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<1>
Accession Number
2005928593
Title
Ecmo in cardiac arrest: A narrative review of the literature.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-15), 2021. Article Number: 534.
Date of Publication: 01 Feb 2021.
Author
De Charriere A.; Assouline B.; Scheen M.; Mentha N.; Banfi C.; Bendjelid
K.; Giraud R.
Institution
(De Charriere, Assouline, Scheen, Bendjelid, Giraud) Intensive Care Unit,
Geneva University Hospitals, Geneva 1205, Switzerland
(De Charriere, Assouline, Scheen, Mentha, Banfi, Bendjelid, Giraud)
Faculty of Medicine, University of Geneva, Geneva 1205, Switzerland
(Banfi, Bendjelid, Giraud) Geneva Hemodynamic Research Group, Geneva 1206,
Switzerland
(Banfi) Department of Cardio-Thoracic Surgery, Istituto Clinico
Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, and Chair of Cardiac
Surgery, University of Milan, Milan 20149, Italy
Publisher
MDPI AG
Abstract
Cardiac arrest (CA) is a frequent cause of death and a major public health
issue. To date, conventional cardiopulmonary resuscitation (CPR) is the
only efficient method of resuscitation available that positively impacts
prognosis. Extracorporeal membrane oxygenation (ECMO) is a complex and
costly technique that requires technical expertise. It is not considered
standard of care in all hospitals and should be applied only in
high-volume facilities. ECMO combined with CPR is known as ECPR
(extracorporeal cardiopulmonary resuscitation) and permits hemodynamic and
respiratory stabilization of patients with CA refractory to conventional
CPR. This technique allows the parallel treatment of the underlying
etiology of CA while maintaining organ perfusion. However, current
evidence does not support the routine use of ECPR in all patients with
refractory CA. Therefore, an appropriate selection of patients who may
benefit from this procedure is key. Reducing the duration of low blood
flow by means of performing high-quality CPR and promoting access to ECPR,
may improve the survival rate of the patients presenting with refractory
CA. Indeed, patients who benefit from ECPR seem to carry better
neurological outcomes. The aim of this present narrative review is to
present the most recent literature available on ECPR and to clarify its
potential therapeutic role, as well as to provide an in-depth explanation
of equipment and its set up, the patient selection process, and the
patient management post-ECPR. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<2>
Accession Number
2005928580
Title
Low-intensity resistance training with moderate blood flow restriction
appears safe and increases skeletal muscle strength and size in
cardiovascular surgery patients: A pilot study.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-13), 2021. Article Number: 547.
Date of Publication: 01 Feb 2021.
Author
Ogawa H.; Nakajima T.; Shibasaki I.; Nasuno T.; Kaneda H.; Katayanagi S.;
Ishizaka H.; Mizushima Y.; Uematsu A.; Yasuda T.; Yagi H.; Toyoda S.;
Hortobagyi T.; Mizushima T.; Inoue T.; Fukuda H.
Institution
(Ogawa, Shibasaki, Fukuda) Department of Cardiovascular Surgery, School of
Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293,
Japan
(Nakajima, Nasuno, Kaneda, Yagi, Toyoda, Inoue) Department of
Cardiovascular Medicine, School of Medicine, Dokkyo Medical University,
Shimotsuga-gun, Tochigi 321-0293, Japan
(Nakajima) Department of Medical KAATSU Training, Dokkyo Medical
University, Shimotsuga-gun, Tochigi 321-0293, Japan
(Katayanagi, Ishizaka, Mizushima, Mizushima) Department of Rehabilitation,
Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi 321-0293,
Japan
(Uematsu) Department of Health and Sport Sciences, Premedical Sciences,
Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan
(Yasuda) School of Nursing, Seirei Christopher University, Shizuoka,
Hamamatsu 433-8558, Japan
(Hortobagyi) University Medical Center Groningen, University of Groningen,
Groningen, Groningen 9713 GZ, Netherlands
Publisher
MDPI AG
Abstract
We examined the safety and the effects of low-intensity resistance
training (RT) with moderate blood flow restriction (KAATSU RT) on muscle
strength and size in patients early after cardiac surgery. Cardiac
patients (age 69.6 +/- 12.6 years, n = 21, M = 18) were randomly assigned
to the control (n = 10) and the KAATSU RT group (n = 11). All patients had
received a standard aerobic cardiac rehabilitation program. The KAATSU RT
group additionally executed low-intensity leg extension and leg press
exercises with moderate blood flow restriction twice a week for 3 months.
RT-intensity and volume were increased gradually. We evaluated the
anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI),
handgrip strength, knee extensor strength, and walking speed at baseline,
5-7 days after cardiac surgery, and after 3 months. A physician monitored
the electrocardiogram, rate of perceived exertion, and the color of the
lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer
were measured at baseline and after 3 months. There were no side effects
during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI,
walking speed, and knee extensor strength increased after 3 months with
KAATSU RT compared with baseline. Relatively low vs. high physical
functioning patients tended to increase physical function more after 3
months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard
cardiac rehabilitation can safely increase skeletal muscle strength and
size in cardiovascular surgery patients. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<3>
Accession Number
2005866690
Title
Impact of chronic kidney disease on chronic total occlusion
revascularization outcomes: A meta-analysis.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-9), 2021. Article Number: 440.
Date of Publication: 01 Feb 2021.
Author
Lee W.-C.; Wu P.-J.; Fang C.-Y.; Chen H.-C.; Wu C.-J.; Fang H.-Y.
Institution
(Lee, Wu, Fang, Chen, Wu, Fang) Division of Cardiology, Department of
Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung
University College of Medicine, Kaohsiung 83301, Taiwan (Republic of
China)
(Lee) Institute of Clinical Medicine, College of Medicine, National Cheng
Kung University, Tainan 83301, Taiwan (Republic of China)
Publisher
MDPI AG
Abstract
Objectives: To examine the impact of revascularization and associated
clinical outcomes of chronic kidney disease (CKD) chronic total occlusion
(CTO) and non-CKD CTO groups. Background(s): The influence of CKD on
clinical outcomes after percutaneous coronary intervention (PCI) for CTO
lesions is unknown, and there is no systemic review of this topic to date.
 Method(s): We searched the PubMed, Embase, ProQuest, ScienceDirect,
Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov
databases for articles published between 1 January 2010 and 31 March 2020.
CKD was defined as estimated glomerular filtration rate of <60 mL/min/1.73
m2 according to the Modification of Diet in Renal Disease
formula. Data included demographics, lesion distributions, incidence of
contrast-induced nephropathy (CIN), acute kidney injury (AKI), procedural
success rate, mortality, and target lesion revascularization (TLR)/target
vessel revascularization (TVR). Result(s): Six studies were
ultimately included in this systematic review. A high prevalence (25.5%;
range, 19.6-37.9%) of CKD was noted in the CTO population. In the non-CKD
group, outcomes were better: less incidence of CIN or AKI (odds ratio
(OR), 2.860; 95% confidence interval (CI), 1.775-4.608), higher procedural
success rate (OR, 1.382; 95% CI, 1.036-1.843), and lower long-term
mortality (OR, 4.502; 95% CI, 3.561-5.693). The incidence of TLR/TVR (OR,
1.118; 95% CI, 0.888-1.407) did not differ between groups.
 Conclusion(s): In the CKD CTO PCI population, a lower procedural
success rate, a higher incidence of CIN or AKI, and higher in-hospital and
long-term mortality rate were noted due to more complex lesions and more
comorbidities. However, the incidence of TLR/TVR did not differ between
groups. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<4>
Accession Number
2005860894
Title
Perioperative individualized goal directed therapy for cardiac surgery: A
historical-prospective, comparative effectiveness study.
Source
Journal of Clinical Medicine. 10 (3) (pp 1-11), 2021. Article Number: 400.
Date of Publication: January 2021.
Author
Ramsingh D.; Hu H.; Yan M.; Lauer R.; Rabkin D.; Gatling J.; Floridia R.;
Martinez M.; Dorotta I.; Razzouk A.
Institution
(Ramsingh, Hu, Yan, Lauer, Gatling, Martinez, Dorotta) Department of
Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA
92354, United States
(Rabkin, Floridia, Razzouk) Department of Cardiothoracic Surgery, Loma
Linda University Medical Center, Loma Linda, CA 92354, United States
Publisher
MDPI AG
Abstract
Introduction: Cardiac surgery patients are at increased risk for
post-operative complications and prolonged length of stay. Perioperative
goal directed therapy (GDT) has demonstrated utility for non-cardiac
surgery, however, GDT is not common for cardiac surgery. We initiated a
quality improvement (QI) project focusing on the implementation of a GDT
protocol, which was applied from the immediate post-bypass period into the
intensive care unit (ICU). Our hypothesis was that this novel GDT protocol
would decrease ICU length of stay and possibly improve postoperative
outcomes. Method(s): This was a historical prospective, QI study for
patients undergoing cardiac surgery requiring cardiopulmonary bypass
(CPB). Integral to the QI project was education towards all associated
providers on the concepts related to GDT. The protocol involved
identifying patient specific targets for cardiac index and mean arterial
pressure. These targets were maintained from the post-CPB period to the
first 12 h in the ICU. Statistical comparisons were performed between the
year after GDT therapy was launched to the last two years prior to
protocol implementation. The primary outcome was ICU length of stay.
 Result(s): There was a significant decrease in ICU length of stay
when comparing the year after the protocol initiation to years prior, from
a median of 6.19 days to 4 days (2017 vs. 2019, p < 0.0001), and a median
of 5.88 days to 4 days (2018 vs. 2019, p < 0.0001). Secondary outcomes
demonstrated a significant reduction in total administered volumes of
inotropic medication(milrinone). All other vasopressors demonstrated no
differences across years. Hospital length of stay comparisons did not
demonstrate a significant reduction. Conclusion(s): These results
suggest that an individualized goal directed therapy for cardiac surgery
patients can reduce ICU length of stay and decrease amount of inotropic
therapy. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<5>
Accession Number
2007134768
Title
High flow oxygen therapy at two initial flow settings versus conventional
oxygen therapy in cardiac surgery patients with postextubation hypoxemia:
A single-center, unblinded, randomized, controlled trial.
Source
Journal of Clinical Medicine. 10 (10) (no pagination), 2021. Article
Number: 2079. Date of Publication: 02 May 2021.
Author
Theologou S.; Ischaki E.; Zakynthinos S.G.; Charitos C.; Michopanou N.;
Patsatzis S.; Mentzelopoulos S.D.
Institution
(Theologou, Charitos, Michopanou, Patsatzis) Department of Cardiac
Surgery, Evaggelismos General Hospital, Athens 10675, Greece
(Ischaki, Zakynthinos, Mentzelopoulos) First Department of Intensive Care
Medicine, National and Kapodistrian University of Athens Medical School,
Evaggelismos General Hospital, Athens 10675, Greece
Publisher
MDPI AG
Abstract
In cardiac surgery patients with pre-extubation PaO<inf>2</inf> /inspired
oxygen fraction (FiO<inf>2</inf> ) < 200 mmHg, the possible benefits and
optimal level of high-flow nasal cannula (HFNC) support are still unclear;
therefore, we compared HFNC support with an initial gas flow of 60 or 40
L/min and conventional oxygen therapy. Ninety nine patients were randomly
allocated (respective ratio: 1:1:1) to I = intervention group 1 (HFNC
initial flow = 60 L/min, FiO<inf>2</inf> = 0.6), intervention group 2
(HFNC initial flow = 40 L/min, FiO<inf>2</inf> = 0.6), or control group
(Venturi mask, FiO<inf>2</inf> = 0.6). The primary outcome was occurrence
of treatment failure. The baseline characteristics were similar. The
hazard for treatment failure was lower in intervention group 1 vs. control
(hazard ratio (HR): 0.11, 95% CI: 0.03-0.34) and intervention group 2 vs.
control (HR: 0.30, 95% CI: 0.12-0.77). During follow-up, the probability
of peripheral oxygen saturation (SpO<inf>2</inf> ) > 92% and respiratory
rate within 12-20 breaths/min was 2.4-3.9 times higher in intervention
group 1 vs. the other 2 groups. There was no difference in PaO<inf>2</inf>
/FiO<inf>2</inf>, patient comfort, intensive care unit or hospital stay,
or clinical course complications or adverse events. In hypoxemic cardiac
surgery patients, postextubation HFNC with an initial gas flow of 60 or 40
L/min resulted in less frequent treatment failure vs. conventional
therapy. The results in terms of SpO<inf>2</inf> /respiratory rate targets
favored an initial HFNC flow of 60 L/min. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<6>
Accession Number
2007825121
Title
Surgical aortic mitral curtain replacement: Systematic review and
metanalysis of early and long-term results.
Source
Journal of Clinical Medicine. 10 (14) (no pagination), 2021. Article
Number: 3163. Date of Publication: 02 Jul 2021.
Author
Giambuzzi I.; Bonalumi G.; Di Mauro M.; Roberto M.; Corona S.; Alamanni
F.; Zanobini M.
Institution
(Giambuzzi, Bonalumi, Roberto, Corona, Alamanni, Zanobini) IRCCS Centro
Cardiologico Monzino, Department of Cardiovascular Surgery, Milan 20100,
Italy
(Giambuzzi, Corona, Alamanni) DISCCO Department, University of Milan,
Milan 20100, Italy
(Di Mauro) Heart and Vascular Centre, Cardio-Thoracic Surgery Unit,
Maastricht University Medical Centre (MUMC), 9 Cardiovascular Research
Institute Maastricht (CARIM), Maastricht 6221, Netherlands
Publisher
MDPI AG
Abstract
The Commando procedure is challenging, and aims to replace the mitral
valve, the aortic valve and the aortic mitral curtain, when the latter is
severely affected by pathological processes (such as infective
endocarditis or massive calcification). Given the high complexity, it is
seldomly performed. We aim to review the literature on early
(hospitalization and up to 30 days) and long-term (at least 3 years of
follow-up) results. Bibliographical research was performed on PubMed and
Cochrane with a dedicated string. Papers regarding double valve
replacement or repair in the con-text of aortic mitral curtain disease
were included. The metaprop function was used to assess early survival and
complications (pacemaker implantation, stroke and bleeding). Nine papers
(540 pa-tients, median follow-up 41 (IQR 24.5-51.5) months) were included
in the study. Pooled proportion of early mortality, stroke, pacemaker
implant and REDO for bleeding were, respectively 16.2%, 7.8%, 25.1% and
13.1%. The long-term survival rate ranged from 50% to 92.2%. Freedom from
re-intervention was as high as 90.9% when the endocarditis was not the
first etiology and 78.6% in case of valvular infection (one author had
100%). Freedom from IE recurrences reached 85% at 10 years. Despite the
high mortality, the rates of re-intervention and infective endocarditis
recurrences following the Commando procedure are satisfactory and confirm
the need for an aggressive strategy to improve long-term
outcomes. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<7>
Accession Number
2005604918
Title
Safety and efficacy of minimum-or zero-contrast ivus-guided percutaneous
coronary interventions in chronic kidney disease patients: A systematic
review.
Source
Journal of Clinical Medicine. 10 (9) (no pagination), 2021. Article
Number: 1996. Date of Publication: 01 May 2021.
Author
Burlacu A.; Tinica G.; Brinza C.; Crisan-Dabija R.; Popa I.V.; Covic A.
Institution
(Burlacu, Tinica, Brinza) Institute of Cardiovascular Diseases "Prof. Dr.
George I.M. Georgescu", Iasi 700503, Romania
(Burlacu, Tinica, Crisan-Dabija, Popa, Covic) Faculty of Medicine,
University of Medicine and Pharmacy "Grigore T Popa", Iasi 700115, Romania
(Burlacu, Covic) Medical Sciences Academy, Bucharest 030167, Romania
(Crisan-Dabija) Pulmonology Department, Clinic of Pulmonary Diseases, Iasi
700115, Romania
(Covic) Nephrology Clinic, Dialysis, Renal Transplant Center, C.I. Parhon"
University Hospital, Iasi 700503, Romania
Publisher
MDPI AG
Abstract
Conventional percutaneous coronary interventions (PCIs) frequently cause
severe complications in chronic kidney disease (CKD) patients. Low-to-zero
contrast intravascular ultrasound (IVUS) guided PCIs are promising
alternatives in the CKD setting. We aim to systematically review
up-to-date literature that have reported data and outcomes of low-to-zero
contrast PCIs performed in CKD patients. We searched Embase, PubMed, and
Cochrane databases for full-text articles that reported original data
regarding efficacy and/or safety outcomes of IVUSguided PCIs in patients
with CKD. The quality of non-randomized trials included was assessed using
the Newcastle-Ottawa scale. Six papers were included in the present
systematic review: One non-randomized trial, two case series, and three
case reports. Given the literature reported so far, contrast-free and
IVUS-guided PCI procedures in patients with CKD appear to be safe (both in
cardiac and renal outcomes) with a comparable efficacy to the conventional
procedure, even in complex atherosclerotic lesions. No patient included in
the mentioned studies showed renal function deterioration and did not need
renal replacement therapy after the zero-contrast IVUSguided percutaneous
procedures. From a cardiovascular point of view, this technique proved to
be safe in terms of cardiovascular outcomes. The undesirable consequences
of conventional PCI in the CKD population might soon be effectively
hampered by safer low-to-zero contrast IVUS-guided PCI procedures after a
mandatory and rigorous evidence-based validation in long-awaited
randomized controlled trials. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<8>
Accession Number
2003583404
Title
Predicting mortality with cardiac troponins: Recent insights from
meta-analyses.
Source
Diagnosis. 8 (1) (no pagination), 2021. Date of Publication: 01 Feb 2021.
Author
Lippi G.; Cervellin G.; Sanchis-Gomar F.
Institution
(Lippi) Section of Clinical Biochemistry, University of Verona, Piazzale
LA Scuro, Verona 37134, Italy
(Cervellin) Emergency Department, University Hospital of Parma, Parma,
Italy
(Sanchis-Gomar) Department of Physiology, Faculty of Medicine, University
of Valencia, INCLIVA Biomedical Research Institute, Valencia, Spain
Publisher
Walter de Gruyter GmbH
Abstract
The introduction of cardiac troponin (cTn) testing in clinical practice
has been one of the most important breakthroughs that have occurred in the
recent history of laboratory medicine. Although it is now uncontestable
that cTn values are essential for diagnosing acute coronary syndrome
(ACS), solid evidence is also emerging that assessment of either cardiac
troponin I (cTnI) or T (cTnT) may provide valuable prognostic information
in the general healthy population, as well as in patients with a vast
array of cardiac and extra-cardiac diseases. We have hence performed a
critical review of the scientific literature for identifying meta-analyses
which have investigated the potential contribution of cTns in predicting
the risk of death in health and disease. According to the articles
identified with our research, we can conclude that increased cTn values
may be considered independent risk factors for all-cause mortality in the
general population, as well as in patients with ACS, in those undergoing
revascularization procedures, or with stable coronary artery disease
(CAD), heart failure (HF) and atrial fibrillation (AF). Measurement of cTn
may then be helpful for stratifying the mortality risk in non-cardiac
hospitalized patients, in those with critical illness or sepsis, syncope,
stroke, acute aortic dissection, pulmonary diseases, brain injury, renal
failure, vascular and non-cardiac surgery. Although this evidence has
notable clinical implications, the cost-effectiveness of population
screening with high-sensitivity (hs) cTn immunoassays has not been proven
so far. Copyright © 2019 Walter de Gruyter GmbH, Berlin/Boston
2019.

<9>
Accession Number
2006747342
Title
Left ventricular noncompaction-a systematic review of risk factors in the
pediatric population.
Source
Journal of Clinical Medicine. 10 (6) (pp 1-18), 2021. Article Number:
1232. Date of Publication: 02 Mar 2021.
Author
Luczak-Wozniak K.; Werner B.
Institution
(Luczak-Wozniak) Department of Pediatric Cardiology and General
Pediatrics, Doctoral School, Medical University of Warsaw, Warsaw 02-091,
Poland
(Werner) Department of Pediatric Cardiology and General Pediatrics,
Medical University of Warsaw, Warsaw 02-091, Poland
Publisher
MDPI AG
Abstract
Left ventricular noncompaction (LVNC) is a heterogeneous, often hereditary
group of diseases, which may have diverse clinical manifestations. This
article reviews the risk factors for unfavorable outcomes of LVNC in
children, as well as discuss the diagnostic methods and the differences
between pediatric and adult LVNC. Through a systematic review of the
literature, a total of 1983 articles were outlined; 23 of them met the
inclusion criteria. In echocardiography the following have been associated
with adverse outcomes in children: Left ventricular ejection fraction,
end-diastolic dimension, left ventricular posterior wall compaction, and
decreased strains. T-wave abnormalities and increased spatial peak QRS-T
angle in ECG, as well as arrhythmia, were observed in children at greater
risk. Cardiac magnetic resonance is a valuable tool to identify those with
systolic dysfunction and late gadolinium enhancement. Genetic testing
appears to help identify children at risk, because mutations in particular
genes have been associated with worse outcomes. ECG and imaging tests,
such as echocardiography and magnetic resonance, help outline risk factors
for unfavorable outcomes of LVNC in children and in identifying
outpatients who require more attention. Refining the current diagnostic
criteria is crucial to avoid inadequate restrain from physical
activity. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<10>
Accession Number
2006707404
Title
Temporal trends of bleeding episodes during half-vs. Standard-dose
ticagrelor in acute coronary syndrome patients with low platelet
reactivity: A randomized bleeding-acs trial.
Source
Journal of Clinical Medicine. 10 (6) (pp 1-12), 2021. Article Number:
1159. Date of Publication: 02 Mar 2021.
Author
Kim L.; Choe J.C.; Ahn J.H.; Lee H.W.; Oh J.-H.; Choi J.H.; Lee H.C.; Cha
K.S.; Hong T.J.; Jeong Y.-H.; Park J.S.
Institution
(Kim, Choe, Ahn, Lee, Oh, Choi, Lee, Cha, Hong, Park) Department of
Cardiology and Medical Research Institute, Pusan National University
Hospital, Busan 49241, South Korea
(Jeong) Department of Internal Medicine, Gyeongsang National University
School of Medicine, Jinju 52727, South Korea
(Jeong) Cardiovascular Center, Gyeongsang National University Changwon
Hospital, Changwon 51472, South Korea
Publisher
MDPI AG
Abstract
To assess the temporal trends of bleeding episodes during half-vs.
standard-dose ticagrelor in acute coronary syndrome (ACS) patients with
low platelet reactivity (LPR) during standard-dose ticagrelor (90 mg bid).
ACS Patients with LPR (<85 P2Y<inf>12</inf> reaction units) (n = 122) were
randomly assigned to receive either half-dose (45 mg bid) or standard-dose
ticagrelor (90 mg bid). The primary endpoint was incidence of Bleeding
Academic Research Consortium (BARC) bleeding at 1 week, 1, 3 and 6 months.
Dyspnea and ischemic events were also evaluated. Bleeding episodes were
most commonly observed at 1 month and then decreased over time. Half-dose
ticagrelor did not reduce any BARC bleeding (odds ratio [OR] 0.900, 95%
confidence interval [CI] 0.563-1.440, p = 0.661). However, serious
bleeding (BARC type >=2) occurred less often in half-dose ticagrelor (OR
0.284, 95% CI 0.088-0.921, p = 0.036). The rate of moderate-to-severe
dyspnea was highest at 1 month, then decreased over time. Half-dose
ticagrelor did not decrease moderate-to-severe dyspnea (Borg scale >= 3)
(OR 1.066, 95% CI 0.322-3.530, p = 0.916). The risk of ischemic events was
also similar between the groups. In conclusions, compared with
standard-dose ticagrelor, half-dose ticagrelor reduced serious bleeding
events during early period of dual-antiplatelet therapy in ACS patients
with LPR; however, the risk of any bleeding events and dyspnea did not
differ according to ticagrelor dose. Clinical registration:
KCT0004640. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<11>
Accession Number
2006144373
Title
Cardiac rupture-the most serious complication of takotsubo syndrome: A
series of five cases and a systematic review.
Source
Journal of Clinical Medicine. 10 (5) (pp 1-11), 2021. Article Number:
1066. Date of Publication: 01 Mar 2021.
Author
Zalewska-Adamiec M.; Bachorzewska-Gajewska H.; Dobrzycki S.
Institution
(Zalewska-Adamiec, Bachorzewska-Gajewska, Dobrzycki) Department of
Invasive Cardiology, Medical University of Bialystok, Bialystok 15-276,
Poland
(Bachorzewska-Gajewska) Department of Clinical Medicine, Medical
University of Bialystok, Bialystok 15-295, Poland
Publisher
MDPI AG
Abstract
Background: The most serious complication of the acute Takotsubo phase is
a myocardial perforation, which is rare, but it usually results in the
death of the patient. Method(s): In the years 2008-2020, 265 patients
were added to the Podlasie Takotsubo Registry. Cardiac rupture was
ob-served in five patients (1.89%), referred to as the Takotsubo syndrome
with complications of cardiac rupture (TS+CR) group. The control group
consisted of 50 consecutive patients with uncomplicated TS. The diagnosis
of TS was based on the Mayo Clinic Criteria. Result(s): Cardiac
rupture was observed in women with TS aged 74-88 years. Patients with TS
and CR were older (82.20 vs. 64.84; p = 0.011), than the control group,
and had higher troponin, creatine kinase, aspartate aminotransferase, and
blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group
demonstrated a higher heart rate (95.75 vs. 68.38; p <0.0001) and the
Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs.
121.24; p <0.0001) than the control group. In patients with CR, ST segment
elevation was recorded significantly more often in the III, V4, V5 and V6
leads. Left ventricular free wall rupture was noted in four patients, and
in one case, rupture of the ventricular septum. In a multi-variate
logistic regression, the factors that increase the risk of CR in TS were
high GRACE scores, and the presence of ST segment elevation in lead III.
 Conclusion(s): Cardiac rupture in TS is rare but is the most severe
mechanical complication and is associated with a very high risk of death.
The main risk factors for left ventricular perforation are female gender,
older age, a higher concentration of cardiac enzymes, higher GRACE scores,
and ST elevations shown using electrocardiogram (ECG). Copyright
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

<12>
Accession Number
2006134466
Title
Comprehensive comparisons among inotropic agents on mortality and risk of
renal dysfunction in patients who underwent cardiac surgery: A network
meta-analysis of randomized controlled trials.
Source
Journal of Clinical Medicine. 10 (5) (pp 1-12), 2021. Article Number:
1032. Date of Publication: 01 Mar 2021.
Author
Chen W.-C.; Lin M.-H.; Chen C.-L.; Chen Y.-C.; Chen C.-Y.; Lin Y.-C.; Hung
C.-C.
Institution
(Chen) Graduate Institute of Biomedical Sciences, China Medical
University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan (Republic of
China)
(Chen, Chen, Chen, Lin) Division of Pulmonary and Critical Care Medicine,
Department of Internal Medicine, China Medical University Hospital, No. 2,
Yude Rd., North Dist., Taichung 404332, Taiwan (Republic of China)
(Chen) Department of Education, China Medical University Hospital, No. 2,
Yude Rd., North Dist., Taichung 404332, Taiwan (Republic of China)
(Lin, Hung) Department of Pharmacy, China Medical University, No. 100,
Sec. 1, Jingmao Rd., Beitun Dist., Taichung 406040, Taiwan (Republic of
China)
(Chen) Department of Pharmacy, China Medical University Hsinchu Hospital,
China Medical University, No. 199, Sec. 1, Xinglong Rd., Hsinchu County,
Zhubei 30272, Taiwan (Republic of China)
(Lin) School of Medicine, China Medical University, No. 91, Hsueh-Shih
Road, Taichung 40402, Taiwan (Republic of China)
(Hung) Department of Pharmacy, China Medical University Hospital, No. 2
Yude Road, Taichung 40447, Taiwan (Republic of China)
(Hung) Department of Healthcare Administration, Asia University, 500,
Lioufeng Rd., Wufeng, Taichung 41354, Taiwan (Republic of China)
Publisher
MDPI AG
Abstract
Several kinds of inotropes have been used in critically ill patients to
improve hemodynamics and renal dysfunction after cardiac surgery; however,
the treatment strategies for reducing mortality and increasing renal
protection in patients who underwent cardiac surgery remain controversial.
Therefore, we performed a comprehensive network meta-analysis to overcome
the lack of head-to-head comparisons. A systematic database was searched
up to 31 December 2020, for randomized controlled trials that compared
different inotropes on mortality outcomes and renal protective effects
after cardiac surgery. A total of 29 trials were included and a
frequentist network meta-analysis was performed. Inconsistency analyses,
publication bias, and subgroup analyses were also conducted. Compared with
placebo, use of levosimendan significantly decreased the risks of
mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56-0.97)
and risk of acute renal injury (OR: 0.61; 95% CI: 0.45-0.82), especially
in low systolic function patients. Use of levosimendan also ranked the
best treatment based on the P-score (90.1%), followed by placebo (64.5%),
milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam
(17.0%). Taking all the available data into consideration, levosimendan
was a safe renal-protective choice for the treatment of patients
undergoing cardiac surgery, especially for those with low systolic
function. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<13>
Accession Number
2006038667
Title
Transcatheter aortic valve implantation: The new challenges of cardiac
rehabilitation.
Source
Journal of Clinical Medicine. 10 (4) (pp 1-10), 2021. Article Number: 810.
Date of Publication: 02 Feb 2021.
Author
Sperlongano S.; Renon F.; Bigazzi M.C.; Sperlongano R.; Cimmino G.;
D'andrea A.; Golino P.
Institution
(Sperlongano, Renon, Bigazzi, Cimmino, Golino) Department of Translational
Medical Sciences, Division of Cardiology, University of Campania Luigi
Vanvitelli, Monaldi Hospital, Naples 80131, Italy
(Sperlongano) Department of Experimental Sciences, University of Campania
Luigi Vanvitelli, Naples 80138, Italy
(D'andrea) Department of Cardiology and Intensive Coronary Care, Umberto I
Hospital, Nocera Inferiore 84014, Italy
Publisher
MDPI AG
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly
widespread percutaneous intervention of aortic valve replacement (AVR).
The target population for TAVI is mainly composed of elderly, frail
patients with severe aortic stenosis (AS), multiple comorbidities, and
high perioperative mortality risk for surgical AVR (sAVR). These
vulnerable patients could benefit from cardiac rehabilitation (CR)
programs after percutaneous intervention. To date, no major guidelines
currently recommend CR after TAVI. However, emerging scientific evidence
shows that CR in patients undergoing TAVI is safe, and improves exercise
tolerance and quality of life. Moreover, preliminary data prove that a CR
program after TAVI has the potential to reduce mortality during follow-up,
even if randomized clinical trials are needed for confirmation. The
present review article provides an overview of all scientific evidence
concerning the potential beneficial effects of CR after TAVI, and suggests
possible fields of research to improve cardiac care after
TAVI. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<14>
Accession Number
2003235793
Title
A randomised single-centre trial of inhaled liposomal cyclosporine for
bronchiolitis obliterans syndrome post-lung transplantation.
Source
ERJ Open Research. 5 (4) (no pagination), 2019. Article Number:
00167-2019. Date of Publication: October 2019.
Author
Iacono A.; Wijesinha M.; Rajagopal K.; Murdock N.; Timofte I.; Griffith
B.; Terrin M.
Institution
(Iacono, Murdock, Timofte) Shock, Trauma and Transplantation and Dept of
Medicine, University of Maryland, Baltimore, MD, United States
(Wijesinha, Terrin) Dept of Epidemiology, University of Maryland,
Baltimore, MD, United States
(Rajagopal) Memorial Hermann Hospital Texas Medical Center, Houston, TX,
United States
(Griffith) Dept of Cardiothoracic Surgery, University of Maryland,
Baltimore, MD, United States
Publisher
European Respiratory Society
Abstract
No proven treatments exist for bronchiolitis obliterans syndrome (BOS)
following lung transplantation. Inhaled liposomal cyclosporine (L-CsA) may
prevent BOS progression. Method(s): A 48-week phase IIb randomised
clinical trial was conducted in 21 lung transplant patients with BOS
assigned to either L-CsA with standard-of-care (SOC) oral
immunosuppression (L-CsA group) or SOC (SOC-alone group). Efficacy
end-points were BOS progression-free survival (defined as absence of >=20%
decline in forced expiratory volume in 1 s (FEV1) from randomisation,
re-transplantation or death) and BOS grade change. Result(s): BOS
progression-free survival was 82% for L-CsA versus 50% for SOC-alone
(p=0.1) and BOS grade worsened in 18% for L-CsA versus 60% for SOC-alone
(p=0.05). Mean changes in deltaFEV<inf>1</inf> and forced vital capacity,
respectively, stabilised with L-CsA: +0.005 (95% CI -0.004-+0.013) and
-0.005 (95% CI -0.015-+0.006) L.month-1, but worsened with
SOC-alone: -0.023 (95% CI -0.033--0.013) and -0.026 (95% CI -0.039--0.014)
L.month-1 (p<0.0001 and p=0.009). Median survival (4.1 versus
2.9 years; p=0.03) and infection rate (45% versus 60%; p=0.7) improved
with L-CsA versus SOC-alone; creatinine and tacrolimus levels were
similar. Conclusion(s): L-CsA was well tolerated and stabilised lung
function in lung transplant recipients affected by BOS without systemic
toxicity, providing a basis for a global phase III trial using
L-CsA. Copyright © ERS 2019.

