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<1>
Accession Number
2011981519
Title
Noninvasive cardiovascular imaging for myocardial necrosis, viability,
stunning and hibernation: Evidence from an umbrella review encompassing 12
systematic reviews, 286 studies, and 201,680 patients.
Source
Minerva Cardiology and Angiology. 69(2) (pp 191-200), 2021. Date of
Publication: April 2021.
Author
Nudi F.; Iskandrian A.E.; Schillaci O.; Nudi A.; Di Belardino N.; Frati
G.; Biondi Zoccai G.
Institution
(Nudi, Nudi) Service of Hybrid Cardio Imaging, Madonna della Fiducia
Clinic, Rome, Italy
(Nudi) Replycare, Rome, Italy
(Iskandrian) Division of Cardiovascular Diseases, Department of Medicine,
University of Alabama at Birmingham, Birmingham, AL, United States
(Schillaci) Department of Biomedicine and Prevention, Tor Vergata
University, Rome, Italy
(Di Belardino) Unit of Cardiology, Ospedali Riuniti di Anzio-Nettuno,
Anzio, Rome, Italy
(Frati, Biondi Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Rome, Italy
(Frati) IRCCS Neuromed, Pozzilli, Isernia, Italy
(Biondi Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The concomitant presence of myocardial necrosis with
myocardial ischemia, stunning or hibernation may complicates appraisal of
left ventricular (LV) function and patient management. Several imaging
modalities have been proposed for the accurate assessment of myocardial
necrosis, viability, stunning and hibernation, with mixed results. We
aimed to review the evidence base on myocardial necrosis, stunning and
hibernation by conducting an umbrella review (i.e. overview of systematic
reviews). EVIDENCE ACQUISITION: We searched PubMed and The Cochrane
Library for meta-analyses focusing on the diagnostic, prognostic, or
management appraisal of myocardial necrosis, viability, stunning and
hibernation. Diagnostic test accuracy, prognostic yield, and clinical
outcomes were systematically abstracted from shortlisted reviews. EVIDENCE
SYNTHESIS: From an initial set of 6069 citations, 12 systematic reviews
were finally included, encompassing 286 studies and 201,680 patients.
Cardiac magnetic resonance imaging (CMR) had favorable results in 4
reviews that focused on the diagnosis of myocardial stunning or
hibernation in patients followed for 6+/-4 months after coronary
revascularization (sensitivity 96% and specificity 91%). Positron emission
tomography (PET), single photon emission tomography (SPECT) and CMR in 6
meta-analyses had each a significant and independent prognostic role for
the prediction of fatal and non-fatal cardiovascular events in patients
with follow-up of 2.8+/-1.7 years. Finally, 2 reviews with 2.3+/-1.1 years
of follow-up showed moderate quality evidence in favor of coronary
revascularization in patients with objective signs of myocardial
viability. CONCLUSION(S): The appraisal of myocardial necrosis and
residual viability remains a cornerstone of the modern management of
patients with CAD. Current imaging modalities (echocardiography, PET,
SPECT and CMR) are widely used. Further trials using contemporary methods
are warranted to further clarify the impact of viability assessment on
patient management, and the cumulative risk of morbidity and
mortality. Copyright © 2020 EDIZIONI MINERVA MEDICA.

<2>
Accession Number
2011981514
Title
Effects of treprostinil on pulmonary arterial hypertension during surgery
for congenital heart disease complicated with severe pulmonary arterial
hypertension.
Source
Minerva Cardiology and Angiology. 69(2) (pp 154-160), 2021. Date of
Publication: April 2021.
Author
Jiang H.; Yu X.; Zhang L.; Wang M.
Institution
(Jiang, Wang) Department of Ultrasonography, Weihai Central Hospital,
Weihai, China
(Yu) Blood Purification Center, Weihai Central Hospital, Weihai, China
(Zhang) Penglai People's Hospital, Yantai, China
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: The aim of this study is to evaluate the effects of
treprostinil injection on the control of pulmonary blood pressure in
children with congenital heart disease (CHD) complicated by severe
pulmonary arterial hypertension (PAH). METHOD(S): Eighty children
with CHD complicated by severe pulmonary arterial hypertension admitted to
our hospital from January 2015 to June 2018 were selected and randomly
divided into a control group (N.=40) and a treatment group (N.=40). Based
on standard treatment, the treatment group was intravenously infused with
8-12 ng/kg.min treprostinil, while the control group received the same
dose of normal saline. Hemodynamic parameters such as BP, AP, P and SpO2%
were monitored before anesthesia induction (T0), before cardiopulmonary
bypass (T1), 1 h after cardiopulmonary bypass (T2) and at the end of
cardiopulmonary bypass (T3). Pulmonary arterial pressure parameters (PASP,
PADP and PAMP) were measured at T1, T2 and T3 by transesophageal
echocardiography. RESULT(S): For the treatment group, the HR values
at T2 and T3 were lower than that at T0 (P<0.05). For the control group,
HR at T3 was lower than that at T0 (P<0.05). HR at T3 of the treatment
group was lower than that of the control group (P<0.05). SpO2 of the
treatment group was higher than that of the control group at T3 (P<0.05).
At T2 and T3, PASP, PADP and PAMP of both groups were lower than those
before surgery (P<0.05), and the values of the treatment group were lower
than those of the control group (P<0.05). CONCLUSION(S): Treprostinil
can improve cardiac function and reduce pulmonary circulation resistance
in PAH children. Copyright © 2020 EDIZIONI MINERVA MEDICA.

<3>
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

<4>
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

<5>
Accession Number
2013610073
Title
Surgery re-imagined: The digital revolution.
Source
Journal of the Pakistan Medical Association. 71(1 B) (pp 184-185), 2021.
Date of Publication: January 2021.
Author
Rizvi I.
Institution
(Rizvi) Mid-Atlantic Permanente Medical Group, Virginia, United States
Publisher
Pakistan Medical Association
Abstract
Anaesthesia and asepsis made surgery humane and safe in the latter half of
the nineteenth century. The twentieth century brought laparoscopy,
open-heart surgery, organ transplant and surgical staplers, amongst other
advances. Today, the digital revolution is ushering in a new era in
surgery. While some contend that this might serve to further dehumanize
medicine, there is no denying that the smart deployment of technology can
improve surgical safety and precision as well as improve the well-being of
those it serves. Copyright © 2021 Pakistan Medical Association.
All rights reserved.

<6>
Accession Number
2014271561
Title
Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation
Following Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Pierik R.; Zeillemaker-Hoekstra M.; Scheeren T.W.L.; Erasmus M.E.; Luijckx
G.-J.R.; Rienstra M.; Uyttenboogaart M.; Nijsten M.; van den Bergh W.M.
Institution
(Pierik, Nijsten, van den Bergh) Department of Critical Care, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Zeillemaker-Hoekstra, Scheeren) Department of Anesthesiology, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Erasmus) Department of Cardiac Surgery, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Luijckx, Uyttenboogaart) Department of Neurology, University Medical
Center Groningen, University of Groningen, Groningen, Netherlands
(Rienstra) Department of Cardiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to study the association between
postoperative atrial fibrillation (POAF) and thromboembolic stroke and to
determine risk factors for thromboembolic stroke after cardiac surgery.
 Design(s): The authors performed a secondary analysis from a
randomized controlled trial (GRIP-COMPASS). The patients with
thromboembolic stroke were compared with those without thromboembolic
stroke, and the difference in the incidence of POAF between these groups
was assessed. Odds ratios (OR) were calculated using logistic regression
analyses. Brain imaging was studied for the occurrence of thromboembolic
stroke during hospital admission, and POAF was monitored for seven days.
To assess which characteristics were associated with occurrence of
thromboembolic stroke, stepwise backward regression analysis was
performed. Participant(s): All adult consecutive cardiac surgery
patients admitted postoperatively to the intensive care unit.
 Setting(s): Academic tertiary care medical center.
 Intervention(s): None. Measurements and Main Results: Of the 910
patients included in this study, 26 patients (2.9%) had a thromboembolic
stroke during hospital admission. The incidence of POAF during the first
seven days after cardiac surgery in those with thromboembolic stroke was
65%, compared with 39% in those without thromboembolic stroke: adjusted OR
3.01 (95% confidence interval, 1.13-8.00). POAF, a history of peripheral
vascular disease, a higher EuroSCORE, and a longer duration of surgery
were associated with thromboembolic stroke. Conclusion(s): POAF
within seven days after cardiac surgery was associated with a three-fold
increased risk for a thromboembolic stroke during hospital admission.
Expeditious treatment of POAF may, therefore, reduce early stroke risk
after cardiac surgery. Copyright © 2021 The Authors

<7>
Accession Number
2014353967
Title
Thiamine increases resident endoglin positive cardiac progenitor cells and
atrial contractile force in humans: A randomised controlled trial.
Source
International Journal of Cardiology. 341 (pp 70-73), 2021. Date of
Publication: 15 Oct 2021.
Author
Coffey S.; Dixit P.; Saw E.L.; Babakr A.A.; van Hout I.; Galvin I.F.;
Saxena P.; Bunton R.W.; Davis P.J.; Lamberts R.R.; Katare R.; Williams
M.J.A.
Institution
(Coffey, Williams) Department of Medicine - HeartOtago, Dunedin School of
Medicine, University of Otago, New Zealand
(Coffey, Williams) Department of Cardiology, Southern District Health
Board, New Zealand
(Dixit, Saw, Babakr, van Hout, Lamberts, Katare) Department of Physiology
- HeartOtago, School of Biomedical Sciences, University of Otago, New
Zealand
(Galvin, Saxena, Bunton, Davis) Department of Cardiothoracic Surgery,
Southern District Health Board, New Zealand
Publisher
Elsevier Ireland Ltd
Abstract
Background: The heart has an intrinsic ability to regenerate, orchestrated
by progenitor or stem cells. However, the relative complexity of
non-resident cardiac progenitor cell (CPC) therapy makes modulation of
resident CPCs a more attractive treatment target. Thiamine analogues
improve resident CPC function in pre-clinical models. In this double
blinded randomised controlled trial (identifier: ACTRN12614000755639), we
examined whether thiamine would improve CPC function in humans.
 Methods and Results: High dose oral thiamine (one gram twice daily)
or matching placebo was administered 3-5 days prior to coronary artery
bypass surgery (CABG). Right atrial appendages were collected at the time
of CABG, and CPCs isolated. There was no difference in the primary outcome
(proliferation ability of CPCs) between treatment groups. Older age was
not associated with decreased proliferation ability. In exploratory
analyses, isolated CPCs in the thiamine group showed an increase in the
proportion of CD34-/CD105+ (endoglin) cells, but no
difference in CD34-/CD90+ or CD34+ cells.
Thiamine increased maximum force developed by isolated trabeculae, with no
difference in relaxation time or beta-adrenergic responsiveness.
 Conclusion(s): Thiamine does not improve proliferation ability of CPC
in patients undergoing CABG, but increases the proportion of
CD34-/CD105+ cells. Having not met its primary
endpoint, this study provides the impetus to re-examine CPC biology prior
to any clinical outcome-based trial examining potential beneficial
cardiovascular effects of thiamine. Copyright © 2021 Elsevier
B.V.

<8>
Accession Number
2014317460
Title
Survival effect of radial artery usage in addition to bilateral internal
thoracic arterial grafting: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Formica F.; Maestri F.; D'Alessandro S.; Di Mauro M.; Singh G.; Gallingani
A.; Nicolini F.
Institution
(Formica, Maestri, Gallingani, Nicolini) Cardiac Surgery Unit, Department
of Medicine and Surgery, Parma General Hospital, University of Parma,
Parma, Italy
(D'Alessandro) Cardiac Surgery Unit, Vito Fazzi Hospital, Lecce, Italy
(Di Mauro) Invasive Cardiology and Heart Failure Unit, Medicine
Department, "Pierangeli" Hospital, Pescara, Italy
(Di Mauro) Cardio-Thoracic Surgery Unit, Heart and Vascular Centre,
Maastricht University, Maastricht, Netherlands
(Singh) Medical Centre (MUMC), Cardiovascular Research Institute
Maastricht (CARIM), Maastricht, Netherlands
(Singh) Division of Cardiac Surgery and Department of Critical Care
Medicine, Mazankowski Alberta Heart Institute, University of Alberta,
Edmonton, AB, Canada
Publisher
Mosby Inc.
Abstract
Objective: Little evidence shows whether the radial artery (RA) as third
arterial graft provides superior outcomes compared with the use of the
bilateral internal thoracic artery (BITA) and saphenous vein (SV) graft in
patients undergoing coronary artery bypass grafting. A meta-analysis of
propensity score-matched observational studies that compared the long-term
outcomes of coronary artery bypass grafting with the use of BITA and the
RA (BITA + RA) versus BITA and SV (BITA + SV) was performed.
 Method(s): Electronic databases from January 2000 to November 2020
were screened. Studies that reported long-term mortality were analyzed.
The primary outcome was long-term overall mortality. A secondary end point
was in-hospital/30-day mortality. Pooled hazard ratio with 95% confidence
interval (CI) were calculated for survival and time-to-event analysis
according to a random effect model. Differences were expressed as odds
ratio with 95% CI for in-hospital/30-day mortality. Result(s): Six
propensity score-matched studies that reported on 2500 matched patients
(BITA + RA: 1250; BITA + SV: 1250) were identified for comparison. The use
of BITA + RA was not statistically associated with early mortality (odds
ratio, 0.90; 95% CI, 0.36-2.28; P = .83). The mean follow-up time ranged
from 7.5 to 12 years. The pooled analysis of long-term survival revealed a
significant difference between the 2 groups favoring BITA + RA treatment
(hazard ratio, 0.71; 95% CI, 0.50-0.91; P = .031). The survival rate for
BITA + RA versus BITA + SV at 5, 10, and 15 years were: 96.2% versus
94.8%, 88.9% versus 87.4%, and 83% versus 77.9%, respectively (log rank
test, P = .02). Conclusion(s): In patients with coronary artery
bypass grafting, BITA + RA usage is not associated with higher rates of
operative risk and is associated with superior long-term overall
survival. Copyright © 2021 The American Association for Thoracic
Surgery

<9>
Accession Number
2013570825
Title
Correlation of Near-Infrared Spectroscopy Oximetry and Corresponding
Venous Oxygen Saturations in Children with Congenital Heart Disease.
Source
Pediatric Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Loomba R.S.; Rausa J.; Sheikholeslami D.; Dyson A.E.; Farias J.S.;
Villarreal E.G.; Flores S.; Bronicki R.A.
Institution
(Loomba, Rausa) Cardiology, Pediatrics, Advocate Children's Hospital, Oak
Lawn, IL, United States
(Loomba, Sheikholeslami, Dyson) Medicine, Chicago Medical School/Rosalind
Franklin University of Medicine and Science, North Chicago, IL, United
States
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Flores, Bronicki) Division of Critical Care, Texas Children's
Hospital/Baylor College of Medicine, Houston, TX, United States
Publisher
Springer
Abstract
Invasive and non-invasive monitoring allow for early detection of
hemodynamic compromise, facilitating timely intervention and avoidance of
further decline. While venous oximetry is useful for assessing the
adequacy of systemic oxygen delivery (DO<inf>2</inf>), it is most often
intermittent, invasive, and costly. Near-infrared spectroscopy (NIRS)
oximetry allows for the non-invasive estimation of the adequacy of
DO<inf>2</inf>. We assessed the correlation between cerebral NIRS oximetry
and superior vena cava (SVC) and jugular venous (JV) oxygen saturations
and between renal NIRS oximetry and inferior vena cava (IVC) oxygen
saturations. Systematic review of the literature was conducted to identify
studies with data regarding near-infrared spectroscopy and venous
saturation. The PubMed, EMBASE, Medline, and Cochrane databases were
queried using the following terms in isolation and various combinations:
"congenital heart disease," "near infrared spectroscopy," "venous
saturation," and "pediatric." Pediatric studies in which simultaneous NIRS
oximetry and corresponding venous oxygen saturations were simultaneously
collected after cardiac surgery or catheterization were identified. Data
were pooled from these studies to analyze the correlation between NIRS
oximetry and the corresponding venous oxygen saturations. A total of 16
studies with 613 patients were included in the final analyses. Data were
present to compare cerebral and renal NIRS oximetry with corresponding
venous oxygen saturation. Cerebral NIRS and SVC and JV oxygen saturations
and renal NIRS and IVC oxygen saturations demonstrated strong degrees of
correlation (r-value 0.70 for each). However, cerebral NIRS and IVC oxygen
saturation had a week degree of correlation (r-value of 0.38). Pooled
analyses demonstrate that cerebral NIRS oximetry correlates strongly with
SVC or JV oxygen saturation while renal NIRS oximetry correlates strongly
with IVC oxygen saturations. A weak correlation was noted between cerebral
NIRS oximetry and IVC oxygen saturations. Copyright © 2021, The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature.

<10>
Accession Number
2013567593
Title
All roads lead to Rome, but some are safer.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Di Mauro M.; Calafiore A.M.; Lorusso R.
Institution
(Di Mauro, Lorusso) Department of Cardio-Thoracic Surgery, Heart &
Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastricht,
Netherlands
(Calafiore) Department of Cardiac Surgery, Anthea Hospital, GVM Research
and Care, Bari, Italy
(Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
Publisher
John Wiley and Sons Inc
Abstract
Since the first in-human implantation, trans-catheter aortic valve
replacement (TAVR) has shown an exciting development in both technical and
technological terms, becoming the standard of care for many patients, even
not only inoperable ones. Although trans-femoral (TF) access has the
scepter of first-line route for TAVR, in some cases, this access is not
feasible, so several alternative routes were introduced over time. The
network meta-analysis by Hameed et al. has the great merit to provide a
comprehensive picture. Hence, through either direct and indirect
comparison, the authors confirmed as TF is the gold standard as access,
followed by trans-carotid and trans-subclavian. Conversely, trans-thoracic
(trans apical and trans-aortic) routes are the least safe and should be
reserved only to sporadic cases. Copyright © 2021 Wiley
Periodicals LLC

<11>
Accession Number
2013566005
Title
C-reactive protein and procalcitonin after congenital heart surgery
utilizing cardiopulmonary bypass: When should we be worried?.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Farias J.S.; Villarreal E.G.; Dhargalkar J.; Kleinhans A.; Flores S.;
Loomba R.S.
Institution
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Dhargalkar, Loomba) Department of Pediatrics, Chicago Medical
School/Rosalind Franklin University of Medicine and Science, North
Chicago, IL, United States
(Kleinhans, Flores) Section of Critical Care and Cardiology, Texas
Children's Hospital, Houston, TX, United States
(Kleinhans, Flores) Department of Pediatrics, Baylor School of Medicine,
Houston, TX, United States
(Loomba) Department of Pediatric Critical Care, Advocate Children's
Hospital, Oak Lawn, IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: To assess the efficacy of C-reactive protein (CRP) and
procalcitonin (PCT) at identifying infection in children after congenital
heart surgery (CHS) with cardiopulmonary bypass (CPB). Material(s)
and Method(s): Systematic review of the literature was conducted to
identify studies with data regarding CRP and/or PCT after CHS with CPB.
The primary variables identified to be characterized were CRP and PCT at
different timepoints. The main inclusion criteria were children who
underwent CHS with CPB. Subset analyses for those with and without
documented infection were conducted in similar fashion. A p value of less
than.05 was considered statistically significant. Result(s): A total
of 21 studies were included for CRP with 1655 patients and a total of 9
studies were included for PCT with 882 patients. CRP peaked on
postoperative Day 2. A significant difference was noted in those with
infection only on postoperative Day 4 with a level of 53.60 mg/L in those
with documented infection versus 29.68 mg/L in those without. PCT peaked
on postoperative Day 2. A significant difference was noted in those with
infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in
those with documented infection versus 5.6 ng/ml in those without.
 Conclusion(s): Both CRP and PCT increase after CHS with CPB and peak
on postoperative day 2. PCT has a greater statistically significant
difference in those with documented infection when compared to CRP and a
PCT of greater than 5.6 ng/ml should raise suspicion for
infection. Copyright © 2021 Wiley Periodicals LLC

<12>
Accession Number
2010533944
Title
Infective endocarditis by Klebsiella species: a systematic review.
Source
Journal of Chemotherapy. 33(6) (pp 365-374), 2021. Date of Publication:
2021.
Author
Ioannou P.; Miliara E.; Baliou S.; Kofteridis D.P.
Institution
(Ioannou, Miliara, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
(Baliou) National Hellenic Research Foundation, Athens, Greece
Publisher
Taylor and Francis Ltd.
Abstract
This study aimed to systematically analyze all cases of infective
endocarditis (IE) by Klebsiella species in the literature. A systematic
review of PubMed, Scopus and Cochrane library (through 27th
January 2021) for studies providing epidemiological, clinical,
microbiological as well as treatment data and outcomes of IE by Klebsiella
species was performed. In this review, a total of 66 studies were
included, providing data for 67 patients. A prosthetic valve was present
in 16.4%, while the most common causative pathogen was K. pneumoniae
followed by K. oxytoca. The aortic valve was the most commonly infected
intracardiac site, followed by the mitral valve. The diagnosis was based
on transthoracic echocardiography in 46.2%, while the diagnosis was set at
autopsy in 9.2% of included patients. Blood cultures were positive in
93.8%. Fever and sepsis were the most frequent clinical presentations,
followed by embolic phenomena, paravalvular abscess, and heart failure.
Cephalosporins, aminoglycosides, and carbapenems were the most frequently
used antimicrobials. Surgical treatment along with antimicrobials was
performed in 37.3% of included patients. Clinical cure was noted in 80.3%,
while the overall mortality was 19.4%. Infection at the aortic valve was
independently associated with mortality by IE. This systematic review
gives a comprehensive description of IE by Klebsiella and provides
information on epidemiology, clinical manifestations, therapeutic
strategies and their outcomes. Copyright © 2021 Edizioni
Scientifi che per l'Informazione su Farmaci e Terapia.

<13>
[Use Link to view the full text]
Accession Number
636016368
Title
Comparison of results of transcatheter femoral aortic valve replacement
under local and general anesthesia: A protocol for systematic review and
meta-analysis.
Source
Medicine. 100(34) (pp e27085), 2021. Date of Publication: 27 Aug 2021.
Author
Han X.; Liu S.; Wang J.; Chen H.; Chen Y.; Song B.
Institution
(Han, Wang, Chen, Chen) First Clinical Medical College of Lanzhou
University
(Liu, Song) Department of Cardiovascular Surgery, First Hospital of
Lanzhou University, Lanzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Traditionally, TAVR (Transcatheter Aortic Valve Replacement)
has been performed under general anesthesia (GA). Thus GA facilitates the
use of TEE (Transesophageal echocardiography), and the use of TEE is an
important means to improve the quality of cardiac surgery and reduce
postoperative complications. However, GA was also associated with
prolonged mechanical ventilation, longer hospitalization and intensive
care unit hours, and the need for positive inotropic agents. With
increasing clinical experience and advances in transcatheter techniques,
transfemoral TAVR may also be feasible under local anesthesia (LA).
Studies have shown that LA can avoid hemodynamic fluctuations caused by
general anesthesia and lung damage caused by positive pressure
ventilation, and can also reduce medical costs. METHOD(S): Two
researchers independently read the titles and abstracts of the literature
obtained. After excluding the studies that did not meet the inclusion
criteria, they read through the full text of the remaining literatures to
determine whether they truly met the inclusion criteria. When two
researchers disagree on the included literature, the third researcher
decides whether to include it or not. For literature with incomplete data,
contact the author via email for unpublished data. The included studies
were assessed by two researchers for the risk of bias, and cross-checked.
Stata16.0 was used for meta-analysis. Heterogeneity was assessed by chi2
test and I2 quantification. Pooled analysis was performed by random
effects model. Sensitivity analysis was performed by excluding references
one by one. We will perform subgroup analysis based on data conditions.
 RESULT(S): In this study, high quality evidence was provided by
selecting local anesthesia and general anesthesia during transfemoral
transcatheter aortic valve replacement for patients with primary arterial
stenosis. CONCLUSION(S): Local anesthesia provides anaesthetic-guided
sedation that does not require intubation and is safe and effective. Local
anesthesia may be a better alternative to TAVR under general anesthesia.
ETHICS AND DISSEMINATION: The study does not require ethical approval.
INPLASY REGISTRATION NUMBER: INPLASY202170078. Copyright © 2021
the Author(s). Published by Wolters Kluwer Health, Inc.

<14>
Accession Number
629353731
Title
The effects of multimedia education on postoperative delirium in patients
undergoing coronary artery bypass graft: A randomized clinical trial.
Source
Nursing in critical care. 25(6) (pp 346-352), 2020. Date of Publication:
01 Nov 2020.
Author
Fahimi K.; Abbasi A.; Zahedi M.; Amanpour F.; Ebrahimi H.
Institution
(Fahimi) Shahid Sayyad Shirazi Hospital, Golestan University of Medical
Sciences, Gorgan, Iran, Islamic Republic of
(Abbasi) Department of Nursing, School of Nursing and Midwifery, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
(Zahedi) Ischemic Disorders Research Center, Golestan University of
Medical Sciences, Gorgan, Iran, Islamic Republic of
(Amanpour) Clinical Research Development Unit, Bahar Hospital, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
(Ebrahimi) Randomized Controlled Trial Research Center, Shahroud
University of Medical Sciences, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients undergoing cardiac surgeries are at high risk of
developing delirium. AIMS AND OBJECTIVES: The present study aimed to
determine the effects of multimedia education on postoperative delirium in
patients undergoing a coronary artery bypass graft. DESIGN: This study was
a randomized clinical trial. METHOD(S): In this study, 110 patients
undergoing a coronary artery bypass graft were assigned to two groups,
control and intervention. Patients in the intervention group received
multimedia education, and those in the control group received routine
training. The inclusion criteria were experiencing the coronary artery
bypass graft for the first time and non-development of post-operative
cardiogenic shock or myocardial rupture. After measuring the level of
consciousness, patients were examined in terms of delirium using the
confusion assessment method for the ICU scale twice a day from admission
to discharge from the ICU. The data were statistically analysed using chi2
test and Fisher's exact test. RESULT(S): Patients of both groups were
matched in terms of demographics. The highest incidence of delirium was
observed on the first day after surgery in the intervention group (14.5%)
and in the morning of the second day after surgery (29.1%) in the control
group. Moreover, there was a significant difference between the two groups
in the incidence of delirium in the morning of the second, third, and
fourth days after surgery as it was higher in the control group over these
days. CONCLUSION(S): Considering the lower incidence of
post-operative delirium in patients who experienced multimedia education
rather than control group, the use of this non-pharmaceutical method is
recommended to prevent delirium in such patients. RELEVANCE TO CLINICAL
PRACTICE: Delirium is also an acute organic brain syndrome that often
leads to complicated conditions after cardiac surgeries. Fortunately,
delirium is a preventable issue. The implementation of multimedia
education as a non-pharmacological approach had positive effects on
patients' delirium. Copyright © 2019 British Association of
Critical Care Nurses.

<15>
Accession Number
636025608
Title
PVP iodine vs chlorhexidine in alcohol for preparation of the surgical
site: A cluster-randomized multicenter cross-over trial.
Source
Antimicrobial Resistance and Infection Control. Conference: 6th
International Conference on Prevention and Infection Control, ICPIC 2021.
Geneva Switzerland. 10(SUPPL 1) (no pagination), 2021. Date of
Publication: September 2021.
Author
Widmer A.F.; Atkinson A.; Sax H.; Jent P.; Kuster S.; Sommerstein R.;
Marschall J.; Schweiger A.
Institution
(Widmer, Schweiger) Hospital Epidemiology, University Hospital Basel,
Basel, Switzerland
(Atkinson) Bern University Hospital, Inselspital, University of Bern,
Zurich, Switzerland
(Sax) Hospital Epidemiology, Universitatsspital, Zurich, Switzerland
(Jent) Hospitabl Epidemiology, Inselspital Bern, Bern, Switzerland
(Kuster) Hospital Epidemiology, Universitatsspital Zurich, Zurich,
Switzerland
(Sommerstein, Marschall) Hospital Epidemiology, Inselspital Bern, Bern,
Switzerland
Publisher
BioMed Central Ltd.
Abstract
Introduction: Preoperative skin antisepsis is an established infection
control procedure to prevent surgical site infections (SSIs) The choice of
antiseptic agent-chlorhexidine (CHX) or iodine (PI) remains matter of
debate: Objectives: To compare rates of surgical site infections after
preparation of the skin with alcoholic soluttion with either PVP iodine or
Chlorhexidine. Method(s): In this multicenter, cluster-randomized,
triple -blinded, randomized, controlled trial, we compared the rate of
SSIs after preparation of the skin with alcoholic solutions with either
CHX or PI. The primary outcome was SSIs within 30 days after abdominal,
and one year after cardiac surgery, using CDC definitions. Result(s):
From September 2017 through June 2020, a total of 3321patients from three
university hospitals were enrolled: 1155 to PI vs 1011 assigned to CHX.
SSIs were diagnosed overall in 80 (5.1%) patients in the PI group vs 97
(5.5%) in the CHX group (relative risk [ CI950.92, 0.69- 1.23], P = 0.50).
PI was superior to CHX in abdominal surgeries (P = 0.06), but slightly
less active to prevent SSIs in cardiac surgery (P = 0.29) [Table].
 Conclusion(s): This largest cluster randomized trial demonstrated
minuscule difference in the rates of SSIs, independent of the choice of PI
or CHX to prepare the surgical site. Discordant results of other studies
might be related to the type of intervention studied, the high free
available content of PI tested, and the different products under
investigation. (Figure Presented).

<16>
Accession Number
636023999
Title
CardioEgypt 2020 - Conference.
Source
European Heart Journal, Supplement. Conference: 47th Annual International
Congress of the Egyptian Society of Cardiology, CardioEgypt 2020. Cairo
Egypt. 22(SUPPL K) (no pagination), 2020. Date of Publication: October
2020.
Author
Anonymous
Publisher
Oxford University Press
Abstract
The proceedings contain 68 papers. The topics discussed include:
predictors and management of cardiac perforation caused by cardiac rhythm
device implantation; heart rate variability in the post-infarctus; image
quality and attenuation values of multidetector CT coronary angiography
using high iodine-concentration contrast material: a comparison of the use
of iopromide 300 and iopromide 370; determining cardioembolic origin of
ischemic cerebrovascular accident in Holter ECG monitoring; assessment of
the efficacy of verapamil to prevent radial artery occlusion during
cardiac catheterization procedures: a randomized study comparing verapamil
vs. placebo; the right ventricle in pulmonary arterial hypertension (about
15 cases); heart failure: a rare complication of hypocalcemia; clinical,
functional and hemodynamic responses to specific treatment in group 1
pulmonary arterial hypertension: monocentric prospective study; and
orthostatic blood pressure drop and exercise tolerance of patients with
heart failure with preserved ejection fraction: the relation to
microvascular dysfunction.

<17>
Accession Number
636023970
Title
Assessment of the efficacy of verapamil to prevent radial artery occlusion
during cardiac catheterization procedures: A randomized study comparing
verapamil vs. placebo.
Source
European Heart Journal, Supplement. Conference: 47th Annual International
Congress of the Egyptian Society of Cardiology, CardioEgypt 2020. Cairo
Egypt. 22(SUPPL K) (pp K2), 2020. Date of Publication: October 2020.
Author
Tamara A.F.; Ramadan Salama A.Y.; El Etriby S.A.M.K.; Mohamadin Tantawy
M.A.; Kamel Sharaf S.M.
Institution
(Tamara, Ramadan Salama, El Etriby, Mohamadin Tantawy, Kamel Sharaf)
Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia
square, Abbasia, Cairo 11566, Egypt
Publisher
Oxford University Press
Abstract
Objective: To evaluate verapamil as radial artery spasmolytic in
transradial catheterization procedures. Radial artery spasm is a
relatively frequent complication during transradial approach, causing
patient discomfort or even making it impossible to continue the procedure.
We designed a randomized double-blind study to compare verapamil vs.
placebo, the standard spasmolytic agent. One hundred and fifty patients
(75 in each arm) submitted to a transradial cardiac catheterization were
consecutively included and randomly assigned to receive 2.5mg of verapamil
after sheath insertion and another 2.5mg before sheath removal at the end
of cardiac procedure (each diluted in 5 ml normal saline) or placebo 5ml
of normal saline after sheath insertion and before removal, then radial
artery patency is then assessed by pulse oximetery and radial arterial
duplex study. Both agents didn't show statistical significant differences
as regard verapamil use (86.7% were patent artery with normal flow), or
normal saline use (80% were patent artery with normal flow) in reduction
of radial occlusion rate with P-value 0.273. Patients and Methods: we
have conducted a two centre prospective study for patients aged > 40 years
presented undergoing elective coronary angiography (CA) or percutaneous
coronary intervention (PCI) for evaluation of chest pain or undergoing CA
for any other medical condition, We designed a randomized double-blind
study to compare verapamil vs. placebo, the standard spasmolytic agent.
One hundred and fifty patients (75 in each arm) submitted to a transradial
cardiac catheterization were consecutively included and randomly assigned
to receive 2.5mg of verapamil after sheath insertion and another 2.5mg
before sheath removal at the end of cardiac procedure (each diluted in 5
ml normal saline) or placebo 5ml of normal saline after sheath insertion
and before removal, then radial artery patency is then assessed by pulse
oximetery and radial arterial duplex study. Result(s): Follow-up (24
h) evaluation of the radial artery patency by pulse oximetry and radial
arterial duplex showed no differences between the two groups in the rate
of radial occlusion (10% vs. 15% in verapamil and placebo treated
patients, respectively). Radial artery occlusion rate was almost identical
for both groups. Both agents didn't show statistical significant
differences as regard verapamil use (65% were patent artery with normal
flow), or normal saline use (60% were patent artery with normal flow) in
reduction of radial occlusion rate with P-value 0.273. Conclusion(s):
The preventive use of verapamil may be unnecessary for transradial
procedures. The omission of prophylactic verapamil may not only reduce the
rate of potential complications related to the drug but also allow the
safe extension of the transradial method to those with contraindications
to verapamil.

<18>
Accession Number
636022909
Title
Safety of combined low-dose aspirin and warfarin vs. warfarin alone in
patients with a mechanical prosthetic heart valve.
Source
European Heart Journal, Supplement. Conference: 46th Annual International
Congress of the Egyptian Society of Cardiology, CardioEgypt 2019. Cairo
Egypt. 22(SUPPL A) (pp A1-A2), 2020. Date of Publication: January 2020.
Author
Yongsmith L.; Wongcharoen W.; Chinwong D.; Phrommintikul A.
Institution
(Yongsmith, Wongcharoen, Chinwong, Phrommintikul) Chiang Mai University,
Thailand
Publisher
Oxford University Press
Abstract
Background: Despite appropriate anticoagulant therapy, annual risk of
thromboembolic events is 1-2% in mechanical heart valve patients. While
adding antiplatelet reduces risk of thrombosis, bleeding also increases
without consistent international recommendations. Therefore we conducted
this study to compare incidence of bleeding and thrombosis in mechanical
heart valve patients receiving warfarin with or without aspirin.
 Method(s): This was a retrospective study on bleeding and thrombosis
events in post mechanical heart valve surgical patients in Maharaj Nakorn
Chiang Mai Hospital during 2004-2014, excluding patients who have other
indication for antiplatelet. Propensity-scored adjusted analysis was
performed to compare these incidences. Result(s): A total of 106 and
280 patients were randomly selected in combination group and warfarin
alone group respectively. With median follow-up time 5.69 years, the
incidence of overall bleeding was significantly higher in combination
group (hazard ratio; HR 2.44 (1.46-4.06), P=0.001), while major bleeding
was not significant different (HR 2.51 (0.76-8.30), P=0.131), after
stratified by age, site of prosthetic valve, and coronary heart disease
and time in therapeutic range (TTR). The thromboembolic events occurred
only in five patients in this study. Conclusion(s): The combination
of low-dose aspirin plus warfarin resulted in a higher incidence of total
bleeding but not in major bleeding in mechanical prosthetic heart valve
patients. There were few thromboembolic events in both groups.

<19>
Accession Number
2013747251
Title
A randomised controlled trial of succinylated gelatin (4%) fluid on
urinary acute kidney injury biomarkers in cardiac surgical patients.
Source
Intensive Care Medicine Experimental. 9(1) (no pagination), 2021. Article
Number: 48. Date of Publication: December 2021.
Author
Smart L.; Boyd C.; Litton E.; Pavey W.; Vlaskovsky P.; Ali U.; Mori T.;
Barden A.; Ho K.M.
Institution
(Smart, Boyd, Pavey, Ho) College of Science, Health, Engineering and
Education, Murdoch University, South St, Murdoch, WA 6150, Australia
(Smart) Centre for Clinical Research in Emergency Medicine, Perth,
Australia
(Litton) Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Australia
(Litton) Intensive Care Unit, St John of God Hospital, Subiaco, Australia
(Pavey) Department of Anaesthesia, Fiona Stanley Hospital, Murdoch,
Australia
(Vlaskovsky, Mori, Barden, Ho) Medical School, University of Western
Australia, Perth, Australia
(Ali) Department of Cardiothoracic Surgery and Transplantation, Fiona
Stanley Hospital, Murdoch, Australia
(Ho) Intensive Care Unit, Royal Perth Hospital, Perth, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Fluid resuscitation is frequently required for cardiac
surgical patients admitted to the intensive care unit. The ideal fluid of
choice in regard to efficacy and safety remains uncertain. Compared with
crystalloid fluid, colloid fluid may result in less positive fluid
balance. However, some synthetic colloids are associated with increased
risk of acute kidney injury (AKI). This study compared the effects of
succinylated gelatin (4%) (GEL) with compound sodium lactate (CSL) on
urinary AKI biomarkers in patients after cardiac surgery. Method(s):
Cardiac surgical patients who required an intravenous fluid bolus of at
least 500 mL postoperatively were randomly allocated to receive GEL or CSL
as the resuscitation fluid of choice for the subsequent 24 h. Primary
outcomes were serial urinary neutrophil gelatinase-associated lipocalin
(NGAL) and cystatin C concentrations measured at baseline, 1 h, 5 h and 24
h after enrolment, with higher concentrations indicating greater kidney
injury. Secondary biomarker outcomes included urinary clusterin,
alpha1-microglobulin and F<inf>2</inf>-isoprostanes concentrations.
Differences in change of biomarker concentration between the two groups
over time were compared with mixed-effects regression models. Statistical
significance was set at P < 0.05. Result(s): Forty cardiac surgical
patients (n = 20 per group) with similar baseline characteristics were
included. There was no significant difference in the median volume of
fluid boluses administered over 24 h between the GEL (1250 mL, Q1-Q3
500-1750) and CSL group (1000 mL, Q1-Q3 500-1375) (P = 0.42). There was a
significantly greater increase in urinary cystatin C (P < 0.001),
clusterin (P < 0.001), alpha1-microglobulin (P < 0.001) and
F<inf>2</inf>-isoprostanes (P = 0.020) concentrations over time in the GEL
group, compared to the CSL group. Change in urinary NGAL concentration (P
= 0.68) over time was not significantly different between the groups. The
results were not modified by adjustment for either urinary osmolality or
EuroSCORE II predicted risk of mortality. Conclusion(s): This
preliminary randomised controlled trial showed that use of succinylated
gelatin (4%) for fluid resuscitation after cardiac surgery was associated
with increased biomarker concentrations of renal tubular injury and
dysfunction, compared to crystalloid fluid. These results generate concern
that use of intravenous gelatin fluid may contribute to clinically
relevant postoperative AKI. Trial registration ANZCTR.org.au,
ACTRN12617001461381. Registered on 16th October, 2017,
http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373619&isR
eview=true. Copyright © 2021, The Author(s).

