EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
Accession Number
2012335509
Title
Revascularisation or medical therapy in elderly patients with acute
anginal syndromes: The RINCAL randomised trial.
Source
EuroIntervention. 17(1) (pp 67-74), 2021. Date of Publication: May 2021.
Author
De Belder A.; Myat A.; Blaxill J.; Haworth P.; O'Kane P.; Hatrick R.;
Aggarwal R.; Davie A.; Smith W.; Gerber R.; Byrne J.; Adamson D.; Witherow
F.; Alsanjari O.; Wright J.; Robinson D.R.; Hildick-Smith D.
Institution
(De Belder, Myat, Alsanjari, Hildick-Smith) Sussex Cardiac Centre,
Brighton, United Kingdom
(Myat, Wright) Brighton and Sussex Medical School, Brighton, United
Kingdom
(Blaxill) Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
(Haworth) Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
(O'Kane) The Royal Bournemouth and Christchurch Hospitals NHS Foundation
Trust, Bournemouth, United Kingdom
(Hatrick) Western Sussex Hospitals NHS Foundation Trust, Worthing, United
Kingdom
(Aggarwal) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Davie) Golden Jubilee National Hospital, Queen Elizabeth University
Hospital, Glasgow, United Kingdom
(Smith) Trent Cardiac Centre, Nottingham, United Kingdom
(Gerber) East Sussex Healthcare NHS Trust, Hastings, United Kingdom
(Byrne) King's College Hospital NHS Foundation Trust, London, United
Kingdom
(Adamson) University Hospitals Coventry and Warwickshire NHS Trust,
Coventry, United Kingdom
(Witherow) Dorset County Hospital NHS Foundation Trust, Dorchester, United
Kingdom
(Robinson) University of Sussex, Brighton, United Kingdom
Publisher
Europa Group
Abstract
Background: Historically the elderly have been under-represented in
non-ST-elevation myocardial infarction (NSTEMI) management trials.
<br/>Aim(s): The aim of this trial was to demonstrate that an
intervention-guided strategy is superior to optimal medical therapy (OMT)
alone for treating NSTEMI in elderly individuals. <br/>Method(s): Patients
(>=80 years, chest pain, ischaemic ECG, and elevated troponin) were
randomised 1:1 to an intervention-guided strategy plus OMT versus OMT
alone. The primary endpoint was a composite of all-cause mortality and
non-fatal myocardial reinfarction at 1 year. Ethics approval was obtained
by the institutional review board of every recruiting centre.
<br/>Result(s): From May 2014 to September 2018, 251 patients (n=125
invasive vs n=126 conservative) were enrolled. Almost 50% of participants
were female. The trial was terminated prematurely due to slow recruitment.
A Kaplan-Meier estimate of event-free survival revealed no difference in
the primary endpoint at 1 year (invasive 18.5% [23/124] vs conservative
22.2% [28/126]; p=0.39). No significant difference persisted after Cox
proportional hazards regression analysis (hazard ratio 0.79, 95%
confidence interval 0.45-1.35; p=0.39). There was greater freedom from
angina at 3 months (p<0.001) after early intervention but this was similar
at 1 year. Both non-fatal reinfarction (invasive 9.7% [12/124] vs
conservative 14.3% [18/126]; p=0.22) and unplanned revascularisation
(invasive 1.6% [2/124] vs conservative 6.4% [8/126]; p=0.10) occurred more
frequently in the OMT alone cohort. <br/>Conclusion(s): An
intervention-guided strategy was not superior to OMT alone to treat very
elderly NSTEMI patients. The trial was underpowered to demonstrate this
definitively. Early intervention resulted in fewer cases of reinfarction
and unplanned revascularisation but did not improve
survival.<br/>Copyright &#xa9; Europa Digital & Publishing 2021. All
rights reserved.

<2>
Accession Number
2010406809
Title
Response to: Angiography versus FFR-guided coronary artery bypass
grafting.
Source
Catheterization and Cardiovascular Interventions. 97(7) (pp E1058-E1059),
2021. Date of Publication: 01 Jun 2021.
Author
Bruno F.; De Filippo O.; Conrotto F.; D'Ascenzo F.
Institution
(Bruno, De Filippo, Conrotto, D'Ascenzo) Division of Cardiology,
Cardiovascular and Thoracic Department, Citta della Salute e della Scienza
Hospital and University of Turin, Torino, Italy
Publisher
John Wiley and Sons Inc

<3>
Accession Number
636546163
Title
Propitious temporal changes in clinical outcomes after transcatheter
compared to surgical aortic valve replacement; a meta-analysis of over
65,000 patients.
Source
Journal of cardiothoracic surgery. 16(1) (pp 312), 2021. Date of
Publication: 20 Oct 2021.
Author
Panchal A.; Kyvernitakis A.; Rayarao G.; Doyle M.; Biederman R.W.W.
Institution
(Panchal) Department of Internal Medicine, University of Pittsburgh
Medical Center, PA, Pittsburgh, United States
(Kyvernitakis, Rayarao, Doyle, Biederman) Department of Cardiovascular
disease, Allegheny General Hospital, PA, Pittsburgh, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: The treatment of symptomatic severe aortic stenosis (AS) has
rapidly evolved over the past decade, in both transcatheter (TAVR) and
surgical aortic valve replacement (SAVR), resulting in reported improved
clinical outcomes. Operator experience and technical improvements have
improved outcomes especially for patients undergoing TAVR. We sought to
determine and compare 1-year outcomes using a contemporary meta-analysis.
<br/>METHOD(S): We searched the Medline (MESH), Cochrane and Google
scholar databases using keywords "AS", "atrial fibrillation" (AFib) and
"stroke". We performed a meta-analysis to compare TAVR with SAVR
populations for post-procedural stroke, all-cause and cardiovascular
mortality at 1-year. <br/>RESULT(S): A total of 23 studies met criteria
for analysis with total population of 66,857 patients, of which 61,913 had
TAVR and 4944 had SAVR. Temporal trends demonstrated overall improvement
in outcome for both, TAVR and SAVR groups through the decade. Outcomes, in
terms of stroke (3.1% vs. 5%), all-cause (12.4% vs. 10.3%) and
cardiovascular mortality (7.2% vs. 6.2%) were similar at 1-year, in TAVR
versus SAVR, respectively. <br/>CONCLUSION(S): Despite overall gradual
improvement in both TAVR and SAVR outcomes over the decade, there is a
statistical overlap in confidence intervals for all-cause, cardiovascular
mortality and postprocedural stroke at 1-year. While 23 individual studies
demonstrate considerable advantages of each technique in certain cohorts,
integrating over 65,000 pts with our stratified surgical analysis suggests
that TAVR is comparable to SAVR for low and intermediate risk population
while superior to SAVR only in the highest-risk population for short and
intermediate term outcomes. This has substantial socio-economic
implications as we contemplate expanding our TAVR indications to
low/intermediate risk populations.<br/>Copyright &#xa9; 2021. The
Author(s).

<4>
[Use Link to view the full text]
Accession Number
636544100
Title
Clinical risk score for postoperative pneumonia following heart valve
surgery.
Source
Chinese medical journal. 134(20) (pp 2447-2456), 2021. Date of
Publication: 15 Sep 2021.
Author
Wang D.-S.; Huang X.-F.; Wang H.-F.; Le S.; Du X.-L.
Institution
(Wang) Department of Cardiovascular Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
Hubei 430022, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative pneumonia (POP) is one of the most common
infections following heart valve surgery (HVS) and is associated with a
significant increase in morbidity, mortality, and health care costs. This
study aimed to identify the major risk factors associated with the
occurrence of POP following HVS and to derive and validate a clinical risk
score. <br/>METHOD(S): Adults undergoing open HVS between January 2016 and
December 2019 at a single institution were enrolled in this study.
Patients were randomly assigned to the derivation and validation sets at
1:1 ratio. A prediction model was developed with multivariable logistic
regression analysis in the derivation set. Points were assigned to
independent risk factors based on their regression coefficients.
<br/>RESULT(S): POP occurred in 316 of the 3853 patients (8.2%).
Multivariable analysis identified ten significant predictors for POP in
the derivation set, including older age, smoking history, chronic
obstructive pulmonary disease, diabetes mellitus, renal insufficiency,
poor cardiac function, heart surgery history, longer cardiopulmonary
bypass, blood transfusion, and concomitant coronary and/or aortic surgery.
A 22-point risk score based on the multivariable model was then generated,
demonstrating good discrimination (C-statistic: 0.81), and calibration
(Hosmer-Lemeshow chi2 = 8.234, P = 0.312). The prediction rule also showed
adequate discriminative power (C-statistic: 0.83) and calibration
(Hosmer-Lemeshow chi2 = 5.606, P = 0.691) in the validation set. Three
risk intervals were defined as low-, medium-, and high-risk groups.
<br/>CONCLUSION(S): We derived and validated a 22-point risk score for POP
following HVS, which may be useful in preventive interventions and risk
management. TRIAL REGISTRATION: Chictr.org, ChiCTR1900028127;
http://www.chictr.org.cn/showproj.aspx?proj=46932.<br/>Copyright &#xa9;
2021 The Chinese Medical Association, produced by Wolters Kluwer, Inc.
under the CC-BY-NC-ND license.

<5>
Accession Number
636513468
Title
Transcatheter Aortic Valve Implantation: The Evolving Role of the
Radiologist in 2021.
Source
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden
Verfahren. 193(12) (pp 1411-1425), 2021. Date of Publication: 01 Dec 2021.
Author
Salgado R.; El Addouli H.; Budde R.P.J.
Institution
(Salgado, El Addouli) Radiology, UZA, Edegem, Belgium
(Salgado) Radiology, Holy Heart Hospital, Lier, Belgium
(Budde) Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
(Salgado, El Addouli) Radiology, Antwerp University Hospital,
Wilrijkstraat 10, Edegem 2650, Belgium
Publisher
Georg Thieme Verlag
Abstract
Background Transcatheter aortic valve implantation (TAVI) has gained
worldwide acceptance and implementation as an alternative therapeutic
option in patients with severe aortic valve stenosis unable to safely
undergo surgical aortic valve replacement. This transformative technique
places the radiologist in a key position in the pre-procedural assessment
of potential candidates for this technique, delivering key anatomical
information necessary for patient eligibility and procedural safety.
Recent trials also provide encouraging results to potentially extend the
indication to patients with safer risk profiles. Method The review is
based on a PubMed literature search using the search terms transcatheter
heart valve, TAVI, TAVR, CT, imaging, MR over a period from 2010-2020,
combined with personal comments based on the author's experience. Results
and Conclusion CT plays a prominent role in the pre-procedural workup,
delivering as a true 3D imaging modality optimal visualization of the
complex anatomy of the aortic root with simultaneous evaluation of the
patency of the different access routes. As such, the contribution of CT is
key for the determination of patient eligibility and procedural safety.
This input is supplementary to the contributions of other imaging
modalities and forms an important element in the discussions of the Heart
Valve Team. Knowledge of the procedure and its characteristics is
necessary in order to provide a comprehensive and complete report. While
the role of CT in the pre-procedural evaluation is well established, the
contribution of CT and MR and the clinical significance of their findings
in the routine follow-up after the intervention are less clear and
currently the subject of intense investigation. Important issues remain,
including the occurrence and significance of subclinical leaflet
thrombosis, prosthetic heart valve endocarditis, and long-term structural
valve degeneration. Key Points: CT plays a crucial role in evaluating
transcatheter heart valve candidates Evaluation must include the
dimensions of the aortic root and access paths The exact post-procedural
role of CT and MRI has not yet been determined. Citation Format Salgado R,
El Addouli H, Budde RP. Transcatheter Aortic Valve Implantation: The
Evolving Role of the Radiologist in 2021. Fortschr Rontgenstr 2021; 193:
1411-1425.<br/>Copyright &#xa9; 2021 Georg Thieme Verlag. All rights
reserved.

<6>
Accession Number
636544099
Title
Impact of preprocedural biological markers on 10-year mortality in the
SYNTAXES trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2021. Date of Publication: 21 Oct 2021.
Author
Hara H.; Kawashima H.; Ono M.; Takahashi K.; Mack M.J.; Holmes D.R.;
Morice M.-C.; Davierwala P.M.; Mohr F.W.; Thuijs D.J.F.M.; Kappetein A.P.;
O'Leary N.; van Klaveren D.; Onuma Y.; Serruys P.W.
Institution
(Hara) Department of Cardiology, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Creatinine clearance (CrCl) is an independent determinant of
mortality in predictive models of revascularisation outcomes for complex
coronary artery disease. AIMS: This study aimed to investigate the impact
of preprocedural biological markers on 10-year mortality following
coronary revascularisation. <br/>METHOD(S): The SYNTAX Extended Survival
(SYNTAXES) study evaluated the 10-year vital status follow-up of 1,800
patients with de novo three-vessel (3VD) and/or left main coronary artery
disease (LMCAD) randomised to include percutaneous or surgical coronary
revascularisation. The associations between mortality and preprocedural
C-reactive protein (CRP), haemoglobin, HbA1c, CrCl, fasting triglycerides,
low-density lipoprotein cholesterol, and high-density lipoprotein
cholesterol were analysed. <br/>RESULT(S): Out of 1,800 patients, 460
patients died before the 10-year follow-up. CRP, HbA1c and CrCl with
threshold values of >=2 mg/L, >=6% (42 mmol/mol) and &lt;60 ml/min,
respectively, were associated with 10-year all-cause death (adjusted
hazard ratio [95% confidence interval]: 1.35 [1.01-1.82], 1.51
[1.16-1.95], and 1.46 [1.07-2.00], respectively). There was no significant
interaction between the biological markers on all-cause mortality and the
type of revascularisation. Preprocedural lipid markers were not
significantly associated with 10-year all-cause death, but the non-use of
statins was a determinant factor of worse prognosis (adjusted confidence
interval [95% confidence interval]: 1.68 [1.26-2.25]). <br/>CONCLUSION(S):
Preprocedural biomarkers, such as CRP and HbA1c, are associated with
long-term mortality post revascularisation, regardless of the
revascularisation technique. Conventional lipidic biomarkers associated
with high-risk of cardiovascular events seem to be effectively mitigated
by the long-term use of statins, whereas the non-use of statins was a
factor of a worse prognosis, emphasising the importance of pharmacological
treatment. TRIAL REGISTRATION: SYNTAXES ClinicalTrials.gov reference:
NCT03417050. SYNTAX ClinicalTrials.gov reference: NCT00114972.

<7>
Accession Number
636543772
Title
Prothrombin complex concentrates in cardiac surgery: where are we?.
Source
Current opinion in anaesthesiology. (no pagination), 2021. Date of
Publication: 19 Oct 2021.
Author
Santana J.M.; Brovman E.Y.
Institution
(Santana) Department of Anesthesiology, Tufts Medical Center, Boston, MA,
United States
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Major bleeding in cardiac surgery is commonly
encountered, and, until recently, most frequently managed with fresh
frozen plasma (FFP). However, a Cochrane review found this practice to be
associated with a significant increase in red blood cell (RBC)
transfusions and costs. These findings have led to off-label uses of
prothrombin complex concentrates (PCCs) in cardiac surgery. The purpose of
this review is to compare and contrast the use of FFP and PCC, review the
components, limitations and risks of different types of PCCs, and discuss
the latest evidence for the use of PCC versus FFP in cardiac surgery.
RECENT FINDINGS: A recent review and meta-analysis suggests that PCC
administration in cardiac surgery is more effective than FFP in reducing
RBC transfusions and costs. SUMMARY: The current data supports the use of
4F-PCC instead of FFP as the primary hemostatic agent in cases of major
bleeding in cardiac surgery. The use of PCCs is associated with reduced
rates of RBC transfusions while maintaining a favorable safety profile.
Clear advantages of PCC over FFP include its smaller volume, higher
concentration of coagulation factors and shorter acquisition and
administration times.<br/>Copyright &#xa9; Copyright &#xa9; 2021 YEAR
Wolters Kluwer Health, Inc. All rights reserved.

<8>
Accession Number
2014634466
Title
Aminophylline for prevention and/or treatment of post-dural puncture
headache: A systematic review and meta-analysis study protocol.
Source
Anesthesiology and Pain Medicine. 11(6) (no pagination), 2021. Article
Number: e119674. Date of Publication: 2021.
Author
Safarpour A.R.; Mehrabi M.; Tarkesh F.; Ashrafizadeh H.; Keshtkar A.;
Askari H.; Abazari D.; Amini A.; Barati-Boldaji R.
Institution
(Safarpour, Tarkesh, Askari, Barati-Boldaji) Gastroenterohepatology
Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Islamic Republic of
(Mehrabi) Department of E-Learning, Virtual School, Shiraz University of
Medical Sciences, Shiraz, Iran, Islamic Republic of
(Ashrafizadeh) Department of Nursing, School of Nursing and Midwifery,
Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran, Islamic
Republic of
(Keshtkar) Department of Health Sciences Education Development, School of
Public Health, Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Abazari) Department of Cellular & Physiological Sciences & the Brain
Research Center, University of British Columbia, Vancouver, Canada
(Amini) Department of Anesthesiology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran, Islamic Republic of
Publisher
Kowsar Medical Institute
Abstract
Objectives: Post-dural Puncture Headache (PDPH) is prevalent among
individuals undergoing lumbar punctures. The non-invasive effect of some
drugs, such as aminophylline on PDPH has been investigated in several
clinical studies. As there is no comprehensive systematic review and
meta-analysis about the preventive and therapeutic effects of
aminophylline on PDPH in the literature, the clinical effectiveness of
this drug on the prevention and/or treatment of PDPH will be assessed in
this study. <br/>Method(s): PubMed/MEDLINE, Embase, WoS (Clarivate
Analytics), the Cochrane Central Register of Controlled Trials (CENTRAL),
CINAHL Complete, Scopus, and Google Scholar as electronic databases will
be precisely searched for clinical studies that assessed the effect of
aminophylline on PDPH. Studies between 01-01-1980 and 30-06-2020 will be
evaluated in this study, and there will not be any language restrictions.
Contradictions between the reviewers within any phase of the study
(screening, selecting, quality assess-ment, and data extraction) will be
resolved by consensus; in case of unsolved disagreements, a third reviewer
will eventually decide. The combination method will be applied according
to the methodological resemblance in the selected articles using the
Random Effect Model or the Fixed Effect Model. Also, for the included
articles, forest plots will be drawn. For assessing statistical
heterogene-ity, the I² statistic and the Q-statistic test will
be applied. In addition, funnel plots will be used for assessing
non-significant study effects and potential reporting bias. Furthermore,
Egger's and Begg's tests will be done, and publication bias will be
indicated by significant findings (P < 0.05). <br/>Conclusion(s): It is
expected that the results of this study will be of benefit to researchers
and clinicians for managing PDPH, and will be reported in conferences and
publications.<br/>Copyright &#xa9; 2021, Author(s).

<9>
Accession Number
2014164499
Title
An rct: To evaluate the clinical characteristics of patients having spinal
anaesthesia with intrathecal bupivacaine and clonidine, as well as
intrathecal bupivacaine and fentanyl.
Source
International Journal of Toxicological and Pharmacological Research. 11(4)
(pp 1-6), 2021. Date of Publication: 2021.
Author
Kumar S.
Institution
(Kumar) Department of Anaesthesiology, Katihar Medical College Hospital,
Katihar, India
Publisher
Dr. Yashwant Research Labs Pvt. Ltd.
Abstract
Aim: The aim of this study to assess the clinical profile of patients
undergoing spinal Anesthesia with intrathecal bupivacaine with clonidine
and intrathecal bupivacaine with fentanyl. <br/>Method(s): A prospective
double blind randomized controlled study was conducted in the Department
of anaesthesiology, Katihar medical college Hospital, Katihar, Bihar,
India. for 1 year. 110 adult patients were randomly divided on an
alternative basis into two groups of 55 each. Group "A"-Bupivacaine plus
clonidine group. Group "B"-Bupivacaine plus fentanyl group. Patients with
ASA grade 1 and 2 patients and age group of 18-72 yrs. Those patients
scheduled to undergo elective lower abdominal, lower extremity,
gynaecological or urological surgeries under subarachnoid block were
included in this study. Patients belonging to group 'A' received 3 ml (15
mg) of hyperbaric bupivacaine 0.5% plus 1 microg.kg^-1 of
clonidine. Patients of group 'B' received 3 ml (15 mg) of hyperbaric
bupivacaine 0.5% plus (25 microg) of fentanyl. After injection, patient
was immediately turned to supine position. <br/>Result(s): Majority of
patients in the both the groups belonged to thegroup 30 to 40 years
34.54%. The number of males 43.64% and females 56.36%. Majority of female
patients in the both the groups belonged to the group 160 to 170 cms and
males 171 to 175 cms, Samples were height matched. Most of the patients
41.82 percent from gynaecology surgery followed by lower limb surgery
33.63 percent and Lower Abdominal Surgery 24.55 percent.
<br/>Conclusion(s): We concluded that the administration of local
anaesthetics in combination with opioids intrathecally is an established
technique for managing postoperative pain following abdominal, pelvic,
thoracic or orthopaedic procedures on lower extremities. Local
anaesthetics with opioids demonstrate significant synergy.<br/>Copyright
&#xa9; 2021, Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.

<10>
Accession Number
2010397186
Title
High Coronary Wall Shear Stress Worsens Plaque Vulnerability: A Systematic
Review and Meta-Analysis.
Source
Angiology. 72(8) (pp 706-714), 2021. Date of Publication: September 2021.
Author
Bajraktari A.; Bytyci I.; Henein M.Y.
Institution
(Bajraktari, Bytyci, Henein) Institute of Public Health and Clinical
Medicine, Umea University, Sweden
(Bytyci) University College, Bardhosh, Kosovo
(Bytyci) Clinic of Cardiology, University Clinical Centre of Kosovo,
Prishtina, Kosovo
(Henein) Molecular and Clinic Research Institute, St George University,
London, United Kingdom
(Henein) Brunel University, United Kingdom
Publisher
SAGE Publications Inc.
Abstract
Aim: The aim of this meta-analysis is to assess the impact of wall shear
stress (WSS) severity on arterial plaque vulnerability. <br/>Method(s): We
systematically searched electronic databases and selected studies which
assessed the relationship between WSS measured by intravascular ultrasound
and coronary artery plaque features. In 7 studies, a total of 615 patients
with 28 276 arterial segments (median follow-up: 7.71 months) were
identified. At follow-up, the pooled analysis showed high WSS to be
associated with regression of plaque fibrous area, weighted mean
difference (WMD) -0.11 (95% CI: -0.20 to -0.02, P =.02) and fibrofatty
area, WMD -0.09 (95% CI: -0.17 to -0.01, P =.02), reduction in plaque
total area, WMD -0.09 (95% CI: -0.14 to -0.04, P =.007) and increased
necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P =.03) compared with
low WSS. Dense calcium deposits remained unchanged in high and low WSS
(0.01 vs 0.02 mm²; P >.05). High WSS resulted in profound
remodeling (40% vs 18%, P <.05) and with more constructive remodeling than
low WSS (78% vs 40%, P <.01). <br/>Conclusion(s): High WSS in coronary
arteries is associated with worsening plaque vulnerability and more
profound arterial wall remodeling compared with low WSS.<br/>Copyright
&#xa9; The Author(s) 2021.

<11>
Accession Number
2008042450
Title
Economic evaluation of complete revascularization versus stress
echocardiography-guided revascularization in the STEACS with multivessel
disease.
Source
Revista Espanola de Cardiologia. 74(12) (pp 1055-1062), 2021. Date of
Publication: December 2021.
Author
Flores-Rios X.; Calvino-Santos R.A.; Estevez-Loureiro R.; Peteiro-Vazquez
J.; Salgado-Fernandez J.; Rodriguez-Vilela A.; Franco-Gutierrez R.;
Bouzas-Mosquera A.; Rodriguez-Fernandez J.A.; Marzoa-Rivas R.;
Gonzalez-Juanatey C.; Aldama-Lopez G.; Pinon-Esteban P.; Vazquez-Gonzalez
N.; Muniz-Garcia J.; Vazquez-Rodriguez J.M.
Institution
(Flores-Rios, Calvino-Santos, Peteiro-Vazquez, Salgado-Fernandez,
Bouzas-Mosquera, Rodriguez-Fernandez, Aldama-Lopez, Pinon-Esteban,
Vazquez-Gonzalez, Vazquez-Rodriguez) Unidad de Hemodinamica, Servicio de
Cardiologia, Instituto de Investigacion Biomedica de A Coruna (INIBIC),
Complejo Hospitalario Universitario de A Coruna (CHUAC), A Coruna, Spain
(Calvino-Santos, Peteiro-Vazquez, Salgado-Fernandez, Bouzas-Mosquera,
Vazquez-Gonzalez, Muniz-Garcia, Vazquez-Rodriguez) Centro de Investigacion
Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
(Estevez-Loureiro) Unidad de Hemodinamica, Servicio de Cardiologia,
Hospital Universitario Alvaro Cunqueiro, Vigo, Pontevedra, Spain
(Rodriguez-Vilela, Marzoa-Rivas) Servicio de Cardiologia, Complexo
Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruna, Spain
(Franco-Gutierrez, Gonzalez-Juanatey) Servicio de Cardiologia, Hospital
Universitario Lucus Augusti, Lugo, Spain
(Muniz-Garcia) Departamento de Ciencias de la Salud, Universidad de A
Coruna, A Coruna, Spain
Publisher
Ediciones Doyma, S.L.
Abstract
Introduction and objectives: Economic studies may help decision making in
the management of multivessel disease in the setting of myocardial
infarction. We sought to perform an economic evaluation of CROSS-AMI
(Complete Revascularization or Stress Echocardiography in Patients With
Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction)
randomized clinical trial. <br/>Method(s): We performed a cost
minimization analysis for the strategies (complete angiographic
revascularization [ComR] and selective stress echocardiography-guided
revascularization [SelR]) compared in the CROSS-AMI clinical trial (N =
306), attributable the initial hospitalization and readmissions during the
first year of follow-up, using current rates for health services provided
by our health system. <br/>Result(s): The index hospitalization costs were
higher in the ComR group than in SelR arm (19 657.9 +/- 6236.8 vs 14
038.7 +/- 4958.5 ; P < .001). There were no differences in the costs of
the first year of follow-up rehospitalizations between both groups for
(ComR 2423.5 +/- 4568.0 vs SelR 2653.9 +/- 5709.1; P = .697). Total cost
was 22 081.3 +/- 7505.6 for the ComR arm and 16 692.6 +/- 7669.9 for the
SelR group (P < .001). <br/>Conclusion(s): In the CROSS-AMI trial, the
initial extra economic costs of the ComR versus SelR were not offset by
significant savings during follow-up. SelR seems to be more efficient than
ComR in patients with ST-segment elevation acute coronary syndrome and
multivessel disease treated by emergent angioplasty. Study registred at
ClinicalTrial.gov (Identifier: NCT01179126).<br/>Copyright &#xa9; 2020
Sociedad Espanola de Cardiologia

<12>
Accession Number
2013979152
Title
SARS-CoV-2 infection in heart transplant recipients: a systematic
literature review of clinical outcomes and immunosuppression strategies.
Source
Heart Failure Reviews. (no pagination), 2021. Date of Publication: 2021.
Author
Ilonze O.J.; Ballut K.; Rao R.S.; Jones M.A.; Guglin M.
Institution
(Ilonze, Ballut, Rao, Jones, Guglin) Krannert Institute of Cardiology,
Section of Advanced Heart Failure and Transplant Cardiology, Division of
Cardiology, Indiana University School of Medicine, Indianapolis, United
States
(Ilonze) IndianapolisUnited States
Publisher
Springer
Abstract
The impact of SARS-CoV-2 infection on heart transplant recipients is
unknown. Literature is limited to case reports and series. The purpose of
this study is to identify the clinical features, outcomes, and
immunosuppression strategies of heart transplant recipients with COVID-19
infection. A systematic review was conducted using the search term
"Coronavirus" or COVID," "SARS-CoV-2," "cardiac transplantation," and
"heart transplant." Case reports and retrospective studies were gathered
by searching Medline/PubMed, Google Scholar, CINAHL, Cochrane CENTRAL, and
Web of Science. Thirty-three articles were selected for review. We
identified 74 cases of SARS-CoV-2 infection in heart transplant and
heart-kidney transplant recipients. The mean age was 60.5 +/- 15.8 years,
and 82.4% were males with median time from transplant of 6.5 years.
Commonest symptoms were fever, cough, and dyspnea, but new left
ventricular (LV) dysfunction was rare. Leukocytosis, lymphopenia, elevated
inflammatory markers, and bilateral ground-glass opacities were common.
Mortality was high, with particularly poor survival in patients who
required intensive care unit (ICU) admission and older patients.
Immunosuppression involved discontinuation of antimetabolites and
steroids. COVID-19 infection in heart transplant (HT) recipients presents
similarly to the general population, but new onset of LV dysfunction is
uncommon. Immunosuppression strategies include increase in corticosteroids
and discontinuation of antimetabolites.<br/>Copyright &#xa9; 2021, The
Author(s), under exclusive licence to Springer Science+Business Media,
LLC, part of Springer Nature.

<13>
Accession Number
2014308431
Title
A multicenter randomized placebo-controlled trial of intravenous thyroxine
for heart-eligible brain-dead organ donors.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 852. Date of
Publication: December 2021.
Author
Dhar R.; Klinkenberg D.; Marklin G.
Institution
(Dhar) Department of Neurology, Washington University in St. Louis School
of Medicine, St. Louis, MO, United States
(Klinkenberg, Marklin) Mid-America Transplant, St. Louis, MO, United
States
Publisher
BioMed Central Ltd
Abstract
Background: Brain death frequently induces hemodynamic instability and
cardiac stunning. Impairments in cardiac performance are major
contributors to hearts from otherwise eligible organ donors not being
transplanted. Deficiencies in pituitary hormones (including
thyroid-stimulating hormone) may contribute to hemodynamic instability,
and replacement of thyroid hormone has been proposed as a means of
improving stability and increasing hearts available for transplantation.
Intravenous thyroxine is commonly used in donor management. However, small
controlled trials have not been able to demonstrate efficacy.
<br/>Method(s): This multicenter study will involve organ procurement
organizations (OPOs) across the country. A total of 800 heart-eligible
brain-dead organ donors who require vasopressor support will be randomly
assigned to intravenous thyroxine for at least 12 h or saline placebo. The
primary study hypotheses are that thyroxine treatment will result in a
higher proportion of hearts transplanted and that these hearts will have
non-inferior function to hearts not treated with thyroxine. Additional
outcome measures are the time to achieve hemodynamic stability (weaning
off vasopressors) and improvement in cardiac ejection fraction on
echocardiography. <br/>Discussion(s): This will be the largest randomized
controlled study to evaluate the efficacy of thyroid hormone treatment in
organ donor management. By collaborating across multiple OPOs, it will be
able to enroll an adequate number of donors and be powered to definitively
answer the critical question of whether intravenous thyroxine treatment
increases hearts transplanted and/or provides hemodynamic benefits for
donor management. Trial registration: ClinicalTrials.govNCT04415658.
Registered on June 4, 2020.<br/>Copyright &#xa9; 2021, The Author(s).

<14>
Accession Number
51726129
Title
Effects on 11-year mortality and morbidity of lowering LDL cholesterol
with simvastatin for about 5 years in 20 536 high-risk individuals: A
randomised controlled trial.
Source
The Lancet. 378(9808) (pp 2013-2020), 2011. Date of Publication: 10 Dec
2011.
Author
Bulbulia R.; Bowman L.; Wallendszus K.; Peto R.; Collins R.; Meade T.;
Sleight P.; Armitage J.; Parish S.; Youngman L.; Buxton M.; De Bono D.;
George C.; Fuller J.; Keech A.; Mansfield A.; Pentecost B.; Simpson D.;
Warlow C.; McNamara J.; O'Toole L.; Doll R.; Wilhelmsen L.; Fox K.M.; Hill
C.; Sandercock P.
Institution
(Bulbulia, Bowman, Wallendszus, Parish, Armitage, Peto, Collins, Collins,
Meade, Sleight, Armitage, Parish, Youngman, Buxton, De Bono, George,
Fuller, Keech, Mansfield, Pentecost, Simpson, Warlow, McNamara, O'Toole,
Doll, Wilhelmsen, Fox, Hill, Sandercock) Clinical Trial Service Unit,
Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF,
United Kingdom
Publisher
Lancet Publishing Group (E-mail: cususerv@lancet.com)
Abstract
Findings of large randomised trials have shown that lowering LDL
cholesterol with statins reduces vascular morbidity and mortality rapidly,
but limited evidence exists about the long-term efficacy and safety of
statin treatment. The aim of the extended follow-up of the Heart
Protection Study (HPS) is to assess long-term efficacy and safety of
lowering LDL cholesterol with statins, and here we report cause-specific
mortality and major morbidity in the in-trial and post-trial periods. 20
536 patients at high risk of vascular and non-vascular outcomes were
allocated either 40 mg simvastatin daily or placebo, using minimised
randomisation. Mean in-trial follow-up was 5.3 years (SD 1.2), and
post-trial follow-up of surviving patients yielded a mean total duration
of 11.0 years (SD 0.6). The primary outcome of the long-term follow-up of
HPS was first post-randomisation major vascular event, and analysis was by
intention to treat. This trial is registered with ISRCTN, number 48489393.
During the in-trial period, allocation to simvastatin yielded an average
reduction in LDL cholesterol of 1.0 mmol/L and a proportional decrease in
major vascular events of 23 (95 CI 19-28; p<0.0001), with significant
divergence each year after the first. During the post-trial period (when
statin use and lipid concentrations were similar in both groups), no
further significant reductions were noted in either major vascular events
(risk ratio [RR] 0.95 [0.89-1.02]) or vascular mortality (0.98
[0.90-1.07]). During the combined in-trial and post-trial periods, no
significant differences were recorded in cancer incidence at all sites
(0.98 [0.92-1.05]) or any particular site, or in mortality attributed to
cancer (1.01 [0.92-1.11]) or to non-vascular causes (0.96 [0.89-1.03]).
More prolonged LDL-lowering statin treatment produces larger absolute
reductions in vascular events. Moreover, even after study treatment
stopped in HPS, benefits persisted for at least 5 years without any
evidence of emerging hazards. These findings provide further support for
the prompt initiation and long-term continuation of statin treatment. UK
Medical Research Council, British Heart Foundation, Merck & Co, Roche
Vitamins. &#xa9; 2011 Elsevier Ltd.

<15>
Accession Number
2013307575
Title
Preoperative walking recommendation for non-cardiac surgery patients to
reduce the length of hospital stay: a randomized control trial.
Source
BMC Sports Science, Medicine and Rehabilitation. 13(1) (no pagination),
2021. Article Number: 80. Date of Publication: December 2021.
Author
Cortes O.L.; Herrera-Galindo M.; Becerra C.; Rincon-Roncancio M.;
Povea-Combariza C.; Esparza-Bohorquez M.
Institution
(Cortes) Research Unit and Nursing Department, Fundacion
Cardioinfantil-Instituto de Cardiologia, Cl. 163a #13B-60, Bogota D.C,
Colombia
(Herrera-Galindo) Faculty of Health Sciences, Universidad Autonoma de
Bucaramanga, Avenida 42 No 48-11PBX, Bucaramanga, Colombia
(Becerra) Nursing Department, Fundacion Cardioinfantil-Instituto de
Cardiologia, Cl. 163a #13B-60, Bogota D.C, Colombia
(Rincon-Roncancio) Cardiovascular Rehabilitation Department, Fundacion
Cardioinfantil-Instituto de Cardiologia, Cl. 163a #13B-60, Bogota D.C,
Colombia
(Povea-Combariza) Faculty of Medicine, Universidad Nacional de Colombia,
Cra 45, Bogota D.C, Colombia
(Esparza-Bohorquez) Nursing Department, Fundacion Oftalmologica de
Santander-Clinica Carlos Ardila Lulle, FOSCAL, Calle 155A No23-60,
Floridablanca, Colombia
Publisher
BioMed Central Ltd
Abstract
Background: Even though the importance of preparing patients for a
surgical event is recognized, there are still gaps about the benefit of
improving functional capacity by walking during the waiting time among
patients scheduled for non-cardiac surgery. The aim of this study was to
evaluate the impact of pre-surgical walking in-hospital length of stay,
early ambulation, and the appearance of complications after surgery among
patients scheduled for non-cardiac surgery. <br/>Method(s): A two-arm,
single- blinded randomized controlled trial was developed from May 2016 to
August 2017. Eligible outpatients scheduled for non-cardiac surgery,
capable of walking, were randomized (2:1 ratio) to receive a prescription
of walking 150 min/week during the whole pre-surgical waiting time (n =
249) or conventional care (n = 119). The primary outcome was the
difference in hospital length of stay, and secondary results were time to
first ambulation during hospitalization, description of ischemic events
during hospitalization and after six months of hospital discharge, and the
walking continuation. We performed an intention to treat analysis and
compared length of stay between both groups by Kaplan-Meier estimator
(log-rank test). <br/>Result(s): There were no significant differences in
the length of hospital stay between both groups (log-rank test p = 0.367)
and no differences in the first ambulation time during hospitalization
(log-rank test p = 0.299). Similar rates of postoperative complications
were observed in both groups, but patients in the intervention group
continued to practice walking six months after discharge (p < 0.001).
<br/>Conclusion(s): Our study is the first clinical trial evaluating the
impact of walking before non-cardiac surgery in the length of stay, early
ambulation, and complications after surgery. Prescription of walking for
patients before non-cardiac surgery had no significant effect in reducing
the length of stay, and early ambulation. The results become a crucial
element for further investigation. Trial registration: PAMP-Phase2 was
registered in ClinicalTrials.gov NCT03213496 on July 11,
2017.<br/>Copyright &#xa9; 2021, The Author(s).

<16>
Accession Number
2014620351
Title
Nonautologous Grafts in Coronary Artery Bypass Surgery: A Systematic
Review.
Source
Annals of Thoracic Surgery. 112(6) (pp 2094-2103), 2021. Date of
Publication: December 2021.
Author
Lampridis S.; George S.J.
Institution
(Lampridis, George) Bristol Medical School, University of Bristol,
Bristol, United Kingdom
Publisher
Elsevier Inc.
Abstract
Background: Suitable autologous conduits may be lacking when performing
coronary artery bypass grafting. The aim of this review is to determine
the status of nonautologous grafts in coronary artery bypass grafting.
<br/>Method(s): We conducted a literature search on MEDLINE All, Embase
Classic, and Embase through Ovid from 1960 to April 2020. <br/>Result(s):
Of the 1579 records identified, 21 studies were included in the review.
The following grafts were assessed for patency: 109 homologous saphenous
veins (patency rates ranged from 66.7% at a median follow-up of 8.5 months
to 0% at 6-12 months and 7-18 months, respectively), 29 expanded
polytetrafluoroethylene grafts (from 80% at a median follow-up of 5 months
to 14.3% at 45 months), 12 human umbilical veins (50% at a median
follow-up of 6 months), 50 Bioflow bovine internal mammary arteries (from
15.8% to 0% at a mean follow-up of 9.5 months and 19 months,
respectively), 39 Perma-Flow grafts (80% and 76.9% at 1-3 months and 12
months, respectively), 20 No-React bovine internal mammary arteries (57.1%
at a median follow-up of 28 months and 23.1% at a mean follow-up of 7
months), 40 autologous venous endothelial cell-seeded expanded
polytetrafluoroethylene grafts (94.7% and 81% at a mean follow-up of 27
months and 60 months, respectively), and 12 autologous venous endothelial
cell-seeded cryopreserved homologous veins (83.3% at a mean follow-up of
8.5 months). <br/>Conclusion(s): The goal of an alternative conduit with
patency and attributes that match those of autografts remains elusive.
Autologous endothelial cell-seeded synthetic grafts have demonstrated
promising results but require further investigation.<br/>Copyright &#xa9;
2021 The Society of Thoracic Surgeons

<17>
Accession Number
2014154113
Title
Acute and Chronic Kidney Disease Following Congenital Heart Surgery: A
Review.
Source
Annals of Thoracic Surgery. 112(5) (pp 1698-1706), 2021. Date of
Publication: November 2021.
Author
Khuong J.N.; Wilson T.G.; Iyengar A.J.; d'Udekem Y.
Institution
(Khuong, Wilson, Iyengar) Heart Research Group, Murdoch Children's
Research Institute, Melbourne, Australia
(Khuong, Wilson, Iyengar) Department of Paediatrics, Faculty of Medicine,
University of Melbourne, Melbourne, Australia
(d'Udekem) Division of Cardiac Surgery, Children's National Hospital,
Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: There is an increasing prevalence of chronic kidney disease in
the population of adults currently living with congenital heart disease. A
considerable proportion of children who undergo congenital heart surgery
experience postoperative acute kidney injury. Whether there is an
association between acute kidney injury after cardiac surgery in childhood
and development of chronic kidney disease is unclear. <br/>Method(s):
Three electronic databases were searched to capture relevant studies
exploring the relationship between acute kidney injury after congenital
heart surgery in children and progression to chronic kidney disease.
<br/>Result(s): A literature search identified a total of 212 research
articles, 7 of which were selected for in-depth review.
<br/>Conclusion(s): There is a likely association between acute kidney
injury in children undergoing congenital heart surgery and progression to
chronic kidney disease. Research should be developed to mitigate factors
contributing to postoperative acute kidney injury in neonates, infants,
and children undergoing cardiac surgery. Better targeted follow-up
protocols to monitor renal function in children undergoing cardiac surgery
should be implemented. A universal definition for acute kidney injury and
chronic kidney disease is needed to improve detection and research in this
field.<br/>Copyright &#xa9; 2021 The Society of Thoracic Surgeons

<18>
Accession Number
2015568740
Title
Association between perioperative hypotension and postoperative delirium
and atrial fibrillation after cardiac surgery: A post-hoc analysis of the
DECADE trial.
Source
Journal of Clinical Anesthesia. 76 (no pagination), 2022. Article Number:
110584. Date of Publication: February 2022.
Author
Wang J.; Mao G.; Malackany N.; Marciniak D.; Donaldson C.; Wakefield B.;
Hassan M.; Ruetzler K.; Sessler D.I.; Turan A.
Institution
(Wang, Mao, Hassan, Ruetzler, Sessler, Turan) Department of Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Malackany, Marciniak, Donaldson, Wakefield) Department of Cardiovascular
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
(Ruetzler, Turan) Department of General Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Mao) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Wang) Department of Anesthesiology, Shanghai Ninth People's Hospital,
Shanghai JiaoTong University School of Medicine, Shanghai, China
Publisher
Elsevier Inc.
Abstract
Study objective: To test the hypotheses that in adults having cardiac
surgery with cardio-pulmonary bypass, perioperative hypotension increases
the risk of delirium and atrial fibrillation during the initial five
postoperative days. <br/>Design(s): Sub-analysis of the DECADE
multi-center randomized trial. <br/>Setting(s): Patients who had cardiac
surgery with cardiopulmonary bypass at the Cleveland Clinic.
<br/>Intervention(s): In the underlying trial, patients were randomly
assigned 1:1 to dexmedetomidine or normal saline placebo. Measurements:
Intraoperative mean arterial pressures were recorded at 1-min intervals
from arterial catheters or at 1-5-min intervals oscillometrically.
Postoperative blood pressures were recorded every half-hour or more often.
The co-primary outcomes were atrial fibrillation and delirium occurring
between intensive care unit admission and the earlier of postoperative day
5 or hospital discharge. Delirium was assessed twice daily during the
initial 5 postoperative days while patients remained hospitalized with the
Confusion Assessment Method for the intensive care unit. Assessments were
made by trained research fellows who were blinded to the dexmedetomidine
administration. <br/>Main Result(s): There was no significant association
between intraoperative hypotension and delirium, with an adjusted odds
ratio of 0.94 (95% CI: 0.81, 1.09; P = 0.419) for a doubling in AUC of
mean arterial pressure (MAP) <60 mmHg. An increase in intraoperative AUC
of MAP <60 mmHg was not significantly associated with the odds of atrial
fibrillation (adjusted odds ratio = 0.99; 95% CI: 0.87, 1.11; P = 0.819).
Postoperative MAP <70 mmHg per hour 1.14 (97.5% CI: 1.04,1.26; P = 0.002)
and MAP <80 mmHg per hour 1.05 (97.5%: 1.01, 1.10; P = 0.010) were
significantly associated with atrial fibrillation. <br/>Conclusion(s): In
patients having cardiac surgery with cardio-pulmonary bypass, neither
intraoperative nor postoperative hypotension were associated with
delirium. Postoperative hypotension was associated with atrial
fibrillation, although intraoperative hypotension was not.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<19>
Accession Number
2015527063
Title
Data quality of longitudinally collected patient-reported outcomes after
thoracic surgery: Comparison of paper- And web-based assessments.
Source
Journal of Medical Internet Research. 23(11) (no pagination), 2021.
Article Number: e28915. Date of Publication: November 2021.
Author
Yu H.; Yu Q.; Nie Y.; Xu W.; Pu Y.; Dai W.; Wei X.; Shi Q.
Institution
(Yu, Yu, Xu, Pu, Shi) School of Public Health and Management, Chongqing
Medical University, Chonqqing, China
(Nie, Shi) State Key Laboratory of Ultrasound in Medicine and Engineering,
College of Biomedical Engineering, Chongqing Medical University,
Chongqing, China
(Dai, Wei, Shi) Department of Thoracic Surgery, Sichuan Cancer Hospital
and Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China, Sichuan, Chengdu, China
Publisher
JMIR Publications Inc.
Abstract
Background: High-frequency patient-reported outcome (PRO) assessments are
used to measure patients' symptoms after surgery for surgical research;
however, the quality of those longitudinal PRO data has seldom been
discussed. <br/>Objective(s): The aim of this study was to determine data
quality-influencing factors and to profile error trajectories of data
longitudinally collected via paper-and-pencil (P&P) or web-based
assessment (electronic PRO [ePRO]) after thoracic surgery. <br/>Method(s):
We extracted longitudinal PRO data with 678 patients scheduled for lung
surgery from an observational study (n=512) and a randomized clinical
trial (n=166) on the evaluation of different perioperative care
strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung
Cancer Module and single-item Quality of Life Scale before surgery and
then daily after surgery until discharge or up to 14 days of
hospitalization. Patient compliance and data error were identified and
compared between P&P and ePRO. Generalized estimating equations model and
2-piecewise model were used to describe trajectories of error incidence
over time and to identify the risk factors. <br/>Result(s): Among 678
patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P
assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of
patients had at least one error, including (1) missing items (64.69%,
1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3)
selection of multiple options (3.02%, 50/1654), (4) missing patient
signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%,
24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who
completed ePRO had fewer errors than those who completed P&P assessments
(ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P<.001). Compared with
ePRO patients, those using P&P were older, less educated, and sicker.
Common risk factors of having errors were a lower education level (P&P:
Odds ratio [OR] 1.39, 95% CI 1.20-1.62; P<.001; ePRO: OR 1.82, 95% CI
1.22-2.72; P=.003), treated in a provincial hospital (P&P: OR 3.34, 95% CI
2.10-5.33; P<.001; ePRO: OR 4.73, 95% CI 2.18-10.25; P<.001), and with
severe disease (P&P: OR 1.63, 95% CI 1.33-1.99; P<.001; ePRO: OR 2.70, 95%
CI 1.53-4.75; P<.001). Errors peaked on postoperative day (POD) 1 for P&P,
and on POD 2 for ePRO. <br/>Conclusion(s): It is possible to improve data
quality of longitudinally collected PRO through ePRO, compared with P&P.
However, ePRO-related sampling bias needs to be considered when designing
clinical research using longitudinal PROs as major outcomes.<br/>Copyright
&#xa9; 2021 Journal of Medical Internet Research. All rights reserved.

