transfusion rate in adult cardiac surgery: A prospective randomized
clinical trial.
Source
Asian journal of surgery. 44 (8) (pp 1083-1084), 2021. Date of
Publication: 01 Aug 2021.
Author
Chen R.-Q.; Li J.-B.; Lin J.; Lin Z.-J.
Institution
(Chen, Li, Lin, Lin) Department of Anesthesiology, Zhangzhou Municipal
Hospital Affiliated to Fujian Medical University, Zhangzhou 363000, China
Publisher
NLM (Medline)

<46>
Accession Number
635097174
Title
Association between Achieved ?-3 Fatty Acid Levels and Major Adverse
Cardiovascular Outcomes in Patients with High Cardiovascular Risk: A
Secondary Analysis of the STRENGTH Trial.
Source
JAMA Cardiology. 6 (8) (pp 910-917), 2021. Date of Publication: August
2021.
Author
Nissen S.E.; Lincoff A.M.; Wolski K.; Ballantyne C.M.; Kastelein J.J.P.;
Ridker P.M.; Ray K.K.; McGuire D.K.; Mozaffarian D.; Koenig W.; Davidson
M.H.; Garcia M.; Katona B.G.; Himmelmann A.; Loss L.E.; Poole M.; Menon
V.; Nicholls S.J.
Institution
(Nissen, Lincoff, Wolski, Garcia, Menon) Cleveland Clinic Coordinating
Center for Clinical Research, Department of Cardiovascular Medicine,
Cleveland Clinic, Cleveland, OH, United States
(Ballantyne) Baylor College of Medicine, Houston, TX, United States
(Kastelein) Academic Medical Center, Amsterdam, Netherlands
(Ridker) Center for Cardiovascular Disease Prevention, Harvard Medical
School, Boston, MA, United States
(Ray) Imperial College of London, London, United Kingdom
(McGuire) University of Texas, Southwestern Medical Center, Dallas, United
States
(Mozaffarian) Friedman School of Nutrition Science and Policy, Tufts
University, Boston, MA, United States
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
DZHK (German Centre for Cardiovascular Research) Munich Heart Alliance,
Munich, Germany
(Koenig) Institute of Epidemiology and Medical Biometry, University of
Ulm, Ulm, Germany
(Davidson) University of Chicago, Chicago, IL, United States
(Katona, Loss) AstraZeneca BioPharmaceuticals RandD, Late-stage
Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD, United
States
(Himmelmann, Poole) AstraZeneca BioPharmaceuticals RandD, Late-stage
Development, Cardiovascular, Renal and Metabolic, Gothenburg, Sweden
(Nicholls) Monash Cardiovascular Research Centre, Melbourne, VIC,
Australia
Publisher
American Medical Association
Abstract
Importance: In patients treated with ?-3 fatty acids, it remains uncertain
whether achieved levels of eicosapentaenoic acid (EPA) or docosahexaenoic
acid (DHA) are associated with cardiovascular outcomes. Objective(s):
To determine the association between plasma levels of EPA and DHA and
cardiovascular outcomes in a trial of ?-3 fatty acids compared with corn
oil placebo. Design, Setting, and Participant(s): A double-blind,
multicenter trial enrolled patients at high cardiovascular risk with
elevated triglyceride levels and low levels of high-density lipoprotein
cholesterol at 675 centers (enrollment from October 30, 2014, to June 14,
2017; study termination January 8, 2020; last visit May 14, 2020).
 Intervention(s): Participants were randomized to receive 4 g daily of
?-3 carboxylic acid (CA) or an inert comparator, corn oil. Main
Outcomes and Measures: The primary prespecified end point was a composite
of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina requiring hospitalization.
The primary outcome measure was the hazard ratio, adjusted for baseline
characteristics, for patients treated with the ?-3 CA compared with corn
oil for the top tertile of achieved EPA and DHA plasma levels 12 months
after randomization. Result(s): Of the 13078 total participants, 6539
(50%) were randomized to receive ?-3 CA and 6539 (50%) randomized to corn
oil. ?-3 Fatty acid levels were available at both baseline and 12 months
after randomization in 10382 participants (5175 ?-3 CA patients [49.8%]
and 5207 corn oil-treated patients [50.2%]; mean [SD] age, 62.5 [8.9]
years, 3588 [34.6%] were women, 9025 [86.9%] were White, and 7285 [70.2%]
had type 2 diabetes). The median plasma levels at 12 months in ?-3 CA
patients were 89 microg/mL (interquartile range [IQR], 46-131 microg/mL)
for EPA and 91 microg/mL (IQR, 71-114 microg/mL) for DHA with top tertile
levels of 151 microg/mL (IQR, 132-181 microg/mL) and 118 microg/mL (IQR,
102-143 microg/mL), respectively. Compared with corn oil, the adjusted
hazard ratios for the highest tertile of achieved plasma levels were 0.98
(95% CI, 0.83-1.16; P =.81) for EPA, and 1.02 (95% CI, 0.86-1.20; P =.85
for DHA. Sensitivity analyses based on changes in plasma and red blood
cell levels of EPA and DHA and primary and secondary prevention subgroups
showed similar results. Conclusions and Relevance: Among patients
treated with ?-3 CA, the highest achieved tertiles of EPA and DHA were
associated with neither benefit nor harm in patients at high
cardiovascular risk. Trial Registration: ClinicalTrials.gov Identifier:
NCT02104817. Copyright © 2021 American Medical Association. All
rights reserved.

<47>
Accession Number
634651024
Title
Effectiveness of music on anxiety and pain among cardiac surgery patients:
A quantitative systematic review and meta-analysis of randomized
controlled trials.
Source
International journal of nursing practice. 27 (4) (pp e12928), 2021. Date
of Publication: 01 Aug 2021.
Author
Chandrababu R.; Ramesh J.; Sanatombi Devi E.; Nayak B.S.; George A.
Institution
(Chandrababu, Sanatombi Devi, Nayak, George) Manipal College of Nursing,
Manipal Academy of Higher Education, Manipal, Karnataka, India
(Ramesh) Udupi College of Nursing, Shree Krishna Educational Trust,
Manipal, Karnataka, India
Publisher
NLM (Medline)
Abstract
AIM: The aim of this study is to evaluate the effectiveness of music on
anxiety and pain among patients following cardiac surgery. BACKGROUND:
Cardiac surgery affects patients physically, psychologically and socially.
Anxiety and pain are the usual problems among patients following cardiac
surgery. DESIGN: The study design is a systematic review and
meta-analysis. DATA SOURCES: The Medical Literature Analysis and Retrieval
System Online (MEDLINE), Cumulative Index to Nursing and Allied Health
Literature (CINAHL), Cochrane Central Register of Controlled Trials
(CENTRAL), Excerpta Medica database (EMBASE) and Web of Science databases
were searched for randomized controlled trials from January 2000 to
December 2017. REVIEW METHODS: The Cochrane collaboration guidelines were
followed and reported using the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement. The Grading of
Recommendations, Assessment, Development, and Evaluations (GRADE) approach
was used to summarize the quality of evidence. RESULT(S): Fourteen
studies were included in systematic review and 13 in meta-analysis. The
meta-analysis revealed that there was a significant reduction in anxiety
and pain among patients who received musical intervention compared with
those who did not. CONCLUSION(S): Music has positive benefits on
anxiety and pain. However, well-designed and high-quality trials are
needed to generate higher quality evidence. Copyright © 2021 John
Wiley & Sons Australia, Ltd.

<48>
Accession Number
2013495015
Title
Representation of women in randomized trials in cardiac surgery: A
meta-analysis.
Source
Journal of the American Heart Association. 10 (16) (no pagination), 2021.
Article Number: e020513. Date of Publication: 17 Aug 2021.
Author
Gaudino M.; Di Mauro M.; Fremes S.E.; Di Franco A.
Institution
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York City, NY, United States
(Di Mauro) Cardio-Thoracic Surgery Unit, Heart and Vascular Centre,
Maastricht University Medical Centre, Cardiovascular Research Institute
Maastricht, Maastricht, Netherlands
(Fremes) Schulich Heart Centre, Division of Cardiac Surgery, Department of
Surgery, Sunnybrook Health Sciences Centre, University of Toronto,
Toronto, ON, Canada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Women have traditionally been underrepresented in randomized
clinical trials (RCTs). We performed a systematic evaluation of the
inclusion of women in cardiac surgery RCTs published in the past 2
decades. METHODS AND RESULTS: MEDLINE, EMBASE, and the Cochrane Library
were searched (2000 to July 2020) for RCTs written in English, comparing
>=2 adult cardiac surgical procedures. The percentage of women enrolled
and its association with year of publication, sample size, mean age,
funding source, geographic location, number of sites involved, and
interventions tested were analyzed using a meta-analytic approach.
Fifty-one trials were included. Of 25 425 total patients, 5029 were women
(20.8%; 95% CI, 17.6-24.4; range, 0.5%-57.9%). The proportion of women
dropped significantly during the study period (29.6% in 2000 versus 13.1%
in 2019, P<0.001). Women were significantly more represented in European
trials (26.2%; 95% CI, 21.2-31.9), and less represented in trials of
coronary bypass surgery versus other interventions (16.8%; 95% CI,
12.3-22.7 versus 33.6%; 95% CI, 27.4-40.5; P=0.0002) and in trials
enrolling younger patients (P=0.009); the percentage of women was higher
in industry-sponsored versus non-industry sponsored trials (31.7%; 95% CI,
27.2-36.6 versus 15.5%; 95% CI, 10.0-23.2; P=0.0004) and was not
associated with trial sample size (P=0.52) or study design (multicenter
versus monocenter: P=0.22). After exclusion of trials conducted at Veteran
Affairs centers, women representation was 24.4% (95% CI, 21.1-28.0; range,
10.4%-57.9%), with no significant changes during the study period.
 CONCLUSION(S): The proportion of women in cardiac surgery trials is
low and likely inadequate to provide meaningful estimates of the treatment
effect. Copyright © 2021 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley. This is an open access article
under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs
License, which permits use and distribution in any medium, provided the
original work is properly cited, the use is non-commercial and no
modifications or adaptations are made.

<49>
Accession Number
2013510238
Title
Postoperative 20% albumin vs standard care and acute kidney injury after
high-risk cardiac surgery (ALBICS): study protocol for a randomised trial.
Source
Trials. 22 (1) (no pagination), 2021. Article Number: 558. Date of
Publication: December 2021.
Author
Balachandran M.; Banneheke P.; Pakavakis A.; Al-Bassam W.; Sarode V.;
Rowland M.; Shehabi Y.
Institution
(Balachandran, Banneheke) School of Clinical Sciences at Monash Health,
Monash University, Clayton, VIC, Australia
(Pakavakis, Al-Bassam, Shehabi) Intensive Care Services, School of
Clinical Sciences at Monash Health, Monash University, Clayton, VIC,
Australia
(Sarode) Intensive Care Services, Cabrini Health, Malvern, VIC, Australia
(Sarode) Cabrini Monash University Department of Medicine, Monash
University, Malvern, VIC, Australia
(Rowland) Department of Cardiothoracic Surgery, Barwon Health, Geelong,
VIC, Australia
(Shehabi) University of New South Wales, Prince of Wales Clinical School
of Medicine, Randwick, NSW, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Acute kidney injury (AKI) is a common complication of cardiac
surgery. Factors such as cardiopulmonary bypass, aortic cross-clamping and
surgical stress may precipitate renal hypoperfusion and ischaemia,
inflammation and oxidative stress are associated with development of AKI.
Albumin's pharmacological properties and widespread availability have the
potential to mitigate these factors. However, the effect of albumin on
cardiac surgery-associated AKI is unknown. Objective(s): To evaluate
the impact of postoperative 20% albumin infusion on kidney function after
high-risk cardiac surgery. Method(s): We designed an open-label,
multicentre, randomised controlled trial-the ALBICS study (ALBumin
Infusion and acute kidney injury following Cardiac Surgery). A total of
590 patients undergoing high-risk cardiac surgery (combined procedure or
estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73
m2) will be enrolled into the study and randomly allocated to
receive a postoperative 20% albumin infusion or standard care in a 1:1
ratio, stratified by centre and baseline renal function. The study fluid
will be administered upon arrival in intensive care for 15 h. Patients
will be followed up until 28 days after surgery or until discharge from
the hospital. The primary outcome is the proportion of patients who
develop AKI in both groups. Secondary outcomes to be measured are
proportions of AKI stage II and III, 28-day mortality, mechanical
ventilation time and length of stay in intensive care and hospital.
 Conclusion(s): This trial aims to determine if a postoperative
infusion of concentrated albumin reduces the risk of AKI following
high-risk cardiac surgery. Trial registration: Australian New Zealand
Clinical Trials Registry ACTRN12619001355167. Registered on 03 October
2019-retrospectively registered.
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378383.Copyright © 2021, The Author(s).

<50>
Accession Number
2014181974
Title
Frailty Assessment in Heart Failure and Ventricular Assist Device
Populations: A Review from the United States.
Source
Heart and Lung. 50 (6) (pp 941-952), 2021. Date of Publication: 01 Nov
2021.
Author
Schroeder S.E.; Pozehl B.J.; Alonso W.W.
Institution
(Schroeder) College of Nursing, University of Nebraska Medical Center,
Omaha, Nebraska, 985330 Nebraska Medical Center Omaha, NE USA, 68198-5330;
Division of Mechanical Circulatory Support, Bryan Heart, Lincoln, NE, 1600
South 48th Street, Suite 600, Lincoln, NE 68506, United States
(Pozehl, Alonso) College of Nursing, University of Nebraska Medical
Center, Omaha, Nebraska; 985330 Nebraska Medical Center Omaha, NE
68198-5330, United States
Publisher
Mosby Inc.
Abstract
Importance: Post-operative risk is increased with frail individuals
undergoing cardiac surgery. Yet, there is no consensus for frailty
assessment prior to durable left ventricular assist device (dLVAD)
evaluation. Objective(s): The objectives of this integrative review
were to describe frailty measures, examine psychometrics of measures used,
and identify variables related to frailty in heart failure with reduced
ejection fraction (HFrEF) and dLVAD populations. Design, Setting,
Participants: PubMed, CINAHL, and Embase databases were searched for terms
related to frailty, HFrEF and dLVAD that met inclusion criteria.
 Result(s): Fourteen articles met inclusion criteria. Frailty was
inconsistently defined. The Fried Phenotype Criteria was the most widely
used approach to measurement. Validity was reported in all articles.
Variables related to frailty included readmissions, higher mortality and
increased adverse events. Conclusion(s): There was variability in
frailty definition and frailty measurement across studies. Further
research in HFrEF and dLVAD populations is needed for frailty
evaluation. Copyright © 2021 Elsevier Inc.

<51>
Accession Number
2014169761
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. (no pagination), 2021. Date of
Publication: 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, Germany
(Kohl, Niemann) German Centre for Infection Research (DZIF), Partner Site
Hamburg-Lubeck-Borstel-Riems, Germany
Publisher
Elsevier B.V.
Abstract
Background: With the increasing dimensions of the international cardiac
surgery-associated Mycobacterium chimaera outbreak the hypothesis of a
point source arose. Objective(s): 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. Method(s): Two authors
independently extracted data from included studies. Available genome data
from published studies were subjected to a joint analysis. 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 the 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 data sets, 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%). Conclusion(s): HCD contamination during production seems
plausible as the predominant point source for the global M. chimaera
outbreak. Although HCDs can be contaminated with mixed populations, M.
chimaera strains of the subgroup 1.1 caused most infections. Copyright
© 2021 European Society of Clinical Microbiology and Infectious
Diseases

<52>
Accession Number
635783682
Title
Recommendations for the use of coronary and valve simulators in cardiac
surgical training: a systematic review.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 31 Jul 2021.
Author
Whittaker G.; Salmasi M.Y.; Aydin A.; Magouliotis D.; Raja S.G.;
Asimakopoulos G.; Moorjani N.; Athanasiou T.
Institution
(Whittaker, Salmasi, Athanasiou) Department of Surgery and Cancer,
Imperial College London, London, United Kingdom
(Whittaker) Department of Cardiothoracic Surgery, Manchester University
NHS Foundation Trust, Manchester, United Kingdom
(Aydin) MRC Centre for Transplantation, King's College London, London,
United Kingdom
(Magouliotis) Department of Cardiothoracic Surgery, University of
Thessaly, Greece
(Raja, Asimakopoulos) Department of Cardiothoracic Surgery, Royal Brompton
& Harefield NHS Foundation Trust, London, United Kingdom
(Moorjani) Department of Cardiothoracic Surgery, Royal Papworth Hospital
NHS Foundation Trust, Cambridge, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The aim of this study was to systematically review the
simulators that are currently available for coronary artery bypass graft
and valve surgery and, in addition, to review the validation evidence
supporting them and to recommend several simulators for training based on
the analysis of results. METHOD(S): A systematic literature search of
the MEDLINE (1946 to May 2021) and EMBASE (1947 to May 2021) databases was
performed to identify simulators for coronary artery and valvular
procedures in cardiothoracic surgery. A selection of keywords and MeSH
terms was used to execute the literature search. After identification of
relevant articles, data were extracted and analysed. RESULT(S):
Thirty-seven simulators were found in 31 articles. Simulators were found
for coronary artery bypass graft (n=24) and valve surgery (n=13). The
majority of models were either benchtop (n=28) or hybrid (n=8) modalities.
Evidence of validity was demonstrated in 15 (40.5%) simulators. Twenty-two
(59.5%) simulators had no validation evidence, and 1 (2.7%) simulator had
3 or more elements of validity established. CONCLUSION(S): Two
simulators were recommended for supplemental training in cardiothoracic
surgery. Low-fidelity models can provide a broad foundation for surgical
skills' development whereas high-fidelity simulators can be used for
immersive training scenarios and appraisals. These should be utilized in
early training, at which point the learning curve of trainees is
steepest. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<53>
Accession Number
635782311
Title
Evidence and Challenges in Left Atrial Appendage Management.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2021. Date of Publication: 31 Jul 2021.
Author
Yamamoto T.; Endo D.; Matsushita S.; Shimada A.; Nakanishi K.; Asai T.;
Amano A.
Institution
(Yamamoto, Endo, Matsushita, Shimada, Nakanishi, Asai, Amano) Department
of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
This review aimed to discuss the anatomical properties of the left atrial
appendage (LAA), its relationship with atrial fibrillation (AF),
effectiveness of LAA occlusion (LAAO), techniques, and new devices used to
perform this procedure. An electronic search was performed to identify
studies, in the English language, on LAA management. Searches were
performed on PubMed Central, Scopus, and Medline from the dates of
database inception to February 2020. For the assessed papers, data were
extracted from the reviewed text, tables, and figures, by two independent
authors. Anticoagulant therapy for patients with AF has proven beneficial
and is highly recommended, but it is challenging for many patients to
maintain optimal treatment. Surgery is the most cost-effective option;
surgical methods include simple LAA resection, thoracoscopic surgery, and
catheter treatment. Each procedure has its advantages and disadvantages,
and many prospective studies have been conducted to evaluate various
treatment methods. In managing the LAA, dissection of the LAA, such as
changes in its shape and size due to remodeling during AF, changes in
autonomic nerve function, and thrombosis, must be understood anatomically
and physiologically. We believe that early treatment intervention for the
LAA should be considered particularly in cases of recurrent AF.

<54>
Accession Number
635780253
Title
Sublingual sufentanil in pain management after pulmonary resection: a
randomized prospective study.
Source
The Annals of thoracic surgery. (no pagination), 2021. Date of
Publication: 28 Jul 2021.
Author
Lomangino I.; Berni A.; Lloret Madrid A.; Terzi S.; Melan L.; Cannone G.;
Rebusso A.; Zuin A.; Dell'Amore A.; Rea F.
Institution
(Lomangino, Berni, Lloret Madrid, Terzi, Melan, Cannone, Rebusso, Zuin,
Dell'Amore, Rea) Thoracic Surgery Unit, Department of Cardiac, Thoracic
and Vascular Sciences and Public Health, University of Padova, Via N.
Giustiniani, 2 35121 Padova, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Successful postoperative pain management after major lung
resection surgery is mostly achieved through intravenous administration of
analgesic drugs. This study explored the use of sublingual sufentanil
cartridges (Zalviso) as a noninvasive alternative to post-operative
analgesia. METHOD(S): From July 2019 to April 2020, patients who
underwent major thoracoscopic lung resection surgery were randomly
allocated to receive either intravenous pain management, or patient
controlled analgesia via the Zalviso system. Pain assessment scores were
collected for a 72-h time window, and requests for additional medication
due to insufficient pain control were recorded. RESULT(S): Of the 80
patients enlisted, 40 were assigned to the Zalviso group and 40 to the
control group. The groups were not statistically different from each
other. The difference in the mean pain scores reported was statistically
significant in the first 24-h in favor of the Zalviso group (p=0.046) and
the need of additional pain medication was significantly higher in the
control group (p=0.004). CONCLUSION(S): Patient controlled analgesia
using sublingual sufentanil cartridges can provide an effective pain
relief in patients undergoing video-assisted thoracic surgery and reduce
the need for additional medication, offering a noninvasive alternative to
traditional intravenous therapy. Copyright © 2021. Published by
Elsevier Inc.

<55>
Accession Number
563076055
Title
Prostaglandin E1 increases the blood flow rate of saphenous vein grafts in
patients undergoing off-pump coronary artery bypass grafting.
Source
Journal of cardiothoracic and vascular anesthesia. 27 (6) (pp 1208-1211),
2013. Date of Publication: Dec 2013.
Author
Zhao L.; Lu J.; Wang C.; Zhao W.; Qing E.; Ma J.
Institution
(Zhao) Department of Anesthesiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China.
Abstract
To compare the effects of prostaglandin E1 (PGEl) versus placebo on blood
flow rate in coronary artery bypass grafts. A prospective, randomized,
double-blinded study. A teaching hospital. Forty-six patients with stable
angina scheduled for isolated elective OPCAB were recruited and randomized
into group PGE1 and group placebo. Following randomization, the patients
in the PGE1 group (Group PGE1, n = 23) received a continuous intravenous
infusion of PGEl (10 ng/kg/min) after endotracheal intubation and the
placebo group (Group placebo, n = 23) received the same volume of normal
saline. The infusion administration was removed after leaving the
intensive care unit. The grafts' blood flow rate was measured with a
transit time flowmeter at 10 minutes and 30 minutes after coronary artery
grafting. The hemodynamic parameters, including mean arterial pressure
(MAP), heart rate, and SvO2, VO2I, DO2I, ERO2 monitored by a pulmonary
artery catheter, were recorded. The blood flow of the saphenous vein
grafts was significantly higher in the PGE1 group than the placebo group
at both 10 and 30 minutes after coronary artery grafting. At the 10-minute
mark, the graft flow was 54.9 +/- 31.4 mL/min versus 47.3 +/- 24.6 mL/min
in venous nonsequential grafts to the left coronary artery for group PGE1
and placebo (p = 0.000). Corresponding values at 30 minutes were 60.1 +/-
27.8 mL/min versus 48.4 +/- 26.3 mL/min (p = 0.002). In the venous
non-sequential grafts to the right coronary artery, a tendency of blood
flow also was found to be higher in the PGE1 group than in the placebo
group at 10-minutes (52.7 +/- 29.4 mL/min versus 49.3 +/- 23.8 mL/min, p =
0.048) and the 30-minutes (58.6 +/- 26.5 mL/min, 50.9 +/- 25.9 mL/min, p =
0.037). The blood flow rate of the left internal mammary artery (LIMA)
grafts in group PGE1 was higher than that in the placebo group but did not
reach statistical significance. The VO2I, DO2I, and ERO2 in the 2 groups
at the 2 time points did not reach statistical significance. The cardiac
index (CI) in group PGE1 was higher than that of the placebo group at T3
and T4 (p = 0.035 and p = 0.012, respectively). The lactate (LAC) at the
end of the operation (T2), 4 hours after the operation (T3), and 24 hours
after operation (T4) in the placebo group were higher than that of group
PGE1 (p = 0.023, p = 0.015, and p = 0.043, respectively). The oxygenation
saturation of the mixed venous blood (SvO2) in the 2 groups was decreased
but without significant difference. PGE1 significantly increased the flow
rate in anastomosed saphenous vein grafts, and its beneficial effects on
hemodynamics and oxygen metabolism were observed. Copyright © 2013
Elsevier Inc. All rights reserved.