<20>
Accession Number
635979510
Title
Randomised controlled trial into the role of ramipril in fibrosis
reduction in rheumatic heart disease: The RamiRHeD trial protocol.
Source
BMJ Open. 11(9) (no pagination), 2021. Article Number: e048016. Date of
Publication: 13 Sep 2021.
Author
Ambari A.M.; Setianto B.; Santoso A.; Radi B.; Dwiputra B.; Susilowati E.;
Tulrahmi F.; Wind A.; Cramer M.J.M.; Doevendans P.
Institution
(Ambari, Setianto, Santoso, Radi, Dwiputra) Department of Cardiovascular
Prevention and Rehabilitation, National Cardiovascular Center Harapan
Kita, West Jakarta Jakarta, Indonesia
(Ambari, Setianto, Santoso, Radi, Dwiputra) Department of Cardiology and
Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West
Jakarta Jakarta, Indonesia
(Susilowati, Tulrahmi) Research Assistant of Department of Cardiovascular
Prevention and Rehabilitation, National Cardiovascular Center Harapan
Kita, West Jakarta Jakarta, Indonesia
(Wind, Cramer, Doevendans) Department of Cardiology, University Medical
Centre Utrecht, Utrecht, Netherlands
(Doevendans) Central Military Hospital, Netherlands Heart Institute,
Utrecht, Netherlands
Publisher
BMJ Publishing Group
Abstract
Introduction Rheumatic heart disease (RHD) is a major burden in developing
countries and accounts for 80% of all people living with the disease,
where it causes most cardiovascular morbidity and mortality in children
and young adults. Chronic inflammation and fibrosis of heart valve tissue
due to chronic inflammation in RHD will cause calcification and thickening
of the impacted heart valves, especially the mitral valve. This
fibrogenesis is enhanced by the production of angiotensin II by increased
transforming growth factor beta expression and later by the binding of
interleukin-33, which is known to have antihypertrophic and antifibrotic
effects, to soluble sST2. sST2 binding to this non-natural ligand worsens
fibrosis. Therefore, we hypothesise that ACE inhibitors (ACEIs) would
improve rheumatic mitral valve stenosis. Methods and analysis This is a
single-centre, double-blind, placebo-controlled, randomised clinical trial
with a pre-post test design. Patients with rheumatic mitral stenosis and
valve dysfunction will be planned for cardiac valve replacement operation
and will be given ramipril 5 mg or placebo for a minimum of 12 weeks
before the surgery. The expression of ST2 in the mitral valve is
considered to be representative of cardiac fibrosis. Mitral valve tissue
will be stained by immunohistochemistry to ST2. Plasma ST2 will be
measured by ELISA. This study is conducted in the Department of Cardiology
and Vascular Medicine, Universitas Indonesia, National Cardiac Center
Harapan Kita Hospital, Jakarta, Indonesia, starting on 27 June 2019.
Ethics and dissemination The performance and dissemination of this study
were approved by the ethics committee of National Cardiovascular Center
Harapan Kita with ethical code LB.02.01/VII/286/KEP.009/2018. Trial
registration number NCT03991910. Copyright © 2021 BMJ Publishing
Group. All rights reserved.

<21>
Accession Number
2013746396
Title
In-hospital outcomes of self-expanding and balloon-expandable
transcatheter heart valves in Germany.
Source
Clinical Research in Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Stachon P.; Hehn P.; Wolf D.; Heidt T.; Oettinger V.; Zehender M.; Bode
C.; von zur Muhlen C.; Kaier K.
Institution
(Stachon, Wolf, Heidt, Oettinger, Zehender, Bode, von zur Muhlen)
Department of Cardiology and Angiology I, Faculty of Medicine and Medical
Center, University of Freiburg, Freiburg, Germany
(Stachon, Oettinger, Zehender, von zur Muhlen, Kaier) Center of Big Data
Analysis in Cardiology (CeBAC), Heart Center Freiburg University,
Freiburg, Germany
(Hehn, Kaier) Institute of Medical Biometry and Statistics, Faculty of
Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: The effect of valve type on outcomes in transfemoral
transcatheter aortic valve replacement (TF-TAVR) has recently been subject
of debate. We investigate outcomes of patients treated with
balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of
all these procedures performed in Germany in 2018. Method(s): All
patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413)
valves in Germany in 2018 were identified. In-hospital outcomes were
analyzed for the endpoints in-hospital mortality, major bleeding, stroke,
acute kidney injury, postoperative delirium, permanent pacemaker
implantation, mechanical ventilation > 48 h, length of hospital stay, and
reimbursement. Since patients were not randomized to the two treatment
options, logistic or linear regression models were used with 22 baseline
patient characteristics and center-specific variables as potential
confounders. As a sensitivity analysis, the same confounding factors were
taken into account using the propensity score methods (inverse probability
of treatment weighting). Result(s): Baseline characteristics differed
substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate
of female sex (p < 0.001) in SE treated patients. After risk adjustment,
no marked differences in outcomes were found for in-hospital mortality
[risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI
0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400],
stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97
(0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p =
0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893],
length of hospital stay (risk adjusted difference in days of
hospitalization (SE instead of BE): - 0.05 [- 0.34;0.25], p = 0.762) and
reimbursement [risk adjusted difference in reimbursement (SE instead of
BE): - 72 (- 291;147), p = 0.519)] There is, however, an increased risk of
PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were
found after application of propensity score adjustment.
 Conclusion(s): We find broadly equivalent outcomes in contemporary
TF-TAVR procedures, regardless of the valve type used. Incidence of major
complications is very low for both types of valve. Copyright ©
2021, The Author(s).

<22>
Accession Number
636027874
Title
Mitral valve surgery with extensive annular calcification: review of
surgical techniques and postoperative complications.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2021. Date of Publication: 27 Aug 2021.
Author
Baudo M.; Petruccelli R.D.; Muneretto C.
Institution
(Baudo) Department of Cardiac Surgery, University of Brescia, Spedali
Civili di Brescia, Brescia, Italy
Publisher
NLM (Medline)
Abstract
Mitral annular calcification (MAC) represents an important risk factor in
mitral valve (MV) surgery. Despite several procedures having been
described, no surgical treatment of choice has been established so far:
whether a decalcification should be systematically carried out, or if the
MV should be preferentially repaired rather than replaced. A review of the
literature on patients undergoing MV surgery associated with MAC was
performed. Studies were excluded if dealing with endovascular procedures
or emergency surgery for associated endocarditis. Case reports were also
not considered in the final analysis. The literature search identified
1429 potentially eligible studies, and 25 papers were eventually included.
Several surgical techniques were described to approach this challenging
condition. During MV surgery, the presence of MAC favors the occurrence of
suboptimal intraoperative outcomes. MAC-related complications such as
atrioventricular groove rupture, cerebrovascular accident, new permanent
pacemaker implantation, intraoperative conversion from valve repair to
replacement and mortality were analyzed. MV surgery in the presence of MAC
considerably impacts the postoperative outcomes in terms of morbidity and
mortality. A great variability of surgical techniques is reported,
suggesting the need for standardization of the approach. Copyright
© 2021 Italian Federation of Cardiology. All rights reserved.

<23>
Accession Number
636027028
Title
Letter to the Editor regarding "Effectiveness of preoperative breathing
exercise interventions in patients undergoing cardiac surgery: a
systematic review".
Source
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa
de Cardiologia = Portuguese journal of cardiology : an official journal of
the Portuguese Society of Cardiology. (no pagination), 2021. Date of
Publication: 26 Aug 2021.
Author
Rodrigues M.; Vaz I.M.
Institution
(Rodrigues) Centro Hospitalar Vila Nova de Gaia/Espinho - Centro de
Reabilitacao do Norte, Vila Nova de Gaia, Portugal
(Vaz) Centro Hospitalar de Tras-os-Montes e Alto Douro - Servico de
Medicina Fisica e de Reabilitacao, Vila Real, Portugal
Publisher
NLM (Medline)

<24>
Accession Number
2014302728
Title
Effect of postoperative high load long duration inspiratory muscle
training on pulmonary function and functional capacity after mitral valve
replacement surgery: A randomized controlled trial with follow-up.
Source
PLoS ONE. 16(8 August) (no pagination), 2021. Article Number: e0256609.
Date of Publication: August 2021.
Author
Hegazy F.A.; Kamel S.M.M.; Abdelhamid A.S.; Aboelnasr E.A.; Elshazly M.;
Hassan A.M.
Institution
(Hegazy) Department of Physiotherapy, Collage of Health Sciences,
University of Sharjah, Sharjah, United Arab Emirates
(Hegazy, Aboelnasr) Faculty of Physical Therapy, Cairo University, Giza,
Egypt
(Kamel) Department of Physical Therapy, National Heart Institute, Cairo,
Egypt
(Abdelhamid) Department of Physical Therapy for Musculoskeletal Disorders
and Its Surgeries, Faculty of Physical Therapy, South Valley University,
Qena, Egypt
(Elshazly) Department of Physical Therapy for Surgery, Faculty of Physical
Therapy, South Valley University, Qena, Egypt
(Hassan) Department of Physical Therapy for Internal Medicine and
Geriatrics, Faculty of Physical Therapy, South Valley University, Qena,
Egypt
Publisher
Public Library of Science
Abstract
Objectives: Although, pre-operative inspiratory muscle training has been
investigated and reported to be an effective strategy to reduce
postoperative pulmonary complications, the efficacy of postoperative
inspiratory muscle training as well as the proper load, frequency, and
duration necessary to reduce the postoperative pulmonary complications has
not been fully investigated. This study was designed to investigate the
effect of postoperative high-load longduration inspiratory muscle training
on pulmonary function, inspiratory muscle strength, and functional
capacity after mitral valve replacement surgeries. Design Prospective
randomized controlled trial. Method(s): A total of one hundred
patients (mean age 38.3+/-3.29years) underwent mitral valve replacement
surgery were randomized into experimental (n = 50) and control (n = 50)
groups. The control group received conventional physiotherapy care, while
experimental group received conventional care in addition to inspiratory
muscle training, with 40% of the baseline maximal inspiratory pressure
targeting a load of 80% by the end of the 8 weeks intervention protocol.
Inspiratory muscle training started on the patient's first day in the
inpatient ward. Lung functions, inspiratory muscle strength, and
functional capacity were evaluated using a computer-based spirometry
system, maximal inspiratory pressure measurement and 6MWT respectively at
5 time points and a follow-up assessment was performed 6 months after
surgery. Repeated measure ANOVA and post-hoc analyses were used (p <0.05).
 Result(s): Group-time interactions were detected for all the studied
variables (p<0.001). Betweengroup analysis revealed statistically
significant postoperative improvements in all studied variables in the
experimental group compared to the control group (p <0.001) with large
effect size of eta2 >0.14. Within-group analysis indicated substantial
improvements in lung function, inspiratory pressure and functional
capacity in the experimental group (p <0.05) over time, and these
improvements were maintained at follow-up. Conclusion(s): High
intensity, long-duration postoperative inspiratory muscle training is
highly effective in improving lung function, inspiratory muscle strength,
and functional capacity after mitral valve replacement
surgeries. Copyright © 2021 Hegazy et al. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<25>
Accession Number
2007809863
Title
The effects of melatonin on the oxidative stress and duration of atrial
fibrillation after coronary artery bypass graft surgery: A randomized
controlled trial.
Source
Endocrine, Metabolic and Immune Disorders - Drug Targets. 21(6) (pp
1142-1149), 2021. Date of Publication: 2021.
Author
Barati S.; Jahangirifard A.; Ahmadi Z.H.; Tavakoli-Ardakani M.; Dastan F.
Institution
(Barati, Dastan) Department of Clinical Pharmacy, School of Pharmacy,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Jahangirifard, Ahmadi) Lung Transplantation Research Center, National
Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Tavakoli-Ardakani) Department of Clinical Pharmacy, School of Pharmacy
and Pharmaceutical Sciences Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Dastan) Chronic Respiratory Diseases Research center, National Research
Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Bentham Science Publishers
Abstract
Background: Atrial Fibrillation (AF) is a common complication following
Coronary artery bypass graft (CABG) Surgery, which may be due to oxidative
stress, necrosis and inflammation during CABG and can lead to increases
the length of hospital stay and the risk of morbidity and mortality.
Melatonin is a hormone with anti-oxidant and anti-inflammatory properties
in the cardiovascular sys-tem. This study assessed the efficacy of
sublingual consumption of melatonin in reducing necrosis and inflammation,
in patients undergoing CABG with respect to C-reactive protein (hs-CRP),
Creatine Kinase-Muscle-Brain subunits (CK-MB) and cardiac Troponin T
(cTnT) levels. Method(s): One hundred and two patients were enrolled
and twenty-six patients were excluded during the study process and finally
seventy-six patients undergoing CABG surgery randomly assigned to
melatonin group (n = 38, 12 mg sublingual melatonin the evening before and
1 hour before surgery, or the control group which did not receive
Melatonin, n = 38). Three patients in the melatonin group and three
patients in the control group were excluded from the study because of
discontinued intervention and lost to follow up. The samples were
collected before and 24 hours after surgery. hs-CRP, CK-MB, and cTnT
levels were measured in all patients with the Elisa method.
 Result(s): There was no significant difference in influencing
variables among the groups at the baseline. The incidence of AF following
CABG surgery was not statistically significant between the two groups,
(p-value = 0.71). However, the duration of AF (p-value = 0.01), the levels
of hs-CRP (p-value = 0.001) and CK-MB (p-value = 0.004) measured, 24 hours
after surgery were significantly lower in the melatonin group. cTnT levels
measured 24 hours post-CABG did not show any significant difference in
both groups (p-value = 0.52). Conclusion(s): Our findings suggest
that the administration of melatonin may help modulate oxidative stress,
based on the reduction of the levels of hs-CRP, CK-MB, and the duration of
AF following CABG surgery. Copyright © 2021, Bentham Science
Publishers. All rights reserved.

<26>
Accession Number
2013205203
Title
Does medical or surgical treatment for aortic stenosis improve outcome in
dogs?.
Source
Veterinary Evidence. 6(2) (no pagination), 2021. Date of Publication:
2021.
Author
Thomas J.; Marshall S.; Conway G.; Gormley K.; Borgeat K.
Institution
(Thomas, Marshall, Conway, Gormley, Borgeat) University of Bristol,
Bristol Veterinary School, Langford House, Langford, Bristol BS40 5DU,
United Kingdom
Publisher
Royal College of Veterinary Surgeons

<27>
Accession Number
2005154469
Title
Synchronous versus staged carotid artery stenting and coronary artery
bypass graft for patients with concomitant severe coronary and carotid
artery stenosis: A systematic review and meta-analysis.
Source
Vascular. 28(6) (pp 808-815), 2020. Date of Publication: 01 Dec 2020.
Author
Tzoumas A.; Giannopoulos S.; Charisis N.; Texakalidis P.; Kokkinidis D.G.;
Zisis S.N.; Machinis T.; Koullias G.J.
Institution
(Tzoumas) Fourth Department of Surgery, Medical School, Aristotle
University, Thessaloniki, Greece
(Giannopoulos) Division of Cardiology, Rocky Mountain Regional VA Medical
Center, Aurora, CO, United States
(Charisis) Department of Surgery, Stonybrook University, Stonybrook, NY,
United States
(Texakalidis) Department of Neurosurgery, Emory University, Atlanta, GA,
United States
(Kokkinidis) Department of Medicine, Jacobi Medical Center, Albert
Einstein College of Medicine New York, NY, United States
(Zisis) Fourth Department of Surgery, National and Kapodistrian University
of Athens, Attikon University Hospital, Athens, Greece
(Machinis) Department of Neurosurgery, Virginia Commonwealth University,
Richmond, VA, United States
(Koullias) Division of Vascular and Endovascular Surgery, Department of
Surgery, Stony Brook University Hospital, Stony Brook, NY, United States
Publisher
SAGE Publications Ltd
Abstract
Background: Coronary artery disease requiring coronary artery bypass graft
(CABG) frequently coexists with critical carotid stenosis. The most
optimized strategy for treating concomitant carotid and coronary artery
disease remains debatable. Objective(s): The aim of this
meta-analysis was to compare synchronous CAS and CABG versus staged CAS
and CABG for patients with concomitant coronary artery disease and carotid
artery stenosis in terms of peri-operative (30-day) and long-term clinical
outcomes. Method(s): This study was performed according to the PRISMA
guidelines. Eligible studies were identified through a search of PubMed,
Scopus and Cochrane database until December 2019. A meta-analysis was
conducted with the use of a random effects model. The I-square statistic
was used to assess heterogeneity. Result(s): Four studies comprising
357 patients were included in this meta-analysis. Patients who were
treated with the synchronous approach had a statistically significant
higher risk for peri-operative stoke (OR: 3.71; 95% CI: 1.00-13.69;
I2 = 0%) compared tomicron the staged group. Peri-operative
mortality (OR: 4.50; 95% CI: 0.88-23.01; I2 = 0%), myocardial
infarction (MI) (OR: 1.54; 95% CI: 0.18- 13.09; I2 = 0%),
postoperative bleeding (OR: 0.27;95% CI: 0.02-3.12; I2 = 0%),
transient ischemic attacks (TIA) (OR: 0.60; 95% CI: 0.04- 9.20;
I2 = 0.0%), acute kidney injury (AKI) (OR: 0.34; 95% CI:
0.03-4.03; I2 = 0.0%) and atrial fibrillation rates (OR:0.27;
95% CI: 0.02-3.12; I2 = 0.0%) were similar between the two
groups. Synchronous CAS-CABG and staged CAS followed by CABG were
associated with similar rates of late mortality (OR: 3.75; 95% CI:
0.50-27.94; I2 = 0.0%), MI (OR: 0.33; 95% CI: 0.01-12.03;
I2 = 0.0%) and stroke (OR:3.58; 95% CI:0.84-15.20;
I2 = 0.0%) after a mean follow-up of 47 months.
 Conclusion(s): The simultaneous approach was associated with an
increased risk of 30-day stroke compared to staged CAS and CABG. However,
no statistically significant difference was found in long-term results of
mortality, MI and stroke between the two approaches. Future studies are
warranted to validate our results. Copyright © The Author(s)
2020.

<28>
Accession Number
2013262856
Title
Implantable cardioverter defibrillators in left ventricular assist device
patients: A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. 40(10) (pp 1098-1106), 2021.
Date of Publication: October 2021.
Author
Rorris F.-P.; Antonopoulos C.N.; Kyriakopoulos C.P.; Drakos S.G.; Charitos
C.
Institution
(Rorris, Antonopoulos, Charitos) Department of Thoracic and Cardiovascular
Surgery, Evangelismos General Hospital, Athens, Greece
(Kyriakopoulos, Drakos) Division of Cardiovascular Medicine, Department of
Internal Medicine, University of Utah Health & School of Medicine, Salt
Lake City, UT, United States
Publisher
Elsevier Inc.
Abstract
Implantable cardioverter-defibrillators (ICDs) remain the standard of care
in advanced heart failure with reduced ejection fraction patients for the
prevention of sudden cardiac death. However, current guidelines remain
conflicting with respect to the use of ICDs in patients supported with a
continuous flow left ventricular assist device (CF-LVAD). The current
review adhered to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guidelines. Studies comparing the use of ICD in patients
with CF-LVADs were included. The 2 primary outcomes studied were all-cause
mortality, and a successful bridge to heart transplantation. We calculated
pooled odds ratios (ORs) with 95% confidence intervals (CIs). We also
compared baseline characteristics between US and European studies, for
CF-LVAD patients with an ICD. Among all studies, the use of an ICD was not
associated with all-cause mortality in patients with CF-LVADs (OR: 0.85,
95% CIs: 0.64-1.12, p = 0.24). The presence of an ICD was associated with
a trend towards increased likelihood of successful bridge to heart
transplantation (OR: 1.12, 95% CI: 1.0-1.3, p = 0.06). A subgroup analysis
of studies published by European centers revealed a significant decrease
in pooled mortality (OR: 0.58, 95% CI: 0.4-0.83, p = 0.003) with the use
of ICD, contrary to an increase in pooled mortality among studies
published by US centers (OR: 1.2, 95% CI 1.02-1.33, p = 0.025). Moreover,
we identified significant differences in baseline characteristics such as
bridge to transplantation rate, Interagency Registry for Mechanically
Assisted Circulatory Support profiles, and use of an intra-aortic balloon
pump or extracorporeal membrane oxygenation preoperatively, between the US
and European populations. While this meta-analysis did not show an overall
survival benefit with the use of an ICD in CF-LVAD patients, it revealed
significant differences in the derived benefit, in distinct patient
populations. This might reflect differences in baseline patient
characteristics and warrants further investigation. Copyright ©
2021 International Society for Heart and Lung Transplantation

<29>
Accession Number
2006907476
Title
Comparing anticoagulation therapy alone versus anticoagulation plus single
antiplatelet drug therapy after transcatheter aortic valve implantation in
patients with an indication for anticoagulation: a systematic review and
meta-analysis.
Source
Cardiovascular Drugs and Therapy. 35(5) (pp 995-1002), 2021. Date of
Publication: October 2021.
Author
Zhu Y.; Meng S.; Chen M.; Jia R.; Nan J.; Li H.; Zhu H.; Li L.; Jin Z.
Institution
(Zhu, Chen, Li, Zhu, Jin) Department of Cardiology, Beijing Anzhen
Hospital, Capital Medical University, Beijing 100029, China
(Meng, Jia, Nan, Li, Jin) Department of Cardiology, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
Publisher
Springer
Abstract
Purpose: This meta-analysis compared the efficacy and safety of oral
anticoagulation (OAC) therapy alone versus OAC plus single antiplatelet
therapy (SAPT) in patients with an indication for chronic OAC (mostly due
to atrial fibrillation) after transcatheter aortic valve implantation
(TAVI). Method(s): A systematic literature search was performed in
the PubMed, Embase, and Cochrane Library databases to identify relevant
studies. Data was extracted from the eligible studies and outcomes
expressed as relative risks (RRs) with 95% confidence intervals (CIs).
 Result(s): Five studies comprising 1344 patients with an indication
for chronic OAC and undergoing TAVI were included. Of the 1344 patients,
480 patients received OAC therapy alone and 864 patients received OAC plus
SAPT. There were no significant differences between OAC alone versus OAC
plus SAPT in all-cause mortality (RR = 1.05, 95% CI 0.84-1.30, p = 0.69)
and ischemic stroke (RR = 0.95, 95% CI 0.95-1.61, p = 0.86). However, OAC
alone was associated with significantly lower risks of all bleeding events
(RR = 0.62, 95% CI 0.49-0.69, p < 0.0001) and major and/ life-threatening
bleeding events (RR = 0.57, 95% CI 0.42-0.76, p = 0.0002) compared to OAC
plus SAPT. Conclusion(s): In patients with an indication for chronic
anticoagulation, post-TAVI antithrombotic therapy with OAC alone compared
to OAC plus SAPT may be not significantly different in reducing all-cause
mortality and ischemic stroke, but has an important benefit in a
significantly lower risk of all bleeding and major and/life-threatening
bleeding events. Copyright © 2020, Springer Science+Business
Media, LLC, part of Springer Nature.

<30>
[Use Link to view the full text]
Accession Number
631584423
Title
Postoperative pain and analgesic requirements in the first year after
intraoperative methadone for complex spine and cardiac surgery.
Source
Anesthesiology. (pp 330-342), 2020. Date of Publication: 2020.
Author
Murphy G.S.; Avram M.J.; Greenberg S.B.; Shear T.D.; Deshur M.A.;
Dickerson D.; Bilimoria S.; Benson J.; Maher C.E.; Trenk G.J.; Teister
K.J.; Szokol J.W.
Institution
(Murphy, Greenberg, Shear, Deshur, Dickerson, Bilimoria, Benson, Maher,
Trenk, Teister, Szokol) Department of Anesthesiology, NorthShore
University HealthSystem, University of Chicago Pritzker, School of
Medicine, Evanston, IL, United States
(Avram) Department of Anesthesiology, Northwestern University Feinberg,
School of Medicine, Chicago, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Methadone is a long-acting opioid that has been reported to
reduce postoperative pain scores and analgesic requirements and may
attenuate development of chronic postsurgical pain. The aim of this
secondary analysis of two previous trials was to follow up with patients
who had received a single intraoperative dose of either methadone or
traditional opioids for complex spine or cardiac surgical procedures.
 Method(s): Preplanned analyses of long-term outcomes were conducted
for spinal surgery patients randomized to receive 0.2 mg/kg methadone at
the start of surgery or 2 mg hydromorphone at surgical closure, and for
cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12
mug/kg fentanyl intraoperatively. A pain questionnaire assessing the
weekly frequency (the primary outcome) and intensity of pain was mailed to
subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared
with the Mann-Whitney U test, and nominal data were compared using the
chi-square test or Fisher exact probability test. The criterion for
rejection of the null hypothesis was P < 0.01. Result(s): Three
months after surgery, patients randomized to receive methadone for spine
procedures reported the weekly frequency of chronic pain was less (median
score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the
hydromorphone group, P = 0.004). Patients randomized to receive methadone
for cardiac surgery reported the frequency of postsurgical pain was less
at 1 month (median score 0) than it was in patients randomized to receive
fentanyl (median score 2 [twice per week], P = 0.004). Conclusion(s):
Analgesic benefits of a single dose of intraoperative methadone were
observed during the first 3 months after spinal surgery (but not at 6 and
12 months), and during the first month after cardiac surgery, when the
intensity and frequency of pain were the greatest. Copyright ©
2020, the American Society of Anesthesiologists, Inc. All Rights Reserved.

<31>
Accession Number
2013729135
Title
ACTION-1: study protocol for a randomised controlled trial on ACT-guided
heparinization during open abdominal aortic aneurysm repair.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 639. Date of
Publication: December 2021.
Author
Wiersema A.M.; Roosendaal L.C.; Koelemaij M.J.W.; Tijssen J.G.P.; van
Dieren S.; Blankensteijn J.D.; Debus E.S.; Middeldorp S.; Heyligers
J.M.M.; Fokma Y.S.; Reijnen M.M.P.J.; Jongkind V.
Institution
(Wiersema, Roosendaal, Jongkind) Department of Vascular Surgery,
Dijklander ziekenhuis, Maelsonstraat 3, Hoorn, NP 1624, Netherlands
(Wiersema, Roosendaal, Blankensteijn, Jongkind) Department of Vascular
Surgery, Amsterdam UMC, loc. Vrije Universiteit Medical center, De
Boelenlaan 1117, Amsterdam, HV 1081, Netherlands
(Koelemaij, van Dieren) Department of Vascular Surgery, Amsterdam UMC,
loc. AMC, Meibergdreef 9, Amsterdam, AZ 1105, Netherlands
(Tijssen) Emeritus Professor of Clinical Epidemiology & Biostatistics,
Department of Cardiology, Amsterdam UMC - University of Amsterdam,
Amsterdam, AZ 1105, Netherlands
(Debus) Department of Vascular Surgery, University Heart Centre
Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20251, Germany
(Middeldorp) Division of Internal Medicine, Department of Haematology,
Amsterdam UMC, loc. AMC, Meibergdreef 9, Amsterdam, AZ 1105, Netherlands
(Heyligers) Department of Vascular Surgery, Elisabeth-TweeSteden
ziekenhuis, Hilvarenbeekseweg 60, Tilburg, GC 5022, Netherlands
(Fokma) Member of Board of Directors, Dijklander ziekenhuis, Maelsonstraat
3, Hoorn, NP 1624, Netherlands
(Reijnen) Department of Vascular Surgery, Rijnstate ziekenhuis, Wagnerlaan
55, Arnhem, AD 6815, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Heparin is used worldwide for 70 years during all non-cardiac
arterial procedures (NCAP) to reduce thrombo-embolic complications (TEC).
But heparin also increases blood loss causing possible harm for the
patient. Heparin has an unpredictable effect in the individual patient.
The activated clotting time (ACT) can measure the effect of heparin.
Currently, this ACT is not measured during NCAP as the standard of care,
contrary to during cardiac interventions, open and endovascular. A RCT
will evaluate if ACT-guided heparinization results in less TEC than the
current standard: a single bolus of 5000 IU of heparin and no measurements
at all. A goal ACT of 200-220 s should be reached during ACT-guided
heparinization and this should decrease (mortality caused by) TEC, while
not increasing major bleeding complications. This RCT will be executed
during open abdominal aortic aneurysm (AAA) surgery, as this is a
standardized procedure throughout Europe. Method(s): Seven hundred
fifty patients, who will undergo open AAA repair of an aneurysm
originating below the superior mesenteric artery, will be randomised in 2
treatment arms: 5000 IU of heparin and no ACT measurements and no
additional doses of heparin, or a protocol of 100 IU/kg bolus of heparin
and ACT measurements after 5 min, and then every 30 min. The goal ACT is
200-220 s. If the ACT after 5 min is < 180 s, 60 IU/kg will be
administered; if the ACT is between 180 and 200 s, 30 IU/kg. If the ACT is
> 220 s, no extra heparin is given, and the ACT is measured after 30 min
and then the same protocol is applied. The expected incidence for the
combined endpoint of TEC and mortality is 19% for the 5000 IU group and
11% for the ACT-guided group. Discussion(s): The ACTION-1 trial is an
international RCT during open AAA surgery, designed to show superiority of
ACT-guided heparinization compared to the current standard of a single
bolus of 5000 IU of heparin. A significant reduction in TEC and mortality,
without more major bleeding complications, must be proven with a relevant
economic benefit. Trial registration {2a}: NTR NL8421 ClinicalTrials.gov
NCT04061798. Registered on 20 August 2019 EudraCT 2018-003393-27 Trial
registration: data set {2b}: ClinicalTrials.gov: NCT04061798NTR:
NL8421Arno@wiersema.nuArno@wiersema.nu Copyright © 2021, The
Author(s).

<32>
Accession Number
2013714681
Title
Use of PCR in the diagnosis of pericardial amebiasis: a case report and
systematic review of the literature.
Source
BMC Infectious Diseases. 21(1) (no pagination), 2021. Article Number: 960.
Date of Publication: December 2021.
Author
Matsuo T.; Saito A.; Kawai F.; Ishikawa K.; Hasegawa R.; Suzuki T.; Fujino
T.; Kinoshita K.; Asano T.; Mizuno A.; Yagita K.; Komiyama N.; Uehara Y.;
Mori N.
Institution
(Matsuo, Ishikawa, Hasegawa, Uehara, Mori) Department of Infectious
Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku,
Tokyo, Japan
(Saito, Suzuki, Asano, Mizuno, Komiyama) Department of Cardiovascular
Medicine, St. Luke's International Hospital, Tokyo, Japan
(Kawai) St. Luke's International University Library, Tokyo, Japan
(Fujino, Kinoshita) Department of Internal Medicine, St. Luke's
International Hospital, Tokyo, Japan
(Yagita) Department of Parasitology, National Institute of Infectious
Diseases, Tokyo, Japan
(Uehara) Department of Clinical and Laboratory, St. Luke's International
Hospital, Tokyo, Japan
Publisher
BioMed Central Ltd
Abstract
Background: Entamoeba histolytica (E. histolytica) is rarely identified as
a cause of amebic pericarditis. We report a case of amebic pericarditis
complicated by cardiac tamponade, in which the diagnosis was missed
initially and was made retrospectively by polymerase chain reaction (PCR)
testing of a stored sample of pericardial fluid. Furthermore, we performed
a systematic review of the literature on amebic pericarditis. Case
presentation: A 71-year-old Japanese man who had a history of sexual
intercourse with several commercial sex workers 4 months previously,
presented to our hospital with left chest pain and cough. He was admitted
on suspicion of pericarditis. On hospital day 7, he developed cardiac
tamponade requiring urgent pericardiocentesis. The patient's symptoms
temporarily improved, but 1 month later, he returned with fever and
abdominal pain, and multiple liver lesions were found in the right lobe.
Polymerase chain reaction of the aspiration fluid of the liver lesion and
pericardial and pleural fluid stored from the previous hospitalization
were all positive for E. histolytica. Together with the positive serum
antibody for E. histolytica, a diagnosis of amebic pericarditis was made.
Notably, the diagnosis was missed initially and was made retrospectively
by performing PCR testing. The patient improved with metronidazole 750 mg
thrice daily for 14 days, followed by paromomycin 500 mg thrice daily for
10 days. Conclusion(s): This case suggests that, although only 122
cases of amebic pericarditis have been reported, clinicians should be
aware of E. histolytica as a potential causative pathogen. The polymerase
chain reaction method was used to detect E. histolytica in the pericardial
effusion and was found to be useful for the diagnosis of amebic
pericarditis in addition to the positive results for the serum antibody
testing for E. histolytica. Because of the high mortality associated with
delayed treatment, prompt diagnosis should be made. Copyright ©
2021, The Author(s).

<33>
Accession Number
2013710304
Title
Comparison of enhanced recovery after surgery protocol and conventional
approach after laparoscopic transperitoneal radical prostatectomy: a
retrospective analysis.
Source
African Journal of Urology. 27(1) (no pagination), 2021. Article Number:
129. Date of Publication: December 2021.
Author
Guleser A.S.; Basaga Y.; Karadag M.A.
Institution
(Guleser, Basaga, Karadag) Urology Department, Ministry of Health Kayseri
City Education and Research Hospital, Kayseri, Turkey
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Although open radical prostatectomy has been used in the
treatment of localized prostate cancer for a long time, minimally invasive
surgical approaches such as laparoscopic radical prostatectomy and
robot-assisted radical prostatectomy have recently gained importance in
order to improve postoperative results and shorten hospital stay. Although
the enhanced recovery after surgery (ERAS) protocol was first defined for
gastrointestinal surgeries in 2001, it has now been used in gynecological,
orthopedic, thoracic and urological surgeries. In our study, we aimed to
compare the results of the ERAS protocol with the conventional approach in
patients who underwent laparoscopic radical prostatectomy. Method(s):
There is a retrospective analysis of 70 patients who underwent
laparoscopic radical prostatectomy at Kayseri City Hospital between May
2018 and January 2021. Data were analyzed using the Statistical Package
for the Social Sciences (SPSS) for Windows, version 25.0 (IBM SPSS,
Armonk, NY, USA). Seventy patients were included in the study. While 48
patients who underwent perioperative care with the traditional approach
were included in the conventional group, 22 patients were included in the
ERAS group. Age, comorbidities, preoperative PSA level, digital rectal
examination findings, preoperative imaging, extra prostatic spread and
lymph node involvement, location of tumors, time between biopsy and
surgery, lymphadenectomy status, and histopathological findings of
transrectal ultrasound biopsy and prostatectomy specimens were recorded
for each patient. Initiation of enteral feeding, time to first defecation,
duration of antibiotic use, ileus development rate and length of hospital
stay (LOS) were compared for both groups. Result(s): The mean age of
48 patients in the conventional group was 63.37 +/- 7.01 years, while the
mean age of 22 patients in the ERAS group was 66.36 +/- 5.31 years (p =
0.080). Although the first defecation time was shorter in the ERAS group
(4.75 +/- 3.21 vs. 3.73 +/- 2.12 days, p = 0.179), there was no
statistically significant difference. Ileus developed in 10 (20.8%)
patients in the conventional group and 2 (9.1%) in the ERAS group. Use of
antibiotics in the postoperative period in the conventional group (5.83
+/- 3.62 vs. 3.18 +/- 2.42 days, p = 0.003) and LOS (7.92 +/- 3.26 vs.
5.91 +/- 2, 15 days, p = 0.011) were statistically significantly longer.
 Conclusion(s): In summary, ERAS protocol is associated with short
LOS, time to initiation of enteral feeding and duration of antibiotics
use. There was no statistically significant difference in the rate of
ileus and time to first defecation between the two groups. Randomized
prospective studies on heterogeneous and larger patient groups are needed
to confirm our findings. Copyright © 2021, The Author(s).