<15>
Accession Number
2006727190
Title
Platelet quiescence in patients with acute coronary syndrome undergoing
coronary artery bypass graft surgery.
Source
Journal of the American Heart Association. 10 (5) (pp 1-4), 2021. Article
Number: e016602. Date of Publication: 2021.
Author
Sarathy K.; Wells G.A.; Singh K.; Couture E.; Chong A.Y.; Rubens F.;
Lordkipanidze M.; Tanguay J.-F.; So D.
Institution
(Sarathy, Wells, Chong, Rubens, So) University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Singh) Gold Coast University Hospital, QLD, Australia
(Couture) Universite de Sherbrooke, Sherbrooke, QC, Canada
(Lordkipanidze, Tanguay) Montreal Heart Institute, Montreal, QC, Canada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The optimal antiplatelet strategy for patients with acute
coronary syndromes who require coronary artery bypass surgery remains
unclear. While a more potent antiplatelet regimen will predispose to
perioperative bleeding, it is hypothesized that through "platelet
quiescence," ischemic protection conferred by such therapy may provide a
net clinical benefit. METHODS AND RESULTS: We compared patients undergoing
coronary artery bypass surgery who were treated with a more potent
antiplatelet inhibition strategy with those with a less potent inhibition
through a meta-analysis. The primary outcome was all-cause mortality after
bypass surgery. The analysis identified 4 studies in which the
antiplatelet regimen was randomized and 6 studies that were nonrandomized.
Combining all studies, there was an overall higher mortality with weaker
strategies compared with more potent strategies (odds ratio, 1.38; 95% CI,
1.03-1.85; P=0.03). CONCLUSION(S): Our findings support the concept
of platelet quiescence, in reducing mortality for patients with acute
coronary syndrome requiring coronary artery bypass surgery. This suggests
the routine up-front use of potent antiplatelet regimens in acute coronary
syndrome, irrespective of likelihood of coronary artery bypass
graft. Copyright © 2021 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<16>
Accession Number
2006726895
Title
Effect of melatonin on delirium after on-pump coronary artery bypass graft
surgery: A randomized clinical trial.
Source
Iranian Journal of Medical Sciences. 46 (2) (pp 120-127), 2021. Date of
Publication: 2021.
Author
Zadeh F.J.; Janatmakan F.; Shafaeebejestan E.; Jorairahmadi S.
Institution
(Zadeh, Janatmakan, Shafaeebejestan, Jorairahmadi) Department of
Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic
of
Publisher
Shriaz University of Medical Sciences
Abstract
Background: Patients undergoing cardiac surgery are particularly prone to
delirium. This study aimed to evaluate the effect of melatonin
administration on the inhibition of postoperative delirium in patients
undergoing open-heart surgery. Method(s): This study was conducted as
a double-blind randomized clinical trial in Golestan Hospital. Ahvaz,
Iran, (September 2018 to March 2019). Sixty patients undergoing elective
on-pump coronary artery bypass graft surgery were enrolled in the study,
and they were randomly divided into a group receiving 3 mg of melatonin
and a group receiving a placebo. The main outcomes were delirium
occurrence and delirium intensity up to 48 hours after extubation. The
data were analyzed using SPSS, version 22, (SPSS, Chicago, IL). Group
comparisons were performed using the t test and the Chi-square test.
Statistical significance was defined as a P value of less than 0.05.
 Result(s): On the first postoperative day, delirium developed in four
(13.3%) patients in the melatonin group and 11 (36.6%) patients in the
control group; the difference between the groups was statistically
significant (P=0.037). On the second postoperative day, delirium developed
in three (10%) patients in the melatonin group and 14 (46.6%) patients in
the control group, with the difference in the incidence of delirium
between the groups constituting statistical significance (P=0.029). The
severity of delirium between group was significant on the first and second
postoperative days (P=0.003). Conclusion(s): Melatonin may be
effective in reducing the severity of delirium after cardiac surgery. The
effect of melatonin as a delirium prevention agent should be considered in
patients admitted in the cardiovascular intensive care. Trial Registration
Number: IRCT20180909040979N3. Copyright © 2021, Shriaz University
of Medical Sciences. All rights reserved.

<17>
Accession Number
2006095017
Title
Periprocedural and long-term safety and feasibility of direct oral
anticoagulants in patients with biological valve undergoing radiofrequency
catheter ablation for atrial fibrillation: a prospective multicenter
study.
Source
Journal of Interventional Cardiac Electrophysiology. 61 (3) (pp 617-622),
2021. Date of Publication: September 2021.
Author
Di Biase L.; Romero J.; Briceno D.; Lakkireddy D.; Trivedi C.; Mohanty P.;
Mohanty S.; Horton R.; Hranitzky P.; Gallinghouse G.J.; Alviz I.; Turagam
M.; Gopinathannair R.; Della Rocca D.G.; Beheiry S.; Burkhardt J.D.;
Viles-Gonzales J.; Natale A.
Institution
(Di Biase, Trivedi, Mohanty, Mohanty, Horton, Hranitzky, Gallinghouse,
Della Rocca, Beheiry, Burkhardt, Natale) Texas Cardiac Arrhythmia
Institute, St David Medical Center, 3000 N. I-35, Suite 720, Austin, TX
78705, United States
(Di Biase, Romero, Briceno, Alviz) Albert Einstein College of Medicine,
Montefiore Hospital, New York, NY, United States
(Lakkireddy, Turagam, Gopinathannair) Kansas City Heart Rhythm Institute,
HCA Midwest Health, Kansas City, MO, United States
(Viles-Gonzales) University of Miami, Coral Gables, FL, United States
Publisher
Springer
Abstract
Background: Direct oral anticoagulants (DOACs) are contraindicated in
patients with atrial fibrillation (AF) and mechanical cardiac valves.
However, safety and efficacy are controversial in patients with biological
cardiac valves. Objective(s): We report the safety and feasibility of
periprocedural and long-term treatment with DOACs in patients with
biological valves undergoing ablation for AF. Method(s): A total of
127 patients with AF and biological cardiac valve undergoing CA on
uninterrupted DOAC were matched by gender and age with 127 patients with
AF and biological cardiac valves undergoing CA on uninterrupted warfarin.
All patients were anticoagulated for at least 3-4 weeks prior to ablation
with either rivaroxaban (70%) or apixaban (30%), which were continued for
at least 3 months and subsequently based on
CHA<inf>2</inf>DS<inf>2</inf>-VASc score. Result(s): Mean age of the
study population was 63.0 +/- 10.9 with 66% being male. The majority of
patients on NOACs had aortic valve replacement (59%), while mitral valve
was replaced in 41% of patients, which did not differ from the matched
cohort on coumadin (aortic valve 57% and mitral valve 43%, (p = 0.8) (p =
0.8), respectively). The CHADS<inf>2</inf> score was >= 2 in 90 patients
(71.0%) on DOAC and 86 patients in (68%) the control (p = 0.6) group.
Patients underwent ablation predominantly with uninterrupted rivaroxaban
[89 (70%)], while the remaining 38 patients (30%) underwent ablation while
on apixaban. Two groin hematomas were observed periprocedurally in both
groups. No stroke/transient ischemic attack (TIA) was observed both
periprocedurally and at long-term follow-up in either group.
 Conclusion(s): Periprocedural and long-term administration of DOACs
in patients with biological cardiac valves undergoing AF ablation appears
as safe as warfarin therapy. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<18>
Accession Number
2014049676
Title
Effects of combined and general anesthesia on cognitive functions for
patients undergoing cardiac surgery under CPB.
Source
Heart Surgery Forum. 24 (4) (pp E593-E597), 2021. Date of Publication: 21
Jul 2021.
Author
Kasputyte G.; Bukauskiene R.; Sirvinskas E.; Lenkutis T.; Vimantaite R.;
Andrejaitiene J.
Institution
(Kasputyte, Bukauskiene, Lenkutis) Department of Cardiac, Thoracic and
Vascular Surgery, Lithuanian University of Health Sciences, Kaunas
Clinics, Gaziler cd. No 468 Izmir, Kaunas, Lithuania
(Sirvinskas, Andrejaitiene) Institute of Cardiology, Lithuanian University
of Health Sciences, Kaunas, Lithuania
(Vimantaite) Lithuanian University of Health Sciences, Medical Academy,
Faculty of Nursing, Kaunas, Lithuania
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Patients may experience a variety of neurological
complications after heart surgery. The most common complication observed
in clinical practice is delayed neurocognitive recovery (dNCR). The role
of the anesthesiologist is very important, as the risk of dNCR may be
reduced, depending on the anesthesia tactic chosen. Although the
possibility that neuropsychological complications are less common in
patients undergoing combined anesthesia (general + epidural) than in
patients undergoing general anesthesia is not yet confirmed, the results
are being discussed. The aim of this study was to determine impact of
combined anesthesia (general + epidural) on cognitive functions of
patients after cardiac surgery. Method(s): The prospective,
case-controlled study included 80 patients undergoing cardiac surgery from
2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in
the Hospital of Lithuanian University of Health Sciences Kauno Klinikos.
After approval from the local bioethics center, informed consent was
obtained from all study participants. Inclusion criteria were age 51 to 80
years, elective cardiac surgery, left ventricular ejection fraction > 35%,
anamnesis of not using agents affecting the central nervous system,
absence of neuropathology, and sufficient renal function. Exclusion
criteria were patients suffering from diseases causing cognitive function
or using agents affecting the central nervous system, emergency or
re-surgery, carotid artery atherosclerosis with artery diameter 50 or more
percent reduction, and a patient's disagreement. MMSE test and 6-CIT test
were used for a cognitive function assessment, Trail making test and WAIS
Digital Symbol Substitution test were used for psychomotor function
assessment. All tests were used a day before surgery and seven days after
surgery. According to the planned anesthesia, patients were assigned into
two groups: 1 - combined general + epidural anesthesia and 2 - general
anesthesia. Standardized protocol of anesthesia was followed for all
patients. Preoperative patients and surgery factors, preoperative and
postoperative neuropsychological test results were recorded.
 Result(s): Eighty patients were enrolled in the study. Both groups
did not differ in demographic, perioperative values, and baseline
(preoperative) test results. Postoperative (7th day) WAIS (P = .042) and
6-item cognitive impairment (P = .016) test results were statistically
different when comparing the GA and CA groups. Comparing preoperative and
postoperative test results, there was a significant decline in the WAIS
test score in the GA group (P = .013). Copyright © 2021 Forum
Multimedia Publishing LLC. All rights reserved.

<19>
Accession Number
2010778684
Title
Impact of chronic obstructive pulmonary disease on 10-year mortality after
percutaneous coronary intervention and bypass surgery for complex coronary
artery disease: insights from the SYNTAX Extended Survival study.
Source
Clinical Research in Cardiology. 110 (7) (pp 1083-1095), 2021. Date of
Publication: July 2021.
Author
Wang R.; Tomaniak M.; Takahashi K.; Gao C.; Kawashima H.; Hara H.; Ono M.;
van Klaveren D.; van Geuns R.-J.; Morice M.-C.; Davierwala P.M.; Mack
M.J.; Witkowski A.; Curzen N.; Berti S.; Burzotta F.; James S.; Kappetein
A.P.; Head S.J.; Thuijs D.J.F.M.; Mohr F.W.; Holmes D.R.; Tao L.; Onuma
Y.; Serruys P.W.
Institution
(Wang, Gao, Tao) Department of Cardiology, Xijing Hospital, Xi'an, China
(Wang, Gao, Kawashima, Hara, Ono, Onuma, Serruys) Department of
Cardiology, National University of Ireland, Galway (NUIG), P.O. University
Road, Galway H91 TK33, Ireland
(Wang, Gao, van Geuns) Department of Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Tomaniak) First Department of Cardiology, Medical University of Warsaw,
Warsaw, Poland
(Tomaniak) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Takahashi, Kawashima, Hara, Ono) Department of Cardiology, Amsterdam
Universities Medical Centers, Location Academic Medical Center, University
of Amsterdam, Amsterdam, Netherlands
(van Klaveren) Department of Public Health, Erasmus University Medical
Center, Rotterdam, Netherlands
(van Klaveren) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, United States
(Morice) ICPS Ramsay-Generale de Sante, Massy, France
(Davierwala, Mohr) Department of Cardiac Surgery, Heart Centre Leipzig,
Leipzig, Germany
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Witkowski) Department of Interventional Cardiology and Angiology,
National Institute of Cardiology, Warsaw, Poland
(Curzen) Cardiology Department, University Hospital Southampton,
Southampton, United Kingdom
(Berti) Cardiology Department, Heart Hospital-Fondazione C.N.R. Reg.
Toscana G. Monasterio, Massa, Italy
(Burzotta) Institute of Cardiology, Fondazione Policlinico Universitario
Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
(James) Department of Medical Sciences and Uppsala Clinical Research
Center, Uppsala University, Uppsala, Sweden
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Serruys) Erasmus University Medical Center, Rotterdam, Netherlands
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Aims: To evaluate the impact of chronic obstructive pulmonary disease
(COPD) on 10-year all-cause death and the treatment effect of CABG versus
PCI on 10-year all-cause death in patients with three-vessel disease (3VD)
and/or left main coronary artery disease (LMCAD) and COPD. Method(s):
Patients were stratified according to COPD status and compared with regard
to clinical outcomes. Ten-year all-cause death was examined according to
the presence of COPD and the revascularization strategy. Result(s):
COPD status was available for all randomized 1800 patients, of whom, 154
had COPD (8.6%) at the time of randomization. Regardless of the
revascularization strategy, patients with COPD had a higher risk of
10-year all-cause death, compared with those without COPD (43.1% vs.
24.9%; hazard ratio [HR]: 2.03; 95% confidence interval [CI]: 1.56-2.64; p
< 0.001). Among patients with COPD, CABG appeared to have a slightly lower
risk of 10-year all-cause death compared with PCI (42.3% vs. 43.9%; HR:
0.96; 95% CI: 0.59-1.56, p = 0.858), whereas among those without COPD,
CABG had a significantly lower risk of 10-year all-cause death (22.7% vs.
27.1%; HR: 0.81; 95% CI: 0.67-0.99, p = 0.041). There was no significant
differential treatment effect of CABG versus PCI on 10-year all-cause
death between patients with and without COPD (p<inf>interaction</inf> =
0.544). Conclusion(s): COPD was associated with a higher risk of
10-year all-cause death after revascularization for complex coronary
artery disease. The presence of COPD did not significantly modify the
beneficial effect of CABG versus PCI on 10-year all-cause death. Trial
registration: SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX
Extended Survival: ClinicalTrials.gov reference: NCT03417050 Graphic
abstract: [Figure not available: see fulltext.] Copyright © 2021,
The Author(s).

<20>
Accession Number
2010240844
Title
Diagnostic performance of cardiac computed tomography versus
transesophageal echocardiography in infective endocarditis: A contemporary
comparative meta-analysis :Cardiac CT and TEE for infective endocarditis:
Contemporary Meta-analysis.
Source
Journal of Cardiovascular Computed Tomography. 15 (4) (pp 313-321), 2021.
Date of Publication: 01 Jul 2021.
Author
Jain V.; Wang T.K.M.; Bansal A.; Farwati M.; Gad M.; Montane B.; Kaur S.;
Bolen M.A.; Grimm R.; Griffin B.; Xu B.
Institution
(Jain, Bansal, Farwati, Gad, Montane, Kaur) Department of Internal
Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
(Wang, Bolen, Grimm, Griffin, Xu) Section of Cardiovascular Imaging,
Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell
and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland
Clinic, Cleveland, OH 44195, United States
(Bolen) Section of Cardiovascular and Thoracic Radiology, Imaging
Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Publisher
Elsevier Inc.
Abstract
Objective: To compare the diagnostic accuracy of transesophageal
echocardiography (TEE) and cardiac computed tomography (CCT) in diagnosing
infective endocarditis (IE). Background(s): TEE is a mainstay imaging
modality for IE, while the use of CCT is becoming increasingly prevalent.
Data directly comparing the diagnostic performance of these two imaging
modalities for IE are limited. Method(s): We conducted a systematic
review and meta-analysis of published literature in Embase, PubMed and
Cochrane databases through October 1, 2020 for studies comparing
diagnostic performance of CCT and TEE for the diagnosis of IE in the same
patient populations. A meta-analysis of diagnostic accuracy was performed
using the bivariate model based on studies that used surgical pathology as
a reference standard for defining endocarditis. From a total of 10 studies
included in the meta-analysis, a total of 872 patients were evaluated.
 Result(s): The pooled sensitivities and specificities of TEE for
detecting vegetations were 96% and 83% respectively, whereas for CCT, they
were 85% and 84%, respectively. In the prosthetic valve sub-group, the
pooled sensitivities and specificities of TEE for detecting vegetations
were 89% and 74% respectively, whereas for CCT, they were 78% and 94%,
with CCT being more specific than TEE (p < 0.05). The pooled sensitivities
and specificities of TEE for detecting periannular complications were 70%
and 96% respectively, whereas for CCT, they were 88% and 93%,
respectively. CCT showed a trend (p = 0.06) towards higher sensitivity
than TEE for detection of periannular complications. The pooled
sensitivities and specificities of TEE for detecting leaflet perforation
were 79% and 93% respectively, whereas for CCT, they were 48% and 93%
respectively, with TEE being more sensitive (p < 0.05). The two modalities
also showed comparable diagnostic performance for detecting fistulae,
paravalvular leaks and prosthetic valve dehiscence. Conclusion(s): In
a contemporary comparative meta-analysis, TEE and CCT demonstrated both
good diagnostic accuracy for detecting valvular involvement and
complications of IE. TEE performed better for detecting leaflet defects,
whereas CCT performed better in cases of prosthetic valve involvement, and
showed a trend towards improved detection of periannular complications.
Appropriate, complementary use of both TEE and CCT in a multimodality
imaging approach in clinical practice may achieve the highest diagnostic
performance. Copyright © 2020 Society of Cardiovascular Computed
Tomography

<21>
Accession Number
2007629295
Title
Pedicled versus skeletonized internal thoracic artery grafts: a randomized
trial.
Source
Asian Cardiovascular and Thoracic Annals. 29 (6) (pp 490-497), 2021. Date
of Publication: July 2021.
Author
Dreifaldt M.; Samano N.; Geijer H.; Liden M.; Bodin L.; Souza D.
Institution
(Dreifaldt, Souza) Department of Cardiovascular and Thoracic Surgery,
School of Medical Sciences, Orebro University, Orebro, Sweden
(Samano) Department of Cardiothoracic and Vascular Surgery, and University
Health Care Research Center, Faculty of Medicine and Health, Orebro
University, Orebro, Sweden
(Geijer, Liden) Department of Radiology, School of Medical Sciences,
Orebro University, Orebro, Sweden
(Bodin) Institute of Environmental Medicine, Unit of Intervention and
Implementation Research, Karolinska Institute, Stockholm, Sweden
Publisher
SAGE Publications Inc.
Abstract
Objective: Concerns have been raised regarding whether skeletonization of
the internal thoracic artery could damage the graft and thereby reduces
its patency. The objective of this study was to compare patency rates at
mid- and long-term follow-up between pedicled and skeletonized left
internal thoracic artery grafts. Method(s): This randomized
controlled trial included 109 patients undergoing coronary artery bypass
surgery. The patients were assigned to receive either one pedicled or one
skeletonized left internal thoracic artery graft to the left anterior
descending artery. Follow-up was performed at 3 years with conventional
angiography, and at 8 years with computed tomography angiography.
Differences between patency rates were analyzed with Fisher's exact test
and a generalized linear model. Result(s): The patency rates for
pedicled and skeletonized left internal thoracic artery grafts were 46/48
(95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%)
versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in
patency rates for pedicled and skeletonized grafts was 5.4% (95%
confidence interval: -4.2-14.5) at 3 years and 2.8% (95% confidence
interval: -9.9-14.1) at 8 years. All failed grafts, except for one with a
localized stenosis, were anastomosed to native coronary arteries with a
stenosis less than 70%. Three patients suffered sternal wound infections
(two in the pedicled group, one in the skeletonized group).
 Conclusion(s): The skeletonization technique can be used without
jeopardizing the patency of the left internal thoracic artery. The most
important factor in graft failure was target artery stenosis below
70%. Copyright © The Author(s) 2020.

<22>
Accession Number
635626986
Title
Low dose intraoperative ketamine infusion with multilevel paravertebral
block for pain after video-assisted thoracic surgery: a
randomized-controlled study.
Source
Annals of palliative medicine. 10 (7) (pp 7258-7269), 2021. Date of
Publication: 01 Jul 2021.
Author
Suksompong S.; Chaikittisilpa N.; Wanchiange S.; Poolsuppasit S.;
Thongcharoen P.; Limratana P.
Institution
(Suksompong, Chaikittisilpa, Wanchiange, Poolsuppasit, Limratana)
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital,
Mahidol University, Bangkok, Thailand
(Thongcharoen) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative low-dose ketamine infusion has been reported to
be an effective adjuvant to opioids for postoperative pain control without
major side effects, but it has not been tested in video-assisted thoracic
surgery (VATS). The aim of this study was to examine the effect of
low-dose intraoperative intravenous ketamine infusion on 24-hour morphine
requirement and acute postoperative pain following VATS for lung
resection. METHOD(S): This study was a single center, randomized,
double-blind, placebo-controlled study. Thirty-two patients undergoing
elective VATS for lung resection in a university hospital were included.
Patients were randomly allocated (1:1 ratio) to receive either
intraoperative low-dose ketamine (0.2 mg/kg/h) or normal saline infusion
starting from intubation to the beginning of chest closure. All patients
received multilevel thoracic paravertebral block (TPVB) and morphine was
administered postoperatively via the patient-controlled analgesia pump
using the same protocol. Time to first analgesia, postoperative cumulative
morphine doses at 10, 30 minutes, and the consecutive 1, 2, 6, 12, 18, and
24 hours were recorded. Pain intensity during rest and deep breathing were
also assessed by numeric rating scale (NRS) score at 1- and 24-hour
postoperatively. RESULT(S): There was no significant difference in
median (P25, P75) cumulative 24-hour morphine requirement between the
ketamine and the control groups [15 (5.5, 29.5) vs. 22.5 (15.3, 40.8) mg,
P=0.090]. Patients in ketamine group had significantly longer median pain
free time than the control group (27 vs. 2 minutes, P=0.006). No
difference in overall NRS score at rest or during deep breathing at 1- and
24-hour postoperatively was demonstrated (P=0.861). CONCLUSION(S):
Intraoperative low dose ketamine infusion in addition to TPVB does not
reduce postoperative morphine consumption or pain intensity but may
prolong pain free time in patients undergoing VATS for lung resection.

<23>
Accession Number
635626689
Title
Transcatheter versus surgical aortic valve replacement in aortic stenosis
patients with advanced chronic kidney disease: a systematic review and
meta-analysis.
Source
Annals of palliative medicine. 10 (7) (pp 7157-7172), 2021. Date of
Publication: 01 Jul 2021.
Author
Wei S.; Zhang P.; Zhai K.; Wang S.; Wang W.; Tian Y.; Liu D.; Li Y.
Institution
(Wei, Zhang, Zhai, Wang, Wang, Tian, Liu) Department of Cardiac Surgery,
Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
(Li) Department of Cardiac Surgery, Lanzhou University Second Hospital,
Lanzhou University, Lanzhou, China; Laboratory of Extracorporeal Life
Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou,
China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been
increasingly used in all levels of risk patients, which is less invasive
and has fewer complications. However, the benefits of transcatheter and
surgical methods of aortic valve replacement remain controversial for
aortic stenosis (AS) patients with advanced chronic kidney disease (stage
3-5). METHOD(S): We comprehensively searched PubMed, Embase, the
Cochrane Library, and the International Clinical Trials Registry Platform
(ICTRP) from January 2000 to October 2020 and performed a systematic
review to evaluate the two techniques. Two investigators independently
conducted the literature searches, study eligibility assessment, and data
extraction in duplicate. RESULT(S): Compared to surgical aortic valve
replacement (SAVR), TAVR had lower risk of in-hospital mortality [odds
ratio (OR): 0.53; 95% confidence interval (CI): 0.36-0.78; P=0.001], lower
stroke rate (OR: 0.68; 95% CI: 0.47-0.96; P=0.03), lower risk of acute
kidney injury (AKI) (OR: 0.42; 95% CI: 0.34-0.52; P<0.00001) and AKI
requiring dialysis (OR: 0.65; 95% CI: 0.58-0.73; P<0.00001), lower rate of
bleeding (OR: 0.35; 95% CI: 0.31-0.38; P<0.00001) and blood transfusion
(OR: 0.41; 95% CI: 0.32-0.52; P<0.00001), lower infection rate (OR: 0.23;
95% CI: 0.13-0.38; P<0.00001), lower risk of atrial fibrillation (AF) (OR:
0.37; 95% CI: 0.17-0.79; P=0.01) and cardiac tamponade (OR: 0.53; 95% CI:
0.37-0.75; P=0.0003), shorter ICU stay [weighted mean difference (WMD):
-2.55; 95% CI: -4.13 to -0.98; P=0.002] and hospital stay (WMD: -7.06; 95%
CI: -8.41 to -5.71; P<0.00001). DISCUSSION: TAVR is a safe, efficient, and
feasible technique for AS patients with advanced CKD and probably a better
solution for its advantage in reducing in-hospital mortality,
postoperative complications, ICU, and hospital stay.

<24>
Accession Number
635626590
Title
The incidence, risk factors, and prognosis of postoperative
hyperbilirubinemia after cardiac surgery: a systematic review and
meta-analysis.
Source
Annals of palliative medicine. 10 (7) (pp 7247-7257), 2021. Date of
Publication: 01 Jul 2021.
Author
Bai M.; Zhang W.; Sun S.; Chen X.
Institution
(Chen, Bai, Zhang, Sun) Department of Nephrology, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
(Chen) Department of Nephrology, Xijing Hospital, The Fourth Military
Medical University, Xi'an, China; State Key Laboratory of Kidney Disease,
Department of Nephrology, Chinese People's Liberation Army General
Hospital and Military Medical Postgraduate College, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The purpose of the present systematic review was to evaluate
the incidence, risk factors, and outcome of hyperbilirubinemia after
cardiac surgery. METHOD(S): The Population, Interventions,
Comparators, Outcomes, and Study design (PICOS) framework was employed to
develop the search strategy, and the findings are reported in accordance
with the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) statement. PubMed, Embase, and the Cochrane Library
were systematically searched for studies that provided data on the
incidence, risk factors, and outcomes of hyperbilirubinemia in cardiac
surgery patients from January 1960 to May 2020. Publication bias was
graphically explored through funnel plots, and the Newcastle-Ottawa
quality assessment scale (NOS) was used to evaluate the quality of the
included studies. RESULT(S): Ten studies with 6,100 patients were
included in our systematic review. The pooled incidence of
hyperbilirubinemia was 23% [95% confidence interval (CI), 0.13-0.32].
Preoperative factors, including right atrial pressure [mean difference
(MD), 4.65; 95% CI, 4.43-4.88], total bilirubin (TB) concentration (MD,
0.72; 95% CI, 0.65-0.79), alkaline phosphatase (MD, 27.38; 95% CI,
12.94-41.82), and alanine aminotransferase (MD, 12.02; 95% CI,
10.73-13.31), and intraoperative factors, including cardiopulmonary bypass
(CPB) time (MD, 1.57; 95% CI, 0.52-2.63), aortic cross-clamping (ACC) time
(MD, 11.82; 95% CI, 9.50-14.14), and the amount of blood transfused (MD,
3.77; 95% CI, 0.68-6.85), were the most robust risk factors for
hyperbilirubinemia after cardiac surgery. Additionally, postoperative
hyperbilirubinemia was associated with increased in-hospital mortality
[odds ratio (OR), 9.9; 95% CI, 5.00-19.60, P<0.0001]. DISCUSSION:
Hyperbilirubinemia was common and was associated with increased
in-hospital mortality. Preoperative high right atrial pressure, high TB
concentration, prolonged CPB and ACC time, and a large amount of blood
transfused were the commonly observed risk factors for postoperative
hyperbilirubinemia in cardiac surgery patients. Addressing these risk
factors may be helpful to lower the occurrence of postoperative
hyperbilirubinemia.

<25>
Accession Number
2013402253
Title
The Use of Corticosteroids for Cardiopulmonary Bypass in Adults.
Source
Current Anesthesiology Reports. 11 (3) (pp 292-297), 2021. Date of
Publication: September 2021.
Author
Perchermeier S.; Tassani-Prell P.
Institution
(Perchermeier, Tassani-Prell) Institute of Anesthesiology, German Heart
Center, Technical University of Munich, Lazarettstr. 36, Munich D-80636,
Germany
Publisher
Springer
Abstract
Purpose of Review: Cardiopulmonary bypass for on-pump cardiac surgery
induces a systemic inflammation that may contribute to postoperative major
complications. To reduce this inflammatory response in patients undergoing
heart surgery, the perioperative use of anti-inflammatory corticosteroids
has long been recommended to improve clinical outcomes. However, the
efficacy and safety of steroids remain still unclear. Recent Findings: We
reviewed recent published literature, including the large clinical trials
DECS and SIRS and the two meta-analysis by Dvirnik et al. (2018) and Ng et
al. (2020), on mortality and major postoperative complications, such as
myocardial complications, atrial fibrillation, stroke, pulmonary adverse
events, length of ICU and hospital stay, renal failure, and infection.
 Summary: The perioperative application of corticosteroids did not
improve mortality rates beyond standard care or other secondary outcomes,
such as myocardial infarction, stroke, renal failure, and infection. The
observed increased risk of myocardial damage in patients receiving
corticosteroids in the SIRS trial is mainly related to the author-defined
CK-MB threshold as indicator for early myocardial injury. Interestingly,
the use of steroids may have some beneficial effects on secondary
outcomes: they significantly decreased the risk of respiratory failure and
pneumonia and shortened the length of ICU and hospital stay, but the
mechanism involved in pulmonary injury is multifactorial and it is
difficult to evaluate this result. Patients receiving steroids did not
have a decreased incidence of atrial fibrillation shown by the two large
trials unlike some previous small sample size trials have
demonstrated. Copyright © 2021, The Author(s).

