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<1>
Accession Number
2013725904
Title
Long-term ticagrelor in patients with prior coronary stenting in the
pegasus-timi 54 trial.
Source
Journal of the American Heart Association. 10(17) (no pagination), 2021.
Article Number: e020446. Date of Publication: 2021.
Author
Bergmark B.A.; Bhatt D.L.; Steg P.G.; Budaj A.; Storey R.F.; Gurmu Y.;
Kuder J.F.; Im K.; Magnani G.; Ophuis T.O.; Hamm C.; Spinar J.; Kiss R.G.;
Van de Werf F.J.; Montalescot G.; Johanson P.; Braunwald E.; Sabatine
M.S.; Bonaca M.P.
Institution
(Bergmark, Bhatt, Gurmu, Kuder, Im, Braunwald, Sabatine, Bonaca) TIMI
Study Group, Cardiovascular Medicine, Department of Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Steg) French Alliance for Cardiovascular Trials, AP-HP, Hopital Bichat,
Universite de Paris, Institut National de la Sante et de la Recherche
Medicale U-1148, Paris, France
(Steg) National Heart and Lung Institute, Royal Brompton Hospital,
Imperial College London, London, United Kingdom
(Budaj) Centre of Postgraduate Medical Education, Grochowski Hospital,
Warsaw, Poland
(Storey) University of Sheffield, Sheffield, United Kingdom
(Magnani) University Hospital of Parma, Parma, Italy
(Ophuis) Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
(Hamm) Kerckhoff Heart Center, Bad Nauheim, University of Giessen,
Giessen, Germany
(Spinar) University hospital St. Ann, Pekarska and Medical faculty, Brno,
Czechia
(Kiss) Department of Cardiology, Military Hospital, Budapest, Hungary
(Van de Werf) University of Leuven, Leuven, Belgium
(Montalescot) Sorbonne Universite, Paris 6, ACTION Study Group,
INSERM-UMRS 1166, Institut de Cardiologie, Pitie-Salpetriere Hospital
(AP-HP), Paris, France
(Johanson) AstraZeneca, Molndal, Sweden
(Bonaca) Colorado Prevention Center (CPC) Clinical Research, the
Department of Medicine, Division of Cardiovascular Medicine, University of
Colorado Anschutz Medical Campus, Aurora, CO, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Coronary stent type and risk of stent thrombosis remain
important factors affecting recommended duration of dual antiplatelet
therapy. We investigated the efficacy and safety of long-term ticagrelor
in patients with prior coronary stenting enrolled in the PEGASUS-TIMI 54
(Prevention of Cardiovascular Events in Patients with Prior Heart Attack
Using Ticagrelor Compared to Placebo on a Background of
Aspirin-Thrombolysis in Myocardial Infarction 54) trial. METHODS AND
RESULTS: Patients in PEGASUS-TIMI 54 had a myocardial infarction 1 to 3
year prior and were randomized 1:1:1 to ticagrelor 60 or 90 mg BID or
placebo. The primary end point was a composite of cardiovascular death,
myocardial infarc-tion, or stroke (major adverse cardiovascular events).
Stent thrombosis was prospectively adjudicated (Academic Research
Consortium definition). Baseline characteristics were compared by most
recent stent type (bare metal versus drug-eluting stent and first-versus
later-generation drug-eluting stent). Treatment arms were compared using
Cox proportional hazards models. Of 21 162 patients randomized, 80% (n=16
891) had prior coronary stenting. Following randomization, myocardial
infarction was the most frequent ischemic event in patients with prior
stenting in the placebo arm, occurring in 5.2% of patients (Type 1: 4.1%),
followed by cardiovascular death (2.3%), stroke (1.7%), and stent
thrombosis (0.9%). Ticagrelor<inf>pooled</inf> reduced major adverse
cardiovascular events (7.0% versus 8.0%; hazard ratio [HR], 0.85; 95% CI,
0.75- 96) regardless of stent type (bare metal stent versus drug-eluting
stent: p<inf>interaction</inf> =0.767; first versus later generation:
p<inf>interaction</inf> =0.940). The rate of any stent thrombosis was
numerically lower with ticagrelor<inf>pooled</inf> (0.7% versus 0.9%; HR,
0.73; 95% CI, 0.50-1.05) and Thrombolysis in Myocardial Infarction major
bleeding was increased (HR, 2.65; 95% CI, 1.90- 3.68). CONCLUSION(S):
Long-term ticagrelor reduces major adverse cardiovascular events in
patients with prior myocardial infarction and coronary stenting regardless
of stent type, with the benefit driven predominantly by reduction in de
novo events. Nonfatal major bleeding is increased with
ticagrelor. Copyright © 2021 The Authors. Published on behalf of
the American Heart Association, Inc., by Wiley.

<2>
Accession Number
2013510238
Title
Postoperative 20% albumin vs standard care and acute kidney injury after
high-risk cardiac surgery (ALBICS): study protocol for a randomised trial.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 558. Date of
Publication: December 2021.
Author
Balachandran M.; Banneheke P.; Pakavakis A.; Al-Bassam W.; Sarode V.;
Rowland M.; Shehabi Y.
Institution
(Balachandran, Banneheke) School of Clinical Sciences at Monash Health,
Monash University, Clayton, VIC, Australia
(Pakavakis, Al-Bassam, Shehabi) Intensive Care Services, School of
Clinical Sciences at Monash Health, Monash University, Clayton, VIC,
Australia
(Sarode) Intensive Care Services, Cabrini Health, Malvern, VIC, Australia
(Sarode) Cabrini Monash University Department of Medicine, Monash
University, Malvern, VIC, Australia
(Rowland) Department of Cardiothoracic Surgery, Barwon Health, Geelong,
VIC, Australia
(Shehabi) University of New South Wales, Prince of Wales Clinical School
of Medicine, Randwick, NSW, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Acute kidney injury (AKI) is a common complication of cardiac
surgery. Factors such as cardiopulmonary bypass, aortic cross-clamping and
surgical stress may precipitate renal hypoperfusion and ischaemia,
inflammation and oxidative stress are associated with development of AKI.
Albumin's pharmacological properties and widespread availability have the
potential to mitigate these factors. However, the effect of albumin on
cardiac surgery-associated AKI is unknown. Objective(s): To evaluate
the impact of postoperative 20% albumin infusion on kidney function after
high-risk cardiac surgery. Method(s): We designed an open-label,
multicentre, randomised controlled trial-the ALBICS study (ALBumin
Infusion and acute kidney injury following Cardiac Surgery). A total of
590 patients undergoing high-risk cardiac surgery (combined procedure or
estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73
m2) will be enrolled into the study and randomly allocated to
receive a postoperative 20% albumin infusion or standard care in a 1:1
ratio, stratified by centre and baseline renal function. The study fluid
will be administered upon arrival in intensive care for 15 h. Patients
will be followed up until 28 days after surgery or until discharge from
the hospital. The primary outcome is the proportion of patients who
develop AKI in both groups. Secondary outcomes to be measured are
proportions of AKI stage II and III, 28-day mortality, mechanical
ventilation time and length of stay in intensive care and hospital.
 Conclusion(s): This trial aims to determine if a postoperative
infusion of concentrated albumin reduces the risk of AKI following
high-risk cardiac surgery. Trial registration: Australian New Zealand
Clinical Trials Registry ACTRN12619001355167. Registered on 03 October
2019-retrospectively registered.
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378383.Copyright © 2021, The Author(s).

<3>
Accession Number
2013342741
Title
Comparison between intraoperative bleeding score and ROTEM measurements to
assess coagulopathy during major pediatric surgery.
Source
Transfusion and Apheresis Science. 60(5) (no pagination), 2021. Article
Number: 103191. Date of Publication: October 2021.
Author
Restin T.; Schmugge M.; Cushing M.M.; Haas T.
Institution
(Restin) Newborn Research Zurich, Department of Neonatology, University
hospital Zurich, Zurich, Switzerland
(Restin) Institute of Physiology, Zurich Center for Integrative Human
Physiology, University of Zurich, Zurich, Switzerland
(Schmugge) Department of Hematology, Zurich University Children's
Hospital, Zurich, Switzerland
(Schmugge, Haas) Children's Research Center, University Children's
Hospital of Zurich, Zurich, Switzerland
(Cushing) Department of Pathology and Laboratory Medicine, Weill Cornell
Medical College, New York, NY, United States
(Haas) Department of Anesthesia, Zurich University Children's Hospital,
Zurich, Switzerland
Publisher
Elsevier Ltd
Abstract
Purpose: Intraoperative bleeding should be regularly assessed visually to
guide coagulation management. Whereas viscoelastic testing with ROTEM
measurement has been proven to be useful in detecting coagulopathies, the
visual assessment is not standardized. This study therefore aims to
compare a standardized visual assessment with ROTEM results.
 Method(s): A 5-point bleeding score was created and applied in a
recently published randomized controlled trial in major pediatric
non-cardiac surgery. This score assesses overall bleeding tendency and the
occurrence of diffuse bleeding, aqueous bleeding, bleeding outside the
operative field, and the ability to control bleeding. Validity of this
score was tested by post hoc comparison to the results of simultaneously
performed ROTEM measurements. Result(s): Signs of coagulopathic
bleeding were assessed at 183 time points. Mild to moderate bleeding
intensity was judged at 103 time points, in 42 % abnormal ROTEM traces
were obtained simultaneously. When severe bleeding was scored, abnormal
ROTEM values occurred in 58 %, and FIBTEM-values were significantly lower
than in the "no bleeding group". Altogether, the correlation between
bleeding score and ROTEM measurements was not significant.
 Conclusion(s): The standardized visual assessment did not correlate
well with ROTEM measurements, suggesting that it is not useful to detect
coagulopathy. Trial registry number: ClinicalTrials.gov identifier No.
NCT01487837. Copyright © 2021

<4>
Accession Number
634570004
Title
The Effect of Home Care Training on Anxiety and Vital Signs Levels in
Coronary Artery Bypass Grafting Patients: A Randomized Clinical Trial.
Source
Journal of perianesthesia nursing : official journal of the American
Society of PeriAnesthesia Nurses. 36(4) (pp 393-397), 2021. Date of
Publication: 01 Aug 2021.
Author
Shirdel Z.; Behzad I.; Manafi B.; Sahebi M.
Institution
(Shirdel) Student Research Committee, Department of Operating Room,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Behzad) Department of Operating Room, School of Paramedicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Manafi) Department of Heart Surgery, School of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Sahebi) Farshchian Hospital, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
PURPOSE: Patients after coronary artery bypass grafting (CABG) require
special care at home, and not being aware of this need before surgery can
result in anxiety. This study aimed to determine the effect of home care
training on the level of anxiety and vital signs in CABG patients. DESIGN:
The study was a randomized clinical trial study. METHOD(S): The study
included 80 patients undergoing CABG surgery in January 2020. Samples were
selected by convenience sampling and were randomly divided into
intervention and control groups. The control group received only routine
training, whereas the intervention group received two additional training
sessions on home care. Data were collected using the Spielberger
situational anxiety questionnaire and a checklist of vital signs, and then
analyzed using descriptive and inferential statistics. FINDINGS: Results
showed that before the intervention, the mean anxiety scores, heart rate,
respiratory rate, temperature, and systolic and diastolic blood pressure
between the two groups were not significantly different (P > .05).
However, after the intervention, the mean anxiety score, heart rate,
respiratory rate, and systolic and diastolic blood pressure in the
intervention group was significantly (P < .05) lower than the control
group, but the mean temperature of the two groups showed no significant
difference (P > .05). CONCLUSION(S): Home care training before
surgery reduces anxiety and improves vital signs. The use of home care
training before surgery is recommended for this patient
population. Copyright © 2020 American Society of PeriAnesthesia
Nurses. Published by Elsevier Inc. All rights reserved.

<5>
Accession Number
635967427
Title
Assessment of the cardiovascular system in horses with naturally acquired
ischaemic intestinal disease.
Source
Equine Veterinary Education. Conference: 13th International Equine Colic
Research Symposium. Birmingham United Kingdom. 33(SUPPL 12) (pp 16), 2021.
Date of Publication: September 2021.
Author
Beasley E.; Giguere S.; Barton N.H.
Institution
(Beasley, Giguere, Barton) The Department of Large Animal Medicine,
College of Veterinary Medicine, University of Georgia, Athens, GA, United
States
Publisher
Equine Veterinary Journal Ltd
Abstract
Objectives: To compare indices of cardiovascular system status between
horses with acute surgical colic and those undergoing elective surgical
procedures at admission, and at Days 1 and 2 post-operatively.
 Method(s): Adult horses presented to a Veterinary Teaching Hospital
for acute gastrointestinal (GI) disease requiring exploratory laparotomy
(n = 62) or for elective surgical procedures (control, n = 12) were
included in this prospective clinical study. Horses were categorized by
surgical lesion, presence or absence of hypotension under anaesthesia, and
survival to discharge. A complete blood count, blood lactate,
electrolytes, and serum cardiac troponin I (cTnI) concentrations were
measured at admission and at Day 1 and 2 post-operatively. The
cardiovascular status was assessed post-operatively by telemetric
electrocardiography for determination of rate, rhythm and heart rate
variability (HRV), and by 2-D and M-mode echocardiography. Result(s):
Horses with ischaemic GI disease had significantly higher cTnI and lactate
concentrations, higher heart rate, lower HRV, greater left ventricular
relative wall thickness (RWT), were more frequently hypotensive under
anesthesia, and had 10 times more ectopic beats per 24 h than horses with
non-ischemic lesions or controls. The presence of a pathologic arrhythmia
was best explained in a multivariable logistic regression (MLR) model by
peak cTnI and by decreased ionized magnesium concentrations. In the MLR
model for survival, nonsurvival was best explained by RWT >0.68 and low
frequency heart rate variability over 30 minutes of >63 nu within the
first 48 h post-operatively. Conclusions and clinical relevance: Horses
with ischemic GI lesions and nonsurvivors are more likely to have evidence
of cardiovascular system dysfunction.

<6>
Accession Number
635967956
Title
Phase 3 open-label study of maribavir for refractory/resistant
cytomegalovirus infection in transplant recipients: subgroup analyses by
organ type.
Source
Transplant International. Conference: 20th Biennial European Society for
Organ Transplantation Congress, ESOT 2021. Milan Italy. 34(SUPPL 1) (pp
46), 2021. Date of Publication: August 2021.
Author
Kamar N.; Avery R.K.; Blumberg E.A.; Florescu D.; Kumar D.; Wu J.;
Sundberg A.
Institution
(Kamar) Hopital De Rangueil, Toulouse, France
(Avery) Johns Hopkins Hospital, Baltimore, United States
(Blumberg) University of Pennsylvania, Philadelphia, United States
(Florescu) University of Nebraska Medical Center, Omaha, United States
(Kumar) University Health Network, Toronto, Canada
(Wu, Sundberg) Shire Human Genetic Therapies,Inc.,a Takeda company,
Lexington, United States
Publisher
Blackwell Publishing Ltd
Abstract
Background: Treatments (Tmt) for refractory with/without resistance (R/R)
cytomegalovirus (CMV) infections are limited. We report subgroup analyses
by SOT type from a multicenter randomized trial that assessed the efficacy
of maribavir (MBV) vs investigator-assigned therapy (IAT) in pts with R/R
CMV infection. Method(s): Transplant recipients (>=12 yrs) with CMV
infection (viral load [VL] >=2730 IU/ml/>=910 IU/ml CMV DNA
[blood/plasma]) refractory to recent Tmt (failure to achieve > 1 log10
decrease in CMV DNA after >=14 days) were eligible (NCT02931539).
Stratified (HCT/SOT + screening CMV VL) pts were randomized 2:1 to MBV 400
mg BID or IAT (val/ganciclovir, foscarnet, cidofovir,
foscarnet+val/ganciclovir) for 8 wk Tmt period + 12 wks follow-up. Primary
endpoint: confirmed CMV clearance (plasma CMV DNA < 137 IU/ml in 2
consecutive tests >=5 days apart) at end of Wk 8. Key secondary endpoint:
CMV clearance and symptom control at end of Wk 8 and maintained through Wk
16. Tmt group differences, adjusted for baseline CMV DNA ( < 9100/>=9100
IU/ml) + SOT/HCT were compared (Cochran-Mantel-Haenszel tests). Subgroup
analyses by SOT type were conducted. Result(s): 352 pts were
randomized (235 MBV, 117 IAT; median age 55 yrs [range 19-79]).
Significantly more pts (MBV vs IAT) achieved the primary (55.7% vs 23.9%;
difference, 95% CI: 32.8%, 22.8-42.7; P < 0.001) and key secondary
endpoint (18.7% vs 10.3%; difference, 95% CI: 9.5%, 2.0- 16.9; P = 0.013).
211 pts (59.9%) were SOT recipients (kidney, 50.2%; lung, 29.4%; heart,
10.9%; liver, 3.3%; pancreas, 0.9%; intestine, 0.5%; multiple, 4.7%). No
SOT pts lost grafts. A benefit trend for MBV vs IAT in kidney, lung, and
heart transplants (subgroups with adequate sample size) was seen (Figure).
Overall population: Tmt-emergent AEs (TEAEs) occurred in 97.4% MBV vs
91.4% IAT pts; 2 Tmt-related serious TEAEs led to death (1 pt/arm). Acute
kidney injury (TEAE) was lower with MBV vs foscarnet (8.5% vs 21.3%) as
was Tmt-related acute kidney injury (1.7% vs 19.1%). Neutropenia (TEAE)
was lower with MBV vs val/ganciclovir (9.4% vs 33.9%) as was Tmt-related
neutropenia (1.7% vs 25.0%). Conclusion(s): MBV had superior efficacy
vs IAT in clearing CMV in transplant recipients with R/R CMV infection,
with consistent trends across organ types. Overall, MBV exhibited lower
rates of Tmt limiting toxicities common with IAT.

<7>
Accession Number
635968516
Title
Case reportand systematic review of iatrogenic leftatrial dissection in
different cardiovascular specialties: A common treatment for an uncommon
complication?.
Source
European Heart Journal, Supplement. Conference: 51st Congress of the
ItalianAssociation of Hospital Cardiologists, ANMCO 2020. Rimini Italy.
22(SUPPL G) (pp G66-G67), 2020. Date of Publication: August 2020.
Author
Cereda A.; Iorio R.; Celano G.; Bongo S.; Cioffi P.; Carosio G.; Sangiorgi
G.; De Luca F.
Institution
(Cereda, Iorio, Celano, Bongo, Cioffi, Carosio, Sangiorgi, De Luca)
Clinica San Gaudenzio, Novara, Italy
Publisher
Oxford University Press
Abstract
Background: Left atrial dissection (LatD) is an exceedingly rare but
potentially fatal complication of cardiac surgical or catheter-based
interventional and electrophysiology procedures. Most cases are iatrogenic
and its incidence is expected to increase. The management of this
complication is controversial and it may depend on related aetiologies. A
case report and literature review are reported herein to delineate the
decision-making process with multimodality imaging techniques and identify
the best strategical approach for management. Case Report: Iatrogenic
percutaneous LatD associated with a giant hematoma of left atrium caused
by wire perforation during PCI treatment for ACS is described. Even if
perforation demanded surgical repair for hemodynamic instability, LatD was
managed conservatively with spontaneous healing of the LatD and hematoma.
Integrated cardiac imaging (Echo, 3D reconstruction, CT and CMR) was
crucial for management decision making of this case. Literature Review:
115 cases of left atrial dissection were reviewed according to aetiologies
and treatment. The most frequent aetiologies were cardiac surgeryrelated
LatD and percutaneous related LatD with an overall mortality of 15,6%.
Treatment and mortality were different according to LatD etiology.
Conservative treatment seems to be preferred in the case of percutaneous
LatD with a trend towards lower mortality. Conclusion(s): A
watchful-waiting strategy supported by multimodality deemed safe and
effective in our case of iatrogenic percutaneous left atrial dissection. A
conservative approach resulted in being the most performed strategy in
literature for percutaneous LatD with favorable outcomes compared to other
aetiologies.

<8>
Accession Number
635967828
Title
Venoarterial ecmo versus impellavr in patients with cardiogenic shock: A
metanalysis.
Source
European Heart Journal, Supplement. Conference: 51st Congress of the
ItalianAssociation of Hospital Cardiologists, ANMCO 2020. Rimini Italy.
22(SUPPL G) (pp G29-G30), 2020. Date of Publication: August 2020.
Author
Lanzillo G.; Fortuni F.; Casula M.; Ferrario Ormezzano M.; Oltrona
Visconti L.; Ferlini M.
Institution
(Lanzillo, Fortuni, Casula, Ferrario Ormezzano, Oltrona Visconti, Ferlini)
STRUTTURA COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN
MATTEO; SCUOLA DI SPECIALIZZAZIONE IN MALATTIE DELL'APPARATO
CARDIOVASCOLARE, UNIVERSITA' DEGLI STUDI DI PAVIA, PAVIA; STRUTTURA
COMPLESSA DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA
Publisher
Oxford University Press
Abstract
Introduction: Cardiogenic shock (CS) incidence remained stable during last
40 years, with an overall mortality of about 50% of the cases. In this
scenario, the correct use of short-term percutaneous mechanical support
systems - i.e., VenoArterial ExtraCorporeal Membrane Oxygenation (VA-ECMO)
and ventricular unloading system ImpellaVR is still not completely
defined; moreover, comparison data between these two systems just derive
from observational, non-randomized trials. The aim of our work was to
perform a systematic review of the literature and subsequent metanalysis
to compare VA-ECMO vs ImpellaVR in patients with CS. Method(s):
Primary endpoint was the overall mortality; secondary endpoints were:
percentage of patients successfully weaned from mechanical support;
percentage of patients in whom the support was used as "bridge" therapy to
ventricular assistance device (VAD) or heart transplant; major vascular
complications rate. A random-effect model was used to estimate odds ratio
(OR) of outcomes of interest. Result(s): Three retrospective studies
were included in our analysis with an overall population of 283 patients,
116 in VA-ECMO group and 167 in ImpellaVR group. Mean age was 5463 years
old, 73% were male patients, 44% underwent intubation. For what concerns
aetiology of CS, 56% of patients had ischemic CS; 91% of patient was
treated with Intra-aortic balloon pump (IABP). In patients with ImpellaVR,
the 5.0/CP model was used in 52% of the cases. Mean duration of mechanical
support was 119664 hours in the VA-ECMO group and 109672 hours in the
ImpellaVR group. At median follow-up time of 12 (IQ range 6.5-30) months
there were not statistically significant differences between the two
groups in terms of mortality for all causes (OR 0.94, IC 0.58-1.53),
successful weaning from support system (OR 0.81, IC 0.49-1.33) and use of
support as bridge therapy to VAD (OR 0.61, IC 0.15-2.4) or heart
transplant (OR 0.40, IC 0.06-2.4). A significant reduction was observed in
terms of major vascular complication in the group treated with ImpellaVR
system (OR 0.28, IC 0.12-0.62). Conclusion(s): In patients with
ischemic CS, "on-top" of treatment with IABP, there were no significant
differences between VA-ECMO and ImpellaVR in terms of mortality, weaning
from support system and use of support as bridge therapy to VAD or heart
transplant, while a statistically significant reduction of vascular
complications was observed in patients treated with ImpellaVR system.

<9>
Accession Number
2014564489
Title
A multicenter study to evaluate the pharmacokinetics and safety of
liposomal bupivacaine for postsurgical analgesia in pediatric patients
aged 6 to less than 17 years (PLAY).
Source
Journal of Clinical Anesthesia. 75 (no pagination), 2021. Article Number:
110503. Date of Publication: December 2021.
Author
Tirotta C.F.; de Armendi A.J.; Horn N.D.; Hammer G.B.; Szczodry M.;
Matuszczak M.; Wang N.Q.; Scranton R.; Ballock R.T.
Institution
(Tirotta) Nicklaus Children's Hospital, Miami, FL, United States
(de Armendi) University of Oklahoma Health Sciences Center, Oklahoma City,
OK, United States
(Horn) Indiana University School of Medicine, Indianapolis, IN, United
States
(Hammer) Stanford University School of Medicine, Stanford, CA, United
States
(Szczodry) Shriners Hospital for Children, Chicago, IL, United States
(Matuszczak) University of Texas, McGovern Medical School, Houston, TX,
United States
(Wang) Pacira BioSciences, Inc., Parsippany, NJ, United States
(Scranton) Lyndra Therapeutics, Watertown, MA, United States
(Ballock) Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Study objective: To evaluate the pharmacokinetics and safety of liposomal
bupivacaine in pediatric patients undergoing spine or cardiac surgery.
 Design(s): Multicenter, open-label, phase 3, randomized trial (PLAY;
NCT03682302). Setting(s): Operating room. Patient(s): Two
separate age groups were evaluated (age group 1: patients 12 to <17 years
undergoing spine surgery; age group 2: patients 6 to <12 years undergoing
spine or cardiac surgery). Intervention(s): Randomized allocation of
liposomal bupivacaine 4 mg/kg or bupivacaine hydrochloride (HCl) 2 mg/kg
via local infiltration at the end of spine surgery (age group 1);
liposomal bupivacaine 4 mg/kg via local infiltration at the end of spine
or cardiac surgery (age group 2). Measurements: The primary and secondary
objectives were to evaluate the pharmacokinetics (eg, maximum plasma
bupivacaine concentrations [C<inf>max</inf>], time to C<inf>max</inf>) and
safety of liposomal bupivacaine, respectively. Main Result(s):
Baseline characteristics were comparable across groups. Mean
C<inf>max</inf> after liposomal bupivacaine administration was lower
versus bupivacaine HCl in age group 1 (357 vs 564 ng/mL); mean
C<inf>max</inf> in age group 2 was 320 and 447 ng/mL for spine and cardiac
surgery, respectively. Median time to C<inf>max</inf> of liposomal
bupivacaine occurred later with cardiac surgery versus spine surgery (22.7
vs 7.4 h). In age group 1, the incidence of adverse events (AEs) was
comparable between liposomal bupivacaine (61% [19/31]) and bupivacaine HCl
(73% [22/30]). In age group 2, 100% (5/5) and 31% (9/29) of patients
undergoing spine and cardiac surgery experienced AEs, respectively. AEs
were generally mild or moderate, with no discontinuations due to AEs or
deaths. Conclusion(s): Plasma bupivacaine levels following local
infiltration with liposomal bupivacaine remained below the toxic threshold
in adults (~2000-4000 ng/mL) across age groups and procedures. AEs were
mild to moderate, supporting the safety of liposomal bupivacaine in
pediatric patients undergoing spine or cardiac surgery. Clinical trial
number and registry URL: ClinicalTrials.gov identifier:
NCT03682302 Copyright © 2021 The Authors

<10>
Accession Number
2013680532
Title
Blood cysts of the cardiac valves in adults: Review and analysis of
published cases.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Bortolotti U.; Vendramin I.; Lechiancole A.; Sponga S.; Pucci A.; Milano
A.D.; Livi U.
Institution
(Bortolotti, Vendramin, Lechiancole, Sponga, Livi) Cardiothoracic
Department, University Hospital of Udine, Udine, Italy
(Pucci) Division of Pathology, Pisa University Hospital, Pisa, Italy
(Milano) Division of Cardiac Surgery, University of Bari Aldo Moro, Bari,
Italy
Publisher
John Wiley and Sons Inc
Abstract
Background and aim: Blood cysts of cardiac valves are generally seen in
newborns and infants and very rarely in adults. Although in most cases
they are incidental findings they may be associated to severe cardiac or
systemic complications. This study analyzes incidence, presentation, and
treatment of valvular blood cysts in adults. Method(s): A review of
the pertinent literature through a search mainly on PubMed and Medline was
performed. Result(s): In patients >=18 years of age, our search
disclosed 54 patients with mitral blood cysts (mean age, 48 +/- 18 years),
9 with a tricuspid valve cyst (mean age, 67 +/- 15 years), 3 with a blood
cyst on the pulmonary valve (age 31, 43, and 44 years), and 1 aortic valve
cyst in a 22-year-old man. Most patients were asymptomatic while stroke,
syncope, or myocardial infarction occurred in six patients with a mitral
valve cyst. Blood cysts were removed surgically in 70% of patients with a
mitral cyst, in 55% with a tricuspid cyst, and in all those with a
pulmonary or aortic cyst. At histology, the cyst wall was composed mainly
by fibrous tissue and with the inner surface lined with typical
endothelium. Conclusion(s): Blood cysts of cardiac valves are rare in
adults but may cause life-threatening complications, particularly when
located on the mitral valve. For such reason, surgical removal appears
advisable, with low-risk procedures. Widespread use of multimodality
imaging techniques will most likely increase the number of valvular blood
cysts diagnosed also in adults. Copyright © 2021 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals LLC.