<34>
Accession Number
2014658113
Title
Effects of Glucocorticoids on Postoperative Delirium in Adult Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.
Source
Clinical Therapeutics. (no pagination), 2021. Date of Publication: 2021.
Author
Liu W.; Wang Y.; Wang J.; Shi J.; Pan J.; Wang D.
Institution
(Liu, Wang, Wang, Shi, Pan, Wang) Department of Thoracic and
Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Institute of Cardiothoracic Vascular Disease,
Nanjing University, China
Publisher
Elsevier Inc.
Abstract
Purpose: Delirium is a common neurologic complication after cardiac
surgery and is associated with a poor prognosis. Several studies have
explored the effects of glucocorticoids on postoperative delirium (POD).
However, conclusion have been inconsistent. The purpose of this systematic
review and meta-analysis is to evaluate the effects of glucocorticoids on
POD in adult patients undergoing cardiac surgery. Method(s): A
systematic literature search was conducted using PubMed/MEDLINE, Embase,
Cochrane Library/Central, and Web of Science from inception to January 28,
2021. Randomized controlled trials evaluating the effects of perioperative
glucocorticoids administration on the incidence of POD in adults (>=18
years of age) undergoing cardiac surgery were included. The primary
outcome of incidence of POD was assessed using the risk ratio (RR) with a
fixed-effects model. Secondary analyses included the severity or duration
of delirium, mortality at 30 days, length of hospital and intensive care
unit (ICU) stay, duration of mechanical ventilatory support, the incidence
of myocardial injury, new atrial fibrillation, renal and respiratory
failure, postoperative infection and stroke, and the level of glucose and
inflammatory factors. Finding(s): A total 4 trials (n = 8448
patients) were included. Glucocorticoids did not significantly reduce the
incidence of POD (RR = 0.99; 95% CI, 0.86-1.14) but increased the risk of
myocardial injury (RR = 1.22; 95% CI, 1.08-1.38), decreased the duration
of mechanical ventilatory support (mean difference, -0.83; 95% CI, -1.32
to -0.34), and led to a tendency toward short length of ICU stay (mean
difference, -0.22; 95% CI, -0.47 to -0.03). No significant differences
were observed in other secondary outcomes. Implications: The perioperative
administration of glucocorticoids did not reduce the incidence of POD in
adult patients undergoing cardiac surgery but might be associated with
shorter duration of mechanical ventilatory support and a tendency toward a
shorter length of ICU stay. Furthermore, we found that glucocorticoids may
increase the rate of myocardial injury but have no effects on other
clinical outcomes. International Prospective Register of Systematic
Reviews identifier: CRD42021233458. Copyright © 2021

<35>
Accession Number
2014637976
Title
Current and Future Applications of Virtual, Augmented, and Mixed Reality
in Cardiothoracic Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Sadeghi A.H.; Mathari S.E.; Abjigitova D.; Maat A.P.W.M.; Taverne
Y.J.H.J.; Bogers A.J.J.C.; Mahtab E.A.F.
Institution
(Sadeghi, Mathari, Abjigitova, Maat, Taverne, Bogers, Mahtab) Department
of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam,
Netherlands
Publisher
Elsevier Inc.
Abstract
Background: This review aims to examine the existing literature to address
currently used virtual, augmented, and mixed reality modalities in the
areas of preoperative surgical planning, intraoperative guidance, and
postoperative management in the field of cardiothoracic surgery. In
addition this innovative technology provides future perspectives and
potential benefits for cardiothoracic surgeons, trainees, and patients.
 Method(s): A targeted, nonsystematic literature assessment was
performed within the Medline and Google Scholar databases to help identify
current trends and to provide better understanding of the current
state-of-the-art extended reality (XR) modalities in cardiothoracic
surgery. Related articles published up to July 2020 were included in the
review. Result(s): XR is a novel technique gaining increasing
application in cardiothoracic surgery. It provides a 3-dimensional and
realistic view of structures and environments and offers the user the
ability to interact with digital projections of surgical targets. Recent
studies showed the validity and benefits of XR applications in
cardiothoracic surgery. Examples include XR-guided preoperative planning,
intraoperative guidance and navigation, postoperative pain and
rehabilitation management, surgical simulation, and patient education.
 Conclusion(s): XR is gaining interest in the field of cardiothoracic
surgery. In particular there are promising roles for XR applications in
televirtuality, surgical planning, surgical simulation, and perioperative
management. However future refinement and research are needed to further
implement XR in the aforementioned settings within cardiothoracic
surgery. Copyright © 2020 The Society of Thoracic Surgeons

<36>
Accession Number
2013743186
Title
Intercostal Cryo Nerve Block in Minimally Invasive Cardiac Surgery: The
Prospective Randomized FROST Trial.
Source
Pain and Therapy. (no pagination), 2021. Date of Publication: 2021.
Author
Lau W.C.; Shannon F.L.; Bolling S.F.; Romano M.A.; Sakwa M.P.; Trescot A.;
Shi L.; Johnson R.L.; Starnes V.A.; Grehan J.F.
Institution
(Lau, Shannon, Johnson) William Beaumont Hospital, 3601 West 13 Mile Road,
Royal Oak, MI 48703, United States
(Bolling, Romano) University of Michigan, Ann Arbor, MI, United States
(Sakwa) Memorial Care Heart and Vascular Institute, Long Beach, CA, United
States
(Trescot) The Pain and Headache Center, Eagle River, AK, United States
(Shi) NAMSA, Minneapolis, MN, United States
(Starnes) University of Southern California, Los Angeles, CA, United
States
(Grehan) United Heart and Vascular Institute-Allina, Saint Paul, MN,
United States
Publisher
Adis
Abstract
Introduction: Intercostal cryo nerve block has been shown to enhance
pulmonary function recovery and pain management in post-thoracotomy
procedures. However, its benefit have never been demonstrated in minimal
invasive thoracotomy heart valve surgery (Mini-HVS). The purpose of the
study was to determine whether intraoperative intercostal cryo nerve block
in conjunction with standard of care (collectively referred to hereafter
as CryoNB) provided superior analgesic efficacy in patients undergoing
Mini-HVS compared to standard-of-care (SOC). Method(s): FROST was a
prospective, 3:1 randomized (CryoNB vs. SOC), multicenter trial in
patients undergoing Mini-HVS. The primary endpoint was the 48-h
postoperative forced expiratory volume in 1 s (FEV1) result. Secondary
endpoints were visual analog scale (VAS) scores for pain at the surgical
site and general pain, intensive care unit and hospital length-of-stay,
total opioid consumption, and allodynia at 6 months postoperatively.
 Result(s): A total of 84 patients were randomized to the two arms of
the trial CryoNB (n = 65) and SOC (n = 19). Baseline Society of Thoracic
Surgeons Predictive Risk of Mortality (STS PROM) score, ejection fraction,
and FEV1 were similar between cohorts. A higher 48-h postoperative FEV1
result was demonstrated in the CryoNB cohort versus the SOC cohort (1.20
+/- 0.46 vs. 0.93 +/- 0.43 L; P = 0.02, one-sided two-sample t test).
Surgical site VAS scores were similar between the CryoNB and SOC cohorts
at all postoperative timepoints evaluated, but VAS scores not related to
the surgical site were lower in the SOC group at 72, 94, and 120 h
postoperatively. The SOC cohort had a 13% higher opioid consumption than
the CryoNB cohort. One of 64 CryoNB patients reported allodynia that did
not require pain medication at 10 months. Conclusion(s): The results
of FROST demonstrated that intercostal CryoNB provided enhanced FEV1 score
at 48 h postoperatively with optimized analgesic effectiveness versus SOC.
Future larger prospective randomized trials are warranted to determine
whether intercostal CryoNB has an opioid-sparing effect in patients
undergoing Mini-HVS. Trial Registration: Clinicaltrials.gov identifier:
NCT02922153. Copyright © 2021, The Author(s).

<37>
Accession Number
636009103
Title
Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR.
Source
The New England journal of medicine. (no pagination), 2021. Date of
Publication: 28 Aug 2021.
Author
Van Mieghem N.M.; Unverdorben M.; Hengstenberg C.; Mollmann H.; Mehran R.;
Lopez-Otero D.; Nombela-Franco L.; Moreno R.; Nordbeck P.; Thiele H.; Lang
I.; Zamorano J.L.; Shawl F.; Yamamoto M.; Watanabe Y.; Hayashida K.;
Hambrecht R.; Meincke F.; Vranckx P.; Jin J.; Boersma E.; Rodes-Cabau J.;
Ohlmann P.; Capranzano P.; Kim H.-S.; Pilgrim T.; Anderson R.; Baber U.;
Duggal A.; Laeis P.; Lanz H.; Chen C.; Valgimigli M.; Veltkamp R.; Saito
S.; Dangas G.D.
Institution
(Van Mieghem, Unverdorben, Hengstenberg, Mollmann, Mehran, Lopez-Otero,
Nombela-Franco, Moreno, Nordbeck, Thiele, Lang, Zamorano, Shawl, Yamamoto,
Watanabe, Hayashida, Hambrecht, Meincke, Vranckx, Jin, Boersma,
Rodes-Cabau, Ohlmann, Capranzano, Kim, Pilgrim, Anderson, Baber, Duggal,
Laeis, Lanz, Chen, Valgimigli, Veltkamp, Saito, Dangas) From the
Department of Cardiology, Erasmus University Medical Center, Thoraxcenter,
Rotterdam, the Netherlands (N.M.V.M., E.B.); Daiichi Sankyo, Basking
Ridge, NJ (M.U., J.J., A.D., C.C.); the Department of Internal Medicine
II, Division of Cardiology, Vienna General Hospital, Medical University,
Vienna (C.H., I.L.); the Department of Internal Medicine, St. Johannes
Hospital, Dortmund (H.M.), the Department of Internal Medicine I,
University Hospital Wurzburg, Wurzburg (P.N.), the Department of Internal
Medicine-Cardiology, Heart Center Leipzig at University of Leipzig,
Leipzig (H.T.), Bremer Institute for Heart and Circulation Research at
Klinikum Links der Weser, Bremen (R.H.), the Department of Cardiology,
Asklepios Klinik St. Georg, Hamburg (F.M.), Daiichi Sankyo Europe, Munich
(P.L., H.L.), the Department of Neurology, Alfried Krupp Krankenhaus,
Essen (R.V.), and the Department of Neurology, University Hospital
Heidelberg, Heidelberg (R.V.) - all in Germany; Zena and Michael A. Wiener
Cardiovascular Institute, Mount Sinai Hospital, New York (R. Mehran,
G.D.D.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The role of direct oral anticoagulants as compared with
vitamin K antagonists for atrial fibrillation after successful
transcatheter aortic-valve replacement (TAVR) has not been well studied.
 METHOD(S): We conducted a multicenter, prospective, randomized,
open-label, adjudicator-masked trial comparing edoxaban with vitamin K
antagonists in patients with prevalent or incident atrial fibrillation as
the indication for oral anticoagulation after successful TAVR. The primary
efficacy outcome was a composite of adverse events consisting of death
from any cause, myocardial infarction, ischemic stroke, systemic
thromboembolism, valve thrombosis, or major bleeding. The primary safety
outcome was major bleeding. On the basis of a hierarchical testing plan,
the primary efficacy and safety outcomes were tested sequentially for
noninferiority, with noninferiority of edoxaban established if the upper
boundary of the 95% confidence interval for the hazard ratio did not
exceed 1.38. Superiority testing of edoxaban for efficacy would follow if
noninferiority and superiority were established for major bleeding.
 RESULT(S): A total of 1426 patients were enrolled (713 in each
group). The mean age of the patients was 82.1 years, and 47.5% of the
patients were women. Almost all the patients had atrial fibrillation
before TAVR. The rate of the composite primary efficacy outcome was 17.3
per 100 person-years in the edoxaban group and 16.5 per 100 person-years
in the vitamin K antagonist group (hazard ratio, 1.05; 95% confidence
interval [CI], 0.85 to 1.31; P=0.01 for noninferiority). Rates of major
bleeding were 9.7 per 100 person-years and 7.0 per 100 person-years,
respectively (hazard ratio, 1.40; 95% CI, 1.03 to 1.91; P=0.93 for
noninferiority); the difference between groups was mainly due to more
gastrointestinal bleeding with edoxaban. Rates of death from any cause or
stroke were 10.0 per 100 person-years in the edoxaban group and 11.7 per
100 person-years in the vitamin K antagonist group (hazard ratio, 0.85;
95% CI, 0.66 to 1.11). CONCLUSION(S): In patients with mainly
prevalent atrial fibrillation who underwent successful TAVR, edoxaban was
noninferior to vitamin K antagonists as determined by a hazard ratio
margin of 38% for a composite primary outcome of adverse clinical events.
The incidence of major bleeding was higher with edoxaban than with vitamin
K antagonists. (Funded by Daiichi Sankyo; ENVISAGE-TAVI AF
ClinicalTrials.gov number, NCT02943785.). Copyright © 2021
Massachusetts Medical Society.

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

<39>
Accession Number
2013396068
Title
Citrulline, biomarker of enterocyte functional mass and dietary
supplement. Metabolism, transport, and current evidence for clinical use.
Source
Nutrients. 13(8) (no pagination), 2021. Article Number: 2794. Date of
Publication: August 2021.
Author
Maric S.; Restin T.; Muff J.L.; Camargo S.M.; Guglielmetti L.C.;
Holland-Cunz S.G.; Crenn P.; Vuille-Dit-bille R.N.
Institution
(Maric, Muff) School of Medicine, University of Basel, Basel 4001,
Switzerland
(Restin, Camargo, Vuille-Dit-bille) Institute of Physiology, University of
Zurich, Zurich 8091, Switzerland
(Restin) Newborn Research Zurich, Department of Neonatology, University
Hospital Zurich and University of Zurich, Zurich 8091, Switzerland
(Guglielmetti) Department of Visceral und Thoracic Surgery, Cantonal
Hospital of Winterthur, Winterthur 8400, Switzerland
(Holland-Cunz, Vuille-Dit-bille) Department of Pediatric Surgery,
University Children's Hospital of Basel, Basel 4001, Switzerland
(Crenn) Hepato-gastroenterology and Nutrition, Hopital Ambroise Pare,
Boulogne Billancourt, APHP-Universite Paris Saclay, Boulogne-Billancourt
92100, France
Publisher
MDPI
Abstract
L-Citrulline is a non-essential but still important amino acid that is
released from enterocytes. Because plasma levels are reduced in case of
impaired intestinal function, it has become a biomarker to monitor
intestinal integrity. Moreover, oxidative stress induces protein
citrullination, and antibodies against anti-citrullinated proteins are
useful to monitor rheumatoid diseases. Citrullinated histones, however,
may even predict a worse outcome in cancer patients. Supplementation of
citrulline is better tolerated compared to arginine and might be useful to
slightly improve muscle strength or protein balance. The following article
shall provide an overview of L-citrulline properties and functions, as
well as the current evidence for its use as a biomarker or as a
therapeutic supplement. Copyright © 2021 by the authors. Licensee
MDPI, Basel, Switzerland.

<40>
Accession Number
2003583404
Title
Predicting mortality with cardiac troponins: Recent insights from
meta-analyses.
Source
Diagnosis. 8(1) (no pagination), 2021. Date of Publication: 01 Feb 2021.
Author
Lippi G.; Cervellin G.; Sanchis-Gomar F.
Institution
(Lippi) Section of Clinical Biochemistry, University of Verona, Piazzale
LA Scuro, Verona 37134, Italy
(Cervellin) Emergency Department, University Hospital of Parma, Parma,
Italy
(Sanchis-Gomar) Department of Physiology, Faculty of Medicine, University
of Valencia, INCLIVA Biomedical Research Institute, Valencia, Spain
Publisher
Walter de Gruyter GmbH
Abstract
The introduction of cardiac troponin (cTn) testing in clinical practice
has been one of the most important breakthroughs that have occurred in the
recent history of laboratory medicine. Although it is now uncontestable
that cTn values are essential for diagnosing acute coronary syndrome
(ACS), solid evidence is also emerging that assessment of either cardiac
troponin I (cTnI) or T (cTnT) may provide valuable prognostic information
in the general healthy population, as well as in patients with a vast
array of cardiac and extra-cardiac diseases. We have hence performed a
critical review of the scientific literature for identifying meta-analyses
which have investigated the potential contribution of cTns in predicting
the risk of death in health and disease. According to the articles
identified with our research, we can conclude that increased cTn values
may be considered independent risk factors for all-cause mortality in the
general population, as well as in patients with ACS, in those undergoing
revascularization procedures, or with stable coronary artery disease
(CAD), heart failure (HF) and atrial fibrillation (AF). Measurement of cTn
may then be helpful for stratifying the mortality risk in non-cardiac
hospitalized patients, in those with critical illness or sepsis, syncope,
stroke, acute aortic dissection, pulmonary diseases, brain injury, renal
failure, vascular and non-cardiac surgery. Although this evidence has
notable clinical implications, the cost-effectiveness of population
screening with high-sensitivity (hs) cTn immunoassays has not been proven
so far. Copyright © 2019 Walter de Gruyter GmbH, Berlin/Boston
2019.

<41>
[Use Link to view the full text]
Accession Number
632434613
Title
Effects of Different Doses of Remote Ischemic Preconditioning on Kidney
Damage among Patients Undergoing Cardiac Surgery: A Single-Center
Mechanistic Randomized Controlled Trial.
Source
Critical Care Medicine. 48(8) (pp E690-E697), 2020. Date of Publication:
01 Aug 2020.
Author
Meersch M.; Kullmar M.; Pavenstadt H.; Rossaint J.; Kellum J.A.; Martens
S.; Klausmeyer P.; Schmidt E.A.; Kerschke L.; Zarbock A.
Institution
(Meersch, Kullmar, Rossaint, Klausmeyer, Schmidt, Zarbock) Department of
Anaesthesiology, Intensive Care Medicine and Pain Medicine, University
Hospital Munster, Munster, Germany
(Pavenstadt) Department of Medicine, Division D, Nephrology, University
Hospital Munster, Munster, Germany
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Martens) Department of Cardiac Surgery, University of Munster, Munster,
Germany
(Kerschke) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: We have previously shown that remote ischemic preconditioning
reduces acute kidney injury (acute kidney injury) in high-risk patients
undergoing cardiopulmonary bypass and that the protective effect is
confined to patients who exhibit an increased urinary tissue inhibitor of
metalloproteinases-2 and insulin-like growth factor-binding protein 7 in
response to remote ischemic preconditioning. The purpose of this study was
to determine the optimal intensity of remote ischemic preconditioning to
induce required [tissue inhibitor of metalloproteinases-2]*[insulin-like
growth factor-binding protein 7] changes and further explore mechanisms of
remote ischemic preconditioning. Design(s): Observational and
randomized controlled, double-blind clinical trial. Setting(s):
University Hospital of Muenster, Germany. Patient(s): High-risk
patients undergoing cardiac surgery as defined by the Cleveland Clinic
Foundation Score. Intervention(s): In the interventional part,
patients were randomized to receive either one of four different remote
ischemic preconditioning doses (3 x 5 min, 3 x 7 min, 3 x 10 min remote
ischemic preconditioning, or 3 x 5 min remote ischemic preconditioning + 2
x 10 min remote ischemic preconditioning in nonresponders) or sham-remote
ischemic preconditioning (control). Measurements and Main Results:
The primary endpoint of the interventional part was change in urinary
[tissue inhibitor of metalloproteinases-2]*[insulin-like growth
factor-binding protein 7] between pre- A nd postintervention. To examine
secondary objectives including acute kidney injury incidence, we included
an observational cohort. A total of 180 patients were included in the
trial (n = 80 observational and n = 100 randomized controlled part [20
patients/group]). The mean age was 69.3 years (10.5 yr), 119 were men
(66.1%). Absolute changes in [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7] were
significantly higher in all remote ischemic preconditioning groups when
compared with controls (p < 0.01). Although we did not observe a
dose-response relationship on absolute changes in [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7]
across the four different remote ischemic preconditioning groups, in the
15 patients failing to respond to the lowest dose, nine (60%) responded to
a subsequent treatment at a higher intensity. Compared with controls,
fewer patients receiving remote ischemic preconditioning developed acute
kidney injury within 72 hours after surgery as defined by both Kidney
Disease: Improving Global Outcomes criteria (30/80 [37.5%] vs 61/100
[61.0%]; p = 0.003). Conclusion(s): All doses of remote ischemic
preconditioning significantly increased [tissue inhibitor of
metalloproteinases-2]*[insulin-like growth factor-binding protein 7] and
significantly decreased acute kidney injury compared with controls.
High-dose remote ischemic preconditioning could stimulate [tissue
inhibitor of metalloproteinases-2]*[insulin-like growth factor-binding
protein 7] increases in patients refractory to low-dose remote ischemic
preconditioning. Copyright © 2020 by the Society of Critical Care
Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

<42>
[Use Link to view the full text]
Accession Number
630628734
Title
Cardiac complications in systemic sclerosis: Early diagnosis and
treatment.
Source
Chinese Medical Journal. 132(23) (pp 2865-2871), 2019. Date of
Publication: 05 Dec 2019.
Author
Nie L.-Y.; Wang X.-D.; Zhang T.; Xue J.
Institution
(Nie, Wang, Zhang, Xue) Department of Rheumatology, Second Affiliated
Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang
310009, China
(Wang) Department of Rheumatology, People's Hospital of Lishui, Lishui,
Zhejiang 323000, China
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:Systemic sclerosis (SSc) is a remarkably systemic heterogeneous
connective tissue disease with many organs involved. The heart is one of
the major organs involved, carrying the threat of sudden cardiac death,
especially in diffuse cutaneous SSc. This review summarizes the
pathophysiology, types, new diagnostic approaches, and imaging and novel
therapies of primary cardiac complications while underlining the effects
of recently developed non-contrast cardiovascular magnetic resonance (CMR)
in early diagnosis.Data sources:Medline and Embase were searched for
articles published up to July 2019. A combination of Medical Subject
Headings (MeSH) terms and keywords pertaining to SSc ("Scleroderma,
Systemic" OR "Systemic sclerosis" OR" SSc"), AND cardiology ("cardiology"
OR "heart" OR "cardiac") were applied to the search strategies.Study
selection:Literature was mainly printed in English and Chinese about
cardiac complications in systemic sclerosis. After selected simply on the
title and abstract, the articles were included for the full text. Article
type was not limited. Result(s):Relevant cardiac manifestations are
complex, including arrhythmias, pericardial effusion, myocardial
dysfunction, and valvular diseases. Even though the symptoms of cardiac
complications are well known, unfortunately, they appear to be poor
prognostic factors. As systemic sclerosis with cardiac complications has a
high mortality rate and patients might have a poor quality of life, it is
essential to promote early diagnosis and treatment. With the advent of
non-invasive imaging techniques, such as CMR, early diagnosis of cardiac
complications in SSc is becoming more effective.
 Conclusion(s):Cardiac complications play an essential role in SSc and
carry the threat of sudden cardiac death. More basic and clinical studies
are warranted to develop better management of cardiac involvement in
patients with SSc. Copyright © 2019 The Chinese Medical
Association, produced by Wolters Kluwer, Inc.

<43>
Accession Number
633435168
Title
Perioperative antimicrobial prophylaxis in adult patients: The first
multicenter clinical practice audit with intervention in Greek surgical
departments.
Source
Infection Control and Hospital Epidemiology. 42(6) (pp 702-709), 2021.
Date of Publication: June 2021.
Author
Chorafa E.; Iosifidis E.; Tsiodras S.; Skoutelis A.; Kourkouni E.;
Kopsidas I.; Tsopela G.-C.; Chorianopoulou E.; Triantafyllou C.; Kourlaba
G.; Zaoutis T.; Roilides E.
Institution
(Chorafa, Iosifidis, Roilides) Infectious Diseases Unit, Third Department
of Pediatrics, Aristotle University School of Health Sciences,
Thessaloniki, Greece
(Tsiodras) Fourth Department of Internal Medicine, National and
Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
(Skoutelis) Fifth Department of Medicine and Infectious Diseases Unit,
Evangelismos General Hospital, Athens, Greece
(Kourkouni, Kopsidas, Tsopela, Chorianopoulou, Triantafyllou, Kourlaba,
Zaoutis) Center for Clinical Epidemiology and Outcomes Research (CLEO),
Nonprofit Civil Partnership, Athens, Greece
Publisher
Cambridge University Press
Abstract
Objective: To audit clinical practice and implement an intervention to
promote appropriate use of perioperative antimicrobial prophylaxis (PAP).
 Design(s): Prospective multicenter before-And-After study.
 Setting(s): This study was conducted in 7 surgical departments of 3
major Greek hospitals. Method(s): Active PAP surveillance in adults
undergoing elective surgical procedures was performed before and after
implementation of a multimodal intervention. The surveillance monitored
use of appropriate antimicrobial agent according to international and
local guidelines, appropriate timing and duration of PAP, overall
compliance with all 3 parameters and the occurrence of surgical site
infections (SSIs). The intervention included education, audit, and
feedback. Result(s): Overall, 1,447 patients were included: 768
before and 679 after intervention. Overall compliance increased from 28.2%
to 43.9% (P =.001). Use of antimicrobial agents compliant to international
guidelines increased from 89.6% to 96.3% (P =.001). In 4 of 7 departments,
compliance with appropriate timing was already >90%; an increase from
44.3% to 73% (P =.001) and from 20.4% to 60% (P =.001), respectively, was
achieved in 2 other departments, whereas a decrease from 64.1% to 10.9% (P
=.001) was observed in 1 department. All but one department achieved a
shorter PAP duration, and most achieved duration of ~2 days. SSIs
significantly decreased from 6.9% to 4% (P =.026). After the intervention,
it was 2.3 times more likely for appropriate antimicrobial use, 14.7 times
more likely to administer an antimicrobial for the appropriate duration
and 5.3 times more likely to administer an overall appropriate PAP.
 Conclusion(s): An intervention based on education, audit, and
feedback can significantly contribute to improvement of appropriate PAP
administration; further improvement in duration is needed. Copyright
© 2021 Infection Control and Hospital Epidemiology. All rights
reserved.

<44>
Accession Number
2004261542
Title
The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ
Transplant Recipients.
Source
Sexual Medicine Reviews. 9(2) (pp 331-339), 2021. Date of Publication:
April 2021.
Author
Payne K.; Popat S.; Lipshultz L.I.; Thirumavalavan N.
Institution
(Payne) Baylor College of Medicine, Houston, TX, United States
(Popat, Lipshultz) Scott Department of Urology, Baylor College of
Medicine, Houston, TX, United States
(Thirumavalavan) Urology Institute, University Hospitals/Case Western
Reserve University School of Medicine, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Erectile dysfunction (ED) is a prevalent and
under-recognized complaint among male solid organ transplant recipients.
Most research on this topic has focused on kidney transplant recipients
alone. In this review, we integrate current research on ED across all
types of solid organ transplant recipients and assess the success of
current methods of ED treatment in transplant populations. Aim(s): To
review the current literature addressing the prevalence and treatment of
ED in the male solid organ transplant population. Method(s): A
literature search was conducted using PubMed to identify relevant studies.
Search terms included "organ transplant" and "erectile dysfunction."
Titles and abstracts were reviewed for relevance. References from
identified articles were also searched and included, if appropriate.
 Main Outcome Measure(s): Review of peer-reviewed literature.
 Result(s): The prevalence of ED among transplant recipients is higher
than that in the general population: 39.8-86.2% in liver transplant
recipients, 54-66% in renal transplant recipients, 71-78% in heart
transplant recipients, and 79% in simultaneous pancreas-kidney transplant
recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in
treating ED in kidney transplant recipients. Intracavernosal injections
have been used with success rates of 60-70% in cardiac and renal
transplant recipients. Penile prostheses have also been shown to be safe
and effective across transplant types. A low incidence of infection has
been reported in several case series, although there is concern for an
increased rate of mechanical complications in pelvic organ transplant
recipients. Accordingly, placement of a two-piece or malleable prosthesis
or ectopic reservoir placement with a three-piece inflatable prosthesis is
suggested in this population. Conclusion(s): ED is highly prevalent
among male solid organ transplant recipients and should be routinely
screened in this population. Current modalities of ED treatment used in
the general population are safe and effective in solid organ transplant
recipients, although success rates are often lower than those in the
general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence
and Treatment of Erectile Dysfunction in Male Solid Organ Transplant
Recipients. Sex Med Rev 2021;9:331-339. Copyright © 2019
International Society for Sexual Medicine

<45>
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.

<46>
Accession Number
2013046140
Title
A comparative study of IV fentanyl versus IV paracetamol for pain relief
in postoperatively after cardiac surgery.
Source
Medical Forum Monthly. 32(4) (pp 149-152), 2021. Date of Publication:
April 2021.
Author
Khan N.A.; Sattar M.K.; Adnan M.; Khan Z.; Mohsin M.U.; Ammar A.
Institution
(Khan, Sattar, Mohsin, Ammar) Department of Anaesthesia, Nishtar Medical
University, Multan, Pakistan
(Adnan) Department of Anaesthesia, The Children Hospital, Institute of
Child Health, Multan, Pakistan
(Khan) Department of Anaesthesia, Sheikh Zaid Medical College, Hospital
Rahim Yar Khan, Pakistan
Publisher
Medical Forum Monthly
Abstract
Objective: To compare the efficacy of IV acetaminophen and IV fentanyl for
pain reduction after cardiac surgery. Study Design: Randomized
Controlled Trial study. Place and Duration of Study: This study was
conducted at the Department of Anesthesia, Nishtar Hospital Multan, and
Shaikh Zaid Hospital Rahim Yar Khan, from March, 2019 to February, 2021.
 Material(s) and Method(s): Total 76 patients underwent cardiac
surgery requiring general anesthesia. A Visual Analog Scale (VAS) on 0-10
scales was used for assessment of pain. The scores for pain assessment
were given as 0 for no pain, 1-4 for mild, 5-7 for moderate and 8-10 for
severe pain. Patient's pain score was recorded by the same author that
recorded the intraoperative observations, after 5, 15, and 30 minutes
after surgical procedure. If the score on the numerical rating score was
greater than 3, rescue analgesia fentanyl 25 mug was administered in
increments. Total dose of fentanyl used was also recorded. SPSS version 23
was used for data analysis. Numerical variables like age and VAS score
were analyzed and presented as mean and SD. Categorical variables like age
were presented as frequency and percentages. Tests of significance
student's t-test and chi square test were applied to see association among
variables. P value <= 0.05 was considered as significant. Result(s):
Mean pain score was 1.66 +/- 0.74 and 2.16 +/- 0.88 in fentanyl and
paracetamol groups, respectively, and the difference was statistically
significant (p =0.010). QoR score was 14.63 +/- 1.34 and 15.34 +/- 1.38 in
fentanyl and paracetamol groups, respectively, and the difference was of
statistical significance (p =0.026). Nausea was reported by 36.8 %
patients of the fentanyl group and 26.3 % of the paracetamol group,
however, the difference was not statistically significant (p = 0.324).
Vomiting was reported by 34.2 % patients of the fentanyl group and 13.2 %
of the paracetamol group, and the difference was statistically significant
(p = 0.031). Complaint of dry mouth was present in 52.6 % patients of the
fentanyl group and 28.9 % of the paracetamol group, and the observed
difference was of statistical significance (p = 0.036).
 Conclusion(s): It can be concluded from the results of our study
that, IV paracetamol was not associated with significant pain reduction as
compared to IV fentanyl however it was safer in terms of dry mouth and
vomiting. Copyright © 2021 Medical Forum Monthly. All rights
reserved.

<47>
Accession Number
2013615672
Title
Perioperative risk factors for new-onset postoperative atrial fibrillation
after coronary artery bypass grafting: a systematic review.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
418. Date of Publication: December 2021.
Author
Seo E.J.; Hong J.; Lee H.-J.; Son Y.-J.
Institution
(Seo) Ajou University College of Nursing and Research Institute of Nursing
Science, Suwon 16499, South Korea
(Hong) Department of Thoracic and Cardiovascular Surgery, Chung-Ang
University, Seoul 06974, South Korea
(Lee) Department of Nursing, Tongmyoung University, Busan 48520, South
Korea
(Son) Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro
Dongjak-Gu, Seoul 06974, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
cardiac dysrhythmia to occur after coronary artery bypass grafting (CABG).
However, the risk factors for new-onset POAF after CABG during the
perioperative period have yet to be clearly defined. Accordingly, the aim
of our systematic review was to evaluate the perioperative predictors of
new-onset POAF after isolated CABG. Method(s): Our review methods
adhered to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guideline. We searched seven electronic databases (PubMed,
Embase, CINAHL, PsycArticles, Cochrane, Web of Science, and SCOPUS) to
identify all relevant English articles published up to January 2020.
Identified studies were screened independently by two researchers for
selection, according to predefined criteria. The Newcastle-Ottawa Scale
was used to evaluate the quality of studies retained. Result(s):
After screening, nine studies were retained for analysis, including 4798
patients, of whom 1555 (32.4%) experienced new-onset POAF after CABG. The
incidence rate of new-onset POAF ranged between 17.3% and 47.4%. The
following risk factors were identified: old age (p < 0.001), a high
preoperative serum creatinine level (p = 0.001), a low preoperative
hemoglobin level (p = 0.007), a low left ventricle ejection fraction in
Asian patients (p = 0.001), essential hypertension (p < 0.001), chronic
obstructive pulmonary disease (p = 0.010), renal failure (p = 0.009),
cardiopulmonary bypass use (p = 0.002), perfusion time (p = 0.017),
postoperative use of inotropes (p < 0.001), postoperative renal failure (p
= 0.001), and re-operation (p = 0.005). All studies included in the
analysis were of good quality. Conclusion(s): The risk factors
identified in our review could be used to improve monitoring of at-risk
patients for early detection and treatment of new-onset POAF after CABG,
reducing the risk of other complications and negative clinical
outcomes. Copyright © 2021, The Author(s).

<48>
Accession Number
2013389127
Title
The effects of radiotherapy after thoracic and laparoscopic surgery on
patients with esophageal cancer and on their prognoses.
Source
American Journal of Translational Research. 13(6) (pp 6446-6456), 2021.
Date of Publication: 2021.
Author
Gao Y.; Kang M.; Niu L.; Xu L.; Xie X.; Chen D.; Zhu L.; Wang F.
Institution
(Gao, Kang, Niu, Xu, Xie, Chen, Zhu, Wang) Department of Radiation
Oncology, Anhui Medical University, Anhui Province, Hefei, China
Publisher
E-Century Publishing Corporation
Abstract
Objective: This paper aimed to explore the effects of radiotherapy after
thoracic and laparoscopic surgery (TLS) in patients with esophageal cancer
and on their prognoses. Method(s): Altogether 118 patients with
esophageal cancer diagnosed in our hospital were recruited as the study
cohort and randomly divided into a postoperative radiotherapy group (59
cases) and a postoperative chemotherapy group (59 cases). All the patients
were treated with TLS. In addition to the TLS, the patients in the
postoperative radiotherapy group underwent radiotherapy, and the patients
in the postoperative chemotherapy group were administered cisplatin and
5-fluorouracil (PF) chemotherapy. Before the treatment and at 6 months
after the treatment, the serum carbohydrate antigen 199 (CA199),
carbohydrate antigen 153 (CA153), and carcinoembryonic antigen (CEA)
levels were measured using immunity transmission turbidity (ITT). The
expression levels of Bax and Bcl-2 in the peripheral blood mononuclear
cells (PBMCs) were measured using Western blot (WB). The CD4+,
CD8+ and CD3+ levels in the peripheral venous blood
were measured using a flow cytometer. The two groups were compared in
terms of their effective treatment rates, their incidences of
complications, and their postoperative survival rates. Result(s):
After the treatment, the serum CEA, CA153, and CA199 levels in the
postoperative radiotherapy group were significantly lower than they were
in the postoperative chemotherapy group (P<0.05). After the treatment, the
expression level of Bcl-2 was significantly lower in the postoperative
radiotherapy group, but the Bax expression level was significantly higher
in the postoperative radiotherapy group (P<0.05). After the treatment,
there were no statistically significant differences in the
CD4+, CD3+ or CD8+ levels between the two
groups (P>0.05). After the treatment, the overall response rate (ORR) and
the total incidence of adverse reactions were significantly higher in the
postoperative radiotherapy group (P<0.05). After the treatment, the
1-year, 3-year, and 5-year survival rates were significantly elevated in
the postoperative radiotherapy group (P<0.05). Conclusion(s):
Compared with the esophageal cancer patients treated with chemotherapy
after TLS, the serum CA153, CA199, and CEA levels were significantly
improved in the patients treated with radiotherapy. The Bcl-2 and Bax
levels in the PBMCs tended close to normal. Therefore, undergoing
radiotherapy after TLS is markedly effective in prolonging patients'
survival times and improving their prognoses. Copyright © 2021
E-Century Publishing Corporation. All rights reserved.

<49>
Accession Number
2013208752
Title
The Effect of Rhythmic Breathing on the Severity of Sternotomy Pain after
Coronary Artery Bypass Graft Surgery: A Randomized Controlled Clinical
Trial.
Source
Evidence-based Complementary and Alternative Medicine. 2021 (no
pagination), 2021. Article Number: 9933876. Date of Publication: 2021.
Author
Babamohamadi H.; Karkeabadi M.; Ebrahimian A.
Institution
(Babamohamadi, Ebrahimian) Nursing Care Research Center, Semnan University
of Medical Sciences, Semnan 3513138111, Iran, Islamic Republic of
(Babamohamadi) Department of Nursing, Faculty of Nursing and Midwifery,
Semnan University of Medical Sciences, Semnan 3513138111, Iran, Islamic
Republic of
(Karkeabadi) Student Research Committee, Semnan University of Medical
Sciences, Semnan 3513138111, Iran, Islamic Republic of
(Ebrahimian) Emergency Medicine Group, School of Medicine, Qom University
of Medical Sciences, Qom Muq.ac.ir, Iran, Islamic Republic of
Publisher
Hindawi Limited
Abstract
Background. Moderate-to-severe pain is reported in up to 75% of the
patients in the first 48 hours after cardiac surgery. Evidence suggests
that distraction is an effective nursing intervention for controlling
short-term and transient pain. Distraction can be achieved by various
techniques, including progressive muscle relaxation, meditation, and
rhythmic breathing (RB). The present research aimed at evaluating the
impacts of RB on the severity of sternotomy pain after Coronary Artery
Bypass Graft (CABG). Methods. This randomized, controlled clinical trial
was conducted on 60 patients after CABG surgery at the open-heart surgery
Intensive Care Unit (ICU) of Kowsar Hospital, affiliated to Semnan
University of Medical Sciences in Semnan, Iran. The patients were selected
through convenience sampling and randomly assigned to two groups,
including (1) intervention or RB and (2) control groups. RB was performed
in the intervention group every 12 hours (9 a.m. and 9 p.m.) for three
consecutive days after the surgery. The control group received only
routine care for pain control (opioid analgesics) with no additional
interventions. The severity of pain was measured every day in both groups
of patients before and after the interventions using the Visual Analog
Scale (VAS). Results. The mean postintervention pain scores were
significantly different from the mean preintervention scores in the
intervention group (p < 0.05). The changes in the mean pain score in the
intervention group were also significantly different from the
corresponding changes in the controls (p < 0.05). Conclusion. Based on the
results, the severity of pain after the intervention was significantly
lower in the RB group compared to the control. RB was found to be an
effective technique for reducing the patients' pain and is therefore
recommended as a post-CABG pain control technique. Iranian Registry of
Clinical Trials: this trial is clinically registered with
IRCT20120109008665N7, registered 3 September 2018. Copyright ©
2021 Hassan Babamohamadi et al.