<56>
Accession Number
563061188
Title
Levosimendan use decreases atrial fibrillation in patients after coronary
artery bypass grafting: a pilot study.
Source
The heart surgery forum. 16 (5) (pp E287-294), 2013. Date of Publication:
Oct 2013.
Author
Dogan O.F.
Abstract
Atrial fibrillation (AF) often occurs after coronary artery bypass
grafting (CABG) and can result in increased morbidity and mortality due to
complications. In the present study, our goal was to investigate whether
the use of levosimendan can reduce the frequency of AF after coronary
artery bypass grafting in patients with poor left ventricle function. To
investigate the effectiveness of levosimendan in the prophylaxis of AF, we
conducted a prospective, randomized, placebo-controlled clinical study on
200 consecutive patients in whom we performed elective CABG operations.
Baseline characteristics were similar in both groups. A control group of
100 patients were treated with placebo (500 mL saline solution), whereas
the levosimendan group (n = 100 patients) was treated with levosimendan.
High-sensitivity C-reactive protein, cardiac troponin, and creatine
kinase-MB levels were measured before surgery and 5 days postoperatively.
AF occurred in 12% of the levosimendan group and 36% of the control group.
The occurrence of AF was significantly lower in the levosimendan group (P
< 0.05). The duration of AF in the levosimendan group was significantly
shorter than that in the control group (4.83 +/- 1.12 and 6.50 +/- 1.55
hours, respectively; P = 0.028). Our research showed that C-reactive
protein was higher postoperatively in the control group than in the
levosimendan group (P < 0.05). The incidence of postoperative AF in the
levosimendan group was reduced significantly in patients with poor left
ventricle function after CABG operations.

<57>
[Use Link to view the full text]
Accession Number
634905156
Title
Protective effect of sevoflurane on vascular endothelial glycocalyx in
patients undergoing heart valve surgery: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 38 (5) (pp 477-486), 2021. Date of
Publication: May 2021.
Author
Fang F.-Q.; Sun J.-H.; Wu Q.-L.; Feng L.-Y.; Fan Y.-X.; Ye J.-X.; Gao W.;
He G.-L.; Wang W.-J.
Institution
(Fang) Zhejiang University School of Medicine, Hangzhou, China
(Sun, Wu, Feng, Fan, Ye, Gao, He, Wang) Hospital of Wenzhou Medical
University, Wenzhou, China
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUNDThe glycocalyx plays an important physiological role and may be
damaged during cardiopulmonary bypass. Sevoflurane can protect the
glycocalyx; however, its relevance in a clinical setting is
unknown.OBJECTIVEGlycocalyx degradation during cardiopulmonary bypass in
patients was investigated. On the basis of the available experimental
data, we hypothesised that sevoflurane-based anaesthesia would confer
additional protection against cardiopulmonary bypass-induced glycocalyx
damage.DESIGNRandomised controlled study.SETTINGClinical study at The
First Affiliated Hospital of Wenzhou Medical University between June 2018
and March 2019.PATIENTSFifty-one patients.INTERVENTIONSAfter intubation
and mechanical ventilation, patients undergoing elective heart valve
surgery were maintained under general anaesthesia with either propofol or
sevoflurane during surgery.MAIN OUTCOME MEASURESGlycocalyx markers (such
as syndecan-1, heparan sulphate and hyaluronan), sheddases responsible for
the degradation of the endothelial glycocalyx (such as matrix
metalloproteinase-9 and cathepsin-B), urine albumin-To-creatinine ratio
and levels of lactic acid and myocardial enzymes were all measured.
Postoperative mechanical ventilation time and length of stay in the
cardiac care unit and hospital were also measured. Morbidity and mortality
after 30 days and 1 year were evaluated.RESULTSThe vascular endothelial
glycocalyx was damaged during cardiopulmonary bypass. The glycocalyx
damage in the sevoflurane group was less extensive than that in the
propofol group. The urine albumin-To-creatinine ratio increased in both
groups but was lower in the sevoflurane group. Enzymes including matrix
metalloproteinase-9 and cathepsin-B were positively correlated with
glycocalyx marker concentrations. After operation, the sevoflurane group
showed lower levels of lactic acid and myocardial enzyme, as well as
shorter duration of postoperative mechanical ventilation than the propofol
group.CONCLUSIONSevoflurane can decrease glycocalyx degradation in
patients undergoing heart valve surgery under cardiopulmonary bypass.TRIAL
REGISTRATIONChinese Clinical Trial Registry, chictr.org.cn, identifier:
ChiCTR1800016367. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<58>
Accession Number
634443865
Title
Five-year outcomes of PFO closure or antiplatelet therapy for cryptogenic
stroke.
Source
New England Journal of Medicine. 384 (10) (no pagination), 2021. Article
Number: 10. Date of Publication: 11 Mar 2021.
Author
Kasner S.E.; Rhodes J.F.; Andersen G.; Iversen H.K.; Nielsen-Kudsk J.E.;
Settergren M.; Sjostrand C.; Roine R.O.; Hildick-Smith D.; Spence J.D.;
Sondergaard L.
Institution
(Kasner) University of Pennsylvania, Philadelphia, PA, United States
(Rhodes) Medical University of South Carolina, Charleston, SC, United
States
(Andersen) Aarhus University, Aarhus, Denmark
(Iversen, Sondergaard) Rigshospitalet, Copenhagen, Denmark
(Nielsen-Kudsk) Aarhus University Hospital, Aarhus, Denmark
(Settergren, Sjostrand) Karolinska Institutet, Stockholm, Sweden
(Roine) Turku University Hospital, Turku, Finland
(Hildick-Smith) Sussex Cardiac Centre, Brighton, United Kingdom
(Spence) Western University, London, ON, Canada
Publisher
Massachussetts Medical Society

<59>
Accession Number
2013136058
Title
Surgical Repair of Postinfarction Ventricular Septal Rupture: Systematic
Review and Meta-Analysis.
Source
Annals of Thoracic Surgery. 112 (1) (pp 326-337), 2021. Date of
Publication: July 2021.
Author
Matteucci M.; Ronco D.; Corazzari C.; Fina D.; Jiritano F.; Meani P.;
Kowalewski M.; Beghi C.; Lorusso R.
Institution
(Matteucci, Ronco, Fina, Jiritano, Meani, Kowalewski, Lorusso) Department
of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht
University Medical Centre, Maastricht, Netherlands
(Matteucci, Ronco, Corazzari, Beghi) Department of Surgical and
Morphological Sciences, Circolo Hospital, University of Insubria, Varese,
Italy
(Jiritano) Department of Cardiac Surgery, University Magna Graecia of
Catanzaro, Catanzaro, Italy
(Kowalewski) Clinical Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
(Kowalewski) Thoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcs, Poland
Publisher
Elsevier Inc.
Abstract
Background: Ventricular septal rupture (VSR) is a rare but
life-threatening complication after acute myocardial infarction. Although
surgical correction is challenging and associated with high mortality, it
remains the treatment of choice. This systematic review and meta-analysis
aimed to evaluate the early outcome of surgical VSR repair.
 Method(s): We searched electronic databases from January 1998 to
February 2020. Studies reporting patients undergoing surgical treatment
for VSR were analyzed. The primary outcome assessed was operative
mortality. Differences were expressed as odds ratios (ORs) with 95%
confidence intervals (CIs) to assess the relationships of predefined
surgical variables and clinical prognosis. Result(s): A total of 6361
adult patients from 41 studies were identified. Operative mortality was
38.2%. Pooled ORs showed increased odds of operative mortality in patients
with preoperative or perioperative intraaortic balloon pump insertion (OR
= 3.48; 95% CI, 3.01-4.02; P <.001), right ventricular dysfunction (OR =
2.85; 95% CI, 1.47-5.52; P =.002), posterior VSR (OR = 1.73; 95% CI,
1.30-2.31; P <.001), and emergency surgery (OR = 3.79; 95% CI, 2.52-5.72;
P <.001). Temporal trend evaluation revealed no difference over time in
the operative mortality rate; it was 34% in both time-related groups
(1971-2000 versus 2001-2018). Conclusion(s): Ventricular septal
rupture repair has a high operative mortality. Patients with preoperative
or perioperative intraaortic balloon pump support, right ventricular
dysfunction at presentation, or posterior defects, and those undergoing
emergent VSR correction have increased odds of operative
mortality. Copyright © 2021 The Society of Thoracic Surgeons

<60>
Accession Number
2013133956
Title
Congenital Anomalies of the Tracheobronchial Tree: A Meta-Analysis and
Clinical Considerations.
Source
Annals of Thoracic Surgery. 112 (1) (pp 315-325), 2021. Date of
Publication: July 2021.
Author
Wong L.M.; Cheruiyot I.; de Oliveira M.H.S.; Keet K.; Tomaszewski K.A.;
Walocha J.A.; Tubbs S.; Henry B.M.
Institution
(Wong) Department of Anesthesiology, The Christ Hospital, Cincinnati, OH,
United States
(Cheruiyot, Tomaszewski, Walocha, Henry) International Evidence-Based
Anatomy Working Group, Krakow, Poland
(Cheruiyot) Department of Human Anatomy, University of Nairobi, Nairobi,
Kenya
(de Oliveira) Department of Statistics, Federal University of Parana,
Curitiba, Brazil
(Keet) Division of Clinical Anatomy, Department of Biomedical Sciences,
Stellenbosch University, Stellenbosch, South Africa
(Tomaszewski) Faculty of Medicine and Health Sciences, Andrzej Frycz
Modrzewski Krakow University, Krakow, Poland
(Walocha) Department of Anatomy, Jagiellonian University Medical College,
Krakow, Poland
(Tubbs) Departments of Neurosurgery and Structural and Cellular Biology,
Tulane University School of Medicine, New Orleans, LA, United States
(Henry) Cardiac Intensive Care Unit, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
Publisher
Elsevier Inc.
Abstract
Background: The aim of this study was to determine the prevalence and
anatomic features of major tracheobronchial anomalies. Method(s):
Major electronic databases were systematically searched to identify
eligible studies. Data were extracted and pooled into a meta-analysis. The
primary outcome was the prevalence of major tracheobronchial anomalies,
specifically tracheal bronchus (TB) and accessory cardiac bronchus (ACB).
Secondary outcomes included the origin and types of TB and ACB.
 Result(s): A total of 27 studies (n = 119,695 patients) were
included. A TB was present in 0.99% (95% confidence interval, 0.67 to
1.37) of patients, and an ACB was present in 0.14% (95% confidence
interval, 0.09 to 0.20). The overall prevalence of TB was higher in
imaging than in operative studies (1.81% vs 0.82%). It was also higher in
pediatric (2.55%) than in adult studies (0.50%). Patients with other
congenital anomalies were 15 times more likely to have a TB (odds ratio
14.89; 95% confidence interval, 7.09 to 31.22). The most common origin of
TBs was from the trachea (81.42%), primarily from the right side (96.43%).
The most common origin of ACBs was from the intermediate bronchus
(74.32%). The ACBs terminated as blind-ending diverticulum in two thirds
of cases. Conclusion(s): Major tracheobronchial anomalies are present
in approximately 1% of the population, although the prevalence is higher
among pediatric patients and patients with accompanying congenital
anomalies. Although rare, major tracheobronchial anomalies can be
associated with significant respiratory morbidities and present challenges
during airway management in surgical and critical care patients.
Establishing a preoperative diagnosis of these variations is essential for
planning and implementing an appropriate airway management strategy to
minimize attendant complications. Copyright © 2021 The Society of
Thoracic Surgeons

<61>
Accession Number
2013115056
Title
Managing the Congenital Heart Disease Patient With Suspected or Confirmed
Necrotizing Enterocolitis.
Source
Current Treatment Options in Pediatrics. 7 (3) (pp 109-118), 2021. Date of
Publication: September 2021.
Author
Kataria-Hale J.; Roddy D.; Vogel A.M.; Heinle J.; Hair A.
Institution
(Kataria-Hale) The Woman's Hospital of Texas, Houston, TX, United States
(Roddy, Vogel, Hair) Department of Pediatrics, Baylor College of Medicine,
Texas Children's Hospital, 6621 Fannin Street WT6104, Houston, TX 77030,
United States
(Roddy) Section of Pediatric Critical Care Medicine, Texas Children's
Hospital, 6621 Fannin Street WT6104, Houston, TX 77030, United States
(Vogel) Division of Pediatric Surgery, Texas Children's Hospital, 6621
Fannin Street WT6104, Houston, TX 77030, United States
(Heinle) Division of Congenital Heart Surgery, Texas Children's Hospital,
6621 Fannin Street WT6104, Houston, TX 77030, United States
(Hair) Section of Neonatology, Texas Children's Hospital, 6621 Fannin
Street WT6104, Houston, TX 77030, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose of review: Necrotizing enterocolitis (NEC) is a devastating
gastrointestinal illness that affects high-risk populations such as those
with congenital heart disease (CHD). A diagnosis of NEC, before and after
cardiac surgery, can have serious and irreversible consequences. Here, we
review perioperative management strategies that could potentially reduce
the incidence of NEC in CHD. Recent findings: The literature is rich in
investigative work regarding NEC in preterm infants; however, these data
are extrapolated to infants with CHD. The pathogenesis of NEC in CHD is
thought to be multifactorial, with splanchnic hypoperfusion being a major
contributor. The data suggest that early enteral feeding with human milk,
the use of probiotics, thoughtful use of red blood cell transfusions, and
near-infrared spectroscopy may be useful tools in the prevention of NEC.
 Summary: NEC is an illness with the potential for high morbidity and
mortality, particularly in CHD. Therefore, prevention of NEC should be the
clinician's focus when caring for these infants. Well-designed studies and
evidence-based guidelines to standardize care in these infants are much
needed to improve the outcome of NEC. Copyright © 2021, The
Author(s), under exclusive licence to Springer Nature Switzerland AG.

<62>
Accession Number
2012941607
Title
Does multivessel revascularization fit all patients with STEMI and
multivessel coronary artery disease? A systematic review and
meta-analysis.
Source
IJC Heart and Vasculature. 35 (no pagination), 2021. Article Number:
100813. Date of Publication: August 2021.
Author
Hu M.-J.; Li X.-S.; Jin C.; Yang Y.-J.
Institution
(Hu, Li, Jin, Yang) State Key Laboratory of Cardiovascular Disease, Fuwai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences & Peking Union Medical College, Beijing 100037, China
Publisher
Elsevier Ireland Ltd
Abstract
Objective: We sought to assess the relative merits of different
revascularization strategies in patients with ST-segment elevation
myocardial infarction (STEMI) and multivessel coronary artery disease
complicated by cardiogenic shock or chronic total occlusion (CTO).
 Background(s): Recent randomized trials and meta-analysis have
suggested that multivessel percutaneous coronary intervention (PCI) is
associated with better outcomes in patients with STEMI and multivessel
coronary artery disease, however, patients complicated by cardiogenic
shock or CTO were excluded. Method(s): Studies that compared
multivessel PCI (immediate or staged) with culprit-only PCI in patients
with STEMI and multivessel coronary artery disease complicated by
cardiogenic shock or CTO were included. Random odd ratio (OR) and 95%
confidence interval (CI) were conducted. Result(s): Sixteen studies
with 8695 patients complicated by cardiogenic shock and eight studies with
2259 patients complicated by CTO were included. In patients complicated by
cardiogenic shock, a strategy of CO-PCI was associated with lower risk for
short-term renal failure (OR: 0.75; 95% CI: 0.61-0.93; I2 =
0.0%), with no significant difference in MACE, all-cause mortality,
re-infarction, revascularization, cardiac death, heart failure, major
bleeding, or stroke compared with an immediate MV-PCI strategy. In
patients complicated by CTO, a strategy of CO-PCI was associated with
higher risk for long-term MACE (OR: 2.06; 95% CI: 1.39-3.06; I2
= 54.0%), all-cause mortality (OR: 2.89; 95% CI: 2.09-4.00; I2
= 0.0%), cardiac death (OR: 3.12; 95% CI: 2.05-4.75; I2 =
16.8%), heart failure (OR: 1.99; 95% CI: 1.22-3.24; I2 = 0.0%),
and stroke (OR: 2.80; 95% CI: 1.04-7.53; I2 = 0.0%) compared
with a staged MV-PCI strategy, without any difference in re-infarction,
revascularization, or major bleeding. Conclusion(s): For patients
with STEMI and multivessel coronary artery disease complicated by
cardiogenic shock, an immediate multivessel PCI was not advocated due to a
higher risk for short-term renal failure, whereas for patients complicated
by CTO, a staged multivessel PCI was advocated due to reduced risks for
long-term MACE, all-cause mortality, cardiac death, heart failure, and
stroke. Copyright © 2021

<63>
Accession Number
2012845928
Title
Does continuous positive airway pressure therapy benefit patients with
coronary artery disease and obstructive sleep apnea? A systematic review
and meta-analysis.
Source
Clinical Cardiology. 44 (8) (pp 1041-1049), 2021. Date of Publication:
August 2021.
Author
Chen Y.; Wen F.; He Z.; Niu W.; Ren C.; Li N.; Wang Q.; Ren Y.; Liang C.
Institution
(Chen, Chen, Wen, He, Niu, Ren, Li, Wang, Ren, Liang) Department of
Cardiology, Shanghai Changzheng Hospital, Navy Medical University,
Shanghai, China
Publisher
John Wiley and Sons Inc
Abstract
The prevalent co-morbidity of coronary artery disease (CAD) and
obstructive sleep apnea (OSA) has attracted great interest. However,
effects of continuous positive airway pressure (CPAP) in patients with OSA
and CAD for cardiovascular outcomes and deaths are still controversial.
Usage of CPAP among patients with CAD and OSA could decrease the risk of
cardiovascular events and death in adults. PubMed, EMBASE, Web of science,
and Cochrane Library were systematically searched. Studies that described
association of CPAP treatment with cardiovascular events in CAD and OSA
patients were included. The main outcome was the major adverse
cardiovascular events (MACE), including all-cause death, cardiovascular
death, myocardial infarction (MI), stroke, and repeat revascularization.
Summary relative risks (risk ratios [RRs]) and 95% confidence intervals
(CIs) of outcomes were pooled and heterogeneity was assessed with the
I2 statistic. Nine studies enrolling 2590 participants with OSA
and CAD were included and extracted data. There was significant
association of CPAP with reduced risk of MACE (RR, 0.73, 95% CI [0.55,
0.96]), particularly among those with AHI less than 30 events/h (RR, 0.43,
95% CI [0.22, 0.84]). Similarly, the same result was found in all-cause
death (RR, 0.66, 95% CI, [0.46, 0.94]) and cardiovascular death (RR,
0.495, 95% CI [0.292, 0.838]). Our data suggested that CPAP usage,
compared to usual care, was associated with reduced risks of
cardiovascular outcomes or death in patients with OSA and CAD,
particularly in the subgroup with AHI less than 30 events/h, which still
needs further studies to confirm. Copyright © 2021 The Authors.
Clinical Cardiology published by Wiley Periodicals LLC.

<64>
Accession Number
2013396068
Title
Citrulline, biomarker of enterocyte functional mass and dietary
supplement. Metabolism, transport, and current evidence for clinical use.
Source
Nutrients. 13 (8) (no pagination), 2021. Article Number: 2794. Date of
Publication: August 2021.
Author
Maric S.; Restin T.; Muff J.L.; Camargo S.M.; Guglielmetti L.C.;
Holland-Cunz S.G.; Crenn P.; Vuille-Dit-bille R.N.
Institution
(Maric, Muff) School of Medicine, University of Basel, Basel 4001,
Switzerland
(Restin, Camargo, Vuille-Dit-bille) Institute of Physiology, University of
Zurich, Zurich 8091, Switzerland
(Restin) Newborn Research Zurich, Department of Neonatology, University
Hospital Zurich and University of Zurich, Zurich 8091, Switzerland
(Guglielmetti) Department of Visceral und Thoracic Surgery, Cantonal
Hospital of Winterthur, Winterthur 8400, Switzerland
(Holland-Cunz, Vuille-Dit-bille) Department of Pediatric Surgery,
University Children's Hospital of Basel, Basel 4001, Switzerland
(Crenn) Hepato-gastroenterology and Nutrition, Hopital Ambroise Pare,
Boulogne Billancourt, APHP-Universite Paris Saclay, Boulogne-Billancourt
92100, France
Publisher
MDPI AG
Abstract
L-Citrulline is a non-essential but still important amino acid that is
released from enterocytes. Because plasma levels are reduced in case of
impaired intestinal function, it has become a biomarker to monitor
intestinal integrity. Moreover, oxidative stress induces protein
citrullination, and antibodies against anti-citrullinated proteins are
useful to monitor rheumatoid diseases. Citrullinated histones, however,
may even predict a worse outcome in cancer patients. Supplementation of
citrulline is better tolerated compared to arginine and might be useful to
slightly improve muscle strength or protein balance. The following article
shall provide an overview of L-citrulline properties and functions, as
well as the current evidence for its use as a biomarker or as a
therapeutic supplement. Copyright © 2021 by the authors. Licensee
MDPI, Basel, Switzerland.

<65>
Accession Number
2013395630
Title
Pediatric cardiothoracic ct guideline provided by the asian society of
cardiovascular imaging congenital heart disease study group: Part 2.
contemporary clinical applications.
Source
Korean Journal of Radiology. 22 (8) (pp 1397-1415), 2021. Date of
Publication: 2021.
Author
Goo H.W.; Siripornpitak S.; Chen S.-J.; Lilyasari O.; Zhong Y.-M.; Latiff
H.A.; Maeda E.; Kim Y.J.; Tsai I.-C.; Seo D.M.
Institution
(Goo) Department of Radiology and Research Institute of Radiology, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, South
Korea
(Siripornpitak) Department of Diagnostic and Therapeutic Radiology,
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand
(Chen) Department of Medical Imaging, National Taiwan University, Medical
College and Hospital, Taipei, Taiwan (Republic of China)
(Lilyasari) Department of Cardiology and Vascular Medicine, Universitas
Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
(Zhong) Diagnostic Imaging Center, Shanghai Children's Medical Center,
Shanghai, China
(Latiff) Pediatric and Congenital Heart Centre, Institut Jantung Negara,
Kuala Lumpur, Malaysia
(Maeda) Department of Radiology, The University of Tokyo, Tokyo, Japan
(Kim) Department of Radiology, Severance Hospital, Yonsei University
College of Medicine, Seoul, South Korea
(Tsai) Congenital Heart Disease Study Group Member of the Asian Society of
Cardiovascular Imaging, Taichung, Taiwan (Republic of China)
(Seo) Department of Cardiothoracic Surgery, Ewha Womans University Seoul
Hospital, Seoul, South Korea
Publisher
Korean Radiological Society
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD)
was traditionally limited to the morphologic evaluation of the
extracardiac thoracic vessels, lungs, and airways. Currently, the
applications of CT have increased, owing to technological advancements in
hardware and software as well as several dose-reduction measures. In the
previously published part 1 of the guideline by the Asian Society of
Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed
the prerequisite technical knowledge for clinical applications in a
user-friendly and vendor-specific manner. Herein, we present the second
part of our guideline on contemporary clinical applications of pediatric
cardiothoracic CT for CHD based on the consensus of experts from the Asian
Society of Cardiovascular Imaging CHD Study Group. This guideline
describes up-to-date clinical applications effectively in a systematic
fashion. Copyright © 2021 The Korean Society of Radiology.

