EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014315671
Title
Generalizability of the REDUCE-IT trial and cardiovascular outcomes
associated with hypertriglyceridemia among patients potentially eligible
for icosapent ethyl therapy: An analysis of the REduction of
Atherothrombosis for Continued Health (REACH) registry.
Source
International Journal of Cardiology. 340 (pp 96-104), 2021. Date of
Publication: 01 Oct 2021.
Author
Picard F.; Bhatt D.L.; Ducrocq G.; Ohman E.M.; Goto S.; Eagle K.A.; Wilson
P.W.F.; Smith S.C.; Elbez Y.; Steg P.G.
Institution
(Picard, Ducrocq, Elbez, Steg) FACT (French Alliance for Cardiovascular
Trials), Paris, France
(Picard) Cardiology Department, Assistance Publique-Hopitaux de Paris,
Hopital Cochin, Paris, France
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center, Harvard
Medical School, Boston, MA, United States
(Ducrocq, Steg) Assistance Publique-Hopitaux de Paris, hopital Bichat, and
INSERM U1148, Paris, France
(Ducrocq, Steg) Universite de Paris, Paris, France
(Ohman) Duke University Medical Center, Durham, NC, United States
(Goto) Department of Medicine, Tokai University School of Medicine,
Isehara, Japan
(Eagle) University of Michigan Health System, Ann Arbor, MI, United States
(Wilson) Atlanta VA Medical Center and Emory Cardiovascular Research
Institute, GA, United States
(Smith) Heart and Vascular Center, University of North Carolina at Chapel
Hill, NC, United States
(Steg) NHLI Imperial College, ICMS, Royal Brompton Hospital, London,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: The REDUCE-IT (Reduction of Cardiovascular Events with
Icosapent Ethyl-Intervention Trial) trial demonstrated that high-dose
icosapent-ethyl reduced the risk of ischemic events in statin-treated
patients with elevated triglycerides (TG) and either atherosclerotic
cardiovascular disease (ASCVD) or diabetes plus at least one risk factor.
<br/>Methods and Results: Using data from REACH (Reduction of
Atherothrombosis for Continued Health), a large international registry of
outpatients with or at risk of ASCVD, we evaluated the proportion of
patients potentially eligible for enrolment in REDUCE-IT and compared
their outcomes to those excluded because of low TG. Among 62,464 patients
with either ASCVD or diabetes enrolled in the REACH Registry, 1036/8418
(12.3%) patients in primary prevention and 6049/54046 (11.2%) patients in
secondary prevention (11.3% overall) would have been eligible for
inclusion in REDUCE-IT. Compared with patients excluded for low TG level,
adjusted risk of the primary composite outcome of cardiovascular death,
non-fatal myocardial infarction (MI), non-fatal stroke, unstable angina,
or coronary revascularization was higher in the REDUCE-IT eligible group
(HR:1.06, 95%CI:1.00-1.13, p = 0.04). In addition, unstable angina,
non-fatal MI, percutaneous coronary intervention and coronary artery
bypass grafting were also more frequent in the REDUCE-IT eligible group
(HR:1.17, 95%CI:1.07-1.27, p < 0.001; HR:1.25, 95%CI:1.07-1.45, p < 0.001;
HR:1.42, 95%CI:1.27-1.57, p < 0.001; HR:1.43, 95%CI:1.19-1.71, p < 0.001,
respectively), whereas the adjusted risk of non-fatal stroke was lower
(HR:0.64, 95%CI:0.54-0.75, p < 0.001). <br/>Conclusion(s): In this large
international registry of patients with or at high-risk of ASCVD, 11.3%
met the REDUCE-IT trial selection criteria. REDUCE-IT eligible patients
were found to be at higher risk of cardiac atherothrombotic events, but at
lower risk of stroke than trial-ineligible patients with lower
TG.<br/>Copyright &#xa9; 2021 Elsevier B.V.

<2>
Accession Number
2013840238
Title
Trimetazidine offers myocardial protection in elderly coronary artery
disease patients undergoing non-cardiac surgery: a randomized,
double-blind, placebo-controlled trial.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
473. Date of Publication: December 2021.
Author
Dai Z.-L.; Song Y.-F.; Tian Y.; Li Y.; Lin M.; Lin J.; Wang Q.; Wang P.;
Gao W.-L.
Institution
(Dai, Song, Tian, Li, Lin, Lin, Wang, Wang, Gao) Department of
Anesthesiology, Shenzhen People's Hospital (The Second Clinical Medical
College, Jinan University; The First Affiliated Hospital, Southern
University of Science and Technology), Shenzhen, Guangdong 518020, China
(Dai, Song, Tian, Li, Lin, Lin, Wang, Wang, Gao) Shenzhen Engineering
Research Center of Anesthesiology, No. 1017 Dongmen North Road, Shenzhen,
Guangdong 518020, China
Publisher
BioMed Central Ltd
Abstract
Background: Trimetazidine (TMZ) pretreatment protects cardiomyocytes
during cardiac surgery. TMZ may protect elderly patients with ischaemic
heart disease (IHD) undergoing non-cardiac surgery. <br/>Method(s): This
was a randomized, double-blind, placebo-controlled trial (registration
#ChiCTR1900025018) of patients with IHD scheduled to undergo non-cardiac
surgery at Shenzhen People's Hospital (Shenzhen, Guangdong Province,
China) between June 2014 and September 2015, randomized to 60 mg TMZ or
placebo 12 h before surgery. The primary endpoint was the occurrence of
in-hospital cardiovascular events. The secondary endpoints were myocardial
ischaemia on five-lead electrocardiogram (cECG), cardiac troponin I (cTnI)
elevation, cardiac death, acute coronary events, heart failure, and
arrhythmia requiring treatments. <br/>Result(s): Compared with the placebo
group, the TMZ group showed a lower occurrence of in-hospital
cardiovascular events (primary endpoint, 20.0% vs. 37.5%, P = 0.02),
myocardial ischaemia (15.0% vs. 32.5%, P < 0.01), cTnI elevation (2.5% vs.
10%, P < 0.01), acute coronary events (10.0% vs. 20.0%, P < 0.05), heart
failure (0% vs. 2.5%, P < 0.05), and arrhythmia requiring treatment (17.5%
vs. 35.0%, P < 0.05). There was no acute myocardial infarction during the
30-day postoperative period. <br/>Conclusion(s): In elderly patients with
IHD undergoing non-cardiac surgery, TMZ pretreatment was associated with
myocardial protective effects. Trial registration The trial was
prospectively registered at
http://www.chictr.org.cn/showproj.aspx?proj=41909 with registration number
[ChiCTR1900025018] (7/8/2019).<br/>Copyright &#xa9; 2021, The Author(s).

<3>
Accession Number
2013600416
Title
His-bundle pacing following transcatheter aortic valve replacement.
Source
PACE - Pacing and Clinical Electrophysiology. 44(10) (pp 1786-1789), 2021.
Date of Publication: October 2021.
Author
Garg J.; Shah S.; Shah K.; Turagam M.K.; Natale A.; Lakkireddy D.
Institution
(Garg) Division of Cardiology, Cardiac Arrhythmia Service, Loma Linda
University Health, Loma Linda, CA, United States
(Shah) Division of Cardiology, State University of New York Upstate
Medical University, Syracuse, NY, United States
(Shah) Department of Cardiovascular Medicine, Beaumont Hospital, Oakland
University William Beaumont School of Medicine, Royal Oak, MI, United
States
(Turagam) Helmsley Electrophysiology Center, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Natale) Texas Cardiac Arrhythmia Institute at St. David's Medical Center,
Austin, TX, United States
(Lakkireddy) Kansas City Heart Rhythm Institute and Research Foundation,
Kansas City, KS, United States
Publisher
John Wiley and Sons Inc

<4>
Accession Number
2013566005
Title
C-reactive protein and procalcitonin after congenital heart surgery
utilizing cardiopulmonary bypass: When should we be worried?.
Source
Journal of Cardiac Surgery. 36(11) (pp 4301-4307), 2021. Date of
Publication: November 2021.
Author
Farias J.S.; Villarreal E.G.; Dhargalkar J.; Kleinhans A.; Flores S.;
Loomba R.S.
Institution
(Farias, Villarreal) Tecnologico de Monterrey, Escuela de Medicina y
Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
(Dhargalkar, Loomba) Department of Pediatrics, Chicago Medical
School/Rosalind Franklin University of Medicine and Science, North
Chicago, IL, United States
(Kleinhans, Flores) Section of Critical Care and Cardiology, Texas
Children's Hospital, Houston, TX, United States
(Kleinhans, Flores) Department of Pediatrics, Baylor School of Medicine,
Houston, TX, United States
(Loomba) Department of Pediatric Critical Care, Advocate Children's
Hospital, Oak Lawn, IL, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: To assess the efficacy of C-reactive protein (CRP) and
procalcitonin (PCT) at identifying infection in children after congenital
heart surgery (CHS) with cardiopulmonary bypass (CPB). <br/>Material(s)
and Method(s): Systematic review of the literature was conducted to
identify studies with data regarding CRP and/or PCT after CHS with CPB.
The primary variables identified to be characterized were CRP and PCT at
different timepoints. The main inclusion criteria were children who
underwent CHS with CPB. Subset analyses for those with and without
documented infection were conducted in similar fashion. A p value of less
than.05 was considered statistically significant. <br/>Result(s): A total
of 21 studies were included for CRP with 1655 patients and a total of 9
studies were included for PCT with 882 patients. CRP peaked on
postoperative Day 2. A significant difference was noted in those with
infection only on postoperative Day 4 with a level of 53.60 mg/L in those
with documented infection versus 29.68 mg/L in those without. PCT peaked
on postoperative Day 2. A significant difference was noted in those with
infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in
those with documented infection versus 5.6 ng/ml in those without.
<br/>Conclusion(s): Both CRP and PCT increase after CHS with CPB and peak
on postoperative day 2. PCT has a greater statistically significant
difference in those with documented infection when compared to CRP and a
PCT of greater than 5.6 ng/ml should raise suspicion for
infection.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<5>
Accession Number
2013354319
Title
Cell therapy for nonischemic dilated cardiomyopathy: A systematic review
and meta-analysis of randomized controlled trials.
Source
Stem Cells Translational Medicine. 10(10) (pp 1394-1405), 2021. Date of
Publication: October 2021.
Author
Tripathi A.; Khan M.S.; Khan A.R.; Vaughn V.M.; Bolli R.
Institution
(Tripathi, Khan) Division of Cardiology, University of Kentucky College of
Medicine, Bowling Green, KY, United States
(Khan) Department of Cardiology, Cheyenne Regional Medical Center,
Cheyenne, WY, United States
(Khan, Vaughn) Kornhauser Health Science Library, University of
Louisville, Louisville, KY, United States
(Bolli) Institute of Molecular Cardiology, University of Louisville,
Louisville, KY, United States
Publisher
John Wiley and Sons Ltd
Abstract
Cell therapy involves transplantation of human cells to promote repair of
diseased or injured tissues and/or cells. Only a limited number of mostly
small-scale trials have studied cell therapy in nonischemic cardiomyopathy
(NICM). We performed a meta-analysis of randomized clinical trials (RCTs)
to assess the safety and efficacy of cell therapy in NICM. Electronic
databases were searched for relevant RCTs from inception until August
2020. Outcomes assessed were left ventricular ejection fraction (LVEF),
left ventricular end-diastolic diameter or volume (LVEDD), quality of life
(QoL) indices, and major adverse cardiac events (MACEs). Weighted mean
differences (MDs) and standardized mean differences (SMDs) were calculated
using random-effects methods. Eleven RCTs with 574 participants were
included in the analysis. There was a significant increase in mean LVEF
(MD, 4.17%; 95% confidence interval [CI] = 1.66-6.69) and modest decrease
in LVEDD (SMD, -0.50; 95% CI = -0.95 to -0.06) in patients treated with
cell therapy compared with controls. Cell therapy was also associated with
improvement in functional capacity, as assessed by the 6-minute walking
distance (MD, 72.49 m; 95% CI = 3.44-141.53). No significant differences
were seen in MACEs and QoL indices between treated and control groups.
This meta-analysis suggests that cell therapy may improve LV systolic
function and may be associated with improvement in LVEDD and functional
capacity compared with maximal medical therapy. Cell therapy was safe,
with no significant difference in MACEs between treatment and control
groups. However, given the limitations of current studies, larger
well-designed RCTs are needed to evaluate the efficacy of cell therapy in
patients with NICM.<br/>Copyright &#xa9; 2021 The Authors. STEM CELLS
TRANSLATIONAL MEDICINE published by Wiley Periodicals LLC on behalf of
AlphaMed Press.

<6>
Accession Number
2011173246
Title
Percutaneous mitral valve repair with MitraClip device in hemodynamically
unstable patients: A systematic review.
Source
Catheterization and Cardiovascular Interventions. 98(4) (pp E617-E625),
2021. Date of Publication: October 2021.
Author
Martinez-Gomez E.; McInerney A.; Tirado-Conte G.; de Agustin J.A.;
Jimenez-Quevedo P.; Escudero A.; Pozo Osinalde E.; Viana-Tejedor A.;
Goirigolzarri J.; Marroquin L.; Vivas D.; Ferrera C.; Noriega F.;
Restrepo-Cordoba M.A.; Gonzalo N.; Escaned J.; Fernandez-Ortiz A.;
Amat-Santos I.; Estevez-Loureiro R.; Macaya C.; Nombela-Franco L.
Institution
(Martinez-Gomez, McInerney, Tirado-Conte, de Agustin, Jimenez-Quevedo,
Escudero, Pozo Osinalde, Viana-Tejedor, Goirigolzarri, Marroquin, Vivas,
Ferrera, Noriega, Restrepo-Cordoba, Gonzalo, Escaned, Fernandez-Ortiz,
Macaya, Nombela-Franco) Cardiology Department, Cardiovascular Institute,
Hospital Clinico San Carlos, IdISSC, Madrid, Spain
(Amat-Santos) Cardiology Department, CIBERCV, Hospital Clinico
Universitario, Valladolid, Spain
(Estevez-Loureiro) Interventional Cardiology Unit, University Hospital
Alvaro Cunqueiro, Vigo, Spain
Publisher
John Wiley and Sons Inc
Abstract
Background: Very few data exist on percutaneous mitral valve repair (PMVr)
in unstable patients with concomitant moderate-severe mitral regurgitation
(MR). The purpose of this systematic review was to evaluate baseline
characteristics, management and clinical outcomes of critically ill
patients undergoing PMVr with MitraClip. <br/>Method(s): We conducted a
systematic review of the published data on MitraClip from its first use in
2003 to December 2020. Studies referring to critically ill patients in
cardiogenic shock or acute refractory pulmonary edema were included. A
total of 40 publications including 254 patients with significant MR (Grade
4 in 91%) were included. <br/>Result(s): Mean age was 70 +/- 12 years with
mean Euroscore II and STS of 21 +/- 13 and 20.5 +/- 16, respectively.
Clinical presentation was with cardiogenic shock and acute myocardial
infarction in 72.8 and 60.0% of patients, respectively. Device success was
achieved in 238 (93.7%) patients with a significant reduction in MR (Grade
<= 2 in 91.8%, p <.001). The median weaning time from the procedure, to
discontinuation of mechanical circulatory or respiratory support, was 2
days (IQR 1-4), with an in-hospital mortality and non-fatal complication
rate of 12.6 and 9.1%, respectively. Kaplan-Meier curves estimated an
overall mortality rate of 39.1% at 12-month follow-up, with persistent
reduction in MR severity for survivors (Grade <= 2 in 81.3%) and one case
of mitral valve reintervention. <br/>Conclusion(s): Percutaneous mitral
valve repair with MitraClip device is a technically feasible and
potentially viable management option in high-risk patients with
cardiogenic shock or refractory pulmonary edema and concomitant
moderate-severe MR. Prospective trials are required to confirm these
findings, and definitively determine the value of MitraClip in
hemodynamically unstable patients.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC.

<7>
Accession Number
2006915092
Title
Side branch fractional flow reserve after provisional stenting of
calcified bifurcation lesions: The ORBID-FFR study.
Source
Catheterization and Cardiovascular Interventions. 98(4) (pp 658-668),
2021. Date of Publication: October 2021.
Author
Kini A.S.; Okamoto N.; Barman N.; Vengrenyuk Y.; Yasumura K.; Chamaria S.;
Bhatheja S.; Kapur V.; Hasan C.; Sweeny J.; Baber U.; Mehran R.; Stone
G.W.; Sharma S.
Institution
(Kini, Okamoto, Barman, Vengrenyuk, Yasumura, Chamaria, Bhatheja, Kapur,
Hasan, Sweeny, Baber, Mehran, Stone, Sharma) Division of Cardiology, Mount
Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY,
United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We examined the incidence of side branch (SB) compromise after
provisional stenting of calcified bifurcation lesions treated with
rotational atherectomy (RA) or cutting balloon angioplasty (CBA) and the
utility of optical coherence tomography (OCT) to detect functionally
significant SB stenoses. <br/>Background(s): The comparative impact of RA
versus CBA on SB compromise and functional significance remains poorly
characterized. <br/>Method(s): Seventy-one consecutive patients with 71
calcified bifurcation lesions with angiographically intermediate SB
stenoses were randomized to RA (n = 35) or CBA (n = 36). The primary
endpoint was SB compromise defined as SB diameter stenosis >=70%, SB
dissection or thrombolysis in myocardial infarction flow grade < 3 after
provisional stenting. Secondary endpoints included SB FFR in
noncompromised SBs and its correlation with SB ostium area (SBOA) assessed
by three-dimensional OCT. <br/>Result(s): SB compromise after provisional
stenting was observed in 7 (20.0%) lesions that underwent RA and in 9
(25.0%) lesions treated with CBA (p =.62). Mean SB FFR was 0.83 +/- 0.08
and was similar between the study arms. Functionally significant SB
stenosis (FFR <= 0.80) was detected in 17(30.9%) angiographically
noncompromised SBs. SBOA after stenting was an independent predictor of
FFR <= 0.80 (OR 0.002, 95% CI: 0.00-0.15, p =.002). The optimal cutoff
value for SBOA to predict functionally significant SB stenosis was 0.76
mm² (sensitivity 82%, specificity 89% and area under the curve
0.92, 95% CI: 0.84-0.99). <br/>Conclusion(s): The rates of SB compromise
and functionally significant stenosis after provisional stenting of
calcified bifurcation lesions were similar between two lesion preparation
strategies. OCT SBOA can detect SB branches with FFR <= 0.80 with high
sensitivity and specificity.<br/>Copyright &#xa9; 2020 Wiley Periodicals
LLC.

<8>
Accession Number
2014658113
Title
Effects of Glucocorticoids on Postoperative Delirium in Adult Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.
Source
Clinical Therapeutics. (no pagination), 2021. Date of Publication: 2021.
Author
Liu W.; Wang Y.; Wang J.; Shi J.; Pan J.; Wang D.
Institution
(Liu, Wang, Wang, Shi, Pan, Wang) Department of Thoracic and
Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Institute of Cardiothoracic Vascular Disease,
Nanjing University, China
Publisher
Elsevier Inc.
Abstract
Purpose: Delirium is a common neurologic complication after cardiac
surgery and is associated with a poor prognosis. Several studies have
explored the effects of glucocorticoids on postoperative delirium (POD).
However, conclusion have been inconsistent. The purpose of this systematic
review and meta-analysis is to evaluate the effects of glucocorticoids on
POD in adult patients undergoing cardiac surgery. <br/>Method(s): A
systematic literature search was conducted using PubMed/MEDLINE, Embase,
Cochrane Library/Central, and Web of Science from inception to January 28,
2021. Randomized controlled trials evaluating the effects of perioperative
glucocorticoids administration on the incidence of POD in adults (>=18
years of age) undergoing cardiac surgery were included. The primary
outcome of incidence of POD was assessed using the risk ratio (RR) with a
fixed-effects model. Secondary analyses included the severity or duration
of delirium, mortality at 30 days, length of hospital and intensive care
unit (ICU) stay, duration of mechanical ventilatory support, the incidence
of myocardial injury, new atrial fibrillation, renal and respiratory
failure, postoperative infection and stroke, and the level of glucose and
inflammatory factors. <br/>Finding(s): A total 4 trials (n = 8448
patients) were included. Glucocorticoids did not significantly reduce the
incidence of POD (RR = 0.99; 95% CI, 0.86-1.14) but increased the risk of
myocardial injury (RR = 1.22; 95% CI, 1.08-1.38), decreased the duration
of mechanical ventilatory support (mean difference, -0.83; 95% CI, -1.32
to -0.34), and led to a tendency toward short length of ICU stay (mean
difference, -0.22; 95% CI, -0.47 to -0.03). No significant differences
were observed in other secondary outcomes. Implications: The perioperative
administration of glucocorticoids did not reduce the incidence of POD in
adult patients undergoing cardiac surgery but might be associated with
shorter duration of mechanical ventilatory support and a tendency toward a
shorter length of ICU stay. Furthermore, we found that glucocorticoids may
increase the rate of myocardial injury but have no effects on other
clinical outcomes. International Prospective Register of Systematic
Reviews identifier: CRD42021233458.<br/>Copyright &#xa9; 2021

<9>
Accession Number
2013831795
Title
Impact of chronic medications in the perioperative period -anesthetic
implications (part ii).
Source
Postgraduate Medicine. (no pagination), 2021. Date of Publication: 2021.
Author
Elvir-Lazo O.L.; White P.F.; Cruz Eng H.; Yumul F.; Chua R.; Yumul R.
Institution
(Elvir-Lazo, White, Yumul) Department of Anesthesiology, Cedars-Sinai
Medical Center, Los Angeles, CA, United States
(White) The White Mountain Institute, The Sea Ranch, CA, United States
(Cruz Eng) Adena Health System, department of anesthesiology, Chillicothe,
OH, United States
(Yumul) Department of family medicine, Skagit Regional Health, Family
Medicine, Arlington, WA, United States
(Chua) Department of Internal Medicine, Huntington Hospital, Prasadena,
CA, United States
(Yumul) David Geffen School of Medicine-UCLA, Drew University of Medicine
and Science, Los Angeles, CA, United States
Publisher
Taylor and Francis Ltd.
Abstract
Background: This review article discusses the pharmacodynamic effects of
the most commonly used chronic medications by patients undergoing elective
surgical procedures, namely cardiovascular drugs (e.g., beta blockers,
alpha-2 agonist, calcium channel blockers, ACE inhibitors, diuretics,
etc.), lipid-lowering drugs, gastrointestinal medications (H2-blockers,
proton pump inhibitors), pulmonary medications (inhaled beta-agonists,
anticholinergics,), antibiotics (tetracyclines, clindamycin and macrolide,
linezolid.), opioids and non-opioids analgesics (NSAIDs, COX-2 inhibitors,
acetaminophen), gabapentanoids, erectile dysfunction (ED) drugs,
psychotropic drugs (tricyclic antidepressants [TCAs], monoamine oxidase
inhibitors [MAOI], selective serotonin reuptake inhibitors [SSRIs],
serotonin norepinephrine reuptake inhibitors [SNRIs], and
cannabinol-containing drugs). In addition, the potential adverse
drug-interactions between these chronic medications and commonly used
anesthetic drugs during the perioperative period will be reviewed.
Finally, recommendations regarding the management of chronic medications
during the preoperative period will be provided. <br/>Material(s) and
Method(s): An online search was conducted from January 2000 through
February 2021 with the Medline database through PubMed and Google Scholar
using the following search terms/keywords: "chronic medications in the
perioperative period", and "chronic medications and anesthetic
implications." In addition, we searched for anesthetic side effects
associated with the major drug groups. Results and <br/>Conclusion(s): An
understanding of the pharmacodynamic effects of most used chronic
medications is important to avoid untoward outcomes in the perioperative
period. These drug interactions may result in altered efficacy and
toxicity of the anesthetic medications administered during surgery. These
drug-drug interactions can also affect the morbidity, mortality, recovery
time of surgical patients and acute relapse of chronic illnesses which
could lead to last minute cancellation of surgical procedures. Part II of
this two-part review article focuses on the reported interactions between
most commonly taken chronic medications by surgical patients and
anesthetic and analgesic drugs, as well as recommendations regarding the
handling these chronic medications during the perioperative period.
.<br/>Copyright &#xa9; 2021 Informa UK Limited, trading as Taylor &
Francis Group.

<10>
Accession Number
2005366453
Title
Subclinical valve thrombosis in transcatheter aortic valve implantation: A
systematic review and meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 162(5) (pp 1491-1499.e2),
2021. Date of Publication: November 2021.
Author
Woldendorp K.; Doyle M.P.; Black D.; Ng M.; Keech A.; Grieve S.M.; Bannon
P.G.
Institution
(Woldendorp, Black, Ng, Keech, Grieve, Bannon) Sydney Medical School, The
University of Sydney, Sydney, Australia
(Woldendorp, Doyle, Black, Bannon) The Baird Institute of Applied Heart
and Lung Surgical Research, Sydney, Australia
(Woldendorp, Doyle, Bannon) Cardiothoracic Surgical Unit, Royal Prince
Alfred Hospital, Sydney, Australia
(Ng, Keech) Cardiology Department, Royal Prince Alfred Hospital, Sydney,
Australia
(Grieve) Department of Radiology, Royal Prince Alfred Hospital, Sydney,
Australia
(Grieve) Sydney Translational Imaging Laboratory, Heart Research Institute
& Charles Perkins Centre, Sydney Medical School, University of Sydney,
Sydney, Australia
(Bannon) Institute of Academic Surgery, Royal Prince Alfred Hospital,
Sydney, Australia
Publisher
Elsevier Inc.
Abstract
Background: Recent high-resolution computed tomography studies after
transcatheter aortic valve insertion (TAVI) have reported a high
prevalence of subclinical valve thrombosis (SCVT), potentially
contributing to increased risk of late stroke. We aimed to investigate
SCVT in patients after TAVI, with a focus on prevalence, predisposing
factors, management, and potential sequelae. <br/>Method(s): A
comprehensive literature review of patients with SCVT after TAVI was
carried out on all published studies in 3 major electronic databases from
their inception until October 2019. Studies with sufficient data were
included in a meta-analysis comparing the risk of stroke between patients
with SCVT and those with normal valve function, as well as the protective
effects of antiplatelet and anticoagulation on preventing SCVT.
<br/>Result(s): From 3456 patients examined in a comprehensive review, 398
patients (11.5%) demonstrated evidence of SCVT during follow-up. Dual
antiplatelet therapy was given in 45.5% of cases, single antiplatelet
therapy in 19.8%, and oral anticoagulation in 28.5%. A meta-analysis
demonstrated that rates of stroke were more than 3 times greater in
patients with SCVT compared with those without (logistic odds, 1.10; 95%
confidence interval, 0.63-1.57, P < .0001). Oral anticoagulation was
superior to dual antiplatelet therapy or single antiplatelet therapy,
preventing the formation of SCVT (logistic odds, -1.05, 95% confidence
interval, -1.71 to -0.39, P < .0001). <br/>Conclusion(s): Subclinical
valve thrombosis is seen in 11.5% of patients after TAVI and is associated
with increased risk of stroke. When oral anticoagulation is used
postprocedurally, it is more effective than either dual or
single-antiplatelet therapy in preventing subclinical valve thrombosis.
These findings suggest that further studies are needed to define the
optimal antithrombotic regimen to mitigate thrombotic and embolic sequelae
after TAVI.<br/>Copyright &#xa9; 2020

<11>
Accession Number
633521046
Title
Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart
Surgery in Muslim Patients (Shia and Sunni).
Source
The journal of pastoral care & counseling : JPCC. 74(4) (pp 234-240),
2020. Date of Publication: 01 Dec 2020.
Author
Fasihizadeh H.; Nasiriani K.
Institution
(Fasihizadeh) Department of Nursing, Research Center for Nursing and
Midwifery Care, Shahid Sadoughi University of Medical Sciences and Health
Services, Iran, Islamic Republic of
(Nasiriani) Department of Nursing, Research Center for Nursing and
Midwifery Care, Mother and Newborn Health Research Center, Shahid Sadoughi
University of Medical Sciences and Health Services, Iran, Islamic Republic
of
Publisher
NLM (Medline)
Abstract
The process of removal of a chest tube can cause pain and anxiety.
Spiritual care can be considered as a component of nursing care,
especially in the pain and anxiety relating to such procedures. This study
was a randomized clinical trial. Eighty patients completed the study. The
findings showed significant differences in anxiety and pain between groups
(p=0.001). Spiritual care reduced anxiety and pain caused by chest tube
removal in patients (Shia and Sunni Islam) undergoing heart surgery.

<12>
Accession Number
2015065808
Title
Effect of desflurane on changes in regional cerebral oxygenation in
patients undergoing one-lung ventilation is equivalent to the effect of
propofol.
Source
Respiratory Physiology and Neurobiology. 296 (no pagination), 2022.
Article Number: 103798. Date of Publication: February 2022.
Author
Sato S.; Edanaga M.; Kondo M.; Yamakage M.
Institution
(Sato, Edanaga, Kondo, Yamakage) Department of Anesthesiology, Sapporo
Medical University School of Medicine, West 16, South 1, Chuo-ward,
Sapporo, Hokkaido 060-8543, Japan
Publisher
Elsevier B.V.
Abstract
Objectives: Desaturation is an important clinical problem during one-lung
ventilation (OLV) since it may induce cerebral hypoxia. Measurement of
cerebral oxygenation has been shown to provide accurate information about
episodes of cerebral hypoxemia. The purpose of this study was to compare
the effect of desflurane on changes in cerebral oxygenation during OLV
with the effect of propofol. <br/>Method(s): A randomized, single-blinded,
prospective study was conducted. Fifty adult patients who were scheduled
to undergo thoracic surgery were randomly assigned to anesthetic
management using desflurane with remifentanil (Group D: n = 25) or using
propofol and remifentanil (Group P: n = 25). <br/>Result(s): The
characteristics of the patients were very similar. Intergroup analysis of
changes in cerebral oxygenation showed no significant difference on the
operative side (two-way ANOVA, F (7, 368) = 0.425, p = 0.887) or the
non-operative side (two-way ANOVA, F (7, 367) = 1.342, p = 0.229).
Intragroup analysis of changes in cerebral oxygenation using one-way ANOVA
showed no significant difference on the operative side (Group P; p =
0.585, Group D; p = 0.928) or the non-operative side in both groups (Group
P; p = 0.657, Group D; p = 0.602). <br/>Conclusion(s): The effects of
desflurane and propofol on changes in cerebral oxygenation in patients
undergoing OLV were equivalent. Our results indicated that desflurane
might be an appropriate anesthetic during OLV for maintaining cerebral
oxygenation with an effective equivalent to that of
propofol.<br/>Copyright &#xa9; 2021 Elsevier B.V.

<13>
Accession Number
2014434688
Title
Meta-analysis of randomised controlled trials of perioperative
dexmedetomidine to reduce delirium and mortality after cardiac surgery.
Source
British Journal of Anaesthesia. 127(5) (pp e168-e170), 2021. Date of
Publication: November 2021.
Author
Sanders R.D.; Wehrman J.; Irons J.; Dieleman J.; Scott D.; Shehabi Y.
Institution
(Sanders, Wehrman, Irons) University of Sydney, Camperdown, NSW, Australia
(Sanders, Irons) Department of Anaesthetics, Royal Prince Alfred Hospital,
Camperdown, NSW, Australia
(Sanders) Institute of Academic Surgery, Camperdown, NSW, Australia
(Dieleman) Department of Anaesthesia & Perioperative Medicine, Westmead
Hospital, Westmead, NSW, Australia
(Scott) Department of Anaesthesia & Acute Pain Medicine, St Vincent's
Hospital, Melbourne, VIC, Australia
(Scott) University of Melbourne, Melbourne, VIC, Australia
(Shehabi) Monash Health School of Clinical Sciences, Monash University,
Melbourne, VIC, Australia
(Shehabi) Prince of Wales Clinical School of Medicine, University of New
South Wales, Randwick, NSW, Australia
Publisher
Elsevier Ltd

<14>
Accession Number
2014999813
Title
Clinical Outcomes Following Isolated Transcatheter Tricuspid Valve Repair:
A Meta-Analysis and Meta-Regression Study.
Source
JACC: Cardiovascular Interventions. 14(20) (pp 2285-2295), 2021. Date of
Publication: 25 Oct 2021.
Author
Bocchino P.P.; Angelini F.; Vairo A.; Andreis A.; Fortuni F.; Franchin L.;
Frea S.; Raineri C.; Pidello S.; Conrotto F.; Montefusco A.; Alunni G.; De
Ferrari G.M.
Institution
(Bocchino, Angelini, Vairo, Andreis, Fortuni, Franchin, Frea, Raineri,
Pidello, Conrotto, Montefusco, Alunni, De Ferrari) Division of Cardiology,
Department of Medical Sciences, University of Turin, "Citta della Salute e
della Scienza" Hospital, Turin, Italy
(Fortuni) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess the pooled clinical and
echocardiographic outcomes of different isolated transcatheter tricuspid
valve repair (ITTVR) strategies for significant (moderate or greater)
tricuspid regurgitation (TR). <br/>Background(s): Significant TR is a
common valvular heart disease worldwide. <br/>Method(s): Published
research was systematically searched for studies evaluating the efficacy
and safety of ITTVR for significant TR in adults. The primary outcomes
were improvement in New York Heart Association (NYHA) functional class and
6-minute walking distance and the presence of severe or greater TR at the
last available follow-up of each individual study. Random-effect
meta-analysis was performed comparing outcomes before and after ITTVR.
<br/>Result(s): Fourteen studies with 771 patients were included. The mean
age was 77 +/- 8 years, and the mean European System for Cardiac Operative
Risk Evaluation II score was 6.8% +/- 5.4%. At a weighted mean follow-up
of 212 days, 209 patients (35%) were in NYHA functional class III or IV
compared with 586 patients (84%) at baseline (risk ratio: 0.23; 95% CI:
0.13-0.40; P < 0.001). Six-minute walking distance significantly improved
from 237 +/- 113 m to 294 +/- 105 m (mean difference +50 m; 95% CI: +34 to
+66 m; P < 0.001). One hundred forty-seven patients (24%) showed severe or
greater TR after ITTVR compared with 616 (96%) at baseline (risk ratio:
0.29; 95% CI: 0.20-0.42; P < 0.001). <br/>Conclusion(s): Patients
undergoing ITTVR for significant TR experienced significant improvements
in NYHA functional status and 6-minute walking distance and a significant
reduction in TR severity at mid-term follow-up.<br/>Copyright &#xa9; 2021
American College of Cardiology Foundation

<15>
Accession Number
636124116
Title
Early computed tomography coronary angiography in patients with suspected
acute coronary syndrome: Randomised controlled trial.
Source
The BMJ. 374 (no pagination), 2021. Article Number: n2106. Date of
Publication: 29 Sep 2021.
Author
Gray A.J.; Roobottom C.; Smith J.E.; Goodacre S.; Oatey K.; O'Brien R.;
Storey R.F.; Curzen N.; Keating L.; Kardos A.; Felmeden D.; Lee R.J.;
Thokala P.; Lewis S.C.; Newby D.E.
Institution
(Gray, Oatey, Lee, Lewis, Newby) University of Edinburgh, Edinburgh,
United Kingdom
(Gray, O'Brien, Newby) Royal Infirmary of Edinburgh, NHS Lothian,
Edinburgh, United Kingdom
(Roobottom, Smith) University Hospitals Plymouth NHS Trust, Plymouth,
United Kingdom
(Roobottom) University of Plymouth, Plymouth, United Kingdom
(Goodacre, Storey, Thokala) University of Sheffield, Sheffield, United
Kingdom
(Curzen) University of Southampton, Southampton, United Kingdom
(Keating) Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
(Kardos) Milton Keynes University Hospital NHS Foundation Trust, Milton
Keynes, United Kingdom
(Kardos) University of Buckingham, Buckingham, United Kingdom
(Felmeden) Torbay and South Devon NHS Foundation Trust, Torquay, United
Kingdom
Publisher
BMJ Publishing Group
Abstract
Objectives To establish if the use of early computed tomography (CT)
coronary angiography improves one year clinical outcomes in patients
presenting to the emergency department with acute chest pain and at
intermediate risk of acute coronary syndrome and subsequent clinical
events. Design Randomised controlled trial. Setting 37 hospitals in the
UK. Participants Adults with suspected or a provisional diagnosis of acute
coronary syndrome and one or more of previous coronary heart disease,
raised levels of cardiac troponin, or abnormal electrocardiogram.
Interventions Early CT coronary angiography and standard of care compared
with standard of care only. Main outcome measures Primary endpoint was all
cause death or subsequent type 1 or 4b myocardial infarction at one year.
Results Between 23 March 2015 and 27 June 2019, 1748 participants (mean
age 62 years (standard deviation 13), 64% men, mean global registry of
acute coronary events (GRACE) score 115 (standard deviation 35)) were
randomised to receive early CT coronary angiography (n=877) or standard of
care only (n=871). Median time from randomisation to CT coronary
angiography was 4.2 (interquartile range 1.6-21.6) hours. The primary
endpoint occurred in 51 (5.8%) participants randomised to CT coronary
angiography and 53 (6.1%) participants who received standard of care only
(adjusted hazard ratio 0.91 (95% confidence interval 0.62 to 1.35),
P=0.65). Invasive coronary angiography was performed in 474 (54.0%)
participants randomised to CT coronary angiography and 530 (60.8%)
participants who received standard of care only (adjusted hazard ratio
0.81 (0.72 to 0.92), P=0.001). There were no overall differences in
coronary revascularisation, use of drug treatment for acute coronary
syndrome, or subsequent preventive treatments between the two groups.
Early CT coronary angiography was associated with a slightly longer time
in hospital (median increase 0.21 (95% confidence interval 0.05 to 0.40)
days from a median hospital stay of 2.0 to 2.2 days). Conclusions In
intermediate risk patients with acute chest pain and suspected acute
coronary syndrome, early CT coronary angiography did not alter overall
coronary therapeutic interventions or one year clinical outcomes, but
reduced rates of invasive angiography while modestly increasing length of
hospital stay. These findings do not support the routine use of early CT
coronary angiography in intermediate risk patients with acute chest pain
and suspected acute coronary syndrome. Trial registration ISRCTN19102565,
NCT02284191.<br/>Copyright &#xa9;

<16>
Accession Number
634735973
Title
The effect of lavender aromatherapy on sleep quality and physiological
indicators in patients after cabg surgery: A clinical trial study.
Source
Indian Journal of Critical Care Medicine. 25(4) (pp 429-434), 2021. Date
of Publication: April 2021.
Author
Davari H.; Ebrahimian A.; Rezayei S.; Tourdeh M.
Institution
(Davari) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Ebrahimian) Department of Medical Emergencies, School of Medicine, Qom
University of Medical Sciences, Qom, Iran, Islamic Republic of
(Ebrahimian) Nursing Care Research Center, Semnan University of Medical
Sciences, Semnan, Iran, Islamic Republic of
(Rezayei) Student Research Committee, Nursing School, Semnan University of
Medical Sciences, Semnan, Iran, Islamic Republic of
(Tourdeh) Department of Anaesthesia, Paramedic School, Qom University of
Medical Sciences, Qom, Iran, Islamic Republic of
Publisher
Jaypee Brothers Medical Publishers (P) Ltd
Abstract
Background: Sleep disorders occur in the first days after heart surgery.
One of the major causes of sleep disorders after coronary artery bypass
graft (CABG) is subsequent changes in physiological indicators, such as
systolic blood pressure (BP), respiratory rate (RR), saturation of oxygen
(O2), and heart rate (RR). This study is aimed to determine the effect of
lavender aromatherapy on patients' sleep quality and physiological
indicators after CABG. <br/>Patients and Methods: This study was a
randomized clinical trial. Patients after CABG surgery were randomly
allocated into the lavender and distilled water groups. Patients in the
intervention group inhaled lavender while those in the control group
inhaled distilled water for 10 hours. Sleep quality and physiological
postoperative data were collected for 3 days. Data were analyzed using
repeated measurement test, sample t-test, and chi-square test.
<br/>Result(s): Repeated measurement test showed no significant difference
between the lavender and distilled water groups in terms of systolic BP,
RR, O2 saturation, HR, and body temperature after matching the effect of
time and its interactive effect with the intervention (p > 0.05). This
test revealed a significant difference between the lavender and distilled
water groups in terms of sleep quality (p < 0.001), such that the sleep
quality was higher in the lavender group. <br/>Conclusion(s): Lavender
aromatherapy can increase patients' sleep quality after CABG surgery.
However, it cannot completely treat sleep disorders in such patients.
Furthermore, aromatherapy with lavender does not affect the physiological
parameters, such as HR, BP, RR, and O2 saturation.<br/>Copyright &#xa9;
Jaypee Brothers Medical Publishers.

<17>
Accession Number
2014128994
Title
Automated Fastener vs Hand-tied Knots in Heart Valve Surgery: A Systematic
Review and Meta-analysis.
Source
Annals of Thoracic Surgery. 112(3) (pp 970-980), 2021. Date of
Publication: September 2021.
Author
Sazzad F.; Ler A.; Kuzemczak M.; Ng S.; Choong A.M.T.L.; Kofidis T.
Institution
(Sazzad, Ler, Choong, Kofidis) Department of Cardiac, Thoracic, and
Vascular Surgery, National University Heart Centre, Singapore
(Sazzad, Choong, Kofidis) Department of Surgery, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore
(Sazzad, Ng, Choong, Kofidis) Cardiovascular Research Institute, National
University of Singapore, Singapore
(Ler) School of Medicine, National University of Ireland, Galway, Ireland
(Kuzemczak) Division of Emergency Medicine, Department of Medical Rescue,
Poznan University of Medical Sciences, Poznan, Poland
(Kuzemczak) Peter Munk Cardiac Centre, Division of Cardiology, Toronto
General Hospital, University Health Network, Toronto, Canada
Publisher
Elsevier Inc.
Abstract
Background: Although several studies revealed that the Cor-knot automated
fastener (LSI Solutions, Victor, NY) reduces aortic cross-clamp and
cardiopulmonary bypass times, the influence of the device on postoperative
morbidity and mortality still needs to be evaluated. The aim of this study
was to verify the hypothesis that the use of the Cor-knot device for heart
valve surgery reduces aortic cross-clamp and cardiopulmonary bypass times,
and this time saving translates into reduced morbidity and mortality.
<br/>Method(s): Retrospective cohort studies and randomized controlled
trials reporting on the use of the automated fastener vs hand-tied knots
were reviewed. The following end points were compared: aortic cross-clamp
and cardiopulmonary bypass times, postoperative valvular regurgitation,
postoperative ejection fraction, prolonged ventilator support, renal
failure, and mortality. <br/>Result(s): Eight studies reporting data on
942 patients were included in the final analysis. The Cor-knot device was
associated with shorter cardiopulmonary bypass (mean difference [MD],
-11.74; 95% confidence interval [CI], -14.54 to -8.93; P < .00001) and
aortic cross-clamp times (MD, -14.36; 95% CI, -19.63 to -9.09; P < .00001)
in minimally invasive heart valve procedures. Overall, lower rates of
postoperative valvular regurgitation (risk ratio [RR], 0.40; 95% CI, 0.26
to 0.62; P < .0001) and prolonged ventilator support (RR, 0.29; 95% CI,
0.13 to 0.65; P = .003) were observed. No difference was observed in
postoperative atrial fibrillation, ejection fraction, renal failure, and
mortality. <br/>Conclusion(s): The use of the Cor-knot device in heart
valve surgery reduced aortic cross-clamp and cardiopulmonary bypass times.
Furthermore, as compared with hand-tie methods, the automated fastener may
lead to decreased rates of prolonged ventilator support and valvular
regurgitation while being noninferior in terms of other postoperative
outcomes and mortality.<br/>Copyright &#xa9; 2021 The Society of Thoracic
Surgeons

<18>
Accession Number
2013803805
Title
Dietary recommendations of magnesium for cardiovascular prevention and
treatment. A position paper of the israel heart society and the israel
dietetic association.
Source
Magnesium Research. 34(2) (pp 35-42), 2021. Date of Publication:
April-June 2021.
Author
Shechter M.; Eilat-Adar S.
Institution
(Shechter) The Leviev Cardiothoracic & Vascular Center, Chaim Sheba
Medical Center, Tel Hashomer, Ramat Gan, Israel
(Shechter) Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Israel
(Eilat-Adar) The Academic College at Wingate, Wingate Institute, Netanya,
Israel
Publisher
John Libbey
Abstract
Modern life and the Western industrial diet has enhanced the reduction of
magnesium in our food, which may contribute to a marginal or absolute
magnesium deficiency. Magnesium deficiency is evident in, among others,
the elderly population, those after myocardial infarction and/or chronic
heart failure, and diabetics. In Israel, over 60% of the drinking water
originates from desalinated seawater lacking magnesium, which may cause
hypomagne-semia. Magnesium deficiency can easily be treated by magnesium
supplemen-tation if we are aware of the situation. This paper summarizes
the magnesium chapter in a position paper published in April 2021 by the
Israeli Cardiology Society together with the Israeli Dietetic Association.
It summarizes evidence-based nutritional recommendations for prevention
and treatment of cardiovascular disease, with emphasis on the level of
evidence and practical recommendations according to the European Society
of Cardiology definitions. The best recommendation is to increase
consumption of magnesium-rich food, such as leafy green vegetables (mainly
spinach), nuts, avocado, whole grains, legumes (e.g., beans, peas and soy
beans), chocolate and certain seafood. However, for people who do not get
sufficient magnesium from their diet completing the daily amount, as
needed, with supplements of up to 600 mg/day should be considered. In
addition, serum magnesium levels should be checked at least every six
months in patients with heart failure, people taking diuretic therapy, and
people taking proton-pump inhibitors. In addition, it may be beneficial to
add magnesium following myocardial infarction in people with hypertension
and in heart failure patients in order to reduce cardiovascular morbidity
and mortality (class of recommendation IIa, level of evidence
B).<br/>Copyright &#xa9; 2021, John Libbey. All rights reserved.

