EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2014523602
Title
Effects of high versus low inspiratory oxygen fraction on postoperative
clinical outcomes in patients undergoing surgery under general anesthesia:
A systematic review and meta-analysis of randomized controlled trials.
Source
Journal of Clinical Anesthesia. 75 (no pagination), 2021. Article Number:
110461. Date of Publication: December 2021.
Author
Lim C.-H.; Han J.-Y.; Cha S.-H.; Kim Y.-H.; Yoo K.-Y.; Kim H.-J.
Institution
(Lim) Department of Anesthesiology and Pain Medicine, College of Medicine,
Korea University, Seoul, South Korea
(Han) College of Medicine, Korea University, Seoul, South Korea
(Cha) Department of Radiology, Korea University Anam Hospital, Korea
University Medical Center, Seoul, South Korea
(Kim) Department of Anesthesiology and Pain Medicine, Hanyang University
Hanmaeum Changwon Hospital, Changwon, South Korea
(Yoo) Department of Anesthesiology and Pain Medicine, Chonnam National
University Medical School, Gwangju, South Korea
(Kim) Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, South Korea
Publisher
Elsevier Inc.
Abstract
Objectives: To determine whether high perioperative inspired oxygen
fraction (FiO<inf>2</inf>) compared with low FiO<inf>2</inf> has more
deleterious postoperative clinical outcomes in patients undergoing
non-thoracic surgery under general anesthesia. <br/>Design(s):
Meta-analysis of randomized controlled trials. <br/>Setting(s): Operating
room, postoperative recovery room and surgical ward. <br/>Patient(s):
Surgical patients under general anesthesia. <br/>Intervention(s): High
perioperative FiO<inf>2</inf> (>=0.8) vs. low FiO<inf>2</inf> (<=0.5).
Measurements: The primary outcome was mortality within 30 days. Secondary
outcomes were pulmonary outcomes (atelectasis, pneumonia, respiratory
failure, postoperative pulmonary complications [PPCs], and postoperative
oxygen parameters), intensive care unit (ICU) admissions, and length of
hospital stay. A subgroup analysis was performed to explore the treatment
effect by body mass index (BMI). <br/>Main Result(s): Twenty-six trials
with a total 4991 patients were studied. The mortality in the high
FiO<inf>2</inf> group did not differ from that in the low FiO<inf>2</inf>
group (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.42-1.97, P =
0.810). Nor were there any significant differences between the groups in
such outcomes as pneumonia (RR 1.19, 95% CI 0.74-1.92, P = 0.470),
respiratory failure (RR 1.29, 95% CI 0.82-2.04, P = 0.270), PPCs (RR 1.05,
95% CI 0.69-1.59, P = 0.830), ICU admission (RR 0.94, 95% CI 0.55-1.60, P
= 0.810), and length of hospital stay (mean difference [MD] 0.27 d, 95% CI
-0.28-0.81, P = 0.340). The high FiO<inf>2</inf> was associated with
postoperative atelectasis more often (risk ratio 1.27, 95% CI 1.00-1.62, P
= 0.050), and lower postoperative arterial partial oxygen pressure (MD
-5.03 mmHg, 95% CI -7.90- -2.16, P < 0.001)<inf>.</inf> In subgroup
analysis of BMI >30 kg/m², these parameters were similarly
affected between the groups. <br/>Conclusion(s): The use of high
FiO<inf>2</inf> compared to low FiO<inf>2</inf> did not affect the
short-term mortality, although it may increase the incidence of
atelectasis in adult, non-thoracic patients undergoing surgical
procedures. Nor were there any significant differences in other secondary
outcomes.<br/>Copyright &#xa9; 2021 The Authors

<2>
Accession Number
2014620659
Title
Impact of sex on outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Dixon L.K.; Di Tommaso E.; Dimagli A.; Sinha S.; Sandhu M.; Benedetto U.;
Angelini G.D.
Institution
(Dixon, Di Tommaso, Dimagli, Sinha, Sandhu, Benedetto, Angelini) Bristol
Heart Institute, Translational Health Sciences, University of Bristol, UK,
United Kingdom
Publisher
Elsevier Ireland Ltd
Abstract
Background: Despite advances in cardiac surgery, observational studies
suggest that females have poorer post-operative outcomes than males. This
study is the first to review sex related outcomes following both coronary
artery bypass graft (CABG) and valve surgery with or without combined
CABG. <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.

<3>
Accession Number
2013691318
Title
The association of prothrombin complex concentrates with postoperative
outcomes in cardiac surgery: an observational substudy of the FIBRES
randomized controlled trial.
Source
Canadian Journal of Anesthesia. (no pagination), 2021. Date of
Publication: 2021.
Author
Bartoszko J.; Callum J.; Karkouti K.
Institution
(Bartoszko, Karkouti) Department of Anesthesia and Pain Management,
Toronto General Hospital - University Health Network, Sinai Health System,
Women's College Hospital, University of Toronto, 200 Elizabeth Street,
3EN-464, Toronto, ON M5G 2C4, Canada
(Bartoszko, Karkouti) Peter Munk Cardiac Centre and Toronto General
Hospital Research Institute, University Health Network, Toronto, ON,
Canada
(Callum) Department of Pathology and Molecular Medicine, Kingston Health
Sciences Centre, Toronto, ON, Canada
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Kingston, ON, Canada
(Karkouti) Institute of Health Policy Management and Evaluation,
University of Toronto, Toronto, ON, Canada
Publisher
Springer
Abstract
Purpose: The mainstay of therapy for coagulation factor deficiency in
cardiac surgical patients is frozen plasma (FP); however, prothrombin
complex concentrates (PCCs) may offer logistical and safety advantages. As
there is limited comparative evidence, we conducted this study to explore
the association of comparable PCC or FP doses with transfusion and
outcomes. <br/>Method(s): This was a post hoc analysis of a multicentre
randomized trial comparing fibrinogen concentrate with cryoprecipitate
(FIBRES trial) in bleeding cardiac surgical patients. This analysis
included 415 patients who received only PCC (n = 72; 17%) or only FP (n =
343; 83%) for factor replacement. The main outcomes of interest were red
blood cell (RBC) and platelet transfusion within 24 hr of cardiopulmonary
bypass. Secondary outcomes included postoperative adverse events.
Associations were examined by hierarchical generalized estimating equation
models adjusted for demographic and surgical characteristics.
<br/>Result(s): The median [interquartile range (IQR)] PCC dose was 1,000
[1,000-2,000] units, while the median [IQR] FP dose was 4 [2-6] units.
Each unit of FP was independently associated with increased adjusted odds
of RBC (1.60; 95% confidence interval [CI], 1.36 to 1.87; P < 0.01) and
platelet transfusion (1.40; 95% CI, 1.15 to 1.69; P < 0.01) while each 500
units of PCC was independently associated with reduced adjusted odds of
RBC (0.67; 95% CI, 0.50 to 0.90; P < 0.01) and platelet transfusion (0.80;
95% CI, 0.70 to 0.92; P < 0.01). Adverse event rates were comparable.
<br/>Conclusion(s): In cardiac surgical patients with post-cardiopulmonary
bypass bleeding, PCC use was associated with lower RBC and platelet
transfusion than FP use was. Prospective, randomized clinical trials
comparing FP with PCC in this setting are warranted.<br/>Copyright &#xa9;
2021, Canadian Anesthesiologists' Society.

<4>
Accession Number
2013365395
Title
Prognostic models for mortality after cardiac surgery in patients with
infective endocarditis: a systematic review and aggregation of prediction
models.
Source
Clinical Microbiology and Infection. 27(10) (pp 1422-1430), 2021. Date of
Publication: October 2021.
Author
Fernandez-Felix B.M.; Barca L.V.; Garcia-Esquinas E.; Correa-Perez A.;
Fernandez-Hidalgo N.; Muriel A.; Lopez-Alcalde J.; Alvarez-Diaz N.; Pijoan
J.I.; Ribera A.; Elorza E.N.; Munoz P.; Farinas M.D.C.; Goenaga M.A.;
Zamora J.
Institution
(Fernandez-Felix, Correa-Perez, Muriel, Lopez-Alcalde, Zamora) Clinical
Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS), Madrid,
Spain
(Fernandez-Felix, Garcia-Esquinas, Muriel, Lopez-Alcalde, Pijoan, Ribera,
Zamora) CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
(Barca) Department of Cardiovascular Surgery, Fundacion Jimenez Diaz
University Hospital, Madrid, Spain
(Garcia-Esquinas) Department of Preventive Medicine and Public Health,
School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
(Garcia-Esquinas) IdiPaz (Hospital Universitario La Paz-Universidad
Autonoma de Madrid), Madrid, Spain
(Correa-Perez, Lopez-Alcalde) Faculty of Medicine, Universidad Francisco
de Vitoria, Madrid, Spain
(Fernandez-Hidalgo) Servei de Malalties Infeccioses, Hospital Universitari
Vall d'Hebron, Barcelona, Spain
(Fernandez-Hidalgo) Red Espanola de Investigacion en Patologia Infecciosa
(REIPI), Instituto de Salud Carlos III, Madrid, Spain
(Lopez-Alcalde) Institute for Complementary and Integrative Medicine,
University Hospital Zurich and University of Zurich, Zurich, Switzerland
(Alvarez-Diaz) Medical Library, Hospital Universitario Ramon y Cajal
(IRYCIS), Madrid, Madrid, Spain
(Pijoan) Hospital Universitario Cruces/OSI EEC, Barakaldo, Spain
(Pijoan) Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
(Ribera) Cardiovascular Epidemiology and Research Unit, Hospital
Universitari Vall d'Hebron, Barcelona, Spain
(Elorza) Department of Infectology, Hospital Universitario Ramon y Cajal
(IRYCIS), Madrid, Spain
(Munoz) Clinical Microbiology and Infectious Diseases Service, Hospital
General Universitario Gregorio Maranon, Instituto de Investigacion
Sanitaria Gregorio Maranon, CIBER Enfermedades Respiratorias-CIBERES,
Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
(Farinas) Infectious Diseases Service, Hospital Universitario Marques de
Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
(Goenaga) Infectious Diseases Service, Hospital Universitario Donostia,
IIS Biodonostia, OSI Donostialdea, San Sebastian, Spain
(Zamora) WHO Collaborating Centre for Global Women's Health, Institute of
Metabolism and Systems Research, University of Birmingham, Birmingham,
United Kingdom
Publisher
Elsevier B.V.
Abstract
Background: There are several prognostic models to estimate the risk of
mortality after surgery for active infective endocarditis (IE). However,
these models incorporate different predictors and their performance is
uncertain. <br/>Objective(s): We systematically reviewed and critically
appraised all available prediction models of postoperative mortality in
patients undergoing surgery for IE, and aggregated them into a meta-model.
Data sources: We searched Medline and EMBASE databases from inception to
June 2020. Study eligibility criteria: We included studies that developed
or updated a prognostic model of postoperative mortality in patient with
IE. <br/>Method(s): We assessed the risk of bias of the models using
PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated
them into an aggregate meta-model based on stacked regressions and
optimized it for a nationwide registry of IE patients. The meta-model
performance was assessed using bootstrap validation methods and adjusted
for optimism. <br/>Result(s): We identified 11 prognostic models for
postoperative mortality. Eight models had a high risk of bias. The
meta-model included weighted predictors from the remaining three models
(EndoSCORE, specific ES-I and specific ES-II), which were not rated as
high risk of bias and provided full model equations. Additionally, two
variables (age and infectious agent) that had been modelled differently
across studies, were estimated based on the nationwide registry. The
performance of the meta-model was better than the original three models,
with the corresponding performance measures: C-statistics 0.79 (95% CI
0.76-0.82), calibration slope 0.98 (95% CI 0.86-1.13) and
calibration-in-the-large -0.05 (95% CI -0.20 to 0.11). <br/>Conclusion(s):
The meta-model outperformed published models and showed a robust
predictive capacity for predicting the individualized risk of
postoperative mortality in patients with IE. <br/>Protocol Registration:
PROSPERO (registration number CRD42020192602).<br/>Copyright &#xa9; 2021
European Society of Clinical Microbiology and Infectious Diseases

<5>
Accession Number
636128438
Title
The comparison of albumin and 6% hydroxyethyl starches (130/0.4) in
cardiac surgery: a meta-analysis of randomized controlled clinical trials.
Source
BMC surgery. 21(1) (pp 342), 2021. Date of Publication: 11 Sep 2021.
Author
Wei L.; Li D.; Sun L.
Institution
(Wei) Department of Rehabilitation, Second Xiangya Hospital, Central South
University, Changsha 410011, China
(Wei, Sun) Hunan Key Laboratory of Kidney Disease and Blood Purification,
Department of Nephrology, Second Xiangya Hospital, Central South
University, Changsha 410011, China
(Li) Department of Cardiothoracic Surgery, Second Xiangya Hospital,
Central South University, Changsha, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Fluid administration is a key tool in the maintenance of
normovolemia in patients with cardiac surgery. The trials that evaluated
the safety of 6% hydroxyethyl starch (HES) 130/0.4 in cardiac surgical
patients were inconsistent. It is necessary to compare the efficacy and
safety of albumin and 6% HES (130/0.4). <br/>METHOD(S): We searched for
the randomized controlled clinical trials that compared human albumin with
6% HES (130/0.4) in cardiac surgery in PubMed, Cochrane, and Embase.
<br/>RESULT(S): Ten studies involved a total of 1567 patients were
included in our meta-analysis. For the efficiency, there was no difference
in total volume of infusion between compared groups [P=0.64, Fixed Effect
Model (FEM): standardized mean difference (SMD)=0.04, 95% confidence
interval (CI) (- 0.12, 0.20)]. As for safety, the albumin show more risk
than hydroxyethyl starch 130/0.4 in blood loss [P=0.02, FEM: SMD: 0.22,
95% CI (0.03, 0.41)]. There was no difference in the frequency of
transfusions (P=0.20, RR=1.11; 95% CI (0.95, 1.27)) between the two
groups. No difference was observed for the days in intensive care unit
[P=0.05, FEM: SMD=- 0.18, 95% CI (- 0.36, 0.00)], and the days in hospital
[P=0.32, FEM: SMD=- 0.11, 95% CI (- 0.32, 0.10)]. Furthermore, both the
incidence of AKI, RRT, and mortality were comparable in the two groups.
<br/>CONCLUSION(S): This study provided evidence that the 6% HES (130/0.4)
might be the substitute for HA, which reduced the economic burden for
patients with cardiac surgery. However, the effect of 6% HES (130/0.4) and
HA on AKI still needs to be further studied.<br/>Copyright &#xa9; 2021.
The Author(s).

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

<7>
Accession Number
636033241
Title
Ventricular Assist Device Driveline Infections: A Systematic Review.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2021. Date of
Publication: 2021.
Author
Krzelj K.; Petricevic M.; Gasparovic H.; Biocina B.; McGiffin D.
Institution
(Krzelj, Gasparovic, Biocina) Department of Cardiac Surgery, University
Hospital Center Zagreb, Zagreb, Croatia
(Petricevic) Division of Health Studies, Department of Cardiac Surgery,
University of Split, University Hospital Center Zagreb, Zagreb, Croatia
(Gasparovic, Biocina) School of Medicine, University of Zagreb, Zagreb,
Croatia
(McGiffin) Department of Cardiothoracic Surgery and Transplantation,
Alfred Hospital, Melbourne, VIC, Australia
(McGiffin) Monash University, Clayton, VIC, Australia
Publisher
Georg Thieme Verlag
Abstract
Infection is the most common complication in patients undergoing
ventricular assist device (VAD) implantation. Driveline exit site (DLES)
infection is the most frequent VAD infection and is a significant cause of
adverse events in VAD patients, contributing to morbidity, even mortality,
and repetitive hospital readmissions. There are many risk factors for
driveline infection (DLI) including younger age, smaller constitution of
patients, obesity, exposed velour at the DLES, longer duration of device
support, lower cardiac index, higher heart failure score, DLES trauma, and
comorbidities such as diabetes mellitus, chronic kidney disease, and
depression. The incidence of DLI depends also on the device type. Numerous
measures to prevent DLI currently exist. Some of them are proven, whereas
the others remain controversial. Current recommendations on DLES care and
DLI management are predominantly based on expert consensus and clinical
experience of the certain centers. However, careful and uniform DLES care
including obligatory driveline immobilization, previously prepared sterile
dressing change kits, and continuous patient education are probably
crucial for prevention of DLI. Diagnosis and treatment of DLI are often
challenging because of certain immunological alterations in VAD patients
and microbial biofilm formation on the driveline surface areas. Although
there are many conservative and surgical methods described in the DLI
treatment, the only possible permanent solution for DLI resolution in VAD
patients is heart transplantation. This systematic review brings a
comprehensive synthesis of recent data on the prevention, diagnostic
workup, and conservative and surgical management of DLI in VAD
patients.<br/>Copyright &#xa9; 2021. Thieme. All rights reserved.

<8>
Accession Number
2014887428
Title
The Effect of Pulmonary Rehabilitation on Respiratory Functions, and the
Quality of Life, following Coronary Artery Bypass Grafting: A Randomised
Controlled Study.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
6811373. Date of Publication: 2021.
Author
Girgin Z.; Cigerci Y.; Yaman F.
Institution
(Girgin) Health Care Service, Afyonkarahisar State Hospital,
Afyonkarahisar 03200, Turkey
(Cigerci) Department of Nursing, Faculty of Health Science, Afyonkarahisar
Health Science University, Afyonkarahisar 03200, Turkey
(Yaman) Department of Physical Medicine and Rehabilitation, Faculty of
Medicine, Kutahya Health Science University, Kutahya 43100, Turkey
Publisher
Hindawi Limited
Abstract
Objective. Examining the effects of a pulmonary rehabilitation (PR)
program applied to patients undergoing coronary artery bypass grafting
(CABG) surgery with open heart technique on respiratory functions,
functional capacity, and quality of life (QoL). Design. This randomised
controlled study applied the Consolidated Standards of Reporting Trials
statement. Methods. The study was conducted with two groups: the
intervention group (n=25) and the control group (n=25). The control group
received standard care after coronary artery bypass grafting. On the
contrary, the experimental group participated in a PR program created by
the researchers in addition to standard care. After coronary artery bypass
grafting, the respiratory functions (on the 4th day of clinical care) and
QoL (at the 6th week) of both groups were evaluated. The primary outcome
measure was the respiratory function (forced expiratory volume in one
second (FEV1), forced vital capacity (FVC), and FEV1/FVC). The secondary
outcome measure of this study was the QoL. Results. When the average
pulmonary function test values of the patients were examined, the mean FVC
and FEV1 values of the patients in the intervention group on the 4th day
of clinical care were significantly higher with a medium level size effect
than the control group (p=0.027; effect size d=0.643; p<0.024; effect size
d=0.658, respectively). At the postoperative 6th week measurement of QoL,
a decrease was observed in all subdimensions of the scale, albeit less in
the intervention group (p<0.05). There was a decrease in both the mental
and physical component summary of QoL (p<0.05). Conclusion. The results of
this study revealed that pulmonary rehabilitation applied to patients who
have undergone coronary artery bypass graft recover their functional
capacity faster. <br/>Copyright &#xa9; 2021 Zumrut Girgin et al.

<9>
Accession Number
636145361
Title
Sarcopenia predicts adverse outcomes in an elderly population with
coronary artery disease: a systematic review and meta-analysis.
Source
BMC geriatrics. 21(1) (pp 493), 2021. Date of Publication: 14 Sep 2021.
Author
Xue Q.; Wu J.; Ren Y.; Hu J.; Yang K.; Cao J.
Institution
(Xue, Wu, Ren, Hu) Department of Geriatrics, Ruijin Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai 200025, China
(Yang) Department of Vascular & Cardiology, Ruijin Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai 200025, China
(Cao) Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai 200025, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The development of sarcopenia is attributed to normal aging
and factors like type 2 diabetes, obesity, inactivity, reduced
testosterone levels, and malnutrition, which are factors of poor prognosis
in patients with coronary artery disease (CAD). This study aimed to
perform a meta-analysis to assess whether preoperative sarcopenia can be
used to predict the outcomes after cardiac surgery in elderly patients
with CAD. <br/>METHOD(S): PubMed, Embase, the Cochrane library, and Web of
Science were searched for available papers published up to December 2020.
The primary outcome was major adverse cardiovascular outcomes (MACE). The
secondary outcomes were mortality and heart failure (HF)-related
hospitalization. The random-effects model was used. Hazard ratios (HRs)
with 95% confidence intervals (95%CIs) were estimated. <br/>RESULT(S): Ten
studies were included, with 3707 patients followed for 6months to
4.5+/-2.3years. The sarcopenia population had a higher rate of MACE
compared to the non-sarcopenia population (HR=2.27, 95%CI: 1.58-3.27,
P<0.001; I2 =60.0%, Pheterogeneity=0.02). The association between
sarcopenia and MACE was significant when using the psoas muscle area index
(PMI) to define sarcopenia (HR=2.86, 95%CI: 1.84-4.46, P<0.001; I2 =0%,
Pheterogeneity=0.604). Sarcopenia was not associated with higher late
mortality (HR=2.15, 95%CI: 0.89-5.22, P=0.090; I2 =91.0%,
Pheterogeneity<0.001), all-cause mortality (HR=1.35, 95%CI: 0.14-12.84,
P=0.792; I2 =90.5%, Pheterogeneity=0.001), and death, HF-related
hospitalization (HR=1.37, 95%CI: 0.59-3.16, P=0.459; I2 =62.0%,
Pheterogeneity=0.105). The sensitivity analysis revealed no outlying study
in the analysis of the association between sarcopenia and MACE after
coronary intervention. <br/>CONCLUSION(S): Sarcopenia is associated with
poor MACE outcomes in patients with CAD. The results could help determine
subpopulations of patients needing special monitoring after CAD surgery.
The present study included several kinds of participants; although
non-heterogeneity was found, interpretation should be
cautious.<br/>Copyright &#xa9; 2021. The Author(s).

<10>
Accession Number
2014886518
Title
Robotic and video-assisted lobectomy/segmentectomy for non-small cell lung
cancer have similar perioperative outcomes: A systematic review and
meta-analysis.
Source
Translational Cancer Research. 10(9) (pp 3883-3893), 2021. Date of
Publication: September 2021.
Author
Mao J.; Tang Z.; Mi Y.; Xu H.; Li K.; Liang Y.; Wang N.; Wang L.
Institution
(Mao, Tang, Mi, Xu, Li, Liang, Wang) Department of Thoracic Surgery, the
Fourth Hospital, Hebei Medical University, Shijiazhuang, China
(Wang) Department of Cancer Institute, the Fourth Hospital, Hebei Medical
University, Shijiazhuang, China
Publisher
AME Publishing Company
Abstract
Background: At present, the clinical conclusion that robotic-assisted
thoracic surgery (RATS) and video-assisted thoracic surgery (VATS), which
is better for patients with non-small cell lung cancer (NSCLC) is not
clear. Therefore, this meta-analysis aimed to compare the perioperative
outcomes between RATS and VATS for NSCLC. <br/>Method(s): The Population,
Interventions, Comparators, Outcomes, and Study design (PICOS) framework
was employed to develop the search strategy, and the findings was reported
in accordance with the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) statement. We searched EMbase, The Cochrane
Library, PubMed, Web of Science, CNKI, and Wan Fang Data to collect
clinical studies about RATS vs. VATS for patients with NSCLC from
inception to October 2019. The following outcomes were measured: Rate of
conversion to thoracotomy, postoperative complications, postoperative
hospital mortality, lymph node dissection, hospitalization time, operating
time, and postoperative drainage days. Estimation of potential publication
bias was conducted by Begg's test and Egger's test. The Standardized Mean
Difference (SMD) and Odds Ratio (OR) with 95% confidence intervals (CI)
were pooled using Stata 15.0 software. <br/>Result(s): A total of 18
studies involving 60,349 patients were included. Among them, 8,726 cases
were in the RATS group, and 51,623 were in the VATS group. The results of
meta-analysis showed that the operation time of RATS group was longer than
that of VATS group (SMD=0.532, 95% CI: 0.391-0.674, P=0.000). And the
further meta-analysis suggested that the incidence of postoperative
complications was lower in patients who underwent RATS after 2015
(OR=0.848, 95% CI: 0.748-0.962, P=0.010). Meanwhile, there was no
significant difference between both groups in postoperative
hospitalization time (SMD=0.003, 95% CI: -0.104-0.110, P=0.957). In
addition, more lymph nodes were retrieved in RATS group than VATS
(SMD=0.308, 95% CI: 0.131-0.486, P=0.001). However, the conversion rate,
retrieved lymph node station, days to tube removal and in-hospital
mortality rate have no significant differences between both groups.
<br/>Discussion(s): The current meta-analysis indicates that the
perioperative outcomes of RATS and VATS for NSCLC are equivalence. Due to
the limited quantity and quality of included studies, the above
conclusions still need to be verified by more high-quality
studies.<br/>Copyright &#xa9; 2021 AME Publishing Company. All rights
reserved.

<11>
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

<12>
Accession Number
2013859482
Title
TAVR and Dialysis Are a Challenging Combination. A Case Report and
Systematic Review of Literature.
Source
Structural Heart. (no pagination), 2021. Date of Publication: 2021.
Author
Iadanza A.; Antenore A.; Biancofiore A.; Contorni F.; Biagioni G.; Bellan
C.; Davoli G.; Fineschi M.
Institution
(Iadanza, Fineschi) Department of Cardiovascular Diseases, Azienda
Ospedaliera Universitaria Senese, Siena, Italy
(Antenore, Biancofiore, Contorni, Biagioni) Department of Medical
Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
(Bellan) Department of Medical Biotechnologies, Institute of Pathological
Anatomy, University of Siena, Siena, Italy
(Davoli) Department of Cardiovascular Diseases, Azienda Ospedaliera
Universitaria Senese, Siena, Italy
Publisher
Taylor and Francis Ltd.
Abstract
Advanced chronic kidney disease (CKD) is associated with poor outcomes in
patients undergoing surgical aortic valve replacement, while its
prognostic role in transcatheter aortic valve replacement (TAVR) remains
unclear. Advanced CKD was defined according to estimated glomerular
filtration rate (eGFR): 15-29 mL/min/1.73 m² (Stage 4-CKD G5),
<15 mL/min/1.73 m² (Stage 5-CKD G5), and CKD G5D if the patient
is on hemodialysis. End-stage renal disease (ESRD) increases the risk of
developing heart valve disease, mainly aortic stenosis. Nonetheless, ESRD
is also known to carry a very high surgical risk, and all the main scoring
systems (i.e., STS, Euroscore II) developed to assess prognosis in
patients undergoing cardiac surgery take into account this risk factor.
Transcatheter aortic valve replacement (TAVR) appears to be a feasible
alternative to surgical valve replacement (SAVR), but the initial trials
testing this approach systematically excluded patients on dialysis.
Several observational studies have been recently conducted among patients
with severely impaired renal function and all found a worse prognosis in
both the short and long term. We present a case report in which a
successful TAVR procedure was performed due to severe symptomatic aortic
stenosis in a subject with severe nephropathy. The patient in chronic
dialysis developed an early degeneration of aortic bioprosthesis Medtronic
CoreValve, which required surgical replacement with a mechanical
valve.<br/>Copyright &#xa9; 2021 Cardiovascular Research Foundation.