<66>
Accession Number
2013370492
Title
Ultrasound-guided infraclavicular axillary vein cannulation: - Is it a
good alternative to internal jugular vein cannulation in pediatric cardiac
surgery?.
Source
Anestezi Dergisi. 29 (1) (pp 32-39), 2021. Date of Publication: 2021.
Author
Elbaser I.I.A.; Abdelmageed N.A.; El-Morsy M.
Institution
(Elbaser, Abdelmageed, El-Morsy) Department of Anesthesia and Surgical
Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Publisher
Anestezi Dergisi
Abstract
Objective: This study was designed to compare the rates of successful
first attempt and mechanical complications between internal jugular vein
(IJV) and axillary vein (AXV) cannulation. Method(s): This
prospective, randomized, comparative, controlled study included 220
pediatric patients with age range 1 to 12 years scheduled for cardiac
surgery. Patients were allocated into 2 equal groups as IJV and AXV
groups. The rates of successful first, second and third puncture attempts
and the mechanical complications (arterial puncture, pneumothorax,
catheter occlusion, catheter malposition, nerve injury) were investigated.
 Result(s): There was no statistically significant difference
(p=0.053) in the first skin puncture success rates in both groups (AXV
group 80% and IJV group 68%). There were no significant differences
regarding the second and third skin puncture success rates. The incidence
rates of failed vein punctures were similar in IJV (3%) and AXV (2%)
groups. The vein puncture and catheter insertion times and the rates.
Arterial puncture, pneumothorax and catheter malposition were similar in
IJV and AXV groups (12% vs 11%, 4% vs 1%, 3% vs 5% respectively). The
rates of catheter occlusion with sternal retraction were significantly
higher (p=0.029) in AXV than IJV group (6% vs 0%). Postoperative phrenic
(IJV group) or brachial plexus nerve injury (AXV group) was not developed
in any patient. Conclusion(s): Ultrasound-guided cannulation of both
infraclavicular AXV and IJV were similarly associated with high success
rates and low incidence of mechanical complications. © Copyright
Anesthesiology and Reanimation Specialists' Society. This journal
published by Logos Medical Publishing. Licenced by Creative Commons
Attribution 4.0 International (CC)

<67>
Accession Number
2007317674
Title
Aortic annular sizing using novel software in three-dimensional
transesophageal echocardiography for transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Diagnostics. 11 (5) (no pagination), 2021. Article Number: 751. Date of
Publication: 22 Apr 2021.
Author
Mork C.; Wei M.; Jiang W.; Ren J.; Ran H.
Institution
(Mork, Wei, Jiang, Ren, Ran) Department of Ultrasound, The Second
Affiliated Hospital of Chongqing Medical University, Chongqing 400010,
China
(Jiang, Ren, Ran) Chongqing Key Laboratory of Ultrasound Molecular
Imaging, Chongqing 400010, China
Publisher
MDPI AG
Abstract
(1) Background: We performed this study to evaluate the agreement between
novel automated software of three-dimensional transesophageal
echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for
aortic annular measurements of preprocedural transcatheter aor-tic valve
replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and
Cochrane Library (Wiley) databases were systematically searched for
studies that compared 3D-TEE and MDCT as the reference standard for aortic
annular measurement of the following parameters: annular area, annular
perimeter, area derived-diameter, perimeter derived-diameter, maximum and
minimum diameter. Meta-analytic methods were utilized to determine the
pooled correlations and mean differences between 3D-TEE and MDCT.
Heterogeneity and publication bias were also assessed. Meta-regression
analyses were performed based on the potential factors affecting the
correlation of aortic annular area; (3) Results: A total of 889 patients
from 10 studies were included in the meta-analysis. Pooled correlation
coefficients between 3D-TEE and MDCT of annulus area, perimeter, area
derived-diameter, perimeter derived-diameter, maximum and minimum diameter
measurements were strong 0.89 (95% CI: 0.84-0.92), 0.88 (95% CI:
0.83-0.92), 0.87 (95% CI: 0.77-0.93), 0.87 (95% CI: 0.77-0.93), 0.79 (95%
CI: 0.64-0.87), and 0.75 (95% CI: 0.61-0.84) (Overall p < 0.0001),
respectively. Pooled mean differences between 3D-TEE and MDCT of annulus
area, perimeter, area derived-diameter, perimeter derived-diameter,
maximum and minimum diameter measurements were -20.01 mm2 ((95%
CI: -35.37 to -0.64), p = 0.011), -2.31 mm ((95% CI: -3.31 to -1.31), p <
0.0001), -0.22 mm ((95% CI: -0.73 to 0.29), p = 0.40), -0.47 mm ((95% CI:
-1.06 to 0.12), p = 0.12), -1.36 mm ((95% CI: -2.43 to -0.30), p = 0.012),
and 0.31 mm ((95% CI: -0.15 to 0.77), p = 0.18), respectively. There were
no statistically significant associations with the baseline patient
characteristics of sex, age, left ventricular ejection fraction, mean
transaortic gradient, and aortic valve area to the correlation between
3D-TEE and MDCT for aortic annular area sizing; (4) Conclusion(s):
The present study implies that 3D-TEE using novel software tools,
automatically analysis, is feasible to MDCT for annulus sizing in clinical
practice. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<68>
Accession Number
2005419632
Title
Association between surgical risk and 30-day stroke after transcatheter
versus surgical aortic valve replacement: a systematic review and
meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 97 (4) (pp E536-E543),
2021. Date of Publication: March 2021.
Author
Matsuda Y.; Nai Fovino L.; Giacoppo D.; Scotti A.; Massussi M.; Ueshima
D.; Sasano T.; Fabris T.; Tarantini G.
Institution
(Matsuda, Nai Fovino, Giacoppo, Scotti, Massussi, Ueshima, Fabris,
Tarantini) Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padua Medical School, Padua, Italy
(Matsuda, Sasano) Department of Cardiovascular Medicine, Graduate School
of General Medical and Dental Science, Tokyo Medical and Dental
University, Tokyo, Japan
Publisher
John Wiley and Sons Inc
Abstract
Background: Stroke is a feared complication of transcatheter aortic valve
replacement (TAVR) and surgical aortic valve replacement (SAVR).
 Objective(s): With this meta-analysis we aimed to evaluate the
incidence of 30-day stroke with TAVR and SAVR focusing on its possible
correlation with surgical risk. Method(s): Major electronic databases
were searched for studies published between January 2002 and October 2019
reporting the rates of 30-day stroke after TAVR and SAVR. Data were pooled
using fixed- and random-effects models. The primary outcome of the study
was stroke rate within 30-day from TAVR or SAVR. Results were stratified
according to surgical risk score (high, intermediate and low).
 Result(s): A total of 23 studies were identified (TAVR: 14,589
patients; SAVR: 11,681 patients). Regardless of the model used, in the
overall population TAVR was associated with a significant reduction in the
risk of stroke compared with SAVR (fixed effect: OR 0.78, 95% CI
0.66-0.92, p =.003; random-effects: OR 0.80, 95% CI 0.64-1.00, p =.045).
Rates of 30-day stroke after TAVR and SAVR were not significantly
different in the high- (OR 1.01, 95% CI 0.44-1.98, p =.105) and
intermediate-risk groups (OR 0.92, 95% CI 0.63-1.36, p =.319), while
low-risk patients had a lower rate of 30-day stroke after TAVR than SAVR
(OR 0.65, 95% CI 0.50-0.83, p <.001). Meta-regression showed a significant
association between surgical risk score and 30-day stroke rate (p =.007).
 Conclusion(s): TAVR is associated with a lower risk of 30-day stroke
compared with SAVR, mainly as a result of the significant advantage
observed in patients at low surgical risk. Copyright © 2020 Wiley
Periodicals LLC.

<69>
Accession Number
2012052964
Title
Temperature monitoring and temperature-driven irrigated radiofrequency
energy titration do not prevent thermally induced esophageal lesions in
pulmonary vein isolation: A randomized study controlled by esophagoscopy
before and after catheter ablation.
Source
Heart Rhythm. 18 (6) (pp 926-934), 2021. Date of Publication: June 2021.
Author
Grosse Meininghaus D.; Blembel K.; Waniek C.; Kruells-Muench J.; Ernst H.;
Kleemann T.; Geller J.C.
Institution
(Grosse Meininghaus, Blembel, Waniek, Kruells-Muench) Department of
Cardiology, Carl-Thiem-Hospital Cottbus, Germany
(Waniek) Thiem Research, Carl-Thiem-Hospital Cottbus, Germany
(Ernst, Kleemann) Department of Gastroenterology, Carl-Thiem-Hospital
Cottbus, Germany
(Geller) Division of Cardiology, Arrhythmia Section, Zentralklinik Bad
Berka, Germany
(Geller) Otto-von-Guericke University School of Medicine, Magdeburg,
Germany
Publisher
Elsevier B.V.
Abstract
Background: Endoscopically detected esophageal lesions (EDELs) are common
following pulmonary vein isolation (PVI) and may progress to
atrioesophageal fistula (AEF). Objective(s): The purpose of this
study was to study (1) the benefit of luminal esophageal temperature (LET)
monitoring and (2) the impact of esophagogastroduodenoscopy (EGD) in
detecting EDEL and defining pre-existing lesions. The primary endpoint was
the number of ablation-induced lesions. Method(s): Patients with
atrial fibrillation were randomized to PVI with LET monitoring (LET[+]) or
without LET monitoring (LET[-]). All patients underwent EGD before and
after PVI. Ablation power at the left atrial (LA) posterior wall was
limited to 25 W in all patients and was titrated to a minimum of 10 W
guided by esophageal temperature in the LET[+] group. Result(s):
Eighty-six patients (age 67 +/- 10 years; 57% male) were included (44
LET[+], 42 LET[-]). PVI was achieved in all, and additional linear LA
lesions were done in 50%. Eight patients developed EDEL (6 LET[+], 2
LET[-]; P = NS). Whereas LET <41degreeC did not differentiate with regard
to EDEL formation, temperature overshooting >=42degreeC was associated
with a higher risk for new EDEL. Two-thirds of patients showed incidental
findings (esophagitis, gastric ulcer) on preprocedural EGD; 8 esophageal
lesions were pre-existing. Four patients in the LET[+] group developed
epistaxis following insertion of the probe. Conclusion(s): Monitoring
of LET does not prevent ablation-induced esophageal lesions. Patients
without temperature surveillance were not at higher risk, but temperatures
>=42degreeC were associated with increased likelihood of mucosal
lesions. Copyright © 2021 Heart Rhythm Society

<70>
Accession Number
2011859241
Title
Perioperative dexmedetomidine administration to prevent delirium in adults
after non-cardiac surgery: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 73 (no pagination), 2021. Article Number:
110308. Date of Publication: October 2021.
Author
Qin C.; Jiang Y.; Lin C.; Li A.; Liu J.
Institution
(Qin, Jiang, Lin, Li) Department of Anesthesiology, Affiliated Hospital of
Guilin Medical University, Guilin, Guangxi 541001, China
(Qin, Liu) Department of Anesthesiology, The First Affiliated Hospital of
Guangxi Medical University, Nanning, Guangxi 530021, China
Publisher
Elsevier Inc.
Abstract
Study objective: To evaluate the efficacy of perioperative dexmedetomidine
(DEX) administration for preventing delirium in adults after non-cardiac
surgery. Design(s): Systematic review and meta-analysis of randomized
controlled trials (RCTs). Intervention(s): Perioperative
administration of DEX to prevent delirium in adults following non-cardiac
surgery. Measurements: The incidence of postoperative delirium (POD).
 Method(s): The databases of PubMed, Embase and Cochrane Central
Register were searched from inception to Mar 4, 2021 for all available
RCTs that assessed DEX for POD in adults after non-cardiac surgery. Risk
ratio (RR) with a 95% confidence interval (CI) was calculated for
dichotomous data. Standardized mean difference (SMD) was calculated for
continuous data. Risk of bias was assessed using the second version of the
Cochrane risk-of-bias tool for RCTs (RoB 2.0), and the level of certainty
for main outcomes were assessed by the Grading of Recommendations
Assessment, Development, and Evaluation (GRADE) methodology. Main
Result(s): Thirteen studies, including the meta-analysis with a total of
4015 patients (DEX group: 2050 patients; placebo group: 1965 patients),
showed that DEX significantly reduced the incidence of POD in adults after
non-cardiac surgery compared with control group (RR: 0.60; 95%CI: 0.46 to
0.77, P = 0.0001, I2 = 55%, GRADE = moderate). Meanwhile, there
was a statistical difference by the subgroup analysis between the mean age
>= 65 years group and the mean age<65 years group. There were no
statistical differences in length of hospital stay following surgery (SMD:
-0.36; 95%CI: -0.80 to 0.07, P = 0.1, I2 = 97%, GRADE = low)
and all-cause mortality rate (RR:0.57; 95%CI: 0.25 to 1.28, P < 0.17,
I2 = 0%, GRADE = moderate) compared with placebo group.
However, Meta-analysis showed that DEX administration significantly
resulted in intraoperative bradycardia when compared with placebo group
(RR: 1.39; 95%CI: 1.14 to 1.69, P = 0.0009, I2 = 0%, GRADE =
high), and as well as intraoperative hypotension (RR: 1.25; 95%CI: 1.11 to
1.42, P = 0.0004, I2 = 0%, GRADE = high). Conclusion(s):
This systematic review and meta-analysis suggests that perioperative
administration of DEX could significantly reduce the incidence of POD in
patients elder than 65 years following non-cardiac surgery. However, there
was no definite evidence that perioperative DEX could reduce the incidence
of POD in patients younger than 65 years of age after non-cardiac surgery.
In addition, perioperative DEX administration was associated with an
elevated risk of bradycardia and hypotension. Copyright © 2021
Elsevier Inc.

<71>
Accession Number
2011656815
Title
Benefits with drug-coated balloon as compared to a conventional
revascularization strategy for the treatment of coronary and non-coronary
arterial disease: a comprehensive meta-analysis of 45 randomized trials.
Source
Vascular Pharmacology. 138 (no pagination), 2021. Article Number: 106859.
Date of Publication: June 2021.
Author
Verdoia M.; Negro F.; Kedhi E.; Suryapranata H.; Marcolongo M.; De Luca G.
Institution
(Verdoia, Marcolongo) Division of Cardiology, ASL Biella, Italy
(Verdoia, Negro, De Luca) Department of Translational Medicine, Eastern
Piedmont University, Novara, Italy
(Kedhi) Department of Cardiology, Erasmus Hospital, Universite Libre de
Bruxelles, Belgium
(Suryapranata) Department of Cardiology, UMC St Radboud, Nijmegen,
Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Drug-coated balloons (DCB) have shown promising results for
the percutaneous treatment of de novo and restenotic lesions, involving
both the coronary and femoropopliteal district. However, clinical outcomes
data associated with the use of this devices are still unclear, with
potential warnings on increased mortality being raised from initial
studies. We aimed at performing an updated and comprehensive meta-analysis
comparing DCB with conventional percutaneous revascularization strategies
for the treatment of coronary (CAD) or peripheral artery disease (PAD).
 Method(s): Literature and main scientific session abstracts were
searched for studies comparing DCB vs a standard percutaneous
revascularization strategy, with or without stenting, for the treatment of
CAD and PAD. The primary efficacy endpoint was mortality. Secondary
endpoints were recurrent acute ischemic events (myocardial infarction or
amputation) or target lesion revascularization (TLR). Result(s): We
included 45 randomized trials, (CAD: 27 studies, PAD: 18 studies) with an
overall population of 7718 patients, (56.4%) randomized to a DCB strategy.
At a mean follow-up of19.3 +/- 15.2 months, death occurred in 5.8% of the
patients, with no significant difference between DCB or conventionally
treated patients (5.9% vs 5.7%, OR[95%CI] = 0.89[0.71,1.11], p = 0.31;
phet = 0.43). We observed a non-significant reduction in recurrent acute
ischemic events, whereas the use of DCB significantly reduced the rate of
TLR, with larger benefits observed in patients with PAD and respect to
balloon-only angioplasty, while being lower in comparison with stent
implantation. No significant interaction was observed with de novo lesions
or in-stent restenosis. Conclusion(s): Based on the current
meta-analysis, the use of drug-coated balloons for the percutaneous
treatment of CAD and PAD is associated to a comparable risk of mortality
and recurrent acute ischemic events as compared to a conventional
revascularization strategy, although offering larger benefits in terms of
TLR, especially when compared with balloon-only angioplasty and in
femoropopliteal disease. Copyright © 2021

<72>
Accession Number
2010746302
Title
Clinical Implications of the ISCHEMIA Trial: Invasive vs Conservative
Approach in Stable Coronary Disease.
Source
Current Cardiology Reports. 23 (5) (no pagination), 2021. Article Number:
43. Date of Publication: May 2021.
Author
Choudhary J.; Chiu S.; Bhugra P.; Bikdeli B.; Supariwala A.; Jauhar R.;
Chatterjee S.
Institution
(Choudhary) Frank H. Netter, MD School of Medicine, Quinnipiac University,
North Haven, CT, United States
(Chiu) Department of Internal Medicine, Kaiser Permanente Los Angeles
Medical Center, Los Angeles, CA, United States
(Bhugra) Department of Internal Medicine, Houston Methodist Hospital,
Houston, TX, United States
(Bikdeli) Cardiovascular Medicine Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Bikdeli) Yale/YNHH Center for Outcomes Research & Evaluation, New Haven,
CT, United States
(Bikdeli) Cardiovascular Research Foundation (CRF), New York, NY, United
States
(Supariwala) South Shore University Hospital, Northwell Health, Zucker
School of Medicine, New York, NY, United States
(Jauhar) Sandra Atlas Bass Heart Hospital, Manhasset, NY 11030, United
States
(Jauhar) North Shore University Hospita, Manhasset, NY 11030, United
States
(Jauhar) Hofstra Northwell School of Medicine, Hempstead, NY 11549, United
States
(Chatterjee) Division of Cardiovascular Medicine, Long Island Jewish
Medical Center, Northwell Health, Zucker School of Medicine, 270-05 76th
Street, New Hyde Park, New York, NY, United States
Publisher
Springer
Abstract
Purpose of Review: To identify key strengths and weaknesses of the
International Study of Comparative Health Effectiveness with Medical and
Invasive Approaches (ISCHEMIA) trial and explore its clinical implications
in patients with stable ischemic heart disease. Recent Findings: Previous
studies have shown inconsistent benefit of early angiography and
revascularization in patients with stable ischemic heart disease. The
ISCHEMIA trial showed no significant reduction in mortality or
cardiovascular outcomes in patients undergoing early angiography and
revascularization with guideline-directed medical therapy compared to
patients on medical therapy alone in specific patient population with
stable coronary artery disease. Summary: The ISCHEMIA trial provides
insights into invasive versus pharmacological treatment for patients with
stable ischemic heart disease. Though it may have reduced applicability
given its broad exclusion criteria, it offers useful information about the
utility of non-invasive imaging modalities for selecting optimal
revascularization candidates. Copyright © 2021, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC part of
Springer Nature.

<73>
Accession Number
2010277195
Title
Multivariable risk scores for predicting short-term outcomes for emergency
department patients with unexplained syncope: A systematic review.
Source
Academic Emergency Medicine. 28 (5) (pp 502-510), 2021. Date of
Publication: May 2021.
Author
Sweanor R.A.L.; Redelmeier R.J.; Simel D.L.; Albassam O.T.; Shadowitz S.;
Etchells E.E.
Institution
(Sweanor, Redelmeier, Albassam, Shadowitz, Etchells) Department of
Medicine, University of Toronto, Toronto, ON, Canada
(Redelmeier, Albassam, Shadowitz, Etchells) Department of Medicine
Sunnybrook Health Science Centre, University of Toronto, Toronto, ON,
Canada
(Albassam) Division of Cardiology, King Abdulaziz University Hospital,
King Abdulaziz University, Jeddah, Saudi Arabia
(Simel) Division of General Internal Medicine, Duke Veterans Affairs
Medical Center, Durham, NC, United States
(Simel) Duke University, Durham, NC, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Emergency department (ED) patients with unexplained syncope
are at risk of experiencing an adverse event within 30 days. Our objective
was to systematically review the accuracy of multivariate risk
stratification scores for identifying adult syncope patients at high and
low risk of an adverse event over the next 30 days. Method(s): We
conducted a systematic review of electronic databases (MEDLINE, Cochrane,
Embase, and CINAHL) from database creation until May 2020. We sought
studies evaluating prediction scores of adults presenting to an ED with
syncope. We included studies that followed patients for up to 30 days to
identify adverse events such as death, myocardial infarction, stroke, or
cardiac surgery. We only included studies with a blinded comparison
between baseline clinical features and adverse events. We calculated
likelihood ratios and confidence intervals (CIs). Result(s): We
screened 13,788 abstracts. We included 17 studies evaluating nine risk
stratification scores on 24,234 patient visits, where 7.5% (95% CI = 5.3%
to 10%) experienced an adverse event. A Canadian Syncope Risk Score (CSRS)
of 4 or more was associated with a high likelihood of an adverse event
(LR<inf>score>=4</inf> = 11, 95% CI = 8.9 to 14). A CSRS of 0 or less
(LR<inf>score<=0</inf> = 0.10, 95% CI = 0.07 to 0.20) was associated with
a low likelihood of an adverse event. Other risk scores were not validated
on an independent sample, had low positive likelihood ratios for
identifying patients at high risk, or had high negative likelihood ratios
for identifying patients at low risk. Conclusion(s): Many risk
stratification scores are not validated or not sufficiently accurate for
clinical use. The CSRS is an accurate validated prediction score for ED
patients with unexplained syncope. Its impact on clinical decision making,
admission rates, cost, or outcomes of care is not known. Copyright
© 2021 by the Society for Academic Emergency Medicine

<74>
Accession Number
2008474427
Title
Longitudinal Neointimal Distribution Pattern After Everolimus-Eluting
Stent Implantation: Insights From Optical Coherence Tomography Study.
Source
Cardiovascular Revascularization Medicine. 26 (pp 17-23), 2021. Date of
Publication: May 2021.
Author
Curio J.; Hioki H.; Brugaletta S.; Gomez-Lara J.; Romaguera R.; Cequier
A.; Herrera R.; Jimenez-Quevedo P.; Otsuki S.; Masotti M.; Sabate M.
Institution
(Curio, Hioki, Brugaletta, Masotti, Sabate) Interventional Cardiology
Department, Cardiovascular Institute, Hospital Clinic, Institut
d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona,
Spain
(Curio) Charite University Medical Care, Campus Benjamin Franklin,
Department of Cardiology, Berlin, Germany
(Hioki, Otsuki) Division of Cardiology, Department of Internal Medicine,
Teikyo University Hospital, Tokyo, Japan
(Gomez-Lara, Romaguera, Cequier) Heart Disease Institute, Hospital de
Bellvitge, Institut d'Investigacio Biomedica de Bellvitge (IDIBELL),
University of Barcelona, Barcelona, Spain
(Herrera, Jimenez-Quevedo) Interventional Cardiology Department, Hospital
Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos
(IdISSC), Madrid, Spain
Publisher
Elsevier Inc.
Abstract
Background/purpose: Everolimus-eluting stents (EES) are established as
latest generation drug eluting stents. However, optical coherence
tomography (OCT) assessment of neointimal distribution after EES
implantation is lacking. We aimed to assess the longitudinal neointimal
distribution pattern after EES implantation using OCT. Method(s):
Data from 3 prospective studies (HEAL-EES, REVER and RESERVOIR), including
patients with EES implantation and OCT follow-up study, were merged.
Analyzed stents were divided into 3 segments of equal length (distal,
medial, proximal). Longitudinal neointimal distribution patterns were
compared between the 3 segments using generalized estimating equation.
Neointimal thickness (NIT), neointimal area obstruction, and uncovered or
malapposed struts were analyzed. Result(s): In total, 86 patients (92
lesions) were analyzed. Time of OCT follow-up was 9.0 +/- 1.5 months. NIT
was 101.7 +/- 65.4 mum and neointimal obstruction area was 12.2 +/- 7.6%.
The number of assessed struts was the same in all three segments. NIT
tended to be higher at the medial segment (108.8 +/- 71.1 mum) compared to
distal (103.0 +/- 63.4 mum) and proximal (93.3 +/- 61.1 mum) (p = 0.076).
Neointimal area obstruction was significantly different between the 3
segments (12.4 +/- 7.5% [distal], 13.1 +/- 7.7% [medial], 11.1 +/- 7.5%
[proximal]; p = 0.037). In the proximal segment, there was a significantly
higher frequency of uncovered struts compared to medial and distal
segments (3.9% vs. 2.1% vs. 2.5%, p = 0.009). The distribution of
malapposed struts was not significantly different. Conclusion(s):
Distribution of neointimal hyperplasia seems to be different between stent
segments, being higher in the medial segment as compared to proximal and
distal. Whether this may reflect a response to local pre-interventional
plaque burden centrally covered by the stent should be confirmed in a
future study. Manuscript summary: As optical coherence tomography based
assessment of neointimal distribution after everolimus-eluting stent
implantation is lacking, we analyzed data of 86 patients (92 lesions) from
3 prospective trials to evaluate neointimal distribution in distal, medial
and proximal stent segments. Neointimal hyperplasia seemed to be different
between the three segments, with a higher burden in the medial stent
segment. Whether this reflects a response to local pre-interventional
plaque burden centrally covered by the stent should be confirmed in a
future study. Copyright © 2020 Elsevier Inc.

<75>
Accession Number
2007555898
Title
The risk of post-polypectomy bleeding among patients receiving
antithrombotic agents: A prospective observational study.
Source
Sao Paulo Medical Journal. 139 (3) (pp 218-225), 2021. Date of
Publication: 2021.
Author
Bozkurt H.; Sert O.Z.; Olmez T.; Keklikkiran Z.Z.; Uzun O.; Gulmez S.;
Polat E.; Duman M.
Institution
(Bozkurt) University of Health Sciences, Haseki Research and Education
Hospital, Istanbul, Turkey
(Sert) University of Health Sciences, Haydarpasa Research and Education
Hospital, Istanbul, Turkey
(Olmez, Keklikkiran, Uzun, Gulmez, Polat, Duman) University of Health
Sciences, Kosuyolu Research and Education Hospital, Istanbul, Turkey
Publisher
Associacao Paulista de Medicina
Abstract
BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society
updated their guidelines for gastroenterological endoscopy in patients
receiving antithrombotic therapy. Colonoscopic polypecto-my procedures are
associated with a high risk of bleeding. OBJECTIVE(S): The present
study evaluated the safety of colonoscopic polypectomy procedures in terms
of bleeding, among patients receiving antithrombotic therapy. DESIGN AND
SETTING: Prospective observational study conducted in a tertiary-level
public cardiovascular hospital in Istanbul, Turkey. METHOD(S):
Colonoscopic polypectomies carried out in a single endoscopy unit between
July 2018 and July 2019 were evaluated prospectively. The patients' data,
including age, gender, comorbidities, whether antithrombotic drug use was
ceased or whether patients were switched to bridging therapy, polyp size,
polyp type, polyp location, histopathology, resection methods (hot snare,
cold snare or forceps) and complications relating to the procedures were
recorded. RESULT(S): The study was completed with 94 patients who
underwent a total of 167 polypectomy proce-dures. As per the advice of the
physicians who prescribed antithrombotic medications, 108 polypecto-my
procedures were performed on 60 patients without discontinuing medication
and 59 polypectomy procedures were performed on 34 patients after
discontinuing medication. The age, gender distribution and rate of
bleeding did not differ significantly between the patients whose
medication was discontin-ued and those whose medication was continued (P >
0.05). CONCLUSION(S): This study found that the colonoscopic
polypectomy procedure without discontinuation of antithrombotic medication
did not increase the risk of bleeding. This procedure can be safely
performed by experienced endoscopists in patients with an international
normalized ratio (INR) below 2.5. Copyright © 2021, Associacao
Paulista de Medicina. All rights reserved.