<19>
Accession Number
2013508889
Title
Effects of different feeding intervals on the feeding outcomes of infants
who underwent surgical repair of ventricular septal defects.
Source
Journal of Cardiac Surgery. 36(11) (pp 4134-4138), 2021. Date of
Publication: November 2021.
Author
Liu J.-F.; Xie W.-P.; Lei Y.-Q.; Cao H.; Yu X.-R.; Chen Q.
Institution
(Liu, Xie, Lei, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Branch of Shanghai Children's Medical Center, Fuzhou, China
(Liu, Xie, Lei, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Children's Hospital, Fuzhou, China
(Liu, Xie, Lei, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Liu, Xie, Lei, 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: The objective of the present study is to explore the effect of
different feeding intervals on the feeding outcomes of infants who
underwent ventricular septal defect (VSD) closure. <br/>Method(s): This
study is a prospective, randomized controlled trial conducted by a
provincial hospital in China. According to different feeding intervals, 78
eligible participants were randomly divided into Group A (2-h interval, n
= 39) and Group B (3-h interval, n = 39). The basic clinical data, total
feeding time, incidence of feeding intolerance, and nurse job satisfaction
scores of the two groups were collected. <br/>Result(s): The total feeding
time in Group A was significantly longer than that in Group B (142.5 +/-
15.4 vs. 132.0 +/- 16.1 min/d, p =.020). The nurse job satisfaction scores
in Group A were significantly lower than those in Group B (101.7 +/- 9.8
vs. 108.8 +/- 10.1, p =.005). There were no significant differences in the
duration of mechanical ventilation (3.7 +/- 1.1 vs. 3.9 +/- 1.0 d, p
=.272), length of ICU stay (4.5 +/- 1.1 d vs. 4.7 +/- 0.9 d, p =.451), or
length of hospital stay (13.2 +/- 1.4 vs. 13.3 +/- 1.0 d, p =.642) between
the two groups. Although the incidence of feeding intolerance in Group A
was slightly lower than that in Group B, the difference was not
statistically significant. <br/>Conclusion(s): Feeding at an interval of 2
or 3 h has no significant effect on the feeding outcomes of infants, and
feeding at intervals of 3 h can reduce nurses' workload and improve
nursing job satisfaction.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<20>
Accession Number
2012752707
Title
Left Internal Mammary Artery Skeletonization Reduces Bleeding-A Randomized
Controlled Trial.
Source
Annals of Thoracic Surgery. 112(3) (pp 794-801), 2021. Date of
Publication: September 2021.
Author
Mazur P.; Litwinowicz R.; Tchantchaleishvili V.; Natorska J.; Zabczyk M.;
Bochenek M.; Przybylski R.; Iwaniec T.; Kedziora A.; Filip G.; Kapelak B.
Institution
(Mazur, Litwinowicz, Kedziora, Filip, Kapelak) Department of
Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow,
Poland
(Mazur, Natorska, Zabczyk, Kapelak) Institute of Cardiology, Jagiellonian
University Medical College, Krakow, Poland
(Tchantchaleishvili) Division of Cardiac Surgery, Department of Surgery,
Thomas Jefferson University, Philadelphia, PA, United States
(Bochenek, Przybylski) Department of Heart Transplantation and Mechanical
Circulatory Support, Wroclaw Medical University, Wroclaw, Poland
(Iwaniec) Department of Hematology, Jagiellonian University Medical
College, Poland
Publisher
Elsevier Inc.
Abstract
Background: The objective of this study was to compare the impact of
skeletonized versus pedicled left internal mammary artery (LIMA)
harvesting on bleeding after coronary artery bypass grafting (CABG).
<br/>Method(s): In a randomized, single-blinded trial with a parallel
group design and equal allocation, we randomly assigned 62 patients
undergoing primary elective CABG in a tertiary cardiac center to
skeletonized or pedicled LIMA dissection. Before surgery, all aspects of
coagulation were assessed. Patients were blinded to LIMA dissection
technique and monitored for cumulative drainage at 12 hours (primary
outcome) as well as myocardial necrosis markers. <br/>Result(s): With
recruitment complete, there were 31 patients in each group; all patients
were analyzed. Median postoperative drainage was 395 mL at 12 hours in all
patients; it was lower by 28% at 12 hours (P = .02) in patients with
skeletonized LIMA (Cohen's d, 0.6; 95% confidence interval (CI),
0.09-1.11). Patients with a LIMA pedicle received more fresh-frozen plasma
transfusions than did the skeletonized LIMA group (Median 3; interquartile
range 3-5 versus median 3; interquartile range 3-3; P = .03). Study arms
did not differ in blood coagulation. Left internal mammary artery
skeletonization (odds ratio = 0.04; 95% CI, 0.003-0.44; P = .009) and
higher body mass index (odds ratio = 0.63; 95% CI, 0.45-0.89; P = .008)
decreased the odds of being in the top drainage quartile at 12 hours
(>=550 mL). Creatine kinase was lower in skeletonized LIMA directly after
surgery (median 218 U/L; interquartile range 175-310 U/L versus median 424
U/L; interquartile range 256-510 U/L; P < .001), at 6 hours (median 324
U/L; interquartile range 239-424 U/L versus median 529 U/L; interquartile
range 374-707 U/L; P < .001), and 12 hours after surgery (median 351 U/L;
interquartile range 277-552 U/L versus median 695 U/L; interquartile range
509-1067 U/L; P < .001). <br/>Conclusion(s): Left internal mammary artery
skeletonization results in lower mediastinal drainage after CABG than
pedicled LIMA harvesting.<br/>Copyright &#xa9; 2021 The Society of
Thoracic Surgeons

<21>
Accession Number
2011117182
Title
Sustained physical activity in peripheral artery disease: Associations
with disease severity, functional performance, health-related quality of
life, and subsequent serious adverse events in the LITE randomized
clinical trial.
Source
Vascular Medicine (United Kingdom). 26(5) (pp 497-506), 2021. Date of
Publication: October 2021.
Author
Slysz J.T.; Rejeski W.J.; Treat-Jacobson D.; Bazzano L.A.; Forman D.E.;
Manini T.M.; Criqui M.H.; Tian L.; Zhao L.; Zhang D.; Guralnik J.M.;
Ferrucci L.; Kibbe M.R.; Polonsky T.S.; Spring B.; Sufit R.; Leeuwenburgh
C.; McDermott M.M.
Institution
(Slysz, Zhao, Zhang, Spring, Sufit, McDermott) Feinberg School of
Medicine, Northwestern University, Chicago, IL, United States
(Rejeski) Department of Health and Exercise Science and Geriatric
Medicine, Wake Forest University, Winston Salem, NC, United States
(Treat-Jacobson) School of Nursing, University of Minnesota, Minneapolis,
MN, United States
(Bazzano) School of Public Health and Tropical Medicine, Tulane
University, New Orleans, LA, United States
(Forman) School of Medicine, University of Pittsburgh, Pittsburg, PA,
United States
(Manini, Leeuwenburgh) Department of Aging and Geriatric Research,
University of Florida, Gainesville, FL, United States
(Criqui) Department of Family Medicine and Public Health, University of
California at San Diego, San Diego, CA, United States
(Tian) Department of Biomedical Data Science, Stanford University, Palo
Alto, CA, United States
(Guralnik) Department of Epidemiology, University of Maryland, Baltimore,
MD, United States
(Ferrucci) National Institute of Aging, The Intramural Research Program,
Baltimore, MD, United States
(Kibbe) Department of Surgery, University of North Carolina, Chapel Hill,
NC, United States
(Polonsky) Department of Medicine, University of Chicago, Chicago, IL,
United States
Publisher
SAGE Publications Ltd
Abstract
This study investigated cross-sectional associations of peripheral artery
disease (PAD) severity (defined by the ankle-brachial index (ABI)) and
amounts of daily sustained physical activity (PA) (defined as > 100
activity counts per minute lasting 5 consecutive minutes or more). This
study also investigated associations of amounts of daily sustained PA with
6-minute walk (6MW) distance and the Short Form-36 physical functioning
domain (SF-36 PF) score in cross-sectional analyses and with serious
adverse events (SAEs) in longitudinal analyses of people with PAD. PA was
measured continuously for 10 days using a tri-axial accelerometer at
baseline in 277 participants with PAD randomized to the LITE clinical
trial. In regression analyses, each 0.15 lower ABI value was associated
with a 5.67% decrease in the number of daily bouts of sustained PA (95%
CI: 3.85-6.54; p < 0.001). Every additional bout of sustained PA per day
was associated with a 4.56-meter greater 6MW distance (95% CI: 2.67-6.46;
p < 0.0001), and a 0.81-point improvement in SF-36 PF score (95% CI:
0.34-1.28; p < 0.001). Participants with values of daily bouts of
sustained PA below the median had higher rates of SAEs during follow-up,
compared to participants above the median (41% vs 24%; p = 0.002). In
conclusion, among participants with PAD, lower ABI values were associated
with fewer bouts of daily sustained PA. A greater number of bouts of daily
sustained PA were associated with better 6MW performance and SF-36 PF
score, and, in longitudinal analyses, lower rates of SAEs.
Clinicaltrials.gov ID: NCT02538900.<br/>Copyright &#xa9; The Author(s)
2021.

<22>
Accession Number
2007028390
Title
Clinical implications of physical function and resilience in patients
undergoing transcatheter aortic valve replacement.
Source
Journal of the American Heart Association. 9(17) (no pagination), 2020.
Article Number: e017075. Date of Publication: 2020.
Author
Goel K.; O'leary J.M.; Barker C.M.; Levack M.; Rajagopal V.; Makkar R.R.;
Bajwa T.; Kleiman N.; Linke A.; Kereiakes D.J.; Waksman R.; Allocco D.J.;
Rizik D.G.; Reardon M.J.; Lindman B.R.
Institution
(Goel, O'leary, Barker, Levack, Lindman) Structural Heart and Valve
Center, Vanderbilt University Medical Center, Nashville, TN, United States
(Goel, O'leary, Barker, Levack, Lindman) Cardiovascular Medicine Division,
Vanderbilt University Medical Center, Nashville, TN, United States
(Levack) Cardiac Surgery Department, Vanderbilt University Medical Center,
Nashville, TN, United States
(Rajagopal) Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta,
GA, United States
(Makkar) Smidt Heart Institute, Cedars-Sinai Heart Institute, Los Angeles,
CA, United States
(Bajwa) Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's
Medical Centers, Milwaukee, WI, United States
(Kleiman, Reardon) Department of Cardiovascular Surgery, Houston Methodist
DeBakey Heart and Vascular Center, Houston, TX, United States
(Linke) Department of Internal Medicine and Cardiology, Heart Center
Dresden, Technical University of Dresden, Germany
(Kereiakes) The Christ Hospital Heart and Vascular Center, Lindner
Research Center, Cincinnati, OH, United States
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Allocco) Clinical Sciences, Boston Scientific Corp, Marlborough, MA,
United States
(Rizik) HonorHealth and the Scottsdale-Lincoln Health Network, Scottsdale,
AZ, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Gait speed is a reliable measure of physical function and
frailty in patients with aortic stenosis undergoing transcatheter aortic
valve replacement (TAVR). Slow gait speed pre-TAVR predicts worse clinical
outcomes post-TAVR. The consequences of improved versus worsened physical
function post-TAVR are unknown. METHODS AND RESULTS: The REPRISE III
(Repositionable Percutaneous Replacement of Stenotic Aortic Valve Through
Implantation of Lotus Valve System-Randomized Clinical Evaluation) trial
randomized high/extreme risk patients to receive a mechanically-expanded
or self-expanding transcatheter heart valve. Of 874 patients who underwent
TAVR, 576 with complete data at baseline and 1 year were included in this
analysis. Slow gait speed in the 5-m walk test was defined as <0.83 m/s. A
clinically meaningful improvement (>=0.1 m/s) in gait speed 1 year after
TAVR occurred in 39% of patients, 35% exhibited no change, and 26%
declined (>=0.1 m/s). Among groups defined by baseline/1-year post-TAVR
gait speeds, 1-to 2-year mortality or hospitalization rates were as
follows: 6.6% (normal/normal), 8.0% (slow/normal), 20.9% (normal/slow),
and 21.5% (slow/ slow). After adjustment, slow gait speed at 1 year
(regardless of baseline speed) was associated with a 3.5-fold increase in
death/hospitalization between 1 and 2 years compared with those with
normal baseline/1-year gait speed. Patients whose slow gait speed
normalized at 1 year had no increased risk. One-year, but not baseline,
gait speed was associated with death or hospitalization between 1 and 2
years (adjusted hazard ratio, 0.83 per 0.1 m/s faster gait; 95% CI,
0.74-0.93, P=0.001). <br/>CONCLUSION(S): Marked heterogeneity exists in
the trajectory of physical function after TAVR and this, more than
baseline function, has clinical consequences. Identifying and optimizing
factors associated with physical resilience after TAVR may improve
outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT02202434.<br/>Copyright &#xa9; 2020 The Authors.

<23>
Accession Number
2007018276
Title
Prognostic assessment of right ventricular systolic dysfunction on
post-transcatheter aortic valve replacement short-term outcomes:
Systematic review and meta-analysis.
Source
Journal of the American Heart Association. 9(12) (no pagination), 2020.
Article Number: e014463. Date of Publication: 16 Jun 2020.
Author
Grevious S.N.; Fernandes M.F.; Annor A.K.; Ibrahim M.; Saint Croix G.R.;
de Marchena E.; Cohen M.G.; Alfonso C.E.
Institution
(Grevious, Ibrahim) Cardiovascular Division, Department of Medicine,
Boston University School of Medicine, Boston, MA, United States
(Fernandes) Cardiovascular Division, Department of Medicine, Emory
University School of Medicine, Atlanta, GA, United States
(Annor) Department of Medicine, Baylor College of Medicine, Houston, TX,
United States
(Saint Croix, de Marchena, Cohen, Alfonso) Department of Medicine,
University of Miami Miller School of Medicine, Miami, FL, United States
(de Marchena, Cohen, Alfonso) Cardiovascular Division, Department of
Medicine, University of Miami Miller School of Medicine, Miami, FL, United
States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Right ventricular systolic dysfunction (RVSD) is a known risk
factor for adverse outcome in surgical aortic valve replacement.
Transcatheter aortic valve replacement (TAVR), on the other hand, has been
shown to be either beneficial or have no effect on right ventricular
systolic function. However, the prognostic significance of RVSD on TAVR
has not been clearly determined. We conducted a systematic review and
meta-analysis to define the impact of RVSD on outcomes in terms of 1-year
mortality in patients with severe aortic stenosis undergoing TAVR. METHODS
AND RESULTS: An extensive literature review was performed, with an aim to
identify clinical studies that focused on the prognosis and short-term
mortality of patients with severe symptomatic aortic stenosis who
underwent TAVR. A total of 3166 patients from 8 selected studies were
included. RVSD, as assessed with tricuspid annular plane systolic
excursion, fractional area change or ejection fraction, was found to be a
predictor of adverse procedural outcome after TAVR (hazard ratio, 1.31;
95% CI, 1.1-1.55; P=0.002). Overall, we found that RVSD did affect
post-TAVR prognosis in 1-year mortality rate. <br/>CONCLUSION(S): Patients
with severe, symptomatic aortic stenosis and concomitant severe RVSD have
a poor 1-year post-TAVR prognosis when compared with patients without
RVSD. Right ventricular dilation and severe tricuspid regurgitation were
associated with increased 1-year morality post-TAVR and should be
considered as independent risk factors. Further evaluations of long-term
morbidity, mortality, as well as sustained improvement in functional class
and symptoms need to be conducted to determine the long-term
effects.<br/>Copyright &#xa9; 2020, American Heart Association Inc.. All
rights reserved.

<24>
Accession Number
2013746396
Title
In-hospital outcomes of self-expanding and balloon-expandable
transcatheter heart valves in Germany.
Source
Clinical Research in Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Stachon P.; Hehn P.; Wolf D.; Heidt T.; Oettinger V.; Zehender M.; Bode
C.; von zur Muhlen C.; Kaier K.
Institution
(Stachon, Wolf, Heidt, Oettinger, Zehender, Bode, von zur Muhlen)
Department of Cardiology and Angiology I, Faculty of Medicine and Medical
Center, University of Freiburg, Freiburg, Germany
(Stachon, Oettinger, Zehender, von zur Muhlen, Kaier) Center of Big Data
Analysis in Cardiology (CeBAC), Heart Center Freiburg University,
Freiburg, Germany
(Hehn, Kaier) Institute of Medical Biometry and Statistics, Faculty of
Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26,
Freiburg 79104, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Introduction: The effect of valve type on outcomes in transfemoral
transcatheter aortic valve replacement (TF-TAVR) has recently been subject
of debate. We investigate outcomes of patients treated with
balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of
all these procedures performed in Germany in 2018. <br/>Method(s): All
patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413)
valves in Germany in 2018 were identified. In-hospital outcomes were
analyzed for the endpoints in-hospital mortality, major bleeding, stroke,
acute kidney injury, postoperative delirium, permanent pacemaker
implantation, mechanical ventilation > 48 h, length of hospital stay, and
reimbursement. Since patients were not randomized to the two treatment
options, logistic or linear regression models were used with 22 baseline
patient characteristics and center-specific variables as potential
confounders. As a sensitivity analysis, the same confounding factors were
taken into account using the propensity score methods (inverse probability
of treatment weighting). <br/>Result(s): Baseline characteristics differed
substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate
of female sex (p < 0.001) in SE treated patients. After risk adjustment,
no marked differences in outcomes were found for in-hospital mortality
[risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI
0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400],
stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97
(0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p =
0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893],
length of hospital stay (risk adjusted difference in days of
hospitalization (SE instead of BE): - 0.05 [- 0.34;0.25], p = 0.762) and
reimbursement [risk adjusted difference in reimbursement (SE instead of
BE): - 72 (- 291;147), p = 0.519)] There is, however, an increased risk of
PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were
found after application of propensity score adjustment.
<br/>Conclusion(s): We find broadly equivalent outcomes in contemporary
TF-TAVR procedures, regardless of the valve type used. Incidence of major
complications is very low for both types of valve.<br/>Copyright &#xa9;
2021, The Author(s).

<25>
[Use Link to view the full text]
Accession Number
636136928
Title
Patient satisfaction with deep versus light/moderate sedation for
non-surgical procedures: A systematic review and meta-analysis.
Source
Medicine. 100(36) (pp e27176), 2021. Date of Publication: 10 Sep 2021.
Author
Hoshijima H.; Higuchi H.; Sato Boku A.; Shibuya M.; Morimoto Y.; Fujisawa
T.; Mizuta K.
Institution
(Hoshijima, Mizuta) Division of Dento-oral Anesthesiology, Tohoku
University Graduate School of Dentistry, Seiryomachi 1-1 ,Aoba-ku, Sendai,
Japan
(Hoshijima) Department of Anesthesiology, Saitama Medical University
Hospital, Saitama, Japan
(Higuchi) Department of Dental Anesthesiology, Okayama University
Hospital, Okayama, Japan
(Sato Boku) Department of Anesthesiology, Aichi Gakuin University School
of Dentistry, 2-11 Suemori-dori ,Chikusa-ku, Nagoya, Aichi, Japan
(Shibuya, Fujisawa) Dental Anesthesiology, Department of Oral
Pathobiological Science, Faculty of Dental Medicine and Graduate School of
Dental Medicine, Hokkaido University, Kita-13, Nishi-7, Kita-ku, Sapporo,
Japan
(Morimoto) Department of Critical Care Medicine and Dentistry, Graduate
School of Dentistry, Kanagawa Dental University, 82, Yokosuka, Kanagawa,
Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Deep sedation relieves a patient's anxiety and stress during
the procedure by inducing patient unconsciousness. However, it remains
unclear whether deep sedation actually improves patient satisfaction with
the procedure. Therefore, we performed a systematic review and
meta-analysis to compare the satisfaction of patients undergoing deep
sedation with that of those undergoing light/moderate sedation during
non-surgical procedures. <br/>METHOD(S): A comprehensive literature search
was performed using electronic databases (search until September 2020).
The primary outcome was whether patient satisfaction was higher after deep
sedation or light/moderate sedation. The secondary outcome was the
relative safety of deep sedation compared with light/moderate sedation in
terms of oxygen saturation, systolic blood pressure, and heart rate. The
tertiary outcomes were the relative procedure and recovery times for deep
versus light/moderate sedation.Data from each of the trials were combined,
and calculations were made using DerSimonian and Laird random effects
models. The pooled effect estimates for patient satisfaction were
evaluated using relative risk (RR) with the 95% confidence interval (CI).
The pooled effect estimates for continuous data are expressed as weighted
mean difference with the 95% CI. We assessed heterogeneity with the
Cochrane Q statistic and the I2 statistic. The risk of bias assessment and
Grading of Recommendations Assessment, Development and Evaluation approach
were used as the quality assessment method. <br/>RESULT(S): After removing
unrelated studies and applying the exclusion criterion, 5 articles
satisfied the inclusion criteria. Patient satisfaction was significantly
higher in those who received deep sedation compared with light/moderate
sedation (relative risk = 1.12; 95% CI, 1.04-1.20; P = .003; Cochrane Q =
25.0; I2 = 76%).There was no significant difference in oxygen saturation,
systolic blood pressure, heart rate, and procedure times according to
whether the procedures were performed under deep or light/moderate
sedation. However, the recovery time was significantly prolonged in
patients under deep sedation. <br/>CONCLUSION(S): Our meta-analysis
suggests that deep sedation resulted in improved patient satisfaction
compared with light/moderate sedation. Deep sedation is recommended for
patients undergoing procedures because it improves patient satisfaction.
However, respiration and circulation should be carefully monitored both
intra-operatively and postoperatively.<br/>Copyright &#xa9; 2021 the
Author(s). Published by Wolters Kluwer Health, Inc.

<26>
[Use Link to view the full text]
Accession Number
636135659
Title
Increased FIO2 influences SvO2 interpretation and accuracy of Fick-based
cardiac output assessment in cardiac surgery patients: A prospective
randomized study.
Source
Medicine. 100(36) (pp e27020), 2021. Date of Publication: 10 Sep 2021.
Author
Lin S.-Y.; Chang F.-C.; Lin J.-R.; Chou A.-H.; Tsai Y.-F.; Liao C.-C.;
Tsai H.-I.; Chen C.-Y.
Institution
(Lin, Chang, Chou, Tsai, Liao, Tsai, Chen) Department of Anesthesiology,
Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
(Republic of China)
(Lin) College of Medicine, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Chang) College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
(Republic of China)
(Lin) Clinical Informatics and Medical Statistics Research Center and
Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan,
Taiwan (Republic of China)
(Lin) Biostatistics, National Taiwan University, Taipei, Taiwan (Republic
of China)
(Chou, Tsai, Liao, Tsai, Chen) College of Medicine, Chang Gung University,
Taoyuan, Taiwan (Republic of China)
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The study aimed to reveal how the fraction of inspired
oxygen (FIO2) affected the value of mixed venous oxygen saturation (SvO2)
and the accuracy of Fick-equation-based cardiac output (Fick-CO).
<br/>METHOD(S): Forty two adult patients who underwent elective cardiac
surgery were enrolled and randomly divided into 2 groups: FIO2 < 0.7 or
>0.85. Under stable general anesthesia, thermodilution-derived cardiac
output (TD-CO), SvO2, venous partial pressure of oxygen, hemoglobin,
arterial oxygen saturation, arterial partial pressure of oxygen, and blood
pH levels were recorded before surgical incision. <br/>RESULT(S):
Significant differences in FIO2 values were observed between the 2 groups
(0.56 +/- 0.08 in the <70% group and 0.92 +/- 0.03 in the >0.85 group; P <
.001). The increasing FIO2 values lead to increases in SvO2, venous
partial pressure of oxygen, and arterial partial pressure of oxygen, with
little effects on cardiac output and hemoglobin levels. When comparing to
TD-CO, the calculated Fick-CO in both groups had moderate Pearson
correlations and similar linear regression results. Although the FIO2 <0.7
group presented a less mean bias and a smaller limits of agreement,
neither group met the percentage error criteria of <30% in Bland-Altman
analysis. <br/>CONCLUSION(S): Increased FIO2 may influence the
interpretation of SvO2 and the exacerbation of Fick-CO estimation, which
could affect clinical management. TRIAL REGISTRATION: ClinicalTrials.gov
ID number: NCT04265924, retrospectively registered (Date of registration:
February 9, 2020).<br/>Copyright &#xa9; 2021 the Author(s). Published by
Wolters Kluwer Health, Inc.

<27>
Accession Number
2015024460
Title
Extracorporeal life support in adult patients with out-of-hospital cardiac
arrest.
Source
Singapore Medical Journal. 62(8) (pp 433-437), 2021. Date of Publication:
August 2021.
Author
Lim J.H.; Chakaramakkil M.J.; Tan B.K.K.
Institution
(Lim, Tan) Department of Emergency Medicine, Singapore General Hospital,
Singapore
(Chakaramakkil) Department of Cardiothoracic Surgery, National Heart
Centre, Singapore
Publisher
Singapore Medical Association
Abstract
The use of extracorporeal life support in cardiopulmonary resuscitation
(CPR) of adult patients experiencing out-of-hospital cardiac arrest by the
application of veno-arterial extracorporeal membrane oxygenation (ECMO)
during cardiac arrest has been increasing over the past decade. This can
be attributed to the encouraging results of extracorporeal CPR (ECPR) in
multiple observational studies. To date, only one randomised controlled
trial has compared ECPR to conventional advanced life support measures.
Patient selection is crucial for the success of ECPR programmes. A rapid
and organised approach is required for resuscitation, i.e. cannula
insertion with ECMO pump initiation in combination with other aspects of
post-cardiac arrest care such as targeted temperature management and early
coronary reperfusion. The provision of an ECPR service can be costly,
resource intensive and technically challenging, as limited studies have
reported on its cost-effectiveness.<br/>Copyright &#xa9; 2021 Singapore
Medical Association. All rights reserved.

<28>
[Use Link to view the full text]
Accession Number
2015008804
Title
Reliable and valid assessment of procedural skills in resuscitative
endovascular balloon occlusion of the aorta.
Source
Journal of Trauma and Acute Care Surgery. 91(4) (pp 663-671), 2021. Date
of Publication: 01 Oct 2021.
Author
Engberg M.; Lonn L.; Konge L.; Mikkelsen S.; Horer T.; Lindgren H.; Sovik
E.; Svendsen M.B.; Frendo M.; Taudorf M.; Russell L.
Institution
(Engberg, Konge, Svendsen, Frendo, Russell) Copenhagen Academy for Medical
Education and Simulation (CAMES), Centre for Human Resources and
Education, Capital Region of Denmark, Kobenhavn, Denmark
(Engberg, Lonn, Konge, Taudorf) Department of Clinical Medicine, Faculty
of Health and Medical Sciences, University of Copenhagen, Denmark
(Lonn, Taudorf) Department of Radiology, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Mikkelsen) Mobile Emergency Care Unit, Department of Anaesthesiology and
Intensive Care, Region of Southern Denmark, Odense University Hospital,
Denmark
(Mikkelsen) Prehospital Research Unit, Region of Southern Denmark, Odense
University Hospital, Denmark
(Mikkelsen) Department of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Horer) Department of Cardiothoracic and Vascular Surgery, Department of
Surgery Faculty of Life Science, Orebro University Hospital, Orebro,
Sweden
(Lindgren) Department of Clinical Sciences, Faculty of Medicine, Lund
University, Lund, Sweden
(Lindgren) Section of Interventional Radiology, Department of Surgery,
Helsingborg Hospital, Helsingborg, Sweden
(Sovik) Department of Radiology and Nuclear Medicine, St. Olavs University
Hospital, Trondheim, Norway
(Frendo) Department of Otorhinolaryngology Head & Neck Surgery and
Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
Denmark
(Russell) Department of Intensive Care, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND Valid and reliable assessment of skills is essential for
improved and evidence-based training concepts. In a recent study, we
presented a novel tool to assess procedural skills in resuscitative
endovascular balloon occlusion of the aorta (REBOA), REBOA-RATE, based on
international expert consensus. Although expert consensus is a strong
foundation, the performance of REBOA-RATE has not been explored. The study
aimed to examine the reliability and validity of REBOA-RATE. METHODS This
was an experimental simulation-based study. We enrolled doctors with three
levels of expertise to perform two REBOA procedures in a simulated
scenario of out-of-hospital cardiac arrest. Procedures were
video-recorded, and videos were blinded and randomized. Three clinical
experts independently rated all procedures using REBOA-RATE. Data were
analyzed using Messick's framework for validity evidence, including
generalizability analysis of reliability and determination of a pass/fail
standard. RESULTS Forty-two doctors were enrolled: 16 novices, 13
anesthesiologists, and 13 endovascular experts. They all performed two
procedures, yielding 84 procedures and 252 ratings. The REBOA-RATE
assessment tool showed high internal consistency (Cronbach's alpha = 0.95)
and excellent interrater reliability (intraclass correlation coefficient,
0.97). Assessment using one rater and three procedures could ensure
overall reliability suitable for high-stakes testing (G-coefficient
>0.80). Mean scores (SD) for the three groups in the second procedure were
as follows: novices, 32% (24%); anesthesiologists, 55% (29%); endovascular
experts, 93% (4%) (p < 0.001). The pass/fail standard was set at 81%,
which all experts but no novices passed. CONCLUSION Data strongly support
the reliability and validity of REBOA-RATE, which successfully
discriminated between all experience levels. The REBOA-RATE assessment
tool requires minimal instruction, and one rater is sufficient for
reliable assessment. Together, these are strong arguments for the use of
REBOA-RATE to assess REBOA skills, allowing for competency-based training
and certification concepts. <br/>Copyright &#xa9; 2021 Wolters Kluwer
Health, Inc. All rights reserved.

<29>
Accession Number
2013917788
Title
Effect of remimazolam induction on hemodynamics in patients undergoing
valve replacement surgery: A randomized, double-blind, controlled trial.
Source
Pharmacology Research and Perspectives. 9(5) (no pagination), 2021.
Article Number: e00851. Date of Publication: October 2021.
Author
Liu T.; Lai T.; Chen J.; Lu Y.; He F.; Chen Y.; Xie Y.
Institution
(Liu, Chen, Xie) Department of Anesthesiology, The First Affiliated
Hospital of Guangxi Medical University, Nanning, China
(Lai, Lu, He, Chen) Department of Anesthesiology, Cardiovascular
Institute, The First Affiliated Hospital of Guangxi Medical University,
Nanning, China
Publisher
John Wiley and Sons Inc
Abstract
Background: The stability of hemodynamics during anesthesia induction in
patients undergoing valve replacement surgery is particularly important.
Remimazolam is a new type of benzodiazepine drug, with supposed advantages
of rapid induction, rapid recovery, stable hemodynamics, and mild
respiratory inhibition. <br/>Aim(s): To evaluate the effect of remimazolam
anesthesia induction on hemodynamics in patients undergoing valve
replacement surgery. <br/>Method(s): This randomized, double-blind,
controlled trial enrolled consecutive patients undergoing mitral valve
replacement (MVR)/aortic valve replacement (AVR)/double-valve replacement
(DVR) surgery on cardiopulmonary bypass (CPB). The study was conducted
according to the Consolidated Standards of Reporting Trials statement.
Participants were randomly assigned to receive either remimazolam or
propofol induction of 30 patients each. All patients, data collectors, and
data analyzers were blinded to the group allocation. The primary outcomes
were the fluctuations in hemodynamic parameters (the difference of maximum
or minimum heart rate to baseline, HR, the difference of maximum or
minimum mean arterial pressure to baseline, MAP), the occurrence of
cardiovascular events (hypotension, severe bradycardia), and the
cumulative norepinephrine doses used per patient, averaged per group
during induction. The secondary outcomes were hemodynamic parameters
(heart rate, HR, mean arterial pressure, MAP, bispectral index, BIS,
plasma lactic acid, Lac, and blood glucose, Glu values). <br/>Result(s): A
total of 60 patients with heart valve replacement were included in the
final analysis, with 30 patients in each group. The MAP was significantly
lower in the remimazolam group than in the propofol group during induction
(p <.05). The incidences of hypotension and the cumulative norepinephrine
doses used per patient, averaged per group during induction were
significantly lower in the remimazolam group than in the propofol group (p
<.05). <br/>Conclusion(s): Remimazolam may be safe and effective for
induction and may as an alternative to propofol during anesthesia
induction in patients undergoing valve replacement surgery.<br/>Copyright
&#xa9; 2021 The Authors. Pharmacology Research & Perspectives published by
British Pharmacological Society and American Society for Pharmacology and
Experimental Therapeutics and John Wiley & Sons Ltd.

<30>
Accession Number
2013906511
Title
Do continuous forms of intra-operative ultrafiltration enhance recovery
after adult cardiac surgery with cardiopulmonary bypass? A protocol for
systematic review and meta-analysis of randomized controlled trials.
Source
Systematic Reviews. 10(1) (no pagination), 2021. Article Number: 265. Date
of Publication: December 2021.
Author
Bierer J.; Horne D.; Stanzel R.; Henderson M.; Boulos L.; Hayden J.
Institution
(Bierer, Horne) Division of Cardiac Surgery, Department of Surgery,
Dalhousie University, Halifax, Canada
(Stanzel, Henderson) Department of Clinical Perfusion, Nova Scotia Health
Authority, Halifax, Canada
(Boulos) Maritime SPOR SUPPORT Unit, Halifax, Canada
(Hayden) Department of Community Health & Epidemiology, Dalhousie
University, Halifax, Canada
Publisher
BioMed Central Ltd
Abstract
Background: Cardiac surgery with cardiopulmonary bypass (CPB) is
associated with a systemic inflammatory syndrome that adversely impacts
cardiopulmonary function and can contribute to prolonged postoperative
recovery. Intra-operative ultrafiltration during CPB is a strategy
developed by pediatric cardiac specialists, aiming to dampen the
inflammatory syndrome by removing circulating cytokines and improving
coagulation profiles during the cardiac operation. Although
ultrafiltration is commonly used in the pediatric population, it is not
routinely used in the adult population. This study aims to evaluate if
randomized evidence supports the use of continuous intra-operative
ultrafiltration to enhance recovery for adults undergoing cardiac surgery
with CPB. <br/>Method(s): This systematic review and meta-analysis will
include randomized controlled trials (RCT) that feature continuous forms
of ultrafiltration during adult cardiac surgery with CPB, specifically
assessing for benefit in mortality rates, invasive ventilation time and
intensive care unit length of stay (ICU LOS). Relevant RCTs will be
retrieved from databases, including MEDLINE, Embase, CENTRAL and Scopus,
by a pre-defined search strategy. Search results will be screened for
inclusion and exclusion criteria by two independent persons with
consensus. Selected RCTs will have study demographics and outcome data
extracted by two independent persons and transferred into RevMan. Risk of
bias will be independently assessed by the Revised Cochrane Risk-of-Bias
(RoB2) tool and studies rated as low-, some-, or high- risk of bias.
Meta-analyses will compare the intervention of continuous ultrafiltration
against comparators in terms of mortality, ventilation time, ICU LOS, and
renal failure. Heterogeneity will be measured by the chi² test
and described by the I² statistic. A sensitivity analysis will
be completed by excluding included studies judged to have a high risk of
bias. Summary of findings and certainty of the evidence, determined by the
GRADE approach, will display the analysis findings. <br/>Discussion(s):
The findings of this systematic review and meta-analysis will summarize
the evidence to date of continuous forms of ultrafiltration in adult
cardiac surgery with CPB, to both inform adult cardiac specialists about
this technique and identify critical questions for future research in this
subject area. Systematic review registration: This systematic review and
meta-analysis is registered in PROSPERO CRD42020219309
(https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219309)
.<br/>Copyright &#xa9; 2021, The Author(s).

<31>
Accession Number
2015005119
Title
Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus
Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac
Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Pengelly J.; Royse C.; Williams G.; Bryant A.; Clarke-Errey S.; Royse A.;
El-Ansary D.
Institution
(Pengelly, Royse, Royse, El-Ansary) Department of Nursing and Allied
Health, Swinburne University of Technology, Melbourne, Vic, Australia
(Pengelly) School of Science, Psychology and Sport, Federation University
Australia, Ballarat, Vic, Australia
(Royse, Royse, El-Ansary) Department of Surgery, University of Melbourne,
Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Outcomes Research Consortium Cleveland Clinic, Cleveland, OH,
United States
(Williams, Bryant) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
(Clarke-Errey) Statistical Consulting Centre, University of Melbourne,
Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(El-Ansary) Clinical Research Institute, Westmead Private Hospital,
Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Aims: To investigate the effects of a 12-week early moderate-intensity
resistance training program compared to aerobic-based rehabilitation on
postoperative cognitive recovery following cardiac surgery via median
sternotomy. <br/>Method(s): This was a multicentre, prospective,
pragmatic, non-blinded, pilot randomised controlled trial (1:1
randomisation) of two parallel groups that compared a 12-week early
moderate-intensity resistance training group to a control group, receiving
aerobic-based rehabilitation. English-speaking adults (>=18 years)
undergoing elective cardiac surgery via median sternotomy were randomised
using sealed envelopes, with allocation revealed before surgery. The
primary outcome was cognitive function, assessed using the Alzheimer's
Disease Assessment Scale-cognitive subscale (ADAS-cog), at baseline, 14
weeks and 6 months postoperatively. <br/>Result(s): The ADAS-cog score at
14 weeks was significantly better for the resistance training group (n=14,
7.2+/-1.4; 95% CI 4.3, 10.2, vs n=17, 9.2+/-1.3; 95% CI 6.6, 11.9,
p=0.010). At 14 weeks postoperatively, 53% of the aerobic-based
rehabilitation group (n=9/17) experienced cognitive decline by two points
or more from baseline ADAS-cog score, compared to 0% of the resistance
training group (n=0/14; p=0.001). <br/>Conclusion(s): Early resistance
training appears to be safe and may improve cognitive recovery compared to
standard, aerobic-based rehabilitation following cardiac surgery via
median sternotomy, however as this was a pilot study, the sample size was
small and further research is needed to determine a causal
relationship.<br/>Copyright &#xa9; 2021 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<32>
Accession Number
2013920817
Title
Estimating the optimal timing of surgery by imputing potential outcomes.
Source
Statistics in Medicine. (no pagination), 2021. Date of Publication: 2021.
Author
Chen X.; Heitjan D.F.; Greil G.; Jeon-Slaughter H.
Institution
(Chen, Heitjan) Department of Statistical Science, Southern Methodist
University, Dallas, TX, United States
(Chen, Heitjan) Department of Population & Data Sciences, UT Southwestern
Medical Center, Dallas, TX, United States
(Greil) Department of Pediatrics, UT Southwestern Medical Center, Dallas,
TX, United States
(Jeon-Slaughter) Department of Internal Medicine, UT Southwestern Medical
Center, Dallas, TX, United States
Publisher
John Wiley and Sons Ltd
Abstract
Hypoplastic left heart syndrome is a congenital anomaly that is uniformly
fatal in infancy without immediate treatment. The standard treatment
consists of an initial Norwood procedure (stage 1) followed some months
later by stage 2 palliation (S2P). The ideal timing of the S2P is
uncertain. The Single Ventricle Reconstruction Trial (SVRT) randomized the
procedure used in the initial Norwood operation, leaving the timing of the
S2P to the discretion of the surgical team. To estimate the causal effect
of the timing of S2P, we propose to impute the potential post-S2P survival
outcomes using statistical models under the Rubin Causal Model framework.
With this approach, it is straightforward to estimate the causal effect of
S2P timing on post-S2P survival by directly comparing the imputed
potential outcomes. Specifically, we consider a lognormal model and a
restricted cubic spline model, evaluating their performance in Monte Carlo
studies. When applied to the SVRT data, the models give somewhat different
imputed values, but both support the conclusion that the optimal time for
the S2P is at 6 months after the Norwood procedure.<br/>Copyright &#xa9;
2021 John Wiley & Sons Ltd.

<33>
Accession Number
2013908612
Title
The Effect of N-acetyl Cysteine Injection on Liver Function After On-Pump
Coronary Artery Bypass Graft Surgery: a Randomized Clinical Trial.
Source
SN Comprehensive Clinical Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Javaherforooshzadeh F.; Abbasi Hormozi P.; Akhondzadeh R.; Olapour A.;
Hashemi S.J.
Institution
(Javaherforooshzadeh, Abbasi Hormozi, Akhondzadeh, Olapour, Hashemi)
Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic
Republic of
(Javaherforooshzadeh) Imam Khomeini Hospital, Azadegan Street, P.O. Box:
6155979939, Ahvaz, Iran, Islamic Republic of
Publisher
Springer Nature
Abstract
Somebody's organ dysfunctions are associated with the cardiopulmonary
bypass in open-heart surgery such as liver dysfunction. This study aimed
at the impact of the N-acetyl cysteine for improvement of liver function
subsequently on-pump coronary artery bypass graft. Following a clinical
trial design, 60 candidates of on-pump CABG, age 30 to 70 years, normal
liver function, and normal renal function were selected. The candidates
were randomly divided into intervention: IV100 mg/kg N-acetyl cysteine in
three doses (2 intraoperative and 1 postoperative) over 24 h, and control
groups (normal saline as placebo) (n = 30 in each group). The main
outcomes were serum alkaline phosphatase, aspartate aminotransferase,
alanine aminotransferase, bilirubin, partial thromboplastin time, and the
international normalized ratio at first and second postoperative day after
surgery. Secondary outcomes were the hemodynamic variables and blood
product transfusion. There were significant differences in ALP (P <
0.001), AST (P = 0.02), ALT (P < 0.001), bilirubin (P = 0.01), PTT (P <
0.001), and INR (P = 0.005) levels between the two groups at the first day
after surgery. There were significant differences in ALP (P = 0.002), AST
(P < 0.001), ALT (P = 0.001), and bilirubin (P = 0.004) levels between the
two groups on the second day after surgery. These levels were
significantly lower in the N-acetyl cysteine group. Significant
differences were observed between the two groups in terms of MAP levels on
the first day (P = 0.002) and the second day after surgery (P < 0/001).
There was a significant difference between the two groups in terms of
packed cell (P = 0.002) and FFP (P < 0.001) transfusion. Based on the
findings, intravenous administration of N-acetyl cysteine in patients with
CABG significantly may be preserved liver function. Registered under No.
Trial registration number IRCT20190506043492N2, date of registration:
2020.05.23. Retrospectively registered.<br/>Copyright &#xa9; 2021, The
Author(s), under exclusive licence to Springer Nature Switzerland AG.

<34>
Accession Number
636189630
Title
Urinary Neutrophil Gelatinase-Associated Lipocalin/Hepcidin-25 Ratio for
Early Identification of Patients at Risk for Renal Replacement Therapy
After Cardiac Surgery: A Substudy of the BICARBONATE Trial.
Source
Anesthesia and analgesia. (no pagination), 2021. Date of Publication: 20
Sep 2021.
Author
Elitok S.; Kuppe H.; Devarajan P.; Bellomo R.; Isermann B.; Westphal S.;
Kube J.; Albert C.; Ernst M.; Kropf S.; Haase-Fielitz A.; Haase M.
Institution
(Elitok, Ernst) From the Department of Nephrology and Endocrinology, Ernst
von Bergmann Hospital Potsdam, Potsdam, Germany
(Kuppe) Institute of Cardiac Thoracic Vascular Anesthesia and Intensive
Care Medicine, German Heart Center Berlin & Charite-University Medicine
Berlin, Berlin, Germany
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital, Cincinnati, OH, United States
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, Austin Health, Heidelberg, VIC,
Australia
(Bellomo) Department of Integrated Critical Care, Center for Integrated
Critical Care, University of Melbourne, Melbourne, VIC, Australia
(Isermann) Department of Laboratory Medicine, Institute of Laboratory
Medicine, Clinical Chemistry, Molecular Diagnostic, Leipzig University
Hospital, Leipzig, Germany
(Westphal) Department of Laboratory Medicine, Institute of Laboratory
Medicine, Tertiary Hospital Dessau, Germany
(Kube, Haase) Department of Anesthesiology and Intensive Care, Leisnig,
Germany
(Albert) Diaverum Renal Care Center, Potsdam, Germany
(Albert) Medical Faculty, University Clinic for Cardiology and Angiology
(Ernst, Haase) Medical Faculty
(Kropf) Medical Faculty, Institute for Biometrics and Medical Informatics,
Otto von-Guericke-University Magdeburg, Magdeburg, Germany
(Haase-Fielitz) Brandenburg Medical School Theodor Fontane, Neuruppin,
Germany
(Haase-Fielitz) Faculty of Health Sciences Brandenburg, Potsdam, Germany
(Haase-Fielitz) Institute of Integrated Health Care Systems Research &
Social Medicine, Otto von-Guericke-University Magdeburg, Magdeburg,
Germany
(Haase-Fielitz) Department of Cardiology, Brandenburg Heart Center,
Immanuel Hospital, Bernau, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute kidney injury requiring renal replacement therapy
(AKI-RRT) is strongly associated with mortality after cardiac surgery;
however, options for early identification of patients at high risk for
AKI-RRT are extremely limited. Early after cardiac surgery, the predictive
ability for AKI-RRT even of one of the most extensively evaluated novel
urinary biomarkers, neutrophil gelatinase-associated lipocalin (NGAL),
appears to be only moderate. We aimed to determine whether the
NGAL/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of
hepcidin-25) early after surgery may compare favorably to NGAL for
identification of high-risk patients after cardiac surgery.
<br/>METHOD(S): This is a prospective substudy of the BICARBONATE trial, a
multicenter parallel-randomized controlled trial comparing perioperative
bicarbonate infusion for AKI prevention to usual patient care. At a
tertiary referral center, 198 patients at increased kidney risk undergoing
cardiac surgery with cardiopulmonary bypass were included into the present
study. The primary outcome measure was defined as AKI-RRT. Secondary
outcomes were in-hospital mortality and long-term mortality. We compared
area under the curve of the receiver operating characteristic (AUC-ROC) of
urinary NGAL with that of the urinary NGAL/hepcidin-25 ratio within 60
minutes after end of surgery. We compared adjusted AUC and performed
cross-validated reclassification statistics of the (logarithmic) urinary
NGAL/hepcidin-25 ratio adjusted to Cleveland risk score/EuroScore,
cross-clamp time, age, volume of packed red blood cells, and (logarithmic)
urinary NGAL concentration. The association of the NGAL/hepcidin-25 ratio
with long-term patient survival was assessed using Cox proportional hazard
regression analysis adjusting for EuroScore, aortic cross-clamp time,
packed red blood cells and urinary NGAL. <br/>RESULT(S): Patients with
AKI-RRT (n = 13) had 13.7-times higher NGAL and 3.3-times lower
hepcidin-25 concentrations resulting in 46.9-times higher NGAL/hepcidin-25
ratio early after surgery compared to patients without AKI-RRT. The
NGAL/hepcidin-25 ratio had higher AUC-ROC compared with NGAL for risk of
AKI-RRT and in-hospital mortality (unadjusted AUC-ROC difference 0.087,
95% confidence interval [CI], 0.036-0.138, P < .001; 0.082, 95% CI,
0.018-0.146, P = .012). For AKI-RRT, the NGAL/hepcidin-25 ratio increased
adjusted category-free net reclassification improvement (cfNRI; 0.952, 95%
CI, 0.437-1.468; P < .001) and integrated discrimination improvement (IDI;
0.040, 95% CI, 0.008-0.073; P = .016) but not AUC difference. For
in-hospital mortality, the ratio improved AUC of the reference model (AUC
difference 0.056, 95% CI, 0.003-0.108; P = .037) and cfNRI but not IDI.
The urinary NGAL/hepcidin-25 ratio remained significantly associated with
long-term mortality after adjusting for the model covariates.
<br/>CONCLUSION(S): The urinary NGAL/hepcidin-25 ratio appears to early
identify high-risk patients and outperform NGAL after cardiac surgery.
Confirmation of our findings in other cardiac surgery centers is now
needed.<br/>Copyright &#xa9; 2021 International Anesthesia Research
Society.