<26>
Accession Number
2013387311
Title
Derivation and validation of a model to predict acute kidney injury
following cardiac surgery in patients with normal renal function.
Source
Renal Failure. 43 (1) (pp 1205-1213), 2021. Date of Publication: 2021.
Author
Hu P.; Mo Z.; Chen Y.; Wu Y.; Song L.; Zhang L.; Li Z.; Fu L.; Liang H.;
Tao Y.; Liu S.; Ye Z.; Liang X.
Institution
(Hu) Division of Nephrology, The Affiliated Yixing Hospital of Jiangsu
University, Yixing, China
(Hu, Chen, Wu, Song, Zhang, Li, Fu, Liang, Tao, Liu, Ye, Liang) Division
of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy
of Medical Sciences, Guangzhou, China
(Hu, Mo, Liang) The Second School of Clinical Medicine, Southern Medical
University, Guangzhou, China
Publisher
Taylor and Francis Ltd.
Abstract
Background: The study aimed to construct a clinical model based on
preoperative data for predicting acute kidney injury (AKI) following
cardiac surgery in patients with normal renal function. Method(s): A
total of 22,348 consecutive patients with normal renal function undergoing
cardiac surgery were enrolled. Among them, 15,701 were randomly selected
for the training group and the remaining for the validation group. To
develop a model visualized as a nomogram for predicting AKI, logistic
regression was performed with variables selected using least absolute
shrinkage and selection operator regression. The discrimination,
calibration, and clinical value of the model were evaluated.
 Result(s): The incidence of AKI was 25.2% in the training group. The
new model consisted of nine preoperative variables, including age, male
gender, left ventricular ejection fraction, hypertension, hemoglobin, uric
acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and
non-steroidal anti-inflammatory drug within 1 week before surgery. The
model had a good performance in the validation group. The discrimination
was good with an area under the receiver operating characteristic curve of
0.740 (95% confidence interval, 0.726-0.753). The calibration plot
indicated excellent agreement between the model prediction and actual
observations. Decision curve analysis also showed that the model was
clinically useful. Conclusion(s): The new model was constructed based
on nine easily available preoperative clinical data characteristics for
predicting AKI following cardiac surgery in patients with normal kidney
function, which may help treatment decision-making, and rational
utilization of medical resources. Copyright © 2021 The Author(s).
Published by Informa UK Limited, trading as Taylor & Francis Group.

<27>
Accession Number
2013331794
Title
Atrial fibrillation ablation in heart failure patients.
Source
Journal of Clinical Medicine. 10 (16) (no pagination), 2021. Article
Number: 3512. Date of Publication: 02 Aug 2021.
Author
Derndorfer M.; Chen S.; Purerfellner H.
Institution
(Derndorfer, Purerfellner) Ordensklinikum Linz Elisabethinen, Interne
II/Kardiologie und Interne Intensivmedizin, Fadingerstrase 1, Linz 4020,
Austria
(Chen) Cardioangiologisches Centrum Bethanien (CCB), Kardiologie,
Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches
Lehrkrankenhaus der Goethe-Universitat Frankfurt am Main, Frankfurt am
Main 60431, Germany
Publisher
MDPI AG
Abstract
Atrial Fibrillation (AF) and Heart Failure (HF) are closely linked to each
other, as each can be either the cause of or the result of the other.
Successfully treating one of the two entities means laying the basis for
treating the other one as well. Management of patients with AF and HF can
be challenging and should primarily adhere to available guidelines.
Concerning AF, medication is limited and causes many side effects, leading
to low medical adherence. Several smaller studies, summarized in a big
meta-analysis, provide evidence that ablation of AF in HF patients is
crucial for improving quality of life, reducing HF hospitalizations, and
reducing death, provided the LVEF is at least 25% or higher. In advanced
HF, alternative treatment options (including assist devices, heart
transplant) might still be the better option. Early rhythm control should
be taken into consideration, as there is evidence that it is associated
with better cardiovascular outcome. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<28>
Accession Number
2013091735
Title
Neurally-adjusted ventilatory assist (NAVA) versus pneumatically
synchronized ventilation modes in children admitted to PICU.
Source
Journal of Clinical Medicine. 10 (15) (no pagination), 2021. Article
Number: 3393. Date of Publication: 01 Aug 2021.
Author
Sugunan P.; Hosheh O.; Garcia Cusco M.; Mildner R.
Institution
(Sugunan, Hosheh, Mildner) Paediatric Intensive Care Unit, Birmingham
Children's Hospital, Birmingham B4 6NH, United Kingdom
(Garcia Cusco) Paediatric Intensive Care Unit, Royal Bristol Children's
Hospital, Bristol BS 2 8BJ, United Kingdom
Publisher
MDPI AG
Abstract
Traditionally, invasively ventilated children in the paediatric intensive
care unit (PICU) are weaned using pneumatically-triggered ventilation
modes with a fixed level of assist. The best weaning mode is currently not
known. Neurally adjusted ventilatory assist (NAVA), a newer weaning mode,
uses the electrical activity of the diaphragm (Edi) to synchronise
ventilator support proportionally to the patient's respiratory drive. We
aimed to perform a systematic literature review to assess the effect of
NAVA on clinical outcomes in invasively ventilated children with
nonneonatal lung disease. Three studies (n = 285) were included for
analysis. One randomised controlled trial (RCT) of all comers showed a
significant reduction in PICU length of stay and sedative use. A cohort
study of acute respiratory distress syndrome (ARDS) patients (n = 30)
showed a significantly shorter duration of ventilation and improved
sedation with the use of NAVA. A cohort study of children recovering from
cardiac surgery (n = 75) showed significantly higher extubation success,
shorter duration of ventilation and PICU length of stay, and a reduction
in sedative use. Our systematic review presents weak evidence that NAVA
may shorten the duration of ventilation and PICU length of stay, and
reduce the requirement of sedatives. However, further RCTs are required to
more fully assess the effect of NAVA on clinical outcomes and treatment
costs in ventilated children. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<29>
Accession Number
2013091729
Title
Should we monitor glucose and biomarkers in diabetics over heart surgery?.
Source
Journal of Clinical Medicine. 10 (15) (no pagination), 2021. Article
Number: 3399. Date of Publication: 01 Aug 2021.
Author
Golukhova E.Z.; Lifanova L.S.; Pugovkina Y.V.; Grigoryan M.V.; Bulaeva
N.I.
Institution
(Golukhova, Lifanova, Pugovkina, Grigoryan, Bulaeva) Cardiology
Department, Bakulev National Medical Research Center of Cardiovascular
Surgery, Roublyevskoe Shosse 135, Moscow 121552, Russian Federation
Publisher
MDPI AG
Abstract
Hyperglycemia is associated with adverse outcomes after coronary artery
bypass grafting (CABG). While there is a consensus that blood glucose
control may benefit patients undergoing CABG, the role of biomarkers,
optimal method, and duration of such monitoring are still unclear. The aim
of this study is to define the efficacy of a continuous glucose monitoring
system (CGMS) and link it to pro-inflammatory biomarkers while on insulin
pump therapy in diabetic patients undergoing CABG. We prospectively
assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing
isolated CABG. In diabetics, CGMS was connected to an insulin pump for
precise glucose control. On top of conventional biomarkers (HbA1C, lipid
profile), high sensitive C-reactive protein (hs-CRP), Regulated upon
Activation Normal T cell Expressed and presumably Secreted (RANTES), and
leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1
year after CABG. Overall, CGMS revealed high glucose independently from
underlying diabetes during first 48 h following CABG but was higher (p <
0.05) in diabetics. The insulin pump improved glycemic control over early
follow-up (72 h) post-CABG. There were no hypoglycemic episodes in
patients on insulin pump therapy and those receiving bolus insulin
therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in
patients on insulin pump therapy compared to patients prescribed bolus
insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and
RANTES levels were lower in patients with T2DM on insulin pump therapy
compared to patients prescribed bolus insulin therapy in the early
postoperative period (p < 0.05). It is most likely due to the fact that
insulin pump therapy decreases systemic inflammatory response. Further
controlled trials should assess whether CGMS improves outcomes after
cardiac surgery. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<30>
Accession Number
2007872671
Title
Effect of deep versus moderate neuromuscular blockade on quantitatively
assessed postoperative atelectasis using computed tomography in thoracic
surgery; a randomized double-blind controlled trial.
Source
Journal of Clinical Medicine. 10 (15) (no pagination), 2021. Article
Number: 3228. Date of Publication: 01 Aug 2021.
Author
Lee B.-J.; Lee H.N.; Chung J.-Y.; Kim D.; Kim J.I.; Seo H.
Institution
(Lee, Chung, Seo) Department of Anesthesiology and Pain Medicine, Kyung
Hee University Hospital at Gangdong, College of Medicine, Kyung Hee
University, Seoul 05278, South Korea
(Lee, Kim) Department of Radiology, Kyung Hee University Hospital at
Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South
Korea
(Kim) Department of Thoracic Surgery, Kyung Hee University Hospital at
Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South
Korea
Publisher
MDPI AG
Abstract
Background: postoperative atelectasis is a significant clinical problem
during thoracic surgery with one-lung ventilation. Intraoperative deep
neuromuscular blockade can improve surgical conditions, but an increased
risk of residual paralysis may aggravate postoperative atelectasis. Every
patient was verified to have full reversal before extubation. We compared
the effect of deep versus moderate neuromuscular blockade on postoperative
atelectasis quantitatively using chest computed tomography.
 Method(s): patients undergoing thoracic surgery were randomly
allocated to two groups: moderate neuromuscular blockade during surgery
(group M) and deep neuromuscular blockade during surgery (group D). The
primary outcome was the proportion and the volume of postoperative
atelectasis measured by chest computed tomography on postoperative day 2.
The mean values of the repeatedly measured intraoperative dynamic lung
compliance during surgery were also compared. Result(s): the
proportion of postoperative atelectasis did not differ between the groups
(1.32 [0.47-3.20]% in group M and 1.41 [0.24-3.07]% in group D, p =
0.690). The actual atelectasis volume was 38.2 (12.8-61.4) mL in group M
and 31.9 (7.84-75.0) mL in group D (p = 0.954). Some factors described in
the lung protective ventilation were not taken into account and might
explain the atelectasis in both groups. The mean lung compliance during
one-lung ventilation was higher in group D (26.6% in group D vs. 24.1% in
group M, p = 0.026). Conclusion(s): intraoperative deep neuromuscular
blockade did not affect postoperative atelectasis when compared with
moderate neuromuscular blockade if full reversal was
verified. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<31>
Accession Number
2007792290
Title
Effects of mediterranean diet or low-fat diet on blood fatty acids in
patients with coronary heart disease. A randomized intervention study.
Source
Nutrients. 13 (7) (no pagination), 2021. Article Number: 2389. Date of
Publication: July 2021.
Author
Giroli M.G.; Werba J.P.; Rise P.; Porro B.; Sala A.; Amato M.; Tremoli E.;
Bonomi A.; Veglia F.
Institution
(Giroli, Werba, Porro, Amato, Tremoli, Bonomi, Veglia) Centro Cardiologico
Monzino, IRCCS, Via Parea, 4, Milan 20138, Italy
(Rise, Sala) Department of Pharmaceutical Sciences, University of Milan,
Via Balzaretti, 9, Milan 20133, Italy
(Sala) IRIB Consiglio Nazionale delle Ricerche, Via Ugo la Malfa, 153,
Palermo 90146, Italy
(Tremoli) Maria Cecilia Hospital, Via Corriera, 1, Cotignola 48033, Italy
Publisher
MDPI AG
Abstract
The Mediterranean diet (MD) prevents cardiovascular disease by different
putative mech-anisms, including modifications in the blood fatty acid (FA)
profile. Polytherapy for secondary cardiovascular prevention might mask
the effect of MD on the FA profile. This study was aimed to assess whether
MD, in comparison with a low-fat diet (LFD), favorably modifies the blood
FA profile in patients with coronary heart disease (CHD) on polytherapy.
One hundred and twenty patients with a recent history of coronary
stenting, randomized to MD or to LFD, completed 3 months of this
open-label dietary intervention study. Diet Mediterranean-ness was
evaluated using the Mediterranean Diet Adherence Screener (MeDAS) score.
Both diets significantly reduced saturated FA (p < 0.01). Putative
favorable changes in total n-3 FA (p = 0.03) and eicosapentaenoic acid
plus docosahexaenoic acid (EPA + DHA; p = 0.04) were significantly larger
with MD than with LFD. At 3 months, in the whole cohort, the MeDAS score
correlated inversely with palmitic acid (R = -0.21, p = 0.02), and with
palmitoleic acid (R = -0.32, p = 0.007), and positively with total n-3 FA
(R = 0.19, p = 0.03), EPA (R = 0.28, p = 0.002), and EPA + DHA (R = 0.21,
p = 0.02). In CHD patients on polytherapy, both MD and LFD shift FA blood
composition towards a healthier profile, with a more favorable effect of
MD on omega-3 levels. Copyright © 2021 by the authors. Licensee
MDPI, Basel, Switzerland.

<32>
Accession Number
2007618184
Title
Role of concomitant coronary artery bypass grafting in valve surgery for
infective endocarditis.
Source
Journal of Clinical Medicine. 10 (13) (no pagination), 2021. Article
Number: 2867. Date of Publication: 01 Jul 2021.
Author
Diab M.; Lehmann T.; Weber C.; Petrov G.; Luehr M.; Akhyari P.; Tugtekin
S.-M.; Schulze P.C.; Franz M.; Misfeld M.; Borger M.A.; Matschke K.;
Wahlers T.; Lichtenberg A.; Hagl C.; Doenst T.
Institution
(Diab, Doenst) Department of Cardiothoracic Surgery, Jena University
Hospital-Friedrich Schiller University of Jena, Jena 07747, Germany
(Lehmann) Center of Clinical Studies, Jena University Hospital-Friedrich
Schiller University of Jena, Jena 07747, Germany
(Weber, Luehr, Wahlers) Department of Cardiothoracic Surgery, Heart Center
of the University of Cologne, Colonge 50937, Germany
(Petrov, Akhyari, Lichtenberg) Department of Cardiothoracic Surgery,
Heinrich-Heine-University Duesseldorf, Duesseldof 40225, Germany
(Tugtekin, Matschke) Department of Cardiac Surgery, Heart Center Dresden,
Dresden 01307, Germany
(Schulze, Franz) Department of Internal Medicine I, Jena University
Hospital-Friedrich Schiller University of Jena, Jena 07747, Germany
(Misfeld) Department of Cardiothoracic Surgery, Royal Prince Alfred
Hospital, Sydney 2050, Australia
(Misfeld, Borger) Department of Cardiac Surgery, Heart Center Leipzig,
Leipzig 04289, Germany
(Hagl) Department of Cardiac Surgery, Ludwig Maximilian University Munich,
Munich 80539, Germany
Publisher
MDPI AG
Abstract
Background: It is current practice to perform concomitant coronary artery
bypass grafting (CABG) in patients with infective endocarditis (IE) who
have relevant coronary artery disease (CAD). However, CABG may add
complexity to the operation. We aimed to investigate the impact of
concomitant CABG on perioperative outcomes in patients undergoing surgery
for IE. Method(s): We retrospectively used data of surgically treated
IE patients between 1994 and 2018 in six German cardiac surgery centers.
We performed inverse probability weighting (IPW), multivariable
adjust-ment, chi-square analysis, and Kaplan-Meier survival estimates.
 Result(s): CAD was reported in 1242/4917 (25%) patients. Among them,
527 received concomitant CABG. After adjustment for basal characteristics
between CABG and no-CABG patients using IPW, concomitant CABG was
associated with higher postoperative stroke (26% vs. 21%, p = 0.003) and a
trend towards higher postoperative hemodialysis (29% vs. 25%, p = 0.052).
Thirty-day mortality was similar in both groups (24% vs. 23%, p = 0.370).
Multivariate Cox regression analysis after IPW showed that CABG was not
associated with better long-term survival (HR: 1.00, 95% CI: 0.82-1.23, p
= 0.998). Conclusion(s): In endocarditis patients with CAD, adding
CABG to valve surgery may be associated with a higher likelihood of
postoperative stroke without adding long-term survival benefits.
Therefore, in the absence of critical CAD, concomitant CABG may be omitted
without impacting outcome. The results are limited due to a lack of data
on the severity of CAD, and therefore there is a need for a randomized
trial. Copyright © 2021 by the authorsLicensee MDPI, Basel,
Switzerland.

<33>
Accession Number
2007532304
Title
Impact of bundle branch block on permanent pacemaker implantation after
transcatheter aortic valve implantation: A meta-analysis.
Source
Journal of Clinical Medicine. 10 (12) (no pagination), 2021. Article
Number: 2719. Date of Publication: 02 Jun 2021.
Author
Ravaux J.M.; Di Mauro M.; Vernooy K.; Mariani S.; Ronco D.; Simons J.;
Van'T Hof A.W.; Veenstra L.; Kats S.; Maessen J.G.; Lorusso R.
Institution
(Ravaux, Di Mauro, Mariani, Ronco, Simons, Kats, Maessen, Lorusso)
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre,
Maastricht University Medical Centre (MUMC), Maastricht 6202 AZ,
Netherlands
(Vernooy, Van'T Hof, Veenstra) Department of Cardiology, Maastricht
University Medical Centre (MUMC), Maastricht 6202 AZ, Netherlands
(Vernooy, Van'T Hof, Maessen, Lorusso) Cardiovascular Research Institute
Maastricht (CARIM), Maastricht University Medical Center, Maastricht 6202
AZ, Netherlands
(Vernooy) Department of Cardiology, Radboud University Medical Center
(Radboudumc), Nijmegen 6525 GA, Netherlands
(Ronco) Department of Medicine and Surgery, Circolo Hospital, University
of Insubria, Varese 21100 VA, Italy
Publisher
MDPI AG
Abstract
Data regarding the impact of infra-Hisian conduction disturbances leading
to permanent pacemaker implantation (PPI) after transcatheter aortic valve
implantation (TAVI) remain limited. The aim of this study was to determine
the impact of right and/or left bundle branch block (RBBB/LBBB) on
post-TAVI PPI. We performed a systematic literature review to identify
studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study
design, patient characteristics, and the presence of branch block were
analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis
included 36 studies, reporting about 55,851 patients. Data on LBBB were
extracted from 33 studies. Among 51,026 patients included, 5503 showed
pre-implant LBBB (11.9% (10.4%- 13.8%)). The influence of LBBB on
post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618.
Data on RBBB were extracted from 28 studies. Among 46,663 patients
included, 31,603 showed pre-implant RBBB (9.2% (7.3%-11.6%)). The
influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571;
5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB
increased the risk for post-TAVI PPI, independent of age or LVEF, while
this finding was not con-firmed for patients experimenting with LBBB. This
result emphasizes the need for pre-operative evaluation strategies in
patient selection for TAVI. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<34>
Accession Number
2007230937
Title
Cardiac rehabilitation in german speaking countries of
europe-evidence-based guidelines from germany, austria and switzerland
llkardreha-dach-part 1.
Source
Journal of Clinical Medicine. 10 (10) (no pagination), 2021. Article
Number: 2192. Date of Publication: 02 May 2021.
Author
Rauch B.; Salzwedel A.; Bjarnason-Wehrens B.; Albus C.; Meng K.; Schmid
J.-P.; Benzer W.; Hackbusch M.; Jensen K.; Schwaab B.; Altenberger J.;
Benjamin N.; Bestehorn K.; Bongarth C.; Dorr G.; Eichler S.; Einwang
H.-P.; Falk J.; Glatz J.; Gielen S.; Grilli M.; Grunig E.; Guha M.;
Hermann M.; Hoberg E.; Hofer S.; Kaemmerer H.; Ladwig K.-H.; Mayer-Berger
W.; Metzendorf M.-I.; Nebel R.; Neidenbach R.C.; Niebauer J.; Nixdorff U.;
Oberhoffer R.; Reibis R.; Reiss N.; Saure D.; Schlitt A.; Voller H.; von
Kanel R.; Weinbrenner S.; Westphal R.
Institution
(Rauch) Institut fur Herzinfarktforschung Ludwigshafen, Ludwigshafen
D-67063, Germany
(Rauch) Zentrum fur Ambulante Rehabilitation, ZAR Trier GmbH, Trier
D-54292, Germany
(Salzwedel, Eichler, Voller) Department of Rehabilitation Medicine,
Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam
D-14469, Germany
(Bjarnason-Wehrens) Institut fur Kreislaufforschung und Sportmedizin, Abt.
Praventive und rehabilitative Sport-und Leistungsmedizin, Deutsche
Sporthochschule Koln, Koln D-50937, Germany
(Albus) Department of Psychosomatics and Psychotherapy, Faculty of
Medicine, University Hospital, Koln D-50937, Germany
(Meng) Institut fur Klinische Epidemiologie und Biometrie (IKE-B),
Universitat Wurzburg, Wurzburg D-97078, Germany
(Schmid) Klinik Barmelweid AG, Barmelweid CH-5017, Switzerland
(Benzer) Reha-Klinik Montafon, Schruns A-6780, Austria
(Hackbusch, Jensen, Saure) Institute of Medical Biometry and Informatics
(IMBI), University of Heidelberg, Heidelberg D-69120, Germany
(Schwaab) Curschmann Klinik Dr. Guth GmbH & Co KG, Timmendorfer Strand
D-23669, Germany
(Altenberger) Rehabilitationszentrum Grosgmain, Grosgmain A-5084, Austria
(Benjamin, Grunig) Zentrum fur Pulmonale Hypertonie, Thorax-Klinik am
Universitatsklinikum Heidelberg, Heidelberg D-69126, Germany
(Bestehorn) Institut fur Klinische Pharmakologie, Technische Universitat
Dresden, Fiedlerstrase 42, Dresden D-01307, Germany
(Bongarth, Einwang) Klinik Hohenried gGmbH, Rehabilitationszentrum am
Starnberger See, Bernried D-82347, Germany
(Dorr) Alexianer St. Josefs-Krankenhaus Potsdam-Sanssouci, Potsdam
D-14471, Germany
(Falk, Weinbrenner) Deutsche Rentenversicherung Bund (DRV-Bund), Berlin
D-10709, Germany
(Glatz) Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, Teltow
D-14513, Germany
(Gielen) Klinikum Lippe, Standort Detmold, Detmold D-32756, Germany
(Grilli) Universitatsbibliothek, Universitatsmedizin Mannheim, Mannheim
D-68167, Germany
(Guha) Reha-Zentrum am Sendesaal, Bremen D-28329, Germany
(Hermann) Klinik fur Kardiologie, Universitatsspital Zurich, Ramistrasse
100, Zurich CH-8091, Switzerland
(Hoberg) Wismarstrase 13, Heikendorf D-24226, Germany
(Hofer) Universitatsklinik fur Medizinische Psychologie und
Psychotherapie, Medizinische Universitat Innsbruck, Innsbruck A-6020,
Austria
(Kaemmerer) Klinik fur Angeborene Herzfehler und Kinderkardiologie,
Deutsches Herzzentrum Munchen, Klinik der Technischen Universitat Munchen,
Munchen D-80636, Germany
(Ladwig) Department of Psychosomatic Medicine and Psychotherapy, Klinikum
rechts der Isar, Technische Universitat Munchen (TUM), Langerstrase 3,
Munich D-81675, Germany
(Mayer-Berger) Klinik Roderbirken der Deutschen Rentenversicherung
Rheinland, Leichlingen D-42799, Germany
(Metzendorf) Cochrane Metabolic and Endocrine Disorders Group, Institute
of General Practice (ifam), Medical Faculty of the Heinrich-Heine
University, Werdener Strase. 4, Dusseldorf D-40227, Germany
(Nebel) Hermann-Albrecht-Klinik METTNAU, Medizinische Reha-Einrichtungen
der Stadt Radolfzell, Radolfzell D-73851, Germany
(Neidenbach) Institut fur Sportwissenschaft, Universitat Wien, Auf der
Schmelz 6 (USZ I), Wien AU-1150, Austria
(Niebauer) Universitatsinstitut fur Praventive und Rehabilitative
Sportmedizin, Uniklinikum Salzburg Paracelsus Medizinische
Privatuniversitat, Salzburg A-5020, Austria
(Nixdorff) EPC GmbH, European Prevention Center, Medical Center
Dusseldorf, Dusseldorf D-40235, Germany
(Oberhoffer) Lehrstuhl fur Praventive Padiatrie, Fakultat fur Sport-und
Gesundheitswissenschaften, Technische Universitat Munchen, Munchen
D-80992, Germany
(Reibis) Kardiologische Gemeinschaftspraxis Am Park Sanssouci, Potsdam
D-14471, Germany
(Reiss) Schuchtermann-Schiller'sche Kliniken, Ulmenallee 5-12, Bad
Rothenfelde D-49214, Germany
(Schlitt) Paracelsus Harz-Klinik Bad Suderode GmbH, Quedlinburg D-06485,
Germany
(Voller) Klinik am See, Rudersdorf D-15562, Germany
(von Kanel) Klinik fur Konsiliarpsychiatrie und Psychosomatik,
Universitatsspital Zurich, Zurich CH-8091, Switzerland
(Westphal) Herzzentrum Segeberger Kliniken, Bad Segeberg D-23795, Germany
Publisher
MDPI AG
Abstract
Background: Although cardiovascular rehabilitation (CR) is well accepted
in general, CR-attendance and delivery still considerably vary between the
European countries. Moreover, clinical and prognostic effects of CR are
not well established for a variety of cardiovascular diseases.
 Method(s): The guidelines address all aspects of CR including
indications, contents and delivery. By processing the guidelines, every
step was externally supervised and moderated by independent members of the
"Association of the Scientific Medical Societies in Germany" (AWMF). Four
meta-analyses were performed to evaluate the prognostic effect of CR after
acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in
patients with severe chronic systolic heart failure (HFrEF), and to define
the effect of psychological interventions during CR. All other indications
for CR-delivery were based on a predefined semi-structured literature
search and recommendations were established by a formal consenting process
including all medical societies involved in guideline generation.
 Result(s): Multidisciplinary CR is associated with a significant
reduction in all-cause mortality in patients after ACS and after CABG,
whereas HFrEF-patients (left ventricular ejection fraction <40%)
especially benefit in terms of exercise capacity and health-related
quality of life. Patients with other cardiovascular diseases also benefit
from CR-participation, but the scientific evidence is less clear. There is
increasing evidence that the beneficial effect of CR strongly depends on
"treatment intensity" including medical supervision, treatment of
cardiovascular risk factors, information and education, and a minimum of
individually adapted exercise volume. Additional psychologic interventions
should be performed on the basis of individual needs. Conclusion(s):
These guidelines reinforce the substantial benefit of CR in specific
clinical indications, but also describe remaining deficits in CR-delivery
in clinical practice as well as in CR-science with respect to methodology
and presentation. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<35>
Accession Number
635862874
Title
Perioperative outcomes of combined heart surgery and lung tumor resection:
a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 16 (1) (pp 227), 2021. Date of
Publication: 09 Aug 2021.
Author
Cheng S.; Jiang Y.; Li X.; Lu X.; Zhang X.; Sun D.
Institution
(Cheng, Li, Lu, Zhang) Department of Thoracic Surgery, Tianjin Chest
Hospital, Tianjin 300222, China
(Jiang) Department of Cardiac Surgery, Tianjin First Central Hospital,
Tianjin 300074, China
(Sun) Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin
300222, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The prevalence of patients with concomitant heart and lung
lesions requiring surgical intervention is increasing. Simultaneous
cardiac surgery and pulmonary resection avoids the need for a second
operation. However, there are concerns regarding the potentially increased
mortality and complication rates of simultaneous surgery and the adequacy
of lung exposure during heart surgery. Therefore, we performed a
meta-analysis to evaluate the perioperative mortality and complication
rates of combined heart surgery and lung tumor resection. METHOD(S):
A comprehensive literature search was performed in July 2020. The PubMed,
Embase, and Web of Science databases were searched to identify studies
that reported the perioperative outcomes of combined heart surgery and
lung tumor resection. Two reviewers independently screened the studies,
extracted data, and assessed the risk of bias of included studies. Pooled
proportions and 95% confidence intervals (95% CI) were calculated by R
version 3.6.1 using the meta package. RESULT(S): A total of 536
patients from 29 studies were included. Overall, the pooled proportion of
operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled
proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57)
for patients who underwent combined cardiothoracic surgery. Subgroup
analysis by lung pathology revealed that, for patients with lung cancer,
the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95,
1.00) and the pooled proportion of systematic lymph node dissection or
sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery
procedure found that the pooled proportion of postoperative complications
of patients who underwent coronary artery bypass grafting (CABG) patients
using the off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled
proportion of complications after CABG using the on-pump method was 0.61
(95% CI: 0.38, 0.82). CONCLUSION(S): Combined heart surgery and lung
tumor resection had a low mortality rate and an acceptable complication
rate. Subgroup analyses revealed that most patients with lung cancer
underwent uncompromised anatomical resection and mediastinal lymph node
sampling or dissection during combined cardiothoracic surgery, and showed
off-pump CABG may reduce the complication rate compared with on-pump CABG.
Further researches are still needed to verify these
findings. Copyright © 2021. The Author(s).