<11>
Accession Number
2013028543
Title
BRG1 inhibits apoptosis of human aortic dissection smooth muscle cells and
promotes proliferation by regulating the expression of incrna HIF1A-AS 1.
Source
Acta Medica Mediterranea. 37(3) (pp 1491-1495), 2021. Date of Publication:
2021.
Author
Wang L.
Institution
(Wang) Chengdu First People's Hospital, Chengdu, China
Publisher
A. CARBONE Editore
Abstract
Objective: To analyze the role of Brahma related gene-1 (BRG1) in
inhibiting apoptosis and promoting proliferation of aortic dissection
smooth muscle cells by regulating the expression of long non-coding RNA
hypoxia-inducing factor-1A-antisense chain 2 (IncRNA HIF1A-AS 1).
 Method(s): The study group was randomly selected from 20 cases of
aortic dissection in thoracic surgery. Twenty normal healthy donors were
selected as a control group. The expression level of BRG1 in the two
groups was measured by real-time fluorescence quantitative PCR and protein
imprinting. The human primary aortic smooth muscle cells were HAoSMC
cultured, and the BRG1 low expression group and the control group were
obtained by lentivirus infection. Real-time quantitative PCR method was
used to determine the expression level of IncRNA HIF1A-AS 1 for each
group. HAoSMC cells were transfected with an empty plasmid or an HIF1A-AS
1 interference plasmid to obtain an HIF1A-AS 1 interference control group
and an HIF1A-AS 1 interference group. Real-time quantitative PCR was used
to determine the expression level of IncRNA HIF1A-AS 1 in each group. The
expression levels of apoptosis-related proteins were determined by western
blotting and real-time fluorescence quantitative PCR caspase3. Bcl-2 two
groups. Changes in cell proliferation were determined with the CCK-8
method. Result(s): Compared with the control group, the expression
level of BRG1 in the middle aortic tissues of the experimental group was
significantly increased (P<0.01). Compared with the BRG1 control group,
the expression level of IncRNA HIF1A-AS 1 in the BRG1 low-expression group
was significantly reduced (P<0.01). Compared with the HIF1A-AS 1
interference control group, the expression levels of IncRNA HIF1A-AS 1 and
caspase-3 in the HIF1A-AS 1 interference group were significantly reduced,
and the expression levels of Bcl-2 were significantly increased (P<0.01).
Compared with the HIF1A-AS 1 interference control group, the expression
level of caspase-3 in the HIF1A-AS 1 interference group was significantly
reduced, and the expression level of Bcl-2 was significantly increased
(P<0.01). Conclusion(s): Low expression of BRG1 can significantly
inhibit the expression of IncRNA HIF1A-AS 1, thereby inhibiting the
apoptosis of human aortic dissection smooth muscle cells and promoting
cell proliferation. Copyright © 2021 A. CARBONE Editore. All
rights reserved.

<12>
Accession Number
2007118991
Title
Role of perioperative rosuvastatin in preventing post-operative cardiac
complications after non-cardiac surgery in patients with moderate to high
cardiac risk.
Source
World Heart Journal. 12(3) (pp 269-280), 2020. Date of Publication: 2020.
Author
Mathew S.R.; Mohanan S.; Shamsu A.; Chacko M.P.; Unnikrishnan M.K.; Anil
Babu A.; Sareena A.
Institution
(Mathew) Qatar
(Mohanan) Consultant Interventional Cardiologist, KMCT Medical College,
Department of Cardiology, Kozhikode, Kerala, India
(Shamsu, Chacko, Unnikrishnan, Sareena) National College of Pharmacy,
Department of Pharmacy Practice, Kozhikode, Kerala, India
(Anil Babu) Westfort College of Pharmacy, Department of Pharmacy Practice,
Thrissur, Kerala, India
Publisher
Nova Science Publishers, Inc.
Abstract
Objective: To assess the cardioprotective effect of high dose,
perioperative rosuvastatin therapy in moderate to high cardiac-risk
patients undergoing non-cardiac surgery (NCS). Method(s): The
following was a randomized, prospective interventional study of patients
with moderate to high cardiac risk identified by revised cardiac risk
index (RCRI) and Gupta's criteria during a routine NCS fitness test in the
cardiology department. Patients were randomized into a treatment arm (N =
38), receiving 20mg perioperative rosuvastatin, and control (N = 39)
receiving standard care. The primary outcome was the identification of
elevation of Troponin I (trop I) and creatine kinase-muscle/brain (CK-MB)
levels at 24-hour post-surgery. The secondary outcome included follow-up
at 30 days for cardiac morbidity and mortality in patients.
 Result(s): Among 100 enrolled, 77 patients (54.5% female) completed
the study. Postoperative trop I and CK-MB levels were found to be
significantly lower in the treatment arm (trop I: p < 0.001; CK-MB: p <
0.001) in comparison to the control. The treatment arm had less (13%)
30-day cardiac complications in comparison to control (33.3%). The matched
population (N = 44) also had less cardiac morbidities in the treatment
group (13.64%) than in control (45.5%). The prominent 30-day cardiac
complication was identified as acute coronary syndrome.
 Conclusion(s): Perioperative rosuvastatin therapy provided
significant cardioprotective effect in moderate to high cardiac risk
patients undergoing NCS. The intervention group had decreased elevation of
trop I and CK-MB levels post-surgery and reduced 30-day cardiac morbidity
and mortality. Large randomized trials are required for further assessment
of perioperative rosuvastatin therapy in NCS. Copyright © Nova
Science Publishers, Inc.

<13>
Accession Number
2014136331
Title
Direct oral anticoagulants versus vitamin K antagonists in patients with
atrial fibrillation and bioprosthetic valves: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Yokoyama Y.; Briasoulis A.; Ueyama H.; Mori M.; Iwagami M.; Misumida N.;
Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, Pa, United States
(Briasoulis) Division of Cardiovascular Diseases, University of Iowa
Hospitals and Clinics, Iowa City, IA, United States
(Ueyama) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Mori) Division of Cardiac Surgery, Yale School of Medicine, New Haven,
Conn, United States
(Iwagami) Department of Health Services Research, University of Tsukuba,
Tsukuba, Japan
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, Ky, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein Medical College, New York, NY, United States
Publisher
Mosby Inc.
Abstract
Background: The optimal anticoagulation strategy for patients with
bioprosthetic valves and atrial fibrillation remains uncertain. We
conducted a meta-analysis using updated evidence comparing direct
anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with
bioprosthetic valves and atrial fibrillation. Method(s): Medline and
Embase were searched through March 2021 to identify randomized controlled
trials (RCTs) and observational studies investigating the outcomes of DOAC
therapy and VKA therapy in patients with bioprosthetic valves and atrial
fibrillation. The outcomes of interest were all-cause death, major
bleeding, and stroke or systemic embolism. Result(s): Our analysis
included 4 RCTs and 6 observational studies enrolling a total of 6405
patients with bioprosthetic valves and atrial fibrillation assigned to a
DOAC group (n = 2142) or a VKA group (n = 4263). Pooled analysis
demonstrated the similar rates of all-cause death (hazard ratio [HR],
0.90; 95% confidence interval [CI], 0.77-1.05; P = .18; I2 =
0%) in the DOAC and VKA groups. However, the rate of major bleeding was
significantly lower in the DOAC group (HR, 0.66; 95% CI, 0.48-0.89; P =
.006; I2 = 0%), whereas the rate of stroke or systemic embolism
was similar in the 2 groups (HR, 0.72; 95% CI, 0.44-1.17; P = .18;
I2 = 39%). Conclusion(s): DOAC might decrease the risk of
major bleeding without increasing the risk of stroke or systemic embolism
or all-cause death compared with VKA in patients with bioprosthetic valves
and atrial fibrillation. Copyright © 2021 The American
Association for Thoracic Surgery

<14>
[Use Link to view the full text]
Accession Number
632692819
Title
Perioperative ADministration of Dexamethasone And blood Glucose
concentrations in patients undergoing elective non-cardiac surgery - the
randomised controlled PADDAG trial.
Source
European journal of anaesthesiology. 38(9) (pp 932-942), 2021. Date of
Publication: 01 Sep 2021.
Author
Corcoran T.B.; O'Loughlin E.; Chan M.T.V.; Ho K.M.
Institution
(Corcoran) From the Department of Anaesthesia and Pain Medicine, Royal
Perth Hospital (TBC), School of Medicine and Pharmacology, University of
Western Australia, Perth, Western Australia (TBC, EOL), Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne,
Victoria (TBC), Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Perth, Western Australia, Australia (EOL), Department of
Anaesthesia and Intensive Care, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong Special Administrative Region, China
(MAC), Department of Intensive Care Medicine, Royal Perth Hospital (KMH),
Medical School, University of Western Australia (KMH) and School of
Veterinary & Life Sciences, Murdoch University, Perth, Western Australia,
Australia (KMH)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The hyperglycaemic effect of dexamethasone in diabetic and
nondiabetic patients in the peri-operative period is unknown.
 OBJECTIVE(S): To assess the effect of a single dose of
intra-operative dexamethasone on peri-operative blood glucose. DESIGN:
Multicentre, stratified, randomised trial. SETTING: University hospitals
in Australia and Hong Kong. PATIENTS: A total of 302 adults scheduled for
elective, noncardiac and nonobstetric surgical procedures under general
anaesthesia, stratified by diabetes mellitus status, were randomised to
receive placebo, 4 or 8 mg dexamethasone administered intravenously after
induction of anaesthesia. MAIN OUTCOME MEASURES: Maximum blood glucose
within 24 h of surgery, and the interaction between glycated haemoglobin
(HbA1c) and dexamethasone were the primary and secondary outcomes.
 RESULT(S): The median [IQR] baseline blood glucose in the nondiabetes
stratum in the placebo (n=81), 4 mg (n=81) and 8 mg dexamethasone (n=77)
trial arms were respectively 5.3 [4.6 to 5.8], 5.0 [4.7 to 5.4] and 5.0
[4.2 to 5.9] mmol l-1. In the diabetes stratum these values were 6.6 [6.0
to 8.3]; (n=22), 6.1 [5.5 to 10.4]; (n=22) and 6.7 [5.6 to 8.3]; (n=19)
mmol l-1. The median [IQR] maximum peri-operative blood glucose values in
the nondiabetes stratum were 6.0 [5.3 to 6.8], 6.3 [5.5 to 7.3] and 6.3
[5.8 to 7.4] mmol l-1 in the control, dexamethasone 4 mg and dexamethasone
8 mg arms, respectively. In the diabetes stratum these values were 10.3
[8.1 to 12.4], 12.6 [10.3 to 18.3] and 13.6 [11.2 to 20.1] mmol l-1. There
was a significant interaction between pre-operative HbA1c value and 8 mg
dexamethasone: every 1% increment in HbA1c produced a 4.0 mmol l-1
elevation in maximal peri-operative glucose concentration.
 CONCLUSION(S): Dexamethasone 4 mg or 8 mg did not induce greater
hyperglycaemia compared with placebo for nondiabetic and well controlled
diabetic patients. Maximal peri-operative blood glucose concentrations in
patients with diabetes were related to baseline HbA1c values in a
concentration-dependent fashion after 8 mg of dexamethasone. TRIAL
REGISTRATION: Australia and New Zealand Clinical Trials Registry
(ACTRN12614001145695): URL:
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367272.Copyright © 2020 European Society of Anaesthesiology and Intensive
Care. Unauthorized reproduction of this article is prohibited.

<15>
Accession Number
635530479
Title
Effect of an Educational Support Programme on Caregiver Burden Among the
Family Members of Patients Undergoing Coronary Artery Bypass Graft
Surgery.
Source
Sultan Qaboos University medical journal. 21(2) (pp e266-e274), 2021. Date
of Publication: 01 May 2021.
Author
Dalirirad H.; Najafi T.; Seyedfatemi N.
Institution
(Dalirirad, Najafi, Seyedfatemi) Department of Emergency & Critical Care
Nursing, School of Nursing & Midwifery, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
Objectives: The family caregivers of patients undergoing coronary artery
bypass graft (CABG) surgery experience considerable physical and emotional
distress. This study aimed to investigate the effect of an educational
support programme on caregiver burden among the family caregivers of
patients undergoing CABG surgery in Iran. Method(s): This
non-randomised controlled clinical trial was conducted from January to
April 2017 at a cardiovascular centre in Tehran, Iran. A total of 80
family caregivers of patients undergoing CABG surgery were sequentially
selected and non-randomly assigned to intervention and control groups. The
control group received routine care, whereas the intervention group
received additional education sessions at baseline, prior to surgery, the
day after surgery and before discharge. Caregiver burden was compared at
baseline and six weeks post-discharge using the Persian-language versions
of the Caregiver Burden Inventory (CBI) and Katz Index of Independence in
Activities of Daily Living (IADL). Result(s): A significant
difference was observed between family caregivers in the control and
intervention groups with regards to pre-post differences in mean CBI
scores (+1.67 +/- 19.23 versus +17.45 +/- 9.83; P <0.001), with an effect
size of -1.14. In addition, there was a significant increase in mean
post-discharge IADL scores among CABG patients in the intervention group
compared to the control group (4.42 +/- 1.05 versus 3.07 +/- 1.09; P
<0.001). Conclusion(s): An educational support programme
significantly reduced caregiver burden among the family members of
patients undergoing CABG surgery in Iran. As such, in addition to routine
care, healthcare providers should provide educational support to this
population to help mitigate caregiver burden. © Copyright 2021,
Sultan Qaboos University Medical Journal, All Rights Reserved.

<16>
[Use Link to view the full text]
Accession Number
635004678
Title
Does a balanced colloid decrease perioperative blood loss in paediatric
cardiac surgery: A double-blinded randomized controlled trial?.
Source
European journal of anaesthesiology. 38(9) (pp 923-931), 2021. Date of
Publication: 01 Sep 2021.
Author
Willems A.; De Groote F.; Schmartz D.; Fils J.-F.; Van der Linden P.
Institution
(Willems) From the Paediatric Intensive Care Unit, Department of Intensive
Care, Leiden University Medical Centre, Leiden, The Netherlands (AW),
Department of Anaesthesiology, University Hospital Brugmann and Queen
Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS,
P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Unbalanced fluid solutions cause metabolic acidosis and could
be associated with impaired coagulation and increased blood loss.
 OBJECTIVE(S): To investigate whether the use of a balanced colloid
compared with a saline colloid for peri-operative fluid therapy in
children undergoing cardiac surgery is associated with decreased blood
loss and exposure to blood products. DESIGN: Double-blinded randomised
controlled trial. SETTING: Tertiary children's hospital from 2013 to 2016.
PATIENTS: Children older than 29 days and younger than 3 years admitted
for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria
were emergency cardiac surgery, moribund (American Society of
Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure,
liver injury, intracranial haemorrhage and electrolyte disturbances. From
the 128 patients eligible, 88 were included in the study. INTERVENTION:
Random assignment of patients to either a saline colloid (6% hydroxyethyl
starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6%
hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and
intra- and postoperative fluid therapy during the first postoperative 48
h. MAIN OUTCOME MEASURE: The primary outcome measure was calculated blood
loss until the third postoperative day (POD3). RESULT(S): A total of
44 patients were included in each study arm. Calculated blood loss at POD3
was not significantly different between the groups (saline colloid 19.9
[IQR 13.8 to 26.1] ml kg-1 versus balanced colloid 15.9 [IQR 9.0 to 25.3
ml kg-1], P = 0.409). Secondary outcomes related to bleeding, exposure to
blood products and coagulation were not different between groups. There
was also no difference in length of mechanical ventilation, intensive care
and hospital length of stay between groups. CONCLUSION(S): The use of
a balanced colloid for peri-operative fluid therapy compared with a saline
one is not associated with decreased blood loss or exposure to blood
products. TRIAL REGISTRATION: EudraCT identifier: 2012-006034-17 and
ClinicalTrial.gov identifier: NCT02584868. Copyright © 2021
European Society of Anaesthesiology and Intensive Care. Unauthorized
reproduction of this article is prohibited.

<17>
Accession Number
2008352106
Title
Sex-related differences in early- A nd long-term mortality after
transcatheter and surgical aortic valve replacement: A systematic review
and meta-analysis.
Source
Journal of Invasive Cardiology. 32(8) (pp 295-301), 2020. Date of
Publication: August 2020.
Author
Parikh P.B.; Wang T.-Y.; Sharma N.; Kort S.; Skopicki H.A.; Gruberg L.;
Jeremias A.; Chikwe R.P.J.; Butler J.
Institution
(Parikh, Wang, Sharma, Kort, Skopicki, Gruberg, Jeremias, Butler)
Department of Medicine, Division of Cardiovascular Medicine, State
University of New York at Stony Brook, Stony Brook, NY, United States
(Chikwe) Division of Cardiothoracic Surgery, State University of New York
at Stony Brook, Stony Brook, NY, United States
(Chikwe) Division of Cardiothoracic Surgery, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
Publisher
Cliggott Publishing Co.
Abstract
Background. Observational data suggest that early- A nd long-term outcomes
of transcatheter aortic valve replacement (TAVR) and surgical aortic valve
replacement (SAVR) differ significantly between men and women, but have
demonstrated conflicting results. This study sought to examine early- A nd
long-term mortality with TAVR and SAVR in women versus men. Methods.
Electronic search was performed until February 2018 for studies reporting
sex-specific mortality following TAVR or isolated SAVR. Data were pooled
using random-effects models. Outcomes included rates of early mortality
(in hospital or 30 days) and long term (1 year or longer). Results. With
35 studies, a total of 80,928 patients were included in our systematic
review and meta-analysis, including 40,861 men and 40,067 women. Pooled
analyses suggested considerable sex-related differences in longterm
mortality following TAVR and SAVR. Following SAVR, women had higher
long-term mortality (odds ratio [OR], 1.35; 95% confidence interval [CI],
1.16-1.56; P<.001) and a trend toward higher early mortality (OR, 1.69;
95% CI, 0.97-2.97; P=.07) compared to men. Following TAVR, women had lower
long-term mortality (OR, 0.78; 95% CI, 0.71-0.86; P<.001) and no
difference in early mortality (OR, 1.09; 95% CI, 0.96-1.23; P=.17)
compared to men. Conclusions. In this systematic review and meta-analysis,
women had higher long-term mortality and a trend toward higher early
mortality compared to men following SAVR. Following TAVR, women had lower
long-term mortality and no difference in early mortality compared with
men. Copyright © 2020 HMP Communications. All rights reserved.

<18>
Accession Number
635957489
Title
Effect of pericardial carbon dioxide insufflation on neurocognitive
outcome after open heart surgery.
Source
European Heart Journal, Supplement. Conference: 24th Asean Federation
Congress of Cardiology inconjunction with 28th ASMIHA Conference. Jakarta
Indonesia. 21(SUPPL F) (pp F51), 2019. Date of Publication: September
2019.
Author
Po S.; Lwin K.M.; Myo A.Z.
Institution
(Po, Lwin, Myo) Department of Cardiovascular Surgery, University of
Medicine (1), Yangon, Myanmar
Publisher
Oxford University Press
Abstract
Background: Neurocognitive dysfunction after open heart surgery continues
to threaten postoperative quality of life, raise mortality, and increase
length of hospital stay. Many centers in the world are using carbon
dioxide insufflation method to reduce air embolism following open heart
surgery. This prospective comparative study was performed to determine the
effect of pericardial carbon dioxide insufflation on neurocognitive
outcome after open heart surgery. Objective(s): To describe the
various symptoms and signs of neurocognitive dysfunction in open heart
surgery patients with or without CO2 insufflation by the field flooding
technique and to compare the neurocognitive outcomes of open heart surgery
patients undergoing cardiopulmonary bypass with or without CO2
insufflation by the field flooding technique Methods: In this study,
randomly selected patients are differentiated two groups (Group A and
Group B). Group A (n=88) was given carbon dioxide and Group B (n=88) was
not given carbon dioxide. Mini Mental State Examination was performed one
week preoperatively, one week and one month postoperatively.
 Result(s): In this study, the means and standard deviations of scores
of neurocognitive tests of group A at preoperative, one week and one month
after operations were 29.1 (6 1.15), 28.6 (6 1.77) and 29.2 (6 1.35), and
those of group B were 28.7 (6 1.50), 28.4 (6 2.03) and 29.0 (6 1.76)
respectively. The incidence of the neurocognitive dysfunction of the
patients in group A (CO2 used) and group B (non-CO2 used) were 0.05, (95%
CI: 0.01, 0.11) and 0.06 (95% CI: 0.01, 0.11) respectively. The relative
risk between the groups is 0.8 (95% CI: 0.25, 2.55). There was no
statistically significant difference between groups (P=0.14).
 Conclusion(s): In this study, the use of pericardial carbon dioxide
insufflation is ineffective on neurocognitive outcome after open heart
surgery.

<19>
Accession Number
635957835
Title
Transcatheter or surgical pulmonary valve replacement in congenital heart
disease patients with ventricular outflow tract pathology: A meta-analysis
and systematic review.
Source
European Heart Journal, Supplement. Conference: 24th Asean Federation
Congress of Cardiology inconjunction with 28th ASMIHA Conference. Jakarta
Indonesia. 21(SUPPL F) (pp F59), 2019. Date of Publication: September
2019.
Author
Utami I.; Wiliam A.; Prakoso R.
Institution
(Utami, Wiliam, Prakoso) Departemen of Cardiology and Vascular Medicine,
Universitas Indonesia, National Cardiac Centre Harapan Kita, Indonesia
Publisher
Oxford University Press
Abstract
Background: Transcatheter pulmonary valve replacement (TPVR) has been one
of the greatest advances in interventional catheterization over the past
decade. It is increasingly utilized to address right ventricular outflow
tract pathology in congenital heart disease patients as it allows for
intervention before the development of ventricular dysfunction while
decreasing the number of sternotomies required over a lifetime. While this
approach might seem attractive to both patients and physicians, available
literature is still limited due to small patient population, and it does
not reflect massive procedural practice pattern change over the last
decade. Objective(s): To describe the comparative benefits and
pitfalls of TPVR over SPVR for congenital heart disease patients with
right ventricular outflow tract pathology Method: A systematic search was
conducted using MEDLINE, CENTRAL, and EBSCO databases, identifying all
relevant studies with comparative data on TPVR versus SPVR published until
April 2019. The primary outcomes were 30-day mortality and
echocardiographic indicators. We also included secondary outcomes such as
periprocedural complications, reintervention rate, length of stay, and
hospital cost. Qualities of studies were assessed according to The GRADE
tool. Analysis of the results were performed with random effect model
(Mantel-Hanszel method) using RevMan to calculate the mean difference or
pooled risk ratio (RR). Result(s): In 7 retrospective cohorts, 648
patients underwent TPVR and 1494 patients underwent SPVR. We found no
difference in mortality (pooled RR 0.78, CI 0.19 - 3.16 ), or pulmonary
valve (PV) reintervention rate (pooled RR 0.57 CI 0.17 - 1.89) between 2
groups. Peak pulmonary valve gradient as indicators of PV function was
3.7mmHg higher (mean difference 0.38 - 7.13 mmHg) in TPVR cohorts. In
terms of periprocedural outcomes, TPVR group has significantly lower
incidence of major haemorrhage (pooled RR 0.24, CI 0.06 - 0.98)
 Conclusion(s): Our study provides favourable updated estimates of
clinical outcomes with marginally higher mean hospital cost after
transcatheter pulmonary valve replacement.