<13>
Accession Number
2013842897
Title
To understand a meta-analysis, best read the fine print.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Greason K.L.
Institution
(Greason) Department of Cardiovascular Surgery, Mayo Clinic, Rochester,
MN, United States
Publisher
John Wiley and Sons Inc
Abstract
The results of a meta-analysis are more than just the reported odds ratio,
95% confidence interval (CI), and p value. Of equal importance is the fine
print of the study which should include assessment of the risk of bias,
certainty in evidence, and heterogeneity in the individual point estimates
and CIs. These areas all have an influence on the quality of the data in
the analysis. Reading and understanding the fine print is
important.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<14>
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.

<15>
Accession Number
636146080
Title
Spanish Society of Thoracic Surgery (SECT) consensus document. Long-term
follow-up for operated patients with lung cancer.
Source
Cirugia espanola. (no pagination), 2021. Date of Publication: 11 Sep
2021.
Author
Cilleruelo Ramos A.; Figueroa Almanzar S.; Lopez Castro R.; Martinez
Hernandez N.J.; Mezquita Perez L.; Moreno Casado P.; Zabaleta Jimenez J.
Institution
(Cilleruelo Ramos) Servicio de Cirugia Toracica, Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Figueroa Almanzar) Servicio de Cirugia Toracica, Hospital Clinico
Universitario de Valencia, Valencia, Spain
(Lopez Castro) Servicio de Oncologia Medica. Hospital Clinico
Universitario de Valladolid, Valladolid, Spain
(Martinez Hernandez) Servicio de Cirugia Toracica. Hospital Universitario
de la Ribera, Alzira, Valencia, Spain
(Mezquita Perez) Servicio de Oncologia Medica. Hospital Clinic de
Barcelona, Barcelona, Spain
(Moreno Casado) Servicio de Cirugia Toracica. Hospital Universitario Reina
Sofia de Cordoba, Cordoba, Spain
(Zabaleta Jimenez) Servicio de Cirugia Toracica. Hospital Universitario de
Donostia, San Sebastian, Spain
Publisher
NLM (Medline)

<16>
Accession Number
636145176
Title
Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery:
A Randomized, Placebo-controlled, Double-blinded Clinical Trial.
Source
Anesthesiology. (no pagination), 2021. Date of Publication: 14 Sep 2021.
Author
Dhawan R.; Daubenspeck D.; Wroblewski K.E.; Harrison J.-H.; McCrorey M.;
Balkhy H.H.; Chaney M.A.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intrathecal morphine decreases postoperative pain in standard
cardiac surgery. Its safety and effectiveness have not been adequately
evaluated in minimally invasive cardiac surgery. The authors hypothesized
that intrathecal morphine would decrease postoperative morphine
consumption after minimally invasive cardiac surgery. <br/>METHOD(S): In
this randomized, placebo-controlled, double-blinded clinical trial,
patients undergoing robotic totally endoscopic coronary artery bypass
received either intrathecal morphine (5 mcg/kg) or intrathecal saline
before surgery. The primary outcome was postoperative morphine equivalent
consumption in the first 24 h after surgery; secondary outcomes included
pain scores, side effects, and patient satisfaction. Pain was assessed via
visual analog scale at 1, 2, 6, 12, 24, and 48 h after intensive care unit
arrival. Opioid-related side effects (nausea/vomiting, pruritus, urinary
retention, respiratory depression) were assessed daily. Patient
satisfaction was evaluated with the Revised American Pain Society Outcome
Questionnaire. <br/>RESULT(S): Seventy-nine patients were randomized to
receive intrathecal morphine (n = 37) or intrathecal placebo (n = 42),
with 70 analyzed (morphine 33, placebo 37). Intrathecal morphine patients
required significantly less median (25th to 75th percentile) morphine
equivalents compared to placebo during first postoperative 24 h (28 [16 to
46] mg vs. 59 [41 to 79] mg; difference, -28 [95% CI, -40 to -18]; P <
0.001) and second postoperative 24 h (0 [0 to 2] mg vs. 5 [0 to 6] mg;
difference, -3.3 [95% CI, -5 to 0]; P < 0.001), exhibited significantly
lower visual analog scale pain scores at rest and cough at all
postoperative timepoints (overall treatment effect, -4.1 [95% CI, -4.9 to
-3.3] and -4.7 [95% CI, -5.5 to -3.9], respectively; P < 0.001), and
percent time in severe pain (10 [0 to 40] vs. 40 [20 to 70]; P = 0.003)
during the postoperative period. Mild nausea was more common in the
intrathecal morphine group (36% vs. 8%; P = 0.004). <br/>CONCLUSION(S):
When given before induction of anesthesia for totally endoscopic coronary
artery bypass, intrathecal morphine decreases use of postoperative opioids
and produces significant postoperative analgesia for 48 h.<br/>Copyright
&#xa9; 2021, the American Society of Anesthesiologists. All Rights
Reserved.

<17>
Accession Number
2014700583
Title
Polypills with or without aspirin for primary prevention of cardiovascular
disease.
Source
The Lancet. 398(10306) (pp 1106-1107), 2021. Date of Publication: 25 Sep
2021.
Author
Mant J.; McManus R.
Institution
(Mant) Primary Care Unit, Department of Public Health & Primary Care,
University of Cambridge, Cambridge CB2 0SR, United Kingdom
(McManus) Nuffield Department of Primary Care Health Sciences, University
of Oxford, Oxford, United Kingdom
Publisher
Elsevier B.V.

<18>
Accession Number
2013642346
Title
Alternate accesses for transcatheter aortic valve replacement: A network
meta-analysis.
Source
Journal of Cardiac Surgery. 36(11) (pp 4308-4319), 2021. Date of
Publication: November 2021.
Author
Hameed I.; Oakley C.T.; Hameed N.U.F.; Ahmed A.; Naeem N.; Singh S.;
Rizwana K.; Brackett A.; Forrest J.K.; Kaple R.; Mangi A.; Salemi A.;
Geirsson A.; Gaudino M.; Vallabhajosyula P.
Institution
(Hameed, Singh, Mangi, Geirsson, Vallabhajosyula) Department of Surgery,
Section of Cardiac Surgery, Yale School of Medicine, New Haven, CT, United
States
(Oakley, Hameed, Ahmed, Naeem, Rizwana, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY,
United States
(Brackett) Cushing/Whitney Medical Library, Yale School of Medicine, New
Haven, CT, United States
(Forrest, Kaple) Department of Internal Medicine, Division of Cardiology,
Yale School of Medicine, New Haven, CT, United States
(Salemi) Department of Cardiothoracic Surgery, Robert Wood
Johnson/Barnabas Health, West Orange, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: When transfemoral (TF) access is contraindicated in patients
undergoing transcatheter aortic valve replacement (TAVR), alternate access
strategies are considered. The choice of one alternate access over the
other remains controversial. <br/>Method(s): Following a comprehensive
literature search, studies comparing any combination of TF, transapical
(TA), transaortic (TAo), transcarotid (TC), and trans-subclavian (TS) TAVR
were identified. Data were pooled using fixed- and random-effects network
meta-analysis. Rank scores with probability ranks of different treatment
groups were calculated. <br/>Result(s): Eighty-four studies (26,449
patients) were included. Compared to TF access, TA and TAo accesses were
associated with higher 30-day mortality (odds ratio [OR] 1.60, 95%
confidence interval [CI] 1.31-1.94; OR 1.79, 95% CI 1.21-2.66,
respectively), while the TC and TS showed no difference (OR 1.12, 95% CI
0.64-1.95; OR 1.23, 95% CI 0.67-2.27, respectively); TF access ranked best
followed by TC. There was no significant difference in 30-day stroke; TC
access ranked best followed by TS. At a weighted mean follow-up of 1.6
years, TA and TAo accesses were associated with higher long-term mortality
versus TF (incidence rate ratio [IRR] 1.31, 95% CI 1.18-1.45; IRR 1.41,
95% CI 1.11-1.79, respectively); there was no difference between TC and TS
versus TF access (IRR 1.02, 95% CI 0.70-1.47; IRR 1.16, 95% CI 0.82-1.66,
respectively); TF access ranked best followed by TC. At a weighted mean
follow-up of 1.4 years, only TA access was associated with higher
long-term stroke compared to TF (IRR 3.01, 95% CI 1.15-7.87); TF access
ranked as the best strategy followed by TAo. <br/>Conclusion(s): TC and TS
approaches are associated with superior postoperative outcomes compared to
other TAVR alternate access strategies. Randomized trials definitively
assessing the safety and efficacy of alternate access strategies are
needed.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<19>
[Use Link to view the full text]
Accession Number
634905191
Title
The effect of immediate postoperative Boussignac CPAP on adverse pulmonary
events after thoracic surgery: A multicentre, randomised controlled trial.
Source
European Journal of Anaesthesiology. 38(2) (pp 164-170), 2021. Date of
Publication: February 2021.
Author
Puente-Maestu L.; Lopez E.; Sayas J.; Alday E.; Planas A.; Parise D.J.;
Martinez-Borja M.; Garutti I.
Institution
(Puente-Maestu) Servicio de Neumologia Hospital General Universitario
Gregorio Maranon, Spain
(Puente-Maestu, Garutti) Instituto de Investigacion Sanitaria Gregorio
Maranon (IiSGM), Spain
(Puente-Maestu, Lopez, Sayas, Garutti) Facultad de Medicina, Universidad
Complutense de Madrid (UCM), Spain
(Garutti) Servicio de Anestesia Hospital General Universitario Gregorio
Maranon, Spain
(Lopez) Servicio de Anestesia Hospital General Universitario 12 de
Octubre, Spain
(Lopez, Sayas) Instituto de Investigacion Sanitaria 12 de Octubre (I12),
Spain
(Sayas) Servicio de Neumologia Hospital General Universitario 12 de
Octubre, Spain
(Sayas, Planas) Servicio de Anestesia Hospital General Universitario La
Princesa, Spain
(Alday, Planas) Instituto de Investigacion Sanitaria del Hospital de la
Princesa (IIS La Princea), Spain
(Alday, Planas) Facultad de Medicina, Universidad Autonoma de Madrid
(UAM), Spain
(Parise, Martinez-Borja) Servicio de Anestesia Hospital General
Universitario Ramon y Cajal, Spain
(Parise, Martinez-Borja) Instituto de Investigacion Sanitaria Hospital
Ramon y Cajal (IRICYS), Spain
(Parise, Martinez-Borja) Facultad de Medicina Universidad de Alcala de
Henares (UAH), Madrid, Spain
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND The effectiveness of prophylactic continuous positive pressure
ventilation (CPAP) after thoracic surgery is not clearly established.
OBJECTIVE The aim of this study was to assess the effectiveness of CPAP
immediately after lung resection either by thoracotomy or thoracoscopy in
preventing atelectasis and pneumonia. DESIGN A multicentre, randomised,
controlled, open-label trial. SETTINGS Four large University hospitals at
Madrid (Spain) from March 2014 to December 2016. PATIENTS Immunocompetent
patients scheduled for lung resection, without previous diagnosis of
sleep-apnoea syndrome or severe bullous emphysema. Four hundred and
sixty-four patients were assessed, 426 were randomised and 422 were
finally analysed. INTERVENTION Six hours of continuous CPAP through a
Boussignac system versus standard care. MAIN OUTCOME MEASURES Primary
outcome: incidence of the composite endpoint 'atelectasis R pneumonia'.
Secondary outcome: incidence of the composite endpoint 'persistent air
leak R pneumothorax'. RESULTS The primary outcome occurred in 35 patients
(17%) of the CPAP group and in 58 (27%) of the control group [adjusted
relative risk (ARR) 0.53, 95% CI 0.30 to 0.93]. The secondary outcome
occurred in 33 patients (16%) of the CPAP group and in 29 (14%) of the
control group [ARR 0.92, 95% CI 0.51 to 1.65]. CONCLUSION Prophylactic
CPAP decreased the incidence of the composite endpoint 'postoperative
atelectasis R pneumonia' without increasing the incidence of the endpoint
'postoperative persistent air leaks R pneumothorax'.<br/>Copyright &#xa9;
2020 European Society of Anaesthesiology and Intensive Care. Unauthorized
reproduction of this article is prohibited.

<20>
Accession Number
2014810044
Title
Characteristics and Quality of National Cardiac Registries: A Systematic
Review.
Source
Circulation: Cardiovascular Quality and Outcomes. (pp 986-994), 2021.
Date of Publication: 2021.
Author
Dawson L.P.; Biswas S.; Lefkovits J.; Stub D.; Burchill L.; Evans S.M.;
Reid C.; Eccleston D.
Institution
(Dawson, Lefkovits, Burchill, Eccleston) Department of Cardiology, Royal
Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
(Biswas, Stub, Evans, Reid) Department of Epidemiology and Preventive
Medicine, Monash University, Melbourne, VIC, Australia
(Dawson, Stub) Department of Cardiology, Alfred Hospital, Melbourne, VIC,
Australia
(Lefkovits) Baker Institute, Melbourne, VIC, Australia
(Burchill) Department of Medicine, Melbourne University, VIC, Australia
(Reid) Curtin School of Population Health, Curtin University, Perth, WA,
Australia
Publisher
Lippincott Williams and Wilkins
Abstract
Background: National cardiac registries are increasingly used for
informing health policy, improving the quality and cost-effectiveness of
patient care, clinical research, and monitoring the safety of novel
treatments. However, the quality of registries is variable. We aimed to
assess the characteristics and quality of national cardiac registries
across all subspecialties of cardiac care. <br/>Method(s): Publications
relating to national cardiac registries across six cardiac subspecialty
domains were identified by searching MEDLINE and the Google advanced
search function with 26 438 citations and 4812 full-text articles
reviewed. <br/>Result(s): A total of 155 registries, representing 49
countries, were included in the study. Of these, 45 related to coronary
disease or percutaneous coronary intervention, 28 related to devices,
arrhythmia, and electrophysiology, 24 related to heart failure,
transplant, and mechanical support, 21 related to structural heart
disease, 21 related to congenital heart disease, and 16 related to cardiac
surgery. Enrollment was procedure-based in 60% and disease-based in 40%. A
total of 73.10 million patients were estimated to have been enrolled in
cardiac registries. Quality scoring was performed using a validated
registry grading system, with registries performing best in the use of
explicit variable definitions and worst in assessment of data reliability.
Higher quality scores were associated with government funding, mandated
enrollment, linkage to other registries, and outcome risk adjustment.
Quality scores and number of registries within a country were positively
correlated with each other and with measures of national economic output,
health expenditure, and urbanization. <br/>Conclusion(s): There has been
remarkable growth in the uptake of national cardiac registries across the
last few decades. However, the quality of processes used to ensure data
completeness and accuracy remain variable and few countries have
integrated registries covering multiple subspecialty domains. Clinicians,
funders, and health policymakers should be encouraged to focus on the
range, quality, and integration of these registries.<br/>Copyright &#xa9;
2021 Lippincott Williams and Wilkins. All rights reserved.

<21>
Accession Number
2014603047
Title
Study design for a randomized crossover study investigating myocardial
strain analysis in patients with coronary artery disease at hyperoxia and
normoxemia prior to coronary artery bypass graft surgery
(StrECHO-O<inf>2</inf>).
Source
Contemporary Clinical Trials. 110 (no pagination), 2021. Article Number:
106567. Date of Publication: November 2021.
Author
Fischer K.; Ranjan R.; Friess J.-O.; Erdoes G.; Mikasi J.; Baumann R.;
Schoenhoff F.S.; Carrel T.P.; Brugger N.; Eberle B.; Guensch D.P.
Institution
(Fischer, Ranjan, Friess, Erdoes, Mikasi, Baumann, Eberle, Guensch)
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
(Schoenhoff, Carrel) Department of Cardiovascular Surgery, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
(Brugger) Department of Cardiology, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Supplemental oxygen (O<inf>2</inf>) is used routinely during
anesthesia. In the treatment of acute myocardial infarction, it has been
established that hyperoxia is to be avoided, whereas information on
benefit and risk of hyperoxia in patients with stable coronary artery
disease (CAD) remain scarce, especially in the setting of general
anesthesia. This study will compare the immediate effects of normoxemia
and hyperoxia on cardiac function, with a primary focus on changes in peak
longitudinal left-ventricular strain, in anesthetized stable chronic CAD
patients using peri-operative transesophageal echocardiography (TEE).
<br/>Method(s): A single-center randomized cross-over clinical trial will
be conducted, enrolling 106 patients undergoing elective coronary artery
bypass graft surgery. After the induction of anesthesia and prior to the
start of surgery, cardiac function will be assessed by 2D and 3D TEE.
Images will be acquired at two different oxygen states for each patient in
randomized order. The fraction of inspired oxygen
(F<inf>I</inf>O<inf>2</inf>) will be titrated to a normoxemic state
(oxygen saturation of 95-98%) and adjusted to a hyperoxic state
(F<inf>I</inf>O<inf>2</inf> = 0.8). TEE images will be analyzed in a
blinded manner for standard cardiac function and strain parameters.
<br/>Conclusion(s): By using myocardial strain assessed by TEE, early and
subtle signs of biventricular systolic and diastolic dysfunction can be
promptly measured intraoperatively prior to the onset of severe signs of
ischemia. The results may help anesthesiologists to better understand the
effects of F<inf>I</inf>O<inf>2</inf> on cardiac function and potentially
tailor oxygen therapy to patients with CAD undergoing general
anesthesia.<br/>Copyright &#xa9; 2021 The Authors

<22>
Accession Number
2014595645
Title
Improved recovery protocols in cardiac surgery: A systematic review and
meta-analysis of observational and quasi-experimental studies.
Source
MEDICC Review. 23(3) (pp 46-53), 2021. Date of Publication: July 2021.
Author
Aguero-Martinez M.O.; Tapia-Figueroa V.M.; Hidalgo-Costa T.
Institution
(Aguero-Martinez) Hermanos Ameijeiras Clinical-Surgical Hospital (HHA),
Havana, Cuba
(Tapia-Figueroa, Hidalgo-Costa) HHA, Havana, Cuba
Publisher
MEDICC Medical Education Cooperation with Cuba
Abstract
INTRODUCTION Improved recovery protocols were implemented in surgical
specialties over the last decade, which decreased anesthetic and surgical
stress and the incidence of perioperative complications. However, these
recovery protocols were introduced more slowly for cardiac surgeries. The
most frequent complications in cardiac surgery are related to patient
clinical status and the characteristics of the surgical procedures
involved, which are becoming more varied and complex every day. The first
version of the enhanced recovery program for cardiac surgery was published
in 2019, but its recommendations were based on only a few studies, and
scant research has evaluated its implementation. Randomized and controlled
clinical trials for these protocols are scarce, so research that
summarizes the results of studies with other methodological designs are
useful in demonstrating their benefits in cardiovascular surgery services
in Cuba and in other limited-resource settings. OBJECTIVE Estimate the
effectiveness of improved recovery protocols in the perioperative
evolution of patients undergoing cardiac surgery. METHODS We performed a
systematic review and meta-analysis according to the guidelines of manual
5.1.0 for reviews of the Cochrane library. We included observational and
quasi-experimental studies published from January 2015 through May 2020
that compared enhanced recovery protocols with conventional treatments in
patients older than 18 years, and used a quality score to evaluate them.
We used the following sources: the Cochrane Library, PubMed, LILACS,
SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate
and HINARI. The following keywords were used for the database searches in
English: ERAS, protocols and cardiac surgery, enhanced recovery after
cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery,
perioperative care and cardiac surgery. We used the following search terms
for databases in Spanish: protocolos de recuperacion precoz and cirugia
cardiaca, protocolos de recuperacion mejorada and cirugia cardiaca,
cuidados perioperatorios and cirugia cardiaca, programas de recuperacion
precoz and cirugia cardiovascular. Methodological quality of included
investigations was evaluated using the surgical research methodology
scale. Meta-analyses were performed for perioperative complications,
intensive care unit and hospital stays, and hospital readmission within 30
days of surgery. We calculated effect sizes of the interventions and the
corresponding 95% confidence intervals. We used mean differences and
confidence intervals for continuous variables, and for qualitative
variables we calculated relative risk (RR). Random effects analysis was
used. Heterogeneity of the studies was assessed using the Q statistic and
the I² statistic. RESULTS We selected 15 studies (a total of
5059 patients: study group, n = 1706; control group, n = 3353). The
average quality score for the 15 articles included was 18.9 (out of a
maximum of 36 according to the scale) and 66.6% had a score >=18. With
improved recovery protocols in cardiac surgery, the incidence of
perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did
hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95%
CI: 0.31-0.86). Differences in extubation time, hospital stay and length
of stay in intensive care units were less marked, but always favored the
group in which the enhanced protocols were implemented. CONCLUSIONS
Improved recovery protocols in cardiac surgery increase quality of care
evidenced by reductions in perioperative complications and decreased
incidence of hospital readmission in the month following
surgery.<br/>Copyright &#xa9; 2021 MEDICC Medical Education Cooperation
with Cuba. All rights reserved.

<23>
Accession Number
635979510
Title
Randomised controlled trial into the role of ramipril in fibrosis
reduction in rheumatic heart disease: The RamiRHeD trial protocol.
Source
BMJ Open. 11(9) (no pagination), 2021. Article Number: e048016. Date of
Publication: 13 Sep 2021.
Author
Ambari A.M.; Setianto B.; Santoso A.; Radi B.; Dwiputra B.; Susilowati E.;
Tulrahmi F.; Wind A.; Cramer M.J.M.; Doevendans P.
Institution
(Ambari, Setianto, Santoso, Radi, Dwiputra) Department of Cardiovascular
Prevention and Rehabilitation, National Cardiovascular Center Harapan
Kita, West Jakarta Jakarta, Indonesia
(Ambari, Setianto, Santoso, Radi, Dwiputra) Department of Cardiology and
Vascular Medicine, Faculty of Medicine, Universitas Indonesia, West
Jakarta Jakarta, Indonesia
(Susilowati, Tulrahmi) Research Assistant of Department of Cardiovascular
Prevention and Rehabilitation, National Cardiovascular Center Harapan
Kita, West Jakarta Jakarta, Indonesia
(Wind, Cramer, Doevendans) Department of Cardiology, University Medical
Centre Utrecht, Utrecht, Netherlands
(Doevendans) Central Military Hospital, Netherlands Heart Institute,
Utrecht, Netherlands
Publisher
BMJ Publishing Group
Abstract
Introduction Rheumatic heart disease (RHD) is a major burden in developing
countries and accounts for 80% of all people living with the disease,
where it causes most cardiovascular morbidity and mortality in children
and young adults. Chronic inflammation and fibrosis of heart valve tissue
due to chronic inflammation in RHD will cause calcification and thickening
of the impacted heart valves, especially the mitral valve. This
fibrogenesis is enhanced by the production of angiotensin II by increased
transforming growth factor beta expression and later by the binding of
interleukin-33, which is known to have antihypertrophic and antifibrotic
effects, to soluble sST2. sST2 binding to this non-natural ligand worsens
fibrosis. Therefore, we hypothesise that ACE inhibitors (ACEIs) would
improve rheumatic mitral valve stenosis. Methods and analysis This is a
single-centre, double-blind, placebo-controlled, randomised clinical trial
with a pre-post test design. Patients with rheumatic mitral stenosis and
valve dysfunction will be planned for cardiac valve replacement operation
and will be given ramipril 5 mg or placebo for a minimum of 12 weeks
before the surgery. The expression of ST2 in the mitral valve is
considered to be representative of cardiac fibrosis. Mitral valve tissue
will be stained by immunohistochemistry to ST2. Plasma ST2 will be
measured by ELISA. This study is conducted in the Department of Cardiology
and Vascular Medicine, Universitas Indonesia, National Cardiac Center
Harapan Kita Hospital, Jakarta, Indonesia, starting on 27 June 2019.
Ethics and dissemination The performance and dissemination of this study
were approved by the ethics committee of National Cardiovascular Center
Harapan Kita with ethical code LB.02.01/VII/286/KEP.009/2018. Trial
registration number NCT03991910.<br/>Copyright &#xa9; 2021 BMJ Publishing
Group. All rights reserved.