<36>
Accession Number
2013551352
Title
Left ventricular apex: A "minimally invasive motorway" for safe
cardiovascular procedures.
Source
Journal of Clinical Medicine. 10 (17) (no pagination), 2021. Article
Number: 3857. Date of Publication: 01 Sep 2021.
Author
Agostinelli A.; Gallingani A.; Maestri F.; Grossi S.; Gripshi F.; Donno
L.D.; Nicolini F.
Institution
(Agostinelli, Gallingani, Maestri, Gripshi, Donno, Nicolini) Cardiac
Surgery Division, Parma University Hospital, Via Gramsci 14, Parma 43126,
Italy
(Grossi) Cardiac Surgery Intensive Care Unit, Parma University Hospital,
Via Gramsci 14, Parma 43126, Italy
Publisher
MDPI AG
Abstract
Since the advent of TAVR (transcatheter aortic valve replacement), the
transapical surgical approach has been affirmed as a safe and effective
alternative access for patients with unsuitable peripheral arteries. With
the improvement of devices for transfemoral approach and the development
of other alternative accesses, the number of transapical procedures has
decreased significantly worldwide. The left ventricular apex, however, has
proved to be a safe and valid alternative access for various other
structural heart procedures such as mitral valve repair, mitral
valve-in-valve or valve-in-ring replacement, transcatheter mitral valve
replacement (TMVR), transcatheter mitral paravalvular leak repair, and
thoracic aorta endovascular repair (TEVAR). We review the literature and
our experience of various hybrid transcatheter structural heart procedures
using the transapical surgical approach and discuss pros and
cons. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<37>
Accession Number
635827228
Title
Comparison of Midterm Outcomes Associated with Aspirin and Ticagrelor vs
Aspirin Monotherapy after Coronary Artery Bypass Grafting for Acute
Coronary Syndrome.
Source
JAMA Network Open. 4 (8) (no pagination), 2021. Article Number: e2122597.
Date of Publication: 26 Aug 2021.
Author
Bjorklund E.; Malm C.J.; Nielsen S.J.; Hansson E.C.; Tygesen H.; Romlin
B.S.; Martinsson A.; Omerovic E.; Pivodic A.; Jeppsson A.
Institution
(Bjorklund, Malm, Nielsen, Hansson, Tygesen, Romlin, Martinsson, Omerovic,
Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
(Bjorklund, Tygesen) Department of Medicine, South Alvsborg Hospital,
Boras, Sweden
(Malm, Nielsen, Hansson, Jeppsson) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg SE-41345, Sweden
(Romlin) Department of Anesthesiology and Intensive Care, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Martinsson, Omerovic) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Pivodic) Statistiska Konsultgruppen, Gothenburg, Sweden
(Pivodic) Department of Ophthalmology, Institute of Neuroscience and
Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
Publisher
American Medical Association
Abstract
Importance: Guidelines recommend dual antiplatelet therapy after coronary
artery bypass grafting (CABG) for patients with acute coronary syndrome
(ACS). However, the evidence for these recommendations is weak.
 Objective(s): To compare midterm outcomes after CABG in patients with
ACS treated postoperatively with acetylsalicylic acid (ASA) and ticagrelor
or with ASA monotherapy. Design, Setting, and Participant(s): This
cohort study used merged data from several national registries of Swedish
patients who were diagnosed with ACS and subsequently underwent CABG. All
included patients underwent isolated CABG in Sweden between 2012 and 2017
with an ACS diagnosis less than 6 weeks before the procedure, survived 14
days after discharge from hospital, and were treated postoperatively with
ASA plus ticagrelor or ASA monotherapy. A multivariable Cox regression
model was used for the main analysis, and propensity score-matched models
were performed as sensitivity analysis. Data were analyzed between May and
September 2020. Exposures: Postoperative antiplatelet treatment, defined
as filled prescriptions, with either ASA and ticagrelor or ASA only.
 Main Outcomes and Measures: Major adverse cardiovascular events
(MACE), defined as all-cause mortality, myocardial infarction, and stroke,
and major bleeding, at 12 months and at the end of follow-up.
 Result(s): A total of 6558 patients (5281 [80.5%] men; mean [SD] age
at surgery, 67.6 [9.3] years) were included; 1813 (27.6%) were treated
with ASA plus ticagrelor and 4745 (72.4%) were treated with ASA
monotherapy. Crude MACE rate was 3.0 per 100 person years (95% CI, 2.5-3.6
per 100 person years) in the ASA plus ticagrelor group and 3.8 per 100
person years (95% CI, 3.5-4.1 per 100 person years) in the ASA group.
After adjustment, there was no significant difference in MACE risk between
ASA plus ticagrelor vs ASA only, neither during the first 12 months
(adjusted hazard ratio [aHR], 0.84; 95% CI, 0.58-1.21; P =.34) or during
total follow-up (aHR, 0.89; 95% CI, 0.71-1.11; P =.29). The use of ASA
plus ticagrelor was associated with a significantly increased risk for
major bleeding during the first 12 months (aHR, 1.90; 95% CI, 1.16-3.13; P
=.011). Sensitivity analyses confirmed the results. Conclusions and
Relevance: In patients with ACS who survived 2 weeks after CABG, no
significant difference in the risk of death or ischemic events could be
demonstrated between ASA plus ticagrelor and patients treated with ASA
only, while the risk for major bleeding was higher in patients treated
with ASA plus ticagrelor. Sufficiently powered prospective randomized
trials comparing different antiplatelet therapy strategies after CABG are
warranted. Copyright © 2021 Bjorklund E et al.

<38>
Accession Number
635827223
Title
Effect of Continuous Electrocardiogram Monitoring on Detection of
Undiagnosed Atrial Fibrillation after Hospitalization for Cardiac Surgery:
A Randomized Clinical Trial.
Source
JAMA Network Open. 4 (8) (no pagination), 2021. Article Number: e2121867.
Date of Publication: 27 Aug 2021.
Author
Ha A.C.T.; Verma S.; Mazer C.D.; Quan A.; Yanagawa B.; Latter D.A.; Yau
T.M.; Jacques F.; Brown C.D.; Singal R.K.; Yamashita M.H.; Saha T.; Teoh
K.H.; Lam B.-K.; Deyell M.W.; Wilson M.; Hibino M.; Cheung C.C.;
Kosmopoulos A.; Garg V.; Brodutch S.; Teoh H.; Zuo F.; Thorpe K.E.; Juni
P.; Bhatt D.L.; Verma A.
Institution
(Ha, Yau) Peter Munk Cardiac Centre, Toronto General Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Verma, Quan, Yanagawa, Latter, Wilson, Hibino, Kosmopoulos, Garg,
Brodutch, Teoh) Department of Cardiac Surgery, St Michael's Hospital,
University of Toronto, 30 Bond St, Toronto, ON M5B 1W8, Canada
(Mazer) Department of Anesthesiology, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Jacques) University Institute of Cardiology and Respirology of Quebec,
Quebec City, QC, Canada
(Brown) Division of Cardiac Surgery, New Brunswick, Saint John, NB, Canada
(Singal, Yamashita) Division of Surgery, Cardiac Science Program, St
Boniface General Hospital, Winnipeg, MB, Canada
(Saha) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Kingston, ON, Canada
(Teoh, Verma) Southlake Regional Health Center, University of Toronto,
602-581 Davis Dr, Newmarket, ON L3Y 2P6, Canada
(Lam) University of Ottawa Heart Institute, Ottawa, ON, Canada
(Deyell, Cheung) Division of Cardiology, St Paul's Hospital, Vancouver,
BC, Canada
(Zuo, Thorpe, Juni) Applied Health Research Centre, Li Ka Shing Knowledge
Institute, St Michael's Hospital, Toronto, ON, Canada
(Bhatt) Heart and Vascular Center, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
American Medical Association
Abstract
Importance: Postoperative atrial fibrillation (POAF) occurring after
cardiac surgery is associated with adverse outcomes. Whether POAF persists
beyond discharge is not well defined. Objective(s): To determine
whether continuous cardiac rhythm monitoring enhances detection of POAF
among cardiac surgical patients during the first 30 days after hospital
discharge compared with usual care. Design, Setting, and
Participant(s): This study is an investigator-initiated, open-label,
multicenter, randomized clinical trial conducted at 10 Canadian centers.
Enrollment spanned from March 2017 to March 2020, with follow-up through
September 11, 2020. As a result of the COVID-19 pandemic, enrollment
stopped on July 17, 2020, at which point 85% of the proposed sample size
was enrolled. Cardiac surgical patients with CHA2DS2-VASc (congestive
heart failure, hypertension, age >=75 years, diabetes, prior stroke or
transient ischemic attack, vascular disease, age 65-74 years, female sex)
score greater than or equal to 4 or greater than or equal to 2 with risk
factors for POAF, no history of preoperative AF, and POAF lasting less
than 24 hours during hospitalization were enrolled. Intervention(s):
The intervention group underwent continuous cardiac rhythm monitoring with
wearable, patch-based monitors for 30 days after randomization. Monitoring
was not mandated in the usual care group within 30 days after
randomization. Main Outcomes and Measures: The primary outcome was
cumulative AF and/or atrial flutter lasting 6 minutes or longer detected
by continuous cardiac rhythm monitoring or by a 12-lead electrocardiogram
within 30 days of randomization. Prespecified secondary outcomes included
cumulative AF lasting 6 hours or longer and 24 hours or longer within 30
days of randomization, death, myocardial infarction, ischemic stroke,
non-central nervous system thromboembolism, major bleeding, and oral
anticoagulation prescription. Result(s): Of the 336 patients
randomized (163 patients in the intervention group and 173 patients in the
usual care group; mean [SD] age, 67.4 [8.1] years; 73 women [21.7%];
median [interquartile range] CHA2DS2-VASc score, 4.0 [3.0-4.0] points),
307 (91.4%) completed the trial. In the intent-to-treat analysis, the
primary end point occurred in 32 patients (19.6%) in the intervention
group vs 3 patients (1.7%) in the usual care group (absolute difference,
17.9%; 95% CI, 11.5%-24.3%; P <.001). AF lasting 6 hours or longer was
detected in 14 patients (8.6%) in the intervention group vs 0 patients in
the usual care group (absolute difference, 8.6%; 95% CI, 4.3%-12.9%; P
<.001). Conclusions and Relevance: In post-cardiac surgical patients
at high risk of stroke, no preoperative AF history, and AF lasting less
than 24 hours during hospitalization, continuous monitoring revealed a
significant increase in the rate of POAF after discharge that would
otherwise not be detected by usual care. Studies are needed to examine
whether these patients will benefit from oral anticoagulation therapy.
Trial Registration: ClinicalTrials.gov Identifier: NCT02793895.
 Copyright © 021 Ha ACT et al.

<39>
Accession Number
2014313573
Title
Comparative study of clinical outcomes of methylprednisolone and
dexamethasone in prime solution during cardiopulmonary pump after coronary
artery bypass grafting.
Source
Journal of Cellular and Molecular Anesthesia. 6 (2) (pp 174-180), 2021.
Date of Publication: April 2021.
Author
Tahmasbi T.; Shahzamani M.; Satehi S.B.; Khodadadi F.
Institution
(Tahmasbi, Khodadadi) Department of Extracorporeal Technology, Isfahan
University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Shahzamani) Department of Surgery, School of Medicine, Chamran Hospital,
Isfahan University of Medical Sciences, Isfahan, Iran, Islamic Republic of
(Satehi) Department of Intensive Care, School of Nursing and Midwifery,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
Shahid Beheshti University of Medical Sciences, Anesthesiology Research
Center
Abstract
Background: The study was performed to compare clinical outcomes of
methylprednisolone and dexamethasone in prime solution during
cardiopulmonary pump after coronary artery bypass grafting (CABG).
 Material(s) and Method(s): In this double-blind clinical trial,
sixty-two patients who underwent CABG were divided into the control group
(31 patients with dexamethasone in their prime solution) and the study
group (31 patients using methylprednisolone in their prime solution).
Duration of mechanical ventilation, length of intensive care unit (ICU)
stays, bleeding rate (chest tube volume), arrhythmia, and need for
inotropic intake were compared. Result(s): The mean duration of
mechanical ventilation and ICU stay in the dexamethasone group were
significantly higher than the methylprednisolone group and the mean
bleeding rate in the dexamethasone group was significantly lower than the
methylprednisolone group (p<0.05). Conclusion(s): The mean duration
of mechanical ventilation and ICU stay in the dexamethasone group was
higher than the methylprednisolone group, but the use of dexamethasone has
the advantage of being associated with less bleeding. Copyright ©
2021 Journal of Cellular and Molecular Anesthesia. All rights reserved.

<40>
Accession Number
2013567593
Title
All roads lead to Rome, but some are safer.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Di Mauro M.; Calafiore A.M.; Lorusso R.
Institution
(Di Mauro, Lorusso) Department of Cardio-Thoracic Surgery, Heart &
Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht,
Netherlands
(Calafiore) Department of Cardiac Surgery, Anthea Hospital, GVM Research
and Care, Bari, Italy
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Since the first in-human implantation, trans-catheter aortic valve
replacement (TAVR) has shown an exciting development in both technical and
technological terms, becoming the standard of care for many patients, even
not only inoperable ones. Although trans-femoral (TF) access has the
scepter of first-line route for TAVR, in some cases, this access is not
feasible, so several alternative routes were introduced over time. The
network meta-analysis by Hameed et al. has the great merit to provide a
comprehensive picture. Hence, through either direct and indirect
comparison, the authors confirmed as TF is the gold standard as access,
followed by trans-carotid and trans-subclavian. Conversely, trans-thoracic
(trans apical and trans-aortic) routes are the least safe and should be
reserved only to sporadic cases. Copyright © 2021 Wiley
Periodicals LLC

<41>
Accession Number
2011014675
Title
COVID-19 in immunocompromised patients: A systematic review of cancer,
hematopoietic cell and solid organ transplant patients.
Source
Journal of Infection. 82 (3) (pp 329-338), 2021. Date of Publication:
March 2021.
Author
Belsky J.A.; Tullius B.P.; Lamb M.G.; Sayegh R.; Stanek J.R.; Auletta J.J.
Institution
(Belsky, Tullius, Lamb, Stanek, Auletta) Division of
Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's
Drive, Columbus, OH 43205, United States
(Belsky, Tullius, Lamb, Auletta) Department of Pediatrics, The Ohio State
University School of Medicine, Columbus, OH, United States
(Sayegh, Auletta) Division of Infectious Diseases, Nationwide Children's
Hospital, 700 Children's Drive, Columbus, OH 43205, United States
(Sayegh, Auletta) The Ohio State University Comprehensive Cancer Center,
Columbus, OH, United States
Publisher
W.B. Saunders Ltd
Abstract
Background: The clinical impact of severe coronavirus disease 2019
(COVID-19), caused by severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), in immunocompromised patients has not been systematically
evaluated. Method(s): We reviewed current literature reporting on
COVID-19 in cancer (CA), hematopoietic cell (HCT), and solid organ
transplant (SOT) patients and compared their clinical data and outcomes to
the general population. For adult CA, HCT and SOT patients, an extensive
search strategy retrieved all articles published until July 20, 2020 by
combining the terms coronavirus, coronavirus infection, COVID-19, and
SARS-CoV-2 in PubMed, Cochrane, and Web of Science, and following the
Preferred Reporting Items for Systematic Reviews and Meta-analysis
guidelines. For the pediatric CA cohort, a global COVID-19 registry was
used. For the general population cohort, a large meta-analysis was used to
compare pooled prevalence estimates, and two large meta-analyses were
utilized to serve as pooled comparators for hospitalized COVID-19
patients. Finding(s): Compared to the general population, adult CA
and SOT patients with COVID-19 had higher comorbidities, greater levels of
inflammatory markers at diagnosis, and higher rates of intensive care and
hospital mortality. Pediatric CA patients and HCT patients with COVID-19
tended to have clinical presentations and outcomes similar to the general
population. Interpretation(s): To our knowledge, this is the first
systematic review evaluating COVID-19 phenotype and outcomes in
immunocompromised patients and comparing them to the general population,
which shows that hospital outcomes appear to be worse in adult CA and SOT
patients, potentially due to their higher co-morbidity burden.
 Funding(s): None Copyright © 2021

<42>
Accession Number
2007644687
Title
The comparison of radiofrequency and cyanoacrylate embolization therapy in
vena saphena magna ablation.
Source
Annals of Clinical and Analytical Medicine. 12 (Supplement 1) (pp
S68-S71), 2021. Date of Publication: 2021.
Author
Er Z.C.; Destan B.; Ozcan S.
Institution
(Er) Department of Cardiovascular Surgery, Bozok University, Faculty of
Medicine, Yozgat, Turkey
(Destan) Department of Cardiovascular Surgery, Mehmet Akif Ersoy State
Hospital, Canakkale, Turkey
(Ozcan) Department of Cardiovascular Surgery, Canakkale Onsekiz Mart
University Faculty of Medicine, Canakkale, Turkey
Publisher
Derman Medical Publishing
Abstract
Aim: Chronic venous insufficiency is a frequent and disabling illness
causing loss of life quality and labor. In this study, we aimed to compare
the cyanoacrylate embolization and radiofrequency methods in vena saphena
magna ablation therapy. Material(s) and Method(s): Two hundred twenty
patients with symptomatic venous insufficiency were involved in this study
between November 2015 and January 2020 in Bozok University faculty of
medicine cardiovascular surgery department. Patients were grouped into two
groups. Group 1 included patients who were applied radiofrequency, and
Group 2 included patients who underwent cyanoacrylate embolization.
Preoperatively, Doppler ultrasound showed venous reflux and VSM diameter
in all patients. Patient with non-tortuous veins and VSM diameter of more
than 5.5 mm and a reflux duration of more than 0.5 seconds in the
saphenofemoral junction were taken into consideration. This study included
110 cases in each group with similar demographic characteristics. After
discharge, patients were called for control after one week, and in the
first and sixth months they were evaluated with Doppler ultrasound.
 Result(s): A month later, during the procedure in Doppler USG
control, we found o that VSM in 108 out of 110 patients (%98.18) was
obliterated in the RF group. In the cyanoacrylate embolization (CAE)
group, VSM was totally obliterated in all patients. Six months later,
obliteration was 107 (%97.27) in RF and 109 (%99.09) in the cyanoacrylate
group. In a month, %8.18 ecchymosis, %0.9 cellulitis and %1.81
thrombophlebitis were seen in the RF group. Complications in the
cyanoacrylate group were ecchymosis in %10.9, cellulitis in %2.72 and
trombophlebitis in %0.9. The duration of the procedure was 32.14 minutes
in the RF group and 15.32 minutes in the CAE group. Preoperatively, the
patients were asked 8 questions about the symptoms. After six months, the
same questions were asked and answers were compared with the previous
ones. In both groups, the recovery was similar. Discussion(s):
Although the classical surgical procedure of venous insufficiency is a
successful method, it has complications. When deciding the therapy method,
cosmetic results should be kept in mind. Also, the short operation
duration affects the choice. Frequently applied methods are EVLA, RFA,
foam sclerotherapy, and CAE. RF and CAE technics were effective as
classical surgery in chronic venous insufficiency. Effectiveness and
complication rates were not different, but the shorter duration of
procedure makes CAE more advantageous. Copyright © 2021, Derman
Medical Publishing. All rights reserved.

<43>
Accession Number
2007632250
Title
Anaesthesia for the child with a univentricular heart: A practical
approach.
Source
Southern African Journal of Anaesthesia and Analgesia. 27 (3) (pp
144-153), 2021. Date of Publication: 2021.
Author
Veronese L.; Swanevelder J.; Brooks A.
Institution
(Veronese) Logan Hospital, Australia
(Swanevelder, Brooks) Red Cross War Memorial Children's Hospital,
University of Cape Town, South Africa
Publisher
Medpharm Publications
Abstract
Congenital heart disease (CHD) represents a major challenge for
anaesthetists. This is due to the complexities in pathophysiology and the
impact of surgery and anaesthesia, which predisposes to significant
perioperative morbidity and mortality.1 Univentricular heart (UH) consists
of a large variety of rare and complex congenital cardiac malformations.
There are rare cases of children having only a single functional ventricle
from birth. More commonly, children may receive surgical palliation for
complex cardiac defects by creating a univentricular heart when
biventricular repair is not feasible. About 30% of patients with
univentricular physiology have complications when undergoing non-cardiac
surgery.2 During this review, we aim to provide a practical understanding
of the pathophysiology of UH and outline a systematic approach to the
perioperative management of these patients presenting for non-cardiac
surgery. We conclude with an evaluation of the use of near-infrared
spectroscopy, transoesophageal echocardiography and ventricular assist
devices, as technologies with increasing application in the management of
this challenging patient population. Supplementary video available online:
http://www.sajaa.co.za/index.php/sajaa/article/view/2572. Copyright
© 2021 The Author(s).

<44>
Accession Number
2014224162
Title
Regulatory role of microRNA-320 during off-pump coronary artery bypass
grafting with dexmedetomidine adjunct anesthesia.
Source
Experimental and Therapeutic Medicine. 22 (5) (no pagination), 2021.
Article Number: 1201. Date of Publication: 23 Aug 2021.
Author
GAO Y.; ZHU X.; YU H.; WANG W.; WANG Y.; LI F.; TENG J.
Institution
(GAO, WANG, LI, TENG) Departments of Anesthesiology, The First Affiliated
Hospital of Hebei North University, Hebei, Zhangjiakou 075000, China
(ZHU) Departments of Medical Imaging, The First Affiliated Hospital of
Hebei North University, Hebei, Zhangjiakou 075000, China
(YU) Departments of Ultrasound, The First Affiliated Hospital of Hebei
North University, Hebei, Zhangjiakou 075000, China
(WANG) Departments of Operating Room, The First Affiliated Hospital of
Hebei North University, Hebei, Zhangjiakou 075000, China
Publisher
Spandidos Publications
Abstract
The present study investigated the effects of dexmedetomidine on the
expression level of microRNA-320 (miR-320) and neuroglobin (NGB) in
patients undergoing off-pump coronary artery bypass grafting (OPCABG). A
total of 40 patients undergoing OPCABG were recruited and randomly divided
into the dexmedetomidine and normal saline groups (treated before
anesthesia), respectively. The NGB levels in the blood samples before and
after surgery were analyzed and compared. The CATH.a cells were cultured
and induced with dexmedetomidine, and the NGB expression level was
detected. CATH.a cells were treated with NGB and lipopolysaccharide (LPS),
and the cell survival rate was determined. The miR-320 expression levels
in the blood samples and dexmedetomidine-induced cells were detected.
Dual-luciferase reporter assay was performed. Compared with control
subjects, patients in the dexmedetomidine group had higher NGB levels in
the blood. In the CATH.a cells, the dexmedetomidine treatment upregulated
the NGB levels. Moreover, upon pre-incubation with NGB and LPS
stimulation, dexmedetomidine elevated cell viability. Furthermore, miR-320
expression levels were significantly downregulated in the blood of
patients in the dexmedetomidine group, as well as in the
dexmedetomidine-induced cells. Dual-luciferase reporter assay confirmed
that miRNA-320a directly targeted on NGB, and upregulated miRNA-320a in
CATH.a cells decreased cell proliferation activity. Pre-administration of
dexmedetomidine can decrease miR-320 expression level in the blood of
patients undergoing OPCABG, stimulating the high expression of NGB and
increasing the proliferation activity of neuronal cells, which may
decrease the postoperative cognitive impairment. Copyright © 2021
Spandidos Publications. All rights reserved.

<45>
Accession Number
2013795960
Title
Invasive versus conservative management in spontaneous coronary artery
dissection: A meta-analysis and meta-regression study.
Source
Hellenic Journal of Cardiology. 62 (4) (pp 297-303), 2021. Date of
Publication: 01 Jul 2021.
Author
Bocchino P.P.; Angelini F.; Franchin L.; D'Ascenzo F.; Fortuni F.; De
Filippo O.; Conrotto F.; Alfonso F.; Saw J.; Escaned J.; Liu C.; De
Ferrari G.M.
Institution
(Bocchino, Angelini, Franchin, D'Ascenzo, De Filippo, Conrotto, De
Ferrari) Division of Cardiology, Department of Medical Sciences,
University of Turin, "Citta della Salute e della Scienza" Hospital, Turin,
Italy
(Fortuni) Coronary Care Unit and Laboratory of Clinical and Experimental
Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Fortuni) Department of Molecular Medicine, University of Pavia, Pavia,
Italy
(Alfonso) Cardiology Department, Hospital Universitario de La Princesa,
IIS-IP, Universidad Autonoma de Madrid, CIBER-CV, Madrid, Spain
(Saw) Division of Cardiology, Vancouver General Hospital, Vancouver, BC,
Canada
(Escaned) Unidad de Cardiologia Intervencionista, Hospital Clinico San
Carlos, Madrid, Spain
(Liu) Department of Cardiology, Wuhan Asia Hospital, Wuhan University of
Science and Technology, Wuhan, China
Publisher
Hellenic Cardiological Society
Abstract
Background: Data regarding the best treatment for spontaneous coronary
artery dissection (SCAD) are limited. The aim of the present study was to
compare the clinical outcomes of conservative versus invasive treatment in
SCAD patients. Method(s): We systematically searched the literature
for studies evaluating the comparative efficacy and safety of invasive
revascularization versus medical therapy for the treatment of SCAD from
1990 to 2020. The study endpoints were all-cause death, cardiovascular
death, myocardial infarction, heart failure, SCAD recurrence and target
vessel revascularization (TVR) rates. Random effect meta-analysis was
performed by comparing the clinical outcomes between the two groups. A
univariate meta-regression analysis was also performed. Result(s):
Twenty-four observational studies with 1720 patients were included. After
28 +/- 14 months, a conservative approach was associated with lower TVR
rate compared with invasive treatment (OR = 0.50; 95%CI 0.28-0.90; P =
0.02). No statistical difference was found regarding all-cause death (OR =
0.81; 95%CI 0.31-2.08; P = 0.66), cardiovascular death (OR = 0.89; 95%CI
0.15-5.40; P = 0.89), myocardial infarction (OR = 0.95; 95%CI 0.50-1.81; P
= 0.87), heart failure (OR 0.96; 95%CI 0.41-2.22; P = 0.92) and SCAD
recurrence (OR = 0.94; 95%CI 0.52-1.72; P = 0.85). The meta-regression
analysis suggested that male gender, diabetes mellitus, smoking habit,
prior coronary artery disease, left main coronary artery involvement,
lower ejection fraction and low TIMI flow at admission were related with
high overall mortality, whereas SCAD recurrence was higher among patients
with fibromuscular dysplasia. Conclusion(s): A conservative approach
was associated with similar clinical outcomes and lower TVR rates compared
with an invasive strategy in SCAD patients; future prospective studies are
needed to confirm these results. Copyright © 2021 Hellenic
Society of Cardiology

<46>
Accession Number
2012906136
Title
Biomechanical Effects of Combined Anterior Cruciate Ligament
Reconstruction and Anterolateral Ligament Reconstruction: A Systematic
Review and Meta-analysis.
Source
Orthopaedic Journal of Sports Medicine. 9 (6) (no pagination), 2021. Date
of Publication: 2021.
Author
Kelly S.R.; Cutter B.M.; Huish E.G.
Institution
(Kelly, Cutter, Huish) San Joaquin General Hospital, French Camp, CA,
United States
(Kelly, Cutter, Huish) Valley Orthopedic Surgery Residency, Modesto, CA,
United States
Publisher
SAGE Publications Ltd
Abstract
Background: Combined anterior cruciate ligament (ACL) reconstruction
(ACLR) and anterolateral ligament reconstruction (ALLR) are performed with
the intention to restore native knee kinematics after ACL tears. There
continue to be varying results as to the difference in kinematics between
combined and isolated procedures, including anterior tibial translation
(ATT) and internal tibial rotation (IR). Purpose(s): To perform a
systematic review and meta-analysis to evaluate the kinematic changes of a
combined ACLR/ALLR versus isolated ACLR and to assess the effects of
different fixation techniques. Study Design: Systematic review.
 Method(s): We conducted a systematic review and meta-analysis of 15
human cadaveric biomechanical studies evaluating combined ACLR/ALLR versus
isolated ACLR and their effects on ATT and IR in 149 specimens. The
primary outcomes were ATT and IR. Secondary outcomes included graft type
and size as well as fixation methods such as type, angle, tension, and
position of fixation. Meta-regression was used to examine the effect of
various cofactors on the resulting measures. Result(s): Compared with
isolated ACLR, combined ACLR/ALLR decreased ATT and IR by 0.01 mm (95% CI,
-0.059 to 0.079 mm; P =.777) and 1.64degree (95% CI,
1.30degree-1.98degree; P <.001), respectively. Regarding ACLR/ALLR,
increasing the knee flexion angle and applied IR force led to a
significant reduction in IR (P <.001 and P =.044, respectively). There was
also a significant reduction in IR in combined procedures with
semitendinosus ALL graft, higher flexion fixation angles, and tension but
no change in IR with differing femoral fixation points (P <.001, P <.001,
and P =.268, respectively). Multivariate meta-regression showed that the
use of tibial-sided suture anchor fixation significantly reduced IR (P
<.001). Conclusion(s): These results suggest that a combined
ACLR/ALLR procedure significantly decreases IR compared with isolated
ACLR, especially at higher knee flexion angles. Semitendinosus ALL graft,
fixation at higher knee flexion, increased tensioning, and tibial-sided
interference screw fixation in ALLR may help to further reduce
IR. Copyright © The Author(s) 2021.

<47>
Accession Number
2013314383
Title
Influence of frailty on outcome in older patients undergoing non-cardiac
surgery - A systematic review and meta-analysis.
Source
Aging and Disease. 11 (5) (pp 1276-1290), 2020. Date of Publication: 2020.
Author
Tjeertes E.K.M.; Van Fessem J.M.K.; Mattace-Raso F.U.S.; Hoofwijk A.G.M.;
Stolker R.J.; Hoeks S.E.
Institution
(Tjeertes, Van Fessem, Stolker, Hoeks) Department of Anesthesiology,
Erasmus MC University Medical Center, Rotterdam, Netherlands
(Mattace-Raso) Department of Internal Medicine, Division of Geriatric
Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
(Hoofwijk) Department of Surgery, Zuyderland Medical Center, Geleen,
Netherlands
Publisher
International Society on Aging and Disease
Abstract
Frailty is increasingly recognized as a better predictor of adverse
postoperative events than chronological age. The objective of this review
was to systematically evaluate the effect of frailty on postoperative
morbidity and mortality. Studies were included if patients underwent
non-cardiac surgery and if frailty was measured by a validated instrument
using physical, cognitive and functional domains. A systematic search was
performed using EMBASE, MEDLINE, Web of Science, CENTRAL and PubMed from
1990 - 2017. Methodological quality was assessed using an assessment tool
for prognosis studies. Outcomes were 30-day mortality and complications,
one-year mortality, postoperative delirium and discharge location.
Meta-analyses using random effect models were performed and presented as
pooled risk ratios with confidence intervals and prediction intervals. We
included 56 studies involving 1.106.653 patients. Eleven frailty
assessment tools were used. Frailty increases risk of 30-day mortality (31
studies, 673.387 patients, risk ratio 3.71 [95% CI 2.89-4.77] (PI
1.38-9.97; I2=95%) and 30-day complications (37 studies, 627.991 patients,
RR 2.39 [95% CI 2.02-2.83). Risk of 1-year mortality was threefold higher
(six studies, 341.769 patients, RR 3.40 [95% CI 2.42-4.77]). Four studies
(N=438) reported on postoperative delirium. Meta-analysis showed a
significant increased risk (RR 2.13 [95% CI 1.23-3.67). Finally, frail
patients had a higher risk of institutionalization (10 studies, RR 2.30
[95% CI 1.81-2.92]). Frailty is strongly associated with risk of
postoperative complications, delirium, institutionalization and mortality.
Preoperative assessment of frailty can be used as a tool for patients and
doctors to decide who benefits from surgery and who doesn't. Copyright
© 2019 Tjeertes EKM, et al.

