EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
635926984
Title
Comparison between Custodiol, del Nido and modified del Nido in the
myocardial protection-Cardioplegia Trial: A study protocol for a
randomised, double-blind clinical trial.
Source
BMJ Open. 11(9) (no pagination), 2021. Article Number: e047942. Date of
Publication: 06 Sep 2021.
Author
Almeida A.S.; Ceron R.O.; Anschau F.; Kopittke L.; Lira K.B.; Delvaux
R.S.; Rode J.; Rey R.A.W.; Wittke E.I.; Rombaldi A.R.
Institution
(Almeida, Ceron, Lira, Delvaux, Rode, Rey, Wittke, Rombaldi)
Cardiothoracic Surgery Division, Hospital Nossa Senhora da Conceicao,
Porto Alegre, Brazil
(Almeida, Anschau, Kopittke) Health Technology Assessment Center (NATS),
Education and Research Center (GEP), Hospital Nossa Senhora da Conceicao,
Porto Alegre, Brazil
Publisher
BMJ Publishing Group
Abstract
Introduction Myocardial protection is essential for successful cardiac
surgery, and the search for an ideal cardioplegic solution has continued
since its beginning. In this context, Custodiol, del Nido and modified del
Nido are single-dose cardioplegic solutions with good safety profiles and
great relevance in modern surgical practice. While these solutions have
all been evaluated for their impact on patient outcomes independently,
limited research exists comparing them directly. Thus, the present study
aims to examine the effects of these cardioplegic solutions on myocardial
protection and clinical outcomes in adult patients undergoing elective
cardiac surgery. The assessment of the increase in myocardial injury
biomarkers in patients submitted to all treatment methods may be
considered a major strength of our study. Methods and analysis This is a
clinical trial study protocol that will compare myocardial protection and
clinical outcomes among three patient groups based on which cardioplegic
solution was used. Patients will be randomised to receive del Nido (n=30),
modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers
will be measured at the baseline and 2 hours, 12 hours and 24 hours after
the cardiopulmonary bypass. Clinical outcomes will be assessed during the
trans operative period and the intensive care unit stay, in addition to
other haematological parameters. Ethics and dissemination This protocol
and its related documents were approved by the Research Ethics Committee
of the Hospital Nossa Senhora da Conceicao, Brazil, registered under no.
4.029.545. The findings of this study will be published in a peer-reviewed
journal in the related field. Trial registration number
RBR-7g5s66.<br/>Copyright &#xa9; 2021 BMJ Publishing Group. All rights
reserved.

<2>
Accession Number
2007111339
Title
Angiogenic CD34 stem cell therapy in coronary microvascular repair-A
systematic review.
Source
Cells. 10(5) (no pagination), 2021. Article Number: 1137. Date of
Publication: May 2021.
Author
Rai B.; Shukla J.; Henry T.D.; Quesada O.
Institution
(Rai, Henry, Quesada) Lindner Center for Research, The Christ Hospital,
Cincinnati, OH 45219, United States
(Shukla) University of Cincinnati Medical School, Cincinnati, OH 45219,
United States
(Quesada) Women's Heart Center, Vascular and Lung Institute, The Christ
Hospital, Cincinnati, OH 45219, United States
Publisher
MDPI
Abstract
Ischemia with non-obstructive coronary arteries (INOCA) is an increasingly
recognized disease, with a prevalence of 3 to 4 million individuals, and
is associated with a higher risk of morbidity, mortality, and a worse
quality of life. Persistent angina in many patients with INOCA is due to
coronary microvascular dysfunction (CMD), which can be difficult to
diagnose and treat. A coronary flow reserve <2.5 is used to diagnose
endothelial-independent CMD. Antianginal treatments are often ineffective
in endothelial-independent CMD and thus novel treatment modalities are
currently being studied for safety and efficacy. CD34⁺ cell
therapy is a promising treatment option for these patients, as it has been
shown to promote vascular repair and enhance angiogenesis in the
microvasculature. The resulting restoration of the microcirculation
improves myocardial tissue perfusion, resulting in the recovery of
coronary microvascular function, as evidenced by an improvement in
coronary flow reserve. A pilot study in INOCA patients with
endothelialindependent CMD and persistent angina, treated with autologous
intracoronary CD34⁺ stem cells, demonstrated a significant
improvement in coronary flow reserve, angina frequency, Canadian
Cardiovascular Society class, and quality of life (ESCaPE-CMD,
NCT03508609). This work is being further evaluated in the ongoing FREEDOM
(NCT04614467) placebo-controlled trial.<br/>Copyright &#xa9; 2021 by the
authors. Licensee MDPI, Basel, Switzerland.

<3>
Accession Number
632334891
Title
Outcomes after transcatheter aortic valve replacement in cancer survivors
with prior chest radiation therapy: A systematic review and meta-analysis.
Source
Cardio-Oncology. 6(1) (no pagination), 2020. Article Number: 8. Date of
Publication: 14 Jul 2020.
Author
Zafar M.R.; Mustafa S.F.; Miller T.W.; Alkhawlani T.; Sharma U.C.
Institution
(Zafar, Miller, Alkhawlani, Sharma) Department of Medicine, Division
Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875
Ellicott Street, Buffalo, NY 14203, United States
(Mustafa) Department of Internal Medicine, William Beaumont Hospital,
Royal Oak, MI, United States
Publisher
BioMed Central Ltd
Abstract
Background: Cancer survivors with prior chest radiation therapy (C-XRT)
frequently present with aortic stenosis (AS) as the first manifestation of
radiation-induced heart disease. They are considered high-risk for
surgical valve replacement. Transcatheter aortic valve replacement (TAVR)
is as an attractive option for this patient population but the outcomes
are not well established in major clinical trials. The authors performed a
systemic review and meta-analysis of clinical studies for the outcomes
after TAVR in cancer survivors with prior C-XRT. <br/>Method(s): Online
databases were searched from inception to April 2020 for studies
evaluating the outcomes of TAVR in patients with and without C-XRT. We
analyzed the pooled estimates (with their 95% confidence intervals) of the
odds ratio (OR) for the all-cause mortality at 30-day and 1-year
follow-ups, 4-point safety outcomes (stroke, major bleed, access-related
vascular complications and need for a pacemaker), a 2-point efficacy
outcome (mean aortic valve gradient and left ventricular ejection
fraction) and worsening of congestive heart failure (CHF). Four studies
were included following 2054 patients with and without prior C-XRT
exposure (164 patients and 1890 patients respectively). <br/>Result(s):
The C-XRT group had similar 30-day mortality compared to the control group
(OR 1.29, 95% CI 0.64 to 2.58, p = 0.48). The 1-year mortality was higher
in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p = 0.01). Apart from higher
congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03,
CI 1.36 to 3.04, p = 0.0006), TAVR resulted in similar safety and efficacy
outcomes in both groups. <br/>Conclusion(s): TAVR in the C-XRT group has
similar 30-day mortality, safety, and efficacy outcomes compared to the
control group; however, they have higher 1-year mortality and CHF
exacerbation. Including an oncologist to the cardiology team who considers
cancer stage in the decision-making process and applying additional
preoperative scores such as frailty indices may refine the risk assessment
for these patients. The quality of analyzed data is modest, warranting
randomized trials to assess the true benefits of TAVR in these
patients.<br/>Copyright &#xa9; 2020 The Author(s).

<4>
Accession Number
2013736275
Title
The impact of post-operative atrial fibrillation on outcomes in coronary
artery bypass graft and combined procedures.
Source
Journal of Geriatric Cardiology. 18(5) (pp 319-326), 2021. Date of
Publication: May 2021.
Author
Chau Y.-L.A.; Yoo J.W.; Yuen H.C.; Waleed K.B.; Chang D.; Liu T.; Liu
F.Z.; Tse G.; Lee S.; Li K.H.C.
Institution
(Chau, Yoo) Faculty of Pharmaceutical Sciences, University of British
Columbia, BC, Canada
(Yuen) Department of Medicine and Geriatrics, Princess Margaret Hospital,
Hong Kong
(Waleed) Department of Cardiology, Fuwai Hospital, Chinese Academy of
Medical Sciences Shenzhen, Shenzhen, China
(Waleed) Institute of Biomedicine and Biotechnology, Shenzhen Institutes
of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(Chang) Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
(Liu, Tse) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular Disease, Department of Cardiology, Tianjin Institute of
Cardiology, The Second Hospital of Tianjin Medical University, Tianjin,
China
(Liu) Department of Cardiology, Guangdong Cardiovascular Institute,
Guangdong Provincial People's Hospital, Guangdong Academy of Medical
Sciences, Guangzhou, China
(Tse) Faculty of Health and Medical Sciences, University of Surrey,
Guildford GU2 7AL, United Kingdom
(Lee) Cardiovascular Analytics Group, Laboratory of Cardiovascular
Physiology, Hong Kong, Hong Kong
(Li) Arrowe Park Acute Stroke Unit, Wirral University, Teaching Hospital,
NHS Foundation Trust, Wirral, United Kingdom
Publisher
Science Press
Abstract
BACKGROUND Post-operative atrial fibrillation (POAF) is a common yet
understudied clinical issue after coronary artery bypass graft (CABG)
leading to higher mortality rates and stroke. This systematic review and
meta-analysis evaluated the rates of adverse outcomes between patients
with and without POAF in patients treated with CABG or combined
procedures. METHODS The search period was from the beginning of PubMed and
Embase to May 18^th, 2020 with no language restrictions. The
inclusion criteria were: (1) studies comparing new onset atrial
fibrillation before or after revascularization vs. no new onset AF before
or after revascularization. The outcomes assessed included all-cause
mortality, cardiac death, cerebral vascular accident (CVA), myocardial
infarction (MI), repeated revascularization, major adverse cardiac event
(MACE), and major adverse cardiac and cerebrovascular events (MACCEs).
RESULTS Of the 7,279 entries screened, 11 studies comprising of 57,384
patients were included. Compared to non-POAF, POAF was significantly
associated with higher risk of all-cause mortality (Risk Ratio (RR) =
1.58; 95% Confidence Interval (CI): 1.42-1.76, P < 0.00001) with
accompanying high level of heterogeneity (I² = 62%).
Conclusions Patients with POAF after CABG or combined procedures are at an
increased risk of all-cause mortality or CVAs. Therefore, POAF after such
procedures should be closely monitored and treated judiciously to minimize
risk of further complications. While there are studies on POAF versus no
POAF on outcomes, the heterogeneity suggests that further studies are
needed.<br/>Copyright &#xa9; 2021 JGC All rights reserved; www.jgc301.com

<5>
Accession Number
2013625873
Title
Efficacy of compressive ischemic pressure release on pectoral's trigger
points on RT side cardiac output following open heart surgery: Randomized
clinical trial.
Source
Turkish Journal of Physiotherapy and Rehabilitation. 32(3) (pp 8725-8729),
2021. Date of Publication: 2021.
Author
Elhafez H.M.; Badr S.A.A.; Abdelghany M.M.; Rezkallah S.S.; Tekla M.K.
Institution
(Elhafez) Faculty of Physical Therapy, Suez University
(Badr) Physical Therapy Department, KasrAlainy Hospital, Cairo University
Hospitals
(Abdelghany) Cardiovascular Department, Faculty of Medicine, Cairo
University
(Elhafez, Rezkallah, Tekla) Basic Science Department, Faculty of Physical
Therapy, Cairo University
Publisher
Turkish Physiotherapy Association
Abstract
Background: Every open heart surgery (OHS) presents a great risk for
complications according to the type of procedure being performed. This is
a widespread significant health problem with a huge burden on the
individual and economy. Finding a noninvasive effective treatment that's
non exhaustive for the therapist and non painful for the patient is highly
needed. Aim of Study: This study investigated the efficacy of compressive
ischemic pressure releases on pectorals Trigger Points (TrPs) on chest
pain, Pressure Pain Threshold (ppt) and Cardiac Output (CO) following OHS.
<br/>Method(s): Forty patients with OHS performed sternal- approach
maneuver participated in this study. They were recruited from Kasr
Al-ainy, between 20: 50 years oldwere assigned into two equal groups, the
experimental group (A) received compression ischemic pressure release of
pectorals muscles TrPs and diaphragmatic deep breathing exercise. The
control group (B) received diaphragmatic deep breathing exercise.Pain and
CO measurements were used to evaluate patients before and after treatment.
<br/>Result(s): there was a significant improvement in the Pain pressure
thresholds (p<0.0001) after ischemic pressure release of pectorals muscles
TrPs and significant improvement in the Rt side CO TAPSe thresholds
(p<0.0001), using mixed MANOVA test between the two groups.
<br/>Conclusion(s):compressive ischemic pressure release of trigger points
in pectoral muscles post open heart surgery was effective in reducing pain
and improving cardiac output in open heart patients.<br/>Copyright &#xa9;
2021 Turkish Physiotherapy Association. All rights reserved.

<6>
Accession Number
2013091735
Title
Neurally-adjusted ventilatory assist (NAVA) versus pneumatically
synchronized ventilation modes in children admitted to PICU.
Source
Journal of Clinical Medicine. 10(15) (no pagination), 2021. Article
Number: 3393. Date of Publication: 01 Aug 2021.
Author
Sugunan P.; Hosheh O.; Garcia Cusco M.; Mildner R.
Institution
(Sugunan, Hosheh, Mildner) Paediatric Intensive Care Unit, Birmingham
Children's Hospital, Birmingham B4 6NH, United Kingdom
(Garcia Cusco) Paediatric Intensive Care Unit, Royal Bristol Children's
Hospital, Bristol BS 2 8BJ, United Kingdom
Publisher
MDPI
Abstract
Traditionally, invasively ventilated children in the paediatric intensive
care unit (PICU) are weaned using pneumatically-triggered ventilation
modes with a fixed level of assist. The best weaning mode is currently not
known. Neurally adjusted ventilatory assist (NAVA), a newer weaning mode,
uses the electrical activity of the diaphragm (Edi) to synchronise
ventilator support proportionally to the patient's respiratory drive. We
aimed to perform a systematic literature review to assess the effect of
NAVA on clinical outcomes in invasively ventilated children with
nonneonatal lung disease. Three studies (n = 285) were included for
analysis. One randomised controlled trial (RCT) of all comers showed a
significant reduction in PICU length of stay and sedative use. A cohort
study of acute respiratory distress syndrome (ARDS) patients (n = 30)
showed a significantly shorter duration of ventilation and improved
sedation with the use of NAVA. A cohort study of children recovering from
cardiac surgery (n = 75) showed significantly higher extubation success,
shorter duration of ventilation and PICU length of stay, and a reduction
in sedative use. Our systematic review presents weak evidence that NAVA
may shorten the duration of ventilation and PICU length of stay, and
reduce the requirement of sedatives. However, further RCTs are required to
more fully assess the effect of NAVA on clinical outcomes and treatment
costs in ventilated children.<br/>Copyright &#xa9; 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<7>
Accession Number
2010963257
Title
Anticoagulation management of postoperative atrial fibrillation after
cardiac surgery: A systematic review.
Source
Journal of Cardiac Surgery. 36(6) (pp 2081-2094), 2021. Date of
Publication: June 2021.
Author
Yao R.J.R.; Hawkins N.M.; Lavaie Y.; Deyell M.W.; Andrade J.G.; Bashir J.
Institution
(Yao, Lavaie) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Hawkins, Deyell, Andrade) Division of Cardiology, University of British
Columbia, Vancouver, BC, Canada
(Bashir) Division of Cardiovascular Surgery, University of British
Columbia, Vancouver, BC, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Postoperative atrial fibrillation (POAF) often complicates
cardiac surgery and is associated with increased mortality and risk of
thromboembolism. However, the optimal oral anticoagulation (OAC) strategy
is uncertain. We performed a systematic review to examine the OAC practice
patterns and efficacy in these circumstances. <br/>Method(s): MEDLINE and
EMBASE were searched from 2000 to 2019 using the search terms cardiac
surgical procedures, cardiac surgery, postoperative complications, atrial
fibrillation, atrial flutter, and terms for anticoagulants. Collected data
included anticoagulation patterns (time of initiation, type, and duration)
and outcomes (stroke, bleeding, and mortality). <br/>Result(s): From 763
records, 4 prospective and 13 retrospective studies were included totaling
44,908 patients with 8929 (19.9%) who developed POAF. Anticoagulation
rates ranged from 4% to 43% (mean 21% overall). Sixteen studies used
warfarin, 3 nonvitamin K OAC (NOAC), and 2 both. Four studies reported the
use of bridging unfractionated or low-molecular-weight heparin.
Concomitant antiplatelet therapy was reported in half the studies, ranging
from 80% to 99%. OAC use was associated with lower risk of thromboembolic
events in two retrospective studies (including a national Danish cohort
with 2108 patients with POAF). Patients discharged on warfarin experienced
reduced mortality in a large, single center, retrospective analysis, but
no association was observed in the Danish cohort. <br/>Conclusion(s):
There is wide practice variation in the uptake, timing of initiation,
duration, and choice of OAC for POAF following cardiac surgery. The
evidence is largely retrospective and insufficient to assess the efficacy
of different OAC strategies. Further studies are warranted to guide
clinical practice.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<8>
Accession Number
2010454212
Title
Effect of institutional transcatheter aortic valve replacement volume on
mortality: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 98(3) (pp E453-E461),
2021. Date of Publication: September 2021.
Author
Kir D.; Shapero K.; Chatterjee S.; Grimshaw A.; Oddleifson A.; Spatz E.S.;
Goldsweig A.M.; Desai N.R.
Institution
(Kir, Shapero, Oddleifson) Department of Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Kir) Department of Cardiology, University of Miami/Jackson Memorial
Hospital, Miami, FL, United States
(Chatterjee) Hofmann Heart and Vascular Institute, Saint Francis Hospital
and Medical Center, Hartford, CT, United States
(Grimshaw) Harvey Cushing/John Hay Whitney Medical Library, Yale
University, New Haven, CT, United States
(Spatz, Desai) Center for Outcomes Research and Evaluation, Yale-New Haven
Hospital, New Haven, CT, United States
(Spatz, Desai) Section of Cardiovascular Medicine, Yale University School
of Medicine, New Haven, CT, United States
(Goldsweig) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: We sought to conduct a systematic review and network
meta-analysis to examine the association between institutional
transcatheter aortic valve replacement (TAVR) volume and all-cause
mortality. <br/>Background(s): Since inception in 2011, there has been an
exponential increase in the number of TAVR centers across the world.
Multiple studies have questioned if a relationship exists between
institutional TAVR volume and patient outcomes. <br/>Method(s): We
performed a systematic literature search for relevant articles using a
combination of free text terms in the title/abstract related to volume,
TAVR, and patient outcomes. Two reviewers independently screened all
titles/abstracts for eligibility based on pre-specified criteria.
All-cause mortality data was pooled from eligible studies and centers were
categorized as low-(30-50 cases), intermediate-, or high-volume (75-130
cases) based on their annual TAVR volumes. <br/>Result(s): Our search
yielded an initial list of 11,153 citations, 120 full text studies were
reviewed and 7 studies met all inclusion and exclusion criteria, yielding
a total of 1,93,498 TAVRs. Categorized according to center's annual
volume; 25,062 TAVRs were performed in low-, 77,093 in intermediate- and
91,343 in high-volume centers. Network meta-analysis showed a relative
reduction in mortality rates of 37%, 23% and 19%, for high volume versus
low volume centers, high volume versus intermediate volume centers and
intermediate versus low volume centers, respectively. <br/>Conclusion(s):
Existing research clearly shows an inverse relationship between annual
TAVR procedural volume and all-cause mortality. We need to focus on
development of strong referral networks and consolidation rather than
expansion of existing TAVR centers to improve patient outcomes, while
ensuring adequate access-to-care.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC.

<9>
Accession Number
2007063508
Title
Long-term follow-up of percutaneous coronary intervention versus coronary
artery bypass grafting in left main coronary artery disease: A systematic
review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. 98(3) (pp 427-433),
2021. Date of Publication: September 2021.
Author
Garg A.; Rout A.; Raheja H.; Hakeem H.; Sharma S.
Institution
(Garg, Sharma) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, New York, NY, United States
(Rout) Division of Cardiology, Einstein Medical Center Philadelphia,
Philadelphia, PA, United States
(Raheja) Division of Cardiology, Maimonides Medical Center, New York, NY,
United States
(Hakeem) Division of Cardiology, Newark Beth Israel Medical center,
Newark, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We conducted a systematic review and meta-analysis to evaluate
the long-term outcomes of PCI compared to CABG in patients with LMCAD.
<br/>Background(s): Recent data from randomized controlled trials (RCTs)
has raised concerns regarding the long-term efficacy and safety of
percutaneous coronary intervention (PCI) compared with coronary artery
bypass grafting (CABG) in patients with left main coronary artery disease
(LMCAD). <br/>Method(s): We searched MEDLINE and EMBASE databases for
published RCTs comparing PCI using stenting with CABG in patients with
LMCAD. Preferred reporting items for systematic review and meta-analysis
guidelines were used for the present study. End-points of interest were
all-cause mortality, cardiovascular (CV) mortality, myocardial infarction
(MI), stroke, and repeat revascularization at longest available follow-up.
Relevant data were collected and pooled odds ratio (OR) with 95%
confidence intervals (CI) was calculated using random-effects model.
<br/>Result(s): Five RCTs including a total of 4,499 patients were
included in the final analysis. Mean duration of follow-up was 96 months.
The risks of all-cause mortality [OR 1.09 (95% CI 0.88-1.34)] and
cardiovascular mortality [1.14 (0.88-1.47)] were comparable between PCI
and CABG. There were no statistically significant differences between PCI
and CABG for MI [1.52 (0.98-2.37)] and stroke [0.84 (0.48-1.45)].
Conversely, repeat revascularization was significantly higher with PCI as
compared with CABG [1.82 (1.49-2.22)]. <br/>Conclusion(s): At long-term
follow-up, PCI is associated with similar risks of mortality but a higher
risk of repeat revascularization compared with CABG in LMCAD. Long-term
risk of MI with PCI compared to CABG needs to be further explored in
future studies.<br/>Copyright &#xa9; 2020 Wiley Periodicals LLC.

<10>
Accession Number
2013642346
Title
Alternate accesses for transcatheter aortic valve replacement: A network
meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Hameed I.; Oakley C.T.; Hameed N.U.F.; Ahmed A.; Naeem N.; Singh S.;
Rizwana K.; Brackett A.; Forrest J.K.; Kaple R.; Mangi A.; Salemi A.;
Geirsson A.; Gaudino M.; Vallabhajosyula P.
Institution
(Hameed, Singh, Mangi, Geirsson, Vallabhajosyula) Department of Surgery,
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, United
States
(Oakley, Hameed, Ahmed, Naeem, Rizwana, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY,
United States
(Brackett) Cushing/Whitney Medical Library, Yale School of Medicine, New
Haven, CT, United States
(Forrest, Kaple) Department of Internal Medicine, Division of Cardiology,
Yale School of Medicine, New Haven, CT, United States
(Salemi) Department of Cardiothoracic Surgery, Robert Wood
Johnson/Barnabas Health, West Orange, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: When transfemoral (TF) access is contraindicated in patients
undergoing transcatheter aortic valve replacement (TAVR), alternate access
strategies are considered. The choice of one alternate access over the
other remains controversial. <br/>Method(s): Following a comprehensive
literature search, studies comparing any combination of TF, transapical
(TA), transaortic (TAo), transcarotid (TC), and trans-subclavian (TS) TAVR
were identified. Data were pooled using fixed- and random-effects network
meta-analysis. Rank scores with probability ranks of different treatment
groups were calculated. <br/>Result(s): Eighty-four studies (26,449
patients) were included. Compared to TF access, TA and TAo accesses were
associated with higher 30-day mortality (odds ratio [OR] 1.60, 95%
confidence interval [CI] 1.31-1.94; OR 1.79, 95% CI 1.21-2.66,
respectively), while the TC and TS showed no difference (OR 1.12, 95% CI
0.64-1.95; OR 1.23, 95% CI 0.67-2.27, respectively); TF access ranked best
followed by TC. There was no significant difference in 30-day stroke; TC
access ranked best followed by TS. At a weighted mean follow-up of 1.6
years, TA and TAo accesses were associated with higher long-term mortality
versus TF (incidence rate ratio [IRR] 1.31, 95% CI 1.18-1.45; IRR 1.41,
95% CI 1.11-1.79, respectively); there was no difference between TC and TS
versus TF access (IRR 1.02, 95% CI 0.70-1.47; IRR 1.16, 95% CI 0.82-1.66,
respectively); TF access ranked best followed by TC. At a weighted mean
follow-up of 1.4 years, only TA access was associated with higher
long-term stroke compared to TF (IRR 3.01, 95% CI 1.15-7.87); TF access
ranked as the best strategy followed by TAo. <br/>Conclusion(s): TC and TS
approaches are associated with superior postoperative outcomes compared to
other TAVR alternate access strategies. Randomized trials definitively
assessing the safety and efficacy of alternate access strategies are
needed.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<11>
Accession Number
2013642333
Title
Clinical and hemodynamic outcomes of the Dor procedure in adults with
ischemic cardiomyopathy.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Fatehi Hassanabad A.; Wiebe K.; Ali I.S.
Institution
(Fatehi Hassanabad, Ali) Section of Cardiac Surgery, Department of Cardiac
Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
(Wiebe) Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
Publisher
John Wiley and Sons Inc
Abstract
Ischemic cardiomyopathy continues to be a major contributor to congestive
heart failure, which places a significant burden on our healthcare system.
Improving medications and different coronary revascularization strategies
are the mainstays in the management of ischemic cardiomyopathy. Although
medications and mechanical circulatory support are playing an
ever-increasing role, cardiac transplantation remains the gold standard
for treating advanced heart failure. Given the small number of available
and suitable donor hearts, transplantation is limited for the majority of
patients. Surgical ventricular restoration has repeatedly been suggested
as a viable alternative in managing heart failure in select patients, as
it is believed that surgically returning the ventricle to its original
dimensions is possible and associated with favorable outcomes. The purpose
of this manuscript is to comprehensively review the current literature on
various surgical strategies for ventricular restoration. We also
contextualize the published data with respect to ventricular function,
volume, structure, arrhythmias, mitral regurgitation, and clinical
outcomes.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<12>
[Use Link to view the full text]
Accession Number
631516961
Title
A Randomized Controlled Trial Comparing Flat Times Versus Standard Care in
Pediatric Patients Post Cardiac Catheterization.
Source
The Journal of cardiovascular nursing. 35(3) (pp 307-313), 2020. Date of
Publication: 01 May 2020.
Author
Raic R.; Steurer L.M.; Balakas K.; Ercole P.M.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Pediatric patients undergoing cardiac catheterization
procedures are required to lie flat for 4 hours for femoral venous access
and 6 hours for femoral arterial access. Authors of research in adults
suggest the flat time for the same access can be safely reduced to 1.5 to
2 hours post procedure. No literature was found that flat times could be
safely reduced for pediatric patients. <br/>OBJECTIVE(S): The purpose of
this study was to determine whether decreased flat time for the
post-cardiac catheterization pediatric patient would impact the incidence
of site bleeding, additional sedation, and the need for a critical care
admission. <br/>METHOD(S): A randomized controlled trial was designed and
participants were randomly assigned to experimental or control group. The
experimental group reduced flat times to 2 hours for venous and 4 hours
for arterial. The control group was standard care of 4 hours for venous
and 6 hours for arterial. <br/>RESULT(S): A total of 119 participants were
enrolled, 60 in the experimental group and 59 in the control group.
Results suggest no difference in the incidence of site bleeding (P =
.999), additional sedation (P = .653), or need for a critical care
admission. <br/>CONCLUSION(S): For pediatric patients undergoing arterial
or venous cardiac catheterizations, flat times can safely be reduced
without increasing site bleeding, additional sedation, or critical care
admissions.

<13>
Accession Number
636090697
Title
Systematic review and meta-analysis of the sedative effects and safety of
dexmedetomidine in patients after cardiac surgery.
Source
Annals of palliative medicine. 10(8) (pp 8952-8962), 2021. Date of
Publication: 01 Aug 2021.
Author
Wu J.; Li G.; Zhang H.; Li H.
Institution
(Wu, Li, Zhang, Li) Department of Anesthesiology, Fourth Hospital of
Shijiazhuang, Obstetrics and Gynecology Hospital of Hebei Medical
University, Shijiazhuang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In order to increase the sample size and improve the test
efficiency from a statistical perspective, we conducted a combined
analysis of multiple results from similar studies. In this study, we
conducted a meta-analysis to investigate the sedative effect of
dexmedetomidine on patients after cardiac surgery, so as to provide
theoretical basis and help for clinical treatment of cardiac diseases.
<br/>METHOD(S): The Boolean logic search method was employed to search
online databases for publications, with "dexmedetomidine", "cardiac
surgery", "competitive antagonist", and "analgesic sedation" used as
keywords. In addition, the literature was screened for comparative studies
on the use of midazolam and propofol as controls. The Newcastle-Ottawa
Scale (NOS) of Cochrane Collaborative Network was used to evaluate the
pathological control studies in Meta-analysis, and the star rating system
(out of 9 stars) was used to measure the results from the subjects, cases
and groups. Finally, a meta-analysis was performed with Review Manager
software (Cochrane). <br/>RESULT(S): Thirteen references containing mostly
low-risk biases (medium-high quality) were included in this study. The
meta-analysis showed no statistically obvious heterogeneity in the
mechanical ventilation time (MVT) between patients in the control group
(group A) or patients in the experimental group (group B) (Chi2=74.71;
I2=92%; P<0.00001), showing no statistical significance (Z=1.57; P=0.12).
Heterogeneity was found as a complication in both groups (Chi2=14.82;
I2=60%; P=0.02), but fewer complications were observed in group B (Z=2.06,
P=0.04). The sedative effect displayed by patients from the 2 groups
during the induction of anesthesia was statistically heterogeneous
(Chi2=6.45; I2=38%; P=0.17), but the sedative effect in group B was shown
to be greater (Z=3.31, P=0.0009). <br/>CONCLUSION(S): Dexmedetomidine can
significantly reduce the mechanical ventilation time and the incidence of
complications in patients after cardiac surgery, and has a high safety and
good sedative effect on patients.

<14>
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). <br/>Design(s): This was a
single-center, randomized, unblinded clinical trial. <br/>Setting(s): The
study was performed in a teaching hospital. <br/>Participant(s): Between
January 2020 and January 2021, a total of 150 infants underwent CHS in the
authors' hospital. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2021 Elsevier
Inc.

<15>
Accession Number
636090405
Title
Meta-analysis of randomised controlled trials of perioperative
dexmedetomidine to reduce delirium and mortality after cardiac surgery.
Source
British journal of anaesthesia. (no pagination), 2021. Date of
Publication: 03 Sep 2021.
Author
Sanders R.D.; Wehrman J.; Irons J.; Dieleman J.; Scott D.; Shehabi Y.
Institution
(Sanders) University of Sydney, Camperdown, NSW, Australia; Department of
Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia;
Institute of Academic Surgery, Camperdown, NSW, Australia
(Wehrman) University of Sydney, NSW, Camperdown, Australia
(Irons) University of Sydney, Camperdown, NSW, Australia; Department of
Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
(Dieleman) Department of Anaesthesia & Perioperative Medicine, NSW,
Westmead Hospital ,Westmead, Australia
(Scott) Department of Anaesthesia & Acute Pain Medicine, St Vincent's
Hospital, Melbourne, VIC, Australia; University of Melbourne, Melbourne,
VIC, Australia
(Shehabi) Monash Health School of Clinical Sciences, Monash University,
Melbourne, VIC, Australia; Prince of Wales Clinical School of Medicine,
University of New South Wales, Randwick, NSW, Australia
Publisher
NLM (Medline)

<16>
Accession Number
636089760
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 : journal of the
International Society for Quality in Health Care. (no pagination), 2021.
Date of Publication: 07 Sep 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
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Zhang, Lei, Liu, Cao, Chen) Fujian Key Laboratory of Women and Children's
Critical Diseases Research, Fujian Maternity and Child Health Hospital,
Fuzhou, China
(Zhang, Lei, Liu, Cao, Chen) Fujian Branch of Shanghai Children's Medical
Center, Fuzhou, China
(Zhang, Lei, Liu, Cao, Chen) Fujian Children's Hospital, Fuzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: 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 surgery after discharge. <br/>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 congenital heart disease 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. <br/>RESULT(S): One month after
discharge, the SAS and 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 one month after
discharge (P<0.05), while the scores of parents in the control group were
similar at one 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 were, the higher their SAS and SDS scores were
(P<0.05). One month after discharge, in the control group, the lower the
parents' education levels were, 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 WHOQOL-BREF scale showed that the scores of the
physiological, psychological, social and environmental fields at one month
after discharge in the intervention group were significantly higher than
those in the control group (P<0.05). <br/>CONCLUSION(S): Providing health
education and medical support to the parents of infants with congenital
heart disease surgery after discharge via telemedicine can effectively
relieve the parents' anxiety and depression and improve their quality of
life.<br/>Copyright &#xa9; The Author(s) 2021. Published by Oxford
University Press on behalf of International Society for Quality in Health
Care. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<17>
Accession Number
636079854
Title
Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review.
Source
Pain medicine (Malden, Mass.). (no pagination), 2021. Date of
Publication: 06 Sep 2021.
Author
Lobova V.A.; Roll J.M.; Roll M.L.C.
Institution
(Lobova, Roll) Elson S. Floyd College of Medicine, Washington State
University, Spokane, WA, United States
(Roll) Department of Community and Behavioral Health, Program of
Excellence in the Addictions, Washington State University, Spokane, WA,
United States
(Roll) Macalester College, Saint Paul, Minnesota
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To investigate the effects of intraoperative methadone to
standard of care opioids such as fentanyl and morphine on pain scores,
opioid consumption, and adverse effects in adults undergoing
cardiothoracic surgery. <br/>METHOD(S): The literature was reviewed on
PubMed, Embase, Cochrane Library, and Google Scholar, followed by a manual
search using reference lists of the identified articles. Search terms
included a combination of intraoperative methadone, methadone, and cardiac
surgery. Our review includes four studies published between 2011 and 2020.
Quality assessment of the studies was performed. <br/>RESULT(S): The
initial search identified 715 articles with 461 duplicates removed, and
236 eliminated based on inclusion and exclusion criteria. Eighteen
articles underwent full-text review. Four studies evaluating a total of
435 patients with various cardiothoracic procedures were included in this
review. We found that intraoperative methadone decreases acute
postoperative pain and reduces postoperative opioid consumption in the
first 24 postoperative hours in patients who received 0.1-0.3mg/kg
intraoperative methadone in comparison to morphine and fentanyl. No
difference was found in adverse effects between the groups. Quality
assessment of the studies showed a low risk of bias in three of the
randomized controlled trials and a high risk of bias in the retrospective
review because of the baseline confounding bias in the study design.
<br/>CONCLUSION(S): Intraoperative methadone use reduces acute
postoperative pain and lowers opioid consumption in comparison to morphine
and fentanyl. Initial results suggest that methadone may be an equivalent
opioid to be administered during cardiothoracic procedures to reduce acute
post-surgical pain, though further research is warranted.<br/>Copyright
&#xa9; The Author(s) 2021. Published by Oxford University Press on behalf
of the American Academy of Pain Medicine.

<18>
Accession Number
2005442925
Title
Bright light therapy for depressive symptoms in hospitalized cardiac
patients: A randomized controlled pilot trial.
Source
PLoS ONE. 15(3) (no pagination), 2020. Article Number: e0230839. Date of
Publication: March-2020.
Author
Eisenberg M.J.; Habib B.; Alcaraz M.; Thombs B.D.; Filion K.B.
Institution
(Eisenberg, Habib, Alcaraz, Thombs, Filion) Center for Clinical
Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC,
Canada
(Eisenberg, Thombs, Filion) Department of Medicine, McGill University,
Montreal, QC, Canada
(Eisenberg, Thombs, Filion) Department of Epidemiology, Biostatistics and
Occupational Health, McGill University, Montreal, QC, Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, McGill
University, Montreal, QC, Canada
(Thombs) Departments of Psychiatry, of Psychology, and of Educational and
Counselling Psychology, McGill University, Montreal, QC, Canada
Publisher
Public Library of Science
Abstract
Depression is common among cardiac patients and associated with adverse
cardiovascular outcomes. Bright light therapy has emerged as a promising
treatment for depressive symptoms, however it has not yet been
investigated in this population. We conducted a double-blind, randomized,
placebo-controlled pilot trial to assess the feasibility of a larger-scale
trial testing bright light therapy for depressive symptoms in cardiac
patients. Patients hospitalized for an acute coronary syndrome or
undergoing cardiac surgery were randomized to either bright light (10,000
lux) or dim light placebo (500 lux) lamps for 30 minutes each day over 4
weeks, beginning in-hospital. Depression was quantified using the Patient
Health Questionnaire 9 (PHQ-9) and Depression Anxiety and Stress Scales
(DASS-21). The Short-Form Health Survey 36 (SF-36) was used to measure
quality of life. A total of 175 patients were screened and 15 were
randomized (8 treatment, 7 placebo) (8.6%) over 10 months. Despite
protocol amendments which broadened the inclusion criteria, the trial was
terminated early for infeasibility based on the rate of enrollment (1-2
participants/month), with 39.5% of the target sample (38 participants)
enrolled. Future trials should take into account the timing of the onset
of depressive symptoms in these patients, and consider a less conservative
approach to eligibility as well as ways to increase the acceptability of
bright light therapy in hospitalized cardiac patients. Once enrolled, our
findings suggest that most participants will adhere to the assigned
treatment and complete follow-up.<br/>Copyright &#xa9; 2020 Eisenberg et
al. This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author
and source are credited.

<19>
Accession Number
2005079509
Title
A systematic review and meta-analysis on the effectiveness of an invasive
strategy compared to a conservative approach in patients > 65 years old
with non-ST elevation acute coronary syndrome.
Source
PLoS ONE. 15(2) (no pagination), 2020. Article Number: e0229491. Date of
Publication: February-2020.
Author
Reano J.D.P.; Shiu L.A.B.; Miralles K.V.; Dimalala M.G.C.; Pestano N.S.;
Punzalan F.E.R.; Tumanan-Mendoza B.; Reyes M.J.T.; Castillo R.R.
Institution
(Reano, Shiu, Miralles, Pestano, Punzalan, Tumanan-Mendoza, Reyes,
Castillo) Adult Cardiology, Manila Doctors Hospital, Manila, Philippines
(Dimalala, Reyes) Interventional Cardiology, Manila Doctors Hospital,
Manila, Philippines
(Punzalan) Division of Cardiology, Department of Medicine, Philippine
General Hospital, College of Medicine University of the Philippines,
Manila, Philippines
(Castillo) Cardiovascular Medicine, Adventist University of the
Philippines, Silang, Philippines
(Castillo) FAME Leaders Academy, Makati, Philippines
Publisher
Public Library of Science
Abstract
Background Patients 65 years old and older largely represent (>50%)
hospital-admitted patients with acute coronary syndrome (ACS). Data are
conflicting comparing efficacy of early routine invasive (within 48-72
hours of initial evaluation) versus conservative management of ACS in this
population. Objective We aimed to determine the effectiveness of routine
early invasive strategy compared to conservative treatment in reducing
major adverse cardiovascular events in patients 65 years old and older
with non-ST elevation (NSTE) ACS. Data sources We conducted a systematic
review of randomized controlled trials (RCTs) through PubMed, Cochrane,
and Google Scholar database. Study selection The studies included were
RCTs that evaluated the effectiveness of invasive strategy compared to
conservative treatment among patients >= 65 years old diagnosed with
NSTEACS. Studies were included if they assessed any of the following
outcomes of death, cardiovascular mortality, myocardial infarction (MI),
stroke, recurrent angina, and need for revascularization. Six articles
were subsequently included in the meta-analysis. Data extraction Three
independent reviewers extracted the data of interest from the articles
using a standardized data collection form that included study quality
indicators. Disparity in assessment was adjudicated by another reviewer.
Data synthesis All pooled analyses were initially done using Fixed Effects
model. For pooled analyses with significant heterogeneity (I²>=
50%), the Random Effects model was used. A total of 3,768 patients were
included, 1,986 in the invasive strategy group, and 1,782 in the
conservative treatment group. Results Meta-analysis showed less incidence
of revascularization in the invasive (2%) over conservative treatment
groups (8%), with overall risk ratio of 0.29 (95% CI 0.14 to 0.59). Across
all pooled studies, no significant effect of invasive strategy on
all-cause mortality, cardiovascular mortality, stroke, and MI was
observed. Only one study assessed the outcome of recurrent angina.
Conclusion There was a significantly lower rate of revascularization in
the invasive strategy group compared to the conservative treatment group.
In the reduction of all-cause mortality, cardiovascular mortality, MI, and
stroke there was no significant effect of invasive strategy versus
conservative treatment. This finding does not support the bias against
early routine invasive intervention in patients >= 65 years old with
NSTEACS. Further studies focusing on these patients with larger population
sizes are still needed.<br/>Copyright &#xa9; 2020 Reano et al. This is an
open access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<20>
Accession Number
2004751247
Title
A review on cardiorenal syndrome.
Source
Journal of the Indian Medical Association. 118(4) (pp 9-13), 2020. Date of
Publication: April 2020.
Author
Arulrhaj S.; Princy John P.
Institution
(Arulrhaj, Princy John) Sundaram Arulrhaj Hospitals, Tuticorin, India
Publisher
Indian Medical Association
Abstract
Cardio-renal syndrome is a blanket term which is used to denote clinical
conditions where there is coexistence of cardiac & renal deteriorations.
Considering the multitude of articles written about this topic, still the
underlying pathophysiological mechanisms continue to be puzzled and
implications for management continue to be debated. A classification for
CRS has been proposed in 2008 which is being used in clinical practice.
There is also need for cardio-renal interdisciplinary team for early
identification of decompensated cardio-renal syndrome and their
appropriate management. Here we review the epidemiology, classification of
CRS, the pathological mechanisms proposed & then focus on management
strategies. In this review article, we try to summarize the results from
MEDLINE, PubMed, Cochrane Library, Google and Google Scholar search (last
article updated till 2019) on the current understanding Cardio-renal
syndrome.<br/>Copyright &#xa9; 2020, Indian Medical Association. All
rights reserved.