<20>
Accession Number
2014364957
Title
Right Ventricular Outflow Tract Obstruction in Adults: A Systematic Review
and Meta-analysis.
Source
CJC Open. 3(9) (pp 1153-1168), 2021. Date of Publication: September 2021.
Author
Zeng Y.H.; Calderone A.; Rousseau-Saine N.; Elmi-Sarabi M.; Jarry S.;
Couture E.J.; Aldred M.P.; Dorval J.-F.; Lamarche Y.; Miles L.F.;
Beaubien-Souligny W.; Denault A.Y.
Institution
(Zeng, Calderone, Rousseau-Saine, Elmi-Sarabi, Jarry, Aldred, Denault)
Department of Anesthesiology, Montreal Heart Institute, University of
Montreal, Montreal, QC, Canada
(Couture) Department of Anesthesiology and Department of Medicine,
Division of Intensive Care Medicine, University Institute of Cardiology
and Respirology, Quebec, QC, Canada
(Dorval) Department of Cardiology, Montreal Heart Institute, University of
Montreal, Montreal, QC, Canada
(Lamarche) Department of Cardiac Surgery, Montreal Heart Institute,
University of Montreal, Montreal, QC, Canada
(Lamarche, Denault) Critical Care Division, Montreal Heart Institute,
University of Montreal, Montreal, QC, Canada
(Miles) Centre for Integrated Critical Care, The University of Melbourne,
Melbourne, Victoria, Australia and Department of Anaesthesia, Austin
Health, Melbourne, Australia
(Beaubien-Souligny) Department of Medicine, Nephrology Division, Centre
Hospitalier of the University of Montreal, Montreal, QC, Canada
Publisher
Elsevier Inc.
Abstract
Background: Right ventricular outflow tract obstruction (RVOTO) is a cause
of hemodynamic instability that can occur in several situations, including
cardiac surgery, lung transplantation, and thoracic surgery, and in
critically ill patients. The timely diagnosis of RVOTO is important
because it requires specific considerations, including the adverse effects
of positive inotropes, and depending on the etiology, the requirement for
urgent surgical intervention. <br/>Method(s): The objective of this
systematic review and meta-analysis was to determine the prevalence of
RVOTO in adult patients, and the distribution of all reported cases by
etiology. <br/>Result(s): Of 233 available reports, there were 229 case
reports or series, and 4 retrospective cohort studies, with one study also
reporting a prospective cohort. Of 291 reported cases of RVOTO, 61 (21%)
were congenital, 56 (19%) were iatrogenic, and 174 (60%) were neither
congenital nor iatrogenic (including intracardiac tumour). The mechanism
of RVOTO was an intrinsic obstruction in 169 cases (58%), and an extrinsic
obstruction in 122 cases (42%). A mechanical obstruction causing RVOTO was
present in 262 cases (90%), and 29 cases of dynamic RVOTO (10%) were
reported. In the 5 included cohorts, with a total of 1122 patients, the
overall prevalence was estimated to be 4.0% (1%-9%). <br/>Conclusion(s):
RVOTO, though rare, remains clinically important, and therefore,
multicentre studies are warranted to better understand the prevalence,
causes, and consequences of RVOTO.<br/>Copyright &#xa9; 2021 The Authors

<21>
Accession Number
2014243765
Title
Effectiveness of interventions for prevention of common infections in
people who use opioids: a protocol for a systematic review of systematic
reviews.
Source
Systematic Reviews. 10(1) (no pagination), 2021. Article Number: 298. Date
of Publication: December 2021.
Author
Kudrina I.; Puzhko S.; Filion K.B.; Gore G.; Paraskevopoulos E.; Windle
S.; Martel M.O.; Eisenberg M.J.
Institution
(Kudrina, Puzhko, Paraskevopoulos) Department of Family Medicine, Faculty
of Medicine and Health Sciences, McGill University, 5858 Chemin de la
Cote-des-Neiges, Suite 300, Montreal, QC H3S 1Z1, Canada
(Kudrina, Martel) Department of Anesthesia, Faculty of Medicine and Health
Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4, Canada
(Filion, Windle, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, Faculty of Medicine and Health Sciences, McGill
University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2,
Canada
(Filion, Eisenberg) Lady Davis Institute for Medical Research, Jewish
General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC
H3T 1E2, Canada
(Filion) Department of Medicine, Faculty of Medicine and Health Sciences,
McGill University Health Center, McGill University, 1001 Decarie
Boulevard, Suite D05-2212, Montreal, QC H4A3JI, Canada
(Gore) Schulich Library of Physical Sciences, Life Sciences, and
Engineering, McGill University, 3459 rue McTavish, Montreal, QC H3A OC9,
Canada
(Paraskevopoulos) Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa,
ON K2H 8P4, Canada
(Martel) Faculty of Dentistry, McGill University, 2001 Avenue McGill
College, Suite 500, Montreal, QC H3A 1G1, Canada
(Eisenberg) Department of Medicine, Faculty of Medicine and Health
Sciences, McGill University, 3605 de la Montagne, Montreal, Qc H3G 2M1,
Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, 3755 Chemin
de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
Publisher
BioMed Central Ltd
Abstract
Background: The North American opioid crisis is driven by opioid-related
mortality and morbidity, including opioid use-associated infections
(OUAIs), resulting in a substantial burden for society. Users of legal and
illegal opioids are at an increased risk of OUAIs compared to individuals
not using opioids. As reported for hepatitis C virus (HCV), human
immunodeficiency virus (HIV), bacterial, fungal, and other infections,
OUAIs transmission and acquisition risks may be modifiable. Several
systematic reviews (SRs) synthetized data regarding interventions to
prevent infections in persons using drugs (e.g., opioid substitution
therapy, needle and syringes exchange programs, psycho-social
interventions); however, their conclusions varied. Therefore, SR of
published SRs is needed to synthesize the highest level of evidence on the
scope and effectiveness of interventions to prevent OUAIs in people using
opioids legally or illegally. <br/>Method(s): We will comprehensively
search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of
Systematic Reviews, Epistemonikos, and Google Scholar databases from
inception to November 2020. Data selection and extraction for each SR will
be performed independently by two researchers, with disagreements resolved
by consensus. All SRs regarding interventions with evaluated effectiveness
to prevent OUAI in legal and/or illegal opioid users will be eligible.
Risk of bias assessment will be performed using the AMSTAR2 tool. The
results will be qualitatively synthesized, and a typology of
interventions' effectiveness with a statement on the strength of evidence
for each category will be created. <br/>Discussion(s): Our pilot search of
PubMed resulted in 379 SRs analyzing the effectiveness of interventions to
prevent HCV and HIV in persons who inject different types of drugs,
including opioids. Of these 379 SRs, 8 evaluated primary studies where
participants used opioids and would therefore be eligible for inclusion.
The search results thus justify the application of SR of SRs approach.
Comprehensive data on the scope and effectiveness of existing
interventions to prevent OUAIs will help policy-makers to plan and
implement preventive interventions and will assist clinicians in the
guidance for their patients using opioids. Systematic review registration:
Registered in PROSPERO on 30 July 2020 (#195929).<br/>Copyright &#xa9;
2021, The Author(s).

<22>
Accession Number
2014217742
Title
What is Standard Dose of Rivaroxaban in Elderly Asian Patients with Atrial
Fibrillation: 20ms versus. 15mg?.
Source
Clinical and Applied Thrombosis/Hemostasis. 27 (no pagination), 2021. Date
of Publication: 2021.
Author
Kim S.S.; Lee K.H.; Yoon N.S.; Park H.W.; Cho J.G.
Institution
(Kim) Chosun University Hospital, Gwangju, South Korea
(Lee, Yoon, Park, Cho) The Heart Center of Chonnam, National University
Hospital, Gwangju, South Korea
(Lee, Yoon, Park, Cho) Chonnam National University Medical School,
Gwangju, South Korea
Publisher
SAGE Publications Inc.
Abstract
Although there is no age criterion for rivaroxaban dose reduction, elderly
patients with atrial fibrillation (AF) are often prescribed an off-label
reduced dose. We aimed to evaluate whether age is a necessary criterion
for rivaroxaban dose reduction in Korean patients with AF. Among 2208
patients who prescribed warfarin or rivaroxaban, 552 patients over 75
years without renal dysfunction (creatinine clearance >50 mL/min) were
compared based on propensity score matching. The rivaroxaban group was
further divided into a 20 mg (R20; on-label) and a 15 mg (R15; off-label).
Primary net clinical benefit (NCB) was defined as the composite of stroke,
systemic embolism, major bleeding, and all-cause mortality. Secondary NCB
was defined as the composite of stroke, systemic embolism, and major
bleeding. Patients were followed for 1 year, or until the first outcome
occurrence. Both rivaroxaban groups had comparable efficacy compared with
warfarin. However, both R20 (0.9% vs 7.4%, p =.014) and R15 (2.3% vs 7.4%,
p =.018) had a significant reduction in major bleeding. There were no
differences in efficacy or safety outcomes between R20 and R15. R20 had
significantly reduced primary (hazard ratio [HR] 0.33, 95% confidence
interval [CI]: 0.12-0.93) and secondary (HR 0.31, 95% CI: 0.10-0.93) NCBs
compared with warfarin. However, primary and secondary NCBs were not
reduced in R15. In real-world practice with elderly patients with AF,
off-label rivaroxaban dose reduction to 15 mg conferred no benefits.
Therefore, guideline-adherent rivaroxaban 20 mg is favorable in elderly
Korean patients with AF.<br/>Copyright &#xa9; The Author(s) 2021.

<23>
Accession Number
2005737801
Title
Myocardial protection in cardiac surgery: how limited are the options? A
comprehensive literature review.
Source
Perfusion (United Kingdom). 36(4) (pp 338-351), 2021. Date of Publication:
May 2021.
Author
Whittaker A.; Aboughdir M.; Mahbub S.; Ahmed A.; Harky A.
Institution
(Whittaker, Aboughdir, Mahbub) Department of Medicine, St George's,
University of London, London, United Kingdom
(Aboughdir, Ahmed) Department of Medicine, Imperial College London,
London, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
Publisher
SAGE Publications Ltd
Abstract
For patients undergoing cardiopulmonary bypass, myocardial protection is a
key for successful recovery and improved outcomes following cardiac
surgery that requires cardiac arrest. Different solutions, components and
modes of delivery have evolved over the last few decades to optimise
myocardial protection. These include cold and warm and blood and
crystalloid solution through antegrade, retrograde or combined
cardioplegia delivery approach. However, each method has its own
advantages and disadvantages, posing a challenge to establish a
gold-standard cardioplegic solution with an optimised mode of delivery for
enhanced myocardial protection during cardiac surgery. The aim of this
review is to provide a brief history of the development of cardioplegia,
explain the electrophysiological concepts behind myocardial protection in
cardioplegia, analyse the current literature and summarise existing
evidence that warrants the use of varying cardioplegic techniques. We
provide a comprehensive and comparative overview of the effectiveness of
each technique in achieving optimal cardioprotection and propose novel
techniques for optimising myocardial protection in the
future.<br/>Copyright &#xa9; The Author(s) 2020.

<24>
Accession Number
2012853534
Title
Frailty Assessment of Transcatheter Aortic Valve Replacement Patients:
Contemporary Practice and Future Directions.
Source
Structural Heart. 5(4) (pp 357-366), 2021. Date of Publication: 2021.
Author
Chuang M.-Y.; Akodad M.; Chatfield A.; Landes U.; Ihdayhid A.; Lal S.;
Wood D.A.; Webb J.G.; Sathananthan J.
Institution
(Chuang, Akodad, Chatfield, Landes, Ihdayhid, Lal, Wood, Webb,
Sathananthan) Centre for Cardiovascular Innovation, St Paul's and
Vancouver General Hospital, Vancouver, Canada
(Chuang, Akodad, Chatfield, Landes, Ihdayhid, Lal, Wood, Webb,
Sathananthan) Centre for Heart Valve Innovation, St Paul's Hospital,
University of British Columbia, Vancouver, Canada
Publisher
Taylor and Francis Ltd.
Abstract
Frailty is a multi-system clinical syndrome characterized by reduced
physiological reserve and increased vulnerability to stressors. There is
now established evidence recognizing its incremental value as a predictor
of suboptimal outcomes in patients undergoing transcatheter aortic valve
replacement (TAVR) beyond conventional surgical risk scores and objective
frailty assessment is integrated in major guidelines. Several frailty
assessment tools have been developed and validated for use in patients
undergoing TAVR with varying complexity, clinical pragmatism and outcomes
assessed. In contemporary TAVR practice, frailty assessment guides patient
selection, informs care requirements, and identifies those who may require
supplemental treatment. Further opportunities to improve patient care in
this area include identification of interventions that can mitigate the
deleterious impact of frailty, evaluation of the role of frailty
assessment in low surgical risk patients, and development of frailty
management models that can be delivered virtually. In this review, we aim
to provide an overview of the concept of frailty, the available assessment
tools, peri-procedural considerations in frail patients undergoing TAVR
and future directions.<br/>Copyright &#xa9; 2021 Cardiovascular Research
Foundation.

<25>
Accession Number
2012213301
Title
Addition of low-dose sufentanil to ropivacaine for reducing shivering and
visceral traction pain during cesarean section.
Source
Journal of International Medical Research. 49(5) (no pagination), 2021.
Date of Publication: 2021.
Author
Chen X.-R.; Gao T.; Zhang Y.; Peng M.-Q.
Institution
(Chen, Peng) Department of Anesthesia, Yongchuan Hospital of Chongqing
Medical University, Chongqing, China
(Gao, Zhang) Department of Anesthesia, University-Town Hospital of
Chongqing Medical University, Chongqing, China
Publisher
SAGE Publications Ltd
Abstract
Objective: To investigate the efficacy of low-dose sufentanil for
preventing shivering and visceral traction pain during cesarean section
under spinal anesthesia. <br/>Method(s): This was a prospective,
randomized, controlled study. A total of 112 full-term parturients who
underwent elective caesarean delivery were randomly divided into two
groups. Group R received 0.75% isobaric ropivacaine intrathecally and
group RS received 0.75% isobaric ropivacaine plus 5 microg sufentanil
intrathecally. <br/>Result(s): There were no significant differences in
the maximum sensory block time, motor block time, duration of the surgery,
and heart rate, mean arterial pressure, and blood oxygen saturation before
and 1, 5, and 10 minutes after spinal anesthesia, and at the end of the
surgery between the two groups. Shivering was significantly more common in
group R (n = 30) than in group RS (n = 8). The incidence of visceral
traction pain in group R (46.43%) was significantly higher than that in
group RS (14.29%). There was no significant difference in the newborns'
Apgar scores between the groups. <br/>Conclusion(s): Adding low-dose
sufentanil to ropivacaine can significantly reduce the incidence of
shivering and visceral traction pain after spinal
anesthesia.<br/>Copyright &#xa9; The Author(s) 2021.

<26>
Accession Number
2011882500
Title
Ivabradine Versus Amiodarone in the Management of Postoperative Junctional
Ectopic Tachycardia: A Randomized, Open-Label, Noninferiority Study.
Source
JACC: Clinical Electrophysiology. 7(8) (pp 1052-1060), 2021. Date of
Publication: August 2021.
Author
Arvind B.; Kothari S.S.; Juneja R.; Saxena A.; Ramakrishnan S.; Gupta
S.K.; Chowdhury U.K.; Devagourou V.; Talwar S.; Hote M.P.; Rajashekar P.;
Sahu M.K.; Singh S.P.
Institution
(Arvind, Kothari, Juneja, Saxena, Ramakrishnan, Gupta) Department of
Cardiology, All India Institute of Medical Sciences, New Delhi, India
(Chowdhury, Devagourou, Talwar, Hote, Rajashekar, Sahu, Singh) Department
of Cardiothoracic and Vascular Surgery, All India Institute of Medical
Sciences, New Delhi, India
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to compare the efficacy of ivabradine and
amiodarone in the management of postoperative junctional ectopic
tachycardia (JET) after cardiac surgery in children. <br/>Background(s):
JET is a serious arrhythmia occurring in children after cardiac surgery
and requires aggressive management. Amiodarone has been conventionally
used in its treatment. Recent studies have reported the utility of
ivabradine in this regard. <br/>Method(s): In this open-label randomized
controlled trial, 94 children (age <=18 years) who developed postoperative
JET were allocated to receive either amiodarone or ivabradine. The primary
endpoint was restoration of normal sinus rhythm. <br/>Result(s): Sinus
rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone
group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean
difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to
11.5%). The median (interquartile range) time taken to achieve sinus
rhythm conversion was similar in both the groups: 21.5 (17-30.2) hours
versus 22 (13.4-38.5) hours (p = 0.36)]. The time taken to rate control of
JET was significantly less in the amiodarone group: median 7.0 (5.5-9.5)
hours versus 8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse
events were observed in the ivabradine group. <br/>Conclusion(s): Oral
ivabradine is not inferior to intravenous amiodarone in converting
postoperative JET to sinus rhythm. There was no difference in time taken
to sinus rhythm conversion between the groups, although the rate control
was earlier in patients who received amiodarone. Monotherapy with
ivabradine may be considered as an alternative to amiodarone in the
management of postoperative JET. (Comparison of Two Drugs, Ivabradine and
Amiodarone, in the Management of Junctional Ectopic Tachycardia, an
Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo
Cardiac Surgery: CTRI/2018/08/015182)<br/>Copyright &#xa9; 2021 American
College of Cardiology Foundation

<27>
Accession Number
2011830235
Title
Short dual antiplatelet therapy followed by P2Y<inf>12</inf>inhibitor
monotherapy vs. prolonged dual antiplatelet therapy after percutaneous
coronary intervention with second-generation drug-eluting stents: A
systematic review and meta-analysis of randomized clinical trials.
Source
European Heart Journal. 42(4) (pp 308-319), 2021. Date of Publication: 21
Jan 2021.
Author
Giacoppo D.; Matsuda Y.; Fovino L.N.; D'Amico G.; Gargiulo G.; Byrne R.A.;
Capodanno D.; Valgimigli M.; Mehran R.; Tarantini G.
Institution
(Giacoppo, Matsuda, Fovino, D'Amico, Tarantini) Department of
Cardiac-Thoracic-Vascular Sciences, University of Padova, Via Giustiniani
2, Padua 35128, Italy
(Giacoppo) Department of Cardiology, ISAResearch, German Heart Center,
Lazarettstrasse 36, Munich 80636, Germany
(Giacoppo, Byrne) Cardiovascular Research Institute, Mater Private
Hospital, Eccles Street 73, Dublin 7 D07 WKW8, Ireland
(Matsuda) Department of Cardiovascular Medicine, Tokyo Medical and Dental
University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
(Gargiulo) Department of Advanced Biomedical Sciences, Federico II
University of Naples, Via Pansini 5, Naples 80131, Italy
(Byrne) School of Pharmacy and Biomolecular Sciences, Royal College of
Surgeons in Ireland, 123 St. Stephen's Green, Saint Peter's, Dublin 2 D02
YN77, Ireland
(Capodanno) Department of Cardiology, Policlinico Rodolico-San Marco,
University of Catania, Via S. Sofia 78, Catania 95125, Italy
(Valgimigli) Department of Cardiology, Inselspital Bern, University of
Bern, Freiburgstrasse 10, Bern 3010, Switzerland
(Mehran) The Zena and Michael A. Weiner Cardiovascular Institute, The
Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New
York, NY 10029, United States
(Mehran) Cardiovascular Research Foundation, 1700 Broadway, New York, NY
10019, United States
Publisher
Oxford University Press
Abstract
Aims: After percutaneous coronary intervention (PCI) with
second-generation drug-eluting stent (DES), whether short dual
antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT)
with a P2Y12 receptor inhibitor confers benefits compared with prolonged
DAPT is unclear. <br/>Methods and Results: Multiple electronic databases,
including PubMed, Scopus, Web of Sciences, Ovid, and ScienceDirect, were
searched to identify randomized clinical trials comparing <=3 months of
DAPT followed by P2Y12 inhibitor SAPT vs. 12 months of DAPT after PCI with
second-generation DES implantation. The primary and co-primary outcomes of
interest were major bleeding and stent thrombosis 1 year after
randomization. Summary hazard ratios (HRs) and 95% confidence intervals
(CIs) were estimated by fixed-effect and random-effects models. Multiple
sensitivity analyses including random-effects models 95% CI adjustment
were applied. A sensitivity analysis comparing trials using P2Y12
inhibitor SAPT with those using aspirin SAPT was performed. A total of
five randomized clinical trials (32 145 patients) were available. Major
bleeding was significantly lower in the patients assigned to short DAPT
followed by P2Y12 inhibitor SAPT compared with those assigned to 12-month
DAPT (random-effects model: HR 0.63, 95% 0.45-0.86). No significant
differences between groups were observed in terms of stent thrombosis
(random-effects model: HR 1.19, 95% CI 0.86-1.65) and the secondary
endpoints of all-cause death (random-effects model: HR 0.85, 95% CI
0.70-1.03), myocardial infarction (random-effects model: HR 1.05, 95% CI
0.89-1.23), and stroke (random-effects model: HR 1.08, 95% CI 0.68-1.74).
Sensitivity analyses showed overall consistent results. By comparing
trials testing <=3 months of DAPT followed by P2Y12 inhibitor SAPT vs. 12
months of DAPT with trials testing <=3 months of DAPT followed by aspirin
SAPT vs. 12-month of DAPT, there was no treatment-by-subgroup interaction
for each endpoint. By combining all these trials, regardless of the type
of SAPT, short DAPT was associated with lower major bleeding
(random-effects model: HR 0.63, 95% CI 0.48-0.83) and no differences in
stent thrombosis, all-cause death, myocardial infarction, and stroke were
observed between regimens. <br/>Conclusion(s): After second-generation DES
implantation, 1-3 months of DAPT followed by P2Y12 inhibitor SAPT is
associated with lower major bleeding and similar stent thrombosis,
all-cause death, myocardial infarction, and stroke compared with prolonged
DAPT. Whether P2Y12 inhibitor SAPT is preferable to aspirin SAPT needs
further investigation.<br/>Copyright &#xa9; 2020 Published on behalf of
the European Society of Cardiology. All rights reserved.

<28>
Accession Number
2011609085
Title
Double Blind Pilot Randomized Trial Comparing Extended Anticoagulation to
Placebo Following Major Lung Resection for Cancer.
Source
Seminars in Thoracic and Cardiovascular Surgery. 33(4) (pp 1123-1134),
2021. Date of Publication: Winter 2021.
Author
Shargall Y.; Schneider L.; Linkins L.-A.; Crowther M.; Farrokhyar F.;
Waddell T.K.; de Perrot M.; Douketis J.; Lopez-Hernandez Y.; Schnurr T.;
Haider E.; Agzarian J.; Hanna W.C.; Finley C.
Institution
(Shargall, Schneider, Farrokhyar, Lopez-Hernandez, Schnurr, Agzarian,
Hanna, Finley) Division of Thoracic Surgery, Department of Surgery,
McMaster University, Hamilton, ON, Canada
(Linkins, Crowther, Douketis) Division of Hematology and Thromboembolism,
Department of Medicine, McMaster University, Hamilton, ON, Canada
(Haider) Department of Radiology, McMaster University, Hamilton, ON,
Canada
(Shargall, Waddell, de Perrot) Division of Thoracic Surgery, Department of
Surgery, University of Toronto, Toronto, ON, Canada
(Shargall, Douketis, Agzarian, Hanna, Finley) Division of Thoracic
Surgery, St. Joseph's Healthcare Hamilton, Firestone Institute for
Respiratory Health, Hamilton, ON, Canada
Publisher
W.B. Saunders
Abstract
Venous thromboembolism (VTE), which comprises pulmonary embolus (PE) and
deep vein thrombosis (DVT), is a significant cause of postoperative
morbidity and mortality. This pilot randomized control trial (RCT)
evaluated the feasibility of a full-scale RCT investigating extended
thromboprophylaxis in patients undergoing oncological lung resections.
Patients undergoing oncological lung resections in 2 tertiary centers
received in-hospital, thromboprophylaxis and were randomized to receive
post-discharge low-molecular-weight heparin (LMWH) or placebo injections
once-daily for 30 days. At 30 days postoperatively, all patients underwent
chest computed tomography with PE protocol and bilateral leg venous
ultrasound. Primary outcomes included feasibility and safety; VTE
incidence and 90-day survival were secondary outcomes. Between December
2015 and June 2018, 619 patients were screened, of whom 62.7% (165/263) of
eligible patients consented to participate, and 133 (81%) were randomized.
One-hundred and 3 patients, (77.4%), completed the 90-day study follow-up.
Reasons for non-participation pre-randomization included patient
discomfort and LMWH/placebo administration challenges. Post-randomization
withdrawals were due to patient preference, surgeon preference and minor
adverse events. Six asymptomatic VTE events (5 PE and 1 DVT) were detected
within 30 days (3 in each group), for an overall incidence of 7%. There
were 3 minor and no major adverse events. This study is the first to
demonstrate the feasibility and safety of a full-scale extended
thromboprophylaxis RCT in thoracic surgical oncology. Our results
demonstrate that, while recruitment and retention rates were modest, the
study design is feasible and with minimal adverse events and no
intervention-related mortality.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<29>
Accession Number
2011298106
Title
A randomized controlled trial of ultrasound-assisted technique versus
conventional puncture method for saphenous venous cannulations in children
with congenital heart disease.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 131. Date
of Publication: December 2021.
Author
Bian Y.; Bai J.; Zheng J.; Huang Y.
Institution
(Bian, Huang, Bai, Huang) Department of Anesthesiology, Shanghai
Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao
Tong University, 1678 Dongfang Road, Pudong, Shanghai 200127, China
(Zheng) Department of Anesthesiology and Pediatric Clinical Pharmacology
Laboratory, Shanghai Children's Medical Center Affiliated to School of
Medicine, Shanghai Jiao Tong University, Shanghai, China
Publisher
BioMed Central Ltd
Abstract
Background: The study investigated the success rate of the great saphenous
venous catheter placement performed by ultrasound-assisted technique
compared with the conventional puncture method in infants and toddlers
with congenital heart disease and aimed to assess the efficiency and
feasibility of this method within the context of pediatric peripheral
venous access. <br/>Method(s): We selected infants and toddlers who
underwent congenital cardiac surgery in our medical center from June 1,
2020, to September 7, 2020, by convenience sampling. Children were
stratified by the presence of the manifesting cardiac types (cyanotic or
acyanotic heart disease). They were assigned to the conventional puncture
method group or the ultrasound-assisted group through randomly blocked
randomization. The primary outcome was the success rate of the first
attempt. The second outcomes included the time to cannulation at the first
attempt, the redirections of the first attempt, overall puncture time, and
overall redirections of efforts. Besides, a binary logistic regression
model was implemented to identify the possible variables related to the
success rate of the first attempt. <br/>Result(s): A total of 144 children
in our medical center were recruited in the study. The success rate of the
first attempt in the ultrasound-assisted group was higher than that of the
conventional puncture method group in the stratification of cyanotic
children (66.7% vs. 33.3%, P = 0.035). Among children of acyanotic kind,
the difference in the success rate of the first attempt between the two
groups was not significant (57.6% vs. 42.4%, P = 0.194). Overall puncture
time (45.5 s vs. 94 s, P = 0.00) and the time to cannulation at the first
attempt (41.0 s vs. 60 s, P = 0.00) in the ultrasound-assisted group was
less than the conventional puncture method group. The ultrasound-assisted
group also required fewer redirections of the first attempt (three
attempts vs. seven attempts, P = 0.002) and fewer total redirections of
efforts (two attempts vs. three attempts, P = 0.027) than the conventional
puncture method group. The result of binary Logistic regression showed
that the success rate of the first attempt was related to age (OR:1.141;
95% CI = 1.010-1.290, P = 0.034), the redirections of the first attempt
(OR:0.698; 95% CI = 0.528-0.923, P = 0.012) and the saphenous venous width
(OR:1.181; 95% CI = 1.023-1.364, P = 0.023). <br/>Conclusion(s): The
ultrasound-assisted technique improves the saphenous venous cannulation
sufficiently in children with difficult peripheral veins. The younger age
is associated with a higher likelihood of peripheral venous difficulty.
The ultrasound-assisted methods can effectively screen peripheral veins,
e.g., selecting thicker diameter peripheral veins, making puncture less
uncomfortable, and improving success rates. This method can be used as one
of the effective and practical ways of peripheral venipuncture in
children, especially in difficult situations. It should be widely applied
as one of the alternative ultrasound techniques in the operating room.
Trial registration: ChiCTR.org.cn (ChiCTR-2,000,033,368). Prospectively
registered May 29, 2020.<br/>Copyright &#xa9; 2021, The Author(s).

<30>
Accession Number
2012851178
Title
Long-term mortality after percutaneous coronary intervention with
drug-eluting stents compared with coronary artery bypass grafting for
multivessel and left main disease: A meta-analysis.
Source
Kardiologia Polska. 78(78) (pp 759-761), 2020. Date of Publication: 12 May
2020.
Author
Kowalewski M.; Gozdek M.; Zielinski K.; Raffa G.M.; Suwalski P.; Lorusso
R.
Institution
(Kowalewski, Suwalski) Department of Cardiac Surgery, Central Clinical
Hospital of the Ministry of the Interior and Administration, Centre of
Postgraduate Medical Education, Warsaw, Poland
(Kowalewski) Thoracic Research Centre, Collegium Medicum, Nicolaus
Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland
(Kowalewski, Lorusso) Cardiothoracic Surgery Department, Heart and
Vascular Centre, Maastricht University Medical Centre, Maastricht,
Netherlands
(Gozdek) Department of Cardiology and Internal Medicine, Collegium
Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Zielinski) Medical University of Warsaw, Warsaw, Poland
(Raffa) Department for the Treatment and Study of Cardiothoracic Diseases
and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo
per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy
Publisher
Medycyna Praktyczna Cholerzyn

<31>
Accession Number
2014089962
Title
Cardiorenal outcomes in eligible patients referred for bariatric surgery.
Source
Obesity. 29(12) (pp 2035-2043), 2021. Date of Publication: December 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. <br/>Method(s): This study
retrospectively assessed cardiorenal outcomes in 8,568 patients after
acceptance of referral for surgery. <br/>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. <br/>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.<br/>Copyright &#xa9; 2021 The Obesity Society

<32>
Accession Number
636530483
Title
A meta-analysis of randomized controlled studies comparing off-pump vs
on-pump CABG in the elderly.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1250), 2021. Date of
Publication: October 2021.
Author
Machado R.J.; Saraiva F.A.; Mancio J.; Sousa P.; Cerqueira R.J.; Barros
A.S.; Lourenco A.P.; Leite-Moreira A.F.
Institution
(Machado, Saraiva, Mancio, Sousa, Cerqueira, Barros, Lourenco,
Leite-Moreira) Faculty of Medicine University of Porto, Surgery and
Physiology Department and Cardiovascular and Research Centre, Porto,
Portugal
Publisher
Oxford University Press
Abstract
Background: The increasing demand for coronary revascularization in the
elderly has raised the interest in off-pump coronary artery bypass graft
(CABG) as an option in these high-risk patients. <br/>Purpose(s): We
sought to investigate the differences between off-pump CABG (OPCAB) and
on-pump CABG (ONCAB), among patients older than 60, in short and mid-term
results throughout a meta-analysis of randomized clinical trials (RCTs).
<br/>Method(s): A literature search was conducted using MEDLINE, ISI Web
of Science and Cochrane Library (1960-2020). RCTs reporting mortality
outcomes of OPCAB vs ONCAB within elderly patients (as prespecified or
secondary analysis) were included. Data on myocardial infarction, stroke,
repeat revascularization, renal failure and composite endpoints after CABG
were also collected. Hazard ratio (HR) and variance for follow-up outcomes
and frequencies or odds ratio (OR) for early endpoints were collected.
Random effect models were used to compute statistical combined measures
and 95% confidence intervals (CI). <br/>Result(s): Seven RCTs encompassing
a total of 6,609 patients were included (3,303 OPCAB and 3,306 ONCAB, 50%
were men). Five trials reported mortality during follow-up (6 months (2
studies) to 5 years). There were no significant differences on mid-term
mortality (pooled HR: 1.02, 95% CI: 0.88-1.17, p=0.82) and composite
endpoint incidence (4 studies pooled HR: 0.98, 95% CI: 0.88-1.09, p=0.73)
between OPCAB and ONCAB. At 30-days, no differences between groups were
noted in mortality (5 studies pooled OR: 0.90, 95% CI: 0.62-1.31, p=0.59),
early myocardial infarction (5 studies pooled OR: 0.95, 95% CI: 0.60-1.51,
p=0.82) and renal complications (3 studies pooled OR: 0.74, 95% CI:
0.50-1.11, p=0.14). The need for early repeat revascularization was
significantly higher in OPCAB (2 studies pooled OR: 2.58, 95% CI:
1.16-5.75, p=0.02), with higher percentage of incomplete revascularization
among OPCAB in both trials included in this pooled result (34% in OPCAB vs
29% in ONCAB, p<0.01). However, OPCAB showed a tendency for lower risk of
early stroke (6 studies pooled OR: 0.70, 95% CI: 0.48-1.03, p=0.07).
<br/>Conclusion(s): Pooling data from RCTs in elderly patients showed that
OPCAB and ONCAB provide similar mid-term results. However, OPCAB was
associated with a higher risk of early repeat revascularization and there
was a trend for reduced early stroke risk. Further randomized studies,
specifically designed to include elderly patients, are needed to establish
the better CABG strategy.

<33>
Accession Number
636530367
Title
Cardiovascular benefits outweigh risks in patients with atrial
fibrillation in REDUCE-IT (Reduction of Cardiovascular Events with
Icosapent Ethyl-Intervention Trial).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2568), 2021. Date of
Publication: October 2021.
Author
Olshansky B.; Bhatt D.; Miller M.; Steg P.G.; Brinton E.A.; Jacobson T.A.;
Ketchum S.B.; Doyle R.T.; Juliano R.A.; Jiao L.; Kowey P.; Reiffel J.A.;
Tardif J.-C.; Ballantyne C.M.; Chung M.K.
Institution
(Olshansky) University of Iowa, Department of Medicine, Iowa City, United
States
(Bhatt) Brigham and Women's Hospital, Heart and Vascular Center, Harvard
Medical School, Boston, United States
(Miller) University of Maryland, Department of Medicine, Baltimore, United
States
(Steg) FACT, Hopital Bichat, AP-HP,INSERM Unite 1148, Paris, France
(Brinton) Utah Lipid Center, Salt Lake City, United States
(Jacobson) Emory University, School of Medicine, Department of Medicine,
Atlanta, United States
(Ketchum, Doyle, Juliano, Jiao) Amarin Pharma,Inc., Bridgewater, United
States
(Kowey) Lankenau Institute for Medical Research, Wynnewood, United States
(Reiffel) Columbia University, Vagelos College of Physicians and Surgeons,
New York, United States
(Tardif) University of Montreal, Montreal Heart Institute, Montreal,
Canada
(Ballantyne) Baylor College of Medicine, Department of Medicine, Houston,
United States
(Chung) Cleveland Clinic, Cleveland, United States
Publisher
Oxford University Press
Abstract
Background/Introduction: REDUCE-IT, a multinational, double-blind trial,
randomized 8179 statin-treated patients with controlled low density
lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV)
risk, to icosapent ethyl (IPE) 4 grams/day or placebo. IPE reduced the
primary (CV death, myocardial infarction [MI], stroke, coronary
revascularization, hospitalization for unstable angina) and key secondary
(CV death, MI, stroke) endpoints 25% and 26%, respectively (each
p<0.0001), and individual components including stroke (28%), MI (31%),
cardiac arrest (48%), and sudden cardiac death (31%) (all p<=0.01). With
IPE, bleeding was greater (11.8% vs 9.9%; p=0.006), serious bleeding
trended higher (2.7% vs 2.1%; p=0.06), and atrial fibrillation/flutter
(AF/F) hospitalization endpoints increased (3.1% vs 2.1%; p=0.004).
<br/>Purpose(s): To evaluate the effects of IPE on the risk of CV events
and safety measures in patients by either history of AF/F or in-study
occurrence of positively adjudicated AF/F hospitalization. <br/>Method(s):
Conduct post hoc efficacy and safety subgroup analyses of patients with or
without either baseline history of AF/F or in-study adjudicated AF/F
hospitalization, including hospitalization for >=24 hours; AF/F not
meeting endpoint criteria were reported as adverse events. <br/>Result(s):
Patients with (n=751; 9.2%) AF/F history at baseline (vs without; n=7428;
90.8%) (Figure 1), or those with (n=211; 2.6%) positively adjudicated
in-study AF/F hospitalization endpoints (vs without; n=7968; 97.4%)
(Figure 2), had higher event rates of primary, key secondary, and fatal or
nonfatal stroke endpoints, but relative risk reductions with IPE were not
significantly different (all interaction p-values [pint]=ns). Similar
reductions were observed with IPE across the prespecified endpoint testing
hierarchy in patients with or without AF/F history or in-study
hospitalization endpoints. Patients with baseline AF/F history had similar
relative risk for in-study occurrence of AF/F hospitalization with IPE
versus placebo (pint=0.21) but had greater absolute risk (12.5% vs 6.3%,
IPE vs placebo) vs patients without baseline AF/F history (2.2% vs 1.6%,
IPE vs placebo); i.e., recurrent AF/F in those with a prior history of
AF/F was more prevalent than de novo AF/F. Serious bleeding trended higher
regardless of AF/F history or in-study AF/F hospitalization endpoints (all
pint=ns); absolute risk of serious bleeding was greater in patients with
AF/F history at baseline (7.3% vs 6.0%) vs those without a baseline
history of AF/F (2.3% vs 1.7%), and serious bleeding also trended higher
in patients with in-study AF/F hospitalization (8.7% vs 6.0%) vs without
(2.5% vs 2.0%) [all IPE vs placebo]. <br/>Conclusion(s): REDUCE-IT
patients with AF/F history or in-study AF/F hospitalization endpoints had
greater CV risk, but similar relative risk reduction in primary, key
secondary, and fatal or nonfatal stroke endpoints with IPE. (Figure
Presented).

<34>
Accession Number
636530356
Title
Direct oral anti-coagulants in patients with atrial fibrillation and
bioprosthetic valve: A meta-analysis of randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2989), 2021. Date of
Publication: October 2021.
Author
Abella F.; Castro R.; Tiongco R.H.; Rosano A.L.; Bailon D.
Institution
(Abella, Castro, Tiongco, Rosano, Bailon) Saint Lukes Medical Center
Global City, Taguig, Philippines
Publisher
Oxford University Press
Abstract
Background: Patients with atrial fibrillation (AF) and bioprosthetic valve
(BPV) are at increased risk for thromboembolic events and require
anticoagulation. However, management strategies for these patients have
not yet been well addressed by randomized controlled trials (RCTs). For
years, warfarin was the only available oral anticoagulant, but this
changed with the introduction of the direct oral anticoagulants (DOACs).
However, there is no clear consensus about indications for DOACs in these
patients due to the lack of prospective trials. <br/>Purpose(s): The
objective of this meta-analysis is to show the efficacy of DOACs in AF
patients with BPV in terms of composite cardiovascular outcomes. In
addition, the study aims to show the safety of DOACs in terms of major
bleeding. <br/>Method(s): A comprehensive literature search for randomized
controlled trials (RCTs) was performed in MEDLINE, PubMed and
Clinicaltrials.gov in human subjects done within 2010 to 2020. Results
were pooled using fixed effects. The primary outcome was a composite
cardiovascular outcome from all included studies, which include death,
major bleeding and major adverse cardiac events (stroke, transient
ischemic attack, valve thrombosis, myocardial infarction, systemic
embolism, and hospitalization for heart failure). Secondary outcomes
include all-cause stroke or systemic embolism, major bleeding, death from
cardiovascular cause and all-cause death. <br/>Result(s): Four RCTs were
included in the meta-analysis. DOACs used were Apixaban, Dabigatran,
Edoxaban and Rivaroxaban. In patients with AF and BPV, DOACs performed
similarly with warfarin in terms of composite cardiovascular outcome (RR
1.01, 95% CI 0.86-1.19, P=0.88, I2=0%). On the other hand, DOACs performed
better than warfarin in reduction of all cause stroke and systemic
embolism (RR 0.48, 95% CI 0.27-0.87, P=0.01). There is non-statistically
significant risk reduction for major bleeding (RR 0.81, 95% CI 0.56-1.17,
P=0.26, I2=0%) and other secondary outcomes such as death from
cardiovascular causes (RR 0.79, 95% CI 0.39- 1.60, P=0.51, I2=0%) and all
cause death (RR 0.94, 95% CI 0.55-1.62, P=0.71, I2=0%) showing similar
outcomes with NOACs and warfarin. <br/>Conclusion(s): DOACs compared with
warfarin are similar in terms of composite cardiovascular outcome, major
bleeding and death. However, DOACs performed better than warfarin in
reducing all-cause stroke/systemic embolism and can be an alternative for
oral anticoagulation in patients with AF and BPV.