<20>
Accession Number
635957807
Title
Community-based education and exercise program results in improving
quality of life and reduce rehospitalization rate among stable coronary
artery disease patients of Malang cardiovascular care community.
Source
European Heart Journal, Supplement. Conference: 24th Asean Federation
Congress of Cardiology inconjunction with 28th ASMIHA Conference. Jakarta
Indonesia. 21(SUPPL F) (pp F85), 2019. Date of Publication: September
2019.
Author
Karimullah D.H.; Rohman M.S.; Anjarwani S.; Adriyanto T.; Fadlan M.R.;
Sidarta E.P.
Institution
(Karimullah, Rohman, Anjarwani, Adriyanto, Fadlan, Sidarta) Department of
Cardiology and Vascular Medicine, Faculty of Medicine, Universitas
Brawijaya-Dr. Saiful Anwar General Hospital, Malang East Java, Indonesia
Publisher
Oxford University Press
Abstract
Background: Previous studies suggested that community-based cardiac
rehabilitation program improve Health Related Quality of Life (HRQOL)
among CAD patients. However, whether this program more effective performed
in a certain cardiac-interested group rather than in wide general
population remained uncertain. Objective(s): This study compared the
efficacy of community-based rehabilitation (education and exercise
program) between member or not member of Malang Cardiovascular Care
Community (MC3) in improving HRQOL, rehospitalization rate among CAD
patients undergoing Primary Coronary Intervention (PCI) or Coronary Artery
Bypass Graft (CABG) with optimal medical therapy Methods: This cohort
study conducted to stable CAD patients with optimal medical treatment and
outpatient-based education. They also have undergone either PCI or CABG as
indicated by ESC guideline. The CAD patients were randomly assigned to
Control Group, not member of Malang Cardiovascular Care Community (CG=78)
or Intervention Group, member of Malang Cardiovascular Care Community
(IG=70). IG received exercise program three times a week (396
METs/min/week) for 6 months. We used population-wide intervention focused
on group discussion, posters, leaflets and handouts for IG. Patients with
poor medical compliance and inadequate treatment were excluded. All
participants were individually interviewed with a structured questionnaire
for collecting baseline characteristics. Quality of life (sf 36 and SAQ),
Diet (DASH diet), Physical activity (IPAQ), and Outcome (MACE and POCE)
were assessed by the individual level at the baseline and 6-month
post-intervention. Body mass index (BMI), waist to hip, and
echocardiography were measured according to standard protocol.
 Result(s): A significant better quality of life observed in CAD
patient who are the member of Malang Cardiovascular Care Community (IG) in
term of HRQOL (SAQ score 94.80+/-6.98 vs 84.54+/-14,8, p<0.000), physical
functioning (SF 36 score 90.22+/-9.79 vs 82.11+/-17,49, p<0.001). The salt
diet also more strictly taken by IG as shown by DASH score (32.58+/-2.85
vs 29.98+/-1.90, p<0.000, respectively). However, both groups consumed
higher than a standard total salt diet should be taken. The physical
activity level (IPAQ score) also showed higher IG than CG (44.3% vs 23.1%,
p<0.000) suggesting the CAD patients of IG more active than those of CG.
The rehospitalization rate was lower in IG compare to CG (2.9% vs 20.5%,
p<0.000). Conclusion(s): This study has shown that improving quality
of life and reducing rehospitalization more effectively achieved when
education and routinely exercise given in a certain cardiac
interested-group such as Malang cardiovascular care community.

<21>
Accession Number
2014488561
Title
In patients with multi-vessel coronary artery diseases, does hybrid
revascularization provide similar outcomes to conventional coronary artery
bypass grafting?.
Source
Interactive Cardiovascular and Thoracic Surgery. 33(3) (pp 367-371), 2021.
Date of Publication: 01 Sep 2021.
Author
Maskell P.; Graham C.; Roberts L.; Harky A.
Institution
(Maskell) Department of Surgery, Cambridge University NHS Foundation
Trust, Cambridge, United Kingdom
(Graham, Roberts) School of Clinical Medicine, University of Cambridge,
Cambridge, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: In [patients with
multivessel coronary artery diseases (CAD)] is [hybrid revascularization
(HCR)] equal to [coronary artery bypass grafting (CABG)] in regard to
[mortality, myocardial infarction, stroke and target vessel
revascularization (TVR)]? Three-hundred and fifty-five papers were found
using the reported search, of which 8 represented the best evidence to
answer the question. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. The studies included 4
observational studies, 3 randomized controlled trials (RCTs) and 1
meta-Analysis. The meta-Analysis consisted of predominantly observational
data with 1 randomized controlled trial and suggested non-significant
differences in all major clinical outcomes. The observational studies
generally cited benefit towards hybrid revascularization on the basis of
equivalent major clinical outcomes rates compared to coronary artery
bypass grafting, yet favourable in-hospital outcomes. One randomized
controlled trial provided robust evidence of equivalent 5-year outcomes;
however, the others were insufficiently powered for an effective
comparison. There is a paucity of robustly designed studies to answer our
clinical question effectively, given hybrid procedures are not routine in
clinical practice. On the basis of mostly observational and small
randomized cohorts with relatively short follow-up intervals, we conclude
that current evidence suggests similar mid-Term rates of major clinical
outcomes after hybrid revascularization and coronary artery bypass
grafting. However, without longer-Term follow-up, the comparison of the
two techniques, particularly relating to repeat revascularization, is
still very much uncertain. Copyright © 2021 Oxford University
Press. All rights reserved.

<22>
Accession Number
2014488560
Title
In patients undergoing coronary artery bypass grafting is
semi-skeletonization superior to pedicled harvesting of the left internal
mammary artery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 33(3) (pp 362-366), 2021.
Date of Publication: 01 Sep 2021.
Author
Maskell P.; Berks M.; Vibhishanan J.; Harky A.
Institution
(Maskell) Department of Surgery, Cambridge University NHS Foundation
Trust, Cambridge, United Kingdom
(Berks, Vibhishanan) School of Clinical Medicine, University of Cambridge,
Cambridge, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Liverpool Centre of Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, in patients undergoing
coronary artery bypass grafting is semi-skeletonized harvesting superior
to pedicled harvesting of the left internal mammary artery (LIMA) in terms
of conduit length, flow, rate of sternal wound infections and
post-operative bleeding? . Altogether, 235 papers were found using the
reported search, of which 5 represented the best evidence to answer the
clinical question. Three studies were cohort studies and 2 were randomized
controlled trials. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. One randomized controlled trial showed superiority
with semi-skeletonized harvesting in terms of conduit length (P<0.001),
flow (P = 0.004) and diastolic filling (P = 0.005). Three studies included
data on surgical wound infections/mediastinitis, all of which reported n =
0. One randomized controlled trial and 3 cohort studies reported that
semi-skeletonized harvesting reduced postoperative bleeding. No studies
reported a statistically significant difference in operative time. This
review suggests that semi-skeletonized harvesting could possibly be
associated with favourable outcomes when compared to pedicled harvesting
with respect to graft length and flow, and lower postoperative bleeding,
without increasing operative time; although there is insufficient data to
compare sternal wound infections or long-Term outcomes. In conclusion, the
limited evidence base prevents robust informed decision-making when
comparing both techniques. Copyright © 2021 Oxford University
Press. All rights reserved.

<23>
Accession Number
2013646655
Title
The acurate neoTM and neo2TM valve systems.
Source
Heart International. 15(1) (pp 37-41), 2021. Date of Publication: 2021.
Author
Reardon M.J.
Institution
(Reardon) Department of Cardiovascular Surgery, Houston Methodist DeBakey
Heart and Vascular Center, Houston, TX, United States
Publisher
Touch Medical Media
Abstract
Based on the strength of data from randomized trials and real-world
clinical studies, transcatheter aortic valve replacement (TAVR) has become
a popular and effective alternative to surgical valve replacement in
patients with symptomatic aortic stenosis. The ACURATE neoTM (Boston
Scientific, Marlborough, MA, USA) valve system has been commercially
available for transfemoral TAVR in Europe since 2014. ACURATE neo2TM is an
evolution of the neo design and was declared CE marked by the manufacturer
in 2020. The neo and neo2 valves have been studied in high-risk patients,
and the currently active randomized trial for neo2 will include over 1,500
patients of all risk categories in the USA. The goal of this review is to
help inform the TAVR community about the ACURATE valve. Copyright
© 2021, Touch Medical Media. All rights reserved.

<24>
Accession Number
635961524
Title
Retrograde autologous priming in cardiac surgery: a systematic review and
meta-analysis.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 21 Aug 2021.
Author
Gupta S.; McEwen C.; Basha A.; Panchal P.; Eqbal A.; Wu N.; Belley-Cote
E.P.; Whitlock R.
Institution
(Gupta, Eqbal, Whitlock) Department of Surgery, Division of Cardiac
Surgery, McMaster University, ON, Hamilton, Canada
(Gupta, Whitlock) Department of Health Research Methods, McMaster
University, ON, Hamilton, Canada
(McEwen, Panchal, Wu) Faculty of Health Sciences, McMaster University, ON,
Hamilton, Canada
(Basha) Libin Cardiovascular Institute of Alberta, University of Calgary,
AB, Calgary, Canada
(Belley-Cote, Whitlock) Population Health Research Institute, ON,
Hamilton, Canada
(Belley-Cote) Department of Medicine, McMaster University, ON, Hamilton,
Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Guidelines recommend retrograde autologous priming (RAP) of
the cardiopulmonary bypass circuit. However, the efficacy and safety of
RAP is not well-established. We performed a systematic review and
meta-analysis to determine the effects of RAP on transfusion requirements,
morbidity and mortality. METHOD(S): We searched Cochrane Central
Register of Controlled Trials, Medline, ScienceDirect, Cumulative Index to
Nursing and Allied Health Literature and Embase for randomized controlled
trials (RCTs) and observational studies comparing RAP to no-RAP. We
performed title and abstract review, full-text screening, data extraction
and risk of bias assessment independently and in duplicate. We pooled data
using a random effects model. RESULT(S): Twelve RCTs (n=1206) and 17
observational studies (n=3565) were included. Fewer patients required
blood transfusions with RAP [RCTs; risk ratio 0.58 [95% confidence
interval (CI): 0.51, 0.65], P<0.001, and observational studies; risk ratio
0.65 [95% CI: 0.53, 0.80], P<0.001]. The number of units transfused per
patient was also lower among patients who underwent RAP (RCTs; mean
difference -0.38 unit [95% CI: -0.72, -0.04], P=0.03, and observational
studies; mean difference -1.03 unit [95% CI: -1.76, -0.29], P<0.006).
 CONCLUSION(S): This meta-analysis supports the use of RAP as a blood
conservation strategy since its use during cardiopulmonary bypass appears
to reduce transfusion requirements. Copyright © The Author(s)
2021. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
2012996323
Title
Percutaneous versus Surgical Intervention for Severe Aortic Valve
Stenosis: A Systematic Review.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
3973924. Date of Publication: 2021.
Author
Iervolino A.; Singh S.S.A.; Nappi P.; Bellomo F.; Nappi F.
Institution
(Iervolino) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCSS, Italy
(Singh) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Nappi, Bellomo) Department of Clinical and Experimental Medicine,
University of Messina, Italy
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
Publisher
Hindawi Limited
Abstract
Aortic stenosis is a disease that is increasing in prevalence and
manifests as decreased cardiac output, which if left untreated can result
in heart failure and ultimately death. It is primarily a disease of the
elderly who often have multiple comorbidities. The advent of transcatheter
aortic valve therapies has changed the way we treat these conditions.
However, long-term results of these therapies remain uncertain. Recently,
there has been an increasing number of studies examining the role of both
surgical aortic valve replacement and transcatheter aortic valve
replacement. We therefore performed a systematic review using Ovid
MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched
papers published between January 1, 2007, and to date using the following
terms: "aortic valve stenosis,""aortic valve operation,"and "transcatheter
aortic valve therapy."Both strategies in aortic stenosis treatment
highlighted specific indications alongside the pitfalls such as structural
valve degeneration and valve thrombosis which have a bearing on clinical
outcomes. We propose some recommendations to help clinicians in the
decision-making process as technological improvements make both surgical
and transcatheter therapies viable options for patients with aortic
stenosis. Finally, we assess the role of finite element analysis in
patient selection for aortic valve replacement. THVT and AVR-S are both
useful tools in the armamentarium against aortic stenosis. The decision
between the two treatment strategies should be best guided by a strong
robust evidence base, ideally with a long-term follow-up. This is best
performed by the heart team with the patient as the center of the
discussion. Copyright © 2021 Adelaide Iervolino et al.

<26>
Accession Number
2011023358
Title
Minimally Invasive Versus Sternotomy for Mitral Surgery in the Elderly: A
Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 16(4) (pp 310-316), 2021. Date of Publication: July 2021.
Author
Hage A.; Hage F.; Al-Amodi H.; Gupta S.; Papatheodorou S.I.; Hawkins R.;
Ailawadi G.; Mittleman M.A.; Chu M.W.A.
Institution
(Hage, Hage, Al-Amodi, Chu) Western University, London, ON, Canada
(Hage, Hage, Gupta, Papatheodorou, Mittleman) Department of Epidemiology,
Harvard T.H. Chan School of Public Health, Boston, MA, United States
(Hawkins, Ailawadi) University of Virginia, Charlottesville, VA, United
States
Publisher
SAGE Publications Ltd
Abstract
Objective: The safety of minimally invasive mitral valve surgery (MIMVS)
in elderly patients is still debated. Our objective was to perform a
systematic review and meta-analysis of studies comparing MIMVS with
conventional sternotomy (CS) in elderly patients (>=65 years old).
 Method(s): We searched PubMed, EMBASE, Web of Science,
clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for
trials and observational studies comparing MIMVS with CS in patients >=65
years old presenting for mitral valve surgery. We performed a
random-effects meta-analysis of all outcomes. Result(s): The MIMVS
group had lower odds of acute renal failure (odds ratio [OR] 0.27; 95% CI
0.10 to 0.78), prolonged intubation (>48 h; OR 0.47; 95% CI 0.31 to 0.70),
less blood product transfusion (weighted mean difference [WMD] -0.82
units; 95% CI -1.29 to -0.34 units), shorter ICU length of stay (LOS; WMD
-2.57 days; 95% CI -3.24 to -1.90 days) and hospital LOS (WMD -4.06 days;
95% CI -5.19 to -2.94 days). There were no significant differences in the
odds of mortality, stroke, respiratory infection, reoperation for
bleeding, and postoperative atrial fibrillation. MIMVS was associated with
longer cross-clamp (WMD 11.8 min; 95% CI 3.5 to 20.1 min) and
cardiopulmonary bypass times (WMD 23.0 min; 95% CI 10.4 to 35.6 min).
 Conclusion(s): MIMVS in elderly patients is associated with lower
postoperative complications, blood transfusion, shorter ICU, and hospital
LOS, and longer cross-clamp and bypass times. Copyright © The
Author(s) 2021.

<27>
Accession Number
2010323581
Title
An aetiology-based subanalysis of the Telerehabilitation in Heart Failure
Patients (TELEREH-HF) trial.
Source
ESC Heart Failure. 8(2) (pp 1263-1273), 2021. Date of Publication: April
2021.
Author
Szalewska D.; Glowczynska R.; Piotrowicz R.; Kowalik I.; Pencina M.J.;
Opolski G.; Zareba W.; Banach M.; Orzechowski P.; Pluta S.; Irzmanski R.;
Kalarus Z.; Piotrowicz E.
Institution
(Szalewska) Chair and Clinic of Rehabilitation Medicine, Faculty of Health
Sciences, Medical University of Gdansk, Gdansk, Poland
(Glowczynska, Opolski) 1st Chair and Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland
(Piotrowicz) Department of Coronary Disease and Rehabilitation, National
Institute of Cardiology, Academy of Medical Rehabilitation, Warsaw, Poland
(Kowalik) National Institute of Cardiology, Warsaw, Poland
(Pencina) Duke University School of Medicine, Durham, NC, United States
(Zareba) University of Rochester Medical Center, Rochester, NY, United
States
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland
(Orzechowski, Piotrowicz) Telecardiology Center, National Institute of
Cardiology, Warsaw, Poland
(Pluta) Silesian Center for Heart Diseases, Zabrze, Poland
(Irzmanski) Department of Internal Medicine and Cardiac Rehabilitation,
Medical University of Lodz, Lodz, Poland
(Kalarus) Department of Cardiology, DMS in Zabrze, Medical University of
Silesia, Katowice, Poland
Publisher
John Wiley and Sons Inc
Abstract
Aims: The aim of our study was to analyse the benefits of a 9 week hybrid
comprehensive telerehabilitation (HCTR) programme in heart failure (HF)
patients according to aetiology, as a subanalysis of the
Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial.
 Methods and Results: Overall, 555 (65.3%) patients with ischaemic
(IS) and 295 (34.7%) patients with non-ischaemic (NIS) HF aetiology were
randomized. There were no differences between the effect of HCTR and usual
care (UC) on the primary outcome of number of days alive and out of the
hospital in 26 months from the time of randomization in either aetiology
(Wilcoxon-Mann-Whitney test), and no heterogeneity of effect between the
aetiologies was noted (van Elteren test, P = 0.746). In Cox proportional
hazards regression analysis, treatment was not independently associated
with the secondary outcomes. For all-cause mortality, the adjusted hazard
ratio for HCTR vs. UC was 0.90 (95% confidence interval, 0.54-1.51) in IS
and 1.42 (95% confidence interval, 0.69-2.94) in NIS (P interaction =
0.316). Differences between HCTR and UC in terms of change in the 6 min
walk test distance and cardiopulmonary exercise test time after 9 weeks
reached statistical significance in the IS arm (P = 0.015 and P < 0.001,
respectively), but not in the NIS arm; however, tests of heterogeneity
indicated no statistically significant differences. Conclusion(s):
The trial showed no difference between HCTR and UC in the primary outcome
of percentage of days alive and out of the hospital for either IS or NIS
aetiology. Moreover, the magnitude of changes in the clinical and
functional statuses of the HF patients did not differ by aetiology. HCTR
might have had beneficial effects on the 6 min walk test distance and
cardiopulmonary exercise test time after 9 weeks in the IS patients;
however, the effect was not statistically significantly different from
that observed in the NIS patients. Copyright © 2021 The Authors.
ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European
Society of Cardiology.

<28>
Accession Number
2011969705
Title
Dexmedetomidine attenuates acute kidney injury in children undergoing
congenital heart surgery with cardiopulmonary bypass by inhibiting the
TLR3/NF-kappaB signaling pathway.
Source
American Journal of Translational Research. 13(4) (pp 2763-2773), 2021.
Date of Publication: 2021.
Author
Xie Y.; Jiang W.; Cao J.; Xie H.
Institution
(Xie, Cao, Xie) Department of Anesthesiology and Critical Care, The Second
Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
(Xie, Jiang) Department of Anesthesiology, Suzhou Hospital Affiliated to
Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu
Province, China
Publisher
E-Century Publishing Corporation
Abstract
Objective: To investigate the effect of dexmedetomidine (DMED) on acute
kidney injury in children undergoing congenital heart surgery (CHS) with
cardiopulmonary bypass (CPB). Method(s): The children undergoing CHS
with CPB were randomized to the control and the DMED groups. The children
in the DMED group were injected with DMED (1 mug/kg) followed by DMED
infusion (0.5 mug/kg/h) until 12 h after operation; the controls received
normal saline. Markers were detected before operation (T0), 30 min after
anesthesia induction (T1), and at 24 h, 48 h, and 72 h after operation
(T2, T3, T4). Result(s): The heart rate and mean arterial pressure in
the DMED group decreased at T1 and differed from controls at T1-T3 (all
P<0.05). No intergroup differences were observed in the central venous
pressure and caspase-3 level (all P>0.05). The DMED group had higher
central venous pressure at T3 than at T0 (P<0.05). At T2-T4, the DMED
group had lower percentages of TLR3+cells than the controls
(all P<0.05). In the DMED group, the percentagesof TLR3+cells
decreased with time; whereas in the control group, the percentage
increased with time (all P<0.05). Compared with the controls, the DMED
group had lower levels of NF-kappaB and TLR3 at T2-T4, lower levels of
sCr, IL-1beta, and TNF-a at T3-T4, and lower incidence of AKI at T3 (all
P=0.01). Conclusion(s): DMED can reduce the risk of AKI in children
undergoing CHS with CPB, which may be because DMED can inhibit
TLR3/NF-kappaB signaling and its downstream inflammatory
mediators. Copyright © 2021 E-Century Publishing Corporation. All
rights reserved.

<29>
Accession Number
2011708507
Title
Diversity and Inclusion: A Review of Effective Initiatives in Surgery.
Source
Journal of Surgical Education. 78(5) (pp 1500-1515), 2021. Date of
Publication: 01 Sep 2021.
Author
Hemal K.; Reghunathan M.; Newsom M.; Davis G.; Gosman A.
Institution
(Hemal, Newsom) Department of Plastic and Reconstructive Surgery, Wake
Forest School of Medicine, Winston-Salem, NC, United States
(Reghunathan, Davis, Gosman) Division of Plastic and Reconstructive
Surgery, University of San Diego, San Diego, CA, United States
Publisher
Elsevier Inc.
Abstract
OBJECTIVE: Surgery lacks women and racial minorities that are
underrepresented in medicine (UIM). This systematic review evaluates
interventions used to promote diversity in surgery. DESIGN: The PubMed
(MEDLINE), EMBASE, and Cochrane databases were searched for studies (1)
describing interventions for increasing UIM and gender diversity, (2)
within surgery, and (3) targeting any learner prior to residency. SETTING:
Nine surgical specialties were searched: general, neurosurgery, plastics,
orthopedics, otolaryngology, urology, cardiothoracic, vascular, and
ophthalmology. RESULT(S): Of the 982 studies identified, 16 were
included. Awards, clerkships, and workshops were each described by three
studies; awards funded research or travel to national meetings, clerkships
referred to a third- or fourth-year rotation that provided exposure to
surgery, and workshops were hands-on skills sessions for learners. Two
studies proposed a holistic review of residency applications, which
involves emphasizing an individual's attributes and life experiences
rather than strictly academics. Two studies detailed a longitudinal
mentoring program comprised of mentorship throughout medical school plus
opportunities for research, lectures, and workshops. One study described a
combination of interventions and the remaining 2 presented interventions
that were characterized as "other." Longitudinal mentoring programs
significantly increased the likelihood of women and UIM applying to
surgical residency, while holistic review significantly increased the
numbers of women and UIM being interviewed and ranked by residency
programs. One award increased the number of female residents matriculating
into surgical residency. Clerkships significantly increased the number of
women applying to surgical residency. The mere mention of diversity
initiatives on a program's website was associated with more female
surgical residents, but not UIM residents. Workshops led to a higher, but
not statistically significant, proportion of women applying to surgery.
 CONCLUSION(S): Holistic review and longitudinal mentoring programs
are the most effective interventions for increasing UIM and female
representation among surgical trainees. Copyright © 2021
Association of Program Directors in Surgery

<30>
Accession Number
2013501749
Title
Post-ablation P wave characteristics correlate with recurrent atrial
fibrillation in the ABCD-AF cohort.
Source
Journal of Interventional Cardiac Electrophysiology. (no pagination),
2021. Date of Publication: 2021.
Author
Supanekar N.; Gilge J.L.; Ahmed A.; Patel P.J.
Institution
(Supanekar, Gilge, Ahmed, Patel) St Vincent Medical Group, 8333 Naab Road,
#400, Indianapolis, IN 46260, United States
Publisher
Springer
Abstract
Purpose: Atrial fibrillation (AF) ablation is a common procedure to reduce
cardiovascular morbidity but is limited by recurrence. The objective of
this study was to determine if post-ablation acute surface P wave
morphology and other electrocardiographic parameters correlate with AF
recurrence. Method(s): The Avoiding Bladder Catheters During AF
ablation (ABCD-AF) trial was a randomized, prospective trial in 160
subjects undergoing AF ablation. The present study examined correlation
between AF recurrence in follow-up and acute post-ablation
electrocardiographic P wave parameters. Result(s): Median follow-up
was 255 (188, 306) days. The ABCD-AF cohort had a mean age of 62.7 +/-
12.8 with 32.1% being females. Rate of recurrent AF was 35.8%, with a
median time to AF of 135 (109, 182) days. There was no baseline
demographic associated with AF recurrence. There was more AF recurrence in
those with longer follow-up (p = 0.001). Lead 2 PR interval, lead 2 P wave
duration/PR (Pdur/PR), lead V1 PR interval, and lead V1 Pdur/PR were all
significantly associated with recurrent AF (p = 0.03, 0.02, 0.01, 0.01).
Longer PR and shorter Pdur/PR predicted AF recurrence. In a multivariable
model, lead V1 Pdur/PR provided the best predictor of AF recurrence, with
an odds ratio of 0.018 (p = 0.016) per standard deviation change.
 Conclusion(s): Shorter P wave duration combined with longer AV node
delay, as measured by proportion of the PR that the P wave occupies, was
the best predictor of AF recurrence post-ablation. Copyright ©
2021, Springer Science+Business Media, LLC, part of Springer Nature.