<21>
Accession Number
359715944
Title
Comparative study of postoperative analgesia and sedation after upper
abdominal surgery with thoracic epidural administration of bupivacaine
with/without midazolam.
Source
Journal of the Indian Medical Association. 107(1) (pp 26-29), 2009. Date
of Publication: January 2009.
Author
Shroff P.P.; Kaushal V.; Kamdar B.M.
Institution
(Shroff, Kaushal, Kamdar) Department of Anaesthesiology, TN Medical
College, BYL Nair Charitable Hospital, Mumbai 400008, India
Publisher
Indian Medical Association
Abstract
Currently continuous epidural administration of local anaesthetics with
opioids is widely used for postoperative analgesia. To avoid the
side-effects of opioids a drug that can replace opioids is most welcome.
Midazolam not only has no side-effects but also has the advantages of
sedation and amnesia. In a prospective randomised clinical study ASA class
1 or 2 patients undergoing upper abdominal surgeries were studied to
compare the analgesic and sedative effect of continuous thoracic epidural
infusion of bupivacaine versus continuous thoracic epidural administration
of bupivacaine with midazolam postoperatively. They were divided into 2
groups. Via thoracic epidural route patients in group A (n=24) were given
60 ml of 0.25% bupivacaine while those in group B (n=25) were given 58 ml
of 0.25% bupivacaine + midazolam 2 ml (10mg). Each patient was infused
using a syringe pump at the rate of 5 ml/hour. Variables studied
postoperatively were pulse, BP, RR, SpO<inf>2</inf>, analgesia score and
sedation score. Statistically significant differences in pulse, BP, RR and
SpO<inf>2</inf> were not seen. Better sedation, analgesia scores and
amnesia were noted in patients belonging to group B as compared to
patients of group A. This combination may thus replace routinely used
combinations of opioids and local anaesthetics.

<22>
Accession Number
2014071056
Title
New internet-based warfarin anticoagulation management approach after
mechanical heart valve replacement: Prospective, multicenter, randomized
controlled trial.
Source
Journal of Medical Internet Research. 23(8) (no pagination), 2021. Article
Number: e29529. Date of Publication: August 2021.
Author
Zhu Z.; Li C.; Shen J.; Wu K.; Liu K.; Zhang F.; Zhang Z.; Li Y.; Han J.;
Qin Y.; Yang Y.; Fan G.; Ding Z.; Xu D.; Chen Y.; Zheng Y.; Zheng Z.; Meng
X.; Zhang H.
Institution
(Zhu, Shen, Wu, Li, Liu, Zhang, Zhang, Li, Han, Qin, Meng, Zhang)
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical
University, Beijing, China
(Zhu) Ludwig Maximilian University of Munich, Munich, Germany
(Li) Renal Division, Department of Medicine IV, Ludwig Maximilian
University of Munich, Munich, Germany
(Zhang) Department of Cardiovascular Surgery, Beijing Luhe Hospital,
Capital Medical University, Beijing, China
(Yang, Xu) Department of Cardiovascular Surgery, Beijing Xuanwu Hospital,
Beijing, China
(Fan, Chen) Department of Cardiovascular Surgery, Peking University
People's Hospital, Beijing, China
(Zhang) Department of Cardiovascular Surgery, PLA General Hospital,
Beijing, China
(Ding, Zheng) Department of Pharmacy, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China
(Zheng) Department of Cardiovascular Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences,
Peking Union Medical College, Beijing, China
Publisher
JMIR Publications Inc.
Abstract
Background: Mechanical heart valve replacement (MHVR) is an effective
method for the treatment of severe heart valve disease; however, it
subjects patient to lifelong warfarin therapy after MHVR with the
attendant risk of bleeding and thrombosis. Whether internet-based warfarin
management reduces complications and improves patient quality of life
remains unknown. <br/>Objective(s): This study aimed to compare the
effects of internet-based warfarin management and the conventional
approach in patients who received MHVR in order to provide evidence
regarding alternative strategies for long-term anticoagulation.
<br/>Method(s): This was a prospective, multicenter, randomized,
open-label, controlled clinical trial with a 1-year follow-up. Patients
who needed long-term warfarin anticoagulation after MHVR were enrolled and
then randomly divided into conventional and internet-based management
groups. The percentage of time in the therapeutic range (TTR) was used as
the primary outcome, while bleeding, thrombosis, and other events were the
secondary outcomes. <br/>Result(s): A total of 721 patients were enrolled.
The baseline characteristics did not reach statistical differences between
the 2 groups, suggesting the random assignment was successful. As a
result, the internet-based group showed a significantly higher TTR (mean
0.53, SD 0.24 vs mean 0.46, SD 0.21; P<.001) and fraction of time in the
therapeutic range (mean 0.48, SD 0.22 vs mean 0.42, SD 0.19; P<.001) than
did those in the conventional group. Furthermore, as expected, the
anticoagulation complications, including the bleeding and embolic events
had a lower frequency in the internet-based group than in the conventional
group (6.94% vs 12.74%; P=.01). Logistic regression showed that
internet-based management increased the TTR by 7% (odds ratio [OR] 1.07,
95% CI 1.05-1.09; P<.001) and reduced the bleeding and embolic risk by 6%
(OR 0.94, 95% CI 0.92-0.96; P=.01). Moreover, low TTR was found to be a
risk factor for bleeding and embolic events (OR 0.87, 95% CI 0.83-0.91;
P=.005). <br/>Conclusion(s): The internet-based warfarin management is
superior to the conventional method, as it can reduce the anticoagulation
complications in patients who receive long-term warfarin anticoagulation
after MHVR.<br/>Copyright &#xa9;Zhihui Zhu, Chenyu Li, Jinglun Shen,
Kaisheng Wu, Yuehuan Li, Kun Liu, Fan Zhang, Zhenhua Zhang, Yan Li, Jie
Han, Ying Qin, Yu Yang, Guangpu Fan, Huajun Zhang, Zheng Ding, Dong Xu, Yu
Chen, Yingli Zheng, Zhe Zheng, Xu Meng, Haibo Zhang.

<23>
Accession Number
2013626001
Title
Guided relaxation-based virtual reality for acute postoperative pain and
anxiety in a pediatric population: pilot observational study.
Source
Journal of Medical Internet Research. 23(7) (no pagination), 2021. Article
Number: e26328. Date of Publication: July 2021.
Author
Olbrecht V.A.; O'Conor K.T.; Williams S.E.; Boehmer C.O.; Marchant G.W.;
Glynn S.M.; Geisler K.J.; Ding L.; Yang G.; King C.D.
Institution
(Olbrecht) Center for Understanding Pediatric Pain, Department of
Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, United States
(O'Conor, Boehmer, Marchant, Glynn, Geisler) Department of Anesthesiology,
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United
States
(Williams, King) Center for Understanding Pediatric Pain, Division of
Behavioral Medicine and Clinical Psychology, Department of Pediatrics,
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United
States
(Ding, Yang) Division of Biostatistics and Epidemiology, Department of
Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,
United States
Publisher
JMIR Publications Inc.
Abstract
Background: Distraction-based therapies, such as virtual reality (VR),
have been used to reduce pain during acutely painful procedures. However,
distraction alone cannot produce prolonged pain reduction to manage
sustained postoperative pain. Therefore, the integration of VR with other
pain-reducing therapies, like guided relaxation, may enhance its clinical
impact. <br/>Objective(s): The goal of this pilot study was to assess the
impact of a single guided relaxation-based VR (VR-GR) session on
postoperative pain and anxiety reduction in children. We also explored the
influence of pain catastrophizing and anxiety sensitivity on this
association. <br/>Method(s): A total of 51 children and adolescents (7-21
years) with postoperative pain and followed by the Acute Pain Service at
Cincinnati Children's Hospital were recruited over an 8-month period to
undergo a single VR-GR session. Prior to VR, the patients completed 2
questionnaires: Pain Catastrophizing Scale for Children (PCS-C) and the
Child Anxiety Sensitivity Index (CASI). The primary outcome was a change
in pain intensity following the VR-GR session (immediately, 15 minutes,
and 30 minutes). The secondary outcomes included changes in pain
unpleasantness and anxiety. <br/>Result(s): The VR-GR decreased pain
intensity immediately (P<.001) and at 30 minutes (P=.04) after the VR
session, but not at 15 minutes (P=.16) postsession. Reductions in pain
unpleasantness were observed at all time intervals (P<.001 at all
intervals). Anxiety was reduced immediately (P=.02) but not at 15 minutes
(P=.08) or 30 minutes (P=.30) following VR-GR. Patients with higher CASI
scores reported greater reductions in pain intensity (P=.04) and
unpleasantness (P=.01) following VR-GR. Pain catastrophizing was not
associated with changes in pain and anxiety. <br/>Conclusion(s): A single,
short VR-GR session showed transient reductions in pain intensity, pain
unpleasantness, and anxiety in children and adolescents with acute
postoperative pain. The results call for a future randomized controlled
trial to assess the efficacy of VR-GR.<br/>Copyright &#xa9; Vanessa A
Olbrecht, Keith T O'Conor, Sara E Williams, Chloe O Boehmer, Gilbert W
Marchant, Susan M Glynn, Kristie J Geisler, Lili Ding, Gang Yang,
Christopher D King. Originally published in the Journal of Medical
Internet Research (https://www.jmir.org), 12.07.2021. This is an
open-access article distributed under the terms of the Creative Commons
Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in the Journal of Medical
Internet Research, is properly cited. The complete bibliographic
information, a link to the original publication on https://www.jmir.org/,
as well as this copyright and license information must be included.

<24>
Accession Number
2010778812
Title
Comparison of alternate preparative techniques on wall thickness in
coronary artery bypass grafts: The HArVeST randomized controlled trial.
Source
Journal of Cardiac Surgery. 36(6) (pp 1985-1995), 2021. Date of
Publication: June 2021.
Author
Angelini G.D.; Johnson T.; Culliford L.; Murphy G.; Ashton K.; Harris T.;
Edwards J.; Clayton G.; Kim Y.; Newby A.C.; Reeves B.C.; Rogers C.A.
Institution
(Angelini, Johnson, Newby) Bristol Heart Institute, University of Bristol,
Bristol, United Kingdom
(Culliford, Ashton, Harris, Reeves, Rogers) Clinical Trials and Evaluation
Unit, Bristol Trials Centre, University of Bristol, Bristol, United
Kingdom
(Murphy) MRC Integrative Epidemiology Unit, University of Bristol,
Bristol, United Kingdom
(Edwards) Department of Cardiovascular Sciences, University of Leicester,
Leicester, United Kingdom
(Clayton) School of Health and Related Research, University of Sheffield,
Sheffield, United Kingdom
(Kim) Yongin Severance Hospital, Yonsei University College of Medicine,
Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background: The success of coronary artery bypass grafting surgery (CABG)
is dependent on long-term graft patency, which is negatively related to
early wall thickening. Avoiding high-pressure distension testing for leaks
and preserving the surrounding pedicle of fat and adventitia during vein
harvesting may reduce wall thickening. <br/>Method(s): A single-centre,
factorial randomized controlled trial was carried out to compare the
impact of testing for leaks under high versus low pressure and harvesting
the vein with versus without the pedicle in patients undergoing CABG. The
primary outcomes were graft wall thickness, as indicator of medial-intimal
hyperplasia, and lumen diameter assessed using intravascular ultrasound
after 12 months. <br/>Result(s): Ninety-six eligible participants were
recruited. With conventional harvest, low-pressure testing tended to yield
a thinner vessel wall compared with high-pressure (mean difference [MD;
low minus high] -0.059 mm, 95% confidence interval (CI) -0.12, +0.0039, p
=.066). With high pressure testing, veins harvested with the pedicle fat
tended to have a thinner vessel wall than those harvested conventionally
(MD [pedicle minus conventional] -0.057 mm, 95% CI: -0.12, +0.0037, p
=.066, test for interaction p =.07). Lumen diameter was similar across
groups (harvest comparison p =.81; pressure comparison p =.24).
Low-pressure testing was associated with fewer hospital admissions in the
12 months following surgery (p =.0008). Harvesting the vein with the
pedicle fat was associated with more complications during the index
admission (p =.0041). <br/>Conclusion(s): Conventional saphenous vein
graft preparation with low-pressure distension and harvesting the vein
with a surrounding pedicle yielded similar graft wall thickness after 12
months, but low pressure was associated with fewer adverse
events.<br/>Copyright &#xa9; 2021 The Authors. Journal of Cardiac Surgery
Published by Wiley Periodicals LLC

<25>
Accession Number
2010533944
Title
Infective endocarditis by Klebsiella species: a systematic review.
Source
Journal of Chemotherapy. 33(6) (pp 365-374), 2021. Date of Publication:
2021.
Author
Ioannou P.; Miliara E.; Baliou S.; Kofteridis D.P.
Institution
(Ioannou, Miliara, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
(Baliou) National Hellenic Research Foundation, Athens, Greece
Publisher
Taylor and Francis Ltd.
Abstract
This study aimed to systematically analyze all cases of infective
endocarditis (IE) by Klebsiella species in the literature. A systematic
review of PubMed, Scopus and Cochrane library (through 27^th
January 2021) for studies providing epidemiological, clinical,
microbiological as well as treatment data and outcomes of IE by Klebsiella
species was performed. In this review, a total of 66 studies were
included, providing data for 67 patients. A prosthetic valve was present
in 16.4%, while the most common causative pathogen was K. pneumoniae
followed by K. oxytoca. The aortic valve was the most commonly infected
intracardiac site, followed by the mitral valve. The diagnosis was based
on transthoracic echocardiography in 46.2%, while the diagnosis was set at
autopsy in 9.2% of included patients. Blood cultures were positive in
93.8%. Fever and sepsis were the most frequent clinical presentations,
followed by embolic phenomena, paravalvular abscess, and heart failure.
Cephalosporins, aminoglycosides, and carbapenems were the most frequently
used antimicrobials. Surgical treatment along with antimicrobials was
performed in 37.3% of included patients. Clinical cure was noted in 80.3%,
while the overall mortality was 19.4%. Infection at the aortic valve was
independently associated with mortality by IE. This systematic review
gives a comprehensive description of IE by Klebsiella and provides
information on epidemiology, clinical manifestations, therapeutic
strategies and their outcomes.<br/>Copyright &#xa9; 2021 Edizioni
Scientifi che per l'Informazione su Farmaci e Terapia.

<26>
Accession Number
2008566461
Title
The Effect of Propofol Versus Volatile Anesthetics on Persistent Pain
After Cardiac Surgery: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(8) (pp 2438-2446),
2021. Date of Publication: August 2021.
Author
Xu Z.; Dai S.-H.; Jiang J.-L.; He L.-L.; Zheng J.-Q.; Yu H.
Institution
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) Department of Anesthesiology, West
China Hospital, Sichuan University, Chengdu, China
(Yu, Xu, Dai, Jiang, He, Zheng, Yu) The Research Units of West China
(2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
Publisher
W.B. Saunders
Abstract
Objectives: Sternal incisions can generate persistent and intense
post-sternotomy pain. Propofol has been shown to improve postoperative
analgesia, but the preventive effect on persistent pain after cardiac
surgery is unknown. The hypothesis of the present study was that
intraoperative propofol-based anesthesia compared with volatile anesthesia
could reduce the risk of chronic pain after cardiac surgery.
<br/>Design(s): A single-center, two-arm, patient-and-evaluator-blinded,
randomized controlled trial. <br/>Setting(s): A single major urban
teaching and university hospital. <br/>Patient(s): Five-hundred adult
patients undergoing cardiac surgery via sternotomy randomly were assigned.
With six withdrawals from the study and five from surgery, 244 in the
total intravenous anesthesia group and 245 in the volatile group were
included in the modified intention-to-treat analysis.
<br/>Intervention(s): Patients randomly were assigned to receive either
propofol-based total intravenous anesthesia or volatile anesthesia during
surgery. <br/>Measurements and Main Results: The primary outcomes were the
incidence of pain at three, six, and 12 months after surgery defined as
pain score >0 on the numeric rating scale. The secondary outcomes included
acute pain, opioid use during the first 72 hours after surgery, and
quality of life. The use of propofol did not significantly affect chronic
pain at three months (55.4% v 52.9%, difference 2.5%, 95% confidence
interval [CI] -6.6 to 11.6; p = 0.656), six months (35.5% v 37.5%,
difference -2.0%, 95% CI -10.9 to 6.9; p = 0.657), or 12 months (18.2% v
20.7%, difference -2.5%, 95% CI -9.8 to 4.8; p = 0.495) compared with
volatile anesthetics. Furthermore, there were no differences in acute pain
score; morphine-equivalent consumption during the first 72 hours; and
quality of life at three, six, and 12 months after surgery.
<br/>Conclusion(s): Intraoperative administration of propofol did not
reduce persistent pain after cardiac surgery compared with volatile
anesthetics.<br/>Copyright &#xa9; 2020 Elsevier Inc.

<27>
Accession Number
2007872671
Title
Effect of deep versus moderate neuromuscular blockade on quantitatively
assessed postoperative atelectasis using computed tomography in thoracic
surgery; a randomized double-blind controlled trial.
Source
Journal of Clinical Medicine. 10(15) (no pagination), 2021. Article
Number: 3228. Date of Publication: 01 Aug 2021.
Author
Lee B.-J.; Lee H.N.; Chung J.-Y.; Kim D.; Kim J.I.; Seo H.
Institution
(Lee, Chung, Seo) Department of Anesthesiology and Pain Medicine, Kyung
Hee University Hospital at Gangdong, College of Medicine, Kyung Hee
University, Seoul 05278, South Korea
(Lee, Kim) Department of Radiology, Kyung Hee University Hospital at
Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South
Korea
(Kim) Department of Thoracic Surgery, Kyung Hee University Hospital at
Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, South
Korea
Publisher
MDPI
Abstract
Background: postoperative atelectasis is a significant clinical problem
during thoracic surgery with one-lung ventilation. Intraoperative deep
neuromuscular blockade can improve surgical conditions, but an increased
risk of residual paralysis may aggravate postoperative atelectasis. Every
patient was verified to have full reversal before extubation. We compared
the effect of deep versus moderate neuromuscular blockade on postoperative
atelectasis quantitatively using chest computed tomography.
<br/>Method(s): patients undergoing thoracic surgery were randomly
allocated to two groups: moderate neuromuscular blockade during surgery
(group M) and deep neuromuscular blockade during surgery (group D). The
primary outcome was the proportion and the volume of postoperative
atelectasis measured by chest computed tomography on postoperative day 2.
The mean values of the repeatedly measured intraoperative dynamic lung
compliance during surgery were also compared. <br/>Result(s): the
proportion of postoperative atelectasis did not differ between the groups
(1.32 [0.47-3.20]% in group M and 1.41 [0.24-3.07]% in group D, p =
0.690). The actual atelectasis volume was 38.2 (12.8-61.4) mL in group M
and 31.9 (7.84-75.0) mL in group D (p = 0.954). Some factors described in
the lung protective ventilation were not taken into account and might
explain the atelectasis in both groups. The mean lung compliance during
one-lung ventilation was higher in group D (26.6% in group D vs. 24.1% in
group M, p = 0.026). <br/>Conclusion(s): intraoperative deep neuromuscular
blockade did not affect postoperative atelectasis when compared with
moderate neuromuscular blockade if full reversal was
verified.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<28>
Accession Number
2007517245
Title
Comparison of the effect of cognitive-behavioral therapy and dialectical
behavioral therapy on perceived stress and coping skills in patients after
myocardial infarction.
Source
ARYA Atherosclerosis. 17(1) (no pagination), 2021. Article Number: 2188.
Date of Publication: 15 Jan 2021.
Author
Nourisaeed A.; Ghorban-Shiroudi S.; Salari A.
Institution
(Nourisaeed) Department of Psychology, Rasht Branch, Islamic Azad
University, Rasht, Iran, Islamic Republic of
(Ghorban-Shiroudi) Department of Psychology, Tonekabon Branch, Islamic
Azad University, Tonekabon, Iran, Islamic Republic of
(Salari) Cardiovascular Diseases Research Center AND Department of
Cardiology, Heshmat Hospital, School of Medicine, Guilan University of
Medical Sciences AND, Department of Psychology, Rasht Branch, Islamic Azad
University, Rasht, Iran, Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS)
Abstract
BACKGROUND: Among the cardiovascular diseases (CVDs), myocardial
infraction (MI) is one of the main causes of mortality around the world. A
diagnosis of MI may be followed by psychological problems, such as
depression, anxiety, and stress. Therefore, psychological interventions
can be beneficial in routine treatment. The purpose of this study was to
compare the effect of cognitive-behavioral therapy (CBT) and dialectical
behavioral therapy (DBT) on perceived stress and coping skills in patients
after MI. <br/>METHOD(S): This study was a randomized clinical trial with
a pretest-posttest design and control group. The statistical population
consisted of 45 patients after MI who referred to Noor Heart Clinic in
Rasht, Iran, between 2018 and 2019. They were randomly divided into 3
groups of 15 individuals (2 interventions including CBT and DBT, and 1
control group). In the intervention groups, participants underwent 8
weekly 90-minute sessions. Data were collected using a 3 part self-report
questionnaire including a demographic information form, the Ways of Coping
Questionnaire (WCQ), and the Perceived Stress Scale-14 (PSS-14). The
statistical methods used for data analysis included chi-square test,
one-way ANOVA, repeated-measures ANOVA, and post hoc Bonferroni test.
<br/>RESULT(S): We found significant main effects of group
(F<inf>(2,42)</inf>=6.11; P=0.005) and time (F<inf>(2,84)</inf>=28.48;
P<0.001), and a significant group-by-time interaction
(F<inf>(4,84)</inf>=8.97; P<0.001) on perceived stress scores. For
problem-focused coping scores, findings indicated significant main effects
of group (F<inf>(2,42)</inf>=7.33; P=0.002) and time
(F<inf>(2,84)</inf>=30.71; P<0.001), and a significant group-by-time
interaction (F<inf>(4,84)</inf>=12.86; P<0.001). For emotion-focused
coping scores, the results also indicated significant main effects of
group (F<inf>(2,42)</inf> = 17.41; P < 0.001) and time
(F<inf>(2,84)</inf>=31.74; P<0.001), and a significant group-by-time
interaction (F<inf>(4,84)</inf>=14.90; P<0.001). <br/>CONCLUSION(S): The
current study revealed that DBT was more effective in improving
emotionfocused coping than CBT.<br/>Copyright &#xa9; 2021, Isfahan
University of Medical Sciences(IUMS). All rights reserved.

<29>
Accession Number
2014435285
Title
Coronary artery bypass with single versus multiple arterial grafts in
women: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Robinson N.B.; Lia H.; Rahouma M.; Audisio K.; Soletti G.; Demetres M.;
Leonard J.R.; Fremes S.E.; Girardi L.N.; Gaudino M.
Institution
(Robinson, Rahouma, Audisio, Soletti, Leonard, Girardi, Gaudino)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York,
NY, United States
(Lia, Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Centre, Weill Cornell, Medicine, New York, NY, United States
Publisher
Mosby Inc.
Abstract
Objective: The study objective was to investigate the impact of multiple
arterial grafting on long-term all-cause mortality in women undergoing
isolated coronary artery bypass grafting. <br/>Method(s): A comprehensive
search was performed to identify observational studies reporting outcomes
after coronary artery bypass grafting reported by sex and stratified into
multiple arterial grafting versus single arterial grafting strategies.
Articles were considered for inclusion if they were written in English and
were propensity-matched observational studies. Included studies were then
pooled in a meta-analysis performed using the generic inverse variance
method. The primary outcome was long-term all-cause mortality. Secondary
outcomes were operative mortality and spontaneous myocardial infarction.
Meta-regression was used to explore the effects of preoperative and
intraoperative variables on the primary outcome. <br/>Result(s): A total
of 6 studies with 32,793 women (25,714 single arterial grafting and 7079
multiple arterial grafting) were included. Women who received multiple
arterial grafting had lower long-term mortality (incidence rate ratio,
0.86; 95% confidence interval, 0.76-0.96; P = .007) and spontaneous
myocardial infarction (incidence rate ratio, 0.80; 95% confidence
interval, 0.68-0.93; P = .003) compared with women who received single
arterial grafting, but the difference in mortality disappeared when
including only the 3 largest studies. There was no difference between
groups in operative mortality (odds ratio, 0.99; 95% confidence interval,
0.84-1.17; P = .91). Meta-regression did not identify any associations
with the incidence rate ratio for long-term mortality. <br/>Conclusion(s):
The use of multiple arterial grafting in women undergoing coronary artery
bypass grafting is associated with lower long-term mortality, although the
difference is mostly driven by small series. Further studies, including
randomized trials, are needed to evaluate the efficacy of multiple
arterial grafting in women undergoing coronary artery bypass
grafting.<br/>Copyright &#xa9; 2021 The American Association for Thoracic
Surgery

<30>
Accession Number
2013674373
Title
Management of pediatric cardiac surgery wound: A literature review.
Source
Acta Biomedica. 92(4) (no pagination), 2021. Article Number: e2021203.
Date of Publication: 02 Sep 2021.
Author
Prendin A.; Tabacco B.; Fazio P.C.; de Barbieri I.
Institution
(Prendin) University-Hospital of Padua, Padua, Italy
(Tabacco) Independent researcher, Seattle, United States
(Fazio) Pediatric Intensive Care Unit, UniversityHospital of Padua, Padua,
Italy
(de Barbieri) Woman's & Child's Health Department, University-Hospital of
Padua, Padua, Italy
Publisher
Mattioli 1885
Abstract
Background: Sternal wound infection is a severe complication of cardiac
surgery in the pediatric population (0-18 years old) that can lead to
increased morbidity, mortality, and prolonged hospitalization. Health
professionals have the ability to perform some interventions during the
pre, intra and post-surgery to correctly manage sternal wounds, with the
goal of preventing infections. <br/>Objective(s): To identify and discuss
current best practice in the prevention, incidence, and treatment of
infections of the cardiac surgery site in the pediatric population.
<br/>Method(s): Between February 20^th 2021 and February
28^th 2021 we consulted the PubMed database adopting full text,
20 years, Humans, English, Child aged 0 to 18 years as criteria. Twenty
articles out of sixty-six were considered relevant to this study. These
were divided into four themes. <br/>Result(s): All studies highlight the
lack of standard guidelines for managing pediatric patients undergoing
cardiac surgery. Some centers developed protocols for managing antibiotic
prophylaxis supported by measurable interventions; others implemented
infection surveillance systems involving families taking care of patients
after hospital discharge. <br/>Discussion(s): the identification of
healthcare-associated infections in the pediatric population after cardiac
surgery is useful in all peri-operative phases. The limited and restricted
literature connected to single centers, with relatively small sample
sizes, the use of a single database. <br/>Conclusion(s): There is a lack
of standard guidelines. The prevention of site infection ought to the goal
of reducing surgical site infections. Building a network between the
multidisciplinary staff and the pediatric patient's family improves the
infection surveillance system, reducing the incidence of infections.
(www.actabiomedica.it).<br/>Copyright &#xa9; Mattioli 1885.

<31>
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. <br/>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. <br/>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. <br/>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. <br/>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.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<32>
Accession Number
636031370
Title
Effects of Esketamine on Acute and Chronic Pain After Thoracoscopy
Pulmonary Surgery Under General Anesthesia: A Multicenter-Prospective,
Randomized, Double-Blind, and Controlled Trial.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 693594.
Date of Publication: 08 Sep 2021.
Author
Lei Y.; Liu H.; Xia F.; Gan S.; Wang Y.; Huo W.; Wang Q.; Ji F.
Institution
(Lei, Liu, Xia, Gan, Wang, Huo, Wang, Ji) Department of Anesthesiology,
The First Affiliated Hospital of Soochow University, Suzhou, China
Publisher
Frontiers Media S.A.
Abstract
Background: Post-operative pain management for patients undergoing
thoracoscopy surgery is challenging for clinicians which increase both
health and economic burden. The non-selective NMDA receptor antagonist
esketamine possesses an analgesic effect twice that of ketamine. The
application of esketamine might be beneficial in alleviating acute and
chronic pain after thoracic surgery. The current study describes the
protocol aiming to evaluate the analgesic effect of esketamine after
pulmonary surgery via visual analog scale (VAS) score for acute and
chronic pain. <br/>Method(s): A multi-center, prospective, randomized,
controlled, double-blind study is designed to explore the analgesic effect
of esketamine in randomized patients undergoing video-assisted
thoracoscopic surgery (VATS) with general anesthesia. Patients will be
randomly assigned to Esketamine Group (Group K) and Control Group (Group
C) in a ratio of 1:1. Group K patients will receive esketamine with a
bolus of 0.1 mg/kg after anesthesia induction, 0.1 mg/kg/h throughout the
operation and 0.015 mg/kg/h in PCIA after surgery while Group C patients
will receive the same volume of normal saline. The primary outcome is to
measure the pain intensity through the VAS score at 3 months after the
operation. The secondary outcome includes VAS score at 1, 4, 8, 24, and 48
h and on the 7th day and 1 month after the operation, complications,
ketamine-related neurological side effects, recovery time of bowel
function, and total amount of supplemental analgesics. <br/>Discussion(s):
The results of the current study might illustrate the analgesic effect of
esketamine for patients undergoing thoracoscopy pulmonary surgery and
provide evidence and insight for perioperative pain management. Study
Registration: The trial was registered with Chinese Clinical Trial
Registry (CHICTR) on Nov 18th, 2020 (ChiCTR2000040012).<br/>&#xa9;
Copyright &#xa9; 2021 Lei, Liu, Xia, Gan, Wang, Huo, Wang and Ji.

<33>
Accession Number
2014723469
Title
Comparative evaluation of high-flow nasal cannula oxygenation vs nasal
intermittent ventilation in postoperative paediatric patients operated for
acyanotic congenital cardiac defects.
Source
Medical Journal Armed Forces India. (no pagination), 2021. Date of
Publication: 2021.
Author
Kumar A.; Joshi S.; Tiwari N.; Kumar V.; Ramamurthy H.R.; Kumar G.; Sharma
V.
Institution
(Kumar) Classified Specialist (Anaesthesia & Cardio-Thoracic Anaesthesia),
Army Hospital (R&R), New Delhi, India
(Joshi) Senior Advisor (Anaesthesia) & Trained in Paediatric Anaesthesia,
Army Hospital (R&R), New Delhi, India
(Tiwari) Senior Advisor (Surgery) & Cardio-Thoracic Surgeon, Army Hospital
(R&R), New Delhi, India
(Kumar) Classified Specialist (Paediatric) & Trained in Paediatric
Cardiology, Army Hospital (R&R), New Delhi, India
(Ramamurthy) Senior Advisor (Paediatric) & Trained in Paediatric
Cardiology, Army Hospital (R&R), New Delhi, India
(Kumar) Senior Consultant (Paediatric Cardiac Surgery), Fortis Hospital,
Delhi, India
(Sharma) Head & Consultant (Cardiac Anaesthesia), KEM Hospital, Pune,
India
Publisher
Elsevier B.V.
Abstract
Background: This study aimed to compare high-flow nasal cannula (HFNC)
oxygenation vs nasal intermittent ventilation (NIV) oxygenation for
respiratory care after extubation in postoperative paediatric cardiac
patients. <br/>Method(s): This study was a randomised controlled trial.
One hundred twenty-one paediatric patients with acyanotic congenital heart
disease undergoing corrective cardiac surgery on cardiopulmonary bypass
were included in the study. Patients were randomised to receive either
HFNC (AIRVO) or NIV (RAM Cannula) postextubation. Arterial blood gas was
analysed at different time points perioperatively. <br/>Result(s):
Patients in both the groups were matched with respect to diagnosis and
demographic profiles. Baseline hemodynamic and respiratory parameters were
also similar in both the groups. Patients in HFNC/AIRVO group did not show
improved carbon dioxide (CO<inf>2</inf>) washout but showed improved
pO<inf>2</inf> and pO<inf>2</inf>/FiO<inf>2</inf> ratio immediate
postextubation. Reintubation rate and other intensive care unit (ICU)
complications were similar in both the groups. <br/>Conclusion(s):
Postcardiopulmonary bypass respiratory complications in paediatric
patients with congenital acyanotic heart disease can be minimised with
newer oxygen therapy devices such as AIRVO (HFNC) or RAM cannula (NIV). In
comparison between these two, AIRVO did not show improved CO<inf>2</inf>
washout over RAM cannula; however, it did provide better oxygenation as
measured by pO<inf>2</inf> in arterial blood and
pO<inf>2</inf>/FiO<inf>2</inf> ratio immediate postextubation. Also,
long-term results such as duration of mechanical ventilation and ICU stay
were not affected by the choice of device.<br/>Copyright &#xa9; 2021

<34>
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). <br/>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). <br/>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. <br/>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.<br/>Copyright &#xa9; 2021
Wiley Periodicals LLC.

<35>
Accession Number
2013615672
Title
Perioperative risk factors for new-onset postoperative atrial fibrillation
after coronary artery bypass grafting: a systematic review.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
418. Date of Publication: December 2021.
Author
Seo E.J.; Hong J.; Lee H.-J.; Son Y.-J.
Institution
(Seo) Ajou University College of Nursing and Research Institute of Nursing
Science, Suwon 16499, South Korea
(Hong) Department of Thoracic and Cardiovascular Surgery, Chung-Ang
University, Seoul 06974, South Korea
(Lee) Department of Nursing, Tongmyoung University, Busan 48520, South
Korea
(Son) Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro
Dongjak-Gu, Seoul 06974, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
cardiac dysrhythmia to occur after coronary artery bypass grafting (CABG).
However, the risk factors for new-onset POAF after CABG during the
perioperative period have yet to be clearly defined. Accordingly, the aim
of our systematic review was to evaluate the perioperative predictors of
new-onset POAF after isolated CABG. <br/>Method(s): Our review methods
adhered to the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses guideline. We searched seven electronic databases (PubMed,
Embase, CINAHL, PsycArticles, Cochrane, Web of Science, and SCOPUS) to
identify all relevant English articles published up to January 2020.
Identified studies were screened independently by two researchers for
selection, according to predefined criteria. The Newcastle-Ottawa Scale
was used to evaluate the quality of studies retained. <br/>Result(s):
After screening, nine studies were retained for analysis, including 4798
patients, of whom 1555 (32.4%) experienced new-onset POAF after CABG. The
incidence rate of new-onset POAF ranged between 17.3% and 47.4%. The
following risk factors were identified: old age (p < 0.001), a high
preoperative serum creatinine level (p = 0.001), a low preoperative
hemoglobin level (p = 0.007), a low left ventricle ejection fraction in
Asian patients (p = 0.001), essential hypertension (p < 0.001), chronic
obstructive pulmonary disease (p = 0.010), renal failure (p = 0.009),
cardiopulmonary bypass use (p = 0.002), perfusion time (p = 0.017),
postoperative use of inotropes (p < 0.001), postoperative renal failure (p
= 0.001), and re-operation (p = 0.005). All studies included in the
analysis were of good quality. <br/>Conclusion(s): The risk factors
identified in our review could be used to improve monitoring of at-risk
patients for early detection and treatment of new-onset POAF after CABG,
reducing the risk of other complications and negative clinical
outcomes.<br/>Copyright &#xa9; 2021, The Author(s).

<36>
Accession Number
2011014770
Title
The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane
Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(8) (pp 2483-2495),
2021. Date of Publication: August 2021.
Author
Kaddoura R.; Omar A.S.; Ibrahim M.I.M.; Alkhulaifi A.; Lorusso R.;
Elsherbini H.; Soliman O.; Caliskan K.
Institution
(Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical
Corporation, Doha, Qatar
(Omar, Alkhulaifi) Department of Cardiothoracic Surgery/Cardiac Anesthesia
& ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
(Ibrahim) Faculty of Pharmacy, Qatar University, Doha, Qatar
(Lorusso) Maastricht University Medical Centre (MUMC) Cardiovascular
Research Institute, Maastricht (CARIM) Maastricht University, Roterdam,
Netherlands
(Elsherbini) Cardiology, Erasmus University Medical Center, Roterdam,
Netherlands
(Soliman) National University of Ireland Galway, Galway, Ireland
(Caliskan) Cardiology, Erasmus University Medical Center, Roterdam,
Netherlands
Publisher
W.B. Saunders
Abstract
Objectives: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)
provides a temporary support system for patients with cardiogenic shock
refractory to conventional medical therapies. It has been reported that
levosimendan may facilitate VA-ECMO weaning and improve survival. The
primary objective of this review was to examine the effect of levosimendan
use on VA-ECMO weaning and mortality in critically ill patients on
VA-ECMO. <br/>Design(s): MEDLINE, EMBASE, and CENTRAL were searched. A
pair of reviewers identified eligible clinical trials. Two reviewers
extracted data and independently assessed the risk of bias. A
random-effect model was used to combine data. The primary outcome was the
success of weaning from VA-ECMO. <br/>Measurements and Main Results: Seven
studies of observational design, including a total of 630 patients, were
selected in the final analysis. The sample size ranged from ten-to-240
patients, with a mean age between 53 and 65 years, and more than half of
them underwent cardiac surgeries. The VA-ECMO durations varied between
four and 11.6 days. Overall, levosimendan use was significantly associated
with successful weaning compared with control (odds ratio [OR] 2.89, 95%
CI, 1.53-5.46; p<inf>overall effect</inf> = 0.001); I² = 49%).
For survival, six studies (n = 617) were included in the meta-analysis
involving 326 patients in the levosimendan group and 291 in the comparator
group. Pooled results showed a significantly higher survival rate in the
levosimendan group (OR 0.46, 95% CI, 0.30-0.71; p<inf>overall effect</inf>
= 0.0004; I² = 20%). <br/>Conclusion(s): Levosimendan therapy
was significantly associated with successful weaning and survival benefit
in patients with cardiogenic or postcardiotomy shock needing VA-ECMO
support for severe cardiocirculatory compromise. To date, there is limited
literature and absence of evidence from randomized trials addressing the
use of levosimendan in VA-ECMO weaning. This study may be considered a
hypothesis-generating research for randomized controlled trials to confirm
its findings.<br/>Copyright &#xa9; 2021 The Authors

<37>
Accession Number
2010636470
Title
The best approach for functional tricuspid regurgitation: A network
meta-analysis.
Source
Journal of Cardiac Surgery. 36(6) (pp 2072-2080), 2021. Date of
Publication: June 2021.
Author
Di Mauro M.; Lorusso R.; Parolari A.; Ravaux J.M.; Bonalumi G.; Guarracini
S.; Ricci F.; Benedetto U.; Calafiore A.M.
Institution
(Di Mauro, Lorusso, Ravaux) Cardio-Thoracic Surgery Unit, Heart and
Vascular Centre, Maastricht University Medical Centre (MUMC),
Cardiovascular Research Institute Maastricht (CARIM), Maastricht,
Netherlands
(Parolari) IRCCS Policlinic S. Donato and Department of Biomedical
Sciences for Health, UOC of University Cardiac Surgery and Translational
Research, University of Milan, Milan, Italy
(Bonalumi) Department of Cardiac Surgery, Centro Cardiologico
Monzino-IRCCS, Milan, Italy
(Guarracini) Department of Cardiovascular Disease, "Pierangeli" Hospital,
Pescara, Italy
(Ricci) Department of Neuroscience, Imaging and Clinical Sciences, "G.
d'Annunzio" University, Chieti, Italy
(Ricci) Department of Clinical Sciences, Lund University, Malmo, Sweden
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
Bristol University, Bristol, United Kingdom
(Calafiore) Department of Cardiac Surgery, Gemelli Molise, Campobasso,
Italy
Publisher
John Wiley and Sons Inc
Abstract
Objective: For many years, functional tricuspid regurgitation (FTR) was
considered negligible after treatment of left-sided heart valve surgery.
The aim of the present network meta-analysis is to summarize the results
of four approaches to establish the possible gold standard.
<br/>Method(s): A systematic search was performed to identify all
publications reporting the outcomes of four approaches for FTR, not
tricuspid annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA),
rigid rings (RRA). All studies reporting at least one the four endpoints
(early and late mortality, early and late moderate or more TFR) were
included in a Bayesian network meta-analysis. <br/>Result(s): There were
31 included studies with 9663 patients. Aggregate early mortality was 5.3%
no TA, 7.2% SA, 6.6% FRA, and 6.4% RRA; early TR moderate-or-more was
9.6%, 4.8%, 4.6%, and 3.8%; late mortality was 22.5%, 18.2%, 11.9%, and
11.9%; late TR moderate-or-more was 27.9%, 18.3%, 14.3%, and 6.4%. Rigid
or semirigid ring annuloplasty was the most effective approach for
decreasing the risk of late moderate or more FTR (-85% vs. no TA; -64% vs.
SA; -32% vs. FRA). Concerning late mortality, no significant differences
were found among different surgical approaches; however, flexible or rigid
rings reduced significantly the risk of late mortality (78% and 47%,
respectively) compared with not performing TA mortality. No differences
were found for early outcomes. <br/>Conclusion(s): Ring annuloplasty seems
to offer better late outcomes compare to either suture annuloplasty or not
performing TA. In particular rigid or semirigid rings provide more stable
FTR across time.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<38>
Accession Number
2014353967
Title
Thiamine increases resident endoglin positive cardiac progenitor cells and
atrial contractile force in humans: A randomised controlled trial.
Source
International Journal of Cardiology. 341 (pp 70-73), 2021. Date of
Publication: 15 Oct 2021.
Author
Coffey S.; Dixit P.; Saw E.L.; Babakr A.A.; van Hout I.; Galvin I.F.;
Saxena P.; Bunton R.W.; Davis P.J.; Lamberts R.R.; Katare R.; Williams
M.J.A.
Institution
(Coffey, Williams) Department of Medicine - HeartOtago, Dunedin School of
Medicine, University of Otago, New Zealand
(Coffey, Williams) Department of Cardiology, Southern District Health
Board, New Zealand
(Dixit, Saw, Babakr, van Hout, Lamberts, Katare) Department of Physiology
- HeartOtago, School of Biomedical Sciences, University of Otago, New
Zealand
(Galvin, Saxena, Bunton, Davis) Department of Cardiothoracic Surgery,
Southern District Health Board, New Zealand
Publisher
Elsevier Ireland Ltd
Abstract
Background: The heart has an intrinsic ability to regenerate, orchestrated
by progenitor or stem cells. However, the relative complexity of
non-resident cardiac progenitor cell (CPC) therapy makes modulation of
resident CPCs a more attractive treatment target. Thiamine analogues
improve resident CPC function in pre-clinical models. In this double
blinded randomised controlled trial (identifier: ACTRN12614000755639), we
examined whether thiamine would improve CPC function in humans.
<br/>Methods and Results: High dose oral thiamine (one gram twice daily)
or matching placebo was administered 3-5 days prior to coronary artery
bypass surgery (CABG). Right atrial appendages were collected at the time
of CABG, and CPCs isolated. There was no difference in the primary outcome
(proliferation ability of CPCs) between treatment groups. Older age was
not associated with decreased proliferation ability. In exploratory
analyses, isolated CPCs in the thiamine group showed an increase in the
proportion of CD34^-/CD105⁺ (endoglin) cells, but no
difference in CD34^-/CD90⁺ or CD34⁺ cells.
Thiamine increased maximum force developed by isolated trabeculae, with no
difference in relaxation time or beta-adrenergic responsiveness.
<br/>Conclusion(s): Thiamine does not improve proliferation ability of CPC
in patients undergoing CABG, but increases the proportion of
CD34^-/CD105⁺ cells. Having not met its primary
endpoint, this study provides the impetus to re-examine CPC biology prior
to any clinical outcome-based trial examining potential beneficial
cardiovascular effects of thiamine.<br/>Copyright &#xa9; 2021 Elsevier
B.V.