<50>
Accession Number
2013208749
Title
Outcome Reporting Variability in Trials of Chinese Medicine for
Hyperlipidemia: A Systematic Review for Developing a Core Outcome Set.
Source
Evidence-based Complementary and Alternative Medicine. 2021 (no
pagination), 2021. Article Number: 8822215. Date of Publication: 2021.
Author
Li G.; Han R.; Cao W.; Wen Z.; Chen X.
Institution
(Li, Wen, Chen) Second Affiliated Hospital, Guangzhou University of
Chinese Medicine, Guangdong, Guangzhou 510120, China
(Li, Wen, Chen) Key Unit of Methodology in Clinical Research, Guangdong
Provincial Hospital of Chinese Medicine, Guangdong, Guangzhou 510120,
China
(Han) Foshan Hospital of Traditional Chinese Medicine, Guangdong, Foshan
528000, China
(Cao) Second Clinical Medical College (Second Affiliated Hospital),
Guangzhou University of Chinese Medicine, Guangzhou 510405, China
(Wen) State Key Laboratory of Dampness Syndrome of Chinese Medicine,
Second Affiliated Hospital, Guangzhou University of Chinese Medicine,
Guangdong, Guangzhou 510120, China
(Wen) Guangdong Provincial Key Laboratory of Clinical Research on
Traditional Chinese Medicine Syndrome, Guangdong, Guangzhou 510120, China
(Chen) Department of Global Public Health, Health Systems and Policy,
Karolinska Institute, Stockholm 17177, Sweden
Publisher
Hindawi Limited
Abstract
Introduction. Hyperlipidemia is an underlying process behind
cardiovascular disease. Chinese medicine (CM) may be effective in treating
hyperlipidemia, but there is a lack of studies with high methodological
quality. A major reason for this is heterogeneity in outcome reporting.
Therefore, this study explores the degree of outcome reporting variation
in CM trials for hyperlipidemia. It then generates a list of potentially
important outcomes for developing a core outcome set (COS). Methods. A
systematic review of literature focusing on studies of CM for
hyperlipidemia was conducted. Outcomes were listed verbatim and grouped
into 8 domains. Outcome frequency and definition uniformity were analyzed.
Results. 3,702 studies and 452 individual outcomes were identified. These
outcomes were reported 27,328 times, of which 1.6% were reported as
primary outcomes, and 13.3% were defined. The most frequent outcome was
total triglyceride, represented in 86.7% of the studies, followed by total
cholesterol (86.0%), total effective rate (75.1%), high-density
lipoprotein cholesterol (73.2%), and low-density lipoprotein cholesterol
(60.5%). However, 43.6% of outcomes were reported only once. The largest
outcome domain was "pathological or pathophysiological outcomes,"which
included 67.0% of outcomes. Of the "response rate related outcomes"domain,
total effective rate was the most frequently reported outcome (n = 2,780),
and 95.3% of the studies gave a clear definition. However, these
definitions were often contradictory. Only 10 papers reported
cardiovascular events, 3 of which referred to them as primary outcomes.
Moreover, ten patient-reported outcomes were reported in the retrieved
literature 19 times in total. The majority of the outcomes did not report
measurement instruments (MIs) (269/453, 59.4%). MIs of the surrogate
outcomes were reported more frequently. Conclusion. Outcome reporting in
CM trials for hyperlipidemia is inconsistent and ill-defined, creating
barriers to data synthesis and comparison. Thus, we propose and are
developing a COS for CM trials for hyperlipidemia. Copyright ©
2021 Geng Li et al.

<51>
Accession Number
2011412902
Title
Impact of stent length and diameter on 10-year mortality in the SYNTAXES
trial.
Source
Catheterization and Cardiovascular Interventions. 98(3) (pp E379-E387),
2021. Date of Publication: September 2021.
Author
Hara H.; Ono M.; Kawashima H.; Kogame N.; Mack M.J.; Holmes D.R.; Morice
M.-C.; Davierwala P.M.; Mohr F.W.; Thuijs D.J.F.M.; Head S.J.; Kappetein
A.P.; Onuma Y.; Serruys P.W.
Institution
(Hara, Ono, Kawashima, Kogame) Department of Cardiology, Academic Medical
Center, University of Amsterdam, Amsterdam, Netherlands
(Hara, Ono, Kawashima, Onuma, Serruys) Department of Cardiology, National
University of Ireland, Galway (NUIG), Galway, Ireland
(Mack) Department of Cardiothoracic Surgery, Baylor Scott & White Health,
Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, Hopital prive Jacques Cartier,
Generale de Sante Massy, France
(Davierwala, Mohr) Heart Centre Leipzig, University Department of Cardiac
Surgery, Leipzig, Germany
(Thuijs, Head, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We investigated the impact of total stent length (TSL) and
average nominal stent diameter (ASD) on 10-year mortality after
percutaneous coronary intervention (PCI) in the SYNTAXES trial.
 Background(s): TSL and ASD in patients treated with PCI are
associated with major adverse cardiovascular events. However, the
treatment effect of PCI with extensive and/or small stenting as compared
with coronary artery bypass grafting (CABG) for complex coronary artery
disease has not been fully evaluated. Method(s): Impacts on mortality
of extensive stenting defined as TSL >100 mm and small stenting as ASD <3
mm were analyzed in 893 PCI patients and were compared to 865 CABG
patients. Result(s): TSL as a continuous variable was significantly
associated with 10-year mortality (adjusted hazard ratio [HR], 1.05
[1.01-1.09] per 10 mm increase). PCI patients with extensive stenting had
a higher 10 year mortality than CABG patients (adjusted HR, 1.97
[1.41-2.74]) or not- extensive stenting PCI (adjusted HR, 1.94
[1.36-2.77]). Although ASD did not have a significant association with 10
year mortality (adjusted HR, 0.97 [0.85-1.11] per 0.25 mm increase), PCI
with small stents was associated with a higher 10 year mortality, compared
to CABG (adjusted HR, 1.66 [1.23-2.26]) and PCI performed with large
stents (adjusted HR, 1.74 [1.19-2.53]). Patients treated with
not-extensive and large stents had similar mortality rates (24.0 versus
23.8%) as those treated with CABG. Conclusion(s): Extensive and small
stenting were associated with higher 10 year mortality, compared with
CABG. When patients have to be treated with extensive or small stenting,
revascularization with CABG should be preferred. Copyright © 2021
The Authors. Catheterization and Cardiovascular Interventions published by
Wiley Periodicals LLC.

<52>
Accession Number
2011127386
Title
Clinical practice patterns and ascertainment bias for cardiovascular
events in a randomized trial: A survey of investigators in the BEST-CLI
trial.
Source
Vascular Medicine (United Kingdom). 26(2) (pp 180-186), 2021. Date of
Publication: April 2021.
Author
Albaghdadi M.S.; Young M.N.; Chowdhury M.M.; Assmann S.; Hamza T.; Siami
S.; Villarreal M.; Strong M.; Menard M.; Farber A.; Rosenfield K.
Institution
(Albaghdadi, Rosenfield) Division of Cardiology and Section of Vascular
Medicine, Massachusetts General Hospital, Harvard Medical School, Boston,
MA, United States
(Albaghdadi) Department of Medicine, Division of Cardiology, University of
Toronto, Toronto, ON, Canada
(Young) Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel
School of Medicine at Dartmouth, NH, United States
(Chowdhury) Department of Vascular and Endovascular Surgery, Department of
Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge,
United Kingdom
(Assmann, Hamza, Siami) HealthCore-New England Research Institutes, Inc,
Watertown, MA, United States
(Villarreal) Department of Vascular Surgery, Boston Medical Center, Boston
University, Boston, MA, United States
(Strong, Menard, Farber) Department of Vascular Surgery, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
Publisher
SAGE Publications Ltd
Abstract
Ascertainment bias is a well-recognized source of bias in research, but
few studies have systematically analyzed sources of ascertainment bias in
randomized trials in which blinding is not possible and endpoint
assessment is not protocolized. In the current study, we sought to
evaluate differences in the clinical practice patterns of trial
investigators with respect to bias in the ascertainment of
pre-revascularization patient risk and the incidence of secondary
endpoints post-revascularization. We conducted a cross-sectional survey of
active investigators (n = 936) from the Best Endovascular Versus Best
Surgical Therapy for Patients with Critical Limb Ischemia (BEST-CLI)
trial. The total survey response rate was 19.6% (183/936). Vascular
surgeons were more likely than nonsurgical interventionalists to order
tests for cardiac complications after both surgical bypass (p < 0.001) and
endovascular revascularization (p = 0.038). Post-procedure, investigators
were more likely to order additional testing for cardiac complications in
open surgery versus endovascular cases (7% vs 16% never, 41% vs 65%
rarely, 43% vs 17% sometimes, 9% vs 2% always, respectively; p < 0.0001).
Significant variation in practice patterns exist in the pre- and
post-procedure assessment of cardiac risk and events for patients with CLI
undergoing revascularization. Variation in the ascertainment of risk and
outcomes according to the type of revascularization procedure and
physician specialty should be considered when interpreting the results of
clinical studies, such as the BEST-CLI trial. ClinicalTrials.gov
Identifier: NCT02060630 Copyright © The Author(s) 2021.

<53>
Accession Number
2007669944
Title
Effects of sevoflurane and desflurane on microcirculation during
non-cardiac surgery.
Source
Kuwait Medical Journal. 53(2) (pp 173-178), 2021. Date of Publication:
June 2021.
Author
Cil H.; Kilicaslan B.; Cizmeci E.A.; Kanbak M.; Ince C.
Institution
(Cil, Kilicaslan, Cizmeci, Kanbak) Department of Anesthesiology and
Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
(Cil) Department of Anesthesia and Perioperative Care, University of
California San Francisco, San Francisco, CA, United States
(Ince) Department of Intensive Care, Erasmus Medical Center University
Hospital, Rotterdam, Netherlands
Publisher
Kuwait Medical Association
Abstract
Objectives: Assessment of microcirculation is thought to be a surrogate of
tissue perfusion and anesthetic drugs are known to alter the
microcirculation in cardiac surgery patients, but their effects in less
complicated non-cardiac surgery remain unknown. Our aim is to investigate
the effects of sevoflurane and desflurane on the microcirculation
parameters during non-cardiac surgery. Design(s): Prospective cohort
study Setting: Hacettepe University Medical Faculty and Hospital Subjects:
Patients with American Society of Anesthesiologists (ASA) score of I-II
who underwent >=2 hours of non-cardiac surgery were randomly divided into
two groups: sevoflurane (n=20) and desflurane (n=19).
 Intervention(s): Sevoflurane or desflurane Main Outcome
Measure(s): Demographic, hemodynamic (heart rate, mean arterial pressure)
and laboratory parameters (hematocrit, hemoglobin, urea and creatinine)
were measured. Microcirculation imaging was performed by using side stream
dark field imaging. Result(s): There were no statistical differences
in demographic, hemodynamic and laboratory parameters between groups. In
the sevoflurane group, the proportion of perfused vessel (PPV) was
slightly increased at the second hour intraoperatively compared to the
post-induction period in small vessels (94.7% vs 93%, P=.036), but other
parameters (microvascular flow index, total vascular density and perfused
vascular density) were comparable in both measurement periods. In the
desflurane group, all microcirculation parameters were comparable between
post-induction period and second hour intraoperatively.
 Conclusion(s): Sevoflurane anesthesia slightly increases the PPV in
small vessels, whereas desflurane has no effect on microcirculation
parameters in ASA I-II non-cardiac surgery patients. Neither sevoflurane
nor desflurane have major effects on microcirculation in this patient
population. Copyright © 2021, Kuwait Medical Association. All
rights reserved.

<54>
Accession Number
2014052666
Title
Colchicine in Patients With Chronic Coronary Disease in Relation to Prior
Acute Coronary Syndrome.
Source
Journal of the American College of Cardiology. 78(9) (pp 859-866), 2021.
Date of Publication: 31 Aug 2021.
Author
Opstal T.S.J.; Fiolet A.T.L.; van Broekhoven A.; Eikelboom J.W.; Duyvendak
M.; van Beek E.A.; den Hartog F.; Budgeon C.A.; Bax W.A.; Tijssen J.G.P.;
El Messaoudi S.; Nidorf S.M.; Xu X.F.; Ireland M.A.; Latchem D.; Whelan
A.; Hendriks R.; Salkani P.; Tan I.W.; Thompson A.G.; Morton A.M.;
Hockings B.E.; Thompson P.L.; King B.; Cornel J.H.; Bakker-Lohmeijer H.;
Mosterd A.; Bunschoten P.; The S.H.K.; van der Kooi S.; Lenderink T.;
Lardinois R.G.J.L.; Hoogslag P.A.M.; de Vos A.; Jerzewski A.; Jansen S.;
Nierop P.R.; van der Knaap M.; Swart H.P.; Kingma R.; Schaap J.; Blom
L.B.; Kuijper A.F.M.; Bayraktar-Verver E.; van Hessen M.W.J.; Engelen
W.C.T.C.; van Eck J.W.M.; van der Ven-Elzebroek N.; van Hal J.M.C.; Drost
I.M.J.; den Hartog F.R.; van Wijk D.; van Beek E.; van der Horst C.;
Bartels G.L.; Hendriks M.; de Nooijer C.; Welten C.; Ronner E.; Dijkshoorn
A.; Prins F.J.; Rutten R.N.A.; Beele D.P.W.; Hendriks I.; van der Sluis
A.; Badings E.A.; Westendorp I.C.D.; Melein A.; Romer T.J.; Bruines P.;
van de Wal R.; Leenders - van Lieshout I.; Hemels M.E.W.; Meinen-Werner
K.; de Groot M.R.; Post G.; Mulder M.W.C.; Stuij S.; van Nes E.; Luyten
P.; Plomp J.; Veldmeijer S.V.; Asselman M.J.; Scholtus P.A.
Institution
(Opstal, van Broekhoven, El Messaoudi, Cornel) Department of Cardiology,
Radboud University Medical Center, Nijmegen, Netherlands
(Opstal, Cornel) Department of Cardiology, Northwest Clinics, Alkmaar,
Netherlands
(Fiolet) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Fiolet, Mosterd, Cornel) Dutch Network for Cardiovascular Research,
Utrecht, Netherlands
(Mosterd) Department of Cardiology, Meander Medical Center, Amersfoort,
Netherlands
(Eikelboom) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Nidorf, Thompson) Heart and Vascular Research Institute of Western
Australia, Sir Charles Gairdner Hospital, Perth, Western Australia,
Australia
(Nidorf) GenesisCare Western Australia, Perth, Western Australia,
Australia
(Thompson) Harry Perkins Institute of Medical Research, Perth, Western
Australia, Australia
(Thompson, Budgeon) University of Western Australia, Perth, Western
Australia, Australia
(Duyvendak) Department of Clinical Pharmacy, Antonius Hospital Sneek,
Sneek, Netherlands
(Duyvendak) Pharmacy D&A Research, Sneek, Netherlands
(van Eck) Department of Cardiology, Jeroen Bosch Hospital,
's-Hertogenbosch, Netherlands
(van Beek) Department of Cardiology, St Jansdal Hospital, Harderwijk,
Netherlands
(den Hartog) Department of Cardiology, Gelderse Vallei Hospital, Ede,
Netherlands
(Bax) Department of Internal Medicine, Northwest Clinics, Alkmaar,
Netherlands
(Tijssen) Department of Cardiology, Amsterdam University Medical Center,
Amsterdam, Netherlands
(Tijssen) Cardialysis BV, Rotterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Colchicine reduces risk of cardiovascular events in patients
post-myocardial infarction and in patients with chronic coronary disease.
It remains unclear whether this effect is related to the time of onset of
treatment following an acute coronary syndrome (ACS). Objective(s):
This study investigates risk for major adverse cardiovascular events in
relation to history and timing of prior ACS, to determine whether the
benefits of colchicine are consistent independent of prior ACS status.
 Method(s): The LoDoCo2 (Low-Dose Colchicine 2) trial randomly
allocated patients with chronic coronary disease to colchicine 0.5 mg once
daily or placebo. The rate of the composite of cardiovascular death,
spontaneous myocardial infarction, ischemic stroke, or ischemia-driven
coronary revascularization was compared between patients with no prior,
recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS;
interaction between ACS status and colchicine treatment effect was
assessed. Result(s): In 5,522 randomized patients, risk of the
primary endpoint was independent of prior ACS status. Colchicine
consistently reduced the primary endpoint in patients with no prior ACS
(incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR]:
0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4
vs 3.3 events per 100 person-years; HR: 0.75; 95% CI: 0.51-1.10), remote
ACS (incidence: 1.8 vs 3.2 events per 100 person-years, HR: 0.55; 95% CI:
0.37-0.82), and very remote ACS (incidence: 3.0 vs 4.3 events per 100
person-years, HR: 0.70; 95% CI: 0.51-0.96) (P for interaction = 0.59).
 Conclusion(s): The benefits of colchicine are consistent irrespective
of history and timing of prior ACS. (The LoDoCo2 Trial: Low Dose
Colchicine for secondary prevention of cardiovascular disease [LoDoCo2]
ACTRN12614000093684) Copyright © 2021 American College of
Cardiology Foundation

<55>
Accession Number
2013930263
Title
Impact of Corticosteroids on Cardiopulmonary Bypass Induced Inflammation
in Children: A Meta-Analysis.
Source
Annals of Thoracic Surgery. 112(4) (pp 1363-1370), 2021. Date of
Publication: October 2021.
Author
Bronicki R.A.; Flores S.; Loomba R.S.; Checchia P.A.; Pollak U.;
Villarreal E.G.; Nickerson P.; Graham E.M.
Institution
(Bronicki, Flores, Checchia, Villarreal, Nickerson) Department of
Pediatrics, Baylor College of Medicine, Section of Critical Care Medicine
and Cardiology, Texas Children's Hospital, Houston, TX, United States
(Loomba) Department of Pediatrics, Chicago Medical School, Section of
Cardiology, Advocate Children's Hospital, Oak Lawn, IL, United States
(Pollak) Department of Pediatrics, Hebrew University-Hadassah Medical
School, Hebrew University of Jerusalem, Hadassah Hebrew University Medical
Center, Jerusalem, Israel
(Villarreal) Tecnologico de Monterrey, Escuela de Medicina y Ciencias de
la Salud, Nuevo Leon, Monterrey, Mexico, Mexico
(Graham) Department of Pediatrics, Medical University of South Carolina,
Section of Cardiology, Medical University of South Carolina, Charleston,
SC, United States
Publisher
Elsevier Inc.
Abstract
Background: Corticosteroids suppress the inflammatory response to
cardiopulmonary bypass in children undergoing cardiac surgery. What is
less clear is the impact of corticosteroids on the postoperative course.
 Method(s): A systematic review and meta-analysis was made of
prospective randomized blinded placebo-controlled trials of pediatric
patients who received corticosteroids or saline placebo before surgery was
performed. Ten studies met inclusion criteria for a total of 768 patients.
In a prespecified subgroup analysis, studies that either were limited to
The Society of Thoracic Surgeons-European Association for Cardio-Thoracic
Surgery congenital heart surgery mortality categories 1 and 2 or excluded
neonates were eliminated and a secondary analysis was conducted, which
consisted of seven studies and 555 patients. Result(s):
Corticosteroids were associated with a significant improvement in fluid
balance at 24 and 36 hours after surgery, with a mean difference of -15.2
mL/kg (95% confidence interval, 25.3 to -5.1 mL/kg; P <.01) and -5.7 mL/kg
(95% confidence interval, -9.8 to -1.6 mL/kg; P <.01), respectively.
Corticosteroids had no impact on the incidence of infection or mortality.
With the secondary analysis, corticosteroids were associated with a trend
toward significance in shortening the duration of mechanical ventilation
(mean difference -0.7 days; 95% confidence interval, -1.7 to 0.1; P =.08).
 Conclusion(s): Corticosteroids were found to have a favorable impact
on postoperative fluid balance and may be associated with shortening the
duration of mechanical ventilation. Although corticosteroids had no impact
on mortality, they may be beneficial particularly for neonates and
patients undergoing highly complex surgery. Copyright © 2021 The
Society of Thoracic Surgeons

<56>
Accession Number
2013148920
Title
Incidence of herpes zoster in adult solid organ transplant recipients: A
meta-analysis and comprehensive review.
Source
Transplant Infectious Disease. 23(4) (no pagination), 2021. Article
Number: e13674. Date of Publication: August 2021.
Author
Kwon D.E.; Lee H.S.; Lee K.H.; La Y.; Han S.H.; Song Y.G.
Institution
(Kwon, Lee, La, Han, Song) Division of Infectious Disease, Department of
Internal Medicine, Yonsei University College of Medicine, Seoul, South
Korea
(Lee) Biostatistics Collaboration Unit, Yonsei University College of
Medicine, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background: Chronic immunosuppressive therapy in solid organ transplant
(SOT) recipients can trigger latent varicella zoster virus reactivation
even in those with stable graft function. The inactivated herpes zoster
(HZ) vaccine can be effective in preventing post-transplant HZ, which can
cause severe neuralgia or disseminated disease. This meta-analysis aims to
assess the incidences of HZ across transplant organs in SOT recipients.
 Method(s): We included 12 observational studies (6560 recipients)
from a PubMed and EMBASE search of articles through October 2019 and
collected data from single-center dating from January 2001 to December
2017 (3498 recipients). The pooled HZ incidence and its differences
between subgroups were obtained from random-effect models and
meta-analysis of variance tests using R package. Result(s): The
overall pooled crude incidence was 9.1% (95% confidence interval [CI],
7.6%-10.8%). The pooled incidence was similar between sexes but
significantly different between transplanted organs (P <.001). Heart
transplants (HT) (n = 644) have the highest pooled incidence with 15.2%
(95% CI, 12.7%-18.2%), followed by lung transplants (LTX) (n = 780) with
11.0% (8.3%-14.4%). Kidney transplants (n = 5435) have the lowest
incidence of 6.7 (5.1%-8.8%). The meta-regression analysis revealed that
HZ development had a relationship with past graft rejection (P =.024).
 Conclusion(s): These data support the need for subunit HZ vaccination
in SOT recipients with a high risk for HZ, especially HT and LTX
recipients, without respect to the late post-transplant
period. Copyright © 2021 Wiley Periodicals LLC.

<57>
Accession Number
2007872297
Title
Recent developments in rodent models of high-fructose diet-induced
metabolic syndrome: A systematic review.
Source
Nutrients. 13(8) (no pagination), 2021. Article Number: 2497. Date of
Publication: August 2021.
Author
Chan A.M.L.; Ng A.M.H.; Mohd Yunus M.H.; Idrus R.B.H.; Law J.X.; Yazid
M.D.; Chin K.-Y.; Shamsuddin S.A.; Lokanathan Y.
Institution
(Chan, Ng, Idrus, Law, Yazid, Shamsuddin, Lokanathan) Centre for Tissue
Engineering and Regenerative Medicine, Faculty of Medicine, Universiti
Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, Kuala
Lumpur 56000, Malaysia
(Chan) Ming Medical Sdn. Bhd, D3-3 (2nd Floor), Block D3 Dana 1 Commercial
Centre, Jalan PJU 1A/22, Petaling Jaya 47101, Malaysia
(Mohd Yunus) Department of Physiology, Faculty of Medicine, Universiti
Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, Kuala
Lumpur 56000, Malaysia
(Chin) Department of Pharmacology, Faculty of Medicine, Universiti
Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, Kuala
Lumpur 56000, Malaysia
Publisher
MDPI
Abstract
Metabolic syndrome (MetS) is the physiological clustering of hypertension,
hyperglycemia, hyperinsulinemia, dyslipidemia, and insulin resistance. The
MetS-related chronic illnesses encompass obesity, the cardiovascular
system, renal operation, hepatic function, oncology, and mortality. To
perform pre-clinical research, it is imperative that these symptoms be
successfully induced and optimized in lower taxonomy. Therefore, novel and
future applications for a disease model, if proven valid, can be
extrapolated to humans. MetS model establishment is evaluated based on the
significance of selected test parameters, paradigm shifts from new
discoveries, and the accessibility of the latest technology or advanced
methodologies. Ultimately, the outcome of animal studies should be
advantageous for human clinical trials and solidify their position in
advanced medicine for clinicians to treat and adapt to serious or specific
medical situations. Rodents (Rattus norvegicus and Mus musculus) have been
ideal models for mammalian studies since the 18th century and have been
mapped extensively. This review compiles and compares studies published in
the past five years between the multitude of rodent comparative models.
The response factors, niche parameters, and replicability of diet
protocols are also compiled and analyzed to offer insight into
MetS-related disease-specific modelling. Copyright © 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<58>
[Use Link to view the full text]
Accession Number
2007624116
Title
Outcomes of cardiac surgery in Jehovah's Witness patients: A review.
Source
Perfusion (United Kingdom). 36(7) (pp 661-671), 2021. Date of Publication:
October 2021.
Author
Chambault A.-L.; Brown L.J.; Mellor S.; Harky A.
Institution
(Chambault, Brown, Mellor) Medical School, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Sciences,
University of Liverpool, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Harky) Department of Cardiac Surgery, Alder Hey Children Hospital,
Liverpool, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Objective: To review current literature evidence on outcomes of cardiac
surgery in Jehovah's Witness patients. Method(s): A comprehensive
electronic literature search was done from 2010 to 20th August 2020
identifying articles that discussed optimisation/outcomes of cardiac
surgery in Jehovah's Witness either as a solo cohort or as comparative to
non-Jehovah's Witnesses. No limit was placed on place of publication and
the evidence has been summarised in a narrative manner within the
manuscript. Result(s): The outcomes of cardiac surgery in Jehovah's
Witness patients has been described, and also compared, to non-Witness
patients within a number of case reports, case series and comparative
cohort studies. Many of these studies note no significant differences
between outcomes of the two groups for a number of variables, including
mortality. Pre-, intra and post-operative optimisation of the patients by
a multidisciplinary team is important to achieve good outcomes.
 Conclusion(s): The use of a bloodless protocol for Jehovah's
Witnesses does not appear to significantly impact upon clinical outcomes
when compared to non-Witness patients, and it has even been suggested that
a bloodless approach could provide advantages to all patients undergoing
cardiac surgery. Larger cohorts and research across multiple centres into
the long term outcomes of these patients is required. Copyright ©
The Author(s) 2020.

<59>
Accession Number
2007008517
Title
The effect of levosimendan on postoperative bleeding and blood transfusion
in cardiac surgical patients: a PRISMA-compliant systematic review and
meta-analysis.
Source
Perfusion (United Kingdom). 36(7) (pp 694-703), 2021. Date of Publication:
October 2021.
Author
Yao Y.-T.; He L.-X.; Zhao Y.-Y.
Institution
(Yao, He, Zhao) Department of Anesthesiology, Fuwai Hospital, National
Center for Cardiovascular Diseases, Peking Union Medical College and
Chinese Academy of Medical Sciences, Beijing, China
Publisher
SAGE Publications Ltd
Abstract
Background: Levosimendan (LEVO), is an inotropic agent which has been
shown to be associated with better myocardial performance, and higher
survival rate in cardiac surgical patients. However, preliminary clinical
evidence suggested that LEVO increased the risk of post-operative bleeding
in patients undergoing valve surgery. Currently, there has been no
randomized controlled trials (RCTs) designed specifically on this issue.
Therefore, we performed present systemic review and meta-analysis.
 Method(s): Electronic databases were searched to identify all RCTs
comparing LEVO with Control (placebo, blank, dobutamine, milrinone, etc).
Primary outcomes include post-operative blood loss and re-operation for
bleeding. Secondary outcomes included post-operative transfusion of red
blood cells (RBC), fresh frozen plasma (FFP) and platelet concentrates
(PC). For continuous variables, treatment effects were calculated as
weighted mean difference (WMD) and 95% confidential interval (CI). For
dichotomous data, treatment effects were calculated as odds ratio (OR) and
95% CI. Result(s): Search yielded 15 studies including 1,528
patients. Meta-analysis suggested that, LEVO administration was not
associated with increased risk of reoperation for bleeding
post-operatively (OR = 1.01; 95%CI: 0.57 to 1.79; p = 0.97) and more blood
loss volume (WMD = 28.25; 95%CI: -19.21 to 75.72; p = 0.24). Meta-analysis
also demonstrated that, LEVO administration did not increase
post-operative transfusion requirement for RBC (rate: OR = 0.97; 95%CI:
0.72 to 1.30; p = 0.83 and volume: WMD = 0.34; 95%CI: -0.55 to 1.22; p =
0.46), FFP (volume: WMD = 0.00; 95%CI: -0.10 to 0.10; p = 1.00) and PC
(rate: OR = 1.01; 95%CI: 0.41 to 2.50; p = 0.98 and volume: WMD = 0.00;
95%CI: -0.05 to 0.04; p = 0.95). Conclusion(s): This meta-analysis
suggested that, peri-operative administration of LEVO was not associated
with increased risks of post-operative bleeding and blood transfusion
requirement in cardiac surgical patients. Copyright © The
Author(s) 2020.

<60>
Accession Number
2006893205
Title
Off-pump versus on-pump redo coronary artery bypass grafting: a systematic
review and meta-analysis.
Source
Perfusion (United Kingdom). 36(7) (pp 724-736), 2021. Date of Publication:
October 2021.
Author
Zhang P.; Wang L.; Zhai K.; Huang J.; Wang W.; Ma Q.; Liu D.; Gao B.; Li
Y.
Institution
(Zhang, Wang, Zhai, Huang, Wang, Ma, Liu, Gao, Li) Department of Cardiac
Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou,
China
(Zhang, Zhai, Huang, Li) Laboratory of Extracorporeal Life Support,
Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
Publisher
SAGE Publications Ltd
Abstract
Background: Redo coronary artery bypass grafting (redo CABG) is associated
with increased mortality and morbidity. The aim of this study was to
systematically evaluate the evidence comparing the outcomes of off-pump
with on-pump redo CABG. Method(s): Studies were systematically
searched and identified using PubMed, EMBASE, the Cochrane Library, and
the International Clinical Trials Registry Platform (ICTRP) by two
researchers independently. The primary outcome was 30-day mortality, and
the secondary outcomes were in-hospital mortality, post-operative
complications, completeness of revascularization, blood transfusion rate,
duration of mechanical ventilation, intensive care unit and hospital
stays. Result(s): The 21 studies including 4,889 patients were
enrolled in our meta-analysis. Compared with on-pump, the off-pump
technique was associated with significantly reduced 30-day mortality (odds
ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001).
Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI =
0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial
fibrillation, myocardial infarction, acute kidney injury, low cardiac
output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p <
0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI =
0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR =
0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration
of mechanical ventilation, intensive care unit and hospital stays (mean
difference [MD] = -8.21 h, 95% CI = -11.74 to -4.68, p < 0.00001; MD =
-0.77 d, 95% CI = -0.81 to -0.73, p < 0.00001; MD = -2.24 d, 95% CI =
-3.17 to -1.32, p < 0.00001) could be observed when comparing the outcomes
of off-pump with on-pump redo CABG. There was nonsignificant difference
between off-pump and on-pump redo CABG in completeness of
revascularization. Conclusion(s): In patients undergoing redo CABG
surgery, the off-pump technique was associated with decreased mortality,
less post-operative complications when compared to on-pump. Copyright
© The Author(s) 2020.

<61>
Accession Number
2006140373
Title
The impact of minimal invasive extracorporeal circulation on postoperative
kidney function.
Source
Perfusion (United Kingdom). 36(7) (pp 745-750), 2021. Date of Publication:
October 2021.
Author
Media A.S.; Juhl-Olsen P.; Magnusson N.E.; Modrau I.S.
Institution
(Media, Modrau) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Juhl-Olsen) Department of Anaesthesiology and Intensive Care, Aarhus
University Hospital, Aarhus, Denmark
(Juhl-Olsen, Magnusson, Modrau) Department of Clinical Medicine, Aarhus
University, Aarhus, Denmark
(Magnusson) Medical Research Laboratory, Aarhus University, Aarhus,
Denmark
Publisher
SAGE Publications Ltd
Abstract
Introduction: Acute kidney injury following cardiac surgery is a frequent
complication associated with increased mortality and morbidity. Minimal
invasive extracorporeal circulation is suggested to preserve postoperative
renal function. The aim of this study was to assess the impact of minimal
invasive versus conventional extracorporeal circulation on early
postoperative kidney function. Method(s): Randomized controlled trail
including 60 patients undergoing elective stand-alone coronary artery
bypass graft surgery and allocated in a 1:1 ratio to either minimal
invasive (n = 30) or conventional extracorporeal circulation (n = 30).
Postoperative kidney injury was assessed by elevation of plasma neutrophil
gelatinase-associated lipocalin (NGAL), a sensitive tubular injury
biomarker. In addition, we assessed changes in estimated glomerular
filtration rate (eGFR), and the incidence of acute kidney injury according
to the Acute Kidney Injury Network (AKIN) classification. Result(s):
We observed no differences between groups regarding increase of plasma
NGAL (p = 0.31) or decline of eGFR (p = 0.82). In both groups, 6/30
patients developed acute kidney injury according to the AKIN
classification, all regaining preoperative renal function within 30 days.
 Conclusion(s): Our findings challenge the superiority of minimal
invasive compared to conventional extracorporeal circulation in terms of
preservation of renal function following low-risk coronary
surgery. Copyright © The Author(s) 2020.

<62>
[Use Link to view the full text]
Accession Number
632915588
Title
A Single Prophylactic Dose of Ondansetron Given at Cessation of
Postoperative Propofol Sedation Decreases Postoperative Nausea and
Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial.
Source
Anesthesia and Analgesia. (pp 1164-1172), 2020. Date of Publication:
2020.
Author
Wang E.H.Z.; Sunderland S.; Edwards N.Y.; Chima N.S.; Yarnold C.H.;
Schwarz S.K.W.; Coley M.A.
Institution
(Wang) Pharmacy Department, St Paul's Hospital, Providence Health Care,
Vancouver, BC, Canada
(Wang) Faculty of Pharmaceutical Sciences
(Sunderland, Chima, Yarnold, Schwarz, Coley) Department of Anesthesiology,
Pharmacology and Therapeutics, University of British Columbia, Vancouver,
BC, Canada
(Edwards, Yarnold, Schwarz, Coley) Department of Anesthesia, St Paul's
Hospital, Providence Health Care, Vancouver, BC, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common
occurrence after cardiac surgery. However, in contrast to other surgical
populations, routine PONV prophylaxis is not a standard of care in cardiac
surgery. We hypothesized that routine administration of a single
prophylactic dose of ondansetron (4 mg) at the time of stopping
postoperative propofol sedation before extubation in the cardiac surgery
intensive care unit would decrease the incidence of PONV. METHOD(S):
With institutional human ethics board approval and written informed
consent, we conducted a randomized controlled trial in patients >=19 years
of age with no history of PONV undergoing elective or urgent cardiac
surgery procedures requiring cardiopulmonary bypass. The primary outcome
was the incidence of PONV in the first 24 hours postextubation, compared
by the chi2 test. Secondary outcomes included the incidence and times to
first dose of rescue antiemetic treatment administration, the incidence of
headaches, and the incidence of ventricular arrhythmias. RESULT(S):
PONV within the first 24 hours postextubation occurred in 33 of 77
patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in
the placebo group (relative risk, 0.70 [95% confidence interval {CI},
0.51-0.95]; absolute risk difference, -18% [95% CI, -33 to -2]; number
needed to treat, 5.5 [95% CI, 3.0-58.4]; chi2 test, P =.022). Kaplan-Meier
"survival"analysis of the times to first rescue antiemetic treatment
administration over 24 hours indicated that patients in the ondansetron
group fared better than those in the placebo group (log-rank [Mantel-Cox]
test; P =.028). Overall, 32 of 77 patients (42%) in the ondansetron group
received rescue antiemetic treatment over the first 24 hours
postextubation versus 47 of 82 patients (57%) in the placebo group
(relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference, -16%
[95% CI, -31 to 1]); P =.047. There were no significant differences
between the groups in the incidence of postoperative headache (ondansetron
group, 5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%];
Fisher exact test; P =.740) or ventricular arrhythmias (ondansetron group,
2 of 77 patients [3%] versus placebo group, 4 of 82 patients [5%]; P
=.68). CONCLUSION(S): These findings support the routine
administration of ondansetron prophylaxis at the time of discontinuation
of postoperative propofol sedation before extubation in patients following
cardiac surgery. Further research is warranted to optimize PONV
prophylaxis in cardiac surgery patients. Copyright © 2020
International Anesthesia Research Society.