<35>
Accession Number
636530295
Title
HbA1c, coronary atheroma progression and cardiovascular events.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2514), 2021. Date of
Publication: October 2021.
Author
Dykun I.; Bayturan O.; Carlo J.; Nissen S.E.; Nicholls S.J.; Puri R.
Institution
(Dykun, Carlo, Nissen, Puri) Cleveland Clinic, Cleveland Clinic
Coordinating Center for Clinical Research, Department of Cardiovascular
Medicine, Cleveland, United States
(Bayturan) Celal Bayar University Faculty of Medicine, Department of
Cardiology, Manisa, Turkey
(Nicholls) Monash University, Monash Cardiovascular Research Centre,
Melbourne, Australia
Publisher
Oxford University Press
Abstract
Background: Hemoglobin A1c (HbA1c) reflects long-term glycemic control and
is associated with an increased risk of cardiovascular events among
diabetic and non-diabetic patients. The specific impact of HbA1c upon
atheroma progression and incident cardiovascular events relative to the
presence of other cardiovascular risk factors remains uncertain.
<br/>Purpose(s): We tested the hypothesis that on-treatment HbA1c levels
independently associate with coronary atheroma progression measured with
serial intravascular ultrasonography (IVUS) and major adverse
cardiovascular events (MACE: death, myocardial infarction, cerebrovascular
accident, coronary revascularization, or hospitalization for unstable
angina) rates. <br/>Method(s): We performed a post-hoc pooled analysis of
data from eight prospective, randomized trials involving serial coronary
IVUS. HbA1c was measured at baseline and the average of the follow-up
values was taken. The percent atheroma volume (PAV) was calculated as the
proportion of the entire vessel wall occupied by atherosclerotic plaque,
throughout the segment of interest. Using multivariable mixed modeling, we
determined the association of HbA1c with annualized change in PAV. Cox
proportional hazard models were used to assess the association of HbA1c
with incidence of MACE. <br/>Result(s): Among 2,791 patients, mean age was
58.9+/-9 years and 29.1% were women. Mean on-treatment low-density
lipoprotein (LDL)-cholesterol was 80.2+/-33.7 mg/dl and median
on-treatment triglycerides (TG) were 125.5 (94.7, 170.2) mg/dl. Mean
baseline and follow-up HbA1c was 6.2+/-1.2% and 6.3+/-1.2%, respectively.
Overall, there was no net significant annualized change in PAV
(0.15+/-0.21, p=0.47). In a fully adjusted multivariable analysis
(following adjustment of age, sex, body mass index (BMI), systolic blood
pressure, smoking, LDL- and high-density lipoprotein cholesterol, TG
levels, peripheral artery disease, trial, region, and baseline PAV),
higher on-treatment HbA1c levels were independently associated with
annualized changes in PAV [beta-estimate (95% confidence interval): 0.13
(0.07, 0.19), p<0.001]. On-treatment HbA1c levels were significantly and
independently associated with incidence of MACE [hazard ratio (95%
confidence interval): 1.17 (1.07, 1.28), p<0.001]. <br/>Conclusion(s):
Independent of achieved cholesterol levels, vascular risk factors and BMI,
greater HbA1c levels significantly associate with coronary atheroma
progression and clinical outcomes. These results support the notion of a
direct, specific effect of glycemic control upon the natural history of
coronary atheroma and atherosclerotic events, supporting the rationale of
therapies designed to directly modulate it.

<36>
Accession Number
636530203
Title
Local or general anesthesia for TAVI surgery? An updated systematic review
and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1670), 2021. Date of
Publication: October 2021.
Author
Cheng D.R.
Institution
(Cheng) West China Hospital, Sichuan University, Cardiac Surgery, Chengdu,
China
Publisher
Oxford University Press
Abstract
Background: The choice of anesthesia for transcatheter aortic valve
implantation (TAVI) is still under controversial. This systematic review
and meta-analysis was performed to evaluate the safety of local anesthesia
(LA) with or without conscious sedation (CS) and general anesthesia (GA)
for the TAVI-procedure. <br/>Method(s): This meta-analysis is registered
with PROSPERO (CRD42021221777). We searched OVID, PUBMED, EMBASE, Web of
Science databases to collect all the related studies published from
January 1, 2002 to December 31, 2020. The primary outcome measures were
hospital length of stay, operation time, 30-day mortality, use of
cardiovascular drugs, permanent pacemaker (PPM) implantation rate, stroke
rate, the incidence of myocardial infarction (MI), incidence of acute
kidney injury (AKI), major bleeding (MB) rate, rate of procedural success.
<br/>Result(s): A total of 33 studies (3 RCT studies, 23 retrospective
cohort studies, 4 prospective cohort studies, 3 case-control studies)
including 23244 patients were analyzed. There were no significant
statistically differences between LA and GA with respect to PPM [OR=0.99,
95% CI (0.88, 1.11), P=0.88], shock [OR=0.91, 95% CI (0.69, 1.21),
P=0.52], MI [OR=0.89, 95% CI (0.52, 1.53), P=0.68], AKI [OR=1.26, 95% CI
(0.99, 1.62), P=0.06], rate of procedural success [OR=0.66, 95% CI (0.43,
1.03), P=0.06]. However, compared to GA, LA for TAVI was associated with a
significantly shorter hospital length of stay [WMD=-2.45, 95% CI (-2.77,
-2.13), P<0.00001], a reduction in procedure time [WMD=-12.32, 95% CI
(-13.78, -10.87), P<0.00001], a reduction in using of cardiovascular drugs
[OR=0.52, 95% CI (0.35, 0.78), P=0.002] and in MB [OR=0.59, 95% CI (0.46,
0.75), P<0.0001], reduced 30-day mortality rate [OR=1.19, 95% CI (1.00,
1.42), P=0.05]. <br/>Conclusion(s): This Systematic review and
meta-analysis showed that compared to GA, LA for TAVI can reduce hospital
length of stay, procedure time, 30-day mortality rate, use of
cardiovascular drugs, and MB rate, but no significant differences in PPM,
shock, MI, AKI, and the rate of procedural success.

<37>
Accession Number
636530142
Title
Prognostic value of left ventricular ejection fraction and symptom
severity in patients with moderate aortic stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1570), 2021. Date of
Publication: October 2021.
Author
Stassen J.; Butcher S.C.; Hirasawa K.; Singh G.K.; Pio S.M.; Amanullah
M.R.; Chew N.; Ewe S.H.; Kong W.; Cohen D.J.; Genereux P.; Leon M.B.;
Marsan N.A.; Delgado V.; Bax J.J.
Institution
(Stassen, Butcher, Hirasawa, Singh, Pio, Marsan, Delgado, Bax) Leiden
University Medical Center, Leiden, Netherlands
(Amanullah, Ewe) National Heart Centre Singapore, Singapore, Singapore
(Chew) National University Health System, Singapore, Singapore
(Kong) National University Heart Centre, Singapore, Singapore
(Cohen) University of Missouri, Kansas City, United States
(Genereux) Morristown Medical Center, Morristown, United States
(Leon) Columbia University Medical Center, New York, United States
Publisher
Oxford University Press
Abstract
Background: Moderate aortic stenosis (MAS) is associated with an increased
risk of adverse events. Risk assessment in these patients, however, has
not been thoroughly investigated. <br/>Purpose(s): To investigate the
independent determinants of survival in patients with MAS, stratified by
left ventricular ejection fraction (LVEF) and severity of symptoms at the
time of first diagnosis. <br/>Method(s): Patients with an
echocardiographic diagnosis of tricuspid MAS (aortic valve area >1.0 and
<=1.5cm2) were identified. Patients were stratified by LVEF (LVEF >=60%,
LVEF 50-59%, or LVEF <50%) and NYHA functional class (NYHA I, NYHA II, or
NYHA III-IV) at time of MAS diagnosis. The relationship between LVEF, NYHA
Class, and the composite of death or aortic valve replacement (AVR) was
explored using univariable and multivariable proportional hazards
regression. <br/>Result(s): Of 2003 patients with MAS (mean age 73+/-10
years, 51% men, AVA 1.22+/-0.15 cm2), 1063 (53%), had LVEF>=60%, 550 (27%)
LVEF 50- 59% and 390 (20%) LVEF<50%. Among 1763 patients with available
NYHA class data, 1036 (59%) patients were in NYHA I, 435 (25%) in NYHA II
and 292 (16%) in NYHA III-IV. During a median follow-up of 34 (13-60)
months, 1323 (67.1%) patients underwent AVR (31.1%) or died (36.0%)
without AVR. Patients with LVEF<50% and within the 50-59% range had
significantly higher event rates compared with patients with an LVEF>=60%
(log rank p<0.001; figure 1A). Likewise, patients with NYHA II and NYHA
III-IV had significantly worse outcomes compared with patients in NYHA I
(log rank p<0.001, figure 1B). On multivariable analysis, LVEF 50-59% (HR:
1.17; 95% CI: 1.02 - 1.35; p=0.028), LVEF <50% (HR: 1.36; 95% CI: 1.15 -
1.61; p<0.001), NYHA II (HR: 1.84; 95% CI: 1.59 - 2.13; p<0.001) and NYHA
III-IV (HR: 2.38; 95% CI: 2.03 - 2.79; p<0.001) were independently
associated with worse outcome (figure 2). <br/>Conclusion(s): Baseline
LVEF and symptom severity are associated with worse outcomes in patients
with MAS. Although current guidelines recommend conservative management
for MAS, randomized trials appear warranted to determine whether AVR at an
earlier stage would be beneficial in these patients. (Figure Presented).

<38>
Accession Number
636530000
Title
Discontinuation of anticoagulation and its associated factors in atrial
fibrillation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 575), 2021. Date of
Publication: October 2021.
Author
Sanchez Bustamante S.; Navarro Estrada J.L.; Rossi E.; Gamarra A.L.; Maid
G.F.; Pizarro R.
Institution
(Sanchez Bustamante, Navarro Estrada, Rossi, Gamarra, Maid, Pizarro)
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Publisher
Oxford University Press
Abstract
Background/Introduction: Oral anticoagulation has been shown to reduce the
incidence of embolic events associated with atrial fibrillation, however
the discontinuation of these drugs observed in clinical trials may not be
representative of the real-world setting due to the inclusion of selected
populations. <br/>Purpose(s): The objective of the study was to compare
whether there is a difference in the incidence rate of discontinuation
between vitamin K antagonists and direct anticoagulants and to evaluate
the factors associated with non-adherence in patients newly diagnosed with
atrial fibrillation. <br/>Method(s): This was a prospective cohort study.
Adult patients (age >18 years) who had newly started anticoagulation
therapy for atrial fibrillation or atrial flutter were enrolled. Patients
with previous oral anticoagulation, mechanical prosthetic heart valves or
creatinine clearance less than 30 mL/min were excluded. The follow-up
period was 12 months. As the treatment allocation was not randomized, a
propensity score weighting was performed considering baseline
characteristics potentially associated with exposure and outcome. Factors
associated with anticoagulant discontinuation were evaluated using a
weighted Cox model. <br/>Result(s): A total of 379 patients were included
(mean age 78+/-9 years, 58% females). The median follow-up was 362 days
(IQR 347-370). Loss to follow-up was 1%. The anticoagulation
discontinuation rate was 24.6% in the direct anticoagulant group and 15.6%
in the vitamin K antagonist group. A weighted model of time to
discontinuation of anticoagulation treatment showed a crude HR of 1.40
(95% CI 0.79-2.48) for the direct anticoagulant therapy group compared to
the vitamin K antagonist group, and a model adjusted for age, type of
atrial fibrillation, radiofrequency ablation, bleeding, number of chronic
drugs, and cardiology consultations during follow-up showed an adjusted HR
of 1.26 (95% CI 0.75-2.12). The main reason for discontinuation of
anticoagulation was high risk of bleeding in the vitamin K antagonist
group and performance of a radiofrequency ablation procedure in the direct
anticoagulant group. There was no statistically significant difference in
the discontinuation rate between both groups when the baseline
characteristics of the patients were considered. Conclusion(s): There was
no statistically significant difference in the discontinuation rate
between both groups when the baseline characteristics of the patients were
considered. The study showed that the discontinuation of anticoagulants in
atrial fibrillation in our setting was not associated with the type of
drug used, the age of patients, or the type of arrhythmia.

<39>
Accession Number
636529907
Title
Effects of medical graphic narratives (Patient Comic) on patient reported
outcome measures (PROMs) in patients undergoing coronary angiography and
PCI.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 3123), 2021. Date of
Publication: October 2021.
Author
Brand A.; Gao L.; Dreger H.; Hamann A.; Crayen C.; Brand H.; Squier S.M.;
Stangl K.; Kendel F.; Stangl V.
Institution
(Brand, Dreger, Stangl, Stangl) Universitatsmedizin Berlin, Campus Mitte,
Department of Cardiology and Angiology, Berlin, Germany
(Gao) Charite Universitatsmedizin Berlin, Department of Nephrology,
Berlin, Germany
(Hamann) Mintwissen-science communication agency and publishing house,
Berlin, Germany
(Crayen) Freie Universitat, Department of Education and Psychology,
Berlin, Germany
(Brand, Kendel) Department - Universitatsmedizin Berlin, Institute of
Gender in Medicine, Berlin, Germany
(Squier) Pennsylvania State University, English and Women's, Gender and
Sexuality Studies, Pennsylvania, United States
Publisher
Oxford University Press
Abstract
Background/Introduction: Increasing evidence suggests that patients
scheduled for invasive cardiac procedures such as coronary angiography /
PCI feel insufficiently informed about the planned procedure.
<br/>Purpose(s): To improve the Patient Informed Consent (IC) before
coronary angiography by using medical graphic narratives (patient comic)
that illustrate central IC-related aspects in a simple and understandable
manner. <br/>Method(s): A patient comic illustrating central steps of the
procedure, risks, treatment alternatives and behavioural measures was
created in collaboration with professional scientific visual
communicators. In a randomised, controlled, prospective trial, we included
121 patients undergoing coronary angiography/PCI. Patients were randomised
to a group that was informed about the procedure using the usual Patient
IC approach (official consent form and conversation with physician;
Control group) or a group that additionally obtained a patient comic for
reading (graphic illustrations of central IC aspects based on the official
consent form; Comic group). Patient Reported Outcome Measures (PROMs),
i.e. satisfaction with and perceived quality of the patient IC, were
tested in both groups comparing single items of the Client Satisfaction
Questionnaire-8 (CSQ-8) and self-designed single items in both IC groups.
Differences were compared using the Fisher's exact test. A p-value <0.05
was considered statistically significant. <br/>Result(s): PROMs showed
significant benefits in favour of the Comic group: Quality of the patient
IC was perceived to be very good in 45.0% of the Comic group compared to
24.9% of patients in the Control group (p=0.023). Only 23.0% of the
patients in the Control group, compared to 40.0% in the Comic group,
stated that the IC procedure completely met their expectations (p=0.012).
57.4% in the Control group and 76.7% in the Comic group stated that all of
their questions were satisfactorily adressed before the procedure
(p=0.015). 43.3% in the Comic group, in contrast to 18.0% in the Control
group, declared to feel very satisfied with the obtained IC procedure
(p=0.002). The acceptance of the patient comic was very high: no patient
(0%) expressed feelings of not being taken seriously by reading the
patient comic. <br/>Conclusion(s): Our data confirm pronounced limitations
of the usual Patient IC practice before coronary angiography. The use of a
patient comic that narratively illustrates central steps of the procedure
positively impacts on patient-centered endpoints and significantly
improves the patient IC procedure.

<40>
Accession Number
636529889
Title
Predictors of atrial fibrillation recurrence after surgical ablation of
long-standing persistent AF with concomitant coronary artery bypass
grafting.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 423), 2021. Date of
Publication: October 2021.
Author
Kalybekova A.; Lukinov V.; Rakhmonov S.; Chernyavskyi A.
Institution
(Kalybekova, Lukinov, Rakhmonov, Chernyavskyi) Meshalkin National Medical
Research Center, Novosibirsk, Russian Federation
Publisher
Oxford University Press
Abstract
Background: A long-standing persistent form of atrial fibrillation (AF) in
anamnesis, requiring surgical ablation together with coronary artery
bypass surgery (CABG), significantly increases the risk of reccurence in
the postoperative period. Before operation should consider the predictors
of AF for long-term preservation of rhythm after surgery. <br/>Purpose(s):
To evaluate the predictors of AF recurrence on 3rd day and at discharge in
patients after CABG with concomitant surgical ablation of long-standing
persistent AF. <br/>Method(s): A prospective randomized single-center
analysis was performed on patients with long-standing persistent AF,
undergoing CABG with concomitant left atrial ablation (LAA) or biatrial
ablation (BA) between 2016 and 2019. 116 patients were randomized into two
groups: 58 in LAA+CABG, 58 in BA+CABG. The median age of the patients was
65 (IQR, 61 to 67.75) years in gr. BA and 62 (IQR, 58 to 66) in gr. LAA
(Mann-Whitney U-test, p=0.050), 83% of men were in gr. BA (Fisher test,
p>0.999). Predictors of AF development on day 3 were identified using
multivariable logistic regression from the following baseline
characteristics: myocardial infarction in anamnesis, time of artificial
circulation, time of application of radiofrequency energy, the size of the
left and right atrium, funcrional class of cardiac angina and heart
failure, gender, age, acute cerebrovascular accident (CVA), additional
intervention on the heart (operations for aortic aneurysm, mitral, aortic
and tricuspid valves replacement), concomitant cardiovascular,
respiratory, digestive and urogenital diseases. <br/>Result(s): Using a
multivariate model of logistic regression, the following significant
predictors of arrhythmias on the 3rd day in gr. BA were included:
additional intervention on the heart valves (OR 63.13, p=0.001); an
increase in the functional class (FC) of chronic heart failure (CHF) NYHA
by 1 (OR 40.06, p=0.018); a history of CVA (OR 9.13, p=0.026). The
following significant predictors of AF reccurence on the 3rd day in gr.LAA
were identified: an increase in the long axis of the right atrium by 1 cm
(OR 3.05, p=0.006); an increase of the FC of cardiac angina by 1 (OR 7.11,
p=0.011); in women (OR 7.14, p=0.017). In BA significant predictors of AF
reccurence at discharge were: an increase in the long axis of the left
atrium by 1 cm (OR4.86, p=0.015); reccurence of AF on the 3rd day (OR
17.45, p=0.005); 1 year increase in age (OR 1.24, p=0.023); the presence
of diabetes (OR 47.67, p=0.002). In gr. LAA the predictors at discharge
were: reccurence of AF on 3rd day (OR 38.35, p=0.001); a history of CVA
increases the chances of arrhythmia (OR 210.83, p=0.032).
<br/>Conclusion(s): Number of clinical and functional characteristics of a
patient may be predictors of AF. We examined the predictors of reccurence
of AF after surgical ablation of long-standing persistent AF with
concomitant CABG. Taking them into account when choosing the optimal
strategy of treatment is important. (Figure Presented).

<41>
Accession Number
636529852
Title
Transcatheter aortic valve replacement in severe aortic stenosis and
cardiac amyloidosis: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1650), 2021. Date of
Publication: October 2021.
Author
Pinto G.; Villaschi A.; Sanz-Sanchez J.; Fazzari F.; Regazzoli D.;
Mangieri A.; Pini D.; Bragato R.M.; Colombo A.; Reimers B.; Condorelli G.;
Stefanini G.G.; Chiarito M.; Cannata F.
Institution
(Pinto, Villaschi, Condorelli, Stefanini, Chiarito, Cannata) Humanitas
University, Department of Biomedical Sciences, Pieve Emanuele - Milan,
Italy
(Sanz-Sanchez) Hospital Universitario y Politecnico La Fe, Valencia, Spain
(Fazzari, Regazzoli, Mangieri, Pini, Bragato, Colombo, Reimers) IRCCS
Humanitas Research Hospital, Rozzano - Milano, Italy
Publisher
Oxford University Press
Abstract
Background: Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical
degenerative diseases of the elderly. According to recent studies, up to
16% of patients referred to transcatheter aortic valve replacement (TAVR)
have a concomitant diagnosis of CA. Until recently, TAVR in patients with
CA and AS has been considered futile, following the results of small
observational studies. However, few studies recently suggested a
beneficial impact of TAVR in patients with AS and CA as compared with
medical therapy alone. <br/>Purpose(s): To clarify the efficacy and safety
profile of TAVR in CA-AS patients. <br/>Method(s): We performed a
systematic review and meta-analysis of studies evaluating the risk of
mortality after TAVR in CA-AS patients as compared with medical therapy.
Moreover, we performed a systematic review and descriptive meta-analysis
of studies reporting outcomes and complication rates of TAVR in CA-AS
patients as compared with patients with AS alone. <br/>Result(s): We
identified 4 observational studies reporting data on mortality in CA-AS
patients treated with either TAVR or medical therapy. Mortality was
significantly lower in patients undergoing TAVR (OR 0.23, 95% CI
0.07-0.73, I2=0%, NNT=2.6) as compared with medical therapy. A sensitivity
analysis with hazard ratio as effect estimate showed consistent results.
Then, we identified 4 observational studies reporting data on mortality,
re-hospitalizations and periprocedural complications of TAVR in CA-AS
patients as compared with patients with AS alone. We found higher rates of
mortality, cardiovascular hospitalization and need for permanent pacemaker
implantation in CA-AS patients as compared to lone AS patients undergoing
TAVR. Conversely, no differences were found in terms of stroke, acute
kidney injury and vascular complications. <br/>Conclusion(s): Our analysis
rejects the idea of futility of TAVR in CA-AS patients showing a clear
survival benefit of CA-AS patients undergoing TAVR as compared with
medical therapy. Moreover, these patients may undergo TAVR with an
acceptable procedural risk, that is substantially comparable to lone AS
patients, except for a higher incidence of permanent pacemaker
implantation.

<42>
Accession Number
636529670
Title
Outcomes of trans-catheter versus surgical aortic valve replacement for
patients with classic low-flow low-gradient aortic stenosis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1644), 2021. Date of
Publication: October 2021.
Author
Vandermolen S.; Patel K.P.; Saberwal B.; Cooper J.; Pugliese F.; Khanji
M.; Mullen M.J.; Ozkor M.; Kennon S.; Baumbach A.; Awad W.
Institution
(Vandermolen, Patel, Saberwal, Pugliese, Khanji, Mullen, Ozkor, Kennon,
Baumbach, Awad) Barts Heart Centre, London, United Kingdom
(Cooper) Queen Mary University of London, London, United Kingdom
Publisher
Oxford University Press
Abstract
Background: Classical low-flow low-gradient aortic stenosis (cLFLG-AS) is
frequently encountered within clinical practice [1], and is often
associated with high mortality [2]. Whilst aortic valve replacement can
improve outcomes, there is a lack of real-world data guiding the decision
between trans-catheter aortic valve implantation (TAVI) or surgical aortic
valve replacement (SAVR) in this specific patient cohort. <br/>Purpose(s):
To compare outcomes between TAVI and SAVR in patients with cLFLG-AS.
<br/>Method(s): cLFLG-AS was defined by an aortic valve area <1cm2, mean
gradient <40mmHg or peak velocity <4m/s and left ventricular ejection
fraction <50%. All patients who met cLFLG-AS criteria who underwent TAVI
or SAVR at our tertiary referral centre between 2015 and 2020 were
included. Inverse probability weighting was used to adjust for differences
in baseline characteristics and the non-random assignment of treatment
modalities. The primary end-point was all-cause mortality. Secondary
endpoints were procedure-related permanent pacemaker implantation, renal
replacement therapy (RRT) and stroke. <br/>Result(s): 322 patients were
included (220 TAVI and 102 SAVR). Baseline characteristics were: male sex
70%, mean gradient 30mmHg (23-35), aortic valve area 0.8cm2 (0.6-0.9).
Patients undergoing TAVI were older than the SAVR group (81.3+/-8.5 vs
70.6+/-11.1 years, p<0.0001) with higher Logistic Euroscore (19.3
(11.8-32.3) vs 7.1 (3.7-14.1), p<0.0001) (figure 1). At median follow-up
of 2.7 years (1.5-4.1), 99 patients had died; 70 (31.8%) had TAVI and 29
(28.4%) had SAVR. Both unweighted and weighted Kaplan-Meier curve analysis
was performed; there was similar survival between SAVR and TAVI (log rank
test 0=0.27 and p=0.4 respectively) (figure 2). Adjusted hazard ratio (HR)
for mortality with SAVR was 0.78 unweighted (95% CI 0.5-1.21; p=0.27) and
0.66 weighted (95% CI 0.26-1.64; p=0.37). In terms of contributory
procedural factors, concomitant multiple valve intervention in the SAVR
group independently affected mortality (HR 5.47, 95% CI 2.52-11.51,
p<0.001). There was no difference in permanent pacemaker insertion or
stroke across the two groups, but rates of RRT were higher in SAVR cohort
(13.7% vs 0%, p<0.001). <br/>Conclusion(s): Despite the TAVI cohort being
both older and at higher risk, there was no observed difference in
mortality between TAVI and SAVR in the mid-term. Deciding upon
intervention choice can therefore be based upon criteria other than the
specific presence of a classic low-flow lowgradient state.

<43>
Accession Number
636529609
Title
Insights on clinical outcomes in according to age in patients undergoing
transcatheter aortic valve replacement.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2814), 2021. Date of
Publication: October 2021.
Author
Munoz-Garcia M.; Munoz-Garcia E.; Munoz Garcia A.J.; Dominguez-Franco
A.J.; Alonso-Briales J.H.; Jimenez-Navarro M.F.; Hernandez-Garcia J.M.;
Gomez-Doblas J.J.
Institution
(Munoz-Garcia, Munoz-Garcia, Munoz Garcia, Dominguez-Franco,
Alonso-Briales, Jimenez-Navarro, Hernandez-Garcia, Gomez-Doblas)
University Hospital Virgen de la Victoria, Department of Cardiology,
Malaga, Spain
Publisher
Oxford University Press
Abstract
Transcatheter Aortic Valve Replacement (TAVR) is considered the treatment
in patients older or at high or intermediate risk. Results form
contemporary randomized trials in low-risk patients will likely broaden
the indication of TAVR, but the data regarding long-term are limited by
older population. The aim of this study was to evaluate the survival and
the factors predicting mortality after TAVR in according to age.
<br/>Method(s): From April 2008 to December 2019, the self-expandable and
balloon-expandable prostheses were was implanted in 765 patients with
symptomatic severe aortic stenosis with deemed high risk on base to age,
<80 years and >=80 years old. The rate of acute complications was defined
by the combined endpoint of death, vascular complications, myocardial
infarction, majopr bleeding or stroke. <br/>Result(s): The mean age in
patients <80 compared with >=80 years, was 73.69+/-6.5 vs. 83.4+/-2.1
years and the logistic EuroSCORE and STS score were 15.9+/-11% vs.
18+/-11%, 4.8+/-3 vs. 6.3+/-4, p>0.001, respectively Inhospital mortality
was 4% vs. 3.4%, p=0.404, and the rate of acute complications was 19.6 vs.
16.5%, p=0.168. The late mortality (beyond 30 days) was 36.9 vs. 35.2%,
p=0.352. When compared in both groups, there were no differences for the
presence of threatening bleeding 3.4% vs. 3.2% (HR = 1.028 [IC95%
0.722-1.463], p=0.516), myocardial infarction 4% vs. 2.5% (HR = 1.263
[IC95% 0.814- 1.960], p=0.167), stroke 8% vs. 9.1% (HR = 1.149 [IC95%
0.686-1.925], p=0.347) and acute kidney innjury 14.1% vs. 19.1% (HR=0.1.14
[IC95% 0.969-2.141], p=0.071) and there was difference in between groups
in hospitalizations for heart failure 14.6% vs. 7.9% (HR = 1.398 [IC95%
1.075- 1.817], p=0.008 Survival at 1, 3, and 5were similar in both groups
(88% vs. 89.5%, 73.3 vs. 78.2%, 58.8 vs. 62.6%, log Rank 0.992, p=0.319),
respectively, after a mean follow-up of 42.3+/-27 months. The main
predictors of cumulative mortality in young patients were: Charlson index
[HR 1.18 (95% CI 1.06-1.30), p=0.001], Acute Kidney Injury [HR 2.21 (95%
CI 1.42-3.47), p=0.001], Left ventricular ejection fraction [HR 1.02 (95%
CI 1.009-1.035), p=0,001], and protective factor was a higher Karnosfky
index [HR 0.98 (95% CI 0.97-0.99) p=0.006]. And in older patients were:
Frailty [HR 1.67 (95% CI 1.13-2.47), p=0.010], COPD [HR 2.09 (95% CI
1.41-2.91), p=0,001], Stroke [HR 3.01 (95% CI 1.54-5.89), p=0.001]
Charlson index [HR 1.14 (95% CI 1.02-1.27), p=0.015], Acute Kidney Injury
[HR 1.57 (95% CI 1.06-2.32), p=0.001. <br/>Conclusion(s): TAVR is
associated with low complications rate in young and older patients.
Survival during follow-up was similar in both groups, but the predictive
factors of mortality differ, with greater impact on the comorbidtiy in the
elderly patients.

<44>
Accession Number
636529440
Title
Effects of physical prehabilitation on markers of endothelial function in
patients undergoing elective coronary artery bypass grafting.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2691), 2021. Date of
Publication: October 2021.
Author
Argunova Y.; Belik E.; Gruzdeva O.; Barbarash O.
Institution
(Argunova, Belik, Gruzdeva, Barbarash) Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
Publisher
Oxford University Press
Abstract
Purpose: To evaluate the effects of preoperative exercise training on the
perioperative serum levels of asymmetric dimethylarginine (ADMA) and
endothelin-1 (ET-1) in patients with stable coronary artery disease (CAD).
<br/>Method(s): 78 male patients with stable coronary artery disease
referred to elective on-pump CABG were screened and randomized either to
receive prehabilitation, or routine preoperative management without
training. Group 1 (n=43, age 61.5 [55; 65] years) patients underwent
preoperative exercise training (treadmill sessions at 80% of peak oxygen
uptake (VO2peak) intensity for 5-10 days), whereas group 2 (n=35, age 63.0
[56; 66] years) received routine preoperative management without training.
Levels of endothelial function (ADMA and ET-1) were measured using enzyme
immunoassay in the preoperative period of CABG before exercise training,
the day before surgery, and in the postoperative period on days 5-7.
Logistic regression analysis was used to determine significant risk
factors contributing to postoperative complications in the early
postoperative period. Statistical analysis was performed using the
Statistica 10.0 software (Statsoft, USA). <br/>Result(s): Patients from
both study groups did not differ in the main preoperative clinical and
demographic parameters. They had similar comorbid profile and were also
comparable in terms of the intraoperative parameters. No differences in
baseline echocardiography and cardiopulmonary exercise testing were
reported. By the end of the exercise training, group 1 patients had a
significantly lower level of ADMA than patients from group 2 without
prehabilitation (p=0.01). Correlation analysis reported a direct
correlation between the levels of ADMA and ET-1 the day before surgery
(rho = 0.28, P=0.04) in the absence of significant intergroup differences
in ET-1 levels. Stepwise logistic regression adjusted for comorbidities
(chronic bronchopulmonary disease) and intraoperative risk factors (aortic
cross-clamp time) reported a correlation of the pre-existing diabetes with
an increased risk of complications in the early postoperative period (OR
12.3, 95% CI [1, 18-127.6], p=0.03). Elevated ET-1 levels also increased
the risk of complications (OR 10.7, 95% CI [1.1-105.2], p=0.03), whereas
preoperative exercise training reduced the risk of postoperative
complications (OR 0.1, 95% CI [0.01-0.82], p=0.02). <br/>Conclusion(s):
Our findings indicate favorable effects of prehabilitation on the
improvement of endothelial function and prevention of the complications in
the early postoperative period.

<45>
Accession Number
636529418
Title
Effectiveness of implanted cardiac rhythm recorders with
electrocardiographic monitoring for detecting arrhythmias in peripartum
cardiomyopathy (PPCM).
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2905), 2021. Date of
Publication: October 2021.
Author
Hoevelmann J.; Viljoen C.A.; Chin A.; Briton O.; Sliwa K.
Institution
(Hoevelmann, Viljoen, Briton, Sliwa) University of Cape Town, Hatter
Institute for Cardiovascular Research in Africa, Cape Town, South Africa
(Chin) University of Cape Town, Division of Cardiology, Cape Town, South
Africa
Publisher
Oxford University Press
Abstract
Introduction: Peripartum cardiomyopathy (PPCM) is a form of dilated
cardiomyopathy that occurs within the last months of pregnancy or up to 5
months postpartum. Previous studies have shown that up to 30% of deaths in
PPCM are related to sudden cardiac death (SCD). However, little is known
about the burden of arrythmias in PPCM and their contribution to SCD.
<br/>Purpose(s): We aimed to compare implantable loop recorder (ILR) plus
24-hour Holter monitoring to 24h Holter monitoring alone to assess its
utility in the detection of arrhythmias in PPCM. <br/>Method(s): In this
single-centre, prospective clinical trial, 20 consecutive patients with
PPCM were randomized to either standard care (SC cohort: ECG & 24-hour
Holter) or SC plus ILR (SC-ILR cohort: ECG, 24-hour Holter, ILR).
Follow-up included the first six months after ILR implantation.
<br/>Result(s): The median age of this cohort was 31.7 years with a parity
of 2 (IQR 1-4). They presented with a median left ventricular ejection
fraction (LVEF) of 28% (IQR 24-35) and LVEDD of 60mm (IQR 55-66). The
12-lead ECG recorded sinus tachycardia in half of the patients, with
median heart rate of 90bpm (IQR 79-106) compared to 94.5bpm (IQR 85-99) on
24h-Holter-monitoring. The median QTc-interval was 464ms (IQR 424- 494).
Ambulatory ECG monitoring detected major arrhythmias in three women (one
in SC cohort, two in SC-ILR cohort). One patient (5%) died shortly after
ILR implantation. Her ILR detected sinus arrest with an escape rhythm
(figure 1A) that failed and resulted in an out of hospital cardiac arrest.
Non-sustained ventricular tachycardia (nsVT) occurred in two women (10%),
one of which was detected by Holter monitoring and the other on ILR
(figure 1B, 1C). Both women presented with acute heart failure with
severely impaired systolic function (LVEF 12% and 21% respectively). One
of these patients had persistent LV systolic dysfunction despite optimal
medical therapy and received an implantable cardioverter-defibrillator
(ICD). The other patient had intractable heart failure requiring recurrent
intensive-care treatment and underwent heart transplantation. There was no
atrial fibrillation or atrioventricular block detected in any patient by
ECG, Holter or ILR monitoring throughout the study period.
<br/>Conclusion(s): This study on ambulatory ECG monitoring in PPCM showed
a high prevalence of potentially fatal arrhythmias, which occurred
predominantly in the acute phase of the disease. One patient had sinus
arrest and asystole detected by ILR as the terminal arrhythmia. Both
Holter monitoring and ILR played an important role in ventricular
arrhythmia detection, which in two cases had a direct influence on
clinical decision making. ILR is more effective than 24-hour Holter
monitoring in paroxysmal arrhythmia detection because of extended
monitoring.

<46>
Accession Number
636529341
Title
Meta-analysis of cardiovascular outcome trials assessing the
cardiovascular efficacy and safety of dipeptidyl peptidase-4 inhibitors in
patients with type 2 diabetes mellitus.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2954), 2021. Date of
Publication: October 2021.
Author
Patoulias D.; Boulmpou A.; Teperikidis E.; Katsimardou A.; Siskos F.;
Tranidou A.; Nikolaidis A.; Mouselimis D.; Doumas M.; Papadopoulos C.E.;
Vassilikos V.
Institution
(Patoulias, Katsimardou, Siskos, Nikolaidis, Mouselimis, Doumas)
Hippokration General Hospital of Thessaloniki, Second Propedeutic
Department of Internal Medicine, Thessaloniki, Greece
(Boulmpou, Teperikidis, Papadopoulos, Vassilikos) Hippokration General
Hospital of Thessaloniki, Third Department of Cardiology, Thessaloniki,
Greece
(Tranidou) Hippokration General Hospital of Thessaloniki, Fourth
Department of Internal Medicine, Thessaloniki, Greece
Publisher
Oxford University Press
Abstract
Background: Type 2 diabetes mellitus (T2DM) represents an independent risk
factor for the development of cardiovascular disease, which accounts for
half of deaths among the affected patients. Patients with T2DM experience
higher incidence of vascular interventions compared to high-risk patients
without T2DM or cardiovascular disease at baseline, underscoring the
necessity for targeted therapeutic interventions. Dipeptidyl peptidase-4
(DPP-4) inhibitors constitute a safe treatment option with fair glycemic
efficacy in T2DM whose cardiovascular efficacy has been doubted over
recent years. A series of randomized controlled trials (RCTs) addressing
cardiovascular outcomes with DPP-4 inhibitors have been recently
published, while previous meta-analyses failed to show any cardiovascular
benefit with their use in patients with T2DM. <br/>Purpose(s): The purpose
of our analysis was to report the impact of antidiabetic treatment with
DPP-4 inhibitors on different cardiovascular efficacy outcomes.
<br/>Method(s): We searched PubMed for all published RCTs assessing
cardiovascular outcomes after antidiabetic treatment with DPP-4
inhibitors. We extracted data related to the following efficacy outcomes:
fatal and nonfatal myocardial infarction, fatal and non-fatal stroke,
hospitalization for heart failure, hospitalization for unstable angina,
hospitalization for coronary revascularization and cardiovascular death.
<br/>Result(s):We pooled data from a total of 6 trials in a total of
52,520 patients. Antidiabetic treatment with DPP-4 inhibitors did not
significantly affect any of the prespecified cardiovascular efficacy
outcomes. More specifically, DPP-4 inhibitors compared to control led to a
non-significant increase in the risk for fatal and non-fatal myocardial
infarction (RR=1.02, 95% CI: 0.94- 1.11, I2=0%), hospitalization for heart
failure (RR=1.09, 95% CI: 0.92-1.29, I2=65%) and cardiovascular death
(RR=1.02, 95% CI: 0.93-1.11, I2=0%), as shown in figures 1a, 1c and 1f. In
addition, DPP-4 inhibitors produced a non-significant decrease in the risk
for fatal and non-fatal stroke (RR=0.96, 95% CI: 0.85-1.08, I2=0%) and
coronary revascularization (RR=0.99, 95% CI: 0.90-1.09, I2=0%), as
depicted in figures 1b and 1e. Finally, DPP-4 inhibitors demonstrated a
neutral effect on the risk for hospitalization due to unstable angina
(RR=1.00, 95% CI: 0.85-1.18, I2=0%), as shown in figure 1d.
<br/>Conclusion(s): Antidiabetic treatment with DPP-4 inhibitors does not
seem to confer any significant cardiovascular benefit for patients with
T2DM.

<47>
Accession Number
636529316
Title
Transfemoral versus transapical approach for transcatheter aortic valve
implantation: A systematic review and meta-analysis of adjusted studies.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1624), 2021. Date of
Publication: October 2021.
Author
Hage F.; Harris A.R.; Clerc O.; Altibi A.; Hage A.; Hamaya R.;
Papatheodorou S.
Institution
(Hage, Hage) London Health Sciences Centre, Cardiac surgery, London,
Canada
(Harris, Altibi, Hamaya, Papatheodorou) Harvard T. H. Chan School of
Public Health, Epidemiology, Boston, United States
(Clerc) University Hospital Basel, Basel, Switzerland
Publisher
Oxford University Press
Abstract
Background: In selected patients with severe aortic stenosis,
transcatheter aortic valve implantation (TAVI), via either transfemoral
(TF) or transapical (TA) access, offers a less invasive alternative to
standard surgical replacement. Comparison of TF- vs. TA-TAVI is usually
confounded by the higher comorbidities of patients undergoing TA-TAVI,
rendering the observed comparison of the TF- vs. TA-approach unclear. The
present meta-analysis provides updated evidence of this comparison by
focusing on studies reporting adjusted outcomes. <br/>Method(s): A
systematic review of the literature was performed in MEDLINE, EMBASE, Web
of Science, clinicaltrials.gov, and Cochrane database. We only included
studies in which the comparison between TFand TA-TAVI was adjusted for
potential confounders. Primary outcomes were early and mid-term mortality.
Secondary outcomes included cardiovascular events, bleeding, pacemaker,
and acute kidney injury. Survival data was either obtained directly from
reported outcomes or estimated from Kaplan-Meier curves. Meta-regression
was used to adjust for followup duration. Meta-analyses were performed
using random effects models on odds ratios (OR) and hazard ratios (HR).
The protocol was registered on PROSPERO (ID: CRD42020218163).
<br/>Result(s): A total of 24 studies with 36,158 patients were included
in the present analyses. Of these studies, 7 used propensity score
adjustment techniques and 17 used multivariable regression. TA-TAVI was
associated with significantly higher postoperative mortality at 30 days
(OR=1.67; 95% CI, 1.34 to 2.09; p<0.001) and 1 year (HR, 1.36; 95% CI,
1.21 to 1.53; p<0.001). However, meta-analysis of studies censoring
patients who died in the first 30 days showed no significant difference in
1 year mortality by access route (HR, 1.20; 95% CI, 0.95 to 1.52; p=0.13).
TA-approach was associated with increased perioperative surgical
complications, such as bleeding (OR, 1.46, 95% CI, 1.09 to 1.96; p=0.012),
acute kidney injury (OR, 2.31, 95% CI 1.60 to 3.33; p=0.001), and
myocardial infarction (OR, 1.83, 95% CI 1.06 to 3.16; p=0.029). TA-TAVI
was associated with reduced vascular complications (OR, 0.32, 95% CI
0.18-0.56; p<0.001), late postoperative aortic regurgitation (OR, 0.48,
95% CI 0.30 to 0.75; p=0.001), and a trend towards less pacemaker
requirement (OR, 0.80, 95% CI 0.60- 1.08, p=0.15). <br/>Conclusion(s):
Based on this meta-analysis of adjusted studies, a TA approach is
associated with higher early and mid-term mortality compared to TF-TAVI.
Excess mortality is likely driven by higher perioperative bleeding, renal
complications and myocardial infarction. TA-TAVI did confer some benefits,
such as reduced vascular complications, late postoperative aortic
regurgitation, and a trend towards less pacemaker requirement. The optimal
TAVI route should be based on individualized assessment by a
multidisciplinary team. Longer follow-up and randomized studies are needed
to ascertain long-term outcomes. (Figure Presented).

<48>
Accession Number
636529195
Title
Comparing predictors of permanent pacemaker insertion after TAVR in
new-generation versus early generation heart valves.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 405), 2021. Date of
Publication: October 2021.
Author
Gupta R.; Mahajan S.; Malik A.; Mehta S.; Patel N.
Institution
(Gupta, Patel) Lehigh Valley Health Network, Allentown, United States
(Mahajan, Mehta) Carle Foundation Hospital, Urbana, United States
(Malik) New York Medical College, Cardiology, Valhalla, United States
Publisher
Oxford University Press
Abstract
Introduction: Transcatheter Aortic Valve Replacement (TAVR) has emerged as
the standard of care for patient with severe aortic stenosis. Conduction
abnormalities leading to permanent pacemaker (PPM) implantation is one of
the most common complication after TAVR. Newer generation valves (NGV)
such as Sapien S3, XT and Evolut are widely being used in real time
practice. The aim of this analysis is to compare the predictors associated
with increased risk of PPM implantation after TAVR in newer generation
valves (NGV) as compared to older generation valves (OGV). <br/>Method(s):
A comprehensive literature search was performed in PubMed, Embase, and
Cochrane to identify relevant trials. Summary effects were calculated
using a DerSimonian and Laird random-effects model as odds ratio with 95%
confidence intervals for all the clinical endpoints. <br/>Result(s): 18
observational studies with 16,004 patients were identified. The incidence
of PPM implantation after TAVR in our analysis was 8.9%. For the NGV,
right bundle branch block (RBBB) and atrioventricular (AV) block were
independent predictors of PPM insertion after TAVR. Baseline heart rate,
presence of atrial fibrillation, and baseline intraventricular conduction
delay were not significant predictors. However, for the OGV, risk of PPM
implantation after TAVR was higher in presence of RBBB, depth of implant,
valve size/annulus size, presence of atrial fibrillation and
post-procedure AV block. <br/>Conclusion(s): Our analysis identified 2
factors that were significantly associated with increased risk of PPM
insertion after TAVR in NGV compared to 6 factors with OGV. With the
increasing physician expertise with TAVI and use of NGV, the incidence of
post TAVR PPM insertion has reduced but baseline RBBB and AV conduction
block still continue to be significant predictors of increased PPM
insertion after TAVR.