<35>
Accession Number
622339568
Title
NOBLE and EXCEL: The debate for excellence in dealing with left main
stenosis.
Source
Global Cardiology Science and Practice. 2018(1) (no pagination), 2018.
Article Number: 3. Date of Publication: 2018.
Author
Al Kindi H.; Samaan A.; Hosny H.
Institution
(Al Kindi, Samaan, Hosny) Aswan Heart Centre, Aswan, Egypt
(Al Kindi) Sultan Qaboos University Hospital, Muscat, Oman
(Samaan) Cairo University, Cairo, Egypt
Publisher
HBKU Press
Abstract
Left main coronary artery (LMCA) disease is associated with increased
morbidity and mortality. Coronary artery bypass grafting surgery (CABG)
has always been the standard revascularization strategy for this group of
patients. However, with the recent developments in stents design and
medical therapy over the past decade, several trials have been designed to
evaluate the safety and efficacy of percutaneous coronary intervention
(PCI) as an alternative to CABG surgery in patients with LMCA disease.
Recently, the results of two major trials, EXCEL and NOBLE, comparing CABG
versus PCI in this patient population have been released. In fact, the
results of both trials might appear contradictory at first glance. While
the EXCEL trial showed that PCI was non-inferior to CABG surgery, the
NOBLE trial suggested that CABG surgery is a better option. In the
following review, we will discuss some of the similarities and contrasts
between these two trials and conclude with lessons to be learned to our
daily practice.<br/>Copyright &#xa9; 2018 The Author(s), licensee Magdi
Yacoub Institute.

<36>
Accession Number
604740241
Title
TASTE: One-year follow-up results.
Source
Global Cardiology Science and Practice. 2015(2) (no pagination), 2015.
Article Number: 18. Date of Publication: 01 Apr 2015.
Author
Elmahdy M.F.; ElGuindy A.M.; Antoniucci D.
Institution
(Elmahdy, ElGuindy) Aswan Heart Center, Division of Cardiology, Aswan,
Egypt
(Antoniucci) Head of Cardiology Department, Careggi Hospital, Florence,
Italy
Publisher
HBKU Press

<37>
Accession Number
2014828254
Title
Comparative Reductions in Investigator-Reported and Adjudicated Ischemic
Events in REDUCE-IT.
Source
Journal of the American College of Cardiology. 78(15) (pp 1525-1537),
2021. Date of Publication: 12 Oct 2021.
Author
Gaba P.; Bhatt D.L.; Giugliano R.P.; Steg P.G.; Miller M.; Brinton E.A.;
Jacobson T.A.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz
C.; Tardif J.-C.; Ballantyne C.M.; Pinto D.S.; Budoff M.J.; Gibson C.M.
Institution
(Gaba, Bhatt, Giugliano) Division of Cardiovascular Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA, United States
(Steg) Universite de Paris, FACT (French Alliance for Cardiovascular
Trials), Assistance Publique-Hopitaux de Paris, Hopital Bichat, INSERM
Unite 1148, Paris, France
(Miller) Department of Medicine, University of Maryland School of
Medicine, Baltimore, MD, United States
(Brinton) Utah Lipid Center, Salt Lake City, UT, United States
(Jacobson) Office of Health Promotion and Disease Prevention, Department
of Medicine, Emory University School of Medicine, Atlanta, GA, United
States
(Ketchum, Juliano, Jiao, Doyle, Granowitz) Amarin Pharma, Inc,
Bridgewater, NJ, United States
(Tardif) Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Ballantyne) Department of Medicine, Baylor College of Medicine, and the
Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and
Vascular Center, Houston, TX, United States
(Pinto, Gibson) Department of Cardiovascular Diseases, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, United
States
(Budoff) Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA,
United States
Publisher
Elsevier Inc.
Abstract
Background: REDUCE-IT (Reduction of Cardiovascular Events With Icosapent
Ethyl-Intervention Trial) randomized statin-treated patients with elevated
triglycerides to icosapent ethyl (IPE) or placebo. There was a significant
reduction in adjudicated events, including the primary endpoint
(cardiovascular [CV] death, myocardial infarction [MI], stroke, coronary
revascularization, unstable angina requiring hospitalization) and key
secondary endpoint (CV death, MI, stroke) with IPE. <br/>Objective(s): The
purpose of this study was to determine the effects of IPE on
investigator-reported events. <br/>Method(s): Potential endpoints were
collected by blinded site investigators and subsequently adjudicated by a
blinded Clinical Endpoint Committee (CEC) according to a prespecified
charter. Investigator-reported events were compared with adjudicated
events for concordance. <br/>Result(s): There was a high degree of
concordance between investigator-reported and adjudicated endpoints. The
simple Kappa statistic between CEC-adjudicated vs site-reported events for
the primary endpoint was 0.89 and for the key secondary endpoint was 0.90.
Based on investigator-reported events in 8,179 randomized patients, IPE
significantly reduced the rate of the primary endpoint (19.1% vs 24.6%;
HR: 0.74 [95% CI: 0.67-0.81]; P < 0.0001) and the key secondary endpoint
(10.5% vs 13.6%; HR: 0.75 [95% CI: 0.66-0.85]; P < 0.0001). Among
adjudicated events, IPE similarly reduced the rate of the primary and key
secondary endpoints. <br/>Conclusion(s): IPE led to consistent,
significant reductions in CV events, including MI and coronary
revascularization, as determined by independent, blinded CEC adjudication
as well as by blinded investigator-reported assessment. These results
highlight the robust evidence for the substantial CV benefits of IPE seen
in REDUCE-IT and further raise the question of whether adjudication of CV
outcome trial endpoints is routinely required in blinded,
placebo-controlled trials. (Evaluation of the Effect of AMR101 on
Cardiovascular Health and Mortality in Hypertriglyceridemic Patients With
Cardiovascular Disease or at High Risk for Cardiovascular Disease:
REDUCE-IT [Reduction of Cardiovascular Events With EPA - Intervention
Trial]; NCT01492361)<br/>Copyright &#xa9; 2021 The Authors

<38>
Accession Number
636151033
Title
What role for PCI in stable ischaemic heart disease?.
Source
Drug and Therapeutics Bulletin. 59(10) (pp 150-151), 2021. Date of
Publication: 01 Oct 2021.
Author
Kimpton J.; Khong T.K.
Institution
(Kimpton, Khong) Clinical Pharmacology, St George's University of London,
London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Commentary on: Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive
or Conservative Strategy for Stable Coronary Disease. N Engl J Med.
2020;382:1395-1407. Series co-ordinator: Dr Teck Khong, DTB Associate
Editor Clinical Pharmacology, St George's, University of London,
UK<br/>Copyright &#xa9;

<39>
Accession Number
2013748625
Title
Small vessel coronary artery disease: How small can we go with myocardial
revascularization?.
Source
Cardiology Journal. 28(5) (pp 767-778), 2021. Date of Publication: 2021.
Author
Wybraniec M.T.; Banka P.; Bochenek T.; Roleder T.; Mizia-Stec K.
Institution
(Wybraniec, Banka, Bochenek, Mizia-Stec) First Department of Cardiology,
School of Medicine in Katowice, Medical University of Silesia, Katowice,
Poland
(Wybraniec, Banka, Bochenek, Mizia-Stec) Upper Silesia Medical Center,
Katowice, Poland
(Roleder) Regional Specialist Hospital, Research and Development Center,
Wroclaw, Poland
Publisher
Via Medica
Abstract
The issue of small coronary artery atherosclerosis represents an
intriguing aspect of coronary artery disease, which is related with higher
rates of peri-and post-procedural complications and impaired long-term
outcome. This problem is further complicated by the unclear definition of
small coronary vessel. Recent randomized controlled trials have provided
new data on possible novel interventional treatment of small coronary
vessels with drug-coated balloons instead of traditional new-generation
drug-eluting stent implantation. Also, the conservative management
represents a therapeutic option in light of the results of the recent
ISCHEMIA trial. The current article provides an overview of the most
appropriate definition, interventional management, and prognosis of small
coronary artery atherosclerosis.<br/>Copyright &#xa9; 2021 Via Medica.

<40>
Accession Number
2012934959
Title
The Impact of Transfusions on Mortality After Transcatheter or Surgical
Aortic Valve Replacement.
Source
Annals of Thoracic Surgery. 112(3) (pp 778-785), 2021. Date of
Publication: September 2021.
Author
Mumtaz M.; Wyler von Ballmoos M.C.; Deeb G.M.; Popma J.J.; Van Mieghem
N.M.; Kleiman N.S.; Gleason T.G.; Chawla A.; Hockmuth D.; Zorn G.L.;
Tadros P.; Li S.; Reardon M.J.
Institution
(Mumtaz) Department of Cardiovascular and Thoracic Surgery, University of
Pittsburgh Medical Center, Pinnacle Heath, Harrisburg, PA, United States
(Wyler von Ballmoos, Kleiman, Reardon) Department of Cardiothoracic
Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX,
United States
(Deeb) Department of Cardiac Surgery, University of Michigan Hospitals,
Ann Arbor, MI, United States
(Popma) Department of Interventional Cardiology, Beth Israel Deaconess
Medical Center, Boston, MA, United States
(Van Mieghem) Department of Interventional Cardiology, Erasmus University
Medical Center, Rotterdam, Netherlands
(Gleason) University of Pittsburgh Medical Center, Pittsburgh, PA, United
States
(Chawla, Hockmuth) Iowa Heart Center, Des Moines, IA, United States
(Zorn, Tadros) University of Kansas Medical Center, Kansas City, KS,
United States
(Li) Department of Statistics, Medtronic, Mounds View, MN, United States
Publisher
Elsevier Inc.
Abstract
Background: An increasing body of evidence suggests that packed red blood
cell (PRBC) transfusion may be associated with increased morbidity and
mortality after transcatheter and surgical aortic valve replacement. It
remains unclear whether PRBC transfusion is a surrogate marker or truly an
independent risk factor for mortality after aortic valve replacement in
different populations. <br/>Method(s): The Surgical Replacement and
Transcatheter Aortic Valve Implantation (SURTAVI) trial randomized 1660
patients with symptomatic, severe aortic stenosis at intermediate risk for
operative death to transcatheter aortic valve replacement or surgical
aortic valve replacement. Baseline characteristics and outcomes including
all-cause and cardiovascular mortality at 30 days and thereafter were
compared between participants with and participants without PRBC
transfusion. Cox proportional hazards models with time-varying covariates
were fitted to estimate the effect of PRBC transfusion on mortality after
adjustment for comorbidities and procedural complications. <br/>Result(s):
Patients receiving PRBC were older, more commonly female and frail, with
more comorbidities. The Society of Thoracic Surgeons Predicted Risk of
Mortality baseline score was higher in the transfused group. After
adjustment for these differences, PRBC transfusion was associated with
mortality at 30 days, but not thereafter. The effect of PRBC on mortality
(hazard ratio 1.04; 95% confidence interval, 0.96 to 1.11; P = .304) at 30
days was not independent of procedural complications (hazard ratio 21.04;
95% CI, 7.26 to 60.95; P < .001). <br/>Conclusion(s): Poor health status,
procedural complications, PRBC transfusion, and mortality are correlated
with each other. Transfusion of PRBC did not independently increase risk
for mortality. In this intermediate-risk population, transfusion appears
to be a risk marker of chronic conditions and periprocedural complications
as opposed to a risk factor for postprocedural mortality. (Clinical trial
registration: www.clinicaltrials.gov NCT01586910.)<br/>Copyright &#xa9;
2021 The Society of Thoracic Surgeons

<41>
Accession Number
2011983465
Title
The effect of immediate coronary angiography after cardiac arrest without
ST-segment elevation on left ventricular function. A sub-study of the
COACT randomised trial.
Source
Resuscitation. 164 (pp 93-100), 2021. Date of Publication: July 2021.
Author
Lemkes J.S.; Spoormans E.M.; Demirkiran A.; Leutscher S.; Janssens G.N.;
van der Hoeven N.W.; Jewbali L.S.D.; Dubois E.A.; Meuwissen M.; Rijpstra
T.A.; Bosker H.A.; Blans M.J.; Bleeker G.B.; Baak R.; Vlachojannis G.J.;
Eikemans B.J.W.; van der Harst P.; van der Horst I.C.C.; Voskuil M.; van
der Heijden J.J.; Beishuizen A.; Stoel M.; Camaro C.; van der Hoeven H.;
Henriques J.P.; Vlaar A.P.J.; Vink M.A.; van den Bogaard B.; Heestermans
T.A.C.M.; de Ruijter W.; Delnoij T.S.R.; Crijns H.J.G.M.; Jessurun G.A.J.;
Oemrawsingh P.V.; Gosselink M.T.M.; Plomp K.; Magro M.; Elbers P.W.G.; van
de Ven P.M.; van Loon R.B.; van Royen N.
Institution
(Lemkes, Spoormans, Demirkiran, Leutscher, Janssens, van der Hoeven, van
Loon, van Royen) Department of Cardiology, Amsterdam University Medical
Centre, Location VUmc, Amsterdam, Netherlands
(Jewbali, Dubois) Department of Cardiology, Erasmus Medical Centre,
Rotterdam, Netherlands
(Dubois) Department of Intensive Care Medicine, Erasmus Medical Centre,
Rotterdam, Netherlands
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Rijpstra) Department of Intensive Care Medicine, Amphia Hospital, Breda,
Netherlands
(Bosker) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Blans) Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem,
Netherlands
(Bleeker) Department of Cardiology, HAGA Hospital, Den Haag, Netherlands
(Baak) Department of Intensive Care Medicine, HAGA Hospital, Den Haag,
Netherlands
(Vlachojannis) Department of Cardiology, Maasstad Hospital, Rotterdam,
Netherlands
(Eikemans) Department of Intensive Care Medicine, Maasstad Hospital,
Rotterdam, Netherlands
(van der Harst) University of Groningen, University Medical Centre
Groningen, Department of Cardiology, Groningen, Netherlands
(van der Horst) University of Groningen, University Medical Centre
Groningen, Department of Intensive Care Medicine, Groningen, Netherlands
(Vlachojannis, van der Harst, Voskuil) Department of Cardiology,
University Medical Centre Utrecht, Netherlands
(van der Heijden) Department of Intensive Care Medicine, University
Medical Centre Utrecht, Netherlands
(Beishuizen) Department of Intensive Care Medicine, Medisch Spectrum
Twente, Enschede, Netherlands
(Stoel) Department of Cardiology, Medisch Spectrum Twente, Enschede,
Netherlands
(Camaro, van Royen) Department of Cardiology, Radboud University Medical
Centre, Nijmegen, Netherlands
(van der Hoeven) Department of Intensive Care Medicine, Radboud University
Medical Centre, Nijmegen, Netherlands
(Henriques) Department of Cardiology, Amsterdam University Medical Centre,
Location AMC, Amsterdam, Netherlands
(Vlaar) Department of Intensive Care Medicine, Amsterdam University
Medical Centre, Location AMC, Amsterdam, Netherlands
(Vink) Department of Cardiology, OLVG, Amsterdam, Netherlands
(van den Bogaard) Department of Intensive Care Medicine, OLVG, Amsterdam,
Netherlands
(Heestermans) Department of Cardiology, Noord West Ziekenhuisgroep,
Alkmaar, Netherlands
(de Ruijter) Department of Intensive care medicine, Noord West
Ziekenhuisgroep, Alkmaar, Netherlands
(van der Horst, Delnoij) Department of Intensive Care Medicine, Maastricht
University Medical Centre, University Maastricht, Maastricht, Netherlands
(Crijns) Department of Cardiology, Maastricht University Medical Centre,
Maastricht, Netherlands
(Jessurun) Department of Cardiology, Scheper Hospital, Emmen, Netherlands
(Oemrawsingh) Department of Cardiology, Haaglanden Medical Centre, Den
Haag, Netherlands
(Gosselink) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Plomp) Department of Cardiology, Ter Gooi Hospital, Blaricum, Netherlands
(Magro) Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg,
Netherlands
(Elbers) Department of Intensive Care Medicine, Amsterdam University
Medical Centre, Location VUmc, Amsterdam, Netherlands
(van de Ven) Department of Epidemiology and Data Science, Amsterdam
University Medical Centre, Location VUmc, Amsterdam, Netherlands
Publisher
Elsevier Ireland Ltd
Abstract
Background: The effect of immediate coronary angiography and percutaneous
coronary intervention (PCI) in patients who are successfully resuscitated
after cardiac arrest in the absence of ST-segment elevation myocardial
infarction (STEMI) on left ventricular function is currently unknown.
<br/>Method(s): This prespecified sub-study of a multicentre trial
evaluated 552 patients, successfully resuscitated from out-of-hospital
cardiac arrest without signs of STEMI. Patients were randomized to either
undergo immediate coronary angiography or delayed coronary angiography,
after neurologic recovery. All patients underwent PCI if indicated. The
main outcomes of this analysis were left ventricular ejection fraction and
end-diastolic and systolic volumes assessed by cardiac magnetic resonance
imaging or echocardiography. <br/>Result(s): Data on left ventricular
function was available for 397 patients. The mean (+/- standard deviation)
left ventricular ejection fraction was 45.2% (+/-12.8) in the immediate
angiography group and 48.4% (+/-13.2) in the delayed angiography group
(mean difference: -3.19; 95% confidence interval [CI], -6.75 to 0.37).
Median left ventricular end-diastolic volume was 177 ml in the immediate
angiography group compared to 169 ml in the delayed angiography group
(ratio of geometric means: 1.06; 95% CI, 0.95-1.19). In addition, mean
left ventricular end-systolic volume was 90 ml in the immediate
angiography group compared to 78 ml in the delayed angiography group
(ratio of geometric means: 1.13; 95% CI 0.97-1.32). <br/>Conclusion(s): In
patients successfully resuscitated after out-of-hospital cardiac arrest
and without signs of STEMI, immediate coronary angiography was not found
to improve left ventricular dimensions or function compared with a delayed
angiography strategy. Clinical Trial Registration: Netherlands Trial
Register number, NTR4973<br/>Copyright &#xa9; 2021 The Author(s)

<42>
Accession Number
2007553062
Title
Assessment of cardiopulmonary bypass duration improves novel biomarker
detection for predicting postoperative acute kidney injury after
cardiovascular surgery.
Source
Journal of Clinical Medicine. 10(13) (no pagination), 2021. Article
Number: 2741. Date of Publication: 01 Jul 2021.
Author
Lee T.H.; Lee C.-C.; Chen J.-J.; Fan P.-C.; Tu Y.-R.; Yen C.-L.; Kuo G.;
Chen S.-W.; Tsai F.-C.; Chang C.-H.
Institution
(Lee, Lee, Chen, Fan, Tu, Yen, Kuo, Chang) Kidney Research Center,
Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch,
Taoyuan 33305, Taiwan (Republic of China)
(Lee, Fan, Chang) Graduate Institute of Clinical Medical Science, College
of Medicine, Chang Gung University, Taoyuan 33302, Taiwan (Republic of
China)
(Chen, Tsai) Department of Cardiothoracic and Vascular Surgery, Chang Gung
Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan (Republic of
China)
Publisher
MDPI
Abstract
Urinary liver-type fatty acid binding protein (L-FABP) is a novel
biomarker with promising performance in detecting kidney injury. Previous
studies reported that L-FABP showed moderate discrimination in patients
that underwent cardiac surgery, and other studies revealed that longer
duration of cardiopulmonary bypass (CPB) was associated with a higher risk
of postoperative acute kidney injury (AKI). This study aims to examine
assessing CPB duration first, then examining L-FABP can improve the
discriminatory ability of L-FABP in postoperative AKI. A total of 144
patients who received cardiovascular surgery were enrolled. Urinary L-FABP
levels were examined at 4 to 6 and 16 to 18 h postoperatively. In the
whole study population, the AUROC of urinary L-FABP in predicting
postoperative AKI within 7 days was 0.720 at 16 to 18 h postoperatively.
By assessing patients according to CPB duration, the urinary L-FABP at 16
to 18 h showed more favorable discriminating ability with AUROC of 0.742.
Urinary L-FABP exhibited good performance in discriminating the onset of
AKI within 7 days after cardiovascular surgery. Assessing postoperative
risk of AKI through CPB duration first and then using urinary L-FABP
examination can provide more accurate and satisfactory performance in
predicting postoperative AKI.<br/>Copyright &#xa9; 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<43>
Accession Number
2007369628
Title
Three-Dimensional vs Two-Dimensional Completely Minimally Invasive 2-Stage
Esophagectomy With Intrathoracic Hand-Sewn Anastomosis for Esophageal
Cancer: Comparison of Intra-and Postoperative Outcomes.
Source
Surgical Innovation. 28(5) (pp 582-589), 2021. Date of Publication:
October 2021.
Author
Abbassi O.; Patel K.; Jayanthi N.V.
Institution
(Abbassi, Patel, Jayanthi) Essex Upper GI, Regional Centre for
Oesophagogastric Surgery, Broomfield Hospital, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Background. Completely minimally invasive esophagectomy (CMIE) has been
associated with reduced morbidity compared to open esophagectomy in the
treatment of esophageal cancer. Three-dimensional (3D) vision can enhance
depth perception during minimally invasive surgery when compared to
two-dimensional (2D) vision. We aimed to compare outcomes from 2-stage
CMIEs when performed in 2D vs 3D. Method. All consecutive 2-stage CMIEs
performed for esophageal or gastroesophageal junctional cancer at a
single-centre between 2016 and 2018 were identified from a prospectively
maintained database. All operations were completed in either 2D or 3D. All
esophagogastric anastomoses were hand-sewn thoracoscopically.
Intraoperative and postoperative clinical parameters were compared between
2D and 3D CMIE. Results. Overall, 98 patients underwent a 2-stage CMIE, of
which 59 (60.2%) were in 2D and 39 (39.8%) in 3D. Median operative blood
loss was less in the 3D group compared to the 2D group (283 mls vs 409
mls, P =.016). A higher number of lymph nodes were retrieved from 3D CMIE
(30 vs 25, P =.010). The median duration of surgery was 407 minutes
(interquartile ranges (IQR): 358-472 minutes) and 426 minutes (IQR:
369-509 minutes) when performed in 2D and 3D, respectively (P =.162).
There were no significant intergroup differences in 30-day postoperative
complications, short-term mortality, and hospital stay. Conclusion. We
report reduced blood loss and higher lymph node yield when performing 3D
CMIE than 2D CMIE. Other intraoperative and postoperative clinical
outcomes were similar in both groups. A randomized controlled trial is
needed to validate these findings of superior outcomes from CMIE performed
in 3D over 2D.<br/>Copyright &#xa9; The Author(s) 2020.

<44>
Accession Number
2007017990
Title
Cancer mortality in trials of heart failure with reduced ejection
fraction: A systematic review and meta-analysis.
Source
Journal of the American Heart Association. 9(18) (no pagination), 2020.
Article Number: e016309. Date of Publication: 2020.
Author
Tini G.; Bertero E.; Signori A.; Sormani M.P.; Maack C.; De Boer R.A.;
Canepa M.; Ameri P.
Institution
(Tini, Canepa, Ameri) Cardiovascular Disease Unit, IRCCS Ospedale
Policlinico San Martino, Genova, Italy
(Tini, Canepa, Ameri) Department of Internal Medicine, University of
Genova, Italy
(Bertero, Maack) Comprehensive Heart Failure Center (CHFC), University
Clinic Wurzburg, Wurzburg, Germany
(Signori, Sormani) Department of Health Sciences, Section of
Biostatistics, University of Genova, Italy
(De Boer) Department of Cardiology, University of Groningen, University
Medical Center Groningen, Groningen, Netherlands
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The burden of cancer in heart failure with reduced ejection
fraction is apparently growing. Randomized controlled trials (RCTs) may
help understanding this observation, since they span decades of heart
failure treatment. METHODS AND RESULTS: We assessed cancer,
cardiovascular, and total mortality in phase 3 heart failure RCTs
involving >=90% individuals with left ventricular ejection fraction <45%,
who were not acutely decompensated and did not represent specific patient
subsets. The pooled odds ratios (ORs) of each type of death for the
control and treatment arms were calculated using a random-effects model.
Temporal trends and the impact of patient and RCT characteristics on
mortality outcomes were evaluated by meta-regression analysis. Cancer
mortality was reported for 15 (25%) of 61 RCTs, including 33 709 subjects,
and accounted for 6% to 14% of all deaths and 17% to 67% of
noncardiovascular deaths. Cancer mortality rate was 0.58 (95% CI,
0.46-0.71) per 100 patient-years without temporal trend (P=0.35).
Cardiovascular (P=0.001) and total (P=0.001) mortality rates instead
decreased over time. Moreover, cancer mortality was not influenced by
treatment (OR, 1.08; 95% CI, 0.92-1.28), unlike cardiovascular (OR, 0.88;
95% CI, 0.79-0.98) and all-cause (OR, 0.91; 95% CI, 0.84-0.99) mortality.
Meta-regression did not reveal significant sources of heterogeneity.
Possible reasons for excluding patients with malignancy overlapped among
RCTs with and without published cancer mortality, and malignancy was an
exclusion criterion only for 4 (8.7%) of the RCTs not reporting cancer
mortality. <br/>CONCLUSION(S): Cancer is a major, yet overlooked cause of
noncardiovascular death in heart failure with reduced ejection fraction,
which has become more prominent with cardiovascular mortality
decline.<br/>Copyright &#xa9; 2020 The Authors.

<45>
Accession Number
2007017820
Title
Outcomes of atrial arrhythmia surgery in patients with congenital heart
disease: A systematic review.
Source
Journal of the American Heart Association. 9(19) (no pagination), 2020.
Article Number: e016921. Date of Publication: 06 Oct 2020.
Author
Houck C.A.; de Groot N.M.S.; Kardys I.; Niehot C.D.; Bogers A.J.J.C.;
Mouws E.M.J.P.
Institution
(Houck, de Groot, Kardys) Department of Cardiology, Erasmus MC, University
Medical Center Rotterdam, Rotterdam, Netherlands
(Houck, Bogers, Mouws) Department of Cardiothoracic Surgery, Erasmus MC,
University Medical Center Rotterdam, Rotterdam, Netherlands
(Niehot) Medical Library, Erasmus MC, University Medical Center Rotterdam,
Rotterdam, Netherlands
(Mouws) Department of Anesthesiology, Amsterdam University Medical Center,
Amsterdam, Netherlands
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The improved life expectancy of patients with congenital heart
disease is often accompanied by the development of atrial
tachyarrhythmias. Similarly, the number of patients requiring redo
operations is expected to continue to rise as these patients are aging.
Consequently, the role of arrhythmia surgery in the treatment of atrial
arrhythmias is likely to become more important in this population.
Although atrial arrhythmia surgery is a well-established part of Fontan
conversion procedures, evidence-based recommendations for arrhythmia
surgery for macroreentrant atrial tachycardia and atrial fibrillation in
other patients with congenital heart disease are still lacking. METHODS
AND RESULTS: Twenty-eight studies were included in this systematic review.
The median reported arrhythmia recurrence was 13% (interquartile range,
4%-26%) during follow-up ranging from 3 months to 15.2 years. A large
variation in surgical techniques was observed. Based on the acquired data,
biatrial lesions are more effective in the treatment of atrial
fibrillation than exclusive right-sided lesions. Right-sided lesions may
be more appropriate in the treatment of macroreentrant atrial tachycardia;
evidence for the superiority of additional left-sided lesions is lacking.
There are not enough data to support the use of exclusive left-sided
lesions. Theoretically, prophylactic atrial arrhythmia surgery may be
beneficial in this population, but evidence is currently limited.
<br/>CONCLUSION(S): To be able to provide recommendations for arrhythmia
surgery in patients with congenital heart disease, future studies should
report outcomes according to the type of preoperative arrhythmia,
underlying congenital heart disease, lesion set, and energy source. This
is essential for determining which surgical techniques should ideally be
applied under which circumstances.<br/>Copyright &#xa9; 2020 The Authors.
Published on behalf of the American Heart Association, Inc., by Wiley.

<46>
Accession Number
2014072515
Title
Effects of inorganic nitrate on ischaemia-reperfusion injury after
coronary artery bypass surgery: a randomised controlled trial.
Source
British Journal of Anaesthesia. 127(4) (pp 547-555), 2021. Date of
Publication: October 2021.
Author
Eriksson K.E.; Eidhagen F.; Liska J.; Franco-Cereceda A.; Lundberg J.O.;
Weitzberg E.
Institution
(Eriksson, Eidhagen, Lundberg, Weitzberg) Department of Physiology and
Pharmacology, Karolinska Institutet, Stockholm, Sweden
(Eriksson, Weitzberg) Department of Perioperative Medicine and Intensive
Care, Karolinska University Hospital, Stockholm, Sweden
(Eidhagen) Stockholm Center for Spine Surgery (RKC), Stockholm, Sweden
(Liska, Franco-Cereceda) Department of Molecular Medicine and Surgery,
Karolinska Institutet, Stockholm, Sweden
(Liska, Franco-Cereceda) Department of Cardiothoracic Surgery, Karolinska
University Hospital, Stockholm, Sweden
Publisher
Elsevier Ltd
Abstract
Background: Nitric oxide (NO) is an important signalling molecule in the
cardiovascular system with protective properties in ischaemia-reperfusion
injury. Inorganic nitrate, an oxidation product of endogenous NO
production and a constituent in our diet, can be recycled back to
bioactive NO. We investigated if preoperative administration of inorganic
nitrate could reduce troponin T release and other plasma markers of injury
to the heart, liver, kidney, and brain in patients undergoing cardiac
surgery. <br/>Method(s): This single-centre, randomised, double-blind,
placebo-controlled trial included 82 patients undergoing coronary artery
bypass surgery with cardiopulmonary bypass. Oral sodium nitrate (700 mgx2)
or placebo (NaCl) were administered before surgery. Biomarkers of
ischaemia-reperfusion injury and plasma nitrate and nitrite were collected
before and up to 72 h after surgery. Troponin T release was our predefined
primary endpoint and biomarkers of renal, liver, and brain injury were
secondary endpoints. <br/>Result(s): Plasma concentrations of nitrate and
nitrite were elevated in nitrate-treated patients compared with placebo.
The 72-h release of troponin T did not differ between groups. Other plasma
biomarkers of organ injury were also similar between groups. Blood loss
was not a predefined outcome parameter, but perioperative bleeding was 18%
less in nitrate-treated patients compared with controls.
<br/>Conclusion(s): Preoperative administration of inorganic nitrate did
not influence troponin T release or other plasma biomarkers of organ
injury in cardiac surgery. Clinical trial registration:
NCT01348971.<br/>Copyright &#xa9; 2021 The Authors

<47>
Accession Number
2013729135
Title
ACTION-1: study protocol for a randomised controlled trial on ACT-guided
heparinization during open abdominal aortic aneurysm repair.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 639. Date of
Publication: December 2021.
Author
Wiersema A.M.; Roosendaal L.C.; Koelemaij M.J.W.; Tijssen J.G.P.; van
Dieren S.; Blankensteijn J.D.; Debus E.S.; Middeldorp S.; Heyligers
J.M.M.; Fokma Y.S.; Reijnen M.M.P.J.; Jongkind V.
Institution
(Wiersema, Roosendaal, Jongkind) Department of Vascular Surgery,
Dijklander ziekenhuis, Maelsonstraat 3, Hoorn, NP 1624, Netherlands
(Wiersema, Roosendaal, Blankensteijn, Jongkind) Department of Vascular
Surgery, Amsterdam UMC, loc. Vrije Universiteit Medical center, De
Boelenlaan 1117, Amsterdam, HV 1081, Netherlands
(Koelemaij, van Dieren) Department of Vascular Surgery, Amsterdam UMC,
loc. AMC, Meibergdreef 9, Amsterdam, AZ 1105, Netherlands
(Tijssen) Emeritus Professor of Clinical Epidemiology & Biostatistics,
Department of Cardiology, Amsterdam UMC - University of Amsterdam,
Amsterdam, AZ 1105, Netherlands
(Debus) Department of Vascular Surgery, University Heart Centre
Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20251, Germany
(Middeldorp) Division of Internal Medicine, Department of Haematology,
Amsterdam UMC, loc. AMC, Meibergdreef 9, Amsterdam, AZ 1105, Netherlands
(Heyligers) Department of Vascular Surgery, Elisabeth-TweeSteden
ziekenhuis, Hilvarenbeekseweg 60, Tilburg, GC 5022, Netherlands
(Fokma) Member of Board of Directors, Dijklander ziekenhuis, Maelsonstraat
3, Hoorn, NP 1624, Netherlands
(Reijnen) Department of Vascular Surgery, Rijnstate ziekenhuis, Wagnerlaan
55, Arnhem, AD 6815, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: Heparin is used worldwide for 70 years during all non-cardiac
arterial procedures (NCAP) to reduce thrombo-embolic complications (TEC).
But heparin also increases blood loss causing possible harm for the
patient. Heparin has an unpredictable effect in the individual patient.
The activated clotting time (ACT) can measure the effect of heparin.
Currently, this ACT is not measured during NCAP as the standard of care,
contrary to during cardiac interventions, open and endovascular. A RCT
will evaluate if ACT-guided heparinization results in less TEC than the
current standard: a single bolus of 5000 IU of heparin and no measurements
at all. A goal ACT of 200-220 s should be reached during ACT-guided
heparinization and this should decrease (mortality caused by) TEC, while
not increasing major bleeding complications. This RCT will be executed
during open abdominal aortic aneurysm (AAA) surgery, as this is a
standardized procedure throughout Europe. <br/>Method(s): Seven hundred
fifty patients, who will undergo open AAA repair of an aneurysm
originating below the superior mesenteric artery, will be randomised in 2
treatment arms: 5000 IU of heparin and no ACT measurements and no
additional doses of heparin, or a protocol of 100 IU/kg bolus of heparin
and ACT measurements after 5 min, and then every 30 min. The goal ACT is
200-220 s. If the ACT after 5 min is < 180 s, 60 IU/kg will be
administered; if the ACT is between 180 and 200 s, 30 IU/kg. If the ACT is
> 220 s, no extra heparin is given, and the ACT is measured after 30 min
and then the same protocol is applied. The expected incidence for the
combined endpoint of TEC and mortality is 19% for the 5000 IU group and
11% for the ACT-guided group. <br/>Discussion(s): The ACTION-1 trial is an
international RCT during open AAA surgery, designed to show superiority of
ACT-guided heparinization compared to the current standard of a single
bolus of 5000 IU of heparin. A significant reduction in TEC and mortality,
without more major bleeding complications, must be proven with a relevant
economic benefit. Trial registration {2a}: NTR NL8421 ClinicalTrials.gov
NCT04061798. Registered on 20 August 2019 EudraCT 2018-003393-27 Trial
registration: data set {2b}: ClinicalTrials.gov: NCT04061798NTR:
NL8421Arno@wiersema.nuArno@wiersema.nu<br/>Copyright &#xa9; 2021, The
Author(s).

<48>
Accession Number
2014810477
Title
Support with extracorporeal membrane oxygenation for over 1 year duration
as a bridge to cardiac transplantation: A case report and review of the
literature.
Source
Cardiology in the Young. (pp 1-3), 2021. Date of Publication: 2021.
Author
Shanefield S.C.; Knewitz D.; Philip J.; Fricker F.J.; Sullivan K.;
Laucerica C.; Jacobs J.P.; Peek G.J.; Bleiweis M.S.
Institution
(Shanefield, Knewitz) University of Florida, College of Medicine,
Gainesville, FL, United States
(Philip, Fricker, Sullivan, Laucerica, Jacobs, Peek, Bleiweis) Congenital
Heart Center, University of Florida, College of Medicine, Gainesville, FL,
United States
Publisher
Cambridge University Press
Abstract
We present the case of a 13-year-old male with a complex congenital
cardiac history who was supported with extracorporeal membrane oxygenation
for 394 days while awaiting cardiac transplantation. The patient underwent
successful cardiac transplantation after 394 days of support with
veno-arterial extracorporeal membrane oxygenation and is currently alive 2
years after cardiac transplantation. We believe that this case represents
the longest period of time that a patient has been supported with
extracorporeal membrane oxygenation as a bridge to cardiac
transplantation. We also review the literature associated with prolonged
support with extracorporeal membrane oxygenation. This case report
documents many of the challenges associated with prolonged support with
extracorporeal membrane oxygenation, including polymicrobial bacterial and
fungal infections, as well as renal dysfunction. It is possible to
successfully bridge a patient to cardiac transplantation with prolonged
support with extracorporeal membrane oxygenation of over 1 year; however,
multidisciplinary collaboration is critical. <br/>Copyright &#xa9; The
Author(s), 2021. Published by Cambridge University Press.

<49>
Accession Number
2014637874
Title
Percutaneous coronary intervention versus coronary artery surgery for left
main disease according to lesion site: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
De Filippo O.; Di Franco A.; Boretto P.; Bruno F.; Cusenza V.; Desalvo P.;
Demetres M.; Saglietto A.; Franchin L.; Piroli F.; Marengo G.; Elia E.;
Falk V.; Conrotto F.; Doenst T.; Rinaldi M.; De Ferrari G.M.; D'Ascenzo
F.; Gaudino M.
Institution
(De Filippo, Boretto, Bruno, Cusenza, Desalvo, Saglietto, Franchin,
Piroli, Marengo, Elia, Conrotto, De Ferrari, D'Ascenzo) Division of
Cardiology, Cardiovascular and Thoracic Department, AOU Citta della Salute
e della Scienza di Torino and University of Turin, Turin, Italy
(Di Franco, Gaudino) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Centre, Weill Cornell Medicine, New York, NY, United States
(Falk) Department of Cardiothoracic and Vascular Surgery, German Heart
Center Berlin, Berlin, Germany
(Falk) Department of Cardiothoracic Surgery, Charite-Universitatsmedizin
Berlin, Corporate Member of Freie Universitat Berlin, Humboldt-Universitat
Berlin, Berlin Institute of Health, Berlin, Germany
(Falk) Department of Health Sciences, Translational Cardiovascular
Technologies, ETH Zurich, Zurich, Switzerland
(Doenst) Jena University Hospital, Friedrich-Schiller-University of Jena,
Jena, Germany
(Rinaldi) Division of Cardiac Surgery, Cardiovascular and Thoracic
Department, AOU Citta della Salute e della Scienza di Torino and
University of Turin, Turin, Italy
Publisher
Mosby Inc.
Abstract
Background: Comparative data after percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) for unprotected left main
coronary artery (ULMCA) disease according to lesion site (ostial/shaft vs
distal) are scant. The aim of this meta-analysis was to investigate
outcomes after PCI or CABG for ULMCA disease according to lesion site.
<br/>Method(s): Randomized controlled trials (RCTs) and adjusted
observational studies that compared PCI versus CABG in patients with ULMCA
disease and reported outcomes according to lesion site were systematically
identified. Major adverse cardiovascular events (MACE; a composite of
all-cause death, myocardial infarction, stroke, and repeat
revascularization) and all-cause death were the co-primary end points.
Individual components of MACE were secondary end points. Sensitivity
analysis including RCTs only were performed for each outcome.
<br/>Result(s): Nine studies (3 RCTs, 6 adjusted observational),
encompassing 6296 patients (2274 and 4022 treated for ostial/shaft or
distal ULMCA, respectively) were included. At the 5-year follow-up, there
were no significant differences between CABG and PCI for MACE, death, or
any other secondary outcome for ostial/shaft ULMCA lesions (MACE: hazard
ratio [HR], 1.0 [95% confidence interval (CI), 0.79-1.27]; death: HR, 1.10
[95% CI, 0.84-1.46]). For distal ULMCA, PCI was associated with an
increased risk of MACE (HR, 1.32; 95% CI, 1.10-1.58), death (HR, 1.56; 95%
CI, 1.19-2.04), and revascularization (HR, 2.07; 95% CI, 1.5-2.84). The
benefit of CABG for MACE and revascularization was confirmed in the
analysis limited to RCTs, whereas the benefit for mortality was not.
<br/>Conclusion(s): Among patients with distal ULMCA disease, CABG is
associated with lower incidence of MACE and revascularization compared
with PCI, whereas no differences in outcomes were observed for
ostial/shaft ULMCA disease.<br/>Copyright &#xa9; 2021 The American
Association for Thoracic Surgery

<50>
Accession Number
2014620659
Title
Impact of sex on outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. 343 (pp 27-34), 2021. Date of
Publication: 15 Nov 2021.
Author
Dixon L.K.; Di Tommaso E.; Dimagli A.; Sinha S.; Sandhu M.; Benedetto U.;
Angelini G.D.
Institution
(Dixon, Di Tommaso, Dimagli, Sinha, Sandhu, Benedetto, Angelini) Bristol
Heart Institute, Translational Health Sciences, University of Bristol, UK,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Despite advances in cardiac surgery, observational studies
suggest that females have poorer post-operative outcomes than males. This
study is the first to review sex related outcomes following both coronary
artery bypass graft (CABG) and valve surgery with or without combined
CABG. <br/>Method(s): We identified 30 primary research articles reporting
either short-term mortality (in-hospital/30 day), long-term mortality, and
post-operative stroke, sternal wound infection and myocardial infarction
(MI) in both sexes following CABG and valve surgery with or without
combined CABG. Reported adjusted odds/hazard ratio were pooled using an
inverse variance model. <br/>Result(s): Females undergoing CABG and
combined valve and CABG surgery were at higher risk of short-term
mortality (odds ratio (OR) 1.40; 95% confidence interval (CI) 1.32-1.49;
I² = 79%) and post-operative stroke (OR 1.2; CI 1.07-1.34;
I² = 90%) when compared to males. However, for isolated AVR,
there was no difference found (OR 1.19; 95% CI 0.74-1.89). There was no
increased risk in long-term mortality (OR 1.04; 95% CI: 0.93-1.16;
I² = 82%), post-operative MI (OR 1.22; 95%CI: 0.89-1.67;
I² = 60%) or deep sternal wound infection (OR 0.92; 95%CI:
0.65-1.03, I² = 87%). No evidence of publication bias or small
study effect was found. <br/>Conclusion(s): Females are at a greater risk
of short-term mortality and post-operative stroke than males following
CABG and valve surgery combined with CABG. However, there is no difference
for Isolated AVR. Long-term mortality is equivalent in both sexes.
PROSPERO Registration: CRD42021244603.<br/>Copyright &#xa9; 2021 Elsevier
B.V.

<51>
Accession Number
2014194547
Title
Effect of live oud music on physiological and psychological parameters in
patients undergoing cardiac surgery.
Source
Global Cardiology Science and Practice. 2019(2) (no pagination), 2019.
Article Number: 17. Date of Publication: 2019.
Author
Luis M.; Doss R.; Zayed B.; Yacoub M.
Institution
(Luis, Doss, Yacoub) Aswan Heart Centre, Aswan, Egypt
(Zayed) Music and Art therapist, Ellenhorn, MA, United States
Publisher
HBKU Press
Abstract
Background. Music therapy has emerged as a promising evidence-based
adjuvant method of intervention. This study aims to assess the effect of
live oud music on physiological and psychological parameters in patients
undergoing cardiac surgery, pre- and post-operatively. Methods. Twelve
patients undergoing cardiac operations were randomly allocated into either
intervention group or control group, six patients in each group. Patients
in the intervention group listened to 20 minutes of improvised and
personally customized live oud music before and after surgery while
patients in the control group heard the normal hospital sounds. While
anxiety scores were assessed preoperatively, vital signs and pain scores
were assessed postoperatively together with serum levels of cortisol,
which was used as a surrogate marker of the stress response. Results. In
the intervention group, pain scores and respiratory rates showed
statistically significant reduction after listening to music (P values of
0.043 and 0.034 respectively). Additionally, heart rates, anxiety scores
and serum cortisol levels showed borderline significant reduction in
patients who listened to music with P values, 0.063, 0.066 and 0.068
respectively. These changes were not found in the control group.
Conclusions. This preliminary study suggests a role of live oud music
therapy in decreasing stress response of the patients undergoing cardiac
surgery, in addition to its positive effects on pain perception and
anxiety scores. <br/>Copyright &#xa9; 2019 The Author(s).