<24>
[Use Link to view the full text]
Accession Number
635322405
Title
Impact of Comorbidities and Antiplatelet Regimen on Platelet Reactivity
Levels in Patients Undergoing Transcatheter Aortic Valve Implantation.
Source
Journal of cardiovascular pharmacology. 78(3) (pp 463-473), 2021. Date of
Publication: 01 Sep 2021.
Author
Trejo-Velasco B.; Tello-Montoliu A.; Cruz-Gonzalez I.; Moreno R.;
Baz-Alonso J.A.; Salvadores P.J.; Romaguera R.; Molina-Navarro E.;
Paredes-Galan E.; Fernandez-Barbeira S.; Ortiz-Saez A.; Bastos-Fernandez
G.; De Miguel-Castro A.; Figueiras-Guzman A.; Iniguez-Romo A.;
Jimenez-Diaz V.A.
Institution
(Trejo-Velasco, Cruz-Gonzalez) Cardiology Department, Hospital
Universitario de Salamanca, Instituto de Investigacion Biomedica de
Salamanca (IBSAL), Salamanca, Spain
(Tello-Montoliu) Cardiology Department, Hospital Universitario Virgen de
la Arrixaca, IMIB-Arrixaca, Murcia, Spain
(Tello-Montoliu, Cruz-Gonzalez, Moreno, Iniguez-Romo, Jimenez-Diaz) Centro
de Investigacion en Red de Enfermedades Cardiovasculares (Network Research
Center for Cardiovascular Diseases), Madrid, Spain
(Moreno) Interventional Cardiology, Instituto de Investigacion del
Hospital La Paz (IDIPAZ), University Hospital La Paz, Madrid, Spain
(Baz-Alonso, Paredes-Galan, Fernandez-Barbeira, Ortiz-Saez,
Bastos-Fernandez, De Miguel-Castro, Iniguez-Romo, Jimenez-Diaz) Cardiology
Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo,
Spain
(Salvadores, Jimenez-Diaz) Cardiovascular Research Unit, Cardiology
Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo,
Spain
(Salvadores, Jimenez-Diaz) Cardiovascular Research Group, Galicia Sur
Health Research Institute (IIS Galicia Sur), Vigo, Spain
(Romaguera) Cardiology Department, Hospital Universitario de Bellvitge,
Barcelona, Spain
(Molina-Navarro) Cardiology Department, Hospital Universitario Virgen de
las Nieves, Granada, Spain; and
(Figueiras-Guzman) Departamento de Medicina Preventiva y Salud Publica,
Facultad de Medicina, Universidad de Santiago de Compostela
Publisher
NLM (Medline)
Abstract
ABSTRACT: The aim of our study is to assess the impact of anemia, chronic
kidney disease, and diabetes mellitus on platelet reactivity (PR) in
patients with severe aortic stenosis, both at baseline and after
transcatheter aortic valve implantation (TAVI). This study is a
prespecified subanalysis of the REAC-TAVI prospective, multicenter trial
that included patients pretreated with aspirin + clopidogrel before TAVI.
PR was measured at baseline and at 5 different time points after TAVI with
the VerifyNow assay (Accriva Diagnostics, San Diego, CA), over a 3-month
follow-up period. Patients with high PR (HPR) at baseline, before TAVI (n
= 48) were randomized to aspirin + clopidogrel or aspirin + ticagrelor for
3 months, whereas those with normal PR (NPR) (n = 20) were continued on
aspirin + clopidogrel. A "raiser response" in PR was defined as an
increase in PR units >20% of baseline after TAVI. Patients with HPR before
TAVI presented concomitant anemia and chronic kidney disease more
frequently than their counterparts with NPR. Anemia and higher body mass
index were independently associated with HPR to clopidogrel at baseline.
Moreover, anemic patients with baseline HPR who were continued on
clopidogrel presented higher PR after TAVI than patients with HPR switched
to ticagrelor. All patients with baseline NPR presented a "raiser
response" after TAVI, which was nonexistent among patients with HPR
managed with ticagrelor. In summary, anemia seems as a relevant factor
associated with baseline HPR and higher PR after TAVI in patients with
baseline HPR randomized to clopidogrel, whereas ticagrelor proved more
effective than clopidogrel at attaining sustained reductions in PR during
follow-up, regardless of baseline comorbidities.<br/>Copyright &#xa9; 2021
Wolters Kluwer Health, Inc. All rights reserved.

<25>
Accession Number
2014313924
Title
Meta-Analysis Comparing Valve Durability Among Different Transcatheter and
Surgical Aortic Valve Bioprosthesis.
Source
American Journal of Cardiology. 158 (pp 104-111), 2021. Date of
Publication: 01 Nov 2021.
Author
Ueyama H.; Kuno T.; Takagi H.; Kobayashi A.; Misumida N.; Pinto D.S.;
Laham R.J.; Baeza C.; Kini A.; Lerakis S.; Latib A.; Sondergaard L.;
Attizzani G.F.
Institution
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, New York, NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kobayashi, Baeza, Attizzani) Harrington Heart and Vascular Institute,
University Hospital Cleveland Medical Center, Case Western Reserve
University, Cleveland, OH, United States
(Misumida) Division of Cardiovascular Medicine, Gill Heart and Vascular
Institute, University of Kentucky, Lexington, KY, United States
(Pinto, Laham) Division of Cardiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, Boston, Massachusetts
(Kini, Lerakis) Division of Cardiology, Icahn School of Medicine at Mount
Sinai, Mount Sinai Hospital, NY, United States
(Kuno, Latib) Division of Cardiology, Montefiore Medical Center, Albert
Einstein College of Medicine, New York, NY, United States
(Sondergaard) Department of Cardiology, The Heart Centre, Rigshospitalet,
Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Durability of transcatheter heart valve (THV) is critical as the
indication of transcatheter aortic valve implantation (TAVI) expands to
patients with longer life-expectancy. We aimed to compare the durability
of different THV systems (balloon-expandable [BE] and self-expandable
[SE]) and surgical aortic valve replacement (SAVR) prosthesis. PUBMED and
EMBASE were searched through February 2021 for randomized trials
investigating parameters of valve durability after TAVI and/or SAVR in
severe aortic stenosis. A network meta-analysis using random-effect model
was performed. Synthesis was performed with 5-year follow-up data for
echocardiographic outcomes and the longest available follow-up data for
clinical outcomes. Ten trials with a total of 9,388 patients (BE-THV:
2,562; SE-THV: 2,863; SAVR: 3,963) were included. Follow-up ranged from 1
to 6 years. SE-THV demonstrated significantly larger effective orifice
area, lower mean aortic valve gradient (AVG), and less increase in mean
AVG at 5-year compared with BE-THV and SAVR. Structural valve
deterioration (SVD) was less frequent in SE-THV compared with BE-THV and
SAVR (HR 0.14, 95% CI 0.07 to 0.27; HR 0.34, 95% CI 0.24 to 0.47,
respectively). Total moderate-severe aortic regurgitation and
reintervention was more frequent in BE-THV (HR 4.21, 95% CI 2.40 to 7.39;
HR 2.22, 95% CI 1.16 to 4.26, respectively), and SE-THV (HR 7.51, 95% CI
3.89 to 14.5; HR 2.86, 95% CI 1.59 to 5.13, respectively) compared with
SAVR. In conclusion, TAVI with SE-THV demonstrated favorable forward-flow
hemodynamics and lowest risk of SVD compared with BE-THV and SAVR at
mid-term. However, both THV systems suffer an increased risk of AR and
re-intervention, and long-term data from newer generation valves is
warranted.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<26>
Accession Number
2013680532
Title
Blood cysts of the cardiac valves in adults: Review and analysis of
published cases.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Bortolotti U.; Vendramin I.; Lechiancole A.; Sponga S.; Pucci A.; Milano
A.D.; Livi U.
Institution
(Bortolotti, Vendramin, Lechiancole, Sponga, Livi) Cardiothoracic
Department, University Hospital of Udine, Udine, Italy
(Pucci) Division of Pathology, Pisa University Hospital, Pisa, Italy
(Milano) Division of Cardiac Surgery, University of Bari Aldo Moro, Bari,
Italy
Publisher
John Wiley and Sons Inc
Abstract
Background and aim: Blood cysts of cardiac valves are generally seen in
newborns and infants and very rarely in adults. Although in most cases
they are incidental findings they may be associated to severe cardiac or
systemic complications. This study analyzes incidence, presentation, and
treatment of valvular blood cysts in adults. <br/>Method(s): A review of
the pertinent literature through a search mainly on PubMed and Medline was
performed. <br/>Result(s): In patients >=18 years of age, our search
disclosed 54 patients with mitral blood cysts (mean age, 48 +/- 18 years),
9 with a tricuspid valve cyst (mean age, 67 +/- 15 years), 3 with a blood
cyst on the pulmonary valve (age 31, 43, and 44 years), and 1 aortic valve
cyst in a 22-year-old man. Most patients were asymptomatic while stroke,
syncope, or myocardial infarction occurred in six patients with a mitral
valve cyst. Blood cysts were removed surgically in 70% of patients with a
mitral cyst, in 55% with a tricuspid cyst, and in all those with a
pulmonary or aortic cyst. At histology, the cyst wall was composed mainly
by fibrous tissue and with the inner surface lined with typical
endothelium. <br/>Conclusion(s): Blood cysts of cardiac valves are rare in
adults but may cause life-threatening complications, particularly when
located on the mitral valve. For such reason, surgical removal appears
advisable, with low-risk procedures. Widespread use of multimodality
imaging techniques will most likely increase the number of valvular blood
cysts diagnosed also in adults.<br/>Copyright &#xa9; 2021 The Authors.
Journal of Cardiac Surgery published by Wiley Periodicals LLC.

<27>
[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.

<28>
[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.

<29>
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).

<30>
Accession Number
636108915
Title
Surgery for deep venous insufficiency.
Source
Cochrane Database of Systematic Reviews. 2021(9) (no pagination), 2021.
Article Number: CD001097. Date of Publication: 30 Sep 2021.
Author
Goel R.R.; Hardy S.C.; Brown T.
Institution
(Goel, Hardy) Department of Vascular Surgery, East Lancashire Hospitals
NHS Trust, Royal Blackburn Hospital (Trust HQ), Blackburn, United Kingdom
(Brown) Cochrane Vascular, University of Edinburgh, Edinburgh, United
Kingdom
Publisher
John Wiley and Sons Ltd
Abstract
Background: Chronic deep venous insufficiency is caused by incompetent
vein valves, blockage of large-calibre leg veins, or both; and causes a
range of symptoms including recurrent ulcers, pain and swelling. Most
surgeons accept that well-fitted graduated compression stockings (GCS) and
local care of wounds serve as adequate treatment for most people, but
sometimes symptoms are not controlled and ulcers recur frequently, or they
do not heal despite compliance with conservative measures. In these
situations, in the presence of severe venous dysfunction, surgery has been
advocated by some vascular surgeons. This is an update of the review first
published in 2000. <br/>Objective(s): To assess the effects of surgical
management of deep venous insufficiency on ulcer healing and recurrence,
complications of surgery, clinical outcomes, quality of life (QoL) and
pain. <br/>Search Method(s): The Cochrane Vascular Information Specialist
searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE,
Embase and CINAHL databases, and the WHO ICTRP and ClinicalTrials.gov
trials registries to 23 June 2020. <br/>Selection Criteria: We considered
randomised controlled trials (RCTs) of surgical treatment versus another
surgical procedure, usual care or no treatment, for people with deep
venous insufficiency. <br/>Data Collection and Analysis: Two review
authors independently assessed trials for inclusion, extracted data and
assessed the risk of bias with the Cochrane risk of bias tool. We
evaluated the certainty of the evidence using GRADE. We were unable to
pool data due to differences in outcomes reported and how these were
measured. Outcomes of interest were ulcer healing and recurrence,
complications of surgery, clinical changes, QoL and pain. <br/>Main
Result(s): We included four RCTs (273 participants) comparing
valvuloplasty plus surgery of the superficial venous system with surgery
of the superficial venous system for primary valvular incompetence.
Follow-up was two to 10 years. All included studies investigated primary
valve incompetence. No studies investigated other surgical procedures for
the treatment of people with deep venous insufficiency or surgery for
secondary valvular incompetence or venous obstruction. The certainty of
the evidence was downgraded for risk of bias concerns and imprecision due
to small numbers of included trials, participants and events. None of the
studies reported ulcer healing or ulcer recurrence. One study included 27
participants with active venous ulceration at the time of surgery; the
other three studies did not include people with ulcers. There were no
major complications of surgery, no incidence of deep vein thrombosis and
no deaths reported (very low-certainty evidence). All four studies
reported clinical changes but the data could not be pooled due to
different outcome measures and reporting of the data. Two studies assessed
clinical changes using subjective and objective measurements, as specified
in the clinical, aetiological, anatomical and pathophysiological (CEAP)
classification score (low-certainty evidence). One study reported mean
CEAP severity scores and one study reported change in clinical class using
CEAP. At baseline, the mean CEAP severity score was 18.1 (standard
deviation (SD) 4.4) for limbs undergoing external valvuloplasty with
surgery to the superficial venous system and 17.8 (SD 3.4) for limbs
undergoing surgery to the superficial venous system only. At three years
post-surgery, the mean CEAP severity score was 5.2 (SD 1.6) for limbs that
had undergone external valvuloplasty with surgery to the superficial
venous system and 9.2 (SD 2.6) for limbs that had undergone surgery to the
superficial venous system only (low-certainty evidence). In another study,
participants with progressive clinical dynamics over the five years
preceding surgery had higher rates of improvement in clinical condition in
the treatment group (valvuloplasty plus ligation) compared with the
control group (ligation only) (80% versus 51%) after seven years of
follow-up. Participants with stable preoperative clinical dynamics
demonstrated similar rates of improvement in both groups (95% with
valvuloplasty plus ligation versus 90% with ligation only) (low-certainty
evidence). One study reported disease-specific QoL using cumulative scores
from a 10-item visual analogue scale (VAS) and reported that in the
limited anterior plication (LAP) plus superficial venous surgery group the
score decreased from 49 to 11 at 10 years, compared to a decrease from 48
to 36 in participants treated with superficial venous surgery only (very
low-certainty evidence). Two studies reported pain. Within the QoL VAS
scale, one item was 'pain/discomfort' and scores decreased from 4 to 1 at
10 years for participants in the LAP plus superficial venous surgery group
and increased from 2 to 3 at 10 years in participants treated with
superficial venous surgery only. A second study reported that 'leg
heaviness and pain' was resolved completely in 36/40 limbs treated with
femoral vein external valvuloplasty plus high ligation and stripping of
the great saphenous vein (GSV) and percutaneous continuous circumsuture
and 22/40 limbs treated with high ligation and stripping of GSV and
percutaneous continuous circumsuture alone, at three years' follow-up
(very low-certainty evidence). Authors' conclusions: We only identified
evidence from four RCTs for valvuloplasty plus surgery of the superficial
venous system for primary valvular incompetence. We found no studies
investigating other surgical procedures for the treatment of people with
deep venous insufficiency, or that included participants with secondary
valvular incompetence or venous obstruction. None of the studies reported
ulcer healing or recurrence, and few studies reported complications of
surgery, clinical outcomes, QoL and pain (very low- to low-certainty
evidence). Conclusions on the effectiveness of valvuloplasty for deep
venous insufficiency cannot be made.<br/>Copyright &#xa9; 2021 The
Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<31>
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

<32>
Accession Number
2014888696
Title
Hemopericardium in the setting of direct oral anticoagulant use: An
updated systematic review.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Sheikh A.B.; Shah I.; Sagheer S.; Javed N.; Minhas A.M.K.; Lopez E.D.;
Parikh C.; Shekhar R.
Institution
(Sheikh, Shah, Lopez) University of New Mexico Health Sciences Center,
Department of Internal Medicine, Albuquerque, NM, United States
(Sagheer) Division of Cardiology, University of New Mexico Health Sciences
Center, Albuquerque, NM, United States
(Javed) Shifa College of Medicine, Shifa Tameer-e-Millat University,
Islamabad, Pakistan
(Minhas) Forrest General Hospital, Department of Internal Medicine,
Hattiesburg, United States
(Parikh) Pramukh Swami Medical College, Department of Internal Medicine,
Karamsad, Gujarat, India
(Shekhar) Division of Hospital Medicine, University of New Mexico School
of Medicine, Department of Internal Medicine, Albuquerque, NM, United
States
Publisher
Elsevier Inc.
Abstract
Background: Spontaneous hemopericardium, associated with direct oral
anticoagulant (DOAC) use, is one of the uncommon complications with high
morbidity that has not been extensively studied We aimed to determine
demographic characteristics, clinical features, lab evaluation,
management, and outcomes of the studies focusing on hemopericardium as a
DOAC use. <br/>Method(s): PubMed, Web of Science, Google Scholar, and
CINAHL databases were searched for relevant articles using MeSH key-words
and imported into referencing/review software. The data regarding
demographics, clinical characteristics, cardiac investigations, and
management were analyzed in IBM Statistics SPSS 21. t-Test and Chi-square
test were used. A P score of <0.05 was considered statistically
significant. <br/>Result(s): After literature search, a total of 41
articles were selected for analysis. The mean age of the patients was
70.09 +/- 11.06 years (p < 0.05); the majority of them were males (58.5%).
Most of the patients presented with shortness of breath (75.2%) and had
more than 3 co-morbid conditions (43.9%). The most frequently used
anticoagulant was rivaroxaban (15/41; 36.6%); the common indication being
arrhythmia (78.0%). CYP4503A4/P-Gp inhibitors (22.2%) were commonly used
by the patients. Majority of the cases had a favorable outcome (95.1%).
Pericardial tamponade was noted in 31/41 cases. Pericardiocentesis was
performed in 37/41 cases. <br/>Conclusion(s): Hemopericardium from DOAC
use has a favorable outcome but requires urgent pericardiocentesis.
However, long term mortality, monitoring of DOAC activity, and drug-drug
interactions have not been widely studied.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<33>
Accession Number
2014888595
Title
Serratus Anterior Plane Block in Pediatric Patients Undergoing Thoracic
Surgeries: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Gado A.A.; Abdalwahab A.; Ali H.; Alsadek W.M.; Ismail A.A.
Institution
(Gado, Abdalwahab, Ali, Alsadek, Ismail) Anesthesia and Pain Management,
Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo
University, Egypt
Publisher
W.B. Saunders
Abstract
Objective(s): This study was designed to evaluate the efficacy and safety
of serratus anterior plane block (SAPB) as an analgesic technique for
thoracotomies in pediatric patients. <br/>Design(s): Double-blinded
randomized controlled trial. <br/>Setting(s): A single-center study at
Aboelrish Pediatric Hospital, one tertiary hospital of Cairo University
Hospitals. <br/>Participant(s): Seventy pediatric patients aged six
months-to-three years scheduled for thoracotomies. <br/>Intervention(s):
Patients were randomized into two groups, group SF and group F. Group SF
received an ultrasound-guided SAPB (n = 35), whereas group F (n = 35) did
not. All groups received an intraoperative fentanyl infusion (at 0.5
mug/kg /h). Measurements: The primary outcome was the total dose of
postoperatively administrated fentanyl in the first 24 hours. The
secondary outcomes included the total dose of intraoperative additional
fentanyl boluses; time of the first postoperative rescue analgesia; and
postoperative Face, Legs, Activity, Cry, Consolability scale (FLACC) score
values. <br/>Main Result(s): The main results of this study showed that
the administrated fentanyl in the 24 hours postoperatively was
significantly lower in SF group than in F group (p value < 0.001). In
addition, significant decreases of the postoperative FLACC pain score (p
value < 0.001), reduction of intraoperative fentanyl consumption (p value
< 0.001), and delay of the first rescue analgesia (p value < 0.001) were
recorded in SF group in relation to F group without significant
complications in both groups. <br/>Conclusion(s): Serratus anterior plane
block can provide a safe, effective, and easy-to-perform regional
technique for children undergoing thoracotomies.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<34>
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.

<35>
Accession Number
2013832787
Title
Risk factors for acute kidney injury after pediatric cardiac surgery: a
meta-analysis.
Source
Pediatric Nephrology. (no pagination), 2021. Date of Publication: 2021.
Author
Van den Eynde J.; Delpire B.; Jacquemyn X.; Pardi I.; Rotbi H.; Gewillig
M.; Kutty S.; Mekahli D.
Institution
(Van den Eynde, Kutty) Helen B. Taussig Heart Center, The Johns Hopkins
Hospital and School of Medicine, Baltimore, United States
(Van den Eynde, Delpire, Jacquemyn, Pardi, Gewillig) Department of
Cardiovascular Sciences, University Hospitals Leuven, KU Leuven,
Herestraat 49, Leuven 3000, Belgium
(Rotbi) Faculty of Medicine, Radboud University, Nijmegen, Netherlands
(Rotbi) Department of Physiology, Radboud University Medical Center,
Radboud Institute for Health Sciences, Nijmegen, Netherlands
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Mekahli) Department of Pediatric Nephrology, University Hospitals of
Leuven, Leuven, Belgium
(Mekahli) PKD Research Group, GPURE, Department of Development and
Regeneration, KU Leuven, Leuven, Belgium
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Cardiac surgery-associated acute kidney injury (AKI) is
associated with increased morbidity and mortality in both adults and
children. <br/>Objective(s): This study aimed to identify clinical risk
factors for AKI following cardiac surgery in the pediatric population.
Data sources: PubMed/MEDLINE, Embase, Scopus, and reference lists of
relevant articles were searched for studies published by August 2020.
Study eligibility criteria: Studies were included if (1) the population
consisted of pediatric patients (< 18 years old), (2) patients underwent
cardiac surgery, (3) risk factors were compared between patients who
developed AKI and those who did not, and (4) studies were prospective or
retrospective observational studies or randomized controlled trials.
Participants and interventions: Children undergoing pediatric cardiac
surgery. Study appraisal and synthesis methods: Random-effects
meta-analysis was performed, comparing potential risk factors between
pediatric patients who developed CS-AKI and those who did not.
<br/>Result(s): Sixty-one publications including a total of 19,680
participants (AKI: 7257 participants; no AKI: 12,423 participants) were
included from studies published between 2008 and 2020. The pooled
estimated incidence of AKI was 34.3% (95% confidence interval 30.0-38.8%,
I² = 96.8%). Binary risk factors that were significantly and
consistently associated with AKI were the presence of pulmonary
hypertension, cyanotic heart disease, univentricular heart, risk
adjustment for congenital heart surgery 1 (RACHS-1) score >= 3,
vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis.
Significant continuous risk factors included younger age, lower body
weight, lower preoperative creatinine, higher preoperative estimated
glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery
time, longer cardiopulmonary bypass time, longer aortic cross-clamp time,
and higher red blood cell transfusion volume. <br/>Limitation(s): Results
are limited by heterogeneity and potential residual confounding.
Conclusions and implications of key findings: Our meta-analysis identified
clinical risk factors that are associated with AKI in children undergoing
cardiac surgery. This might help clinicians anticipate and manage more
carefully this population and implement standardized preventive
strategies. Systematic review registration number: CRD42021262699.
Graphical abstract: A higher resolution version of the Graphical abstract
is available as Supplementary information. [Figure not available: see
fulltext.]<br/>Copyright &#xa9; 2021, The Author(s), under exclusive
licence to International Pediatric Nephrology Association.

<36>
Accession Number
2013443761
Title
A retrospective study of coronary artery bypass grafting with low-thermal
plasma dissection device compared to conventional monopolar
electrosurgery.
Source
Brazilian Journal of Cardiovascular Surgery. 36(3) (pp 379-387), 2021.
Date of Publication: 2021.
Author
Uysal D.; Ibrisim E.
Institution
(Uysal, Ibrisim) Department of Cardiovascular Surgery, Suleyman Demirel
Universitesi Tip Fakultesi, Isparta, Turkey
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: The objective of this study is to compare the effects of
conventional monopolar electrosurgery (CMES) and low-thermal plasma
kinetic cautery (PKC) on complications such as bleeding, abnormal wound
healing, pain, and drainage in patients who underwent on-pump coronary
artery bypass grafting (CABG). <br/>Method(s): This retrospective clinical
study included 258 patients undergoing CABG; the patients were randomized
to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients'
clinical data were examined retrospectively for biochemical variables,
postoperative drainage, post-surgery erythrocyte suspension transfusion
count, surgical site pain examined with visual analogue scale (VAS), and
wound healing. Two-sided P-value > 0.05 was considered as statistically
significant. <br/>Result(s): The median post-surgery erythrocyte
suspension transfusion number was significantly lower with PKC compared to
CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative
drain output and time until removal of drain tubes were significantly
lower with PKC compared to CMES (300+/-113 vs. 547+/-192 and 1.95+/-1.5
vs. 2.44+/-1.8; P<0.001 and P=0.025, respectively). Mean VAS score for
spontaneous and cough-induced pain were significantly lower with PKC
compared to CMES (1.98+/-1.51 vs. 3.94+/- 2.09 and 3.76+/-1.46 vs.
5.6+/-1.92; P<0.001 for both comparisons). Reoperation due to bleeding was
significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001).
<br/>Conclusion(s): Use of PKC during CABG considerably reduces
postoperative drainage, need for blood transfusion, reoperation due to
bleeding, and postoperative pain. PCK appears to be a good alternative to
CMES for CABG.<br/>Copyright &#xa9; 2021, Sociedade Brasileira de Cirurgia
Cardiovascular. All rights reserved.

<37>
Accession Number
2011448595
Title
The effect of dexmedetomidine on intraoperative blood glucose homeostasis:
secondary analysis of a randomized controlled trial.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 139. Date
of Publication: December 2021.
Author
Li C.-J.; Wang B.-J.; Mu D.-L.; Wang D.-X.
Institution
(Li, Wang, Mu, Wang) Department of Anesthesiology, Peking University First
Hospital, Beijing, China
Publisher
BioMed Central Ltd
Abstract
Purpose: To investigate the effect of dexmedetomidine on intraoperative
blood glucose hemostasis in elderly patients undergoing non-cardiac major
surgery. <br/>Method(s): This was secondary analysis of a randomized
controlled trial. Patients in dexmedetomidine group received a loading
dose dexmedetomidine (0.6 mug/kg in 10 min before anaesthesia induction)
followed by a continuous infusion (0.5 mug/kg/hr) till 1 h before the end
of surgery. Patients in control group received volume-matched normal
saline at the same time interval. Primary outcome was the incidence of
intraoperative hyperglycemia (blood glucose higher than 10 mmol/L).
<br/>Result(s): 303 patients in dexmedetomidine group and 306 patients in
control group were analysed. The incidence of intraoperative hyperglycemia
showed no statistical significance between dexmedetomidine group and
control group (27.4% vs. 22.5%, RR = 1.22, 95%CI 0.92-1.60, P = 0.167).
Median value of glycemic variation in dexmedetomidine group (2.5, IQR
1.4-3.7, mmol) was slightly lower than that in control group (2.6, IQR
1.5-4.0, mmol), P = 0.034. In multivariable logistic analysis, history of
diabetes (OR 3.007, 95%CI 1.826-4.950, P < 0.001), higher baseline blood
glucose (OR 1.353, 95%CI 1.174-1.560, P < 0.001) and prolonged surgery
time (OR 1.197, 95%CI 1.083-1.324, P < 0.001) were independent risk
factors of hyperglycaemia. <br/>Conclusion(s): Dexmedetomidine presented
no effect on intraoperative hyperglycemia in elderly patients undergoing
major non-cardiac surgery. Trial registration: Present study was
registered at Chinese Clinical Trial Registry on December 1, 2015
(www.chictr.org.cn, registration number
ChiCTR-IPR-15007654).<br/>Copyright &#xa9; 2021, The Author(s).

<38>
Accession Number
634954079
Title
Exercise-based cardiac rehabilitation for adults after heart valve
surgery.
Source
Cochrane Database of Systematic Reviews. 2021(5) (no pagination), 2021.
Article Number: CD010876. Date of Publication: 07 May 2021.
Author
Abraham L.N.; Sibilitz K.L.; Berg S.K.; Tang L.H.; Risom S.S.; Lindschou
J.; Taylor R.S.; Borregaard B.; Zwisler A.-D.
Institution
(Abraham) Institute of Infection, Immunity and Inflammation, University of
Glasgow, Glasgow, United Kingdom
(Sibilitz, Berg) Department of Cardiology, Centre for Cardiac, Vascular,
Pulmonary and Infectious Diseases, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
(Tang) The research unit PROgrez, Department of Physiotherapy and
Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse,
Denmark
(Tang) Department of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Risom) Faculty of Health and Medical Sciences, Copenhagen University,
Copenhagen, Denmark
(Risom) The Heart Centre, University Hospital Rigshospitalet, Copenhagen,
Denmark
(Risom) Institute for Nursing and Nutrition, University College
Copenhagen, Copenhagen, Denmark
(Lindschou) Copenhagen Trial Unit, Centre for Clinical Intervention
Research, Department 7812, Copenhagen University Hospital, Copenhagen,
Denmark
(Taylor) MRC/CSO Social and Public Health Sciences Unit & Robertson Centre
for Biostatistics, Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom
(Borregaard) Department of Cardiac, Thoracic and Vascular Surgery, Odense
University Hospital, Odense, Denmark
(Zwisler) REHPA, The Danish Knowledge Centre for Rehabilitation and
Palliative Care, Odense University Hospital, Nyborg, Denmark
(Zwisler) Department of Clinical Research, University of Southern Denmark,
Odense, Denmark
Publisher
John Wiley and Sons Ltd
Abstract
Background: The impact of exercise-based cardiac rehabilitation (CR)
following heart valve surgery is uncertain. We conducted an update of this
systematic review and a meta-analysis to assess randomised controlled
trial evidence for the use of exercise-based CR following heart valve
surgery. <br/>Objective(s): To assess the benefits and harms of
exercise-based CR compared with no exercise training in adults following
heart valve surgery or repair, including both percutaneous and surgical
procedures. We considered CR programmes consisting of exercise training
with or without another intervention (such as an intervention with a
psycho-educational component). <br/>Search Method(s): We searched the
Cochrane Central Register of Clinical Trials (CENTRAL), in the Cochrane
Library; MEDLINE (Ovid); Embase (Ovid); the Cumulative Index to Nursing
and Allied Health Literature (CINAHL; EBSCO); PsycINFO (Ovid); Latin
American Caribbean Health Sciences Literature (LILACS; Bireme); and
Conference Proceedings Citation Index-Science (CPCI-S) on the Web of
Science (Clarivate Analytics) on 10 January 2020. We searched for ongoing
trials from ClinicalTrials.gov, Clinical-trials.com, and the World Health
Organization International Clinical Trials Registry Platform on 15 May
2020. <br/>Selection Criteria: We included randomised controlled trials
that compared exercise-based CR interventions with no exercise training.
Trial participants comprised adults aged 18 years or older who had
undergone heart valve surgery for heart valve disease (from any cause) and
had received heart valve replacement or heart valve repair. Both
percutaneous and surgical procedures were included. <br/>Data Collection
and Analysis: Two review authors independently extracted data. We assessed
the risk of systematic errors ('bias') by evaluating risk domains using
the 'Risk of bias' (RoB2) tool. We assessed clinical and statistical
heterogeneity. We performed meta-analyses using both fixed-effect and
random-effects models. We used the GRADE approach to assess the quality of
evidence for primary outcomes (all-cause mortality, all-cause
hospitalisation, and health-related quality of life). <br/>Main Result(s):
We included six trials with a total of 364 participants who have had open
or percutaneous heart valve surgery. For this updated review, we
identified four additional trials (216 participants). One trial had an
overall low risk of bias, and we classified the remaining five trials as
having some concerns. Follow-up ranged across included trials from 3 to 24
months. Based on data at longest follow-up, a total of nine participants
died: 4 CR versus 5 control (relative risk (RR) 0.83, 95% confidence
interval (CI) 0.26 to 2.68; 2 trials, 131 participants; GRADE quality of
evidence very low). No trials reported on cardiovascular mortality. One
trial reported one cardiac-related hospitalisation in the CR group and
none in the control group (RR 2.72, 95% CI 0.11 to 65.56; 1 trial, 122
participants; GRADE quality of evidence very low). We are uncertain about
health-related quality of life at completion of the intervention in CR
compared to control (Short Form (SF)-12/36 mental component: mean
difference (MD) 1.28, 95% CI -1.60 to 4.16; 2 trials, 150 participants;
GRADE quality of evidence very low; and SF-12/36 physical component: MD
2.99, 95% CI -5.24 to 11.21; 2 trials, 150 participants; GRADE quality of
evidence very low), or at longest follow-up (SF-12/36 mental component: MD
-1.45, 95% CI -4.70 to 1.80; 2 trials, 139 participants; GRADE quality of
evidence very low; and SF-12/36 physical component: MD -0.87, 95% CI -3.57
to 1.83; 2 trials, 139 participants; GRADE quality of evidence very low).
Authors' conclusions: Due to lack of evidence and the very low quality of
available evidence, this updated review is uncertain about the impact of
exercise-CR in this population in terms of mortality, hospitalisation, and
health-related quality of life. High-quality (low risk of bias) evidence
on the impact of CR is needed to inform clinical guidelines and routine
practice.<br/>Copyright &#xa9; 2021 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<39>
Accession Number
2013497741
Title
Balanced forced-diuresis as a renal protective approach in cardiac
surgery: Secondary outcomes of electrolyte changes.
Source
Journal of Cardiac Surgery. 36(11) (pp 4125-4131), 2021. Date of
Publication: November 2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Department of Cardiothoracic Surgery, Consultant Cardiothoracic
Surgeon, American Hospital, Dubai, United Arab Emirates
(Giri) Department of Cardiothoracic Anaesthesiology, Consultant
Cardiothoracic Anaesthesiologist, Heart & Lung Centre, Wolverhampton,
United Kingdom
(Wrigley) Department of Cardiology, Consultant Interventional
Cardiologist, Heart & Lung Centre, Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Department of Cardiothoracic Surgery, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Sharman) Research Nurse, Research & Development Department, Heart & Lung
Centre, Wolverhampton, United Kingdom
(Beare) Department of Cardiothoracic Surgery, Chief Clinical Perfusionist,
University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom
(Nevill) Department of Statistics, Faculty of Education, Health, and
Wellbeing, University of Wolverhampton, Walsall, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Forced-diuresis during cardiopulmonary bypass (CPB) can be
associated with significant electrolyte shifts. This study reports on the
serum electrolyte changes during balanced forced-diuresis with the
RenalGuard system (RG) during CPB. <br/>Method(s): Patients at risk of
acute kidney injury (AKI)-(history of diabetes &/or anaemia, e-GFR 20-60
ml/min/1.73 m², anticipated CPB time >120 min, Log EuroScore
>5)-were randomized to either RG (study group) or managed as per current
practice (control group). <br/>Result(s): The use of RG reduced AKI rate
(10% for RG and 20.9% in control, p =.03). Mean urine output was
significantly higher in the RG group during surgery (2366 +/- 877 ml vs.
765 +/- 549 ml, p <.001). The serum potassium levels were maintained
between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for
the controls. Median potassium supplemental dose was 60 (0-220) mmol (RG
group) as compared to 30 (0-190) mmol for control group over first 24 h (p
<.001). On Day 1 post-op, there were no significant differences in the
serum sodium, potassium, calcium, magnesium, phosphate, and chloride
levels between the two groups. Otherwise, postoperative clinical recovery
was also similar. <br/>Conclusion(s): Balanced forced-diuresis with the RG
reduced AKI rates after on-pump cardiac surgery compared to controls.
Although the RG group required higher doses of IV potassium replacement in
the postoperative period, normal serum levels of potassium were maintained
by appropriate intravenous potassium supplementation and the clinical
outcomes between groups were similar.<br/>Copyright &#xa9; 2021 The
Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC

<40>
Accession Number
635029742
Title
The opioid sparing effect of erector spinae plane block for various
surgeries: a meta-analysis of randomized-controlled trials.
Source
Minerva anestesiologica. 87(8) (pp 903-914), 2021. Date of Publication: 01
Aug 2021.
Author
Fanelli A.; Torrano V.; Cozowicz C.; Mariano E.R.; Balzani E.
Institution
(Fanelli) Anesthesia and Pain Medicine Unit, Department of Emergency and
Urgency, S. Orsola-Malpighi Polyclinic Hospital, Bologna, Italy
(Torrano) Anesthesia and Intensive Care Unit 1, Department of Emergency
and Urgency, ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan,
Italy
(Cozowicz) Department of Anesthesiology, Perioperative Medicine and
Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
(Mariano) Department of Anesthesiology, Perioperative and Pain Medicine,
Stanford University School of Medicine, Stanford, CA, USA
(Mariano) Anesthesiology and Perioperative Care Service, Veterans Affairs
Palo Alto Health Care System, Palo Alto, CA, USA
(Balzani) Department of Medicine and Surgery, University of Turin, Turin,
Italy
Publisher
NLM (Medline)
Abstract
INTRODUCTION: The erector spinae plane block (ESPB) is a newer fascial
plane block which has been broadly applied for postoperative analgesia
after various surgeries, but the effectiveness in these populations is not
well established. EVIDENCE ACQUISITION: A systematic database search was
conducted in PubMed, PMC, Embase, and Scopus for randomized controlled
trials (RCTs) comparing ESPB with control, placebo, or other blocks. The
primary outcome was intravenous opioid consumption in milligram morphine
equivalents 24 h after surgery. Standardized mean differences (SMDs) with
95% confidence intervals (CI) were calculated using a random-effects
model. EVIDENCE SYNTHESIS: A total of 29 RCTs were included. An analysis
was conducted by subgroups differentiated by surgery type, 'no block' vs.
ESPB, and other blocks vs. ESPB. ESPB was effective in reducing opioid
consumption against no block for breast surgery (SMD -1.13; 95% CI),
thoracic surgery (SMD -3.00; 95% CI), and vertebral surgery (SMD -1.78;
95% CI). ESPB was effective against alternative blocks for breast surgery
(vs. paravertebral, SMD -1.07; 95% CI) and abdominal surgery (SMD -1.77;
95% CI). ESPB showed moderate effect in thoracic surgery against
paravertebral (SMD 0.58; 95% CI) and against no block in abdominal surgery
(SMD 0.80; 95% CI). In only one case did ESPB perform worse than another
block: vs. PECS block for breast surgery (SMD 1.66; 95% CI).
<br/>CONCLUSION(S): ESPB may be a useful addition to the multimodal
analgesic regimen for a variety of surgeries especially when the
alternative is no block. Unanswered questions include determining of the
mechanism of action, refining of the EPSB technique, and establishing
recommended local anesthetic dose and volume.

<41>
Accession Number
634952520
Title
Volatile anesthetics versus intravenous anesthetics for noncardiac
thoracic surgery: a systematic review and meta-analysis.
Source
Minerva anestesiologica. 87(8) (pp 927-939), 2021. Date of Publication: 01
Aug 2021.
Author
Fan Y.; Yu D.; Liang X.
Institution
(Fan) School of Medicine, Department of Anesthesiology, Sichuan Cancer
Center, Sichuan Cancer Hospital &amp; Institute, University of Electronic
Science and Technology of China, Chengdu, China
(Yu) Department of Anesthesiology, Second People's Hospital of Yibin,
China
(Liang) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
NLM (Medline)
Abstract
INTRODUCTION: We performed this meta-analysis of randomized controlled
trials (RCTs) to investigate two types of anesthetics for noncardiac
thoracic surgery regarding their effects on clinical outcomes and the
inflammatory response. EVIDENCE ACQUISITION: We searched Cochrane Library,
PubMed and Embase for RCTs comparing volatile anesthetics to intravenous
anesthetics for noncardiac thoracic surgery. EVIDENCE SYNTHESIS: This
study reviewed 16 RCTs with 1467 patients. Volatile anesthetics reduced
postoperative complications and the length of intensive care unit stay for
lung surgery. They also lowered the concentrations of interleukin
(IL)-1beta, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-alpha) in the
airways of patients undergoing noncardiac thoracic surgery. However, there
was no difference in short-term mortality, postoperative complications
after esophagectomy, IL-1beta, IL-6, IL-8 or TNF-alpha concentrations in
the blood, IL-10 level in either the airway or the blood, overall monocyte
chemoattractant protein-1. <br/>CONCLUSION(S): In lung surgery, but not
esophagectomy, volatile anesthetics may be a better choice than
intravenous anesthetics, possibly because volatile anesthetics reduce
airway inflammation.

<42>
Accession Number
2014516616
Title
Proteomic profiling identifies CLEC4C expression as a novel biomarker of
primary graft dysfunction after heart transplantation.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Truby L.K.; Kwee L.C.; Agarwal R.; Grass E.; DeVore A.D.; Patel C.B.; Chen
D.; Schroder J.N.; Bowles D.; Milano C.A.; Shah S.H.; Holley C.L.
Institution
(Truby, Agarwal, DeVore, Patel, Shah, Holley) Department of Medicine,
Division of Cardiology, Duke University School of Medicine, Durham, NC,
United States
(Truby, Kwee, Grass, Shah) Duke Molecular Physiology Institute, Duke
University Medical Center, Durham, NC, United States
(Chen) Duke Molecular Physiology Institute, Duke University Medical
Center, Durham, NC, United States
(Schroder, Bowles, Milano) Duke Molecular Physiology Institute, Duke
University Medical Center, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
PURPOSE: Clinical models to identify patients at high risk of primary
graft dysfunction (PGD) after heart transplantation (HT) are limited, and
the underlying pathophysiology of this common post-transplant complication
remains poorly understood. We sought to identify whether pre-transplant
levels of circulating proteins reporting on immune activation and
inflammation are associated with incident PGD. <br/>METHOD(S): The study
population consisted of 219 adult heart transplant recipients identified
between 2016 and 2020 at Duke University Medical Center, randomly divided
into derivation (n = 131) and validation (n = 88) sets. PGD was defined
using modified ISHLT criteria. Proteomic profiling was performed using
Olink panels (n = 354 proteins) with serum samples collected immediately
prior to transplantation. Association between normalized relative protein
expression and PGD was tested using univariate and multivariable
(recipient age, creatinine, mechanical circulatory support, and sex; donor
age; ischemic time) models. Significant proteins identified in the
derivation set (p < 0.05 in univariate models), were then tested in the
validation set. Pathway enrichment analysis was used to test candidate
biological processes. The predictive performance of proteins was compared
to that of the RADIAL score. <br/>RESULT(S): Nine proteins were associated
with PGD in univariate models in the derivation set. Of these, only CLEC4C
remained associated with PGD in the validation set after Bonferroni
correction (OR [95% CI] = 3.04 [1.74,5.82], p = 2.8 x 10^-4).
Patterns of association were consistent for CLEC4C in analyses stratified
by biventricular/left ventricular and isolated right ventricular PGD.
Pathway analysis identified interferon-alpha response and C-type lectin
signaling as significantly enriched biologic processes. The RADIAL score
was a poor predictor of PGD (AUC = 0.55). CLEC4C alone (AUC = 0.66, p =
0.048) and in combination with the clinical covariates from the
multivariable model (AUC = 0.69, p = 0.018) improved discrimination for
the primary outcome. <br/>CONCLUSION(S): Pre-transplantation circulating
levels of CLEC4C, a protein marker of plasmacytoid dendritic cells (pDCs),
may identify HT recipients at risk for PGD. Further studies are needed to
better understand the potential role pDCs and the innate immune response
in PGD.<br/>Copyright &#xa9; 2021 International Society for Heart and Lung
Transplantation

<43>
Accession Number
2014313895
Title
Response to the letter from Rodrigues M and Vaz IM regarding the article
"Effectiveness of a preoperative breathing exercise intervention in
patients undergoing cardiac surgery: a systematic review".
Source
Revista Portuguesa de Cardiologia. 40(10) (pp 809-810), 2021. Date of
Publication: October 2021.
Author
Rodrigues S.N.; Henriques H.R.; Henriques M.A.
Institution
(Rodrigues) Lisbon University, Lisbon, Portugal
(Rodrigues, Henriques, Henriques) Lisbon Nursing School, Lisbon, Portugal
(Rodrigues) Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto,
Portugal
(Henriques) ISAMB, Lisbon Medical School, Lisbon, Portugal
Publisher
Sociedade Portuguesa de Cardiologia

<44>
Accession Number
2014271043
Title
Letter to the Editor regarding "Effectiveness of preoperative breathing
exercise interventions in patients undergoing cardiac surgery: a
systematic review".
Source
Revista Portuguesa de Cardiologia. 40(10) (pp 807-808), 2021. Date of
Publication: October 2021.
Author
Rodrigues M.; Vaz I.M.
Institution
(Rodrigues) Centro Hospitalar Vila Nova de Gaia/Espinho - Centro de
Reabilitacao do Norte, Vila Nova de Gaia, Portugal
(Vaz) Centro Hospitalar de Tras-os-Montes e Alto Douro - Servico de
Medicina Fisica e de Reabilitacao, Vila Real, Portugal
Publisher
Sociedade Portuguesa de Cardiologia

<45>
Accession Number
2014866892
Title
Perioperative Care Standards in Cardiac Surgery Patients Aiming at
Enhancing Recovery: A Nationwide Survey in the Netherlands and Belgium.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Damstra J.; Geerts B.F.; Rex S.; Vlaar A.P.J.; Driessen A.H.G.; Engelman
D.T.; Klautz R.J.M.; Eberl S.
Institution
(Damstra, Eberl) Department of Anesthesiology, Amsterdam UMC, Location
AMC, Netherlands
(Rex) Department of Anesthesiology, University Hospital Leuven, Belgium;
and Department of Cardiovascular Sciences, KU Leuven, Belgium
(Vlaar) Department of Intensive Care, Amsterdam UMC, Location AMC,
Netherlands
(Driessen, Klautz) Department of Cardiothoracic Surgery, Amsterdam UMC,
location AMC, Netherlands
(Engelman) Heart and Vascular Program, Baystate Health, Springfield and
University of Massachusetts Medical School-Baystate, Springfield, MA,
United States
(Geerts) Department for Intensive Care, Spaarne Gasthuis, Haarlem,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: The aim of this survey was to describe existing perioperative
care standards and best practices in the Netherlands and Belgium.
<br/>Design(s): An online survey was followed up by an in-depth personal
interview. The main outcomes were the existing standards of perioperative
care for patients undergoing cardiac surgery. <br/>Setting(s): The online
survey and subsequent interviews were targeted to one representative in
the intensive care unit (ICU), cardiac surgery, and anesthesiology
department from each cardiac surgical center in the Netherlands and
Belgium. <br/>Participant(s): A representative intensive care physician,
cardiac surgeon, and cardiac anesthesiologist. <br/>Intervention(s): None.
<br/>Measurements and Main Results: The response rate was 60% (71% for the
Netherlands, and 44% in Belgium). Agreement across centers was found for
discontinuation of proton-pump inhibitors (80%) and avoiding intra- and
postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally, 98%
of respondents stated that physiotherapy should be started immediately in
the ICU. Major divergence was found for elements such as the
discontinuation of angiotensin-converting enzyme inhibitors (55%) or the
postoperative use of chest support vests (44%). <br/>Conclusion(s): The
authors demonstrated a wide range of different local protocols. Strategies
differed among disciplines, hospitals, and countries. This emphasized the
need for the implementation of a more universal protocol to further reduce
variance and improve recovery practices. This nationwide survey was the
first of its kind simultaneously studying best practices for cardiac
surgery through the entire care pathway at the advent of Enhanced Recovery
After Surgery (ERAS) Cardiac implementation. A multinational randomized
controlled trial to test the implementation of an evidence-based ERAS
Cardiac protocol is the next step to pave the way for further outcome
improvements in this high-risk population.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<46>
Accession Number
2013831529
Title
The impact of del Nido cardioplegia solution on blood morphology
parameters.
Source
Perfusion (United Kingdom). (no pagination), 2021. Date of Publication:
2021.
Author
Sanetra K.; Domaradzki W.; Cisowski M.; Shrestha R.; Bialek K.; Bochenek
A.; Jankowska-Sanetra J.; Pawel Buszman P.; Gerber W.
Institution
(Sanetra, Pawel Buszman) Faculty of Medicine and Health Sciences, Andrzej
Frycz Modrzewski Krakow University, Krakow, Poland
(Sanetra, Domaradzki, Shrestha, Bialek, Bochenek, Gerber) Department of
Cardiac Surgery, American Heart of Poland, Bielsko-Biala, Poland
(Cisowski) Department of Cardiac Surgery, Clinical University Hospital,
Opole, Poland
(Bochenek) Faculty of Medicine, University of Technology, Katowice, Poland
(Bochenek, Pawel Buszman) Center for Cardiovascular Research and
Development, American Heart of Poland, Katowice, Poland
(Jankowska-Sanetra, Pawel Buszman) Department of Cardiology, American
Heart of Poland, Bielsko-Biala, Poland
Publisher
SAGE Publications Ltd
Abstract
Background: Crystalloid cardioplegic solutions are believed to reduce
hemoglobin significantly and increase the transfusion rate. However,
recent reports indicate that the del Nido cardioplegia may preserve blood
morphology parameters. <br/>Method(s): In "The del Nido versus cold blood
cardioplegia in aortic valve Replacement" trial patients undergoing aortic
valve replacement were randomized into the del Nido (DN) or cold blood
cardioplegia (CB) group. For the subanalysis, patients who underwent blood
transfusions were excluded from the study. Red blood cell (RBC) count,
hemoglobin, white blood cell (WBC) count and platelet (PLT) count were
measured before the surgery, 24-, 48-, and 96 hours postoperatively.
Furthermore, percental variation in first-last measure was compared in
groups. In addition, indexed normalized ratio (INR) and activated partial
thromboplastin time (aPTT) were compared preoperatively and 24 hours after
the surgery. <br/>Result(s): Eighteen (24%) patients from the del Nido
group and 22 (29.3%) patients from the CB group received blood product
transfusions (p = 0.560) and were excluded from further analysis. As such,
57 patients remained in DN group and 53 patients remained in CB group. No
difference was found in RBC, hemoglobin, WBC, and platelet count in time
intervals. Percental variation in first-last measure revealed higher fall
in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No
difference was shown in preoperative and 24-hour postoperative INR and
aPTT. <br/>Conclusion(s): The del Nido cardioplegia does not decrease
blood morphology parameters when compared to cold blood cardioplegia and
may be used alternatively regardless of bleeding and coagulopathy
risk.<br/>Copyright &#xa9; The Author(s) 2021.

<47>
Accession Number
636125874
Title
Effects of initial invasive vs. initial conservative treatment strategies
on recurrent and total cardiovascular events in the ISCHEMIA trial.
Source
European heart journal. (no pagination), 2021. Date of Publication: 13
Sep 2021.
Author
Lopez-Sendon J.L.; Cyr D.D.; Mark D.B.; Bangalore S.; Huang Z.; White
H.D.; Alexander K.P.; Li J.; Nair R.G.; Demkow M.; Peteiro J.; Wander
G.S.; Demchenko E.A.; Gamma R.; Gadkari M.; Poh K.K.; Nageh T.; Stone
P.H.; Keltai M.; Sidhu M.; Newman J.D.; Boden W.E.; Reynolds H.R.;
Chaitman B.R.; Hochman J.S.; Maron D.J.; O'Brien S.M.
Institution
(Lopez-Sendon) Cardiology department, Hospital Universitario La Paz,
Idipaz, UAM, Paseo de la Castellana 261, Madrid 28046, Spain
(Cyr, Mark, Huang, Alexander, Li, O'Brien) Duke Clinical Research
Institute and Duke University, 300 W. Morgan Street, Durham, United States
(Bangalore, Newman, Reynolds, Hochman) NYU Grossman School of Medicine,
530 First Avenue, NY, NY, United States
(White) Auckland City Hospital Green Lane Cardiovascular Services and
University of Auckland ,2 Park Road, Grafton, Auckland 1023, New Zealand
(Nair) Government Medical College, Thiruvananthapuram, Kerala 695002,
India
(Demkow) Department of Coronary and Structural Heart Diseases, National
Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland
(Peteiro) CHUAC, Universidad de A Coruna, As Xubias ,84, A Coruna 15006,
Spain
(Wander) Dayanand Medical College & Hospital, Civil Lines ,Tagore Nagar,
Ludhiana, Punjab 141001, India
(Demchenko) Almazov National Medical Research Centre, Russian Federation
(Gamma) Broomfield Hospital, Court Rd, Broomfield, Chelmsford CM1 7ET, UK
(Gadkari) Kem Hospital Maharashtra, 489, Mudaliar Rd, Rasta Peth, Pune,
Maharashtra 411011, India
(Poh) National University Heart Center Singapore, Singapore
(Poh) Yong Loo Lin School of Medicine, National University of Singapore,
10 Medical Dr, Singapore
(Nageh) Southend University Hospital, Westcliff-on-Sea, Prittlewell Chase,
United Kingdom
(Stone) Brigham and Women's Hospital, MA, 75 Francis St, Boston, United
States
(Keltai) Semmelweis University, Ulloi ut 26, Budapest 1085, Hungary
(Sidhu) Albany Medical College, 47 New Scotland Avenue, Physicians
Pavilion, 2nd Floor, Albany, NY 12208, USA
(Boden) VA New England Healthcare System, Boston University School of
Medicine, MA, 150 South Huntington Avenue, Boston, United States
(Chaitman) St Louis University School of Medicine Center for Comprehensive
Cardiovascular Care, 1034 S. Brentwood Blvd., Suite 1120, St. Louis, MO,
USA
(Maron) Department of Medicine, Stanford University, 300 Pasteur Drive,
Falk CVRC 265, Stanford, CA 94305-5406, USA
Publisher
NLM (Medline)
Abstract
AIMS: The International Study of Comparative Health Effectiveness with
Medical and Invasive Approaches (ISCHEMIA) trial prespecified an analysis
to determine whether accounting for recurrent cardiovascular events in
addition to first events modified understanding of the treatment effects.
METHODS AND RESULTS: Patients with stable coronary artery disease (CAD)
and moderate or severe ischaemia on stress testing were randomized to
either initial invasive (INV) or initial conservative (CON) management.
The primary outcome was a composite of cardiovascular death, myocardial
infarction (MI), and hospitalization for unstable angina, heart failure,
or cardiac arrest. The Ghosh-Lin method was used to estimate mean
cumulative incidence of total events with death as a competing risk. The
5179 ISCHEMIA patients experienced 670 index events (318 INV, 352 CON) and
203 recurrent events (102 INV, 101 CON). A single primary event was
observed in 9.8% of INV and 10.8% of CON patients while >=2 primary events
were observed in 2.5% and 2.8%, respectively. Patients with recurrent
events were older; had more frequent hypertension, diabetes, prior MI, or
cerebrovascular disease; and had more multivessel CAD. The average number
of primary endpoint events per 100 patients over 4years was 18.2 in INV
[95% confidence interval (CI) 15.8-20.9] and 19.7 in CON (95% CI
17.5-22.2), difference -1.5 (95% CI -5.0 to 2.0, P=0.398). Comparable
results were obtained when all-cause death was substituted for
cardiovascular death and when stroke was added as an event.
<br/>CONCLUSION(S): In stable CAD patients with moderate or severe
myocardial ischaemia enrolled in ISCHEMIA, an initial INV treatment
strategy did not prevent either net recurrent events or net total events
more effectively than an initial CON strategy. CLINICAL TRIAL
REGISTRATION: ISCHEMIA ClinicalTrials.gov number, NCT01471522,
https://clinicaltrials.gov/ct2/show/NCT01471522.<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.