<49>
Accession Number
636529142
Title
Temporal changes of biomarkers in myocardial infarction patients with
non-obstructive compared to obstructive coronary arteries.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1491), 2021. Date of
Publication: October 2021.
Author
Hjort M.; Eggers K.M.; Becker R.C.; Budaj A.; Cornel J.H.; Giannitsis E.;
James S.K.; Katus H.A.; Ghukasyan Lakic T.; Lindback J.; Siegbahn A.;
Storey R.F.; Wallentin L.; Lindahl B.
Institution
(Hjort, James, Wallentin, Lindahl) Uppsala Clinical Research Center,
Department of Medical Sciences, Uppsala University, Uppsala, Sweden
(Eggers, Siegbahn) Department of Medical Sciences, Uppsala University,
Uppsala, Sweden
(Becker) Division of Cardiovascular Health and Diseases, University of
Cincinnati Heart, Lung and Vascular Institute, Cincinnati, United States
(Budaj) Department of Cardiology, Centre of Postgraduate Medical
Education, Grochowski Hospital, Warsaw, Poland
(Cornel) Department of Cardiology, Northwest Clinics,Alkmaar,and The
Radboud University Medical Center, Nijmegen, Netherlands
(Giannitsis, Katus) Department of Medicine III, University of Heidelberg,
Heidelberg, Germany
(Ghukasyan Lakic, Lindback) Uppsala Clinical Research Center, Uppsala
University, Uppsala, Sweden
(Storey) Department of Infection,Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
Publisher
Oxford University Press
Abstract
Background: About 5-10% of all myocardial infarction (MI) patients have
non-obstructive coronary arteries (MINOCA). The pathobiology of MINOCA is
largely unknown compared to myocardial infarction with obstructive
coronaries (MI-CAD). <br/>Purpose(s): To investigate whether baseline
concentrations and temporal changes of circulating biomarkers may offer
insights into the activation of pathophysiological pathways in MINOCA
compared to MI-CAD. <br/>Method(s): From the PLATelet inhibition and
patient Outcomes (PLATO) trial, we retrospectively identified 114 patients
with MINOCA (adjudicated MI, coronary stenoses <50% and excluding patients
with previous coronary revascularization) and 2750 patients with MI-CAD
(adjucated MI and stenoses >=50%) with available biomarker data.
Concentrations of high sensitivity cardiac troponin T (hs-cTnT),
C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide
(NT-proBNP) were centrally measured by immunoassays in plasma samples
obtained at randomization/ baseline (median 15 hours from index event) and
after one month. Differences in biomarker concentrations and their changes
were evaluated by Wilcoxon-Mann-Whitney tests and data at one month were
also analysed with adjusted linear regression models. <br/>Result(s): In
MINOCA patients, median concentrations decreased during one month from 238
to 9 ng/L for hs-cTnT, from 3.5 to 1.6 mg/L for CRP and from 507 to 228
pmol/L for NT-proBNP (Figure 1 and 2). In MICAD patients, median
concentrations decreased from 198 to 13 ng/L for hs-cTnT, from 3.2 to 2.3
mg/L for CRP and increased from 372 to 566 pmol/L for NT-proBNP. Compared
to MI-CAD, the baseline concentrations were higher in MINOCA for NT-proBNP
(p=0.011), but similar for hs-cTnT (p=0.555) and CRP (p=0.834). However,
patients with MINOCA had statistically larger reductions of concentrations
from baseline to one month for hs-cTnT (p=0.002), CRP (p=0.005) and
NT-proBNP (p<0.001) as compared to patients with MI-CAD. At one month,
concentrations were lower in MINOCA than MI-CAD patients for all three
biomarkers, which remained significant after adjustment for the baseline
biomarker concentration, clinical characteristics and medications
(p<0.001). <br/>Conclusion(s): In MINOCA compared to MI-CAD patients,
higher concentrations of NT-proBNP and similar concentrations of hs-cTnT
and CRP at baseline indicate a higher degree of acute myocardial
dysfunction but similar degree of acute myocardial injury and
inflammation. Furthermore, concentrations of these biomarkers were lower
at one month in MINOCA, suggesting other or less remaining underlying
disease processes after MI in MINOCA than MI-CAD.

<50>
Accession Number
636529127
Title
Efficacy and safety of colchicine after myocardial infarction: A
systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1418), 2021. Date of
Publication: October 2021.
Author
Diaz-Arocutipa C.; Benites-Meza J.; Chambergo-Michilot D.; Barboza J.;
Pasupuleti V.; Bueno H.; Sambola A.; Hernandez A.V.
Institution
(Diaz-Arocutipa, Barboza) Universidad San Ignacio de Loyola, Lima, Peru
(Benites-Meza) Universidad Nacional de Trujillo, Trujillo, Peru
(Chambergo-Michilot) Universidad Cientifica del Sur, Lima, Peru
(Pasupuleti) MedErgy HealthGroup, Yardley, United States
(Bueno) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Sambola) Centro de Investigacion Biomedica en Red Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain
(Hernandez) University of Connecticut, School of Pharmacy, Storrs, United
States
Publisher
Oxford University Press
Abstract
Background: Inflammation plays a key role in atherosclerotic plaque
destabilization and adverse cardiac remodeling. Recent evidence has shown
a promising role of colchicine in patients with coronary artery disease.
<br/>Purpose(s): We evaluated the efficacy and safety of colchicine in
post-acute myocardial infarction (MI) patients. <br/>Method(s): We
searched five electronic databases from inception to January 18, 2021, for
randomized controlled trials (RCTs) evaluating colchicine in post-acute MI
patients. Primary outcomes were cardiovascular mortality and recurrent MI.
Secondary outcomes were all-cause mortality, stroke, urgent coronary
revascularization, levels of follow-up highsensitivity C-reactive protein
(hs-CRP), and drug-related adverse events. All meta-analyses used
inverse-variance random-effects models. <br/>Result(s): Six RCTs (n=6005)
patients were included. Colchicine did not significantly reduce
cardiovascular mortality (risk ratio [RR], 0.91; 95% confidence interval
[95% CI], 0.52-1.61; p=0.64), recurrent MI (RR, 0.87; 95% CI, 0.62-1.22;
p=0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61-1.85; p=0.78), stroke
(RR, 0.28; 95% CI, 0.07-1.09; p=0.05), urgent coronary revascularization
(RR, 0.46; 95% CI, 0.02-8.89; p=0.19), or decreased levels of follow-up
hs-CRP (MD, -1.95 mg/L; 95% CI, -12.88 to 8.98; p=0.61) compared to the
control group. There was no increase of any adverse event (RR, 0.97; 95%
CI, 0.89-1.07; p=0.34) or gastrointestinal adverse events (RR, 2.49; 95%
CI, 0.48-12.99; p=0.20). Subgroup analyses by colchicine dose (0.5 versus
1 mg/day), time of follow-up (<1 versus >=1 year), and treatment duration
(<=30 versus >30 days) showed no changes in the overall findings.
<br/>Conclusion(s): In post-acute MI patients, colchicine does not reduce
cardiovascular or all-cause mortality, recurrent MI, or other
cardiovascular outcomes. Also, colchicine did not increase drug-related
adverse events.

<51>
Accession Number
636529101
Title
Changes in EPA and DHA during supplementation with omega-3 fatty acids and
incident cardiovascular events: Secondary analysis from the OMEMI trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2429), 2021. Date of
Publication: October 2021.
Author
Myhre P.; Smith E.B.; Kalstad A.A.; Tveit S.; Laake K.; Smith P.; Nilsen
D.W.T.; Tveit A.; Solheim S.; Arnesen H.; Seljeflot I.
Institution
(Myhre, Tveit, Smith) Akershus University Hospital, Division of Medicine,
Akershus, Norway
(Smith) Aalborg University Hospital, Aalborg, Denmark
(Kalstad, Laake, Solheim, Arnesen, Seljeflot) Oslo University Hospital
Ulleval, Oslo, Norway
(Nilsen) Stavanger University Hospital, Stavanger, Norway
(Tveit) Baerum Hospital, Department of Medical Research, Baerum, Norway
Publisher
Oxford University Press
Abstract
Background: In the OMEMI trial, elderly post-MI patients did not achieve
reduction in cardiovascular events from supplementation of 1.8g n-3
polyunsaturated fatty acids (PUFA). In two recent trials of
hypertriglyceridaemic patients the REDUCE-IT trial demonstrated an
association between high levels of serum eicosapentaenoic acid (EPA) and
reduced risk of CV events with 4 g/day icosapent ethyl supplements while
in the STRENGTH trial no such association was present in patients treated
with 4 g/day of EPA+ docosahexaenoic acid (DHA). <br/>Purpose(s): To
assess associations between changes in concentrations of EPA and DHA
during two years supplementation with n-3 PUFA and incident cardiovascular
events in the OMEMI trial. <br/>Method(s): In the randomized controlled
OMEMI trial, 1014 elderly patients with a recent acute myocardial
infarction (AMI) were treated with 1.8g/day of EPA and docosahexaenoic
acid (DHA) or placebo for two years, and followed for the primary outcome
of MACE (AMI, coronary revascularization, stroke or heart failure
hospitalization) and secondary outcome of newonset atrial fibrillation
(AF). Serum concentrations of EPA and DHA were measured at inclusion and
at study completion by gas chromatography, and reported as % weight of
total FA (%wt) in serum phospholipids. <br/>Result(s): Serial EPA and DHA
measurements at study inclusion and completion were available in 881
patients (92% of survivors). At baseline EPA and DHA concentrations were
(mean+/-SD) 2.84+/-1.41 and 5.71+/-1.35%wt, respectively. Higher baseline
EPA and DHA concentrations were associated with previous n-3 PUFA
supplementation, lower prevalence of current smoking and diabetes, lower
levels of triglycerides and higher levels of HDL-cholesterol (all p<0.05).
In patients randomized to n-3 PUFA, EPA and DHA increased with 2.32+/-1.92
and 0.91+/-1.19%wt, respectively, whereas in the placebo group EPA and DHA
decreased with -0.39+/-1.37 and -0.43+/-1.13%wt, respectively. Greater
increases in EPA and DHA during follow-up were associated with a lowering
of triglyceride concentrations, increasing HDL concentrations, and lower
baseline concentrations of EPA and DHA (all p<0.001). Among patients
treated with n-3 PUFA (n=438), a greater increase in EPA was associated
with a lower risk of incident MACE (HR 0.89 [95% CI 0.78-1.00] per %wt,
p=0.059) and higher risk of newonset AF in patients free of AF at
inclusion (n=339): HR 1.31 [1.06-1.62] per %wt, p=0.012 (Figure). There
were no such associations for changes in DHA: HR 0.86 (95% CI 0.70-1.05),
p=0.13 for MACE and HR 1.29 (0.91- 1.83), p=0.16 for new-onset AF.
<br/>Conclusion(s): Patients treated with 1.8 g/day n-3 PUFA for two years
experienced a doubling of serum EPA concentrations. Greater increases in
EPA were associated with a lower risk of MACE, but also a higher risk of
new-onset AF. Changes in DHA concentrations were not associated with
outcomes, suggesting that EPA may be the more important n-3 PUFA with
respect to risk of cardiovascular events. (Figure Presented).

<52>
Accession Number
636529092
Title
Acute arterial events across all vascular territories in the FOURIER
trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2947), 2021. Date of
Publication: October 2021.
Author
Oyama K.; Giugliano R.; Tang M.; Bonaca M.; Saver J.; Murphy S.; Ruzza A.;
Sever P.; Sabatine M.; Bergmark B.
Institution
(Oyama, Giugliano, Tang, Murphy, Sabatine, Bergmark) Brigham and Women's
Hospital, Harvard Medical School, Division of Cardiovascular Medicine,
Boston, United States
(Bonaca) University of Colorado, CPC Clinical Research, Department of
Medicine, Aurora, United States
(Saver) University of California Los Angeles, Department of Neurology and
Comprehensive Stroke Center, Los Angeles, United States
(Ruzza) Amgen, Thousand Oaks, United States
(Sever) Imperial College London, International Centre for Circulatory
Health, London, United Kingdom
Publisher
Oxford University Press
Abstract
Background: In the FOURIER (Further Cardiovascular Outcomes Research With
PCSK9 Inhibition in Patients With Elevated Risk) trial, adding the PCSK9
inhibitor evolocumab to statin therapy reduced lowdensity lipoprotein
cholesterol (LDL-C) and cardiovascular risk. Although atherosclerotic
coronary, cerebrovascular, and peripheral vascular events share a related
pathobiology, the effect of aggressive LDL-C lowering with PCSK9
inhibition on the risk of acute arterial events across all three vascular
beds is not well-described. <br/>Purpose(s): To assess the efficacy of
evolocumab on acute arterial events in all vascular territories including
coronary, cerebral, and peripheral vascular beds. <br/>Method(s): In the
FOURIER trial, patients (n=27,564) with stable atherosclerotic
cardiovascular disease and LDL-C >=70 mg/dL on a statin were randomly
assigned to evolocumab versus placebo and followed for a median of 2.2
years (1.8-2.5). Acute arterial events were defined as a composite of
coronary (coronary heart disease [CHD] death, myocardial infarction [MI],
or urgent coronary revascularization), cerebrovascular (ischemic stroke,
transient ischemic attack [TIA], or urgent cerebral revascularization), or
peripheral vascular (acute limb ischemia, major amputation, or urgent
peripheral revascularization) events. Cox proportional-hazard models were
used to assess the efficacy of evolocumab on these outcomes. Landmark and
total event analyses were also done. <br/>Result(s): Of the 2,210 first
acute arterial events occurring during follow-up, 74% were coronary, 22%
were cerebrovascular, and 4% were peripheral vascular. Evolocumab reduced
the risk of a first acute arterial event by 19% (HR 0.81, 95% CI
0.74-0.88; P<0.001), with significant individual reductions in acute
coronary (HR 0.83; 95% CI 0.75-0.91; P<0.001), acute cerebrovascular (HR
0.77; 95% CI 0.65-0.92; P=0.004), and acute peripheral vascular (HR 0.58;
95% CI 0.38-0.88; P=0.01) events (Figure, top). The magnitude of the risk
reduction with evolocumab tended to increase over time, with a 16%
reduction (HR 0.84; 95% CI 0.75-0.96) in the first year followed by a 24%
reduction (HR 0.76; 95% CI 0.67-0.85) thereafter (Figure, bottom). There
were 3,780 total acute arterial events (first plus recurrent), with a 22%
reduction with evolocumab (incidence rate ratio [RR] 0.78; 95% CI
0.70-0.87). Evolocumab prevented 496 total acute arterial events as
compared to 222 first events. <br/>Conclusion(s): The addition of the
PCSK9 inhibitor evolocumab to statin therapy reduced the risk of acute
arterial events across all vascular territories with a robust effect over
time. These findings indicate a pan-vascular impact of aggressive
lipid-lowering therapy on these acute and clinically meaningful events.

<53>
Accession Number
636529015
Title
The global effect of Covid-19 on acute coronary syndromes management.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1361), 2021. Date of
Publication: October 2021.
Author
Lunardi M.; Mylotte D.; Serruys P.; Wijns W.
Institution
(Lunardi, Mylotte, Wijns) National University of Ireland Galway, Division
of Cardiology, Galway, Ireland
(Serruys) Imperial College London, Department of Cardiology, London,
United Kingdom
Publisher
Oxford University Press
Abstract
Aim: Covid-19 has had a dramatic impact on the healthcare systems
globally. Despite efforts to maintain systems of cardiovascular care
during the pandemic, public health responses to the virus have contributed
to adverse cardiovascular outcomes. Herein, we summarize current evidence
detailing the impact of Covid-19 on interventional cardiology.
<br/>Method(s): According to PRISMA criteria, a systematic review was
performed through Medline, Embase, and Cochrane databases, to identify
reports on the impact of Covid-19 on interventional cardiovascular
procedures. We identified 50 published studies that met the prespecified
inclusion and exclusion criteria. <br/>Result(s): In the acute setting,
several datasets report a reduction of acute coronary syndrome (ACS)
admission by 40% globally (-40%, 95% CI 37-43 from the National Health
Service hospital trusts in England). Most surveys and registries reported
a numerically higher impact on NSTEMI/unstable angina cases compared to
STEMI (-42%, 95% CI 38- 46 and -23%, 95% CI 16-30 respectively, from the
National Health Service hospital trusts in England). In STEMI care
pathways, several studies report increased delays between symptom onset
and first medical contact (105 min, 95% CI 45-222 during the pandemic vs
71 min, 95% CI 30-180 before it, p<0.001, from the National STEMI registry
in Spain), with a subsequent increased duration of the ischaemic period
(200 min, 95% CI 140-332 during the pandemic vs 233 min, 95% CI 150-375
before it, p<0.001, from the National STEMI registry in Spain).
Importantly, hospital door-to-balloon times were unchanged. Most studies
suggest similar in-hospital mortality for STEMI during the pandemic
compared to historic controls (1.7% vs 1.8%, p=0.67 from British National
Institute of Cardiovascular Outcomes Research database). An increased
incidence of mechanical complications were observed (41.2% vs 19.6%,
p=0.030, from an Italian monocentric experience). In the United States
(New York city), overall mortality from ischemic heart diseases depicted a
2-fold increase during the pandemic (relative change 2.39, 95% CI
1.39-4.09). Of note, in the same city home deaths increased from 35/day in
2013-2017 to 200/day during the pandemic. These data suggest that ACS
incidence has not decreased, but more likely patients presenting ischemic
symptoms may have not contacted health care services, and have died at
home. <br/>Conclusion(s): The Covid-19 pandemic has adversely impacted
outcomes in patients with ischemic heart disease (IHD). The diagnosis and
treatment of IHD should be designated a health system priority that
remains intact during pandemic events as the magnitude of harm induced by
its interruption is substantial.

<54>
Accession Number
636528824
Title
High-sensitivity cardiac troponin I and T kinetics after coronary artery
bypass grafting in relation to current definitions of myocardial
infarction: A systematic review and meta-anal.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2251), 2021. Date of
Publication: October 2021.
Author
Denessen E.J.S.; Heuts S.; Daemen J.H.T.; Vroemen W.H.M.; Sels J.W.;
Segers P.; Van 'T Hof A.W.J.; Maessen J.G.; Bekers O.; Van Der Horst
I.C.C.; Mingels A.M.A.
Institution
(Denessen, Vroemen, Bekers, Mingels) Cardiovascular Research Institute
Maastricht (CARIM), Maastricht, Netherlands
(Heuts, Segers, Maessen) Maastricht University Medical Centre (MUMC),
Department of Cardiothoracic Surgery, Maastricht, Netherlands
(Daemen) Zuyderland Medical Center, Department of Surgery, Division of
General Thoracic Surgery, Heerlen, Netherlands
(Sels, Van Der Horst) Maastricht University Medical Centre (MUMC),
Department of Intensive Care Medicine, Maastricht, Netherlands
(Van 'T Hof) Maastricht University Medical Centre (MUMC), Department of
Cardiology, Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Background: Cardiac troponins - either cardiac troponin T (cTnT) or
cardiac troponin I (cTnI) - are the preferred biomarkers for the diagnosis
of myocardial infarction (MI), also after coronary artery bypass grafting
(CABG), also known as type 5 MI. Two distinct arbitrarily chosen
definitions of MI have been formulated, proposing different diagnostic cTn
cut-off concentrations for both cTnT and cTnI (defined by multiples of the
99th percentile upper reference limit of 10x, 35x or 70x URL, with or
without need for additional electrocardiographical or imaging findings).
Remarkably, these cut-off values are not (yet) validated for the current
highsensitivity (hs-cTn) assays. <br/>Purpose(s): Investigating the
kinetics of hs-cTnT and hs-cTnI in relation to the current definitions of
myocardial infarction type 5 in patients undergoing isolated CABG.
<br/>Method(s): A systematic search was applied to MEDLINE and EMBASE. The
search terms were coronary artery bypass AND high-sensitivity cardiac
troponin, including alternative names and abbreviations. All studies
reporting hs-cTnT or hs-cTnI on at least two different time points were
included. Hs-cTn concentrations were extracted, stratified and normalized
to the URL of the assay. The search was performed by 2 independent
reviewers, in agreement with the PRISMA guidelines. <br/>Result(s): For
hs-cTnT, and hs-cTnI, 15 (2646 patients) and 18 studies (1760 patients)
were included for meta-analysis, respectively. The mean age of the total
hs-cTnT and hs-cTnI patient population was 65 (11) and 63 (11) years, 22%
and 21% was female, respectively. Preoperative hscTnT and hs-cTnI was
1.2xURL (mean, 95% CI: 0.9-1.4) and 6.1xURL (4.9-7.2), respectively. Peak
hs-cTnT and hs-cTnI was reached 6-8h postoperative up to 44.9xURL
(28.6-61.1) and 135xURL (109-161), respectively (figure 1). For patients
where MI-5 was ruled out, peak hs-cTnT and hs-cTnI level was 43.9xURL
(20.1-67.6) and 97.1xURL (20.6-214) respectively. Peak hs-cTnT and hs-cTnI
concentrations were dependent on surgical strategy. Patients undergoing
off-pump CABG, reached a peak 16-24h post-operatively (hs-cTnT: 13.4xURL,
8.1-18.8) and (hs-cTnI: 60.6xURL, 47.0-74.2). This was notably different
from on-pump CABG, where peak hs-cTnT and hs-cTnI was reached 6-8h
postoperative (44.8xURL, 37.8- 51.9) and (144xURL, 114-174) respectively.
MI incidence was 2.7% (range 0-7.0%) and 6.9% (range 0-32%) and the 30-day
mortality was ranging from 0-4% and 0-2.5% for hs-cTnT and hs-cTnI
respectively. <br/>Conclusion(s): Postoperative hs-cTn surpasses most of
the proposed cut-off concentrations by current definitions of type 5 MI,
for hs-cTnT but especially for hs-cTnI. Differences in hs-cTn release
following on-pump versus off-pump CABG were also observed, implying the
need for different cut-off values for different surgical strategies.
Furthermore, future clinical studies should focus on the diagnostic
accuracy of cTn in type 5 MI and the reevaluation of hs-cTn cut-off values
in particular.

<55>
Accession Number
636528815
Title
The coronary arteries in adults after arterial switch: A systematic
review.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1845), 2021. Date of
Publication: October 2021.
Author
Engele L.J.; Mulder B.J.M.; Schoones J.W.; Kies P.; Egorova A.D.; Vliegen
H.W.; Hazekamp M.G.; Bouma B.J.; Jongbloed M.R.M.
Institution
(Engele, Mulder, Bouma) Academic Medical Center, Cardiology, Amsterdam,
Netherlands
(Schoones) Leiden University Medical Center, Directorate of Research
Policy, Leiden, Netherlands
(Kies, Egorova, Vliegen) Leiden University Medical Center, Cardiology,
Leiden, Netherlands
(Hazekamp) Leiden University Medical Center, Cardiothoracic Surgery,
Leiden, Netherlands
(Jongbloed) Leiden University Medical Center, Departments of Cardiology
and Anatomy and Embryology, Leiden, Netherlands
Publisher
Oxford University Press
Abstract
Background: Coronary artery status in adults longterm after the arterial
switch operation (ASO) is unclear. As a consequence, current follow-up
strategies for coronary assessment remain controversial. We conducted a
systemic review to provide an overview of coronary complications during
adulthood and to evaluate the value of coronary imaging in adults after
ASO, in light of current guidelines. <br/>Material(s) and Method(s):
Studies describing coronary complications or coronary imaging after ASO in
adults were considered eligible for review and analysis. Articles were
screened for the inclusion of adult ASO patients and data on coronary
complications and findings of coronary imaging were collected. In cohort
studies with both adults (>=18 years) and non-adults (<18 years) only
outcomes in identifiable adults were analyzed. <br/>Result(s): A total of
993 adults were followed with a median follow-up of 2.0 years after
reaching adulthood. Myocardial ischemia was suspected in 16/192 patients
(6.8%). The number of coronary interventions was 4 (0.4%) and coronary
death was reported in 4 (0.4%) patients. The following coronary
abnormalities were found by routine coronary computer tomography CT (cCT):
stenosis (4%), acute angle (40%), kinking (24%) and interaterial course
(11%). No coronary events were reported during pregnancy (n=45).
<br/>Conclusion(s): The reported number of coronary interventions (0.4%)
and of coronary death (0.4%) during a median follow-up of 2 years in 993
ASO adults is low. Coronary abnormalities including acute angle, kinking
and interarterial course were commonly found by cCT. The 2020 European
Society of Cardiology (ESC) guidelines state that routine screening for
coronary pathologies is questionable. However, based on current findings
and in line with the 2018 American ACC/AHA guidelines we suggest a
baseline assessment of the coronary arteries in all adult ASO patients.
Thereafter, an individualized coronary follow-up strategy, based upon
coronary findings, is advisable.

<56>
Accession Number
636528786
Title
Valve-in-valve transcatheter aortic valve replacement or re-surgical
aortic valve replacement in degenerated bioprostheses: A systematic review
and meta-analysis of short and mid-term results.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2188), 2021. Date of
Publication: October 2021.
Author
Bruno F.; Elia E.; D'Ascenzo F.; Marengo G.; De Filippo O.; Gallone G.;
Andreis A.; Fortuni F.; Salizzoni S.; Rinaldi M.; La Torre M.; Conrotto
F.; De Ferrari G.M.
Institution
(Bruno, Elia, D'Ascenzo, Marengo, De Filippo, Gallone, Andreis, Fortuni,
Conrotto, De Ferrari) Hospital Molinette of the University Hospital S.
Giovanni Battista, City University Hosp of Health an, Turin, Italy
(Salizzoni, Rinaldi, La Torre) A.O.U. Citta della Salute e della Scienza
di Torino, Cardiosurgery, Turin, Italy
Publisher
Oxford University Press
Abstract
Introduction: Despite limited to short and mid-term outcomes,
Valve-invalve (ViV) transcatheter aortic valve implantation (TAVI) has
emerged as a less invasive alternative to redo surgery for high and
intermediate-risk patients with good outcomes across different surgical
risk profiles. <br/>Purpose(s): The aim of the resent meta-analysis is to
compare short and mid-term outcomes of VIV and surgical redo fo patients
with a degenerative aortic bioprosthesis. <br/>Method(s): All studies
comparing with multivariate adjustment between ViV TAVI and re-SAVR were
screened. All-cause mortality at 30-day and at follow-up were the primary
endpoints, while Valve Academy research Consortium (VARC) endpoints at 30
days including stroke, myocardial infarction (MI), major vascular
complications, major bleeding, new onset atrial fibrillation (AF) and
permanent pacemaker implantation (PPI) during the index hospitalization
were the secondary endpoints. Subgroup analysis were performed according
to the surgical risk. All the analyses were stratified according to the
design of the study (observational vs propensity-matched study).
<br/>Result(s): We obtained data from 11 studies, encompassing 8570
patients, 4224 undergoing ViV TAVI and 4346 re-SAVR. Four studies included
intermediate-risk patients and seven high-risk patients. Mean age was 76
and 71.5 years in the ViV and re-SAVR group respectively, with a 60.2% and
61.3% of male. For the ViV procedure, BE prostheses were used in the 49.6%
of patients and SE prostheses in the 45.8%. The ViV group have higher
prevalence of previous CAD (53.8% vs 41.1%) and CABG (35% vs 23.6%) and
more history of HF (72.1% vs 65.6%), CKD (26.6% vs 14.8%) and COPD (25.4
vs 14.8%). 30-day all-cause and CV mortality were significantly lower in
ViV (OR 0.43, 0.29-0.64 and OR 0.44, 0.26- 0.73 respectively), while after
a mean follow-up of 717 (180-1825) days, there were no difference between
the two groups (OR 1.04, 0.87-1.25 and OR 1.05, 0.78-1.43 respectively).
The result were consistent both in intermediate and high-risk classes. The
risk of stroke (OR 1.03, 0.59-1.82), MI (OR 0.70, 0.34-1.44), major
vascular complications (OR 0.92, 0.50-1.67) and permanent pacemaker
implantation (OR 0.67, 0.36-1.25) at 30 days did not differ, while major
bleedings and new onset atrial fibrillation were significantly lower in
ViV patients (OR 0.41, 0.25-0.67 and OR 0.23, 0.12- 0.42 respectively, all
CI 95%). <br/>Conclusion(s): In patients with a degenerated aortic
bioprosthesis, ViV TAVI is associated with better short-term outcomes,
including all-cause mortality, without any difference in all-cause and
cardiovascular mortality at mid-term follow-up compared to surgical redo.

<57>
Accession Number
636528760
Title
Sex-related differences in long-term mortality after coronary artery
bypass graft surgery: A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2246), 2021. Date of
Publication: October 2021.
Author
Al-Sadawi M.; Kane J.; Stevens G.A.; Parikh P.
Institution
(Al-Sadawi, Kane, Stevens, Parikh) Stony Brook University Medical Center,
Cardiovascular Medicine, Stony Brook, United States
Publisher
Oxford University Press
Abstract
Background: This meta-analysis assessed the sex-related differences in
long-term mortality (>7 years) after Coronary Artery Bypass Graft (CABG)
Surgery. <br/>Purpose(s): Women has higher incidence of short-term
cardiovascular mortality after CABG compared to men. However, data about
long-term differences are controversial. <br/>Method(s): We searched the
databases for studies reporting sex-specific mortality following CABG
including Ovid MEDLINE, Ovid, Embase, Scopus, Web of Science, Google
Scholar, and EBSCO CINAHL from inception up to December 31st, 2020. The
search was not restricted to time or publication status. Outcomes included
rates of long-term mortality (>7 year or longer). <br/>Result(s): A total
of 518 studies were resulted from literature search. A total of 14 studies
and 204,223 patients; 158,663 men and 45,556 women, with a mean age of the
men 60.2 years and 63.2 years for women, were included in our systematic
review and meta-analysis. Our analysis suggested sex-related differences
in long-term mortality (>7 years) following CABG (odds ratio (1), 1.15;
95% confidence interval (2), 1.017-1.30; P<.02). <br/>Conclusion(s): Our
results suggest that women had higher long-term mortality following CABG
compared with men. It is the largest study to date of sex-specific
differences in long-term mortality (>7 years).

<58>
Accession Number
636528733
Title
Electrocardiographic predictors of recovery from pacemaker dependency
after transcatheter aortic valve implantation: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2184), 2021. Date of
Publication: October 2021.
Author
Maier O.; Afzal S.; Piayda K.; Polzin A.; Westenfeld R.; Jung C.; Zeus T.;
Kelm M.; Veulemans V.
Institution
(Maier, Afzal, Piayda, Polzin, Westenfeld, Jung, Zeus, Kelm, Veulemans)
University Hospital Duesseldorf, Duesseldorf, Germany
Publisher
Oxford University Press
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is a
wellestablished alternative to surgery for the treatment of patients with
severe symptomatic aortic stenosis at high and intermediate surgical risk.
The occurrence of electrical conduction disturbances with the need for
permanent pacemaker (PPM) implantation remains one of the most frequent
complications of the procedure. But PPM dependency after TAVI is often
transient and conduction abnormalities may improve over time.
<br/>Purpose(s): We performed a meta-analysis to summarize available
studies that reported the incidence of new PPM after TAVI and investigated
the rate and possible predictors of recovery from PPM dependency during
followup. <br/>Method(s): The authors conducted a literature search in
PubMed and MEDLINE databases from January of 2012 until February of 2021.
Eleven observational studies (n=6794) met inclusion criteria for the final
analysis. The effect size was estimated using a random-effects model with
95% confidence interval (CI). <br/>Result(s): PPM implantation was
performed in 902 patients after TAVI (13.3%), mostly due to high degree
atrioventricular (AV) block (81.3%). A follow-up of 683 patients was
performed after a median period of 139 days. 322 of the patients examined
during follow-up (48.6%) showed recovery from PPM dependency. Regarding
secondary endpoints' analysis of relative risk (RR) and mean difference
(MD) predictors of PPM recovery during follow-up were female sex (RR 1.37;
95% CI 1.10-1.71; p=0.006), preexisting coronary artery disease (RR 1.12;
95% CI 0.99-1.27; p=0.08) and reduced left ventricular ejection fraction
(MD -2.08%; 95% CI 0.23- 3.93%; p=0.03). ECG predictors for long-term PPM
dependency after TAVI appeared to be preexisting right bundle branch block
(RBBB) (RR 1.84; 95% CI 1.38-2.45; p<0.0001), bifascicular block (RR 4.41;
95% CI 1.64- 11.86; p=0.003) and prolonged QRS duration (MD 8.69 ms; 95%
CI 0.11- 17.28 ms; p=0.05). While postprocedural complete heart block was
highly predictive for long-term PPM dependency after TAVI (RR 1.35; 95% CI
0.97-1.89; p<0.0001), patients with recovery of PPM dependency showed more
indications other than complete heart block for PPM implantation like
lower degree AV block or sick sinus syndrome (RR 2.28; 95% CI 1.53-3.38;
p<0.0001). Especially postprocedural AV block grade I (RR 1.73; 95% CI
0.96-3.14; p=0.07) and new left bundle branch block (LBBB) (RR 1.94; 95%
CI 1.22-3.08; p=0.005) turned out to be predictors of PPM recovery during
follow-up. <br/>Conclusion(s): This structured meta-analysis proved new
PPM implantation in 13.3% of patients following TAVI with half of the
cases (48.6%) recovering from PPM dependency during follow-up. Therefore,
it should be considered to carefully reassess the indication for PPM
rather than to immediately implant PPM after TAVI, especially regarding
postprocedural ECG predictors for early pacemaker recovery (lower degree
AV block, postprocedural LBBB).

<59>
Accession Number
636528625
Title
Intracoronary pharmacological therapy versus aspiration thrombectomy in
patients presenting with ST-segment elevation myocardial infarction
(IPAT-STEMI): A systematic review and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2112), 2021. Date of
Publication: October 2021.
Author
Kaddoura R.; Mohamed Ibrahim M.I.; Al-Badriyeh D.; Omar A.; Al-Kindi F.;
Arabi A.
Institution
(Kaddoura, Omar, Al-Kindi, Arabi) Hamad Medical Corporation Heart
Hospital, Doha, Qatar
(Mohamed Ibrahim, Al-Badriyeh) Qatar University, Doha, Qatar
Publisher
Oxford University Press
Abstract
Background: Large thrombus load remains a challenge in the interventional
cardiology practice. It precludes direct stent implementation and
aggravates coronary obstruction leading to impaired myocardial perfusion,
worsened cardiac function, and adverse clinical outcomes. Thus, various
strategies have been advocated such as aspiration thrombectomy (AT),
and/or localized or intracoronary (IC) treatment with thrombolytic agents
and/or glycoprotein IIb/IIIa inhibitors (GPI). <br/>Purpose(s): To
evaluate the effectiveness of IC-administered pharmacological agents alone
or combined with AT compared with AT alone as an adjunct to percutaneous
coronary intervention (PCI) in STEMI patients with large thrombus burden.
<br/>Method(s): The method was conducted according to the Cochrane
Handbook for Systematic Reviews and the Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic
search strategy using MEDLINE, EMBASE, CENTRALE, Scopus, Pro- Quest Public
Health, Web of Science databases was performed on February 22, 2020 and
updated on February 13, 2021. Eligible trials were randomized controlled
trials (RCT) comparing IC-administered thrombolytic agents and/or GPI with
or without AT to AT alone in patients presenting with STEMI who underwent
PCI. The primary outcomes included coronary reperfusion indices e.g.,
thrombolysis in myocardial infarction (TIMI) flow grade 3 (G3), TIMI
myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3,
ST-segment resolution (STR). Others included clinical outcomes e.g., major
adverse cardiovascular events (MACE). <br/>Result(s): Twelve RCT enrolled
1,466 patients were included in the final analysis. The trials were
categorized into 3 groups: (1) Thrombolytics [4 RCT], (2) GPI [3 RCT], and
(3) GPI+AT [7 RCT]. Groups 2 and 3 included two mutual studies with
multiple arms. In comparison with AT alone, thrombolytic therapy, as
presented in four RCT, significantly improved TIMI flow G3 (OR = 3.71, 95%
CI: 1.85-7.45; P overall effect = 0.0002; heterogeneity = 0%), complete
STR (OR = 3.64, 95% CI: 1.60-8.26; P overall effect = 0.002; heterogeneity
= 34%) and MACE (OR = 0.47, 95% CI: 0.22-0.99; P overall effect = 0.05;
heterogeneity = 46%), but not TMPG 3. Pooling the data of the two studies
with similar intervention i.e., thrombolytics + AT further refined the
results with statistical improvement of TMPG 3 as well (OR = 5.44, 95% CI:
2.61- 11.34; P overall effect <0.000001; heterogeneity = 0%) (Fig. 1).
Pooled results for GPI and GPI+AT groups did not show statistical
improvement in TIMI flow G3, MBG 2/3, nor complete STR (Fig. 2).
<br/>Conclusion(s): The findings of this meta-analysis showed that
ICadministered thrombolytic agents improved myocardial reperfusion and
MACE compared with AT alone in STEMI patients undergoing PCI.

<60>
Accession Number
636528584
Title
Clinical characteristics and medical therapy in randomized clinical trial
eligible-and-enrolled vs. eligible-but-not enrolled patients with
ischaemic heart failure.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 3179), 2021. Date of
Publication: October 2021.
Author
Czyz L.; Chmiel J.; Mazurek A.; Drabik L.; Kwiecien E.; Sikorska M.;
Skubera M.; Kozynacka A.; Olszowska M.; Zasada W.; Podolec P.; Musialek P.
Institution
(Czyz, Chmiel, Mazurek, Kwiecien, Sikorska, Skubera, Olszowska, Podolec,
Musialek) Jagiellonian University Medical College, John Paul II Hospital,
Dept of Cardiac and Vascular Diseases, Krakow, Poland
(Drabik) Jagiellonian University Medical College, John Paul II Hospital,
Dept of Cardiac and Vascular Diseases, Krakow, Poland
(Kozynacka) Jagiellonian University Medical College, John Paul II
Hospital, Department of Coronary Disease, Krakow, Poland
(Zasada) Jagiellonian University, Medical College, 2nd Department of
Cardiology and Krakow Cardiovascular Research Institute, Krakow, Poland
Publisher
Oxford University Press
Abstract
Introduction: Clinical trial applicability to routine clinical practice is
a fundamental consideration. Little is known about eligibility and
enrolment in ischaemic heart failure (iHF) trials. <br/>Aim(s): To compare
clinical characteristics and medical therapy between subjects
eligible-and-enrolled vs eligible-but-not-enrolled in iHF interventional
randomized controlled trials (RCT). <br/>Material(s) and Method(s): Using
our detailed database of consecutive hospitalizations, iHF patients
clinical characteristics and medical treatment were compared for 4
following periods: P1 (6 months of RCT#1 recruitment), P2 (6 months after
the RCT#1), P3 (6 months of RCT#2 recruitment), P4 (6 months after RCT#2).
RCT#1 and RCT#2 had similar criteria that involved 18-80 years old, NYHA
Class II-IV inclusion and LVEF <=40% (inclusion), and tumor/neoplasm
history, recent (<=3 months) or planned major surgery, heart transplant
waiting list (exclusion). Eligibility and enrolment, and reasons for
non-eligibility and non-enrolment, were evaluated along baseline clinical
characteristics and medical treatment. <br/>Result(s): Data of 5,436
patients were reviewed. Eligibility rate was similar between the periods
evaluated (P1-56.45%, P2-43.14%, P3-58.49%, P4-50.25%). One in 2 (50.62%)
ineligible patients had a single-only reason for ineligibility (recent
[<=3 months] or recommended cardiac surgery/cardiovascular intervention
outside the trial 16.3%, age>80 years 14.6%, Fig. 1 and Fig. 2). 13.2% of
eligible patients were not enrolled due to lack of consent.
Eligible-and-enrolled patients did not differ in baseline clinical
characteristics such as sex, age, diabetes, and the clinical stage of
heart failure against the eligible-but-not-enrolled patients. However, the
eligible-and-enrolled had lower left ventricle ejection fraction
(echocardiography; 31.2% vs. 33.9%, p=0.0393) and higher end-diastolic
volume (197.8ml vs 160.4ml, p<0.0001). There were no differences in
ACE/ARB inhibitor, B-blocker, diuretic (thiazide, loop, K+ sparing),
sacubitril/valsartan and statin therapy between the groups. Eligible
patients characteristics were not different between the recruitment (P1,
P3) and non-recruitment periods (P2, P4). <br/>Conclusion(s): Enrolment
rate was high. Ineligibility resulted mainly from recent or recommended
cardiovascular intervention outside RCT. Medical treatment was similar
between eligible-and-enrolled and eligible-but-notenrolled patients. Age
(when within the inclusion criteria), gender and time frame were not
factors of bias. However, the trial-enrolled patients had more severe left
ventricle impairment. This argues, for iHF RCTs, against the routinely
assumed lower-risk patient enrolment bias as signalled in other trial
types and populations.

<61>
Accession Number
636528455
Title
Self-expanding and balloon-expandable transfemoral transcatheter aortic
valve replacement: in-hospital outcomes in Germany.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2174), 2021. Date of
Publication: October 2021.
Author
Oettinger V.; Zehender M.; Bode C.; Kaier K.; Von Zur Muehlen C.; Stachon
P.
Institution
(Oettinger, Zehender, Bode, Von Zur Muehlen, Stachon) University Heart
Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology I,
University of Freiburg, Freiburg, Germany
(Kaier) Medical Center - University of Freiburg, Institute of Medical
Biometry and Statistics, University of Freiburg, Freiburg, Germany
Publisher
Oxford University Press
Abstract
Background: The impact of valve type used in transfemoral transcatheter
aortic valve replacement (TF-TAVR) on outcomes is currently under
discussion. <br/>Purpose(s): We examine the in-hospital outcomes of
balloon-expandable (BE) and self-expanding (SE) valves in a complete
national cohort in Germany in 2018. <br/>Method(s): All 17,295 patients
receiving TF-TAVR with BE (N=9,882) or SE (N=7,413) valves in Germany in
2018 were identified. Outcomes were analyzed for the endpoints in-hospital
mortality, major bleeding, stroke, acute kidney injury, postoperative
delirium, mechanical ventilation >48h, length of hospital stay, and
reimbursement. Since there was no randomization of patients to the two
treatment options, logistic or linear regression models were carried out
using 22 baseline patient characteristics and center-specific variables as
potential confounders. Propensity score methods served as sensitivity
analysis. <br/>Result(s): Both valve types differed significantly in
baseline characteristics with higher EuroSCORE (p<0.001), age (p<0.001)
and rate of female sex (p<0.001) in patients treated with SE valves. After
risk adjustment, there were no marked differences in outcomes for
in-hospital mortality (risk adjusted odds ratio (aOR) for SE instead of
BE: 0.94 [95% CI 0.76; 1.17], p=0.617), major bleeding (aOR 0.91 [0.73;
1.14], p=0.400), stroke (aOR 1.13 [0.88; 1.46], p=0.347), acute kidney
injury (aOR 0.97 [0.85; 1.10], p=0.621), postoperative delirium (aOR 1.09
[0.96; 1.24], p=0.184), mechanical ventilation >48h (aOR 0.98 [0.77;
1.25], p=0.893), length of hospital stay (risk adjusted difference in days
of hospitalization: -0.05 [-0.34; 0.25], p=0.762) and reimbursement (--72
[--291; -147], p=0.519). Similar results were found using propensity score
methods. <br/>Conclusion(s): Outcomes in contemporary TF-TAVR procedures
are broadly equivalent regardless of the valve type used. Major
complications rarely occur in both types of valve.

