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<1>
Accession Number
2010930550
Title
Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An
Individual Patient-Level Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14(4) (pp 444-456), 2021. Date of
Publication: 22 Feb 2021.
Author
Valgimigli M.; Mehran R.; Franzone A.; da Costa B.R.; Baber U.; Piccolo
R.; McFadden E.P.; Vranckx P.; Angiolillo D.J.; Leonardi S.; Cao D.;
Dangas G.D.; Mehta S.R.; Serruys P.W.; Gibson C.M.; Steg G.P.; Sharma
S.K.; Hamm C.; Shlofmitz R.; Liebetrau C.; Briguori C.; Janssens L.; Huber
K.; Ferrario M.; Kunadian V.; Cohen D.J.; Zurakowski A.; Oldroyd K.G.;
Yaling H.; Dudek D.; Sartori S.; Kirkham B.; Escaned J.; Windecker S.;
Pocock S.; Juni P.; Mehta S.; Gibson M.C.; Kastrati A.; Krucoff M.; Ohman
M.E.; Gurbel P.; Henry T.D.; Moliterno D.; Heg D.; McFadden E.; Marx S.O.;
Darrow B.; Corvaja N.; DeStefano D.; Ghodsi N.; Meller J.; Franklin-Bond
T.; Cha J.Y.; Waseem Z.; Weisz G.; Kornowski R.; Oldroyd K.; Kaul U.;
Witzenbichler B.; Dzavik V.; Gil R.; Sardella G.; Benit E.; Diletti R.;
Dominici M.; Slagboom T.; Buszman P.; Bolognese L.; Tumscitz C.;
Bryniarski K.; Aminian A.; Vrolix M.; Petrov I.; Garg S.; Naber C.;
Prokopczuk J.; Steg P.G.
Institution
(Valgimigli, Windecker) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Lugano, Switzerland
(Mehran, Baber, Cao, Dangas, Sharma, Sartori) Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Franzone, Piccolo) Department of Advanced Biomedical Sciences, University
of Naples Federico II, Naples, Italy
(da Costa, Kirkham, Juni) Applied Health Research Centre of the Li Ka
Shing Knowledge Institute, Department of Medicine, St. Michael's Hospital,
University of Toronto, Toronto, ON, Canada
(McFadden) Cardialysis Core Laboratories and Clinical Trial Management,
Rotterdam, Netherlands
(McFadden) Department of Cardiology, Cork University Hospital, Cork,
Ireland
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
(Angiolillo, Ferrario) Division of Cardiology, University of Florida
College of Medicine, Jacksonville, FL, United States
(Leonardi) University of Pavia and Fondazione IRCCS Policlinico S. Matteo,
Pavia, Italy
(Mehta) McMaster University and Hamilton Health Sciences, Hamilton, ON,
Canada
(Serruys) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College, London, United Kingdom
(Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Steg) Universite de Paris and Hopital Bichat, Assistance
Publique-Hopitaux de Paris, Paris, France
(Hamm, Liebetrau) German Center for Cardiovascular Research, partner site
RheinMain, Frankfurt am Main, Germany
(Hamm, Liebetrau) Department of Cardiology, Kerckhoff Heart and Thorax
Center, Bad Nauheim, Germany
(Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Briguori) Clinica Mediterranea, Naples, Italy
(Janssens) Imelda Hospital, Bonheiden, Belgium
(Huber) 3rd Medical Department, Cardiology and Intensive Care Medicine,
Wilhelminen Hospital, and Sigmund Freud University Medical School, Vienna,
Austria
(Kunadian) Translational and Clinical Research Institute, Faculty of
Medical Sciences, Newcastle University, and Cardiothoracic Centre, Freeman
Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle
upon Tyne, United Kingdom
(Cohen) Cardiovascular Research, Saint Luke's Mid America Heart Institute,
Kansas City, MO, United States
(Zurakowski) Department of Interventional Cardiology Chrzanow, Andrzej
Frycz Modrzewski Krakow University, Krakow, Poland
(Oldroyd) The West of Scotland Heart and Lung Centre, Golden Jubilee
National Hospital, Glasgow, United Kingdom
(Yaling) General Hospital of Northern Theater Command, Shenyang, Liaoning,
China
(Dudek) Institute of Cardiology, Jagiellonian University Medical College,
Krakow, Poland
(Dudek) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
(Escaned) Instituto de Investigacion Sanitaria del Hospital Clinico San
Carlos and Complutense University, Madrid, Spain
(Heg) Clinical Trials Unit, London School of Hygiene and Tropical
Medicine, London, United Kingdom
(Pocock) London School of Hygiene and Tropical Medicine, London, United
Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare ticagrelor monotherapy
with dual-antiplatelet therapy (DAPT) after percutaneous coronary
intervention (PCI) with drug-eluting stents. Background(s): The role
of abbreviated DAPT followed by an oral P2Y<inf>12</inf> inhibitor after
PCI remains uncertain. Method(s): Two randomized trials, including
14,628 patients undergoing PCI, comparing ticagrelor monotherapy with
standard DAPT on centrally adjudicated endpoints were identified, and
individual patient data were analyzed using 1-step fixed-effect models.
The protocol was registered in PROSPERO (CRD42019143120). The primary
outcomes were the composite of Bleeding Academic Research Consortium type
3 or 5 bleeding tested for superiority and, if met, the composite of
all-cause death, myocardial infarction, or stroke at 1 year, tested for
noninferiority against a margin of 1.25 on a hazard ratio (HR) scale.
 Result(s): Bleeding Academic Research Consortium type 3 or 5 bleeding
occurred in fewer patients with ticagrelor than DAPT (0.9% vs. 1.7%,
respectively; HR: 0.56; 95% confidence interval [CI]: 0.41 to 0.75; p <
0.001). The composite of all-cause death, myocardial infarction, or stroke
occurred in 231 patients (3.2%) with ticagrelor and in 254 patients (3.5%)
with DAPT (HR: 0.92; 95% CI: 0.76 to 1.10; p < 0.001 for noninferiority).
Ticagrelor was associated with lower risk for all-cause (HR: 0.71; 95% CI:
0.52 to 0.96; p = 0.027) and cardiovascular (HR: 0.68; 95% CI: 0.47 to
0.99; p = 0.044) mortality. Rates of myocardial infarction (2.01% vs.
2.05%; p = 0.88), stent thrombosis (0.29% vs. 0.38%; p = 0.32), and stroke
(0.47% vs. 0.36%; p = 0.30) were similar. Conclusion(s): Ticagrelor
monotherapy was associated with a lower risk for major bleeding compared
with standard DAPT, without a concomitant increase in ischemic
events. Copyright © 2021 American College of Cardiology
Foundation

<2>
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

<3>
Accession Number
2013691198
Title
The Impact of Bariatric Surgery Versus Non-Surgical Treatment on Blood
Pressure: Systematic Review and Meta-Analysis.
Source
Obesity Surgery. 31(11) (pp 4970-4984), 2021. Date of Publication:
November 2021.
Author
Wang L.; Lin M.; Yu J.; Fan Z.; Zhang S.; Lin Y.; Chen X.; Peng F.
Institution
(Wang, Lin, Yu, Fan, Zhang, Lin, Chen, Peng) Department of Cardiology, The
First Affiliated Hospital of Fujian Medical University, Chazhong Road 20,
Fuzhou, Fujian 350005, China
Publisher
Springer
Abstract
The purpose of this study was to compare bariatric surgery versus
non-surgical treatment on blood pressure for patients with obesity.
Nineteen RCTs (1353 total patients) were included. In the pooled analyses,
bariatric surgery reduces more systolic blood pressure (WMD: - 3.937 mmHg,
CI95%: - 6.000 to - 1.875, p < 0.001, I2 = 0%), diastolic blood
pressure (WMD: - 2.690 mmHg, CI95%: - 3.994 to - 1.385, P < 0.001,
I2 = 0%) and more antihypertensives. In subgroup analyses,
patients after Roux-en-Y gastric bypass, with poor control of hypertension
(BP > 130/80 mmHg) and diabetes mellitus (HbA1C > 7.0%, FPG > 7.0 mmol/L),
elder patients (> 45 years), non-severe obesity (BMI < 40
kg/cm2, body weight < 120 kg), less waist circumference (< 115
cm) tend to decrease more blood pressure. Besides, patients after surgery
also lost more weight (p < 0.001), decreased more waist circumference (p <
0.001), fasting plasma glucose (p < 0.001), glycosylated hemoglobin (p <
0.001), triglycerides (p < 0.001), hsCRP (p = 0.001), increased more
high-density lipoprotein cholesterol (p < 0.001), and had better remission
of metabolic syndrome (p < 0.001). Changes in total cholesterol,
low-density lipoprotein cholesterol, renal function, resting heart rate,
and 6-min walking test were not significantly different. Therefore,
bariatric surgery is more effective than non-surgical treatment in
controlling patients' blood pressure. Graphical abstract: [Figure not
available: see fulltext.] Copyright © 2021, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<4>
Accession Number
2012391158
Title
Preventative effects of bisoprolol transdermal patches on postoperative
atrial fibrillation in high-risk patients undergoing non-cardiac surgery:
A subanalysis of the MAMACARI study.
Source
Journal of Cardiology. 78(5) (pp 349-354), 2021. Date of Publication:
November 2021.
Author
Iwano T.; Toda H.; Nakamura K.; Shimizu K.; Ejiri K.; Naito Y.; Mori H.;
Masuda T.; Miyoshi T.; Yoshida M.; Hikasa Y.; Morimatsu H.; Ito H.
Institution
(Iwano, Toda, Nakamura, Ejiri, Masuda, Miyoshi, Yoshida, Ito) Department
of Cardiovascular Medicine, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho,
Kita-ku, Okayama 700-8558, Japan
(Shimizu, Hikasa, Morimatsu) Department of Anesthesiology, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Naito) Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
(Mori) Department of Cardiology, Tsuyama Chuo Hospital, Tsuyama, Japan
(Masuda) Department of Cardiology, Himeji Red Cross Hospital, Himeji,
Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Perioperative atrial fibrillation (POAF) after non-cardiac
surgery is a risk factor for cardiovascular events including stroke and
death. The aim of this subanalysis of the MAMACARI study, a multicenter
randomized control study on the effectiveness of a bisoprolol transdermal
patch for prevention of perioperative myocardial injury in high-risk
patients undergoing non-cardiac surgery, was to identify the predictors of
POAF after non-cardiac surgery in high-risk patients and to determine
changes in blood pressure and heart rate during bisoprolol patch
administration in the perioperative period. Methods and Results:
Patients aged over 60 years with hypertension and a high revised cardiac
risk index (>=2) who were scheduled to undergo non-cardiac surgery were
randomly assigned to a bisoprolol patch group (n = 120) or a control group
(n = 120). We divided the patients into two groups: patients with POAF
(POAF group; n = 16) and patients without POAF (non-POAF group; n = 206).
Multivariate analysis showed that bisoprolol patch therapy (OR: 0.30, 95%
CI: 0.092-0.978) and surgery time of 250 min or more (OR: 4.99, 95% CI:
1.37-18.2) were independently associated with POAF. Although systolic
blood pressure did not differ significantly between the two groups
throughout the perioperative period, treatment with a bisoprolol patch
significantly reduced heart rate throughout the perioperative period
compared with that in the control group. Conclusion(s): Low dose of a
bisoprolol patch in the perioperative period was effective for prevention
of POAF after non-cardiac surgery in high-risk patients, while long
surgery time was an independent risk factor for POAF. It is expected that
low dose of a bisoprolol patch can prevent POAF without causing
hypotension. Copyright © 2021

<5>
Accession Number
2012124425
Title
An assessment of the effectiveness of regional analgesia after VATS
measured by an objective method for assessing testosterone, cortisol,
a-Amylase, sIgA, and b-endorphin levels a randomised controlled trial.
Source
Endokrynologia Polska. 72(2) (pp 133-142), 2021. Date of Publication: 11
Jan 2021.
Author
Bialka S.; Sliwczynska M.; Marciniak A.; Czyzewski D.; Misiolek H.
Institution
(Bialka, Czyzewski, Misiolek) Department of Anaesthesiology, Intensive
Care, and Emergency Medicine, Medical University of Silesia, Zabrze 41
800, Poland
(Sliwczynska, Marciniak) Department of Thoracic Surgery, Faculty of
Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
Publisher
Via Medica
Abstract
Introduction: Thoracic surgeries are associated with intense postoperative
pain. General opioid analgesia is still the main anaesthetic method. Due
to the large number of opioid-induced side effects, alternative methods of
pain relief are sought. One of them is the use of balanced analgesia,
which consists of regional analgesia, non-opioid painkillers, and small
doses of opioids. Material(s) and Method(s): The objective of this
study was to assess the effectiveness of preoperative thoracic
paravertebral block (ThPVB) in the treatment of postoperative pain after
video-Assisted thoracic surgery (VATS) by measuring hormone levels in
blood serum or saliva. It was a randomised, open-label study conducted in
a single university hospital setting between May 2018 and September 2019.
In total, 119 patients were scheduled for elective video-Assisted thoracic
surgery. Performed interventions included: preoperative thoracic
paravertebral block with 0.5% bupivacaine, followed by postoperative
oxycodone combined with nonopioid analgesics. Follow-up period comprised
first 24 hours and one, two, and six months after surgery. Main outcomes
were measured by pain intensity assessed using the Numerical Rating Scale
(NRS) and the levels of the following hormones: Testosterone, cortisol,
a-Amylase activity, sIgA, and b-endorphin. Result(s): A total of 119
patients were randomised into two groups and, of these, 49 were
subsequently excluded from the analysis. The final analysis included 37
patients from the study group and 33 from the control group. There were no
statistically significant differences in the analysed parameters the
relative change T1 T0. There was a tendency towards statistical
significance in the relative change T2 T0 in testosterone levels. At rest,
no statistically significant differences were found between groups and
time in the percentage of patients with NRS 1. During cough, the
percentage of patients with NRS 1 was higher at T1 and T2 time points in
the ThPVB group. Of the factors considered, only a-Amylase levels
statistically significantly increased the chance for higher NRS score
after a month [OR = 1.013; 95% PU: 1.001 1.025; p 0.01].
 Conclusion(s): ThPVB is effective and safe for patients undergoing
VATS. It can be an effective alternative for general anaesthesia using
high doses of opioids. Copyright © 2021 Via Medica. All rights
reserved.

<6>
Accession Number
2011816127
Title
Exploring the impact of the COVID-19 pandemic on provision of cardiology
services: A scoping review.
Source
Reviews in Cardiovascular Medicine. 22(1) (pp 83-95), 2021. Date of
Publication: March 2021.
Author
Yasmin F.; Shujauddin S.M.; Naeem A.; Jabeen A.; Shah S.M.I.; Ochani R.K.;
Mohiuddin O.; Khan A.A.; Jalees S.; Razzack A.A.; Salman S.; Khan S.A.K.;
Mustafa A.; Lak H.M.
Institution
(Yasmin, Shujauddin, Naeem, Jabeen, Ochani, Mohiuddin, Khan, Jalees, Khan)
Department of Internal Medicine, Dow Medical College, Dow University of
Health Sciences, Karachi 247000, Pakistan
(Shah) Department of Internal Medicine, Ziauddin Medical University,
Karachi 247000, Pakistan
(Razzack) Dr NTR University of Health Sciences, Vijayawada 502355, India
(Salman) Department of Internal Medicine, Dow International Medical
College, Karachi 247000, Pakistan
(Mustafa) Department of Internal Medicine, Staten Island University
Hospital, NY 10001, United States
(Lak) Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
44111, United States
Publisher
IMR Press Limited
Abstract
The coronavirus disease-19 (COVID-19) pandemic has forced hospitals to
prioritize COVID-19 patients, restrict resources, and cancel all
non-urgent elective cardiac procedures. Clinical visits have only been
facilitated for emergency purposes. Fewer patients have been admitted to
the hospital for both ST-segment elevation myocardial infarctions (STEMI)
and non-ST segment elevation myocardial infarctions (NSTEMI) and a
profound decrease in heart failure services has been reported. A similar
reduction in the patient presentation is seen for ischemic heart disease,
decompensated heart failure, and endocarditis. Cardiovascular services,
including catheterization, primary percutaneous coronary intervention
(PPCI), cardiac investigations such as electrocardiograms (ECGs), exercise
tolerance test (ETT), dobutamine stress test, computed tomography (CT)
angiography, transesophageal echocardiography (TOE) have been reported to
have declined and performed on a priority basis. The long-term
implications of this decline have been discussed with major concerns of
severe cardiac complications and vulnerabilities in cardiac patients. The
pandemic has also had psychological impacts on patients causing them to
avoid seeking medical help. This review discusses the effects of the
COVID-19 pandemic on the provision of various cardiology services and aims
to provide strategies to restore cardiovascular services including
structural changes in the hospital to make up for the reduced staff
personnel, the use of personal protective equipment in healthcare workers,
and provides alternatives for high-risk cardiac imaging, cardiac
interventions, and procedures. Implementation of the triage system, risk
assessment scores, and telemedicine services in patients and their
adaptation to the cardiovascular department have been
discussed. Copyright © 2021 The Authors. Published by IMR Press.

<7>
Accession Number
2011573309
Title
Dexmedetomidine reduces the incidence of postoperative delirium after
cardiac surgery: a meta-analysis of randomized controlled trials.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 153. Date
of Publication: December 2021.
Author
Li P.; Li L.-X.; Zhao Z.-Z.; Xie J.; Zhu C.-L.; Deng X.-M.; Wang J.-F.
Institution
(Li, Li, Zhao, Xie, Zhu, Deng, Wang) Faculty of Anesthesiology, Changhai
Hospital, Naval Medical University, 168 Changhai Road, Shanghai, China
Publisher
BioMed Central Ltd
Abstract
Background: The role of dexmedetomidine in preventing postoperative
delirium (POD) after cardiac surgery remains controversial because of
several recent trials with negative results. We aimed to perform an
updated meta-analysis of randomized controlled trials (RCTs) to clarify
this controversy. Method(s): RCTs investigating the perioperative
administration of dexmedetomidine in cardiac surgery were retrieved from
PubMed, Web of Science, and the Cochrane library until August,27,2020. Two
researchers independently screened the literature, collected the data and
evaluated the bias risk of the included studies. The meta-analysis was
performed with the RevMan 5.3. Result(s): A total of 15 studies
including 2813 patients were included in the study. A pooled result showed
that dexmedetomidine could reduce the risk of POD in adult population
underwent cardiac surgery (OR 0.56, 95%CI 0.36-0.89, P = 0.0004,
I2 = 64%). The subgroup analysis demonstrated that the
protective effect of dexmedetomidine was only present in the patients
injected with dexmedetomidine after surgery but not from the start of
surgery, in the adult patients without specific age limitation but not in
the elderly, and in the studies in comparison with other sedatives but not
with placebo. There were no statistical differences when analyzing the
secondary outcomes including hypotension (OR 1.13; 95% CI 0.54-2.37, P <
0.00001, I2 = 85%), bradycardia (OR 1.72; 95% CI 0.84-3.53, P =
0.04, I2 = 58%) and atrial fibrillation (OR 0.87; 95% CI
0.70-1.08, P = 0.43, I2 = 0). Conclusion(s):
Dexmedetomidine can reduce the incidence of POD compared to other
sedatives and opioids after cardiac surgery in adult patients. The proper
population and timing for perioperative use of dexmedetomidine after
cardiac surgery remain to be further investigated. Copyright ©
2021, The Author(s).

<8>
Accession Number
2011178571
Title
The Outcomes of Surgical Separation in Thoracopagus Twins with Conjoined
Hearts: An Analysis of the Literature.
Source
Pediatric Cardiology. 42(4) (pp 875-882), 2021. Date of Publication: April
2021.
Author
Collins R.T.; O'Connor M.J.
Institution
(Collins) Division of Pediatric Cardiology, Stanford University School of
Medicine, 750 Welch Road, Suite 321, Palo Alto, CA 94304, United States
(Collins) Lucile Packard Children's Hospital Stanford, Palo Alto, CA,
United States
(O'Connor) Division of Pediatric Cardiology, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, United States
(O'Connor) The Children's Hospital of Philadelphia, Philadelphia, PA,
United States
Publisher
Springer
Abstract
We sought to perform a comprehensive review of reported cases of conjoined
thoracopagus twins with cardiovascular conjunction to determine the
overall survival after separation and factors that might be associated
with survival. We performed a systematic review of cases of thoracopagus
twins with conjoined cardiovascular systems reported in the English
medical literature using Embase, PubMed, Web of Science, and Scopus. We
employed standard statistical methods to analyze differences among groups.
We identified 102 unique cases of thoracopagus twins (69% female) with
some degree of cardiovascular conjunction who had undergone surgical
separation. We identified 6 distinct types of cardiovascular union. Median
age was 47 days (IQR 12, 120). Survival to at least hospital discharge
occurred in 51% (105/204). Median age at separation was lower in emergent
(9 days, IQR 1, 25) versus elective cases (93 days, IQR 49, 180) (p <
0.0001). Survival to hospital discharge was higher in those who underwent
elective separation (70%, 93/132 total children versus 17%, 12/72) (p <
0.0001). Survival was associated with the type of cardiovascular union (p
< 0.0001). The separation of thoracopagus twins with cardiovascular
conjunction is higher than expected. Increased survival is associated with
elective separation, older age, and shared pericardium only. These
findings suggest survival could be improved with better delineation of
degree of union and delayed separation. Copyright © 2021, The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature.

<9>
Accession Number
2010886225
Title
A polysomnography study examining the association between sleep and
postoperative delirium in older hospitalized cardiac surgical patients.
Source
Journal of Sleep Research. 30(5) (no pagination), 2021. Article Number:
e13322. Date of Publication: October 2021.
Author
Ibala R.; Mekonnen J.; Gitlin J.; Hahm E.Y.; Ethridge B.R.; Colon K.M.;
Marota S.; Ortega C.; Pedemonte J.C.; Cobanaj M.; Chamadia S.; Qu J.; Gao
L.; Barbieri R.; Akeju O.
Institution
(Ibala, Mekonnen, Gitlin, Hahm, Ethridge, Colon, Marota, Ortega,
Pedemonte, Chamadia, Qu, Gao, Akeju) Department of Anesthesia, Critical
Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United
States
(Pedemonte) Division de Anestesiologia, Escuela de Medicina, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Cobanaj, Barbieri) Department of Electronics Informatics and
Bioengineering, Politecnico di Milano, Milan, Italy
(Akeju) Henry and Allison McCance Center for Brain Health, Massachusetts
General Hospital, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Hospitalized older patients who undergo elective cardiac surgery with
cardiopulmonary bypass are prone to postoperative delirium. Self-reported
shorter sleep and longer sleep have been associated with impaired
cognition. Few data exist to guide us on whether shorter or longer sleep
is associated with postoperative delirium in this hospitalized cohort.
This was a prospective, single-site, observational study of hospitalized
patients (>60 years) scheduled to undergo elective major cardiac surgery
with cardiopulmonary bypass (n = 16). We collected and analysed overnight
polysomnography data using the Somte PSG device and assessed for delirium
twice a day until postoperative day 3 using the long version of the
confusion assessment method and a structured chart review. We also
assessed subjective sleep quality using the Pittsburg Sleep Quality Index.
The delirium median preoperative hospital stay of 9 [Q1, Q3: 7, 11] days
was similar to the non-delirium preoperative hospital stay of 7 [4, 9]
days (p =.154). The incidence of delirium was 45.5% (10/22) in the entire
study cohort and 50% (8/16) in the final cohort with clean polysomnography
data. The preoperative delirium median total sleep time of 323.8 [Q1, Q3:
280.3, 382.1] min was longer than the non-delirium median total sleep time
of 254.3 [210.9, 278.1] min (p =.046). This was accounted for by a longer
delirium median non-rapid eye movement (REM) stage 2 sleep duration of
282.3 [229.8, 328.8] min compared to the non-delirium median non-REM stage
2 sleep duration of 202.5 [174.4, 208.9] min (p =.012). Markov chain
modelling confirmed these findings. There were no differences in measures
of sleep quality assessed by the Pittsburg Sleep Quality Index.
Polysomnography measures of sleep obtained the night preceding surgery in
hospitalized older patients scheduled for elective major cardiac surgery
with cardiopulmonary bypass are suggestive of an association between
longer sleep duration and postoperative delirium. Copyright ©
2021 European Sleep Research Society

<10>
Accession Number
2007728961
Title
Association of excessive daytime sleepiness with the zung self-rated
depression subscales in adults with coronary artery disease and
obstructive sleep apnea.
Source
Diagnostics. 11(7) (no pagination), 2021. Article Number: 1176. Date of
Publication: July 2021.
Author
Celik Y.; Yapici-Eser H.; Balcan B.; Peker Y.
Institution
(Celik, Yapici-Eser, Peker) School of Medicine, Koc University Research
Center for Translational Medicine (KUTTAM), Istanbul 34450, Turkey
(Celik) Graduate School of Health Sciences, Koc University, Istanbul
34450, Turkey
(Yapici-Eser) Department of Psychiatry, School of Medicine, Koc
University, Istanbul 34450, Turkey
(Balcan) Department of Pulmonary Medicine, School of Medicine, Marmara
University, Istanbul 34722, Turkey
(Peker) Department of Clinical Sciences, Respiratory Medicine and
Allergology, School of Medicine, Lund University, Lund 22185, Sweden
(Peker) Department of Molecular and Clinical Medicine/Cardiology,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg 40530, Sweden
(Peker) Division of Pulmonary, Allergy, and Critical Care Medicine,
University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United
States
Publisher
MDPI
Abstract
Excessive daytime sleepiness (EDS) is a factor associated with both
obstructive sleep apnea (OSA) and depressive symptoms. Continuous positive
airway pressure (CPAP) treatment may decrease EDS in adults with OSA;
however, the modulatory role of depressive symptoms on the improvement of
EDS is not known. We aimed to explore the association between subscales of
the Zung Self-rated Depression Scale (SDS) and Epworth Sleepiness Scale
(ESS) over a 2-year period in coronary artery disease (CAD) patients with
OSA. This was a post-hoc analysis of the RICCADSA cohort, in which 399
adults with CAD (155 sleepy OSA [apnea-hypopnea index >= 15/h] and ESS
score >= 10, who were offered CPAP; and 244 nonsleepy OSA [ESS < 10]),
randomized to CPAP [n = 122] or no-CPAP [n = 122]) were included. Three
factors were extracted from the Zung SDS, based on the principal component
analysis: F1, cognitive symptoms and anhedonia; F2, negative mood; and F3,
appetite. In a mixed model, the ESS score decreased by 3.4 points (p <
0.001) among the sleepy OSA phenotype, which was predicted by the decline
in the F2, but not in the F1 and F3 scores. The fixed effects of time were
not significant in the nonsleepy OSA groups, and thus, further analyses
were not applicable. Additional within-group analyses showed a significant
decrease in all subscales over time both in the sleepy and nonsleepy OSA
patients on CPAP whereas there was a significant increase in the nonsleepy
OSA group randomized to no-CPAP. We conclude that the improvement in
negative mood symptoms of depression, but not changes in cognitive
symptoms and anhedonia as well as appetite, was a significant predictor of
decline in the ESS scores over a 2-year period in this CAD cohort with
sleepy OSA on CPAP treatment. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<11>
Accession Number
2006858932
Title
The venous thromboembolism prophylaxis in patients receiving thoracic
surgery: A systematic review.
Source
Asia-Pacific Journal of Clinical Oncology. 17(5) (pp e142-e152), 2021.
Date of Publication: October 2021.
Author
Wang Q.; Ding J.; Yang R.
Institution
(Wang, Ding, Yang) Department of Thoracic Surgery, The Affiliated Brain
Hospital of Nanjing Medical University (South Branch, Nanjing Chest
Hospital), Nanjing, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Venous thromboembolism (VTE) is a significant and preventable
cause of mortality and morbidity in thoracic surgery. It usually deep
venous thromboembolism (DVT) and pulmonary thromboembolism (PE). We
conducted this article to perform a systematic review on prophylaxis of
perioperative VTE in patients undergoing thoracic surgery especially lung
surgery and esophageal surgery and to identify potential areas for future
research. Method(s): The systematic review we conducted included
studies of patients undergoing thoracic surgery especially lung surgery
and esophageal surgery. Result(s): The study identified 2621
references. Finally, 22 trials with a total of 9072 patients were
included. Only six studies declared that they continued a follow-up after
the discharge of the patients. (range: 1-3 months); three studies reported
on major bleeding events as an outcome measure, and the incidence varied
from 0.8% to 1.6%. Total 346 VTEs occurred, and the overall mean risk of
VTE was estimated at 3.8% (range: 0.77-27%). Conclusion(s): The
evidence for using thromboprophylaxis in thoracic surgery is limited and
controversial, predominantly based on clinical consensus. Future research
is needed to focus on identifying risk of VTE and providing sufficient
evidence with high quality to support clinical strategies concerning the
prophylaxis for VTE. Copyright © 2020 John Wiley & Sons
Australia, Ltd

<12>
Accession Number
2013976452
Title
Device profile of the VEST for external support of SVG Coronary artery
bypass grafting: historical development, current status, and future
directions.
Source
Expert Review of Medical Devices. 18(10) (pp 921-931), 2021. Date of
Publication: 2021.
Author
Goldstein D.J.
Institution
(Goldstein) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center - Cardiothoracic Surgery, New York, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction : A search for strategies to address saphenous vein graft
(SVG) failure-the main factor limiting the long-term success of coronary
bypass grafting-has led to trialing of external stenting technologies.
Areas covered : The manuscript covers historical development and current
status of external scaffolding for the treatment of SVG intimal
hyperplasia. Comprehensive literature review and personal communication
with VGS leadership, the developer of the VEST device, served as the
sources. Expert opinion : If the external scaffolding concept proves to be
successful in mitigating the intimal hyperplasia inherent to arterialized
saphenous vein conduits, it could have a dramatic impact on the recurrence
of anginal symptoms, the need for repeat revascularization, and the
incidence of myocardial infarction following CABG surgery. These laudable
sequelae could ultimately convey significant public health repercussions
by reducing healthcare resource use and improving the long-term survival
and quality of life of CABG recipients. Copyright © 2021 Informa
UK Limited, trading as Taylor & Francis Group.

<13>
Accession Number
2015286879
Title
TCT-116 Impact of Optimal Medical Therapy on 10-Year Mortality After
Coronary Revascularization.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B49), 2021. Date of Publication: 09
Nov 2021.
Author
Kawashima H.; Serruys P.; Ono M.; McEvoy J.; Onuma Y.
Institution
(Kawashima) Teikyo University Hospital, Tokyo, Japan
(Serruys, Ono, Onuma) Department of Cardiology, Saolta Group, Galway
University Hospital, Health Service Executive and National University of
Ireland Galway (NUIG), Galway, Ireland
(McEvoy) Department of Cardiology, National University of Ireland, Galway
(NUIG), Galway, Ireland
Publisher
Elsevier Inc.
Abstract
Background: The benefit of optimal medical therapy (OMT) on 5-year
outcomes in patients with 3-vessel (3VD) or left main (LM) disease after
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) was demonstrated in the randomized SYNTAX trial. The
objective of this analysis is to assess the impact of the status of OMT at
5 years on 10-year mortality after PCI or CABG. Method(s): This is a
subanalysis of the SYNTAXES study, which evaluated the vital status up to
10 years of patients who were originally enrolled in the SYNTAX trial. OMT
was defined as the combination of 4 types of medications: at least 1
antiplatelet drug, statin, angiotensin-converting enzyme inhibitor or
angiotensin receptor blocker, and beta blocker. After stratifying
participants by the number of individual OMT agents at 5 years and
randomized treatment, we conducted a landmark analysis to assess the
association between treatment response and 10-year mortality.
 Result(s): In 1,472 patients, patients on OMT at 5 years had a
significantly lower mortality at 10 years compared with those on <= 2
types of medications (13.1% vs 19.9%; adjusted hazard ratio [aHR]: 0.470;
95% confidence interval [CI]: 0.292-0.757; P = 0.002) but had a mortality
similar to those on 3 types of medications. Furthermore, patients
undergoing CABG with the individual OMT agents, antiplatelet drugs, and
statins, at 5 years had lower 10-year mortality than those without.
 Conclusion(s): In patients with 3VD or LM undergoing PCI or CABG,
medication status at 5 years had a significant impact on 10-year
mortality. Patients on OMT with guideline-recommended pharmacologic
therapy at 5 years had a survival benefit. Categories: CORONARY: Complex
and Higher-Risk Procedures for Indicated Patients (CHIP) Copyright
© 2021

<14>
Accession Number
2015286416
Title
TCT-13 Ten-Year Follow-Up After Revascularization in Elderly Patients With
Complex Coronary Artery Disease.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B6-B7), 2021. Date of Publication: 09
Nov 2021.
Author
Ono M.; Serruys P.; Hara H.; Kawashima H.; Gao C.; Wang R.; Takahashi K.;
O'Leary N.; Garg S.; Mack M.; Holmes D.; Morice M.-C.; Kappetein P.;
Thuijs D.; Noack T.; Davierwala P.; Mohr F.-W.; Onuma Y.
Institution
(Ono, Serruys, Onuma) Department of Cardiology, Saolta Group, Galway
University Hospital, Health Service Executive and National University of
Ireland Galway (NUIG), Galway, Ireland
(Hara) National University of Ireland Galway, Galway, Ireland
(Kawashima) National University of Ireland Galway, Galway, Ireland
(Gao) Xijing Hospital, Xi'an, Shaanxi, China
(Wang) Xijing Hospital, Xi'an, Shaanxi, China
(Takahashi) Academic Medical Center, Amsterdam, Netherlands
(O'Leary) National University of Ireland, Galway (NUIG), Galway, Ireland
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Mack) Baylor Scott & White-The Heart Hospital-Plano, Plano, TX, United
States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Morice) CERC, Massy, France
(Kappetein) Medtronic, Fridley, MN, United States
(Thuijs) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, Netherlands
(Noack, Mohr) Heart Center Leipzig, Leipzig, Germany
(Davierwala) University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: The optimal revascularization strategy for the elderly with
complex coronary artery disease remains unclear. We aimed to investigate
10-year all-cause mortality, life expectancy, 5-year major adverse cardiac
or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after
percutaneous coronary intervention (PCI) or coronary artery bypass graft
(CABG) in elderly (> 70 years old) with 3-vessel disease (3VD) or
left-main disease (LMD). Method(s): In the present pre-specified
analysis on age of the SYNTAX Extended Survival study, 10-year all-cause
death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox
proportional hazards models among elderly or nonelderly patients. Life
expectancy was estimated by restricted mean survival time within 10 years,
whereas QOL status up to 5 years according to the Seattle Angina
Questionnaire, was assessed by linear mixed-effects models.
 Result(s): Among 1,800 randomized patients, 575 patients (31.9%) were
elderly. Ten-year mortality did not differ significantly between PCI and
CABG in elderly (44.1% vs 41.1%; hazard ratio [HR]: 1.08; 95% confidence
interval [CI]: 0.84-1.40) and nonelderly patients (21.1% vs 16.6%; HR:
1.30; 95% CI: 1.00-1.69; P interaction = 0.332). Among elderly patients,
5-year MACCE were comparable between PCI and CABG (39.4% vs 35.1%; HR:
1.18; 95% CI: 0.90-1.56), whereas it was significantly higher in PCI over
CABG among nonelderly patients (36.3% vs 23.0%; HR: 1.69; 95% CI:
1.36-2.10; P interaction = 0.043). There was no significant difference in
life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4
to 0.7) and 5-year QOL status between PCI and CABG among elderly patients.
 Conclusion(s): Elderly patients with 3VD or LMD had comparable
10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL
status irrespective of revascularization mode. Categories: CORONARY:
Stents: Drug-Eluting Copyright © 2021

<15>
Accession Number
2015285876
Title
TCT-51 Complete Cerebral Protection via Left Radial Approach During
Transcatheter Aortic Valve Replacement: Results From the PROTEMBO C Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B20-B21), 2021. Date of Publication:
09 Nov 2021.
Author
Jagielak D.; Targonski R.; Schmidt T.; Frerker C.; Abdel-Wahab M.; Wilde
J.; Lauterbach M.; Leick J.; Grygier M.; Misterski M.; Erglis A.; Narbute
I.; Witkowski A.; Adam M.; Frank D.; Gatto F.; Werner N.
Institution
(Jagielak) Uniwersyteckie Centrum Kliniczne, Gdansk, Poland
(Targonski) Clinical Cardiologist, Gdansk, Poland
(Schmidt) Universitatsklinikum Lubeck, Lubeck, Germany
(Frerker) UKSH Lubeck Germany, Cologne, Germany
(Abdel-Wahab) Heart Center Leipzig, University Hospital, Leipzig, Germany
(Wilde) Heart Center Leipzig at the University of Leipzig, Leipzig,
Germany
(Lauterbach, Leick, Werner) Krankenhaus der Barmherzigen Bruder Trier,
Trier, Germany
(Grygier) Poznan University of Medical Sciences, Poznan, Poland
(Misterski) Department of Cardiac Surgery, Poznan University of Medical
Sciences, Poznan, Poland
(Erglis) Pauls Stradins Clinical University Hospital, University of
Latvia, Riga, Latvia
(Narbute) Pauls Stradins Clinical University Hospital, University of
Latvia, Riga, Latvia
(Witkowski) Department of Interventional Cardiology and Angiology,
National Institute of Cardiology, Warsaw, Poland
(Adam) University Hospital Cologne, Cologne, Germany
(Frank) UKSH University Clinical Center Schleswig-Holstein, Kiel, Germany
(Gatto) HerzZentrum Saar, Saarlouis, Germany
Publisher
Elsevier Inc.
Abstract
Background: The objective of the PROTEMBO C Trial was to evaluate the
safety and performance of the ProtEmbo Cerebral Protection System
(Protembis) in 60 patients during transcatheter aortic valve replacement
(TAVR) (NCT04618718). At the time of this report, the primary endpoints
were met early, with 35 subjects enrolled in the study. Method(s):
The primary safety endpoint was the rate of major adverse cardiac and
cerebrovascular events (MACCE) at 30 days defined by Valve Academic
Research Consortium (VARC)-2 criteria. The primary performance endpoint
was defined as the rate of technical success. The performance goals were
established based upon data from randomized controlled trials of similar
embolic protection devices. The secondary objective was to assess the
efficacy of the device by comparing the new diffusion-weighted magnetic
resonance imaging (DW-MRI) lesion volume in the brain and the rate of
death or all strokes to historical data. Result(s): Both primary
safety and performance endpoints were met early in this study. The MACCE
rate at 30 days was 8.6% (upper limit of the 95% confidence interval =
22.4%; 2.6% below the predefined performance goal of 25%; P = 0.0124) (3
MACCE events in 35 patients in the safety cohort). Performance success was
achieved in 93.8% of patients (lower limit of the 95% confidence interval
= 79.9%; 4.9% above the predefined performance goal of 75%; P = 0.0072)
(30 of 32 successful procedures in the intention-to-treat cohort). The
volume of new DW-MRI lesions after use of the ProtEmbo was reduced
compared with historical data. There were no deaths or strokes in the per
protocol cohort of the study; 1 single cerebral infarct was observed in
the safety cohort in a patient in whom the device was removed prematurely,
and no cerebral protection was used during final positioning and
post-dilatation of the valve prosthesis. Conclusion(s): The primary
safety and performance endpoints of the PROTEMBO C trial were met. The
device was easy to use and fits into the workflow of TAVR procedures. Use
of the ProtEmbo was associated with a reduction in the volume of new
DW-MRI lesions in comparison with historical data. Final results of the
study including DW-MRI results will be presented for the first time at TCT
2021. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2021

<16>
Accession Number
2015285671
Title
Impact of Diabetes Mellitus on the Effectiveness of Aspirin Versus
Clopidogrel as a Chronic Maintenance Antiplatelet Monotherapy After
Percutaneous Coronary Intervention: Results From the HOST-EXAM Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B4), 2021. Date of Publication: 09
Nov 2021.
Author
Rhee T.-M.; Kang J.; Woo (KW) Park K.; Yang H.-M.; Won K.-B.; Rha S.-W.;
Bae J.W.; Lee N.H.; Hur S.-H.; Yoon J.; Park T.-H.; Kim B.S.; Lim S.W.;
Cho Y.H.; Jeon D.W.; Kim S.-H.; Han K.-R.; Moon K.-W.; Oh S.-K.; Kim U.;
Rhee M.-Y.; Kim D.-I.; Lee S.; Lee S.U.; Kim S.-W.; Kim S.-Y.; Jeon H.-K.;
Cha K.S.; Jo S.-H.; Ryu J.K.; Suh I.-W.; Choi H.H.; Woo S.-I.; Chae I.-H.;
Shin W.-Y.; Kim D.-K.; Oh J.H.; Jeong M.H.; Kim Y.H.; Han J.-K.; Shin
E.-S.; Koo B.-K.; Kim H.-S.
Institution
(Rhee, Kang, Woo (KW) Park, Han, Koo, Kim) Seoul National University
Hospital, Seoul, South Korea
(Yang) Seoul National University Hospital, Seoul, South Korea
(Won) Ulsan University, Ulsan, South Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Bae) Chungbuk National University Hospital, Chungbuk, South Korea
(Lee) Kangnam Sacred Heart Hospital, Seoul, South Korea
(Hur) Keimyung University Dongsan Medical Center, Daegu, South Korea
(Yoon) Yonsei University Wonju Severance Hospital, Wonju, South Korea
(Park) Dong-A University Hospital, Busan, South Korea
(Kim) Sang wook Lim- Bundang CHA medical center, CHA university, Sungnam,
South Korea
(Lim) Bundang CHA Medical Center, CHA University, Sungnam, South Korea
(Cho) Soonchunhyang University Hospital, Busan, South Korea
(Jeon) National Health Insurance Ilsan Hospital, Gyeonggi, South Korea
(Kim) Seoul Boramae Center, Seoul, South Korea
(Han) Kangdong Sacred Heart Hospital, Seoul, South Korea
(Moon) Oh -Wonkwang University School of Medicine, Iksan, South Korea
(Oh) Wonkwang University School of Medicine, Iksan, South Korea
(Kim) Yeungnam University Hospital, Daegu, South Korea
(Rhee) Dongguk University Ilsan Hospital, Ilsan, South Korea
(Kim) Inje University Haeundae Paik ospital, Busan, South Korea
(Kim) Jeju National University Hospital, Jeju-Si, Jeju-Do, South Korea
(Lee) Ilsan Paik Hospital, Seoul, South Korea
(Lee) Kwangju Christian Hospital, Gwangju, South Korea
(Kim) Chung-Ang University Hospital, Seoul, South Korea
(Kim) Seoul Medical Center, Seoul, South Korea
(Jeon) Uijeongbu St. Mary's Hospital, Uijongbu, South Korea
(Cha) Pusan National University Hospital, Pusan, South Korea
(Jo) Hallym University Sacred Heart Hospital, Anyang-si, South Korea
(Ryu) Cardiology Daegu Catholic University Hospital, Daegu, South Korea
(Suh) XXX
(Choi) Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
(Woo) Inha University Hospital, Incheon, South Korea
(Chae) Seoul National University Bundang Hospital, Seongnamsi, South Korea
(Shin) Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
(Kim) Busan Paik Hospital, Busan, South Korea
(Oh) Samsung Changwon Hospital, Changwon, South Korea
(Jeong) Chonnam National University Hospital, Gwangju, South Korea
(Kim) Kangwon National University School of Medicine, Chuncheon City,
South Korea
(Shin) Ulsan University Hospital, Ulsan, South Korea
Publisher
Elsevier Inc.
Abstract
Background: The Extended Antiplatelet Monotherapy (HOST-EXAM) randomized
trial reported a significant risk reduction of clopidogrel monotherapy
compared with aspirin for the 2-year composite primary endpoint of
all-cause death, nonfatal myocardial infarction (MI), stroke, readmission
due to acute coronary syndrome, and major bleeding in patients who had
completed the dual antiplatelet therapy (DAPT) after coronary stenting. In
this pre-specified subgroup analysis, we investigated whether this result
is consistent in patients with diabetes mellitus (DM). Method(s): The
study population included patients who received DAPT without any clinical
event for 12 +/- 6 months after coronary stenting. We randomized patients
to clopidogrel or aspirin monotherapy group in a 1:1 ratio and stratified
by the presence of DM. The primary endpoint was a composite of all-cause
death, MI, and stroke at 2 years. [Formula presented] Results: The rate of
the primary composite endpoint was significantly lower in the clopidogrel
group compared with the aspirin group (5.4% vs 3.1%; hazard ratio: 0.56
[0.35-0.89]; P = 0.014) in patients with diabetes, whereas the rate was
similar in nondiabetic patients, showing significant interaction (P for
interaction = 0.040). The results were mainly driven by the significant
risk reduction of MI and stroke in the clopidogrel group for patients with
diabetes. The type of treatment or the control status of DM did not affect
the results significantly. Conclusion(s): As a chronic maintenance
after DAPT for coronary stenting, clopidogrel monotherapy significantly
reduced the 2-year risk of the composite of all-cause death, MI, and
stroke only in patients with diabetes compared with aspirin monotherapy.
Categories: CORONARY: Pharmacology and Pharmacotherapy Copyright
© 2021

