EPICORE Embase Updates: EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
636156120
Title
Continuation versus discontinuation of aspirin-based antiplatelet therapy
for perioperative bleeding and ischaemic events in adults undergoing
neurosurgery: Protocol for a systematic review and meta-analysis.
Source
BMJ Open. 11(9) (no pagination), 2021. Article Number: e046741. Date of
Publication: 30 Sep 2021.
Author
Wang X.; Yu Y.; Han R.
Institution
(Wang, Wang, Yu, Han) Department of Anesthesiology, Capital Medical
University, Beijing Tiantan Hospital, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Antiplatelet therapy is commonly used in primary or secondary
prevention of atherosclerotic and thrombotic diseases, such as coronary
artery disease, transient ischaemic attack or stroke. Recent studies noted
that antiplatelet therapy should be continued perioperatively in patients
at high risk of thrombosis and low bleeding risk in orthopaedic, spinal or
urological surgery. However, evidence in neurosurgery is lacking. Thus, we
aim to conduct a systematic review and meta-analysis to assess whether the
continuous use of antiplatelet drugs in neurosurgery increases the risk of
perioperative bleeding. Methods and analysis We will search PubMed,
Cochrane Central Register of Controlled Trials and Embase using a strategy
that combines the terms aspirin, bleeding/ischaemic and neurosurgery. Two
reviewers will independently screen all identified abstracts for
eligibility and evaluate the risk of bias of the included studies using
the Cochrane risk of bias tool for randomised controlled studies and the
Newcastle-Ottawa Scale for observational studies (including cohort
studies, case-control studies, case series). Discrepancies will be
resolved by consultation with a third researcher. We will conduct a
systematic review and meta-analysis. If evidence suggests moderate
statistical or clinical heterogeneity, we plan to investigate this
heterogeneity by performing subgroup analyses and sensitivity analysis.
Ethics and dissemination No ethics approval will be sought as no original
data will be collected for this review. Findings will be disseminated
through peer-reviewed publication and conference presentations. PROSPERO
registration number CRD42020202590. Copyright © Author(s) (or
their employer(s)) 2021. Published by BMJ.

<2>
Accession Number
2012221939
Title
Reduction in acute kidney injury post cardiac surgery using balanced
forced diuresis: A randomized, controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 59(3) (pp 562-569), 2021.
Date of Publication: 01 Mar 2021.
Author
Luckraz H.; Giri R.; Wrigley B.; Nagarajan K.; Senanayake E.; Sharman E.;
Beare L.; Nevill A.
Institution
(Luckraz) Cardiothoracic Surgeon, American Hospital, Dubai, United Arab
Emirates
(Giri) Cardiothoracic Anaesthesiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Wrigley) Interventional Cardiologist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nagarajan, Senanayake) Specialist Registrar Cardiothoracic Surgery, Heart
and Lung Centre, Wolverhampton, United Kingdom
(Sharman) Research and Development Department, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Beare) Senior Clinical Perfusionist, Heart and Lung Centre,
Wolverhampton, United Kingdom
(Nevill) Statistics, Faculty of Education, Health and Wellbeing,
University of Wolverhampton, Wolverhampton, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Our goal was to investigate the efficacy of balanced forced
diuresis in reducing the rate of acute kidney injury (AKI) in cardiac
surgical patients requiring cardiopulmonary bypass (CPB), using the
RenalGuard (RG) system. METHOD(S): Patients at risk of developing AKI
(history of diabetes and/or anaemia; estimated glomerular filtration rate
20-60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5)
were randomized to the RG system group (n = 110) or managed according to
current practice (control = 110). The primary end point was the
development of AKI within the first 3 postoperative days as defined by the
RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal
disease) criteria. RESULT(S): There were no significant differences
in preoperative and intraoperative characteristics between the 2 groups.
Postoperative AKI rates were significantly lower in the RG system group
compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025].
This effect persisted even after controlling for a number of potential
confounders (odds ratio 2.82, 95% confidence interval 1.20-6.60; P =
0.017) when assessed by binary logistic regression analysis. The mean
volumes of urine produced during surgery and within the first 24 h
postoperatively were significantly higher in the RG system group (P <
0.001). There were no significant differences in the incidence of blood
transfusions, atrial fibrillation and infections and in the median
duration of intensive care unit stays between the groups. The number
needed to treat with the RG system to prevent AKI was 9 patients (95%
confidence interval 6.0-19.2). CONCLUSION(S): In patients at risk for
AKI who had cardiac surgery with CPB, the RS RG system significantly
reduced the incidence of AKI and can be used safely and reproducibly.
Larger studies are required to confirm cost benefits. Clinical trial
registration number: NCT02974946. Copyright © 2020 The Author(s)
2020. Published by Oxford University Press on behalf of the European
Association for Cardio-Thoracic Surgery.

<3>
Accession Number
2012180036
Title
Survival of patients with acute pulmonary embolism treated with
venoarterial extracorporeal membrane oxygenation: A systematic review and
meta-analysis.
Source
Journal of Critical Care. 64 (pp 245-254), 2021. Date of Publication:
August 2021.
Author
Karami M.; Mandigers L.; Miranda D.D.R.; Rietdijk W.J.R.; Binnekade J.M.;
Knijn D.C.M.; Lagrand W.K.; den Uil C.A.; Henriques J.P.S.; Vlaar A.P.J.
Institution
(Karami, Henriques) Heart Center, Department of Cardiology, Amsterdam
Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam,
Amsterdam, Netherlands
(Mandigers, Miranda, Rietdijk, den Uil) Department of Intensive Care
Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
(Binnekade, Knijn, Lagrand, Vlaar) Department of Intensive Care Medicine,
Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
(den Uil) Department of Cardiology, Erasmus University Medical Center,
Rotterdam, Netherlands
Publisher
W.B. Saunders
Abstract
Background: To examine whether venoarterial extracorporeal membrane
oxygenation (VA-ECMO) improves survival of patients with acute pulmonary
embolism (PE). Method(s): Following the PRISMA guidelines, a
systematic search was conducted up to August 2019 of the databases:
PubMed/MEDLINE, EMBASE and Cochrane. All studies reporting the survival of
adult patients with acute PE treated with VA-ECMO and including four
patients or more were included. Exclusion criteria were: correspondences,
reviews and studies in absence of a full text, written in other languages
than English or Dutch, or dating before 1980. Short-term (hospital or
30-day) survival data were pooled and presented with relative risks (RR)
and 95% confidence intervals (95% CI). Also, the following pre-defined
factors were evaluated for their association with survival in VA-ECMO
treated patients: age > 60 years, male sex, pre-ECMO cardiac arrest,
surgical embolectomy, catheter directed therapy, systemic thrombolysis,
and VA-ECMO as single therapy. Result(s): A total of 29 observational
studies were included (N = 1947 patients: VA-ECMO N = 1138 and control N =
809). There was no difference in short-term survival between VA-ECMO
treated patients and control patients (RR 0.91, 95% CI 0.71-1.16). In
acute PE patients undergoing VA-ECMO, age > 60 years was associated with
lower survival (RR 0.72, 95% CI 0.52-0.99), surgical embolectomy was
associated with higher survival (RR 1.96, 95% CI 1.39-2.76) and pre-ECMO
cardiac arrest showed a trend toward lower survival (RR 0.88, 95% CI
0.77-1.01). The other evaluated factors were not associated with a
difference in survival. Conclusion(s): At present, there is
insufficient evidence that VA-ECMO treatment improves short-term survival
of acute PE patients. Low quality evidence suggest that VA-ECMO patients
aged <=60 years or who received SE have higher survival rates. Considering
the limited evidence derived from the present data, this study emphasizes
the need for prospective studies. Protocol Registration: PROSPERO
CRD42019120370. Copyright © 2021 The Authors

<4>
Accession Number
2015178815
Title
Effect of high-flow nasal Oxygen on respiratory parameters and pulmonary
complications after early extubation following pediatric heart surgery.
Source
Journal of Comprehensive Pediatrics. 12(3) (no pagination), 2021. Article
Number: e116104. Date of Publication: August 2021.
Author
Enayati F.; Amini S.; Gerdrodbari M.G.; Jarahi L.; Ansari M.
Institution
(Enayati) Sabzevar University of Medical Sciences, Sabzevar, Iran, Islamic
Republic of
(Amini) Department of Anesthesia, School of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran, Islamic Republic of
(Gerdrodbari, Ansari) Department of Nursing, Nursing & Midwifery School,
Sabzevar University of Medical Sciences, Sabzevar, Iran, Islamic Republic
of
(Jarahi) Community Medicine Department, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Objectives: The aim of this study was to evaluate the effect of high-flow
nasal cannula (HFNC) after early extubation on children undergoing cardiac
surgery. Method(s): This randomized controlled clinical trial was
performed among 92 children aged 1 to 24 months undergoing cardiac surgery
from March 5 to August 30, 2020, in a pediatric post-cardiac surgery
intensive care unit (ICU). The patients were randomized to receive either
HFNC or conventional oxygen therapy after extubation. Arterial blood
samples were collected after anesthesia induction, after the end of the
surgery, at the time of entering the ICU while they were intubated, 6
hours after entering the ICU, before removing the endotracheal tube,
immediately after extubation, as well as 1, 6, 12, 24, and 36 hours after
extubation. The patients were compared regarding PaCO2, PaO2/FiO2 ratios,
respiratory failure, need for reintubation, development of atelectasis,
pneumothorax, pleural effusion, and length of ICU stay. Result(s):
The patients were similar regarding demographic characteristics, the
duration of surgery, and mechanical ventilation (P > 0.05). On the first
and second days after the surgery, the mean modified radiologic
atelectasis score (m-RAS) was lower in the HFNC group compared to the
conventional oxygen therapy group (P < 0.05). The frequency of respiratory
failure did not differ in the groups before and after the surgery (P >
0.05). PaCO2 was lower in the HFNC group than in the control group after
extubation (P < 0.001). PaO2/FIO2 ratio was significantly higher in the
HFNC group one hour after extubation and afterward in comparison to the
control group (P < 0.001). The need for re-intubation (P < 0.013) and the
length of ICU stay (P < 0.001) were significantly lower in the HFNC group
compared to the control group. Conclusion(s): It was found that HFNC
could improve the respiratory parameters and reduce postoperative
pulmonary complications in infants following a congenital heart
surgery. Copyright © 2021, Author(s).

<5>
Accession Number
636308951
Title
Efficacy of left ventricular unloading strategies during venoarterial
extracorporeal membrane oxygenation in patients with cardiogenic shock: A
protocol for a systematic review and Bayesian network meta-analysis.
Source
BMJ Open. 11(10) (no pagination), 2021. Article Number: e047046. Date of
Publication: 19 Oct 2021.
Author
Zhang P.; Wei S.; Zhai K.; Huang J.; Cheng X.; Tao Z.; Gao B.; Liu D.; Li
Y.
Institution
(Zhang, Wei, Zhai, Huang, Cheng, Tao, Gao, Liu, Li) Department of Cardiac
Surgery, Lanzhou University Second Hospital, Gansu, Lanzhou, China
(Zhang) State Key Laboratory of Cardiovascular Disease, Fuwai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Wei, Zhai, Huang, Cheng, Tao, Li) Laboratory of Extracorporeal Life
Support, Lanzhou University Second Hospital, Gansu, Lanzhou, China
Publisher
BMJ Publishing Group
Abstract
Introduction Venoarterial extracorporeal membrane oxygenation (VA-ECMO)
has been widely used for patients with refractory cardiogenic shock. A
common side effect of this technic is the resultant increase in left
ventricular (LV) afterload which could potentially aggravate myocardial
ischaemia, delay ventricular recovery and increase the risk of pulmonary
congestion. Several LV unloading strategies have been proposed and
implemented to mitigate these complications. However, it is still
indistinct that which one is the best choice for clinical application.
This Bayesian network meta-analysis (NMA) aims to compare the efficacy of
different LV unloading strategies during VA-ECMO. Methods and analysis
PubMed, Embase, the Cochrane Library and the International Clinical Trials
Registry Platform will be explored from their inception to 31 December
2020. Random controlled trials and cohort studies that compared different
LV unloading strategies during VA-ECMO will be included in this study. The
primary outcome will be in-hospital mortality. The secondary outcomes will
include neurological complications, haemolysis, bleeding, limb ischaemia,
renal failure, gastrointestinal complications, sepsis, duration of
mechanical ventilation, length of intensive care unit and hospital stays.
Pairwise and NMA will respectively be conducted using Stata (V.16,
StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the
cumulative probability will be used to rank the included LV unloading
strategies. The risk of bias will be conducted using the Cochrane
Collaboration's tool or Newcastle-Ottawa Quality Assessment Scale
according to their study design. Subgroup analysis, sensitivity analysis
and publication bias assessment will be performed. The Grading of
Recommendations Assessment, Development and Evaluation will be conducted
to explore the quality of evidence. Ethics and dissemination Either ethics
approval or patient consent is not necessary, because this study will be
based on literature. The results will be disseminated through
peer-reviewed publications and conference presentations. PROSPERO
registration number CRD42020165093. Copyright © Author(s) (or
their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial
re-use. See rights and permissions. Published by BMJ.

<6>
Accession Number
2014089962
Title
Cardiorenal outcomes in eligible patients referred for bariatric surgery.
Source
Obesity. (no pagination), 2021. Date of Publication: 2021.
Author
Dash S.; Everett K.; Jackson T.; Okrainec A.; Urbach D.R.; Sockalingam S.;
Shah B.R.; Farkouh M.E.
Institution
(Dash) Division of Endocrinology, University Health Network, Toronto, ON,
Canada
(Dash, Shah, Farkouh) Department of Medicine, University of Toronto,
Toronto, ON, Canada
(Dash, Jackson, Okrainec, Urbach, Sockalingam) Bariatric Program,
University Health Network, Toronto, ON, Canada
(Everett, Shah) Division of Endocrinology, Sunnybrook Health Sciences
Centre Toronto, Toronto, ON, Canada
(Jackson, Okrainec) Department of Surgery, Faculty of Medicine, University
of Toronto, Toronto, ON, Canada
(Urbach) Department of Surgery, Women's College Hospital, Toronto, ON,
Canada
(Sockalingam) Centre for Addiction, & Mental Health, Toronto, ON, Canada
(Sockalingam) Department of Psychiatry, University of Toronto, Toronto,
ON, Canada
(Shah) ICES, Toronto, ON, Canada
(Farkouh) Peter Munk Cardiac Centre, University Health Network, Toronto,
ON, Canada
(Farkouh) St. Michael's Hospital Research Institute, Toronto, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Objective: Bariatric surgery is associated with reduced atherosclerotic
cardiovascular disease (CVD) and heart failure hospitalization in people
with type 2 diabetes (T2D) and those with prior CVD. Most patients
undergoing bariatric surgery do not have T2D or CVD. Many otherwise
eligible patients do not have surgery because of self-exclusion. Clinical
outcomes in these groups are less established. Method(s): This study
retrospectively assessed cardiorenal outcomes in 8,568 patients after
acceptance of referral for surgery. Result(s): A total of 63.8%
patients did not undergo surgery. After multivariate adjustment for sex,
age, BMI, income quintile, distance from hospital, hypertension, T2D, and
CVD, hazard ratios (HR) for the primary (incident myocardial infarction,
stroke, heart failure hospitalization, and death; HR = 0.52, 95% CI:
0.4-0.66) and secondary CVD outcomes (primary outcomes and
coronary/carotid revascularization; HR = 0.53, 95% CI: 0.42-0.67) were
lower in the surgery cohort. This reduction was seen in those with
(primary: HR = 0.45, 95% CI: 0.32-0.63, secondary: HR = 0.47, 95% CI:
0.34-0.65) and without T2D (primary: HR = 0.61, 95% CI: 0.42-0.88,
secondary: HR = 0.53, 95% CI: 0.42-0.67). Reduced kidney disease (HR =
0.46, 95% CI: 0.22-0.92) but increased liver disease hospitalization (HR =
2.5, 95% CI: 1.45-4.27) was observed with surgery. Conclusion(s):
Non-progression to surgery associates with increased CVD despite low
baseline prevalence of CVD. The cardiorenal benefits of bariatric surgery
warrant confirmation in a well-powered randomized clinical
trial. Copyright © 2021 The Obesity Society

<7>
Accession Number
633940752
Title
Minimally invasive surgery versus transcatheter aortic valve replacement:
A systematic review and meta-analysis.
Source
Open Heart. 8(1) (no pagination), 2021. Article Number: e001535. Date of
Publication: 17 Jan 2021.
Author
Sayed A.; Almotawally S.; Wilson K.; Munir M.; Bendary A.; Ramzy A.; Hirji
S.; Ibrahim Abushouk A.
Institution
(Sayed, Almotawally, Wilson, Munir) Faculty of Medicine, Ain Shams
University, Cairo, Egypt
(Bendary, Ramzy) Faculty of Medicine, Cardiology, Benha University, Benha,
Egypt
(Hirji) Division of Cardiac Surgery, Brigham and Women's Hospital, Boston,
MA, United States
(Ibrahim Abushouk) Division of Cardiology, Beth Israel Deaconess Medical
Center, Boston, MA, United States
Publisher
BMJ Publishing Group
Abstract
Transcatheter aortic valve replacement (TAVR) has recently been approved
for use in patients who are at intermediate and low surgical risk.
Moreover, recent years have witnessed a renewed interest in minimally
invasive aortic valve replacement (miAVR). The present meta-analysis
compared the outcomes of TAVR and miAVR in the management of aortic
stenosis (AS). We conducted an electronic search across six databases from
2002 (TAVR inception) to December 2019. Data from relevant studies
regarding the clinical and length of hospitalisation outcomes were
extracted and analysed using R software. We identified a total of 11
cohort studies, of which seven were matched/propensity matched. Our
analysis demonstrated higher rates of midterm mortality (>=1 year) with
TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant
differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to
1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95%
CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to
experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet
less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69)
compared with miAVR. The duration of hospitalisation was significantly
longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading
of Recommendations Assessment, Development and Evaluation assessment
revealed <=moderate quality of evidence in all outcomes. TAVR was
associated with lower acute kidney injury rate and shorter length of
hospitalisation, yet higher risks of midterm mortality and paravalvular
leakage. Given the increasing adoption of both techniques, there is an
urgent need for head-to-head randomised trials with adequate follow-up
periods. Copyright © Author(s) (or their employer(s)) 2021.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<8>
Accession Number
629366089
Title
Antithrombotic therapy for atrial fibrillation with stable coronary
disease.
Source
New England Journal of Medicine. 381(12) (pp 1103-1113), 2019. Date of
Publication: 19 Sep 2019.
Author
Yasuda S.; Kaikita K.; Akao M.; Ako J.; Matoba T.; Nakamura M.; Miyauchi
K.; Hagiwara N.; Kimura K.; Hirayama A.; Matsui K.; Ogawa H.
Institution
(Yasuda, Ogawa) National Cerebral and Cardiovascular Center, Suita, Japan
(Hirayama) Department of Cardiology, Osaka Police Hospital, Osaka, Japan
(Kaikita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, Kumamoto, Japan
(Matsui) Department of General Medicine, Kumamoto University Hospital,
Kumamoto, Japan
(Akao) Department of Cardiology, National Hospital Organization, Kyoto
Medical Center, Kyoto, Japan
(Ako) Department of Cardiovascular Medicine, Kitasato University, School
of Medicine, Sagamihara, Japan
(Matoba) Department of Cardiovascular Medicine, Kyushu University
Hospital, Fukuoka, Japan
(Nakamura) Division of Cardiovascular Medicine, Toho University, Ohashi
Medical Center, Tokyo, Japan
(Miyauchi) Department of Cardiology, Juntendo University, School of
Medicine, Tokyo, Japan
(Hagiwara) Department of Cardiology, Tokyo Women's Medical University,
Tokyo, Japan
(Kimura) Cardiovascular Center, Yokohama City University Medical Center,
Yokohama, Japan
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND There are limited data from randomized trials evaluating the
use of antithrombotic therapy in patients with atrial fibrillation and
stable coronary artery disease. METHODS In a multicenter, open-label trial
conducted in Japan, we randomly assigned 2236 patients with atrial
fibrillation who had undergone percutaneous coronary intervention (PCI) or
coronary-artery bypass grafting (CABG) more than 1 year earlier or who had
angiographically confirmed coronary artery disease not requiring
revascularization to receive monotherapy with rivaroxaban (a non-vitamin K
antagonist oral anticoagulant) or combination therapy with rivaroxaban
plus a single antiplatelet agent. The primary efficacy end point was a
composite of stroke, systemic embolism, myocardial infarction, unstable
angina requiring revascularization, or death from any cause; this end
point was analyzed for noninferiority with a noninferiority margin of
1.46. The primary safety end point was major bleeding, according to the
criteria of the International Society on Thrombosis and Hemostasis; this
end point was analyzed for superiority. RESULTS The trial was stopped
early because of increased mortality in the combination-therapy group.
Rivaroxaban monotherapy was noninferior to combination therapy for the
primary efficacy end point, with event rates of 4.14% and 5.75% per
patient-year, respectively (hazard ratio, 0.72; 95% confidence interval
[CI], 0.55 to 0.95; P<0.001 for noninferiority). Rivaroxaban monotherapy
was superior to combination therapy for the primary safety end point, with
event rates of 1.62% and 2.76% per patient-year, respectively (hazard
ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01 for superiority). CONCLUSIONS As
antithrombotic therapy, rivaroxaban monotherapy was noninferior to
combination therapy for efficacy and superior for safety in patients with
atrial fibrillation and stable coronary artery disease. Copyright
© 2019 Massachusetts Medical Society.

<9>
Accession Number
2010298979
Title
Association between intra-operative cardiac arrest and country Human
Development Index status: a systematic review with meta-regression
analysis and meta-analysis of observational studies*.
Source
Anaesthesia. 76(9) (pp 1259-1273), 2021. Date of Publication: September
2021.
Author
Braz L.G.; Einav S.; Heesen M.A.; Betini M.; Corrente J.E.; Pacchioni M.;
Cury J.B.; Braz M.G.; Braz J.R.C.
Institution
(Braz, Pacchioni, Cury, Braz, Braz) Anaesthesia Cardiac Arrest and
Mortality Study Commission, Department of Surgical Specialties and
Anaesthesiology, Botucatu Medical School, Sao Paulo State University -
UNESP, Botucatu, Brazil
(Einav) Shaare Zedek Medical Centre, Jerusalem, Israel
(Einav) Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem,
Israel
(Heesen) Department of Anaesthesia, Kantonsspital Baden, Baden,
Switzerland
(Betini) Technical Division of Library and Documentation, Institute of
Biosciences, Sao Paulo State University - UNESP, Botucatu, Brazil
(Corrente) Department of Biostatistics, Institute of Biosciences, Sao
Paulo State University - UNESP, Botucatu, Brazil
Publisher
John Wiley and Sons Inc
Abstract
Intra-operative cardiac arrests differ from most in-hospital cardiac
arrests because they reflect not only the patient's condition but also the
quality of surgery and anaesthesia care provided. We assessed the
relationship between intra-operative cardiac arrest rates and country
Human Development Index (HDI), and the changes occurring in these rates
over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science,
CINAHL and SciELO from inception to 29 January 2020. For the global
population, rates of intra-operative cardiac arrest and baseline ASA
physical status were extracted. Intra-operative cardiac arrest rates were
analysed by time, country HDI status and ASA physical status using
meta-regression analysis. Proportional meta-analysis was performed to
compare intra-operative cardiac arrest rates and ASA physical status in
low- vs. high-HDI countries and in two time periods. Eighty-two studies
from 25 countries with more than 29 million anaesthetic procedures were
included. Intra-operative cardiac arrest rates were inversely correlated
with country HDI (p = 0.0001); they decreased over time only in high-HDI
countries (p = 0.040) and increased with increasing ASA physical status (p
< 0.0001). Baseline ASA physical status did not change in high-HDI
countries (p = 0.106), while it decreased over time in low-HDI countries
(p = 0.040). In high-HDI countries, intra-operative cardiac arrest rates
(per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59-13.16)
pre-1990 to 5.17 (95%CI 4.42-5.97) in 1990-2020 (p = 0.013). During the
same time periods, no improvement was observed in the intra-operative
cardiac arrest rates in low-HDI countries (p = 0.498). Odds ratios of
intra-operative cardiac arrest rates in ASA 3-5 patients were 8.48 (95%CI
1.67-42.99) times higher in low-HDI countries than in high-HDI countries
(p = 0.0098). Intra-operative cardiac arrest rates are related to
country-HDI and decreased over time only in high-HDI countries. The
widening gap in these rates between low- and high-HDI countries needs to
be addressed globally. Copyright © 2021 Association of
Anaesthetists

<10>
Accession Number
636244560
Title
Investigation of the Emerging Nosocomial Wickerhamomyces anomalus
Infections at a Chinese Tertiary Teaching Hospital and a Systemic Review:
Clinical Manifestations, Risk Factors, Treatment, Outcomes, and
Anti-fungal Susceptibility.
Source
Frontiers in Microbiology. 12 (no pagination), 2021. Article Number:
744502. Date of Publication: 06 Oct 2021.
Author
Zhang L.; Xiao M.; Arastehfar A.; Ilkit M.; Zou J.; Deng Y.; Xu Y.; Liao
W.; Zhao J.; Fang W.; Pan W.
Institution
(Zhang, Zhao) Department of Dermatology, Tongji Hospital, Tongji
University School of Medicine, Shanghai, China
(Xiao, Xu) Peking Union Medical College Hospital, Beijing, China
(Arastehfar) Center for Discovery and Innovation, Hackensack Meridian
Health, Nutley, NJ, United States
(Ilkit) Division of Mycology, Faculty of Medicine, Cukurova University,
Adana, Turkey
(Zou) The Fourth People's Hospital of Nanning, Nanning, China
(Deng, Liao, Fang, Pan) Shanghai Key Laboratory of Molecular Medical
Mycology, Department of Dermatology, Second Affiliated Hospital of Naval
Medical University, Shanghai, China
Publisher
Frontiers Media S.A.
Abstract
Wickerhamomyces anomalus is an emerging pathogen, which has been
associated with clonal outbreaks and poor clinical outcomes. Despite being
an important emerging yeasts species, our understanding concerning the
microbiological and clinical characteristics of infections due to this
species is limited. Herein, we are reporting a retrospective analysis of
fungemia patients with W. anomalus from a 2,100-bed hospital in Shanghai
during 2014-2016. Moreover, we conducted an extensive literature review to
gain a deeper clinical and microbiological insights. Detailed clinical
data were recorded. Antifungal susceptibility testing (AFST) followed CLSI
M27-A3, and isolates were identified using MALDI-TOF MS. In total, 13
patients were identified with a mortality rate of 38.5% (5/13). Central
venous catheter (CVC), broad-spectrum antibiotic therapy, total parenteral
nutrition (TPN), surgery, and mechanical ventilation were the most
frequently observed risk factors. Eight patients (61.5%) experienced mixed
bacterial/Candida bloodstream infections, and four patients developed
mixed candidemia (MC). W. anomalus isolates showed high minimum inhibitory
concentrations (MICs) against all azoles tested and flucytosine, while AMB
showed the highest in vitro activity. Azoles were used for 84.6% (11/13)
of the cases, while 36.4% (4/11) of them died. When combining with the
AFST data and the literature review, our study highlights the poor
efficacy of azoles and optimal efficacy of AMB and LAMB against infections
caused by W. anomalus. In conclusion, our study highlights the emerging
threat of W. anomalus affecting both neonates and adults. Furthermore, our
results advocate the use of AMB formulations rather than azoles among
patients infected with W. anomalus. Future studies are warranted to reach
a definitive consensus regarding the utility of echinocandins among such
patients. © Copyright © 2021 Zhang, Xiao, Arastehfar, Ilkit,
Zou, Deng, Xu, Liao, Zhao, Fang and Pan.

<11>
Accession Number
2015185458
Title
In patients with lung cancer is combined endobronchial ultrasound and
endoscopic ultrasound superior to conventional mediastinoscopy in staging
the mediastinum?.
Source
Annals of Medicine and Surgery. 71 (no pagination), 2021. Article Number:
102953. Date of Publication: November 2021.
Author
Gunawan A.; Manuel L.; Fong L.S.; Bassin L.
Institution
(Gunawan) St Vincent's Hospital Clinical School, University of New South
Wales, Randwick, NSW, Australia
(Manuel, Bassin) Department of Cardiothoracic Surgery, Royal North Shore
Hospital, St Leonards, NSW, Australia
(Fong) Department of Cardiothoracic Surgery, Liverpool Hospital,
Liverpool, NSW, Australia
Publisher
Elsevier Ltd
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was 'In patients with lung
cancer, is combined endobronchial ultrasound and endoscopic ultrasound
(EBUS + EUS) superior to cervical mediastinoscopy (CM) in staging the
mediastinum?' Altogether more than 110 papers were found, of which one
meta-analysis, two RCTs, and two cohort studies represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Studies directly
comparing EBUS + EUS and CM are limited in number and quality, with the
majority of studies focusing on comparing endosonographic techniques or a
single technique with surgical staging. Moreover, in four out of five
studies, surgical staging of the mediastinum was undertaken following a
negative EBUS + EUS result, limiting the utility of comparing
endosonography alone. Regardless of this, the initial EBUS + EUS approach
followed by surgical staging if negative resulted in greater sensitivity
and detection of N2/3 metastases as well as greater sampling in the
majority of studies, resulting in higher likelihood of upstaging and
treatment alterations for patients. There was also improved quality of
life demonstrated in the EBUS + EUS group with significant reductions in
futile thoracotomies and less complications when compared with exclusive
CM staging. We conclude that a combined approach of combined
endosonography in the first instance, followed by CM staging of the
mediastinum results in greater sensitivity of nodal disease and subsequent
greater accuracy in upstaging and determining treatment plans with a
concurrent reduction in complication rates and futile
procedures. Copyright © 2021 The Authors

<12>
Accession Number
2014987007
Title
The relationship between Warfarin resistance and CYP2C9*2 and CYP2C9*3
variations.
Source
Medical Journal of Bakirkoy. 17(3) (pp 209-213), 2021. Date of
Publication: 2021.
Author
Kirac D.; Yaman A.E.; Doran T.; Altunok E.C.
Institution
(Kirac, Doran) Yeditepe University, Faculty of Medicine, Department of
Medical Biology, Istanbul, Turkey
(Yaman) Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and
Research Hospital, Clinic of Cardiology, Istanbul, Turkey
(Altunok) Yeditepe University, Faculty of Medicine, Department of
Biostatistics and Medical Informatics, Istanbul, Turkey
Publisher
Galenos Publishing House
Abstract
Objective: Warfarin is one of the most widely used anticoagulants
worldwide. Some patients need >15 mg/day of warfarin to get their
therapeutic international normalized ratio (INR). This condition is known
as warfarin resistance (WR). WR is related to enzyme deficiencies, which
play a role in warfarin metabolism. One of the most important
enzyme-related drug metabolism is the cytochrome P450, family 2, subfamily
C, member 9 (CYP2C9). Therefore, this study aimed to investigate the
relationship between CYP2C9 variations and WR. Method(s): To find
patients with WR, 650 patients who used warfarin for at least 6 months
were screened. Then, patients were grouped into two according to the INR
values, wherein 30 patients with INR levels not reaching the therapeutic
range (<2) despite using 15 mg of warfarin per day were included in the
non-responder group and 30 randomly selected patients who received
low-dose warfarin, whose INR levels were within the therapeutic range
(2-3), were included in the responder group. After the genomic
deoxyribonucleic acid isolation from the peripheral blood, CYP2C9*2 and
CYP2C9*3 variations were investigated using the real-time polymerase chain
reaction. Results were statistically evaluated. Result(s):
Heterozygous genotype of CYP2C9*3 was statistically high in responders
(33.3%), whereas the wild-type genotype was statistically high in
nonresponders (90%) (p<0.05). In addition, the T allele of CYP2C9*2
(18.3%) and the C allele of CYP2C9*3 (16.7%) were statistically high in
responders (p<0.05). Conclusion(s): Patients with gene variations
that reduced the CYP2C9 activity are termed poor metabolizers. These
individuals metabolize warfarin more slowly and require smaller doses of
the drug to reach the therapeutic INR values. Therefore, adjusting the
warfarin dose is possible depending on the genotype of
patients. ©Copyright 2021 by Medical Journal of Bakirkoy
published by Galenos Yayinevi.

<13>
Accession Number
2014181913
Title
Non-vitamin k antagonist oral anticoagulants and risk of myocardial
infarction in patients with atrial fibrillation with or without
percutaneous coronary interventions: A meta-analysis.
Source
Journal of Personalized Medicine. 11(10) (no pagination), 2021. Article
Number: 1013. Date of Publication: October 2021.
Author
Grajek S.; Kaluzna-Oleksy M.; Siller-Matula J.M.; Grajek M.; Michalak M.
Institution
(Grajek, Kaluzna-Oleksy) 1st Department of Cardiology, Poznan University
of Medical Sciences, Poznan 61-848, Poland
(Siller-Matula) Department of Internal Medicine II, Division of
Cardiology, Medical University of Vienna, Vienna 1090, Austria
(Siller-Matula) Center for Preclinical Research and Technology (CEPT),
Department of Experimental and Clinical Pharmacology, Medical University
of Warsaw, Warsaw 02-097, Poland
(Grajek) International School of Poznan, Poznan 60-147, Poland
(Michalak) Department of Computer Science and Statistics, Poznan
University of Medical Sciences, Poznan 60-806, Poland
Publisher
MDPI
Abstract
The study aimed to assess the risk of myocardial infarction (MI) and major
adverse cardiac events during non-vitamin K antagonist oral anticoagulants
(NOAC) compared to warfarin therapy in patients with atrial fibrillation
(AF), both treated and not treated with percutaneous coronary
interventions (PCI). In a systematic search, we selected eight randomized
clinical trials with a total of 81,943 patients. Dabigatran, compared to
warfarin, significantly increased the risk of MI (relative risk [RR] 1.38,
95% CI 1.14-1.67), while the FXa inhibitors' effect did not differ
significantly from warfarin (RR 0.96, 95% CI 0.86-1.09). The RR comparison
between analyzed subgroups (dabigatran vs. FXa inhibitors) showed a
significant difference (Chi2 = 9.51, df = 1, p = 0.002). In a
network meta-analysis, dabigatran 110 mg b.i.d. increased the risk of MI
compared to warfarin, apixaban, edoxaban, and rivaroxaban. Also,
dabigatran 150 mg b.i.d. increased the risk of MI compared to warfarin,
apixaban, and rivaroxaban. Moreover, we tried to estimate the treatment
ranking of the best therapy for MI prevention in patients with AF treated
with PCI. Rivaroxaban had a 90% probability of being ranked the best
therapy for MI prevention, whereas dabigatran 110 mg had an 8.2%
probability. Dabigatran 150 mg was the most effective in stroke prevention
(94% probability). Each NOAC is associated with a different risk of MI.
Furthermore, we should consider FXa inhibitors as the first line NOACs in
AF and coronary artery disease patients. PROSPERO ID
CRD42020179808. Copyright © 2021 by the authors. Licensee MDPI,
Basel, Switzerland.

<14>
Accession Number
2013509437
Title
Optical coherence tomography tissue coverage and characterization at six
months after implantation of bioresorbable scaffolds versus conventional
everolimus eluting stents in the ISAR-Absorb MI trial.
Source
International Journal of Cardiovascular Imaging. 37(10) (pp 2815-2826),
2021. Date of Publication: October 2021.
Author
Rai H.; Alfonso F.; Maeng M.; Bradaric C.; Wiebe J.; Cuesta J.;
Christiansen E.H.; Cassese S.; Hoppmann P.; Colleran R.; Harzer F.; Bresha
J.; Nano N.; Schneider S.; Laugwitz K.-L.; Joner M.; Kastrati A.; Byrne
R.A.
Institution
(Rai, Wiebe, Cassese, Colleran, Harzer, Bresha, Nano, Joner, Kastrati)
Deutsches Herzzentrum Munchen, Technische Universitat Munchen, Munich,
Germany
(Alfonso, Cuesta) Hospital Universitario de La Princesa Madrid, Madrid,
Spain
(Maeng, Christiansen) Aarhus University Hospital, Aarhus, Denmark
(Bradaric, Hoppmann, Schneider, Laugwitz) Medizinische Klinik Und
Poliklinik Innere Medizin I, Klinikum Rechts Der Isar, Technische
Universitat Munchen, Munich, Germany
(Laugwitz, Joner, Kastrati) DZHK (German Centre for Cardiovascular
Research), Partner Site Munich Heart Alliance, Munich, Germany
(Rai, Colleran, Byrne) Cardiovascular Research Institute Dublin, Mater
Private Network, Dublin, Ireland
(Rai, Colleran, Byrne) School of Pharmacy and Biomolecular Sciences, RCSI
University of Medicine and Health Sciences, Dublin, Ireland
Publisher
Springer Science and Business Media B.V.
Abstract
Purpose: Data regarding vessel healing by optical coherence tomography
(OCT) after everolimus-eluting bioresorbable scaffolds (BRS) or
everolimus-eluting metallic stent (EES) implantation in acute myocardial
infarction (AMI) patients is scarce. We compared OCT findings after BRS or
EES implantation in patients with AMI enrolled in a randomized trial.
 Method(s): In ISAR-Absorb MI, AMI patients were randomized to BRS or
EES implantation, with 6-8 month angiographic follow-up. This analysis
includes patients who underwent OCT during surveillance angiography.
Tissue characterization was done using grey-scale signal intensity
analysis. The association between OCT findings and target lesion failure
(TLF) at 2 years was investigated. Result(s): OCT was analyzed in 103
patients (2237 frames, 19,827 struts) at a median of 216 days
post-implantation. Of these, 70 were treated with BRS versus 32 with EES.
Pre-(92.8 vs. 68.7%, p = 0.002) and post-dilation (51.4 vs. 12.5%, p <
0.001) were more common in BRS as compared to EES. Strut coverage was
higher in BRS vs. EES (97.5% vs. 90.9%, p < 0.001). Mean neointimal
thickness was comparable in both groups [85.5 (61.9, 124.1) vs. 69.5
(32.7, 127.5) microm, respectively, p = 0.20]. Mature neointimal regions
were numerically more common in BRS (43.0% vs. 24.6%; p = 0.35); this
difference was statistically significant in ST-elevation myocardial
infarction patients (40.9% vs. 21.1%, p = 0.03). At two-years, 8 (7.8%)
patients experienced TLF. Mean neointimal area [0.61 (0.21, 1.33) vs. 0.41
(0.11, 0.75) mm2, p = 0.03] and mean neointimal coverage [106.1
(65.2, 214.8) vs. 80.5 (53.5, 122.1) microm, p < 0.01] were higher, with
comparable tissue maturity, in lesions with versus without TLF.
 Conclusion(s): In selected patients who underwent OCT surveillance
6-8 months after coronary intervention for AMI with differing implantation
characteristics depending on the device type used, vessel healing was more
advanced in BRS compared with EES, particularly in the STEMI
subgroup. Copyright © 2021, The Author(s).

<15>
Accession Number
2015036698
Title
Prevalence and prognosis of pericardial effusion in patients affected by
pectus excavatum: A case-control study.
Source
International Journal of Cardiology. 344 (pp 179-183), 2021. Date of
Publication: 01 Dec 2021.
Author
Conte E.; Agalbato C.; Lauri G.; Mushtaq S.; Carollo C.; Bonomi A.;
Zanotto L.; Melotti E.; Dalla Cia A.; Guglielmo M.; Baggiano A.; Annoni
A.; Formenti A.; Mancini E.; D'Angelo A.M.; Rota A.; Assanelli E.; Sforza
C.; Pontone G.; Pepi M.; Andreini D.; Brucato A.
Institution
(Conte, Agalbato, Lauri, Mushtaq, Carollo, Bonomi, Zanotto, Melotti, Dalla
Cia, Guglielmo, Baggiano, Annoni, Formenti, Mancini, D'Angelo, Rota,
Assanelli, Pontone, Pepi, Andreini) Centro Cardiologico Monzino, IRCCS,
Milan, Italy
(Conte, Sforza) Universita di Milano, Deptartment of Biomedical Sciences
for Health, University of Milan, Milan, Italy
(Baggiano) Department of Clinical Sciences and Community Health -
Cardiovascular Section, University of Milan, Milan, Italy
(Andreini, Brucato) Universita di Milano, Department of Biomedical and
Clinical Sciences "Luigi Sacco", Fatebefratelli Hospital, Milan, Italy
Publisher
Elsevier Ireland Ltd
Abstract
Background: The presence of pectus excavatum(PEX) has been occasionally
associated with pericardial effusion. Aim of the present study was to
compare incidence and prognosis of pericardial effusion in a group of
unselected patients with PEX vs a control group. Method(s): From a
prospective registry of consecutive patients who underwent chest CT for
cardiovascular disease, subjects with a radiological diagnosis of PEX were
retrospectively identified (cases); from the same registry patients
(controls) without rib cage abnormalities were randomly selected, until a
1:2 ratio was reached. The presence of pericardial effusion at CT was
quantified. Follow-up was obtained for a composite end-point: cardiac
tamponade, need for pericardiocentesis, need for cardiac surgery for
relapsing pericardial effusion. Result(s): A total of 43 patients
with PEX (20 females) and a control group of 86 cases (31 females) without
rib cage abnormalities were identified. Pericardial effusion evaluated at
CT was significatively more prevalent in patients with PEX vs control
group, 37.2% vs 13.9% (p < 0.001), respectively; four patients with PEX
(9.3%) had at least moderate pericardial effusion vs no subjects among the
controls (p = 0.004). PEX diagnosis was significantly associated to
pericardial effusion at multi-variate analysis (OR95%CI 10.91[3.47-34.29],
p < 0.001). At a mean follow-up of 6.5 +/- 3.4 years no pericardial events
were recorded. Conclusion(s): Our findings support the higher
prevalence of pericardial effusion in patients with PEX when compared to a
control group. The absence of adverse pericardial events at follow-up
suggest the good prognosis of these effusions, that in the appropriate
clinical setting might not be considered "idiopathic". Copyright
© 2021 Elsevier B.V.

<16>
Accession Number
2013920817
Title
Estimating the optimal timing of surgery by imputing potential outcomes.
Source
Statistics in Medicine. (no pagination), 2021. Date of Publication: 2021.
Author
Chen X.; Heitjan D.F.; Greil G.; Jeon-Slaughter H.
Institution
(Chen, Heitjan) Department of Statistical Science, Southern Methodist
University, Dallas, TX, United States
(Chen, Heitjan) Department of Population & Data Sciences, UT Southwestern
Medical Center, Dallas, TX, United States
(Greil) Department of Pediatrics, UT Southwestern Medical Center, Dallas,
TX, United States
(Jeon-Slaughter) Department of Internal Medicine, UT Southwestern Medical
Center, Dallas, TX, United States
Publisher
John Wiley and Sons Ltd
Abstract
Hypoplastic left heart syndrome is a congenital anomaly that is uniformly
fatal in infancy without immediate treatment. The standard treatment
consists of an initial Norwood procedure (stage 1) followed some months
later by stage 2 palliation (S2P). The ideal timing of the S2P is
uncertain. The Single Ventricle Reconstruction Trial (SVRT) randomized the
procedure used in the initial Norwood operation, leaving the timing of the
S2P to the discretion of the surgical team. To estimate the causal effect
of the timing of S2P, we propose to impute the potential post-S2P survival
outcomes using statistical models under the Rubin Causal Model framework.
With this approach, it is straightforward to estimate the causal effect of
S2P timing on post-S2P survival by directly comparing the imputed
potential outcomes. Specifically, we consider a lognormal model and a
restricted cubic spline model, evaluating their performance in Monte Carlo
studies. When applied to the SVRT data, the models give somewhat different
imputed values, but both support the conclusion that the optimal time for
the S2P is at 6 months after the Norwood procedure. Copyright ©
2021 John Wiley & Sons Ltd.

<17>
Accession Number
2013787642
Title
A Prospective Study on Type-2 Diabetic Complications and Efficacy of
Integrated Yoga: A Pan India 2017.
Source
Annals of Neurosciences. 28(1-2) (pp 21-28), 2021. Date of Publication:
January 2021.
Author
Patil S.S.; Raghuram N.; Singh A.; Rajesh S.K.; Ahmed S.; Hongasandra N.
Institution
(Patil, Raghuram, Singh, Ahmed, Hongasandra) Department of Yoga and Life
Science, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru,
Karnataka, India
(Rajesh) Department of Yoga and Physical Science, Swami Vivekananda Yoga
Anusandhana Samsthana, Bengaluru, Karnataka, India
Publisher
SAGE Publications Inc.
Abstract
Background: Type 2 diabetes (T2DM) contributes to high mortality and
morbidity because of its major complications related to kidney, heart,
brain, and eyes. It also poses a high risk for mortality because of
COVID-19. Studies suggest the possible implications of Yoga in delaying or
attenuating such complications. Methodology: This was a pan-India multi
centered cluster-randomized (4 level) two-armed trial in the rural and
urban population of all populous states of India. Data were obtained using
mobile app in all adults in the household of the selected clusters.
 Result(s): We report the diabetes related complications in 16623
adults (48% males, 52% females) from 65 districts (1 in 10 districts, 2011
census) of 29 (out of 35) states and Union Territories of India; mean age
was 48.2 +/- 12.46 years. Out of this 40% lived in rural and 62% in urban
locations. In high risk diabetes individuals (scored >= 60 points on
Indian diabetes risk score key), 18.0% had self-reported history of
(peripheral neuropathy, 6.1% had h/o major strokes, 5.5% had minor strokes
(transient ischemic episodes), 18.1% had lower limb claudication, 20.5%
leg ulcers, 4.4% had h/o cardiac surgery, 4.8% angioplasty, and 15.1% had
diabetes retinopathy. Complications were higher in rural than in urban
areas, higher in people with extended duration of diabetes. Integrated
yoga module for three months (one hour daily) showed significantly better
reduction in symptoms related to complications as compared to control
group (P <.001) Conclusion(s): The alarming high prevalence of
complications in diabetes population calls for urgent action, where yoga
may show the benefits in reduction of symptoms of
complications. Copyright © 2021 Indian Academy of Neurosciences
(IAN).

<18>
Accession Number
2015306315
Title
Native vs Prosthetic Valve Histoplasma capsulatum Infective Endocarditis:
A Case Report and Systemic Literature Review Comparing Patient
Presentation, Treatment Modalities, Clinical Outcomes, and Diagnostic
Laboratory Testing.
Source
Open Forum Infectious Diseases. 8(8) (no pagination), 2021. Article
Number: ofab360. Date of Publication: 01 Aug 2021.
Author
Boyanton B.L.; Boamah H.; Lauter C.B.
Institution
(Boyanton) Department of Pathology, Arkansas Children's Hospital, 1
Children's Way, Little Rock, AR 72202, United States
(Boyanton) Department of Pathology, University of Arkansas for Medical
Sciences, Little Rock, AK, United States
(Boamah) Division of Infectious Diseases, Department of Medicine, Western
Michigan School of Medicine, Kalamazoo, MI, United States
(Lauter) Sections of Infectious Diseases Allergy and Immunology,
Department of Medicine, Beaumont Hospital, Royal Oak, MI, United States
(Lauter) Department of Medicine, Oakland University William Beaumont
School of Medicine, Rochester Hills, MI, United States
Publisher
Oxford University Press
Abstract
Histoplasma capsulatum is a rare cause of fungal endocarditis that affects
both native and prosthetic valves. It is associated with a high mortality
rate if not diagnosed early and treated with a combination of antifungal
therapy and surgical intervention. We present a case of a 47-year-old man
with histoplasmosis infective endocarditis. He was successfully treated
with antifungal therapy and surgical replacement of the infected
bioprosthetic aortic valve. Our systemic literature review includes 52
articles encompassing 60 individual cases of H. capsulatum infective
endocarditis from 1940 to 2020. Patient presentations, diagnostic
laboratory testing accuracy, treatment modalities, and patient outcomes
comparing and contrasting native and prosthetic valve infection are
described. Copyright © 2021 The Author(s).

<19>
Accession Number
2014064893
Title
Recruitment maneuvers in patients undergoing thoracic surgery: a
meta-analysis.
Source
General Thoracic and Cardiovascular Surgery. 69(12) (pp 1553-1559), 2021.
Date of Publication: December 2021.
Author
Hu M.-C.; Yang Y.-L.; Chen T.-T.; Chen J.-T.; Tiong T.-Y.; Tam K.-W.
Institution
(Hu, Chen) Graduate Institute of Clinical Medicine, College of Medicine,
Taipei Medical University, Taipei, Taiwan (Republic of China)
(Hu, Chen) Division of Pulmonary Medicine, Department of Internal
Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City,
Taiwan (Republic of China)
(Yang) School of Respiratory Therapy, College of Medicine, Taipei Medical
University, Taipei, Taiwan (Republic of China)
(Yang) Department of Respiratory Therapy, Landseed International Hospital,
Taoyuan, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical
University, New Taipei City, Taiwan (Republic of China)
(Chen) Department of Anesthesiology, School of Medicine, College of
Medicine, Taipei Medical University, Taipei, Taiwan (Republic of China)
(Tiong) Division of Thoracic Surgery, Department of Surgery, Shuang Ho
Hospital, Taipei Medical University, New Taipei City, Taiwan (Republic of
China)
(Tam) Division of General Surgery, Department of Surgery, Shuang Ho
Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe
District, New Taipei City 23561, Taiwan (Republic of China)
(Tam) Division of General Surgery, Department of Surgery, School of
Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
(Republic of China)
(Tam) Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan (Republic
of China)
Publisher
Springer Japan
Abstract
Objective: Pulmonary atelectasis is a common postoperative complication
that may lead to intrapulmonary shunt, refractory hypoxemia, and
respiratory distress. Recruitment maneuvers may relieve pulmonary
atelectasis in patients undergoing thoracic surgery. This meta-analysis of
randomized controlled trials (RCTs) is to evaluate the effectiveness and
safety of recruitment maneuvers in patients undergoing thoracic surgery.
 Method(s): We performed a literature search on the PubMed, Embase,
and Cochrane Library databases and the ClinicalTrials.gov registry for
trials published before April 2021. We investigated postoperative
pulmonary atelectasis incidence, intrapulmonary shunt fraction, static
lung compliance, and mean arterial pressure. Result(s): Six RCTs
involving 526 patients were reviewed. Patients receiving a recruitment
maneuver exhibited a significant decrease in intrapulmonary shunt fraction
[weighted mean difference (WMD) - 0.02, 95% CI - 0.03 to - 0.01], improved
static lung compliance (WMD 2.16; 95% CI 1.14-3.18), and
PaO<inf>2</inf>/FIO<inf>2</inf> ratio (WMD 31.31; 95% CI 12.11-50.52)
without a significant difference in mean arterial pressure (WMD - 0.64;
95% CI - 4.92 to 3.64). The incidence pulmonary atelectasis favored
recruitment maneuver group, but was not statistically significant (RR
0.55; 95% CI 0.27-1.12). Conclusion(s): Recruitment maneuvers may be
a viable treatment for reducing intra-pulmonary shunt and improving static
lung compliance and PaO<inf>2</inf>/FIO<inf>2</inf> ratio without the
disturbance of hemodynamics in patients undergoing thoracic
surgery. Copyright © 2021, The Japanese Association for Thoracic
Surgery.

<20>
Accession Number
2014031343
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
(Fras) Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
(Mikhailidis) Department of Clinical Biochemistry, Royal Free Hospital
Campus, University College Medical School, University College London,
London, United Kingdom
Publisher
Bentham Science Publishers
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. Copyright © 2021 Bentham Science Publishers.

<21>
Accession Number
2014068463
Title
Safety and efficacy of concomitant ablation for atrial fibrillation in
rheumatic mitral valve surgery: A meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Ma J.; Wei P.; Yan Q.; Liu J.; Yao X.; Chen Z.; Zhuang J.; Guo H.-M.
Institution
(Ma, Wei, Liu, Chen, Zhuang, Guo) Department of Cardiovascular Surgery,
Guangdong Provincial Key Laboratory of South China Structural Heart
Disease, Guangdong Provincial People's Hospital, Guangdong Cardiovascular
Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
(Yan, Yao) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, Shenzhen, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This review aimed to evaluate the safety and efficacy of
concomitant surgical ablation (SA) for patients with atrial fibrillation
(AF) undergoing rheumatic mitral valve (MV) surgery. Method(s): A
systematic search of relevant studies focusing on SA for patients with AF
undergoing rheumatic MV surgery was performed. The primary outcomes
included mortality, efficacy, and complications. Result(s): Four
randomized controlled trials (RCTs) and four observational studies
covering 1931 patients met the inclusion criteria. In RCTs, no significant
differences in reoperation for bleeding, low cardiac output syndrome,
thromboembolic events, and early (risk ratio [RR], 2.07; 95% confidence
intervals [CI], 0.37-11.40; p =.41) and midterm all-cause death (RR, 1.07;
95% CI, 0.40-2.88; p =.89) were noted between the SA group and the
nonablation group. These results were similar to those obtained from
observational studies. However, ablation was associated with a higher
incidence of permanent pacemaker implantation (RR, 2.44; 95% CI,
1.15-5.18; p =.02) in observational studies but not in RCTs (RR, 2.03; 95%
CI, 0.19-21.26; p =.56). Furthermore, additional SA was significantly more
effective in sinus rhythm (SR) restoration than MV surgery alone at
discharge and at the 12-month and 3-year follow-ups. Conclusion(s):
Concomitant SA during rheumatic MV surgery does not increase perioperative
adverse events. In addition, SA promotes considerable restoration of SR.
Although some evidence exists that permanent pacemaker implantation is
more common after ablation, not all studies support this
notion. Copyright © 2021 Wiley Periodicals LLC

<22>
Accession Number
636362174
Title
Non-Vitamin K Antagonists versus Warfarin in Patients with Atrial
Fibrillation and Bioprosthetic Valves: a Systematic Review and
Meta-Analysis.
Source
The American journal of medicine. (no pagination), 2021. Date of
Publication: 08 Oct 2021.
Author
Cardoso R.; Ternes C.M.P.; Justino G.B.; Fernandes A.; Rocha A.V.; Knijnik
L.; d'Avila A.; Lopes R.D.
Institution
(Cardoso) Heart and Vascular Center, Brigham and Women's Hospital, Harvard
Medical School, Boston, United States
(Ternes) Department of Medicine, Federal University of Santa Catarina,
Florianopolis, Brazil; Cardiac Arrhythmia Service, Hospital SOS Cardio,
Florianopolis, Brazil
(Justino) Department of Medicine, Federal University of Santa Catarina,
Florianopolis, Brazil
(Fernandes, Knijnik) Division of Medicine, University of Miami, Miami,
United States
(Rocha) Division of Medicine, Federal University of Goias, Brazil
(d'Avila) Cardiac Arrhythmia Service, Hospital SOS Cardio, Florianopolis,
Brazil; Harvard-Thorndike Electrophysiology Institute, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
(Lopes) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with atrial fibrillation and bioprosthetic valves are
at high risk for thromboembolic events. The pooled efficacy and safety of
NOACs, as a class, relative to warfarin in this population is not well
known. We aimed to compare the efficacy and safety of NOACs relative to
warfarin in patients with bioprosthetic valves or valve repair.
 METHOD(S): We systematically searched EMBASE, PubMed, and Cochrane
databases for randomized controlled trials comparing NOACs to warfarin in
patients with atrial fibrillation and bioprosthetic valves or valve
repair. We pooled outcomes for stroke or systemic embolism; ischemic
stroke; hemorrhagic stroke; and major bleeding. RESULT(S): We
included 4 trials with 1,379 patients, of whom 723 (52.4%) received a
NOAC. Mean follow-up ranged from 90 days to 2.8 years. In the pooled
analysis, stroke or systemic embolism was significantly lower in patients
treated with NOACs (1.9%) compared with warfarin (3.7%) (OR 0.43; 95% CI
0.22-0.85; p=0.02). Ischemic stroke (OR 0.72; 95% CI 0.18-2.93),
hemorrhagic stroke (OR 0.18; 95% CI 0.03-1.05), cardiovascular death (OR
0.78; 95% CI 0.38-1.62), and all-cause mortality (OR 0.94; 95% CI
0.55-1.62) were not significantly different between groups. Major bleeding
was significantly lower in patients treated with NOAC (2.8%) compared with
warfarin (4.7%) (OR 0.49; 95% CI 0.28-0.88; p=0.02). CONCLUSION(S):
In patients with atrial fibrillation and bioprosthetic valves or valve
repair, NOACs are associated with a reduced incidence of thromboembolic
events and major bleeding as compared with warfarin. Thus, NOACs may be
considered a preferred option for this patient population. Copyright
© 2021. Published by Elsevier Inc.

<23>
Accession Number
636361995
Title
Antifibrinolytic Drugs for the Prevention of Bleeding in Pediatric Cardiac
Surgery on Cardiopulmonary Bypass: A Systematic Review and Meta-analysis.
Source
Anesthesia and analgesia. (no pagination), 2021. Date of Publication: 11
Oct 2021.
Author
Siemens K.; Sangaran D.P.; Hunt B.J.; Murdoch I.A.; Tibby S.M.
Institution
(Siemens, Sangaran, Murdoch, Tibby) From the Pediatric Intensive Care,
Evelina London Children's Hospital, St Thomas' Hospital, London, United
Kingdom
(Hunt) Department of Hematology, St Thomas' Hospital, London, United
Kingdom
Publisher
NLM (Medline)
Abstract
BACKGROUND: Bleeding is one of the commonest complications affecting
children undergoing cardiac surgery on cardiopulmonary bypass.
Antifibrinolytic drugs are part of a multifaceted approach aimed at
reducing bleeding, though sufficiently sized pediatric studies are sparse,
and dosing algorithms are heterogeneous. Our objective was to evaluate the
efficacy and safety of antifibrinolytic agents as well as the
effectiveness of different dosing regimens in pediatric cardiac surgery
using cardiopulmonary bypass. METHOD(S): We performed a systematic
review and meta-analysis evaluating randomized controlled trials published
between 1980 and 2019, identified by searching the databases MEDLINE,
EMBASE, PubMed, and CENTRAL. All studies investigating patients <18 years
of age without underlying hematological disorders were included. The
primary outcome was postoperative bleeding; secondary end points included
blood product transfusion, mortality, and safety (thromboses, anaphylaxis,
renal or neurological dysfunction, and seizures). Different dosing
regimens were compared. Studies were dual appraised, outcomes were
reported descriptively and, if appropriate, quantitatively using the
Review Manager 5 (REVMAN 5) software (The Cochrane Collaboration).
 RESULT(S): Thirty of 209 articles were included, evaluating the
following drugs versus control: aprotinin n = 14, tranexamic acid (TXA) n
= 12, and epsilon-aminocaproic acid (EACA) n = 4. The number of
participants per intervention group ranged from 11 to 100 (median, 25;
interquartile range [IQR], 20.5) with a wide age span (mean, 13 days to
5.8 years) and weight range (mean, 3.1-26.3 kg). Methodological quality
was low to moderate.All agents reduced mean 24-hour blood loss compared to
control: aprotinin by 6.0 mL/kg (95% confidence interval [CI], -9.1 to
-3.0; P = .0001), TXA by 9.0 mL/kg (95% CI, -11.3 to -6.8; P < .00001),
and EACA by 10.5 mL/kg (95% CI, -21.1 to 0.0; P = .05). Heterogeneity was
low for TXA (I2 = 29%; P = .19), moderate for aprotinin (I2 = 41%; P =
.11), and high for EACA (I2 = 95%; P = <.00001). All agents also reduced
24-hour blood product transfusion. There was no clear dose-response effect
for TXA nor aprotinin. Studies were underpowered to detect significant
differences in mortality, thromboses, anaphylaxis, and renal or
neurological dysfunction. CONCLUSION(S): The available data
demonstrate efficacy for all 3 antifibrinolytic drugs. Therefore, the
agent with the most favorable safety profile should be used. As sufficient
data are lacking, large comparative trials are warranted to assess the
relative safety and appropriate dosing regimens in
pediatrics. Copyright © 2021 International Anesthesia Research
Society.

<24>
Accession Number
2015373884
Title
Cost comparison between transcatheter aortic valve implantation and
surgical valve replacement using individual data in a Spanish public
hospital.
Source
Cirugia Cardiovascular. (no pagination), 2021. Date of Publication: 2021.
Author
Areces S.; Hernandez-Vaquero D.; Avanzas P.; Garcia-Aranda F.J.; Silva J.;
Moris C.
Institution
(Areces, Hernandez-Vaquero, Avanzas, Garcia-Aranda, Silva, Moris) Area del
Corazon, Hospital Universitario Central de Asturias, Oviedo, Spain
(Areces, Hernandez-Vaquero, Avanzas, Silva, Moris) Universidad de Oviedo,
Oviedo, Spain
Publisher
Elsevier Doyma
Abstract
Background: Transcatheter aortic valve implantation has revolutionized the
management of aortic stenosis and is currently an alternative to surgical
aortic valve replacement. Some studies have found costs of percutaneous
procedure to be greater than those of surgical replacement. However, these
published studies are based on pooled data from clinical registries. The
objective of the present study was to compare costs of both treatments
during the hospital phase in a Spanish public hospital. Method(s): A
hospital phase cost study consisted of patients diagnosed and treated with
aortic stenosis in a Spanish tertiary hospital between 1st January 2019
and 29th February 2020. An individual analysis was conducted in relation
to real costs pertaining to materials, staffing and hospital stay. Several
baseline characteristics were controlled for. Result(s): Mean costs
per patient from procedure through to discharge were 26,684.1 in the
percutaneous group and 14,939.5 in the surgical group (p < 0.001).
Independent of comorbidities, the cost of transcatheter aortic valve
implantation was, on average, 8636.6 greater than that of surgical aortic
valve replacement (95% CI 6086.3-11,186.9; p < 0.001). Conclusion(s):
Aortic stenosis treatment costs in hospital phase were greater when
percutaneous option was used in comparison to surgery. Copyright
© 2021 Sociedad Espanola de Cirugia Cardiovascular y Endovascular

<25>
Accession Number
2015373847
Title
Definition and assessment of high risk in patients considered for
lobectomy for stage I non-small cell lung cancer: The American Association
for Thoracic Surgery expert panel consensus document.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Pennathur A.; Brunelli A.; Criner G.; Keshavarz H.; Mazzone P.; Walsh G.;
Luketich J.; Liptay M.; Wafford E.; Murthy S.; Marshall M.B.; Tong B.;
Lanuti M.; Wolf A.; Pettiford B.; Loo B.; Merritt R.; Rocco G.; Schuchert
M.; Varghese T.; Swanson S.J.
Institution
(Pennathur, Luketich, Schuchert) Department of Cardiothoracic Surgery,
University of Pittsburgh School of Medicine and University of Pittsburgh
Medical Center, Pittsburgh, Pa, United States
(Brunelli) Department of Thoracic Surgery, Leeds Hospital, Leeds, United
Kingdom
(Criner) Department of Pulmonology, Temple University Hospital,
Philadelphia, Pa, United States
(Keshavarz) Department of Epidemiology, University Health Network,
Toronto, ON, Canada
(Mazzone) Department of Pulmonology, Cleveland Clinic, Cleveland, OH,
United States
(Walsh) Department of Thoracic Surgery, Univeristy of Texas M.D. Anderson
Cancer Center, Houston, Tex, United States
(Liptay) Department of Thoracic Surgery, Rush University Medical Center,
Chicago, Ill, United States
(Wafford) Department of Library Science, Northwestern University Feinberg
School of Medicine, Chicago, Ill, United States
(Murthy) Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH,
United States
(Marshall) Department of Thoracic Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Tong) Department of Thoracic Surgery, Duke University Hospital, Durham,
NC, United States
(Lanuti) Department of Thoracic Surgery, Massachusetts General Hospital,
Boston, MA, United States
(Wolf) Department of Thoracic Surgery, Mount Sinai Hospital, New York, NY,
United States
(Pettiford) Department of Thoracic Surgery, Ochsner Medical Center, New
Orleans, La, United States
(Loo) Department of Radiation Oncology, Stanford University Medical
Center, Stanford, Calif, United States
(Merritt) Department of Thoracic Surgery, The Ohio State University-Wexner
Medical Center, Columbus, OH, United States
(Rocco) Department of Thoracic Surgery, Memorial Sloan Kettering Cancer
Center, New York, NY, United States
(Varghese) Department of Thoracic Surgery, University of Utah, Huntsman
Cancer Center, Salt Lake City, UT, United States
(Swanson) Division of Thoracic Surgery, Harvard Medical School and Brigham
and Women's Hospital, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Objective: Lobectomy is a standard treatment for stage I non-small cell
lung cancer, but a significant proportion of patients are considered at
high risk for complications, including mortality, after lobectomy and
might not be candidates. Identifying who is at risk is important and in
evolution. The objective of The American Association for Thoracic Surgery
Clinical Practice Standards Committee expert panel was to review important
considerations and factors in assessing who is at high risk among patients
considered for lobectomy. Method(s): The American Association for
Thoracic Surgery Clinical Practice Standards Committee assembled an expert
panel that developed an expert consensus document after systematic review
of the literature. The expert panel generated a priori a list of important
risk factors in the determination of high risk for lobectomy. A survey was
administered, and the expert panel was asked to grade the relative
importance of each risk factor. Recommendations were developed using
discussion and a modified Delphi method. Result(s): The expert panel
survey identified the most important factors in the determination of high
risk, which included the need for supplemental oxygen because of severe
underlying lung disease, low diffusion capacity, the presence of frailty,
and the overall assessment of daily activity and functional status. The
panel determined that factors, such as age (as a sole factor), were less
important in risk assessment. Conclusion(s): Defining who is at high
risk for lobectomy for stage I non-small cell lung cancer is challenging,
but remains critical. There was impressive strong consensus on
identification of important factors and their hierarchical ranking of
perceived risk. The panel identified several key factors that can be
incorporated in risk assessment. The factors are evolving and as the
population ages, factors such as neurocognitive function and frailty
become more important. A minimally invasive approach becomes even more
critical in this older population to mitigate risk. The determination of
risk is a clinical decision and judgement, which should also take into
consideration patient perspectives, values, preferences, and quality of
life. Copyright © 2021

<26>
Accession Number
2015371370
Title
Autologous pericardium for adult and elderly patients undergoing aortic
valve replacement: A systematic review.
Source
Cirugia Cardiovascular. (no pagination), 2021. Date of Publication: 2021.
Author
Dilawar I.; Putra M.A.; Makdinata W.; Billy M.; Paat R.K.
Institution
(Dilawar, Putra, Makdinata, Billy, Paat) Division of Adult Cardiac
Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas
Indonesia, Indonesia
Publisher
Elsevier Doyma
Abstract
Ozaki et al. first performed aortic valve replacement using autologous
pericardium in 2007. Compared to mechanical and bioprosthetic valves which
have apparent disadvantages, this technique has been an alternative with a
promising safety and efficacy result. A comprehensive search was carried
out in 4 databases (Pubmed, Cochrane Library, Proquest, Scopus) from
February to March 2021 using search terms "autologous pericardium",
"aortic valve replacement", and "aortic valve reconstruction". Outcomes
measured in this study were mortality, freedom of operation,
thromboembolic and endocarditis event, and echocardiography finding. Risk
bias of all studies was measured using MINORS criteria. A total of 12
studies involving 1427 subjects were included. The mean age was 64.95
years and 52.1% subjects were male. Mortality due to cardiac and
noncardiac cause was 1.75%. Reoperation was needed in 1.12% subjects.
Thromboembolic and endocarditis events occurred in 0.21% and 0.91%
respectively. All studies reported lower average peak pressure gradient
after surgery. Aortic valve replacement using autologous pericardium has a
tolerable safety and efficacy. Copyright © 2021 Sociedad Espanola
de Cirugia Cardiovascular y Endovascular

<27>
Accession Number
2014077915
Title
Safety of direct oral anticoagulants in solid organ transplant recipients:
A meta-analysis.
Source
Clinical Transplantation. (no pagination), 2021. Date of Publication:
2021.
Author
Zakko J.; Ganapathi A.M.; Whitson B.A.; Mokadam N.A.; Henn M.C.; Lampert
B.; Kahwash R.; Franco V.; Haas G.; Emani S.; Hasan A.; Vallakati A.
Institution
(Zakko) Department of Surgery, The Ohio State University Wexner Medical
Center, Columbus, OH, United States
(Ganapathi, Whitson, Mokadam, Henn) Department of Surgery, Division of
Cardiac Surgery, The Ohio State University Wexner Medical Center,
Columbus, OH, United States
(Lampert, Kahwash, Franco, Haas, Emani, Hasan, Vallakati) Department of
Internal Medicine, Division of Cardiology, The Ohio State University
Wexner Medical Center, Columbus, OH, United States
Publisher
John Wiley and Sons Inc
Abstract
There is limited evidence comparing direct oral anticoagulants (DOACs) and
warfarin in solid organ transplant (SOT) recipients. We performed a pooled
analysis to study the safety and efficacy of DOACs in this patient
population. We searched PubMed, Embase, and Scopus databases using the
search terms "heart transplant" or "lung transplant" or "liver transplant"
or "kidney transplant" or "pancreas transplant" and "direct oral
anticoagulant" for literature search. Random effects model with
Mantel-Haenszel method was used to pool the outcomes. Pooled analysis
included 489 patients, of which 259 patients received DOACs and 230
patients received warfarin. When compared to warfarin, the use of DOACs
was associated with decreased risk of composite bleed (RR.49, 95%
CI.32-.76, p =.002). There were no differences in rates of major bleeding
(RR.55, 95% CI.20-1.49, p =.24) or venous thromboembolism (RR.65, 95%
CI.25-1.70, p =.38) between the two groups. Evidence from pooled analysis
suggests that DOACs are comparable to warfarin in terms of safety in SOT
recipients. Further research is warranted to conclusively determine
whether DOACs are safe alternatives to warfarin for anticoagulation in SOT
recipients. Copyright © 2021 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<28>
Accession Number
2014348340
Title
Efficacy of single-shot thoracic paravertebral block combined with
intravenous analgesia versus continuous thoracic epidural analgesia for
chronic pain after thoracotomy.
Source
Pain Physician. 24(6) (pp E753-E759), 2021. Date of Publication: September
2021.
Author
Li X.-L.; Zhang J.; Wan L.; Wang J.
Institution
(Li, Zhang, Wan) Department of Anesthesiology, Beijing Friendship
Hospital, Capital Medical University, Beijing, China
(Wang) The Pain Department, Zao Zhuang Municipal Hospital, Shandong
Province, Zaozhuang, China
Publisher
American Society of Interventional Pain Physicians
Abstract
Background: Patients undergoing thoracic surgery frequently suffer from
chronic pain after thoracotomy. Chronic pain can lead to a significant
decline in a patient's quality of life. However, the effect of single-shot
thoracic paravertebral block (TPVB) combined with intravenous analgesia on
chronic pain incidence is unclear. Objective(s): The objective was to
evaluate the impact of single-shot TPVB combined with intravenous
analgesia versus continuous thoracic epidural analgesia (TEA) on chronic
pain incidence after thoracotomy. Study Design: A randomized
controlled study. Setting(s): Hospital department in China.
 Method(s): Ninety-six patients undergoing thoracotomy were randomly
assigned to 2 groups: single-shot TPVB combined with intravenous analgesia
(Group P) and continuous TEA (Group E). The pain intensity was assessed
using the Verbal Rating Scale (VRS). The outcome measures were chronic
pain incidence and the acute and chronic pain intensity. Result(s):
The chronic pain incidence at rest in Group P was significantly higher
than that in Group E at 3 months and 12 months postoperation (55.2% versus
28.6%, P = 0.019; 34.5% versus 14.3%, P = 0.027). The patients in Group E
showed less pain intensity at rest compared with those in Group P at 3
months postoperation (0.0 versus 1.0, P = 0.034). At 6 hours and 24 hours
postoperation, the acute pain intensity at coughing and at rest in Group E
was lower than that in group P (VRS at coughing: 6 hours: 0.0 versus 2.0,
P = 0.001; 24 hours: 3.0 versus 5.0, P = 0.010. VRS at rest: 6 hours: 0.0
versus 2.0, P = 0.000; 24 hours: 1.0versus. 2.0, P = 0.001).
 Limitation(s): An important limitation of this study is that it is
not a double-blind study. Conclusion(s): In patients undergoing
thoracotomy, continuous TEA significantly reduced the chronic pain
incidence at rest at 3 months and 12 months after operation and provided
better acute pain relief up to 24 hours after operation compared with
single-shot TPVB combined with intravenous analgesia. Copyright ©
2021, American Society of Interventional Pain Physicians. All rights
reserved.

<29>
Accession Number
635149007
Title
Systematic review of prospective studies focused on regionalization of
care in surgical oncology.
Source
Updates in surgery. 73(5) (pp 1699-1707), 2021. Date of Publication: 01
Oct 2021.
Author
Goel S.; Symer M.M.; Alzghari T.; Baltich Nelson B.; Yeo H.L.
Institution
(Goel) Department of Surgery, Weill Cornell Medical College, NY, NY,
United States
(Goel) Department of Surgical Oncology, Department of Healthcare Policy,
Weill Cornell Medicine, 525 E 68th St, NY, NY 10065, United States
(Symer, Alzghari, Yeo) Department of Surgery, Weill Cornell Medical
College, NY, NY, United States
(Baltich Nelson) Clinical and Systems Librarian, Weill Cornell Medical
College, NY, NY, United States
(Yeo) Department of Surgical Oncology, Department of Healthcare Policy,
Weill Cornell Medicine, 525 E 68th St, NY, NY 10065, United States
Publisher
NLM (Medline)
Abstract
To perform a systematic review of studies prospectively analyzing the
impact of regionalization of complex surgical oncology care on patient
outcomes. High volume care of complex surgical oncology patients has been
repeatedly associated with improved outcomes. Most studies, however, are
retrospective and have not prospectively accounted for confounders such as
financial ability and social support. Four electronic databases (Ovid
MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), and EBSCHOHost) were
searched from inception until August 25, 2018. Two authors independently
reviewed 5887 references, with a third independent reviewer acting as
arbitrator when needed. Data extracted from 11 articles that met inclusion
criteria. Risk of bias assessments conducted using MINORS criteria for the
non-randomized, observational studies, and the Cochrane tool for the
randomized-controlled trial. Of the 11 studies selected, we found 7
historically-controlled trials, two retrospective cohort studies with
prospective data collection, one prospective study, and one
randomized-controlled trial. 73% of studies were from Northern Europe, 18%
from Ontario, Canada, and 9% from England. Pancreatic surgery accounted
for 36% of studies, followed by gynecologic oncology (27%), thoracic
surgery (18%), and dermatologic surgery (9%). The studies reported varying
outcome parameters, but all showed improvement post-regionalization.
Included studies featured poor-to-fair risk of bias. 11 studies indicated
improved outcomes following regionalization of surgical oncology, but most
exhibit poor methodological rigor. Prospective evidence for the
regionalization of surgical oncology is lacking. More research addressing
patient access to care and specialist availability is needed to understand
the shortcomings of centralization. Copyright © 2021. Italian
Society of Surgery (SIC).

<30>
Accession Number
2015005119
Title
Effects of 12-Week Supervised Early Resistance Training (SEcReT) Versus
Aerobic-Based Rehabilitation on Cognitive Recovery Following Cardiac
Surgery via Median Sternotomy: A Pilot Randomised Controlled Trial.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Pengelly J.; Royse C.; Williams G.; Bryant A.; Clarke-Errey S.; Royse A.;
El-Ansary D.
Institution
(Pengelly, Royse, Royse, El-Ansary) Department of Nursing and Allied
Health, Swinburne University of Technology, Melbourne, Vic, Australia
(Pengelly) School of Science, Psychology and Sport, Federation University
Australia, Ballarat, Vic, Australia
(Royse, Royse, El-Ansary) Department of Surgery, University of Melbourne,
Melbourne, Vic, Australia
(Royse) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, Vic, Australia
(Royse) Outcomes Research Consortium Cleveland Clinic, Cleveland, OH,
United States
(Williams, Bryant) Department of Physiotherapy, University of Melbourne,
Melbourne, Vic, Australia
(Clarke-Errey) Statistical Consulting Centre, University of Melbourne,
Melbourne, Vic, Australia
(Royse) Department of Cardiothoracic Surgery, Royal Melbourne Hospital,
Melbourne, Vic, Australia
(El-Ansary) Clinical Research Institute, Westmead Private Hospital,
Sydney, NSW, Australia
Publisher
Elsevier Ltd
Abstract
Aims: To investigate the effects of a 12-week early moderate-intensity
resistance training program compared to aerobic-based rehabilitation on
postoperative cognitive recovery following cardiac surgery via median
sternotomy. Method(s): This was a multicentre, prospective,
pragmatic, non-blinded, pilot randomised controlled trial (1:1
randomisation) of two parallel groups that compared a 12-week early
moderate-intensity resistance training group to a control group, receiving
aerobic-based rehabilitation. English-speaking adults (>=18 years)
undergoing elective cardiac surgery via median sternotomy were randomised
using sealed envelopes, with allocation revealed before surgery. The
primary outcome was cognitive function, assessed using the Alzheimer's
Disease Assessment Scale-cognitive subscale (ADAS-cog), at baseline, 14
weeks and 6 months postoperatively. Result(s): The ADAS-cog score at
14 weeks was significantly better for the resistance training group (n=14,
7.2+/-1.4; 95% CI 4.3, 10.2, vs n=17, 9.2+/-1.3; 95% CI 6.6, 11.9,
p=0.010). At 14 weeks postoperatively, 53% of the aerobic-based
rehabilitation group (n=9/17) experienced cognitive decline by two points
or more from baseline ADAS-cog score, compared to 0% of the resistance
training group (n=0/14; p=0.001). Conclusion(s): Early resistance
training appears to be safe and may improve cognitive recovery compared to
standard, aerobic-based rehabilitation following cardiac surgery via
median sternotomy, however as this was a pilot study, the sample size was
small and further research is needed to determine a causal
relationship. Copyright © 2021 Australian and New Zealand Society
of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<31>
Accession Number
2015004597
Title
Rigid Ring Versus Flexible Band for Tricuspid Valve Repair in Patients
Scheduled for Mitral Valve Surgery: A Prospective Randomized Study.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Bogachev-Prokophiev A.V.; Ovcharov M.A.; Sapegin A.V.; Lavinykov S.O.;
Astapov D.A.; Ivanzov S.M.; Sharifulin R.M.; Afanasyev A.V.; Demin I.I.;
Zeleznev S.I.
Institution
(Bogachev-Prokophiev, Ovcharov, Sapegin, Lavinykov, Astapov, Ivanzov,
Sharifulin, Afanasyev, Demin, Zeleznev) Heart Valves Surgery Department,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
Publisher
Elsevier Ltd
Abstract
Background: Tricuspid valve repair for functional regurgitation is
effectively performed with different annuloplasty devices. However, it
remains unclear whether there are advantages associated with rigid rings
compared to flexible bands. This prospective randomised study aimed to
compare results of using a flexible band ring versus a rigid ring for
functional tricuspid regurgitation in patients undergoing mitral valve
surgery. Method(s): A single-centre randomised study was designed to
allocate patients with functional tricuspid regurgitation undergoing
mitral valve surgery to be treated with a flexible band or rigid ring.
These patients were analysed by echocardiographic follow-up. The primary
outcome was freedom from recurrent tricuspid regurgitation at 12-months
follow-up. Secondary outcomes were 30-day mortality, survival, freedom
from tricuspid valve reoperation, right ventricular reverse remodelling,
and rate of major adverse events. Result(s): A total of 308 patients
were allocated to receive concomitant tricuspid valve annuloplasty with
the flexible band or rigid ring. There was no between-group difference in
freedom from recurrent tricuspid regurgitation: 97.3% in Rigid group (95%
CI, 93.0-98.8) and 96.2% in the Flexible group (95% CI, 92.0-98.5) at
12-months follow-up (log-rank, p=0.261). Early mortality, survival,
freedom from tricuspid valve reoperation, and global right ventricle
systolic function were also comparable in both groups of patients.
However, the flexible band had advantage in restoring regional right
ventricle function (Doppler-derived systolic velocities of the annulus
[S], tricuspid annular plane systolic excursion) at 12-months follow-up.
 Conclusion(s): Both the rigid ring and flexible band offered
acceptable outcomes for functional tricuspid regurgitation correction
without significant differences, as assessed at 12-months
follow-up. Copyright © 2021 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<32>
Accession Number
636355839
Title
Transcatheter mitral valve replacement for degenerated mitral valve
bioprostheses, failure of mitral valvuloplasty and native valve with
severe mitral annulus calcification: a systematic review and
meta-analysis.
Source
Journal of cardiothoracic surgery. 16(1) (pp 293), 2021. Date of
Publication: 10 Oct 2021.
Author
You T.; Wang W.; Yi K.; Gao J.; Zhang X.; He S.-E.; Xu X.-M.; Ma Y.-H.; Li
X.-Y.
Institution
(You, Yi) Department of Cardiovascular Surgery, Gansu Provincial Hospital,
No. 204, Donggang West RoadGansu Province 730000, China
(You, Wang, Yi, Gao, Zhang, He, Xu, Ma, Li) Gansu International Scientific
and Technological Cooperation Base of Diagnosis and Treatment of
Congenital Heart Disease, Lanzhou, China
(Wang, Gao, Xu, Ma, Li) First Clinical Medical College of Lanzhou
University, Lanzhou, China
(Zhang) First School of Clinical Medical of Gansu University of Chinese
Medicine, Lanzhou, China
(He) Second Clinical Medical College of Lanzhou University, Lanzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Although transcatheter technology has achieved some success in
the field of mitral valves, the feasibility of applying it to patients
with degenerated mitral valve bioprostheses (valve-in-valve, ViV), failure
of mitral valvuloplasty (valve-in-ring, ViR) and serious mitral annulus
calcification (vale-in-MAC, ViMAC) has not been effectively evaluated.
 METHOD(S): By searching published literature before December 5, 2020
in four databases, we found all the literature related to the evaluation
of feasibility assessment of TMViV, TMViR and TMViMAC. Outcomes focused on
all-cause mortality within 30 days, bleeding and LVOT obstruction.
 RESULT(S): A total of six studies were included, and all of them were
followed up for at least 30 days. After analysis of the ViV-ViR group, we
obtained the following results: the all-cause mortality within 30 days of
the ViV group was lower than that of the ViR group. Life-threatening or
fatal bleeding was more likely to occur in the ViR group after surgery. At
the same time, the ViR group was more prone to left ventricular outflow
tract obstruction. However, in the ViMAC-ViR group, only the all-cause
mortality within 30 days and stroke were statistically significant. In the
indirect comparison, we found that TMViV had the best applicability,
followed by TMViR. There were few TMViMAC available for analysis, and it
requires further studies to improve the accuracy of the results.
 CONCLUSION(S): TMViV and TMViR had good applicability and could
benefit patients who underwent repeat valve surgery. The feasibility of
TMViMAC needs to be further explored and improved. Copyright ©
2021. The Author(s).

<33>
Accession Number
636355029
Title
A systematic review and meta-analysis on the curative effects of
cardiothoracic surgery for critical patients in the intensive care unit.
Source
Annals of palliative medicine. 10(9) (pp 9879-9888), 2021. Date of
Publication: 01 Sep 2021.
Author
Geng M.; Li Z.; Cui W.; Cheng J.; Li L.; Li J.; Li F.
Institution
(Geng, Li, Cui, Cheng, Li, Li, Li) Department of Critical Care, Jincheng
People's Hospital (Jincheng Hospital Affiliated to Changzhi Medical
College), Jincheng, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this study was to explore the curative effects of
cardiothoracic surgery (CTS) for critical patients in the intensive care
unit (ICU) using meta-analysis. METHOD(S): Literature was searched
using the following search terms: "cardiothoracic surgery", "intensive
care unit", "critical patients", "post-operation", and "curative effects".
Rev Man 5.3 was used for meta-analysis. RESULT(S): A total of 15
randomized controlled trials (RCTs) were included, all of which had a low
risk of bias, indicating medium and high quality. At 30 days after CTS,
the number of patients with grade III and IV cardiac function was reduced
by 76.84%, and the overall heterogeneity test results revealed that
Tau2=0.09, Chi2=17.08, df=5, I2=71%, P=0.004<0.01, Z=7.62, RR =0.33, and
95% CI: 0.24 to 0.43. The incidence of adverse reactions was analyzed in 6
RCTs, and mainly manifested as improper anticoagulation thrombosis and
bleeding. The overall heterogeneity test results revealed that Chi2=1.07,
df=5, I2=0%, P=0.96, Z=4.93, OR =0.46, 95% CI: 0.34 to 0.63, and P<0.01.
The 30-day mortality rate was analyzed in 8 RCTs. The overall analysis
using the fixed effects model revealed that there was a notable difference
between the experimental group and the baseline, with Z=10.11, OR =0.12,
95% CI: 0.08 to 0.18, and P<0.01. DISCUSSION: CTS can reduce the incidence
of adverse events and the mortality rate of critical patients in the ICU,
demonstrating high safety.

<34>
Accession Number
2014347258
Title
Incidence and outcomes of infective endocarditis after transcatheter or
surgical aortic valve replacement.
Source
Journal of the American Heart Association. 10(19) (no pagination), 2021.
Article Number: e020368. Date of Publication: 05 Oct 2021.
Author
Lanz J.; Reardon M.J.; Pilgrim T.; Stortecky S.; Deeb G.M.; Chetcuti S.;
Yakubov S.J.; Gleason T.G.; Huang J.; Windecker S.
Institution
(Lanz, Pilgrim, Stortecky, Windecker) Department of Cardiology,
Inselspital, Bern University Hospital, Bern, Switzerland
(Reardon) Methodist DeBakey Heart & Vascular Center, Houston, TX, United
States
(Deeb, Chetcuti) University of Michigan Medical Center, Ann Arbor, MI,
United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Gleason) Division of Cardiac Surgery, Brigham & Women's Hospital &
Harvard Medical School, Boston, MA, United States
(Huang) Department of Statistics, Medtronic, plc, Minneapolis, MN, United
States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Data comparing the frequency and outcomes of infective
endocarditis (IE) after transcatheter (TAVR) to surgical aortic valve
replacement (SAVR) are scarce. The objective of this study is to compare
the incidence and outcomes of IE after TAVR using a supra-annular,
self-expanding platform (CoreValve and Evolut) to SAVR. METHODS AND
RESULTS: Data of 3 randomized clinical trials comparing TAVR to SAVR and a
prospective continued TAVR access study were pooled. IE was defined on the
basis of the modified Duke criteria. The cumulative incidence of IE was
determined by modeling the cause-specific hazard. Estimates of all-cause
mortality were calculated by means of the Kaplan-Meier method. Outcomes
are reported for the valve-implant cohort. During a mean follow-up time of
2.17+/-1.51 years, 12 (0.5%) of 2249 patients undergoing TAVR and 21
(1.1%) of 1828 patients undergoing SAVR developed IE. Patients with IE
more frequently had diabetes mellitus than those without (57.6% versus
34.2%; P=0.005). The cumulative incidence of IE was 1.01% (95% CI,
0.47%-1.96%) after TAVR and 1.58% (95% CI, 0.97%-2.46%) after SAVR
(P=0.047) at 5 years. Among patients with IE, the rate of all-cause
mortality was 27.3% (95% CI, 1.0%-53.6%) in the TAVR and 51.8% (95% CI,
28.2%-75.3%) in the SAVR group at 1 year (log-rank P=0.15).
 CONCLUSION(S): Pooled prospectively collected data comparing TAVR
with a supra-annular, self-expanding device to SAVR showed a low
cumulative risk of IE irrespective of treatment modality, although the
risk was lower in the TAVR implant group. Once IE occurred, mortality was
high. Copyright © 2021 The Authors.

<35>
Accession Number
636357115
Title
Patient-reported quality of life after stand-alone and concomitant
arrhythmia surgery: a systematic review and meta-analysis.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 11 Oct 2021.
Author
Maesen B.; van der Heijden C.A.J.; Bidar E.; Vos R.; Athanasiou T.;
Maessen J.G.
Institution
(Maesen, van der Heijden, Bidar, Maessen) Department of Cardiothoracic
Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
(Maesen, Bidar, Maessen) Cardiovascular Research Institute Maastricht,
Maastricht, Netherlands
(Vos) Department of Methodology and Statistics, Maastricht University,
Maastricht, Netherlands
(Athanasiou) Department of Cardiothoracic Surgery, Imperial College
London, St Mary's Hospital, London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Patient-reported quality of life (QOL) has become an important
endpoint for arrhythmia surgery for atrial fibrillation (AF). While
studies specifically evaluating the effect of arrhythmia surgery on QOL
are scarce, we aimed to summarize current evidence of QOL following
concomitant and stand-alone arrhythmia surgery for AF. METHOD(S): All
studies reporting on QOL using questionnaires from patients undergoing
arrhythmia surgery for AF, both stand-alone and concomitant, were included
in this systematic review. A meta-analysis was performed on inter-study
heterogeneity of changes in QOL on 9 of 12 included studies that used the
Short-Form 36 tool and meta-regression based on rhythm outcome after 1
year was executed. Finally, differences in QOL following stand-alone
arrhythmia surgery and concomitant procedures were evaluated.
 RESULT(S): Overall, QOL scores improved 1 year after surgical
ablation for AF evaluated by several questionnaires. In stand-alone
arrhythmia procedures, meta-regression showed significant improvements in
those who were in sinus rhythm compared to those in AF after 1 year. This
association between an improved QOL and the procedural effectiveness was
also suggested in concomitant procedures. However, when comparing QOL of
patients undergoing cardiac surgery with and without add-on surgical
ablation for AF, only the variable 'physical role' demonstrated a
significant improvement. CONCLUSION(S): In patients with AF, QOL
improves after both stand-alone and concomitant arrhythmia surgery. In the
concomitant group, this improvement can be attributed to both the cardiac
procedure itself as well as the add-on arrhythmia surgery. However, both
in stand-alone and concomitant procedures, the improvement in QOL seems to
be related to the effectiveness of the procedure to maintain sinus rhythm
after 12 months. Copyright © The Author(s) 2021. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<36>
Accession Number
636356899
Title
Dyslipidemia and aortic valve disease.
Source
Current opinion in lipidology. (no pagination), 2021. Date of
Publication: 08 Oct 2021.
Author
Mata P.; Alonso R.; Perez de Isla L.; Badimon L.
Institution
(Mata) Fundacion Hipercolesterolemia Familiar, Madrid, Spain Center for
Advanced Metabolic Medicine and Nutrition, Santiago, Chile Cardiology
Department, Hospital Clinico San Carlos, IDISSC, Facultad de Medicina,
Universidad Complutense, Madrid Cardiovascular Program - ICCC, Institut de
Recerca del Hospital Santa Creu i Sant Pau, IIB Sant Pau, Ciber CV,
Barcelona, Spain
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Degenerative aortic stenosis (AS) is one of the most
prevalent heart valve diseases in the adult population. The understanding
of AS pathophysiology and involved risk factors have recently undergone a
great advance, with low-density lipoprotein cholesterol (LDL-C),
lipoprotein (a) [Lp(a)] and other clinical conditions taking on a relevant
role. Although little is known about the prevention of AS, we can
progressively find more evidence of the possible use of drugs to control
risk factors as tools that may delay the progression to severe AS and
aortic valve replacement. RECENT FINDINGS: Several factors have shown to
be solid predictors of the development of AS. Mendelian randomization and
observational studies on risk factors specifically lipid factors, such as
hypercholesterolemia, Lp(a), proprotein convertase subtilisin/kexin type 9
and hypertension have provided meaningful new information. The SAFEHEART
study has significantly contributed to define the role of LDL-C and Lp(a)
in AS. SUMMARY: In this review we discuss the interrelationship of
dyslipidemia, especially hypercholesterolemia and Lp(a) in the development
and prognosis of valvular AS. New imaging tools may contribute to its
early detection. Future studies with proprotein convertase
subtilisin/kexin type 9 inhibitors and specific therapies to lower Lp(a)
might contribute to delay AS development. Copyright © 2021
Wolters Kluwer Health, Inc. All rights reserved.

<37>
Accession Number
2015123206
Title
Is Epicardial Adipose Tissue Associated with Atrial Fibrillation following
Cardiac Surgery? A Systematic Review and Meta-Analysis.
Source
Heart Surgery Forum. 24(5) (pp E801-E807), 2021. Date of Publication: 08
Sep 2021.
Author
Sha R.; Han W.; Lin M.; Zhong J.
Institution
(Sha, Han, Lin, Zhong) Key Laboratory of Cardiovascular Remodeling and
Function Research, Chinese Ministry of Education, Chinese National Health
Commission and Chinese Academy of Medical Sciences, State and Shandong
Province Joint Key Laboratory of Translational Cardiovascular Medicine,
Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine,
Shandong University, Jinan, China
(Lin) Peking University First Hospital, Beijing, China
(Zhong) Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College
of Medicine, Shandong University, Qingdao, China
Publisher
Forum Multimedia Publishing LLC
Abstract
Background: Although epicardial adipose tissue (EAT) has been proven to be
related to atrial fibrillation (AF) and post-ablation AF recurrence, the
association between EAT and AF after cardiac surgery (AFACS) remains
unclear. Objective(s): This study was a systematic review and
meta-analysis that assessed the relationship between EAT and AFACS.
 Method(s): Electronic databases were systematically searched for
"atrial fibrillation" and "epicardial adipose tissue." The analysis was
stratified according to the EAT measurement into three meta-analyses as
(1) total EAT volume, (2) left atrial (LA)-EAT volume, and (3) EAT
thickness. Standardized mean difference (SMD) was estimated using a random
effects model. Result(s): Eight articles with 10 studies (546
patients) were included. The meta-analysis revealed that EAT was higher in
those with AFACS irrespective of the EAT measurement (total EAT volume:
SMD = 0.56 mL, 95% confidence interval, CI = 0.56-1.10 mL, I2 =
0.90, P = .04; EAT thickness: SMD = 0.85 mm, 95% CI = 0.04-1.65 mm,
I2 = 0.90, P = .04; LA-EAT volume: SMD = 0.57 mL, 95% CI =
0.23-0.92 mL, I2 = 0.00, P = .001). Conclusion(s): EAT was
higher in patients with AFACS, measured either as volume or
thickness. Copyright © 2021 Forum Multimedia Publishing, LLC

<38>
Accession Number
2013906511
Title
Do continuous forms of intra-operative ultrafiltration enhance recovery
after adult cardiac surgery with cardiopulmonary bypass? A protocol for
systematic review and meta-analysis of randomized controlled trials.
Source
Systematic Reviews. 10(1) (no pagination), 2021. Article Number: 265. Date
of Publication: December 2021.
Author
Bierer J.; Horne D.; Stanzel R.; Henderson M.; Boulos L.; Hayden J.
Institution
(Bierer, Horne) Division of Cardiac Surgery, Department of Surgery,
Dalhousie University, Halifax, Canada
(Stanzel, Henderson) Department of Clinical Perfusion, Nova Scotia Health
Authority, Halifax, Canada
(Boulos) Maritime SPOR SUPPORT Unit, Halifax, Canada
(Hayden) Department of Community Health & Epidemiology, Dalhousie
University, Halifax, Canada
Publisher
BioMed Central Ltd
Abstract
Background: Cardiac surgery with cardiopulmonary bypass (CPB) is
associated with a systemic inflammatory syndrome that adversely impacts
cardiopulmonary function and can contribute to prolonged postoperative
recovery. Intra-operative ultrafiltration during CPB is a strategy
developed by pediatric cardiac specialists, aiming to dampen the
inflammatory syndrome by removing circulating cytokines and improving
coagulation profiles during the cardiac operation. Although
ultrafiltration is commonly used in the pediatric population, it is not
routinely used in the adult population. This study aims to evaluate if
randomized evidence supports the use of continuous intra-operative
ultrafiltration to enhance recovery for adults undergoing cardiac surgery
with CPB. Method(s): This systematic review and meta-analysis will
include randomized controlled trials (RCT) that feature continuous forms
of ultrafiltration during adult cardiac surgery with CPB, specifically
assessing for benefit in mortality rates, invasive ventilation time and
intensive care unit length of stay (ICU LOS). Relevant RCTs will be
retrieved from databases, including MEDLINE, Embase, CENTRAL and Scopus,
by a pre-defined search strategy. Search results will be screened for
inclusion and exclusion criteria by two independent persons with
consensus. Selected RCTs will have study demographics and outcome data
extracted by two independent persons and transferred into RevMan. Risk of
bias will be independently assessed by the Revised Cochrane Risk-of-Bias
(RoB2) tool and studies rated as low-, some-, or high- risk of bias.
Meta-analyses will compare the intervention of continuous ultrafiltration
against comparators in terms of mortality, ventilation time, ICU LOS, and
renal failure. Heterogeneity will be measured by the chi2 test
and described by the I2 statistic. A sensitivity analysis will
be completed by excluding included studies judged to have a high risk of
bias. Summary of findings and certainty of the evidence, determined by the
GRADE approach, will display the analysis findings. Discussion(s):
The findings of this systematic review and meta-analysis will summarize
the evidence to date of continuous forms of ultrafiltration in adult
cardiac surgery with CPB, to both inform adult cardiac specialists about
this technique and identify critical questions for future research in this
subject area. Systematic review registration: This systematic review and
meta-analysis is registered in PROSPERO CRD42020219309
(https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219309)
. Copyright © 2021, The Author(s).

<39>
Accession Number
2014940733
Title
Pentoxifylline for treatment of major depression after percutaneous
coronary intervention or coronary artery bypass grafting: A randomized,
double-blind, placebo-controlled trial.
Source
Journal of Psychosomatic Research. 150 (no pagination), 2021. Article
Number: 110635. Date of Publication: November 2021.
Author
Yasrebi S.-O.; Momtazmanesh S.; Moghaddam H.S.; Shahmansouri N.; Mehrpooya
M.; Arbabi M.; Ghazizadeh-Hashemi F.; Akhondzadeh S.
Institution
(Yasrebi, Momtazmanesh, Moghaddam, Akhondzadeh) Psychiatric Research
Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Shahmansouri, Arbabi, Ghazizadeh-Hashemi) Psychosomatics Ward, Imam
Hospital, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Mehrpooya) Cardiology Ward, Imam Hospital, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
Introduction: Near one-fifth of patients with coronary artery disease
(CAD) develop major depressive disorder (MDD), an independent risk factor
of mortality in these patients. We investigated the efficacy of oral
pentoxifylline in treating MDD in CAD patients undergoing percutaneous
coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a
6-week trial. Method(s): We only included patients with mild to
moderate MDD (having a score between 14 and 17 on the Hamilton depression
rating scale (HAM-D)). Sixty-four CAD patients undergoing PCI or CABG aged
40-60 years were randomly assigned to either the pentoxifylline (800 mg
daily) or the placebo group. The outcome was assessed with the HAM-D at
weeks 2, 4, and 6. Result(s): Patients receiving pentoxifylline had
greater improvement in HAM-D scores from baseline at each follow-up than
patients receiving placebo (p-value = 0.036 at week 2, p-value < 0.001 at
week 4, and p-value < 0.001 at week 6). We found a significant effect for
treatment, time, and timextreatment interaction in depression improvement
(p-value < 0.001). Rate of remission, treatment response, and adverse
effects did not differ between the two groups. Discussion(s): Our
study supports the safety and efficacy of pentoxifylline in treatment of
MDD in CAD patients. However, further investigations are required to
confirm the generalizability of our results since the results need to be
interpreted cautiously because of the imitated range of disease severity
for inclusion. This trial was registered with the Iranian Registry of
Clinical Trials (www.irct.ir; No. IRCT20090117001556N132). Copyright
© 2021 Elsevier Inc.

<40>
Accession Number
2014905953
Title
Cost-effectiveness of low-dose colchicine after myocardial infarction in
the Colchicine Cardiovascular Outcomes Trial (COLCOT).
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 7(5) (pp
486-495), 2021. Date of Publication: 01 Nov 2021.
Author
Samuel M.; Tardif J.-C.; Khairy P.; Roubille F.; Waters D.D.; Gregoire
J.C.; Pinto F.J.; Maggioni A.P.; Diaz R.; Berry C.; Koenig W.; Ostadal P.;
Lopez-Sendon J.; Gamra H.; Kiwan G.S.; Dube M.-P.; Provencher M.; Orfanos
A.; Blondeau L.; Kouz S.; L'allier P.L.; Ibrahim R.; Bouabdallaoui N.;
Mitchell D.; Guertin M.-C.; Lelorier J.
Institution
(Samuel, Tardif, Khairy, Gregoire, Dube, L'allier, Ibrahim, Bouabdallaoui,
Lelorier) Montreal Heart Institute, Universite de Montreal, 5000 Belanger
Street, Montreal, QC H1T 1C8, Canada
(Roubille) Universite de Montpellier, INSERM, CNRS, CHU de Montpellier,
Cardiology Department, CHU Arnaud de Villeneuve, 371, avenue du Doyen
Gaston-Giraud, Montpellier 34090, France
(Waters) San Francisco General Hospital, Zuckerberg San Francisco General
Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States
(Pinto) Santa Maria University Hospital (Centro Hospitalar Universitario
Lisboa Norte), Centro Academico de Medicina de Lisboa, Centro
Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da
Universidade de Lisboa, Lisbon, Portugal
(Maggioni) ANMCO Research Center, Via La Marmora 34, Firenze 50121, Italy
(Diaz) Estudios Clinicos Latinoamerica, Paraguay 160, Rosario 2000,
Argentina
(Berry) University of Glasgow and NHS Glasgow Clinical Research Facility,
126 University Pl, University of Glasgow, Glasgow G12 8TA, United Kingdom
(Koenig) Deutsches Herzzentrum Munchen, Technische Universitat Munchen,
Munich, Institute of Epidemiology and Medical Biometry, University of Ulm,
Ulm, Lazarettstr. 36, Munchen D-80636, Germany
(Ostadal) Cardiovascular Center, Na Homolce Hospital, Roentgenova 2,
Prague 150 00, Czechia
(Lopez-Sendon) H La Paz, IdiPaz, UAM, Ciber-CV Madrid, La Paz University
Hospital, Paseo de la Castellana, 261, Madrid 28046, Spain
(Gamra) Fattouma Bourguiba University Hospital, Monastir 5000, Tunisia
(Kiwan) Bellevue Medical Center, Qanater Zubayda- Mansouriyeh, Mansourieh,
Metn District, Beirut, Lebanon
(Provencher, Orfanos, Blondeau, Guertin) The Montreal Health Innovations
Coordinating Center, 4100 Molson St. Suite 400, Montreal, QC H1Y 3N1,
Canada
(Kouz) Centre Hospitalier Regional de Lanaudiere, 1000 Sainte-Anne Blvd,
Saint-Charles-Borromee, QC J6E 6J2, Canada
(Mitchell) Logimetrix Inc., 3600 Rhodes Drive, Windsor, ON N8W 5A4, Canada
(Lelorier) Centre de recherche du Centre hospitalier de l'Universite de
Montreal, 900 St Denis St, Montreal, QC H2X 0A9, Canada
Publisher
Oxford University Press
Abstract
Aims: In the randomized, placebo-controlled Colchicine Cardiovascular
Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after
myocardial infarction (MI), low-dose colchicine (0.5 mg once daily)
reduced the incidence of the primary composite endpoint of cardiovascular
death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization
for angina leading to coronary revascularization. To assess the in-trial
period and lifetime cost-effectiveness of low-dose colchicine therapy
compared to placebo in post-MI patients on standard-of-care therapy.
 Methods and Results: A multistate Markov model was developed
incorporating the primary efficacy and safety results from COLCOT, as well
as healthcare costs and utilities from the Canadian healthcare system
perspective. All components of the primary outcome, non-cardiovascular
deaths, and pneumonia were included as health states in the model as both
primary and recurrent events. In the main analysis, a deterministic
approach was used to estimate the incremental cost-effectiveness ratio
(ICER) for the trial period (24 months) and lifetime (20 years). Over the
in-trial period, the addition of colchicine to post-MI standard-of-care
treatment decreased the mean overall per-patient costs by 47%, from $502
to $265 Canadian dollar (CAD), and increased the quality-adjusted life
years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were
further reduced (69%) and QALYs increased with colchicine therapy (from
8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated
colchicine therapy was a dominant strategy. Conclusion(s):
Cost-effectiveness analyses indicate that the addition of colchicine to
standard-of-care therapy after MI is economically dominant and therefore
generates cost savings. Copyright © 2020 The Author(s) 2020.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<41>
Accession Number
2012741871
Title
Perspectives of solid organ transplant recipients on medicine-taking:
Systematic review of qualitative studies.
Source
American Journal of Transplantation. 21(10) (pp 3369-3387), 2021. Date of
Publication: October 2021.
Author
Tang J.; Kerklaan J.; Wong G.; Howell M.; Scholes-Robertson N.; Guha C.;
Kelly A.; Tong A.
Institution
(Tang, Wong, Howell, Scholes-Robertson, Guha, Tong) Sydney School of
Public Health, The University of Sydney, Sydney, NSW, Australia
(Tang, Kerklaan, Wong, Howell, Scholes-Robertson, Guha, Kelly, Tong)
Centre for Kidney Research, The Children's Hospital at Westmead, Westmead,
NSW, Australia
(Kerklaan) Department of Pediatric Nephrology, Academic Medical Center,
Emma Children's Hospital, Amsterdam, Netherlands
(Wong) Centre for Transplant and Renal Research, Westmead Hospital,
Westmead, NSW, Australia
Publisher
John Wiley and Sons Inc
Abstract
Medicine-taking among transplant recipients is a complex and ubiquitous
task with significant impacts on outcomes. This study aimed to describe
the perspectives and experiences of medicine-taking in adult solid organ
transplant recipients. Electronic databases were searched to July 2020,
and thematic synthesis was used to analyze the data. From 119 studies (n =
2901), we identified six themes: threats to identity and ambitions
(impaired self-image, restricting goals and roles, loss of financial
independence); navigating through uncertainty and distrust (lacking
tangible/perceptible benefits, unprepared for side effects, isolation in
decision-making); alleviating treatment burdens (establishing and
mastering routines, counteracting side effects, preparing for the
unexpected); gaining and seeking confidence (clarity with knowledge,
reassurance through collective experiences, focusing on the future
outlook); recalibrating to a new normal posttransplant (adjusting to
ongoing dependence on medications, in both states of illness and health,
unfulfilled expectations); and preserving graft survival (maintaining the
ability to participate in life, avoiding rejection, enacting a social
responsibility of giving back). Transplant recipients take medications to
preserve graft function, but dependence on medications jeopardizes their
sense of normality. Interventions supporting the adaptation to
medicine-taking and addressing treatment burdens may improve patient
satisfaction and capacities to take medications for improved
outcomes. Copyright © 2021 The American Society of
Transplantation and the American Society of Transplant Surgeons

<42>
Accession Number
2012091692
Title
Efficacy and Safety of Dual Antiplatelet Therapy in Patients Undergoing
Coronary Stent Implantation: A Systematic Review and Network
Meta-Analysis.
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 9934535. Date of Publication: 2021.
Author
Xu Y.; Shen Y.; Chen D.; Zhao P.; Jiang J.
Institution
(Xu, Shen, Chen, Jiang) Department of Cardiology, Second Affiliated
Hospital of Zhejiang University School of Medicine, 88 Jiefang Road,
Hangzhou, Zhejiang 310009, China
(Zhao) School of Chinese Materia Medica, Nanjing University of Chinese
Medicine, 138 Xianlin Avenue, Nanjing 210023, China
(Zhao) State Key Laboratory of Drug Research, Shanghai Institute of
Materia Medica, Chinese Academy of Sciences, 501 Haike Road, Shanghai
201203, China
Publisher
Hindawi Limited
Abstract
Introduction. This network meta-Analysis aimed to evaluate the efficacy
and safety of different dual antiplatelet therapies (DAPTs) after
percutaneous coronary intervention (PCI) with drug-eluting stents (DESs).
Methods. Randomized controlled trials (RCTs) comparing longer-Term (>12
months) DAPT (L-DAPT), 12-month DAPT (DAPT 12Mo), 6-month DAPT (DAPT 6Mo),
3-month DAPT followed by aspirin monotherapy (DAPT 3Mo + ASA), 3-month
DAPT followed by a P2Y12 receptor inhibitor monotherapy (DAPT 3Mo +
P2Y12), or 1-month DAPT with a P2Y12 receptor inhibitor monotherapy (DAPT
1Mo + P2Y12) were searched. Primary endpoints were all-cause mortality,
cardiac death, myocardial infarction (MI), major bleeding, any bleeding,
definite or probable stent thrombosis (ST), and net adverse clinical
events (NACE). This Bayesian network meta-Analysis was performed with the
random-effects model. Results. Twenty-four RCTs (n = 81339) were included.
In comparison with L-DAPT, DAPT 6Mo (OR: 0.50, 95% CI: 0.29-0.83), DAPT
3Mo + P2Y12 (OR: 0.38, 95% CI: 0.18-0.82), DAPT 3Mo + ASA (OR: 0.44, 95%
CI: 0.17-0.98), and DAPT 1Mo + P2Y12 (OR: 0.45, 95% CI: 0.14-0.93) were
associated with a lower risk of major bleeding. DAPT 3Mo + P2Y12 (OR:
0.58, 95% CI: 0.38-0.88) reduced the risk of any bleeding when compared
with DAPT 12Mo. L-DAPT decreased the risk of MI and definite or probable
stent ST when compared with DAPT 6Mo. DAPT 3Mo + P2Y12 decreased the risk
of NACE in comparison with DAPT 6Mo and DAPT 12Mo. No significant
difference in all-cause mortality and cardiac death was observed. In
patients with acute coronary syndrome, DAPT 6Mo was comparable to DAPT
12Mo. Conclusion. Short-Term (1-3 months) DAPT is noninferior to DAPT 6Mo
after DESs implantation, while L-DAPT reduces MI and definite or probable
ST rates. DAPT 3Mo + P2Y12 might be a reasonable trade-off in patients
with high risk of bleeding accompanied by ischemia. Copyright ©
2021 Yi Xu et al.

<43>
Accession Number
2011573713
Title
Mitochondrial transplantation therapy for ischemia reperfusion injury: a
systematic review of animal and human studies.
Source
Journal of Translational Medicine. 19(1) (no pagination), 2021. Article
Number: 214. Date of Publication: December 2021.
Author
Hayashida K.; Takegawa R.; Shoaib M.; Aoki T.; Choudhary R.C.; Kuschner
C.E.; Nishikimi M.; Miyara S.J.; Rolston D.M.; Guevara S.; Kim J.;
Shinozaki K.; Molmenti E.P.; Becker L.B.
Institution
(Hayashida, Takegawa, Shoaib, Aoki, Choudhary, Kuschner, Nishikimi,
Miyara, Kim, Shinozaki, Becker) The Feinstein Institutes for Medical
Research, Northwell Health System, 350 Community Drive, Manhasset, NY,
United States
(Hayashida, Takegawa, Shoaib, Aoki, Choudhary, Kuschner, Nishikimi,
Miyara, Rolston, Kim, Shinozaki, Becker) Department of Emergency Medicine,
North Shore University Hospital, Northwell Health System, 350 Community
Dr, Manhasset, NY 11030, United States
(Shoaib, Kuschner, Rolston, Kim, Shinozaki, Molmenti, Becker) Zucker
School of Medicine At Hofstra/Northwell, New York, NY, United States
(Guevara, Molmenti) Department of Surgery, Northwell Health, Manhasset,
NY, United States
Publisher
BioMed Central Ltd
Abstract
Background: Mitochondria are essential organelles that provide energy for
cellular functions, participate in cellular signaling and growth, and
facilitate cell death. Based on their multifactorial roles, mitochondria
are also critical in the progression of critical illnesses.
Transplantation of mitochondria has been reported as a potential promising
approach to treat critical illnesses, particularly ischemia reperfusion
injury (IRI). However, a systematic review of the relevant literature has
not been conducted to date. Here, we systematically reviewed the animal
and human studies relevant to IRI to summarize the evidence for
mitochondrial transplantation. Method(s): We searched MEDLINE, the
Cochrane library, and Embase and performed a systematic review of
mitochondrial transplantation for IRI in both preclinical and clinical
studies. We developed a search strategy using a combination of keywords
and Medical Subject Heading/Emtree terms. Studies including cell-mediated
transfer of mitochondria as a transfer method were excluded. Data were
extracted to a tailored template, and data synthesis was descriptive
because the data were not suitable for meta-analysis. Result(s):
Overall, we identified 20 animal studies and two human studies. Among
animal studies, 14 (70%) studies focused on either brain or heart IRI.
Both autograft and allograft mitochondrial transplantation were used in 17
(85%) animal studies. The designs of the animal studies were heterogeneous
in terms of the route of administration, timing of transplantation, and
dosage used. Twelve (60%) studies were performed in a blinded manner. All
animal studies reported that mitochondrial transplantation markedly
mitigated IRI in the target tissues, but there was variation in biological
biomarkers and pathological changes. The human studies were conducted with
a single-arm, unblinded design, in which autologous mitochondrial
transplantation was applied to pediatric patients who required
extracorporeal membrane oxygenation (ECMO) for IRI-associated myocardial
dysfunction after cardiac surgery. Conclusion(s): The evidence
gathered from our systematic review supports the potential beneficial
effects of mitochondrial transplantation after IRI, but its clinical
translation remains limited. Further investigations are thus required to
explore the mechanisms of action and patient outcomes in critical settings
after mitochondrial transplantation. Systematic review registration The
study was registered at UMIN under the registration number
UMIN000043347. Copyright © 2021, The Author(s).

<44>
Accession Number
2011532557
Title
Early outcomes from the CLASP IID trial roll-in cohort for prohibitive
risk patients with degenerative mitral regurgitation.
Source
Catheterization and Cardiovascular Interventions. 98(4) (pp E637-E646),
2021. Date of Publication: October 2021.
Author
Lim D.S.; Smith R.L.; Zahr F.; Dhoble A.; Laham R.; Lazkani M.; Kodali S.;
Kliger C.; Hermiller J.; Vora A.; Sarembock I.J.; Gray W.; Kapadia S.;
Greenbaum A.; Rassi A.; Lee D.; Chhatriwalla A.; Shah P.; Rodes-Cabau J.;
Ibrahim H.; Satler L.; Herrmann H.C.; Mahoney P.; Davidson C.; Petrossian
G.; Guerrero M.; Koulogiannis K.; Marcoff L.; Gillam L.
Institution
(Lim) Department of Medicine, Division of Cardiovascular Medicine,
University of Virginia Health System, Charlottesville, VA, United States
(Smith) Department of Surgery, Division of Cardiovascular Surgery, Baylor
Scott and White The Heart Hospital Plano, Plano, TX, United States
(Zahr) Department of Medicine, Division of Cardiovascular Medicine, Oregon
Health & Science University, Portland, OR, United States
(Dhoble) Department of Medicine, Division of Cardiovascular Medicine, The
University of Texas Health Science Center at Houston, Houston, TX, United
States
(Laham) Department of Medicine, Division of Cardiovascular Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Lazkani) Department of Medicine, Division of Cardiovascular Medicine,
UCHealth Medical Center of the Rockies, Loveland, CO, United States
(Kodali) Department of Medicine, Division of Cardiovascular Medicine,
Columbia University Medical Center, New York, NY, United States
(Kliger) Department of Medicine, Division of Cardiovascular Medicine,
Northwell-Lenox Hill, New York, NY, United States
(Hermiller) Department of Medicine, Division of Cardiovascular Medicine,
St. Vincent Heart Center of Indiana, Indianapolis, IN, United States
(Vora) Department of Medicine, Division of Cardiovascular Medicine, UPMC
Pinnacle Health Harrisburg, Harrisburg, PA, United States
(Sarembock) Department of Medicine, Division of Cardiovascular Medicine,
The Christ Hospital and Lindner Clinical Research Center, Cincinnati, OH,
United States
(Gray) Department of Medicine, Division of Cardiovascular Medicine,
Lankenau Heart Institute, Wynnewood, PA, United States
(Kapadia) Department of Medicine, Division of Cardiovascular Medicine,
Cleveland Clinic Foundation, Cleveland, OH, United States
(Greenbaum) Department of Medicine, Division of Cardiovascular Medicine,
Emory University, Atlanta, GA, United States
(Rassi) Department of Medicine, Division of Cardiovascular Medicine,
Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United
States
(Lee) Department of Medicine, Division of Cardiovascular Medicine,
Stanford University Medical Center, Palo Alto, CA, United States
(Chhatriwalla) Department of Medicine, Division of Cardiovascular
Medicine, Saint Luke's Hospital of Kansas City, Kansas City, MO, United
States
(Shah) Department of Medicine, Division of Cardiovascular Medicine,
Brigham and Women's Hospital, Boston, MA, United States
(Rodes-Cabau) Department of Medicine, Division of Cardiovascular Medicine,
Laval Hospital, Quebec City, QC, Canada
(Ibrahim) Department of Medicine, Division of Cardiovascular Medicine, New
York University Langone Medical Center, New York, NY, United States
(Satler) Department of Medicine, Division of Cardiovascular Medicine,
MedStar Washington Hospital Center, Washington, DC, United States
(Herrmann) Department of Medicine, Division of Cardiovascular Medicine,
University of Pennsylvania, Philadelphia, PA, United States
(Mahoney) Department of Medicine, Division of Cardiovascular Medicine,
Sentara Norfolk General Hospital, Norfolk, VA, United States
(Davidson) Department of Medicine, Division of Cardiovascular Medicine,
Northwestern University, Chicago, IL, United States
(Petrossian) Department of Medicine, Division of Cardiovascular Medicine,
St. Francis Hospital, The Heart Center, Roslyn, NY, United States
(Guerrero) Department of Medicine, Division of Cardiovascular Medicine,
Mayo Clinic Rochester, Rochester, MN, United States
(Koulogiannis, Marcoff, Gillam) Department of Medicine, Division of
Cardiovascular Medicine, Atlantic Health System Morristown Medical Center,
Morristown, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We report the 30-day outcomes from the roll-in cohort of the
CLASP IID trial, representing the first procedures performed by each site.
 Background(s): The currently enrolling CLASP IID/IIF pivotal trial is
a multicenter, prospective, randomized trial assessing the safety and
effectiveness of the PASCAL transcatheter valve repair system in patients
with clinically significant MR. The trial allows for up to three roll-in
patients per site. Method(s): Eligibility criteria were: DMR >=3+,
prohibitive surgical risk, and deemed suitable for transcatheter repair by
the local heart team. Trial oversight included a central screening
committee and echocardiographic core laboratory. The primary safety
endpoint was a 30-day composite MAE: cardiovascular mortality, stroke,
myocardial infarction (MI), new need for renal replacement therapy, severe
bleeding, and non-elective mitral valve re-intervention, adjudicated by an
independent clinical events committee. Thirty-day echocardiographic,
functional, and quality of life outcomes were assessed. Result(s): A
total of 45 roll-in patients with mean age of 83 years and 69% in NYHA
class III/IV were treated. Successful implantation was achieved in 100%.
The 30-day composite MAE rate was 8.9% including one cardiovascular death
(2.2%) due to severe bleeding from a hemorrhagic stroke, one MI, and no
need for re-intervention. MR<=1+ was achieved in 73% and <=2+ in 98% of
patients. 89% of patients were in NYHA class I/II (p <.001) with
improvements in 6MWD (30 m; p =.054) and KCCQ (17 points; p <.001).
 Conclusion(s): Early results representing sites with first experience
with the PASCAL repair system showed favorable 30-day outcomes in patients
with DMR>=3+ at prohibitive surgical risk. Copyright © 2021 Wiley
Periodicals LLC.

<45>
Accession Number
2010676561
Title
Methylene blue for vasoplegic syndrome in cardiopulmonary bypass surgery:
A systematic review and meta-analysis.
Source
Asian Cardiovascular and Thoracic Annals. 29(8) (pp 717-728), 2021. Date
of Publication: October 2021.
Author
Perdhana F.; Kloping N.A.; Witarto A.P.; Nugraha D.; Yogiswara N.; Luke
K.; Kloping Y.P.; Rehatta N.M.
Institution
(Perdhana, Rehatta) Department of Anaesthesiology and Reanimation, Faculty
of Medicine, Universitas Airlangga - Dr Soetomo General Hospital,
Surabaya, Indonesia
(Kloping, Witarto, Nugraha, Yogiswara, Luke, Kloping) Faculty of Medicine,
Universitas Airlangga, Surabaya, Indonesia
Publisher
SAGE Publications Inc.
Abstract
Background: To evaluate the benefit of methylene blue as an adjunct
treatment by assessing hemodynamic, morbidity rate, intensive care unit
length of stay, and mortality rate outcomes in adult patients with
vasoplegic syndrome. Method(s): A systematic search through
electronic databases including Pubmed, Embase, Scopus, and Medline for
studies assessing the use of methylene blue in patients with vasoplegic
syndrome compared to control treatments. The Newcastle-Ottawa Scale tool
was used for observational studies, and Jadad Scale was used for
controlled trials to assess the risk of bias. Result(s): This
systematic review included six studies for qualitative synthesis and five
studies for quantitative synthesis. Pooled analysis revealed that mean
arterial pressure, systemic vascular resistance, heart rate, and hospital
stay were not statistically significant in methylene blue administration
compared to control. However, administration of methylene blue in
vasoplegic syndrome patients significantly reduces renal failure (OR =
0.25; 95% CI = 0.08-0.75), development of multiple organ failure (OR =
0.09; 95% CI = 0.02-0.51), and mortality rate (OR = 0.12; 95% CI =
0.03-0.46). Conclusion(s): Adjunct administration of methylene blue
for vasoplegic syndrome patients significantly reduces renal failure,
multiple organ failure, and mortality. Copyright © The Author(s)
2021.

<46>
Accession Number
2010402319
Title
Therapeutic Controversies in the Medical Management of Valvular Heart
Disease.
Source
Annals of Pharmacotherapy. 55(11) (pp 1379-1385), 2021. Date of
Publication: November 2021.
Author
Barry A.R.; Wang E.H.Z.
Institution
(Barry) University of British Columbia, Vancouver, BC, Canada
(Barry) Chilliwack General Hospital, Lower Mainland Pharmacy Services,
Chilliwack, BC, Canada
(Wang) St Paul's Hospital, Lower Mainland Pharmacy Services, Vancouver,
BC, Canada
Publisher
SAGE Publications Inc.
Abstract
Objective: To evaluate the evidence for common therapeutic controversies
in the medical management of valvular heart disease (VHD). Data
Sources: A literature search of PubMed (inception to December 2020) was
performed using the terms angiotensin-converting enzyme (ACE) inhibitors
or angiotensin receptor blockers (ARBs) and aortic stenosis (AS); and
adrenergic beta-antagonists and aortic valve regurgitation (AR) or mitral
stenosis (MS). Study Selection and Data Extraction: Randomized controlled
trials (RCTs) and meta-analyses conducted in humans and published in
English that reported >=1 clinical outcome were included. Data
Synthesis: Nine articles were included: 3 RCTs and 1 meta-analysis for ACE
inhibitors/ARBs in AS, 1 RCT for beta-blockers in AR, and 4 RCTs for
beta-blockers in MS. Evidence suggests that ACE inhibitors/ARBs do not
increase the risk of adverse outcomes in patients with AS but may delay
valve replacement. beta-Blockers do not appear to worsen outcomes in
patients with chronic AR and may improve left-ventricular function in
patients with a reduced ejection fraction. beta-Blockers do not improve
and may actually worsen exercise tolerance in patients with MS in sinus
rhythm. Relevance to Patient Care and Clinical Practice: ACE
inhibitors/ARBs and beta-blockers can likely be safely used in patients
with AS or AR, respectively, who have a compelling indication. There is
insufficient evidence to recommend routine use of beta-blockers in
patients with MS without atrial fibrillation. Conclusion(s): Common
beliefs about the medical treatment of VHD are not supported by
high-quality data. There remains a need for larger-scale RCTs in the
medical management of VHD. Copyright © The Author(s) 2021.

<47>
Accession Number
2007230870
Title
Duration of antiplatelet therapy following transcatheter aortic valve
replacement: Systematic review and network meta-analysis.
Source
Journal of the American Heart Association. 10(9) (no pagination), 2021.
Article Number: e019490. Date of Publication: 2021.
Author
Kuno T.; Yokoyama Y.; Briasoulis A.; Mori M.; Iwagami M.; Ando T.; Takagi
H.; Bangalore S.
Institution
(Kuno) Department of Medicine, Icahn School of Medicine at Mount Sinai,
Mount Sinai Beth Israel, New York, NY, United States
(Yokoyama) Department of Surgery, St. Luke's University Health Network,
Bethlehem, PA, United States
(Briasoulis) Division of Cardiology, Heart Failure and Transplantation,
University of Iowa, Iowa City, IA, United States
(Mori) Division of Cardiac Surgery, Yale School of Medicine, New Haven,
CT, United States
(Iwagami) Department of Health Services Research, University of Tsukuba,
Japan
(Ando) Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
(Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Bangalore) Division of Cardiovascular Medicine, New York University
School of Medicine, New York, NY, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: Although current guidelines recommend dual antiplatelet
therapy (DAPT) for 3 to 6 months following transcath-eter aortic valve
replacement (TAVR), there are no studies directly comparing outcomes of
different durations of DAPT following TAVR. METHODS AND RESULTS: PubMed,
EMBASE, and Cochrane Database were searched through November 2020 to
identify clinical studies that investigated single antiplatelet therapy
versus DAPT use following TAVR. Studies using oral anticoagulants and
antiplatelet therapy concomitantly were excluded. The DAPT group was
subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of
major or life-threatening bleeding, stroke, and all-cause mortality. Four
randomized controlled trials, 2 propensity-score matched studies, and 1
observational study were identified, yielding a total of 2498 patients who
underwent TAVR assigned to the single antiplatelet therapy group (n=1249),
3-month DAPT group (n=485), or 6-month DAPT group (n=764). Pooled analyses
demonstrated that when compared with the single antiplatelet therapy
group, the rates of major or life-threatening bleeding were significantly
higher in the 3-and 6-month DAPT groups (RR [95% CI]=2.13 [1.33- 3.40],
P=0.016; RR [95% CI]=2.54 [1.49- 4.33], P=0.007, respectively) with no
difference between the 3-month DAPT versus 6-month DAPT groups. The rates
of stroke and all-cause mortality were similar among the 3 groups.
 CONCLUSION(S): In this network meta-analysis of antiplatelet therapy
following TAVR, single antiplatelet therapy with aspirin had lower
bleeding without increasing stroke or death when compared with either 3-or
6-month DAPT. Copyright © 2021 The Authors. Published on behalf
of the American Heart Association, Inc., by Wiley.

<48>
Accession Number
2014117499
Title
New thoracotomy closure, a simple way to decrease chronic post-operative
pain in selected patients-blinded prospective study.
Source
Journal of Personalized Medicine. 11(10) (no pagination), 2021. Article
Number: 1007. Date of Publication: October 2021.
Author
Petrache I.A.; Oancea C.; Hasan E.M.; Neagoe O.C.; Tudorache E.; Ionica
M.; Burlacu O.N.
Institution
(Petrache, Burlacu) First Discipline of Surgical Semiology, First
Department of Surgery, "Victor Babes" University of Medicine and Pharmacy
Timisoara, Eftimie Murgu Square No. 2, Timisoara 300041, Romania
(Petrache, Hasan, Burlacu) Clinic of Thoracic Surgery, Emergency Clinical
Municipal Hospital Timisoara, Gheorghe Dima Street No. 5, Timisoara
300079, Romania
(Oancea, Tudorache) Discipline of Pneumology, Department of Infectious
Diseases, "Victor Babes" University of Medicine and Pharmacy Timisoara,
Eftimie Murgu Square No. 2, Timisoara 300041, Romania
(Neagoe, Ionica) Second Clinic of General Surgery and Surgical Oncology,
Emergency Clinical Municipal Hospital Timisoara, Gheorghe Dima Street No.
5, Timisoara 300079, Romania
(Neagoe) Second Discipline of Surgical Semiology, First Department of
Surgery, "Victor Babes" University of Medicine and Pharmacy Timisoara,
Eftimie Murgu Square No. 2, Timisoara 300041, Romania
Publisher
MDPI
Abstract
Background and Objectives: Chronic post-thoracotomy pain syndrome (PTPS)
is a very common and uncomfortable complication, occurring frequently
after thoracic operations, leading to the necessity of further medication
and hospitalizations. One important risk factor in developing chronic pain
is the chest closure technique, which can lead to chronic intercostal
nerve damage. This study proposes an alternative nerve-sparring closure
technique to standard peri-costal sutures, aimed toward minimizing the
risk of chronic pain in selected patients. Material(s) and Method(s):
We performed a prospective randomized study on 311 patients operated for
various thoracic pathology over a period of 12 months, evaluating incision
types, chest closure technique, and number of drains with drainage
duration. The patients were divided into three groups: peri-costal (PC),
proposed extra-costal (EC), and simple (SC) suture, respectively. Pain was
measured on day 1, 2, 5, 7, and at 6 months post-operatively using the
Visual Analogic Scale. Result(s): No significant differences in pain
level were recorded in the first two post-operative days between the PC
and EC groups. How-ever, a significant decrease in pain level was observed
on day 5 and at 6 months post-operatively, with a mean level of 3.5 +/-
1.8, 1.2 +/- 1 for the EC group compared to a mean value of 5.3 +/- 1.6,
3.2 +/- 1.5, respectively. No significant differences were observed
regarding other evaluated variables. Conclusion(s): The lower
recorded pain scores in patients with extra-costal chest closure are a
strong argument to use this technique. Its ease of use is similar to the
classic peri-costal closure, and the time needed to perform it is not
significantly increased. The association of this technique with less
invasive procedures and short drainage duration limits chronic
post-operative pain. This procedure may represent an option for decreasing
healthcare costs associated with the management of PTPS. Copyright
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

<49>
Accession Number
2014114926
Title
The influence of the mechanical ventilation weaning protocol in patients
with acute kidney injury undergoing adult cardiac surgery.
Source
Iranian Heart Journal. 22(4) (pp 6-14), 2021. Date of Publication: Autumn
2021.
Author
Ziyaeifard M.; Assadzade H.; Makhmalbaf G.; Totonchi Z.; Faritus S.Z.
Institution
(Ziyaeifard, Assadzade, Totonchi, Faritus) Rajaie Cardiovascular Medical
and Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Makhmalbaf) Faculty of medicine, Birjand University of Medical Sciences,
Iran, Islamic Republic of
Publisher
Iranian Heart Association
Abstract
Background: Mechanical ventilation is an important risk factor for acute
kidney injury (AKI) in cardiac surgery patients. The Weaning protocol can
speed weaning after open-heart surgery and might reduce the AKI risk in
these patients. We explore the influence of the weaning protocol on the
intubation time in cardiac surgery patients who developed AKI.
 Method(s): In a randomized clinical trial, 100 patients with AKI
after open-heart surgery were enrolled. After surgery, the patients were
randomized to the weaning protocol group (the intervention group) and the
conventional weaning group (the control group). Arterial blood gas,
hemodynamic variables, the serum blood urea nitrogen level, the creatinine
level, and the intubation time were recorded and compared between the 2
groups. Result(s): The weaning protocol group displayed a
statistically significant shorter intubation time than the conventional
weaning group (8.89+/-1.74 h vs 9.93+/-1.56 h; P=0.002). The postoperative
serum urea level (r=0.240, P<0.016) and creatinine level (r=0.245,
P<0.014) were positively correlated with the intubation time and the
weaning protocol compared with conventional weaning. The weaning protocol
decreased the urea and creatinine levels in cardiac surgery patients
(P<0.04). Conclusion(s): The use of the weaning protocol in cardiac
surgery patients with AKI conferred shorter intubation times and lower
blood urea nitrogen and creatinine levels than the use of conventional
weaning. Copyright © 2021, Iranian Heart Association. All rights
reserved.

<50>
Accession Number
2014114922
Title
Acute kidney injury after coronary artery bypass graft surgery: A
narrative review of causes, diagnosis, and prevention.
Source
Family Medicine and Primary Care Review. 23(3) (pp 372-379), 2021. Date of
Publication: 2021.
Author
Jannati M.; Kojuri J.
Institution
(Jannati) Cardiac Surgery Ward, Namazi Hospital, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Kojuri) Cardiology Department, Shiraz University of Medical Sciences,
Shiraz, Iran, Islamic Republic of
Publisher
Polish Society of Family Medicine
Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is
a common cardiac event associated with short and long-term consequences
and occurs in 30-51% of CABG patients. AKI may be associated with many
other factors and is also responsible for many other pathologies. An
increased level of serum creatinine (SCr) after surgery is one of the
signs of AKI that may occur more often during cardiopulmonary bypass (CPB)
in susceptible individuals. Preparing preoperative checklists is a good
practice for the prevention of AKI. Defining new opportunities and
strategies of perioperative care is a useful procedure for decreasing the
risk of AKI after cardiac surgery. Collecting more data on preoperative
risk factors and improving the intraoperative practices may decrease the
incidence of AKI in the aggregate population. In this review study, we are
going to review the literature on the pathophysiology of AKI and introduce
the discussion about the features of patients who are more at the risk of
AKI than others. Copyright © by Wydawnictwo Continuo.

<51>
Accession Number
2013588506
Title
Safety and efficacy of oral anticoagulants in atrial fibrillation and
bioprosthetic heart valves.
Source
European Journal of Internal Medicine. 92 (pp 128-130), 2021. Date of
Publication: October 2021.
Author
Yandrapalli S.; Gupta R.; Malik A.H.
Institution
(Yandrapalli, Malik) Department of Cardiology, Westchester Medical Center,
Valhalla, NY, United States
(Gupta) Division of Cardiology, Lehigh Valley Health Network, Allentown,
PA, United States
Publisher
Elsevier B.V.

<52>
Accession Number
636226120
Title
Cardiovascular Mortality after Venous Thromboembolism: A Meta-Analysis of
Prospective Cohort Studies.
Source
Seminars in Thrombosis and Hemostasis. (no pagination), 2021. Date of
Publication: 2021.
Author
Noumegni S.R.; Grangereau T.; Demir A.; Bressollette L.; Couturaud F.;
Hoffmann C.
Institution
(Noumegni, Grangereau, Bressollette, Hoffmann) Department of Vascular
Medicine, Brest Teaching Hospital, Brest University, GETBO, Brest EA 3878,
France
(Noumegni, Bressollette, Couturaud, Hoffmann) EA3878 (GETBO), Western
Brittany Thrombosis Study Group, Brest University, Brest, France
(Grangereau) Department of Cardiovascular Medicine, Guingamp Hospital,
Guingamp, France
(Demir) Department of Vascular Medicine, Bordeaux Teaching Hospital,
Bordeaux, France
(Couturaud) Department of Internal Medicine and Pneumology, Brest Teaching
Hospital, Brest, France
Publisher
Thieme Medical Publishers, Inc.
Abstract
Many studies from current literature show that cardiovascular diseases in
patients with venous thromboembolism (VTE) are more frequent than in the
general population without VTE. However, data summarizing the impact of
cardiovascular diseases on mortality of patients with VTE are lacking. In
this systematic review and meta-analysis, we aimed to determine the
frequency and incidence rate of cardiovascular death in patients with VTE.
MEDLINE and EMBASE were searched from January 1, 2000 to February 28,
2021. Eligible studies were observational prospective cohort studies
including patients with VTE and reporting all causes of death.
Cardiovascular death was defined as deaths that result from new or
recurrent pulmonary embolism, death due to acute myocardial infarction,
sudden cardiac death or heart failure, death due to stroke, death due to
cardiovascular procedures or hemorrhage, death due to ruptured aortic
aneurysm or aortic dissection and death due to other cardiovascular
causes. Random-effect models meta-analysis served to determine all pooled
effect size of interest with their 95% confidence interval (CI). Thirteen
observational studies enrolling 22,251 patients were identified and
included. The mean/median age varied between 49 and 75 years. The
proportion of men ranged from 38.3 to 53.2%. The overall pooled frequency
of cardiovascular death in patients with VTE was 3.9% (95% CI: 2.5-5.6%),
while the overall pooled frequency of all-cause mortality was 12.0% (95%
CI: 9.1-15.4%). The pooled proportion of cardiovascular death among all
causes of deaths in patients with VTE was 35.2% (95% CI: 22.2-49.3%). The
pooled incidence rate of cardiovascular death was 1.92 per 100
patient-years (95% CI: 0-4.1). The frequency of cardiovascular death in
patients with VTE was significantly higher than in patients without VTE
(risk ratio: 3.85, 95% CI: 2.75-5.39). Based on this updated meta-analysis
from 13 prospective cohort studies, cardiovascular death in patients with
VTE is more frequent than in the general population without
VTE. Copyright © 2021 Georg Thieme Verlag. All rights reserved.

<53>
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. 31(9) (pp 1495-1497), 2021. Date of Publication:
20 Sep 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. Copyright © 2021 The
Author(s). Published by Cambridge University Press.

<54>
Accession Number
2014620554
Title
Traditional vs Extended Hybrid Cardiac Rehabilitation Based on the
Continuous Care Model for Patients Who Have Undergone Coronary Artery
Bypass Surgery in a Middle-Income Country: A Randomized Controlled Trial.
Source
Archives of Physical Medicine and Rehabilitation. 102(11) (pp
2091-2101.e3), 2021. Date of Publication: November 2021.
Author
Pakrad F.; Ahmadi F.; Grace S.L.; Oshvandi K.; Kazemnejad A.
Institution
(Pakrad, Ahmadi) Department of Nursing, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
(Grace) Faculty of Health, York University, Toronto, Canada
(Grace) KITE- Toronto Rehabilitation Institute, Peter Munk Cardiac Centre,
University Health Network, University of Toronto, Toronto, Canada
(Oshvandi) Department of Nursing, Faculty of Nursing and Midwifery,
Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of
(Kazemnejad) Department of Biostatistics, Faculty of Medical Sciences,
Tarbiat Modares University, Tehran, Iran, Islamic Republic of
Publisher
W.B. Saunders
Abstract
Objective: To compare traditional (1-month supervised) vs hybrid cardiac
rehabilitation (CR; usual care) with an additional 3 months offered
remotely based on the continuous care model (intervention) in patients who
have undergone coronary artery bypass graft (CABG). Design(s):
Randomized controlled trial, with blinded outcome assessment.
 Setting(s): A major heart center in a middle-income country.
 Participant(s): Of 107 eligible patients who were referred to CR
during the period of study, 82.2% (N=88) were enrolled (target sample
size). Participants were randomly assigned 1:1 (concealed; 44 per parallel
arm). There was 92.0% retention. Intervention(s): After CR,
participants were given a mobile application and communicated biweekly
with the nurse from months 1-4 to control risk factors. Main Outcome
Measure(s): Quality of life (QOL, Short Form-36, primary outcome);
functional capacity (treadmill test); and the Depression, Anxiety and
Stress Scale were evaluated pre-CR, after 1 month, and 3 months after CR
(end of intervention), as well as rehospitalization. Result(s): The
analysis of variance interaction effects for the physical and mental
component summary scores of QOL were <.001, favoring intervention (per
protocol); there were also significant increases from pre-CR to 1 month,
and from 1 month to the final assessment in the intervention arm (P<.001),
with change in the control arm only to 1 month. The effect sizes were
0.115 and 0.248, respectively. Similarly, the interaction effect for
functional capacity was significant (P<.001), with a clinically
significant 1.5 metabolic equivalent of task increase in the intervention
arm. There were trends for group effects for the psychosocial indicators,
with paired t tests revealing significant increases in each at both
assessment points in the intervention arm. At 4 months, there were 4
(10.3%) rehospitalizations in the control arm and none in intervention
(P=.049). Intended theoretical mechanisms were also affected by the
intervention. Conclusion(s): Extending CR in this accessible manner,
rendering it more comprehensive, was effective in improving
outcomes. Copyright © 2021

<55>
Accession Number
2013892224
Title
Efficacy and safety of low intensity vitamin K antagonists in Western and
East-Asian patients with left-sided mechanical heart valves.
Source
Journal of Thrombosis and Thrombolysis. (no pagination), 2021. Date of
Publication: 2021.
Author
Pandey A.K.; Xu K.; Zhang L.; Gupta S.; Eikelboom J.; Lopes R.D.; Crowther
M.; Belley-Cote E.P.; Whitlock R.P.
Institution
(Pandey) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, Canada
(Xu) Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong
University, Shanghai, China
(Zhang) Banner University Medical Center, Tucson, United States
(Gupta, Whitlock) Division of Cardiac Surgery, Department of Surgery,
McMaster University, Hamilton, Canada
(Eikelboom, Crowther) Department of Medicine, McMaster University,
Hamilton, Canada
(Eikelboom, Belley-Cote, Whitlock) Population Health Research Institute,
237 Barton Street East, Hamilton, ON, Canada
(Lopes) Duke Clinical Research Institute, Durham, United States
(Lopes) Duke University School of Medicine, Durham, United States
(Crowther) Division of Hematology, Department of Medicine, McMaster
University, Hamilton, Canada
(Belley-Cote, Whitlock) Department of Health Research Methods, Evidence
and Impact, McMaster University, Hamilton, Canada
(Belley-Cote) Division of Cardiology, Department of Medicine, McMaster
University, Hamilton, Canada
Publisher
Springer
Abstract
The optimal INR target in patients with mechanical heart valves is
unclear. Higher INR targets are often used in Western compared with East
Asian countries. The objective of this systematic review and meta-analysis
was to summarize the evidence for the efficacy and safety of lower versus
higher INR targets in Western and East Asian left-sided mechanical heart
valve patients. We searched Western databases including Cochrane CENTRAL,
Medline, and Embase as well as Chinese databases including SinoMed, CNKI,
and Wanfang Data in addition to grey literature for Randomized Controlled
Trials (RCTs) and observational studies. We pooled risk ratios (RRs) using
random-effects model. Low and high INR targets were defined by the
individual studies. We identified nine RCTs, including six Western (n =
5496) and three East Asian (n = 209) trials, and 17 observational studies,
including two Western (n = 3199) and 15 East Asian (n = 5485) studies. In
the RCTs, lower compared with higher targets were associated with similar
rates of thromboembolism (2.4 vs. 2.3%; RR: 1.14, 95% CI 0.82, 1.60,
I2 = 0%) and lower rates of both total bleeding (21.9 vs.
40.9%, RR: 0.46, 95% CI 0.28, 0.78, I2 = 88%) and major
bleeding. RCT data showed no statistical heterogeneity by region. These
effects were consistent in the observational data. We downgraded the
quality of evidence due to serious risk of bias and imprecision. In
patients with left-sided contemporary mechanical heart valves, low quality
evidence suggests lower INR targets are associated with similar rates of
thromboembolism and moderate quality evidence suggests lower rates of
bleeding. Copyright © 2021, The Author(s), under exclusive
licence to Springer Science+Business Media, LLC, part of Springer Nature.

<56>
Accession Number
2012931208
Title
COVID-19 in heart transplant recipients during February-August 2020: A
systematic review.
Source
Clinical Transplantation. 35(9) (no pagination), 2021. Article Number:
e14390. Date of Publication: September 2021.
Author
Diaz-Arocutipa C.; Carvallo-Castaneda D.; Luis-Ybanez O.; Pariona M.;
Rivas-Lasarte M.; Alvarez-Garcia J.
Institution
(Diaz-Arocutipa) Vicerrectorado de Investigacion, Universidad San Ignacio
de Loyola, Lima, Peru
(Diaz-Arocutipa) Programa de Atencion Domiciliaria (PADOMI) - EsSalud,
Lima, Peru
(Diaz-Arocutipa, Carvallo-Castaneda, Luis-Ybanez) Asociacion para el
Desarrollo de la Investigacion Estudiantil en Ciencias de la Salud
(ADIECS), Lima, Peru
(Carvallo-Castaneda) Puesto de Salud Pacaycasa, Ministerio de Salud,
Ayacucho, Peru
(Luis-Ybanez) Facultad de Medicina de San Fernando, Universidad Nacional
Mayor de San Marcos, Lima, Peru
(Pariona) Departamento de Cardiologia, Hospital Nacional Edgardo
Rebagliati Martins, Lima, Peru
(Rivas-Lasarte) Unidad de Insuficiencia Cardiaca Avanzada y Trasplante
Cardiaco, Hospital Universitario Puerta de Hierro, Madrid, Spain
(Rivas-Lasarte, Alvarez-Garcia) Centro de Investigacion Biomedica en Red
de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
(Alvarez-Garcia) Unidad de Insuficiencia Cardiaca Avanzada. Servicio de
Cardiologia del Hospital Universitario Ramon y Cajal, Madrid, Spain
(Alvarez-Garcia) Universidad Autonoma de Barcelona, Barcelona, Spain
Publisher
John Wiley and Sons Inc
Abstract
The coronavirus disease 2019 (COVID-19) pandemic represents a major
concern in immunosuppressed patients such as heart transplant recipients.
Therefore, we performed a systematic review to summarize the clinical
features, treatment, and outcomes of heart transplant recipients with
COVID-19. We searched electronic databases from inception to January 11,
2021. Thirty-nine articles (22 case reports and 17 cohorts) involving 415
patients were included. The mean age was 59.9 +/- 15.7 years and 77% of
patients were men. In cohort studies including outpatients and inpatients,
the hospitalization rate was 77%. The most common symptoms were fever
(70%) and cough (67%). Inflammatory biomarkers (C-reactive protein and
procalcitonin) were above the normal range. Forty-eight percent of
patients presented with severe or critical COVID-19. Hydroxychloroquine
(54%), azithromycin (14%), and lopinavir/ritonavir (14%) were the most
commonly used drugs. Forty-nine percent of patients discontinued the
baseline regimen of antimetabolites. In contrast, 59% and 73% continued
the same regimen of calcineurin inhibitors and corticosteroids,
respectively. Short-term mortality among cohorts limited to inpatients was
25%. Our review suggests that heart transplant recipients with COVID-19
exhibited similar demographic and clinical features to the general
population. However, the prognosis was poor in these
patients. Copyright © 2021 John Wiley & Sons A/S. Published by
John Wiley & Sons Ltd.

<57>
Accession Number
635872118
Title
A three-dimensional printed model in preoperative consent for ventricular
septal defect repair.
Source
Journal of cardiothoracic surgery. 16(1) (pp 229), 2021. Date of
Publication: 11 Aug 2021.
Author
Deng X.; He S.; Huang P.; Luo J.; Yang G.; Zhou B.; Xiao Y.
Institution
(Deng) Heart Center, Hunan Children's Hospital, No. 86 Ziyuan Road,
Changsha 410007, China
(He) Department of Radiology, Hunan Children's Hospital, Changsha 410007,
China
(Huang, Luo, Yang, Xiao) Heart Center, Hunan Children's Hospital, No. 86
Ziyuan Road, Changsha 410007, China
(Zhou) Department of Radiology, Second Xiangya Hospital, Central South
University, Changsha, Hunan 410007, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: The 3D printing technology in congenital cardiac surgery has
been widely utilized to improve patients' understanding of their disease.
However, there has been no randomized controlled study on its usefulness
in surgical consent for congenital heart disease repair. METHOD(S): A
randomized controlled study was performed during consent process in which
guardians of candidates for ventricular septal defect repair were given
detailed explanation of the anatomy, indication for surgery and potential
complication and risks using 3D print ventricular septal defect model
(n=20) versus a conventional 2D diagram (n=20). A questionnaire was
finished by each guardian of the patients. Data collected from
questionnaires as well as medical records were statistically analyzed.
 RESULT(S): Statistically significant improvements in ratings of
understanding of ventricular septal defect anatomy (p=0.02), and of the
surgical procedure and potential complications (p=0.02) were noted in the
group that used the 3D model, though there was no difference in overall
ratings of the consent process (p=0.09). There was no difference in
questionnaire score between subjects with different education levels. The
clinical outcomes, as represented by the duration of intensive care unit
stay, intubation duration was comparable between the two groups.
 CONCLUSION(S): The results indicated that it was an effective tool
which may be used to consent for congenital heart surgery. Different
education levels do not affect guardians' understanding in consent. The
impact of 3D printing used in this scenario on long term outcomes remains
to be defined. Copyright © 2021. The Author(s).

<58>
Accession Number
635862874
Title
Perioperative outcomes of combined heart surgery and lung tumor resection:
a systematic review and meta-analysis.
Source
Journal of cardiothoracic surgery. 16(1) (pp 227), 2021. Date of
Publication: 09 Aug 2021.
Author
Cheng S.; Jiang Y.; Li X.; Lu X.; Zhang X.; Sun D.
Institution
(Cheng, Li, Lu, Zhang) Department of Thoracic Surgery, Tianjin Chest
Hospital, Tianjin 300222, China
(Jiang) Department of Cardiac Surgery, Tianjin First Central Hospital,
Tianjin 300074, China
(Sun) Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin
300222, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The prevalence of patients with concomitant heart and lung
lesions requiring surgical intervention is increasing. Simultaneous
cardiac surgery and pulmonary resection avoids the need for a second
operation. However, there are concerns regarding the potentially increased
mortality and complication rates of simultaneous surgery and the adequacy
of lung exposure during heart surgery. Therefore, we performed a
meta-analysis to evaluate the perioperative mortality and complication
rates of combined heart surgery and lung tumor resection. METHOD(S):
A comprehensive literature search was performed in July 2020. The PubMed,
Embase, and Web of Science databases were searched to identify studies
that reported the perioperative outcomes of combined heart surgery and
lung tumor resection. Two reviewers independently screened the studies,
extracted data, and assessed the risk of bias of included studies. Pooled
proportions and 95% confidence intervals (95% CI) were calculated by R
version 3.6.1 using the meta package. RESULT(S): A total of 536
patients from 29 studies were included. Overall, the pooled proportion of
operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled
proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57)
for patients who underwent combined cardiothoracic surgery. Subgroup
analysis by lung pathology revealed that, for patients with lung cancer,
the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95,
1.00) and the pooled proportion of systematic lymph node dissection or
sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery
procedure found that the pooled proportion of postoperative complications
of patients who underwent coronary artery bypass grafting (CABG) patients
using the off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled
proportion of complications after CABG using the on-pump method was 0.61
(95% CI: 0.38, 0.82). CONCLUSION(S): Combined heart surgery and lung
tumor resection had a low mortality rate and an acceptable complication
rate. Subgroup analyses revealed that most patients with lung cancer
underwent uncompromised anatomical resection and mediastinal lymph node
sampling or dissection during combined cardiothoracic surgery, and showed
off-pump CABG may reduce the complication rate compared with on-pump CABG.
Further researches are still needed to verify these
findings. Copyright © 2021. The Author(s).

<59>
Accession Number
636341377
Title
Arterial function in preadolescent children with congenital heart disease:
A systematic review.
Source
Archives of Disease in Childhood. Conference: Royal College of Paediatrics
and Child Health Conference, RCPCH 2021. Online. 106(SUPPL 1) (pp
A362-A363), 2021. Date of Publication: October 2021.
Author
Zimianiti I.; Cheang C.; Mansfield R.; Pedraz C.T.; Cecula P.; Elsaddig
M.; Sathiyamurthy S.; Banerjee J.
Institution
(Zimianiti, Pedraz, Cecula) Imperial College London School of Medicine
(Cheang) Queen Charlotte's and Chelsea Hospital, Imperial College
Healthcare NHS Trust
(Mansfield) Department of Neonatology, Queen Charlotte's and Chelsea
Hospital, Imperial College Healthcare NHS Trust, Biomedical Research
Centre, Imperial College London
(Elsaddig, Sathiyamurthy, Banerjee) Department of Neonatology, Queen
Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust
Publisher
BMJ Publishing Group
Abstract
Background Congenital heart disease (CHD) can increase longterm
cardiovascular disease risk. Studying arterial stiffness, an independent
predictor of cardiovascular morbidity and mortality, can improve
understanding of the pathophysiology of cardiovascular disease in CHD.
Objectives To systematically review the literature to examine how CHD
affects arterial stiffness in children 12 years, following PRISMA
guidelines. Methods PubMed was searched using the terms: 'pulse wave
velocity' (PWV), 'carotid intima-media thickness' (cIMT), 'arterial
stiffness index' (SIx), 'flow-mediated dilation' (FMD), 'flow imaging',
'laser flow Doppler', 'venous plethysmography', 'cardi* magnetic resonance
imaging', 'aortic intima-media thickness' (aIMT), 'vascular ultrasound'
and 'neonat*', 'paediatric', 'infant*', 'child*'. Case reports, case
series, reviews, commentaries, conference proceedings, animal studies,
articles not in English and articles with children >12 years were
excluded. Articles exploring the effect of CHD on arterial stiffness
measures were included. Results 13/1084 identified studies were included.
7 studies measured PWV, 4 studies measured SIx of the ascending or
descending aorta, and 6 studies measured distensibility as measures of
arterial stiffness; methods included MRI, M-mode ultrasound, and
oscillometry. One study performed FMD assessing endothelial function.
Patients with hypoplastic left heart syndrome following surgical
correction had lower ascending aorta distensibility than healthy controls
and those with other single-ventricle anatomy (3.5+/-2.9x10-3 vs
7.8+/-3.7x10-3 mmHg-1, p=004). Toddlers with single-ventricle pathologies
had lower brachial artery FMD (2.4+/-3.7% vs 11.3+/-6.0%, p<0.0005) but
similar carotid-femoral PWV than those with double-ventricle circulations.
In a similar cohort, aortic PWV was higher in patients with dilated aortic
roots, suggesting that PWV may be an independent determinant of aortic
dilatation. Thoracic aorta PWV was higher in children with Tetralogy of
Fallot (TOF) than controls in three studies, both before and after
surgery. PWV was an independent determinant of aortic dilatation in TOF
too. Neonates with coarctation of the aorta had reduced ascending aortic
distensibility and increased SIx pre-and postoperatively compared to
controls: findings persisted three years post-surgery. Similar results
were reported in asymptomatic school-aged children: higher SIx compared to
healthy controls at rest (4.87+/-1.94 vs 3.57+/-1.19, p=0.021) and after
exercise (4.33+/-1.91 vs 3.2+/-1.26, p=0.034). However, the method of CoA
repair may affect stiffness: 6-year-olds had higher rightarm PWV and
systolic blood pressure following subclavian flap repair than end-to-end
anastomosis. Aortic SIx was higher in patients with PDA requiring
transcatheter closure compared to healthy controls. The delayed closure
(>1y) group had higher SIx before (9.4+/-2.7 vs 6.7 +/-2.8; p<0.05) and
after closure (6.3+/-2.4 vs 3.8+/-1.4; p<0.05), than the early closure
(<1y) group. Ascending aorta distensibility was reduced in 36 children who
had previously undergone arterial switch operations for transposition of
the great arteries. Conclusions CHD can significantly increase arterial
stiffness; the method or timing of correction may have an influence.
Proposed mechanisms include damage to vasa vasorum due to surgery, and
hypoxaemia-induced endothelial dysfunction. Differences in conditions
studied, techniques used, and demographics may explain inter-study
variability. Increased aortic stiffness causes premature reflected waves,
leading to hypertension and increased cardiovascular disease risk.
Therefore, CHD patients might benefit from arterial function monitoring.
Longitudinal studies examining the progression of arterial stiffness in
different forms of CHD would be beneficial.

<60>
Accession Number
636338798
Title
Use of solvent/detergent-treated plasma (octaplas) in children.
Source
Archives of Disease in Childhood. Conference: 10th Europaediatrics
Congress. Zagreb Croatia. 106(SUPPL 2) (pp A148-A149), 2021. Date of
Publication: October 2021.
Author
Polic B.
Institution
(Polic) Pediatric Intensive Care Unit, Department of Pediatrics,
University Hospital of Split Spinciceva 1, Split, Croatia
Publisher
BMJ Publishing Group
Abstract
Introduction The use of fresh frozen plasma (FFP) has increased
significantly in recent years. Clinical practice guidelines recommend
plasma transfusion in children and neonates with coagulation disorder and
clinically significant bleeding or before invasive procedures with a high
risk of bleeding. The use of solvent/detergent (S/D) treatment before
freezing significantly reduced the risk of possible side effects. Octaplas
is a bio pharmaceutically standardized coagulation active substitute for
plasma, and has been used in Europe since 1991. Harmful antibodies and
allergic substances have been neutralized and lipid-coated viruses (HIV,
HBV and HCV) have been inactivated by S/D. Octaplas contains a
well-standardized content of coagulation factors and inhibitors. The
structure and function of plasma proteins are not changed, blood cells and
leukocyte antibodies, micro vesicles, cell fragments, bioactive lipids are
completely removed and the cytokine concentration is lower. Objective To
examine the indications for use of Octaplas in children and its
efficiency. Methods A review of the available literature related to
application of Octaplas in children. Results The use of Octaplas in severe
patients reduces the possibility of immune and anaphylactic reactions and
transfusion-induced acute lung injury. Also, a smaller volume of Octaplas
compared to FFP is required to correct coagulopathy. No additional
bleeding with reduction in the number of transfusions in liver transplant
patients was observed. An increase in platelets has been demonstrated in
patients with thrombotic thrombocytopenic purpura who were refractory to
FFP. The survival rate in Pediatric Intensive Care Unit (PICU) was higher
in children treated with Octaplas compared to FFP. Recent research has
shown that in children who received Octaplas during cardiac surgery ACT
values were lower with lower doses of heparin, and platelets, APTV, INR,
fibrinogen values were higher compared to children who received FFP.
Reduction in postoperative infections and shorter stay in PICU were
observed. The latest prospective, multicenter study in the United States
examined the safety, tolerability, and efficacy of Octaplas in the
treatment of children who required replacement of multiple coagulation
factors due to cardiac surgery, transplantation and/or liver dysfunction,
with coagulopathy and sepsis-related coagulopathy as well as hypoxic
encephalopathy. No thromboembolic events associated with hyper
fibrinolysis or treatment have been reported. The overall safety,
tolerability and efficiency was defined as excellent. Hemostatic
parameters measured with INR, PT, APTV, thromboelastography, or
thromboelastometry were within the expected range. Conclusion The results
of previous research support the use of Octaplas in children. Octaplas has
an advantage over FFP due to its strong hemostatic effect, less frequent
side effects, safety and in critically ill children may be associated with
improved survival.

<61>
Accession Number
636330527
Title
Randomized phase 3 open-label study of maribavir vs investigator assigned
therapy for refractory/resistant cytomegalovirus infection in transplant
recipients: Subgroup analyses of efficacy by organ.
Source
American Journal of Transplantation. Conference: American Transplant
Congress, ATC 2021. Virtual. 21(SUPPL 4) (pp 441), 2021. Date of
Publication: June 2021.
Author
Avery R.K.; Blumberg E.A.; Florescu D.; Kamar N.; Kumar D.; Wu J.;
Sundberg A.
Institution
(Avery) Johns Hopkins Hospital, Baltimore, MD, United States
(Blumberg) University of Pennsylvania, Philadelphia, PA, United States
(Florescu) University of Nebraska, School of Medicine, Omaha, NE, United
States
(Kamar) Hopital de Rangueil, Toulouse, France
(Kumar) University Health Network, Toronto, ON, Canada
(Wu, Sundberg) Shire Human Genetic Therapies,Inc.,a Takeda Company,
Lexington, KY, United States
Publisher
Blackwell Publishing Ltd
Abstract
Purpose: Therapeutic options for refractory, with/without resistance
(R/R), CMV infections are limited. We report organ type subgroup analyses
from a large multicenter trial that studied the efficacy of maribavir
(MBV) vs investigator-assigned therapy (IAT) in pts with R/R CMV
infection. Method(s): Transplant recipients aged >=12 yrs, with CMV
infection (viral load [VL] >=2730 IU/mL/>=910 IU/mL CMV DNA
[blood/plasma]) refractory to recent Tx (failure to achieve >1 log10
decrease in CMV DNA after >=14 days) were eligible (NCT02931539). Pts were
stratified (HCT/SOT + screening CMV VL) and randomized 2:1 to MBV 400 mg
BID or IAT (val/ganciclovir, foscarnet, cidofovir,
foscarnet+val/ganciclovir) for 8 wks + 12 wks follow-up. Primary endpoint:
confirmed CMV clearance (plasma CMV DNA <137 IU/mL in 2 consecutive tests
>=5 days apart) at end of Wk 8. Key secondary endpoint: CMV clearance and
symptom control at end of Wk 8 and maintained through Wk 16. Group
differences, adjusted for baseline CMV DNA level <9100/>=9100 IU/mL, and
SOT/HCT were compared (Cochran-Mantel-Haenszel tests). Subgroup analyses
by SOT type were conducted. Result(s): 352 pts were randomized (235
MBV, 117 IAT; age range 19-79 years). Significantly more pts (MBV vs IAT)
achieved the primary (55.7% vs 23.9%; difference, 95% CI: 32.8%,
22.8-42.7; p<0.001) and key secondary endpoint (18.7% vs 10.3%;
difference, 95% CI: 9.5%, 2.0-16.9; p=0.013). 211 pts (59.9%) were SOT
recipients (kidney, 50.2%; lung, 29.4%; heart, 10.9%; liver, 3.3%;
pancreas, 0.9%; intestine, 0.5%; multiple, 4.7%). A benefit trend for MBV
vs IAT in kidney, lung, and heart transplants was seen (Fig). No SOT pts
lost grafts. Tx-emergent AEs (TEAEs) with MBV vs IAT (overall % pts):
97.4% and 91.4%. Acute kidney injury with MBV vs foscarnet was lower: 8.5%
vs 21.3% (TEAE) and 1.7% vs 19.1% (Tx-related TEAE). Neutropenia with MBV
vs val/ganciclovir was lower: 9.4% vs 33.9% (TEAE) and 1.7% vs 25.0%
(Tx-related TEAE). Overall, 2 Tx-related serious TEAEs led to death (1 pt
per arm). Conclusion(s): MBV showed superior efficacy vs IAT in
clearing CMV in transplant recipients with R/R CMV infection, with
consistent trends across organ types and lower rates of Tx limiting
toxicities common with IAT. (Table Presented).

<62>
Accession Number
636330029
Title
Restriction of sulfur-containing amino acid intake for prevention of AKI
in cardiac surgery: Unicorn, a randomized, controlled, double-blinded
trial.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2021. San Diego, CA United States. 32 (pp 123), 2021. Date of Publication:
2021.
Author
Osterholt T.; Gloistein C.; Todorova P.; Becker I.; Arenskrieger K.; Melka
R.; Koehler F.C.; Benzing T.; Mueller R.-U.; Burst V.R.; Grundmann F.
Institution
(Osterholt, Gloistein, Todorova, Arenskrieger, Melka, Koehler, Benzing,
Mueller, Burst, Grundmann) Department II of Internal Medicine, Center for
Molecular Medicine Cologne, University of Cologne, Cologne, Germany
(Benzing, Mueller) Cologne Excellence Cluster on Cellular Stress Responses
in Aging-Associated Diseases (CECAD), University of Cologne, Cologne,
Germany
(Becker) Institute of Medical Statistics and Computational Biology,
University of Cologne, Cologne, Germany
Publisher
American Society of Nephrology
Abstract
Background: Acute kidney injury (AKI) can result in short-and long-term
complications and increased mortality. Nonetheless, preventive and
therapeutic strategies are lacking. Protein restriction has been shown to
protect from organ failure in mice and this protection depended on
restriction of sulfur-containing amino acids (SAA). The UNICORN study aims
to evaluate the impact of restricting SAA intake by replacing milkderived
dietary protein by collagen prior to cardiac surgery on AKI.
 Method(s): In this single-center, randomized, controlled,
double-blinded trial 115 patients scheduled for cardiac surgery, were
assigned in a 1:1 ratio into a LowS group (SAA depleted formula diet) or a
regular formula diet (control group, CG) for 7 days prior to surgery. The
primary endpoint was incidence of AKI within 72 hours after surgery
(KDIGO), secondary endpoints included increase of serum creatinine at 24h,
48h and 72h as well as safety parameters. Quantitative variables were
analyzed with t-test or nonparametric methods, while categorical variables
were evaluated by means of Chi-Square or Fisher's test. Result(s):
Baseline characteristics: LowS serum creatinine 1.0 mg/dl[0.34] vs. CG
0.85 mg/dl[0.42]; LowS 77% male vs. CG 54%; age: LowS 67y[IQR: 13] vs. CG
69y[12], body weight: LowS 88 kg[20] vs. CG 78kg[18], crossclamp time:
LowS 67min[32] vs. CG 68min[35]). Patients in the LowS group had a 77,6%
reduction in SAA as compared to CG. There was no difference in the primary
endpoint between the groups (LowS AKI incidence 23% vs. CG 16%; p=0.37).
Likewise, no differences were observed with respect to secondary endpoints
(AKI during hospitalization, creatinine at 24h, 48h, 72h after surgery).
Subgroup analysis focusing on age, gender, body mass index and markers of
organ damage did not reveal any between-group differences.
 Conclusion(s): In this first-in-humans translational clinical trial,
dietary SAA restriction before cardiac surgery did not result in a lower
incidence of AKI. However, larger studies are needed to confirm this
finding.

<63>
Accession Number
636329663
Title
Improve AKI: A cluster-randomized trial of team-based coaching
interventions to improve AKI.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2021. San Diego, CA United States. 32 (pp 3), 2021. Date of Publication:
2021.
Author
Brown J.R.; Solomon R.J.; Stabler M.E.; Davis S.E.; Cox K.C.; Westerman
D.; Dorn C.A.; O'Malley J.; Matheny M.E.
Institution
(Brown, Stabler, Cox, O'Malley) Dartmouth College, Geisel School of
Medicine, Hanover, NH, United States
(Solomon) University of Vermont, College of Medicine, Burlington, VT,
United States
(Davis, Westerman, Dorn, Matheny) Vanderbilt University, Nashville, TN,
United States
Publisher
American Society of Nephrology
Abstract
Background: Over 2 million people in the U.S. undergo cardiac
catheterization procedures each year with acute kidney injury (AKI)
occurring in up to 14% of all patients. However, orders are often not
standardized to ensure adequate oral and intravenous fluids, reduced NPO
time, and limited contrast dye dose across or within hospitals to prevent
AKI. Therefore, we hypothesized that providing team-based coaching in a
Virtual Learning Collaborative (VLC) would reduce post-procedural AKI
incidence compared to Technical Assistance (TA), both with and without
Automated Surveillance Reporting (ASR). Method(s): We conducted a 2x2
factorial cluster-randomized trial that randomized 20 hospitals to receive
TA, TA+ASR, VLC, or VLC+ASR for 18-months. All sites received an AKI
Prevention Toolkit that included AKI preventive strategies. We fit
multilevel logistic models for AKI with site-level random effects to
account for the clustered design. Result(s): Across 20 randomized
Veterans Administration medical centers, there were 4,517 patients
including 1,153 patients with pre-existing chronic kidney disease (CKD)
during the 18-month intervention phase of the trial. There were 510 AKI
events (214 among CKD patients). In all patients, the VLC+ASR intervention
cluster had a substantial reduction in AKI when compared to TA alone
(aOR=0.55; 0.36, 0.84) mirrored by a strong yet non-significant effect
among CKD patients (aOR: 0.76; 0.46, 1.24). Conclusion(s): This
implementation trial estimates that the combination of VLC with ASR
reduces AKI by a highly significant 45% at an institution and is
suggestive of a reduction among CKD patients. Therefore, the combined VLC
with ASR teambased coaching intervention is an effective, scalable
framework to establish aggressive prevention protocols to prevent AKI.

<64>
Accession Number
636327836
Title
Prophylactic pd catheter placement for children undergoing cardiac surgery
with cardiopulmonary bypass: Systematic review with meta-analysis.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2021. San Diego, CA United States. 32 (pp 603), 2021. Date of Publication:
2021.
Author
Ulrich E.H.; Bedi P.K.; Alobaidi R.; Morgan C.; Paulden M.; Zappitelli M.;
Bagshaw S.M.
Institution
(Ulrich, Alobaidi, Morgan, Bagshaw) University of Alberta, Faculty of
Medicine and Dentistry, Edmonton, AB, Canada
(Bedi) University of Winnipeg, Winnipeg, MB, Canada
(Paulden) University of Alberta, Edmonton, AB, Canada
(Zappitelli) University of Toronto, Toronto, ON, Canada
Publisher
American Society of Nephrology
Abstract
Background: Infants undergoing cardiopulmonary bypass (CPB) are at high
risk of fluid overload, requiring peritoneal dialysis (PD). This
systematic review evaluates whether prophylactic PD catheter (PDC)
insertion at the time of cardiac surgery improves post-operative outcomes.
 Method(s): Comprehensive literature search was completed Oct-2020. We
identified studies that compared children <=18 years undergoing cardiac
surgery with CPB and receiving prophylactic PDC (inserted intraoperatively
or <=24 hours postoperatively) vs. children who do not undergo
prophylactic PDC placement. Data was extracted on population
characteristics; perioperative variables; and short-term postoperative
outcomes, including time to negative fluid balance (FB); presence and
degree of fluid overload; duration of inotropic support and mechanical
ventilation; hospital length of stay; and mortality. Result(s): Out
of 1067 studies, 208 underwent full-text review for eligibility, and 15
were included: 4 randomized controlled trials; 9 cohort studies; and 2
case-control studies. Intervention was prophylactic PDC insertion with
passive peritoneal drainage in 6; PD in 7; and passive peritoneal drainage
or PD in 2. The comparator group typically received furosemide. Baseline
characteristics were heterogeneous for the included studies with respect
to age, weight, and illness severity. Surgical procedures performed were
also variable within and between studies. Time to negative FB and
prevention of fluid overload showed mixed results with some studies
favoring prophylactic PDC and others showing no difference. Pooled
unadjusted OR for in-hospital mortality was 0.75 (95% CI: 0.05-11.11)
(Figure 1). No studies reported serious PDC-related complications. Risk of
bias was high in most studies, due to higher illness severity in the
intervention groups, small sample size, and observational nature of
studies. Conclusion(s): Prophylactic PDC insertion is relatively safe
in children undergoing cardiac surgery with CPB. Some studies have shown
prophylactic PDC improves postoperative outcomes, including time to
negative FB and in-hospital mortality; others have shown no difference.

<65>
Accession Number
636327454
Title
Kidney Week 2021.
Source
Journal of the American Society of Nephrology. Conference: Kidney Week
2021. San Diego, CA United States. 32 (no pagination), 2021. Date of
Publication: 2021.
Author
Anonymous
Publisher
American Society of Nephrology
Abstract
The proceedings contain 3029 papers. The topics discussed include:
nephrotoxin exposure and AKI: a magnitude assessment using NINJA
methodology in the adult population; readmission and mortality after AKI
hospitalization; proton pump inhibitor exposure and risk of AKI after
cardiac surgery; cardiovascular drug use after AKI among hospitalized
patients with a history of myocardial infarction: a population-based
study; IMPROVE AKI: a cluster-randomized trial of team-based coaching
interventions to improve AKI; renal outcomes after chimeric antigen
receptor T Cell (CAR-T) therapy: a single-center perspective; treatment of
osteoporosis in CKD5D patients based on bone turnover: a randomized
controlled trial showing better survival in patients with non-high
turnover; properties of proenkephalin (penKid) in septic AKI; the
calcified vasculature in CKD secretes signal proteins that inhibit bone
mineralization; HIF-PHI have direct actions in osteocytes: implications
for anemia treatment in CKD; and association of genetically predicted
FGF23 with heart failure: a mendelian randomization study.

<66>
Accession Number
636326008
Title
4th MiECT Symposium 2021.
Source
Perfusion. Conference: 4th MiECT Symposium 2021. Virtual. 36(7) (no
pagination), 2021. Date of Publication: October 2021.
Author
Anonymous
Publisher
SAGE Publications Inc.
Abstract
The proceedings contain 11 papers. The topics discussed include: propofol
pharmacokinetics and pharmacodynamics during minimally invasive
extracorporeal circulation (MiECC); magnetic levitation pump vs
constrained vortex pump: a pilot study on the hemolysis effect during
MiECC; minimally invasive extracorporeal circulation: effects on
coagulation and platelet function compared to optimized conventional
cardiopulmonary bypass; the influence of vasopressors on venous return
during cardiopulmonary bypass with minimally invasive extracorporeal
circulation; the impact of minimally invasive extracorporeal circulation
on myocardial edema and microvascular integrity; are there any safety
issues during cardiac surgery with minimally invasive extracorporeal
circulation? a systematic review of the literature; minimal invasive
extracorporeal circulation preserves coagulation integrity after cardiac
surgery; and implementation of minimally invasive extracorporeal
circulation system in minimally invasive aortic valve surgery: results
from 156 patients.

<67>
Accession Number
636325987
Title
Are there any safety issues during cardiac surgery with minimally invasive
extracorporeal circulation? A systematic review of the literature.
Source
Perfusion. Conference: 4th MiECT Symposium 2021. Virtual. 36(7) (pp 658),
2021. Date of Publication: October 2021.
Author
Anastasiadis K.; Antonitsis P.; Asteriou C.; Deliopoulos A.; Argiriadou H.
Institution
(Anastasiadis, Antonitsis, Asteriou, Deliopoulos, Argiriadou)
Cardiothoracic Department, School of Medicine, Aristotle University of
Thessaloniki, Greece
Publisher
SAGE Publications Inc.
Abstract
Background: Despite extensive available evidence that shows clinical
superiority of MiECC, worldwide penetration remains low due to concerns,
mainly raised by perfusionists, regarding prompt handling of unexpected
intraoperative scenarios in the context of a closed system. The purpose of
this study is to thoroughly investigate perfusion safety and technical
feasibility of performing cardiac surgery with MiECC aiming to ultimately
clarify whether there are any issues regarding MiECC technology.
 Method(s): A systematic review of the literature was conducted
following the PRISMA guidelines. Moreover, data from major conference
proceedings were screened. All reported critical perfusion issues
associated with MiECC were collected. Moreover, relation to clinical
outcome was also investigated. In studies involving use of modular MiECC
the rate and cause of conversion to open circuit was recorded and
quantitative synthesis of data was performed. Risk of bias was assessed
for each study. Result(s): One-hundred and twenty-three manuscripts
were assessed for eligibility after reading full-text, of which 14 studies
were included in the qualitative synthesis. Safety of the procedure was
challenged by a single small series which reported air entrainment in a
type I MiECC, while no clinical adverse event related to MiECC use was
identified. Studies involving modular MiECC reported 100% technical
feasibility; the quantitative synthesis revealed a cumulative conversion
rate of 2%. Conclusion(s): Systematic review of the literature
identified literally no safety issues during cardiac surgery on MiECC. Use
of contemporary modular MiECC ultimately eliminates any perfusion concerns
regarding air handling and volume management, while it overcomes any
unexpected intraoperative scenario.

<68>
Accession Number
2015313335
Title
Management of acute aortic syndromes from initial presentation to
definitive treatment.
Source
American Journal of Emergency Medicine. 51 (pp 108-113), 2022. Date of
Publication: January 2022.
Author
Mehta C.K.; Son A.Y.; Chia M.C.; Budd A.N.; Allen B.D.; Vassallo P.; Hoel
A.W.; Brady W.J.; Nable J.V.
Institution
(Mehta, Son) Division of Cardiac Surgery, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Chia, Hoel) Division of Vascular Surgery, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Budd) Department of Anesthesiology, Northwestern Medicine, Chicago, IL,
United States
(Allen) Department of Radiology, Northwestern Medicine, Chicago, IL,
United States
(Vassallo) Division of Cardiology, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Brady) Departments of Emergency Medicine and Internal Medicine,
University of Virginia, Charlottesville, VA, United States
(Nable) Department of Emergency Medicine, MedStar Georgetown University
Hospital, Washington D.C., United States
Publisher
W.B. Saunders
Abstract
Background: Acute aortic syndromes comprise a spectrum of diseases
including aortic dissection, intramural hematoma, and penetrating
atherosclerotic ulcers. Early diagnosis, rapid intervention, and
multidisciplinary team care are vital to efficiently manage time-sensitive
aortic emergencies, mobilize appropriate resources, and optimize clinical
outcomes. Objective(s): This comprehensive review outlines the
multidisciplinary team approach from initial presentation to definitive
interventional treatment and post-operative care. Discussion(s):
Acute aortic syndromes can be life-threatening and require prompt
diagnosis and aggressive initiation of blood pressure and pain control to
prevent subsequent complications. Early time to diagnosis and intervention
are associated with improved outcomes. Conclusion(s): A
multidisciplinary team can help promptly diagnose and manage aortic
syndromes. Copyright © 2021

<69>
Accession Number
2015288021
Title
A review of literature on ischemic heart disease and risk of development
of cognitive disorders.
Source
European Journal of Molecular and Clinical Medicine. 8(4) (pp 1188-1200),
2021. Date of Publication: June 2021.
Author
PrajnaTeja D.
Institution
(PrajnaTeja) MallaReddy Medical College for Women, Telangana, Hyderabad,
India
Publisher
EJMCM, International House
Abstract
Aim: A Review of literature on Ischemic Heart Disease and Risk of
Development of Cognitive Disorders Methods: The literature search was
conducted in Medline, Embase, PsycINFO, and CINAHL. The search string
consisted of predictor-related terms (e.g. myocardial infarction, angina
pectoris), outcome-related terms (e.g. dementia, Alzheimer, cognition), as
well as some specific limitations. All publications until 2021 were
included if they fulfilled the following eligibility criteria: 1) MI, AP,
or a CHD variable that is a combination of MI and AP (e.g. ischemic heart
disease (IHD)) as predictor variable; 2) cognition, cognitive impairment
or dementia as outcome; 3) population-based study; 4) prospective (>=1
year follow-up), cross-sectional or case-control study design; 5) >=100
participants; and 6) aged >=45 years. Reference lists of publications and
secondary literature were hand-searched for possible missing articles.
 Result(s): The search yielded 3500 abstracts, of which (number***)
were included in this study. This resulted in 5 cross-sectional studies, 3
case-control studies, 6 prospective cohort studies and 1 study with both
cross-sectional and prospective analyses (designated as crosssectional
regarding study quality). Quality assessment of all 15 included studies
was sufficient (overall mean NOS score = 6.7, SD = 1.30, range = 3-10).
Separate analyses for each study design showed similar results for
prospective (mean NOS score = 6.92, SD = 1.14, range = 5-9) and
cross-sectional studies (mean NOS score = 7.23, SD = 0.98, range = 6-8),
but the quality of case-control studies was somewhat lower (mean NOS score
= 5.9, SD = 1.93, range = 3-7), mainly due to the effects of one
particular study with a score of 3. Conclusion(s): We concluded that
the CHD was associated with an increased risk of cognitive impairment or
dementia in prospective cohort studies. More mechanistic studies are
needed that focus on the underlying biological pathways (e.g. left
ventricular dysfunction, cerebral small vessel disease, hypoperfusion) and
shared risks that link CHD with the occurence of cognitive impairment or
dementia. Copyright © 2021 Ubiquity Press. All rights reserved.

<70>
Accession Number
2015208076
Title
Low Dose of Methylprednisolone for Pain and Immune Function After Thoracic
Surgery.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Li X.; Song B.; Teng X.; Li Y.; Yang Y.; Zhu J.
Institution
(Li, Song, Teng, Li, Yang, Zhu) Department of Anesthesiology, Shengjing
Hospital of China Medical University, Shenyang, Liaoning, China
(Song) Department of Anesthesiology, Beijing Friendship Hospital of
Capital Medical University, Beijing, China
Publisher
Elsevier Inc.
Abstract
Background: This study evaluated the effects of single low-dose
preoperative methylprednisolone (MP) on the immunologic function and
postoperative pain of patients undergoing elective video-assisted
thoracoscopic surgery under general anesthesia. Method(s): The study
randomly assigned 81 patients who underwent elective video-assisted
thoracoscopic surgery to the MP group or the control group. The
T-lymphocyte subsets of CD3+, CD4+, and
CD8+, and the CD4+/CD8+ ratio at
T<inf>0</inf> (before anesthesia), T<inf>1</inf> (after operation), and
T<inf>2</inf> (24 hours after operation) were recorded. Also recorded were
postoperative rest and cough pain scores and postoperative adverse effects
and surgery complications. Result(s): Compared with T<inf>0</inf>,
the levels of CD3+ and CD4+ subsets and
CD4+/CD8+ were significantly decreased, and the
level of CD8+ was increased after surgery in both groups. There
was no significant difference in the variation of CD3+,
CD4+, CD8+, and CD4+/CD8+
between the MP group and the control group. The rest and cough pain of
patients in the MP group was significantly lower compared with the control
group at 2, 4, 6, and 24 hours after surgery. The incidences of nausea and
vomiting and dizziness were also significantly higher in the control group
than those in the MP group. Conclusion(s): A preoperative single low
dose of MP (1 mg/kg) had no effect on immune function but had effective
analgesic effects and could reduce the incidence of dizziness and
postoperative nausea and vomiting. Copyright © 2021 The Society
of Thoracic Surgeons

<71>
Accession Number
636321024
Title
Commentary on "Motor Developmental Delay After Cardiac Surgery in Children
With a Critical Congenital Heart Defect: A Systematic Literature Review
and Meta-analysis".
Source
Pediatric physical therapy : the official publication of the Section on
Pediatrics of the American Physical Therapy Association. 33(4) (pp
198-199), 2021. Date of Publication: 01 Oct 2021.
Author
Long S.H.; Eagleson K.; Charlton J.K.
Institution
(Long) MelbourneVICAustralia
(Eagleson) Queensland Paediatric Cardiac Service, Queensland Children's
Hospital, Faculty of Medicine The University of Queensland, Brisbane, QLD,
Australia
(Charlton) Mother of HeartKid Emily; Department of Paediatrics, Mercy
Hospital for Women, and Heart Research Group, Murdoch Children's Research
Institute, and Department of Paediatrics, University of Melbourne,
Melbourne, Victoria, Australia
Publisher
NLM (Medline)

<72>
Accession Number
636320870
Title
Motor Developmental Delay After Cardiac Surgery in Children With a
Critical Congenital Heart Defect: A Systematic Literature Review and
Meta-analysis.
Source
Pediatric physical therapy : the official publication of the Section on
Pediatrics of the American Physical Therapy Association. 33(4) (pp
186-197), 2021. Date of Publication: 01 Oct 2021.
Author
Sprong M.C.A.; Broeders W.; van der Net J.; Breur J.M.P.J.; de Vries L.S.;
Slieker M.G.; van Brussel M.
Institution
(Sprong) Center for Child Development, Exercise and Physical literacy
(Mrs/Ms Sprong, Dr van Brussel, Dr van der Net), Pediatric Cardiology ,
Department of Neonatology , Wilhelmina Children's Hospital, University
Medical Center Utrecht, Utrecht, Netherlands
Publisher
NLM (Medline)
Abstract
PURPOSE: To systematically review evidence regarding the severity and
prevalence of motor development in children with a critical congenital
heart defect (CCHD) without underlying genetic anomalies. SUMMARY OF KEY
POINTS: Twelve percent of all included studies reported abnormal mean
motor developmental scores, and 38% reported below average motor scores.
Children with single-ventricle physiology, especially those with
hypoplastic left heart syndrome, had the highest severity and prevalence
of motor delay, particularly at 0 to 12 months. Most included studies did
not differentiate between gross and fine motor development, yet gross
motor development was more affected. RECOMMENDATIONS FOR CLINICAL
PRACTICE: We recommend clinicians differentiate between the type of heart
defect, fine and gross motor development, and the presence of genetic
anomalies. Furthermore, increased knowledge about severity and prevalence
will enable clinicians to tailor their interventions to prevent motor
development delays in CCHD. Copyright © 2021 Academy of Pediatric
Physical Therapy of the American Physical Therapy Association.

<73>
Accession Number
2014029870
Title
Supra-systemic pulmonary hypertension after complicated percutaneous
mitral balloon valvuloplasty: a case report and review of literature.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 258. Date
of Publication: December 2021.
Author
Navas-Blanco J.R.; Miranda J.; Gonzalez V.; Mohammed A.; Aljure O.D.
Institution
(Navas-Blanco) Department of Anesthesiology, Oakland University William
Beaumont School of Medicine, Beaumont Hospital Royal Oak, 3601 W Mile Rd,
Royal Oak, MI 48073, United States
(Miranda) University of Miami Miller School of Medicine, Miami, FL, United
States
(Gonzalez, Mohammed, Aljure) Department of Anesthesiology, Perioperative
Medicine and Pain Management, University of Miami Miller School of
Medicine, Jackson Memorial Hospital, Miami, FL, United States
Publisher
BioMed Central Ltd
Abstract
Background: The World Symposium of Pulmonary Hypertension in 2018, updated
the definition of pulmonary hypertension (PH) as mean pulmonary artery
pressures (PAP) > 20 mmHg. Pulmonary venous hypertension secondary to
left-heart disease, constitutes the most common cause of PH, and the
determination of a co-existent pre-capillary (primary) PH becomes
paramount, particularly at the moment of evaluating and managing patients
with heart failure. Pulmonary artery pressures above the systemic
pressures define supra-systemic PH and generally leads to frank right
ventricular failure and high mortality. Case presentation: We present the
perioperative management of a patient with rheumatic mitral valve disease,
initially found to have severe PH due to pulmonary venous hypertension,
who underwent percutaneous mitral balloon valvuloplasty complicated with
mitral chordae rupture, severe mitral regurgitation and supra-systemic PH.
Multiple medical therapies and an intra-aortic balloon pump were used as
means of non-surgical management of this complication. Conclusion(s):
This case report illustrates the perioperative implications of combined
pre- and post-capillary PH and supra-systemic PH, as this has not been
widely discussed in previous literature. A thorough literature review of
the clinical characteristics of PH, methods to determine co-existent pre-
and post-capillary PH components, as well as concomitant right ventricular
failure is presented. Severe PH has known detrimental effects on the
hemodynamic status of patients, which can ultimately lead to a decrease in
effective cardiac output and poor tissue perfusion. Copyright ©
2021, The Author(s).

<74>
Accession Number
636306110
Title
Levosimendan to Facilitate Weaning From Cardiorespiratory Support in
Critically Ill Patients: A Meta-Analysis.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 741108.
Date of Publication: 12 Oct 2021.
Author
Luo J.-C.; Zheng W.-H.; Meng C.; Zhou H.; Xu Y.; Tu G.-W.; Luo Z.; Huang
H.-B.
Institution
(Luo, Tu, Luo) Department of Critical Care Medicine, Zhongshan Hospital,
Fudan University, Shanghai, China
(Zheng) Department of Critical Care Medicine, The Second People's
Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
(Meng, Zhou, Xu, Huang) Department of Critical Care Medicine, School of
Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua
University, Beijing, China
(Luo) Department of Critical Care Medicine, Xiamen Branch, Zhongshan
Hospital, Fudan University, Xiamen, China
Publisher
Frontiers Media S.A.
Abstract
Background: Cardiopulmonary support, as extracorporeal membrane
oxygenation (ECMO) or mechanical ventilation (MV), is crucial for ICU
patients. However, some of these patients are difficult to wean.
Therefore, we aimed to assess the efficacy and safety of levosimendan in
facilitating weaning from cardiorespiratory support in this patient
population. Method(s): We searched for potentially relevant articles
in PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and
the Cochrane database from inception up to Feb 30, 2021. Studies focusing
on weaning data in MV/ECMO adult patients who received levosimendan
compared to controls were included. We used the Cochrane risk of bias tool
or the Newcastle-Ottawa Quality Assessment Scale to evaluate the study
quality. The primary outcome was the weaning rate from MV/ECMO. Secondary
outcomes were mortality, duration of MV, and ICU stay. Subgroup analysis,
sensitivity analysis, and publication bias were also conducted.
 Result(s): Eighteen studies with 2,274 patients were included. The
quality of the included studies was low to moderate. Overall, levosimendan
effectively improved weaning rates from MV/ECMO [odds ratio (OR) = 2.32;
95%CI, 1.60-3.36; P < 0.00001, I2 = 68%]. Subgroup analyses
confirmed the higher successful weaning rates in ventilated patients with
low left ventricular ejection fractions (OR = 4.06; 95%CI, 2.16-7.62),
patients with ECMO after cardiac surgery (OR = 2.04; 95%CI, 1.25-3.34),
and patients with ECMO and cardiogenic shock (OR = 1.98; 95%CI,
1.34-2.91). However, levosimendan showed no beneficial effect on patients
with MV weaning difficulty (OR = 2.28; 95%CI, 0.72-7.25). Additionally, no
differences were found concerning the secondary outcomes between the
groups. Conclusion(s): Levosimendan therapy significantly increased
successful weaning rates in patients with cardiopulmonary support,
especially patients with combined cardiac insufficiency. Large-scale,
well-designed RCTs will be needed to define the subgroup of patients most
likely to benefit from this strategy. © Copyright © 2021
Luo, Zheng, Meng, Zhou, Xu, Tu, Luo and Huang.

<75>
Accession Number
636301613
Title
Assessing the development status of intraoperative fluorescence imaging
for perfusion assessments, using the IDEAL framework.
Source
BMJ Surgery, Interventions, and Health Technologies. 3(1) (no pagination),
2021. Article Number: e000088. Date of Publication: 20 Oct 2021.
Author
Ishizawa T.; McCulloch P.; Muehrcke D.; Carus T.; Wiesel O.; Dapri G.;
Schneider-Koriath S.; Wexner S.D.; Abu-Gazala M.; Boni L.; Cassinotti E.;
Sabbagh C.; Cahill R.; Ris F.; Carvello M.; Spinelli A.; Vibert E.;
Terasawa M.; Takao M.; Hasegawa K.; Schols R.M.; Pruimboom T.; Murai Y.;
Matano F.; Bouvet M.; Diana M.; Kokudo N.; Dip F.; White K.; Rosenthal
R.J.
Institution
(Ishizawa, Takao, Hasegawa) Hepato-Biliary-Pancreatic Surgery Division,
Department of Surgery, Graduate School of Medicine, The University of
Tokyo, Bunkyo-ku, Tokyo, Japan
(McCulloch) IDEAL Collaboration, Nuffield Department of Surgical Science,
University of Oxford, John Radcliffe Hospital, Oxfordshire, Oxford, United
Kingdom
(Muehrcke) Flagler Hospital, St. Augustine, FL, United States
(Carus) Elisabeth-Krankenhaus Thuine, Thuine, Germany
(Wiesel) Maimonides Medical Center, Brooklyn, NY, United States
(Wiesel) Rabin Medical Center, Petah Tikva, Israel
(Dapri) Saint-Pierre University Hospital, Bruxelles, Belgium
(Schneider-Koriath) Klinikum Sudstadt Rostock, Mecklenburg-Vorpommern,
Rostock, Germany
(Wexner, Dip, Rosenthal) Cleveland Clinic Florida, Weston, FL, United
States
(Abu-Gazala) General Surgery Department, Hadassah Medical Center Hebrew
University Biotechnology Park, Jerusalem, Israel
(Boni, Cassinotti) Department of Surgery, Fondazione IRCCS Ca' Granda
Ospedale Maggiore Policlinico, Lombardia, Milan, Italy
(Sabbagh) Department of Digestive Surgery, Amiens University Hospital,
Hauts-de-France, Amiens, France
(Sabbagh) Simplication of Surgical Pateint Care Research Unit, University
of Picardie Jules Verne, Amiens, France
(Cahill) UCD Centre for Precision Surgery, University College Dublin,
Dublin, Ireland
(Cahill) Department of Surgery, Mater Misericordiae University Hospital,
Dublin, Ireland
(Ris) Service of Visceral Surgery, Geneva University Hospitals and Medical
School, Geneva, Switzerland
(Carvello, Spinelli) Department of Biomedical Sciences, Humanitas
University, Milan, Italy
(Carvello, Spinelli) IRCCS Humanitas Research Hospital, Lombardia,
Rozzano, Italy
(Vibert, Terasawa) Centre Hepato-Biliaire, Hopital Universitaire Paul
Brousse, Villejuif, France
(Schols, Pruimboom) Department of Plastic, Reconstructive and Hand
Surgery, Maastricht University Medical Centre+, Limburg, Maastricht,
Netherlands
(Murai, Matano) Department of Neurological Surgery, Nippon Medical School,
Shinjuku-ku, Tokyo, Japan
(Bouvet) University of California San Diego, San diego, CA, United States
(Diana) IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD,
Research Institute against Cancer of the Digestive System, Strasbourg,
France
(Kokudo) National Center for Global Health and Medicine, Shinjuku-ku,
Tokyo, Japan
(Dip) Hospital de Clinicas Buenos Aires, University of Buenos Aires,
Buenos Aires, Argentina
(White) Science Right Research Consulting London, ON, Canada
Publisher
BMJ Publishing Group
Abstract
Intraoperative fluorescence imaging is currently used in a variety of
surgical fields for four main purposes: assessing tissue perfusion;
identifying/localizing cancer; mapping lymphatic systems; and visualizing
anatomy. To establish evidence-based guidance for research and practice,
understanding the state of research on fluorescence imaging in different
surgical fields is needed. We evaluated the evidence on fluorescence
imaging for perfusion assessments using the Idea, Development,Exploration,
Assessment, Long Term Study (IDEAL) framework, which was designed for
describing the stages of innovation in surgery and other interventional
procedures. Narrative literature review with analysis of IDEAL stage of
each field of study. All publications on intraoperative fluorescence
imaging for perfusion assessments reported in PubMed through 2019 were
identified for six surgical procedures: coronary artery bypass grafting
(CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid
organ transplantation, reconstructive surgery, and cerebral aneurysm
surgery. The IDEAL stage of research evidence was determined for each
specialty field using a previously described approach. 196 articles (15003
cases) were selected for analysis. Current status of research evidence was
determined to be IDEAL Stage 2a for upper GI and transplantation surgery,
IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL
Stage 3 for reconstructive surgery. Using the technique resulted in a high
(up to 50%) rate of revisions among surgical procedures, but its efficacy
improving postoperative outcomes has not yet been demonstrated by
randomized controlled trials in any discipline. Only one possible adverse
reaction to intravenous indocyanine green was reported. Using fluorescence
imaging intraoperatively to assess perfusion is feasible and appears
useful for surgical decision making across a range of disciplines.
Identifying the IDEAL stage of current research knowledge aids in planning
further studies to establish the potential for patient
benefit. Copyright © 2021, BMJ Publishing Group Ltd. All rights
reserved.

<76>
Accession Number
636343882
Title
Drug-Eluting or Bare-Metal Stents for Left Anterior Descending or Left
Main Coronary Artery Revascularization.
Source
Journal of the American Heart Association. (pp e018828), 2021. Date of
Publication: 08 Oct 2021.
Author
Piccolo R.; Bonaa K.H.; Efthimiou O.; Varenne O.; Urban P.; Kaiser C.;
Raber L.; de Belder A.; Remkes W.; Van't Hof A.W.J.; Stankovic G.; Lemos
P.A.; Wilsgaard T.; Reifart J.; Rodriguez A.E.; Ribeiro E.E.; Serruys
P.W.J.C.; Abizaid A.; Sabate M.; Byrne R.A.; de la Torre Hernandez J.M.;
Wijns W.; Esposito G.; Juni P.; Windecker S.; Valgimigli M.
Institution
(Piccolo, Esposito) Department of Advanced Biomedical Sciences University
of Naples Federico II Naples Italy
(Bonaa, Wilsgaard) Department of Community Medicine University of
Tromso-The Arctic University of Norway Tromso Norway
(Efthimiou) Institute of Social and Preventive Medicine University of Bern
Switzerland
(Varenne) Department of Cardiology Hopital CochinAP-HP Paris France
(Varenne) Faculte de Medecine Universite de Paris France
(Urban) Hopital de la Tour Geneva Switzerland
(Kaiser) Department of Cardiology University Hospital BaselUniversity of
Basel Switzerland
(Raber, Windecker, Valgimigli) Department of Cardiology Bern University
HospitalUniversity of Bern Switzerland
(de Belder) Department of Cardiology Sussex Cardiac Centre Brighton and
Sussex University Hospitals Brighton United Kingdom
(Remkes) Department of Cardiology Isala Heart Centre Zwolle the
Netherlands
(Van't Hof) Department of Cardiology Maastricht University Medical Center
Maastricht the Netherlands
(Van't Hof) Department of Cardiology Zuyderland Medical Center Heerlen the
Netherlands
(Stankovic) Department of Cardiology Clinical Center of Serbia University
of Belgrade Serbia
(Lemos) Heart Institute (InCor) University of Sao Paulo Medical School Sao
Paulo Brazil
(Lemos) Hospital Israelita Albert Einstein Sao Paulo-SP Brazil
(Reifart) Department of Cardiology Kerckhoff Klinik Bad Nauheim Germany
(Rodriguez) Cardiac Unit Cardiology Fellow Training Program Otamendi
HospitalBuenos Aires School of Medicine Buenos Aires Argentina
(Ribeiro) Instituto do Coracao (INCOR) Sao Paulo Brazil
(Serruys) International Centre for Circulatory Health National Heart and
Lung InstituteImperial College, London London United Kingdom
(Abizaid) Department of Invasive Cardiology Institute Dante Pazzanese of
Cardiology Sao Paulo Brazil
(Sabate) Cardiology Department Cardiovascular Institute (ICCV) and
Hospital ClinicIDIBAPSUniversity of Barcelona Spain
(Byrne) Dublin Cardiovascular Research Institute Mater Private Hospital
Dublin Ireland
(Byrne) School of Pharmacy and Biomolecular Sciences Royal College of
Surgeons in Ireland Dublin Ireland
(de la Torre Hernandez) Hospital Marques de Valdecilla Santander Spain
(Wijns) Lambe Institute for Translational Medicine and Curam Galway
Ireland
(Wijns) Department of Cardiology National University of Ireland Galway
Galway Ireland
(Juni) Department of Medicine Applied Health Research Centre of the Li Ka
Shing Knowledge Institute St Michael's HospitalUniversity of Toronto
Ontario Canada
(Valgimigli) CardioCentro Ticino Lugano Switzerland
Publisher
NLM (Medline)
Abstract
Background New-generation drug-eluting stents (DES) reduce target-vessel
revascularization compared with bare-metal stents (BMS), and recent data
suggest that DES have the potential to decrease the risk of myocardial
infarction and cardiovascular mortality. We evaluated the treatment effect
of DES versus BMS according to the target artery (left anterior descending
[LAD] and/or left main [LM] versus other territories [no-LAD/LM]). Methods
and Results The Coronary Stent Trialist (CST) Collaboration gathered
individual patient data of randomized trials of DES versus BMS for the
treatment of coronary artery disease. The primary outcome was the
composite of cardiac death or myocardial infarction. Hazard ratios (HRs)
with 95% CIs were derived from a 1-stage individual patient data
meta-analysis. We included 26 024 patients across 19 trials: 13 650
(52.4%) in the LAD/LM and 12 373 (47.6%) in the no-LAD/LM group. At 6-year
follow-up, there was strong evidence that the treatment effect of DES
versus BMS depended on the target vessel (P-interaction=0.024). Compared
with BMS, DES reduced the risk of cardiac death or myocardial infarction
to a greater extent in the LAD/LM (HR, 0.76; 95% CI, 0.68-0.85) than in
the no-LAD/LM territories (HR, 0.93; 95% CI, 0.83-1.05). This benefit was
driven by a lower risk of cardiac death (HR, 0.83; 95% CI, 0.70-0.98) and
myocardial infarction (HR, 0.74; 95% CI, 0.65-0.85) in patients with
LAD/LM disease randomized to DES. An interaction (P=0.004) was also found
for all-cause mortality with patients with LAD/LM disease deriving benefit
from DES (HR, 0.86; 95% CI, 0.76-0.97). Conclusions As compared with BMS,
new-generation DES were associated with sustained reduction in the
composite of cardiac death or myocardial infarction if used for the
treatment of LAD or left main coronary stenoses. Registration URL:
https://www.crd.york.ac.uk/PROSPERO; Unique identifier: CRD42017060520.

<77>
Accession Number
636343553
Title
Transcatheter aortic valve implantation results are not superimposable to
surgery in patients with aortic stenosis at low surgical risk.
Source
Cardiology journal. (no pagination), 2021. Date of Publication: 08 Oct
2021.
Author
Acconcia M.C.; Perrone M.A.; Sergi D.; Di Luozzo M.; Marchei M.; De Vico
P.; Sili Scavalli A.; Pannarale G.; Chiocchi M.; Gaudio C.; Romeo F.;
Caretta Q.; Barilla F.
Institution
(Acconcia, Sili Scavalli, Pannarale, Gaudio, Barilla) Department of
Cardiovascular Disease, University of Rome La Sapienza, Rome, Italy
(Perrone, Sergi, Di Luozzo, Marchei, De Vico, Romeo) Department of
Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
(Chiocchi) Department of Diagnostic Imaging, Molecular Imaging,
Interventional Radiology and Radiotherapy, University of Rome Tor Vergata,
Rome, Italy
(Caretta) Department of Experimental and Clinical Medicine, University of
Florence, Florence, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: The aim of this meta-analysis was to compare the impact of
transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve
replacement (SAVR) in patients with severe aortic valve stenosis at low
surgical risk. METHOD(S): All randomized controlled trials (RCTs) and
observational studies (Obs) published from January 2014 until March 31st,
2020 were retrieved through the PubMed computerized database and at the
site https://www.clinicaltrials.com. The relative risk (RR) with the 95%
confidence interval (CI) was used to evaluate the effect of the
intervention under comparison. The primary endpoints were all-cause 30-day
mortality and 1-year mortality. The 30-day safety endpoints were: stroke,
acute kidney injury stage 2 or 3, major bleeding, moderate/severe
paravalvular leak, need for new permanent pacemaker (PM) implantation.
 RESULT(S): After detailed review 9 studies, related to 4 RCTs and 5
Obs, were selected. The overall analysis of RCTs plus Obs showed a
significantly lower 30-day mortality for TAVI (RR = 0.55; 95% CI
0.45-0.68, p < 0.00001; I2 = 0%). However, an increased risk of new PM
implantation (RR = 2.87; 95% CI 2.01-3.67, p < 0.00001, I2 = 0%) and of
paravalvular leak (RR = 7.28; 95% CI 3.83-13.81, p < 0.00001, I2 = 0%) was
observed in TAVI compared to SAVR. On the contrary, a lower incidence of
major bleeding (RR = 0.38; 95% CI 0.27-0.54, p < 0.00001, I2 = 0%) and of
acute kidney injury was observed (RR = 0.33; 95% CI 0.19-0.56, p < 0.0001,
I2 = 0%) in TAVI. CONCLUSION(S): TAVI and SVAR in the treatment of AS
in the patients at low surgical risk are not superimposable. In
particular, if 30-day and 1-year mortality, major bleeding and acute
kidney injury were significantly lower for TAVI, the need of new PM
implantation and paravalvular leak were significantly lower in SAVR.
Consequently, we suggest the need of more trials to evaluate the
effectiveness of TAVI as routine therapeutic procedure in the treatment of
patients with low surgical risk AS.

<78>
Accession Number
636319349
Title
Long-term survival after coronary bypass surgery with multiple versus
single arterial grafts.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 07 Oct 2021.
Author
Thuijs D.J.F.M.; Davierwala P.; Milojevic M.; Deo S.V.; Noack T.;
Kappetein A.P.; Serruys P.W.; Mohr F.-W.; Morice M.-C.; Mack M.J.; Stahle
L.E.G.E.; Verberkmoes N.J.; Holmes D.R.; Head S.J.
Institution
(Thuijs, Milojevic, Kappetein, Head) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Davierwala, Noack, Mohr) University Department of Cardiac Surgery, Heart
Centre Leipzig, Leipzig, Germany
(Davierwala) Division of Cardiovascular Surgery, Peter Munk Cardiac
Centre, Toronto General Hospital, 15 University Health Network, Toronto,
ON, Canada
(Davierwala) Department of Surgery, University of Toronto, Toronto, Canada
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Deo) Department of Cardiovascular Surgery, Louis Stokes Cleveland VA
Medical Center, Cleveland, OH, USA
(Serruys) Department of Cardiology, National University of Ireland,
Galway, Ireland
(Morice) Department of Cardiology, Cardiovascular Institute Paris-Sud
(ICPS), Hopital prive Jacques Cartier, Generale de Sante Massy, France
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Center, TX, Dallas, United States
(Stahle) Department of Thoracic and Cardiovascular Surgery, University
Hospital, Uppsala, Sweden
(Verberkmoes) Department of Cardiothoracic Surgery, Catharina Hospital,
Eindhoven, Netherlands
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, MN, Rochester, United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: This study sought to evaluate the long-term differences in
survival between multiple arterial grafts (MAG) and single arterial grafts
(SAG) in patients who underwent coronary artery bypass grafting (CABG) in
the SYNTAX study. METHOD(S): The present analysis included the
randomized and registry-treated CABG patients (n = 1509) from the SYNTAX
Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or
synthetic grafts (n = 1) were excluded. The primary end point was
all-cause death at the longest follow-up. Multivariable Cox regression was
used to adjust for differences in baseline characteristics. Sensitivity
analysis using propensity matching with inverse probability for treatment
weights was performed. RESULT(S): Of the 1466 included patients, 465
(31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were
younger and at lower risk. At the longest follow-up of 12.6 years,
all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients
[adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI)
(0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG
in patients with the three-vessel disease was associated with significant
lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR
0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was
observed after risk adjustment in patients with the left main disease,
with and without diabetes, or among SYNTAX score tertiles.
 CONCLUSION(S): In the present post hoc analysis of all-comers
patients from the SYNTAX trial, MAG resulted in markedly lower all-cause
death at 12.6-year follow-up compared to a SAG strategy. Hence, this
striking long-term survival benefit of MAG over SAG encourages more
extensive use of multiple arterial grafting in selected patients with
reasonable life expectancy. TRIAL REGISTRATION: SYNTAXES
ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov
reference: NCT00114972. Copyright © The Author(s) 2021. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery.

<79>
Accession Number
2014057689
Title
Proximal junctional kyphosis in pediatric spinal deformity surgery: a
systematic review and critical analysis.
Source
Spine Deformity. (no pagination), 2021. Date of Publication: 2021.
Author
Erkilinc M.; Baldwin K.D.; Pasha S.; Mistovich R.J.
Institution
(Erkilinc, Mistovich) Division of Pediatric Orthopaedic Surgery, Rainbow
Babies and Children's Hospital, University Hospitals Cleveland Medical
Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States
(Baldwin, Pasha) Department of Orthopaedic Surgery, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mistovich) Case Western Reserve University School of Medicine, Cleveland,
United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Proximal junctional kyphosis (PJK) is a commonly encountered
clinical and radiographic phenomenon after pediatric and adolescent spinal
deformity surgery that may lead to post-operative deformity, pain, and
dissatisfaction. Understanding the risk factors of PJK can be useful for
pre-operative informed consent as well as to identify any potential
preventative strategies. Method(s): We performed a systematic review
and critical analysis following the PRISMA statement in July 2019 by
searching the PubMed, Scopus, and Embase databases, including all prior
published studies. We included articles with data on PJK in patients with
operative pediatric and adolescent scoliosis and those that detailed risk
factors and/or preventative strategies for PJK. Levels of evidence were
determined based on consensus. Findings were summarized and grades of
recommendation were assigned by consensus. This study was registered in
the PROSPERO database; 202,457. Result(s): Six hundred and thirty
five studies were identified. Thirty-seven studies met criteria for
inclusion into the analysis. No studies including neuromuscular scoliosis
met inclusion criteria. No findings had Grade A evidence. There were 4
findings found to contribute to PJK with Grade B evidence in EOS: higher
number of distractions, disruption of posterior elements, greater sagittal
plane correction. There was no difference in incidence noted between
etiology of the curvature. Five findings with Grade B evidence were found
to contribute to PJK in AIS populations: higher pre-operative thoracic
kyphosis, higher pre-operative lumbar lordosis, longer fusion constructs,
greater sagittal plane correction, and posterior versus anterior fusion
constructs. Conclusion(s): Greater sagittal plane correction has
Grade B evidence as a risk factor for PJK in both EOS and AIS populations.
In EOS patients, an increased number of distractions and posterior element
disruption are Grade B risk factors. In AIS patients, longer fusion
constructs, higher pre-operative thoracic kyphosis and lumbar lordosis,
and posterior (as opposed to anterior) constructs also contributed to PJK
with Grade B evidence. These findings can guide informed consent and
surgical management, and provide the foundation for future
studies. Copyright © 2021, Scoliosis Research Society.

<80>
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. Objective(s): The
purpose of this study was to determine the effects of IPE on
investigator-reported events. 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. 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. 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) Copyright © 2021 The Authors

<81>
Accession Number
2014115047
Title
Strategies to prevent acute kidney injury after pediatric cardiac surgery
a network meta-analysis.
Source
Clinical Journal of the American Society of Nephrology. 16(10) (pp
1480-1490), 2021. Date of Publication: October 2021.
Author
Van den Eynde J.; Cloet N.; Van Lerberghe R.; Saa M.P.B.O.; Vlasselaers
D.; Toelen J.; Verbakel J.Y.; Budts W.; Gewillig M.; Kutty S.; Pottel H.;
Mekahli D.
Institution
(Van den Eynde, Kutty) Helen B. Taussig Heart Center, The Johns Hopkins
Hospital and School of Medicine, Baltimore, MD, United States
(Van den Eynde, Cloet, Van Lerberghe, Budts, Gewillig) Department of
Cardiovascular Sciences, KU Leuven, Leuven, Belgium
(Saa) Division of Cardiovascular Surgery of Pronto Socorro Cardioloogico
de Pernambuco-PROCAPE, University of Pernambuco-UPE, Recife, Brazil
(Vlasselaers) Department of Intensive Care Medicine, University Hospitals
Leuven, Leuven, Belgium
(Toelen) Division of Woman and Child, Department of Pediatrics, University
Hospitals Leuven, Leuven, Belgium
(Toelen) Department of Development and Regeneration, KU Leuven, Leuven,
Belgium
(Verbakel) Department of Public Health and Primary Care, KU Leuven,
Leuven, Belgium
(Verbakel) Nuffield Department of Primary Care Health Sciences, University
of Oxford, Oxford, United Kingdom
(Budts) Congenital and Structural Cardiology, University Hospitals Leuven,
Leuven, Belgium
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Pottel) Department of Public Health and Primary Care, KU Leuven Campus
Kulak Kortrijk, Kortrijk, Belgium
(Mekahli) Department of Pediatric Nephrology, University Hospitals of
Leuven, Leuven, Belgium
(Mekahli) PKD Research Group, GPURE, Department of Development and
Regeneration, KU Leuven, Leuven, Belgium
Publisher
American Society of Nephrology
Abstract
Background and objectives AKI is a common complication after pediatric
cardiac surgery and has been associated with higher morbidity and
mortality. We aimed to compare the efficacy of available pharmacologic and
nonpharmacologic strategies to prevent AKI after pediatric cardiac
surgery. Design, setting, participants, & measurements PubMed/MEDLINE,
Embase, Cochrane Controlled Trials Register, and reference lists of
relevant articles were searched for randomized controlled trials from
inception until August 2020. Random effects traditional pairwise, Bayesian
network meta-analyses, and trial sequential analyses were performed.
Results Twenty randomized controlled trials including 2339 patients and 11
preventive strategies met the eligibility criteria. No overall significant
differences were observed compared with control for corticosteroids,
fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in
traditional pairwise meta-analysis. In contrast, trial sequential analysis
suggested a 80% relative risk reduction with dexmedetomidine and evidence
of <57% relative risk reduction with remote ischemic preconditioning.
Nonetheless, the network meta-analysis was unable to demonstrate any
significant differences among the examined treatments, including also
acetaminophen, aminophylline, levosimendan, milrinone, and normothermic
cardiopulmonary bypass. Surface under the cumulative ranking curve
probabilities showed that milrinone (76%) was most likely to result in the
lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%),
aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote
ischemic preconditioning (55%), although all showing important overlap.
Conclusions Current evidence from randomized controlled trials does not
support the efficacy of most strategies to prevent AKI in the pediatric
population, apart from limited evidence for dexmedetomidine and remote
ischemic preconditioning. Copyright © 2021 by the American
Society of Nephrology.

<82>
Accession Number
2013891164
Title
Effectiveness of chlorhexidine in preventing infections among patients
undergoing cardiac surgeries: a meta-analysis and systematic review.
Source
Antimicrobial Resistance and Infection Control. 10(1) (no pagination),
2021. Article Number: 140. Date of Publication: December 2021.
Author
Wei J.; He L.; Weng F.; Huang F.; Teng P.
Institution
(Wei, He, Weng, Huang, Teng) Surgical Intensive Care Unit, The First
Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
310003, China
Publisher
BioMed Central Ltd
Abstract
Background: Although several meta-analyses reported the impact of
chlorhexidine (CHX) use in patients undergoing various types of surgery,
no meta-analysis summarized the overall effectiveness of CHX specifically
for cardiac surgery. This meta-analysis aimed to examine the impact of CHX
on infections after cardiac surgery compared with other cleansers or
antiseptics. Method(s): PubMed, Embase, and the Cochrane Library were
searched from inception up to October 2020 for potentially eligible
studies: (1) population: patients who underwent cardiac surgery; (2)
intervention or exposure: any type of CHX use in the treatment or exposed
group; (3) outcome: number of patients with infections; (4) comparison:
placebo or other antiseptic agents; (5) English. The primary outcome was
surgical site infection (SSI). Result(s): Fourteen studies were
included, with 8235 and 6901 patients in the CHX and control groups. CHX
was not protective against SSI (OR = 0.77, 95% CI: 0.57-1.04, P = 0.090).
CHX was protective for superficial wound infection (OR = 0.42, 95% CI:
0.26-0.70, P = 0.001), but not with deep wound infection (P = 0.509). CHX
was not protective against urinary tract of infection (P = 0.415) but was
protective for bloodstream infection (OR = 0.36, 95% CI: 0.16-0.80, P =
0.012), nosocomial infections (OR = 0.55, 95% CI: 0.44-0.69, P < 0.001),
and pneumonia (OR = 0.26, 95% CI: 0.11-0.61, P = 0.002).
 Conclusion(s): In patients undergoing cardiac surgery, CHX does not
protect against SSI, deep wound infection, and urinary tract infections
but might protect against superficial SSI, bloodstream infection,
nosocomial infections, and pneumonia. Copyright © 2021, The
Author(s).

<83>
Accession Number
2005221304
Title
Extrapolation of Survival Benefits in Patients with Transthyretin Amyloid
Cardiomyopathy Receiving Tafamidis: Analysis of the Tafamidis in
Transthyretin Cardiomyopathy Clinical Trial.
Source
Cardiology and Therapy. 9(2) (pp 535-540), 2020. Date of Publication: 01
Dec 2020.
Author
Li B.; Alvir J.; Stewart M.
Institution
(Li, Alvir) Pfizer, New York, NY, United States
(Stewart) Pfizer, Groton, CT, United States
Publisher
Adis
Abstract
Introduction: In the Tafamidis in Transthyretin Cardiomyopathy Clinical
Trial (ATTR-ACT; ClinicalTrials.gov number NCT01994889), tafamidis reduced
the risk of all-cause mortality in patients with transthyretin amyloid
cardiomyopathy (ATTR-CM) by 30% versus placebo. Median overall survival
was not achieved in either treatment arm (57.1 and 70.5% of patients in
the placebo and tafamidis groups, respectively, survived at 30 months),
limiting assessment of the potential survival benefits of treatment.
 Method(s): A survival extrapolation analysis was conducted following
technical support guidelines from the National Institute for Health and
Care Excellence. Multiple models (i.e., exponential, Weibull, gamma,
log-logistic, log-normal, Gompertz, generalized gamma, and generalized F)
were applied to systematically fit different candidate curves to existing
patient-level data from the 30-month treatment period in ATTR-ACT. The
relative goodness-of-fit for each candidate curve was then tested by
Akaike's and Bayesian information criteria to select a single model that
was fitted to the placebo and pooled tafamidis treatment arms.
 Result(s): A gamma distribution was selected as best fitting model
and fitted to both treatment arms. The resulting estimated median overall
survival was 35.16 months for placebo and 52.64 months for tafamidis
(difference 17.48 months). Conclusion(s): This extrapolation of
survival data from ATTR-ACT further supports the efficacy of tafamidis in
patients with ATTR-CM. Owing to the limitations of this analysis, these
survival estimates should be interpreted with caution; however, they are
consistent with recently presented findings from a combined analysis of
data from ATTR-ACT and interim data from an ongoing long-term extension
study (median follow-up 36 months; ClinicalTrials.gov number NCT02791230).
Trial Registration: ClinicalTrials.gov: NCT01994889. Copyright ©
2020, The Author(s).

<84>
Accession Number
2004937022
Title
Mitraclip Plus Medical Therapy Versus Medical Therapy Alone for Functional
Mitral Regurgitation: A Meta-Analysis.
Source
Cardiology and Therapy. 9(1) (pp 5-17), 2020. Date of Publication: 01 Jun
2020.
Author
Goel S.; Pasam R.T.; Wats K.; Chava S.; Gotesman J.; Sharma A.; Malik
B.A.; Ayzenberg S.; Frankel R.; Shani J.; Gidwani U.
Institution
(Goel, Gidwani) Department of Cardiology, Icahn School of Medicine at
Mount Sinai, New York, NY, United States
(Pasam, Wats, Chava, Gotesman, Malik, Ayzenberg, Frankel, Shani)
Department of Cardiology, Maimonides Medical Center, Brooklyn, New York,
NY, United States
(Sharma) Division of Cardiology, Gundersen Health System, La Crosse, WI,
United States
(Sharma) Institute of Cardiovascular Science and Technology, New York, NY,
United States
Publisher
Adis
Abstract
Introduction: The purpose of this meta-analysis is to compare the efficacy
of MitraClip plus medical therapy versus medical therapy alone in patients
with functional mitral regurgitation (FMR). FMR caused by left ventricular
dysfunction is associated with poor prognosis. Whether MitraClip improves
clinical outcomes in this patient population remains controversial.
 Method(s): We conducted an electronic database search of PubMed,
CINAHL, Cochrane Central, Scopus, Google Scholar, and Web of Science
databases for randomized control trials (RCTs) and observational studies
with propensity score matching (PSM) that compared MitraClip plus medical
therapy with medical therapy alone for patients with FMR and reported on
subsequent mortality, heart failure re-hospitalization, and other outcomes
of interest. Event rates were compared using a random-effects model with
odds ratio as the effect size. Result(s): Five studies (n = 1513;
MitraClip = 796, medical therapy = 717) were included in the final
analysis. MitraClip plus medical therapy compared to medical therapy alone
was associated with a significant reduction in overall mortality (OR =
0.66, 95% CI = 0.44-0.99, P = 0.04) and heart failure (HF)
re-hospitalization rates (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). There
was reduced need for heart transplantation or mechanical support
requirement (OR = 0.48, 95% CI = 0.25-0.91, P = 0.02) and unplanned mitral
valve surgery (OR = 0.21, 95% CI = 0.07-0.61, P = 0.004) in the MitraClip
group. No effect was observed on cardiac mortality (P = 0.42) between the
two groups. Conclusion(s): MitraClip plus medical therapy improves
overall mortality and reduces HF re-hospitalization rates compared to
medical therapy alone in patients with FMR. Copyright © 2019, The
Author(s).

<85>
Accession Number
622467924
Title
Clinical Acceptability Of Trimetazidine Modified-Release 80 mg Once Daily
Versus Trimetazidine Modified-Release 35 mg Twice Daily In Stable Angina
Pectoris.
Source
Cardiology and Therapy. 7(1) (pp 61-70), 2018. Date of Publication: 01 Jun
2018.
Author
Pozdnyakov Y.M.; Uskov V.L.; Gon-charenko I.I.; Prasolova T.P.; Guseva
V.G.; Shinkar A.S.; Samsonova S.M.; Vikhrova I.V.; Kuz'kina S.A.; Mitina
L.V.; Timofeeva I.V.; Archakova T.M.; Kovaleva N.Y.; Romanova E.A.; Tivon
Y.V.; Antonova Y.N.; Kurganova O.B.; Davydova N.N.; Klyuchantseva O.V.;
Popovskaya Y.V.; Kharitonova E.I.; Kuzmina T.N.; Buzmakova K.V.; Kaplenko
L.I.; Pospelova N.V.; Stepanova A.Y.; Kol-basheva N.A.; Krasnova G.M.;
Pal'vin-skaya A.Y.; Toloknova V.A.; Bikmullina R.F.; Gainullina A.A.;
Kedrina E.V.; Mikhailova S.A.; Nabiullina T.A.; Nizamova A.F.; Uskova
A.A.; Yushkova A.E.; Andreeva O.V.; Fedotova G.V.; Besser-geneva O.L.;
Gavrilyuk D.D.; Ehalo N.V.; Zlo-bina M.V.; Zhemartseva E.Y.; Markushina
I.A.; Pavlovets V.P.; Sobolenko A.A.; Apanovich I.E.; Kireeva N.V.;
Maksimova I.V.; Butz T.V.; Pavlova I.A.; Bachurina S.N.; Orlyachenko S.V.;
Zaitseva T.V.; Beznogova V.F.; Litsis N.N.; Novozhenina A.Y.; Abramyan
L.L.; Adamyan M.M.; Askerko S.N.; Bolmosov A.N.; Vasilieva I.N.; Volodova
S.I.; Grishko P.V.; Zherebetskaya E.S.; Zemlyanaya N.S.; Klysh-nikova
L.N.; Kononchik E.I.; Kuznetsova N.A.; Kuz'minova I.A.; Marmurova I.V.;
Mikhailova R.Y.; Mordovina I.P.; Nazarkina O.V.; Per-epechko A.P.;
Pivovarova N.G.; Potapova T.P.; Prokofiev D.A.; Proniushkina N.E.;
Savelieva E.V.; A Semovskikh N.; Timonenkova L.D.; Fomin V.V.; Furman
O.A.; Tsutsieva R.M.; Chibrikina M.V.; Shoshina I.N.; Yashchenko P.;
Bocharova T.I.; Demya-nenko O.L.; Zhukova L.B.; Melnikov A.Y.; Mer-kulieva
I.A.; Tyasina E.I.; Pakholkova N.S.; Rogozina S.V.; Chugunova I.V.;
Brazhnik M.L.; Guseva Y.V.; Anisimova A.N.; Kuzeyina S.S.; Kulakhmetova
R.G.; Petrova I.S.; Ignatyeva I.A.; Morozova T.A.; Ryb-nikova N.V.;
Gritsenko I.I.; Kondratskaya O.V.; Shishkin A.V.; Gogleva N.N.; Kulipanova
V.M.; Mitrofanova S.V.; Parada E.V.; Svistunova S.Y.; Sergeeva T.M.;
Kryukova V.V.; Suprun T.N.; Fedorova E.M.; Shnor O.F.; Mitroshina T.N.;
Shemetova T.S.; Val'kevich L.P.; Varnikova S.N.; Ivanova E.A.; Shlykova
O.N.; Guryanova I.R.; Zheltova V.L.; Bulygina E.D.; Gorskaya E.V.; Kosenko
L.V.; Musaeva F.K.; Fedorchenko M.Y.; Harish V.I.; Serbarinova O.M.;
Yatsenya Y.A.; Golubev M.N.; Kopaev D.E.; Miludina L.A.; Polischuk L.V.;
Shilintseva O.A.; Krylova L.M.; Vasilik M.V.; Zotov D.D.; Kalishevich
N.B.; Kachmazova L.I.; Kontorikova S.G.; Mamoshko T.A.; Osnovin S.A.;
Timosh-enko (Schmalz) I.O.; Kashina A.N.; Kiryanova O.G.; Kotova L.E.;
Kuvshinova L.E.; Ulyanova I.M.; Shevelo O.F.; Kir-eeva I.B.; Korohova
L.V.; Lisunova T.I.; Medvedeva E.V.; Matvienko T.E.; Shovgaryan S.L.;
Nebolsina T.F.; Mikusheva M.A.; Misharin N.N.; Kutaliya T.O.; Chernova
V.N.; Yanina Y.A.; Permyakova O.V.; Skurikhina N.N.; Goldinova L.M.;
Pri-khodko T.N.; Myshyakova A.G.; Akhmerova E.Z.; Zaitseva K.V.; Ozerchuk
A.A.; Polyakova I.M.; Rodionova; Safiullina I.D.; Arsentieva I.N.; Volkova
O.O.; Kondrina I.N.; Kharlova T.E.; Grigorieva T.L.; Kurtmulaeva K.V.;
Rogozina O.M.
Institution
(Pozdnyakov) Moscow Regional Cardiology Centre, Zhukovsky, Russian
Federation
Publisher
Springer Healthcare
Abstract
Introduction: Trimetazidine (TMZ) is an anti-ischemic metabolic agent that
has been shown to be efficacious in angina treatment, both in monotherapy
and in combination. A new formulation of TMZ modified-release (MR) 80 mg
was developed, which is to be taken once daily (od), instead of twice
daily (bid) for the currently available TMZ MR 35 mg, with the aim of
simplifying the medication regimen. Method(s): The present study was
an international, multicenter, randomized, double-blind, parallel-group
phase III study with a 12-week treatment period. The safety of TMZ MR 80
mg once daily was assessed compared to TMZ MR 35 mg twice daily, in
patients previously treated successfully by the latter. Emergent adverse
events (EAEs), biological parameters, vital signs, 12-lead resting ECG
(electrocardiogram) and Canadian Cardiovascular Society (CCS)
classification were recorded. Result(s): One-hundred and sixty-five
patients previously diagnosed with stable angina pectoris on treatment
were randomized to receive either TMZ MR 80 mg od or TMZ MR 35 mg bid. In
the TMZ MR 80 mg group, fewer patients had >= 1 EAE (17.1 vs. 22.9% in the
TMZ MR 35 mg group). Serious EAEs were reported by three patients in each
group. No EAE required dose modification, withdrawal, or temporary
interruption of study treatments. Vital signs, 12-lead ECG, and laboratory
parameters did not change. No worsening in CCS classes was observed with
either treatment. Conclusion(s): TMZ MR 80 mg od and TMZ MR 35 mg bid
have similar safety profiles. This new once-daily formulation could
improve patient compliance with therapy, thereby enhancing clinical
benefit. Trial Registration: ISRCTN registry, ISRCTN 84362208.
 Funding(s): Institut de Recherches Internationales Servier and
Servier, Moscow, Russian Federation. Plain Language Summary: Plain
language summary available for this article. Copyright © 2018,
The Author(s).

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

<87>
Accession Number
616464036
Title
A Randomized Trial to Assess the Contribution of a Novel Thorax Support
Vest (Corset) in Preventing Mechanical Complications of Median Sternotomy.
Source
Cardiology and Therapy. 6(1) (pp 41-51), 2017. Date of Publication: 01 Jun
2017.
Author
Caimmi P.P.; Sabbatini M.; Kapetanakis E.I.; Cantone S.; Ferraz M.V.;
Cannas M.; Tesler U.F.
Institution
(Caimmi) Department of Cardiac Surgery, University Hospital of Novara
"Maggiore della Carita", Novara, Italy
(Caimmi, Cannas) Department of Science Health, UPO University, Novara,
Italy
(Caimmi, Tesler) "Policlinico di Monza" Hospital Group, Department Cardiac
Surgery, San Gaudenzio Clinic, Novara, Italy
(Sabbatini) Department of Science and Innovation Technology, UPO
University, Alessandria, Italy
(Kapetanakis) Department of Thoracic Surgery, "Sotiria" Chest Diseases
Hospital of Athens, Athens, Greece
(Cantone) "Policlinico di Monza" Health Care Group, Department Cardiac
Anaestehsiology, San Gaudenzio Clinic, Novara, Italy
(Ferraz) Department of Cardiac Surgery, Beneficencia Portouguesa Hospital,
Piracicaba, Brazil
Publisher
Springer Healthcare
Abstract
Objectives: Mechanical complications of median sternotomy may cause
significant morbidity and mortality in cardiac surgical patients. This
study was aimed at assessing the role of Posthorax support vest (Epple,
Inc., Vienna, Austria) in the prevention of sternal complications and the
improvement of anatomical healing in patients at high risk for mechanical
sternal dehiscence after cardiac surgery by mean of median sternotomy.
 Method(s): A prospective, randomized, study was performed and 310
patients with predisposing factors for sternal dehiscence after sternotomy
for cardiac surgery were included. The patients were divided into two
groups: patients who received the Posthorax support vest after surgery,
and patients who did not. Primary variables assessed included the
incidence of mechanical sternal complications, the quality of sternal
healing, the rate of re-operation, the duration of hospitalization, rate
and duration of hospital, re-admission for sternal complications.
Secondary variables assessed were the post-operative pain, the number of
requests for supplemental analgesia and the quality of life measured by
means of the EQ-5D format. Result(s): Patients using vest
demonstrated a lower incidence of mechanical sternal complications, a
better anatomical sternum healing, lower hospital stay, no re-operations
for sternal dehiscence before discharge and lower re-admissions for
mechanical sternal complication. In addition, patients using a vest
reported a better quality of life with better freedom from limitations in
mobility, self-care, and pain. Conclusion(s): Our findings
demonstrate that the use of the Posthorax vest reduces post-sternotomy
mechanical complications and improves the healing of the sternotomy, the
clinical course, and the post-operative quality of life. Copyright
© 2016, The Author(s).

<88>
Accession Number
601111717
Title
Ivabradine Versus Beta-Blockers in Patients with Conduction Abnormalities
or Left Ventricular Dysfunction Undergoing Cardiac Surgery.
Source
Cardiology and Therapy. 3(1-2) (pp 13-26), 2013. Date of Publication:
2013.
Author
Iliuta L.; Rac-Albu M.
Institution
(Iliuta, Rac-Albu) "Carol Davila" University of Medicine and Pharmacy,
Bucharest, Romania
Publisher
Springer Healthcare
Abstract
Introduction: In patients with conduction abnormalities or left ventricle
(LV) dysfunction the use of beta-blockers for post cardiac surgery rhythm
control is difficult and controversial, with a paucity of information
about other drugs such ivabradine used postoperatively. The objective of
this study was to compare the efficacy and safety of ivabradine versus
metoprolol used perioperatively in cardiac surgery patients with
conduction abnormalities or LV systolic dysfunction.
Methods: This was an open-label, randomized clinical trial enrolling 527
patients with conduction abnormalities or LV systolic dysfunction
undergoing coronary artery bypass grafting or valvular replacement,
randomized to take ivabradine or metoprolol, or metoprolol plus
ivabradine. The primary endpoints were the composites of 30-day mortality,
in-hospital atrial fibrillation (AF), in-hospital three-degree
atrioventricular block and need for pacing, in-hospital worsening heart
failure (HF; safety endpoints), duration of hospital stay and
immobilization and the above endpoint plus in-hospital bradycardia,
gastrointestinal symptoms, sleep disturbances, cold extremities (efficacy
plus safety endpoint).
Results: Heart rate reduction and prevention of postoperative AF or
tachyarrhythmia with combined therapy was more effective than with
metoprolol or ivabradine alone during the immediate postoperative
management of cardiac surgery patients. In the Ivabradine group, the
frequency of early postoperative pacing and HF worsening was smaller than
in the Metoprolol group and in combined therapy group. The frequency of
primary combined endpoint was lower in the combined Ivabradine +
Metoprolol group compared with the monotherapy groups.
Conclusion: Considering efficacy and safety, the cardiac rhythm reduction
after open heart surgery in patients with conduction abnormalities or LV
dysfunction with ivabradine plus metoprolol emerged as the best treatment
in this trial. Copyright © 2013, The Author(s).

<89>
Accession Number
2013917792
Title
Mizagliflozin, a selective SGLT1 inhibitor, improves vascular cognitive
impairment in a mouse model of small vessel disease.
Source
Pharmacology Research and Perspectives. 9(5) (no pagination), 2021.
Article Number: e00869. Date of Publication: October 2021.
Author
Ishida N.; Saito M.; Sato S.; Tezuka Y.; Sanbe A.; Taira E.; Hirose M.
Institution
(Ishida, Hirose) Division of Molecular and Cellular Pharmacology,
Department of Pathophysiology and Pharmacology, Iwate Medical University,
School of Pharmaceutical Sciences, Iwate, Japan
(Saito) Department of Pharmacy, Iryo Sosei University, Fukushima, Japan
(Sato, Taira) Department of Pharmacology, Iwate Medical University, School
of Medicine, Iwate, Japan
(Tezuka, Sanbe) Division of Pharmacotherapeutics, Department of
Pathophysiology and Pharmacology, Iwate Medical University School of
Pharmaceutical Sciences, Iwate, Japan
Publisher
John Wiley and Sons Inc
Abstract
Previously, we showed that sodium/glucose cotransporter 1 (SGLT1)
participates in vascular cognitive impairment in small vessel disease. We
hypothesized that SGLT1 inhibitors can improve the small vessel disease
induced-vascular cognitive impairment. We examined the effects of
mizagliflozin, a selective SGLT1 inhibitor, and phlorizin, a non-selective
SGLT inhibitor, on vascular cognitive impairment in a mouse model of small
vessel disease. Small vessel disease was created using a mouse model of
asymmetric common carotid artery surgery (ACAS). Two and/or 4 weeks after
ACAS, all experiments were performed. Cerebral blood flow (CBF) was
decreased in ACAS compared with sham-operated mice. Phlorizin but not
mizagliflozin reversed the decreased CBF of ACAS mice. Both mizagliflozin
and phlorizin reversed the ACAS-induced decrease in the latency to fall in
a wire hang test of ACAS mice. Moreover, they reversed the ACAS-induced
longer escape latencies in the Morris water maze test of ACAS mice. ACAS
increased SGLT1 and proinflammatory cytokine gene expressions in mouse
brains and phlorizin but not mizagliflozin normalized all gene expressions
in ACAS mice. Hematoxylin/eosin staining demonstrated that they inhibited
pyknotic cell death in the ACAS mouse hippocampus. In PC12HS cells,
IL-1beta increased SGLT1 expression and decreased survival rates of cells.
Both mizagliflozin and phlorizin increased the survival rates of
IL-1beta-treated PC12HS cells. These results suggest that mizagliflozin
and phlorizin can improve vascular cognitive impairment through the
inhibition of neural SGLT1 and phlorizin also does so through the
improvement of CBF in a mouse model of small vessel disease. Copyright
© 2021 The Authors. Pharmacology Research & Perspectives published by
British Pharmacological Society and American Society for Pharmacology and
Experimental Therapeutics and John Wiley & Sons Ltd.

<90>
Accession Number
2013917788
Title
Effect of remimazolam induction on hemodynamics in patients undergoing
valve replacement surgery: A randomized, double-blind, controlled trial.
Source
Pharmacology Research and Perspectives. 9(5) (no pagination), 2021.
Article Number: e00851. Date of Publication: October 2021.
Author
Liu T.; Lai T.; Chen J.; Lu Y.; He F.; Chen Y.; Xie Y.
Institution
(Liu, Chen, Xie) Department of Anesthesiology, The First Affiliated
Hospital of Guangxi Medical University, Nanning, China
(Lai, Lu, He, Chen) Department of Anesthesiology, Cardiovascular
Institute, The First Affiliated Hospital of Guangxi Medical University,
Nanning, China
Publisher
John Wiley and Sons Inc
Abstract
Background: The stability of hemodynamics during anesthesia induction in
patients undergoing valve replacement surgery is particularly important.
Remimazolam is a new type of benzodiazepine drug, with supposed advantages
of rapid induction, rapid recovery, stable hemodynamics, and mild
respiratory inhibition. Aim(s): To evaluate the effect of remimazolam
anesthesia induction on hemodynamics in patients undergoing valve
replacement surgery. Method(s): This randomized, double-blind,
controlled trial enrolled consecutive patients undergoing mitral valve
replacement (MVR)/aortic valve replacement (AVR)/double-valve replacement
(DVR) surgery on cardiopulmonary bypass (CPB). The study was conducted
according to the Consolidated Standards of Reporting Trials statement.
Participants were randomly assigned to receive either remimazolam or
propofol induction of 30 patients each. All patients, data collectors, and
data analyzers were blinded to the group allocation. The primary outcomes
were the fluctuations in hemodynamic parameters (the difference of maximum
or minimum heart rate to baseline, HR, the difference of maximum or
minimum mean arterial pressure to baseline, MAP), the occurrence of
cardiovascular events (hypotension, severe bradycardia), and the
cumulative norepinephrine doses used per patient, averaged per group
during induction. The secondary outcomes were hemodynamic parameters
(heart rate, HR, mean arterial pressure, MAP, bispectral index, BIS,
plasma lactic acid, Lac, and blood glucose, Glu values). Result(s): A
total of 60 patients with heart valve replacement were included in the
final analysis, with 30 patients in each group. The MAP was significantly
lower in the remimazolam group than in the propofol group during induction
(p <.05). The incidences of hypotension and the cumulative norepinephrine
doses used per patient, averaged per group during induction were
significantly lower in the remimazolam group than in the propofol group (p
<.05). Conclusion(s): Remimazolam may be safe and effective for
induction and may as an alternative to propofol during anesthesia
induction in patients undergoing valve replacement surgery. Copyright
© 2021 The Authors. Pharmacology Research & Perspectives published by
British Pharmacological Society and American Society for Pharmacology and
Experimental Therapeutics and John Wiley & Sons Ltd.

<91>
Accession Number
2010292981
Title
Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac
Surgery: A Narrative Review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(11) (pp 3394-3403),
2021. Date of Publication: November 2021.
Author
Boons J.; Van Biesen S.; Fivez T.; de Velde M.V.; Al Tmimi L.
Institution
(Boons, Van Biesen, de Velde, Al Tmimi) Department of Anesthesiology,
University Hospitals Leuven, Leuven, Belgium
(Boons, Fivez) Department of Intensive Care Medicine, Ziekenhuis
Oost-Limburg, Genk, Belgium
(Van Biesen) Department of Intensive Care Medicine, OLVG-Hospital,
Amsterdam, Netherlands
(de Velde) Department of Cardiovascular Sciences, KU Leuven, University of
Leuven, Leuven, Belgium
Publisher
W.B. Saunders
Abstract
New onset of postoperative atrial fibrillation (AF) generally is
recognized as a frequent and debilitating complication after cardiac
surgery, contributing to a considerable health- care cost. Extensive
research has been conducted to study the underlying mechanisms and risk
factors of AF in the perioperative period. Many options have been
suggested to lower the incidence, and the concurrent cost in health
resources. This review attempts to synthesize the large body of existing
literature on AF, as well as expand and illustrate the available knowledge
on its management strategies. The latter incorporates recent developments
in the anesthesthetic approach as well as in the pharmacologic arsenal. In
addition, the current review provides a tool for understanding the
pathophysiology of AF and for reducing the occurrence after cardiac
surgery. By using it, clinicians can manage patients with AF in the
perioperative period of cardiac surgery and minimize the relatively high
economic cost that accompanies it. Copyright © 2020 Elsevier Inc.

<92>
Accession Number
2015065808
Title
Effect of desflurane on changes in regional cerebral oxygenation in
patients undergoing one-lung ventilation is equivalent to the effect of
propofol.
Source
Respiratory Physiology and Neurobiology. 296 (no pagination), 2022.
Article Number: 103798. Date of Publication: February 2022.
Author
Sato S.; Edanaga M.; Kondo M.; Yamakage M.
Institution
(Sato, Edanaga, Kondo, Yamakage) Department of Anesthesiology, Sapporo
Medical University School of Medicine, West 16, South 1, Chuo-ward,
Sapporo, Hokkaido 060-8543, Japan
Publisher
Elsevier B.V.
Abstract
Objectives: Desaturation is an important clinical problem during one-lung
ventilation (OLV) since it may induce cerebral hypoxia. Measurement of
cerebral oxygenation has been shown to provide accurate information about
episodes of cerebral hypoxemia. The purpose of this study was to compare
the effect of desflurane on changes in cerebral oxygenation during OLV
with the effect of propofol. Method(s): A randomized, single-blinded,
prospective study was conducted. Fifty adult patients who were scheduled
to undergo thoracic surgery were randomly assigned to anesthetic
management using desflurane with remifentanil (Group D: n = 25) or using
propofol and remifentanil (Group P: n = 25). Result(s): The
characteristics of the patients were very similar. Intergroup analysis of
changes in cerebral oxygenation showed no significant difference on the
operative side (two-way ANOVA, F (7, 368) = 0.425, p = 0.887) or the
non-operative side (two-way ANOVA, F (7, 367) = 1.342, p = 0.229).
Intragroup analysis of changes in cerebral oxygenation using one-way ANOVA
showed no significant difference on the operative side (Group P; p =
0.585, Group D; p = 0.928) or the non-operative side in both groups (Group
P; p = 0.657, Group D; p = 0.602). Conclusion(s): The effects of
desflurane and propofol on changes in cerebral oxygenation in patients
undergoing OLV were equivalent. Our results indicated that desflurane
might be an appropriate anesthetic during OLV for maintaining cerebral
oxygenation with an effective equivalent to that of
propofol. Copyright © 2021 Elsevier B.V.

<93>
Accession Number
2014713868
Title
Applicability of Transcatheter Aortic Valve Replacement Trials to
Real-World Clinical Practice: Findings From EXTEND-CoreValve.
Source
JACC: Cardiovascular Interventions. 14(19) (pp 2112-2123), 2021. Date of
Publication: 11 Oct 2021.
Author
Butala N.M.; Secemsky E.; Kazi D.S.; Song Y.; Strom J.B.; Faridi K.F.;
Brennan J.M.; Elmariah S.; Shen C.; Yeh R.W.
Institution
(Butala, Secemsky, Kazi, Strom, Shen, Yeh) Richard A. and Susan F. Smith
Center for Outcomes Research in Cardiology, Division of Cardiovascular
Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
(Butala, Elmariah) Cardiology Division, Department of Medicine,
Massachusetts General Hospital, Boston, MA, United States
(Song) Baim Institute for Clinical Research, Boston, MA, United States
(Faridi) Section of Cardiology, Department of Medicine, Yale School of
Medicine, New Haven, CT, United States
(Brennan) Duke Clinical Research Institute, Duke University School of
Medicine, Durham, NC, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to examine the applicability of
pivotal transcatheter aortic valve replacement (TAVR) trials to the
real-world population of Medicare patients undergoing TAVR.
 Background(s): It is unclear whether randomized controlled trial
results of novel cardiovascular devices apply to patients encountered in
clinical practice. Method(s): Characteristics of patients enrolled in
the U.S. CoreValve pivotal trials were compared with those of the
population of Medicare beneficiaries who underwent TAVR in U.S. clinical
practice between November 2, 2011, and December 31, 2017. Inverse
probability weighting was used to reweight the trial cohort on the basis
of Medicare patient characteristics, and a "real-world" treatment effect
was estimated. Result(s): A total of 2,026 patients underwent TAVR in
the U.S. CoreValve pivotal trials, and 135,112 patients underwent TAVR in
the Medicare cohort. Trial patients were mostly similar to real-world
patients at baseline, though trial patients were more likely to have
hypertension (50% vs 39%) and coagulopathy (25% vs 17%), whereas
real-world patients were more likely to have congestive heart failure (75%
vs 68%) and frailty. The estimated real-world treatment effect of TAVR was
an 11.4% absolute reduction in death or stroke (95% CI: 7.50%-14.92%) and
an 8.7% absolute reduction in death (95% CI: 5.20%-12.32%) at 1 year with
TAVR compared with conventional therapy (surgical aortic valve replacement
for intermediate- and high-risk patients and medical therapy for
extreme-risk patients). Conclusion(s): The trial and real-world
populations were mostly similar, with some notable differences.
Nevertheless, the extrapolated real-world treatment effect was at least as
high as the observed trial treatment effect, suggesting that the absolute
benefit of TAVR in clinical trials is similar to the benefit of TAVR in
the U.S. real-world setting. Copyright © 2021 American College of
Cardiology Foundation

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

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

<96>
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. 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. 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. 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). 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. Protocol Registration:
PROSPERO (registration number CRD42020192602). Copyright © 2021
European Society of Clinical Microbiology and Infectious Diseases

<97>
Accession Number
2015286410
Title
TCT-112 Repeat Revascularization Impact on 10-Year Survival After PCI or
CABG: Post Hoc Analysis of the SYNTAXES Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B47), 2021. Date of Publication: 09
Nov 2021.
Author
Lunardi M.; Wang R.; Hara H.; Serruys P.; Onuma Y.
Institution
(Lunardi) NUI Galway, Galway, Ireland
(Wang) Xijing Hospital, Xi'an, Shaanxi, China
(Hara) National University of Ireland Galway, Galway, Ireland
(Serruys, Onuma) Department of Cardiology, Saolta Group, Galway University
Hospital, Health Service Executive and National University of Ireland
Galway (NUIG), Galway, Ireland
Publisher
Elsevier Inc.
Abstract
Background: Higher rates of repeat revascularization after percutaneous
coronary intervention (PCI) than coronary artery bypass graft (CABG) have
been described in 3-vessel (3VD) or left main (LM) disease, with a
negative influence on outcomes up to 5 years. The impact of repeat
revascularization on very long-term outcomes remains unclear. This study
aims to investigate the impact on 10-year all-cause death of repeat
revascularizations in patients with 3VD or LM. Method(s): The
SYNTAXES study evaluated the vital status out to 10 years of patients with
3VD or LMCAD (or both) enrolled in the SYNTAX trial. Effects of repeat
revascularizations occurred within 5 years on 10-year all-cause death were
investigated through time-dependent Cox-regression analysis.
 Result(s): During the first 5 years, 330 of 1,800 patients (18.3%)
underwent a minimum of 1 repeat revascularization, for a total of 459
repeat revascularization procedures, mostly consisting of repeat-PCI (393,
85.6%). Repeat revascularizations were more frequent among patients
initially randomized to PCI (hazard ratio [HR]: 2.3; 95% confidence
interval [CI]: 1.8-3.0; P < 0.0001). At 10 years, all-cause death was
comparable between patients who underwent any repeat revascularization and
those who did not (27.6% vs 25.1%; adjusted HR: 2.3, 95% CI: 0.8-6.2; P =
0.11). However, among patients requiring repeat revascularizations, who
underwent initial PCI versus initial CABG, presented a significantly
higher 10-year all-cause death (32.7% vs 17.3%, P = 0.004). The adjusted
risk for 10-year all-cause death according to the subtypes of repeat
revascularizations revealed that only revascularization with CABG was an
independent predictor (HR: 6.2; 95% CI: 1.5-25.2; P = 0.011).
 Conclusion(s): In the SYNTAX trial, repeat revascularizations were
more frequent after initial PCI. Although no difference on 10-year
all-cause death was observed between patients who did undergo repeat
revascularizations and those who did not, higher death rates were reported
among those required any repeat procedures after initial PCI or
revascularization with CABG. These exploratory findings should be
investigated with larger populations in future studies. Categories:
CORONARY: Stents: Drug-Eluting Copyright © 2021

<98>
Accession Number
2015286280
Title
TCT-305 Cost-Effectiveness of Cerebral Embolic Protection With the
SENTINEL Device in Transcatheter Aortic Valve Replacement: A US Medicare
Payer Perspective.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B125), 2021. Date of Publication: 09
Nov 2021.
Author
Alkhouli M.; Ganz M.; Mercaldi K.; McGovern A.; Griffiths R.; Kapadia S.
Institution
(Alkhouli) Mayo Clinic, Rochester, MN, United States
(Ganz, Mercaldi) Evidera, Waltham, MA, United States
(McGovern, Griffiths) Boston Scientific, Marlborough, MA, United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background: Observational studies suggested an incremental increase in the
cost of transcatheter aortic valve replacement (TAVR) with routine
cerebral embolic protection (CEP). However, cost-effectiveness analyses
assessing the cost of CEP relative to its effects are lacking.
 Method(s): A decision analytic model was constructed to simulate
outcomes and costs of TAVR with CEP (Sentinel, Boston Scientific
Corporation) versus no CEP. Probabilities of periprocedural stroke were
obtained from a patient-level analysis of 1,306 randomized or
propensity-matched patients in which the incidence of stroke was 1.88%
with CEP versus 5.44% without CEP. Probabilities of death were obtained
from an analysis of Medicare claims data (7/1/2016-6/30/2017) in which 490
patients who had post-TAVR stroke were propensity matched to 2,429
patients without post-TAVR stroke. Utility inputs were obtained from the
literature. Result(s): At 5 years, the modeled mean predicted
quality-adjusted months alive was 29.4 for CEP and 28.7 for no CEP. The
cumulative cost to Medicare per patient was $147,711 for CEP and $148,711
for no CEP (difference = $1,000). CEP was less costly and more effective
when the mean results were considered. In the probabilistic sensitivity
analysis, CEP was less costly and more effective than no CEP in 57.5% of
the 1,000 simulations performed. At a willingness-to-pay threshold of
$10,000 per quality-adjusted month alive, CEP with Sentinel was
cost-effective (dominated or had a cost-effectiveness ratio of <=$10,000
per quality-adjusted month alive) in 88.9% of simulations. These results
remained similar in sensitivity analyses with different incidences of
post-TAVR strokes. Conclusion(s): Cerebral embolic protection in TAVR
using the Sentinel device is projected to be economically cost-effective
from a Medicare payer perspective. Categories: OTHER: Quality, Guidelines,
Appropriateness Criteria, Cost-Effectiveness, and Public Health
Issues Copyright © 2021

<99>
Accession Number
2015286279
Title
TCT-177 Direct Oral Anticoagulants Versus Vitamin K Antagonist After
Transcatheter Aortic Valve Replacement in Patients With Concomitant
Indication for Oral Anticoagulation: A Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B73), 2021. Date of Publication: 09
Nov 2021.
Author
Vutthikraivit W.; Rattanawong P.; Putthapiban P.; Kewcharoen J.
Institution
(Vutthikraivit) Texas Tech University Health Science Center, Lubbock, TX,
United States
(Rattanawong) Mayo Clinic Arizona, Scottsdale, United States
(Putthapiban) Loma Linda University Health, Redlands, CA, United States
(Kewcharoen) Loma Linda University Health, Loma Linda, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve implantation (TAVR) has become the
treatment of choice in patients with severe aortic stenosis. Concomitant
atrial fibrillation (AF) is highly prevalent among patients undergoing
TAVR. Optimal anticoagulation strategy, whether vitamin K antagonist (VKA)
or direct oral anticoagulant (DOAC), is controversial in this population.
 Method(s): We comprehensively searched the databases of Medline and
Embase from inception to July 2021. Included studies were published cohort
or randomized controlled trials that compared clinical outcomes between
DOAC and VKA after TAVR in patients with concomitant indication for OAC.
The primary outcome was all-cause mortality. Secondary outcomes were major
and/or life-threatening bleeding and stroke. Data from each study were
combined with the use of the random-effects model. Result(s): Nine
studies were included involving 6,629 patients with concomitant indication
for OAC who underwent TAVR (3,751 received VKA and 2,878 received DOAC).
Most patients had AF as an indication for OAC. There was no significant
difference in the primary outcome and stroke between the 2 groups (OR:
0.78; 95% CI: 0.52-1.18; I2 = 82.6%; P = 0.239; and OR: 1.04;
95% CI: 0.69-1.56; I2 = 18.9%; P = 0.846; respectively). Major
and/or life-threatening bleeding was significantly lower in patients who
received DOAC compared with VKA (OR: 0.71; 95% CI: 0.54-0.92;
I2 = 30.0%; P = 0.009). [Formula presented] Conclusion(s):
Compared tdegree VKA, DOAC was associated with lower major and/or
life-threatening bleeding but similar all-cause mortality and stroke rates
in TAVR patients with concomitant indication for OAC. Categories:
STRUCTURAL: Valvular Disease: Aortic Copyright © 2021

<100>
Accession Number
2015286183
Title
TCT-244 Impact of Patient-Reported Preprocedural Physical and Mental
Health on 10-Year Mortality After Percutaneous or Surgical Coronary
Revascularization.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B99), 2021. Date of Publication: 09
Nov 2021.
Author
Ono M.; Serruys P.; Garg S.; Kawashima H.; Gao C.; Hara H.; Lunardi M.;
Wang R.; O'Leary N.; Mack M.; Holmes D.; Morice M.-C.; Kappetein P.;
Thuijs D.; Noack T.; Mohr F.-W.; Davierwala P.; Spertus J.; Onuma Y.
Institution
(Ono, Serruys, Onuma) Saolta Group, Galway University Hospital, Health
Service Executive, and National University of Ireland Galway, Galway,
Ireland
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(Kawashima, Hara, Lunardi, O'Leary) National University of Ireland Galway,
Galway, Ireland
(Gao, Wang) Xijing Hospital, Xi'an, Shaanxi, China
(Mack) Baylor Scott and White Heart Hospital-Plano, Plano, TX, United
States
(Holmes) Mayo Clinic, Rochester, MN, United States
(Morice) CERC, Massy, France
(Kappetein) Medtronic, Rotterdam, Netherlands
(Thuijs) Erasmus University Medical Center, Rotterdam, Netherlands
(Noack, Mohr) Heart Center Leipzig, Leipzig, Germany
(Davierwala) University of Toronto, Toronto, ON, Canada
(Spertus) Mid America Heart Institute, Kansas City, MO, United States
Publisher
Elsevier Inc.
Abstract
Background: Clinical and anatomical characteristics are often considered
to be key factors in deciding between percutaneous coronary intervention
(PCI) or coronary artery bypass grafting (CABG) in patients with complex
coronary artery disease (CAD) such as left main CAD (LM-CAD) or 3-vessel
disease (3VD). However, little is known about the interaction between
patient-reported pre-procedural physical/mental health and clinical
outcomes after revascularization. Method(s): This subgroup analysis
of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended
follow-up of the randomized SYNTAX trial comparing PCI and CABG in
patients with LM-CAD and/or 3VD, stratified patients by terciles of their
baseline 36-Item Short-Form Health Survey (SF-36) physical (PCS) or mental
(MCS) component summary score. The primary end point was all-cause death
at 10 years. Result(s): A total of 1,656 patients with preprocedural
SF-36 scores were included in the present study. Both higher PCS and MCS
were independently associated with lower 10-year mortality (adjusted HRs
[95% CIs]: 10-point increase in PCS: 0.84 [0.73-0.97; P = 0.021]; 10-point
increase in MCS: 0.85 [0.76-0.95; P = 0.005). A significant survival
benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS
(>52.3) terciles with significant treatment-by-subgroup interactions (PCS
P interaction = 0.033; MCS P interaction = 0.015). In patients with high
PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher
with PCI compared with CABG (30.5% vs 12.2%; HR: 2.87; 95% CI: 1.55-5.30;
P = 0.001; P interaction = 0.002). Conclusion(s): Patient-reported
preprocedural physical and mental health had a significant impact on
long-term mortality. Patients with the best physical and mental health had
better 10-year survival with CABG compared with PCI. Assessment of
patient-reported physical and mental health is important to improve the
accuracy in predicting 10-year mortality and selecting the optimal
revascularization strategy. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2021

<101>
Accession Number
2015286163
Title
TCT-188 Short- and Long-Term Mortality Risk for Alternative Transcatheter
Aortic Valve Replacement Access Routes: A Frequentist Network
Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B77), 2021. Date of Publication: 09
Nov 2021.
Author
Ranka S.; Lahan S.
Institution
(Ranka) University of Kansas Medical Center, Kansas City, MO, United
States
(Lahan) University College of Medical Sciences, Delhi, Delhi, India
Publisher
Elsevier Inc.
Abstract
Background: Previous studies have compared alternative transcatheter
aortic valve replacement (TAVR) access outcomes in a pairwise fashion.
Pooled mortality outcomes for multiple TAVR access sites are not well
understood. Method(s): Thirty-four studies with a pooled sample size
of 30,986 records were selected with the use of PubMed and Cochrane
library databases for patients undergoing TAVR via 1 of 6 different access
sites: transfemoral (TF), transaortic (TAO), transapical (TA),
transcarotid (TC), transaxillary/subclavian (TSA), and transcaval (TCV).
Data extracted from these studies were used to conduct a frequentist
network meta-analysis with a random-effects model using TF access as a
reference group. Result(s): Compared with TF access, TAO access was
associated with an 87% risk of 30-day mortality (RR: 1.87; 95% CI:
1.38-2.54). A similar risk was observed with TA access (RR: 1.89; 95% CI:
1.57-2.28). However, mortality risks with TSA (RR: 1.12; 95% CI:
0.85-1.48), TC (RR: 1.19; 95% CI: 0.88-1.60), or TCV (RR: 1.68; 95% CI:
0.46-6.10) access were similar (Figure). At >=1 year, all-cause mortality
remained high with both TAO (RR: 1.35; 95% CI: 1.01-1.81) and TA (RR:
1.44; 95% CI: 1.14-1.81) access for TAVR, whereas the risks of mortality
associated with TSA (RR: 1.1; 95% CI: 0.95-1.42) and TC (RR: 0.92; 95% CI:
0.54-1.56) access were similar to TF access. [Formula presented]
 Conclusion(s): Thoracic TAVR access (TAO and TA) is associated with
increased short- and long-term mortality although nonthoracic alternative
access sites (TC, TSA, and TCV) for TAVR implantation yield outcomes
similar to conventional TF access. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2021

<102>
Accession Number
2015285942
Title
TCT-48 Incidence and Outcomes of Atrial Fibrillation in Patients
Undergoing TAVR Versus SAVR: Experience From SURTAVI and Low-Risk
Randomized Studies.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B19), 2021. Date of Publication: 09
Nov 2021.
Author
Vora A.; Gada H.; Sherwood M.; Lopes R.; Forrest J.; Huang J.; Reardon M.
Institution
(Vora) UPMC Heart and Vascular Institute, Harrisburg, PA, United States
(Gada) UPMC Pinnacle, Harrisburg, PA, United States
(Sherwood) Inova Heart And Vascular Institute, Falls Church, VA, United
States
(Lopes) Duke University Medical Center, Durham, North Carolina, United
States
(Forrest) Yale New Haven Hospital, New Haven, Connecticut, United States
(Huang) Medtronic, Minneapolis, MN, United States
(Reardon) Houston Methodist DeBakey Heart & Vascular Center, Houston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: Atrial fibrillation (AF) is common among patients with aortic
valve replacement (AVR) and has been associated with worse outcomes. We
evaluated incidence, predictors, management, and outcomes in patients
undergoing surgical (S)AVR and transcatheter (T)AVR at low-to-intermediate
risk. Method(s): Data from the randomized intermediate-risk CoreValve
SURTAVI and Evolut (Medtronic) Low-Risk trials were pooled. Patients were
stratified by baseline AF, new AF within 14 days, or no new AF <= 14 days.
Multivariable regression was used to identify predictors of new AF.
Clinical outcomes are reported as landmarked Kaplan-Meier estimates from
15 days to 2 years. [Formula presented] Results: Of 3,069 patients (1,591
TAVR, 1,478 SAVR), 22.6% of TAVR and 21.5% of SAVR patients had baseline
AF; 6.5% of TAVR and 33.8% of SAVR patients had new AF. Patients with new
AF after TAVR were more likely to be women, have peripheral artery disease
(PAD), and chronic lung disease. At discharge, 70% of TAVR and 67% of SAVR
patients with new AF were on anticoagulation therapy. Significant
predictors of new AF in TAVR patients were chronic lung disease (hazard
ratio [HR]: 1.69; 95% confidence interval [CI]: 1.12-2.57), PAD (HR: 2.11;
95% CI: 1.38-3.23), and baseline mean gradient (HR: 1.02/mm Hg; 95% CI:
1.00-1.03). Only age predicted new AF among SAVR patients (HR: 1.03 per
year; 95% CI: 1.01-1.04). Among TAVR patients, the rate of death and
disabling stroke at 2 years was similar between patients with new AF and
no AF and lower than baseline AF patients; the risk of all stroke and
transient ischemic attack (TIA) and stroke and disabling bleeding was
significantly higher among patients with new AF compared with those with
no AF and similar to those with baseline AF. Among SAVR patients, there
was a higher risk of death or disabling stroke, all stroke and TIA, and
disabling bleeding with new AF compared with no AF (Table 1).
 Conclusion(s): In the SURTAVI and Low-Risk trials, new AF was more
common following SAVR compared with TAVR, with only 70% of patients
discharged on anticoagulation. New AF is associated with higher death or
disabling stroke after SAVR but higher bleeding and stroke and TIA after
TAVR. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2021

<103>
Accession Number
2015285928
Title
TCT-159 Balloon-Expandable or Self-Expandable Valves in Valve-in-Valve
Transcatheter Aortic Valve Implantation?.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B66), 2021. Date of Publication: 09
Nov 2021.
Author
van Nieuwkerk A.; Fernandez-Nofrerias E.; Tchetche D.; Brito F.; Barbanti
M.; Kornowski R.; Latib A.; d'Onofrio A.; Ribichini F.; Tello V.M.;
Dumonteil N.; Baan J.; Abizaid A.; Sartori S.; d'Errigo P.; Tarantini G.;
Lunardi M.; Orvin K.; Pagnesi M.; Ghattas A.; Dangas G.; Mehran R.; Delewi
R.
Institution
(van Nieuwkerk) Amsterdam UMC, Amsterdam, Netherlands
(Fernandez-Nofrerias) Hospital Germans Trias i Pujol, Badalona, Spain
(Tchetche) Clinique Pasteur Toulouse, Toulouse, France
(Brito) InCor, Heart Institute, University of Sao Paulo Medical School,
Sao Paulo, Sao Paulo, Brazil
(Barbanti) AOU Policlinico "G. Rodolico-San Marco,", Catania, Italy
(Kornowski, Orvin) Rabin Medical Center, Petach Tikva, Israel
(Latib) Montefiore Medical Center, Scarsdale, New York, United States
(d'Onofrio) Azienda Ospedaliera Universita di Padova, Padova, Venice,
Italy
(Ribichini) Universita di Verona, Verona, Italy
(Tello) Hospital General de Alicante, Alicante, Spain
(Dumonteil) Clinique-Pasteur Toulouse, Toulouse, France
(Baan) Academic Medical Center, Amsterdam, Netherlands
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo,
Brazil
(Sartori) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
(d'Errigo) Istituto Superiore di Sanita, Rome, Rome, Italy
(Tarantini) University of Padua, Padova, Italy
(Lunardi) National University of Ireland Galway, Galway, Ireland
(Pagnesi) Spedali Civili di Brescia, Brescia, Italy
(Ghattas) Golden Jubilee Hospital, Birmingham, United Kingdom
(Dangas) Mount Sinai Medical Center, New York, NY, United States
(Mehran) Icahn School of Medicine, New York, NY, United States
(Delewi) Academic Medical Center, Amsterdam, Netherlands
Publisher
Elsevier Inc.
Abstract
Background: Bioprosthetic valves are increasingly implanted in patients
with aortic valve stenosis. These valves have a limited durability.
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a
treatment option for bioprosthetic valve failure. Both balloon-expandable
(BE) and self-expandable (SE) valves are widely used in ViV-TAVI
procedures. However, studies comparing outcomes between these
fundamentally different valve designs in ViV-TAVI are lacking.
 Method(s): The CENTER study is a patient pooled analysis, comprising
data of 12,381 patients undergoing transfemoral TAVI in 6 countries. We
assessed differences in clinical outcomes between SE and BE valves in
ViV-TAVI patients, as defined by the Valve Academic Research Consortium.
 Result(s): A total of 256 patients were treated with transfemoral
ViV-TAVI. Of these, 50% were female, median age was 82 (IQR: 78-85) years,
and median STS-PROM was 6.3% (IQR: 4.0%-10.4%). SE valves were used in 162
patients (63%) and BE valves in 94 (37%) patients. SE and BE valve
recipients were similar regarding female sex (53% vs 47%; P = 0.38), age
(82 years [78-85] vs 81 [78-84]; P = 0.24), and STS-PROM (6.5%
[4.2%-10.2%] vs 6.2% [4.0%-10.9%]; P = 1.00). Third generation valves were
used in 91 (56%) of SE valves and in 40 (43%) of BE valves. There was a
trend towards lower 30-day mortality in SE valve patients (3% vs 7%; RR:
0.37; 95% CI: 0.11-1.26; P = 0.10). In addition, 30-day major bleeding was
less frequent in SE valve patients (3% vs 13%; RR: 0.27; 95% CI:
0.09-0.79; P = 0.01). Rates of conversion to surgery (1% vs 0; P = 0.44)
and device success were similar (90% vs 92%; P = 0.62). Moreover, 30-day
rates of stroke (1.9% vs 4.6%; P = 0.22), myocardial infarction (0.7% vs
1.8%; P = 0.46), and permanent pacemaker implantation (9.3% vs 7.9%; P =
0.70) were similar. There was no difference in 1-year mortality (12.5% vs
17.6%; P = 0.32) and stroke rates (3.7% vs 7.4%; P = 0.25).
 Conclusion(s): There was a trend toward lower 30-day mortality in
ViV-TAVI patients treated with SE valves. Moreover, the use of SE valves
in ViV-TAVI was associated with lower rates of major bleeding than BE
valves. Our findings warrant randomized controlled trials directly
comparing SE and BE valves in ViV-TAVI patients. Categories: STRUCTURAL:
Valvular Disease: Aortic Copyright © 2021

<104>
Accession Number
2015285912
Title
TCT-113 Ten-Year Survival Benefit and Appropriateness of Surgical or
Percutaneous Revascularization Based on Individual Predicted All-Cause
Mortality in Patients With Complex Coronary Artery Disease.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B47-B48), 2021. Date of Publication:
09 Nov 2021.
Author
Serruys P.; Hamandi M.; Gao C.; Hara H.; Garg S.; van Klaveren D.; Kent
D.; Steyerberg E.W.; Onuma Y.; Thuijs D.; Davierwala P.; Kappetein A.;
Holmes D.; Morice M.-C.; Lytle B.; Mohr F.-W.; Mack M.
Institution
(Serruys, Onuma) Department of Cardiology, Saolta Group, Galway University
Hospital, Health Service Executive and National University of Ireland
Galway (NUIG), Galway, Ireland
(Hamandi) Baylor Cardiovascular Research Institute, Dallas, TX, United
States
(Gao) Xijing Hospital, Xi'an, Shaanxi, China
(Hara) National University of Ireland Galway, Galway, Ireland
(Garg) Royal Blackburn Hospital, Blackburn, United Kingdom
(van Klaveren) Erasmus Medical Center, Rotterdam, Netherlands
(Kent) Tufts Medical Center, Boston, MA, United States
(Steyerberg) Erasmus Medical Center, Rotterdam, Netherlands
(Thuijs) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, Netherlands
(Davierwala) University of Toronto, Toronto, ON, Canada
(Kappetein) Thoraxcenter Erasmus Medical Center, Rotterdam, Netherlands
(Holmes) Mayo Clinic, Rochester, MN, United States
(Morice) CERC, Massy, France
(Lytle) The Cleveland Clinic Foundation, Cleveland, OH, United States
(Mohr) Heart Center Leipzig, Leipzig, Germany
(Mack) Baylor Scott & White-The Heart Hospital- Plano, Plano, TX, United
States
Publisher
Elsevier Inc.
Abstract
Background: We sought to compare the observed and individual predicted
mortalities according to the SYNTAX score II 2020 (SSII-2020) in the
all-comers SYNTAX population. Method(s): Internal validation of the
SYNTAX score 2020 in the randomized population and external validation in
the registries was performed to predict 10-year all-cause death.
 Result(s): A total of 2,636 participants were included in the
randomized and registry cohorts. The 10-year all-cause mortality, as
average treatment effect in the randomized cohorts, was 24.5% (212 of 897)
with coronary artery bypass graft (CABG) and 28.4% (248 of 903) with
percutaneous coronary intervention (PCI), with a differential survival
benefit of 3.9% (95% confidence interval [CI]: -0.2% to 8.1%; log-rank P
value = 0.066). In the CABG registry and PCI registry cohorts, mortalities
were respectively 27.8% (167 of 644) and 55.4% (99 of 192). Calibration
and discrimination of the SSII-2020 were helpful both in CABG and PCI
patients either randomized or registered. In the PCI registry, SSII-2020
underestimates the mortality, as specific comorbidities that entail high
mortality are not included (C-index: 0.72, intercept: 0.38, slope: 0.66).
In the CABG registry, SSII-2020 predicts mortality both in the CABG and
PCI patients with a helpful calibration and discrimination (C-index: 0.70,
intercept: 0.00, slope: 0.76). The proportions of patients with a
predicted benefit survival treated either with CABG or PCI were 78.3%
(1,410 of 1,800) and 21.7% (390 of 1,800) in the randomized cohorts and
82.3 (2,170 of 2,636) and 17.7% (466 of 2,170) in the enrolled SYNTAX
all-comer population, respectively. [Formula presented]
 Conclusion(s): Among this all-comers population for revascularization
of 3VD and LMCAD, individual predicted and observed mortalities after CABG
or PCI were in reasonable agreement in the randomized and registered arms,
and the predicted 10-year survival benefit is helpful in determining the
appropriateness of each modality of revascularization. Categories:
CORONARY: Complex and Higher-Risk Procedures for Indicated Patients
(CHIP) Copyright © 2021

<105>
Accession Number
2015285830
Title
TCT-416 Clinical Impact of Tricuspid Regurgitation on Transcatheter
Edge-to-Edge Mitral Valve Repair for Secondary Mitral Regurgitation: A
Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B170), 2021. Date of Publication: 09
Nov 2021.
Author
Chitturi K.; Bhardwaj B.; Murtaza G.; Karuparthi P.; Faza N.; Goel S.;
Reardon M.; Kleiman N.; Aggarwal K.
Institution
(Chitturi, Murtaza) University of Missouri, Columbia, Columbia, MO, United
States
(Bhardwaj) Oregon Health & Science University, Portland, OR, United States
(Karuparthi, Aggarwal) Harry S Truman Veterans' Memorial Hospital,
Columbia, MO, United States
(Faza, Reardon, Kleiman) Houston Methodist DeBakey Heart & Vascular
Center, Houston, Texas, United States
(Goel) Houston Methodist Hospital, Houston, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Baseline tricuspid regurgitation (TR) is common among patients
undergoing transcatheter edge-to-edge repair (TEER) for secondary mitral
regurgitation (MR), although its impact on clinical outcomes is disputed.
 Method(s): The Cochrane Library, PubMed/MEDLINE, and Google Scholar
were searched according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guidelines from January 1, 2011, through January
31, 2021. Randomized controlled trials and nonrandomized prospective
studies that evaluated baseline TR by echocardiography before TEER of
secondary MR were included. The primary outcomes were a composite of
mortality and heart failure hospitalization (HFH) at 30 days.
 Result(s): A total of 5 studies (n = 1,430 patients) were included
for analysis. Concurrent moderate or severe TR was associated with greater
mortality and HFH at 30 days (odds ratio: 1.60; 95% confidence interval:
1.12-2.29; P = 0.009) after TEER for severe MR. Conclusion(s):
Baseline moderate to severe TR was associated with increased 30-day
mortality and HFH among patients undergoing TEER. Categories: STRUCTURAL:
Valvular Disease: Mitral Copyright © 2021

<106>
Accession Number
2015285826
Title
TCT-394 Late Outcomes After Transcatheter Aortic Valve Replacement With a
Mechanically Expanded Versus Self-Expandable Valve: Final 5-Year Results
From the REPRISE III Randomized Trial.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B162), 2021. Date of Publication: 09
Nov 2021.
Author
Reardon M.; Rajagopal V.; Makkar R.; Bajwa T.; Kleiman N.; Linke A.;
Kereiakes D.; Underwood P.; Allocco D.; Rizik D.
Institution
(Reardon, Kleiman) Houston Methodist DeBakey Heart & Vascular Center,
Houston, TX, United States
(Rajagopal) Piedmont Heart Institute, Atlanta, GA, United States
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Bajwa) Aurora St. Luke's Medical Center, Milwaukee, WI, United States
(Linke) Heart Center Dresden, Technical University of Dresden, Dresden,
Germany
(Kereiakes) The Christ Hospital Health Network, Cincinnati, OH, United
States
(Underwood) Boston Scientific, Phoenix, AZ, United States
(Allocco) Boston Scientific, Maple Grove, MN, United States
(Rizik) HonorHealth Heart Group, Scottsdale, AZ, United States
Publisher
Elsevier Inc.
Abstract
Background: REPRISE III is the first large randomized comparison of 2
transcatheter aortic valve replacement platforms: the mechanically
expanded Lotus valve (Boston Scientific) and the self-expanding CoreValve
(CV; Medtronic). The Lotus valve was noninferior for 30-day safety (death,
stroke, life-threatening or major bleeding, stage 2 or 3 acute kidney
injury, major vascular complications) and superior for 1-year
effectiveness (1-year death, disabling stroke, and moderate or greater
paravalvular leak [PVL]). This analysis assessed the final, 5-year
outcomes in REPRISE III. Method(s): Patients at high or extreme
surgical risk were randomized (2:1) to receive the Lotus or CV for severe,
symptomatic aortic stenosis at 55 centers globally (N = 912; Lotus, n =
607; CV, n = 305). Rates are postrandomization in the intent-to-treat
population. Follow-up in the study is complete. Result(s): At 5
years, all-cause mortality and disabling stroke rates were similar in
Lotus- and CV-randomized patients, as was all-cause mortality (Table 1).
Disabling stroke occurred less frequently in the Lotus cohort compared
with the CV cohort; more Lotus than CV patients received new permanent
pacemakers. At 5 years, valve areas were smaller and mean gradient higher
with Lotus than CV (area, 1.42 +/- 0.42 cm2 vs 1.57 +/- 0.56
cm2; gradient 12.64 +/- 6.68 mm Hg vs 7.79 +/- 4.20 mm Hg; P <
0.01 for both). Moderate or greater PVL was low in both cohorts at 5 years
(0% vs 1.9%; P = 0.31); mild PVL was lower with Lotus than CV (7.8% vs
23.1%; P = 0.006). Similar improvements in functional and health status
were found in each group. [Formula presented] Conclusion(s): This
5-year analysis from the REPRISE III study demonstrates the durability of
safety and effectiveness after Lotus valve implantation through 5 years of
follow-up. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2021

<107>
Accession Number
2015285800
Title
TCT-283 Large-Bore Arterial Access Closure After Transcatheter Aortic
Valve Replacement: A Systematic Review and Network Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B116-B117), 2021. Date of
Publication: 09 Nov 2021.
Author
Montalto C.; Munafo A.; Arzuffi L.; Soriano F.; Mangieri A.; De Maria
G.L.; Burzotta F.; Colombo A.; Latib A.; Oreglia J.; Banning A.; Porto I.;
Crimi G.
Institution
(Montalto) Oxford University Hospital NHS Trust, Oxford, United Kingdom
(Munafo) Irccs San Matteo Hospital, Pavia, Milan, Milan, Italy
(Arzuffi) University of Pavia, Pavia, Italy
(Soriano) AAST Grande Ospedale Metropolitano Niguarda, Milan, Italy
(Mangieri) Humanitas Research Hospital, Milan, Italy
(De Maria) Oxford University Hospitals, Oxford, United Kingdom
(Burzotta) Institute of Cardiology, Fondazione Policlinico Universitario
A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
(Colombo) Columbus Hospital, Milan, Italy
(Latib) Montefiore Medical Center, Scarsdale, NY, United States
(Oreglia) Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy
(Banning) John Radcliffe Hospital, Oxford, United Kingdom
(Porto) Policlinico Gemelli Hospital, Rome, Italy
(Crimi) IRCCS Policlinico San Matteo, Genoa, Italy
Publisher
Elsevier Inc.
Abstract
Background: As the indications to transcatheter aortic valve replacement
(TAVR) expand to patients at increasingly lower risk, procedure-related
vascular and bleeding complication events must be minimized.
 Method(s): We searched for papers that reported outcomes according to
the type of vascular closure device/technique used after TAVR and
performed a Bayesian network meta-analysis (NMA). Result(s): Eighteen
studies involving 9,277 patients who underwent access site closure using
surgical cutdown, the PROSTA XL percutaneous vascular surgical system
(Abbott), the Perclose ProGlid suture-mediated closure system (Abbott), or
the MANTA vascular closure device (Teleflex) were included. The NMA showed
MANTA to be the most likely best treatment in reducing a primary composite
end point of intrahospital death, major vascular complications, and major
or life-threatening bleedings (surface under the cumulative ranking curve
analysis [SUCRA] = 83.3%), as well as major or life-threatening bleedings
alone (SUCRA = 71.4%) (Figure 1). Additionally, MANTA was the second-best
option for minimizing major vascular complication, the first being
surgical cutdown (SUCRA = 34.6% and 47.6%, respectively). In patients
undergoing fully percutaneous TAVR, the MANTA and ProGlide were the best
and second-best option to reduce the primary end point. The ProStar XL
device performed poorly in all explored end points. [Formula presented]
 Conclusion(s): The available evidence summarized through the NMA
shows that the MANTA and ProGlide devices appear to be the best options to
minimize vascular complications and reduce bleeding in patients undergoing
TAVR. Further evidence from robust randomized clinical trials is eagerly
awaited. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2021

<108>
Accession Number
2015285791
Title
TCT-57 Updated Clinical and Procedural Outcomes in TAVR for Bicuspid
Versus Tricuspid Aortic Valve Stenosis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B23-B24), 2021. Date of Publication:
09 Nov 2021.
Author
Ansari M.M.; Garcia D.; Shurmur S.
Institution
(Ansari) Texas Tech University Health Sciences Center, Lubbock, TX, United
States
(Garcia) Texas Tech University Health Science Center, Lubbock, TX, United
States
(Shurmur) Texas Tech University, Lubbock, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is considered
safe and feasible in high-, intermediate-, and low-risk patients with
tricuspid aortic valve (TAV) stenosis but not well investigated for
bicuspid valve (BAV) stenosis. Majority of the randomized trials excluded
patients with BAV, given its challenges. We aimed to evaluate the global
experience with meta-analysis of all studies. Method(s): PubMed and
Cochrane databases were searched for studies comparing clinical outcomes
of patients with severe BAV or TAV stenosis. Primary outcomes included >=
2 aortic insufficiency (AI) and 30-day mortality. Secondary outcomes
included pacemaker implantation, neurologic events, major bleeding, acute
myocardial infarction (AMI), surgical replacement post-TAVR. We used fixed
(I2 < 55%) otherwise random effect analysis. Result(s):
Ten studies provided a total 44,927 patients (1,316 = BAV and 43,611 =
TAV). CoreValve (Medtronic) was the most commonly used in patients with
BAV, followed by SAPIEN (Edwards Lifesciences) valve. Primary endpoints
analysis showed that BAV group had more >= 2 AI but not significantly
different (12% vs 9%). There was no mortality difference between groups
(4% vs 4%; P = 0.1). Secondary endpoint analysis showed no difference in
AMI between BAV (1.5%) compared with TAV group (3%). There was no
difference in pacemaker implantation, neurologic events and major
bleeding. [Formula presented] Conclusion(s): Analysis suggested that
TAVR in patients with BAV anatomy has acceptable procedural and midterm
results. Larger annulus size and an oval annular shape with 2 commissures
make the virtual basal-ring identification more ambiguous, making the
procedure more challenging. Newer-generation valves with 3D reconstruction
might improve these challenges; it is, as yet, underinvestigated.
Categories: STRUCTURAL: Valvular Disease: Aortic Copyright © 2021

<109>
Accession Number
2015285735
Title
TCT-350 Left vs Right Ventricular Pacing for TAVR.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B143-B144), 2021. Date of
Publication: 09 Nov 2021.
Author
Iskander M.; Iskander F.; Osman M.; Abugroun A.; Attanasio S.; Suradi H.;
Kaple R.; Kavinsky C.
Institution
(Iskander) Yale New Haven Hospital, New Haven, CT, United States
(Iskander) St Elizabeth Medical Center, Boston, MA, United States
(Osman) Oregon Health and Science University, Portland, OR, United States
(Abugroun) Medical College of Wisconsin, Milwaukee, WI, United States
(Attanasio, Suradi, Kavinsky) Rush University Medical Center, Chicago, IL,
United States
(Kaple) Yale School of Medicine, New Haven, CT, United States
Publisher
Elsevier Inc.
Abstract
Background: Rapid ventricular pacing (RVP) is an established technique
used during transcatheter aortic valve replacement (TAVR) to temporarily
reduce the cardiac output and facilitate optimal balloon and valve
placement. Traditionally, right ventricular (RV) pacing is used, which
requires additional venous access and placement of a pacing lead in the RV
apex under fluoroscopy. This carries additional risk for vascular injury,
pericardial effusion, and a prolonged procedure time. Few studies have
investigated the safety of left ventricular (LV) compared with RV pacing.
We aimed to compare the 2 pacing techniques by performing a meta-analysis
of the currently available studies. Method(s): A comprehensive
electronic search was done up to February 2021; we identified 1 randomized
controlled trial and 2 observational studies with a total of 648 patients
(LV pacing in 51.3% [n = 333] and RV pacing in 48.6% [n = 315]). The
outcomes of interest were procedural mortality, vascular complications,
cardiac tamponade, stroke, and procedural time. The results were pooled,
and we calculated the mean difference for continuous data and the odds
ratio for categoric variables. Result(s): Compared with RV pacing, LV
pacing was associated with a significant reduction in procedural time with
a mean difference of -6.65 minutes (95% confidence interval: -8.42 to
-4.87; P < 0.001; Figure 1). Moreover, there was a trend toward a lower
risk for mortality, vascular complications, cardiac tamponade, and stroke
with LV pacing; however, it did not meet statistical significance (Figure
1). Rates of requiring a second TAVR valve at the index procedure were
rare in both groups. [Formula presented] Conclusion(s): In
conclusion, LV pacing resulted in a significant reduction of TAVR
procedural time without an apparent increase in risk. Thus, LV pacing may
offer a safe and elegant approach to further simplify TAVR procedures in
selected patients. Additional studies with a larger patient sample size
are warranted. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2021

<110>
Accession Number
2015285733
Title
TCT-361 Clinical Outcomes in Patients Undergoing Percutaneous Coronary
Intervention Treated With Colchicine.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B148-B149), 2021. Date of
Publication: 09 Nov 2021.
Author
Jimenez C.S.; Sanchez J.S.; Hayat F.; Chang J.; Garcia-Garcia H.
Institution
(Jimenez, Hayat) MedStar Washington Hospital Center, Washington, DC,
United States
(Sanchez) Cardio Center, Humanitas Research Hospital, Rozzano, Italy
(Chang) New York University Langone Health, New York, NY, United States
(Garcia-Garcia) Washington Hospital Center, Chevy Chase, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: The central role of inflammation in the pathogenesis of
coronary artery disease (CAD) as well as that resulting from treatment
with percutaneous coronary intervention (PCI) is increasingly recognized.
The effect of colchicine in attenuating peri-PCI inflammation remains
unknown. This meta-analysis investigated the efficacy and safety of adding
colchicine to standard medical treatment in patients undergoing PCI for
secondary prevention of CAD. Method(s): The Web of Science, Embase,
PubMed, Ovid, Cochrane Central Register of Controlled Trials, and
databases (inception to May 31, 2021) were searched. Studies assessing the
efficacy and safety of colchicine in patients undergoing PCI were
included. Data were pooled by meta-analysis using a random-effects model.
 Result(s): Of 1,053 unique reports identified, 12 studies following
7,235 patients were included. No differences were observed between
patients treated with colchicine compared with those treated without
colchicine in terms of all-cause death (odds ratio [OR]: 1.1; 95%
confidence interval [CI]: 0.72-1.56; I2 = 0%), cardiovascular
death (OR: 0.98; 95% CI: 0.42-2.28; I2 = 14.2%), and coronary
revascularization (OR: 0.64; 95% CI: 0.28-1.42; I2 = 49.3%).
However, patients treated with colchicine showed a lower risk of stroke
(OR: 0.33; 95% CI: 0.15-0.72, I2 = 0%) and a trend toward a
lower risk of myocardial infarction (OR: 0.84; 95% CI: 0.65-1.08;
I2 = 1.4%). At sensitivity analysis calculating both OR and
risk ratio with a fixed effect model, patients treated with colchicine
compared with those treated without colchicine showed a lower risk of
coronary revascularization (OR: 0.56; 95% CI: 0.37-0.82 and risk ratio:
0.56; 95% CI: 0.38-0.83). Conclusion(s): The addition of colchicine
to standard medical therapy in patients undergoing PCI did not decrease
all-cause death and cardiovascular death but did show a lower risk of
stroke, a trend toward lower risk of myocardial infarction, and a lower
risk of coronary revascularization at sensitivity analysis when using a
fixed effect model. Categories: CORONARY: Acute Coronary
Syndromes Copyright © 2021

<111>
Accession Number
2015285676
Title
TCT-347 Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo
Surgical Aortic Valve Replacement for Failed Surgical Aortic
Bioprostheses: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B142-B143), 2021. Date of
Publication: 09 Nov 2021.
Author
Raschpichler M.; De Waha-Thiele S.; Holzhey D.; Schwarzer G.; Kaewkes D.;
Brauchle P.; Dvir D.; Makkar R.; Ailawadi G.; Abdel-Wahab M.; Thiele H.;
Borger M.
Institution
(Raschpichler, Holzhey, Brauchle, Abdel-Wahab, Thiele, Borger) Heart
Center Leipzig, Leipzig, Germany
(De Waha-Thiele) University Heart Center Luebeck, Leipzig, Germany
(Schwarzer) University of Freiburg, Freiburg, Germany
(Kaewkes) Khon Kaen University, Khon Kaen, Thailand
(Dvir) Shaare Zedek Medical Center, Jerusalem, Israel
(Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Ailawadi) University Of Michigan Cardiovascular Center, Ann Arbor, MI,
United States
Publisher
Elsevier Inc.
Abstract
Background: In the absence of randomized controlled trials, reports from
nonrandomized studies comparing valve-in-valve implantation (ViV) with
redo surgical aortic valve replacement (rAVR) have shown inconsistent
results. The aim of this meta-analysis is to provide evidence on the
comparison of ViV versus rAVR in patients with failed surgical aortic
bioprostheses. Method(s): PubMed/MEDLINE, Google Scholar, and the
Cochrane Central Register of Controlled Trials (CENTRAL) were searched
through December 2020. Studies eligible for inclusion had to compare ViV
to rAVR in patients with failed surgical aortic bioprostheses and reported
at least all-cause mortality at <=30 days. Random effects models were
applied. The primary outcomes of interest were short- and long-term
mortality. The secondary outcomes included stroke, myocardial infarction,
acute renal failure, and permanent pacemaker implantation as well as
prosthetic aortic valve regurgitation, mean transvalvular gradient, and
severe prosthesis-patient mismatch. Result(s): Of 8,655 patients
included in 13 studies, 4,316 (49.9%) underwent ViV and 4,339 (50.1%)
rAVR. Short-term mortality was 2.7% in patients undergoing ViV compared
with 5.1% in rAVR patients (risk ratio [RR]: 0.60; 95% confidence interval
[CI]: 0.39-0.91; P = 0.02). The landmark analysis of events occurring
between short- and long-term follow-up demonstrated a higher mortality for
ViV (RR: 1.29; 95% CI: 1.04-1.60; P = 0.03), resulting in equivalent
long-term mortality (RR: 1.11; 95% CI: 0.92-1.40; P = 0.25). The rate of
acute kidney failure was lower after ViV (RR: 0.54; 95% CI: 0.29-1.00; P =
0.02), whereas prosthetic aortic valve regurgitation (RR: 2.95; 95% CI:
1.56-5.60; P = 0.005) as well as severe patient-prothesis mismatch (25.5%
vs 9.3%; RR: 3.43; 95% CI: 2.65-4.40; P < 0.001) occurred more frequently.
The mean transvalvular gradient was higher after ViV (RR: 0.45; 95% CI:
0.09-0.81; P = 0.02). There were no significant differences between groups
with respect to stroke (P = 0.34), myocardial infarction (P = 0.93), or
pacemaker implantation (P = 0.25). Conclusion(s): The results of this
meta-analysis demonstrate better short-term mortality after ViV compared
with rAVR. Long-term mortality was similar between groups due to late
events in patients undergoing ViV. Given the likely selection bias in
these individual reports, an adequately powered multicenter randomized
clinical trial in patients with low-to-intermediate surgical risk is
warranted. Categories: STRUCTURAL: Valvular Disease: Aortic Copyright
© 2021

<112>
Accession Number
2015285633
Title
TCT-194 Short- and Long-Term Outcomes With Use of Novel Oral
Anticoagulants Versus Standard of Care (Vitamin K Antagonist and/or
Antiplatelets) After Transcatheter Aortic Valve Replacement: A
Meta-Analysis of 10,404 Procedures.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B79-B80), 2021. Date of Publication:
09 Nov 2021.
Author
Sachdeva S.; Desai R.; Jain A.; Khandait H.; Ijaz H.; Mahmood A.; Lodhi
M.U.; Kumar G.; Sachdeva R.
Institution
(Sachdeva) Boston University School of Medicine, Boston, MA, United States
(Desai, Sachdeva) Atlanta VA Medical Center, Decatur, GA, United States
(Jain) Mercy Catholic Medical Center, Darby, PA, United States
(Khandait) Trinitas Regional Medical Center, Union, NJ, United States
(Ijaz) Westside Regional Medical Center, Jackson, NJ, United States
(Mahmood) Corpus Christi Medical Center, Corpus Christi, TX, United States
(Lodhi) Eastern Idaho Regional Medical Center, Idaho Falls, United States
(Kumar) Emory University/Atlanta VA Medical Center, Atlanta, GA, United
States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
established therapy for severe aortic stenosis (AS) in patients with
intermediate-high surgical risk. Data regarding safety and efficacy of
novel oral anticoagulants (NOACs) as opposed to the standard of care (SOC:
vitamin K antagonist/antiplatelets) after TAVR remain limited. We
performed a meta-analysis to compare the adverse events between NOACs and
SOC after TAVR. Method(s): PubMed, Scopus, and Web of Science were
systematically searched for studies reporting outcomes with NOAC versus
SOC after TAVR. All-cause mortality was the primary end point, and
major/life-threatening bleeding and stroke/transient ischemic attack (TIA)
were secondary end points. Random-effects models were used to analyze
pooled odds ratios (ORs) with 95% CIs. I2 statistics were used
to assess heterogeneity. Result(s): A total of 11 studies were
included in the final analysis, of which short- and long-term outcomes
were reported in 4 and 10 studies respectively. Of 10,404 patients (52%
male, overall mean age 82.08 +/- 4.36 years), 4,626 (44.26%) received
NOACs after TAVR and 5,365 (51.5%) received SOC. No difference was
observed between the 2 groups for short-term outcomes: ORs (95% CIs):
all-cause mortality: 0.967 (0.348-2.689), bleeding: 0.971 (0.598-1.575),
stroke/TIA: 1.004 (0.444-2.271) (Figure A) (P > 0.05). Similarly,
long-term outcomes were also similar between the 2 groups: ORs (95% CIs):
all-cause mortality: 0.937 (0.612-1.432), bleeding: 0.952 (0.662-1.369),
stroke/TIA: 1.281 (0.840-1.951) (Figure B) (P > 0.05). [Formula presented]
 Conclusion(s): This meta-analysis revealed that NOACs and SOC had
similar short- and long-term outcomes in post-TAVR patients. Categories:
STRUCTURAL: Valvular Disease: Aortic Copyright © 2021

<113>
Accession Number
2015285608
Title
TCT-304 Ten-Year All-Cause Mortality Following Percutaneous or Surgical
Revascularization in Patients With Heavy Calcification.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B125), 2021. Date of Publication: 09
Nov 2021.
Author
Kawashima H.; Serruys P.; Hara H.; Ono M.; Onuma Y.
Institution
(Kawashima) Teikyo University Hospital, Tokyo, Japan
(Serruys, Ono, Onuma) Department of Cardiology, Saolta Group, Galway
University Hospital, Health Service Executive and National University of
Ireland Galway, Galway, Ireland
(Hara) National University of Ireland, Galway, Ireland
Publisher
Elsevier Inc.
Abstract
Background: Limited data are available on very long-term outcomes in
patients with heavily calcified lesions (HCLs) according to the mode of
revascularization. The objective of this study is to assess 10-year
all-cause mortality in patients with HCLs undergoing percutaneous coronary
intervention (PCI) or coronary artery bypass grafting (CABG).
 Method(s): This substudy of the SYNTAXES study assessed 10-year
all-cause mortality according to the presence of HCLs within lesions with
a >50% diameter stenosis and identified during the calculation of the
anatomical SYNTAX score among 1,800 patients with the 3-vessel disease
(3VD) and/or left main disease (LM) randomized to PCI or CABG in the
SYNTAX trial. Patients with HCLs were further stratified according to
disease type (3VD/LM) and assigned treatment (PCI/CABG). Result(s):
The 532 patients with >=1 HCL had a higher crude mortality at 10 years
than those without (36.4% vs 22.3%; hazard ratio [HR]: 1.79; 95%
confidence interval [CI]: 1.49-2.16; P < 0.001). After adjustment, an HCL
remained an independent predictor of 10-year mortality (HR: 1.36; 95% CI:
1.09-1.69; P = 0.006). There was significant interaction in mortality
between treatment effect (PCI and CABG) and the presence or absence of
HCLs (P interaction = 0.005). In patients without HCLs, mortality was
significantly higher after PCI than CABG (26.0% vs 18.8%; HR: 1.44; 95%
CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no
significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P =
0.264). Conclusion(s): At 10 years, the presence of an HCL was an
independent predictor of mortality, with a similar prognosis after PCI or
CABG. Whether HCLs require special consideration when deciding the mode of
revascularization beyond their current contribution to the anatomical
SYNTAX score deserves further evaluation. Categories: CORONARY: Complex
and Higher Risk Procedures for Indicated Patients (CHIP) Copyright
© 2021

<114>
Accession Number
2015285605
Title
TCT-473 Impact of Major Infections on 10-Year Mortality After
Revascularization in Patients With Complex Coronary Artery Disease.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B194), 2021. Date of Publication: 09
Nov 2021.
Author
Ono M.; Kawashima H.; Hara H.; Mancone M.; Mack M.; Holmes D.; Morice
M.-C.; Kappetein P.; Thuijs D.; Noack T.; Mohr F.-W.; Davierwala P.; Onuma
Y.; Serruys P.
Institution
(Ono, Onuma, Serruys) Department of Cardiology, Saolta Group, Galway
University Hospital, Health Service Executive and National University of
Ireland Galway, Galway, Ireland
(Kawashima, Hara) National University of Ireland Galway, Galway, Ireland
(Mancone) Policlinico Umberto I University, Rome, Italy
(Mack) Baylor Scott & White The Heart Hospital - Plano, TX, United States
(Holmes) Mayo Clinic, Rochester, Minnesota, United States
(Morice) CERC, Massy, France
(Kappetein) Medtronic, Minneapolis, MN, United States
(Thuijs) Department of Cardiothoracic Surgery, Erasmus University Medical
Center, Rotterdam, Netherlands
(Noack, Mohr) Heart Center Leipzig, Leipzig, Germany
(Davierwala) University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: The significant interaction between major infection and 5-year
mortality after percutaneous coronary intervention (PCI) or coronary
artery bypass grafting (CABG) for complex coronary artery disease (CAD)
was observed previously. However, very long term outcomes beyond 5 years
remain unclear. Method(s): This was a subgroup analysis of the SYNTAX
Extended Survival (SYNTAXES) trial, which is the extended follow-up of the
randomized SYNTAX trial comparing PCI versus CABG in patients with
3-vessel disease or left main CAD. [Formula presented] Results: Among
1,517 patients enrolled in the SYNTAX trial with available survival status
from 5 to 10 years, 140 patients experienced major infections and survived
at 5 years (major infection group). From 5 to 10 years, the mortality of
the major infection group was 19.8%, whereas the mortality of the no major
infection group was 15.1% (P = 0.157). After the adjustment of other
clinical factors, the risk for mortality from 5 to 10 years did not
significantly differ between the major infection and no major infection
groups (hazard ratio: 1.10; 95% confidence interval: 0.62-1.96; P =
0.740). When stratified by the presence or absence of periprocedural major
infections, defined as a major infection within 60 days after index
procedure, there was also no significant difference in 10-year mortality
between the 2 groups (30.8% vs 24.5%; P = 0.057). Conclusion(s):
Despite the initial association between major infections and 5-year
mortality, postprocedural major infection was not evident during 10-year
follow-up, suggesting that the impact of major infection on mortality
subsided over time beyond 5 years. Categories: CORONARY: Stents:
Drug-Eluting Copyright © 2021

<115>
Accession Number
2015285597
Title
TCT-296 Atrial Fibrillation in Patients Undergoing Transcatheter Aortic
Valve Implantation Is Associated With Increased Mortality.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B122), 2021. Date of Publication: 09
Nov 2021.
Author
van Nieuwkerk A.; Blanco R.; Tchetche D.; Brito F.; Barbanti M.; Kornowski
R.; Latib A.; D'Onofrio A.; Ribichini F.; Oteo Dominguez J.F.; Dumonteil
N.; Abizaid A.; Baan J.; Sartori S.; D'Errigo P.; Tarantini G.; Lunardi
M.; Orvin K.; Ghattas A.; Pagnesi M.; Dangas G.; Mehran R.; Delewi R.
Institution
(van Nieuwkerk) Amsterdam UMC, Amsterdam, Netherlands
(Blanco) Hospital de Cruces, Etxebarri, Spain
(Tchetche, Dumonteil) Clinique Pasteur Toulouse, Toulouse Cedex 3, France
(Brito) InCor, Heart Institute, University of Sao Paulo Medical School,
Sao Paulo, Sao Paulo, Brazil
(Barbanti) AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
(Kornowski, Orvin) Rabin Medical Center, Petach Tikva, Israel
(Latib) Montefiore Medical Center, Scarsdale, NY, United States
(D'Onofrio) Azienda Ospedaliera Universita di Padova, Padova, Italy
(Ribichini) Universita di Verona, Verona, Italy
(Oteo Dominguez) Hospital Universitario Puerta de Hierro, Madrid, Spain
(Abizaid) Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
(Baan, Delewi) Academic Medical Center, Amsterdam, Netherlands
(Sartori, Mehran) Icahn School of Medicine at Mount Sinai, New York, New
York, United States
(D'Errigo) Istituto Superiore di Sanita, Rome, Italy
(Tarantini) University of Padua, Department of Cardiac, Thoracic and
Vascular Sciences, Padova, Italy
(Lunardi) NUI Galway, Galway, Galway, Ireland
(Ghattas) Golden Jubilee Hospital, Birmingham, United Kingdom
(Pagnesi) Spedali Civili di Brescia, Brescia, Italy
(Dangas) Mount Sinai Medical Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Atrial fibrillation (AF) is common in patients with aortic
valve stenosis undergoing transcatheter aortic valve implantation (TAVI).
We compared clinical outcomes between TAVI patients with baseline AF
versus TAVI patients without AF. Method(s): The CENTER study is an
international collaboration including 12,381 patients treated with
transfemoral TAVI. This pooled analysis consists of patient level data
from 10 different studies. End points were stroke and mortality rates at
30 days and 1 year after TAVI as defined by the Valve Academic Research
Consortium. Result(s): Of the 12,381 patients, 58% were female, the
mean age was 81.5 +/- 7.0 years, and the median logistic EuroSCORE was
14.4% (9.0%-23.0%). A total of 3,354 patients (27%) had known baseline AF.
In patients with AF, there was a trend toward higher in-hospital mortality
(5.3% vs 3.5%; relative risk [RR]: 1.18; 95% confidence interval [CI]:
0.99-1.41; P = 0.06). Moreover, 30-day mortality (7.1% vs 5.3%; RR: 1.35;
95% CI: 1.16-1.59; P < 0.001) as well as 1-year mortality (20.8% vs 15.3%;
RR: 1.35; 95% CI: 1.23-1.52; P < 0.001) was higher in AF patients. In
contrast, stroke rates were comparable in patients with versus without AF
during hospital admission (2.2% vs 2.0%, P = 0.60), at 30 days (2.9% vs
2.4%, P = 0.18), and 1 year after TAVI (5.3% vs 5.1%, P = 0.75). Also,
30-day rates of myocardial infarction (0.8% vs 1.0%, P = 0.38) and major
bleeding (7.6% vs 7.3%, P = 0.53) were similar between both patient
groups. However, permanent pacemakers were more frequently implanted in AF
patients (14.8% vs 13.4%; RR: 1.11; 95% CI: 1.00-1.23; P = 0.05).
 Conclusion(s): In this global study of >12,000 patients undergoing
transfemoral TAVI, AF was associated with higher 30-day and 1-year
mortality. Moreover, patients with AF more frequently required a permanent
pacemaker. Although AF is a common condition in patients undergoing TAVI,
it is undoubtedly not a benign arrhythmia. Therefore, our results
underscore the evident need for further research in treatment options for
patients with AF undergoing TAVI. Categories: STRUCTURAL: Valvular
Disease: Aortic Copyright © 2021

<116>
Accession Number
2015285594
Title
TCT-311 Prognostic Impact of Preprocedural Right Ventricular Dysfunction
and Tricuspid Regurgitation on Late All-Cause Mortality Following
MitraClip Implantation: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B127), 2021. Date of Publication: 09
Nov 2021.
Author
Safiriyu I.; Lao N.; Adebolu O.; Lim J.; Idowu A.; Lukan A.; Shamaki G.R.;
Kakkar A.
Institution
(Safiriyu) Jacobi Medical Center, Bronx, NY, United States
(Lao, Adebolu, Lim) Cleveland Clinic Akron General Medical Center, Akron,
OH, United States
(Idowu) University of Lagos College of Medicine, Lagos, Nigeria
(Lukan) Advocate Illinois Masonic Medical Center, Chicago, IL, United
States
(Shamaki) Rochester Regional Health/Unity Hospital, Rochester, NY, United
States
(Kakkar) NYC Health + Hospitals/Jacobi, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Preoperative right ventricular dysfunction (RVD) and
moderate-severe/severe tricuspid regurgitation (TR) are established
predictors of mortality following cardiac surgery. However, there is a
paucity of evidence on their impact on late (>= 1 year) all-cause
mortality following transcatheter mitral valve repair (TMVR) with
MitraClip (MC, Abbott), a lifesaving therapeutic intervention for
high-risk surgical candidates with chronic symptomatic grade 3 or 4 mitral
regurgitation. This study aims to bridge that knowledge gap.
 Method(s): PubMed, Embase, and Web of Science were systematically
reviewed from inception to May 2021 for studies evaluating MitraClip
outcomes according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses guidelines. A random-effects model meta-analysis was
performed for the included studies, and heterogeneity was assessed with
the I2 test. Result(s): Of 3,780 articles, 10 articles
with a total of 3,356 patients were included in the meta-analysis. The
pooled multivariate hazard ratio (HR) revealed that preprocedural
moderate-severe/severe TR and RVD were predictors of a higher late
all-cause mortality following MC implantation for TMVR (hazard ratio [HR]:
1.56; 95% confidence interval [CI]: 1.22-2.00, I2 = 22% and HR:
2.14; 95% CI: 1.40-3.26, I2 = 36%, respectively) (Figures 1 and
2). [Formula presented] Conclusion(s): Moderate-severe/severe TR and
RVD are both predictors of a higher late all-cause mortality following MC
implantation for TMVR. These should be considered in the clinical
decision-making process for patients undergoing MC implantation for TMVR.
Categories: STRUCTURAL: Valvular Disease: Mitral Copyright © 2021

<117>
Accession Number
2015285591
Title
TCT-356 Safety and Efficacy of Transcatheter Aortic Valve Implantation in
Stenotic Bicuspid Aortic Valve: A Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B146-B147), 2021. Date of
Publication: 09 Nov 2021.
Author
Zghouzi M.; Ullah W.; Osman H.; Abdalrazzak M.; Suleiman A.-R.; Ahmad B.;
Rabbat F.; Chalek A.; Dandu C.; Razvi P.; Sattar Y.; Alraies M.C.
Institution
(Zghouzi) Detroit Medical Center, Dearborn, MI, United States
(Ullah) Thomas Jefferson University, Philadelphia, PA, United States
(Osman, Abdalrazzak, Suleiman, Ahmad, Razvi, Alraies) Detroit Medical
Center, Detroit, MI, United States
(Rabbat) Baptist Hospital of Miami, Miami, FL, United States
(Chalek, Dandu) Wayne State University School of Medicine, Detroit, MI,
United States
(Sattar) Icahn School of Medicine at Mount Sinai Elmhurst Hospital,
Queens, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged as
a safe and effective alternative to surgical replacement for the tricuspid
aortic valve (TAV). However, the utilization of TAVI for aortic stenosis
in the bicuspid aortic valve (BAV) remains controversial. Method(s):
Online databases were queried with various combinations of keywords to
identify relevant articles. Major adverse cardiovascular events (MACEs)
and their components were compared using a random effects model to
calculate odds ratios (ORs). Result(s): A total of 21 studies
comprising 183,361 patients (BAV 9,502 vs TAV 173,860) were included. At
30 days, the odds of MACEs (OR: 1.06; 95% confidence interval [CI]:
0.56-2.02; P < 0.89), cardiovascular (CV) mortality (OR: 1.57; 95% CI:
0.73-3.36; P < 0.74), all-cause mortality (OR: 1.07; 95% CI: 0.84-1.37; P
< 0.87), myocardial infarction (OR: 1.27; 95% CI: 0.18-8.82; P < 0.58),
stroke (OR: 1.57; 95% CI: 1.15-2.16; P < 0.98), acute kidney injury (OR:
2.08; 95% CI: 0.87-4.93; P < 0.41), life-threatening bleeding (OR: 1.14;
95% CI: 0.42-3.07; P < 0.41), vascular complications (OR: 1.07; 95% CI:
0.64-1.77; P < 0.31), and pacemaker implantation (OR: 1.18; 95% CI:
0.99-1.41; P < 0.57) were similar between groups. Outcomes in the hospital
and at 1 year mirrored these results, except for stroke. Figure 1 is a
forest plot showing CV mortality of TAVI in BAV versus TAV. Figure 2 is a
forest plot showing all-cause mortality of TAVI in BAV versus TAV.
[Formula presented] [Formula presented] Conclusion(s): The use of
TAVI for the treatment of aortic stenosis in BAV is a safe and effective
alternative to surgical intervention and has a comparable and similar
outcome of TAVI in TAV. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2021

<118>
Accession Number
2015285575
Title
TCT-234 Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid
Versus Tricuspid Anatomy: A Systematic Review and Meta-Analysis.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B95), 2021. Date of Publication: 09
Nov 2021.
Author
Montalto C.; Sticchi A.; Crimi G.; Laricchia A.; Khokhar A.; Giannini F.;
Reimers B.; Colombo A.; Latib A.; Waksman R.; Mangieri A.
Institution
(Montalto) Oxford University Hospital NHS Trust, Oxford, United Kingdom
(Sticchi) Inselspital, University Hospital of Bern, Bern, Switzerland
(Crimi) IRCCS Policlinico San Matteo, Genova, Genoa, Italy
(Laricchia) ASST Melegnano Martesana, Vizzolo Predabissi (Milan), Milan,
Italy
(Khokhar) Maria Cecilia Hospital, Cotignola, Italy, Cotignola, Ravenna,
Italy
(Giannini) Maria Cecilia Hospital, Cotignola, Italy
(Reimers) Humanitas Clinical and Research Center, Rozzano-Milano, Milan,
Italy
(Colombo) Columbus Hospital, Milan, Italy
(Latib) Montefiore Medical Center, Scarsdale, NY, United States
(Waksman) Medstar Heart Institute, Washington, DC, United States
(Mangieri) Humanitas Research Hospital, Milan, Italy
Publisher
Elsevier Inc.
Abstract
Background: At present, limited observational data exist supporting
transcatheter atrial valve replacement (TAVR) in the context of bicuspid
anatomy. We aimed to compare the feasibility, safety, and clinical
outcomes of TAVR in bicuspid (BAV) versus tricuspid (TAV) aortic valve
stenosis. Method(s): Primary end points were 1-year survival and
device success. Secondary end points included moderate-severe paravalvular
leak (PVL) and a composite end point of periprocedural complications;
incidence rates of individual procedural end points were also explored
individually. Result(s): In our main analysis we included 17 studies
with 181,433 patients undergoing TAVR, of whom 6,669 (0.27%) had BAV. A
secondary analysis of 7,071 matched subjects with similar baseline
characteristics was also performed. Device success and 1-year survival
rates were similar between BAV and TAV subjects (97% and 94% [P = 0.55]
and 91.3% vs 90.8% [P = 0.22], respectively). In patients with BAV, a
trend toward a higher risk of periprocedural complications was observed in
our main analysis (RR: 1.12; 95% CI: 0.99-1.27; P = 0.07), but not in the
matched population secondary analysis (RR: 1.00; 95% CI: 0.81-1.24; P =
0.99). The risk of moderate-severe PVL was higher in BAV subjects (RR:
1.42; 95% CI: 1.29-1.58; P < 0.0001) as were the incidences of cerebral
ischemic events (2.4% vs 1.6%; P = 0.015) and annulus rupture (0.3% vs
0.02%; P = 0.014) in matched subjects. [Formula presented]
 Conclusion(s): TAVR is a feasible option amongst selected patients
with BAV anatomy, but the higher rates of moderate-severe PVL, annulus
rupture, and cerebral ischemic events observed in the BAV group warrant
caution and further evidence. Categories: STRUCTURAL: Valvular Disease:
Aortic Copyright © 2021

<119>
Accession Number
2015285558
Title
TCT-407 Rate of Periprocedural Neurologic Events With and Without Cerebral
Embolic Protection During Transcatheter Aortic Valve Replacement: A 5-Year
Contemporary Retrospective Review.
Source
Journal of the American College of Cardiology. Conference: Thirty-Third
Annual Symposium Transcatheter Cardiovascular Therapeutics (TCT). Orlando
United States. 78(19 Supplement) (pp B167), 2021. Date of Publication: 09
Nov 2021.
Author
Khong A.; Southard J.; Stripe B.
Institution
(Khong) University of California, Davis, Sacramento, CA, United States
(Southard, Stripe) University of California, Davis, Medical Center,
Sacramento, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Despite increased provider experience with transcatheter
aortic valve replacement (TAVR), contemporary stroke rates in TAVR
patients have remained unchanged. Cerebral embolic protection (CEP)
devices were developed to reduce ischemic injury. Although randomized
trials have shown mixed results for CEP, the aim of this study was to
review neurologic outcomes of CEP at a single center over 5 years.
 Method(s): This retrospective review of TAVR patients with and
without CEP implantation at the University of California, Davis, Medical
Center was performed in an all-comers fashion before and after US Food and
Drug Administration approval. Nine hundred ninety patients were identified
using TVT Registry data from 2015 to 2020. The primary endpoint was any
acute periprocedural neurologic event, defined as a transient ischemic
attack or an ischemic stroke within 24 hours post-TAVR, per the Valve
Academic Research Consortium-3 criteria. Secondary endpoints were
periprocedural and 30-day ischemic stroke rate, fluoroscopy time, contrast
volume, radiation dose, procedure duration, and minor and major bleeding.
All neurologic events were adjudicated by an attending neurologist. P
values were calculated using the Pearson chi-square test or 2-tailed
unpaired Student's t-test, as appropriate. Result(s): Both TAVR with
CEP (n = 425) and TAVR only (n = 565) groups had similar baseline
characteristics, vascular access, and valve type. Acute periprocedural
neurologic events were significantly lower in patients with CEP compared
with TAVR only (1.17% vs 3.18%; P = 0.037). Both periprocedural (0.94% vs
2.65%; P = 0.051) and 30-day (4.01% vs 6.19%; P = 0.125) ischemic strokes
were lower in the CEP group, though not statistically significantly. No
differences were shown for any other secondary endpoints that were
measured. Conclusion(s): These findings suggest CEP use to be
associated with a significant decrease in periprocedural neurologic events
without differences in procedural characteristics. Statistical
significance was not met, because of the small number of ischemic strokes
observed in the study. However, patients with CEP use had a lower rate of
periprocedural ischemic strokes, suggesting that larger, randomized
studies are needed to determine statistical significance. Categories:
STRUCTURAL: Valvular Disease: Aortic Copyright © 2021

<120>
Accession Number
636314742
Title
Perioperative analgesia for the prolepsis of persistence of
post-thoracotomy chronic neuropathic pain.
Source
Signa Vitae. Conference: 21st Panhellenic Congress on Regional
Anaesthesia, Pain Management and Palliative Care. Agios Nikolaos Greece.
17(SUPPL 1) (pp S32), 2021. Date of Publication: September 2021.
Author
Boura D.; Anastassopoulou E.; Koufopoulou P.; Anastasiou N.; Antonios K.;
Konstantina L.
Institution
(Boura, Anastassopoulou, Antonios, Konstantina) Anesthesiology Department,
GONK oI AG. ANARGYROI, Athens, Greece
(Anastassopoulou) Department of Nursing, School of Health & Welfare
Sciences, UNIWA, Athens, Greece
(Koufopoulou) Department of Economics, Laboratory of Economics & Health
Management, School of Economics, Business & International Studies, Univ.
of Piraeus, MSc. State Pub. Plcy. (Dept. of Mgmt. Sci.), Dept. of Polit.
Sci. Pub. Admin., Sch. of NOPE, EKPA, BSc. of Social Plcy. Social
Anthropol., Panteion Univ. of Social Polit. Sci., PPC SA, Former Deputy
Governor of GNA KAT, Former Chmn. of the Bd. KEKYKAMEA Cyclades, Athens,
Greece
(Anastasiou) Thoracic Surgery Department, GONK oI AG. ANARGYROI, Athens,
Greece
Publisher
Pharmamed Mado Ltd
Abstract
Proper perioperative analgesic management of Thoracic surgery cases
constitutes a primary factor for the successful outcome of the surgery,
having created the ideal conditions for both the thoracic surgeon and the
anesthesiologist, but mainly for the avoidance of postoperative pain for
the patient. 5%-67% of thoracic surgery cases reports post thoracotomy
pain syndrome that can persist for up to 20 years. Purpose(s): To
give prominence to the benefits of analgesics for the patient undergoing
thoracic surgery after having received appropriate perioperative treatment
and starts analgesic protection from the time preceding surgical incision
to the patient's complete recovery, as far as prevention of chronic
neuropathic pain is concerned. Complete analgesic protection presupposes
the interdisciplinary collaboration of the surgeon and the
anesthesiologist with the patient. Material(s) and Method(s):
Thorough review of scientific literature in scientific databases (PubMed,
Scopus, SignaVitae) concerning perioperative analgesia in thoracotomies.
 Result(s): In our effort to prevent the persistence of Chronic
Neuropathic Pain, we always take into consideration the fact that
thoracotomy patients suffer from respiratory complications/uneasy
breathing with invasive analgesia techniques. Therefore, we remain alert
to reduce the use of opioids and their adverse effects on those patients.
Major analgesic outcomes and avoidance of persistence of chronic
neuropathic pain can be achieved with the following procedure: (1)
Intravenous administration of non-steroidal anti-inflammatories,
paracetamol, dexamethasone 8 mg, NMDA receptor antagonist (Ketamine 30 mg)
before incision as well as local infusion of Ropivacaine 2% solution. (2)
Intravenous infusion of lidocaine, fentanyl, remifentanil, morphine,
tramadol, Mg, ketamine, during surgery by adjusting doses per patient and
operative time. (3) Particular caution is suggested in the immediate
postoperative period so as to avoid transition from acute postoperative
pain to chronic neuropathic pain. Our armamentarium includes paracetamol,
tramadol, dexketoprofen, oxycodone per os, PCA morphine, pain busters
(paired drainage catheters with elastomeric pumps) of ropivacaine 2%,
patch lidocaine and thoracic epidural analgesia with ropivacaine pumps and
intercostal block nerve conduction. A medical record of the postoperative
analgesic course of our patients is kept and completed by our medical and
nursing staff. Conclusion(s): Perioperative analgesia is our key
concern in all thoracic surgeries, so as to prevent post thoracotomy pain
syndrome. For the purpose of this concern, we administer analgesic
treatment on all surgery stages as well as keep postoperative analgesic
record.

<121>
Accession Number
2015249113
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:
August 2021.
Author
Fan Y.; Yu D.; Liang X.
Institution
(Fan) School of Medicine, Department of Anesthesiology, University of
Electronic Science and Technology of China, Chengdu, China
(Yu) Department of Anesthesiology, Second People s Hospital of Yibin,
Yibin, China
(Liang) Department of Anesthesiology, West China Hospital, Sichuan
University, Chengdu, China
Publisher
Edizioni Minerva Medica
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. 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. (Cite this article as: Fan Y, Yu D, Liang X. Volatile
anesthetics versus intravenous anesthetics for noncardiac thoracic
surgery: A systematic review and meta-Analysis. Copyright © 2021
Edizioni Minerva Medica. All rights reserved.

<122>
Accession Number
2015249111
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:
August 2021.
Author
Fanelli A.; No V.T.; 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
(No) 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, United States
(Mariano) Anesthesiology and Perioperative Care Service, Veterans Affairs
Palo Alto Health Care System, Palo Alto, CA, United States
(Balzani) Department of Medicine and Surgery, University of Turin, Turin,
Italy
Publisher
Edizioni Minerva Medica
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). 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. Copyright © 2021 Edizioni Minerva Medica. All rights
reserved.

<123>
Accession Number
2015290505
Title
Efficacy and safety of long-term evolocumab use among Asian subjects - A
subgroup analysis of the further cardiovascular outcomes research with
PCSK9 inhibition in subjects with elevated risk (fourier) trial - A s.
Source
Circulation Journal. 85(11) (pp 2063-2070), 2021. Date of Publication:
2021.
Author
Keech A.C.; Oyama K.; Sever P.S.; Tang M.; Murphy S.A.; Hirayama A.; Lu
C.; Tay L.; Deedwania P.C.; Siu C.-W.; Pineda A.L.; Choi D.; Charng M.-J.;
Amerena J.; Ahmad W.A.W.; Chopra V.K.; Pedersen T.R.; Giugliano R.P.;
Sabatine M.S.
Institution
(Keech) National Health and Medical Research Council, Clinical Trials
Centre, Sydney Medical School, University of Sydney, Sydney, NSW,
Australia
(Oyama, Tang, Murphy, Giugliano, Sabatine) TIMI Study Group, Division of
Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical
School, Boston, MA, United States
(Oyama) Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine, Sendai, Japan
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, London, United Kingdom
(Hirayama) Division of Cardiology, Department of Medicine, Nihon
University School of Medicine, Tokyo, Japan
(Lu, Pineda) Amgen, Thousand Oaks, CA, United States
(Tay) Cardiology Department, Changi General Hospital, Singapore, Singapore
(Deedwania) University of California San Francisco, School of Medicine,
San Francisco, CA, United States
(Siu) Cardiology Division, Department of Medicine, Li Ka Shing Faculty of
Medicine, The University of Hong Kong, Hong Kong
(Choi) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Charng) Division of Cardiology, Taipei Veterans General Hospital, Taipei,
Taiwan (Republic of China)
(Charng) Faculty of Medicine, School of Medicine, National Yang Ming
University, Taipei, Taiwan (Republic of China)
(Amerena) Geelong Cardiology Research Unit, Barwon Health, Geelong, VIC,
Australia
(Ahmad) Cardiology Department, University Malaya Medical Center, Kuala
Lumpur, Malaysia
(Chopra) Department of Cardiology, Max Super Speciality Hospital, New
Delhi, Saket, India
(Pedersen) Medical Faculty, Oslo University Hospital Aker, Oslo, Norway
Publisher
Japanese Circulation Society
Abstract
Background: There are concerns that Asian patients respond differently to
some medications. This study evaluated the efficacy and safety of
evolocumab among Asian vs. other subjects in the FOURIER trial, which
randomized stable atherosclerosis patients to receive either evolocumab or
placebo. Methods and Results: Effects of adding evolocumab vs.
placebo to background statin therapy on low-density lipoprotein
cholesterol (LDL-C) reductions, cardiovascular outcomes, and adverse
events were compared among 27, 564 participants with atherosclerotic
disease, according to self-reported Asian (n=2, 723) vs. other (n=24, 841)
races followed for a median of 2.2 years in the FOURIER trial. The primary
endpoint was a composite of cardiovascular death, myocardial infarction,
stroke, hospitalization for unstable angina, or coronary
revascularization. At randomization, Asians had slightly lower LDL-C
(median 89 [IQR 78-104] mg/dL vs. 92 [80-109] mg/dL; P<0.001) and were
much less likely to be on a high-intensity statin (33.3% vs. 73.3%;
P<0.001). Evolocumab lowered LDL-C more in Asians than in others (66% vs.
58%; P<0.001). The effect of evolocumab on the primary endpoint was
similar in Asians (HR, 0.79; 95% CI, 0.61-1.03) and others (HR, 0.86; 95%
CI, 0.79-0.93; P interaction=0.55). There was no excess of serious adverse
events with evolocumab among Asians over others. Conclusion(s): Use
of evolocumab robustly lowers LDL-C and is equally efficacious in lowering
the risk of cardiovascular events and safe in Asians as it is in
others. Copyright © 2021 Japanese Circulation Society. All rights
reserved.

<124>
Accession Number
2015265796
Title
Fate of Patients With Single Ventricles Who Do Not Undergo the Fontan
Procedure.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Zheng W.C.; Lee M.G.Y.; d'Udekem Y.
Institution
(Zheng, Lee, d'Udekem) Department of Paediatrics, University of Melbourne,
Melbourne, Australia
(Zheng, Lee, d'Udekem) Department of Cardiac Surgery, The Royal Children's
Hospital, Melbourne, Australia
(Lee, d'Udekem) Heart Research, Clinical Sciences, Murdoch Children's
Research Institute, Melbourne, Australia
(Lee) Department of Medicine, The Royal Melbourne Hospital, University of
Melbourne, Melbourne, Australia
(d'Udekem) Division of Cardiac Surgery, Children's National Hospital,
Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: The Fontan procedure, the last of a series of palliative
operations for patients born with single ventricles, is associated with a
significant late burden of complications. There are other strategies for
patients who are suboptimal candidates for Fontan completion; however, the
long-term outcomes of these different surgical options have not been
clearly elucidated. We performed a systematic literature review to
establish the current role of other treatment approaches besides the
Fontan procedure. Method(s): The MEDLINE and Embase databases were
systematically searched for articles describing the long-term outcomes of
patients with single ventricles who have not received the Fontan
procedure. Result(s): A total of 36 articles met all inclusion
criteria. There is a scarcity of contemporary data on the non-Fontan
cohort. Historical studies provided a significant contribution.
 Conclusion(s): Long-term survival of unoperated patients with single
ventricles is possible under the rare conditions of having balanced
hemodynamics. As many as half of patients may survive on only a
systemic-to-pulmonary artery shunt or bidirectional cavopulmonary shunt
for more than 20 years with reasonable functional status. In patients with
a failing single ventricle, the bidirectional cavopulmonary shunt is an
excellent bridge to heart transplantation and may provide better
posttransplant survival than patients with a Fontan circulation.
Currently, the Fontan procedure continues to be the best definitive
palliation for patients born with single ventricle lesions. However, for
those with borderline indications, other strategies should be carefully
considered. Copyright © 2021 The Society of Thoracic Surgeons

<125>
Accession Number
2014028092
Title
Acute Changes in Myocardial Expression of Heat Shock Proteins and
Apoptotic Response Following Blood, delNido, or Custodiol Cardioplegia in
Infants Undergoing Open-Heart Surgery.
Source
Pediatric Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Yayla-Tuncer E.; Sengelen A.; Tan-Recep B.Z.; Savluk O.F.; Yilmaz A.A.;
Ceyran H.; Onay-Ucar E.
Institution
(Yayla-Tuncer, Tan-Recep, Yilmaz, Ceyran) Pediatric Cardiovascular Surgery
Clinic, Kartal Kosuyolu High Specialization Training and Research
Hospital, Health Sciences University, Denizer Road No:2,
Cevizli-Kartal/Istanbul 34846, Turkey
(Sengelen) Department of Molecular Biology and Genetics, Institute of
Graduate Studies in Sciences, Istanbul University, Istanbul, Turkey
(Savluk) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High
Specialization Training and Research Hospital, Health Sciences University,
Istanbul, Turkey
(Onay-Ucar) Department of Molecular Biology and Genetics, Faculty of
Science, Istanbul University, Balabanaga, Sehzadebasi Road, Vezneciler,
Istanbul 34134, Turkey
(Tan-Recep) Pediatric Cardiovascular Surgery Clinic, Konya City Hospital,
Health Sciences University, Konya, Turkey
Publisher
Springer
Abstract
Stress caused by cardioplegic ischemic arrest was shown to alter the
expression levels of heat shock proteins (Hsp), but little is known about
their effects, particularly on pediatric hearts. This study aimed to
investigate whether myocardial cellular stress and apoptotic response
changes due to different cardioplegia (CP) solutions during
cardiopulmonary bypass (CPB) in infants and to determine their influence
on surgical/clinical outcomes. Therefore, twenty-seven infants for
surgical closure of ventricular septal defect were randomly assigned to a
CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol
(CCP). Hsp levels and apoptosis were determined by immunoblotting in
cardiac tissue from the right atrium before and after CP, and their
correlations with cardiac parameters were evaluated. No significant change
was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased
significantly in the BCP-group but increased markedly in the CCP-group.
Decreased Hsp60 and increased Hsp70 expression were detected in
dNCP-group. Importantly, apoptosis was not observed in dNCP- and
CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were
determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury
marker, was markedly lower in the BCP- and dNCP-groups than CCP.
Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated
with aortic cross-clamp time, total perfusion time, and cTn-I release. Our
findings show that dNCP provides the most effective myocardial
preservation in pediatric open-heart surgery and indicate that an increase
in Hsp70 expression may be associated with a cardioprotective effect,
while an increase in Hsp60 and Hsp90 levels may be an indicator of
myocardial damage during CPB. Copyright © 2021, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

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