<48>
Accession Number
2013916866
Title
The emergency department evaluation and management of massive hemoptysis.
Source
American Journal of Emergency Medicine. 50 (pp 148-155), 2021. Date of
Publication: December 2021.
Author
Atchinson P.R.A.; Hatton C.J.; Roginski M.A.; Backer E.D.; Long B.; Lentz
S.A.
Institution
(Atchinson, Roginski) Department of Emergency Medicine, Geisel School of
Medicine at Dartmouth, Hanover, NH, United States
(Hatton, Backer) Dartmouth-Hitchcock Medical Center, Section of Critical
Care Medicine, Department of Medicine, Geisel School of Medicine at
Dartmouth, Hanover, NH, United States
(Long) Department of Emergency Medicine, Brooke Army Medical Center, San
Antonio, TX, United States
(Lentz) Division of Emergency Medicine and Pulmonary Disease and Critical
Care Medicine, The University of Vermont Larner College of Medicine,
Burlington, VT, United States
Publisher
W.B. Saunders
Abstract
Introduction: Massive hemoptysis is a life-threatening emergency that
requires rapid evaluation and management. Recognition of this deadly
condition, knowledge of the initial resuscitation and diagnostic
evaluation, and communication with consultants capable of definitive
management are key to successful treatment. Objective(s): The
objective of this narrative review is to provide an evidence-based review
on the management of massive hemoptysis for the emergency clinician.
 Discussion(s): Rapid diagnosis and management of life-threatening
hemoptysis is key to patient survival. The majority of cases arise from
the bronchial arterial system, which is under systemic blood pressure.
Initial management includes patient and airway stabilization, reversal of
coagulopathy, and identification of the source of bleeding using computed
tomography angiogram. Bronchial artery embolization with interventional
radiology has become the mainstay of treatment; however, unstable patients
may require advanced bronchoscopic procedures to treat or temporize while
additional information and treatment can be directed at the underlying
pathology. Conclusion(s): Massive hemoptysis is a life-threatening
condition that emergency clinicians must be prepared to manage. Emergency
clinicians should focus their management on immediate resuscitation,
airway preservation often including intubation and isolation of the
non-bleeding lung, and coordination of definitive management with
available consultants including interventional radiology, interventional
pulmonology, and thoracic surgery. Copyright © 2021 Elsevier Inc.

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

<50>
Accession Number
2013387147
Title
The role of viscoelastic testing in assessing peri-interventional platelet
function and coagulation.
Source
Platelets. (no pagination), 2021. Date of Publication: 2021.
Author
Tantry U.S.; Hartmann J.; Neal M.D.; Schoechl H.; Bliden K.P.; Agarwal S.;
Mason D.; Dias J.D.; Mahla E.; Gurbel P.A.
Institution
(Tantry, Bliden, Gurbel) Sinai Center for Thrombosis Research and Drug
Development, Sinai Hospital of Baltimore, Baltimore, MD, United States
(Hartmann, Mason, Dias) Medical Affairs and Clinical Development,
Haemonetics Corporation, Boston, MA, United States
(Neal) Department of General Surgery, The University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Schoechl) Department of Anesthesiology and Intensive Care Medicine, AUVA
Trauma Centre Salzburg, Academic Teaching Hospital, Paracelsus Medical
University, Salzburg, Austria
(Schoechl) AUVA Trauma Research Centre, Ludwig Boltzmann Institute for
Experimental and Clinical Traumatology, Vienna, Austria
(Agarwal) Department of Anaesthesia, Manchester University Foundation
Trust, Manchester, United Kingdom
(Mahla) Department of Anaesthesiology and Intensive Care Medicine, Medical
University of Graz, Graz, Austria
Publisher
Taylor and Francis Ltd.
Abstract
We carried out a literature search in MEDLINE (PubMed) and EMBASE
literature databases to provide a concise review of the role of
viscoelastic testing in assessing peri-interventional platelet function
and coagulation. The search identified 130 articles that were relevant for
the review, covering the basic science of VHA and VHA in clinical settings
including cardiac surgery, cardiology, neurology, trauma, non-cardiac
surgery, obstetrics, liver disease, and COVID-19. Evidence from these
articles is used to describe the important role of VHAs and platelet
function testing in various peri-interventional setups. VHAs can help us
to comprehensively assess the contribution of platelets and coagulation
dynamics to clotting at the site-of-care much faster than standard
laboratory measures. In addition to standard coagulation tests, VHAs are
beneficial in reducing allogeneic transfusion requirements and bleeding,
in predicting ischemic events, and improving outcomes in several
peri-interventional care settings. Further focused studies are needed to
confirm their utility in the peri-interventional case. Copyright
© 2021 The Author(s). Published with license by Taylor & Francis
Group, LLC.

<51>
Accession Number
2013385714
Title
Infective endocarditis by Enterobacter cloacae: a systematic review and
meta-analysis.
Source
Journal of Chemotherapy. (no pagination), 2021. Date of Publication: 2021.
Author
Ioannou P.; Vamvoukaki R.; Kofteridis D.P.
Institution
(Ioannou, Vamvoukaki, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete,
Greece
Publisher
Taylor and Francis Ltd.
Abstract
Enterobacter species are Gram-negative, non-spore-forming, facultative
anaerobes typically motile due to the presence of peritrichous flagella.
E. cloacae, the species responsible for the majority of Enterobacter
infections in humans, is part of the intestinal microbiota and may cause
infection in patients that have previously received antimicrobial therapy
or who have been admitted to the Intensive Care Unit. E. cloacae may cause
several infections, such as pneumonia, urinary tract, skin and soft tissue
and intravascular infections. Infective Endocarditis (IE) is a rare
disease with notable morbidity and mortality. Even though IE is rarely
caused by E. cloacae, these infections can be problematic due to the
relative lack of experience in their management. The purpose of this study
was to systematically review all published cases of IE by E. cloacae in
the literature. A systematic review of PubMed, Scopus and Cochrane library
(through 14th November 2020) for studies providing
epidemiological, clinical, microbiological as well as treatment data and
outcomes of IE by E. cloacae was performed. A total of 20 studies,
containing data of 20 patients, were included. A prosthetic valve was
present in 27.8%. Mitral valve was the commonest infected site, followed
by aortic valve. Diagnosis was facilitated by transthoracic and
transesophageal echocardiography in 38.5% each, while the diagnosis was
set at autopsy in 10%. Fever, sepsis, shock and immunologic phenomena were
the most common clinical presentations, followed by heart failure.
Aminoglycosides, cephalosporins and carbapenems were the most common
antimicrobials used. Clinical cure was noted in 75%, while overall
mortality was 30%. Development of shock and treatment with the combination
of piperacillin with tazobactam were associated with overall
mortality. Copyright © 2021 Edizioni Scientifi che per
l'Informazione su Farmaci e Terapia.

<52>
Accession Number
2013160678
Title
Distal transradial access for post-CABG coronary and surgical grafts
angiography and interventions.
Source
Indian Heart Journal. 73 (4) (pp 440-445), 2021. Date of Publication: 01
Jul 2021.
Author
Oliveira M.D.P.; Navarro E.C.; Caixeta A.
Institution
(Oliveira, Caixeta) Department of Interventional Cardiology, Hospital Sao
Paulo, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao
Paulo, SP, Brazil
(Oliveira, Navarro) Department of Interventional Cardiology, Hospital
Regional Do Vale Do Paraiba, Taubate, Sao Paulo, Brazil
Publisher
Elsevier B.V.
Abstract
Background: Post-CABG coronary and grafts angiography (CGAG) and
interventions (PCI) have historically been performed via classic
transfemoral approach. Particularly for those with left internal mammary
artery (LIMA) grafts, left standard transradial access (lsTRA) represents
a feasible alternative, with significant fewer vascular complications, but
it has ergonomic disadvantage for the operator because of the need to bend
over the patients, especially in obese ones. Distal transradial access
(dTRA) may provide important advantages, including shorter hemostasis and
greater patient and operator comfort, mainly for left dTRA (ldTRA). We aim
to describe the feasibility and safety of right and left dTRA for
post-CABG CGAG and PCI. Material(s) and Method(s): From February 2019
to April 2021, 111 consecutive post-CABG patients submitted to CGAG and/or
PCI via dTRA have been enrolled. Result(s): Mean patient age was 67.6
years old. Most were male (88.3%) and had chronic coronary syndromes
(61.3%). Overall, 35.1% had acute coronary syndromes. Distal RA was
successfully punctured in all 111 patients, always without ultrasound
guidance. All procedures involving LIMA grafts were done via ipsilateral
ldTRA. We had only 5 (4.5%) access site crossovers. Successful dTRA sheath
insertion was then achieved in 95.5% of all patients, mostly (74.8%) via
ldTRA and with standard 6Fr sheath (99.1%). Distal and proximal RA pulses
were palpable in all patients at hospital discharge. No major adverse
cardiac and cerebrovascular events and no major complications related to
dTRA were recorded. Conclusion(s): dTRA for routine post-CABG CGAG
and PCI by experienced transradial operators appears to be feasible.
Further randomized and larger trials are needed to assure clinical
benefits and safety of this new technique. Copyright © 2021
Cardiological Society of India

<53>
Accession Number
635848914
Title
Transthoracic aortic valve implantation (tavi) in hemophilia.
Source
HemaSphere. Conference: 26th Congress of the European Hematology
Association, EHA 2021. Virtual. 5 (SUPPL 2) (pp 699), 2021. Date of
Publication: June 2021.
Author
Lopez M.; Ansoar E.L.; Vazquez A.N.; Muniz O.D.; Lopez C.A.
Institution
(Lopez, Ansoar, Vazquez, Muniz, Lopez) Hematology Department, Hospital
Alvaro Cunqueiro, Vigo, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The increase in life expectancy of hemophiliac patients leads
to the appearance of health problems whose proper managment is not clearly
defined. Cardiac Surgery presents a major hemostatic challenge for a
multitude of reasons, particularly in patients suffering from congenital
or acquired hemostatic disorders. Acknowledging that, evidence from the
literature suggests that cardiac surgery can be performed safely in this
patient population Aims: We reported the first TAVI performed in our
hospital in hemophiliac patient, the management during and after hospital
discharge Methods: Male, 74 years, mild hemophilia A (F8:C 9%, F8
chromogenic 5,4%) without inibitor AntiF8(< 0.6 Bethesda Units, uBT). We
not know the responsible mutation. In the past, he received treatment with
different Concentrates of F8 (the last, ReFacto AF.). Previous surgeries:
Total Hip Prostesis. CV Risk Factors: Arterial Hypertension (Medical
treatment), Obesity, Diet-controlled hyperglycemia. He has a chronic liver
disease due Virus C. He had an Severe Aortic stenosis who needed surgical
replacement and the chosen option was TAVI to reduce the surgical risks,
among which bleeding Results: 30 minutes before the procedure, ReFacto AF.
50 IU / kg was administered; A 29 mm Corevalve Evolut. R prosthesis was
implanted, for which access was required through both femoral and right
jugular veins to place a temporary pacemaker, a procedure that required
the use of Unfractionated Heparin (5000 IU) without complications. At 3
hours, a 2nd dose of ReFacto AF. of approx. 10 IU / Kg was administered
and the plasma levels of F8 were monitored using the chromogenic technique
(level 110%). 8 hours after the 1st administration, ReFacto AF. started
every 8 hours to maintain a trough level of approx 80% for first 48 hours,
then adjusted every 12 hours (trough level of 50%) up to 7 days, then 30%
(Desmopressin and ReFacto AF, alternate days) until completing 12 days of
treatment. Simultaneously, antithrombotic prophylaxis was started with
Enoxaparin. 40 mg (from day +1 to discharge) and simple antiplatelet
therapy (ASA 100 mg / day), which he currently maintains. Hospital
dischage was at day +14. The inhibitor was removed 15 days and 2 months
after the procedure - according to the protocol of our service - resulting
negative. The patient reports an improvement of his quality of life,
compared with the previous one, with disappearance of associated symptoms
and progressive increase of physical activity, more according to his age
and general condition Summary/Conclusion: We present a succesfully case of
TAVI in mild haemophiliac patient. TAVI is a safe and effective option
versus open heart surgery in high-risk patients as haemophiliac patients.
A search in PuBmed. database, crossing 2 topics: Aortic Stenosis and
Haemophilia, showed 5 citations, 1 for Haemophilia B and 4 Haemophilia A;
just case reports, so we consider it interesting to communicate our
experience in order to generate scientific evidence so as not only to
recomend this therapeutic option as of choice in these patients but also
to guide the performance of the procedure, in close collaboration with
cardiologists and anesthetists.

<54>
Accession Number
2014313005
Title
Comparison of high-flow nasal cannula (hfnc) and conventional oxygen
therapy in obese patients undergoing cardiac surgery: A systematic review
and meta-analysis.
Source
In Vivo. 35 (5) (pp 2521-2529), 2021. Date of Publication: October 2021.
Author
WANG Y.; ZHU J.; WANG X.; LIU N.; YANG Q.; LUAN G.; MA X.; LIU J.
Institution
(WANG, ZHU, WANG, YANG, LUAN, MA, LIU) Zhaoyuan Renmin Hospital, Yantai,
China
(LIU) Weihai Municipal Hospital, Weihai, China
Publisher
International Institute of Anticancer Research
Abstract
Background/Aim: High-flow nasal cannula (HFNC), a new method for
postoperative oxygenation, has increasingly received attention during
postoperative care. However, its importance for obese patients undergoing
cardiac surgery remains controversial. This systematic review and
meta-analysis compared and evaluated HFNC and conventional oxygen therapy
(COT) in this patient group. Material(s) and Method(s): Literature
was retrieved by searching eight public databases. Randomized controlled
trials (RCTs) were selected. RevMan 5.3 was used to analyze the results
and any potential bias. The primary outcome included atelectasis score at
24 h postoperatively. The secondary outcomes included PaO2/FiO2 (ratio),
dyspnea score at 24 h postoperatively, intensive care unit (ICU) length of
stay, and reintubation. Result(s): The search strategy yielded 382
studies after duplicates were removed. Finally, 3 RCTs with a total of 526
patients were included in the present study. Compared with COT, there was
no significant difference in atelectasis score, dyspnea score,
reintubation, and ICU length of stay. Conclusion(s): For obese
patients undergoing cardiac surgery, postoperative use of HFNC can
maintain patient's oxygenation. Additional clinical studies are needed to
investigate the role of HFNC in this patient group. Copyright ©
2021 International Institute of Anticancer Research. All rights reserved.

<55>
Accession Number
2014302728
Title
Effect of postoperative high load long duration inspiratory muscle
training on pulmonary function and functional capacity after mitral valve
replacement surgery: A randomized controlled trial with follow-up.
Source
PLoS ONE. 16 (8 August) (no pagination), 2021. Article Number: e0256609.
Date of Publication: August 2021.
Author
Hegazy F.A.; Kamel S.M.M.; Abdelhamid A.S.; Aboelnasr E.A.; Elshazly M.;
Hassan A.M.
Institution
(Hegazy) Department of Physiotherapy, Collage of Health Sciences,
University of Sharjah, Sharjah, United Arab Emirates
(Hegazy, Aboelnasr) Faculty of Physical Therapy, Cairo University, Giza,
Egypt
(Kamel) Department of Physical Therapy, National Heart Institute, Cairo,
Egypt
(Abdelhamid) Department of Physical Therapy for Musculoskeletal Disorders
and Its Surgeries, Faculty of Physical Therapy, South Valley University,
Qena, Egypt
(Elshazly) Department of Physical Therapy for Surgery, Faculty of Physical
Therapy, South Valley University, Qena, Egypt
(Hassan) Department of Physical Therapy for Internal Medicine and
Geriatrics, Faculty of Physical Therapy, South Valley University, Qena,
Egypt
Publisher
Public Library of Science
Abstract
Objectives: Although, pre-operative inspiratory muscle training has been
investigated and reported to be an effective strategy to reduce
postoperative pulmonary complications, the efficacy of postoperative
inspiratory muscle training as well as the proper load, frequency, and
duration necessary to reduce the postoperative pulmonary complications has
not been fully investigated. This study was designed to investigate the
effect of postoperative high-load longduration inspiratory muscle training
on pulmonary function, inspiratory muscle strength, and functional
capacity after mitral valve replacement surgeries. Design Prospective
randomized controlled trial. Method(s): A total of one hundred
patients (mean age 38.3+/-3.29years) underwent mitral valve replacement
surgery were randomized into experimental (n = 50) and control (n = 50)
groups. The control group received conventional physiotherapy care, while
experimental group received conventional care in addition to inspiratory
muscle training, with 40% of the baseline maximal inspiratory pressure
targeting a load of 80% by the end of the 8 weeks intervention protocol.
Inspiratory muscle training started on the patient's first day in the
inpatient ward. Lung functions, inspiratory muscle strength, and
functional capacity were evaluated using a computer-based spirometry
system, maximal inspiratory pressure measurement and 6MWT respectively at
5 time points and a follow-up assessment was performed 6 months after
surgery. Repeated measure ANOVA and post-hoc analyses were used (p <0.05).
 Result(s): Group-time interactions were detected for all the studied
variables (p<0.001). Betweengroup analysis revealed statistically
significant postoperative improvements in all studied variables in the
experimental group compared to the control group (p <0.001) with large
effect size of eta2 >0.14. Within-group analysis indicated substantial
improvements in lung function, inspiratory pressure and functional
capacity in the experimental group (p <0.05) over time, and these
improvements were maintained at follow-up. Conclusion(s): High
intensity, long-duration postoperative inspiratory muscle training is
highly effective in improving lung function, inspiratory muscle strength,
and functional capacity after mitral valve replacement
surgeries. Copyright © 2021 Hegazy 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.

<56>
Accession Number
2014317460
Title
Survival effect of radial artery usage in addition to bilateral internal
thoracic arterial grafting: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Formica F.; Maestri F.; D'Alessandro S.; Di Mauro M.; Singh G.; Gallingani
A.; Nicolini F.
Institution
(Formica, Maestri, Gallingani, Nicolini) Cardiac Surgery Unit, Department
of Medicine and Surgery, Parma General Hospital, University of Parma,
Parma, Italy
(D'Alessandro) Cardiac Surgery Unit, Vito Fazzi Hospital, Lecce, Italy
(Di Mauro) Invasive Cardiology and Heart Failure Unit, Medicine
Department, "Pierangeli" Hospital, Pescara, Italy
(Di Mauro) Cardio-Thoracic Surgery Unit, Heart and Vascular Centre,
Maastricht University, Maastricht, Netherlands
(Singh) Medical Centre (MUMC), Cardiovascular Research Institute
Maastricht (CARIM), Maastricht, Netherlands
(Singh) Division of Cardiac Surgery and Department of Critical Care
Medicine, Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Publisher
Mosby Inc.
Abstract
Objective: Little evidence shows whether the radial artery (RA) as third
arterial graft provides superior outcomes compared with the use of the
bilateral internal thoracic artery (BITA) and saphenous vein (SV) graft in
patients undergoing coronary artery bypass grafting. A meta-analysis of
propensity score-matched observational studies that compared the long-term
outcomes of coronary artery bypass grafting with the use of BITA and the
RA (BITA + RA) versus BITA and SV (BITA + SV) was performed.
 Method(s): Electronic databases from January 2000 to November 2020
were screened. Studies that reported long-term mortality were analyzed.
The primary outcome was long-term overall mortality. A secondary end point
was in-hospital/30-day mortality. Pooled hazard ratio with 95% confidence
interval (CI) were calculated for survival and time-to-event analysis
according to a random effect model. Differences were expressed as odds
ratio with 95% CI for in-hospital/30-day mortality. Result(s): Six
propensity score-matched studies that reported on 2500 matched patients
(BITA + RA: 1250; BITA + SV: 1250) were identified for comparison. The use
of BITA + RA was not statistically associated with early mortality (odds
ratio, 0.90; 95% CI, 0.36-2.28; P = .83). The mean follow-up time ranged
from 7.5 to 12 years. The pooled analysis of long-term survival revealed a
significant difference between the 2 groups favoring BITA + RA treatment
(hazard ratio, 0.71; 95% CI, 0.50-0.91; P = .031). The survival rate for
BITA + RA versus BITA + SV at 5, 10, and 15 years were: 96.2% versus
94.8%, 88.9% versus 87.4%, and 83% versus 77.9%, respectively (log rank
test, P = .02). Conclusion(s): In patients with coronary artery
bypass grafting, BITA + RA usage is not associated with higher rates of
operative risk and is associated with superior long-term overall
survival. Copyright © 2021 The American Association for Thoracic
Surgery

<57>
Accession Number
2014313924
Title
Meta-Analysis Comparing Valve Durability Among Different Transcatheter and
Surgical Aortic Valve Bioprosthesis.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Ueyama H.; Kuno T.; Takagi H.; Kobayashi A.; Misumida N.; Pinto D.S.;
Laham R.J.; Baeza C.; Kini A.; Lerakis S.; Latib A.; Sondergaard L.;
Attizzani G.F.
Institution
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kobayashi, Baeza, Attizzani) Harrington Heart and Vascular Institute,
University Hospital Cleveland Medical Center, Case Western Reserve
University, Cleveland, OH, United States
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, KY, United States
(Pinto, Laham) Division of Cardiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, Massachusetts
(Kini, Lerakis) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, Mount Sinai Hospital, NY, United States
(Kuno, Latib) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, New York, NY, United States
(Sondergaard) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Durability of transcatheter heart valve (THV) is critical as the
indication of transcatheter aortic valve implantation (TAVI) expands to
patients with longer life-expectancy. We aimed to compare the durability
of different THV systems (balloon-expandable [BE] and self-expandable
[SE]) and surgical aortic valve replacement (SAVR) prosthesis. PUBMED and
EMBASE were searched through February 2021 for randomized trials
investigating parameters of valve durability after TAVI and/or SAVR in
severe aortic stenosis. A network meta-analysis using random-effect model
was performed. Synthesis was performed with 5-year follow-up data for
echocardiographic outcomes and the longest available follow-up data for
clinical outcomes. Ten trials with a total of 9,388 patients (BE-THV:
2,562; SE-THV: 2,863; SAVR: 3,963) were included. Follow-up ranged from 1
to 6 years. SE-THV demonstrated significantly larger effective orifice
area, lower mean aortic valve gradient (AVG), and less increase in mean
AVG at 5-year compared with BE-THV and SAVR. Structural valve
deterioration (SVD) was less frequent in SE-THV compared with BE-THV and
SAVR (HR 0.14, 95% CI 0.07 to 0.27; HR 0.34, 95% CI 0.24 to 0.47,
respectively). Total moderate-severe aortic regurgitation and
reintervention was more frequent in BE-THV (HR 4.21, 95% CI 2.40 to 7.39;
HR 2.22, 95% CI 1.16 to 4.26, respectively), and SE-THV (HR 7.51, 95% CI
3.89 to 14.5; HR 2.86, 95% CI 1.59 to 5.13, respectively) compared with
SAVR. In conclusion, TAVI with SE-THV demonstrated favorable forward-flow
hemodynamics and lowest risk of SVD compared with BE-THV and SAVR at
mid-term. However, both THV systems suffer an increased risk of AR and
re-intervention, and long-term data from newer generation valves is
warranted. Copyright © 2021 Elsevier Inc.

<58>
Accession Number
2013570825
Title
Correlation of Near-Infrared Spectroscopy Oximetry and Corresponding
Venous Oxygen Saturations in Children with Congenital Heart Disease.
Source
Pediatric Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Loomba R.S.; Rausa J.; Sheikholeslami D.; Dyson A.E.; Farias J.S.;
Villarreal E.G.; Flores S.; Bronicki R.A.
Institution
(Loomba, Rausa) Cardiology, Pediatrics, Advocate Children's Hospital, Oak
Lawn, IL, United States
(Loomba, Sheikholeslami, Dyson) Medicine, Chicago Medical School/Rosalind
Franklin University of Medicine and Science, North Chicago, IL, United
States
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Flores, Bronicki) Division of Critical Care, Texas Children's
Hospital/Baylor College of Medicine, Houston, TX, United States
Publisher
Springer
Abstract
Invasive and non-invasive monitoring allow for early detection of
hemodynamic compromise, facilitating timely intervention and avoidance of
further decline. While venous oximetry is useful for assessing the
adequacy of systemic oxygen delivery (DO<inf>2</inf>), it is most often
intermittent, invasive, and costly. Near-infrared spectroscopy (NIRS)
oximetry allows for the non-invasive estimation of the adequacy of
DO<inf>2</inf>. We assessed the correlation between cerebral NIRS oximetry
and superior vena cava (SVC) and jugular venous (JV) oxygen saturations
and between renal NIRS oximetry and inferior vena cava (IVC) oxygen
saturations. Systematic review of the literature was conducted to identify
studies with data regarding near-infrared spectroscopy and venous
saturation. The PubMed, EMBASE, Medline, and Cochrane databases were
queried using the following terms in isolation and various combinations:
"congenital heart disease," "near infrared spectroscopy," "venous
saturation," and "pediatric." Pediatric studies in which simultaneous NIRS
oximetry and corresponding venous oxygen saturations were simultaneously
collected after cardiac surgery or catheterization were identified. Data
were pooled from these studies to analyze the correlation between NIRS
oximetry and the corresponding venous oxygen saturations. A total of 16
studies with 613 patients were included in the final analyses. Data were
present to compare cerebral and renal NIRS oximetry with corresponding
venous oxygen saturation. Cerebral NIRS and SVC and JV oxygen saturations
and renal NIRS and IVC oxygen saturations demonstrated strong degrees of
correlation (r-value 0.70 for each). However, cerebral NIRS and IVC oxygen
saturation had a week degree of correlation (r-value of 0.38). Pooled
analyses demonstrate that cerebral NIRS oximetry correlates strongly with
SVC or JV oxygen saturation while renal NIRS oximetry correlates strongly
with IVC oxygen saturations. A weak correlation was noted between cerebral
NIRS oximetry and IVC oxygen saturations. Copyright © 2021, The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature.

<59>
Accession Number
635855221
Title
Patient Reported Outcomes Measures (PROMS) in Cardiovascular Disease.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2021. Date of Publication: 09 Aug 2021.
Author
Kornowski R.
Institution
(Kornowski) Belinson & Hasharon Hospitals, Petach Tikva & The Faculty of
Medicine, Tel Aviv University, Rabin Medical Center, Israel
Publisher
NLM (Medline)
Abstract
In today's medical ecosystem, it is vital to measure the outcomes that are
most important to the patients. As such, Patient-Reported Outcome
Measurements (PROMS) can be an essential metric to deliver high-quality
cardiovascular care, particularly in the subset of patients who remain
disappointed with their outcomes. PROMS should be a reproducible and
reflective report of what is fundamental to a patient over time and across
treatments with proper standards in the analysis, interpretation, and
reporting of the collected data. These reports can also be sensitive to
changes, whether improvements or deteriorations in the quality of care and
medical attitude, but a lack of standardization makes it difficult to draw
robust conclusions and compare findings across treatments. As a research
tool, PROMS can have a significant prognostic prominence, offering a
powerful instrument of comparison between different treatment modalities.
With the information technology (IT) abilities of today, we can leverage
mobile tools and powerful computer systems to perform sophisticated data
analysis using patient-derived data and randomization. This may eliminate
guess work and generate impactful metrics to better inform the
decision-making process. PROMS analyzed by proper standardized algorithms
can avoid physician bias, and be integrated in the hospital team work.
Therefore, there is a strong need for integration of PROMS into the
evaluation of cardiovascular interventions and procedures; and also,
establish international standards in the analyses of Patient-Reported
Outcomes and Quality of Life Data to address this need and develop
therapeutic recommendations. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<60>
[Use Link to view the full text]
Accession Number
635378614
Title
Left ventricular mass reduction and hypertrophy regression following renal
artery revascularization: Ameta-analysis.
Source
Journal of Hypertension. 39 (1) (pp 4-11), 2021. Date of Publication:
January 2021.
Author
Cuspidi C.; Tadic M.; Sala C.; Quarti-Trevano F.; Gherbesi E.; Mancia G.;
Grassi G.
Institution
(Cuspidi, Quarti-Trevano, Mancia, Grassi) Department of Medicine and
Surgery, University of Milano-Bicocca, Italy
(Cuspidi) Clinical Research Unit, Istituto Auxologico Italiano, Milan,
Italy
(Tadic) Department of Cardiology, University Hospital 'Dr Dragisa Misovic
- Dedinje', Belgrade, Serbia
(Sala, Gherbesi) Department of Clinical Sciences and Community Health,
University of Milano and Fondazione Ospedale Maggiore Irccs Policlinico di
Milano, Milan, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Aim: Few echocardiographic studies have focused on regression of left
ventricular hypertrophy (LVH) in patients with renal artery stenosis after
revascularization, with inconsistent results. We performed a systematic
metaanalysis of these studies in order to offer a comprehensive
information on this topic. Method(s): The PubMed, OVID-MEDLINE, and
Cochrane library databases were analyzed to search English-language
articles published from 1 January 1990 up to 31 March 2020. Studies were
identified by crossing the following terms: 'renal artery stenosis',
'renovascular hypertension', 'fibromuscular dysplasia', 'renal artery
stenting', 'renal artery surgery' with 'cardiac damage', 'hypertensive
heart disease' 'left ventricular mass', 'left ventricular hypertrophy',
'echocardiography'. Result(s): A total of 726 hypertensive patients
with renal artery stenosis (mean age 61 years, 64% men, 98% treated, 10%
with fibromuscular dysplasia) were included in 13 studies. Baseline and
postintervention pooled mean LVM values were 220+/-15 and 203+/-19 g,
respectively (SMD -0.24+/-0.06, CI -0.37 to -0.21, P<0.0001);
corresponding values for LV mass index were 129.0+/-6 and 115+/-7 g/m2,
respectively (SMD -0.28+/-0.04, CI -0.36 to 0.21, P<0.0001). Renal
revascularization was associated with a 40% lower risk of LVH. This trend
was accompanied by a reduction in the number of antihypertensive drugs
(SMD -0.27+/-0.04, CI -0.37 to 0.17, P<0.0001). Conclusion(s): The
present meta-analysis suggests that renal artery revascularization added
to antihypertensive therapy promotes a favourable effect on LV structure,
as reflected by a significant decrease in absolute and indexed LV mass
index as well by a lower risk of LVH. Limitations include: High prevalence
of modest renal artery stenosis (>=50%); small sample of fibromuscular
dysplasia; lack of randomized design of most studies. Copyright ©
2021 Lippincott Williams and Wilkins. All rights reserved.

<61>
Accession Number
2011117206
Title
Systematic Review of Minimally Invasive Surgery for Mitral Valve Infective
Endocarditis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 16 (3) (pp 244-248), 2021. Date of Publication: May 2021.
Author
Shih E.; Squiers J.J.; DiMaio J.M.
Institution
(Shih, Squiers, DiMaio) Baylor Scott White Research Institute, The Heart
Hospital Baylor Plano, Plano, TX, United States
(Shih, Squiers) Department of Surgery, Baylor University Medical Center,
Dallas, TX, United States
(DiMaio) Department of Cardiothoracic Surgery, The Heart Hospital, Plano,
TX, United States
Publisher
SAGE Publications Ltd
Abstract
Objective: The scope of application of minimally invasive mitral valve
surgery is expanding. However, the safety and efficacy of minimally
invasive mitral valve surgery in the setting of infective endocarditis is
not well known. We sought to identify the best evidence available to
support a minimally invasive surgical approach for mitral valve infective
endocarditis. Method(s): A systematic review of minimally invasive
mitral valve surgery for infective endocarditis was conducted according to
the Preferred Reporting Items for Systematic reviews and Meta-Analyses
(PRISMA) guidelines. Result(s): A total of 6 manuscripts describing
271 patients were identified. Mean age was 60.4 +/- 14.9 years old, and
60.1% patients were male. Mean EuroSCORE II was 24.6 +/- 23.2. Mitral
valve repair was achieved in 32.4% of cases. The average in-hospital
mortality was 9.4%, and average length of hospital stay was 21.6 days.
Survival was 89.1% at 30 days, and 1-year survival was 79.3%. Rate of
conversion to sternotomy was 1.8%. Postoperative complications included:
6.9% postoperative bleeding, 9.3% new postoperative dialysis, 2.3%
postoperative stroke, and 3.4% recurrence of endocarditis. Reoperation
over the long-term was required in 9.3% of cases. Conclusion(s):
Minimally invasive mitral valve surgery for infective endocarditis has
acceptable perioperative morbidity as well as short- and intermediate-term
mortality at experienced centers. Minimally invasive mitral valve surgery
may be an acceptable alternative approach to infective endocarditis and
warrants further study. Copyright © The Author(s) 2021.

<62>
Accession Number
2008334656
Title
Reducing Opioid Use in Patients Undergoing Cardiac Surgery - Preoperative,
Intraoperative, and Critical Care Strategies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2155-2165),
2021. Date of Publication: July 2021.
Author
Ochroch J.; Usman A.; Kiefer J.; Pulton D.; Shah R.; Grosh T.; Patel S.;
Vernick W.; Gutsche J.T.; Raiten J.
Institution
(Ochroch, Usman, Kiefer, Pulton, Shah, Grosh, Patel, Vernick, Gutsche,
Raiten) Department of Anesthesiology and Critical Care, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, United States
Publisher
W.B. Saunders
Abstract
Patients undergoing cardiothoracic surgery are exposed to opioids in the
operating room and intensive care unit and after hospital discharge.
Opportunities exist to reduce perioperative opioid use at all stages of
care and include alternative oral and intravenous medications, novel
intraoperative regional anesthetic techniques, and postoperative
opioid-sparing sedative and analgesic strategies. In this review,
currently used and investigational strategies to reduce the opioid burden
for cardiothoracic surgical patients are explored. Copyright ©
2020 Elsevier Inc.

<63>
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.

<64>
Accession Number
2013894802
Title
Comparison of outcomes of direct-acting oral anticoagulants vs. vitamin K
antagonists in patients with bioprosthetic heart valves or valve repair: A
systematic review and meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 25 (15) (pp
5006-5017), 2021. Date of Publication: 2021.
Author
Tang L.-L.; Liang S.-W.; Shi H.-L.; Ye J.-J.
Institution
(Tang, Liang, Shi, Ye) Department of Pharmacy, XinChang County Hospital of
Traditional Chinese Medicine, Zhejiang Province, Shaoxing, China
Publisher
Verduci Editore s.r.l
Abstract
OBJECTIVE: To compare the outcomes between direct-acting oral
anticoagulants and vitamin K antagonists, particularly for risk of stroke
and bleeding, among patients with atrial fibrillation (AF) and
bioprosthetic heart valve replacement or repair. MATERIALS AND METHODS: A
systematic search was conducted in the PubMed, Scopus, Cochrane Database
of Systematic Reviews and Google scholar databases. Studies that were done
in patients with AF who underwent bioprosthetic heart valve replacement or
repair and that compared the outcomes between the use of direct-acting
oral anticoagulants (DOACs) and vitamin K antagonists were eligible for
inclusion. Studies that were preferably randomized controlled trials or
adopted a cohort approach or retrospective data-based studies were
considered for inclusion. The strength of association was presented in the
form of pooled hazards risk (HR). Statistical analysis was done using
STATA version 16.0. RESULT(S): A total of 8 articles were included in
the meta-analysis. There were no significant differences in the risk of
"all-cause stroke" [HR 0.72, 95% CI: 0.39, 1.34] and ischemic stroke [HR
0.79, 95% CI: 0.49, 1.29] between the two groups. The risk of "any
bleeding" [HR 0.74, 95% CI: 0.64, 0.87], major bleeding [HR 0.60, 95% CI:
0.42, 0.86] and intra-cranial bleeding [HR 0.54, 95% CI: 0.36, 0.81] was
much lower in those that received DOAC compared to warfarin. Compared to
those receiving warfarin, those on DOACs had substantially reduced risk of
any clinical thromboembolic events [HR 0.52, 95% CI: 0.39, 0.70]. No
significant differences were noted for all-cause mortality [HR 0.88, 95%
CI: 0.74, 1.05], cardiovascular events/myocardial infarction (MI) [HR
0.58, 95% CI: 0.33, 1.04] and and readmission rates [HR 0.85, 95% CI:
0.62, 1.18]. CONCLUSION(S): Findings suggest that the use DOACs in
patients with AF with bioprosthetic valve replacement or repair is
comparatively better than vitamin K antagonists in reducing the risk of
bleeding and thrombo-embolic events. Future studies with a randomized
design and larger sample sizes are needed to further substantiate these
findings. Copyright © 2021 Verduci Editore s.r.l. All rights
reserved.

<65>
Accession Number
635830888
Title
Duration of dual antiplatelet therapy in coronary heart disease: A
60,000-patient meta-analysis of randomised controlled trials.
Source
Scottish Medical Journal. Conference: 30th Annual General Meeting of the
Scottish Cardiac Society. Virtual. 66 (3) (pp NP15-NP16), 2021. Date of
Publication: 2021.
Author
Bularga A.; Meah M.; Doudesis D.; Shah A.S.V.; Mills N.L.; Lee K.K.; Newby
D.E.
Institution
(Bularga, Meah, Doudesis, Shah, Mills, Lee, Newby) BHF/University Centre
for Cardiovascular Science, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
SAGE Publications Ltd
Abstract
Introduction: Dual antiplatelet therapy (DAPT) is the cornerstone of
pharmacological treatment for patients w ith acute coronary syndrome (ACS)
and in those undergoing percutaneous coronary intervention for stable
coronary disease. Despite widespread use, the optimal duration of DAPT
remains uncertain. We present an updated meta- analysis comparing outcomes
in shortterm DAPT (6<=months) versus long-term DAPT (>=12 months).
 Method(s): Four major databases were searched for randomised
controlled trials of interest. Data were c ollec ted on the primary
outcome of all-cause mortality. Secondary safety outcomes included any
bleeding and major bleeding. Efficacy outcomes included cardiovascular
death, myocardial infarction, stent thrombosis, coronary revascularization
and thrombotic stroke. Further subgroup analysis stratified by index
presentation and a sensitivity analysis to evaluate shorter duration DAPT
restricted to studies comparing<=3 months DAPT versus 12 months DAPTwas
performed. Result(s): Nineteen randomised controlled trials were
included (n = 60,879) in the primary analysis of which 8 compared shorter
duration DAPT (>=3 months) with standard duration (12 months) (n =
38,036). Short-term DAP T was associated with an apparent modest increase
in myocardial infarction (risk ratio RR 1.09; 95% confidence interval
[CI], 0.98-1.22) with a major reduction in bleeding (RR 0.68; 95% CI,
0.55-0.83 for major bleeding and RR 0.66; 95% CI, 0.56-0.77 for any
bleeding) and an overall apparent reduction in all-cause mortality (RR
0.90; 95% CI 0.81-1.01) when compared to long-term DAPT (>=12 months).
These associations persisted when evaluating even shorter duration DAPT
restricted to <=3 months versus standard duration of 12 months (RR 0.91;
95% CI, 0.79-1.05 for all-cause mortality). Subgroup analysis of patients
with stable disease or ACS identified no significant heterogenicity in
efficacy, safety or mortality outcomes. Conclusion(s): In the largest
meta-analysis to date comparing duration of DAPT, we show that short (6
months) and shorter (<=3 months) DAPT is associated with continuing trends
for small reductions in all-cause mortality irrespective of index
presentation.

<66>
Accession Number
2014263143
Title
Eight-year outcomes for patients with aortic valve stenosis at low
surgical risk randomized to transcatheter vs. surgical aortic valve
replacement.
Source
European Heart Journal. 42 (30) (pp 2912-2919), 2021. Date of Publication:
07 Aug 2021.
Author
Jorgensen T.H.; Thyregod H.G.Ho.; Ihlemann N.; Nissen H.; Petursson P.;
Kjeldsen B.J.; Steinbruchel D.A.; Olsen P.S.; Sondergaard L.
Institution
(Jorgensen, Sondergaard) Department of Cardiology, Heart Centre,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Thyregod, Olsen) Department of Cardiothoracic Surgery, Heart Centre,
Copenhagen University Hospital, Blegdamsvej 9, Copenhagen 2100, Denmark
(Ihlemann, Nissen) Department of Cardiology, Odense University Hospital,
J. B. Winslows Vej 4, Odense 5000, Denmark
(Petursson) Department of Cardiology, Sahlgrenska University Hospital, Bla
straket 5, Gothenburg 41345, Sweden
(Kjeldsen) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, J. B. Winslows Vej 4, Odense 5000, Denmark
(Steinbruchel) Department of Medicine, Nykoebing F Hospital and University
of Southern Denmark, J. B. Winslows Vej 4, Odense 5000, Denmark
Publisher
Oxford University Press
Abstract
Aims: The aims of the study were to compare clinical outcomes and valve
durability after 8 years of follow-up in patients with symptomatic severe
aortic valve stenosis at low surgical risk treated with either
transcatheter aortic valve implantation (TAVI) or surgical aortic valve
replacement (SAVR). Methods and Results: In the NOTION trial,
patients with symptomatic severe aortic valve stenosis were randomized to
TAVI or SAVR. Clinical status, echocardiography, structural valve
deterioration, and failure were assessed using standardized definitions.
In total, 280 patients were randomized to TAVI (n = 145) or SAVR (n =
135). Baseline characteristics were similar, including mean age of 79.1
+/- 4.8 years and a mean STS score of 3.0 +/- 1.7%. At 8-year follow-up,
the estimated risk of the composite outcome of all-cause mortality,
stroke, or myocardial infarction was 54.5% after TAVI and 54.8% after SAVR
(P = 0.94). The estimated risks for all-cause mortality (51.8% vs. 52.6%;
P = 0.90), stroke (8.3% vs. 9.1%; P = 0.90), or myocardial infarction
(6.2% vs. 3.8%; P = 0.33) were similar after TAVI and SAVR. The risk of
structural valve deterioration was lower after TAVI than after SAVR (13.9%
vs. 28.3%; P = 0.0017), whereas the risk of bioprosthetic valve failure
was similar (8.7% vs. 10.5%; P = 0.61). Conclusion(s): In patients
with severe aortic valve stenosis at low surgical risk randomized to TAVI
or SAVR, there were no significant differences in the risk for all-cause
mortality, stroke, or myocardial infarction, as well as the risk of
bioprosthetic valve failure after 8 years of follow-up. Clinical trial
registration: URL: http://www.ClinicalTrials.gov. Unique identifier:
NCT01057173. Copyright © 2021 The Author(s) 2021. Published by
Oxford University Press on behalf of the European Society of Cardiology.

<67>
Accession Number
2014262927
Title
Postoperative analgesic effects of paravertebral block versus erector
spinae plane block for thoracic and breast surgery: A meta-analysis.
Source
PLoS ONE. 16 (8 August) (no pagination), 2021. Article Number: e0256611.
Date of Publication: August 2021.
Author
Xiong C.; Han C.; Zhao D.; Peng W.; Xu D.; Lan Z.
Institution
(Xiong, Zhao, Peng, Xu, Lan) Department of Anesthesiology, Affiliated
Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, Jinhua,
China
(Han) Department of Rehabilitation, Jinhua Maternal and Child Health Care
Hospital, Zhejiang, Jinhua, China
Publisher
Public Library of Science
Abstract
Background Paravertebral block (PVB) is the most recognized regional
anesthesia technique after thoracic epidural anesthesia for postoperative
analgesia in thoracic and breast surgery. Erector spinae plane block
(ESPB) is a recently discovered blocking technique, and it has evidenced
excellent postoperative analgesia for breast and thoracic surgery with
fewer adverse reactions. However, there are controversies about the
postoperative analgesic effects of the two analgesic techniques. Objective
To assess the analgesic effects of PVB versus ESPB in postoperative
thoracic and breast surgery. Methods We systematically searched PubMed,
Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up
to April 5, 2021. The primary outcome was postoperative pain scores.
Secondary outcomes included: opioid consumption, additional analgesia,
postoperative nausea and vomiting (PONV) 24 hours post-operation, and the
time required for completing block procedure. This study was registered in
PROSPERO, number CRD42021246160. Results After screening relevant,
full-text articles, ten randomized controlled trials (RCTs) that met the
inclusion criteria were retrieved for this meta-analysis. Six studies
involved thoracic surgery patients, and four included breast surgery
patients. Thoracic surgery studies included all of the outcomes involved
in this meta-analysis while breast surgery did not report pain scores at
movement and additional analgesia in 24 hours post-operation. For thoracic
surgery, PVB resulted in significant reduction in the following pain
scores: 0-1 hours (MD = -0.79, 95% CI: -1.54 to -0.03, P = 0.04), 4-6
hours (MD = -0.31, 95% CI: -0.57 to -0.05, P = 0.02), and 24 hours (MD =
-0.42, 95% CI: -0.81 to -0.02, P = 0.04) at rest; significant reduction in
pain scores at 4-6 hours (MD = -0.47, 95% CI: -0.93 to -0.01, P = 0.04),
8-12 hours (MD = -1.09, 95% CI: -2.13 to -0.04, P = 0.04), and 24 hours
(MD = -0.31, 95% CI: -0.57 to -0.06, P = 0.01) at movement. Moreover, the
opioid consumption at 24 hours post-operation (MD = -2.74, 95% CI: -5.41
to -0.07, P = 0.04) and the incidence of additional analgesia in 24 hours
of the postoperative course (RR: 0.53, 95% CI: 0.29 to 0.97, P = 0.04)
were significantly lower in the PVB group than in the ESPB group for
thoracic surgery. However, no significant differences were found in pain
scores at rest at various time points postoperatively, and opioid
consumption at 24 hours post-operation for breast surgery. The time
required for completing block procedure was longer in the PVB group than
in the ESPB group for thoracic and breast surgery, and the incidence of
PONV between the two groups showed no significant difference. Conclusion
The postoperative analgesic effects of PVB versus ESPB are distinguished
by the surgical site. For thoracic surgery, the postoperative analgesic
effect of PVB is better than that of ESPB. For breast surgery, the
postoperative analgesic effects of PVB and ESPB are similar. Copyright
© 2021 Xiong 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.

<68>
Accession Number
635841884
Title
Coronary artery revascularizations and cognitive decline - A systematic
review.
Source
Current problems in cardiology. (pp 100960), 2021. Date of Publication: 04
Aug 2021.
Author
Lappalainen L.; Rajamaki B.; Tolppanen A.-M.; Hartikainen S.
Institution
(Lappalainen) School of Pharmacy, University of Eastern Finland, P.O. Box
1627, Kuopio FI-70211, Finland
(Rajamaki, Tolppanen, Hartikainen) Kuopio Research Centre of Geriatric
Care, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio,
Finland; School of Pharmacy, University of Eastern Finland, P.O. Box 1627,
FI-70211, Kuopio, Finland
Publisher
NLM (Medline)
Abstract
Coronary artery disease (CAD) is a risk factor for cognitive decline. The
aim of this study was to systematically review recent literature on
whether coronary artery revascularizations are associated to cognitive
decline and dementia. Pubmed, Scopus, and CINAHL (EBSCO) were searched
systematically from January 2009 till September 2020. Studies were
conducted on persons with CAD undergoing coronary artery bypass grafting
(CABG) or percutaneous coronary intervention (PCI) procedure compared to
other coronary artery disease treatments, and the outcome was cognitive
decline or dementia. Altogether four of the 680 reviewed articles met
inclusion criteria. Results were inconsistent, and the outcome
measurements heterogeneous between studies. Our findings indicate an
evidence gap in the current understanding of long-term outcomes following
coronary artery revascularization. However, evidence of long-term effects
on cognition would complement our understanding of their benefits. There
is a need for more studies on long-term cognitive outcomes after coronary
artery revascularizations. Copyright © 2021. Published by
Elsevier Inc.

<69>
Accession Number
635175302
Title
Cost-effectiveness of Dapagliflozin for Treatment of Patients with Heart
Failure with Reduced Ejection Fraction.
Source
JAMA Cardiology. 6 (8) (pp 926-935), 2021. Date of Publication: August
2021.
Author
Parizo J.T.; Goldhaber-Fiebert J.D.; Salomon J.A.; Khush K.K.; Spertus
J.A.; Heidenreich P.A.; Sandhu A.T.
Institution
(Parizo, Khush, Heidenreich, Sandhu) Division of Cardiovascular Medicine,
Stanford University, School of Medicine, 870 Quarry Rd, Falk Building,
Stanford, CA 94305, United States
(Goldhaber-Fiebert, Salomon) Stanford Health Policy, Centers for Health
Policy and Primary Care and Outcomes Research, Freeman Spogli Institute,
Department of Medicine, Stanford University, Stanford, CA, United States
(Spertus) St Luke's Mid America Heart Institute, University of
Missouri-Kansas City, United States
(Heidenreich) Division of Cardiology, Veterans Affairs Palo Alto Health
Care System, Palo Alto, CA, United States
Publisher
American Medical Association
Abstract
Importance: In the Dapagliflozin and Prevention of Adverse Outcomes in
Heart Failure (DAPA-HF) trial, dapagliflozin was shown to reduce
cardiovascular mortality and hospitalizations due to heart failure while
improving patient-reported health status. However, the cost-effectiveness
of adding dapagliflozin therapy to standard of care (SOC) is unknown.
 Objective(s): To estimate the cost-effectiveness of dapagliflozin
therapy among patients with chronic heart failure with reduced ejection
fraction (HFrEF). Design, Setting, and Participant(s): This Markov
cohort cost-effectiveness model used estimates of therapy effectiveness,
transition probabilities, and utilities from the DAPA-HF trial and other
published literature. Costs were derived from published sources. Patients
with HFrEF included subgroups based on diabetes status and health status
impairment due to heart failure. We compiled parameters from the
literature including DAPA-HF, on which our model is based, and many other
sources from December 2019 to February 27, 2021. We performed our analysis
in February 2021. Exposures: Dapagliflozin or SOC. Main Outcomes and
Measures: Hospitalizations for heart failure, life-years, quality-adjusted
life-years (QALYs), costs, and the cost per QALY gained (incremental
cost-effectiveness ratio). Result(s): In the model, dapagliflozin
therapy yielded a mean of 0.78 additional life-years and 0.46 additional
QALYs compared with SOC at an incremental cost of $38212, resulting in a
cost per QALY gained of $83650. The cost per QALY was similar for patients
with or without diabetes and for patients with mild or moderate impairment
of health status due to heart failure. The cost-effectiveness was most
sensitive to estimates of the effect on mortality and duration of therapy
effectiveness. If the cost of dapagliflozin decreased from $474 to $270
(43% decline), the cost per QALY gained would drop below $50000.
 Conclusions and Relevance: These findings suggest that dapagliflozin
provides intermediate value compared with SOC, based on American College
of Cardiology/American Heart Association benchmarks. Additional data
regarding the magnitude of mortality reduction would improve the precision
of cost-effectiveness estimates. Copyright © 2021 American
Medical Association. All rights reserved.

<70>
Accession Number
635118723
Title
Consensus document on optimal management of patients with common arterial
trunk.
Source
Cardiology in the Young. 31 (6) (pp 915-939), 2021. Date of Publication:
June 2021.
Author
Hazekamp M.G.; Barron D.J.; Dangel J.; Homfray T.; Jongbloed M.R.M.; Voges
I.
Institution
(Hazekamp) Department of Cardiothoracic Surgery, University Hospital
Leiden, Leiden, Netherlands
(Barron) Division of Cardiovascular Surgery, Hospital for Sick Children,
Toronto, Canada
(Dangel) Department of Perinatal Cardiology and Congenital Anomalies,
Centre of Postgraduate Medical Education, Warsaw, Poland
(Homfray) Department of Medical Genetics, Royal Brompton and Harefield
Hospitals NHS Trust, London, United Kingdom
(Jongbloed) Department of Anatomy and Embryology, Leiden University
Medical Center, Leiden, Netherlands
(Voges) Department for Congenital Cardiology and Pediatric Cardiology,
University Medical Center of Schleswig-Holstein, Kiel, Germany
Publisher
Cambridge University Press

<71>
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.

<72>
Accession Number
2007540289
Title
Prothrombin complex concentrate vs. fresh frozen plasma in adult patients
undergoing heart surgery - a pilot randomised controlled trial (PROPHESY
trial).
Source
Anaesthesia. 76 (7) (pp 892-901), 2021. Date of Publication: July 2021.
Author
Green L.; Roberts N.; Cooper J.; Agarwal S.; Brunskill S.J.; Chang I.;
Gill R.; Johnston A.; Klein A.A.; Platton S.; Rossi A.; Sepehripour A.;
Stanworth S.; Monk V.; O'Brien B.
Institution
(Green) Blizard Institute, Barts and the London School of Medicine, Queen
Mary University of London, London, United Kingdom
(Green) Department of Haematology, Barts Health NHS Trust, London, United
Kingdom
(Green, Platton) Department of Cardiac Surgery, Barts Health NHS Trust,
London, United Kingdom
(Roberts, Rossi, Sepehripour) William Harvey Research Institute, Barts and
the London School of Medicine, Queen Mary University of London, London,
United Kingdom
(Cooper, Chang, Monk) Department of Anaesthesia, Manchester Royal
Infirmary, Manchester, United Kingdom
(Agarwal) Systematic Review Initiative, NHS Blood and Transplant, Oxford,
United Kingdom
(Brunskill) Department of Anaesthesia, University Hospital Southampton,
Southampton, United Kingdom
(Gill) William Harvey Research Institute, Barts and The London School of
Medicine and Dentistry, Queen Mary University of London, London, United
Kingdom
(Johnston) Department of Anaesthesia, Royal Papworth Hospital, Cambridge,
United Kingdom
(Klein) Department of Haematology, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Stanworth, O'Brien) Department of Anaesthesia, Barts Health NHS Trust,
London, United Kingdom
(Stanworth) NHS Blood and Transplant, Oxford, United Kingdom
(O'Brien) Outcomes Research Consortium, Cleveland Clinic, OH, United
States
Publisher
John Wiley and Sons Inc
Abstract
There is equipoise regarding the use of prothrombin complex concentrate
vs. fresh frozen plasma in bleeding patients undergoing cardiac surgery.
We performed a pilot randomised controlled trial to determine the
recruitment rate for a large trial, comparing the impact of prothrombin
complex concentrate vs. fresh frozen plasma on haemostasis (1 h and 24 h
post-intervention), and assessing safety. Adult patients who developed
bleeding within 24 h of cardiac surgery that required coagulation factor
replacement were randomly allocated to receive prothrombin complex
concentrate (15 IU.kg-1 based on factor IX) or fresh frozen
plasma (15 ml.kg-1). If bleeding continued after the first
administration of prothrombin complex concentrate or fresh frozen plasma
administration, standard care was administered. From February 2019 to
October 2019, 180 patients were screened, of which 134 (74.4% (95%CI
67-81%)) consented, 59 bled excessively and 50 were randomly allocated; 25
in each arm, recruitment rate 35% (95%CI 27-44%). There were 23 trial
protocol deviations, 137 adverse events (75 prothrombin complex
concentrate vs. 62 fresh frozen plasma) and 18 serious adverse events (5
prothrombin complex concentrate vs. 13 fresh frozen plasma). There was no
increase in thromboembolic events with prothrombin complex concentrate. No
patient withdrew from the study, four were lost to follow-up and two died.
At 1 h after administration of the intervention there was a significant
increase in fibrinogen, Factor V, Factor XII, Factor XIII,
alpha<inf>2</inf>-antiplasmin and antithrombin levels in the fresh frozen
plasma arm, while Factor II and Factor X were significantly higher in the
prothrombin complex concentrate group. At 24 h, there were no significant
differences in clotting factor levels. We conclude that recruitment to a
larger study is feasible. Haemostatic tests have provided useful insight
into the haemostatic changes following prothrombin complex concentrate or
fresh frozen plasma administration. A definitive trial is needed to
ascertain the benefits and safety for each. Copyright © 2020 The
Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of
Association of Anaesthetists

<73>
Accession Number
2012394341
Title
Indirect impact of the COVID-19 pandemic on hospitalisations for
cardiometabolic conditions and their management: A systematic review.
Source
Primary Care Diabetes. 15 (4) (pp 653-681), 2021. Date of Publication:
August 2021.
Author
Seidu S.; Kunutsor S.K.; Cos X.; Khunti K.
Institution
(Seidu, Khunti) Leicester Real World Evidence Unit, Diabetes Research
Centre, University of Leicester, UK, United Kingdom
(Kunutsor) National Institute for Health Research Bristol Biomedical
Research Centre, University Hospitals Bristol and Weston NHS Foundation
Trust and the University of Bristol, Bristol, UK, United Kingdom
(Kunutsor) Musculoskeletal Research Unit, Translational Health Sciences,
Bristol Medical School, University of Bristol, Learning & Research
Building (Level 1), Southmead Hospital, Bristol, UK BS10 5NB, United
Kingdom
(Cos) DAP_Cat Research Group, Gerencia Territorial Barcelona Ciutat,
Institut Catala de la Salut, Foundation University Institute for Primary
Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
Publisher
Elsevier Ltd
Abstract
Background: The Coronavirus disease 2019 (COVID-19) pandemic has led to a
dramatic crisis in health care systems worldwide. These may have
significant implications for the management of cardiometabolic diseases.
We conducted a systematic review of published evidence to assess the
indirect impact of the COVID-19 pandemic on hospitalisations for
cardiovascular diseases and their management. Method(s): Studies that
evaluated volume of hospitalisations for cardiometabolic conditions and
their management with comparisons between the COVID-19 and pre-COVID
periods were identified from MEDLINE, Embase and the reference list of
relevant studies from January 2020 to 25 February 2021. Result(s): We
identified 103 observational studies, with most studies assessing
hospitalisations for acute cardiovascular conditions such as acute
coronary syndrome, ischemic strokes and heart failure. About 89% of
studies reported a decline in hospitalisations during the pandemic
compared to pre-pandemic times, with reductions ranging from 20.2 to 73%.
Severe presentation, less utilization of cardiovascular procedures, and
longer patient- and healthcare-related delays were common during the
pandemic. Most studies reported shorter length of hospital stay during the
pandemic than before the pandemic (1-8 vs 2-12 days) or no difference in
length of stay. Most studies reported no change in in-hospital mortality
among hospitalised patients. Conclusion(s): Clinical care of patients
for acute cardiovascular conditions, their management and outcomes have
been adversely impacted by the COVID-19 pandemic. Patients should be
educated via population-wide approaches on the need for timely medical
contact and health systems should put strategies in place to provide
timely care to patients at high risk. Systematic review registration:
PROSPERO 2021: CRD42021236102 Copyright © 2021 Primary Care
Diabetes Europe

<74>
Accession Number
2012114667
Title
Long-Term Renal Outcomes in Children With Acute Kidney Injury Post Cardiac
Surgery.
Source
Kidney International Reports. 6 (7) (pp 1850-1857), 2021. Date of
Publication: July 2021.
Author
Sethi S.K.; Sharma R.; Gupta A.; Tibrewal A.; Akole R.; Dhir R.; Soni K.;
Bansal S.B.; Jha P.K.; Bhan A.; Kher V.; Raina R.
Institution
(Sethi, Dhir, Soni) Department of Pediatric Nephrology, Kidney Institute,
Medanta - The Medicity, Gurgaon, Haryana, India
(Sharma, Akole) Pediatric Cardiac Intensive Care, Medanta - The Medicity,
Gurgaon, Haryana, India
(Gupta) Department of Biochemistry, Aster Clinical Lab, Bangalore, India
(Tibrewal, Raina) Department of Nephrology, Akron's Children Hospital,
Akron, OH, United States
(Bansal, Jha, Kher) Kidney Institute, Medanta, The Medicity Hospital,
Gurgaon, Haryana, India
(Bhan) CTVS, Medanta - The Medicity, Gurgaon, Haryana, India
Publisher
Elsevier Inc.
Abstract
Introduction: The long-term renal outcomes of survivors of pediatric acute
kidney injury (AKI) are varied within the current literature, and we aim
to establish long-term renal outcomes for pediatric patients after cardiac
surgery. We studied long-term renal outcomes and markers of kidney injury
in pediatric patients after congenital cardiac surgery. Method(s): In
a prospective case-control observational study (the Renal Outcomes in
Children with acute Kidney injury post cardiac Surgery [ROCKS] trial) we
reviewed all children who underwent cardiac surgery on cardiopulmonary
bypass (December 2010-2017). Result(s): During the study period, 2035
patients underwent cardiac surgery, of whom 9.8% developed AKI
postoperatively. Forty-four patients who had postoperative AKI had a
long-term follow-up, met our inclusion criteria, and were compared with 49
control subjects. We conducted a univariate analysis of reported
parameters. At a median follow-up of 41 months, the cases had
significantly higher urine levels of neutrophil gelatinase-associated
lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1
(KIM-1). The biomarkers remained higher after adjusting for the urine
creatinine, and the ratio of urine KIM-1/urine creatinine was
significantly higher among cases. None of the patients had proteinuria or
hypertension on follow-up. The presence of AKI, AKI stage, and younger age
were not associated with the occurrence of low glomerular filtration rate
(GFR) at follow-up. Conclusion(s): Urinary biomarker abnormalities
persist years after a congenital cardiac surgery in children, who may have
a low GFR on follow-up. The presence of AKI, AKI stage, and younger age at
surgery are not associated with the occurrence of low GFR at follow-up.
Children with a higher surgical complexity score have lower GFR on
follow-up. Copyright © 2021

<75>
Accession Number
2011498911
Title
Predicting Readmission to Intensive Care After Cardiac Surgery Within
Index Hospitalization: A Systematic Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35 (7) (pp 2166-2179),
2021. Date of Publication: July 2021.
Author
Kimani L.; Howitt S.; Tennyson C.; Templeton R.; McCollum C.; Grant S.W.
Institution
(Kimani, Howitt, McCollum, Grant) Division of Cardiovascular Sciences,
University of Manchester, ERC, Manchester University Hospital Foundation
Trust, Manchester, United Kingdom
(Howitt, Templeton) Department of Cardiothoracic Anaesthesia and Critical
Care, Wythenshawe Hospital, Manchester University Hospital Foundation
Trust, Manchester, United Kingdom
(Tennyson) Department of Cardiothoracic Surgery, Blackpool Victoria
Hospital, Blackpool, United Kingdom
Publisher
W.B. Saunders
Abstract
Readmission to the cardiac intensive care unit after cardiac surgery has
significant implications for both patients and healthcare providers.
Identifying patients at risk of readmission potentially could improve
outcomes. The objective of this systematic review was to identify risk
factors and clinical prediction models for readmission within a single
hospitalization to intensive care after cardiac surgery. PubMed, MEDLINE,
and EMBASE databases were searched to identify candidate articles. Only
studies that used multivariate analyses to identify independent predictors
were included. There were 25 studies and five risk prediction models
identified. The overall rate of readmission pooled across the included
studies was 4.9%. In all 25 studies, in-hospital mortality and duration of
hospital stay were higher in patients who experienced readmission.
Recurring predictors for readmission were preoperative renal failure, age
>70, diabetes, chronic obstructive pulmonary disease, preoperative left
ventricular ejection fraction <30%, type and urgency of surgery, prolonged
cardiopulmonary bypass time, prolonged postoperative ventilation,
postoperative anemia, and neurologic dysfunction. The majority of
readmissions occurred due to respiratory and cardiac complications. Four
models were identified for predicting readmission, with one external
validation study. As all models developed to date had limitations, further
work on larger datasets is required to develop clinically useful models to
identify patients at risk of readmission to the cardiac intensive care
unit after cardiac surgery. Copyright © 2021 Elsevier Inc.