<52>
Accession Number
2014061586
Title
Investigation of inflammatory and oxidative stress biomarkers in multi
vessels minimally invasive coronary artery bypass graft surgery versus
off-pump coronary artery bypass graft.
Source
American Journal of Biochemistry and Biotechnology. 17(3) (pp 354-361),
2021. Date of Publication: 2021.
Author
Abdel-Hafez M.F.; El-Minshawy A.; Taha A.M.; Mandour A.M.; Mahmoud M.G.;
Mohany K.M.
Institution
(Abdel-Hafez, El-Minshawy, Taha) Department of Cardiothoracic Surgery,
Faculty of Medicine, Assiut University, P.O. Box 71515, Assiut, Egypt
(Mandour) Department of Anesthesia and Intensive Care Unit, Faculty of
medicine, Assiut University, P.O. Box 71515, Assiut, Egypt
(Mandour, Mahmoud) Department of Medical Bioinformatics, Egyptian
E-learning University, Egypt
(Mohany) Department of Medical Biochemistry and Molecular Biology, Faculty
of Medicine, Assiut University, Assiut, Egypt
Publisher
Science Publications
Abstract
Traditional Coronary Artery Bypass Graft (CABG) is currently among of the
chief methods in dealing with patients suffering from atherosclerotic
coronary heart disease. The current study aimed to measure and compare the
levels of proinflammatory cytokines and oxidative stress marker in
patients who underwent multivessels Minimally Invasive Coronary Artery
Bypass Graft Surgery (MICS- CABG) versus off-pump Coronary Artery Bypass
Grafting (off-pump CABG) in the cardiothoracic department, Assiut
University hospitals, Upper Egypt. the study included 67 patients, all of
them suffering from atherosclerotic coronary artery disease, which confirm
by cardiac catheter angiography. The patients were divided randomly into
two groups, first group (A) included 34 patients to whom Multi Vessels
Coronary Artery Bypass Graft Surgery (MICS-CABG) under off pump had been
done. The second group (B) included 33 patients whom underwent off pump
Coronary Artery Bypass Grafting (off-pump CABG). Tumor Necrosis Factor-A
(TNF-alpha), interlukin-2 (IL-2), lipid peroxides, Superoxide Dismutase
(SOD), total thiols and Nitric Oxide (NO) were estimated in sera of all
patients by their corresponding methods; 48 h before the operation, 15 min
before the operation end and 72 h after the operation. After testing the
normality, Mann-Whitney U test and Spearman correlation coefficient were
used to compare the two groups and tested the variables' correlations with
the duration of the operation. p<=0.05 was considered significant. Serum
TNF-alpha, IL-2 and lipid peroxides levels were significantly higher while
total thiols and SOD were significantly lower, intraoperative and
postoperatively, while No was significantly higher intraoperative only, in
off-pump CABG group compared to MICS-CABG group and in both groups,
intraoperative and postoperatively compared to preoperative levels.
Especially in the postoperative samples, TNF-alpha, IL-2 and NO levels
correlated positively while those of SOD correlated negatively with the
operation duration the clinical data obtained presented in details in the
result sector and revealed that. MICS-CABG group associated with less
postoperative pain, less need for blood transfusion, less hospital stays
and rapid regain to normal activity. The current study revealed that
MICS-CABG is an effective procedure that is associated with small surgical
trauma and lower inflammations and oxidative stress compared to off-pump
CABG.<br/>Copyright &#xa9; 2021 Mohammed Farouk Abdel-Hafez, Ahmed
El-Minshawy, Ahmed M. Taha, Ahmed Mohamed Mandour, Mahmoud Gamal Mahmoud
and Khalid M. Mohany.

<53>
Accession Number
636111787
Title
Trial of intensive blood-pressure control in older patients with
hypertension.
Source
New England Journal of Medicine. 385(14) (pp 1268-1279), 2021. Date of
Publication: 30 Sep 2021.
Author
Zhang W.; Zhang S.; Deng Y.; Wu S.; Ren J.; Sun G.; Yang J.; Jiang Y.; Xu
X.; Wang T.-D.; Chen Y.; Li Y.; Yao L.; Li D.; Wang L.; Shen X.; Yin X.;
Liu W.; Zhou X.; Zhu B.; Guo Z.; Liu H.; Chen X.; Feng Y.; Tian G.; Gao
X.; Kario K.; Cai J.
Institution
(Zhang, Zhang, Deng, Cai) The Hypertension Center, FuWai Hospital, State
Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of
Medical Sciences, China
(Zhang) Peking Union Medical College Hospital, Beijing, China
(Li) Beijing Pinggu Hospital, Beijing, China
(Liu) Beijing Hospital, Beijing, China
(Wu) Kailuan General Hospital, Tangshan, China
(Ren) Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, China
(Shen) The First Affiliated Hospital of Shanxi Medical University, Baotou,
China
(Sun) Taiyuan, the Second Affiliated Hospital of Baotou Medical College,
Baotou, China
(Yang) The People's Hospital of Ji Xian District, Tianjin, China
(Jiang) The First Affiliated Hospital, Dalian Medical University, Dalian,
China
(Gao) Omron Dalian, Dalian, China
(Xu) The First Affiliated Hospital of Xinjiang Medical University, Urumqi,
China
(Chen) The Second Affiliated Hospital of Medical College Shantou
University, Shantou, China
(Yao) Benxi Railway Hospital, Benxi, China
(Li) Hongxinglong Center Hospital, Shuangyashan, China
(Shen) The First Affiliated Hospital of Hebei North University,
Zhangjiakou, China
(Yin) The First Affiliated Hospital of Harbin Medical University, Harbin,
China
(Yin) Renmin Hospital of Wuhan University, Wuhan, China
(Zhu) Kang Ya Hospital, Yiyang, China
(Guo) FuWai Yunnan Cardiovascular Hospital, Kunming, China
(Chen) Zhoukou City Central Hospital, Zhoukou, China
(Chen) West China Hospital, Sichuan University, Chengdu, China
(Feng) Guangdong Cardiovascular Institute, Guangzhou, China
(Tian) The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an,
China
(Wang) The Cardiovascular Center and Divisions of Cardiology and Hospital
Medicine, Department of Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan (Republic of China)
(Kario) Jichi Medical University School of Medicine, Shimotsuke, Japan
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The appropriate target for systolic blood pressure to reduce
cardiovascular risk in older patients with hypertension remains unclear.
METHODS In this multicenter, randomized, controlled trial, we assigned
Chinese patients 60 to 80 years of age with hypertension to a systolic
blood-pressure target of 110 to less than 130 mm Hg (intensive treatment)
or a target of 130 to less than 150 mm Hg (standard treatment). The
primary outcome was a composite of stroke, acute coronary syndrome (acute
myocardial infarction and hospitalization for unstable angina), acute
decompensated heart failure, coronary revascularization, atrial
fibrillation, or death from cardiovascular causes. RESULTS Of the 9624
patients screened for eligibility, 8511 were enrolled in the trial; 4243
were randomly assigned to the intensive-treatment group and 4268 to the
standard-treatment group. At 1 year of follow-up, the mean systolic blood
pressure was 127.5 mm Hg in the intensive-treatment group and 135.3 mm Hg
in the standard-treatment group. During a median follow-up period of 3.34
years, primary-outcome events occurred in 147 patients (3.5%) in the
intensive-treatment group, as compared with 196 patients (4.6%) in the
standard-treatment group (hazard ratio, 0.74; 95% confidence interval
[CI], 0.60 to 0.92; P=0.007). The results for most of the individual
components of the primary outcome also favored intensive treatment: the
hazard ratio for stroke was 0.67 (95% CI, 0.47 to 0.97), acute coronary
syndrome 0.67 (95% CI, 0.47 to 0.94), acute decompensated heart failure
0.27 (95% CI, 0.08 to 0.98), coronary revascularization 0.69 (95% CI, 0.40
to 1.18), atrial fibrillation 0.96 (95% CI, 0.55 to 1.68), and death from
cardiovascular causes 0.72 (95% CI, 0.39 to 1.32). The results for safety
and renal outcomes did not differ significantly between the two groups,
except for the incidence of hypotension, which was higher in the
intensive-treatment group. CONCLUSIONS In older patients with
hypertension, intensive treatment with a systolic blood-pressure target of
110 to less than 130 mm Hg resulted in a lower incidence of cardiovascular
events than standard treatment with a target of 130 to less than 150 mm
Hg.<br/>Copyright &#xa9; 2021 Massachusetts Medical Society.

<54>
Accession Number
2015036698
Title
Prevalence and prognosis of pericardial effusion in patients affected by
pectus excavatum: A case-control study.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Conte E.; Agalbato C.; Lauri G.; Mushtaq S.; Carollo C.; Bonomi A.;
Zanotto L.; Melotti E.; Dalla Cia A.; Guglielmo M.; Baggiano A.; Annoni
A.; Formenti A.; Mancini E.; D'Angelo A.M.; Rota A.; Assanelli E.; Sforza
C.; Pontone G.; Pepi M.; Andreini D.; Brucato A.
Institution
(Conte, Agalbato, Lauri, Mushtaq, Carollo, Bonomi, Zanotto, Melotti, Dalla
Cia, Guglielmo, Baggiano, Annoni, Formenti, Mancini, D'Angelo, Rota,
Assanelli, Pontone, Pepi, Andreini) Centro Cardiologico Monzino, IRCCS,
Milan, Italy
(Conte, Sforza) Universita di Milano, Deptartment of Biomedical Sciences
for Health, University of Milan, Milan, Italy
(Baggiano) Department of Clinical Sciences and Community Health -
Cardiovascular Section, University of Milan, Milan, Italy
(Andreini, Brucato) Universita di Milano, Department of Biomedical and
Clinical Sciences "Luigi Sacco", Fatebefratelli Hospital, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: The presence of pectus excavatum(PEX) has been occasionally
associated with pericardial effusion. Aim of the present study was to
compare incidence and prognosis of pericardial effusion in a group of
unselected patients with PEX vs a control group. <br/>Method(s): From a
prospective registry of consecutive patients who underwent chest CT for
cardiovascular disease, subjects with a radiological diagnosis of PEX were
retrospectively identified (cases); from the same registry patients
(controls) without rib cage abnormalities were randomly selected, until a
1:2 ratio was reached. The presence of pericardial effusion at CT was
quantified. Follow-up was obtained for a composite end-point: cardiac
tamponade, need for pericardiocentesis, need for cardiac surgery for
relapsing pericardial effusion. <br/>Result(s): A total of 43 patients
with PEX (20 females) and a control group of 86 cases (31 females) without
rib cage abnormalities were identified. Pericardial effusion evaluated at
CT was significatively more prevalent in patients with PEX vs control
group, 37.2% vs 13.9% (p < 0.001), respectively; four patients with PEX
(9.3%) had at least moderate pericardial effusion vs no subjects among the
controls (p = 0.004). PEX diagnosis was significantly associated to
pericardial effusion at multi-variate analysis (OR95%CI 10.91[3.47-34.29],
p < 0.001). At a mean follow-up of 6.5 +/- 3.4 years no pericardial events
were recorded. <br/>Conclusion(s): Our findings support the higher
prevalence of pericardial effusion in patients with PEX when compared to a
control group. The absence of adverse pericardial events at follow-up
suggest the good prognosis of these effusions, that in the appropriate
clinical setting might not be considered "idiopathic".<br/>Copyright
&#xa9; 2021 Elsevier B.V.

<55>
Accession Number
2015004597
Title
Rigid Ring Versus Flexible Band for Tricuspid Valve Repair in Patients
Scheduled for Mitral Valve Surgery: A Prospective Randomized Study.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Bogachev-Prokophiev A.V.; Ovcharov M.A.; Sapegin A.V.; Lavinykov S.O.;
Astapov D.A.; Ivanzov S.M.; Sharifulin R.M.; Afanasyev A.V.; Demin I.I.;
Zeleznev S.I.
Institution
(Bogachev-Prokophiev, Ovcharov, Sapegin, Lavinykov, Astapov, Ivanzov,
Sharifulin, Afanasyev, Demin, Zeleznev) Heart Valves Surgery Department,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
Publisher
Elsevier Ltd
Abstract
Background: Tricuspid valve repair for functional regurgitation is
effectively performed with different annuloplasty devices. However, it
remains unclear whether there are advantages associated with rigid rings
compared to flexible bands. This prospective randomised study aimed to
compare results of using a flexible band ring versus a rigid ring for
functional tricuspid regurgitation in patients undergoing mitral valve
surgery. <br/>Method(s): A single-centre randomised study was designed to
allocate patients with functional tricuspid regurgitation undergoing
mitral valve surgery to be treated with a flexible band or rigid ring.
These patients were analysed by echocardiographic follow-up. The primary
outcome was freedom from recurrent tricuspid regurgitation at 12-months
follow-up. Secondary outcomes were 30-day mortality, survival, freedom
from tricuspid valve reoperation, right ventricular reverse remodelling,
and rate of major adverse events. <br/>Result(s): A total of 308 patients
were allocated to receive concomitant tricuspid valve annuloplasty with
the flexible band or rigid ring. There was no between-group difference in
freedom from recurrent tricuspid regurgitation: 97.3% in Rigid group (95%
CI, 93.0-98.8) and 96.2% in the Flexible group (95% CI, 92.0-98.5) at
12-months follow-up (log-rank, p=0.261). Early mortality, survival,
freedom from tricuspid valve reoperation, and global right ventricle
systolic function were also comparable in both groups of patients.
However, the flexible band had advantage in restoring regional right
ventricle function (Doppler-derived systolic velocities of the annulus
[S], tricuspid annular plane systolic excursion) at 12-months follow-up.
<br/>Conclusion(s): Both the rigid ring and flexible band offered
acceptable outcomes for functional tricuspid regurgitation correction
without significant differences, as assessed at 12-months
follow-up.<br/>Copyright &#xa9; 2021 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<56>
Accession Number
2014824563
Title
Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With
Chronic Kidney Disease.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Sandner S.E.; Schunkert H.; Kastrati A.; Milojevic M.; Boning A.; Zimpfer
D.; Zellmer S.; Wiedemann D.; Laufer G.; von Scheidt M.
Institution
(Sandner, Zimpfer, Wiedemann, Laufer) Department of Cardiac Surgery,
Medical University of Vienna, Vienna, Austria
(Schunkert, Kastrati, Zellmer, von Scheidt) German Heart Center Munich,
Technical University of Munich, Munich, Germany
(Schunkert, Kastrati, Zellmer, von Scheidt) German Center for
Cardiovascular Research, Munich Heart Alliance, Munich, Germany
(Milojevic) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Boning) Department of Cardiovascular Surgery, University Hospital
Giessen, Giessen, Germany
Publisher
Elsevier Inc.
Abstract
Background: The optimal antiplatelet therapy for patients with chronic
kidney disease (CKD) undergoing coronary artery bypass graft surgery
remains unknown. <br/>Method(s): This post hoc analysis of the Ticagrelor
in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety
of ticagrelor vs aspirin in patients with and patients without CKD. The
primary endpoint was major adverse cardiac and cerebrovascular events
(MACCE), namely, the composite of cardiovascular death, stroke, myocardial
infarction, or revascularization at 1 year after coronary artery bypass
graft surgery. Secondary endpoints included individual components of the
primary endpoint, all-cause death, and major bleeding. <br/>Result(s):
Chronic kidney disease was present in 276 of 1843 randomized patients
(15%). Patients with CKD vs patients without CKD had higher 1-year rates
of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval
[CI], 1.12 to 2.39; P =.01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95%
CI, 1.03 to 3.28; P =.04). The 1-year rate of MACCE was increased with
ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95%
CI, 1.08 to 4.30; P =.03), but not in patients without CKD (8.5% vs 8.1%,
HR 1.05; 95% CI, 0.74 to 1.49; P =.79; P<inf>interaction</inf> =.067).
There was no difference in the 1-year rate of major bleeding with
ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI,
0.52 to 3.97; P =.48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95%
CI, 0.64 to 2.01; P =.65). <br/>Conclusion(s): Among patients with CKD and
coronary artery bypass graft surgery, those who received ticagrelor had a
higher incidence of MACCE but a similar incidence of major bleeding
compared with those who received aspirin.<br/>Copyright &#xa9; 2021 The
Society of Thoracic Surgeons

<57>
Accession Number
2014808201
Title
Outcomes of peri-operative glucocorticosteroid use in major pancreatic
resections: a systematic review.
Source
HPB. (no pagination), 2021. Date of Publication: 2021.
Author
Kuan L.L.; Dennison A.R.; Garcea G.
Institution
(Kuan, Dennison, Garcea) Department of Hepatobiliary and Pancreatic
Surgery, University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Kuan) Discipline of Surgery, The University of Adelaide, The Queen
Elizabeth Hospital, Adelaide, South Australia, Australia
Publisher
Elsevier B.V.
Abstract
Background: There is increasing evidence that peri-operative
glucocorticosteroid can ameliorate the systemic response following major
surgery. Preliminary evidence suggests peri-operative usage of
glucocorticosteroid may decrease post-operative complications. These
positive associations have been observed in a range of different
operations including intra-abdominal, thoracic, cardiac, and orthopaedic
surgery. This review aims to investigate the impact of peri-operative
glucocorticosteroid in major pancreatic resections. <br/>Method(s): A
systematic review based on a search in Medline and Embase databases was
performed. PRISMA guidelines for systematic reviews were followed.
<br/>Result(s): A total of five studies were analysed; three randomised
controlled trials and two retrospective cohort studies. The total patient
population was 1042. The glucocorticosteroids used were intravenous
hydrocortisone or dexamethasone. Three studies reported significantly
lower morbidity in the peri-operative glucocorticosteroid group. The
number needed to treat to prevent one major complication with
hydrocortisone is four patients. Two studies demonstrated that
dexamethasone was associated with a statistically significantly improved
median overall survival in pancreatic cancer. <br/>Conclusion(s): This is
the first systematic review conducted to investigate the significance of
peri-operative glucocorticosteroid in patients undergoing pancreatic
resection. This review shows a correlation of positive outcomes with the
administration of glucocorticosteroid in the peri-operative setting
following a major pancreatic resection. More randomised clinical trials
are required to confirm if this is a true effect, as it would have
significant implications.<br/>Copyright &#xa9; 2021

<58>
Accession Number
2013892224
Title
Efficacy and safety of low intensity vitamin K antagonists in Western and
East-Asian patients with left-sided mechanical heart valves.
Source
Journal of Thrombosis and Thrombolysis. (no pagination), 2021. Date of
Publication: 2021.
Author
Pandey A.K.; Xu K.; Zhang L.; Gupta S.; Eikelboom J.; Lopes R.D.; Crowther
M.; Belley-Cote E.P.; Whitlock R.P.
Institution
(Pandey) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, Canada
(Xu) Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong
University, Shanghai, China
(Zhang) Banner University Medical Center, Tucson, United States
(Gupta, Whitlock) Division of Cardiac Surgery, Department of Surgery,
McMaster University, Hamilton, Canada
(Eikelboom, Crowther) Department of Medicine, McMaster University,
Hamilton, Canada
(Eikelboom, Belley-Cote, Whitlock) Population Health Research Institute,
237 Barton Street East, Hamilton, ON, Canada
(Lopes) Duke Clinical Research Institute, Durham, United States
(Lopes) Duke University School of Medicine, Durham, United States
(Crowther) Division of Hematology, Department of Medicine, McMaster
University, Hamilton, Canada
(Belley-Cote, Whitlock) Department of Health Research Methods, Evidence
and Impact, McMaster University, Hamilton, Canada
(Belley-Cote) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, Canada
Publisher
Springer
Abstract
The optimal INR target in patients with mechanical heart valves is
unclear. Higher INR targets are often used in Western compared with East
Asian countries. The objective of this systematic review and meta-analysis
was to summarize the evidence for the efficacy and safety of lower versus
higher INR targets in Western and East Asian left-sided mechanical heart
valve patients. We searched Western databases including Cochrane CENTRAL,
Medline, and Embase as well as Chinese databases including SinoMed, CNKI,
and Wanfang Data in addition to grey literature for Randomized Controlled
Trials (RCTs) and observational studies. We pooled risk ratios (RRs) using
random-effects model. Low and high INR targets were defined by the
individual studies. We identified nine RCTs, including six Western (n =
5496) and three East Asian (n = 209) trials, and 17 observational studies,
including two Western (n = 3199) and 15 East Asian (n = 5485) studies. In
the RCTs, lower compared with higher targets were associated with similar
rates of thromboembolism (2.4 vs. 2.3%; RR: 1.14, 95% CI 0.82, 1.60,
I² = 0%) and lower rates of both total bleeding (21.9 vs.
40.9%, RR: 0.46, 95% CI 0.28, 0.78, I² = 88%) and major
bleeding. RCT data showed no statistical heterogeneity by region. These
effects were consistent in the observational data. We downgraded the
quality of evidence due to serious risk of bias and imprecision. In
patients with left-sided contemporary mechanical heart valves, low quality
evidence suggests lower INR targets are associated with similar rates of
thromboembolism and moderate quality evidence suggests lower rates of
bleeding.<br/>Copyright &#xa9; 2021, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<59>
Accession Number
636185145
Title
Extended, virtual and augmented reality in thoracic surgery: a systematic
review.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 20 Sep 2021.
Author
Arjomandi Rad A.; Vardanyan R.; Thavarajasingam S.G.; Zubarevich A.; Van
den Eynde J.; Sa M.P.B.O.; Zhigalov K.; Sardiari Nia P.; Ruhparwar A.;
Weymann A.
Institution
(Arjomandi Rad, Vardanyan, Thavarajasingam) Department of Medicine,
Faculty of Medicine, Imperial College London, London, United Kingdom
(Zubarevich, Zhigalov, Ruhparwar, Weymann) Department of Thoracic and
Cardiovascular Surgery, West German Heart and Vascular Center Essen,
University Hospital of Essen, University Duisburg-Essen, Essen, Germany
(Van den Eynde) Department of Cardiovascular Diseases, University
Hospitals Leuven, KU Leuven, Leuven, Belgium
(Sa) Department of Cardiovascular Surgery, Pronto Socorro Cardiologico de
Pernambuco (PROCAPE), University of Pernambuco, Recife, Brazil
(Sardiari Nia) Department of Cardiothoracic Surgery, Maastricht University
Medical Center, Maastricht, Netherlands
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Extended reality (XR), encompassing both virtual reality (VR)
and augmented reality, allows the user to interact with a
computer-generated environment based on reality. In essence, the immersive
nature of VR and augmented reality technology has been warmly welcomed in
all aspects of medicine, gradually becoming increasingly feasible to
incorporate into everyday practice. In recent years, XR has become
increasingly adopted in thoracic surgery, although the extent of its
applications is unclear. Here, we aim to review the current applications
of XR in thoracic surgery. <br/>METHOD(S): A systematic database search
was conducted of original articles that explored the use of VR and/or
augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane
database and Google Scholar, from inception to December 2020.
<br/>RESULT(S): Our search yielded 1494 citations, of which 21 studies
published from 2007 to 2019 were included in this review. Three main areas
were identified: (i) the application of XR in thoracic surgery training;
(ii) preoperative planning of thoracic procedures; and (iii)
intraoperative assistance. Overall, XR could produce progression along the
learning curve, enabling trainees to reach acceptable standards before
performing in the operating theatre. Preoperatively, through the
generation of 3D-renderings of the thoracic cavity and lung anatomy, VR
increases procedural accuracy and surgical confidence through
familiarization of the patient's anatomy. XR-assisted surgery may have
therapeutic use particularly for complex cases, where conventional methods
would yield inadequate outcomes due to inferior accuracy.
<br/>CONCLUSION(S): XR represents a salient step towards improving
thoracic surgical training, as well as enhancing preoperative planning and
intraoperative guidance.<br/>Copyright &#xa9; The Author(s) 2021.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<60>
Accession Number
636183583
Title
Effect of evolocumab on acute arterial events across all vascular
territories : results from the FOURIER trial.
Source
European heart journal. (no pagination), 2021. Date of Publication: 19
Sep 2021.
Author
Oyama K.; Giugliano R.P.; Tang M.; Bonaca M.P.; Saver J.L.; Murphy S.A.;
Ruzza A.; Keech A.C.; Sever P.S.; Sabatine M.S.; Bergmark B.A.
Institution
(Oyama, Giugliano, Tang, Murphy, Sabatine, Bergmark) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard
Medical School, 60 Fenwood Road, Boston MA 02115, United States
(Oyama) Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine, 1-1 Seiryo-machi ,Aoba-ku, Sendai 980-8574, Japan
(Bonaca) CPC Clinical Research, Department of Medicine, University of
Colorado Anschutz School of Medicine, 2115 N. Scranton St. CO 80045,
United States
(Saver) Department of Neurology and Comprehensive Stroke Center, David
Geffen School of Medicine at UCLA, 710 Westwood Plaza, Los Angeles, CA
90095, USA
(Ruzza) Amgen, Thousand Oaks, 1 Amgen Center Drive, CA 91320, United
States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Level 6 ,Medical
Foundation Building ,92-94 Parramatta Road ,Camperdown, Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, 59 North Wharf Road, London W2
1LA, United Kingdom
Publisher
NLM (Medline)
Abstract
AIMS: We assessed the impact of the proprotein convertase subtilisin-kexin
type 9 (PCSK9) inhibitor evolocumab on acute arterial events across all
vascular territories, including coronary, cerebrovascular, and peripheral
vascular beds, in patients with established atherosclerotic cardiovascular
disease (ASCVD). METHODS AND RESULTS: In the FOURIER trial, 27 564
patients with stable ASCVD on statin therapy were randomly assigned to
evolocumab or placebo. Acute arterial events were a composite of acute
coronary (coronary heart disease death, myocardial infarction, or urgent
coronary revascularization), cerebrovascular (ischaemic stroke, transient
ischaemic attack, or urgent cerebral revascularization), or peripheral
vascular (acute limb ischaemia, major amputation, or urgent peripheral
revascularization) events. Of the 2210 first acute arterial events, 74%
were coronary, 22% were cerebrovascular, and 4% were peripheral vascular.
Evolocumab reduced first acute arterial events by 19% (hazard ratio [HR]
0.81 [95% confidence interval 0.74-0.88]; P < 0.001), with significant
individual reductions in acute coronary (HR 0.83 [0.75-0.91]),
cerebrovascular (HR 0.77 [0.65-0.92]), and peripheral vascular (HR 0.58
[0.38-0.88]) events. There were 3437 total events (first plus recurrent),
with evolocumab reducing total events by 24% (incidence rate ratio 0.76
[0.69-0.85]). The magnitude of reduction in acute arterial events with
evolocumab numerically increased over time, with a 16% reduction (HR 0.84
[0.75-0.95]) in the first year followed by a 24% reduction (HR 0.76
[0.67-0.85]) thereafter. <br/>CONCLUSION(S): The addition of the PCSK9
inhibitor evolocumab to statin therapy reduced acute arterial events
across all vascular territories with a robust effect over time, indicating
a pan-vascular impact of aggressive lipid-lowering therapy on these acute
and clinically meaningful events. CLINICAL TRIAL REGISTRATION: URL:
https://www.clinicaltrials.gov. Unique identifier:
NCT01764633.<br/>Copyright Published on behalf of the European Society of
Cardiology. All rights reserved. &#xa9; The Author(s) 2021. For
permissions, please email: journals.permissions@oup.com.

<61>
Accession Number
636183577
Title
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral
Transcatheter Aortic Valve Replacement Access: A Systematic Review and
Meta-Analysis.
Source
Circulation. Cardiovascular interventions. (pp
CIRCINTERVENTIONS121010742), 2021. Date of Publication: 20 Sep 2021.
Author
Kotronias R.A.; Bray J.J.H.; Rajasundaram S.; Vincent F.; Delhaye C.;
Scarsini R.; Marin F.; Terentes-Printzios D.; Halcox J.P.J.; Mamas M.A.;
Kharbanda R.; Van Belle E.; Banning A.P.
Institution
(Kotronias, Bray, Rajasundaram, Scarsini, Marin, Terentes-Printzios,
Kharbanda, Banning) Oxford Heart Centre, Oxford University Hospitals, NHS
Trust, United Kingdom (R.A.K., S.R., R.S., F.M., D.T.-P.
(Kotronias) Department of Cardiovascular Medicine, University of Oxford,
United Kingdom (R.A.K.)
(Bray, Halcox) Institute of Life Sciences 2, United Kingdom (J.J.H.B.,
Swansea Bay University Health Board and Swansea University Medical School
(Bray) University Hospital of Wales, Cardiff and Vale University Health
Board, United Kingdom (J.J.H.B.)
(Vincent, Delhaye, Van Belle) Centre Hospitalier Universitaire de
Lille-Cardiologie, C.D.
(Scarsini) Department of Medicine, Division of Cardiology, University of
Verona
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Keele University, UK and Heart Centre, Thomas Jefferson
University
Publisher
NLM (Medline)
Abstract
BACKGROUND: Access site vascular and bleeding complications remain
problematic for patients undergoing transcatheter aortic valve replacement
(TAVR). Ultrasound-guided transfemoral access approach has been suggested
as a technique to reduce access site complications, but there is wide
variation in adoption in TAVR. We performed a systematic review and
meta-analysis to compare access site vascular and bleeding complications
according to the Valve Academic Research Consortium-2 classification
following the use of either ultrasound- or conventional fluoroscopy-guided
transfemoral TAVR access. <br/>METHOD(S): Medline, Embase, Web of Science,
and The Cochrane Library were searched to November 2020 for studies
comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR.
A priori defined primary outcomes were extracted: (1) major, (2) minor,
and (3) major and minor (total) access site vascular complications and (4)
life-threatening/major, (5) minor, and (6) life-threatening, major, and
minor (total) access site bleeding complications. <br/>RESULT(S): Eight
observational studies (n=3875) were included, with a mean participant age
of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%.
An ultrasound-guided approach was significantly associated with a reduced
risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI,
0.35-0.73]), major (MH-OR, 0.51 [95% CI, 0.35-0.74]), and minor (MH-OR,
0.59 [95% CI, 0.38-0.91]) access site vascular complications. Ultrasound
guidance was also significantly associated with total access site bleeding
complications (MH-OR, 0.59 [95% CI, 0.39-0.90]). The association remained
significant in sensitivity analyses of maximally adjusted minor and total
vascular access site complications (MH-OR, 0.51 [95% CI, 0.29-0.90];
MH-OR, 0.44 [95% CI, 0.20-0.99], respectively). <br/>CONCLUSION(S): In the
absence of randomized studies, our data suggests a potential benefit for
ultrasound guidance to obtain percutaneous femoral access in TAVR.
REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique
identifier: CRD42020218259.

<62>
Accession Number
2014564489
Title
A multicenter study to evaluate the pharmacokinetics and safety of
liposomal bupivacaine for postsurgical analgesia in pediatric patients
aged 6 to less than 17 years (PLAY).
Source
Journal of Clinical Anesthesia. 75 (no pagination), 2021. Article Number:
110503. Date of Publication: December 2021.
Author
Tirotta C.F.; de Armendi A.J.; Horn N.D.; Hammer G.B.; Szczodry M.;
Matuszczak M.; Wang N.Q.; Scranton R.; Ballock R.T.
Institution
(Tirotta) Nicklaus Children's Hospital, Miami, FL, United States
(de Armendi) University of Oklahoma Health Sciences Center, Oklahoma City,
OK, United States
(Horn) Indiana University School of Medicine, Indianapolis, IN, United
States
(Hammer) Stanford University School of Medicine, Stanford, CA, United
States
(Szczodry) Shriners Hospital for Children, Chicago, IL, United States
(Matuszczak) University of Texas, McGovern Medical School, Houston, TX,
United States
(Wang) Pacira BioSciences, Inc., Parsippany, NJ, United States
(Scranton) Lyndra Therapeutics, Watertown, MA, United States
(Ballock) Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Study objective: To evaluate the pharmacokinetics and safety of liposomal
bupivacaine in pediatric patients undergoing spine or cardiac surgery.
<br/>Design(s): Multicenter, open-label, phase 3, randomized trial (PLAY;
NCT03682302). <br/>Setting(s): Operating room. <br/>Patient(s): Two
separate age groups were evaluated (age group 1: patients 12 to <17 years
undergoing spine surgery; age group 2: patients 6 to <12 years undergoing
spine or cardiac surgery). <br/>Intervention(s): Randomized allocation of
liposomal bupivacaine 4 mg/kg or bupivacaine hydrochloride (HCl) 2 mg/kg
via local infiltration at the end of spine surgery (age group 1);
liposomal bupivacaine 4 mg/kg via local infiltration at the end of spine
or cardiac surgery (age group 2). Measurements: The primary and secondary
objectives were to evaluate the pharmacokinetics (eg, maximum plasma
bupivacaine concentrations [C<inf>max</inf>], time to C<inf>max</inf>) and
safety of liposomal bupivacaine, respectively. <br/>Main Result(s):
Baseline characteristics were comparable across groups. Mean
C<inf>max</inf> after liposomal bupivacaine administration was lower
versus bupivacaine HCl in age group 1 (357 vs 564 ng/mL); mean
C<inf>max</inf> in age group 2 was 320 and 447 ng/mL for spine and cardiac
surgery, respectively. Median time to C<inf>max</inf> of liposomal
bupivacaine occurred later with cardiac surgery versus spine surgery (22.7
vs 7.4 h). In age group 1, the incidence of adverse events (AEs) was
comparable between liposomal bupivacaine (61% [19/31]) and bupivacaine HCl
(73% [22/30]). In age group 2, 100% (5/5) and 31% (9/29) of patients
undergoing spine and cardiac surgery experienced AEs, respectively. AEs
were generally mild or moderate, with no discontinuations due to AEs or
deaths. <br/>Conclusion(s): Plasma bupivacaine levels following local
infiltration with liposomal bupivacaine remained below the toxic threshold
in adults (~2000-4000 ng/mL) across age groups and procedures. AEs were
mild to moderate, supporting the safety of liposomal bupivacaine in
pediatric patients undergoing spine or cardiac surgery. Clinical trial
number and registry URL: ClinicalTrials.gov identifier:
NCT03682302<br/>Copyright &#xa9; 2021 The Authors

<63>
Accession Number
2013357332
Title
Effects of kinect mira versus conventional rehabilitation therapy in young
adults with unilateral vestibular hypo-function.
Source
Rawal Medical Journal. 46(3) (pp 736-740), 2021. Date of Publication:
July-September 2021.
Author
Azhar N.; Ahmad Z.; Fatima A.; Naz I.; Aziz S.; Ali M.
Institution
(Azhar, Ahmad, Fatima, Naz, Aziz, Ali) Department of Physiotherapy, NCS
University Swabi, Women Institute of Rehabilitation Sciences, University
of Lahore, Islamabad Campus, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: To determine the effect of conventional versus virtual reality
based vestibular rehabilitation through Kinect Mira software in young
adults with unilateral peripheral vestibular hypo-function. Methodology:
This randomized control trial included 60 young adults with unilateral
peripheral vestibular hypo-function; randomly divided as 30 in control
group and 30 in experimental group. Study was conducted at Armed Forces
Institute of Rehab Medicine, Rawalpindi, Pakistan using Non-probability
purposive sampling technique. Exclusion criteria was patients with
bilateral vestibular hypo-function, CNS involvement or fluctuating
vestibular symptoms. Control group received Cawthorn Cooksey vestibular
exercises and experimental group received virtual reality based
Exer-gamming with Kinect Mira software. Data were analyzed through SPSS
20. <br/>Result(s): Mean of all three components (physical, emotional and
functional) of Dizziness Handicap Inventory (DHI) of control and
experimental group was 9.26+/-3.65, 6.80+/-3.50 and 7.86+/-3.18 and
4.20+/-2.94, 3.86+/-3.96 and 5.06+/-4.41, respectively with mild to
moderate significant difference. Mean of balance measured on ABC scale of
control and experimental group was 82.19+/-10.19 and 85.63+/-7.1,
respectively. Gait was measured through Dynamic Gait index scale and its
mean of control and experimental group was 17.53+/-15.14 and 19.00+/-2.54
with no significant difference. <br/>Conclusion(s): Virtual reality
exercise performed through Kinect Mira evaluation by software was equally
effective to conventional rehabilitation therapy. There was no significant
difference between both groups. But participants showed more adherence to
virtual reality based exercise.<br/>Copyright &#xa9; 2021, Pakistan
Medical Association. All rights reserved.

<64>
Accession Number
2012283360
Title
Utility of positron emission tomography imaging in the diagnosis of
chronic Q fever: A Systematic Review.
Source
Journal of Medical Imaging and Radiation Oncology. 65(6) (pp 694-709),
2021. Date of Publication: October 2021.
Author
Sivabalan P.; Visvalingam R.; Grey V.; Blazak J.; Henderson A.; Norton R.
Institution
(Sivabalan, Grey, Henderson) Department of Infectious Diseases, Princess
Alexandra Hospital, Woolloongabba, QLD, Australia
(Sivabalan, Norton) Pathology Queensland, Townsville University Hospital,
Douglas, QLD, Australia
(Sivabalan, Grey, Henderson, Norton) Faculty of Medicine, University of
Queensland, Brisbane, QLD, Australia
(Visvalingam) Department of Radiology, Princess Alexandra Hospital,
Woolloongabba, QLD, Australia
(Blazak) Department of Radiology, Sunshine Coast University Hospital,
Birtinya, QLD, Australia
Publisher
John Wiley and Sons Inc
Abstract
Chronic Q fever is a diagnostic challenge. Diagnosis relies on serology
and/or the detection of DNA from blood or tissue samples. PET-CT
identifies tissues with increased glucose metabolism, thus identifying
foci of inflammation. Our aim was to review the existing literature on the
use of PET-CT to help diagnose chronic Q fever. A literature search was
conducted in PubMed and Google Scholar to ascertain publications that
included the terms 'Positron Emission Tomography' and 'PET CT' in
combination with subheadings 'chronic Q fever' and 'Coxiella burnetii'
within the search. To broaden our search retrieval, we used the terms
'chronic Q fever' and 'PET-CT'. Published literature up to 16^th
April 2020 was included. 274 articles were initially identified.
Post-exclusion criteria, 46 articles were included. Amongst case reports
and series, the most frequent focus of infection was vascular, followed by
musculoskeletal then cardiac. 79.5% of patients had a focus detected with
55.3% of these having proven infected prosthetic devices. Amongst the
retrospective and prospective studies, a total of 394 positive sites of
foci were identified with 186 negative cases. Some had follow-up scans
(53), with 75.5% showing improvement or resolution. Average timeframe for
documented radiological resolution post-initiating treatment was 8.86
months. PET-CT is a useful tool in the management of chronic Q fever.
Knowledge of a precise focus enables for directed surgical management
helping reduce microbial burden, preventing future complications.
Radiological resolution of infection can give clinicians reassurance on
whether antimicrobial therapy can be ceased earlier, potentially limiting
side effects.<br/>Copyright &#xa9; 2021 The Royal Australian and New
Zealand College of Radiologists

<65>
Accession Number
2011243402
Title
The effect of preoperative aminophylline on the recovery profile after
major pelvic-abdominal surgeries: a randomized controlled double-blinded
study.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 122. Date
of Publication: December 2021.
Author
Kasim S.A.; Bahr M.H.; Abdelkader M.; Rashwan D.A.E.
Institution
(Kasim, Bahr, Abdelkader, Rashwan) Faculty of Medicine, Beni -Suef
University, Beni - Suef, Egypt
Publisher
BioMed Central Ltd
Abstract
Background: This study compared the effects of premedication with
different doses of aminophylline on the recovery profile after general
anaesthesia. <br/>Method(s): Forty-five patients scheduled for
pelvic-abdominal surgeries were divided into 3 groups: Group C: the
patients received 100 ml of IV normal saline, Group A1: the patients
received 2 mg/kg IV aminophylline, and Group A2: the patients received 4
mg/kg IV aminophylline 30 min before induction of general anaesthesia. The
following data were recorded: demographic data, ASA physical status,
duration of anaesthesia and surgery, heart rate, mean arterial blood
pressure, propofol dose, fentanyl dose, times to reach BIS (48 +/- 2)
after induction of anaesthesia and to reach a value of 80 after
discontinuation of sevoflurane anaesthesia, time to recovery of
consciousness and to tracheal extubation and to discharge from the
post-anaesthesia care unit, and side effects of aminophylline.
<br/>Result(s): The time to reach a BIS of 48 +/- 2 was significantly
lower for the control group than group A2 (70.67 +/- 22.50 and 106.67 +/-
34.77 s for groups C and A2, respectively, p -value =0.01). The time to
reach a BIS of 80 was significantly longer for the control group than
group A1 andA2 (5.6 +/- 1.40,3.5 +/- 1.93and 2.53 +/- 1.72 min for groups
C,A1 and A2, respectively, p -value < 0.01). The time to ROC was
significantly longer for the control group than groups A1 and A2 (8.93 +/-
0.92, 5.6 +/- 2.47 and 4.53 +/- 3.33 min for groups C, A1 and A2,
respectively; p -value < 0.01). The extubation time was significantly
longer for the control group than groups A1 and A2 (12.4 +/- 1.08, 7.87
+/- 3.27 and 6.6 +/- 2.47 min for groups C, A1 and A2, respectively; p
-value < 0.01). <br/>Conclusion(s): Premedication with aminophylline
enhanced the recovery profile after pelvic-abdominal surgeries under
general anaesthesia without cardiovascular complications. Clinical trial
registration: Name of the registry: Register@ClinicalTrials.gov Trial
registration number: ClinicalTrials.gov Identifier: NCT04151381. Date of
registration, November 5, 2019, 'Retrospectively
registered'.<br/>Copyright &#xa9; 2021, The Author(s).

<66>
Accession Number
2006828888
Title
The impact of influenza vaccination in patients with cardiovascular
disease: An overview of systematic reviews.
Source
Trends in Cardiovascular Medicine. 31(5) (pp 315-320), 2021. Date of
Publication: July 2021.
Author
Rodrigues B.S.; Alves M.; Duarte G.S.; Costa J.; Pinto F.J.; Caldeira D.
Institution
(Rodrigues) Faculdade de Medicina, Universidade de Lisboa, Lisbon,
Portugal
(Alves) Servico de Medicina III, Hospital Pulido Valente, CHLN, Lisboa,
Portugal
(Alves, Duarte, Costa, Caldeira) Laboratory of Clinical Pharmacology and
Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Portugal
(Alves, Duarte, Costa) Instituto de Medicina Molecular, Faculdade de
Medicina, Universidade de Lisboa, Portugal
(Pinto, Caldeira) Centro Cardiovascular da Universidade de Lisboa - CCUL,
CAML, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz,
Lisboa 1649-028, Portugal
(Pinto, Caldeira) Servico de Cardiologia, Hospital Universitario de Santa
Maria - CHULN, Portugal
Publisher
Elsevier Inc.
Abstract
Whether influenza vaccination can play a prognostic role in patients with
cardiovascular (CV) disease (coronary artery disease (CAD), heart failure,
stroke, peripheral artery disease (PAD)) is still not completely
well-established. We conducted this overview of systematic reviews (SR)
evaluating the effects of influenza vaccination in secondary prevention of
CV disease. An electronic search was performed in the MEDLINE (to November
2019). Eligibility criteria included SR evaluating the effect of influenza
vaccination in patients with CV disease. The risk of bias of the included
systematic reviews was evaluated using the ROBIS tool. All-cause
mortality, CV mortality, major adverse cardiovascular events (MACE) and
hospitalizations were evaluated. Whenever required, data were recalculated
through a random-effects meta-analysis to obtain pooled data for the
patients at secondary CV prevention. The search process yielded four SR:
two in CAD, one in heart failure and one in stroke. There were no SR
evaluating the vaccine in PAD. The risk of bias was unclear (2 SR) and
high (2 SR). Influenza vaccination in patients with CAD showed a risk
reduction in all-cause mortality (data recalculated), cardiovascular
mortality and MACE, particularly in patients with recent acute coronary
syndrome. In patients with heart failure, vaccination was associated with
a decreased risk of all-cause mortality. There was a non-significant trend
in recurrent stroke risk reduction in patients with previous stroke. The
available evidence suggests that influenza vaccination was associated with
a protective effect in CAD and HF patients. However, these results need to
be clarified with higher quality evidence studies.<br/>Copyright &#xa9;
2020

<67>
Accession Number
2007711135
Title
Effectiveness of Telepharmacy Versus Face-to-Face Anticoagulation Services
in the Ambulatory Care Setting: A Systematic Review and Meta-analysis.
Source
Annals of Pharmacotherapy. 55(9) (pp 1084-1095), 2021. Date of
Publication: September 2021.
Author
Tran R.J.C.; Yamzon J.; Stewart T.L.; Hernandez E.A.; Cao D.X.
Institution
(Tran, Stewart) Keck Graduate Institute School of Pharmacy and Health
Sciences, Claremont, CA, United States
(Yamzon, Hernandez, Cao) University College of Pharmacy, Fullerton, CA,
United States
Publisher
SAGE Publications Inc.
Abstract
Background: Effectiveness of anticoagulation services managed via
telepharmacy (TP) has not been clearly demonstrated. <br/>Objective(s):
This systematic review and meta-analysis compares the effectiveness of TP
anticoagulation services to face-to-face (FTF) anticoagulation services in
the ambulatory care setting. <br/>Method(s): A literature search for
studies assessing the effectiveness of TP services was conducted using
PubMed, EMBASE, and Cochrane Central databases, from inception through
November 18, 2020. Studies that compared TP with FTF anticoagulation
services in the ambulatory care setting were included. Outcomes of
interest included thromboembolic events, major bleeding, minor bleeding,
any bleeding, warfarin international normalized ratio (INR) time in
therapeutic range (TTR), frequency of extreme INR, anticoagulation-related
emergency department visits, anticoagulation-related hospitalization, any
hospitalization, and mortality. Relative risk (RR) and weighted mean
difference were calculated using the DerSimonian and Laird random-effects
model. <br/>Result(s): Overall, 11 studies involving 8395 patients were
included in the systematic review, and 9 studies were included in the
pooled meta-analysis. Compared with FTF service, TP was associated with a
lower risk of any bleeding and any hospitalization, with RRs of 0.65 (95%
CI = 0.47 to 0.90; P = 0.01) and 0.59 (95% CI = 0.39 to 0.87; P = 0.01),
respectively. There was no statistically significant difference in TTR or
the risk of extreme supratherapeutic INR, major bleeding, minor bleeding,
or thromboembolic events between the 2 groups. <br/>Conclusion(s): TP
appears to be at least as effective as FTF anticoagulation services.
Findings from this study support the utilization of TP practice models in
ambulatory care anticoagulation management.<br/>Copyright &#xa9; The
Author(s) 2020.