<17>
Accession Number
2015285669
Title
TCT-236 Short- and Mid-Term Clinical Outcomes of Transcatheter Tricuspid
Valve Repair for Tricuspid Regurgitation: Systematic Review and
Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B96), 2021. Date of Publication: 09
Nov 2021.
Author
Sayed A.; Awad A.; El-Shahat N.; Said K.; Moustafa K.; Mahdi A.; Okasha
O.; Souka A.; Saleh Y.; Abdelfattah O.
Institution
(Sayed, Awad) Ain Shams University, Cairo, Egypt
(El-Shahat) Al-Azhar University, Cairo, Egypt
(Said) Alexandria University, Kafr Eldawar, Egypt
(Moustafa) Alexandria University, Alexandria, Egypt
(Mahdi) University of Kansas School of Medicine, Wichita, KS, United
States
(Okasha) University of Missouri Kansas City, Kansas City, MO, United
States
(Souka) University of Cincinnati, Cincinnati, OH, United States
(Saleh) Houston Methodist, Houston, TX, United States
(Abdelfattah) Morristown Medical Center, Morristown, NJ, United States
Publisher
Elsevier Inc.
Abstract
Background: Tricuspid regurgitation (TR) commonly occurs as a complication
of elevated pulmonary pressures resulting from heart failure (HF),
valvular disease, or lung disease. Recently, transcatheter tricuspid valve
repair (TTVR) has been adopted as an alternative to surgical repair. We
sought to summarize the short- and mid-term clinical outcomes of patients
undergoing TTVR. Method(s): We systematically searched Medline/PubMed
and CENTRAL for studies reporting on TTVR. Outcomes of interest included
mortality, hospitalization, and New York Heart Association (NYHA)
functional class III/IV reduction. We used a random-intercept logistic
regression model to calculate the percentage of patients experiencing each
outcome at different follow-up intervals after TTVR. Result(s): A
total of 47 studies (n = 3,811) were included. TTVR was associated with
relatively low procedural/in-hospital mortality (1.41%; 95% CI:
0.66%-3.02%). However, mortality at 1 year (19.31%; 95% CI: 14.70%-24.93%)
remained relatively high. HF hospitalization rates in the first 30 days
after TTVR were relatively low (1.85%; 95% CI: 0.39%-8.34%), but increased
significantly at 1 year (25.71%; 95% CI: 21.20%-30.81%). Improvements in
NYHA functional classification were sustainable up to 1 year following
TTVR (60.43%; 95% CI: 56.03%-64.66%). [Formula presented]
 Conclusion(s): TTVR was associated with high mortality and morbidity
at midterm follow-up, despite a significant reduction in NYHA functional
classification. Further studies are warranted to determine long-term
outcomes. Categories: STRUCTURAL: Valvular Disease:
Tricuspid Copyright © 2021

<18>
Accession Number
2015285490
Title
TCT-109 Ten-Year All-Cause Death After Percutaneous or Surgical
Revascularization in Diabetic Patients With Complex Coronary Artery
Disease.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B46), 2021. Date of Publication: 09
Nov 2021.
Author
Wang R.; Gao C.; Hara H.; Takahashi K.; Ono M.; Kawashima H.; O'Leary N.;
Holmes D.; Van Geuns R.-J.; Kappetein A.; Morel M.-A.; Thuijs D.;
Davierwala P.; O'Brien T.; Fuster V.; Garg S.; Onuma Y.; Serruys P.
Institution
(Wang) Xijing hospital, Xi'an, Shaanxi, China
(Gao) Xijing Hospital, Xi'an, Shaanxi, China
(Hara, Morel, O'Brien) National University of Ireland, Galway, Galway,
Ireland
(Takahashi) Academic Medical Center, Amsterdam, Netherlands
(Ono, Onuma, Serruys) Department of Cardiology, Saolta Group, Galway
University Hospital, Health Service Executive and National University of
Ireland Galway (NUIG), Galway, Ireland
(Kawashima) National University of Ireland Galway, Ireland
(O'Leary) National University of Ireland, Galway (NUIG), Galway, Ireland
(Holmes) Mayo Clinic, Rochester, MN, United States
(Van Geuns) Radboud University Medical Center, Nijmegen, Netherlands
(Kappetein) Thoraxcenter Erasmus MC, Rotterdam, Netherlands
(Thuijs) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, Netherlands
(Davierwala) University of Toronto, Toronto, ON, Canada
(Fuster) Mount Sinai Medical Center, New York, NY, United States
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Randomized trials have shown that coronary artery bypass graft
surgery (CABG) is superior to percutaneous coronary intervention (PCI) in
patients with diabetes and multivessel disease in terms of
patient-oriented composite endpoints. However, whether CABG results in an
improved survival in the very long term, compared with PCI with
drug-eluting stents (DES) in patients with diabetes and complex coronary
disease remains to be ascertained. Method(s): The SYNTAXES study
evaluated up to 10-year survival of 1,800 patients with the 3-vessel
disease (3VD) or left main coronary artery disease (LMCAD), randomized to
receive either PCI or CABG in the SYNTAX trial. Ten-year all-cause death
according to diabetic status and revascularization strategy was examined.
 Result(s): In patients with diabetes (n = 452), the risk of mortality
was numerically higher with PCI compared with CABG at 5 years (19.6% vs
13.3%; hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 0.96, 2.43;
P = 0.075), with the opposite seen between 5 to 10 years (PCI vs CABG:
20.8% vs 24.4%; HR: 0.82; 95% CI: 0.52, 1.27; P = 0.366). Irrespective of
diabetic status, there was no significant difference in all-cause death at
10 years between patients receiving PCI or CABG; the absolute treatment
difference was 1.9% in patients with diabetes (PCI vs CABG: 36.4% vs
34.5%, difference: 1.9%; 95% CI: -7.6%, 11.1%; P = 0.551). Among
insulin-treated patients (n = 182), all-cause death at 10 years was
numerically higher with PCI (47.9% vs 39.6%, difference: 8.2%; 95% CI:
-6.5%, 22.5%; P = 0.227). Conclusion(s): The treatment effects of PCI
versus CABG on all-cause death at 10 years in patients with 3VD or LMCAD
were similar irrespective of the presence of diabetes. There may, however,
be a survival benefit with CABG in patients with insulin-treated diabetes.
The association between revascularization strategy and very long-term
ischemic and safety outcomes for patients with diabetes needs further
investigation in dedicated trials. Categories: OTHER: Diabetes, Lipid
Disorders, and Risk-Factor Management Copyright © 2021

<19>
Accession Number
2015266862
Title
Next-Day Discharge vs Early Discharge After Transcatheter Aortic Valve
Replacement: Systematic Review and Meta-Analysis.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
100998. Date of Publication: 2021.
Author
Gupta R.; Mahajan S.; Mehta A.; Nyaeme M.; Mehta N.A.; Cheema A.; Khanal
L.; Malik A.H.; Aronow W.S.; Vyas A.V.; Mehta S.S.; Patel N.C.
Institution
(Gupta, Vyas, Patel) Lehigh Valley Heart Institute, Lehigh Valley Health
Network, Allentown, PA, United States
(Mahajan, Mehta, Nyaeme, Cheema, Khanal) Department of Internal Medicine,
Carle Foundation Hospital, Urbana, IL, United States
(Mehta) Department of Cardiology, University of Missouri Kansas City,
Kansas City, MO, United States
(Malik, Aronow) Department of Cardiology, Westchester Medical Center and
New York Medical College, Valhalla, NY, United States
(Mehta) Heart and Vascular Institute, Carle Foundation Hospital, Urbana,
IL, United States
Publisher
Elsevier Inc.
Abstract
With the growing utilization of transcatheter aortic valve replacement
(TAVR) as an alternative option to surgical valve replacement (SAVR) in
patients considered to be suboptimal for surgery, there is a need to
explore the possibility of next day discharge (NDD) and its potential
outcomes. The aim of our study is to compare outcomes and complications
following NDD vs the standard early discharge (ED) (less than 3 days). A
comprehensive literature search was performed in PubMed, Embase, and
Cochrane to identify relevant trials. Summary effects were calculated
using a DerSimonian and Laird random effects model as odds ratio with 95%
confidence intervals for all the clinical endpoints. Studies comparing
same-day or next-day discharge vs discharge within the next three days
were included in our analysis. 6 studies with 2,672 patients were
identified. The risk of bleeding and vascular complications was
significantly lower in patients with NDD compared to ED (OR 0.10, P <
0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent
pacemaker (PPM) implants was significantly lower in patients who had NDD
compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality,
stroke, AKI and readmission rates was not different between the two
groups. NDD after TAVR allows for reduction in hospital stay and can
mitigate hospital costs without an increased risk of complications. Our
analysis shows that complication rate is comparable to ED, NDD is a
reasonable option for certain patients with severe aortic stenosis who
undergo TAVR. Further studies are needed to elucidate whether higher risk
patients who would benefit from an extended inpatient monitoring post
TAVR. Copyright © 2021 Elsevier Inc.

<20>
Accession Number
2015265708
Title
Lung Ultrasound for Detecting Tracheal and Mainstem Intubation: A
Systematic Review and Meta-Analysis.
Source
Ultrasound in Medicine and Biology. (no pagination), 2021. Date of
Publication: 2021.
Author
Yang F.M.; Ma B.Z.; Liu Y.; Sun Q.; Li N.; Feng S.Y.; Wang W.J.
Institution
(Yang, Ma, Sun, Li, Feng, Wang) Emergency Department, Cangzhou Central
Hospital, Cangzhou City, China
(Liu) Anesthesiology Department, Cangzhou People's Hospital, Cangzhou
City, China
Publisher
Elsevier Inc.
Abstract
Precise positioning of the left or right main bronchus is a prerequisite
for effective lung isolation in thoracic surgeries. This study aimed to
clarify the ability of lung ultrasound to detect tracheal and mainstem
intubation. Studies that investigated the ability of lung ultrasound to
detect tracheal and mainstem intubation were searched from PubMed and
ScienceDirect databases from their inception to March 2021. The pooled
accuracy of this method and its sensitivity and specificity were computed
with a fixed-effects model using Stata 14.0. Nine eligible articles that
involved a total of 617 participants were included in this systematic
review and meta-analysis. Overall, the accuracy of lung ultrasound in
detecting tracheal and mainstem intubation was 86.7%, with a sensitivity
of 93.0% and a specificity of 75.0%. Subgroup analysis revealed that the
accuracy remained high regardless of patient age, ultrasonic method,
sample size, study design or ultrasonic skills training. Sensitivity
analysis indicated that the results were stable. Deeks' test showed no
publication bias. These findings imply that lung ultrasound is an
effective method for detecting tracheal and mainstem
intubation. Copyright © 2021 World Federation for Ultrasound in
Medicine & Biology

<21>
Accession Number
2012008231
Title
Comparison of High-Flow Humidified Oxygen With Conventional Continuous
Positive Airway Pressure in Nonventilated Lungs During Thoracic Surgery: A
Randomized Cross-Over Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(10) (pp 2945-2951),
2021. Date of Publication: October 2021.
Author
Sawasdiwipachai P.; Weerayutwattana R.; Thongcharoen P.; Suksompong S.
Institution
(Sawasdiwipachai, Suksompong) Department of Anesthesiology, Faculty of
Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
(Weerayutwattana) Department of Anesthesiology, Faculty of Medicine,
Vajira Hospital, Bangkok, Thailand
(Thongcharoen) Division of Cardiothoracic Surgery, Department of Surgery,
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok,
Thailand
Publisher
W.B. Saunders
Abstract
Objective: This study assessed the efficacy of high-flow humidified oxygen
(HFHO) as an alternative to continuous positive airway pressure (CPAP) for
improving oxygenation while preserving nonventilated lung collapse during
one-lung ventilation. Design(s): A prospective randomized cross-over
trial. Setting(s): A tertiary medical center. Participant(s):
The study comprised 28 patients undergoing elective thoracotomy with
one-lung ventilation using a double-lumen endobronchial tube placement.
 Intervention(s): The patients received prophylactic CPAP or HFHO to
the nonventilated lung for 20 minutes and were then crossedover to the
other oxygenation modality for 20 minutes, with a 20-minute recovery
interval between the two modalities. Measurements and Main Results:
Changes in respiratory parameters and lung deflation quality were
recorded. Both CPAP and HFHO increased the partial pressure of arterial
oxygen in either sequence in both groups, ranging from 31.8-to-66.0 mmHg.
However, the increments from these two interventions were not
statistically significant (95% confidence interval -12.84 to 21.87; p =
0.597). There were no differences in other parameters. Half the patients
receiving CPAP experienced worsening of the surgical condition, whereas
the HFHO patients experienced no change or reported a better lung
deflation (p < 0.001). Conclusion(s): HFHO could be an alternative
method to CPAP for improving arterial oxygenation while preserving lung
deflation during one-lung ventilation. However, additional studies are
warranted in regard to its cost-effectiveness and establishment as a
routine treatment. Copyright © 2021 Elsevier Inc.

<22>
Accession Number
2010747575
Title
Serratus Anterior Plane Block and Erector Spinae Plane Block Versus
Thoracic Epidural Analgesia for Perioperative Thoracotomy Pain Control: A
Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(10) (pp 2928-2936),
2021. Date of Publication: October 2021.
Author
Elsabeeny W.Y.; Ibrahim M.A.; Shehab N.N.; Mohamed A.; Wadod M.A.
Institution
(Elsabeeny, Ibrahim, Shehab, Wadod) Department of Anesthesia and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
(Mohamed) Department of Surgical Oncology, National Cancer Institute,
Cairo University, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objectives: This study was designed to evaluate the safety and efficacy of
erector spinae plane block and serratus anterior plane block versus
thoracic epidural in perioperative pain control for patients with cancer
undergoing lung surgeries. Design(s): Single blinded, randomized,
controlled trial. Setting(s): The study was carried out at the
National Cancer Institute in Cairo, Egypt. Participant(s): Fifty-one
patients with cancer. Intervention(s): Patients were allocated
randomly into three groups: thoracic epidural analgesia (TEA) group,
serratus anterior plane block (SAPB) group, and erector spinae plane block
(ESPB) group. Measurements and Main Results: Outcome measures were 24
hours postoperative visual analog scale (VAS), intraoperative rescue
fentanyl consumption, perioperative heart rate, mean blood pressure (mean
arterial pressure [MAP]), and total postoperative morphine consumption.
VAS scores at rest were significantly lower in the TEA group at the
postanesthesia care unit and 24 hours. VAS scores with cough were
significantly higher in the SAPB group at eight and 24 hours. The first
time to receive morphine was significantly longer in the TEA group. No
patients in the TEA group required postoperative morphine, whereas 88.2%
and 47.1% required morphine in the SAPB and ESPB groups, respectively, p <
0.001. In the TEA group, intraoperative MAP values were lower than the
other two groups, p < 0.05. Conclusion(s): Erector spinae plane block
can be used as an effective and safe alternative to thoracic epidural
analgesia and shows superior analgesic profile to serratus anterior plane
block for patients with lung cancer undergoing posterolateral
thoracotomy. Copyright © 2021 Elsevier Inc.

<23>
Accession Number
2010719386
Title
Randomized controlled trial of energy healing effects on pain and anxiety
in AIS posterior surgery: a pilot study.
Source
Spine Deformity. 9(4) (pp 1029-1034), 2021. Date of Publication: July
2021.
Author
McNeil N.; Bastrom T.P.; Bartley C.E.; Yaszay B.; Upasani V.V.; Newton
P.O.
Institution
(McNeil, Bastrom, Bartley, Yaszay, Upasani, Newton) Rady Children's
Hospital, 3020 Children's Way, MC 5063, San Diego, CA 92123, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: Energy healing (EH) is a part of the diverse group of
Complementary and Alternative Medicines (CAM). The purpose of this study
was to evaluate the effects of EH therapy prior to and following posterior
surgical correction for adolescent idiopathic scoliosis (AIS) compared to
controls. Method(s): Patients were prospectively randomized to one of
two groups: standard operative care for surgery (controls) vs. standard
care with the addition of three EH sessions. The outcomes included visual
analog scales (VAS) for pain and anxiety (0-10), days until conversion to
oral pain medication, and length of hospital stay. For the experimental
group, VAS was assessed pre- and post-EH session. Result(s): Fifty
patients were enrolled-28 controls and 22 EH patients. The controls had a
median of 12 levels fused vs. 11 in the EH group (p = 0.04). Pre-operative
thoracic and lumbar curve magnitudes were similar (p > 0.05). Overall VAS
pain scores increased from pre- to post-operative (p < 0.001), whereas the
VAS anxiety scores decreased immediately post-operative (p < 0.001). The
control and pre-EH assessments were statistically similar. Significant
decreases in VAS pain and anxiety scores from pre to post-EH assessment
were noted for the EH group. Both groups transitioned to oral pain
medication a median of 2 days post-operative (p = 0.11). The median days
to discharge was four in the controls and three in the EH group (p =
0.07). Conclusion(s): In this pilot study, EH therapy resulted in a
decrease in patient's pre-operative anxiety. Offering this CAM modality
may enhance the wellbeing of the patient and their overall recovery when
undergoing posterior surgical correction for AIS. Level of Evidence:
Therapeutic Level II. Copyright © 2021, Scoliosis Research
Society.

<24>
Accession Number
2013846371
Title
Parental Post-traumatic Stress and Healthcare Use in Infants with Complex
Cardiac Defects.
Source
Journal of Pediatrics. 238 (pp 241-248), 2021. Date of Publication:
November 2021.
Author
Golfenshtein N.; Hanlon A.L.; Lozano A.J.; Srulovici E.; Lisanti A.J.; Cui
N.; Medoff-Cooper B.
Institution
(Golfenshtein, Srulovici) Department of Nursing, University of Haifa,
Haifa, Israel
(Hanlon, Lozano) Center for Biostatistics and Health Data Science,
Virginia Tech, Roanoke, VA, United States
(Lisanti) Center for Pediatric Nursing Research & Evidence-Based Practice,
Children's Hospital of Philadelphia, Philadelphia, PA, United States
(Cui) School of Nursing & Rehabilitation, Shandong University, Jinan,
Shandong Province, China
(Medoff-Cooper) University of Pennsylvania, School of Nursing,
Philadelphia, PA, United States
(Medoff-Cooper) Children's Hospital of Philadelphia, Philadelphia, PA,
United States
Publisher
Elsevier Inc.
Abstract
Objective: To examine the associations between post-traumatic stress of
parents of infants with complex congenital heart defects and their
healthcare use for their infants during the early months of life. Study
design: The current study is a secondary data analysis from a randomized
controlled trial in which 216 parent-infant dyads were recruited from 3
cardiac intensive care units of large pediatric centers in Northeastern
America. The current sample included 153 dyads with post-traumatic stress
data at hospital discharge and at 4-months' follow-up. Poisson regressions
were used to estimate the effect of post-traumatic stress change scores on
number of emergency department (ED) visits, unscheduled cardiologist
visits, and unscheduled pediatrician visits outcomes. Result(s):
Infants whose parents gained post-traumatic stress disorder over the study
period were at increased risk for ED visits and unscheduled cardiologist
visits. Increased symptom severity predicted more unscheduled cardiologist
visits and more unscheduled pediatrician visits. Increased symptom
clusters (avoidance, arousal, re-experiencing) predicted more ED visits,
more unscheduled cardiologist visits, and more unscheduled pediatrician
visits. Conclusion(s): Parents of infants with cardiac conditions may
experience post-traumatic stress following cardiac surgery, which can be
linked to greater healthcare use. Findings highlight the importance of
screening and treating post-traumatic stress to preserve parental mental
health and prevent adverse outcomes. Copyright © 2021 Elsevier
Inc.

<25>
Accession Number
2013842897
Title
To understand a meta-analysis, best read the fine print.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Greason K.L.
Institution
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
Publisher
John Wiley and Sons Inc
Abstract
The results of a meta-analysis are more than just the reported odds ratio,
95% confidence interval (CI), and p value. Of equal importance is the fine
print of the study which should include assessment of the risk of bias,
certainty in evidence, and heterogeneity in the individual point estimates
and CIs. These areas all have an influence on the quality of the data in
the analysis. Reading and understanding the fine print is
important. Copyright © 2021 Wiley Periodicals LLC

<26>
Accession Number
2013135387
Title
Effect of levosimendan on renal function in background of left ventricular
dysfunction: a meta-analysis of randomized trials.
Source
Expert Opinion on Drug Safety. 20(11) (pp 1411-1420), 2021. Date of
Publication: 2021.
Author
Long Y.-X.; Cui D.-Y.; Kuang X.; Hu Y.; Hu S.; Wang C.-P.; Liu Z.-Z.
Institution
(Long, Cui, Kuang, Hu, Hu, Wang, Liu) Department of Cardiology, The Second
Affiliated Hospital of Chongqing Medical University, Chongqing, China
Publisher
Taylor and Francis Ltd.
Abstract
Objective: Levosimendan, an inotrope, is widely used in the management of
heart failure (HF) and cardiac surgery, but it remains uncertain whether
levosimendan can improve renal function in patients with left ventricular
dysfunction (LVD). Method(s): PubMed, Embase, and Cochrane CENTRAL
from the inception to June 2020 were systematically screened for
randomized controlled trials (RCTs) to investigate whether levosimendan
offers kidney-related advantages in cardiovascular patients with LVD. We
pooled the effects using a random-effect model. Result(s):
Twenty-eight studies enrolling 5069 patients were included. Levosimendan
reduced the sCr (SMD -0.28, 95% CI (-0.48, -0.09), P = 0.005,
I2 = 52.5%, high quality) and the risk of ARF (relative risk
0.75, 95%CI (0.60, 0.95), P = 0.017, I2 = 11.3%,
moderate-quality) in patients with LVD compared with control group. The
reduction of sCr was more pronounced in patients with a relatively higher
baseline sCr level. For secondary outcomes, levosimendan therapy was
associated with the improvement of GFR (SMD 0.32, 95%CI (-0.05, 0.68), P =
0.092, I2 = 55.1%, low-quality) and urine output (SMD 0.42,
95%CI (0.06, 0.79), P = 0.024, I2 = 50.0%, very low-quality),
but there was no significant reduction in BUN (SMD -0.14, 95%CI (-0.97,
0.70), P = 0.774, I2 = 77.9%, very low-quality).
 Conclusion(s): Levosimendan might improve renal function of patients
with LVD. Copyright © 2021 Informa UK Limited, trading as Taylor
& Francis Group.

<27>
Accession Number
2012109410
Title
Erector spinae plane block in acute interventional pain management: A
systematic review.
Source
Scandinavian Journal of Pain. 21(4) (pp 671-679), 2021. Date of
Publication: 01 Oct 2021.
Author
Viderman D.; Dautova A.; Sarria-Santamera A.
Institution
(Viderman, Sarria-Santamera) Department of Biomedical Sciences, Nazarbayev
University School of Medicine (NUSOM), Kerei-Zhanibek Str. 5/1, Nur-Sultan
010000, Kazakhstan
(Dautova) Nazarbayev University Library, Nazarbayev University,
Nur-Sultan, Kazakhstan
Publisher
De Gruyter Open Ltd
Abstract
Erector Spinae Plane Block (ESPB) was described by Forero in 2016. ESPB is
currently widely used in acute postoperative pain management. The benefits
of ESPB include simplicity and efficacy in various surgeries. The aim of
this review was to conduct a comprehensive overview of available evidence
on erector spinae plane block in clinical practice. We included randomized
controlled trials and systematic reviews reporting the ESPB in human
subjects. The review was conducted in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. Twenty-one articles including five systematic reviews and 16
randomized controlled trials were included and analyzed. ESPB appears to
be an effective, safe, and simple method for acute pain management in
cardiac, thoracic, and abdominal surgery. The incidence of side effects
has been reported to be rare. A critical issue is to make sure that new
evidence is not just of the highest quality, in form of well powered and
designed randomized controlled trials but also including a standardized
and homogeneous set of indicators that permit to assess the comparative
effectiveness of the application of ESPB in acute interventional pain
management. Copyright © 2021 Walter de Gruyter GmbH,
Berlin/Boston.

<28>
Accession Number
636245318
Title
Incidence and Outcomes of Infective Endocarditis After Transcatheter or
Surgical Aortic Valve Replacement.
Source
Journal of the American Heart Association. 10(19) (pp e020368), 2021. Date
of Publication: 05 Oct 2021.
Author
Lanz J.; Reardon M.J.; Pilgrim T.; Stortecky S.; Deeb G.M.; Chetcuti S.;
Yakubov S.J.; Gleason T.G.; Huang J.; Windecker S.
Institution
(Lanz, Pilgrim, Stortecky, Windecker) Department of Cardiology
InselspitalBern University Hospital Bern Switzerland
(Reardon) Methodist DeBakey Heart & Vascular Center Houston TX
(Deeb, Chetcuti) University of Michigan Medical Center Ann Arbor MI
(Yakubov) Riverside Methodist Hospital Columbus OH
(Gleason) Division of Cardiac Surgery, Brigham & Women's Hospital &
Harvard Medical School Boston MA
(Huang) Department of Statistics Medtronic, plc Minneapolis MN
Publisher
NLM (Medline)
Abstract
Background Data comparing the frequency and outcomes of infective
endocarditis (IE) after transcatheter (TAVR) to surgical aortic valve
replacement (SAVR) are scarce. The objective of this study is to compare
the incidence and outcomes of IE after TAVR using a supra-annular,
self-expanding platform (CoreValve and Evolut) to SAVR. Methods and
Results Data of 3 randomized clinical trials comparing TAVR to SAVR and a
prospective continued TAVR access study were pooled. IE was defined on the
basis of the modified Duke criteria. The cumulative incidence of IE was
determined by modeling the cause-specific hazard. Estimates of all-cause
mortality were calculated by means of the Kaplan-Meier method. Outcomes
are reported for the valve-implant cohort. During a mean follow-up time of
2.17+/-1.51 years, 12 (0.5%) of 2249 patients undergoing TAVR and 21
(1.1%) of 1828 patients undergoing SAVR developed IE. Patients with IE
more frequently had diabetes mellitus than those without (57.6% versus
34.2%; P=0.005). The cumulative incidence of IE was 1.01% (95% CI,
0.47%-1.96%) after TAVR and 1.58% (95% CI, 0.97%-2.46%) after SAVR
(P=0.047) at 5 years. Among patients with IE, the rate of all-cause
mortality was 27.3% (95% CI, 1.0%-53.6%) in the TAVR and 51.8% (95% CI,
28.2%-75.3%) in the SAVR group at 1 year (log-rank P=0.15). Conclusions
Pooled prospectively collected data comparing TAVR with a supra-annular,
self-expanding device to SAVR showed a low cumulative risk of IE
irrespective of treatment modality, although the risk was lower in the
TAVR implant group. Once IE occurred, mortality was high. Registration
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01240902,
NCT01586910, NCT02701283.

<29>
[Use Link to view the full text]
Accession Number
636125766
Title
No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After
Coronary Artery Bypass Grafting Surgery: Multicenter Randomized,
Controlled Trial.
Source
Circulation. 144(14) (pp 1120-1129), 2021. Date of Publication: 05 Oct
2021.
Author
Tian M.; Wang X.; Sun H.; Feng W.; Song Y.; Lu F.; Wang L.; Wang Y.; Xu
B.; Wang H.; Liu S.; Liu Z.; Chen Y.; Miao Q.; Su P.; Yang Y.; Guo S.; Lu
B.; Sun Z.; Liu K.; Zhang C.; Wu Y.; Xu H.; Zhao W.; Han C.; Zhou X.; Wang
E.; Huo X.; Hu S.
Institution
(Tian, Wang, Sun, Feng, Song, Lu, Wang, Yang, Guo, Sun, Liu, Zhang, Wu,
Xu, Zhao, Han, Zhou, Wang, Huo, Hu) Department of Surgery (M.T., H.S.,
F.L., S.G., K.L., C.H., Chinese Academy of Medical Sciences & Peking Union
Medical College, Beijing, China
(Wang) Medical Research & Biometrics Center (Yang Wang), Chinese Academy
of Medical Sciences & Peking Union Medical College, Beijing, China
(Xu) Department of Cardiology (B.X.), Chinese Academy of Medical Sciences
& Peking Union Medical College, Beijing, China
(Wang) Beijing Hospital, China (H.W.)
(Liu) Second Hospital of Hebei Medical University, China (S.L.)
(Liu) TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, China (Z.L.), Tianjin,
China
(Chen) Peking University People's Hospital, China (Y.C.), Beijing, China
(Miao) National Center for Cardiovascular Disease, China & Fuwai Hospital,
Peking Union Medical College Hospital (Q.M.), Chinese Academy of Medical
Sciences & Peking Union Medical College, Beijing, China
(Su) Beijing Chaoyang Hospital, Capital Medical University, China (P.S.)
(Lu) Department of Radiology (B.L.), Chinese Academy of Medical Sciences &
Peking Union Medical College, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Vein graft occlusion is deemed a major challenge in coronary
artery bypass grafting. Previous studies implied that the no-touch
technique for vein graft harvesting could reduce occlusion rate compared
with the conventional approach; however, evidence on the clinical benefit
and generalizability of the no-touch technique is scare. METHOD(S):
From April 2017 to June 2019, we randomly assigned 2655 patients
undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio
to receive no-touch technique or conventional approach for vein
harvesting. The primary outcome was vein graft occlusion on computed
tomography angiography at 3 months and the secondary outcomes included
12-month vein graft occlusion, recurrence of angina, and major adverse
cardiac and cerebrovascular events. The generalized estimate equation
model was used to account for the cluster effect of grafts from the same
patient. RESULT(S): During the follow-up, 2533 (96.0%) participants
received computed tomography angiography at 3 months after coronary artery
bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch
group had significantly lower rates of vein graft occlusion than the
conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57
[95% CI, 0.41-0.80]; P<0.001) and 12 months (3.7% versus 6.5%; odds ratio,
0.56 [95% CI, 0.41-0.76]; P<0.001). Recurrence of angina was also less
common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio,
0.55 [95% CI, 0.35-0.85]; P<0.01). Rates of major adverse cardiac and
cerebrovascular events were of no significant difference between the 2
groups. The no-touch technique was associated with higher rates of leg
wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds
ratio, 2.55 [95% CI, 1.85-3.52]; P<0.001). CONCLUSION(S): Compared
with the conventional vein harvesting approach in coronary artery bypass
grafting, the no-touch technique significantly reduced the risk of vein
graft occlusion and improved patient prognosis. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier: NCT03126409.

<30>
[Use Link to view the full text]
Accession Number
636055503
Title
Teprasiran, a Small Interfering RNA, for the Prevention of Acute Kidney
Injury in High-Risk Patients Undergoing Cardiac Surgery: A Randomized
Clinical Study.
Source
Circulation. 144(14) (pp 1133-1144), 2021. Date of Publication: 05 Oct
2021.
Author
Thielmann M.; Corteville D.; Szabo G.; Swaminathan M.; Lamy A.; Lehner
L.J.; Brown C.D.; Noiseux N.; Atta M.G.; Squiers E.C.; Erlich S.;
Rothenstein D.; Molitoris B.; Mazer C.D.
Institution
(Thielmann) Department of Thoracic and Cardiovascular Surgery, West-German
Heart and Vascular Center Essen, University Duisburg-Essen, Germany (M.T.)
(Corteville) Sands Constellation Heart Institute, Rochester Regional
Health, Rochester
(Szabo) Central German Heart Center University Hospital Halle (Saale),
University Clinic and Polyclinic for Cardiac Surgery, Germany (G.S.),
Halle, Belgium
(Swaminathan) Division of Cardiothoracic Anesthesiology and Critical Care
Medicine, Duke University Medical Center, Durham
(Lamy) David Braley Cardiac, Vascular and Stroke Research Institute,
McMaster University, ON, Hamilton, Bermuda
(Lehner) Department of Nephrology and Medical Intensive Care, Charite
Universitatsmedizin, Germany (L.J.L.), Berlin, Germany
(Brown) New Brunswick Heart Centre, Saint John Regional Hospital
(Noiseux) Division of Cardiac Surgery, University of Montreal Hospital
Center, CHUM Research Center, QC, Montreal, France
(Atta) Division of Nephrology, Johns Hopkins School of Medicine,
Baltimore, United States
(Squiers) Coastal Vista Consulting LLC, Half Moon Bay
(Erlich, Molitoris) Nephrology Division, Department of Medicine, Indiana
University School of Medicine; Indiana Center for Biological Microscopy,
Indianapolis (B.M.)
(Rothenstein) Quark Pharmaceuticals, Inc, Newark, United States
(Mazer) Li Ka Shing Knowledge Institute of St. Michael's Hospital,
Institute of Medical Sciences and Departments of Anesthesia and
Physiology, University of Toronto, ON
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute kidney injury (AKI) affects up to 30% of patients
undergoing cardiac surgery, leading to increased in-hospital and long-term
morbidity and mortality. Teprasiran is a novel small interfering RNA that
temporarily inhibits p53-mediated cell death that underlies AKI.
 METHOD(S): This prospective, multicenter, double-blind, randomized,
controlled phase 2 trial evaluated the efficacy and safety of a single 10
mg/kg dose of teprasiran versus placebo (1:1), in reducing the incidence,
severity, and duration of AKI after cardiac surgery in high-risk patients.
The primary end point was the proportion of patients who developed AKI
determined by serum creatinine by postoperative day 5. Other end points
included AKI severity and duration using various prespecified criteria. To
inform future clinical development, a composite end point of major adverse
kidney events at day 90, including death, renal replacement therapy, and
>=25% reduction of estimated glomerular filtration rate was assessed. Both
serum creatinine and serum cystatin-C were used for estimated glomerular
filtration rate assessments. RESULT(S): A total of 360 patients were
randomly assigned in 41 centers; 341 dosed patients were 73+/-7.5 years of
age (mean+/-SD), 72% were men, and median European System for Cardiac
Operative Risk Evaluation score was 2.6%. Demographics and surgical
parameters were similar between groups. AKI incidence was 37% for
teprasiran- versus 50% for placebo-treated patients, a 12.8% absolute risk
reduction, P=0.02; odds ratio, 0.58 (95% CI, 0.37-0.92). AKI severity and
duration were also improved with teprasiran: 2.5% of teprasiran- versus
6.7% of placebo-treated patients had grade 3 AKI; 7% teprasiran- versus
13% placebo-treated patients had AKI lasting for 5 days. No significant
difference was observed for the major adverse kidney events at day 90
composite in the overall population. No safety issues were identified with
teprasiran treatment. CONCLUSION(S): The incidence, severity, and
duration of early AKI in high-risk patients undergoing cardiac surgery
were significantly reduced after teprasiran administration. A phase 3
study with a major adverse kidney event at day 90 primary outcome that has
recently completed enrollment was designed on the basis of these findings
(NCT03510897). Registration: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT02610283.

<31>
Accession Number
635906502
Title
Posterior pericardiotomy to prevent new-onset atrial fibrillation after
coronary artery bypass grafting: a systematic review and meta-analysis of
10 randomized controlled trials.
Source
Journal of cardiothoracic surgery. 16(1) (pp 233), 2021. Date of
Publication: 14 Aug 2021.
Author
Xiong T.; Pu L.; Ma Y.-F.; Zhu Y.-L.; Li H.; Cui X.; Li Y.-X.
Institution
(Xiong, Pu, Ma, Zhu, Li, Cui, Li) Department of Cardiac Surgery, Kunming
Yan'an Hospital, Affiliated Hospital of Kunming Medical University,
Kunming, Yunnan 650000, China
(Pu, Li, Cui, Li) Cardiovascular Surgery, Kunming, Yunnan 650000, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Atrial fibrillation (AF) is associated with adverse events
after cardiac surgery. Multiple studies have reported that posterior
pericardiotomy (PP) may be effective for preventing AF after coronary
artery bypass grafting (CABG), but some conflicting results have been
reported and the quality of evidence from previous meta-analyses has been
limited. The present study aimed to systematically evaluate the safety and
efficacy of PP for preventing AF after CABG in adults. METHOD(S): We
conducted a quantitative meta-analysis of randomized controlled trials
(RCTs) published before May 31, 2021. The primary outcome was AF after
CABG under cardiopulmonary bypass. Secondary outcomes included early
pericardial effusion, late pericardial effusion, pericardial tamponade,
pleural effusion, length of hospital stay, length of intensive care unit
(ICU) stay, pulmonary complications, intra-aortic balloon pump use,
revision surgery for bleeding, and mortality. RESULT(S): Ten RCTs
with 1829 patients (910 in the PP group and 919 in the control group) were
included in the current meta-analysis. The incidence of AF was 10.3%
(94/910) in the PP group and 25.7% (236/919) in the control group. A
random-effects model indicated that incidence of AF after CABG
significantly lower in the PP group than in the control group (risk
ratio=0.45, 95% confidence interval 0.29-0.64, P<0.0001). PP also
effectively reduced the post-CABG occurrence of early pericardial effusion
(RR=0.28, 95% CI 0.15-0.50; P<0.05), late pericardial effusion (RR=0.06,
95% CI 0.02-0.16; P<0.05), and pericardial tamponade (RR=0.08, 95% CI
0.02-0.33; P<0.05) as well as the length of ICU stay (weighted mean
difference [WMD]=0.91,95% CI 0.57-1.24; P<0.05), while increasing the
occurrence pleural effusion (RR=1.51, 95% CI 1.19-1.92; P<0.05). No
significant differences length of hospital stay (WMD=-0.45, 95% CI-2.44 to
1.54, P=0.66), pulmonary complications (RR=0.99, 95% CI 0.71-1.39,
P=0.97), revision surgery for bleeding (RR=0.84, 95% CI 0.43-1.63,
P=0.60), use of IABP (RR=1, 95% CI 0.61-1.65, P=1.0), or death (RR=0.45,
95% CI 0.07-3.03, P=0.41) were observed between the PP and control groups.
 CONCLUSION(S): PP may be a safe, effective, and economical method for
preventing AF after CABG in adult patients. Copyright © 2021. The
Author(s).

<32>
Accession Number
2014888696
Title
Hemopericardium in the setting of direct oral anticoagulant use: An
updated systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Sheikh A.B.; Shah I.; Sagheer S.; Javed N.; Minhas A.M.K.; Lopez E.D.;
Parikh C.; Shekhar R.
Institution
(Sheikh, Shah, Lopez) University of New Mexico Health Sciences Center,
Department of Internal Medicine, Albuquerque, NM, United States
(Sagheer) Division of Cardiology, University of New Mexico Health Sciences
Center, Albuquerque, NM, United States
(Javed) Shifa College of Medicine, Shifa Tameer-e-Millat University,
Islamabad, Pakistan
(Minhas) Forrest General Hospital, Department of Internal Medicine,
Hattiesburg, United States
(Parikh) Pramukh Swami Medical College, Department of Internal Medicine,
Karamsad, Gujarat, India
(Shekhar) Division of Hospital Medicine, University of New Mexico School
of Medicine, Department of Internal Medicine, Albuquerque, NM, United
States
Publisher
Elsevier Inc.
Abstract
Background: Spontaneous hemopericardium, associated with direct oral
anticoagulant (DOAC) use, is one of the uncommon complications with high
morbidity that has not been extensively studied We aimed to determine
demographic characteristics, clinical features, lab evaluation,
management, and outcomes of the studies focusing on hemopericardium as a
DOAC use. Method(s): PubMed, Web of Science, Google Scholar, and
CINAHL databases were searched for relevant articles using MeSH key-words
and imported into referencing/review software. The data regarding
demographics, clinical characteristics, cardiac investigations, and
management were analyzed in IBM Statistics SPSS 21. t-Test and Chi-square
test were used. A P score of <0.05 was considered statistically
significant. Result(s): After literature search, a total of 41
articles were selected for analysis. The mean age of the patients was
70.09 +/- 11.06 years (p < 0.05); the majority of them were males (58.5%).
Most of the patients presented with shortness of breath (75.2%) and had
more than 3 co-morbid conditions (43.9%). The most frequently used
anticoagulant was rivaroxaban (15/41; 36.6%); the common indication being
arrhythmia (78.0%). CYP4503A4/P-Gp inhibitors (22.2%) were commonly used
by the patients. Majority of the cases had a favorable outcome (95.1%).
Pericardial tamponade was noted in 31/41 cases. Pericardiocentesis was
performed in 37/41 cases. Conclusion(s): Hemopericardium from DOAC
use has a favorable outcome but requires urgent pericardiocentesis.
However, long term mortality, monitoring of DOAC activity, and drug-drug
interactions have not been widely studied. Copyright © 2021
Elsevier Inc.

<33>
Accession Number
2014888595
Title
Serratus Anterior Plane Block in Pediatric Patients Undergoing Thoracic
Surgeries: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Gado A.A.; Abdalwahab A.; Ali H.; Alsadek W.M.; Ismail A.A.
Institution
(Gado, Abdalwahab, Ali, Alsadek, Ismail) Anesthesia and Pain Management,
Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo
University, Egypt
Publisher
W.B. Saunders
Abstract
Objective(s): This study was designed to evaluate the efficacy and safety
of serratus anterior plane block (SAPB) as an analgesic technique for
thoracotomies in pediatric patients. Design(s): Double-blinded
randomized controlled trial. Setting(s): A single-center study at
Aboelrish Pediatric Hospital, one tertiary hospital of Cairo University
Hospitals. Participant(s): Seventy pediatric patients aged six
months-to-three years scheduled for thoracotomies. Intervention(s):
Patients were randomized into two groups, group SF and group F. Group SF
received an ultrasound-guided SAPB (n = 35), whereas group F (n = 35) did
not. All groups received an intraoperative fentanyl infusion (at 0.5
mug/kg /h). Measurements: The primary outcome was the total dose of
postoperatively administrated fentanyl in the first 24 hours. The
secondary outcomes included the total dose of intraoperative additional
fentanyl boluses; time of the first postoperative rescue analgesia; and
postoperative Face, Legs, Activity, Cry, Consolability scale (FLACC) score
values. Main Result(s): The main results of this study showed that
the administrated fentanyl in the 24 hours postoperatively was
significantly lower in SF group than in F group (p value < 0.001). In
addition, significant decreases of the postoperative FLACC pain score (p
value < 0.001), reduction of intraoperative fentanyl consumption (p value
< 0.001), and delay of the first rescue analgesia (p value < 0.001) were
recorded in SF group in relation to F group without significant
complications in both groups. Conclusion(s): Serratus anterior plane
block can provide a safe, effective, and easy-to-perform regional
technique for children undergoing thoracotomies. Copyright © 2021
Elsevier Inc.

<34>
[Use Link to view the full text]
Accession Number
636302609
Title
The Use of Intraoperative Transit Time Flow Measurement for Coronary
Artery Bypass Surgery: Systematic Review of the Evidence and Expert
Opinion Statements.
Source
Circulation. 144(14) (pp 1160-1171), 2021. Date of Publication: 05 Oct
2021.
Author
Gaudino M.; Sandner S.; Di Giammarco G.; Di Franco A.; Arai H.; Asai T.;
Bakaeen F.; Doenst T.; Fremes S.E.; Glineur D.; Kieser T.M.; Lawton J.S.;
Lorusso R.; Patel N.; Puskas J.D.; Tatoulis J.; Taggart D.P.; Vallely M.;
Ruel M.
Institution
(Gaudino, Di Franco) Department of Cardiothoracic Surgery, Weill Cornell
Medicine
(Sandner) Division of Cardiac Surgery, Department of Surgery, Medical
University of Vienna
(Di Giammarco) Cardiac Surgery Unit, University of Chieti
(Arai) Department of Cardiovascular Surgery, Tokyo Medical and Dental
University Graduate School of Medical and Dental Sciences, Japan (H.A.)
(Asai) Department of Cardiovascular Surgery, Juntendo University, Japan
(T.A.), Tokyo, Japan
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Heart,
Vascular and Thoracic Institute, Cleveland Clinic
(Doenst) Department of Cardiothoracic Surgery,
Friedrich-Schiller-University Jena, University Hospital, Germany (T.D.)
(Fremes) Division of Cardiac Surgery, Schulich Heart Centre, Department of
Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON
(Glineur) Division of Cardiac Surgery (D.G.), University of Ottawa Heart
Institute, ON, Canada
(Kieser) Department of Cardiac Sciences, Libin Cardiovascular Institute,
University of Calgary
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University, Baltimore, United States
(Lorusso) Department of Cardio-Thoracic Surgery, CARIM School for
Cardiovascular Diseases, Heart and Vascular Centre, Maastricht University
Medical Centre
(Patel) Department of Cardiovascular and Thoracic Surgery, Lenox Hill
Hospital/Northwell Health
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Morningside
Hospital
(Tatoulis) Royal Melbourne Hospital, University of Melbourne, VIC
(Taggart) Nuffield Department of Surgical Sciences, University of Oxford,
John Radcliffe Hospital, United Kingdom (D.P.T.)
(Vallely) Division of Cardiac Surgery, Ohio State University Wexner
Medical Center
(Ruel) Division of Cardiac Surgery (M.R.), University of Ottawa Heart
Institute, ON, Canada
Publisher
NLM (Medline)
Abstract
Transit time flow measurement (TTFM) allows quality control in coronary
artery bypass grafting but remains largely underused, probably because of
limited information and the lack of standardization. We performed a
systematic review of the evidence on TTFM and other methods for quality
control in coronary artery bypass grafting following PRISMA standards and
elaborated expert recommendations by using a structured process. A panel
of 19 experts took part in the consensus process using a 3-step modified
Delphi method that consisted of 2 rounds of electronic voting and a final
face-to-face virtual meeting. Eighty percent agreement was required for
acceptance of the statements. A 2-level scale (strong, moderate) was used
to grade the statements based on the perceived likelihood of a clinical
benefit. The existing evidence supports an association between TTFM
readings and graft patency and postoperative clinical outcomes, although
there is high methodological heterogeneity among the published series. The
evidence is more robust for arterial, rather than venous, grafts and for
grafts to the left anterior descending artery. Although TTFM use increases
the duration and the cost of surgery, there are no data to quantify this
effect. Based on the systematic review, 10 expert statements for TTFM use
in clinical practice were formulated. Six were approved at the first round
of voting, 3 at the second round, and 1 at the virtual meeting. In
conclusion, although TTFM use may increase the costs and duration of the
procedure and requires a learning curve, its cost/benefit ratio seems
largely favorable, in view of the potential clinical consequences of graft
dysfunction. These consensus statements will help to standardize the use
of TTFM in clinical practice and provide guidance in clinical
decision-making.

<35>
[Use Link to view the full text]
Accession Number
2015250281
Title
Risk of Stroke after Transcatheter Aortic Valve Implantation:
Epidemiology, Mechanism, and Management.
Source
American Journal of Therapeutics. 28(5) (pp E560-E572), 2021. Date of
Publication: 25 Sep 2021.
Author
Ciobanu A.-O.; Gherasim L.; Vinereanu D.
Institution
(Ciobanu, Gherasim, Vinereanu) University of Medicine and Pharmacy Carol
Davila, Bucharest, Romania
(Ciobanu, Vinereanu) Department of Cardiology and Cardiovascular Surgery
University and Emergency Hospital Bucharest, Bucharest, Romania
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Transcatheter aortic valve implantation (TAVI) has become an
established and increasingly used approach for management of severe
symptomatic aortic stenosis, showing similar or even superior outcomes
compared with standard surgical aortic valve replacement (SAVR). Stroke
after TAVI is a relatively rare, but serious complication, associated with
potential prolonged disability and increased mortality.Areas of
Uncertainty:The overall incidence of 30-day stroke in TAVI patients is
3%-4%, but varies between different trials. Initial data suggested a
higher risk of stroke after TAVI when compared with SAVR. The association
between subclinical leaflet thrombosis and cerebral embolism, presented as
stroke, transient ischemic accident, or silent cerebral ischemia is not
entirely elucidated yet. Moreover, TAVI for severe bicuspid aortic
stenosis is a relatively new issue, bicuspid anatomy being initially
excluded from the pivotal clinical trials investigating TAVI procedure.
Efficient stroke prevention strategies are under investigation. Data
Sources:In the present manuscript, we used the available published data
from the most relevant clinical trials, registries, and meta-analysis of
patients from different risk categories who underwent TAVI or
SAVR.Therapeutic Advances:Predictors of acute stroke are mainly procedure
related. Technological development, improvements in bioprosthesis valve
delivery catheters, and implantation technique may explain the decrease of
stroke over the years since the beginning of TAVI procedures.
 Conclusion(s):The overall evidences confirm similar or lower rate of
stroke in TAVI versus SAVR. Risk predictors for acute stroke after TAVI
are generally related to procedural factors, whereas late stroke is mainly
associated with patient characteristics, with a variable impact on
cognitive function. The optimal choice for the antithrombotic treatment in
TAVI for stroke prevention is yet to be determined. Current data do not
support routine use of cerebral embolic protection devices during TAVI.
 Copyright © 2021 Wolters Kluwer Health, Inc. All rights
reserved.

<36>
[Use Link to view the full text]
Accession Number
2015249946
Title
Prehabilitation before elective coronary artery bypass grafting surgery: A
scoping review protocol.
Source
JBI Evidence Synthesis. 19(2) (pp 469-476), 2021. Date of Publication: 16
Feb 2021.
Author
Olsen D.B.; Pedersen P.U.; Noergaard M.W.
Institution
(Olsen) Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
(Pedersen, Noergaard) Danish Centre of Systematic Reviews, A JBI Centre of
Excellence, Centre of Clinical Guidelines, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
(Noergaard) Department of Cardiology, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:The objective of this scoping review is to identify and map
existing preoperative interventions, referred to as prehabilitation, in
adult patients at home awaiting coronary bypass grafting (CABG) surgery.
This scoping review also seeks to examine the feasibility and patient
experiences in order to inform clinical practice and underpin a future
systematic review.Introduction:As patients age, comorbidities become more
common. Strategies to improve postoperative outcomes and to accelerate
recovery are required in patients undergoing CABG. Prehabilitation refers
to a proactive process of increasing functional capacity before surgery to
improve the patient's capacity to withstand upcoming physiologic stress
and thus avoid postoperative complications.Inclusion criteria:This scoping
review will consider any studies including adult patients at home awaiting
CABG surgery. Studies will provide information on any prehabilitation
intervention to optimize preoperative physical and psychological health
status. Studies conducted in any setting will be included.
 Method(s):The methodology will follow the JBI recommendations for
scoping reviews. Any published or unpublished source of information will
be considered. Studies published in English, German, Danish, Swedish, and
Norwegian will be included, with no geographical or cultural limitations.
Retrieved papers will be screened by two independent reviewers, and a
standardized tool will be used to extract data from each included source.
The results will be presented as a map of the data extracted in a tabular
form together with a narrative summary to provide a description of the
existing evidence. Copyright © 2021 JBI. All Rights Reserved.

<37>
Accession Number
2014164499
Title
An rct: To evaluate the clinical characteristics of patients having spinal
anaesthesia with intrathecal bupivacaine and clonidine, as well as
intrathecal bupivacaine and fentanyl.
Source
International Journal of Toxicological and Pharmacological Research. 11(4)
(pp 1-6), 2021. Date of Publication: 2021.
Author
Kumar S.
Institution
(Kumar) Department of Anaesthesiology, Katihar Medical College Hospital,
Katihar, India
Publisher
Dr. Yashwant Research Labs Pvt. Ltd.
Abstract
Aim: The aim of this study to assess the clinical profile of patients
undergoing spinal Anesthesia with intrathecal bupivacaine with clonidine
and intrathecal bupivacaine with fentanyl. Method(s): A prospective
double blind randomized controlled study was conducted in the Department
of anaesthesiology, Katihar medical college Hospital, Katihar, Bihar,
India. for 1 year. 110 adult patients were randomly divided on an
alternative basis into two groups of 55 each. Group "A"-Bupivacaine plus
clonidine group. Group "B"-Bupivacaine plus fentanyl group. Patients with
ASA grade 1 and 2 patients and age group of 18-72 yrs. Those patients
scheduled to undergo elective lower abdominal, lower extremity,
gynaecological or urological surgeries under subarachnoid block were
included in this study. Patients belonging to group 'A' received 3 ml (15
mg) of hyperbaric bupivacaine 0.5% plus 1 microg.kg-1 of
clonidine. Patients of group 'B' received 3 ml (15 mg) of hyperbaric
bupivacaine 0.5% plus (25 microg) of fentanyl. After injection, patient
was immediately turned to supine position. Result(s): Majority of
patients in the both the groups belonged to thegroup 30 to 40 years
34.54%. The number of males 43.64% and females 56.36%. Majority of female
patients in the both the groups belonged to the group 160 to 170 cms and
males 171 to 175 cms, Samples were height matched. Most of the patients
41.82 percent from gynaecology surgery followed by lower limb surgery
33.63 percent and Lower Abdominal Surgery 24.55 percent.
 Conclusion(s): We concluded that the administration of local
anaesthetics in combination with opioids intrathecally is an established
technique for managing postoperative pain following abdominal, pelvic,
thoracic or orthopaedic procedures on lower extremities. Local
anaesthetics with opioids demonstrate significant synergy. Copyright
© 2021, Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

<38>
Accession Number
2015133671
Title
Using telemedicine to improve the quality of life of parents of infants
with CHD surgery after discharge.
Source
International Journal for Quality in Health Care. 33(3) (no pagination),
2021. Article Number: mzab133. Date of Publication: 2021.
Author
Zhang Q.-L.; Lei Y.-Q.; Liu J.-F.; Cao H.; Chen Q.
Institution
(Zhang, Lei, Liu, Cao, Chen) Department of Cardiac Surgery, Fujian Branch
of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou,
Fujian 350014, China Fujian Children's Hospital, No.966 of Hengyu Road,
Fuzhou, Fujian 350014, China Fujian Maternity and Child Health Hospital,
Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road,
Fuzhou, Fujian 350001, China Fujian Key Laboratory of Women and Children's
Critical Diseases Research, Fujian Maternity and Child Health Hospital,
No.18 of Danshan Road, Fuzhou, Fujian 350001, China
Publisher
Oxford University Press
Abstract
Objective: The purpose of this study was to investigate the effect of
using telemedicine to improve the quality of life of parents of infants
with congenital heart disease (CHD) surgery after discharge.
 Method(s): A prospective randomized controlled study was conducted in
a provincial hospital in China from November 2020 to April 2021 to compare
the quality of life of parents of infants with CHD surgery after discharge
between the WeChat follow-up group and the outpatient follow-up group. A
total of 84 patients (42 in each group) and 168 parents (84 in each group)
participated in this study. Result(s): One month after discharge, the
Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)
scores of parents in the intervention group were significantly lower than
those in the control group (P < 0.05). Compared with the SAS and SDS
scores at discharge, the scores of parents in the intervention group were
significantly lower at 1 month after discharge (P < 0.05), while the
scores of parents in the control group were similar at 1 month after
discharge (P > 0.05). At discharge, in both the intervention group and the
control group, the SAS and SDS scores of the mothers were higher than
those of the fathers (P < 0.05). One month after discharge, in the control
group, the SAS and SDS scores of the mothers were higher than those of the
fathers (P < 0.05). One month after discharge, in the intervention group,
the SAS and SDS scores of the mothers were similar to those of the fathers
(P > 0.05). The comparison of the SAS and SDS scores of parents with
different education levels showed that in both the intervention group and
control group, the lower the parents' educational levels, the higher their
SAS and SDS scores (P < 0.05). One month after discharge, in the control
group, the lower the parents' education levels, the higher their SAS and
SDS scores (P < 0.05). One month after discharge, in the intervention
group, the SAS and SDS scores were similar among parents with different
educational levels. The results of the World Health Organization Quality
of Life Brief scale showed that the scores of the physiological,
psychological, social and environmental fields at 1 month after discharge
in the intervention group were significantly higher than those in the
control group (P < 0.05). Conclusion(s): Providing health education
and medical support to the parents of infants with CHD surgery after
discharge via telemedicine can effectively relieve parents' anxiety and
depression and improve their quality of life. Copyright © 2021
The Author(s) 2021. Published by Oxford University Press on behalf of
International Society for Quality in Health Care. All rights reserved.

<39>
Accession Number
2015266762
Title
Comparison of Ultrasound-Guided Pectointercostal Fascial Block and
Transversus Thoracic Muscle Plane Block for Acute Poststernotomy Pain
Management After Cardiac Surgery: A Prospective, Randomized, Double-Blind
Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Kaya C.; Dost B.; Dokmeci O.; Yucel S.M.; Karakaya D.
Institution
(Kaya, Dost, Dokmeci, Karakaya) Department of Anaesthesiology and
Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
(Yucel) Department of Cardiovascular Surgery, Ondokuz Mayis University
Faculty of Medicine, Samsun, Turkey
Publisher
W.B. Saunders
Abstract
Objective: The objective of the present study was to evaluate morphine
consumption and pain scores 24 hours postoperatively to compare the
effects of a bilateral pectointercostal fascial block (PIFB) with those of
a transversus thoracic muscle plane block (TTMPB) on acute poststernotomy
pain in cardiac surgery patients who have undergone median sternotomy.
 Design(s): Prospective, randomized, double-blinded. Setting(s):
The operating room, intensive care unit, and patient ward at a university
hospital. Participant(s): Thirty-nine American Society of
Anesthesiologists II-to-III patients aged 18- to-80 years, scheduled for
elective cardiac surgery via median sternotomy. Intervention(s):
Patients randomly were allocated to groups scheduled to receive bilateral
ultrasound-guided PIFB or TTMPB. Measurements and Main Results: The
primary outcome was postoperative morphine use within the first 24 hours.
Secondary outcomes were the numerical pain rating scale (NRS) scores at
rest and during coughing, time of first analgesic demand from the
patient-controlled analgesia (PCA) device, and rescue analgesia use. The
nausea/vomiting scores, time to extubation, length of stays in intensive
care and the hospital, patient satisfaction scores, and complications were
also recorded. The first 24-hour morphine use did not significantly differ
between the PIFB and TTMPB groups (mean +/- standard deviation [95% CI],
13.89 +/- 6.80 [10.83-16.95] mg/24 h and 15.08 +/- 7.42 [11.83-18.33]
mg/24 h, respectively, p = 0.608). No significant difference between the
two groups in the NRS scores at rest and during coughing was observed; the
groups had similar requirements for rescue analgesia in the first 24 hours
(n [%], three [15.8] and seven [35], p = 0.273, respectively). The time
from PCA to the first analgesia request was longer in the PIFB than in the
TTMPB group (median [interquartile range], 660 [540-900] minutes, and 240
[161-525] minutes, respectively, p = 0.002). Conclusion(s): PIFB and
TTMPB showed similar effectiveness for morphine consumption within 24
hours postoperatively and in pain scores in cardiac surgery
patients. Copyright © 2021 Elsevier Inc.

<40>
Accession Number
636295104
Title
Continuous Pecto-Intercostal Fascial Block Provides Effective Analgesia in
Patients Undergoing Open Cardiac Surgery: A Randomized Controlled Trial.
Source
Pain medicine (Malden, Mass.). (no pagination), 2021. Date of
Publication: 02 Oct 2021.
Author
Zhang Y.; Min J.; Chen S.
Institution
(Zhang, Min, Chen) Department of Anesthesiology, First Affiliated Hospital
of Nanchang University, Nanchang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The optimal analgesia regimen after open cardiac surgery was
unclear. The aim of this study was to investigate the beneficial effects
of continuous Pecto-Intercostal Fascial Block (PIFB) blocks initiated
before surgery on outcomes following open cardiac surgery. METHOD(S):
A group of 116 patients were randomly allocated to either receive
bilateral continuous PIFB (PIF group) or the same block with saline (SAL
group). The primary endpoint was postoperative pain at 4, 8, 16, 24, 48,
and 72h after extubation at rest and exercise. The secondary outcome
measures included analgesia requirements (sufentanil and flurbiprofen
consumption), time to extubation, length of stay in the ICU, incidence of
postoperative nausea and vomiting (PONV), time until return of bowel
function, time to mobilization, urinary catheter removal and the length of
hospital stay. RESULT(S): The length of stay in the ICU (29+/-7h vs
13+/-4h, p<0.01) and length of hospital stay (8.9+/-0.9 d vs 6.5+/-1.1 d,
p<0.01) was significantly longer in the SAL group than in the PIF group.
Resting pain scores (2h after extubation : 1.1 vs 3.3, p<0.01; 4h after
extubation : 1.0 vs 3.5, p<0.01; 8h after extubation : 1.2 vs 3.7, p<0.01;
16h after extubation : 1.3 vs 3.7, p<0.01; 24h after extubation : 1.4 vs
2.8, p<0.01; 48h after extubation : 0.9 vs 2.2, p<0.01; 72h after
extubation : 0.8 vs 2.1, p<0.01) and dynamic pain scores (2h after
extubation : 1.4 vs 3.7, p<0.01; 4h after extubation : 1.3 vs 3.8, p<0.01;
8h after extubation : 1.4 vs 3.5, p<0.01; 16h after extubation : 1.2 vs
3.4, p<0.01; 24h after extubation : 1.1 vs 3.1, p<0.01; 48h after
extubation : 1.0 vs 2.9, p<0.01; 72h after extubation: 0.9 vs 2.8, p<0.01)
were significantly lower in PIF group compared with SAL group at all time
points. The PIF group required significantly less intraoperative
(123+/-32mug vs 63+/-16mug, p<0.01) and postoperative sufentanil
(102+/-22mug vs 52+/-17mug, p<0.01) consumption, postoperative
flurbiprofen consumption (350+/-100mg vs 100+/-100mg, p<0.01) than the SAL
groups. Time to extubation (8.9+/-2.4h vs 3.2+/-1.3h, p<0.01), time to
first flatus (43+/-6h vs 30+/-7h, p<0.01), time until mobilization
(35+/-5h vs 24+/-7h, p<0.01), time until urinary catheter removal (47+/-9h
vs 31+/-4h, p<0.01) was significantly earlier in the PIF group than in the
SAL group. The incidence of PONV was significantly lower in the PIF group
(9.1% vs 27.3%, p<0.01). CONCLUSION(S): Bilateral continuous PIFB
reduced the length of hospital stay and provided effective postoperative
pain for three days. Copyright © The Author(s) 2021. Published by
Oxford University Press on behalf of the American Academy of Pain
Medicine.

<41>
Accession Number
2014009365
Title
Comparison of high-flow and conventional nasal cannula oxygen in patients
undergoing endobronchial ultrasonography.
Source
Internal Medicine Journal. (no pagination), 2020. Date of Publication:
2020.
Author
Yilmazel Ucar E.; Araz O.; Kerget B.; Akgun M.; Saglam L.
Institution
(Yilmazel Ucar, Araz, Kerget, Akgun, Saglam) Department of Pulmonary
Diseases, Ataturk University School of Medicine, Erzurum, Turkey
Publisher
John Wiley and Sons Inc
Abstract
Background: Oxygen therapy is required to prevent hypoxaemia during the
endobronchial ultrasonography (EBUS) procedure. Aim(s): To compare
the effectiveness of oxygen therapy delivered through high-flow nasal
cannula (HFNC) and conventional nasal cannula (CNC) in patients undergoing
EBUS. The primary outcome was the proportion of patients who desaturated.
Patient compliance and satisfaction were also evaluated. Method(s):
This single-centre prospective interventional study was conducted in a
tertiary hospital among patients who presented to the EBUS unit in 2018
and 2019. Patients were randomly assigned to the HFNC group or the CNC
group. Result(s): The study included 170 patients (111 men and 59
women) with a mean age of 58 +/- 14 years. The number of patients
experiencing desaturation while receiving oxygen was statistically
significantly lower (P < 0.001) in the HFNC group (n = 5) compared with
the CNC group (n = 26). Oxygen therapy was adjusted in two patients in the
CNC group due to desaturation. Saturation was significantly higher in the
HFNC group (P < 0.0001) at the end of the EBUS procedure. Heart rate at
the end of EBUS was lower in the HFNC group, but this difference was not
statistically significant (96 +/- 16 vs 101 +/- 19, P = 0.13). Five
patients in the HFNC group and 18 patients in the CNC group reported
discomfort during the procedure (P = 0.006). Conclusion(s): Oxygen
therapy delivered by HFNC seems to be safer and more effective than by CNC
in patients undergoing EBUS. Oxygen therapy with HFNC may be considered as
an alternative to CNC because it may increase patient comfort and thereby
improve compliance. Copyright © 2020 Royal Australasian College
of Physicians

<42>
Accession Number
2005552925
Title
Medical thoracoscopy in the diagnosis of pleural disease: a guide for the
clinician.
Source
Expert Review of Respiratory Medicine. (pp 987-1000), 2020. Date of
Publication: 2020.
Author
Shaikh F.; Lentz R.J.; Feller-Kopman D.; Maldonado F.
Institution
(Shaikh) Division of Pulmonary and Critical Care Medicine, David Geffen
School of Medicine, University of Los Angeles, Los Angeles, CA, United
States
(Lentz, Maldonado) Division of Allergy, Pulmonary, and Critical Care
Medicine, Vanderbilt University Interventional Pulmonology, Nashville, TN,
United States
(Feller-Kopman) Division of Pulmonary, Critical Care, and Sleep Medicine,
Johns Hopkins Hospital, Baltimore, MD, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Developing a feasible and accurate means of evaluating
pleural pathology has been an ongoing effort for over 150 years. Pleural
fluid cellular and biomarker analyses are simple ways of characterizing
and uncovering pathologic entities of pleural disease. However, obtaining
samples of pleural tissue has become increasingly important. In cases of
suspected malignancy and certain infections histopathology, culture, and
molecular testing are necessary to profile diseases more effectively. The
pleura is sampled via several techniques including blind transthoracic
biopsy, image-guided biopsy, and surgical thoracotomy. Given the
heterogeneity of pleural disease, low diagnostic yields, or invasiveness
no procedural gold standard has been established in pleural diagnostics.
Areas covered: Herein, we provide a review of the literature on medical
thoracoscopy (MT), its development, technical approach, indications,
risks, current and future role in the evaluation of thoracic disease.
Pubmed was searched for articles published on MT, awake thoracoscopy, and
pleuroscopy with a focus on reviewing literature published in the past 5
years. Expert opinion: As the proficiency and number of interventional
pulmonologists continues to grow, MT is ideally positioned to become a
front-line diagnostic tool in pleural disease and play an increasingly
prominent role in the treatment algorithm of various pleural
pathologies. Copyright © 2020, © 2020 Informa UK Limited,
trading as Taylor & Francis Group.

<43>
Accession Number
365787657
Title
Prasugrel versus clopidogrel for acute coronary syndromes without
revascularization.
Source
New England Journal of Medicine. 367(14) (pp 1297-1309), 2012. Date of
Publication: 04 Oct 2012.
Author
Roe M.T.; Armstrong P.W.; Fox K.A.A.; White H.D.; Prabhakaran D.; Goodman
S.G.; Cornel J.H.; Bhatt D.L.; Clemmensen P.; Martinez F.; Ardissino D.;
Nicolau J.C.; Boden W.E.; Gurbel P.A.; Ruzyllo W.; Dalby A.J.; McGuire
D.K.; Leiva-Pons J.L.; Parkhomenko A.; Gottlieb S.; Topacio G.O.; Hamm C.;
Pavlides G.; Goudev A.R.; Oto A.; Tseng C.D.; Merkely B.; Gasparovic V.;
Corbalan R.; McLendon R.C.; Winters K.J.; Brown E.B.; Lokhnygina Y.;
Aylward P.E.; Huber K.; Hochman J.S.; Ohman E.; Bassand J.P.; Castillo
V.R.; Chua T.; Cinteza M.; Erlinge D.; Foley D.P.; Fridrich V.; Ge J.;
Goudev A.; Gratsiansky N.; Hamm C.W.; Jeong M.H.; Jun-Ren Z.; Lopez-Sendon
J.; Luscher T.; Mogrovejo W.E.; Nicolau J.; Petrauskiene B.; Roe M.;
Sritara P.; Syvanne M.; Topacio G.; Verheugt F.; Widimsky P.; Wiviott
S.D.; Zambahari R.; Van de Werf F.; Budaj A.; Gersh B.J.; Montalescot G.;
Pocock S.J.; Wilcox R.G.; Williams D.O.; Wilson M.; Mehta R.H.; Alexander
J.H.; Kong D.F.; Lopes R.; Mahaffey K.W.; Melloni C.; Newby L.; Shah B.R.;
Tricoci P.; George D.J.; Beaven A.W.; Blackwell K.L.; Morse M.A.; Onken
J.E.; Ready N.E.; Strickler J.H.; Zafar S.; Hafley G.; Pieper K.; Stevens
S.; Schibler T.; Chan M.; Chin C.T.; Gharacholou S.; Subherwal S.;
McLendon R.; Marshall D.; Macias W.; Lenarz L.; Petijean H.; Plat F.; van
Kranen R.; Zamoryakhin D.; Albisu J.; Alvarez C.; Amuchastegui M.;
Astesiano A.L.; Beloscar J.; Bergallo J.; Bono J.; Bordonava A.; Botta
C.E.; Budassi N.; Caccavo A.; Cartasegna L.; Colombo H.; Costello R.;
Covelli G.; De Valais F.; Dran R.; Duronto E.; Forte E.H.; Garcia D.F.;
Garcia Escudero A.; Hominal M.; Hrabar A.D.; Ibanez J.O.; Jure H.; Leon de
la Fuente R.; Lobo Marquez L.; Luciardi H.; Luquez H.; Marino J.;
Martingano R.; Moises Azize G.; Nul D.; Patocchi C.; Piombo A.; Prado A.;
Rodriguez M.; Romero Acuna A.; Scaro G.B.; Sosa Liprandi A.; Varini S.D.;
Vigo S.J.; Aroney G.; Arstall M.; Blenkhorn A.; Carroll P.; Chew D.;
Collins N.; Hammett C.; Lee A.; Marrinan M.; Roberts-Thomson P.; Waites
J.; Benzer W.; Lang I.; Podczeck-Schweighofer A.; Baetsle P.; Beauloye C.;
De Tollenaere M.; Lancellotti P.; Marechal P.; Van Dorpe A.; Albuquerque
D.; Andrade Lotufo P.; Ardnt M.; Arminio G.; Alves da Cost F.A.; Baracioli
L.M.; Bertolim Precoma D.; Carvalho Neuenschwander F.; Damiao Gomes Seabra
M.; De Souza J.; Duda N.T.; Dutra O.P.; Feitosa A.; Filho H.; Finimundi
H.C.; Gomes M.; Gubolino L.; Guimaraes A.E.; Hernandes M.; Jardim C.A.;
Kunz Sebba Barroso de Souza W.; Leaes P.E.; Maia L.N.; Manenti E.; Marin
Neto J.A.; Marino R.; Michalaros Y.; Mora Junior R.; Moraes Junior J.B.;
Nogueira Liberato de Sousa L.; Pimentel Filho P.; Polanczyk C.; Rabelo
Alves A.; Ramos R.; Reis G.; Rocha Faria Neto J.; Rossi Dos Santos F.;
Saporito W.; Saraiva J.F.; Sartori P.C.; Scholz Issa J.; Silva Junior D.;
Sousa A.; Teixeira M.; Zimmermann S.L.; Lazov P.; Tokmakova M.; Penchev
K.; Petrov I.; Baldjiev E.; Georgiev P.; Hergeldjieva V.; Manolova A.;
Dimov B.; Mihov A.; Pencheva G.; Raev D.; Ramshev K.; Tumbev H.; Tzekova
M.; Boichev B.; Kadiiski A.; Devedzhiev T.; Bakbak A.; Berlingieri J.;
Burstein J.; Dery J.P.; Heath J.; Huynh T.; Kassam S.; Kostuk W.; Labonte
R.; Maccallum C.; Nawaz S.; Quraishi A.U.; Senaratne M.; Syan G.; Syan R.;
Vizel S.; Castro P.; Florenzano F.; Lamich R.; Manriquez L.; Potthoff S.;
Stockins B.; Bugueno C.; Cobos J.; Sepulveda P.; Opazo M.; Montecinos H.;
Ke Y.; Chen Y.D.; Chen J.; Wang J.; Li W.; Xu B.; Ma G.; Li Z.; Sun Y.;
Tang J.; Yuan Z.; Tang L.; Zhou Y.; He Q.; Xu J.; Zhang H.; Yang K.; Zhou
S.; Zhao S.; Zheng Z.; Li X.; Wang D.; Hong X.; Guan R.; Wang L.; Huang
H.; Xia Y.; Hao Y.; Zhang S.; Zhao X.; Liu X.; Yan J.; Huang Y.; Wang B.;
Vallejo G.S.; Bohorquez R.; Gomez N.I.; Fernandez R.; Mayorga L.E.; Gomez
J.; Quintero A.; Figueredo A.; Senior J.; Accini J.L.; Roncallo E.;
Frischwasser S.; Sanchez M.S.; Bouzid Y.; Ciglenecki N.; Certic J.F.;
Grman J.; Sutalo K.; Bergovec M.; Knezevic A.; Mirat J.; Padovan M.; Car
S.; Samardzic P.; Bagatin J.; Kraus L.; Coufal Z.; Janota T.; Kettner J.;
Linhart A.; Hondl M.; Osmancik P.; Padour M.; Telekes P.; Vojacek J.;
Vojtisek P.; Francek L.; Sedlon P.; Bronnum-Schou J.; Hansen P.; Nielsen
H.; El-Etreby A.; El Hawary A.; El Rakshy Y.; Mowafy A.; Ragy H.; Reda A.;
Sabri S.; Nyman K.; Laine M.; Bressollette E.; Rifai A.; Danchin N.; Ovize
M.; Cottin Y.; Farah B.; Furber A.; Coste P.; Elbaz M.; Morel O.; Schiele
F.; Elhadad S.; Belhassane A.; El Mansour N.; Leroy F.; Coisne D.; Ferrari
E.; Nguyen-Khac O.; Range G.; Moulin F.; Poulard J.E.; Sechtem U.; Kaelsch
T.; Ebelt H.; Gawaz M.; Genth-Zotz S.; Moellmann H.; Heuer H.; Kadel C.;
Klein H.; Werner G.; Boudriot E.; Kruells-Muench J.; Baer F.; Alexopoulos
D.; Manolis A.; Platogiannis D.; Anastasiou-Nana M.; Nanas I.; Cokkinos
D.; Fotiadis I.; Koliopoulos N.; Moschos N.; Olympios C.; Ples Z.; Illyes
L.; Csikasz J.; Zolyomi S.; Kis E.; Kovacs Z.; Lupkovics G.; Nagy A.;
Regos L.; Tomcsanyi J.; Janosi A.; Medvegy M.; Szakal I.; Vertes A.;
Szalai G.; Banker D.; Dani S.; Kumar S.; Sarna M.K.; Seerangachar R.K.;
Deshpande A.; Khan I.A.; Gupta S.K.; Dharmadhikari A.; Babu P.; Fulwani
M.; Kerkar P.G.; Varma S.; Singh P.; Babu R.; Menon J.; Sengupta S.; Sathe
S.; Premchand R.K.; Kalra R.; Kalashetti S.; Pai V.; Bose V.; Jain V.;
Kale V.; Benjarge P.; Ghaisas N.; Thanvi S.; Durgaprasad R.; Kulkarni
R.L.; Joshi H.; Abyankar A.; Bisne V.; Chopra V.; Reddy P.; Sarma R.; Garg
N.; Agarwal D.K.; Arneja J.; Bandyopadhyay S.; Bharani A.; Yadav R.; Dutta
S.; Chidambaram N.; Dande A.; Gadkari M.; Grant P.; Khan A.; Gupta R.;
Gupta J.B.; Shetty G.; Lavhe P.V.; Jain R.; Joseph J.; Calambur N.; Joseph
S.; Mardikar H.; Mathur A.; Mohanan P.; Kumbla M.; Nair T.; Nambiar A.;
Jathappa N.; Parale G.; Patel T.; Puri A.; Rao B.; Saligrama R.; Sawhney
J.; Sethi S.; Singh B.; Srinivas A.; Jagadesa B.S.; Foley D.; Mahon N.;
Mulvihill N.; Nash P.; Arad T.; Balkin J.; Francis A.; Hammerman H.; Hasin
Y.; Katz A.; Kracoff O.; Marmor A.; Mosseri M.; Atar S.; Roth A.; Zahger
D.; Turgeman Y.; Weiss A.; De Luca M.; Antonelli G.; Piovaccari G.;
Barbiero M.; Cuccia C.; De Servi S.; Fedele F.; Golino P.; Manari A.;
Menozzi A.; Berti S.; Moretti L.; Musumeci G.; Pajes G.; Paloscia L.; Mos
L.; Salvioni A.; Volpe M.; De Luca G.; Astarita C.; Merlini P.; Di Lorenzo
L.; Fattore L.; Ambrosio G.; Mircoli L.; Galvani M.; Cavallini C.;
Nassiacos D.; Scioli R.; Yoon J.; Kim D.K.; Hur S.H.; Bae J.H.; Rha S.W.;
Lee S.R.; Kim K.S.; Ko Y.G.; Jeong J.O.; Lee S.K.; Hong T.J.; Kim M.;
Hwang J.Y.; Shin E.K.; Kim S.W.; Anusauskiene J.; Dambrauskaite A.;
Jarasuniene D.; Raugaliene R.; Babarskiene M.R.; Ahmad W.A.; Yusof Z.;
Maskon O.; Ong T.K.; Abdullah H.N.; Chandran A.; Chong Y.S.; Lee C.Y.;
Ramanathan L.; Sciberras R.; Xuereb R.G.; Fajardo P.; Ramos-Lopez G.;
Alcocer M.A.; Ramirez M.C.; Ibarra M.O.; Esperon G.L.; Diaz C.S.; Hamer
A.; Elliott J.; Harding S.; Hart H.; Castillo B.G.; Ortega R.N.; Frago G.;
Henriquez F.; Acosta D.C.; Zambrano E.C.; Mogrovejo W.; Chois A.; Gamio
C.F.; Barrera M.A.; Cabrera J.; Dextre L.Z.; Reyes M.; Tellez D.; Castillo
R.; Chavez C.; Godoy A.; Llerena N.; Morales C.A.; Habaluyas R.; Rogelio
G.; Ramos E.J.; Chua P.; Mendoza V.; Tirador L.; Abanilla J.; Edmilao
M.I.; Coching R.M.; Morales D.; Dalkowski M.; Sciborski R.; Lewczuk J.;
Hoffmann A.; Lesnik J.; Andruszkiewicz B.; Wojciechowski D.; Kus W.; Jozwa
R.; Kasprzak J.; Lubinski A.; Karczmarczyk A.; Wojcik J.; Gruchala M.;
Bartus S.; Bronisz M.; Mirek-Bryniarska E.; Dudek D.; Gorny J.; Grzywna
R.; Kawka-Urbanek T.; Niezgoda K.; Olszewski R.; Ogorek M.; Gniot J.;
Nessler J.; Ponikowski P.; Wita K.; Zinka E.; Zmudka K.; Szelemej R.;
Moreira J.; Bastos J.M.; Ferreira J.; Martins D.; Providencia L.; Ribeiro
V.G.; Silva G.; Seixo F.; Morais J.; Rinaldi R.; Rodriguez-Ospina L.;
Colon-Hernandez P.; Matei C.; Tatu-Chitoiu G.P.; Iordachescu-Petica D.;
Teodorescu I.; Ochean V.; Constantinescu M.C.; Stanciulescu G.E.; Bobescu
E.; Bolohan F.R.; Coman I.M.; Creteanu M.; Dan G.A.; Dobre I.; Ionescu P.;
Minescu B.; Olinic D.M.; Pop C.; Stamate S.C.; Gurevich V.; Bichan N.;
Baranov E.; Zateyshchikov D.; Barbarich V.; Gordeev I.; Tereshchenko S.;
Dovgalevskiy Y.; Boyarkin M.; Shogenov Z.; Suprun E.; Shalaev S.;
Arutyunov G.; Supryadkina T.; Perepech N.; Nikolskaya I.; Rossovskaya M.;
Khaisheva L.; Simanenkov V.; Boldueva S.; Zrazhevskiy K.; Barbarash O.;
Egorova L.; Markov V.; Novikova N.; Alexeeva N.; Ermoshkina L.; Ishmurzin
G.; Miloradovic V.; Pavlovic M.; Ilic S.; Krotin M.; Neskovic A.; Otasevic
P.; Vasiljevic-Pokrajcic Z.; Ostojic M.; Chan M.Y.; Goh P.P.; Kokles M.;
Bugan V.; Urban M.; Sirotiakova J.; Belicova M.; Duris T.; Poliacik P.;
Slanina M.; Letcher G.; Abelson M.; Dalby A.; Gould T.; Manga P.; Pillay
T.; Theron H.; Venter T.; van Zyl L.; Essop M.; van der Merwe N.; Alegret
J.M.; Gomez D.L.; Vera T.R.; Bruguera I Cortada J.; Garcia J.H.; Dalli E.;
Paz M.A.; Ridocci F.; Coronado J.L.; Romero C.; Urbano R.H.; Carlsson R.;
Falck G.; Gallino A.; Linka A.; Lai W.T.; Shyu K.G.; Li A.H.; Chiang C.E.;
Hou J.Y.; Kuanprasert S.; Srimahachota S.; Wongvipaporn C.; Laothavorn P.;
Krittayaphong R.; Tangsuntornwiwat S.; Moleerergpoom W.; Kaewsuwanna P.;
Sakulsaengprapha T.; Viboolkitvarakul N.; Buakhamsri A.; Braam R.; Basart
D.C.; Troquay R.P.; Herrman J.P.; van der Heijden D.J.; Broeders M.; Romer
T.; Post J.C.; Viergever E.; Zwart P.; Groutars R.; Breedveld R.; Ronner
E.; Hoedemaker G.; van Kalmthout P.; Kuijper A.; Geertman J.H.; Hamer B.;
Werter C.; Westendorp I.; Kruik H.J.; Zouari S.B.; Boughzala E.; Boujnah
R.; Gamra H.; Haouala H.; Kammoun S.; Ben Khalfallah A.; Maatouk F.; Ural
D.; Kutlu M.; Sahin M.; Ebinc H.; Kucukoglu S.; Demirtas M.; Kirma C.;
Altun A.; Aydinlar A.; Aydogdu S.; Cayli M.; Bozkurt E.; Buyukoner E.E.;
Erdogan D.; Acikel M.; Ozdemir M.; Ozdemir K.; Yazici M.; Goloborodko B.;
Nykonov V.; Vakaliuk I.; Yagensky A.; Vatutin M.; Shcherbak V.; Kovalskyy
I.; Bagriy A.; Ushakov O.; Zhurba S.; Sierkova V.; Bashkirtsev O.;
Vasylenko A.; Karpenko Y.; Kaidashev I.; Amosova K.; Batushkin V.; Faynyk
A.; Horbach L.; Karpenko O.; Koval' O.; Kraiz I.; Potapenko P.; Rudenko
L.; Malynovsky Y.; Tseluyko V.; Volkov V.; Prokhorov O.; Sarkar D.;
Moriarty A.; El-Harari M.; Brigden G.; Qureshi N.; Alamgir F.; de Belder
A.; Keeling P.; Cooke J.; Brown N.; Junejo S.; Vuyyuru R.; Connolly D.;
Kadr H.; Griffiths H.; Tang K.; Cotton J.; Barr C.; Lindsay S.;
Venkataraman A.; Rittoo D.; Jacob A.; Watkin R.; Lang C.; Pye M.; Chambers
J.; Mavromatis K.; Rossi P.; Ahmad A.; Anderson H.; Roberts J.; Klugherz
B.; Haidar A.; Downes T.; Russo D.; Wallace W.; Bhagwat R.; Mathew T.;
Jetty P.; Henderson D.; Dy J.; Isserman S.; Kondle V.; Quintana O.; Brener
S.; Masud Z.; Vijay N.; Jain M.; Longo J.; Safley D.; Pancholy S.;
Shaoulian E.; Allan J.; Bazzi A.; Chahin J.; Shurmur S.; Santos R.;
Goldberg J.; Gigliotti O.; Irimpen A.; Khan M.; Kusnick B.; Treasure C.;
Rogers J.; Zebrack J.; Turner M.; Adjei N.; Ingram C.; Mathis C.; Buchanan
W.; Heins G.; Ahsan C.; Anderson J.; Atassi K.; Bachinsky W.; Baig M.;
Rodriguez A.; Tang A.; Foreman R.; Berlin H.; Bouchard A.; Thew S.;
Borromeo S.; Bowden W.; Boyek T.; Arter J.; Blair J.; Chandna H.; Katz J.;
Conn E.; Connelly T.; Del Core M.; Shanes J.; Dotani I.; Drenning D.;
Bustros N.; Fastabend C.; Flores E.; Goudreau E.; Gredler F.; Greenfield
R.; Guidera S.; Gogia H.; Hearne S.; Hermany P.; Taheri H.; Izzo M.;
Jaffrani N.; Johnson G.; Keedy D.; Waxman F.; Kesselbrenner M.; Floro J.;
Korban E.; Labroo A.; Lui H.; Georgeson S.; Breall J.; Baman R.; Mandak
J.; Marais H.; Lee D.; Meisner J.; Micale P.; Meymandi S.; Vicari R.;
Mouhaffel A.; Moscoso R.; Papademetriou V.; Piegari G.; Promisloff S.;
Rivera E.; Rogers W.; Roth D.; Sadler D.; Canto J.; Schmedtje J.; Shaikh
S.; Shalev Y.; Sharma M.; Rahman A.; Schwartz S.; Sporn D.; Staniloae C.;
Tami L.; Barnum O.; Tu T.; Tuma J.; Wali A.; Welka S.; Wilson V.; Younis
L.; Zakhary B.; Ziperman D.; Singh N.; Kukuy E.; Leimbach W.; Chang M.;
Carter M.; Simpson P.; Miklin J.; Niess G.; Schaefer S.; Lambert C.; Soh
E.; Heintz K.; Miller J.; Chandrashekhar Y.; Pappas J.; Rashid H.U.;
Wright W.; Rees A.; Bach R.; Wu W.; Singhi S.; Quyyumi A.; Lau T.; Nobel
J.; Kamdar A.; Kabour A.; Stys T.; Keller N.; Kumar A.; Danisa K.; Smith
S.; Espinoza A.; Deac D.; Roberts D.; Gumm D.; Saucedo J.; Gimple L.;
Weinstein D.; Blonder R.; Moran M.; Iwaoka R.; Bayron C.; Tejada L.; White
L.; Ingersoll H.; Casterella P.; Chiaramida S.; Harris J.; Rodriguez R.;
Vo A.; Dave K.; Giacomini J.; Kotha P.; Park C.; Arif I.; McGrew F.; Atieh
M.; Huang X.; Zarrella G.; McGarvey J.; Koganti D.; Albirini A.; Kozman
H.; Slepian M.; Quion J.A.; Ramanathan K.; Bessen M.; Rafael A.; Aycock G.
Institution
(Roe, McLendon, Lokhnygina, Ohman) Duke Clinical Research Institute, Duke
University Medical Center, 2400 Pratt St, Durham, NC 27705, United States
(Roe, Ohman) Division of Cardiology, Department of Medicine, Duke
University Medical Center, Durham, NC, United States
(Armstrong) Division of Cardiology, University of Alberta, Edmonton, AB,
Canada
(Goodman) Division of Cardiology, St. Michael's Hospital, University of
Toronto, Toronto, ON, Canada
(Fox) Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(White) Auckland City Hospital, Green Lane Cardiovascular Service,
Auckland, New Zealand
(Prabhakaran) Center for Chronic Disease Control, New Delhi, India
(Cornel) Department of Cardiology, Medical Center Alkmaar, Alkmaar,
Netherlands
(Bhatt) VA Boston Healthcare System, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Clemmensen) Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Martinez) Department of Cardiology, Cordoba National University, Cordoba,
Argentina
(Ardissino) Division of Cardiology, Azienda Ospedaliero-Universitaria di
Parma, Parma, Italy
(Nicolau) Heart Institute (InCor), University of Sao Paulo Medical School,
Sao Paulo, Brazil
(Boden) Department of Medicine, Stratton VA Medical Center, Albany Medical
College, Albany, NY, United States
(Hochman) Leon H. Charney Division of Cardiology, New York University
School of Medicine, NYU Langone Medical Center, NY, United States
(Gurbel) Sinai Center for Thrombosis Research, Sinai Hospital of
Baltimore, Baltimore, United States
(Ruzyllo) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Dalby) Milpark Hospital, Johannesburg, South Africa
(McGuire) University of Texas-Southwestern Medical Center, Dallas, TX,
United States
(Leiva-Pons) Cardiology Department, Hospital Central Dr. Morones Prieto,
San Luis Potosi, Mexico
(Parkhomenko) Emergency Cardiology, Institute of Cardiology, Kiev, Ukraine
(Gottlieb) Department of Cardiology, Bikur Cholim Hospital, Jerusalem,
Israel
(Topacio) Department of Medicine, Medical Center Manila, Manila,
Philippines
(Hamm) Kerckhoff Heart Center, Bad Nauheim, Germany
(Pavlides) Cardiology Division, Onassis Cardiac Surgery Center, Kallithea,
Greece
(Goudev) Cardiology Department, Queen Giovanna University Hospital, Sofia,
Bulgaria
(Oto) Department of Cardiology, Hacettepe University Faculty of Medicine,
Ankara, Turkey
(Tseng) Division of Cardiology, National Taiwan University College of
Medicine, Taipei, Taiwan (Republic of China)
(Merkely) Heart Center, Semmelweis University, Budapest, Hungary
(Gasparovic) Department of Intensive Care Medicine, Clinical Hospital
Center Zagreb, Zagreb, Croatia
(Corbalan) Cardiovascular Division, Faculty of Medicine, Pontificia
Universidad Catolica de Chile, Santiago, Chile
(Cinteza) Division of Cardiology, Emergency University Hospital of
Bucharest, Bucharest, Romania
(Winters, Brown) Eli Lilly, Indianapolis, IN, United States
(Aylward) South Australian Health and Medical Research Institute, Flinders
University Medical Centre, Adelaide, SA, Australia
(Huber) Third Department of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND: The effect of intensified platelet inhibition for patients
with unstable angina or myocardial infarction without ST-segment elevation
who do not undergo revascularization has not been delineated.
 METHOD(S): In this double-blind, randomized trial, in a primary
analysis involving 7243 patients under the age of 75 years receiving
aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg
daily) versus clopidogrel (75 mg daily). In a secondary analysis involving
2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel
versus 75 mg of clopidogrel. RESULT(S): At a median follow-up of 17
months, the primary end point of death from cardiovascular causes,
myocardial infarction, or stroke among patients under the age of 75 years
occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel
group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval
[CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the
overall population. The prespecified analysis of multiple recurrent
ischemic events (all components of the primary end point) suggested a
lower risk for prasugrel among patients under the age of 75 years (hazard
ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and
intracranial bleeding were similar in the two groups in all age groups.
There was no significant between-group difference in the frequency of
nonhemorrhagic serious adverse events, except for a higher frequency of
heart failure in the clopidogrel group. CONCLUSION(S): Among patients
with unstable angina or myocardial infarction without ST-segment
elevation, prasugrel did not significantly reduce the frequency of the
primary end point, as compared with clopidogrel, and similar risks of
bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY
ACS ClinicalTrials.gov number, NCT00699998.) Copyright © 2012
Massachusetts Medical Society.

<44>
Accession Number
369762011
Title
Matrix metalloproteinases in T cell mediated pulmonary diseases.
Source
Frontiers in Bioscience - Elite. 4 E(6) (pp 2162-2169), 2012. Date of
Publication: 01 Jan 2012.
Author
Benson H.L.; Wilkes D.S.
Institution
(Benson, Wilkes) Department of Medicine, Microbiology and Immunology,
Indiana University School of Medicine, Fairbanks Hall, Indianapolis, IN
46202, United States
(Benson, Wilkes) Center for Immunobiology, Indiana University School of
Medicine, Indianapolis, IN 46202, United States
Publisher
Bioscience Research Institute
Abstract
Lung transplantation is the only conclusive treatment for many patients
suffering from end-stage pulmonary disease. Unfortunately, the leading
cause of death in lung transplant recipients is the development of chronic
rejection known as obliterative bronchiolitis, characterized by extensive
remodeling. Matrix metalloproteinases (MMPs) are endopeptidases known for
their role in matrix remodeling and their involvement in many biological
processes including end-stage pulmonary disease and transplant rejection.
Our understanding of MMPs involvement in pulmonary immunity is rapidly
expanding. As a result there has been some focus on MMPs role in T
cell-associated pulmonary diseases, such as pulmonary fibrosis, emphysema,
asthma and bronchiolitis obliterans syndrome. However, not much is known
about the role of MMPs in regulating immune cell function. It is now
commonly known that MMP inhibition via, broad spectrum or specific
synthetic or naturally occurring inhibitors (TIMPs) can down regulated
many pulmonary disease states. In this review, we explore the idea that T
cell targeted MMP inhibition may provide a novel approach of immune
regulation in the treatment of T cell-mediated diseases.

<45>
Accession Number
2014620659
Title
Impact of sex on outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 343 (pp 27-34), 2021. Date of
Publication: 15 Nov 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.

<46>
Accession Number
2014444038
Title
Effects of the interactive web-based video "mon coeur, mon basic" on drug
adherence of patients with myocardial infarction: Randomized controlled
trial.
Source
Journal of Medical Internet Research. 23(8) (no pagination), 2021. Article
Number: e21938. Date of Publication: August 2021.
Author
Bruggmann C.; Adjedj J.; Sardy S.; Muller O.; Voirol P.; Sadeghipour F.
Institution
(Bruggmann, Voirol, Sadeghipour) Department of Pharmacy, University
Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
(Bruggmann, Voirol, Sadeghipour) Institute of Pharmaceutical Sciences of
Western Switzerland, University of Geneva, Geneva, Switzerland
(Bruggmann) Department of Pharmacy, University Hospital of Geneva, Geneva,
Switzerland
(Adjedj, Muller) Department of Cardiology, University Hospital of
Lausanne, University of Lausanne, Lausanne, Switzerland
(Sardy) Section of Mathematics, University of Geneva, Geneva, Switzerland
Publisher
JMIR Publications Inc.
Abstract
Background: Secondary prevention strategies after acute coronary syndrome
(ACS) presentation with the use of drug combinations are essential to
reduce the recurrence of cardiovascular events. However, lack of drug
adherence is known to be common in this population and to be related to
treatment failure. To improve drug adherence, we developed the "Mon Coeur,
Mon BASIC" video. This online video has been specifically designed to
inform patients about their disease and their current medications.
Interactivity has been used to increase patient attention, and the video
can also be viewed on smartphones and tablets. Objective(s): The
objective of this study was to assess the long-term impact of an
informative web-based video on drug adherence in patients admitted for an
ACS. Method(s): This randomized study was conducted with consecutive
patients admitted to University Hospital of Lausanne for ACS. We
randomized patients to an intervention group, which had access to the
web-based video and a short interview with the pharmacist, and a control
group receiving usual care. The primary outcome was the difference in drug
adherence, assessed with the Adherence to Refills and Medication Scale
(ARMS; 9 multiple-choice questions, scores ranging from 12 for perfect
adherence to 48 for lack of adherence), between groups at 1, 3, and 6
months. We assessed the difference in ARMS score between both groups with
the Wilcoxon rank sum test. Secondary outcomes were differences in
knowledge, readmissions, and emergency room visits between groups and
patients' satisfaction with the video. Result(s): Sixty patients were
included at baseline. The median age of the participants was 59 years (IQR
49-69), and 85% (51/60) were male. At 1 month, 51 patients participated in
the follow-up, 50 patients participated at 3 months, and 47 patients
participated at 6 months. The mean ARMS scores at 1 and 6 months did not
differ between the intervention and control groups (13.24 vs 13.15, 13.52
vs 13.68, respectively). At 3 months, this score was significantly lower
in the intervention group than in the control group (12.54 vs 13.75;
P=.03). We observed significant increases in knowledge from baseline to 1
and 3 months, but not to 6 months, in the intervention group. Readmissions
and emergency room visits have been very rare, and the proportion was not
different among groups. Patients in the intervention group were highly
satisfied with the video. Conclusion(s): Despite a lower sample size
than we expected to reach, we observed that the "Mon Coeur, Mon BASIC"
web-based interactive video improved patients' knowledge and seemed to
have an impact on drug adherence. These results are encouraging, and the
video will be offered to all patients admitted to our hospital with
ACS. Copyright © 2021 Journal of Medical Internet Research. All
rights reserved.

<47>
Accession Number
2014418102
Title
Understanding treatment-subgroup effect in primary and secondary
prevention of cardiovascular disease: An exploration using meta-analyses
of individual patient data.
Source
Journal of Clinical Epidemiology. 139 (pp 160-166), 2021. Date of
Publication: November 2021.
Author
Torres Roldan V.D.; Ponce O.J.; Urtecho M.; Torres G.F.; Belluzzo T.;
Montori V.; Liu C.; Barrera F.; Diaz A.; Prokop L.; Guyatt G.; Montori
V.M.
Institution
(Torres Roldan, Ponce, Urtecho, Montori, Barrera, Montori) Knowledge and
Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
(Torres, Liu) School of Medicine, Cayetano Heredia Peruvian University,
Lima, Peru
(Belluzzo) Internal Medicine, Jablonec nad Nisou Hospital, Jablonec nad
Nisou, Czechia
(Barrera, Diaz) Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER
Unit Mexico), School of Medicine, Universidad Autonoma de Nuevo Leon,
Monterrey, Nuevo Leon, Mexico
(Prokop) Department of Library-Public Services, Mayo Clinic, Rochester,
MN, United States
(Guyatt) McMaster University, Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background and Objective: Recommendations for preventing cardiovascular
(CV) disease are currently separated into primary and secondary
prevention. We hypothesize that relative effects of interventions for CV
prevention are not different across primary and secondary prevention
cohorts. Our aim was to test for differences in relative effects on CV
events in common preventive CV interventions across primary and secondary
prevention cohorts. Methods and Results: A systematic search was
performed to identify individual patient data (IPD) meta-analyses that
included both primary and secondary prevention populations. Eligibility
assessment, data extraction, and risk of bias assessment were conducted
independently and in duplicate. We extracted relative risks (RR) with 95%
confidence intervals (95% CI) of the interventions over patient-important
outcomes and estimated the ratio of RR for primary and secondary
prevention populations. We identified five eligible IPDs representing
524,570 participants. Quality assessment resulted in overall
low-to-moderate methodological quality. We found no subgroup effect across
prevention categories in any of the outcomes assessed. Conclusion(s):
In the absence of significant treatment-subgroup interactions between
primary and secondary CV prevention cohorts for common preventive
interventions, clinical practice guidelines could offer recommendations
tailored to individual estimates of CV risk without regard to membership
to primary and secondary prevention cohorts. This would require the
development of reliable ASCVD risk estimators that apply across both
cohorts. Copyright © 2021

<48>
Accession Number
2014016254
Title
Aortic chordae tendineae strands with significant aortic regurgitation: A
case report and review of the literature.
Source
International Heart Journal. 62(5) (pp 1160-1163), 2021. Date of
Publication: 2021.
Author
Yuan S.; Mou R.; Sun X.; Mou Y.
Institution
(Yuan, Sun, Mou) Department of Echocardiography and Vascular Ultrasound
Center, The First Affiliated Hospital, College of Medicine, Zhejiang
University, Hangzhou, China
(Mou) Departments of Clinical Medicine, Hangzhou Medical College,
Hangzhou, China
Publisher
International Heart Journal Association
Abstract
The aortic chordae tendineae strands are suggested to be embryonic
remnants of the cusp formation process. We herein describe a 70-year-old
male who was admitted to our hospital for shortness of breath and chest
tightness. During echocardiographic examination, severe aortic
regurgitation with a ruptured fibrous strand was detected. Moreover,
another fibrous strand was found by three-dimensional transesophageal
echocardiography (TEE). To our knowledge, this is the first literature
review of aortic chordae tendineae strands, including diagnosis,
management, and mechanisms of aortic regurgitation due to such informal
strands. Copyright © by the International Heart Journal
Association.

<49>
Accession Number
2011445027
Title
The effect of peri-operative dexmedetomidine on the incidence of
postoperative delirium in cardiac and non-cardiac surgical patients: a
randomised, double-blind placebo-controlled trial.
Source
Anaesthesia. 76(10) (pp 1342-1351), 2021. Date of Publication: October
2021.
Author
van Norden J.; Spies C.D.; Borchers F.; Mertens M.; Kurth J.; Heidgen J.;
Pohrt A.; Mueller A.
Institution
(van Norden, Spies, Borchers, Mertens, Kurth, Heidgen, Mueller) Department
of Anaesthesia and Intensive Care Medicine, Institute of Biometry and
Clinical Epidemiology, Charite - Universitatsmedizin Berlin, Freie
Universitat Berlin, Humboldt-Universitat zu Berlin, Berlin Institute of
Health, Berlin, Germany
(Pohrt) Institute of Biometry and Clinical Epidemiology, Charite -
Universitatsmedizin Berlin, Freie Universitat Berlin, Humboldt-Universitat
zu Berlin, Berlin Institute of Health, Berlin, Germany
Publisher
John Wiley and Sons Inc
Abstract
Delirium occurs commonly following major non-cardiac and cardiac surgery
and is associated with: postoperative mortality; postoperative
neurocognitive dysfunction; increased length of hospital stay; and major
postoperative complications and morbidity. The aim of this study was to
investigate the effect of peri-operative administration of dexmedetomidine
on the incidence of postoperative delirium in non-cardiac and cardiac
surgical patients. In this randomised, double-blind placebo-controlled
trial we included 63 patients aged >= 60 years undergoing major open
abdominal surgery or coronary artery bypass graft surgery with
cardiopulmonary bypass. The primary outcome was the incidence of
postoperative delirium, as screened for with the Confusion Assessment
Method. Delirium assessment was performed twice daily until postoperative
day 5, at the time of discharge from hospital or until postoperative day
14. We found that dexmedetomidine was associated with a reduced incidence
of postoperative delirium within the first 5 postoperative days, 43.8% vs.
17.9%, p = 0.038. Severity of delirium, screened with the Intensive Care
Delirium Screening Checklist, was comparable in both groups, with a mean
maximum score of 1.54 vs. 1.68, p = 0.767. No patients in the
dexmedetomidine group died while five (15.6%) patients in the placebo
group died, p = 0.029. For patients aged >= 60 years undergoing major
cardiac or non-cardiac surgery, we conclude that the peri-operative
administration of dexmedetomidine is associated with a lower incidence of
postoperative delirium. Copyright © 2021 The Authors. Anaesthesia
published by John Wiley & Sons Ltd on behalf of Association of
Anaesthetists.

<50>
Accession Number
2011027252
Title
Association Between Sternotomy Versus Thoracotomy and the Prevalence and
Severity of Chronic Postsurgical Pain After Mitral Valve Repair: An
Observational Cohort Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(10) (pp 2937-2944),
2021. Date of Publication: October 2021.
Author
Minami K.; Kabata D.; Kakuta T.; Fukushima S.; Fujita T.; Yoshitani K.;
Ohnishi Y.
Institution
(Minami) Department of Surgical Intensive Care, National Cerebral and
Cardiovascular Center, Osaka, Japan
(Kabata) Department of Medical Statistics, Osaka City University Graduate
School of Medicine, Osaka, Japan
(Kakuta, Fukushima, Fujita) Department of Cardiac Surgery, National
Cerebral and Cardiovascular Center, Osaka, Japan
(Yoshitani, Ohnishi) Department of Anesthesiology, National Cerebral and
Cardiovascular Center, Osaka, Japan
Publisher
W.B. Saunders
Abstract
Objective: Investigate differences in the prevalence and severity of
chronic postsurgical pain (CPSP) after cardiac surgery via thoracotomy
versus sternotomy are not well-understood. Design(s): An
observational cohort study. Setting(s): A tertiary care hospital.
 Participant(s): Four hundred twenty-eight patients (sternotomy: 192
patients, thoracotomy: 236 patients) who underwent mitral valve repair.
 Intervention(s): A questionnaire about the severity of surgical wound
pain evaluated with a numerical rating scale (NRS) was sent. NRS responses
for current pain, peak pain in the last four weeks, and average pain in
the last four weeks were evaluated. Measurements and Main Results:
The main outcomes were the severity of CPSP evaluated using NRS and the
prevalence of CPSP. CPSP was defined as pain >0 that developed after a
surgical procedure. During the median follow-up of 29 months, 79 patients
complained of CPSP. (sternotomy: 15 patients, thoracotomy: 64 patients).
Multivariate ordinal logistic regression showed that NRS responses for
current pain (adjusted odds ratio [aOR], 3.17; 95% confidence interval
[CI] 1.64-6.12; p = 0.001), peak pain in the last four weeks (aOR, 2.00;
95% CI 1.11-3.61; p = 0.021), and average pain in the last four weeks
(aOR, 2.21; 95% CI 1.31-3.72; p = 0.003) were significantly higher in
patients who underwent thoracotomy. Multivariate logistic regression
showed that thoracotomy was an independent predictor of CPSP (aOR, 3.63;
95% CI 1.67-7.88; p = 0.001). Conclusion(s): The prevalence and
severity of CPSP were higher among patients who underwent mitral valve
repair via thoracotomy than sternotomy. Copyright © 2021 Elsevier
Inc.

<51>
Accession Number
2007902358
Title
Quality of Life After Ministernotomy Versus Full Sternotomy Aortic Valve
Replacement.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33(2) (pp 328-334), 2021.
Date of Publication: Summer 2021.
Author
Rodriguez-Caulo E.A.; Guijarro-Contreras A.; Guzon A.; Otero-Forero J.;
Mataro M.J.; Sanchez-Espin G.; Porras C.; Villaescusa J.M.; Melero-Tejedor
J.M.; Jimenez-Navarro M.
Institution
(Rodriguez-Caulo, Guzon, Otero-Forero, Mataro, Sanchez-Espin, Porras,
Villaescusa, Melero-Tejedor) UGC Heart Area, Cardiovascular Surgery
Department, Hospital Universitario Virgen de la Victoria de Malaga,
Fundacion Publica Andaluza para la Investigacion de Malaga en Biomedicina
y Salud (FIMABIS), University of Malaga, CIBERCV Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
(Guijarro-Contreras, Jimenez-Navarro) UGC Heart Area, Cardiology
Department, Hospital Universitario Virgen de la Victoria de Malaga,
Fundacion Publica Andaluza para la Investigacion de Malaga en Biomedicina
y Salud (FIMABIS), University of Malaga, CIBERCV Enfermedades
Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
Publisher
W.B. Saunders
Abstract
Quality of life and patient satisfaction after ministernotomy have never
been compared to conventional full sternotomy in randomized trials. The
QUALITY-AVR trial is a single-blind, single-center, independent,
randomized clinical trial comparing ministernotomy to full sternotomy in
patients with isolated severe aortic stenosis scheduled for elective
aortic valve replacement. One hundred patients were randomized in a 1:1
computational fashion. The primary endpoint was a difference between
intervention groups of >=0.10 points in change from baseline quality of
life Questionnaire EuroQOL-index, measured at 1, 6, or 12 months.
Secondary endpoints were differences in change from other baseline
EuroQOL-index utilities, cardiac surgery-specific satisfaction
questionnaire (SATISCORE), a combined safety endpoint of 4 major adverse
complications at 1 month (all-cause mortality, acute myocardial
infarction, neurologic events, and acute renal failure), bleeding through
drains within the first 24 hours, intubation time, and other minor
endpoints. Clinical follow-up was scheduled at baseline, 1, 6, and 12
months after randomization. Change from baseline mean difference
EQ-5D-index was +0.20 points (95% confidence interval 0.10-0.30, P <
0.001) and median difference +0.14 (95% confidence interval 0.06-0.22, P <
0.001), favoring the ministernotomy group at 1 month. Patient satisfaction
was also better at 1 month (Satiscore 83 +/- 9 vs 77 +/- 13 points; P =
0.010). The ministernotomy group had significantly less bleeding in the
first 24 hours (299 +/- 140 vs 509 +/- 251 mL, P = 0.001). Ministernotomy
provides a faster recovery with improved quality of life and satisfaction
at 1 month compared to full sternotomy. Copyright © 2020 Elsevier
Inc.

<52>
Accession Number
2014866892
Title
Perioperative Care Standards in Cardiac Surgery Patients Aiming at
Enhancing Recovery: A Nationwide Survey in the Netherlands and Belgium.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Damstra J.; Geerts B.F.; Rex S.; Vlaar A.P.J.; Driessen A.H.G.; Engelman
D.T.; Klautz R.J.M.; Eberl S.
Institution
(Damstra, Eberl) Department of Anesthesiology, Amsterdam UMC, Location
AMC, Netherlands
(Rex) Department of Anesthesiology, University Hospital Leuven, Belgium;
and Department of Cardiovascular Sciences, KU Leuven, Belgium
(Vlaar) Department of Intensive Care, Amsterdam UMC, Location AMC,
Netherlands
(Driessen, Klautz) Department of Cardiothoracic Surgery, Amsterdam UMC,
location AMC, Netherlands
(Engelman) Heart and Vascular Program, Baystate Health, Springfield and
University of Massachusetts Medical School-Baystate, Springfield, MA,
United States
(Geerts) Department for Intensive Care, Spaarne Gasthuis, Haarlem,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: The aim of this survey was to describe existing perioperative
care standards and best practices in the Netherlands and Belgium.
 Design(s): An online survey was followed up by an in-depth personal
interview. The main outcomes were the existing standards of perioperative
care for patients undergoing cardiac surgery. Setting(s): The online
survey and subsequent interviews were targeted to one representative in
the intensive care unit (ICU), cardiac surgery, and anesthesiology
department from each cardiac surgical center in the Netherlands and
Belgium. Participant(s): A representative intensive care physician,
cardiac surgeon, and cardiac anesthesiologist. Intervention(s): None.
 Measurements and Main Results: The response rate was 60% (71% for the
Netherlands, and 44% in Belgium). Agreement across centers was found for
discontinuation of proton-pump inhibitors (80%) and avoiding intra- and
postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally, 98%
of respondents stated that physiotherapy should be started immediately in
the ICU. Major divergence was found for elements such as the
discontinuation of angiotensin-converting enzyme inhibitors (55%) or the
postoperative use of chest support vests (44%). Conclusion(s): The
authors demonstrated a wide range of different local protocols. Strategies
differed among disciplines, hospitals, and countries. This emphasized the
need for the implementation of a more universal protocol to further reduce
variance and improve recovery practices. This nationwide survey was the
first of its kind simultaneously studying best practices for cardiac
surgery through the entire care pathway at the advent of Enhanced Recovery
After Surgery (ERAS) Cardiac implementation. A multinational randomized
controlled trial to test the implementation of an evidence-based ERAS
Cardiac protocol is the next step to pave the way for further outcome
improvements in this high-risk population. Copyright © 2021
Elsevier Inc.

<53>
Accession Number
2014844898
Title
Myocardial Protection With Different Cardioplegia in Adult Cardiac
Surgery: A Network Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Zhou K.; Zhang X.; Li D.; Song G.
Institution
(Zhou, Li) Department of Cardiac Surgery, Shengjing Hospital of China
Medical University, Shenyang, China
(Zhang, Song) Department of Ultrasound, Shengjing Hospital of China
Medical University, Shenyang, China
Publisher
Elsevier Ltd
Abstract
Aim: Cardioplegia is one of the most studied fields of myocardial
protection during cardiac surgery. However, the most effective
cardioplegia for protection in adult cardiac surgery remains unknown.
 Method(s): PubMed and other databases were searched and a network
meta-analysis with a Bayesian framework was performed. The primary
outcomes were the serum concentrations of creatine kinase-myocardial band
(CK-MB), cardiac troponin I, and cardiac troponin T (cTnT) at four time
points. Several clinical outcomes were evaluated, including low output
syndrome, myocardial infarction, and risk of early mortality. All studies
that involved crystalloid cardioplegia without reference to St Thomas
cardioplegia or histidine-tryptophan-ketoglutarate solution, and if the
cardioplegia was used at a temperature between 4degreeC and 16degreeC were
classified as cold crystalloid (cCCP) or cold blood cBCP cardioplegia.
Warm blood cardioplegia (wBCP) was defined as the blood cardioplegia used
at a temperature between 32degreeC and 37degreeC. Result(s):
Forty-seven (47) studies with a total of 4,175 patients were included.
Seven (7) cardioplegia solutions were used, including cold CCP or BCP, del
Nido solution, histidine-tryptophan-ketoglutaratesolution, St Thomas
cardioplegia, wBCP and warm terminal blood cardioplegia (wtBCP). The serum
concentrations of CK-MB at 2 hours (mean difference [MD], 213.56; 95%
confidence interval [CI], -25.79 to -1.59) and cTnT at 24 hours of wBCP
(MD, -1.50; 95% CI, -2.69 to -0.31) were significantly lower than that of
cCCP. There were no significant differences in other outcomes of these six
cardioplegia solutions, when compared to cCCP. Conclusion(s): The
seven cardioplegia solutions analysed had similar myocardial protective
effects after adult cardiac surgery, although wBCP had a lower CK-MB at 2
hours and lower cTnT at 24 hours. Copyright © 2021 Australian and
New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the
Cardiac Society of Australia and New Zealand (CSANZ)

<54>
Accession Number
2012840618
Title
Association between perioperative chlorhexidine oral care and
postoperative pneumonia in non-cardiac surgical patients: A systematic
review and meta-analysis.
Source
Surgery (United States). 170(5) (pp 1418-1431), 2021. Date of Publication:
November 2021.
Author
Liang S.; Zhang X.; Hu Y.; Yang J.; Li K.
Institution
(Liang, Zhang, Hu, Li) West China School of Nursing, West China Hospital,
Sichuan University, Chengdu, China
(Yang) Department of Gastrointestinal Surgery, West China School of
Nursing, West China Hospital, Sichuan University, Chengdu, China
Publisher
Elsevier Inc.
Abstract
Background: Postoperative pneumonia is the third most common complication
after surgery, and its occurrence is associated with a poor prognosis in
patients. Perioperative chlorhexidine oral care has been reported to
reduce the incidence of postoperative pneumonia in patients undergoing
cardiac surgery. However, whether perioperative chlorhexidine oral care
can reduce the incidence of postoperative pneumonia in noncardiac surgical
patients is still unknown. The aim of this systematic review and
meta-analysis was to determine the association between perioperative
chlorhexidine oral care and postoperative pneumonia in noncardiac surgical
patients. Method(s): A comprehensive systematic search of PubMed,
Ovid Embase, Web of Science, the Cochrane Library, Wanfang Database, and
the China National Knowledge Infrastructure was conducted to include
studies from the inception of each database through March 2021. The
reference lists of all included studies were also searched by hand.
Eligible studies were published and unpublished randomized controlled
trials and observational studies evaluating the effect of perioperative
chlorhexidine oral care on the reported incidence of postoperative
pneumonia. Relative risks or odds ratio with their 95% confidence
intervals were calculated and risk of bias was assessed for eligible
studies. Result(s): Seven randomized controlled trials with a total
of 1,773 patients and 3 observational studies with a total of 12,528
noncardiac surgical patients were included. A total of 621 and 5,904
patients received perioperative chlorhexidine oral care in randomized
controlled trials and observational studies, respectively. Six (85%)
randomized controlled trials had a high risk of bias, and 2 (67%)
observational studies had a high quality. Perioperative chlorhexidine oral
care significantly reduced the incidence of postoperative pneumonia in
randomized controlled trials (relative risk, 0.60; 95% confidence
interval, 0.44-0.80; P < .001) and observational studies (odds ratio,
0.26; 95% confidence interval, 0.08-0.90; P = .03). Conclusion(s):
Perioperative chlorhexidine oral care led by a nurse significantly
decreases the incidence of postoperative pneumonia in noncardiac surgical
patients and may be more convenient and economical compared with dental
professional-led perioperative oral care. Copyright © 2021
Elsevier Inc.

<55>
Accession Number
636287833
Title
Using proenkephalin as a novel biomarker to estimate glomerular filtration
rate.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
Beunders R.; Donato L.; Van Groenendael R.; Arlt B.; Carvalho C.; Schulte
J.; Coolen A.; Lieske J.; Meeusen J.; Jaffe A.; Pickkers P.
Institution
(Beunders, Pickkers) Department of Intensive Care Medicine, Radboud
University Medical Center, Nijmegen, Netherlands
(Donato, Meeusen) Department of Laboratory Medicine and Pathology, Mayo
Clinic, Rochester, United States
(Van Groenendael) Anesthesiology, Pain and Palliative Medicine, Radboud
University Medical Center, Nijmegen, Netherlands
(Arlt, Carvalho, Schulte) Research and Biostatistics, SphingoTec, GmbH,
Hennigsdorf, Germany
(Coolen) Donders Institute for Brain, Cognition and Behaviour, Radboud
University Medical Center, Nijmegen, Netherlands
(Lieske) Division of Nephrology and Hypertension, Mayo Clinic, Rochester,
United States
(Jaffe) Department of Cardiology, Mayo Clinic, Rochester, United States
Publisher
Springer
Abstract
Introduction. Deterioration of kidney function is an independent predictor
of clinical outcomes including mortality. Glomerular filtration rate (GFR)
is the overall best indicator of kidney health. Accurate assessment of GFR
is important for early diagnosis of acute kidney injury, monitoring of
treatment regimens for affected patients, and proper dosing of renally
excreted medications. Traditionally, GFR has been estimated (eGFR) using
serum creatinine and demographic information including age, sex and race.
However, currently available equations have limitations regarding accuracy
and precision. In addition, changes in serum creatinine lag changes in GFR
by up to 24 h-48 h when there is an acute injury. Although GFR can be
measured using exogenous small molecules such as iohexol or iothalamate,
these methods are labour-intensive and not practical in many
circumstances. We have recently reported that serum Proenkephalin (PENK)
is a promising biomarker of GFR. Here we report the performance of
equations using PENK to predict mGFR as compared to available creatinine
based equations. Objectives. To develop an equation to estimate the GFR
using PENK plasma concentrations. Methods. In this international
multicenter study, GFR was measured (mGFR) in 1354 adult patients using
iohexol or iothalamate plasma clearance. GFR was calculated using the
slope-intercept method and the Brochner-Mortensen correction [1]. Plasma
PENK concentrations were determined using the sphingotestR penKidR
immunoassay [2]. Covariates for the equation-finding analysis were sex,
age, race (African-American, American-Indian, Asian and Caucasian),
patient type (cardiac surgery, sepsis, organ donor/recipient, chronic
kidney disease), and plasma Cr and PENK concentration. A generalized
linear model with a sigmoidal nonlinear transfer function was used for
continuous output regression considering variable selection and equation
building in a block randomized training sample cohort (n = 811). Bias,
precision, and accuracy were assessed in a validation cohort (n = 543),
and results were compared with the creatinine based Modification of Diet
in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology
Collaboration (CKD-EPI) eGFR equations. Results.Mean +/- SD mGFR was 64
+/- 29 mL/min/1.73m2. Data-driven covariate selection resulted in an
optimal eGFR equation using PENK, creatinine, and age. Gender and race did
not further improve the performance (see Fig. 1 for a scatter plot of the
eGFR vs. mGFR). The R-squared of mGFR with eGFRpenk-cr was 0.73 (p <
0.001), compared to with eGFRmdrd: 0.66 (p < 0.001) and with eGFRckd-epi:
0.71 (p < 0.001). The mean bias +/- SD from mGFR was ? 2.3 +/- 15.5 for
the eGFRpenk-cr, compared to eGFRmdrd: ? 7.7 +/- 16.9 and eGFRckdepi: ?
5.0 +/- 15.7. The accuracy of the eGFRpenk-cr was 82.7%, compared to the
eGFRmdrd: 77.3% and eGFRckd-epi: 75.0%. Conclusion. Our study demonstrates
that a PENK-based equation including creatinine and age to estimate GFR
performs better than existing Creatinine-based existing eGFR equations
(MDRD and CKDEPI). Therefore, PENK represents a promising biomarker for
accurate estimation of GFR. External validation in other patient cohorts
is warranted.

<56>
Accession Number
636287799
Title
The Utility of Central Venous to Arterial Carbon Dioxide Tension Gap in
Predicting Outcomes among Postoperative Cardiac Patients: A Systematic
Review and Meta-Analysis.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
Tan A.D.; Patricio M.; Tortosa C.; Permejo C.; Habana L.M.I.
Institution
(Tan, Patricio, Tortosa, Permejo, Habana) Department of Ambulatory,
Emergency and Critical Care, Philippine Heart Center, Quezon City,
Philippines
Publisher
Springer
Abstract
Introduction. Aberrations in tissue perfusion have been associated with
organ dysfunction in high-risk surgical patients. The difference between
venous and arterial carbon dioxide pressures (pCO2 gap) is an easily
obtainable marker of tissue hypoperfusion in critically ill patients who
have not been resuscitated adequately. In this review, we sought to
determine the use of the pCO2 gap in predicting adverse outcomes among
patients who underwent cardiac surgery. Objectives. The general objective
of our study was to evaluate the ability of the pCO2 gap to predict
postoperative outcomes in terms of mortality and morbidity. Our specific
objectives included determining the use of pCO2 gap in predicting
all-cause mortality and determining the role of pCO2 gap in predicting
postoperative outcomes in terms of hospital length of stay, duration of
mechanical ventilation, need for and duration of vasoactive medications,
other organ dysfunction, and need for renal replacement therapy. Methods.
A systematic search of electronic databases from inception to April 2021
was conducted. We searched through PubMed, the Cochrane Database, and the
Herdin Plus network (for local research data). Records were included if
they involved adult patients (age >= 18 yr) and studied our outcomes of
interest. Case reports and conference abstracts were excluded. Data
extraction and study quality assessment were performed independently by
three reviewers. The Newcastle-Ottawa Scale was used to assess
methodological study quality. Results. Out of 1350 records identified,
only 10 qualified for systematic review. Except for 2 studies, the
majority suggested that an elevated pCO2 gap taken upon ICU admission
after cardiac surgery was associated with increased morbidity and
mortality. However, the cut-offs of pCO2 gap and the definitions of organ
morbidity varied between these studies. Only 4 of the studies qualified
for meta-analysis because of their similarities in study design. The
generated area under the curve (AUC) for pCO2 gap was 0.749 (95% CI 0.307
to 1.000 P = 0.001; I2 = 0.00). Taken together, these results indicate
that PCO2 is a useful hemodynamic marker for the prognostication of
adverse outcomes after cardiac surgery. The Egger's test showed that the
publication bias was not significant (P = 0.69). Conclusion. The findings
of our study suggest that an increased pCO2 gap is a valuable predictor of
postoperative complications after cardiac surgery. Measures must thus be
taken to aim for a lower target of this variable. Interventions for
hemodynamic optimization include adequate hydration, judicious use of
vasoactive drugs, treatment of anemia, and correction of electrolytes. The
pCO2 gap that was found to be associated with and predictive of
significant postoperative morbidity was taken upon ICU admission after
surgery. Thus, there may be a role for intraoperative monitoring of this
parameter, whereby corrections may be instituted earlier.

<57>
Accession Number
636291518
Title
Restrictive versus liberal red-cell transfusion strategy in ICU patients:
A Meta-analysis with Trial Sequential Analysis.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
La Via L.; Morgana A.; Tigano S.; Perna F.; Tringali E.; Merola F.;
Messina S.; Murabito P.; Sanfilippo F.; Astuto M.
Institution
(La Via, Tigano, Merola) School of Anaesthesia and Intensive Care,
University Hospital G. Rodolico, Catania, Italy
(Morgana, Messina) School of Anaesthesia and Intensive Care, Magna Gracia
University, Catanzaro, Italy
(Perna, Tringali, Murabito, Sanfilippo, Astuto) Department of
Anesthesiology and Intensive Care, University Hospital G. Rodolico,
Catania, Italy
Publisher
Springer
Abstract
Introduction. Transfusion of red blood cell is very frequently
administered in patients admitted to intensive care unit (ICU). Current
recommendations suggest that a restrictive transfusion strategy (if
hemoglobin [Hb] level is below 7 g/dL) is as effective as a liberal
strategy (with variable cut-offs for transfusions ranging between 9 and 10
g/dL). We conducted a meta-analysis with Trial Sequential Analysis (TSA)
to evaluate the effects of a restrictive transfusion strategy compared to
a liberal transfusion strategy in critically ill adults. Methods. In this
preliminary analysis we screened MEDLINE and EMBASE for randomized
clinical trials (RCTs), up to May 7th, 2021. We calculated relative risk
(RR) for the primary outcome of all-cause mortality at longest follow-up,
using a random-effect model with 95% confidence interval (CI).
Meta-analysis was performed with separation in subgroups according to the
clinical setting of patients (general ICU, septic shock, surgical ICU,
cardiac surgery ICU, traumatic brain injury). For the TSA, the information
size was computed assuming an alpha risk of 5% with a power of 80%. The RR
reduction was set at 20%, estimating a mortality in the liberal
transfusion group of 45%, according to published evidence. Results.
Fourteen RCTs were included in our analysis (10.496 patients in total).
All-cause mortality was not statistically different when the restrictive
transfusion strategy was compared with the liberal transfusion strategy
(RR 1.02, 95% confidence interval [CI] 0.91, 1.15, p = 0.09). None of the
subgroup presented significant differences in mortality between the two
strategies. The TSA conducted on the outcome showed that the sample size
required (11.635 patients) was not yet reached, but the Z-line crossed the
futility line, demonstrating the robustness of these finding which may not
need further investigation (Figure 1). However, these data are pooled from
clinically heterogeneous populations and research on specific subgroups
may be valuable. Figure 1. Forest plot analysis and Trial Sequential
Analysis on mortality at longest follow-up in ICU patients randomized to
restrictive transfusion or liberal transfusion of red blood cell with
subgroup analysis. Analysis performed with random effect model and
Mantel-Haenszel (M-H). CI: confidence interval, RRR: relative risk
reduction, RE: Random effect. Conclusion. There is currently no evidence
that a restrictive red-cell transfusion strategy reduces overall mortality
as compared to a liberal transfusion strategy in critically ill patients.
Future research should be focused on specific populations of ICU patients.

<58>
Accession Number
636291514
Title
Retrospective evaluation of economy in blood products transfusion for
cardiac surgery patients thanks to a point-of-care viscoelastic test.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
Roussiaux A.; Bigeon J.Y.; Halchini C.; Burtin P.; Ducrocq N.; Lorne E.
Institution
(Roussiaux, Bigeon, Halchini, Burtin, Ducrocq, Lorne) Anesthesie et
Reanimation, Clinique du Millenaire, Montpellier, France
Publisher
Springer
Abstract
Introduction. Viscoelastic tests are relevant for postoperative bleeding
management of cardiac surgery patients requiring cardiopulmonary bypass
(CPB) (1) but a systematic review and meta-analysis did not demonstrate a
reduction in the proportion of patients receiving any blood product (2).
Objectives. We aim to assess the real transfusion savings achieved through
the implementation of a point-of-care (POC) viscoelastic tool in our
practice. Methods. We performed a retrospective analysis on two groups of
patients. The first one pooled the 140 surgical patients who underwent
cardiac surgery with CPB between September and December 2018 while the
transfusion attitude was guided by clinical practice and guidances. The
second group of 131 patients consisted of those operated between September
and December 2019, after more than 6 months of practice with the
sonorheometric haemostasis evaluation device Quantra (Stago Biocare,
France). The data collected were blood loss volumes as well as any blood
products transfused during the first 48 h in the intensive care unit
(ICU). Results. The demographics, the surgical case mix performed and the
overall blood loss volumes (753 ml vs 770 ml) were comparable in both
populations during the ICU stay. The comparison of transfusion attitudes
shows that, although not using Quantra systematically for each patient
operated on, we used significantly more fibrinogen concentrate but
significantly less fresh frozen plasma (in fact none in the Quantra
group). Although not being statistically significant, the number of
patients receiving platelets was reduced by 68% (16 vs 5 patients; odd
ratio 3,25[1,16;9,14]) and by 85% for packed red blood cells (120 vs 18
patients; odd ratio 37,67[18,96;74,85]) after the implementation of the
device in our department. Regarding transfusion- related costs only in the
low-bleeding risk sub-category of patients undergoing coronary artery
bypass graft(s) witch accounted for 40% of the whole population, the 88%
reduction in the average transfusion cost per patient is very significant
(p < 0.0001). This important shift might be explained by the team's
evolution towards practices that now aim to treat each of the biological
anomalies leading to insufficient haemostasis in a specific way and no
longer globally. Conclusion. The availability of Quantra in our
department rapidly led to significant positive changes in transfusion
practices, with a marked reduction in the number of patients receiving
blood products. This evolution was not associated with increased
blood-loss volumes. Although not used in every single patient case, such a
tool has allowed for the cardiac surgery team to improve transfusion
management, towards the "essential only ", resulting in a significant
reduction in the global transfusion costs.

<59>
Accession Number
636290824
Title
To assess stress response to Propofol infusion vs. Midazolam infusion in
severe traumatic brain injury (TBI) patients measured by serum cortisol
levels. A randomised control trial.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
Hazarika A.; Kurni M.; Kaloria N.; Jonna D.
Institution
(Hazarika) Anaesthesia and Intensive Care, Post Graduate Institute of
Medical Education & Research, Chandigarh, Chandigarh, India
(Kurni, Kaloria, Jonna) Anaesthesia & Intensive Care, Post Graduate
Institute of Medical Education & Research, Chandigarh, Chandigarh, India
Publisher
Springer
Abstract
Introduction. Stress response following Traumatic brain injury (TBI)
causes a lot of endogenous systemic alterations in the brain. The primary
insult induces the hyperadrenergic response that may be a factor of many
complications. Sedatives are useful in dealing with this response. In
acute phase (first 24 h up to 48 h) continuous infusion of opioid agents
and sedatives is considered to protect the injured brain and reduce
intracranial pressure (ICP)0.1 Several drugs are useful as sedatives but
none of the sedatives are perfect. Propofol demonstrated favourable
effects in reducing CBF, ICP, and CMRO2.2 Midazolam has been proven to
reduce CMRO2, CBF and ICP.1 Both propofol and midazolam are being used to
sedate TBI patient on mechanical ventilation. However, no study have shown
the effect of propofol and midazolam sedation on the stress response
during acute phase of TBI.So our study will try to assess the effect of
these two drugs on stress response as measured by serum cortisol levels.
Objectives. To assess if intravenous propofol infusion provides better
obtundation of stress response due to traumatic brain injury as compared
to midazolam infusion when measured by change in serum cortisol levels.
Changes in hemodynamic variables during 48 h of drug infusion, GOS after
ICU discharge, complications and additional therapy for management.
Methods. This study was a single-institution double-blind prospective
randomized controlled trial.The study was registered in the Clinical trial
registry of India (www. ctri. nic. in) (CTRI/2019/11/022121) after
institutional ethical clearance. Inclusion criteria: Adult patients of 18
years and above with GCS of 8 or less with isolated head injury on first
CT finding requiring mechanical ventilation for > 48 h with normal
coagulation profiles were included. Exclusion criteria: Refusal to give
consent for the study, An elapsed time between trauma and ICU admission in
excess of 24 h, GCS of 3 or less Patients undergoing
operation/intervention/cardiac arrest within the study period,pregnant
patients,patients whose baseline serum cortisol level less then 15 mug/dl,
known allergy or contraindication to infusion drugs,deranged liver
function test (LFT)and renal function test (RFT), Randomization and
allocation: Patients were randomized using computer-generated random
number tables (www. rando misat ion. com) and allocated to one of the two
groups.Patients in Group I were administered with 1% Propofol infusion and
Midazolam infusion was used in Group II. Study Protocol: For all patients,
basic demographic data, baseline vital parameters including GCS, pupillary
reactions, ONSD and investigations was recorded.The drug used along with
its total dose were documented. All patients received fentanyl as a fixed
analgesic. Two samples of serum cortisol level were taken: 1st- Within 24
h of ICU admission; 2nd-After 48 h of 1st sample.Sedation end point: To
maintain RA-SS score of-3. Intracranial pressure was indirectly measured
by optic nerve sheath diameter (ONSD). Neurological Outcome was measured
at ICU discharge using GOS (Glasgow Outcome Scale). Results. Of the 104
patients were recruited, 21 patients were excluded. Fig. 1 shows the
CONSORT diagram. Table 2: Shows the initial and 48 h cortisol levels,
hemodynamic variables and ONSD value between Propofol and Midazolam group.
Table 3 Shows the Glasgow Outcome Score between the groups Conclusion. Our
study found that there is no significant difference between infusion
propofol and midazolam in obtundation of stress response in TBI patients
using serum cortisol as marker.There were no difference in the hemodynamic
parameters, ONSD measurement and even on the outcome of the patients. The
propofol infusion rate used in the study also had no complication/side
effect on the study population. Quest for ideal sedative and marker to
gauge its effect in Traumatic Brain Injury patients is still open. A large
study will be required to effectively bring about a proper conclusion.

<60>
Accession Number
636288020
Title
Evaluation of guideline adherence during preoperative evaluation for
elective surgery using an electronic decision support system.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
Biegert F.; Andonov D.; Ulm B.; Blobner M.; Jungwirth B.; Kagerbauer S.
Institution
(Biegert, Andonov, Ulm, Blobner, Kagerbauer) Department of Anaesthesiology
and Intensive Care, Klinikum Rechts der Isar der Technischen Universitat
Munchen, Munchen, Germany
(Jungwirth) Department of Anaesthesiology and Intensive Care, University
Hospital of Ulm, Ulm, Germany
Publisher
Springer
Abstract
Introduction. Different international and national guidelines exist for
evaluating patients undergoing elective surgery. There is a wide consensus
that proper implementation of clinical guidelines can significantly
improve patient outcome. However, few clinical studies exist to assess how
well these recommendations are followed in day-to-day practice. Past
surveys have indicated a generally poor adherence to current guidelines
[1,2]. Here, we present the results of a retrospective study to evaluate
the preoperative management of 2000 patients that underwent elective
surgery as part of an ongoing project to implement an electronic decision
support system (DSS). Methods. After ethical approval (ethics committee
number 450/20 S-EB, ClinicalTrials.gov ID NCT04843202), a total of 2000
patients who underwent elective non-cardiac surgery between June 2018 and
June 2020 were randomly selected and their data extracted from the
electronic premedication protocol for retrospective evaluation.
Eligibility criteria included an age of 18 or older, as well as a planned
surgery classified as elective. The patient population consisted of 57.1%
(n = 1142) male and 42.9% (n = 858) female patients. Mean age was 55.4 (SD
= 17.8), mean BMI was 26.3 (SD = 4.9), proportions of patients' ASA-scores
I through IV were 21.8% (n = 435), 44.8% (n = 895), 32.5% (n = 651) and
0.9% (n = 19) respectively. The attained data from each premedication
questionnaire was entered into a newly developed software which then
presented the appropriate guideline recommendations applicable for the
particular case. Included in the tool at the time of the study were the
current guidelines of the European Society of Anaesthesiology (ESA) [3,4]
and of the German Society for Anaesthesiology and Intensive Care Medicine
(DGAI) [5]. By comparing the original premedication documentation with the
outputs of the software, guideline compliance was assessed. For
evaluation, guideline recommendations were grouped together according to
the aim of the specific recommendation, for example comments that advised
for an ECG to be performed, resulting in 17 subgroups. Results. In total,
9774 individual recommendations occurred of which around 81% (n = 7955)
originated from ESA guidelines. 46.5% of all recommendations were
correctly followed with the overall rate of adherence being 44.9% in ESA
and 53.5% in DGAI recommendations. Among ESA comments, grade 1
recommendations had a better rate of adherence than grade 2 comments
(64.1% vs. 38.5%). When grouping together recommendations that target the
same procedures, the largest ones were those for renal values (17.8%), ECG
(16.0%) and haemoglobin (11.6%). Groups with the best rate of adherence
were imaging stress testing (86.1%, 62/72), ECG (78.2%, 1221/1562) and
haemoglobin (71.3%, 811/1138). Worst adherence was observed in coronary
angiography (0%, 0/15), spirometry (4.2%, 15/353) and oximetry (11.4%,
49/428) groups. In the patient population, better adherence rates were
associated with a higher ASA score (24% vs. 41% vs. 52% vs. 66%), a lower
BMI (54% in BMI < 30 vs. 36% in BMI > 30), a higher risk surgery (46% in
low and medium risk surgery vs. 61% in high-risk surgery) and a higher age
(35% in patients < 65 y/o vs. 56% in patients > 65 y/o). No significant
differences were observed between male and female patients, smokers and
non-smokers and alcoholics vs. non-alcoholics. Conclusion. With around
every second recommendation being followed, overall guideline adherence is
consistent with self-assessment of anesthesiologists in former studies.
However one possible reason for weak guideline adherence in our study
could be due to the retrospective study design. A personal discussion with
the patient, the content of which was not fully documented on the
premedication sheet, may have rendered one or another guideline
recommendation obsolete. In general, guidelines published by the DGAI had
a better adherence than ESA guidelines. Probable contributing factors are
national guidelines tending to be more commonly known due to the familiar
language, as well as the fact that the German publication compared with
latest European releases relies more on graphs and tables rather than
text, which improves readability. Wether implementation of a DSS improves
adherence or not, as well as how high dependency might be, is subject to
evaluation through an ongoing prospective study and remains to be shown.

<61>
Accession Number
636288009
Title
Impact of Temporary Mechanical Circulatory Support on mortality in
Cardiogenic Shock: An emulated target trial with a prospective,
multicenter, French cohort study.
Source
Intensive Care Medicine Experimental. Conference: European Society of
Intensive Care Medicine Annual Congress, ESICM 2021. Virtual. 9(SUPPL 1)
(no pagination), 2021. Date of Publication: October 2021.
Author
Ughetto A.; Eliet J.; David H.; Nagot N.; Bazalgette F.; Marin G.; Mourad
M.; Kollen S.; Gaudard P.; Colson P.
Institution
(Ughetto, Eliet, David, Bazalgette, Mourad, Gaudard, Colson) Department of
Anesthesiology and Intensive Care, CHU Arnaud de Villeneuve, Montpellier,
France
(Nagot, Marin) Epidemiology and Clinical Research, University of
Montpellier, Montpellier, France
(Kollen) Department of Critical Care Medicine, PERPIGNAN HOSPITAL CENTRE,
Perpignan, France
Publisher
Springer
Abstract
Introduction. The field of temporary mechanical circulatory support (TMCS)
has advanced in last decade justifying that TMCS is increasingly used for
treatment of refractory cardiogenic shock (CS). Nevertheless, the efficacy
of TMCS (extracorporeal life support (ECLS) and Impella) in CS remains
controversial due to the lack of high-quality evidence. Objectives. The
aim of this prospective multicenter observational study simulating a
randomized trial was to assess the impact of TMCS on the hospital
mortality in patients with CS. Methods. This study (ClinicalTrials.gov ID:
NCT03528291) was conducted at 3 TMCS centers organized in a cardiac
assistance network, one as a level 1 TMCS center (expert center), and 2 as
level 2 centers (hub centers). The study was designed and led by the heart
team of the expert center with input from the hub centers.All patients
admitted to an intensive care unit between July 2017 and May 2020 either
directly at the TMCS centers or after transfer from a non-specialized
hospital, were screened for TMCS indication provided they were admitted
for CS. CS was defined according to the European Society of Cardiology
criteria. Were excluded patients younger than 18 years, CS after cardiac
surgery, or after cardiac arrest if it was refractory or with a no flow >
3 min and/or out-of-hospital cardiac arrest with non-shockable rhythm, or
CS in the context of myocardial infarction complications, massive
pulmonary embolism, and if TMCS was contraindicated TMCS indication was
decided after a multidisciplinary discussion carried out by the "heart
team". Implantation of TMCS resulted from an agreement of the heart team
within the first 24 h after admission mainly based on the initial severity
of the CS, or if CS was refractory to the medical treatment.The primary
outcome was inhospital survival. A propensity score-weighted analysis was
done for treatment-effect estimation. This method, which weights each
patient according to their propensity score, includes all participants in
the analysis. Results. 246 patients with CS were included in the study:
121 in TMCS group (72% ECLS, 14% Impella, 14% both ECLS and Impella) and
125 in control group. After adjustment by a propensity score, hospital
mortality was comparable in the two groups (32% TMCS group vs 27% control
group; Odds ratio with TMCS, 1.28; 95% confidence interval, 0.87 to 1.88;
p = 0.21). Mortality at D180 was also similar in the two group (33% vs 30%
respectively; p = 0.51). Mechanical ventilation duration was higher in the
TMCS group (median (IQR) 9.0 days (3.0;16.0) vs 1.0 days (0.0;6.0); p <
0.01)) as well as ICU and hospital length of stay (median (IQR) 29.0 days
(16.0;49.0) vs 15.0 days (10.0;24.0); p < 0.01). Concerning the side
effects, thromboembolic events were significantly more frequent in the
TCMS group (14% vs 4%; p < 0.01) as well as the transfusion rate ((median
(IQR); 4.0 (0.0;9.0) vs 0.0 (0.0;0.0); p < 0.01). In addition, hemolysis
and blood infection were significantly higher in the TMCS group. Quality
of life as assessed by SF36 score was similar in both groups (TMCS group;
54.0 (36.0;80.0) vs control group 63.0 (36.0;79.0); p = 0.73). Conclusion.
In our study simulating a randomized trial, the use of TMCS does not seem
to improve hospital survival in patients with cardiogenic shock. Thus,
TMCS, which are iatrogenic side effects providers, should be reserved for
the most severe patient and discussed by a multidisciplinary team.

<62>
Accession Number
2014248376
Title
Non-invasive continuous measurement of haemodynamic parameters-clinical
utility.
Source
Journal of Clinical Medicine. 10(21) (no pagination), 2021. Article
Number: 4929. Date of Publication: November-1 2021.
Author
Bodys-Pelka A.; Kusztal M.; Boszko M.; Glowczynska R.; Grabowski M.
Institution
(Bodys-Pelka, Kusztal, Boszko, Glowczynska, Grabowski) 1st Department of
Cardiology, Medical University of Warsaw, Warsaw 02-097, Poland
(Bodys-Pelka) Doctoral School, Medical University of Warsaw, Warsaw
02-091, Poland
Publisher
MDPI
Abstract
The evaluation and monitoring of patients' haemodynamic parameters are
essential in everyday clinical practice. The application of continuous,
non-invasive measurement methods is a relatively recent solution. CNAP,
ClearSight and many other technologies have been introduced to the market.
The use of these techniques for assessing patient eligibility before
cardiac procedures, as well as for intraoperative monitoring is currently
being widely investigated. Their numerous ad-vantages, including the
simplicity of application, time-and cost-effectiveness, and the limited
risk of infection, could enforce their further development and potential
utility. However, some limita-tions and contradictions should also be
discussed. The aim of this paper is to briefly describe the new findings,
give practical examples of the clinical utility of these methods, compare
them with invasive techniques, and review the literature on this
subject. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<63>
Accession Number
2015219584
Title
Effect of Benson and progressive muscle relaxation techniques on sleep
quality after coronary artery bypass graft: A randomized controlled trial.
Source
Complementary Therapies in Medicine. 63 (no pagination), 2021. Article
Number: 102784. Date of Publication: December 2021.
Author
Bagheri H.; Moradi-Mohammadi F.; Khosravi A.; Ameri M.; Khajeh M.; Chan
S.W.-C.; Abbasinia M.; Mardani A.
Institution
(Bagheri, Ameri, Khajeh) School of Nursing and Midwifery, Shahroud
University of Medical Sciences, Shahroud, Iran, Islamic Republic of
(Moradi-Mohammadi) ICU department, Shahid Beheshti Hospital, Shahid
Beheshti Boulevard, Azadegan Square, Qom, Iran, Islamic Republic of
(Khosravi) School of Public Health, Shahroud University of Medical
Sciences, Shahroud, Iran, Islamic Republic of
(Chan) Tung Wah College, Hong Kong
(Abbasinia) Nursing faculty, Qom University of Medical Sciences, Qom,
Iran, Islamic Republic of
(Mardani) Nursing Care Research Center, Department of Medical Surgical
Nursing, School of Nursing and Midwifery, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Churchill Livingstone
Abstract
Objective: This study aimed to investigate the effect of Benson relaxation
(BR) and progressive muscle relaxation (PMR) techniques on the sleep
quality of patients undergoing coronary artery bypass graft (CABG)
surgery. Method(s): This study was a three-arm, parallel, randomized
controlled trial. 120 patients who underwent CABG surgery at two academic
hospitals in an urban area of Iran were randomly allocated into three
groups (40 per group): the BR, PMR, and control groups. Patients in the BR
and the PMR groups performed relevant exercises twice a day for four
weeks. Sleep quality was measured before and immediately after the
intervention using Pittsburgh Sleep Quality Index. Result(s):
Within-group comparison in the BR (t = 3.51, p = 0.001) and the PMR (t =
4.58, p < 0.001) group showed that the overall sleep quality showed a
significant improvement after the intervention when compared to baseline.
The between-group comparison showed that both the BR and PMR groups showed
significant improvements in subjective sleep quality (F = 3.75, p = 0.02),
habitual sleep efficiency (F = 4.81, p = 0.01), and overall sleep quality
(F = 5.53, p = 005) when compared to the control group after the
intervention. However, no statistically significant differences were
identified among the three study groups in terms of sleep latency, sleep
duration, sleep disturbances, sleeping medication, and daytime dysfunction
after the intervention (p > 0.05). Conclusion(s): The study showed
that a four-week program of both PMR and BR can be effective in the
overall improvement of sleep quality in patients following CABG. Further
research is required to replicate the findings of the present
study. Copyright © 2021 The Authors

<64>
Accession Number
2013963298
Title
Effect of remimazolam besylate compared with propofol on the incidence of
delirium after cardiac surgery: study protocol for a randomized trial.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 717. Date of
Publication: December 2021.
Author
Yang M.; Liu X.; Yang D.; Bai Y.; Qin B.; Tian S.; Dong R.; Song X.
Institution
(Yang, Liu, Yang, Bai, Qin, Tian, Dong) Liaocheng Cardiac Hospital,
Shandong 252200, China
(Yang, Liu, Yang, Bai, Qin, Tian, Dong, Song) Dong E Hospital Affiliated
to Shandong First Medical University, Shandong 252200, China
(Song) ICU, Shandong First Medical University, Shandong 250117, China
(Song) ICU, Shandong Provincial Hospital Affiliated to Shandong First
Medical University, Shandong 250021, China
Publisher
BioMed Central Ltd
Abstract
Background: Delirium is an acute cognitive disorder that presents with
fluctuation in cognition, apathy, and non-organized thinking, resulting in
increased morbidity, mortality, intensive care unit (ICU) stay, and total
healthcare costs. In patients undergoing cardiac surgery, delirium also
increases the risk of postoperative complications, such as respiratory
insufficiency, sternum instability, and need for re-operation of the
sternum. This study aims to understand the incidence of delirium in
patients after cardiac surgery in patients sedated with remimazolam
besylate versus propofol. Method(s): In this prospective,
double-blind, randomized controlled clinical trial, we aim to recruit 200
patients undergoing cardiac surgery between January 1, 2021, and December
31, 2021, who will be randomized to receive either remimazolam besylate or
propofol infusions postoperatively, until they are extubated. The primary
outcome is the incidence of delirium within 5 days after surgery.
Secondary outcomes include the time of delirium onset, duration of
delirium, ICU length of stay, hospital length of stay, and mechanical
ventilation time. Discussion(s): The key objective of this study is
to assess whether remimazolam besylate reduces the incidence of delirium
in patients after cardiac surgery compared to propofol sedation. In this
preliminary randomized controlled clinical trial, we will test the
hypothesis that the use of remimazolam besylate lowers the incidence of
delirium when compared to propofol in patients undergoing cardiac surgery.
Trial registration: chictr.org.cn ChiCTR2000038976. Registered on October
11, 2020 Copyright © 2021, The Author(s).

<65>
Accession Number
636235283
Title
Efficacy and Safety of Transcatheter vs. Surgical Aortic Valve Replacement
in Low-to-Intermediate-Risk Patients: A Meta-Analysis.
Source
Frontiers in Cardiovascular Medicine. 7 (no pagination), 2020. Article
Number: 590975. Date of Publication: 16 Nov 2020.
Author
Lou Y.; Gao Y.; Yu Y.; Li Y.; Xi Z.; Swe K.N.C.; Zhou Y.; Nie X.; Liu W.
Institution
(Lou, Gao, Xi, Zhou, Nie, Liu) Department of Cardiology, Beijing Institute
of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Yu) Department of Neurology, Beijing Tiantan Hospital, Capital Medical
University, Beijing, China
(Li) Department of Geriatrics, The Affiliated People's Hospital of Inner
Mongolia Medical University, Huhhot, China
(Swe) International School of Capital Medical University, Beijing, China
Publisher
Frontiers Media S.A.
Abstract
Background: The efficacy and safety of transcatheter aortic-valve
replacement (TAVR) vs. surgical aortic valve replacement (SAVR) for low-
to intermediate-surgical risk patients remains uninvestigated.
 Objective(s): We aimed to investigate the efficacy and safety of
transcatheter aortic-valve replacement (TAVR) vs. surgical aortic valve
replacement (SAVR) for low-intermediate surgical risk patients.
 Method(s): PubMed, Cochrane Library, and Embase databases were
searched to identify potential references. Only randomized controlled
trials (RCTs) or observational studies using propensity score matching
were eligible for screening. The primary endpoint was all-cause death. The
secondary outcomes were bleeding, stroke, myocardial infarction (MI), and
other complications of aortic-valve replacement. In addition, we performed
subgroup analysis based on surgical risk and study type. Result(s):
Eight RCTs and 13 observational studies covering 12,467 patients were
included in the current meta-analysis. For patients with low-surgical
risk, compared with SAVR, TAVR was found to be associated with a lower
mortality at a follow-up period of 1 year (odds ratio, OR: 0.66, 95% CI:
[0.46, 0.96], P = 0.03). This benefit disappeared when the follow-up was
extended to 2 years (OR: 0.89, 95% CI: [0.61, 1.30], P = 0.56). For
patients with intermediate-surgical risk, TAVR showed to have similar
mortality with SAVR regardless of follow-up period (30-day, 1-year, or
2-year). TAVR could reduce the incidence of bleeding, AF, and AKI. For
complications, such as MI and stroke, TAVR exhibited to have similar
safety with SAVR. However, TAVR was found to be associated with a higher
incidence of reintervention, major vascular complication, paravalvular
leak, and PPI. Conclusion(s): For patients with a low-to-intermediate
surgical risk, TAVR has at least an equivalent clinical effect to SAVR for
2 years after the procedure. © Copyright © 2020 Lou, Gao,
Yu, Li, Xi, Swe, Zhou, Nie and Liu.

<66>
Accession Number
2013991878
Title
"Tailored" antiplatelet bridging therapy with cangrelor: moving toward
personalized medicine.
Source
Platelets. (no pagination), 2021. Date of Publication: 2021.
Author
Valenti R.; Muraca I.; Marcucci R.; Ciatti F.; Berteotti M.; Gori A.M.;
Carrabba N.; Migliorini A.; Marchionni N.; Valgimigli M.
Institution
(Valenti, Muraca, Ciatti, Carrabba, Migliorini, Marchionni) Interventional
Cardiology Unit, Cardiovascular Department, Careggi University Hospital,
Florence, Italy
(Marcucci, Berteotti, Gori) Department of Clinical and Experimental
Medicine, University of Florence, Florence, Italy
(Valgimigli) Division of Cardiology, Cardiocentro Ticino Institute, Ente
Ospedaliero Cantonale (Eoc), Lugano, Switzerland
(Valgimigli) Department of Cardiology, University of Bern, Bern,
Switzerland
Publisher
Taylor and Francis Ltd.
Abstract
In the setting of patients with indication to receive dual antiplatelet
therapy undergoing surgery or invasive procedures, the risk of
perioperative cardiac ischemic events, particularly stent thrombosis, is
high, because surgery has a prothrombotic effect and antiplatelet therapy
is withdrawn in order to avoid bleeding complications. Cangrelor, an
intravenous P2Y<inf>12</inf> receptor antagonist, has been tested in a
randomized trial as a "bridge" to cardiac surgery from discontinuation of
oral P2Y<inf>12</inf> receptor antagonists. Thus, a consensus document
extended its off-label use in this setting and before non-cardiac surgery.
Currently, despite the implementation of a standardized bridging protocol
with cangrelor, a residual risk of adverse outcome mainly due to bleeding
events, still persist during the perioperative phase. Accordingly, a
personalized management driven by platelet reactivity serial measurements
and careful assessment of ischemic and bleeding risks has potential to
optimize outcomes and costs as compared to a standardized bridging
protocol, based on average pharmacodynamic data of oral P2Y<inf>12</inf>
inhibitors. While specific indications for bridging have been extensively
addressed in the aforementioned consensus statement, the aim of the
present document is the proposal of a "tailored" clinical decision-making
algorithm inspired to the principle of personalized medicine dealing with
complex clinical scenarios. Copyright © 2021 Taylor & Francis
Group, LLC.

<67>
Accession Number
636282679
Title
Surgeon Strength: Ergonomics and Strength Training in Cardiothoracic
Surgery.
Source
Seminars in thoracic and cardiovascular surgery. (no pagination), 2021.
Date of Publication: 28 Sep 2021.
Author
Dairywala M.I.; Gupta S.; Salna M.; Nguyen T.C.
Institution
(Dairywala) Department of Cardiothoracic and Vascular Surgery, University
of Texas Health Science Center Houston, McGovern Medical School, TX,
Houston
(Gupta) Division of Cardiac Surgery, Department of Surgery, McMaster
University, ON, Hamilton, Canada
(Salna) Division of Cardiac, Thoracic, Vascular Surgery, Department of
Surgery, Columbia University Irving Medical Center, NY, NY
(Nguyen) Division of Adult Cardiothoracic Surgery, Department of Surgery,
UCSF Health, San Francisco, CA
Publisher
NLM (Medline)
Abstract
With the high prevalence of musculoskeletal pain in surgeons and
interventionalists, it is critical to analyze the impact of ergonomics on
cardiothoracic surgeon health. Here, we review the existing literature and
propose recommendations to improve physical preparedness for surgery both
in and outside the operating room. For decades, cardiothoracic surgeons
have suffered from musculoskeletal pain, most commonly in the neck and
back due to a lack of proper ergonomics during surgery. A lack of
dedicated ergonomics curriculum during training may leave surgeons at a
high predisposition for work-related musculoskeletal disorders. We
searched PubMed, Google Scholar, and other sources for studies relevant to
surgical ergonomics and prevalence of musculoskeletal disease among
surgeons and interventionalists. Whenever possible, data from quantitative
studies and meta-analyses are presented. We also contacted experts and
propose an exercise routine to improve physical preparedness for demands
of surgery. To date, many studies have reported astonishingly high rates
of work-related pain in surgeons with rates as high as 87% in
minimally-invasive surgeons. Several optimizations regarding correct table
height, monitor positioning, and loupe angles have been discussed. Lastly,
implementation of ergonomics training at some programs have been effective
at reducing the rates of musculoskeletal pain among surgeons. Surgical
work-related stress injuries are more common than we think. Many factors
including smaller incisions and technological advancements have led to
this plight. Ultimately, work-related injuries are underreported and
understudied and the field of surgical ergonomics remains open for
investigative study. Copyright © 2021. Published by Elsevier Inc.

<68>
Accession Number
636281853
Title
Letter on "RenalGuard system and conventional hydration for preventing
contrast-associated acute kidney injury in patients undergoing cardiac
interventional procedures: A systematic review and meta-analysis".
Source
International journal of cardiology. (no pagination), 2021. Date of
Publication: 28 Sep 2021.
Author
Gu Z.
Institution
(Gu) Heart Center, First Hospital of Lanzhou University, Gansu, China
Publisher
NLM (Medline)

<69>
Accession Number
2013840238
Title
Trimetazidine offers myocardial protection in elderly coronary artery
disease patients undergoing non-cardiac surgery: a randomized,
double-blind, placebo-controlled trial.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
473. Date of Publication: December 2021.
Author
Dai Z.-L.; Song Y.-F.; Tian Y.; Li Y.; Lin M.; Lin J.; Wang Q.; Wang P.;
Gao W.-L.
Institution
(Dai, Song, Tian, Li, Lin, Lin, Wang, Wang, Gao) Department of
Anesthesiology, Shenzhen People's Hospital (The Second Clinical Medical
College, Jinan University; The First Affiliated Hospital, Southern
University of Science and Technology), Shenzhen, Guangdong 518020, China
(Dai, Song, Tian, Li, Lin, Lin, Wang, Wang, Gao) Shenzhen Engineering
Research Center of Anesthesiology, No. 1017 Dongmen North Road, Shenzhen,
Guangdong 518020, China
Publisher
BioMed Central Ltd
Abstract
Background: Trimetazidine (TMZ) pretreatment protects cardiomyocytes
during cardiac surgery. TMZ may protect elderly patients with ischaemic
heart disease (IHD) undergoing non-cardiac surgery. Method(s): This
was a randomized, double-blind, placebo-controlled trial (registration
#ChiCTR1900025018) of patients with IHD scheduled to undergo non-cardiac
surgery at Shenzhen People's Hospital (Shenzhen, Guangdong Province,
China) between June 2014 and September 2015, randomized to 60 mg TMZ or
placebo 12 h before surgery. The primary endpoint was the occurrence of
in-hospital cardiovascular events. The secondary endpoints were myocardial
ischaemia on five-lead electrocardiogram (cECG), cardiac troponin I (cTnI)
elevation, cardiac death, acute coronary events, heart failure, and
arrhythmia requiring treatments. Result(s): Compared with the placebo
group, the TMZ group showed a lower occurrence of in-hospital
cardiovascular events (primary endpoint, 20.0% vs. 37.5%, P = 0.02),
myocardial ischaemia (15.0% vs. 32.5%, P < 0.01), cTnI elevation (2.5% vs.
10%, P < 0.01), acute coronary events (10.0% vs. 20.0%, P < 0.05), heart
failure (0% vs. 2.5%, P < 0.05), and arrhythmia requiring treatment (17.5%
vs. 35.0%, P < 0.05). There was no acute myocardial infarction during the
30-day postoperative period. Conclusion(s): In elderly patients with
IHD undergoing non-cardiac surgery, TMZ pretreatment was associated with
myocardial protective effects. Trial registration The trial was
prospectively registered at
http://www.chictr.org.cn/showproj.aspx?proj=41909 with registration number
[ChiCTR1900025018] (7/8/2019). Copyright © 2021, The Author(s).

<70>
Accession Number
632930532
Title
Transcatheter versus surgical aortic valve replacement in patients with
cardiac surgery: Meta-analysis and systematic review of the literature.
Source
Journal of Cardiovascular Development and Disease. 7(3) (no pagination),
2020. Article Number: 36. Date of Publication: September 2020.
Author
Latif A.; Lateef N.; Ahsan M.J.; Kapoor V.; Usman R.M.; Cooper S.;
Andukuri V.; Mirza M.; Ashfaq M.Z.; Khouzam R.
Institution
(Latif, Lateef, Ahsan, Kapoor, Cooper, Andukuri, Mirza, Ashfaq) Department
of Internal Medicine, Creighton University, Omaha, NE 68124, United States
(Usman) Department of Internal Medicine, University of Tennessee, Memphis,
TN 38152, United States
(Khouzam) Department of Cardiology, University of Tennessee, Memphis, TN
38152, United States
Publisher
MDPI
Abstract
The number of patients with severe aortic stenosis (AS) and a history of
prior cardiac surgery has increased. Prior cardiac surgery increases the
risk of adverse outcomes in patients undergoing aortic valve replacement.
To evaluate the impact of prior cardiac surgery on clinical endpoints in
patients undergoing transcatheter aortic valve replacement (TAVR) versus
surgical aortic valve replacement (SAVR), we performed a literature search
using PubMed, Embase, Google Scholar, and Scopus databases. The clinical
endpoints included in our study were 30-day mortality, 1-2-year mortality,
acute kidney injury (AKI), bleeding, stroke, procedural time, and duration
of hospital stay. Seven studies, which included a total of 8221 patients,
were selected. Our study found that TAVR was associated with a lower
incidence of stroke and bleeding complications. There was no significant
difference in terms of AKI, 30-day all-cause mortality, and 1-2-year
all-cause mortality between the two groups. The average procedure time and
duration of hospital stay were 170 min less (p <= 0.01) and 3.6 days
shorter (p < 0.01) in patients with TAVR, respectively. In patients with
prior coronary artery bypass graft and severe AS, both TAVR and SAVR are
reasonable options. However, TAVR may be associated with a lower incidence
of complications like stroke and perioperative bleeding, in addition to a
shorter length of stay. Copyright © 2020 by the authors.

<71>
Accession Number
2014892502
Title
Antiplatelet strategies in acute coronary syndromes: Design and
methodology of an international collaborative network meta-analysis of
randomized controlled trials.
Source
Minerva Cardiology and Angiology. 69(4) (pp 398-407), 2021. Date of
Publication: August 2021.
Author
Madhavan M.V.; Bikdeli B.; Redfors B.; Biondi-Zoccai G.; Varunok N.J.;
Burton J.R.; Crowley A.; Francese D.P.; Gupta A.; der Nigoghossian C.;
Chatterjee S.; Palmerini T.; Benedetto U.; You S.C.; Ohman E.M.; Kastrati
A.; Steg P.G.; Gibson C.M.; Angiolillo D.J.; Krumholz H.M.; Stone G.W.
Institution
(Redfors, Varunok, Burton, der Nigoghossian) Columbia University Irving
Medical Center, The NewYork-Presbyterian Hospital, New York, NY, United
States
(Redfors, Crowley, Francese) Clinical Trials Center, Cardiovascular
Research Foundation, New York, NY, United States
(Bikdeli) Cardiovascular Medicine Division, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
(Bikdeli) Yale/YNHH Center for Outcomes Research and Evaluation (CORE),
New Haven, CT, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Biondi-Zoccai) Department of Medico-Surgical Sciences and
Biotechnologies, Sapienza University, Rome, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
(Chatterjee) St. Francis Hospital, Hartford, CT, United States
(Palmerini) Unit of Cardiology, S. Orsola Polyclinic, Bologna, Italy
(Benedetto) University of Bristol, Bristol, United Kingdom
(You) Ajou University, Suwon, South Korea
(Ohman) Duke Clinical Research Institute, Duke University Medical Center,
Durham, NC, United States
(Kastrati) Deutsches Herzzentrum Munchen (DHM), Technical University of
Munich, Munich, Germany
(Kastrati) DZHK - German Center for Cardiovascular Research, Partner Site
Munich Heart Alliance, Munich, Germany
(Steg) INSERM U-1148, French Alliance for Cardiovascular Trials (FACT),
Bichat Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), University
of Paris, Paris, France
(Gibson) Beth Israel Deaconess Medical Center, Boston, MA, United States
(Angiolillo) Division of Cardiology, College of Medicine, University of
Florida, Jacksonville, FL, United States
(Krumholz) Yale School of Medicine, New Haven, CT, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY,
United States
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The optimal choice of oral P2Y<inf>12</inf> receptor
inhibitors has the potential to significantly influence outcomes. We seek
to compare the safety and efficacy of the three most commonly used oral
P2Y<inf>12</inf> receptor inhibitors (clopidogrel, prasugrel, and
ticagrelor) in acute coronary syndromes (ACS) via a comprehensive
systematic review and network meta-analysis. EVIDENCE ACQUISITION: In line
with the Preferred Reporting Items for Systematic Reviews (PRISMA)
guidelines, we performed a comprehensive search for RCTs which compared
cardiovascular and hemorrhagic outcomes after use of at least two of the
distinct oral P2Y<inf>12</inf> receptor inhibitors (i.e. clopidogrel,
prasugrel, and ticagrelor). A search strategy has been designed to
systematically search multiple databases, including MEDLINE with PubMed
interface, The Cochrane Central Register of Controlled Trials, and Embase.
In addition, key inclusion criteria will be trial size of at least 100
patients and at least 1 month of follow-up time. Several prespecified
subgroups will be explored, including Asian patients, patients presenting
with ST-elevation myocardial infarction, patients of advanced age, and
others. EVIDENCE SYNTHESIS: Exploratory frequentist pairwise meta-analyses
will be based primarily on a random-effects method, relying on relative
risks (RR) for short-term outcomes and incidence rate ratios (IRR) for
long-term outcomes. Inferential frequentist network meta-analysis will be
based primarily on a random-effects method, relying on RR and IRR as
specified above. Results will be reported as point summary of effect, 95%
CI, and P values for effect, and graphically represented using forest
plots. CONCLUSION(S): An international collaborative network
meta-analysis has begun to comprehensively analyze the safety and efficacy
of prasugrel, ticagrelor and clopidogrel, each on a background of aspirin,
for management of patients with A C S. It is our hope that the rigor and
breadth of the undertaking described herein will provide novel insights
that will inform optimal patient care for patients with ACS treated
conservatively, or undergoing revascularization. Copyright © 2020
EDIZIONI MINERVA MEDICA

<72>
Accession Number
2015125080
Title
Protamine sulfate during transcatheter aortic valve implantation (PS TAVI)
- A single-center, single-blind, randomized placebo-controlled trial.
Source
Kardiologia Polska. 79(9) (pp 995-1002), 2021. Date of Publication: 30 Sep
2021.
Author
Zbronski K.; Grodecki K.; Gozdowska R.; Ostrowska E.; Wysinska J.; Rymuza
B.; Scislo P.; Wilimski R.; Kochman J.; Filipiak K.J.; Opolski G.; Huczek
Z.
Institution
(Zbronski, Grodecki, Gozdowska, Ostrowska, Wysinska, Rymuza, Scislo,
Kochman, Filipiak, Opolski, Huczek) 1st Department of Cardiology, Medical
University of Warsaw, Warszawa, Poland
(Wilimski) Department of Cardiac Surgery, Medical University of Warsaw,
Warszawa, Poland
Publisher
Via Medica
Abstract
Background: Bleeding complications after transcatheter aortic valve
implantation (TAVI) negatively affect the post-procedural prognosis.
Routine use of protamine sulfate (PS) to reverse unfractionated heparin
after TAVI was never assessed in a randomized controlled trial.
 Aim(s): The aim of this study was to assess the impact of PS on
bleeding complications after TAVI. Method(s): Between December 2016
and July 2020 311 patients qualified to TAVI in one academic center were
screened. Patients that met the inclusion criteria were randomized to
either PS or normal saline administration at the moment of optimal valve
deployment. Baseline, procedural, and follow-up data for up to 30 days
were collected and analyzed. The primary endpoint (PE) was a composite of
life-threatening and major bleeding according to Valve Academic Research
Consortium within 48 hours after the procedure. Result(s): Overall,
100 patients (48 males, median age 82 years) met the inclusion criteria
and were included in the study. Forty-seven subjects (47%) were randomized
to PS. The primary endpoint occurred in 29% of the study population.
Despite numerically lower rates of PE in patients randomized to PS, a
statistical significance was not reached (21% in the PS group and 36% in
the placebo group; odds ratio [OR], 0.48; 95% confidence intervals [CI]
0.2-1.2; P = 0.11). There were no significant differences in secondary
endpoints. Conclusion(s): Routine protamine sulfate administration
did not significantly decrease the rate of major and life-threatening
bleeding complications after TAVI. Larger studies are required to assess
the impact of routine PS use. Copyright © by the Author(s), 2021

<73>
Accession Number
2015123206
Title
Is Epicardial Adipose Tissue Associated with Atrial Fibrillation following
Cardiac Surgery? A Systematic Review and Meta-Analysis.
Source
Heart Surgery Forum. 24(5) (pp E801-E807), 2021. Date of Publication: 08
Sep 2021.
Author
Sha R.; Han W.; Lin M.; Zhong J.
Institution
(Sha, Han, Lin, Zhong) Key Laboratory of Cardiovascular Remodeling and
Function Research, Chinese Ministry of Education, Chinese National Health
Commission and Chinese Academy of Medical Sciences, State and Shandong
Province Joint Key Laboratory of Translational Cardiovascular Medicine,
Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine,
Shandong University, Jinan, China
(Lin) Peking University First Hospital, Beijing, China
(Zhong) Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College
of Medicine, Shandong University, Qingdao, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Although epicardial adipose tissue (EAT) has been proven to be
related to atrial fibrillation (AF) and post-ablation AF recurrence, the
association between EAT and AF after cardiac surgery (AFACS) remains
unclear. Objective(s): This study was a systematic review and
meta-analysis that assessed the relationship between EAT and AFACS.
 Method(s): Electronic databases were systematically searched for
"atrial fibrillation" and "epicardial adipose tissue." The analysis was
stratified according to the EAT measurement into three meta-analyses as
(1) total EAT volume, (2) left atrial (LA)-EAT volume, and (3) EAT
thickness. Standardized mean difference (SMD) was estimated using a random
effects model. Result(s): Eight articles with 10 studies (546
patients) were included. The meta-analysis revealed that EAT was higher in
those with AFACS irrespective of the EAT measurement (total EAT volume:
SMD = 0.56 mL, 95% confidence interval, CI = 0.56-1.10 mL, I2 =
0.90, P = .04; EAT thickness: SMD = 0.85 mm, 95% CI = 0.04-1.65 mm,
I2 = 0.90, P = .04; LA-EAT volume: SMD = 0.57 mL, 95% CI =
0.23-0.92 mL, I2 = 0.00, P = .001). Conclusion(s): EAT was
higher in patients with AFACS, measured either as volume or
thickness. Copyright © 2021 Forum Multimedia Publishing, LLC

<74>
Accession Number
2014502000
Title
Intensive glucose control during the perioperative period for diabetic
patients undergoing surgery: An updated systematic review and
meta-analysis.
Source
Journal of Clinical Anesthesia. 75 (no pagination), 2021. Article Number:
110504. Date of Publication: December 2021.
Author
Jiang J.; Li S.; Zhao Y.; Zhou Z.; Zhang J.; Sun R.; Luo A.
Institution
(Jiang, Li, Zhao, Zhou, Zhang, Sun, Luo) Department of Anesthesiology,
Tongji Hospital, Tongji Medical College, Huazhong University of Science
and Technology, Wuhan 430030, China
Publisher
Elsevier Inc.
Abstract
Study objective: To evaluate the impact of intensive glucose control on
diabetic patients undergoing surgery. Design(s): A systematic review
and meta-analysis of randomized controlled trials. PubMed, CENTRAL,
EMBASE, ISI Web of Science, and CINAHL databases were searched from
inception to 13 December 2020. Setting(s): Operating room,
postoperative recovery area and ward, up to 30 days after surgery.
 Patient(s): Diabetic patients undergoing surgery.
 Intervention(s): We used Review Manager 5.4 to pool the data with a
random-effects model. The quality of evidence was rated using the Grading
of Recommendations, Assessment, Development and Evaluation system.
Measurements: The primary outcomes were infectious complications,
postoperative mortality, and hypoglycaemia. The secondary outcomes
included atrial fibrillation, myocardial infarction, stroke, delirium,
renal failure, postoperative mechanical ventilation time, length of
intensive care unit (ICU) stay, and hospital stay. Main Result(s):
Thirteen studies involving 1582 participants were included. Compared with
conventional glucose control, intensive glucose control was associated
with a lower risk of infectious complications (risk ratio [RR], 0.35; 95%
confidence interval [CI], 0.19-0.63; low-quality evidence), atrial
fibrillation (RR, 0.55; 95% CI, 0.42-0.71; high-quality evidence), and
renal failure (RR, 0.38; 95% CI, 0.15-0.95; moderate-quality evidence), as
well as a shorter length of stay in the ICU (mean difference (MD), -0.55
day; 95% CI, -1.05 to -0.05 days; very-low-quality evidence) and hospital
(MD, -1.61 days; 95% CI, -2.78 to -0.44 days; very-low-quality evidence).
However, intensive glucose control was associated with a higher risk of
hypoglycaemia (RR, 3.00; 95% CI, 1.97-4.55; high-quality evidence). There
were no significant differences in postoperative mortality, myocardial
infarction, stroke, delirium, or postoperative mechanical ventilation
time. Conclusion(s): Intensive glucose control in diabetic patients
is associated with a reduction in some adverse postoperative outcomes
including infectious complications, but also appears to increase the risk
of hypoglycaemia. Further well-designed studies may be needed to determine
appropriate regimens to reduce hypoglycaemia incidence. PROSPERO
registration number: CRD42021226138. Copyright © 2021 Elsevier
Inc.

<75>
Accession Number
2014115047
Title
Strategies to prevent acute kidney injury after pediatric cardiac surgery
a network meta-analysis.
Source
Clinical Journal of the American Society of Nephrology. 16(10) (pp
1480-1490), 2021. Date of Publication: October 2021.
Author
Van den Eynde J.; Cloet N.; Van Lerberghe R.; Saa M.P.B.O.; Vlasselaers
D.; Toelen J.; Verbakel J.Y.; Budts W.; Gewillig M.; Kutty S.; Pottel H.;
Mekahli D.
Institution
(Van den Eynde, Kutty) Helen B. Taussig Heart Center, The Johns Hopkins
Hospital and School of Medicine, Baltimore, MD, United States
(Van den Eynde, Cloet, Van Lerberghe, Budts, Gewillig) Department of
Cardiovascular Sciences, KU Leuven, Leuven, Belgium
(Saa) Division of Cardiovascular Surgery of Pronto Socorro Cardioloogico
de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife, Brazil
(Vlasselaers) Department of Intensive Care Medicine, University Hospitals
Leuven, Leuven, Belgium
(Toelen) Division of Woman and Child, Department of Pediatrics, University
Hospitals Leuven, Leuven, Belgium
(Toelen) Department of Development and Regeneration, KU Leuven, Leuven,
Belgium
(Verbakel) Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
(Verbakel) Nuffield Department of Primary Care Health Sciences, University
of Oxford, Oxford, United Kingdom
(Budts) Congenital and Structural Cardiology, University Hospitals Leuven,
Leuven, Belgium
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Pottel) Department of Public Health and Primary Care, KU Leuven Campus
Kulak Kortrijk, Kortrijk, Belgium
(Mekahli) Department of Pediatric Nephrology, University Hospitals of
Leuven, Leuven, Belgium
(Mekahli) PKD Research Group, GPURE, Department of Development and
Regeneration, KU Leuven, Leuven, Belgium
Publisher
American Society of Nephrology
Abstract
Background and objectives AKI is a common complication after pediatric
cardiac surgery and has been associated with higher morbidity and
mortality. We aimed to compare the efficacy of available pharmacologic and
nonpharmacologic strategies to prevent AKI after pediatric cardiac
surgery. Design, setting, participants, & measurements PubMed/MEDLINE,
Embase, Cochrane Controlled Trials Register, and reference lists of
relevant articles were searched for randomized controlled trials from
inception until August 2020. Random effects traditional pairwise, Bayesian
network meta-analyses, and trial sequential analyses were performed.
Results Twenty randomized controlled trials including 2339 patients and 11
preventive strategies met the eligibility criteria. No overall significant
differences were observed compared with control for corticosteroids,
fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in
traditional pairwise meta-analysis. In contrast, trial sequential analysis
suggested a 80% relative risk reduction with dexmedetomidine and evidence
of <57% relative risk reduction with remote ischemic preconditioning.
Nonetheless, the network meta-analysis was unable to demonstrate any
significant differences among the examined treatments, including also
acetaminophen, aminophylline, levosimendan, milrinone, and normothermic
cardiopulmonary bypass. Surface under the cumulative ranking curve
probabilities showed that milrinone (76%) was most likely to result in the
lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%),
aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote
ischemic preconditioning (55%), although all showing important overlap.
Conclusions Current evidence from randomized controlled trials does not
support the efficacy of most strategies to prevent AKI in the pediatric
population, apart from limited evidence for dexmedetomidine and remote
ischemic preconditioning. Copyright © 2021 by the American
Society of Nephrology.

<76>
Accession Number
2014097512
Title
Effect of different loading doses of dexmedetomidine on controlled
hypotension and the incidence of bradycardia during rhinoplasty: A
clinical trial.
Source
Anesthesiology and Pain Medicine. 11(4) (no pagination), 2021. Article
Number: e118857. Date of Publication: August 2021.
Author
Motlagh S.D.; Rokhtabnak F.; Ghodraty M.R.; Delarestaghi M.M.; Saadat S.;
Araghi Z.
Institution
(Motlagh, Rokhtabnak, Ghodraty, Saadat, Araghi) Department of
Anesthesiology, Pain, and Intensive Care Medicine, Firoozgar University
Hospital, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Delarestaghi) Department of Otolaryngology Head and Neck Surgery,
Firoozgar University Hospital, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Delarestaghi) Department of ENT and Head and Neck Research and the Five
Senses Institute, Firoozgar University Hospital, Iran University of
Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Controlled hypotension, with a mean arterial pressure (MAP) of 60 mmHg-70
mmHg, provides a bloodless and visible surgical field during rhinoplasty.
It has been shown that dexmedetomidine, an alpha2-adrenoreceptor agonist,
is a suitable choice in this regard. One of the disadvantages of this drug
is the possibility of severe bradycardia during infusion. Therefore, we
compared lower intravenous (IV) loading doses to determine whether the
hypotensive effect of the drug was preserved and the bradycardia incidence
decreased. In this randomized, double-blinded clinical trial, 81 patients
aged 18 to 50 years with the American Society of Anesthesiologists
physi-cal status (ASA-PS) class I and II, scheduled for rhinoplasty
randomly received 1.0, 0.9, and 0.8 microg/kg (named as groups 1.0, 0.9,
and 0.8, respectively) of IV dexmedetomidine before the induction of
anesthesia followed by infusion (0.3-0.7 microg/kg/h) during operation.
The patients' heart rate (HR), MAP, the requirements for nitroglycerin
(NTG) and extra fentanyl, as well as the incidence of bradycar-dia, were
recorded. Bleeding and visibility of the surgical field were scored by the
surgeon using a 6-point visual scale. MAPs, HRs, and consumption of NTG
and extra fentanyl were similar in the studied groups. The surgical field
was more visible and bloodless in group 1.0 compared to group 0.8 (P <
0.001); the differences were not significant between groups 1.0 and 0.9 (P
= 0.605). The incidence (P = 0.027) and the severity of bradycardia (P =
0.017) were higher in the groups with higher loading doses. We concluded
that dexmedetomidine is an acceptable agent to provide controlled
hypotension. A loading dose of 0.9 microg/kg, but not 0.8 microg/kg,
provides similar surgical field conditions as the dose of 1 microg/kg.
Furthermore, despite the decrease in the incidence of bradycardia, the
hypotensive effect of the drug is preserved. Copyright © 2021,
Author(s).

<77>
Accession Number
2013475881
Title
Exploring the Operative Strategy for Secondary Mitral Regurgitation: A
Systematic Review.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
3466813. Date of Publication: 2021.
Author
Nappi F.; Singh S.S.A.; Bellomo F.; Nappi P.; Chello C.; Iervolino A.;
Chello M.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Singh) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Bellomo, Nappi) Department of Clinical and Experimental Medicine,
University of Messina, Italy
(Chello) Regenerative Medicine, Universita Campus Bio-Medico di Roma, Rome
00128, Italy
(Iervolino) Department of Cardiovascular Sciences, Fondazione Policlinico
Universitario A. Gemelli IRCSS, Italy
(Chello) Cardiovascular Surgery, Universita Campus Bio-Medico di Roma,
Rome 00128, Italy
Publisher
Hindawi Limited
Abstract
Background. Mitral valve disease surgery is an evolving field with
multiple possible interventions. There is an increasing body of evidence
regarding the optimal strategy in secondary mitral regurgitation where the
pathology lies within the ventricle. We conducted a systematic review to
identify the benefits and limitations of each surgical option. Methods. A
systematic review of the literature was performed to identify pertinent
randomized controlled trials (RCTs), propensity-matched observational
series, and meta-analyses which were considered initially and followed by
unmatched observational series using the MEDLINE, Ovid EMBASE, and
Cochrane Library. Results. We identified 6 different strategies for
treating secondary mitral valve regurgitation: mitral valve replacement,
restrictive mitral annuloplasty, surgical revascularization (with and
without mitral annuloplasty), subvalvular procedures (papillary muscle
approximation, papillary muscle relocation, ring and string procedure),
and procedures directly targeting the mitral valve (edge-to-edge repair
and anterior leaflet enlargement) alongside transcatheter heart valve
therapy. We also highlighted the role of left ventricular assist devices
in the management of this condition. The benefits and limitations of each
intervention are highlighted. Conclusion. There is currently no unanimous
and shared strategy for the optimal treatment of patients with secondary
IMR. The management of patients with secondary mitral regurgitation must
be entrusted to a multidisciplinary Heart Team to ensure ideal
intervention and patient matching for the best outcomes. Copyright
© 2021 Francesco Nappi et al.

<78>
Accession Number
2013142659
Title
Association of Pain With Atrial Fibrillation and Delirium After Cardiac
Surgery: A DECADE Sub-Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(10) (pp 3021-3026),
2021. Date of Publication: October 2021.
Author
Ince I.; Chiu A.; Sagir A.; Chahar P.; Lin J.; Douglas A.; Adi A.; Fang
J.; Mao G.; Turan A.
Institution
(Ince, Chiu, Chahar, Fang, Turan) Department of Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
(Ince) Anesthesiology Clinical Research Office, Ataturk University,
Erzurum, Turkey
(Sagir, Chahar, Turan) Department of General Anesthesia, Cleveland Clinic,
Cleveland, OH, United States
(Lin, Douglas, Adi) Department of Cardiovascular Anesthesiology, Cleveland
Clinic, Cleveland, OH, United States
(Mao) Department Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to evaluate the effects of postoperative pain
on the incidence of atrial fibrillation and delirium in patients having
surgery with cardiopulmonary bypass (CPB). Design(s): Post hoc
analysis of the (An investigator-initiated, multicentre, double-blind
trial (ClinicalTrials NCT02004613) (DECADE)), a randomized,
placebo-controlled trial. Setting(s): Tertiary, academic hospital.
 Participant(s): Six hundred five adults from the DECADE enrolled at
Cleveland Clinic Main Campus, who had had surgery with CPB.
 Intervention(s): Dexmedetomidine versus placebo started before
surgical incision and postoperatively was maintained until 24 hours.
Measurements: Primary outcomes were atrial fibrillation, diagnosed by
clinicians in the intensive care unit (ICU), presence of delirium assessed
with the Confusion Assessment Method for the ICU, data on pain scores, and
opioid consumption, occurring between ICU admission and the earlier of
postoperative day five or hospital discharge. Result(s):
Postoperative pain levels were similar among patients with or without
atrial fibrillation. Two hundred six (34%) patients had atrial
fibrillation and ninety-two (15%) had delirium before hospital discharge
within the first five postoperative days. The risk of atrial fibrillation
was not significantly different between groups (hazard ratio: 1.09; 97.5%
confidence interval [CI]: 0.99, 1.20, p = 0.039); there were no
associations between postoperative pain and the risk of postoperative
delirium (hazard ratio: 0.96; 97.5% CI: 0.84-1.11; p = 0.57).
Postoperative opioid consumption was neither significantly associated with
postoperative atrial fibrillation nor delirium. Conclusion(s): Atrial
fibrillation and delirium was not associated with pain after cardiac
surgery. Opioid use was not associated with atrial fibrillation and
delirium. Because both atrial fibrillation and delirium have a
multifactorial nature, further studies should be focused on other
plausible mechanisms. Copyright © 2021

<79>
Accession Number
2011577522
Title
High Versus Normal Blood Pressure Targets in Relation to Right Ventricular
Dysfunction After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(10) (pp 2980-2990),
2021. Date of Publication: October 2021.
Author
Bootsma I.T.; de Lange F.; Scheeren T.W.L.; Jainandunsing J.S.; Boerma
E.C.
Institution
(Bootsma, de Lange, Boerma) Department of Intensive Care, Medical Center
Leeuwarden, Leeuwarden, Netherlands
(Scheeren, Jainandunsing) Department of Anesthesiology, University of
Groningen, University Medical Center Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: Management of right ventricular (RV) dysfunction is
challenging. Current practice predominantly is based on data from
experimental and small uncontrolled studies and includes augmentation of
blood pressure. However, whether such intervention is effective in the
clinical setting of cardiac surgery is unknown. Design(s): Randomized
controlled trial. Setting(s): Single-center study in a tertiary
teaching hospital. Participant(s): The study comprised 78 patients
equipped with a pulmonary artery catheter (PAC), classified according to
PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of <20%,
and 34 patients had an RVEF between >=20% and <30%. Intervention(s):
Patients randomly were assigned to either a normal target group (mean
arterial pressure 65 mmHg) or a high target group [mean arterial pressure
85 mmHg]). The primary end- point was the change in RVEF over a one-hour
study period. Measurements and Main Results: There was no significant
between-group difference in change of RVEF <20% (-1% [-3.3 to 1.8] in the
normal-target group v 0.5% [-1 to 4] in the high-target group; p = 0.159).
There was no significant between-group difference in change in RVEF
20%-to-30% (-1% [-3 to 0] in the normal-target group v 1% [-1 to 3] in the
high-target group; p = 0.074). These results were in line with the
simultaneous observation that echocardiographic variables of RV and left
ventricular function also remained unaltered over time, irrespective of
either baseline RVEF or treatment protocol. Conclusion(s): In a mixed
cardiac surgery population with RV dysfunction, norepinephrine-mediated
high blood pressure targets did not result in an increase in PAC-derived
RVEF compared with normal blood pressure targets. Copyright ©
2021 The Authors

<80>
Accession Number
2011132227
Title
Deep Hypothermic Circulatory Arrest in the Pediatric Population Undergoing
Cardiac Surgery With Electroencephalography Monitoring: A Systematic
Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(10) (pp 2875-2888),
2021. Date of Publication: October 2021.
Author
Alkhatip A.A.A.M.M.; Kamel M.G.; Farag E.M.; Elayashy M.; Farag A.; Yassin
H.M.; Bahr M.H.; Abdelhaq M.; Sallam A.; Kamal A.M.; Emady M.F.E.; Wagih
M.; Naguib A.A.; Helmy M.; Algameel H.Z.; Abdelkader M.; Mohamed H.;
Younis M.; Purcell A.; Elramely M.; Hamza M.K.
Institution
(Alkhatip) Department of Anaesthesia, Birmingham Children's Hospital,
Birmingham, United Kingdom
(Alkhatip, Farag, Bahr, Abdelkader) Department of Anaesthesia, Beni-Suef
University Hospital and Faculty of Medicine, Beni-Suef University,
Beni-Suef, Egypt
(Kamel) Faculty of Medicine, Minia University, Minia, Egypt
(Elayashy, Abdelhaq, Kamal, Emady, Wagih, Naguib, Helmy, Mohamed, Hamza)
Department of Anaesthesia, Faculty of Medicine, Cairo University, Cairo,
Egypt
(Farag) Department of Anesthesia, King Abdullah Medical City - Holy
Capital, Makkah, Saudi Arabia
(Yassin) Department of Anesthesia, Faculty of Medicine, Fayoum University,
Fayoum, Egypt
(Sallam, Purcell) Department of Anaesthesia, Beaumont Hospital, Dublin,
Ireland
(Sallam) Department of Anaesthesia, Faculty of Medicine, Ain-Shams
University, Cairo, Egypt
(Algameel) Department of Anaesthesia, Aberdeen Royal Infirmary Hospital,
Aberdeen, UK, United Kingdom
(Mohamed) Department of Anaesthesia, Royal Papworth Hospital, Cambridge,
UK, United Kingdom
(Younis) Department of Anaesthesia, Cambridge University Hospital,
Cambridge, UK, United Kingdom
(Elramely) Department of Anaesthesia, National Cancer Institute, Cairo
University, Cairo, Egypt
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgery for repair of congenital heart defects poses
unique hazards to the developing brain. Deep hypothermic circulatory
arrest (DHCA) is a simple and effective method for facilitating a
bloodless surgical field during congenital heart defect repair. There are,
however, some concerns that prolonged DHCA increases the risk of nervous
system injury. The electroencephalogram (EEG) is used in adult and, to a
lesser extent, pediatric cardiac procedures as a neuromonitoring method.
The present study was performed to assess outcomes following DHCA with EEG
monitoring in the pediatric population. Design(s): In this systematic
review and meta-analysis, the PubMed, Cochrane Central Register of
Controlled Trials, Scopus, Institute of Science Index, and Embase
databases were searched from inception for relevant articles. A fixed- or
random-effects model, as appropriate, was used. Setting(s): Surgical
setting. Participant(s): Pediatric population (<=18 y old).
 Intervention(s): DHCA (18degreeC) with EEG monitoring.
 Measurements and Main Results: Nineteen articles with 1,267 pediatric
patients <=18 years were included. The event rate of clinical and EEG
seizures among patients who underwent DHCA was 12.9% and 14.9%,
respectively. Mortality was found to have a 6.3% prevalence. A longer
duration of DHCA was associated with a higher risk of EEG seizure and
neurologic abnormalities. In addition, seizures were associated with
increased neurologic abnormalities and neurodevelopmental delay.
 Conclusion(s): EEG and neurologic abnormalities were common after
DHCA. A longer duration of DHCA was found to lead to more EEG seizure and
neurologic abnormalities. Moreover, EEG seizures were more common than
clinical seizures. Seizures were found to be associated with increased
neurologic abnormalities and neurodevelopmental delay. Copyright
© 2021 Elsevier Inc.

<81>
Accession Number
2010303014
Title
Ten-year all-cause death following percutaneous or surgical
revascularization in patients with prior cerebrovascular disease: insights
from the SYNTAX Extended Survival study.
Source
Clinical Research in Cardiology. 110(10) (pp 1543-1553), 2021. Date of
Publication: October 2021.
Author
Wang R.; Takahashi K.; Garg S.; Thuijs D.J.F.M.; Kappetein A.P.; Mack
M.J.; Morice M.-C.; Mohr F.-W.; Curzen N.; Davierwala P.; Milojevic M.;
van Geuns R.J.; Head S.J.; Onuma Y.; Holmes D.R.; Serruys P.W.
Institution
(Wang) Department of Cardiology, Xijing Hospital, Xi'an, China
(Wang, Onuma, Serruys) Department of Cardiology, National University of
Ireland Galway, University Road, Galway H91 TK33, Ireland
(Wang, van Geuns) Department of Cardiology, Radboud UMC, Nijmegen,
Netherlands
(Takahashi) Department of Cardiology, Amsterdam University Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Garg) East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United
Kingdom
(Thuijs, Kappetein, Milojevic, Head) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Center, Dallas, TX, United States
(Morice) Departement of Cardiologie, Hopital Prive Jacques Cartier,
Generale de Sante Massy, Massy, France
(Mohr, Davierwala) University Department of Cardiac Surgery, Heart Centre
Leipzig, Leipzig, Germany
(Curzen) Cardiology Department, University Hospital Southampton,
Southampton, United Kingdom
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Coronary bypass artery grafting (CABG) has a higher procedural
risk of stroke than percutaneous coronary intervention (PCI), but may
offer better long-term survival. The optimal revascularization strategy
for patients with prior cerebrovascular disease (CEVD) remains unclear.
 Methods and Results: The SYNTAXES study assessed the vital status out
to 10 year of patients with three-vessel disease and/or left main coronary
artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI
vs. CABG in terms of 10 year all-cause death was assessed according to
prior CEVD. The primary endpoint was 10 year all-cause death. The status
of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients
had prior CEVD. Patients with prior CEVD were older and had more
comorbidities (medically treated diabetes, insulin-dependent diabetes,
metabolic syndrome, peripheral vascular disease, chronic obstructive
pulmonary disease, impaired renal function, and congestive heart failure),
compared with those without prior CEVD. Prior CEVD was an independent
predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI:
1.04-1.73; p = 0.021). Patients with prior CEVD had a significantly higher
risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI:
1.54-2.40; p < 0.001). The risk of 10 year all-cause death was similar
between patients receiving PCI or CABG irrespective of the presence of
prior CEVD (p<inf>-interaction</inf> = 0.624). Conclusion(s): Prior
CEVD was associated with a significantly increased risk of 10 year
all-cause death which was similar in patients treated with PCI or CABG.
These results do not support preferential referral for PCI rather than
CABG in patients with prior CEVD. Trial registration: SYNTAX:
ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival:
ClinicalTrials.gov reference: NCT03417050. Graphic abstract: [Figure not
available: see fulltext.]. Copyright © 2021, The Author(s).

<82>
Accession Number
2005492740
Title
Fetal arrhythmia and related fetal and neonatal outcome.
Source
Donald School Journal of Ultrasound in Obstetrics and Gynecology. 15(1)
(pp 87-96), 2021. Date of Publication: January-March 2021.
Author
Vladareanu R.; Vladareanu S.; Bot M.
Institution
(Vladareanu, Bot) Department of Obstetrics and Gynecology, Elias
University Emergency Hospital, University of Medicine and Pharmacy Carol
Davila, Bucharest, Romania
(Vladareanu) Department of Neonatology, Elias University Emergency
Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest,
Romania
Publisher
Jaypee Brothers Medical Publishers (P) Ltd
Abstract
The evolution of fetal echocardiography (Motion and pulsed Doppler modes)
has made possible the antenatal diagnosis of cardiac rhythm anomalies.
Fetal cardiac arrhythmias are common anomalies, 20% of which are
potentially dangerous. M-mode (motion-mode) echocardiography recording of
the fetal heart cannot identify electrical events in the heart, but does
depict the mechanical events that succeed them. Pulsed Doppler
echocardiography identifies possible arrhythmias over a period of time,
allowing for the measurement of these time intervals, a parameter
absolutely necessary for the classification of various types of cardiac
arrhythmias. Irregular cardiac rhythm (premature atrial contraction,
premature ventricular contractions) is the most common disorder seen in
practice in specialized fetal echography. These anomalies are usually
benign and resolve spontaneously until delivery, thus do not require
treatment. Fetal tachyarrhythmia (increased heart rate of 160-189 bpm) is
detected by echocardiography, with a wide range of rhythm disorders. It is
imperative to understand the mechanism of tachyarrhythmia, so that an
accurate and rational management strategy can be formulated in each case.
Fetal bradyarrhythmia is characterized by frequent irregular rhythm, low
sustained heart rate (10 seconds-few minutes), below 110 bpm, or a
combination of both. The diagnosis of the specific bradycardia depends on
the echocardiogram findings and the atrioventricular conduction
pattern.Once fetal bradycardia is noted, a quick fetal ultrasonographic
examination should be performed to assess the normal fetal movements,
fetal tone, thus contributing to the diagnosis of fetuses in distress, who
require emergency delivery by cesarean section. This paper is an update of
the diagnostic approaches in the current practice for different types of
fetal heart rhythm disorders, the impact on the fetus and the newborn and
their management. Copyright © Jaypee Brothers Medical Publishers.

<83>
[Use Link to view the full text]
Accession Number
632187085
Title
Randomized comparison of the polymer-free biolimus-coated biofreedom stent
with the ultrathin strut biodegradable polymer sirolimus-eluting orsiro
stent in an all-comers population treated with percutaneous coronary
intervention.
Source
Circulation. 141(45) (pp 2052-2063), 2020. Date of Publication: 2020.
Author
Jensen L.O.; Maeng M.; Raungaard B.; Kahlert J.; Ellert J.; Jakobsen L.;
Villadsen A.B.; Veien K.T.; Kristensen S.D.; Ahlehoff O.; Carstensen S.;
Christensen M.K.; Terkelsen C.J.; Engstroem T.; Hansen K.N.; Botker H.E.;
Aaroe J.; Thim T.; Thuesen L.; Freeman P.; Aziz A.; Eftekhari A.; Junker
A.; Jensen S.E.; Lassen J.F.; Hansen H.S.; Christiansen E.H.
Institution
(Jensen) Odense University Hospital, Department of Cardiology, Sdr.
Boulevard 29, Odense C 5000, Denmark
(Jensen, Ellert, Veien, Ahlehoff, Hansen, Aziz, Junker, Lassen, Hansen)
Department of Cardiology, Odense University Hospital, Denmark
(Maeng, Jakobsen, Kristensen, Carstensen, Terkelsen, Botker, Thim,
Eftekhari, Christiansen) Department of Cardiology, Aarhus University
Hospital, Skejby Hospital, Denmark
(Raungaard, Villadsen, Christensen, Aaroe, Thuesen, Freeman, Jensen)
Department of Cardiology, Aalborg University Hospital, Denmark
(Kahlert) Department of Clinical Epidemiology, Aarhus University, Denmark
(Lassen) Department of Cardiology, Copenhagen University Hospital, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: In patients with increased bleeding risk, the biolimus
A9-coated BioFreedom stent, a stainless steel drug-coated stent free from
polymer, has shown superiority compared with a bare-metal stent. The aim
of this study was to investigate whether the BioFreedom stent is
noninferior to a modern ultrathin strut biodegradable polymer
cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient
population treated with percutaneous coronary intervention.
 METHOD(S): The SORT OUT IX trial (Scandinavian Organization for
Randomized Trials With Clinical Outcome IX), was a large-scale,
registry-based, randomized, multicenter, single-blind, 2-arm,
noninferiority trial. The primary end point, major adverse cardiovascular
events, was defined as the composite of cardiac death, myocardial
infarction not related to any segment other than the target lesion, or
target lesion revascularization within 1 year, analyzed by
intention-to-treat. The trial was powered to assess noninferiority for
major adverse cardiovascular events of the BioFreedom stent compared with
the Orsiro stent with a predetermined noninferiority margin of 0.021.
 RESULT(S): Between December 14, 2015 and April 21, 2017, 3151
patients were assigned to treatment with the BioFreedom stent (1572
patients, 1966 lesions) or to the Orsiro stent (1579 patients, 1985
lesions). Five patients were lost to follow-up because of emigration
(99.9% follow-up rate). Mean age was 66.3+/-10.9, diabetes mellitus was
seen in 19.3% of patients, and 53% of the patients had acute coronary
syndromes. At 1 year, intention-to-treat analysis showed that 79 (5.0%)
patients, who were assigned the BioFreedom stent, and 59 (3.7%), who were
assigned the Orsiro stent, met the primary end point (absolute risk
difference 1.29% [upper limit of one-sided 95% CI 2.50%];
P<inf>noninferiority</inf>=0.14). Significantly more patients in the
BioFreedom stent group had target lesion revascularization than those in
the Orsiro stent group (55 [3.5%] vs 20 [1.3%], rate ratio 2.77 [95% CI,
1.66-4.62]; P<0.0001). CONCLUSION(S): The biolimus A9-coated
BioFreedom polymer-free stent did not meet criteria for noninferiority for
major adverse cardiovascular events at 12 months when compared with the
ultrathin strut biodegradable polymer sirolimus-eluting Orsiro stent in an
all-comers population REGISTRATION: URL: https://www.clinicaltrials.gov;
Unique identifier: NCT02623140. Copyright © 2020 American Heart
Association, Inc.

<84>
Accession Number
2014808521
Title
Comparison of Two Noninvasive Ventilation Strategies (NHFOV Versus NIPPV)
as Initial Postextubation Respiratory Support in High-Risk Infants After
Congenital Heart Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Wu H.-L.; Lei Y.-Q.; Lin W.-H.; Huang S.-T.; Chen Q.; Zheng Y.-R.
Institution
(Wu, Lei, Lin, Huang, Chen, Zheng) Department of Cardiac Surgery, Fujian
Branch of Shanghai Children's Medical Center, Fuzhou, China
(Wu, Lei, Lin, Huang, Chen, Zheng) Fujian Children's Hospital, Fuzhou,
China
(Wu, Lei, Lin, Huang, Chen, Zheng) Fujian Maternity and Child Health
Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
(Wu, Lei, Lin, Huang, Chen, Zheng) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
Publisher
W.B. Saunders
Abstract
Objective: This study aimed to compare the effects of nasal high-frequency
oscillatory ventilation (NHFOV) and noninvasive positive-pressure
ventilation (NIPPV) as the initial postextubation therapies on preventing
extubation failure (EF) in high-risk infants younger than three months
after congenital heart surgery (CHS). Design(s): This was a
single-center, randomized, unblinded clinical trial. Setting(s): The
study was performed in a teaching hospital. Participant(s): Between
January 2020 and January 2021, a total of 150 infants underwent CHS in the
authors' hospital. Intervention(s): Infants younger than three months
with a high risk for extubation failure who were ready for extubation were
randomized to either an NHFOV therapy group or an NIPPV therapy group, and
received the corresponding noninvasive mechanical ventilation to prevent
EF. Measurements: Primary outcomes were reintubation, long-term
noninvasive ventilation (NIV) support (more than 72 hours), and the time
in NIV therapy. The secondary outcomes were adverse events, including
mild-moderate hypercapnia, severe hypercapnia, severe hypoxemia, treatment
intolerance, signs of discomfort, unbearable dyspnea, inability to clear
secretions, emesis, and aspiration. Main Result(s): Of 92 infants, 45
received NHFOV therapy, and 47 received NIPPV therapy after extubation.
There were no significant differences between the NHFOV and the NIPPV
therapy groups in the incidences of reintubation, long-term NIV support,
and total time under NIV therapy. No significant difference was found of
the severe hypercapnia between the two groups, but NHFOV treatment
significantly decreased the rate of mild-moderate hypercapnia (p < 0.05).
Other outcomes were similar in the two groups. Conclusion(s): Among
infants younger than three months after CHS who had undergone extubation,
NIPPV therapy and NHFOV therapy were the equivalent NIV strategies for
preventing extubation failure, and NHFOV therapy was more effective in
avoiding mild-moderate hypercapnia. Copyright © 2021 Elsevier
Inc.

<85>
Accession Number
2014808201
Title
Outcomes of peri-operative glucocorticosteroid use in major pancreatic
resections: a systematic review.
Source
HPB. (no pagination), 2021. Date of Publication: 2021.
Author
Kuan L.L.; Dennison A.R.; Garcea G.
Institution
(Kuan, Dennison, Garcea) Department of Hepatobiliary and Pancreatic
Surgery, University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Kuan) Discipline of Surgery, The University of Adelaide, The Queen
Elizabeth Hospital, Adelaide, South Australia, Australia
Publisher
Elsevier B.V.
Abstract
Background: There is increasing evidence that peri-operative
glucocorticosteroid can ameliorate the systemic response following major
surgery. Preliminary evidence suggests peri-operative usage of
glucocorticosteroid may decrease post-operative complications. These
positive associations have been observed in a range of different
operations including intra-abdominal, thoracic, cardiac, and orthopaedic
surgery. This review aims to investigate the impact of peri-operative
glucocorticosteroid in major pancreatic resections. Method(s): A
systematic review based on a search in Medline and Embase databases was
performed. PRISMA guidelines for systematic reviews were followed.
 Result(s): A total of five studies were analysed; three randomised
controlled trials and two retrospective cohort studies. The total patient
population was 1042. The glucocorticosteroids used were intravenous
hydrocortisone or dexamethasone. Three studies reported significantly
lower morbidity in the peri-operative glucocorticosteroid group. The
number needed to treat to prevent one major complication with
hydrocortisone is four patients. Two studies demonstrated that
dexamethasone was associated with a statistically significantly improved
median overall survival in pancreatic cancer. Conclusion(s): This is
the first systematic review conducted to investigate the significance of
peri-operative glucocorticosteroid in patients undergoing pancreatic
resection. This review shows a correlation of positive outcomes with the
administration of glucocorticosteroid in the peri-operative setting
following a major pancreatic resection. More randomised clinical trials
are required to confirm if this is a true effect, as it would have
significant implications. Copyright © 2021

<86>
Accession Number
635874245
Title
The association between mean arterial pressure and outcomes in patients
with cardiogenic shock: insights from the DOREMI trial.
Source
European heart journal. Acute cardiovascular care. 10(7) (pp 712-720),
2021. Date of Publication: 01 Oct 2021.
Author
Parlow S.; Di Santo P.; Mathew R.; Jung R.G.; Simard T.; Gillmore T.; Mao
B.; Abdel-Razek O.; Ramirez F.D.; Marbach J.A.; Dick A.; Glover C.; Russo
J.J.; Froeschl M.; Labinaz M.; Fernando S.M.; Hibbert B.
Institution
(Parlow, Di Santo, Mathew, Jung, Simard, Abdel-Razek, Ramirez, Marbach,
Dick, Glover, Russo, Froeschl, Labinaz, Fernando, Hibbert) CAPITAL
Research Group, University of Ottawa Heart Institute, 40 Ruskin Street,
Ottawa, ON K1Y 4W7, Canada
(Parlow, Di Santo, Mathew, Abdel-Razek, Ramirez, Dick, Glover, Russo,
Froeschl, Labinaz, Hibbert) Division of Cardiology, University of Ottawa
Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
(Di Santo) School of Epidemiology and Public Health, Faculty of Medicine,
University of Ottawa, 600 Peter Morand Crescent ,Room 101, Ottawa, ON K1G
5Z3, United States
(Jung, Gillmore, Mao) Faculty of Medicine, University of Ottawa, Roger
Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON K1H 8M5, Canada
(Jung, Simard, Hibbert) Department of Cellular and Molecular Medicine,
Faculty of Medicine, University of Ottawa, Room #3206, 451 Smyth Road,
Ottawa, ON K1H 8M5, United States
(Simard) Department of Cardiovascular Diseases, Mayo Clinic School of
Medicine, 200 First St. SW, Rochester, MN 55905, United States
(Marbach) Division of Pulmonary, Critical Care, Sleep Medicine, Tufts
Medical Center ,800 Washington Street, Boston, MA 02111
(Fernando) Division of Critical Care, Department of Medicine, University
of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
Publisher
NLM (Medline)
Abstract
AIMS: Cardiogenic shock (CS) is a state of low cardiac output resulting in
end-organ hypoperfusion. Despite high in-hospital mortality rates, little
evidence exists regarding the optimal mean arterial pressure (MAP) target
in CS. We therefore evaluated the relationship between achieved MAP and
clinical outcomes in patients with CS. METHODS AND RESULTS: We performed a
post hoc analysis of the CAPITAL DOREMI trial: a randomized, double-blind
trial comparing dobutamine to milrinone in patients with CS. We divided
patients into a high MAP group (average MAP >= 70mmHg over the 36h
following randomization), and a low MAP group (average MAP < 70mmHg). Our
primary outcome included in-hospital all-cause mortality, resuscitated
cardiac arrest, need for cardiac transplantation or mechanical circulatory
support, non-fatal myocardial infarction, transient ischaemic attack or
stroke, or initiation of renal replacement therapy. In total, 71 (37.0%)
patients achieved an average MAP < 70mmHg, and 121 (63.0%) achieved an
average MAP >= 70mmHg. The primary outcome occurred in 48 (67.6%) patients
in the low MAP group and 51 (42.2%) patients in the high MAP group
[adjusted relative risk (aRR) 0.70; 95% confidence interval (CI)
0.53-0.92; P=0.01]. All-cause mortality occurred in 41 (57.8%) and 35
(28.9%) patients in the low and high MAP groups, respectively (aRR 0.56;
95% CI 0.40-0.79; P<0.01). There were no significant differences in any
secondary outcomes between each group. CONCLUSION(S): In patients
with CS treated with inotrope therapy, low MAP is associated with worse
clinical outcomes. Randomized data evaluating optimal MAP targets in CS is
needed to guide medical therapy. Copyright Published on behalf of the
European Society of Cardiology. All rights reserved. © The Author(s)
2021. For permissions, please email: journals.permissions@oup.com.

<87>
Accession Number
635517843
Title
'Ticagrelor alone vs. dual antiplatelet therapy from 1 month after
drug-eluting coronary stenting among patients with STEMI': a post hoc
analysis of the randomized GLOBAL LEADERS trial.
Source
European heart journal. Acute cardiovascular care. 10(7) (pp 756-773),
2021. Date of Publication: 01 Oct 2021.
Author
Gamal A.S.; Hara H.; Tomaniak M.; Lunardi M.; Gao C.; Ono M.; Kawashima
H.; Juni P.; Vranckx P.; Windecker S.; Hamm C.; Steg P.G.; Onuma Y.;
Serruys P.W.
Institution
(Gamal, Hara, Lunardi, Gao, Ono, Kawashima, Onuma, Serruys) Department of
Cardiology, National University of Ireland, Galway (NUIG), University
Road, Galway H91 TK33, Ireland
(Gamal) Department of Cardiology, North Cumbria University Hospital NHS
Trust, Newtown Road, Cumbria CA2 7HY, United Kingdom
(Gamal) Department of Cardiology, Zagazig University, Zagazig 44519, Egypt
(Hara, Ono, Kawashima) Department of Cardiology, Academic Medical Center,
University of Amsterdam, Meibergdreef 9, AZ Amsterdam 1105, Netherlands
(Tomaniak) Department of Cardiology, Erasmus University MC, Dr.
Molewaterplein 40 Street, GD Rotterdam 3015, Netherlands
(Tomaniak) First Department of Cardiology, Medical University of Warsaw,
Banacha 1a Street, Warsaw 02-097, Poland
(Lunardi) Division of Cardiology, University of Verona, Piazzale Stefani
1, Verona 37100, Italy
(Gao) Department of Cardiology, Radboud University Medical Center, Geert
Grooteplein Zuid 8, GA Nijmegen 6525, Netherlands
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, 30 Bond Street Toronto, ON M5B 1W8, Canada
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Stadsomvaart 11, Hasselt 3500, Belgium
(Windecker) Department of Cardiology, Bern University Hospital,
Freiburgstrasse 4, Bern 3010, Switzerland
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center, Campus
Kerckhoff of the University of GiessenBenekestrasse 2-8, Bad Nauheim
61231, Germany
(Steg) Universite de Paris, FACT, Assistance Publique-Hopitaux de Paris
Hopital Bichat, AP-HP, 46 rue Henri Huchard, Paris 75018, France
(Serruys) Department of Cardiology, Imperial College London, Exhibition
Road, London SW7 2BX, United Kingdom
Publisher
NLM (Medline)
Abstract
AIM: To evaluate the efficacy and safety of ticagrelor monotherapy beyond
1 month and up to 24months vs. standard 12-month dual antiplatelet therapy
(DAPT) with aspirin and ticagrelor followed by aspirin monotherapy among
ST-elevation myocardial infarction (STEMI) patients undergoing
percutaneous coronary intervention (PCI) in the GLOBAL LEADERS trial.
METHODS AND RESULTS: We performed a post hoc analysis of STEMI patients in
the GLOBAL LEADERS trial comparing experimental ticagrelor monotherapy
(1062 patients) with standard 12-month DAPT (1030 patients). We evaluated
predefined primary and secondary endpoints in both treatment arms. Rates
of net adverse clinical events (NACE), patient-oriented composite
endpoints (POCE), and bleeding academic research consortium (BARC)-defined
bleeding Type 3 or 5 were also evaluated. At 2 years, there were no
significant differences in rates of primary endpoints in patients who had
STEMI [0.89 (0.61-1.31)]. There were similar rates of NACE and POCE in
both experimental and reference treatment groups at 2years post-PCI
[hazard ratio (HR) 0.96 (0.77-1.20) and 0.96 (0.77-1.21), respectively].
BARC 3 or 5 bleeding events were numerically less in experimental compared
to reference treatment groups at 1 year [HR 0.55 (0.27-1.13)] and 2years
[0.61 (0.32-1.16)]. CONCLUSION(S): Presentation with STEMI has not
influenced the incidence of GLOBAL LEADERS defined primary endpoints.
There were no significant differences in rates of NACE, POCE, and BARC
bleeding between the two treatment groups up to 2years of follow-up.
Although these findings should be viewed as exploratory, they expand the
evidence on potential safety of aspirin-free antiplatelet strategies after
PCI in STEMI. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<88>
Accession Number
2014769926
Title
Adherence to immunosuppression in adult heart transplant recipients: A
systematic review.
Source
Transplantation Reviews. 35(4) (no pagination), 2021. Article Number:
100651. Date of Publication: December 2021.
Author
Hussain T.; Nassetta K.; O'Dwyer L.C.; Wilcox J.E.; Badawy S.M.
Institution
(Hussain) Department of Internal Medicine, Northwestern University McGaw
Medical Center, 251 E. Huron St., Ste. 16-738, Chicago, IL 60611, United
States
(Nassetta) Department of Pediatrics, Lurie Children's Hospital, 225 E.
Chicago Ave., Chicago, IL 60611, United States
(O'Dwyer) Galter Health Sciences Library & Learning Center, Northwestern
University Feinberg School of Medicine, 320 E. Superior Street, Chicago,
IL 60611, United States
(Wilcox) Department of Cardiology, Northwestern Memorial Hospital,
NMH/Arkes Family Pavilion, Ste. 600; 676 N. St. Clair Ave., Chicago, IL
60611, United States
(Badawy) Division of Hematology, Oncology, and Stem Cell Transplant, Lurie
Children's Hospital of Chicago, Chicago, IL 60611, United States
(Badawy) Department of Pediatrics, Northwestern University Feinberg School
of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, United States
Publisher
W.B. Saunders
Abstract
Background: Successful maintenance of a heart transplant (HTx) graft
requires adherence to a triple-drug regimen of immunosuppression. However,
achieving adequate adherence can be difficult secondary to complicated
dosing regimens, side effects, and mental/emotional barriers. A detailed
review of current patterns of adherence to immunosuppression in adult HTx
recipients is lacking. Objective(s): This systematic review aims to
detail the current landscape of adherence to immunosuppression in adult
heart transplant patients, including the measurement of adherence,
correlates to adherence, health outcomes associated with nonadherence, as
well as strategies to improve adherence in HTx patients. Method(s):
We conducted searches in PubMed MEDLINE, Embase, CENTRAL register of
Controlled Trials (Wiley), and Scopus, from inception to March 2020.
Studies were eligible if they outlined an aspect of adherence (as noted
above in the objective) to immunosuppression in adult HTx patients. The
HTx cohort had to contain at least 10 patients and measurement of
adherence had to be done with an objective or otherwise validated measure
of adherence (e.g. drug levels, automated pill bottles or adherence
questionnaires). Two authors independently screened the articles for
inclusion, then subsequently reviewed the full texts of the included
articles. Data was extracted into standardized forms and bias evaluations
were done using the Newcastle-Ottawa or modified Newcastle-Ottawa tools,
depending on the study type. The authors followed all guidelines for the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) statement. Result(s): The titles/abstracts of 880 articles
were reviewed. Ultimately, 23 articles were included in the final review.
The median number of participants was 101, with a range of 19 to 1397.
Studies provided information on baseline levels of adherence (17 studies),
correlates to adherence (14 studies), health outcomes related to
nonadherence (3 studies) and interventions to improve adherence (3
studies). Baseline adherence estimates varied greatly depending on the
adherence measure. Multiple significant correlates to nonadherence exist
and appear to affect patients with certain sociodemographic backgrounds,
those with psychological/psychiatric comorbidities and those with poor
support structures. Nonadherence is associated with transplant coronary
artery disease and acute late rejection; it may also be associated with
long-term mortality. Finally, a simplified dosing regimen with once-a-day
tacrolimus as well as use of a mobile phone-based intervention were
associated with improved adherence. Bias scores were most deficient due to
self-reported outcomes in 18 studies, and lack of controls/adjustments for
confounders, in 7 studies. Conclusion(s): Adherence to
immunosuppression in transplant patients varies, but is associated with
observable and modifiable factors which are worth addressing. Further
high-quality studies regarding strategies to improve adherence are needed
in the literature. Copyright © 2021 Elsevier Inc.

<89>
Accession Number
2013832787
Title
Risk factors for acute kidney injury after pediatric cardiac surgery: a
meta-analysis.
Source
Pediatric Nephrology. (no pagination), 2021. Date of Publication: 2021.
Author
Van den Eynde J.; Delpire B.; Jacquemyn X.; Pardi I.; Rotbi H.; Gewillig
M.; Kutty S.; Mekahli D.
Institution
(Van den Eynde, Kutty) Helen B. Taussig Heart Center, The Johns Hopkins
Hospital and School of Medicine, Baltimore, United States
(Van den Eynde, Delpire, Jacquemyn, Pardi, Gewillig) Department of
Cardiovascular Sciences, University Hospitals Leuven, KU Leuven,
Herestraat 49, Leuven 3000, Belgium
(Rotbi) Faculty of Medicine, Radboud University, Nijmegen, Netherlands
(Rotbi) Department of Physiology, Radboud University Medical Center,
Radboud Institute for Health Sciences, Nijmegen, Netherlands
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Mekahli) Department of Pediatric Nephrology, University Hospitals of
Leuven, Leuven, Belgium
(Mekahli) PKD Research Group, GPURE, Department of Development and
Regeneration, KU Leuven, Leuven, Belgium
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Cardiac surgery-associated acute kidney injury (AKI) is
associated with increased morbidity and mortality in both adults and
children. Objective(s): This study aimed to identify clinical risk
factors for AKI following cardiac surgery in the pediatric population.
Data sources: PubMed/MEDLINE, Embase, Scopus, and reference lists of
relevant articles were searched for studies published by August 2020.
Study eligibility criteria: Studies were included if (1) the population
consisted of pediatric patients (< 18 years old), (2) patients underwent
cardiac surgery, (3) risk factors were compared between patients who
developed AKI and those who did not, and (4) studies were prospective or
retrospective observational studies or randomized controlled trials.
Participants and interventions: Children undergoing pediatric cardiac
surgery. Study appraisal and synthesis methods: Random-effects
meta-analysis was performed, comparing potential risk factors between
pediatric patients who developed CS-AKI and those who did not.
 Result(s): Sixty-one publications including a total of 19,680
participants (AKI: 7257 participants; no AKI: 12,423 participants) were
included from studies published between 2008 and 2020. The pooled
estimated incidence of AKI was 34.3% (95% confidence interval 30.0-38.8%,
I2 = 96.8%). Binary risk factors that were significantly and
consistently associated with AKI were the presence of pulmonary
hypertension, cyanotic heart disease, univentricular heart, risk
adjustment for congenital heart surgery 1 (RACHS-1) score >= 3,
vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis.
Significant continuous risk factors included younger age, lower body
weight, lower preoperative creatinine, higher preoperative estimated
glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery
time, longer cardiopulmonary bypass time, longer aortic cross-clamp time,
and higher red blood cell transfusion volume. Limitation(s): Results
are limited by heterogeneity and potential residual confounding.
Conclusions and implications of key findings: Our meta-analysis identified
clinical risk factors that are associated with AKI in children undergoing
cardiac surgery. This might help clinicians anticipate and manage more
carefully this population and implement standardized preventive
strategies. Systematic review registration number: CRD42021262699.
Graphical abstract: A higher resolution version of the Graphical abstract
is available as Supplementary information. [Figure not available: see
fulltext.] Copyright © 2021, The Author(s), under exclusive
licence to International Pediatric Nephrology Association.

<90>
Accession Number
2012931076
Title
Coronary revascularisation in patients with chronic kidney disease and
end-stage renal disease: A meta-analysis.
Source
International Journal of Clinical Practice. 75(11) (no pagination), 2021.
Article Number: e14506. Date of Publication: November 2021.
Author
Li X.; Xiao F.; Zhang S.
Institution
(Li, Xiao, Zhang) Department of Cardiac Surgery, Peking University First
Hospital, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To compare coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI) for revascularising coronary
arteries in patients with chronic kidney disease (CKD) and end-stage renal
disease (ESRD). CKD is described as a continuous decrease in the
glomerular filtration rate or abnormalities in kidney structure or
function. Method(s): PubMed, Cochrane Library and Embase databases
were searched for studies on the revascularisation of coronary arteries in
patients with CKD and ESRD. Result(s): Since no randomised controlled
trials (RCTs) have addressed this issue so far, 31 observational studies
involving 74 805 patients were included in this meta-analysis. Compared
with PCI, patients undergoing CABG have significantly higher early
mortality (CKD: RR = 1.62, 95% CI: 1.17-2.25, pheterogeneity = 0.476,
I2 = 0; ESRD: RR = 1.99, 95% CI: 1.46-2.71, pheterogeneity =
0.001, I2 = 66.9%). Patients with ESRD undergoing CABG have
significantly lower all-cause mortality (RR = 0.95, 95% CI: 0.93-0.96,
pheterogeneity < 0.001, I2 = 82.9%) and cardiac mortality (RR =
0.73, 95% CI: 0.58-0.92, pheterogeneity = 0.908, I2 = 0). The
long-term risk of repeat revascularisation (CKD: RR = 0.24, 95% CI:
0.19-0.30, pheterogeneity = 0.489, I2 = 0; ESRD: RR = 0.23, 95%
CI: 0.15-0.34, pheterogeneity = 0.012, I2 = 54.4%) and
myocardial infarction (CKD: RR =.57, 95% CI: 0.38-0.85, pheterogeneity =
0.025, I2 = 49.9%; ESRD: RR = 0.42, 95% CI: 0.40-0.44,
pheterogeneity = 0.49, I2 = 0) remained significantly higher in
the PCI group. Conclusion(s): Patients with ESRD, but not CKD, who
underwent CABG had significantly lower all-cause mortality and cardiac
mortality. However, CABG was associated with an increased risk of early
mortality in patients with CKD or ESRD. Adequately powered, contemporary,
prospective RCTs are needed to define the optimal revascularisation
strategy for patients with CKD and ESRD. Copyright © 2021 The
Authors. International Journal of Clinical Practice published by John
Wiley & Sons Ltd.

<91>
Accession Number
636264527
Title
Does removal of inflammatory factors during bypass improve outcome in
high-risk patient undergoing cardiac surgery?.
Source
Blood Purification. Conference: 38th Vicenza Course on AKI and CRRT.
Virtual. 50(6) (pp 1016), 2021. Date of Publication: September 2021.
Author
Xiong J.; Cui Y.; Bian L.; Wu Z.; Du L.
Institution
(Xiong, Cui, Du) Department of Anesthesiology, West China Hospital,
Sichuan University, Chengdu, Sichuan, China
(Bian, Wu) Department of Cardiac Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Publisher
S. Karger AG
Abstract
Objective: To investigate whether removal of proinflamma-tory factors
during cardiopulmonary bypass (CPB) improves the postoperative outcomes
for the high-risk patients undergoing cardiac surgery. Method(s):
This prospective, randomized, controlled study included adult patients
(over 18 years) scheduled for cardiac or vascular surgery under CPB and
their EuroSCORE II > 2 combined with the plasma TNF-a over 8.0 pg/mL.
Patients who were pregnant, or had long-term glucocorticoid use, or with
immune system diseases, or without informed consent were excluded. The
patients were randomly divided into HA380 group and Control group. In the
former group, an adsorber (HA380 hemoperfusion cartridge, Jafron
Biomedical Co., China) was used continuously during CPB. The primary
outcome were composite events, including all-cause mortality in 30-day,
permanent or transient neurological dysfunction, new onset myocardial
infarction or low cardiac output, renal failure, acute respiratory disease
syndrome, intestinal bleeding or ischemia, and prolonged intubation time
(> 24-hours). The secondary outcomes were hospitalization time, blood
product consumption and chest drainage. Result(s): A total of 40
patients were included into the study (20 in each group). Their
demographic characteristics were comparable between groups. There were no
significant difference between control group and HA380 group regarding the
preoperative complications, EuroScore II, surgical types, CPB time, and
cross-clamp time. The composite events occurred in 4 (20%) patients in
HA380 group, and in 7 (35%) patients in control group (p=0.48). Both
hospitalization time and blood product consumption were similar between
groups, but the chest drainage after 4 hours were slightly lower in HA380
group (median: 75 mL) than that in control group (median: 150 mL)
(p=0.19). Although there were no significant differences regarding to peak
plasma levels of creatinine, bilirubin, transaminase, troponin between
groups (all p>0.1), TNF-a levels (28+/-12 pg/mL vs. 30+/-17 pg/mL,
p=0.78), counts of leukocyte (median: 7.5*109/L, vs 10.9*109/L, p=0.08),
neutrophil (5.9 *109/L vs 8.3*109/L p=0.11) and monocyte (0.36 *109/L vs
0.64 *109/L, p=0.02) were slightly lower in HA380 group than control
group. Conclusion(s): This prospective, randomized, controlled study
showed that removal of inflammatory factors during cardiopul-monary bypass
may help to attenuate the systemic inflammation for the high-risk patients
undergoing cardiac surgery on CPB. Whether it improves outcomes for these
population needs further studies with larger sample size.

<92>
Accession Number
636274131
Title
Diabetic striatopathy in a Choctaw female.
Source
Annals of Neurology. Conference: 146th Annual Meeting American
Neurological Association, ANA 2021. Virtual. 90(SUPPL 27) (pp S147), 2021.
Date of Publication: October 2021.
Author
Cothern J.G.; Lu S.; Sharma S.
Institution
(Cothern, Lu, Sharma) Neurology, University of Mississippi Medical Center,
Jackson, MS, United States
Publisher
John Wiley and Sons Inc.
Abstract
Objective: To describe a case of diabetic striatopathy in a 55-year-old
female Background: Diabetic Striatopathy (DS) is an uncommon complication
of chronically uncontrolled diabetes mellitus (DM). Pathophysiology of DS
is not entirely understood; theories include GABA depletion and
proliferative vascular abnormalities. DS is a rare clinical entity; one
2018 review recognized only 7 cases over 15 years at a US referral medical
center. It is thought to be underdiagnosed in Western populations. DS has
a predominance for female, Asian, and elderly people. Patients present
with hyperglycemia and acute onset hemichorea. The contralateral basal
ganglia are hyperdense/ hyperintense on CT or MRI. Method(s):
Retrospective chart review and literature review. Our Case: Our patient
was a 55-year-old Choctaw female with a past medical history of coronary
artery bypass graft type II diabetes, and oxygen dependence following
Covid-19 infection. She presented with acute onset of involuntary right
upper limb movements. The movements were suppressed during sleep and
resumed upon waking. On exam, her right arm writhed violently in a
choreiform fashion. Her right face and right leg were involved too. Her
exam was otherwise normal. She reported two family members with these
symptoms in the past. CT head revealed a hyperdensity in the left basal
ganglia, with no mass effect. CTA revealed enlarged veins in the left
putamen. Lab studies revealed a hemoglobin A1C of 14.7 and glucose of 281.
She was admitted and given haloperidol and lorazepam which did not
alleviate symptoms. Endocrinology was consulted to improve glycemic
control. Multiple attempts to obtain MRI failed due to our patient's
inability to lie still. On the sixth day of admission, our patient's
movements were controlled with improved diabetes management and
clonazepam. Conclusion(s): DS is an uncommon complication of
uncontrolled Type II diabetes that can be corrected with glycemic control
and should be considered in presentations of acute hemichorea. Our report
is unique as no case report in existence, to our knowledge, presents this
rare disorder in a person of Choctaw heritage.