<31>
Accession Number
2013497741
Title
Balanced forced-diuresis as a renal protective approach in cardiac
surgery: Secondary outcomes of electrolyte changes.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Department of Cardiothoracic Surgery, Consultant Cardiothoracic
Surgeon, American Hospital, Dubai, United Arab Emirates
(Giri) Department of Cardiothoracic Anaesthesiology, Consultant
Cardiothoracic Anaesthesiologist, Heart & Lung Centre, Wolverhampton,
United Kingdom
(Wrigley) Department of Cardiology, Consultant Interventional
Cardiologist, Heart & Lung Centre, Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Department of Cardiothoracic Surgery, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Sharman) Research Nurse, Research & Development Department, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Beare) Department of Cardiothoracic Surgery, Chief Clinical Perfusionist,
University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nevill) Department of Statistics, Faculty of Education, Health, and
Wellbeing, University of Wolverhampton, Walsall, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Forced-diuresis during cardiopulmonary bypass (CPB) can be
associated with significant electrolyte shifts. This study reports on the
serum electrolyte changes during balanced forced-diuresis with the
RenalGuard system (RG) during CPB. Method(s): Patients at risk of
acute kidney injury (AKI)-(history of diabetes &/or anaemia, e-GFR 20-60
ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore
>5)-were randomized to either RG (study group) or managed as per current
practice (control group). Result(s): The use of RG reduced AKI rate
(10% for RG and 20.9% in control, p =.03). Mean urine output was
significantly higher in the RG group during surgery (2366 +/- 877 ml vs.
765 +/- 549 ml, p <.001). The serum potassium levels were maintained
between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for
the controls. Median potassium supplemental dose was 60 (0-220) mmol (RG
group) as compared to 30 (0-190) mmol for control group over first 24 h (p
<.001). On Day 1 post-op, there were no significant differences in the
serum sodium, potassium, calcium, magnesium, phosphate, and chloride
levels between the two groups. Otherwise, postoperative clinical recovery
was also similar. Conclusion(s): Balanced forced-diuresis with the RG
reduced AKI rates after on-pump cardiac surgery compared to controls.
Although the RG group required higher doses of IV potassium replacement in
the postoperative period, normal serum levels of potassium were maintained
by appropriate intravenous potassium supplementation and the clinical
outcomes between groups were similar. Copyright © 2021 The
Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC

<32>
Accession Number
2013497740
Title
Using machine learning to improve survival prediction after heart
transplantation.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Ayers B.; Sandholm T.; Gosev I.; Prasad S.; Kilic A.
Institution
(Ayers) Department of Surgery, The Massachusetts General Hospital, Boston,
MA, United States
(Sandholm) Carnegie Mellon University, Pittsburgh, PA, United States
(Gosev, Prasad) Division of Cardiac Surgery, The University of Rochester
Medical Center, Rochester, NY, United States
(Kilic) Division of Cardiothoracic Surgery, Medical University of South
Carolina, Charleston, SC, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: This study investigates the use of modern machine learning
(ML) techniques to improve prediction of survival after orthotopic heart
transplantation (OHT). Method(s): Retrospective study of adult
patients undergoing primary, isolated OHT between 2000 and 2019 as
identified in the United Network for Organ Sharing (UNOS) registry. The
primary outcome was 1-year post-transplant survival. Patients were
randomly divided into training (80%) and validation (20%) sets.
Dimensionality reduction and data re-sampling were employed during
training. Multiple machine learning algorithms were combined into a final
ensemble ML model. The discriminatory capability was assessed using the
area under receiver-operating-characteristic curve (AUROC), net
reclassification index (NRI), and decision curve analysis (DCA).
 Result(s): A total of 33,657 OHT patients were evaluated. One-year
mortality was 11% (n = 3738). In the validation cohort, the AUROC of
singular logistic regression was 0.649 (95% CI, 0.628-0.670) compared to
0.691 (95% CI, 0.671-0.711) with random forest, 0.691 (95% CI,
0.671-0.712) with deep neural network, and 0.653 (95% CI, 0.632-0.674)
with Adaboost. A final ensemble ML model was created that demonstrated the
greatest improvement in AUROC: 0.764 (95% CI, 0.745-0.782) (p <.001). The
ensemble ML model improved predictive performance by 72.9% +/-3.8% (p
<.001) as assessed by NRI compared to logistic regression. DCA showed the
final ensemble method improved risk prediction across the entire spectrum
of predicted risk as compared to all other models (p <.001).
 Conclusion(s): Modern ML techniques can improve risk prediction in
OHT compared to traditional approaches. This may have important
implications in patient selection, programmatic evaluation, allocation
policy, and patient counseling and prognostication. Copyright ©
2021 Wiley Periodicals LLC

<33>
Accession Number
2011471721
Title
Impact of COVID-19 infection on the cardiovascular system: An
evidence-based analysis of risk factors and outcomes.
Source
Best Practice and Research: Clinical Anaesthesiology. 35(3) (pp 437-448),
2021. Date of Publication: October 2021.
Author
Kaye A.D.; Spence A.L.; Mayerle M.; Sardana N.; Clay C.M.; Eng M.R.; Luedi
M.M.; Carroll Turpin M.A.; Urman R.D.; Cornett E.M.
Institution
(Kaye) Department of Anesthesiology and Pharmacology, Toxicology, and
Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA
71103, United States
(Spence) Department of Pharmaceutical Sciences, Regis University School of
Pharmacy, Denver, CO 80221, United States
(Mayerle) Regis University School of Pharmacy, Denver, CO 80221, United
States
(Sardana) Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln W,
Piscataway, NJ 08854, United States
(Clay) LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103,
United States
(Eng) Department of Anesthesiology, LSU Health Sciences Center, 1542
Tulane Avenue, New Orleans, LA 70112, United States
(Luedi) Bern University Hospital Inselspital, University of Bern, Bern,
Switzerland
(Carroll Turpin) Department of Biomedical Sciences, College of Medicine,
University of Houston, Health 2 Building, Room 8037, United States
(Urman) Department of Anesthesiology, Perioperative and Pain Medicine,
Harvard Medical School, Brigham and Women's Hospital, 75 Francis St,
Boston, MA 02115, United States
(Cornett) Department of Anesthesiology, LSU Health Shreveport, 1501 Kings
Highway, Shreveport, LA 71103, United States
Publisher
Bailliere Tindall Ltd
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known
as COVID-19, emerged in late 2019 in Wuhan, China. The World Health
Organization declared the virus a pandemic on March 11, 2020. Disease
progression from COVID-19 infection has shown significant symptom
manifestations within organ systems beyond the respiratory system. The
literature has shown increasing evidence of cardiovascular involvement
during disease course and an associated increase in mortality among
infected patients. Although the understanding of this novel virus is
continually evolving, it is currently proposed that the mechanism by which
the SARS-CoV-2 virus contributes to cardiovascular manifestations involves
the ACE2 transmembrane protein. The protein ACE2 is highly expressed in
blood vessel pericytes, and infection can result in microvascular
dysfunction and subsequent acute coronary syndromes. Complications
involving the cardiovascular system include myocardial infarction,
arrhythmias, shock, and heart failure. In this evidence-based review, we
discuss risk factors of cardiovascular involvement in COVID-19 infection,
pathophysiology of COVID-19-related cardiovascular infection, and injury,
COVID-19 effects on the cardiovascular system and corresponding
treatments, and hematologic effects of COVID-19 and COVID-19 in heart
transplant patients. Clinicians managing COVID-19 patients should
appreciate the potential cardiovascular effects related to the disease
process. Copyright © 2021 Elsevier Ltd

<34>
Accession Number
2014436138
Title
Non-Governmental Organizations Delivering Global Cardiac Surgical Care: A
Quantitative Impact Assessment.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Vervoort D.; Guetter C.R.; Munyaneza F.; Trager L.E.; Argaw S.T.; Abraham
P.J.; Dayan V.
Institution
(Vervoort, Guetter) Department of Health Policy and Management, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
(Munyaneza) College of Medicine and Health Sciences, University of Rwanda,
Kigali, Rwanda
(Trager) School of Medicine, University of Minnesota, Minneapolis, MN,
United States
(Argaw) Feinberg School of Medicine, Northwestern University, Chicago, IL,
United States
(Abraham) Department of Surgery, University of Alabama at Birmingham,
Birmingham, AL, United States
(Dayan) Centro Cardiovascular Universitario, Hospital de Clinicas,
Facultad de Medicina, Universidad de la Republica, Montevideo, Uruguay
Publisher
W.B. Saunders
Abstract
In low- and middle-income countries (LMICs), 93% of the population lacks
safe, timely, and affordable access to cardiac surgical care when needed.
As countries slowly build or expand local, independent cardiac centers,
non-governmental organizations (NGOs) partially bridge the gap in cardiac
surgical care delivery in LMICs. However, little is known about the
current scope of cardiac NGOs. Here, we perform an analysis of active NGOs
involved with the delivery of cardiac surgical services in LMICs or for
patients from LMICs. Cardiac surgery NGOs were identified from medical
literature, established NGO databases, and Google Scholar searches. The
search was performed between December 2019 and May 2020. NGOs whose
websites were not updated or described missions or projects taking place
no later than 2015 were considered inactive. Eighty-six NGOs are actively
providing cardiac surgery services in LMICs or treating patients from
LMICs. Five NGOs performed adult cardiac surgery only, 56 performed
pediatric cardiac surgery only, and 25 performed both adult and pediatric
cardiac surgery. NGOs originated from 23 different countries and were
operational in a total of 111 countries, 96 of them being LMICs.
Fifty-three NGOs reported data on annual surgical volume, of which half
performed less than 50 operations per year. NGOs effectively address the
burden of cardiac surgical disease in LMICs and contribute to local
capacity-building. Increased, more detailed, and standardized reporting of
the impact and outcomes of NGOs is necessary to better understand annual
cardiac surgical volume and to support local centers working towards
independent services. Copyright © 2021 Elsevier Inc.

<35>
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.

<36>
Accession Number
2014119140
Title
Valve-in-valve transcatheter aortic valve implantation for the failing
surgical Perceval bioprosthesis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Suleiman T.; Tanseco K.; Arunothayaraj S.; Michail M.; Cockburn J.;
Hadjivassilev S.; Hildick-Smith D.
Institution
(Suleiman, Tanseco, Arunothayaraj, Michail, Cockburn, Hadjivassilev,
Hildick-Smith) Sussex Cardiac Centre, University Hospitals Sussex,
Brighton, United Kingdom
Publisher
Elsevier Inc.
Abstract
Introduction: The Perceval Valve has been increasingly used in Surgical
Aortic Valve Replacement (SAVR) recently due to ease of implantation.
However, we have seen some cases of relatively early haemodynamic failure
of the Perceval valve and these patients may then present for
valve-in-valve transcatheter aortic valve implantation (ViV-TAVI).
Experience of ViV-TAVI in the Perceval valve is limited. Method(s):
We report our experience of VIV-TAVI in four cases of early-failing
Perceval valves, two with stenosis and two with regurgitation. We also
review the literature with regard to ViV-TAVI for this indication.
 Result(s): Four patients aged between 66 and 78 years presented with
Perceval valve dysfunction an average of 4.6 years following SAVR. All
cases underwent Heart Team discussion and a ViV-TAVI procedure was planned
thereafter. Strategies to ensure crossing through the centre of the valve
and not outside any portion of the frame were found to be essential. Three
patients had self-expanding valves implanted and one had a
balloon-expandable prosthesis. The average aortic valve area (AVA)
improved from 0.8 cm2 pre-procedure to 1.5 cm2
post-procedure*. The mean gradient (MG) improved from 35.5 mmHg (range
19.7-53 mmHg) pre-procedure to 14.8 mmHg (range 7-30 mmHg) post-procedure.
In one patient a MG of 30 mmHg persisted following valve deployment. There
were no significant peri-procedural complications. Conclusion(s):
ViV-TAVI is a useful option for failed Perceval prostheses and appears
safe and effective in this small series. Crossing inside the whole frame
of the Perceval valve is essential. Copyright © 2021 Elsevier
Inc.

<37>
Accession Number
2014100106
Title
Risk factors for postoperative delirium: An umbrella review of systematic
reviews.
Source
International Journal of Surgery. 93 (no pagination), 2021. Article
Number: 106063. Date of Publication: September 2021.
Author
Bramley P.; McArthur K.; Blayney A.; McCullagh I.
Institution
(Bramley) Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield
University, UK, United Kingdom
(McArthur, Blayney) University Hospitals Coventry and Warwickshire, UK,
United Kingdom
(McCullagh) Newcastle Upon Tyne NHS Trust and Newcastle University, UK,
United Kingdom
Publisher
Elsevier Ltd
Abstract
Background: Postoperative delirium (POD) is associated with increased
mortality, increased length of hospital stays and increased rates and
severity of subsequent cognitive decline including dementia. A wide range
of risk factors for POD have been suggested in the literature across
multiple surgical specialities. However few are validated and no accurate
prognostic models exist. We therefore aimed to map the existing evidence
regarding risk factors for POD to help guide future research by
undertaking an umbrella review of systematic reviews examining risk
factors for POD in any context. Material(s) and Method(s): We
systematically searched multiple medical databases for systematic reviews
examining the risk factors for POD in adults undergoing any surgery. We
then selected relevant reviews with minimal overlap in primary studies and
extracted information about individual risk factors. Result(s):
Thirty-five relevant reviews were identified of which ten were in trauma
and orthopaedic surgery patients (four exclusively examined hip
fractures), five were in cardiac surgery patients, and four were in
vascular surgery patients. Due to substantial overlap in reviews, eighteen
reviews were analysed in detail finding the widely examined and consistent
risk factors were increasing age, nursing home residency, pre-existing
cognitive impairment, psychiatric disorders, cerebrovascular disease, end
stage renal failure, low albumin, higher ASA score, and intra-operative
blood transfusion. Many other risk factors were examined, but they were
either not studied in multiple systematic reviews, or inconsistent either
in results or in categorisation (which for many factors was heterogenous
even within systematic reviews). There are also a large number of existing
prognostic models, many of which remain unvalidated. Conclusion(s):
Given the wealth of existing literature, future research should avoid
simple risk factor evaluation except for novel candidates, validate
existing prognostic models where possible, and instead focus on
interventional research. Copyright © 2021

<38>
Accession Number
635867223
Title
Comparative effectiveness of metoprolol, ivabradine, and its combination
in the management of inappropriate sinus tachycardia in coronary artery
bypass graft patients.
Source
Indian Journal of Pharmacology. 53(4) (pp 264-269), 2021. Date of
Publication: July-August 2021.
Author
Bhatt P.; Bhavsar N.; Naik D.; Shah D.
Institution
(Bhatt, Bhavsar, Naik, Shah) Cardiovascular and Thoracic Surgery,
Department Care Institute of Medical Sciences, 12B, Riddhi Siddhi
Bungalows, Gujarat, Ahmedabad 380 015, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
BACKGROUND: Inappropriate sinus tachycardia (IST) is an arrhythmic
complication observed after coronary artery bypass graft (CABG) surgery
which left untreated, commonly increases chances of postoperative stroke.
The primary study objective was comparing effectiveness of beta
blocker-metoprolol; a specific I<inf>f</inf>blocker-ivabradine and its
combination in patients who develop IST as a complication following CABG.
MATERIALS AND METHODS: An open-labeled, investigator initiated, clinical
study was conducted on 150 patients who developed IST (heart rate [HR]
>100 beats/min) following elective CABG surgery. The patients were
randomized into three treatment groups. Group I-received ivabradine (5
mg), Group II-metoprolol (25 mg), and Group III-ivabradine (5 mg) and
metoprolol (25 mg). Treatment was given orally, twice a day for 7 days in
all the three groups postoperatively. Primary endpoints were comparative
effectiveness in HR and blood pressure reduction following treatment.
 RESULT(S): IST was diagnosed by an electrocardiogram (12-lead)
considering morphological features of P-wave and with 32% increase from
baseline HR in all the three groups. Compared to IST arrthymic rate, HR
was reduced in all groups following respective treatment (P = 0.05).
Reduction in HR was significant (P < 0.05) in combination group followed
by ivabradine which was significantly greater than metoprolol treated
group. None of the treatments clinically changed the systolic, diastolic
and mean blood pressure till discharge. No surgery/treatment-related
complications were observed in any groups. CONCLUSION(S): Ivabradine
stands as a pharmacological option for controlling HR and rhythm without
associated side effects in postoperative CABG patients with
IST. Copyright © 2021 Wolters Kluwer Medknow Publications. All
rights reserved.

<39>
Accession Number
634651024
Title
Effectiveness of music on anxiety and pain among cardiac surgery patients:
A quantitative systematic review and meta-analysis of randomized
controlled trials.
Source
International journal of nursing practice. 27(4) (pp e12928), 2021. Date
of Publication: 01 Aug 2021.
Author
Chandrababu R.; Ramesh J.; Sanatombi Devi E.; Nayak B.S.; George A.
Institution
(Chandrababu, Sanatombi Devi, Nayak, George) Manipal College of Nursing,
Manipal Academy of Higher Education, Manipal, Karnataka, India
(Ramesh) Udupi College of Nursing, Shree Krishna Educational Trust,
Manipal, Karnataka, India
Publisher
NLM (Medline)
Abstract
AIM: The aim of this study is to evaluate the effectiveness of music on
anxiety and pain among patients following cardiac surgery. BACKGROUND:
Cardiac surgery affects patients physically, psychologically and socially.
Anxiety and pain are the usual problems among patients following cardiac
surgery. DESIGN: The study design is a systematic review and
meta-analysis. DATA SOURCES: The Medical Literature Analysis and Retrieval
System Online (MEDLINE), Cumulative Index to Nursing and Allied Health
Literature (CINAHL), Cochrane Central Register of Controlled Trials
(CENTRAL), Excerpta Medica database (EMBASE) and Web of Science databases
were searched for randomized controlled trials from January 2000 to
December 2017. REVIEW METHODS: The Cochrane collaboration guidelines were
followed and reported using the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) statement. The Grading of
Recommendations, Assessment, Development, and Evaluations (GRADE) approach
was used to summarize the quality of evidence. RESULT(S): Fourteen
studies were included in systematic review and 13 in meta-analysis. The
meta-analysis revealed that there was a significant reduction in anxiety
and pain among patients who received musical intervention compared with
those who did not. CONCLUSION(S): Music has positive benefits on
anxiety and pain. However, well-designed and high-quality trials are
needed to generate higher quality evidence. Copyright © 2021 John
Wiley & Sons Australia, Ltd.

<40>
Accession Number
635946053
Title
Iatrogenic aorto-coronary dissection: A case series systematic review.
Source
European Heart Journal, Supplement. Conference: 52nd Congress of the
ItalianAssociation of Hospital Cardiologists, ANMCO 2021. Rimini Italy.
23(SUPPL C) (pp C59-C60), 2021. Date of Publication: August 2021.
Author
Cereda A.; Conconi B.; Carla M.; Barbieri L.; Tumminello G.; Lucreziotti
S.; Mafrici A.
Institution
(Cereda, Conconi, Carla, Barbieri, Tumminello, Lucreziotti, Mafrici) ASST
Santi Paolo E Carlo, Milano, Italy
Publisher
Oxford University Press
Abstract
Introduction: Coronary artery dissections (IACD) are a feared complication
of interventional procedures, a nightmare for the interventional
cardiologist, and potentially fatal for the patient. Their incidence is
rare (about 0.1% of interventional procedures); they most often concern
the right coronary artery. Clinical manifestations are highly variable,
may be asymptomatic or associated with coronary ischemia and cardiogenic
shock in the context of an aortic dissection.The mechanism of IACD is
multifactorial, from simple catheter cannulation, induced by contrast
injection, or during wiring or angioplasty. Methodology: 125 cases of
IACDs reported in the literature from 1990 to 2020 have been
systematically reviewed. Result(s): The mean age of the patients was
62 years without a proper cluster of predisposing risk.27/125 patients
with IACD had chronic total occlusion. 80% of IACDs were located in the
right coronary artery, and the most common cause of dissection was
cannulation with a guide catheter. The most common clinical manifestation
was coronary ischemia (39/125 patients). In 89 out of 125 patients, the
coronary stent was used to seal the IACD dissection. The coronary stent
was not always effective, with a failure rate of 13.4% (12/89). The
surgical approach was necessary in 27 of the 125 cases reported in the
literature (21.6%). Mortality in this case-series review was 6.4% (8/125),
in line with literature data. Significant predictors of fatal outcome were
the most extensive aortic dissections according to Dunning's
classification (RR 5.84 2.9-10.0), hemodynamic instability (RR 3.93
2.5-6.0), non-coronary stenting (RR 7.3 2.7-19.1), and surgery (2.5
1.1-5-5) Conclusion(s): IACD is a poorly understood iatrogenic
complication, and there is no unanimous consensus on management. Where
feasible, based on angiographic and hemodynamic characteristics, early
coronary stenting would appear to be the best strategy to limit the damage
of this iatrogenic complication. (Table Presented).

<41>
Accession Number
635944841
Title
Lambl' s excrescense: Rare cause of cardioembolic stroke.
Source
Neurology. Conference: 73rd Annual Meeting of the American Academy of
Neurology, AAN 2021. Virtual. 96(15 SUPPL 1) (no pagination), 2021. Date
of Publication: May 2021.
Author
Habib S.; Kravtsova M.; Al-Awwad A.
Institution
(Habib) University Oklahoma Health Sci Ctr
(Kravtsova) University of Oklahoma Health Sciences Center
(Al-Awwad) Neurology Department, University of Oklahoma
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: Lambl's excresence (LE) is a rare cause of cardioembolic
stroke, most often noted in middle cerebral artery territory. We present
two cases of cardioembolic strokes secondary to LE seen on transesophageal
echocardiogram (TEE) Background: LE was described by Vilem Dusan Lambl. It
is characterized by branched filiform structures with undulating
movements, usually found on aortic and mitral valves. An atheroma from LE
or LE fragments per se may embolize to cerebrovascular arterial territory
causing stroke Design/Methods: Case reports and review of literature Case
1: 63-year-old man with a history of migraines was admitted for large
ischemic strokes in the right cerebellum manifested by sudden onset
vertigo. Head, neck CT angiogram and transthoracic echo (TTE) were
unremarkable. TEE showed small, mobile structure on the arotic valve on
the left ventricle side of the left coronary cusp consistent with LE. He
was discharged home with outpatient physical therapy, on aspirin 325mg and
clopidogrel 75mg daily. Case 2: 51-year-old man with a history of
hypertension and old left middle cerebral artery infarct 5 years ago with
previous negative stroke work-up, admitted for two acute ischemic strokes
in the head of the right caudate and posterior limb of the right internal
capsule manifested by dysarthria, left hemiparesis and left hemisensory
deficits. Head, neck CT angiogram and TTE were unremarkable and TEE
revealed Lambl's excrescence on the left ventricular aspect of the right
coronary cusp. Patient was discharged to rehab on aspirin 81mg and
apixaban 5mg twice daily. Result(s): NA Conclusion(s): TEE is
superior to TTE in detection of LE. There are no definitive guidelines for
its management. Literature suggest dual antiplatelet after the first
episode of stroke and an antiplatelet plus anticoagulation after the
second stroke attributed to LE. Literature also recommends offering valve
replacement after second stroke related to LE as the recurrence rate is
high.

<42>
Accession Number
635947018
Title
Identifying high thrombotic risk in atrial fibrillation patients
undergoing percutaneous coronary intervention: Is there a benefit of
triple therapy?.
Source
European Heart Journal, Supplement. Conference: 52nd Congress of the
ItalianAssociation of Hospital Cardiologists, ANMCO 2021. Rimini Italy.
23(SUPPL C) (pp C19), 2021. Date of Publication: August 2021.
Author
Bor W.
Institution
(Bor) St Antonius Hospital, Nieuwegein, Netherlands
Publisher
Oxford University Press
Abstract
Patients requiring concomitant use of oral anticoagulants and dual
antiplatelet therapy after PCI are at increased risk of bleeding and
mortality. Omittance of aspirin (dual antithrombotic therapy, DAT) reduces
bleeding as compared to triple antithrombotic therapy (TAT), but might not
ascertain antithrombotic efficacy. The study was performed in a combined
cohort of two randomised controlled trials (WOEST, RE-DUAL PCI) comparing
TAT versus DAT after PCI. A Cox proportional hazards model predictive for
the composite thrombotic endpoint of MACE was built by stepwise selection
of plausible predictor variables. Area under the receiver operating curve
(AUC) was obtained, and clinical outcomes (thrombotic endpoint, bleeding
[BARC 2,3+5], and all-cause mortality) were compared between the highest
quintile of predicted thrombotic risk (high risk) and the remainder of
patients (low-intermediate risk). Within the different risk groups, effect
of TAT versus DAT was compared. A total of 3288 patients in the combined
WOEST and RE-DUAL cohorts were included in this analysis. Approximately
half underwent PCI for acute coronary syndrome. In 250 patients (7.6%) the
composite thrombotic endpoint occurred during the first year. The final
Cox proportional hazards model predicting thrombotic events contained:
left ventricular ejection fraction, 3-vessel disease, MI at index PCI,
peripheral artery disease, prior stroke, left circumflex coronary artery
stenting, a history of MI, PCI to a bypass graft, and platelet count. The
discriminatory capacity of the ischaemic model was fair (AUC 0.68, 95%
confidence interval 0.64-0.71). Incidence of thrombotic events and
mortality was higher in the high-risk as compared to low-intermediate risk
patients (15.8% vs 5.6%, and 8.4% vs 3.2%, respectively, both p<0.001),
whereas bleeding was comparable (20.5% vs 19.6%, p=0.60). No statistically
significant effect of TAT over DAT was seen with regards to the thrombotic
endpoint in both high and low-intermediate risk patients (13.9% vs 17.0%,
p=0.36, and 6.5% vs 5.0%, p=0.11, respectively). Bleeding was
significantly reduced with DAT versus TAT in both high and
low-intermediate risk patients (minus 12.8% and 8.1%, both p<0.02). For
low-intermediate risk patients a statistically significant increase in
mortality was found with TAT versus DAT (4.2% vs 2.5%, p=0.02), whereas
this was not found in high-risk patients (7.2% vs 9.1%, p=0.47).

<43>
Accession Number
635926984
Title
Comparison between Custodiol, del Nido and modified del Nido in the
myocardial protection-Cardioplegia Trial: A study protocol for a
randomised, double-blind clinical trial.
Source
BMJ Open. 11(9) (no pagination), 2021. Article Number: e047942. Date of
Publication: 06 Sep 2021.
Author
Almeida A.S.; Ceron R.O.; Anschau F.; Kopittke L.; Lira K.B.; Delvaux
R.S.; Rode J.; Rey R.A.W.; Wittke E.I.; Rombaldi A.R.
Institution
(Almeida, Ceron, Lira, Delvaux, Rode, Rey, Wittke, Rombaldi)
Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceicao,
Porto Alegre, Brazil
(Almeida, Anschau, Kopittke) Health Technology Assessment Center (NATS),
Education and Research Center (GEP), Hospital Nossa Senhora da Conceicao,
Porto Alegre, Brazil
Publisher
BMJ Publishing Group
Abstract
Introduction Myocardial protection is essential for successful cardiac
surgery, and the search for an ideal cardioplegic solution has continued
since its beginning. In this context, Custodiol, del Nido and modified del
Nido are single-dose cardioplegic solutions with good safety profiles and
great relevance in modern surgical practice. While these solutions have
all been evaluated for their impact on patient outcomes independently,
limited research exists comparing them directly. Thus, the present study
aims to examine the effects of these cardioplegic solutions on myocardial
protection and clinical outcomes in adult patients undergoing elective
cardiac surgery. The assessment of the increase in myocardial injury
biomarkers in patients submitted to all treatment methods may be
considered a major strength of our study. Methods and analysis This is a
clinical trial study protocol that will compare myocardial protection and
clinical outcomes among three patient groups based on which cardioplegic
solution was used. Patients will be randomised to receive del Nido (n=30),
modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers
will be measured at the baseline and 2 hours, 12 hours and 24 hours after
the cardiopulmonary bypass. Clinical outcomes will be assessed during the
trans operative period and the intensive care unit stay, in addition to
other haematological parameters. Ethics and dissemination This protocol
and its related documents were approved by the Research Ethics Committee
of the Hospital Nossa Senhora da Conceicao, Brazil, registered under no.
4.029.545. The findings of this study will be published in a peer-reviewed
journal in the related field. Trial registration number
RBR-7g5s66. Copyright © 2021 BMJ Publishing Group. All rights
reserved.