<48>
Accession Number
636125766
Title
No-Touch Versus Conventional Vein Harvesting Techniques at 12 Months After
Coronary Artery Bypass Grafting Surgery: Multicenter Randomized,
Controlled Trial.
Source
Circulation. (no pagination), 2021. Date of Publication: 13 Sep 2021.
Author
Tian M.; Wang X.; Sun H.; Feng W.; Song Y.; Lu F.; Wang L.; Wang Y.; Xu
B.; Wang H.; Liu S.; Liu Z.; Chen Y.; Miao Q.; Su P.; Yang Y.; Guo S.; Lu
B.; Sun Z.; Liu K.; Zhang C.; Wu Y.; Xu H.; Zhao W.; Han C.; Zhou X.; Wang
E.; Huo X.; Hu S.
Institution
(Tian, Wang, Sun, Feng, Song, Lu, Wang, Yang, Guo, Sun, Liu, Zhang, Wu,
Xu, Zhao, Han, Zhou, Wang, Huo, Hu) Department of Surgery, Chinese Academy
of Medical Sciences & Peking Union Medical College, Beijing, China
(Wang) Medical Research & Biometrics Center, Chinese Academy of Medical
Sciences & Peking Union Medical College, Beijing, China
(Xu) Department of Cardiology, Chinese Academy of Medical Sciences &
Peking Union Medical College, Beijing, China
(Wang) Beijing Hospital, China
(Liu) Second Hospital of Hebei Medical University, China
(Liu) TEDA International Cardiovascular Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Tianjin, China
(Chen) Peking University People's Hospital, Beijing, China
(Miao) National Center for Cardiovascular Disease, China & Fuwai Hospital,
Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
& Peking Union Medical College, Beijing, China
(Su) Beijing Chaoyang Hospital, Capital Medical University, China
(Lu) Department of Radiology, Chinese Academy of Medical Sciences & Peking
Union Medical College, Beijing, China
Publisher
NLM (Medline)

<49>
Accession Number
2014468492
Title
Effect of Rosa damascena on improvement of adults' sleep quality: a
systematic review and meta-analysis of randomized controlled trials.
Source
Sleep Medicine. 87 (pp 8-19), 2021. Date of Publication: November 2021.
Author
Ghorbani Rami M.S.; Nasiri M.; Aghili Nasab M.S.; Jafari Z.; Torkaman M.;
Feizi S.; Farahmandnia B.; Asadi M.
Institution
(Ghorbani Rami) Department of Nursing, School of Nursing and Midwifery,
Babol University of Medical Sciences, Babol, Iran, Islamic Republic of
(Nasiri, Torkaman) Student Research Committee, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Nasiri) Department of Operating Room Nursing, School of Nursing and
Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
(Aghili Nasab) Student Research Committee, School of Nursing and
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Jafari) Department of Nursing, Islamic Azad University, Khorramabad
Branch, Khorramabad, Iran, Islamic Republic of
(Torkaman) Student Research Committee, Kerman University of Medical
Sciences, Kerman, Iran, Islamic Republic of
(Feizi) Student Research Committee, Department of Medical Surgical
Nursing, School of Nursing and Midwifery, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Farahmandnia) Department of Psychiatric Nursing, School of Nursing and
Midwifery, Dezful University of Medical Sciences, Dezful, Iran, Islamic
Republic of
(Asadi) Department of Operating Room Nursing, Abadan University of Medical
Sciences, Abadan, Iran, Islamic Republic of
Publisher
Elsevier B.V.
Abstract
Background: Recent studies have reported inconclusive results regarding
the potential effects of Rosa damascena on sleep quality. Therefore, this
review aimed to summarize the findings of parallel-group and cross-over
randomized controlled trials (RCTs) on the effects of aromatherapy and
oral intake of Rosa damascena on adults' sleep quality. <br/>Method(s):
The electronic data sources of PubMed, Scopus, Web of Science Core
Collection, Embase, CENTRAL, ProQuest, CINAHL, SID, and MagIran were
searched from inception to June 30, 2021. Out of 1341 publications found
in the initial search, 10 RCTs were considered eligible for this review.
The Cochrane risk-of-bias assessment tool was used to evaluate the risk of
bias. Sufficient data were statistically pooled by a random-effects model
using Stata software (version 11.2); otherwise, a narrative summary was
presented. <br/>Result(s): Based on the systematic review, the inhalation
and oral intake of Rosa damascena could improve some sleep-related
outcomes. The pooled analysis of seven effect sizes revealed that
inhalation aromatherapy with Rosa damascena significantly improved sleep
quality (standardized mean difference: 2.24; 95% confidence interval:
1.01-3.48; P < 0.001). Most RCTs had fair methodological quality, and two
RCTs reported the adverse effects of treatment, including headache,
nausea, vomiting, and frequent sneezing. <br/>Conclusion(s): The
administration of Rosa damascena seems to be a promising approach in
complementary and alternative medicine for the improvement of adults'
sleep quality. However, considering the fair methodological quality of
most RCTs and reported adverse effects, it is required to perform further
high-quality RCTs to draw an evidence-based conclusion on the use of Rosa
damascena for the improvement of adults' sleep quality. Prospero no:
CRD42020211778.<br/>Copyright &#xa9; 2021 Elsevier B.V.

<50>
Accession Number
635010040
Title
Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After
Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 601470. Date of Publication: 18 Mar 2021.
Author
Liu Z.; Zhao Y.; Lei M.; Zhao G.; Li D.; Sun R.; Liu X.
Institution
(Liu, Zhao, Zhao, Li, Sun, Liu) Department of Thoracic and Cardiovascular
Surgery, Shenzhen Baoan Women's and Children's Hospital, Jinan University,
Guangzhou, China
(Lei) Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Beijing,
China
Publisher
Frontiers Media S.A.
Abstract
Objective: Randomized controlled trials (RCTs) evaluating the influence of
remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after
cardiac surgery showed inconsistent results. We performed a meta-analysis
to evaluate the efficacy of RIPC on AKI after cardiac surgery.
<br/>Method(s): Relevant studies were obtained by search of PubMed,
Embase, and Cochrane's Library databases. A random-effect model was used
to pool the results. Meta-regression and subgroup analyses were used to
determine the source of heterogeneity. <br/>Result(s): Twenty-two RCTs
with 5,389 patients who received cardiac surgery -2,702 patients in the
RIPC group and 2,687 patients in the control group-were included. Moderate
heterogeneity was detected (p for Cochrane's Q test = 0.03, I²
= 40%). Pooled results showed that RIPC significantly reduced the
incidence of AKI compared with control [odds ratio (OR): 0.76, 95%
confidence intervals (CI): 0.61-0.94, p = 0.01]. Results limited to
on-pump surgery (OR: 0.78, 95% CI: 0.64-0.95, p = 0.01) or studies with
acute RIPC (OR: 0.78, 95% CI: 0.63-0.97, p = 0.03) showed consistent
results. Meta-regression and subgroup analyses indicated that study
characteristics, including study design, country, age, gender, diabetic
status, surgery type, use of propofol or volatile anesthetics, cross-clamp
time, RIPC protocol, definition of AKI, and sample size did not
significantly affect the outcome of AKI. Results of stratified analysis
showed that RIPC significantly reduced the risk of mild-to-moderate AKI
that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI:
0.60-0.96, p = 0.02) but did not significantly reduce the risk of severe
AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI:
0.50-1.07, p = 0.11). <br/>Conclusion(s): Current evidence supports RIPC
as an effective strategy to prevent AKI after cardiac surgery, which seems
to be mainly driven by the reduced mild-to-moderate AKI events that did
not require RRT. Efforts are needed to determine the influences of patient
characteristics, procedure, perioperative drugs, and RIPC protocol on the
outcome.<br/>&#xa9; Copyright &#xa9; 2021 Liu, Zhao, Lei, Zhao, Li, Sun
and Liu.

<51>
Accession Number
2014488335
Title
Safety and efficacy of very short dual antiplatelet therapy followed by
P2Y12 inhibitor monotherapy in older patients undergoing percutaneous
coronary intervention: Meta-analysis of randomised controlled trials.
Source
Age and Ageing. 50(4) (pp 1102-1107), 2021. Date of Publication: 01 Jul
2021.
Author
Roule V.; Lemaitre A.; Pommier W.; Bignon M.; Sabatier R.; Blanchart K.;
Beygui F.
Institution
(Roule, Lemaitre, Bignon, Sabatier, Blanchart, Beygui) Chu de Caen
Normandie, Service de Cardiologie, Caen 14000, France
(Roule, Beygui) Normandie Univ, Unicaen, Ea 4650 Signalisation,
lectrophysiologie et Imagerie des L sions d'Isch
mie-reperfusionmyocardique, Caen 14000, France
(Pommier) Chu de Caen Normandie, Service de G riatrie, Caen , 14000,
France
(Beygui) Action Academic Group, Pitie Salpetriere University Hospital,
Paris 75013, France
Publisher
Oxford University Press
Abstract
Background: older patients undergoing percutaneous coronary intervention
(PCI) represent a growing population sharing both a high ischemic and
bleeding risk. Dual antiplatelet therapy (DAPT) reduces the incidence of
thrombotic events but exposes patients to an increased risk of bleeding
and subsequent mortality. Its optimal duration after PCI remains unclear.
<br/>Objective(s): to assess the impact of short-duration DAPT on both
bleeding and ischemic events in the specific population of older patients
undergoing PCI. <br/>Method(s): we performed a meta-analysis of randomised
controlled trials comparing the safety and efficacy of standard versus
very short duration (<= 3 months, followed by P2Y12 inhibitor monotherapy)
DAPT after PCI with a drug-eluting stent in older patients.
<br/>Result(s): four studies, representing 8,961 older patients, were
finally included. Compared with standard duration, short-duration DAPT was
associated with similar rates of major bleeding (relative risks, RR 0.70
[0.47; 1.05]) and the composite efficacy endpoint (RR 0.85 [0.63; 1.14]).
There was a high level of heterogeneity between the studies (I2 = 68%)
regarding major bleeding. <br/>Conclusion(s): our meta-analysis suggests
that short DAPT may be a valid option in older patients after PCI but it
also highlights the need for specific studies in such patients on optimal
duration of antiplatelet therapy.<br/>Copyright &#xa9; 2021 The Author(s)
2021. Published by Oxford University Press on behalf of the British
Geriatrics Society. All rights reserved. For permissions, please email:
journals.permissions@oup.com.

<52>
Accession Number
2013980615
Title
Menopausal hormone therapy and women's health: An umbrella review.
Source
PLoS Medicine. 18(8) (no pagination), 2021. Article Number: e1003731. Date
of Publication: August 2021.
Author
Zhang G.-Q.; Chen J.-L.; Luo Y.; Mathur M.B.; Anagnostis P.; Nurmatov U.;
Talibov M.; Zhang J.; Hawrylowicz C.M.; Lumsden M.A.; Critchley H.; Sheikh
A.; Lundback B.; Lasser C.; Kankaanranta H.; Lee S.H.; Nwaru B.I.
Institution
(Zhang, Lundback, Lasser, Kankaanranta, Nwaru) Krefting Research Centre,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Chen) Department of Geriatrics, First Affiliated Hospital, Chongqing
Medical University, Chongqing, China
(Luo) Department of Gastroenterology, Children's Hospital of Chongqing
Medical University, National Clinical Research Center for Child Health and
Disorders, Ministry of Education Key Laboratory of Child Development and
Disorders, China International Science and Technology Cooperation Base of
Child Development and Critical Disorders, Chongqing, China
(Mathur) Quantitative Sciences Unit, Stanford University, Palo Alto, CA,
United States
(Anagnostis) Unit of Reproductive Endocrinology, 1st Department of
Obstetrics and Gynecology, Medical School, Aristotle University of
Thessaloniki, Thessaloniki, Greece
(Nurmatov) Division of Population Medicine, School of Medicine, Cardiff
University, Cardiff, United Kingdom
(Talibov) UMR1086, INSERM-Unite de Recherche Interdisciplinaire pour la
Prevention et le Traitement des Cancers (ANTICIPE), Centre de Lutte Contre
le Cancer Francois Baclesse, Caen, France
(Zhang) Department of Intensive Care Unit, Chongqing General Hospital,
University of Chinese Academy of Sciences, Chongqing, China
(Hawrylowicz) MRC and Asthma UK Centre in Allergic Mechanisms of Asthma,
King's College London, Guy's Hospital, London, United Kingdom
(Lumsden) Section of Reproductive and Maternal Medicine, Glasgow Royal
Infirmary, School of Medicine, University of Glasgow, Glasgow, United
Kingdom
(Critchley) MRC Centre for Reproductive Health, Queen's Medical Research
Institute, University of Edinburgh, Edinburgh, United Kingdom
(Sheikh, Nwaru) Asthma UK Centre for Applied Research, Centre for Medical
Informatics, Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
(Kankaanranta) Department of Respiratory Medicine, Seinajoki Central
Hospital, Seinajoki, Finland
(Kankaanranta) Faculty of Medicine and Health Technology, University of
Tampere, Tampere, Finland
(Lee) School of Nursing, Midwifery and Paramedic Practice, Robert Gordon
University, Aberdeen, United Kingdom
(Nwaru) Wallenberg Centre for Molecular and Translational Medicine,
University of Gothenburg, Gothenburg, Sweden
Publisher
Public Library of Science
Abstract
Background There remains uncertainty about the impact of menopausal
hormone therapy (MHT) on women's health. A systematic, comprehensive
assessment of the effects on multiple outcomes is lacking. We conducted an
umbrella review to comprehensively summarize evidence on the benefits and
harms of MHT across diverse health outcomes. Methods and findings We
searched MEDLINE, EMBASE, and 10 other databases from inception to
November 26, 2017, updated on December 17, 2020, to identify systematic
reviews or meta-analyses of randomized controlled trials (RCTs) and
observational studies investigating effects of MHT, including
estrogen-alone therapy (ET) and estrogen plus progestin therapy (EPT), in
perimenopausal or postmenopausal women in all countries and settings. All
health outcomes in previous systematic reviews were included, including
menopausal symptoms, surrogate endpoints, biomarkers, various morbidity
outcomes, and mortality. Two investigators independently extracted data
and assessed methodological quality of systematic reviews using the
updated 16-item AMSTAR 2 instrument. Random-effects robust variance
estimation was used to combine effect estimates, and 95% prediction
intervals (PIs) were calculated whenever possible. We used the term MHT to
encompass ET and EPT, and results are presented for MHT for each outcome,
unless otherwise indicated. Sixty systematic reviews were included,
involving 102 meta-analyses of RCTs and 38 of observational studies, with
102 unique outcomes. The overall quality of included systematic reviews
was moderate to poor. In meta-analyses of RCTs, MHT was beneficial for
vasomotor symptoms (frequency: 9 trials, 1,104 women, risk ratio [RR]
0.43, 95% CI 0.33 to 0.57, p < 0.001; severity: 7 trials, 503 women, RR
0.29, 95% CI 0.17 to 0.50, p = 0.002) and all fracture (30 trials, 43,188
women, RR 0.72, 95% CI 0.62 to 0.84, p = 0.002, 95% PI 0.58 to 0.87), as
well as vaginal atrophy (intravaginal ET), sexual function, vertebral and
nonvertebral fracture, diabetes mellitus, cardiovascular mortality (ET),
and colorectal cancer (EPT), but harmful for stroke (17 trials, 37,272
women, RR 1.17, 95% CI 1.05 to 1.29, p = 0.027) and venous thromboembolism
(23 trials, 42,292 women, RR 1.60, 95% CI 0.99 to 2.58, p = 0.052, 95% PI
1.03 to 2.99), as well as cardiovascular disease incidence and recurrence,
cerebrovascular disease, nonfatal stroke, deep vein thrombosis,
gallbladder disease requiring surgery, and lung cancer mortality (EPT). In
meta-analyses of observational studies, MHT was associated with decreased
risks of cataract, glioma, and esophageal, gastric, and colorectal cancer,
but increased risks of pulmonary embolism, cholelithiasis, asthma,
meningioma, and thyroid, breast, and ovarian cancer. ET and EPT had
opposite effects for endometrial cancer, endometrial hyperplasia, and
Alzheimer disease. The major limitations include the inability to address
the varying effects of MHT by type, dose, formulation, duration of use,
route of administration, and age of initiation and to take into account
the quality of individual studies included in the systematic reviews. The
study protocol is publicly available on PROSPERO (CRD42017083412).
Conclusions MHT has a complex balance of benefits and harms on multiple
health outcomes. Some effects differ qualitatively between ET and EPT. The
quality of available evidence is only moderate to poor.<br/>Copyright:
&#xa9; 2021 Zhang et al. This is an open access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<53>
Accession Number
2013019807
Title
Factor VIII inhibitor bypass activity (FEIBA) for the reduction of
transfusion in cardiac surgery: a randomized, double-blind,
placebo-controlled, pilot trial.
Source
Pilot and Feasibility Studies. 7(1) (no pagination), 2021. Article Number:
137. Date of Publication: December 2021.
Author
Sera V.A.; Stevens A.E.; Song H.K.; Rodriguez V.M.; Tibayan F.A.;
Treggiari M.M.
Institution
(Sera, Treggiari) Department of Anesthesiology and Perioperative Medicine,
Oregon Health & Science University, Portland, OR, United States
(Stevens) Department of Anesthesiology, Kaiser Permanente, Portland, OR,
United States
(Song, Tibayan) Department of Cardiothoracic Surgery, Oregon Health &
Science University, Portland, OR, United States
(Rodriguez) Department of Surgery, Division of Cardiothoracic Surgery, UC
Davis Vascular Center, Davis, CA, United States
(Treggiari) Department of Anesthesiology, Yale University, 333 Cedar
Street, TMP-3, New Haven, CT, United States
Publisher
BioMed Central Ltd
Abstract
Background: Uncontrolled bleeding after cardiac surgery can be
life-threatening. Factor eight inhibitor bypassing activity (FEIBA) is a
prothrombin complex concentrate empirically used as rescue therapy for
correction of refractory bleeding diathesis post-cardiopulmonary bypass
(CPB). FEIBA used as rescue therapy for bleeding diathesis after CPB has
been associated with a low incidence of complications and a reduction in
transfusion requirement and re-exploration. The feasibility and efficacy
of early administration of FEIBA after the termination of CPB have not
been studied in a prospective randomized trial. <br/>Method(s): We
designed a small randomized, double-blinded, placebo-controlled pilot
trial to determine the feasibility of a larger trial testing the
hypothesis that FEIBA decreases transfusion requirements after CPB. The
study was designed to evaluate the feasibility of a larger pivotal trial
to determine the effectiveness of FEIBA in reducing the total volume of
blood products transfused perioperatively, and its safety profile. Study
participants were adult patients undergoing elective major aortic
cardiovascular surgery at a tertiary referral hospital, who were equally
randomized to receive a single dose of either FEIBA or matched placebo
intraoperatively at the end of CPB. <br/>Result(s): Twenty patients were
screened and 12 were randomized and included in the analysis. Protocol
adherence was high, and all patients received the study drug per
intention-to-treat except one patient. There were no protocol deviations
or events of unblinding, and adverse events were not different between
groups. Patients in the FEIBA group were older and more likely to be
female and had higher BMI, lower hematocrit, and longer hypothermic
circulatory arrest. There were no differences in post-randomization blood
product transfusions (difference FEIBA vs. placebo -899 mL; 95% CI -5206
to 3409) or in the administration of open-label FEIBA. <br/>Conclusion(s):
This pilot trial confirmed the adequacy of the trial design that involved
the early, blinded administration of FEIBA, by demonstrating excellent
protocol adherence. We conclude that a larger trial establishing the
effectiveness of early prothrombin complex concentrate administration to
reduce the use of blood products in the setting of high-risk cardiac
surgery is feasible. Trial registration: ClinicalTrials.gov, NCT02577614.
Registered 16 October 2015<br/>Copyright &#xa9; 2021, The Author(s).

<54>
Accession Number
2011181830
Title
Navigating inferior vena cava filters in invasive cardiology procedures: A
systematic review.
Source
Journal of Cardiovascular Electrophysiology. 32(5) (pp 1440-1448), 2021.
Date of Publication: May 2021.
Author
Shah K.; Patel S.; Hanson I.; Williamson B.; Kutinsky I.; Dixon S.; Haines
D.E.; Mehta N.K.
Institution
(Shah, Hanson, Williamson, Kutinsky, Dixon, Haines, Mehta) Department of
Cardiovascular Medicine, Beaumont Hospital, Oakland University William
Beaumont School of Medicine, Royal Oak, MI, United States
(Patel) Department of Cardiovascular Medicine, Henry Ford Hospital,
Detroit, MI, United States
(Mehta) Department of Cardiovascular Medicine, University of Virginia,
Charlottesville, VA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Transfemoral venous access (TFV) is the cornerstone of
minimally invasive cardiac procedures. Although the presence of inferior
vena cava filters (IVCFs) was considered a relative contraindication to
TFV procedures, small experiences have suggested safety. We conducted a
systematic review of the available literature on cardiac procedural
success of TFV with IVCF in-situ. <br/>Method(s): Two independent
reviewers searched PubMed, EMBASE, SCOPUS, and Google Scholar from
inception to October 2020 for studies that reported outcomes in patients
with IVCFs undergoing TFV for invasive cardiac procedures. We investigated
a primary outcome of acute procedural success and reviewed the pooled data
for patient demographics, procedural complications, types of IVCF, IVCF
dwell time, and procedural specifics. <br/>Result(s): Out of the 120
studies initially screened, 8 studies were used in the final analysis with
a total of 100 patients who underwent 110 procedures. The most common IVCF
was the Greenfield Filter (36%), 60% of patients were males and the mean
age was 67.8 years. The overall pooled incidence of acute procedural
success was 95.45% (95% confidence interval = 89.54-98.1) with no
heterogeneity (I² = 0%, p = 1) and there were no reported
filter-related complications. <br/>Conclusion(s): This systematic review
is the largest study of its kind to demonstrate the safety and feasibility
of TFV access in a variety of cardiac procedures in the presence of
IVCF.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<55>
Accession Number
2010533140
Title
Nine-month angiographic and 2-year clinical outcomes of the RECOVERY
trial: A randomized study of the biodegradable polymer sirolimus-eluting
COMBO dual-therapy stent versus a polymer-free sirolimus-eluting stent in
Chinese patients.
Source
Catheterization and Cardiovascular Interventions. 97(S2) (pp 966-975),
2021. Date of Publication: 01 May 2021.
Author
Tao L.; Li Z.; Yin Z.; Lin W.; Liu Y.; Li H.; Yu B.; Li W.; Xu B.
Institution
(Tao, Yin) Department of Cardiology, The First Affiliated Hospital of Air
Force Medical University, Xi'an, China
(Li) Department of Cardiology, The People Hospital of Liaoning Province,
Shenyang, China
(Lin) Department of Cardiology, TEDA International Cardiovascular
Hospital, Tianjin, China
(Liu) Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
(Li) Department of Cardiology, Daqing Oilfields General Hospital, Daqing,
China
(Yu) Department of Cardiology, The Second Affiliated Hospital of Harbin
Medical University, Harbin, China
(Li) Medical Research and Biometrics Center, National Center for
Cardiovascular Diseases, Beijing, China
(Xu) Catheterization Laboratories, Fu Wai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, National Clinical Research Center for
Cardiovascular Diseases, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We evaluated the safety and efficacy of the novel dual-therapy
sirolimus-eluting and endothelial progenitor cell (EPC) capture COMBO
stent. <br/>Background(s): (Very) late stent thrombosis (ST) and
neo-atherosclerosis limit the performance of drug-eluting stents. The
capture of EPCs accelerates stent re-endothelialization, thereby
potentially decreasing the risk of restenosis and ST. <br/>Method(s): In
total, 440 patients with de novo lesions in native coronary arteries were
randomized (1:1) to either receive the COMBO stent (n = 220) or Nano
polymer-free sirolimus-eluting stent (n = 220). The primary endpoint was
the 9-month angiographic in-segment late lumen loss (LLL). Secondary
endpoints included target lesion failure (TLF), a patient-oriented
composite endpoint (PoCE), and ST. <br/>Result(s): At 9 months, the COMBO
in-segment LLL (0.29 +/- 0.46 mm) was non-inferior to that of the Nano
comparator stent (0.31 +/- 0.44 mm; p<inf>non-inferiority</inf> <.0001).
Clinical outcomes were also similar between the COMBO and Nano stents,
with TLF rates of 9.3% and 7.9% (p =.61) at 12 months, and 9.4% and 8.0%
(p =.62) at 24 months, respectively. The PoCE rate was 14.8% and 10.6% (p
=.19) at 12 months, and 16.0% and 11.3% (p =.16) at 24 months,
respectively. Ischemia-driven target lesion revascularization rates were
6.0% and 3.7% (p =.26) at 12 months, and 6.2% and 3.8% (p =.26) at 24
months, respectively. No case of ST occurred in either group.
<br/>Conclusion(s): The RECOVERY trial has shown the COMBO stent was
effective, meeting the primary non-inferiority angiographic endpoint, and
safe, with an overall low rate of clinical events in both stent groups,
including no ST for up to 2 years.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC.