<68>
Accession Number
2007616637
Title
Endocarditis in kidney transplant recipients: a systematic review.
Source
Journal of Chemotherapy. 33(5) (pp 269-275), 2021. Date of Publication:
2021.
Author
Ioannou P.; Alexakis K.; Kofteridis D.P.
Institution
(Ioannou, Alexakis, Kofteridis) Department of Internal Medicine &
Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
Publisher
Taylor and Francis Ltd.
Abstract
Infective Endocarditis (IE) carries significant mortality. Bacteremia,
which is a predisposing factor for IE, occurs more frequently in
immunocompromised individuals. Interestingly, IE in kidney transplant
recipients has not been adequately described. The aim of this study was to
systematically review all published cases of IE in kidney transplant
recipients and describe their epidemiology, microbiology, clinical
characteristics, treatment and outcomes. A systematic review of PubMed
(through 13^th December 2019) for studies providing
epidemiological, clinical, microbiological as well as treatment data and
outcomes of IE in kidney transplant recipients was performed. A total of
60 studies, containing data of 117 patients, were included in the
analysis. The most common causative pathogens were gram-positive
microorganisms in 57.4%, gram-negative microorganisms in 14.8%, fungi in
20%, while in 18.9% of cases, IE was culture-negative. Aortic valve was
the most commonly infected valve followed by mitral, tricuspid and the
pulmonary valve. Diagnosis was set with a transthoracic ultrasound in half
the cases, followed by transesophageal ultrasound and autopsy. Fever was
present in most cases, while embolic phenomena were noted in two out of
five cases. Aminoglycosides, cephalosporins and aminopenicillins were the
most commonly used antimicrobials, and surgical management was performed
in one out of three cases. Clinical cure was noted in 60.9%, while overall
mortality was 45.3%. To conclude, this systematic review thoroughly
describes IE in kidney transplant recipients and provides information on
epidemiology, clinical presentation, treatment and outcomes. Moreover, it
identifies the emerging role of Enterococci, gram-negatives and fungi in
IE in this population.<br/>Copyright &#xa9; 2020 Edizioni Scientifi che
per l'Informazione su Farmaci e Terapia.

<69>
Accession Number
2007018057
Title
Femoral versus nonfemoral subclavian/ carotid arterial access route for
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Journal of the American Heart Association. 9(19) (no pagination), 2020.
Article Number: e017460. Date of Publication: 06 Oct 2020.
Author
Faroux L.; Junquera L.; Mohammadi S.; Del Val D.; Muntane-Carol G.; Alperi
A.; Kalavrouziotis D.; Dumont E.; Paradis J.-M.; Delarochelliere R.;
Rodes-Cabau J.
Institution
(Faroux, Junquera, Mohammadi, Del Val, Muntane-Carol, Alperi,
Kalavrouziotis, Dumont, Paradis, Delarochelliere, Rodes-Cabau) Quebec
CityQCCanada
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Some concerns remain regarding the safety of transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement. We
aimed to compare the risk of 30-day complications and death in
transcarotid/transsubclavian versus transfemoral transcatheter aortic
valve replacement recipients. METHODS AND RESULTS: Data from 20 studies,
including 79 426 patients (16 studies) and 3992 patients (4 studies) for
the evaluation of the unadjusted and adjusted impact of the arterial
approach were sourced, respectively. The use of a transcarotid/
transsubclavian approach was associated with an increased risk of stroke
when using unadjusted data (risk ratio [RR], 2.28; 95% CI, 1.90-2.72) as
well as adjusted data (odds ratio [OR], 1.53; 95% CI, 1.05-2.22). The
pooled results deriving from unadjusted data showed an increased risk of
30-day death (RR, 1.46; 95% CI, 1.22-1.74) and bleeding (RR, 1.53; 95% CI,
1.18-1.97) in patients receiving transcatheter aortic valve replacement
through a transcarotid/transsubclavian access (compared with the
transfemoral group), but the associations between the arterial access and
death (OR, 1.22; 95% CI, 0.89-1.69), bleeding (OR, 1.05; 95% CI,
0.68-1.61) were no longer significant when using adjusted data. No
significant effect of the arterial access on vascular complication was
observed in unadjusted (RR, 0.84; 95% CI, 0.66-1.06) and adjusted (OR,
0.79; 95% CI, 0.53-1.17) analyses. <br/>CONCLUSION(S): Transcarotid and
transsubclavian approaches for transcatheter aortic valve replacement were
associated with an increased risk of stroke compared with the transfemoral
approach. However, these nonfemoral arterial alternative accesses were not
associated with an increased risk of 30-day death, bleeding, or vascular
complication when taking into account the confounding
factors.<br/>Copyright &#xa9; 2020 The Authors. Published on behalf of the
American Heart Association, Inc., by Wiley.

<70>
Accession Number
635317125
Title
Anti-Xa Monitoring of Low-Molecular-Weight Heparin during Pregnancy: A
Systematic Review.
Source
Seminars in Thrombosis and Hemostasis. 47(7) (pp 824-842), 2021. Date of
Publication: 01 Oct 2021.
Author
Kjaergaard A.B.; Fuglsang J.; Hvas A.-M.
Institution
(Kjaergaard, Hvas) Department of Clinical Biochemistry, Palle Juul-Jensens
Boulevard 99, Aarhus N 8200, Denmark
(Fuglsang) Department of Obstetrics and Gynecology, Aarhus University
Hospital, Aarhus, Denmark
(Fuglsang, Hvas) Department of Clinical Medicine, Aarhus University,
Aarhus, Denmark
Publisher
Thieme Medical Publishers, Inc.
Abstract
Low-molecular-weight heparin (LMWH) is commonly used for preventing or
treating venous thromboembolic disease (VTE) during pregnancy. The
physiological changes in maternal metabolism have led to discussions on
optimal LMWH dosing strategy and possible need for monitoring. The aim of
this systematic review is to summarize and discuss whether LMWH dose
adjustment according to anti-Xa provides superior effectiveness and safety
compared with weight adjusted or fixed dosed LMWH in pregnant women. A
systematic literature search was performed in PubMed, Embase, and Scopus
on September 26, 2020. The study is reported according to Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines. Effectiveness was defined as episodes of thrombosis and safety
as bleeding episodes. In total, 33 studies were included: 4 randomized
controlled studies and 29 cohort studies. Prophylactic dosing strategies
employing weight dosed, fixed dosed, or anti-Xa adjusted LMWH dosing
performed equal in effectiveness and safety. In pregnant women with VTE or
high thromboembolic risk, therapeutic weight-adjusted LMWH and weight plus
anti-Xa-adjusted LMWH provided equal results in terms of effectiveness and
safety. Pregnant women with mechanical heart valves (MHVs) received
therapeutic anti-Xa-adjusted LMWH with four out of seven studies
presenting mean peak anti-Xa within target ranges. Still, pregnant women
with MHV experienced both thrombosis and bleeding with anti-Xa in target.
Based on the results of this systematic review, current evidence does not
support the need for anti-Xa monitoring when using LMWH as
thromboprophylaxis or treatment during pregnancy. Nonetheless, the need
for anti-Xa monitoring in pregnant women with MHV may need further
scrutiny.<br/>Copyright &#xa9; 2021 Georg Thieme Verlag. All rights
reserved.

<71>
Accession Number
2013859948
Title
Management of ganciclovir resistance cytomegalovirus infection with CMV
hyperimmune globulin and leflunomide in seven cardiothoracic transplant
recipients and literature review.
Source
Transplant Infectious Disease. (no pagination), 2021. Date of
Publication: 2021.
Author
Santhanakrishnan K.; Yonan N.; Iyer K.; Callan P.; Al-aloul M.;
Venkateswaran R.
Institution
(Santhanakrishnan, Yonan, Iyer, Callan, Al-aloul, Venkateswaran)
Transplant Department, Wythenshawe Hospital, Manchester University NHS
Foundation Trust, Manchester, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Cytomegalovirus (CMV) disease caused by genetically resistant CMV poses a
major challenge in solid organ transplant recipients, and the development
of resistance is associated with increased morbidity and mortality.
Antiviral resistance affects 5%-12% of patients following ganciclovir
(GCV) therapy, but is more common in individuals with specific underlying
risk factors. These include the CMV D+R- serostatus, type of transplanted
organ, dose and duration of (Val)GCV ([V]GCV) prophylaxis, peak viral
loads, and the intensity of immunosuppressive therapy. Guideline
recommendations for the management of GCV resistance (GanR) in solid organ
transplant recipients are based on expert opinion as there is a lack of
data from controlled trials. Second-line options to treat GanR include
foscarnet (FOS) and cidofovir (CDV), but these drugs are often poorly
tolerated due to high rates of toxicity, such as renal dysfunction and
neutropenia. Here, we report seven cardiothoracic transplant recipients
with GCV resistance CMV infection from our centre treated with CMV
immunoglobulin (CMVIG) +/- leflunomide (LEF) and reviewed the literature
on the use of these agents in this therapeutic setting.<br/>Copyright
&#xa9; 2021 Wiley Periodicals LLC

<72>
Accession Number
2010402319
Title
Therapeutic Controversies in the Medical Management of Valvular Heart
Disease.
Source
Annals of Pharmacotherapy. 55(11) (pp 1379-1385), 2021. Date of
Publication: November 2021.
Author
Barry A.R.; Wang E.H.Z.
Institution
(Barry) University of British Columbia, Vancouver, BC, Canada
(Barry) Chilliwack General Hospital, Lower Mainland Pharmacy Services,
Chilliwack, BC, Canada
(Wang) St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver,
BC, Canada
Publisher
SAGE Publications Inc.
Abstract
Objective: To evaluate the evidence for common therapeutic controversies
in the medical management of valvular heart disease (VHD). <br/>Data
Sources: A literature search of PubMed (inception to December 2020) was
performed using the terms angiotensin-converting enzyme (ACE) inhibitors
or angiotensin receptor blockers (ARBs) and aortic stenosis (AS); and
adrenergic beta-antagonists and aortic valve regurgitation (AR) or mitral
stenosis (MS). Study Selection and Data Extraction: Randomized controlled
trials (RCTs) and meta-analyses conducted in humans and published in
English that reported >=1 clinical outcome were included. <br/>Data
Synthesis: Nine articles were included: 3 RCTs and 1 meta-analysis for ACE
inhibitors/ARBs in AS, 1 RCT for beta-blockers in AR, and 4 RCTs for
beta-blockers in MS. Evidence suggests that ACE inhibitors/ARBs do not
increase the risk of adverse outcomes in patients with AS but may delay
valve replacement. beta-Blockers do not appear to worsen outcomes in
patients with chronic AR and may improve left-ventricular function in
patients with a reduced ejection fraction. beta-Blockers do not improve
and may actually worsen exercise tolerance in patients with MS in sinus
rhythm. Relevance to Patient Care and Clinical Practice: ACE
inhibitors/ARBs and beta-blockers can likely be safely used in patients
with AS or AR, respectively, who have a compelling indication. There is
insufficient evidence to recommend routine use of beta-blockers in
patients with MS without atrial fibrillation. <br/>Conclusion(s): Common
beliefs about the medical treatment of VHD are not supported by
high-quality data. There remains a need for larger-scale RCTs in the
medical management of VHD.<br/>Copyright &#xa9; The Author(s) 2021.

<73>
Accession Number
2006135383
Title
Effects of anesthetics on microvascular reactivity measured by vascular
occlusion tests during off-pump coronary artery bypass surgery: a
randomized controlled trial.
Source
Journal of Clinical Monitoring and Computing. 35(5) (pp 1219-1228), 2021.
Date of Publication: October 2021.
Author
Cho Y.J.; Yoo S.J.; Nam K.; Bae J.Y.; Lee S.H.; Jeon Y.
Institution
(Cho, Yoo, Nam, Bae, Lee, Jeon) Department of Anesthesiology and Pain
Medicine, Seoul National University Hospital, Seoul National University
College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
Publisher
Springer Science and Business Media B.V.
Abstract
Abstract: Microvascular function may be modulated by various anesthetics.
Desflurane and propofol anesthesia have different effects on microvascular
function. However, there are few reports on the effects of sevoflurane and
desflurane on microvascular function during cardiac surgery. We compared
the effects of sevoflurane and desflurane on microvascular reactivity, as
measured by the vascular occlusion tests (VOTs) during off-pump coronary
artery bypass (OPCAB) surgery. Patients undergoing OPCAB were eligible for
study inclusion. Patients were excluded if they were unsuitable for
treatment with volatile agents or the VOT, had renal failure or
uncontrolled diabetes, or were pregnant. The enrolled patients were
randomized to receive sevoflurane or desflurane during surgery. Tissue
oxygen saturation (StO<inf>2</inf>) dynamics during the VOT were measured
at baseline (pre-anesthesia), pre-anastomosis, post-anastomosis of vessel
grafts, and at the end of surgery. Macrohemodynamic variables, arterial
blood gas parameters, and in-hospital adverse events were also evaluated.
A total of 64 patients (32 in each group) were analyzed. StO<inf>2</inf>
dynamics did not differ between the groups. Compared to baseline,
StO<inf>2</inf> and the rate of recovery following vascular occlusion
decreased at the end of surgery in both groups (adjusted p-value, <
0.001), and no group difference was observed. Macrohemodynamic variables,
blood gas analysis results, and the rate of postoperative in-hospital
adverse events were similar between the groups. Microvascular reactivity,
as measured by the VOT during OPCAB, showed no difference between the
sevoflurane and desflurane groups. Also, there were no group differences
in macrohemodynamics or the rate of postoperative adverse events. Trial
registration: Clinicaltrials.gov, identifier NCT03209193; registered on
July 3, 2017.<br/>Copyright &#xa9; 2020, Springer Nature B.V.

<74>
Accession Number
2014980621
Title
Cerebrovascular autoregulation impairments during cardiac surgery with
cardiopulmonary bypass are associated with postoperative cognitive
deterioration.
Source
Journal of the Neurological Sciences. Conference: World Congress of
Neurology (WCN 2021). Rome Italy. 429(Supplement) (no pagination), 2021.
Article Number: 118329. Date of Publication: October 2021.
Author
Petkus V.; Kumpaitiene B.; Svagzdiene M.; Sirvinskas E.; Zakelis R.;
Benetis R.; Ragauskas A.
Institution
(Petkus, Zakelis, Ragauskas) Kaunas University of Technology, Health
Telematics Science Institute, Kaunas, Lithuania
(Kumpaitiene, Svagzdiene, Sirvinskas, Benetis) Hospital of Lithuanian
University of Health Sciences Kauno Klinikoss, Clinic of Cardiothoracic
and Vascular Surgery, Kaunas, Lithuania
Publisher
Elsevier B.V.
Abstract
Background and aims: Post-operative cognitive dysfunction (POCD) occurs in
33-83% of patients after cardiac surgery with cardiopulmonary bypass
(CPB). Intraoperative non-invasive monitoring of cerebrovascular
autoregulation (CA) of individual patient may help to prevent POCD by
detecting and control of optimal mean arterial blood pressure (optABP) or
optimal cerebral perfusion pressure (optCPP). Objectives of the study are
to investigate the association between CA dynamics and POCD.
<br/>Method(s): The study of non-invasive ultrasonic CA monitoring
included 59 patients undergoing elective coronary artery bypass graft
surgery with CPB. Non-invasive ultrasonic CA monitor for identification of
real-time volumetric reactivity index (VRx(t)) was used in order to
identify dynamics of CA changes. Feedback from CA monitor to surgical
theatre will be used at first time in order to optimize dynamic control of
optCPP(t) in our new prospective study. <br/>Result(s): 22 patients
experienced POCD, 37 patients (63%) showed no cognitive deterioration. The
duration of the single longest CA impairment (LCAI) event was associated
with occurrence of POCD. The critical duration of the single longest CA
impairment event was 5.02 min (odds ratio 14.5; CI 3.9-51.8). ROC area
under curve 0.81, sensitivity 76%, specificity 82% has been shown for the
duration of the LCAI event. Protocol of novel study with feedback will be
presented. <br/>Conclusion(s): Prospective observational clinical study
showed that too long patient-specific single CA impairment is associated
with POCD. Novel prospective clinical study already started in order to
get evidences that dynamic control of optABP keeping intact CA can
decrease a rate of POCD.<br/>Copyright &#xa9; 2021

<75>
Accession Number
2014929861
Title
CLOT IN TRANSIT: A DILEMA OF MEDICAL OR SURGICAL MANAGEMENT.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A2190), 2021. Date of Publication: October 2021.
Author
Frey J.; Brownback K.
Publisher
Elsevier Inc.
Abstract
TOPIC: Pulmonary Vascular Disease TYPE: Fellow Case Reports INTRODUCTION:
Clot in transit (CIT) constitutes a rare manifestation of venous
thromboembolism that is associated with a high mortality. Here, we present
a case of CIT that was managed medically. CASE PRESENTATION: A 53-year-old
female with history of metastatic gastric adenocarcinoma presented to our
institution for evaluation of a two-day history of progressive dyspnea. On
arrival, the patient was tachycardic with a heart rate of 110 beats per
minute, hypoxic requiring 2L of supplemental oxygen, but normotensive. An
electrocardiogram demonstrated sinus tachycardia with non-specific ST
changes. Initial laboratory data demonstrated and unremarkable complete
blood count and comprehensive metabolic panel. Brain natriuretic peptide
and troponin were also normal. A CT angiography of the chest was obtained
which demonstrated a saddle pulmonary embolus. A transthoracic
echocardiogram was obtained which demonstrated normal bi-ventricular
function, but there two mobile densities in the right atrium concerning
for mobile thrombus. The patient was started on therapeutic
anticoagulation with Enoxaparin 1 mg/kg twice daily. With concern for CIT,
interventional radiology and cardiothoracic surgery were consulted for
possible intervention, which the patient ultimately declined, opting for
medical management. She was ultimately discharged home on therapeutic
anticoagulation with Apixaban. DISCUSSION: CIT is a an uncommon
manifestation of venous thromboembolism with a prevalence between 3-18% in
patients with acute pulmonary embolus. Risk factors associated with the
development of CIT include heart failure, hypotension, presence of central
venous catheters, and more severe pulmonary emboli. Echocardiogram is the
imaging modality of choice for diagnosing CIT, but has a low sensitivity
between 50-60%. Multiple treatment modalities have been described for the
treatment of CIT including systemic anticoagulation, systemic
thrombolysis, catheter-directed thrombolysis, and surgical embolectomy. A
recent pooled analysis demonstrated lower mortality among those who
underwent surgical embolectomy or thrombolysis when compared to
anticoagulation in both hemodynamically stable and unstable patients.
Nevertheless, mortality is high for patients with CIT, with 30-day
mortality as high as 45% in patients receiving treatment.
<br/>CONCLUSION(S): CIT is uncommon, but can represent a life-threatening
form of venous thromboembolism. More research is needed to identify the
optimal treatment, but this case suggests therapeutic anticoagulation may
be sufficient for a certain subset of patients. REFERENCE #1: Garvey S,
Dudzinski DM, Giordano N, Torrey J, Zheng H, Kabrhel C. Pulmonary embolism
with clot in transit: An analysis of risk factors and outcomes. Thromb
Res. 2020 Mar;187:139-147. REFERENCE #2: Kabrhel C, Rosovsky R, Garvey S.
Special Considerations in Pulmonary Embolism: Clot-in-Transit and
Incidental Pulmonary Embolism. Crit Care Clin. 2020 Jul;36(3):531-546.
REFERENCE #3: Athappan G, Sengodan P, Chacko P, Gandhi S. Comparative
efficacy of different modalities for treatment of right heart thrombi in
transit: A pooled analysis. Vasc Med. 2015;20(2):131-38. DISCLOSURES: No
relevant relationships by Kyle Brownback, source=Web Response,
value=Honoraria Removed 04/24/2021 by Kyle Brownback, source=Web Response
No relevant relationships by John Frey, source=Web Response<br/>Copyright
&#xa9; 2021 American College of Chest Physicians

<76>
Accession Number
2014929815
Title
CARDIAC TEMPONADE SECONDARY TO ENASIDENIB-INDUCED DIFFERENTIATION SYNDROME
IN A PATIENT WITH ACUTE MYELOID LEUKEMIA.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A911), 2021. Date of Publication: October 2021.
Author
Shah S.Y.; Janagam P.; Thomas A.; Hussain R.
Publisher
Elsevier Inc.
Abstract
TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Isocitrate dehydrogenase differentiation syndrome (IDH-DS)
is a life-threatening complication that occurs in patients with acute
myeloid leukemia (AML) receiving target mutant therapy with IDH
inhibitors. Here we will report a case of IDH-DS in a patient with AML
receiving Enasidenib therapy presenting as cardiac tamponade, which is
rarely reported. CASE PRESENTATION: A 75 years old male with AML diagnosed
two months ago presented to the emergency for exertional shortness of
breath and cough that started two weeks after initiation of Enasidenib
therapy. On examination, blood pressure was 94/74 mm Hg, the pulse of
110/min, peripheral oxygen saturation of 90% on room air, bilateral (b/l)
mild expiratory wheezes, and muffled heart sounds. Routine labs were
abnormal for a white blood cell count of 32x103/ul, serum creatinine of
2.5 mg/dl, and blood urea nitrogen of 30 mg/dl. Chest X-ray was
unremarkable. A computed tomography scan of the chest showed b/l
ground-glass micronodules, a subtle mosaic pattern in the lungs b/l, small
right-sided pleural effusion, and a massive pericardial effusion.
Echocardiography showed an ejection fraction of 50-55%, moderately large
anterior pericardial effusion with evidence of early right atrial and
right ventricular diastolic collapse, suggesting early tamponade. The
patient was started on intravenous dexamethasone based on clinical
suspicion of IDH-DS. Pericardiocentesis was performed and 625 ml of
hemorrhagic fluid was drained. During the procedure, the patient went into
cardiac arrest and was successfully resuscitated. Pericardial fluid
analysis showed lymphocytic predominant effusion, a total protein of 5.3
g/dl, and an LDH of 536 u/l. Bacteriological and fungal cultures performed
on the pericardial fluid were negative. Due to the high probability of
recurrence of pericardial effusion, a pericardial window procedure was
planned but the patient refused and desired to be on Hospice care. Later
on, the patient died after two months DISCUSSION: The early diagnosis of
IDH-DS can be challenging due to a lack of diagnostic criteria. There are
no randomized studies to compare patients treated with steroids compared
to those who are not. Also, there is no definitive data on steroids
therapy for IDH-DS prophylaxis. Given the life-threatening nature of DS
and no significant risk associated with starting steroids for a limited
time course, initiation of empiric treatment is recommended as soon as
IDH-DS is suspected. <br/>CONCLUSION(S): IDH-DS is a fatal adverse
reaction of IDH inhibitors that requires immediate recognition and
management. Despite being well described, several issues remain unresolved
therefore well-controlled randomized studies need to be done to better
understand the disease. REFERENCE #1: Patel SA. Enasidenib-Induced
Differentiation Syndrome in IDH2-Mutant Acute Myeloid Leukemia. JAMA
Oncol. 2018 Aug 1;4(8):1110-1111. doi: 10.1001/jamaoncol.2017.4724. PMID:
29346477 REFERENCE #2: Fathi AT, DiNardo CD, Kline I, Kenvin L, Gupta I,
Attar EC, Stein EM, de Botton S; AG221-C-001 Study Investigators.
Differentiation Syndrome Associated With Enasidenib, a Selective Inhibitor
of Mutant Isocitrate Dehydrogenase 2: Analysis of a Phase 1/2 Study. JAMA
Oncol. 2018 Aug 1;4(8):1106-1110. doi: 10.1001/jamaoncol.2017.4695. PMID:
29346478; PMCID: PMC5885269. REFERENCE #3: Norsworthy KJ, Mulkey F, Scott
EC, Ward AF, Przepiorka D, Charlab R, Dorff SE, Deisseroth A, Kazandjian
D, Sridhara R, Beaver JA, Farrell AT, de Claro RA, Pazdur R.
Differentiation Syndrome with Ivosidenib and Enasidenib Treatment in
Patients with Relapsed or Refractory IDH-Mutated AML: A U.S. Food and Drug
Administration Systematic Analysis. Clin Cancer Res. 2020 Aug
15;26(16):4280-4288. doi: 10.1158/1078-0432.CCR-20-0834. Epub 2020 May 11.
PMID: 32393603; PMCID: PMC7442588. DISCLOSURES: No relevant relationships
by Raza Hussain, source=Web Response No relevant relationships by Pragna
Janagam, source=Web Response No relevant relationships by Syed yousaf
Shah, source=Web Response No relevant relationships by Akesh Thomas,
source=Web Response<br/>Copyright &#xa9; 2021 American College of Chest
Physicians

<77>
Accession Number
2014929600
Title
CATAMENIAL HEMOPNEUMOTHORAX: AN UNUSUAL CASE OF ENDOMETRIOSIS OF THE
PLEURA.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A1358), 2021. Date of Publication: October 2021.
Author
Hassan A.; Jafry A.; Gupta S.; Ul Haq A.; Moad J.; Bhardwaj H.
Publisher
Elsevier Inc.
Abstract
TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Catamenial Pneumothorax is a rare cause of recurrent
spontaneous pneumothorax in ovulating females due to abnormal presence of
endometrial tissue in pleura and diaphragm. A temporal correlation of
menstrual cycles and spontaneous pneumothoraces is the key clue.[1][2] We
present a case of recurrent pneumothoraces and right sided pleural
effusions with histopathological evidence of pleural and diaphragmatic
endometriosis. CASE PRESENTATION: A 33-year-old African American female
with past medical history of recurrent right sided pleural effusion
drained multiple times and right sided pneumothoraxes, reportedly three
and occurring every other month for the last 8 months, presented to an our
hospital for shortness of breath. She had never been a smoker, denied
vaping or any recreational inhalational drugs. She had no family history
of pneumothoraces. Her body habitus did not suggest a connective tissue
disorder. Her review of systems was only remarkable for heavy painful
menses. Her chest X-ray right sided pleural effusion. A bedside
thoracentesis was performed and approximately 1L of bloody fluid was
drained. The fluid was exudative per Light's criteria, cytology was
concerning for atypical cells suggesting endometrial cells and the
pathology was negative for any malignancy. On further investigation, the
patient reported shortness of breath and subsequent development of
hemopneumothorax only during her menstrual cycle or right after that. She
had surgical removal of an intra-uterine device (IUD) 9 years and
dilatation and curettage (DnC) procedure done 5 years prior to this
presentation. Interestingly, her transvaginal ultrasound was negative for
pelvic endometriosis. She underwent a video-assisted thoracoscopic (VATS)
procedure and had right partial pleurectomy, right mechanical and chemical
pleurodesis, resection of diaphragmatic implants and repair of
diaphragmatic fenestrations. The biopsy from diaphragmatic and pleural
site confirmed the diagnosis of diaphragmatic and pleural endometriosis.
The patient was started on birth-control with medroxyprogestrone depot
shot every three months and reported improvement in her menstrual symptoms
with no further episode of pneumothorax. DISCUSSION: The mechanism of
catamenial pneumothorax is poorly understood, the likely explanation is
vascular metastasis or extra-vascular migration of endometrial tissue,
from uterus to pelvis and peritoneal cavity, and finally implanting in
diaphragm. The proliferation of these endometrial tissue implants
secondary to hormonal changes causes local necrosis and rupture causing
hemopneumothorax. Treatment involves birth control, VATS and pleurodesis.
Careful examination of diaphragm for any acquired fenestrations is also
important.[3] <br/>CONCLUSION(S): Recurrent spontaneous pneumothorax and
pleural effusions in young females due to endometriosis is extremely rare
but should be suspected in absence of other secondary causes. REFERENCE
#1: Alifano, Marco, et al. "Catamenial pneumothorax: a prospective study."
Chest 124.3 (2003) REFERENCE #2: Korom, Stephan, et al. "Catamenial
pneumothorax revisited: clinical approach and systematic review of the
literature." The Journal of Thoracic and Cardiovascular Surgery 128.4
(2004): 502-508. REFERENCE #3: Bagan, Patrick, et al. "Catamenial
pneumothorax: retrospective study of surgical treatment." The Annals of
thoracic surgery 75.2 (2003): 378-381 DISCLOSURES: No relevant
relationships by Himanshu Bhardwaj, source=Web Response No relevant
relationships by Samiksha Gupta, source=Web Response No relevant
relationships by Ahmad Hassan, source=Web Response No relevant
relationships by Ali Jafry, source=Web Response No relevant relationships
by Jeremy Moad, source=Web Response No relevant relationships by Aejaz Ul
Haq, source=Web Response<br/>Copyright &#xa9; 2021 American College of
Chest Physicians

<78>
Accession Number
2014929203
Title
HEREDITARY MULTIPLE EXOSTOSES PRESENTING WITH CHEST PAIN IN ADOLESCENT
MALE.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A1940), 2021. Date of Publication: October 2021.
Author
Gustafson B.; Ulrich L.
Publisher
Elsevier Inc.
Abstract
TOPIC: Pediatrics TYPE: Fellow Case Reports INTRODUCTION: Hereditary
multiple exostoses (HME) is a syndrome characterized by presence of two or
more osteochondromas (exostoses) in the appendicular or axial skeleton.
Here, we present a case of an adolescent patient presenting with chest
pain as the only symptom of an intrathoracic exostosis leading to the
diagnosis of HME. CASE PRESENTATION: A previously healthy 15-year-old male
presented to the pediatric pulmonary clinic for months-long history of
recurrent left-sided chest pain, without any associated symptoms. Chest
x-ray showed an ill-defined nodular opacity in the left upper lobe, with
central calcification identified. Additional work-up with spirometry,
complete blood count, fungal antibody panel, and Histoplasma urine antigen
testing was normal. Family history was positive for pulmonary embolism and
"blood clotting issues" with no specific syndromes identified. A chest
computed tomography angiography (CTA) with contrast was ordered for
further evaluation.Chest CTA revealed a large bony exostosis arising from
the anterior aspect of the left third rib, with two areas of surrounding
nodular soft tissue measuring 3 cm x 1.3 cm x 2.6 cm. There was extension
into the lung abutting the pleura and lateral aspect of the mediastinum.
Additional bony protuberances were noted along the left fifth rib, right
second rib, and bilateral scapulae. A diagnosis of HME was made because of
the presence of multiple exostoses. Due to continued chest pain he was
referred to cardiothoracic surgery. The decision was made to monitor
symptoms and obtain repeat imaging in six months to monitor growth or
worsening lung impingement. DISCUSSION: HME is characterized by the
presence of two or more exostoses in the appendicular or axial skeleton.
The most common location of exostoses is in the appendicular skeleton.
Though rare, involvement of the ribs can occur [1]. Previous case reports
have identified presence of multiple costal exostoses in patients with
known HME [1,2]. The patient presented here represents a case with chest
pain as the only presenting complaint prior to diagnosis of HME being
made. The presence of a costal exostosis should be considered in
adolescents presenting with chest pain if other more common causes are
ruled out. The presence of multiple exostoses supports the diagnosis of
HME. Cases of HME with costal exostoses can be associated with
intrathoracic complications, including hemothorax, pneumothorax, and
pericardial effusion [3]. Supportive care and observation is the usual
plan of care. However, if complications develop, surgical resection may be
necessary and cardiothoracic surgery consultation is recommended.
<br/>CONCLUSION(S): Chest pain may be the only presenting symptom in
pediatric patients with HME. REFERENCE #1: Mazza D, Fabbri M, Calderaro C,
Iorio C, Labianca L, Poggi C, Turturro F, Montanaro A, Ferretti A. Chest
pain caused by multiple exostoses of the ribs: A case report and a review
of literature. World J Orthop. 2017 May 18;8(5):436-440 REFERENCE #2:
Khosla A, Parry RL. Costal osteochondroma causing pneumothorax in an
adolescent: a case report and review of the literature. J Pediatr Surg.
2010 Nov;45(11):2250-3. REFERENCE #3: Yan G, Littlewood A, Latimer MD.
Unusual cause of pleuritic chest pain in a child. BMJ Case Rep. 2016 Nov
28;2016:bcr2016217307. DISCLOSURES: No relevant relationships by Brooke
Gustafson, source=Web Response No relevant relationships by Lisa Ulrich,
source=Web Response<br/>Copyright &#xa9; 2021 American College of Chest
Physicians

<79>
Accession Number
2014928605
Title
PULMONARY TUMOR THROMBOTIC MICROANGIOPATHY: THE RARE AND FATAL ASSOCIATION
OF ADENOCARCINOMA AND RIGHT VENTRICULAR FAILURE.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A2185), 2021. Date of Publication: October 2021.
Author
Sharma R.; Ismail R.; Sallam O.; Hegab S.
Publisher
Elsevier Inc.
Abstract
TOPIC: Pulmonary Vascular Disease TYPE: Fellow Case Reports INTRODUCTION:
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare etiology of
pulmonary hypertension (PH). It is fatal with diagnosis often made
postmortem. It should be suspected in patients with adenocarcinoma with
sudden onset of dyspnea with right ventricular (RV) failure. We describe a
patient whose first presentation of signet cell gastric adenocarcinoma was
acute RV failure. CASE PRESENTATION: 52-year old woman presented with
sudden dyspnea, tachycardia, abdominal swelling and fatigue. Chest
radiograph was significant for pulmonary edema. Computed Tomography
Angiography (CTA) of the chest showed a dilated pulmonary artery, large
pericardial effusion, interlobular septal thickening, with centrilobular
nodules and scattered ground glass opacities (GGO), with no evidence of
pulmonary embolism. CTA of the abdomen and pelvis revealed large mixed
density masses within the pelvis, presumed to be ovarian in origin.
Additionally, numerous mixed lytic and sclerotic lesions were noted in the
axial skeleton. Echocardiogram revealed a hyperdynamic left ventricular
ejection fraction of 70%, flattened interventricular septum, severe RV
enlargement, large circumferential pericardial effusion, RV fractional
area change of 6.9%, and TAPSE of 1.61. Cardiac tamponade was present as
evidenced by severe right atrial collapse. Right heart catheterization
showed the following in mmHg: mean right atrial pressure of 29, right
ventricular end diastolic pressure of 30, mean pulmonary arterial pressure
of 72, pulmonary capillary wedge pressure of 39, cardiac output and index
of 3.58 l/min and 1.85 l/min respectively with pulmonary vascular
resistance of 8.37 Wood Units. A pericardiocentesis was performed with
removal of 150 ml of fluid at which time the patient developed hemodynamic
instability, requiring inotropic support. Patient enrolled in hospice care
and died during the admission. Autopsy results revealed metastatic signet
cell gastric adenocarcinoma with invasion of the lung, pleura, right and
left ventricles, pericardium, bilateral ovaries and axial skeleton.
Notable was lymphovascular invasion in the pulmonary arterial bed.
DISCUSSION: PTTM results from microscopic tumor emboli that causes
fibrocellular intimal proliferation in small vessels of the lung,
resulting in pulmonary capillary stenosis and increased PVR, causing PH.
PTTM is associated with gastric adenocarcinoma. Patients present with
acute dyspnea with mean interval between symptoms and death only a month.
CT findings include GGO, intra and interlobular septal thickening,
lymphadenopathy and right sided heart failure. <br/>CONCLUSION(S): PTTM is
a radiographic, clinical and pathologic entity. The rapidity of onset and
severity of decompensation make large pulmonary embolism and pulmonary
venous occlusive disease as considerations in the differential of PTTM.
Earlier recognition of PTTM and aggressive diagnostic workup for
malignancy may improve mortality. REFERENCE #1: Seol SH, Park BM, Jin HY,
Kim DI. Fatal acute right heart failure in gastric cancer patients. Heart
Views. 2013 Oct;14(4):179-81. doi: 10.4103/1995-705X.126883. PMID:
24696760; PMCID: PMC3970374. REFERENCE #2: Godbole RH, Saggar R, Kamangar
N. Pulmonary tumor thrombotic microangiopathy: a systematic review. Pulm
Circ. 2019 Apr-Jun;9(2):2045894019851000. doi: 10.1177/2045894019851000.
PMID: 31032740; PMCID: PMC6540517. REFERENCE #3: Godbole R, Ghatol A,
Betancourt J, Sacoolidge J, Kamangar N. Pulmonary Tumor Thrombotic
Microangiopathy: Clinical, Radiologic, and Histologic Correlation. J Clin
Imaging Sci. 2015 Jul 31;5:44. doi: 10.4103/2156-7514.161978. PMID:
26312142; PMCID: PMC4541166. DISCLOSURES: No relevant relationships by
Sara Hegab, source=Web Response Speaker/Speaker's Bureau relationship with
Bayer Please note: 11/20/20-4/2021 Added 04/29/2021 by Reem Ismail,
source=Web Response, value=Consulting fee No relevant relationships by
Omar Sallam, source=Web Response No relevant relationships by Rajaninder
Sharma, source=Web Response<br/>Copyright &#xa9; 2021 American College of
Chest Physicians

<80>
Accession Number
2014928574
Title
AN INCIDENTAL FINDING OF TYPICAL CARCINOID.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A1674), 2021. Date of Publication: October 2021.
Author
Villamizar J.; Hernandez F.
Publisher
Elsevier Inc.
Abstract
TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Typical carcinoid is a rare neuroendocrine tumor (NET); they
represent 1 to 2% of all lung malignancies in adults. Typical NETs are
more common than atypical carcinoid, characterized by a low mitotic rate.
Risk factors remain unclear; most cases are sporadic. We present the case
of an asymptomatic woman diagnosed with a typical carcinoid tumor. CASE
PRESENTATION: 59-year-old woman with a past medical history significant
for hyperlipidemia, non-alcoholic fatty liver disease, and a smoking
history of 9 pack-years. After findings on low dose computed tomography
(CT) of a right middle lobe lung nodule as part of routine lung cancer
screening, she was referred to our Pulmonary clinic. Subsequently, a
High-Resolution CT chest confirmed an 11 x 10 mm nodule that was
suspicious for malignancy, as well as fibrotic changes in the apices and
atelectasis in the left lung base. Abdominal CT showed no abnormalities.
On history, she denied any symptoms. Routine laboratory work up, physical
examination and pulmonary function test were unremarkable. She underwent
an Electromagnetic Navigational Bronchoscopy (ENB) for biopsy of the
lesion. Histopathologic findings confirmed a carcinoid tumor of the right
lung, with mitotic figures averaging less than 1 per high power field,
cells were positive for keratin, TTF-1, chromogranin, synaptophysin, and
Ki-67 proliferation index less than 5%. Afterward, she was evaluated by
thoracic surgery; due to a centrally located tumor, the decision was made
to proceed with a right middle lobectomy and mediastinal lymph node
dissection, performed via limited right thoracotomy. Her postoperative
period progressed without complications. DISCUSSION: Typical carcinoid is
usually considered a benign tumor. However, occasional metastases do
occur. Symptoms of NETs are often nonspecific or absent, which could lead
to a delay in the diagnosis. Complete surgical resection of carcinoid
tumors with preservation of uninvolved pulmonary parenchyma is often
curative in the early stages, and the risk of recurrence is very low. Due
to the location of our patient's tumor, surgery was the treatment of
choice. Nodal involvement and histological subtype are the most important
factor for prognosis. <br/>CONCLUSION(S): Due to the complexity of the
tumor, NET requires a multidisciplinary approach and long term follow up.
Our patient will require close follow up for monitoring and imaging
surveillance. REFERENCE #1: Wang Z, Yang MQ, Huang WJ, Zhang D, Xu HT.
Sclerosing pneumocytoma mixed with a typical carcinoid tumor: A case
report and review of literature. Medicine (Baltimore). 2019
Feb;98(5):e14315. doi: 10.1097/MD.0000000000014315. PMID: 30702609; PMCID:
PMC6380861. REFERENCE #2: Nilforoshan M, Matus IA. Combined Typical
Carcinoid-Adenocarcinoma Lung Tumor. J Bronchology Interv Pulmonol. 2017
Apr;24(2):e23-e25. doi: 10.1097/LBR.0000000000000359. PMID: 28323740.
REFERENCE #3: Demirci I, Herold S, Kopp A, Flashove M, Klosterhalfen B,
Jansen H. Overdiagnosis of a typical carcinoid tumor as an adenocarcinoma
of the lung: a case report and review of the literature. World J Surg
Oncol. 2012 Jan 23;10:19. doi: 10.1186/1477-7819-10-19. PMID: 22269186;
PMCID: PMC3317839. DISCLOSURES: No relevant relationships by Felix
Hernandez, source=Web Response No relevant relationships by Jeany
Villamizar, source=Web Response<br/>Copyright &#xa9; 2021 American College
of Chest Physicians

<81>
Accession Number
2014927183
Title
PARTIAL PARIETAL PLEURECTOMY AND PLEURODESIS IN NONINTUBATED UNIPORTAL
VIDEO-ASSISTED THORACOSCOPY VS INTUBATED UNIPORTAL
VIDEO-ASSISTED-THORACOSCOPY: IS NI-UVATS ENOUGH SAFE FOR ELDERLY PATIENTS
IN ASA III-IV?.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A1366), 2021. Date of Publication: October 2021.
Author
Mahoozi H.
Publisher
Elsevier Inc.
Abstract
TOPIC: Disorders of the Pleura TYPE: Original Investigations PURPOSE: Most
recent studies show improved postoperative outcomes for non-intubated VATS
procedures (NI-VATS) compared to the intubated VATS technique in terms of
recovery from anesthesia, earlier mobilization and shorter hospital stay
and lower costs. In this study we show a comparison between these two
surgical procedures. <br/>METHOD(S): In this study we have 114 patients in
ASA III or ASA IV classification, who underwent a non-intubated uniportal
video-assisted thoracoscopy (NI-UVATS) with partial parietal pleurectomy
and talc pleurodesis in the period from 01.10.2018 to 10.01.2021 and 105
Patients in ASA III or ASA IV, who underwent Uniportal Video-Assisted
Thoracoscopy (UVATS) with partial parietal pleurectomy and talc
pleurodesis. Analgesic sedation in the NI-UVATS group was carried out
according to the Pinneberger protocol for non-intubated uniportal VATS.
The intraoperative and postoperative data such as operative and anesthesia
times, postoperative recovery, length of hospital stay, the rate of
postoperative pneumonia, atelectasis, pleural effusion and postoperative
cardiac events as well as the costs in both groups were compared.
<br/>RESULT(S): The patients in the NI-UVATS group showed a faster and
more stable recovery in the recovery room and IMC ward, the shorter length
of stay (P <0.05), the lower use of sedatives and analgesics (P <0.05) and
lower cardiac events (p <0.05). The incidence of atelectasis, and
recurrent pleural effusion was similar in both groups (P <0.05). The rate
of Pneumonia was in NI_UVATS group lower than UVATS group (P<0,05).
Although intraoperative SpO2 was lower and intraoperative SpCO2 was higher
(P <0.01) in the NI-UVATS group, postoperative PaCO2 and SaO2 values
??were similar in both groups (P> 0.05). The resulting costs were
significantly lower in the NI-UVATS group than in the UVATS group (P
<0.05). <br/>CONCLUSION(S): NI-UVATS is a feasible and safe procedure in
an experienced team (especially anesthesia and thoracic surgery) for
patients in ASA III and ASA IV classification. Strict selection criteria,
skills and experience are required. The more randomized prospective
studies are needed. CLINICAL IMPLICATIONS: Non-intubated Uniportal VATS is
a safe procedure in multimorbid patients with recurrent exudative pleural
effusion. It's feasible with lower hospital length of stay and lower rate
of postoperative Pneumonia compared with patients in UVATS group.
DISCLOSURES: No relevant relationships by Hamidreza Mahoozi, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<82>
Accession Number
2014927077
Title
INDWELLING CATHETER FOR MALIGNANT PLEURAL EFFUSION: SUBCUTANEOUS IS
BETTER?.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A1370), 2021. Date of Publication: October 2021.
Author
Errico L.; Mellone F.; Vaisitti F.; Ganio S.; Sandri A.; Donatello
Delcuratolo M.; Leo F.
Publisher
Elsevier Inc.
Abstract
TOPIC: Disorders of the Pleura TYPE: Original Investigations PURPOSE: In
the management of malignant pleural effusion (MPE), the only option for
symptoms control in case of trapped lung or symptomatic recurrence after
talc pleurodesis is the positioning of a long-term indwelling pleural
catheter. The inconvenient of such a solution is that a part of the tube
remains outside the skin. A technical alternative is represented by a
totally implantable device in which the chest tube is connected to a
subcutaneous reservoir allowing aspiration by a simple cutaneous puncture.
This study present early results from a series of patients with MPE in
which this device was implanted. <br/>METHOD(S): Since April 2019, at the
Thoracic Surgery Department of S. Luigi Hospital, Orbassano, Italy, a
totally implantable indwelling catheter (Celsite Drainaport, Braun,
Berlin) was implanted in all patients with MPE associated with trapped
lung or recurrence after surgical pleurodesis. Patients data was obtained
by the institutional research database (Architor) and analysed in terms
of: 1) symptoms control (defined as ineffective when additional pleural
procedures were required after catheter positioning), 2) device
malfunction, 3) local infection, 4) feasibility of systemic treatment
after the procedure, and 5) management of fluid removal (homecare Vs
hospital). <br/>RESULT(S): In the period April 2019-March 2021, a Pleural
Port was implanted in 40 consecutive patients (median age 73 years, 21
men). MPE was due to lung cancer in 21 cases, mesothelioma in 7, other
tumors in 22. Indication was presence of a trapped lung in 23 patients and
recurrence in 17 patients. Effective symptom control was obtained in 39
cases (97%). In one patient (2.5%) in poor general condition multiple
thoracentesis were required due to device malfunction. No sign of local
infection was detected in any patient. After the procedure, 17 cases (42%)
started a systemic treatment and 16 cases (40%) required exclusive home
palliative care. At follow-up on April 2021, 36 deaths were recorded due
to tumor progression with a median survival time of 74,5 days.
<br/>CONCLUSION(S): The use of a totally implantable system is an
effective palliative treatment in MPE associated with trapped lung or
recurrence after surgical pleurodesis. The absence of potential
contamination due to a totally subcutaneous device seems to reduce the
risk of local infection but this advantage has to be confirmed in the
context of a randomized trial. CLINICAL IMPLICATIONS: In complex MPE, the
use of a totally implantable pleural system represents an additional
option allowing an effective symptoms control without the risk of local
complications. DISCLOSURES: No relevant relationships by Marco Donatello
Delcuratolo, source=Web Response No relevant relationships by Luca Errico,
source=Web Response No relevant relationships by Stefano Ganio, source=Web
Response No relevant relationships by Francesco Leo, source=Web Response
No relevant relationships by Federica Mellone, source=Web Response No
relevant relationships by Alberto Sandri, source=Web Response No relevant
relationships by Federico Vaisitti, source=Web Response<br/>Copyright
&#xa9; 2021 American College of Chest Physicians