<62>
Accession Number
636528249
Title
Comparison of valve durability among different transcatheter and surgical
aortic valve prostheses: A network meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2169), 2021. Date of
Publication: October 2021.
Author
Ueyama H.; Kuno T.; Takagi H.; Kobayashi A.; Misumida N.; Baeza C.; Kini
A.; Lerakis S.; Latib A.; Sondergaard L.A.R.S.; Attizzani G.
Institution
(Ueyama, Kuno) Mount Sinai Beth Israel, New York, United States
(Takagi) Shizuoka Medical Center, Shizuoka, Japan
(Kobayashi, Baeza, Attizzani) University Hospitals Case Medical Center,
Cleveland, United States
(Misumida) University of Kentucky, Lexington, United States
(Kini, Lerakis) Mount Sinai Hospital, New York, United States
(Latib) Montefiore Medical Center, New York, United States
(Sondergaard) Copenhagen University Hospital, Copenhagen, Denmark
Publisher
Oxford University Press
Abstract
Background: Durability of different transcatheter heart valve (THV) is
critical as the indication of transcatheter aortic valve replacement
(TAVR) expands to patients with longer life-expectancy. <br/>Purpose(s):
We aimed to compare the durability of THV systems (balloonexpandable [BE]
and self-expandable [SE]) and surgical aortic valve replacement (SAVR)
prosthesis. <br/>Method(s): PUBMED and EMBASE were searched through
February 2021 for randomized trials investigating parameters of valve
durability after TAVR and/or SAVR in severe aortic stenosis. A network
meta-analysis using random-effect model was performed. Synthesis was
performed with 5- year follow-up data for echocardiographic outcomes and
longest available follow-up data for clinical outcomes. <br/>Result(s):
Ten trials with a total of 9,388 patients (BE-THV: 2,562; SE-THV 2,863;
SAVR:3,963) were included. Follow-up ranged from 1-6 years. SETHV
demonstrated significantly larger effective orifice area, lower mean
aortic valve gradient (AVG), and less increase in mean AVG at 5-years
compared to BE-THV and SAVR (Figure 1). Structural valve deterioration
(SVD) was less frequent in SE-THV compared to BE-THV and SAVR (HR 0.14,
95% CI 0.07-0.27; HR 0.34, 95% CI 0.24-0.47, respectively) (Figure 1).
Total moderate-severe aortic regurgitation and re-intervention was more
frequent in BE-THV (HR 4.21, 95% CI 2.40-7.39; HR 2.22, 95% CI 1.16-4.26,
respectively) and SE-THV (HR 7.51, 95% CI 3.89-14.5; HR 2.86, 95% CI
1.59-5.13, respectively) compared to SAVR. <br/>Conclusion(s): TAVR with
SE-THV demonstrated favorable forward-flow hemodynamics and lowest risk of
SVD compared to BE-THV and SAVR at mid-term. However, both THV systems
suffer an increased risk of aortic regurgitation and re-intervention, and
long-term data from newer generation valve is warranted.

<63>
Accession Number
636528161
Title
Long-term outcomes of catheter ablation for ventricular arrhythmias in
post-myocarditis patients; Insights from a meta-analysis of current datv.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 379), 2021. Date of
Publication: October 2021.
Author
Androulakis E.; Briasoulis A.; Falconer D.; Lim W.; Siasos G.; Ahluwalia
N.; Graham A.; Papageorgiou N.
Institution
(Androulakis) Royal Brompton and Harefield Hospital, London, United
Kingdom
(Briasoulis) Alexandra University Hospital, Athens, Greece
(Falconer, Lim, Ahluwalia, Graham, Papageorgiou) Barts Health NHS Trust,
London, United Kingdom
(Siasos) National and Kapodistrian University of Athens Medical School,
Athens, Greece
Publisher
Oxford University Press
Abstract
Background: In the past decade, catheter ablation (CA) has become a
rapidly expanding treatment option for ventricular tachycardia (VT),
however it is not commonly utilized for patients with post-myocarditis VT.
We aimed to systematically review up-to-date evidence regarding
feasibility, effectiveness, and safety of CA, with a specific focus on
long-term relapse rate and procedural complications. <br/>Method(s): A
structured electronic database search (PubMed, Embase, Cochrane) of the
scientific literature was performed for studies describing outcomes at up
to 7.3 years after CA. The primary outcome measured was VT recurrence
post-ablation. Procedural success was defined as freedom of ventricular
arrhythmias (at the end of follow-up after an ablation procedure). The
secondary outcome was significant procedural complications which included
procedural death, stroke, cardiac tamponade, acute myocardial infarction,
major vascular complications, and major bleeding, assessed on a
study-by-study basis. <br/>Result(s): A total of 186 patients were
included in analysis with most patients (88%) being male. Over the follow
up period there was a 18% relapse rate (n=34) (Confidence Interval (CI);
0.12-0.24, I²=0, p=0.77) with the majority of patients
remaining VT free for the duration of follow up. Only one study recorded
the percentage of re-do procedures. The overall procedural complication
rate was 3.0% (n=7, (CI; 0.01-0.07, I²=0, p=0.44) and of note,
there were no peri-procedural deaths or heart transplant surgeries
reported. However, a single study reported a mortality of 10% (n=2) during
the follow up period. <br/>Conclusion(s): CA is an effective and durable
long-term therapeutic strategy for post myocarditis VT patients with
limited relapse rate and very low complication rates based on these
non-randomised data. Larger randomised-controlled trials with standardised
treatment and long followup are required to compare CA versus conventional
treatment in the postacute myocardial phase. (Figure Presented).

<64>
Accession Number
636528119
Title
Transcatheter aortic valve implantation outcomes compared between bicuspid
aortic and tricuspid aortic valve stenosis: an updated systematic review
and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2225), 2021. Date of
Publication: October 2021.
Author
Aedma S.; Gupta R.; Mahajan S.; Mahajan P.; Patel M.; Malik A.; Naik A.;
Mehta S.; Patel N.C.
Institution
(Aedma, Mahajan, Mahajan, Naik, Mehta) Carle Foundation Hospital, Internal
medicine, Urbana, United States
(Gupta, Patel) Lehigh Valley Health Network, Cardiology, Allentown, United
States
(Patel) Sumandeep Vidyapeeth, Vadodara, India
(Malik) New York Medical College, Cardiology, Valhalla, United States
Publisher
Oxford University Press
Abstract
Background: TAVI has emerged as an attractive treatment modality based on
promising recent trial data. Patients with BAV, a commonly encountered
clinical condition have largely been excluded from a majority of trials.
<br/>Purpose(s): Elderly patients with BAV and severe AS are increasingly
encountered in clinical practice. This meta-analysis compares clinical
outcomes between bicuspid and tricuspid AV patients to address the current
knowledge-gap and identify optimal management strategies of these
patients. <br/>Method(s): A comprehensive literature search was performed
in PubMed, Embase, and Cochrane to identify the available observational
studies comparing outcomes of TAVI in BAV and TAV patients. Summary
effects were calculated using a DerSimonian and Laird random-effects model
as odds ratio with 95% confidence intervals for all the clinical
endpoints. <br/>Result(s): 16 Observational studies met inclusion
criteria, comprising 10,053 patients with BAV and 173,307 patients with
TAV that underwent TAVI. No significant differences in 30-day and
long-term mortality rates were observed. Patients with BAV had an
increased risk of stroke (OR 1.23; 95% CI [1.06-1.44], p=0.007),
re-intervention (OR 1.90; 95% CI [1.15-3.15], p=0.01), paravalvular leak
(OR 1.42; 95% CI [1.25-1.61], p<0.00001), conversion to open surgery (OR
1.93; 95% CI [1.21-3.07], p=0.006), and new pacemaker implantation (1.57;
95% CI (1.06 - 2.33, p=0.02). Adverse event rates are lower with the use
of newer generation of valves. No significant difference in major vascular
complications, major bleeding, or incidence of AKI was noted.
<br/>Conclusion(s): Complication rates for BAV TAVI are higher, but
mortality is similar to TAV TAVI indicating TAVI is an appropriate
alternative for intermediate-high risk patients with BAV. A better
understanding of valve anatomy, physician expertise, the use of
newer-generation valves can help reduce these complications.

<65>
Accession Number
636528022
Title
Clinical outcomes following isolated transcatheter tricuspid valve repair:
A meta-analysis and meta-regression study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2222), 2021. Date of
Publication: October 2021.
Author
Bocchino P.P.; Angelini F.; Vairo A.; Andreis A.; Fortuni F.; Franchin L.;
Frea S.; Raineri C.; Pidello S.; Conrotto F.; Montefusco A.; Alunni G.; De
Ferrari G.M.
Institution
(Bocchino, Angelini, Vairo, Andreis, Fortuni, Franchin, Frea, Raineri,
Pidello, Conrotto, Montefusco, Alunni, De Ferrari) Hospital Citta Della
Salute e della Scienza di Torino, Turin, Italy
Publisher
Oxford University Press
Abstract
Background: Significant tricuspid regurgitation (TR) is a common valvular
heart disease worldwide. <br/>Purpose(s): We aimed to assess the pooled
clinical and echocardiographic outcomes of different isolated
transcatheter tricuspid valve repair (ITTVR) strategies for significant
(>= moderate) TR. <br/>Method(s): We systematically searched the
literature for studies evaluating the efficacy and safety of ITTVR for
significant TR in adult. The primary outcomes were the improvement of New
York Heart Association (NYHA) functional class and 6-minutes walking
distance (6MWD) and the presence of severe or greater TR at the last
available follow-up of each individual study. Random-effect meta-analysis
was performed comparing outcomes before and after ITTVR. <br/>Result(s):
14 studies with 771 patients were included. Mean age was 77+/-8 years and
mean EuroScore II was 6.8%+/-5.4%. At a weighted mean followup of 212
days, 209 (35%) patients had a NYHA III to IV functional class compared to
586 (84%) patients at baseline (risk ratio: 0.23, 95% CI 0.13 to 0.40,
P-value<0.001). 6MWD significantly improved from 237+/-113 meters to
294+/-105 meters (mean difference: +50 meters, 95% CI +34 to +66 meters,
P-value<0.001). 147 (24%) patients showed severe or greater TR after ITTVR
compared to 616 (96%) at baseline (risk ratio: 0.29, 95% CI 0.20 to 0.42,
P-value<0.001). <br/>Conclusion(s): Patients undergoing ITTVR for
significant TR experienced a significant improvement in NYHA functional
status and 6MWD and a significant reduction in TR severity at mid-term
follow-up.

<66>
Accession Number
636527829
Title
Meta-analysis assessing cardiovascular outcomes with febuxostat versus
allopurinol for patients with gout.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 3264), 2021. Date of
Publication: October 2021.
Author
Patoulias D.; Boulmpou A.; Tranidou A.; Nikolaidis A.; Papadopoulos C.E.;
Vassilikos V.; Bakatselos S.; Damianidis G.; Doumas M.
Institution
(Patoulias, Nikolaidis, Doumas) Hippokration General Hospital of
Thessaloniki, Second Propedeutic Department of Internal Medicine,
Thessaloniki, Greece
(Boulmpou, Papadopoulos, Vassilikos) Hippokration General Hospital of
Thessaloniki, Third Department of Cardiology, Thessaloniki, Greece
(Tranidou) Hippokration General Hospital of Thessaloniki, Fourth
Department of Internal Medicine, Thessaloniki, Greece
(Bakatselos, Damianidis) Hippokration General Hospital of Thessaloniki,
First Department of Internal Medicine, Thessaloniki, Greece
Publisher
Oxford University Press
Abstract
Background: Gout, the most common inflammatory arthritis in the USA,
represents an established risk factor for cardiovascular disease and
coronary artery disease mortality. In addition, patients with gout
experience an increased risk for non-fatal myocardial infarction, while
they might also feature increased risk for stroke. Recent real-world data
also highlight the association between gout and atrial fibrillation, which
inevitably augments cardiovascular burden. Allopurinol, a xanthine oxidase
inhibitor, remains the uric acid-lowering treatment option of first
choice, while febuxostat is prescribed, when allopurinol is
contraindicated or not tolerated. Unfortunately, medication adherence
among gout patients is poor, associated with age and related
co-morbidities. <br/>Purpose(s): We sought to determine the comparative
efficacy of febuxostat versus allopurinol across surrogate cardiovascular
outcomes of interest, by pooling data from the 2 dedicated cardiovascular
outcome trials available so far. The motive for this analysis was the U.S.
Food and Drug Administration (FDA) warning raised after the publication of
the CARES trial, regarding the increased risk for cardiovascular and
all-cause death with febuxostat compared to allopurinol. <br/>Method(s):
We pooled data from the 2 dedicated cardiovascular outcome trials (CARES
and FAST) and we assessed the following cardiovascular outcomes of
interest: cardiovascular death, all-cause death, non-fatal myocardial
infarction (MI), non-fatal stroke, fatal MI, fatal stroke, transient
ischemic attack, hospitalization for heart failure, coronary
revascularization, cerebrovascular revascularization and atrial
fibrillation. Risk of bias was low across the included studies.
<br/>Result(s): Our analysis in a total of 12,318 patients with gout
showed that febuxostat compared to allopurinol treatment does not confer
significant risk reduction for any of the assessed, prespecified surrogate
outcomes in a study population with significant cardiovascular
co-morbidities (Figure 1). One third of patients enrolled in the FAST
trial and 40% of the patients enrolled in the CARES trial had pre-existing
cardiovascular disease, as depicted in Figure 2. Heterogeneity was low for
the vast majority of the assessed outcomes, except for cardiovascular and
all-cause death and fatal MI. <br/>Conclusion(s): There is no significant
difference across surrogate cardiovascular outcomes of interest between
febuxostat and allopurinol in patients with gout and cardiovascular
co-morbidities. Febuxostat seems to be a safe treatment alternative to
allopurinol, despite initial concerns in terms of its cardiovascular
safety.

<67>
Accession Number
636527814
Title
Evaluation of the prophylactic role of pethidine in avoiding radial artery
spasm during transradial cardiac interventions.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2080), 2021. Date of
Publication: October 2021.
Author
Bouras G.; Giannainas N.; Lourmpa V.; Tsounis D.; Adreanides E.;
Antoniadis D.; Lazaridis K.; Kalpakos D.; Toutouzas K.
Institution
(Bouras, Giannainas, Lourmpa, Tsounis, Lazaridis, Kalpakos) NIMTS Veterans
Hospital, Athens, Greece
(Adreanides, Antoniadis) 401Army General Hospital of Athens, Athens,
Greece
(Toutouzas) Ippokrateio General Hospital of Athens, Athens, Greece
Publisher
Oxford University Press
Abstract
Introduction: Prophylactic use of benzodiazepine and opioids (fentanyl,
morphine) is an established method for tackling radial artery spasm, in
patients undergoing left cardiac catheterization procedures. Meperidine
(Pethidine) is a synthetic opioid with elimination half life of 2-4 hours
and duration of action of only 2-3 hours, making it ideal for in-lab
administration. <br/>Purpose(s): We aimed to test primarily the role of
pethidine administration in preventing radial artery spasm and secondarily
to assess patient discomfort during transradial coronary interventions.
<br/>Method(s): This is a prospective, randomized, double blinded study.
Patients were randomized to either pethidine 0,25mg administration (Group
A) or normal saline (Group B) i.v. 10 minutes before the beginning of the
procedure. As standard prophylactic measures against spasm, both groups
received verapamil 5mg and nitroglycerin 100mug, after sheath introduction
in the radial artery. Artery spasm was assessed clinically by the
difficulty in advancing or exchanging catheters, as reported by the
operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate
the patientperceived discomfort, one hour after the end of the procedure.
<br/>Result(s): 66 patients were included, 42 in Group A and 24 in Group
B. Mean age of the patients was 65.9 years, mean duration of the procedure
was 27 minutes and 24% of patients proceeded to PTCA overall. Operators
reported no problems in catheter manipulations (CHUGH 0) in 67% of
patients from Group A vs 38% of pts from Group B. 64% Group A patients and
21% Group B patients reported no symptoms (VAS 0). Pethidine
administration had a negative correlation with VAS (r: -0.418, p: 0.001)
and CHUGH Scale (r: -0.295, p: 0.016) scores. <br/>Conclusion(s):
Pethidine low dose administration before radial artery catheterization,
shows a positive trend in preventing spasm and reducing procedure-related
patient discomfort. Larger studies are required to evaluate the role of
pethidine as an alternative prophylactic measure against artery spasm in
transradial cardiac interventions.

<68>
Accession Number
636527752
Title
Cerebrovascular events after transcatheter mitral valve repair or
guideline-directed medical therapy in patients with mitral regurgitation
and heart failure in the COAPT trial.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2210), 2021. Date of
Publication: October 2021.
Author
Vincent F.; Redfors B.; Kotinkaduwa L.N.; Kar S.; Lim D.S.; Mishell J.M.;
Whisenant B.K.; Lindenfeld J.; Abraham W.T.; Mack M.J.; Stone G.W.
Institution
(Vincent, Redfors, Kotinkaduwa) Cardiovascular Research Foundation, New
York, United States
(Kar) Los Robles Regional Medical Center, Thousand Oaks, United States
(Lim) University of Virginia, Charlottesville, United States
(Mishell) Kaiser Permanente, San Francisco Medical Center, San Francisco,
United States
(Whisenant) Intermountain Medical Center, Salt Lake City, United States
(Lindenfeld) Vanderbilt University Medical Center, Nashville, United
States
(Abraham) Ohio State University, Columbus, United States
(Mack) Baylor Scott and White The Heart Hospital, Plano, United States
(Stone) Mount Sinai School of Medicine, New York, United States
Publisher
Oxford University Press
Abstract
Background: Our knowledge regarding the risk of cerebrovascular events
(CVE) in patients with heart failure (HF) and severe secondary mitral
regurgitation (SMR) treated by transcatheter mitral valve repair (TMVr) is
limited. <br/>Purpose(s): To examine the incidence, predictors, timing,
and prognostic impact of CVE in patients with heart failure and SMR
treated with TMVr vs guideline-directed medical therapy (GDMT) alone.
<br/>Method(s): In the COAPT trial, 614 patients with HF with
moderate-tosevere or severe SMR were randomized to TMVr with the MitraClip
+ GDMT vs GDMT alone. After 2 years, patients who were randomized to GDMT
alone could crossover and undergo TMVr. CVE (defined as stroke or TIA)
were adjudicated by an independent clinical events committee.
<br/>Result(s): A total of 43 CVE occurred in 42 patients within 3-year
follow-up (34 strokes and 9 TIAs; 1 patient had both). CVE occurred in
10.0% (n=20) of patients randomized to TMVR and 11.3% (n=22) of patients
randomized to GDMT alone (p=0.53) (Figure). Of the 22 CVE in the GDMT
alone group, 3 occurred after the patient had crossed over to TMVr. The
incidence rates in the TMVr and GDMT groups were similar within the first
3 months (incidence rate ratio [IRR] 0.78, 95% CI 0.17-3.48, p=0.74) and
between 3 months and 3 years (IRR 0.83, 95% CI 0.43-1.60, p=0.58) after
randomization. After multivariable adjustment, baseline estimated
glomerular filtration rate (eGFR) was associated with CVE in the overall
population (HR per 5 ml/min increase in eGFR 0.91, 95% CI 0.84-0.99,
p=0.03). Peripheral vascular disease was associated with CVE in patients
treated by GDMT (HR=3.21, 95% CI [1.35, 7.67]) but not TMVr (HR 0.53 95%
CI 0.12-2.24; p-interaction=0.04). In contrast, baseline chronic oral
anticoagulation use was associated with a reduced risk of CVE in patients
in the TMVr group (HR 0.18, 95% CI 0.05-0.63) but not in the GDMT alone
group (HR 1.66, 95% CI 0.70-3.94; p-interaction=0.004). In a time-adjusted
multivariable analysis, CVE was associated with a higher risk of death (HR
2.51, 95% CI 1.54-4.08; p=0.0002), a risk that was marked in the first 30
days after the event (HR 14.21, 95% CI 7.30-27.97, p<0.0001), and declined
thereafter (HR 1.37, 95% CI 0.72-2.59, p=0.34). <br/>Conclusion(s): In
patients with HF and severe SMR, CVE at 3 years was not infrequent,
increased linearly over time, was similar after treatment with the
MitraClip and GDMT alone, and was associated with a marked increase in
all-cause death. Whether anticoagulation is especially effective at
preventing CVE in patients treated by TMVr, as suggested by this report,
warrants further study. (Figure Presented).

<69>
Accession Number
636527696
Title
Costs analysis from a randomized comparison of immediate versus delayed
angiography in patients successfully resuscitated after out-of-hospital
cardiac arrest.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 3154), 2021. Date of
Publication: October 2021.
Author
Camaro C.; Bonnes J.L.; Adang E.M.; Spoormans E.M.; Janssens G.N.;
Meuwissen M.; Van Der Horst I.C.C.; Voskuil M.; Stoel M.; Vlaar A.P.J.;
Elbers P.W.G.; Van De Ven P.M.; Lemkes J.S.; Van Royen N.
Institution
(Camaro, Bonnes, Van Royen) Radboud University Medical Centre, Nijmegen,
Netherlands
(Adang) Radboud University Medical Center, Department of Health Evidence,
Nijmegen, Netherlands
(Spoormans, Janssens, Lemkes) Amsterdam UMC - Location VUmc, Amsterdam,
Netherlands
(Meuwissen) Amphia Hospital, Breda, Netherlands
(Van Der Horst) Maastricht University Medical Centre (MUMC), Maastricht,
Netherlands
(Voskuil) University Medical Center Utrecht, Utrecht, Netherlands
(Stoel) Thorax Centre in Medisch Spectrum Twente (MST), Enschede,
Netherlands
(Vlaar, Elbers) Amsterdam UMC - Location Academic Medical Center,
Amsterdam, Netherlands
(Van De Ven) University of Amsterdam, Department of Epidemiology and Data
Science, Amsterdam, Netherlands
Publisher
Oxford University Press
Abstract
Background: In out-of-hospital cardiac arrest (OHCA) patients without
STsegment elevation, immediate coronary angiography did not improve
clinical outcomes when compared to delayed angiography in the Coronary
Angiography after Cardiac Arrest (COACT) trial (1,2). Whether one of the
two strategies has benefits in terms of healthcare resource use and costs
is currently unknown. We assess the healthcare resource use and costs in
patients with OHCA. <br/>Method(s): 521 patients were eligible for a cost
consequence analysis. Detailed healthcare resource use and cost-prices
were collected from the initial hospital episode and compared between both
groups. A generalized model (GLM) with a log link function and a gamma
distribution was performed. Generic quality of life was measured with the
RAND36 and collected at 12 months follow-up. <br/>Result(s): Overall total
mean costs were similar between both groups (EUR 33575+/-19612 vs EUR
33880+/-21044, P=0.86). GLM: (B 0.991 (95% CI 0.894-1.099), P=0.86. Mean
procedural costs (CAG and/or PCI, coronary artery bypass graft) were
higher in the immediate angiography group (EUR 4384+/-3447 vs EUR
3028+/-4220, P<0.001). Costs concerning Intensive Care Unit and ward stay
did not show any significant difference. The median for the RAND-36
questionnaire physical component score was 49.2 in the immediate
angiography group and 50.4 in the delayed group, P=0.57.
<br/>Conclusion(s): The mean total costs between OHCA patients randomized
to an immediate angiography or a delayed invasive strategy were similar.
With respect to the higher invasive procedure costs in the immediate
group, a strategy awaiting neurological recovery followed by coronary
angiography and planned revascularization may be considered.

<70>
Accession Number
636527659
Title
Long-term survival benefit of SAVR over TAVR in low-risk elective
patients.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2207), 2021. Date of
Publication: October 2021.
Author
Kowalowka A.; Kowalewski M.; Wanha W.; Kolodziejczak M.; Mariani S.; Li
T.; Stefaniak S.; Los A.; Hudziak D.; Gocol R.; Suwalski P.; Rogowski J.;
Jemielity M.; Wojakowski W.; Deja M.
Institution
(Kowalowka, Deja) School of Medicine in Katowice, Medical University of
Silesia, Department of Cardiac Surgery, Katowice, Poland
(Kowalewski, Suwalski) Central Research Hospital the Ministry of The
Interior and Administration, Department of Cardiac Surgery, Warsaw, Poland
(Wanha, Wojakowski) School of Medicine in Katowice, Medical University of
Silesia, Department of Cardiology and Structural Heart Diseases, Katowice,
Poland
(Kolodziejczak) Nicolaus Copernicus University, Department of
Anaesthesiology and Intensive Care, Bydgoszcz, Poland
(Mariani, Li) Hannover Medical School, Department of
Cardio-thoracic,Transplantation and Vascular Surgery, Hannover, Germany
(Stefaniak, Jemielity) Poznan University of Medical Sciences, Department
of Cardiac Surgery and Transplantology, Poznan, Poland
(Los, Rogowski) Medical University of Gdansk, Department of Cardiac and
Vascular Surgery, Gdansk, Poland
(Hudziak, Gocol) 7th Public Hospital of the Silesian Medical University,
Katowice, Poland
Publisher
Oxford University Press
Abstract
Background: Aortic valve (AV) stenosis can be treated either by surgical
AV replacement (SAVR) or since 2002 by transcatheter aortic valve
implantation (TAVI). Due to lower invasiveness, TAVI is a preferred
approach in high- and prohibitive risk surgical candidates, yet outcome
data is conflicting when lower risk patients are considered and in
particular at long-term. <br/>Purpose(s): Our study evaluates long-term
survival in elective low-risk patients after AV replacement with severe AV
stenosis. <br/>Method(s): We conducted a registry data analyses of
patients scheduled for elective isolated AV with AV stenosis between 2015
and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage
procedures were excluded. In TAVI group only transfemoral access was
considered. Propensity score matching to determine SAVR controls for TAVI
group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1).
<br/>Result(s): Study group included 2393 elective AVR patients 1765 was
in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years
([IQR: 1.32-4.08], max 6.0). Propensity matching with replacement returned
329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile
range [IQR:71-73]) and EuroScore II 1.81 [IQR:1.36-2.53]). 30- day
mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR
respectively (RR 1.10 [0.52-2.37]; p=0.801). At two years, there was no
difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83-
1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which
was associated with 30% lower mortality (HR 0.70 [0.496-0.997]; p=0.048,
see figure 2). <br/>Conclusion(s): TAVI as compared to SAVR is equally
safe in elective lowrisk patients up to 2 years post-op. After that time
survival is better in surgically managed patients. Extended observations
from randomized trials in low-risk patients are warranted to draw definite
conclusions regarding long-term safety of TAVI in this population. (Figure
Presented).

<71>
Accession Number
636527560
Title
Outcomes of permanent pacemaker insertion after TAVR: A systematic review
and meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2201), 2021. Date of
Publication: October 2021.
Author
Mahajan P.; Mahajan S.; Gupta R.; Aedma S.; Samala V.; Malik A.; Mehta S.
Institution
(Mahajan, Mahajan, Aedma) Carle Foundation Hospital, Internal Medicine,
Urbana, United States
(Gupta) Lehigh Valley Hospital, Allentown, United States
(Samala) Cheshire Medical Center/Dartmouth-Hitchcock, Keene, United States
(Malik) New York Medical College, Cardiology, Valhalla, United States
(Mehta) Carle Foundation Hospital, Cardiology, Urbana, United States
Publisher
Oxford University Press
Abstract
Background/Introduction: Conduction abnormalities are frequently
encountered after transcatheter aortic valve replacement (TAVR) performed
for severe aortic stenosis, leading to post-procedure permanent pacemaker
(PPM) insertion. Although the predictors of- and factors leading to
post-TAVR PPM have been studied extensively, its short-term and longterm
outcomes have not been established. <br/>Purpose(s): PPM placement can
lead to significant changes in outcomes in post-TAVR patients, which
remain unclear. With this analysis, we aim to evaluate the differences
between outcomes of patients requiring PPM and those not requiring PPM
post-TAVR. <br/>Method(s): A comprehensive literature search was performed
in PubMed, EMBASE, and Cochrane to identify relevant trials. Outcomes were
compared between the two groups of patients- those requiring post-TAVR PPM
and those not requiring post-TAVR PPM. Summary effects were calculated
using a DerSimonian and Laird random-effects model as odds ratio (OD) with
95% confidence intervals (CI) for all the clinical endpoints.
<br/>Result(s): 34 studies, including observational and prospective
studies, met our inclusion criteria, with a total of 76,402 patients
undergoing TAVR and 10,381 requiring post-TAVR PPM. There were no
significant differences between 30-days (OR 1.04; 95% CI 0.96-1.13) and
1-year (OR 1.09; 95% CI 0.72-1.03) all-cause mortality rates, and 30-days
(OR 0.86; 95% CI 0.72-1.03) and 1-year (OR 0.85; 95% CI 0.70-1.04)
cardiovascular deaths among the two groups. Incidence of heart failure was
higher in the post- TAVR PPM group at 30 days (OR 1.26; 95% CI 1.05-1.51)
but not at 1 year (OR 1.21; 95% CI 0.93-1.57). No significant difference
was noted between the two groups in 30-days or 1-year stroke, 30-days or
1-year myocardial infarction, 30-days or 1-year atrial fibrillation,
30-days or 1-year major bleeding, or 30-days and 1-year readmission rate.
Other outcomes, including post-procedure aortic regurgitation, major
vascular complications, minor bleeding, valve migration, and device
success, also did not have any statistically significant difference in the
two patient groups (Figure 1). Of all the patients who received post-TAVR
PPM, an average of 46.4% and 58.5% patients had >40% ventricular pacing,
and 48.9% and 41.4% had <40% ventricular pacing at 1-month, and 1-year
follow up respectively. <br/>Conclusion(s): Although there were no
differences in the outcomes between the two groups at 30-days and 1-year
follow-ups (except the higher incidence of heart failure at 30 days in the
post-TAVR PPM group), longterm follow-up studies would be needed to
identify any possible adverse events after one year. Also, a significant
number of patients requiring post- TAVR PPM had <40% ventricular pacing at
1-month and even at 1-year intervals, which might suggest adopting an
alternate approach of closely monitoring any conduction disturbances and
avoiding early PPM implantation in post-TAVR patients, if possible.

<72>
Accession Number
636527556
Title
Impact of temporary mechanical circulatory support on mortality in
cardiogenic shock: An emulated target trial with a prospective,
multicenter, French cohort study.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 942), 2021. Date of
Publication: October 2021.
Author
Ughetto A.; Eliet J.; Nagot N.; David H.; Bazalgette F.; Marin G.; Mourad
M.; Kollen S.; Gaudard P.; Colson P.
Institution
(Ughetto, Eliet, David, Mourad, Gaudard, Colson) University Hospital
Arnaud de Villeneuve, Department of Anesthesiology and Critical Care
Medicine, Montpellier, France
(Nagot, Marin) University of Montpellier, Epidemiology and Clinical
Research, Montpellier, France
(Bazalgette) University Hospital of Nimes, Department of Critical care
medicine, Nimes, France
(Kollen) Perpignan Hospital Centre, Department of Critical care medicine,
Perpignan, France
Publisher
Oxford University Press
Abstract
Background: The field of temporary mechanical circulatory support (TMCS)
has advanced in last decade justifying that TMCS is increasingly used for
treatment of refractory cardiogenic shock (CS). Nevertheless, the efficacy
of TMCS (extracorporeal life support (ECLS) and Impella) in CS remains
controversial due to the lack of high-quality evidence. The aim of this
prospective multicenter observational study simulating a randomized trial
was to assess the impact of TMCS on the hospital mortality in patients
with CS. <br/>Method(s): This study (ClinicalTrials.gov ID: NCT03528291)
was conducted at 3 TMCS centers organized in a cardiac assistance network,
one as a level 1 TMCS center (expert center), and 2 as level 2 centers
(hub centers). The study was designed and led by the heart team of the
expert center with input from the hub centers. All patients admitted to an
intensive care unit between July 2017 and May 2020 either directly at the
TMCS centers or after transfer from a nonspecialized hospital, were
screened for TMCS indication provided they were admitted for CS. CS was
defined according to the European Society of Cardiology criteria. Were
excluded patients younger than 18 years, CS after cardiac surgery, or
after cardiac arrest if it was refractory or with a no flow >3 min and/or
out-of-hospital cardiac arrest with non-shockable rhythm, or CS in the
context of myocardial infarction complications, massive pulmonary
embolism, and if TMCS was contraindicated TMCS indication was decided
after a multidisciplinary discussion carried out by the heart team.
Implantation of TMCS resulted from an agreement of the heart team within
the first 24 hours after admission mainly based on the initial severity of
the CS, or if CS was refractory to the medical treatment. The primary
outcome was in-hospital survival. A propensity score-weighted analysis was
done for treatment-effect estimation. This method, which weights each
patient according to their propensity score, includes all participants in
the analysis. <br/>Result(s): 246 patients with CS were included in the
study: 121 in TMCS group (72% ECLS, 14% Impella, 14% both ECLS and
Impella) and 125 in control group. After adjustment by a propensity score,
hospital mortality was comparable in the two groups (32% TMCS group vs 27%
control group; Odds ratio with TMCS, 1.28; 95% confidence interval, 0.87
to 1.88; p=0.21). Mortality at D180 was also similar in the two group (33%
vs 30% respectively; p=0.51). Thromboembolic events were significantly
higher in the TCMS group (14% vs 4%; p<0.01) as well as the transfusion
rate ((median (IQR); 4.0 (0.0; 9.0) vs 0.0 (0.0; 0.0); p<0.01).
<br/>Conclusion(s): In our study, the use of TMCS does not seem to improve
hospital survival in patients with cardiogenic shock. Thus, TMCS, which
are iatrogenic side effects providers, should be reserved for the most
severe patient and discussed by a multidisciplinary team.

<73>
Accession Number
636527521
Title
Late Clinical and Hemodynamic Outcomes in patients with degenerated
bioprosthetic aortic valves undergoing transcatheter valve-in-valve
implantation.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2200), 2021. Date of
Publication: October 2021.
Author
Abushouk A.I.; Abdelfattah O.; Saad A.; Gad M.M.; Reed G.W.; Puri R.; Yun
J.; Vargo P.R.; Weiss A.; Burns D.; Popovic Z.; Harb S.C.; Krishnaswamy
A.; Svensson L.G.; Kapadia S.R.
Institution
(Abushouk, Abdelfattah, Saad, Gad, Reed, Puri, Popovic, Harb,
Krishnaswamy, Kapadia) Cleveland Clinic Foundation, Cardiovascular
Medicine, Cleveland, United States
(Yun, Vargo, Weiss, Burns, Svensson) Cleveland Clinic Foundation, Thoracic
and Cardiovascular Surgery, Cleveland, United States
Publisher
Oxford University Press
Abstract
Background: Clinical studies have shown promising early outcomes for
valve-in-valve transcatheter aortic valve implantation (ViV-TAVI);
however, the late outcomes of this procedure remain under-investigated.
<br/>Purpose(s): We performed the present analysis to assess the late
clinical and hemodynamic outcomes of ViV-TAVI in patients with degenerated
bioprosthetic aortic valves. <br/>Method(s): A comprehensive chart review
was performed for eligible patients to retrieve data on procedural
characteristics, admission details following the procedure, and
echocardiographic parameters. Clinical outcomes included all-cause
mortality, heart failure hospitalization and structural valve
deterioration (SVD), as defined by VARC-II criteria, up to 5 years of
follow-up. To assess the trends in mean and peak transvalvular gradients,
data from the follow-up echocardiographic reports were analyzed using
Syngo Dynamics imaging software. <br/>Result(s): A total of 188 patients
were included with a mean age of 75.8+/-10.4 years. Balloon- and
self-expandable valves were used in 155 (82.4%) and 33 (17.6%) patients,
respectively. At 30 days, 3 (1.6%) patients died and 8 (4.2%) required
hospitalization for heart failure, while at 5 years, both events were
recorded in 29 (15.4%) and 37 (19.7) patients, respectively. Kaplan-Meier
survival analysis showed that patients with smaller surgical valves
(internal diameter <=21 mm) had a significantly higher mortality rate
(log-rank p=0.021) than those with larger valves; however, no significant
difference (log-rank p=0.59) was detected between different transcatheter
valves (self vs. balloon-expandable). Three patients underwent
re-intervention, performed via a transcatheter approach. Further,
assessment of follow-up echocardiographic reports revealed 9 (4.8%) cases
of SVD, as well as stable mean (16.3+/-6.9 at discharge and 16.9+/-11.3)
and peak (30.3+/-12.1 at discharge and 30.7+/-18.4 at 5 years)
transvalvular gradients. No difference (p>0.05) was observed based on
transcatheter valve type or surgical valve internal diameter in terms of
mean and peak transvalvular gradients throughout the follow-up period.
<br/>Conclusion(s): The present study showed good clinical outcomes among
patients undergoing VIV-TAVI, with stable VIV performance over a five-year
period. Future long-term studies are warranted to analyze the predictors
of outcomes following ViV-TAVI and explore the role of this treatment
option in the life-long management of aortic stenosis. (Figure Presented).

<74>
Accession Number
636527428
Title
Changes in aortic valve hemodynamics and ventricular functional
measurements in patients undergoing transcatheter and surgical aortic
valve replacement: A head-to-head comparison.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2262), 2021. Date of
Publication: October 2021.
Author
Manla Y.; Khalouf A.; El Zouhbi A.; Lee St John T.; Bafadel A.; Traina M.;
Al Badarin F.J.; Edris A.
Institution
(Manla, Khalouf, Bafadel, Traina, Al Badarin, Edris) Cleveland Clinic Abu
Dhabi, Heart and Vascular Institute, Abu Dhabi, United Arab Emirates
(El Zouhbi, Lee St John) Cleveland Clinic Abu Dhabi, Academic office, Abu
Dhabi, United Arab Emirates
Publisher
Oxford University Press
Abstract
Introduction: Both surgical and transcatheter aortic valve replacement are
effective interventions for treatment of patients with severe aortic
stenosis. Data from landmark randomized trials have shown comparable
improvement in aortic valve hemodynamics and left ventricular remodeling.
Whether similar patterns will be observed in real-world practice has not
been completely investigated. <br/>Purpose(s): To compare the impact of
transcatheter aortic valve replacement (TAVR) and surgical aortic valve
replacement (SAVR) on short- and intermediate-term changes in aortic valve
hemodynamics and left ventricular reverse-remodeling. <br/>Method(s): A
total of 213 patients with severe AS were referred for TAVR (n=137) or
SAVR (n=76) at a single center (August/ 2015-Feb/ 2021). Patient
demographics and echocardiographic parameters of aortic valve stenosis
severity were collected retrospectively. Changes over-time in aortic valve
area, mean gradient, dimensionless index, left ventricular ejection
fraction (EF), and ventricular septal thickness were examined using linear
mixed models. <br/>Result(s): Patients undergoing TAVR were older with
higher STS risk scores and a greater burden of comorbidities (Table). Over
a median follow-up of 13 months (IQR 4-31), both groups experienced a
significant reduction in aortic valve mean gradient (25.7 mmHg with TAVR
and 18.8 mmHg with SAVR), with no significant between-group difference
(P=0.15). Aortic valve dimensionless index significantly increased in TAVR
and SAVR groups (0.23 and 0.13, respectively) and was more pronounced in
the TAVR group (P=0.01). Similarly, aortic valve area increased
significantly in both groups (0.66 cm2 and 0.42 cm2, respectively) without
a significant across-group difference (P=0.07). On the other hand, left
ventricular ejection fraction did not change significantly over time
(-0.61 and 1.15 EF points, respectively) with no significant between-group
difference at 12 months (P=0.06). Ventricular septal thickness was
significantly reduced in both groups, with no significant between group
difference (P=0.4; Figure). <br/>Conclusion(s): In this real-world
experience, both TAVR and SAVR were associated with significant
improvement in aortic valve hemodynamic parameters and modest reverse left
ventricular remodeling. Furthermore, these changes were comparable with
both modalities, adding to available evidence from randomized clinical
trials on beneficial effects of both TAVR and SAVR. (Figure Presented).

<75>
Accession Number
636527345
Title
Cerebral embolic protection devices for stroke prevention in transcatheter
aortic valve implantation: A meta-analysis.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 2256), 2021. Date of
Publication: October 2021.
Author
Perez Camargo D.; Travieso Gonzalez A.; Carnero Alcazar M.; Cobiella
Carnicer J.; Maroto Castellanos L.C.; Taramasso M.
Institution
(Perez Camargo) University Hospital Zurich, Cardiac Surgery Department,
Zurich, Switzerland
(Travieso Gonzalez) Hospital Clinico San Carlos, Cardiology Department,
Madrid, Spain
(Carnero Alcazar, Cobiella Carnicer, Maroto Castellanos) Hospital Clinico
San Carlos, Cardiac Surgery Department, Madrid, Spain
(Taramasso) Hirslanden Heart Center, Cardiac Surgery Department, Zurich,
Switzerland
Publisher
Oxford University Press
Abstract
Introduction: Stroke is a feared complication in patients undergoing
transcatheter aortic valve implantation (TAVI), affecting up to 2.3% of
patients in contemporary series. Cerebral embolic protection devices
(CEPD) are designed to prevent embolization of debris during the
procedure. Current evidence from randomized clinical trials (RCTs) and
adjusted observational studies is controversial. <br/>Purpose(s): Study
the influence of CEPD on stroke, mortality, silent ischemic lesions and
neurocognitive function. <br/>Method(s): A systematic search was conducted
of the Cochrane Library, EMBASE, MEDLINE, Web of Science and conference
abstracts in any language from database conception until March 2nd 2021
including RCTs or observational studies with propensity score (PS)
adjustment comparing TAVI with or without the use of CEPD. Estimates for
clinical outcomes (30-day stroke, death and composite) were combined using
a randomeffects meta-analysis using the Inverse of Variance method to
determine the pooled odds ratio (OR) of CEPD compared with non-CEPD. For
neurocognitive function assessment, results were pooled to obtain the
relative risk (RR) using the Mantel-Haenzel method. Finally, continuous
outcomes from the MRI cerebral evaluation were combined in a
random-effects model with standardized mean difference (SMD) between EPD
and non-EPD. <br/>Result(s): Twelve studies were eligible (n=165,315), six
RCTs and six observational studies with PS adjustment. Median age of the
patients was 80.8 (IQR=80-81.84) in patients with CEPD and 80.92
(IQR=79.75- 82.15) in non-CEPD. Previous stroke or transient ischemic
attack was 588/25,056 in CEPD and 673/25,583 in non-CEPD. STS-PROM score
was 5.6% (IQR=4.64-6.2) for CEPD and 6.41% (IQR=4.72-6.9) for non-CEPD.
Pooled analysis detected no-significant differences between CEPD and
non-CEPD (OR=0.74; 95% CI 0.52-1.06; P=0.101; I2=82.6%) for 30-day Stroke
but a significant difference favoring CEPD (OR=0.75; 95% CI 0.68- 0.82;
P<0.000; I2=0%) for 30-day mortality (Figure 1). Regarding cerebral DW-MRI
assessment and neurocognitive function evaluation, we observed no
significant differences between groups (Figure 2) <br/>Conclusion(s): In
the present metanalysis of six RCTs and six PS adjusted observational
studies, the use of a CEPD during TAVI was associated with a lower risk in
30-day mortality. We found no statistical difference between TAVI with or
without CEPD for 30-day stroke, total lesion volume per patient, number of
ischemic lesions per patient and neurocognitive function assessments.
(Figure Presented).

<76>
Accession Number
636527103
Title
The impact of non-pharmacological therapies on cardiovascular outcomes in
patients with refractory angina: A systematic review and meta-analysis of
randomized controlled trials.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1071), 2021. Date of
Publication: October 2021.
Author
Verhemel S.; Jones D.A.; Weeraman D.; Veerapen J.; Baumbach A.; Mathur A.
Institution
(Verhemel, Jones, Weeraman, Baumbach, Mathur) Barts Heart Centre,
Department of Interventional Cardiology, London, United Kingdom
(Veerapen) Queen Mary University of London, Barts NIHR Biomedical Research
Centre, London, United Kingdom
Publisher
Oxford University Press
Abstract
Despite advances in revascularization techniques and optimal medical
management, refractory angina (RFA) represents an essential group of
patients where progress has stalled, and in which therapeutic approaches
remain uncertain. Numerous randomized control trials have reported
clinical outcomes on a variety of treatments but to date no direct outcome
comparison has been made. Our aim is to investigate and compare the
outcomes of these different non-pharmacological technologies in RFA,
centring on major adverse cardiac events and all-cause mortality. We
performed a systematic review and meta-analysis of randomized controlled
trials using the Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines. A comprehensive search was performed of PubMed,
EMBASE (Excerpta Medica database),Cochrane, ClinicalTrials. gov, Google
Scholar databases of randomized controlled trials, and scientific session
abstracts. Studies were deemed eligible if they met the following
criteria: (1) full-length publications in peer-reviewed journals; (2)
evaluated non-pharmacological therapies use in patients with no further
revascularization options while on optimal medical treatment; (3) patients
had ongoing angina, Canadian Cardiovascular Society class II-IV; and (4)
included a placebo/control arm. We calculated risk ratios for all-cause
mortality, combined MACE events. We assessed heterogeneity using
chi² and I2 tests. We analysed 3292 citations with 51
randomized control trials testing 9 therapies including angiogenic
proteins, stem-cell therapy, lipoprotein apheresis, coronary sinus
reducer, spinal cord stimulator, percutaneous laser revascularization,
shock-wave therapy, transmyocardial laser revascularization and enhanced
external counter pulsation all meeting the inclusion criteria (table 1).
Our analysis identified stem cell therapy as the only therapy with a
reduction in all-cause mortality (Odds ratio, 0.45; CI, 0.21- 1.00)
(figure 1). A corresponding reduction in major adverse cardiac events
(MACE) was also seen with stem cell therapy (OR 0.48: CI 0.30-0.75)
alongside patients who received angiogenic proteins (OR 0.72: CI 0.55-
0.93) and cardiac shockwave therapy (OR, 0.21: CI 0.10-0.46) Improvements
in secondary measures of angina symptoms or frequency were seen with stem
cell therapy, angiogenic proteins, coronary sinus reducer, spinal cord
stimulator, shock-wave therapy, transmyocardial laser revascularization
and enhanced external counterpulsation. This is the largest meta-analysis
comparing outcomes of novel technologies used in refractory angina. This
suggests that stem cell therapy is the only non-pharmacological therapy
for RFA associated with a reduction in mortality, MACE and anginal
symptoms. We propose further larger randomized control trials, to support
these findings.