<93>
Accession Number
2015185458
Title
In patients with lung cancer is combined endobronchial ultrasound and
endoscopic ultrasound superior to conventional mediastinoscopy in staging
the mediastinum?.
Source
Annals of Medicine and Surgery. 71 (no pagination), 2021. Article Number:
102953. Date of Publication: November 2021.
Author
Gunawan A.; Manuel L.; Fong L.S.; Bassin L.
Institution
(Gunawan) St Vincent's Hospital Clinical School, University of New South
Wales, Randwick, NSW, Australia
(Manuel, Bassin) Department of Cardiothoracic Surgery, Royal North Shore
Hospital, St Leonards, NSW, Australia
(Fong) Department of Cardiothoracic Surgery, Liverpool Hospital,
Liverpool, NSW, Australia
Publisher
Elsevier Ltd
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In patients with lung
cancer, is combined endobronchial ultrasound and endoscopic ultrasound
(EBUS + EUS) superior to cervical mediastinoscopy (CM) in staging the
mediastinum?' Altogether more than 110 papers were found, of which one
meta-analysis, two RCTs, and two cohort studies represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Studies directly
comparing EBUS + EUS and CM are limited in number and quality, with the
majority of studies focusing on comparing endosonographic techniques or a
single technique with surgical staging. Moreover, in four out of five
studies, surgical staging of the mediastinum was undertaken following a
negative EBUS + EUS result, limiting the utility of comparing
endosonography alone. Regardless of this, the initial EBUS + EUS approach
followed by surgical staging if negative resulted in greater sensitivity
and detection of N2/3 metastases as well as greater sampling in the
majority of studies, resulting in higher likelihood of upstaging and
treatment alterations for patients. There was also improved quality of
life demonstrated in the EBUS + EUS group with significant reductions in
futile thoracotomies and less complications when compared with exclusive
CM staging. We conclude that a combined approach of combined
endosonography in the first instance, followed by CM staging of the
mediastinum results in greater sensitivity of nodal disease and subsequent
greater accuracy in upstaging and determining treatment plans with a
concurrent reduction in complication rates and futile
procedures. Copyright © 2021 The Authors

<94>
Accession Number
2015131593
Title
A pooled analysis of pacemaker implantation after Perceval sutureless
aortic valve replacement.
Source
Interactive Cardiovascular and Thoracic Surgery. 33(4) (pp 501-509), 2021.
Date of Publication: 01 Oct 2021.
Author
Moscarelli M.; Santarpino G.; Athanasiou T.; Mastroroberto P.; Fattouch
K.; Nasso G.; Speziale G.
Institution
(Moscarelli, Nasso, Speziale) Department of Cardiovascular Surgery, Anthea
Hospital, Gvm Care and Research, Bari, Italy
(Moscarelli, Athanasiou) Imperial College, Nhli, Hammersmith Hospital,
London, United Kingdom
(Santarpino, Mastroroberto) Department of Clinical and Experimental
Medicine, Magna Graecia University, Catanzaro, Italy
(Santarpino) Department of Cardiac Surgery, Paracelsus Medical University,
Nuremberg, Germany
(Fattouch) Department of Cardiovascular Surgery, Maria Eleonora Hospital,
Gvm Care and Research, Palermo, Italy
Publisher
Oxford University Press
Abstract
OBJECTIVES: We performed a literature meta-analysis to estimate the rate
of pacemaker implantation after Perceval sutureless aortic valve
replacement. METHOD(S): Pertinent articles were identified from the
PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible
studies reported the de novo incidence of postoperative pacemaker
implantation after Perceval valve surgery. Among 394 articles retrieved,
26 studies including 9492 patients met the inclusion criteria.
 RESULT(S): The pooled event rate for postoperative pacemaker
implantation was 7% [95% confidence interval (CI) 6-9%]; however,
significant heterogeneity was observed across studies. In a sub-analysis,
there was no difference between the rates of pacemaker implantation
calculated from multicentre and registry studies (8 studies, 6845
patients; 7%, 95% CI 5-10%) and single-centre studies (18 studies, 2647
patients; 7%, 95% CI 5-9%; P = 0.75). Implantation rates were similar in
high-volume studies (16 studies, 9121 patients; 7%, 95% CI 5-8%) than in
low-volume studies (10 studies, 371 patients; pooled rate: 7%, 95% CI
4-14%; P = 0.5). Postoperative pacemaker implantation rates tended to
decrease over time. CONCLUSION(S): With a pooled event rate of 7%,
postoperative pacemaker implantation remains an important limitation of
Perceval sutureless valve surgery, although we observed a degree of
variability across included studies. The resultant findings provide a
useful estimate for physicians and patients and can serve as a benchmark
for future comparative studies. Copyright © 2021 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<95>
Accession Number
2015208345
Title
Surgical Sutureless and Sutured Aortic Valve Replacement in Low-risk
Patients.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Lam K.Y.; Reardon M.J.; Yakubov S.J.; Modine T.; Fremes S.; Tonino P.A.L.;
Tan M.E.; Gleason T.G.; Harrison J.K.; Hughes G.C.; Oh J.K.; Head S.J.;
Huang J.; Deeb G.M.
Institution
(Lam, Tonino, Tan) Department of Cardiothoracic Surgery, Catharina
Hospital Eindhoven, Eindhoven, Netherlands
(Reardon) Department of Cardiovascular Surgery, Houston Methodist Debakey
Heart and Vascular Center, Houston, TX, United States
(Yakubov) Department of Cardiology, Riverside Methodist-Ohio Health,
Columbus, OH, United States
(Modine) Department of Cardiac Surgery, Lille University Hospital, Lille,
France
(Fremes) Department of Surgery, Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
(Gleason) Department of Cardiothoracic Surgery, University of Pittsburgh
Medical Center, Pittsburg, PA, United States
(Harrison) Departments of Interventional Cardiology and Cardiothoracic
Surgery, Duke University Medical Center, Durham, NC, United States
(Hughes) Department of Cardiothoracic Surgery, Duke University Medical
Center, Durham, NC, United States
(Oh) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN,
United States
(Head, Huang) Department of Statistics, Medtronic, Minneapolis, MN, United
States
(Deeb) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: Randomized clinical trials have shown that transcatheter
aortic valve replacement is noninferior to surgery in low surgical risk
patients. We compared outcomes in patients treated with a sutured (stented
or stentless) or sutureless surgical valve from the Evolut Low Risk Trial.
 Method(s): The Evolut Low Risk Trial enrolled patients with severe
aortic stenosis and low surgical risk. Patients were randomized to
self-expanding transcatheter aortic valve replacement or surgery. Use of
sutureless or sutured valves was at the surgeons' discretion.
 Result(s): Six hundred eighty patients underwent surgical aortic
valve implantation (205 sutureless, 475 sutured). The Valve Academic
Research Consortium-2 30-day safety composite endpoint was similar in the
sutureless and sutured group (10.8% vs 11.0%, P = .93). All-cause
mortality between groups was similar at 30 days (0.5% vs 1.5%, P = .28)
and 1 year (3.3% vs 2.6%, P = .74). Disabling stroke was also similar at
30 days (2.0% vs 1.5%, P = .65) and 1 year (2.6% vs 2.2%, P = .76).
Permanent pacemaker implantation at 30 days was significantly higher in
the sutureless compared with the sutured group (14.4% vs 2.9%, P < .001).
Aortic valve-related hospitalizations occurred more often at 1 year with
sutureless valves (9.1% vs 5.1%, P = .04). Mean gradients 1 year after
sutureless and sutured aortic valve replacement were 9.9 +/- 4.2 versus
11.7 +/- 4.7 mm Hg (P < .001). Conclusion(s): Among low-risk
patients, sutureless versus sutured valve use did not demonstrate a
benefit in terms of 30-day complications and produced marginally better
hemodynamics but with an increased rate of pacemaker implantation and
valve-related hospitalizations. Copyright © 2021 The Society of
Thoracic Surgeons

<96>
Accession Number
2015200199
Title
Abbreviated Antiplatelet Therapy in Patients at High Bleeding Risk with or
without Oral Anticoagulant Therapy after Coronary Stenting: An Open-Label,
Randomized, Controlled Trial.
Source
Circulation. (pp 1196-1211), 2021. Date of Publication: 2021.
Author
Smits P.C.; Frigoli E.; Tijssen J.; Juni P.; Vranckx P.; Ozaki Y.; Morice
M.-C.; Chevalier B.; Onuma Y.; Windecker S.; Tonino P.A.L.; Roffi M.;
Lesiak M.; Mahfoud F.; Bartunek J.; Hildick-Smith D.; Colombo A.;
Stankovic G.; Iniguez A.; Schultz C.; Kornowski R.; Ong P.J.L.; Alasnag
M.; Rodriguez A.E.; Moschovitis A.; Laanmets P.; Heg D.; Valgimigli M.
Institution
(Smits) Department of Cardiology, Maasstad Ziekenhuis, Maasstadweg 21,
Rotterdam 3079 DZ, Netherlands
(Frigoli, Heg) Clinical Trial Unit, University of Bern, Switzerland
(Tijssen) Department of Cardiology, Amsterdam University, Medical Centers,
Netherlands
(Tijssen) ECRI, Rotterdam, Netherlands
(Juni) University of Toronto, Applied Health Research Centre, Li Ka Shing
Knowledge Institute, St Michael's Hospital, Canada
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Belgium
(Vranckx) Faculty of Medicine and Life Sciences, Hasselt University,
Belgium
(Ozaki) Department of Cardiology, School of Medicine, Fujita Health
University, Toyoake, Japan
(Morice) Cardiovascular European Research Center, Massy, France
(Chevalier) Ramsay Generale de Sante, Interventional Cardiology
Department, Institut Cardiovasculaire Paris Sud, Massy, France
(Onuma) National University of Ireland, Galway, Ireland
(Windecker) Department of Cardiology, Bern University Hospital,
Switzerland
(Tonino) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Roffi) Division of Cardiology, Geneva University Hospitals, Switzerland
(Lesiak) First Department of Cardiology, University of Medical Sciences,
Poznan, Poland
(Mahfoud) Department of Cardiology, Angiology, Intensive Care Medicine,
Saarland University, Homburg, Germany
(Bartunek) Cardiovascular Center, OLV Hospital, Aalst, Belgium
(Hildick-Smith) Brighton and Sussex University Hospitals NHS Trust, United
Kingdom
(Colombo) Unit of Cardiovascular Interventions, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Stankovic) Department of Cardiology, Clinical Center of Serbia, Faculty
of Medicine, University of Belgrade
(Iniguez) Hospital Alvaro Cunqueiro, Vigo, Spain
(Schultz) Department of Cardiology, Royal Perth Hospital Campus,
University of Western Australia, Australia
(Kornowski) Rabin Medical Center, Sackler School of Medicine, Tel Aviv
University, Israel
(Ong) Tock Seng Hospital, Singapore, Singapore
(Alasnag) Department of Cardiology, King Fahad Armed Forces Hospital,
Jeddah, Saudi Arabia
(Rodriguez) Cardiac Unit Otamendi Hospital, Buenos Aires School of
Medicine, Cardiovascular Research Center, Argentina
(Moschovitis) Herz Zentrum, Hirslanden, Zurich, Switzerland
(Laanmets) North-Estonia Medical Centre Foundation, Tallinn, Estonia
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Universita della Svizzera Italiana, Lugano, Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimal duration of antiplatelet therapy (APT) in patients
at high bleeding risk with or without oral anticoagulation (OAC) after
coronary stenting remains unclear. Method(s): In the
investigator-initiated, randomize, open-label MASTER DAPT trial
(Management of High Bleeding Risk Patients Post Bioresorbable Polymer
Coated Stent Implantation With an Abbreviated Versus Standard DAPT
Regimen), 4579 patients at high bleeding risk were randomized after
1-month dual APT to abbreviated or nonabbreviated APT strategies.
Randomization was stratified by concomitant OAC indication. In this
subgroup analysis, we report outcomes of populations with or without an
OAC indication. In the population with an OAC indication, patients changed
immediately to single APT for 5 months (abbreviated regimen) or continued
>=2 months of dual APT and single APT thereafter (nonabbreviated regimen).
Patients without an OAC indication changed to single APT for 11 months
(abbreviated regimen) or continued >=5 months of dual APT and single APT
thereafter (nonabbreviated regimen). Coprimary outcomes at 335 days after
randomization were net adverse clinical outcomes (composite of all-cause
death, myocardial infarction, stroke, and Bleeding Academic Research
Consortium 3 or 5 bleeding events); major adverse cardiac and cerebral
events (all-cause death, myocardial infarction, and stroke); and type 2,
3, or 5 Bleeding Academic Research Consortium bleeding. Result(s):
Net adverse clinical outcomes or major adverse cardiac and cerebral events
did not differ with abbreviated versus nonabbreviated APT regimens in
patients with OAC indication (n=1666; hazard ratio [HR], 0.83 [95% CI,
0.60-1.15]; and HR, 0.88 [95% CI, 0.60-1.30], respectively) or without OAC
indication (n=2913; HR, 1.01 [95% CI, 0.77-1.33]; or HR, 1.06 [95% CI,
0.79-1.44]; P<inf>interaction</inf>=0.35 and 0.45, respectively). Bleeding
Academic Research Consortium 2, 3, or 5 bleeding did not significantly
differ in patients with OAC indication (HR, 0.83 [95% CI, 0.62-1.12]) but
was lower with abbreviated APT in patients without OAC indication (HR,
0.55 [95% CI, 0.41-0.74]; P<inf>interaction</inf>=0.057). The difference
in bleeding in patients without OAC indication was driven mainly by a
reduction in Bleeding Academic Research Consortium 2 bleedings (HR, 0.48
[95% CI, 0.33-0.69]; P<inf>interaction</inf>=0.021). Conclusion(s):
Rates of net adverse clinical outcomes and major adverse cardiac and
cerebral events did not differ with abbreviated APT in patients with high
bleeding risk with or without an OAC indication and resulted in lower
bleeding rates in patients without an OAC indication. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03023020. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<97>
Accession Number
2015172292
Title
Effects of neuromuscular electrical stimulation on functional capacity and
quality of life among patients after cardiac surgery: A systematic review
and meta-analysis.
Source
Journal of Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Zhang X.; Peng Y.; Zhong F.; Li S.; Huang X.; Huang Q.; Chen L.; Lin Y.
Institution
(Zhang) School of Nursing, Fujian Medical University, Fuzhou, China
(Peng, Li, Huang, Huang, Chen) Department of Cardiac Surgery, Fujian
Medical University Union Hospital, Fuzhou, China
(Zhong, Lin) Department of Nursing, Fujian Medical University Union
Hospital, Fuzhou, China
(Chen, Lin) Fujian Heart Medicine Research Center, Fuzhou, China
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Neuromuscular electrical stimulation (NMES) is a possible
adjunctive therapy applied to cardiac surgery patients to improve physical
function, but the results are still controversial. A systematic review and
meta-analysis was conducted to investigate the effects of NMES on
functional capacity and quality of life (QoL) in cardiac surgery patients.
 Method(s): The following databases PubMed, Embase, Medicine, CINAHL,
and the Cochrane Central Register of Controlled Trials were searched for
the English language from inception up to March 2021. A systematic
targeted literature search evaluating the effects of NMES on physical
function and QoL in cardiac surgery patients. The effect size of NMES was
presented as the mean difference (MD)/standardized mean difference (SMD)
and its 95% confidence interval using fixed/random effect models according
to heterogeneity. Two reviewers independently screened and appraised each
study by using the Cochrane Risk of Bias Tool. Result(s): Six studies
were included involving 400 cardiac surgery patients. The meta-analysis
showed that NMES had effect on knee extensor strength (SMD=1.68; p=0.05),
but had no effects on 6-minute walking distance (MD=44.08; p=0.22),
walking speed (MD=0.05; p=0.24), grip strength (MD=3.01; p=0.39), or QoL
(SMD=0.53; p=0.19). Conclusion(s): NMES use in cardiac surgery
patients is limited by low to moderate quality. Existing evidence shows
that NMES is safe and effective for improving knee extensor
strength. Copyright © 2021

<98>
Accession Number
2015172289
Title
Colchicine-new horizons for an ancient drug.
Source
European Journal of Internal Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Schattner A.
Institution
(Schattner) The Faculty of Medicine, Hebrew University and Hadassah
Medical School, Jerusalem, Israel
Publisher
Elsevier B.V.
Abstract
Colchicine is an old, inexpensive, and relatively safe anti-inflammatory
drug traditionally used in gout and over the last 50 years in familial
Mediterranean fever. A search of all high-hierarchy studies (randomized
controlled trials [RCTs], systematic reviews and meta-analysis of RCTs)
over the last 20 years revealed myriad other evidence-based applications.
Colchicine seems efficacious in the treatment of acute pericarditis and
prevention of recurrences and the prevention of postcardiac injury
syndrome and atrial fibrillation following cardiac surgery or percutaneous
interventions. In patients already fully treated with statins and
antiplatelet agents following acute coronary syndromes or stable coronary
disease, adding low-dose colchicine achieved secondary prevention of major
cardiovascular events (myocardial infarction, stroke, or cardiovascular
death) with pooled risk reduction 0.75. Colchicine may also be useful in
Behcet's syndrome and most recently, in improving outcomes of COVID-19
disease. Colchicine in the low doses used in most trials (<= 1 mg/d) was
generally safe and well-tolerated, excepting diarrhea (~x223C 10%) which
sometimes led to drug discontinuation. Further RCTs are required to
confirm these results, and will likely lead to expanding indications for
low-dose colchicine. Increasing numbers of patients will be treated with
colchicine in the near future, with improved health outcomes, as long as
basic caveats are heeded. Copyright © 2021

<99>
[Use Link to view the full text]
Accession Number
2015123624
Title
Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery:
A Randomized, Placebo-controlled, Double-blinded Clinical Trial.
Source
Anesthesiology. (pp 864-876), 2021. Date of Publication: 2021.
Author
Dhawan R.; Daubenspeck D.; Wroblewski K.E.; Harrison J.-H.; McCrorey M.;
Balkhy H.H.; Chaney M.A.
Institution
(Dhawan, Daubenspeck, Chaney) Department of Anesthesia and Critical Care,
University of Chicago Medicine, Chicago, IL, United States
(McCrorey, Balkhy) Department of Cardiothoracic Surgery, University of
Chicago Medicine, Chicago, IL, United States
(Wroblewski) Department of Public Health Sciences, University of Chicago,
Chicago, IL, United States
(Harrison) Department of Anesthesiology, University of Wisconsin School of
Medicine and Public Health, Madison, WI, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Intrathecal morphine decreases postoperative pain in standard
cardiac surgery. Its safety and effectiveness have not been adequately
evaluated in minimally invasive cardiac surgery. The authors hypothesized
that intrathecal morphine would decrease postoperative morphine
consumption after minimally invasive cardiac surgery. Method(s): In
this randomized, placebo-controlled, double-blinded clinical trial,
patients undergoing robotic totally endoscopic coronary artery bypass
received either intrathecal morphine (5 mcg/kg) or intrathecal saline
before surgery. The primary outcome was postoperative morphine equivalent
consumption in the first 24 h after surgery; secondary outcomes included
pain scores, side effects, and patient satisfaction. Pain was assessed via
visual analog scale at 1, 2, 6, 12, 24, and 48 h after intensive care unit
arrival. Opioid-related side effects (nausea/vomiting, pruritus, urinary
retention, respiratory depression) were assessed daily. Patient
satisfaction was evaluated with the Revised American Pain Society Outcome
Questionnaire. Result(s): Seventy-nine patients were randomized to
receive intrathecal morphine (n = 37) or intrathecal placebo (n = 42),
with 70 analyzed (morphine 33, placebo 37). Intrathecal morphine patients
required significantly less median (25th to 75th percentile) morphine
equivalents compared to placebo during first postoperative 24 h (28 [16 to
46] mg vs. 59 [41 to 79] mg; difference,-28 [95% CI,-40 to-18]; P < 0.001)
and second postoperative 24 h (0 [0 to 2] mg vs. 5 [0 to 6] mg;
difference,-3.3 [95% CI,-5 to 0]; P < 0.001), exhibited significantly
lower visual analog scale pain scores at rest and cough at all
postoperative timepoints (overall treatment effect,-4.1 [95% CI,-4.9
to-3.3] and-4.7 [95% CI,-5.5 to-3.9], respectively; P < 0.001), and
percent time in severe pain (10 [0 to 40] vs. 40 [20 to 70]; P = 0.003)
during the postoperative period. Mild nausea was more common in the
intrathecal morphine group (36% vs. 8%; P = 0.004). Conclusion(s):
When given before induction of anesthesia for totally endoscopic coronary
artery bypass, intrathecal morphine decreases use of postoperative opioids
and produces significant postoperative analgesia for 48 h. Copyright
© 2021 Lippincott Williams and Wilkins. All rights reserved.

<100>
Accession Number
2013992742
Title
Transition to heart transplantation in post-myocardial infarction
ventricular septal rupture: a systematic review.
Source
Heart Failure Reviews. (no pagination), 2021. Date of Publication: 2021.
Author
Perez-Villa B.; Cubeddu R.J.; Brozzi N.; Sleiman J.R.; Navia J.;
Hernandez-Montfort J.
Institution
(Perez-Villa, Brozzi, Sleiman, Navia, Hernandez-Montfort) Heart, Vascular
and Thoracic Institute, Cleveland Clinic Florida, Weston, FL, United
States
(Cubeddu) Naples Heart Institute, NCH Healthcare System, Naples, FL,
United States
Publisher
Springer
Abstract
Post-myocardial infarction ventricular septal rupture (MI-VSR) remains a
dreadful complication with dismal prognosis. Surgical repair is the
primary treatment strategy, whereas the role of heart transplantation (HT)
as a primary option in MI-VSR is limited to case reports (CRs). We
performed a systematic review of CRs to describe in-hospital mortality,
and survival at 6 and 12 months in adult patients with MI-VSR treated with
HT as a primary or bailout strategy. We performed a comprehensive search
of Web of Science, PubMed, and Ovid Medline. The last search was completed
on March 10, 2020. An aggregated score based on the CARE case report
guideline was used to assess the quality of the CRs. We included CRs that
described adult patients with MI-VSR treated with HT as a primary or
bailout strategy. A total of 14 CRs between 1994 and 2015 were included,
retrieving and analyzing the characteristics of 17 patients. A total of 12
patients underwent HT, with HT being the primary strategy in 8 patients
and a bailout strategy for 4 patients following initial surgical repair,
while 5 patients died awaiting HT under mechanical circulatory support
(MCS), accounting for the total in-hospital mortality of this series
(29%). Regarding long-term outcomes, 6 patients were reported to be alive
at 6 months and 1 year after HT, while information was missing in the
remaining 6 patients. In conclusion, HT supported by the use of temporary
and durable MCS as a bridge to HT could be a feasible primary or bailout
strategy to reduce the high in-hospital mortality of patients with
MI-VSR. Copyright © 2021, The Author(s), under exclusive licence
to Springer Science+Business Media, LLC, part of Springer Nature.

<101>
Accession Number
636151033
Title
What role for PCI in stable ischaemic heart disease?.
Source
Drug and Therapeutics Bulletin. 59(10) (pp 150-151), 2021. Date of
Publication: 01 Oct 2021.
Author
Kimpton J.; Khong T.K.
Institution
(Kimpton, Khong) Clinical Pharmacology, St George's University of London,
London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Commentary on: Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive
or Conservative Strategy for Stable Coronary Disease. N Engl J Med.
2020;382:1395-1407. Series co-ordinator: Dr Teck Khong, DTB Associate
Editor Clinical Pharmacology, St George's, University of London,
UK Copyright ©

<102>
Accession Number
636124116
Title
Early computed tomography coronary angiography in patients with suspected
acute coronary syndrome: Randomised controlled trial.
Source
The BMJ. 374 (no pagination), 2021. Article Number: n2106. Date of
Publication: 29 Sep 2021.
Author
Gray A.J.; Roobottom C.; Smith J.E.; Goodacre S.; Oatey K.; O'Brien R.;
Storey R.F.; Curzen N.; Keating L.; Kardos A.; Felmeden D.; Lee R.J.;
Thokala P.; Lewis S.C.; Newby D.E.
Institution
(Gray, Oatey, Lee, Lewis, Newby) University of Edinburgh, Edinburgh,
United Kingdom
(Gray, O'Brien, Newby) Royal Infirmary of Edinburgh, NHS Lothian,
Edinburgh, United Kingdom
(Roobottom, Smith) University Hospitals Plymouth NHS Trust, Plymouth,
United Kingdom
(Roobottom) University of Plymouth, Plymouth, United Kingdom
(Goodacre, Storey, Thokala) University of Sheffield, Sheffield, United
Kingdom
(Curzen) University of Southampton, Southampton, United Kingdom
(Keating) Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
(Kardos) Milton Keynes University Hospital NHS Foundation Trust, Milton
Keynes, United Kingdom
(Kardos) University of Buckingham, Buckingham, United Kingdom
(Felmeden) Torbay and South Devon NHS Foundation Trust, Torquay, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives To establish if the use of early computed tomography (CT)
coronary angiography improves one year clinical outcomes in patients
presenting to the emergency department with acute chest pain and at
intermediate risk of acute coronary syndrome and subsequent clinical
events. Design Randomised controlled trial. Setting 37 hospitals in the
UK. Participants Adults with suspected or a provisional diagnosis of acute
coronary syndrome and one or more of previous coronary heart disease,
raised levels of cardiac troponin, or abnormal electrocardiogram.
Interventions Early CT coronary angiography and standard of care compared
with standard of care only. Main outcome measures Primary endpoint was all
cause death or subsequent type 1 or 4b myocardial infarction at one year.
Results Between 23 March 2015 and 27 June 2019, 1748 participants (mean
age 62 years (standard deviation 13), 64% men, mean global registry of
acute coronary events (GRACE) score 115 (standard deviation 35)) were
randomised to receive early CT coronary angiography (n=877) or standard of
care only (n=871). Median time from randomisation to CT coronary
angiography was 4.2 (interquartile range 1.6-21.6) hours. The primary
endpoint occurred in 51 (5.8%) participants randomised to CT coronary
angiography and 53 (6.1%) participants who received standard of care only
(adjusted hazard ratio 0.91 (95% confidence interval 0.62 to 1.35),
P=0.65). Invasive coronary angiography was performed in 474 (54.0%)
participants randomised to CT coronary angiography and 530 (60.8%)
participants who received standard of care only (adjusted hazard ratio
0.81 (0.72 to 0.92), P=0.001). There were no overall differences in
coronary revascularisation, use of drug treatment for acute coronary
syndrome, or subsequent preventive treatments between the two groups.
Early CT coronary angiography was associated with a slightly longer time
in hospital (median increase 0.21 (95% confidence interval 0.05 to 0.40)
days from a median hospital stay of 2.0 to 2.2 days). Conclusions In
intermediate risk patients with acute chest pain and suspected acute
coronary syndrome, early CT coronary angiography did not alter overall
coronary therapeutic interventions or one year clinical outcomes, but
reduced rates of invasive angiography while modestly increasing length of
hospital stay. These findings do not support the routine use of early CT
coronary angiography in intermediate risk patients with acute chest pain
and suspected acute coronary syndrome. Trial registration ISRCTN19102565,
NCT02284191. Copyright ©

<103>
Accession Number
2014434414
Title
Meta-Analysis of Percutaneous Coronary Intervention of Chronic Total
Occlusions.
Source
American Journal of Cardiology. 159 (pp 148-151), 2021. Date of
Publication: 15 Nov 2021.
Author
Krittanawong C.; Virk H.H.; Mhanna M.; Wang Z.; Poommipanit P.; Jneid H.
Institution
(Krittanawong, Jneid) Michael E. DeBakey VA Medical Center, Houston, TX,
United States
(Krittanawong, Jneid) Section of Cardiology, Baylor School of Medicine,
Houston, TX, United States
(Virk, Poommipanit) Section of Cardiology, University Hospitals, Case
Western Reserve University, Cleveland, OH, United States
(Mhanna) Department of Internal Medicine, The University of Toledo,
Toledo, OH, United States
(Wang) Robert D. and Patricia E. Kern Center for the Science of Health
Care Delivery, Mayo Clinic, Rochester, MN, United States
(Wang) Division of Health Care Policy and Research, Department of Health
Sciences Research, Mayo Clinic, Rochester, MN, United States
Publisher
Elsevier Inc.

<104>
Accession Number
2014114936
Title
The effect of patient-controlled analgesia on patient satisfaction after
coronary artery bypass grafting: A clinical trial.
Source
Iranian Heart Journal. 22(4) (pp 101-111), 2021. Date of Publication:
2021.
Author
Hosseinzadeh A.; Lakdizaji S.; Zamanzadeh V.; Totonchi M.Z.
Institution
(Hosseinzadeh, Totonchi) Rajaie Cardiovascular Medical and Research
Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Lakdizaji, Zamanzadeh) Department of Nursing, Faculty of Nursing and
Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Publisher
Iranian Heart Association
Abstract
Background: Acute pain management has been a challenge for health
professionals. We designed the present study to evaluate the effectiveness
of pain control between intravenous patient-controlled analgesia (IV PCA)
and conventional nurse-controlled analgesia (NCA) after coronary artery
bypass graft (CABG) surgery concerning patient satisfaction during the
postoperative period in the intensive care unit (ICU). Method(s): In
this randomized clinical trial, 80 patients who underwent first-time
elective CABG were enrolled by the convenience sampling method and were
randomly allocated to 2 groups: PCA and NCA. PCA plus a continuous
infusion of morphine was started immediately after the transfer of the
patients to the ICU. NCA was based on the IV injections of morphine on
demand. The level of pain was assessed using a numeric rating scale, and
patient satisfaction was assessed using the pain treatment satisfaction
scale. Further, sedation levels, morphine consumption, and side effects
were evaluated from extubation until 48 hours after surgery. Additionally,
nurses' opinions regarding the PCA method were obtained. Result(s):
Numeric rating scale scores were higher in the NCA group than in the PCA
group. Morphine consumption in the PCA group was significantly higher than
that in the NCA group. Patient satisfaction was higher in the PCA group
than in the NCA group (P<0.001). PCA was safe, and there were no
differences in the incidence of serious adverse effects such as nausea and
vomiting or respiratory depression. Conclusion(s): In our patients,
PCA with a background infusion of morphine increased morphine consumption
and improved pain relief, without increasing side effects. It appears that
NCA can be recommended for patients after CABG. Copyright © 2021,
Iranian Heart Association. All rights reserved.

<105>
Accession Number
2013795145
Title
Coronary Artery Bypass Grafting Transit Time Flow Measurement: Graft
Patency and Clinical Outcomes.
Source
Annals of Thoracic Surgery. 112(3) (pp 701-707), 2021. Date of
Publication: September 2021.
Author
Quin J.A.; Noubani M.; Rove J.Y.; Krstacic J.E.; Hattler B.; Collins J.F.;
Grover F.L.; Almassi G.H.; Shroyer A.L.
Institution
(Quin) VA Boston Healthcare System, West Roxbury, MA, United States
(Quin) Harvard Medical School, Boston, MA, United States
(Noubani, Krstacic, Shroyer) Northport VA Medical Center, Northport, NY,
United States
(Noubani, Krstacic, Shroyer) Stony Brook University, Stony Brook, NY,
United States
(Rove, Hattler, Grover) Rocky Mountain Regional VA Medical Center, Aurora,
CO, United States
(Rove, Grover) Division of Cardiothoracic Surgery, Department of Surgery,
University of Colorado School of Medicine, Aurora, CO, United States
(Hattler) Division of Cardiology, Department of Medicine, University of
Colorado School of Medicine, Aurora, CO, United States
(Collins) VA Cooperative Studies Program, Perry Point, MD, United States
(Almassi) Clement J. Zablocki VA Medical Center, Milwaukee, WI, United
States
(Almassi) Medical College of Wisconsin, Milwaukee, WI, United States
Publisher
Elsevier Inc.
Abstract
Background: This subanalysis of the Randomized On-Off Bypass (ROOBY) trial
examined transit time flow measurement (TTFM) use and its impact on graft
patency and long-term clinical outcomes after coronary artery bypass graft
surgery. Method(s): Use of TTFM for ROOBY centers and surgeons was
assessed. Comparative patient outcomes based on TTFM use included 1-year
graft patency and 1-year and 5-year major adverse cardiac events:
all-cause mortality, nonfatal myocardial infarction, and revascularization
(percutaneous coronary intervention or repeat coronary artery bypass graft
surgery). Result(s): Transit time flow measurement was used in 1067
patients (TTFM group) and not used in 501 patients (non-TTFM group); of
the TTFM group, median percentage TTFM use was 79% (interquartile range,
41% to 98%) among 18 Veterans Affairs Medical Centers, and 74%
(interquartile range, 13% to 98%) among 48 surgeons. Patients were
comparable in age (63 +/- 8.5 years TTFM vs 62 +/- 8 years non-TTFM, P =
.30) and estimated 30-day mortality risk (1.8 +/- 1.7 TTFM vs 1.9
non-TTFM, P = .53). One-year FitzGibbon A patency was 83% (1600 of 1988
grafts) for TTFM assessed grafts and 78% (629 of 803) for non-TTFM
assessed grafts (P < .01). Fewer TTFM patients had an occluded graft (29%,
vs 38% non-TTFM; P = .01). Comparing TTFM patients with non-TTFM patients,
5-year major adverse cardiac event rates were 30% vs 25% (P = .06).
Individual component rates were 14% vs 11% for death (P = .06), 12% vs
8.8% for myocardial infarction (P = .07), and 13% vs 12% for
revascularization (P = .62). Conclusion(s): The association of TTFM
use with graft patency and clinical outcome is uncertain. Future
randomized studies that account for patient risk factors and practice
variation would help address this knowledge gap. Copyright © 2021
The Society of Thoracic Surgeons

<106>
Accession Number
2011518103
Title
Effects of dexmedetomidine on neurocognitive disturbance after elective
non-cardiac surgery in senile patients: a systematic review and
meta-analysis.
Source
Journal of International Medical Research. 49(5) (no pagination), 2021.
Date of Publication: 2021.
Author
Bi X.; Wei J.; Zhang X.
Institution
(Bi) Department of Anesthesiology, the Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan Province, China
(Wei) Department of Pharmacology, the Sixth People's Hospital of Chengdu,
Chengdu, Sichuan, China
(Zhang) Department of Neonatology, the Affiliated Hospital of Southwest
Medical University, Luzhou, Sichuan Province, China
Publisher
SAGE Publications Ltd
Abstract
Objective: Senile patients often experience neurocognitive disturbance
after non-cardiac surgery. Several clinical trials have investigated if
the perioperative intravenous use of dexmedetomidine has a positive effect
on the prevention of neurocognitive dysfunction, but the results have been
inconsistent. We performed a meta-analysis to investigate the effects of
dexmedetomidine on neurocognitive disturbance after elective non-cardiac
surgery in senile patients. Method(s): The PubMed, Cochrane Library,
EMBASE and China National Knowledge Infrastructure databases were
comprehensively searched for all randomized controlled trials published
before 1 February 2020 that investigated the efficacy of dexmedetomidine
in the prevention of postoperative delirium (POD) or postoperative
cognitive dysfunction (POCD). Result(s): Sixteen studies involving
4376 patients were included in this meta-analysis. Compared with the
control (i.e., saline), the perioperative intravenous use of
dexmedetomidine significantly reduced the incidence of POD and POCD.
However, patients in the dexmedetomidine group were more likely to develop
bradycardia and hypotension during the administration of dexmedetomidine
than patients in the control group. There were no differences between the
two groups in the incidence of nausea and vomiting or mortality rate.
 Conclusion(s): Dexmedetomidine has a positive effect on the
prevention of neurocognitive disturbance in senile patients after elective
non-cardiac surgery. Copyright © The Author(s) 2021.

<107>
Accession Number
2010718948
Title
Heart failure re-hospitalizations and subsequent fatal events in coronary
artery disease: insights from COMMANDER-HF, EPHESUS, and EXAMINE.
Source
Clinical Research in Cardiology. 110(10) (pp 1554-1563), 2021. Date of
Publication: October 2021.
Author
Ferreira J.P.; Cleland J.G.; Lam C.S.P.; Anker S.D.; Mehra M.R.; van
Veldhuisen D.J.; Byra W.M.; La Police D.A.; Pitt B.; Greenberg B.; Zannad
F.
Institution
(Ferreira, Zannad) Centre d'investigations Cliniques Plurithematique,
Inserm 1433, Universite de Lorraine, Institut Lorrain du Coeur et des
Vaisseaux Louis Mathieu, CHRU Nancy-Hopitaux de Brabois, 4 rue du Morvan,
Nancy, Vandoeuvre les Nancy 54500, France
(Ferreira, Zannad) CHRU de Nancy, Inserm U1116, Nancy, France
(Ferreira, Zannad) FCRIN INI-CRCT, Nancy, France
(Cleland) Robertson Centre for Biostatistics and Clinical Trials,
University of Glasgow, Glasgow, United Kingdom
(Lam) National Heart Centre Singapore, Duke-National University of
Singapore, Singapore, Singapore
(Lam, van Veldhuisen) Department of Cardiology, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Anker) Berlin-Brandenburg Center for Regenerative Therapies, Berlin,
Germany
(Anker) Department of Cardiology, German Center for Cardiovascular
Research Partner Site Berlin, Charite Universitatsmedizin Berlin, Berlin,
Germany
(Mehra) Brigham and Women's Hospital, Harvard Medical School, Boston, MA,
United States
(Byra, La Police) Janssen Research and Development, Raritan, NJ, United
States
(Pitt) Department of Medicine, University of Michigan School of Medicine,
Ann Arbor, United States
(Greenberg) Cardiology Division, Department of Medicine, University of
California, La Jolla, San Diego, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Patients with coronary artery disease (CAD) are at increased
risk of developing and being hospitalised for heart failure (HFH).
However, the risk of HFH versus ischemic events may vary among patients
with CAD, depending on whether acute myocardial infarction (MI), left
ventricular dysfunction or decompensated HF is present at baseline.
 Aim(s): We aim to explore the risk of non-fatal events (HFH, MI,
stroke) and subsequent death in 3 landmark trials, COMMANDER-HF, EPHESUS
and EXAMINE that, together, included patients with CAD with and without
reduced ejection fraction and acute MI. Method(s): Events,
person-time metrics and time-updated Cox models. Result(s): In
COMMANDER-HF the event-rate for the composite of AMI, stroke or all-cause
death was 13.5 (12.8-14.3) events/100 py. Rates for AMI and stroke were
much lower (2.2 [2.0-2.6] and 1.3 [1.1-1.6] events/100 py, respectively)
than the rate of HFH (16.9 [16.1-17.9] events/100 py). In EPHESUS, the
rates of MI and stroke were also lower than the rate of HFH: 7.2
(6.7-7.8), 1.9 (1.7-2.3), and 10.6 (9.9-11.3) events/100 py, but this was
not true for EXAMINE with 4.4 (4.0-4.9), 0.7 (0.6-0.9), and 2.4 (2.0-2.7)
events/100 py, respectively. In all 3 trials, a non-fatal event (HFH, MI
or stroke) during follow-up doubled the risk of subsequent mortality. This
most commonly followed a HFH. Conclusion(s): A first or recurrent HFH
is common in patients with CAD and AMI or HFrEF and indicates a poor
prognosis. Preventing the development of heart failure after AMI and
control of congestion in patients with CAD and HFrEF are key unmet needs
and therapeutic targets. Registration: ClinicalTrials.gov Identifier:
NCT01877915. URL:
https://clinicaltrials.gov/ct2/show/NCT01877915. Copyright ©
2021, Springer-Verlag GmbH, DE part of Springer Nature.

<108>
Accession Number
2010284454
Title
Left or bilateral internal mammary artery employment in coronary artery
bypass grafting: midterm results.
Source
Asian Cardiovascular and Thoracic Annals. 29(8) (pp 758-762), 2021. Date
of Publication: October 2021.
Author
Fomenko M.S.; Schneider Y.A.; Tsoi V.G.; Pavlov A.A.; Shilenko P.A.
Institution
(Fomenko, Schneider, Tsoi, Pavlov, Shilenko) Federal State Budgetary
Institution, Federal Centers of High Medical Technologies, Health
Ministry, Kaliningrad, Russian Federation
Publisher
SAGE Publications Inc.
Abstract
Background: The gold standard for coronary artery bypass grafting to the
left anterior descending artery is use of the left internal mammary
artery. Better long-term survival has been reported using bilateral
internal mammary arteries compared to left internal mammary artery only,
but many surgeons are reluctant to employ bilateral internal mammary
arteries in coronary artery bypass grafting. This study aimed to evaluate
the effectiveness and safety of bilateral internal mammary artery use.
 Method(s): From 2014 to 2017, 1703 patients underwent coronary artery
bypass grafting in our institute. Of these, 772 met the inclusion criteria
and were randomly assigned to receive bilateral (n = 387) or left (n =
385) internal mammary artery grafts. The mean age was 67.1 +/- 6.0 years
(range 48-85 years) and 474 (61.4%) were male. The mean number of diseased
vessels was 3.1 +/- 0.9, and mean EuroSCORE II was 3.4% +/- 1.1%.
 Result(s): Hospital mortality was 1.2% in the left internal mammary
artery group vs. 1.8% in the bilateral internal mammary artery group (p =
0.55). There was no difference in procedure-related complications between
groups. Mean follow-up was 65.9 months. Survival in the bilateral internal
mammary artery group at 1, 3, and 5 years was 98.7%, 98.7%, and 94.8% vs.
98.1%, 98.1%, and 90.9%, respectively, in the left internal mammary artery
group (p = 0.63). Conclusion(s): Application of bilateral internal
mammary arteries in coronary artery bypass grafting is safe and effective,
with comparable midterm results to those with the left internal mammary
artery only. Copyright © The Author(s) 2021.

<109>
Accession Number
636009220
Title
Ross for Valve replacement in AduLts (REVIVAL) pilot trial: Rationale and
design of a randomised controlled trial.
Source
BMJ Open. 11(9) (no pagination), 2021. Article Number: e046198. Date of
Publication: 16 Sep 2021.
Author
Whitlock R.; Belley-Cote E.; Rega F.; Chu M.W.A.; Mcclure G.R.; Hronyecz
H.; Verbrugghe P.; Devereaux P.J.; Bangdiwala S.; Eikelboom J.; Brady K.;
Sharifulin R.; Bogachev-Prokophiev A.; Stoica S.
Institution
(Whitlock, Mcclure) Department of Surgery, McMaster University, Faculty of
Health Sciences, Hamilton, ON, Canada
(Belley-Cote, Devereaux, Eikelboom) Department of Medicine, McMaster
University, Faculty of Health Sciences, Hamilton, ON, Canada
(Rega, Verbrugghe) Department of Cardiac Surgery, KU Leuven University,
Hospitals Leuven, Leuven, Belgium
(Chu) Cardiac Surgery, University of Western, Ontario Faculty of Health
Sciences, London, ON, Canada
(Hronyecz) McMaster University, Hamilton, ON, Canada
(Bangdiwala, Brady) Population Health Research Institute, Hamilton, ON,
Canada
(Sharifulin, Bogachev-Prokophiev) FSBI National Medical Research Center
named after E N Meshalkin, Novosibirskaa, Novosibirsk, Russian Federation
(Stoica) Cardiac Surgery, Bristol Royal Hospital for Children, Bristol,
United Kingdom
Publisher
BMJ Publishing Group
Abstract
Introduction In non-elderly adults, aortic valve replacement (AVR) with
conventional prostheses yield poor long-term outcomes. Recent publications
suggest a benefit of the Ross procedure over conventional AVR and
highlight the need for high-quality randomised controlled trial (RCTs) on
the optimal AVR. We have initiated a pilot trial assess two feasibility
criteria and one assumption: (1) evaluate the capacity to enrol six
patients per centre per year in at least five international centre, (2)
validate greater than 90% compliance with allocation and (3) to validate
the proportion of mechanical (>=65%) vs biological (<=35%) valves in the
conventional arm. Methods and analysis Ross for Valve replacement In
AduLts (REVIVAL) is a multinational, expertise-based RCT in adults aged
18-60 years undergoing AVR, comparing the Ross procedure versus one of the
alternative approaches (mechanical vs stented or stentless bioprosthesis).
The feasibility objectives will be assessed after randomising 60 patients;
we will then make a decision regarding whether to expand the trial with
the current protocol. We will ultimately examine the impact of the Ross
procedure as compared with conventional AVR in non-elderly adults on
survival free of valve-related life-threatening complications (major
bleeding, systemic thromboembolism, valve thrombosis and valve
reoperation) over the duration of follow-up. The objectives of the pilot
trial will be analysed using descriptive statistics. In the full trial,
the intention-to-treat principle will guide all primary analyses. A
time-to-event analysis will be performed and Kaplan-Meier survival curves
with comparison between groups using a log rank test will be presented.
Ethics and dissemination REVIVAL will answer whether non-elderly adults
benefit from the Ross procedure over conventional valve replacement. The
final results at major meetings, journals, regional seminars, hospital
rounds and via the Reducing Global Perioperative Risk Multimedia Resource
Centre. Trial registration number ClinicalTrials.gov Identifier:
NCT03798782 Protocol version January 29, 2019 (Final Version
1.0) Copyright ©

<110>
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.

<111>
Accession Number
635396863
Title
Efficacy and Safety of Antifibrinolytic Drugs in Pediatric Surgery: A
Systematic Review.
Source
Seminars in Thrombosis and Hemostasis. 47(5) (pp 538-568), 2021. Date of
Publication: 01 Jul 2021.
Author
Hovgesen N.T.; Larsen J.B.; Fenger-Eriksen C.; Hansen A.K.; Hvas A.-M.
Institution
(Hovgesen, Larsen, Hvas) Thrombosis and Hemostasis Research Unit,
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus,
Denmark
(Fenger-Eriksen) Department of Anesthesiology, Aarhus University Hospital,
Aarhus, Denmark
(Hansen) Neonatal Intensive Care Unit, Department of Pediatrics and
Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
(Hvas) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Publisher
Thieme Medical Publishers, Inc.
Abstract
Antifibrinolytic drugs are used to reduce blood loss and subsequent
transfusions during surgery and following trauma, but the optimal dosing
regimen in the pediatric population is still unresolved. The aim of this
systematic review was to evaluate efficacy and safety of antifibrinolytic
drugs in pediatric surgery and trauma to determine the optimal dosing
regimen. A literature search was performed in PubMed, Embase, Cochrane,
and Web of Science on May 3, 2020. We included randomized controlled
studies investigating the effect of tranexamic acid (TXA), aprotinin, and
epsilon-aminocaproic acid, in terms of reducing blood loss, blood
transfusions, reoperations, and rebleeds in pediatric patients aged 0 to
18 years undergoing cardiac surgery, noncardiac surgery, or trauma. Fifty
randomized controlled trials (RCTs) were included; 28 RCTs investigated
cardiac surgery and 22 investigated noncardiac surgery. No RCTs regarding
trauma met the inclusion criteria. All antifibrinolytic drugs reduced
postoperative blood loss and transfusions when used in pediatric surgery.
The dosing regimen varied between studies, but similar effect sizes were
found in terms of reduced blood loss regardless of the cumulative dose
used. Few studies found adverse events, and no difference in incidence or
type of adverse events was seen between the antifibrinolytic and the
placebo group. In conclusion, use of antifibrinolytics is efficient and
safe in children undergoing surgery. We propose TXA as the drug of choice
based on its level of evidence and safety profile; we recommend a dosing
regimen composed of a loading dose of 10 to 15 mg/kg prior to surgery
followed by 1 to 5 mg/kg/h as continuous infusion throughout
surgery. Copyright © 2021 SPIE. All rights reserved.

<112>
Accession Number
2014887428
Title
The Effect of Pulmonary Rehabilitation on Respiratory Functions, and the
Quality of Life, following Coronary Artery Bypass Grafting: A Randomised
Controlled Study.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
6811373. Date of Publication: 2021.
Author
Girgin Z.; Cigerci Y.; Yaman F.
Institution
(Girgin) Health Care Service, Afyonkarahisar State Hospital,
Afyonkarahisar 03200, Turkey
(Cigerci) Department of Nursing, Faculty of Health Science, Afyonkarahisar
Health Science University, Afyonkarahisar 03200, Turkey
(Yaman) Department of Physical Medicine and Rehabilitation, Faculty of
Medicine, Kutahya Health Science University, Kutahya 43100, Turkey
Publisher
Hindawi Limited
Abstract
Objective. Examining the effects of a pulmonary rehabilitation (PR)
program applied to patients undergoing coronary artery bypass grafting
(CABG) surgery with open heart technique on respiratory functions,
functional capacity, and quality of life (QoL). Design. This randomised
controlled study applied the Consolidated Standards of Reporting Trials
statement. Methods. The study was conducted with two groups: the
intervention group (n=25) and the control group (n=25). The control group
received standard care after coronary artery bypass grafting. On the
contrary, the experimental group participated in a PR program created by
the researchers in addition to standard care. After coronary artery bypass
grafting, the respiratory functions (on the 4th day of clinical care) and
QoL (at the 6th week) of both groups were evaluated. The primary outcome
measure was the respiratory function (forced expiratory volume in one
second (FEV1), forced vital capacity (FVC), and FEV1/FVC). The secondary
outcome measure of this study was the QoL. Results. When the average
pulmonary function test values of the patients were examined, the mean FVC
and FEV1 values of the patients in the intervention group on the 4th day
of clinical care were significantly higher with a medium level size effect
than the control group (p=0.027; effect size d=0.643; p<0.024; effect size
d=0.658, respectively). At the postoperative 6th week measurement of QoL,
a decrease was observed in all subdimensions of the scale, albeit less in
the intervention group (p<0.05). There was a decrease in both the mental
and physical component summary of QoL (p<0.05). Conclusion. The results of
this study revealed that pulmonary rehabilitation applied to patients who
have undergone coronary artery bypass graft recover their functional
capacity faster. Copyright © 2021 Zumrut Girgin et al.