<39>
Accession Number
2013747251
Title
A randomised controlled trial of succinylated gelatin (4%) fluid on
urinary acute kidney injury biomarkers in cardiac surgical patients.
Source
Intensive Care Medicine Experimental. 9(1) (no pagination), 2021. Article
Number: 48. Date of Publication: December 2021.
Author
Smart L.; Boyd C.; Litton E.; Pavey W.; Vlaskovsky P.; Ali U.; Mori T.;
Barden A.; Ho K.M.
Institution
(Smart, Boyd, Pavey, Ho) College of Science, Health, Engineering and
Education, Murdoch University, South St, Murdoch, WA 6150, Australia
(Smart) Centre for Clinical Research in Emergency Medicine, Perth,
Australia
(Litton) Intensive Care Unit, Fiona Stanley Hospital, Murdoch, Australia
(Litton) Intensive Care Unit, St John of God Hospital, Subiaco, Australia
(Pavey) Department of Anaesthesia, Fiona Stanley Hospital, Murdoch,
Australia
(Vlaskovsky, Mori, Barden, Ho) Medical School, University of Western
Australia, Perth, Australia
(Ali) Department of Cardiothoracic Surgery and Transplantation, Fiona
Stanley Hospital, Murdoch, Australia
(Ho) Intensive Care Unit, Royal Perth Hospital, Perth, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Fluid resuscitation is frequently required for cardiac
surgical patients admitted to the intensive care unit. The ideal fluid of
choice in regard to efficacy and safety remains uncertain. Compared with
crystalloid fluid, colloid fluid may result in less positive fluid
balance. However, some synthetic colloids are associated with increased
risk of acute kidney injury (AKI). This study compared the effects of
succinylated gelatin (4%) (GEL) with compound sodium lactate (CSL) on
urinary AKI biomarkers in patients after cardiac surgery. <br/>Method(s):
Cardiac surgical patients who required an intravenous fluid bolus of at
least 500 mL postoperatively were randomly allocated to receive GEL or CSL
as the resuscitation fluid of choice for the subsequent 24 h. Primary
outcomes were serial urinary neutrophil gelatinase-associated lipocalin
(NGAL) and cystatin C concentrations measured at baseline, 1 h, 5 h and 24
h after enrolment, with higher concentrations indicating greater kidney
injury. Secondary biomarker outcomes included urinary clusterin,
alpha1-microglobulin and F<inf>2</inf>-isoprostanes concentrations.
Differences in change of biomarker concentration between the two groups
over time were compared with mixed-effects regression models. Statistical
significance was set at P < 0.05. <br/>Result(s): Forty cardiac surgical
patients (n = 20 per group) with similar baseline characteristics were
included. There was no significant difference in the median volume of
fluid boluses administered over 24 h between the GEL (1250 mL, Q1-Q3
500-1750) and CSL group (1000 mL, Q1-Q3 500-1375) (P = 0.42). There was a
significantly greater increase in urinary cystatin C (P < 0.001),
clusterin (P < 0.001), alpha1-microglobulin (P < 0.001) and
F<inf>2</inf>-isoprostanes (P = 0.020) concentrations over time in the GEL
group, compared to the CSL group. Change in urinary NGAL concentration (P
= 0.68) over time was not significantly different between the groups. The
results were not modified by adjustment for either urinary osmolality or
EuroSCORE II predicted risk of mortality. <br/>Conclusion(s): This
preliminary randomised controlled trial showed that use of succinylated
gelatin (4%) for fluid resuscitation after cardiac surgery was associated
with increased biomarker concentrations of renal tubular injury and
dysfunction, compared to crystalloid fluid. These results generate concern
that use of intravenous gelatin fluid may contribute to clinically
relevant postoperative AKI. Trial registration ANZCTR.org.au,
ACTRN12617001461381. Registered on 16th October, 2017,
http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373619&isR
eview=true.<br/>Copyright &#xa9; 2021, The Author(s).

<40>
Accession Number
2014640124
Title
Plasma and lung tissue pharmacokinetics of ceftaroline fosamil in patients
undergoing cardiac surgery with cardiopulmonary bypass: An in vivo
microdialysis study.
Source
Antimicrobial Agents and Chemotherapy. 65(10) (no pagination), 2021.
Article Number: e00679-21. Date of Publication: October 2021.
Author
Edlinger-Stanger M.; Al Jalali V.; Andreas M.; Jager W.; Bohmdorfer M.;
Zeitlinger M.; Hutschala D.
Institution
(Edlinger-Stanger, Hutschala) Medical University of Vienna, Department of
Anesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac
Thoracic Vascular Anesthesia and Intensive Care Medicine, Vienna, Austria
(Al Jalali, Zeitlinger) Medical University of Vienna, Department of
Clinical Pharmacology, Vienna, Austria
(Andreas) Medical University of Vienna, Department of Surgery, Division of
Cardiac Surgery, Vienna, Austria
(Jager, Bohmdorfer) University of Vienna, Department of Pharmaceutical
Chemistry, Vienna, Austria
Publisher
American Society for Microbiology
Abstract
Ceftaroline fosamil, a fifth-generation cephalosporin antibiotic with
activity against methicillin-resistant Staphylococcus aureus (MRSA), is
currently approved for the treatment of pneumonia and complicated skin and
soft tissue infections. However, pharmacokinetics data on free lung tissue
concentrations in critical patient populations are lacking. The aim of
this study was to evaluate the pharmacokinetics of the high-dose regimen
of ceftaroline in plasma and lung tissue in cardiac surgery patients
during intermittent and continuous administration. Nine patients
undergoing elective cardiac surgery on cardiopulmonary bypass were
included in this study and randomly assigned to intermittent or continuous
administration. Eighteen hundred milligrams of ceftaroline fosamil was
administered intravenously as either 600 mg over 2 h every 8 h (q8h)
(intermittent group) or 600 mg over 2 h (loading dose) plus 1,200 mg over
22 h (continuous group). Interstitial lung tissue concentrations were
measured by in vivo microdialysis. Relevant pharmacokinetics parameters
were calculated for each group. Plasma exposure levels during intermittent
and continuous administration were comparable to those of previously
published studies and did not differ significantly between the two groups.
In vivo microdialysis demonstrated reliable and adequate penetration of
ceftaroline into lung tissue during intermittent and continuous
administration. The steady-state area under the concentration-time curve
from 0 to 8 h (AUC<inf>ss</inf> 0-<inf>8</inf>) and the ratio of
AUC<inf>SS 0-8</inf> in lung tissue and AUC in plasma
(AUC<inf>lung/plasma</inf>) were descriptively higher in the continuous
group. Continuous administration of ceftaroline fosamil achieved a
significantly higher proportion of time for which the free drug
concentration remained above 4 times the minimal inhibitory concentration
(MIC) during the dosing interval (% fT<inf>.4xMIC</inf>) than intermittent
administration for pathogens with a MIC of 1 mg/liter. Ceftaroline showed
adequate penetration into interstitial lung tissue of critically ill
patients undergoing major cardiothoracic surgery, supporting its use for
pneumonia caused by susceptible pathogens.<br/>Copyright &#xa9; 2021
American Society for Microbiology. All Rights Reserved.

<41>
Accession Number
2013619355
Title
Intra-aortic balloon pump versus percutaneous Impella^&#xa9; in
emergency revascularisation for myocardial infarction and cardiogenic
shock: systematic review.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Frain K.; Rees P.
Institution
(Frain) Faculty of Medicine, University of St Andrews, St Andrews, United
Kingdom
(Rees) Academic Department of Military Medicine, Barts Heart Centre,
London, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Objectives: Mortality rates in patients with acute myocardial infarction
and cardiogenic shock (AMI-CS) remain persistently high despite advances
over the past decade in percutaneous mechanical circulatory support. This
systematic review aims to analyse the existing literature to compare
mortality outcomes in patients mechanically supported by intra-aortic
balloon pump or percutaneous Impella 2.5/CP^&#xa9; for AMI-CS
undergoing emergency revascularisation. <br/>Method(s): The following MeSH
terms were applied to the databases Ovid Medline, Ovid Embase, Cochrane
and Web of Science: 'Intra-aortic balloon pump', 'Impella', 'Cardiogenic
shock', 'Myocardial Infarction' and 'Mortality'. This yielded 2643
studies. Using predefined inclusion and exclusion criteria, the studies
were initially screened by title and abstract before full text analysis.
<br/>Result(s): Fourteen studies met eligibility criteria: two randomised
controlled trials (RCTs) and 12 observational studies. Data from a total
of 21,006 patients were included across the studies. Notably, one study
claimed reduced mortality with IABP versus control, and one study
concluded that Impella^&#xa9; improved survival rates over the
IABP. The average 30-day all-cause mortality in patients supported by IABP
was 38.1%, 54.3% in Impella^&#xa9; groups and 39.4% in control
groups. <br/>Conclusion(s): AMI-CS presents an important cohort of
patients in whom conducting RCTs is difficult. As a result, the literature
is limited. Analysis of the available literature suggests that there is
insufficient evidence to support superior survival in those supported by
IABP or Impella^&#xa9; when compared to control despite
suggestions that the Impella^&#xa9; offers superior haemodynamic
support. Limitations of the studies have been discussed to outline
suggestions for future research.<br/>Copyright &#xa9; The Author(s) 2021.

<42>
Accession Number
2013619342
Title
Impact of minimal invasive extracorporeal circulation on perioperative
intravenous fluid management in coronary artery bypass surgery.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Ellam S.; Rasanen J.; Hartikainen J.; Selander T.; Juutilainen A.; Halonen
J.
Institution
(Ellam) Department of Anesthesiology and Operative Services, Kuopio
University Hospital, Kuopio, Finland
(Rasanen, Hartikainen, Juutilainen, Halonen) School of Medicine,
University of Eastern Finland, Kuopio, Finland
(Hartikainen, Halonen) Heart Center, Kuopio University Hospital, Kuopio,
Finland
(Selander) Research Support Services, Kuopio University Hospital, Kuopio,
Finland
Publisher
SAGE Publications Ltd
Abstract
Objective: Compare the use of blood products and intravenous fluid
management in patients scheduled for coronary artery bypass surgery and
randomized to minimal invasive extracorporeal circulation (MiECC) and
conventional extracorporeal circulation (CECC). <br/>Method(s): A total of
240 patients who were scheduled for their first on-pump CABG, were
randomized to MiECC or CECC groups. The study period was the first 84
hours after surgery. Hemoglobin <80 g/l was used as transfusion trigger.
<br/>Result(s): Red blood cell transfusions intraoperatively were given
less often in the MiECC group (23.3% vs 9.2%, p = 0.005) and the total
intravenous fluid intake was significantly lower in the MiECC group (3300
ml [2950-4000] vs 4800 ml [4000-5500], p < 0.001). Hemoglobin drop also
was lower in the MiECC group (35.5 +/- 8.9 g/l vs 50.7 +/- 9 g/l, p <
0.001) as was hemoglobin drop percent (25.3 +/- 6% vs 35.3 +/- 5.9%, p <
0.001). Chest tube drainage output was higher in the MiECC group (645 ml
[500-917.5] vs 550 ml [412.5-750], p = 0.001). Particularly, chest tube
drainage in up to 600 ml category, was in benefit of CECC group (59.1% vs
40.8%, p = 0.003). ROC curve analysis showed that patients with hemoglobin
level below 95 g/l upon arrival to intensive care unit was associated with
increased risk of developing postoperative atrial fibrillation (POAF) (p =
0.002, auc = 0.61, cutoff <95, sensitivity = 0.47, positive predictive
value = 0.64). <br/>Conclusion(s): MiECC reduced the intraoperative need
for RBC transfusion and intravenous fluids compared to the CECC group,
also reducing hemoglobin drop compared to the CECC group in CABG surgery
patients. Postoperative hemoglobin drop was a predictor of
POAF.<br/>Copyright &#xa9; The Author(s) 2021.

<43>
Accession Number
2013619241
Title
Current Perspectives on Contemporary Rheumatic Mitral Valve Repair.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. (no pagination), 2021. Date of Publication: 2021.
Author
Dejsupa C.; Chotivatanapong T.; Caputo M.; Vohra H.A.
Institution
(Dejsupa, Caputo, Vohra) Department of Cardiac Surgery/Cardiovascular
Sciences, University of Bristol, United Kingdom
(Chotivatanapong) Department of Cardiothoracic Surgery, Central Chest
Institute of Thailand, Nonthabhuri, Thailand
Publisher
SAGE Publications Ltd
Abstract
The surgical management of rheumatic mitral valve disease remains a
challenge for cardiac surgeons. Durability of mitral valve repair (MVr) is
likely compromised not simply due to high technical demand, but surgeon
reluctance, despite boasting copious advantages over MV replacement. This
comprehensive review aims to evoke a deeper understanding of MVr concepts
necessary to abate these limitations and shift mindset towards a more
holistic approach to repair. Details of commonly utilized techniques in
contemporary MVr for rheumatic heart disease will be discussed. Of
importance, the reparative procedures will be mapped to an in-depth
physiological exploration of the mitral complex-dynamism and rheumatic
interplay. This is further emphasized by outlining the current
"aggressive" resection strategy in contemporary rheumatic
MVr.<br/>Copyright &#xa9; The Author(s) 2021.

<44>
Accession Number
636066636
Title
Systematic review and meta-analysis of the prevalence of unrecognized
cognitive impairment in older surgical patients.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 647-648), 2021. Date of
Publication: September 2021.
Author
Kapoor P.; Saripella A.; Chen L.; Riazi S.; Wong J.; Englesakis M.;
Nagappa M.; Chung F.
Institution
(Kapoor, Riazi, Wong, Chung) Institute of Medical Science, Temerty Faculty
of Medicine, University of Toronto, Toronto, Canada
(Kapoor, Saripella, Chen, Riazi, Wong, Chung) Department of Anesthesiology
and Pain Medicine, University Health Network, University of Toronto,
Toronto, Canada
(Englesakis) Library and Information Services, University Health Network,
Toronto, Canada
(Nagappa) Department of Anesthesia and Perioperative Medicine, London
Health Sciences Centre and St. Joseph Health Care, Western University,
London, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Pre-existing cognitive impairment is emerging as a predictor
of poor postoperative outcomes in older surgical patients. Due to a
substantial under-diagnosis, the prevalence of unrecognized cognitive
impairment has not been well defined in those undergoing surgery. The
objective of this systematic review and meta-analysis was to determine the
pooled prevalence of unrecognized cognitive impairment in elderly patients
undergoing elective noncardiac surgery. <br/>Method(s): An expert
librarian conducted the literature search, which included MEDLINE (Ovid),
Pub- Med (non-MEDLINE records only), Embase, Cochrane Central, Cochrane
Database of Systematic Reviews, PsycINFO, and Emcare Nursing for relevant
articles from 1946 to April 2021. The following MeSH search terms were
used for the literature search: 'cognitive impairment', 'prevalence',
'elderly', and 'preoperative'. Inclusion criteria were (1) patients >= 60
years old undergoing elective noncardiac surgeries; (2) preoperative
cognitive impairment assessed by validated cognitive screening tests; (3)
published in English language. Descriptive analysis was conducted for the
cognitive impairment group. Data were extracted from each study and
prevalence of cognitive impairment with 95% confidence interval (CI) was
calculated for each study. We used the random effect model to calculate
the pooled prevalence value with 95% CI. Comprehensive meta-analysis
software was used for statistical analysis. <br/>Result(s): Of 8,896
citations, 20 studies were included consisting of 4,308 patients
undergoing a variety of non-cardiac surgeries. 19 were prospective cohort
studies, and one was a cross-sectional study. Of the cognitive impairment
group, the mean age was 75.1 +/- 7.0 years, and 59.8% were male. The
pooled prevalence of cognitive impairment was 40.2% (95% CI: 31.0%, 50.1%;
I2: 98%; P<0.005; predictive interval: -1.47 to 2.27) (Table 1). The
Eggers and Beggs tests did not show any publication bias.
<br/>Conclusion(s): The prevalence of unrecognized cognitive impairment is
very high at 40.2% in geriatric patients undergoing non-cardiac surgery.

<45>
Accession Number
636065974
Title
Exercise prehabilitation (Prequel) for patients undergoing cardiac
surgery: Preliminary results.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 1485-1486), 2021. Date of
Publication: September 2021.
Author
Yau K.W.D.; Underwood M.; Joynt G.; Lee A.
Institution
(Yau, Joynt, Lee) Department of Anaesthesia and Intensive Care, Chinese
University of Hong Kong, Hong Kong
(Underwood) Division of Cardiothoracic Surgery, Department of Surgery,
Chinese University of Hong Kong, Hong Kong
Publisher
Lippincott Williams and Wilkins
Abstract
Background and aim: Preoperative frailty is associated with poorer
clinical outcomes and higher healthcare costs in patients undergoing
cardiac surgery. Prehabilitation before surgery could offer an opportunity
to improve physical fitness and frailty, and enhance postoperative
recovery. The objective of this preliminary report was to investigate the
potential benefits of a prehabilitation programme (PREQUEL), supervised by
physiotherapist for pre-frail and frail adults awaiting coronary artery
bypass grafting/valve surgery. <br/>Method(s): After written informed
consent, we have randomised 63 patients (Intervention Group: 34; Usual
Care Group: 29) in the ongoing PREQUEL, a single-centre, superiority,
stratified randomised controlled trial (ChiCTR1800016098). The structured
exercise prehabilitation intervention was two sessions/week of aerobic and
resistance training (ideally for 6-8 weeks) before surgery with health
promotion advice. The main effect of prehabilitation, time and group*time
interaction on perioperative outcomes: functional capacity (by 6-minute
walk test), quality of recovery (QoR-15), days (alive and) at home within
30 days of surgery (DAH30) and disability-free survival (by WHODAS) was
analysed using appropriate univariate tests and generalised estimating
equations from baseline up to 3- months after surgery, for
intention-to-treat analyses. <br/>Result(s): Seven participants were frail
(Clinical Frailty Scale [CFS] >=5) while remaining was pre-frail (CFS=4).
The median (IQR) number of exercise sessions performed before surgery and
attendance rate were 7 (4-11) and 100% (100%-100%) respectively. Patients
tolerated individually prescribed exercise well without any adverse events
reported. Prehabilitation may improve functional capacity with clinically
important significance before surgery (mean difference: 24.4 metres, 95%
CI: 1.7-47.2, p=0.04; Group*Time p=0.05) (Figure 1). There was no
significant group*time difference for CFS (p=0.39), QoR-15 (p=0.32), DAH30
(p=0.52) or WHODAS scores (p=0.70). <br/>Conclusion(s): The
physiotherapist-supervised prehabilitation programme was well tolerated by
prefrail and frail patients awaiting cardiac surgery. Exercise
prehabilitation might improve preoperative functional capacity of the
patients.

<46>
Accession Number
636065674
Title
To evaluate safety and efficacy of Intravenous Sildenafil in the
perioperative management of pulmonary hypertension in patients undergoing
congenital heart surgery-A prospective randomized study.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 353), 2021. Date of
Publication: September 2021.
Author
Sachan P.; Keswani S.; Pujara J.
Institution
(Sachan, Keswani, Pujara) Cardiac Anesthesia, UN Mehta institute of
cardiology and research centre, Ahmedabad, Gujarat, India
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Pulmonary hypertension is commonly associated with congenital
heart diseases. Pulmonary vascular disease is one of the most serious
complications of defects with increased pulmonary blood flow. Once
established, it's progressive and leads to premature death.
<br/>Objective(s): We compared pulmonary artery pressures (using 2D
echocardiogram), PaO2: FiO2 ratio, ventilation time, length of ICU stay,
length of hospital stay, morbidity and mortality between two groups of
patients where one of them received IV sildenafil in the post bypass
period for the management of pulmonary hypertension. Methodology: A
prospective, randomized, single centre study where 100 patients with
VSD/TAPVC etc were equally allotted in two groups (S = sildenafil; C =
Control). Group S patients received two doses of oral sildenafil 0.5 mg/kg
preoperatively followed by IV infusion in the post-bypass period for 24
hours, whereas Group C patients received standard perioperative care.
<br/>Result(s): Pulmonary artery systolic pressures (PASP) was comparable
between the two groups at T1 (Pre bypass) and T2 (Post bypass), but PASP
were significantly lower in Group S at T3 (12 hours, C = 28.74 +/- 4.08, S
= 25.9 +/- 2.77), T4 (at 24 hours, C = 23.66 +/- 2.78, S = 21.4 +/- 2.19),
and T5 (at 48 hours, C = 20.84 +/- 2.02, S = 18.84 +/- 1.56). Mean
arterial pressures and PaO2: FiO2 ratio were comparable between the two
groups at all time intervals. Ventilation time (C = 30.14 +/- 11.01, S =
25.72 +/- 8.11), length of ICU stay (S = 77.74 +/- 12.61, C = 87.56 +/-
27.78) and length of hospital stay (S= 10.5 +/- 1.23, C = 12.46 +/- 1.99)
was significant lower in the Group S. <br/>Conclusion(s): Perioperative
administration of sildenafil reduces pulmonary artery pressures, time
required for weaning from mechanical ventilation, ICU and hospital length
of stay.

<47>
Accession Number
636065641
Title
Inhaled nitric oxide for the prevention of heart and lung injuries in
high-risk patients during cardiac surgery.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 343), 2021. Date of
Publication: September 2021.
Author
Pichugin V.; Domnin S.; Seyfetdinov I.; Shirshin A.; Buranov S.
Institution
(Pichugin, Domnin, Seyfetdinov) Anaesthesiology and Intensive Care,
Specialized Cardiac Surgical Clinical Hospital, Nizhny Novgorod, Russian
Federation
(Shirshin, Buranov) All-Russian Scientific Research Institute of
Experimental Physics, Sarov, Nizhny Novgorod District, Russian Federation
Publisher
Lippincott Williams and Wilkins
Abstract
The aim of the study was to evaluate effectiveness of inhaled NO in the
prevention of heart and lungs injuries during heart valves surgery with
cardiopulmonary bypass (CPB) in patients with high pulmonary hypertension
(PH). <br/>Material(s) and Method(s): The study included 90 patients (mean
PAP 42.2 +/- 1.5 mm Hg), mean age 58.9 +/- 1.9 who underwent heart valves
surgery. All patients were randomized into three groups: the first (30) -
control; the second (30) - patients received NO inhalation (20 ppm) before
and after the CPB; the third (30) - patients received NO inhalation (20
ppm) during the entire operation: during CPB - by ventilation with NO (20
ppm) and pulmonary artery perfusion. 'TIANOX' device was used as NO
generator (provides NO synthesis directly from the air, NO supply to the
patient's breathing circuit and monitoring of NO/NO2 concentration). A
comparative assessment of functional lungs parameters and the dynamics of
troponin I after surgery (1, 12, 24 and 48 hours) were performed.
<br/>Result(s): Patients received inhaled NO showed a significantly lower
increase in the alveolar-arterial oxygen difference, a significantly
higher PaO<inf>2</inf>/FiO<inf>2</inf> ratio, a significantly lower level
of intrapulmonary shunting and preserved lung compliance after CPB. The
functional safety of the lungs was higher in the 3rd group. Troponin I in
patients of the 2nd and 3rd group was significantly lower (2 times) than
in the 1st group at the end of surgery. Troponin I more rapid declined and
normalized within 48 hours after surgery in the same groups. The dynamics
of a decrease in the troponin I level occurred more rapidly in the 3rd
group. <br/>Conclusion(s): Inhaled NO therapy effectively preserved lungs
and heart during cardiac valves surgery in patients with high PH. The
combined technology (NO inhalation during the entire operation) provided
more effective heart and lungs protection.

<48>
Accession Number
636065546
Title
Comparing the hemodynamic effect of dexmedetomidine alone with
dexmedetomidine plus ketamine combination in post cardiac surgery
patients.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 322), 2021. Date of
Publication: September 2021.
Author
Khan M.I.; Furqan A.
Institution
(Khan, Furqan) Anesthesia and ICU, Choudhary Pervaiz Elahi Institute Of
Cardiology, Multan, Pakistan
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: To compare the hemodynamic effect of Dexmedetomidine alone with
a combination of ketamine plus Dexmedetomidine in post-cardiac surgery
patients. Study type: Randomized Control Trial Study place and duration:
1st January to 1st December 2020, Department of Cardiac surgery, Multan
<br/>Material(s) and Method(s): Group DA received dexmedetomidine alone 1
mug/kg bolus followed by25-50 mug/kg/hr. Group KD received ketamine +
dexmedetomidine 1 mug/kg over 20 min and then 0.2-0.07 mug/kg/hr. Sedation
level >= 04 during assisted ventilation was assessed using Ramsay Sedation
Scale. All patients received fentanyl for postoperative analgesia started
at 1 mug/kg/hr infusion then adjusted accordingly to adult nonverbal pain
score. A p-value <= of 0.05 was taken as statically significant.
<br/>Result(s): Total fentanyl dose was 45.65 +/- 8.23 mug in group KD and
146.01 +/- 14.18 mug in group DA and the difference was statically
significant (p<0.001). The time of weaning was 344.65 +/- 43.89 minutes
and 446.60 +/- 73.75 minutes in groups DK and DA respectively, with the
difference being statically significant (p<0.001). The time of extubation
was 389.90 +/- 35.89 minutes and 535.30 +/- 36.25 minutes in groups Dk and
DA respectively, with the difference being statically significant
(p<0.001). The ICU stay, heart rate, and mean arterial blood pressure was
not significantly different between the two groups (p-value 0.194, 0.434,
and 0.247, respectively). There was no statically significant difference
in terms of Ramsay score and non-verbal pain score between both the groups
(p-value 0.427 and 0.516 respectively). <br/>Conclusion(s): Utilizing
ketamine + dexmedetomidine combination for sedation of post-CABG surgical
procedure gave a short duration of mechanical ventilation and less
fentanyl dose in comparing to dexmedetomidine alone with no significant
effect on post CABG patients.

<49>
Accession Number
636065514
Title
Influence of anaesthesia method on neurocognitive function in patients
undergoing transcatheter transfemoral aortic valve implant surgery.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 313), 2021. Date of
Publication: September 2021.
Author
Gultjajeva N.; Ripa E.; Leibuss R.; Strike E.; Miscuks A.
Institution
(Gultjajeva, Ripa, Leibuss, Strike) Pauls Stradins Clinical University
Hospital, Riga, Latvia
(Gultjajeva, Miscuks) University of Latvia, Riga, Latvia
(Ripa, Leibuss, Strike) Riga Stradins University, Riga, Latvia
(Miscuks) Dr.Maurinsh Laser Medical clinic, Riga, Latvia
Publisher
Lippincott Williams and Wilkins
Abstract
In recent years transcatheter aortic valve implantation (TAVI) has grown
compared to surgical approach in high-risk patients. However, TAVI has
been associated with an increased risk of neurological events. The aim of
current study is to compare moderate sedation (MS) with general laryngeal
mask anaesthesia (GLMA) and their effect on patients' neurocognitive
ability and QOL after TAVI. This prospective study was conducted in Pauls
Stradins Clinical university hospital investigating 50 patients (33
females, 17 males, mean age 81.96 years) with severe aortic stenosis
undergoing TAVI. Preoperative parameters, medical history, duration of
procedure and length of in-hospital stay were analysed. Patients were
randomly divided in two groups: one group (n=29) received local
anaesthesia with fentanyl and benzodiazepines; the second group (n=21)
underwent general anaesthesia. Montreal Cognitive Assessment test (MoCA)
and Mini-Mental State Examination (MMSE) were used for assessment of
cognitive ability and conducted before, 24h and 48h after TAVI. Quality of
Life Scale (QLS) was measured one month post-procedure. There was no
significant statistical difference between age, MAP and length of
procedure between groups. Cognitive impairment (MoCA<26points,
MMSE<23points) before surgery was detected in 19 patients receiving
moderate sedation, GLMA - 2 patients. 24h after TAVI cognitive
deterioration was detected in 52% (n=26, GLMA-2, MS-24, Mann-Whitney
p<0.003), after 48h - in 58% (n=29, GLMA-3, MS-26, Mann-Whitney p<0.004).
The mean in-hospital stay: MS - 5.48 days, GLMA - 4.05 days (p<0.001).
After one month, 44.8% of MS group struggled with daily home
responsibilities (QLS=5); 42.8% of GLMA group were able to work few hours
a day with simple social activities (QLS=7) compared with 13.8% of MS
group. The present study confirmed that patients who receive
opioid/benzodiazepine anaesthetic agents have longer in-hospital stays,
greater cognitive decline and worse quality of life after surgery,
therefore it is advised to perform TAVI under general anaesthesia.

<50>
Accession Number
636065336
Title
Improving in cardiac surgery: Sevoflurane may take it to a new level.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 293), 2021. Date of
Publication: September 2021.
Author
Abreu J.B.; Amorim A.; Costa D.; Gama K.
Institution
(Abreu, Amorim, Costa, Gama) Anesthesiology, Hospital Central do Funchal,
Funchal, Portugal
Publisher
Lippincott Williams and Wilkins
Abstract
Background: For the past several years, the best anesthetic approach has
been discussed for patients undergoing cardiac surgery. The comparison of
sevoflurane and propofol has been subject to several studies. There is a
necessity to shorten the hospital length stay, speed up the recovery
process without compromising patient's outcome, safety and comfort.
<br/>Objective(s): This project aims to highlight the benefits of using
sevoflurane in cardiac surgery. <br/>Method(s): PubMed database was
searched and articles with the words 'sevoflurane', 'propofol' and
'cardiac surgery'. <br/>Result(s): Sevoflurane may lead to a shorter
duration of endotracheal intubation and intensive care unit (ICU) length
of stay. In some studies, the total length of hospital stay seemed to be
shorter as well. Sevoflurane can decrease glycocalyx degradation in
patients undergoing heart valve surgery, under cardiopulmonary bypass
(CPB). Sevoflurane showed a significantly lower postoperative 24- hour
troponin concentration. In the 6-month period following cardiac surgery
with the use of extracorporeal circulation, patients have fewer
interventions (less need for treatment, fewer hospital admissions)
associated with sevoflurane post-conditioning, in patients experiencing
any event. In patients undergoing cardiac valve replacement with CPB,
there was no difference between sevoflurane and propofol in regard to the
effect on oxygenation, respiratory mechanics, and hemodynamics during the
early stage of cardiopulmonary bypass. In both, lung injury was mild.
Discussion and conclusion: Due to the necessity for a better anesthetic
approach to positive clinical outcomes within the shortest hospital length
stay, we provide a summary of the benefits of sevoflurane compared to
propofol for patients undergoing cardiac surgery. We recognize that, at
the same time, the need for large randomized trials that should focus on
survival.

<51>
Accession Number
636065262
Title
Comparison of albumin, gelatine, and ringer lactate as volume expander
post-resuscitative phase on cardiac output and lactate serum after
coronary arterial bypass graft (CABG) on Pump: The use of protein colloid
for post cardiac surgery revisited.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 280-281), 2021. Date of
Publication: September 2021.
Author
Adriane P.; Apriyana A.; Dewi N.L.K.
Institution
(Adriane, Apriyana, Dewi) Cardiac surgery intensive care, Harapan Kita
National Cardiovascular Centre, Jakarta, Indonesia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Use of protein colloid in fluid management post cardiac
surgery still debatable, whether it is more beneficial compare to
non-protein colloid or crystalloid. Due to cost efficiency it is rationale
to restrict its application to complex cases. Patients who have received
fluid during resuscitative phase, but still require volume to improve
cardiovascular performance, might have advantages with fluid management by
choosing the right fluid. The objective of this study is to compare
albumin 4% administration than gelofusin and ringer lactate as volume
expander post-resuscitative phase after CABG with pump. <br/>Method(s): We
conducted single center, single blind, randomized study which assigned 120
patients undergoing elective CABG on-pump who met inclusion criteria to
receive 125 ml-1 hour-1 of either albumin 4% (Plasmanate), gelatin
containing colloid (Gelofusin), or Ringer's lactate (RL) as the only
infusion fluid for 4 hours period after first assessment,
post-resuscitative phase (4 hours after ICU admission). After fluid
administration, patients were reassessed. Assessment included cardiac
output and lactate serum as primary outcome, duration of mechanical
ventilation, intensive care unit and hospital stay were recorded as
secondary outcome. <br/>Result(s): Mean of cumulative cardiac output
improvement (delta) was significantly different between the group
plasmanate 1.18 L/mnt (0.69), gelofusin 0.88 (0.29), and RL 0.74 (0.69)
with p value = 0.002. Lactate serum decreased significantly in plasmanate
group as much as 3.31 gr/dl (2.04) compare to gelofusin 2.13 (1.27) and RL
group 2.37 (1.17) with p value =0,005. Duration of mechanical ventilation,
length of stay in ICU and hospital postoperative were shorter in
plasmanate group than gelofusin and RL group. <br/>Conclusion(s): Albumin
4% (plasmanate) as protein colloid improved cardiac output and decreased
lactate serum level more significant compare to gelofusin and RL, promoted
shorter duration of mechanical ventilation and length of stay in ICU and
hospital postoperatively.

<52>
Accession Number
636065020
Title
Erector Spinae Plane Block as an adjuvant for pain management in lumbar
spine surgery.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 1003), 2021. Date of
Publication: September 2021.
Author
Tamayo R.S.; Gutierrez A.G.
Institution
(Tamayo, Gutierrez) Neuroanesthesia, National Institute of Neurology and
Neurosurgery, Mexico City, Mexico
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative pain management continues to be a subject of
research in order to optimize its treatment. With the advent of ultrasound
and its use for the application of regional anesthesia techniques, the
emergence of new regional anesthesia techniques became more feasible. For
lumbar spine surgeries, one of the options presented are muscle plane
blockages. It has been shown that an erector spinae plane (ESP) block can
provide pain relief for thoracic and lumbar surgery. <br/>Objective(s):
Evaluate the use of Erector Spinae Plane block to reduce the requirements
of remifentanil and the pain scale in postoperative patients of lumbar
spine surgery. <br/>Method(s): Through a single blind interventional
clinical trial, a sample of 30 patients scheduled for lumbar spine surgery
was captured and divided into two groups; in the first group (intervention
group), we realized an ESP block, and in the second group (control group)
we do not. Then the opioid consumption was measured in both groups as well
as the Visual Analogue Scale of Pain at 2 hours, 6 hours, 12 hours and 24
hours. Besides, a quantification of adjuvants and a registration of days
of hospital stay was realized. <br/>Result(s): Thirty patients between
25-78 years were included, divided into two groups: the intervention group
and the control group. There was a statistically significant reduction in
the consumption of opioids and adjuvants, as well as in the Visual
Analogue Scale of Pain at 2 hours and the days of hospital stay in the
intervention group. <br/>Conclusion(s): The ESP block is an effective
measure to reduce the requirements of opioids and adjuvants in the
transoperative period, as well as the Visual Analogue Scale of Pain in the
first two hours of the postoperative period and the hospital stay.

<53>
Accession Number
636064749
Title
Bilateral bi-level Erector spine plane block as a component of general
anesthesia in scoliosis correction surgery.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 1670-1671), 2021. Date of
Publication: September 2021.
Author
Barsa M.
Institution
(Barsa) Anesthesiology and Intensive Care Unit, Rivne Oblast State
Hospital, Rivne, Ukraine
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Scoliosis correction surgery (SCS) is one of the most
difficult surgical interventions in anesthesiology due to the
decompensation of the respiratory system, high blood loss, traumatic and
long-term surgery. Regional anesthesia is one of the best ways to reduce
complications after surgery. Erector spine plane block (ESB) is a
technique that provides sufficient analgesia. However, a large amount of
anesthetic does not allow its use at two levels of the spine bilaterally.
In our study, we reduced the volume and concentration of anesthetic for
one injection and at the expense of adjuvants, provided sufficient
duration of pain-relief. We compared general anesthesia (GA) with ESB and
without ESB and describe a new multimodal approach to anesthesia for SCS.
Materials: Forty patients that underwent SCS were randomly assigned to two
groups: The 1st group (n = 20) - included GA without ESB; the 2nd group (n
= 20) - included GA with bilateral ESB at two levels (T5-6 and L2-3). We
used 40 ml solution of Bupivacaine 0,375% with Dexamethasone 0,02% and
Epinephrine 0,00018%. The primary outcomes evaluated glucose levels (GL),
intensity of pain using a visual analogue scale (VAS), and the duration of
mechanical ventilation (MV) after surgery. Heart rate (HR) and mean
arterial pressure (MAP) during surgery were also documented, compared, and
assessed. <br/>Result(s): Six hours after surgery, GL and VAS score were
significantly better (Fig.1). During surgery HR and MAP had also improved
results (Fig.2). MV was longer in the 1st group (31,6min+/-5,62) then in
the 2nd group (17min+/-1,16). <br/>Conclusion(s): Our method of bilateral
bi-level ESB resulted in a reduction of stress-response in patients with a
significantly lower intensity of pain in the early postoperative period
and reduced opiate use intraoperatively. As a result, duration of MV was
also reduced and ensured normal GL.

<54>
Accession Number
636064656
Title
Postoperative analgesic efficacy of erector spinae plane block in thoracic
spine surgery - a descriptive study.
Source
Anesthesia and Analgesia. Conference: 17th World Congress of
Anaesthesiologists. Virtual. 133(3 SUPPL 2) (pp 1710), 2021. Date of
Publication: September 2021.
Author
Itagi S.; Subramanian B.J.
Institution
(Itagi) Medical ICU, Psg Institute of Medical Sciences and Research,
Peelamedu, Coimbatore, India
(Subramanian) Anaesthesia, Ganga Medical Centre and Hospital Pvt.Ltd,
Coimbatore, India
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Intravenous opioids have been conventionally used for acute
postoperative pain management after spine surgeries. The Erector Spinae
Plane (ESP) block, a novel block, may reduce the opioid burden in these
patients significantly. Our aim was to evaluate the postoperative
analgesic efficacy of Ultrasound-guided ESP block in patients undergoing
thoracic spine surgery with reference to pain scores and total morphine
consumption. Methodology: 40 consecutive patients of Indian origin
undergoing thoracic spine surgery of either sex, between 15-60yrs were
recruited from 2017-2018 in a tertiary care hospital in South India after
ethical approval. All patients received bilateral ESP block with 20ml of
0.25% Bupivacaine + 4mg Dexamethasone on each side at T5 level, prior to
skin incision. All surgeries were performed by certified trained surgeons.
Pain scores were assessed using Numerical Rating Scale (NRS) 0-10. All
patients received intravenous morphine infusion in the postoperative
period for 24hrs. The total morphine consumption for 24hrs was noted.
<br/>Result(s): The median NRS scores at 6hrs, 12hrs and 24hrs were 3, 3
and 2 respectively. The mean (SD) morphine consumption in the
postoperative period at 6hrs, 12 hrs and 24hrs were 4.20mg (+0.69mg),
7.62mg (+0.69mg) and 14.68mg (+1.31mg) respectively. The median (IQR) for
Pulse rate and Mean arterial pressure over 24hrs was 90.00 (90.00, 92.00)
and 63.08mmHg (62.46mmHg, 73.85mmHg) respectively. A similar study with
intravenous morphine by Singh et al, 2017 showed the mean (SD) of 24hr
morphine consumption to be 31.80mg (+6.72mg) as opposed to 14.68mg
(+1.31mg) in our study. <br/>Conclusion(s): The ESP block coupled with
morphine infusion ensures good pain relief and provides stable
haemodynamics postoperatively. Randomized controlled trials are
recommended.

<55>
Accession Number
2013871808
Title
Particle flow rate from the airways as fingerprint diagnostics in
mechanical ventilation in the intensive care unit: A randomised controlled
study.
Source
ERJ Open Research. 7(3) (no pagination), 2021. Article Number: 00961-2020.
Date of Publication: 01 Jul 2021.
Author
Hallgren F.; Stenlo M.; Niroomand A.; Broberg E.; Hyllen S.; Malmsjo M.;
Lindstedt S.
Institution
(Hallgren, Lindstedt) Dept of Cardiothoracic Surgery and Transplantation,
Skane University Hospital, Lund University, Lund, Sweden
(Stenlo, Broberg, Hyllen) Cardiothoracic Anaesthesia and Intensive Care,
Skane University Hospital, Lund University, Lund, Sweden
(Stenlo, Niroomand, Broberg, Hyllen, Lindstedt) Wallenberg Center for
Molecular Medicine, Lund University, Lund, Sweden
(Stenlo, Niroomand, Broberg, Hyllen, Malmsjo, Lindstedt) Dept of Clinical
Sciences, Lund University, Lund, Sweden
(Stenlo, Niroomand, Broberg, Hyllen, Lindstedt) Lund Stem Cell Center,
Lund University, Lund, Sweden
(Niroomand) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,
United States
Publisher
European Respiratory Society
Abstract
Introduction Mechanical ventilation can be monitored by analysing
particles in exhaled air as measured by particle flow rate (PFR). This
could be a potential method of detecting ventilator-induced lung injury
(VILI) before changes in conventional parameters can be detected. The aim
of this study was to investigate PFR during different ventilation modes in
patients without lung pathology. Method A prospective study was conducted
on patients on mechanical ventilation in the cardiothoracic intensive care
unit (ICU). A PExA 2.0 device was connected to the expiratory limb on the
ventilator for continuous measurement of PFR in 30 patients randomised to
either volume-controlled ventilation (VCV) or pressure-controlled
ventilation (PCV) for 30 min including a recruitment manoeuvre. PFR
measurements were continued as the patients were transitioned to
pressure-regulated volume control (PRVC) and then pressure support
ventilation (PSV) until extubation. Results PRVC resulted in significantly
lower PFR, while those on PSV had the highest PFR. The distribution of
particles differed significantly between the different ventilation modes.
Conclusions Measuring PFR is safe after cardiac surgery in the ICU and may
constitute a novel method of continuously monitoring the small airways in
real time. A low PFR during mechanical ventilation may correlate to a
gentle ventilation strategy. PFR increases as the patient transitions from
controlled mechanical ventilation to autonomous breathing, which most
likely occurs as recruitment by the diaphragm opens up more distal
airways. Different ventilation modes resulted in unique particle patterns
and could be used as a fingerprint for the different ventilation
modes.<br/>Copyright &#xa9; The authors 2021.

<56>
Accession Number
636064264
Title
Comparison of three ultrasound views for internal jugular venous
cannulation in patients undergoing cardiac surgery: A randomized trial.
Source
Journal of Medical Ultrasound. 29(3) (pp 176-180), 2021. Date of
Publication: July-September 2021.
Author
Chennakeshavallu G.N.; Gadhinglajkar S.; Sreedhar R.; Babu S.; Sankar S.;
Dash P.K.
Institution
(Chennakeshavallu, Gadhinglajkar, Sreedhar, Babu, Sankar, Dash) Department
of Cardiac Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences
and Technology, Kerala, Thiruvananthapuram, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: The quality of needle visualization during ultrasound-guided
internal jugular vein (IJV) cannulation determines the ease of procedure,
whereas posterior IJV wall puncture is the most common risk associated.
The IJV can be imaged in different views, which offer certain advantages
over each other. We compared three different ultrasound views for IJV
cannulation short axis (SAX), long axis (LAX), and oblique axis (OAX) with
respect to the quality of needle visualization, first pass success rate,
and posterior IJV wall puncture. <br/>Method(s): Two hundred ten patients
undergoing elective cardiac surgery were analyzed in this prospective
randomized clinical trial. Patients were randomly assigned to one of the
three groups: SAX (n = 70), LAX (n = 70), and OAX (n = 70). The quality of
needle visualization, first pass success rate, and incidence of posterior
IJV wall puncture in each of the three ultrasound views were studied. The
Chi-square test and ANOVA were used for the comparison of means and
proportion between the groups. <br/>Result(s): The quality of needle
visualization was graded as good in 90% patients in OAX group, 81.4%
patients in LAX group, and 14.2% patients in SAX group, respectively (P <
0.0001). OAX group had the highest first pass success rate (94.2%)
followed by SAX (88.5%), and then, LAX (82.8%), but it was statistically
insignificant among the groups (P = 0.105). The mean IJV access time was
longer in LAX group when compared to OAX and SAX group (P < 0.0001).The
incidence of IJV posterior wall puncture was 14.2% patients in SAX group
and none in other groups (P = 0.0011). <br/>Conclusion(s): The results
suggest that OAX view can be adopted as standard approach during
ultrasound-guided IJV cannulation as it safe and reliable.<br/>Copyright
&#xa9; 2021 Journal of Medical Ultrasound

<57>
Accession Number
636044158
Title
Perioperative Outcome of Robotic Approach Versus Manual Videothoracoscopic
Major Resection in Patients Affected by Early Lung Cancer: Results of a
Randomized Multicentric Study (ROMAN Study).
Source
Frontiers in Oncology. 11 (no pagination), 2021. Article Number: 726408.
Date of Publication: 09 Sep 2021.
Author
Veronesi G.; Abbas A.E.-S.; Muriana P.; Lembo R.; Bottoni E.; Perroni G.;
Testori A.; Dieci E.; Bakhos C.T.; Car S.; Luzzi L.; Alloisio M.; Novellis
P.
Institution
(Veronesi, Muriana, Perroni, Dieci, Novellis) Department of Thoracic
Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
(Veronesi) Faculty of Medicine and Surgery, Vita-Salute San Raffaele
University, Milan, Italy
(Abbas, Bakhos) Department of Thoracic Medicine and Surgery, Lewis Katz
School of Medicine, Temple University Hospital, Philadelphia, PA, United
States
(Abbas, Bakhos) Department of Surgery, Lewis Katz School of Medicine,
Temple University Hospital, Philadelphia, PA, United States
(Lembo) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Bottoni, Testori, Alloisio) Division of Thoracic and General Surgery,
Humanitas Clinical and Research Center, Rozzano, Italy
(Car) Division of Thoracic Surgery, Department of Surgery, University of
Maryland School of Medicine, Baltimore, MD, United States
(Luzzi) Thoracic Surgery Unit, Department of Medicine, Surgery and Neuro
Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera
Universitaria Senese, Siena, Italy
(Alloisio) Department of Biomedical Science, Humanitas University,
Rozzano, Italy
Publisher
Frontiers Media S.A.
Abstract
Introduction: We report the results of the first prospective international
randomized control trial to compare the perioperative outcome and surgical
radicality of the robotic approach with those of traditional
video-assisted surgery in the treatment of early-stage lung cancer.
<br/>Method(s): Patients with clinical stage T1-T2, N0-N1 non-small cell
lung cancer (NSCLC) were randomly assigned to robotic-assisted
thoracoscopic surgery (RATS) or video-assisted thoracic surgery (VATS)
resection arms. The primary objective was the incidence of adverse events
including complications and conversion to thoracotomy. The secondary
objectives included extent of lymph node (LN) dissection and other
indicators. <br/>Result(s): This trial was closed at 83 cases as the
probability of concluding in favor of the robot arm for the primary
outcome was null according to the observed trend. In this study, we report
the results of the analysis conducted on the patients enrolled until trial
suspension. Thirty-nine cases were randomized in the VATS arm and 38 in
the robotic arm. Six patients were excluded from analysis. Despite finding
no difference between the two arms in perioperative complications,
conversions, duration of surgery, or duration of postoperative stay, a
significantly greater degree of LN assessment by the robotic technique was
observed in regards to the median number of sampled LN stations [6,
interquartile range (IQR) 4-6 vs. 4, IQR 3-5; p = 0.0002], hilar LNs (7,
IQR 5-10 vs. 4, IQR 2-7; p = 0.0003), and mediastinal LNs (7, IQR 5-10 vs.
5, IQR 3-7; p = 0.0001). <br/>Conclusion(s): The results of this trial
demonstrated that RATS was not superior to VATS considering the
perioperative outcome for early-stage NSCLC, but the robotic approach
allowed an improvement of LN dissection. Further studies are suggested to
validate the results of this trial. Clinical Trial Registration:
clinicaltrials.gov, identifier NCT02804893.<br/>&#xa9; Copyright &#xa9;
2021 Veronesi, Abbas, Muriana, Lembo, Bottoni, Perroni, Testori, Dieci,
Bakhos, Car, Luzzi, Alloisio and Novellis.

<58>
Accession Number
2014745132
Title
Higher Mortality in Women After Coronary Artery Bypass: Meta-analysis and
Bias Analysis of Confounding.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Shi D.; Zhang B.; Motamed M.; Lee S.; Wang P.; McLaren C.; Petsikas D.;
Brogly S.B.
Institution
(Shi, Motamed, Wang, McLaren) School of Medicine, Queen's University,
Kingston, ON, Canada
(Zhang) School of Medicine, McMaster University, Hamilton, ON, Canada
(Lee) Faculty of Health Sciences, McMaster University, Hamilton, ON,
Canada
(Petsikas, Brogly) Department of Surgery, Queen's University, Kingston,
ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Some studies suggest that the observed higher mortality in
women compared with men after coronary artery bypass grafting (CABG) is
due to confounding. Our meta-analysis aimed to (1) summarize the effect of
sex on mortality after CABG and (2) identify whether unmeasured
confounding likely explains the apparent higher mortality in women.
<br/>Method(s): We searched MEDLINE, Embase, and CENTRAL databases for
studies examining sex and 30-day mortality after CABG. We used
random-effects meta-analysis to estimate the summary odds ratio (OR) of
mortality in women versus men using (1) unadjusted study results and (2)
adjusted study results. Available confounders data from included studies
were identified. Using the OR of measured confounders and the risk of
death to inform unmeasured confounding effects, we performed bias analysis
simulation to correct potential unmeasured confounding in the summary OR.
<br/>Result(s): From 7,138 retrieved studies, 112 were included (N =
5,008,262 patients); 25 studies reported adjusted OR (N = 770,450
patients). Overall 30-day mortality was 4.9% in women versus 3.3% in men.
The unadjusted summary OR (1.81; 95% confidence interval, 1.72-1.91) and
adjusted summary OR (1.40, 95% confidence interval, 1.35-1.45)
demonstrated women had an increased risk for 30-day mortality compared
with men. Simulations correcting for unmeasured confounding mostly ranged
from 1.05 to 1.80, which supports a higher risk for death in women after
CABG. <br/>Conclusion(s): The findings of this review suggest that
confounding is unlikely to account for the increased risk for mortality in
women after CABG and that biological factors have a causal
effect.<br/>Copyright &#xa9; 2021 The Society of Thoracic Surgeons

<59>
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.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<60>
Accession Number
2013787537
Title
Intrinsic left ventricular impairment in Marfan syndrome: A systematic
review and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Xu H.; Ma N.; Guo R.; Luo H.; Zhang L.; Liu D.; Zang S.; Zhao L.; Zhang
X.; Qiao C.
Institution
(Xu, Ma, Guo, Luo, Zhang, Liu, Zang, Zhao, Zhang, Qiao) Department of
Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University,
Zhengzhou University, Zhengzhou, Henan, China
(Xu, Ma, Guo, Luo, Zhang, Liu, Zang, Zhao, Zhang, Qiao) Heart
Transplantation Center, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou University, Zhengzhou, Henan, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Intrinsic cardiac impairment in Marfan syndrome (MFS) has been
explored in many clinical studies; however, their results have been
inconsistent. This meta-analysis aimed to assess the difference in cardiac
structure and function between Marfan patients and healthy individuals,
and to verify the hypothesis of intrinsic cardiac impairment in MFS.
<br/>Method(s): Electronic searches for studies were performed in the
PubMed, Embase, and Cochrane Library databases. Nine studies with 490
patients with MFS and 478 controls were included in the analysis. Age and
sex were strictly matched between Marfan patients and healthy controls in
every study. <br/>Result(s): There was no difference in the left
ventricular end systolic diameter index (mean difference [MD]: 0.33; 95%
confidence interval [CI]: (-0.24, 0.89); p = 0.26) and left ventricular
end diastolic diameter index (MD: 0.18; 95% CI: [-0.47, 0.83]; p = 0.58)
between Marfan patients and controls. Marfan patients showed larger left
ventricular end systolic volume index (MD: 2.62; 95% CI: [0.27, 4.97]; p =
0.03) and left ventricular end diastolic volume index (MD: 4.16; 95% CI:
[2.70, 5.63]; p < 0.01) than the control group. Furthermore, Marfan
patients showed a lower left ventricular ejection fraction than healthy
people (MD: -2.59%; 95% CI: [-4.64%, -0.54%]; p = 0.01).
<br/>Conclusion(s): Intrinsic cardiac impairment was observed in MFS. MFS
patients showed the larger left ventricular volume and poorer left
ventricular function than matched controls. Considering the potentially
adverse impact on cardiac function, intrinsic cardiac impairment in MFS
should be considered during the cardiac surgery.<br/>Copyright &#xa9; 2021
Wiley Periodicals LLC

<61>
Accession Number
2008363299
Title
Systematic review and consensus definitions for the Standardized Endpoints
in Perioperative Medicine (StEP) initiative: cardiovascular outcomes.
Source
British Journal of Anaesthesia. 126(1) (pp 56-66), 2021. Date of
Publication: January 2021.
Author
Beattie W.S.; Lalu M.; Bocock M.; Feng S.; Wijeysundera D.N.; Nagele P.;
Fleisher L.A.; Kurz A.; Biccard B.; Leslie K.; Howell S.; Grocott H.; Lamy
A.; Richards T.; Myles P.; Gan T.J.; Peyton P.; Sessler D.; Tramer M.;
Cyna A.; De Oliveira G.S.; Wu C.; Jensen M.; Kehlet H.; Botti M.; Boney
O.; Haller G.; Grocott M.; Cook T.; Fleisher L.; Neuman M.; Story D.;
Gruen R.; Bampoe S.; Evered L.; Scott D.; Silbert B.; van Dijk D.; Kalkman
C.; Chan M.; Eckenhoff R.; Rasmussen L.; Eriksson L.; Landoni G.; Bartlett
R.J.; McMonnies R.; Gerstl J.; Jay M.; Kishlyansky D.; Machina M.; Bobcock
M.; Pearse R.; Mythen M.; Canet J.; Moller A.; Gin T.; Schultz M.; Pelosi
P.; Gabreu M.; Futier E.; Creagh-Brown B.; Abbott T.; Klein A.; Corcoran
T.; Cooper D.J.; Dieleman S.; Diouf E.; McIlroy D.; Bellomo R.; Shaw A.;
Prowle J.; Karkouti K.; Billings J.; Mazer D.; Jayarajah M.; Murphy M.;
Bartoszko J.; Sneyd R.; Morris S.; George R.; Moonesinghe R.; Shulman M.;
Lane-Fall M.; Nilsson U.; Stevenson N.; Cooper J.D.; van Klei W.; Cabrini
L.; Miller T.; Pace N.; Jackson S.; Buggy D.; Short T.; Riedel B.;
Gottumukkala V.; Alkhaffaf B.; Johnson M.
Institution
(Beattie) Cardiovascular Anesthesia, University Health Network, University
of Toronto, Toronto, ON, Canada
(Lalu, Bocock, Feng) Department of Anesthesia, University of Ottawa,
Ottawa, ON, Canada
(Wijeysundera) Li Ka Shing Knowledge Institute, St Michaels Hospital,
University of Toronto, Toronto, ON, Canada
(Nagele) Department of Anesthesia and Critical Care, University of
Chicago, Chicago, IL, United States
(Fleisher) Department of Anesthesiology and Critical Care, University of
Pennsylvania Health System, Philadelphia, PA, United States
(Kurz) Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
(Biccard) Department of Anesthesia and Perioperative Medicine, University
of Cape Town, Cape Town, South Africa
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic., Australia
(Howell) University of Leeds School of Medicine, Leeds, United Kingdom
(Landoni) Center for Intensive Care and Anesthesiology, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Grocott) Department of Anesthesia and Perioperative Medicine, University
of Manitoba, Winnipeg, MB, Canada
(Lamy) Department of Surgery, McMaster University, Hamilton, ON, Canada
(Richards) University of Western Australia, Perth, Australia
(Myles) Alfred Health and Monash University Department of Anaesthesia and
Perioperative Medicine, Melbourne, Vic., Australia
Publisher
Elsevier Ltd
Abstract
Background: Adverse cardiovascular events are a leading cause of
perioperative morbidity and mortality. The definitions of perioperative
cardiovascular adverse events are heterogeneous. As part of the
international Standardized Endpoints in Perioperative Medicine initiative,
this study aimed to find consensus amongst clinical trialists on a set of
standardised and valid cardiovascular outcomes for use in future
perioperative clinical trials. <br/>Method(s): We identified currently
used perioperative cardiovascular outcomes by a systematic review of the
anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase,
and Cochrane Library). We performed a three-stage Delphi consensus-gaining
process that involved 55 clinician researchers worldwide. Cardiovascular
outcomes were first shortlisted and the most suitable definitions
determined. These cardiovascular outcomes were then assessed for validity,
reliability, feasibility, and clarity. <br/>Result(s): We identified 18
cardiovascular outcomes. Participation in the three Delphi rounds was 100%
(n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine
cardiovascular outcomes was elicited from the consensus: myocardial
infarction, myocardial injury, cardiovascular death, non-fatal cardiac
arrest, coronary revascularisation, major adverse cardiac events,
pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These
nine cardiovascular outcomes were rated by the majority of experts as
valid, reliable, feasible, and clearly defined. <br/>Conclusion(s): These
nine consensus cardiovascular outcomes can be confidently used as
endpoints in clinical trials designed to evaluate perioperative
interventions with the goal of improving perioperative
outcomes.<br/>Copyright &#xa9; 2020 British Journal of Anaesthesia

<62>
Accession Number
2006979598
Title
Surgical and transcatheter mitral valve replacement in mitral annular
calcification: A systematic review.
Source
Journal of the American Heart Association. 10(7) (no pagination), 2021.
Article Number: e018514. Date of Publication: 2021.
Author
Alexis S.L.; Malik A.H.; El-Eshmawi A.; George I.; Sengupta A.; Kodali
S.K.; Hahn R.T.; Khalique O.K.; Zaid S.; Guerrero M.; Bapat V.N.; Leon
M.B.; Adams D.H.; Tang G.H.L.
Institution
(Alexis, El-Eshmawi, Sengupta, Adams, Tang) From the Department of
Cardiovascular Surgery, Mount Sinai Health System, New York, NY, United
States
(Malik) Department of Medicine, Westchester Medical Center, Valhalla, NY,
United States
(George, Bapat) Division of Cardiac Surgery, New York Presbyterian
Hospital, Columbia University Medical Center, New York, NY, United States
(Kodali, Hahn, Khalique, Leon) Division of Cardiology, New York
Presbyterian Hospital, Columbia University Medical Center, New York, NY,
United States
(Zaid) Department of Cardiology, Westchester Medical Center, Valhalla, NY,
United States
(Guerrero) Division of Cardiology, Mayo Clinic, Rochester, MN, United
States
(Bapat) Now with Department of Cardiothoracic Surgery, Minneapolis Heart
Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States
Publisher
American Heart Association Inc.
Abstract
Mitral annular calcification with mitral valve disease is a challenging
problem that could necessitate surgical mitral valve replacement (SMVR).
Transcatheter mitral valve replacement (TMVR) is emerging as a feasible
alternative in high-risk patients with appropriate anatomy. PubMed,
Embase, and Cochrane Central Register of Controlled Trials were searched
from inception to December 25, 2019 for studies discussing SMVR or TMVR in
patients with mitral annular calcification; 27 of 1539 articles were
selected for final review. TMVR was used in 15 studies. Relevant data were
available on 82 patients who underwent hybrid transatrial TMVR, and 354
patients who underwent transapical or transseptal TMVR. Outcomes on SMVR
were generally reported as small case series (447 patients from 11
studies); however, 1 large study recently reported outcomes in 9551
patients. Patients who underwent TMVR had a shorter median follow-up of 9
to 12 months (range, in-hospital-19 months) compared with patients with
SMVR (54 months; range, in-hospital-120 months). Overall, those undergoing
TMVR were older and had higher Society of Thoracic Surgeons risk scores.
SMVR showed a wide range of early (0%-27%; median 6.3%) and long-term
mortality (0%-65%; median at 1 year, 15.8%; 5 years, 38.8%, 10 years,
62.4%). The median in-hospital, 30-day, and 1-year mortality rates were
16.7%, 22.7%, and 43%, respectively, for transseptal/transapical TMVR, and
9.5%, 20.0%, and 40%, respectively, for transatrial TMVR. Mitral annular
calcification is a complex disease and TMVR, with a versatile option of
transatrial approach in patients with challenging anatomy, offers a
promising alternative to SMVR in high-risk patients. However, further
studies are needed to improve technology, patient selection, operative
expertise, and long-term outcomes.<br/>Copyright &#xa9; 2021 The Authors.

<63>
Accession Number
635396061
Title
Rationale and Design of Assessing the Effectiveness of Short-Term Low-Dose
Lithium Therapy in Averting Cardiac Surgery-Associated Acute Kidney
Injury: A Randomized, Double Blinded, Placebo Controlled Pilot Trial.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 639402.
Date of Publication: 14 Jun 2021.
Author
Sharif S.; Chen B.; Brewster P.; Chen T.; Dworkin L.; Gong R.
Institution
(Sharif) Division of Critical Care Medicine, St Francis Hospital, New
York, NY, United States
(Sharif, Chen, Dworkin, Gong) Division of Kidney Disease and Hypertension,
Department of Medicine, Rhode Island Hospital, Brown University School of
Medicine, Providence, RI, United States
(Chen, Brewster, Dworkin, Gong) Division of Nephrology, Department of
Medicine, University of Toledo Medical Center, Toledo, OH, United States
(Chen) Department of Mathematics and Statistics, The University of Toledo,
Toledo, OH, United States
Publisher
Frontiers Media S.A.
Abstract
Background: Burgeoning pre-clinical evidence suggests that therapeutic
targeting of glycogen synthase kinase 3beta (GSK3beta), a convergence
point of multiple cellular protective signaling pathways, confers a
beneficial effect on acute kidney injury (AKI) in experimental models.
However, it remains unknown if GSK3beta inhibition likewise mitigates AKI
in humans. Cardiac surgery associated acute kidney injury (CSA-AKI) poses
a significant challenge for clinicians and currently the only treatment
available is general supportive measures. Lithium, an FDA approved mood
stabilizer, is the best-known GSK3beta inhibitor and has been safely used
for over half a century as the first line regimen to treat bipolar
affective disorders. This study attempts to examine the effectiveness of
short term low dose lithium on CSA-AKI in human patients. Methods/Design:
This is a single center, prospective, randomized, double blinded, placebo
controlled pilot study on patients undergoing cardiac surgery with
cardiopulmonary bypass. Patients will be randomized to receive a small
dose of lithium or placebo treatment for three consecutive days. Renal
function will be measured via creatinine as well as novel AKI biomarkers.
The primary outcome is incidence of AKI according to Acute Kidney Injury
Network (AKIN) criteria, and secondary outcomes include receipt of new
dialysis, days on dialysis, days on mechanical ventilation, infections
within 1 month of surgery, and death within 90 days of surgery.
<br/>Discussion(s): As a standard selective inhibitor of GSK3beta, lithium
has been shown to exert a beneficial effect on tissue repair and
regeneration upon acute injury in multiple organ systems, including the
central nervous system and hematopoietic system. In experimental AKI,
lithium at small doses is able to ameliorate AKI and promote kidney
repair. Successful completion of this study will help to assess the
effectiveness of lithium in CSA-AKI and could potentially pave the way for
large-scale randomized trials to thoroughly evaluate the efficacy of this
novel regimen for preventing AKI after cardiac surgery. Trial
Registration: This study was registered prospectively on the 17th February
2017 at ClinicalTrials.gov (NCT03056248,
https://clinicaltrials.gov/ct2/show/NCT03056248?term=NCT03056248&draw=2&ra
nk=1).<br/>&#xa9; Copyright &#xa9; 2021 Sharif, Chen, Brewster, Chen,
Dworkin and Gong.

<64>
Accession Number
2014611181
Title
A comparison of continuation of one-quarter dose and full-dose ACEIs /ARBs
effect on incidence of intraoperative hypotension in patients undergoing
non-cardiac surgery, a randomized controlled study.
Source
Journal of Cardiovascular Disease Research. 12(3) (pp 515-521), 2021. Date
of Publication: 2021.
Author
Apinyachon W.; Chenboonthai T.; Sangkum L.; Sangasilpa I.
Institution
(Apinyachon, Chenboonthai, Sangkum, Sangasilpa) Department of
Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
Publisher
EManuscript Technologies
Abstract
Background: Angiotensin-converting enzyme inhibitors (ACEIs) and
angioensin II receptor blockers (ARBs) are commonly prescribed to treat
hypertension in general surgical patients. However, the patients who
continued ACEIs/ARBs preoperatively increased incidence of postinduction
hypotension. Due to there was dose-related efficacy for lowering blood
pressure of ACEIs/ARBs. Our objective was to compare the incidence of
hypotension in patients who received continuation of one-quarter dose or
full dose of ACEIs/ARBs on the morning of surgery. <br/>Method(s): After
IRB approval, a prospective randomized-control study consisted of 40
patients who received ACEIs/ARBs were scheduled for non-cardiac surgery.
Patients were randomized into two groups, continued full dose (FD) group
who continued the same dose ACEIs/ARBs and one-quarter dose (QD) group who
received a quarter dose of their own ACEIs or ARBs on the morning of
surgery. The baseline and intraoperative blood pressures were measured.
<br/>Result(s): Twenty-seven patients (67.5%) had been treated with ARBs.
Either means of baseline or preinduction blood pressure in two groups was
not significant difference. Four patients (20%) in QD group had episode of
hypotension whereas ten patients (50%) in FD group. The incidence of
hypotension in FD group had significantly higher than that of QD group
(p=0.047). However, the incidences of intraoperative hypertension of QD
and FD group were 55% and 30%, respectively. There was not significant
difference between two groups. <br/>Conclusion(s): The continuation of
one-quarter dose ACEIs/ARBs in patients undergoing non-cardiac surgery was
associated with a lower incidence of intraoperative hypotension compared
with full-dose of medications.<br/>Copyright &#xa9; 2021 EManuscript
Technologies. All rights reserved.

<65>
Accession Number
2014436121
Title
Impact of major infections on 10-year mortality after revascularization in
patients with complex coronary artery disease.
Source
International Journal of Cardiology. 341 (pp 9-12), 2021. Date of
Publication: 15 Oct 2021.
Author
Ono M.; Kawashima H.; Hara H.; Mancone M.; Mack M.J.; Holmes D.R.; Morice
M.-C.; Kappetein A.P.; Thuijs D.J.F.M.; Noack T.; Mohr F.W.; Davierwala
P.M.; Onuma Y.; Serruys P.W.
Institution
(Ono, Kawashima, Hara) Amsterdam UMC, University of Amsterdam, Heart
Center, Department of Clinical and Experimental Cardiology, Amsterdam
Cardiovascular Sciences, Meibergdreef 9, Amsterdam, Netherlands
(Ono, Kawashima, Hara, Onuma, Serruys) Department of Cardiology, National
University of Ireland, Galway (NUIG), Galway, Ireland
(Mancone) Department of Clinical, Internal, Anesthesiology and
Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Center, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, hopital prive Jacques Cartier,
Generale de Sante Massy, France
(Kappetein, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Noack, Mohr, Davierwala) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Serruys) NHLI, Imperial College London, London, United Kingdom
(Onuma, Serruys) CURAM-SFI Centre for Research in Medical Devices, Galway,
Ireland
Publisher
Elsevier Ireland Ltd
Abstract
Background: The significant interaction between major infection and 5-year
mortality after percutaneous coronary intervention (PCI) or coronary
artery bypass graft (CABG) for complex coronary artery disease (CAD) was
observed previously. However, the very long-term outcomes beyond 5 years
remains unclear. <br/>Methods and Results: This is a subgroup analysis of
the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended
follow-up of the randomized SYNTAX trial comparing PCI versus CABG in
patients with three-vessel disease (3VD) or left-main CAD (LMCAD). Out of
1517 patients enrolled in the SYNTAX trial with available survival status
from 5 to 10 years, 140 patients had experienced major infections and
survived at 5 years (major infection group). From 5 to 10 years, the
mortality of major infection group was 19.8% whereas the mortality of no
major infection group was 15.1% (p = 0.157). After the adjustment of other
clinical factors, the risk of mortality from 5 to 10 years did not
significantly differ between major infection and no major infection groups
(HR: 1.10; 95% CI: 0.62-1.96; p = 0.740). When stratified by the presence
or absence of periprocedural major infections, defined as a major
infection within 60 days after index procedure, there was also no
significant difference in 10-year mortality between two groups (30.8% vs.
24.5%; p = 0.057). <br/>Conclusion(s): Despite the initial association
between major infections and 5 years mortality, postprocedural major
infection was not evident in the 10 years follow-up, suggesting that the
impact of major infection on mortality subsided over time beyond 5 years.
Trial registration: SYNTAXES ClinicalTrials.gov reference: NCT03417050
SYNTAX ClinicalTrials.gov reference: NCT00114972<br/>Copyright &#xa9; 2021
The Author(s)

<66>
Accession Number
2013683888
Title
Dose-response relationship among body mass index, abdominal adiposity and
atrial fibrillation in patients undergoing cardiac surgery: A
meta-analysis of 35 cohorts.
Source
PeerJ. 9 (no pagination), 2021. Article Number: e11855. Date of
Publication: 21 Jul 2021.
Author
Liu M.; Mei K.; Xie L.; Ma J.; Yu P.; Niu S.; Xu Y.; Zhao Y.; Liu X.
Institution
(Liu, Niu, Xu, Zhao) Department of Cardiology, Seventh People's Hospital
of Zhengzhou, Henan, Zhengzhou, China
(Mei) Anesthesiology Department, The People's Hospital of Shanggrao,
Jiangxi, Shangrao, China
(Xie) Department of Respiratory and Critical Care Medicine, The Second
Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, China
(Ma) Department of Pharmacology and Systems Physiology, University of
Cincinnati, College of Medicine, Cincinnati, Oh, United States
(Yu) Department of Endocrine, The Second Affiliated Hospital of Nanchang
University, Jiangxi, Nanchang, China
(Liu) Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen
University, Guangdong, Guangzhou, China
(Liu) Guangdong Province Key Laboratory of Arrhythmia and
Electrophysiology, Guangdong, Guangzhou, China
(Liu) Guangzhou Key Laboratory of Molecular Mechanism and Translation in
Major Cardiovascular Disease, Guangzhou, China
Publisher
PeerJ Inc.
Abstract
Background. Whether overweight increases the risk of postoperative atrial
fibrillation (POAF) is unclear, and whether adiposity independently
contributes to POAF has not been comprehensively studied. Thus, we
conducted a meta-analysis to clarify the strength and shape of the
exposure-effect relationship between adiposity and POAF. Methods. The
PubMed, Cochrane Library, and EMBASE databases were searched for revelant
studies (randomized controlled trials (RCTs), cohort studies, and
nest-case control studies) reporting data regarding the relationship
between adiposity and the risk of POAF. Results. Thirty-five publications
involving 33,271 cases/141,442 patients were included. Analysis of
categorical variables showed that obesity (RR: 1.39, 95% CI [1.21-1.61]; P
< 0.001), but not being underweight (RR: 1.44, 95% CI [0.90-2.30]; P =
0.13) or being overweight (RR: 1.03, 95% CI [0.95-1.11]; P = 0.48) was
associated with an increased risk of POAF. In the exposure-effect analysis
(BMI) was 1.09 (95% CI [1.05-1.12]; P < 0.001) for the risk of POAF. There
was a significant linear relationship between BMI and POAF
(P<inf>nonlinearity</inf> = 0.44); the curve was flat and began to rise
steeply at a BMI of approximately 30. Notably, BMI levels below 30
(overweight) were not associated with a higher risk of POAF. Additionally,
waist obesity or visceral adiposity index was associated with the risk of
POAF. Conclusion. Based on the current evidence, our findings showed that
high body mass index or abdominal adiposity was independently associated
with an increased risk of POAF, while underweight or overweight might not
significantly increase the POAF risk.<br/>Copyright &#xa9; 2021 Liu et al.
Distributed under Creative Commons CC-BY 4.0

<67>
Accession Number
2013578994
Title
The relationship between circulating bone morphogenetic protein-4 and
inflammation cytokines in patients undergoing thoracic surgery: A
prospective randomized study.
Source
Journal of Inflammation Research. 14 (pp 4069-4077), 2021. Date of
Publication: 2021.
Author
Zhao X.; Zhang J.; Zhang W.; Dai R.; Xu J.; Li Z.; Yang L.
Institution
(Zhao, Zhang, Dai, Xu, Li, Yang) Department of Anesthesiology, The Second
Xiangya Hospital, Central South University, Hunan, Changsha 410011, China
(Zhang) Department of Laboratory Medicine, The Second Xiangya Hospital,
Central South University, Hunan, Changsha 410011, China
Publisher
Dove Medical Press Ltd
Abstract
Background: Bone morphogenetic protein-4 (BMP4) has been identified as an
inflammation regulator in the diseases of arteries and other organs.
However, the relationship between circulating BMP4 and perioperative
inflammation remains unclear. <br/>Patients and Methods: Forty patients
undergoing lobectomy were randomly allocated into the Control group (not
receiving flurbiprofen) and the Flurb group (received 100mg flurbi-profen
during surgery). Arterial blood was obtained before surgery (T1), at the
end of surgery (T2), and 24 hours after surgery (T3) to test the plasma
concentrations of BMP4, its antagonist Noggin, interleukin (IL)-1beta,
tumor necrosis factor-alpha (TNF-alpha), and IL-10. The relationship
between BMP4 and other variables and the effects of flurbiprofen on BMP4
changes were investigated. <br/>Result(s): A total of 35 patients were
included. Circulating BMP4 was positively correlated with IL-1beta
(P<0.01, r=0.575) and TNF-alpha (P<0.01, r=0.491), negatively correlated
with IL-10 (P<0.01, r=-0.675), but not correlated with Noggin. The plasma
concentrations of BMP4, IL-1beta, and TNF-alpha increased at T2 (P<0.01,
compared with T1) and decreased at T3 (P<0.05, compared with T2). BMP4
concentrations at T3 were significantly higher than at T1 in the Control
group (P<0.05), while showing no significant difference in the Flurb
group. However, in the Flurb group, the relative changes of BMP4 and
IL-1beta at T2 and T3 were significantly lower than those in the Control
group. <br/>Conclusion(s): Circulating BMP4 was elevated during surgery
and highly correlated with inflammation cytokines. The elevation of BMP4
and inflammatory cytokines could be alleviated by flurbiprofen, indicating
that BMP4 may exert pro-inflammatory properties via cyclooxygenase-II
signaling pathways.<br/>Copyright &#xa9; 2021 Zhao et al.

<68>
Accession Number
2011731500
Title
Impact of Anesthesia Strategy and Valve Type on Clinical Outcomes After
Transcatheter Aortic Valve Replacement.
Source
Journal of the American College of Cardiology. 77(17) (pp 2204-2215),
2021. Date of Publication: 04 May 2021.
Author
Feistritzer H.-J.; Kurz T.; Stachel G.; Hartung P.; Lurz P.; Eitel I.;
Marquetand C.; Nef H.; Doerr O.; Vigelius-Rauch U.; Lauten A.; Landmesser
U.; Treskatsch S.; Abdel-Wahab M.; Sandri M.; Holzhey D.; Borger M.; Ender
J.; Ince H.; Oner A.; Meyer-Saraei R.; Hambrecht R.; Wienbergen H.; Fach
A.; Augenstein T.; Frey N.; Konig I.R.; Vonthein R.; Funkat A.-K.;
Berggreen A.E.; Heringlake M.; Desch S.; de Waha-Thiele S.; Thiele H.
Institution
(Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri, Holzhey,
Borger, Ender, Desch, Thiele) Heart Center Leipzig at University of
Leipzig, Leipzig, Germany
(Feistritzer, Stachel, Hartung, Lurz, Abdel-Wahab, Sandri, Holzhey,
Borger, Ender, Funkat, Desch, Thiele) Leipzig Heart Institute, Leipzig,
Germany
(Kurz, Eitel, Marquetand, Meyer-Saraei, Berggreen, Heringlake, de
Waha-Thiele) University Clinic Schleswig-Holstein and University Heart
Center Lubeck, Lubeck, Germany
(Kurz, Eitel, Marquetand, Lauten, Landmesser, Meyer-Saraei, Konig, Desch,
de Waha-Thiele) German Center for Cardiovascular Research (DZHK), Lubeck,
Germany
(Nef, Doerr, Vigelius-Rauch) Medizinische Klinik I, Abteilung fur
Kardiologie, Universitatsklinikum Marburg/Giesen, Giesen, Germany
(Lauten, Landmesser, Treskatsch) Universitatsklinikum Charite, Campus
Benjamin Franklin, Berlin, Germany
(Ince, Oner) Medizinische Klinik I im Zentrum fur Innere Medizin,
Universitatsklinikum Rostock, Rostock, Germany
(Hambrecht, Wienbergen, Fach, Augenstein) Klinikum Links der Weser,
Herzzentrum Bremen, Bremen, Germany
(Frey) Department of Cardiology, Angiology and Pulmology, University
Hospital Heidelberg, Heidelberg, Germany
(Konig, Vonthein) Institut fur Medizinische Biometrie und Statistik,
University of Lubeck, Lubeck, Germany
(Vonthein) Institut fur Statistik, Ludwig-Maximilians-Universitat Munchen,
Munich, Germany
Publisher
Elsevier Inc.
Abstract
Background: The randomized SOLVE-TAVI (compariSon of secOnd-generation
seLf-expandable vs. balloon-expandable Valves and gEneral vs. local
anesthesia in Transcatheter Aortic Valve Implantation) trial compared
newer-generation self-expanding valves (SEV) and balloon-expandable valves
(BEV) as well as local anesthesia with conscious sedation (CS) and general
anesthesia (GA) in patients undergoing transfemoral transcatheter aortic
valve replacement (TAVR). Both strategies showed similar outcomes at 30
days. <br/>Objective(s): The purpose of this study was to compare clinical
outcomes during 1-year follow-up in the randomized SOLVE-TAVI trial.
<br/>Method(s): Using a 2 x 2 factorial design 447 intermediate- to
high-risk patients with severe, symptomatic aortic stenosis were randomly
assigned to transfemoral TAVR using either the SEV (Evolut R, Medtronic
Inc., Minneapolis, Minnesota) or the BEV (Sapien 3, Edwards Lifesciences,
Irvine, California) as well as CS or GA at 7 sites. <br/>Result(s): In the
valve-comparison strategy, rates of the combined endpoint of all-cause
mortality, stroke, moderate or severe paravalvular leakage, and permanent
pacemaker implantation were similar between the BEV and SEV group (n = 84,
38.3% vs. n = 87, 40.4%; hazard ratio: 0.94; 95% confidence interval: 0.70
to 1.26; p = 0.66) at 1 year. Regarding the anesthesia comparison, the
combined endpoint of all-cause mortality, stroke, myocardial infarction,
and acute kidney injury occurred with similar rates in the GA and CS
groups (n = 61, 25.7% vs. n = 54, 23.8%; hazard ratio: 1.09; 95%
confidence interval: 0.76 to 1.57; p = 0.63). <br/>Conclusion(s): In
intermediate- to high-risk patients undergoing transfemoral TAVR,
newer-generation SEV and BEV as well as CS and GA showed similar clinical
outcomes at 1 year using a combined clinical endpoint. (SecOnd-generation
seLf-expandable Versus Balloon-expandable Valves and gEneral Versus Local
Anesthesia in TAVI [SOLVE-TAVI]; NCT02737150)<br/>Copyright &#xa9; 2021
American College of Cardiology Foundation

<69>
Accession Number
2011718367
Title
Deep sedation versus general anaesthesia for transcatheter mitral valve
repair: An individual patient data meta-analysis of observational studies.
Source
EuroIntervention. 16(16) (pp 1359-1365), 2021. Date of Publication: 2021.
Author
Jobs A.; Grund S.; De Waha-Thiele S.; Ledwoch J.; Sievert H.; Rassaf T.;
Luedike P.; Kelm M.; Hellhammer K.; Horn P.; Westenfeld R.; Patzelt J.;
Langer H.F.; Lurz P.; Desch S.; Eitel I.; Thiele H.
Institution
(Jobs, Lurz, Desch, Thiele) Heart Center Leipzig at University of Leipzig,
Department of Internal Medicine/Cardiology, Leipzig Heart Institute,
Leipzig, Germany
(Jobs, De Waha-Thiele, Patzelt, Langer, Eitel) Department of Cardiology,
Angiology and Intensive Care Medicine, University Heart Center Lubeck,
Medical Clinic II, University of Lubeck, Lubeck, Germany
(Jobs, De Waha-Thiele, Ledwoch, Patzelt, Langer, Eitel) German Center for
Cardiovascular Research (DZHK), Berlin, Germany
(Grund) Leibniz Institute for Science and Mathematics Education Kiel,
Kiel, Germany
(Ledwoch) Medizinische Klinik und Poliklinik, Klinikum rechts der Isar,
Technische Universitat Munchen, Munich, Germany
(Ledwoch, Sievert) CardioVascular Center Frankfurt, Frankfurt, Germany
(Rassaf, Luedike) Department of Cardiology and Vascular Medicine, West
German Heart and Vascular Center Essen, University Hospital Essen, Essen,
Germany
(Kelm, Hellhammer, Horn, Westenfeld) Department of Cardiology,
Pulmonology, and Vascular Medicine, Medical Faculty of the Heinrich Heine
University Dusseldorf, Dusseldorf, Germany
(Patzelt, Langer) Department of Cardiology and Cardiovascular Medicine,
University Hospital, Eberhard Karls University Tubingen, Tubingen, Germany
Publisher
Europa Group
Abstract
Aims: The aim of this meta-analysis was to compare general anaesthesia
(GA) and deep sedation (DS) with regard to safety and length of intensive
care unit (ICU) stay in patients undergoing percutaneous edge-toedge
mitral valve repair (PMVR). <br/>Methods and Results: Four studies
comparing GA and DS in patients undergoing PMVR were included in an
individual patient data meta-analysis. Data were pooled after multiple
imputation. The composite safety endpoint of all-cause death, stroke,
pneumonia, or major to life-threatening bleeding occurred in 87 of 626
(13.9%) patients with no difference between patients treated with DS as
compared to GA (56 and 31 events in 420 and 206 patients, respectively).
In this regard, the odds ratio (OR) was 1.27 (95% confidence interval
[CI]: 0.78 to 2.09; p=0.338) and 1.26 (95% CI: 0.49 to 3.22; p=0.496)
following the onestage and two-stage approach, respectively. Length of ICU
stay was longer after GA as compared to DS (ratio of days 3.08, 95% CI:
2.18 to 4.36, p<0.001, and 2.88, 95% CI: 1.45 to 5.73, p=0.016, following
the one-stage and two-stage approach, respectively). <br/>Conclusion(s):
Both DS and GA might offer a similar safety profile. However, ICU stay
seems to be shorter after DS.<br/>Copyright &#xa9; Europa Digital &
Publishing 2021. All rights reserved.

<70>
Accession Number
2011540551
Title
Meta-analysis of minimalist versus standard care approach for
transcatheter aortic valve replacement.
Source
Expert Review of Cardiovascular Therapy. 19(6) (pp 565-574), 2021. Date of
Publication: 2021.
Author
Qureshi W.T.; Kundu A.; Mir T.; Khan A.; Anwaruddin S.; Sattar Y.; Ogunsua
A.; Dutta A.; Majeed C.N.; Walker J.; Kakouros N.
Institution
(Qureshi, Kundu, Khan, Ogunsua, Kakouros) Division of Cardiovascular
Medicine, University of Massachusetts Medical School, Worcester, MA,
United States
(Mir) Department of Internal Medicine, Detroit Medical Centre, Wayne State
University, Detroit, United States
(Anwaruddin) Division of Cardiovascular Medicine, Hospital of the
University of Pennsylvania, Philadelphia, PA, United States
(Sattar) Department of Internal Medicine, Icahn School of Medicine at
Mount, Sinai Elmhurst Hospital, Queens, NY, United States
(Dutta) Department of Critical Care Medicine, Memorial Sloan Kettering,
NY, United States
(Majeed) Department of Internal Medicine, Section on Hospital Medicine,
Wake Forest School of Medicine, Winston-Salem, NC, United States
(Walker) Division of Cardiothoracic Surgery, University of Massachusetts
Medical School, Worcester, MA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: The change in practice of transcatheter aortic valve
replacement (TAVR) to a minimalist approach is a debate. <br/>Method(s):
Online database search for studies that compared the minimalist approach
with the standard approach for TAVR were searched from inception through
September 2020. We calculated pooled odds ratios (ORs) and 95% confidence
intervals (CIs) using the fixed or random-effects model. <br/>Result(s): A
total of 9 studies with 2,880 TAVR patients (minimalist TAVR;1066 and
standard TAVR; 1,814) were included. Compared to standard approach, there
were no significant differences in in-hospital mortality, 30-day
mortality, or hospital readmissions. However, there was a reduced risk of
acute kidney injury (OR0.49;95%CI0.27-0.89), major bleeding
(OR0.21;95%CI0.12-0.38) and major vascular complications
(OR0.60,95%CI0.39-0.91) associated with the minimalist TAVR group. There
was comparatively shorter hospital length of stay (mean difference
-2.41;95%CI-2.99,-1.83) days, procedural time (mean difference
-43.99;95%CI-67.25,-20.75) minutes, fluoroscopy time (mean difference
-2.69;95%CI-3.44,-1.94) minutes and contrast volume (mean difference
-26.98;95%CI-42.18,-11.79) ml in the minimalist TAVR group.
<br/>Conclusion(s): This meta-analysis demonstrated potential benefits of
the minimalist TAVR approach over the standard approach regarding some
adverse clinical outcomes as well as procedural outcomes without
significant differences in mortality or readmission rates.<br/>Copyright
&#xa9; 2021 Informa UK Limited, trading as Taylor & Francis Group.

<71>
Accession Number
2011132303
Title
Meta-Analysis and Critical Review of Observational Studies Comparing
Drug-Eluting and Bare Metal Stents for Revascularization of Large Coronary
Arteries.
Source
Cardiovascular Revascularization Medicine. 31 (pp 91-92), 2021. Date of
Publication: October 2021.
Author
Changal K.; Meenakshisundaram C.; Zafarullah F.N.U.; Nazir S.; Sheikh M.A.
Institution
(Changal, Meenakshisundaram, Zafarullah, Nazir) Cardiovascular Medicine,
University of Toledo, OH, United States
(Sheikh) Cardiovascular Medicine and Interventional Cardiology, Promedica
Toledo Hospital, OH, United States
Publisher
Elsevier Inc.

<72>
Accession Number
2010795825
Title
A narrative review of platelet-rich plasma (PRP) in reproductive medicine.
Source
Journal of Assisted Reproduction and Genetics. 38(5) (pp 1003-1012), 2021.
Date of Publication: May 2021.
Author
Sharara F.I.; Lelea L.-L.; Rahman S.; Klebanoff J.S.; Moawad G.N.
Institution
(Sharara, Rahman) Virginia Center for Reproductive Medicine, 11150 Sunset
Hills Rd, Suite 100, Reston, VA 20190, United States
(Sharara, Moawad) Department of Obstetrics and Gynecology, George
Washington University, Washington, DC, United States
(Lelea) Department of Obstetrics and Gynecology, University of Central
Florida-HCA Consortium, Orlando, FL, United States
(Klebanoff) Department of Obstetrics and Gynecology, Main Line Health
Wynnewood, Wynnewood, PA, United States
(Moawad) The Center for Endometriosis and Advanced Pelvic Surgery,
Washington, DC, United States
Publisher
Springer
Abstract
Purpose: Platelet-rich plasma (PRP) has become a novel treatment in
various aspects of medicine including orthopedics, cardiothoracic surgery,
plastic surgery, dermatology, dentistry, and diabetic wound healing. PRP
is now starting to become an area of interest in reproductive medicine
more specifically focusing on infertility. Poor ovarian reserve,
menopause, premature ovarian failure, and thin endometrium have been the
main areas of research. The aim of this article is to review the existing
literature on the effects of autologous PRP in reproductive medicine
providing a summation of the current studies and assessing the need for
additional research. <br/>Method(s): A literature search is performed
using PubMed, MEDLINE, and CINAHL Plus to identify studies focusing on the
use of PRP therapy in reproductive medicine. Articles were divided into 3
categories: PRP in thin lining, PRP in poor ovarian reserve, and PRP in
recurrent implantation failure. <br/>Result(s): In women with thin
endometrium, the literature shows an increase in endometrial thickness and
increase in chemical and clinical pregnancy rates following autologous PRP
therapy. In women with poor ovarian reserve, autologous intraovarian PRP
therapy increased anti-Mullerian hormone (AMH) levels and decreased
follicle-stimulating hormone (FSH), with a trend toward increasing
clinical and live birth rates. This trend was also noted in women with
recurrent implantation failure. <br/>Conclusion(s): Limited literature
shows promise in increasing endometrial thickness, increasing AMH, and
decreasing FSH levels, as well as increasing chemical and clinical
pregnancy rates. The lack of standardization of PRP preparation along with
the lack of large randomized controlled trials needs to be addressed in
future studies. Until definitive large RCTs are available, PRP use should
be considered experimental.<br/>Copyright &#xa9; 2021, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<73>
Accession Number
2010195585
Title
Short term outcomes of rotational atherectomy versus orbital atherectomy
in patients undergoing complex percutaneous coronary intervention: a
systematic review and meta-analysis.
Source
Scandinavian Cardiovascular Journal. 55(3) (pp 129-137), 2021. Date of
Publication: 2021.
Author
Doshi R.; Thakkar S.; Patel K.; Majmundar M.; Shlofmitz E.; Kumar A.;
Gupta N.; Adalja D.; Patel H.P.; Jauhar R.; Meraj P.
Institution
(Doshi) Department of Internal Medicine, University of Nevada Reno School
of Medicine, Reno, NV, United States
(Thakkar) Department of Internal Medicine, Rochester Regional Hospital,
Rochester, NY, United States
(Patel) Department of Internal Medicine, St. Mary Medical Center,
Langhorne, PA, United States
(Majmundar) Department of Internal Medicine, Metropolitan Hospital Center,
New York Medical College, New York, NY, United States
(Shlofmitz) Department of Cardiology, St. Francis Hospital, Roslyn, NY,
United States
(Kumar) Department of Critical Care, St John's Medical College Hospital,
Bangalore, India
(Gupta) Department of Internal Medicine, University of South Alabama,
Mobile, AL, United States
(Adalja) Department of Medicine, GMERS Gotri Medical College, Vadodara,
India
(Patel) Department of Internal Medicine, Louis A. Weiss Memorial Hospital,
Chicago, IL, United States
(Jauhar, Meraj) Department of Cardiology, North Shore University Hospital,
Manhasset, NY, United States
Publisher
Taylor and Francis Ltd.
Abstract
Objective: Coronary artery calcification (CAC) is one of the paramount
hurdles for percutaneous coronary intervention (PCI) since it impedes
stent delivery and complete expansion. This study intended to evaluate the
short-term clinical and procedural outcomes comparing rotational
atherectomy (RA) and orbital atherectomy (OA) in patients with heavily
calcified coronary lesions undergoing PCI. <br/>Design(s): This systematic
review and meta-analysis included all head-to-head published comparisons
of coronary RA versus OA. Procedural endpoints and post-procedural
clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3
software was used for data analysis. <br/>Result(s): Seven retrospective
observational investigations with a total of 4623 patients, including 3203
patients in the RA group and 1420 patients in the OA group, were
incorporated. Compared with OA, the RA group was associated with a higher
incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95%
CI: 1.07-2.29, p =.02, I ² = 0%). No difference was noted among
other short-term post-procedural clinical outcomes including all-cause
mortality, target vessel revascularization, or major adverse cardiac
events. Among procedural complications, RA was associated with reduced
coronary artery dissection and arterial perforation. Increased fluoroscopy
time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI:
2.25-7.30, p =.0002, I ² = 80%). <br/>Conclusion(s): RA was
associated with fewer vascular complications, but at a cost of higher
incidence of myocardial infarction and higher fluoroscopy time compared
with OA, at short term follow-up. OA is a safe and effective alternative
for the management of CAC.<br/>Copyright &#xa9; 2021 Informa UK Limited,
trading as Taylor & Francis Group.

<74>
Accession Number
2008593629
Title
Peripheral Arterial Disease in Patients with Atrial Fibrillation: The
AFFIRM Study.
Source
American Journal of Medicine. 134(4) (pp 514-518), 2021. Date of
Publication: April 2021.
Author
Vitalis A.; Shantsila A.; Proietti M.; Vohra R.K.; Kay M.; Olshansky B.;
Lip G.Y.H.
Institution
(Vitalis, Shantsila, Proietti, Lip) Liverpool Centre for Cardiovascular
Science, University of Liverpool and Liverpool Heart & Chest Hospital,
United Kingdom
(Vitalis) Institute of Cardiovascular Sciences, University of Birmingham,
United Kingdom
(Vitalis, Vohra, Kay) Department of Vascular Surgery, University Hospitals
Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham,
United Kingdom
(Proietti) Department of Clinical Sciences and Community Health,
University of Milan, Italy
(Proietti) Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore
Policlinico, Milan, Italy
(Olshansky) University of Iowa Carver College of Medicine, Iowa City,
United States
(Lip) Aalborg Thrombosis Research Unit, Department of Clinical Medicine,
Aalborg University, Denmark
Publisher
Elsevier Inc.
Abstract
Background: Peripheral arterial disease has been linked with worse
outcomes in patients with atrial fibrillation. The aim of this study is to
assess the impact of peripheral arterial disease on mortality and stroke
in a cohort of patients with atrial fibrillation. <br/>Method(s): This was
an ancillary analysis of the Atrial Fibrillation Follow-up Investigation
of Rhythm Management (AFFIRM) trial. A comparison of baseline
characteristics was made between patients with atrial fibrillation with
and without diagnosed peripheral arterial disease. Multivariate cox
regression analysis was performed to compare the risk of stroke, death,
and cardiovascular death among the two groups. <br/>Result(s): The
prevalence of peripheral arterial disease in the whole cohort of 4060
patients with atrial fibrillation was 6.7%. Patients with peripheral
arterial disease tended to be older; had higher prevalence of diabetes
mellitus, hypertension, and smoking; and were more likely to have a
history of coronary artery disease, heart failure, cardiac surgery or
cardiac intervention, and stroke or transient ischemic attack (all P <
.05). After multivariate adjustment, peripheral arterial disease was
significantly associated with overall higher mortality (hazard ratio 1.34,
95% confidence interval 1.06-1.70, P = .016) in patients with atrial
fibrillation, but the rates of ischemic stroke were similar in the two
groups (3.9% vs 3.5%, P = 0.874). Subgroup analysis confined to the
patients with non-anticoagulated atrial fibrillation showed that
peripheral arterial disease was an independent predictor of ischemic
stroke (hazard ratio 3.37, 95% confidence interval 1.25-9.09, P < .016).
<br/>Conclusion(s): Peripheral arterial disease predicts higher mortality
in atrial fibrillation, and was an independent predictor of ischemic
stroke in patients with non-anticoagulated atrial fibrillation. Proactive
surveillance and optimization of medical management in this group of
patients is warranted, given the high risks associated with peripheral
arterial disease where atrial fibrillation is also present.<br/>Copyright
&#xa9; 2020 Elsevier Inc.

<75>
Accession Number
2007881105
Title
Post-coronary artery bypass graft surgery insomnia: Quetiapine vs
alprazolam.
Source
Iranian Heart Journal. 22(3) (pp 74-80), 2021. Date of Publication: 2021.
Author
Mirmohammadsadeghi A.; Narimani I.; Chitsaz A.
Institution
(Mirmohammadsadeghi) Cardiovascular Surgery, Isfahan University of Medical
Sciences (IUMS), Isfahan, Iran, Islamic Republic of
(Narimani, Chitsaz) Isfahan University of Medical Sciences (IUMS),
Isfahan, Iran, Islamic Republic of
Publisher
Iranian Heart Association
Abstract
Background: Given that insomnia is common and not always easily handled
after coronary artery bypass graft surgery (CABG), this study was
conducted to compare the efficacy of quetiapine and alprazolam in
post-CABG insomnia. <br/>Method(s): In this clinical trial, 90 patients
undergoing CABG were selected and randomly divided into 2 groups of 45
patients. The first group received 12.5 mg of oral quetiapine and the
second group received 0.5 mg of alprazolam before bedtime (at 10 PM). The
patients' insomnia was evaluated and compared using the Insomnia Severity
Index (ISI) questionnaire on 3 occasions: 1 month before surgery and then
3 days and 14 days after surgery. <br/>Result(s): The mean score of
insomnia 1 month before surgery and 3 days after surgery had no
statistically significant difference in both groups (P =0.89 and P =0.55,
respectively). The mean score of insomnia on the 14th postoperative day,
which was at the end of the 10-day treatment period, was 15.33 +/- 3.87 in
the alprazolam group and 13.33 +/- 4.71 in the quetiapine group (P >0.05
and P =0.043, respectively). In the quetiapine group, 2 patients
experienced drowsiness on the following day and 1 patient developed
pruritus; none of them experienced restless leg syndrome or dystonia. Nine
patients in the quetiapine group and 3 patients in the alprazolam group
had drug noncompliance. <br/>Conclusion(s): Despite more drug
noncompliance, very low-dose quetiapine was more effective than alprazolam
in improving the sleep quality of our early postoperative CABG
patients.<br/>Copyright &#xa9; 2021, Iranian Heart Association. All rights
reserved.

<76>
Accession Number
2007701128
Title
Transcatheter versus surgical aortic valve replacement in patients with
chronic obstructive pulmonary disease.
Source
Scandinavian Cardiovascular Journal. 55(3) (pp 168-172), 2021. Date of
Publication: 2021.
Author
Takagi H.; Kuno T.; Hari Y.; Nakashima K.; Yokoyama Y.; Ueyama H.; Ando T.
Institution
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Shizuoka
Medical Center, Shizuoka, Japan
(Takagi, Hari, Nakashima) Department of Cardiovascular Surgery, Kitasato
University School of Medicine, Sagamihara, Japan
(Kuno, Ueyama) Department of Medicine, Mount Sinai Beth Israel Medical
Center, New York, NY, United States
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA, United
States
(Ando) Division of Interventional Cardiology, Department of Cardiology,
New York Presbyterian Hospital/Columbia University Medical Center, New
York, NY, United States
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: Although a number of studies compared mortality after
transcatheter aortic valve implantation (TAVI) with that after surgical
aortic replacement (SAVR) in patients with chronic obstructive pulmonary
disease (COPD), no meta-analysis of them has been conducted to date. To
determine whether TAVI or SAVR is associated with better postprocedural
survival in patients with COPD, a meta-analysis of all studies currently
available was performed. Design. To identify all comparative studies of
TAVI with SAVR in patients with COPD, PubMed and Web of Science were
searched through January 2020. Studies meeting the following criteria were
included in the present meta-analysis: the design was an observational
comparative study or a randomized controlled trial; the study population
was patients with COPD; patients were assigned to TAVI versus SAVR; and
outcomes included all-cause mortality. Adjusted (if unavailable,
unadjusted) odds or hazard ratios with their confidence intervals (CIs) of
mortality for TAVI versus SAVR were extracted from each study.
Study-specific estimates were combined in the random-effects model.
Results. Six eligible studies with a total of 4771 patients with COPD were
identified and included in the present meta-analysis. The meta-analysis
indicated significantly lower early (in-hospital or 30-day) mortality
after TAVI than after SAVR (odds ratio, 0.69; 95% CI, 0.53-0.90; p =.006)
but no significant difference in midterm (1-year to 5-year) mortality
between TAVI and SAVR (hazard ratio, 1.07; 95% CI, 0.79-1.44; p =.68).
Conclusions. In patients with COPD, TAVI was associated with reduced early
mortality, while midterm mortality appeared similar, as compared with
SAVR.<br/>Copyright &#xa9; 2020 Informa UK Limited, trading as Taylor &
Francis Group.

<77>
Accession Number
2007011876
Title
Effects of exercise training in postoperative patients with congenital
heart disease: A systematic review and meta-analysis of randomized
controlled trials.
Source
Journal of the American Heart Association. 9(5) (no pagination), 2020.
Article Number: e013516. Date of Publication: 2020.
Author
Xu C.; Su X.; Ma S.; Shu Y.; Zhang Y.; Hu Y.; Mo X.
Institution
(Xu, Su, Ma, Shu, Zhang, Hu, Mo) Department of Cardiothoracic Surgery,
Children's Hospital of Nanjing Medical University, Nanjing, China
Publisher
American Heart Association Inc.
Abstract
Background--The purpose of this meta-analysis is to assess the effects of
exercise training on quality of life, specific biomarkers, exercise
capacity, and vascular function in congenital heart disease (CHD) subjects
after surgery. Methods and Results--We searched the Cochrane Central
Register of Controlled Trials, MEDLINE, and EMBASE from the date of the
inception of the database through April 2019. Altogether, 1161 records
were identified in the literature search. Studies evaluating outcomes
before and after exercise training among postoperative patients with
congenital heart disease were included. The assessed outcomes were
exercise capacity, vascular function, serum NT-proBNP (N-terminal
pro-B-type natriuretic peptide) levels and quality of life. We analyzed
heterogeneity by using the I² statistic and evaluated the
evidence quality according to the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) guidelines. Nine randomized controlled
trials were included. The evidence indicated that exercise interventions
increased the one of the quality of life questionnaire score (mean
difference=3.19 [95% CI, 0.23, 6.16]; P=0.03; I² =39%) from the
score before the interventions. However, no alterations in exercise
capacity, vascular function, NT-proBNP or quality of life were observed
after exercise training. The results of the subgroup analysis showed that
NT-proBNP levels were lower in the group with exercise training than in
the group without exercise training over the same duration of follow-up.
The evidence quality was generally assessed to be low. Conclusions--In
conclusion, there is insufficient evidence to suggest that physical
exercise improves long-term follow-up outcomes of congenital heart
disease, although it has some minor effects on quality of
life.<br/>Copyright &#xa9; 2020 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<78>
Accession Number
2013796114
Title
Meta-analysis of Surgical Left Atrial Appendage Occlusion During Cardiac
Surgery.
Source
American Journal of Cardiology. 155 (pp 150-151), 2021. Date of
Publication: 15 Sep 2021.
Author
Mohamed M.M.G.; Faisaluddin M.; Kheiri B.; Osman M.
Institution
(Mohamed) Internal Medicine Department, SSM Health St. Mary's Hospital,
St. Louis, MO, United States
(Faisaluddin) Internal Medicine Department, Rochester General Hospital,
Rochester, NY, United States
(Kheiri) Knight Cardiovascular Institute, Oregon Health & Science
University, Portland, OR, United States
(Osman) Division of Cardiology, West Virginia University School of
Medicine, Morgantown, WV, United States
Publisher
Elsevier Inc.

<79>
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. <br/>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). <br/>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). <br/>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.<br/>Copyright &#xa9; 2021
The Society of Thoracic Surgeons

<80>
Accession Number
2013604510
Title
Effect of music therapy on infants who underwent mechanical ventilation
after cardiac surgery.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Huang Y.-L.; Lei Y.-Q.; Xie W.-P.; Cao H.; Yu X.-R.; Chen Q.
Institution
(Huang, Lei, Xie, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Branch of Shanghai Children's Medical Center, Fuzhou, China
(Huang, Lei, Xie, Cao, Yu, Chen) Fujian Children's Hospital, Fuzhou, China
(Huang, Lei, Xie, Cao, Yu, Chen) Fujian Maternity and Child Health
Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
(Huang, Lei, Xie, Cao, Yu, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Objective: To investigate the effect of music therapy on infants who
underwent mechanical ventilation after cardiac surgery. <br/>Method(s): A
prospective randomized controlled study was conducted in a provincial
hospital in southeast China. The subjects were randomly divided into the
music therapy (MT) group and the control group. Both groups were given
standardized sedation treatment and routine nursing. Infants in the MT
group received 60 min of MT three times a day. The sedation medication,
Richmond sedation agitation scale (RASS) score, incidence of delirium,
mechanical ventilation duration, length of cardiac intensive care unit
(CICU) stay, restraint belt use time, and successful ventilation
withdrawal rate were collected. <br/>Result(s): Infants in the control
group had a higher total amount of on-demand midazolam (p =.039). Infants
in the MT group had a significantly lower incidence of delirium, shorter
mechanical ventilation duration, and restraint band use time (p =.047, p
=.046, and p =.038, respectively). Although infants in the MT group had a
higher success rate of ventilation withdrawal, lower RASS scores, and
shorter ICU stay, the difference was not statistically significant (p
=.427, p =.585, and p =.068, respectively). <br/>Conclusion(s): MT in the
ICU can reduce the use of on-demand sedative drugs, shorten mechanical
ventilation, and reduce the occurrence of delirium in infants who
underwent mechanical ventilation after cardiac surgery. MT is a safe and
reliable treatment and worthy of clinical application.<br/>Copyright
&#xa9; 2021 Wiley Periodicals LLC

<81>
Accession Number
2012285227
Title
Clinical anatomy of the lumbar sinuvertebral nerve with regard to
discogenic low back pain and review of literature.
Source
European Spine Journal. 30(10) (pp 2999-3008), 2021. Date of Publication:
October 2021.
Author
Quinones S.; Konschake M.; Aguilar L.L.; Simon C.; Aragones P.; Hernandez
L.M.; Abramovic A.; Tubbs R.S.; Bouzada J.; Valderrama-Canales F.J.;
Vazquez T.; Sanudo J.
Institution
(Quinones, Aragones, Bouzada, Valderrama-Canales, Vazquez, Sanudo)
Department of Anatomy and Embryology, Faculty of Medicine, Universidad
Complutense de Madrid, Madrid, Spain
(Konschake, Abramovic) Department of Anatomy, Histology and Embryology,
Institute of Clinical and Functional Anatomy, Medical University of
Innsbruck (MUI), Mullerstr. 59, Innsbruck 6020, Austria
(Aguilar) Unidad de Columna. Servicio de COT., Hospital Plato., Barcelona,
Spain
(Simon) Computer Science and Statistics, URJC., Madrid, Spain
(Simon) Instituto Universitario de Evaluacion Sanitaria, UCM, Madrid,
Spain
(Aragones) Department of Orthopedics. Hospital, Universitario Santa
Cristina, Madrid, Spain
(Hernandez) Human Anatomy and Embryology Unit, Department of Surgery,
Medical and Social Sciences, Scholl of Medicine and Health Sciences,
University of Alcala, UAH, Alcala de Henares, Madrid, Spain
(Abramovic) Department of Neurosurgery, Medical University of Innsbruck
(MUI), Innsbruck, Austria
(Tubbs) Department of Neurosurgery, Tulane University School of Medicine,
New Orleans, LA, United States
(Tubbs) Department of Neurology, Tulane University School of Medicine, New
Orleans, LA, United States
(Tubbs) Department of Surgery, Tulane University School of Medicine, New
Orleans, LA, United States
(Tubbs) Department of Structural and Cellular Biology, Tulane University
School of Medicine, New Orleans, LA, United States
(Tubbs) Department of Neurosurgery and Ochsner Neuroscience Institute,
Ochsner Health System, New Orleans, LA, United States
(Tubbs) Department of Anatomical Sciences, School of Medicine, St.
George's University, West Indies, Grenada
(Tubbs) University of Queensland, Brisbane, Australia
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Lumbar discogenic diffuse pain is still not understood. Authors
describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor
studies are rare and controversial. Therefore, the aim was to revisit the
origin, course and distribution in a body-donor study. <br/>Method(s): Six
lumbar blocks (3 female, 3 male) aged between 59 and 94 years were
dissected. After removal of the back muscles, lamina, dura mater and cauda
equina, the anterior vertebral venous plexus, spinal artery and SVN were
exposed and evaluated. <br/>Result(s): 43 nerves out of 48 levels could be
evaluated. The origin of the SVN was constituted by two roots: a somatic
and a sympathetic branch arising from the rami communicantes. In 4/48
intervertebral canals studied (8.3%), we found two SVN at the same level.
In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The
SVN had a recurrent course below the inferior vertebral notch; in the
vertebral canal it showed different patterns: ascending branch (31/43,
72.1%), common branch diverging into two branches (10/43, 23.3%), double
ascending branch (1/43, 2.3%) finalizing two levels above and a descending
branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral
connections with another SVN. The distribution ended in the middle of the
vertebral body supplying adjacent structures. <br/>Conclusion(s): A
thorough understanding of the anatomy of the SVN might lead to significant
benefits in therapy of discogenic low back pain. We suggest blocking the
SVN at the level of the inferior vertebral notch of two adjacent segments.
Level of evidence I: Diagnostic: individual cross-sectional studies with
consistently applied reference standard and blinding<br/>Copyright &#xa9;
2021, The Author(s).

<82>
Accession Number
636043339
Title
Relationship Between Cardiac Surgery and Acute Ischemic Stroke: An
Examination in Terms of Clinical, Radiological, and Functional Outcomes
and Possible Pathophysiological Mechanisms.
Source
The heart surgery forum. 24(4) (pp E713-E723), 2021. Date of Publication:
25 Aug 2021.
Author
Isik M.; Kozak H.H.; Gormus N.
Institution
(Isik) Department of Cardiovascular Surgery, Meram Faculty of Medicine,
Necmettin Erbakan University, Konya, Turkey
(Kozak) Department of Neurology, Meram Faculty of Medicine, Necmettin
Erbakan University, Konya, Turkey
(Gormus) Department of Cardiovascular Surgery, Meram Faculty of Medicine,
Necmettin Erbakan University, Konya, Turkey
Publisher
NLM (Medline)
Abstract
AIM: The aim is to discuss the clinical characteristics, time, anatomical
vascular distribution, radiological features, functional outcomes after
stroke and possible pathophysiological mechanisms of acute ischemic stroke
(AIS) that develop after cardiac surgery. <br/>METHOD(S): A total of 3,474
patients, who underwent cardiac surgery between 2015-2020, retrospectively
were analyzed. Forty-nine patients, who developed AIS and had brain CT and
diffusion MR images during hospitalization, were included in the study.
<br/>RESULT(S): AIS distribution was at 53% CABG, 12.2% isolated mitral
valve, 8.1% isolated aortic valve, and 26.5% combined surgical procedures.
Patients with a <=2 days (P = 0.03) preop preparation time and body
surface area (BSA) of <1.85 m2 (P = 0.02) had a high discharge rate. While
newly developing AF was low in the early stroke group, it was higher in
the late stroke group (P = 0.02). A history of previous cerebrovascular
events was found in 3.3% of the patients. Postoperative new AIS was
detected in 7.8% of those with a history of cerebrovascular events. Total
anterior circulation infarction (TACI) case rate was 8.1%, partial
anterior circulation infarction (PACI) 12.2%, posterior circulation
infarction (POCI) 24.4%, cortical border zone infarction (CBZI) 30.6%,
combined POCI + CBZI 12.2%, multiple territorial infarcts (MTI) 10.2%, and
lacunar circulation infarction (LACI) rate was 2%. The modified Rankin
Scale means following AIS was 3.45. The worst Rankin score was 5.75 in
CABG+MVR cases; it was found to be 5 in the valve + ascending aorta case
and 5 in the five bypass cases. <br/>CONCLUSION(S): Calculation of
cerebrovascular reserve with extra/intracranial vascular imaging is
important in patients with multiple risk factors, whose association with
stroke has been determined before cardiac surgery. We believe that
cardiovascular surgery and neurology multidisciplinary prospective
randomized studies should be conducted to obtain pre-, peri- and
post-procedural risk calculation scales, according to cardiac surgery type
and to reshape surgical procedures accordingly.

<83>
Accession Number
636042981
Title
Risk Factors Associated with an Increased Risk of Deep Sternal Wound
Infections in Patients After Coronary Artery Bypass Grafting and Heart
Defect Surgery.
Source
The heart surgery forum. 24(4) (pp E741-E745), 2021. Date of Publication:
25 Aug 2021.
Author
Vitartaite M.; Vaiciulyte D.; Vencloviene J.; Sirvinskas E.
Institution
(Vitartaite) Faculty of Medicine, Medical Academy, Lithuanian University
of Health Sciences, Kaunas, Lithuania
(Vaiciulyte) Faculty of Medicine, Medical Academy, Lithuanian University
of Health Sciences, Kaunas, Lithuania
(Vencloviene) Institute of Cardiology, Lithuanian University of Health
Sciences, Kaunas, Lithuania
(Sirvinskas) Department of Cardiothoracic and Vascular Surgery, Medical
Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Publisher
NLM (Medline)
Abstract
BACKGROUND: Despite improvements over time with regard to morbidity,
mortality, and long-term survival, deep sternal wound infection (DSWI)
continues to be a major complication after open-heart surgery. This is why
it is important to identify possible risk factors for postoperative
development of DSWI in patients undergoing coronary artery bypass grafting
and valve replacement. The aim of this study was to identify the risk
factors for postoperative development of deep sternal wound infection in
patients after coronary artery bypass grafting and heart defect surgery at
the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital
of Lithuanian University of Health Sciences. <br/>METHOD(S): This
retrospective study analyzed 201 patients, who underwent coronary artery
bypass grafting and heart defect surgery between January 2017 and December
2018. The case group contained 45 patients, who had to be reoperated
because of deep sternal wound infection, and the control group consisted
of 156 randomly selected patients. For descriptive statistics, we used
means, median values, ranges, standard deviations, and 95% confidence
intervals, where appropriate. Categorical data were analyzed using the
chi-square or Fisher's exact test. Student T-test and Mann-Whitney used to
compare numerical variables. Logistic regression model adjusting for age
and gender was used to compare the risk of infection. A P-value of<0.05
was considered to be statistically significant. SPSS 26.0 was used for
calculations. <br/>RESULT(S): Logistic regression analysis revealed that
independent risk factors for sternal wound infection were high BMI (odds
ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16),
long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03),
intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP
concentration (OR 1.10; CI 1.05-1.16). <br/>CONCLUSION(S): Preoperative
assessment to identify obese individuals as being at risk and techniques
to minimize the duration of surgery and intraoperative blood loss may help
reduce postoperative deep sternal wound infections.

<84>
Accession Number
635002949
Title
Lowering cholesterol, blood pressure, or both to prevent cardiovascular
events: results of 8.7 years of follow-up of Heart Outcomes Evaluation
Prevention (HOPE)-3 study participants.
Source
European heart journal. 42(31) (pp 2995-3007), 2021. Date of Publication:
17 Aug 2021.
Author
Bosch J.; Lonn E.M.; Jung H.; Zhu J.; Liu L.; Lopez-Jaramillo P.; Pais P.;
Xavier D.; Diaz R.; Dagenais G.; Dans A.; Avezum A.; Piegas L.S.;
Parkhomenko A.; Keltai K.; Keltai M.; Sliwa K.; Held C.; Peters R.J.G.;
Lewis B.S.; Jansky P.; Yusoff K.; Khunti K.; Toff W.D.; Reid C.M.; Varigos
J.; Joseph P.; Leiter L.A.; Yusuf S.
Institution
(Bosch, Lonn, Jung, Joseph, Yusuf) The Population Health Research
Institute, Hamilton Health Sciences, 237 Barton Street East, Hamilton,
Ontario L8L 2X2, Canada
(Bosch, Joseph, Yusuf) School of Rehabilitation Science, McMaster
University, IAHS, Room 403, 1400 Main St. West, Hamilton, Canada
(Lonn) Department of Medicine, McMaster University, 1200 Main St. West,
Hamilton, Canada
(Zhu, Liu) Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking
Union Medical College, 9 Dongdan 3rd Alley ,Dong Dan ,Dongcheng, Beijing,
China
(Lopez-Jaramillo) Instituto Masira, Facultad de Salud, Universidad de
Santander, Calle 70 No 55-210, Bucaramanga, Colombia
(Pais, Xavier) St. John's Research Institute, 100 Feet Rd ,Koramangala
,Bangalore, Karnataka 560034, India
(Xavier) St. John's Medical College, Sarjarpur Road ,Bangalore, Karnataka
560034, India
(Diaz) Instituto Cardiovascular de Rosario, DSR, S2000 Rosario, Santa Fe,
Argentina
(Dagenais) Institut Universitaire de Cardiologie et Pneumologie de Quebec,
Universite Laval, 2725 Ch Ste-Foy, Quebec, Canada
(Dans) College of Medicine, University of the Philippines, Pedro Gil
Street, Taft Ave, Ermita, Manila, 1000 Metro Manila, Philippines
(Avezum) Dante Pazzanese Institute of Cardiology and Sao Paulo University,
Av. Dr. Dante Pazzanese, 500 - Vila Mariana, Sao Paulo - SP, 04012-909,
Brazil
(Piegas) HCor-Hospital do Coracao, Des. Eliseu Guilherme, 147 - Paraiso
Sao Paulo - SP, Brazil
(Parkhomenko) Institute of Cardiology, Narodnoho Opolchennya St, Ukraine
(Keltai, Keltai) Hungarian Institute of Cardiology, Semmelweis University,
Budapest, Hungary
(Sliwa) Department of Medicine, Hatter Institute for Cardiovascular
Research, University of Cape Town, Soweto Cardiovascular Research Group,
4th, Chris Barnard Building Faculty of Health Sciences, 5th and 6th
FloorPrivate Bag X3 7935, Cape Town, South Africa
(Held) Uppsala Clinical Research Centre and Institute for Medical
Sciences, Cardiology, Uppsala University, Uppsala Academic Hospital,
Uppsala 752 37, Sweden
(Peters) Department of Cardiology, Academic Medical Center, Meibergdreef
9, AZ Amsterdam 1105, Netherlands
(Lewis) Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School
of Medicine, Technion-Israel Institute of Technology, Efron St 1, Haifa,
Israel
(Jansky) University Hospital Motol, V Uvalu 84Czechia, 150 06 Praha 5
(Yusoff) Universiti Teknologi Majlis Amansh Rakyat, Jalan Ilmu 1/1, Shah
Alam, Selangor 40450, Malaysia
(Yusoff) University College Sedaya International University, UCSI Heights,
Taman Connaught, Wilayah Persekutuan Kuala Lumpur, Jalan Puncak Menara
Gading56000 Cheras, Malaysia
(Khunti) Leicester Diabetes Centre, Gwendolen Rd, Leicester LE5 4PW,
United Kingdom
(Toff) Department of Cardiovascular Sciences, University of Leicester,
University Rd, Leicester LE1 7RH, United Kingdom
(Toff) UK and National Institute for Health Research, Leicester Biomedical
Research Centre, Glenfield Hospital ,Groby Road, Leicester LE3 9QP, United
Kingdom
(Reid, Varigos) School of Public Health and Preventive Medicine, Monash
University, 553 St. Kilda Rd., Melbourne, VIC 3004, Australia
(Reid) School of Public Health, Curtin University, Kent St, WA 6102,
Australia
(Leiter) Li Ka Shing Knowledge Institute and Keenan Research Centre for
Biomedical Science, St. Michael's Hospital, University of Toronto, 209
Victoria St, Toronto, Canada
Publisher
NLM (Medline)
Abstract
AIMS: Rosuvastatin (10 mg per day) compared with placebo reduced major
adverse cardiovascular (CV) events by 24% in 12 705 participants at
intermediate CV risk after 5.6 years. There was no benefit of blood
pressure (BP) lowering treatment in the overall group, but a reduction in
events in the third of participants with elevated systolic BP. After
cessation of all the trial medications, we examined whether the benefits
observed during the active treatment phase were sustained, enhanced, or
attenuated. METHODS AND RESULTS: After the randomized treatment period
(5.6 years), participants were invited to participate in 3.1 further years
of observation (total 8.7 years). The first co-primary outcome for the
entire length of follow-up was the composite of myocardial infarction,
stroke, or CV death [major adverse cardiovascular event (MACE)-1], and the
second was MACE-1 plus resuscitated cardiac arrest, heart failure, or
coronary revascularization (MACE-2). In total, 9326 (78%) of 11 994
surviving Heart Outcomes Prevention Evaluation (HOPE)-3 subjects consented
to participate in extended follow-up. During 3.1 years of post-trial
observation (total follow-up of 8.7 years), participants originally
randomized to rosuvastatin compared with placebo had a 20% additional
reduction in MACE-1 [95% confidence interval (CI), 0.64-0.99] and a 17%
additional reduction in MACE-2 (95% CI 0.68-1.01). Therefore, over the 8.7
years of follow-up, there was a 21% reduction in MACE-1 (95% CI 0.69-0.90,
P = 0.005) and 21% reduction in MACE-2 (95% CI 0.69-0.89, P = 0.002).
There was no benefit of BP lowering in the overall study either during the
active or post-trial observation period, however, a 24% reduction in
MACE-1 was observed over 8.7 years. <br/>CONCLUSION(S): The CV benefits of
rosuvastatin, and BP lowering in those with elevated systolic BP, compared
with placebo continue to accrue for at least 3 years after cessation of
randomized treatment in individuals without cardiovascular disease
indicating a legacy effect. TRIAL REGISTRATION NUMBER:
NCT00468923.<br/>Copyright &#xa9; The Author(s) 2021. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<85>
Accession Number
636053353
Title
On-pump versus of-pump coronary artery bypass grafting: A review of
current literature.
Source
European Heart Journal, Supplement. Conference: CardioAlex 2019.
Alexandria Egypt. 21(SUPPL H) (pp H4), 2019. Date of Publication: November
2019.
Author
Ahmed K.; Ayyad M.A.K.S.
Institution
(Ahmed, Ayyad) Cardiothoracic Surgery Department, Faculty of Medicine,
Assiut University, Egypt
Publisher
Oxford University Press
Abstract
Aim: This is an article review through which we try to conclude the
current up-todate guidelines and recommendations concerning the ongoing
debate of when to perform Off-Pump Coronary Artery Bypass Surgery (OPCAB).
<br/>Method(s): We used PubMed database to search for the current
literature Using keywords: off-pump, OPCAB, On-Pump CABG, coronary
revascularization, Hybrid coronary revascularization. Our inclusion
criteria are: published and unpublished peer-reviewed papers written in
English from 2010 till now. All types of studies are included.
<br/>Result(s): Beating heart coronary surgery is one of the most
challenging and controversial operations in the world up till now.[1]
Although the first operation was done in the early 1960s but the debate
for pros and cons of this unique surgery is still ongoing. In the early
2000s OPCAB surgery reached its peak with recorded 25% of coronary surgery
in the USA performed using Off-pump technique.[2] During the subsequent
years OPCAB performance has declined again to reach 12.5% in 2010.[2] This
decline is due to thorough research studies which showed unfavorable
outcomes at the long term. Short term outcomes have turned out to be
almost the same in most studies. On the long run, most studies show
increasing in the need for repeated revascularization (RR) for patients
who had Off-Pump CABG than those who had Onpump CABG according to CORONARY
and ROOBY clinical trials.[3] However, there are some specific groups who
might have the most benefit out of Off-Pump CABG including Old age group,
those with neurological history, Female sex and those who suffer impaired
ventricular dysfunction with ejection fraction (EF) less than 30%.[3-5].
Yet, it also depends on the experience of the surgeon in the first place.
Most studies agreed that surgeons experience is the most important factor
that determines the outcomes of OPCAB surgery considering it a very
challenging technique which need fine skills and high level of training.
[6, 7] <br/>Conclusion(s):The use of off-pump coronary bypass graft
surgery did not deliver any superadded advantage over on-pump surgery in
terms of hard endpoints or quality of life. The choice of surgical
procedure thus depends mainly on operator expertise and individual patient
characteristics and preferences.

<86>
Accession Number
636046535
Title
Association between Transcatheter Aortic Valve Replacement for Bicuspid vs
Tricuspid Aortic Stenosis and Mortality or Stroke among Patients at Low
Surgical Risk.
Source
JAMA - Journal of the American Medical Association. 326(11) (pp
1034-1044), 2021. Date of Publication: 21 Sep 2021.
Author
Makkar R.R.; Yoon S.-H.; Chakravarty T.; Kapadia S.R.; Krishnaswamy A.;
Shah P.B.; Kaneko T.; Skipper E.R.; Rinaldi M.; Babaliaros V.; Vemulapalli
S.; Trento A.; Cheng W.; Kodali S.; Mack M.J.; Leon M.B.; Thourani V.H.
Institution
(Makkar, Yoon, Chakravarty, Trento, Cheng) Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Kapadia, Krishnaswamy) Heart and Vascular Institute, Cleveland Clinic,
Cleveland, OH, United States
(Shah, Kaneko) Brigham and Women's Hospital, Boston, MA, United States
(Skipper, Rinaldi) Sanger Heart and Vascular Institute, Carolinas Medical
Center, Charlotte, NC, United States
(Babaliaros) Emory University School of Medicine, Atlanta, GA, United
States
(Vemulapalli) Duke University Medical Center, Durham, NC, United States
(Kodali, Leon) Columbia University Medical Center, New York, NY, United
States
(Mack) Baylor Scott and White Health, Plano, TX, United States
(Thourani) Piedmont Heart Institute, Atlanta, GA, United States
Publisher
American Medical Association
Abstract
Importance: There are limited data on outcomes of transcatheter aortic
valve replacement (TAVR) for bicuspid aortic stenosis in patients at low
surgical risk. <br/>Objective(s): To compare the outcomes of TAVR with a
balloon-expandable valve for bicuspid vs tricuspid aortic stenosis in
patients who are at low surgical risk. <br/>Design, Setting, and
Participant(s): Registry-based cohort study of patients undergoing TAVR at
684 US centers. Participants were enrolled in the Society of Thoracic
Surgeons (STS)/American College of Cardiology Transcatheter Valve
Therapies Registry from June 2015 to October 2020. Among 159661 patients
(7058 bicuspid, 152603 tricuspid), 37660 patients (3243 bicuspid and 34417
tricuspid) who were at low surgical risk (defined as STS risk score <3%)
were included in the analysis. Exposures: TAVR for bicuspid vs tricuspid
aortic stenosis. <br/>Main Outcomes and Measures: Coprimary outcomes were
30-day and 1-year mortality and stroke. Secondary outcomes included
procedural complications and valve hemodynamics. <br/>Result(s): Among
159661 patients (7058 bicuspid; 152603 tricuspid), 3168 propensity-matched
pairs of patients with bicuspid and tricuspid aortic stenosis at low
surgical risk were analyzed (mean age, 69 years; 69.8% men; mean [SD]
STS-predicted risk of mortality, 1.7% [0.6%] for bicuspid and 1.7% [0.7%]
for tricuspid). There was no significant difference between the bicuspid
and tricuspid groups' rates of death at 30 days (0.9% vs 0.8%; hazard
ratio [HR], 1.18 [95% CI, 0.68-2.03]; P =.55) and at 1 year (4.6% vs 6.6%;
HR, 0.75 [95% CI, 0.55-1.02]; P =.06) or stroke at 30 days (1.4% vs 1.2%;
HR, 1.14 [95% CI, 0.73-1.78]; P =.55) and at 1 year (2.0% vs 2.1%; HR 1.03
[95% CI, 0.69-1.53]; P =.89).There were no significant differences between
the bicuspid and tricuspid groups in procedural complications, valve
hemodynamics (aortic valve gradient: 13.2 mm Hg vs 13.5 mm Hg; absolute
risk difference [RD], 0.3 mm Hg [95% CI, -0.9 to 0.3 mm Hg]), and moderate
or severe paravalvular leak (3.4% vs 2.1%; absolute RD, 1.3% [95% CI,
-0.6% to 3.2%]). <br/>Conclusions and Relevance: In this preliminary,
registry-based study of propensity-matched patients at low surgical risk
who had undergone TAVR for aortic stenosis, patients treated for bicuspid
vs tricuspid aortic stenosis had no significant difference in mortality or
stroke at 30 days or 1 year. Because of the potential for selection bias
and absence of a control group treated surgically for bicuspid aortic
stenosis, randomized trials are needed to adequately assess the efficacy
and safety of transcatheter aortic valve replacement for bicuspid aortic
stenosis in patients at low surgical risk..<br/>Copyright &#xa9; 2021
American Medical Association. All rights reserved.

<87>
Accession Number
635996429
Title
In-Hospital Outcomes of Acute Kidney Injury After Pediatric Cardiac
Surgery: A Meta-Analysis.
Source
Frontiers in Pediatrics. 9 (no pagination), 2021. Article Number: 733744.
Date of Publication: 03 Sep 2021.
Author
Van den Eynde J.; Rotbi H.; Gewillig M.; Kutty S.; Allegaert K.; 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, Gewillig) Department of Cardiovascular Sciences, KU
Leuven, Leuven, Belgium
(Rotbi) Faculty of Medicine, Radboud University, Nijmegen, Netherlands
(Rotbi) Department of Physiology, Radboud Institute for Health Sciences,
Radboud University Medical Center, Nijmegen, Netherlands
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Allegaert) Department of Development and Regeneration, KU Leuven, Leuven,
Belgium
(Allegaert) Department of Pharmacy and Pharmaceutical Sciences, KU Leuven,
Leuven, Belgium
(Allegaert) Department of Hospital Pharmacy, Erasmus Medical Center,
Rotterdam, Netherlands
(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
Frontiers Media S.A.
Abstract
Background: Cardiac surgery-associated acute kidney injury (CS-AKI) is
associated with increased morbidity and mortality in both adults and
children. This study aimed to investigate the in-hospital outcomes of
CS-AKI in the pediatric population. <br/>Method(s): PubMed/MEDLINE,
Embase, Scopus, and reference lists of relevant articles were searched for
studies published by August 2020. Random-effects meta-analysis was
performed, comparing in-hospital outcomes between patients who developed
CS-AKI and those who did not. <br/>Result(s): Fifty-eight publications
between 2008 and 2020 consisting of 18,334 participants (AKI: 5,780; no
AKI: 12,554) were included. Higher rates of in-hospital mortality (odds
ratio [OR] 7.22, 95% confidence interval [CI] 5.27-9.88), need for renal
replacement therapy (RRT) (OR 18.8, 95% CI 11.7-30.5), and cardiac
arrhythmias (OR 2.67, 95% 1.86-4.80) were observed in patients with
CS-AKI. Furthermore, patients with AKI had longer ventilation times (mean
difference [MD] 1.76 days, 95% CI 1.05-2.47), pediatric intensive care
unit (PICU) length of stay (MD 3.31, 95% CI 2.52-4.10), and hospital
length of stay (MD 5.00, 95% CI 3.34-6.67). <br/>Conclusion(s): CS-AKI in
the pediatric population is associated with a higher risk of mortality,
cardiac arrhythmias and need for RRT, as well as greater mechanical
ventilation time, PICU and hospital length of stay. These results might
help improve the clinical care protocols prior to cardiac surgery to
minimize the disease burden of CS-AKI in children. Furthermore,
etiology-specific approaches to AKI are warranted, as outcomes are likely
impacted by the underlying cause.<br/>&#xa9; Copyright &#xa9; 2021 Van den
Eynde, Rotbi, Gewillig, Kutty, Allegaert and Mekahli.

<88>
Accession Number
2013844358
Title
Sex differences in clinical outcomes of patients with stable coronary
artery disease after percutaneous coronary intervention.
Source
Current Pharmaceutical Design. 27(29) (pp 3180-3185), 2021. Date of
Publication: 2021.
Author
Vardas E.P.; Oikonomou E.; Siasos G.; Theofilis P.; Dilaveris P.;
Papanikolaou A.; Tousoulis D.
Institution
(Vardas, Oikonomou, Siasos, Theofilis, Dilaveris, Papanikolaou, Tousoulis)
1st Cardiology Clinic, 'Hippokration' General Hospital, National and
Kapodistrian University of Athens, School of Medicine, Athens, Greece
Publisher
Bentham Science Publishers
Abstract
Potential sex-related differences in the periprocedural and long-term
postprocedural outcomes of coronary angioplasty in patients with stable
coronary artery disease have been studied thoroughly over the last few
decades, to determine whether female sex should be regarded as an
independent risk factor that affects clinical outcomes. Based on a
significant number of observational studies and meta-analyses, sex has not
yet emerged as an independent risk factor for either mortality or major
cardiac and cerebrovascular events, despite the fact that in the early
1980s, for several reasons, female sex was associated with unfavourable
outcomes. Therefore, it remains debatable whether the female sex should be
considered as an independent risk factor for periprocedural and long-term
bleeding events. The pharmacological and technological advancements that
support current coronary angioplasty procedures, as well as the
non-delayed treatment of coronary artery disease in females, have
certainly lessened the outcome differences between the two sexes. However,
females show fluctuations in blood coagulability through their lifetime
and a higher prevalence of bleeding episodes associated with the
antithrombotic treatment following transcatheter coronary reperfusion
interventions. In conclusion, the clinical results of percutaneous
coronary intervention in patients with stable coronary artery disease,
during the periprocedural and long-term postprocedural periods, appear to
show no significant differences between the two sexes, except for bleeding
rates, which seem to be higher in females, a difference that mandates
further systematic research.<br/>Copyright &#xa9; 2021 Bentham Science
Publishers.

<89>
Accession Number
2013765404
Title
Effect of recruitment maneuvers and PEEP on respiratory failure after
cardiothoracic surgery in obese subjects: A randomized controlled trial.
Source
Respiratory Care. 66(8) (pp 1306-1314), 2021. Date of Publication: 01 Aug
2021.
Author
Amaru P.; Delannoy B.; Genty T.; Desebbe O.; Laverdure F.;
Rezaiguia-Delclaux S.; Stephan F.
Institution
(Amaru, Genty, Rezaiguia-Delclaux, Stephan) Cardiothoracic ICU, Department
of Anesthesiology and ICU, Hopital Marie Lannelongue, Le Plessis Robinson,
France
(Laverdure) Department of Anesthesiology and ICU, Hopital Marie
Lannelongue, Le Plessis Robinson, France
(Delannoy, Desebbe) Clinique de la Sauvegarde, Lyon, France
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Obesity may increase the risk of respiratory failure after
cardiothoracic surgery. A recruitment maneuver followed by PEEP might
decrease the risk of respiratory failure in obese subjects. We
hypothesized that the routine use after heart surgery of a recruitment
maneuver followed by high or low PEEP level would decrease the frequency
of respiratory failure in obese subjects. <br/>METHOD(S): In a pragmatic,
randomized controlled trial, we assigned obese subjects (ie, with body
mass index [BMI] >= 30 kg/m²) in the immediate postoperative
period of cardiothoracic surgery to either volume control ventilation with
5 cm H<inf>2</inf>O of PEEP (control group) or a recruitment maneuver
followed by 5 or 10 cm H<inf>2</inf>O of PEEP in the intervention arms
(RM5 and RM10 groups, respectively). The primary outcome was the
proportion of subjects with postextubation respiratory failure, defined as
the need for re-intubation, bi-level positive airway pressure, or
high-flow nasal cannula within the first 48 h. <br/>RESULT(S): The study
included 192 subjects: 65 in the control group (BMI 33.5 +/- 3.2 kg/
m²), 66 in the RM5 group (BMI 34.5 +/- 3.2 kg/m²,
and 61 in RM10 group (BMI 33.8 +/- 4.8 kg/m²). Postextubation
respiratory failure occurred in 14 subjects in the control group (21.5%
[95% CI 13.3- 35.3]), 21 subjects in the RM5 group (31.8% [95% CI
21.2-44.6]), and 9 subjects in the RM10 group (14.7% [95% CI 7.4-26.7]) (P
5.07). The recruitment maneuver was stopped prematurely due to severe
hypotension in 8 (12.1%) RM5 subjects and in 4 (6.6%) RM10 subjects (P
5.28). There were no significant differences between the 3 groups for the
frequencies of atelectasis, pneumonia, and death in the ICU.
<br/>CONCLUSION(S): The routine use after heart surgery of a recruitment
maneuver followed by 5 or 10 cm H<inf>2</inf>O of PEEP did not decrease
the frequency of respiratory failure in obese subjects. A recruitment
maneuver followed by 5 cm H<inf>2</inf>O of PEEP is
inappropriate.<br/>Copyright &#xa9; 2021 Daedalus Enterprises.

<90>
Accession Number
2014713868
Title
Applicability of Transcatheter Aortic Valve Replacement Trials to
Real-World Clinical Practice: Findings From EXTEND-CoreValve.
Source
JACC: Cardiovascular Interventions. 14(19) (pp 2112-2123), 2021. Date of
Publication: 11 Oct 2021.
Author
Butala N.M.; Secemsky E.; Kazi D.S.; Song Y.; Strom J.B.; Faridi K.F.;
Brennan J.M.; Elmariah S.; Shen C.; Yeh R.W.
Institution
(Butala, Secemsky, Kazi, Strom, Shen, Yeh) Richard A. and Susan F. Smith
Center for Outcomes Research in Cardiology, Division of Cardiovascular
Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
(Butala, Elmariah) Cardiology Division, Department of Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Song) Baim Institute for Clinical Research, Boston, MA, United States
(Faridi) Section of Cardiology, Department of Medicine, Yale School of
Medicine, New Haven, CT, United States
(Brennan) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to examine the applicability of
pivotal transcatheter aortic valve replacement (TAVR) trials to the
real-world population of Medicare patients undergoing TAVR.
<br/>Background(s): It is unclear whether randomized controlled trial
results of novel cardiovascular devices apply to patients encountered in
clinical practice. <br/>Method(s): Characteristics of patients enrolled in
the U.S. CoreValve pivotal trials were compared with those of the
population of Medicare beneficiaries who underwent TAVR in U.S. clinical
practice between November 2, 2011, and December 31, 2017. Inverse
probability weighting was used to reweight the trial cohort on the basis
of Medicare patient characteristics, and a "real-world" treatment effect
was estimated. <br/>Result(s): A total of 2,026 patients underwent TAVR in
the U.S. CoreValve pivotal trials, and 135,112 patients underwent TAVR in
the Medicare cohort. Trial patients were mostly similar to real-world
patients at baseline, though trial patients were more likely to have
hypertension (50% vs 39%) and coagulopathy (25% vs 17%), whereas
real-world patients were more likely to have congestive heart failure (75%
vs 68%) and frailty. The estimated real-world treatment effect of TAVR was
an 11.4% absolute reduction in death or stroke (95% CI: 7.50%-14.92%) and
an 8.7% absolute reduction in death (95% CI: 5.20%-12.32%) at 1 year with
TAVR compared with conventional therapy (surgical aortic valve replacement
for intermediate- and high-risk patients and medical therapy for
extreme-risk patients). <br/>Conclusion(s): The trial and real-world
populations were mostly similar, with some notable differences.
Nevertheless, the extrapolated real-world treatment effect was at least as
high as the observed trial treatment effect, suggesting that the absolute
benefit of TAVR in clinical trials is similar to the benefit of TAVR in
the U.S. real-world setting.<br/>Copyright &#xa9; 2021 American College of
Cardiology Foundation

<91>
Accession Number
2014713865
Title
Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid Versus
Tricuspid Anatomy: A Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14(19) (pp 2144-2155), 2021. Date of
Publication: 11 Oct 2021.
Author
Montalto C.; Sticchi A.; Crimi G.; Laricchia A.; Khokhar A.A.; Giannini
F.; Reimers B.; Colombo A.; Latib A.; Waksman R.; Mangieri A.
Institution
(Montalto) Department of Molecular Medicine, University of Pavia, Pavia,
Italy
(Montalto) Oxford Heart Center, Oxford University Hospital NHS Trust,
Oxford, United Kingdom
(Sticchi) Centro per la Lotta Contro l'Infarto Foundation, Rome, Italy
(Sticchi) Unicamillus, Saint Camillus International University of Health
Sciences, Rome, Italy
(Crimi) Cardio-Thoraco-Vascular Department, IRCCS Ospedale Policlinico San
Martino, Genova, Italy
(Laricchia, Khokhar, Giannini) GVM Care and Research, Maria Cecilia
Hospital, Cotignola, Italy
(Reimers, Colombo, Mangieri) Department of Biomedical Sciences, Humanitas
University, Pieve Emanuele, Milan, Italy
(Reimers, Colombo, Mangieri) Cardio Center, Humanitas Research Hospital
IRCCS, Rozzano, Milan, Italy
(Latib) Montefiore Medical Center, New York, NY, United States
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare the feasibility, safety,
and clinical outcomes of transcatheter aortic valve replacement (TAVR) in
bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis.
<br/>Background(s): At present, limited observational data exist
supporting TAVR in the context of bicuspid anatomy. <br/>Method(s):
Primary endpoints were 1-year survival and device success. Secondary
endpoints included moderate to severe paravalvular leak (PVL) and a
composite endpoint of periprocedural complications; incidence rates of
individual procedural endpoints were also explored individually.
<br/>Result(s): In the main analysis, 17 studies and 181,433 patients
undergoing TAVR were included, of whom 6,669 (0.27%) had BAV. A secondary
analysis of 7,071 matched subjects with similar baseline characteristics
was also performed. Device success and 1-year survival rates were similar
between subjects with BAV and those with TAV (97% vs 94% [P = 0.55] and
91.3% vs 90.8% [P = 0.22], respectively). In patients with BAV, a trend
toward a higher risk for periprocedural complications was observed in our
main analysis (risk ratio [RR]: 1.12; 95% CI: 0.99-1.27; P = 0.07) but not
in the matched population secondary analysis (RR: 1.00; 95% CI: 0.81-1.24;
P = 0.99). The risk for moderate to severe PVL was higher in subjects with
BAV (RR: 1.42; 95% CI: 1.29-1.58; P < 0.0001) as well as the incidence of
cerebral ischemic events (2.4% vs 1.6%; P = 0.015) and of annular rupture
(0.3% vs 0.02%; P = 0.014) in matched subjects. <br/>Conclusion(s): TAVR
is a feasible option among selected patients with BAV anatomy, but the
higher rates of moderate to severe PVL, annular rupture, and cerebral
ischemic events observed in the BAV group warrant caution and further
evidence.<br/>Copyright &#xa9; 2021 American College of Cardiology
Foundation

<92>
Accession Number
2014701401
Title
Persistent under-representation of female patients in United States trials
of common vascular diseases from 2008 to 2020.
Source
Journal of Vascular Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Mayor J.M.; Preventza O.; McGinigle K.; Mills J.L.; Montero-Baker M.;
Gilani R.; Pallister Z.; Chung J.
Institution
(Mayor, Mills, Montero-Baker, Gilani, Pallister, Chung) Division of
Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of
Surgery, Baylor College of Medicine, Houston, Tex, United States
(Preventza) Division of Cardiothoracic Surgery, Michael E DeBakey
Department of Surgery, Baylor College of Medicine, Houston, Tex, United
States
(McGinigle) Division of Vascular Surgery, Department of Surgery,
University of North Carolina, Chapel Hill, NC, United States
Publisher
Mosby Inc.
Abstract
Background: Women have been historically under-represented in vascular
surgery and cardiovascular medicine trials. The rate and change in
representation of women in trials of common vascular diseases over the
last decade is not understood completely. <br/>Method(s): We used publicly
available data from ClinicalTrials.gov to evaluate trials pertaining to
carotid artery stenosis (CAS), peripheral arterial disease (PAD), thoracic
and abdominal aortic aneurysms (TAA and AAA), and type B aortic
dissections (TBAD) from 2008 to the present. We evaluated representation
of women in these trials based on the participation-to-prevalence ratios
(PPR), which are calculated by dividing the percentage of women among
trial participants by the percentage of women in the disease population.
Values of 0.8 to 1.2 reflect similar representation. <br/>Result(s): The
sex distribution was reported in all 97 trials, including 11 CAS trials,
68 PAD trials, 16 TAA/AAA trials, and 2 TBAD trials. The total number of
participants in these trials was 41,622 and the median number of
participants per trial was 150.5 (interquartile range [IQR], 50-252). The
percentage of women in the disease population was 51.9% for CAS, 53.1% for
PAD, 34.1% for TAA/AAA, and 30.9% for TBAD. Industry sources funded 76 of
the trials (77.6%), and the Veterans Affairs Administration (n = 4
[4.1%]), unspecified university (n = 7 [7.1%]), and extramural sources (n
= 11 [11.2%]) funded the remainder of the trials. The overall median PPR
for all four diseases was 0.65 (IQR, 0.51-0.80). Women were
under-represented for all four conditions studied (CAS, 0.73 [IQR,
0.62-0.96]; PAD, 0.65 [IQR, 0.53-0.77]; TAA/AAA, 0.59 [IQR, 0.38-1.20];
and TBAD, 0.74 [IQR, 0.65-0.84]). There was no significant difference in
PPR among the diseases (P = .88). From 2008 to the present, there was no
significant change in PPR values over time overall (r² = 0.002;
P = .70). When examined individually, PPR did not change significantly
over time for any of the diseases studied (for each, r² < 0.04;
P > .45). The PPR did not vary significantly over time for any of the
funding sources (for each, r² < 0.85, P > .08). There was
appropriate representation (PPR of 0.8-1.2) in a minority of trials for
each disease except TBAD (CAS, 27.3%; PAD, 15.9%; TAA/AAA, 18.8%; and
TBAD, 50%). Trials that were primarily funded from university sources had
the highest median PPR (1.04; IQR, 0.21-1.27), followed by industry-funded
(0.67; IQR, 0.54-0.81), and extramurally funded (0.60; IQR, 0.34-0.73).
Studies funded by Veterans Affairs had the lowest PPR (0.02; IQR,
0.00-0.11; P = .004). <br/>Conclusion(s): Participation of women in US
trials of common vascular diseases remains low and has not improved since
2008. Therefore, the generalizability of recent trial results to women
with these vascular diseases remains unknown. An improved understanding of
the underlying root causes for poor female trial participation, advocacy,
and education are required to improve the generalizability of trial
results for female vascular patients.<br/>Copyright &#xa9; 2021 Society
for Vascular Surgery

<93>
Accession Number
2013787642
Title
A Prospective Study on Type-2 Diabetic Complications and Efficacy of
Integrated Yoga: A Pan India 2017.
Source
Annals of Neurosciences. (no pagination), 2021. Date of Publication:
2021.
Author
Patil S.S.; Raghuram N.; Singh A.; Rajesh S.K.; Ahmed S.; Hongasandra N.
Institution
(Patil, Raghuram, Singh, Ahmed, Hongasandra) Department of Yoga and Life
Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru,
Karnataka, India
(Rajesh) Department of Yoga and Physical Science, Swami Vivekananda Yoga
Anusandhana Samsthana, Bengaluru, Karnataka, India
Publisher
SAGE Publications Inc.
Abstract
Background: Type 2 diabetes (T2DM) contributes to high mortality and
morbidity because of its major complications related to kidney, heart,
brain, and eyes. It also poses a high risk for mortality because of
COVID-19. Studies suggest the possible implications of Yoga in delaying or
attenuating such complications. Methodology: This was a pan-India multi
centered cluster-randomized (4 level) two-armed trial in the rural and
urban population of all populous states of India. Data were obtained using
mobile app in all adults in the household of the selected clusters.
<br/>Result(s): We report the diabetes related complications in 16623
adults (48% males, 52% females) from 65 districts (1 in 10 districts, 2011
census) of 29 (out of 35) states and Union Territories of India; mean age
was 48.2 +/- 12.46 years. Out of this 40% lived in rural and 62% in urban
locations. In high risk diabetes individuals (scored >= 60 points on
Indian diabetes risk score key), 18.0% had self-reported history of
(peripheral neuropathy, 6.1% had h/o major strokes, 5.5% had minor strokes
(transient ischemic episodes), 18.1% had lower limb claudication, 20.5%
leg ulcers, 4.4% had h/o cardiac surgery, 4.8% angioplasty, and 15.1% had
diabetes retinopathy. Complications were higher in rural than in urban
areas, higher in people with extended duration of diabetes. Integrated
yoga module for three months (one hour daily) showed significantly better
reduction in symptoms related to complications as compared to control
group (P <.001) <br/>Conclusion(s): The alarming high prevalence of
complications in diabetes population calls for urgent action, where yoga
may show the benefits in reduction of symptoms of
complications.<br/>Copyright &#xa9; 2021 Indian Academy of Neurosciences
(IAN).

<94>
Accession Number
2013785921
Title
Iron supplementation for patients undergoing cardiac surgery: a systematic
review and meta-analysis of randomized controlled trials.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Yang S.S.; Al Kharusi L.; Gosselin A.; Chirico A.; Baradari P.G.; Cameron
M.J.
Institution
(Yang, Al Kharusi, Gosselin, Chirico, Baradari, Cameron) Faculty of
Medicine, McGill University, Montreal, QC, Canada
(Yang, Cameron) Division of Critical Care, Department of Anesthesia,
Jewish General Hospital, K1400-3755, Cote Sainte Catherine, Montreal, QC
H3T 1E2, Canada
Publisher
Springer
Abstract
Purpose: Iron supplementation has been evaluated in several randomized
controlled trials (RCTs) for its potential to increase baseline hemoglobin
and decrease red blood cell transfusion during cardiac surgery. This
study's main objective was to evaluate the current evidence for iron
administration in cardiac surgery patients. <br/>Method(s): We searched
MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google Scholar
from inception to 19 November 2020 for RCTs evaluating perioperative iron
administration in adult patients undergoing cardiac surgery. The RCTs were
assessed using a risk of bias assessment and the quality of evidence was
assessed using the grading of recommendations, assessments, development,
and evaluations. <br/>Result(s): We reviewed 1,767 citations, and five
studies (n = 554) met the inclusion criteria. The use of iron showed no
statistical difference in incidence of transfusion (risk ratio, 0.86; 95%
confidence interval, 0.65 to 1.13). Trial sequential analysis suggested an
optimal information size of 1,132 participants, which the accrued
information size did not reach. <br/>Conclusion(s): The current literature
does not support or refute the routine use of iron therapy in cardiac
surgery patients. Trial registration: PROSPERO (CRD42020161927);
registered 19 December 2019.<br/>Copyright &#xa9; 2021, Canadian
Anesthesiologists' Society.

<95>
Accession Number
636056269
Title
Sex differences in outcomes following coronary artery bypass grafting: a
meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 03 Sep 2021.
Author
Bryce Robinson N.; Naik A.; Rahouma M.; Morsi M.; Wright D.; Hameed I.; Di
Franco A.; Girardi L.N.; Gaudino M.
Institution
(Bryce Robinson, Naik, Rahouma, Morsi, Hameed, Di Franco, Girardi,
Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, NY,
NY, United States
(Wright) Weill Cornell Medicine, Samuel J. Wood Library and C.V. Starr
Biomedical Information Centre, NY, NY, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Previous reports have found females are a higher risk of
morbidity and mortality following isolated coronary artery bypass grafting
(CABG). Here, we describe the differences in outcomes following isolated
CABG between males and females. <br/>METHOD(S): Following a systematic
literature search, studies reporting sex-related outcomes following
isolated CABG were pooled in a meta-analysis performed using the generic
inverse variance method. The primary outcome was operative mortality.
Secondary outcomes included rates of stroke, repeat revascularization,
myocardial infarction, major adverse cardiac events, and late mortality.
Subgroup analyses were performed for studies published before and after
the year 2000 and for the type of risk adjustment. <br/>RESULT(S):
Eighty-four studies were included with a total of 903 346 patients.
Females were at higher risk for operative mortality (odds ratio: 1.77, 95%
confidence interval [CI]: 1.64-1.92, P<0.001). At subgroup analysis, there
was no difference in operative or late mortality between studies published
prior and after 2000 or between studies using risk adjustment. Females
were at a higher risk of late mortality (incidence rate ratio [IRR]: 1.16,
95% CI: 1.06-1.26, P<0.001), major adverse cardiac events (IRR: 1.40, 95%
CI: 1.19-1.66, P<0.001), myocardial infarction (IRR: 1.28, 95% CI:
1.13-1.45, P<0.001) and stroke (IRR: 1.31, 95% CI: 1.15-1.51, P>0.001) but
not repeat revascularization (IRR: 0.99, 95% CI: 0.76-1.29, P=0.95). The
use of the off-pump technique or multiple arterial grafts was not
associated with the primary outcome. <br/>CONCLUSION(S): Females
undergoing CABG are at higher risk for operative and late mortality as
well as postoperative events including major adverse cardiac events,
myocardial infarction and stroke. PROSPERO REGISTRATION:
CRD42020187556.<br/>Copyright &#xa9; The Author(s) 2021. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<96>
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. (no pagination), 2021. Date of Publication: 03 Sep 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, Essen, Germany
(Corteville) Sands Constellation Heart Institute, Rochester Regional
Health. Rochester, NY
(Szabo) Central German Heart Center University Hospital Halle (Saale),
University Clinic and Polyclinic for Cardiac Surgery, Halle, Germany
(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, Canada
(Lehner) Department of Nephrology and Medical Intensive Care, Charite
Universitatsmedizin, Berlin, Germany
(Brown) New Brunswick Heart Centre, Saint John Regional Hospital, Saint
John, Canada
(Noiseux) Division of Cardiac Surgery, University of Montreal Hospital
Center, CHUM Research Center, QC, Montreal, Canada
(Atta) Division of Nephrology, Johns Hopkins School of Medicine, MD,
Baltimore, United States
(Squiers) Coastal Vista Consulting L.L.C, Half Moon Bay, CA, Italy
(Erlich, Rothenstein) Quark Pharmaceuticals, Inc., Newark, CA
(Molitoris) Nephrology Division, Department of Medicine, Indiana
University School of Medicine; Indiana Center for Biological Microscopy,
Indianapolis, IN
(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, Toronto, Canada
Publisher
NLM (Medline)
Abstract
Background: Acute kidney injury (AKI) affects up to 30% of cardiac surgery
patients, leading to increased in-hospital and long-term morbidity and
mortality. Teprasiran is a novel small interfering RNA (siRNA) that
temporarily inhibits p53-mediated cell death, which underlies AKI.
<br/>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 vs. placebo (1:1), in reducing the incidence,
severity, and duration of AKI following cardiac surgery in high-risk
patients. The primary endpoint was proportion of patients who developed
AKI determined by serum creatinine (sCr) by post-operative day 5. Other
endpoints included AKI severity and duration using various prespecified
criteria. To inform future clinical development, a composite endpoint of
major adverse kidney events at day 90 (MAKE90), including death, renal
replacement therapy (RRT) and >=25% reduction of estimated glomerular
filtration rate (eGFR) was assessed. Both sCr and serum cystatin-C (sCys)
were used for eGFR assessments. <br/>Result(s): A total of 360 patients
were randomized in 41 centers. 341 dosed patients were 73+/-7.5 years old
(mean+/-SD), 72% were male, and median Euroscore-II (European System for
Cardiac Operative Risk Evaluation) was 2.6%. Demographics and surgical
parameters were similar between groups. AKI incidence was 37% for
teprasiran vs. 50% for placebo-treated patients, a 12.8% absolute risk
reduction (ARR), p=0.02; OR=0.58 (95% CI 0.37 to 0.92). AKI severity and
duration were also improved with teprasiran: 2.5% of teprasiran vs. 6.7%
of placebo-treated patients had Grade 3 AKI; 7% teprasiran vs. 13%
placebo-treated patients had AKI lasting for 5 days. No significant
difference was observed for the MAKE90 composite in the overall
population. No safety issues were identified with teprasiran treatment.
<br/>Conclusion(s): The incidence, severity, and duration of early AKI in
high-risk patients undergoing cardiac surgery were significantly reduced
following teprasiran administration. A Phase 3 study with a MAKE90 primary
outcome which has recently completed enrollment was designed based on
these findings (NCT03510897). Clinical Trial Registration: URL:
https://clinicaltrials.gov/ Unique Identifier: NCT02610283.

<97>
Accession Number
2014049676
Title
Effects of combined and general anesthesia on cognitive functions for
patients undergoing cardiac surgery under CPB.
Source
Heart Surgery Forum. 24(4) (pp E593-E597), 2021. Date of Publication: 21
Jul 2021.
Author
Kasputyte G.; Bukauskiene R.; Sirvinskas E.; Lenkutis T.; Vimantaite R.;
Andrejaitiene J.
Institution
(Kasputyte, Bukauskiene, Lenkutis) Department of Cardiac, Thoracic and
Vascular Surgery, Lithuanian University of Health Sciences, Kaunas
Clinics, Gaziler cd. No 468 Izmir, Kaunas, Lithuania
(Sirvinskas, Andrejaitiene) Institute of Cardiology, Lithuanian University
of Health Sciences, Kaunas, Lithuania
(Vimantaite) Lithuanian University of Health Sciences, Medical Academy,
Faculty of Nursing, Kaunas, Lithuania
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Patients may experience a variety of neurological
complications after heart surgery. The most common complication observed
in clinical practice is delayed neurocognitive recovery (dNCR). The role
of the anesthesiologist is very important, as the risk of dNCR may be
reduced, depending on the anesthesia tactic chosen. Although the
possibility that neuropsychological complications are less common in
patients undergoing combined anesthesia (general + epidural) than in
patients undergoing general anesthesia is not yet confirmed, the results
are being discussed. The aim of this study was to determine impact of
combined anesthesia (general + epidural) on cognitive functions of
patients after cardiac surgery. <br/>Method(s): The prospective,
case-controlled study included 80 patients undergoing cardiac surgery from
2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in
the Hospital of Lithuanian University of Health Sciences Kauno Klinikos.
After approval from the local bioethics center, informed consent was
obtained from all study participants. Inclusion criteria were age 51 to 80
years, elective cardiac surgery, left ventricular ejection fraction > 35%,
anamnesis of not using agents affecting the central nervous system,
absence of neuropathology, and sufficient renal function. Exclusion
criteria were patients suffering from diseases causing cognitive function
or using agents affecting the central nervous system, emergency or
re-surgery, carotid artery atherosclerosis with artery diameter 50 or more
percent reduction, and a patient's disagreement. MMSE test and 6-CIT test
were used for a cognitive function assessment, Trail making test and WAIS
Digital Symbol Substitution test were used for psychomotor function
assessment. All tests were used a day before surgery and seven days after
surgery. According to the planned anesthesia, patients were assigned into
two groups: 1 - combined general + epidural anesthesia and 2 - general
anesthesia. Standardized protocol of anesthesia was followed for all
patients. Preoperative patients and surgery factors, preoperative and
postoperative neuropsychological test results were recorded.
<br/>Result(s): Eighty patients were enrolled in the study. Both groups
did not differ in demographic, perioperative values, and baseline
(preoperative) test results. Postoperative (7th day) WAIS (P = .042) and
6-item cognitive impairment (P = .016) test results were statistically
different when comparing the GA and CA groups. Comparing preoperative and
postoperative test results, there was a significant decline in the WAIS
test score in the GA group (P = .013).<br/>Copyright &#xa9; 2021 Forum
Multimedia Publishing LLC. All rights reserved.

<98>
Accession Number
2014049674
Title
Leg wound complications: A comparison between endoscopic and open
saphenous vein harvesting techniques.
Source
Heart Surgery Forum. 24(4) (pp E604-E610), 2021. Date of Publication: 26
Jul 2021.
Author
Mubarak Y.; Abdeljawad A.
Institution
(Mubarak) Cardiothoracic Surgery Department, Minia University, Egypt
(Mubarak) Madinah Cardiac Center, KSA, Saudi Arabia
(Abdeljawad) Cardiothoracic Surgery Department, Cairo University, Egypt
(Abdeljawad) Clinical of Cardiothoracic and Vascular Surgery, Stadtisches
Klinikum Braunschweig, Germany
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: The most common conduit for coronary artery bypass graft
(CABG) surgery is saphenous vein graft (SVG). There are two techniques for
SVG harvesting: open and endoscopic. Our aim is to evaluate clinical
results of endoscopic versus open SVG harvesting. Nowadays, endoscopic
vein harvesting (EVH) has become prevalent because of reduced
complications with more patient satisfaction. <br/>Objective(s): We
designed and performed a prospective randomized cohort study of patients
undergoing CABG to compare the results of open versus endoscopic
harvesting technique. <br/>Method(s): Patients who underwent elective CABG
at our hospitals were divided into two groups, during the period of
January 2019 to March 2021. The EVH group (50 patients) underwent
endoscopic technique compared with the open vein harvesting (OVH) group
(50 patients) that was underwent open surgical incision for great
saphenous vein (GSV) harvesting. The two groups demographically were
similar and received identical management. Leg wound was evaluated at
discharge, two weeks, and four weeks for evidence of any complications.
Early outcomes were recorded, including infection, gaped wound and
surgical re-suture, degree of pain, level of cosmetic satisfaction, and
early mobilization. <br/>Result(s): In the EVH group, harvesting time
increased, and incision closure time decreased in comparison with OVH. The
hospital stay was 5.5 +/- 2.4 days in the EVH group versus 9.5 +/- 2.7
days in the OVH group. Leg wound complications were significantly reduced
in the EVH group in comparison with the OVH group. <br/>Conclusion(s):
Endoscopic vein harvesting technique reduced leg wound complications.
Conveniently, patients also were cosmetically satisfied.<br/>Copyright
&#xa9; 2021 Forum Multimedia Publishing LLC. All rights reserved.

<99>
Accession Number
2014049663
Title
CD133+ stem cell therapy effects on myocardial regeneration through
increased vascular endothelial growth factor correlate with cardiac
magnetic resonance imaging results in coronary artery bypass graft surgery
patients with low ejection fraction.
Source
Heart Surgery Forum. 24(4) (pp E670-E674), 2021. Date of Publication: 29
Jul 2021.
Author
Soetisna T.W.
Institution
(Soetisna) Department of Cardiothoracic and Vascular Surgery, National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Stem cell implantation has become a promising therapy for
heart failure due to coronary heart disease (CHD). CD133+ stem cell
therapy, together with increases of vascular endothelial growth factor
(VEGF) and other growth hormones, can induce myocardial repair.
<br/>Objective(s): To prove that VEGF plays a role in cardiac
regeneration. <br/>Method(s): Twenty-six patients with CHD and ejection
fractions <35% from Harapan Kita Heart and Vascular Center, Jakarta,
Indonesia, from 2016 to 2018 were randomized into 2 groups. The treatment
group underwent coronary artery bypass graft (CABG) + CD133+ implantation,
and the control group underwent CABG only. Six months later, perfusion and
myocardial function were assessed by ejection fraction, wall motion score
index (WMSI), ventricular dimensions, and scar size using cardiovascular
magnetic resonance imaging. VEGF was assessed with enzyme-linked
immunosorbent assay. <br/>Result(s): There was significant improvement in
ejection fraction (8.69% +/- 9.49% versus 1.43% +/- 7.87%, P = .04), WMSI
(0.51 +/- 0.48 versus -0.01 +/- 0.21, P = .003), and scar size (25.46 +/-
12.91 versus 27.32 +/- 12.92 mm, P = .047) and a significant increase in
blood VEGF levels (61.05 +/- 63.01 versus 19.88 +/- 33.78 pg/mL, P = .01).
Improvements in perfusion defects (13.69 +/- 5.03 versus 11.53 +/- 5.81 P
= .32) and ventricular dimensions (-27.59 +/- 84.48 versus -19.08 +/-
36.79 mm, P = .06) were not statistically significant. <br/>Conclusion(s):
CD133+ stem cell implantation improves myocardial function. The increase
in VEGF levels is expected to continue improving restoration of myocardial
function when myocardial perfusion improvement is still not
optimal.<br/>Copyright &#xa9; 2021 Forum Multimedia Publishing LLC. All
rights reserved.

<100>
Accession Number
2013598987
Title
Implications of the Landmark ISCHEMIA Trial on the Initial Management of
High-Risk Patients with Stable Ischemic Heart Disease.
Source
Current Atherosclerosis Reports. 23(11) (no pagination), 2021. Article
Number: 70. Date of Publication: November 2021.
Author
Vafaei P.; Naderi S.; Ambrosy A.P.; Slade J.J.
Institution
(Vafaei, Naderi, Ambrosy, Slade) Department of Cardiology, Kaiser
Permanente San Francisco Medical Center, 2238 Geary Boulevard, San
Francisco, CA 94115, United States
(Ambrosy) Division of Research, Kaiser Permanente Northern California,
Oakland, CA, United States
Publisher
Springer
Abstract
Purpose of the Review: In the decades following the advent of percutaneous
coronary intervention, the optimal treatment strategy for managing stable
ischemic heart disease has remained a topic of debate. The purpose of this
review is to discuss current literature that provides insight into
preferred treatment strategies for managing stable coronary artery
disease. Recent Findings: The COURAGE trial (2007) compared patients with
stable coronary artery disease treated with percutaneous coronary
intervention plus optimal medical therapy versus optimal medical therapy
alone and found no difference in death from any cause and non-fatal
myocardial infarction at 4.6 years. The more recent ISCHEMIA trial (2020)
compared an initial invasive revascularization strategy with optimal
medical therapy to optimal medical therapy alone and similarly found no
difference in death from cardiovascular causes, myocardial infarction, or
hospitalization for unstable angina, heart failure, or resuscitated
cardiac arrest at 5 years. <br/>Summary: When applied to a broad
population with stable coronary artery disease, evidence suggests there is
no benefit to an initial invasive revascularization strategy relative to
optimal medical therapy alone. Further investigation is warranted to
determine whether there are subgroups of individuals that may benefit from
earlier revascularization.<br/>Copyright &#xa9; 2021, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<101>
Accession Number
2013407522
Title
Impact of bilateral versus single internal thoracic artery grafting on the
long-term survival in adults: A systematic review.
Source
Vascular Health and Risk Management. 17 (pp 509-518), 2021. Date of
Publication: 2021.
Author
Smady M.N.A.; Zaki M.N.; Alataywi E.; Jegaden O.
Institution
(Smady, Zaki, Alataywi) College of Medicine, Mohammed Bin Rashid
University of Medicine and Health Sciences, Dubai, United Arab Emirates
(Jegaden) Cardiothoracic Surgery Department, Mediclinic Airport Road
Hospital, Abu Dhabi, United Arab Emirates
Publisher
Dove Medical Press Ltd
Abstract
Objective: To analyse the survival of patients who had undergone bilateral
internal thoracic artery grafting versus those with single internal
thoracic artery grafting from the available literature. Moreover, this
study will review the available literature regarding which of the two
techniques seems to be the safest with long-term survival and reduced
mortality rates. <br/>Method(s): A literature search of the databases was
conducted to retrieve studies that fall under the study design of cohort
and randomized controlled clinical trials in English from January 2015 to
July 2021. Finally, seven studies were selected: four cohort studies and
three other from a randomized trial. <br/>Result(s): The cohort studies
revealed that bilateral internal thoracic artery grafting is associated
with lower mortality rates and better long-term survival outcomes than
single internal thoracic artery grafting, while the ART randomized
controlled clinical trials showed that there is no significant difference
in mortality rates between both the coronary artery bypass grafting
techniques. However, all studies concluded that bilateral internal
thoracic artery grafting is associated with a higher frequency of deep
sternal wound infections. <br/>Conclusion(s): The discrepancy in results
between the cohort studies and randomized controlled clinical trial
remains persistent. However, the stated advantages of bilateral internal
thoracic artery grafting are not strong enough to convince surgeons to
alter their practice and the wide magnitude of expectations from the ART
study was reckoned as inadequate. This may well be due to the presence of
limited criteria for bilateral internal thoracic artery grafting in
identifying the impact on survival of extended arterial revascularization,
and there is a new colossal expectation from the ongoing randomized trial
based on multiple arterial grafting versus single arterial
grafting.<br/>Copyright &#xa9; 2021 Al Smady et al.

<102>
Accession Number
635392408
Title
Prediction of Left Double-Lumen Tube Size by Measurement of Cricoid
Cartilage Transverse Diameter by Ultrasound and CT Multi-Planar
Reconstruction.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 657612.
Date of Publication: 16 Jun 2021.
Author
Zhang C.; Qin X.; Zhou W.; He S.; Liu A.; Zhang Y.; Dai Z.; Yin J.
Institution
(Zhang, Qin, Zhou, He, Liu, Zhang, Dai, Yin) Department of Anesthesiology,
First Affiliated Hospital, School of Medicine, Shihezi University,
Shihezi, China
Publisher
Frontiers Media S.A.
Abstract
Background: Currently, there is no uniform standard for selecting the left
double lumen tubes (LDLT). Advantages, such as safety and convenience of
the ultrasonic technology, and measurement accuracy, make it more widely
applied in the clinical anesthesia, and computed tomography (CT)
multi-planar reconstruction (MPR) technology will certainly provide a more
accurate measurement. For better application for thoracic surgery choice
LDLT, relieving the injury to patients, and reducing the complications,
this study will compare the two approaches. <br/>Method(s): The first
part, 120 cases of patients were selected according to the height and
gender; recording the patient's optimum LDLT and measurement the
transverse diameter of the cricoid cartilage (TD-C) by ultrasound and CT
MPR, and then obtained the TD-C range measurement by ultrasound and CT MPR
corresponding to different types of LDLT. The second part, total of 102
patients were divided into the ultrasound group and the CT MPR group. In
the ultrasound group, TD-C was measured by ultrasound, the corresponding
size for intubation was selected based on the conclusions derived from the
first part. In the CT MPR group, TD-C was measured by CT MPR, the
corresponding size of LDLT based on the conclusions derived from the first
part. <br/>Result(s): In the first part, 120 patients were no significant
difference in the basic characteristics (P > 0.05). The accuracy of
selecting the LDLT by conventional experience, namely height and gender
was 58.3%. Ultrasonic measurement TD-C range was as follows: 32 Fr <15.88,
35 Fr: 15.88-16.80, 37 Fr: 16.75-17.81, and 39 Fr > 17.80. CT MPR
measurement TD-C range was as follows: 32 Fr <15.74, 35 Fr: 15.74-16.65,
37 Fr: 16.56-17.68, and 39 Fr > 17.65. In the second part, there was no
significant difference in the basic characteristics between the two groups
(P > 0.05). The accuracy of intubation in the ultrasound group was 90.2%
and the corresponding in the CT MPR group was 94.1% (P > 0.05).
<br/>Conclusion(s): The accuracy of selecting the LDLT based on TD-C is
significantly higher than conventional experience; it can significantly
reduce the post-operative complications and there was no statistical
significance in the accuracy of LDLT selected for TD-C measurement by
ultrasound vs. CT, and both of them could be safely used for the
evaluation before intubation under anesthesia in thoracic
surgery.<br/>&#xa9; Copyright &#xa9; 2021 Zhang, Qin, Zhou, He, Liu,
Zhang, Dai and Yin.

<103>
Accession Number
635358125
Title
Skeletonized vs Pedicled Internal Mammary Artery Graft Harvesting in
Coronary Artery Bypass Surgery: A Post Hoc Analysis from the COMPASS
Trial.
Source
JAMA Cardiology. 6(9) (pp 1042-1049), 2021. Date of Publication: September
2021.
Author
Lamy A.; Browne A.; Sheth T.; Zheng Z.; Dagenais F.; Noiseux N.; Chen X.;
Bakaeen F.G.; Brtko M.; Stevens L.-M.; Alboom M.; Lee S.F.; Copland I.;
Salim Y.; Eikelboom J.
Institution
(Lamy, Browne, Sheth, Lee, Copland, Salim, Eikelboom) Population Health
Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
(Lamy, Alboom) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Lamy, Lee, Salim) Department of Health Research Methods, Evidence, and
Impact, McMaster University, Hamilton, ON, Canada
(Sheth, Salim, Eikelboom) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Zheng) Department of Cardiovascular Surgery, Fuwai Hospital, Beijing,
China
(Dagenais) Department of Cardiac Surgery, Quebec Heart and Lung Institute
Affiliated with Laval University, Quebec City, QC, Canada
(Noiseux, Stevens) Department of Cardiac Surgery, Centre Hospitalier de
l'Universite de Montreal, Montreal, QC, Canada
(Chen) Department of Thoracic and Cardiovascular Surgery, Nanjing First
Hospital Affiliated with Nanjing Medical University, Nanjing, China
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Cleveland, United States
(Brtko) Department of Cardiac Surgery, Fakultni Nemocnice Hradec Kralove,
Hradec Kralove, Kralovehradecky, Czechia
Publisher
American Medical Association
Abstract
Importance: The relative safety and patency of skeletonized vs pedicled
internal mammary artery grafts in patients undergoing coronary artery
bypass graft (CABG) surgery are unknown. <br/>Objective(s): To investigate
the association of skeletonized vs pedicled harvesting with internal
mammary artery graft patency and clinical outcomes 1 year after CABG
surgery. <br/>Design, Setting, and Participant(s): This study was a post
hoc analysis of the multicenter, randomized, double-blind,
placebo-controlled Cardiovascular Outcomes for People Using
Anticoagulation Strategies (COMPASS) clinical trial, which enrolled 27 395
patients from 602 centers in 33 countries from March 2013 through May
2016. Eligibility criteria for the trial included CABG surgery for
coronary artery disease with at least 2 grafts implanted and an estimated
glomerular filtration rate of at least 30 mL/min. A total of 1002 of 1448
patients were randomized to the CABG arm of the COMPASS trial and
underwent skeletonized (282 [28.1%]) or pedicled (720 [71.9%]) internal
mammary artery harvesting. The patients had evaluable angiography results
1 year after surgery. Data were analyzed from October 11, 2019, to May 14,
2020. <br/>Intervention(s): Patients underwent graft harvesting with
either the pedicled technique or skeletonized technique. <br/>Main
Outcomes and Measures: The primary outcome was graft occlusion 1 year
after CABG surgery, as assessed by computed tomography angiography.
<br/>Result(s): A total of 1002 patients underwent skeletonized (282
[28.1%]; mean [SD] age, 65.9 [8.1] years; 229 men [81.2%]; 194 White
patients [68.8%]) or pedicled (720 [71.9%]; mean [SD] age, 64.8 [7.6]
years; 603 men [83.8%]; 455 White patients [63.2%]) internal mammary
artery harvesting. Rates of internal mammary artery graft occlusion 1 year
after CABG surgery were higher in the skeletonized group than in the
pedicled group (33 of 344 [9.6%] vs 30 of 764 [3.9%]; graft-level adjusted
odds ratio, 2.41; 95% CI, 1.39-4.20; P =.002), including the left internal
mammary artery to left anterior descending artery (21 of 289 [7.3%] vs 25
of 725 [3.4%]; graft-level adjusted odds ratio, 2.10; 95% CI, 1.14-3.88, P
=.02). After a mean follow-up of 23 months, skeletonized graft harvesting
was also associated with a higher rate of major adverse cardiovascular
events (20 [7.1%] vs 15 [2.1%]; adjusted hazard ratio, 3.19; 95% CI,
1.53-6.67; P =.002) and repeated revascularization (14 [5.0%] vs 10
[1.4%]; adjusted hazard ratio, 2.75; 95% CI, 1.10-6.88; P =.03).
<br/>Conclusions and Relevance: This post hoc analysis of the COMPASS
randomized clinical trial found that harvesting of the internal mammary
artery during CABG surgery using a skeletonized technique was associated
with a higher rate of graft occlusion and worse clinical outcomes than the
traditional pedicled technique. Future randomized clinical trials are
needed to establish the safety and patency of the skeletonized technique.
Trial Registration: ClinicalTrials.gov Identifier:
NCT01776424.<br/>Copyright &#xa9; 2021 American Medical Association. All
rights reserved.

<104>
Accession Number
2011718361
Title
Keeping it simple but not simpler: The pros and cons of deep sedation
versus general anaesthesia for percutaneous mitral valve repair.
Source
EuroIntervention. 16(16) (pp 1301-1302), 2021. Date of Publication: 2021.
Author
Burkhard Mackensen G.; Sheu R.
Institution
(Burkhard Mackensen, Sheu) Division of Cardiothoracic Anesthesiology,
Department of Anesthesiology and Pain Medicine, University of Washington,
Seattle, WA, United States
Publisher
Europa Group

<105>
Accession Number
2013600436
Title
Harvesting techniques of the saphenous vein graft for coronary artery
bypass: Insights from a network meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Yokoyama Y.; Shimamura J.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
PA, United States
(Shimamura) Division of Cardiac Surgery, Department of Surgery, Western
University, London Health Sciences Centre, ON, Canada
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, United States
(Kuno) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The optimal harvesting technique of saphenous vein (SVG) in
coronary artery bypass grafting (CABG) is still to be elucidated. The
present study aimed to compare the methods of SVG harvesting technique,
which were open vein harvesting (OVH), endoscopic vein harvesting (EVH),
and no-touch vein harvesting (NT), using a network meta-analysis of
randomized controlled trials (RCTs), and propensity-score matched (PSM)
studies. <br/>Method(s): MEDLINE and EMBASE were searched through April
2021 to identify RCTs and PSM studies that investigated the outcomes in
patients who underwent CABG with the SVG using one of three methods; OVH,
EVH, and NT. The outcomes of interest were all-cause mortality, the rates
of revascularization, and graft failure. Risk ratios (RRs) were extracted
for the rates of graft failure, and hazard ratios (HRs) were extracted for
all-cause mortality and the rates of revascularization. <br/>Result(s):
Eligible seven RCT and five PSM studies were identified which enrolled a
total of 8111 patients. All-cause mortality was significantly lower in
patients with EVH compared with OVH (HR [95% confidence interval (CI)]
=0.77 [0.65-0.92], p =.0032). The rates of revascularization were similar
among the groups. The rate of graft failures was significantly lower in
patients with NT compared with OVH (HR [95% CI] =0.54 [0.32-0.90], p
=.019) and with EVH (HR [95% CI] =0.39 [0.17-0.86], p =.023).
<br/>Conclusion(s): NT vein harvesting is favorable for graft patency, and
OVH showed higher all-cause mortality than EVH. Further well-powered RCTs
are needed to confirm our findings.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC

<106>
Accession Number
2014313924
Title
Meta-Analysis Comparing Valve Durability Among Different Transcatheter and
Surgical Aortic Valve Bioprosthesis.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Ueyama H.; Kuno T.; Takagi H.; Kobayashi A.; Misumida N.; Pinto D.S.;
Laham R.J.; Baeza C.; Kini A.; Lerakis S.; Latib A.; Sondergaard L.;
Attizzani G.F.
Institution
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kobayashi, Baeza, Attizzani) Harrington Heart and Vascular Institute,
University Hospital Cleveland Medical Center, Case Western Reserve
University, Cleveland, OH, United States
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, KY, United States
(Pinto, Laham) Division of Cardiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, Massachusetts
(Kini, Lerakis) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, Mount Sinai Hospital, NY, United States
(Kuno, Latib) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, New York, NY, United States
(Sondergaard) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Durability of transcatheter heart valve (THV) is critical as the
indication of transcatheter aortic valve implantation (TAVI) expands to
patients with longer life-expectancy. We aimed to compare the durability
of different THV systems (balloon-expandable [BE] and self-expandable
[SE]) and surgical aortic valve replacement (SAVR) prosthesis. PUBMED and
EMBASE were searched through February 2021 for randomized trials
investigating parameters of valve durability after TAVI and/or SAVR in
severe aortic stenosis. A network meta-analysis using random-effect model
was performed. Synthesis was performed with 5-year follow-up data for
echocardiographic outcomes and the longest available follow-up data for
clinical outcomes. Ten trials with a total of 9,388 patients (BE-THV:
2,562; SE-THV: 2,863; SAVR: 3,963) were included. Follow-up ranged from 1
to 6 years. SE-THV demonstrated significantly larger effective orifice
area, lower mean aortic valve gradient (AVG), and less increase in mean
AVG at 5-year compared with BE-THV and SAVR. Structural valve
deterioration (SVD) was less frequent in SE-THV compared with BE-THV and
SAVR (HR 0.14, 95% CI 0.07 to 0.27; HR 0.34, 95% CI 0.24 to 0.47,
respectively). Total moderate-severe aortic regurgitation and
reintervention was more frequent in BE-THV (HR 4.21, 95% CI 2.40 to 7.39;
HR 2.22, 95% CI 1.16 to 4.26, respectively), and SE-THV (HR 7.51, 95% CI
3.89 to 14.5; HR 2.86, 95% CI 1.59 to 5.13, respectively) compared with
SAVR. In conclusion, TAVI with SE-THV demonstrated favorable forward-flow
hemodynamics and lowest risk of SVD compared with BE-THV and SAVR at
mid-term. However, both THV systems suffer an increased risk of AR and
re-intervention, and long-term data from newer generation valves is
warranted.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<107>
Accession Number
634637704
Title
Effect of perioperative mechanical ventilation strategies on postoperative
pulmonary complications in patients undergoing thoracic surgery:a
Meta-analysis.
Source
Asian journal of surgery. 44(5) (pp 776-777), 2021. Date of Publication:
01 May 2021.
Author
Zhu Y.; Chen X.; Wang F.; Gao J.
Institution
(Zhu) Dalian Medical University, Dalian 116044, China
(Chen) Northern Jiangsu People's Hospital, Yangzhou 225001, China
(Wang) Dalian Medical University, Dalian 116044, China
(Gao) Department of Anesthesiology, Northern Jiangsu People's Hospital,
Clinical Medical College, Yangzhou University, China
Publisher
NLM (Medline)

<108>
Accession Number
636034474
Title
Cardiovascular outcomes of patients referred for home based cardiac
rehabilitation track: Cardiovascular rehabilitation & clinical cardiology.
Source
Journal of Cardiopulmonary Rehabilitation and Prevention. Conference: 36th
American Association of Cardiovascular and Pulmonary Rehabilitation Annual
Meeting, AACVPR 2021. Virtual. 41(5) (pp E16-E17), 2021. Date of
Publication: 2021.
Author
Jafri S.H.; Imran T.F.; Medbury E.; Jeannie J.; Ahmad K.; Imran H.; Wu
W.-C.
Institution
(Jafri, Imran, Ahmad, Imran, Wu) Brown university, Providence, RI, United
States
(Medbury, Jeannie) Providence Veterans Affairs Medical Center, Providence,
RI, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Home Based Cardiac Rehabilitation (HBCR) has been beneficial
in patients with cardiovascular disease, although remains underutilized.
One possible reason is that the long-term cardiovascular outcomes of HBCR
remains unknown. <br/>Purpose(s): To identify if HBCR can improve
morbidity and mortality among patients who were referred and have attended
HBCR vs patients who were referred but not attended CR. <br/>Design(s): We
did retrospective chart review of 269 patients (after IRB approval) at
Providence VA Medical Center. To compare cardiovascular outcomes including
overall deaths and cardiovascular hospitalizations in patients who has
completed HBCR vs patients not attended HBCR (Non-HBCR). <br/>Method(s):
Patients referred for HBCR were from ACC/AHA guidelines including MI, PCI,
CABG, angina, post valve procedure, CHF, heart transplant and PAD. HBCR,
like regular CR consists of exercise sessions over 12 weeks. We compared
outcomes of patients who were referred and attended HBCR vs patients
referred but did not attend HBCR (Non- HBCR) from 3 to 12 months of the
referral date. HBCR consisted of face-to-face entry exam, weekly phone
calls for education and exercise prescription adjustment for 12-weeks and
an exit exam. Primary outcome was composite of all-cause mortality and
cardiovascular hospitalizations. Secondary outcomes were all-cause
hospitalization, allcause mortality and cardiovascular hospitalizations,
separately. We used cox proportional methods to calculate hazard ratios
(HR) and 95% CI. We adjusted for imbalanced characteristics at baseline:
smoking, left ventricular ejection fraction (LVEF) and CABG status. We did
subgroup analysis of patients who have completed HBCR and compared
outcomes (weight, blood pressure, cholesterol, low density lipoprotein,
high density lipoprotein, triglycerides, duke score, 6MWD, PHQ-9 and RYP)
before and after HBCR. <br/>Result(s): From November 2017 to March 2020,
269 patients (mean age: 72, 98% Male) were referred to HBCR, however, only
157 (58%) patients attended HBCR. Patients in HBCR group were less likely
to be smokers (HBCR: 13% vs NCHBCR: 28%, p<0.01) , have higher LVEF (HBCR:
51 +/- 15 vs NCHBCR: 47 +/- 14, p=0.02) and less likely to have CABG
(HBCR: 17% vs NCHBCR: 27%, p=0.04) then patients in Non-HBCR group.
Primary event occurred in 19 patients (12.1%) in the HBCR group and 22
patients (22%) in the Non- HBCR group (adjusted HR=0.51, CI 0.27-0.95,
p=0.03). All cause death occurred in 6.4% of patients in the HBCR group
and 13% patients in the Non-HBCR group within 12 months (adjusted HR=0.43,
CI 0.19 - 1.0, p=0.05). There was no difference in cardiovascular
hospitalizations (HBCR: 5.7% vs Non-HBCR: 10%, adjusted HR 0.58, CI
0.22-1.4, p=0.23) or all cause hospitalizations ((HBCR: 12.7% vs Non-HBCR:
21%, adjusted HR 0.53, CI 0.28- 1.01, p=0.05) among both groups at 12
months. In subgroup analysis, following outcomes have improved in patients
after completing HBCR: blood pressure, cholesterol, high density
lipoprotein, PHQ-9 and RYP. <br/>Conclusion(s): Completion of HBCR among
referred patients was associated with a lower risk of long-term
cardiovascular outcomes. Randomized-controlled studies are needed to
confirm these findings.

<109>
Accession Number
636034685
Title
Impact of coronary stenting on top of medical therapy on hard composite
endpoints in patients with chronic coronary syndromes: A meta-analysis of
randomized controlled trials.
Source
European Heart Journal, Supplement. Conference: 81st SIC National Congress
2020. Virtual. 22(SUPPL N) (pp N106), 2020. Date of Publication: December
2020.
Author
Galli M.; Vescovo G.M.; Andreotti F.; Porto I.; D'Amario D.; Crea F.
Institution
(Galli, Andreotti, D'Amario, Crea) Universita Cattolica del Sacro Cuore,
Roma, Italy
(Vescovo) University of Pad Ova, Padova, Italy
(Porto) University of Genova, Genova, Italy
Publisher
Oxford University Press
Abstract
Aims: Whether percutaneous coronary intervention (PCI) with stent
implantation on top of optimal medical therapy (OMT) modifies hard
composite clinical outcomes in chronic coronary syndromes (CCS) patients
remains controversial. <br/>Methods and Results: This study was registered
in PROSPERO (CRD42020166754) and follows the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses and Cochrane Collaboration reporting.
Randomized controlled trials (RCTs) that compared PCI with stent
implantation on top of OMT vs. OMT alone in CCS patients were included.
Main exclusion criteria were left main disease, severe left ventricular
dysfunction and severe kidney failure. To overcome the potential
limitations deriving from different follow-up durations among studies or
multiple events by the same person, Incidence Risk Ratio (IRR) with 95%
confidence intervals (CIs) were calculated. Six RCTs enrolling a total of
10,751 patients were included. At an average Follow-up of 3.6 years,
PCI+OMT compared with OMT alone was associated with no difference in the
two co-primary composite endpoints of all-cause death/myocardial
infarction (MI)/stroke (IRR, 1.00; 95% CI, 0.91-1.10) and cardiovascular
(CV) death/ MI (IRR, 0.97; 95% CI, 0.86-1.11). There was no significant
difference in the individual secondary endpoints constituting primary
outcomes between groups. Consistent results were found when limiting
analysis to RCTs enrolling patients with moderateto- severe ischemia or
using DES in the PCI arm or enrolling patients since the year 2000 or
using a definite and more specific definition of periprocedural MI.
<br/>Conclusion(s): In CCS patients with inducible myocardial ischemia and
without severely reduced ejection fraction or left main disease, adding
PCI to OMT does not reduce the incidence of hard composite or individual
outcomes.

<110>
Accession Number
636034609
Title
Aortic valve replacement vs balloon-expandable and self-expandable
transcatheter implantation: A network meta-analysis.
Source
European Heart Journal, Supplement. Conference: 81st SIC National Congress
2020. Virtual. 22(SUPPL N) (pp N54), 2020. Date of Publication: December
2020.
Author
Bruno F.; D'Ascenzo F.; Baldetti L.; Franchin L.; Marengo G.; Beviario S.;
Melillo F.; Gallone G.; De Filippo O.; La Torre M.; Rinaldi M.; Omede P.;
Conrotto F.; Salizzoni S.; Giustetto C.; De Ferrari G.M.
Institution
(Bruno, D'Ascenzo, Franchin, Marengo, Beviario, Gallone, De Filippo,
Omede, Conrotto, Giustetto, De Ferrari) A.O.U. Citta Della Salute e Della
Scienza Torino, Divisione di Cardiologia
(La Torre, Rinaldi, Salizzoni) A.O.U. Citta Della Salute e Della Scienza
Torino, Divisione di Cardiochirurgia
(Baldetti, Melillo) IRCCS San Raffaele Scientif Institute Milan, Divisione
di Cardiologia
Publisher
Oxford University Press
Abstract
Aims: While clinical equipoise has been demonstrated for surgery and
transcatheter aortic valve interventions (TAVI) in appropriate candidates
with severe aortic stenosis, observational data have raised concerns about
safety of self-expandable (SE) compared to balloon-expandable (BE) valves
in TAVI, although potentially limited by patient selection bias.
<br/>Methods and Results: All Randomized Controlled Trials (RCTs)
comparing BE vs. SE TAVI or/and vs. aortic valve replacement (AVR) were
included and compared through Network Meta Analysis (NMA). All-cause and
cardiovascular (CV) mortality during Follow-up were the primary endpoints,
while stroke, rates of permanent pacemaker implantation (PPI),
moderate/severe paravalvular leak (PVL) and re-intervention were the
secondary endpoints. We obtained data from 11 RCTs, encompassing 9752
patients (3 with patients at low, 3 with patients at intermediate and 5
with patients at high surgical risk). After one and two years, no
significant differences were noted for all-cause and CV mortality between
BE, SE and surgical bioprosthetic valves. Compared to surgical
bioprostheses, both BE and SE TAVI reduced the risk of acute kidney injury
(OR 0.42; CI 95% 0.30-0.60 and OR 0.44; CI 95% 0.32-0.60), new-onset
atrial fibrillation (OR 0.24; CI 95% 0.14-0.42 and OR 0.21; CI 95%
0.13-0.34) and major bleedings (OR 0.32; CI 95% 0.16-0.65 and OR 0.47; CI
95% 0.25-0.89) but were associated with increased risk of vascular
complications (OR 2.29; CI 95% 1.37-3.85 for BE and OR 2.76; CI 95%
1.66-4.61 for SE). The BE prostheses reduced the risk of moderate/severe
PVL at 30-day (OR 0.31; CI 95% 0.17-0.55) and of PPI both at 30- day (OR
0.51; CI 95% 0.33-0.79) and 1 year (OR 0.40; CI 95% 0.30-0.55) as compared
to SE TAVI. Aortic valve reintervention was increased in SE prostheses
compared to surgery (OR 3.13; CI 95% 1.47-6.64), while in BE prostheses
were not (OR 2.26; CI 95% 0.93-5.47). <br/>Conclusion(s): A TAVI strategy,
independently from BE or SE prostheses, offers a survival benefits
comparable to AVR. The BE prostheses are associated with a reduction of
PPI and PVL compared to SE prostheses without any differences in all-cause
and CV mortality during two years of Follow-up.

<111>
Accession Number
636035646
Title
Prognostic significance of cardiac amyloidosis in patients with aortic
stenosis: A systematic review and meta-analysis.
Source
European Heart Journal, Supplement. Conference: 81st SIC National Congress
2020. Virtual. 22(SUPPL N) (pp N118-N119), 2020. Date of Publication:
December 2020.
Author
Ceriello L.; Ricci F.; Khanji M.Y.; Dangas G.; Bucciarelli-Ducci C.; Di
Mauro M.; Fedorowski A.; Zimarino M.; Gallina S.
Institution
(Ceriello, Gallina) Department of Neuroscience,Imaging and Clinical
Sciences, G. D'annunzio Universityitaly, Chieti 66100, Italy
(Ricci, Fedorowski) Department of Clinical Sciences, Lund
Universitysweden, Malmo 214 28, Sweden
(Khanji) Newham University Hospital, Barts Health NHS Trustuk, London,
United Kingdom
(Khanji) Centre for Advanced Cardiovascular Imaging and Research, William
Harvey Research Institute, Queen Mary University Of London, United Kingdom
(Dangas) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinaiusa, New york, NY, United States
(Bucciarelli-Ducci) Bristol Heart Institute, NIHR Bristol Biomedical
Research Centre, University Hospitals Bristol And Weston NHS Trustuk,
Bristol, United Kingdom
(Bucciarelli-Ducci) University of Bristoluk, Bristol, United Kingdom
(Di Mauro) Cardio-Thoracic Surgery Unit, Heart and Vascular Centre,
Maastricht University Medical Centre (Mumc), Cardiovascular Research
Institute Maastricht (Carim), Maastricht, Netherlands
(Fedorowski) Department of Cardiology, Skane University Hospital Sweden,
Malmo 214 28, Sweden
(Zimarino) Interventional Cath Labitaly, Asl 2 Abruzzo, 66100, Chieti,
Italy
(Ricci) Casa di Cura Villa Serena, Citta' S. Angeloitaly, Pescara, Italy
Publisher
Oxford University Press
Abstract
Aims: We performed a systematic review and meta-analysis to clarify
whether concurrent cardiac amyloidosis (CA) portends excess mortality in
elderly patients with aortic stenosis (AS). CA has been increasingly
recognized in elderly patients with AS, but with uncertain prognostic
significance. <br/>Methods and Results: Our systematic review of the
literature published between January 2000 and April 2020, sought
observational studies reporting summary-level outcome data of all-cause
mortality in AS patients with or without concurrent CA. Pooled estimate of
Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for
all-cause death was assessed as the primary endpoint. We performed
subgroup analysis stratified by severity of left ventricular hypertrophy
(LVH) and studylevel meta-regression analysis to explore the effect of
covariates on summary effect size and to address statistical
heterogeneity. We identified 4 studies including 609 AS patients (9%
AS-CA; 69% men; age, 84+/-5 years). The average follow-up was 2065 months.
Compared with lone AS, AS-CA was associated with 2-fold increase in
all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2=62%). When
analysed according to LVH severity, pooled ORs (95% CI) for all-cause
mortality were 1.20 (0.65-2.22) for mild LVH (<16 mm), and 4.81
(2.19-10.56) for moderate/severe LVH (>=16 mm). Meta-regression analysis
confirmed a stronger relationship proportional to the degree of LVH,
regardless of age and aortic valve replacement, explaining between-study
heterogeneity variance. <br/>Conclusion(s): Cardiac amyloidosis heralds
significantly higher risk of all-cause death in elderly patients with AS.
Severity of LVH appears to be a major prognostic determinant in patients
with dual AS-CA pathology.

<112>
Accession Number
636035853
Title
Acute inflammatory cardiomiopathy: Prevalence, characterization and
prognostic impact of immunosuppressive therapy.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J184), 2019. Date of Publication:
December 2019.
Author
Gentile P.; Ballaben A.; Artico J.; Porcari A.; Castrichini M.; Cannata
A.; Perkan A.; Barbati G.; Bussani R.; Merlo M.; Sinagra G.
Institution
(Gentile, Ballaben, Artico, Porcari, Castrichini, Cannata, Perkan, Merlo,
Sinagra) Cardiovascular Department, Azienda Sanitaria Universitaria
(ASUITS), University of Trieste, Italy
(Barbati) Biostatics Unit, Department of Medical Sciences, University of
Trieste, Italy
(Bussani) Department of Pathology, Azienda Sanitaria Universitaria
(ASUITS), University of Trieste, Italy
Publisher
Oxford University Press
Abstract
Background: Inflammatory cardiomyopathy (IC) belongs to the spectrum of
dilated cardiomyopathy (DCM). The real efficacy and indication to
immunosuppressive therapy in acute (i.e. <6 months) IC remain debated.
<br/>Aim(s): To assess the prevalence of biopsy-proven IC in a population
with acute left ventricular (LV) dysfunction and indications for
endomyocardial biopsy (EMB). Moreover, we evaluated the prognostic impact
of immunosuppressive therapy in that population. <br/>Method(s): We
analyzed retrospectively all the patients with acute (<6 months) LV
systolic dysfunction and indications for EMB consecutively admitted
between 2000 and 2018. According to EMB results, we divided the whole
population in two groups: IC and DCM. Thereafter, we divided the IC group
in two subgroups: patients treated or no treated with immunosuppressive
therapy. The study outcome measure was a composite of death from any cause
or heart transplant (HTx) or major ventricular arrhythmias (MVAs).
Finally, we evaluated the prevalence of left ventricular reverse
remodelling (LVRR), defined as previously reported, at 24 months (range 9
to 36 months). <br/>Result(s): The study population included 81 patients
(45+/-16 years, 59% males; mean LV ejection fraction 29+/-10% and LV
end-diastolic diameter 61+/-8 mm). The IC group included 65 (80.2%)
subjects. There were no significant differences between IC and DCM group,
except for the NYHA IV class, that was slightly more frequent in the IC
group (p=0.049). At a mean follow-up of 163+/-12 months, no differences
were found between IC and DCM (p=0.743) in terms of Death/Htx/MVAs. In the
IC group, immunosuppression therapy was administered in 52% (N=34).
Descriptive analysis showed no significant differences between the group
treated or no treated with immunosuppressive therapy. At Kaplan-meier
analysis, no differences in terms of the combined endpoint experience were
found in immunosuppressed compared to the non-immunosuppressed group
(23.5% Vs 22.6% respectively; p=0.845). At 24 months of follow-up, LVRR
was found in 19 patients (70.4%) in the immunosuppressed group and in 12
patients (63.2%) in non-immunosuppressed group (p=0.607).
<br/>Conclusion(s): To the best of our knowledge, this study is the first
that evaluates the prevalence of IC and the impact of immunosuppressive
therapy in a cohort of patients with acute LV dysfunction and indication
to EMB according the most recent international statements. In patients
with high clinical suspect of acute IC, EMB confirmed the diagnosis in 80%
of cases. The use of immunosuppressive therapy in this setting seems not
to impact on LVRR or on the rate of major events during long term
follow-up. New prospective, randomized, controlled trials will be
necessary to clarify the role of immunosuppressive therapy in patients
with biopsy-proven acute IC.

<113>
Accession Number
636035803
Title
Amiodarone therapy for ICD intervention prevention. AN observational
single centre cohort study.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J16), 2019. Date of Publication:
December 2019.
Author
Bissolino A.; Fioravanti F.; Andreis A.; Saglietto A.; Mazzilli S.; Errigo
D.; Peyracchia M.; Magnano M.; Castagno D.; Budano C.; Golzio P.G.;
Giustetto C.; De Ferrari G.M.
Institution
(Bissolino, Fioravanti, Andreis, Saglietto, Mazzilli, Errigo, Peyracchia,
Magnano, Castagno, Budano, Golzio, Giustetto, De Ferrari) AOU San Giovanni
Battista, Ospedale Molinette, Torino, Italy
Publisher
Oxford University Press
Abstract
Introduction and Aim: Medicine evolution, particularly in the Cardiology
field, bring us longer survivals to acute coronary syndrome and
cardiovascular diseases. Nonetheless, the other face of the medal is the
increasing number of patients suffering from Heart Failure (HF) in its
broad spectrum of manifestations, from acute HF to life-threatening
arrhythmias. Implantable Cardioverter Defibrillators (ICDs) represent a
clear answer to the latter clinical problem. However, even an appropriate
ICD intervention has a huge impact on patients' life. For this reason, in
our paper, we tried to assess whether Amiodarone could reduce ICD
appropriate interventions. <br/>Method(s): This work represents an
observational study of a cohort of consecutive patients from a single
institution. The study was carried out according to the latest
international guidelines and to the Declaration of Helsinki. We screened
4157 implantation procedures performed in our centre, identifying 637
consecutive patients who received an ICD in primary or secondary
prevention, considering the period 2010- 2016. Other inclusion criteria
were: clinical follow-up at least every 6 months, assessing symptoms,
recent medical history, medications and technical functioning of the
device. Considering pre-implantation clinical and psychological screening
and the prognosis evaluation, no exclusion criteria was applied. For
patients who underwent heart transplantation, the follow-up was closed on
that date. Clinical decision to prescribe or not amiodarone, was not
influenced by the authors and was leaved to single physician choice. Every
patient was on optimal medical therapy (OMT). Every ICD intervention was
assessed through direct ICD interrogation, excluding those not
confirmable. In every case, an experienced electrophysiologist was
consulted for independent adjudication. Statistical analysis was performed
applying SPSS 24.0. Continuous variables were compared with t-test.
Categorical data were tested with chi-square test. <br/>Result(s): 521
patients matched the inclusion criteria and were enrolled. The major
indication for ICD implantation was Ischaemic Heart Disease (276 patients,
53%), followed by non-ischaemic Dilated Cardiomyopathy (DCM) (156
patients, 30%). 405 patients received ICD for primary prevention (Ip),
while 116 for secondary prevention (IIp). Mean Left Ventricular Ejection
Fraction (LVEF) was 27% (+/- 6%) in Ip and 38% (+/- 12.8%) in IIp. No
statistically significant differences resulted between Ip and IIp
considering QRS width and medical therapy. 19% of Ip and 41% of IIp were
on amiodarone (A). After a mean follow-up of 67 months, in Ip patients,
there were no differences in the rate of appropriate shock (15.3% A vs
13.7% nA, p=0.699) and ATP intervention (16% A vs 15.2% nA, p=0.965).
These results were also confirmed for IIp patients (Shock 15.9% A vs 18%
nA, p=0.541; ATP 16% A vs 15.2% nA, p=0.231). <br/>Conclusion(s): In our
study, amiodarone did not show a significant reduction of ICD intervention
in primary and secondary prevention ICD patients. The observational nature
of our work is an intrinsic limit of these findings and further randomized
clinical trial are needed to confirm our results.

<114>
Accession Number
636035737
Title
Subclinical leaflet thrombosis after transcatheter aortic valve
replacement: prevalence and prognostic implications.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J99-J100), 2019. Date of Publication:
December 2019.
Author
Fortuni F.; Ferlini M.; Mauri S.; Rebuffi C.; Rossini R.; Ferrario M.;
Visconti L.O.
Institution
(Fortuni, Ferlini, Mauri, Ferrario, Visconti) Division of
Cardiology,Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
(Fortuni) University of Pavia, Pavia, Italy
(Rossini) Division of Cardiology, Santa Croce e Carle Hospital, Cuneo,
Italy
(Rebuffi) Scientific Documentation Center, Fondazione IRCCS Policlinico
San Matteo, Pavia, Italy
Publisher
Oxford University Press
Abstract
Background: Subclinical leaflet thrombosis (SLT) following transcatheter
aortic valve replacement (TAVR) has been increasingly detected on
multidetector computed tomography (MDCT). Its actual prevalence and
consequences are unclear. Therefore the aim of this study-level
meta-analysis was to investigate the prevalence of SLT detected by MDCT
after TAVR and its prognostic impact in terms of stroke or transient
ischaemic attack (TIA) incidence and all-cause mortality. <br/>Method(s):
We searched the literature for studies reporting SLT after TAVR detected
by MDCT. Pooled analysis of incidence was performed with a random effect
model. Endpoints of interest were stroke or transient ischaemic attack
(TIA) and all-cause mortality. A univariate meta-regression analysis was
conducted to explore the potential moderator effect of age, gender,
ejection fraction (EF), dual antiplatelet therapy and oral anticoagulation
therapy after TAVR (continuous variables were expressed as mean and
dichotomous variables were expressed as percentage). <br/>Result(s):
Overall, 8 observational studies met our inclusion criteria, with a total
of 2257 patients; mean age was 82.8+/-1.8; 42% were male and mean
follow-up was 9.56months. 35.5% of patients received oral anticoagulation
and 54% received dual antiplatelet therapy. Mean EF was 56%. Meta-analytic
pooling of event rates showed an SLT rate of 13.5% (95% CI 8.4%-18.6%; I2:
94%-Fig. 1 A). At meta-regression analysis none of the parameters taken
into account showed an interaction with SLT. SLT was associated with an
increased risk of stroke or TIA (OR 4.73; 95% 1.32-17.04; P=0.017 - Fig.
1B) and with a non-significant increased risk of all-cause mortality (OR
1.63; 95% CI 0.43-6.22; P=0.47 - Fig 1 C) compared with the absence of SLT
at MDCT. <br/>Discussion(s): Our meta-analysis, pooling the largest cohort
of patients who underwent TAVR that were systematically screened for SLT
with MDCT shows that SLT has an important prevalence in this population.
Moreover, our results demonstrate that SLT may affect prognosis as its
presence is associated with an increased risk of stroke or TIA. Therefore
strategies aimed at detecting, with MDCT scan, and treating or preventing
SLT, such as with oral anticoagulation, may be indicated especially in
patients at increased risk for it.

<115>
Accession Number
636035287
Title
Incidence, predictors and outcomes of valve-in-valve TAVI: A systematic
review and meta-analysis.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J92), 2019. Date of Publication:
December 2019.
Author
Bruno F.; Giordana F.; Conrotto F.; Saglietto A.; D'Ascenzo F.; Marra
W.G.; Salizzoni S.; La Torre M.; Trompeo A.C.; D'Amico M.; Rinaldi M.;
Giustetto C.; De Ferrari G.M.
Institution
(Bruno, Giordana, Conrotto, Saglietto, D'Ascenzo, Marra, D'Amico,
Giustetto, De Ferrari) Division of Cardiology, Department of Medical
Sciences, University of Turin,Citta' della Salute e della Scienza
Hospital, Turin, Italy
(Salizzoni, La Torre, Trompeo, Rinaldi) Division of Cardiosurgery,
Department of Medical Sciences, University of Turin,Citta' della Salute e
della Scienza Hospital, Turin, Italy
Publisher
Oxford University Press
Abstract
Objectives: Surgical aortic valve replacement has been the treatment of
choice for patients with aortic valve disease before the arrival of
transcatheter aortic valve replacement (TAVI), although limited by
degeneration of the bioprosthesis. Redo intervention itself is burdened by
high risk of complications and valve-in-valve (ViV) TAVI could be a valid
strategy of redo for patients with comorbidities. The aim of this
meta-analysis is to give an overview of the state of the art of ViV TAVI
in high-risk patients, analyzing efficacy, safety, intra-hospital outcomes
and 1-year outcomes in literature and assess with meta-regression some
possible predictors of survival at short and mid-term Follow-up.
<br/>Method(s): In this systematic review and meta-analysis, two
independent reviewers screened all studies investigating patients
undergoing ViV TAVI. PubMed database was searched for reports published in
English according to the following highly sensitive strategy, in
compliance with established methods and incorporating wildcards
(identified by *): (Transcatheter[All Fields] AND aortic[All Fields]) AND
valve-invalve[ All Fields] AND implantation[All Fields] NOT (review[pt] OR
editorial[pt] OR letter[pt])AND humans[MeSH Terms]). Mortality at 30 days
and at 1 year were the primary Endpoint, while procedural and short-term
outcomes and echocardiographic parameters at hospital discharge were the
secondary end points. <br/>Result(s): Of 286 studies identified, 26
articles were included in this review, representing a combined total of
1448 patients. Median age was 78.8 years, 57.7% of the patients were male.
Median STS-predicted risk of mortality was 9.4 % while median Logistic
EuroSCORE was 31.3%. Median age of the bioprosthesis was 10 years with
84.6% of stented valves. Stenosis (45%), followed by regurgitation (31%)
and mixed defects (21%) were the causes of prosthesis failure. The
diameter of the degenerated valve was<=21mm in 25.4%, 22-25mm in 55% and
>;25mm in 11.7% of the patients. Transfemoral approach was preferred
(76%), with a prevalence of balloon expandable valve (73.3%). Mean post
procedural gradient was 16.7+/-0.8 mmHg. Mean Follow-up was 376 days.
Overall and cardiovascular mortality at 30 days was 6.5% and 5.5%
respectively, while at 1 year it was 14.5 % and 8.9% respectively.
Regarding shortterm outcomes, overall bleeding (10.4%), pacemaker
implantation (9.4%) and vascular complications (8.3%) were the most common
peri-procedural complications, while stroke (2.3%), myocardial infarction
(2.7%) and coronary obstruction (2.8%) were less frequent. At
meta-regression analysis study year (p<0.001), Logistic Euroscore (p<0.01)
and valve diameter<=21mm (p<0.05) at 30 days, and stenosis as reason for
failure (p=0.05) at 1 year were identified as possible predictors of
survival. <br/>Conclusion(s): In the era of the trans-catheter techniques,
percutaneous valve-invalve aortic valve implantation offers a valid
strategy to treat high risk patients with a degenerative bioprosthesis.
The short and mid-term outcomes are substantially superimposable to those
of TAVI, except for coronary obstruction which appears more frequent.
Considering the possible need to approach and treat a following coronary
artery disease, this feature has to be taken in account in the selection
of the patients and in the planning time of the procedure. Future studies
are needed to find predictors of long term survival and outcomes in lower
risk patients.

<116>
Accession Number
636035136
Title
Efficacy and safety of catheter ablation of post-incisional atrial
tachycardias in patients with prior history of mitral valve surgery: A
metaanalysis.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J20-J21), 2019. Date of Publication:
December 2019.
Author
Marazzato J.; Crippa M.; Golino M.; Cappabianca G.; Adriano Doni L.; Giani
R.; Telli G.; Marazzi R.; De Ponti R.
Institution
(Marazzato, Crippa, Golino, Cappabianca, Adriano Doni, Giani, Telli,
Marazzi, De Ponti) Dipartimento Cardiovascolare, Ospedale di Circolo,
Universita' degli Studi dell'Insubria, Varese, Italy
Publisher
Oxford University Press
Abstract
Introduction: Data regarding catheter ablation (CA) of post-incisional
atrial tachycardias (AT) are scarce in literature, especially in patients
with prior history of mitral valve surgery (MVS) where mechanical
protheses and thick fibrosis around the MV anulus may pose a challenge for
a safe and effective procedure. Aim of this study is to assess the
efficacy and safety of CA of post-incisional AT in these patients and to
investigate specific features of these arrhythmias through a systematic
review of the literature. <br/>Method(s): A systematic search on
PubMed/MEDLINE, EMBASE, and Web of Science was performed. An adult
population undergoing radiofrequency CA procedure for postincisional AT
with prior history of MVS and with/without concomitant Maze procedure was
considered. Articles published before 2000 were excluded because the use
of 3 D electro-anatomic mapping systems was not well established yet. The
haemorrhagic, thromboembolic complications and deaths were recorded. The
periprocedural success rate (i.e. restoration to sinus rhythm due to
radiofrequency delivery during CA procedure) and mid-long term outcome
(i.e. persistence of sinus rhythm after single/ multiple procedures on/off
antiarrhythmic drugs) were carefully looked for. Finally, the most
frequent pathophysiologic mechanism (focal vs. macro-reentrant), site of
origin of the ablated AT (left atrium vs. right atrium) and association of
the surgical scar location with specific AT morphologies were
investigated. <br/>Result(s): After systematic review, 8 studies were
regarded as eligible for the analysis. One-hundred seventy-three patients
without severely impaired FEVS (42-72.1%) and with mild-to-severe atrial
dilatation (37-63 mm) were considered with prior history of MV replacement
(59.5%) or valvuloplasty (40.5%) and concomitant Maze procedure (56%). All
the patients underwent 239 CA procedures (1.4 procedure/patient) and in
all cases a 3 D electro-anatomic mapping system was used. Major
complications were recorded in 3/173 cases (1.7%) with 2 retroperitoneal
haemorrhages (1.2%), 1 intracranial haemorrhage leading to death (0.06%).
Acute success rate was achieved in 167/173 patients (95.6%) and 112/173
patients (65%) were in sinus rhythm at followup (2.1-60 months). In 97% of
patients the whole number of AT morphologies were specified: 272 AT
(92.2%) were macro-reentrant and 23 (7.8%) were focal in origin. In the
macro-reentrant AT group, CA was performed in the right atrium in 144
morphologies (53%) and in most of these cases ablation was performed at
the cavo-tricuspid isthmus (CTI) (63%). When CA was performed in the left
atrium (47% of cases), mitral isthmus was the main target for ablation
(55%). Type of surgical incision was reported in 112 patients (65%). In
these patients, most of the AT were found in the right atrium (133/215
morphologies - 62%) with involvement of CTI in 55% of cases. In these
patients a trans-septal approach was very frequently encountered (52%)
either as superior trans-septal one or via a lateral free wall incision in
the right atrium. <br/>Conclusion(s): After a systematic literature
review, CA of post-incisional AT in patients with prior MVS should be
regarded as a safe and effective procedure. A trans-septal surgical
incision is the main surgical approach in this population associated with
lateonset macro-reentrant AT most frequently and quite surprisingly
located in the right atrial chamber with involvement, in many cases, of
the CTI.

<117>
Accession Number
636035069
Title
Transcatheter aortic valve implantation with core valve prosthesis: Five
year durability.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J203-J204), 2019. Date of Publication:
December 2019.
Author
Carrabba N.; Ciatti F.; Berteotti M.; Taborchi G.; Ceschia N.; Migliorini
A.; Stefano P.; Marchionni N.; Valenti R.
Institution
(Carrabba, Ciatti, Berteotti, Taborchi, Ceschia, Migliorini, Stefano,
Marchionni, Valenti) Department of Cardiology, Careggi Hospital, Florence,
Italy
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
a valid option for patients with severe aortic stenosis (SAO) who are at
intermediate or high/prohibitive surgical risk. Multiple trials are
currently evaluating TAVI for treating patients who are at low surgical
risk. However, the treatment of younger patients with longer life
expectancies has raised questions regarding valve durability, due to the
biological tissue that is prone to structural valve degeneration (SVD).
<br/>Purpose(s): We sought to evaluate five-year durability of TAVI using
the current technology of self-expanding CoreValve prosthesis.
<br/>Method(s): All consecutive patients with SAO who underwent TAVI with
the third generation 18-F CoreValve device in our centre were
prospectively included in a quality improvement registry of our Hospital.
In this registry we included all consecutive patients (n=182) treated from
January 2009 to December 2017. All TAVI cases were discussed and approved
by interdisciplinary Heart Team. SVD and all outcomes were reported
according to VARC (Valve Academic Research Consortium)- 2 criteria.
<br/>Result(s): Overall, at average time of 772+/-717 days all-cause
mortality was 34% (62/ 182 patients); the neurological event rate was 4.9%
(1 case fatal stroke); 94 (52%) patients were re-hospitalized for
cardiovascular reason: 73 (40.1%) patients for recurrent heart failure
(HF) and 21 (11.6%) patients for permanent pacemaker implantation. Two
patients underwent upgrade from bicameral to biventricular pacing due to
symptomatic HF associated with large QRS. All causes mortality rates at 1,
2, 3, 4, and 5-year completed follow-up (93 patients) were 20.4%, 47.3%,
59.1%, 62.3%, and 65.5%, respectively. On echocardiography, mean trans
aortic gradients decreased from 54+/-13.9mm Hg (pre-TAVI) to 11.2+/-9.4mm
Hg (5-year post-TAVI) (p<0.001). Late non SVD occurred in 2 patients
(2.15%); among these, surgical replacement of aortic valve was
successfully carried out in 1 patient presenting with recurrent symptoms
of heart failure due to a prosthesis migration, determining an aortic
pseudo-aneurysm. The second case of non SVD did not undergo further
invasive interventions. Late SVD was found in 3 patients (3.2%) showing
mild stenosis with a mean trans aortic gradient ranging from 20 to 40mm Hg
by echo, in one case combined with moderate aortic regurgitation. None
patients with SVD needed reintervention. Throughout follow-up, prosthetic
valve thrombosis or late valve embolization were not observed.
<br/>Conclusion(s): Using CoreValve for TAVI procedures, a 3.2% low rate
of SVD was observed in our registry, none of them requiring
reintervention. These findings appear reassuring in term of TAVI 5-year
durability. However, results of ongoing large randomized trials with
long-term follow-up are needed before extending the indication to TAVI for
low-risk young patients.

<118>
Accession Number
636035055
Title
TAVI for low-risk patients: Comparison between patients enrolled in notion
trial and in Florence real world registry.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J203), 2019. Date of Publication:
December 2019.
Author
Carrabba N.; Ciatti F.; Taborchi G.; Berteotti M.; Migliorini A.; Stefano
P.; Marchionni N.; Valenti R.
Institution
(Carrabba, Ciatti, Taborchi, Berteotti, Migliorini, Stefano, Marchionni,
Valenti) Department of Cardiology, Careggi Hospital, Florence, Italy
Publisher
Oxford University Press
Abstract
Background: In the randomized NOTION trial at 5 years no significant
difference between transcatheter aortic valve implantation (TAVI) and
surgical aortic valve replacement (SAVR) was found for the composite rate
of death for any cause, stroke and myocardial infarction in lower-risk
patients. However, patients were excluded from this trial if they had
another severe valve disease or coronary artery disease (CAD) requiring
intervention, or previous cardiac surgery, myocardial infarction or
stroke, and severe renal failure or severe lung disease. <br/>Purpose(s):
To assess long-term clinical outcomes among patients with estimated
surgical low risk patients undergoing TAVI in clinical practice, without
exclusion criteria adopted in randomized NOTION trial. <br/>Methods and
Results: This study was a quality improvement registry aimed to evaluate
outcomes in patients admitted for TAVI to our tertiary centre. From
January 2009 to December 2017, 182 consecutive patients who underwent TAVI
were categorized according to the Society of Thoracic Surgeons (STS) score
into low (<4%; n=78, 43%), intermediate (STS >=4% and <= 8%; n=70, 38.4%),
and high risk (STS>8%; n=34, 18.6%). All TAVI cases were discussed and
approved by interdisciplinary Heart Team. The transfemoral access was the
most common approach adopted (97.8%) for the procedures. Among low risk
patients: 4 have history of CABG, 11 mitral valve surgery, 9 chest
radiation, 6 cancer, 7 chronic renal failure, 9 chronic lung failure, 1
myasthenia gravis, 12 severe CAD, 3 recent myocardial infarction, 1 recent
stroke, 4 porcelain aorta and the remaining 11 patients gave consent only
for TAVI procedure. Significant differences were found between the groups
(low vs. intermediate vs. high risk) for age (79.2+/-5.1 yrs vs.
85.2+/-4.8 yrs vs. 86.5+/-5.3 yrs, p <.0001), chronic renal failure (7.6%
vs. 28.6% vs. 50%, p<.0001), and left ventricular ejection fraction<=40%
(15.3% vs. 27.1% vs. 41.2%, p =.015), but not for previous acute
myocardial infarction (8.9% vs. 15.7% vs. 17.6%, p=.334), chronic
obstructive pulmonary disease (17.9% vs. 14.3% vs. 26.8%, p=.270) and
peripheral arterial vascular disease (3.8% vs. 14.3% vs. 14.7%, p=.061).
By Kaplan Meier analysis, all-cause mortality at 1-year Follow-up was
significantly lower in low vs. intermediate and high risk group (6.4% vs.
12.8%, vs. 38%, P<0001) and progressively increased during the follow-up
(median time 772+/-717 days) remaining significantly lower in low risk
patients (28% vs. 24.3% vs. 55.8%, P<.0001). <br/>Conclusion(s): Our
findings suggest that in clinical practice low risk patients, without
exclusion criteria, can benefit from TAVI's procedure, showing a long-term
mortality rate quite similar to the 27.7% 5-year mortality rate reported
in NOTION trial in both TAVI and SAVR groups. However, given the inherent
limitations of any registry, results of ongoing large randomized trials
are needed before extending the indication to TAVI in low-risk patients.

<119>
Accession Number
636035009
Title
Prognostic accuracy of multiparametric scores for heart failure with
reduced ejection fraction in patients with severe mitral regurgitation
undergoing mitraclip treatment.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J202), 2019. Date of Publication:
December 2019.
Author
Iannicelli A.; Silverio A.; Di Maio M.; Esposito L.; Fierro G.; Di Feo F.;
Di Muro M.R.; Citro R.; Baldi C.; Ciccarelli M.; Vecchione C.; Galasso G.
Institution
(Iannicelli, Silverio, Esposito, Fierro, Di Feo, Di Muro, Citro, Baldi,
Ciccarelli, Vecchione, Galasso) Cardio-Thoracic Department, University
Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
(Di Maio) Division of Cardiology, Department of Cardiothoracic and
Respiratory Sciences, University of Campania Luigi Vanvitelli, Naples,
Italy
Publisher
Oxford University Press
Abstract
Background: The selection of patients with severe functional mitral
regurgitation (FMR) to candidate to MitraClip treatment is based on a
multiparametric approach. To date, prognostic scores derived and
externally validated in this particular clinical setting are not
available. <br/>Aim(s): To assess the discrimination and calibration
accuracy in terms of cardiac death and all-cause death at long-term of
heart failure with reduced ejection fraction (HFrEF) prognostic scores in
patients with severe FMR undergoing percutaneous mitral valve repair with
MitraClip device. <br/>Material(s) and Method(s): We prospectively
enrolled all patients with severe FMR who consecutively underwent
percutaneous mitral valve repair with MitraClip from March 2012 to
November 2018 at our Institution. Demographic, clinical, echocardiographic
and laboratory data were collected. Cardiopulmonary exercise test (CPET)
was performed in all patients before the procedure. The following HFrEF
scores were retrospectively calculated: Metabolic Exercise, Cardiac,
Kidney Index (MECKI), Cardiac and Comorbid Conditions Heart Failure (3
C-HF), (HFSS), Heart Failure Survival Score (SHFM) and meta-analysis group
in chronic heart failure (MAGGIC). Two outcomes were assessed at the
longest available follow-up: all-cause death and cardiac death.
<br/>Result(s): The study population included 75 patients (mean age:
70.6+/-8.68 years; 79.5% males). The patients showed a high surgical risk
(EuroSCORE logistic: 20.0+/-14.2%; EuroSCORE II: 8.0+/-6.0%) and impaired
average CPET values (peak oxygen uptake, VO2: 10.5+/-3.1ml/kg/min;
ventilation/carbon dioxide consumption ratio, VE/VCO2: 44.8+/-12.2). Mean
follow-up was 891.6 days. During the study period, 38 deaths were
observed; of them, 24 were secondary to cardiac cause. In terms of cardiac
death, the MECKI score showed a higher discrimination ability than the
other scores. Moreover, an upward trend in the the area under the curve
(AUC) values of the MECKI score from the first to the fifth year of
observation was observed. The MECKI score showed the highest
discriminative power for all-cause death for each time frame analyzed and
increasing AUC values through the years of observation. The MECKI score
had a significantly better discrimination ability than the other scores,
except for the HFSS, for the occurrence of cardiac death and allcause
death at 3, 4 and 5 years (p<0.05). Hosmer-Lemeshow analysis showed a good
calibration accuracy for all the scores in terms of cardiac death. MECKI
score had a suboptimal calibration ability for all-cause death event.
<br/>Conclusion(s): HFrEF scores might improve the pre-procedural
prognostic stratification in patients with FMR candidate to MitraClip
treatment. The MECKI score, which includes two parameters from CPET,
showed the best discriminative performance in terms of all-cause death and
cardiac death, especially at long term follow-up.

<120>
Accession Number
636035417
Title
Clinical impact of atrial fibrillation in stable coronary artery disease:
A meta-analysis.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J25), 2019. Date of Publication:
December 2019.
Author
Saglietto A.; Varbella V.; Anselmino M.; Giustetto C.; De Ferrari G.M.
Institution
(Saglietto, Varbella, Anselmino, Giustetto, De Ferrari) Division of
Cardiology, Department of Medical Sciences, University of Turin, Italy
Publisher
Oxford University Press
Abstract
Background: Atrial fibrillation (AF) is the most common supraventricular
arrhythmia and is often associated with stable coronary artery disease
(SCAD). Recent computational studies suggest that AF can exert influence
on coronary circulation. <br/>Aim(s): Given the likely influence of AF on
coronary hemodynamics, we aimed to explore the clinical impact that
super-imposed AF can exert in SCAD patients, in terms of mortality,
cerebral vascular accidents (CVA) and coronary events (myocardial
infarction - MI, and coronary revascularization). <br/>Method(s):
PUBMED/Embase databases were screened for observational studies on SCAD
patients providing adjusted estimates on the risk of mortality, CVA, MI or
TLR for AF patients with respect to patients without any history of the
arrhythmia. Metaanalysis of the adjusted risk estimates was performed
using a random-effect model. <br/>Result(s): After bibliographic search, 5
studies were finally selected, with a total of 30, 230 subjects included
(2, 844 in the AF group, 27, 386 in the non-AF group). Meta-analysis of
the included studies indicates an increased risk of mortality (HR 1.39,
95% CI 1.17-1.66) and CVA (HR 1.88, 95% CI 1.45-2.45) in SCAD patients
with AF; on the contrary, there was no significant differences between AF
and non-AF groups in terms of MI (HR=0.90, 95% CI 0.66-1.22) and coronary
revascularization (HR=0.96, 95% CI 0.79-1.16). <br/>Conclusion(s): AF in
SCAD patients is an independent negative prognostic factor, associated
with mortality and risk of cerebral vascular accidents. However, in terms
of coronary events, the risk of MI or coronary revascularization was not
different in patients with AF with respect to patients without the
arrhythmia.

<121>
Accession Number
636035379
Title
Left ventricular size predicts clinical benefit after percutaneous mitral
valve repair for secondary mitral regurgitation: A systematic review and
metaregression analysis.
Source
European Heart Journal, Supplement. Conference: 80th SIC National Congress
2019. Rome Italy. 21(SUPPL J) (pp J109), 2019. Date of Publication:
December 2019.
Author
Verrengia E.; Zimarino M.; Ricci F.; Capodanno D.; De Innocentiis C.;
Swaans M.J.; Lombardi C.; Brouwer J.; Gallina S.; Grasso C.; De Caterina
R.; Tamburino C.
Institution
(Verrengia, Zimarino, De Innocentiis, Gallina) Institute of Cardiology, G.
D'Annunzio University, Chieti, Italy
(Ricci) Institute for Advanced Biomediucal Technologies, Department of
Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University,
Chieti, Italy
(Capodanno, Grasso, Tamburino) Division of Cardiology, Ferrarotto
Hospital, University of Catania, Catania, Italy
(Swaans, Brouwer) Department of Cardiology, St. Antonius Hospital,
Nieuwegein, Netherlands
(Lombardi) Cardiology, Department of Medical and Surgical Specialties,
University of Brescia, Italy
(De Caterina) Institute of Cardiology, University of Pisa, Italy
Publisher
Oxford University Press
Abstract
Background: The benefit of percutaneous mitral valve repair (PMVR) in
patients with secondary MR is still debated. We aimed to compare the
outcome of PMVR with optimal medical therapy (OMT) vs. OMT alone in
patients with secondary mitral regurgitation (MR), and to assess the role
of potential effect modifiers. <br/>Method(s): We performed a systematic
review and meta-analysis of 2 randomized clinical trials (RCT) and 7
non-randomized observational studies (nROS). Hazard ratios (HR) and 95%
confidence intervals (CI) were pooled through inverse variance
randomeffect model to compute the summary effect size for all-cause death,
cardiovascular death and cardiac-related hospitalization. Subgroup and
meta-regression analysis were also performed. <br/>Result(s): An overall
population of 3, 118 individuals (67% men; mean age, 73 years) was
included: 1, 775 PMVR+OMT and 1, 343 OMT patients, with mean follow-up of
24+/-15 months. PMVR+OMT was associated with a lower risk of all-cause
death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95%
CI: 0.34-0.89) and cardiac- related hospitalization (HR: 0.77; 95% CI:
0.64-0.92). Meta-regression analysis showed that larger left ventricular
end-diastolic volume index (LVEDVI) portends higher risk of all-cause
death, cardiovascular death and cardiac-related hospitalization after PMVR
(p<0.001 for all). <br/>Conclusion(s): This study-level meta-analysis
shows that PMVR+OMT is associated with reduced all-cause death,
cardiovascular death and cardiac-related hospitalization when compared
with OMT alone in secondary MR. LVEDVI is a predictive marker of efficacy,
as patients with smaller LVEDVI have been shown to derive the largest
benefit from PMVR..

<122>
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)
<br/>Copyright &#xa9;

<123>
Accession Number
636037846
Title
Response to the letter from Rodrigues M and Vaz IM regarding the article
"Effectiveness of a preoperative breathing exercise intervention in
patients undergoing cardiac surgery: a systematic review".
Source
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa
de Cardiologia = Portuguese journal of cardiology : an official journal of
the Portuguese Society of Cardiology. (no pagination), 2021. Date of
Publication: 29 Aug 2021.
Author
Rodrigues S.N.; Henriques H.R.; Henriques M.A.
Institution
(Rodrigues) Lisbon University, Lisbon, Portugal; Lisbon Nursing School,
Lisbon, Portugal; Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto,
Portugal. Electronic address: soraia.nicola@gmail.com
(Henriques) Lisbon Nursing School, Lisbon, Portugal
(Henriques) Lisbon Nursing School, Lisbon, Portugal; ISAMB, Lisbon Medical
School, Lisbon, Portugal
Publisher
NLM (Medline)

<124>
Accession Number
636036098
Title
Thoracic Paravertebral Block Ameliorates Postoperative Delirium in
Geriatric Patients.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2021. Date of
Publication: 2021.
Author
Heng L.; Wang M.; Li L.; Zhu S.
Institution
(Heng, Zhu) Department of Anesthesia, Xuzhou Cancer Hospital, Jiangsu
Province, Xuzhou City, China
(Wang) Department of Anesthesia, Xuzhou Maternity and Child Health Care
Hospital, Jiangsu Province, Xuzhou City, China
(Wang) Department of Anesthesia, People's Hospital of Jiawang District of
Xuzhou, Jiangsu Province, Xuzhou City, China
(Li) Intensive Care Unit, Xuzhou No. 1 People's Hospital, College Road,
Jiangsu Province, Xuzhou City, China
Publisher
Georg Thieme Verlag
Abstract
Objectives Thoracic surgery often causes postoperative delirium (POD) in
geriatric patients. This study aimed to explore the effect of
ultrasound-guided continuous thoracic paravertebral block (UG-TPVB) on POD
in geriatric patients undergoing pulmonary resection. Methods Total 128
patients who underwent pulmonary resection were randomly allocated to
either the conventional patient-controlled analgesia (PCA) group or the
UG-TPVB group (n = 64 per group). The consumption of opioid agents
(propofol and remifentanil), postoperative hospital stay, postoperative
pulmonary atelectasis, postoperative nausea/vomiting, and postoperative
itchiness were recorded. The diagnosis of delirium was dependent on the
Nursing Delirium Screening Scale. The postoperative pain was assessed by
visual analogue scale (VAS) score. The serum levels of interleukin
(IL)-1beta, IL-6, and tumor necrosis factor-alpha were used to evaluate
the postoperative neuroinflammation. Results The consumption of propofol
and remifentanil, postoperative hospital stay, postoperative pulmonary
atelectasis, postoperative nausea/vomiting, and postoperative itchiness in
the UG-TPVB group were lower than that in the PCA group. Compared with the
PCA group, the prevalence of POD was decreased in the UG-TPVB group. In
addition, use of UG-TPVB not only reduced postoperative pain (VAS score)
but also decreased postoperative neuroinflammation compared with PCA in
geriatric patients undergoing pulmonary resection. Conclusions This study
determined the benefits of UG-TPVB over PCA, providing an effectiveness
approach to alleviate POD in geriatric patients undergoing pulmonary
resection.<br/>Copyright &#xa9; 2021. Thieme. All rights reserved.

<125>
Accession Number
636033241
Title
Ventricular Assist Device Driveline Infections: A Systematic Review.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2021. Date of
Publication: 2021.
Author
Krzelj K.; Petricevic M.; Gasparovic H.; Biocina B.; McGiffin D.
Institution
(Krzelj, Gasparovic, Biocina) Department of Cardiac Surgery, University
Hospital Center Zagreb, Zagreb, Croatia
(Petricevic) Division of Health Studies, Department of Cardiac Surgery,
University of Split, University Hospital Center Zagreb, Zagreb, Croatia
(Gasparovic, Biocina) School of Medicine, University of Zagreb, Zagreb,
Croatia
(McGiffin) Department of Cardiothoracic Surgery and Transplantation,
Alfred Hospital, Melbourne, VIC, Australia
(McGiffin) Monash University, Clayton, VIC, Australia
Publisher
Georg Thieme Verlag
Abstract
Infection is the most common complication in patients undergoing
ventricular assist device (VAD) implantation. Driveline exit site (DLES)
infection is the most frequent VAD infection and is a significant cause of
adverse events in VAD patients, contributing to morbidity, even mortality,
and repetitive hospital readmissions. There are many risk factors for
driveline infection (DLI) including younger age, smaller constitution of
patients, obesity, exposed velour at the DLES, longer duration of device
support, lower cardiac index, higher heart failure score, DLES trauma, and
comorbidities such as diabetes mellitus, chronic kidney disease, and
depression. The incidence of DLI depends also on the device type. Numerous
measures to prevent DLI currently exist. Some of them are proven, whereas
the others remain controversial. Current recommendations on DLES care and
DLI management are predominantly based on expert consensus and clinical
experience of the certain centers. However, careful and uniform DLES care
including obligatory driveline immobilization, previously prepared sterile
dressing change kits, and continuous patient education are probably
crucial for prevention of DLI. Diagnosis and treatment of DLI are often
challenging because of certain immunological alterations in VAD patients
and microbial biofilm formation on the driveline surface areas. Although
there are many conservative and surgical methods described in the DLI
treatment, the only possible permanent solution for DLI resolution in VAD
patients is heart transplantation. This systematic review brings a
comprehensive synthesis of recent data on the prevention, diagnostic
workup, and conservative and surgical management of DLI in VAD
patients.<br/>Copyright &#xa9; 2021. Thieme. All rights reserved.

<126>
Accession Number
636029937
Title
Impact of Antibiotic Stewardship Rounds in the Intensive Care Setting: a
prospective cluster-randomized crossover study.
Source
Clinical infectious diseases : an official publication of the Infectious
Diseases Society of America. (no pagination), 2021. Date of Publication:
30 Aug 2021.
Author
Seidelman J.L.; Turner N.A.; Wrenn R.H.; Sarubbi C.; Anderson D.J.; Sexton
D.J.; Moehring R.W.
Institution
(Seidelman, Turner, Wrenn, Anderson, Sexton, Moehring) Duke University
Medical Center, Department of Medicine, Division of Infectious Diseases,
Durham, NC, United States
(Seidelman, Turner, Wrenn, Anderson, Sexton, Moehring) Duke Center for
Antimicrobial Stewardship and Infection Prevention, Durham, NC, United
States
(Sarubbi) UNC Rex Healthcare, Raleigh, NC, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Few groups have formally studied the effect of dedicated
antibiotic stewardship rounds (ASRs) on antibiotic use (AU) in intensive
care units (ICUs). <br/>METHOD(S): We implemented weekly ASRs using a
two-arm, cluster-randomized, crossover study in 5 ICUs at Duke University
Hospital from 11/2017 to 6/2018. We excluded patients without an active
antibiotic order, or if they had a marker of high complexity including an
existing infectious disease consult, transplant, ventricular assist
device, or ECMO. AU during and following ICU stay for patients with ASRs
was compared to the controls. We recorded the number of reviews,
recommendations delivered, and responses. We evaluated change in
ICU-specific AU during and after the study. <br/>RESULT(S): Our analysis
included 4,683 patients: 2330 intervention and 2353 controls. Teams
performed 761 reviews during ASRs, which excluded 1569 patients: 60% of
patients off antibiotics, and 8% complex patients. Exclusions affected 88%
the cardiac surgery ICU (CTICU) patients. AU rate ratio (RR) was 0.97
(0.91-1.04). When CTICU was removed, the RR was 0.93 (0.89-0.98). AU in
the post-study period decreased by 16% (95% CI 11-24%) compared to the AU
in the baseline period. Change in AU was differential among units: largest
in the neurology ICU (-28%) and smallest in the CTICU (-2%).
<br/>CONCLUSION(S): Weekly multi-disciplinary ASRs was a high-resource
intervention associated with a small AU reduction. The noticeable ICU AU
decline over time is possibly due to indirect effects of ASRs. Effects
differed among specialty ICUs, emphasizing the importance of customizing
ASRs to match unit-specific population, workflow, and
culture.<br/>Copyright &#xa9; The Author(s) 2021. Published by Oxford
University Press for the Infectious Diseases Society of America. All
rights reserved. For permissions, e-mail: journals.permissions@oup.com.

<127>
Accession Number
636026897
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. (no pagination), 2021. Date of Publication: 29 Aug 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 Hospital, Rotterdam,
Netherlands
(Frigoli, Heg) Clinical Trial Unit, University of Bern, Bern, Switzerland
(Tijssen) Amsterdam University Medical Centers, Department of Cardiology,
Amsterdam, and ECRI, Rotterdam, the Netherlands
(Juni) University of Toronto, Applied Health Research Centre, Li Ka Shing
Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
(Vranckx) Department of Cardiology and Critical Care Medicine, Hartcentrum
Hasselt, Jessa Ziekenhuis, Hasselt, Belgium; Faculty of Medicine and Life
Sciences, Hasselt University, Hasselt, Belgium
(Ozaki) Department of Cardiology, School of Medicine, Fujita Health
University, Toyoake, Aichi, Japan
(Morice) Cardiovascular European Research Center (CERC), 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, Bern,
Switzerland
(Tonino) Department of Cardiology, Catharina Hospital, Eindhoven,
Netherlands
(Roffi) Division of Cardiology, Geneva University Hospitals, Geneva,
Switzerland
(Lesiak) 1st 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,
Brighton, 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, Belgrade, Serbia
(Iniguez) Hospital Alvaro Cunqueiro, Vigo, Spain
(Schultz, Kornowski) Department of Cardiology, Royal Perth Hospital
Campus, University of Western Australia, Perth, Australia
(Ong) Tan Tock Seng Hospital, 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 (CECI) Buenos Aires, Argentina
(Moschovitis) Hirslanden, HerzZentrum, Zurich, Switzerland
(Laanmets) North-Estonia Medical Centre Foundation, Tallinn, Estonia
(Valgimigli) Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale,
Universita della Svizzera Italiana (USI), CH- 6900 Lugano, Switzerland
Publisher
NLM (Medline)
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. <br/>Method(s): In the
investigator-initiated, randomized, open-label MASTER DAPT trial, 4579
patients at high bleeding risk were randomized after 1-month dual APT
(DAPT) 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 indication, patients changed immediately to single APT
(SAPT) for 5 months (abbreviated regimen) or continued >= 2 months DAPT
and SAPT thereafter (nonabbreviated regimen). Patients without an OAC
indication changed to SAPT for 11 months (abbreviated regimen) or
continued >=5 months of DAPT and SAPT thereafter (nonabbreviated regimen).
Coprimary outcomes at 335 days after randomization were: net adverse
clinical outcomes (NACE; composite of all-cause death, myocardial
infarction, stroke, and Bleeding Academic Research Consortium [BARC] 3 or
5 bleeding events); major adverse cardiac and cerebral events (MACCE;
all-cause death, myocardial infarction, and stroke); and type 2, 3, or 5
BARC bleeding. <br/>Result(s): NACE or MACE did not differ with
abbreviated versus nonabbreviated APT regimens in patients with OAC
indication (n=1666; HR, 0.83; 95% CI, 0.60 to 1.15, HR, 0.88; 95% CI, 0.60
to 1.30; respectively) or without OAC indication (n=2913; HR, 1.01; 95%
CI, 0.77 to 1.33; HR, 1.06; 95% CI, 0.79 to 1.44; Pinteraction=0.35 and
0.45, respectively). BARC 2, 3 or 5 bleeding did not significantly differ
in patients with OAC indication (HR, 0.83; 95% CI, 0.62 to 1.12) but was
lower with abbreviated APT in patients without OAC indication (HR, 0.55;
95% CI, 0.41 to 0.74; Pinteraction=0.057). The difference in bleeding in
patients without OAC indication was driven mainly by a reduction in BARC 2
bleedings (HR, 0.48; 95% CI 0.33 to 0.69; Pinteraction=0.021).
<br/>Conclusion(s): Rates of NACE and MACCE did not differ with
abbreviated APT in high bleeding risk patients with or without an OAC
indication and resulted in lower bleeding rates in patients without an OAC
indication. Clinical Trial Registration: URL:
https://www.clinicaltrials.gov Unique identifier:NCT03023020.