<76>
Accession Number
2007514307
Title
To assess the effectiveness of video-assisted teaching on knowledge
regarding lifestyle modifications and drug regimen in postoperative
coronary artery bypass graft (Cabg) patients attending opd.
Source
Indian Journal of Forensic Medicine and Toxicology. 15 (2) (pp 801-808),
2021. Date of Publication: April-June 2021.
Author
Pohekar S.; Singh S.; Gujar S.
Institution
(Pohekar, Singh, Gujar) Medical-Surgical Nursing Department, Data Meghe
Institute of Medical Sciences Deemed to be University, Smt.RadhikabaiMeghe
Memorial College of Nursing, Sawangi(Meghe),Wardha, India
Publisher
Institute of Medico-Legal Publications
Abstract
Background:In patients suffering from coronary heart disease ( CHD) after
coronary artery bypass grafting (CABG), non-adherence to dietary
guidelines, exercise, and prescription medication regimens is a major
health care concern worldwide. Aim of the Study:To assess the
effectiveness of video-assisted teaching on adherence to lifestyle
modifications and drug regimen among postoperative coronary artery bypass
graft (CABG) patients attending the outpatient department.
 Objective(s):1. Assess the knowledge regarding lifestyle
modifications and drugregimen among post-operative CABG patients attending
OPD.2. Evaluate the effectiveness of video-assisted teaching on knowledge
regarding lifestyle modifications and drugregimen among post-operative
CABG patients attending cardiac and medicine OPD.3. Associate post-test
knowledge score with selected demographic variables of CABG patients.
 Material(s) and Method(s): A hospital-based interventional study was
used one group pre-test and post-test study design with a Quantitative
research approach. This study was conducted among 100postoperative
CABGattending outpatient departments of the age group from 55 years to 70
and above in Wardha city of Maharashtra state. The demographic data such
asage, sex, educational status, monthly income, dietary pattern and
duration after CABGalong with 30 knowledge questionnaire regarding
lifestyle modifications and drugregimen in postoperativecoronary artery
bypass graftwas obtained using a structured pre-tested questionnaire.Data
collected were entered into the Microsoft Excel sheet. The statistical
analysis was done using SPSS software. Frequencies and percentages were
presented for categorical variables. Result(s): The pre-test findings
show that 0-20%had a poor level of knowledge,21-40%had average
knowledge,41-60% had good knowledge,61-80 % had very good knowledge.
Aftervideo-assistedteaching the post-test scorewas26-50%had average
knowledge,51-75% had good knowledgeand76-100 %had very good knowledge,
thus it shows that after post-test the knowledge score was increased,
applied to find the efficacy of video-assisted teaching't' test was
applied and't' value was calculated, The post-test score was considerably
higher at 0.05 level than that of pretest score. Hence it indicates that
video-assistedefficient teaching. Conclusion(s):In general, knowledge
of lifestyle changes and drug regimen in post-operative patients (CABG)
has been average in the pretest and after video-assisted knowledge of
adherence to drug regimen and regulation of lifestyle factors like high
fat, high cholesterol diet, obesity, smoking and lack of regular exercise
has been increased and understanding of the disease dimension has
therefore been generated. Copyright © 2021, Institute of
Medico-Legal Publications. All rights reserved.

<77>
[Use Link to view the full text]
Accession Number
634905247
Title
Postoperative pain therapy with hydromorphone; comparison of
patient-controlled analgesia with target-controlled infusion and standard
patient-controlled analgesia: A randomised controlled trial.
Source
European Journal of Anaesthesiology. 37 (12) (pp 1168-1175), 2020. Date of
Publication: December 2020.
Author
Wehrfritz A.; Ihmsen H.; Fuchte T.; Kim M.; Kremer S.; Weiss A.; Schuttler
J.; Jeleazcov C.
Institution
(Wehrfritz, Ihmsen, Fuchte, Kim, Kremer, Weis, Schuttler, Jeleazcov)
Department of Anaesthesiology, University Hospital Erlangen,
Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Erlangen, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND The challenge of managing acute postoperative pain is the well
tolerated and effective administration of analgesics with a minimum of
side effects. The standard therapeutic approach is patient-controlled
analgesia (PCA) with systemic opioids. To overcome problems of oscillating
opioid concentrations, we studied patient-controlled analgesia by
target-controlled infusion (TCI-PCA) as an alternative. OBJECTIVE To
compare efficacy, safety and side effects of standard PCA with TCI-PCA for
postoperative pain therapy with hydromorphone. DESIGN Single-blinded,
randomised trial. SETTING University Hospital, Germany from December 2013
to April 2015. PARTICIPANTS Fifty adults undergoing cardiac surgery.
INTERVENTIONS Postoperative pain therapy on the ICU was managed with
intravenous (i.v.) hydromorphone and patients randomised to TCI-PCA with
target plasma concentrations between 0.8 and 10 ng ml-1, or PCA
with bolus doses of 0.2 mg. Pain was regularly assessed using the 11-point
numerical rating scale (NRS). Blood pressure, heart rate, oxygen
saturation and cardiac output were continuously monitored, and adverse
events were registered throughout the study. MAIN OUTCOME MEASURES NRS
pain ratings, hydromorphone doses, haemodynamic effects and side effects.
RESULTS NRS pain ratings, total doses of hydromorphone and haemodynamic
data did not differ significantly between TCI-PCA and PCA. The number of
bolus doses during PCA was significantly higher than the number of target
increases during TCI-PCA (P = 0.006). The number of negative requests was
also significantly higher during PCA than during TCI-PCA (P = 0.02). The
respiratory rate on the first postoperative morning was 25 +/- 6
min-1 during TCI-PCA, compared with 19 +/- 4 min-1
during PCA (P = 0.022). Nausea occurred in 30% after TCI-PCA and 24% after
PCA (P = 0.46). CONCLUSION TCI-PCA was effective and well tolerated in
acute postoperative pain management after cardiac surgery. Further studies
are needed to evaluate this approach in clinical practice. Copyright
© 2020 European Society of Anaesthesiology and Intensive Care.
Unauthorized reproduction of this article is prohibited.

<78>
Accession Number
2013320320
Title
Cost-Consequence Analysis of Using Cangrelor in High Angiographic Risk
Percutaneous Coronary Intervention Patients: A US Hospital Perspective.
Source
American Journal of Cardiovascular Drugs. (no pagination), 2021. Date of
Publication: 2021.
Author
Jensen I.S.; Wu E.; Cyr P.L.; Claussen M.; Winkler T.; Salahuddin K.;
Prats J.; Mahaffey K.W.; Gibson C.M.; Steg P.G.; Stone G.W.; Bhatt D.L.
Institution
(Jensen, Wu, Cyr) Precision Health Economics, 133 Federal Street, 10th
floor, Boston, MA 02110, United States
(Cyr) University of North Carolina at Charlotte, College of Health and
Human Services, Charlotte, NC, United States
(Claussen, Winkler, Salahuddin) Chiesi, Inc., Cary, NC, United States
(Prats) Elysis, CarlisleMAUnited States
(Mahaffey) Department of Medicine, Stanford Center for Clinical Research,
Stanford, CA, United States
(Gibson) Division of Cardiology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Steg) Universite de Paris, Assistance Publique-Hopitaux de Paris, Hopital
Bichat, INSERM U-1148, Paris, France
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, and the Cardiovascular Research
Foundation, New York, NY, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, and
Harvard Medical School, Boston, MA, United States
Publisher
Adis
Abstract
Objectives: The objective of this study was to evaluate a US hospital's
cost implications and outcomes of cangrelor use in percutaneous coronary
intervention (PCI) patients with two or more angiographic high-risk
features (HRFs), including avoidance of oral P2Y<inf>12</inf> inhibitor
pretreatment in patients requiring cardiac surgery. Intravenous cangrelor
provides direct, immediate onset and rapid-offset P2Y<inf>12</inf>
inhibition, which may reduce the necessity for oral P2Y<inf>12</inf>
pretreatment. Method(s): A decision analytic model was developed,
estimating the annual impact over 3 years of cangrelor availability.
Ischemic and bleeding events (48 h) from randomized clinical trial data
were extrapolated to 30 days. Event costs were from the CHAMPION PHOENIX
Economics substudy. Rates of coronary artery disease (CAD) presentation,
PCI, oral P2Y<inf>12</inf> pretreatment, and inpatient hospitalization
costs were from published literature and clinical experts. Scenario
analyses evaluated the impact of cangrelor availability on potential
reduced P2Y<inf>12</inf> pretreatment rates by 50-100%. Drug costs were
2019 wholesale acquisition costs and, where necessary, all costs were
adjusted to 2019 dollars. Result(s): In a hospital treating 1000 CAD
PCI inpatients annually, increasing cangrelor use from 11 to 32% resulted
in a reduction in 48-h ischemic events/year by 5.7%, while bleeding events
increased by 2.9%. Total costs of $1,135,472 declined 12.8%, with a 50%
reduction in P2Y<inf>12</inf> pretreatment or 30% with no pretreatment.
Savings were driven by a decrease in ischemic events, decrease in
glycoprotein IIb/IIIa inhibitor use, and less need for and shorter oral
P2Y<inf>12</inf> inhibitor washout period for surgery patients.
 Conclusion(s): Use of cangrelor in patients with two or more
angiographic HRFs may improve outcomes and lower hospital budgets, mainly
from avoiding surgery delays necessitated by oral P2Y<inf>12</inf>
inhibitor pretreatment. Copyright © 2021, The Author(s).

<79>
Accession Number
2012934959
Title
The Impact of Transfusions on Mortality After Transcatheter or Surgical
Aortic Valve Replacement.
Source
Annals of Thoracic Surgery. 112 (3) (pp 778-785), 2021. Date of
Publication: September 2021.
Author
Mumtaz M.; Wyler von Ballmoos M.C.; Deeb G.M.; Popma J.J.; Van Mieghem
N.M.; Kleiman N.S.; Gleason T.G.; Chawla A.; Hockmuth D.; Zorn G.L.;
Tadros P.; Li S.; Reardon M.J.
Institution
(Mumtaz) Department of Cardiovascular and Thoracic Surgery, University of
Pittsburgh Medical Center, Pinnacle Heath, Harrisburg, PA, United States
(Wyler von Ballmoos, Kleiman, Reardon) Department of Cardiothoracic
Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX,
United States
(Deeb) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, MI, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Gleason) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Chawla, Hockmuth) Iowa Heart Center, Des Moines, IA, United States
(Zorn, Tadros) University of Kansas Medical Center, Kansas City, KS,
United States
(Li) Department of Statistics, Medtronic, Mounds View, MN, United States
Publisher
Elsevier Inc.
Abstract
Background: An increasing body of evidence suggests that packed red blood
cell (PRBC) transfusion may be associated with increased morbidity and
mortality after transcatheter and surgical aortic valve replacement. It
remains unclear whether PRBC transfusion is a surrogate marker or truly an
independent risk factor for mortality after aortic valve replacement in
different populations. Method(s): The Surgical Replacement and
Transcatheter Aortic Valve Implantation (SURTAVI) trial randomized 1660
patients with symptomatic, severe aortic stenosis at intermediate risk for
operative death to transcatheter aortic valve replacement or surgical
aortic valve replacement. Baseline characteristics and outcomes including
all-cause and cardiovascular mortality at 30 days and thereafter were
compared between participants with and participants without PRBC
transfusion. Cox proportional hazards models with time-varying covariates
were fitted to estimate the effect of PRBC transfusion on mortality after
adjustment for comorbidities and procedural complications. Result(s):
Patients receiving PRBC were older, more commonly female and frail, with
more comorbidities. The Society of Thoracic Surgeons Predicted Risk of
Mortality baseline score was higher in the transfused group. After
adjustment for these differences, PRBC transfusion was associated with
mortality at 30 days, but not thereafter. The effect of PRBC on mortality
(hazard ratio 1.04; 95% confidence interval, 0.96 to 1.11; P = .304) at 30
days was not independent of procedural complications (hazard ratio 21.04;
95% CI, 7.26 to 60.95; P < .001). Conclusion(s): Poor health status,
procedural complications, PRBC transfusion, and mortality are correlated
with each other. Transfusion of PRBC did not independently increase risk
for mortality. In this intermediate-risk population, transfusion appears
to be a risk marker of chronic conditions and periprocedural complications
as opposed to a risk factor for postprocedural mortality. (Clinical trial
registration: www.clinicaltrials.gov NCT01586910.) Copyright ©
2021 The Society of Thoracic Surgeons

<80>
Accession Number
2012858898
Title
Novel autologous, high concentrated fibrin as advanced hemostatic agent
for coronary surgery.
Source
Transfusion and Apheresis Science. 60 (4) (no pagination), 2021. Article
Number: 103171. Date of Publication: August 2021.
Author
Micovic S.; Everts P.; Calija B.; Strugarevic E.; Grubor N.; Boricic M.;
Lesanovic J.; Box H.; Abazovic D.
Institution
(Micovic, Calija, Strugarevic, Boricic, Lesanovic) Cardiovascular
Institute Dedinje, Milana Tepica 1, Belgrade 11000, Serbia
(Everts) Gulf Coasts Biologics Inc, 4331 Veronica S Shoemaker Blvd, Fort
Myers, FL 33916, United States
(Grubor) Clinical Centre of Serbia, Pasterova2, Belgrade 11000, Serbia
(Box) St Catherine's Hospital, Michelangelolaan 2, Eindhoven 5623 EJ,
Netherlands
(Abazovic) Emergency Medical Centre of Montenegro, Vaka Durovica bb,
Podgorica 81110, Montenegro
Publisher
Elsevier Ltd
Abstract
Background: Variability in transfusion outcomes and excessive
postoperative bleeding represents a significant problem in cardiac
surgery. The effort to reduce bleeding complications and transfusion
outcomes is desirable. Our study investigated the feasibility of reducing
bleeding complications and transfusion requirements by applying
perioperatively prepared autologous bio-regenerative fibrin sealant.
 Method(s): A prospective, case-control study enrolled 74 patients
undergoing coronary artery bypass grafting by a single surgeon. Patients
in the control group (N = 43), received traditional methods of hemostasis,
while patients in the experimental group (N = 31) were treated
additionally with autologous bio-regenerative fibrin. Result(s):
Patients were well-matched with regard to basic demographic, laboratory
and procedural data. Allogeneic blood transfusion requirement in control
group was 39.5 % (17 of 43 patients), compared to 6.5 % (2 of 31 patients)
in treated group (p < 0,001). The lower infection rate in the experimental
group was also noted. No safety issues were identified during the
preparation and application process. Conclusion(s): Autologous
bio-regenerative fibrin can be safely prepared, with no time consuming,
and was demonstrated to be a useful tool to decrease allogeneic blood
transfusion requirements following elective coronary artery bypass
grafting surgery. A prospective randomized trial is needed to confirm
these findings. Copyright © 2021 Elsevier Ltd

<81>
Accession Number
2008450239
Title
The Effect of Transcatheter Mitral Valve Repair on Short-Term Mortality in
Patients With Chronic Kidney Disease - A Systematic Review and
Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 30 (pp 78-84), 2021. Date of
Publication: September 2021.
Author
Dave P.; Abunassar J.G.; Sayed N.; Sharma S.; Babiolakis C.S.; Bisleri G.;
Abuzeid W.
Institution
(Dave) Department of Internal Medicine, Kingston Health Sciences Centre,
Queen's University, Kingston, ON, Canada
(Abunassar, Abuzeid) Division of Cardiology, Kingston Health Sciences
Centre, Queen's University, Kingston, ON, Canada
(Sayed, Sharma) Department of Medicine, Undergraduate School of Medicine,
Queen's University, Kingston, ON, Canada
(Babiolakis) Department of Medicine, Division of Cardiology, Queen's
University, Kingston, ON, Canada
(Bisleri) Department of Surgery, Division of Cardiac Surgery, Kingston
Health Sciences Centre, Queen's University, Kingston, ON, Canada
Publisher
Elsevier Inc.
Abstract
Transcatheter Mitral Valve Repair (TMVr) offers clinically significant
benefit to select symptomatic patients with severe mitral regurgitation
(MR). We conducted a systematic review and meta-analysis of clinical
trials and observational studies to identify the effect of pre-procedural
Chronic Kidney disease (CKD) on short-term mortality in TMVr. We found CKD
is a predictor of 30-day mortality in patients undergoing TMVr.
Specifically, a GFR < 30 mL/min conveys a significant increase in 30-day
mortality. This is significant for patient selection, prognostication, as
well as identifies an area of need for further research. Summary for
annotated table of contents: A systematic review and meta-analysis looking
at short-term mortality in patients undergoing Transcatheter Mitral Valve
Repair with chronic kidney disease. Findings show severe renal disease is
associated with increased 30-day mortality. Copyright © 2020
Elsevier Inc.

<82>
Accession Number
2014134289
Title
Impact of Lesion Complexity and Stent Characteristics on One-Year Clinical
Outcomes: A Sub-Analysis of the Recre8 Trial.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S18), 2021. Date of Publication: July 2021.
Author
van Hemert N.D.; Rozemeijer R.; Voskuil M.; Stein M.; Frambach P.;
Leenders G.E.H.; Rittersma S.Z.; Kraaijeveld A.O.; van der Harst P.;
Agostoni P.; Stella P.R.
Institution
(van Hemert, Rozemeijer, Voskuil, Leenders, Rittersma, Kraaijeveld, van
der Harst, Stella) UMC, Utrecht, Utrecht, Netherlands
(Stein) Zuyderland Medical Center, Heerlen, Netherlands
(Frambach) National Institute of Cardiac Surgery and Interventional
Cardiology, Luxembourg, Luxembourg
(Agostoni) Hospital Network Antwerp Middelheim, Antwerp, Belgium
Publisher
Elsevier Inc.
Abstract
Background: The presence of a complex lesion anatomy can influence
clinical outcomes after percutaneous coronary interventions (PCI). This
sub-analysis of the ReCre8 trial assessed the impact of lesion complexity
on post-discharge clinical outcomes at 12 months as well as the difference
between a permanent polymer- and polymer-free stent in a population with
complex lesion anatomy. Method(s): Patients with coronary artery
disease requiring PCI with implantation of a drug-eluting stent were
stratified for troponin status and diabetes after which they were
randomized to receive a permanent polymer zotarolimus-eluting stent or a
polymer-free amphilimus-eluting stent. Patients with troponin positive
disease were treated with 12 months of dual antiplatelet therapy (DAPT)
whereas troponin negative patients received one month of DAPT. During
index PCI, all lesions were classified as non-complex (A/B1) or complex
(B2/C) according to the American College of Cardiology/American Heart
Association criteria. The primary endpoint was target-lesion failure (TLF)
- a composite of cardiac death, target-vessel myocardial infarction and
target-lesion revascularization - at 12 months. Result(s): A total of
1491 patients were randomized and treated, of whom 873 (58.6%) patients
underwent complex PCI. Complex patients more frequently presented with an
acute coronary syndrome, multi-vessel disease and a history of myocardial
infarction and coronary artery bypass grafting. TLF occurred in 43 (4.9%)
patients undergoing complex PCI and in 15 (2.4%) patients undergoing
non-complex PCI (p=0.014). There was a higher rate of all net adverse
clinical events, although not statistically significant, in patients
undergoing complex and non-complex PCI: 80 patients (9.2%) vs. 47 patients
(7.7%; p=0.28). Among patients undergoing complex PCI, there was no
difference in the primary endpoint of TLF between the two study stents: 20
patients (4.6%) in the permanent polymer arm and 23 patients (5.3%) in the
polymer-free arm (p=0.64). Conclusion(s): Complex PCI was associated
with an increased risk of TLF after 12months. No differences were observed
between the two study stents in a population with complex lesion
anatomy. Copyright © 2021

<83>
Accession Number
2014133796
Title
Clinical and Procedural Outcomes in TAVR for Bicuspid Versus Tricuspid
Severe Aortic Valve Stenosis.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S44), 2021. Date of Publication: July 2021.
Author
Ansari M.; Garcia D.C.
Institution
(Ansari, Garcia) Texas Tech University Health Science Center, Lubbock, TX,
United States
Publisher
Elsevier Inc.
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) is considered
safe and feasible in high-, intermediate-, and low-risk patients with
severe tri-leaflet aortic valve (TAV) stenosis. Bicuspid aortic valve
(BAV) stenosis treated with TAVR might be challenging given elliptical
anatomical variations. We aimed to evaluate the global experience with a
meta-analysis of all clinical studies comparing BAV to TAV.
 Method(s): PubMed and Cochrane databases were systematically searched
for clinical studies comparing clinical and procedural outcomes of
patients with severe BAV or TAV stenosis who underwent TAVR. Primary
outcomes included >=2 aortic insufficiency (AI) and 30-day mortality.
Secondary outcomes included pacemaker implantation, neurological events,
major bleeding, acute myocardial infarction (AMI), surgical replacement
post-TAVR. We used fixed-effect (I2 < 55%) or random-effects analysis
using the Cochrane Handbook of Systematic Reviews. Result(s): Nine
studies were included and provided a total 50,150 patients (3,932=BAV and
46,218=TAV). First-generation CoreValve was the most commonly used in the
BAV patients. Primary endpoints analysis showed that the BAV group had
more patients with >= 2 AI as compared to the TAV group (12% vs. 8%), but
this was not statistically significant. There was no significant
difference in mortality between the BAV and TAV groups (5.3% vs. 4.2%;
p=0.07). Secondary endpoint analysis showed a trend toward more AMI in the
BAV group (1.4%) in comparison with the TAV group (3.3%). There was no
difference in pacemaker implantation, neurological events, conversion to
open heart surgery, and major bleeding. Conclusion(s): Our analysis
suggested that TAVR in patients with BAV stenosis is clinically safe,
although it might be associated with higher procedural challenges given
the less favorable anatomy. The newer-generation valves might improve
outcomes with these challenges and are currently under
investigation. Copyright © 2021

<84>
Accession Number
2014133735
Title
Clinical Outcome of TAVR Patients With the Use of TriGUARD 3 CE-Approved
Cerebral Embolic Protection Device: Results From the First 50 Consecutive
Cases in a Single Centre.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S38-S39), 2021. Date of Publication: July
2021.
Author
Jimenez-Rodriguez G.M.; Voskuil M.; Kraaijeveld A.; Stella P.R.
Institution
(Jimenez-Rodriguez, Voskuil, Kraaijeveld, Stella) UMC Utrecht, Utrecht,
Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Procedure-related neurological events are still a matter of
concern to discuss when performing transcatheter aortic valve replacement
(TAVR).1 The latest TriGUARD 3 CE-approved device was designed
to facilitate deployment with minimal device interaction and full 3-vessel
cerebral protection. Method(s): From July 28 to December 8, 2020, 50
consecutive subjects undergoing transfemoral (TF)-TAVR were evaluated
using the TriGUARD 3 cerebral embolic protection device. The primary
endpoint was absence of neurological symptoms (stroke or transient
ischemic attack (TIA)) within 72 hours after TAVR. Secondary endpoints
were protection device-related safety outcomes. Result(s): Technical
success, which included complete 3-vessel cerebral coverage throughout the
procedure, was achieved in all cases. The primary in-hospital endpoint was
met in all cases (no clinical stroke/TIA). The secondary safety outcome
was also met (no bleeding, dissection, or other vascular complication).
 Conclusion(s): TriGUARD 3 CE, cerebral protection device during
TF-TAVR is an easy and safe way to prevent cerebral embolic lesions. In
this first consecutive analysis no cases of overt clinical stroke were
detected. References: 1. Giustino G, Mehran R, Veltkamp R, Faggioni M,
Baber U, Dangas GD. Neurological Outcomes With Embolic Protection Devices
in Patients Undergoing Transcatheter Aortic Valve Replacement: A
Systematic Review and Meta-Analysis of Randomized Controlled Trials. JACC
Cardiovasc Interv. 2016;9(20):2124-2133. doi: Copyright © 2021