<83>
Accession Number
2014926945
Title
Off- Vs On-pump Coronary Revascularization: A Single Surgeon Study.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2021 Annual Clinical Congress. Virtual, Online. 233(5
Supplement 2) (pp e20), 2021. Date of Publication: November 2021.
Author
Tasnim S.; Roughneen P.T.
Institution
(Tasnim, Roughneen) University of Texas Medical Branch, Galveston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Introduction: Multi-center, multi-surgeon randomized controlled trials
have reported that off-pump coronary artery bypass grafting (OPCAB) has
either equivalent or inferior outcomes compared to on-pump arrested heart
coronary artery bypass grafting (PCAB-A). We present a single-surgeon
observational study to remove the confounding bias of multiple surgeon
expertise and multiple center cost variations. <br/>Method(s): A
retrospective review of 129 patients that underwent coronary artery bypass
grafting (CABG) between September 2015-January 2019 was analyzed.
Fifty-one patients underwent OPCAB and 78 underwent PCAB-A according to
the surgeon's discretion. Quality and cost metrics were analyzed.
<br/>Result(s): A higher percentage of OPCAB patients had previous
coronary artery stents before undergoing CABG compared to PCAB-A (35% vs.
17%, p=0.02). The number of grafts and OR time in the OPCAB group was
significantly less than PCAB-A: 2.2 vs. 3.15, p=0 (grafts), and 298.24 vs.
357.69 min, p=0 (OR time), respectively. OPCAB had a shorter ICU length of
stay (2.08 vs. 2.44 days, p=0.273), shorter total ventilation time (1.18
vs. 1.54 days, p=0.055), and required less pRBC compared to PCAB-A (41%
vs. 64%, p=0.715). OPCAB also had lower revascularization rate at one year
(7% vs. 13%, p=0.355) and significantly lower OR cost ($8,657 vs. $13,247
p=0). The cost difference between the two groups for the entire length of
the hospitalization was $5,152. <br/>Conclusion(s): We found significant
quality and cost differences between OPCAB and PCAB-A when performed by an
experienced surgeon. OPCAB can be more or equally effective and
cost-friendly when performed by experienced surgeons on the appropriate
patient population.<br/>Copyright &#xa9; 2021

<84>
Accession Number
2014926859
Title
Systematic Review of Graft Patency after Robotically Assisted Coronary
Artery Bypass Grafting Surgery.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2021 Annual Clinical Congress. Virtual, Online. 233(5
Supplement 2) (pp e21-e22), 2021. Date of Publication: November 2021.
Author
Sherazee E.A.; Guenther T.M.; Kiaii B.
Institution
(Sherazee, Guenther, Kiaii) Department of Surgery, Division of General
Surgery, UC Davis Medical Center, Sacramento, CA, United States
(Sherazee, Guenther, Kiaii) Department of General Surgery, David Grant
USAF Medical Center, Travis AFB, Fairfield, CA, United States
(Sherazee, Guenther, Kiaii) Department of Surgery, Division of Cardiac
Surgery, UC Davis Medical Center, Sacramento, CA, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Robotically assisted coronary artery bypass grafting surgery
(RACABG) avoids the morbidities of a sternotomy and cardiopulmonary bypass
and is becoming increasingly popular. Robotically assisted minimally
invasive direct CABG (RMIDCAB) and totally endoscopic CABG (TECAB) have
been shown to have similar patency rates compared to conventional CABG
(Left internal mammary artery patency: 98%, 95%, 88% at 5, 10 and 15
years, respectively). A systematic review was performed to evaluate graft
patency and clinical outcomes in patients who underwent RACABG.
<br/>Method(s): A systematic review of studies reporting graft patency
after RACABG was performed using PubMed, Google Scholar, and Embase.
<br/>Result(s): Between June 1998 and August 2018, 4,316 patients
underwent RACABG, either by RMIDCAB (2,643) or TECAB (1,673) approach.
Compared to RMIDCAB, those that underwent TECAB were more frequently
evaluated for graft patency (70.6% vs 65.1%). The average graft patency at
short- (<1 month), mid- (<5 years) and long-term (>=5 years) follow up was
97.6%, 95.4% and 93.2% for RMIDCAB, respectively and 98%, 95.6% and 94%
for TECAB, respectively. Rates of 30-day mortality, conversion to
sternotomy and post op reintervention for an occluded graft were 0.3%,
2.3% and 2.2%, respectively. <br/>Conclusion(s): RACABG has comparable
patency rates to conventional CABG with a low rate of reintervention.
Short term patency rates are well documented in the literature; however,
there are only a few studies reporting on the mid- and long-term outcomes.
Although the initial data is very encouraging, further investigation is
warranted to further assess this minimally invasive technique for surgical
coronary artery revascularization.<br/>Copyright &#xa9; 2021

<85>
Accession Number
2014926579
Title
Tool-tissue Forces in Surgery: A Systematic Review.
Source
Journal of the American College of Surgeons. Conference: The American
College of Surgeons 2021 Annual Clinical Congress. Virtual, Online. 233(5
Supplement 2) (pp e70), 2021. Date of Publication: November 2021.
Author
Golahmadi A.K.; Khan D.Z.; Mylonas G.; Marcus H.
Institution
(Golahmadi, Khan, Mylonas, Marcus) Imperial College London, London, United
Kingdom, The National Hospital for Neurology and Neurosurgery, London,
United Kingdom
Publisher
Elsevier Inc.
Abstract
Introduction: Excessive tool-tissue interaction forces in surgery may
result in tissue damage and intraoperative complications, while
insufficient forces prevent the completion of the task. <br/>Method(s): A
systematic review of studies exploring tool-tissue forces applied during
surgery was performed in accordance with PRISMA guidelines.
<br/>Result(s): 45 studies discussing tool-tissue forces during surgical
procedures or tasks were included. Mean forces per speciality were as
follows: ophthalmology (0.04N), vascular (0.7N), neurosurgery (0.68N),
cardiothoracic surgery (1.5N), general surgery (4.7N), otorhinolaryngology
(8.5N), obstetrics & gynaecology (mean 8.7N), urology (9.8N) and
orthopaedic surgery (210N). Senior surgeons applied 25% less force than
novice surgeons, and feedback (haptic, visual or audio) reduced force
application by 40% - across specialities and tasks. Nervous tissue
required the least amount of force to manipulate (0.4N, n=17), followed by
epithelial (3.8N, n=18), muscle (4.1N, n=4) and connective tissue (45.8,
n=10). For manoeuvres, retraction-with-grasping recorded the highest
forces (3.65N, n=13), whilst vessel clamping recorded the lowest (0.5N,
n=2). <br/>Conclusion(s): The measurement of tool-tissue forces is a novel
but rapidly expanding field. Knowledge of the safe range of surgical
forces will improve surgical safety whilst maintaining effectiveness.
Measuring surgical forces may provide an objective metric for training and
assessment. Development of smart instruments, robotics and integrated
feedback systems will facilitate this.<br/>Copyright &#xa9; 2021

<86>
Accession Number
636171468
Title
Dental injury during endoscopy: An underrecognized teething safety issue.
Source
Gut. Conference: International Digestive Disease Forum, IDDF 2021. Hong
Kong Hong Kong. 70(SUPPL 2) (pp A133), 2021. Date of Publication:
September 2021.
Author
Yi Wen G.L.; Lin C.T.Q.; Rong B.T.W.; Mok J.; Jianyi C.K.; Juanda L.; Siah
T.H.
Institution
(Yi Wen, Lin) National University of Singapore, Singapore
(Rong, Mok, Jianyi, Juanda, Siah) National University Hospital, Singapore
Publisher
BMJ Publishing Group
Abstract
Background Dental injury is an underrecognized preventable complication
during endoscopy. An audit of same-day procedure cancellation in our
endoscopy center showed that 43% of cases are related to tooth safety
concerns. A review of the literature showed that dental injury was
under-reported in endoscopy related journals but an important issue in
anaesthesia. Dental injury in anaesthesia is variably estimated to occur
at a rate of approximately one in 1,000 to 4,500. It represents up to half
of all anaesthetic claims. We reviewed the preventive measures and
management strategy of dental injury. Methods We have reviewed the
available literature and worked with a dental expert to suggest a few
steps to improve tooth safety during endoscopy: Results Key steps in
preventive measures: 1) Pre-endoscopic tooth screening: Optimal
pre-endoscopic assessment should include a comprehensive dental
assessment, documentation and explanation of individualized risk involved.
2) Identification of risk factors: Evidence of periodontal disease and its
infective complications, pre-existing dental pathology such as missing or
loose teeth, and dental restorations. 3) Comprehensive documentation of
pre-existing dental defects prior to endoscopy should be done. Key steps
in dental injury management: 1) Early involvement of dentist: If a dental
injury occurs or a missing tooth is found during endoscopy, a dentist
should be called to do an on-table consult. 2) Tooth retrieval whenever
possible: If the dentist is unavailable or delayed, the missing tooth
should be localised and retrieved. Upon retrieval of the tooth or tooth
fragments, the dental officer on-call should be consulted for specific
management. 3) Radiographic assistance: If localisation is not possible, a
chest X-ray should be done, with the consultation of Thoracic Surgery.
Conclusions We encourage these simple measures to be implemented in the
clinic and endoscopy center to prevent dental injury during endoscopy.

<87>
Accession Number
2013956446
Title
The role of 18FDG PET/CT in the assessment of endocarditis, Myocarditis
and pericarditis.
Source
Current Radiopharmaceuticals. 14(3) (pp 259-272), 2021. Date of
Publication: September 2021.
Author
Giorgetti A.; Genovesi D.; Emdin M.
Institution
(Giorgetti, Genovesi, Emdin) Fondazione CNR/Regione Toscana "Gabriele
Monasterio", Pisa, Italy
(Emdin) Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa,
Italy
Publisher
Bentham Science Publishers
Abstract
Endocarditis, myocarditis and pericarditis are a heterogeneous group of
phenotypic syndromes where the culprit area of inflammation is the heart.
Inflammation may be determined by an infective agent, toxins, drugs or an
activated immune system. Clinical manifestations can be subtle and
diagnosis remains a challenge for cardiologists, requiring high level of
suspicion and advanced multimodal cardiac imaging to avoid
life-threatening consequences. The purpose of this review is to report the
recent advances of PET/CT imaging with 18FDG in helping the management of
patients affected by inflammatory heart disease. Two independent reviewers
searched in PubMed articles published before or in June 2019 and final
decisions on the inclusion of references were done in consensus with a
third reviewer. At the end of the selection process 23/206 articles on
"cardiac inflammation"; 26/235 articles on "endocarditis", "prosthetic
heart valve", "pacemaker", "implantable cardiac device"; 7/103 articles on
"myocarditis"; 13/330 articles on sarcoidosis" and 2/19 articles on
"pericarditis" were included. Compared with the conventional methods,
molecular imaging has the advantage to non-invasively and directly trace
the inflammatory process, and to identify earlier the presence and the
extent of intra-cardiac and extra-cardiac involvement, to enable
quantification of disease activity, guide therapeutic interventions, and
monitor treatment success.<br/>Copyright &#xa9; 2021 Bentham Science
Publishers.

<88>
Accession Number
2013891164
Title
Effectiveness of chlorhexidine in preventing infections among patients
undergoing cardiac surgeries: a meta-analysis and systematic review.
Source
Antimicrobial Resistance and Infection Control. 10(1) (no pagination),
2021. Article Number: 140. Date of Publication: December 2021.
Author
Wei J.; He L.; Weng F.; Huang F.; Teng P.
Institution
(Wei, He, Weng, Huang, Teng) Surgical Intensive Care Unit, The First
Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
310003, China
Publisher
BioMed Central Ltd
Abstract
Background: Although several meta-analyses reported the impact of
chlorhexidine (CHX) use in patients undergoing various types of surgery,
no meta-analysis summarized the overall effectiveness of CHX specifically
for cardiac surgery. This meta-analysis aimed to examine the impact of CHX
on infections after cardiac surgery compared with other cleansers or
antiseptics. <br/>Method(s): PubMed, Embase, and the Cochrane Library were
searched from inception up to October 2020 for potentially eligible
studies: (1) population: patients who underwent cardiac surgery; (2)
intervention or exposure: any type of CHX use in the treatment or exposed
group; (3) outcome: number of patients with infections; (4) comparison:
placebo or other antiseptic agents; (5) English. The primary outcome was
surgical site infection (SSI). <br/>Result(s): Fourteen studies were
included, with 8235 and 6901 patients in the CHX and control groups. CHX
was not protective against SSI (OR = 0.77, 95% CI: 0.57-1.04, P = 0.090).
CHX was protective for superficial wound infection (OR = 0.42, 95% CI:
0.26-0.70, P = 0.001), but not with deep wound infection (P = 0.509). CHX
was not protective against urinary tract of infection (P = 0.415) but was
protective for bloodstream infection (OR = 0.36, 95% CI: 0.16-0.80, P =
0.012), nosocomial infections (OR = 0.55, 95% CI: 0.44-0.69, P < 0.001),
and pneumonia (OR = 0.26, 95% CI: 0.11-0.61, P = 0.002).
<br/>Conclusion(s): In patients undergoing cardiac surgery, CHX does not
protect against SSI, deep wound infection, and urinary tract infections
but might protect against superficial SSI, bloodstream infection,
nosocomial infections, and pneumonia.<br/>Copyright &#xa9; 2021, The
Author(s).

<89>
Accession Number
2014940733
Title
Pentoxifylline for treatment of major depression after percutaneous
coronary intervention or coronary artery bypass grafting: A randomized,
double-blind, placebo-controlled trial.
Source
Journal of Psychosomatic Research. 150 (no pagination), 2021. Article
Number: 110635. Date of Publication: November 2021.
Author
Yasrebi S.-O.; Momtazmanesh S.; Moghaddam H.S.; Shahmansouri N.; Mehrpooya
M.; Arbabi M.; Ghazizadeh-Hashemi F.; Akhondzadeh S.
Institution
(Yasrebi, Momtazmanesh, Moghaddam, Akhondzadeh) Psychiatric Research
Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Shahmansouri, Arbabi, Ghazizadeh-Hashemi) Psychosomatics Ward, Imam
Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Mehrpooya) Cardiology Ward, Imam Hospital, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Introduction: Near one-fifth of patients with coronary artery disease
(CAD) develop major depressive disorder (MDD), an independent risk factor
of mortality in these patients. We investigated the efficacy of oral
pentoxifylline in treating MDD in CAD patients undergoing percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a
6-week trial. <br/>Method(s): We only included patients with mild to
moderate MDD (having a score between 14 and 17 on the Hamilton depression
rating scale (HAM-D)). Sixty-four CAD patients undergoing PCI or CABG aged
40-60 years were randomly assigned to either the pentoxifylline (800 mg
daily) or the placebo group. The outcome was assessed with the HAM-D at
weeks 2, 4, and 6. <br/>Result(s): Patients receiving pentoxifylline had
greater improvement in HAM-D scores from baseline at each follow-up than
patients receiving placebo (p-value = 0.036 at week 2, p-value < 0.001 at
week 4, and p-value < 0.001 at week 6). We found a significant effect for
treatment, time, and timextreatment interaction in depression improvement
(p-value < 0.001). Rate of remission, treatment response, and adverse
effects did not differ between the two groups. <br/>Discussion(s): Our
study supports the safety and efficacy of pentoxifylline in treatment of
MDD in CAD patients. However, further investigations are required to
confirm the generalizability of our results since the results need to be
interpreted cautiously because of the imitated range of disease severity
for inclusion. This trial was registered with the Iranian Registry of
Clinical Trials (www.irct.ir; No. IRCT20090117001556N132).<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<90>
Accession Number
2014915415
Title
A meta-analysis of pharmacological neuroprotection in noncardiac surgery:
Focus on statins, lidocaine, ketamine, and magnesium sulfate.
Source
European Review for Medical and Pharmacological Sciences. 22(6) (pp
1798-1811), 2018. Date of Publication: 2018.
Author
ZENG Z.-W.; ZHANG Y.-N.; LIN W.-X.; ZHANG W.-Q.; LUO R.
Institution
(ZENG, ZHANG, LIN, ZHANG, LUO) First Anesthesia Department, Meizhou
People's Hospital, Guangdong Province, China
Publisher
Verduci Editore s.r.l
Abstract
OBJECTIVE: Non-cardiac surgery is associated with perioperative cerebral
complications (delirium, postoperative cognition dysfunction, stroke).
While rare, these complications can lead to disabilities and deaths.
Information is ambiguous as to whether pharmacological preoperative
treatment exerts neuroprotection. We wished to systematically assess
potential modulation by statins, lidocaine, ketamine or magnesium sulfate
of the relative risk of cerebral complications in noncardiac surgery.
Selection of these pharmacological agents was based on their known
neuroprotective abilities. <br/>PATIENTS AND METHODS: By searching
Medline, EMBASE and Cochrane databases, we identified 4 suitable
publications that collectively enrolled 1358 patients (intent-to-treat
population), of which 679 patients were treated preoperatively with
statins (404 patients on atorvastatin and 275 on rosuvastatin) and 679
patients with preoperative placebo. The reported cerebral outcome was
stroke, assessed either within 30 days (4 publications) or 6 months (2
publications) after surgery. <br/>RESULT(S): Episodes of stroke within 30
days and 6 months postoperatively were observed in several publications,
enabling aggregate analyses. No modulation by statins of the relative risk
of stroke at 30 days was observed (risk ratio 1.59, 95% confidence
interval 0.08-30.97; p = 0.76). At 6 months, statins showed an
insignificant trend toward neuroprotection (risk ratio 0.33, 95%
confidence interval 0.05-2.10; p = 0.24). <br/>CONCLUSION(S): The
available clinical data are still scarce. Our analyses indicate no
protective effects by statins against perioperative stroke but some
favorable trends toward delayed stroke. Further randomized trials are
needed to unequivocally assess the neuroprotective potential of current
pharmacological agents in non-cardiac surgery.<br/>Copyright &#xa9; 2018
Verduci Editore s.r.l. All rights reserved.

<91>
Accession Number
2014931813
Title
Evaluation of a "tummy time" intervention to improve motor skills in
infants after cardiac surgery.
Source
Cardiology in the Young. (no pagination), 2021. Date of Publication:
2021.
Author
Uzark K.; Smith C.; Yu S.; Lowery R.; Tapley C.; Romano J.C.; Butcher J.
Institution
(Uzark, Romano) Department of Cardiac Surgery, University of Michigan,
Mott Children's Hospital, Ann Arbor, MI, United States
(Uzark, Smith, Yu, Lowery, Tapley, Romano, Butcher) Department of
Pediatrics, University of Michigan, Mott Children's Hospital, Ann Arbor,
MI, United States
Publisher
Cambridge University Press
Abstract
Background: Infants who require open heart surgery are at increased risk
for developmental delays including gross motor impairments which may have
implications for later adaptive skills and cognitive performance. We
sought to evaluate the feasibility and efficacy of a tummy time
intervention to improve motor skill development in infants after cardiac
surgery. <br/>Method(s): Infants <4 months of age who underwent cardiac
surgery were randomly assigned to tummy time with or without outpatient
reinforcement or standard of care prior to hospital discharge. The Alberta
Infant Motor Scale (AIMS) was administered to each infant prior to and 3
months after discharge. Groups were compared, and the association between
parent-reported tummy time at home and change in motor scores at follow-up
was examined. <br/>Result(s): Parents of infants (n = 64) who had cardiac
surgery at a median age of 5 days were randomly assigned to tummy time
instruction (n = 20), tummy time + outpatient reinforcement (n = 21) or
standard of care (n = 23). Forty-nine (77%) returned for follow-up. At
follow-up, reported daily tummy time was not significantly different
between groups (p = 0.17). Fifteen infants had <15 minutes of tummy time
daily. Infants who received >15 minutes of tummy time daily had a
significantly greater improvement in motor scores than infants with <15
minutes of tummy time daily (p = 0.01). <br/>Conclusion(s): In infants
following cardiac surgery, <15 minutes of tummy time daily is associated
with increased motor skill impairment. Further research is needed to
elucidate the best strategies to optimise parental compliance with tummy
time recommendations. <br/>Copyright &#xa9; The Author(s), 2021. Published
by Cambridge University Press.

<92>
[Use Link to view the full text]
Accession Number
2014921656
Title
Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and
Ischemia Severity.
Source
Circulation. (pp 1024-1038), 2021. Date of Publication: 2021.
Author
Reynolds H.R.; Shaw L.J.; Min J.K.; Page C.B.; Berman D.S.; Chaitman B.R.;
Picard M.H.; Kwong R.Y.; O'Brien S.M.; Huang Z.; Mark D.B.; Nath R.K.;
Dwivedi S.K.; Smanio P.E.P.; Stone P.H.; Held C.; Keltai M.; Bangalore S.;
Newman J.D.; Spertus J.A.; Stone G.W.; Maron D.J.; Hochman J.S.
Institution
(Reynolds, Bangalore, Newman, Hochman) Leon H. Charney Division of
Cardiology, Department of Medicine, New York University, Grossman School
of Medicine, 30 First Ave, SKI-9R, New York, NY 10016, United States
(Shaw) Weill Cornell Medicine, New York Presbyterian Hospital, United
States
(Min) Cleerly Inc, New York, NY, United States
(Page, O'Brien, Huang, Mark) Duke Clinical Research Institute, Durham, NC,
United States
(Berman) Cedars-Sinai Medical Centerc, Los Angeles, CA, United States
(Chaitman) St. Louis University, School of Medicine, Center for
Comprehensive Cardiovascular Care, MO, United States
(Picard) Massachusetts General Hospital, Harvard Medical School, Boston,
United States
(Kwong, Stone) Brigham and Women's Hospital, Boston, MA, United States
(Nath) Dr. Ram Manohar Lohia Hospital, New Delhi, India
(Dwivedi) King George's Medical University, Lucknow, India
(Smanio) Instituto Dante Pazzanese de Cardiologia e Fleury Medicina e
Saude, Sao Paulo, Brazil
(Held) Department of Medical Sciences, Cardiology, Uppsala University,
Uppsala Clinical Research Center, Sweden
(Keltai) Semmelweis University, Budapest, Hungary
(Spertus) Saint Luke's Mid America Heart Institute, University of
Missouri, Kansas City, United States
(Stone) Icahn School of Medicine at Mount Sinai, Cardiovascular Research
Foundation, New York, United States
(Maron) Department of Medicine, Stanford University, CA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The ISCHEMIA trial (International Study of Comparative Health
Effectiveness With Medical and Invasive Approaches) postulated that
patients with stable coronary artery disease (CAD) and moderate or severe
ischemia would benefit from revascularization. We investigated the
relationship between severity of CAD and ischemia and trial outcomes,
overall and by management strategy. <br/>Method(s): In total, 5179
patients with moderate or severe ischemia were randomized to an initial
invasive or conservative management strategy. Blinded, core
laboratory-interpreted coronary computed tomographic angiography was used
to assess anatomic eligibility for randomization. Extent and severity of
CAD were classified with the modified Duke Prognostic Index (n=2475, 48%).
Ischemia severity was interpreted by independent core laboratories
(nuclear, echocardiography, magnetic resonance imaging, exercise tolerance
testing, n=5105, 99%). We compared 4-year event rates across subgroups
defined by severity of ischemia and CAD. The primary end point for this
analysis was all-cause mortality. Secondary end points were myocardial
infarction (MI), cardiovascular death or MI, and the trial primary end
point (cardiovascular death, MI, or hospitalization for unstable angina,
heart failure, or resuscitated cardiac arrest). <br/>Result(s): Relative
to mild/no ischemia, neither moderate ischemia nor severe ischemia was
associated with increased mortality (moderate ischemia hazard ratio [HR],
0.89 [95% CI, 0.61-1.30]; severe ischemia HR, 0.83 [95% CI, 0.57-1.21];
P=0.33). Nonfatal MI rates increased with worsening ischemia severity (HR
for moderate ischemia, 1.20 [95% CI, 0.86-1.69] versus mild/no ischemia;
HR for severe ischemia, 1.37 [95% CI, 0.98-1.91]; P=0.04 for trend, P=NS
after adjustment for CAD). Increasing CAD severity was associated with
death (HR, 2.72 [95% CI, 1.06-6.98]) and MI (HR, 3.78 [95% CI, 1.63-8.78])
for the most versus least severe CAD subgroup. Ischemia severity did not
identify a subgroup with treatment benefit on mortality, MI, the trial
primary end point, or cardiovascular death or MI. In the most severe CAD
subgroup (n=659), the 4-year rate of cardiovascular death or MI was lower
in the invasive strategy group (difference, 6.3% [95% CI, 0.2%-12.4%]),
but 4-year all-cause mortality was similar. <br/>Conclusion(s): Ischemia
severity was not associated with increased risk after adjustment for CAD
severity. More severe CAD was associated with increased risk. Invasive
management did not lower all-cause mortality at 4 years in any ischemia or
CAD subgroup. Registration: URL: https://www.clinicaltrials.gov. Unique
identifier: NCT01471522.<br/>Copyright &#xa9; 2021 Lippincott Williams and
Wilkins. All rights reserved.

<93>
Accession Number
2013887783
Title
Outcomes of sutureless aortic valve replacement versus conventional aortic
valve replacement and transcatheter aortic valve replacement, updated
systematic review, and meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Kim K.S.; Makhdoum A.; Koziarz A.; Gupta S.; Alsagheir A.; Pandey A.; Reza
S.; Um K.; Teoh K.; Alhazzani W.; Lamy A.; Yanagawa B.; Belley-Cote E.P.;
Whitlock R.P.
Institution
(Kim, Pandey, Reza, Um, Lamy, Belley-Cote, Whitlock) Population Health
Research Institute, McMaster University, Hamilton, Canada
(Kim, Alhazzani) Department of Health Research Methodology, Evidence and
Impact, McMaster University, Hamilton, Canada
(Makhdoum, Yanagawa) Division of Cardiac Surgery, Department of Surgery,
University of Toronto, Toronto, Canada
(Koziarz) Temerty Faculty of Medicine, University of Toronto, Toronto,
Canada
(Gupta, Alsagheir, Lamy, Whitlock) Division of Cardiac Surgery, Department
of Surgery, McMaster University, Hamilton, ON, Canada
(Um, Alhazzani, Belley-Cote) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(Teoh) Southlake Regional Health Sciences Centre, Newmarket, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Sutureless aortic valve replacement (SuAVR) is an alternative
to surgical aortic valve replacement (SAVR) and transcatheter aortic valve
replacement (TAVR). This study compares the effectiveness of SuAVR to SAVR
and TAVR. <br/>Method(s): We searched MEDLINE and EMBASE from inception to
July 2021 for studies evaluating SuAVR, SAVR, and TAVR in adults with
aortic stenosis. We performed screening, full-text assessment, data
collection, and risk of bias evaluation independently and in duplicate. We
evaluated risk of bias using by Cochrane and CLARITY's tools, and
certainty in evidence using the GRADE framework. Data were pooled using a
random-effects model. <br/>Result(s): We identified one randomized and 78
observational studies (n = 60,689; SuAVR vs. SAVR = 39,171, vs. TAVR =
21,518). All studies were at high or unclear risk of bias, with very-low
certainty in effect estimates. Compared to TAVR, SuAVR demonstrates no
significant difference in mortality at 30-days (odds ratio [OR]: 0.52, 95%
confidence interval [CI: 0.85, 1.16], I² = 0%), but decreased
odds at 2-years (OR: 0.39, 95% CI [0.17, 0.88], I² = 0%). SuAVR
also reduced odds of mild paravalvular regurgitation (OR: 0.11, 95% CI
[0.06, 0.21], I² = 50%). Compared to SAVR, SuAVR was associated
with a similar mortality at 30-days (OR: 0.99, 95% CI [0.85, 1.16],
I² = 0%) and 2-years (OR: 0.99, 95% CI [0.43-2.30],
I² = 7%). SuAVR significantly increased odds of permanent
pacemaker implantation (OR: 2.5, 95% CI [2.25, 2.77], I² = 0%).
Pooled effect estimates were consistent with results from the randomized
trial comparing SuAVR and SAVR. <br/>Conclusion(s): Based on very-low
quality evidence, SuAVR is associated with similar short- and midterm
outcomes compared to TAVR and SAVR. Comparative randomized data with
long-term follow-up are required to clarify the role of
SuAVR.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<94>
Accession Number
2014364611
Title
Effects of omega-3 polyunsaturated fatty acids supplementation for
patients with cardiovascular disease risks: A dose-response meta-analysis.
Source
American Journal of Translational Research. 13(8) (pp 8526-8539), 2021.
Date of Publication: 2021.
Author
Xie L.; Zhen P.; Wei Q.; Yu F.; Song S.; Tong J.
Institution
(Xie, Zhen, Wei, Yu, Song, Tong) School of Medicine, Southeast University,
Jiangsu, Nanjing, China
(Xie) Jinling Hospital, School of Medicine, Nanjing University, Jiangsu,
Nanjing, China
(Zhen, Wei, Yu, Song, Tong) Department of Cardiology, Zhongda Hospital,
Jiangsu, Nanjing, China
Publisher
E-Century Publishing Corporation
Abstract
Background: Previous studies assessing the impact of omega-3
polyunsaturated fatty acids (omega-3 PUFA) have shown conflicting results
in regard to the cardiovascular mortality. It is likely that higher dose
of omega-3 PUFA would have a greater effect on the major adverse
cardiovascular events (MACEs). Therefore, we performed a dose-response
meta-analysis to explore the potential protective effect of omega-3 PUFA,
with the increase of daily intake and extension of the intervention
period, on patients with cardiovascular disease risks. Outcomes included
major adverse cardiovascular events, cardiovascular and all-cause
mortality. <br/>Method(s): A systematic literature search of PubMed,
Embase and the Cochrane Library from inception to September 31, 2019 was
conducted to identify the randomized controlled trails (RCTs) of omega-3
PUFA supplementation, which reported cardiovascular events or deaths and
recruited no less than 500 participants. We evaluated the effect of
omega-3 PUFA through the pooled relative risks (RR) and 95% confidence
intervals (95% CI), and further carried out subgroup analysis and
dose-response meta-analysis. <br/>Result(s): Fourteen trials including
87718 individuals were reviewed. By conventional statistical significance,
there was no apparent difference between the two groups on major adverse
cardiovascular effects (RR 0.94, 95% CI 0.84-1.04) and all-cause mortality
(RR 0.96, 95% CI 0.91-1.00), but there was an effect on the cardiovascular
mortality (RR 0.93, 95% CI 0.88-0.99). However, with the dose increased
and intervention period prolonged (daily dose x intervention period > 8
grams/day x years), subgroup analyses showed a more obvious reduction of
MACEs (RR 0.79, 95% CI 0.65-0.95) and all-cause mortality (RR 0.93, 95% CI
0.85-1.03). Furthermore, the dose-response meta-analysis presented a
13.05% reduction of MACEs and 8.99% reduction of all-cause mortality with
10 grams/day x years increments. <br/>Conclusion(s): Updated with the
newly published RCTs, this meta-analysis indicated that large dose and
long period of interventions with omega-3 PUFA supplementation produce a
close association with MACEs and cardiovascular or all-cause mortality. A
dose-response beneficial effect was preliminarily
established.<br/>Copyright &#xa9; 2021 E-Century Publishing Corporation.
All rights reserved.

<95>
Accession Number
2013618728
Title
Coronary artery bypass grafting (Cabg) versus percutaneous coronary
intervention (pci) in the treatment of multivessel coronary disease: A
review.
Source
Australasian Medical Journal. 14(1) (pp 29-33), 2021. Date of Publication:
2021.
Author
Al Ansari A.E.; Alzahrani H.A.; Alqulayti W.M.; Rawah M.A.; Alnajjar L.L.;
Subedar A.T.M.; Aloufi B.M.M.; Ajwah I.M.H.; Albalawi A.A.M.; Aljohani
K.M.A.; Albalawi A.M.K.; Aljoaid S.S.A.; Alatawi R.A.S.; Alsaiari A.S.M.;
Alrefai L.M.S.; Hameed A.M.H.; Al Masoud D.K.H.; Alsada A.M.S.
Institution
(Al Ansari, Alzahrani, Alqulayti, Rawah, Alnajjar, Subedar, Aloufi, Ajwah)
Saudi Commission for Health Specialties, Saudi Arabia
(Albalawi, Aljohani, Albalawi, Aljoaid, Alatawi, Alsaiari, Alrefai)
University of Tabuk, Saudi Arabia
(Hameed) Ibn-Sina college, Jeddah, Saudi Arabia
(Al Masoud) Taibah University, Saudi Arabia
(Alsada) Salmaniya Medical Complex, Bahrain
Publisher
Australasian Medical Journal Pty Ltd
Abstract
Background Revascularization for patients who suffer multivessel coronary
artery disease is a common procedure around the world. Taking United about
700,000 patients have multivessel coronary revascularization per year 1/4
of these patients are diagnosed with diabetes. Aims To summarize the
current evidence that compare CABG to PCI in multivessel coronary
diseasein form of cardiac death, stroke, MI and unplanned
devascularization. Methods This is a systematic review was carried out,
including PubMed, Google Scholar, and EBSCO that examining randomized
trials of treatment of multivessel coronary disease to summarize the major
RCT concerning this topic. Results The review included five randomized
studies that compare coronary artery bypass grafting and percutaneous
coronary intervention. The findings showed that CABG show better result
with less mortality rate. Conclusion This review concluded that there
revascularization in treating coronary artery disease could be conducted
either by CABG or PCI, CABG show better result as it cause less death, MI
and revascularization rates, but the usage of new additions such as second
generation DES, can also improve the safety and efficacy of PCI when added
to it.<br/>Copyright &#xa9; 2021, Australasian Medical Journal Pty Ltd.
All rights reserved.

<96>
Accession Number
2010798049
Title
The efficacy of mobile health in alleviating risk factors related to the
occurrence and development of coronary heart disease: A systematic review
and meta-analysis.
Source
Clinical Cardiology. 44(5) (pp 609-619), 2021. Date of Publication: May
2021.
Author
Xu Y.; Ye H.; Zhu Y.; Du S.; Xu G.; Wang Q.
Institution
(Xu, Ye, Zhu, Du, Xu, Wang) School of Nursing, Nanjing university of
Chinese Medicine, Nanjing, Jiangsu Province, China
Publisher
John Wiley and Sons Inc
Abstract
The association between the efficacy of mobile health and the occurrence
and development of coronary heart disease (CHD) is still unclear. Mobile
health can alleviate the risk factors for CHD. PubMed, EMbase, Web of
Science, The Cochrane Library, CNKI, WanFang, and VIP databases were
searched from inception through May 28, 2020. Randomized controlled trials
of the effect of mobile health in alleviating the risk factors of CHD's
occurrence and development were included. Risks of bias were assessed by
two independent reviewers by using the RevMan 5.3, GRADEpro, and RoB2.0 to
generate findings. Meta-analyses were performed to investigate the effects
of mobile health on risk factors for CHD. Subgroup analyses were
conducted. Sixteen randomized controlled trials, including 3898 patients
with CHD, were included. Meta-analysis results showed that mobile health
can reduce BMI (mean difference [MD] = - 1.24, 95% CI = - 2.02 to - 0.45,
p <.05), waist circumference (MD = - 4.40, 95% CI = - 4.72 to - 4.08, p
<.00001), total cholesterol (TC) level (MD = - 0.43, 95% CI = - 0.64 to -
0.22, p < 0.00001), low-density lipoprotein cholesterol (LDL-C) level (MD
= - 0.31, 95% CI = - 0.48 to - 0.15, p <.05), diastolic blood pressure (MD
= - 2.01, 95% CI = - 3.40 to - 0.623, p <.05), and depression (MD = -
8.32, 95% CI = - 12.83 to - 3.81, p <.05) and increase high-density
lipoprotein cholesterol level (MD = 0.16, 95% CI = 0.01 to 0.32, p <.05)
with statistically significant differences. The results of subgroup
analyses indicated that the simple mobile health intervention has more
remarkable advantages in reducing BMI, TC, LDL-C, and systolic blood
pressure than the complex mobile health intervention. Mobile health can
alleviate the risk factors for CHD and has a certain effect on the
prevention and recovery of CHD. Simple mobile health has a remarkable
advantage. Limited by the quantity and quality of included studies, future
research enrolling high-quality studies should be taken to verify the
above conclusions.<br/>Copyright &#xa9; 2021 The Authors. Clinical
Cardiology published by Wiley Periodicals LLC.

<97>
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.

<98>
Accession Number
2014766137
Title
Stereotactic ablative radiotherapy for operable stage I non-small-cell
lung cancer (revised STARS): long-term results of a single-arm,
prospective trial with prespecified comparison to surgery.
Source
The Lancet Oncology. 22(10) (pp 1448-1457), 2021. Date of Publication:
October 2021.
Author
Chang J.Y.; Mehran R.J.; Feng L.; Verma V.; Liao Z.; Welsh J.W.; Lin S.H.;
O'Reilly M.S.; Jeter M.D.; Balter P.A.; McRae S.E.; Berry D.; Heymach
J.V.; Roth J.A.; Antonoff M.; Hofstetter W.; Rajaram R.; Rice D.; Sepesi
B.; Swisher S.; Vaporciyan A.; Walsh G.; DeGraaf C.; Correa A.; Chen A.;
Gandhi S.; Komaki R.; Lee P.; Nguyen Q.-N.; Ning M.; Gao S.;
Pollard-Larkin J.; Nitsch P.; Sadagopan R.; Wang X.
Institution
(Chang, Verma, Liao, Welsh, Lin, O'Reilly, Jeter) Department of Radiation
Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX,
United States
(Mehran, Roth) Department of Thoracic and Cardiovascular Surgery, The
University of Texas MD Anderson Cancer Center, Houston, TX, United States
(Feng, Berry) Department of Biostatistics, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Balter) Department of Radiation Physics, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(McRae) Department of Interventional Radiology, The University of Texas MD
Anderson Cancer Center, Houston, TX, United States
(Heymach) Department of Thoracic and Head/Neck Medical Oncology, The
University of Texas MD Anderson Cancer Center, Houston, TX, United States
Publisher
Elsevier Ltd
Abstract
Background: A previous pooled analysis of the STARS and ROSEL trials
showed higher survival after stereotactic ablative radiotherapy (SABR)
than with surgery for operable early-stage non-small-cell lung cancer
(NSCLC), but that analysis had notable limitations. This study reports
long-term results of the revised STARS trial, in which the SABR group was
re-accrued with a larger sample size, along with a protocol-specified
propensity-matched comparison with a prospectively registered,
contemporary institutional cohort of patients who underwent video-assisted
thoracoscopic surgical lobectomy with mediastinal lymph node dissection
(VATS L-MLND). <br/>Method(s): This single-arm prospective trial was done
at the University of Texas MD Anderson Cancer Center (Houston, TX, USA)
and enrolled patients aged 18 years or older with a Zubrod performance
status of 0-2, newly diagnosed and histologically confirmed NSCLC with
N0M0 disease (squamous cell, adenocarcinoma, large cell, or NSCLC not
otherwise specified), and a tumour diameter of 3 cm or less. This trial
did not include patients from the previous pooled analysis. SABR dosing
was 54 Gy in three fractions (for peripheral lesions) or 50 Gy in four
fractions (for central tumours; simultaneous integrated boost to gross
tumour totalling 60 Gy). The primary endpoint was the 3-year overall
survival. For the propensity-matching analysis, we used a surgical cohort
from the MD Anderson Department of Thoracic and Cardiovascular Surgery's
prospectively registered, institutional review board-approved database of
all patients with clinical stage I NSCLC who underwent VATS L-MLND during
the period of enrolment in this trial. Non-inferiority could be claimed if
the 3-year overall survival rate after SABR was lower than that after VATS
L-MLND by 12% or less and the upper bound of the 95% CI of the hazard
ratio (HR) was less than 1.965. Propensity matching consisted of
determining a propensity score using a multivariable logistic regression
model including several covariates (age, tumour size, histology,
performance status, and the interaction of age and sex); based on the
propensity scores, one patient in the SABR group was randomly matched with
one patient in the VATS L-MLND group using a 5:1 digit greedy match
algorithm. This study is registered with ClinicalTrials.gov, NCT02357992.
<br/>Finding(s): Between Sept 1, 2015, and Jan 31, 2017, 80 patients were
enrolled and included in efficacy and safety analyses. Median follow-up
time was 5.1 years (IQR 3.9-5.8). Overall survival was 91% (95% CI 85-98)
at 3 years and 87% (79-95) at 5 years. SABR was tolerated well, with no
grade 4-5 toxicity and one (1%) case each of grade 3 dyspnoea, grade 2
pneumonitis, and grade 2 lung fibrosis. No serious adverse events were
recorded. Overall survival in the propensity-matched VATS L-MLND cohort
was 91% (95% CI 85-98) at 3 years and 84% (76-93) at 5 years.
Non-inferiority was claimed since the 3-year overall survival after SABR
was not lower than that observed in the VATS L-MLND group. There was no
significant difference in overall survival between the two patient cohorts
(hazard ratio 0.86 [95% CI 0.45-1.65], p=0.65) from a multivariable
analysis. <br/>Interpretation(s): Long-term survival after SABR is
non-inferior to VATS L-MLND for operable stage IA NSCLC. SABR remains
promising for such cases but multidisciplinary management is strongly
recommended. <br/>Funding(s): Varian Medical Systems and US National
Cancer Institute (National Institutes of Health).<br/>Copyright &#xa9;
2021 Elsevier Ltd

<99>
Accession Number
2013714681
Title
Use of PCR in the diagnosis of pericardial amebiasis: a case report and
systematic review of the literature.
Source
BMC Infectious Diseases. 21(1) (no pagination), 2021. Article Number: 960.
Date of Publication: December 2021.
Author
Matsuo T.; Saito A.; Kawai F.; Ishikawa K.; Hasegawa R.; Suzuki T.; Fujino
T.; Kinoshita K.; Asano T.; Mizuno A.; Yagita K.; Komiyama N.; Uehara Y.;
Mori N.
Institution
(Matsuo, Ishikawa, Hasegawa, Uehara, Mori) Department of Infectious
Diseases, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku,
Tokyo, Japan
(Saito, Suzuki, Asano, Mizuno, Komiyama) Department of Cardiovascular
Medicine, St. Luke's International Hospital, Tokyo, Japan
(Kawai) St. Luke's International University Library, Tokyo, Japan
(Fujino, Kinoshita) Department of Internal Medicine, St. Luke's
International Hospital, Tokyo, Japan
(Yagita) Department of Parasitology, National Institute of Infectious
Diseases, Tokyo, Japan
(Uehara) Department of Clinical and Laboratory, St. Luke's International
Hospital, Tokyo, Japan
Publisher
BioMed Central Ltd
Abstract
Background: Entamoeba histolytica (E. histolytica) is rarely identified as
a cause of amebic pericarditis. We report a case of amebic pericarditis
complicated by cardiac tamponade, in which the diagnosis was missed
initially and was made retrospectively by polymerase chain reaction (PCR)
testing of a stored sample of pericardial fluid. Furthermore, we performed
a systematic review of the literature on amebic pericarditis. Case
presentation: A 71-year-old Japanese man who had a history of sexual
intercourse with several commercial sex workers 4 months previously,
presented to our hospital with left chest pain and cough. He was admitted
on suspicion of pericarditis. On hospital day 7, he developed cardiac
tamponade requiring urgent pericardiocentesis. The patient's symptoms
temporarily improved, but 1 month later, he returned with fever and
abdominal pain, and multiple liver lesions were found in the right lobe.
Polymerase chain reaction of the aspiration fluid of the liver lesion and
pericardial and pleural fluid stored from the previous hospitalization
were all positive for E. histolytica. Together with the positive serum
antibody for E. histolytica, a diagnosis of amebic pericarditis was made.
Notably, the diagnosis was missed initially and was made retrospectively
by performing PCR testing. The patient improved with metronidazole 750 mg
thrice daily for 14 days, followed by paromomycin 500 mg thrice daily for
10 days. <br/>Conclusion(s): This case suggests that, although only 122
cases of amebic pericarditis have been reported, clinicians should be
aware of E. histolytica as a potential causative pathogen. The polymerase
chain reaction method was used to detect E. histolytica in the pericardial
effusion and was found to be useful for the diagnosis of amebic
pericarditis in addition to the positive results for the serum antibody
testing for E. histolytica. Because of the high mortality associated with
delayed treatment, prompt diagnosis should be made.<br/>Copyright &#xa9;
2021, The Author(s).

<100>
Accession Number
2011532557
Title
Early outcomes from the CLASP IID trial roll-in cohort for prohibitive
risk patients with degenerative mitral regurgitation.
Source
Catheterization and Cardiovascular Interventions. 98(4) (pp E637-E646),
2021. Date of Publication: October 2021.
Author
Lim D.S.; Smith R.L.; Zahr F.; Dhoble A.; Laham R.; Lazkani M.; Kodali S.;
Kliger C.; Hermiller J.; Vora A.; Sarembock I.J.; Gray W.; Kapadia S.;
Greenbaum A.; Rassi A.; Lee D.; Chhatriwalla A.; Shah P.; Rodes-Cabau J.;
Ibrahim H.; Satler L.; Herrmann H.C.; Mahoney P.; Davidson C.; Petrossian
G.; Guerrero M.; Koulogiannis K.; Marcoff L.; Gillam L.
Institution
(Lim) Department of Medicine, Division of Cardiovascular Medicine,
University of Virginia Health System, Charlottesville, VA, United States
(Smith) Department of Surgery, Division of Cardiovascular Surgery, Baylor
Scott and White The Heart Hospital Plano, Plano, TX, United States
(Zahr) Department of Medicine, Division of Cardiovascular Medicine, Oregon
Health & Science University, Portland, OR, United States
(Dhoble) Department of Medicine, Division of Cardiovascular Medicine, The
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Laham) Department of Medicine, Division of Cardiovascular Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Lazkani) Department of Medicine, Division of Cardiovascular Medicine,
UCHealth Medical Center of the Rockies, Loveland, CO, United States
(Kodali) Department of Medicine, Division of Cardiovascular Medicine,
Columbia University Medical Center, New York, NY, United States
(Kliger) Department of Medicine, Division of Cardiovascular Medicine,
Northwell-Lenox Hill, New York, NY, United States
(Hermiller) Department of Medicine, Division of Cardiovascular Medicine,
St. Vincent Heart Center of Indiana, Indianapolis, IN, United States
(Vora) Department of Medicine, Division of Cardiovascular Medicine, UPMC
Pinnacle Health Harrisburg, Harrisburg, PA, United States
(Sarembock) Department of Medicine, Division of Cardiovascular Medicine,
The Christ Hospital and Lindner Clinical Research Center, Cincinnati, OH,
United States
(Gray) Department of Medicine, Division of Cardiovascular Medicine,
Lankenau Heart Institute, Wynnewood, PA, United States
(Kapadia) Department of Medicine, Division of Cardiovascular Medicine,
Cleveland Clinic Foundation, Cleveland, OH, United States
(Greenbaum) Department of Medicine, Division of Cardiovascular Medicine,
Emory University, Atlanta, GA, United States
(Rassi) Department of Medicine, Division of Cardiovascular Medicine,
Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United
States
(Lee) Department of Medicine, Division of Cardiovascular Medicine,
Stanford University Medical Center, Palo Alto, CA, United States
(Chhatriwalla) Department of Medicine, Division of Cardiovascular
Medicine, Saint Luke's Hospital of Kansas City, Kansas City, MO, United
States
(Shah) Department of Medicine, Division of Cardiovascular Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Rodes-Cabau) Department of Medicine, Division of Cardiovascular Medicine,
Laval Hospital, Quebec City, QC, Canada
(Ibrahim) Department of Medicine, Division of Cardiovascular Medicine, New
York University Langone Medical Center, New York, NY, United States
(Satler) Department of Medicine, Division of Cardiovascular Medicine,
MedStar Washington Hospital Center, Washington, DC, United States
(Herrmann) Department of Medicine, Division of Cardiovascular Medicine,
University of Pennsylvania, Philadelphia, PA, United States
(Mahoney) Department of Medicine, Division of Cardiovascular Medicine,
Sentara Norfolk General Hospital, Norfolk, VA, United States
(Davidson) Department of Medicine, Division of Cardiovascular Medicine,
Northwestern University, Chicago, IL, United States
(Petrossian) Department of Medicine, Division of Cardiovascular Medicine,
St. Francis Hospital, The Heart Center, Roslyn, NY, United States
(Guerrero) Department of Medicine, Division of Cardiovascular Medicine,
Mayo Clinic Rochester, Rochester, MN, United States
(Koulogiannis, Marcoff, Gillam) Department of Medicine, Division of
Cardiovascular Medicine, Atlantic Health System Morristown Medical Center,
Morristown, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We report the 30-day outcomes from the roll-in cohort of the
CLASP IID trial, representing the first procedures performed by each site.
<br/>Background(s): The currently enrolling CLASP IID/IIF pivotal trial is
a multicenter, prospective, randomized trial assessing the safety and
effectiveness of the PASCAL transcatheter valve repair system in patients
with clinically significant MR. The trial allows for up to three roll-in
patients per site. <br/>Method(s): Eligibility criteria were: DMR >=3+,
prohibitive surgical risk, and deemed suitable for transcatheter repair by
the local heart team. Trial oversight included a central screening
committee and echocardiographic core laboratory. The primary safety
endpoint was a 30-day composite MAE: cardiovascular mortality, stroke,
myocardial infarction (MI), new need for renal replacement therapy, severe
bleeding, and non-elective mitral valve re-intervention, adjudicated by an
independent clinical events committee. Thirty-day echocardiographic,
functional, and quality of life outcomes were assessed. <br/>Result(s): A
total of 45 roll-in patients with mean age of 83 years and 69% in NYHA
class III/IV were treated. Successful implantation was achieved in 100%.
The 30-day composite MAE rate was 8.9% including one cardiovascular death
(2.2%) due to severe bleeding from a hemorrhagic stroke, one MI, and no
need for re-intervention. MR<=1+ was achieved in 73% and <=2+ in 98% of
patients. 89% of patients were in NYHA class I/II (p <.001) with
improvements in 6MWD (30 m; p =.054) and KCCQ (17 points; p <.001).
<br/>Conclusion(s): Early results representing sites with first experience
with the PASCAL repair system showed favorable 30-day outcomes in patients
with DMR>=3+ at prohibitive surgical risk.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC.

<101>
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;

<102>
Accession Number
635123488
Title
The Effectiveness of the Transitional Care Program Among People Awaiting
Coronary Artery Bypass Graft Surgery: A Randomized Control Trial.
Source
Journal of nursing scholarship : an official publication of Sigma Theta
Tau International Honor Society of Nursing. 53(5) (pp 585-594), 2021. Date
of Publication: 01 Sep 2021.
Author
Yuroong A.; Asdornwised U.; Pinyopasakul W.; Wongkornrat W.; Chansatitporn
N.
Institution
(Yuroong) PhD Candidate, Faculty of Nursing, Ramathibodi School of
Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University,
Bangkok, Thailand
(Asdornwised, Pinyopasakul) Faculty of Nursing, Mahidol University,
Bangkok, Thailand
(Wongkornrat) Cardiothoracic Division, Department of Surgery, Siriraj
Hospital, Mahidol University, Bangkok, Thailand
(Chansatitporn) Department of Biostatistics, Faculty of Public Health,
Mahidol University, Bangkok, Thailand
Publisher
NLM (Medline)
Abstract
PURPOSE: This study examined the effectiveness of the Transitional Care
Program (TCP) on the anxiety, depression, cardiac self-efficacy, number of
hospitalizations, and satisfaction with care among people awaiting
elective coronary artery bypass graft (CABG) surgery. DESIGN: The study
design was a randomized controlled trial. <br/>METHOD(S): The participants
with coronary artery disease who met the study criteria (n = 104) were
randomly assigned to the intervention group (n = 52) receiving the TCP
plus routine care, or the control group (n = 52) receiving routine care
only. The TCP, developed based on the Transitional Care Model, comprised
hospital discharge planning and six weekly home telephone follow-ups to
provide health education, counseling, monitoring, and emotional support
tailored to the individual's needs. Data were collected at baseline, and
then at weeks 1, 6, and 8 after program enrollment. Data were analyzed
using descriptive statistics, repeated-measures analysis of variance, and
the Z test. FINDINGS: The intervention group had lower anxiety and
depression than did the control group at weeks 1, 6, and 8 after program
enrollment. At weeks 6 and 8, the intervention group exhibited higher
cardiac self-efficacy and satisfaction with care than the control group.
Further, the intervention group had a significantly lower number of
hospitalizations than the control group at week 8. <br/>CONCLUSION(S): The
TCP can reduce anxiety, depression, and number of hospitalizations, while
increasing cardiac self-efficacy and satisfaction with care among people
awaiting CABG. CLINICAL RELEVANCE: Nurses are in a pivotal position to
make care transitions safer. Provision of discharge education and regular
telephone contacts could enhance positive outcomes regarding patients
awaiting elective cardiac surgery.<br/>Copyright &#xa9; 2021 Sigma Theta
Tau International.

<103>
Accession Number
633877836
Title
Safety and Efficacy of Using Tranexamic Acid at the Beginning of
Robotic-Assisted Radical Prostatectomy in a Double-Blind Prospective
Randomized Pilot Study.
Source
Acta medica (Hradec Kralove). 63(4) (pp 176-182), 2020. Date of
Publication: 2020.
Author
Balik M.; Kosina J.; Husek P.; Brodak M.; Cecka F.
Institution
(Balik, Kosina, Husek, Brodak) Department of Urology, Faculty of Medicine
and University Hospital Hradec Kralove, Czechia
(Cecka) Department of Surgery, Faculty of Medicine and University Hospital
Hradec Kralove, Czechia
Publisher
NLM (Medline)
Abstract
BACKGROUND: The prophylactic administration of tranexamic acid has been
shown to be appropriate for procedures with a high risk of perioperative
bleeding in cardiac surgery and orthopaedics. In urology the ambiguous
results have been reported. Our goal was to evaluate the effect of
tranexamic acid administration in robotic-assisted radical prostatectomy
(RARP). A pilot, prospective, double-blind, randomized study was conducted
to evaluate this effect. <br/>METHOD(S): The study included 100 patients
who received RARP in the period from April 2017 to January 2018. The
patients were randomly assigned to study and control groups of 50 patients
each. <br/>RESULT(S): The median follow-up was 6 months. Lower haemoglobin
level drop weighted for gram of operated prostate was observed in the
study group when treating the dorsal vein complex (DVC) at the beginning
of the procedure (p = 0.004 after 3 hours and p < 0.001 after 24 hours).
There was no evidence of any serious side effect of tranexamic acid.
<br/>CONCLUSION(S): We demonstrated the safety of tranexamic acid at RARP.
In addition, we showed that administration of tranexamic acid at the
beginning of RARP significantly reduces the decrease in haemoglobin after
the procedure when treating the DVC at the beginning of the procedure.

<104>
Accession Number
2014930130
Title
WHEN THE WAY TO A MAN'S HEART IS THROUGH THE STOMACH: A RARE CASE OF
GASTRO-PERICARDIAL FISTULA AFTER PERCUTANEOUS GASTRIC TUBE DISPLACEMENT.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A68), 2021. Date of Publication: October 2021.
Author
Hyder S.; Vaishnavi Gadela N.; Jacob J.; Swales H.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Gastro-pericardial fistula is an acquired abnormal
communication between the stomach and the pericardium. We report one such
case presenting as an unusual complication of percutaneous gastric tube
(PEG) dislodgement. Early identification of this rare life-threatening
condition can prevent fatal outcomes. CASE PRESENTATION: A 53-year-old
male presented to our facility with acute substernal chest pain associated
with dyspnea. He has a past medical history of chronic sclerosing
peritonitis with a draining PEG tube. On presentation, his vital signs and
physical examination were within normal limits. Laboratory investigation
were unremarkable. Electrocardiogram (EKG) showed diffuse ST segment
elevation concerning for pericarditis and he was started on steroids.
During the course of his hospitalization his dyspnea worsened, and he
subsequently underwent a Computerized Tomography(CT) scan of the chest
which was significant for a pneumopericardium. An echocardiogram was
performed which revealed a pericardial effusion which was free flowing
without any stranding or loculations. There were no signs of tamponade. He
consequently underwent an upper endoscopy which showed dislodgement of the
PEG with the tip abutting the inferioapical region of the pericardium
forming a fistulous tract. The PEG tube was therefore removed, and he was
empirically treated with broad spectrum antibiotics. Endoscopic repair of
the fistula was attempted, however it failed. Considering the clinical
stability of the patient and absence of purulent drainage, the fistula was
allowed to heal naturally while the patient remained on total parenteral
nutrition in the Intensive Care Unit (ICU). DISCUSSION: Fistulous
complications following PEG tube placement are extremely rare with an
incidence of 0.3 to 6.7%. They have high mortality rate of 50%.
Pneumopericardium can have a range of clinical presentations from being
asymptomatic to presenting with chest pain, dyspnea, dyspepsia, epigastric
pain, left shoulder due to diaphragmatic/pericardial irritation as well as
sudden cardiac death due to cardiac tamponade. The diagnosis is
challenging and is made using a combination of clinical suspicion,
radiographic findings using small amount of methylene blue/contrast to
visualize the fistula. An endoscopy may be helpful in establishing the
diagnosis, but should be used with caution, because excessive air
insufflation by the endoscope may exacerbate thecardiac tamponade.
Treatment varies depending on the clinical stability and includes surgical
closure of the fistula, pericardial drain placement or even conservative
management. <br/>CONCLUSION(S): Gastro-pericardial fistula can be seen as
a late complication of PEG tube and can present as an unusual cause of
chest pain. Early detection of pneumo-pericardium and timely intervention
while monitoring the patient in the ICU can prevent catastrophic outcomes.
REFERENCE #1: Grandhi TM, Rawlings D, Morran CGGastropericardial fistula:
a case report and review of literature Emergency Medicine Journal
2004;21:644-645. REFERENCE #2: Kato T, Mori T, Niibori K. A case of
gastropericardial fistula of a gastric tube after esophagectomy: a case
report and review. World J Emerg Surg. 2010 Jul 21;5:20. doi:
10.1186/1749-7922-5-20. PMID: 20663167; PMCID: PMC2917401. DISCLOSURES: No
relevant relationships by Naga Vaishnavi Gadela, source=Web Response No
relevant relationships by Sana Hyder, source=Web Response no disclosure on
file for Jason Jacob; No relevant relationships by Heather Swales,
source=Web Response<br/>Copyright &#xa9; 2021 American College of Chest
Physicians

<105>
Accession Number
2014930003
Title
A MAN CRIED FOWL: A RARE CAUSE OF A ZOONOTIC EMPYEMA.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A346), 2021. Date of Publication: October 2021.
Author
Winterton B.; McMenamy K.; Sunna R.; Reed M.
Publisher
Elsevier Inc.
Abstract
TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Pasteurella is commonly found in the oral cavities and
digestive tracts in many household pets and farm animals [1]. P. multocida
most commonly causes soft tissue infections from dog and cat bites, or
scratches. We report an unusual case of bacteremia and empyema caused by
P. multocida in a turkey farmer. CASE PRESENTATION: A 61-year-old male
with a 50 pack year smoking history presented with a left anterior chest
wall pleuritic pain and a productive cough. He denied fevers, night
sweats, chills, or weight changes. In the ER, the patient was hypoxic
requiring 6 Liters per minute oxygen via nasal cannula. Labs were
significant for white blood cell (WBC) of 13.37 x10(9), troponin <0.01
ng/dL, and blood pressure 184/76 mmHg. CT chest revealed a left pleural
effusion. Blood cultures were obtained and IV antibiotics were started.
The patient was admitted to the general medical ward.Patient underwent a
thoracentesis in which 450ml of straw-colored pleural fluid was obtained.
Analysis of pleural fluid was significant for pH 7.09, glucose <2 mg/dL,
LDH 524 units/L, total protein 4.5 g/dL and WBC count 62,725/mcl.
Pulmonary was consulted and placed a 12 French chest tube. Thoracic
surgery was consulted and advised continued chest tube drainage.
Intrapleural alteplase and dornase were administered to help resolve the
empyema.On day three of hospitalization, P. multocida grew in blood
culture and pleural fluid that was obtained. Further patient history
revealed the patient was currently employed at a turkey farm that was
experiencing a fowl cholera outbreak. He endorsed frequently being bit and
scratched by turkeys. On day nine the chest tube was removed with
subsequent discharge on day ten with levofloxacin for a total of 28 days
of antibiotics. DISCUSSION: P. multocida can be found in oral,
nasopharyngeal, and upper respiratory tract in 70-90% of cats and 50-66%
of dogs; and in many other common animals including turkeys. Even though
genus Pasteurella was first isolated as the causative agent of fowl
cholera by Louis Pasteur, fowl to human transmission is less common [1].
Literature review revealed empyema cases of P. multocida were typically
characterized as grossly purulent (87%) with a low pleural fluid pH (mean
6.8), high protein (mean 4.8 g/dl), high LDH (mean 1911 U/L) and low
glucose (mean 28.6 mg/dl). Pleural fluid drainage with tube thoracostomy
was required in the majority (62%) of cases [2]. Fortunately, the
bacterium generally responds favorably to antibiotic treatment. It is
susceptible to antibiotics including penicillins, doxycycline,
fluoroquinolones, third generation cephalosporins and carbapenems [3].
<br/>CONCLUSION(S): In conclusion, P. multocida is a rare cause of empyema
[2]. Health care providers need to have a high clinical suspicion of P.
multocida infection in patients that handle fowl. REFERENCE #1: Weber
David J., John S. Wolfson, Morton N. Swartz, David C Hooper. 1984.
"Pasteurella multocida Infections." Medicine (The Williams & Wilkins Co. )
63 (2): 133-154. REFERENCE #2: Jogani SN, Subedi R, Chopra A, Judson MA.
Pasteurella multocida pleural effusion: A case report and review of
literature. Respir Med Case Rep. 2016;19:68-70. Published 2016 Jul 21.
doi:10.1016/j.rmcr.2016.07.013 REFERENCE #3: Lion. C, M.C. Conroy, A.M.
Carpentier, A. Lozniewski. 2006. "Antimicrobial susceptibilities of
Pasteurella strains isolated from humans." International Journal of
Antimicrobial Agents 27 (4): 290-293.
https://doi.org/10.1016/j.ijantimicag.2006.02.004 DISCLOSURES: No relevant
relationships by Kyle McMenamy, source=Web Response No relevant
relationships by Mark Reed, source=Web Response No relevant relationships
by Ramez Sunna, source=Web Response No relevant relationships by Blaine
Winterton, source=Web Response<br/>Copyright &#xa9; 2021 American College
of Chest Physicians

<106>
Accession Number
2014929941
Title
WHY IS THERE AIR IN THERE? INTUBATION-ASSOCIATED IATROGENIC TRACHEAL
LACERATION RESULTING IN PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A607), 2021. Date of Publication: October 2021.
Author
Kotok D.; Hadeh A.
Publisher
Elsevier Inc.
Abstract
TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Tracheal
laceration complicating endotracheal intubation is uncommon, with an
incidence between 0.05% and 0.37% reported (1). Pneumomediastinum and
subcutaneous emphysema following tracheal laceration are an independent
risk factor for death (1). Appropriate management strategy is
controversial. We present a patient treated with oxygen and observation
after traumatic endotracheal intubation and associated tracheal injury who
recovered uneventfully with conservative measures. CASE PRESENTATION: Our
patient is a 57-year-old male with class 3 obesity (BMI 54.87 kg/m2)
status-post sleeve gastrectomy who presented with upper gastrointestinal
bleeding suspected to be from a known anastomosis-site ulcer. As part of
his evaluation, he was scheduled to undergo esophagogastroduodenoscopy
(EGD) under general anesthesia (GA). After induction of GA the anesthesia
team was not able to intubate the patient using a 7.5 endotracheal tube
(ETT). A smaller size ETT (7.0) nor a size 6.5 ETT could be passed due to
resistance felt by the operator. The procedure was cancelled and patient
transferred to the recovery area. He was noted to have subcutaneous
emphysema and associated crepitus involving his chest and neck. This was
further investigated with a non-contrast CT showing extensive
pneumomediastinum and subcutaneous emphysema associated with small
tracheal laceration (Figure 1A-B). The patient was put on supplemental
oxygen and observed in the hospital with gradual improvement. Serial
non-contrast CTs neck were obtained that showed improving anterior
tracheal defect and subcutaneous emphysema (Figure 1C-D). Radiographic
improvement continued (Figure 1E-F) on outpatient follow-up 3 weeks after
the index event where a small defect was directly visualized on fiberoptic
laryngoscopy (Figure 2). DISCUSSION: An uncommon complication of
endotracheal intubation, tracheal laceration and associated subcutaneous
emphysema and pneumomediastinum have been reported in the literature. Risk
factors for tracheal laceration include female age and older age (>=65).
The presence of subcutaneous emphysema is an adverse factor for mortality
(1). Definitive management is controversial (surgical vs conservative) but
some sources suggest a high rate of resolution with conservative
management regardless of site and size (2). In our patient, careful
observation resulted in gradual improvement of the defect size and
resolution of subcutaneous emphysema and pneumomediastinum.
<br/>CONCLUSION(S): Tracheal laceration following endotracheal intubation
is uncommon but dangerous complication. All difficult intubations should
raise suspicion for iatrogenic trauma, particularly in the presence of
subcutaneous air collection. Conservative treatment may be appropriate for
most patients (2) although large, prospective studies are required to
identify patients who would benefit from early surgical intervention.
REFERENCE #1: Minambres E, Buron J, Gonzalez-Castro A, et al. Tracheal
rupture after endotracheal intubation: a literature systematic review.
European Journal of Cardio-Thoracic Surgery, Volume 35, Issue 6, June
2009, Pages 1056-1062. REFERENCE #2: 2. Gomez-Caro Andres A, Javier
Moradiellos Diez F, Luis Martin De Nicolas J, et al. Successful
Conservative Management in Iatrogenic Tracheobronchial Injury. The Annals
of Thoracic Surgery, Volume 79, Issue 6, June 2005, Pages 1878.
DISCLOSURES: No relevant relationships by Anas Hadeh, source=Web Response
No relevant relationships by Daniel Kotok, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<107>
Accession Number
2014929803
Title
HOW SLOW CAN YOU GO: A COMPLEX CASE OF PROSTHETIC VALVE THROMBOSIS TREATED
WITH ULTRASLOW THROMBOLYTIC THERAPY.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A104), 2021. Date of Publication: October 2021.
Author
Tandan N.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiovascular Disease TYPE: Global Case Reports INTRODUCTION:
Mitral valve (MV) replacement can be affected by many different
complications, including but not limited to infection and thrombosis.
Prosthetic valve thrombosis occurs infrequently at a rate of 0.03%-0.13%
per patient year (1). There is limited evidence to support medical versus
surgical therapies in immobile ("stuck") prosthetic valve leaflets due to
underlying thrombosis. Here, we will discuss a case of a mechanical MV
treated unsuccessfully with prolonged ultraslow thrombolytic therapy
leading to need for surgical correction. CASE PRESENTATION: The patient is
a 44 year old female with a history of Crohn disease, CKD stage 3,
infective endocarditis requiring Saint Jude bileaflet mechanical MV
replacement, presented two months after her initial MV surgery due to
increasing palpitations and worsening dyspnea for 8 days. Vitals were
stable. CTA of the chest was negative for PE. TTE showed severe prosthetic
MV stenosis with thrombosis with mean gradient 16 mm Hg. Low-dose tPA
infusion was started, with resolution of the superficial layer of the
thrombus after 72 hours. However, TEE showed immobile posterior leaflets,
likely a result of underlying thrombus that was not resolved with
thrombolytics. The patient underwent repair of a malfunctioning prosthetic
MV on cardiopulmonary bypass with redo sternotomy. The left atrium was
opened posterior to the interatrial groove, and the MV was exposed to
demonstrate a thrombus on the posterior leaflet. This was pushed and the
MV worked normally. Repeat TTE showed a well-functioning MV with mean
transmitral gradient 4 mm Hg. She was bridged to warfarin and discharged
with close follow-up. DISCUSSION: Variable success rates have been
reported for prosthetic valve thrombosis. Medical therapies include
different protocols with heparin and fibrinolysis. A case report indicated
treatment of a "stuck" mechanical aortic valve successfully treated with
ultraslow infusion of alteplase (2). Surgical correction is optimal but
tends to carry higher risk. While the same ultraslow fibrinolysis protocol
was followed in treating this patient, there were only mild improvements
in mean pressure gradient and in the anatomy of the valve, likely due to
partial resolution of thrombus on the prosthetic heart valve. Thus,
cardiothoracic surgery with MV repair became a necessity, leading to
complete resolution of thrombus and to improvement of symptoms. While it
is still debated as to whether or not thrombolytics are a useful clinical
management strategy, this case demonstrated the inefficiency of ultraslow
thrombolytic therapy requiring surgical intervention. <br/>CONCLUSION(S):
Ultraslow infusion of thrombolytic therapy may offer alternative solutions
to prosthetic valve thrombosis; however, they may not be as helpful in
management of immobile posterior leaflet valves. Further prospective
studies should be performed to clarify optimal management protocols and
strategies. REFERENCE #1: Hammermeister K, Sethi GK, Henderson WG, Grover
FL, Oprian C, Rahimtoola SH. Outcomes 15 years after valve replacement
with a mechanical versus a bioprosthetic valve: final report of the
Veterans Affairs randomized trial. J Am Coll Cardiol. 2000
Oct;36(4):1152-8. doi: 10.1016/s0735-1097(00)00834-2. PMID: 11028464.
REFERENCE #2: Naeim HA, Alamodi O, Karam A, et al. Ultraslow thrombolytic
therapy in stuck mechanical aortic valve, case report, and review of the
literature. J Saudi Heart Assoc. 2020;32(2):186-189. Published 2020 May 8.
doi:10.37616/2212-5043.11 DISCLOSURES: No relevant relationships by Nitin
Tandan, source=Web Response<br/>Copyright &#xa9; 2021 American College of
Chest Physicians

<108>
Accession Number
2014929717
Title
DROWNING ASPHYXIA AND ACCIDENTAL HYPOTHERMIC CARDIAC ARREST WITH FAVORABLE
OUTCOME: A CASE REPORT.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A610), 2021. Date of Publication: October 2021.
Author
Mukhtar O.; Ahmad S.
Publisher
Elsevier Inc.
Abstract
TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Drowning with
accidental hypothermia (AH) and cardiac arrest is a challenging clinical
situation-severe hypothermia with core body temperature (CBT) < 28 C by
itself is life-threatening. The overall mortality ranges from 30-80% and
increases to 100% in submersion victims who are comatose and required
prolonged CPR. CASE PRESENTATION: A 22-year-old female was seen by
bystanders as she intentionally jumped into an ice-covered lake in
Minnesota on a cold December night when the outdoor temperature was < 20 F
(-6 C). She was submerged in the lake for 25 minutes. On retrieval, she
was in asystole, and CPR was commenced at scene and continued along the
way to the nearest ER. In the ER, she remained in asystole for another 25
minutes before achieving ROSC. She was immediately intubated for a GCS of
3 and hypoxia. Her initial CBT was 27.7 C (82 F). Multiple active external
and internal rewarming techniques were employed. Her initial laboratory
workup revealed pH of 6.8, serum K of 2.5 mEq/L and LA of 10.7 mmol/L.
Ongoing care in the ICU included deep sedation and rewarming. A chest
X-ray showed extensive bilateral pulmonary opacities. Her oxygenation
continued to worsen, with PF ratio of 65, suggesting severe ARDS.
Unfortunately, she was considered not a suitable candidate for ECMO based
on suspected asphyxia and prolonged asystole and subsequent severe anoxic
brain injury. Consequently, she was managed with protective lung
ventilation and prone positioning. Re-warming was continued (using Arctic
SunTM TTM system), normothermia was achieved with rewarming at a rate of 1
C/hr. On Day 2, she tolerated SAT and SBT. However, she developed jerky
movements of her extremities. A diagnosis of post-hypoxic myoclonus
(Lance-Adams myoclonus) was made and responded well to Levetiracetam. She
was successfully extubated on Day 4 and left the ICU on Day 5. In the
medical ward, an MRI brain revealed scattered areas of acute infarction
involving the cerebral cortex bilaterally. She was discharged on Day 14.
Levetiracetam was discontinued on a follow-up visit as she made a complete
neurological recovery. DISCUSSION: The outcome of severe hypothermia has
substantially improved with ECLS use as survival has improved to 100%. A
subgroup of severe hypothermia, submersion, continued to have significant
morbidity and mortality, despite the use of ECLS. Current guidelines
recommend aggressive management of all patients, particularly young
victims, as no methods can reliably predict who will likely to survive. In
drowning-related hypothermia, an immersion period > 25 min invariably
prove fatal. This poor outcome is due to asphyxia which leads to
irreversible brain damage, usually preceding the protective effects of
hypothermia on brain tissue. <br/>CONCLUSION(S): Despite known poor
survival, asphyxia should not be considered a contraindication for ECLS in
hypothermic cardiac arrest, especially in young submersion victims.
REFERENCE #1: Avellanas Chavala, M. L., Ayala Gallardo, M., Soteras
Martinez, I., & Subirats Bayego, E. (2019). Management of accidental
hypothermia: A narrative review. Gestion de la hipotermia accidental:
revision narrativa. Medicina intensiva, 43(9), 556-568. PMID: 30683520.
REFERENCE #2: Ledoux, A., & Saint Leger, P. (2020). Therapeutic management
of severe hypothermia with veno-arterial ECMO: where do we stand? Case
report and review of the current literature. Scandinavian journal of
trauma, resuscitation and emergency medicine, 28(1), 30. PMID: 32316980.
REFERENCE #3: Farstad, M., Andersen, K. S., Koller, M. E., Grong, K.,
Segadal, L., & Husby, P. (2001). Rewarming from accidental hypothermia by
extracorporeal circulation. A retrospective study. European journal of
cardio-thoracic surgery : official journal of the European Association for
Cardio-thoracic Surgery, 20(1), 58-64. PMID: 11423275. DISCLOSURES: No
relevant relationships by Sumera Ahmad, source=Web Response No relevant
relationships by Osama Mukhtar, source=Web Response<br/>Copyright &#xa9;
2021 American College of Chest Physicians

<109>
Accession Number
2014929716
Title
AORTIC ROOT ABSCESS: A RARE COMPLICATION OF STAPHYLOCOCCUS EPIDERMIDIS
PROSTHETIC VALVE ENDOCARDITIS.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A295), 2021. Date of Publication: October 2021.
Author
Rajendraprasad S.; Kenny D.; Cruz Torres R.; Velagapudi M.
Publisher
Elsevier Inc.
Abstract
TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Aortic
root abscess is a lethal complication of infective endocarditis. Here, we
report a case of aortic root abscess that occurred as a complication of S.
epidermidis prosthetic valve endocarditis, which is a rare cause of aortic
abscess. CASE PRESENTATION: 71-year-old woman with complex cardiac history
including a bioprosthetic aortic valve replacement, ascending aorta
aneurysm repair, and coronary artery bypass graft x4 presented to the ER
with worsening chest pain, fevers, chills and rigors. On arrival,
temperature was 97.5degreeF heart rate was 61 beats/min, respiratory rate
was 20 per minute and blood pressure was 139/82 mm Hg. On exam, she had a
grade 4/6 ejection systolic murmur, heard best at the right upper sternal
border radiating to carotids. Laboratory investigations showed hemoglobin,
10.5 g/ dL; total leukocyte count, 10 k/uL with 80% neutrophils; platelet
count, 311 k/uL; and sedimentation rate, 74 mm/hr. Rest of the labs were
normal. She tested negative for SARS-Cov-2 by polymerase chain reaction
(PCR). Blood cultures grew isolated Staphylococcus epidermidis. She was
persistently bacteremic on vancomycin monotherapy and required ceftaroline
and daptomycin combination therapy for clearance of bacteremia.
Transesophageal echo cardiography was obtained which showed an area of
echolucency adjacent to the posterior aortic valve annulus suggestive of
abscess. PET CT was obtained, confirmed the diagnosis of aortic abscess.
She was referred to Mayo Clinic. She underwent, extensive debridement of
previously implanted tissue aortic valve and entire root complex, coronary
artery bypass grafting and aortic root replacement. DISCUSSION: Aortic
root abscess is a life-threatening complication of aortic valve
endocarditis, known to occur in patients with native and prosthetic aortic
valves. Staphylococcus aureus is the reported as most common cause.
Persistent fever, shortness of breath, chest pain and other signs of
severe aortic regurgitations are the most common presentation. Aggressive
surgical debridement and medical therapy are the key to treatment. If
untreated, can result in severe valvular dysfunction, fistula formation,
perforation of cusps, pseudoaneurysm, obstruction of coronary flow or
fatal arrhythmia. Even with surgery, reported mortality remains high
12.2-30%. <br/>CONCLUSION(S): Aortic root abscess should be considered as
a diagnosis in persistently febrile and bacteremic patients with
prosthetic valve endocarditis and should be treated promptly with surgical
debridement and reconstruction. REFERENCE #1: Chen G-J, Lo W-C, Tseng H-W,
Pan S-C, Chen Y-S, Chang S-C. Outcome of surgical intervention for aortic
root abscess: a meta-analysis. Eur J Cardiothorac Surg 2018;53:807-14
DISCLOSURES: No relevant relationships by Rosa Cruz Torres, source=Web
Response No relevant relationships by Dorothy Kenny, source=Web Response
No relevant relationships by Sanu Rajendraprasad, source=Web Response No
relevant relationships by Manasa Velagapudi, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<110>
Accession Number
2014929698
Title
FLU KILLS: ACUTE INFLUENZA B PRESENTING WITH CARDIAC TAMPONADE.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A398), 2021. Date of Publication: October 2021.
Author
mir J.; Mumtaz S.; AKRAM A.; Aamir M.; Ibrar Islam M.; Lund J.
Publisher
Elsevier Inc.
Abstract
TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Influenza virus usually affects the upper and lower
respiratory tract, manifesting with cough, fever, rhinorrhea, and nasal
congestion. Cardiac tamponade as an initial presentation of influenza B is
rare. We report a case of a patient who presented with cardiac tamponade
in the setting of influenza. CASE PRESENTATION: A 31-year-old gentleman
with no significant past medical history presented with dyspnea, cough,
and postnasal drip for 3-4 days. Physical exam was notable for tachypnea
and accessory muscle use. Abnormal vitals included blood pressure 90/60 mm
hg, heart rate 130/min, and SpO2 of 88% on room air. EKG showed
nonspecific ST and T wave abnormalities. Infectious workup was
unremarkable except for positive influenza B. CXR was unremarkable. Lactic
acid was elevated at 14. He was given a bolus of Normal saline and started
on broad-spectrum antibiotics. The patients' blood pressure and breathing
started to deteriorate, and he had a cardiac arrest. Bedside Cardiac
ultrasound showed pericardial effusion with right ventricular diastolic
collapse (tamponade physiology) and global hypokinesia (fig 1). Emergent
pericardiocentesis was done, and about 50 ml was evacuated; ROSC was
achieved. However, the patient had a cardiac arrest again and was placed
on Venoarterial Extracorporeal membrane oxygenation (V-A ECMO) (Fig 2).
There was insufficient ECMO flow with absent pulsatility, so a repeat
echocardiogram was done that showed pericardial effusion with Tamponade
physiology and global hypokinesia with an ejection fraction of 5-10% (Fig
3). He underwent pericardial window and 500 ml of pericardial fluid was
evacuated. ECMO flow improved, however, without any pulsatility. He had a
multiorgan failure, and eventually, transitioned to comfort care on the
third day of his admission. DISCUSSION: Cardiac complications in influenza
include myocarditis, pericarditis, arrhythmia, heart failure, ischemia,
and Cardiac tamponade. Cardiac manifestations are either due to the
virus's direct effect on the heart or through the aggravation of the
underlying cardiovascular conditions. (1) Influenza patients who have
cardiac tamponade mostly present with chest pain and dyspnea. (2) Cardiac
tamponade is diagnosed by echocardiogram. Pericardial effusion with the
right ventricular collapse in diastole, right atrium collapse, and dilated
inferior vena cava are the sensitive features of Cardiac tamponade on
echocardiogram. (3) Pericardiocentesis is the treatment of choice. The
mortality rate of influenza patients with Cardiac tamponade is 14% (2)
<br/>CONCLUSION(S): There are only 28 case reports of patients diagnosed
with cardiac tamponade in the setting of influenza, of which only three
patients had influenza B. (2) Clinicians should keep cardiac complications
in their minds while treating hemodynamically, unstable influenza
patients. Bedside cardiac ultrasound, along with EKG, can be employed to
assess these patients. REFERENCE #1: 1) Pandey Y, Hasan R, Joshi KP,
Habash FJ, Jagana R. Acute Influenza Infection Presenting with Cardiac
Tamponade: A Case Report and Review of Literature. Perm J. 2019;
23:18-104. doi:10.7812/TPP/18-104 REFERENCE #2: 2)R. Desai, S. Raina
Jilmil, V. Itare, A. Jain, S. Singh, R. Bhuva, et al. Circulation 2020
Vol. 142 Issue Suppl_3 Pages A15587-A15587 DOI:
10.1161/circ.142.suppl_3.15587https://doi.org/10.1161/circ.142.suppl_3.155
87. REFERENCE #3: 3) Perez-Casares A, Cesar S, Brunet-Garcia L,
Sanchez-de-Toledo J. Echocardiographic Evaluation of Pericardial Effusion
and Cardiac Tamponade. Front Pediatr. 2017; 5:79. Published 2017 Apr 24.
doi:10.3389/fped.2017.00079 DISCLOSURES: No relevant relationships by
Muhammad Aamir, source=Web Response No relevant relationships by Ali
AKRAM, source=Web Response No relevant relationships by Muhammad Ibrar
Islam, source=Web Response No relevant relationships by Jeet Lund,
source=Web Response No relevant relationships by Junaid mir, source=Web
Response No relevant relationships by Salmaan Mumtaz, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<111>
Accession Number
2014929691
Title
COVID-19-RELATED MYOCARDITIS RESULTING IN CARDIOGENIC SHOCK.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A150), 2021. Date of Publication: October 2021.
Author
Nguyen S.; Wasserman E.; Perosevic N.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Coronavirus-19 (COVID-19) myocarditis showed increased
mortality despite team work of experts. We present a case of a middle-aged
male with COVID-19 related myocarditis leading to cardiogenic shock. CASE
PRESENTATION: 64-year-old male with history of hypertension,
hyperlipidemia, hypothyroidism and positive COVID-19 infection with
related stroke presented with 2 weeks of myalgias, malaise, and dyspnea.
He was tachycardic on exam with bibasilar crackles and mild pedal edema.
Labs revealed elevated inflammatory markers, cardiac biomarkers and
leukocytosis with peripheral eosinophilia. Pulse dose steroids were
initiated for suspected vasculitis. Transthoracic echocardiogram (TTE)
revealed global hypokinesis and cardiac catheterization revealed LVEDP of
28 mmHg, LVEF of 10%, and cardiac index of 1.7 L/min/m2 without ischemic
disease. Inotropes were started, and the patient was transferred to the
center for advanced heart failure and cardiac transplant evaluation.
Cardiac MRI (CMRI) revealed late enhancing subendocardial myocardial
scarring of anteroseptal segments and endomyocardial biopsy revealed focal
ischemic injury suggestive of COVID-19 related myocarditis in the setting
of multisystem inflammatory syndrome (MIS-A). DISCUSSION: MIS-A is a rare
subacute complication of COVID-19, thought to be caused by direct cell
injury from ACE2 upregulation and a dysregulated immune response resulting
in acute myocarditis. Elevated troponins have been reported in these
patients due to ventricular dilation and direct myocardial injury.
Electrocardiograms have poor sensitivity for myocarditis, thus TTE is
performed which reveals wall abnormalities with reduced ventricular
function and has been reported in 60% of COVID-19 related myocarditis
cases. CMRI is preferred to evaluate myocarditis and may reveal hyperemia,
edema, and myocardial necrosis. Endomyocardial biopsy (EMB) is the gold
standard for diagnosing myocarditis, but should be a shared decision due
to lack of studies to support EMB diagnosis in suspected COVID-19
myocarditis. Patients with cardiogenic shock need vasopressors and
inotropes, and mechanical circulatory support via extracorporeal membrane
oxygenation or intra-aortic balloon pumps if needed. It is unclear if
intravenous immunoglobulins or steroids have benefit treating
COVID-19-related myocarditis and requires further evaluation.
<br/>CONCLUSION(S): Myocarditis should be suspected in patients with
COVID-19 infection presenting with acute heart failure. Given limited data
for COVID-19 related myocarditis, we need more studies to better treat
these patients. REFERENCE #1: Morris SB, Schwartz NG, Patel P, et al. Case
series of multisystem inflammatory syndrome in adults associated with
sars-cov-2 infection - united kingdom and united states, march-august
2020. MMWR Morb Mortal Wkly Rep. 2020;69:1450-1456. REFERENCE #2: Sawalha
K, Abozenah M, Kadado AJ, et al. Systematic review of COVID-19 related
myocarditis: insights on management and outcome. Cardiovasc Revasc Med.
2021;23,107-113. REFERENCE #3: Siripanthong B, Nazarian S, Muser D, et al.
Recognizing covid-19-related myocarditis: the possible pathophysiology and
proposed guideline for diagnosis and management. Heart Rhythm.
2020;17(9):1463-1471. DISCLOSURES: No relevant relationships by Suong
Nguyen, source=Web Response No relevant relationships by Nikola Perosevic,
source=Web Response No relevant relationships by Evan Wasserman,
source=Web Response<br/>Copyright &#xa9; 2021 American College of Chest
Physicians

<112>
Accession Number
2014929603
Title
SPONTANEOUS HEMOPNEUMOTHORAX RESULTING IN SHOCK.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A59), 2021. Date of Publication: October 2021.
Author
Wegner Wippel C.; Duarte S.; Blum C.; Ballester E.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiothoracic Surgery TYPE: Fellow Case Reports INTRODUCTION:
Spontaneous hemopneumothorax (SHP) is a rare disorder reported to occur in
approximately 3% of patients with spontaneous pneumothorax (SP) (1). The
mechanism involves a torn in an apical vascular adhesion or aberrant
vessels located between the parietal pleura and the bulla (2). Large SHP
can lead to hemodynamic instability and shock. Thus, early recognition and
prompt surgical intervention are key for patient survival. CASE
PRESENTATION: A 21-year-old man presented to the emergency department with
a two-day history of pleuritic chest pain and dyspnea. There was no
history of trauma and past medical history was noncontributory. Vital
signs showed an oxygen saturation of 94%, blood pressure of 110/70, and
heart rate of 106 bpm. Physical examination was notable for absent breath
sounds on the left. Chest X-ray showed left-sided large hydropneumothorax.
A chest tube was placed, draining 1600ml of dark-colored blood with clots.
A few hours later, the patient went into shock, with BP of 60/40 and HR of
130 bpm, and hematocrit of 29%. A central line was placed, fluid
resuscitation was performed, and blood products were given. After
stabilization, the patient underwent open thoracotomy with removal of
additional 500ml of clotted blood from his left hemithorax. Bullectomy and
pleurodesis were performed and a large bore chest tube was placed. The
patient was discharged two days later with no complications. DISCUSSION:
SHP mostly results from a SP, with young men being disproportionate
affected (3). Clinical presentation includes pleuritic chest pain and
dyspnea. When accompanied by hypotension, hemorrhagic shock, secondary to
bleeding into the thoracic cavity, should be suspected. In hemodynamically
unstable patients, early surgical intervention with either thoracotomy or
video-assisted thoracic surgery (VATS) should be performed. Conservative
treatment may be considered in selected and stable patients (1).
<br/>CONCLUSION(S): Sudden pleuritic chest pain and dyspnea in a young man
with the radiologic findings of hydropneumothorax should prompt a
diagnostic hypothesis of SHP. Early identification and intervention are
key for patient prognosis. REFERENCE #1: Hsu NY, Shih CS, Hsu CP, Chen PR.
Spontaneous hemopneumothorax revisited: clinical approach and systemic
review of the literature. Ann Thorac Surg. 2005 Nov;80(5):1859-63.
REFERENCE #2: Kakaris S, Athanassiadi K, Vassilikos K, Skottis I.
Spontaneous hemopneumothorax: a rare but life-threatening entity. Eur J
Cardiothorac Surg. 2004 May;25(5):856-8. REFERENCE #3: Kim ES, Kang JY,
Pyo CH, Jeon EY, Lee WB. 12-year experience of spontaneous
hemopneumothorax. Ann Thorac Cardiovasc Surg. 2008 Jun;14(3):149-53.
DISCLOSURES: No relevant relationships by Eduardo Ballester, source=Web
Response No relevant relationships by Caroline Blum, source=Web Response
No relevant relationships by Sasckia Duarte, source=Web Response No
relevant relationships by Catherine Wegner Wippel, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<113>
Accession Number
2014929098
Title
PERICARDIAL EFFUSION IN A MIDDLE AGED WOMAN AS INITIAL PRESENTATION OF
SYSTEMIC LUPUS ERYTHEMATOSUS.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A13), 2021. Date of Publication: October 2021.
Author
Creed K.; Randhawa N.; Siddiqui S.; Wichmann A.; Test V.
Publisher
Elsevier Inc.
Abstract
TOPIC: Allergy and Airway TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Systemic lupus erythematosus (SLE) is a multisystemic,
autoimmune connective tissue disorder, with a prevalence of 20 to 150
cases per 100,000 in the US. and estimated incidence of 1 to 25 per 100,00
in North America. Cardiac complications are common for patients with SLE,
but an initial presentation with pericardial effusion is rare. CASE
PRESENTATION: Our patient is a 57-year-old Hispanic female with type 2
diabetes mellitus, chronic kidney disease stage 3 and obesity, who
presented with a syncopal episode at home. She was found slumped over in
her chair and had difficulty speaking. Blood sugar was 35, for which she
was resuscitated and transported to the nearest hospital where a full
workup for syncope was done The only remarkable finding was a large
pericardial effusion on transthoracic echocardiogram (TTE). She was
transferred to our facility for possible pericardiocentesis. No tamponade
physiology was noted at the time of transfer. During her hospitalization,
she remained asymptomatic, denying chest pain, dyspnea, orthopnea,
pleuritic pain, dizziness, or fatigue. She had no further syncope or
hypoglycemia. TTE repeated on day 4 of hospitalization showed the same
large pericardial effusion (figure 1). Bedside examination demonstrated no
pulsus paradoxus or electrical alternans. She remained hemodynamically
stable and pericardiocentesis was not recommended by cardiology.The
etiology of the pericardial effusion was initially unclear. She had no
uremia, history of viral illness, heart failure, drug abuse, or prior
autoimmune disorders. An autoimmune panel revealed the following: positive
ANA and double-stranded DNA antibodies. She was diagnosed with SLE and
started on a combination of prednisone, mycophenolate mofetil, and
hydroxychloroquine per rheumatology recommendations. She was lost to
follow up after discharge. DISCUSSION: The prevalence of SLE is 10-fold
higher in females versus males, and there is evidence of an overall
decreasing prevalence among middle age in the last decade. Our patient's
age at presentation makes her a relative oddity. No additional systemic
symptoms were identified at the time and she was said to have followed up
with a rheumatologist out of state. She was discharged in stable condition
with follow up for further outpatient management. <br/>CONCLUSION(S): With
pericardial effusions, further investigation and treatment is prudent, as
this condition can result in cardiac tamponade and obstructive shock. In
this case, it led to this patient's diagnosis of SLE prior to other
systemic manifestations. Though transthoracic echocardiogram may indicate
early tamponade physiology, bedside examination for pulsus paradoxus and
electrical alternans are a clinician's best tools for evaluating for and
diagnosing cardiac tamponade. REFERENCE #1: Rees, F., Doherty, M.,
Grainge, M. J., Lanyon, P., & Zhang, W. (2017). The worldwide incidence
and prevalence of systemic lupus erythematosus: a systematic review of
epidemiological studies. Rheumatology, 56(11), 1945-1961. doi:
10.1093/rheumatology/kex260 REFERENCE #2: Schur, P. H., & Hahn, B. H.
(2019, April 12). Epidemiology and pathogenesis of systemic lupus
erythematosus. Retrieved March 5, 2020, from
https://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-systemi
c-lupus-erythematosus REFERENCE #3: Swinkels, B. M., Scheffer, R. C. H.,
Tahapary, G. J. M., Jaarsma, W., Plokker, H. W. M., Mast, E. G., &
Boersma, L. V. A. (2007). Cardiac tamponade as the initial manifestation
of systemic lupus erythematosus in a young female patient. Netherlands
Heart Journal, 15(2), 71-71. doi: 10.1007/bf03085958 DISCLOSURES: No
relevant relationships by Kendall Creed, source=Web Response No relevant
relationships by Navkiran Randhawa, source=Web Response No relevant
relationships by Sabrina Siddiqui, source=Web Response No relevant
relationships by Victor Test, source=Web Response No relevant
relationships by Alexandra Wichmann, source=Web Response<br/>Copyright
&#xa9; 2021 American College of Chest Physicians