<77>
Accession Number
636527015
Title
Consequences of adding standardized levosimendan infusion in VA-ECMO
weaning protocol.
Source
European Heart Journal. Conference: European Society of Cardiology
Congress, ESC 2021. Virtual. 42(SUPPL 1) (pp 1063), 2021. Date of
Publication: October 2021.
Author
Plaza Martin M.; Pastor Baez G.; Uribarri Gonzalez A.; Garcia Cabello A.;
Tobar Ruiz J.; Stepanenko A.; San Roman Calvar J.A.
Institution
(Plaza Martin, Pastor Baez, Uribarri Gonzalez, Garcia Cabello, Tobar Ruiz,
Stepanenko, San Roman Calvar) University Hospital Clinic, Valladolid,
Spain
Publisher
Oxford University Press
Abstract
Introduction: Employment of VA-ECMO in the treatment of refractory
cardiogenic shock is increasing. Weaning rates are highly variable between
studies. <br/>Method(s): We designed a retrospective observational
single-centre study in order to analyse procedural success rate after
including scheduled and standardized levosimendan infusion as part of our
weaning protocol. Procedural success rate includes weaning from VA-ECMO,
bridging to other mechanical circulatory support (MCS) or transplantation.
<br/>Result(s): A total of 37 VA-ECMO were managed in our Cardiac
Intensive Care Unit (CICU) between January 2019 and March 2021. Most
frequent aetiologies are reflected in table 1. Ventricular unloading was
accomplished in 62.2% (23). We included four phases in our weaning
protocol as described in figure 1. Second phase was used to select
patients who could benefit from levosimendan infusion. This group included
patients who accomplished the following criteria: appropriate aetiological
treatment of shock, tolerance for 50% VA-ECMO flow reduction,
noradrenaline dose <0,5 ug/kg/min, inotropic score <10 and correction of
blood lactate, kidney and liver function parameters. Levosimendan was
administered in 62.2% (23). 5 patients (13.5%) were not considered
candidates to benefit from levosimendan (2 of them had early systolic
function recovery and 3 patients seemed to have no chance to recover).
Average time from VA-ECMO implantation to levosimendan infusion was 3.6
days, with a medium dose of 0,1 ug/kg/min. Norepinephrine medium dose was
0,12 mg/kg/min, with a medium inotropic score of 3 and
vasoactive-inotropic score of 16,1. Levosimendan infusion did not cause
any major side effects and was well tolerated by entire cohort even though
norepinephrine dose had to be slightly increased in some cases. Whole
sample procedural success rate reached 64.9% (24) whereas weaning rate
from VA-ECMO without further support was 51.4% (19). 5 patients were
upgraded to another MCS and 4 of them survived after transplantation. The
subgroup which meets inclusion criteria to levosimendan reached a
procedural success rate of 82.6% (19) and a weaning rate of 73.9% (19).
Differences between patients with and without levosimendan treatment were
statistically significant (procedural success rate: 82.6% vs 35.7%, p
0.006, weaning rate: 73.9% vs 14.3%, p<0.001). Meanwhile there were no
significant differences regarding in-hospital mortality rate: 47.8% (11)
vs 71.4% (10), p 0.160, even though there was a downward trend in
levosimendan treated patients. Most frequent causes of death are shown in
table 1. Only 3 patients died due to cardiac failure (1 was rejected for
cardiac surgery and 2 were not candidates to other advanced therapies).
<br/>Conclusion(s): Standardized levosimendan infusion as part of VA-ECMO
weaning protocol could enhance myocardial recovery and significantly
increase procedural success rate. Randomized or propensity score matching
studies would be desirable to prove this hypothesis.

<78>
Accession Number
636515810
Title
A Comparative Study of Preemptive Effect of Pregabalin and Gabapentin on
Postoperative Pain After Coronary Artery Bypass Graft Surgery.
Source
QJM. Conference: 41st Annual International Ain Shams Medical Congress.
Online. 114(SUPPL 1) (no pagination), 2021. Date of Publication: October
2021.
Author
Abdelaziz M.S.; Mohamed R.A.S.; Ismail M.A.A.; Ahmed Talaat Mohamed A.N.
Publisher
Oxford University Press
Abstract
Background Pain that pursues coronary artery bypass graft (CABG) surgery
is usually associated with increased both recovery duration and hospital
stay. Patient outcome could be worsened owing to large doses of opioids
for pain control through over sedation, and prolonged mechanical
ventilation. This study was designed to evaluate the effect of preemptive
gabapentinoids on post CABG surgery pain control. Objective to evaluate
the effect of pre-operative administration of pregabalin and gabapentin in
limiting the post-operative pain in coronary artery bypass surgeries.
Patients and Methods Type of Study: Prospective double - blinded,
randomized controlled Trial. After Approval is obtained from the research
ethics committee of anesthesia and intensive care department, Ain Shams
University. Study Setting: National Heart Institute, Egypt. Study Period:
6 months. Study Population: adult undergoing coronary artery bypass graft
surgeries. Results The primary outcome of this study was to compare the
effect of gabapentinoids on post CABG pain as reflected by morphine
consumption. The secondary outcome was to address the influence of
gabapentinoids on patient satisfaction post CABG, the incidence of
respiratory depression, nausea, vomiting, ventilatory hours and length of
hospital stay. Conclusion Pregabalin, and gabapentin both can be effective
for reduction of post CABG morphine consumption and have better patient
satisfaction if given preemptively with single dose preoperatively.

<79>
Accession Number
636515543
Title
A Comparative Study of the efficacy of preoperative of oral Pregabalin and
placebo on acute Postoperative Pain After Coronary Artery Bypass Graft
Surgery.
Source
QJM. Conference: 41st Annual International Ain Shams Medical Congress.
Online. 114(SUPPL 1) (no pagination), 2021. Date of Publication: October
2021.
Author
Ahmed M.A.I.; Abdel Hamed H.S.; Fahmy N.G.; Abdel Aziz Mohamed W.
Publisher
Oxford University Press
Abstract
Background Pain that pursues coronary artery bypass graft (CABG) surgery
is usually associated with increased both recovery duration and hospital
stay. Patient outcome could be worsened owing to large doses of opioids
for pain control through over sedation, and prolonged mechanical
ventilation. This study was designed to evaluate the effect of preemptive
pregabalin on post CABG surgery pain control. Objective To study the
effect of pregabalin administration before surgery in the treatment of
acute postoperative pain after coronary artery bypass surgery. To study
the effect of pregabalin on the consumption of opioids for acute
postoperative pain. Patients and Methods Type of Study: Prospective double
- blinded, randomized controlled Trial. After Approval is obtained from
the research ethics committee of anesthesia and intensive care department,
Ain Shams University. Study Setting: National Heart Institute, Egypt.
Study Period: 6 months. Study Population: adult undergoing coronary artery
bypass graft surgeries. Results Analysis of VAS in the first 24 hours
after extubation showed significant difference between Groups 1 and 2.
Analysis of systolic blood pressure and heart rate in the first 24 hours
showed no significant difference between Groups 1 and 2. It is important
to note that because the observed "average" differences in systolic blood
pressure and heart rate between groups were small, the clinical
significance of such differences can be questioned. Furthermore, it would
not be realistic to expect a big, dramatic benefit from a single
intervention in a complex, multifactorial care process, such as in cardiac
surgery Given the complexity of these cases, we believe that even a small
reduction in pain intensity is a meaningful improvement as we all try to
improve care for these patients. Conclusion Pregabalin can be effective
for reduction of post CABG pain and have better patient satisfaction if
given preemptively with single dose preoperatively.

<80>
Accession Number
636515425
Title
The Effect of Low Dose Ketamine Infusion versus Low Dose Dexmedetomidine
Infusion on Stress Responses in Coronary Artery Bypass Graft Surgery.
Source
QJM. Conference: 41st Annual International Ain Shams Medical Congress.
Online. 114(SUPPL 1) (no pagination), 2021. Date of Publication: October
2021.
Author
Ibrahim I.A.; AL Taher W.A.; Abd Elhamid H.M.; Ibrahim D.E.
Publisher
Oxford University Press
Abstract
Background In cardiac surgery, the extent of systemic inflammatory
response is closely Mobile associated with patient's outcome. A systemic
inflammatory response syndrome (SIRS) may develop after operations using
cardiopulmonary bypass (CPB). Aim of the Work to evaluate the 01006705713
potential effects of intravenous infusion of ketamine versus
dexmedetomidine on attenuation f stress responses during coronary artery
bypass grafting (CABG) operation. Patients and Email elsayed@hotmail.com
Methods This randomized controlled interventional study was conducted on
90 patients who dinaunderwent elective CABG procedure at Ain Shams
University Hospital over 24 months from Jan 2018 to Jan 2020. The patients
were divided into 3 groups, 30 patients for each group. Group D: received
dexmedetomidine infusion, Group K: received ketamine infusion and Group N
(control group): received normal saline. Then following measurements
recorded at following time interval before induction of anesthesia (T1),
after weaning from CPB (T2), 24h(T3) and 48 h(T4) after completion of the
anastomoses. Mean arterial blood pressure records, heart rate &
Inflammatory and stress markers including CRP, cortisol, WBC count,
glucose and lactate levels. Results Mean arterial pressure among three
groups was not statistically significant. Also serum glucose level was not
statistically significant between groups. Serum lactate level didn't show
statistically significant difference between groups. From aspects of
inflammatory markers, we got good results which were superior for
dexmedetomidine followed by ketamine infusion group suggested by
statistically significant, suggesting that dexmedetomidine and ketamine
may have a role in attenuation inflammatory response during cardiac
surgery but have no role in attenuation stress response to surgery.
Conclusion Our study that compared Intravenous infusion of ketamine and
dexmedetomidine on attenuation of stress responses during coronary artery
bypass grafting (CABG) operation suggests that dexmedetomidine was
superior to ketamine infusion in attenuation of inflammatory response
during cardiac surgery but have no role in attenuation stress response to
surgery.

<81>
Accession Number
636515402
Title
Perioperative Risk Factors of Atrial Fibrillation Post CABG Surgeries, a
Retrospective Non-Randomized Study.
Source
QJM. Conference: 41st Annual International Ain Shams Medical Congress.
Online. 114(SUPPL 1) (no pagination), 2021. Date of Publication: October
2021.
Author
Karim M.A.; Omar A.H.; El-Shahat Hikal T.; Youssef H.M.
Publisher
Oxford University Press
Abstract
Background Atrial fibrillation represents a common complication after
coronary artery bypass and valvular surgery, although it is a benign
arrhythmia it may contribute to the morbidity, high cost and prolonged ICU
stay. Objectives The purpose of this study is to investigate and analyze
the incidence and risk factors associated with postoperative atrial
fibrillation (POAF) and its impact on intensive care unit (ICU) and
postoperative hospital stay in patients undergoing coronary artery bypass
graft surgeries (CABG) at Ain Shams University hospitals using the medical
records of patients who underwent(CABG) surgeries from July 2018 to July
2019. Patients and Methods Our study was conducted in Ain Shams University
hospitals from July 2018 to July 2019. This study was a retrospective non
randomized on total 660 patients who undergone isolated Coronary artery
bypass graft surgeries (CABG) during this period, of them we targeted 100
cases who developed POAF after surgery. Results Our results show that age,
history of hypertension,smoking,history of renal impairment and recent
myocardial infarction were all predictors of atrial fibrillation after
cardiac surgery. POAF developed more frequent in patients who had larger
left atrium diameter and lower ejection fraction. Our present results
indicate that there is significant association between longer bypass and
cross clamping time and development of POAF. We also found that patients
who had postoperative lower serum potassium experienced more frequent POAF
than who had normal potassium levels. In our study, we found that use of
preoperative beta blocking drugs reduces risk of developing POAF. Early
electrocardiographic ischemic postop. changes was also associated with
high risk to develop POAF. No significant relation between use of
intra-aortic balloon pump and development of POAF. Also, no significant
relation between POAF and development of stroke or thromboembolic
manifestations as POAF is usually self limiting,transient and resolves
spontaneously in most of cases. Conclusion The current study found that
low ejection fraction, dilated left atrium, hypertension, smoking, old
age, male gender, prolonged bypass time, prolonged cross clamping time,
renal impairment, previous myocardial infarction, ungrafted dominant right
coronary artery, low temperatures on bypass, early ischemic changes
postoperative, hypokalemia, use of adrenaline and nor adrenaline, all of
these factors were a significant predictors for development of atrial
fibrillation after cardiac surgery.

<82>
Accession Number
636515291
Title
Sutureless aortic valve replacement: a meta-analysis.
Source
QJM. Conference: 41st Annual International Ain Shams Medical Congress.
Online. 114(SUPPL 1) (no pagination), 2021. Date of Publication: October
2021.
Author
Abd El Mabood Metwaly H.; Omar A.H.A.; Abd Al Jawad M.N.M.; Amer M.S.M.
Publisher
Oxford University Press
Abstract
Background and objectives Sutureless aortic valves aim to achieve better
outcomes and to aid and facilitate the minimally invasive aortic valve
replacement procedure by tackling the issue of cross clamp time, which is
an independent predictor of post-operative outcomes especially in patients
with serious comorbidities. ⁽², ³⁾ By reducing the
number of sutures, the time for sutures placement is reduced.
⁽¹⁾ Our Meta-analysis tries to assess the safety and
hemodynamic performance of the sutureless aortic valve prosthesis's in an
attempt to ascertain their benefits as a viable alternative to current
established measures. Methodology From their beginnings to February 2017,
electronic searches were conducted using six databases. Relevant studies
using commercially accessible suture-free valves to replace the aortic
valve have been recognized. Based on the predefined endpoints, data were
collected and analyzed. Results FC For incorporation in qualitative and
quantitative analyses, twenty-four studies were recognized, with a total
number of 5073 patients undergoing sutureless aortic valve replacement
(SU-AVR). Mortality incidence at 30 days and 12 months follow-ups were
2.5% and 2.7%, respectively, while the incidence of thromboembolic events
(1.6%) and paravalvular leak (PVL) (0.5%) were acceptable. Conclusion
Current available evidence indicates that sutureless aortic valve
replacement is a safe operation showing low mortality and complication
rates, with satisfactory hemodynamic performance.

<83>
Accession Number
636514822
Title
Transesophageal echocardiography: Dysphagia risk in acute stroke (TEDRAS):
A prospective, blind, randomized and controlled clinical trial.
Source
International Journal of Stroke. Conference: World Stroke Congress 2021.
Virtual. 16(2 SUPPL) (pp 50), 2021. Date of Publication: October 2021.
Author
Hamzic S.; Braun T.; Butz M.; Khilan H.; Yeniguen M.; Gerriets T.; Schramm
P.; Juenemann M.
Institution
(Hamzic, Braun, Butz, Khilan, Yeniguen, Gerriets, Schramm, Juenemann)
University Hospital Giessen and Marburg, Campus Giessen, Department of
Neurology, Giessen, Germany
Publisher
SAGE Publications Inc.
Abstract
Background and Aims: Dysphagia is common in acute stroke and leads to
worse overall outcome. Transesophageal echocardiography (TEE) is used in
the diagnostic evaluation of stroke etiology and is a known cause of
postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in
acute stroke patients undergoing TEE remains unknown. The TEDRAS study
assessed the influence of TEE on swallowing among patients with acute
stroke. <br/>Method(s): TEDRAS was a prospective, blind, randomized,
controlled trial including two groups of patients with acute stroke.
Simple unrestricted randomization was performed. Examiners were blinded to
each other's results. Flexible endoscopic evaluation of swallowing (FEES)
tested swallowing at three different time points in the intervention group
(24 h before, immediately after and 24 h after TEE) and in the control
group (FEES on three consecutive days and TEE earliest after the third
FEES). Validated scales were used to assess dysphagia severity for all
time points as primary outcome measures. <br/>Result(s): A total of 34
patients were randomized: 19 to the intervention group and 15 to the
control group. The key findings were significant increases in the
intervention group for: secretion severity score (immediately after TEE:
P<0.001; 24 h after TEE: P<0.001) and penetration-aspiration score score
for saliva (immediately after TEE: P<0.001; 24 h after TEE: P=0.007), for
small (immediately after TEE: P=0.009) and large liquid boli (immediately
after TEE: P=0.009; 24 h after TEE: P=0.025). <br/>Conclusion(s): The
results indicate a negative influence of TEE on swallowing in acute stroke
patients for at least 24 hours.

<84>
Accession Number
636514022
Title
Pulmonary emboli in a teenager with GPA: Management dilemmas.
Source
Rheumatology Advances in Practice. Conference: Adult and Paediatric
Case-based Conference 2020. Online. 4(SUPPL 1) (pp i15-i16), 2020. Date of
Publication: October 2020.
Author
Deepak S.; Rangaraj S.; Warrier K.
Institution
(Deepak, Rangaraj, Warrier) Nottingham Children's Hospital, Queens Medical
Centre, Nottingham, United Kingdom
Publisher
Oxford University Press
Abstract
Case report-Introduction15 year old girl with the diagnosis of
granulomatosis polyangiitis (GPA) managed with induction regimen of
intravenous cyclophosphamide and whilst on maintenance mycophenolate
mofetil (MMF) developed multiple cavitating lung lesions with the large
cavity abutting pulmonary vein and bilateral segmental pulmonary embolism
(PE) posing complex management dilemmas.Case report-Case
description15-year-old girl presented with being unwell for 3 months with
malaise, lethargy, joint pains, significant weight loss (10 kg), mouth
ulcer and significant hearing loss. Investigations showed anaemia, raised
inflammatory markers, and impaired kidney function (estimated glomerular
filtration rate eGFR 40). Her ANCA was positive, hearing test showed
significant mixed hearing loss and CXR was normal. The renal biopsy
confirmed pauci-immune ANCA associated glomerulonephritis with 70%
crescents. She was initially managed with intravenous pulse of steroids
followed by oral weaning regime, double filtration plasmapheresis and
commenced on induction regimen of intravenous cyclophosphamide. She
received 6 doses of cyclophosphamide 500 mg/m2 and following good recovery
with normalising kidney function; was commenced on maintenance MMF.At this
point she developed new onset earache, sore throat, and hoarseness of
voice with raised inflammatory markers and worsening symptoms despite
antibiotics. This was presumed to a flare of vasculitis and hence was
given further pulse of steroids and increased the dose of MMF. The ENT
assessment did not reveal any subglottic stenosis. After few weeks,
symptoms recurred with cough/hoarseness of voice and associated tiredness.
Bloods showed raised inflammatory markers; CXR revealed cavitating lung
lesions and a CT chest was arranged.CT chest showed apical sub pleural
lung nodule and a large thick-walled cavity measuring 6.6x 4.4 cm abutting
the pulmonary vein on the right side and bilateral segmental pulmonary
emboli. The child was systemically stable with no respiratory distress and
oxygen saturations were 100% in air.Case report-DiscussionThe management
of GPA was further complicated by the pulmonary embolism and cavitating
lung lesions abutting pulmonary vein.The management included escalation of
immunosuppression with pulse of steroids, further dose of cyclophosphamide
and commence Rituximab.The key challenges with the immediate management
were risk of bleeding associated with the anticoagulation, treating the
pulmonary embolism, risk of diffuse alveolar haemorrhage and managing the
patient in a safe setting equipped with all the expertise required.The
child was screened for cardiolipin antibodies on multiple occasions and
these were negative. An ECHO was done to look for evidence of clot at the
end of central line tip, but this was normal. Deep venous thrombosis of
legs was ruled out by Doppler scanning. There was no clear source of
emboli identified.Although there is emerging evidence for increased
incidence of vascular events in GPA adult patients, the data on vascular
events in children with GPA is scarce. Merkel and co-workers reported a
high occurrence of pulmonary embolism (PE) and deep venous thrombosis
(DVT) among GPA patients included in a randomized therapeutic trial
(WeCLOT study) 1.FAURSCHOU et al. reported that GPA was associated with a
much lower relative risk of stroke than of pulmonary embolism and deep
venous thrombosis; the risk of venous thromboembolic events among GPA
patients was increased during early as well as late follow up periods.
Currently there are no significant data on the use of antiplatelet and/or
anticoagulant therapy in AAV. Following extensive multidisciplinary
discussion with respiratory, haematology, cardiology, cardiothoracic
surgical and paediatric intensive care teams, and the child was
anticoagulated with close monitoring in paediatric high dependency unit
and immunosuppression escalated alongside.Case report-Key learning points
This case highlights the risk of thromboembolic events in children with
GPAProposed mechanisms in the literature for thrombosis in vasculitis at
molecular level would probably explain the episode in the absence of
source identifiedMultidisciplinary team approach is crucial for management
of complex patientsThere were few challenges due to geographical location
of the patient and the regional variation of subspecialty cover provided
for their local District General HospitalFor discussion-Role of Rituximab
early in GPA?.

<85>
Accession Number
2015744277
Title
Clinical features of Danon disease and insights gained from LAMP-2
deficiency models.
Source
Trends in Cardiovascular Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Zhai Y.; Miao J.; Peng Y.; Wang Y.; Dong J.; Zhao X.
Institution
(Zhai, Peng, Dong, Zhao) Centre for Cardiovascular Diseases, Henan Key
Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated
Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
(Miao) Academy of Medical Sciences, Zhengzhou University, Zhengzhou, P.R.
China;Department of Science and Technology, Henan University of Chinese
Medicine, Zhengzhou, Henan, China
(Miao, Wang) Sino-British Research Center for Molecular Oncology, National
Center for the International Research in Cell and Gene Therapy, School of
Basic Sciences, Academy of Medical Sciences, Zhengzhou University,
Zhengzhou, Henan, China
(Wang) Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary
University of London, London, UK, United Kingdom
(Dong) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
Elsevier Inc.
Abstract
Danon disease (DD) is an X-linked multisystem disorder with clinical
features characterized by the triad of hypertrophic cardiomyopathy,
skeletal muscle weakness, and mental retardation. Cardiac involvement can
be fatal in the absence of an effective treatment option such as heart
transplantation. Molecular studies have proved that LAMP-2 protein
deficiency, mainly LAMP-2B isoform, resulting from LAMP2 gene mutation, is
the culprit for DD. Autophagy impairment due to LAMP-2 deficiency mediated
the accumulation of abnormal autophagic vacuoles in cells. While it is not
ideal for mimicking DD phenotypes in humans, the emergence of
LAMP-2-deficient animal models and induced pluripotent stem cells from DD
patients provided powerful tools for exploring DD mechanism. In both in
vitro and in vivo studies, much evidence has demonstrated that
mitochondria dysfunction and fragmentation can result in DD pathology.
Fundamental research contributes to the therapeutic transformation. By
targeting the molecular core, several potential therapies have
demonstrated promising results in partial phenotypes improvement. Among
them, gene therapies anticipate inaugurate a class of symptom control and
prevention drugs as their in vivo effects are promising, and one clinical
trial is currently underway.<br/>Copyright &#xa9; 2021

<86>
Accession Number
2015743730
Title
Sublingual Sufentanil in Pain Management After Pulmonary Resection: A
Randomized Prospective Study.
Source
Annals of Thoracic Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Lomangino I.; Berni A.; Lloret Madrid A.; Terzi S.; Melan L.; Cannone G.;
Rebusso A.; Zuin A.; Dell'Amore A.; Rea F.
Institution
(Lomangino, Berni, Lloret Madrid, Terzi, Melan, Cannone, Rebusso, Zuin,
Dell'Amore, Rea) Thoracic Surgery Unit, Department of Cardiac, Thoracic
and Vascular Sciences, and Public Health, University of Padova, Padova,
Italy
Publisher
Elsevier Inc.
Abstract
Background: Successful postoperative pain management after major lung
resection surgery is mostly achieved through intravenous administration of
analgesic drugs. This study explored the use of sublingual sufentanil
cartridges (Zalviso) as a noninvasive alternative to postoperative
analgesia. <br/>Method(s): From July 2019 to April 2020, patients who
underwent major thoracoscopic lung resection surgery were randomly
allocated to receive either intravenous pain management, or
patient-controlled analgesia by the Zalviso system. Pain assessment scores
were collected for a 72-hour time window, and requests for additional
medication due to insufficient pain control were recorded. <br/>Result(s):
Of the 80 patients enlisted, 40 were assigned to the Zalviso group and 40
to the control group. The groups were not statistically different from
each other. The difference in the mean pain scores reported was
statistically significant in the first 24 hours in favor of the Zalviso
group (P = .046), and the need for additional pain medication was
significantly higher in the control group (P = .004). <br/>Conclusion(s):
Patient-controlled analgesia using sublingual sufentanil cartridges can
provide effective pain relief for patients undergoing video-assisted
thoracic surgery and can reduce the need for additional medication,
offering a noninvasive alternative to traditional intravenous
therapy.<br/>Copyright &#xa9; 2021 The Society of Thoracic Surgeons

<87>
Accession Number
636452724
Title
Effect of dexmedetomidine on postoperative delirium in patients undergoing
brain tumour resections: Study protocol of a randomised controlled trial.
Source
BMJ Open. 11(11) (no pagination), 2021. Article Number: e051584. Date of
Publication: 10 Nov 2021.
Author
Wang D.; Li R.; Li S.; Wang J.; Zeng M.; Dong J.; Liu X.; Lin N.; Peng Y.
Institution
(Wang, Li, Li, Wang, Zeng, Dong, Liu, Lin, Peng) Department of
Anesthesiology, Beijing Tiantan Hospital, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium (POD) is a common complication. The
incidence of POD is about 25% in non-cardiac surgery and ranges from 10%
to 30% in neurological procedures. A lot of trials show that
dexmedetomidine might help to reduce the incidence of delirium in patients
undergoing non-cardiac surgery. However, the impact of dexmedetomidine on
POD for patients undergoing craniotomy and tumour resections remains
unclear. Methods and analysis The study is a prospective, single-centre,
randomised, double-blinded, paralleled-group controlled trial. Patients
undergoing elective frontotemporal tumour resections will be randomly
assigned to the dexmedetomidine group and the control group. After
endotracheal intubation, patients in the dexmedetomidine group will be
administered with a loading dose of dexmedetomidine 0.6 mug/kg in 10 min
followed by continuous infusion at a rate of 0.4 mug/kg/hour until the
start of dural closure. In the control group, patients will receive the
identical volume of normal saline in the same setting. The primary outcome
will be the cumulative incidence of POD within 5 days. The delirium
assessment will be performed by using the confusion assessment method in
the first 5 consecutive days after surgery. Secondary outcomes include the
pain severity assessed by Numerical Rating Scale pain score, quality of
postoperative sleep assessed by the Richards Campbell sleep questionnaire
and postoperative quality of recovery from anaesthesia by the
Postoperative Quality Recovery Scale. Ethics and dissemination The
protocol (V.1.0, 10 November 2020) has been approved by the Ethics Review
Committee of the Chinese Clinical Trial Registry (number
ChiECRCT-20200436). The findings of the study will be disseminated in a
peer-reviewed journal and at a scientific conference. Trial registration
number NCT04674241.<br/>Copyright &#xa9; 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.

<88>
Accession Number
636452721
Title
Single-centre, double-blind, randomised, parallel-group, superiority study
to evaluate the effectiveness of general anaesthesia and ultrasound-guided
transversus thoracis muscle plane block combination in adult cardiac
surgery for reducing the surgical stress response: Clinical trial
protocol.
Source
BMJ Open. 11(11) (no pagination), 2021. Article Number: e051008. Date of
Publication: 11 Nov 2021.
Author
Gde Putra Semara Jaya A.A.; Tantri A.R.; Heriwardito A.; Mansjoer A.
Institution
(Gde Putra Semara Jaya, Tantri, Heriwardito) Department of Anesthesiology
and Intensive Care, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine,
Universitas Indonesia, Jakarta Pusat, Indonesia
(Mansjoer) Division of Cardiology, Department of Internal Medicine, Dr.
Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia,
Jakarta Pusat, Indonesia
Publisher
BMJ Publishing Group
Abstract
Introduction Adult open-heart surgery is a major surgery that causes
surgical stress response and activation of the immune system, contributing
further to postoperative complications. Transversus thoracis muscle plane
block (TTPB) may potentially benefit in reducing the surgical stress
response. This study aims to know the effectiveness of preoperative TTPB
in adult open-heart surgery for reducing the surgical stress response.
Methods and analysis This study is a prospective, double-blind, randomised
control trial comparing the combination of general anaesthesia and TTPB
versus general anaesthesia only in adult open-heart surgery. Forty-two
eligible subjects will be randomly assigned to the TTPB group or control
group. The primary outcomes are the difference between the two groups in
the means of postoperative cortisol and interleukin-6 plasma levels at 24
hours and 48 hours after cardiac intensive care unit admission. The
secondary outcomes are the difference between the two groups in the means
of total 24-hour postoperative morphine consumption and time of first
postoperative patient-controlled analgesia (PCA) dose. Ethics and
dissemination The study protocol and informed consent forms have been
reviewed and approved by the Ethics Committee of Faculty of Medicine
Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital. The result will be
released to the medical community through presentation and publication in
peer-reviewed journals. Trial registration number
NCT04544254.<br/>Copyright &#xa9; 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.

<89>
Accession Number
2015648971
Title
The effects of eye masks on post-operative sleep quality and pain in
school-age children with CHD.
Source
Cardiology in the Young. (no pagination), 2021. Date of Publication:
2021.
Author
Dai W.-S.; Xie W.-P.; Liu J.-F.; Chen Q.; Cao H.
Institution
(Dai, Xie, Liu, Chen, Cao) Department of Cardiac Surgery, Fujian Branch,
Shanghai Children's Medical Center, Fuzhou, China
(Dai, Xie, Liu, Chen, Cao) Department of Cardiac Surgery, Fujian
Children's Hospital, Fuzhou, China
(Dai, Xie, Liu, Chen, Cao) Department of Cardiac Surgery, Fujian Maternity
and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Dai, Xie, Liu, Chen, Cao) Fujian Key Laboratory of Women and Children's
Critical Diseases Research, Fujian Maternity and Child Health Hospital,
Fuzhou, China
Publisher
Cambridge University Press
Abstract
Objective: This study aimed to explore the effects of eye masks on the
sleep quality and pain of school-age children with CHD after surgery.
<br/>Method(s): Forty school-age children with CHD who underwent
open-heart surgery in the Cardiac Surgery Department of a provincial
hospital in China from January 2020 to December 2020 were selected. The
children were randomly divided into the experimental group (n = 20) and
the control group (n = 20). Children in the control group were given
routine sleep care, and the children in the experimental group were given
a sleep intervention with eye masks for three nights following the removal
of tracheal intubation. The Pittsburgh Sleep Quality Index was used to
evaluate the sleep quality of the children. The Children's Pain Behaviour
Scale was used to evaluate the pain of the children. <br/>Result(s): After
three nights of receiving the eye masks intervention, the sleep quality
scores of the children in the experimental group were significantly lower
than those of the control group, the difference was statistically
significant (p < 0.05) and the sleep quality of the children in the
experimental group was higher. The pain scores of the children in the
experimental group were significantly lower than those of the children in
the control group, the difference was statistically significant (p <
0.05), and the children in the experimental group suffered less
post-operative pain. <br/>Conclusion(s): Eye masks are a simple, safe and
economical intervention, that is beneficial for improving the
post-operative sleep quality and relieving post-operative pain in
school-age children with congenital heart disease. <br/>Copyright &#xa9;
The Author(s), 2021. Published by Cambridge University Press.

<90>
Accession Number
2014276871
Title
Surgical ablation in rheumatic heart disease-Uncharted territory.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Leviner D.B.; Sharoni E.
Institution
(Leviner, Sharoni) Department of Cardiothoracic Surgery, Carmel Medical
Center, Haifa, Israel
(Leviner, Sharoni) Technion-Israel Institute of Technology, Faculty of
Medicine, Haifa, Israel
Publisher
John Wiley and Sons Inc
Abstract
Background: Atrial fibrillation is a common arrhythmia with a large impact
on society and on patients. Rheumatic valve disease is still prevalent in
low- and medium-income countries. Performing surgical ablation during
surgery for mitral valve disease has been shown to restore sinus rhythm in
most patients. Aims, <br/>Material(s) and Method(s): In this issue of the
Journal of Cardiac Surgery, Ma et al., publish a meta-analysis of surgical
ablation in patients with rheumatic heart disease (RHD). <br/>Result(s):
They found no difference in short-term outcomes with a higher incidence of
restoration to sinus rhythm. In mid- to long-term follow-up, there was no
difference in mortality with a signal towards more permanent pacemaker
implantation. Discussion and <br/>Conclusion(s): Despite some inherent
limitations and some methodological flows, this meta-analysis has
important insights and is valuable for surgeons taking care of patients
with RHD.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<91>
Accession Number
2014504860
Title
Postoperative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis.
Source
Annals of Thoracic Surgery. 112(6) (pp 2084-2093), 2021. Date of
Publication: December 2021.
Author
Woldendorp K.; Farag J.; Khadra S.; Black D.; Robinson B.; Bannon P.
Institution
(Woldendorp, Farag, Khadra, Black, Bannon) Faculty of Health and Medicine,
University of Sydney, Sydney, Australia
(Woldendorp, Farag, Robinson, Bannon) Cardiothoracic Surgical Department,
Royal Prince Alfred Hospital, Sydney, Australia
(Woldendorp, Black, Robinson, Bannon) Baird Institute of Applied Heart and
Lung Research, Sydney, Australia
Publisher
Elsevier Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) is common after
cardiac surgery and linked to poorer short-term and long-term outcomes;
however, conflicting evidence exists on stroke risk and how the index
procedure affects outcomes. This study aims to provide a comprehensive
review of the published outcomes of POAF after cardiac surgery, examined
as a whole and by index procedure. <br/>Method(s): A systematic review of
POAF after cardiac surgery was conducted. Outcomes related to POAF were
analyzed in a meta-analysis, and aggregate survival data were derived to
examine long-term survival. <br/>Result(s): Sixty-one studies with 239,018
patients were identified, the majority (78.7%) undergoing coronary
surgery. POAF occurred in 25.5% of patients and was associated with
significantly higher rates of early mortality and stroke (odds ratio [OR],
1.74; P <.001; and OR, 2.21, P <.001, respectively) along with longer
intensive care and overall hospital length of stay (mean difference 0.8
days, P =.008; and mean difference 2.8 days, P <.001, respectively). After
a median of 6.6 years (range, 0.5-20 years), mortality and stroke remained
significantly higher for those with POAF (OR, 1.57, P <.001; and OR, 1.81,
P =.001). Pooled hazard ratio for long-term mortality was significantly
higher for patients who underwent coronary surgery compared with isolated
valve surgery. <br/>Conclusion(s): POAF is common after cardiac surgery
and is associated with significantly higher rates of both short-term and
long-term stroke and mortality as well as increased hospital stay.
Differences in hazard for long-term survival may be due to the underlying
pathophysiological risk factors for POAF, which differ by surgical
procedure.<br/>Copyright &#xa9; 2021 The Society of Thoracic Surgeons

<92>
Accession Number
2014448980
Title
Short-term pre-operative protein caloric restriction in elective vascular
surgery patients: A randomized clinical trial.
Source
Nutrients. 13(11) (no pagination), 2021. Article Number: 4024. Date of
Publication: November 2021.
Author
Kip P.; Sluiter T.J.; Moore J.K.; Hart A.; Ruske J.; O'leary J.; Jung J.;
Tao M.; Macarthur M.R.; Heindel P.; de Jong A.; de Vries M.R.; Burak M.F.;
Mitchell S.J.; Mitchell J.R.; Ozaki C.K.
Institution
(Kip, Sluiter, Hart, Ruske, O'leary, Tao, Heindel, Burak, Ozaki)
Department of Surgery and the Heart and Vascular Center, Brigham & Women's
Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115,
United States
(Kip, Sluiter, Jung, Macarthur, Burak, Mitchell, Mitchell) Department of
Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston,
MA 02115, United States
(Kip, Sluiter, de Jong, de Vries) Einthoven Laboratory for Experimental
Vascular Medicine, Department of Surgery, Leiden University Medical
Center, Leiden 2333 ZC, Netherlands
(Moore) Department of Systems Biology, Harvard Medical School, Boston, MA
02115, United States
(Jung) School of Medicine, University of Glasgow, Glasgow G12 8QF, United
Kingdom
(Macarthur, Mitchell, Mitchell) Department of Health Sciences and
Technology, ETH Zurich, Zurich 8092, Switzerland
Publisher
MDPI
Abstract
(1) Background: Vascular surgery operations are hampered by high failure
rates and frequent occurrence of peri-operative cardiovascular
complications. In pre-clinical studies, pre-operative restriction of
proteins and/or calories (PCR) has been shown to limit
ischemia-reperfusion damage, slow intimal hyperplasia, and improve
metabolic fitness. However, whether these dietary regimens are feasible
and safe in the vascular surgery patient population remains unknown. (2)
Methods: We performed a randomized controlled trial in patients scheduled
for any elective open vascular procedure. Participants were randomized in
a 3:2 ratio to either four days of outpatient pre-operative PCR (30%
calorie, 70% protein restriction) or their regular ad-libitum diet. Blood
was drawn at baseline, pre-operative, and post-operative day 1 timepoints.
A leukocyte subset flow cytometry panel was performed at these timepoints.
Subcutaneous/perivascular adipose tissue was sampled and analyzed.
Follow-up was one year post-op. (3) Results: 19 patients were enrolled, of
whom 11 completed the study. No diet-related reasons for non-completion
were reported, and there was no intervention group crossover. The PCR diet
induced weight loss and BMI decrease without malnutrition. Insulin
sensitivity was improved after four days of PCR (p = 0.05). Between diet
groups, there were similar rates of re-intervention, wound infection, and
cardiovascular complications. Leukocyte populations were maintained after
four days of PCR. (4) <br/>Conclusion(s): Pre-operative PCR is safe and
feasible in elective vascular surgery patients.<br/>Copyright &#xa9; 2021
by the authors. Licensee MDPI, Basel, Switzerland.

<93>
Accession Number
2014200609
Title
Efficacy and safety of antithrombotic therapy with non-vitamin K
antagonist oral anticoagulants after transcatheter aortic valve
replacement: a systematic review and meta-analysis.
Source
Therapeutic Advances in Chronic Disease. 12 (no pagination), 2021. Date of
Publication: 2021.
Author
An Q.; Su S.; Tu Y.; Gao L.; Xian G.; Bai Y.; Zhan Q.; Xu X.; Xu D.; Zeng
Q.
Institution
(An, Tu) State Key Laboratory of Organ Failure Research, Department of
Cardiology, Nanfang Hospital, First Clinical Medical College, Southern
Medical University, Guangzhou, China
(Su, Gao, Xian, Bai, Zhan) State Key Laboratory of Organ Failure Research,
Department of Cardiology, Nanfang Hospital, First Clinical Medical
College, Southern Medical University, Guangzhou, China
(Xu) Department of Cardiology and Pneumology, University Medical Center of
Gottingen, Georg-August-University, Gottingen, Germany
(Xu, Zeng) State Key Laboratory of Organ Failure Research, Department of
Cardiology, Nanfang Hospital, First Clinical Medical College, Southern
Medical University, 1838 Northern Guangzhou Avenue, Guangzhou 510515,
China
(Su, Gao, Xian, Bai, Zhan) Guangdong Provincial Key Laboratory of Shock
and Microcirculation, Southern Medical University, Guangzhou, China
(Su, Gao, Xian, Bai, Zhan) Bioland Laboratory (Guangzhou Regenerative
Medicine and Health Guangdong Laboratory), Guangzhou, China
Publisher
SAGE Publications Ltd
Abstract
Objective: A meta-analysis was performed to compare the efficacy and
safety of antithrombotic therapy with non-vitamin K antagonist oral
anticoagulants (NOACs) versus standard care in patients after successful
transcatheter aortic valve replacement (TAVR). <br/>Method(s): A
systematic search of PubMed, Cochrane Central Register of Controlled
Trials, and EMBASE databases and ClinicalTrials.gov website (through 21
October 2020) was performed. Risk ratios (RRs) with 95% confidence
intervals (CIs) for all outcomes were calculated using random-effects
models. <br/>Result(s): Twelve studies (two studies were randomized
controlled trials) comprising 6943 patients were included (5299 had
indications for oral anticoagulation (OAC) and 1644 had none). No
significant differences were found between NOACs and the standard care in
the incidences of all stroke, a composite endpoint, and
major/life-threatening bleeding. NOACs were associated with lower
all-cause mortality than vitamin K antagonists (VKAs) in post-TAVR
patients with indications for OAC after more than 1 year of follow-up [RR
= 0.64; 95% CI, (0.42, 0.96); p = 0.03], whereas NOACs exhibited poor
outcomes than antiplatelet therapy (APT) in patients without indications
for OAC [RR = 1.66; 95% CI, (1.12, 2.45); p = 0.01]. In the prevention of
valve thrombosis, NOACs and VKAs were not significantly different in
patients with indications for OAC [RR = 0.66; 95% CI, (0.24, 1.84); p =
0.43], whereas NOACs were better than APT in patients without indications
for OAC [RR = 0.19; 95% CI, (0.04, 0.83); p = 0.03]. <br/>Conclusion(s):
In patients with indications for OAC, post-TAVR antithrombotic therapy
with NOACs was more favorable due to its lower all-cause mortality after
more than 1 year of follow-up. In those without indications for OAC, NOACs
presented poorer outcomes due to its higher all-cause
mortality.<br/>Copyright &#xa9; The Author(s), 2021.

<94>
Accession Number
2011842511
Title
Impact of surgical treatment of pectus carinatum on cardiopulmonary
function: A prospective study.
Source
European Journal of Cardio-thoracic Surgery. 59(2) (pp 382-388), 2021.
Date of Publication: 01 Feb 2021.
Author
Del Frari B.; Sigl S.; Schwabegger A.H.; Blank C.; Morawetz D.; Gassner
E.; Schobersberger W.
Institution
(Del Frari, Sigl, Schwabegger) Department of Plastic, Reconstructive and
Aesthetic Surgery, Medical University Innsbruck, Innsbruck, Austria
(Blank, Morawetz, Schobersberger) Department of Psychology and Medical
Sciences, Institute of Sports Medicine, Alpine Medicine and Health Tourism
(ISAG), University for Health Sciences, Medical Informatics and Technology
(UMIT), Tyrol, Austria
(Morawetz, Schobersberger) Institute for Sports Medicine, Alpine Medicine
and Health Tourism (ISAG), Tirol Kliniken GmbH Innsbruck, Innsbruck,
Austria
(Gassner) Department of Radiology, Medical University Innsbruck,
Innsbruck, Austria
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: The frequency of sternochondroplasty in cases of pectus
carinatum (PC) has increased due to greater surgeon experience and
modified surgical techniques. PC deformity does not usually cause
cardiopulmonary malfunction or impairment. However, whether
cardiopulmonary function changes after surgical repair remains a matter of
controversy. The aim of our prospective study was to determine if surgery
changes preoperative cardiopulmonary function. <br/>Method(s): Nineteen
patients (16 males, 3 females) were enrolled in a prospective, open-label,
single-arm, single-centre clinical trial (Impact of Surgical Treatments of
Thoracic Deformation on Cardiopulmonary Function) (NCT02163265) between
July 2013 and January 2017. All patients underwent PC repair via a
modified Ravitch procedure and wore a lightweight, patient-controlled
chest brace for 8 weeks postoperatively (the Innsbruck protocol). The
average follow-up surgical examination was 8.3 months after surgery. In
all enrolled patients, before surgery and not before 6 months
postoperatively chest X-ray, 3-dimensional volume-rendered computed
tomography thorax imaging, cardiopulmonary function tests with stepwise
cycle spiroergometry (sitting and supine position) and Doppler
echocardiography were performed; questionnaires about daily physical
activity were also completed. <br/>Result(s): Fourteen patients (aged 16.3
+/- 2.6 years at study entry) completed the study. Changes in submaximal
and peak power output were not detected during sitting, or when in the
supine position. Also, no clinically relevant postoperative changes in
spirometry or echocardiography were noted. <br/>Conclusion(s): Our
findings confirm that surgical correction of PC does not impair
cardiopulmonary function at rest or during physical
exercise.<br/>Copyright &#xa9; 2020 The Author(s).