<76>
Accession Number
2010670022
Title
Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A
Systematic Review of the Literature.
Source
Journal of Clinical Pharmacology. 61 (7) (pp 848-856), 2021. Date of
Publication: July 2021.
Author
Schurr J.W.; Ambrosi L.; Lastra J.L.; McLaughlin K.C.; Hacobian G.;
Szumita P.M.
Institution
(Schurr, Ambrosi, Lastra) Renaissance School of Medicine at Stony Brook
University, Stony Brook, NY, United States
(McLaughlin, Hacobian, Szumita) Department of Pharmacy Services, Brigham
and Women's Hospital, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Dexmedetomidine-associated fever has been reported in the literature and
can lead to lengthy workups and unnecessary antibiotic exposure. We
conducted a systematic review to evaluate and describe the evidence of
fever or hyperthermia caused by dexmedetomidine in adult patients. Data
sources included PubMed/MEDLINE, EMBASE, CINAHL, and Web of Sciences.
English-language studies of any design published from inception through
April 2020 including conference abstracts were included. The target
population was hospitalized adult patients. Quality of evidence was
determined based on GRADE recommendations and risk of bias assessed using
the Evidence Project Risk of Bias tool. Naranjo scores were assessed to
determine the likeliness of adverse event being caused by dexmedetomidine.
All data were extracted independently and with the guidance of a medical
librarian. Four hundred and eighty-eight total citations were found on
formal search, with 329 left after removal of duplicates. Independent
record screening was performed, leaving 17 citations including 4
retrospective cohort studies, 1 case series, and 12 case reports. Quality
of evidence ranged from very low to low for identified analyses. Evidence
with patient-level data (case reports and series) were combined to
establish a cohort for descriptive results. The median Naranjo score was 4
(range, 3 to 8), and dexmedetomidine doses ranged from 0.1 to 2 mug.h/kg.
Obesity and cardiac surgery appear to be significant risk factors.
Dexmedetomidine-associated fever appears uncommon, but the true incidence
is unknown. Clinicians should keep dexmedetomidine-associated fever in
their differential, and stewardship programs should consider assessing for
this adverse effect in their patient monitoring. Copyright ©
2021, The American College of Clinical Pharmacology

<77>
Accession Number
2010173236
Title
Cardiovascular events in patients undergoing hip fracture surgery treated
with remote ischaemic preconditioning: 1-year follow-up of a randomised
clinical trial.
Source
Anaesthesia. 76 (8) (pp 1042-1050), 2021. Date of Publication: August
2021.
Author
Ekeloef S.; Koyuncu S.; Holst-Knudsen J.; Gundel O.; Meyhoff C.S.;
Homilius M.; Stilling M.; Ekeloef P.; Munster A.M.B.; Mathiesen O.;
Gogenur I.
Institution
(Ekeloef, Gogenur) Center for Surgical Science, Department of Surgery,
Zealand University Hospital, Koege, Denmark
(Koyuncu, Holst-Knudsen, Mathiesen) Centre for Anaesthesiological
Research, Department of Anaesthesiology, Zealand University Hospital,
Koege, Denmark
(Gundel, Meyhoff) Department of Anaesthesia and Intensive Care, Bispebjerg
and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
(Homilius, Stilling) Department of Orthopaedic Surgery, University Clinic
for Hand, Hip and Knee Surgery, Regional Hospital West Jutland, Holstebro,
Denmark
(Ekeloef) Department of Anaesthesiology, Regional Hospital West Jutland,
Holstebro, Denmark
(Munster) Unit for Thrombosis Research, Department of Clinical
Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
Publisher
John Wiley and Sons Inc
Abstract
Remote ischaemic preconditioning reduces the risk of myocardial injury
within 4 days of hip fracture surgery. We aimed to investigate the effect
of remote ischaemic preconditioning on the incidence of major adverse
cardiovascular events 1 year after hip fracture surgery. We performed a
phase-2, multicentre, randomised, observer-blinded, clinical trial between
February 2015 and September 2017. We studied patients aged >= 45 years
with a hip fracture and a minimum of one cardiovascular risk factor.
Patients were allocated randomly to remote ischaemic preconditioning
applied just before surgery or no treatment (control group). Remote
ischaemic preconditioning was performed on the upper arm with a tourniquet
in four cycles of 5 min ischaemia and 5 min reperfusion. Primary outcome
was the occurrence of major adverse cardiovascular events within 1 year of
surgery. A total of 316 patients were allocated randomly to the remote
ischaemic preconditioning group and 309 patients to the control group.
Major adverse cardiovascular events occurred in 43 patients (13.6%) in the
remote ischaemic preconditioning group compared with 51 patients (16.5%)
in the control group (adjusted hazard ratio (95%CI) 0.83 (0.55-1.25); p =
0.37). Fewer patients in the remote ischaemic preconditioning group had a
myocardial infarction (11 (3.5%) vs. 22 (7.1%); hazard ratio (95%CI) 0.48
(CI 0.23-1.00); p = 0.04). Remote ischaemic preconditioning did not reduce
the occurrence of major adverse cardiovascular events within 1 year of hip
fracture surgery. The effect of remote ischaemic preconditioning on
clinical cardiovascular outcomes in non-cardiac surgery needs confirmation
in appropriately powered randomised clinical trials. Copyright ©
2021 Association of Anaesthetists.

<78>
Accession Number
2013485637
Title
Short- and long-term follow-up outcomes of patients with Brucella
endocarditis: a systematic review of 207 Brucella endocarditis Cases.
Source
Bioengineered. 12 (1) (pp 5162-5172), 2021. Date of Publication: 2021.
Author
Li X.; Wang T.; Wang Y.; Xie S.; Tan W.; Li P.
Institution
(Li, Wang, Li) Department of Nursing, School of Medicine, Shihezi
University, Shihezi, China
(Wang, Tan) Department of Basic Medicine, School of Medicine, Shihezi
University, Shihezi, China
(Xie) Department of Infectious Diseases, Hospital of Shihezi University
School of Medicine, Shihezi, China
Publisher
Taylor and Francis Ltd.
Abstract
Brucella endocarditis is a fatal complication and the most frequent cause
of death for human brucellosis. This study aimed to systematically review
the literature on the follow-up outcomes of Brucella endocarditis and
analyze the determinants affecting the follow-up outcomes. The databases
PubMed, Web of Science, Embase, and Cochrane were searched using keywords
and suitable combinations. All studies reporting the follow-up outcomes of
Brucella endocarditis were included. Finally, a total of 76 studies (207
patients), including cases or case series, were included. The event rate
for patients who underwent short- and long-term follow-up was 12.0% (2
relapsed and 1 died) and 8.1% (6 relapsed and 8 died), respectively. The
differences in outcomes between different age groups (18-39, 40-59, and
>=60) were significant (P < 0.05, P = 0.035). The outcomes of the 18-39
age group were worse than those of the 40-59 age group (OR, 0.277; 95% CI,
0.103-0.748; P = 0.011). Accordingly, follow-up (both short- and long-term
follow-up) is essential for Brucella endocarditis patients, especially for
younger patients (18-39 years) in the first 6 months after treatment. The
burden of Brucella endocarditis related complications were immense.
Further studies are needed to explore age-based epidemiology of Brucella
endocarditis and the exact influencing factors of the follow-up
outcomes. Copyright © 2021 The Author(s). Published by Informa UK
Limited, trading as Taylor & Francis Group.

<79>
Accession Number
2013343393
Title
Review of binary, ternary and quaternary mixtures for induction and
maintenance of opioid free anesthesia.
Source
Farmacia Hospitalaria. 45 (3) (pp 135-141), 2021. Date of Publication: May
2021.
Author
Tauste-Hernandez B.; Cortinas-Saenz M.; Fernandez-Gines F.D.;
Exposito-Lopez J.M.
Institution
(Tauste-Hernandez) Department of Pharmacy, Hospital Universitario
Torrecardenas, Almeria, Spain
(Cortinas-Saenz) Department of Anesthesiology and Resuscitation, Hospital
Virgen de las Nieves, Granada, Spain
(Fernandez-Gines) Pharmacy Department, Hospital La Inmaculada, Huercal
Overa, Almeria, Spain
(Exposito-Lopez) MRI Department, Central Research Services, Universidad de
Almeria, Almeria, Spain
Publisher
Grupo Aula Medica S.L.
Abstract
Objective: To describe and organize the current information available on
binary, ternary and/or quaternary mixtures used in opioid-free anesthesia
(OFA), as well as their physicochemical stability, in order to facilitate
its correct administration, optimize its use, and prevent potential
effectiveness and safety issues. Method(s): A systematic review of
the literature on OFA was conducted in PubMed/Medline, Trissel,
Micromedex, Lexicomp, www.ahfsdruginformation.com, ASHP's Extended
Stability for Parenteral Drugs, and www. stabilis.org. Only articles
published in English or Spanish until May 2020 and with access to full
text were considered. MeSH terms used included: "drug incompatibility" AND
"opioid-free anesthesia" AND "administration, intravenous" AND
"dexmedetomidine" AND "lidocaine" AND "ketamine" AND "magnesium sulphate"
OR "infusions, intravenous. A first search was carried out in
PubMed/Medline that included OFA clinical cases. The results obtained were
collected in a database. A second search was carried out on the
incompatibilities of intravenous mixtures. Information was compiled on
mutually-compatible/incompatible drugs, reference concentrations,
stability time at room temperature (23 +/- 2 degreeC) and under
refrigeration (4 +/- 2 C), type of administration recommended, and
relevant results and conclusions. Two two-dimensional tables on the
compatibility of each drug combination were created for administration as
Y-site infusion or as a mixture in a single solution. Result(s):
Seven hundred and eighty articles were identified, with the full text of
203 being accessed. A total of 4,762 cases treated with OFA protocols were
chronologically collected from 32 different publications. Administration
of two concomitant drugs was the most usual regimen (42.4%). The most
frequently drugs were dexmedetomidine (25 studies), ketamine hydrochloride
(25 studies) and lidocaine (14 studies). Compatibility/incompatibility
data was collected for 11 drugs, associated to 7 pharmacological groups;
compatibility with Y-site administration was found in 43 of 55
combinations (78.18%) and with integration into one single solution in 13
of 55 drug combinations (23.63%). None of the sources reviewed reported
any adverse results related to potential pharmacological
incompatibilities. Conclusion(s): Despite the availability of
multiple OFA protocols, few studies analyze the compatibility between
binary drug mixtures. No information exists as yet regarding
compatibilities in the context of ternary and quaternary
mixtures. Copyright © 2021 Grupo Aula Medica S.L.. All rights
reserved.

<80>
Accession Number
2013161500
Title
Use of tropical vancomycin in decreasing the incidence of surgical site
infection in open heart surgery.
Source
Pakistan Journal of Medical and Health Sciences. 15 (5) (pp 968-970),
2021. Date of Publication: May 2021.
Author
Mahmood M.M.; Ahmad A.; Rehman W.
Institution
(Mahmood, Ahmad, Rehman) Department of Cardiothoracic Surgery, Shaikh
Zayed Hospital, Lahore, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Aim: To study the effect of vancomycin tropically in decreasing the
incidence of sternal wound infection in patients undergoing open cardiac
surgery. Study design: Randomized controlled trial Place and duration:
Department of Cardiovascular & Thoracic Surgery Sheikh Zayed Hospital
Lahore from 1st January 2019 to 31st July 2020. Method(s): A total of
180 male and female planned for elective open heart surgery is selected
for this research work. All patients age is between 40 and 70 years and
these patients are bifurcated in two groups. In Group I there are 90
patients in which vancomycin is used on the sternal edges, while in Group
II there are 90 patients in which only normal saline wash is used at the
time of sternal approximation. At the end incidence of sternal wound
infection is monitored to establish the benefits of tropical vancomycin.
 Result(s): One hundred and thirty three (73.89%) were males and 47
(26.11%) were females. Topical vancomycin group has decreased rate of
superficial and deep sternal wound infections as compared to the patients
in which topical vancomycin is not applied (2.22% vs 6.67%) and (1.11% vs
4.4%). Conclusion(s): Application of vancomycin tropically at
surgical site at the time of closure of sternum in conjunction with
prophylactic use of antibiotics reduces wound infection in open heart
surgery. Copyright © 2021 Lahore Medical And Dental College. All
rights reserved.

<81>
Accession Number
2012302548
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

<82>
Accession Number
634288827
Title
Inotropic agents and vasodilator strategies for the treatment of
cardiogenic shock or low cardiac output syndrome.
Source
Cochrane Database of Systematic Reviews. 2020 (11) (no pagination), 2020.
Article Number: CD009669. Date of Publication: 05 Nov 2020.
Author
Uhlig K.; Efremov L.; Tongers J.; Frantz S.; Mikolajczyk R.; Sedding D.;
Schumann J.
Institution
(Uhlig, Schumann) Department of Anaesthesiology and Surgical Intensive
Care, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
(Efremov, Mikolajczyk) Institute for Medical Epidemiology, Biometrics and
Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical
School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale),
Germany
(Tongers, Sedding) Cardiology, Angiology and Intensive Care Medicine,
University Hospital Halle (Saale), Halle (Saale), Germany
(Frantz) Department of Internal Medicine I, University Hospital Wurzburg,
Wurzburg, Germany
Publisher
John Wiley and Sons Ltd
Abstract
Background: Cardiogenic shock (CS) and low cardiac output syndrome (LCOS)
are potentially life-threatening complications of acute myocardial
infarction (AMI), heart failure (HF) or cardiac surgery. While there is
solid evidence for the treatment of other cardiovascular diseases of acute
onset, treatment strategies in haemodynamic instability due to CS and LCOS
remains less robustly supported by the given scientific literature.
Therefore, we have analysed the current body of evidence for the treatment
of CS or LCOS with inotropic and/or vasodilating agents. This is the
second update of a Cochrane review originally published in 2014.
 Objective(s): Assessment of efficacy and safety of cardiac care with
positive inotropic agents and vasodilator agents in CS or LCOS due to AMI,
HF or after cardiac surgery. Search Method(s): We conducted a search
in CENTRAL, MEDLINE, Embase and CPCI-S Web of Science in October 2019. We
also searched four registers of ongoing trials and scanned reference lists
and contacted experts in the field to obtain further information. No
language restrictions were applied. Selection Criteria: Randomised
controlled trials (RCTs) enrolling patients with AMI, HF or cardiac
surgery complicated by CS or LCOS. Data Collection and Analysis: We
used standard methodological procedures according to Cochrane standards.
 Main Result(s): We identified 19 eligible studies including 2385
individuals (mean or median age range 56 to 73 years) and three ongoing
studies. We categorised studies into 11 comparisons, all against standard
cardiac care and additional other drugs or placebo. These comparisons
investigated the efficacy of levosimendan versus dobutamine, enoximone or
placebo; enoximone versus dobutamine, piroximone or
epinephrine-nitroglycerine; epinephrine versus norepinephrine or
norepinephrine-dobutamine; dopexamine versus dopamine; milrinone versus
dobutamine and dopamine-milrinone versus dopamine-dobutamine. All trials
were published in peer-reviewed journals, and analyses were done by the
intention-to-treat (ITT) principle. Eighteen of 19 trials were small with
only a few included participants. An acknowledgement of funding by the
pharmaceutical industry or missing conflict of interest statements
occurred in nine of 19 trials. In general, confidence in the results of
analysed studies was reduced due to relevant study limitations (risk of
bias), imprecision or indirectness. Domains of concern, which showed a
high risk in more than 50% of included studies, encompassed performance
bias (blinding of participants and personnel) and bias affecting the
quality of evidence on adverse events. All comparisons revealed
uncertainty on the effect of inotropic/vasodilating drugs on all-cause
mortality with a low to very low quality of evidence. In detail, the
findings were: levosimendan versus dobutamine (short-term mortality: RR
0.60, 95% CI 0.36 to 1.03; participants = 1701; low-quality evidence;
long-term mortality: RR 0.84, 95% CI 0.63 to 1.13; participants = 1591;
low-quality evidence); levosimendan versus placebo (short-term mortality:
no data available; long-term mortality: RR 0.55, 95% CI 0.16 to 1.90;
participants = 55; very low-quality evidence); levosimendan versus
enoximone (short-term mortality: RR 0.50, 0.22 to 1.14; participants = 32;
very low-quality evidence; long-term mortality: no data available);
epinephrine versus norepinephrine-dobutamine (short-term mortality: RR
1.25; 95% CI 0.41 to 3.77; participants = 30; very low-quality evidence;
long-term mortality: no data available); dopexamine versus dopamine
(short-term mortality: no deaths in either intervention arm; participants
= 70; very low-quality evidence; long-term mortality: no data available);
enoximone versus dobutamine (short-term mortality RR 0.21; 95% CI 0.01 to
4.11; participants = 27; very low-quality evidence; long-term mortality:
no data available); epinephrine versus norepinephrine (short-term
mortality: RR 1.81, 0.89 to 3.68; participants = 57; very low-quality
evidence; long-term mortality: no data available); and dopamine-milrinone
versus dopamine-dobutamine (short-term mortality: RR 1.0, 95% CI 0.34 to
2.93; participants = 20; very low-quality evidence; long-term mortality:
no data available). No information regarding all-cause mortality were
available for the comparisons milrinone versus dobutamine, enoximone
versus piroximone and enoximone versus epinephrine-nitroglycerine.
Authors' conclusions: At present, there are no convincing data supporting
any specific inotropic or vasodilating therapy to reduce mortality in
haemodynamically unstable patients with CS or LCOS. Considering the
limited evidence derived from the present data due to a high risk of bias
and imprecision, it should be emphasised that there is an unmet need for
large-scale, well-designed randomised trials on this topic to close the
gap between daily practice in critical care of cardiovascular patients and
the available evidence. In light of the uncertainties in the field,
partially due to the underlying methodological flaws in existing studies,
future RCTs should be carefully designed to potentially overcome given
limitations and ultimately define the role of inotropic agents and
vasodilator strategies in CS and LCOS. Copyright © 2020 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<83>
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

<84>
Accession Number
2005903583
Title
Syndrome of progressive deforming non-inflammatory arthritis of childhood:
two patients of camptodactyly-arthropathy-coxa vara-pericarditis syndrome.
Source
Rheumatology International. 41 (10) (pp 1875-1882), 2021. Date of
Publication: October 2021.
Author
Johnson N.; Chaudhary H.; Kumrah R.; Pilania R.K.; Sharma Y.; Sharma A.;
Kaur A.; Mukherjee S.; Kakkar N.; Vignesh P.
Institution
(Johnson, Chaudhary, Kumrah, Pilania, Kaur, Mukherjee, Vignesh) Allergy
Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre,
Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh 160012, India
(Kakkar) Department of Histopathology, Postgraduate Institute of Medical
Education and Research, Chandigarh 160012, India
(Sharma, Sharma) Dr. Rajendra Prasad Government Medical College, Kangra,
Himachal Pradesh 176001, India
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare
familial arthropathy of childhood, commonly misdiagnosed as juvenile
idiopathic arthritis. It is characterized by non-inflammatory arthropathy,
coxa vara deformity, and sterile pericarditis. We describe two children
with CACP syndrome who were referred to the rheumatology clinic for the
suspicion of inflammatory arthritis. A literature search was carried out
using PubMed/ Medline and Embase databases. English language reports of
mutation-proven cases of CACP syndrome reported until 31 March 2020 were
retrieved and analysed. Both the children had a delay in diagnosis (age at
diagnosis- 12 and 13 years, respectively) and had received
immunomodulatory therapy for suspected inflammatory arthritis. Presence of
symmetrical arthropathy of large joints, camptodactyly, and normal
inflammatory parameters are clues that indicated CACP syndrome. One child
with a novel variant in PRG4 also had associated mitral valve prolapse and
regurgitation. Both had severe constrictive pericarditis requiring
pericardiectomy. On literature review, a total of 98 mutation-proven cases
of CACP syndrome have been reported till date. Arthropathy in CACP
syndrome mainly involves knees, wrists, ankles, and hips. Pericarditis is
usually mild, however, can present rarely with severe symptoms requiring
surgical intervention. CACP syndrome can closely mimic inflammatory
arthritis and early clinical recognition is important to avoid
misdiagnosis. Molecular confirmation is essential for early diagnosis and
future genetic counselling for affected families. Copyright ©
2020, Springer-Verlag GmbH Germany, part of Springer Nature.

<85>
Accession Number
2011983152
Title
Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in
Patients with Heart Failure with Secondary Mitral Regurgitation: The COAPT
Trial.
Source
Journal of the American Society of Echocardiography. 34 (9) (pp 955-965),
2021. Date of Publication: September 2021.
Author
Medvedofsky D.; Milhorini Pio S.; Weissman N.J.; Namazi F.; Delgado V.;
Grayburn P.A.; Kar S.; Lim D.S.; Lerakis S.; Zhou Z.; Liu M.; Alu M.C.;
Kapadia S.R.; Lindenfeld J.; Abraham W.T.; Mack M.J.; Bax J.J.; Stone
G.W.; Asch F.M.
Institution
(Medvedofsky, Weissman, Asch) MedStar Health Research Institute,
Washington, DC, United States
(Milhorini Pio, Namazi, Delgado, Bax) Department of Cardiology, Leiden
University Medical Center, Leiden, Netherlands
(Weissman, Asch) Georgetown University, Washington, DC, United States
(Grayburn) Baylor University Medical Center, Baylor Heart and Vascular
Institute, Dallas, TX, United States
(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
(Lerakis, Stone) The Zena and Michael A. Wiener Cardiovascular Institute,
Icahn School of Medicine at Mount Sinai, New York, NY, United States
(Zhou, Liu, Alu, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, 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
Medical Center, Columbus, OH, United States
(Mack) Baylor Scott & White Health, Plano, TX, United States
Publisher
Mosby Inc.
Abstract
Background: Left ventricular (LV) global longitudinal strain (GLS) is a
sensitive marker of LV function and may help identify patients with heart
failure (HF) and secondary mitral regurgitation who would have a better
prognosis and are more likely to benefit from edge-to-edge transcatheter
mitral valve repair with the MitraClip. The aim of this study was to
assess the prognostic utility of baseline LV GLS during 2-year follow-up
of patients with HF with secondary mitral regurgitation enrolled in the
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy
for Heart Failure Patients with Functional Mitral Regurgitation trial.
 Method(s): Patients with symptomatic HF with moderate to severe or
severe secondary mitral regurgitation who remained symptomatic despite
maximally tolerated guideline-directed medical therapy (GDMT) were
randomized to transcatheter mitral valve repair plus GDMT or GDMT alone.
Speckle-tracking-derived LV GLS from baseline echocardiograms was obtained
in 565 patients and categorized in tertiles. Death and HF hospitalization
at 2-year follow-up were the principal outcomes of interest.
 Result(s): Patients with better baseline LV GLS had higher blood
pressure, greater LV ejection fraction and stroke volume, lower levels of
B-type natriuretic peptide, and smaller LV size. No significant difference
in outcomes at 2-year follow-up were noted according to LV GLS. However,
the rate of death or HF hospitalization between 10 and 24 months was lower
in patients with better LV GLS (P = .03), with no differences before 10
months. There was no interaction between GLS tertile and treatment group
with respect to 2-year clinical outcomes. Conclusion(s): Baseline LV
GLS did not predict death or HF hospitalization throughout 2-year
follow-up, but it did predict outcomes after 10 months. The benefit of
transcatheter mitral valve repair over GDMT alone was consistent in all
subgroups irrespective of baseline LV GLS. Copyright © 2021
American Society of Echocardiography

<86>
Accession Number
635820832
Title
Point-of-care coagulation testing technologies to improve patient blood
management in cardiac surgery: A quality improvement project.
Source
Anesthesia and Analgesia. Conference: Society for the Advancement of
Patient Blood Management 2021 Annual Meeting. Virtual. 133 (3 SUPPL 1) (pp
73), 2021. Date of Publication: 2021.
Author
Spiess B.; Burger M.; Michael M.; Gore S.; Garvan C.; Shibu V.; Flax S.;
Pelletier J.P.R.; Zumberg M.; Beaver T.
Institution
(Spiess, Burger, Michael, Gore, Garvan, Shibu, Flax, Pelletier, Zumberg,
Beaver) University of Florida
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction:Patient blood management (PBM) guidelines recommend
point-of-care (POC) viscoelastic whole blood coagulation testing in
cardiac surgery. At the University of Florida Health Shands Hospital, this
standard of care varies among providers and POC coagulation testing occurs
after samples are delivered to the core laboratory. A quality improvement
project was designed to compare two POC devices in theater, the TEG 6S
(Haemonetics Inc, Braintree, MA) and Quantra (HemoSonics LLC,
Charlottesville, VA). Method(s): This project was certified by the
Quality Improvement Project Registry (QIPR). A series of didactic
educational sessions on PBM guidelines in cardiac surgery were held for
the cardiac team bimonthly for 16 months. Individual algorithms for POC
coagulation testing in theater with the Quantra and TEG 6S were designed
and providers agreed to follow them in all cardiac cases. The project
began when cardiac surgeons and anesthetists demonstrated proficiency with
interpretation and application of TEG 6S and Quantra. Two TEG 6S and two
Quantra machines were randomly assigned so that there was one in each of
four primary heart surgery operating theaters for 6 weeks. Total time of
POC testing in theater was calculated for each device, starting with time
the blood sample was placed in the machine until results returned, with a
mean score calculated. The cardiac team completed pre- and post-project
electronic surveys. Result(s):Thirty-eight team members answered the
pre- and post-project surveys; 55% were anesthetists, 18% surgeons, and
24% other providers. Sixty-eight patients were included, 37 of whom were
cared for using Quantra and 31 the TEG 6S. Quantra results were obtained
with a mean of 12.9 minutes, whereas the mean for TEG 6S was 24.9 minutes.
Standard practice from the core laboratory required 117 minutes to deliver
full results. Of clinicians, the post-trial questionnaire was concentrated
on the anesthesia team, with 75% of attending staff and 25% of fellows
responding. The Quantra was preferred and all respondents said it was very
easy to use; 62.5% said it improved patient care and 87.5% indicated that
it improved blood product use. The TEG 6S was viewed as easy to use by
37.5% and very easy to use by 37.5%; 25% of respondents were neutral.
 Conclusion(s):The TEG 6S and Quantra outperformed standard laboratory
support in mean time to report results. A preference for the Quantra was
seen. This evaluation engaged our team in the use of PBM to guide POC
coagulation therapy in the cardiac suite.

<87>
Accession Number
635820811
Title
Viscoelastic point-of-care testing for the assessment of hemostasis in
complex cardiac surgery: A cost effectiveness analysis in two Latin
American countries.
Source
Anesthesia and Analgesia. Conference: Society for the Advancement of
Patient Blood Management 2021 Annual Meeting. Virtual. 133 (3 SUPPL 1) (pp
46), 2021. Date of Publication: 2021.
Author
Osuna-Aragon A.; Ariza F.; Garcia-Araque H.F.; Figueroa-Lara A.
Institution
(Osuna-Aragon) French School of Public Health, Paris, France
(Ariza) Fundacion Valle del Lili Hospital, Cali, Colombia
(Garcia-Araque) Central Military Hospital, Bogota, Colombia
(Figueroa-Lara) WERFEN LATAM Clinical Marketing, Mexico City, Mexico
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Reducing patient exposure to unnecessary allogeneic blood
products in complex cardiac surgery is a universally shared goal for all
healthcare systems and institutions. However, the adoption of this concept
into daily practice has been difficult, in part because of limited
cost-effectiveness assessments for decision making. Optimization of
transfusional practice and minimization of blood loss are key areas for
improving postoperative outcomes, which are in line with the secondary aim
of the patient blood management (PBM) approach. The aim of this study is
to evaluate the cost-effectiveness of viscoelastic point-of-care testing
(VE POC) compared to standard laboratory tests (SLT). METHOD(S): Two
independent cost-effectiveness analysis (CEA) from the perspective of the
health care public payer were developed in Mexico (Mexican Institute of
Social Security -IMSS-) and Colombia (General System of Social Security in
Health -SGSSS-). A decision tree was designed to compare the health care
costs and clinical outcomes measured as quality adjusted life years
(QALYs). The alternatives analyzed in each CEA were VE POC by ROTEM
(WERFEN, Bedford, MA, USA) and SLT, both alternatives are used to guide
transfusional therapy among patients who underwent a complex cardiac
surgery. A 12-month time horizon was used in the analysis, therefore short
(1 month) and long term (11 months) adverse clinical events were
considered. Risk of clinical events, costs, medical inputs and QALY values
were collected from observational, randomized clinical trials, local
expert physicians and public sources. Direct medical costs were
standardized to 2020 U.S. dollars. Based on national health technology
assessment guidelines, the decision rule was the incremental
cost-effectiveness ratio (ICER), an alternative was considered
cost-effective if the ICER was equivalent or below the value of three
gross domestic product per capita per QALY gained (Mexico: US$29,838;
Colombia: US$19,286). Probabilistic sensitivity analysis was conducted
using Monte Carlo simulations. The models were developed using TreeAge Pro
softwareTM. RESULT(S): VE POC results in more QALYs (0.07 and 0.04)
and less costs (-$7,167 and -$3,211) when compared to SLT for Mexico and
Colombia, respectively. For both countries, the findings from this model
projects that VE POC is a dominant strategy by improving quality of life
at a lower cost. CONCLUSION(S): VE POC is considered to be a
cost-saving guiding transfusion strategy in patients undergoing complex
cardiac surgery. This is an important consideration for payers in
implementing VE POC as part of multidisciplinary PBM programs in Latin
America.

<88>
Accession Number
2013554513
Title
Effect of dexmedetomidine on hemodynamics in patients undergoing
hysterectomy: a meta-analysis and systematic review.
Source
Journal of International Medical Research. 49 (8) (no pagination), 2021.
Date of Publication: 2021.
Author
Li Z.; Li C.; Zhang M.
Institution
(Li) Surgical Anesthesia Center, Sanya Maternal and Child Health Hospital,
Sanya, Hainan, China
(Li) Department of Anesthesiology, Dongguan Houjie Hospital, Dongguan,
Guangdong, China
(Zhang) Department of Anesthesiology, People's Hospital of Ningxia Hui
Autonomous Region, Yinchuan, Ningxia, China
Publisher
SAGE Publications Ltd
Abstract
Objective: We conducted a meta-analysis and systematic review to evaluate
the effects of dexmedetomidine on the hemodynamics of patients undergoing
hysterectomy. Method(s): We searched the Medline, Embase, and
Cochrane Central Register of Controlled Trials databases for clinical
randomized controlled trials (RCTs) that allowed direct or indirect
comparisons of hemodynamic indicators. We also searched nine
English-language databases up to April 2021 to identify relevant research.
The Cochrane risk-of-bias tool for RCTs was applied to assess the
methodological quality of the eligible studies. The meta-analysis was
conducted using RevMan 5.4 software. Result(s): Nine trials were
included in this systematic review. The effect of dexmedetomidine on heart
rate during surgery was significantly smaller than that of other
sedatives. Intraoperative systolic and diastolic blood pressure and mean
arterial pressure were more stable in the dexmedetomidine group compared
with the control group. The postoperative modified Observer's Assessment
of Alertness Score was also better in the dexmedetomidine compared with
the control group. Conclusion(s): Dexmedetomidine increases
hemodynamic stability in patients undergoing hysterectomy, reduces the
cardiovascular stress response during surgery, and effectively prevents
postoperative adverse reactions, with good safety. Copyright ©
The Author(s) 2021.

<89>
Accession Number
2013413565
Title
Effect of cardioplegia for myocardial protection in pediatric cardiac
surgery: A network meta-analysis.
Source
Congenital Heart Disease. 16 (6) (pp 609-645), 2021. Date of Publication:
2021.
Author
Zhou K.; Li D.; Zhang X.; Wang W.; Li S.; Song G.
Institution
(Zhou, Li, Wang, Li) Department of Cardiac Surgery, Shengjing Hospital of
China Medical University, Shenyang, China
(Zhang, Song) Department of Ultrasound, Shengjing Hospital of China
Medical University, Shenyang, China
Publisher
Tech Science Press
Abstract
Cardioplegia has been widely used to reduce myocardial injury during
pediatric cardiac surgery; however, which cardioplegia solution has the
best protective effect has not been established. Thus, we compared the
myocardial protective effects of different cardioplegia solutions used in
pediatric cardiac surgery. Seven databases were searched to identify the
relevant randomized controlled trials. A network meta-analysis with a
Bayesian framework was conducted. The outcomes included the following
biochemical and clinical outcomes: Serum concentrations of the creatine
kinase-myocardial band at 6 h postoperatively; cardiac troponin I (cTnI)
at 4, 12, and 24 h postoperatively; spontaneous beating after declamping;
postoperative arrhythmias; inotropic support percentage and duration;
mechanical ventilation hours; intensive care unit stay in days; hospital
stay in days; and mortality. The group treated with cold crystalloid
cardioplegia (cCCP) was chosen as the control group. The 22 studies
involved 1529 patients. Six types of cardioplegia solutions were described
in these studies, including cold blood cardioplegia, cCCP, del Nido,
histidine-tryptophan-ketoglutarate (HTK), terminal warm blood
cardioplegia, and warm blood cardioplegia (wBCP). The serum concentrations
of the 24-h cTnI with wBCP (MD = -2.52, 95% CI: -4.74 to -0.27) was
significantly lower than cCCP. The serum concentrations of the 24-h cTnI
with HTK (MD = 4.91, 95% CI: 2.84-7.24) was significantly higher than
cCCP. There was no significant difference in other biochemical and
clinical outcomes when compared to cCCP. In conclusion, wBCP may have a
superior myocardial protective effect with lower 24-h cTnI levels
postoperatively and similar clinical outcomes after pediatric cardiac
surgery. Copyright © 2021, Tech Science Press. All rights
reserved.

<90>
Accession Number
2014262646
Title
Role of coronary angiogram before transcatheter aortic valve implantation.
Source
World Journal of Cardiology. 13 (8) (pp 361-371), 2021. Date of
Publication: 26 Aug 2021.
Author
Beska B.; Manoharan D.; Mohammed A.; Das R.; Edwards R.; Zaman A.;
Alkhalil M.
Institution
(Beska, Manoharan, Mohammed, Das, Edwards, Zaman, Alkhalil) Cardiothoracic
Centre, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, United Kingdom
Publisher
Baishideng Publishing Group Co
Abstract
BACKGROUND Coexistent coronary artery disease is commonly seen in patients
undergoing transcatheter aortic valve implantation (TAVI). Previous
studies showed that pre-TAVI coronary revascularisation was not associated
with improved outcomes, challenging the clinical value of routine coronary
angiogram (CA). AIM To assess whether a selective approach to perform
pre-TAVI CA is safe and feasible. METHODS This was a retrospective
non-randomised single-centre analysis of consecutive patients undergoing
TAVI. A selective approach for performing CA tailored to patient clinical
need was developed. Clinical outcomes were compared based on whether
patients underwent CA. The primary endpoint was a composite of all-cause
mortality, myocardial infraction, repeat CA, and re-admission with heart
failure. RESULTS Of 348 patients (average age 81 +/- 7 and 57% male) were
included with a median follow up of 19 (9-31) mo. One hundred and
fifty-four (44%) patients, underwent CA before TAVI procedure. Patients
who underwent CA were more likely to have previous myocardial infarction
(MI) and previous percutaneous revascularisation. The primary endpoint was
comparable between the two group (22.6% vs 22.2%; hazard ratio 1.05,
95%CI: 0.67-1.64, P = 0.82). Patients who had CA were less likely to be
readmitted with heart failure (P = 0.022), but more likely to have repeat
CA (P = 0.002) and MI (P = 0.007). In those who underwent CA, the presence
of flow limiting lesions did not affect the incidence of primary endpoint,
or its components, except for increased rate of repeat CA. CONCLUSION
Selective CA is a feasible and safe approach. The clinical value of
routine CA should be challenged in future randomised trials Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc.
All rights reserved.

<91>
Accession Number
2014271561
Title
Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation
Following Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Pierik R.; Zeillemaker-Hoekstra M.; Scheeren T.W.L.; Erasmus M.E.; Luijckx
G.-J.R.; Rienstra M.; Uyttenboogaart M.; Nijsten M.; van den Bergh W.M.
Institution
(Pierik, Nijsten, van den Bergh) Department of Critical Care, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Zeillemaker-Hoekstra, Scheeren) Department of Anesthesiology, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Erasmus) Department of Cardiac Surgery, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Luijckx, Uyttenboogaart) Department of Neurology, University Medical
Center Groningen, University of Groningen, Groningen, Netherlands
(Rienstra) Department of Cardiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to study the association between
postoperative atrial fibrillation (POAF) and thromboembolic stroke and to
determine risk factors for thromboembolic stroke after cardiac surgery.
 Design(s): The authors performed a secondary analysis from a
randomized controlled trial (GRIP-COMPASS). The patients with
thromboembolic stroke were compared with those without thromboembolic
stroke, and the difference in the incidence of POAF between these groups
was assessed. Odds ratios (OR) were calculated using logistic regression
analyses. Brain imaging was studied for the occurrence of thromboembolic
stroke during hospital admission, and POAF was monitored for seven days.
To assess which characteristics were associated with occurrence of
thromboembolic stroke, stepwise backward regression analysis was
performed. Participant(s): All adult consecutive cardiac surgery
patients admitted postoperatively to the intensive care unit.
 Setting(s): Academic tertiary care medical center.
 Intervention(s): None. Measurements and Main Results: Of the 910
patients included in this study, 26 patients (2.9%) had a thromboembolic
stroke during hospital admission. The incidence of POAF during the first
seven days after cardiac surgery in those with thromboembolic stroke was
65%, compared with 39% in those without thromboembolic stroke: adjusted OR
3.01 (95% confidence interval, 1.13-8.00). POAF, a history of peripheral
vascular disease, a higher EuroSCORE, and a longer duration of surgery
were associated with thromboembolic stroke. Conclusion(s): POAF
within seven days after cardiac surgery was associated with a three-fold
increased risk for a thromboembolic stroke during hospital admission.
Expeditious treatment of POAF may, therefore, reduce early stroke risk
after cardiac surgery. Copyright © 2021 The Authors

<92>
Accession Number
2013566005
Title
C-reactive protein and procalcitonin after congenital heart surgery
utilizing cardiopulmonary bypass: When should we be worried?.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Farias J.S.; Villarreal E.G.; Dhargalkar J.; Kleinhans A.; Flores S.;
Loomba R.S.
Institution
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Dhargalkar, Loomba) Department of Pediatrics, Chicago Medical
School/Rosalind Franklin University of Medicine and Science, North
Chicago, IL, United States
(Kleinhans, Flores) Section of Critical Care and Cardiology, Texas
Children's Hospital, Houston, TX, United States
(Kleinhans, Flores) Department of Pediatrics, Baylor School of Medicine,
Houston, TX, United States
(Loomba) Department of Pediatric Critical Care, Advocate Children's
Hospital, Oak Lawn, IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: To assess the efficacy of C-reactive protein (CRP) and
procalcitonin (PCT) at identifying infection in children after congenital
heart surgery (CHS) with cardiopulmonary bypass (CPB). Material(s)
and Method(s): Systematic review of the literature was conducted to
identify studies with data regarding CRP and/or PCT after CHS with CPB.
The primary variables identified to be characterized were CRP and PCT at
different timepoints. The main inclusion criteria were children who
underwent CHS with CPB. Subset analyses for those with and without
documented infection were conducted in similar fashion. A p value of less
than.05 was considered statistically significant. Result(s): A total
of 21 studies were included for CRP with 1655 patients and a total of 9
studies were included for PCT with 882 patients. CRP peaked on
postoperative Day 2. A significant difference was noted in those with
infection only on postoperative Day 4 with a level of 53.60 mg/L in those
with documented infection versus 29.68 mg/L in those without. PCT peaked
on postoperative Day 2. A significant difference was noted in those with
infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in
those with documented infection versus 5.6 ng/ml in those without.
 Conclusion(s): Both CRP and PCT increase after CHS with CPB and peak
on postoperative day 2. PCT has a greater statistically significant
difference in those with documented infection when compared to CRP and a
PCT of greater than 5.6 ng/ml should raise suspicion for
infection. Copyright © 2021 Wiley Periodicals LLC

<93>
Accession Number
2011084807
Title
Cardiac computed tomography in the contemporary evaluation of infective
endocarditis.
Source
Journal of Cardiovascular Computed Tomography. 15 (4) (pp 304-312), 2021.
Date of Publication: 01 Jul 2021.
Author
Khalique O.K.; Veillet-Chowdhury M.; Choi A.D.; Feuchtner G.; Lopez-Mattei
J.
Institution
(Khalique) Structural Heart and Valve Center, Division of Cardiology,
Columbia University Medical Center, New York, NY, United States
(Veillet-Chowdhury) Advanced Cardiovascular Imaging, Division of
Cardiology, Wellspan Health System, York, PA, United States
(Choi) Division of Cardiology and Department of Radiology, The George
Washington University School of Medicine, United States
(Feuchtner) Department of Radiology, Innsbruck Medical University,
Innsbruck, Austria
(Lopez-Mattei) Department of Cardiology, Division of Internal Medicine,
University of Texas MD Anderson Cancer Center, Houston, TX, United States
(Lopez-Mattei) Department of Thoracic Imaging, Division of Diagnostic
Imaging, University of Texas MD Anderson Cancer Center, Houston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Increasing data have accumulated on the role of Cardiac Computed
Tomography (CCT) in infective endocarditis (IE) with high accuracy for
large vegetations, perivalvular complications and for exclusion of
coronary artery disease to avoid invasive angiography. CCT can further
help to clarify the etiology of infective prosthetic valve dysfunction
(e.g. malposition, abscess, leak, vegetation or mass). Structural
interventions have increased the relevance of CCT in valvular heart
disease and have amplified its use. CCT may be ideally integrated into a
multimodality approach that incorporates a central role of transesophageal
echocardiography (TEE) with 18-FDG PET and/or cardiac magnetic resonance
in individually selected cases, guided by the Heart Team. The
coronavirus-19 (COVID-19) pandemic has resulted in renewed attention to
CCT as a safe alternative or adjunct to TEE in selected patients. This
review article provides a comprehensive, contemporary review on CCT in IE
to include scan optimization, characteristics of common IE findings on
CCT, published data on the diagnostic accuracy of CCT, multimodality
imaging comparison, limitations and future technical
advancements. Copyright © 2021 Society of Cardiovascular Computed
Tomography

<94>
Accession Number
2006126870
Title
Trimetazidine can prevent the occurrence of contrast-induced nephropathy
after percutaneous coronary intervention in elderly patients with renal
insufficiency.
Source
Perfusion (United Kingdom). 36 (6) (pp 603-609), 2021. Date of
Publication: September 2021.
Author
Fu H.; Zhang J.; Zhang H.; Zhang P.; Fu X.; Zeng Z.; Zhang X.; Li W.; Yang
S.; Liu X.; Fu N.
Institution
(Fu, Fu, Zeng, Zhang) Tianjin Medical University, Tianjin, China
(Zhang, Zhang, Zhang, Li, Yang, Liu, Fu) Tianjin Chest Hospital, Tianjin,
China
Publisher
SAGE Publications Ltd
Abstract
Background: Contrast-induced nephropathy (CIN) has become a common cause
of hospital-acquired acute kidney injury in elderly patients.
Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent
years, which can reduce the incidence of CIN. This study aimed to evaluate
the efficacy of TMZ in the prevention of contrast-induced nephropathy in
elderly patients with renal insufficiency undergoing percutaneous coronary
intervention (PCI) and to explore the mechanism of action. Method(s):
A total of 310 elderly patients with renal insufficiency undergoing
elective PCI were enrolled and randomly assigned to a control group (n =
155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally
24 hours before and 72 hours after PCI). The primary endpoint of the study
was the incidence of CIN, which was defined as an increase of 25% or more,
or an absolute increase of 0.5 mg/dL or more in serum creatinine from
baseline value, at 48 to 72 hours following the exposure to contrast media
(CM). Result(s): The incidence of CIN was significantly lower in the
TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There
was no difference regarding the incidence of major adverse events during
hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p
= 1.000). Binary logistic regression results showed that TMZ was
protective factors of CIN (OR = 0.274; 95% CI: 0.089-0.847; p = 0.025).
 Conclusion(s): Therefore, we came to the conclusion that prophylactic
administration of TMZ can prevent the occurrence of CIN in elderly
patients with renal insufficiency undergoing PCI and has a certain
protective effect on the renal function of patients. According to the
experimental results and the mechanism of TMZ on cardiomyocytes, we
speculate that TMZ increases kidney glucose metabolism, reduces fatty acid
oxidation, and also has a protective effect on kidney free radical damage
and ischemia-reperfusion injury. Copyright © The Author(s) 2021.

<95>
Accession Number
634538498
Title
Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events
in Older Patients Treated With Glucose-Lowering Agents.
Source
Frontiers in Endocrinology. 12 (no pagination), 2021. Article Number:
571568. Date of Publication: 08 Mar 2021.
Author
Mattishent K.; Loke Y.K.
Institution
(Mattishent, Loke) Norwich Medical School, University of East Anglia,
Norwich, United Kingdom
Publisher
Frontiers Media S.A.
Abstract
Aims: We conducted a meta-analysis of serious adverse events (dementia,
macro- and micro-vascular events, falls and fractures, and death)
associated with hypoglycemia in older patients treated with glucose
lowering drugs. Material(s) and Method(s): Meta-analysis of studies
reporting on hypoglycemia and adverse events. The search included studies
from two previously published systematic reviews, and an updated search of
MEDLINE and EMBASE from April 2014 to November 2019. We assessed study
validity based on ascertainment of hypoglycemia, adverse events and
adjustment for confounders, and conducted a random effects meta-analyses,
assessing heterogeneity using the I2 statistic. Result(s):
We included 44 studies involving 2,507,434 participants. Most of the
studies used adjusted analysis for confounders and hypoglycaemic events
were typically identified based on healthcare databases (severe events).
Hypoglycemia was associated with increased likelihood of death in a
meta-analysis of eighteen studies, pooled OR 2.02 (95% Confidence Interval
1.75-2.32). Studies assessing mortality signal a time-response
relationship with a higher risk of adverse events occurring within the
first 90 days after hypoglycemia. Our meta-analysis of nine studies
demonstrated that hypoglycaemic episodes were associated with dementia -
pooled OR 1.50 (95% CI 1.29-1.74). Our meta-analysis of nineteen studies
demonstrated associations between hypoglycaemia and macrovascular
complications, pooled OR 1.81 (95% CI 1.70-1.94), and microvascular
complications (two studies) pooled OR 1.77 (95% CI 1.49-2.10). There is
also an association between hypoglycemia and cardiovascular death (six
studies) - pooled OR 2.11 (95% CI 1.55 to 2.87). Similarly, our
meta-analysis of six studies demonstrated an association between
hypoglycemia and falls and fractures, pooled OR 1.78 (95% CI 1.44-2.21)
and 1.68 (95% CI 1.37-2.07) respectively. Conclusion(s): This
meta-analysis confirms previously reported concerns of serious harm
following hypoglycemia, especially in the immediate time period after a
hypoglycaemic event. Avoidance of hypoglycaemic episodes should be a
priority in this vulnerable population. © Copyright © 2021
Mattishent and Loke.

<96>
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.

<97>
Accession Number
2013379362
Title
Revascularization versus medical therapy in patients aged 80 and older
with stable ischemic heart disease.
Source
Journal of the American Geriatrics Society. (no pagination), 2021. Date of
Publication: 2021.
Author
Phan D.Q.; Zadegan R.; Lee M.-S.
Institution
(Phan, Zadegan) Regional Cardiac Catheterization Lab, Kaiser Permanente
Southern California, Los Angeles, CA, United States
(Lee) Department of Cardiology, Kaiser Permanente Los Angeles Medical
Center, Los Angeles, CA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Older patients are underrepresented in landmark randomized
trials for stable ischemic heart disease (SIHD). Therefore, we sought to
evaluate the benefits of revascularization in patients >=80 years old with
SIHD. Method(s): Retrospective study of patients undergoing invasive
coronary angiography (ICA) for SIHD between 2009 and 2019. Patients were
grouped according to treatment: revascularization (percutaneous coronary
intervention [PCI] or coronary artery bypass grafting [CABG]) versus
initial medical therapy alone. Inverse probability of treatment weighting
(IPTW)-adjusted Cox proportional hazard regression analyses were
performed. Outcomes evaluated were all-cause mortality, non-fatal
myocardial infarction (MI), and repeat revascularization. Result(s):
A total of 1015 patients (median age 83.0, interquartile range [IQR]
81.3-85.2 years; 29% female) underwent ICA for SIHD. Of these, 557 (55%)
were treated with revascularization and 458 (45%) with initial medical
therapy alone. Baseline characteristics were well balanced after IPTW
adjustment. At median follow-up of 3.5 years (IQR 1.7-5.9 years), there
were no differences in all-cause mortality and non-fatal MI between
treatment groups; but there was an increased need for repeat
revascularization (IPTW adjusted hazard ratio 2.22, 95% confidence
interval 1.53-3.22) with revascularization. Separately comparing PCI or
CABG alone versus medical therapy yielded similar results; as well as in
subgroup analysis (except for patients >=90 years old and those without
prior CABG). Conclusion(s): There were no differences in all-cause
mortality and non-fatal MI with invasive revascularization (either PCI or
CABG) versus medical therapy alone in patients >=80 years old with SIHD.
Large randomized trials focusing on older patients are warranted to guide
clinical practice in this growing population. Copyright © 2021
The American Geriatrics Society.

<98>
Accession Number
635650594
Title
Milrinone as compared with dobutamine in the treatment of cardiogenic
shock.
Source
New England Journal of Medicine. 385 (6) (pp 516-525), 2021. Date of
Publication: 05 Aug 2021.
Author
Mathew R.; Di Santo P.; Jung R.G.; Marbach J.A.; Hutson J.; Simard T.;
Ramirez F.D.; Harnett D.T.; Merdad A.; Almufleh A.; Weng W.; Abdel-Razek
O.; Fernando S.M.; Kyeremanteng K.; Bernick J.; Wells G.A.; Chan V.;
Froeschl M.; Labinaz M.; Le May M.R.; Russo J.J.; Hibbert B.
Institution
(Mathew, Di Santo, Jung, Marbach, Hutson, Simard, Ramirez, Harnett,
Abdel-Razek, Froeschl, Labinaz, Le May, Russo, Hibbert) The CAPITAL
Research Group, Division of Cardiology, Canada
(Bernick, Wells) The Cardiovascular Research Methods Centre, Canada
(Chan) The Division of Cardiac Surgery, Canada
(Mathew, Di Santo, Jung, Hutson, Harnett, Weng, Abdel-Razek, Fernando,
Kyeremanteng, Froeschl, Labinaz, Le May, Russo, Hibbert) University of
Ottawa Heart Institute, The Faculty of Medicine, Canada
(Mathew, Hutson, Fernando, Kyeremanteng) The Division of Critical Care,
Department of Medicine, Canada
(Di Santo) The School of Epidemiology and Public Health, Canada
(Jung, Simard, Hibbert) The Department of Cellular and Molecular Medicine,
Canada
(Merdad) University of Ottawa, Ottawa, Canada
(Almufleh) The Division of Cardiology, University of British Columbia,
Vancouver, Canada
(Marbach) The Division of Critical Care, Tufts Medical Center, Boston,
United States
(Simard) The Department of Cardiovascular Medicine, Mayo Clinic,
Rochester, MN, United States
(Ramirez) Hopital Cardiologique du Haut Leveque, Centre Hospitalier
Universitaire Bordeaux, Bordeaux-Pessac, France
(Ramirez) LIRYC (l'Institut de Rythmologie et Modelisation Cardiaque),
Bordeaux-Pessac, France
(Merdad) The Division of Cardiology, University of Toronto, Toronto,
Canada
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Cardiogenic shock is associated with substantial morbidity and
mortality. Although inotropic support is a mainstay of medical therapy for
cardiogenic shock, little evidence exists to guide the selection of
inotropic agents in clinical practice. METHODS We randomly assigned
patients with cardiogenic shock to receive milrinone or dobutamine in a
double-blind fashion. The primary outcome was a composite of in-hospital
death from any cause, resuscitated cardiac arrest, receipt of a cardiac
transplant or mechanical circulatory support, nonfatal myocardial
infarction, transient ischemic attack or stroke diagnosed by a
neurologist, or initiation of renal replacement therapy. Secondary
outcomes included the individual components of the primary composite
outcome. RESULTS A total of 192 participants (96 in each group) were
enrolled. The treatment groups did not differ significantly with respect
to the primary outcome; a primary outcome event occurred in 47
participants (49%) in the milrinone group and in 52 participants (54%) in
the dobutamine group (relative risk, 0.90; 95% confidence interval [CI],
0.69 to 1.19; P = 0.47). There were also no significant differences
between the groups with respect to secondary outcomes, including
in-hospital death (37% and 43% of the participants, respectively; relative
risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%;
hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical
circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to
1.71), or initiation of renal replacement therapy (22% and 17%; hazard
ratio, 1.39; 95% CI, 0.73 to 2.67). CONCLUSIONS In patients with
cardiogenic shock, no significant difference between milrinone and
dobutamine was found with respect to the primary composite outcome or
important secondary outcomes. (Funded by the Innovation Fund of the
Alternative Funding Plan for the Academic Health Sciences Centres of
Ontario; ClinicalTrials.gov number, NCT03207165.) Copyright ©
2021 Massachusetts Medical Society.

<99>
[Use Link to view the full text]
Accession Number
635461696
Title
Acute pain after serratus anterior plane or thoracic paravertebral blocks
for video-assisted thoracoscopic surgery: A noninferiority randomised
trial.
Source
European journal of anaesthesiology. 38 (Supplement 2) (pp S97-S105),
2021. Date of Publication: 01 Aug 2021.
Author
Qiu Y.; Wu J.; Huang Q.; Lu Y.; Xu M.; Mascha E.J.; Yang D.; Ince I.;
Sessler D.I.
Institution
(Qiu) From the Department of Anesthesiology, Shanghai Chest Hospital,
Shanghai Jiao Tong University, Shanghai, China (YQ, JW, QH, YL, MX), the
Department of Outcomes Research, Anesthesiology Institute, Cleveland
Clinic (YQ, EJM, DY, II, DIS), the Outcomes Research Consortium (JW), the
Department of Quantitative Health Sciences, Cleveland Clinic, Ohio, USA
(EJM, DY), the Department of Anesthesiology and Reanimation, Ataturk
University School of Medicine, Anaesthesiology Clinical Research Office,
Erzurum, Turkey (II)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Serratus anterior plane blocks (SAPBs) and thoracic
paravertebral blocks (TPVBs) can both be used for video-assisted thoracic
surgery. However, it remains unknown whether the analgesic efficacy of a
SAPB is comparable to that of a TPVB. OBJECTIVE(S): We tested the
primary hypothesis that SAPBs provide noninferior analgesia compared with
TPVBs for video-assisted thoracic surgery. DESIGN: A noninferiority
randomised trial. SETTING: Shanghai Chest Hospital, between August 2018
and November 2018. PATIENTS: Ninety patients scheduled for video-assisted
thoracic lobectomy or segmentectomy were randomised. Patients were
excluded if they were unable to perform the visual analogue pain scale, or
surgery was converted to thoracotomy. INTERVENTIONS: Blocks were performed
after induction of general anaesthesia. The three groups were
paravertebral blocks (n = 30); serratus anterior plane blocks (n = 29);
and general anaesthesia alone (n = 30). PRIMARY OUTCOME MEASURES: Visual
analogue pain scores (0 to 10 cm) at rest and while coughing, and
Prince-Henry pain scores (0 to 4 points) were used to assess postoperative
analgesia at 2, 24 and 48 h after surgery. We assessed the noninferiority
of SAPBs with TPVBs on all three primary pain outcomes using a delta of 1
cm or one point as appropriate. RESULT(S): The mean difference (95%
confidence intervals) in visual analogue scores between the SAPBs and
TPVBs was -0.04 (-0.10 to 0.03) cm at rest, -0.22 (-0.43 to -0.01) cm
during coughing and -0.10 (-0.25 to 0.05) for Prince-Henry pain scores. As
the upper limit of the confidence intervals were less than 1 (all P <
0.001), noninferiority was claimed for all three primary outcomes.
Compared with general anaesthesia alone, the VAS scores at rest and while
coughing, and the Prince-Henry pain scores for the two blocks were
significantly lower during the initial 2 h after surgery.
 CONCLUSION(S): Serratus anterior plane blocks are quicker and easier
to perform than paravertebral blocks and provide comparable analgesia in
patients having video-assisted thoracic surgery. Both blocks provided
analgesia that was superior to general anaesthesia alone during the
initial 2 h after surgery. TRIAL REGISTRATION: Chinese Clinical Trial
Registry, identifier: ChiCTR1800017671. Copyright © 2021 European
Society of Anaesthesiology and Intensive Care. Unauthorized reproduction
of this article is prohibited.

<100>
Accession Number
635817287
Title
In low-risk patients aged >70-75 with severe aortic stenosis, is
transcatheter superior to surgical aortic valve replacement in terms of
reported cardiovascular composite outcomes and survival?.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 07 Aug 2021.
Author
Magro P.L.; Sousa-Uva M.
Institution
(Magro, Sousa-Uva) Department of Cardiothoracic Surgery, Hospital de Santa
Cruz, Carnaxide, Portugal
Publisher
NLM (Medline)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In low-risk patients aged
>70-75 with severe aortic stenosis, is transcatheter superior to surgical
aortic valve replacement in terms of reported composite outcomes and
survival? More than 73 papers were found using the reported search, of
which 8 represented the best evidence to answer the clinical question. The
authors, journal, date and country of publication, patient group studied,
study type, relevant outcomes and results of these papers were tabulated.
The only low-risk randomized control trial to date [Nordic Aortic Valve
Intervention (NOTION)] regarding an elderly population did not show a
statistically significant difference between the 2 approaches regarding
the composite endpoint of death, stroke or myocardial infarction. A
subgroup analysis of elderly patients in the 2 main low-risk randomized
control trials did not yield statistically different results from those of
the overall population; the results indicated the superiority of
transcatheter aortic valve implantation regarding the composite of death,
stroke or rehospitalization at 1year [The Safety and Effectiveness of the
SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic
Stenosis (PARTNER 3)] and non-inferiority regarding a composite of death
or stroke at 2years [Medtronic Evolut Transcatheter Aortic Valve
Replacement in Low-Risk Patients (Evolut LR)]. The results from lower
evidence studies are largely consistent with these findings. Overall,
there is no compelling evidence indicating that older age should be an
isolated criterion for the choice between transcatheter aortic valve
replacement and surgical aortic valve replacement in otherwise low-risk
patients. The superiority of either technique regarding the aforementioned
composite short-term outcomes in this particular subgroup of patients is
unclear. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<101>
Accession Number
635811916
Title
Efficacy and Safety of Tranexamic Acid for the Control of Surgical
Bleeding in Patients Under Liposuction.
Source
Aesthetic plastic surgery. (no pagination), 2021. Date of Publication: 05
Aug 2021.
Author
Rodriguez-Garcia F.A.; Sanchez-Pena M.A.; de Andrea G.T.;
Villarreal-Salgado J.L.; Alvarez-Trejo H.J.; Medina-Quintana V.M.;
Garcia-Valenzuela S.E.; Morfin-Meza K.E.; Fierro-Rodriguez D.A.;
Dorado-Hernandez E.; Bonilla-Catalan P.V.; Ramos-Maciel J.; Romero-Algara
E.; Jimenez-Pavon K.E.; Torres-Salazar Q.L.
Institution
(Rodriguez-Garcia, Villarreal-Salgado, Alvarez-Trejo, Medina-Quintana,
Garcia-Valenzuela, Morfin-Meza, Fierro-Rodriguez, Dorado-Hernandez,
Bonilla-Catalan, Ramos-Maciel, Romero-Algara, Jimenez-Pavon) Instituto de
Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital
Regional "Dr. Valentin Gomez Farias", Av. Soledad Orozco 203, El Capullo,
45100, Zapopan, Guadalajara, Jalisco, Mexico
(Sanchez-Pena, de Andrea) Hospital INNOVARE, Av. Verona 7412, Zapopan,
Jalisco, Mexico
(Torres-Salazar) Universidad Juarez del Estado de Durango, Calle Paloma
No.806, Colonia Fatima, Durango 34060, Mexico
Publisher
NLM (Medline)
Abstract
Liposuction remains one of the most frequently performed cosmetic surgical
procedures and its popularity is increasing every year. However, since its
inception, justified concerns regarding patient safety have placed limits
on the volume of fat that can be aspirated, influenced by hemodynamic
fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is
an antifibrinolytic agent that competitively inhibits the conversion of
plasminogen to plasmin, thus preventing the binding and degradation of
fibrin. Despite the existence of evidence of the effectiveness of TXA in
orthopedic and cardiac surgeries, there is little evidence of its use in
liposuction. The objective of this study was to evaluate the efficacy and
safety of tranexamic acid in the control of surgical bleeding in patients
undergoing liposuction, through a prospective, open, randomized and
controlled clinical trial. Two groups of 25 participants each were formed
to whom the application of TXA in a tumescent solution prior to
liposuction or liposuction with the traditional technique was randomly
assigned. The results showed a decrease in blood loss reflected by the
differences in the final hematocrit values, as well as decrease in the
same per aspirated volume (p = 0.003). No adverse events were found
related with the TXA application and no blood transfusions were required
in this group, in contrast to the control group where the need for blood
transfusion was present in 20% of the intervened participants. LEVEL OF
EVIDENCE II: This journal requires that authors assign a level of evidence
to each article. For a full description of these Evidence-Based Medicine
ratings, please refer to the Table of Contents or the online Instructions
to Authors www.springer.com/00266. Copyright © 2021. Springer
Science+Business Media, LLC, part of Springer Nature and International
Society of Aesthetic Plastic Surgery.

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