<114>
Accession Number
2014928876
Title
GUILLAIN-BARRE SYNDROME OCCURRING AFTER AORTIC, TRICUSPID, AND MITRAL
VALVE SURGERY: A CASE REPORT AND LITERATURE REVIEW.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A676), 2021. Date of Publication: October 2021.
Author
Aldamouk A.
Publisher
Elsevier Inc.
Abstract
TOPIC: Critical Care TYPE: Global Case Reports INTRODUCTION:
Guillain-Barre syndrome (GBS), an acute inflammatory demyelinating
polyneuropathy with the exact causes not yet known, is a disorder that may
appear after infection or major surgery. CASE PRESENTATION: A 53-year-old
African American man presented to the ER with acute dyspnea, anxiety,
muscle spasms and severe pain in his mid-thoracic spine. He also reported
paresthesia of his arms and legs. Past medical history was notable for
recent open heart surgery with aortic valve replacement, mitral and
tricuspid valve repair and left atrial appendage exclusion which occurred
12 days prior to admission. Additional medical history included ESRD on
hemodialysis, HTN, chronic tophaceous gout and hyperlipidemia. Physical
exam revealed BP 176/94, pulse 97.9, respiratory rate 20, BMI 23.89.
Cardiovascular exam revealed a well healed sternotomy scar and artificial
aortic valve closure on cardiac auscultation. Breath sounds were
diminished in the left lung base. Patient had preserved motor strength in
the upper and lower extremities. The initial CXR revealed an elevated left
hemi-diaphragm. The patient subsequently developed progressive weakness
and numbness of both lower extremities. Physical exam revealed symmetric
bilateral lower extremity weakness, areflexia and a sensory level around T
10. Computed tomography scan of cervical, thoracic and lumbar spine only
showed degenerative changes and osteophytes with no evidence of
compression fracture, hematoma, abscess or transverse myelitis. Lumbar
puncture revealed normal opening pressure with clear fluid, protein 315
mg/dL, WBC 5 cells/mm3, RBC 0 cells/mm3, glucose 62 mg/dL. CSF albumin was
133 mg/dl (0-35) and oligoclonal bands were negative. Acetylcholine
receptor antibodies were 0.0 nmol/L and a nasopharyngeal swab for
respiratory viruses was negative. Electrodiagnostic studies showed diffuse
sensory-motor peripheral neuropathy with axonal degeneration and
demyelinative changes consistent with acute inflammatory demyelinating
polyneuropathy consistent with Guillain-Barre Syndrome. DISCUSSION: The
first case of GBS associated with CABG was reported by Renlund, et. al. in
1987. Since then, eight additional cases have been reported including the
current case (Table 1). All patients were successfully treated with either
IVIG, plasmapheresis or plasma exchange and all patients demonstrated
either significant improvement or complete recovery. The average age of
the patients was 64.8 years old. The average time between the surgical
procedure and development of symptoms was 8 days. <br/>CONCLUSION(S): GBS
following open heart surgery is exceedingly rare and to date there have
only been eight reported cases. We present the ninth case of GBS occurring
after aortic, tricuspid and mitral valve surgery and review the literature
in the context of comparison with the preceding case reports. Clinicians
should be more aware of this association. REFERENCE #1: Hartung HP, Wilson
HJ, Kieseier BC, Acute immunoinflammatory neuropathy: update on
Guillain-Barre syndrome. Curr Opin Neurol 2002; 15:571-577. REFERENCE #2:
Yuki N, Hartung HP, Guillain-Barre Syndrome. N Engl J Med 2012;
366:2294-2304. REFERENCE #3: Wijdicks EF, Klein CJ, Guillain-Barre
Syndrome. Mayo Clin Proc 2017; 92 (3):467-479. DISCLOSURES: No relevant
relationships by Amer Aldamouk, source=Web Response<br/>Copyright &#xa9;
2021 American College of Chest Physicians

<115>
Accession Number
2014928677
Title
CARDIAC SYMPATHECTOMY FOR RESISTANT VENTRICULAR ARRHYTHMIA IN NON-ISCHEMIC
CARDIOMYOPATHY.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A87), 2021. Date of Publication: October 2021.
Author
Ghawanmeh M.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiothoracic Surgery TYPE: Original Investigations PURPOSE:
Treatment options for ventricular arrhythmia (VA) in non-ischemic
cardiomyopathies (NICM) are limited. Anti-arrhythmic drugs and catheter
ablation are conventional treatment options for VA. However, in NICM,
conventional treatment options often fail. We have conducted a
meta-analysis to assess the outcomes of cardiac sympathectomy for
resistant and refractory ventricular arrhythmia. <br/>METHOD(S): Using
electronic databases (PubMed and Google scholar), we performed a
meta-analysis of retrospective studies to evaluate the rate of freedom of
VA after cardiac sympathetic denervation (CSD) performed on patients with
non-ischemic cardiomyopathy and resistant or refractory ventricular
tachycardia. Resistant or refractory VA was defined in these studies as VA
refractory to antiarrhythmic drugs or beta-blockers, and/or catheter
ablation or medication intolerance. <br/>RESULT(S): 8 nonrandomized
studies with a total of 76 patients with NICM who underwent CSD for
refractory VA (16 patients with Chagas, 14 with non-ischemic
cardiomyopathy, 13 with long QTC syndrome, 12 with catecholaminergic
polymorphic ventricular tachycardia, 10 arrhythmogenic right ventricular
cardiomyopathy, 2 with hypertrophic cardiomyopathy, 3 with dilated
cardiomyopathy). 45 patients underwent bilateral CSD, 30 underwent
left-sided CSD, only one underwent right-sided CSD. Median follow-up
duration varied between 1 and 28 months in the included studies. The
primary outcome of interest was freedom of ventricular arrhythmia which
was reported in 49 patients (64.47%). Complications occurred in 7 patients
(9.21%), 1 patient with hemothorax, 1 with pneumo-hemothorax, 1 with
paravertebral venous plexus injury, 2 have suffered from neuropathic pain,
1 with left-sided pneumothorax. <br/>CONCLUSION(S): In our study, CSD may
help with VA burden reduction when conventional therapy including
beta-blockers, antiarrhythmic drugs, and catheter ablation are
unsuccessful. Randomized clinical trials are needed in this field.
CLINICAL IMPLICATIONS: CSD might provide hope to patients with NICM and
refractory VA. DISCLOSURES: No relevant relationships by Malik Ghawanmeh,
source=Web Response<br/>Copyright &#xa9; 2021 American College of Chest
Physicians

<116>
Accession Number
2014927484
Title
AN ALREADY SICK HEART: A CASE OF FATAL SARS-COV-2 MYOCARDITIS.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A176), 2021. Date of Publication: October 2021.
Author
Gajjala S.; Ma R.; Jou S.; Shenoy V.; Kattih Z.; Mahajan A.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
myocarditis has recently been described in case reports. A systematic
review in early 2021 found fourteen case reports of myocarditis or
myopericarditis secondary to this viral infection. We describe an
interesting case of proven non-ischemic cardiac dysfunction in the setting
of acute infection. Despite steroid treatment, which has been suggested to
have favorable outcomes, our patient did not survive. CASE PRESENTATION:
We present a case of a 77-year-old man with extensive electrophysiologic
and ischemic cardiac disease who presented to the hospital for generalized
weakness, malaise, and shortness of breath. The patient's cardiac history
was significant for atrial flutter s/p ablation, coronary artery disease
s/p coronary artery bypass graft in the distant past, peripheral artery
disease s/p right lower extremity revascularization, and carotid stenosis
s/p carotid endarterectomy. SARS-CoV-2 PCR test was positive. The patient
had increasing hypoxia which required non-invasive ventilation and
eventually, tracheal intubation and mechanical ventilation. The hospital
course was complicated by the development of persistent chest pain
associated with elevated cardiac enzymes. EKG showed diffuse ST-segment
depressions. An echocardiogram revealed diffuse left ventricular
hypokinesis and a reduced ejection fraction of 20% which was not present
previously. In this setting, the patient was ruled in for acute coronary
syndrome and underwent cardiac catheterization. Cardiac catheterization
demonstrated patent grafts and no significant obstructive disease. A
presumptive diagnosis of myocarditis was made. The patient's clinical
status deteriorated despite optimal medical treatment, and he developed
hemodynamically unstable atrial fibrillation that did not respond to
pharmacologic treatment or cardioversion and resulted in cardiogenic shock
and, ultimately, his death. DISCUSSION: SARS-CoV-2 myocarditis has been
described in select case reports internationally. Many of these cases are
described in patients with no previously identified comorbid conditions.
This case suggests that in patients with underlying electrophysiologic
dysfunction, SARS-CoV-2 myocarditis is associated with poor outcomes.
<br/>CONCLUSION(S): The mechanism of the effect of SARS-CoV-2 on the heart
is unclear and includes myocarditis or myopericarditis. In our patient,
cardiac catheterization which was performed during his hospitalization
confirmed no ischemic disease and suggested the presence of myocarditis
which was ultimately fatal in the setting of refractory cardiogenic shock.
Further research is needed into the optimal management of myocarditis
associated with SARS-CoV-2. REFERENCE #1: Sawalha K, Abozenah M, Kadado
AJ, et al. Systematic Review of COVID-19 Related Myocarditis- Insights on
Management and Outcome. Cardiovasc Revasc Med. Feb 2021; 23:107-113.
REFERENCE #2: Purdy A, Ido F, Sterner S, et al. Myocarditis in COVID-19
presenting with cardiogenic shock: a case series. Eur Heart J Case Rep.
Feb 2021; 5(2):ytab028. REFERENCE #3: Fried JA, Ramasubbu K, Bhatt R, et
al. The Variety of Cardiovascular Presentations of COVID-19. Circulation.
2020;141(23):1930-1936. DISCLOSURES: No relevant relationships by Sravani
Gajjala, source=Web Response No relevant relationships by Stacey Jou,
source=Web Response No relevant relationships by Zein Kattih, source=Web
Response No relevant relationships by Rosaline Ma, source=Web Response No
relevant relationships by Akhilesh Mahajan, source=Web Response No
relevant relationships by Vinayak Shenoy, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<117>
Accession Number
2014927224
Title
COLD HEARTED: A TALE OF CARDIAC ISCHEMIA UNMASKED BY ACCIDENTAL
HYPOTHERMIA.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A120-A121), 2021. Date of Publication: October 2021.
Author
Kalidas Kulkarni A.; deshpande R.; Manek M.; Bhattarai M.; Cheema A.;
Siddiqui O.; Niaz Z.; Jagtap P.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Hypothermia is a common environmental injury that is
typically seen in regions with severe winters. Despite aggressive
management, associated mortality is almost 40%(1). Hypothermia can be
mild, moderate or severe, based on the core temperature at presentation.
Although multiple cardiac manifestations of hypothermia have been
described, cardiac ischemia is not a typical consequence of hypothermia.
CASE PRESENTATION: History: A 56 year old gentleman was brought to the
emergency room after being found by EMS outdoors in during a rainstorm. He
was found to be confused and hypothermic. Earlier in the day, he had
escaped from the nursing facility of his resident where he was being
managed for severe dementia. He was unable to provide any meaningful
history due to his presenting confusion and significant baseline dementia.
Examination: On presentation, his core temperature was 31.5C, with a BP of
148/56 mmHg and heart rate of 75 BPM and an SpO2 of 94% on RA. He was
noted to be shivering and covered in wet clothes. His cardiopulmonary,
abdominal and musculoskeletal examination was unremarkable. His confusion
was felt to be worse than his baseline. The remainder of his neurologic
examination was intact. Laboratory Investigations: His CBC revealed mild
anemia, which was unchanged from baseline. He was hyperkalemic (K+ was
5.8) and found to have an AKI (creatinine 1.5). His troponin on
presentation was 3.66. His urine toxicology screen was negative. A CPK
level was drawn the following morning was 1413.His presenting EKG (Figure
1) showed prominent motion/ shivering artifact with Osborn waves in the
lateral leads, typical for hypothermia (2). However, with active
rewarming, the patient's serial EKGs showed resolution of the Osborn wave
with residual ST changes concerning for ischemia. Concurrently, the
patient's troponin continued to rise (eventually peaked at 10.3).A
transthoracic echocardiogram was obtained and showed left ventricular
dysfunction (EF 20-25%) with apical and peri-apical hypokinesis. No prior
cardiac diagnostic testing was available for comparison. Subsequently, he
underwent a coronary angiogram (Figure 2) for further evaluation and was
found to have triple vessel coronary artery disease. He was then referred
for coronary artery bypass grafting. DISCUSSION: The effects of
hypothermia on myocardial perfusion is not well understood outside
therapeutic scenarios. One trial suggested that unintentional hypothermia
was associated with myocardial ischemia, angina, and PaO2 < 80 mmHg during
the early postoperative period (3). <br/>CONCLUSION(S): Although used to
protect from neurologic injury or provide a controlled setting for
surgical cardiac intervention in controlled settings, our case suggests
that accidental hypothermia causes a cascade of metabolic complications
which have the potential to precipitate myocardial ischemia. REFERENCE #1:
Vassal T, Benoit-Gonin B, Carrat F, Guidet B, Maury E, Offenstadt G.
Severe accidental hypothermia treated in an ICU: prognosis and outcome.
Chest. 2001 Dec;120(6):1998-2003. doi: 10.1378/chest.120.6.1998. PMID:
11742934. REFERENCE #2: Amal Mattu, William J. Brady, Andrew D. Perron,
Electrocardiographic manifestations of hypothermia, The American Journal
of Emergency Medicine, Volume 20, Issue 4,2002, Pages 314-326, ISSN
0735-6757, https://doi.org/10.1053/ajem.2002.32633. REFERENCE #3: Frank
SM, Beattie C, Christopherson R, Norris EJ, Perler BA, Williams GM,
Gottlieb SO. Unintentional hypothermia is associated with postoperative
myocardial ischemia. The Perioperative Ischemia Randomized Anesthesia
Trial Study Group. Anesthesiology. 1993 Mar;78(3) 468-476.
doi:10.1097/00000542-199303000-00010. PMID: 8457047. DISCLOSURES: No
relevant relationships by Mukul Bhattarai, source=Web Response No relevant
relationships by Asad Cheema, source=Web Response No relevant
relationships by radhika deshpande, source=Web Response No relevant
relationships by Prashant Jagtap, source=Web Response No relevant
relationships by Abhishek Kalidas Kulkarni, source=Web Response No
relevant relationships by Megha Manek, source=Web Response No relevant
relationships by Zurain Niaz, source=Web Response No relevant
relationships by Omar Siddiqui, source=Web Response<br/>Copyright &#xa9;
2021 American College of Chest Physicians

<118>
Accession Number
2014927144
Title
STORMS-A-BREWIN: USE OF SYMPATHECTOMY IN TREATMENT OF REFRACTORY
VENTRICULAR TACHYCARDIA STORM PROVOKED BY THYROID STORM IN A PATIENT WITH
STRUCTURAL HEART DISEASE.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A163), 2021. Date of Publication: October 2021.
Author
Collins J.; Tepper J.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Sympathectomy has been used since the 1960s for treatment of
refractory ventricular tachycardia (VT)(1). However, the procedure has not
been studied with a randomized controlled trial; clear indications and
outcome data remain unclear. In this case report, we describe the use of
sympathectomy in the treatment of a patient with refractory VT storm
provoked by thyroid storm in the setting of underlying structural heart
disease. CASE PRESENTATION: The patient is a 60-year-old male with a
history of biventricular systolic failure secondary to ischemic
cardiomyopathy (ICM). In addition to ICM, he had a history of VT for which
he underwent two prior ablations (20 months and 2 months prior to
admission) as well as permanent pacemaker implantation. One month prior to
presentation, he was diagnosed with hyperthyroidism which was treated with
methimazole. He presented to our institution for a clinic appointment but
collapsed in our hospital parking garage. He was shocked by his pacemaker
4 times before being brought to our ED where he received an additional 10
shocks. ED staff determined the patient was in VT storm. He was sedated
with propofol and intubated for airway protection before admission to the
ICU. Thyroid stimulating hormone was found to be undetectable at this
time, and free T4 was significantly elevated. Given his presentation and
clinical history, he was diagnosed with refractory VT storm secondary to
thyroid storm in the setting of structural heart disease. Thyroid storm
was treated with standard therapies and VT storm was adequately suppressed
with propofol. On hospital day 2, sedation was discontinued, and he was
extubated without complication. Unfortunately, he continued to have runs
of VT on hospital days 2-6. Given his history of previous ablations and
thyroid storm, we elected to pursue bilateral VATS sympathectomy (hospital
day 6) before attempting a third ablation (hospital day 10). The ablation
was complicated by RV perforation requiring pericardiocentesis. The
patient remained VT free from hospital day 6 until discharge on hospital
day 12. He has been VT free at subsequent follow up appointments.
DISCUSSION: To our knowledge, this is the first reported case involving
the use of sympathectomy in the treatment of VT storm provoked by thyroid
storm. Arrhythmias caused by thyroid storm are typically atrial in nature,
with few reports of primary ventricular arrhythmias. Ventricular
arrhythmias in thyroid storm are classically thought to be associated with
structural heart disease. <br/>CONCLUSION(S): Sympathectomy has been shown
to be an effective treatment in refractory VT, but more research is needed
in this area to better characterize indications and outcomes(2,3).
REFERENCE #1: Estes EH Jr., Izlar HL Jr. Recurrent ventricular
tachycardia. A case successfully treated by bilateral cardiac
sympathectomy. Am J Med. 1961;31:493-497. REFERENCE #2: Vaseghi M, Gima J,
Kanaan C, et al. Cardiac sympathetic denervation in patients with
refractory ventricular arrhythmias or electrical storm: intermediate and
long-term follow-up. Heart Rhythm. 2014;11(3):360-366.
doi:10.1016/j.hrthm.2013.11.028 REFERENCE #3: Vaseghi M, Barwad P,
Malavassi Corrales FJ, et al. Cardiac Sympathetic Denervation for
Refractory Ventricular Arrhythmias [published correction appears in J Am
Coll Cardiol. 2017 Aug 8;70(6):811]. J Am Coll Cardiol.
2017;69(25):3070-3080. doi:10.1016/j.jacc.2017.04.035 DISCLOSURES: No
relevant relationships by James Collins, source=Web Response No relevant
relationships by John Tepper, source=Web Response<br/>Copyright &#xa9;
2021 American College of Chest Physicians

<119>
Accession Number
2014927142
Title
NONTRAUMATIC LIVER HERNIATION MIMICKING A LOWER LOBE LUNG MASS.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A64), 2021. Date of Publication: October 2021.
Author
Adeel Samad M.; Ali A.; Tiedebohl S.; Shih-Della Penna D.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Spontaneous diaphragmatic herniation is a rare type of
acquired diaphragmatic hernia without any history of trauma. (1) We
describe a case where a non-traumatic liver herniation through diaphragm
was observed mimicking a lower lobe lung mass. CASE PRESENTATION: A
54-year-old female without prior thoraco-abdominal trauma was seen in the
clinic because of growth of 2 right lower lobe lung nodules. These nodules
were initially noted incidentally on CT scan in August 2009 and measured
1.5 cm x 2.8 cm and 0.9 cm x 1.3. They remained stable on CT scan and PET
performed in 2010. Patient was lost follow-up after that until she had a
CT scan in March 2019 because of concern of pneumonia and it was noted
that the lung nodules have increased in size to 2.8 cm x 4.1 cm and 1.1 cm
x 1.4 cm. The patient was otherwise asymptomatic. A PET scan was obtained
which showed hypermetabolic nodules with maximum SUV of 3.29 and 1.4 for
the larger and smaller nodule respectively. Radiographic appearance as
well as the growth pattern was consistent with low-grade malignancy like
carcinoid tumor. We performed robotic thoracoscopy with plan for wedge
resection and possible completion lobectomy. Gross inspection of the
thoracic cavity revealed abnormal mass on the dome of the diaphragm with
appearance like liver. It was noted to be lying in the oblique fissure and
corelated with the position of larger nodule seen on CT scan. There was a
second area of thinned-out area of the diaphragm where a small nodule was
noted pushing on the diaphragm with appearance like liver consistent with
location of smaller lesion on CT scan. A Tru-Cut needle biopsy showed that
it was benign liver tissue. The decision was made not to proceed with any
diaphragmatic repair or reinforcement with mesh as this was an
asymptomatic herniation through diaphragm and the liver was fibrosed to
the diaphragm protecting from any intestinal herniation. DISCUSSION: A
review of literature (1956-2009) revealed that there are 28 reported cases
spontaneous diaphragmatic rupture (SDH) and of those only 10% had liver
herniation. SDH is caused by events that increase intra-abdominal pressure
like complicated labor, intense physical exercise, psychiatric illness,
and cough secondary to pertussis. Another predisposing factor for SDH is
congenital diaphragmatic defect which creates an area of weakness and
increases the likelihood of herniation secondary to increased
intra-abdominal pressure. SDH has also been described in association with
other conditions like Ehler-Danlos Syndrome (EDS) and endometriosis
because of weakness of diaphragmatic tissue. <br/>CONCLUSION(S): Our case
was unique because the patient had asymptomatic SDH presenting as a lung
mass without any history of etiologies leading to increased
intra-abdominal pressure or weakness of diaphragm. Liver herniation
through diaphragm can be managed without surgical repair if liver if
fibrosed to diaphragm. REFERENCE #1: Losanoff JE, Edelman DA, Salwen WA,
Basson MD. Spontaneous rupture of the diaphragm: case report and
comprehensive review of the world literature. The Journal of thoracic and
cardiovascular surgery. 2010 Jun 1;139(6):e127-8. REFERENCE #2: Stoica SC,
Craig SR, Soon SY, Walker WS. Spontaneous rupture of the right
hemidiaphragm after video-assisted lung volume reduction operation. The
Annals of thoracic surgery. 2002 Sep 1;74(3):929-31. REFERENCE #3: Hamaoui
K, Riaz A, Hay A, Botha A. Massive spontaneous diaphragmatic rupture in
Ehlers-Danlos syndrome. The Annals of The Royal College of Surgeons of
England. 2012 Mar;94(1):e5-7. DISCLOSURES: no disclosure on file for Annis
Ali; No relevant relationships by Muhammad Adeel Samad, source=Web
Response No relevant relationships by Diane Shih-Della Penna, source=Web
Response no disclosure on file for Scott Tiedebohl;<br/>Copyright &#xa9;
2021 American College of Chest Physicians

<120>
Accession Number
2014927090
Title
HISTOPATHOLOGY AIDING IN THE DIAGNOSIS OF AN ATYPICAL CASE OF AORTIC
DISSECTION.
Source
Chest. Conference: CHEST 2021 Annual Meeting. Virtual, Online. 160(4
Supplement) (pp A66-A67), 2021. Date of Publication: October 2021.
Author
Mufty M.; Darrow M.; Tummala P.
Publisher
Elsevier Inc.
Abstract
TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports
INTRODUCTION: Aortic dissection (AD) often presents as acute severe chest
or back pain and hemodynamic compromise[1,2]. Early and accurate diagnosis
and treatment are crucial for survival. Multiple imaging modalities can be
used to demonstrate the dissection, including Computed Tomographic
Angiography (CTA), Magnetic Resonance Angiography (MRA), and
Transesophageal Echocardiography (TEE). We present a case where a patient
with atypical presentation of AD underwent multiple diagnostic studies
with inconsistent results. CASE PRESENTATION: A 47-year-old male with
history of hypertension, asthma, and tobacco use presented with sudden
onset of left-hand numbness, tingling, and pain with associated changes of
color in his hand. Patient had sensory deficits in the left hand and left
big toe. A left upper extremity (LUE) venous duplex was unremarkable. CTA
of the chest showed a filling defect in the right posterior ascending
aorta suggestive of an intimal flap. Esmolol was initiated. TEE did not
reveal AD. Heparin was initiated. Arterial Doppler of the LUE was negative
for any atherosclerotic or thrombotic diseases or evidence of obstruction.
The following day, the patient experienced crushing chest pain radiating
to the back. Transthoracic echocardiogram showed filling defect in the
ascending aorta. Patient was operated on emergently. Although a frank AD
was not observed, a mobile pedunculated mass was reported. The affected
segment of the aorta was resected and a graft was used for repair.
Histopathology results showed focal adventitial hemorrhage and
degenerative medial changes consistent with AD. DISCUSSION: In this case
of atypical AD diagnosis was not made early due to atypical symptoms and
inconclusive and inconsistent imaging studies. The definitive diagnosis
was made through histopathology, as even the inspection at time of surgery
was inconclusive for AD, given unusual gross appearance. Painless
dissection is encountered only in 6.4% of cases [3]. Conventional CT
scanning has a sensitivity of 83-95% but it drops to <80% in the ascending
aorta[4-7]. MRA or TEE is typically performed next to confirm the
diagnosis. Despite a sensitivity of 98%[8,9], TEE was unremarkable in this
case. The features of the AD on histopathology, including the presence of
the intimal tear, hemorrhage near the adventitial layer, and medial
degeneration confirmed the diagnosis. In a recent large cardiovascular
registry, >60% of cases of AD were first identified at autopsy[10,11].
<br/>CONCLUSION(S): This case represents a diagnostic challenge and
highlights the possibility of uncommon presentation of AD, and the
importance of taking the results of multiple imaging modalities into
consideration to confirm the diagnosis. In this case, and due to unusual
gross appearance during surgery, histopathology was necessary to confirm
the diagnosis. It is extraordinarily rare to require histopathology to
confirm diagnosis of AD at time of surgery. REFERENCE #1: 1.Hagan PG,
Nienaber CA, Isselbacher EM, et al. The International Registry of Acute
Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;
283:897 REFERENCE #2: 2. Evangelista A, Isselbacher EM, Bossone E, et al.
Insights From the International Registry of Acute Aortic Dissection: A
20-Year Experience of Collaborative Clinical Research. Circulation 2018;
137:1846. 3. Fatima S, Sharma K. Painless Aortic Dissection-Diagnostic
Dilemma With Fatal Outcomes: What Do We Learn?. J Investig Med High Impact
Case Rep. 2017;5(3):2324709617721252. 4. Nienaber CA, von Kodolitsch Y,
Nicolas V, et al. The diagnosis of thoracic aortic dissection by
noninvasive imaging procedures. N Engl J Med 1993; 328:1. 5. LePage MA,
Quint LE, Sonnad SS, et al. Aortic dissection: CT features that
distinguish true lumen from false lumen. AJR Am J Roentgenol 2001;
177:207. REFERENCE #3: 6. Shiga T, Wajima Z, Apfel CC, et al. Diagnostic
accuracy of transesophageal echocardiography, helical computed tomography,
and magnetic resonance imaging for suspected thoracic aortic dissection:
systematic review and meta-analysis. Arch Intern Med 2006; 166:1350. 7.
Hayter RG, Rhea JT, Small A, et al. Suspected aortic dissection and other
aortic disorders: multi-detector row CT in 373 cases in the emergency
setting. Radiology 2006; 238:841. 8. Moore AG, Eagle KA, Bruckman D, et
al. Choice of computed tomography, transesophageal echocardiography,
magnetic resonance imaging, and aortography in acute aortic dissection:
International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol
2002; 89:1235. 9. Hartnell G, Costello P. The diagnosis of thoracic aortic
dissection by noninvasive imaging procedures. N Engl J Med 1993; 328:1637;
author reply 1638. 10. Hosoda Y. [Pathology of aortic dissection]. Nihon
Geka Gakkai Zasshi. 1996 Oct;97(10):873-8. 11. Huynh N, Thordsen S, Thomas
T, Mackey-Bojack SM, Duncanson ER, Nwuado D, Garberich RF, Harris KM.
Clinical and pathologic findings of aortic dissection at autopsy: Review
of 336 cases over nearly 6 decades. Am Heart J. 2019 Mar;209:108-115.
DISCLOSURES: No relevant relationships by Matthew Darrow, source=Web
Response No relevant relationships by Muhammad Mufty, source=Web Response
No relevant relationships by Pradyumna Tummala, source=Web
Response<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<121>
Accession Number
2014905953
Title
Cost-effectiveness of low-dose colchicine after myocardial infarction in
the Colchicine Cardiovascular Outcomes Trial (COLCOT).
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 7(5) (pp
486-495), 2021. Date of Publication: 01 Nov 2021.
Author
Samuel M.; Tardif J.-C.; Khairy P.; Roubille F.; Waters D.D.; Gregoire
J.C.; Pinto F.J.; Maggioni A.P.; Diaz R.; Berry C.; Koenig W.; Ostadal P.;
Lopez-Sendon J.; Gamra H.; Kiwan G.S.; Dube M.-P.; Provencher M.; Orfanos
A.; Blondeau L.; Kouz S.; L'allier P.L.; Ibrahim R.; Bouabdallaoui N.;
Mitchell D.; Guertin M.-C.; Lelorier J.
Institution
(Samuel, Tardif, Khairy, Gregoire, Dube, L'allier, Ibrahim, Bouabdallaoui,
Lelorier) Montreal Heart Institute, Universite de Montreal, 5000 Belanger
Street, Montreal, QC H1T 1C8, Canada
(Roubille) Universite de Montpellier, INSERM, CNRS, CHU de Montpellier,
Cardiology Department, CHU Arnaud de Villeneuve, 371, avenue du Doyen
Gaston-Giraud, Montpellier 34090, France
(Waters) San Francisco General Hospital, Zuckerberg San Francisco General
Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States
(Pinto) Santa Maria University Hospital (Centro Hospitalar Universitario
Lisboa Norte), Centro Academico de Medicina de Lisboa, Centro
Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da
Universidade de Lisboa, Lisbon, Portugal
(Maggioni) ANMCO Research Center, Via La Marmora 34, Firenze 50121, Italy
(Diaz) Estudios Clinicos Latinoamerica, Paraguay 160, Rosario 2000,
Argentina
(Berry) University of Glasgow and NHS Glasgow Clinical Research Facility,
126 University Pl, University of Glasgow, Glasgow G12 8TA, United Kingdom
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Institute of Epidemiology and Medical Biometry, University of Ulm,
Ulm, Lazarettstr. 36, Munchen D-80636, Germany
(Ostadal) Cardiovascular Center, Na Homolce Hospital, Roentgenova 2,
Prague 150 00, Czechia
(Lopez-Sendon) H La Paz, IdiPaz, UAM, Ciber-CV Madrid, La Paz University
Hospital, Paseo de la Castellana, 261, Madrid 28046, Spain
(Gamra) Fattouma Bourguiba University Hospital, Monastir 5000, Tunisia
(Kiwan) Bellevue Medical Center, Qanater Zubayda- Mansouriyeh, Mansourieh,
Metn District, Beirut, Lebanon
(Provencher, Orfanos, Blondeau, Guertin) The Montreal Health Innovations
Coordinating Center, 4100 Molson St. Suite 400, Montreal, QC H1Y 3N1,
Canada
(Kouz) Centre Hospitalier Regional de Lanaudiere, 1000 Sainte-Anne Blvd,
Saint-Charles-Borromee, QC J6E 6J2, Canada
(Mitchell) Logimetrix Inc., 3600 Rhodes Drive, Windsor, ON N8W 5A4, Canada
(Lelorier) Centre de recherche du Centre hospitalier de l'Universite de
Montreal, 900 St Denis St, Montreal, QC H2X 0A9, Canada
Publisher
Oxford University Press
Abstract
Aims: In the randomized, placebo-controlled Colchicine Cardiovascular
Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after
myocardial infarction (MI), low-dose colchicine (0.5 mg once daily)
reduced the incidence of the primary composite endpoint of cardiovascular
death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization
for angina leading to coronary revascularization. To assess the in-trial
period and lifetime cost-effectiveness of low-dose colchicine therapy
compared to placebo in post-MI patients on standard-of-care therapy.
<br/>Methods and Results: A multistate Markov model was developed
incorporating the primary efficacy and safety results from COLCOT, as well
as healthcare costs and utilities from the Canadian healthcare system
perspective. All components of the primary outcome, non-cardiovascular
deaths, and pneumonia were included as health states in the model as both
primary and recurrent events. In the main analysis, a deterministic
approach was used to estimate the incremental cost-effectiveness ratio
(ICER) for the trial period (24 months) and lifetime (20 years). Over the
in-trial period, the addition of colchicine to post-MI standard-of-care
treatment decreased the mean overall per-patient costs by 47%, from $502
to $265 Canadian dollar (CAD), and increased the quality-adjusted life
years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were
further reduced (69%) and QALYs increased with colchicine therapy (from
8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated
colchicine therapy was a dominant strategy. <br/>Conclusion(s):
Cost-effectiveness analyses indicate that the addition of colchicine to
standard-of-care therapy after MI is economically dominant and therefore
generates cost savings.<br/>Copyright &#xa9; 2020 The Author(s) 2020.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<122>
Accession Number
2014905952
Title
Percutaneous vs. surgical revascularization for patients with unprotected
left main stenosis: a meta-analysis of 5-year follow-up randomized
controlled trials.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 7(5) (pp
476-485), 2021. Date of Publication: 01 Nov 2021.
Author
D'ascenzo F.; De Filippo O.; Elia E.; Doronzo M.P.; Omede P.; Montefusco
A.; Pennone M.; Salizzoni S.; Conrotto F.; Gallone G.; Angelini F.;
Franchin L.; Bruno F.; Boffini M.; Gaudino M.; Rinaldi M.; De Ferrari G.M.
Institution
(D'ascenzo, De Filippo, Elia, Doronzo, Omede, Montefusco, Pennone,
Conrotto, Gallone, Angelini, Franchin, Bruno, De Ferrari) Division of
Cardiology, Department of Medical Sciences, Citta della Salute e della
Scienza, Corso Bramante 88, Turin 10126, Italy
(Salizzoni, Boffini, Rinaldi) Division of Cardiology, Department of
Medical Sciences, Citta della Salute e della Scienza, Corso Bramante 88,
Turin 10126, Italy
(Gaudino) Department of Cardiothoracic Surgery, Cornell Medicine, 1300
York Ave, New York, NY 10065, United States
Publisher
Oxford University Press
Abstract
Aims: A 5-year survival of patients with unprotected left main (ULM)
stenosis according to the choice of revascularization (percutaneous vs.
surgical) remains to be defined. <br/>Methods and Results: Randomized
controlled trials (RCTs) comparing percutaneous coronary intervention
(PCI) vs. coronary artery bypass graft (CABG) with a follow-up of at least
5 years were included. All-cause death was the primary endpoint. MACCE [a
composite endpoint of all-cause mortality, myocardial infarction (MI),
stroke, and repeat revascularization] along with its single components and
cardiovascular (CV) death were the secondary ones. Analyses were
stratified according to the use of first- vs. last-generation coronary
stents. Subgroup comparisons were performed according to SYNTAX score
(below or above 33) and to age (using cut-offs of each trial's subgroup
analysis). Four RCTs with 4394 patients were identified: 2197 were treated
with CABG, 657 with first generation, and 1540 with last-generation
stents. At 5-year rates of all-cause death did not differ [odds ratio (OR)
0.93, 95% confidence interval (CI) 0.71-1.21], as those of CV death and
stroke. Coronary artery bypass graft reduced rates of MACCE (OR 0.69, 95%
CI 0.60-0.79), mainly driven by MI (OR 0.48, 95% CI 0.36-0.65) and
revascularization (OR 0.53, 95% CI 0.45-0.64). Benefit of CABG for MACCE
was consistent, although with different extent, across values of SYNTAX
score (OR 0.76, 95% CI 0.59-0.97 for values < 32 and OR 0.63, 95% CI
0.47-0.84 for values >= 33) while was not evident for 'younger' patients
(OR 0.83, 95% CI 0.65-1.07 vs. OR 0.65, 95% CI 0.51-0.84 for 'older'
patients). <br/>Conclusion(s): For patients with ULM disease followed-up
for 5 years, no significant difference was observed in all-cause and
cardiovascular death between PCI and CABG. Coronary artery bypass graft
reduced risk of MI, revascularization, and MACCE especially in older
patients and in those with complex coronary disease and a high SYNTAX
score.<br/>Copyright &#xa9; 2020 Published on behalf of the European
Society of Cardiology.

<123>
Accession Number
2014048765
Title
Caval valve implantation (CAVI): An emerging therapy for treating severe
tricuspid regurgitation.
Source
Journal of Clinical Medicine. 10(19) (no pagination), 2021. Article
Number: 4601. Date of Publication: October-1 2021.
Author
Altisent O.A.-J.; Benetis R.; Rumbinaite E.; Mizarien V.; Codina P.;
Gual-Capllonch F.; Spitaleri G.; Fernandez-Nofrerias E.; Bayes-Genis A.;
Puri R.
Institution
(Altisent, Codina, Gual-Capllonch, Spitaleri, Fernandez-Nofrerias,
Bayes-Genis) Department of Cardiology, Germans Trias University Hospital,
Badalona 08916, Spain
(Benetis) Department of Cardiothoracic and Vascular Surgery, Lithuanian
University of Health Sciences, Kaunas 44307, Lithuania
(Rumbinaite, Mizarien) Department of Cardiology, Lithuanian University of
Health Sciences, Kaunas 44307, Lithuania
(Puri) Department of Cardiology, Cleveland Clinic, Cleveland, OH 44195,
United States
Publisher
MDPI
Abstract
Severe tricuspid regurgitation remains a challenging heart-valve disease
to effectively treat with high morbidity and mortality at mid-term.
Currently guideline-directed medical treatment is limited to escalating
dose of diuretics, and the rationale and timing of open-heart surgery
remains controversial. Emerging percutaneous therapies for severe
tricuspid regurgitation continue to show promising results in early
feasibility studies. However, randomized trial data is lacking.
Additionally, many patients are deemed unsuitable for these emerging
therapies due to anatomical or imaging constraints. Given the technical
simplicity of the bicaval valve implantation (CAVI) technique compared to
other transcatheter devices, CAVI is postulated as a suitable alternative
for a wide variety of patients affected with severe+ tricuspid
regurgitation. In this review we illustrate the current evidence and
ongoing uncertainties of CAVI, focusing on the novel CAVI-specific
devices.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<124>
Accession Number
636159888
Title
Effect of intensive versus limited monitoring on clinical trial conduct
and outcomes: A randomized trial.
Source
American heart journal. (no pagination), 2021. Date of Publication: 13
Sep 2021.
Author
Butala N.M.; Song Y.; Shen C.; Cohen D.J.; Yeh R.W.
Institution
(Butala) Richard A. and Susan F. Smith Center for Outcomes Research in
Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Boston MA; Cardiology Division, Department of Medicine,
Massachusetts General Hospital, Boston, MA; Harvard Medical School,
Boston, MA
(Song) Richard A. and Susan F. Smith Center for Outcomes Research in
Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Boston MA
(Shen) Richard A. and Susan F. Smith Center for Outcomes Research in
Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Boston MA; Biogen Inc., Cambridge, MA
(Cohen) Cardiovascular Research Foundation, New York, NY; St. Francis
Hospital, Roslyn, NY
(Yeh) Richard A. and Susan F. Smith Center for Outcomes Research in
Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess
Medical Center, Boston MA; Harvard Medical School, Boston, MA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Regulatory agencies have endorsed more limited approaches to
clinical trial site monitoring. However, the impact of different
monitoring strategies on trial conduct and outcomes is unclear.
<br/>METHOD(S): We conducted a patient-level block randomized controlled
trial evaluating the effect of intensive versus limited monitoring on
cardiovascular clinical trial conduct and outcomes nested within the
CoreValve Continued Access and Expanded Use Studies. Intensive monitoring
included complete source data verification of all critical datapoints
whereas limited monitoring included automated data checks only. This
study's endpoints included clinical trial outcome ascertainment as well as
monitoring action items, protocol deviations, and adverse event
ascertainment. <br/>RESULT(S): A total of 2708 patients underwent
transcatheter aortic valve replacement (TAVR) and were randomized to
either intensive monitoring (n=1354) or limited monitoring (n=1354).
Monitoring action items were more common with intensive monitoring (52% vs
15%; p<0.001), but there was no difference in the percentage of patients
with any protocol deviation (91.6% vs 90.4%; p=0.314). The reported
incidence of trial outcomes between intensive and limited monitoring was
similar for mortality (30 days: 4.8% vs. 5.5%, p=0.442; 1 year: 20.3% vs
21.3%, p=0.473) and stroke (30 days: 2.8% vs 2.4%, p=0.458), as well as
most secondary trial outcomes with the exception of bleeding (intensive:
36.3% vs limited: 32.0% at 30 days, p=0.019). There was a higher reported
incidence of cardiac adverse events reported in the intensive monitoring
group at 1 year (76.7% vs 72.4%; p=0.019). <br/>CONCLUSION(S): Tailored
limited monitoring strategies can be implemented without influencing the
integrity of TAVR trial outcomes.<br/>Copyright &#xa9; 2021. Published by
Elsevier Inc.

<125>
Accession Number
636157688
Title
Early percutaneous mitral commissurotomy or conventional management for
asymptomatic mitral stenosis: a randomised clinical trial.
Source
Heart (British Cardiac Society). (no pagination), 2021. Date of
Publication: 15 Sep 2021.
Author
Kang D.-H.; Lee S.-A.; Lee S.; Kim D.-H.; Park D.-W.; Yun S.-C.; Hong
G.-R.; Song J.-M.; Hong M.-K.; Park S.W.; Park S.-J.
Institution
(Kang) Division of Cardiology, Asan Medical Center, Seoul, South Korea
(Park, Park) Division of Cardiology, Samsung Medical Center, Seoul, South
Korea
(Lee, Lee, Kim, Park, Song, Park) Division of Cardiology, Asan Medical
Center, Seoul, South Korea
(Yun) Department of Biostatistics, University of Ulsan College of
Medicine, Seoul, South Korea
(Hong) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei
University Health System, Seoul, South Korea
(Hong) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei
University Health System, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The decision to perform percutaneous mitral commissurotomy
(PMC) on asymptomatic patients requires careful weighing of the potential
benefits against the risks of PMC, and we conducted a multicentre,
randomised trial to compare long-term outcomes of early PMC and
conventional treatment in asymptomatic, severe mitral stenosis (MS).
<br/>METHOD(S): We randomly assigned asymptomatic patients with severe MS
(defined as mitral valve area between 1.0 and 1.5 cm2) to early PMC (84
patients) or to conventional treatment (83 patients). The primary endpoint
was a composite of major cardiovascular events, including PMC-related
complications, cardiovascular mortality, cerebral infarction and systemic
thromboembolic events. The secondary endpoints were death from any cause
and mitral valve (MV) replacement during follow-up. <br/>RESULT(S): In the
early PMC group, there were no PMC-related complications. During the
median follow-up of 6.4 years, the composite primary endpoint occurred in
seven patients in the early PMC group (8.3%) and in nine patients in the
conventional treatment group (10.8%) (HR 0.77; 95% CI 0.29 to 2.07;
p=0.61). Death from any cause occurred in four patients in the early PMC
group (4.8%) and three patients in the conventional treatment group (3.6%)
(HR 1.30; 95% CI 0.29 to 5.77). Ten patients (11.9%) in the early PMC
group and 17 patients (20.5%) in the conventional treatment group
underwent MV replacement (HR 0.59; 95% CI 0.27 to 1.29).
<br/>CONCLUSION(S): Compared with conventional treatment, early PMC did
not significantly reduce the incidence of cardiovascular events among
asymptomatic patients with severe MS during the median follow-up of 6
years. TRIAL REGISTRATION NUMBER: NCT01406353.<br/>Copyright &#xa9;
Author(s) (or their employer(s)) 2021. No commercial re-use. See rights
and permissions. Published by BMJ.