<113>
Accession Number
2013831529
Title
The impact of del Nido cardioplegia solution on blood morphology
parameters.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Sanetra K.; Domaradzki W.; Cisowski M.; Shrestha R.; Bialek K.; Bochenek
A.; Jankowska-Sanetra J.; Pawel Buszman P.; Gerber W.
Institution
(Sanetra, Pawel Buszman) Faculty of Medicine and Health Sciences, Andrzej
Frycz Modrzewski Krakow University, Krakow, Poland
(Sanetra, Domaradzki, Shrestha, Bialek, Bochenek, Gerber) Department of
Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland
(Cisowski) Department of Cardiac Surgery, Clinical University Hospital,
Opole, Poland
(Bochenek) Faculty of Medicine, University of Technology, Katowice, Poland
(Bochenek, Pawel Buszman) Center for Cardiovascular Research and
Development, American Heart of Poland, Katowice, Poland
(Jankowska-Sanetra, Pawel Buszman) Department of Cardiology, American
Heart of Poland, Bielsko-Biala, Poland
Publisher
SAGE Publications Ltd
Abstract
Background: Crystalloid cardioplegic solutions are believed to reduce
hemoglobin significantly and increase the transfusion rate. However,
recent reports indicate that the del Nido cardioplegia may preserve blood
morphology parameters. Method(s): In "The del Nido versus cold blood
cardioplegia in aortic valve Replacement" trial patients undergoing aortic
valve replacement were randomized into the del Nido (DN) or cold blood
cardioplegia (CB) group. For the subanalysis, patients who underwent blood
transfusions were excluded from the study. Red blood cell (RBC) count,
hemoglobin, white blood cell (WBC) count and platelet (PLT) count were
measured before the surgery, 24-, 48-, and 96 hours postoperatively.
Furthermore, percental variation in first-last measure was compared in
groups. In addition, indexed normalized ratio (INR) and activated partial
thromboplastin time (aPTT) were compared preoperatively and 24 hours after
the surgery. Result(s): Eighteen (24%) patients from the del Nido
group and 22 (29.3%) patients from the CB group received blood product
transfusions (p = 0.560) and were excluded from further analysis. As such,
57 patients remained in DN group and 53 patients remained in CB group. No
difference was found in RBC, hemoglobin, WBC, and platelet count in time
intervals. Percental variation in first-last measure revealed higher fall
in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No
difference was shown in preoperative and 24-hour postoperative INR and
aPTT. Conclusion(s): The del Nido cardioplegia does not decrease
blood morphology parameters when compared to cold blood cardioplegia and
may be used alternatively regardless of bleeding and coagulopathy
risk. Copyright © The Author(s) 2021.

<114>
Accession Number
633048120
Title
Wound Infection after CABG Using Internal Mammary Artery Grafts: A
Meta-Analysis.
Source
Thoracic and Cardiovascular Surgeon. 69(7) (pp 639-648), 2021. Date of
Publication: 01 Oct 2021.
Author
Oswald I.; Boening A.; Pons-Kuehnemann J.; Grieshaber P.
Institution
(Oswald, Boening, Grieshaber) Department of Adult and Pediatric
Cardiovascular Surgery, Justus Liebig University Giessen,
Rudolf-Buchheim-Strabetae 7, Giessen 35392, Germany
(Pons-Kuehnemann) Institute of Medical Informatics, Department of Medical
Statistics, Justus Liebig University Giessen, Giessen, Germany
Publisher
Georg Thieme Verlag
Abstract
Background Internal mammary arteries show better long-term patency rates
than venous grafts. The use of both mammary arteries is associated with a
higher risk of sternal wound infections. This meta-analysis was designed
to assess the incidence of a wound healing disorder after bilateral
compared with single mammary artery bypass grafting. Compared with
existing meta-analysis this paper includes more current literature and one
randomized controlled trial. Methods A literature search was performed
using PubMed and the Cochrane Library. The quality of the articles was
assessed by the Newcastle Ottawa Scale. The odds ratio was used as a
measure of the chance of developing a wound healing disorder after
bilateral internal mammary artery (BIMA) surgery. Meta-analyses were
performed for different subgroups. Results Twenty studies met the quality
criteria, including one randomized controlled trial. The use of both
mammary arteries significantly increased the risk of superficial (odds
ratio [OR] 1.72) and deep (OR 1.75) wound healing disorder in the total
population (OR 1.80) as well as in the diabetic subgroup (OR 1.38) and
with both preparation techniques. The increased risk with BIMA grafting
was present independently of the preparation technique (pedicled: OR 1.89,
skeletonized: OR 1.37). Conclusion Bilateral internal mammary artery
grafting, especially in high-risk and diabetic patients, is associated
with an increased risk of wound healing impairment. Skeletonized
preparation does not eliminate the elevated wound healing disorder risk
after BIMA use. Copyright © 2021 Georg Thieme Verlag. All rights
reserved.

<115>
Accession Number
2013803367
Title
A pilot randomized clinical trial of cryopreserved versus liquid-stored
platelet transfusion for bleeding in cardiac surgery: The cryopreserved
versus liquid platelet-New Zealand pilot trial.
Source
Vox Sanguinis. (no pagination), 2021. Date of Publication: 2021.
Author
McGuinness S.; Charlewood R.; Gilder E.; Parke R.; Hayes K.; Morley S.;
Al-Ibousi A.; Deans R.; Howe B.; Johnson L.; Marks D.C.; Reade M.C.
Institution
(McGuinness, Gilder, Parke) Cardiothoracic and Vascular Intensive Care
Unit, Auckland City Hospital, Auckland, New Zealand
(McGuinness, Parke) Medical Research Institute of New Zealand, Wellington,
New Zealand
(McGuinness, Parke, Howe, Reade) Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Charlewood, Morley, Al-Ibousi) New Zealand Blood Service, Auckland, New
Zealand
(Gilder, Parke) School of Nursing, The University of Auckland, Auckland,
New Zealand
(Hayes) Greenlane Department of Cardiothoracic Anaesthesia, Auckland City
Hospital, Auckland, New Zealand
(Deans, Reade) Faculty of Medicine, University of Queensland, Royal
Brisbane and Women's Hospital, Herston, QLD, Australia
(Johnson, Marks) Australian Red Cross Lifeblood, Alexandria, NSW,
Australia
(Reade) Joint Health Command, Australian Defence Force, Canberra, ACT,
Australia
Publisher
John Wiley and Sons Inc
Abstract
Background and Objectives: Platelets for transfusion have a shelf-life of
7 days, limiting availability and leading to wastage. Cryopreservation at
-80degreeC extends shelf-life to at least 1 year, but safety and
effectiveness are uncertain. Material(s) and Method(s): This single
centre blinded pilot trial enrolled adult cardiac surgery patients who
were at high risk of platelet transfusion. If treating clinicians
determined platelet transfusion was required, up to three units of either
cryopreserved or liquid-stored platelets intraoperatively or during
intensive care unit admission were administered. The primary outcome was
protocol safety and feasibility. Result(s): Over 13 months, 89
patients were randomized, 23 (25.8%) of whom received a platelet
transfusion. There were no differences in median blood loss up to 48 h
between study groups, or in the quantities of study platelets or other
blood components transfused. The median platelet concentration on the day
after surgery was lower in the cryopreserved platelet group (122 x
103/mul vs. 157 x 103/mul, median difference 39.5
x103/mul, p = 0.03). There were no differences in any of the
recorded safety outcomes, and no adverse events were reported on any
patient. Multivariable adjustment for imbalances in baseline patient
characteristics did not find study group to be a predictor of 24-h blood
loss, red cell transfusion or a composite bleeding outcome.
 Conclusion(s): This pilot randomized controlled trial demonstrated
the feasibility of the protocol and adds to accumulating data supporting
the safety of this intervention. Given the clear advantage of prolonged
shelf-life, particularly for regional hospitals in New Zealand, a
definitive non-inferiority phase III trial is warranted. Copyright
© 2021 International Society of Blood Transfusion.

<116>
Accession Number
2013802934
Title
Bioprosthetic valve fracture for valve-in-valve transcatheter aortic valve
implantation in patients with structural valve degeneration: Systematic
review with meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Michel Pompeu S.; Rayol S.C.; Van den Eynde J.; Cavalcanti L.R.P.; Escorel
Neto A.C.; Perazzo A.M.; Weymann A.; Ruhparwar A.; Torregrossa G.; Sicouri
S.; Ramlawi B.
Institution
(Michel Pompeu, Torregrossa, Ramlawi) Department of Cardiothoracic
Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line
Health, Wynnewood, PA, United States
(Michel Pompeu, Torregrossa, Sicouri, Ramlawi) Department of
Cardiothoracic Surgery Research, Lankenau Institute for Medical Research,
Wynnewood, PA, United States
(Rayol, Cavalcanti, Escorel Neto, Perazzo) Division of Cardiovascular
Surgery, Pronto Socorro Cardiologico de Pernambuco (PROCAPE), Recife,
Brazil
(Rayol, Cavalcanti, Escorel Neto, Perazzo) University of Pernambuco (UPE),
Recife, Brazil
(Rayol) Nucleus of Postgraduate and Research in Health Sciences of Faculty
of Medical Sciences and Biological Sciences Institute (FCM/ICB), Recife,
Brazil
(Van den Eynde) Department of Cardiovascular Diseases, Unit of Cardiac
Surgery, University Hospitals Leuven, Leuven, Belgium
(Weymann, Ruhparwar) Department of Thoracic and Cardiovascular Surgery,
West German Heart and Vascular Center Essen, University Hospital of Essen,
University Duisburg-Essen, Essen, Germany
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To determine the outcomes of bioprosthetic valve fracture
(BVF) in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI)
for patients with structural valve degeneration (SVD) of bioprosthetic
surgical valves (BSV) implanted during surgical aortic valve replacement
(SAVR). Method(s): A systematic review was conducted including
studies published by May 2021. The primary endpoints of the study were
30-day mortality, annular rupture, stroke, paravalvular leak, pacemaker
implantation, and coronary obstruction. The secondary endpoints were mean
valve gradients (mmHg) and aortic valve area (AVA-cm2). A
meta-analysis was conducted using the software R, version 3.6.3 (R
Foundation for Statistical Computing). Result(s): Four studies
including 242 patients met our eligibility criteria. The overall
proportions for 30-day mortality, annular rupture, stroke, paravalvular
leak, pacemaker implantation and coronary obstruction were 2.1%, <1.0%,
<1.5%, <1.0%, <1.0%, and <1.5%, respectively. After ViV-TAVI with BVF, the
difference in means for mean valve gradients showed a significant
reduction (random-effects model: -26.7; -28.8 to -24.7; p <.001), whereas
the difference in means for AVA showed a significant increase
(random-effects model: 0.55 cm2; 0.13-0.97; p =.029). Despite
the improvement in AVA means, these remain too low after the procedure
highly likely due to the small size of the bioprosthetic valves implanted
during the index SAVR. Conclusion(s): ViV-TAVI with BVF has proven to
be a promising option but data are still too scarce to enable us to draw
definitive conclusions. Despite the decrease in gradients, postprocedural
AVA remains worrisome. Studies with better designs and larger sample sizes
are needed to advance this treatment option. Copyright © 2021
Wiley Periodicals LLC.

<117>
Accession Number
2013800704
Title
The use of point-of-care testing in detecting platelet function recovery
in a patient treated with prasugrel undergoing urgent surgical
revascularization.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Verzelloni Sef A.; Caliandro F.; Sef D.; Raja S.G.
Institution
(Verzelloni Sef, Caliandro) Department of Anesthesia and Critical Care,
Royal Brompton & Harefield Hospitals, Harefield Hospital, London, United
Kingdom
(Sef, Raja) Department of Cardiac Surgery, Royal Brompton & Harefield
Hospitals, Harefield Hospital, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
A recent administration of potent P2Y<inf>12</inf> receptor inhibitor such
as prasugrel in patients undergoing cardiac surgery remains a dilemma and
little is known about its impact on platelet function recovery. Guidelines
recommend discontinuation of prasugrel 7 days before surgery to reduce the
risk of surgery-related bleeding. Patients at risk may benefit from
preoperative platelet function testing to guide individualized
preoperative waiting time. We present a rare case of complete function
recovery in a patient treated with prasugrel revealed by preoperative
platelet function monitoring before urgent coronary artery bypass surgery
(CABG). A complete platelet function recovery was revealed by platelet
function testing after discontinuation of prasugrel for four days and
patient underwent urgent CABG without increased risk of postoperative
bleeding. Our case with a review of literature emphasized that the
decision to proceed with urgent CABG in a patient recently treated with
prasugrel should be based on a personalized risk assessment and might be
supported by preoperative platelet function monitoring to shorten the
waiting time. Copyright © 2021 Wiley Periodicals LLC

<118>
Accession Number
2013137603
Title
Aortic valve myxoma-A systematic review of published cases.
Source
International Journal of Clinical Practice. 75(11) (no pagination), 2021.
Article Number: e14566. Date of Publication: November 2021.
Author
Sachdeva S.; Desai R.; Shamim S.; Gandhi Z.; Shrivastava A.; Patel D.;
Uzair Lodhi M.; Raina J.; Itare V.; Mahmood A.; Sachdeva R.; Kumar G.
Institution
(Sachdeva) Section of Cardiovascular Medicine, Department of Medicine,
Boston University School of Medicine, MA, United States
(Desai, Sachdeva, Kumar) Division of Cardiology, Atlanta VA Medical
Center, Decatur, GA, United States
(Shamim) Internal Medicine, AIM Medical Center, Snellville, GA, United
States
(Gandhi) Department of Medicine, C.U. Shah Medical College, Surendranagar,
Gujarat, India
(Shrivastava) Department of Pediatrics, Children's Hospital of
Michigan/Detroit Medical Center, Detroit, MI, United States
(Patel) Department of Internal Medicine, Texas Tech University Health
Sciences Center El Paso, El Paso, TX, United States
(Uzair Lodhi, Mahmood) Department of Internal Medicine, Eastern Idaho
Regional Medical Center, Idaho Falls, ID, United States
(Raina, Itare) Department of Internal Medicine, Brookdale University
Hospital and Medical Center, New York, NY, United States
(Kumar) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Aortic valve myxoma is the rarest location of the most common
primary tumour of cardiac origin. Because of the paucity of data, there is
little known about their clinical presentation, diagnosis and
complications. Method(s): PUBMED, EMBASE, SCOPUS and WEB OF SCIENCE
were systematically searched to identify all published cases of aortic
valve myxoma through October 2020. Descriptive statistics were used to
report the data. Result(s): Aortic valve myxomas were more prevalent
in young (mean age 41 years) male (75%) patients. It most commonly
involved the right coronary cusp (50%). Cerebrovascular events (25%),
dyspnoea (18.8%), and distal embolisation (18.8%) were found to be the
most frequent complications. Echocardiography remains the diagnostic
modality of choice in all cases, histopathology is used for confirmation.
Most cases were treated with surgical excision (94%); concomitant aortic
valve repair and mechanical aortic valve replacement were performed in 25%
and 37.5% cases respectively. Sudden cardiac death was noted in one
patient. Conclusion(s): Aortic valve myxomas are more often than not
discovered in the context of embolic phenomenon or dyspnoea. The most
feared complication is stroke, although mortality remains low in
surgically managed cases. Copyright © 2021 John Wiley & Sons Ltd

<119>
Accession Number
2013110474
Title
Effect of strict intraoperative blood pressure management strategy on
postoperative acute kidney injury in non-cardiac surgery: A meta-analysis
of randomised controlled trials.
Source
International Journal of Clinical Practice. 75(11) (no pagination), 2021.
Article Number: e14570. Date of Publication: November 2021.
Author
Tu M.-Y.; Hong S.; Lu J.; Liu Y.-H.; Deng M.
Institution
(Tu, Hong, Liu, Deng) Department of Anesthesiology, Huashan Hospital of
Fudan University, Shanghai, China
(Lu) Department of Anesthesiology, Huashan Hospital North Affiliated to
Fudan University, Shanghai, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Acute kidney injury (AKI) is one of the most serious
perioperative complications. 20% to 40% of high-risk patients who undergo
non-cardiac surgery have AKI and those with AKI are eight-times more
likely to die within 30 days after surgery. It may be related to
intraoperative hypotension, which is mainly caused by vasodilatory and
cardiodepressant effects of anaesthesia, and/or hypovolemia. Strict
intraoperative blood pressure management strategy (strict BP management)
is a potential option to prevent postoperative AKI. This strategy refers
to additional administration of vasoactive agents under the premise of a
protocolised fluid delivery. The efficacy of strict BP management for
preventing postoperative AKI in non-cardiac surgery patients was assessed
by a meta-analysis. Method(s): We systematically retrieved randomised
controlled trials (RCTs) and compared strict BP management with
conventional therapy control on effect of postoperative AKI in non-cardiac
surgery patients, which were published on PubMed, EMBASE, Cochrane library
and Web of Science databases before October 5, 2020. Ultimately, a
meta-analysis of all RCTs eligible for inclusion criteria was performed.
 Result(s): Five RCTs, comprising 1485 patients, were included in the
meta-analysis. Strict BP management was associated with a reduced
incidence of postoperative AKI [relative risk (RR) = 0.73, 95% confidence
interval (CI): 0.58-0.92, P =.007]. No significant difference was found
between strict BP management group and conventional therapy control in
mortality at longest follow-up available (RR = 0.92, 95% CI: 0.68-1.25, P
=.60). In the subset analysis, the studies using supranormal BP management
target was significantly lower in the incidence of postoperative AKI (RR =
0.65, 95% CI: 0.51-0.82, P =.0003). Conclusion(s): Strict BP
management is significantly more effective than conventional therapy for
the prevention of postoperative AKI. Supranormal target of intraoperative
BP management may be considered a more appealing option for the prevention
of AKI. Copyright © 2021 John Wiley & Sons Ltd

<120>
[Use Link to view the full text]
Accession Number
635558072
Title
Pharmacological Agents That Prevent Postoperative Cognitive Dysfunction in
Patients With General Anesthesia: A Network Meta-analysis.
Source
American journal of therapeutics. 28(4) (pp e420-e433), 2020. Date of
Publication: 01 Oct 2020.
Author
Li M.; Yang Y.; Ma Y.; Wang Q.
Institution
(Li) Institute of Urology, Chinese Medicine Hospital of Linyi, Linyi City,
China
(Yang) Department of Anesthesiology, Women and Children's Health Care
Hospital of Linyi, Linyi City, China
(Ma) The Evidence Based Medicine Center, Lanzhou University, Lanzhou City,
China; and
(Wang) Department of Health Research Methods, Evidence, McMaster
University, and Impact, Hamilton, Canada
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative cognitive dysfunction (POCD) is associated with
prolonged hospital stays, increased mortality, and negative socioeconomic
consequences. Dexmedetomidine, ketamine, dexamethasone, and lidocaine have
previously been reported to be effective for preventing POCD. STUDY
QUESTION: In this network meta-analysis, we apply direct and indirect
comparisons to rank these pharmacological agents in terms of their effect
on POCD, through which we seek to provide evidence for future clinical
medication. DATA SOURCES: A comprehensive literature search of PubMed,
EMBASE, the Cochrane Library, and Web of Science was conducted to identify
randomized controlled trials that examined the effects of dexmedetomidine,
ketamine, dexamethasone, or lidocaine on POCD induced by general
anesthesia. STUDY DESIGN: For eligible studies, 2 reviewers independently
extracted data and assessed the respective risk of bias. Bayesian network
meta-analysis was conducted using R-3.4.1 software. A total of 30 articles
were included in this meta-analysis. RESULT(S): Direct comparison
showed that dexmedetomidine [odds ratio (OR) = 0.42, 95% confidence
interval (CI): 0.32-0.55] may decrease the incidence of POCD for
noncardiac surgery; dexmedetomidine (OR = 0.08, 95% CI: 0.01-0.63) and
ketamine (OR = 0.09, 95% CI: 0.02-0.32) were found to decrease POCD for
cardiac surgery. The R-software ranking result for prevention of POCD was
dexmedetomidine, lidocaine, ketamine, placebo, and dexamethasone,
respectively, in noncardiac surgery, and dexmedetomidine, ketamine,
lidocaine, placebo, and dexamethasone in cardiac surgery.
 CONCLUSION(S): Dexmedetomidine exhibited obvious superiority to other
agents for noncardiac surgery; dexmedetomidine and ketamine exhibited a
significantly better performance than other agents for cardiac surgery.
Dexamethasone did not show better efficacy than the placebo. However, more
rigorously designed studies comprising larger sample sizes are needed to
confirm our findings. Copyright © 2020 Wolters Kluwer Health,
Inc. All rights reserved.

<121>
[Use Link to view the full text]
Accession Number
632743767
Title
Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft
Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular
CABG): A Randomized, Double-Blind, Placebo-Controlled Trial.
Source
Circulation. 142(19) (pp 1799-1807), 2020. Date of Publication: 10 Nov
2020.
Author
Willemsen L.M.; Janssen P.W.A.; Peper J.; Soliman-Hamad M.A.; van Straten
A.H.M.; Klein P.; Hackeng C.M.; Sonker U.; Bekker M.W.A.; von Birgelen C.;
Brouwer M.A.; van der Harst P.; Vlot E.A.; Deneer V.H.M.; Chan Pin Yin
D.R.P.P.; Gimbel M.E.; Beukema K.F.; Daeter E.J.; Kelder J.C.; Tijssen
J.G.P.; Rensing B.J.W.M.; van Es H.W.; Swaans M.J.; Ten Berg J.M.
Institution
(Willemsen, Janssen, Peper, Chan Pin Yin, Gimbel, Beukema, Kelder,
Rensing, Swaans, Ten Berg) Department of Cardiology (L.M.W., St Antonius
Hospital, Nieuwegein, Netherlands
(Peper) Department of Radiology (J.P.), University Medical Center Utrecht,
Utrecht, Netherlands
(Soliman-Hamad, van Straten) Department of Cardiothoracic Surgery,
Catharina Hospital, Eindhoven, Netherlands
(Klein, Sonker, Daeter) Department of Cardiothoracic Surgery (P.K., St
Antonius Hospital, Nieuwegein, Netherlands
(Hackeng) Department of Clinical Chemistry (C.M.H.), St Antonius Hospital,
Nieuwegein, Netherlands
(Bekker) Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam,
Netherlands
(von Birgelen) Department of Cardiology, Thoraxcentrum Twente, Medisch
Spectrum Twente, Enschede, Netherlands
(von Birgelen) Health Technology and Services Research, University of
Twente, Enschede, Netherlands
(Brouwer) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(van der Harst) Department of Cardiology (P.v.d.H.), University Medical
Center Utrecht, Utrecht, Netherlands
(van der Harst) Department of Cardiology, University Medical Center
Groningen
(Vlot) Department of Anesthesiology, Intensive Care, Pain Medicine
(E.A.V.), St Antonius Hospital, Nieuwegein, Netherlands
(Deneer) Department of Clinical Pharmacy, Division of Laboratories,
Pharmacy, Biomedical Genetics (V.H.M.D.), University Medical Center
Utrecht, Utrecht, Netherlands
(Deneer) Division of Pharmacoepidemiology and Clinical Pharmacology,
Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht,
Netherlands
(Tijssen) Department of Cardiology, Amsterdam University Medical Centers
(Tijssen) Cardialysis B.V. Rotterdam, The Netherlands (J.G.P.T.)
(van Es) Department of Radiology (H.W.v.E.), St Antonius Hospital,
Nieuwegein, Netherlands
(Ten Berg) Cardiovascular Research Institute Maastricht, Maastricht,
Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Approximately 15% of saphenous vein grafts (SVGs) occlude
during the first year after coronary artery bypass graft surgery (CABG)
despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on
Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass
Grafting Surgery) investigated whether ticagrelor added to standard
aspirin improves SVG patency at 1 year after CABG. METHOD(S): In this
investigator-initiated, randomized, double-blind, placebo-controlled,
multicenter trial, patients with >=1 SVGs were randomly assigned (1:1)
after CABG to ticagrelor or placebo added to standard aspirin (80 mg or
100 mg). The primary outcome was SVG occlusion at 1 year, assessed with
coronary computed tomography angiography, in all patients that had primary
outcome imaging available. A generalized estimating equation model was
used to perform the primary analysis per SVG. The secondary outcome was
1-year SVG failure, which was a composite of SVG occlusion, SVG
revascularization, myocardial infarction in myocardial territory supplied
by a SVG, or sudden death. RESULT(S): Among 499 randomly assigned
patients, the mean age was 67.9+/-8.3 years, 87.1% were male, the
indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of
procedures used cardiopulmonary bypass. Primary outcome imaging was
available in 220 patients in the ticagrelor group and 223 patients in the
placebo group. The SVG occlusion rate in the ticagrelor group was 10.5%
(51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds
ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35
(14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the
placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]). CONCLUSION(S):
In this randomized, placebo-controlled trial, the addition of ticagrelor
to standard aspirin did not reduce SVG occlusion at 1 year after CABG.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02352402.

<122>
Accession Number
2015169535
Title
OA04.01 Move For Surgery - A Novel Preconditioning Program to Optimize
Health Before Thoracic Surgery: A Randomized Controlled Trial.
Source
Journal of Thoracic Oncology. Conference: 2021 World Conference on Lung
Cancer Worldwide Virtual Event. Virtual, Online. 16(10 Supplement) (pp
S852-S853), 2021. Date of Publication: October 2021.
Author
Patel Y.S.; Churchill I.F.; Sullivan K.A.; Beauchamp M.; Wald J.; Mbuagbaw
L.; Agzarian J.; Shargall Y.; Finley C.J.; Fahim C.; Hanna W.C.
Institution
(Patel, Churchill, Sullivan, Beauchamp, Wald, Mbuagbaw, Agzarian,
Shargall, Finley, Fahim, Hanna) Mcmaster University / St. Joseph'S
Healthcare Hamilton, Hamilton, ON, Canada
Publisher
Elsevier Inc.
Abstract
Introduction: Preconditioning before surgery can lower complication rates
post-surgery, and hence shorten the length of stay (LOS) in hospital.
However, there are significant barriers to the adoption of preconditioning
in the lung cancer population, which is characteristically older, suffers
multiple comorbidities, and is averse to exercise. In an effort to
overcome these barriers, we designed Move For Surgery (MFS), a home-based,
3-4 week preoperative preconditioning program intervention for thoracic
surgery patients which involves aerobic exercise using wearable technology
and deep breathing exercises, and compared it to the usual preoperative
standard of care (Control) through a prospective randomized controlled
trial. Method(s): Patients undergoing resection for early-stage NSCLC
were preoperatively enrolled and randomized to either MFS or Control in a
1:1 allocation ratio. Those in MFS were provided with a wearable activity
tracker and a booklet describing various aerobic and deep breathing
exercises, and nutritional and smoking cessation tips and underwent the
intervention, whereas those in the Control underwent usual preoperative
care. The daily step count, sleep cycle, and calories burned were synced
and tracked remotely. Daily step goals were set by increasing the
participants' baseline step count by 10% each week until the day of
surgery. Participants were encouraged and motivated to reach their daily
step goal by daily automatic reminders through the wearable activity
tracker. Participants completed the EQ-5D-5L health-related quality of
life instrument at baseline and day of surgery. Data is presented as mean
+/- SD and median (range). Continuous variables were compared using
Student's t-test, and categorical variables were compared using Chi-square
test, with a level of significance p<0.05. Result(s): Of the 117
patients screened, 87.18% (102/117) were eligible and 93.14% (95/102)
completed the trial. The median age was 68 (45-87) and 57.89% (55/95) were
women. The mean predicted FEV1 and DLCO were 88.92% +/- 17.05% and 77.11%
+/- 17.62%, respectively. There were significantly more women in MFS than
Control (p=0.04), otherwise there were no other statistically significant
differences between the groups' baseline demographics. LOS in hospital
after surgery for MFS and Control were 2.67 +/- 1.61 and 4.44 +/- 3.48
days (p=0.002), respectively. Significant improvement was seen in the
overall health component of the EQ-5D-5L health-related quality of life
instrument from before MFS (69.38 +/- 17.11) to after (79.60 +/- 11.63;
p<0.001). Conclusion(s): MFS significantly shortened LOS in hospital
post-surgery when compared to usual preoperative care and resulted in
improved patient-reported quality of life. Keywords: Preconditioning,
thoracic surgery, Randomized Controlled Trial Copyright © 2021

<123>
Accession Number
2015169490
Title
PL02.05 IMpower010: Characterization of Stage IB-IIIA NSCLC Patients by
Type and Extent of Therapy Prior to Adjuvant Atezolizumab.
Source
Journal of Thoracic Oncology. Conference: 2021 World Conference on Lung
Cancer Worldwide Virtual Event. Virtual, Online. 16(10 Supplement) (pp
S845-S846), 2021. Date of Publication: October 2021.
Author
Altorki N.; Felip E.; Zhou C.; Vallieres E.; Moiseyenko V.; Smolin A.;
Rittmeyer A.; Vereshchako R.; Perol M.; Schutte W.; Fang J.; Tao M.;
Teixeira E.; Kim Y.; Gitlitz B.; Bennett E.; Mcnally V.; Wu F.; Deng Y.;
Wakelee H.
Institution
(Altorki) New York-Presbyterian Hospital, Weill Cornell Medicine, New
York, NY, United States
(Felip) Vall D'hebron University Hospital, Vall D'hebron Institute of
Oncology, Barcelona, Spain
(Zhou) Shanghai Pulmonary Hospital, Shanghai, China
(Vallieres) Swedish Cancer Institute, Seattle, WA, United States
(Moiseyenko) Gbuz Saint Petersburg Clinical Research Center of Specialized
Types of Care (Oncology), Saint Petersburg, Russian Federation
(Smolin) Principal Military Clinical Hospital N.A. N.N. Burdenko, Moscow,
Russian Federation
(Rittmeyer) Lungenfachklinik Immenhausen, Immenhausen, Germany
(Vereshchako) Kyiv Railway Clinical Hospital #3 of Branch Health Center of
the Pjsc Ukrainian Railway, Kyiv, Ukraine
(Perol) Centre Leon Berard Centre Regional de Lutte Contre Le Cancer Rhone
Alpes, Lyon, France
(Schutte) Krankenhaus Martha-Maria, Halle-Dolau Ggmbh, Halle, Germany
(Fang) Beijing Cancer Hospital, Beijing, China
(Tao) First Affiliated Hospital of Soochow University, Jiangsu, China
(Teixeira) Centro Hospitalar de Lisboa Norte E.P.E - Hospital Pulido
Valente, Lisbon, Portugal
(Kim) Chonnam National University Hwasun Hospital, Jeollanam-Do, United
Kingdom
(Gitlitz, Bennett, Mcnally, Wu, Deng) Genentech, Inc., South San
Francisco, CA, United States
(Wakelee) Division of Oncology, Department of Medicine, Stanford
University, Palo Alto, CA, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Surgical resection followed by adjuvant chemotherapy is a
standard of care in stage II-III NSCLC. Time from surgery to adjuvant
treatment as well as the type and extent of mediastinal staging remain
topics of interest. At this interim analysis, the Phase III IMpower010
trial met its primary endpoint, showing significant disease-free survival
(DFS) improvement with atezolizumab vs best supportive care (BSC) after
adjuvant chemotherapy in patients with PD-L1 TC>=1% stage II-IIIA NSCLC
and all randomized patients with stage II-IIIA NSCLC; the significance
boundary for DFS was not crossed in the ITT population (stage IB-IIIA
NSCLC). We investigated therapies prior to adjuvant atezolizumab,
including surgery type, and their potential impact on DFS. Method(s):
IMpower010 enrolled patients with completely resected stage IB (tumors >=4
cm)-IIIA NSCLC (AJCC/UICC v7) and ECOG PS 0/1. Complete resection must
have been performed 4-12 weeks prior to enrollment. Patients (N=1280)
received up to four 21-day cycles of cisplatin-based chemotherapy, and
1005 were subsequently randomized 1:1 to atezolizumab 1200 mg Q3W (16
cycles or until disease recurrence or unacceptable toxicity) or BSC. The
primary endpoint of investigator-assessed DFS was tested hierarchically in
the PD-L1 TC>=1% (SP263) stage II-IIIA population, all-randomized stage
II-IIIA population, and ITT population (stage IB-IIIA). Types of Analysis
and Data Reporting: Exploratory analyses of the types and frequency of
thoracic surgery in patients from this global registration trial will be
reported. The type of surgery, time from surgery to adjuvant treatment,
including initiation of both chemotherapy and atezolizumab, and type and
extent of mediastinal staging will be examined for any impact on the DFS
endpoint. DFS by disease stage and nodal status (N0 vs N1 vs N2) will be
presented. Result(s): The ITT population included 507 (atezolizumab)
and 498 (BSC) patients; median follow-up was 32.2 months (data cutoff: 21
Jan 2021). The most common surgery was lobectomy (78.1%); 15.9% had
pneumonectomy and 5.0% had bilobectomy. Mediastinal lymph node dissection
or sampling was performed in 80.7% and 18.0% of patients, respectively.
Median (range) time from surgery to first chemotherapy treatment was 1.8
mo (0.9-5.3) and 1.7 mo (0.8-5.2) in the atezolizumab and BSC arms,
respectively. A median of 4 (range, 1-4) adjuvant chemotherapy cycles were
received for all regimens; 152 patients received cisplatin-docetaxel, 165
received cisplatin-gemcitabine, 303 received cisplatin-vinorelbine and 385
received cisplatin-pemetrexed. Median (range) time from surgery to first
atezolizumab treatment or BSC was 5.2 mo (2.4-7.7) and 5.1 mo (2.3-8.0),
respectively. DFS by disease and prior treatment characteristics in the
PD-L1 TC>=1% stage II-IIIA, all-randomized stage II-IIIA and ITT
populations is shown in the Table. Conclusion(s): In these
exploratory analyses, most patients had lobectomy, lymph node dissection
and 4 cycles of adjuvant chemotherapy. Median time from surgery to start
of randomized treatment was similar between arms. Benefit was seen across
disease stages (stage II-IIIA sub-populations), including patients with
nodal involvement (N1 and N2). Additional details will be presented.
[Formula presented] Keywords: atezolizumab, early-stage resected nsclc,
surgical Copyright © 2021

<124>
Accession Number
2014592485
Title
Preserving the endothelial glycocalyx in patients undergoing
cardiopulmonary bypass: a prospective randomised interventional pilot
study of lidocaine and doxycycline (LiDEG trial) [version 1; peer review:
3 approved with reservations, 1 not approved].
Source
F1000Research. 9 (pp 1-16), 2021. Date of Publication: 2021.
Author
Pannekoek A.; Johnson M.; Buggy D.; Pavey W.
Institution
(Pannekoek, Johnson, Pavey) Fiona Stanley and Fremantle Hospitals, Perth,
WA, Australia
(Johnson, Buggy) School of Medicine and Medical Science, University
College Dublin, Dublin D4, Ireland
(Johnson, Pavey) University of Western Australia, Perth, WA, Australia
Publisher
F1000 Research Ltd
Abstract
Background: During major surgery, particularly heart surgery, an element
of the lining of blood vessels, known as the endothelial glycocalyx (EG),
can be damaged. This can lead to swelling, low oxygenlevels, kidney
failure and other problems, which delay recovery. There are laboratory
studies that show lidocaine (a local anaesthetic) and doxycycline (an
antibiotic) may help protect this lining. The study agents are widely
available, cheap and safe drugs. Trial design and objective: This is a
phase IV, single centre, prospective, unblinded, randomised,
parallel-group trial. The objectives of the trial are to investigate the
role of doxycycline and lidocaine as potential agents to reduce EG
shedding and correlate with early postoperative outcomes. Method(s):
60 adult patients undergoing heart surgery requiring cardiopulmonary
bypass (CPB) will be randomly assigned to one of three groups: doxycycline
group (oral doxycycline, 200mg preoperatively); lidocaine group
(perioperative intravenous lidocaine,1.5mg/kg bolus at induction followed
by 2mg/kg/hr infusion for the duration of surgery); and control group
(standard care). The randomisation will be undertaken using a sealed
opaque envelope method. The primary outcome will be the relative
difference in the biochemical marker of EG injury, syndecan-1, at
different timepoints in the intraoperative and early post-operative
period. Secondary endpoints include vasopressor requirements, markers of
organ dysfunction (lung, kidney, brain, arrhythmia), coagulation and
inflammation. Discussion(s): EG injury is ubiquitous in patients
undergoing CPB. Maintaining homeostasis of this delicate layer would
appear to be a valuable therapeutic target. To date no agents have been
shown to be effective in protecting the EG. Our study agents have shown
some promise in the preclinical setting and would represent a novel
therapeutic approach should they show a protective effect. Trial
registration: Australian New Zealand Clinical Trials Registry,
ACTRN12619000621112 (26th April 2019) Copyright ©
2020. Pannekoek A 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 work is properly cited

<125>
Accession Number
2015124749
Title
Auto-Pericardial Mitral Valve Implantation: A Pilot Study.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Manohar P.; Naik L R.; Mohan Rao P.S.
Institution
(Manohar, Naik L, Mohan Rao) Department of Cardiothoracic and Vascular
Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research,
Bangalore, Karnataka, India
Publisher
Elsevier Ltd
Abstract
Introduction: Developing nations continue to grapple with rheumatic heart
disease, particularly in the young. There is a need for an alternative to
prosthetic mitral valve replacement in irreparable mitral valves, which
avoids the need for anticoagulation and risks of thromboembolism.
 Method(s): Twelve (12) patients with irreparable severe mitral valve
disease underwent auto-pericardial mitral valve implantation from August
2020 to February 2021. The mitral valve leaflets were excised. Autologous
pericardium treated with 0.5% glutaraldehyde for 8 minutes was fashioned
into anterior and posterior mitral leaflets as per the dimensions on an
indigenously designed template based on the studies by Ranganathan and
Lam. The pericardial leaflets were sutured onto an appropriately sized
mitral annuloplasty ring. The ring with the leaflets was implanted onto
the mitral annulus. The leaflets were supported with neo-chordae prepared
with Gore-Tex (W L Gore and Associates, Inc. Newark, DE, USA) and
polyester sutures to mimic a repaired mitral valve in its structure and
dynamics. Result(s): The mean cross-clamp time was 138+/-21.7
minutes. None of the patients required re-exploration. On the third
postoperative day, a mean mitral valve orifice area of 3+/-0.47 cm and
mean mitral valve gradient of 2+/-1.04 were observed. None of the patients
had any more than 1+ mitral regurgitation. None of them have required a
re-intervention for mitral insufficiency to date. Discussion(s):
Auto-pericardial mitral valve re-implantation is a safe and effective
procedure for severe, irreparable, mitral valve pathologies. However, the
mid-term and long-term results need to be compared with conventional
mitral valve replacement with a prosthetic valve in a randomised
controlled trial. Copyright © 2021 Australian and New Zealand
Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society
of Australia and New Zealand (CSANZ)

<126>
Accession Number
2015124711
Title
A Tale of Two Centrifugal-Flow Ventricular Assist Devices As Bridge to
Heart Transplant.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Alwair H.; Whitehouse K.; Slaughter M.S.; Trivedi J.R.
Institution
(Alwair, Whitehouse, Slaughter, Trivedi) Department of Cardiovascular and
Thoracic Surgery, University of Louisville School of Medicine, Louisville,
KY, United States
Publisher
Elsevier Inc.
Abstract
Background: Use of continuous-flow left ventricular assist devices (LVAD)
has increased over the years as a bridge to transplant. The HeartWare HVAD
(Medtronic, Minneapolis, MN) and HeartMate III (HM3, Abbott, Abbott Park,
IL) are currently approved centrifugal-flow devices used for bridge to
transplant. We sought to evaluate outcomes of the patients listed and who
received a transplant after receiving these 2 devices. Method(s): The
United Network of Organ Sharing thoracic transplant database was queried
after August 23, 2017, until December 2018 to identify patients aged older
than 18 years listed for heart transplant and supported by the HVAD or
HM3. Patient characteristics were evaluated at the time of listing and
transplant. The primary study end point was 1-year mortality after LVAD
implantation. Nonparametric tests were used to evaluate the device groups.
 Result(s): Of 569 patients listed for heart transplant during the
study period, 226 had HM3 and 343 had HVAD. The HM3 group had more men
(82% vs 74%, P = .02), patients with diabetes (38% vs 29%, P = .02), and
the body mass index was higher (28 vs 27 kg/m2, P = .04) at
listing. Between the HM3 and HVAD groups, the 1-year mortality was 20% vs
17%, respectively (log-rank P = .28; Figure 1), and the posttransplant
survival at 1 year was 97% and 94%, respectively (P = .1).
 Conclusion(s): In a relatively well-matched group of patients listed
for heart transplant with a centrifugal-flow LVAD, the 6-month and 1-year
mortality on the waiting list as well as after transplant were not
statistically different. Additional real-world experience or a randomized
trial would be needed to determine whether one LVAD is
superior. Copyright © 2021 The Society of Thoracic Surgeons

<127>
Accession Number
2015124708
Title
Effect of Levosimendan Treatment in Pediatric Patients With Cardiac
Dysfunction: An Update of a Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Silvetti S.; Belletti A.; Bianzina S.; Momeni M.
Institution
(Silvetti, Bianzina) Neonatal and Pediatric Intensive Care Unit,
Department of Critical Care and Perinatal Medicine, IRCCS Istituto
Giannina Gaslini, Genova, Italy
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Momeni) Department of Anesthesiology, Cliniques Universitaires Saint Luc,
Universite Catholique de Louvain, Institut de Recherche Experimentale et
Clinique (IREC), Brussels, Belgium
Publisher
W.B. Saunders
Abstract
Levosimendan increasingly has been used to treat heart failure and cardiac
dysfunction in pediatric patients. Currently, there is only limited
evidence that this drug positively affects outcomes. The authors' aim was
to investigate the effects of levosimendan on hemodynamic parameters and
outcomes in pediatric patients in all clinical settings. The study design
was a systematic review of randomized and nonrandomized studies.
Randomized clinical trials (RCTs) were included in a meta-analysis. The
primary outcome of the meta-analysis was the effect of levosimendan on
central venous oxygen saturation (ScvO<inf>2</inf>) and lactate values as
surrogate markers of low-cardiac-output syndrome. The study setting was
any acute care setting. Study participants were pediatric patients (age
<18 years) receiving levosimendan, and the intervention was levosimendan
versus any control treatment. The authors identified 44 studies published
from 2004 to 2020, including a total of 1,131 pediatric patients. Nine
studies (enrolling 547 patients) were RCTs, all performed in a pediatric
cardiac surgery setting. Three RCTs were judged to carry a low risk of
bias. In the RCTs, levosimendan administration was associated with a
significant improvement of ScvO<inf>2</inf> (p = 0.03) and a trend toward
lower postoperative lactate levels (p = 0.08). No differences could be
found for secondary outcomes. Levosimendan use in pediatric patients is
not associated with major side effects and may lead to hemodynamic
improvement after cardiac surgery. However, its impact on major clinical
outcomes remains to be determined. Overall, the quality of evidence for
levosimendan use in pediatric patients is low, and further high-quality
RCTs are needed. Copyright © 2021 Elsevier Inc.

<128>
Accession Number
636260129
Title
Rationale and Design of the Small Annuli Randomized to EvolutTM
or SAPIENTM Trial (SMART Trial).
Source
American heart journal. (no pagination), 2021. Date of Publication: 26
Sep 2021.
Author
Herrmann H.C.; Abdel-Wahab M.; Attizzani G.F.; Batchelor W.; Bleiziffer
S.; Verdoliva S.; Chang Y.; Gada H.; Gillam L.; Guerrero M.; Mahoney P.D.;
Petronio A.S.; Rogers T.; Rovin J.; Szerlip M.; Whisenant B.; Mehran R.;
Tchetche D.
Institution
(Herrmann) Perelman School of Medicine at the University of Pennsylvania,
PA, Philadelphia, United States
(Abdel-Wahab) Heart Center Leipzig at the University of Leipzig, Leipzig,
Germany
(Attizzani) University Hospitals of Cleveland, Cleveland, OH
(Batchelor) Inova Heart and Vascular Institute, Falls Church, VA
(Bleiziffer) Herz- und Diabeteszentrum NRW Bad Oeynhausen, Germany Germany
(Verdoliva, Chang) Medtronic, Mounds View, MN
(Gada) PA, Harrisburg, United States
(Gillam) Morristown Medical Center/Atlantic Health System, Morristown,
United States
(Guerrero) Mayo Clinic, MN, Rochester
(Mahoney) Sentara Healthcare, VA, Norfolk
(Petronio) Ospedale di Cisanello Pisa, Universita di Pisa, Italy
(Rogers) MedStar Washington Hospital Center, Washington, DC; National
Institutes of Health, Bethesda, MD
(Rovin) BayCare Health System/Morton Plant Hospital, FL, Clearwater,
United States
(Szerlip) Baylor Scott and White Heart Hospital, TX, Plano, United States
(Whisenant) UT, Intermountain Medical Center, Murray, United States
(Mehran) Mount Sinai School of Medicine, NY, NY
(Tchetche) Clinique Pasteur, Toulouse, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: The SMall Annuli Randomized To Evolut or SAPIEN (SMART) Trial
was designed to compare the performance of the two most widely available
commercial transcatheter aortic valve replacement (TAVR) devices in
patients with symptomatic severe native aortic stenosis with a small
aortic valve annulus undergoing transfemoral TAVR. Patients with small
aortic valve annuli are typically female and are often underrepresented in
clinical trials. METHOD(S): The SMART Trial is an international,
prospective, multi-center, randomized controlled, post-market trial. The
trial will be conducted in approximately 700 subjects at approximately 90
sites globally. Inclusion criteria include severe aortic stenosis, aortic
valve annulus area of <=430 mm2 based on multi-detector computed
tomography (MDCT), and appropriate anatomy for both the Medtronic Evolut
PRO/PRO+ self-expanding (SE) and Edwards SAPIEN 3/3 Ultra
balloon-expandable (BE) devices. The primary clinical outcome composite
endpoint is defined as mortality, disabling stroke or heart failure
rehospitalization at 12 months. The co-primary valve function composite
endpoint is defined as bioprosthetic valve dysfunction (BVD) at 12 months
which includes hemodynamic structural valve dysfunction (HSVD), defined as
a mean gradient >=20 mmHg, non-structural valve dysfunction (NSVD),
defined as severe prothesis-patient mismatch (PPM) or >=moderate aortic
regurgitation (AR), thrombosis, endocarditis, and aortic valve
re-intervention. Powered secondary endpoints will be assessed
hierarchically. CONCLUSION(S): The SMART trial will be the largest
head-to-head comparative trial of transfemoral TAVR using the two most
widely available contemporary TAVR devices in the setting of small aortic
annuli and the largest trial to enroll primarily women. CLINICAL TRIAL
REGISTRATION: www.clinicaltrials.gov, NCT04722250. Copyright ©
2021 Elsevier Inc. All rights reserved.

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