<63>
[Use Link to view the full text]
Accession Number
632914311
Title
A Comprehensive Update on Aspirin Management during Noncardiac Surgery.
Source
Anesthesia and Analgesia. (pp 1111-1123), 2020. Date of Publication:
2020.
Author
Gerstein N.S.; Albrechtsen C.L.; Mercado N.; Cigarroa J.E.; Schulman P.M.
Institution
(Gerstein) Department of Anesthesiology and Critical Care Medicine,
University of New Mexico School of Medicine, Albuquerque, NM, United
States
(Albrechtsen) L. Burrell College of Osteopathic Medicine, Las Cruces, NM,
United States
(Mercado) Division of Cardiology, Department of Internal Medicine,
University of New Mexico School of Medicine, Albuquerque, NM, United
States
(Cigarroa) Division of Cardiology, Knight Cardiovascular Institute
(Schulman) Department of Anesthesiology and Perioperative Medicine, Oregon
Health and Science University, Portland, OR, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Aspirin is considered critical lifelong therapy for patients with
established cardiovascular (CV) disease (including coronary artery,
cerebrovascular, and peripheral arterial diseases) and is consequently one
of the most widely used medications worldwide. However, the indications
for aspirin use continue to evolve and recent trials question its efficacy
for primary prevention. Although one third of patients undergoing
noncardiac surgery and at risk for a major adverse CV event receive
aspirin perioperatively, uncertainty still exists about how aspirin should
be optimally managed in this context, and significant practice variability
remains. Recent trials suggest that the risks of continuing aspirin during
the perioperative period outweigh the benefits in many cases, but data on
patients with high CV risk remain limited. We performed a comprehensive
PubMed and Medline literature search using the following keywords:
aspirin, aspirin withdrawal, perioperative, coronary artery disease,
cerebrovascular disease, peripheral artery disease, and CV disease; we
manually reviewed all relevant citations for inclusion. Patients taking
aspirin for the primary prevention of CV disease should likely discontinue
it during the perioperative period, especially when there is a high risk
of bleeding. Patients with established CV disease but without a coronary
stent should likely continue aspirin during the perioperative period
unless undergoing closed-space surgery. Patients with a history of
coronary stenting also likely need aspirin continuation throughout the
perioperative period for nonclosed space procedures. Perioperative
clinicians need to balance the risks of ceasing aspirin before surgery
against its continuation during the perioperative interval using a
patient-specific strategy. The guidance on decision-making with regard to
perioperative aspirin cessation or continuation using currently available
clinical data from studies in high-risk patients along with nonclinical
aspirin studies is conflicting and does not enable a simplified or unified
answer. However, pertinent guidelines on CV disease management provide a
basic framework for aspirin management, and large trial findings provide
some insight into the safety of perioperative aspirin cessation in some
contexts, although uncertainty on perioperative aspirin still exists. This
review provides an evidence-based update on perioperative aspirin
management in patients undergoing noncardiac surgery with a focus on
recommendations for perioperative clinicians on continuing versus holding
aspirin during this context. Copyright © 2020 International
Anesthesia Research Society.

<64>
Accession Number
2014595645
Title
Improved recovery protocols in cardiac surgery: A systematic review and
meta-analysis of observational and quasi-experimental studies.
Source
MEDICC Review. 23(3) (pp 46-53), 2021. Date of Publication: July 2021.
Author
Aguero-Martinez M.O.; Tapia-Figueroa V.M.; Hidalgo-Costa T.
Institution
(Aguero-Martinez) Hermanos Ameijeiras Clinical-Surgical Hospital (HHA),
Havana, Cuba
(Tapia-Figueroa, Hidalgo-Costa) HHA, Havana, Cuba
Publisher
MEDICC Medical Education Cooperation with Cuba
Abstract
INTRODUCTION Improved recovery protocols were implemented in surgical
specialties over the last decade, which decreased anesthetic and surgical
stress and the incidence of perioperative complications. However, these
recovery protocols were introduced more slowly for cardiac surgeries. The
most frequent complications in cardiac surgery are related to patient
clinical status and the characteristics of the surgical procedures
involved, which are becoming more varied and complex every day. The first
version of the enhanced recovery program for cardiac surgery was published
in 2019, but its recommendations were based on only a few studies, and
scant research has evaluated its implementation. Randomized and controlled
clinical trials for these protocols are scarce, so research that
summarizes the results of studies with other methodological designs are
useful in demonstrating their benefits in cardiovascular surgery services
in Cuba and in other limited-resource settings. OBJECTIVE Estimate the
effectiveness of improved recovery protocols in the perioperative
evolution of patients undergoing cardiac surgery. METHODS We performed a
systematic review and meta-analysis according to the guidelines of manual
5.1.0 for reviews of the Cochrane library. We included observational and
quasi-experimental studies published from January 2015 through May 2020
that compared enhanced recovery protocols with conventional treatments in
patients older than 18 years, and used a quality score to evaluate them.
We used the following sources: the Cochrane Library, PubMed, LILACS,
SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate
and HINARI. The following keywords were used for the database searches in
English: ERAS, protocols and cardiac surgery, enhanced recovery after
cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery,
perioperative care and cardiac surgery. We used the following search terms
for databases in Spanish: protocolos de recuperacion precoz and cirugia
cardiaca, protocolos de recuperacion mejorada and cirugia cardiaca,
cuidados perioperatorios and cirugia cardiaca, programas de recuperacion
precoz and cirugia cardiovascular. Methodological quality of included
investigations was evaluated using the surgical research methodology
scale. Meta-analyses were performed for perioperative complications,
intensive care unit and hospital stays, and hospital readmission within 30
days of surgery. We calculated effect sizes of the interventions and the
corresponding 95% confidence intervals. We used mean differences and
confidence intervals for continuous variables, and for qualitative
variables we calculated relative risk (RR). Random effects analysis was
used. Heterogeneity of the studies was assessed using the Q statistic and
the I2 statistic. RESULTS We selected 15 studies (a total of
5059 patients: study group, n = 1706; control group, n = 3353). The
average quality score for the 15 articles included was 18.9 (out of a
maximum of 36 according to the scale) and 66.6% had a score >=18. With
improved recovery protocols in cardiac surgery, the incidence of
perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did
hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95%
CI: 0.31-0.86). Differences in extubation time, hospital stay and length
of stay in intensive care units were less marked, but always favored the
group in which the enhanced protocols were implemented. CONCLUSIONS
Improved recovery protocols in cardiac surgery increase quality of care
evidenced by reductions in perioperative complications and decreased
incidence of hospital readmission in the month following
surgery. Copyright © 2021 MEDICC Medical Education Cooperation
with Cuba. All rights reserved.

<65>
Accession Number
2014637874
Title
Percutaneous coronary intervention versus coronary artery surgery for left
main disease according to lesion site: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
De Filippo O.; Di Franco A.; Boretto P.; Bruno F.; Cusenza V.; Desalvo P.;
Demetres M.; Saglietto A.; Franchin L.; Piroli F.; Marengo G.; Elia E.;
Falk V.; Conrotto F.; Doenst T.; Rinaldi M.; De Ferrari G.M.; D'Ascenzo
F.; Gaudino M.
Institution
(De Filippo, Boretto, Bruno, Cusenza, Desalvo, Saglietto, Franchin,
Piroli, Marengo, Elia, Conrotto, De Ferrari, D'Ascenzo) Division of
Cardiology, Cardiovascular and Thoracic Department, AOU Citta della Salute
e della Scienza di Torino and University of Turin, Turin, Italy
(Di Franco, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Centre, Weill Cornell Medicine, New York, NY, United States
(Falk) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Falk) Department of Cardiothoracic Surgery, Charite-Universitatsmedizin
Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat
Berlin, Berlin Institute of Health, Berlin, Germany
(Falk) Department of Health Sciences, Translational Cardiovascular
Technologies, ETH Zurich, Zurich, Switzerland
(Doenst) Jena University Hospital, Friedrich-Schiller-University of Jena,
Jena, Germany
(Rinaldi) Division of Cardiac Surgery, Cardiovascular and Thoracic
Department, AOU Citta della Salute e della Scienza di Torino and
University of Turin, Turin, Italy
Publisher
Mosby Inc.
Abstract
Background: Comparative data after percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) for unprotected left main
coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs
distal) are scant. The aim of this meta-analysis was to investigate
outcomes after PCI or CABG for ULMCA disease according to lesion site.
 Method(s): Randomized controlled trials (RCTs) and adjusted
observational studies that compared PCI versus CABG in patients with ULMCA
disease and reported outcomes according to lesion site were systematically
identified. Major adverse cardiovascular events (MACE; a composite of
all-cause death, myocardial infarction, stroke, and repeat
revascularization) and all-cause death were the co-primary end points.
Individual components of MACE were secondary end points. Sensitivity
analysis including RCTs only were performed for each outcome.
 Result(s): Nine studies (3 RCTs, 6 adjusted observational),
encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or
distal ULMCA, respectively) were included. At the 5-year follow-up, there
were no significant differences between CABG and PCI for MACE, death, or
any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard
ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10
[95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an
increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95%
CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The
benefit of CABG for MACE and revascularization was confirmed in the
analysis limited to RCTs, whereas the benefit for mortality was not.
 Conclusion(s): Among patients with distal ULMCA disease, CABG is
associated with lower incidence of MACE and revascularization compared
with PCI, whereas no differences in outcomes were observed for
ostial/shaft ULMCA disease. Copyright © 2021 The American
Association for Thoracic Surgery

<66>
Accession Number
2013691318
Title
The association of prothrombin complex concentrates with postoperative
outcomes in cardiac surgery: an observational substudy of the FIBRES
randomized controlled trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Bartoszko J.; Callum J.; Karkouti K.
Institution
(Bartoszko, Karkouti) 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
(Bartoszko, Karkouti) Peter Munk Cardiac Centre and Toronto General
Hospital Research Institute, University Health Network, 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) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: The mainstay of therapy for coagulation factor deficiency in
cardiac surgical patients is frozen plasma (FP); however, prothrombin
complex concentrates (PCCs) may offer logistical and safety advantages. As
there is limited comparative evidence, we conducted this study to explore
the association of comparable PCC or FP doses with transfusion and
outcomes. Method(s): This was a post hoc analysis of a multicentre
randomized trial comparing fibrinogen concentrate with cryoprecipitate
(FIBRES trial) in bleeding cardiac surgical patients. This analysis
included 415 patients who received only PCC (n = 72; 17%) or only FP (n =
343; 83%) for factor replacement. The main outcomes of interest were red
blood cell (RBC) and platelet transfusion within 24 hr of cardiopulmonary
bypass. Secondary outcomes included postoperative adverse events.
Associations were examined by hierarchical generalized estimating equation
models adjusted for demographic and surgical characteristics.
 Result(s): The median [interquartile range (IQR)] PCC dose was 1,000
[1,000-2,000] units, while the median [IQR] FP dose was 4 [2-6] units.
Each unit of FP was independently associated with increased adjusted odds
of RBC (1.60; 95% confidence interval [CI], 1.36 to 1.87; P < 0.01) and
platelet transfusion (1.40; 95% CI, 1.15 to 1.69; P < 0.01) while each 500
units of PCC was independently associated with reduced adjusted odds of
RBC (0.67; 95% CI, 0.50 to 0.90; P < 0.01) and platelet transfusion (0.80;
95% CI, 0.70 to 0.92; P < 0.01). Adverse event rates were comparable.
 Conclusion(s): In cardiac surgical patients with post-cardiopulmonary
bypass bleeding, PCC use was associated with lower RBC and platelet
transfusion than FP use was. Prospective, randomized clinical trials
comparing FP with PCC in this setting are warranted. Copyright ©
2021, Canadian Anesthesiologists' Society.

<67>
Accession Number
635827228
Title
Comparison of Midterm Outcomes Associated with Aspirin and Ticagrelor vs
Aspirin Monotherapy after Coronary Artery Bypass Grafting for Acute
Coronary Syndrome.
Source
JAMA Network Open. 4(8) (no pagination), 2021. Article Number: e2122597.
Date of Publication: 26 Aug 2021.
Author
Bjorklund E.; Malm C.J.; Nielsen S.J.; Hansson E.C.; Tygesen H.; Romlin
B.S.; Martinsson A.; Omerovic E.; Pivodic A.; Jeppsson A.
Institution
(Bjorklund, Malm, Nielsen, Hansson, Tygesen, Romlin, Martinsson, Omerovic,
Jeppsson) Department of Molecular and Clinical Medicine, Institute of
Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
(Bjorklund, Tygesen) Department of Medicine, South Alvsborg Hospital,
Boras, Sweden
(Malm, Nielsen, Hansson, Jeppsson) Department of Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg SE-41345, Sweden
(Romlin) Department of Anesthesiology and Intensive Care, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Martinsson, Omerovic) Department of Cardiology, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Pivodic) Statistiska Konsultgruppen, Gothenburg, Sweden
(Pivodic) Department of Ophthalmology, Institute of Neuroscience and
Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg,
Sweden
Publisher
American Medical Association
Abstract
Importance: Guidelines recommend dual antiplatelet therapy after coronary
artery bypass grafting (CABG) for patients with acute coronary syndrome
(ACS). However, the evidence for these recommendations is weak.
 Objective(s): To compare midterm outcomes after CABG in patients with
ACS treated postoperatively with acetylsalicylic acid (ASA) and ticagrelor
or with ASA monotherapy. Design, Setting, and Participant(s): This
cohort study used merged data from several national registries of Swedish
patients who were diagnosed with ACS and subsequently underwent CABG. All
included patients underwent isolated CABG in Sweden between 2012 and 2017
with an ACS diagnosis less than 6 weeks before the procedure, survived 14
days after discharge from hospital, and were treated postoperatively with
ASA plus ticagrelor or ASA monotherapy. A multivariable Cox regression
model was used for the main analysis, and propensity score-matched models
were performed as sensitivity analysis. Data were analyzed between May and
September 2020. Exposures: Postoperative antiplatelet treatment, defined
as filled prescriptions, with either ASA and ticagrelor or ASA only.
 Main Outcomes and Measures: Major adverse cardiovascular events
(MACE), defined as all-cause mortality, myocardial infarction, and stroke,
and major bleeding, at 12 months and at the end of follow-up.
 Result(s): A total of 6558 patients (5281 [80.5%] men; mean [SD] age
at surgery, 67.6 [9.3] years) were included; 1813 (27.6%) were treated
with ASA plus ticagrelor and 4745 (72.4%) were treated with ASA
monotherapy. Crude MACE rate was 3.0 per 100 person years (95% CI, 2.5-3.6
per 100 person years) in the ASA plus ticagrelor group and 3.8 per 100
person years (95% CI, 3.5-4.1 per 100 person years) in the ASA group.
After adjustment, there was no significant difference in MACE risk between
ASA plus ticagrelor vs ASA only, neither during the first 12 months
(adjusted hazard ratio [aHR], 0.84; 95% CI, 0.58-1.21; P =.34) or during
total follow-up (aHR, 0.89; 95% CI, 0.71-1.11; P =.29). The use of ASA
plus ticagrelor was associated with a significantly increased risk for
major bleeding during the first 12 months (aHR, 1.90; 95% CI, 1.16-3.13; P
=.011). Sensitivity analyses confirmed the results. Conclusions and
Relevance: In patients with ACS who survived 2 weeks after CABG, no
significant difference in the risk of death or ischemic events could be
demonstrated between ASA plus ticagrelor and patients treated with ASA
only, while the risk for major bleeding was higher in patients treated
with ASA plus ticagrelor. Sufficiently powered prospective randomized
trials comparing different antiplatelet therapy strategies after CABG are
warranted. Copyright © 2021 Bjorklund E et al.

<68>
Accession Number
2005221304
Title
Extrapolation of Survival Benefits in Patients with Transthyretin Amyloid
Cardiomyopathy Receiving Tafamidis: Analysis of the Tafamidis in
Transthyretin Cardiomyopathy Clinical Trial.
Source
Cardiology and Therapy. 9(2) (pp 535-540), 2020. Date of Publication: 01
Dec 2020.
Author
Li B.; Alvir J.; Stewart M.
Institution
(Li, Alvir) Pfizer, New York, NY, United States
(Stewart) Pfizer, Groton, CT, United States
Publisher
Adis
Abstract
Introduction: In the Tafamidis in Transthyretin Cardiomyopathy Clinical
Trial (ATTR-ACT; ClinicalTrials.gov number NCT01994889), tafamidis reduced
the risk of all-cause mortality in patients with transthyretin amyloid
cardiomyopathy (ATTR-CM) by 30% versus placebo. Median overall survival
was not achieved in either treatment arm (57.1 and 70.5% of patients in
the placebo and tafamidis groups, respectively, survived at 30 months),
limiting assessment of the potential survival benefits of treatment.
 Method(s): A survival extrapolation analysis was conducted following
technical support guidelines from the National Institute for Health and
Care Excellence. Multiple models (i.e., exponential, Weibull, gamma,
log-logistic, log-normal, Gompertz, generalized gamma, and generalized F)
were applied to systematically fit different candidate curves to existing
patient-level data from the 30-month treatment period in ATTR-ACT. The
relative goodness-of-fit for each candidate curve was then tested by
Akaike's and Bayesian information criteria to select a single model that
was fitted to the placebo and pooled tafamidis treatment arms.
 Result(s): A gamma distribution was selected as best fitting model
and fitted to both treatment arms. The resulting estimated median overall
survival was 35.16 months for placebo and 52.64 months for tafamidis
(difference 17.48 months). Conclusion(s): This extrapolation of
survival data from ATTR-ACT further supports the efficacy of tafamidis in
patients with ATTR-CM. Owing to the limitations of this analysis, these
survival estimates should be interpreted with caution; however, they are
consistent with recently presented findings from a combined analysis of
data from ATTR-ACT and interim data from an ongoing long-term extension
study (median follow-up 36 months; ClinicalTrials.gov number NCT02791230).
Trial Registration: ClinicalTrials.gov: NCT01994889. Copyright ©
2020, The Author(s).

<69>
Accession Number
2004937022
Title
Mitraclip Plus Medical Therapy Versus Medical Therapy Alone for Functional
Mitral Regurgitation: A Meta-Analysis.
Source
Cardiology and Therapy. 9(1) (pp 5-17), 2020. Date of Publication: 01 Jun
2020.
Author
Goel S.; Pasam R.T.; Wats K.; Chava S.; Gotesman J.; Sharma A.; Malik
B.A.; Ayzenberg S.; Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Gidwani) Department of Cardiology, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Pasam, Wats, Chava, Gotesman, Malik, Ayzenberg, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, New York,
NY, United States
(Sharma) Division of Cardiology, Gundersen Health System, La Crosse, WI,
United States
(Sharma) Institute of Cardiovascular Science and Technology, New York, NY,
United States
Publisher
Adis
Abstract
Introduction: The purpose of this meta-analysis is to compare the efficacy
of MitraClip plus medical therapy versus medical therapy alone in patients
with functional mitral regurgitation (FMR). FMR caused by left ventricular
dysfunction is associated with poor prognosis. Whether MitraClip improves
clinical outcomes in this patient population remains controversial.
 Method(s): We conducted an electronic database search of PubMed,
CINAHL, Cochrane Central, Scopus, Google Scholar, and Web of Science
databases for randomized control trials (RCTs) and observational studies
with propensity score matching (PSM) that compared MitraClip plus medical
therapy with medical therapy alone for patients with FMR and reported on
subsequent mortality, heart failure re-hospitalization, and other outcomes
of interest. Event rates were compared using a random-effects model with
odds ratio as the effect size. Result(s): Five studies (n = 1513;
MitraClip = 796, medical therapy = 717) were included in the final
analysis. MitraClip plus medical therapy compared to medical therapy alone
was associated with a significant reduction in overall mortality (OR =
0.66, 95% CI = 0.44-0.99, P = 0.04) and heart failure (HF)
re-hospitalization rates (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (OR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (OR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the MitraClip
group. No effect was observed on cardiac mortality (P = 0.42) between the
two groups. Conclusion(s): MitraClip plus medical therapy improves
overall mortality and reduces HF re-hospitalization rates compared to
medical therapy alone in patients with FMR. Copyright © 2019, The
Author(s).

<70>
Accession Number
622467924
Title
Clinical Acceptability Of Trimetazidine Modified-Release 80 mg Once Daily
Versus Trimetazidine Modified-Release 35 mg Twice Daily In Stable Angina
Pectoris.
Source
Cardiology and Therapy. 7(1) (pp 61-70), 2018. Date of Publication: 01 Jun
2018.
Author
Pozdnyakov Y.M.; Uskov V.L.; Gon-charenko I.I.; Prasolova T.P.; Guseva
V.G.; Shinkar A.S.; Samsonova S.M.; Vikhrova I.V.; Kuz'kina S.A.; Mitina
L.V.; Timofeeva I.V.; Archakova T.M.; Kovaleva N.Y.; Romanova E.A.; Tivon
Y.V.; Antonova Y.N.; Kurganova O.B.; Davydova N.N.; Klyuchantseva O.V.;
Popovskaya Y.V.; Kharitonova E.I.; Kuzmina T.N.; Buzmakova K.V.; Kaplenko
L.I.; Pospelova N.V.; Stepanova A.Y.; Kol-basheva N.A.; Krasnova G.M.;
Pal'vin-skaya A.Y.; Toloknova V.A.; Bikmullina R.F.; Gainullina A.A.;
Kedrina E.V.; Mikhailova S.A.; Nabiullina T.A.; Nizamova A.F.; Uskova
A.A.; Yushkova A.E.; Andreeva O.V.; Fedotova G.V.; Besser-geneva O.L.;
Gavrilyuk D.D.; Ehalo N.V.; Zlo-bina M.V.; Zhemartseva E.Y.; Markushina
I.A.; Pavlovets V.P.; Sobolenko A.A.; Apanovich I.E.; Kireeva N.V.;
Maksimova I.V.; Butz T.V.; Pavlova I.A.; Bachurina S.N.; Orlyachenko S.V.;
Zaitseva T.V.; Beznogova V.F.; Litsis N.N.; Novozhenina A.Y.; Abramyan
L.L.; Adamyan M.M.; Askerko S.N.; Bolmosov A.N.; Vasilieva I.N.; Volodova
S.I.; Grishko P.V.; Zherebetskaya E.S.; Zemlyanaya N.S.; Klysh-nikova
L.N.; Kononchik E.I.; Kuznetsova N.A.; Kuz'minova I.A.; Marmurova I.V.;
Mikhailova R.Y.; Mordovina I.P.; Nazarkina O.V.; Per-epechko A.P.;
Pivovarova N.G.; Potapova T.P.; Prokofiev D.A.; Proniushkina N.E.;
Savelieva E.V.; A Semovskikh N.; Timonenkova L.D.; Fomin V.V.; Furman
O.A.; Tsutsieva R.M.; Chibrikina M.V.; Shoshina I.N.; Yashchenko P.;
Bocharova T.I.; Demya-nenko O.L.; Zhukova L.B.; Melnikov A.Y.; Mer-kulieva
I.A.; Tyasina E.I.; Pakholkova N.S.; Rogozina S.V.; Chugunova I.V.;
Brazhnik M.L.; Guseva Y.V.; Anisimova A.N.; Kuzeyina S.S.; Kulakhmetova
R.G.; Petrova I.S.; Ignatyeva I.A.; Morozova T.A.; Ryb-nikova N.V.;
Gritsenko I.I.; Kondratskaya O.V.; Shishkin A.V.; Gogleva N.N.; Kulipanova
V.M.; Mitrofanova S.V.; Parada E.V.; Svistunova S.Y.; Sergeeva T.M.;
Kryukova V.V.; Suprun T.N.; Fedorova E.M.; Shnor O.F.; Mitroshina T.N.;
Shemetova T.S.; Val'kevich L.P.; Varnikova S.N.; Ivanova E.A.; Shlykova
O.N.; Guryanova I.R.; Zheltova V.L.; Bulygina E.D.; Gorskaya E.V.; Kosenko
L.V.; Musaeva F.K.; Fedorchenko M.Y.; Harish V.I.; Serbarinova O.M.;
Yatsenya Y.A.; Golubev M.N.; Kopaev D.E.; Miludina L.A.; Polischuk L.V.;
Shilintseva O.A.; Krylova L.M.; Vasilik M.V.; Zotov D.D.; Kalishevich
N.B.; Kachmazova L.I.; Kontorikova S.G.; Mamoshko T.A.; Osnovin S.A.;
Timosh-enko (Schmalz) I.O.; Kashina A.N.; Kiryanova O.G.; Kotova L.E.;
Kuvshinova L.E.; Ulyanova I.M.; Shevelo O.F.; Kir-eeva I.B.; Korohova
L.V.; Lisunova T.I.; Medvedeva E.V.; Matvienko T.E.; Shovgaryan S.L.;
Nebolsina T.F.; Mikusheva M.A.; Misharin N.N.; Kutaliya T.O.; Chernova
V.N.; Yanina Y.A.; Permyakova O.V.; Skurikhina N.N.; Goldinova L.M.;
Pri-khodko T.N.; Myshyakova A.G.; Akhmerova E.Z.; Zaitseva K.V.; Ozerchuk
A.A.; Polyakova I.M.; Rodionova; Safiullina I.D.; Arsentieva I.N.; Volkova
O.O.; Kondrina I.N.; Kharlova T.E.; Grigorieva T.L.; Kurtmulaeva K.V.;
Rogozina O.M.
Institution
(Pozdnyakov) Moscow Regional Cardiology Centre, Zhukovsky, Russian
Federation
Publisher
Springer Healthcare
Abstract
Introduction: Trimetazidine (TMZ) is an anti-ischemic metabolic agent that
has been shown to be efficacious in angina treatment, both in monotherapy
and in combination. A new formulation of TMZ modified-release (MR) 80 mg
was developed, which is to be taken once daily (od), instead of twice
daily (bid) for the currently available TMZ MR 35 mg, with the aim of
simplifying the medication regimen. Method(s): The present study was
an international, multicenter, randomized, double-blind, parallel-group
phase III study with a 12-week treatment period. The safety of TMZ MR 80
mg once daily was assessed compared to TMZ MR 35 mg twice daily, in
patients previously treated successfully by the latter. Emergent adverse
events (EAEs), biological parameters, vital signs, 12-lead resting ECG
(electrocardiogram) and Canadian Cardiovascular Society (CCS)
classification were recorded. Result(s): One-hundred and sixty-five
patients previously diagnosed with stable angina pectoris on treatment
were randomized to receive either TMZ MR 80 mg od or TMZ MR 35 mg bid. In
the TMZ MR 80 mg group, fewer patients had >= 1 EAE (17.1 vs. 22.9% in the
TMZ MR 35 mg group). Serious EAEs were reported by three patients in each
group. No EAE required dose modification, withdrawal, or temporary
interruption of study treatments. Vital signs, 12-lead ECG, and laboratory
parameters did not change. No worsening in CCS classes was observed with
either treatment. Conclusion(s): TMZ MR 80 mg od and TMZ MR 35 mg bid
have similar safety profiles. This new once-daily formulation could
improve patient compliance with therapy, thereby enhancing clinical
benefit. Trial Registration: ISRCTN registry, ISRCTN 84362208.
 Funding(s): Institut de Recherches Internationales Servier and
Servier, Moscow, Russian Federation. Plain Language Summary: Plain
language summary available for this article. Copyright © 2018,
The Author(s).

<71>
Accession Number
619397142
Title
Treatment of Stable Angina with a New Fixed-Dose Combination of Ivabradine
and Metoprolol: Effectiveness and Tolerability in Routine Clinical
Practice.
Source
Cardiology and Therapy. 6(2) (pp 239-249), 2017. Date of Publication: 01
Dec 2017.
Author
Divchev D.; Stockl G.
Institution
(Divchev) Department of Cardiology and Angiology, University Hospital
Marburg, Baldingerstrasse, Marburg 35043, Germany
(Stockl) Department of Medical Affairs, Servier Deutschland GmbH, Munich,
Germany
Publisher
Springer Healthcare
Abstract
Introduction: In this prospective, multicenter, observational cohort
study, the effectiveness and tolerability of the first fixed-dose
combination (FDC) formulation of the selective heart rate reducing agent
ivabradine and the beta-blocker metoprolol was evaluated in stable angina
pectoris (AP) patients in a clinical practice setting. Method(s):
Stable AP outpatients received a FDC of ivabradine and metoprolol (b.i.d.)
for 4 months, in addition to cardiovascular standard therapy. Resting
heart rate (HR), number of angina attacks, short-acting nitrate
consumption, severity of symptoms (assessed by patient judgment and
documented by CCS score) and tolerability were documented. Medication
adherence was assessed by a modified four-item Morisky questionnaire.
Descriptive statistics were performed on all data. Result(s): A total
of 747 stable AP patients (mean age, 66.4 years, 62% male, 50% and 31%
with previous PCI and myocardial infarction, respectively) were included.
Apart from ivabradine and beta-blockers as free combination, most
frequently used concomitant standard medications at baseline were aspirin
(68%), statins (71%), ACEI/AT1-blockers (76%), diuretics (35%), and
calcium antagonists (15%). Highly prevalent comorbidities were
hypertension (86%), hyperlipidemia (65%), and diabetes (35%). After 4
months, switch to treatment with the FDC was associated with a significant
reduction in mean HR by 10 bpm. Proportion of patients with >= 1 angina
attacks/week decreased from 38 to 7%. Patients in CCS class 1 increased
(25 to 63%), while they decreased in CCS class 3 (19 to 5%). Medication
adherence was also significantly improved (p < 0.001 for all changes from
baseline). Mostly mild adverse events were documented in 5.4% of patients.
 Conclusion(s): In these stable AP patients in a real-life setting,
treatment with a FDC of ivabradine and metoprolol was associated with
reduced HR and angina symptoms, while exercise capacity (CCS score) was
improved. These effects may be mainly mediated by the increased medication
adherence of patients observed with use of the FDC formulation.
 Funding(s): Servier Trial registration number:
ISRCTN51906157. Copyright © 2017, The Author(s).

<72>
Accession Number
616464043
Title
Improvement of Subjective Well-Being by Ranolazine in Patients with
Chronic Angina and Known Myocardial Ischemia (IMWELL Study).
Source
Cardiology and Therapy. 6(1) (pp 81-88), 2017. Date of Publication: 01 Jun
2017.
Author
Bavry A.A.; Park K.E.; Choi C.Y.; Mahmoud A.N.; Wen X.; Elgendy I.Y.
Institution
(Bavry, Park, Choi, Mahmoud, Wen, Elgendy) Department of Medicine,
University of Florida, Gainesville, FL, United States
(Bavry, Park, Choi) North Florida/South Georgia Veterans Health System,
Gainesville, FL, United States
(Wen) Health Outcomes, College of Pharmacy, University of Rhode Island,
Kingston, RI, United States
Publisher
Springer Healthcare
Abstract
Introduction: We aimed to assess if ranolazine would improve angina
symptoms among patients with documented myocardial ischemia.
 Method(s): Eligible subjects had chronic stable angina and at least
one coronary stenosis with fractional flow reserve (FFR) <=0.80 or at
least one chronic total occlusion (CTO) without attempted
revascularization. Subjects were randomized to oral ranolazine 500 mg
twice daily for 1 week, then ranolazine 1000 mg twice daily for 15 weeks
versus matching placebo. The primary end point was change in angina at 16
weeks as assessed by the Seattle Angina Questionnaire (SAQ).
 Result(s): Between September 2014 and January 2016, 25 subjects were
randomized to ranolazine versus 25 to placebo. The most common reason for
eligibility was CTO (72%), while the remainder had myocardial ischemia
documented by low FFR. The mean FFR was 0.57 +/- 0.12. Sixty-eight percent
of subjects were on two or more anti-angina medications at baseline. Study
medication was discontinued in 32% (eight of 25) of the ranolazine group
versus 36% (nine of 25) of the placebo group. By intention-to-treat, 46
subjects had baseline and follow-up SAQ data completed. Ranolazine was not
associated with an improvement in angina compared with placebo at 16
weeks. The results were similar among 33 subjects that completed study
medication. The incidence of ischemia-driven hospitalization or
catheterization was 12% (three of 25) of the ranolazine group versus 20%
(five of 25) in the placebo group (p > 0.05). Conclusion(s): In
subjects with chronic stable angina and documented myocardial ischemia,
ranolazine did not improve angina symptoms at 16 weeks. Funding(s):
Gilead. Clinical trial registration: The study was registered at
ClinicalTrials.gov (NCT02265796). Copyright © 2016, The
Author(s).

<73>
Accession Number
616464036
Title
A Randomized Trial to Assess the Contribution of a Novel Thorax Support
Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.
Source
Cardiology and Therapy. 6(1) (pp 41-51), 2017. Date of Publication: 01 Jun
2017.
Author
Caimmi P.P.; Sabbatini M.; Kapetanakis E.I.; Cantone S.; Ferraz M.V.;
Cannas M.; Tesler U.F.
Institution
(Caimmi) Department of Cardiac Surgery, University Hospital of Novara
"Maggiore della Carita", Novara, Italy
(Caimmi, Cannas) Department of Science Health, UPO University, Novara,
Italy
(Caimmi, Tesler) "Policlinico di Monza" Hospital Group, Department Cardiac
Surgery, San Gaudenzio Clinic, Novara, Italy
(Sabbatini) Department of Science and Innovation Technology, UPO
University, Alessandria, Italy
(Kapetanakis) Department of Thoracic Surgery, "Sotiria" Chest Diseases
Hospital of Athens, Athens, Greece
(Cantone) "Policlinico di Monza" Health Care Group, Department Cardiac
Anaestehsiology, San Gaudenzio Clinic, Novara, Italy
(Ferraz) Department of Cardiac Surgery, Beneficencia Portouguesa Hospital,
Piracicaba, Brazil
Publisher
Springer Healthcare
Abstract
Objectives: Mechanical complications of median sternotomy may cause
significant morbidity and mortality in cardiac surgical patients. This
study was aimed at assessing the role of Posthorax support vest (Epple,
Inc., Vienna, Austria) in the prevention of sternal complications and the
improvement of anatomical healing in patients at high risk for mechanical
sternal dehiscence after cardiac surgery by mean of median sternotomy.
 Method(s): A prospective, randomized, study was performed and 310
patients with predisposing factors for sternal dehiscence after sternotomy
for cardiac surgery were included. The patients were divided into two
groups: patients who received the Posthorax support vest after surgery,
and patients who did not. Primary variables assessed included the
incidence of mechanical sternal complications, the quality of sternal
healing, the rate of re-operation, the duration of hospitalization, rate
and duration of hospital, re-admission for sternal complications.
Secondary variables assessed were the post-operative pain, the number of
requests for supplemental analgesia and the quality of life measured by
means of the EQ-5D format. Result(s): Patients using vest
demonstrated a lower incidence of mechanical sternal complications, a
better anatomical sternum healing, lower hospital stay, no re-operations
for sternal dehiscence before discharge and lower re-admissions for
mechanical sternal complication. In addition, patients using a vest
reported a better quality of life with better freedom from limitations in
mobility, self-care, and pain. Conclusion(s): Our findings
demonstrate that the use of the Posthorax vest reduces post-sternotomy
mechanical complications and improves the healing of the sternotomy, the
clinical course, and the post-operative quality of life. Copyright
© 2016, The Author(s).

<74>
Accession Number
601111717
Title
Ivabradine Versus Beta-Blockers in Patients with Conduction Abnormalities
or Left Ventricular Dysfunction Undergoing Cardiac Surgery.
Source
Cardiology and Therapy. 3(1-2) (pp 13-26), 2013. Date of Publication:
2013.
Author
Iliuta L.; Rac-Albu M.
Institution
(Iliuta, Rac-Albu) "Carol Davila" University of Medicine and Pharmacy,
Bucharest, Romania
Publisher
Springer Healthcare
Abstract
Introduction: In patients with conduction abnormalities or left ventricle
(LV) dysfunction the use of beta-blockers for post cardiac surgery rhythm
control is difficult and controversial, with a paucity of information
about other drugs such ivabradine used postoperatively. The objective of
this study was to compare the efficacy and safety of ivabradine versus
metoprolol used perioperatively in cardiac surgery patients with
conduction abnormalities or LV systolic dysfunction.
Methods: This was an open-label, randomized clinical trial enrolling 527
patients with conduction abnormalities or LV systolic dysfunction
undergoing coronary artery bypass grafting or valvular replacement,
randomized to take ivabradine or metoprolol, or metoprolol plus
ivabradine. The primary endpoints were the composites of 30-day mortality,
in-hospital atrial fibrillation (AF), in-hospital three-degree
atrioventricular block and need for pacing, in-hospital worsening heart
failure (HF; safety endpoints), duration of hospital stay and
immobilization and the above endpoint plus in-hospital bradycardia,
gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy
plus safety endpoint).
Results: Heart rate reduction and prevention of postoperative AF or
tachyarrhythmia with combined therapy was more effective than with
metoprolol or ivabradine alone during the immediate postoperative
management of cardiac surgery patients. In the Ivabradine group, the
frequency of early postoperative pacing and HF worsening was smaller than
in the Metoprolol group and in combined therapy group. The frequency of
primary combined endpoint was lower in the combined Ivabradine +
Metoprolol group compared with the monotherapy groups.
Conclusion: Considering efficacy and safety, the cardiac rhythm reduction
after open heart surgery in patients with conduction abnormalities or LV
dysfunction with ivabradine plus metoprolol emerged as the best treatment
in this trial. Copyright © 2013, The Author(s).