<44>
Accession Number
2014503161
Title
ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter
aortic VAlve implantaTION): A Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. 14(18) (pp 1965-1974), 2021. Date of
Publication: 27 Sep 2021.
Author
Patterson T.; Clayton T.; Dodd M.; Khawaja Z.; Morice M.C.; Wilson K.; Kim
W.-K.; Meneveau N.; Hambrecht R.; Byrne J.; Carrie D.; Fraser D.; Roberts
D.H.; Doshi S.N.; Zaman A.; Banning A.P.; Eltchaninoff H.; Le Breton H.;
Smith D.; Cox I.; Frank D.; Gershlick A.; de Belder M.; Thomas M.;
Hildick-Smith D.; Prendergast B.; Redwood S.; Pocock S.; Wang D.; Irague
F.
Institution
(Patterson, Wilson, Prendergast, Redwood) Cardiovascular Department, St
Thomas' Hospital, Kings College London, London, United Kingdom
(Clayton, Dodd) Department of Medical Statistics, London School of Hygiene
and Tropical Medicine, London, United Kingdom
(Khawaja) Cardiology Department, Lewisham and Greenwich NHS Foundation
Trust, United Kingdom
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Morice) Cardiovascular European Research Center, Massy, France
(Kim) Cardiology Department, Kerckhoff-Klinik Bad Nauheim Abteilung
Kardiologie, Bad Nauheim, Germany
(Meneveau) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(Meneveau) EA3920, University of Burgundy Franche-Comte, Besancon, France
(Hambrecht) Cardiology Department, Klinikum Links der Weser GmbH, Bremen,
Germany
(Byrne) Cardiothoracic Department, King's College Hospital, London, United
Kingdom
(Carrie) Cardiology Department, Hopital Rangueil, Centre Hospitalier
Universitaire de Toulouse, Toulouse, France
(Fraser) Cardiology Department, Manchester Royal Infirmary, Manchester,
United Kingdom
(Roberts) Lancashire Cardiac Centre, Blackpool Victoria Hospital NHS
Trust, Blackpool, United Kingdom
(Doshi) Cardiology Department, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Zaman) Cardiology Department, Newcastle upon Tyne Hospitals NHS
Foundation Trust of the Freeman Hospital, Newcastle, United Kingdom
(Banning) Department of Cardiology, John Radcliffe Hospital, Oxford,
United Kingdom
(Eltchaninoff) Cardiology Department, Hopital Charles-Nicolle, Centre
Hospitalier Universitaire de Rouen, Rouen, France
(Le Breton) Service de Cardiologie, Hopital Pontchaillou, Centre
Hospitalier Universitaire de Rennes, Rennes, France
(Smith) Cardiology Department, Morriston Hospital, Swansea, United Kingdom
(Cox) Cardiology Department, Derriford Hospital, Plymouth, United Kingdom
(Frank) Cardiology Department, Oberarzt Facharzt fur Innere Medizin und
Kardiologie, Kiel, Germany
(Gershlick) Department of Cardiovascular Sciences, Glenfield Hospital,
University of Leicester, Leicester, United Kingdom
(de Belder) Cardiology Department, Barts Heart Centre, London, United
Kingdom
(Thomas) Edwards Lifesciences, Irvine, CA, United States
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals, Brighton, United Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to determine if percutaneous coronary
intervention (PCI) prior to transcatheter aortic valve replacement (TAVR)
in patients with significant coronary artery disease would produce
noninferior clinical results when compared with no PCI (control arm).
 Background(s): PCI in patients undergoing TAVR is not without risk,
and there are no randomized data to inform clinical practice.
 Method(s): Patients with severe symptomatic aortic stenosis and
significant coronary artery disease with Canadian Cardiovascular Society
class <=2 angina were randomly assigned to receive PCI or no PCI prior to
TAVR. The primary endpoint was a composite of all-cause death or
rehospitalization at 1 year. Noninferiority testing (prespecified margin
of 7.5%) was performed in the intention-to-treat population.
 Result(s): At 17 centers, 235 patients underwent randomization. At 1
year, the primary composite endpoint occurred in 48 (41.5%) of the PCI arm
and 47 (44.0%) of the no-PCI arm. The requirement for noninferiority was
not met (difference: -2.5%; 1-sided upper 95% confidence limit: 8.5%;
1-sided noninferiority test P = 0.067). On analysis of the as-treated
population, the difference was -3.7% (1-sided upper 95% confidence limit:
7.5%; P = 0.050). Mortality was 16 (13.4%) in the PCI arm and 14 (12.1%)
in the no-PCI arm. At 1 year, there was no evidence of a difference in the
rates of stroke, myocardial infarction, or acute kidney injury, with
higher rates of any bleed in the PCI arm (P = 0.021). Conclusion(s):
Observed rates of death and rehospitalization at 1 year were similar
between PCI and no PCI prior to TAVR; however, the noninferiority margin
was not met, and PCI resulted in a higher incidence of bleeding.
(Assessing the Effects of Stenting in Significant Coronary Artery Disease
Prior to Transcatheter Aortic Valve Implantation;
ISRCTN75836930) Copyright © 2021 American College of Cardiology
Foundation

<45>
Accession Number
2014501808
Title
5-Year Outcomes Comparing Surgical Versus Transcatheter Aortic Valve
Replacement in Patients With Chronic Kidney Disease.
Source
JACC: Cardiovascular Interventions. 14(18) (pp 1995-2005), 2021. Date of
Publication: 27 Sep 2021.
Author
Garcia S.; Cubeddu R.J.; Hahn R.T.; Ternacle J.; Kapadia S.R.; Kodali
S.K.; Thourani V.H.; Jaber W.A.; Asher C.R.; Elmariah S.; Makkar R.; Webb
J.G.; Herrmann H.C.; Lu M.; Devireddy C.M.; Malaisrie S.C.; Smith C.R.;
Mack M.J.; Sorajja P.; Cavalcante J.L.; Goessl M.; Shroff G.R.; Leon M.B.;
Pibarot P.
Institution
(Garcia, Sorajja, Cavalcante, Goessl) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Garcia, Sorajja, Cavalcante, Goessl) Valve Science Center, Minneapolis
Heart Institute Foundation, Minneapolis, MN, United States
(Cubeddu) NCH Healthcare System, Naples, FL, United States
(Hahn, Smith, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Hahn, Kodali, Smith, Leon) Division of Cardiology, Columbia University
Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Ternacle, Pibarot) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec/Quebec Heart & Lung Institute, Laval University,
Quebec, Quebec, Canada
(Kapadia) Department of Cardiovascular Medicine, Heart, Vascular, and
Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Thourani) Department of Cardiovascular Surgery, Marcus Heart and Vascular
Center, Piedmont Heart and Vascular Institute, Atlanta, GA, United States
(Jaber) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Asher) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic Weston, Weston, FL, United States
(Elmariah) Massachusetts General Hospital, Boston, MA, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Herrmann) Department of Cardiology, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Lu) Edwards Lifesciences, Irvine, CA, United States
(Devireddy) Department of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
(Malaisrie) Department of Cardiac Surgery, Northwestern University
Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago,
IL, United States
(Mack) Department of Cardiothoracic Surgery, Baylor Scott & White Health,
Plano, TX, United States
(Shroff) Hennepin Healthcare and University of Minnesota Medical School,
Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare 5-year cardiovascular,
renal, and bioprosthetic valve durability outcomes in patients with severe
aortic stenosis (AS) and chronic kidney disease (CKD) undergoing
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR). Background(s): Patients with severe AS and CKD
undergoing TAVR or SAVR are a challenging, understudied clinical subset.
 Method(s): Intermediate-risk patients with moderate to severe CKD
(estimated glomerular filtration rate <60 mL/min/m2) from the
PARTNER (Placement of Aortic Transcatheter Valve) 2A trial (patients
randomly assigned to SAPIEN XT TAVR or SAVR) and SAPIEN 3 Intermediate
Risk Registry were pooled. The composite primary outcome of death, stroke,
rehospitalization, and new hemodialysis was evaluated using Cox regression
analysis. Patients with and without perioperative acute kidney injury
(AKI) were followed through 5 years. A core laboratory-adjudicated
analysis of structural valve deterioration and bioprosthetic valve failure
was also performed. Result(s): The study population included 1,045
TAVR patients (512 SAPIEN XT, 533 SAPIEN 3) and 479 SAVR patients. At 5
years, SAVR was better than SAPIEN XT TAVR (52.8% vs 68.0%; P = 0.04) but
similar to SAPIEN 3 TAVR (52.8% vs 58.7%; P = 0.89). Perioperative AKI was
more common after SAVR than TAVR (26.3% vs 10.3%; P < 0.001) and was
independently associated with long-term outcomes. Compared with SAVR,
bioprosthetic valve failure and stage 2 or 3 structural valve
deterioration were significantly greater for SAPIEN XT TAVR (P < 0.05) but
not for SAPIEN 3 TAVR. Conclusion(s): In intermediate-risk patients
with AS and CKD, SAPIEN 3 TAVR and SAVR were associated with a similar
risk for the primary endpoint at 5 years. AKI was more common after SAVR
than TAVR, and SAPIEN 3 valve durability was comparable with that of
surgical bioprostheses. Copyright © 2021 American College of
Cardiology Foundation

<46>
Accession Number
2014523602
Title
Effects of high versus low inspiratory oxygen fraction on postoperative
clinical outcomes in patients undergoing surgery under general anesthesia:
A systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 75 (no pagination), 2021. Article Number:
110461. Date of Publication: December 2021.
Author
Lim C.-H.; Han J.-Y.; Cha S.-H.; Kim Y.-H.; Yoo K.-Y.; Kim H.-J.
Institution
(Lim) Department of Anesthesiology and Pain Medicine, College of Medicine,
Korea University, Seoul, South Korea
(Han) College of Medicine, Korea University, Seoul, South Korea
(Cha) Department of Radiology, Korea University Anam Hospital, Korea
University Medical Center, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Hanyang University
Hanmaeum Changwon Hospital, Changwon, South Korea
(Yoo) Department of Anesthesiology and Pain Medicine, Chonnam National
University Medical School, Gwangju, South Korea
(Kim) Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, South Korea
Publisher
Elsevier Inc.
Abstract
Objectives: To determine whether high perioperative inspired oxygen
fraction (FiO<inf>2</inf>) compared with low FiO<inf>2</inf> has more
deleterious postoperative clinical outcomes in patients undergoing
non-thoracic surgery under general anesthesia. Design(s):
Meta-analysis of randomized controlled trials. Setting(s): Operating
room, postoperative recovery room and surgical ward. Patient(s):
Surgical patients under general anesthesia. Intervention(s): High
perioperative FiO<inf>2</inf> (>=0.8) vs. low FiO<inf>2</inf> (<=0.5).
Measurements: The primary outcome was mortality within 30 days. Secondary
outcomes were pulmonary outcomes (atelectasis, pneumonia, respiratory
failure, postoperative pulmonary complications [PPCs], and postoperative
oxygen parameters), intensive care unit (ICU) admissions, and length of
hospital stay. A subgroup analysis was performed to explore the treatment
effect by body mass index (BMI). Main Result(s): Twenty-six trials
with a total 4991 patients were studied. The mortality in the high
FiO<inf>2</inf> group did not differ from that in the low FiO<inf>2</inf>
group (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.42-1.97, P =
0.810). Nor were there any significant differences between the groups in
such outcomes as pneumonia (RR 1.19, 95% CI 0.74-1.92, P = 0.470),
respiratory failure (RR 1.29, 95% CI 0.82-2.04, P = 0.270), PPCs (RR 1.05,
95% CI 0.69-1.59, P = 0.830), ICU admission (RR 0.94, 95% CI 0.55-1.60, P
= 0.810), and length of hospital stay (mean difference [MD] 0.27 d, 95% CI
-0.28-0.81, P = 0.340). The high FiO<inf>2</inf> was associated with
postoperative atelectasis more often (risk ratio 1.27, 95% CI 1.00-1.62, P
= 0.050), and lower postoperative arterial partial oxygen pressure (MD
-5.03 mmHg, 95% CI -7.90- -2.16, P < 0.001)<inf>.</inf> In subgroup
analysis of BMI >30 kg/m2, these parameters were similarly
affected between the groups. Conclusion(s): The use of high
FiO<inf>2</inf> compared to low FiO<inf>2</inf> did not affect the
short-term mortality, although it may increase the incidence of
atelectasis in adult, non-thoracic patients undergoing surgical
procedures. Nor were there any significant differences in other secondary
outcomes. Copyright © 2021 The Authors

<47>
Accession Number
2014516616
Title
Proteomic profiling identifies CLEC4C expression as a novel biomarker of
primary graft dysfunction after heart transplantation.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Truby L.K.; Kwee L.C.; Agarwal R.; Grass E.; DeVore A.D.; Patel C.B.; Chen
D.; Schroder J.N.; Bowles D.; Milano C.A.; Shah S.H.; Holley C.L.
Institution
(Truby, Agarwal, DeVore, Patel, Shah, Holley) Department of Medicine,
Division of Cardiology, Duke University School of Medicine, Durham, NC,
United States
(Truby, Kwee, Grass, Shah) Duke Molecular Physiology Institute, Duke
University Medical Center, Durham, NC, United States
(Chen) Duke Molecular Physiology Institute, Duke University Medical
Center, Durham, NC, United States
(Schroder, Bowles, Milano) Duke Molecular Physiology Institute, Duke
University Medical Center, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
PURPOSE: Clinical models to identify patients at high risk of primary
graft dysfunction (PGD) after heart transplantation (HT) are limited, and
the underlying pathophysiology of this common post-transplant complication
remains poorly understood. We sought to identify whether pre-transplant
levels of circulating proteins reporting on immune activation and
inflammation are associated with incident PGD. METHOD(S): The study
population consisted of 219 adult heart transplant recipients identified
between 2016 and 2020 at Duke University Medical Center, randomly divided
into derivation (n = 131) and validation (n = 88) sets. PGD was defined
using modified ISHLT criteria. Proteomic profiling was performed using
Olink panels (n = 354 proteins) with serum samples collected immediately
prior to transplantation. Association between normalized relative protein
expression and PGD was tested using univariate and multivariable
(recipient age, creatinine, mechanical circulatory support, and sex; donor
age; ischemic time) models. Significant proteins identified in the
derivation set (p < 0.05 in univariate models), were then tested in the
validation set. Pathway enrichment analysis was used to test candidate
biological processes. The predictive performance of proteins was compared
to that of the RADIAL score. RESULT(S): Nine proteins were associated
with PGD in univariate models in the derivation set. Of these, only CLEC4C
remained associated with PGD in the validation set after Bonferroni
correction (OR [95% CI] = 3.04 [1.74,5.82], p = 2.8 x 10-4).
Patterns of association were consistent for CLEC4C in analyses stratified
by biventricular/left ventricular and isolated right ventricular PGD.
Pathway analysis identified interferon-alpha response and C-type lectin
signaling as significantly enriched biologic processes. The RADIAL score
was a poor predictor of PGD (AUC = 0.55). CLEC4C alone (AUC = 0.66, p =
0.048) and in combination with the clinical covariates from the
multivariable model (AUC = 0.69, p = 0.018) improved discrimination for
the primary outcome. CONCLUSION(S): Pre-transplantation circulating
levels of CLEC4C, a protein marker of plasmacytoid dendritic cells (pDCs),
may identify HT recipients at risk for PGD. Further studies are needed to
better understand the potential role pDCs and the innate immune response
in PGD. Copyright © 2021 International Society for Heart and Lung
Transplantation

<48>
Accession Number
2014504860
Title
Postoperative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Woldendorp K.; Farag J.; Khadra S.; Black D.; Robinson B.; Bannon P.
Institution
(Woldendorp, Farag, Khadra, Black, Bannon) Faculty of Health and Medicine,
University of Sydney, Sydney, Australia
(Woldendorp, Farag, Robinson, Bannon) Cardiothoracic Surgical Department,
Royal Prince Alfred Hospital, Sydney, Australia
(Woldendorp, Black, Robinson, Bannon) Baird Institute of Applied Heart and
Lung Research, Sydney, Australia
Publisher
Elsevier Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) is common after
cardiac surgery and linked to poorer short-term and long-term outcomes;
however, conflicting evidence exists on stroke risk and how the index
procedure affects outcomes. This study aims to provide a comprehensive
review of the published outcomes of POAF after cardiac surgery, examined
as a whole and by index procedure. Method(s): A systematic review of
POAF after cardiac surgery was conducted. Outcomes related to POAF were
analyzed in a meta-analysis, and aggregate survival data were derived to
examine long-term survival. Result(s): Sixty-one studies with 239,018
patients were identified, the majority (78.7%) undergoing coronary
surgery. POAF occurred in 25.5% of patients and was associated with
significantly higher rates of early mortality and stroke (odds ratio [OR],
1.74; P < .001; and OR, 2.21, P < .001, respectively) along with longer
intensive care and overall hospital length of stay (mean difference 0.8
days, P = .008; and mean difference 2.8 days, P < .001, respectively).
After a median of 6.6 years (range, 0.5-20 years), mortality and stroke
remained significantly higher for those with POAF (OR, 1.57, P < .001; and
OR, 1.81, P = .001). Pooled hazard ratio for long-term mortality was
significantly higher for patients who underwent coronary surgery compared
with isolated valve surgery. Conclusion(s): POAF is common after
cardiac surgery and is associated with significantly higher rates of both
short-term and long-term stroke and mortality as well as increased
hospital stay. Differences in hazard for long-term survival may be due to
the underlying pathophysiological risk factors for POAF, which differ by
surgical procedure. Copyright © 2020 The Society of Thoracic
Surgeons

<49>
Accession Number
2006752476
Title
Review article assessing cardiovascular infection and inflammation with
fdg-pe.
Source
American Journal of Nuclear Medicine and Molecular Imaging. 11(1) (pp
46-58), 2021. Article Number: ajnmmi0127778. Date of Publication: 2021.
Author
Martineau P.; Gregoire J.; Harel F.; Pelletier-Galarneau M.
Institution
(Martineau) BC Cancer Agency, Vancouver, BC, Canada
(Gregoire, Harel, Pelletier-Galarneau) Department of Medical Imaging,
Montreal Heart Institute, Montreal, QC, Canada
(Pelletier-Galarneau) Gordon Center for Medical Imaging, Massachusetts
General Hospital, Harvard Medical School, Boston, United States
Publisher
E-Century Publishing Corporation
Abstract
FDG-PET has been shown to be a useful imaging modality for the assessment
of cardiovascular infection and inflammatory pathologies. However,
interpretation of these studies can be challenging in light of the
variability of physiological myocardial uptake and, occasionally,
interpreter's lack of familiarity with the typical findings present in
cardiac pathologies. In this article, we review established and emerging
applications for cardiovascular infection and inflammation imaging with
FDG-PET and present typical examples of representative
pathologies. Copyright © 2021, E-Century Publishing Corporation.
All rights reserved.

<50>
Accession Number
2010459950
Title
Comparison of CryoMaze With Cut-and-Sew Maze Concomitant With Mitral Valve
Surgery: A Randomized Noninferiority Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33(3) (pp 680-688), 2021.
Date of Publication: Autumn 2021.
Author
Han J.; Wang H.; Wang Z.; Yin Z.; Zhang J.; Jin Y.; Han H.
Institution
(Han, Wang, Wang, Yin, Zhang, Jin, Han) Department of Cardiovascular
Surgery, General Hospital of Northern Theater Command, Shenyang, Liaoning
Province, China
Publisher
W.B. Saunders
Abstract
In this trial, we sought to evaluate the efficacy and safety of the
addition of the Maze performed by cryoablation (CryoMaze) to the mitral
valve surgeries. The trial is a randomized, single-center trial to
determine whether CryoMaze was noninferior to cut-and-sew maze procedure
(CSM) in patients with persistent or long-standing persistent atrial
fibrillation (AF), with a 15% margin to establish noninferiority. The
primary endpoint was freedom from AF off antiarrhythmic drugs (AADs) at 12
months. Secondary endpoints included freedom from AF off AADs at 3 and 6
months, and a composite of serious adverse events. Two hundred patients
were randomized to either CryoMaze (n = 100) or CSM (n = 100). Freedom
from AF was achieved in 85 % (95% confidence interval, 0.76-0.91) in the
CryoMaze group and 88% (95% confidence interval, 0.80-0.94) in the CSM
group, showing that CryoMaze was noninferior to CSM at 12 months (P value
for noninferiority = 0.0065). There was no significant difference in
serious adverse effects (n = 12 in CryoMaze; n = 17 in CSM; P = 0.315).
Perioperative bleeding and the length of surgery, ICU stay, postoperative
hospital stay; and the need for temporary pacing decreased significantly
in the CryoMaze group. CryoMaze was noninferior to CSM for efficacy and
safety for patients with persistent or long-standing persistent AF
undergoing mitral valve surgeries. CryoMaze significantly decreased
bleeding, the length of surgery, ICU and hospital stay, as well the need
for temporary pacing. (Chinese Clinical Trial Register number,
ChiCTR-IOR-16008112.) Copyright © 2020 Elsevier Inc.

<51>
Accession Number
2011874895
Title
Study protocol for DICE trial: Video-assisted thoracoscopic surgery
decortication versus interventional radiology guided chest tube insertion
for the management of empyema.
Source
Contemporary Clinical Trials Communications. 22 (no pagination), 2021.
Article Number: 100777. Date of Publication: June 2021.
Author
Williams E.; Hanna N.; Menard A.; Mussari B.; Nasirzadeh R.; Tarulli E.;
Dhillon G.R.; Reid K.; Petsikas D.; Pereira J.; Heffernan P.; Chung W.
Institution
(Williams, Hanna, Reid, Petsikas, Pereira, Chung) Division of Thoracic
Surgery, Department of Surgery, Queen's University, 76 Stuart Street,
Kingston, ON K7L 2V7, Canada
(Menard, Mussari, Nasirzadeh, Tarulli, Dhillon) Division of Interventional
Radiology, Department of Radiology, Queen's University, 76 Stuart Street,
Kingston, ON K7L 2V7, Canada
(Heffernan) Division of Respirology, Department of Medicine, Queen's
University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
Publisher
Elsevier Inc.
Abstract
Background: Empyema is a common thoracic surgery presentation, defined as
pus in the pleural space. Despite the commonality of empyema, consensus on
initial management remains ambiguous. Two standard of care treatment
options include inserting a chest tube (thoracostomy) and the
administration of intrapleural fibrinolytics, or an initial surgical
approach, surgical decortication. Due to the complexity of this pleural
space infection, often repeat interventions are required after initial
management in order to achieve source control and resolution of clinical
symptoms. This study aims to identify the most effective initial
management option for empyema. Study design: We present a study protocol
for a randomized control trial (RCT) comparing adult individuals with
empyema to one of two standard of care initial management options.
Participants will be randomized into either interventional radiology
guided chest tube insertion with intrapleural fibrinolytics (Dornase 5 mg
and Alteplase 10 mg intrapleural twice daily for three days) or
video-assisted thoracoscopic surgery (VATS) decortication. Method(s):
All adults with empyema meeting inclusion criteria will be invited to
participate. They will be randomized into one of two intervention groups;
interventional radiology guided chest tube insertion with fibrinolytics or
initial VATS decortication. Each intervention will take place within 48
hours of randomization. The primary outcome will be the rate of
re-intervention within 30 days. Re-intervention is defined as repeat chest
tube insertion, VATS decortication, or decortication via thoracotomy.
Secondary outcomes include a change in the size of empyema, length of
stay, morbidity, as well as 30-day and 90-day mortality, as well as
quality of life measurements. Anticipated impact: This study is aimed at
identifying the most effective initial management option for individuals
with empyema. Copyright © 2021

<52>
Accession Number
2013284437
Title
Albumin use in bleeding cardiac surgical patients and associated patient
outcomes.
Source
Canadian Journal of Anesthesia. 68(10) (pp 1514-1526), 2021. Date of
Publication: October 2021.
Author
Hanley C.; Callum J.; McCluskey S.; Karkouti K.; Bartoszko J.
Institution
(Hanley) Department of Anesthesia, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre, Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Kingston, ON, Canada
(Karkouti, Bartoszko) Department of Anesthesia and Pain Management,
Toronto General Hospital - University Health Network, Sinai Health System,
Women's College Hospital, University of Toronto, 200 Elizabeth Street,
3EN-464, Toronto, ON M5G 2C4, Canada
(McCluskey, Karkouti, Bartoszko) Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Health Network, Toronto,
ON, Canada
(McCluskey, Karkouti) Institute of Health Policy Management and
Evaluation, University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: Albumin solution is a colloid used for resuscitation in cardiac
surgical patients, but it is unclear if it offers advantages over
crystalloids. We examined current clinical practice across 11 cardiac
surgical centres and the association of albumin with outcomes in a cohort
of bleeding cardiac surgical patients. Method(s): This was a post hoc
analysis of data from the Effect of Fibrinogen Concentrate vs
Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery
(FIBRES) trial. Multivariable regression models adjusted for demographic
and surgical characteristics were used to examine predictors of early
albumin administration (within the initial 24 perioperative hours), late
albumin administration (from 24 hr to seven days after cardiopulmonary
bypass), and the association of albumin use with 28-day acute kidney
injury, mortality, and length of hospital and intensive care unit (ICU)
stay. Result(s): Of the 735 patients included, 525 (71%) received
albumin, ranging from 4.8% to 97.4% of patients across institutions, with
475 (64.6%) receiving albumin early (5% or 25% solution). In the adjusted
models, female sex and preoperative hospital admission were associated
with early use, while heart failure, female sex, bleeding severity, older
age, and prior albumin use were predictors of later administration. Early
albumin use was not associated with differences in acute kidney injury
(adjusted odds ratio [aOR] 1.77; 95% confidence interval [CI], 0.96 to
3.27; P = 0.07), mortality (aOR 1.66; 95% CI, 0.99 to 2.78; P = 0.05), or
length of ICU stay (P = 0.11) or hospital stay (P = 0.67).
 Conclusion(s): Albumin use is common but highly variable within and
across sites. Albumin use was not associated with improved outcomes. High
quality randomized controlled trials should clarify its role in cardiac
surgical patients. Copyright © 2021, Canadian Anesthesiologists'
Society.