<56>
Accession Number
2007791432
Title
NGAL in trans-catheter aortic valve implantation on and off renalguard.
Source
Signa Vitae. 17(4) (pp 55-59), 2021. Date of Publication: July 2021.
Author
Sadon S.; Arbel Y.; Banai A.; Rozenfeld K.-L.; Taieb P.; Hochstadt A.;
Shacham Y.; Banai S.; Finkelstein A.; Merdler I.
Institution
(Sadon, Arbel, Banai, Rozenfeld, Taieb, Hochstadt, Shacham, Banai,
Finkelstein, Merdler) Department of Cardiology, Tel Aviv Sourasky Medical
Center, Israel
(Sadon, Arbel, Banai, Rozenfeld, Taieb, Hochstadt, Shacham, Banai,
Finkelstein, Merdler) Affiliated to Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel
Publisher
Pharmamed Mado Ltd
Abstract
Introduction: Acute kidney injury (AKI) is a well-known complication post
invasive cardiac procedures. RenalGuard system has been shown to reduce
the risk of AKI in high-risk patients by evacuating iodine-based contrast
material rapidly. Neutrophil gelatinase-associated lipocalin (NGAL) is a
glycoprotein stored in granules of mature neutrophils and is released to
the blood stream due to acute tubular damage. This report examined the
biomarker as a sub study of the randomized sham control study REDUCE-AKI
in the setting of Trans-Aortic Valve Implantation (TAVI). <br/>Method(s):
Venous blood was drawn from 27 patients. Blood was drawn at designated
time intervals: before the procedure, after 12 hours and after 24 hours.
Patients were randomly allocated to active versus sham RenalGuard
activity. <br/>Result(s): There was no difference between baseline and 24
hours levels in NGAL values (ng/mL) in the sham group (median 70.3 IQ
21.5, 176.6) versus the active group (median 46.9, IQR 1.3, 127.7) (P =
0.259). There was also no association between NGAL and clinical
complications. <br/>Conclusion(s): Forced diuresis with matched hydration
does not prevent AKI in patients undergoing TAVI and measuring NGAL
correlates with these findings.<br/>Copyright &#xa9; 2021 The Authors.
Published by MRE Press.

<57>
Accession Number
2013648627
Title
Trifecta versus perimount bioprosthesis for surgical aortic valve
replacement; systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 36(11) (pp 4335-4342), 2021. Date of
Publication: November 2021.
Author
Yokoyama Y.; Kuno T.; Takagi H.; Fukuhara S.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Fountain Hill, PA, United States
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York City, NY, United States
(Kuno) Department of Cardiology, Montefiore Medical Center/Albert Einstein
Medical College, New York City, NY, United States
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Fukuhara) Department of Cardiac Surgery, University of Michigan, Ann
Arbor, Michigan, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: Recent studies suggested higher rates of early structural valve
degeneration or reintervention for the Trifecta valve compared to other
valves. Thus, we conducted a systematic review and meta-analysis comparing
the outcomes of the Trifecta valve and the Perimount valves in patients
who underwent a surgical aortic valve replacement (SAVR). <br/>Method(s):
All randomized control trials and observational studies which investigated
the outcomes of the Trifecta valve and Perimount valves were identified
with PubMed and EMBASE. The endpoints were the rates of reintervention and
all-cause mortality. Hazard ratios (HRs) for reintervention and all-cause
mortality were combined with the random-effects model. <br/>Result(s): Our
search identified 6 eligible observational studies which enrolled a total
of 11,135 patients who underwent SAVR with either the Trifecta valve (n =
4932) or Perimount (n = 6203). Pooled analyses demonstrated that the
reintervention rates were significantly higher with the Trifecta valve
compared with Perimount valves (HR [95% confidence interval {CI}] = 3.16
[1.83-5.46]; p <.0001; I²= 40%). In contrast, all-cause
mortality was not significantly different between the two groups (HR [95%
CI] = 1.09 [0.75-1.58]; p =.32, I²= 12%). <br/>Conclusion(s):
Our analysis showed that AVR with the Trifecta valve was associated with
higher rates of reintervention compared for that with the Perimount valve.
Although further long-term randomized trials are warranted, surgeons need
to be cautious when choosing a bioprosthetic valve for patients undergoing
SAVR.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<58>
Accession Number
2013642333
Title
Clinical and hemodynamic outcomes of the Dor procedure in adults with
ischemic cardiomyopathy.
Source
Journal of Cardiac Surgery. 36(11) (pp 4345-4366), 2021. Date of
Publication: November 2021.
Author
Fatehi Hassanabad A.; Wiebe K.; Ali I.S.
Institution
(Fatehi Hassanabad, Ali) Section of Cardiac Surgery, Department of Cardiac
Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
(Wiebe) Cumming School of Medicine, University of Calgary, Calgary, AB,
Canada
Publisher
John Wiley and Sons Inc
Abstract
Ischemic cardiomyopathy continues to be a major contributor to congestive
heart failure, which places a significant burden on our healthcare system.
Improving medications and different coronary revascularization strategies
are the mainstays in the management of ischemic cardiomyopathy. Although
medications and mechanical circulatory support are playing an
ever-increasing role, cardiac transplantation remains the gold standard
for treating advanced heart failure. Given the small number of available
and suitable donor hearts, transplantation is limited for the majority of
patients. Surgical ventricular restoration has repeatedly been suggested
as a viable alternative in managing heart failure in select patients, as
it is believed that surgically returning the ventricle to its original
dimensions is possible and associated with favorable outcomes. The purpose
of this manuscript is to comprehensively review the current literature on
various surgical strategies for ventricular restoration. We also
contextualize the published data with respect to ventricular function,
volume, structure, arrhythmias, mitral regurgitation, and clinical
outcomes.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<59>
Accession Number
2013600436
Title
Harvesting techniques of the saphenous vein graft for coronary artery
bypass: Insights from a network meta-analysis.
Source
Journal of Cardiac Surgery. 36(11) (pp 4369-4375), 2021. Date of
Publication: November 2021.
Author
Yokoyama Y.; Shimamura J.; Takagi H.; Kuno T.
Institution
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
PA, United States
(Shimamura) Division of Cardiac Surgery, Department of Surgery, Western
University, London Health Sciences Centre, ON, Canada
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, NY, United States
(Kuno) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: The optimal harvesting technique of saphenous vein (SVG) in
coronary artery bypass grafting (CABG) is still to be elucidated. The
present study aimed to compare the methods of SVG harvesting technique,
which were open vein harvesting (OVH), endoscopic vein harvesting (EVH),
and no-touch vein harvesting (NT), using a network meta-analysis of
randomized controlled trials (RCTs), and propensity-score matched (PSM)
studies. <br/>Method(s): MEDLINE and EMBASE were searched through April
2021 to identify RCTs and PSM studies that investigated the outcomes in
patients who underwent CABG with the SVG using one of three methods; OVH,
EVH, and NT. The outcomes of interest were all-cause mortality, the rates
of revascularization, and graft failure. Risk ratios (RRs) were extracted
for the rates of graft failure, and hazard ratios (HRs) were extracted for
all-cause mortality and the rates of revascularization. <br/>Result(s):
Eligible seven RCT and five PSM studies were identified which enrolled a
total of 8111 patients. All-cause mortality was significantly lower in
patients with EVH compared with OVH (HR [95% confidence interval (CI)]
=0.77 [0.65-0.92], p =.0032). The rates of revascularization were similar
among the groups. The rate of graft failures was significantly lower in
patients with NT compared with OVH (HR [95% CI] =0.54 [0.32-0.90], p
=.019) and with EVH (HR [95% CI] =0.39 [0.17-0.86], p =.023).
<br/>Conclusion(s): NT vein harvesting is favorable for graft patency, and
OVH showed higher all-cause mortality than EVH. Further well-powered RCTs
are needed to confirm our findings.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC

<60>
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

<61>
Accession Number
2013497740
Title
Using machine learning to improve survival prediction after heart
transplantation.
Source
Journal of Cardiac Surgery. 36(11) (pp 4113-4120), 2021. Date of
Publication: November 2021.
Author
Ayers B.; Sandholm T.; Gosev I.; Prasad S.; Kilic A.
Institution
(Ayers) Department of Surgery, The Massachusetts General Hospital, Boston,
MA, United States
(Sandholm) Carnegie Mellon University, Pittsburgh, PA, United States
(Gosev, Prasad) Division of Cardiac Surgery, The University of Rochester
Medical Center, Rochester, NY, United States
(Kilic) Division of Cardiothoracic Surgery, Medical University of South
Carolina, Charleston, SC, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: This study investigates the use of modern machine learning
(ML) techniques to improve prediction of survival after orthotopic heart
transplantation (OHT). <br/>Method(s): Retrospective study of adult
patients undergoing primary, isolated OHT between 2000 and 2019 as
identified in the United Network for Organ Sharing (UNOS) registry. The
primary outcome was 1-year post-transplant survival. Patients were
randomly divided into training (80%) and validation (20%) sets.
Dimensionality reduction and data re-sampling were employed during
training. Multiple machine learning algorithms were combined into a final
ensemble ML model. The discriminatory capability was assessed using the
area under receiver-operating-characteristic curve (AUROC), net
reclassification index (NRI), and decision curve analysis (DCA).
<br/>Result(s): A total of 33,657 OHT patients were evaluated. One-year
mortality was 11% (n = 3738). In the validation cohort, the AUROC of
singular logistic regression was 0.649 (95% CI, 0.628-0.670) compared to
0.691 (95% CI, 0.671-0.711) with random forest, 0.691 (95% CI,
0.671-0.712) with deep neural network, and 0.653 (95% CI, 0.632-0.674)
with Adaboost. A final ensemble ML model was created that demonstrated the
greatest improvement in AUROC: 0.764 (95% CI, 0.745-0.782) (p <.001). The
ensemble ML model improved predictive performance by 72.9% +/-3.8% (p
<.001) as assessed by NRI compared to logistic regression. DCA showed the
final ensemble method improved risk prediction across the entire spectrum
of predicted risk as compared to all other models (p <.001).
<br/>Conclusion(s): Modern ML techniques can improve risk prediction in
OHT compared to traditional approaches. This may have important
implications in patient selection, programmatic evaluation, allocation
policy, and patient counseling and prognostication.<br/>Copyright &#xa9;
2021 Wiley Periodicals LLC

<62>
Accession Number
2012391158
Title
Preventative effects of bisoprolol transdermal patches on postoperative
atrial fibrillation in high-risk patients undergoing non-cardiac surgery:
A subanalysis of the MAMACARI study.
Source
Journal of Cardiology. 78(5) (pp 349-354), 2021. Date of Publication:
November 2021.
Author
Iwano T.; Toda H.; Nakamura K.; Shimizu K.; Ejiri K.; Naito Y.; Mori H.;
Masuda T.; Miyoshi T.; Yoshida M.; Hikasa Y.; Morimatsu H.; Ito H.
Institution
(Iwano, Toda, Nakamura, Ejiri, Masuda, Miyoshi, Yoshida, Ito) Department
of Cardiovascular Medicine, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho,
Kita-ku, Okayama 700-8558, Japan
(Shimizu, Hikasa, Morimatsu) Department of Anesthesiology, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan
(Naito) Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
(Mori) Department of Cardiology, Tsuyama Chuo Hospital, Tsuyama, Japan
(Masuda) Department of Cardiology, Himeji Red Cross Hospital, Himeji,
Japan
Publisher
Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)
Abstract
Background: Perioperative atrial fibrillation (POAF) after non-cardiac
surgery is a risk factor for cardiovascular events including stroke and
death. The aim of this subanalysis of the MAMACARI study, a multicenter
randomized control study on the effectiveness of a bisoprolol transdermal
patch for prevention of perioperative myocardial injury in high-risk
patients undergoing non-cardiac surgery, was to identify the predictors of
POAF after non-cardiac surgery in high-risk patients and to determine
changes in blood pressure and heart rate during bisoprolol patch
administration in the perioperative period. <br/>Methods and Results:
Patients aged over 60 years with hypertension and a high revised cardiac
risk index (>=2) who were scheduled to undergo non-cardiac surgery were
randomly assigned to a bisoprolol patch group (n = 120) or a control group
(n = 120). We divided the patients into two groups: patients with POAF
(POAF group; n = 16) and patients without POAF (non-POAF group; n = 206).
Multivariate analysis showed that bisoprolol patch therapy (OR: 0.30, 95%
CI: 0.092-0.978) and surgery time of 250 min or more (OR: 4.99, 95% CI:
1.37-18.2) were independently associated with POAF. Although systolic
blood pressure did not differ significantly between the two groups
throughout the perioperative period, treatment with a bisoprolol patch
significantly reduced heart rate throughout the perioperative period
compared with that in the control group. <br/>Conclusion(s): Low dose of a
bisoprolol patch in the perioperative period was effective for prevention
of POAF after non-cardiac surgery in high-risk patients, while long
surgery time was an independent risk factor for POAF. It is expected that
low dose of a bisoprolol patch can prevent POAF without causing
hypotension.<br/>Copyright &#xa9; 2021

<63>
Accession Number
2011487984
Title
A meta-analysis of transcarotid versus transfemoral transcatheter aortic
valve replacement.
Source
Catheterization and Cardiovascular Interventions. 98(4) (pp 767-773),
2021. Date of Publication: October 2021.
Author
McGrath D.P.; Kawabori M.; Wessler B.; Chen F.Y.; Zhan Y.
Institution
(McGrath) Tufts University School of Medicine, Boston, MA, United States
(Kawabori, Chen, Zhan) Division of Cardiac Surgery, CardioVascular Center,
Tufts Medical Center, Boston, MA, United States
(Wessler) Division of Cardiology, CardioVascular Center, Tufts Medical
Center, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Carotid access has shown promise as an excellent delivery
route for transcatheter aortic valve replacement (TAVR). We aimed to
compare outcomes of transcarotid (TC) and transfemoral (TF) TAVR by
conducting a search and analysis of the best evidence in the literature to
shed light on its safety and effectiveness. <br/>Method(s): The
PubMed/MEDLINE, Embase, and Cochrane library from inception to July 2020
were searched to identify articles reporting comparative data on TC versus
TF approaches for TAVR. Patients' baseline characteristics and clinical
outcomes were extracted from the articles and pooled for analysis.
<br/>Result(s): Five studies, including a total of 2470 patients, were
included in the study with 1859 patients in the TF group and 611 patients
in the TC group. The TC group had higher prevalence of peripheral vascular
disease, while the patients in the TF group was older. Meta-analysis
revealed that there was no significant differences between the two groups
with regard to 30-day mortality (p = 0.09), stroke (p = 0.28), new
dialysis (p = 0.58), major bleeding (p = 0.69), or pacemaker implantation
(p = 0.44). The TF group had a higher incidence of vascular complications
(3.9% vs. 2.3%; OR 2.22; 95% CI [1.13, 4.38]; p = 0.02).
<br/>Conclusion(s): Compared with the TF approach, TC-TAVR is associated
with comparable procedural and clinical outcomes. Our analysis found a
lower rate of vascular complication in TC access compared with TF access.
This supports consideration of such an alternative access when there are
concerns over the feasibility of TF access.<br/>Copyright &#xa9; 2021
Wiley Periodicals LLC.

<64>
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.

<65>
Accession Number
2014797214
Title
Unique Challenges of Randomised Controlled Trials in Pediatric Cardiology.
Source
Canadian Journal of Cardiology. 37(9) (pp 1394-1403), 2021. Date of
Publication: September 2021.
Author
Harris K.C.; Mackie A.S.; Dallaire F.; Khoury M.; Singer J.; Mahle W.T.;
Klassen T.P.; McCrindle B.W.
Institution
(Harris) Children's Heart Centre, British Columbia Children's Hospital
&-University of British Columbia, Vancouver, BC, Canada
(Mackie, Khoury) Division of Pediatric Cardiology, Department of
Pediatrics Stollery Children's Hospital. University of Alberta, Edmonton,
AB, Canada
(Dallaire) Division of Pediatric Cardiology, Department of Pediatrics,
Sherbrooke University, Sherbrooke, Quebec, Canada
(Singer) School of Population and Public Health, University of British
Columbia, Vancouver, BC, Canada
(Mahle) Division of Pediatric Cardiology, Emory University, Atlanta,
Georgia, United States
(Klassen) Children's Hospital Research Institute of Manitoba and
Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
(McCrindle) Labatt Family Heart Centre, Hospital for Sick Children and
University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Pediatric cardiology has evolved over time with reductions in childhood
mortality due to congenital heart disease. Surgical innovation drove early
changes in care. Increasingly, the need for more robust evidence provided
by randomised controlled trials (RCTs) has been recognised. Although the
number of RCTs has increased, there remains a relative paucity of truly
impactful trials in the field. However, those trials that have changed
practice have demonstrated the potential and importance of this work.
Examples include the PRIMACORP trial, which established the safety and
efficacy of milrinone after cardiac surgery, and the Single Ventricle
Reconstruction trial, which was the first multicentre pediatric cardiac
surgical RCT. The successful conduct and important findings emanating from
these trials serve as beacons as clinicians strive to improve the evidence
base in this field. The establishment of national and international
networks such as the Pediatric Heart Network and the Canadian Pediatric
Cardiology Research Network provide a strong foundation for future
collaborative work. Despite this progress, there remain important
challenges to designing and executing RCTs in pediatric cardiology. These
include issues of greater disease and patient heterogeneity and increased
costs. The use of innovative study designs and analytic methods and the
establishment of core outcome measures have the potential to overcome some
of the issues related to the smaller patient numbers compared with adult
disciplines. As pediatric cardiologists look to the future, it is
imperative that we work together to derive the maximum benefit from the
considerable efforts directed toward conducting impactful clinical trials
in pediatric cardiology.<br/>Copyright &#xa9; 2021 Canadian Cardiovascular
Society

<66>
Accession Number
2014844898
Title
Myocardial Protection With Different Cardioplegia in Adult Cardiac
Surgery: A Network Meta-Analysis.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Zhou K.; Zhang X.; Li D.; Song G.
Institution
(Zhou, Li) Department of Cardiac Surgery, Shengjing Hospital of China
Medical University, Shenyang, China
(Zhang, Song) Department of Ultrasound, Shengjing Hospital of China
Medical University, Shenyang, China
Publisher
Elsevier Ltd
Abstract
Aim: Cardioplegia is one of the most studied fields of myocardial
protection during cardiac surgery. However, the most effective
cardioplegia for protection in adult cardiac surgery remains unknown.
<br/>Method(s): PubMed and other databases were searched and a network
meta-analysis with a Bayesian framework was performed. The primary
outcomes were the serum concentrations of creatine kinase-myocardial band
(CK-MB), cardiac troponin I, and cardiac troponin T (cTnT) at four time
points. Several clinical outcomes were evaluated, including low output
syndrome, myocardial infarction, and risk of early mortality. All studies
that involved crystalloid cardioplegia without reference to St Thomas
cardioplegia or histidine-tryptophan-ketoglutarate solution, and if the
cardioplegia was used at a temperature between 4degreeC and 16degreeC were
classified as cold crystalloid (cCCP) or cold blood cBCP cardioplegia.
Warm blood cardioplegia (wBCP) was defined as the blood cardioplegia used
at a temperature between 32degreeC and 37degreeC. <br/>Result(s):
Forty-seven (47) studies with a total of 4,175 patients were included.
Seven (7) cardioplegia solutions were used, including cold CCP or BCP, del
Nido solution, histidine-tryptophan-ketoglutaratesolution, St Thomas
cardioplegia, wBCP and warm terminal blood cardioplegia (wtBCP). The serum
concentrations of CK-MB at 2 hours (mean difference [MD], 213.56; 95%
confidence interval [CI], -25.79 to -1.59) and cTnT at 24 hours of wBCP
(MD, -1.50; 95% CI, -2.69 to -0.31) were significantly lower than that of
cCCP. There were no significant differences in other outcomes of these six
cardioplegia solutions, when compared to cCCP. <br/>Conclusion(s): The
seven cardioplegia solutions analysed had similar myocardial protective
effects after adult cardiac surgery, although wBCP had a lower CK-MB at 2
hours and lower cTnT at 24 hours.<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)

<67>
Accession Number
2013765404
Title
Effect of recruitment maneuvers and PEEP on respiratory failure after
cardiothoracic surgery in obese subjects: A randomized controlled trial.
Source
Respiratory Care. 66(8) (pp 1306-1314), 2021. Date of Publication: 01 Aug
2021.
Author
Amaru P.; Delannoy B.; Genty T.; Desebbe O.; Laverdure F.;
Rezaiguia-Delclaux S.; Stephan F.
Institution
(Amaru, Genty, Rezaiguia-Delclaux, Stephan) Cardiothoracic ICU, Department
of Anesthesiology and ICU, Hopital Marie Lannelongue, Le Plessis Robinson,
France
(Laverdure) Department of Anesthesiology and ICU, Hopital Marie
Lannelongue, Le Plessis Robinson, France
(Delannoy, Desebbe) Clinique de la Sauvegarde, Lyon, France
Publisher
American Association for Respiratory Care
Abstract
BACKGROUND: Obesity may increase the risk of respiratory failure after
cardiothoracic surgery. A recruitment maneuver followed by PEEP might
decrease the risk of respiratory failure in obese subjects. We
hypothesized that the routine use after heart surgery of a recruitment
maneuver followed by high or low PEEP level would decrease the frequency
of respiratory failure in obese subjects. <br/>METHOD(S): In a pragmatic,
randomized controlled trial, we assigned obese subjects (ie, with body
mass index [BMI] >= 30 kg/m²) in the immediate postoperative
period of cardiothoracic surgery to either volume control ventilation with
5 cm H<inf>2</inf>O of PEEP (control group) or a recruitment maneuver
followed by 5 or 10 cm H<inf>2</inf>O of PEEP in the intervention arms
(RM5 and RM10 groups, respectively). The primary outcome was the
proportion of subjects with postextubation respiratory failure, defined as
the need for re-intubation, bi-level positive airway pressure, or
high-flow nasal cannula within the first 48 h. <br/>RESULT(S): The study
included 192 subjects: 65 in the control group (BMI 33.5 +/- 3.2 kg/
m²), 66 in the RM5 group (BMI 34.5 +/- 3.2 kg/m²,
and 61 in RM10 group (BMI 33.8 +/- 4.8 kg/m²). Postextubation
respiratory failure occurred in 14 subjects in the control group (21.5%
[95% CI 13.3- 35.3]), 21 subjects in the RM5 group (31.8% [95% CI
21.2-44.6]), and 9 subjects in the RM10 group (14.7% [95% CI 7.4-26.7]) (P
5.07). The recruitment maneuver was stopped prematurely due to severe
hypotension in 8 (12.1%) RM5 subjects and in 4 (6.6%) RM10 subjects (P
5.28). There were no significant differences between the 3 groups for the
frequencies of atelectasis, pneumonia, and death in the ICU.
<br/>CONCLUSION(S): The routine use after heart surgery of a recruitment
maneuver followed by 5 or 10 cm H<inf>2</inf>O of PEEP did not decrease
the frequency of respiratory failure in obese subjects. A recruitment
maneuver followed by 5 cm H<inf>2</inf>O of PEEP is
inappropriate.<br/>Copyright &#xa9; 2021 Daedalus Enterprises.

<68>
Accession Number
2013735912
Title
Long-term outcomes of percutaneous or surgical treatment in left main
disease.
Source
Minerva Cardiology and Angiology. 69(3) (pp 313-321), 2021. Date of
Publication: June 2021.
Author
Chiabrando J.G.; Vescovo G.M.; Lombardi M.; Del Buono M.G.; Romeo F.J.;
Berrocal D.H.; Guzman L.; Biondi-Zoccai G.; Abbate A.
Institution
(Chiabrando, Romeo, Berrocal) Interventional Cardiology Service, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina
(Chiabrando) Health Science Statistics Applied Laboratory (LEACS),
Department of Pharmacology and Toxicology, School of Medicine, University
of Buenos Aires, Buenos Aires, Argentina
(Vescovo) Department of Cardiac Thoracic, Vascular Sciences and Public
Health, University of Padua, Padua, Italy
(Lombardi, Del Buono, Abbate) VCU Pauley Heart Center, Virginia
Commonwealth University, Richmond, VA, United States
(Lombardi, Del Buono) Department of Cardiovascular and Thoracic Sciences,
Sacred Heart Catholic University, Rome, Italy
(Guzman) Wake Forest University, Winston-Salem, NC, United States
(Biondi-Zoccai) Department of Medical-Surgical Sciences and
Biotechnologies, Sapienza University, Latina, Italy
(Biondi-Zoccai) Mediterranea Cardiocentro, Naples, Italy
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: Long-term efficacy and safety of either surgical or
percutaneous treatment left main coronary artery disease treatment is
lacking. EVIDENCE ACQUISITION: We conducted a systematic review and
meta-analysis of the most updated randomized clinical trials that compared
the efficacy of coronary artery bypass surgery (CABG) or percutaneous
coronary intervention (PCI) for the Left Main Coronary Artery (LMCA)
disease. It was also conducted a systematic search of PubMed, Google
Scholar, reference lists of relevant articles, and Medline. The search
utilized the following terms: "left main PCI versus CABG," "drug-eluting
stents," "bypass surgery" and "left main stenting." The search of articles
compatible with our inclusion and exclusion criteria was performed from
inception through April 2020 and returned a combined total of 304
articles. EVIDENCE SYNTHESIS: We identified 6 studies, providing data on
5812 patients. The mean follow-up was 6.7 years. PCI was associated with
an increased risk of major vascular events (MACE) (IRR 1.24, 95% CI
[1.03-1.67], P<0.01), and coronary revascularization (IRR 1.69, 95% CI
[1.42-2.03], P<0.01) compared to CABG. Furthermore, all-cause death, MI
and stroke events were not statistically different between the two
therapeutic revascularization methodologies (IRR 1.06, 95% CI [0.90-1.24],
P=0.47, IRR 1.35, 95% CI [0.84-2.16], P=0.03 and IRR 0.66, 95% CI
[0.43-1.01], P=0.05, respectively). <br/>CONCLUSION(S): LMCA PCI has an
overall same survival compared to CABG in the long term follow-up.
Nevertheless, MACE and revascularization events were more frequent in PCI
compared to CABG.<br/>Copyright &#xa9; 2020 EDIZIONI MINERVA MEDICA

<69>
Accession Number
2013731887
Title
An overview of cardio-oncology, a new frontier to be explored.
Source
Acta Cardiologica Sinica. 37(5) (pp 457-463), 2021. Date of Publication:
September 2021.
Author
Cheng K.-H.; Wu Y.-W.; Hou C.J.; Hung C.-M.
Institution
(Cheng) Division of Cardiology, Department of Internal Medicine, E-Da
Cancer Hospital, China
(Cheng, Hung) College of Medicine, I-Shou University, Kaohsiung, China
(Wu) Division of Cardiology, Cardiovascular Medical Center, Far
EasternMemorial Hospital, New Taipei City, China
(Wu) School of Medicine, National Yang Ming Chiao Tung University, Taipei,
China
(Hou) Department of Medicine, MacKay Medical College, New Taipei City,
China
(Hou) Cardiovascular Division, Department of Internal Medicine, MacKay
Memorial Hospital, Taipei, China
(Hung) Department of Surgery, E-Da Cancer Hospital, I-Shou University, No.
1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 82445, Taiwan
(Republic of China)
Publisher
Republic of China Society of Cardiology
Abstract
Advances in cancer treatments have led to an increasing number of cancer
survivors, but also high rates of shortand long-term cardiovascular (CV)
toxicities. The number of new cancer drugs is constantly increasing, and
the uncertain CV toxicities of these drugs make long-term care and
monitoring difficult. Moreover, traditional type I and type II
cardiotoxicities may not be applicable to all of these agents.
Multidisciplinary care with expertise in oncology, cardiology and other
related specialties is required to mitigate cancer therapeutics-related
cardiovascular dysfunction (CTRCD). The aim of this review is to provide
an overview of themain CTRCD, risk assessment, early diagnosis, and
strategies for the prevention andmanagement of patients receiving cancer
therapies. There are still unmet needs for cardiooncology researchers with
regards to early detection measures, better treatment strategies, better
follow-up protocols, and better management of CTRCD. Experts in
cardiology, oncology, hematology, and radio-oncology should thus work
closely in an attempt to foster patient awareness and research in this
field, as well as call for support from public and industrial sources to
initiate pivotal clinical trials to solve these unmet needs.<br/>Copyright
&#xa9; 2021, Republic of China Society of Cardiology. All rights reserved.

<70>
Accession Number
2013661456
Title
Management of well-differentiated neuroendocrine tumors.
Source
Clinical Advances in Hematology and Oncology. 19(9) (pp 582-593), 2021.
Date of Publication: September 2021.
Author
Tella S.H.; Starr J.S.; Kommalapati A.; Sonbol M.B.; Halfdanarson T.R.
Institution
(Tella, Kommalapati, Halfdanarson) Division of Medical Oncology,
Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN
55906, United States
(Starr) Division of Medical Oncology, Mayo Clinic, Jacksonville, FL,
United States
(Sonbol) Division of Medical Oncology, Mayo Clinic, Phoenix, AZ, United
States
Publisher
Millennium Medical Publishing, Inc.
Abstract
Neuroendocrine tumors (NETs) are a heterogeneous group of epithelial
neoplasms with predominantly neural and endocrine differentiation that
have the ability to produce peptide hormones and other biologically active
substances. The histolog- ic characterization of NETs based on
differentiation and grading is crucial to determining prognosis and
treatment. Surgery still offers the best chance of cure for patients with
NETs, and tumor resection is the preferred approach when possible. For
locally advanced or metastatic disease, approaches to treatment can vary
widely depending on the extent of disease and goals of therapy. A better
understanding of the biology of NETs acquired over the last decade has
facilitated the development of targeted therapies, such as everolimus and
a variety of tyrosine kinase inhibitors. Further- more, the field of
theranostics has led to dramatic improvements in our diagnostic and
treatment abilities. Chemotherapy has a role in the treatment of NETs,
evidenced by the benefit shown with the combination of temozolomide and
capecitabine to treat pancreatic NETs. Somatostatin analogues are a
mainstay of treatment because they reduce secretory products and have
antiproliferative effects on NET cells. In this work, we aim to review the
landscape for the diagnosis and treatment of well-differentiated
NETs.<br/>Copyright &#xa9; 2021, Millennium Medical Publishing, Inc.. All
rights reserved.

<71>
Accession Number
2013610079
Title
Effect of nurse led education on anxiety level among coronary artery
bypass grafting pre-operative patients.
Source
Journal of the Pakistan Medical Association. 71(1 B) (pp 238-242), 2021.
Date of Publication: January 2021.
Author
Ali A.; Masih S.; Rabbi F.; Rasheed A.
Institution
(Ali, Masih) Institute of Nursing, Dow University of Health Sciences,
Karachi, Pakistan
(Rabbi) National Institute of Cardiovascular Diseases, Karachi, Pakistan
(Rasheed) Department of Research, Dow University of Health Sciences,
Karachi, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: The objective of this study was to identify the effect of
nurse-led pre-operative education in minimizing the level of anxiety among
patients waiting for Coronary Artery Bypass Grafting. <br/>Method(s): This
experimental study was accomplished at National Institute of
Cardiovascular Diseases. Out of 136, there were 80 patients identified
with the presence of anxiety using AKUADS 4 to 6 weeks before CABG. Data
were collected by the primary researcher from July 2016 to December 2016.
Patients with anxiety were divided into experimental and non-experimental
groups. After pre-operative education to the experimental group, patients
from both groups were re-assessed for anxiety level one week before CABG.
<br/>Result(s): Data were assessed through non-parametric Wilcoxon sign
ranked and Mann Whitney tests. It was found that anxiety reduced
significantly in post-assessment among experimental group participants. No
significant difference was found for pre-anxiety assessment between
experimental and non-experimental groups. It was noted that post
assessment anxiety differed significantly between experimental and
non-experimental groups. <br/>Conclusion(s): Pre-operative education was
found effective to decrease level of anxiety among patients waiting for
CABG. There was no significant difference between pre and post assessment
among patients from non-experimental group.<br/>Copyright &#xa9; 2021
Pakistan Medical Association. All rights reserved.

<72>
Accession Number
2013293633
Title
Safety and efficacy of simultaneous inoculations of pneumococcal and
influenza vaccines in patients with coronary artery disease.
Source
Journal of Atherosclerosis and Thrombosis. 28(8) (pp 826-834), 2021. Date
of Publication: 2021.
Author
Shimada K.; Morinaga H.; Kiyanagi T.; Miyazaki T.; Nishitani-Yokoyama M.;
Okai I.; Tamura H.; Konishi H.; Kurata T.; Miyauchi K.; Daida H.
Institution
(Shimada, Miyazaki, Nishitani-Yokoyama, Okai, Tamura, Konishi, Kurata,
Miyauchi, Daida) Department of Cardiovascular Medicine, Juntendo
University Graduate School of Medicine, Tokyo, Japan
(Shimada, Daida) Sportology Center, Juntendo University Graduate School of
Medicine, Tokyo, Japan
(Morinaga) Division of Cardiovascular Medicine, Tokyo Metropolitan Tama
Medical Center, Tokyo, Japan
(Kiyanagi) Division of General Medicine, Obihiro Daiichi Hospital,
Hokkaido, Japan
(Daida) Faculty of Health Science, Juntendo University, Tokyo, Japan
Publisher
Japan Atherosclerosis Society
Abstract
Aim: Pneumococcal and influenza infections can cause serious morbidity and
mortality in patients with cardiovascular diseases. The purpose of this
study was to investigate the safety and efficacy of simultaneous
inoculations of 23-valent pneumococcal polysaccharide vaccine (PPSV23) and
trivalent influenza vaccine (TIV) in patients with coronary artery disease
(CAD). <br/>Method(s): This was a prospective, randomized, single-blind,
placebo-controlled study. A total of 40 patients with CAD were randomly
assigned to the TIV+PPSV23 (simultaneous inoculations of TIV and PPSV23)
and TIV+Placebo (inoculations of TIV and placebo) groups. Primary outcomes
were the safety of simultaneous vaccinations and the changing of
circulating cardiovascular biomarkers before, at 4-, and at 12-weeks after
vaccinations. <br/>Result(s): The baseline characteristics between the two
groups were identical. The prevalence of injection-site pain, swelling,
and reddening were 47%, 37%, and 37% in the TIV+PPSV23 group, and 10%, 5%,
and 0% in the TIV+Placebo group, respectively. All reactions were
self-limited. Body temperature 37.0 or serious injection-related reaction
was not observed. The levels of white blood cells, high-sensitivity
C-reactive protein, N-terminal pro-B-type natriuretic peptide,
pentraxin-3, and malondialdehide-modified low-density lipoprotein (LDL),
were not significantly different between the two groups before and after
vaccinations. The levels of antioxidized LDL were significantly and
step-wisely decreased from baseline, to 4-, and 12-weeks vaccinations in
the both groups. No significant changes of other markers were observed in
both groups at each time point. <br/>Conclusion(s): Simultaneous
inoculations of TIV and PPSV23 were safety in patients with CAD,
suggesting that dual vaccinations can be considered even in patients with
CAD.<br/>Copyright &#xa9; 2021 Japan Atherosclerosis Society.

<73>
Accession Number
2010936436
Title
Effects of preoperative nutrition and multimodal prehabilitation on
functional capacity and postoperative complications in surgical lung
cancer patients: a systematic review.
Source
Supportive Care in Cancer. 29(10) (pp 5597-5610), 2021. Date of
Publication: October 2021.
Author
Ferreira V.; Lawson C.; Ekmekjian T.; Carli F.; Scheede-Bergdahl C.;
Chevalier S.
Institution
(Ferreira, Scheede-Bergdahl) Department of Kinesiology and Physical
Education, McGill University, Montreal, QC, Canada
(Lawson, Chevalier) School of Human Nutrition, McGill University,
Macdonald-Stewart Building, MS2-043, Macdonald Campus, 21111 Lakeshore
Road, Ste-Anne-de-Bellevue, Montreal, QC H9X 3V9, Canada
(Ekmekjian) Medical Libraries, McGill University Health Center, Montreal,
QC, Canada
(Carli) Department of Anesthesia, McGill University Health Centre,
Montreal, QC, Canada
(Chevalier) Research Institute of the McGill University Health Centre,
Montreal, QC, Canada
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: To determine the effect of preoperative nutrition and
multimodal prehabilitation on clinical and functional outcomes in surgical
lung cancer patients. <br/>Method(s): We searched MEDLINE, Cochrane
Library and CENTRAL, EMBASE, Scopus, and clinical trial registries
(clinicaltrials.gov, International Clinical Trials Registry Platform and
Google Scholar) to identify studies involving a preoperative
nutrition-based intervention or multimodal prehabilitation (nutrition with
exercise) of at least 7 days, in lung cancer patients awaiting surgery.
Studies must have reported results on at least one of the following
outcomes: functional capacity, pulmonary function, postoperative
complications, and length of hospital stay. The quality of included
studies was assessed using the Cochrane risk of bias assessment tool for
randomized trials and the modified Newcastle-Ottawa scale for
non-controlled trials. <br/>Result(s): Five studies were included (1
nutrition-only and 4 multimodal prehabilitation studies). Due to
substantial heterogeneity in the interventions across studies, a
meta-analysis was not conducted. Findings suggest that multimodal
prehabilitation, compared with standard hospital care, is associated with
improvements in both functional walking capacity and pulmonary function
during the preoperative period; however it does not appear to have an
effect on postoperative outcomes. Rather, the finding of significantly
lower rates of postoperative complications in the intervention group was
unique to the nutrition-only study. <br/>Conclusion(s): Multimodal
prehabilitation programs that combine nutrition and exercise may have
beneficial effects on various physical function outcomes in patients with
lung cancer awaiting surgery. Optimizing preoperative nutrition may have
postoperative benefits which remain to be confirmed.<br/>Copyright &#xa9;
2021, The Author(s), under exclusive licence to Springer-Verlag GmbH
Germany, part of Springer Nature.

<74>
Accession Number
2007552392
Title
Effect of music on patients with cardiovascular diseases and during
cardiovascular interventions: A systematic review.
Source
Wiener Klinische Wochenschrift. 133(15-16) (pp 790-801), 2021. Date of
Publication: August 2021.
Author
Ho C.-Y.; Wexberg P.; Schneider B.; Stollberger C.
Institution
(Ho, Wexberg, Stollberger) Klinik Landstrase, Juchgasse 25, Vienna 1030,
Austria
(Schneider) Sana Kliniken Lubeck, Kahlhorststr. 17, Lubeck 23562, Germany
(Ho) Liechtensteinstr. 8/12, Vienna 1090, Austria
Publisher
Springer
Abstract
Background: The therapeutic effects of music have been known for thousands
of years. Recently, studies with music interventions in patients with
cardiovascular diseases yielded controversial results. The aim of this
review is to provide an overview of the effects of receptive music
intervention on the cardiovascular system. <br/>Method(s): We searched in
PubMed, SCOPUS and CENTRAL for publications between January 1980 and May
2018. Primary endpoints were heart rate, heart rate variability and blood
pressure. Secondary endpoints comprised respiratory rate, anxiety and
pain. The quality of the studies was assessed by using the CONSORT
statement and the Cochrane risk of bias assessment tool. A meta-analysis
and subgroup analyses concerning music style, gender and region were
planned. <br/>Result(s): A total of 29 studies comprising 2579 patients
were included and 18 studies with 1758 patients investigated the effect of
music on patients undergoing coronary angiography or open heart surgery.
Other studies applied music to children with congenital heart diseases,
pregnant women with hypertension or patients with unstable angina. Due to
high methodological study heterogeneity, a meta-analysis was not
performed. The study quality was assessed as medium to low. In ten studies
with higher quality comprising 1054 patients, music intervention was not
associated with significant changes in the cardiovascular endpoints
compared to the control group. The subgroup analyses did not demonstrate
any relevant results. <br/>Conclusion(s): Currently no definite effect of
receptive music intervention on the cardiovascular system can be verified.
Further research is needed to assess music as an inexpensive and easy
applicable form of therapy.<br/>Copyright &#xa9; 2020, Springer-Verlag
GmbH Austria, part of Springer Nature.

<75>
Accession Number
2007396215
Title
One-year clinical and echocardiographic outcomes of direct implantation of
a self-expanding valve.
Source
Catheterization and Cardiovascular Interventions. 98(3) (pp E403-E411),
2021. Date of Publication: September 2021.
Author
Benetos G.; Karmpalioti M.; Drakopoulou M.; Stathogiannis K.; Xanthopoulou
M.; Latsios G.; Synetos A.; Bei E.; Voudris V.; Iakovou I.; Katsimagklis
G.; Moraitis S.; Zeniou V.; Danenberg H.; Halvatsiotis P.; Vavuranakis M.;
Tousoulis D.; Toutouzas K.
Institution
(Benetos, Karmpalioti, Drakopoulou, Stathogiannis, Xanthopoulou, Latsios,
Synetos, Bei, Vavuranakis, Tousoulis, Toutouzas) First Department of
Cardiology, Athens School of Medicine, Hippokration Hospital, Athens,
Greece
(Voudris, Iakovou) Department of Cardiology, Onassis Cardiac Surgery
Center, Athens, Greece
(Katsimagklis, Moraitis) Department of Cardiology, Naval Hospital of
Athens, Athens, Greece
(Zeniou, Danenberg) Heart Institute, Hadassah Hebrew University Medical
Center, Israel
(Halvatsiotis) Second Department of Internal Medicine, Athens School of
Medicine, Attikon University Hospital, Athens, Greece
Publisher
John Wiley and Sons Inc
Abstract
Objective: To present 1 year clinical and echocardiographic outcomes of
the randomized DIRECT (Pre-dilatation in Transcatheter Aortic Valve
Implantation Trial) trial. <br/>Background(s): Intermediate-term data from
randomized studies investigating the safety and efficacy of direct
implantation are lacking. <br/>Method(s): DIRECT trial randomized 171
consecutive patients with severe aortic stenosis at four tertiary centers
to undergo TAVI with the use of self-expanding prostheses with (pre-BAV)
or without pre-dilatation (no-BAV). The primary endpoint was device
success according to the VARC-2 criteria. All patients underwent a
clinical and echocardiographic follow-up at 1 year. All-cause and cardiac
mortality, stroke, heart failure hospitalization, and new pacemaker
implantation were recorded. <br/>Result(s): At 1 year, four deaths were
recorded in pre-BAV group (4.7%) and three deaths in no-BAV group (3.5%).
There was no difference in Kaplan-Meier plots between the two groups in
all-cause mortality at 1 year (log-rank p =.72). Similarly, there was no
difference in the incidence of permanent pacemaker implantation between
the two groups at 1 year (27/67-40.3% in no-BAV group versus 20/69-29% in
pre-BAV group, log-rank p =.24). There was no significant difference
between pre-BAV and no BAV group in aortic valve area (1.84 +/- 0.39
cm² vs. 1.85 +/- 0.44 cm², p =.90), mean aortic
valve gradient (8.36 +/- 5.04 vs. 8.00 +/- 4.04 mmHg, p =.65) and moderate
or severe paravalvular regurgitation (5-6.6 vs. 4-5.7%, respectively) at 1
year. The same applied independently from the performance of
post-dilatation at baseline. <br/>Conclusion(s): Direct, without
pre-dilatation, implantation of a self-expanding valve has no impact on
one-year clinical and echocardiographic outcomes, independently also from
the baseline performance of post-dilatation.<br/>Copyright &#xa9; 2020
Wiley Periodicals LLC.

<76>
Accession Number
635624106
Title
Duration of dual antiplatelet therapy and stability of coronary heart
disease: A 60 000-patient meta-analysis of randomised controlled trials.
Source
Open Heart. 8(2) (no pagination), 2021. Article Number: e001707. Date of
Publication: 02 Aug 2021.
Author
Bularga A.; Meah M.N.; Doudesis D.; Shah A.S.V.; Mills N.L.; Newby D.E.;
Lee K.K.
Institution
(Bularga, Meah, Doudesis, Mills, Newby, Lee) BHF Centre for Cardiovascular
Science, University of Edinburgh Division of Clinical and Surgical
Sciences, Edinburgh, United Kingdom
(Shah) Department of Non-Communicable Diseases, London School of Hygiene
and Tropical Medicine, London, United Kingdom
(Shah) Department of Cardiology, Imperial College Healthcare NHS Trust,
London, United Kingdom
(Mills) Usher Institute, University of Edinburgh Division of Health
Sciences, Edinburgh, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Background Dual antiplatelet therapy (DAPT) has important implications for
clinical outcomes in coronary disease. However, the optimal DAPT duration
remains uncertain. Methods and results We searched four major databases
for randomised controlled trials comparing long-term (>=12 months) with
short-term (<=6 months) or shorter (<=3 months) DAPT in patients with
coronary syndromes. The primary outcome was all-cause mortality. Secondary
outcomes were any bleeding and major bleeding (safety), cardiac death,
myocardial infarction, stent thrombosis, revascularisation and stroke
(efficacy). Nineteen randomised controlled trials (n=60 111) satisfied
inclusion criteria, 8 assessed <=3 months DAPT. Compared with long-term
(>=12 months), short-term DAPT (<=6 months) was associated with a trend
towards reduced all-cause mortality (RR: 0.90, 95% CI: 0.80 to 1.01) and
significant bleeding reduction (RR: 0.68, 95% CI: 0.55 to 0.83 and RR:
0.66, 95% CI: 0.56 to 0.77 for major and any bleeding, respectively).
There were no significant differences in efficacy outcomes. These
associations persisted in sensitivity analysis comparing shorter duration
DAPT (<=3 months) to long-term DAPT (>=12 months) for all-cause mortality
(RR: 0.91, 95% CI: 0.79 to 1.05). In subgroup analysis, short-term DAPT
was associated with lower risk of bleeding in patients with acute or
chronic coronary syndromes (RR: 0.66, 95% CI: 0.54 to 0.81 and RR: 0.53,
95% CI: 0.33 to 0.65, respectively), but higher risk of stent thrombosis
in acute coronary syndrome (RR: 1.49, 95% CI: 1.02 to 2.17 vs RR: 1.25,
95% CI 0.44 to 3.58). Conclusion Our meta-analysis suggests that short
(<=6 months) and shorter (<=3 months) durations DAPT are associated with
lower risk of bleeding, equivalent efficacy and a trend towards lower
all-cause mortality irrespective of coronary artery disease
stability.<br/>Copyright &#xa9; Authors 2021

<77>
Accession Number
634748825
Title
Cognitive Outcomes after DEXmedetomidine sedation in cardiac surgery:
CODEX randomised controlled trial protocol.
Source
BMJ Open. 11(4) (no pagination), 2021. Article Number: e046851. Date of
Publication: 13 Apr 2021.
Author
Choi S.; Jerath A.; Jones P.; Avramescu S.; Djaiani G.; Syed S.; Saha T.;
Kaustov L.; Kiss A.; D'Aragon F.; Hedlin P.; Rajamohan R.; Couture E.J.;
Singh A.; Mapplebeck J.C.S.; Wong S.; Orser B.A.
Institution
(Choi, Jerath, Kaustov, Singh, Mapplebeck, Wong, Orser) Department of
Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
(Choi, Jerath, Avramescu, Djaiani, Wong, Orser) Department of
Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University
of Toronto, Toronto, ON, Canada
(Jones) Department of Anesthsia and Perioperative Medicine, University of
Western Ontario, London, ON, Canada
(Avramescu) Department of Anesthesia, Humber River Hospital, Toronto, ON,
Canada
(Djaiani) Department of Anesthesia and Pain Management, Toronto General
Hospital, University Health Network, Toronto, ON, Canada
(Syed) Department of Anesthesia, McMaster University, Hamilton, ON, Canada
(Saha) Department of Anesthesiology and Perioperative Medicine, Queen's
University, Kingston, ON, Canada
(Kiss) Sunnybrook Research Institute, Toronto, ON, Canada
(D'Aragon) Department d'anesthesiologie, Universite de Sherbrooke,
Sherbrooke, QC, Canada
(Hedlin) Department of Anesthesiology, Perioperative Medicine and Pain
Management, University of Saskatchewan, Saskatoon, SK, Canada
(Rajamohan) Department of Anesthesiology, Pharmacology and Therapeutics,
The University of British Columbia, Vancouver, BC, Canada
(Couture) Department of Anesthesiology and Cardiac Surgical Intensive Care
Division, Montreal Heart Institute, Universite de Montreal, Montreal, QC,
Canada
(Orser) Department of Physiology, University of Toronto, Toronto, ON,
Canada
Publisher
BMJ Publishing Group
Abstract
Introduction Older patients undergoing cardiac surgery carry the highest
risk for developing major postoperative neurocognitive disorder
(postoperative NCD or P-NCD) with up to 25% incidence 3 months after
surgery. P-NCD is associated with significant morbidity, mortality, loss
of independence, premature retirement and increased healthcare costs. This
multicentre randomised trial is investigating the efficacy of
postoperative dexmedetomidine sedation in reducing the incidence of major
P-NCD after cardiac surgery compared with standard protocols. CODEX will
be the largest interventional trial with major P-NCD as the primary
outcome. Methods and analysis CODEX is recruiting patients >=60 years old,
undergoing elective cardiac surgery and without pre-existing major
cognitive dysfunction or dementia. Eligible participants are randomised to
receive postoperative dexmedetomidine or standard institutional sedation
protocols in the intensive care unit. Baseline preoperative cognitive
function is assessed with the computer-based Cogstate Brief Battery. The
primary outcome, major P-NCD, 3 months after surgery is defined as a
decrease in cognitive function >=1.96 SD below age-matched, non-operative
controls. Secondary outcomes include delirium, major P-NCD at 6/12 months,
depressive symptoms, mild P-NCD and quality of surgical recovery at 3/6/12
months. The specific diagnostic criteria used in this protocol are
consistent with the recommendations for clinical assessment and management
of NCD from the Nomenclature Consensus Working Group on perioperative
cognitive changes. Intention-to-treat analysis will compare major P-NCD at
3 months between study groups. Ethics and dissemination CODEX was approved
by Sunnybrook Health Sciences Centre Research Ethics Board (REB) (Project
ID 1743). This will be the first multicentre, randomised controlled trial
to assess the efficacy of a pharmacological intervention to reduce the
incidence of major P-NCD after cardiac surgery in patients >=60 years old.
Dissemination of the study results will include briefings of key findings
and interpretation, conference presentations and peer-reviewed
publications.<br/>Copyright &#xa9; 2021 Author(s).