<75>
Accession Number
2014436121
Title
Impact of major infections on 10-year mortality after revascularization in
patients with complex coronary artery disease.
Source
International Journal of Cardiology. 341 (pp 9-12), 2021. Date of
Publication: 15 Oct 2021.
Author
Ono M.; Kawashima H.; Hara H.; Mancone M.; Mack M.J.; Holmes D.R.; Morice
M.-C.; Kappetein A.P.; Thuijs D.J.F.M.; Noack T.; Mohr F.W.; Davierwala
P.M.; Onuma Y.; Serruys P.W.
Institution
(Ono, Kawashima, Hara) Amsterdam UMC, University of Amsterdam, Heart
Center, Department of Clinical and Experimental Cardiology, Amsterdam
Cardiovascular Sciences, Meibergdreef 9, Amsterdam, Netherlands
(Ono, Kawashima, Hara, Onuma, Serruys) Department of Cardiology, National
University of Ireland, Galway (NUIG), Galway, Ireland
(Mancone) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Center, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, hopital prive Jacques Cartier,
Generale de Sante Massy, France
(Kappetein, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Noack, Mohr, Davierwala) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Onuma, Serruys) CURAM-SFI Centre for Research in Medical Devices, Galway,
Ireland
Publisher
Elsevier Ireland Ltd
Abstract
Background: The significant interaction between major infection and 5-year
mortality after percutaneous coronary intervention (PCI) or coronary
artery bypass graft (CABG) for complex coronary artery disease (CAD) was
observed previously. However, the very long-term outcomes beyond 5 years
remains unclear. Methods and Results: This is a subgroup analysis of
the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended
follow-up of the randomized SYNTAX trial comparing PCI versus CABG in
patients with three-vessel disease (3VD) or left-main CAD (LMCAD). Out of
1517 patients enrolled in the SYNTAX trial with available survival status
from 5 to 10 years, 140 patients had experienced major infections and
survived at 5 years (major infection group). From 5 to 10 years, the
mortality of major infection group was 19.8% whereas the mortality of no
major infection group was 15.1% (p = 0.157). After the adjustment of other
clinical factors, the risk of mortality from 5 to 10 years did not
significantly differ between major infection and no major infection groups
(HR: 1.10; 95% CI: 0.62-1.96; p = 0.740). When stratified by the presence
or absence of periprocedural major infections, defined as a major
infection within 60 days after index procedure, there was also no
significant difference in 10-year mortality between two groups (30.8% vs.
24.5%; p = 0.057). Conclusion(s): Despite the initial association
between major infections and 5 years mortality, postprocedural major
infection was not evident in the 10 years follow-up, suggesting that the
impact of major infection on mortality subsided over time beyond 5 years.
Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050
SYNTAX ClinicalTrials.gov reference: NCT00114972 Copyright © 2021
The Author(s)

<76>
Accession Number
2014262927
Title
Postoperative analgesic effects of paravertebral block versus erector
spinae plane block for thoracic and breast surgery: A meta-analysis.
Source
PLoS ONE. 16(8 August) (no pagination), 2021. Article Number: e0256611.
Date of Publication: August 2021.
Author
Xiong C.; Han C.; Zhao D.; Peng W.; Xu D.; Lan Z.
Institution
(Xiong, Zhao, Peng, Xu, Lan) Department of Anesthesiology, Affiliated
Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, Jinhua,
China
(Han) Department of Rehabilitation, Jinhua Maternal and Child Health Care
Hospital, Zhejiang, Jinhua, China
Publisher
Public Library of Science
Abstract
Background Paravertebral block (PVB) is the most recognized regional
anesthesia technique after thoracic epidural anesthesia for postoperative
analgesia in thoracic and breast surgery. Erector spinae plane block
(ESPB) is a recently discovered blocking technique, and it has evidenced
excellent postoperative analgesia for breast and thoracic surgery with
fewer adverse reactions. However, there are controversies about the
postoperative analgesic effects of the two analgesic techniques. Objective
To assess the analgesic effects of PVB versus ESPB in postoperative
thoracic and breast surgery. Methods We systematically searched PubMed,
Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up
to April 5, 2021. The primary outcome was postoperative pain scores.
Secondary outcomes included: opioid consumption, additional analgesia,
postoperative nausea and vomiting (PONV) 24 hours post-operation, and the
time required for completing block procedure. This study was registered in
PROSPERO, number CRD42021246160. Results After screening relevant,
full-text articles, ten randomized controlled trials (RCTs) that met the
inclusion criteria were retrieved for this meta-analysis. Six studies
involved thoracic surgery patients, and four included breast surgery
patients. Thoracic surgery studies included all of the outcomes involved
in this meta-analysis while breast surgery did not report pain scores at
movement and additional analgesia in 24 hours post-operation. For thoracic
surgery, PVB resulted in significant reduction in the following pain
scores: 0-1 hours (MD = -0.79, 95% CI: -1.54 to -0.03, P = 0.04), 4-6
hours (MD = -0.31, 95% CI: -0.57 to -0.05, P = 0.02), and 24 hours (MD =
-0.42, 95% CI: -0.81 to -0.02, P = 0.04) at rest; significant reduction in
pain scores at 4-6 hours (MD = -0.47, 95% CI: -0.93 to -0.01, P = 0.04),
8-12 hours (MD = -1.09, 95% CI: -2.13 to -0.04, P = 0.04), and 24 hours
(MD = -0.31, 95% CI: -0.57 to -0.06, P = 0.01) at movement. Moreover, the
opioid consumption at 24 hours post-operation (MD = -2.74, 95% CI: -5.41
to -0.07, P = 0.04) and the incidence of additional analgesia in 24 hours
of the postoperative course (RR: 0.53, 95% CI: 0.29 to 0.97, P = 0.04)
were significantly lower in the PVB group than in the ESPB group for
thoracic surgery. However, no significant differences were found in pain
scores at rest at various time points postoperatively, and opioid
consumption at 24 hours post-operation for breast surgery. The time
required for completing block procedure was longer in the PVB group than
in the ESPB group for thoracic and breast surgery, and the incidence of
PONV between the two groups showed no significant difference. Conclusion
The postoperative analgesic effects of PVB versus ESPB are distinguished
by the surgical site. For thoracic surgery, the postoperative analgesic
effect of PVB is better than that of ESPB. For breast surgery, the
postoperative analgesic effects of PVB and ESPB are similar. Copyright
© 2021 Xiong et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<77>
Accession Number
2014181974
Title
Frailty Assessment in Heart Failure and Ventricular Assist Device
Populations: A Review from the United States.
Source
Heart and Lung. 50(6) (pp 941-952), 2021. Date of Publication: 01 Nov
2021.
Author
Schroeder S.E.; Pozehl B.J.; Alonso W.W.
Institution
(Schroeder) College of Nursing, University of Nebraska Medical Center,
Omaha, Nebraska, 985330 Nebraska Medical Center Omaha, NE USA, 68198-5330;
Division of Mechanical Circulatory Support, Bryan Heart, Lincoln, NE, 1600
South 48th Street, Suite 600, Lincoln, NE 68506, United States
(Pozehl, Alonso) College of Nursing, University of Nebraska Medical
Center, Omaha, Nebraska; 985330 Nebraska Medical Center Omaha, NE
68198-5330, United States
Publisher
Mosby Inc.
Abstract
Importance: Post-operative risk is increased with frail individuals
undergoing cardiac surgery. Yet, there is no consensus for frailty
assessment prior to durable left ventricular assist device (dLVAD)
evaluation. Objective(s): The objectives of this integrative review
were to describe frailty measures, examine psychometrics of measures used,
and identify variables related to frailty in heart failure with reduced
ejection fraction (HFrEF) and dLVAD populations. Design, Setting,
Participants: PubMed, CINAHL, and Embase databases were searched for terms
related to frailty, HFrEF and dLVAD that met inclusion criteria.
 Result(s): Fourteen articles met inclusion criteria. Frailty was
inconsistently defined. The Fried Phenotype Criteria was the most widely
used approach to measurement. Validity was reported in all articles.
Variables related to frailty included readmissions, higher mortality and
increased adverse events. Conclusion(s): There was variability in
frailty definition and frailty measurement across studies. Further
research in HFrEF and dLVAD populations is needed for frailty
evaluation. Copyright © 2021 Elsevier Inc.

<78>
Accession Number
2013554513
Title
Effect of dexmedetomidine on hemodynamics in patients undergoing
hysterectomy: a meta-analysis and systematic review.
Source
Journal of International Medical Research. 49(8) (no pagination), 2021.
Date of Publication: 2021.
Author
Li Z.; Li C.; Zhang M.
Institution
(Li) Surgical Anesthesia Center, Sanya Maternal and Child Health Hospital,
Sanya, Hainan, China
(Li) Department of Anesthesiology, Dongguan Houjie Hospital, Dongguan,
Guangdong, China
(Zhang) Department of Anesthesiology, People's Hospital of Ningxia Hui
Autonomous Region, Yinchuan, Ningxia, China
Publisher
SAGE Publications Ltd
Abstract
Objective: We conducted a meta-analysis and systematic review to evaluate
the effects of dexmedetomidine on the hemodynamics of patients undergoing
hysterectomy. Method(s): We searched the Medline, Embase, and
Cochrane Central Register of Controlled Trials databases for clinical
randomized controlled trials (RCTs) that allowed direct or indirect
comparisons of hemodynamic indicators. We also searched nine
English-language databases up to April 2021 to identify relevant research.
The Cochrane risk-of-bias tool for RCTs was applied to assess the
methodological quality of the eligible studies. The meta-analysis was
conducted using RevMan 5.4 software. Result(s): Nine trials were
included in this systematic review. The effect of dexmedetomidine on heart
rate during surgery was significantly smaller than that of other
sedatives. Intraoperative systolic and diastolic blood pressure and mean
arterial pressure were more stable in the dexmedetomidine group compared
with the control group. The postoperative modified Observer's Assessment
of Alertness Score was also better in the dexmedetomidine compared with
the control group. Conclusion(s): Dexmedetomidine increases
hemodynamic stability in patients undergoing hysterectomy, reduces the
cardiovascular stress response during surgery, and effectively prevents
postoperative adverse reactions, with good safety. Copyright ©
The Author(s) 2021.

<79>
Accession Number
2012909324
Title
Glycaemic stability and length of stay: Tight versus conventional
intraoperative glycaemic control protocols among patients with diabetes
mellitus undergoing coronary artery bypass graft surgery.
Source
International Journal of Clinical Practice. 75(10) (no pagination), 2021.
Article Number: e14551. Date of Publication: October 2021.
Author
Hayajneh A.A.; Hweidi I.M.; Zytoon A.M.
Institution
(Hayajneh) Adult Health-Nursing Department, Faculty of Nursing, Jordan
University of Science and Technology, Irbid, Jordan
(Hweidi) School of Nursing, Adult Health Nursing Department, Jordan
University of Science and Technology, Irbid, Jordan
(Zytoon) Adult Health Nursing Department, Jordan University of Science and
Technology, Irbid, Jordan
Publisher
John Wiley and Sons Inc
Abstract
Background: Intraoperative glycaemic stability and control among patients
with diabetes mellitus (DM) undergoing coronary artery bypass grafting
(CABG) surgery have been a major concern. The current study aimed to
compare the effect of tight glycaemic control and conventional glycaemic
control on glycaemic stability and length of stay (LOS) among diabetic
patients undergoing CABG surgery. Method(s): This study utilised a
randomised control trial design among a convenience sample of 144
patients. Participants were randomly assigned to either the tight or
conventional glycaemic control groups. The repeated measures analysis of
variance (ANOVA) test and an independent samples t test were used to
assess the variations in blood glucose (BG) level and LOS based on insulin
therapy type. Result(s): Patients who received the tight glycaemic
control protocol had significantly more consistent and lower mean
intraoperative BG levels than did patients who received the conventional
glycaemic control protocol. No statistically significant differences in
hospital LOS in days were identified between the two groups.
 Conclusion(s): Healthcare providers, including physicians and nurses,
should consider using tight glycaemic control therapy among patients
undergoing coronary artery bypass graft (CABG) surgery. This may lead to
increased BG level consistency and stability and lower mean intraoperative
BG level across time. Copyright © 2021 John Wiley & Sons Ltd

<80>
Accession Number
635358125
Title
Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in
Coronary Artery Bypass Surgery: A Post Hoc Analysis from the COMPASS
Trial.
Source
JAMA Cardiology. 6(9) (pp 1042-1049), 2021. Date of Publication: September
2021.
Author
Lamy A.; Browne A.; Sheth T.; Zheng Z.; Dagenais F.; Noiseux N.; Chen X.;
Bakaeen F.G.; Brtko M.; Stevens L.-M.; Alboom M.; Lee S.F.; Copland I.;
Salim Y.; Eikelboom J.
Institution
(Lamy, Browne, Sheth, Lee, Copland, Salim, Eikelboom) Population Health
Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
(Lamy, Alboom) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Lamy, Lee, Salim) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada
(Sheth, Salim, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Zheng) Department of Cardiovascular Surgery, Fuwai Hospital, Beijing,
China
(Dagenais) Department of Cardiac Surgery, Quebec Heart and Lung Institute
Affiliated with Laval University, Quebec City, QC, Canada
(Noiseux, Stevens) Department of Cardiac Surgery, Centre Hospitalier de
l'Universite de Montreal, Montreal, QC, Canada
(Chen) Department of Thoracic and Cardiovascular Surgery, Nanjing First
Hospital Affiliated with Nanjing Medical University, Nanjing, China
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, United States
(Brtko) Department of Cardiac Surgery, Fakultni Nemocnice Hradec Kralove,
Hradec Kralove, Kralovehradecky, Czechia
Publisher
American Medical Association
Abstract
Importance: The relative safety and patency of skeletonized vs pedicled
internal mammary artery grafts in patients undergoing coronary artery
bypass graft (CABG) surgery are unknown. Objective(s): To investigate
the association of skeletonized vs pedicled harvesting with internal
mammary artery graft patency and clinical outcomes 1 year after CABG
surgery. Design, Setting, and Participant(s): This study was a post
hoc analysis of the multicenter, randomized, double-blind,
placebo-controlled Cardiovascular Outcomes for People Using
Anticoagulation Strategies (COMPASS) clinical trial, which enrolled 27 395
patients from 602 centers in 33 countries from March 2013 through May
2016. Eligibility criteria for the trial included CABG surgery for
coronary artery disease with at least 2 grafts implanted and an estimated
glomerular filtration rate of at least 30 mL/min. A total of 1002 of 1448
patients were randomized to the CABG arm of the COMPASS trial and
underwent skeletonized (282 [28.1%]) or pedicled (720 [71.9%]) internal
mammary artery harvesting. The patients had evaluable angiography results
1 year after surgery. Data were analyzed from October 11, 2019, to May 14,
2020. Intervention(s): Patients underwent graft harvesting with
either the pedicled technique or skeletonized technique. Main
Outcomes and Measures: The primary outcome was graft occlusion 1 year
after CABG surgery, as assessed by computed tomography angiography.
 Result(s): A total of 1002 patients underwent skeletonized (282
[28.1%]; mean [SD] age, 65.9 [8.1] years; 229 men [81.2%]; 194 White
patients [68.8%]) or pedicled (720 [71.9%]; mean [SD] age, 64.8 [7.6]
years; 603 men [83.8%]; 455 White patients [63.2%]) internal mammary
artery harvesting. Rates of internal mammary artery graft occlusion 1 year
after CABG surgery were higher in the skeletonized group than in the
pedicled group (33 of 344 [9.6%] vs 30 of 764 [3.9%]; graft-level adjusted
odds ratio, 2.41; 95% CI, 1.39-4.20; P =.002), including the left internal
mammary artery to left anterior descending artery (21 of 289 [7.3%] vs 25
of 725 [3.4%]; graft-level adjusted odds ratio, 2.10; 95% CI, 1.14-3.88, P
=.02). After a mean follow-up of 23 months, skeletonized graft harvesting
was also associated with a higher rate of major adverse cardiovascular
events (20 [7.1%] vs 15 [2.1%]; adjusted hazard ratio, 3.19; 95% CI,
1.53-6.67; P =.002) and repeated revascularization (14 [5.0%] vs 10
[1.4%]; adjusted hazard ratio, 2.75; 95% CI, 1.10-6.88; P =.03).
 Conclusions and Relevance: This post hoc analysis of the COMPASS
randomized clinical trial found that harvesting of the internal mammary
artery during CABG surgery using a skeletonized technique was associated
with a higher rate of graft occlusion and worse clinical outcomes than the
traditional pedicled technique. Future randomized clinical trials are
needed to establish the safety and patency of the skeletonized technique.
Trial Registration: ClinicalTrials.gov Identifier: NCT01776424.
 Copyright © 2021 American Medical Association. All rights
reserved.

<81>
Accession Number
635306083
Title
Association of Novel Locus with Rheumatic Heart Disease in Black African
Individuals: Findings from the RHDGen Study.
Source
JAMA Cardiology. 6(9) (pp 1000-1011), 2021. Date of Publication: September
2021.
Author
Machipisa T.; Chong M.; Muhamed B.; Chishala C.; Shaboodien G.; Pandie S.;
De Vries J.; Laing N.; Joachim A.; Daniels R.; Ntsekhe M.; Hugo-Hamman
C.T.; Gitura B.; Ogendo S.; Lwabi P.; Okello E.; Damasceno A.; Novela C.;
Mocumbi A.O.; Madeira G.; Musuku J.; Mtaja A.; Elsayed A.; Elhassan
H.H.M.; Bode-Thomas F.; Okeahialam B.N.; Zuhlke L.J.; Mulder N.; Ramesar
R.; Lesosky M.; Parks T.; Cordell H.J.; Keavney B.; Engel M.E.; Pare G.
Institution
(Machipisa, Muhamed, Chishala, Shaboodien, Pandie, De Vries, Laing,
Joachim, Daniels, Ntsekhe, Zuhlke, Lesosky, Engel) Department of Medicine,
University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
(Machipisa, Muhamed, Chishala, Shaboodien) Hatter Institute for
Cardiovascular Diseases Research in Africa, Cape Heart Institute,
Department of Medicine, University of Cape Town, Cape Town, South Africa
(Machipisa, Chong, Muhamed, Pare) Population Health Research Institute,
David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton
St E, Hamilton, ON L8L 2X2, Canada
(Machipisa, Chong, Muhamed, Pare) Thrombosis and Atherosclerosis Research
Institute, David Braley Cardiac, Vascular and Stroke Research Institute,
Hamilton, ON, Canada
(Machipisa, Chong, Muhamed, Pare) Department of Pathology and Molecular
Medicine, McMaster University, Michael G. DeGroote School of Medicine,
Hamilton, ON, Canada
(Hugo-Hamman) Rheumatic Heart Disease Clinic, Windhoek Central Hospital,
Ministry of Health and Social Services, Windhoek, Namibia
(Gitura, Ogendo) Cardiology Department of Medicine, Kenyatta National
Hospital, University of Nairobi, Nairobi, Kenya
(Lwabi, Okello) Uganda Heart Institute, Kampala, Uganda
(Damasceno, Novela) Faculty of Medicine, Eduardo Mondlane
University/Nucleo de Investigacao, Departamento de Medicina, Hospital
Central de Maputo, Maputo, Mozambique
(Mocumbi) Instituto Nacional de Saude Ministerio da Saude, Maputo,
Mozambique
(Madeira) Emergency Department, World Health Organization Mozambique,
Maputo, Mozambique
(Musuku, Mtaja) Department of Paediatrics and Child Health, University
Teaching Hospital-Children's Hospital, University of Zambia, Lusaka,
Zambia
(Elsayed, Elhassan) Department of Cardiothoracic Surgery, Alshaab Teaching
Hospital, Alazhari Health Research Center, Alzaiem Alazhari University,
Khartoum, Sudan
(Bode-Thomas, Okeahialam) Department of Paediatrics, Jos University
Teaching Hospital, University of Jos, Jos, Nigeria
(Zuhlke) Division of Paediatric Cardiology, Department of Paediatrics and
Child Health, Red Cross War Memorial Children's Hospital, University of
Cape Town, South Africa
(Mulder) Computational Biology Division, Department of Integrative
Biomedical Sciences, Institute of Infectious Disease and Molecular
Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town,
South Africa
(Ramesar) Department of Pathology, University of Cape Town, Cape Town,
South Africa
(Parks) Wellcome Centre for Human Genetics, University of Oxford, Oxford,
United Kingdom
(Cordell) Population Health Sciences Institute, Faculty of Medical
Sciences, Newcastle University, International Centre for Life, Newcastle
upon Tyne, United Kingdom
(Keavney) Division of Cardiovascular Sciences, School of Medical Sciences,
Faculty of Biology, Medicine, and Health, The University of Manchester,
Manchester, United Kingdom
(Keavney) Manchester University, National Health Service Foundation Trust,
Manchester Academic Health Science Centre, Manchester, United Kingdom
(Pare) Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada
Publisher
American Medical Association
Abstract
Importance: Rheumatic heart disease (RHD), a sequela of rheumatic fever
characterized by permanent heart valve damage, is the leading cause of
cardiac surgery in Africa. However, its pathophysiologic characteristics
and genetics are poorly understood. Understanding genetic susceptibility
may aid in prevention, control, and interventions to eliminate RHD.
 Objective(s): To identify common genetic loci associated with RHD
susceptibility in Black African individuals. Design, Setting, and
Participant(s): This multicenter case-control genome-wide association
study (GWAS), the Genetics of Rheumatic Heart Disease, examined more than
7 million genotyped and imputed single-nucleotide variations. The 4809
GWAS participants and 116 independent trio families were enrolled from 8
African countries between December 31, 2012, and March 31, 2018. All GWAS
participants and trio probands were screened by use of echocardiography.
Data analyses took place from May 15, 2017, until March 14, 2021.
 Main Outcomes and Measures: Genetic associations with RHD.
 Result(s): This study included 4809 African participants (2548 RHD
cases and 2261 controls; 3301 women [69%]; mean [SD] age, 36.5 [16.3]
years). The GWAS identified a single RHD risk locus, 11q24.1 (rs1219406
[odds ratio, 1.65; 95% CI, 1.48-1.82; P = 4.36 x 10-8]), which reached
genome-wide significance in Black African individuals. Our meta-analysis
of Black (n = 3179) and admixed (n = 1055) African individuals revealed
several suggestive loci. The study also replicated a previously reported
association in Pacific Islander individuals (rs11846409) at the
immunoglobulin heavy chain locus, in the meta-analysis of Black and
admixed African individuals (odds ratio, 1.16; 95% CI, 1.06-1.27; P = 1.19
x 10-3). The HLA (rs9272622) associations reported in Aboriginal
Australian individuals could not be replicated. In support of the known
polygenic architecture for RHD, overtransmission of a polygenic risk score
from unaffected parents to affected probands was observed (polygenic
transmission disequilibrium testing mean [SE], 0.27 [0.16] SDs; P
=.04996), and the chip-based heritability was estimated to be high at 0.49
(SE = 0.12; P = 3.28 x 10-5) in Black African individuals.
 Conclusions and Relevance: This study revealed a novel candidate
susceptibility locus exclusive to Black African individuals and an
important heritable component to RHD susceptibility in African
individuals. Copyright © 2021 American Medical Association. All
rights reserved.

<82>
Accession Number
631611610
Title
The Role of 18FDG PET/CT in the Assessment of Endocarditis, Myocarditis
and Pericarditis.
Source
Current radiopharmaceuticals. 14(3) (pp 259-272), 2021. Date of
Publication: 2021.
Author
Giorgetti A.; Genovesi D.; Emdin M.
Institution
(Giorgetti, Genovesi, Emdin) PisaItaly
Publisher
NLM (Medline)
Abstract
Endocarditis, myocarditis and pericarditis are a heterogeneous group of
phenotypic syndromes where the culprit area of inflammation is the heart.
Inflammation may be determined by an infective agent, toxins, drugs or an
activated immune system. Clinical manifestations can be subtle and
diagnosis remains a challenge for cardiologists, requiring high level of
suspicion and advanced multimodal cardiac imaging to avoid
life-threatening consequences. The purpose of this review is to report the
recent advances of PET/CT imaging with 18FDG in helping the management of
patients affected by inflammatory heart disease. Two independent reviewers
searched in PubMed articles published before or in June 2019 and final
decisions on the inclusion of references were done in consensus with a
third reviewer. At the end of the selection process 23/206 articles on
"cardiac inflammation"; 26/235 articles on "endocarditis", "prosthetic
heart valve", "pacemaker", "implantable cardiac device"; 7/103 articles on
"myocarditis"; 13/330 articles on sarcoidosis" and 2/19 articles on
"pericarditis" were included. Compared with the conventional methods,
molecular imaging has the advantage to non-invasively and directly trace
the inflammatory process, and to identify earlier the presence and the
extent of intra-cardiac and extra-cardiac involvement, to enable
quantification of disease activity, guide therapeutic interventions, and
monitor treatment success. Copyright© Bentham Science Publishers;
For any queries, please email at epub@benthamscience.net.

<83>
Accession Number
635983070
Title
Balanced forced-diuresis compared to control as a reno-protective approach
in cardiac surgery: secondary outcome of a randomized controlled trial,
assessment of neutrophil gelatinase-associated lipocalin levels.
Source
Journal of cardiothoracic surgery. 16(1) (pp 240), 2021. Date of
Publication: 24 Aug 2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) American Hospital, PO Box 5566, Dubai, United Arab Emirates
(Giri, Wrigley, Nagarajan, Senanayake, Sharman) Heart and Lung Centre,
Wolverhampton WV10 0QP, United Kingdom
(Beare) University Hospitals of North Midlands, Stoke-on-Trent ST4 6QG,
United Kingdom
(Nevill) Faculty of Education, Health and Wellbeing, University of
Wolverhampton, Wolverhampton WS1 3BD, United Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a
recognised biomarker for acute kidney injury (AKI).This study investigated
the impact of balanced forced-diuresis using RenalGuard system (RG), in
reducing acute kidney injury (AKI) rates and the associated NGAL levels
(6-h post-CPB plasma level) post adult cardiac surgery with
cardiopulmonary bypass (CPB). METHOD(S): Patients included in the
study were at high-risk for AKI post cardiac surgery, namely history of
diabetes and/or anaemia, e-GFR 20-60 ml/min/1.73 m2, Logistic EuroScore>5,
anticipated CPB time>120 min. Patients were randomized to either RG
(n=110) or managed as per current practice (control=110). RIFLE-defined
AKI rate (based on serum creatinine level increase) within first 3 days of
surgery and 6-h post CPB NGAL levels were the primary and secondary
end-points. RESULT(S): Pre and intra-operative characteristics
between the two groups were similar (p>0.05) including the pre-op NGAL
levels, the oxygen delivery (ecDO2i) and the carbon dioxide production
(ecVCO2i) during CPB. Patients in the RG group had a significantly lower
post-operative RIFLE-defined AKI rate compared to control (10% (11/110)
v/s 20.9% (23/110), p=0.03). Overall, median 6-h post CPB NGAL levels in
patients with AKI were significantly higher than those who did not develop
AKI (211 vs 150 ng/ml, p<0.001). Patients managed by balanced
forced-diuresis had lower post-operative NGAL levels (146 vs 178 ng/ml,
p=0.09). Using previously reported NGAL cut-off level for AKI (142 ng/ml),
binary logistic regression analysis confirmed a beneficial effect of the
RG system, with an increased risk of AKI of 2.2 times in the control group
(OR 2.2, 95% CI 1.14-4.27, p=0.02). CONCLUSION(S): Overall, the 6-h
post-CPB plasma NGAL levels were significantly higher in patients who
developed AKI. Patients managed with the novel approach of balanced
forced-diuresis, provided by the RenalGuard system, had a lower AKI rate
and lower NGAL levels indicating a lesser degree of renal tissue injury.
Trial registration ClinicalTrials.gov website, NCT02974946,
https://clinicaltrials.gov/ct2/show/NCT02974946 . Copyright ©
2021. The Author(s).

<84>
Accession Number
2014603047
Title
Study design for a randomized crossover study investigating myocardial
strain analysis in patients with coronary artery disease at hyperoxia and
normoxemia prior to coronary artery bypass graft surgery
(StrECHO-O<inf>2</inf>).
Source
Contemporary Clinical Trials. 110 (no pagination), 2021. Article Number:
106567. Date of Publication: November 2021.
Author
Fischer K.; Ranjan R.; Friess J.-O.; Erdoes G.; Mikasi J.; Baumann R.;
Schoenhoff F.S.; Carrel T.P.; Brugger N.; Eberle B.; Guensch D.P.
Institution
(Fischer, Ranjan, Friess, Erdoes, Mikasi, Baumann, Eberle, Guensch)
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Schoenhoff, Carrel) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
(Brugger) Department of Cardiology, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Supplemental oxygen (O<inf>2</inf>) is used routinely during
anesthesia. In the treatment of acute myocardial infarction, it has been
established that hyperoxia is to be avoided, whereas information on
benefit and risk of hyperoxia in patients with stable coronary artery
disease (CAD) remain scarce, especially in the setting of general
anesthesia. This study will compare the immediate effects of normoxemia
and hyperoxia on cardiac function, with a primary focus on changes in peak
longitudinal left-ventricular strain, in anesthetized stable chronic CAD
patients using peri-operative transesophageal echocardiography (TEE).
 Method(s): A single-center randomized cross-over clinical trial will
be conducted, enrolling 106 patients undergoing elective coronary artery
bypass graft surgery. After the induction of anesthesia and prior to the
start of surgery, cardiac function will be assessed by 2D and 3D TEE.
Images will be acquired at two different oxygen states for each patient in
randomized order. The fraction of inspired oxygen
(F<inf>I</inf>O<inf>2</inf>) will be titrated to a normoxemic state
(oxygen saturation of 95-98%) and adjusted to a hyperoxic state
(F<inf>I</inf>O<inf>2</inf> = 0.8). TEE images will be analyzed in a
blinded manner for standard cardiac function and strain parameters.
 Conclusion(s): By using myocardial strain assessed by TEE, early and
subtle signs of biventricular systolic and diastolic dysfunction can be
promptly measured intraoperatively prior to the onset of severe signs of
ischemia. The results may help anesthesiologists to better understand the
effects of F<inf>I</inf>O<inf>2</inf> on cardiac function and potentially
tailor oxygen therapy to patients with CAD undergoing general
anesthesia. Copyright © 2021 The Authors

<85>
Accession Number
2014592542
Title
Comment on: Perioperative dexmedetomidine administration to prevent
delirium in adults after non-cardiac surgery: A systematic review and
meta-analysis.
Source
Journal of Clinical Anesthesia. 75 (no pagination), 2021. Article Number:
110515. Date of Publication: December 2021.
Author
Tsaousi G.; Trombi M.; Bilotta F.
Institution
(Tsaousi) Department of Anesthesiology and Critical Care, Faculty of
Medicine, Aristotle University Thessaloniki, Thessaloniki, Greece
(Trombi, Bilotta) Department of Anesthesiology and Critical Care, Sapienza
University of Rome, Piazzale Aldo Moro 5, Rome IT 00185, Italy
Publisher
Elsevier Inc.

<86>
Accession Number
2014611181
Title
A comparison of continuation of one-quarter dose and full-dose ACEIs /ARBs
effect on incidence of intraoperative hypotension in patients undergoing
non-cardiac surgery, a randomized controlled study.
Source
Journal of Cardiovascular Disease Research. 12(3) (pp 515-521), 2021. Date
of Publication: 2021.
Author
Apinyachon W.; Chenboonthai T.; Sangkum L.; Sangasilpa I.
Institution
(Apinyachon, Chenboonthai, Sangkum, Sangasilpa) Department of
Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
EManuscript Technologies
Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs) and
angioensin II receptor blockers (ARBs) are commonly prescribed to treat
hypertension in general surgical patients. However, the patients who
continued ACEIs/ARBs preoperatively increased incidence of postinduction
hypotension. Due to there was dose-related efficacy for lowering blood
pressure of ACEIs/ARBs. Our objective was to compare the incidence of
hypotension in patients who received continuation of one-quarter dose or
full dose of ACEIs/ARBs on the morning of surgery. Method(s): After
IRB approval, a prospective randomized-control study consisted of 40
patients who received ACEIs/ARBs were scheduled for non-cardiac surgery.
Patients were randomized into two groups, continued full dose (FD) group
who continued the same dose ACEIs/ARBs and one-quarter dose (QD) group who
received a quarter dose of their own ACEIs or ARBs on the morning of
surgery. The baseline and intraoperative blood pressures were measured.
 Result(s): Twenty-seven patients (67.5%) had been treated with ARBs.
Either means of baseline or preinduction blood pressure in two groups was
not significant difference. Four patients (20%) in QD group had episode of
hypotension whereas ten patients (50%) in FD group. The incidence of
hypotension in FD group had significantly higher than that of QD group
(p=0.047). However, the incidences of intraoperative hypertension of QD
and FD group were 55% and 30%, respectively. There was not significant
difference between two groups. Conclusion(s): The continuation of
one-quarter dose ACEIs/ARBs in patients undergoing non-cardiac surgery was
associated with a lower incidence of intraoperative hypotension compared
with full-dose of medications. Copyright © 2021 EManuscript
Technologies. All rights reserved.

<87>
Accession Number
2014620659
Title
Impact of sex on outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Dixon L.K.; Di Tommaso E.; Dimagli A.; Sinha S.; Sandhu M.; Benedetto U.;
Angelini G.D.
Institution
(Dixon, Di Tommaso, Dimagli, Sinha, Sandhu, Benedetto, Angelini) Bristol
Heart Institute, Translational Health Sciences, University of Bristol, UK,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Despite advances in cardiac surgery, observational studies
suggest that females have poorer post-operative outcomes than males. This
study is the first to review sex related outcomes following both coronary
artery bypass graft (CABG) and valve surgery with or without combined
CABG. Method(s): We identified 30 primary research articles reporting
either short-term mortality (in-hospital/30 day), long-term mortality, and
post-operative stroke, sternal wound infection and myocardial infarction
(MI) in both sexes following CABG and valve surgery with or without
combined CABG. Reported adjusted odds/hazard ratio were pooled using an
inverse variance model. Result(s): Females undergoing CABG and
combined valve and CABG surgery were at higher risk of short-term
mortality (odds ratio (OR) 1.40; 95% confidence interval (CI) 1.32-1.49;
I2 = 79%) and post-operative stroke (OR 1.2; CI 1.07-1.34;
I2 = 90%) when compared to males. However, for isolated AVR,
there was no difference found (OR 1.19; 95% CI 0.74-1.89). There was no
increased risk in long-term mortality (OR 1.04; 95% CI: 0.93-1.16;
I2 = 82%), post-operative MI (OR 1.22; 95%CI: 0.89-1.67;
I2 = 60%) or deep sternal wound infection (OR 0.92; 95%CI:
0.65-1.03, I2 = 87%). No evidence of publication bias or small
study effect was found. Conclusion(s): Females are at a greater risk
of short-term mortality and post-operative stroke than males following
CABG and valve surgery combined with CABG. However, there is no difference
for Isolated AVR. Long-term mortality is equivalent in both sexes.
PROSPERO Registration: CRD42021244603. Copyright © 2021 Elsevier
B.V.

<88>
Accession Number
2014620554
Title
Traditional vs Extended Hybrid Cardiac Rehabilitation Based on the
Continuous Care Model for Patients Who Have Undergone Coronary Artery
Bypass Surgery in a Middle-Income Country: A Randomized Controlled Trial.
Source
Archives of Physical Medicine and Rehabilitation. (no pagination), 2021.
Date of Publication: 2021.
Author
Pakrad F.; Ahmadi F.; Grace S.L.; Oshvandi K.; Kazemnejad A.
Institution
(Pakrad, Ahmadi) Department of Nursing, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
(Grace) Faculty of Health, York University, Toronto, Canada
(Grace) KITE- Toronto Rehabilitation Institute, Peter Munk Cardiac Centre,
University Health Network, University of Toronto, Toronto, Canada
(Oshvandi) Department of Nursing, Faculty of Nursing and Midwifery,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Kazemnejad) Department of Biostatistics, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
Publisher
W.B. Saunders
Abstract
Objective: To compare traditional (1-month supervised) vs hybrid cardiac
rehabilitation (CR; usual care) with an additional 3 months offered
remotely based on the continuous care model (intervention) in patients who
have undergone coronary artery bypass graft (CABG). Design(s):
Randomized controlled trial, with blinded outcome assessment.
 Setting(s): A major heart center in a middle-income country.
 Participant(s): Of 107 eligible patients who were referred to CR
during the period of study, 82.2% (N=88) were enrolled (target sample
size). Participants were randomly assigned 1:1 (concealed; 44 per parallel
arm). There was 92.0% retention. Intervention(s): After CR,
participants were given a mobile application and communicated biweekly
with the nurse from months 1-4 to control risk factors. Main Outcome
Measure(s): Quality of life (QOL, Short Form-36, primary outcome);
functional capacity (treadmill test); and the Depression, Anxiety and
Stress Scale were evaluated pre-CR, after 1 month, and 3 months after CR
(end of intervention), as well as rehospitalization. Result(s): The
analysis of variance interaction effects for the physical and mental
component summary scores of QOL were <.001, favoring intervention (per
protocol); there were also significant increases from pre-CR to 1 month,
and from 1 month to the final assessment in the intervention arm (P<.001),
with change in the control arm only to 1 month. The effect sizes were
0.115 and 0.248, respectively. Similarly, the interaction effect for
functional capacity was significant (P<.001), with a clinically
significant 1.5 metabolic equivalent of task increase in the intervention
arm. There were trends for group effects for the psychosocial indicators,
with paired t tests revealing significant increases in each at both
assessment points in the intervention arm. At 4 months, there were 4
(10.3%) rehospitalizations in the control arm and none in intervention
(P=.049). Intended theoretical mechanisms were also affected by the
intervention. Conclusion(s): Extending CR in this accessible manner,
rendering it more comprehensive, was effective in improving
outcomes. Copyright © 2021

<89>
Accession Number
2014620351
Title
Nonautologous Grafts in Coronary Artery Bypass Surgery: A Systematic
Review.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Lampridis S.; George S.J.
Institution
(Lampridis, George) Bristol Medical School, University of Bristol,
Bristol, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Suitable autologous conduits may be lacking when performing
coronary artery bypass grafting. The aim of this review is to determine
the status of nonautologous grafts in coronary artery bypass grafting.
 Method(s): We conducted a literature search on MEDLINE All, Embase
Classic, and Embase through Ovid from 1960 to April 2020. Result(s):
Of the 1579 records identified, 21 studies were included in the review.
The following grafts were assessed for patency: 109 homologous saphenous
veins (patency rates ranged from 66.7% at a median follow-up of 8.5 months
to 0% at 6-12 months and 7-18 months, respectively), 29 expanded
polytetrafluoroethylene grafts (from 80% at a median follow-up of 5 months
to 14.3% at 45 months), 12 human umbilical veins (50% at a median
follow-up of 6 months), 50 Bioflow bovine internal mammary arteries (from
15.8% to 0% at a mean follow-up of 9.5 months and 19 months,
respectively), 39 Perma-Flow grafts (80% and 76.9% at 1-3 months and 12
months, respectively), 20 No-React bovine internal mammary arteries (57.1%
at a median follow-up of 28 months and 23.1% at a mean follow-up of 7
months), 40 autologous venous endothelial cell-seeded expanded
polytetrafluoroethylene grafts (94.7% and 81% at a mean follow-up of 27
months and 60 months, respectively), and 12 autologous venous endothelial
cell-seeded cryopreserved homologous veins (83.3% at a mean follow-up of
8.5 months). Conclusion(s): The goal of an alternative conduit with
patency and attributes that match those of autografts remains elusive.
Autologous endothelial cell-seeded synthetic grafts have demonstrated
promising results but require further investigation. Copyright ©
2021 The Society of Thoracic Surgeons

<90>
[Use Link to view the full text]
Accession Number
2014553208
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. (pp 906-914), 2021. Date of Publication: 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) Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United
States
(Tannenbaum) Department of Inflammation and Immunity, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, United States
(Tannenbaum) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Mao, Jia, Leung, Yilmaz, Ince, Duncan) Department of Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
(Soltesz) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, OH, United States
(Soltesz) Department of Cardiothoracic Anesthesia, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
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 (Pao<inf>2</inf>:Fio<inf>2</inf>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 (Pao<inf>2</inf>:Fio<inf>2</inf>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 Lippincott Williams and Wilkins. All
rights reserved.