<53>
Accession Number
2010454212
Title
Effect of institutional transcatheter aortic valve replacement volume on
mortality: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 98(3) (pp E453-E461),
2021. Date of Publication: September 2021.
Author
Kir D.; Shapero K.; Chatterjee S.; Grimshaw A.; Oddleifson A.; Spatz E.S.;
Goldsweig A.M.; Desai N.R.
Institution
(Kir, Shapero, Oddleifson) Department of Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Kir) Department of Cardiology, University of Miami/Jackson Memorial
Hospital, Miami, FL, United States
(Chatterjee) Hofmann Heart and Vascular Institute, Saint Francis Hospital
and Medical Center, Hartford, CT, United States
(Grimshaw) Harvey Cushing/John Hay Whitney Medical Library, Yale
University, New Haven, CT, United States
(Spatz, Desai) Center for Outcomes Research and Evaluation, Yale-New Haven
Hospital, New Haven, CT, United States
(Spatz, Desai) Section of Cardiovascular Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Goldsweig) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: We sought to conduct a systematic review and network
meta-analysis to examine the association between institutional
transcatheter aortic valve replacement (TAVR) volume and all-cause
mortality. Background(s): Since inception in 2011, there has been an
exponential increase in the number of TAVR centers across the world.
Multiple studies have questioned if a relationship exists between
institutional TAVR volume and patient outcomes. Method(s): We
performed a systematic literature search for relevant articles using a
combination of free text terms in the title/abstract related to volume,
TAVR, and patient outcomes. Two reviewers independently screened all
titles/abstracts for eligibility based on pre-specified criteria.
All-cause mortality data was pooled from eligible studies and centers were
categorized as low-(30-50 cases), intermediate-, or high-volume (75-130
cases) based on their annual TAVR volumes. Result(s): Our search
yielded an initial list of 11,153 citations, 120 full text studies were
reviewed and 7 studies met all inclusion and exclusion criteria, yielding
a total of 1,93,498 TAVRs. Categorized according to center's annual
volume; 25,062 TAVRs were performed in low-, 77,093 in intermediate- and
91,343 in high-volume centers. Network meta-analysis showed a relative
reduction in mortality rates of 37%, 23% and 19%, for high volume versus
low volume centers, high volume versus intermediate volume centers and
intermediate versus low volume centers, respectively. Conclusion(s):
Existing research clearly shows an inverse relationship between annual
TAVR procedural volume and all-cause mortality. We need to focus on
development of strong referral networks and consolidation rather than
expansion of existing TAVR centers to improve patient outcomes, while
ensuring adequate access-to-care. Copyright © 2021 Wiley
Periodicals LLC.

<54>
Accession Number
2007063508
Title
Long-term follow-up of percutaneous coronary intervention versus coronary
artery bypass grafting in left main coronary artery disease: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 98(3) (pp 427-433),
2021. Date of Publication: September 2021.
Author
Garg A.; Rout A.; Raheja H.; Hakeem H.; Sharma S.
Institution
(Garg, Sharma) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Rout) Division of Cardiology, Einstein Medical Center Philadelphia,
Philadelphia, PA, United States
(Raheja) Division of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Hakeem) Division of Cardiology, Newark Beth Israel Medical center,
Newark, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We conducted a systematic review and meta-analysis to evaluate
the long-term outcomes of PCI compared to CABG in patients with LMCAD.
 Background(s): Recent data from randomized controlled trials (RCTs)
has raised concerns regarding the long-term efficacy and safety of
percutaneous coronary intervention (PCI) compared with coronary artery
bypass grafting (CABG) in patients with left main coronary artery disease
(LMCAD). Method(s): We searched MEDLINE and EMBASE databases for
published RCTs comparing PCI using stenting with CABG in patients with
LMCAD. Preferred reporting items for systematic review and meta-analysis
guidelines were used for the present study. End-points of interest were
all-cause mortality, cardiovascular (CV) mortality, myocardial infarction
(MI), stroke, and repeat revascularization at longest available follow-up.
Relevant data were collected and pooled odds ratio (OR) with 95%
confidence intervals (CI) was calculated using random-effects model.
 Result(s): Five RCTs including a total of 4,499 patients were
included in the final analysis. Mean duration of follow-up was 96 months.
The risks of all-cause mortality [OR 1.09 (95% CI 0.88-1.34)] and
cardiovascular mortality [1.14 (0.88-1.47)] were comparable between PCI
and CABG. There were no statistically significant differences between PCI
and CABG for MI [1.52 (0.98-2.37)] and stroke [0.84 (0.48-1.45)].
Conversely, repeat revascularization was significantly higher with PCI as
compared with CABG [1.82 (1.49-2.22)]. Conclusion(s): At long-term
follow-up, PCI is associated with similar risks of mortality but a higher
risk of repeat revascularization compared with CABG in LMCAD. Long-term
risk of MI with PCI compared to CABG needs to be further explored in
future studies. Copyright © 2020 Wiley Periodicals LLC.

<55>
Accession Number
635028879
Title
Impact of Lower Versus Higher LDL Cholesterol Targets on Cardiovascular
Events After Ischemic Stroke in Patients With Diabetes.
Source
Diabetes. 70(8) (pp 1807-1815), 2021. Date of Publication: 01 Aug 2021.
Author
Amarenco P.; Kim J.S.; Labreuche J.; Charles H.; Giroud M.; Lee B.-C.;
Lavallee P.C.; Mahagne M.-H.; Meseguer E.; Nighoghossian N.; Steg P.G.;
Vicaut E.; Bruckert E.
Institution
(Amarenco, Charles, Lavallee, Meseguer) INSERM LVTS-U1148, DHU FIRE,
Department of Neurology and Stroke Center, Bichat Hospital, University of
Paris, Assistance Publique-Hopitaux de Paris (APHP), Paris, France
(Kim) Asan Medical Center, Seoul, South Korea
(Labreuche) EA 2694, Sante Publique Epidemiologie et Qualite des Soins,
CHU Lille, Universite Lille, Lille, France
(Giroud) EA 7460, Dijon Stroke Registry, Department of Neurology,
University Hospital of Dijon, University of Burgundy, University of
Burgundy Franche-Comte, Dijon, France
(Lee) Department of Neurology, Hallym University Sacred Heart Hospital,
Anyang, South Korea
(Mahagne) Stroke Unit, Pasteur Hospital, Nice, France
(Nighoghossian) Department of Neurology and Stroke Center, Hospices Civils
de Lyon, Lyon University, Lyon, France
(Steg) INSERM LVTS-U1148, Bichat Hospital, University of Paris, Assistance
Publique-Hopitaux de Paris (APHP), Paris, France
(Vicaut) Department of Biostatistics, Fernand Widal Hospital, APHP,
Universite Paris-Diderot, Sorbonne-Paris Cite, Paris, France
Publisher
NLM (Medline)
Abstract
After an ischemic stroke with evidence of atherosclerosis, lipid-lowering
treatment with a target LDL cholesterol of <70 mg/dL compared with 100 +/-
10 mg/dL reduced the risk of subsequent cardiovascular events. In this
analysis, we explored the effect in the subgroup of patients with diabetes
compared with the subgroup without, as well as in those with newly
diagnosed diabetes. Patients with ischemic stroke in the previous 3 months
or transient ischemic attack within the previous 15 days and evidence of
cerebrovascular or coronary artery atherosclerosis were randomly assigned
at a 1:1 ratio to a target LDL cholesterol of <70 mg/dL or 100 +/- 10
mg/dL using statin or ezetimibe. The primary outcome was the composite of
ischemic stroke, myocardial infarction, new symptoms requiring urgent
coronary or carotid revascularization, and death resulting from vascular
disease. We performed a prespecified analysis to evaluate the effect in
patients with diabetes. Of 2,860 patients enrolled, 643 had diabetes at
baseline, with a mean age of 66.2 years and baseline LDL cholesterol of
127 mg/dL, and were followed for a median of 3 years. The primary
composite end point occurred in 27 (8.2%) of 328 patients in the
lower-target group and in 44 (14.0%) of 315 patients in the higher-target
group (adjusted hazard ratio [HR] 0.56; 95% CI 0.34-0.89; P = 0.016). In
patients without diabetes, the HR was 0.87 (95% CI 0.66-1.14; P = 0.31;
interaction P = 0.15). In those with diabetes, there were three
intracranial hemorrhages in both randomization groups (0.9% vs. 1.0%,
respectively). Newly diagnosed diabetes occurred in 98 (9.2%) of 1,070 and
in 80 (7.4%) of 1,085 patients in the lower- and higher-target groups,
respectively (HR 1.27; 95% CI 0.94-1.71; P = 0.11), and baseline higher
HbA1c was the unique multivariable predictor. In conclusion, after an
ischemic stroke with evidence of atherosclerosis, targeting an LDL
cholesterol of <70 mg/dL compared with 100 +/- 10 mg/dL consistently
reduced the risk of subsequent stroke and other major vascular events in
patients with and without diabetes, but the higher risk in those with
diabetes yielded a higher absolute risk reduction, with number needed to
treat of 17. Copyright © 2021 by the American Diabetes
Association.

<56>
Accession Number
629634839
Title
Music Interventions in Percutaneous Coronary Procedures: A Meta-Analysis.
Source
Clinical nursing research. 30(2) (pp 135-145), 2021. Date of Publication:
01 Feb 2021.
Author
Su S.-F.; Yeh W.-T.
Institution
(Su) Department of Nursing, National Taichung University of Science and
Technology, Taichung City, Taiwan (Republic of China)
(Yeh) Department of Nursing, Taichung Veterans General Hospital, Taichung
City, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
To clarify the effectiveness of music intervention for improving the
well-being of patients undergoing coronary procedures for coronary heart
disease, we conducted full-text searches of various databases (MEDLINE,
Cochrane Library, CINAHL, ProQuest, and Airiti Library; 1966-2019) to
identify randomized controlled trials and quasi-experimental studies of
music intervention in recipients of angiography or percutaneous coronary
intervention. Outcome measures included anxiety, discomfort, pain, heart
rate, and blood pressure. The Cochrane methodology, Jadad Quality Score,
and ROBINS-I were employed to evaluate evidence from 10 studies. Music
intervention reduced anxiety (effect size: Z = 2.15, p = .03; six studies)
and discomfort of lying (Z = 2.40, p = .02; two studies), but did not
affect pain (Z = 0.94; two studies), heart rate (Z = 0.94; five studies),
or blood pressure (systolic, Z = 1.27; diastolic, Z = 1.32; four studies)
(all p > .05). The heterogeneity among studies was high. Large-scale,
transcultural, high-quality trials are warranted to confirm the benefit of
music intervention in patients undergoing coronary procedures.

<57>
Accession Number
633615537
Title
Music therapy as an adjunct in cardiac device lead extraction procedures:
A randomized controlled trial.
Source
Applied nursing research : ANR. 56 (pp 151376), 2020. Date of Publication:
01 Dec 2020.
Author
Blichfeldt-AEro S.C.; Knutsen T.M.; Hagen H.M.; Diep L.M.; Trondalen G.;
Halvorsen S.
Institution
(Blichfeldt-AEro) Centre for Research in Music and Health (CREMAH),
Norwegian Academy of Music, PB 5190, NO-0363 Oslo, Norway
(Knutsen, Hagen) Department of Cardiology, Oslo University Hospital
Ulleval, Kirkeveien 166, Oslo 0450, Norway
(Diep) Oslo Centre for Biostatistics and Epidemiology (OCBE), Oslo
University Hospital, Oslo, Norway
(Trondalen) Centre for Research in Music and Health (CREMAH), Norwegian
Academy of Music, PB 5190, NO-0363 Oslo, Norway
(Halvorsen) Department of Cardiology, Oslo University Hospital Ulleval,
Kirkeveien 166, 0450 Oslo, Norway; Faculty of Medicine, University of
Oslo, Klaus Torgards vei 3, 0372 Oslo, Norway
Publisher
NLM (Medline)
Abstract
BACKGROUND: Evidence of music therapy as an effective supportive therapy
in invasive cardiac procedures is increasing, but more research is needed.
AIMS: To evaluate the impact of music therapy on stress responses during
cardiac device lead extraction procedures performed in local anaesthesia.
 METHOD(S): Sixty-four patients undergoing cardiac implantable
electronic device lead extraction at Oslo University Hospital Ulleval from
March 2018 to September 2019 were randomized to music therapy (n=32) or
control (n=32). Primary endpoints were patient satisfaction with pain
management and average pain intensity during the procedure. Secondary
endpoints were average anxiety intensity, need for analgesic/anxiolytic
drugs, blood pressure, heart and respiration rate. RESULT(S): All
patients in the music therapy group completed the intervention. Patient
satisfaction with pain management was 10.00 (8.00, 10.00) in the music
therapy vs. 10.00 (9.00, 10.00) in the control group (p=0.85), and average
level of pain 0.89 (0.22, 1.13) vs. 0.96 (0.36, 1.58), respectively
(p=0.38). Average anxiety score was 1.00 (0.33, 2.17) in the music therapy
vs 1.67 (0.71, 3.35) in the control group (p=0.056). The use of
analgesic/anxiolytic drugs and physiological parameters were similar
across groups. CONCLUSION(S): In this study of music therapy during
cardiac device lead extractions, no effect was found on patient
satisfaction with pain management or average pain level. A decrease in
patient anxiety of borderline significance was observed in the music
therapy group. More studies with more sensitive measures of pain and
anxiety are needed to determine the value of music therapy in invasive
cardiac procedures. Copyright © 2020 Elsevier Inc. All rights
reserved.

<58>
Accession Number
635935478
Title
A comparative study of the efficacy of Glidescope versus Macintosh direct
laryngoscopy for intubation in pediatric patients undergoing cardiac
surgery.
Source
Saudi Journal of Anaesthesia. 15(4) (pp 419-423), 2021. Date of
Publication: October-December 2021.
Author
Zabani I.; AlHarbi M.; AlHassoun A.; Iqbal S.; Al Amoudi D.; AlOtaibi S.;
Saad H.
Institution
(Zabani, AlHarbi, AlHassoun, Iqbal, Al Amoudi, AlOtaibi, Saad) Department
of Anesthesiology, King Faisal Specialist Hospital and Research Center,
Jeddah, Saudi Arabia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: The Glidescope is a novel, portable, reusable video
laryngoscope that has provided superior laryngeal visualization to
facilitate tracheal intubation, especially in the management of difficult
airways. In this study, we aimed to compare the efficacy of the Glidescope
(video-laryngoscope) against the Macintosh direct laryngoscope.
 Method(s): Fifty patients were randomly selected via simple
randomization using computer-generated random numbers, and sorted into two
groups of 25 patients: the Glidescope group and the Macintosh group. We
included pediatric patients undergoing cardiac surgery for the repair of
congenital heart disease. Those with suspected difficult intubation,
preterm babies with low body weight, and patients at risk of aspiration
were all excluded. Result(s): Patients' baseline demographic and
clinical characteristics were found to be comparable in the two groups.
The mean intubation time was 24.1 +/- 13.6 s in the Glidescope group, as
compared to 18.1 +/- 5.9 s in the Macintosh group. Blade insertion was
easy in 92% and 96% of the patients in the Glidescope and Macintosh
groups, respectively. Tracheal intubation was considered easy in 84% of
the Glidescope group, compared to 92% of the Macintosh group. There was a
statistically significant correlation between the ease of tracheal
intubation and the used intubation method (rho = -0.35; P = 0.014).
 Conclusion(s): Our findings indicate that the Glidescope can be used
as an efficient modality for obtaining successful intubations with no
complications. Ease of tracheal intubation was the only outcome that was
found to be affected by the used modality. Further investigations with
proper sample sizes are needed. Copyright © 2021 Saudi Journal of
Anesthesia Published by Wolters Kluwer - Medknow

<59>
Accession Number
2013674373
Title
Management of pediatric cardiac surgery wound: A literature review.
Source
Acta Biomedica. 92(4) (no pagination), 2021. Article Number: e2021203.
Date of Publication: 02 Sep 2021.
Author
Prendin A.; Tabacco B.; Fazio P.C.; de Barbieri I.
Institution
(Prendin) University-Hospital of Padua, Padua, Italy
(Tabacco) Independent researcher, Seattle, United States
(Fazio) Pediatric Intensive Care Unit, UniversityHospital of Padua, Padua,
Italy
(de Barbieri) Woman's & Child's Health Department, University-Hospital of
Padua, Padua, Italy
Publisher
Mattioli 1885
Abstract
Background: Sternal wound infection is a severe complication of cardiac
surgery in the pediatric population (0-18 years old) that can lead to
increased morbidity, mortality, and prolonged hospitalization. Health
professionals have the ability to perform some interventions during the
pre, intra and post-surgery to correctly manage sternal wounds, with the
goal of preventing infections. Objective(s): To identify and discuss
current best practice in the prevention, incidence, and treatment of
infections of the cardiac surgery site in the pediatric population.
 Method(s): Between February 20th 2021 and February
28th 2021 we consulted the PubMed database adopting full text,
20 years, Humans, English, Child aged 0 to 18 years as criteria. Twenty
articles out of sixty-six were considered relevant to this study. These
were divided into four themes. Result(s): All studies highlight the
lack of standard guidelines for managing pediatric patients undergoing
cardiac surgery. Some centers developed protocols for managing antibiotic
prophylaxis supported by measurable interventions; others implemented
infection surveillance systems involving families taking care of patients
after hospital discharge. Discussion(s): the identification of
healthcare-associated infections in the pediatric population after cardiac
surgery is useful in all peri-operative phases. The limited and restricted
literature connected to single centers, with relatively small sample
sizes, the use of a single database. Conclusion(s): There is a lack
of standard guidelines. The prevention of site infection ought to the goal
of reducing surgical site infections. Building a network between the
multidisciplinary staff and the pediatric patient's family improves the
infection surveillance system, reducing the incidence of infections.
(www.actabiomedica.it). Copyright © Mattioli 1885.

<60>
Accession Number
2013648627
Title
Trifecta versus perimount bioprosthesis for surgical aortic valve
replacement; systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yokoyama Y.; Kuno T.; Takagi H.; Fukuhara S.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Fountain Hill, PA, United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York City, NY, United States
(Kuno) Department of Cardiology, Montefiore Medical Center/Albert Einstein
Medical College, New York City, NY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, Michigan, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: Recent studies suggested higher rates of early structural valve
degeneration or reintervention for the Trifecta valve compared to other
valves. Thus, we conducted a systematic review and meta-analysis comparing
the outcomes of the Trifecta valve and the Perimount valves in patients
who underwent a surgical aortic valve replacement (SAVR). Method(s):
All randomized control trials and observational studies which investigated
the outcomes of the Trifecta valve and Perimount valves were identified
with PubMed and EMBASE. The endpoints were the rates of reintervention and
all-cause mortality. Hazard ratios (HRs) for reintervention and all-cause
mortality were combined with the random-effects model. Result(s): Our
search identified 6 eligible observational studies which enrolled a total
of 11,135 patients who underwent SAVR with either the Trifecta valve (n =
4932) or Perimount (n = 6203). Pooled analyses demonstrated that the
reintervention rates were significantly higher with the Trifecta valve
compared with Perimount valves (HR [95% confidence interval {CI}] = 3.16
[1.83-5.46]; p <.0001; I2= 40%). In contrast, all-cause
mortality was not significantly different between the two groups (HR [95%
CI] = 1.09 [0.75-1.58]; p =.32, I2= 12%). Conclusion(s):
Our analysis showed that AVR with the Trifecta valve was associated with
higher rates of reintervention compared for that with the Perimount valve.
Although further long-term randomized trials are warranted, surgeons need
to be cautious when choosing a bioprosthetic valve for patients undergoing
SAVR. Copyright © 2021 Wiley Periodicals LLC.

<61>
Accession Number
635935221
Title
Percutaneous Coronary Intervention with Stenting versus Coronary Artery
Bypass Grafting in Stable Coronary Artery Disease.
Source
International Journal of Angiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Glenn I.C.; Iacona G.M.; Mangi A.A.
Institution
(Glenn) Department of Thoracic and Cardiovascular Surgery, Heart Vascular,
and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Iacona, Mangi) Medstar Health Cardiac Surgery, Heart and Vascular
Institute, Medstar Washington Hospital Center, 110 Irving Street
Northwest, Washington, DC 20010, United States
Publisher
Thieme Medical Publishers, Inc.
Abstract
The debate over coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) with stent placement for the treatment of
stable multivessel coronary artery disease (CAD) continues in spite of
numerous studies investigating the issue. This paper reviews the most
recent randomized control trials (RCT) and meta-analyses of pooled RCT
data to help address this issue. General trends demonstrated that CABG was
superior in all-cause mortality and fulfilling the need for repeat
revascularization. These advantages tended to be more pronounced in
multivessel CAD and diabetes, and less so in left main CAD. PCI showed a
consistently lower rate of cerebrovascular events. CABG continues to offer
significant advantages over PCI, even as drug-eluting stent technology
continues to evolve. The ideal endpoint for comparing PCI and CABG remains
to be determined. Furthermore, additional research is required to further
refine patient selection criteria for each intervention. Copyright
© 2021 American Medical Association. All rights reserved.

<62>
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.

<63>
Accession Number
635779529
Title
Prediction models for hospital readmissions in patients with heart
disease: A systematic review and meta-analysis.
Source
BMJ Open. 11(8) (no pagination), 2021. Article Number: e047576. Date of
Publication: 17 Aug 2021.
Author
Van Grootven B.; Jepma P.; Rijpkema C.; Verweij L.; Leeflang M.; Daams J.;
Deschodt M.; Milisen K.; Flamaing J.; Buurman B.
Institution
(Van Grootven) Department of Public Health and Primary Care, Katholieke
Universiteit Leuven, Leuven, Belgium
(Van Grootven) Research Foundation Flanders, Brussel, Belgium
(Jepma, Verweij, Buurman) Center of Expertise Urban Vitality, Faculty of
Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
(Rijpkema) Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam,
Netherlands
(Leeflang, Buurman) Faculty of Science, Amsterdam UMC Locatie AMC,
Amsterdam, Netherlands
(Daams) Medical Library, Amsterdam UMC Location AMC, Amsterdam,
Netherlands
(Deschodt, Milisen) Department of Public Health and Primary Care, KU
Leuven - University of Leuven, Leuven, Belgium
(Deschodt) Department of Public Health, University of Basel, Basel,
Switzerland
(Milisen) Department of Geriatric Medicine, University Hospitals Leuven,
Leuven, Belgium
(Flamaing) Department of Public Health and Primary Care, University
Hospitals Leuven, Leuven, Belgium
(Flamaing) Department of Geriatric Medicine, KU Leuven - University of
Leuven, Leuven, Belgium
Publisher
BMJ Publishing Group
Abstract
Objective To describe the discrimination and calibration of clinical
prediction models, identify characteristics that contribute to better
predictions and investigate predictors that are associated with unplanned
hospital readmissions. Design Systematic review and meta-analysis. Data
source Medline, EMBASE, ICTPR (for study protocols) and Web of Science
(for conference proceedings) were searched up to 25 August 2020.
Eligibility criteria for selecting studies Studies were eligible if they
reported on (1) hospitalised adult patients with acute heart disease; (2)
a clinical presentation of prediction models with c-statistic; (3)
unplanned hospital readmission within 6 months. Primary and secondary
outcome measures Model discrimination for unplanned hospital readmission
within 6 months measured using concordance (c) statistics and model
calibration. Meta-regression and subgroup analyses were performed to
investigate predefined sources of heterogeneity. Outcome measures from
models reported in multiple independent cohorts and similarly defined risk
predictors were pooled. Results Sixty studies describing 81 models were
included: 43 models were newly developed, and 38 were externally
validated. Included populations were mainly patients with heart failure
(HF) (n=29). The average age ranged between 56.5 and 84 years. The
incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was
high in almost all studies. The c-statistic was <0.7 in 72 models, between
0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data
source and number of predictors were significant moderators for the
discrimination. Calibration was reported for 27 models. Only the GRACE
(Global Registration of Acute Coronary Events) score had adequate
discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86).
Eighteen predictors were pooled. Conclusion Some promising models require
updating and validation before use in clinical practice. The lack of
independent validation studies, high RoB and low consistency in measured
predictors limit their applicability. PROSPERO registration number
CRD42020159839. Copyright © 2021 Institute of Electrical and
Electronics Engineers Inc.. All rights reserved.

<64>
Accession Number
2013682337
Title
Prognostic relevance of exercise testing in hypertrophic cardiomyopathy. A
systematic review.
Source
International Journal of Cardiology. 339 (pp 83-92), 2021. Date of
Publication: 15 Sep 2021.
Author
Rodrigues T.; Raposo S.C.; Brito D.; Lopes L.R.
Institution
(Rodrigues, Brito) Cardiology Department, Centro Hospitalar Universitario
Lisboa Norte, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal
(Rodrigues, Brito, Lopes) CAML, CCUL, Lisbon School of Medicine,
Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal
(Raposo) Unidade de Saude Familiar Reynaldo dos Santos, Agrupamento de
Centros de Saude Estuario do Tejo, Administracao Regional de Saude Lisboa
e Vale do Tejo, Portugal
(Raposo) Lisbon School of Medicine, Universidade de Lisboa, Lisboa,
Portugal
(Lopes) Barts Heart Centre, St. Bartholomew's Hospital, London, UK, United
Kingdom
(Lopes) Centre for Heart Muscle Disease, Institute of Cardiovascular
Science, University College London, London, UK, United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Cardiopulmonary exercise test (CPET) is indicated as part of
the assessment in hypertrophic cardiomyopathy (HCM) patients and stress
echocardiography is often used to assess symptoms. However, the role of
exercise testing for prognostic stratification in HCM is still not
established. Aim(s): To systematically review the evidence on the
role of exercise testing for prognostic stratification in hypertrophic
cardiomyopathy. Method(s): A systematic review was conducted for
eligible publications, between 2010 and 2020, that included evaluation of
outcomes and prognosis. In these studies, patients underwent exercise
echocardiography and/or cardiopulmonary exercise testing, performed
according to predefined protocols. Diverse parameters were assessed in
order to determine which were relevant for the prognosis. Analyzed
outcomes included death from any cause, sudden cardiac death (SCD) and
equivalents, cardiovascular death, heart failure requiring hospitalization
or progression to New York Heart Association classes III or IV, cardiac
transplantation, non-sustained ventricular tachycardia, stroke, myocardial
infarction and invasive septal reduction therapy. Result(s): Eighteen
publications were included, corresponding to a total of 7525 patients. The
mean follow-up period varied between 1 and 8 years. The main findings of
these studies revealed that the major predictors of outcomes were abnormal
heart rate recovery, abnormal blood pressure response exercise induced
wall motion abnormalities, lower peak VO2, higher VE/VCO2, and pulmonary
hypertension/exercise-induced pulmonary hypertension. Conclusion(s):
Although most studies concluded that exercise test results are useful to
determine prognosis in HCM, further investigation is needed regarding
whether it adds independent value to the current risk stratification
strategies. Copyright © 2021 The Author(s)

<65>
Accession Number
2013407522
Title
Impact of bilateral versus single internal thoracic artery grafting on the
long-term survival in adults: A systematic review.
Source
Vascular Health and Risk Management. 17 (pp 509-518), 2021. Date of
Publication: 2021.
Author
Smady M.N.A.; Zaki M.N.; Alataywi E.; Jegaden O.
Institution
(Smady, Zaki, Alataywi) College of Medicine, Mohammed Bin Rashid
University of Medicine and Health Sciences, Dubai, United Arab Emirates
(Jegaden) Cardiothoracic Surgery Department, Mediclinic Airport Road
Hospital, Abu Dhabi, United Arab Emirates
Publisher
Dove Medical Press Ltd
Abstract
Objective: To analyse the survival of patients who had undergone bilateral
internal thoracic artery grafting versus those with single internal
thoracic artery grafting from the available literature. Moreover, this
study will review the available literature regarding which of the two
techniques seems to be the safest with long-term survival and reduced
mortality rates. Method(s): A literature search of the databases was
conducted to retrieve studies that fall under the study design of cohort
and randomized controlled clinical trials in English from January 2015 to
July 2021. Finally, seven studies were selected: four cohort studies and
three other from a randomized trial. Result(s): The cohort studies
revealed that bilateral internal thoracic artery grafting is associated
with lower mortality rates and better long-term survival outcomes than
single internal thoracic artery grafting, while the ART randomized
controlled clinical trials showed that there is no significant difference
in mortality rates between both the coronary artery bypass grafting
techniques. However, all studies concluded that bilateral internal
thoracic artery grafting is associated with a higher frequency of deep
sternal wound infections. Conclusion(s): The discrepancy in results
between the cohort studies and randomized controlled clinical trial
remains persistent. However, the stated advantages of bilateral internal
thoracic artery grafting are not strong enough to convince surgeons to
alter their practice and the wide magnitude of expectations from the ART
study was reckoned as inadequate. This may well be due to the presence of
limited criteria for bilateral internal thoracic artery grafting in
identifying the impact on survival of extended arterial revascularization,
and there is a new colossal expectation from the ongoing randomized trial
based on multiple arterial grafting versus single arterial
grafting. Copyright © 2021 Al Smady et al.

<66>
Accession Number
2012843406
Title
External validity of randomized clinical trial studying preventing
depressive symptoms following acute coronary syndrome.
Source
Brain and Behavior. 11(8) (no pagination), 2021. Article Number: e02132.
Date of Publication: August 2021.
Author
Madsen M.T.; Juel K.; Simonsen E.; Gogenur I.; Zwisler A.D.O.
Institution
(Madsen, Gogenur) Center for Surgical Science, Department of Surgery,
Zealand University Hospital, Koege, Denmark
(Juel) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
(Simonsen) Psychiatric Research Unit, Slagelse, Denmark
(Simonsen, Gogenur) Department of Clinical Medicine, Faculty of Health and
Medical Sciences, University of Copenhagen, Copenhagen, Denmark
(Zwisler) REHPA - Danish Knowledge Center for Rehabilitation and
Palliative Care, Odense University Hospital, University of Southern
Denmark, Odense, Denmark
(Zwisler) The Danish Clinical Quality Program (RKKP), Danish Cardiac
Rehabilitation Database, National Clinical Registries, Aarhus, Denmark
Publisher
John Wiley and Sons Ltd
Abstract
Objective: The objective of the current study was to quantitatively
explore aspects of external validity, both researcher's choices
(eligibility) and patient's choices (consent), of a recently conducted
clinical trial. Method(s): A cohesive comparison between the MEDACIS
trial (NCT02451293) database and a national quality and research database
was conducted. Comparisons between both participants and nonconsenting
patients (patient consent) and participants and noneligible patients
(researcher selection) were performed. Comparisons of outcomes were
depressive and anxiety symptoms, demographics, and somatic or psychiatric
comorbidity. Result(s): Noneligible patients had significantly higher
levels of depressive symptoms and anxiety and were older and more likely
to suffer from unstable angina pectoris. Furthermore, noneligible patients
were less likely to be married, had a lower educational level, used more
medication, and had a higher frequency of comorbidity. Nonconsenting
patients had significantly higher levels of depressive symptoms and
anxiety and were older and more likely to be females compared to
participants. Conclusion(s): Significant differences were present
between noneligible patients and participants; however, more troublingly
significant differences were shown between nonconsenting patients and
participants. The presence of depressive symptoms and anxiety has a
significant impact on patients' willingness to give informed consent in
clinical trials in cardiology with a focus on psychological
outcomes. Copyright © 2021 The Authors. Brain and Behavior
published by Wiley Periodicals LLC.

<67>
Accession Number
2007320770
Title
Cardiopulmonary exercise test in patients with hypertrophic
cardiomyopathy: A systematic review and meta-analysis.
Source
Journal of Clinical Medicine. 10(11) (no pagination), 2021. Article
Number: 2312. Date of Publication: 01 Jun 2021.
Author
Bayonas-ruiz A.; Munoz-franco F.M.; Ferrer V.; Perez-caballero C.;
Sabater-molina M.; Tome-esteban M.T.; Bonacasa B.
Institution
(Bayonas-ruiz, Bonacasa) Human Physiology Area, Faculty of Sport Sciences,
University of Murcia, Santiago de la Ribera-San Javier, Murcia 30720,
Spain
(Munoz-franco) Cardiology, Virgen de la Arrixaca Universitary Hospital,
Murcia 30120, Spain
(Ferrer) Physiotherapy Department, Faculty of Medicine, University of
Murcia, Campus of Espinardo, Murcia 30100, Spain
(Perez-caballero) Sports Activities Service, University of Murcia, Campus
of Espinardo, Murcia 30100, Spain
(Sabater-molina) Inherited Cardiopathies Unit, Virgen de la Arrixaca,
Universitary Hospital, Institute for Biomedical Research of Murcia (IMIB),
University of Murcia, European Reference Networks (Guard-Heart), El Palmar
Murcia 30120, Spain
(Tome-esteban) Cardiovascular Clinical Academic Group, Inherited
Cardiovascular Disease Unit, St George's Hospital NHS Foundation Trust, St
George's University of London, London SW17 0QT, United Kingdom
Publisher
MDPI
Abstract
Background: Patients with chronic diseases frequently adapt their
lifestyles to their functional limitations. Functional capacity in
Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We
aim to review and analyze the available data from the literature on the
value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective
measurements from CPET are used for evaluation of patient response to
traditional and new developing therapeutic measurements. Method(s): A
systematic review of the literature was conducted in PubMed, Web of
Science and Cochrane in Mar-20. The original search yielded 2628 results.
One hundred and two full texts were read after the first screening, of
which, 69 were included for qualitative synthesis. Relevant variables to
be included in the review were set and 17 were selected, including
comorbidities, body mass index (BMI), cardiac-related symptoms,
echocardiographic variables, medications and outcomes. Result(s):
Study sample consisted of 69 research articles, including 11,672 patients
(48 +/- 14 years old, 65.9%/34.1% men/women). Treadmill was the most
common instrument employed (n = 37 studies), followed by upright
cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max)
was 22.3 +/- 3.8 mL.kg-1.min-1. The highest average
values were observed in supine and upright cycle-ergometer (25.3 +/- 6.5
and 24.8 +/- 9.1 mL.kg-1.min-1; respectively).
Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18
publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was
present at baseline in 31.4% of cases. It increased to 49% during
exercise. Proportion of abnormal blood pressure response (ABPRE) was
higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p
< 0.001). Mean VO2max was not significantly different between severe vs.
milder hypertrophy, or for obstructive vs. non-obstructive groups.
Occurrence of arrhythmias during functional assessment was higher among
younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three
publications (9145 patients) evaluated the prognostic value of exercise
capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0%
sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated
cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter
defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 +/-
2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of
age-gender predicted METs, ABPRE and ventricular arrhythmias were
significantly associated with major outcomes individually. Mean VO2max was
reduced in patients who reached the combined cardiovascular death outcome
compared to those who survived (-6.20 mL.kg-1.min-1;
CI 95%: -7.95, -4.46; p < 0.01). Conclusion(s): CPET is a valuable
tool and can safely perform for assessment of physical functional capacity
in patients with HCM. VO2max is the most common performance measurement
evaluated in functional studies, showing higher values in those based on
cycle-ergometer compared to treadmill. Subgroup analysis shows that
exercise intolerance seems to be more related to age, medication and
comorbidities than HCM phenotype itself. Lower VO2max is consistently seen
in HCM patients at major cardiovascular risk. Copyright © 2021 by
the authors. Licensee MDPI, Basel, Switzerland.

<68>
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
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.

<69>
Accession Number
2014072515
Title
Effects of inorganic nitrate on ischaemia-reperfusion injury after
coronary artery bypass surgery.
Source
British Journal of Anaesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Eriksson K.E.; Eidhagen F.; Liska J.; Franco-Cereceda A.; Lundberg J.O.;
Weitzberg E.
Institution
(Eriksson, Eidhagen, Lundberg, Weitzberg) Department of Physiology and
Pharmacology, Karolinska Institutet, Stockholm, Sweden
(Eriksson, Weitzberg) Department of Perioperative Medicine and Intensive
Care, Karolinska University Hospital, Stockholm, Sweden
(Eidhagen) Stockholm Center for Spine Surgery (RKC), Stockholm, Sweden
(Liska, Franco-Cereceda) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Liska, Franco-Cereceda) Department of Cardiothoracic Surgery, Karolinska
University Hospital, Stockholm, Sweden
Publisher
Elsevier Ltd
Abstract
Background: Nitric oxide (NO) is an important signalling molecule in the
cardiovascular system with protective properties in ischaemia-reperfusion
injury. Inorganic nitrate, an oxidation product of endogenous NO
production and a constituent in our diet, can be recycled back to
bioactive NO. We investigated if preoperative administration of inorganic
nitrate could reduce troponin T release and other plasma markers of injury
to the heart, liver, kidney, and brain in patients undergoing cardiac
surgery. Method(s): This single-centre, randomised, double-blind,
placebo-controlled trial included 82 patients undergoing coronary artery
bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mgx2)
or placebo (NaCl) were administered before surgery. Biomarkers of
ischaemia-reperfusion injury and plasma nitrate and nitrite were collected
before and up to 72 h after surgery. Troponin T release was our predefined
primary endpoint and biomarkers of renal, liver, and brain injury were
secondary endpoints. Result(s): Plasma concentrations of nitrate and
nitrite were elevated in nitrate-treated patients compared with placebo.
The 72-h release of troponin T did not differ between groups. Other plasma
biomarkers of organ injury were also similar between groups. Blood loss
was not a predefined outcome parameter, but perioperative bleeding was 18%
less in nitrate-treated patients compared with controls.
 Conclusion(s): Preoperative administration of inorganic nitrate did
not influence troponin T release or other plasma biomarkers of organ
injury in cardiac surgery. Clinical trial registration:
NCT01348971. Copyright © 2021 The Authors

<70>
Accession Number
2014072382
Title
Perioperative Neutrophil-Lymphocyte Ratio Predicts Mortality After Cardiac
Surgery: Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Perry L.A.; Liu Z.; Loth J.; Penny-Dimri J.C.; Plummer M.; Segal R.; Smith
J.
Institution
(Perry, Liu, Loth, Segal) Department of Anaesthesia, Royal Melbourne
Hospital, Parkville, Australia
(Penny-Dimri, Smith) Department of Surgery, Monash University, Clayton,
Australia
(Penny-Dimri, Smith) School of Clinical Sciences, Monash Health, Clayton,
Australia
(Plummer) Intensive Care Unit, Royal Melbourne Hospital, Parkville,
Australia
(Plummer) Department of Critical Care, University of Melbourne, Parkville,
Australia
(Segal) Department of Medicine, University of Melbourne, Parkville,
Australia
Publisher
W.B. Saunders
Abstract
Objectives: Neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker
that has been evaluated across a variety of surgical disciplines and is
widely predictive of poor postoperative outcome, but its value in cardiac
surgery is unclear. The authors did this systematic review and
meta-analysis to determine the impact of elevated perioperative NLR on
survival after cardiac surgery. Design(s): Systematic review and
meta-analysis of study-level data. Setting(s): Multiple hospitals
involved in an international pool of studies. Participant(s): Adults
undergoing cardiac surgery. Intervention(s): None. Measurements
and Main Results: The authors searched multiple databases from inception
until November 2020. They generated summary hazard ratios (HR) and odds
ratios (OR) for the association of elevated preoperative NLR with
long-term and short-term mortality following cardiac surgery. They
separately reported on elevated postoperative NLR. Between-study
heterogeneity was explored using metaregression. The authors included 12
studies involving 13,262 patients undergoing cardiac surgery. Elevated
preoperative NLR was associated with worse long-term (>30 days) (hazard
ratio [HR] 1.56; 95% CI [confidence interval], 1.18-2.06; 8 studies) and
short-term (<30 days) mortality (OR 3.18; 95% CI, 1.90-5.30; 7 studies).
One study reported the association of elevated postoperative NLR with
long-term mortality (HR 8.58; 95% CI, 2.55-28.85). There was considerable
between-study heterogeneity for the analysis of long-term mortality
(I2 statistic 94.39%), which mostly was explained by
study-level variables, such as the number of variables adjusted for by
included studies and how many of these significantly increased the risk of
long-term mortality, high risk of bias, and number of study centers, as
well as participant level factors, such as average participant age and
hypertension prevalence. Conclusion(s): Perioperative NLR is an
independent predictor of short-term and long-term postoperative mortality
following cardiac surgery. Further research is required to determine which
patient-level factors modify the prognostic value of NLR and to evaluate
its role in routine clinical practice. Copyright © 2021 Elsevier
Inc.

<71>
Accession Number
2014071891
Title
Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From
Pathogenesis to Management: A Case Report Based Systematic Review.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
100933. Date of Publication: 2021.
Author
Kermani-Alghoraishi M.; Pouramini A.; Kafi F.; Khosravi A.
Institution
(Kermani-Alghoraishi, Pouramini) Interventional Cardiology Research
Center, Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran, Islamic Republic of
(Kafi, Khosravi) Hypertension Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran, Islamic
Republic of
Publisher
Mosby Inc.
Abstract
The Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) created a
global pandemic that continues to this day. In addition to pulmonary
symptoms, the virus can have destructive effects on other organs,
especially the heart. For example, large pericardial effusion has been
observed as a critical and life-threatening finding in Coronavirus disease
of 2019 (COVID-19) patients. In this case report based systematic review,
we review the reports of moderate to severe pericardial effusion
associated with tamponade physiology. Direct cardiomyocyte and pericardium
invasion, inflammation and cytokine storms and oxidative stress due to
acute respiratory distress syndrome, are the pathogenesis of this
phenomenon. The results showed that the manifestations of this finding are
variable. Pericardial effusion can be seen as a delayed complication,
accompanied by myocarditis or pericarditis, isolated, or with acute
respiratory distress syndrome. In most patients, emergency percutaneous
pericardiocentesis was performed, and fluid analysis was often exudative
in 3 pattern of hemorrhagic, serous, and serosanguinous. Medical treatment
and follow-up are recommended, especially in cases of
pericarditis. Copyright © 2021 Elsevier Inc.

<72>
Accession Number
2014071889
Title
Maintenance of Serum Potassium Levels >=3.6 mEq/L Versus >=4.5 mEq/L After
Isolated Elective Coronary Artery Bypass Grafting and the Incidence of
New-Onset Atrial Fibrillation: Pilot and Feasibility Study Results.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Campbell N.G.; Allen E.; Montgomery H.; Aron J.; Canter R.R.; Dodd M.;
Sanders J.; Sturgess J.; Elbourne D.; O'Brien B.
Institution
(Campbell) Division of Cardiovascular Sciences, School of Medical
Sciences, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
(Campbell) Wythenshawe Hospital, Manchester University Foundation NHS
Trust, Manchester, United Kingdom
(Allen, Canter, Dodd, Sturgess, Elbourne) Clinical Trials Unit, London
School of Hygiene & Tropical Medicine, London, United Kingdom
(Montgomery) UCL Division of Medicine and Institute for Sport, Exercise,
and Health, London, United Kingdom
(Aron) St. George's Hospital, London, United Kingdom
(Sanders, O'Brien) St. Bartholomew's Hospital, Barts Health NHS Trust,
West Smithfield, London, United Kingdom
(O'Brien) German Heart Center, Department of Cardiac Anesthesiology and
Intensive Care Medicine, Berlin, Germany
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Charite Berlin, Berlin, Germany
(O'Brien) Outcomes Research Consortium, Cleveland, OH, United States
Publisher
W.B. Saunders
Abstract
Objective: Serum potassium levels frequently are maintained at high levels
(>=4.5 mEq/L) to prevent atrial fibrillation after cardiac surgery
(AFACS), with limited evidence. Before undertaking a noninferiority
randomized controlled trial to investigate the noninferiority of
maintaining levels >=3.6 mEq/L compared with this strategy, the authors
wanted to assess the feasibility, acceptability, and safety of recruiting
for such a trial. Design(s): Pilot and feasibility study of full
trial protocol. Setting(s): Two university tertiary-care hospitals.
 Participant(s): A total of 160 individuals undergoing first-time
elective isolated coronary artery bypass grafting. Intervention(s):
Randomization (1:1) to protocols aiming to maintain serum potassium at
either >=3.6 mEq/L or >=4.5 mEq/L after arrival in the postoperative care
facility and for 120 hours or until discharge from the hospital or AFACS
occurred, whichever happened first. Measurements and Main Results:
Primary outcomes: (1) whether it was possible to recruit and randomize 160
patients for six months (estimated 20% of those eligible); (2) maintaining
supplementation protocol violation rate <=10% (defined as potassium
supplementation being inappropriately administered or withheld according
to treatment allocation after a serum potassium measurement); and (3)
retaining 28-day follow-up rates >=90% after surgery. Between August 2017
and April 2018, 723 patients were screened and 160 (22%) were recruited.
Potassium protocol violation rate = 9.8%. Follow-up rate at 28 days =
94.3%. Data on planned outcomes for the full trial also were collected.
 Conclusion(s): It is feasible to recruit and randomize patients to a
study assessing the impact of maintaining serum potassium concentrations
at either >=3.6 mEq/L or >=4.5 mEq/L on the incidence of
AFACS. Copyright © 2021

<73>
Accession Number
632616705
Title
Modified Buried Vertical Mattress Suture Versus Buried Intradermal Suture:
A Prospective Split-Scar Study.
Source
Dermatologic surgery : official publication for American Society for
Dermatologic Surgery [et al.]. 47(3) (pp e75-e80), 2021. Date of
Publication: 01 Mar 2021.
Author
Liu Z.; Tang Z.; Hao X.; Liu X.; He L.; Yu X.; Wang R.; He Y.; Guo Y.; Shu
M.
Institution
(Liu, Tang, Hao, Liu, He, Yu, Wang, He, Guo, Shu) Department of Aesthetic,
Plastic and Maxillofacial Surgery, First Affiliated Hospital of Xi'an
Jiaotong University, Xi'an, Shaanxi, China
(Liu) Department of Plastic Surgery, Xijing Hospital, Air Force Medical
University, Xi'an, Shaanxi, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The modified buried vertical mattress suture (MBVMS) is
believed to provide excellent outcomes by relieving the tension on wound
edges. However, clinical data on the topic remain sparse and inadequate.
 OBJECTIVE(S): To compare the cosmetic results of the MBVMS and the
buried intradermal suture (BIS) in chest wounds using a split-scar model.
MATERIALS AND METHODS: Twenty patients participated in the study. One
randomly selected half of each chest wound was closed with the MBVMS; the
other half was closed with the BIS. Immediately, postoperatively, the
maximum degree of wound eversion was obtained. After 3 months, the wound
complication rates were recorded, and the aesthetic appearance of each
scar was evaluated by the Patient and Observer Scar Assessment Scale
(POSAS), the Vancouver Scar Scale (VSS), the visual analog scale (VAS),
and scar width. RESULT(S): The MBVMS yielded a greater mean
postoperative eversion height and width (p < .05); lower POSAS, VSS, and
VAS scores (p < .05); and a narrower scar width (p < .05) than did the
BIS. CONCLUSION(S): Compared with the BIS, the MBVMS provided
significantly increased wound eversion immediately, postoperatively, and
improved aesthetic outcomes at the end of the 3-month follow-up
period. Copyright © 2020 by the American Society for Dermatologic
Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights
reserved.

<74>
Accession Number
2013496714
Title
Predicting atrial fibrillation after cardiac surgery: a scoping review of
associated factors and systematic review of existing prediction models.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Fleet H.; Pilcher D.; Bellomo R.; Coulson T.G.
Institution
(Fleet) Melbourne Medical School, The University of Melbourne, Melbourne,
VIC, Australia
(Pilcher, Coulson) Department of Epidemiology and Preventative Medicine,
Monash University, Melbourne, VIC, Australia
(Bellomo, Coulson) Centre for Integrated Critical Care, The University of
Melbourne, Parkville, VIC, Australia
(Coulson) Department of Anaesthesia, Austin Hospital, Melbourne, VIC,
Australia
Publisher
SAGE Publications Ltd
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is common after
cardiac surgery and associated with increased hospital length of stay,
patient morbidity and mortality. We aimed to identify factors associated
with POAF and evaluate the accuracy of available POAF prediction models.
 Method(s): We screened articles from Ovid MEDLINE and
PubMed Central (PMC) and included studies that evaluated risk
factors associated with POAF or studies that designed or validated POAF
prediction models. We only included studies in cardiac surgical patients
with sample size n 50 and a POAF outcome group 20. We summarised factors
that were associated with POAF and assessed prediction model performance
by reviewing reported calibration and discriminative ability.
 Result(s): We reviewed 232 studies. Of these, 142 fulfilled the
inclusion criteria. Age was frequently found to be associated with POAF,
while most other variables showed contradictory findings, or were assessed
in few studies. Overall, 15 studies specifically developed and/or
validated 12 prediction models. Of these, all showed poor discrimination
or absent calibration in predicting POAF in externally validated cohorts.
 Conclusion(s): Except for age, reporting of factors associated with
POAF is inconsistent and often contradictory. Prediction models have low
discrimination, missing calibration statistics, are at risk of bias and
show limited clinical applicability. This suggests the need for studies
that prospectively collect AF relevant data in large cohorts and then
proceed to validate findings in external data sets. Copyright ©
The Author(s) 2021.

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

<76>
Accession Number
2013481500
Title
Short- and long-term outcomes after heart transplantation in cardiac
sarcoidosis and giant-cell myocarditis: a systematic review and
meta-analysis.
Source
Clinical Research in Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Bobbio E.; Bjorkenstam M.; Nwaru B.I.; Giallauria F.; Hessman E.; Bergh
N.; Polte C.L.; Lehtonen J.; Karason K.; Bollano E.
Institution
(Bobbio, Bjorkenstam, Bergh, Karason, Bollano) Department of Cardiology,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Bobbio, Bjorkenstam, Bergh, Polte, Karason, Bollano) Institute of
Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
(Nwaru) Krefting Research Centre, Institute of Medicine, University of
Gothenburg, Gothenburg, Sweden
(Nwaru) Wallenberg Centre for Molecular and Translational Medicine,
University of Gothenburg, Gothenburg, Sweden
(Giallauria) Department of Translational Medical Sciences, 'Federico II'
University of Naples, Naples, Italy
(Hessman) Biomedical Library, Gothenburg University Library, University of
Gothenburg, Gothenburg, Sweden
(Polte) Departments of Clinical Physiology and Radiology, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Lehtonen) Heart and Lung Centre, Helsinki University and Helsinki
University Hospital, Helsinki, Finland
(Karason) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Heart transplantation (HTx) is a valid therapeutic option for end-stage
heart failure secondary to cardiac sarcoidosis (CS) or giant-cell
myocarditis (GCM). However, post-HTx outcomes in patients with
inflammatory cardiomyopathy (ICM) have been poorly investigated. We
searched PubMed, Scopus, Science Citation Index, EMBASE, and Google
Scholar, screened the gray literature, and contacted experts in the field.
We included studies comparing post-HTx survival, acute cellular rejection,
and disease recurrence in patients with and without ICM. Data were
synthesized by a random-effects meta-analysis. We screened 11,933
articles, of which 14 were considered eligible. In a pooled analysis,
post-HTx survival was higher in CS than non-CS patients after 1 year (risk
ratio [RR] 0.88, 95% confidence interval [CI] 0.60-1.17; I2 =
0%) and 5 years (RR 0.72, 95% CI 0.52-0.91; I2 = 0%), but
statistically significant only after 5 years. During the first-year
post-HTx, the risk of acute cellular rejection was similar for patients
with and without CS, but after 5 years, it was lower in those with CS (RR
0.38, 95% CI 0.03-0.72; I2 = 0%). No difference in post-HTx
survival was observed between patients with and without GCM after 1 year
(RR 1.16, 95% CI 0.05-2.28; I2 = 0%) or 5 years (RR 0.98, 95%
CI 0.42-1.54; I2 = 0%). During post-HTx follow-up, recurrence
of CS and GCM occurred in 5% and 8% of patients, respectively. Post-HTx
outcomes in patients with CS and GCM are comparable with cardiac
recipients with other heart failure etiologies. Patients with ICM should
not be disqualified from HTx. Graphic abstract: [Figure not available: see
fulltext.] Copyright © 2021, The Author(s).

<77>
Accession Number
2013333897
Title
Invited commentary: A prospective randomized trial on parents' disease
knowledge and quality of life. Shall WeChat about telehealth?.
Source
Journal of Cardiac Surgery. 36(10) (pp 3698-3701), 2021. Date of
Publication: October 2021.
Author
Stevens R.M.; Chilingerian J.; Mulinari L.; Sun J.; Throckmorton A.;
Latifi R.
Institution
(Stevens, Sun) Division of Pediatric Cardiac Surgery, Pediatric Cardiac
Surgery, St. Christopher's Hospital for Children, Drexel University
College of Medicine, Philadelphia, PA, United States
(Chilingerian) The Heller School for Social Policy and Management,
Brandeis University, Waltham, MA, United States
(Chilingerian) Adjunct of Public Health and Community Medicine, Tufts
School of Medicine, Tufts University, Boston, MA, United States
(Mulinari) DeWitt Daughtry Family Department of Surgery, University of
Miami Leonard Miller School of Medicine, Holtz Children's Hospital,
Jackson Memorial Hospital, Miami, FL, United States
(Throckmorton) School of Biomedical Engineering, Drexel University,
Philadelphia, PA, United States
(Latifi) Department of Surgery, New York Medical College, School of
Medicine, West Chester Medical Center, Valhalla, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
WeChat and access to wireless communication may offer a continuum of care
following medical and surgical intervention. This cardiac surgery research
study evaluates the process of parental education and social support
following pediatric cardiac surgery utilizing standard of care compared to
telehealth. Copyright © 2021 Wiley Periodicals LLC

<78>
Accession Number
2013281926
Title
Comparison of dopamine versus norepinephrine in circulatory shock after
cardiac surgery: A randomized controlled trial.
Source
Journal of Cardiac Surgery. 36(10) (pp 3711-3718), 2021. Date of
Publication: October 2021.
Author
Lim J.Y.; Park S.J.; Kim H.J.; Choo S.J.; Chung C.H.; Lee J.W.; Park
D.-W.; Kim J.B.
Institution
(Lim) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Park, Kim, Choo, Chung, Lee, Kim) Department of Thoracic and
Cardiovascular Surgery, Asan Medical Center, University of Ulsan College
of Medicine, Seoul, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Anam Hospital,
University of Korea College of Medicine, Seoul, South Korea
(Park) Department of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim of the Study: Although dopamine and norepinephrine are
recommended as first-line agents in the treatment of shock, it is unclear
which is the optimal vasoactive inotropic agent (VIA) to manage
postcardiotomy circulatory shock. This single-center, randomized clinical
trial aimed to investigate the efficacy and safety of dopamine versus
norepinephrine in postcardiotomy circulatory shock. Method(s): We
randomly assigned the patients with postcardiotomy circulatory shock to
receive either dopamine or norepinephrine. When shock persisted despite
the dose of 20 mug/kg/min of dopamine or the dose of 0.2 mug/kg/min of
norepinephrine, epinephrine or vasopressin could be added. The primary
endpoint was new-onset tachyarrhythmic event during drug infusion.
Secondary endpoints included requirement of additional VIAs, postoperative
complications, and all-cause mortality within 30 days of drug initiation.
 Result(s): At the planned interim analysis of 100 patients, the
boundary for the benefit of norepinephrine has been crossed, and the study
was stopped early. Excluding two patients withdrawing a consent, 48
patients were assigned to dopamine and 50 patients to norepinephrine.
New-onset tachyarrhythmic event occurred in 12 (25%) patients in the
dopamine and one (2%) patient in the norepinephrine group (p =.009). The
requirement for additional VIAs was more common in the dopamine group (p
<.001). Other secondary endpoints were similar between groups.
 Conclusion(s): Despite the limited study subjects with early
determination, in patients with postcardiotomy circulatory shock, dopamine
as a first-line vasopressor was associated with higher tachyarrhythmic
events and greater need for additional VIAs compared with
norepinephrine. Copyright © 2021 Wiley Periodicals LLC

<79>
Accession Number
2013281853
Title
Network meta-analysis of treatment strategies in patients with coronary
artery disease and low left ventricular ejection fraction.
Source
Journal of Cardiac Surgery. 36(10) (pp 3834-3842), 2021. Date of
Publication: October 2021.
Author
Yokoyama Y.; Fukuhara S.; Mori M.; Noguchi M.; Takagi H.; Briasoulis A.;
Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, MI, United States
(Mori) Division of Cardiac Surgery, Yale School of Medicine, New Haven,
CT, United States
(Noguchi) Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical
Center, Urayasu, Japan
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Briasoulis) Division of Cardiology, Heart failure and Transplantation,
University of Iowa, Iowa City, IA, United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York City, NY, United States
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein Medical College, New York, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The optimal treatment strategy in patients with coronary artery
disease (CAD) and low left ventricular ejection fraction (LVEF) remains
controversial. Herein, we conducted a network meta-analysis comparing
coronary artery bypass graft (CABG), percutaneous coronary intervention
(PCI), and optimal medical therapy (OMT) in patients with CAD and low
LVEF. Method(s): MEDLINE and EMBASE were searched through March, 2021
to identify randomized controlled trials (RCTs) and propensity-score
matched (PSM) studies comparing CABG, PCI, and OMT. We extracted hazard
ratios (HRs) of the outcomes. Result(s): A total of three RCTs and 10
PSM trials were identified, yielding a total of 18,855 patients with CAD
with low EF who were treated with CABG (n = 9241), PCI (n = 8771), or OMT
(n = 1003). All-cause mortality was significantly lower in patients with
CABG compared with those with PCI or OMT (HR [95% confidence interval
(CI)] = 0.72 [0.62-0.82], p <.001, HR [95% CI] = 0.65 [0.51-0.82], p
=.004, respectively), while no difference was observed between PCI and
OMT. The rates of MI were significantly lower in patients treated with
CABG compared to those treated with PCI or OMT. However, the subgroup
analysis by limiting the PCI group to patients who received drug-eluting
stent (DES) showed similar all-cause mortality between CABG and PCI, while
both CABG and PCI were associated with lower all-cause mortality compared
with OMT. Concluion: The present study demonstrated that CABG was the
appropriate treatment strategy in patients with CAD and low LVEF. Further
long-term trials were warranted to investigate outcomes of PCI with DES
compared with CABG. Copyright © 2021 Wiley Periodicals LLC

<80>
Accession Number
2013136537
Title
Vasoplegic syndrome after cardiovascular surgery: A review of
pathophysiology and outcome-oriented therapeutic management.
Source
Journal of Cardiac Surgery. 36(10) (pp 3749-3760), 2021. Date of
Publication: October 2021.
Author
Datt V.; Wadhhwa R.; Sharma V.; Virmani S.; Minhas H.S.; Malik S.
Institution
(Datt, Wadhhwa, Sharma, Virmani, Minhas, Malik) Department of Cardiac
Anaesthesia and Cardiothoracic and Vascular Surgery, GB Pant Hospital
[GIPMER], New Delhi, India
Publisher
John Wiley and Sons Inc
Abstract
Background: Vasoplegic syndrome (VPS) is defined as systemic hypotension
due to profound vasodilatation and loss of systemic vascular resistance
(SVR), despite normal or increased cardiac index, and characterized by
inadequate response to standard doses of vasopressors, and increased
morbidity and mortality. It occurs in 9%-44% of cardiac surgery patients
after cardiopulmonary bypass (CPB). The underlying pathophysiology
following CPB consists of resistance to vasopressors (inactivation of
Ca2+ voltage gated channels) on the one hand and excessive
activation of vasodilators (SIRS, iNOS, and low AVP) on the other. Use of
angiotensin-converting enzyme inhibitor (ACE-I), calcium channel blockers,
amiodarone, heparin, low cardiac reserve (EF < 35%), symptomatic
congestive heart failure, and diabetes mellitus are the perioperative risk
factors for VPS after cardiac surgery in adults. Till date, there is no
consensus about the outcome-oriented therapeutic management of VPS.
Vasopressors such as norepinephrine (NE; 0.025-0.2 microg/kg/min) and
vasopressin (0.06 U/min or 6 U/h median dose) are the first choice for the
treatment. The adjuvant therapy (hydrocortisone, calcium, vitamin C, and
thiamine) and rescue therapy (methylene blue [MB] and hydroxocobalamin)
are also considered when perfusion goals (meanarterial pressure [MAP] >
60-70 mmHg) are not achieved with nor-epinephrine and/or vasopressin.
 Aim(s): The aims of this systematic review are to collect all the
clinically relevant data to describe the VPS, its potential risk factors,
pathophysiology after CPB, and to assess the efficacy, safety, and outcome
of the therapeutic management with catecholamine and non-catecholamine
vasopressors employed for refractory vasoplegia after cardiac surgery.
Also, to elucidate the current and practical approach for management of
VPS after cardiac surgery. Material(s) and Method(s): "PubMed,"
"Google," and "Medline" weresearched, and over 150 recent relevant
articles including RCTs, clinical studies, meta-analysis, reviews, case
reports, case series and Cochrane data were analyzed for this systematic
review. The filter was applied specificallyusing key words like VPS after
cardiac surgery, perioperative VPS following CPB, morbidity, and mortality
in VPS after cardiac surgery, vasopressors for VPS that improve outcomes,
VPS after valve surgery, VPS after CABG surgery, VPS following complex
congenital cardiac anomalies corrective surgery, rescue therapy for VPS,
adjuvant therapy for VPS, definition of VPS, outcome in VPS after cardiac
surgery, etiopathology of VPS following CPB. This review did not require
any ethical approval or consent from the patients. Result(s): Despite
the recent advances in therapy, the mortality remains as high as 30%-50%.
NE has been recommended the most frequent used vasopressor for VPS. It
restores and maintain the MAP and provides the outcome benefits.
Vasopressin rescue therapy is an alternative approach, if catecholamines
and fluid infusions fail to improve hemodynamics. It effectively increases
vascular tone and lowers CO, and significantly decreases the 30 days
mortality. Hence, suggested a first-line vasopressor agent in postcardiac
surgery VPS. Terlipressin (1.3mug/kg/h), a longer acting and more specific
vasoconstrictor prevents the development of VPS after CPB in patients
treated with ACE-I. MB significantly reduces morbidity and mortality of
VPS. The Preoperative MB (1%, 2mg/kg/30min, 1h before surgery)
administration in high risk (on ACE-I) patients for VPS undergoing CABG
surgery, provides 100% protection against VPS, and early of MB
significantly reduces operative mortality, and recommended as a rescue
therapy for VPS. Hydroxocobalamin (5 g) has been recommended as a rescue
agent in VPS refractory to multiple vasopressors. A combination of
ascorbic acid (6 g), hydrocortisone (200 mg/day), and thiamine (400
mg/day) as an adjuvant therapy significantly reduces the vasopressors
requirement, and provides mortality and morbidity benefits.
 Conclusion(s): Currently, the VPS is frequently encountered (9%-40%)
in cardiac surgical patients with predisposing patient-specific risk
factors and combined with inflammatory response to CPB. Multidrug therapy
(NE, MB, AVP, ATII, terlipressin, hydroxocobalamin) targeting multiple
receptor systems is recommended in refractory VPS. A combination of high
dosage of ascorbic acid, hydrocortisone and thiamine has been used
successfully as adjunctive therapyto restore the MAP. We also advocate for
the early use of multiagent vasopressors therapy and catecholamine sparing
adjunctive agents to restore the systemic perfusion pressure with a goal
of preventing the progressive refractory VPS. Copyright © 2021
Wiley Periodicals LLC

<81>
Accession Number
2011247284
Title
Immune checkpoint inhibitors-associated pericardial disease: a systematic
review of case reports.
Source
Cancer Immunology, Immunotherapy. 70(10) (pp 3041-3053), 2021. Date of
Publication: October 2021.
Author
Inno A.; Maurea N.; Metro G.; Carbone A.; Russo A.; Gori S.
Institution
(Inno, Gori) Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria,
Via don A. Sempreboni 5, Negrar di Valpolicella, Verona 37024, Italy
(Maurea, Carbone) Divisione di Cardiologia, IRCCS Fondazione G. Pascale,
Napoli, Italy
(Metro) Oncologia Medica, Ospedale Santa Maria della Misericordia, Azienda
Ospedaliera Di Perugia, Perugia, Italy
(Russo) Oncologia Medica, Dipartimento di Discipline Chirurgiche,
Oncologiche E Stomatologiche, Policlinico Universitario "A. Giaccone",
Palermo, Italy
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Treatment with immune checkpoint inhibitors (ICIs) can be complicated by
cardiovascular toxicity, including pericardial disease. To date, no
prospective studies specifically investigated the optimal treatment of
ICI-associated pericardial disease, and the available evidence is based on
case reports and series only. We performed a systematic review of case
reports and series including 20 publications for a total of 28 cases of
ICI-associated pericardial disease. In this review, pericardial disease
was reversible in the majority of cases (75%), although 2 deaths were
reported. The majority of cases were life-threatening (G4, 53.6%) or
severe (G3, 21.4%), requiring pericardiocentesis. Higher rates of
improvement were associated with administration of corticosteroids (86.7%
vs 61.5%), presence of other immune-related adverse events (90.9% vs.
64.7%), and non-malignant effusions (86.7% vs 42.8%). ICIs were
discontinued in the majority of cases and then restarted in 7 patients
with no recurrence of pericardial disease. Based on these results,
ICI-associated G3-G4 pericardial disease as well as G2 pericardial disease
with moderate-severe effusion should be treated with ICIs discontinuation
and high-dose steroids, also performing pericardiocentesis, pericardial
drainage or pericardial window in case of cardiac tamponade. For G2 with
small effusion or G1 pericardial disease, ICIs might be continued and
colchicine or NSAIDs could be considered. For patients requiring ICIs
discontinuation, a rechallenge with ICIs seems to be feasible after
resolution or meaningful improvement of pericardial disease. Copyright
© 2021, The Author(s), under exclusive licence to Springer-Verlag
GmbH Germany, part of Springer Nature.

<82>
Accession Number
635925268
Title
Ten-year all-cause death after percutaneous or surgical revascularization
in diabetic patients with complex coronary artery disease.
Source
European heart journal. (no pagination), 2021. Date of Publication: 18
Aug 2021.
Author
Wang R.; Serruys P.W.; Gao C.; Hara H.; Takahashi K.; Ono M.; Kawashima
H.; O'leary N.; Holmes D.R.; Witkowski A.; Curzen N.; Burzotta F.; James
S.; van Geuns R.-J.; Kappetein A.P.; Morel M.-A.; Head S.J.; Thuijs
D.J.F.M.; Davierwala P.M.; O'Brien T.; Fuster V.; Garg S.; Onuma Y.
Institution
(Wang, Gao) Department of Cardiology, Xijing Hospital, Changle West Road
127, Xi'an 710032, China
(Wang, Serruys, Gao, Hara, Ono, Kawashima, O'leary, Morel, Onuma)
Department of Cardiology, National University of Ireland, Galway (NUIG),
University Road, Galway H91 TK33, Ireland
(Wang, Gao, van Geuns) Department of Cardiology, Radboud University
Medical Center, Geert Grooteplein Zuid 8, GA Nijmegen 6525, Netherlands
(Serruys) Department of Cardiology, Imperial College London, Exhibition
Rd, London SW7 2BX, United Kingdom
(Hara, Takahashi, Ono, Kawashima) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Meibergdreef 9, AZ Amsterdam
1105, Netherlands
(Holmes) Department of Cardiology, Mayo ClinicSchool of Medicine, 200
First St. SW Rochester, United States
(Witkowski) Department of Interventional Cardiology and Angiology,
National Institute of Cardiology, ul. Alpejska 42, Warsaw 04-628, Poland
(Curzen) Cardiology Department, University Hospital Southampton, Coxford
Rd, Southampton SO16 5YA, United Kingdom
(Burzotta) Institute of Cardiology, Catholic University of the Sacred
Heart, Largo F. Vito 1, Rome 00168, Italy
(James) Department of Medical Sciences, Cardiology and Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Dr Molewaterplein 40, GE Rotterdam 3015,
Netherlands
(Davierwala) Department of Cardiac Surgery, Heart Centre Leipzig,
Strumpelstrasse 39, Leipzig 4289, Germany
(O'Brien) Regenerative Medicine Institute, CURAM, National University of
Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
(Fuster) Division of Cardiology, Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicina at Mount Sinai School, 1 Gustave L.
Levy Place, NY, 10029-5674 New York, United States
(Garg) Department of Cardiology, East Lancashire Hospitals NHS Trust,
Haslingden Rd, Blackburn BB2 3HH, Lancashire, UK
Publisher
NLM (Medline)
Abstract
AIMS: The aim of this article was to compare rates of all-cause death at
10years following coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) in patients with or without diabetes. METHODS
AND RESULTS: The SYNTAXES study evaluated up to 10-year survival of 1800
patients with three-vessel disease (3VD) and/or left main coronary artery
disease (LMCAD) randomized to receive either PCI or CABG in the SYNTAX
trial. Ten-year all-cause death according to diabetic status and
revascularization strategy was examined. In diabetics (n=452), the risk of
mortality was numerically higher with PCI compared with CABG at 5 years
[19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval (CI):
0.96, 2.43, P=0.075], with the opposite seen between 5 and 10years (PCI
vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P=0.366).
Irrespective of diabetic status, there was no significant difference in
all-cause death at 10years between patients receiving PCI or CABG, the
absolute treatment difference was 1.9% in diabetics (PCI vs. CABG: 36.4%
vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P=0.551). Among
insulin-treated patients (n=182), all-cause death at 10years was
numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI:
-6.5%, 22.5%, P=0.227). CONCLUSION(S): The treatment effects of PCI
vs. CABG on all-cause death at 10years in patients with 3VD and/or LMCAD
were similar irrespective of the presence of diabetes. There may, however,
be a survival benefit with CABG in patients with insulin-treated diabetes.
The association between revascularization strategy and very long-term
ischaemic and safety outcomes for patients with diabetes needs further
investigation in dedicated trials. TRIAL REGISTRATION: SYNTAX:
ClinicalTrials.gov reference: NCT00114972 and SYNTAX Extended Survival:
ClinicalTrials.gov reference: NCT03417050. Copyright © The
Author(s) 2021. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<83>
[Use Link to view the full text]
Accession Number
635909578
Title
Effects of perioperative interventions for preventing postoperative
delirium: A protocol for systematic review and meta-analysis of randomized
controlled trials.
Source
Medicine. 100(29) (pp e26662), 2021. Date of Publication: 23 Jul 2021.
Author
Li X.; Wang Y.; Liu J.; Xiong Y.; Chen S.; Han J.; Xie W.; Wu Q.
Institution
(Li) Department of Anaesthesiology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative delirium (POD) not only increases the medical
burden but also adversely affects patient prognosis. Although some cases
of delirium can be avoided by early intervention, there is no clear
evidence indicating whether any of these measures can effectively prevent
POD in specific patient groups. OBJECTIVE(S): The aim of this
meta-analysis was to compare the efficacy and safety of the existing
preventive measures for managing POD. METHOD(S): The PubMed, OVID
(Embase and MEDLINE), Web of Science, and the Cochrane Library databases
were searched for articles published before January 2020. The relevant
randomized controlled trials (RCTs) were selected based on the inclusion
and exclusion criteria. Data extraction and methodological quality
assessment were performed according to a predesigned data extraction form
and scoring system, respectively. The interventions were compared on the
basis of the primary outcome like incidence of POD, and secondary outcomes
like duration of delirium and the length of intensive care unit and
hospital stay. RESULT(S): Sixty-three RCTs were included in the
study, covering interventions like surgery, anesthesia, analgesics,
intraoperative blood glucose control, cholinesterase inhibitors,
anticonvulsant drugs, antipsychotic drugs, sleep rhythmic regulation, and
multi-modal nursing. The occurrence of POD was low in 4 trials that
monitored the depth of anesthesia with bispectral index during the
operation (P < .0001). Two studies showed that supplementary analgesia was
useful for delirium prevention (P = .002). Seventeen studies showed that
perioperative sedation with alpha2-adrenergic receptor agonists prevented
POD (P = .0006). Six studies showed that both typical and atypical
antipsychotic drugs can reduce the incidence of POD (P = .002). Multimodal
nursing during the perioperative period effectively reduced POD in 6
studies (P < .00001). Furthermore, these preventive measures can reduce
the duration of delirium, as well as the total and postoperative length of
hospitalized stay for non-cardiac surgery patients. For patients
undergoing cardiac surgery, effective prevention can only reduce the
length of intensive care unit stay. CONCLUSION(S): Measures including
intraoperative monitoring of bispectral index, supplemental analgesia,
alpha2-adrenergic receptor agonists, antipsychotic drugs, and multimodal
care are helpful to prevent POD effectively. However, larger, high-quality
RCTs are needed to verify these findings and develop more interventions
and drugs for preventing postoperative delirium. Copyright © 2021
the Author(s). Published by Wolters Kluwer Health, Inc.

<84>
[Use Link to view the full text]
Accession Number
635909215
Title
Impact of chronic kidney disease on the prognosis of transcatheter aortic
valve replacement in patients with aortic stenosis: A protocol for
systematic review and meta-analysis.
Source
Medicine. 100(29) (pp e26696), 2021. Date of Publication: 23 Jul 2021.
Author
Wang J.; Liu S.; Han X.; Wan Z.; Chen Y.; Chen H.; Song B.
Institution
(Wang, Han, Chen, Chen) First Clinical Medical College of Lanzhou
University, Lanzhou University, Lanzhou, China
(Liu, Wan, Song) Department of Cardiovascular Surgery, First Hospital of
Lanzhou University, Lanzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The prognosis of patients with aortic stenosis, in conjunction
with chronic kidney disease (CKD), after transcatheter aortic valve
replacement (TAVR) remains unclear. This study assessed the impact of CKD,
and different stages of CKD, on prognosis of patients undergoing TAVR.
 METHOD(S): The protocol was written following the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses Protocols statement
guidelines. As of June 2021, we performed a comprehensive literature
search on studies related to CKD and TAVR, using databases such as PubMed,
Embase, Cochrane Library, and Web of Science. Two researchers
independently screened the literature, extracted the data, and evaluated
the risk of bias in the included studies. Then, Stata 15.0 software was
used for meta-analysis. RESULTS AND CONCLUSION(S): The purpose of
this study was to evaluate the effect of CKD and different stages of CKD
on the prognosis of patients with TAVR. It is hoped to provide a
comprehensive reference for clinical practice and related clinical trials
in the future. Copyright © 2021 the Author(s). Published by
Wolters Kluwer Health, Inc.

<85>
Accession Number
2013622882
Title
Efficacy of adding dexmedetomidine as adjuvant with bupivacaine in
ultrasound-guided erector spinae plane block for post thoracotomy pain:
Randomized controlled study: Dexmedetomidine as adjuvant in ESPB for PTP.
Source
Egyptian Journal of Anaesthesia. 37(1) (pp 425-431), 2021. Date of
Publication: 2021.
Author
Elshal M.M.; Gamal R.M.; Ahmed A.M.; Gouda N.M.; Abdelhaq M.M.
Institution
(Elshal, Gamal, Ahmed) Anesthesia and Pain Relief, National Cancer
Institute, Cairo University, Cairo, Egypt
(Gouda, Abdelhaq) Anesthesia, Surgical ICU and Pain Management, Faculty of
Medicine, Cairo University, Cairo, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: Poor management of postoperative pain results in physiological
and psychological side effects with higher morbidity. Erector spinae plane
block (ESPB) has shown efficacy in controlling pain in many surgeries.
Dexmedetomidine has improved the quality of analgesia in many regional
techniques. This study aimed to assess the analgesic outcome of adding
dexmedetomidine to bupivacaine in ultrasound (US) guided ESPB for
perioperative analgesia for thoracic cancer surgeries. Patients and
Methods: In this randomized controlled, double-blind study, 42 patients
aged 18-65 years, ASA (American Society of Anesthesiologists) physical
status II, scheduled for thoracotomy for cancer surgeries under general
anesthesia were included. Patients were allocated into two equal groups:
group 1 (ESPB by 28 ml bupivacaine 0.25% + 2 mL saline) and group 2 (ESPB
28 ml bupivacaine 0.25% + 2 mL dexmedetomidine 0.5 microg/kg). Blocks were
performed before anesthesia induction. Result(s): Group 2 consumed
lower intraoperative fentanyl and postoperative morphine and had a lower
pain score at rest and cough compared to group 1. Group 2 had prolonged
time to first request of rescue analgesia compared to group 1.
Postoperative nausea and vomiting, and sedation were comparable between
both groups. No block-related complications were observed.
 Conclusion(s): Adding dexmedetomidine to bupivacaine in US-guided
ESPB provided more effective and safe analgesia in
thoracotomy. Copyright © 2021 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis Group.

<86>
Accession Number
635926131
Title
Effect of 6% Hydroxyethyl Starch 130/0.4 on Inflammatory Response and
Pulmonary Function in Patients Having Cardiac Surgery: A Randomized
Clinical Trial.
Source
Anesthesia and analgesia. (no pagination), 2021. Date of Publication: 18
Aug 2021.
Author
Lee M.J.; Tannenbaum C.; Mao G.; Jia Y.; Leung S.; Yilmaz H.O.; Ince I.;
Soltesz E.; Duncan A.E.
Institution
(Lee) From the Anesthesiology Institute
(Tannenbaum) Department of Inflammation and Immunity, Lerner Research
Institute
(Mao, Jia, Leung, Yilmaz, Ince, Duncan) Department of Outcomes Research
(Soltesz) Department of Thoracic and Cardiovascular Surgery
(Duncan) Department of Cardiothoracic Anesthesia, Cleveland Clinic,
Cleveland, OH, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac surgery with cardiopulmonary bypass induces a profound
inflammatory response that, when severe, can lead to multiorgan system
dysfunction. Preliminary data suggest that administration of hydroxyethyl
starch (HES) solutions may mitigate an inflammatory response and improve
pulmonary function. Our goal was to examine the effect of 6% HES 130/0.4
versus 5% human albumin given for intravascular plasma volume replacement
on the perioperative inflammatory response and pulmonary function in
patients undergoing cardiac surgery. METHOD(S): This was a
subinvestigation of a blinded, parallel-group, randomized clinical trial
of patients undergoing elective aortic valve replacement surgery at the
Cleveland Clinic main campus, titled "Effect of 6% Hydroxyethyl Starch
130/0.4 on Kidney and Haemostatic Function in Cardiac Surgical Patients."
Of 141 patients who were randomized to receive either 6% HES 130/0.4 or 5%
human albumin for intraoperative plasma volume replacement, 135 patients
were included in the data analysis (HES n = 66, albumin n = 69). We
assessed the cardiopulmonary bypass-induced inflammatory response end
points by comparing the 2 groups' serum concentrations of tumor necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), and macrophage migration
inhibitory factor (MIF), measured at baseline and at 1 and 24 hours after
surgery. We also compared the 2 groups' postoperative pulmonary function
end points, including the ratio of partial pressure of arterial oxygen to
fraction of inspired oxygen (Pao2:Fio2 ratio), dynamic lung compliance,
oxygenation index (OI), and ventilation index (VI) at baseline, within 1
hour of arrival to the intensive care unit, and before tracheal
extubation. The differences in the postoperative levels of inflammatory
response and pulmonary function between the HES and albumin groups were
assessed individually in linear mixed models. RESULT(S): Serum
concentrations of the inflammatory markers (TNF-alpha, IL-6, MIF) were not
significantly different (P >= .05) between patients who received 6% HES
130/0.4 or 5% albumin, and there was no significant heterogeneity of the
estimated treatment effect over time (P >= .15). The results of pulmonary
function parameters (Pao2:Fio2 ratio, dynamic compliance, OI, VI) were not
significantly different (P >= .05) between groups, and there was no
significant heterogeneity of the estimated treatment effect over time (P
>= .15). CONCLUSION(S): Our investigation found no significant
difference in the concentrations of inflammatory markers and measures of
pulmonary function between cardiac surgical patients who received 6% HES
130/0.4 versus 5% albumin. Copyright © 2021 International
Anesthesia Research Society.

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