<85>
Accession Number
2014132621
Title
Comparison of Bioprosthetic Valve Stenosis in Patients Undergoing
Supra-Annular TAVR Versus Surgery: Implications for Late Mortality.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S36-S37), 2021. Date of Publication: July
2021.
Author
Rovin J.D.; Oh J.K.; O'Hair D.; Deeb G.M.; Reardon M.J.; Vora A.; Gada H.;
Grubb K.; Gleason T.G.; Harvey J.; Mahoney P.; Yakubov S.J.; Mumtaz M.;
Rogers T.; Van Mieghem N.M.
Institution
(Rovin) Morton Plant Hospital, Clearwater, FL, United States
(Oh) Mayo Clinic, Rochester, MN, United States
(O'Hair) Boulder Community Health, Boulder, CO, United States
(Deeb) University of Michigan Hospitals, Ann Arbor, MI, United States
(Reardon) Methodist DeBakey Heart and Vascular Center, Houston, TX, United
States
(Vora, Gada, Mumtaz) University of Pittsburgh Medical Center Pinnacle
Health, Harrisburg, PA, United States
(Grubb) Emory University, Atlanta, GA, United States
(Gleason) Brigham and Women's Hospital, Harvard Medical School, Boston,
MA, United States
(Harvey) WellSpan Health, York, PA, United States
(Mahoney) Sentara, Norfolk, VA, United States
(Yakubov) Riverside Methodist - Ohio Health, Columbus, OH, United States
(Rogers) Medstar Heart and Vascular Institute, Washington, DC, United
States
(Van Mieghem) Erasmus Medical Center, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Bioprosthetic valve stenosis (BVS) after aortic valve
replacement (AVR) is defined by standardized echocardiographic criteria,
but these criteria have had uncertain prognostic value in predicting late
mortality after AVR. Method(s): A total of 2228 patients implanted in
the intermediate- and high-risk CoreValve pivotal trials were randomly
assigned to supra-annular transcatheter aortic valve replacement (TAVR) or
surgery and followed for at least 3 years after AVR. BVS was defined on
discharge or at 30 days by mean gradient (MG) >20 mmHg, effective orifice
area (EOA) <=1.2 cm2, indexed EOA (EOAi) <=0.65
cm2/m2, and dimensionless velocity index (DVI)
<=0.3. Kaplan-Meier estimates were calculated for 0-36 month all-cause and
cardiovascular mortality after AVR. Result(s): BVS based on MG, EOA,
EOAi, and DVI was less frequent after supra-annular TAVR (1.6% [19/1191],
4.2% [47/1114], 4.9% [55/1114], 0.6% [7/1151], respectively) than after
surgery (8.9% [92/1037], 17.4% [144/828], 18.1% [150/828], and 3.1%
[30/966], respectively; all p < 0.0001). In patients with supra-annular
TAVR, there was no significant relationship between BVS and late
mortality, likely due to the infrequent occurrence of BVS with
supra-annular TAVR. In contrast, the EOA, EOAi, and DVI were important
predictors of late mortality after surgical AVR, likely due to their more
frequent occurrence after AVR. Conclusion(s): BVS occurs less often
after supra-annular TAVR than after surgical AVR and was not associated
with mortality at 36 months. However, after surgical AVR, these
bioprosthetic valve stenosis indices were associated with late mortality,
likely due to inferior hemodynamics after surgical AVR. [Formula
presented] Copyright © 2021

<86>
Accession Number
2014132605
Title
Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease: A
Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S41), 2021. Date of Publication: July 2021.
Author
Guddeti R.R.; Gill G.S.; Garcia-Garcia H.M.; Alla V.M.
Institution
(Guddeti, Gill, Alla) Creighton University, Omaha, NE, United States
(Garcia-Garcia) MedStar Washington Hospital Center, Washington, DC, United
States
Publisher
Elsevier Inc.
Abstract
Background: Utilization of transcatheter aortic valve replacement (TAVR)
has expanded from high-risk patients to intermediate- and select low-risk
candidates with severe aortic stenosis (AS). TAVR is currently not
indicated for patients with aortic insufficiency, and its outcomes in
mixed aortic valve disease (MAVD) where these lesions coexist are unclear.
 Method(s): A systematic search of PubMed, EMBASE, CINAHL, and
Cochrane databases was performed to identify studies comparing TAVR
outcomes in patients with AS vs. MAVD. Primary outcomes of interest were
all-cause mortality and paravalvular regurgitation (PVR), and secondary
outcomes were major bleeding, vascular complications, device implantation
success, permanent pacemaker, and stroke. For all outcomes, pooled odds
ratios (OR) with their corresponding 95% confidence intervals (CIs) were
calculated using the Der Simonian-Laird random-effects model.
 Result(s): Five observational studies with a total of 4344 patients
(2946 in AS group; 1398 MAVD group) were included in the analysis. There
was no significant difference in all-cause mortality (OR 0.85; 95% CI:
0.61-1.21; p=0.37), however, the MAVD group had higher odds of PVR (OR
1.88; 95% CI: 1.42-2.5; p<0.01). MAVD patients had lower odds of device
implantation success (OR 0.56; 95% CI: 0.35-0.91; p=0.02). Other secondary
outcomes, including major bleeding, vascular complications, stroke, and
need for permanent pacemaker, were statistically similar between the two
groups. Conclusion(s): TAVR in MAVD is associated with increased odds
of paravalvular regurgitation and lower odds of device implantation
success when compared to isolated severe aortic stenosis. These
differences, however, do not translate into a difference in mortality
between the two groups. [Formula presented] Copyright © 2021

<87>
Accession Number
2014132599
Title
Single Versus Dual Antiplatelet Post Transcatheter Aortic Valve
Replacement An Updated Meta-analysis.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S42-S43), 2021. Date of Publication: July
2021.
Author
Khalid M.F.; El Iskandarani M.; Ramu V.; Helton T.
Institution
(Khalid, Ramu, Helton) East Tennessee State University, Johnson City, TN,
United States
(El Iskandarani) St Mary's Regional Medical Center, Lewiston, ME, United
States
Publisher
Elsevier Inc.
Abstract
Background: Perioperative use of dual antiplatelet therapy (DAPT) after
transcatheter aortic valve replacement (TAVR) remains controversial. This
meta-analysis compares the safety and efficacy of single antiplatelet
therapy (SAPT) versus DAPT after TAVR in patients with no indications for
long term anticoagulation. Method(s): Electronic databases were
queried for randomized controlled trials (RCTs) and observational studies
matching the inclusion criteria. The safety endpoints included bleeding
(life-threatening/major) and major vascular complications. The efficacy
outcomes included myocardial infarction (MI), stroke, and short- (<30
days) and long-term all-cause mortality (>30 days). The risk ratio (RR)
with 95% confidence interval (CI) was computed, and p <0.05 was considered
to be a level of significance. Result(s): A total of 4 RCTs and 2
observational studies (n=1417) were included in the final analysis. There
were decreased rates of bleeding (RR: 0.44; CI: 0.31-0.63; p<0.00001) with
aspirin-only therapy. However, there was no difference in MI (RR: 0.73;
CI: 0.28-1.87; p=0.51), stroke (RR: 0.92; CI: 0.55-1.54; p=0.74), major
vascular complications (RR: 0.61; CI: 0.35-1.07; p=0.08), short-term
mortality (RR: 0.82; CI: 0.45-1.49; p=0.51), or long-term mortality (RR:
1.13; CI: 0.73-1.76; p=0.58). Conclusion(s): This analysis showed
lower rates of bleeding with aspirin only compared to dual antiplatelet
among patients who underwent TAVR for aortic stenosis. [Formula
presented] Copyright © 2021

<88>
Accession Number
2014132595
Title
Patients With High Bleeding Risk Undergoing Percutaneous Coronary
Intervention With Drug-Eluting Stent Implantation Treated With Short Dual
Antiplatelet Therapy: A Recre8 Subanalysis.
Source
Cardiovascular Revascularization Medicine. Conference: CRT 2021. Virtual,
Online. 28 (Supplement) (pp S20-S21), 2021. Date of Publication: July
2021.
Author
van Hemert N.D.; Voskuil M.; Rozemeijer R.; Stein M.; Frambach P.;
Leenders G.E.H.; Rittersma S.Z.; Kraaijeveld A.O.; van der Harst P.;
Agostoni P.; Stella P.R.
Institution
(van Hemert, Voskuil, Rozemeijer, Leenders, Rittersma, Kraaijeveld, van
der Harst, Stella) UMC Utrecht, Utrecht, Netherlands
(Stein) Zuyderland Medical Center, Heerlen, Netherlands
(Frambach) National Institute of Cardiac Surgery and Interventional
Cardiology, Luxembourg, Luxembourg
(Agostoni) Hospital Network Antwerp Middelheim, Antwerp, Belgium
Publisher
Elsevier Inc.
Abstract
Background: The pharmacological management of patients with high bleeding
risk (HBR) undergoing percutaneous coronary intervention (PCI) has been
under debate. We aimed to examine the safety of short dual antiplatelet
therapy (DAPT) followed by aspirin monotherapy in HBR patients undergoing
PCI. In order to evaluate these outcomes, we made a division of patients
with and without HBR based on the new definition by the Academic Research
Consortium. Method(s): In the ReCre8 trial, patients undergoing PCI
were stratified for troponin status and diabetes and were randomized to a
permanent polymer zotarolimus-eluting stent or polymer-free
amphilimus-eluting stent. Troponin negative patients were treated with one
month of DAPT after which they continued with aspirin monotherapy. After
one year, target-lesion failure (TLF) and individual ischemic and bleeding
endpoints were assessed. Result(s): A total of 892 patients were
randomized of which 193 (21.6%) were identified as HBR. Compared to
patients without HBR, patients with HBR presented more frequently with
unstable angina, multivessel disease and a history of myocardial
infarction and coronary artery bypass grafting. Procedural characteristics
were similar between groups. At 12 months, TLF was not statistically
significantly different between groups, with a rate of 8.3% in patients
with HBR and 6.4% in patients without HBR (p=0.37). A higher rate of stent
thrombosis was seen in patients with HBR: 2.1% vs 0.6% (p=0.048), leading
to an overall rate of 0.9% in the troponin negative population treated
with one month of DAPT. Clinically relevant bleeding (Bleeding Academic
Research Consortium (BARC) type 2-5) was higher among HBR patients (4.7%
vs. 1.6%; p=0.010). During aspirin monotherapy between 1 and 12 months
this difference decreased: clinically relevant bleeding occurred in 2.1%
of patients with HBR and 0.7% of patients without HBR (p=0.089),
suggesting aspirin monotherapy is relatively safe in this subgroup of
patients. Major bleeding (BARC type 3-5) did not differ between groups
(p=0.19). Conclusion(s): This subanalysis shows that troponin
negative patients with HBR have an increased risk of clinically relevant
bleeding during DAPT, a risk difference that diminishes during aspirin
monotherapy. Copyright © 2021

<89>
Accession Number
2013465791
Title
Developing an intervention to optimise the outcome of cardiac surgery in
people with diabetes: the OCTOPuS pilot study.
Source
Pilot and Feasibility Studies. 7 (1) (no pagination), 2021. Article
Number: 157. Date of Publication: December 2021.
Author
Holt R.I.G.; Barnard-Kelly K.; Dritsakis G.; Thorne K.I.; Cohen L.; Dixon
E.; Patel M.; Newland-Jones P.; Partridge H.; Luthra S.; Ohri S.;
Salhiyyah K.; Picot J.; Niven J.; Cook A.; Velissaris T.; Johnson P.;
Trodden R.; Green M.; Rojkova J.; Sass T.; Stanley J.; Collier A.; Renz
S.; Boxall J.; Northey J.; Stanton L.; Whitehead A.; Dhatariya K.;
Stanisstreet D.; Baig K.; Voysey M.; Drinkwater D.; Lord J.; Shepherd J.
Institution
(Holt) Human Development and Health, Faculty of Medicine, University of
Southampton, Southampton, United Kingdom
(Holt) Southampton National Institute for Health Research Biomedical
Research Centre, University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Barnard-Kelly, Cohen) Barnard Health-Health Psychology Research, Fareham,
United Kingdom
(Barnard-Kelly) Faculty of Health & Social Science, Bournemouth
University, Poole, United Kingdom
(Dritsakis, Thorne, Dixon, Niven, Cook) Clinical Trials Unit, Faculty of
Medicine, University of Southampton, Southampton, United Kingdom
(Patel, Newland-Jones) Diabetes Department, University Hospital
Southampton, Southampton, United Kingdom
(Partridge) Royal Bournemouth and Christchurch Hospitals NHS Foundation
Trust, Bournemouth, United Kingdom
(Luthra, Ohri, Salhiyyah) Division of Cardiac Surgery, Wessex
Cardiothoracic Centre, University Hospital Southampton, Southampton,
United Kingdom
(Salhiyyah) Middle East University, Amman, Jordan
(Picot, Cook) Southampton Health Technology Assessments Centre, University
of Southampton, Southampton, United Kingdom
Publisher
BioMed Central Ltd
Abstract
Background: Cardiothoracic surgical outcomes are poorer in people with
diabetes compared with those without diabetes. There are two important
uncertainties in the management of people with diabetes undergoing major
surgery: (1) how to improve diabetes management in the weeks leading up to
an elective procedure and (2) whether that improved management leads to
improved postoperative outcomes. The aim of this study was to develop and
pilot a specialist diabetes team-led intervention to improve surgical
outcomes in people with diabetes. Design(s): Open pilot feasibility
study Setting: Diabetes and cardiothoracic surgery departments, University
Hospital Southampton NHS Foundation Trust Participants: Seventeen people
with diabetes undergoing cardiothoracic surgery Intervention: Following
two rapid literature reviews, a prototype intervention was developed based
on a previously used nurse-led outpatient intervention and tested.
 Primary Outcome: Feasibility and acceptability of delivering the
intervention Secondary outcomes: Biomedical data were collected at
baseline and prior to surgery. We assessed how the intervention was used.
In depth qualitative interviews with participants and healthcare
professionals were used to explore perceptions and experiences of the
intervention and how it might be improved. Result(s): Thirteen of the
17 people recruited completed the study and underwent cardiothoracic
surgery. All components of the OCTOPuS intervention were used, but not all
parts were used for all participants. Minor changes were made to the
intervention as a result of feedback from the participants and healthcare
professionals. Median (IQR) HbA<inf>1c</inf> was 10 mmol/mol (3, 13) lower
prior to surgery than at baseline. Conclusion(s): This study has
shown that it is possible to develop a clinical pathway to improve
diabetes management prior to admission. The clinical and
cost-effectiveness of this intervention will now be tested in a
multicentre randomised controlled trial in cardiothoracic centres across
the UK. Trial registration: ISRCTN; ISRCTN10170306. Registered 10 May
2018. Copyright © 2021, The Author(s).

<90>
Accession Number
635758699
Title
Evaluation of the Radiomics Method for the Prediction of Atypical
Adenomatous Hyperplasia in Patients With Subcentimeter Pulmonary
Ground-Glass Nodules.
Source
Frontiers in Oncology. 11 (no pagination), 2021. Article Number: 698053.
Date of Publication: 05 Aug 2021.
Author
Wang B.; Hamal P.; Meng X.; Sun K.; Yang Y.; Sun Y.; Sun X.
Institution
(Wang, Sun, Yang, Sun) Department of Radiology, Shanghai Pulmonary
Hospital, Tongji University School of Medicine, Shanghai, China
(Hamal, Meng, Sun) Department of Radiology, Shanghai East Hospital, Tongji
University School of Medicine, Shanghai, China
Publisher
Frontiers Media S.A.
Abstract
Objectives: We aimed to develop a prediction model to distinguish atypical
adenomatous hyperplasia (AAH) from early lung adenocarcinomas in patients
with subcentimeter pulmonary ground-glass nodules (GGNs), which may help
avoid aggressive surgical resection for patients with AAH. Method(s):
Surgically confirmed cases of AAH and lung adenocarcinomas manifesting as
GGNs of less than 1 cm were retrospectively collected. A prediction model
based on radiomics and clinical features identified from a training set of
cases was built to differentiate AAH from lung adenocarcinomas and tested
on a validation set. Result(s): Four hundred and eighty-five eligible
cases were included and randomly assigned to the training (n = 339) or the
validation sets (n = 146). The developed radiomics prediction model showed
good discrimination performance to distinguish AAH from adenocarcinomas in
both the training and the validation sets, with, respectively, 84.1% and
82.2% of accuracy, and AUCs of 0.899 (95% CI: 0.867-0.931) and 0.881 (95%
CI: 0.827-0.936). Conclusion(s): The prediction model based on
radiomics and clinical features can help differentiate AAH from
adenocarcinomas manifesting as subcentimeter GGNs and may prevent
aggressive resection for AAH patients, while reserving this treatment for
adenocarcinomas. © Copyright © 2021 Wang, Hamal, Meng, Sun,
Yang, Sun and Sun.

<91>
Accession Number
2014128994
Title
Automated Fastener vs Hand-tied Knots in Heart Valve Surgery: A Systematic
Review and Meta-analysis.
Source
Annals of Thoracic Surgery. 112 (3) (pp 970-980), 2021. Date of
Publication: September 2021.
Author
Sazzad F.; Ler A.; Kuzemczak M.; Ng S.; Choong A.M.T.L.; Kofidis T.
Institution
(Sazzad, Ler, Choong, Kofidis) Department of Cardiac, Thoracic, and
Vascular Surgery, National University Heart Centre, Singapore
(Sazzad, Choong, Kofidis) Department of Surgery, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
(Sazzad, Ng, Choong, Kofidis) Cardiovascular Research Institute, National
University of Singapore, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Kuzemczak) Division of Emergency Medicine, Department of Medical Rescue,
Poznan University of Medical Sciences, Poznan, Poland
(Kuzemczak) Peter Munk Cardiac Centre, Division of Cardiology, Toronto
General Hospital, University Health Network, Toronto, Canada
Publisher
Elsevier Inc.
Abstract
Background: Although several studies revealed that the Cor-knot automated
fastener (LSI Solutions, Victor, NY) reduces aortic cross-clamp and
cardiopulmonary bypass times, the influence of the device on postoperative
morbidity and mortality still needs to be evaluated. The aim of this study
was to verify the hypothesis that the use of the Cor-knot device for heart
valve surgery reduces aortic cross-clamp and cardiopulmonary bypass times,
and this time saving translates into reduced morbidity and mortality.
 Method(s): Retrospective cohort studies and randomized controlled
trials reporting on the use of the automated fastener vs hand-tied knots
were reviewed. The following end points were compared: aortic cross-clamp
and cardiopulmonary bypass times, postoperative valvular regurgitation,
postoperative ejection fraction, prolonged ventilator support, renal
failure, and mortality. Result(s): Eight studies reporting data on
942 patients were included in the final analysis. The Cor-knot device was
associated with shorter cardiopulmonary bypass (mean difference [MD],
-11.74; 95% confidence interval [CI], -14.54 to -8.93; P < .00001) and
aortic cross-clamp times (MD, -14.36; 95% CI, -19.63 to -9.09; P < .00001)
in minimally invasive heart valve procedures. Overall, lower rates of
postoperative valvular regurgitation (risk ratio [RR], 0.40; 95% CI, 0.26
to 0.62; P < .0001) and prolonged ventilator support (RR, 0.29; 95% CI,
0.13 to 0.65; P = .003) were observed. No difference was observed in
postoperative atrial fibrillation, ejection fraction, renal failure, and
mortality. Conclusion(s): The use of the Cor-knot device in heart
valve surgery reduced aortic cross-clamp and cardiopulmonary bypass times.
Furthermore, as compared with hand-tie methods, the automated fastener may
lead to decreased rates of prolonged ventilator support and valvular
regurgitation while being noninferior in terms of other postoperative
outcomes and mortality. Copyright © 2021 The Society of Thoracic
Surgeons

<92>
Accession Number
2014119996
Title
EVALUATION of DEXMEDETOMIDINE VERSUS PROPOFOL for FAST TRACK ANESTHESIA in
CORONARY OPEN-HEART SURGERY: A COMPARATIVE RANDOMIZED STUDY.
Source
Turkish Journal of Physiotherapy and Rehabilitation. 32 (3) (pp
12705-12711), 2021. Date of Publication: 2021.
Author
Abdelkader H.M.; Eldin H.S.; Mohamed A.K.; Haggag A.M.; Rashed M.M.
Institution
(Abdelkader) Assistantlecturer, misr University for science and
technology, Egypt
(Eldin) Professor of anesthesia, Cairo University, Egypt
(Mohamed) anesthesiaCairo University, Egypt
(Haggag) Ain shams University, Egypt
(Rashed) Ain shamsuniversity, Egypt
Publisher
Turkish Physiotherapy Association
Abstract
Objectives: Our comparative randomized study aims to compare the
intraoperative effectiveness of dexmedetomidine and propofol in fast-track
anesthesia in coronary open-heart surgery. Method(s): We conducted
this study as a randomized controlled prospective investigation at Misr
University Teaching Hospital. The effect on heart rate, postoperative
delirium, mean arterial blood pressure, and BIS spectral index were
assessed among the two groups. Result(s): A total of 40 patients were
included in the present study and randomized into two groups; group I
(dexmedetomidine) (n= 20) and group II (propofol) (n= 20), with a mean age
of 61.21 (10.50), and 61.91 (9.74). Postoperative delirium was
significantly higher in group II than group I (p= 0.042). The mean
arterial blood pressure seemed to be significantly lower in group I than
group II after 10 minutes of drug infusion, on the bypass, after bypass by
15 minutes, and before transferring the patient to the ICU (p< 0.001).
Significantly higher heart rate values were noticed in group II than group
I after induction, after 10 minutes of drug infusion, after bypass by 15
minutes, and before transferring the patient to the ICU (p< 0.001). The
length of ICU stay (p= 0.020) and time of extubation (p< 0.001) were also
significantly longer in group II than group I. Group II showed total
higher mean BIS values after induction, after 10 minutes of drug infusion,
and after bypass by 15 minutes than group I (p< 0.001).
 Conclusion(s): Dexmedetomidine can lower the risk of cardiovascular
complications. Copyright © 2021 Turkish Physiotherapy
Association. All rights reserved.

<93>
Accession Number
2013972352
Title
REVIEW OF PAIN: AN AYURVEDIC APPROACH.
Source
International Research Journal of Pharmacy. 10 (9) (pp 24-34), 2019. Date
of Publication: 2019.
Author
Mahesh S.; Wele A.; Patgiri B.J.; Porszasz R.
Institution
(Mahesh, Patgiri) Department of Rasasastra and Bhaishajya Kalpana,
Institute for Post Graduate Teaching and Research in Ayurveda, Jamnagar,
Gujarat, India
(Wele, Porszasz) Department of Pharmacology, Faculty of Medicine,
University of Debrecen, Hungary
Publisher
International Research Journal of Pharmacy
Abstract
Pain is a serious problem globally due to its high prevalence and is
regarded as the fifth vital sign. The standard methods comprising of NSAID
and opioid group, interventional methods and implantable methods; although
often very effective, have known adverse effects on gastrointestinal,
renal and cardiovascular systems and surgical risks. Ayurvedic pain
management comprises of pharmacological and non-pharmacological
approaches. In this review, we have discussed pain management using herbal
and herbomineral formulations. We began with comparison of Ayurvedic
concept of pain with that of Biomedicine to arrive at concurrence and then
systematically searched the databases PubMed and Scopus using search terms
'pain management, animal models of pain, Ayurveda and herbal medicine'.
Out of 160 initial papers, 16 studies involving a total of 1591
participants befitting inclusion criteria were analyzed for the type of
pain, intervention, outcome measures and results and others were rejected.
PRISMA is followed to report the findings. Studies on Ayurvedic medicines
were conducted in three different countries. Eight of them were RCT's with
five multi-centered studies. Three single herbs, six polyherbal
formulation, one herbomineral formulation and various external therapies
were identified. The studies used standard scales like VAS or WOMAC index
for analyzing the intensity of pain and showed statistically significant
results to Ayurvedic medications in various pain conditions without any
adverse effects. This review gives a comprehensive understanding of the
concept of pain and its management from both Biomedicine and Ayurveda. It
also highlights the unexplored potential of many herbomineral formulations
to treat pain. Copyright © 2019. All Rights Reserved.