<78>
Accession Number
2014470324
Title
Ten-year all-cause mortality following staged percutaneous
revascularization in patients with complex coronary artery disease.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Kawashima H.; Ono M.; Hara H.; de Winter R.J.; Holmes D.R.; Thuijs
D.J.F.M.; Milojevic M.; Garg S.; Serruys P.W.; Onuma Y.
Institution
(Kawashima, Ono, Hara, Serruys, Onuma) Department of Cardiology, National
University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for
Research and Imaging, Galway, Ireland
(Kawashima, Ono, Hara, de Winter) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Thuijs, Milojevic) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Serruys, Onuma) CURAM, the SFI Research Centre for Medical Devices,
Galway, Ireland
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Medical and/or economic reasons sometimes necessitate the
staging of percutaneous coronary intervention (SPCI) procedures in
patients with complex coronary artery disease; however, the impact of this
on very long-term outcomes is unknown. The aim of the present study is to
assess 10-year all-cause mortality in patients with the three-vessel
disease (3VD) and/or left main disease (LM) undergoing SPCI.
<br/>Method(s): This is a sub-analysis of patients undergoing SPCI in the
SYNTAXES study, which investigated 10-year all-cause mortality in patients
with 3VD and/or LM in the randomized SYNTAX trial, beyond its original
5-year follow-up. An SPCI was allowed within 72 h or, if renal
insufficiency or contrast-induced nephropathy occurred, within 14 days of
the index procedure. Mortality was compared between patients having SPCI
versus those not having SPCI or undergoing CABG. PCI patients were further
stratified according to 3VD or LM. <br/>Result(s): In the SYNTAX PCI
population (overall: n = 903, 3VD: n = 546, LM: n = 357), 125 (13.8%)
patients underwent SPCI. Patients with SPCI had a higher 10-year mortality
compared to those who didn't (40.0% vs 26.6%; hazard ratio [HR] 1.69; 95%
confidence interval [CI] 1.23-2.32; p < 0.01) and those having CABG(40.0%
vs 24.5%; HR 1.85; 95%CI 1.35-2.53; p < 0.01). Patients having SPCI with
3VD (n = 103) or LM (n = 22) had higher mortality than respective patients
not having SPCI (3VD: 37.4% vs 27.1%; HR 1.52; 95%CI 1.05-2.21; p = 0.03
and LM: 51.8% vs 25.9%; HR 2.39; 95%CI 1.27-4.47; p = 0.01).
<br/>Conclusion(s): At 10-year follow-up, SPCI was associated with higher
mortality than single-session PCI, so that CABG may be preferable if a
staged procedure is anticipated.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<79>
Accession Number
636090697
Title
Systematic review and meta-analysis of the sedative effects and safety of
dexmedetomidine in patients after cardiac surgery.
Source
Annals of palliative medicine. 10(8) (pp 8952-8962), 2021. Date of
Publication: 01 Aug 2021.
Author
Wu J.; Li G.; Zhang H.; Li H.
Institution
(Wu, Li, Zhang, Li) Department of Anesthesiology, Fourth Hospital of
Shijiazhuang, Obstetrics and Gynecology Hospital of Hebei Medical
University, Shijiazhuang, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In order to increase the sample size and improve the test
efficiency from a statistical perspective, we conducted a combined
analysis of multiple results from similar studies. In this study, we
conducted a meta-analysis to investigate the sedative effect of
dexmedetomidine on patients after cardiac surgery, so as to provide
theoretical basis and help for clinical treatment of cardiac diseases.
<br/>METHOD(S): The Boolean logic search method was employed to search
online databases for publications, with "dexmedetomidine", "cardiac
surgery", "competitive antagonist", and "analgesic sedation" used as
keywords. In addition, the literature was screened for comparative studies
on the use of midazolam and propofol as controls. The Newcastle-Ottawa
Scale (NOS) of Cochrane Collaborative Network was used to evaluate the
pathological control studies in Meta-analysis, and the star rating system
(out of 9 stars) was used to measure the results from the subjects, cases
and groups. Finally, a meta-analysis was performed with Review Manager
software (Cochrane). <br/>RESULT(S): Thirteen references containing mostly
low-risk biases (medium-high quality) were included in this study. The
meta-analysis showed no statistically obvious heterogeneity in the
mechanical ventilation time (MVT) between patients in the control group
(group A) or patients in the experimental group (group B) (Chi2=74.71;
I2=92%; P<0.00001), showing no statistical significance (Z=1.57; P=0.12).
Heterogeneity was found as a complication in both groups (Chi2=14.82;
I2=60%; P=0.02), but fewer complications were observed in group B (Z=2.06,
P=0.04). The sedative effect displayed by patients from the 2 groups
during the induction of anesthesia was statistically heterogeneous
(Chi2=6.45; I2=38%; P=0.17), but the sedative effect in group B was shown
to be greater (Z=3.31, P=0.0009). <br/>CONCLUSION(S): Dexmedetomidine can
significantly reduce the mechanical ventilation time and the incidence of
complications in patients after cardiac surgery, and has a high safety and
good sedative effect on patients.

<80>
[Use Link to view the full text]
Accession Number
636016368
Title
Comparison of results of transcatheter femoral aortic valve replacement
under local and general anesthesia: A protocol for systematic review and
meta-analysis.
Source
Medicine. 100(34) (pp e27085), 2021. Date of Publication: 27 Aug 2021.
Author
Han X.; Liu S.; Wang J.; Chen H.; Chen Y.; Song B.
Institution
(Han, Wang, Chen, Chen) First Clinical Medical College of Lanzhou
University
(Liu, Song) Department of Cardiovascular Surgery, First Hospital of
Lanzhou University, Lanzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Traditionally, TAVR (Transcatheter Aortic Valve Replacement)
has been performed under general anesthesia (GA). Thus GA facilitates the
use of TEE (Transesophageal echocardiography), and the use of TEE is an
important means to improve the quality of cardiac surgery and reduce
postoperative complications. However, GA was also associated with
prolonged mechanical ventilation, longer hospitalization and intensive
care unit hours, and the need for positive inotropic agents. With
increasing clinical experience and advances in transcatheter techniques,
transfemoral TAVR may also be feasible under local anesthesia (LA).
Studies have shown that LA can avoid hemodynamic fluctuations caused by
general anesthesia and lung damage caused by positive pressure
ventilation, and can also reduce medical costs. <br/>METHOD(S): Two
researchers independently read the titles and abstracts of the literature
obtained. After excluding the studies that did not meet the inclusion
criteria, they read through the full text of the remaining literatures to
determine whether they truly met the inclusion criteria. When two
researchers disagree on the included literature, the third researcher
decides whether to include it or not. For literature with incomplete data,
contact the author via email for unpublished data. The included studies
were assessed by two researchers for the risk of bias, and cross-checked.
Stata16.0 was used for meta-analysis. Heterogeneity was assessed by chi2
test and I2 quantification. Pooled analysis was performed by random
effects model. Sensitivity analysis was performed by excluding references
one by one. We will perform subgroup analysis based on data conditions.
<br/>RESULT(S): In this study, high quality evidence was provided by
selecting local anesthesia and general anesthesia during transfemoral
transcatheter aortic valve replacement for patients with primary arterial
stenosis. <br/>CONCLUSION(S): Local anesthesia provides anaesthetic-guided
sedation that does not require intubation and is safe and effective. Local
anesthesia may be a better alternative to TAVR under general anesthesia.
ETHICS AND DISSEMINATION: The study does not require ethical approval.
INPLASY REGISTRATION NUMBER: INPLASY202170078.<br/>Copyright &#xa9; 2021
the Author(s). Published by Wolters Kluwer Health, Inc.

<81>
Accession Number
632475186
Title
Have We Learnt all from IMPROVE-IT? Part I. Core Results and Subanalyses
on the Effects of Ezetimibe Added to Statin Therapy Related to Age, Gender
and Selected Chronic Diseases (Kidney Disease, Diabetes Mellitus and
Non-Alcoholic Fatty Liver Disease).
Source
Current vascular pharmacology. 19(5) (pp 451-468), 2021. Date of
Publication: 2021.
Author
Fras Z.; Mikhailidis D.P.
Institution
(Fras) Centre for Preventive Cardiology, Department of Vascular Medicine,
Division of Medicine, University Medical Centre, Ljubljana, Slovenia
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Hospital
Campus, University College Medical School, University College London,
London, United Kingdom
Publisher
NLM (Medline)
Abstract
IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International
Trial) was a randomized clinical trial (including 18,144 patients) that
evaluated the efficacy of the combination of ezetimibe with simvastatin
vs. simvastatin monotherapy in patients with acute coronary syndrome (ACS)
and moderately increased low-density lipoprotein cholesterol (LDL-C)
levels (of up to 2.6-3.2 mmol/L; 100-120 mg/dL). After 7 years of
follow-up, combination therapy resulted in an additional LDL-C decrease
[to 1.8 mmol/L, or 70 mg/dL, within the simvastatin (40 mg/day)
monotherapy arm and to 1.4 mmol/L, or 53 mg/dL for simvastatin (40 mg/day)
+ ezetimibe (10 mg/day)] and showed an incremental clinical benefit
[composite of cardiovascular death, nonfatal myocardial infarction,
unstable angina requiring rehospitalization, coronary revascularization
(>=30 days after randomization), or nonfatal stroke; hazard ratio (HR) of
0.936, and 95% CI 0.887-0.996, p=0.016]. Therefore, for very high
cardiovascular risk patients "even lower is even better" regarding LDL-C,
independently of the LDL-C reducing strategy. These findings confirm
ezetimibe as an option to treat very-high-risk patients who cannot achieve
LDL-C targets with statin monotherapy. Additional analyses of the
IMPROVE-IT (both prespecified and post-hoc) include specific
very-high-risk subgroups of patients (those with previous acute events
and/or coronary revascularization, older than 75 years, as well as
patients with diabetes mellitus, chronic kidney disease or non-alcoholic
fatty liver disease). The data from IMPROVE-IT also provide reassurance
regarding longer-term safety and efficacy of the intensification of
lipid-lowering therapy in very-high-risk patients resulting in very low
LDL-C levels. We comment on the results of several (sub) analyses of
IMPROVE-IT.<br/>Copyright&#xa9; Bentham Science Publishers; For any
queries, please email at epub@benthamscience.net.

<82>
Accession Number
633467482
Title
Effect of Soft Silicone Foam Dressings on Intraoperatively Acquired
Pressure Injuries: A Randomized Study in Patients Undergoing Spinal
Surgery.
Source
Wound management & prevention. 66(11) (pp 22-29), 2020. Date of
Publication: 01 Nov 2020.
Author
Yang T.-Y.; Shin S.H.
Institution
(Yang) College of Nursing Science, Kyung Hee University, Seoul, South
Korea
(Shin) College of Nursing Science, East-West Nursing Research Institute,
Kyung Hee University, Seoul, South Korea
Publisher
NLM (Medline)
Abstract
The use of prophylactic dressings to help prevent intraoperatively
acquired pressure injuries (IAPIs) merits further study. PURPOSE: To
examine how the use of a soft silicone foam dressing affects the
development of IAPIs in patients undergoing spinal surgery to obtain
baseline data supporting evidence-based nursing care. <br/>METHOD(S):
Using a self-controlled study design, 64 patients requiring thoracic or
lumbar surgery on a Wilson frame at a hospital in Seoul, South Korea, were
recruited between February 12 and September 1, 2018; 50 patients were
eligible. Basic demographic, health, and surgical data were obtained.
Before surgery, the left or right side chest and iliac crest areas were
randomly assigned to be covered with a soft silicone foam dressing. The
areas were assessed at 2 time points: immediately after and 30 minutes
after surgery. If an IAPI was present at 30 minutes after surgery, all
sites were reevaluated after 7 days. <br/>RESULT(S): The majority of
participants were male (26 participants, 52%). Average patient age was
62.54 (+/- 13.83) years, with a body mass index of 24.32 (+/- 4.23) kg/m2.
Average length of surgery was 218.4 (+/- 137) minutes. Immediately after
surgery, 26 IAPIs were observed and there was a significant difference
between dressed and non-dressed chest areas for the number of IAPIs (4%
vs. 28%; P = .002). After 30 minutes, the total number of IAPIs was 20 and
the difference between IAPIs in the iliac crest area was significant
between dressed and non-dressed areas (0% vs. 14%; P = .012). After 1
week, there were no chest or iliac crest IAPIs in the areas that had been
covered by a dressing; however, 8 chest (61.5%) and 4 iliac crest (30.8%)
area IAPIs remained when no dressing had been applied. The majority of
IAPIs were stage 1 at all assessment times. After 1 week, 1 IAPI had
evolved into a stage 3 injury. <br/>CONCLUSION(S): The results of this
study show that many stage 1 IAPIs do resolve over time and that use of
soft silicone foam dressings during spinal surgery can significantly
reduce IAPI rates. Additional longitudinal studies are needed to help
guide postoperative skin assessment intervals and increase the
understanding about the evolution of stage 1 IAPIs.

<83>
Accession Number
2014770600
Title
Standardizing Exercise Prescription Parameters for Patients with LVAD
Placement as a Destination Device: A Scoping Review of Effectiveness and
Impact on Functional Capacity and Quality of Life.
Source
Archives of Physical Medicine and Rehabilitation. Conference: The ACRM
Annual Conference, Progress in Rehabilitation Research. Virtual, Online.
102(10) (pp e120), 2021. Date of Publication: October 2021.
Author
McKevitt S.; OShea R.
Institution
(McKevitt) Governors State University
Publisher
W.B. Saunders
Abstract
Objective(s): To summarize current knowledge regarding the impact of
exercise training in patients supported by LVADs and serve as a foundation
for clinicians to reference when tailoring interventions to improve FC in
patients treated with modern durable LVADs. <br/>Data Sources: Author
searched PubMed, Ovid, CCTR, CDSR, CINAHL, Proquest, and Google Scholar
starting on January 31, 2021. Study Selection: Studies from 2015 to
current, written in English, subjects at least 18 years of age with
end-stage HF, ineligible for heart transplantation, who received an LVAD
with the intent of destination or terminal therapy, and various forms of
publication (systematic reviews, RCT, cohort studies, cross-sectional
studies, observational studies, meta-analyses, retrospective studies, and
case reports), were included. <br/>Data Extraction: Arksey and O'Malley's
framework and the PRISMA Extension for Scoping Reviews guided data
synthesis. Collected data independently extracted by one owner. <br/>Data
Synthesis: 15,179 articles found in the three search strategy attempts, 22
were included. Studies assessing the impact of exercise training on
quality of life (QofL) reported that moderate intensity is safe and
effective in improving cardiopulmonary outcomes and is associated with
favorable QofL parameters. Majority of included studies also indicated
that LVADs can support submaximal exercise, but are not sufficient during
peak exertion. <br/>Conclusion(s): Cardiac rehabilitation programs for
patients with LVAD placement as a destination therapy require a multimodal
approach with specific exercise training parameters. Methods of delivery
should encompass both aerobic exercises and aerobic strength training with
special attention to working at a moderate level intensity in order to
improve cardiopulmonary outcomes without adverse events. In addition,
implementation of a cardiac rehabilitation program can lead to major
improvement in patient's perceived QofL. Author(s) Disclosures: No
conflicts of interest.<br/>Copyright &#xa9; 2021

<84>
[Use Link to view the full text]
Accession Number
636091607
Title
Risk of Stroke After Transcatheter Aortic Valve Implantation:
Epidemiology, Mechanism, and Management.
Source
American journal of therapeutics. 28(5) (pp e560-e572), 2021. Date of
Publication: 25 Jun 2021.
Author
Ciobanu A.-O.; Gherasim L.; Vinereanu D.
Institution
(Ciobanu, Gherasim, Vinereanu) University of Medicine and Pharmacy Carol
Davila, Bucharest, Romania; and
(Ciobanu, Vinereanu) Department of Cardiology and Cardiovascular Surgery
University and Emergency Hospital Bucharest, Bucharest, Romania
Publisher
NLM (Medline)
Abstract
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become an
established and increasingly used approach for management of severe
symptomatic aortic stenosis, showing similar or even superior outcomes
compared with standard surgical aortic valve replacement (SAVR). Stroke
after TAVI is a relatively rare, but serious complication, associated with
potential prolonged disability and increased mortality. AREAS OF
UNCERTAINTY: The overall incidence of 30-day stroke in TAVI patients is
3%-4%, but varies between different trials. Initial data suggested a
higher risk of stroke after TAVI when compared with SAVR. The association
between subclinical leaflet thrombosis and cerebral embolism, presented as
stroke, transient ischemic accident, or silent cerebral ischemia is not
entirely elucidated yet. Moreover, TAVI for severe bicuspid aortic
stenosis is a relatively new issue, bicuspid anatomy being initially
excluded from the pivotal clinical trials investigating TAVI procedure.
Efficient stroke prevention strategies are under investigation. DATA
SOURCES: In the present manuscript, we used the available published data
from the most relevant clinical trials, registries, and meta-analysis of
patients from different risk categories who underwent TAVI or SAVR.
THERAPEUTIC ADVANCES: Predictors of acute stroke are mainly procedure
related. Technological development, improvements in bioprosthesis valve
delivery catheters, and implantation technique may explain the decrease of
stroke over the years since the beginning of TAVI procedures.
<br/>CONCLUSION(S): The overall evidences confirm similar or lower rate of
stroke in TAVI versus SAVR. Risk predictors for acute stroke after TAVI
are generally related to procedural factors, whereas late stroke is mainly
associated with patient characteristics, with a variable impact on
cognitive function. The optimal choice for the antithrombotic treatment in
TAVI for stroke prevention is yet to be determined. Current data do not
support routine use of cerebral embolic protection devices during
TAVI.<br/>Copyright &#xa9; 2021 Wolters Kluwer Health, Inc. All rights
reserved.

<85>
Accession Number
2013955980
Title
The pandora's box of frailty assessments: Which is the best for clinical
purposes in TAVI patients? a critical review.
Source
Journal of Clinical Medicine. 10(19) (no pagination), 2021. Article
Number: 4506. Date of Publication: October-1 2021.
Author
Baritello O.; Salzwedel A.; Sundermann S.H.; Niebauer J.; Voller H.
Institution
(Baritello) Faculty of Health Sciences Brandenburg, Department of
Rehabilitation Medicine, University of Potsdam, Brandenburg 14469, Germany
(Baritello, Salzwedel, Voller) Research Group Molecular and Clinical Life
Science of Metabolic Diseases, Faculty of Health Sciences Brandenburg,
University of Potsdam, Potsdam 14476, Germany
(Sundermann) Department of Cardiovascular Surgery,
Charite-Universitatsmedizin Berlin, Berlin 10117, Germany
(Sundermann) Department of Cardiothoracic and Vascular Surgery, German
Heart Center Berlin, Berlin 13353, Germany
(Sundermann) DZHK (German Center for Cardiovascular Research), Partner
Site Berlin, Berlin 13353, Germany
(Niebauer) University Institute of Sports Medicine, Prevention and
Rehabilitation and Research Institute of Molecular Sports Medicine and
Rehabilitation, Paracelsus Medical University, Salzburg A-5020, Austria
Publisher
MDPI
Abstract
Frailty assessment is recommended before elective transcatheter aortic
valve implantation (TAVI) to determine post-interventional prognosis.
Several studies have investigated frailty in TAVI-patients using numerous
assessments; however, it remains unclear which is the most appropriate
tool for clinical practice. Therefore, we evaluate which frailty
assessment is mainly used and meaningful for <=30-day and >=1-year
prognosis in TAVI patients. Randomized controlled or observational studies
(prospective/retrospective) investigating all-cause mortality in older
(>=70 years) TAVI patients were identified (PubMed; May 2020). In total,
79 studies investigating frailty with 49 different assessments were
included. As single markers of frailty, mostly gait speed (23 studies) and
serum albumin (16 studies) were used. Higher risk of 1-year mortality was
predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95%
confidence interval (CI) 6.50-33.30) and lower serum albumin level
(highest HR: 3.12; 95% CI 1.80-5.42). Composite indices (five items; seven
studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95%
CI 2.71-86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55-4.87).
In conclusion, single markers of frailty, in particular gait speed, were
widely used to predict 1-year mortality. Composite indices were
appropriate, as well as a comprehensive assessment of
frailty.<br/>Copyright &#xa9; 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<86>
Accession Number
2014797315
Title
Development and validation of a nomogram model for early postoperative
hyperlactatemia in patients undergoing cardiac surgery.
Source
Journal of Thoracic Disease. 13(9) (pp 5395-5408), 2021. Date of
Publication: September 2021.
Author
Wang S.; Wang D.; Huang X.; Wang H.; Le S.; Zhang J.; Du X.
Institution
(Wang, Zhang) Department of Emergency Medicine, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
(Wang, Huang, Wang, Le, Du) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
Publisher
AME Publishing Company
Abstract
Background: Postoperative hyperlactatemia (POHL) is common in patients
undergoing cardiac surgery, associated with adverse outcomes. The aim of
this study was to identify predictors for POHL after cardiac surgery and
to develop and validate a predictive model. <br/>Method(s): Adult patients
who underwent open heart surgery at our institution between 2016 and 2019
were retrospectively included. The patients were randomly divided into
training and validation groups at a 2:1 ratio. Multivariate logistic
regression was performed to identify independent predictors for POHL in
the training set. A nomogram was then constructed and was validated in the
validation set. <br/>Result(s): POHL developed in 713 of the 5,323
patients (13.4%). The mortality rate was higher in patients with POHL
compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white
blood cell (WBC) count, left ventricular ejection fraction, renal
insufficiency, cardiac surgery history, red blood cell (RBC) transfusion,
and cardiopulmonary bypass (CPB) time were identified as independent risk
factors. The nomogram based on these predictors indicated good
discrimination in both the training (c-index: 0.787) and validation
(c-index: 0.820) sets. The calibration was reasonable by both visual
inspection and goodness-of-fit test. The decision and clinical impact
curves demonstrated good clinical utility. <br/>Conclusion(s): We
identified 7 independent risk factors and derived a prediction model for
POHL in patients undergoing cardiac surgery. The model may contribute
significantly to early risk assessment and clinical
intervention.<br/>Copyright &#xa9; 2021 AME Publishing Company. All rights
reserved.

<87>
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

<88>
Accession Number
2013803367
Title
A pilot randomized clinical trial of cryopreserved versus liquid-stored
platelet transfusion for bleeding in cardiac surgery: The cryopreserved
versus liquid platelet-New Zealand pilot trial.
Source
Vox Sanguinis. (no pagination), 2021. Date of Publication: 2021.
Author
McGuinness S.; Charlewood R.; Gilder E.; Parke R.; Hayes K.; Morley S.;
Al-Ibousi A.; Deans R.; Howe B.; Johnson L.; Marks D.C.; Reade M.C.
Institution
(McGuinness, Gilder, Parke) Cardiothoracic and Vascular Intensive Care
Unit, Auckland City Hospital, Auckland, New Zealand
(McGuinness, Parke) Medical Research Institute of New Zealand, Wellington,
New Zealand
(McGuinness, Parke, Howe, Reade) Australian and New Zealand Intensive Care
Research Centre, School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Charlewood, Morley, Al-Ibousi) New Zealand Blood Service, Auckland, New
Zealand
(Gilder, Parke) School of Nursing, The University of Auckland, Auckland,
New Zealand
(Hayes) Greenlane Department of Cardiothoracic Anaesthesia, Auckland City
Hospital, Auckland, New Zealand
(Deans, Reade) Faculty of Medicine, University of Queensland, Royal
Brisbane and Women's Hospital, Herston, QLD, Australia
(Johnson, Marks) Australian Red Cross Lifeblood, Alexandria, NSW,
Australia
(Reade) Joint Health Command, Australian Defence Force, Canberra, ACT,
Australia
Publisher
John Wiley and Sons Inc
Abstract
Background and Objectives: Platelets for transfusion have a shelf-life of
7 days, limiting availability and leading to wastage. Cryopreservation at
-80degreeC extends shelf-life to at least 1 year, but safety and
effectiveness are uncertain. <br/>Material(s) and Method(s): This single
centre blinded pilot trial enrolled adult cardiac surgery patients who
were at high risk of platelet transfusion. If treating clinicians
determined platelet transfusion was required, up to three units of either
cryopreserved or liquid-stored platelets intraoperatively or during
intensive care unit admission were administered. The primary outcome was
protocol safety and feasibility. <br/>Result(s): Over 13 months, 89
patients were randomized, 23 (25.8%) of whom received a platelet
transfusion. There were no differences in median blood loss up to 48 h
between study groups, or in the quantities of study platelets or other
blood components transfused. The median platelet concentration on the day
after surgery was lower in the cryopreserved platelet group (122 x
10³/mul vs. 157 x 10³/mul, median difference 39.5
x10³/mul, p = 0.03). There were no differences in any of the
recorded safety outcomes, and no adverse events were reported on any
patient. Multivariable adjustment for imbalances in baseline patient
characteristics did not find study group to be a predictor of 24-h blood
loss, red cell transfusion or a composite bleeding outcome.
<br/>Conclusion(s): This pilot randomized controlled trial demonstrated
the feasibility of the protocol and adds to accumulating data supporting
the safety of this intervention. Given the clear advantage of prolonged
shelf-life, particularly for regional hospitals in New Zealand, a
definitive non-inferiority phase III trial is warranted.<br/>Copyright
&#xa9; 2021 International Society of Blood Transfusion.

<89>
Accession Number
636094424
Title
Trial of Intensive Blood-Pressure Control in Older Patients with
Hypertension.
Source
The New England journal of medicine. (no pagination), 2021. Date of
Publication: 30 Aug 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, Wu, Ren, Sun, Yang, Jiang, Xu, Wang, Chen, Li, Yao,
Li, Wang, Shen, Yin, Liu, Zhou, Zhu, Guo, Liu, Chen, Feng, Tian, Gao,
Kario, Cai) From 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 (W.Z., S.Z., Y.D., J.C.), Peking Union Medical College Hospital
(S.Z.), Beijing Pinggu Hospital (Y.L.), and Beijing Hospital (W.L.),
Beijing, Kailuan General Hospital, Tangshan (S.W.), Shanxi Bethune
Hospital, Shanxi Academy of Medical Sciences (J.R.), and the First
Affiliated Hospital of Shanxi Medical University (X.S.), Taiyuan, the
Second Affiliated Hospital of Baotou Medical College, Baotou (G.S.), the
People's Hospital of Ji Xian District, Tianjin (J.Y.), the First
Affiliated Hospital of Dalian Medical University (Y.J.) and Omron Dalian
(X.G.), Dalian, the First Affiliated Hospital of Xinjiang Medical
University, Urumqi (X.X.), the Second Affiliated Hospital of Medical
College Shantou University, Shantou (Y.C.), Benxi Railway Hospital, Benxi
(L.Y.), Hongxinglong Center Hospital, Shuangyashan (D.L.), the First
Affiliated Hospital of Hebei North University, Zhangjiakou (L.W.), the
First Affiliated Hospital of Harbin Medical University, Harbin (X.Y.),
Renmin Hospital of Wuhan University, Wuhan (X.Z.), Kang Ya Hospital,
Yiyang (B.Z.), FuWai Yunnan Cardiovascular Hospital, Kunming (Z.G.),
Zhoukou City Central Hospital, Zhoukou (H.L.), West China Hospital,
Sichuan University, Chengdu (X.C.), Guangdong Cardiovascular Institute,
Guangzhou (Y.F.), and the First Affiliated Hospital of Xi'an Jiaotong
University, Xi'an (G.T.) - all in China; the Cardiovascular Center and
Divisions of Cardiology and Hospital Medicine, Department of Internal
Medicine, National Taiwan University Hospital, Taipei (T.-D.W.); and Jichi
Medical University School of Medicine, Shimotsuke, Japan (K.K.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The appropriate target for systolic blood pressure to reduce
cardiovascular risk in older patients with hypertension remains unclear.
<br/>METHOD(S): 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. <br/>RESULT(S): 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. <br/>CONCLUSION(S): 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. (Funded by the Chinese Academy of Medical Sciences and others; STEP
ClinicalTrials.gov number, NCT03015311.).<br/>Copyright &#xa9; 2021
Massachusetts Medical Society.