<91>
Accession Number
2014470324
Title
Ten-year all-cause mortality following staged percutaneous
revascularization in patients with complex coronary artery disease.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Kawashima H.; Ono M.; Hara H.; de Winter R.J.; Holmes D.R.; Thuijs
D.J.F.M.; Milojevic M.; Garg S.; Serruys P.W.; Onuma Y.
Institution
(Kawashima, Ono, Hara, Serruys, Onuma) Department of Cardiology, National
University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for
Research and Imaging, Galway, Ireland
(Kawashima, Ono, Hara, de Winter) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Thuijs, Milojevic) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Serruys, Onuma) CURAM, the SFI Research Centre for Medical Devices,
Galway, Ireland
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Medical and/or economic reasons sometimes necessitate the
staging of percutaneous coronary intervention (SPCI) procedures in
patients with complex coronary artery disease; however, the impact of this
on very long-term outcomes is unknown. The aim of the present study is to
assess 10-year all-cause mortality in patients with the three-vessel
disease (3VD) and/or left main disease (LM) undergoing SPCI.
 Method(s): This is a sub-analysis of patients undergoing SPCI in the
SYNTAXES study, which investigated 10-year all-cause mortality in patients
with 3VD and/or LM in the randomized SYNTAX trial, beyond its original
5-year follow-up. An SPCI was allowed within 72 h or, if renal
insufficiency or contrast-induced nephropathy occurred, within 14 days of
the index procedure. Mortality was compared between patients having SPCI
versus those not having SPCI or undergoing CABG. PCI patients were further
stratified according to 3VD or LM. Result(s): In the SYNTAX PCI
population (overall: n = 903, 3VD: n = 546, LM: n = 357), 125 (13.8%)
patients underwent SPCI. Patients with SPCI had a higher 10-year mortality
compared to those who didn't (40.0% vs 26.6%; hazard ratio [HR] 1.69; 95%
confidence interval [CI] 1.23-2.32; p < 0.01) and those having CABG(40.0%
vs 24.5%; HR 1.85; 95%CI 1.35-2.53; p < 0.01). Patients having SPCI with
3VD (n = 103) or LM (n = 22) had higher mortality than respective patients
not having SPCI (3VD: 37.4% vs 27.1%; HR 1.52; 95%CI 1.05-2.21; p = 0.03
and LM: 51.8% vs 25.9%; HR 2.39; 95%CI 1.27-4.47; p = 0.01).
 Conclusion(s): At 10-year follow-up, SPCI was associated with higher
mortality than single-session PCI, so that CABG may be preferable if a
staged procedure is anticipated. Copyright © 2021 Elsevier Inc.

<92>
Accession Number
2007126824
Title
Effectiveness and safety of Suxiao Jiuxin pill in treating acute coronary
syndrome: a systematic review and Meta-analysis.
Source
Journal of Traditional Chinese Medicine. 40(4) (pp 518-529), 2020. Date of
Publication: 15 Aug 2020.
Author
Liu C.; Duan L.; Huang M.; Li J.; Xiong X.; Chen G.; He H.; Zhang Z.; Wang
J.
Institution
(Liu, Duan, Huang, Li, Xiong, Chen, He, Zhang, Wang) Department of
Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical
Sciences, Beijing 100053, China
(Liu, Duan, Huang, Chen, He) Graduate School, Beijing University of
Chinese Medicine, Beijing 100029, China
Publisher
Journal of Traditional Chinese Medicine
Abstract
OBJECTIVE: To evaluate the effectiveness and safety of Suxiao Jiuxin pill
(SX) in acute coronary syndrome (ACS) treatment. METHOD(S): An
extensive search of four English databases (Medline/PubMed, Cochrane
Library, Embase, and World Health Organization International Clinical
Trials Registration Platform) and four Chinese databases (Chinese National
Knowledge Infrastructure, Wanfang, China Science and Technology Journal,
and Chinese Biomedical Literature Service System) was performed.
Randomized, controlled trials (RCTs) involving SX combined with
conventional therapy versus conventional therapy were included. The
extracted data included populations, interventions, outcomes, and risk of
bias. The cardiovascular events served as the primary outcome. Review
Manager 5.3 software was used for data analysis. Relative risks (RRs) with
95% confidence intervals (CIs) were the effect measure. RESULT(S): A
total of eight RCTs with 979 patients were included. There were 559
patients with unstable angina (UA) in six RCTs and 420 patients with acute
myocardial infarction (AMI) in two RCTs. Our review showed that SX plus
conventional therapy might reduce the incidence of the total endpoint (RR:
0.34, 95% CI: 0.17, 0.68, P = 0.002), with no obvious adverse events (RR:
1.29, 95% CI: 0.60, 2.77, P = 0.52) compared with conventional therapy for
patients with UA. Additionally, SX plus conventional therapy also reduced
the incidence of the total endpoint (RR: 0.35, 95% CI: 0.18, 0.68, P =
0.002) compared with conventional therapy in patients with AMI. SX plus
conventional therapy also reduced the incidence of ventricular
fibrillation (RR: 0.23, 95% CI: 0.10, 0.57, P = 0.001) compared with
conventional therapy in patients with AMI. CONCLUSION(S): Our results
suggest that SX is beneficial for treating patients with UA or AMI.
However, our findings should be treated with caution because of the poor
methodological quality of the included trials. Therefore, more
multicenter, large-sample, high-quality RCTs are required to provide
high-quality evidence. Copyright © 2020 JTCM. All rights
reserved.

<93>
Accession Number
2007514220
Title
Pain relief and post-operative outcome in patients receiving tramadol via
thoracic epidural versus intravenous method in coronary artery bypass
graft surgery.
Source
Indian Journal of Forensic Medicine and Toxicology. 15(2) (pp 2620-2628),
2021. Date of Publication: April-June 2021.
Author
Mehta J.; Bhavsar M.; Thomas S.M.; Shah P.; Chauhan D.
Institution
(Mehta, Thomas, Shah, Chauhan) Department of Anaesthesiology, Smt.
B.K.Shah Medical Institute & Research Centre SumandeepVidyapeeth Deemed To
Be University, Piparia, Vadodara, Gujarat, India
(Bhavsar) Critical Care, Zydus Cancer Center, Ahmedabad, Gujarat, India
Publisher
Institute of Medico-Legal Publications
Abstract
Background & Objectives:Acute pain is common after cardiac surgery and can
keep patients from participating in activities that prevent postoperative
complications especially respiratory complications. Accurate assessment
and understanding of pain are vital for providing satisfactory pain
control and optimizing recovery. Our aim of the study was to compare pain
relief and post-operative outcome in patients receiving Tramadol via
Thoracic epidural versus intravenous method in coronary artery bypass
graft surgery. Methodology: Sixty patients aging 40-65 years posted for
off pump coronary artery bypass graft surgery were selected. They were
randomly assigned into two groups.Group IVA (n = 30) received Inj.
Tramadol (1 mg/kgiv)and Group TEA (n = 30) received Tramadol 0.5
mg/kgepidurallyhalf an hour before shifting in cardiac recovery room.
Hemodynamic parameters like Heart rate, systolic and diastolic blood
pressure, pulmonary artery pressure were recorder for 72 hours
postoperatively. We have compared extubation time in both the groups. Pain
was assessed by visual analogue scale (VAS). Any patients with the VAS
more than 4 were treated with rescue analgesic. Duration of analgesia and
total no. of rescue analgesia were recorded. Duration of stay in cardiac
recovery room and in hospital was also recorded. Observation & Results: We
have observed statistically significant difference in hemodynamic
parameters between two groups with better stability in TEA group from
shifting till next 72 hours. Extubation time was also earlier in TEA
group. Mean duration of analgesia and VAS score was also better TEA group.
All these led to shorter length of cardiac recovery stay and earlier
discharge from the hospital with less complication. Conclusion(s):
Thoracic epidural analgesia is better than intravenous technique in terms
of early extubation,maintaining hemodynamic stability and better
postoperative analgesia with reduced length of cardiac recovery and
hospital stay. Copyright © 2021, Institute of Medico-Legal
Publications. All rights reserved.

<94>
Accession Number
2007509201
Title
Risk Factors for Bleeding and Clinical Ineffectiveness Associated With
Clopidogrel Therapy: A Comprehensive Meta-Analysis.
Source
Clinical and Translational Science. 14(2) (pp 645-655), 2021. Date of
Publication: March 2021.
Author
Nguyen K.A.; Eadon M.T.; Yoo R.; Milway E.; Kenneally A.; Fekete K.; Oh
H.; Duong K.; Whipple E.C.; Schleyer T.K.
Institution
(Nguyen) College of Pharmacy, University of Florida, Gainesville, FL,
United States
(Nguyen, Schleyer) Regenstrief Institute, Indianapolis, IN, United States
(Eadon, Whipple, Schleyer) School of Medicine, Indiana University,
Indianapolis, IN, United States
(Yoo, Milway, Kenneally, Fekete, Oh, Duong) College of Pharmacy, Purdue
University, West Lafayette, IN, United States
Publisher
John Wiley and Sons Inc
Abstract
Although clopidogrel is a frequently used antiplatelet medication to treat
and prevent atherothrombotic disease, clinicians must balance its clinical
effectiveness with the potential side effect of bleeding. However, many
previous studies have evaluated beneficial and adverse factors separately.
The objective of our study was to perform a comprehensive meta-analysis of
studies of clopidogrel's clinical effectiveness and/or risk of bleeding in
order to identify and assess all reported risk factors, thus helping
clinicians to balance patient safety with drug efficacy. We analyzed
randomized controlled trials (RCTs) of maintenance use in four stages:
search for relevant primary articles; abstract and full article screening;
quality assessment and data extraction; and synthesis and data analysis.
Screening of 7,109 articles yielded 52 RCTs that met the inclusion
criteria. Twenty-seven risk factors were identified. "Definite risk
factors" were defined as those with aggregated odds ratios (ORs) > 1 and
confidence intervals (CIs) > 1 if analyzed in more than one study.
Definite risk factors for major bleeding were concomitant aspirin use (OR
2.83, 95% CI 2.04-3.94) and long duration of clopidogrel therapy (> 6
months) (OR 1.74, 95% CI 1.21-2.50). Dual antiplatelet therapy, extended
clopidogrel therapy, and high maintenance dose (150 mg/day) of clopidogrel
were definite risk factors for any bleeding. Reduced renal function, both
mild and severe, was the only definite risk factor for clinical
ineffectiveness. These findings can help clinicians predict the risks and
effectiveness of clopidogrel use for their patients and be used in
clinical decision support tools. Copyright © 2020 The Authors.
Clinical and Translational Science published by Wiley Periodicals LLC on
behalf of the American Society for Clinical Pharmacology and Therapeutics.

<95>
Accession Number
2007339890
Title
Donor heart preservation with hydrogen sulfide: A systematic review and
meta-analysis.
Source
International Journal of Molecular Sciences. 22(11) (no pagination), 2021.
Article Number: 5737. Date of Publication: 01 Jun 2021.
Author
Ertugrul I.A.; van Suylen V.; Damman K.; de Koning M.-S.L.Y.; van Goor H.;
Erasmus M.E.
Institution
(Ertugrul, van Suylen, Erasmus) University Medical Centre Groningen,
Department of Cardiothoracic Surgery, University of Groningen, Groningen
9700 RB, Netherlands
(Damman, de Koning) University Medical Centre Groningen, Department of
Cardiology, University of Groningen, Groningen 9700 RB, Netherlands
(van Goor) University Medical Centre Groningen, Department of Pathology
and Medical Biology, University of Groningen, Groningen 9700 RB,
Netherlands
Publisher
MDPI
Abstract
Preclinical studies have shown that postconditioning with hydrogen sulfide
(H<inf>2</inf>S) exerts cardioprotective effects against myocardial
ischemia-reperfusion injury (IRI). The aim of this study was to appraise
the current evidence of the cardioprotective effects of H<inf>2</inf>S
against IRI in order to explore the future implementation of
H<inf>2</inf>S in clinical cardiac transplantation. The current literature
on H<inf>2</inf>S postconditioning in the setting of global myocardial
ischemia was systematically reviewed and analyzed, performing
meta-analyses. A literature search of the electronic databases Medline,
Embase and Cinahl identified 1835 studies that were subjected to our
pre-defined inclusion criteria. Sixteen studies were considered eligible
for inclusion. Postconditioning with H<inf>2</inf>S showed significant
robust effects with regard to limiting infarct size (standardized mean
difference (SMD) = -4.12, 95% CI [-5.53--2.71], p < 0.00001). Furthermore,
H<inf>2</inf>S postconditioning consistently resulted in a significantly
lower release of cardiac injury markers, lower levels of oxidative stress
and improved cardiac function. Postconditioning with slow-releasing
H<inf>2</inf>S donors offers a valuable opportunity for novel therapies
within cardiac preservation for transplantation. Before clinical
implication, studies evaluating the long-term effects of H<inf>2</inf>S
treatment and effects of H<inf>2</inf>S treatment in large animal studies
are warranted. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<96>
Accession Number
2013035474
Title
Pharmacodynamic Effects of Pre-Hospital Administered Crushed Prasugrel in
Patients With ST-Segment Elevation Myocardial Infarction.
Source
JACC: Cardiovascular Interventions. 14(12) (pp 1323-1333), 2021. Date of
Publication: 28 Jun 2021.
Author
Vogel R.F.; Delewi R.; Angiolillo D.J.; Wilschut J.M.; Lemmert M.E.;
Diletti R.; van Vliet R.; van der Waarden N.W.P.L.; Nuis R.-J.; Paradies
V.; Alexopoulos D.; Zijlstra F.; Montalescot G.; Krucoff M.W.; van Mieghem
N.M.; Smits P.C.; Vlachojannis G.J.
Institution
(Vogel, Vlachojannis) Department of Cardiology, University Medical Center
Utrecht, Utrecht, Netherlands
(Delewi) Department of Cardiology, Amsterdam University Medical Center,
Amsterdam, Netherlands
(Angiolillo) Department of Cardiology, University of Florida College of
Medicine, Jacksonville, FL, United States
(Wilschut, Lemmert, Diletti, Nuis, Zijlstra, van Mieghem) Department of
Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
(Lemmert) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(van Vliet, Paradies, Smits, Vlachojannis) Department of Cardiology,
Maasstad Hospital, Rotterdam, Netherlands
(van der Waarden) Emergency Medical Service, AmbulanceZorg
Rotterdam-Rijnmond, Barendrecht, Netherlands
(Alexopoulos) Department of Cardiology, National and Kapodistrian
University of Athens Medical School, Attikon University Hospital, Athens,
Greece
(Montalescot) Department of Cardiology, ACTION Group, Groupe Hospitalier
Pitie-Salpetriere Hospital (Assistance Publique-Hopitaux de Paris),
Sorbonne University, Paris, France
(Krucoff) Department of Cardiology, Duke University Medical Center,
Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to compare the pharmacodynamic effects of
pre-hospitally administered P2Y<inf>12</inf> inhibitor prasugrel in
crushed versus integral tablet formulation in patients with ST-segment
elevation myocardial infarction (STEMI) undergoing primary percutaneous
coronary intervention (pPCI). Background(s): Early dual antiplatelet
therapy is recommended in STEMI patients. Yet, onset of oral
P2Y<inf>12</inf> inhibitor effect is delayed and varies according to
formulation administered. Method(s): The COMPARE CRUSH (Comparison of
Pre-hospital Crushed Versus Uncrushed Prasugrel Tablets in Patients With
STEMI Undergoing Primary Percutaneous Coronary Interventions) trial
randomized patients with suspected STEMI to crushed or integral prasugrel
60-mg loading dose in the ambulance. Pharmacodynamic measurements were
performed at 4 time points: before antiplatelet treatment, at the
beginning and end of pPCI, and 4 h after study treatment onset. The
primary endpoint was high platelet reactivity at the end of pPCI. The
secondary endpoint was impact of platelet reactivity status on markers of
coronary reperfusion. Result(s): A total of 441 patients were
included. In patients with crushed prasugrel, the occurrence of high
platelet reactivity at the end of pPCI was reduced by almost one-half
(crushed 34.7% vs. uncrushed 61.6%; odds ratio [OR] = 0.33; 95% confidence
interval [CI] = 0.22 to 0.50; p < 0.01). Platelet reactivity <150
P2Y<inf>12</inf> reactivity units at the beginning of coronary angiography
correlated with improved Thrombolysis In Myocardial Infarction flow grade
3 in the infarct artery pre-pPCI (OR: 1.78; 95% CI: 1.08 to 2.94; p =
0.02) but not ST-segment resolution (OR: 0.80; 95% CI: 0.48 to 1.34; p =
0.40). Conclusion(s): Oral administration of crushed compared with
integral prasugrel significantly improves platelet inhibition during the
acute phase in STEMI patients undergoing pPCI. However, a considerable
number of patients still exhibit inadequate platelet inhibition at the end
of pPCI, suggesting the need for alternative agents to bridge the gap in
platelet inhibition. Copyright © 2021 American College of
Cardiology Foundation

<97>
Accession Number
2011687025
Title
Establishing how social capital is studied in relation to cardiovascular
disease and identifying gaps for future research - A scoping review
protocol.
Source
PLoS ONE. 16(4 April) (no pagination), 2021. Article Number: e0249751.
Date of Publication: April 2021.
Author
Parker M.; Fang X.; Self-Brown S.R.; Rahimi A.
Institution
(Parker, Fang, Self-Brown) School of Public Health, Georgia State
University, Atlanta, GA, United States
(Rahimi) Cardiology, The Southeast Permanente Medical Group, Atlanta, GA,
United States
Publisher
Public Library of Science
Abstract
Introduction Though the relationship between social capital and health has
been widely studied, the evidence of this relationship in cardiovascular
disease is limited, with varied and inconsistent measures. This scoping
review seeks to address this gap by answering the following questions: (1)
How has social capital been characterized and measured in the literature
related to cardiovascular disease? and (2) What gaps exist in the
evaluation of the relationship between social capital and cardiovascular
disease? Materials and methods A scoping review will be used to answer the
research questions. The scoping review will apply established methods
described by Arksey and O'Malley, Levac and colleagues, and the Joanne
Briggs Institute: (1) identifying the research question(s); (2)
identifying relevant studies; (3) selecting the studies; (4) charting the
data; and (5) collating, summarizing, and reporting the results. Results
Our findings will be reported in accordance with the guidance provided in
the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Protocols (PRISMA-P) statement. Discussion The synthesis of this evidence
base is intended to provide a framework for how social capital has been
defined and measured in the cardiovascular literature, with additional
guidance for future research and evaluation. The findings will be
disseminated through peer-reviewed publication and presentations at
relevant seminars. Copyright © 2021 Parker et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<98>
Accession Number
2007589739
Title
Protective effects of N-acetyl cysteine on cardiac function in diabetic
patients undergoing coronary artery bypass grafting.
Source
Iranian Heart Journal. 22(2) (pp 96-100), 2021. Date of Publication: 2021.
Author
Salimbahrami A.R.; Yazdi A.H.; Afshar L.N.; Mohammadzade-Vizhe Z.;
Bakhshaei M.H.; Farhadian M.
Institution
(Salimbahrami, Yazdi, Afshar, Bakhshaei) Hamadan University of Medical
Sciences, Hamadan, Iran, Islamic Republic of
(Mohammadzade-Vizhe) Department of Anesthesia, Khatam-ol-Anbia Hospital of
Miane, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
(Farhadian) Department of Biostatics, School of Public Health and Research
Center for Health Sciences, Hamadan University of Medical Sciences,
Hamadan, Iran, Islamic Republic of
Publisher
Iranian Heart Association
Abstract
Background: The preservation of cardiac function in diabetic patients
undergoing coronary artery bypass grafting (CABG) would result in improved
prognoses in patients. Therefore, in this study, the protective effects of
N-acetyl cysteine (NAC) on cardiac function in diabetic patients
undergoing CABG were determined. Method(s): This triple-blind,
randomized, clinical trial study recruited 240 consecutive diabetic
patients undergoing CABG in a referral tertiary health-care center,
Hamadan, Iran. The patients were randomly assigned (simple random
sampling) to receive either NAC or a placebo. In both groups, ischemic
preconditioning was developed with a manometer cuff around the arm. The
cuff was filled up to 200 mm Hg for 5 minutes before it was emptied to 0
mm Hg for 5 minutes. This technique was repeated 3 times. Result(s):
The mean preoperative ejection fraction (EF) and the preoperative
myocardial performance index (MPI) were the same in the 2 groups (P>0.05).
The postoperative EF and the MPI were not significantly different between
the 2 groups (P>0.05). The trend of changes in the EF and the MPI was not
different between the groups (P>0.05). Conclusion(s): This study
demonstrated that NAC in the ischemic preconditioning method did not
create a significant effect compared with a placebo, which is in
congruence with previous studies in animal models. Copyright ©
2021, Iranian Heart Association. All rights reserved.

<99>
Accession Number
2007587899
Title
The effect of continuous nursing care program on anxiety level, episodes
of chest pain, and readmission rate after myocardial infarction: A
randomized controlled trial.
Source
International Cardiovascular Research Journal. 15(1) (pp 21-28), 2021.
Article Number: e113459. Date of Publication: 2021.
Author
Baghaei R.; Parizad N.; Sharifi A.; Alinejad V.
Institution
(Baghaei, Parizad) Patient Safety Research Center, Clinical Research
Institute, Nursing & Midwifery School, Urmia University of Medical
Sciences, Urmia, Iran, Islamic Republic of
(Sharifi) Department of Medical Surgical Nursing, Urmia University of
Medical Sciences, Urmia, Iran, Islamic Republic of
(Alinejad) Department of Biostatistics, Urmia University of Medical
Sciences, Urmia, Iran, Islamic Republic of
Publisher
Iranian Cardiovascular Research Journal
Abstract
Background: Chest pain, anxiety, and readmission are patients' adverse
outcomes after Myocardial Infarction (MI). Therefore, post-MI patients
require a proper care program to overcome these outcomes.
 Objective(s): This study aimed to determine the effect of a
continuous nursing care program on patients' anxiety level, episodes of
chest pain, and readmission rate after MI. Method(s): In this
randomized, controlled trial, 120 patients who met the inclusion criteria
were selected using convenience sampling. The patients were allocated into
the control (n = 60) and intervention (n = 60) groups using numbered
opaque sealed envelopes. A demographic information form and the
State-Trait Anxiety Inventory (STAI) were used to collect the data
(primary outcome). The patients in the intervention group received
education and practical rehabilitation exercises from the beginning of
hospitalization until 12 weeks after discharge. However, the control group
only received the routine care. Checklists were used to record the
episodes of chest pain and readmission rate (secondary outcomes). The data
were analyzed using the SPSS software, version 16.0. The data were
distributed normally based on the results of Shapiro-Wilk test. Hence,
they were analyzed using descriptive (mean, standard deviation, number,
and percentage) and inferential (independent t-test, paired t-test,
chi-square, Mann-Whitney U test, and Fisher's exact test) statistics.
 Result(s): The results revealed a significant reduction in the
readmission rate (P = 0.014) and episodes of chest pain (P = 0.025) in the
intervention group after the implementation of the continuous nursing care
program. The results also showed a significant difference between the two
groups regarding the mean scores of trait and state anxiety 12 weeks after
discharge (P = 0.001). Accordingly, anxiety levels reduced significantly
in the intervention group after the intervention (P = 0.001).
 Conclusion(s): This continuous nursing care program, as a low-cost
and non-pharmacological approach, played a vital role in caring for the
patients after MI and positively affected the patients' recovery. Hence,
this program could be used to improve post-MI outcomes in patients and
accelerate their recovery. Copyright © 2021, Iranian
Cardiovascular Research Journal. All rights reserved.

<100>
Accession Number
2013105258
Title
Comparative study of three techniques of repair for severe functional
tricuspid valve regurgitation.
Source
Systematic Reviews in Pharmacy. 11(8) (pp 779-784), 2020. Date of
Publication: 2020.
Author
Shafeek A.M.A.; Bary K.H.A.; Essa M.; Sobhy E.
Institution
(Shafeek, Bary, Essa, Sobhy) Zagazig University Hospitals, Egypt
Publisher
EManuscript Technologies
Abstract
Background: The optimal technique for repair of functional tricuspid valve
regurgitation (FTR) remains uncertain. Various modalities of
annuloplastyhave been used to repair such pathology, including rigid or
flexible rings (complete or incomplete), sutures, and bands. Aim of work:
The goal of this study was to compare the outcome of tricuspid valve (TV)
repair by pericardial band, Dacron band and Carpentier ring in patients
with left sided valve surgery. Patients & Methods: This study was
conducted from October 2016 to December 2019 and included 123 patients
with functionally severe tricuspid regurgitation secondary to left-sided
valve diseases (isolated mitral valve disease or combined mitral and
aortic valve disease).Those patients were operated at Zagazig University
Hospitals and Nasser Institute. We randomized patients into three groups
according to the method used for management of tricuspid regurgitation.
There were 41 patients in each group. Repair of TV was performed using
Carpentier-Edwards Physio Tricuspid annuloplasty ring in group (A), Dacron
band in group (B), and pericardial band in group (C). As, there was one
mortality in each group, only 40 patients were enrolled in statistical
analysis for each group. Result(s): There was no significant
difference between the three groups regarding the preoperative findings
including age, sex, BMI, NYHA functional class and preoperative
echocardiography findings. Duration of ward stay was longer in the
pericardial group. Postoperatively, there was significant reduction in the
mean pulmonary artery systolic pressure (PASP) and right ventricular
dimension in the three groups, and notably evident in group (A).
 Conclusion(s): Using semi-rigid (Carpentier-Edwards Physio Tricuspid
annuloplasty ring) or flexible ring (Dacron band) or pericardial strip are
good options in the repair of functional tricuspid valve regurgitation.
However, Carpentier ring placement is s consistent with improved RV
remodeling and is likely to improve the right ventricular efficiency and a
favorable result. Tricuspid valve (TV), Tricuspid regurgitation (TR),
Dacron band, pericardial band. Copyright © 2020 EManuscript
Technologies. All rights reserved.

<101>
Accession Number
2013732270
Title
Effect of continuous positive airway pressure associated to exercise on
the breathing pattern and heart rate variability of patients undergoing
coronary artery bypass grafting surgery: A randomized controlled trial.
Source
Brazilian Journal of Medical and Biological Research. 54(11) (no
pagination), 2021. Article Number: e10974. Date of Publication: 2021.
Author
Pantoni C.B.F.; Thommazo-Luporini L.D.; Mendes R.G.; Caruso F.C.R.;
Castello-Simoes V.; Mezzalira D.; Borghi-Silva A.
Institution
(Pantoni) Departamento de Gerontologia, Universidade Federal de Sao
Carlos, Sao Carlos, SP, Brazil
(Pantoni, Thommazo-Luporini, Mendes, Caruso, Castello-Simoes, Mezzalira,
Borghi-Silva) Departamento de Fisioterapia, Universidade Federal de Sao
Carlos, Sao Carlos, SP, Brazil
Publisher
Associacao Brasileira de Divulgacao Cientifica
Abstract
Continuous positive airway pressure (CPAP) has been used to improve gas
exchange and diaphragmatic function, among others benefits. Moreover, it
can be used to increase exercise tolerance and positively influence
ventilatory function and breathing pattern (BP) during exercise. However,
there is no information about the long-term effects of CPAP, as an adjunct
to an inpatient cardiac rehabilitation (CR) program, on BP and heart rate
variability (HRV) of patients after coronary artery bypass grafting
surgery (CABG). Twenty patients were allocated to receive, after
randomization, standard inpatient CR without CPAP (control group-CG) or CR
with CPAP between 10 to 12 cmH<inf>2</inf>O (CPAP group-CPG) associated
with the exercises. Participants were assessed preoperatively and on the
discharge day, in the sitting rest position. Outcome measurements included
BP variables, collected by respiratory inductive plethysmography, and HRV,
collected by polar precision performance. The CPG presented lower values
of percent rib cage inspiratory and expiratory contributions to tidal
volume (%RCi and %RCe) at discharge time, compared to CG. No statistical
differences between groups were observed for HRV variables and both groups
presented lower values of these indices, compared to preoperative ones. In
this context, the patients who received CPAP throughout the whole
rehabilitation program were discharged with a better BP, which could
indicate more synchronized breathing. CPAP did not influence cardiac
autonomic modulation in the long term. Copyright © 2021,
Associacao Brasileira de Divulgacao Cientifica. All rights reserved.

<102>
Accession Number
2013622969
Title
Dextran-based priming solution during cardiopulmonary bypass attenuates
renal tubular injury-A secondary analysis of randomized controlled trial
in adult cardiac surgery patients.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2021. Date of
Publication: 2021.
Author
Kolsrud O.; Barbu M.; Dellgren G.; Bjork K.; Corderfeldt A.; Thoren A.;
Jeppsson A.; Ricksten S.-E.
Institution
(Kolsrud, Dellgren, Bjork, Corderfeldt, Jeppsson) Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Kolsrud, Barbu, Dellgren, Jeppsson, Ricksten) Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Barbu) Department of Cardiology, Karlskrona Hospital, Karlskrona, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Thoren, Ricksten) Departments of Cardiothoracic Anesthesiology and
Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
John Wiley and Sons Inc
Abstract
Background: Acute kidney injury (AKI) is a well-known complication after
cardiac surgery and cardiopulmonary bypass (CPB). In the present secondary
analysis of a blinded randomized controlled trial, we evaluated the
effects of a colloid-based versus a conventional crystalloid-based prime
on tubular injury and postoperative renal function in patients undergoing
cardiac surgery with CPB. Method(s): Eighty-four adult patients
undergoing cardiac surgery with CPB were randomized to receive either a
crystalloid- or colloid- (dextran 40) based CPB priming solution. The
crystalloid solution was based on Ringer-Acetate plus mannitol. The
tubular injury biomarker, N-acetyl-b-D-glucosaminidase (NAG), serum
creatinine and diuresis were measured before, during and after CPB. The
incidence of AKI was assessed according to the KDIGO criteria.
 Result(s): The urinary-NAG/urinary-creatinine ratio rose in both
groups during and after CPB, with a more pronounced increase in the
crystalloid group (p =.038). One hour after CPB, the
urinary-NAG/urinary-creatinine ratio was 88% higher in the crystalloid
group (4.7 +/- 6.3 vs. 2.5 +/- 2.7, p =.045). Patients that received the
dextran 40-based priming solution had a significantly lower intraoperative
diuresis (p <.001) compared to the crystalloid group. The incidence of AKI
was 18% in the colloid and 22% in the crystalloid group (p =.66).
Postoperative serum creatinine did not differ between groups.
 Conclusion(s): In patients undergoing cardiac surgery with CPB,
colloid-based priming solution (dextran 40) induced less renal tubular
injury compared to a crystalloid-based priming solution. Whether a
colloid-based priming solution will improve renal outcome in high-risk
cardiac surgery, or not, needs to be evaluated in future studies on higher
risk cardiac surgery patients. Copyright © 2021 Acta
Anaesthesiologica Scandinavica Foundation

<103>
[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.

<104>
[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.

<105>
Accession Number
635866431
Title
Effect of Remote Ischemic Conditioning on Bleeding Complications in
Surgery: A Systematic Review and Meta-Analysis.
Source
Seminars in Thrombosis and Hemostasis. (no pagination), 2021. Date of
Publication: 2021.
Author
Krag A.E.; Hvas C.L.; Kiil B.J.; Hvas A.-M.
Institution
(Krag, Hvas) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens
Boulevard 99, Aarhus N DK-8200, Denmark
(Krag, Hvas) Department of Clinical Medicine, Aarhus University, Aarhus,
Denmark
(Krag, Kiil) Department of Plastic and Breast Surgery, Aarhus University
Hospital, Denmark
(Hvas) Department of Anesthesiology and Intensive Care, Aarhus University
Hospital, Denmark
Publisher
Thieme Medical Publishers, Inc.
Abstract
Remote ischemic conditioning (RIC) is administered with an inflatable
tourniquet by inducing brief, alternating cycles of limb ischemia and
reperfusion. RIC possibly impacts the hemostatic system, and the
intervention has been tested as protective therapy against
ischemia-reperfusion injury and thrombotic complications in cardiac
surgery and other surgical procedures. In the present systematic review,
we aimed to investigate the effect of RIC on intraoperative and
postoperative bleeding complications in meta-analyses of randomized
controlled trials including adult patients undergoing surgery. A
systematic search was performed on November 7, 2020 in PubMed, Embase, and
the Cochrane Central Register of Controlled Trials. Randomized controlled
trials comparing RIC versus no RIC in adult patients undergoing surgery
that reported bleeding outcomes in English publications were included.
Effect estimates with 95% confidence intervals were calculated using the
random-effects model for intraoperative and postoperative bleeding
outcomes. Thirty-two randomized controlled trials with 3,804 patients were
eligible for inclusion. RIC did not affect intraoperative bleeding volume
(nine trials; 392 RIC patients, 399 controls) with the effect estimate
-0.95 [-9.90; 7.99] mL (p = 0.83). RIC significantly reduced postoperative
drainage volume (seven trials; 367 RIC patients, 365 controls) with mean
difference -83.6 [-134.9; -32.4] mL (p = 0.001). The risk of re-operation
for bleeding was reduced in the RIC group (16 trials; 838 RIC patients,
839 controls), albeit not significantly, with the relative risk 0.65
[0.39; 1.09] (p = 0.10). In conclusion, RIC reduced postoperative bleeding
measured by postoperative drainage volume in this meta-analysis of adult
patients undergoing surgery. Copyright © 2021 American Medical
Association. All rights reserved.

<106>
Accession Number
634316525
Title
Effects of Dexmedetomidine on Perioperative Stress Response and Cellular
Immunity in Elderly Patients with Posterior Lumbar Surgery.
Source
Nano LIFE. 11(3) (no pagination), 2021. Article Number: 2140001. Date of
Publication: 01 Sep 2021.
Author
Lin M.; Wang X.; Liu X.; Zhang H.; Liu S.; Huang C.
Institution
(Huang, Wang, Zhang, Liu) Department of Anesthesia, Zhabei District Centre
Hospital of Shanghai, 619 Zhonghuaxin Rd, Shanghai 200070, China
(Lin) Department of Anesthesia, People's Hospital of Suzhou New District,
95 Huashan Rd, Suzhou 215163, China
(Liu) Department of Spine Surgery, Zhabei District Centre Hospital of
Shanghai, 619 Zhonghuaxin Rd, Shanghai 200070, China
(Huang) Department of General Surgery, Huadong Hospital Affiliated to
Fudan University, 221 Yan'an West Rd, Shanghai 200040, China
Publisher
World Scientific
Abstract
The aim of this study was to investigate the effects of dexmedetomidine on
perioperative stress response and cellular immunity in elderly patients
with posterior lumbar surgery. Sixty patients with lumbar degenerative
disease requiring posterior lumbar surgery were included and randomly
divided into the dexmedetomidine group (the test group, n=30) and the
control group (n=30). After the experimental group entered the room,
dexmedetomidine was intravenously pumped 10min before induction of
anesthesia and dexmedetomidine was continuously pumped after anesthesia.
The control group replaced dexmedetomidine with the same amount of normal
saline, and the other operations were exactly the same as the experimental
group. Hemodynamic parameters were routinely monitored and the percentages
of T lymphocyte subsets were analyzed by flow cytometry. Samples for
stress response parameters were sent to the Clinical Laboratory of our
hospital, and perioperative pain, postoperative adverse reactions and
complications were evaluated during the study. The levels of postoperative
stress hormones, including noradrenaline (NE), epinephrine (E), cortisol
(Cor) and acetylcholine (Ach), were reduced in the test group compared
with those in the control group (P<0.05). Proportions of CD3+, CD4+, CD8+
and NK as well as the CD4+/CD8+ in the control group were significantly
decreased at postoperative Day 1 (T6), Day 3 (T7) and Day 7 (T8) compared
with those at preoperative Day 1 (T-1) (P<0.05), while the proportions of
CD4+ and NK in the test group were significantly increased at T6, T7 and
T8 compared with those at T-1 (P<0.05). The mean arterial pressure (MAP)
of the test group was decreased compared with that of the control group at
each time point (P<0.05). After the operation, the heart rate (HR) of the
patients in the test group was significantly decreased compared with the
control group (P<0.05) and the VAS score of the control group were
increased compared with the test group at each time point (P<0.05).
Dexmedetomidine can decrease the stress response and improve postoperative
cellular immune function in patients with posterior lumbar surgery by
reducing postoperative stress hormones to alleviate the postoperative
cellular immunosuppression and the pain in patients. Copyright ©
2021 World Scientific Publishing Company.

<107>
Accession Number
632570384
Title
Influence of Valve Type and Antiplatelet Regimen on Platelet Reactivity
After TAVI: Subanalysis of the REAC-TAVI Trial.
Source
The Journal of invasive cardiology. 32(12) (pp 446-452), 2020. Date of
Publication: 01 Dec 2020.
Author
Trejo-Velasco B.; Cruz-Gonzalez I.; Tello-Montoliu A.; Baz-Alonso J.A.;
Salvadores P.J.; Moreno R.; Romaguera R.; Molina-Navarro E.; Paredes-Galan
E.; De-Miguel-Castro A.; Bastos-Fernandez G.; Ortiz-Saez A.;
Fernandez-Barbeira S.; Iniguez-Romo A.; Jimenez-Diaz V.A.
Institution
(Jimenez-Diaz) Cardiovascular Research Unit & Cardiology Department,
Hospital Alvaro Cunqueiro, University Hospital of Vigo, Estrada de Clara
Campoamor, 341, 36312, Vigo, Spain. sooner_79@hotmail.com or
victor.alfonso.jimenez.diaz@sergas.es
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Ticagrelor has proven more effective than clopidogrel at
attaining a maintained suppression of high platelet reactivity (HPR) in
aortic stenosis patients undergoing transcatheter aortic valve
implantation (TAVI). This study aims to assess the influence of implanted
valve type on the degree of platelet reactivity (PR) after TAVI.
 METHOD(S): This study is a prespecified analysis of REAC-TAVI, a
prospective, multicenter study that included patients on dual-antiplatelet
therapy with aspirin and clopidogrel before TAVI. Patients with HPR (n =
48) were randomized to aspirin and clopidogrel or aspirin and ticagrelor
for 3 months, while those without HPR (n = 20) were continued on aspirin
and clopidogrel. PR was measured 6 hours, 24 hours, 5 days, 30 days, and
90 days after TAVI with VerifyNow assay. Bioprosthetic valves were
classified as balloon-expandable valve (BEV), self-expandable valve (SEV),
or other. RESULT(S): Sixty-eight patients comprising 32 BEVs, 28
SEVs, and 8 other valves were included. Devices were larger and
postdilation was more frequent in the SEV group. Follow-up PR was lower in
patients treated with ticagrelor vs those treated with clopidogrel at all
time points after TAVI, including patients without baseline HPR (P<.001).
PR after TAVI was similar in the three groups. Major cardiovascular
adverse events, stroke, and hemorrhagic complications were comparable
across the different bioprosthesis groups at 4-month follow-up.
 CONCLUSION(S): The effect of valve type on PR after TAVI is similar
across the spectrum of most transcatheter valves. In our sample,
ticagrelor achieved a faster and more effective reduction in PR than
clopidogrel in patients with HPR undergoing TAVI, irrespective of valve
type.