<95>
Accession Number
2011842506
Title
A randomized controlled trial comparing controlled reoxygenation and
standard cardiopulmonary bypass in paediatric cardiac surgery.
Source
European Journal of Cardio-thoracic Surgery. 59(2) (pp 349-358), 2021.
Date of Publication: 01 Feb 2021.
Author
Caputo M.; Scott L.J.; Deave T.; Dabner L.; Parry A.; Angelini G.D.;
Sheehan K.; Stoica S.; Ellis L.; Harris R.; Rogers C.A.
Institution
(Caputo, Parry, Sheehan, Stoica) Department of Cardiac Surgery, Bristol
Royal Hospital for Children, University Hospitals Bristol NHS Foundation
Trust, Bristol, United Kingdom
(Caputo, Angelini) Department of Cardiac Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Scott, Dabner, Ellis, Harris, Rogers) Department of Cardiac Surgery,
Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of
Bristol, Bristol, United Kingdom
(Deave) Department of Cardiac Surgery, Centre for Health and Clinical
Research, University of the West of England, Bristol, United Kingdom
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Objectives: Controlled reoxygenation on starting cardiopulmonary bypass
(CPB) rather than hyperoxic CPB may confer clinical advantages during
surgery for congenital cyanotic heart disease. <br/>Method(s): A
single-centre, randomized controlled trial was carried out to compare the
effectiveness of controlled reoxygenation (normoxia) versus hyperoxic CPB
in children with congenital cyanotic heart disease undergoing open-heart
surgery (Oxic-2). The co-primary clinical outcomes were duration of
inotropic support, intubation time and postoperative intensive care unit
(ICU) and hospital stay. Analysis of the primary outcomes included data
from a previous trial (Oxic-1) conducted to the same protocol.
<br/>Result(s): Ninety participants were recruited to Oxic-2 and 79 were
recruited to the previous Oxic-1 trial. There were no significant
differences between the groups for any of the co-primary outcomes:
inotrope duration geometric mean ratio (normoxia/hyperoxic) 0.97, 95%
confidence interval (CI) (0.69-1.37), P-value = 0.87; intubation time
hazard ratio (HR) 1.03, 95% CI (0.74-1.42), P-value = 0.87; postoperative
ICU stay HR 1.14 95% CI (0.77-1.67), P-value = 0.52, hospital stay HR
0.90, 95% CI (0.65-1.25), P-value = 0.53. Lower oxygen levels were
successfully achieved during the operative period in the normoxic group.
Serum creatinine levels were lower in the normoxic group at day 2, but not
on days 1, 3-5. Childhood developmental outcomes were similar. In the year
following surgery, 85 serious adverse events were reported (51 normoxic
group and 34 hyperoxic group). <br/>Conclusion(s): Controlled
reoxygenation (normoxic) CPB is safe but with no evidence of a clinical
advantage over hyperoxic CPB.<br/>Copyright &#xa9; 2020 The Author(s).

<96>
Accession Number
2011621400
Title
A Randomized Double-Blind Controlled Trial to Assess the Efficacy of
Ultrasound-Guided Erector Spinae Plane Block in Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 35(12) (pp 3574-3580),
2021. Date of Publication: December 2021.
Author
Athar M.; Parveen S.; Yadav M.; Siddiqui O.A.; Nasreen F.; Ali S.; Haseen
M.A.
Institution
(Athar, Parveen, Siddiqui, Nasreen, Ali) Department of Anaesthesiology and
Critical Care, Jawaharlal Nehru Medical College, Aligarh Muslim
University, Aligarh, Uttar Pradesh, India
(Yadav, Haseen) Department of Cardiothoracic and Vascular Surgery,
Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh,
Uttar Pradesh, India
Publisher
W.B. Saunders
Abstract
Objective: Cardiac surgical pain is of moderate-to-severe intensity.
Ineffective pain control may lead to increased cardiopulmonary
complications and poor surgical outcomes. This study aimed to assess the
efficacy of ultrasound-guided erector spinae plane block in providing
analgesia in adult cardiac surgeries. <br/>Design(s): Prospective,
randomized, double-blinded clinical trial. <br/>Setting(s): Single-center,
tertiary care hospital with university affiliation. <br/>Participant(s):
Thirty patients of either sex, aged 18-to-60 years, body mass index
19-to-30 kg/m², undergoing elective on-pump single-vessel
coronary artery bypass grafting or valve replacement under general
anesthesia. <br/>Intervention(s): Patients were randomly categorized into
two groups of 15 patients each to receive bilateral erector spinae plane
block with 20 mL per side of 0.25% levobupivacaine (group E) or sham block
with 20 mL of normal saline (group C). <br/>Main Result(s): Mean analgesic
requirement in terms of fentanyl equivalents (microg) in the first 24
hours postoperatively was 225 +/- 112 in group E and 635 +/- 145 in group
C (95% confidence interval, 313.10-506.90; p < 0.05). Mean time to first
rescue analgesia was 356.9 +/- 34.5 in group E and 123.9 +/- 13.1 minutes
in group C (p < 0.05). Cox proportional hazard ratio for rescue analgesic
requirement in group E-to-group C was 5.0. Duration of mechanical
ventilation was 88.4 +/- 17 and 103.5 +/- 18 minutes in groups E and C,
respectively (p < 0.05). Ramsay sedation score at six hours postextubation
was 1.45 +/- 0.53 in group E and 3.19 +/- 0.62 in group C (p < 0.05). Mean
numerical rating score was 3.67 +/- 1.41 in group E and 4.50 +/- 1.00 in
group C (p = 0.17). No significant differences were observed in the
incidences of postoperative nausea vomiting, pruritus, and erector spinae
plane block-related infection and pneumothorax. <br/>Conclusion(s):
Single-shot erector spinae plane block provides superior analgesia as
compared with sham block. It decreased the first 24-hour postoperative
analgesic consumption by 64.5% and risk of pain by five times in the
authors' population. It also reduced the sedation and duration of
mechanical ventilation in postcardiac surgery patients.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<97>
Accession Number
2010797074
Title
Intranasal administration of 40 and 80 units of insulin does not cause
hypoglycemia during cardiac surgery: a randomized controlled trial.
Source
Canadian Journal of Anesthesia. 68(7) (pp 991-999), 2021. Date of
Publication: July 2021.
Author
Roque P.; Nakadate Y.; Sato H.; Sato T.; Wykes L.; Kawakami A.; Yokomichi
H.; Matsukawa T.; Schricker T.
Institution
(Roque, Wykes) School of Human Nutrition, McGill University,
Ste-Anne-de-Bellevue, Montreal, QC, Canada
(Nakadate) Department of Anesthesiology, University of Yamanashi, 1110
Shimokato, Chuo, Yamanashi 409-3898, Japan
(Sato, Sato, Kawakami, Schricker) Department of Anesthesia, McGill
University Health Centre Glen Site, Royal Victoria Hospital, Montreal, QC,
Canada
(Yokomichi, Matsukawa) Department of Health science, University of
Yamanashi, Shimokato, Chuo, Yamanashi, Japan
Publisher
Springer
Abstract
Purpose: Intranasal insulin administration may improve cognitive function
in patients with dementia and may prevent cognitive problems after
surgery. Although the metabolic effects of intranasal insulin in
non-surgical patients have been studied, its influence on glucose
concentration during surgery is unknown. <br/>Method(s): We conducted a
randomized, double-blind, placebo-contolled trial in patients scheduled
for elective cardiac surgery. Patients with type 2 diabetes mellitus
(T2DM) and non-T2DM patients were randomly allocated to one of three
groups (normal saline, 40 international units [IU] of intranasal insulin,
and 80 IU intranasal insulin). Insulin was given after the induction of
general anesthesia. Glucose and plasma insulin concentrations were
measured in ten-minute intervals during the first hour and every 30 min
thereafter. The primary outcome was the change in glucose concentration 30
min after intranasal insulin administration. <br/>Result(s): A total of
115 patients were studied, 43 of whom had T2DM. In non-T2DM patients, 40
IU intranasal insulin did not affect glucose concentration, while 80 IU
intranasal insulin led to a statistically significant but not clinically
important decrease in blood glucose levels (mean difference, 0.4
mMol.L^-1; 95% confidence interval, 0.1 to 0.7). In T2DM
patients, neither 40 IU nor 80 IU of insulin affected glucose
concentration. No hypoglycemia (< 4.0 mMol.L^-1) was observed
after intranasal insulin administration in any patients. In non-T2DM
patients, changes in plasma insulin were similar in the three groups. In
T2DM patients, there was an increase in plasma insulin concentrations ten
minutes after administration of 80 IU of intranasal insulin compared with
saline. <br/>Conclusion(s): In patients with and without T2DM undergoing
elective cardiac surgery, intranasal insulin administration at doses as
high as 80 IU did not cause clinically important hypoglycemia. Trial
registration: www.ClinicalTrials.gov (NCT02729064); registered 5 April
2016.<br/>Copyright &#xa9; 2021, Canadian Anesthesiologists' Society.

<98>
Accession Number
636468362
Title
Urinary biomarkers to predict severe fluid overload after cardiac surgery:
A pilot study.
Source
Biomarkers in Medicine. 15(16) (pp 1451-1464), 2021. Date of Publication:
November 2021.
Author
Elitok S.; Isermann B.; Westphal S.; Devarajan P.; Albert C.; Kuppe H.;
Ernst M.; Bellomo R.; Haase M.; Haase-Fielitz A.
Institution
(Elitok, Ernst) Department of Nephrology and Endocrinology, Ernst von
Bergmann Hospital Potsdam, Charlottenstr. 72, Potsdam 14467, Germany
(Isermann) Institute of Laboratory Medicine, Leipzig University Hospital,
Paul-List-Str. 13/15, Leipzig 04103, Germany
(Westphal) Institute of Laboratory Medicine, Tertiary Hospital Dessau,
Auenweg 38, Dessau-Roslau 06847, Germany
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, United States
(Albert, Haase) Diaverum Renal Care Center, Am Neuen Garten 11, Potsdam
14469, Germany
(Albert) Medical Faculty, University Clinic for Cardiology and Angiology,
Otto Von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg
39120, Germany
(Kuppe) Institute of Anesthesiology, German Heart Center, Augustenburger
Platz 1, Berlin 13353, Germany
(Ernst, Haase) Medical Faculty, Otto Von-Guericke-University Magdeburg,
Leipziger Str. 44, Magdeburg 39120, Germany
(Bellomo) Department of Intensive Care, Austin Health, 145 Studley Rd,
Heidelberg, Melbourne, VIC 3084, Australia
(Bellomo) Centre for Integrated Critical Care, The University of
Melbourne, Melbourne, Australia
(Haase-Fielitz) Department of Cardiology, Brandenburg Heart Center,
Immanuel Hospital, Ladeburger Str. 17, Bernau 16321, Germany
(Haase-Fielitz) Brandenburg Medical School Theodor Fontane, Fehrbelliner
Str. 38, Neuruppin 16816, Germany
(Haase-Fielitz) Faculty of Health Sciences Brandenburg, University of
Potsdam, Potsdam, Germany
(Haase-Fielitz) Institute of Social Medicine and Health Care Systems
Research, Otto Von-Guericke-University Magdeburg, Leipziger Str. 44,
Magdeburg 39120, Germany
(Albert, Haase-Fielitz) Diaverum AB, Hyllie Boulevard 35, Malmo 21532,
Sweden
Publisher
Future Medicine Ltd.
Abstract
Aim: To assess the predictive ability of urinary and plasma biomarkers and
clinical routine parameters for subsequent severe fluid overload. Patients
& methods: In a pilot study, we studied 100 adult patients after cardiac
surgery. On intensive care unit admission, we measured biomarkers in urine
(midkine, IL-6, neutrophil gelatinase-associated lipocalin [NGAL],
hepcidin-25) and plasma (creatinine, urea, B-type natriuretic peptide,
lactate, C-reactive protein, leukocytes, IL-6, NGAL, hepcidin-25) to
predict postoperative severe fluid overload. <br/>Result(s): Urinary
midkine, IL-6, NGAL and hepcidin-25 (all AUCs =0.79) predicted
postoperative severe fluid overload (n = 5 patients). Urinary
NGAL/hepcidin-25 ratio (AUC 0.867) predicted postoperative severe fluid
overload after adjustment to EuroScore and need for norepinephrine on
surgery day (odds ratio: 2.4). <br/>Conclusion(s): Urinary biomarkers on
intensive care unit admission might be helpful to predict subsequent
severe fluid overload after cardiac surgery. Lay abstract: Aim: To assess
whether proteins in the urine or blood or clinical routine laboratory
parameters can predict severe body fluid overload after cardiac surgery.
Patients & methods: In a pilot study, we studied 100 adult patients after
cardiac surgery. After surgery, we measured proteins in the urine
(midkine, IL-6, neutrophil gelatinase-associated lipocalin [NGAL],
hepcidin-25) and blood (creatinine, urea, B-type natriuretic peptide,
lactate, C-reactive protein, leukocytes, IL-6, NGAL, hepcidin- 25) to
predict postoperative severe fluid overload. <br/>Result(s): Urinary
midkine, IL-6, NGAL and hepcidin- 25 predicted postoperative severe fluid
overload (n = 5 patients). Urinary NGAL/hepcidin-25 ratio predicted
postoperative severe fluid overload after adjustment to important
covariates. <br/>Conclusion(s): Urinary biomarkers might be helpful to
predict subsequent severe fluid overload after cardiac surgery. Tweetable
abstract In a pilot study with 100 adult patients after cardiac surgery,
we found that urinary biomarkers, but not blood biomarkers can help
predict postoperative severe fluid overload after cardiac
surgery.<br/>Copyright &#xa9; 2021 Future Medicine Ltd.

<99>
Accession Number
2015576671
Title
Effectiveness and adverse effects of tranexamic acid in bleeding during
adenotonsillectomy: A randomized, controlled, double-blind clinical trial.
Source
International Archives of Otorhinolaryngology. 25(4) (pp E557-E562), 2021.
Date of Publication: October 2021.
Author
Fornazieri M.A.; Lima Kubo H.K.; de Farias L.C.; da Silva A.M.F.; Duarte
Garcia E.C.; de Alcantara Lopes dos Santos G.; de Rezende Pinna F.;
Voegels R.L.
Institution
(Fornazieri, da Silva, Duarte Garcia) Department of Surgery, Universidade
Estadual de Londrina, PR, Londrina, Brazil
(Fornazieri, Lima Kubo, de Farias, da Silva) Department of Medicine,
Pontificia Universidade Catolica do Parana, PR, Londrina, Brazil
(Fornazieri, de Rezende Pinna, Voegels) Department of Otorhinolaryngology,
Universidade de Sao Paulo, SP, Sao Paulo, Brazil
(Fornazieri, de Alcantara Lopes dos Santos) Centro Londrinense de
Otorrinolaringologia, PR, Londrina, Brazil
Publisher
Georg Thieme Verlag
Abstract
Introduction Intra and postoperative bleeding are the most frequent and
feared complications in adenotonsillectomy (AT). Tranexamic acid (TXA),
which is known for its antifibrinolytic effects, has a proven benefit in
reducing bleeding in hemorrhagic trauma and cardiac surgery; however, the
effectiveness and timing of its application in AT have not yet been
established. Objectives We aimed to evaluate the efficacy of TXA in
controlling bleeding during and after AT and assess its possible adverse
effects in children. Methods The present randomized, controlled,
double-blind clinical trial included 63 children aged 2 to 12 years. They
were randomly assigned to receive either intravenous TXA (10 mg/kg) or
placebo 10 minutes before surgery. The volume of intraoperative bleeding,
presence of postoperative bleeding, and adverse effects during and 8 hours
after the surgery were assessed. Results No difference in bleeding volume
was noted between the 2 groups (mean, 122.7 ml in the TXA group versus
115.5 ml in the placebo group, p 1/4 0.36). No intraoperative or
postoperative adverse effects were noted because of TXA use. Furthermore,
no primary or secondary postoperative bleeding was observed in any of the
participants. Conclusion In our pediatric sample, TXA (10 mg/kg)
administration before AT was safely used, without any adverse effects. It
did not reduce the bleeding volume in children during this type of
surgery. Future studies should assess the use of higher doses of TXA and
its administration at other time points before or during
surgery.<br/>Copyright &#xa9; 2021. Fundacao Otorrinolaringologia. All
rights reserved.

<100>
Accession Number
2015627111
Title
Prevention and management of perioperative hypothermia in adult elective
surgical patients: A systematic review.
Source
Annals of Medicine and Surgery. 72 (no pagination), 2021. Article Number:
103059. Date of Publication: December 2021.
Author
Simegn G.D.; Bayable S.D.; Fetene M.B.
Institution
(Simegn, Bayable, Fetene) Department of Anaesthesia, College of Medicine
and Health Science, Debre Markos University, Ethiopia
Publisher
Elsevier Ltd
Abstract
Background: Body temperature is tightly regulated with hormonal and
cellular metabolism for normal functioning; however perioperative
hypothermia is common secondary to anesthesia and surgical exposure.
Prevention and maintaining body temperature should be started 1-2hrs
before induction of anesthesia, to do this both active and passive warming
system are effective to prevent complications associated with
perioperative hypothermia. <br/>Method(s): The aim of this systematic
review is to develop a clear clinical practice protocol in prevention and
management of perioperative hypothermia for elective adult surgical
patients. The study is conducted in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guideline 2020. After formulating clear criteria for the evidences to be
included an appropriate method of searching was conducted by using the Pub
Med, Google scholar and Cochrane library using the following MeSH terms:
(inadvertent hypothermia AND anesthesia, hypothermia AND perioperative
management and thermoregulation AND anesthesia) were used to draw
evidences. After a reasonable amount of evidences were collected,
appraisal and evaluation of study quality was based on WHO 2011 level of
evidence and degree of recommendation. Final conclusions and
recommendations are done by balancing the benefits and downsides of
alternative management strategies for perioperative management of
hypothermia. This systematic review registered with research registry
unique identifying number (UIN) of "reviewregistry1253" in addition the
overall AMSTAR 2 quality of this systematic review is moderate level.
<br/>Discussion(s): Preserving a patient's body temperature during
anesthesia and surgery is to minimize heat loss by reducing radiation and
convection from the skin, evaporation from exposed surgical areas, and
cooling caused by the introduction of cold intravenous fluids.
<br/>Conclusion(s): Hypothermia is least monitored complication during
anesthesia and surgery results cardiac abnormalities, impaired wound
healing, increased surgical site infections, shivering and delayed
postoperative recovery, and coagulopathies.<br/>Copyright &#xa9; 2021 The
Authors

<101>
Accession Number
2013593990
Title
Transcatheter Aortic Valve Replacement in Low-Risk Bicuspid and Tricuspid
Patients: Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 33 (pp 1-6), 2021. Date of
Publication: December 2021.
Author
Medranda G.A.; Rogers T.; Doros G.; Zhang C.; Case B.C.; Yerasi C.; Shults
C.C.; Waksman R.
Institution
(Medranda, Rogers, Doros, Zhang, Case, Yerasi, Waksman) Section of
Interventional Cardiology, MedStar Washington Hospital Center, Washington,
DC, United States
(Rogers) Cardiovascular Branch, Division of Intramural Research, National
Heart, Lung and Blood Institute, National Institutes of Health, Bethesda,
MD, United States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital
Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: Most pivotal transcatheter aortic valve replacement (TAVR)
trials have excluded patients with bicuspid aortic stenosis (AS). This
study compared TAVR in low-risk patients with bicuspid AS to those with
tricuspid AS, incorporating data from prospective trials. <br/>Method(s):
We selected prospective US low-risk TAVR trials containing a bicuspid arm
for this meta-analysis, examining outcomes at 30 days. Study results were
pooled using a hierarchical Bayesian random-effects model. <br/>Result(s):
Included were 3 Food and Drug Administration (FDA)-approved
investigational device exemption (IDE) trials that enrolled a total of
1810 low-risk patients with symptomatic severe AS for TAVR. We compared
380 bicuspid patients with 1430 tricuspid patients. Event rates at 30 days
overall were low, with similar mortality (odds ratio [OR], 0.38; 95%
credible interval [CrI]: 0.08, 1.78; I², 0%), non-disabling
stroke (OR, 0.45; 95% CrI: 0.15, 1.07; I², 9%), and permanent
pacemaker implantation (OR, 0.86; 95% CrI: 0.41, 1.47; I²,
59%). There were statistically significant differences in disabling stroke
(OR, 0.16; 95% CrI: 0.01, 0.90; I², NA) and coronary
obstruction (OR, 0.21; 95% CrI: 0.05, 0.91) that disappeared after
sensitivity analysis by adding a single event to the tricuspid arm.
Hemodynamics were similar at 30 days. <br/>Conclusion(s): Preliminary data
from the FDA-approved IDE trials of low-risk patients with bicuspid AS
undergoing TAVR demonstrated 30-day outcomes comparable to low-risk
tricuspid patients, except for a trend toward higher stroke in bicuspid
patients. Randomized trials are warranted to reassure the safety and
long-term outcome of TAVR in patients with severe bicuspid
AS.<br/>Copyright &#xa9; 2021

<102>
Accession Number
2010642803
Title
Outcomes of Transcarotid Versus Trans-Subclavian Transcatheter Aortic
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Cardiovascular Revascularization Medicine. 33 (pp 20-25), 2021. Date of
Publication: December 2021.
Author
Amer M.R.; Mosleh W.; Megaly M.; Shah T.; Ooi Y.S.; McKay R.G.
Institution
(Amer, Ooi) Lankenau Medical Center, Main Line Health, Wynnewood, PA,
United States
(Mosleh) University of Connecticut, Farmington, CT, United States
(Megaly) Banner University Medical Center- UA College of Medicine,
Phoenix, AZ, United States
(Shah) St. Vincent's Hospital, Worcester, MA, United States
(McKay) Heart and Vascular Institute, Hartford Hospital, Hartford, CT,
United States
Publisher
Elsevier Inc.
Abstract
Objectives: This study aimed to perform the first meta-analysis of studies
comparing transcarotid (TC) and trans-subclavian (TSc) transcatheter
aortic valve replacement (TAVR). <br/>Background(s): The safety and
feasibility of a TC and a TSc approach for performing TAVR in patients
with prohibitive femoral anatomy have been well described. The potential
advantage of one approach over the other is yet to be ascertained.
<br/>Method(s): A computerized literature search of key medical databases
through September 2020 was performed. Randomized controlled trials (RCTs)
and observational studies comparing TC and TSc TAVR with reported 30-day
outcomes were considered. The primary endpoint was a composite of
all-cause mortality, stroke, life-threatening, and/or major bleeding or
major vascular complications. Statistical analysis using random-effects
models to report the odds ratio (OR) with 95% confidence interval (CI) was
performed. <br/>Result(s): A total of 5 observational studies inclusive of
4164 patients (TC = 1788 and TSc = 2376) met the eligibility criteria. The
average age of patients was 81.1 years. There was no difference in the
occurrence of the composite endpoint between the groups at 30-days. A
statistically insignificant trend towards higher rates of major vascular
complications (OR 1.65; 95% CI 0.94-2.89; P = 0.08; I² = 0%)
and the need for permanent pacemaker placement was observed with the TSc
approach. <br/>Conclusion(s): This meta-analysis of studies comparing TC
and TSc TAVR showed similar 30-day outcomes between the 2 approaches. A
notable trend towards higher rates of major vascular complications and the
need for permanent pacemaker placement was observed with the TSc
approach.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<103>
Accession Number
2005875486
Title
Persistent pulmonary hypertension in corrected valvular heart disease:
Hemodynamic insights and long-term survival.
Source
Journal of the American Heart Association. 10(2) (pp 1-21), 2021. Article
Number: e019949. Date of Publication: 2021.
Author
Bermejo J.; Gonzalez-Mansilla A.; Mombiela T.; Fernandez A.I.;
Martinez-Legazpi P.; Yotti R.; Garcia-Orta R.; Sanchez-Fernandez P.L.;
Castano M.; Segovia-Cubero J.; Escribano-Subias P.; Roman J.A.S.; Borras
X.; Alonso-Gomez A.; Botas J.; Crespo-Leiro M.G.; Velasco S.; Bayes-Genis
A.; Lopez A.; Munoz-Aguilera R.; Jimenez-Navarro M.; Gonzalez-Juanatey
J.R.; Evangelista A.; Elizaga J.; Martin-Moreiras J.; Gonzalez-Santos
J.M.; Moreno-Escobar E.; Fernandez-Aviles F.; Garcia-Robles J.A.;
Perez-David E.; Del Villar C.P.; Sanz R.; Gutierrez-Ibanes E.; Vazquez
M.E.; Mur A.; Benito Y.; Barrio A.; Vazquez A.; Uribe I.; Gonzalez M.;
Arribas A.; Lorenzo M.M.C.; Nieto A.D.; De Prado A.P.; Alonso D.;
Gomez-Bueno M.; Silva I.S.; Cavero M.A.; Dominguez L.; De Meneses R.T.;
Cano M.J.R.; Lopez-Guarch C.J.; Mota P.; Galito C.A.; Mora M.C.B.; Rubio
D.M.; Campuzano R.; Marzoa R.; Cuenca J.; Munoz R.; Suberviola V.; Herrera
C.B.; Mora L.; Sarrion M.M.; Vaqueriza D.; Ferrer E.; Cid B.; Monzonis
A.M.; Arizon De Prado J.M.; Santisteban M.; Garcia-Dorado D.; De Teresa
E.; Chinchilla F.C.; Alonso J.
Institution
(Bermejo, Gonzalez-Mansilla, Mombiela, Fernandez, Martinez-Legazpi,
Elizaga, Fernandez-Aviles, Garcia-Robles, Perez-David, Del Villar, Sanz,
Gutierrez-Ibanes, Vazquez, Mur, Benito, Barrio, Vazquez) Hospital General
Universitario Gregorio Maranon, Instituto de Investigacion Sanitaria
Gregorio Maranon, Facultad de Medicina, Universidad Complutense de Madrid,
CIBERCV, Madrid, Spain
(Yotti) Instituto de Salud Carlos III, Madrid, Spain
(Garcia-Orta, Uribe, Gonzalez) Hospital Virgen de las Nieves, Granada,
Spain
(Sanchez, Sanchez-Fernandez, Martin-Moreiras, Gonzalez-Santos, Arribas,
Lorenzo, Nieto) Hospital Clinico Universitario de Salamanca, CIBERCV
Salamanca, Salamanca, Spain
(Castano, De Prado, Alonso) Hospital Universitario de Leon, Leon, Spain
(Segovia-Cubero, Gomez-Bueno, Silva, Cavero) Hospital Puerta de Hierro
Majadahonda, CIBERCV, Majadahonda, Spain
(Escribano-Subias, Dominguez, De Meneses, Cano, Lopez-Guarch) Hospital 12
de Octubre, CIBERCV, Madrid, Spain
(Roman, Mota) Hospital Clinico de Valladolid, CIBERCV, Valladolid, Spain
(Borras, Galito) Hospital Santa Creu i San Pau, CIBERCV, Barcelona, Spain
(Alonso-Gomez, Mora, Rubio) Hospital Universitario de Araba-Txagorritxu,
Vitoria, Spain
(Botas) Hospital Universitario Fundacion Alcorcon, Alcorcon, Spain
(Crespo-Leiro, Marzoa, Cuenca) Complejo Hospitalario Universitario de A
Coruna, CIBERCV, A Coruna, Spain
(Velasco) Hospital de Galdakao-Usansolo, Usansolo, Spain
(Bayes-Genis, Ferrer) Hospital Universitari Germans Trias i Pujol,
CIBERCV, Badalona, Spain
(Lopez, Arizon De Prado, Santisteban) Hospital Universitario Reina Sofia,
Cordoba, Spain
(Munoz-Aguilera, Munoz, Suberviola, Herrera, Mora, Sarrion, Vaqueriza)
Hospital Infanta Leonor, Madrid, Spain
(Jimenez-Navarro, De Teresa, Chinchilla) Hospital Virgen de la Victoria,
CIBERCV, Malaga, Spain
(Gonzalez-Juanatey, Cid, Monzonis) Hospital Clinico de Santiago de
Compostela, CIBERCV, Santiago de Compostela, Spain
(Evangelista, Garcia-Dorado) Hospital Universitario de la Vall d'Hebron,
CIBERCV, Barcelona, Spain
(Moreno-Escobar) Hospital Universitario San Cecilio, Granada, Spain
(Campuzano) Complejo Universitario Fundacion Alcorcon, Alcorcon, Spain
(Alonso) Hospital Universitario de Getafe, Madrid, Spain
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The determinants and consequences of pulmonary hypertension
after successfully corrected valvular heart disease remain poorly
understood. We aim to clarify the hemodynamic bases and risk factors for
mortality in patients with this condition. METHODS AND RESULTS: We
analyzed long-term follow-up data of 222 patients with pulmonary
hypertension and valvular heart disease successfully corrected at least 1
year before enrollment who had undergone comprehensive hemodynamic and
imaging characterization as per the SIOVAC (Sildenafil for Improving
Outcomes After Valvular Correction) clinical trial. Median (interquartile
range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary
artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were
classified either as having combined precapillary and postcapillary or
isolated postcapillary pulmonary hypertension. After a median follow-up of
4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in
the age-matched population. Risk factors for mortality were male sex,
older age, diabetes mellitus, World Health Organization functional class
III and higher pulmonary vascular resistance-either measured by
catheterization or approximated from ultrasound data. Higher pulmonary
vascular resistance was related to diabetes mellitus and smaller residual
aortic and mitral valve areas. In turn, the latter correlated with
prosthetic nominal size. Six-month changes in the composite clinical score
and in the 6-minute walk test distance were related to survival.
<br/>CONCLUSION(S): Persistent valvular heart disease-pulmonary
hypertension is an ominous disease that is almost universally associated
with elevated pulmonary artery wedge pressure. Pulmonary vascular
resistance is a major determinant of mortality in this condition and is
related to diabetes mellitus and the residual effective area of the
corrected valve. These findings have important implications for
individualizing valve correction procedures. REGISTRATION: URL:
https://www.clini caltr ials.gov; Unique identifier:
NCT00862043.<br/>Copyright &#xa9; 2021 The Authors.

<104>
Accession Number
2015435213
Title
Prevalence of preoperative cognitive impairment in older surgical
patients.: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 76 (no pagination), 2022. Article Number:
110574. Date of Publication: February 2022.
Author
Kapoor P.; Chen L.; Saripella A.; Waseem R.; Nagappa M.; Wong J.; Riazi
S.; Gold D.; Tang-Wai D.F.; Suen C.; Englesakis M.; Norman R.; Sinha S.K.;
Chung F.
Institution
(Kapoor, Chen, Saripella, Waseem, Wong, Riazi, Suen, Chung) Department of
Anesthesiology and Pain Medicine, Toronto Western Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Nagappa) Department of Anesthesia & Perioperative Medicine, Western
University, London, ON, Canada
(Wong) Department of Anesthesiology and Pain Medicine, Women's College
Hospital, Toronto, ON, Canada
(Gold) Department of Psychiatry, University of Toronto, Toronto, ON,
Canada
(Tang-Wai) Division of Neurology, Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Englesakis) Library & Information Services, University Health Network,
Toronto, ON, Canada
(Norman, Sinha) Division of Geriatric Medicine, Department of Medicine,
University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Study objective: Older surgical patients with cognitive impairment are at
an increased risk for adverse perioperative outcomes, however the
prevalence of preoperative cognitive impairment is not well-established
within this population. The purpose of this review is to determine the
pooled prevalence of preoperative cognitive impairment in older surgical
patients. <br/>Design(s): Systematic review and meta-analysis.
<br/>Setting(s): MEDLINE (Ovid), PubMed (non-MEDLINE records only),
Embase, Cochrane Central, Cochrane Database of Systematic Reviews,
PsycINFO, and EMCare Nursing for relevant articles from 1946 to April
2021. <br/>Patient(s): Patients aged >=60 years old undergoing surgery,
and preoperative cognitive impairment assessed by validated cognitive
assessment tools. <br/>Intervention(s): Preoperative assessment.
Measurements: Primary outcomes were the pooled prevalence of preoperative
cognitive impairment in older patients undergoing either elective (cardiac
or non-cardiac) or emergency surgery. <br/>Main Result(s): Forty-eight
studies (n = 42,498) were included. In elective non-cardiac surgeries, the
pooled prevalence of unrecognized cognitive impairment was 37.0% (95%
confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and
diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among
11,676 patients. Within the elective non-cardiac surgery category,
elective orthopedic surgery was analyzed. In this subcategory, the pooled
prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%,
49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0%
(95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the
unrecognized cognitive impairment prevalence across 588 patients was 26.0%
(95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive
impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389
patients. <br/>Conclusion(s): A substantial number of surgical patients
had unrecognized cognitive impairment. In elective non-cardiac and
emergency surgeries, the pooled prevalence of unrecognized cognitive
impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants
more attention for risk assessment and stratification.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<105>
Accession Number
2015524229
Title
Assessment of the ESC quality indicators in patients with acute myocardial
infarction: A systematic review.
Source
European Heart Journal: Acute Cardiovascular Care. 10(8) (pp 878-889),
2021. Date of Publication: 01 Oct 2021.
Author
Rossello X.; Masso-Van Roessel A.; Perello-Bordoy A.; Mas-Llado C.;
Ramis-Barcelo M.F.; Vives-Borras M.; Pons J.; Peral V.
Institution
(Rossello, Masso-Van Roessel, Perello-Bordoy, Mas-Llado, Ramis-Barcelo,
Vives-Borras, Pons, Peral) Cardiology Department, Health Research
Institute of the Balearic Islands (IdISBa), Hospital Universitari Son
Espases, Palma, Spain
(Rossello) Centro Nacional de Investigaciones Cardiovasculares (CNIC),
Madrid, Spain
(Rossello) Facultat de Medicina, Universitat de les Illes Balears (UIB),
Illes Balears, Palma, Spain
Publisher
Oxford University Press
Abstract
Aims: To help improving quality of care in patients with acute myocardial
infarction (AMI), the European Society of Cardiology (ESC) set 20 quality
indicators (QIs). There is a need to compile and summarize QI
availability, feasibility, and global compliance in real-world registries.
<br/>Methods and Results: A systematic review of PubMed and Web of Science
was conducted including all original articles reporting the use of the ESC
QIs in AMI patients. Methods and reporting follow the guidelines of the
PRISMA Statement and the protocol was registered in PROSPERO
(CRD42020190541). Among the 220 screened citations, 9 studies met the
inclusion criteria after full-text review. Among these 9 studies, there
were 11 different cohorts. Patients were recruited from three different
continents (31 countries). The number of QIs assessed ranged from 6 to 20,
with 5 studies (56%) reporting data for at least 75% of the 20 QIs. There
were room for improvement in terms of data availability (i.e. domain 6
measuring patient's satisfaction), feasibility (i.e. difficulties to find
all data for composite QIs in domain 7), and attainment (i.e. high levels
of compliance with the percentage of reperfused ST-segment elevation
myocardial infarction patients, but low levels for a timely reperfusion).
<br/>Conclusion(s): Our systematic review has shown that it is possible to
measure most QIs in existing registries, and that there is room for
improvement in terms of data availability, feasibility, and levels of
attainment to QIs. Our findings may influence the design of future
registries to capture this information and help in QIs definition
updates.<br/>Copyright &#xa9; 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<106>
Accession Number
2015398670
Title
Mirogabalin treatment of postoperative neuropathic pain after thoracic
surgery: Study protocol for a multicenter, randomized, open-label,
parallel-group, interventional trial.
Source
Journal of Thoracic Disease. 13(10) (pp 6062-6070), 2021. Date of
Publication: October 2021.
Author
Doi R.; Miyazaki T.; Tsuchiya T.; Matsumoto K.; Tomoshige K.; Machino R.;
Mizoguchi S.; Matsumoto T.; Yamaguchi K.; Takatsuna H.; Shiosakai K.;
Nagayasu T.
Institution
(Doi, Miyazaki, Tsuchiya, Matsumoto, Tomoshige, Machino, Mizoguchi,
Matsumoto, Nagayasu) Department of Surgical Oncology, Nagasaki University
Graduate School of Biomedical Sciences, Nagasaki, Japan
(Yamaguchi) Oncology Medical Science Department, Daiichi Sankyo Co., Ltd.,
Tokyo, Japan
(Takatsuna) Primary Medical Science Department, Daiichi Sankyo Co., Ltd.,
Tokyo, Japan
(Shiosakai) Data Intelligence Department, Daiichi Sankyo Co., Ltd., Tokyo,
Japan
Publisher
AME Publishing Company
Abstract
Background: Intercostal nerve damage due to thoracotomy or thoracoscopic
manipulation is a major contributor to chronic postsurgical pain after
pulmonary resection. Chronic postsurgical pain may last for months or
years and can negatively impair physical functioning and daily activities.
Global consensus on severe postoperative pain management is lacking, and
chronic pain incidence after thoracic surgery remains high. Many patients
report neuropathic pain, which can be difficult to treat with currently
available therapies. The efficacy and safety of mirogabalin have been
demonstrated for other types of neuropathic pain; thus, this study was
planned to investigate the efficacy and safety of mirogabalin to treat
neuropathic pain after thoracic surgery. <br/>Method(s): In this
multicenter, randomized, open-label, parallel-group, interventional study,
patients who are diagnosed with neuropathic pain following removal of a
chest drain after lung resection will receive conventional therapy
(non-steroidal anti-inflammatory drugs and/or acetaminophen) with or
without the addition of a clinical dose of mirogabalin for 8 weeks. For
patient stratification, a visual analog scale pain intensity score at
baseline of <60 vs. >=60 mm will be used. Treatment efficacy and safety
with and without the addition of mirogabalin will be assessed using a
questionnaire evaluating postoperative changes in pain severity and
activity. The primary study endpoint is the change in pain intensity from
baseline to Week 8, measured by the visual analog scale. Additionally, the
presence of chronic pain at 12 weeks after enrollment in each treatment
group will be recorded. <br/>Discussion(s): This protocol has been
reviewed and approved by the Clinical Research Review Board of Nagasaki
University. Study data will be published in the Japan Registry of Clinical
Trials database and peer-reviewed journals. Mirogabalin is already
approved for the treatment of other types of neuropathic pain. It is
anticipated that this study will provide data to elucidate the impact of
mirogabalin treatment, in combination with conventional therapy, to
benefit patients with neuropathic pain following thoracic surgery. Trial
Registration: Japan Registry of Clinical Trials Identifier:
jRCTs071200053.<br/>Copyright &#xa9; Journal of Thoracic Disease. All
rights reserved.

<107>
Accession Number
2015398656
Title
Evaluation of local aggressive lung therapy versus systemic therapy in
oligometastatic non-small cell lung cancer: A systematic review and
meta-analysis.
Source
Journal of Thoracic Disease. 13(10) (pp 5899-5910), 2021. Date of
Publication: October 2021.
Author
Zhang C.; Ma N.; Zhang Q.; Zheng K.; Sun C.; Tang X.; Li X.; Zhao J.
Institution
(Zhang, Zheng, Tang, Li, Zhao) Department of Thoracic Surgery, Tangdu
Hospital, Air Force Medical University, Xi'an, China
(Ma) Department of Ophthalmology, Tangdu Hospital, Air Force Medical
University, Xi'an, China
(Zhang) School of Stomatology, Xi'an Medical University, Xi'an, China
(Sun) Department of Cardiology, Xi'an International Medical Center
Hospital, Xi'an, China
(Li, Zhao) Department of Thoracic Surgery, Tangdu Hospital, Air Force
Medical University, No. 569, Xinsi Road, Shaanxi, Xi'an 710038, China
Publisher
AME Publishing Company
Abstract
Background: Previous studies have shown the feasibility and effectiveness
of local aggressive thoracic therapy (surgery and radiotherapy) for
oligometastatic non-small cell lung cancer compared with systemic therapy,
but with small sample. This study aims to perform a pooled analysis to
explore whether LT could improve outcomes of oligometastatic patients with
non-small cell lung cancer. <br/>Method(s): Protocol of present study was
registered on PROSPERO as number: CRD42021233095. PubMed, Embase and Web
of knowledge were searched, and eligible studies investigating local
therapy for non-small cell lung cancer with 1-5 metastases regardless of
organs were included. Linear regression between survival and clinical
characteristics were conducted. Hazard ratios of survival and adverse
effects were merged. Pooled survival curves were carried out.
<br/>Result(s): Three randomized controlled trials and 5 cohort studies
enrolling 499 patients were included. There was a trend that median
overall survival declined with the increasing proportion of N2-3 positive
patients in local therapy group, but with no statistical difference
(P=0.09, R²=0.98). Undergoing local therapy for oligometastatic
non-small cell lung cancer achieved reduction of 47% and 60% in the risk
of death and cancer progression (P<0.001), respectively. In subgroup
analysis, patients receiving local therapy including surgery showed hazard
ratio of 0.33 on progression-free survival and 0.55 of these excluding
surgery. Patients receiving consolidative local therapy (local therapy
after systemic therapy) obtained hazard ratios 0.33 and 0.45 on
progression-free and overall survival vs. systemic therapy, respectively.
Hazard ratios of those receiving upfront local therapy (local therapy
first) were 0.62 and 0.68 on progression-free and overall survival vs.
systemic therapy. Pooled survival analysis showed median overall and
progression-free survival of local therapy (21.6 and 14 months) group were
both longer than systemic one (14.3 and 6.5 months). Odds ratio of adverse
effects were no difference between 2 groups (P=0.16). <br/>Conclusion(s):
Local aggressive thoracic therapy could prolong 7 months overall and
progression-free survival compared with systemic therapy in patients with
oligometastatic non-small cell lung cancer. Consolidative local therapy
might be a more favorable choice of local therapy. Benefits of local
therapy for N2-3 positive patients should explored further.<br/>Copyright
&#xa9; Journal of Thoracic Disease. All rights reserved.

<108>
Accession Number
2015569026
Title
Recommendations for the ethical guidelines for publication of scientific
studies: The responsibilities of editors, reviewers and the authors.
Source
Annals of Medicine and Surgery. 72 (no pagination), 2021. Article Number:
103047. Date of Publication: December 2021.
Author
Akbulut S.; Sahin T.T.
Institution
(Akbulut, Sahin) Department of Surgery and Liver Transplant Institute,
Inonu University Faculty of Medicine, Malatya 244280, Turkey
Publisher
Elsevier Ltd
Abstract
Objective: We aimed to evaluate the role of anesthesiologist in the
management of hydatid disease from the perspective of the editors,
reviewers and the authors. <br/>Method(s): We searched the PubMed/Medline
database using the following keywords: (hydatid* OR echinococc*) AND
(disease OR cyst) AND (anesthesiology). We have evaluated the authors,
their institutions and department, and the aim of the studies. We also
evaluated the studies published by anesthesiologists in terms of content.
<br/>Result(s): The literature search showed 6344 articles published
between February 2010 to 2021. Sixty-three had at least one
anesthesiologist in the author list. Anesthesiologists were leading
authors in 35 studies; and in 19 of them, all the authors were
anesthesiologist. Sixteen (84.2%) of these articles defined the outcomes
of surgical therapy and there was no information regarding anesthesia
technique. <br/>Conclusion(s): The results of our study emphasize an
important controversy regarding jurisdiction of different departments in
terms of scientific research ethics. We believe that different disciplines
can work together to evaluate a scientific problem and can publish a study
in collaboration. But collaboration is very important and violating the
subject of another field without collaboration is a deontological
problem.<br/>Copyright &#xa9; 2021

<109>
Accession Number
2014510041
Title
Lung diffusing capacity for nitric oxide measured by two commercial
devices: A randomised crossover comparison in healthy adults.
Source
ERJ Open Research. 7(3) (no pagination), 2021. Article Number: 00193-2021.
Date of Publication: 01 Jul 2021.
Author
Radtke T.; Dressel H.; de Groot Q.; Haile S.R.; Maggi M.; Hsia C.C.W.
Institution
(Radtke, Dressel, de Groot, Maggi) Division of Occupational and
Environmental Medicine, Epidemiology, Biostatistics and Prevention
Institute, University of Zurich & University Hospital Zurich, Zurich,
Switzerland
(de Groot) Zurich University of Applied Sciences, School of Health
Professions, Institute of Physiotherapy, Winterthur, Switzerland
(Haile) Epidemiology, Biostatistics and Prevention Institute, University
of Zurich, Zurich, Switzerland
(Hsia) Dept of Internal Medicine, University of Texas Southwestern Medical
Center, Dallas, TX, United States
Publisher
European Respiratory Society
Abstract
In Europe, two commercial devices are available to measure combined
single-breath diffusing capacity of the lung for nitric oxide
(D<inf>LNO</inf> ) and carbon monoxide (D<inf>LCO</inf> ) in one
manoeuvre. Reference values were derived by pooling datasets from both
devices, but agreement between devices has not been established. We
conducted a randomised crossover trial in 35 healthy adults (age
40.0+/-15.5 years, 51% female) to compare D<inf>LNO</inf> ( primary
end-point) between MasterScreenTM (Vyaire Medical, Mettawa, IL, USA) and
HypAir (Medisoft, Dinant, Belgium) devices during a single visit under
controlled conditions. Linear mixed models were used adjusting for device
and period as fixed effects and random intercept for each participant.
Difference in D<inf>LNO</inf> between HypAir and MasterScreen was 24.0
mL.min^{-1.mmHg -1} (95% CI 21.7-26.3). There was no difference in
D<inf>LCO</inf> (-0.03 mL.min^-1.mmHg-1, 95% CI -0.57-0.12)
between devices while alveolar volume (V<inf>A</inf> ) was higher on
HypAir compared to MasterScreenTM (0.48 L, 95% CI 0.45-0.52). Disparity in
the estimation of V<inf>A</inf> and the rate of NO uptake (K<inf>NO</inf>
=D<inf>LNO</inf> /V<inf>A</inf> ) could explain the discrepancy in
D<inf>LNO</inf> between devices. Disparity in the estimation of
V<inf>A</inf> and the rate of CO uptake (K<inf>CO</inf>
=D<inf>LCO</inf>/V<inf>A</inf> ) per unit of V<inf>A</inf> offset each
other resulting in negligible discrepancy in D<inf>LCO</inf> between
devices. Differences in methods of expiratory gas sampling and sensor
specifications between devices likely explain these observations. These
findings have important implications for derivation of D<inf>LNO</inf>
reference values and comparison of results across studies. Until this
issue is resolved, reference values, established on the respective
devices, should be used for test interpretation.<br/>Copyright &#xa9;The
authors 2021.