<94>
Accession Number
2014136331
Title
Direct oral anticoagulants versus vitamin K antagonists in patients with
atrial fibrillation and bioprosthetic valves: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Yokoyama Y.; Briasoulis A.; Ueyama H.; Mori M.; Iwagami M.; Misumida N.;
Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, Pa, United States
(Briasoulis) Division of Cardiovascular Diseases, University of Iowa
Hospitals and Clinics, Iowa City, IA, United States
(Ueyama) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Mori) Division of Cardiac Surgery, Yale School of Medicine, New Haven,
Conn, United States
(Iwagami) Department of Health Services Research, University of Tsukuba,
Tsukuba, Japan
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, Ky, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein Medical College, New York, NY, United States
Publisher
Mosby Inc.
Abstract
Background: The optimal anticoagulation strategy for patients with
bioprosthetic valves and atrial fibrillation remains uncertain. We
conducted a meta-analysis using updated evidence comparing direct
anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with
bioprosthetic valves and atrial fibrillation. Method(s): Medline and
Embase were searched through March 2021 to identify randomized controlled
trials (RCTs) and observational studies investigating the outcomes of DOAC
therapy and VKA therapy in patients with bioprosthetic valves and atrial
fibrillation. The outcomes of interest were all-cause death, major
bleeding, and stroke or systemic embolism. Result(s): Our analysis
included 4 RCTs and 6 observational studies enrolling a total of 6405
patients with bioprosthetic valves and atrial fibrillation assigned to a
DOAC group (n = 2142) or a VKA group (n = 4263). Pooled analysis
demonstrated the similar rates of all-cause death (hazard ratio [HR],
0.90; 95% confidence interval [CI], 0.77-1.05; P = .18; I2 =
0%) in the DOAC and VKA groups. However, the rate of major bleeding was
significantly lower in the DOAC group (HR, 0.66; 95% CI, 0.48-0.89; P =
.006; I2 = 0%), whereas the rate of stroke or systemic embolism
was similar in the 2 groups (HR, 0.72; 95% CI, 0.44-1.17; P = .18;
I2 = 39%). Conclusion(s): DOAC might decrease the risk of
major bleeding without increasing the risk of stroke or systemic embolism
or all-cause death compared with VKA in patients with bioprosthetic valves
and atrial fibrillation. Copyright © 2021 The American
Association for Thoracic Surgery

<95>
Accession Number
2014119140
Title
Valve-in-valve transcatheter aortic valve implantation for the failing
surgical Perceval bioprosthesis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Suleiman T.; Tanseco K.; Arunothayaraj S.; Michail M.; Cockburn J.;
Hadjivassilev S.; Hildick-Smith D.
Institution
(Suleiman, Tanseco, Arunothayaraj, Michail, Cockburn, Hadjivassilev,
Hildick-Smith) Sussex Cardiac Centre, University Hospitals Sussex,
Brighton, United Kingdom
Publisher
Elsevier Inc.
Abstract
Introduction: The Perceval Valve has been increasingly used in Surgical
Aortic Valve Replacement (SAVR) recently due to ease of implantation.
However, we have seen some cases of relatively early haemodynamic failure
of the Perceval valve and these patients may then present for
valve-in-valve transcatheter aortic valve implantation (ViV-TAVI).
Experience of ViV-TAVI in the Perceval valve is limited. Method(s):
We report our experience of VIV-TAVI in four cases of early-failing
Perceval valves, two with stenosis and two with regurgitation. We also
review the literature with regard to ViV-TAVI for this indication.
 Result(s): Four patients aged between 66 and 78 years presented with
Perceval valve dysfunction an average of 4.6 years following SAVR. All
cases underwent Heart Team discussion and a ViV-TAVI procedure was planned
thereafter. Strategies to ensure crossing through the centre of the valve
and not outside any portion of the frame were found to be essential. Three
patients had self-expanding valves implanted and one had a
balloon-expandable prosthesis. The average aortic valve area (AVA)
improved from 0.8 cm2 pre-procedure to 1.5 cm2
post-procedure*. The mean gradient (MG) improved from 35.5 mmHg (range
19.7-53 mmHg) pre-procedure to 14.8 mmHg (range 7-30 mmHg) post-procedure.
In one patient a MG of 30 mmHg persisted following valve deployment. There
were no significant peri-procedural complications. Conclusion(s):
ViV-TAVI is a useful option for failed Perceval prostheses and appears
safe and effective in this small series. Crossing inside the whole frame
of the Perceval valve is essential. Copyright © 2021 Elsevier
Inc.

<96>
Accession Number
2013897424
Title
Meta-analysis Comparing Mortality After Isolated Surgical Tricuspid Valve
Repair versus Replacement.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Bansal A.; Vargo P.R.; Klein A.L.
Institution
(Bansal, Vargo, Klein) Department of Cardiovascular Medicine, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.

<97>
Accession Number
2013501749
Title
Post-ablation P wave characteristics correlate with recurrent atrial
fibrillation in the ABCD-AF cohort.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2021. Date of Publication: 2021.
Author
Supanekar N.; Gilge J.L.; Ahmed A.; Patel P.J.
Institution
(Supanekar, Gilge, Ahmed, Patel) St Vincent Medical Group, 8333 Naab Road,
#400, Indianapolis, IN 46260, United States
Publisher
Springer
Abstract
Purpose: Atrial fibrillation (AF) ablation is a common procedure to reduce
cardiovascular morbidity but is limited by recurrence. The objective of
this study was to determine if post-ablation acute surface P wave
morphology and other electrocardiographic parameters correlate with AF
recurrence. Method(s): The Avoiding Bladder Catheters During AF
ablation (ABCD-AF) trial was a randomized, prospective trial in 160
subjects undergoing AF ablation. The present study examined correlation
between AF recurrence in follow-up and acute post-ablation
electrocardiographic P wave parameters. Result(s): Median follow-up
was 255 (188, 306) days. The ABCD-AF cohort had a mean age of 62.7 +/-
12.8 with 32.1% being females. Rate of recurrent AF was 35.8%, with a
median time to AF of 135 (109, 182) days. There was no baseline
demographic associated with AF recurrence. There was more AF recurrence in
those with longer follow-up (p = 0.001). Lead 2 PR interval, lead 2 P wave
duration/PR (Pdur/PR), lead V1 PR interval, and lead V1 Pdur/PR were all
significantly associated with recurrent AF (p = 0.03, 0.02, 0.01, 0.01).
Longer PR and shorter Pdur/PR predicted AF recurrence. In a multivariable
model, lead V1 Pdur/PR provided the best predictor of AF recurrence, with
an odds ratio of 0.018 (p = 0.016) per standard deviation change.
 Conclusion(s): Shorter P wave duration combined with longer AV node
delay, as measured by proportion of the PR that the P wave occupies, was
the best predictor of AF recurrence post-ablation. Copyright ©
2021, Springer Science+Business Media, LLC, part of Springer Nature.

<98>
Accession Number
2013497741
Title
Balanced forced-diuresis as a renal protective approach in cardiac
surgery: Secondary outcomes of electrolyte changes.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Department of Cardiothoracic Surgery, Consultant Cardiothoracic
Surgeon, American Hospital, Dubai, United Arab Emirates
(Giri) Department of Cardiothoracic Anaesthesiology, Consultant
Cardiothoracic Anaesthesiologist, Heart & Lung Centre, Wolverhampton,
United Kingdom
(Wrigley) Department of Cardiology, Consultant Interventional
Cardiologist, Heart & Lung Centre, Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Department of Cardiothoracic Surgery, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Sharman) Research Nurse, Research & Development Department, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Beare) Department of Cardiothoracic Surgery, Chief Clinical Perfusionist,
University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nevill) Department of Statistics, Faculty of Education, Health, and
Wellbeing, University of Wolverhampton, Walsall, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Forced-diuresis during cardiopulmonary bypass (CPB) can be
associated with significant electrolyte shifts. This study reports on the
serum electrolyte changes during balanced forced-diuresis with the
RenalGuard system (RG) during CPB. Method(s): Patients at risk of
acute kidney injury (AKI)-(history of diabetes &/or anaemia, e-GFR 20-60
ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore
>5)-were randomized to either RG (study group) or managed as per current
practice (control group). Result(s): The use of RG reduced AKI rate
(10% for RG and 20.9% in control, p =.03). Mean urine output was
significantly higher in the RG group during surgery (2366 +/- 877 ml vs.
765 +/- 549 ml, p <.001). The serum potassium levels were maintained
between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for
the controls. Median potassium supplemental dose was 60 (0-220) mmol (RG
group) as compared to 30 (0-190) mmol for control group over first 24 h (p
<.001). On Day 1 post-op, there were no significant differences in the
serum sodium, potassium, calcium, magnesium, phosphate, and chloride
levels between the two groups. Otherwise, postoperative clinical recovery
was also similar. Conclusion(s): Balanced forced-diuresis with the RG
reduced AKI rates after on-pump cardiac surgery compared to controls.
Although the RG group required higher doses of IV potassium replacement in
the postoperative period, normal serum levels of potassium were maintained
by appropriate intravenous potassium supplementation and the clinical
outcomes between groups were similar. Copyright © 2021 The
Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC

<99>
Accession Number
2013497740
Title
Using machine learning to improve survival prediction after heart
transplantation.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Ayers B.; Sandholm T.; Gosev I.; Prasad S.; Kilic A.
Institution
(Ayers) Department of Surgery, The Massachusetts General Hospital, Boston,
MA, United States
(Sandholm) Carnegie Mellon University, Pittsburgh, PA, United States
(Gosev, Prasad) Division of Cardiac Surgery, The University of Rochester
Medical Center, Rochester, NY, United States
(Kilic) Division of Cardiothoracic Surgery, Medical University of South
Carolina, Charleston, SC, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: This study investigates the use of modern machine learning
(ML) techniques to improve prediction of survival after orthotopic heart
transplantation (OHT). Method(s): Retrospective study of adult
patients undergoing primary, isolated OHT between 2000 and 2019 as
identified in the United Network for Organ Sharing (UNOS) registry. The
primary outcome was 1-year post-transplant survival. Patients were
randomly divided into training (80%) and validation (20%) sets.
Dimensionality reduction and data re-sampling were employed during
training. Multiple machine learning algorithms were combined into a final
ensemble ML model. The discriminatory capability was assessed using the
area under receiver-operating-characteristic curve (AUROC), net
reclassification index (NRI), and decision curve analysis (DCA).
 Result(s): A total of 33,657 OHT patients were evaluated. One-year
mortality was 11% (n = 3738). In the validation cohort, the AUROC of
singular logistic regression was 0.649 (95% CI, 0.628-0.670) compared to
0.691 (95% CI, 0.671-0.711) with random forest, 0.691 (95% CI,
0.671-0.712) with deep neural network, and 0.653 (95% CI, 0.632-0.674)
with Adaboost. A final ensemble ML model was created that demonstrated the
greatest improvement in AUROC: 0.764 (95% CI, 0.745-0.782) (p <.001). The
ensemble ML model improved predictive performance by 72.9% +/-3.8% (p
<.001) as assessed by NRI compared to logistic regression. DCA showed the
final ensemble method improved risk prediction across the entire spectrum
of predicted risk as compared to all other models (p <.001).
 Conclusion(s): Modern ML techniques can improve risk prediction in
OHT compared to traditional approaches. This may have important
implications in patient selection, programmatic evaluation, allocation
policy, and patient counseling and prognostication. Copyright ©
2021 Wiley Periodicals LLC

<100>
Accession Number
2013496714
Title
Predicting atrial fibrillation after cardiac surgery: a scoping review of
associated factors and systematic review of existing prediction models.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Fleet H.; Pilcher D.; Bellomo R.; Coulson T.G.
Institution
(Fleet) Melbourne Medical School, The University of Melbourne, Melbourne,
VIC, Australia
(Pilcher, Coulson) Department of Epidemiology and Preventative Medicine,
Monash University, Melbourne, VIC, Australia
(Bellomo, Coulson) Centre for Integrated Critical Care, The University of
Melbourne, Parkville, VIC, Australia
(Coulson) Department of Anaesthesia, Austin Hospital, Melbourne, VIC,
Australia
Publisher
SAGE Publications Ltd
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is common after
cardiac surgery and associated with increased hospital length of stay,
patient morbidity and mortality. We aimed to identify factors associated
with POAF and evaluate the accuracy of available POAF prediction models.
 Method(s): We screened articles from Ovid MEDLINE and
PubMed Central (PMC) and included studies that evaluated risk
factors associated with POAF or studies that designed or validated POAF
prediction models. We only included studies in cardiac surgical patients
with sample size n 50 and a POAF outcome group 20. We summarised factors
that were associated with POAF and assessed prediction model performance
by reviewing reported calibration and discriminative ability.
 Result(s): We reviewed 232 studies. Of these, 142 fulfilled the
inclusion criteria. Age was frequently found to be associated with POAF,
while most other variables showed contradictory findings, or were assessed
in few studies. Overall, 15 studies specifically developed and/or
validated 12 prediction models. Of these, all showed poor discrimination
or absent calibration in predicting POAF in externally validated cohorts.
 Conclusion(s): Except for age, reporting of factors associated with
POAF is inconsistent and often contradictory. Prediction models have low
discrimination, missing calibration statistics, are at risk of bias and
show limited clinical applicability. This suggests the need for studies
that prospectively collect AF relevant data in large cohorts and then
proceed to validate findings in external data sets. Copyright ©
The Author(s) 2021.

<101>
Accession Number
2013482841
Title
Integrative echocardiographic assessment of patients with secondary mitral
regurgitation undergoing transcatheter edge-to-edge repair.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Brugger N.; Kassar M.; Siontis G.C.M.; Widmer S.; Okuno T.; Winkel M.G.;
Corpataux N.; Grani C.; Bullesfeld L.; Hunziker L.; Pilgrim T.; Windecker
S.; Praz F.
Institution
(Brugger, Kassar, Siontis, Widmer, Okuno, Winkel, Corpataux, Grani,
Hunziker, Pilgrim, Windecker, Praz) Department of Cardiology, Inselspital,
University of Bern, Bern, Switzerland
(Bullesfeld) Department of Internal Medicine and Cardiology, GFO Hospitals
Bonn, Bonn, Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To investigate whether the integrative echocardiographic
criteria used in the cardiovascular outcomes assessment of the mitraclip
percutaneous therapy (COAPT) for heart failure patients with functional
mitral regurgitation study predict outcomes after edge-to-edge
trancatheter mitral valve repair (TMVr) for the treatment of secondary
mitral regurgitation (SMR). Background(s): Two randomized controlled
trials comparing TMVr to medical treatment reported conflicting findings.
Differences in patient selection criteria may have contributed to these
diverging results. Method(s): Patients undergoing TMVr were
stratified following the integrative COAPT echocardiographic criteria in
noneligible and eligible patients who were further classified into three
tiers according to effective regurgitant orifice (EROA) (Tier 1: EROA >=
0.3cm2; Tier 2: EROA 0.2cm2 and 0.29cm2;
Tier 3: EROA<0.2cm2) combined with several other severity
criteria. We assessed between group differences in all-cause mortality,
successful SMR reduction, and symptom relief from baseline to 2-year
follow-up. Result(s): Between March 2011 and March 2018, 138 patients
(mean age 75 years) satisfying the inclusion criteria underwent TMVr for
treatment of symptomatic SMR. The mean EROA area was 0.35 +/- 0.17
mm2. Ten patients (7%) died within 30 days, 29 (21%) within 12
months, and 41 (30%) within 2 years. After stratification according to the
COAPT echocardiographic criteria that were fulfilled in 72% of the studied
population, Tier 2 patients (45%), as well as noneligible patients (38%)
had a higher mortality rate compared to those in Tier 1 (19%).
 Conclusion(s): SMR patients stratified into tiers according to the
COAPT integrative echocardiographic criteria have diverging prognostic and
symptomatic benefit after edge-to-edge TMVr. Copyright © 2021
Wiley Periodicals LLC.

<102>
Accession Number
635774212
Title
Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to
prevent embolic stroke.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 30 Jul 2021.
Author
Knol W.G.; Budde R.P.J.; Mahtab E.A.F.; Bekkers J.A.; Bogers A.J.J.C.
Institution
(Knol, Mahtab, Bekkers, Bogers) Cardiothoracic Surgery, Erasmus Medical
Center, Rotterdam, Netherlands
(Knol, Budde) Radiology and Nuclear Medicine, Erasmus Medical Center,
Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Although the incidence of perioperative stroke after cardiac
surgery gradually decreased over the last decades, there is much variation
between centres. This review aimed to create a concise overview of the
evidence on possible surgical strategies to prevent embolic stroke in
patients with intimal aortic atherosclerosis. METHOD(S): The PubMed
and EMBASE databases were searched for studies on surgical management of
aortic atherosclerosis and the association with perioperative stroke in
cardiac surgery, including specific searches on the most common types of
surgery. Articles were screened with emphasis on studies comparing
multiple strategies and studies reporting on the patients' severity of
aortic atherosclerosis. The main findings were summarized in a figure,
with a grade of the corresponding level of evidence. RESULT(S):
Regarding embolic stroke risk, aortic atherosclerosis of the tunica intima
is most relevant. Although several strategies in general cardiac surgery
seem to be beneficial in severe disease, none have conclusively been
proven most effective. Off-pump surgery in coronary artery bypass grafting
should be preferred with severe atherosclerosis, if the required expertise
is present. Although transcatheter aortic valve replacement is used as an
alternative to surgery in patients with a porcelain aorta, the risk
profile concerning intimal atherosclerosis remains poorly defined.
 CONCLUSION(S): A tailored approach that uses the discussed
alternative strategies in carefully selected patients is best suited to
reduce the risk of perioperative stroke without compromising other
outcomes. More research is needed, especially on the perioperative stroke
risk in patients with moderate aortic atherosclerosis. Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf
of the European Association for Cardio-Thoracic Surgery.

<103>
Accession Number
635774154
Title
Validation and comparison of 28 risk prediction models for coronary artery
disease.
Source
European journal of preventive cardiology. (no pagination), 2021. Date of
Publication: 30 Jul 2021.
Author
Lenselink C.; Ties D.; Pleijhuis R.; van der Harst P.
Institution
(Lenselink, Ties, van der Harst) Department of Cardiology, University
Medical Center Groningen, University of Groningen, Hanzeplein 1, RB
Groningen 9700, Netherlands
(Pleijhuis) Department of Internal Medicine, University Medical Center
Groningen, Hanzeplein 1, Groningen, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: Risk prediction models (RPMs) for coronary artery disease (CAD),
using variables to calculate CAD risk, are potentially valuable tools in
prevention strategies. However, their use in the clinical practice is
limited by a lack of poor model description, external validation, and
head-to-head comparisons. METHODS AND RESULTS: CAD RPMs were identified
through Tufts PACE CPM Registry and a systematic PubMed search. Every RPM
was externally validated in the three cohorts (the UK Biobank, LifeLines,
and PREVEND studies) for the primary endpoint myocardial infarction (MI)
and secondary endpoint CAD, consisting of MI, percutaneous coronary
intervention, and coronary artery bypass grafting. Model discrimination
(C-index), calibration (intercept and regression slope), and accuracy
(Brier score) were assessed and compared head-to-head between RPMs. Linear
regression analysis was performed to evaluate predictive factors to
estimate calibration ability of an RPM. Eleven articles containing 28 CAD
RPMs were included. No single best-performing RPM could be identified
across all cohorts and outcomes. Most RPMs yielded fair discrimination
ability: mean C-index of RPMs was 0.706+/-0.049, 0.778+/-0.097, and
0.729+/-0.074 (P<0.01) for prediction of MI in UK Biobank, LifeLines, and
PREVEND, respectively. Endpoint incidence in the original development
cohorts was identified as a significant predictor for external validation
performance. CONCLUSION(S): Performance of CAD RPMs was comparable
upon validation in three large cohorts, based on which no specific RPM can
be recommended for predicting CAD risk. Copyright © The Author(s)
2021. Published by Oxford University Press on behalf of the European
Society of Cardiology.

<104>
[Use Link to view the full text]
Accession Number
635767384
Title
Relationship between Residual Mitral Regurgitation and Clinical and
Quality-of-Life Outcomes after Transcatheter and Medical Treatments in
Heart Failure: COAPT Trial.
Source
Circulation. (pp 426-437), 2021. Date of Publication: 2021.
Author
Kar S.; Mack M.J.; Lindenfeld J.; Abraham W.T.; Asch F.M.; Weissman N.J.;
Enriquez-Sarano M.; Lim D.S.; Mishell J.M.; Whisenant B.K.; Rogers J.H.;
Arnold S.V.; Cohen D.J.; Grayburn P.A.; Stone G.W.
Institution
(Kar) Los Robles Regional Medical Center, Thousand Oaks, CA, United States
(Kar) Bakersfield Heart Hospital, CA, United States
(Mack) Baylor Scott and White Heart Hospital Plano, TX, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, Ohio State University,
Columbus, United States
(Asch, Weissman) MedStar Health Research Institute, Washington, DC, United
States
(Asch, Weissman) Georgetown University, Washington, DC, United States
(Enriquez-Sarano) Mayo Clinic, Rochester, MN, United States
(Lim) Division of Cardiology, University of Virginia, Charlottesville,
United States
(Mishell) Kaiser Permanente-San Francisco Hospital, CA, United States
(Whisenant) Intermountain Heart Center, Salt Lake City, UT, United States
(Rogers) University of California, Davis Medical Center, Sacramento,
United States
(Arnold) Saint Luke's Mid America Heart Institute, Kansas City, MO, United
States
(Cohen) University of Missouri, Kansas City School of Medicine, United
States
(Kar, Kar, Mack, Lindenfeld, Abraham, Asch, Asch, Weissman, Weissman,
Enriquez-Sarano, Lim, Mishell, Whisenant, Rogers, Arnold, Cohen, Cohen,
Grayburn, Stone, Stone) St Francis Hospital, Roslyn, NY, United States
(Cohen, Stone) Clinical Trials Center, Cardiovascular Research Foundation,
Mount Sinai Medical Center, 1700 Broadway, 8th Floor, New York, NY 10019,
United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(Stone) Zena and Michael A. Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, NY, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: In the randomized COAPT trial (Cardiovascular Outcomes
Assessment of the MitraClip Percutaneous Therapy for Heart Failure
Patients With Functional Mitral Regurgitation), among 614 patients with
heart failure with 3+ or 4+ secondary mitral regurgitation (MR),
transcatheter mitral valve repair (TMVr) with the MitraClip reduced MR,
heart failure hospitalizations, and mortality and improved quality of life
compared with guideline-directed medical therapy (GDMT) alone. We aimed to
examine the prognostic relationship between MR reduction and outcomes
after TMVr and GDMT alone. Method(s): Outcomes in COAPT between 30
days and 2 years were examined on the basis of the severity of residual MR
at 30 days. Result(s): TMVr-treated patients had less severe residual
MR at 30 days than GDMT-treated patients (0/1+, 2+, and 3+/4+: 72.9%,
19.9%, and 7.2% versus 8.2%, 26.1%, and 65.8%, respectively [P0.0001]).
The rate of composite death or heart failure hospitalizations between 30
days and 2 years was lower in patients with 30-day residual MR of 0/1+ and
2+ compared with patients with 30-day residual MR of 3+/4+ (37.7% versus
49.5% versus 72.2%, respectively [P0.0001]). This relationship was
consistent in the TMVr and GDMT arms (P<inf>interaction</inf>=0.92). The
improvement in Kansas City Cardiomyopathy Questionnaire score from
baseline to 30 days was maintained between 30 days and 2 years in patients
with 30-day MR 2+ but deteriorated in those with 30-day MR 3+/4+ (-0.31.7
versus-9.4 4.6 [P=0.0008]) consistently in both groups
(P<inf>interaction</inf>=0.95). Conclusion(s): In the COAPT trial,
reduced MR at 30 days was associated with greater freedom from death or
heart failure hospitalizations and improved quality of life through 2-year
follow-up whether the MR reduction was achieved by TMVr or
GDMT. Copyright © 2021 Lippincott Williams and Wilkins. All
rights reserved.

<105>
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.
 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. 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. 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. Copyright © 2021, The
Author(s).

<106>
Accession Number
626725484
Title
Myocardial protection and clinical outcomes in Tetralogy of Fallot
patients undergoing intracardiac repair: a randomized study of two
cardioplegic techniques.
Source
Perfusion (United Kingdom). 34 (6) (pp 495-502), 2019. Date of
Publication: 01 Sep 2019.
Author
Negi S.L.; Mandal B.; Singh R.S.; Puri G.D.
Institution
(Negi, Mandal, Puri) Department of Anaesthesia and Intensive Care,
Postgraduate Institute of Medical Education and Research, Chandigarh,
India
(Singh) Department of Cardiothoracic and Vascular Surgery, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
Publisher
SAGE Publications Ltd
Abstract
Background: Myocardial protection in Tetralogy of Fallot patients
undergoing intracardiac repair is suboptimal due to hypertrophied right
ventricle. Hypertrophied myocardium is more susceptible to poor myocardial
preservation because of inadequate capillary density as compared to the
myocytes. There is a capillary to myocyte ratio mismatch. But del Nido
Cardioplegia owing to its less viscosity is able to get more evenly
distributed under hypothermic cardiopulmonary bypass as opposed to blood
Cardioplegia. We hypothesized that the del Nido Cardioplegia technique,
would be beneficial in myocardial protection because of its composition
and method of delivery, leading into better early and late clinical
outcomes in patients undergoing Tetralogy of Fallot repair as compared to
blood cardioplegia reconstituted using St Thomas Cardioplegia solution.
The objective of the study was to identify a better technique of
myocardial preservation in Tetralogy of Fallot patient. Method(s): In
total, 56 Tetralogy of Fallot patients undergoing intracardiac repair
under mild hypothermic cardiopulmonary bypass were randomly allocated to
receive antegrade Cardioplegia with either standard blood Cardioplegia
(Group I) or del Nido Cardioplegia (Group II). Preoperative as well as
postoperative data including echocardiographic parameters for right
ventricle functions, creatine kinase MB level, inotropic requirement,
mechanical ventilation duration, intensive care unit stay and hospital
mortality were evaluated. Result(s): Inotropic score in the first 24
hours postoperatively was significantly lower in Group II compared to
Group I (13.4 +/- 7.2 vs. 21.2 +/- 9.6, p = 0.003). Creatine kinase MB
level (ng/mL) was comparable between the groups. Echocardiographic
parameters for right ventricle functions were also comparable between the
groups during early as well as after 3 to 6 months postoperatively.
 Conclusion(s): Del Nido Cardioplegia is equally efficacious in
providing myocardial protection during intracardiac repair under mild
hypothermic cardiopulmonary bypass in Tetralogy of Fallot patients as
compared to blood Cardioplegia solution with the added benefit of reducing
inotropic requirement in first 24 hours postoperative
period. Copyright © The Author(s) 2019.

<107>
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. Copyright © 2021 Published on behalf of
the European Society of Cardiology. All rights reserved.

<108>
Accession Number
2013900018
Title
Aortic valve neocuspidization with autologous pericardium in adult
patients: UK experience and meta-analytic comparison with other aortic
valve substitutes.
Source
European Journal of Cardio-thoracic Surgery. 60 (1) (pp 34-46), 2021. Date
of Publication: 01 Jul 2021.
Author
Benedetto U.; Sinha S.; Dimagli A.; Dixon L.; Stoica S.; Cocomello L.;
Quarto C.; Angelini G.D.; Dandekar U.; Caputo M.
Institution
(Benedetto, Sinha, Dimagli, Dixon, Stoica, Cocomello, Angelini, Caputo)
Bristol Heart Institute, Translational Health Sciences, University of
Bristol, Bristol, United Kingdom
(Quarto) Department of Cardiothoracic Surgery, Royal Brompton Harefield
NHS Trust, London, United Kingdom
(Dandekar) Department of Cardiothoracic Surgery, University Hospital
Coventry Warwickshire NHS Trust, West Midlands, Coventry, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: We sought to provide further evidence on the safety and
efficacy of aortic valve neocuspidization (AVNeo) using autologous
pericardium in adult patients with aortic valve disease by reporting
clinical and echocardiographic results from the first UK experience and
performing a meta-analytic comparison with other biological valve
substitutes. METHOD(S): We reported clinical and echocardiographic
outcomes of 55 patients (mean age 58 +/- 15 years) undergoing AVNeo with
autologous pericardium in 2 UK centres from 2018 to 2020. These results
were included in a meta-analytic comparison between series on AVNeo (7
studies, 1205 patients, mean weighted follow-up 3.6 years) versus Trifecta
(10 studies, 8705 patients, 3.8 years), Magna Ease (3 studies, 3137
patients, 4.1 years), Freedom Solo (4 studies, 1869 patients, 4.4 years),
Freestyle (4 studies, 4307 patients, 7 years), Mitroflow (4 studies, 4760
patients, 4.1 years) and autograft aortic valve (7 papers, 3839 patients,
9.1 years). RESULT(S): In the present series no patients required
intraoperative conversion. After mean follow-up of 12.5 +/- 0.9 months, 3
patients presented with endocarditis and 1 required reintervention. The
remaining patients had absent or mild aortic valve insufficiency with very
low peak and mean transvalvular gradients (16 +/- 3.7 and 9 +/- 2.2 mmHg,
respectively). Meta-analytic estimates showed non-significant difference
between AVNeo and all but Magna Ease valves with regards to structural
valve degeneration, reintervention and endocarditis. When compared Magna
Ease valve, AVNeo and other valve substitutes showed an excess of
valve-related events. CONCLUSION(S): AVNeo is safe, associated with
excellent haemodynamic profile. Its midterm risk of valve-related events
is comparable to most biological valve substitutes. Magna Ease is
potentially the best biological choice as far as risk of reintervention is
concerned. Copyright © 2021 The Author(s) 2021. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<109>
Accession Number
2010744076
Title
Pathway for enhanced recovery after spinal surgery-a systematic review of
evidence for use of individual components.
Source
BMC Anesthesiology. 21 (1) (no pagination), 2021. Article Number: 74. Date
of Publication: December 2021.
Author
Licina A.; Silvers A.; Laughlin H.; Russell J.; Wan C.
Institution
(Licina) Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia
(Silvers) Monash Health, Clayton, Australia, Faculty of Medicine, Nursing
and Health Science, Monash University, Melbourne, VIC, Australia
(Laughlin, Wan) Royal Hobart Hospital, Hobart, TAS, Australia
(Russell) Department of Neurosurgery, Austin Health, Melbourne, VIC,
Australia
(Wan) St Vincent's Hospital, Melbourne, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Enhanced recovery in spinal surgery (ERSS) has shown promising
improvements in clinical and economical outcomes. We have proposed an ERSS
pathway based on available evidence. We aimed to delineate the clinical
efficacy of individual pathway components in ERSS through a systematic
narrative review. Method(s): We included systematic reviews and
meta-analysis, randomized controlled trials, non-randomized controlled
studies, and observational studies in adults and pediatric patients
evaluating any one of the 22 pre-defined components. Our primary outcomes
included all-cause mortality, morbidity outcomes (e.g., pulmonary,
cardiac, renal, surgical complications), patient-reported outcomes and
experiences (e.g., pain, quality of care experience), and health services
outcomes (e.g., length of stay and costs). Following databases (1990
onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane
Database of Systematic Reviews and CENTRAL). Two authors screened the
citations, full-text articles, and extracted data. A narrative synthesis
was provided. We constructed Evidence Profile (EP) tables for each
component of the pathway, where appropriate information was available. Due
to clinical and methodological heterogeneity, we did not conduct a
meta-analyses. GRADE system was used to classify confidence in cumulative
evidence for each component of the pathway. Result(s): We identified
5423 relevant studies excluding duplicates as relating to the 22
pre-defined components of enhanced recovery in spinal surgery. We included
664 studies in the systematic review. We identified specific evidence
within the context of spinal surgery for 14/22 proposed components.
Evidence was summarized in EP tables where suitable. We performed thematic
synthesis without EP for 6/22 elements. We identified appropriate societal
guidelines for the remainder of the components. Conclusion(s): We
identified the following components with high quality of evidence as per
GRADE system: pre-emptive analgesia, peri-operative blood conservation
(antifibrinolytic use), surgical site preparation and antibiotic
prophylaxis. There was moderate level of evidence for implementation of
prehabilitation, minimally invasive surgery, multimodal perioperative
analgesia, intravenous lignocaine and ketamine use as well as early
mobilization. This review allows for the first formalized evidence-based
unified protocol in the field of ERSS. Further studies validating the
multimodal ERSS framework are essential to guide the future evolution of
care in patients undergoing spinal surgery. Copyright © 2021, The
Author(s).

<110>
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.
 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. 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. 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. Copyright © The Author(s) 2020.

<111>
Accession Number
2006048893
Title
Infective endocarditis by Acinetobacter species: a systematic review.
Source
Journal of Chemotherapy. 33 (4) (pp 203-215), 2021. Date of Publication:
2021.
Author
Ioannou P.; Mavrikaki V.; Kofteridis D.P.
Institution
(Ioannou, Mavrikaki, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete,
Greece
Publisher
Taylor and Francis Ltd.
Abstract
A. baumannii-A. calcoaceticus complex infections are increasingly
frequent, especially in intensive care units. Such infections are
associated with a mortality that can be as high as 62%. On the other hand,
infective endocarditis (IE) is an uncommon disease with notable morbidity
and mortality. Even though IE is rarely caused by Acinetobacter species,
these infections can be particularly problematic due to increasing
antimicrobial resistance. The purpose of this study was to systemically
review all published cases of IE by Acinetobacter species in the
literature. A systematic review of PubMed, Scopus and Cochrane library
(through 25 April 2020) for studies providing epidemiological, clinical,
microbiological as well as treatment data and outcomes of IE by
Acinetobacter species was performed. A total of 35 studies, containing
data of 37 patients, were included. A prosthetic valve was present in
40.5%, while the most common causative pathogen was A. baumannii-A.
calcoaceticus complex, followed by A. lwoffii. Aortic valve was the
commonest infected site, followed by mitral valve. Diagnosis was set with
transthoracic echocardiography in 48.6%, while the diagnosis was set at
autopsy in 20%. Fever and sepsis were the commonest clinical
presentations, followed by heart failure and embolic phenomena.
Aminoglycosides, cephalosporins and carbapenems were the commonest
antimicrobials used. Clinical cure was noted in 70.3%, while overall
mortality was 32.4%. Development of heart failure was independently
associated with mortality by IE. This systematic review thoroughly
describes IE by Acinetobacter and provides information on epidemiology,
clinical presentation, treatment and outcomes. Copyright © 2020
Edizioni Scientifi che per l'Informazione su Farmaci e Terapia.

<112>
Accession Number
2013403946
Title
Activation of the innate immune response and organ injury after cardiac
surgery: a systematic review and meta-analysis of randomised trials and
analysis of individual patient data from randomised and non-randomised
studies.
Source
British Journal of Anaesthesia. 127 (3) (pp 365-375), 2021. Date of
Publication: September 2021.
Author
Abbasciano R.G.; Lai F.Y.; Roman M.A.; Rizzello A.; Pathak S.; Ramzi J.;
Lucarelli C.; Layton G.R.; Kumar T.; Wozniak M.J.; Eagle-Hemming B.;
Akowuah E.; Rogers C.A.; Angelini G.D.; Murphy G.J.
Institution
(Abbasciano, Lai, Roman, Rizzello, Pathak, Kumar, Wozniak, Eagle-Hemming,
Murphy) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Ramzi) Leicester Medical School, University of Leicester, Leicester,
United Kingdom
(Lucarelli) Department of Cardiac Surgery, University of Verona, Verona,
Italy
(Layton) University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Akowuah) South Tees Hospitals NHS Foundation Trust, Middlesbrough, United
Kingdom
(Rogers) Clinical Trials and Evaluation Unit, Bristol Trials Centre,
University of Bristol, Bristol, United Kingdom
(Angelini) Bristol Heart Institute, University of Bristol, Bristol, United
Kingdom
Publisher
Elsevier Ltd
Abstract
Background: It is unclear whether the innate immune response represents a
therapeutic target for organ protection strategies in cardiac surgery.
 Method(s): A systematic review of trials of interventions targeting
the inflammatory response to cardiac surgery reporting treatment effects
on both innate immune system cytokines and organ injury was performed. The
protocol was registered at the International Prospective Register of
Systematic Reviews: CRD42020187239. Searches of the Cochrane Central
Register of Controlled Trials, MEDLINE, and Embase were performed.
Random-effects meta-analyses were used for the primary analysis. A
separate analysis of individual patient data from six studies (n=785)
explored sources of heterogeneity for treatment effects on cytokine
levels. Result(s): Searches to May 2020 identified 251 trials
evaluating 24 interventions with 20 582 participants for inclusion. Most
trials had important limitations. Methodological limitations of the
included trials and heterogeneity of the treatment effects on cytokine
levels between trials limited interpretation. The primary analysis
demonstrated inconsistency in the direction of the treatment effects on
innate immunity and organ failure or death between interventions. Analyses
restricted to important subgroups or trials with fewer limitations showed
similar results. Meta-regression, pooling available data from all trials,
demonstrated no association between the direction of the treatment effects
on inflammatory cytokines and organ injury or death. The analysis of
individual patient data demonstrated heterogeneity in the association
between the cytokine response and organ injury after cardiac surgery for
people >75 yr old and those with some chronic diseases.
 Conclusion(s): The certainty of the evidence for a causal
relationship between innate immune system activation and organ injury
after cardiac surgery is low. Copyright © 2021 British Journal of
Anaesthesia

<113>
Accession Number
2013380040
Title
Preoperative inflammatory mediators and postoperative delirium: systematic
review and meta-analysis.
Source
British Journal of Anaesthesia. 127 (3) (pp 424-434), 2021. Date of
Publication: September 2021.
Author
Noah A.M.; Almghairbi D.; Evley R.; Moppett I.K.
Institution
(Noah, Almghairbi, Evley, Moppett) Anaesthesia and Critical Care, Academic
Unit of Injury, Inflammation and Recovery Science, University of
Nottingham, Nottingham, United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Postoperative delirium has eluded attempts to define its
complex aetiology and describe specific risk factors. The role of
neuroinflammation as a risk factor, determined by measuring blood levels
of preoperative 'innate' inflammatory mediator levels, has been
investigated. However, results have been conflicting. We conducted a
systematic review and meta-analysis of the evidence on associations
between preoperative blood levels of inflammatory mediators and
postoperative delirium in the older person. Influence of type of surgery
was also assessed. Method(s): Original, low risk of bias studies,
published in peer-reviewed journals, which fulfilled the eligibility
criteria were included. Seventeen articles fulfilled study criteria. Data
extraction, synthesis, and risk of bias analysis were guided by Preferred
Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and
quality in prognostic studies guidelines. Meta-analyses used a
random-effects model. Inflammatory mediators included C-reactive protein,
interleukin-6, -8, and -10, tumour necrosis factor-alpha, insulin-like
growth factor-1, cortisol, and neopterin. Surgical groups were cardiac,
noncardiac, and hip fracture. Result(s): Higher preoperative
interleukin-6 was associated with postoperative delirium with a
standardised mean difference (95% confidence interval) of 0.33 (0.11-0.56)
and P=0.003. Higher neopterin was also associated with postoperative
delirium. Conclusion(s): The association of preoperative blood levels
of inflammatory mediators with postoperative delirium may be influenced by
the type of surgery and the specific mediator. The potential modulating
effect of type of surgery, intrinsic brain vulnerability, and the complex
interactions between inflammatory mediators and binding proteins will need
to be considered in future studies. Clinical trial registration:
CRD42019159471 (PROSPERO). Copyright © 2021 British Journal of
Anaesthesia

<114>
Accession Number
2012838929
Title
Sex, Racial, and Ethnic Disparities in U.S. Cardiovascular Trials in More
Than 230,000 Patients.
Source
Annals of Thoracic Surgery. 112 (3) (pp 726-735), 2021. Date of
Publication: September 2021.
Author
Preventza O.; Critsinelis A.; Simpson K.; Olive J.K.; LeMaire S.A.;
Cornwell L.D.; Jimenez E.; Byrne J.; Chatterjee S.; Rosengart T.K.;
Coselli J.S.
Institution
(Preventza, Simpson, Olive, LeMaire, Cornwell, Jimenez, Chatterjee,
Rosengart, Coselli) Division of Cardiothoracic Surgery, Michael E. DeBakey
Department of Surgery, Baylor College of Medicine, Houston, TX, United
States
(Preventza, LeMaire, Jimenez, Chatterjee, Rosengart, Coselli) Department
of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, United
States
(Preventza, LeMaire, Byrne, Chatterjee, Rosengart, Coselli) Department of
Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical
Center, Houston, TX, United States
(Critsinelis) Division of Cardiothoracic Transplantation and Circulatory
Support, Michael E. DeBakey Department of Surgery, Baylor College of
Medicine, Houston, TX, United States
(LeMaire) Office of Surgical Research, Michael E. DeBakey Department of
Surgery, Baylor College of Medicine, Houston, TX, United States
(Cornwell, Jimenez) Division of Cardiothoracic Surgery, Michael E. DeBakey
VA Medical Center, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: The current representation of female patients and racial and
ethnic minorities in cardiovascular trials is unclear. We evaluated these
groups' inclusion in U.S. cardiovascular trials. Method(s): Using
publicly available data from ClinicalTrials.gov, we evaluated
cardiovascular trials pertaining to coronary artery bypass grafting
(CABG), heart valve disease, aortic aneurysm, ventricular assist devices,
and heart transplantation. This yielded 178 U.S. trials (159 completed, 19
active but not recruiting) started between September 1998 and May 2017,
with 237,132 participants. To examine female patients' and racial and
ethnic minorities' representation in these trials, we calculated
participation-to-prevalence ratios (PPRs). Values of 0.8 to 1.2 reflect
similar representation. Result(s): All 178 trials reported sex
distribution, whereas only 76 (42.7%) trials reported racial distribution
and 52 (29.2%) trials reported ethnic (Hispanic vs non-Hispanic)
distribution. Among all trials, participants were 28.3% female, 11.2% were
Hispanic/Latino, 4.0% were African American, 10.4% were Asian, and 2.3%
were other. The CABG PPR for female patients was 0.64, for Hispanic
patients was 0.72, for African American patients was 0.28, and for Asian
patients was 3.20. Between 2008-2012 and 2013-2017, the CABG PPR decreased
for female patients (0.67->0.50) and African American patients
(0.37->0.17) but increased for Hispanic patients (0.38->1.32) and Asian
patients (3.51->4.57). Conclusion(s): Participation in cardiovascular
trials by female patients and minorities (except Asian patients) remains
low. Given that inherent differences among the previously mentioned groups
could affect outcomes, balance is clearly needed. The engagement of our
surgical leadership, community, and industry to address these disparities
is vitally important. Copyright © 2021 The Society of Thoracic
Surgeons

<115>
Accession Number
2012752707
Title
Left Internal Mammary Artery Skeletonization Reduces Bleeding-A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. 112 (3) (pp 794-801), 2021. Date of
Publication: September 2021.
Author
Mazur P.; Litwinowicz R.; Tchantchaleishvili V.; Natorska J.; Zabczyk M.;
Bochenek M.; Przybylski R.; Iwaniec T.; Kedziora A.; Filip G.; Kapelak B.
Institution
(Mazur, Litwinowicz, Kedziora, Filip, Kapelak) Department of
Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow,
Poland
(Mazur, Natorska, Zabczyk, Kapelak) Institute of Cardiology, Jagiellonian
University Medical College, Krakow, Poland
(Tchantchaleishvili) Division of Cardiac Surgery, Department of Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Bochenek, Przybylski) Department of Heart Transplantation and Mechanical
Circulatory Support, Wroclaw Medical University, Wroclaw, Poland
(Iwaniec) Department of Hematology, Jagiellonian University Medical
College, Poland
Publisher
Elsevier Inc.
Abstract
Background: The objective of this study was to compare the impact of
skeletonized versus pedicled left internal mammary artery (LIMA)
harvesting on bleeding after coronary artery bypass grafting (CABG).
 Method(s): In a randomized, single-blinded trial with a parallel
group design and equal allocation, we randomly assigned 62 patients
undergoing primary elective CABG in a tertiary cardiac center to
skeletonized or pedicled LIMA dissection. Before surgery, all aspects of
coagulation were assessed. Patients were blinded to LIMA dissection
technique and monitored for cumulative drainage at 12 hours (primary
outcome) as well as myocardial necrosis markers. Result(s): With
recruitment complete, there were 31 patients in each group; all patients
were analyzed. Median postoperative drainage was 395 mL at 12 hours in all
patients; it was lower by 28% at 12 hours (P = .02) in patients with
skeletonized LIMA (Cohen's d, 0.6; 95% confidence interval (CI),
0.09-1.11). Patients with a LIMA pedicle received more fresh-frozen plasma
transfusions than did the skeletonized LIMA group (Median 3; interquartile
range 3-5 versus median 3; interquartile range 3-3; P = .03). Study arms
did not differ in blood coagulation. Left internal mammary artery
skeletonization (odds ratio = 0.04; 95% CI, 0.003-0.44; P = .009) and
higher body mass index (odds ratio = 0.63; 95% CI, 0.45-0.89; P = .008)
decreased the odds of being in the top drainage quartile at 12 hours
(>=550 mL). Creatine kinase was lower in skeletonized LIMA directly after
surgery (median 218 U/L; interquartile range 175-310 U/L versus median 424
U/L; interquartile range 256-510 U/L; P < .001), at 6 hours (median 324
U/L; interquartile range 239-424 U/L versus median 529 U/L; interquartile
range 374-707 U/L; P < .001), and 12 hours after surgery (median 351 U/L;
interquartile range 277-552 U/L versus median 695 U/L; interquartile range
509-1067 U/L; P < .001). Conclusion(s): Left internal mammary artery
skeletonization results in lower mediastinal drainage after CABG than
pedicled LIMA harvesting. Copyright © 2021 The Society of
Thoracic Surgeons

<116>
Accession Number
2007552392
Title
Effect of music on patients with cardiovascular diseases and during
cardiovascular interventions: A systematic review.
Source
Wiener Klinische Wochenschrift. 133 (15-16) (pp 790-801), 2021. Date of
Publication: August 2021.
Author
Ho C.-Y.; Wexberg P.; Schneider B.; Stollberger C.
Institution
(Ho, Wexberg, Stollberger) Klinik Landstrase, Juchgasse 25, Vienna 1030,
Austria
(Schneider) Sana Kliniken Lubeck, Kahlhorststr. 17, Lubeck 23562, Germany
(Ho) Liechtensteinstr. 8/12, Vienna 1090, Austria
Publisher
Springer
Abstract
Background: The therapeutic effects of music have been known for thousands
of years. Recently, studies with music interventions in patients with
cardiovascular diseases yielded controversial results. The aim of this
review is to provide an overview of the effects of receptive music
intervention on the cardiovascular system. Method(s): We searched in
PubMed, SCOPUS and CENTRAL for publications between January 1980 and May
2018. Primary endpoints were heart rate, heart rate variability and blood
pressure. Secondary endpoints comprised respiratory rate, anxiety and
pain. The quality of the studies was assessed by using the CONSORT
statement and the Cochrane risk of bias assessment tool. A meta-analysis
and subgroup analyses concerning music style, gender and region were
planned. Result(s): A total of 29 studies comprising 2579 patients
were included and 18 studies with 1758 patients investigated the effect of
music on patients undergoing coronary angiography or open heart surgery.
Other studies applied music to children with congenital heart diseases,
pregnant women with hypertension or patients with unstable angina. Due to
high methodological study heterogeneity, a meta-analysis was not
performed. The study quality was assessed as medium to low. In ten studies
with higher quality comprising 1054 patients, music intervention was not
associated with significant changes in the cardiovascular endpoints
compared to the control group. The subgroup analyses did not demonstrate
any relevant results. Conclusion(s): Currently no definite effect of
receptive music intervention on the cardiovascular system can be verified.
Further research is needed to assess music as an inexpensive and easy
applicable form of therapy. Copyright © 2020, Springer-Verlag
GmbH Austria, part of Springer Nature.

<117>
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. Copyright © 2021 Cambridge University Press. All
rights reserved.

<118>
[Use Link to view the full text]
Accession Number
635625390
Title
Comparison of postprocedural new-onset atrial fibrillation between
transcatheter and surgical aortic valve replacement: A systematic review
and meta-analysis based on 16 randomized controlled trials.
Source
Medicine. 100 (28) (pp e26613), 2021. Date of Publication: 16 Jul 2021.
Author
Ding Y.; Wan M.; Zhang H.; Wang C.; Dai Z.
Institution
(Ding, Zhang, Wang, Dai) Medical Department
(Wan) Outpatient Department, Zhebei Mingzhou hospital, Huzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Presently, transcatheter aortic valve replacement (TAVR) as an
effective and convenient intervention has been adopted extensively for
patients with severe aortic disease. However, after surgical aortic valve
replacement (SAVR) and TAVR, the incidence of new-onset atrial
fibrillation (NOAF) is prevalently found. This meta-analysis was designed
to comprehensively compare the incidence of NOAF at different times after
TAVR and SAVR for patients with severe aortic disease. METHOD(S): A
systematic search of PubMed, Embase, Cochrane Library, and Web of Science
up to October 1, 2020 was conducted for relevant studies that comparing
TAVR and SAVR in the treatment of severe aortic disease. The primary
outcomes were the incidence of NOAF with early, midterm and long term
follow-up. The secondary outcomes included permanent pacemaker (PM)
implantation, myocardial infarction (MI), cardiogenic shock, as well as
mortality and other complications. Two reviewers assessed trial quality
and extracted the data independently. All statistical analyses were
performed using the standard statistical procedures provided in Review
Manager 5.2. RESULT(S): A total of 16 studies including 13,310
patients were identified. The pooled results indicated that, compared with
SAVR, TAVR experienced a significantly lower incidence of
30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk
ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23-0.41; 5725 pts),
0.30 (95% CI 0.24-0.39; 6321 pts), 0.48 (95% CI 0.38-0.61; 3441 pts), and
0.45 (95% CI 0.37-0.55; 2268 pts) respectively. In addition, TAVR showed
lower incidence of MI (RR 0.62; 95% CI 0.40-0.97) and cardiogenic shock
(RR 0.34; 95% CI 0.19-0.59), but higher incidence of permanent PM (RR
3.16; 95% CI 1.61-6.21) and major vascular complications (RR 2.22; 95% CI
1.14-4.32) at 30-day/in-hospital. At 1- and 2-year after procedure,
compared with SAVR, TAVR experienced a significantly higher incidence of
neurological events, transient ischemic attacks (TIA), permanent PM, and
major vascular complications, respectively. At 5-year after procedure,
compared with SAVR, TAVR experienced a significantly higher incidence of
TIA and re-intervention respectively. There was no difference in 30-day,
1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well
as stroke between TAVR and SAVR. CONCLUSION(S): Our analysis showed
that TAVR was superior to SAVR in decreasing the both short and long term
postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long
term mortality. In addition, TAVR showed lower incidence of
30-day/in-hospital MI and cardiogenic shock after procedure. However,
pooled results showed that TAVR was inferior to SAVR in reducing permanent
pacemaker implantation, neurological events, TIA, major vascular
complications, and re-intervention. Copyright © 2021 the
Author(s). Published by Wolters Kluwer Health, Inc.

<119>
[Use Link to view the full text]
Accession Number
635624811
Title
Individualized positive end-expiratory pressure (PEEP) during one-lung
ventilation for prevention of postoperative pulmonary complications in
patients undergoing thoracic surgery: A meta-analysis.
Source
Medicine. 100 (28) (pp e26638), 2021. Date of Publication: 16 Jul 2021.
Author
Li P.; Kang X.; Miao M.; Zhang J.
Institution
(Li) Department of Anesthesia and Perioperative Medicine, Zhengzhou
University People's Hospital, Henan Provincial People's Hospital,
Zhengzhou, Henan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Positive end-expiratory pressure (PEEP) is an important part
of the lung protection strategies for one-lung ventilation (OLV). However,
a fixed PEEP value is not suitable for all patients. Our objective was to
determine the prevention of individualized PEEP on postoperative
complications in patients undergoing one-lung ventilation. METHOD(S):
We searched the PubMed, Embase, and Cochrane and performed a meta-analysis
to compare the effect of individual PEEP vs fixed PEEP during single lung
ventilation on postoperative pulmonary complications. Our primary outcome
was the occurrence of postoperative pulmonary complications during
follow-up. Secondary outcomes included the partial pressure of arterial
oxygen and oxygenation index during one-lung ventilation. RESULT(S):
Eight studies examining 849 patients were included in this review. The
rate of postoperative pulmonary complications was reduced in the
individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37-0.73; P =
.0001). The partial pressure of arterial oxygen during the OLV in the
individualized PEEP group was higher with a mean difference 34.20 mm Hg
(95% CI: 8.92-59.48; P = .0004). Similarly, the individualized PEEP group
had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21-70.92; P <
.0001). CONCLUSION(S): Individualized PEEP setting during one-lung
ventilation in patients undergoing thoracic surgery was associated with
fewer postoperative pulmonary complications and better perioperative
oxygenation. Copyright © 2021 the Author(s). Published by Wolters
Kluwer Health, Inc.

<120>
Accession Number
2014100106
Title
Risk factors for postoperative delirium: An umbrella review of systematic
reviews.
Source
International Journal of Surgery. 93 (no pagination), 2021. Article
Number: 106063. Date of Publication: September 2021.
Author
Bramley P.; McArthur K.; Blayney A.; McCullagh I.
Institution
(Bramley) Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield
University, UK, United Kingdom
(McArthur, Blayney) University Hospitals Coventry and Warwickshire, UK,
United Kingdom
(McCullagh) Newcastle Upon Tyne NHS Trust and Newcastle University, UK,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Postoperative delirium (POD) is associated with increased
mortality, increased length of hospital stays and increased rates and
severity of subsequent cognitive decline including dementia. A wide range
of risk factors for POD have been suggested in the literature across
multiple surgical specialities. However few are validated and no accurate
prognostic models exist. We therefore aimed to map the existing evidence
regarding risk factors for POD to help guide future research by
undertaking an umbrella review of systematic reviews examining risk
factors for POD in any context. Material(s) and Method(s): We
systematically searched multiple medical databases for systematic reviews
examining the risk factors for POD in adults undergoing any surgery. We
then selected relevant reviews with minimal overlap in primary studies and
extracted information about individual risk factors. Result(s):
Thirty-five relevant reviews were identified of which ten were in trauma
and orthopaedic surgery patients (four exclusively examined hip
fractures), five were in cardiac surgery patients, and four were in
vascular surgery patients. Due to substantial overlap in reviews, eighteen
reviews were analysed in detail finding the widely examined and consistent
risk factors were increasing age, nursing home residency, pre-existing
cognitive impairment, psychiatric disorders, cerebrovascular disease, end
stage renal failure, low albumin, higher ASA score, and intra-operative
blood transfusion. Many other risk factors were examined, but they were
either not studied in multiple systematic reviews, or inconsistent either
in results or in categorisation (which for many factors was heterogenous
even within systematic reviews). There are also a large number of existing
prognostic models, many of which remain unvalidated. Conclusion(s):
Given the wealth of existing literature, future research should avoid
simple risk factor evaluation except for novel candidates, validate
existing prognostic models where possible, and instead focus on
interventional research. Copyright © 2021

<121>
Accession Number
2013481500
Title
Short- and long-term outcomes after heart transplantation in cardiac
sarcoidosis and giant-cell myocarditis: a systematic review and
meta-analysis.
Source
Clinical Research in Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Bobbio E.; Bjorkenstam M.; Nwaru B.I.; Giallauria F.; Hessman E.; Bergh
N.; Polte C.L.; Lehtonen J.; Karason K.; Bollano E.
Institution
(Bobbio, Bjorkenstam, Bergh, Karason, Bollano) Department of Cardiology,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Bobbio, Bjorkenstam, Bergh, Polte, Karason, Bollano) Institute of
Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Nwaru) Krefting Research Centre, Institute of Medicine, University of
Gothenburg, Gothenburg, Sweden
(Nwaru) Wallenberg Centre for Molecular and Translational Medicine,
University of Gothenburg, Gothenburg, Sweden
(Giallauria) Department of Translational Medical Sciences, 'Federico II'
University of Naples, Naples, Italy
(Hessman) Biomedical Library, Gothenburg University Library, University of
Gothenburg, Gothenburg, Sweden
(Polte) Departments of Clinical Physiology and Radiology, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Lehtonen) Heart and Lung Centre, Helsinki University and Helsinki
University Hospital, Helsinki, Finland
(Karason) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Heart transplantation (HTx) is a valid therapeutic option for end-stage
heart failure secondary to cardiac sarcoidosis (CS) or giant-cell
myocarditis (GCM). However, post-HTx outcomes in patients with
inflammatory cardiomyopathy (ICM) have been poorly investigated. We
searched PubMed, Scopus, Science Citation Index, EMBASE, and Google
Scholar, screened the gray literature, and contacted experts in the field.
We included studies comparing post-HTx survival, acute cellular rejection,
and disease recurrence in patients with and without ICM. Data were
synthesized by a random-effects meta-analysis. We screened 11,933
articles, of which 14 were considered eligible. In a pooled analysis,
post-HTx survival was higher in CS than non-CS patients after 1 year (risk
ratio [RR] 0.88, 95% confidence interval [CI] 0.60-1.17; I2 =
0%) and 5 years (RR 0.72, 95% CI 0.52-0.91; I2 = 0%), but
statistically significant only after 5 years. During the first-year
post-HTx, the risk of acute cellular rejection was similar for patients
with and without CS, but after 5 years, it was lower in those with CS (RR
0.38, 95% CI 0.03-0.72; I2 = 0%). No difference in post-HTx
survival was observed between patients with and without GCM after 1 year
(RR 1.16, 95% CI 0.05-2.28; I2 = 0%) or 5 years (RR 0.98, 95%
CI 0.42-1.54; I2 = 0%). During post-HTx follow-up, recurrence
of CS and GCM occurred in 5% and 8% of patients, respectively. Post-HTx
outcomes in patients with CS and GCM are comparable with cardiac
recipients with other heart failure etiologies. Patients with ICM should
not be disqualified from HTx. Graphic abstract: [Figure not available: see
fulltext.] Copyright © 2021, The Author(s).

<122>
Accession Number
635756748
Title
Long-term 5-year outcome of the randomized IMPRESS in severe shock trial:
percutaneous mechanical circulatory support vs. intra-aortic balloon pump
in cardiogenic shock after acute myocardial infarction.
Source
European heart journal. Acute cardiovascular care. (no pagination), 2021.
Date of Publication: 29 Jul 2021.
Author
Karami M.; Eriksen E.; Ouweneel D.M.; Claessen B.E.; Vis M.M.; Baan J.;
Beijk M.; Packer E.J.S.; Sjauw K.D.; Engstrom A.; Vlaar A.; Lagrand W.K.;
Henriques J.P.S.
Institution
(Karami, Ouweneel, Claessen, Vis, Baan, Beijk, Engstrom, Henriques)
Department of Interventional Cardiology, Heart Center, Amsterdam
Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, AZ
Amsterdam 1105, Netherlands
(Eriksen, Packer) Department of Heart Disease, Haukeland University
Hospital, Jonas Lies vei 65, Bergen 5021, Norway
(Claessen) Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar,
Netherlands
(Sjauw) Department of Cardiology, Medical Center Leeuwarden, Henri
Dunantweg 2, AD Leeuwarden 8934, Netherlands
(Engstrom) Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
(Vlaar, Lagrand) Department of Intensive Care, University of Amsterdam,
Meibergdreef 9, AZ Amsterdam 1105, Netherlands
Publisher
NLM (Medline)
Abstract
AIMS: To assess differences in long-term outcome and functional status of
patients with cardiogenic shock (CS) treated by percutaneous mechanical
circulatory support (pMCS) and intra-aortic balloon pump (IABP). METHODS
AND RESULTS: Long-term follow-up of the multicentre, randomized IMPRESS in
Severe Shock trial (NTR3450) was performed 5-year after initial
randomization. Between 2012 and 2015, a total of 48 patients with severe
CS from acute myocardial infarction (AMI) with ST-segment elevation
undergoing immediate revascularization were randomized to pMCS by Impella
CP (n=24) or IABP (n=24). For the 5-year assessment, all-cause mortality,
functional status, and occurrence of major adverse cardiac and
cerebrovascular event (MACCE) were assessed. MACCE consisted of death,
myocardial re-infarction, repeat percutaneous coronary intervention,
coronary artery bypass grafting, and stroke. Five-year mortality was 50%
(n=12/24) in pMCS patients and 63% (n=15/24) in IABP patients (relative
risk 0.87, 95% confidence interval 0.47-1.59, P=0.65). MACCE occurred in
12/24 (50%) of the pMCS patients vs. 19/24 (79%) of the IABP patients
(P=0.07). All survivors except for one were in New York Heart Association
Class I/II [pMCS n=10 (91%) and IABP n=7 (100%), P=1.00] and none of the
patients had residual angina. There were no differences in left
ventricular ejection fraction between the groups (pMCS 52+/-11% vs. IABP
48+/-10%, P=0.53). CONCLUSION(S): In this explorative randomized
trial of patients with severe CS after AMI, there was no difference in
long-term 5-year mortality between pMCS and IABP-treated patients,
supporting previously published short-term data and in accordance with
other long-term CS trials. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<123>
Accession Number
635756199
Title
The efficacy of three-dimensional video-assisted thoracic surgery on
treating lung cancer: An exploratory meta-analysis.
Source
Asian journal of surgery. (no pagination), 2021. Date of Publication: 27
Jul 2021.
Author
Lin H.-H.; Zhou K.; Peng Z.-Y.; Mei J.-D.
Institution
(Lin, Zhou, Peng, Mei) Department of Thoracic Surgery, West China
Hospital, Sichuan University, Chengdu, 610041, PR China; Western China
Collaborative Innovation Center for Early Diagnosis and Multidisciplinary
Therapy of Lung Cancer, Sichuan University, Chengdu, China
Publisher
NLM (Medline)

<124>
Accession Number
635755885
Title
The association between advanced practice nursing roles and outcomes in
adults following cardiac surgery: A systematic review of randomized
controlled trials.
Source
International journal of nursing studies. 122 (pp 104028), 2021. Date of
Publication: 03 Jul 2021.
Author
Audet L.-A.; Paquette L.; Bordeleau S.; Lavoie-Tremblay M.; Kilpatrick K.
Institution
(Audet, Bordeleau, Lavoie-Tremblay) Faculty of Medicine, McGill
University, Ingram School of Nursing, 680 Sherbrooke West, Suite 1800,
Montreal, Canada
(Paquette) Faculte des sciences infirmieres, Pavillon
Marguerite-d'Youville, Universite de Montreal ,2375 chemin de la
Cote-Ste-Catherine, Montreal, Canada
(Kilpatrick) Centre integre universitaire de sante et de services sociaux
de l'Est-de-l'Ile-de-Montreal-Hopital Maisonneuve-Rosemont
(CIUSSS-EMTL-HMR), 5415, boulevard de l'Assomption, Montreal, QC H1T 2M4,
Canada; Susan E. French Chair in Nursing Research and Innovative Practice,
Faculty of Medicine, McGill University, Ingram School of Nursing, 680
Sherbrooke West, Suite 1800, Montreal, QC H4A 2M7, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Empirical findings have shown significant and non-significant
effects of advanced practice nursing roles within postoperative cardiac
settings. The inconsistencies of the current literature preclude the
identification of a significant effect of advanced practice nursing roles
on patient and organizational outcomes. OBJECTIVE(S): 1) identify
patient and organizational outcomes of advanced practice nursing roles in
postoperative cardiac surgery and 2) synthesize the evidence of current
roles of advanced practice nurses in postoperative cardiac surgery to
provide the best quality of care for patients. METHOD(S): A
systematic review of randomized controlled trials was conducted in six
electronic databases, including Medline, CINHAL, Embase, Cochrane
Database, Joanna Briggs Database and Web of Science, and the grey
literature. Randomized controlled trials published after 1999 were
included if they examined advanced practice nursing roles and recruited
patients who underwent cardiac surgery. The study selection was performed
by two independent reviewers, and consensus was achieved with a third
reviewer. Data extraction was conducted by one reviewer and revised by a
second reviewer. The methodological quality of the included studies was
assessed with the Evidence Project risk of bias tool by two independent
reviewers and revised by a third reviewer. A narrative synthesis of the
available evidence was completed. No meta-analysis technique was attempted
because of the high heterogeneity of the included studies. RESULT(S):
Among 4,448 retrieved papers, ten randomized controlled trials and three
secondary analyses were included in this review. The methodological
quality of the included studies was moderate. All studies included a
comparison group and the majority of the studies collected data using a
blinded researcher. However, all studies were based on small sample sizes
and failed to randomly recruit participants. Five studies implemented
nurse practitioner roles and five studies implemented clinical nurse
specialist roles. The advanced practice nursing care included health
condition management, lifestyle promotion and coping strategies with
patients. A total of 22 outcomes were identified, including 13 patient
outcomes (e.g., depressive symptoms) and nine organizational outcomes
(e.g., rehospitalization after discharge). Each outcome was examined in
one to five studies. All of the included outcomes were associated with
inconsistent findings. CONCLUSION(S): The findings from existing
literature remain inconsistent. The high risk of bias and the small sample
sizes could potentially explain the non-significant findings. Avenues for
future research should focus on the development of methodologically
high-quality studies with larger sample sizes to enhance our understanding
of the effectiveness of advanced practice nursing roles. Copyright
© 2021 Elsevier Ltd. All rights reserved.

<125>
Accession Number
635755560
Title
Hemodynamic impact of increasing time between fentanyl and propofol
administration during anesthesia induction: a randomised, clinical trial.
Source
Brazilian journal of anesthesiology (Elsevier). (no pagination), 2021.
Date of Publication: 26 Jul 2021.
Author
Vullo P.A.; Navacerrada M.I.R.; Suay R.N.
Institution
(Vullo, Suay) Hospital Central de la Defensa Gomez Ulla-IMIDEF, Critical
Care and Pain Unit, Department of Anesthesia, Madrid, Spain
(Navacerrada) Critical Care and Pain Unit, Department of Anesthesia,
Hospital Universitario 12 de Octubre, Madrid, Spain
Publisher
NLM (Medline)
Abstract
BACKGROUND AND OBJECTIVE: Anesthesia induction can produce severe propofol
dose-dependent hypotension. Fentanyl coadministration reduces the
catecholaminergic response to orotracheal intubation allowing propofol
dose reduction. The aim of this study is to determine whether the
hemodynamic response is improved by increasing the time between fentanyl
and propofol administration and reducing the dose of the latter without
increasing the time to achieve optimal hypnosis. METHOD(S): After
approval by the Research Ethics Committee, patients undergoing non-cardiac
surgery with endotracheal intubation were randomized by a
computer-generated table into six time-dose groups (1 or 2minutes/ 1, 1.5,
or 2mg.kg-1 of propofol). Patients with high bronchoaspiration risk, a
difficult airway, hemodynamic instability, or anesthetic allergies were
excluded. After giving intravenous fentanyl (2mug.kg-1), each group
received different doses of propofol after 1 or 2minutes. Non-invasive
blood pressure (BP) and heart rate (HR) were measured at pre-induction,
pre-intubation, and post-intubation. Time to hypnosis (bispectral index <
60) was also recorded. RESULT(S): Of the 192 recruited patients, 186
completed the study (1min group n=94; 2min group n=92). It was observed
that HR and BP decreased after propofol administration and increased after
intubation in all groups (p< 0.0001). In patients over 55 years, the 2 min
- 2 mg.kg-1 group showed the greatest systolic BP reduction (36+/-12%) at
pre-intubation, while the 1min-1.5mg.kg-1 group showed the least
hemodynamic alteration between pre- and post-intubation (-4+/-13%). No
significant differences were found in younger patients or in the time to
reach hypnosis between the six groups. While no cases of severe
bradycardia were recorded, 5,4% of the sample required vasopressors.
 CONCLUSION(S): Increasing the time between the administration of
fentanyl and propofol by up to two minutes results in greater hypotension
in patients over 55 years. Copyright © 2021 Sociedade Brasileira
de Anestesiologia. Published by Elsevier Editora Ltda. All rights
reserved.

<126>
Accession Number
635755524
Title
Analgesic effect of intercostal nerve block given preventively or at the
end of operation in video-assisted thoracic surgery: a randomized clinical
trial.
Source
Brazilian journal of anesthesiology (Elsevier). (no pagination), 2021.
Date of Publication: 26 Jul 2021.
Author
Xiao W.; Zhou W.; Chen X.; Zhu J.; Xue Q.; Shi J.
Institution
(Xiao, Shi) Affiliated Hospital of Nantong University, Department of
Cardiothoracic Surgery, Nantong, China; Affiliated Hospital of Nantong
University, Nantong Key Laboratory of Translational Medicine in
Cardiothoracic Diseases, Nantong, China
(Zhou, Xue) Affiliated Hospital of Nantong University, Department of
Anaesthesiology, Nantong, China
(Chen, Zhu) Affiliated Hospital of Nantong University, Department of
Cardiothoracic Surgery, Nantong, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To compare the analgesic effect of intercostal nerve block
(INB) with ropivacaine when given preventively or at the end of the
operation in patients undergoing video-assisted thoracic surgery (VATS).
 METHOD(S): A total of 50 patients undergoing VATS were randomly
divided into two groups. The patients in the preventive analgesia group
(PR group) were given INB with ropivacaine before the intrathoracic
manipulation combined with patient-controlled analgesia (PCA). The
patients in the post-procedural block group (PO group) were administered
INB with ropivacaine at the end of the operation combined with PCA. To
evaluate the analgesic effect, postoperative pain was assessed with the
visual analogue scale (VAS) at rest and Prince Henry Pain Scale (PHPS)
scale at 6, 12, 24, 48, and 72hours after surgery. RESULT(S): At 6h
and 12h post-surgery, the VAS at rest and PHPS scores in the PR group were
significantly lower than those in the PO group. There were no significant
differences in pain scores between two groups at 24, 48, and 72hours
post-surgery. CONCLUSION(S): In patients undergoing VATS, preventive
INB with ropivacaine provided a significantly better analgesic effect in
the early postoperative period (at least through 12h post-surgery) than
did INB given at the end of surgery. Copyright © 2021. Published
by Elsevier Editora Ltda.

<127>
Accession Number
635749236
Title
A Systematic Review and Meta-analysis of Randomized Controlled Trials
Comparing Intraoperative Red Blood Cell Transfusion Strategies.
Source
Annals of surgery. (no pagination), 2021. Date of Publication: 12 May
2021.
Author
Lenet T.; Baker L.; Park L.; Vered M.; Zahrai A.; Shorr R.; Davis A.;
McIsaac D.I.; Tinmouth A.; Fergusson D.A.; Martel G.
Institution
(Lenet, Baker, Park, Vered, Zahrai, Fergusson, Martel) Department of
Surgery, Ottawa Hospital, University of Ottawa, ON, Ottawa, Canada
(Lenet, Baker, McIsaac, Tinmouth, Fergusson, Martel) Clinical Epidemiology
Program, Ottawa Hospital Research Institute, ON, Ottawa, Canada
(Shorr, Davis) Library Services, Ottawa Hospital, ON, Ottawa, Canada
(McIsaac) Department of Anesthesiology, Ottawa Hospital, University of
Ottawa, ON, Ottawa, Canada
(Tinmouth, Fergusson) Department of Medicine, Ottawa Hospital, University
of Ottawa, ON, Ottawa, Canada
(Tinmouth, Fergusson) Canadian Blood Services, ON, Ottawa, Canada
Publisher
NLM (Medline)
Abstract
Objective: The objective of this work was to carry out a meta-analysis of
RCTs comparing intraoperative RBC transfusion strategies to determine
their impact on postoperative morbidity, mortality, and blood product use.
Summary of Background Data: RBC transfusions are common in surgery and
associated with widespread variability despite adjustment for casemix.
Evidence-based recommendations guiding RBC transfusion in the operative
setting are limited. Method(s): The search strategy was adapted from
a previous Cochrane Review. Electronic databases were searched from
January 2016 to February 2021. Included studies from the previous Cochrane
Review were considered for eligibility from before 2016. RCTs comparing
intraoperative transfusion strategies were considered for inclusion.
Co-primary outcomes were 30-day mortality and morbidity. Secondary
outcomes included intraoperative and perioperative RBC transfusion.
Meta-analysis was carried out using random-effects models. Result(s):
Fourteen trials (8641 patients) were included. One cardiac surgery trial
accounted for 56% of patients. There was no difference in 30-day mortality
[relative risk (RR) 0.96, 95% confidence interval (CI) 0.71-1.29] and
pooled postoperative morbidity among the studied outcomes when comparing
restrictive and liberal protocols. Two trials reported worse composite
outcomes with restrictive triggers. Intraoperative (RR 0.53, 95% CI
0.43-0.64) and perioperative (RR 0.70, 95% CI 0.62-0.79) blood
transfusions were significantly lower in the restrictive group compared to
the liberal group. Conclusion(s): Intraoperative restrictive
transfusion strategies decreased perioperative transfusions without added
postoperative morbidity and mortality in 12/14 trials. Two trials reported
worse outcomes. Given trial design and generalizability limitations,
uncertainty remains regarding the safety of broad application of
restrictive transfusion triggers in the operating room. Trials
specifically designed to address intraoperative transfusions are urgently
needed. Copyright (C) 2021 Wolters Kluwer Health, Inc. All rights
reserved.

<128>
Accession Number
635747148
Title
Neurocognitive, Quality of Life, and Behavioral Outcomes for Patients With
Covert Stroke After Cardiac Surgery: Exploratory Analysis of Data From a
Prospectively Randomized Trial.
Source
Anesthesia and analgesia. (no pagination), 2021. Date of Publication: 28
Jul 2021.
Author
Lewis C.; Levine A.; Balmert L.C.; Chen L.; Sherwani S.S.; Nemeth A.J.;
Grafman J.; Gottesman R.; Brown C.H.; Hogue C.W.
Institution
(Lewis, Levine, Sherwani, Hogue) From the Department of Anesthesiology
(Balmert, Chen) Division of Biostatistics, Department of Preventive
Medicine
(Nemeth) Department of Radiology
(Grafman) Shirley Ryan Abilitylab and the Department of Rehabilitation and
Physical Medicine, Northwestern University Feinberg School of Medicine,
Chicago, IL, Mexico
(Gottesman) Department of Neurology
(Brown) Department of Anesthesiology & Critical Care, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Asymptomatic brain ischemic injury detected with
diffusion-weighted magnetic resonance imaging (DWI) is reported in more
than one-half of patients after cardiac surgery. There are conflicting
findings on whether DWI-detected covert stroke is associated with
neurocognitive dysfunction after surgery, and it is unclear whether such
ischemic injury affects quality of life or behavioral outcomes. The
purpose of this study was to perform exploratory analysis on whether
covert stroke after cardiac surgery is associated with delayed
neurocognitive recovery 1 month after surgery, impaired quality of life,
anxiety, or depression. METHOD(S): Analysis of data collected in a
prospectively randomized study in patients undergoing cardiac surgery
testing whether basing mean arterial pressure (MAP) targets during
cardiopulmonary bypass to be above the lower limit of cerebral
autoregulation versus usual practices reduces the frequency of adverse
neurological outcomes. A neuropsychological testing battery was
administered before surgery and then 1 month later. Patients underwent
brain magnetic resonance imaging (MRI) between postoperative days 3 and 5.
The primary outcome was DWI-detected ischemic lesion; the primary end
point was change from baseline in domain-specific neurocognitive Z scores
1 month after surgery. Secondary outcomes included a composite indicator
of delayed neurocognitive recovery, quality of life measures, state and
trait anxiety, and Beck Depression Inventory scores. RESULT(S): Of
the 164 patients with postoperative MRI data, clinical stroke occurred in
10 patients. Of the remaining 154 patients, 85 (55.2%) had a covert
stroke. There were no statistically significant differences for patients
with or without covert stroke in the change from baseline in Z scores in
any of the cognitive domains tested adjusted for sex, baseline cognitive
score, and randomization treatment arm. The frequency of delayed
neurocognitive recovery (no covert stroke, 15.1%; covert stroke, 17.6%; P
= .392), self-reported quality of life measurements, anxiety rating, or
depression scores were not different between those with or without DWI
ischemic injury. CONCLUSION(S): More than one-half of patients
undergoing cardiac surgery demonstrated covert stroke. In this exploratory
analysis, covert stroke was not found to be significantly associated with
neurocognitive dysfunction 1 month after surgery; evidence of impaired
quality of life, anxiety, or depression, albeit a type II error, cannot be
excluded. Copyright © 2021 International Anesthesia Research
Society.

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