<108>
Accession Number
632956813
Title
A Randomized Controlled Trial of Prasugrel for Prevention of Early
Saphenous Vein Graft Thrombosis.
Source
The Journal of invasive cardiology. 32(12) (pp E305-E312), 2020. Date of
Publication: 01 Dec 2020.
Author
Danek B.A.; Karatasakis A.; Abdullah K.; Iwnetu R.; Kalsaria P.; Shunk K.;
Zimmet J.; Vidovich M.; Bavry A.A.; Rangan B.V.; Roesle M.; Griza D.;
Stanley K.; Banerjee S.; Khalili H.; Brilakis E.S.; Abdullah S.M.
Institution
(Abdullah) Shuaib Abdullah, MD, Veterans Affairs North Texas Health Care
System, 4500 South Lancaster, 111A, Dallas, TX 75216 USA
Publisher
NLM (Medline)
Abstract
OBJECTIVES: To test whether administration of prasugrel after coronary
artery bypass grafting (CABG) reduces saphenous vein graft (SVG)
thrombosis. Use of aspirin after CABG improves graft patency, but
administration of other antiplatelet agents has yielded equivocal results.
 METHOD(S): We performed a double-blind trial randomizing patients to
prasugrel or placebo after CABG at four United States centers. Almost all
patients were receiving aspirin. Follow-up angiography, optical coherence
tomography (OCT), intravascular ultrasound (IVUS), and near-infrared
spectroscopy (NIRS) were performed at 12 months. The primary efficacy
endpoint was prevalence of OCT-detected SVG thrombus. The primary safety
endpoint was incidence of Global Utilization of Streptokinase and t-PA for
Occluded Coronary Arteries (GUSTO) severe bleeding. RESULT(S): The
study was stopped early due to slow enrollment after randomizing 84
patients. Mean age was 64 +/- 6 years; 98% of the patients were men.
Follow-up angiography was performed in 59 patients. IVUS was performed in
52 patients, OCT in 53 patients, and NIRS in 33 patients. Thrombus was
identified by OCT in 56% vs 50% of patients in the prasugrel vs placebo
groups, respectively (P=.78). Angiographic SVG failure occurred in 24% of
patients in the prasugrel arm vs 40% in the placebo arm (P=.19). The
1-year incidence of major adverse cardiovascular events was 14.3% vs 2.4%
in the prasugrel and placebo groups, respectively (P=.20), without
significant differences in GUSTO severe bleeding (P=.32).
 CONCLUSION(S): Early SVG failure occurred in approximately one-third
of patients. Prasugrel did not decrease prevalence of SVG thrombus 12
months after CABG.

<109>
Accession Number
635976680
Title
Clinical impact of age in patients with severe aortic stenosis underwent
wih Transcatheter Aortic Valve Replacement.
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 83), 2021.
Date of Publication: September 2021.
Author
Munoz-Garcia M.; Munoz-Garcia E.; Antonio Jesus Munoz Garcia A.J.;
Dominguez-Franco A.J.; Jimenez-Navarro M.F.; Garcia-Pinilla J.M.;
Alonso-Briales J.H.; Hernandez-Garcia J.M.; Gomez-Doblas J.J.
Institution
(Munoz-Garcia, Munoz-Garcia, Antonio Jesus Munoz Garcia, Dominguez-Franco,
Jimenez-Navarro, Garcia-Pinilla, Alonso-Briales, Hernandez-Garcia,
Gomez-Doblas) University Hospital Virgen De la Victoria, Department of
Cardiology, Malaga, Spain
Publisher
John Wiley and Sons Ltd
Abstract
Transcatheter Aortic Valve Replacement (TAVR) is considered the treatment
in patients older or at high or intermediate risk. Results form
contemporary randomized trials in low-risk patients will likely broaden
the indication of TAVR, but the data regarding long-term are limited by
older population. The objetive of this study was to evaluate the survival
and the factors predicting mortality after TAVR in according to age.
 Method(s): From April 2008 to December 2018, the CoreValve and
Sapiens prostheses were implanted in 765 patients with symptomatic severe
aortic stenosis with deemed high risk on base to age,<80 years and >= 80
years old. The rate of acute complications was defined by the combined
endpoint of death, vascular complications, myocardial infarction, majopr
bleeding or stroke. Result(s): The mean age in patients<80 compared
with >= 80 years, was 73.69+/-6.5 vs. 83.4+/-2.1 years and the logistic
EuroSCORE and STS score were 15.9+/-11% vs. 18+/-11%, 4.8+/-3 vs. 6.3+/-4,
p> 0.001, respectively In-hospital mortality was 4% vs. 3.4%, p = 0.404,
and the rate of acute complications was 19.6 vs. 16.5%, p = 0.168. The
late mortality (beyond 30 days) was 36.9 vs. 35.2%, p = 0.352.When
compared in both groups, there were no differences for the presence of
threatening bleeding 3.4% vs. 3.2% (HR = 1.028 [IC95% 0.722-1.463], p =
0.516), myocardial infarction 4% vs. 2.5% (HR = 1.263 [IC95% 0.814-1.960],
p = 0.167), stroke 8% vs. 9.1% (HR = 1.149 [IC95% 0.686-1.925], p = 0.347)
and acute kidney innjury 14.1% vs. 19.1% (HR=0.1.14 [IC95% 0.969-2.141], p
= 0.071) and there was difference in between groups in hospitalizations
for heart failure 14.6% vs. 7.9% (HR = 1.398 [IC95% 1.075-1.817], p =
0.008. Survival at 1, 3, and 5were similar in both groups (88% vs. 89.5%,
73.3 vs. 78.2%, 58.8 vs. 62.6%, log Rank 0.992, p = 0.319), respectively,
after a mean follow-up of 42.3+/-27 months. The main predictors of
cumulative mortality in young patients were: Charlson index [HR 1.18 (95%
CI 1.06-1.30), p = 0.001], Acute Kidney Injury [HR 2.21 (95% CI
1.42-3.47), p = 0.001], Left ventricular ejection fraction [HR 1.02 (95%
CI 1.009-1.035), p = 0.001], and protective factor was a higher Karnosfky
index [HR 0.98 (95% CI 0.97-0.99) p = 0.006]. And in older patients were:
Frailty [HR 1.67 (95% CI 1.13-2.47), p = 0.010], COPD [HR 2.09 (95% CI
1.41-2.91), p = 0.001], Stroke [HR 3.01 (95% CI 1.54-5.89), p = 0.001]
Charlson index [HR 1.14 (95% CI 1.02-1.27), p = 0.015], Acute Kidney
Injury [HR 1.57 (95% CI 1.06-2.32), p = 0.001. Conclusion(s): TAVR is
associated with low complications rate in young and older patients.
Survival during follow-up was similar in both groups, but the predictive
factors of mortality differ, with greater impact on the comorbidtiy in the
elderly patients.

<110>
Accession Number
635975824
Title
Does atrial fibrillation adds discriminatory value for patients with
advanced heart failure with reduced ejection fraction?.
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 53), 2021.
Date of Publication: September 2021.
Author
Francisco Albuquerque F.; Gama F.; Freitas P.; Aguiar C.; Ferreira J.;
Lopes P.M.; Presume J.; Ventosa A.; Tralhao A.; Strong C.; Brizido C.;
Durazzo A.; Trabulo M.; Mendes M.
Institution
(Francisco Albuquerque, Gama, Freitas, Aguiar, Ferreira, Lopes, Presume,
Ventosa, Tralhao, Strong, Brizido, Durazzo, Trabulo, Mendes) Hospital
Santa Cruz, Carnaxide, Portugal
Publisher
John Wiley and Sons Ltd
Abstract
Background: and aim: To predict morbidity and mortality in ambulatory
heart failure patients is an essential step to determine prognosis and
guide listing for transplantation. Heart failure survival scores, when
taken together with other criteria, are important tools in this context.
The occurrence of atrial fibrillation (AF) in this population has been
associated to worse prognosis, although it is not considered in current
survival scores. We evaluated whether AF adds prognostic information to
four contemporary HF scores. Method(s): Single-centre retrospective
cohort study of consecutive HFrEF patients undergoing cardiopulmonary
exercise test (CPET) for functional and prognostic assessment from October
1996 till May 2018. The Heart Failure Survival Score (HFSS), Seattle Heart
Failure Model (SHFM), Meta-analysis Global Group in Chronic Heart Failure
(MAGGIC) and Metabolic Exercise Cardiac Kidney Index (MECKI) were
calculated for each patient. Primary endpoint was all cause mortality or
urgent transplant (whichever came first within 2 years of follow-up).
Cox-regression and ROC curve comparison analyses were performed to assess
the added discriminative power of AF on top of each score. Result(s):
Overall, 387 patients were included in the analysis, median age 58 (IQR 49
- 65) years, and 77% were male. Ischemic heart disease was the most common
aetiology for HFrEF (54%). Median peak oxygen consumption was 15.7
mL/kg/min (IQR 12.8 - 20.0). AF was present in 47 (12.1%) patients. Over
the 2-year follow-up period, 48 patients died, and 52 underwent heart
transplantation (of which 25 were urgent). HFSS showed the weakest
(c-statistic 0.581; 95% [CI] 0.54-0.71) and MECKI score the strongest
(c-statistic 0.848; 95% [CI] 0.76-0.88) discriminatory ability for the
outcome. Adding the occurrence of AF to the MAGGIC and HFSS improved their
prognostic ability, although it did not reach statistical significance.
(see Table 1). In contrast, adding AF on top of the Mecki score
significantly reduced its prognostic ability (p <0.001).
 Conclusion(s): Adding AF on top of current available heart failure
survival prognosis scores did not improve their prognostic ability and
might even prejudice their use. Correctly listing patients for heart
transplant is a crucial step in the management of this population and
further studies are needed to refine objective criteria to help clinicians
in decision making. (Table Presented).

<111>
Accession Number
635975820
Title
The utility of ambulatory ECG monitoring in the detection of arrhythmias
in peripartum cardiomyopathy (PPCM).
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 281), 2021.
Date of Publication: September 2021.
Author
Charle Andre Viljoen C.A.; Hoevelmann J.; Chin A.; Briton O.; Sliwa K.
Institution
(Charle Andre Viljoen, Chin) University of Cape Town, Division of
Cardiology, Cape Town, South Africa
(Hoevelmann, Briton, Sliwa) University of Cape Town, Hatter Institute for
Cardiovascular Research in Africa, Cape Town, South Africa
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Peripartum cardiomyopathy (PPCM) is a form of dilated
cardiomyopathy that occurs within the lastmonths of pregnancy or up to
fivemonths postpartum. Previous studies have shown that up to 30% of
deaths in PPCM are related to sudden cardiac death (SCD). However, little
is known about the burden of arrythmias in PPCM and their contribution to
SCD. Purpose(s): We aimed to compare implantable loop recorder (ILR)
plus 24-hour Holter monitoring to 24-hour Holter monitoring alone to
assess its utility in the detection of arrhythmias in PPCM.
 Method(s): In this single-centre, prospective clinical trial, 20
consecutive patients with PPCM were randomized to either standard care (SC
cohort: ECG &24-hour Holter) or SC plus ILR (SC-ILR cohort: ECG, 24-hour
Holter, ILR). Follow-up included the first six months after ILR
implantation. Result(s): The median age of this cohort was 31.7 years
with a parity of 2 (IQR 1-4). They presented with a median left
ventricular ejection fraction (LVEF) of 28% (IQR 24-35) and LVEDD of 60mm
(IQR 55-66). The 12-lead ECG recorded sinus tachycardia in half of the
patients, with median heart rate of 90bpm (IQR 79-106) compared to 94.5bpm
(IQR 85-99) on 24h-Holter-monitoring. The median QTc-interval was 464ms
(IQR 424-494). Ambulatory ECG monitoring detected major arrhythmias in
three women (one in SC cohort, two in SC-ILR cohort). One patient (5%)
died shortly after ILR implantation. Her ILR detected sinus arrest with an
escape rhythm (figure 1A) that failed and resulted in an out of hospital
cardiac arrest. Non-sustained ventricular tachycardia (nsVT) occurred in
two women (10%), one of which was detected by Holter monitoring and the
other on ILR (figure 1B, 1C). Both women presented with acute heart
failure with severely impaired systolic function (LVEF 12% and 21%
respectively). One of these patients had persistent LV systolic
dysfunction despite optimal medical therapy and received an implantable
cardioverter-defibrillator (ICD). The other patient had intractable heart
failure requiring recurrent intensive-care treatment and underwent heart
transplantation. There was no atrial fibrillation or atrioventricular
block detected in any patient by ECG, Holter or ILR monitoring throughout
the study period. Conclusion(s): This study on ambulatory ECG
monitoring in PPCM showed a high prevalence of potentially fatal
arrhythmias, which occurred predominantly in the acute phase of the
disease. One patient had sinus arrest and asystole detected by ILR as the
terminal arrhythmia. Both Holter monitoring and ILR played an important
role in ventricular arrhythmia detection, which in two cases had a direct
influence on clinical decision making. ILR is more effective than 24-hour
Holter monitoring in paroxysmal arrhythmia detection because of extended
monitoring.

<112>
Accession Number
635975783
Title
Recalibrating the MECKI score in a Portuguese population.
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 69), 2021.
Date of Publication: September 2021.
Author
Sergio Maltes S.; Maltes S.; Freitas P.N.; Rocha B.M.L.; Cunha G.J.L.;
Brizido C.; Strong C.; Tralhao A.; Ventosa A.; Aguiar C.T.; Mendes M.
Institution
(Sergio Maltes, Maltes, Freitas, Rocha, Cunha, Brizido, Strong, Tralhao,
Ventosa, Aguiar, Mendes) Hospital Santa Cruz, Lisbon, Portugal
Publisher
John Wiley and Sons Ltd
Abstract
Background: Recalibration is often needed when applying new models to
external populations where: patient characteristics might be different.
Risk assessment in the setting of advanced heart failure (HF) is
particularly troublesome since critical decisions are often based on these
models. The purpose of this study was to assess the performance of 4
different HF prognostic scores, and recalibrate the risk predictions of
the best one in a Portuguese cohort. Methodology: This is a single-center
retrospective cohort of HF patients with reduced left ventricle ejection
fraction (LVEF<40%) undergoing cardiopulmonary exercise testing (CPET)
between 2003 and 2018. Patients were excluded if they performed a
suboptimal CPET (defined by a respiratory exchange ratio <1.10). The Heart
Failure Survival Score (HFSS), Seattle Heart Failure Model (SHFM),
Meta-analysis Global Group in Chronic Heart Failure (MAGGIC), and
Metabolic Exercise Cardiac Kidney Index (MECKI) were assessed for the
discrimination ability (area under the ROC curve) to predict a combined
endpoint of cardiovascular death or urgent Heart Transplantation (HTx) at
2-years. Calibration analysis was conducted, and logistical recalibration
performed as needed. Result(s): A total of 251 patients (mean age
57+/-12 years; 79% male; 53% with ischemic HF) were included. Mean LVEF
was 28+/-6%. Over a 2-year follow-up period after CPET, 24 cardiovascular
deaths occurred and 16 patients received an urgent HTx. There were no
urgent LVADs implanted used in our population. The original MECKI score
showed the best discrimination ability to predict 2-year risk of
cardiovascular death or urgent HTx (AUC 0.83; 95%CI 0.76 to 0.89; P<0.001)
- see figure panel A. However, the original MECKI score tended to
overestimate event occurence (overall miscalibration of 16.1%), especially
in the highest risk subgroups - see figure panel B. After recalibration -
see figure panel C - miscalibration diminished to 0.2%, allowing a more
accurate prediction of CV death or urgent HTx at 2-years.
 Conclusion(s): The MECKI score showed the best discriminative ability
to predict CV death or: urgent HTx at 2-years, but significantly
overestimated the risk of events. This overestimation was corrected by
recalibrating the model for our population. The newly calibrated MECKI
score might prove useful for guiding decisions in Portuguese patients with
advanced HF. (Table Presented).

<113>
Accession Number
635975698
Title
2-year outcomes for transcatheter repair in patients with functional
mitral regurgitation from the CLASP study.
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 242), 2021.
Date of Publication: September 2021.
Author
Kourkoveli P.; Mazimba S.; Hage A.; Goldschmidt M.; Simmons L.; Moe G.;
Cowger J.; Mishkin J.; Marcoff L.; Toma M.; Grayburn P.
Institution
(Kourkoveli) Hygeia Hospital, Athens, Greece
(Mazimba) University Of Virginia Health System, Cardiovascular Medicine,
Charlottesville, United States
(Hage) Cedars-Sinai Medical Center, Cardiology, Los Angeles, United States
(Goldschmidt, Marcoff) Morristown Medical Center, Cardiology, Morristown,
United States
(Simmons) Royal Prince Alfred Hospital, Cardiology, Camperdown, Australia
(Moe) St. Michael's Hospital, Cardiology, Toronto, Canada
(Cowger) Henry Ford Hospital, Cardiology, Detroit, United States
(Mishkin) Sanger Heart and Vascular Institute, Cardiology, Charlotte,
United States
(Toma) St Paul's Hospital, Cardiology, Vancouver, Canada
(Grayburn) Baylor Scott and White The Heart Hospital, Cardiovascular
Disease, Plano, United States
Publisher
John Wiley and Sons Ltd
Abstract
Background: Transcatheter mitral valve repair has emerged as a favourable
option in patient care for treating functional mitral regurgitation (FMR)
with a need for longer term data. We herein report two-year outcomes from
the FMR group of the multicentre, prospective, single arm CLASP study with
the PASCAL transcatheter valve repair system. Method(s): Patients
with symptomatic, clinically significant FMR >=3+ as evaluated by the core
laboratory and deemed candidates for transcatheter repair by the local
heart team were eligible for the study. Follow-up was conducted at 30
days, one year, and two years with echocardiographic outcomes evaluated by
the core laboratory at all timepoints and major adverse events (MAEs)
evaluated by an independent clinical events committee to one year
(site-reported thereafter). Result(s): Eighty-five FMR patients were
treated with mean age 72 years, 55% male, 65% in NYHA Class III-IVa, 37%
LVEF, and 100% MR grade >=3+. Successful implantation was achieved in 96%
of patients. MAEs included one cardiovascular mortality (1.2%) and one
conversion tomitral valve replacement surgery (1.2%) at 30 days, and two
reinterventions between 30 days and two years. Kaplan-Meier (KM) estimates
for survival were 88% at one year and 72% at two years. Freedom from heart
failure (HF) rehospitalization KM estimates were 81% at one year and 78%
for two years. The reduction in annualized HF hospitalization rate was 81%
at two years (p<0.001). MR <=1+ was achieved in 73% of patients at 30
days, 75% at one year, and 84% at two years; MR <=2+ was achieved in 96%
of patients at 30 days, 100% at one year, and 95% two years (all p<0.001).
Mean LVEDV of 199 mL at baseline decreased by 9 mL at 30 days (p=0.039),
29 mL at one year (p<0.001), and 31 mL at two years (p<0.001). NYHA class
I/II was achieved in 87% of patients at 30 days, 86% at one year, and 88%
at two years (all p<0.001). Six-minute walk distance (6MWD) improved by 22
m at 30 days (p=0.004) and 40 m at one year (p=0.003). Kansas City
Cardiomyopathy Questionnaire (KCCQ) score improved by 16 points at 30 days
and one year (all p<0.001). Conclusion(s): In the CLASP study, the
PASCAL transcatheter valve repair system demonstrated sustained favourable
outcomes at two years in patients with FMR. Results showed a high survival
rate of 72% and freedom from HF rehospitalization of 78% at two years. An
81% reduction in annualized HF hospitalization rate was observed. At two
years, sustained MR reduction of MR <=2+ was achieved in 95% andMR <=1+ in
84% of patients, with evidence of left ventricular reverse remodelling.
Improvements in functional status were significant and sustained at two
years. The CLASP IIF randomized pivotal trial is ongoing.

<114>
Accession Number
635975570
Title
Mitraclip implantation or surgical treatment for secondary mitral
regurgitation: How different are these populations?.
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 238), 2021.
Date of Publication: September 2021.
Author
Jose Miguel Viegas J.M.; Reis J.P.; Morais L.A.; Branco L.M.; Galrinho A.;
Fiarresga A.; Cacela D.; Rodrigues C.; Cerejo R.; Rodrigues R.; Fragata
J.; Ferreira R.C.
Institution
(Jose Miguel Viegas, Reis, Morais, Branco, Galrinho, Fiarresga, Cacela,
Rodrigues, Cerejo, Rodrigues, Fragata, Ferreira) Hospital De Santa Marta,
Lisbon, Portugal
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: There is limited data regarding the best intervention for
severe secondary mitral regurgitation (MR). Percutaneous edge-to-edge
repair is emerging as a feasible alternative to conventional surgery.
Patient selection is often controversial. Objective(s): To
characterize and compare the demographic, clinical and echocardiographic
characteristics of patients (P) with secondary MR submitted to surgery or
Mitraclip implantation (MI). Method(s): Retrospective analysis of all
P admitted between 2013 and 2019 for mitral valve (MV) intervention,
either MI or surgery, in a single tertiary care centre. Categorical
variables were compared with the use of Fisher's exact test or the
chi-square test, as appropriate. Continuous variables were compared with
the use of Student's t-test. Result(s): From 87 patients (P) with
secondary MR admitted for mitral valve intervention, MI was performed in
46P (53%). In the surgery group (41P), 29% underwent MV repair and 71% MV
replacement. Atrial fibrillation was more frequent in MI population (29%
versus 63%, p= 0.002) as well as previous cardiac surgery (12% versus 30%,
p= 0.040). There were no differences regarding age, gender or
cardiovascular risk factors. P enrolled to surgery had more frequently
ischemic etiology (71% versus 39%, p= 0.003). Median Euroscore II was
lower in surgery P (3.2 versus 5.9, p=0.008). Regarding echocardiographic
parameters, MI P had higher LV end-diastolic diameter (58.7+/-7.6 versus
67.4+/-10.7, p= 0.001) and LV end-systolic diameter (39.4+/-7.8 versus
51.1+/-13.6, p<0.001). No differences in left atrial diameter or pulmonary
artery systolic pressure were noticed. MI P had a baseline left ventricle
ejection fraction <30 in 35%, 30-50% in 52% and >50% in 13%, whereas in
surgery P it was 10%, 32% and 59%, respectively, which denotes a
significant difference between groups (p<0.001). Conclusion(s): P
undergoing MI had higher median Euroscore II and LV dimensions. Surgical
P, despite having more frequently ischemic etiology, had better LVEF.
Further large randomized trials are necessary in this area.

<115>
Accession Number
635975395
Title
Precipitating factors for heart failure decompensations and long-term
mortality in severe chronic heart failure reduced ejection fraction
patients.
Source
European Journal of Heart Failure. Conference: Heart Failure 2021 and the
World Congress on Acute Heart Failure. Online. 23(SUPPL 2) (pp 37-38),
2021. Date of Publication: September 2021.
Author
Nathan Mewton N.; Donal E.; Grinberg D.; Picard F.; Derimay F.; Rouleau
F.; Obadia J.F.; Maucort-Boulch D.; Trochu J.N.
Institution
(Nathan Mewton, Grinberg, Derimay, Obadia, Maucort-Boulch) Hospices Civils
of Lyon, Cardiological Hospital Louis Pradel, Bron, France
(Donal) Hospital Pontchaillou of Rennes, Cardiology, Rennes, France
(Picard) University Hospital of Bordeaux, Bordeaux, France
(Rouleau) University Hospital of Angers, Cardiology, Angers, France
(Trochu) Institut du Thorax, Inserm UMR 1087, Cardiology, Nantes, France
Publisher
John Wiley and Sons Ltd
Abstract
Background: There is heterogeneous data on the relationship between
primary heart failure (HF) decompensations (PHF events) and HF
decompensations associated with precipitating factors or secondary HF
decompensations (SHF events) and long-term mortality. Our main objective
was to assess the distribution of primary and secondary HF events in a
chronic reduced ejection fraction HF population and their association with
two-year all-cause mortality. Method(s): In this post-hoc analysis of
the multicenter prospective MITRA.fr study, we included 304 patients with
chronic heart failure (HF) and reduced left ventricular ejection fraction
(LVEF) (<40%), with severe mitral regurgitation and guideline directed
medical treatment (GDMT) randomized to GDMT alone or GDMT with
percutaneous mitral valve repair (PMVR). According to the follow-up, we
defined four different groups of patients: reference patients without any
HF event, patients with a first PHF event, patients with a first SHF
event. The primary outcome was 2-years all-cause mortality.
 Result(s): Among 304 randomized patients, 179 patients (59%) had at
least one HF decompensation within 24-months of follow-up. 129 patients
(72%) had a PHF, 50 patients (28%) had a SHF event. There were no
distribution differences in HF event types between the PMVR group and the
control group. PHF events were 3-times more frequent than SHF events, but
their rates of recurrence were similar (1.95+/-1.39 versus 1.80+/-1.07
respectively; p =NS). The most frequent triggers for SHF events were
infections or supraventricular arrhythmias. Compared to patients without
HF events, PHF and SHF events were associated with a significantly higher
mortality rate at two years (HR=7.43, 95%CI [4.81, 11.50] and 3.00 95%CI
[1.94, 4.63] respectively; p<0.0001). All-cause mortality, was not
different in PHF compared to SHF events (HR=1.81, 95%CI [0.93, 3.51]; p =
0.08). These results remained significant after adjustment on important
clinical parameters. Conclusion(s): In severely reduced LVEF chronic
heart failure patients, primary HF events were three-times more frequent
compared to HF events related to a precipitating factor but without
increased risk in all-cause mortality. However, HF decompensations are a
major predictor of death in this population even after adjustment for HF
recurrence.

<116>
Accession Number
635983074
Title
Preoperative incentive spirometry for preventing postoperative pulmonary
complications in patients undergoing coronary artery bypass graft surgery:
a prospective, randomized controlled trial.
Source
Journal of cardiothoracic surgery. 16(1) (pp 241), 2021. Date of
Publication: 24 Aug 2021.
Author
Sweity E.M.; Alkaissi A.A.; Othman W.; Salahat A.
Institution
(Sweity, Salahat) Faculty of Graduate Studies, An-Najah National
University, Nablus 44839, Palestine
(Sweity) Cardiology Department, An-Najah National University Hospital,
Nablus 44839, Palestine
(Alkaissi) Department of Anaesthesiology and Intensive Care, Faculty of
Medicine and Health Sciences, Nursing and Midwifery Department, An-Najah
National University, Nablus 44839, Palestine
(Othman) An-Najah National University Hospital, Nablus 44839, Palestine
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative pulmonary complications (PPCs) often occur after
cardiac operations and are a leading cause of morbidity, inhibit
oxygenation, and increase hospital length of stay and mortality. Although
clinical evidence for PPCs prevention is often unclear and crucial,
measures occur to reduce PPCs. One device usually used for this reason is
incentive spirometry (IS). The aim of the study is to evaluate the effect
of preoperative incentive spirometry to prevent postoperative pulmonary
complications, improve postoperative oxygenation, and decrease hospital
stay following coronary artery bypass graft (CABG) surgery patients.
 METHOD(S): This was a clinical randomized prospective study. A total
of 80 patients were selected as candidates for CABG at An-Najah National
University Hospital, Nablus-Palestine. Patients had been randomly assigned
into two groups: incentive spirometry group (IS), SI performed before
surgery (study group) and control group, preoperative spirometry was not
performed. The 40 patients in each group received the same protocol of
anesthesia and ventilation in the operating room. RESULT(S): The
study findings showed a significant difference between the IS and control
groups in the incidence of postoperative atelectasis. There were 8
patients (20.0%) in IS group and 17 patients (42.5%) in the control group
(p=0.03). Mechanical ventilation duration was significantly less in IS
group. The median was four hours versus six hours in the control group
(p<0.001). Hospital length of stay was significantly less in IS group, and
the median was six days versus seven days in the control group (p<0.001).
The median of the amount of arterial blood oxygen and oxygen saturation
was significantly improved in the IS group (p<0.005). CONCLUSION(S):
Preoperative incentive spirometry for two days along with the exercise of
deep breathing, encouraged coughing, and early ambulation following CABG
are in connection with prevention and decreased incidence of atelectasis,
hospital stay, mechanical ventilation duration and improved postoperative
oxygenation with better pain control. A difference that can be considered
both significant and clinically relevant. Trial registration Thai Clinical
Trials Registry: TCTR20201020005. Registered 17 October
2020-retrospectively registered. Copyright © 2021. The Author(s).

<117>
Accession Number
635976172
Title
Cooling as an Adjunctive Therapy to Percutaneous Intervention in Acute
Myocardial Infarction: COOL-MI InCor Trial.
Source
Therapeutic Hypothermia and Temperature Management. 11(3) (pp 135-144),
2021. Date of Publication: September 2021.
Author
Dallan L.A.P.; Giannetti N.S.; Rochitte C.E.; Polastri T.F.; San Martin
C.Y.B.; Hajjar L.A.; Lima F.G.; Nicolau J.C.; Oliveira M.T.D.; Dae M.;
Ribeiro Da Silva E.E.; Kalil Filho R.; Lemos Neto P.A.; Timerman S.
Institution
(Dallan, Giannetti, Rochitte, Polastri, San Martin, Hajjar, Lima, Nicolau,
Oliveira, Ribeiro Da Silva, Kalil Filho, Lemos Neto, Timerman) Department
of Cardiology, InCor Heart Institute, School of Medicine, University of
Sao Paulo, Sao Paulo, Brazil
(Dae) Department of Radiology, Ucsf, University of California, San
Francisco, CA, United States
Publisher
Mary Ann Liebert Inc.
Abstract
Endovascular Therapeutic hypothermia (ETH) reduces the damage caused by
postischemia reperfusion injury syndrome in cardiopulmonary arrest and has
already established its role in patients with sudden death; however, its
role in ST-segment elevation myocardial infarction (STEMI) remains
controversial. The objectives of this study were to investigate the
safety, feasibility, and 30-day efficacy of rapid induction of therapeutic
hypothermia as adjunctive therapy to percutaneous coronary intervention
(PCI) in patients with anterior and inferior STEMIs. This was a
prospective, controlled, randomized, two-arm, prospective, interventional
study of patients admitted to the emergency department within 6 hours of
angina onset, with anterior or inferior STEMI eligible for PCI. Subjects
were randomized to the hypothermia group (primary PCI+ETH) or to the
control group (primary PCI) at a 4:1 ratio. The ETH was induced by 1 L
cold saline (1-4degreeC) associated with the ProteusTM System, by cooling
for at least 18 minutes before coronary reperfusion with a target
temperature of 32degreeC +/- 1degreeC. Maintenance of ETH was conducted
for 1-3 hours, and active reheating was done at a rate of 1degreeC/h for 4
hours. Primary safety outcomes were the feasibility of ETH in the absence
of (1) door-to-balloon (DTB) delay; (2) major adverse cardiac events
(MACE) within 30 days after randomization. The primary outcomes of
effectiveness were infarct size (IS) and left ventricular ejection
fraction (LVEF) at 30 days. An as-treated statistical analysis was
performed. Fifty patients were included: 35 (70%) randomized to the
hypothermia group and 15 (30%) to the control group. The mean age was 58
+/- 12 years; 78% were men; and associated diseases were 60% hypertension,
42% diabetes, and 72% dyslipidemia. The compromised myocardial wall was
anterior in 38% and inferior in 62%, and the culprit vessels were left
anterior descending artery (LAD) (40%), right coronary artery (38%), and
left circumflex (18%). All 35 patients who attempted ETH (100%) had
successful cooling, with a mean endovascular coronary reperfusion
temperature of 33.1degreeC +/- 0.9degreeC. The mean ischemic time was 375
+/- 89.4 minutes in the hypothermia group and 359.5 +/- 99.4 minutes in
the control group. The mean DTB was 92.1 +/- 20.5 minutes in the
hypothermia group and 87 +/- 24.4 minutes in the control group. The
absolute difference of 5.1 minutes was not statistically significant (p =
0.509). The MACE rates were similar between both groups (21.7% vs. 20%
respectively, p = 0.237). In the comparison between the hypothermia and
control groups, no statistically significant differences were observed at
30 days between mean IS (13.9% +/- 8% vs. 13.8% +/- 10.8%, respectively, p
= 0.801) and mean final LVEF (43.3% +/- 11.2% vs. 48.3 +/- 10.9%,
respectively; p = 0.194). Hypothermia as an adjunctive therapy to primary
PCI in STEMI is feasible and can be implemented without delay in coronary
reperfusion. Hypothermia was safe regarding the incidence of MACE at 30
days. However, there was a higher incidence of arrhythmia and in-hospital
infection in the hypothermia group, with no increase in mortality.
Regarding efficacy, there was no difference in IS or LVEF at 30 days that
would suggest additional myocardial protection with ETH.
ClinicalTrials.gov: NCT02664194. © Copyright 2021, Mary Ann
Liebert, Inc., publishers 2021.

<118>
Accession Number
2014577867
Title
Outcome of strict peri-operative glycemic control in diabetic patients
following open heart surgery.
Source
Medical Forum Monthly. 32(7) (pp 43-47), 2021. Date of Publication: July
2021.
Author
Imran-Ul-hassan S.; Sharyar; Rashid M.; Liaqat M.; Saleem J.; Zulfiqar T.
Institution
(Imran-Ul-hassan, Sharyar, Liaqat, Saleem, Zulfiqar) Department of
Anesthesia, Punjab Institute of cardiology, Lahore, Pakistan
(Rashid) Department of Anesthesia, University College of Medicine and
Dentistry, University of Lahore, Pakistan
Publisher
Medical Forum Monthly
Abstract
Objective: To compare the outcome in terms of post-operative complications
and early morality of strict glycemic control among diabetics having open
heart surgery with control group following open heart surgery. Study
Design: Prospective Cohort Study Place and Duration of Study: This study
was conducted at the Department of Anesthesia, Punjab Institute of
Cardiology, Lahore from November 2020 to April 2021. Material(s) and
Method(s): In this study, 60 patients were randomly assigned to two groups
(30 patients in each group) according to a computer-generated allocation
table. All the diabetic patients of 18 years to 60 years old with ASA II
and III planned for cardiac surgery during this study period was included.
In the control group no insulin was given to the patient unless blood
glucose level exceeded 180 mg/dl. While in the study group glucose level
between 80 and 110 mg/dl was targeted using continuous infusion of insulin
in saline. Cardiac, Pulmonary, Renal and Neurological problems were noted.
Early mortality was also documented. Result(s): Mean duration of
diabetes in the strict control of diabetes group was 13.57+6.32 years and
in conventional group it was 12.89+5.88 years. Complications or poor
outcome due to occurrence of complications or early mortality was seen in
29 patients in the conventional glycemic control group while only 8
patients in the strict glycemic control group. Cardiac complications were
three times less in the tight control group. Early mortality was observed
in the control group in 2 patients as compared to none in the strict/tight
control group, difference was statistically significant p value <0.0001.
 Conclusion(s): Intra-operative tight glycemic control can help in
controlling post-operative morbidity after open heart surgery. With
control of post-operative complications, the recovery process can be
improved. All types of complications are decreased with strict glycemic
control. Copyright © 2021 Medical Forum Monthly. All rights
reserved.

<119>
Accession Number
635973528
Title
Beta-Blocker Landiolol Hydrochloride in Preventing Atrial Fibrillation
Following Cardiothoracic Surgery: A Systematic Review and Meta-Analysis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2021. Date of Publication: 20 Aug 2021.
Author
Hao J.; Zhou J.; Xu W.; Chen C.; Zhang J.; Peng H.; Liu L.
Institution
(Hao, Zhou, Chen, Zhang, Peng, Liu) Department of Thoracic Surgery, West
China Hospital, Sichuan University, Chengdu, China
(Hao, Zhou, Xu, Chen) West China School of Medicine, Sichuan University,
Chengdu, China
(Zhang) Department of Thoracic Surgery, Chest Oncology Institute, West
China Hospital, Sichuan University, Chengdu, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The purpose of this article was to assess the benefit of
perioperative administration of the intravenous beta-blocker landiolol
hydrochloride in preventing atrial fibrillation (AF) after cardiothoracic
surgery. METHOD(S): We performed a systematic search in PubMed, Web
of Science, CNKI, and OVID to identify randomized controlled trials (RCTs)
and cohorts up to January 2021. Data regarding postoperative atrial
fibrillation (POAF) and safety outcomes were extracted. Odds ratios (ORs)
with 95% confidence intervals (CIs) were determined using the
Mantel-Haenszel method. Meanwhile, subgroup analyses were conducted
according to surgery type including lung cancer surgery, esophageal cancer
surgery, and cardiac surgery. RESULT(S): Seventeen eligible articles
involving 1349 patients within 13 RCTs and four cohorts were included in
our meta-analysis. Compared with control group, landiolol administration
was associated with a significant reduction of the occurrence of AF after
cardiothoracic surgery (OR = 0.32, 95% CI 0.23-0.43, P <0.00001). In
addition, the results demonstrated that perioperative administration of
landiolol hydrochloride minimized the occurrence of postoperative
complications (OR = 0.48, 95% CI 0.33-0.70, P = 0.0002). Funnel plots
indicated no obvious publication bias. CONCLUSION(S): Considering
this analysis, landiolol was effective in the prevention of AF after
cardiothoracic surgery and did not increase the risk of major
postoperative complications.

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