<110>
Accession Number
2011079994
Title
Safety and Efficacy of Non-Vitamin K Oral Anticoagulant Use Early After
Cardiac Surgery: A Systematic Review.
Source
Annals of Pharmacotherapy. 55(12) (pp 1525-1535), 2021. Date of
Publication: December 2021.
Author
Wang E.H.Z.; Ye J.; Turgeon R.
Institution
(Wang, Ye, Turgeon) University of British Columbia, Vancouver, BC, Canada
Publisher
SAGE Publications Inc.
Abstract
Objective: To determine the safety and efficacy of non-vitamin K oral
anticoagulants (NOACs) initiated early after cardiac surgery. <br/>Data
Sources:: Cochrane Central Register of Controlled Trials, EMBASE, and
MEDLINE (database inception to January 20, 2021), www.clinicaltrials.gov,
www.who.int/ictrp/search/en/, NOAC trial registries, and bibliographies of
relevant guidelines and other reviews were used. Study Selection and Data
Extraction: Observational studies and randomized controlled trials (RCTs)
that initiated NOACs within the index hospitalization and that reported
bleeding for the primary outcome were included. <br/>Data Synthesis: A
total of 6 cohort studies, 1 RCT, and 3 ongoing RCTs were included. Most
studies were single-centered, limited to postoperative atrial fibrillation
after coronary artery bypass grafting, and with 30-day follow-up; few
studies included patients with isolated bioprosthetic valve replacement or
valve repair. Bleeding risk varied (0%-28.6%), and all but one study
showed no significantly higher risk with NOAC compared with warfarin.
Relevance to Patient Care and Clinical Practice: Overall, NOACs were used
in 26% to 37.5% of patients early after cardiac surgery. Starting a NOAC
on postoperative day 4 appeared to have similar bleeding rates compared
with warfarin, but clinical application is limited by heterogeneity of
outcome definitions, confounding, and bias. Compared with warfarin, NOACs
may have similar thromboembolism risk, reduced length of stay, and cost.
<br/>Conclusion(s): There is limited evidence to guide NOAC use early
after cardiac surgery. Three ongoing randomized trials will add to the
literature and provide guidance for clinicians on whether, in whom, when,
and how to use NOACs safely early after cardiac surgery.<br/>Copyright
&#xa9; The Author(s) 2021.

<111>
Accession Number
2005755017
Title
Effect of Desmopressin on Platelet Dysfunction During Antiplatelet
Therapy: A Systematic Review.
Source
Neurocritical Care. 34(3) (pp 1026-1046), 2021. Date of Publication: June
2021.
Author
Andersen L.K.; Hvas A.-M.; Hvas C.L.
Institution
(Andersen, Hvas) Thrombosis and Hemostasis Research Unit, Department of
Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
(Hvas) Department of Anaesthesiology and Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
Publisher
Springer
Abstract
Background and Objective: An increasing number of patients receive
antiplatelet therapy. Patients exposed to surgery while receiving platelet
inhibitors hold an increased bleeding risk. Especially in neurosurgery and
neurocritical care patients, bleeding and hematoma expansion are feared
complications as even minor bleedings may be hazardous. The objective of
this systematic review was to investigate the effect of desmopressin
(1-deamino-8-d-arginine vasopressin, DDAVP) on platelet function during
antiplatelet therapy in patients undergoing non-cardiac surgery, patients
who experience spontaneous or traumatic hemorrhage, healthy individuals
and in animals. <br/>Method(s): Studies were identified through a
systematic literature search in PubMed and EMBASE on August 19, 2019, with
an update on May 2, 2020, and from reference lists of the included
studies. Data on clinical and biochemical effect of DDAVP were extracted
from included studies for a qualitative data synthesis. <br/>Result(s): In
total, 22 studies were included: 18 human studies and four animal studies.
Overall, DDAVP improved bleeding time and increased platelet aggregation
in patients undergoing non-cardiac surgery, patients suffering
intracerebral or subarachnoid hemorrhage while receiving antiplatelet
therapy as well as in healthy individuals and animals exposed to
antiplatelet therapy. Observational data indicate that DDAVP may mitigate
hematoma expansion in patients with intracerebral hemorrhage or traumatic
brain injury. <br/>Conclusion(s): The present data hold biochemical
evidence that DDAVP improves platelet function during antiplatelet therapy
in humans and animals. The need for randomized trials is evident in order
to evaluate the potential clinical effect of DDAVP in management of
patients with spontaneous or traumatic hemorrhage, or undergoing
neurosurgery, while receiving antiplatelet therapy.<br/>Copyright &#xa9;
2020, Springer Science+Business Media, LLC, part of Springer Nature and
Neurocritical Care Society.

<112>
Accession Number
2005221914
Title
Predictive value of the respiratory exchange ratio for the occurrence of
postoperative complications in laparoscopic surgery: a prospective and
observational study.
Source
Journal of Clinical Monitoring and Computing. 35(4) (pp 849-858), 2021.
Date of Publication: August 2021.
Author
Bar S.; Santarelli D.; de Broca B.; Abou Arab O.; Leviel F.; Miclo M.;
Dupont H.; Guinot P.-G.; Lorne E.
Institution
(Bar, Santarelli, de Broca, Abou Arab, Leviel, Miclo, Dupont, Lorne)
Anaesthesiology and Critical Care Department, Amiens University Hospital,
Rond-Point Fernand Leger, Amiens 80054, France
(Guinot) Anaesthesiology and Critical Care Department, Dijon University
Hospital, 2 Bd Marechal de Lattre de Tassigny, Dijon 21000, France
(Bar) Research Unit Simplification of Care for Complex Patients, UR 7518,
University of Picardy Jules Verne, Amiens 80000, France
Publisher
Springer Science and Business Media B.V.
Abstract
Indirect measurement of the respiratory exchange ratio (RER) has been
shown to predict the occurrence of postoperative complications after major
open non-cardiac surgery. Our main objective was to demonstrate the
ability of the RER, indirectly measured by the anaesthesia respirator, to
predict the occurrence of postoperative complications following
laparoscopic surgery. We performed an observational, prospective and
monocentric study. Haemodynamic and respiratory parameters were collected
at several timepoints to calculate the RER by a non-volumetric method: RER
= (FetCO<inf>2</inf>-FiCO<inf>2</inf>)/(FiO<inf>2</inf>-FetO<inf>2</inf>).
Fifty patients were prospectively included. Nine patients (18%) had at
least one postoperative complication. The mean RER was significantly
higher for the subgroup of patients with complications than the subgroup
without (1.04 +/- 0.27 vs 0.88 +/- 0.13, p < 0.05). The RER could predict
the occurrence of post-operative complications with an area under the ROC
curve of 0.73 (95% CI 0.59-0.85, p = 0.021). The best cut off was 0.98,
with a sensitivity of 56% and a specificity of 88%. One hour after
insufflation, the FiO<inf>2</inf>-FetO<inf>2</inf> difference was
significantly lower and the RER was significantly higher in the
complications subgroup than in the subgroup without complications (4.4/-
1.6% vs 5.8/- 1.2%, p = 0.001 and 0.95 [0.85-1.04] vs 0.83 [0.75-0.92], p
= 0.04, respectively). The RER measured during laparoscopic surgery can
predict the occurrence of postoperative complications. Trial registration
The objectives and procedures of the study was registered at
Clinicaltrials.gov (NCT03751579); date: November 23, 2018.<br/>Copyright
&#xa9; 2020, Springer Nature B.V.

<113>
Accession Number
636423877
Title
Blockade of IL-6/IL-6R Signaling Attenuates Acute Antibody-Mediated
Rejection in a Mouse Cardiac Transplantation Model.
Source
Frontiers in Immunology. 12 (no pagination), 2021. Article Number: 778359.
Date of Publication: 28 Oct 2021.
Author
Ma M.; Li X.; Deng G.; Zhang Y.; Yang Z.; Han F.; Huang Z.; Fang Y.; Liao
T.; Sun Q.
Institution
(Ma, Deng, Yang, Han, Huang) Organ Transplantation Research Institute,
Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong,
China
(Sun, Zhang, Liao, Sun) Department of Kidney Transplantation, Guangdong
Provincial People's Hospital, Guangdong Academy of Medical Sciences,
Guangzhou, Guangdong, China
(Li) Department of Obstetrics and Gynecology, Third Affiliated Hospital of
Sun Yat-sen University, Guangzhou, Guangdong, China
(Fang) Department of Urology, Third Affiliated Hospital of Sun Yat-sen
University, Guangzhou, Guangdong, China
Publisher
Frontiers Media S.A.
Abstract
Acute antibody-mediated rejection (AAMR) is an important cause of cardiac
allograft dysfunction, and more effective strategies need to be explored
to improve allograft prognosis. Interleukin (IL)-6/IL-6R signaling plays a
key role in the activation of immune cells including B cells, T cells and
macrophages, which participate in the progression of AAMR. In this study,
we investigated the effect of IL-6/IL-6R signaling blockade on the
prevention of AAMR in a mouse model. We established a mouse model of AAMR
for cardiac transplantation via presensitization of skin grafts and
addition of cyclosporin A, and sequentially analyzed its features.
Tocilizumab, anti-IL-6R antibody, and recipient IL-6 knockout were used to
block IL-6/IL-6R signaling. We demonstrated that blockade of IL-6/IL-6R
signaling significantly attenuated allograft injury and improved survival.
Further mechanistic research revealed that signaling blockade decreased B
cells in circulation, spleens, and allografts, thus inhibiting
donor-specific antibody production and complement activation. Moreover,
macrophage, T cell, and pro-inflammatory cytokine infiltration in
allografts was also reduced. Collectively, we provided a highly practical
mouse model of AAMR and demonstrated that blockade of IL-6/IL-6R signaling
markedly alleviated AAMR, which is expected to provide a superior option
for the treatment of AAMR in clinic.<br/>&#xa9; Copyright &#xa9; 2021 Ma,
Sun, Li, Deng, Zhang, Yang, Han, Huang, Fang, Liao and Sun.

<114>
Accession Number
2015004597
Title
Rigid Ring Versus Flexible Band for Tricuspid Valve Repair in Patients
Scheduled for Mitral Valve Surgery: A Prospective Randomised Study.
Source
Heart Lung and Circulation. 30(12) (pp 1949-1957), 2021. Date of
Publication: December 2021.
Author
Bogachev-Prokophiev A.V.; Ovcharov M.A.; Sapegin A.V.; Lavinykov S.O.;
Astapov D.A.; Ivanzov S.M.; Sharifulin R.M.; Afanasyev A.V.; Demin I.I.;
Zeleznev S.I.
Institution
(Bogachev-Prokophiev, Ovcharov, Sapegin, Lavinykov, Astapov, Ivanzov,
Sharifulin, Afanasyev, Demin, Zeleznev) Heart Valves Surgery Department,
E. Meshalkin National Medical Research Center, Novosibirsk, Russian
Federation
Publisher
Elsevier Ltd
Abstract
Background: Tricuspid valve repair for functional regurgitation is
effectively performed with different annuloplasty devices. However, it
remains unclear whether there are advantages associated with rigid rings
compared to flexible bands. This prospective randomised study aimed to
compare results of using a flexible band ring versus a rigid ring for
functional tricuspid regurgitation in patients undergoing mitral valve
surgery. <br/>Method(s): A single-centre randomised study was designed to
allocate patients with functional tricuspid regurgitation undergoing
mitral valve surgery to be treated with a flexible band or rigid ring.
These patients were analysed by echocardiographic follow-up. The primary
outcome was freedom from recurrent tricuspid regurgitation at 12-months
follow-up. Secondary outcomes were 30-day mortality, survival, freedom
from tricuspid valve reoperation, right ventricular reverse remodelling,
and rate of major adverse events. <br/>Result(s): A total of 308 patients
were allocated to receive concomitant tricuspid valve annuloplasty with
the flexible band or rigid ring. There was no between-group difference in
freedom from recurrent tricuspid regurgitation: 97.3% in Rigid group (95%
CI, 93.0-98.8) and 96.2% in the Flexible group (95% CI, 92.0-98.5) at
12-months follow-up (log-rank, p=0.261). Early mortality, survival,
freedom from tricuspid valve reoperation, and global right ventricle
systolic function were also comparable in both groups of patients.
However, the flexible band had advantage in restoring regional right
ventricle function (Doppler-derived systolic velocities of the annulus
[S], tricuspid annular plane systolic excursion) at 12-months follow-up.
<br/>Conclusion(s): Both the rigid ring and flexible band offered
acceptable outcomes for functional tricuspid regurgitation correction
without significant differences, as assessed at 12-months
follow-up.<br/>Copyright &#xa9; 2021 Australian and New Zealand Society of
Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of
Australia and New Zealand (CSANZ)

<115>
Accession Number
2014658113
Title
Effects of Glucocorticoids on Postoperative Delirium in Adult Patients
Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis.
Source
Clinical Therapeutics. 43(9) (pp 1608-1621), 2021. Date of Publication:
September 2021.
Author
Liu W.; Wang Y.; Wang J.; Shi J.; Pan J.; Wang D.
Institution
(Liu, Wang, Wang, Shi, Pan, Wang) Department of Thoracic and
Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing
University Medical School, Institute of Cardiothoracic Vascular Disease,
Nanjing University, China
Publisher
Elsevier Inc.
Abstract
Purpose: Delirium is a common neurologic complication after cardiac
surgery and is associated with a poor prognosis. Several studies have
explored the effects of glucocorticoids on postoperative delirium (POD).
However, conclusion have been inconsistent. The purpose of this systematic
review and meta-analysis is to evaluate the effects of glucocorticoids on
POD in adult patients undergoing cardiac surgery. <br/>Method(s): A
systematic literature search was conducted using PubMed/MEDLINE, Embase,
Cochrane Library/Central, and Web of Science from inception to January 28,
2021. Randomized controlled trials evaluating the effects of perioperative
glucocorticoids administration on the incidence of POD in adults (>=18
years of age) undergoing cardiac surgery were included. The primary
outcome of incidence of POD was assessed using the risk ratio (RR) with a
fixed-effects model. Secondary analyses included the severity or duration
of delirium, mortality at 30 days, length of hospital and intensive care
unit (ICU) stay, duration of mechanical ventilatory support, the incidence
of myocardial injury, new atrial fibrillation, renal and respiratory
failure, postoperative infection and stroke, and the level of glucose and
inflammatory factors. <br/>Finding(s): A total 4 trials (n = 8448
patients) were included. Glucocorticoids did not significantly reduce the
incidence of POD (RR = 0.99; 95% CI, 0.86-1.14) but increased the risk of
myocardial injury (RR = 1.22; 95% CI, 1.08-1.38), decreased the duration
of mechanical ventilatory support (mean difference, -0.83; 95% CI, -1.32
to -0.34), and led to a tendency toward short length of ICU stay (mean
difference, -0.22; 95% CI, -0.47 to -0.03). No significant differences
were observed in other secondary outcomes. Implications: The perioperative
administration of glucocorticoids did not reduce the incidence of POD in
adult patients undergoing cardiac surgery but might be associated with
shorter duration of mechanical ventilatory support and a tendency toward a
shorter length of ICU stay. Furthermore, we found that glucocorticoids may
increase the rate of myocardial injury but have no effects on other
clinical outcomes. International Prospective Register of Systematic
Reviews identifier: CRD42021233458.<br/>Copyright &#xa9; 2021

<116>
Accession Number
2013446865
Title
Thoracic bone mineral density measured by quantitative computed tomography
in patients undergoing spine surgery.
Source
Spine Journal. 21(11) (pp 1866-1872), 2021. Date of Publication: November
2021.
Author
Salzmann S.N.; Okano I.; Jones C.; Basile E.; Iuso A.; Zhu J.; Reisener
M.-J.; Chiapparelli E.; Shue J.; Carrino J.A.; Girardi F.P.; Cammisa F.P.;
Sama A.A.; Hughes A.P.
Institution
(Salzmann, Okano, Jones, Basile, Iuso, Zhu, Reisener, Chiapparelli, Shue,
Carrino, Girardi, Cammisa, Sama, Hughes) Spine Care Institute, Hospital
for Special Surgery, Weill Cornell Medicine, 535 East 70th St, New York,
NY 10021, United States
Publisher
Elsevier Inc.
Abstract
BACKGROUND CONTEXT: The thoracic spine is a common location for vertebral
fractures as well as instrumentation failure after long spinal fusion
procedures. The association between those complications and bone mineral
density (BMD) are well recognized. Due to the overlying sternum and ribs
in the thoracic spine, projectional BMD assessment tools such as dual
energy x-ray absorptiometry (DXA) are limited to the lumbar spine.
Quantitative computed tomography circumvents several shortcomings of DXA
and allows for level-specific BMD measurements. Studies comprehensively
quantifying BMD of the entire thoracic spine in patients undergoing spine
surgery are limited. PURPOSE: The objective of this study was: (1) to
assess the reliability of thoracic QCT measurements, (2) to determine
possible level-specific BMD variation throughout the thoracic spine and
(3) to assess the correlation between BMDs of the T1-T12 spinal levels.
STUDY DESIGN/SETTING: Cross-sectional observation study. PATIENT SAMPLE:
Patients undergoing spine surgery from 2016-2020 at a single, academic
institution with available preoperative CT imaging of the thoracic spine
were included in this study. OUTCOME MEASURES: The outcome measure was BMD
measured by QCT. <br/>METHOD(S): Patients undergoing spine surgery from
2016-2020 at a single, academic institution with available preoperative CT
imaging of the thoracic spine were included in this study. Subjects with
previous instrumentation at any thoracic level, concurrent vertebral
fractures, a Cobb angle of more than 20 degrees, or incomplete thoracic
spine CT imaging were excluded. Asynchronous quantitative computed
tomography (QCT) measurements of T1-T12 were performed. To assess inter-
and intra-observer reliability, a validation study was performed on 120
vertebrae in 10 randomly selected patients. The interclass correlation
coefficient (ICC) was calculated. A pairwise comparison of BMD was
conducted and correlations between each thoracic level were evaluated. The
statistical significance level was set at p<.05. <br/>RESULT(S): 60
patients (men, 51.7%) met inclusion criteria. The study population was 90%
Caucasian with a mean age of 62.2 years and a mean BMI of 30.2
kg/m². The inter- and intra-observer reliability of the
thoracic QCT measurements was excellent (ICC of 0.97 and 0.97,
respectively). The trabecular BMD was highest in the upper thoracic spine
and decreased in the caudal direction (T1 = 182.3 mg/cm³, T2 =
168.1 mg/cm³, T3 = 163.5 mg/cm³, T4 = 164.7
mg/cm³, T5 = 161.4 mg/cm³, T6 = 152.5
mg/cm³, T7 = 143.5 mg/cm³, T8 = 141.3
mg/cm³, T9 = 143.5 mg/cm³, T10 = 145.1
mg/cm³, T11 = 145.3 mg/cm³, T12 = 133.6
mg/cm³). The BMD of all thoracic levels cranial to T6 was
statistically higher than the BMD of all levels caudal to T6 (p <.001).
Nonetheless, significant correlations in BMD among all measured thoracic
levels were observed, with a Pearson's correlation coefficient ranging
from 0.74 to 0.97. <br/>CONCLUSION(S): There is significant regional BMD
variation in the thoracic spine depending on spinal level. This BMD
variation might contribute to several clinically relevant phenomena.
First, vertebral fractures occur most commonly at the thoracolumbar
junction including T12. In addition to mechanical reasons, these fractures
might be partially attributed to thoracic BMD that is lowest at T12.
Second, the optimal upper instrumented vertebra (UIV) for stopping long
fusions to the sacrum and pelvis is controversial. The BMD of surgically
relevant upper thoracic stopping points (T2-T4) was significantly higher
than the BMD of lower thoracic stopping points (T10-T12). Besides stress
concentration at the relatively mobile lower thoracic segments, the low
BMD at these levels might contribute to previously suggested higher rates
of junctional failures with short fusions.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<117>
Accession Number
635935221
Title
Percutaneous Coronary Intervention with Stenting versus Coronary Artery
Bypass Grafting in Stable Coronary Artery Disease.
Source
International Journal of Angiology. 30(3) (pp 221-227), 2021. Date of
Publication: 01 Sep 2021.
Author
Glenn I.C.; Iacona G.M.; Mangi A.A.
Institution
(Glenn) Department of Thoracic and Cardiovascular Surgery, Heart,
Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United
States
(Iacona, Mangi) Medstar Health Cardiac Surgery, Heart and Vascular
Institute, Medstar Washington Hospital Center, 110 Irving Street
Northwest, Washington, DC 20010, United States
Publisher
Thieme Medical Publishers, Inc.
Abstract
The debate over coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) with stent placement for the treatment of
stable multivessel coronary artery disease (CAD) continues in spite of
numerous studies investigating the issue. This paper reviews the most
recent randomized control trials (RCT) and meta-analyses of pooled RCT
data to help address this issue. General trends demonstrated that CABG was
superior in all-cause mortality and fulfilling the need for repeat
revascularization. These advantages tended to be more pronounced in
multivessel CAD and diabetes, and less so in left main CAD. PCI showed a
consistently lower rate of cerebrovascular events. CABG continues to offer
significant advantages over PCI, even as drug-eluting stent technology
continues to evolve. The ideal endpoint for comparing PCI and CABG remains
to be determined. Furthermore, additional research is required to further
refine patient selection criteria for each intervention. <br/>Copyright
&#xa9; 2021. International College of Angiology. All rights reserved.

<118>
Accession Number
635877485
Title
Does Age Affect the Short- And Long-Term Outcomes of Coronary Bypass
Grafting?.
Source
International Journal of Angiology. 30(3) (pp 202-211), 2021. Date of
Publication: 01 Sep 2021.
Author
Anand P.A.; Keshavamurthy S.; Shelley E.M.; Saha S.
Institution
(Anand, Keshavamurthy, Shelley, Saha) Division of Cardiothoracic Surgery,
Department of Surgery, University of Kentucky, College of Medicine, 740 S.
Limestone, Ste.A301, Lexington, KY 40536, United States
Publisher
Thieme Medical Publishers, Inc.
Abstract
The etiology of coronary artery disease (CAD) is multifactorial, stemming
from both modifiable and nonmodifiable risk factors such as age. Several
studies have reported the effects of age on various outcomes of coronary
artery bypass grafting (CABG). This article reviews age-related outcomes
of CABG and offers direction for further studies in the field to create
comprehensive, evidence-based guidelines for the treatment of CAD.
Ninety-two primary sources were analyzed for relevance to the subject
matter, of which 17 were selected for further analysis: 14 retrospective
cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our
review revealed four broad age ranges into which patients can be grouped:
those with CAD (1) below the age of 40 years, (2) between the ages of 40
and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above
80 years. Patients below the age of 40 years fare best overall with total
arterial revascularization (TAR). Patients between the ages of 40 and 60
years also fare well with the use of multiarterial grafts (MAGs) whereas
either MAGs or single-arterial grafts may be of significant benefit to
patients at or above the age of 60 years, with younger and diabetic
patients benefitting the most. Arterial grafting is superior to vein
grafting until the age of 80 years, at which point there is promising
evidence supporting the continued use of the saphenous vein as the favored
graft substrate. Age is a factor affecting the outcomes of CABG but should
not serve as a barrier to offering patients CABG at any age from either a
cost or a health perspective. Operative intervention starts to show
significant mortality consequences at the age of 80 years, but the
increased risk is countered by maintenance or improvement to patients'
quality of life. <br/>Copyright &#xa9; 2021. International College of
Angiology. All rights reserved.

<119>
Accession Number
2015701745
Title
Infective endocarditis following heart transplantation: A systematic
review.
Source
Transplantation Reviews. 36(1) (no pagination), 2022. Article Number:
100672. Date of Publication: January 2022.
Author
Jordan A.M.; Tatum R.; Ahmad D.; Patel S.V.; Maynes E.J.; Weber M.P.; Moss
S.; Royer T.L.; Tchantchaleishvili V.; Massey H.T.; Rame J.E.; Zurlo J.J.;
Aburjania N.
Institution
(Jordan, Tatum, Ahmad, Patel, Maynes, Weber, Tchantchaleishvili, Massey)
Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia,
PA, United States
(Moss, Royer, Zurlo, Aburjania) Division of Infectious Disease, Thomas
Jefferson University, Philadelphia, PA, United States
(Rame) Department of Cardiology, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
W.B. Saunders
Abstract
Purpose: Infective endocarditis (IE) is a rare but potentially fatal
complication following heart transplantation (HTx). There is a lack of
literature regarding the patterns and clinical course of IE development
following HTx. We sought to pool the existing data in regards to defining
characteristics, management options, and outcomes of IE following HTx.
<br/>Method(s): An electronic search of Cochrane Central Register of
Controlled Trials, Cumulative Index to Nursing and Allied Health
Literature, Ovid Medline, and the Scopus databases were performed to
identify all articles in the English literature that report IE following
HTx in adult patients. Patient-level data were extracted and analyzed.
<br/>Result(s): Systematic search yielded 57 patients from 32 articles.
Median patient age was 52 [IQR 43, 59] and 75% of patients (43/57) were
male. Median time to IE presentation post-HTx was 8.4 [IQR 3.0, 35.8]
months. IE of the mitral valve was observed in 36.8% (21/57) of patients,
followed by mural IE in 24.6% (14/57), and tricuspid valve IE in 21.1%
(12/57). The most common organisms were Staphylococcus aureus in 26.3%
(15/57), Aspergillus fumigatus in 19.3% (11/57), Enterococcus faecalis in
12.3% (7/57), and an undetermined or unspecified organism in 14.0% (8/57)
patients. Overall case fatality was 44.6% (25/56). Fungal IE was
associated with a significantly higher case fatality 75.0% (9/12) than
that of bacterial IE 36.1% (13/36) (p = 0.02). Surgical management of
post-HTx IE was observed in 35.1% (20/57) of patients. This included valve
surgery for 70.0% (14/20), including the mitral valve in 50.0% (7/14),
aortic valve in 35.7% (5/14), and the tricuspid valve in 14.3% (2/14) of
patients. <br/>Conclusion(s): In addition to bacterial organisms, fungi
also represent a frequent cause of IE in post-HTx patients. Overall HTx
patient survival in the setting of IE is poor and may be worse if caused
by A. fumigatus.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<120>
Accession Number
2014246820
Title
Urgent transcatheter aortic valve implantation in an all-comer population:
a single-centre experience.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
550. Date of Publication: December 2021.
Author
Lux A.; Veenstra L.F.; Kats S.; Dohmen W.; Maessen J.G.; van 't Hof
A.W.J.; Maesen B.
Institution
(Lux, Veenstra, van 't Hof) Department of Cardiology, Maastricht
University Medical Center+, Maastricht, Netherlands
(Veenstra, Kats, Maessen, Maesen) Department of Cardiothoracic Surgery,
Maastricht University Medical Center+, Maastricht, Netherlands
(Maessen, van 't Hof, Maesen) Cardiovascular Reasearch Institute
Maastricht University, Maastricht, Netherlands
(Lux, van 't Hof) Department of Cardiology, Zuyderland Medical Centrum,
Heerlen, Netherlands
(Dohmen) Business Information Management, Maastricht University Medical
Center+, Maastricht, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: When compared with older reports of untreated symptomatic
aortic valve stenosis (AoS), urgent transcatheter aortic valve
implantation (u-TAVI) seems to improve mortality rates. We performed a
single centre, retrospective cohort analysis to characterize our u-TAVI
population and to identify potential predictors of worse outcomes.
<br/>Method(s): We performed a retrospective analysis of 631 consecutive
TAVI patients between 2013 and 2018. Of these patients, 53 were
categorized as u-TAVI. Data was collected from the local electronic
database. <br/>Result(s): Urgent patients had more often a severely
decreased left ventricular ejection fraction (LVEF < 30%) and increased
creatinine levels (115.5 [88-147] vs 94.5 [78-116] mmol/l; p = 0.001).
Urgent patients were hospitalised for 18 [10-28] days before and
discharged 6 [4-9] days after the implantation. The incidence of
peri-procedural complications and apical implantations was comparable
among the study groups. Urgent patients had higher in-hospital (11.3% vs
3.1%; p = 0.011) and 1-year mortality rates (28.2% vs 8.5%, p < 0.001). An
increased risk of one-year mortality was associated with urgency (HR 3.5;
p < 0.001), apical access (HR 1.9; p = 0.016) and cerebrovascular
complications (HR 4.3; p = 0.002). Within the urgent group, the length of
pre-hospital admission was the only significant predictor of 1-year
mortality (HR 1.037/day; p = 0.003). <br/>Conclusion(s): Compared to
elective procedures, u-TAVI led to increased mortality and comparable
complication rates. This detrimental effect is most likely related to the
length of pre-procedural hospitalisation of urgent patients.<br/>Copyright
&#xa9; 2021, The Author(s).

<121>
Accession Number
2014246819
Title
Impact of oral anticoagulation therapy on postoperative atrial
fibrillation outcomes: a systematic review and meta-analysis.
Source
Thrombosis Journal. 19(1) (no pagination), 2021. Article Number: 89. Date
of Publication: December 2021.
Author
Fragao-Marques M.; Teixeira F.; Mancio J.; Seixas N.; Rocha-Neves J.;
Falcao-Pires I.; Leite-Moreira A.
Institution
(Fragao-Marques, Mancio, Falcao-Pires, Leite-Moreira) Cardiovascular
Research and Development Center, Faculty of Medicine of the University of
Porto, Porto 4200, Portugal
(Fragao-Marques, Rocha-Neves, Leite-Moreira) Sao Joao University Hospital
Center, Porto, Portugal
(Fragao-Marques, Teixeira, Mancio, Rocha-Neves, Falcao-Pires,
Leite-Moreira) Faculty of Medicine of the University of Porto, Porto,
Portugal
(Seixas) Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal
Publisher
BioMed Central Ltd
Abstract
Background: Post-operative atrial fibrillation (POAF) is the most common
complication after cardiac surgery. Recent studies had shown this
phenomenon is no longer considered transitory and is associated with
higher risk of thromboembolic events or death. The aim of this study was
to systematically review and analyze previous studies comparing oral
anticoagulation therapy with no anticoagulation, regarding these long-term
outcomes. <br/>Method(s): PubMed/MEDLINE, EMBASE, Web of Science and
Cochrane Database were systematically searched to identify the studies
comparing the risk of stroke, or thromboembolic events or mortality of
POAF patients who received anticoagulation compared with those who were
not anticoagulated. Incidence of stroke, thromboembolic events and
all-cause mortality were evaluated up to 10 years after surgery.
Time-to-event outcomes were collected through hazard ratio (HR) along with
their variance and the early endpoints using frequencies or odds ratio
(OR). Random effect models were used to compute statistical combined
measures and 95% confidence intervals (CI). Heterogeneity was evaluated
through Q statistic-related measures of variance (Tau²,
I², Chi-squared test). <br/>Result(s): Eight observational
cohort studies were selected, including 15,335 patients (3492 on Oral
Anticoagulants (OAC) vs 11,429 without OAC) that met the inclusion
criteria for qualitative synthesis. Patients had a wide gender
distribution (38.6-82.3%), each study with a mean age above 65 years
(67.5-85). Vitamin K antagonists were commonly prescribed anticoagulants
(74.3-100%). OAC was associated with a protective impact on all-cause
mortality at a mean of 5.0 years of follow-up (HR is 0.85 [0.72-1.01]; p =
0.07; I² = 48%). Thromboembolic events did not differ between
the two treatment arms (HR 0.68 [0.40-1.15], p = 0.15).
<br/>Conclusion(s): Current literature suggests a possibly protective
impact of OAC therapy for all-cause mortality in patients with new-onset
atrial fibrillation after cardiac surgery. However, it does not appear to
impact thromboembolism rate.<br/>Copyright &#xa9; 2021, The Author(s).

<122>
Accession Number
2015274439
Title
Cardiovascular efficacy and safety of dipeptidyl peptidase-4 inhibitors: A
meta-analysis of cardiovascular outcome trials.
Source
World Journal of Cardiology. 13(10) (pp 585-592), 2021. Date of
Publication: 26 Oct 2021.
Author
Patoulias D.I.; Boulmpou A.; Teperikidis E.; Katsimardou A.; Siskos F.;
Doumas M.; Papadopoulos C.E.; Vassilikos V.
Institution
(Patoulias, Katsimardou, Siskos, Doumas) Second Propedeutic Department of
Internal Medicine, Aristotle University of Thessaloniki, Hippokration
General Hospital, Thessaloniki 54642, Greece
(Boulmpou, Teperikidis, Papadopoulos, Vassilikos) Third Department of
Cardiology, Aristotle University of Thessaloniki, Hippokration General
Hospital, Thessaloniki 54642, Greece
Publisher
Baishideng Publishing Group Co
Abstract
BACKGROUND Dipeptidyl peptidase-4 (DPP-4) inhibitors are a generally safe
and well tolerated antidiabetic drug class with proven efficacy in type 2
diabetes mellitus (T2DM). Recently, a series of large, randomized
controlled trials (RCTs) addressing cardiovascular outcomes with DPP-4
inhibitors have been published. AIM To pool data from the aforementioned
trials concerning the impact of DPP-4 inhibitors on surrogate
cardiovascular efficacy outcomes and on major cardiac arrhythmias. METHODS
We searched PubMed and grey literature sources for all published RCTs
assessing cardiovascular outcomes with DPP-4 inhibitors compared to
placebo until October 2020. We extracted data concerning the following
"hard" efficacy outcomes: fatal and non-fatal myocardial infarction, fatal
and non-fatal stroke, hospitalization for heart failure, hospitalization
for unstable angina, hospitalization for coronary revascularization and
cardiovascular death. We also extracted data regarding the risk for major
cardiac arrhythmias, such as atrial fibrillation, atrial flutter,
ventricular fibrillation and ventricular tachycardia. RESULTS We pooled
data from 6 trials in a total of 52520 patients with T2DM assigned either
to DPP-4 inhibitor or placebo. DPP-4 inhibitors compared to placebo led to
a non-significant increase in the risk for fatal and non-fatal myocardial
infarction [risk ratio (RR) = 1.02, 95%CI: 0.94-1.11, I² = 0%],
hospitalization for heart failure (RR = 1.09, 95%CI: 0.92-1.29,
I² = 65%) and cardiovascular death (RR = 1.02, 95%CI:
0.93-1.11, I² = 0%). DPP-4 inhibitors resulted in a
non-significant decrease in the risk for fatal and non-fatal stroke (RR =
0.96, 95%CI: 0.85-1.08, I² = 0%) and coronary revascularization
(RR = 0.99, 95%CI: 0.90-1.09, I² = 0%), Finally, DPP-4
inhibitors demonstrated a neutral effect on the risk for hospitalization
due to unstable angina (RR = 1.00, 95%CI: 0.85-1.18, I² = 0%).
As far as cardiac arrhythmias are concerned, DPP-4 inhibitors did not
significantly affect the risk for atrial fibrillation (RR = 0.95, 95%CI:
0.78-1.17, I² = 0%), while they were associated with a
significant increase in the risk for atrial flutter, equal to 52% (RR =
1.52, 95%CI: 1.03-2.24, I² = 0%). DPP-4 inhibitors did not have
a significant impact on the risk for any of the rest assessed cardiac
arrhythmias. CONCLUSION DPP-4 inhibitors do not seem to confer any
significant cardiovascular benefit for patients with T2DM, while they do
not seem to be associated with a significant risk for any major cardiac
arrhythmias, except for atrial flutter. Therefore, this drug class should
not be the treatment of choice for patients with established
cardiovascular disease or multiple risk factors, except for those cases
when newer antidiabetics (glucagon-like peptide-1 receptor agonists and
sodium-glucose co-transporter-2 inhibitors) are not tolerated,
contraindicated or not affordable for the patient.<br/>Copyright &#xa9;
The Author(s) 2021. Published by Baishideng Publishing Group Inc. All
rights reserved.

<123>
Accession Number
2015688804
Title
Myocardial injury after major noncardiac surgery: A secondary analysis of
a randomized controlled trial.
Source
Surgery (United States). (no pagination), 2021. Date of Publication:
2021.
Author
Ellenberger C.; Schorer R.; Diaper J.; Jeleff A.; Luise S.; Hagermann A.;
Licker M.
Institution
(Ellenberger, Schorer, Diaper, Jeleff, Luise, Hagermann, Licker)
Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency
Medicine, University Hospital of Geneva, Switzerland
(Ellenberger, Licker) Faculty of Medicine, University of Geneva,
Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Myocardial injury after noncardiac surgery frequently occurs
and may influence survival. The aims of this study were to examine the
association between myocardial injury after noncardiac surgery and patient
and procedural factors as well as its impact on postoperative clinical
outcome. <br/>Method(s): A retrospective analysis was conducted from data
collected in adults enrolled in a randomized trial in elective major open
abdominal surgery. Preoperative patient characteristics, intraoperative
hemodynamic changes, and postoperative adverse events were analyzed, and
Kaplan-Meier curves were built for postoperative survival probability.
After adjustment for baseline patient and procedural characteristics, the
effect of myocardial injury after noncardiac surgery on postoperative
outcomes was analyzed in a propensity score matched cohort.
<br/>Result(s): Among 394 patients, myocardial injury after noncardiac
surgery was reported in 109 (27.7%) and was associated with a higher
cardiovascular risk profile, prolonged surgery (333 +/- 111 min vs 295 +/-
134 min, P = .010), greater need for transfusions (41.3% vs 19.3%, P <
.001), higher incidence of major adverse cardiac events (22.9% vs 6.7%, P
< .001), pulmonary complications (31.2% vs 17.9%, P = .004), acute kidney
injury (30.3% vs 18.2%, P = .009), and systemic inflammatory syndrome
(28.4% vs 13.0%, P < .001). After propensity score matching, the operative
time and the need for blood transfusion remained higher among myocardial
injury after noncardiac surgery patients who experienced more frequent
major adverse cardiac events and acute kidney injury. In both the entire
and matched cohorts, survival up to 30 months after surgery was determined
mainly by the presence of cancer. <br/>Conclusion(s): The burden of
cardiovascular disease and operative stress surgery is predictive of
myocardial injury after noncardiac surgery and, in turn, with a higher
incidence of cardiac adverse events, whereas the presence of cancer is
associated with poor survival in patients undergoing major open abdominal
surgery. Further studies are needed to determine whether myocardial injury
after noncardiac surgery can be prevented by better control of the
patient's cardiovascular condition and implementation of less invasive of
surgical procedures.<br/>Copyright &#xa9; 2021 The Author(s)

<124>
Accession Number
2014261122
Title
Robot-assisted thoracic surgery versus video-assisted thoracic surgery for
treatment of patients with thymoma: A systematic review and meta-analysis.
Source
Thoracic Cancer. (no pagination), 2021. Date of Publication: 2021.
Author
Shen C.; Li J.; Che G.
Institution
(Shen, Li, Li, Che) Department of Thoracic Surgery, West-China Hospital,
Sichuan University, Chengdu, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Surgical resection of the thymus is indicated in the presence
of primary thymic diseases such as thymoma. Video-assisted thoracoscopic
surgery (VATS) and robot-assisted thoracic surgery (RATS) offer a
minimally invasive approach to thymectomy. However, there is no clear
conclusion whether RATS can achieve an equal or even better surgical
effect when compared with VATS in treatment of thymoma. We performed this
meta-analysis to explore and compare the outcomes of RATS versus VATS for
thymectomy in patients with thymoma. <br/>Method(s): PubMed, Cochrane
Library, EMBASE, China National Knowledge Infrastructure (CNKI), Medline,
and Web of Science databases were searched for full-text literature
citations. The quality of the articles was evaluated using the
Newcastle-Ottawa Scale and the data analyzed using Review Manager 5.3
software. Fixed or random effect models were applied according to
heterogeneity. Subgroup analysis was conducted. <br/>Result(s): A total of
11 studies with 1418 patients, of whom 688 patients were in the RATS group
and 730 in the VATS group, were involved in the analysis. Compared with
VATS, RATS was associated with less blood loss in operation, lower volume
of drainage, fewer postoperative pleural drainage days, shorter
postoperative hospital stay, and fewer postoperative complications. There
was no significant difference in operative time and patients with or
without myasthenia gravis between the two groups. <br/>Conclusion(s): RATS
has more advantages over VATS, indicating that RATS is better than VATS in
terms of postoperative recovery. We look forward to more large-sample,
high-quality randomized controlled studies published in the
future.<br/>Copyright &#xa9; 2021 The Authors. Thoracic Cancer published
by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

<125>
Accession Number
2014217421
Title
Radial versus femoral secondary access for transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Das T.M.; Shin J.; Czarny M.J.; Nanavati J.; Resar J.R.; Hasan R.K.
Institution
(Das, Shin) Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Czarny, Resar, Hasan) Department of Medicine, Division of Cardiology,
Johns Hopkins University School of Medicine, Baltimore, MD, United States
(Nanavati) Welch Medical Library, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We aimed to evaluate the risk of procedural complications
after TAVR using secondary radial access (RA) versus femoral access (FA)
through a systematic review and meta-analysis of the published literature.
<br/>Background(s): Transcatheter aortic valve replacement (TAVR) entails
both large-bore arterial access for device delivery and secondary arterial
access for hemodynamic and imaging assessments. It is unknown whether RA
versus FA for this secondary access reduces the risk of procedural
complications. <br/>Method(s): We searched PubMed, Embase, the Cochrane
Library, and Web of Science for observational studies comparing TAVR
procedural complications in RA versus FA. Event rates were compared via
weighted summary odds ratios using the Mantel-Haenszel method.
<br/>Result(s): Six manuscripts encompassing 6132 patients were included.
Meta-analysis showed that RA reduced the risk of major vascular
complications (OR 0.58, 95% CI 0.43-0.77, p < 0.001, I² 0%) and
major/life-threatening bleeding (OR 0.46, 95% CI 0.36-0.59, p < 0.001,
I² 0%) as compared to FA for secondary TAVR access. We also
observed a reduction 30-day mortality (OR 0.55, 95% CI 0.38-0.79, p =
0.001, I² 0%), acute kidney injury (OR 0.45, 95% CI 0.34-0.60,
p < 0.001, I² 0%), and stroke and transient ischemic attack (OR
0.43, 95% CI 0.27-0.67, p < 0.001, I² 0%). <br/>Conclusion(s):
RA reduced the risk of major vascular and bleeding complications when
compared to FA for secondary access in TAVR. RA is associated with reduced
risk of other adverse outcomes including mortality, but these associations
may be related to selection bias and confounding given the observational
study designs.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC.