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<1>
Accession Number
2012855550
Title
Two-minute exercise testing is sufficient to estimate maximal
cardiorespiratory fitness in people with epilepsy.
Source
Epilepsy and Behavior. Part A. 121 (no pagination), 2021. Article Number:
108086. Date of Publication: August 2021.
Author
Feter N.; Hafele C.A.; Cassuriaga J.; Smith E.C.; Hafele V.; Rosseto L.;
Coombes J.S.; Rombaldi A.J.; da Silva M.C.
Institution
(Feter, Hafele, Cassuriaga, Hafele, Rombaldi, da Silva) School of Physical
Education, Federal University of Pelotas, Pelotas, Brazil
(Feter, Smith, Coombes) Centre for Research on Exercise, Physical Activity
and Health - Researchers, The University of Queensland, School of Human
Movement and Nutrition Sciences, St Lucia Campus, Brisbane, Australia
(Rosseto) School of Medicine, Federal University of Pelotas, Pelotas,
Brazil
Publisher
Academic Press Inc.
Abstract
We aimed to examine the agreement between submaximal cardiopulmonary
exercise testing (CPET) measures and peak oxygen consumption
(VO<inf>2peak</inf>) in adults with epilepsy. Data from a randomized
controlled trial with adults with epilepsy (N = 21) were analyzed.
VO<inf>2peak</inf> was assessed using indirect calorimetry during a
treadmill graded maximal CPET. Oxygen uptake efficiency slope (OUES) was
calculated from the relationship between oxygen uptake and minute
ventilation during the entire test (OUES<inf>peak</inf>) and the first 2
(OUES<inf>2min</inf>), 3 (OUES<inf>3min</inf>), and 4
(OUES<inf>4min</inf>) minutes of the CPET. The strength of the association
between measures was tested by Pearson correlation. Linear regression
models were used to predict VO<inf>2peak</inf> based on OUES from the
different testing durations. Agreement between measured and predicted
maximal values was tested using intraclass correlation coefficient (ICC)
and Bland-Altman plots. OUES<inf>2min</inf>, OUES<inf>3min</inf>, and
OUES<inf>4min</inf> were highly associated with absolute (r = 0.84, r =
0.76, r = 0.75, respectively) and relative (r = 0.84, r = 0.78, r = 0.78,
respectively) VO<inf>2peak</inf>. Agreement (ICC = 0.83) between
CPET-measured and OUES-predicted VO<inf>2peak</inf> values was stronger
with OUES<inf>2min</inf> than the other time-based OUES markers.
Bland-Altman plot showed satisfactory agreement between predicted and
measured CPET measures with the narrowest limits of agreement observed
with the OUES<inf>2min</inf>. No potential bias was identified between
these two measurements (p = 0.33). Changes in absolute (r = 0.77) and
relative (r = 0.88) VO<inf>2</inf>peak were highly associated with the
change in OUES<inf>2min</inf>. OUES<inf>2min</inf> can be used as a
surrogate for maximal cardiorespiratory fitness in adults with epilepsy.
Studies with larger samples size are encouraged to confirm our findings in
a more heterogeneous population. Copyright © 2021 Elsevier Inc.

<2>
Accession Number
2011266383
Title
Levosimendan or dobutamine in patients with low cardiac output syndrome:
Results from meta-analysis.
Source
International Journal of Cardiology. 333 (pp 145), 2021. Date of
Publication: 15 Jun 2021.
Author
Jaguszewski M.J.; Gasecka A.; Filipiak K.J.; Szarpak L.
Institution
(Jaguszewski) 1st Department of Cardiology, Medical University of Gdansk,
Gdansk, Poland
(Gasecka, Filipiak) 1st Chair and Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland
(Gasecka) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(Szarpak) Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland
(Szarpak) Maria Sklodowska-Curie Bialystok Oncology Centre, Bialystok,
Poland
Publisher
Elsevier Ireland Ltd

<3>
Accession Number
2015265708
Title
Lung Ultrasound for Detecting Tracheal and Mainstem Intubation: A
Systematic Review and Meta-Analysis.
Source
Ultrasound in Medicine and Biology. 48(1) (pp 3-9), 2022. Date of
Publication: January 2022.
Author
Yang F.M.; Ma B.Z.; Liu Y.; Sun Q.; Li N.; Feng S.Y.; Wang W.J.
Institution
(Yang, Ma, Sun, Li, Feng, Wang) Emergency Department, Cangzhou Central
Hospital, Cangzhou City, China
(Liu) Anesthesiology Department, Cangzhou People's Hospital, Cangzhou
City, China
Publisher
Elsevier Inc.
Abstract
Precise positioning of the left or right main bronchus is a prerequisite
for effective lung isolation in thoracic surgeries. This study aimed to
clarify the ability of lung ultrasound to detect tracheal and mainstem
intubation. Studies that investigated the ability of lung ultrasound to
detect tracheal and mainstem intubation were searched from PubMed and
ScienceDirect databases from their inception to March 2021. The pooled
accuracy of this method and its sensitivity and specificity were computed
with a fixed-effects model using Stata 14.0. Nine eligible articles that
involved a total of 617 participants were included in this systematic
review and meta-analysis. Overall, the accuracy of lung ultrasound in
detecting tracheal and mainstem intubation was 86.7%, with a sensitivity
of 93.0% and a specificity of 75.0%. Subgroup analysis revealed that the
accuracy remained high regardless of patient age, ultrasonic method,
sample size, study design or ultrasonic skills training. Sensitivity
analysis indicated that the results were stable. Deeks' test showed no
publication bias. These findings imply that lung ultrasound is an
effective method for detecting tracheal and mainstem
intubation. Copyright © 2021 World Federation for Ultrasound in
Medicine & Biology

<4>
Accession Number
2014029870
Title
Supra-systemic pulmonary hypertension after complicated percutaneous
mitral balloon valvuloplasty: a case report and review of literature.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 258. Date
of Publication: December 2021.
Author
Navas-Blanco J.R.; Miranda J.; Gonzalez V.; Mohammed A.; Aljure O.D.
Institution
(Navas-Blanco) Department of Anesthesiology, Oakland University William
Beaumont School of Medicine, Beaumont Hospital Royal Oak, 3601 W Mile Rd,
Royal Oak, MI 48073, United States
(Miranda) University of Miami Miller School of Medicine, Miami, FL, United
States
(Gonzalez, Mohammed, Aljure) Department of Anesthesiology, Perioperative
Medicine and Pain Management, University of Miami Miller School of
Medicine, Jackson Memorial Hospital, Miami, FL, United States
Publisher
BioMed Central Ltd
Abstract
Background: The World Symposium of Pulmonary Hypertension in 2018, updated
the definition of pulmonary hypertension (PH) as mean pulmonary artery
pressures (PAP) > 20 mmHg. Pulmonary venous hypertension secondary to
left-heart disease, constitutes the most common cause of PH, and the
determination of a co-existent pre-capillary (primary) PH becomes
paramount, particularly at the moment of evaluating and managing patients
with heart failure. Pulmonary artery pressures above the systemic
pressures define supra-systemic PH and generally leads to frank right
ventricular failure and high mortality. Case presentation: We present the
perioperative management of a patient with rheumatic mitral valve disease,
initially found to have severe PH due to pulmonary venous hypertension,
who underwent percutaneous mitral balloon valvuloplasty complicated with
mitral chordae rupture, severe mitral regurgitation and supra-systemic PH.
Multiple medical therapies and an intra-aortic balloon pump were used as
means of non-surgical management of this complication. Conclusion(s):
This case report illustrates the perioperative implications of combined
pre- and post-capillary PH and supra-systemic PH, as this has not been
widely discussed in previous literature. A thorough literature review of
the clinical characteristics of PH, methods to determine co-existent pre-
and post-capillary PH components, as well as concomitant right ventricular
failure is presented. Severe PH has known detrimental effects on the
hemodynamic status of patients, which can ultimately lead to a decrease in
effective cardiac output and poor tissue perfusion. Copyright ©
2021, The Author(s).

<5>
Accession Number
636627805
Title
The Effect of Normal Saline Injection Volumes on the Optic Nerve Sheath
Diameter during Thoracic Epidural Analgesia.
Source
Pain physician. 24(7) (pp E1007-E1013), 2021. Date of Publication: 01 Nov
2021.
Author
Hong J.; Kim J.S.; Lee Y.H.
Institution
(Hong) Department of Anesthesiology and Pain Medicine, Keimyung University
School of Medicine, South Korea
(Kim, Lee) Department of Anesthesiology and Pain Medicine, Keimyung
University DongSan Hospital, Keimyung University School of Medicine,
Daegu, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Saline or local anesthetic injection into the epidural space
increases intracranial pressure (ICP), at least transiently. Measurement
of the optic nerve sheath diameter (ONSD) using ocular ultrasonography is
one of the noninvasive methods for ICP assessment. OBJECTIVE(S): The
purpose of this study is to investigate the effects of the different
volume on the ONSD and cerebral oxygen saturation (rSO2) during thoracic
epidural saline injection under awake conditions. STUDY DESIGN:
Prospective randomized, controlled trial. SETTING: An interventional pain
management practice in South Korea. METHOD(S): This study included 71
patients receiving thoracic epidural catheterization for pain management,
following upper abdominal or thoracic surgery. Following successful
epidural space confirmation, patients were randomly allocated to receive 5
mL (5 mL group), 10 mL (10 mL group), and 20 mL (20 mL group) of epidural
normal saline. Transorbital sonography was performed to measure the ONSD.
This was measured at 3 mm posterior to the optic nerve head. An rSO2 was
measured using cerebral oximeter sensors. RESULT(S): All 3 groups
showed significant increases of ONSD from 10 minutes to 40 minutes as
compared to baseline (before procedure). Among the 3 groups, the 20 mL
group demonstrated the most significantly increased ONSD, as compared to
the 5 mL and 10 mL groups. At the 20 minute and 40 minute time points, the
ONSD showed a volume-dependent increase (P = 0.0005, P = 0.014). All 3
groups showed the rSO2 to be distributed between 60~70% without any
statistical difference. LIMITATIONS: We could not determine the returning
point of the normalized ONSD value. CONCLUSION(S): Twenty milliliters
of normal saline epidural injection resulted in a significant increase of
ONSD, as compared to the 5 mL and 10 mL groups. Our results also indicate
that an increase of ONSD occurs in accordance with the injected volume of
normal saline.

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

<7>
Accession Number
634606928
Title
Effect of remote ischaemic preconditioning on mortality and morbidity
after non-cardiac surgery: meta-analysis.
Source
BJS open. 5(2) (no pagination), 2021. Date of Publication: 05 Mar 2021.
Author
Wahlstrom K.L.; Bjerrum E.; Gogenur I.; Burcharth J.; Ekeloef S.
Institution
(Wahlstrom, Bjerrum, Gogenur, Burcharth, Ekeloef) Department of Surgery,
Centre for Surgical Science, Zealand University Hospital, Denmark
Publisher
NLM (Medline)
Abstract
BACKGROUND: Remote ischaemic preconditioning (RIPC) has been shown to have
a protective role on vital organs exposed to reperfusion injury. The aim
of this systematic review was to evaluate the effects of non-invasive RIPC
on clinical and biochemical outcomes in patients undergoing non-cardiac
surgery. METHOD(S): A systematic literature search of PubMed, EMBASE,
Scopus, and Cochrane databases was carried out in February 2020. RCTs
investigating the effect of non-invasive RIPC in adults undergoing
non-cardiac surgery were included. Meta-analyses and trial sequential
analyses (TSAs) were performed on cardiovascular events, acute kidney
injury, and short- and long-term mortality. RESULT(S): Some 43 RCTs
including 3660 patients were included. The surgical areas comprised
orthopaedic, vascular, abdominal, pulmonary, neurological, and urological
surgery. Meta-analysis showed RIPC to be associated with fewer
cardiovascular events in non-cardiac surgery (13 trials, 1968 patients,
421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P=0.03).
Meta-analyses of the effect of RIPC on acute kidney injury (12 trials,
1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P=0.50; I2 = 9 per
cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65,
0.37 to 1.12; P=0.12; I2 = 0 per cent), and long-term mortality (4 trials,
1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P=0.56; I2 = 0 per cent)
showed no significant differences for RIPC compared with standard
perioperative care in non-cardiac surgery. However, TSAs showed that the
required information sizes have not yet been reached. CONCLUSION(S):
Application of RIPC to non-cardiac surgery might reduce cardiovascular
events, but not acute kidney injury or all-cause mortality, but currently
available data are inadequate to confirm or reject an assumed intervention
effect. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of BJS Society Ltd.

<8>
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Accession Number
2015903863
Title
Pancreaticoduodenectomy preserving aberrant gastroduodenal artery utilized
in a previous coronary artery bypass grafting: A case report and review of
literature.
Source
Medicine (United States). 100(48) (no pagination), 2021. Article Number:
e27788. Date of Publication: 03 Dec 2021.
Author
Toda T.; Kanemoto H.; Tokuda S.; Takagi A.; Oba N.
Institution
(Toda) Department of Gastroenterological Surgery, Shizuoka General
Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi, Shizuoka, Japan
(Kanemoto, Tokuda, Takagi, Oba) Department of Gastroenterological Surgery,
Shizuoka General Hospital, 4-27-1 Kita-Ando, Aoi-Ku, Shizuoka-Shi,
Shizuoka, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
Rationale: Pancreaticoduodenectomy (PD) is a technically demanding
procedure with high rates of morbidity and mortality. Therefore,
preoperative evaluation of anatomy is indispensable. Multi-detector row
computed tomography (CT) enables us to precisely understand arterial
anatomy. It is a well-known fact that anatomical variants are often
present in the hepatic artery (HA) but rarely in the gastroduodenal artery
(GDA). We present the case of a patient with ampullary cancer with a rare
anatomical anomaly, "replaced GDA (rGDA)" arising from the superior
mesenteric artery, along with a history of coronary artery bypass grafting
(CABG) using right gastroepiploic artery (RGEA). Patient concerns: A
69-year-old male patient was referred to our department for further
investigation of elevated hepatobiliary enzymes. He presented with no
symptoms besides intermittent fever of 38degreeC. He had an operative
history of CABG using the RGEA. Diagnosis: Abdominal CT and
esophagogastroduodenoscopy showed an ampullary tumor and biopsy specimen
from the lesion revealed adenocarcinoma. CT angiography revealed the rGDA
instead of a normal common HA. Intervention(s): We performed a safe
PD, preserving the rGDA and the RGEA to maintain hepatic and cardiac
perfusion. Outcome(s): Owing to the presence of a refractory
pancreatic fistula, the length-of-hospital stay was extended, and he was
discharged on postoperative day 72 without vascular complications. At
present, the patient is in good physical condition and does not present
with cardiovascular complications as well as tumor recurrence at 6 months
after surgery. Lessons: This is possibly the first case of a patient who
underwent PD and has a proper HA following a GDA arising from a superior
mesenteric artery (rGDA) and has a previous operative history of CABG
using the gastroepiploic artery. The coexistence of the history of
cardiovascular surgery made PD for this patient considerably more
challenging. In the case of a rare anatomical anomaly, a coronary artery
bypass via the RGEA should not be considered as an obstacle when R0
resection is achievable. Copyright © 2021 the Author(s).

<9>
Accession Number
2015942951
Title
Role of pre-operative transthoracic echocardiography in predicting
post-operative atrial fibrillation after cardiac surgery: A systematic
review of the literature and meta-analysis.
Source
Europace. 23(11) (pp 1731-1743), 2021. Date of Publication: 01 Nov 2021.
Author
Kawczynski M.J.; Gilbers M.; Van De Walle S.; Schalla S.; Crijns H.J.;
Maessen J.G.; Schotten U.; Maesen B.; Bidar E.
Institution
(Kawczynski, Gilbers, Van De Walle, Maessen, Maesen, Bidar) Department of
Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University
Medical Centre, Professor Debyelaan 25, Maastricht 6229 HX, Netherlands
(Kawczynski, Gilbers, Maessen, Schotten, Maesen, Bidar) Department of
Physiology, Maastricht University, Maastricht, Netherlands
(Schalla, Crijns) Cardiovascular Research Institute Maastricht (CARIM),
Maastricht, Netherlands
(Schalla, Crijns) Department of Cardiology, Heart and Vascular Centre,
Maastricht University Medical Centre, Maastricht, Netherlands
(Schalla) Department of Radiology, Maastricht University Medical Centre,
Maastricht, Netherlands
Publisher
Oxford University Press
Abstract
Aims: This systematic review and meta-analysis aims to evaluate the role
of pre-operative transthoracic echocardiography in predicting
post-operative atrial fibrillation (POAF) after cardiac surgery.
 Methods and Results: Electronic databases were searched for studies
reporting on pre-operative echocardiographic predictors of POAF in PubMed,
Cochrane library, and Embase. A meta-analysis of echocardiographic
predictors of POAF that were identified by at least five different
publications was performed. Forty-three publications were included in this
systematic review. Echocardiographic predictors for POAF included
surrogate parameters for total atrial conduction time (TACT), structural
cardiac changes, and functional disturbances. Meta-analysis showed that
prolonged pre-operative PA-TDI interval [5 studies, Cohen's d = 1.4, 95%
confidence interval (CI) 0.9-1.9], increased left atrial volume indexed
for body surface area (LAVI) (23 studies, Cohen's d = 0.8, 95% CI
0.6-1.0), and reduced peak atrial longitudinal strain (PALS) (5 studies,
Cohen's d = 1.4, 95% CI 1.0-1.8), were associated with POAF incidence.
Left atrial volume indexed for body surface was the most important
predicting factor in patients without a history of AF. These parameters
remained important predictors of POAF in heterogeneous populations with
variable age and comorbidities such as coronary artery disease and
valvular disease. Conclusion(s): This meta-analysis shows that
increased TACT, increased LAVI, and reduced PALS are valuable parameters
for predicting POAF in the early post-operative phase in a large variety
of patients. Copyright © 2021 Published on behalf of the European
Society of Cardiology. All rights reserved.

<10>
Accession Number
2012216147
Title
Meta-Analysis of Duration of Dual Antiplatelet Therapy in Acute Coronary
Syndrome Treated With Coronary Stenting.
Source
American Journal of Cardiology. 151 (pp 25-29), 2021. Date of Publication:
15 Jul 2021.
Author
Knijnik L.; Fernandes M.; Rivera M.; Cardoso R.; Goyal A.; Liberman H.;
Sperling L.S.; McDaniel M.C.
Institution
(Knijnik) Division of Medicine, University of Miami, Miami, FL, United
States
(Fernandes, Goyal, Liberman, Sperling, McDaniel) Division of Cardiology,
Emory University, Atlanta, Georgia, Georgia
(Rivera) Division of Cardiology, Washington University-Saint Louis, St.
Louis, MO, United States
(Cardoso) Division of Cardiology, Brigham and Women's Hospital, Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
We aimed to evaluate if a shorter course of DAPT followed by P2Y12
inhibitor monotherapy is as effective as a 12-month course with fewer
bleeding events. PubMed, Scopus, and Cochrane Central were searched for
randomized controlled trials of ACS patients comparing dual antiplatelet
therapy (DAPT) for 1 to 3 months followed by a P2Y12 inhibitor to 12-month
DAPT. Quality assessment was performed with the Cochrane Collaboration
risk of bias assessment tool. Five randomized clinical trials were
included, with a total of 18,046 participants. Antiplatelet strategies
were aspirin and P2Y12 inhibitor for 12 months compared with aspirin and
P2Y12 inhibitor for 1 to 3 months followed by P212 inhibitor alone.
Patients randomized to 1 to 3 months of DAPT followed by P2Y12 inhibitor
monotherapy had lower rates of major bleeding (1.42% vs 2.53%; OR 0.53;
95% CI 0.42-0.67; p < 0.001; I2 = 0%) and all-cause mortality
(1.00% vs 1.42%; OR 0.71; 95% CI 0.53-0.95; p = 0.02; I2=0%)
with similar major adverse cardiac events (MACE) (2.66% vs 3.11%; OR 0.86;
95% CI 0.71 - 1.03; p = 0.10; I2 = 0 %) compared to 12 months
of DAPT. In conclusion, shorter course of DAPT for 1 to 3 months followed
by P2Y12 inhibitor monotherapy reduces major bleeding and all course
mortality without increasing major adverse cardiac events compared with
traditional DAPT for 12 months. Copyright © 2021 Elsevier Inc.

<11>
Accession Number
2011521006
Title
The use of minimal fluoroscopy for cardiac electrophysiology procedures: A
meta-analysis and review of the literature.
Source
Clinical Cardiology. 44(6) (pp 814-823), 2021. Date of Publication: June
2021.
Author
Chiang L.L.W.; Li C.; Hong K.L.; Hui W.S.; Beh S.Y.; Gong M.; Liu T.; Li
G.; Xia Y.; Ho J.; Roever L.; Duong S.; Huang G.; Tse G.; Baranchuk A.;
Glover B.M.
Institution
(Chiang) Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong
Kong
(Li, Tse) Department of Medicine and Therapeutics, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Li, Tse) Li Ka Shing Institute of Health Sciences, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Li, Hui, Beh) Faculty of Medicine, Newcastle University, Newcastle,
United Kingdom
(Hong, Duong, Huang, Glover) Division of Cardiology, University of
Toronto, Toronto, ON, Canada
(Gong, Liu, Li) Tianjin Key Laboratory of Ionic-Molecular Function of
Cardiovascular disease, Department of Cardiology, Tianjin Institute of
Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
(Xia) Department of Cardiology, First Affiliated Hospital of Dalian
Medical University, Dalian, China
(Ho) Department of Anaesthesia and Intensive care, Faculty of Medicine,
Chinese University of Hong Kong, Hong Kong
(Roever) Federal University of Uberlandia, Department of Clinical
Research, Uberlandia, Minas Gerais, Brazil
(Baranchuk) Division of Cardiology, Kingston General Hospital, Queen's
University, Kingston, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Conventional catheter ablation involves prolonged exposure to
ionizing radiation, potentially leading to detrimental health effects.
Minimal fluoroscopy (MF) represents a safer alternative, which should be
explored. Data on the safety and efficacy of this technique are limited.
Hypothesis: Our hypothesis is that MF is of equal efficacy and safety to
conventional catheter ablation with the use of fluoroscopy by performing a
meta-analysis of both randomized controlled trials (RCTs) and real-world
registry studies. Method(s): Pubmed and Embase were searched from
their inception to July 2020 for RCTs, cohort and observational studies
that assessed the outcomes of catheter ablation using a MF technique
versus the conventional approach. Result(s): Fifteen studies
involving 3795 patients were included in this meta-analysis. There was a
significant reduction in fluoroscopy and procedural time with no
difference in acute success (odds ratio [OR]:0.74, 95% CI: 0.50-1.10, p
=.14), long-term success (OR:0.92, 95% CI: 0.65-1.31, p =.38), arrhythmia
recurrence (OR:1.24, 95% CI: 0.75-2.06, p =.97) or rate of complications.
(OR:0.83, 95% CI: 0.46-1.48, p =.65). Additionally sub-group analysis for
those undergoing catheter ablation for atrial fibrillation (AF) did not
demonstrate a difference in success or complication rates (OR:0.86, 95%
CI: 0.30-2.42, p =.77). Multivariate meta-regression did not identify the
presence of moderator variables. Conclusion(s): This updated
meta-analysis demonstrated an overall reduction in procedural and
fluoroscopy time for those undergoing a minimal fluoroscopic approach.
There was no significant difference in either acute or chronic success
rates or complications between a MF approach and conventional approach for
the management of all arrhythmias including those undergoing catheter
ablation for AF. Copyright © 2021 The Authors. Clinical
Cardiology published by Wiley Periodicals LLC.

<12>
Accession Number
2011121323
Title
PASCAL mitral valve repair system versus MitraClip: comparison of
transcatheter edge-to-edge strategies in complex primary mitral
regurgitation.
Source
Clinical Research in Cardiology. 110(12) (pp 1890-1899), 2021. Date of
Publication: December 2021.
Author
Gercek M.; Roder F.; Rudolph T.K.; Fortmeier V.; Zittermann A.; Rudolph
V.; Friedrichs K.P.
Institution
(Gercek, Roder, Rudolph, Fortmeier, Rudolph, Friedrichs) Clinic for
General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum
NRW, Ruhr-Universitat Bochum, Georgstrase 11, Bad Oeynhausen 32545,
Germany
(Zittermann) Clinic for Thoracic and Cardiovascular Surgery, Herz- Und
Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: The PASCAL system is a novel device for edge-to-edge treatment
of mitral regurgitation (MR). The aim of this study was to compare the
safety and efficacy of the PASCAL to the MitraClip system in a highly
selected group of patients with complex primary mitral regurgitation (PMR)
defined as effective regurgitant orifice area (MR-EROA) >= 0.40
cm2, large flail gap (>= 5 mm) or width (>= 7 mm) or Barlow's
disease. Method(s): 38 patients with complex PMR undergoing mitral
intervention using PASCAL (n = 22) or MitraClip (n = 16) were enrolled.
Primary efficacy endpoints were procedural success and degree of residual
MR at discharge. The rate of major adverse events (MAE) according to the
Mitral Valve Academic Consortium (MVARC) criteria was chosen as the
primary safety endpoint. Result(s): Patient collectives did not
differ relevantly regarding pertinent baseline parameters. Patients`
median age was 83.0 [77.5-85.3] years (PASCAL) and 82.5 [76.5-86.5] years
(MitraClip). MR-EROA at baseline was 0.70 [0.68-0.83] cm2
(PASCAL) and 0.70 [0.50-0.90] cm2 (MitraClip), respectively.
3D-echocardiographic morphometry of the mitral valve apparatus revealed no
relevant differences between groups. Procedural success was achieved in
95.5% (PASCAL) and 87.5% (MitraClip), respectively. In 86.4% of the
patients a residual MR grade <= 1 + was achieved with PASCAL whereas
reduction to MR grade <= 1 + with MitraClip was achieved in 62.5%. Neither
procedure time number of implanted devices, nor transmitral gradient
differed significantly. No periprocedural MAE according to MVARC occured.
 Conclusion(s): In this highly selected patient group with complex PMR
both systems exhibited equal procedural safety. MitraClip and PASCAL
reduced qualitative and semi-quantitative parameters of MR to an at least
comparable extent. Graphic abstract: [Figure not available: see
fulltext.] Copyright © 2021, The Author(s).

<13>
Accession Number
2011055764
Title
The music video therapy in postoperative analgesia in preschool children
after cardiothoracic surgery.
Source
Journal of Cardiac Surgery. 36(7) (pp 2308-2313), 2021. Date of
Publication: July 2021.
Author
Huang Y.-L.; Lei Y.-Q.; Liu J.-F.; Cao H.; Yu X.-R.; Chen Q.
Institution
(Huang, Lei, Liu, Cao, Yu, Chen) Department of Cardiac Surgery, Fujian
Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Huang, Lei, Liu, Cao, Yu, Chen) Fujian Key Laboratory of Women and
Children's Critical Diseases Research, Fujian Maternity and Child Health
Hospital, Fuzhou, China
(Huang, Lei, Liu, Cao, Yu, Chen) Department of Cardiac surgery, Fujian
Branch of Shanghai Children's Medical Center, Affiliated to Shanghai
Jiaotong University School of Medicine, Fuzhou, China
(Huang, Lei, Liu, Cao, Yu, Chen) Department of Cardiac surgery, Fujian
Children's Hospital, Fuzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To observe the effect of music video (MV) therapy on early
postoperative pain in preschool children after cardiothoracic surgery.
 Method(s): 116 preschool children undergoing cardiothoracic surgery
were randomly divided into the MV and control groups from June 2019 to
March 2020. The related vital signs parameters, the Wong-Baker FACES pain
rating scale, the FLACC scale, the number of postoperative PCA press and
the cumulants of sufentanil use were recorded and analyzed.
 Result(s): There were no statistically significant differences in
general characteristics and preintervention data between the two groups.
However, there were significantly lower in the heart rate, mean arterial
pressure, respiratory rate, the number of postoperative PCA press, and the
dosage of sufentanil in the MV group than those in the control group after
the intervention. The Wong-Baker FACES and FLACC scales in the MV group
were significantly lower than those in the control group at the time point
of immediately after the first intervention, 1 day, and 2 days after the
intervention. The two pain scores showed a downward trend over time, and
the corresponding scores in the MV group were better than those in the
control group. Conclusion(s): MV therapy can be an effective
nonpharmaceutical intervention in the clinical to relieve children's
postoperative pain after cardiothoracic surgery. Copyright © 2021
Wiley Periodicals LLC

<14>
Accession Number
2010983405
Title
Global longitudinal strain to determine optimal timing for surgery in
primary mitral regurgitation: A systematic review.
Source
Journal of Cardiac Surgery. 36(7) (pp 2458-2466), 2021. Date of
Publication: July 2021.
Author
Modaragamage Dona A.C.; Afoke J.; Punjabi P.P.; Kanaganayagam G.S.
Institution
(Modaragamage Dona) Faculty of Medicine, Imperial College London, London,
United Kingdom
(Afoke, Punjabi) Department of Cardiothoracic Surgery, National Heart and
Lung Institute, Imperial College London, Imperial College Healthcare NHS
Trust, Hammersmith Hospital, London, United Kingdom
(Kanaganayagam) Department of Cardiology, National Heart and Lung
Institute, Imperial College London, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Primary mitral regurgitation (PMR) results in adverse
remodeling changes and left ventricular (LV) dysfunction. Assessing LV
function has prognostic value in predicting morbidity and mortality.
Indications for surgery include parameters such as LV ejection fraction
(LVEF) and systolic dimensions. Current guidelines are limited in
identifying patients at optimal time for surgery. Impaired postoperative
LVEF indicates poor prognostic outcomes and subsequent heart failure.
Global longitudinal strain (GLS) via speckle tracking echocardiography
(STE) presents as a promising parameter to detect subclinical dysfunction
in asymptomatic patients. Method(s): Following PRISMA guidelines, a
literature search was conducted with Cochrane Library, PudMed, SCOPUS, and
Web of Science. Key MeSH terms included "mitral regurgitation," "mitral
valve insufficiency," "global longitudinal strain," "deformation,"
"LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe
PMR, (2) mixed population of symptomatic and asymptomatic patients, (3)
standardized methods in assessing LV systolic function using 2D-STE, (4)
valve repair or replacement surgery, and (5) patient outcomes measured
after surgery. Search returned 234 papers, 12 of which met the inclusion
criteria and were subsequently reviewed. Result(s): Baseline GLS is
an independent predictor of postoperative outcomes, ranging from -17.9 to
-21.7% GLS. A significant negative correlation was observed between
preoperative GLS and postoperative LVEF. Impaired baseline GLS was
associated with higher mortality rates. Better long-term survival rates
were seen in patients who underwent early surgery. Conclusion(s): GLS
shows sensitivity in predicting long-term postoperative outcomes. Further
analysis is required to determine preoperative GLS threshold to identify
asymptomatic patients at the optimal time for mitral valve
surgery. Copyright © 2021 The Authors. Journal of Cardiac Surgery
Published by Wiley Periodicals LLC

<15>
Accession Number
2010531540
Title
The risk of valve thrombosis is higher with intra-annular versus
supra-annular transcatheter aortic valve prosthesis. A meta-analysis from
randomized controlled trials.
Source
Clinical Research in Cardiology. 110(12) (pp 2007-2009), 2021. Date of
Publication: December 2021.
Author
Moreno R.; Unverdorben M.; Jurado-Roman A.; Galeote G.; Jimenez-Valero S.;
Arroyo-Ucar E.; Thiele H.
Institution
(Moreno, Jurado-Roman, Galeote, Jimenez-Valero) Interventional Cardiology,
Hospital La Paz, CIBER-CV, IdiPAZ, Paseo La Castellana, 261, Madrid 28046,
Spain
(Unverdorben) 43 Millstone Lane, Pottstown, PA 19465, United States
(Arroyo-Ucar) Hospital de Vinalopo, Elche, Spain
(Thiele) Heart Center Leipzig, University of Leipzig, Leipzig, Germany
Publisher
Springer Science and Business Media Deutschland GmbH

<16>
Accession Number
2015852289
Title
The influence of preoperative hematocrit levels on early outcomes in
patients undergoing cardiac surgery.
Source
Pakistan Journal of Medical and Health Sciences. 15(10) (pp 2817-2819),
2021. Date of Publication: October 2021.
Author
Farogh A.; Hassan A.; Gull S.; Khan M.I.; Bashir G.; Mahmood H.; Afshan S.
Institution
(Farogh, Hassan, Bashir) Cardiac Center, Bahawalpur, Pakistan
(Gull, Afshan) Punjab Institute of Cardiology, Lahore, Pakistan
(Khan) BVH, Bahawalpur, Pakistan
(Mahmood) Sahara Medical, College, Narowal, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Background: Anemia is a common risk factor for cardiovascular disease. The
impact of preoperative anaemia is unclear in cardiac surgery. Preoperative
anaemia affects early findings in patients undergoing cardiac surgery. Aim
and Objective: The main objective of current research was to investigate
the impact of preoperative anaemia on early outcomes in heart surgery
patients. Material(s) and Method(s): A prospective randomized
clinical research was undertaken after obtaining written informed consent
from patients for cardiac surgery at the PIC, Lahore between Apr 2020 and
Feb 2021. A total of 120 individuals between the ages of 20 and 60 were
chosen for the research. Preoperative anaemia was described as Hb levels
of <13 g/dl for males and <12 g/dl in female patients undergoing cardiac
surgery. Result(s): Total 120 patients were enrolled and stratified
into two groups (60 patients each) with average age 5 +/- 5.75 years.
Early outcomes after surgery such as postoperative stroke (6.67 % versus
1.6 %), AF (37 % versus32 %), and duration of hospital stay > 7 days (50 %
vs 41.67 %) were found to be different between anaemic and normal Hb
groups. Conclusion(s): Preoperative anaemia can be increased risk of
morbidity and mortality in patients after surgery. Low preoperative Hb
found as advanced risk factor for death, renal impairment, stroke, AF and
long hospital stay in our research. Copyright © 2021 Lahore
Medical And Dental College. All rights reserved.

<17>
Accession Number
2014355319
Title
The Dilemma of Peri-Procedural Warfarin Management: A Narrative Review.
Source
Clinical and Applied Thrombosis/Hemostasis. 27 (no pagination), 2021. Date
of Publication: 29 Nov 2021.
Author
Eljilany I.; El-Bardissy A.; Elewa H.
Institution
(Eljilany, Elewa) College of Pharmacy, QU Health, Qatar University, Doha,
Qatar
(El-Bardissy) Department of Pharmacy, Hamad General Hospital, Hamad
Medical Corporation, Doha, Qatar
Publisher
SAGE Publications Inc.
Abstract
Periprocedural vitamin K antagonist management is a complex process and
inherently entails multiple clinical issues. Marked variations have been
reported in different aspects of this process. These differences were
noted at the clinician and institutional levels owing to the lack of
evidence-based data leading to many discrepancies in decision-making. This
review aims to address the gap of vitamin K antagonist periprocedural
management acknowledged by previously published prescribers'
questionnaires. One of the components of this process is "bridging," which
aims to provide minimal interruption of the anticoagulation period through
the use of heparin products. Recent studies showed that bridging is
increasing bleeding risk. Secondly, interruption decision relies on the
classification of thromboembolism risk which depends on trials that did
not include patients with atrial fibrillation. Thirdly, the interruption
duration is different among different International normalization ratio
levels, which strengthens the difference in the clinical practice of
preoperative vitamin K antagonist management. Lastly, the resumption of a
vitamin-K antagonist after surgery has many scenarios according to the
procedure and patient risk of bleeding. Vitamin-K antagonist
periprocedural management is complicated due to individual practice and
the lack of strictly implemented institutional standardized protocols to
guide, manage and evaluate the process. Copyright © The Author(s)
2021.

<18>
Accession Number
2015689015
Title
Percutaneous mitral valve repair in severe secondary mitral regurgitation:
Analysis of index hospitalization and economic evaluation based on the
MITRA-FR trial.
Source
Archives of Cardiovascular Diseases. 114(12) (pp 805-813), 2021. Date of
Publication: December 2021.
Author
Capelle A.; Obadia J.-F.; Iung B.; Messika-Zeitoun D.; Vahanian A.; Guerin
P.; Lefevre T.; Bonnet G.; Donal E.; Leurent G.; Trochu J.-N.; Armoiry X.
Institution
(Capelle) Pharmacy department, CHU de Saint-Etienne, Saint-Etienne, France
(Obadia) Service de cardiologie interventionnelle, hospices civils de
Lyon, hopital cardiovasculaire Louis-Pradel, Lyon, France
(Iung, Vahanian) Inserm 1148, universite de Paris, hopital Bichat, AP-HP,
Paris, France
(Messika-Zeitoun) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Canada
(Guerin, Trochu) Inserm, institut du Thorax, CNRS, CHU de Nantes,
universite Nantes, Nantes, France
(Lefevre) Institut Jacques-Cartier, Massy, France
(Bonnet) Inserm-UMR 626, service de cardiologie interventionnelle,
Assistance Publique-Hopitaux de Marseille, CHU de Timone, Aix-Marseille
universite, Marseille 13385, France
(Donal) Inserm, LTSI-UMR 1099, universite Rennes, CHU de Rennes, Rennes,
France
(Leurent) Inserm, LTSI-UMR 1099, Department of Cardiology, CHU de Rennes,
universite Rennes 1, Rennes, France
(Armoiry) UMR CNRS 5510 MATEIS, Pharmacy Department, School of Pharmacy
(ISPB), University of Lyon, Edouard-Herriot Hospital, Lyon, France
(Armoiry) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Percutaneous mitral valve repair (pMVR) is reimbursed in
France for severe secondary mitral regurgitation (SMR), but French data
regarding the hospitalization index stay are lacking. Aim(s): Our
objectives were to describe the index hospitalization stay and to evaluate
the cost of hospital stay for pMVR used in SMR. Method(s): A
secondary evaluation based on patients who were randomized to the
intervention group of the MITRA-FR study was undertaken. The economic
evaluation was conducted according to the French hospital perspective.
Medical resource use was estimated using specific data collected from
patients enrolled in the MITRA-FR study and non-specific data from
national statistics. Result(s): The population was represented by 144
patients who underwent pMVR at 33 French centres. There was a mean +/-
standard deviation of 7.9 +/- 1.5 hospital staff during procedures. The
mean procedure duration was 154 +/- 68 minutes and increased with the
number of implanted clips. Median total length of stay was 8 days. The
occurrence of a serious adverse event was not associated with an increased
risk of admission to the critical care unit, but was associated with an
increased length of stay. The mean total cost was 28,025 +/- 3424 , which
includes 21,547 for the cost of medical devices used during pMVR and 6478
+/- 3424 for other costs. Conclusion(s): The cost of pMVR is
substantial for patients with SMR, which advocates for further efforts to
identify the patients with SMR who are likely to derive a clear clinical
benefit from the procedure. Copyright © 2021 Elsevier Masson SAS

<19>
Accession Number
2015526628
Title
The Use of Non-Vitamin K Antagonist Oral Anticoagulants in Post-Kidney
Transplantation, Single-Center Experience.
Source
Transplantation Proceedings. 53(10) (pp 2918-2922), 2021. Date of
Publication: December 2021.
Author
Zaitoun M.F.; Sheikh M.E.; Faifi A.S.A.; Mahedy A.W.; Nazer W.E.; El
Hennawy H.M.
Institution
(Zaitoun, Sheikh) Pharmaceutical Care Services, Armed Forces
Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia
(Faifi, El Hennawy) Transplant Surgery Section, Surgery Department, Armed
Forces Hospital-Southern Regions, Khamis Mushayt, Saudi Arabia
(Mahedy, Nazer) Nephrology Department, Armed Forces Hospital-Southern
Regions, Khamis Mushayt, Saudi Arabia
(Mahedy) Internal Medicine Department, Faculty of Medicine, Benah
University, Egypt
Publisher
Elsevier Inc.
Abstract
Background: Novel oral anticoagulants (NOACs) are widely used alternatives
to warfarin, because they do not require routine monitoring and have
better safety profile. There is limited experience for NOACs in organ
transplant recipients. Method(s): This study assessed NOAC safety and
efficacy among renal transplant recipients in a single center. A
retrospective matched cohort study was conducted among the adult renal
transplant recipients concomitantly administered calcineurin inhibitors
(tacrolimus or cyclosporin) and NOACs between November 2015 and December
2019. Result(s): The study included 16 patients divided into 2 equal
groups on NOACs and warfarin. Male patients constitute 50% and 75% of the
NOAC group and warfarin group, respectively, and 75% and 87.5% of cases
are post living donor transplants in the NOAC group and warfarin group,
respectively. In the NOAC group, the most common indication for
anticoagulation was atrial fibrillation (62.5%), followed by deep vein
thrombosis (37.5%), whereas in the warfarin group, the most common
indication was atrial fibrillation (50%), followed by valve replacement
(25%). In the NOAC group, 6 patients (75%) received rivaroxaban, 1 patient
(12.5%) received dabigatran, and 1 patient (12.5%) received apixaban;
68.75% of patients were on a tacrolimus-based regimen. There were no
thromboembolic events, rejection episodes, bleeding, or admissions due to
NOAC adverse events. There were 3 cases of bleeding in the warfarin group.
Calcineurin inhibitor levels and estimated glomerular filtration rate did
not change significantly in the NOAC group (P = .34 and .96,
respectively). Conclusion(s): Compared to warfarin, NOACs are well
tolerated and effective for preventing and treating thromboembolic events
in renal transplant recipients. A larger randomized controlled study is
required. Copyright © 2021 Elsevier Inc.

<20>
Accession Number
2013920817
Title
Estimating the optimal timing of surgery by imputing potential outcomes.
Source
Statistics in Medicine. 40(30) (pp 6900-6917), 2021. Date of Publication:
30 Dec 2021.
Author
Chen X.; Heitjan D.F.; Greil G.; Jeon-Slaughter H.
Institution
(Chen, Heitjan) Department of Statistical Science, Southern Methodist
University, Dallas, TX, United States
(Chen, Heitjan) Department of Population & Data Sciences, UT Southwestern
Medical Center, Dallas, TX, United States
(Greil) Department of Pediatrics, UT Southwestern Medical Center, Dallas,
TX, United States
(Jeon-Slaughter) Department of Internal Medicine, UT Southwestern Medical
Center, Dallas, TX, United States
Publisher
John Wiley and Sons Ltd
Abstract
Hypoplastic left heart syndrome is a congenital anomaly that is uniformly
fatal in infancy without immediate treatment. The standard treatment
consists of an initial Norwood procedure (stage 1) followed some months
later by stage 2 palliation (S2P). The ideal timing of the S2P is
uncertain. The Single Ventricle Reconstruction Trial (SVRT) randomized the
procedure used in the initial Norwood operation, leaving the timing of the
S2P to the discretion of the surgical team. To estimate the causal effect
of the timing of S2P, we propose to impute the potential post-S2P survival
outcomes using statistical models under the Rubin Causal Model framework.
With this approach, it is straightforward to estimate the causal effect of
S2P timing on post-S2P survival by directly comparing the imputed
potential outcomes. Specifically, we consider a lognormal model and a
restricted cubic spline model, evaluating their performance in Monte Carlo
studies. When applied to the SVRT data, the models give somewhat different
imputed values, but both support the conclusion that the optimal time for
the S2P is at 6 months after the Norwood procedure. Copyright ©
2021 John Wiley & Sons Ltd.

<21>
Accession Number
2014057689
Title
Proximal junctional kyphosis in pediatric spinal deformity surgery: a
systematic review and critical analysis.
Source
Spine Deformity. (no pagination), 2021. Date of Publication: 2021.
Author
Erkilinc M.; Baldwin K.D.; Pasha S.; Mistovich R.J.
Institution
(Erkilinc, Mistovich) Division of Pediatric Orthopaedic Surgery, Rainbow
Babies and Children's Hospital, University Hospitals Cleveland Medical
Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States
(Baldwin, Pasha) Department of Orthopaedic Surgery, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mistovich) Case Western Reserve University School of Medicine, Cleveland,
United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Proximal junctional kyphosis (PJK) is a commonly encountered
clinical and radiographic phenomenon after pediatric and adolescent spinal
deformity surgery that may lead to post-operative deformity, pain, and
dissatisfaction. Understanding the risk factors of PJK can be useful for
pre-operative informed consent as well as to identify any potential
preventative strategies. Method(s): We performed a systematic review
and critical analysis following the PRISMA statement in July 2019 by
searching the PubMed, Scopus, and Embase databases, including all prior
published studies. We included articles with data on PJK in patients with
operative pediatric and adolescent scoliosis and those that detailed risk
factors and/or preventative strategies for PJK. Levels of evidence were
determined based on consensus. Findings were summarized and grades of
recommendation were assigned by consensus. This study was registered in
the PROSPERO database; 202,457. Result(s): Six hundred and thirty
five studies were identified. Thirty-seven studies met criteria for
inclusion into the analysis. No studies including neuromuscular scoliosis
met inclusion criteria. No findings had Grade A evidence. There were 4
findings found to contribute to PJK with Grade B evidence in EOS: higher
number of distractions, disruption of posterior elements, greater sagittal
plane correction. There was no difference in incidence noted between
etiology of the curvature. Five findings with Grade B evidence were found
to contribute to PJK in AIS populations: higher pre-operative thoracic
kyphosis, higher pre-operative lumbar lordosis, longer fusion constructs,
greater sagittal plane correction, and posterior versus anterior fusion
constructs. Conclusion(s): Greater sagittal plane correction has
Grade B evidence as a risk factor for PJK in both EOS and AIS populations.
In EOS patients, an increased number of distractions and posterior element
disruption are Grade B risk factors. In AIS patients, longer fusion
constructs, higher pre-operative thoracic kyphosis and lumbar lordosis,
and posterior (as opposed to anterior) constructs also contributed to PJK
with Grade B evidence. These findings can guide informed consent and
surgical management, and provide the foundation for future
studies. Copyright © 2021, Scoliosis Research Society.

<22>
[Use Link to view the full text]
Accession Number
636183577
Title
Ultrasound- Versus Fluoroscopy-Guided Strategy for Transfemoral
Transcatheter Aortic Valve Replacement Access: A Systematic Review and
Meta-Analysis.
Source
Circulation. Cardiovascular interventions. 14(10) (pp e010742), 2021. Date
of Publication: 01 Oct 2021.
Author
Kotronias R.A.; Bray J.J.H.; Rajasundaram S.; Vincent F.; Delhaye C.;
Scarsini R.; Marin F.; Terentes-Printzios D.; Halcox J.P.J.; Mamas M.A.;
Kharbanda R.; Van Belle E.; Banning A.P.
Institution
(Kotronias, Bray, Rajasundaram, Scarsini, Marin, Terentes-Printzios,
Kharbanda, Banning) Oxford Heart Centre, Oxford University Hospitals, NHS
Trust, United Kingdom (R.A.K., S.R., R.S., F.M., D.T.-P.
(Kotronias) Department of Cardiovascular Medicine, University of Oxford,
United Kingdom (R.A.K.)
(Bray, Halcox) Institute of Life Sciences 2, United Kingdom (J.J.H.B.,
Swansea Bay University Health Board and Swansea University Medical School
(Bray) University Hospital of Wales, Cardiff and Vale University Health
Board, United Kingdom (J.J.H.B.)
(Vincent, Delhaye, Van Belle) Centre Hospitalier Universitaire de
Lille-Cardiologie, C.D.
(Scarsini) Department of Medicine, Division of Cardiology, University of
Verona
(Mamas) Keele Cardiovascular Research Group, Centre for Prognosis
Research, Keele University, UK and Heart Centre, Thomas Jefferson
University
Publisher
NLM (Medline)
Abstract
[Figure: see text].

<23>
Accession Number
2015921201
Title
Candida pericarditis presenting with cardiac tamponade and multiple organ
failure after combined damage control thoracotomy and laparotomy with
splenectomy in a trauma patient: Case report and review of literature.
Source
Trauma Case Reports. 37 (no pagination), 2022. Article Number: 100564.
Date of Publication: February 2022.
Author
Siller R.A.; Skubic J.J.; Almeda J.L.; Villarreal J.F.; Kaplan A.E.
Institution
(Siller) University of Texas at Rio Grande Valley - General Surgery
Residency at Doctors Hospital at Renaissance, 5321 S, McColl Road,
Edinburg, TX 78569, United States
(Skubic) DHR Health Surgery Institute, Department of Trauma and Critical
Care, 1100 E. Dove Ave, Suite 201, McAllen, TX 78504, United States
(Almeda) DHR Health Transplant Institute, Hepatobiliary, Pancreas and
Organ Transplantation Center, 5540 Raphael Drive, Edinburg, TX 78539,
United States
(Villarreal) DHR Health Heart Institute, 224 Lindberg Ave, McAllen, TX
78501, United States
(Kaplan) Pulmonary Sleep Center of the Rio Grande Valley, 5300 N, McColl
Rd, McAllen, TX 78504, United States
Publisher
Elsevier Ltd
Abstract
Candida pericarditis is a rare condition which has previously been
described after cardiothoracic surgery and immunosuppressive states
(Geisler et al., 1981; Eng et al., 1981; Kraus et al., 1988; Kaufman et
al., 1988; Tang et al., 2009; Glower et al., 1990; Carrel et al., 1991;
Rabinovici et al., 1997; Canver et al., 1998; Farjah et al., 2005;
Gronemeyer et al., 1982 [1-11]). We describe the case of a 19-year-old
male blunt trauma patient, who survived a damage control thoracotomy and
laparotomy with splenectomy, who later developed a loculated Candida
pericardial effusion, complicated with cardiac tamponade and multiple
organ failure, and required antifungals and surgical reintervention with
thoracotomy for drainage. A literature search of the reported cases
demonstrates that Candida pericarditis is indeed a rare but fatal
condition if not identified and treated appropriately. This article
discusses the difficulties we encountered while recognizing the disorder
in our patient and proposes a guideline to adequately treat the condition
in an effective and timely manner. Candida pericarditis poses a special
challenge for the physician since its correct diagnosis and management
requires a multidisciplinary approach. Copyright © 2021

<24>
Accession Number
2015888685
Title
Tissue Doppler echocardiography in children with OSA before and after
tonsillectomy and adenoidectomy: A systematic review and meta-analysis.
Source
International Journal of Pediatric Otorhinolaryngology. 152 (no
pagination), 2022. Article Number: 111002. Date of Publication: January
2022.
Author
Poupore N.S.; Gudipudi R.; Nguyen S.A.; Pecha P.P.; Pecha T.J.; Carroll
W.W.
Institution
(Poupore, Gudipudi, Nguyen, Pecha, Carroll) Medical University of South
Carolina, Department of Otolaryngology - Head and Neck Surgery, 135
Rutledge Avenue, MSC550, Charleston, SC 29425, United States
(Poupore) University of South Carolina School of Medicine Greenville, 607
Grove Road, Greenville, SC 29605, United States
(Gudipudi) Case Western Reserve University School of Medicine, 9501 Euclid
Ave, Cleveland, OH 44106, United States
(Pecha) Medical University of South Carolina, Department of Anesthesia and
Perioperative Medicine, 167 Ashley Avenue, MSC912, Charleston, SC 29425,
United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: When to order an echocardiogram in children with obstructive
sleep apnea (OSA) is debated. Studies evaluating the utility of
pre-operative standard echocardiography are inconsistent. Tissue Doppler
imaging (TDI) is an additional technique that quantifies the velocity of
myocardial motion to assess cardiac function. The utility of TDI in
pediatric OSA remains unclear. Method(s): A systematic review and
meta-analysis were performed in accordance with PRISMA guidelines using
PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of
echocardiographic findings using TDI in children with polysomnogram
confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were
included. 1,423 studies were screened, and 4 studies met inclusion
criteria. Meta-analysis of echocardiographic findings was performed.
 Result(s): Data from 560 children were analyzed. Study groups
included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A
S' wave at the tricuspid annulus (S' RV) was decreased with a mean
difference of -1.04 [95% CI -1.57, -0.52, p < 0.001] and E'/A' ratio at
the mitral annulus (E'/A' LV) was decreased with a mean difference of
-0.74 [95% CI -0.85, -0.64, p < 0.001] when compared to controls. These
variables were not statistically different when comparing post-T&A to
controls. Conclusion(s): TDI appears to successfully detect
subclinical changes in cardiac function in children with OSA. However,
echocardiography parameters of post-T&A and non OSA control children were
similar. Further prospective studies stratified by OSA severity are needed
with both TDI and standard echocardiography to define the utility of
pre-operative cardiac imaging. Copyright © 2021 Elsevier B.V.

<25>
Accession Number
2015691154
Title
Effect of nursing intervention based on Maslow's hierarchy of needs in
patients with coronary heart disease interventional surgery.
Source
World Journal of Clinical Cases. 9(33) (pp 10189-10197), 2021. Date of
Publication: 26 Nov 2021.
Author
Xu J.-X.; Wu L.-X.; Jiang W.; Fan G.-H.
Institution
(Xu, Wu, Jiang, Fan) Department of Nursing, First Affiliated Hospital of
Qiqihar Medical College, Qiqihar, Heilongjiang Province 161000, China
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND It is very important to provide effective nursing programs to
regulate the physical and mental state of patients and to improve
treatment compliance after interven-tional surgery for coronary heart
disease (CHD).AIM To explore the effect of a nursing intervention based on
Maslow's hierarchy of needs theory on patients with CHD undergoing
percutaneous coronary inter-vention.METHODS Ninety-four patients with CHD
undergoing interventional surgery in our hospital from January 2020 to
February 2021 were randomly divided into a research group (n = 47) and a
control group (n = 47). The control group received routine nursing, and
the research group received a nursing intervention based on Maslow's
hierarchy of needs theory. The scores of self-efficacy, negative emotion
[de-pression (SDS), anxiety (SAS)], intervention compliance (standardized
medication, moderate exercise, healthy diet, and regular review), and
nursing satisfaction were calculated before and after intervention for the
two groups.RESULTS Before intervention, there was no significant
difference in the scores of disease general management self-efficacy,
disease management self-efficacy, and total self-efficacy between the two
groups (P = 0.795, 0.479, and 0.659, respectively). After intervention,
these three scores in the research group were higher than those in the
control group (P < 0.001). Before intervention, there was no significant
difference in the scores of SAS and SDS between the two groups (P = 0.149
and 0.347, respectively). After intervention, the scores of SAS and SDS in
the research group were lower than those in the control group (P < 0.001).
The standardized drug use rate (97.87%), moderate exercise rate (97.87%),
healthy diet rate (95.74%),and regular reexamination rate (97.87%) in the
research group were higher than those in the control group (85.11%,
82.98%, 80.85%, and 87.23%, respectively) (P = 0.027, 0.014, 0.025, and
0.049, respectively). Nursing job satisfaction in the research group
(93.62%) was higher than that in the control group (78.72%) (P = 0.036).
CONCLUSION A nursing program based on Maslow's hierarchy of needs theory
can effectively alleviate negative emotion, enhance self-efficacy and
intervention compliance, and ensure that the patients are highly satisfied
with the nursing work. Copyright © The Author(s) 2021. Published
by Baishideng Publishing Group Inc. All rights reserved.

<26>
[Use Link to view the full text]
Accession Number
2015915801
Title
Relationship between septo-valvular angle and risk of pacemaker
implantation after transcatheter aortic valve implantation: A preliminary
study.
Source
Journal of Cardiovascular Medicine. 22(9) (pp 716-722), 2021. Date of
Publication: 2021.
Author
de Stasio V.; Cavallo A.U.; Spiritigliozzi L.; Pugliese L.; Presicce M.;
Donna C.D.; Tosto F.D.; Pasqualetto M.; D'Errico F.; Benelli L.; Sbordone
F.P.; Grimaldi F.; Cerimele C.; Vanni G.; Romeo F.; Floris R.; Garaci F.;
Chiocchi M.
Institution
(de Stasio, Cavallo, Spiritigliozzi, Pugliese, Presicce, Donna, Tosto,
Pasqualetto, D'Errico, Benelli, Sbordone, Grimaldi, Cerimele, Floris,
Garaci, Chiocchi) Department of Diagnostic Imaging and Interventional
Radiology, Molecular Imaging and Radiotherapy, Radiology Division,
Policlinico Tor Vergata University, Rome, Italy
(Romeo) Department of Medical Sciences, Cardiology Division, Policlinico
Tor Vergata University, Rome, Italy
(Vanni) Breast Unit, Department of Surgical Science, Policlinico Tor
Vergata University, Rome, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Aim Pre-transcatheter aortic valve implantation (TAVI) computed tomography
(CT) has proven to be crucial in identifying pre- and post-procedural
predicting factors predisposing the onset of major arrhythmias that
require permanent pacemaker (PPM) implantation caused by the compressive
effects of the prostheses on the conduction system at the membranous
septum (MS) and the muscular crest of the interventricular septum. Our
analysis aims to verify if the pre-TAVI assessment of the angle between
the MS and the aortic annulus (SVA) might be a predictive factor for the
onset of arrhythmias that requires PPM. Methods Two cardiovascular
specialist radiologists retrospectively and double-blind evaluated a
randomized list of preprocedural CT of 57 patients who underwent TAVI with
a self-expandable valve from April 2019 to February 2020. Two anatomical
features were measured by readers: width of the SVA and MS length (MSL).
Results A PPM was implanted in 18 patients (31%) after the procedure.
There was no significant difference in the anatomical measurements
performed between the two observers, regarding both anatomical
measurements (intraclass correlation coefficient was 0.944 for the SVA and
0.774 for the MSL]. Receiver-operating characteristic curves (ROC)
performed for both measurements have documented: for the SVA sensitivity
94% and Negative predictive value (NPV) 96% (area under the curve: 0.77;
95% confidence interval 0.66 - 0.90). The MSL ROC was not significant. The
mean SVA value stratified for patients who did not undergo PPM
implantation and patients who did resulted as significant (P < 0.005).
Conclusion Measurement of the SVA performed in preprocedural CT scans has
proven to be related to the onset of major arrhythmias after TAVI
requiring permanent pacemaker implantation with high sensitivity (94%) and
NPV (96%). Copyright © 2021 Italian Federation of Cardiology -
I.F.C. All rights reserved.

<27>
Accession Number
636621815
Title
Statin Discontinuation and Cardiovascular Events among Older People in
Denmark.
Source
JAMA Network Open. 4(12) (no pagination), 2021. Article Number: e2136802.
Date of Publication: 02 Dec 2021.
Author
Thompson W.; Morin L.; Jarbol D.E.; Andersen J.H.; Ernst M.T.; Nielsen
J.B.; Haastrup P.; Schmidt M.; Pottegard A.
Institution
(Thompson, Jarbol, Nielsen, Haastrup) Research Unit of General Practice,
Department of Public Health, University of Southern Denmark, J.B.
Winsl?wsvej 9, Odense 5000, Denmark
(Thompson, Pottegard) Hospital Pharmacy Fyn, Odense University Hospital,
Odense, Denmark
(Morin) Inserm CIC 1431, Clinical Investigation Unit, University Hospital
of Besancon, Besancon, France
(Morin) Inserm 1018, High-Dimensional Biostatistics for Drug Safety and
Genomics, Centre de Recherche en Epidemiologie et Sante des Populations,
Villejuif, France
(Andersen, Ernst, Pottegard) Research Unit of Clinical Pharmacology and
Pharmacy, Department of Public Health, University of Southern Denmark,
Odense, Denmark
(Schmidt) Department of Clinical Epidemiology, Aarhus University Hospital,
Aarhus, Denmark
(Schmidt) Department of Cardiology, Regional Hospital West Jutland,
Herning, Denmark
Publisher
American Medical Association
Abstract
Importance: Statin use is common in older persons. Given uncertainties in
ongoing benefit, changes in health status, and shifting goals of care and
preferences, statin discontinuation may be considered in some older
persons, although there is currently little evidence to guide this
decision. Objective(s): To evaluate the association between statin
discontinuation and the rate of major adverse cardiovascular events (MACE)
among people aged 75 years or older who receive long-term statin
treatment. Design, Setting, and Participant(s): This cohort study
included all persons in Denmark aged 75 years or older who were treated
with statins for at least 5 consecutive years as of January 1, 2011.
Participants were followed up until December 31, 2016. Data were analyzed
from July to November, 2020. Exposure: Statin discontinuation. Main
Outcomes and Measures: Rate of occurrence of MACE and its components
(myocardial infarction, ischemic stroke or transient ischemic attack,
coronary revascularization, and death due to myocardial infarction or
ischemic stroke) in persons continuing statins compared with those
discontinuing statins. Confounding adjustment was done using inverse
probability of treatment weighting. Analyses were conducted separately for
primary prevention (no history of cardiovascular disease) and secondary
prevention (history of cardiovascular disease). Result(s): The study
included 67418 long-term statin users, including 27463 in the primary
prevention analysis (median age, 79 years [IQR, 77-83 years]; 18134 [66%]
female) and 39955 in the secondary prevention analysis (median age, 80
years [IQR, 77-84 years]; 18717 [47%] female). In both primary and
secondary prevention analyses, the rate of MACE was higher among persons
who discontinued statins compared with those who continued statins. In the
primary prevention cohort, the weighted rate difference was 9 per 1000
person-years (95% CI, 5-12 per 1000 person-years) and the adjusted
sub-hazard ratio was 1.32 (95% CI, 1.18-1.48), corresponding to 1 excess
MACE per 112 persons who discontinued statins per year. In the secondary
prevention cohort, the weighted rate difference was 13 per 1000
person-years (95% CI, 8-17 per 1000 person-years) and the adjusted
sub-hazard ratio was 1.28 (95% CI, 1.18-1.39), corresponding to 1 excess
MACE per 77 persons who discontinued statins per year. Conclusions
and Relevance: In this cohort study, among older adults receiving
long-term statin treatment, discontinuation of statins was associated with
a higher rate of MACE compared with statin continuation in both the
primary and the secondary prevention cohorts. These findings suggest a
need for robust evidence from randomized clinical trials.. Copyright
© 2021 American Medical Association. All rights reserved.

<28>
Accession Number
636607224
Title
Early Thymectomy Is Associated With Long-Term Impairment of the Immune
System: A Systematic Review.
Source
Frontiers in Immunology. 12 (no pagination), 2021. Article Number: 774780.
Date of Publication: 25 Nov 2021.
Author
Cavalcanti N.V.; Palmeira P.; Jatene M.B.; de Barros Dorna M.;
Carneiro-Sampaio M.
Institution
(Cavalcanti, de Barros Dorna, Carneiro-Sampaio) Children's Hospital,
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo (HC-FMUSP), Sao Paulo, Brazil
(Palmeira, Carneiro-Sampaio) Laboratory of Clinical Investigation LIM-36,
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo (HC-FMUSP), Sao Paulo, Brazil
(Jatene) Pediatric Cardiovascular Surgery Department, Heart Institute,
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo (HC-FMUSP), Sao Paulo, Brazil
Publisher
Frontiers Media S.A.
Abstract
Background and Aims: Congenital heart diseases (CHDs) are diagnosed in
approximately 9 in 1,000 newborns, and early cardiac corrective surgery
often requires partial or complete thymectomy. As the long-term effect of
early thymectomy on the subsequent development of the immune system in
humans has not been completely elucidated, the present study aimed to
evaluate the effects of thymus removal on the functional capacity of the
immune system after different periods. Method(s): A systematic review
of the literature was performed using MEDLINE, EMBASE, LILACS and Scopus.
The inclusion criteria were original studies that analyzed any component
of the immune system in patients with CHD who had undergone thymectomy
during cardiac surgery in the first years of life. The results were
evaluated for the quality of evidence. Result(s): Twenty-three
studies were selected and showed that patients who underwent a thymectomy
in the first years of life tended to exhibit important alterations in the
T cell compartment, such as fewer total T cells, CD4+, CD8+, naive and
CD31+ T cells, lower TRECs, decreased diversity of the TCR repertoire and
higher peripheral proliferation (increased Ki-67 expression) than
controls. However, the numbers of memory T cells and Treg cells differed
across the selected studies. Conclusion(s): Early thymectomy, either
partial or complete, may be associated with a reduction in many T cell
subpopulations and TCR diversity, and these alterations may persist during
long-term follow-up. Alternative solutions should be studied, either in
the operative technique with partial preservation of the thymus or through
the autograft of fragments of the gland. Systematic Review Registration:
Prospero [157188]. Copyright © 2021 Cavalcanti, Palmeira, Jatene,
de Barros Dorna and Carneiro-Sampaio.

<29>
Accession Number
636600006
Title
Antithrombotic treatment following coronary artery bypass surgery: a
network meta-analysis.
Source
Cochrane Database of Systematic Reviews. 2021(12) (no pagination), 2021.
Article Number: CD014817. Date of Publication: 08 Dec 2021.
Author
Abbasciano R.G.; Gradinariu G.; Kourliouros A.; Lai F.; Langrish J.;
Murphy G.; Quarto C.; Radhakrishnan A.; Raja S.; Rogers L.J.; Townend J.;
Tyson N.; Vaja R.; Verdichizzo D.; Wynne R.
Institution
(Gradinariu) Department of Cardiothoracic Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Kourliouros, Langrish, Verdichizzo) Oxford Heart Centre, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Quarto, Raja, Vaja) Department of Cardiac Surgery, Royal Brompton and
Harefield Hospital, London, United Kingdom
(Radhakrishnan) Department of Cardiology, New Cross Hospital,
Wolverhampton, United Kingdom
(Rogers) Bristol Heart Institute, University Hospitals Bristol and Weston
NHS Foundation Trust, Bristol, United Kingdom
(Townend) Department of Cardiology, Queen Elizabeth Hospital, University
Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
(Tyson) Trent Cardiac Centre, Nottingham University Hospitals NHS Trust,
Nottingham, United Kingdom
(Wynne) Western Sydney Nursing & Midwifery Research Centre, Western Sydney
University, Sydney, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Objectives: This is a protocol for a Cochrane Review (intervention). The
objectives are as follows:. Primary objective To assess the clinical
effectiveness of antithrombotic agents in reducing all-cause mortality
after CABG surgery. Secondary objectives To evaluate the effect of
antithrombotic agents on graft patency, cardiovascular morbidity and
bleeding after CABG surgery. To present ranking probabilities of
antithrombotic agents in relation to all-cause mortality and
bleeding. Copyright © 2021 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<30>
Accession Number
2014424578
Title
Influences of remote ischemic preconditioning on postoperative delirium
and cognitive dysfunction in adults after cardiac surgery: a meta-analysis
of randomized controlled trials.
Source
Perioperative Medicine. 10(1) (no pagination), 2021. Article Number: 50.
Date of Publication: December 2021.
Author
Jing Y.; Gao B.; Li X.
Institution
(Jing, Li) Department of Vascular Surgery, The First Affiliated Hospital
of China Medical University, No. 155 Nanjing Bei Street, Heping District,
Shenyang 110001, China
(Gao) Department of Neurology, Shengjing Hospital Affiliated to China
Medical University, Shenyang 110004, China
Publisher
BioMed Central Ltd
Abstract
Background: Remote ischemic preconditioning (RIPC) has been suggested to
confer neuroprotective effect. However, influences of RIPC on
postoperative delirium (POD) and cognitive dysfunction (POCD) in adults
after cardiac surgery are less known. We performed a meta-analysis of
randomized controlled trials (RCTs) to evaluate the effects of RIPC on POD
and POCD. Method(s): Relevant studies were obtained by search of
PubMed, Embase, and Cochrane's Library databases. A random-effect model
was used to pool the results. Result(s): Ten RCTs including 2303
adults who received cardiac surgery were included. Pooled results showed
that RIPC did not significantly affect the incidence of POD (six RCTs,
odds ratio [OR] 1.07, 95% confidence interval [CI] 0.81 to 1.40, P = 0.65)
with no significant heterogeneity (I2 = 0%). In addition,
combined results showed that RIPC did not significantly reduce the
incidence of POCD either (six RCTs, OR 0.64, 95% CI 0.37 to 1.11, P =
0.11) with moderate heterogeneity (I2 = 44%). Sensitivity
analysis by excluding one RCT at a time showed consistent results (P
values all > 0.05). Conclusion(s): Current evidence from RCTs did not
support that RIPC could prevent the incidence of POD or POCD in adults
after cardiac surgery. Although these findings may be validated in
large-scale RCTs, particularly for the results of POCD, based on these
findings, RIPC should not be routinely used as a preventative measure for
POD and POCD in adult patients after cardiac surgery. Copyright ©
2021, The Author(s).

<31>
Accession Number
2014424492
Title
The effects of erector spinae plane block on perioperative opioid
consumption and rehabilitation in video assisted thoracic surgery.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 313. Date
of Publication: December 2021.
Author
Zhang S.; Han X.; Zhou D.; Sun M.; Cang J.; Miao C.; Liang C.
Institution
(Zhang, Han, Zhou, Sun, Cang, Miao, Liang) Department of Anesthesiology,
Zhongshan Hospital, Fudan University, Shanghai 200032, China
Publisher
BioMed Central Ltd
Abstract
Background: This study aimed to determine whether ultrasound-guided
continuous erector spinae plane block (ESPB) had an effect on opioid
consumption and postoperative rehabilitation in patients undergoing
video-assisted thoracic surgery (VATS). Method(s): In this
prospective study, 120 patients aged 20-70 years who underwent elective
VATS were randomly allocated to one of three groups: group C (general
anesthesia with patient-controlled intravenous analgesia [PCIA]), group T
(general anesthesia with patient-controlled epidural analgesia [PCEA]), or
group E (general anesthesia with continuous ESPB and PCIA). Perioperative
opioid consumption, visual analog scale (VAS) scores, preoperative and
postoperative Quality of Recovery-15 scores, and postoperative
opioid-related adverse events were all assessed. Result(s):
Intraoperative sufentanil consumption in groups T and E was significantly
lower than that in group C (both P < 0.001), and the postoperative
sufentanil consumption in group E was also significantly lower than that
in group C (P = 0.001). Compared with group C, the VAS scores at rest or
during coughing immediately out of the post-anesthesia care unit at 6 h,
12 h, and 24 h postoperatively were significantly lower in group T (P <
0.05). However, the VAS scores at rest at 6 h and 12 h postoperatively in
group E were lower than those of group C (P < 0.05), but were
significantly higher than those of group T at all study times (P < 0.05).
 Conclusion(s): Ultrasound-guided continuous ESPB significantly
reduced perioperative opioid consumption during VATS and improved
postoperative rehabilitation. However, these effects were inferior to
those of thoracic epidural anesthesia. Trial registration: The present
study was prospectively registered at http://www.chictr.org/cn
/(registration number: ChiCTR1900023050); registration date: May
82,019. Copyright © 2021, The Author(s).

<32>
Accession Number
2014762076
Title
Iatrogenic acute aortic dissection in the era of minimally invasive
cardiac surgery - Experience of a center and review of literature.
Source
Brazilian Journal of Cardiovascular Surgery. 36(5) (pp 691-699), 2021.
Date of Publication: 2021.
Author
De Viti D.; Dambruoso P.; Izzo P.; Dhojniku I.; Raimondo P.; Carbone C.;
Paparella D.
Institution
(De Viti, Izzo) Department of Cardiology, Santa Maria Hospital, GVM Care
and Research, Bari, Italy
(Dambruoso, Dhojniku) Department of Cardiac Anesthesia and Intensive Care,
Santa Maria Hospital, GVM Care and Research, Bari, Italy
(Raimondo) Department of Emergency and Organ Transplant, University of
Bari "Aldo Moro", Bari, Italy
(Carbone, Paparella) Department of Cardiac Surgery, Santa Maria Hospital,
GVM Care and Research, Bari, Italy
(Paparella) Department of Medical and Surgical Sciences, University of
Foggia, Foggia, Italy
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: Iatrogenic acute aortic dissection (IAAD) type A is a rare
but potentially fatal complication of cardiac surgery. Method(s): The
purpose of this article is to review the literature since the first
reports of IAAD in 1978, examining its clinical characteristics and
describing operative details and surgical outcomes. Moreover, we reviewed
the recent literature to identify current trends and risk factors for IAAD
in minimally invasive cardiac surgery procedures, often related to femoral
artery cannulation for retrograde perfusion. Result(s): We found that
IAAD ranges from 0.04 to 0.29% of cardiac patients in overall trials and
ranged from 0.12 to 0.16% between 1978-1990, before the minimally invasive
surgical era. And we concluded that since the first cases to the recent
reports, the incidence of IAAD has not significantly changed. As minimally
invasive procedures are on the rise, some authors think that the incidence
of IAAD could increase in the future; we think that using all the
precaution - such a strict monitoring of perfusion pressure throughout the
intervention, avoiding extremely high jet pressures using vasodilators,
repositioning of arterial cannula, or splitting perfusion in both femoral
arteries -, this complication can be extremely reduced. Finally, we
describe a very singular case occurring during mitral valve replacement
followed by spontaneous dissection of left anterior descending artery one
month later. Conclusion(s): The present article adds to the
literature a more detailed clinical picture of this entity, including
patients' characteristics, the mechanism, timing, and localization of the
tear, and mortality details. Copyright © 2021, Sociedade
Brasileira de Cirurgia Cardiovascular. All rights reserved.

<33>
Accession Number
2015606043
Title
Comparison of hemodynamic response to tracheal intubation with two
different videolaryngoscopes: A randomized clinical trial.
Source
Brazilian Journal of Anesthesiology (English Edition). (no pagination),
2021. Date of Publication: 2021.
Author
Cardakozu T.; Arslan Z.I.; Cesur S.; Aksu B.
Institution
(Cardakozu, Arslan, Cesur) Kocaeli University of Medical Faculty,
Department of Anesthesiology and Reanimation, Izmit, Turkey
(Aksu) Kocaeli University of Kandira Vocational School, Izmit, Turkey
Publisher
Elsevier Editora Ltda
Abstract
Background: Endotracheal intubation (ETI), which is the gold standard in
coronary artery bypass grafting (CABG), may cause myocardial ischemia by
disturbing the balance between hemodynamic changes and oxygen supply and
consumption of the myocardium as a result of sympathetic stimulation. In
this study, we aimed to compare two different videolaryngoscopes (C-MAC
and Airtraq) in the hemodynamic response to ETI. Method(s): Fifty ASA
II-III CABG surgery patients were randomly assigned to C-MAC or Airtraq.
The hemodynamic data included arterial blood pressure [systolic (SAP),
diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at
six different points in time: before laryngoscopy (T1), during
laryngoscopy (T2), immediately after intubation (T3), and 3 (T4), 5 (T5)
and 10 (T6) minutes after intubation. Intraoperative complications were
recorded. Patients were questioned about postoperative complications 2 and
24 hours following extubation. Result(s): The hemodynamic response to
ETI was significantly greater with C-MAC. The increase in HR started with
the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started
immediately after ETI (p = 0.024; p = 0.012; p = 0.030; p = 0.009,
respectively). In group analyses, T1-T2, T2-T3 and T1-T3 comparisons did
not show any significant differences in HR with Airtraq. However, with
C-MAC, HR after intubation increased significantly compared to the
pre-laryngoscopy values (T1-T3) (p = 0.004). The duration of laryngoscopy
was significantly reduced with C-MAC (p < 0.001), but the duration of
intubation and total intubation were similar (p = 0.36; p = 0.79).
 Conclusion(s): Compared to C-MAC, the hemodynamic response to ETI was
less with Airtraq. Thus, Airtraq may be preferred in CABG patients for
ETI. Copyright © 2021 Sociedade Brasileira de Anestesiologia

<34>
Accession Number
2014440544
Title
Effect of energy- and/or protein-dense enteral feeding on postoperative
outcomes of infant surgical patients with congenital cardiac disease: A
systematic review and meta-analysis.
Source
Nutrition in Clinical Practice. (no pagination), 2021. Date of
Publication: 2021.
Author
Singal A.; Sahu M.K.; Trilok Kumar G.; Kumar A.
Institution
(Singal) Department of Food and Nutrition, Institute of Home Economics,
University of Delhi, New Delhi, India
(Sahu) Department of Cardiothoracic and Vascular Surgery, CT Centre, All
India Institute of Medical Sciences, New Delhi, India
(Trilok Kumar) Institute of Home Economics, University of Delhi, New
Delhi, India
(Kumar) Department of Neurology, All India Institute of Medical Sciences,
New Delhi, India
Publisher
John Wiley and Sons Inc
Abstract
Infants with congenital heart disease (CHD) are malnourished because of
poor dietary intakes and increased requirements. Energy requirements are
higher due to increased resting energy expenditure. There are lacunae of
nutrition recommendations for these infants. Therefore, this systematic
review and meta-analysis was conducted to determine the effect of energy-
and/or protein-dense feeds in postoperative CHD infants as compared with
the standard feeding. An online literature search was performed on four
databases by using different English-language keywords between 2000 and
2020. The inclusion criteria were peer reviewed journals and open access
original articles on the feeding practices in infants undergoing
congenital heart surgery. Exclusion criteria were editorials,
commentaries, discussion papers, conference abstracts, reviews, duplicate
studies, and articles on preterm infants and preoperative nutrition. A
total of five studies matched the inclusion criteria. The standard mean
difference (SMD) of energy intake (SMD = 13.40 kcal, P = 0.001), protein
intake (SMD = 2.37 g, P = 0.001), and weight (SMD = 4.99 g, P = 0.001) was
significantly higher in the intervention group. The SMD of ventilation
duration (SMD = -0.18 h, P = 0.90), intensive care unit (ICU) length of
stay (LOS) (SMD = -0.25 d, P = 0.70), and hospital LOS (SMD = -0.20 d, P =
0.67) were not statistically significant between the two groups. Enriched
enteral nutrition for the postoperative pediatric patients with cardiac
disease helps in achieving energy and protein goals and improves the
overall postoperative outcomes (ie, ventilation duration, maintenance of
weight, ICU LOS, and hospital LOS). Copyright © 2021 American
Society for Parenteral and Enteral Nutrition

<35>
Accession Number
2013947873
Title
Hemodynamic impact of increasing time between fentanyl and propofol
administration during anesthesia induction: a randomised, clinical trial.
Source
Brazilian Journal of Anesthesiology (English Edition). (no pagination),
2021. Date of Publication: 2021.
Author
Vullo P.A.; Real Navacerrada M.I.; Navarro Suay R.
Institution
(Vullo, Navarro Suay) Hospital Central de la Defensa Gomez Ulla-IMIDEF,
Critical Care and Pain Unit, Department of Anesthesia, Madrid, Spain
(Real Navacerrada) Hospital Universitario 12 de Octubre, Critical Care and
Pain Unit, Department of Anesthesia, Madrid, Spain
Publisher
Elsevier Editora Ltda
Abstract
Background and objective: Anesthesia induction can produce severe propofol
dose-dependent hypotension. Fentanyl coadministration reduces the
catecholaminergic response to orotracheal intubation allowing propofol
dose reduction. The aim of this study is to determine whether the
hemodynamic response is improved by increasing the time between fentanyl
and propofol administration and reducing the dose of the latter without
increasing the time to achieve optimal hypnosis. Method(s): After
approval by the Research Ethics Committee, patients undergoing non-cardiac
surgery with endotracheal intubation were randomized by a
computer-generated table into six time-dose groups (1 or 2 minutes/1, 1.5,
or 2 mg.kg-1 of propofol). Patients with high bronchoaspiration
risk, a difficult airway, hemodynamic instability, or anesthetic allergies
were excluded. After giving intravenous fentanyl (2 mug.kg-1),
each group received different doses of propofol after 1 or 2 minutes.
Noninvasive blood pressure (BP) and heart rate (HR) were measured at
pre-induction, pre-intubation, and post-intubation. Time to hypnosis
(bispectral index < 60) was also recorded. Result(s): Of the 192
recruited patients, 186 completed the study (1 min group n = 94; 2 min
group n = 92). It was observed that HR and BP decreased after propofol
administration and increased after intubation in all groups (p < 0.0001).
In patients over 55 years, the 2 min - 2 mg.kg-1 group showed
the greatest systolic BP reduction (36 +/- 12%) at pre-intubation, while
the 1 min - 1.5 mg.kg-1 group showed the least hemodynamic
alteration between pre- and post-intubation (-4 +/- 13%). No significant
differences were found in younger patients or in the time to reach
hypnosis between the six groups. While no cases of severe bradycardia were
recorded, 5,4% of the sample required vasopressors. Conclusion(s):
Increasing the time between the administration of fentanyl and propofol by
up to two minutes results in greater hypotension in patients over 55
years. Copyright © 2021 Sociedade Brasileira de Anestesiologia

<36>
Accession Number
2013930341
Title
Analgesic effect of intercostal nerve block given preventively or at the
end of operation in video-assisted thoracic surgery: a randomized clinical
trial.
Source
Brazilian Journal of Anesthesiology (English Edition). (no pagination),
2021. Date of Publication: 2021.
Author
Xiao W.; Zhou W.; Chen X.; Zhu J.; Xue Q.; Shi J.
Institution
(Xiao, Chen, Zhu, Xue, Shi) Affiliated Hospital of Nantong University,
Department of Cardiothoracic Surgery, Nantong, China
(Xiao, Shi) Affiliated Hospital of Nantong University, Nantong Key
Laboratory of Translational Medicine in Cardiothoracic Diseases, Nantong,
China
(Zhou) Affiliated Hospital of Nantong University, Department of
Anaesthesiology, Nantong, China
Publisher
Elsevier Editora Ltda
Abstract
Objective: To compare the analgesic effect of intercostal nerve block
(INB) with ropivacaine when given preventively or at the end of the
operation in patients undergoing video-assisted thoracic surgery (VATS).
 Method(s): A total of 50 patients undergoing VATS were randomly
divided into two groups. The patients in the preventive analgesia group
(PR group) were given INB with ropivacaine before the intrathoracic
manipulation combined with patient-controlled analgesia (PCA). The
patients in the post-procedural block group (PO group) were administered
INB with ropivacaine at the end of the operation combined with PCA. To
evaluate the analgesic effect, postoperative pain was assessed with the
visual analogue scale (VAS) at rest and Prince Henry Pain Scale (PHPS)
scale at 6, 12, 24, 48, and 72 hours after surgery. Result(s): At 6 h
and 12 h post-surgery, the VAS at rest and PHPS scores in the PR group
were significantly lower than those in the PO group. There were no
significant differences in pain scores between two groups at 24, 48, and
72 hours post-surgery. Conclusion(s): In patients undergoing VATS,
preventive INB with ropivacaine provided a significantly better analgesic
effect in the early postoperative period (at least through 12 h
post-surgery) than did INB given at the end of surgery. Copyright
© 2021 Sociedade Brasileira de Anestesiologia

<37>
Accession Number
636627798
Title
Nickel hypersensitivity and endovascular devices: a systematic review and
meta-analysis.
Source
Heart (British Cardiac Society). (no pagination), 2021. Date of
Publication: 26 Oct 2021.
Author
Gueroult A.M.; Al-Balah A.; Davies A.H.; Shalhoub J.
Institution
(Gueroult) Academic Section of Vascular Surgery, Department of Surgery &
Cancer, Imperial College Healthcare NHS Trust, London, United Kingdom
(Gueroult, Davies, Shalhoub) Imperial Vascular Unit, Imperial College
Healthcare NHS Trust, London, United Kingdom
(Al-Balah, Davies, Shalhoub) Academic Section of Vascular Surgery,
Department of Surgery & Cancer, Imperial College Healthcare NHS Trust,
London, United Kingdom
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Nickel allergy is common; endovascular specialists are often
confronted with nickel allergic patients ahead of the implantation of
endovascular devices, many of which are nickel-containing. Our aim was to
elucidate whether nickel hypersensitivity is significantly associated with
worse or adverse outcomes after placement of a nickel-containing
endovascular device. METHOD(S): Inclusion criteria were: endovascular
and transcatheter procedures for coronary, structural heart, neurovascular
and peripheral vascular pathology involving nickel-allergic patients. All
adverse outcomes were included as defined by included studies. A
systematic review and meta-analysis were undertaken using a random-effects
model. Searches of MEDLINE and EMBASE were conducted for articles
published 1947-2019. RESULT(S): 190 records were identified, 78
articles were included for qualitative synthesis and 15 met criteria for
meta-analysis. Patch-test confirmed nickel allergy was associated with an
increased risk of adverse outcomes following implantation of a
nickel-containing endovascular device (n=14 articles, 1740 patients; OR
2.61, 95% CI 1.41 to 4.85). This finding further was observed in coronary
(n=12 articles, 1624 patients; OR 1.94, 95% CI 1.16 to 3.23) and
structural heart subgroups (n=2 articles, 83 patients; OR 52.28, 95% CI
1.31 to 2079.14), but not in the neurovascular subgroup (n=1 article, 33
patients; OR 3.04, 95% CI 0.59 to 15.72) or with a patient-reported
history of nickel allergy (n=2 articles, 207 patients; OR 2.14, 95% CI
0.23 to 19.70). CONCLUSION(S): Patch-tested nickel allergy is
associated with an increased risk of adverse outcomes following
endovascular device implantation and alternative treatment options should
be considered. Specialists faced with patients' self-reporting nickel
allergy should consider proceeding to diagnostic
patch-testing. Copyright © Author(s) (or their employer(s)) 2021.
No commercial re-use. See rights and permissions. Published by BMJ.

<38>
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. © Copyright © 2021 Ma,
Sun, Li, Deng, Zhang, Yang, Han, Huang, Fang, Liao and Sun.

<39>
Accession Number
2015771495
Title
Glycopyrrolate versus atropine for preventing bradycardia induced by
neostigmine injection after general anesthesia surgery: A randomized open,
parallel-controlled multicenter clinical trial.
Source
American Journal of Translational Research. 13(11) (pp 12996-13002), 2021.
Date of Publication: 2021.
Author
Yun Y.; Cao D.; Zhang X.; Ouyang W.; Min S.; Lv J.; Li L.; Huang F.
Institution
(Yun) Department of Anesthesiology, Beijing Chaoyang Hospital, Capital
Medical University, Beijing 100000, China
(Cao) Department of Anesthesiology, Affiliated Hospital of Guangdong
Medical University, Guangdong, Zhanjiang 524000, China
(Zhang) Department of Anesthesiology, Shanghai Tongji Hospital, Shanghai
200000, China
(Ouyang) Department of Anesthesiology, The Third Xiangya Hospital, Central
South University, Hunan, Changsha 410000, China
(Min) Department of Anesthesiology, The First Affiliated Hospital of
Chongqing Medical University, Chongqing 400000, China
(Lv) Department of Anesthesiology, The Second Affiliated Hospital of Xi'an
Jiaotong University, Shaanxi, Xi'an 710000, China
(Li) Department of Anesthesiology, General Hospital of Shenyang Military
Region of PLA, Liaoning, Shenyang 110000, China
(Huang) Department of Anesthesiology, The First People's Hospital of
Changde, Hunan, Changde 415000, China
Publisher
E-Century Publishing Corporation
Abstract
Objective: With atropine as a positive control, randomized controlled
clinical trials were conducted to verify the efficacy of glycopyrrolate
injection in preventing bradycardia caused by neostigmine. Method(s):
Patients undergoing elective general anesthesia and non-cardiac surgery
were randomly divided into an experimental group (129 cases) and control
group (127 cases) (ChiCTR2100046022,
http://www.chictr.org.cn/showproj.aspx?proj=126075). At the end of the
operation, the test group was given glycopyrrolate 6 ug/kg + neostigmine
0.04 mg/kg, and the control group was given atropine 0.016 mg/kg +
neostigmine 0.04 mg/kg, bolus time 1 min, to antagonize muscle residual
effects of relaxants. We compared the area under the time curve (AUC) of
the difference between heart rate and baseline heart rate within 15
minutes of administration, the measured value of heart rate per minute,
and the change in heart rate compared with baseline. We verified the
safety of glycopyrrolate injection through laboratory tests, clinical
symptoms, signs, and adverse events/serious adverse events.
 Result(s): The AUC of the experimental group's heart rate within 15
minutes after the administration was lower than the baseline heart rate
change value, (P<005). The measured value of the heart rate at each time
changed less than the control group; the experimental group's heart rate
remained at the baseline level for longer than the control group (P<005).
There was no significant difference in the incidence of adverse reactions
between the two groups of patients (P>005). Conclusion(s):
Glycopyrrolate and atropine are safe to prevent heart rate slowing induced
by the non-depolarizing muscle relaxant antagonist neostigmine, and
glycopyrrolate is more conducive to maintaining a stable heart rate in
patients. Copyright © 2021 E-Century Publishing Corporation. All
rights reserved.

<40>
Accession Number
2014735920
Title
Surgical strategies for cardiac perforation after catheter ablation or
electrophysiology study: A systemic review.
Source
International Heart Journal. 62(6) (pp 1257-1264), 2021. Date of
Publication: 2021.
Author
Wu S.-J.; Fan Y.-F.; Chien C.-Y.
Institution
(Wu, Fan, Chien) Division of Cardiovascular Surgery, Departments of
Surgery, MacKay Memorial Hospital, Taipei, Taiwan (Republic of China)
Publisher
International Heart Journal Association
Abstract
Catheter ablation is a treatment modality which has been increasingly used
for cardiac arrhythmias. How-ever, it is not complication-free, and
cardiac perforation is one of its most life-threatening complications. As
surgery is usually not the first-line treatment for this emergent episode,
there were only very few sporadic surgical reports in the literature. This
systemic review primarily aims to collect different surgical approaches
for catheter-induced cardiac perforation to help surgeons manage this kind
of uncommon and critical patients. Of the 452 initially screened articles,
22 studies (38 patients) were included in the systemic review. Of all the
included patients, 84% (32/38) were found to have pericardial effusion
acutely following catheter-related proce-dures, and 16% (6/38) experienced
delayed-onset episodes. Regarding the surgical procedures, four patients
underwent removal of clots only, eight patients underwent suture repair of
the left ventricle (LV), nine patients underwent suture repair of the
right ventricle (RV), five patients underwent suture repair of the LA, and
four patients underwent sutureless repair of the LV and pulmonary vein (LV
1, RV 1, pulmonary vein 1). In addition to repair of perforation sites,
the concomitant combined procedures included repair of intercostal vessels
(compli-cation of pericardiocentesis) for one patient, cryoablation for
two patients, and maze procedure for one patient. For cardiac perforation
following catheter ablation or electrophysiology study, although the
majority of the patients are treated with pericardiocentesis and medical
management at first, cardiovascular surgeons have to pre-pare to take over
if the bleeding is persistent or if the cardiac tamponade is not
relieved. Copyright © 2021, International Heart Journal
Association. All rights reserved.

<41>
Accession Number
2014735918
Title
Active versus conventional side branch protection strategy for coronary
bifurcation lesions a systematic review and meta-analysis.
Source
International Heart Journal. 62(6) (pp 1241-1248), 2021. Date of
Publication: 2021.
Author
Qin Q.; Zheng B.; Liu J.; Zhang B.; Chen M.; Li J.; Huo Y.
Institution
(Qin, Zheng, Liu, Zhang, Chen, Li, Huo) Department of Cardiology,
Institute of Cardiovascular Disease, Peking University First Hospital,
Beijing, China
Publisher
International Heart Journal Association
Abstract
The side branch (SB) provisional stenting strategy is currently the
recommended approach for most coronary bifurcation lesions. However, this
strategy may result in SB deterioration, which is associated with an
increased incidence of periprocedural myocardial infarction (PMI) and may
adversely affect the long-term progno-sis. Various techniques for SB
protection (SB-P) have been developed to reduce SB occlusion and improve
the clinical prognosis. This meta-analysis was performed to compare the
outcomes of an active SB-P strategy of jailed balloon technique,
balloon-stent kissing technique, and jailed Corsair technique versus the
conventional SB-P strategy based on jailed wire technique. This
meta-analysis included 5 studies (4 randomized and 1 observational)
involving a total of 1,174 patients in whom the active and conventional
SB-P strategies were compared. Fixed-and random-effects models were used
to calculate summary risk ratios (RRs). The risk of SB occlusion was
significantly lower in active SB-P strategy [RR 0.47, 95% confidence
interval (CI) 0.30-0.73 in fixed-effect model; RR 0.52, 95% CI 0.31-0.87
in random-effect model]. The risk of PMI was similar between the two
strategies (RR 0.63, 95% CI 0.30-1.33 in fixed-effect model; RR 0.71,
95%CI 0.20-2.48 in random-effect model). The rate of long-term major
adverse cardiovascular events was similar between the groups (RR 0.48, 95%
CI 0.15-1.48 in fixed-effect model; RR 0.49, 95% CI 0.16-1.52 in
random-effect model). The active SB-P strategy in coronary bifurcation
lesions is associated with reduced SB deterioration, but it does not
decrease PMI or improve the long-term prognosis. Copyright ©
2021, International Heart Journal Association. All rights reserved.

<42>
Accession Number
2013030343
Title
Does preoperative pulmonary rehabilitation/physiotherapy improve patient
outcomes following lung resection?.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(6) (pp 933-937), 2021.
Date of Publication: 01 Jun 2021.
Author
Bibo L.; Goldblatt J.; Merry C.
Institution
(Bibo, Merry) Department of Cardiothoracic Surgery, Fiona Stanley
Hospital, Perth, Australia
(Goldblatt) Department of Cardiothoracic Surgery, The Alfred Hospital,
Melbourne, Australia
Publisher
Oxford University Press
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was whether preoperative
physiotherapy (pulmonary prehabilitation) is beneficial for patients
undergoing lung resection. Altogether 177 papers were found using the
reported search, of which 10 represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. A meta-analysis by Li et al. showed that patients
who received a preoperative rehabilitation programme (PRP) had reduced
incidence of postoperative pulmonary complications (PPCs) (odds ratio
0.44, 95% CI 0.27-0.71), reduced length of stay (LOS) (-4.23 days, 95% CI
-6.14 to -2.32 days) and improved 6-min walking distance (71.25 m, 95% CI
39.68-102.82) and peak oxygen uptake consumption (VO2peak)
(3.26, 95% CI 2.17-4.35). A meta-analysis by Steffens et al. showed that
PPCs were reduced in patients with PRP (relative risk 0.49, 95% CI
0.33-0.73) and reduced LOS (-2.86 days, 95% CI -5.40 to -0.33). The
results of 3 additional meta-analyses, 4 randomized controlled trials and
1 observational study all provide further support to PRP in enhanced
recovery after surgery and the improvement in exercise capacity. We
conclude that PRP improves exercise capacity in patients undergoing
surgical resection for lung cancer. Moderate quality evidence supports
preoperative exercise providing significant reduction in PPCs and hospital
LOS. Referral to exercise programmes should be considered in patients
awaiting lung resection, particularly those deemed borderline for
suitability for surgical resection. Copyright © 2021 Oxford
University Press. All rights reserved.

<43>
Accession Number
2012895992
Title
Current clinical applications and potential perspective of micro-computed
tomography in cardiovascular imaging: A systematic scoping review.
Source
Hellenic Journal of Cardiology. 62(6) (pp 399-407), 2021. Date of
Publication: 01 Nov 2021.
Author
Papazoglou A.S.; Karagiannidis E.; Moysidis D.V.; Sofidis G.; Bompoti A.;
Stalikas N.; Panteris E.; Arvanitidis C.; Herrmann M.D.; Michaelson J.S.;
Sianos G.
Institution
(Papazoglou, Karagiannidis, Moysidis, Sofidis, Stalikas, Sianos) First
Department of Cardiology, AHEPA University Hospital, Aristotle University
of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
(Bompoti) Medway NHS Foundation Trust, United Kingdom
(Panteris) Biomic_AUTh, Center for Interdisciplinary Research and
Innovation (CIRI-AUTH), Balkan Center, B1.4, Thessaloniki, 10th km
Thessaloniki-Thermi Rd, P.O. Box 8318 GR 57001, Greece
(Arvanitidis) Institute of Marine Biology, Biotechnology and Aquaculture
(IMBBC), Hellenic Centre for Marine Research (HCMR), Heraklion, Crete
70013, Greece
(Arvanitidis) LifeWatch ERIC, Sector II-II, Plaza de Espana, Seville
41071, Spain
(Herrmann, Michaelson) Department of Pathology, Massachusetts General
Hospital and Harvard Medical School, Boston, United States
Publisher
Hellenic Cardiological Society
Abstract
Micro-computed tomography (micro-CT) constitutes an emerging imaging
technique, which can be utilized in cardiovascular medicine to study
in-detail the microstructure of heart and vessels. This paper aims to
systematically review the clinical utility of micro-CT in cardiovascular
imaging and propose future applications of micro-CT imaging in
cardiovascular research. A systematic scoping review was conducted by
searching for original studies written in English according to Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
extension for scoping reviews. Medline, Scopus, ClinicalTrials.gov, and
the Cochrane library were systematically searched through December 11,
2020 to identify publications concerning micro-CT applications in
cardiovascular imaging. Preclinical-animal studies and case reports were
excluded. The Newcastle-Ottawa assessment scale for observational studies
was used to evaluate study quality. In total, the search strategy
identified 30 studies that report on micro-CT-based cardiovascular imaging
and satisfy our eligibility criteria. Across all included studies, the
total number of micro-CT scanned specimens was 1,227. Six studies involved
postmortem 3D-reconstruction of congenital heart defects, while eleven
studies described atherosclerotic vessel (coronary or carotid)
characteristics. Thirteen other studies employed micro-CT for the
assessment of medical devices (mainly stents or prosthetic valves). In
conclusion, micro-CT is a novel imaging modality, effectively adapted for
the 3D visualization and analysis of cardiac soft tissues and devices at
high spatial resolution. Its increasing use could make significant
contributions to our improved understanding of the histopathophysiology of
cardiovascular diseases, and, thus, has the potential to optimize
interventional procedures and technologies, and ultimately improve patient
outcomes. Copyright © 2021 Hellenic Society of Cardiology

<44>
Accession Number
2011409174
Title
The effect of Remote Ischemic Preconditioning (RIPC) on myocardial injury
and inflammation in patients with severe aortic valve stenosis undergoing
Transcatheter Aortic Valve Replacement (TAVI).
Source
Hellenic Journal of Cardiology. 62(6) (pp 423-428), 2021. Date of
Publication: 01 Nov 2021.
Author
Halapas A.; Kapelouzou A.; Chrissoheris M.; Pattakos G.; Cokkinos D.V.;
Spargias K.
Institution
(Halapas, Chrissoheris, Pattakos, Spargias) THV Department, Heart Team
Hygeia Hospital Athens Greece, Er. Stavrou 9, Marousi, Athens, Greece
(Kapelouzou, Cokkinos) Center of Clinical, Experimental Surgery, &
Translation Research, Biomedical Research Foundation Academy of Athens
(BRFAA), Soranou Efesiou 4, Athens 11527, Greece
Publisher
Hellenic Cardiological Society
Abstract
Background: Remote ischemic preconditioning (RIPC) is being evaluated as a
strategy to reduce cardiac injury and inflammation in patients undergoing
diverse cardiac invasive and surgical procedures. However, it is unclear
whether RIPC has protective effects in patients undergoing the
transfemoral- transcatheter aortic valve implantation (TF-TAVI) procedure.
 Method(s): Between September 2013 and September 2015, 55 random
consecutive patients were prospectively assigned to receive SHAM
preconditioning (SHAM, 22 patients) or Remote Ischemic Preconditioning
(RIPC) (4 cycles of 5 min intermittent leg ischemia and 5 min reperfusion,
33 patients) prior to TF-TAVI. The primary endpoint was to determine the
serum levels of: hs-cTn-I (necrosis), CK-18 (apoptosis), and IL-1b
(inflammation). Quantification was performed using commercially available
ELISA kits. Patients were sampled 1-day pre TF-TAVI and 24-hours post
TF-TAVI. Secondary endpoints included: total mortality, incidence of
periprocedural clinical acute myocardial infarction (AMI), acute kidney
injury (AKI), and stroke. Result(s): 22 SHAM patients and 33 RIPC
patients were finally analyzed. Our data revealed no significant
difference in serum levels of hs-cTn-I and CK-18 among various groups.
However, in the RIPC group, the increase in IL1b level was significantly
lower for 24-h post TF-TAVI, (p < 0.01). There were no significant
differences between groups in the secondary endpoints at the follow-up
interval of one month. RIPC-related adverse events were not observed.
 Conclusion(s): Our data suggest that RIPC did not exhibit significant
cardiac or kidney protective effects regarding necrosis and apoptosis in
patients undergoing TF-TAVI. However, an important anti-inflammatory
effect was detected in the RIPC group. Copyright © 2021 Hellenic
Society of Cardiology

<45>
Accession Number
2007532304
Title
Impact of bundle branch block on permanent pacemaker implantation after
transcatheter aortic valve implantation: A meta-analysis.
Source
Journal of Clinical Medicine. 10(12) (no pagination), 2021. Article
Number: 2719. Date of Publication: 02 Jun 2021.
Author
Ravaux J.M.; Di Mauro M.; Vernooy K.; Mariani S.; Ronco D.; Simons J.;
Van'T Hof A.W.; Veenstra L.; Kats S.; Maessen J.G.; Lorusso R.
Institution
(Ravaux, Di Mauro, Mariani, Ronco, Simons, Kats, Maessen, Lorusso)
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre,
Maastricht University Medical Centre (MUMC), Maastricht 6202 AZ,
Netherlands
(Vernooy, Van'T Hof, Veenstra) Department of Cardiology, Maastricht
University Medical Centre (MUMC), Maastricht 6202 AZ, Netherlands
(Vernooy, Van'T Hof, Maessen, Lorusso) Cardiovascular Research Institute
Maastricht (CARIM), Maastricht University Medical Center, Maastricht 6202
AZ, Netherlands
(Vernooy) Department of Cardiology, Radboud University Medical Center
(Radboudumc), Nijmegen 6525 GA, Netherlands
(Ronco) Department of Medicine and Surgery, Circolo Hospital, University
of Insubria, Varese 21100 VA, Italy
Publisher
MDPI
Abstract
Data regarding the impact of infra-Hisian conduction disturbances leading
to permanent pacemaker implantation (PPI) after transcatheter aortic valve
implantation (TAVI) remain limited. The aim of this study was to determine
the impact of right and/or left bundle branch block (RBBB/LBBB) on
post-TAVI PPI. We performed a systematic literature review to identify
studies reporting on RBBB and/or LBBB status and post-TAVI PPI. Study
design, patient characteristics, and the presence of branch block were
analyzed. Odds ratios (ORs) with 95% CI were extracted. The final analysis
included 36 studies, reporting about 55,851 patients. Data on LBBB were
extracted from 33 studies. Among 51,026 patients included, 5503 showed
pre-implant LBBB (11.9% (10.4%- 13.8%)). The influence of LBBB on
post-TAVI PPI was not significant OR 1.1474 (0.9025; 1.4588), p = 0.2618.
Data on RBBB were extracted from 28 studies. Among 46,663 patients
included, 31,603 showed pre-implant RBBB (9.2% (7.3%-11.6%)). The
influence of RBBB on post-TAVI PPI was significant OR 4.8581 (4.1571;
5.6775), p < 0.0001. From this meta-analysis, the presence of RBBB
increased the risk for post-TAVI PPI, independent of age or LVEF, while
this finding was not con-firmed for patients experimenting with LBBB. This
result emphasizes the need for pre-operative evaluation strategies in
patient selection for TAVI. Copyright © 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<46>
Accession Number
2005711188
Title
Intensity of statin treatment after acute coronary syndrome, residual
risk, and its modification by alirocumab: Insights from the ODYSSEY
OUTCOMES trial.
Source
European Journal of Preventive Cardiology. 28(1) (pp 33-43), 2021. Date of
Publication: 01 Jan 2021.
Author
Diaz R.; Li Q.H.; Bhatt D.L.; Bittner V.A.; Baccara-Dinet M.T.; Goodman
S.G.; Jukema J.W.; Kimura T.; Parkhomenko A.; Pordy R.; Reiner Z.; Roe
M.T.; Szarek M.; Tse H.-F.; White H.D.; Zahger D.; Zeiher A.M.; Schwartz
G.G.; Steg P.G.
Institution
(Diaz) Estudios Clinicos Latino America, Instituto Cardiovascular de
Rosario, Argentina
(Li, Pordy) Regeneron Pharmaceuticals Inc, Tarrytown, United States
(Bhatt) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, United States
(Bittner) Division of Cardiovascular Disease, University of Alabama at
Birmingham, United States
(Baccara-Dinet) Sanofi RandD, Montpellier, France
(Goodman) Canadian VIGOUR Centre, University of Alberta, Canada
(Goodman) St Michael's Hospital, University of Toronto, Canada
(Jukema) Department of Cardiology, Leiden University Medical Center,
Netherlands
(Kimura) Kyoto University, School of Medicine, Japan
(Parkhomenko) MD Strazhesko Institute of Cardiology, AMS of Ukraine,
Ukraine
(Reiner) University Hospital Center Zagreb, University of Zagreb, Croatia
(Roe) Duke Clinical Research Institute, Duke University Medical Center,
United States
(Szarek) State University of New York, Downstate School of Public Health,
United States
(Tse) Queen Mary Hospital, Special Administrative Region of the People's
Republic of China, Hong Kong
(White) Green Lane Cardiovascular Services, Auckland City Hospital, New
Zealand
(Zahger) Soroka University Medical Center, Ben Gurion University of the
Negev, Israel
(Zeiher) Department of Medicine III, Goethe University, Germany
(Schwartz) Division of Cardiology, University of Colorado School of
Medicine, United States
(Steg) Universite de Paris, Assistance Publique-Hopitaux de Paris, Hopital
Bichat, FACT (French Alliance for Cardiovascular Trials), and INSERM,
France
(Steg) Imperial College, Royal Brompton Hospital, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: Statins are pivotal to the secondary prevention of major adverse
cardiovascular events, but some patients are statin-intolerant. We
examined the effects of the proprotein convertase subtilisin/kexin type 9
(PCSK9) inhibitor alirocumab on the risk of major adverse cardiovascular
events according to the intensity of background statin treatment.
 Methods and Results: The ODYSSEY OUTCOMES trial compared alirocumab
with placebo in 18,924 patients with acute coronary syndrome and
dyslipidaemia despite intensive or maximum-tolerated statin treatment
(including no statin if intolerance was documented). The primary outcome
(major adverse cardiovascular events) comprised coronary heart disease
death, non-fatal myocardial infarction, ischaemic stroke, or unstable
angina. Median follow-up was 2.8 years. Baseline statin treatment was
high-intensity (88.8%), low/moderate-intensity (8.7%) or none (2.4%).
Median baseline low-density lipoprotein cholesterol was 86, 89 and 139
mg/dL (P < 0.001) in these statin treatment categories, respectively.
Alirocumab produced similar relative reductions in low-density lipoprotein
cholesterol from baseline across statin treatment subgroups, but the mean
absolute reductions differed (52.9, 56.7 and 86.1 mg/dL, respectively; P <
0.001). With placebo, the incidence of major adverse cardiovascular events
was highest in the no statin subgroup (10.8%, 10.7% and 26.0%
respectively). Alirocumab reduced major adverse cardiovascular events in
each statin subgroup (hazard ratio 0.88, 95% confidence interval (CI)
0.80-0.96; 0.68, 0.49-0.94; and 0.65, 0.44-0.97, respectively;
Pinteraction = 0.14) with a gradient of absolute risk reduction: 1.25%,
95% CI 0.34-2.16; 3.16%, 0.38-5.94; 7.97%, 0.42-15.51; Pinteraction =
0.106). Conclusion(s): PCSK9 inhibition with alirocumab reduces the
relative risk of major adverse cardiovascular events after acute coronary
syndrome irrespective of background statin treatment. However, patients on
no statin are at high absolute risk for recurrent major adverse
cardiovascular events; alirocumab substantially reduces that risk. PCSK9
inhibition may be an important therapeutic strategy for statin-intolerant
patients with acute coronary syndrome. Copyright © 2021 The
Author(s) 2020. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<47>
Accession Number
2005121210
Title
Aspirin-free strategy versus standard term dual antiplatelet therapy in
patients undergoing percutaneous coronary intervention: A meta-analysis of
randomized controlled trials.
Source
European Journal of Preventive Cardiology. 28(12) (pp E25-E28), 2021. Date
of Publication: 01 Nov 2021.
Author
Khan M.S.; Moustafa A.; Azhar A.Z.; Khan A.R.; Ikram S.
Institution
(Khan, Moustafa) Department of Medicine, Miriam Hospital and Warren Alpert
School of Brown University, United States
(Azhar) Department of Medicine, Metropolitan Hospital Center, United
States
(Khan) Division of Cardiology, Massachusetts General Hospital, United
States
(Ikram) Division of Cardiovascular Medicine, University of Louisville
School of Medicine, United States
Publisher
Oxford University Press

<48>
Accession Number
2004735569
Title
Management of complications of cardiac amyloidosis: 10 questions and
answers.
Source
European Journal of Preventive Cardiology. 28(9) (pp 1000-1005), 2021.
Date of Publication: 01 Sep 2021.
Author
Aimo A.; Rapezzi C.; Vergaro G.; Giannoni A.; Spini V.; Passino C.; Emdin
M.
Institution
(Aimo, Vergaro, Giannoni, Passino, Emdin) Institute of Life Sciences,
Scuola Superiore Sant'Anna, Italy
(Rapezzi) University of Ferrara, Italy
(Vergaro, Giannoni, Spini, Passino, Emdin) Fondazione Toscana Gabriele
Monasterio, Italy
Publisher
Oxford University Press
Abstract
Amyloidosis is a systemic disorder characterized by extracellular
deposition of insoluble fibrils. The most common forms are amyloid light
chain and amyloid transthyretin (ATTR) amyloidoses. Cardiac involvement
may be found in both these forms, and is an important cause of morbidity
and mortality. The clinical presentation of cardiac amyloidosis (CA) may
be represented by congestive heart failure (HF), possibly progressing to
end-stage HF, as well as atrial fibrillation with possible thromboembolic
events, and also conduction disturbances related to amyloid infiltration
of conduction fibres. Beyond therapies targeting the blood dyscrasia or
the ATTR amyloidogenic cascade, a careful choice of drug therapies, need
for device implantation, and possibly treatments for advanced HF is then
warranted. In the present review, we try to provide a useful guide to
clinicians treating patients with CA by enucleating 10 main questions and
answering them based on the evidence available as well as expert opinion
and our clinical experience. Copyright © 2021 SAGE Publications
Inc.. All rights reserved.

<49>
Accession Number
2004212660
Title
Impact of bedtime dosing of antihypertensives compared to morning therapy:
A meta-Analysis of randomised controlled trials.
Source
European Journal of Preventive Cardiology. 28(11) (pp E5-E8), 2021. Date
of Publication: 01 Nov 2021.
Author
Gupta R.; Malik A.H.; Popli T.; Ranchal P.; Yandrapalli S.; Aronow W.S.
Institution
(Gupta, Malik, Ranchal, Aronow) Department of Internal Medicine,
Westchester Medical Center, United States
(Popli) Department of Infectious Diseases, Westchester Medical Center,
United States
(Yandrapalli, Aronow) Department of Cardiology, Westchester Medical
Center, United States
Publisher
Oxford University Press

<50>
Accession Number
2003985950
Title
Residential greenness and increased physical activity in patients after
coronary artery bypass graft surgery.
Source
European Journal of Preventive Cardiology. 28(11) (pp 1184-1191), 2021.
Date of Publication: 01 Nov 2021.
Author
Sadeh M.; Brauer M.; Chudnovsky A.; Ziv A.; Dankner R.
Institution
(Sadeh, Dankner) Department of Epidemiology and Preventive Medicine,
School of Public Health, Tel Aviv University, Israel
(Brauer) School of Population and Public Health, University of British
Columbia, Canada
(Chudnovsky) AIR-O Lab, Porter School of Environment and Geosciences,
Department of Geography and Human Environment, Israel
(Ziv) Unit for Data Management and Computerization, Gertner Institute for
Epidemiology and Health Policy Research, Sheba Medical Center, Israel
(Dankner) Unit for Cardiovascular Epidemiology, Gertner Institute for
Epidemiology and Health Policy Research, Sheba, Israel
Publisher
Oxford University Press
Abstract
Aims: Physical activity is a fundamental component of rehabilitation
following coronary artery bypass (CABG) surgery. Proximity to
neighbourhood green spaces may encourage physical activity. We
investigated the association between residential greenness and
exercise-related physical activity post-CABG surgery. Method(s):
Participants in a prospective cohort study of 846 patients (78% men) who
underwent CABG surgery at seven cardiothoracic units during the time
period 2004-2007 were interviewed regarding their physical activity habits
one day before and one year after surgery. Exposure to residential
neighbourhood greenness (within a 300 m buffer around their place of
residence) was measured using the Normalized Difference Vegetative Index.
Participation in exercise-related physical activity (yes/no), weekly
duration of exercise-related physical activity and the change in
exercise-related physical activity between baseline and follow-up were
examined for associations with residential greenness, adjusting for
socio-demographic factors, propensity score adjusted participation in
cardiac rehabilitation and health-related covariates after multiple
imputation for missing variables. Result(s): Living in a higher
quartile of residential greenness was associated with a 52% greater odds
of being physically active (OR 1.52, 95% CI 1.22-1.90). This association
persisted only (OR 1.75, 95% CI 1.35-2.27) among patients who did not
participate in cardiac rehabilitation following surgery and was stronger
in women (OR 2.38, 95% CI 1.40-4.07) than in men (OR 1.37, 95% CI
1.07-1.75). Participants who lived in greener areas were more likely to
increase their post-surgical physical activity than those who lived in
less green areas (OR 1.59, 95% CI 1.25-2.01). Conclusion(s):
Residential greenness appears to be beneficial in increasing
exercise-related physical activity in cardiac patients, especially those
not particpating in cardiac rehabilitation after CABG
surgery. Copyright © 2019 Published on behalf of the European
Society of Cardiology. All rights reserved.

<51>
Accession Number
636486391
Title
Assessment of Pretreatment with Oral P2Y12 Inhibitors and Cardiovascular
and Bleeding Outcomes in Patients with Non-ST Elevation Acute Coronary
Syndromes: A Systematic Review and Meta-analysis.
Source
JAMA Network Open. 4(11) (no pagination), 2021. Article Number: e2134322.
Date of Publication: 19 Nov 2021.
Author
Dawson L.P.; Chen D.; Dagan M.; Bloom J.; Taylor A.; Duffy S.J.; Shaw J.;
Lefkovits J.; Stub D.
Institution
(Dawson, Lefkovits) Department of Cardiology, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Dawson, Chen, Bloom, Taylor, Duffy, Shaw, Lefkovits, Stub) Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC,
Australia
(Dawson, Dagan, Bloom, Taylor, Duffy, Shaw, Stub) Department of
Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004,
Australia
(Bloom, Duffy, Shaw, Stub) Baker Institute, Melbourne, VIC, Australia
Publisher
American Medical Association
Abstract
Importance: The practice of pretreatment with oral P2Y12 inhibitors in
non-ST elevation acute coronary syndromes (NSTEACS) remains common;
however, its association with improved cardiovascular outcomes is unclear.
 Objective(s): To assess the association between oral P2Y12 inhibitor
pretreatment and cardiovascular and bleeding outcomes in patients with
NSTEACS. Data Sources: On March 20, 2021, PubMed, MEDLINE, Embase,
Scopus, Web of Science, Science Direct, clinicaltrials.gov, and the
Cochrane Central Register for Controlled Trials were searched from
database inception. Study Selection: Randomized clinical trials of
patients with NSTEACS randomized to either oral P2Y12 inhibitor
pretreatment (defined as prior to angiography) or no pretreatment (defined
as following angiography, once coronary anatomy was known) among patients
undergoing an invasive strategy. Data Extraction and Synthesis: This study
followed Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines. Data on publication year, sample size, clinical
characteristics, revascularization strategy, P2Y12 inhibitor type and
dosage, time from pretreatment to angiography, and end point data were
independently extracted by 2 authors. A random-effects model was used,
including stratification by (1) P2Y12 inhibitor type, (2)
revascularization strategy, and (3) access site. Main Outcomes and
Measures: The primary end point was 30-day major adverse cardiac events
(MACEs). Secondary end points were 30-day myocardial infarction (MI) and
cardiovascular death. The primary safety end point was 30-day major
bleeding (defined according to individual studies). Result(s): A
total of 7 trials randomizing 13226 patients to either pretreatment (6603
patients) or no pretreatment (6623 patients) were included. The mean age
of patients was 64 years and 3598 (27.2%) were female individuals.
Indication for P2Y12 inhibitors was non-ST elevation myocardial infarction
in 7430 patients (61.7%), radial access was used in 4295 (32.6%), and
10945 (82.8%) underwent percutaneous coronary intervention. Pretreatment
was not associated with a reduction in 30-day MACE (odds ratio [OR], 0.95;
95% CI, 0.78-1.15; I2= 28%), 30-day MI (OR, 0.90; 95% CI,
0.72-1.12; I2= 19%), or 30-day cardiovascular death (OR, 0.79;
95% CI, 0.49-1.27; I2= 0%). The risk of 30-day major bleeding
was increased among patients who underwent pretreatment (OR, 1.51; 95% CI,
1.16-1.97; I2= 41%). The number needed to harm to bring about 1
major bleeding event with oral P2Y12 inhibitor pretreatment was 63
patients. Conclusions and Relevance: In this study, pretreatment with
oral P2Y12 inhibitors among patients with NSTEACS prior to angiography,
compared with treatment once coronary anatomy is known, was associated
with increased bleeding risk and no difference in cardiovascular outcomes.
Routine pretreatment with oral P2Y12 inhibitors in patients with NSTEACS
receiving an early invasive strategy is not supported by this
study.. Copyright © 2021 American Medical Association. All rights
reserved.

<52>
Accession Number
2013221298
Title
Ross Operation in Neonates: A Meta-analysis.
Source
Annals of Thoracic Surgery. 113(1) (pp 192-198), 2022. Date of
Publication: January 2022.
Author
Rajab T.K.; Zorrilla-Vaca A.; Kavarana M.N.; Mokashi S.; Sainathan S.
Institution
(Rajab, Kavarana) Section of Pediatric Cardiothoracic Surgery, Department
of Surgery, Medical University of South Carolina, Charleston, SC, United
States
(Zorrilla-Vaca) Department of Anesthesiology and Perioperative Medicine,
University of Texas MD Anderson Cancer Center, Houston, TX, United States
(Mokashi) Division of Cardiac Surgery, Department of Surgery, Creighton
University, Omaha, NE, United States
(Sainathan) Section of Pediatric Cardiac Surgery, Department of Surgery,
University of North Carolina, Chapel Hill, NC, United States
Publisher
Elsevier Inc.
Abstract
Background: The Ross operation is the preferred treatment for aortic valve
replacement in children. However previous studies indicate that outcomes
in neonates are poor. This meta-analysis examines the pooled outcomes of
the Ross operation in neonates. Method(s): Four major databases
(PubMed/MEDLINE, EMBASE, Scopus, and ScienceDirect) were searched from
inception until May 1, 2020 for studies describing outcomes of the Ross
operation in neonates. The primary outcome was early mortality, and
secondary outcomes were late mortality and mechanical support.
Random-effects models were used to account for possible heterogeneity
between studies, and continuity corrections were used to include zero
total event trials. Result(s): Eighteen studies comprising outcomes
data on 181 neonates were included in the analysis. Meta-analysis showed a
pooled early mortality rate of 24% (95% confidence interval, 12%-38%;
I2 = 52%, P for heterogeneity = .01). Meta-regression analysis
showed that more recently published studies reported significantly worse
early mortality (P = .03). The pooled incidence of postoperative
mechanical support was 15% (95% confidence interval, 5%-28%; I2
= 28%, P for heterogeneity = .22). No evidence of publication bias was
found according to Egger's test (bias coefficient = 0.21, P = .57).
 Conclusion(s): The neonatal Ross operation carries a high early
mortality rate. The treatment of unrepairable aortic valves in neonates
remains an unsolved problem in congenital cardiac surgery. Copyright
© 2022 The Society of Thoracic Surgeons

<53>
Accession Number
2015266762
Title
Comparison of Ultrasound-Guided Pectointercostal Fascial Block and
Transversus Thoracic Muscle Plane Block for Acute Poststernotomy Pain
Management After Cardiac Surgery: A Prospective, Randomized, Double-Blind
Pilot Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Kaya C.; Dost B.; Dokmeci O.; Yucel S.M.; Karakaya D.
Institution
(Kaya, Dost, Dokmeci, Karakaya) Department of Anaesthesiology and
Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
(Yucel) Department of Cardiovascular Surgery, Ondokuz Mayis University
Faculty of Medicine, Samsun, Turkey
Publisher
W.B. Saunders
Abstract
Objective: The objective of the present study was to evaluate morphine
consumption and pain scores 24 hours postoperatively to compare the
effects of a bilateral pectointercostal fascial block (PIFB) with those of
a transversus thoracic muscle plane block (TTMPB) on acute poststernotomy
pain in cardiac surgery patients who have undergone median sternotomy.
 Design(s): Prospective, randomized, double-blinded. Setting(s):
The operating room, intensive care unit, and patient ward at a university
hospital. Participant(s): Thirty-nine American Society of
Anesthesiologists II-to-III patients aged 18- to-80 years, scheduled for
elective cardiac surgery via median sternotomy. Intervention(s):
Patients randomly were allocated to groups scheduled to receive bilateral
ultrasound-guided PIFB or TTMPB. Measurements and Main Results: The
primary outcome was postoperative morphine use within the first 24 hours.
Secondary outcomes were the numerical pain rating scale (NRS) scores at
rest and during coughing, time of first analgesic demand from the
patient-controlled analgesia (PCA) device, and rescue analgesia use. The
nausea/vomiting scores, time to extubation, length of stays in intensive
care and the hospital, patient satisfaction scores, and complications were
also recorded. The first 24-hour morphine use did not significantly differ
between the PIFB and TTMPB groups (mean +/- standard deviation [95% CI],
13.89 +/- 6.80 [10.83-16.95] mg/24 h and 15.08 +/- 7.42 [11.83-18.33]
mg/24 h, respectively, p = 0.608). No significant difference between the
two groups in the NRS scores at rest and during coughing was observed; the
groups had similar requirements for rescue analgesia in the first 24 hours
(n [%], three [15.8] and seven [35], p = 0.273, respectively). The time
from PCA to the first analgesia request was longer in the PIFB than in the
TTMPB group (median [interquartile range], 660 [540-900] minutes, and 240
[161-525] minutes, respectively, p = 0.002). Conclusion(s): PIFB and
TTMPB showed similar effectiveness for morphine consumption within 24
hours postoperatively and in pain scores in cardiac surgery
patients. Copyright © 2021 Elsevier Inc.

<54>
Accession Number
2007563566
Title
A systematic review on durability and structural valve deterioration in
TAVR and surgical AVR.
Source
Acta Cardiologica. 76(9) (pp 921-932), 2021. Date of Publication: 2021.
Author
Okutucu S.; Niazi A.K.; Oliveira D.; Fatihoglu S.G.; Oto A.
Institution
(Okutucu, Oto) Department of Cardiology, Memorial Ankara Hospital, Ankara,
Turkey
(Niazi) Department of Cardiovascular Surgery, Shalamar Medical & Dental
College, Lahore, Pakistan
(Oliveira) Department of Cardiology, Federal University of Pernambuco,
Recife, Brazil
(Fatihoglu) Department of Cardiology, Iskenderun State Hospital, Hatay,
Turkey
Publisher
Taylor and Francis Ltd.
Abstract
Mechanical valves and bioprosthetic heart valves are widely used for
aortic valve replacement (AVR). Mechanical valves are associated with risk
of bleeding because of oral anticoagulation, while the durability and
structural valve deterioration (SVD) represent the main limitation of the
bioprosthetic heart valves. The implantation of bioprosthetic heart valves
is increasing precipitously due aging population, and the widespread use
of transcatheter aortic valve replacement (TAVR). TAVR has become the
standard treatment for intermediate or high surgical risk patients and a
reasonable alternative to surgery for low risk patients with symptomatic
severe aortic stenosis. Moreover, TAVR is increasingly being used for
younger and lower-risk patients with longer life expectancy; therefore it
is important to ensure the valve durability for long-term transcatheter
aortic valves. Although the results of mid-term durability of the
transcatheter heart valves are encouraging, their long-term durability
remains largely unknown. This review summarises the definitions,
mechanisms, risk factors and assessment of SVD; overviews available data
on surgical bioprosthetic and transcatheter heart valves
durability. Copyright © 2020 Belgian Society of Cardiology.

<55>
Accession Number
633225626
Title
The Effect of Melatonin on the Serum Level of Interleukin 6 and
Interleukin 9 in Coronary Artery Bypass Grafting Surgery.
Source
Asian journal of anesthesiology. 58(1) (pp 35-44), 2020. Date of
Publication: 01 Mar 2020.
Author
Jouybar R.; Setoodeh M.; Saravi Z.F.; Ahmadi S.; Karami A.; Khademi S.;
Izadpanah A.; Jannati M.; Shafa M.; Asadpour E.; Masih F.; Malekzadeh M.
Institution
(Jouybar, Karami) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Setoodeh, Izadpanah) Anesthesiology and Critical Care Research Center,
Shiraz University of Medical Science, Shiraz, Iran, Islamic Republic of
(Saravi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Ahmadi) Fasa University of Medical Science, Fasa, Iran, Islamic Republic
of
(Khademi) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Jannati, Shafa) Assosiated Professor of Cardiovascular Surgery,
Cardiovascular Research Center, Shiraz University of Medical Science,
Shiraz, Iran, Islamic Republic of
(Asadpour) Assosiated Professor of Pharmacology, Anesthesiology and
Critical Care Research Center, Shiraz University of Medical Science,
Shiraz, Iran, Islamic Republic of
(Masih) Anesthesiology and Critical Care Research Center, Shiraz
University of Medical Science, Shiraz, Iran, Islamic Republic of
(Malekzadeh) Shiraz Institute for Cancer Research, School of Medicine,
Shiraz University of Medical Science, Shiraz, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
OBJECTIVE: Cardiopulmonary bypass has been recognized as one of the main
causes of systemic inflammatory response syndrome, leading to
post-operative complications. The aim of this study was to investigate the
effect of melatonin on the serum levels of interleukin 6 (IL-6) and IL-9
in patients undergoing coronary artery bypass grafting surgery.
 METHOD(S): Forty-four patients undergoing elective coronary artery
bypass surgery were randomly allocated into two study groups of melatonin
(n = 23) and placebo (n = 21). Patients in the melatonin group received
two melatonin tablet, 5 mg daily for 3 days before surgery, 10 mg tablet
(two doses of 5 mg) 1 h before induction of anesthesia and finally, 10 mg
melatonin tablet in the intensive care unit, placebo group patients
received placebo at the same time periods. Serum levels of IL-9 and IL-6
were measured as baseline (T1), before induction of anesthesia (T2), 6 and
24 h after off pump (T3, T4). Data were analyzed using SPSS 23 software
(IBM Corp., Armonk, NY, USA). RESULT(S): The mean serum level of IL-6
was significantly lower in the melatonin group at T3 and T4 (p < 0.05).
Also, in both groups, serum levels of IL-6 in T3 showed a significant
increase compared to T1. Serum levels of IL-9 had no significant
difference between the two groups at T1, T2, T3, and T4.
 CONCLUSION(S): The results of this study showed that pre-operative
melatonin administration could modify inflammatory cytokines secretion
such as IL-6 while it has no significant effect on the serum levels of IL-
9. Neither of the changes was clinically significant.

<56>
Accession Number
636616287
Title
Comprehensive analysis of early outcomes in radical nephrectomy with
Inferior Venacava thrombectomy-a seven year single center experience.
Source
Journal of Endourology. Conference: 38th World Congress of Endourology,
WCE 2021. Virtual. 35(SUPPL 1) (pp A292-A293), 2021. Date of Publication:
2021.
Author
Thangarasu M.; Jayaprakash S.; Ganesan T.; Venugopal B.; Ragavan N.;
Balakrishnan A.; Raghavan D.; Jain N.
Institution
(Thangarasu, Jayaprakash, Ganesan, Venugopal, Ragavan, Balakrishnan,
Raghavan, Jain) Apollo Main Hospitals, Chennai, Tamil Nadu, India
Publisher
Mary Ann Liebert Inc.
Abstract
Introduction & Objective: Renal cell carcinoma( RCC) accounts to 2-3 % of
all malignancies, among which 3-4% of RCC has tumour thrombus extension
into Inferior Vena Cava (IVC) and 1 % has extension of tumour thrombus
into right atrium. We present a 7 year, single institution experience
during which we have managed 36 cases of RCC with IVC thrombus with
radical nephrectomy along with IVC thrombectomy. Method(s): We did a
retrospective analysis of all patients who underwent radical nephrectomy
along with IVC thrombectomy by a dedicated urology , vascular surgery and
cardiothoracic surgery team, from the year 2013 to 2020. Mayo's
classification was used to classify level of IVC thrombus. We collected
demographic data, presenting symptoms , intra-operative and perioperative
details, histopathology, complications and overall survival status.
 Result(s): Total number of patients included in the study were 36,
out of which 30 (83.3%) of them were males. Mean age of patients were 55.2
+/-8.8 years. The mean size of renal tumour was 10+/- 3.5 cms, 9.7 +/- 3.5
cms, 10+/- 5.9 cms and 9.5+/-2.1 cms (p = 0.998) and the mean operating
time was 2.8 +/-0.3 hours, 4.6 +/- 2.1hours, 4.4+/- 1.1hours and
10.2+/-2.6 hours (p = 0.0001) for level 1,2,3, and 4 tumours respectively.
There was a significant difference in the amount of blood loss between the
different levels, (p = 0.043) but post-hoc analysis showed, there was no
significant difference between level 3 and 4 tumours (p = 0.656).
Histopathology revealed Clear cell variants in 25 patients( 69%). The
overall mean survival time was 66 months with 95% Confidence interval of
53-78 months. Kaplan-Meier survival analysis and Log rank test showed
there was a significant difference in survival,(p = 0.002) between
different levels of thrombus. The mean Body mass index was very low in
patients who died (19+/-1.3) which was significant. The hospital stay was
more in level 3 and 4 patients, but were not statistically significant (p
= 0.112). The death rate was 11%, 16%, 66% in level 2,3 and 4 tumours
respectively which was not statistically significant (p = 0.094). Overall
mortality rate was 16.6% in this study. Conclusion(s): RCC with IVC
thrombus needs radical nephrectomy with IVC thrombectomy, which is a
technically demanding procedure, needing multi-speciality collaboration
and a well equipped critical care unit is a necessity to improve morbidity
and mortality. There was a significant difference in survival between
different levels of thrombus with high mortality in level 4 tumours. The
tumor size doesn't have an influence on the progression of tumour thrombus
into IVC. Further prospective randomised trial to study the disease free
survival are required in patients who receive chemotherapy.

<57>
Accession Number
636614039
Title
Diagnostic accuracy of coronary computed tomography angiography (CCTA) for
the evaluation of obstructive coronary artery disease in patients referred
for transcatheter aortic valve implantation (TAVI): A systematic review
and meta-analysis.
Source
International Journal of Cardiovascular Imaging. Conference: European
Society of Cardiovascular Radiology Meeting, ESCR 2021. Virtual. 37(12)
(pp 3655-3657), 2021. Date of Publication: December 2021.
Author
Gatti M.; Gallone G.; Bruno F.; Poggi V.; Serafini A.; De Filippo O.;
Depaoli A.; Faletti R.; De Ferrari G.M.; Fonio P.; D'Ascenzo F.
Institution
(Gatti) TurinItaly
Publisher
Springer Netherlands
Abstract
Purpose/Objectives TAVI is now the standard procedure for treating
patients with severe aortic stenosis who cannot undergo surgical aortic
valve replacement [1]. CTA is a standard procedure in the pre-TAVI
diagnostic workup [1,3]. However, patients undergoing TAVI have a high
pretest risk of severe coronary calcifications (about 50%) [3], the
presence of abnormal rhythm that cannot be controlled with beta-blockers
is quite common and they cannot be given nitrates, thus complicating the
evaluation of CAD with CCTA [1]. Therefore, in accordance with current
guidelines, ICA is recommended prior to TAVI to evaluate CAD [1]. On the
other hand, CCTA might be a tool to evaluate the presence of coronary tree
significant stenosis avoiding unnecessary ICA (reducing risk of
complication, costs and dose of iodinated contrast medium) [4, 5]. Based
on this consideration, the aim of our metanalysis is to evaluate the
diagnostic accuracy of CCTA for the evaluation of coronary tree in
patients referred for TAVI. Methods and Materials PubMed/MEDLINE, EMBASE
and CENTRAL were searched up to May 1st, 2021. We included studies
reporting data on diagnostic accuracy of CCTA in patients with severe
aortic stenosis referred for TAVI who underwent during the diagnostic
work-up ICA, who served as a reference. QUADAS-2 tool was used to assess
the quality of included studies. The primary endpoint was the
patient-level accuracy of CCTA to identify obstructive CAD. For the
purpose of this analysis, non-evaluable segments were considered positive
based on an intention to diagnose approach. Secondary analysis included
the evaluation of the accuracy of CCTA for obstructive CAD at the
patient-level excluding patients with non-evaluable segments, at the
vessel- and at the segment-level. Subgroup analyses according to CT
scanner characteristics (i.e. single heartbeat scanner CTs vs. others)
were further performed. Any outcome of interest reported by each study
will be included and graphically displayed by forest plots and summary ROC
curves. Results A total of 2228 patients were included in the analysis
performed at the patient-level considering nonevaluable segments as
positive. The pooled sensitivity and specificity for CCTA were 97%(94-98%)
and 68%(56-68%), respectively and the Positive and Negative Likelihood
Radio were 3.0(2.1-4.3) and 0.05[0.03-0.09], respectively; with a
diagnostic Odds Ratio of 60(30-121). The HSROC has an AUC =
0.96(0.94-0.98). To put our results into clinical practice, estimating a
disease prevalence of 40% in a population of 1000 patients, the study of
coronary arteries with CCTA prior to TAVI would correctly avoid 409 (95%CI
335-470) ICAs. A subgroup analysis comparing single heartbeat scanner CTs
to others found no difference in sensitivity [0.96%(91-98%) vs.
97%(94-99%); p = 0.37], whereas the specificity of single heartbeat
scanner CTs is higher than others [81%(67-90%) vs. 58%(43-71%); p <
0.0001]. Conclusion In conclusion, CCTA has excellent diagnostic accuracy
for assessing obstructive CAD in patients referred for TAVI. Routine CCTA
of coronary arteries as part of the pre-TAVI work-up would save more than
40% of ICAs. The use of single-heart beat scanners, which provide greater
specificity, can improve such data even further.

<58>
Accession Number
2015903801
Title
Dexmedetomidine effect on delirium in elderly patients undergoing general
anesthesia: A protocol for systematic review and meta-analysis.
Source
Medicine (United States). 100(48) (no pagination), 2021. Article Number:
027782. Date of Publication: 03 Dec 2021.
Author
Wang Y.; Bu X.; Zhao N.; Wang S.; Wang X.; Ge Y.; Yi H.
Institution
(Wang) Department of Anesthesiology, Nanjing First Hospital, Nanjing
Medical University, Nanjing, China
(Bu, Wang, Ge) Department of Anesthesiology, Nanjing First Hospital,
Nanjing, China
(Zhao, Wang) School of Public Health, Gansu University of Traditional
Chinese Medicine, Lanzhou, China
(Zhao) Center for Evidence-based Medicine, Gansu University of Traditional
Chinese Medicine, Lanzhou, China
(Yi) Department of Biostatistics, School of Public Health, Nanjing Medical
University, Nanjing, China
Publisher
Lippincott Williams and Wilkins
Abstract
Background:Delirium is a common postoperative complication. Many studies
have found that dexmedetomidine is associated with a reduced incidence of
postoperative delirium (POD). This meta-analysis aimed to analyze the
effects of dexmedetomidine on POD incidence among elderly patients
undergoing general anesthesia. Method(s):We searched 4 electronic
databases (i.e., Pubmed, Embase, Cochrane, and Web of Science) from
inception to November 30, 2020, for randomized controlled trials that
evaluated the effects of dexmedetomidine in preventing the occurrence of
POD in elderly patients (aged >=60 years). The study protocol was
registered in PROSPERO (CRD42020192114). Result(s):14 studies with
4173 patients showed that dexmedetomidine was significantly associated
with a decreased POD incidence among elderly patients (relative risk [RR]
= 0.58; 95% confidence interval [CI] = 0.44-0.76). The incidence of POD
was significantly reduced in the noncardiac surgery group (RR 0.51; 95% CI
0.37-0.72), when dexmedetomidine was applied during the postoperative
period (RR = 0.53; 95% CI = 0.40-0.70), and in patients received low-doses
(RR = 0.54; 95% CI = 0.34-0.87) and normal-doses (RR = 0.59; 95% CI =
0.42-0.83). There were no significant differences in POD incidence in the
cardiac surgery group (RR = 0.71; 95% CI = 0.45-1.11), and when
dexmedetomidine was applied during the intra- (RR = 0.55; 95% CI =
0.29-1.01) or perioperative period (RR = 0.95; 95% CI = 0.64-1.40).
 Conclusion(s):Our meta-analysis suggests that dexmedetomidine may
significantly reduce POD incidence in elderly noncardiac surgery patients
and when applied during the postoperative period, in addition, both low-
and normal-doses of dexmedetomidine may reduce POD incidence. However, its
use in cardiac surgery patients and during the intra- or perioperative
period may have no significant effects on POD incidence. Copyright
© 2021 Lippincott Williams and Wilkins. All rights reserved.

<59>
Accession Number
636600293
Title
The Efficacy and Safety of Ultrasound-Guided, Bi-Level, Erector Spinae
Plane Block With Different Doses of Dexmedetomidine for Patients
Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 577885.
Date of Publication: 25 Nov 2021.
Author
Gao X.; Zhao T.; Xu G.; Ren C.; Liu G.; Du K.
Institution
(Gao, Zhao, Xu, Ren, Liu) Department of Anesthesiology, Liaocheng People's
Hospital, Liaocheng, China
(Du) Department of Thoracic Surgery, Liaocheng People's Hospital,
Liaocheng, China
Publisher
Frontiers Media S.A.
Abstract
Background: The anesthetic characteristics of ultrasound-guided bi-level
erector spinae plane block (ESPB) plus dexmedetomidine (Dex) remain
unclear. We compared the efficacy and safety of ultrasound-guided bi-level
ESPB plus different doses of Dex in patients undergoing video-assisted
thoracic surgery (VATS). Method(s): One-hundred eight patients
undergoing VATS were randomized into three groups: R group (n = 38, 15 ml
of 0.375% ropivacaine with 0.1 mg/kg dexamethasone), RD1 group (n = 38, 15
ml of 0.375% ropivacaine plus 0.5 mug/kg DEX with 0.1 mg/kg dexamethasone)
and RD2 group (n = 38, 15 ml of 0.375% ropivacaine plus 1.0 mug/kg DEX
with 0.1 mg/kg dexamethasone). The primary outcome was the pain 12 h after
surgery. Secondary outcomes included the Prince Henry Hospital Pain Score;
hemodynamics; consumption of sufentanil; anesthetized dermatomal
distribution; recovery time; rescue analgesia; satisfaction scores of
patients and surgeon; quick recovery index; adverse effects; the
prevalence of chronic pain and quality of recovery. Result(s): The
visual analog scale (VAS) and the Prince Henry pain score were
significantly lower in both the RD1 and RD2 groups during the first 24 h
after surgery (P < 0.05). Both VAS with coughing and the Prince Henry pain
score were significantly lower in the RD2 group than in the RD1 group 8-24
h after surgery (P < 0.05). Both heart rate and mean arterial pressure
were significantly different from T2 to T6 in the RD1 and RD2 groups (P <
0.05). The receipt of remifentanil, propofol, Dex, and recovery time was
significantly reduced in the RD2 group (P < 0.05). The requirement for
sufentanil during the 8-72 h after surgery, less rescue medication, and
total press times were significantly lower in the RD2 group (P < 0.05).
The time to the first dose of rescue ketorolac was significantly longer in
the RD2 group (P < 0.05). Further, anal exhaust, removal of chest tubes,
and ambulation were significantly shorter in the RD2 group (P < 0.05). The
incidence of tachycardia, post-operative nausea and vomiting, and chronic
pain was significantly reduced in the RD2 group, while the QoR-40 score
was significantly higher in the RD2 group (P < 0.05). Conclusion(s):
Pre-operative bi-level, single-injection ESPB plus 1 mug/kg DEX provided
superior pain relief and long-term post-operative recovery for patients
undergoing VATS. Clinical Trial Registration:
http://www.chictr.org.cn/searchproj.aspx. Copyright © 2021 Gao,
Zhao, Xu, Ren, Liu and Du.

<60>
Accession Number
2015852716
Title
Noninvasive diagnosis of liver fibrosis in the complex cardiac
malformation survivors - a review of the literature.
Source
Medical Ultrasonography. 23(4) (pp 453-462), 2021. Date of Publication:
2021.
Author
Mares R.-C.; Marginean C.O.
Institution
(Mares, Marginean) Department of Pediatrics, "George Emil Palade"
University of Medicine, Pharmacy, Sciences and Technology, Targu Mures,
Romania
Publisher
Societatea Romana de Ultrasonografie in Medicina si Biologie
Abstract
The aim of this review is to summarize the information on the pathogenesis
and diagnosis of congestive liver disease secondary to the Fontan and
Glenn surgery for complex cardiac malformations, focusing on non-invasive
diagnostic modalities. We performed an electronic database search (Pubmed,
Web of Science) with the data range from 2001 to 2020. We selected the
studies that addressed the pathogenesis of congestive liver disease
secondary to cardiac malformations and articles regarding noninvasive
methods of determining liver fibrosis in this group. We found that
conventional imaging methods do not allow the detection of the initial
stages of liver fibrosis. Elastography results are altered by congestion
and cut-off values are not yet validated. More studies are required in
order to provide evidence-based guidelines regarding the non-invasive
diagnosis of hepatic fibrosis secondary to congenital heart disease.
Patients with congenital cardiac malformations require close monitoring
and early diagnosis of liver complications to allow prompt therapeutic
intervention. Copyright © 2021 Societatea Romana de
Ultrasonografie in Medicina si Biologie. All rights reserved.

<61>
Accession Number
2014416838
Title
Target blood pressure management during cardiopulmonary bypass improves
lactate levels after cardiac surgery: a randomized controlled trial.
Source
BMC Anesthesiology. 21(1) (no pagination), 2021. Article Number: 309. Date
of Publication: December 2021.
Author
Miao Q.; Wu D.J.; Chen X.; Xu M.; Sun L.; Guo Z.; He B.; Wu J.
Institution
(Miao, Wu, Chen, Xu, Wu) Department of Anesthesiology, Shanghai Chest
Hospital, Shanghai Jiao Tong University, No. 241 West Huaihai Road,
Shanghai 200030, China
(Sun, Guo) Department of Cardiopulmonary Bypass, Shanghai Chest Hospital,
Shanghai Jiao Tong University, Shanghai, China
(He) Department of Intensive Care Unit, Shanghai Chest Hospital, Shanghai
Jiao Tong University, Shanghai, China
Publisher
BioMed Central Ltd
Abstract
Background: Hyperlactatemia is associated with a poor prognosis in cardiac
surgery patients. This study explored the impact of target blood pressure
management during cardiopulmonary bypass (CPB) on blood lactate levels
after cardiac surgery. Method(s): Adult patients undergoing cardiac
valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital
were enrolled. The patients were randomized into a low mean arterial
pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean
arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n =
20 for each. Norepinephrine was titrated only during CPB to maintain MAP
at the target level. Blood lactate levels in the two groups were detected
before the operation (T0), at the end of CPB (T1), at the end of the
operation (T2), 1 h after the operation (T3), 6 h after the operation (T4)
and 24 h after the operation (T5). The primary outcome was the blood
lactate level at the end of the operation (T2). The secondary outcomes
included the blood lactate level at T1, T3, T4, and T5 and the dose of
epinephrine and dopamine within 24 h after the operation, time to
extubation, length of stay in the ICU, incidence of readmission within 30
days, and mortality within 1 year. Result(s): Forty patents were
enrolled and analyzed in the study. The lactate level in the H-MAP group
was significantly lower than that in the L-MAP group at the end of the
operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at
the end of CPB and 1 hour after surgery. The dose of epinephrine within 24
h after the operation, time to extubation and length of stay in the ICU in
the L-MAP group were significantly higher than those in the H-MAP group.
 Conclusion(s): Maintaining a relatively higher MAP during CPB
deceased the blood lactate level at the end of surgery, reduced
epinephrine consumption, and shortened the time to extubation and length
of stay in the ICU after surgery. Trial registration: This single-center,
prospective, RCT has completed the registration of the Chinese Clinical
Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It
was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in
Shanghai Chest Hospital. Copyright © 2021, The Author(s).

<62>
Accession Number
2015895721
Title
Iatrogenic Atrial Septal Defects Following Transcatheter Mitral Valve
Repair and Implications of Interventional Closure.
Source
JACC: Cardiovascular Interventions. 14(24) (pp 2685-2694), 2021. Date of
Publication: 27 Dec 2021.
Author
Lurz P.; Unterhuber M.; Rommel K.-P.; Kresoja K.-P.; Kister T.; Besler C.;
Fengler K.; Sandri M.; Daehnert I.; Thiele H.; Blazek S.; von Roeder M.
Institution
(Lurz, Unterhuber, Rommel, Kresoja, Kister, Besler, Fengler, Sandri,
Thiele, Blazek, von Roeder) Department of Internal Medicine/Cardiology,
Heart Center Leipzig at Leipzig University, Leipzig, Germany
(Lurz, Kresoja, Thiele) Leipzig Heart Institute, Leipzig, Germany
(Daehnert) Department of Pediatric Cardiology, Heart Center Leipzig at
Leipzig University, Leipzig, Germany
Publisher
Elsevier Inc.
Abstract
Objectives: The authors investigated whether iatrogenic atrial septal
defect (iASD) closure post-transcatheter mitral valve edge-to-edge repair
(TMVR) is superior to conservative therapy (CT) and whether outcomes
(death/heart failure [HF] hospitalization) differ between patients with
and without an iASD post-TMVR. Background(s): Transseptal access for
TMVR can create an iASD, which is associated with impaired outcomes.
Controversially, the creation of an iASD in HF has been linked to improved
hemodynamics. Method(s): 80 patients with an iASD and relevant
left-to-right shunting (Qp:Qs >=1.3) 30 days following TMVR were
randomized to CT or interventional closure of the iASD (MITHRAS [Closure
of Iatrogenic Atrial Septal Defect Following Transcatheter Mitral Valve
Repair] cohort), and 235 patients without an iASD served as a comparative
cohort. Result(s): All patients of the MITHRAS cohort (mean age 77
+/- 9 years, 39% women) received their allocated treatment, and follow-up
was completed for all MITHRAS and comparative cohort (mean age 77 +/- 8
years, 47% women) patients. Twelve months post-TMVR, there was no
significant difference in the combined endpoint of death or HF
hospitalization within the MITHRAS cohort (iASD closure: 35% vs CT 50%; P
= 0.26). The combined endpoint was more frequent among patients within the
MITHRAS cohort as opposed to the comparative cohort (43% vs 17%; P <
0.0001), primarily driven by a higher rate of HF hospitalization (34% vs
8%; P = 0.004). Conclusion(s): In this randomized controlled trial,
interventional closure of a relevant iASD 1 month after TMVR did not
result in improved clinical outcomes at 12 months post-TMVR. Patients with
an iASD are at higher risk for HF hospitalization independent of iASD
management and warrant close follow-up. (Closure of Iatrogenic Atrial
Septal Defect Following Transcatheter Mitral Valve Repair [MITHRAS];
NCT03024268) Copyright © 2021 American College of Cardiology
Foundation

<63>
[Use Link to view the full text]
Accession Number
2015915283
Title
Clinical risk score for postoperative pneumonia following heart valve
surgery.
Source
Chinese Medical Journal. 134(20) (pp 2447-2456), 2021. Date of
Publication: 20 Oct 2021.
Author
Wang D.-S.; Huang X.-F.; Wang H.-F.; Le S.; Du X.-L.
Institution
(Wang, Huang, Wang, Le, Du) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Hubei, Wuhan 430022, China
Publisher
Lippincott Williams and Wilkins
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. 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.
 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. 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. Copyright ©
2021 Lippincott Williams and Wilkins. All rights reserved.

<64>
Accession Number
2015913481
Title
Comparison of Preoperative Surgical Risk Estimated by Thoracic Surgeons vs
a Standardized Surgical Risk Prediction Tool.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Dyas A.R.; Colborn K.L.; Bronsert M.R.; Henderson W.G.; Mason N.J.;
Rozeboom P.D.; Pradhan N.; Lambert-Kerzner A.; Meguid R.A.
Institution
(Dyas, Colborn, Bronsert, Henderson, Mason, Rozeboom, Pradhan,
Lambert-Kerzner, Meguid) Surgical Outcomes and Applied Research Program,
Department of Surgery, University of Colorado School of Medicine, Aurora,
CO, United States
(Bronsert, Henderson, Lambert-Kerzner, Meguid) Adult and Child Center for
Health Outcomes Research and Delivery Science, University of Colorado
School of Medicine, Aurora, CO, United States
(Colborn, Henderson) Department of Biostatistics and Informatics, Colorado
School of Public Health, Aurora, CO, United States
Publisher
W.B. Saunders
Abstract
Considerable variability exists between surgeons' assessments of a
patient's individual preoperative surgical risk. Surgical risk calculators
are not routinely used despite their validation. We sought to compare
thoracic surgeons' prediction of patients' risk of postoperative adverse
outcomes vs a surgical risk calculator, the Surgical Risk Preoperative
Assessment System (SURPAS). We developed vignettes from 30 randomly
selected patients who underwent thoracic surgery in the American College
of Surgeons' National Surgical Quality Improvement Program database.
Twelve thoracic surgeons estimated patients' preoperative risks of
postoperative morbidity and mortality. These were compared to SURPAS
estimates of the same vignettes. C-indices and Brier scores were
calculated for the surgeons' and SURPAS estimates. Agreement between
surgeon estimates was examined using intraclass correlation coefficients
(ICCs). Surgeons estimated higher morbidity risk compared to SURPAS for
low-risk patients (ASA classes 1-2, 11.5% vs 5.1%, P <= 0.001) and lower
morbidity risk compared to SURPAS for high-risk patients (ASA class 5,
37.6% vs 69.8%, P < 0.001). This trend also occurred in high-risk patients
for mortality (ASA 5, 11.1% vs 44.3%, P < 0.001). C-indices for SURPAS vs
surgeons were 0.84 vs 0.76 (P = 0.3) for morbidity and 0.98 vs 0.85 (P =
0.001) for mortality. Brier scores for SURPAS vs surgeons were 0.1579 vs
0.1986 for morbidity (P = 0.03) and 0.0409 vs 0.0543 for mortality (P =
0.006). ICCs showed that surgeons had moderate risk agreement for
morbidity (ICC = 0.654) and mortality (ICC = 0.507). Thoracic surgeons and
patients could benefit from using a surgical risk calculator to better
estimate patients' surgical risks during the informed consent
process. Copyright © 2021 Elsevier Inc.

<65>
Accession Number
2015854702
Title
Risk factors of invasive fungal infections in lung transplant recipients:
A systematic review and meta-analysis.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Phoompoung P.; Villalobos A.P.C.; Jain S.; Foroutan F.; Orchanian-Cheff
A.; Husain S.
Institution
(Phoompoung, Villalobos, Foroutan, Husain) Ajmera Transplant Center,
University Health Network, Toronto, Canada
(Phoompoung) Faculty of Medicine Siriraj Hospital, Mahidol University,
Bangkok, Thailand
(Jain) Trillium Health Partners, Canada
(Orchanian-Cheff) Library and Information Services, University Health
Network, Toronto, Canada
Publisher
Elsevier Inc.
Abstract
Background: : Invasive fungal infection (IFI) remains a common
complication after lung transplantation, causing significant morbidity and
mortality. We have attempted to quantify systematically risk factors of
IFI in lung transplant recipients. Method(s): : Studies were
retrieved from Ovid MEDLINE, Ovid Embase, Cochrane database of systematic
reviews and Cochrane central register of controlled trials. All
case-control and cohort studies evaluating the risk factors of IFI in
adult lung transplant recipients were screened. Two researchers reviewed
and assessed all studies independently. We pooled the estimated effect of
each factor associated with IFI by using a random effect model.
 Result(s): : Eight studies were included in the systematic review and
5 studies were eligible for the meta-analysis. Rates of IFI range from 8%
to 33% in lung transplant recipients. Independent risk factors for
invasive aspergillosis (IA) in lung transplantation include previous
fungal colonization (odds ratio [OR] 2.44; 95% confidence interval [CI]
0.08-0.47), cytomegalovirus infection (OR 1.96; 95% CI 1.08-3.56), and
single lung transplantation (OR 1.77; 95% CI 1.08-2.91). Pre-emptive
antifungal therapy is a protective factor for IA in lung transplant (OR
0.2; 95% CI 0.08-0.47). Conclusion(s): : Cytomegalovirus infection,
previous fungal colonization and single lung transplantation independently
increase the risk of IA in lung transplant recipients. Pre-emptive
antifungal therapy is a protective factor for IA in the lung transplant
population. Copyright © 2021

<66>
Accession Number
2015797354
Title
Hybrid coronary revascularization versus percutaneous coronary
intervention: A systematic review and meta-analysis.
Source
IJC Heart and Vasculature. 37 (no pagination), 2021. Article Number:
100916. Date of Publication: December 2021.
Author
Van den Eynde J.; Sa M.P.; De Groote S.; Amabile A.; Sicouri S.; Ramlawi
B.; Torregrossa G.; Oosterlinck W.
Institution
(Van den Eynde, De Groote, Oosterlinck) Department of Cardiovascular
Diseases, University Hospitals Leuven & Department of Cardiovascular
Sciences, KU Leuven, Leuven, Belgium
(Van den Eynde) Helen B. Taussig Heart Center, The Johns Hopkins Hospital
and School of Medicine, Baltimore, United States
(Sa, Ramlawi, Torregrossa) Department of Cardiothoracic Surgery, Lankenau
Heart Institute, Main Line Health Wynnewood, PA, United States
(Sa, Sicouri, Ramlawi) Department of Cardiac Surgery Research, Lankenau
Institute for Medical Research, Wynnewood, PA, United States
(Amabile) Division of Cardiac Surgery, Department of Surgery, Yale School
of Medicine, New Haven, CT, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Hybrid coronary revascularization (HCR) is an emerging
approach for multivessel coronary artery disease (MVD) which combines the
excellent long-term outcomes of surgery with the early recovery and
reduced short-term complications of percutaneous coronary intervention
(PCI). Here, we evaluated the effectiveness of HCR compared to PCI in
patients with MVD. Method(s): A systematic database search in
PubMed/MEDLINE, Embase, Scopus, and CENTRAL/CCTR was conducted by June
2021. Random-effects meta-analysis was performed, comparing major adverse
cardiac and cerebrovascular events (MACCE) at 30 days and at latest
follow-up between patients undergoing HCR versus PCI. Result(s): A
total of 27,041 patients (HCR: 939 patients, PCI: 26,102 patients) were
included from seven studies published between 2013 and 2021. At latest
follow-up, HCR was associated with lower rates of myocardial infarction
(OR 0.40, 95% CI 0.20-0.80, p = 0.010) and target vessel revascularization
(OR 0.49, 95% CI 0.37-0.64, p < 0.001), while the difference for MACCE did
not reach statistical significance (OR 0.46, 95% CI 0.20-1.05, p = 0.061).
No differences were observed in terms of 30-day outcomes, nor rates of
mortality or stroke at latest follow-up. Conclusion(s): HCR might be
a valid alternative to multivessel PCI, demonstrating a lower incidence of
MI and TVR. Center experience, well-coordinated heart team discussions,
and good patient selection likely remain essential to ensure optimal
outcomes. Future comparative studies are required to define the optimal
target population. Copyright © 2021

<67>
Accession Number
2014754587
Title
Efficacy and safety of tirofiban bridge as an alternative to suspension of
dual antiplatelet therapy in patients undergoing surgery: A systematic
review.
Source
Jornal Vascular Brasileiro. 20 (no pagination), 2021. Article Number:
e20210113. Date of Publication: 2021.
Author
Riscado L.V.S.; de Pinho J.H.S.; Lobato A.C.
Institution
(Riscado, de Pinho) Universidade Federal de Juiz de Fora - UFJF, Faculdade
de Medicina - FAMED, Juiz de Fora, MG, Brazil
(Lobato) Instituto de Cirurgia Vascular e Endovascular de Sao Paulo -
ICVE-SP, Sao Paulo, SP, Brazil
Publisher
Sociedade Brasileira de Angiologia e Cirurgia Vascular
Abstract
Use of a tirofiban bridge is an alternative to simply withdrawing dual
antiplatelet therapy prior to operating on patients at high risk of stent
thrombosis and bleeding. We aimed to evaluate the efficacy and safety of
this protocol in patients undergoing surgery within 12 months of a
percutaneous coronary intervention involving stenting. We performed a
systematic review based on searches of the PubMed, Web of Science,
Cochrane, Embase, Lilacs, and Scielo databases and of the references of
relevant articles on the topic. Five of the 107 studies identified were
included after application of eligibility criteria and analysis of
methodological quality, totaling 422 patients, 227 in control groups.
Notwithstanding the limitations reported, four of the five studies
included indicate that the tirofiban bridge technique is effective for
reducing adverse cardiac events and is safe in terms of not interfering
with the risk of hemorrhagic events or bleeding. However, randomized
clinical trials are needed to provide robust evidence. Copyright
© 2021.

<68>
Accession Number
2010540876
Title
Myocardial bridges: A meta-analysis.
Source
Clinical Anatomy. 34(5) (pp 685-709), 2021. Date of Publication: July
2021.
Author
Roberts W.; Charles S.M.; Ang C.; Holda M.K.; Walocha J.; Lachman N.;
Tubbs R.S.; Loukas M.
Institution
(Roberts, Ang) Department of Medicine, Princess Royal Hospital, Apley
Castle, Telford Shropshire, United Kingdom
(Charles, Tubbs, Loukas) Department of Anatomical Sciences, St. George's
University, School of Medicine, Grenada
(Holda) HEART-Heart Embryology and Anatomy Research Team, Department of
Anatomy, Jagiellonian University Medical College, Cracow, Poland
(Holda) Division of Cardiovascular Sciences, The University of Manchester,
United Kingdom
(Walocha) Department of Anatomy, Jagiellonian University, Medical College,
Krakow, Poland
(Lachman) Department of Clinical Anatomy and Department of Plastic
Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic,
Rochester, MN, United States
(Tubbs) Department of Neurosurgery, Tulane Center for Clinical
Neurosciences, Tulane University School of Medicine, New Orleans, LA,
United States
(Tubbs) Department of Structural & Cellular Biology, Tulane University
School of Medicine, New Orleans, LA, United States
(Tubbs) Department of Neurosurgery and Ochsner Neuroscience Institute,
Ochsner Health System, New Orleans, LA, United States
(Loukas) Department of Anatomy, University of Warmia and Mazury, Olsztyn,
Poland
Publisher
John Wiley and Sons Inc
Abstract
Myocardial bridges are anatomical entities characterized by myocardium
covering segments of coronary arteries. In some patients, the presence of
a myocardial bridge is benign and is only incidentally found on autopsy.
In other patients, however, myocardial bridges can lead to compression of
the coronary artery during systolic contraction and delayed diastolic
relaxation, resulting in myocardial ischemia. This ischemia in turn can
lead to myocardial infarction, ventricular arrhythmias and sudden cardiac
death. Myocardial bridges have also been linked to an increased incidence
of atherosclerosis, which has been attributed to increased shear stress
and the presence of vasoactive factors. Other studies however,
demonstrated the protective roles of myocardial bridges. In this study,
using systematic review and a meta-analytical approach we investigate the
prevalence and morphology of myocardial bridges in both clinical imaging
and cadaveric dissections. We also discuss the pathophysiology, clinical
significance, and management of these anatomical entities. Copyright
© 2020 American Association of Clinical Anatomists

<69>
Accession Number
2007532547
Title
Comparing effect estimates in randomized trials and observational studies
from the same population: An application to percutaneous coronary
intervention.
Source
Journal of the American Heart Association. 10(11) (no pagination), 2021.
Article Number: e020357. Date of Publication: 2021.
Author
Matthews A.A.; Szummer K.; Dahabreh I.J.; Lindahl B.; Erlinge D.;
Feychting M.; Jernberg T.; Berglund A.; Hernan M.A.
Institution
(Matthews, Feychting, Berglund, Hernan) Unit of Epidemiology, Institute of
Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
(Szummer) Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
(Szummer) Department of Medicine, Karolinska Institutet, Huddinge, Sweden
(Dahabreh, Hernan) Department of Biostatistics, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
(Dahabreh, Hernan) Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA, United States
(Lindahl) Department of Medical Sciences, Cardiology and Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Erlinge) Department of Cardiology, Clinical Sciences, Lund University,
Skane University Hospital, Lund, Sweden
(Jernberg) Department of Clinical Sciences, Danderyd University
Hospital-Karolinska Institute, Danderyd, Sweden
(Hernan) Harvard-MIT Division of Health Sciences and Technology, Boston,
MA, United States
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: To understand when results from observational studies and
randomized trials are comparable, we performed an observational emulation
of a target trial designed to ask similar questions as the VALIDATE
(Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation
Myocardial Infarction in Patients on Modern Antiplatelet Therapy)
randomized trial. The VALIDATE trial compared the effect of bivalirudin
and heparin during percutaneous coronary intervention on the risk of
death, myocardial infarction, and bleeding across Sweden. METHODS AND
RESULTS: We specified the protocol of a target trial similar to the
VALIDATE trial, then emulated the target trial in the period before the
VALIDATE trial took place using data from the SWEDEHEART (Swedish Web
System for Enhancement and Development of Evidence-Based Care in Heart
Disease Evaluated According to Recommended Therapies) registry-the same
registry in which the trial was undertaken. The target trial emulation and
the VALIDATE trial both estimated little or no effect of bivalirudin
versus heparin on the risk of death or myocardial infarction by 180 days
(target trial emulation risk ratio for death, 1.21 [95% CI, 0.88 - 1.54];
VALIDATE trial hazard ratio for death, 1.05 [95% CI, 0.78 - 1.41]). The
observational data, however, could not capture less severe cases of
bleeding, resulting in an inability to define a bleeding outcome like the
trial, and could not accurately estimate the comparative risk of death by
14 days, which may be the result of intractable confounding early in
follow-up or the inability to precisely emulate the trial's eligibility
criteria. CONCLUSION(S): Using real-world data to emulate a target
trial can deliver accurate effect estimates. Yet, even with rich
observational data, it is not always possible to estimate the short-term
effect of interventions or the effect on outcomes for which data are not
routinely collected. Copyright © 2021 The Authors. Published on
behalf of the American Heart Association, Inc., by Wiley.

<70>
Accession Number
2005903583
Title
Syndrome of progressive deforming non-inflammatory arthritis of childhood:
two patients of camptodactyly-arthropathy-coxa vara-pericarditis syndrome.
Source
Rheumatology International. 41(10) (pp 1875-1882), 2021. Date of
Publication: October 2021.
Author
Johnson N.; Chaudhary H.; Kumrah R.; Pilania R.K.; Sharma Y.; Sharma A.;
Kaur A.; Mukherjee S.; Kakkar N.; Vignesh P.
Institution
(Johnson, Chaudhary, Kumrah, Pilania, Kaur, Mukherjee, Vignesh) Allergy
Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre,
Postgraduate Institute of Medical Education and Research (PGIMER),
Chandigarh 160012, India
(Kakkar) Department of Histopathology, Postgraduate Institute of Medical
Education and Research, Chandigarh 160012, India
(Sharma, Sharma) Dr. Rajendra Prasad Government Medical College, Kangra,
Himachal Pradesh 176001, India
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a rare
familial arthropathy of childhood, commonly misdiagnosed as juvenile
idiopathic arthritis. It is characterized by non-inflammatory arthropathy,
coxa vara deformity, and sterile pericarditis. We describe two children
with CACP syndrome who were referred to the rheumatology clinic for the
suspicion of inflammatory arthritis. A literature search was carried out
using PubMed/ Medline and Embase databases. English language reports of
mutation-proven cases of CACP syndrome reported until 31 March 2020 were
retrieved and analysed. Both the children had a delay in diagnosis (age at
diagnosis- 12 and 13 years, respectively) and had received
immunomodulatory therapy for suspected inflammatory arthritis. Presence of
symmetrical arthropathy of large joints, camptodactyly, and normal
inflammatory parameters are clues that indicated CACP syndrome. One child
with a novel variant in PRG4 also had associated mitral valve prolapse and
regurgitation. Both had severe constrictive pericarditis requiring
pericardiectomy. On literature review, a total of 98 mutation-proven cases
of CACP syndrome have been reported till date. Arthropathy in CACP
syndrome mainly involves knees, wrists, ankles, and hips. Pericarditis is
usually mild, however, can present rarely with severe symptoms requiring
surgical intervention. CACP syndrome can closely mimic inflammatory
arthritis and early clinical recognition is important to avoid
misdiagnosis. Molecular confirmation is essential for early diagnosis and
future genetic counselling for affected families. Copyright ©
2020, Springer-Verlag GmbH Germany, part of Springer Nature.

<71>
Accession Number
627998519
Title
HDL: Fact, fiction, or function? HDL cholesterol and cardiovascular risk.
Source
European Journal of Preventive Cardiology. 28(2) (pp 166-173), 2021. Date
of Publication: 01 Feb 2021.
Author
Allard-Ratick M.P.; Kindya B.R.; Khambhati J.; Engels M.C.; Sandesara
P.B.; Rosenson R.S.; Sperling L.S.
Institution
(Allard-Ratick, Kindya, Khambhati, Engels) Department of Internal
Medicine, Emory University School of Medicine, United States
(Sandesara, Sperling) Division of Cardiology, Emory University School of
Medicine, United States
(Rosenson) Cardiovascular Institute, Icahn School of Medicine at Mount
Sinai, United States
Publisher
Oxford University Press
Abstract
The measurement of high-density lipoprotein cholesterol is highly utilized
by clinicians to help predict cardiovascular risk, but this measure is not
causally associated with atherosclerotic cardiovascular disease events.
The use of Mendelian randomization studies has led to a change in
investigative attention from the high-density lipoprotein cholesterol
concentration to its physiological functions. High-density lipoprotein
plays key roles in important pathways related to the development of
atherosclerotic disease including reverse cholesterol transport, oxidation
and inflammation, and endothelial function as well as in other
physiological systems including immune system modulation, cellular
apoptosis, and endothelial progenitor cell homeostasis. The identification
of dysfunctional high-density lipoprotein may better predict future
cardiovascular events compared to numerical high-density lipoprotein
cholesterol and aid in enhanced clinical risk stratification. The
emergence of discrete physiological measurements of high-density
lipoprotein, such as cholesterol efflux capacity and the high-density
lipoprotein inflammatory index, may provide an opportunity for clinical
application in the future. However, the validity of these measurements and
their commercial availability remain barriers to a realistic transition to
clinical medicine. Copyright © 2019 Published on behalf of the
European Society of Cardiology. All rights reserved.

<72>
Accession Number
2006080385
Title
Percutaneous coronary intervention versus coronary artery bypass graft for
left main coronary artery disease: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(1) (pp 94-105.e15),
2022. Date of Publication: January 2022.
Author
Gallo M.; Blitzer D.; Laforgia P.L.; Doulamis I.P.; Perrin N.; Bortolussi
G.; Guariento A.; Putzu A.
Institution
(Gallo) Department of Cardiac Surgery, Cardiocentro Ticino, Lugano,
Switzerland
(Blitzer) Department of Surgery, New York Presbyterian Hospital, Columbia
University, New York, NY, United States
(Laforgia) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Doulamis, Guariento) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
(Perrin) Department of Cardiology, Geneva University Hospitals, Geneva,
Switzerland
(Bortolussi) Department of Cardiac Surgery, IRCCS Policlinico San Donato,
Milan, Italy
(Putzu) Division of Anesthesiology, Department of Anesthesiology,
Pharmacology, Intensive Care, and Emergency Medicine, Geneva University
Hospitals, Geneva, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: The optimal revascularization strategy for patients with left
main coronary artery disease is still controversial. This is systematic
review and meta-analysis aims to evaluate the outcomes of percutaneous
coronary intervention (PCI) with drug-eluting stents compared with
coronary artery bypass graft (CABG) for LM disease. Method(s): Online
electronic databases were systematically reviewed until January 2020 for
randomized trials comparing PCI with drug-eluting stents and CABG. Primary
outcomes were: all-cause mortality, myocardial infarction (MI), stroke,
and repeated revascularization. Secondary outcomes included periprocedural
and nonperiprocedural MI. The period of follow-up included 30 days, 1
year, and 5 years. Odds ratio and 95% confidence interval were calculated
with a fixed-effects model. Result(s): A total of 4595 patients (5
randomized trials) with left main coronary artery disease were included.
At 30 days and 1 year, PCI was associated with lower incidence of stroke,
higher repeated revascularization, and similar odds of mortality and MI
compared with CABG. At 5 years, PCI was associated with higher rates of MI
(odds ratio, 1.43; 95% confidence interval, 1.13-1.79; P =.003) and repeat
revascularization (odds ratio, 1.89; 95% CI, 1.58-2.26; P <.001) than
CABG. PCI was associated with lower periprocedural MI at 30 days, whereas
at 5 years PCI was associated with higher nonperiprocedural MI (odds
ratio, 2.32; 95% confidence interval, 1.62-3.31; P <.001). Mortality and
stroke rate did not differ at 5-year follow-up. Conclusion(s):
Patients with left main coronary artery disease treated with either PCI or
CABG do not show significant difference in early or 5-year mortality.
Although CABG was associated with higher stroke rates at 30 days and 1
year, PCI was associated with an increase in MI and need for repeat
revascularization at 5 years. Copyright © 2020 The American
Association for Thoracic Surgery

<73>
Accession Number
2012311807
Title
Coronary artery bypass grafting versus percutaneous coronary intervention
in end-stage kidney disease: A systematic review and meta-analysis of
clinical studies.
Source
Hemodialysis International. 25(3) (pp 288-299), 2021. Date of Publication:
July 2021.
Author
Kanbay M.; Tapoi L.; Ureche C.; Bulbul M.C.; Kapucu I.; Afsar B.; Basile
C.; Covic A.
Institution
(Kanbay) Department of Medicine, Division of Nephrology, Koc University
School of Medicine, Istanbul, Turkey
(Tapoi, Ureche) Cardiovascular Diseases Institute, "Grigore T. Popa"
University of Medicine and Pharmacy, Iasi, Romania
(Bulbul, Kapucu) Department of Medicine, Koc University School of
Medicine, Istanbul, Turkey
(Afsar) Department of Medicine, Division of Nephrology, Suleyman Demirel
University School of Medicine, Isparta, Turkey
(Basile) Division of Nephrology, Miulli General Hospital, Acquaviva delle
Fonti, Italy
(Covic) Department of Nephrology, "Grigore T. Popa" University of Medicine
and Pharmacy, Iasi, Romania
Publisher
John Wiley and Sons Inc
Abstract
The most significant complication of end-stage kidney disease (ESKD) is
cardiovascular disease, mainly coronary artery disease (CAD). Although the
effective treatment of CAD is an important prognostic factor, whether
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG) is better for treating CAD in this group of patients is
still controversial. We searched Pubmed/Medline, Web of Science, Embase,
the Cochrane Central Register of Controlled Trials articles that compared
the outcomes of CABG versus PCI in patients with ESKD requiring dialysis.
A total of 10 observational studies with 39,666 patients were included.
Our analysis showed that when compared to PCI, CABG had lower risk of need
for repeat revascularization (relative risk [RR] = 2.25, 95% confidence
interval [CI] 2.1-2.42, p < 0.00001) and cardiovascular death (RR = 1.19,
95% CI 1.14-1.23, p < 0.00001) and higher risk for short-term mortality
(RR = 0.43, 95% CI 0.38-0.48, p < 0.00001). There was no statistically
significant difference between the PCI and CABG groups in the risk for
late mortality (RR = 1.05, 95% CI 0.97-1.14, p = 0.25), myocardial
infarction (RR = 1.05, 95% CI 0.46-2.36, p = 0.91) or stroke (RR = 1.02,
95% CI 0.64-1.61, p = 0.95). This meta-analysis showed that in ESKD
patients requiring dialysis, CABG was superior to PCI in regard to
cardiovascular death and need for repeat revascularization and inferior to
PCI in regard to short term mortality. However, this meta-analysis has
limitations and needs confirmation with large randomized controlled
trials. Copyright © 2021 International Society for Hemodialysis.

<74>
Accession Number
634662399
Title
Effects of three pulmonary ventilation regimes in patients undergoing
coronary artery bypass graft surgery: a randomized clinical trial.
Source
Scientific reports. 11(1) (pp 6730), 2021. Date of Publication: 24 Mar
2021.
Author
Amin R.; Alaparthi G.K.; Samuel S.R.; Bairapareddy K.C.; Raghavan H.;
Vaishali K.
Institution
(Amin, Samuel) Department of Physiotherapy, Kasturba Medical College,
Manipal Academy of Higher Education, Mangalore 575004, India
(Alaparthi, Bairapareddy) Department of Physiotherapy, College of Health
Sciences, University of Sharjah, Sharjah, United Arab Emirates
(Raghavan) Department of Cardiothoracic Surgery, Kasturba Medical
Hospital, Mangalore 575004, India
(Vaishali) Department of Physiotherapy, Manipal College of Health
Professions, Manipal Academy of Higher Education, Manipal 576104, India
Publisher
NLM (Medline)
Abstract
The aim was to compare the effect of diaphragmatic breathing exercise
(DBE), flow- (FIS) and volume-oriented incentive spirometry (VIS) on
pulmonary function- (PFT), functional capacity-6-Minute Walk Test (6 MWT)
and Functional Difficulties Questionnaire (FDQ) in subjects undergoing
Coronary Artery Bypass Graft surgery (CABG). The purpose of incorporating
pulmonary ventilator regimes is to improve ventilation and avoid
post-operative pulmonary complications. CABG patients (n=72) were
allocated to FIS, VIS and DBE groups (n=24 each) by block randomization.
Preoperative and postoperative values for PFT were taken until day 7 for
all three groups. On 7th postoperative day, 6 MWT and FDQ was analyzed
using ANOVA and post-hoc analysis. PFT values were found to be decreased
on postoperative day 1(Forced Vital Capacity (FVC)=FIS group-65%, VIS
group-47%, DBE group-68%) compared to preoperative day (p<0.001). PFT
values for all 3 groups recovered until postoperative day 7 (FVC=FIS
group-67%, VIS group-95%, DBE group-59%) but was found to reach the
baseline in VIS group (p<0.001). When compared between 3 groups,
statistically significant improvement was observed in VIS group (p<0.001)
in 6 MWT and FDQ assessment. In conclusion, VIS was proven to be more
beneficial in improving the pulmonary function (FVC), functional capacity
and FDQ when compared to FIS and DBE.

<75>
[Use Link to view the full text]
Accession Number
636606373
Title
Clinical outcome of local treatment in synchronous oligometastatic
non-small cell lung cancer (NSCLC): A preliminary analysis of prospective
data.
Source
Journal of Clinical Oncology. Conference: 2020 Annual Meeting of the
American Society of Clinical Oncology, ASCO 2020. Chicago, IL United
States. 38(15) (no pagination), 2020. Date of Publication: 2020.
Author
Li S.; Zhu X.; Zheng Z.
Institution
(Li, Zhu, Zheng) Radiation Oncology Department, Zhujiang Hospital,
Southern Medical University, Guangzhou, China
Publisher
American Society of Clinical Oncology
Abstract
Background: Advanced NSCLC is a heterogeneous disease, a large number of
retrospective studies suggested that patients with oligometastases may
achieve long-term survival from aggressive local treatment. However,
relevant prospective studies were limited. Therefore, we prospectively
evaluated the role of local treatment in synchronous oligometastatic
NSCLC. Method(s):We prospectively identified 50 NSCLC patients newly
diagnosed with synchronous oligometastases (<=5)in two centers between
11/2017 and 12/2019, among whom there were 24 patients from a randomized
clinical trial NCT03119519. Patients were given first-line systemic
therapy according to the latest NCCN guidelines with either local
radiotherapy or surgery to thoracic primary tumor and/or radiotherapy to
metastases. They were divided into combined therapies (Tx), systemic Tx
and untreated groups. Kaplan Meier Survival analysis was used to compare
progression free survival (PFS) and overall survival (OS) among the
groups. Result(s): Median age of all patients was 61 years old
(range: 27-80 years) and median follow up was 5.7 months (range: 0.5-23.3
months). A total of 10 deaths were observed. In the combined Tx group, 23
patients received radiotherapy, and 2 patients received primary surgical
resection. The median OS of the combined Tx group (n = 25), the systemic
Tx group (n = 19) and the untreated group (n = 6) was 18.47 months, not
reached, 3.27 months, respectively. Compared with the untreated group, the
combined group and the systemic Tx group had better OS (hazard ratio [HR]
= 0.1047, p = 0.0001; HR = 0.1125, p= 0.0006). However, the patients in
the combined group did not show significant OS advantage compared with
those in the systemic Tx group (HR = 1.376, p= 0.667). In addition, we
conducted an ITT analysis in clinical trial NCT03119519, in which 8
progression events were observed. There was no significant difference in
PFS between the combined group (n = 13) and the systemic Tx group (n = 11)
(13.2 months vs. not reached, HR = 1.317, p= 0.7015; 1-year PFS: 74% vs.
54%, p = 0.7015, respectively). Conclusion(s): Current analysis shows
that the addition of local treatment to first-line systemic Tx does not
improve PFS and OS. More samples, further updated data and selection of
potential beneficer are necessary.

<76>
Accession Number
2014388766
Title
Nocturnal dexmedetomidine alleviates post-intensive care syndrome
following cardiac surgery: a prospective randomized controlled clinical
trial.
Source
BMC Medicine. 19(1) (no pagination), 2021. Article Number: 306. Date of
Publication: December 2021.
Author
Dong C.-H.; Gao C.-N.; An X.-H.; Li N.; Yang L.; Li D.-C.; Tan Q.
Institution
(Dong, Li, Tan) Department of Cardiac Surgery, Shandong Provincial
Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi
Road, Jinan, Shandong 250021, China
(Gao) Department of Biostatistics, School of Public Health, Cheeloo
College of Medicine, Shandong University, Jinan, Shandong 250012, China
(Gao) Healthcare Big Data Institute of Shandong University, Jinan,
Shandong 250000, China
(An) Department of Anesthesiology, Shandong Provincial Hospital Affiliated
to Shandong First Medical University, Jinan, Shandong 250021, China
(Li) Department of Gynecology, Shandong Provincial Hospital Affiliated to
Shandong First Medical University, Jinan, Shandong 250021, China
(Yang) Department of Cardiology, Shandong Provincial Hospital Affiliated
to Shandong First Medical University, Jinan, Shandong 250021, China
(Tan) Department of Cardiac Surgery, Shandong Provincial Hospital, Cheeloo
College of Medicine, Shandong University, Jinan, Shandong 250021, China
Publisher
BioMed Central Ltd
Abstract
Background: Dexmedetomidine is a sedative agent that may have the
potential to reduce the risk of post-intensive care syndrome (PICS). This
study aimed to establish whether prophylactic nocturnal dexmedetomidine
safely reduces postoperative PICS incidence and to develop an easy-to-use
model for predicting the risk of PICS following cardiac surgery.
 Method(s): This was a single-center, double-blind, randomized,
prospective, placebo-controlled trial. Patients undergoing cardiac surgery
were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline)
groups between January 2019 and July 2020. Dexmedetomidine or a similar
volume of saline was administered, with an infusion rate up to 1.2
mug/kg/h until the RASS remained between - 1 and 0. The primary study
endpoint was PICS incidence at 6 months follow-up, as defined by
cognitive, physical, or psychological impairments. Result(s): We
assessed 703 individuals for eligibility, of whom 508 were enrolled. Of
these, there were 251 in the dexmedetomidine group and 257 in the placebo
group that received the trial agent, forming a modified intention-to-treat
population. PICS incidence at 6-month follow-up was significantly
decreased in the dexmedetomidine group (54/251, 21.5%) relative to the
placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665-0.945;
p = 0.014). Psychological impairment was significantly reduced in the
dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR
0.806, CI 0.672-0.967, p = 0.029). However, dexmedetomidine treatment was
associated with a higher rate of hypotension. A nomogram revealed that
age, education, a medical history of diabetes and smoking, dexmedetomidine
treatment, postoperative atrial fibrillation, and sequential organ failure
assessment scores at 8 h post-surgery were independent predictors of PICS.
 Conclusion(s): Prophylactic nocturnal dexmedetomidine administration
significantly reduced PICS incidence by a marked reduction in
psychological impairment within a 6-month follow-up period. Trial
registration: ChiCTR, ChiCTR1800014314. Registered 5 January 2018,
http://www.chictr.org.cn/index.aspx. Copyright © 2021, The
Author(s).

<77>
Accession Number
636562886
Title
Edoxaban versus vitamin K antagonist for atrial fibrillation after TAVR.
Source
New England Journal of Medicine. 385(23) (pp 2150-2160), 2021. Date of
Publication: 02 Dec 2021.
Author
Van Mieghem N.M.; Unverdorben M.; Hengstenberg C.; Mollmann H.; Mehran R.;
Lopez-Otero D.; Nombela-Franco L.; Moreno R.; Nordbeck P.; Thiele H.; Lang
I.; Zamorano J.L.; Shawl F.; Yamamoto M.; Watanabe Y.; Hayashida K.;
Hambrecht R.; Meincke F.; Vranckx P.; Jin J.; Boersma E.; Rodes-Cabau J.;
Ohlmann P.; Capranzano P.; Kim H.-S.; Pilgrim T.; Anderson R.; Baber U.;
Duggal A.; Laeis P.; Lanz H.; Chen C.; Valgimigli M.; Veltkamp R.; Saito
S.; Dangas G.D.
Institution
(Van Mieghem, Boersma) The Department of Cardiology, Erasmus University
Medical Center, Thoraxcenter, Rotterdam, Netherlands
(Unverdorben, Jin, Duggal, Chen) Daiichi Sankyo, Basking Ridge, NJ, United
States
(Hengstenberg, Lang) The Department of Internal Medicine II, Division of
Cardiology, Vienna General Hospital, Medical University, Vienna, Austria
(Mollmann) The Department of Internal Medicine, St. Johannes Hospital,
Dortmund, Germany
(Nordbeck) The Department of Internal Medicine, University Hospital
Wurzburg, Wurzburg, Germany
(Thiele) The Department of Internal Medicine-Cardiology, Heart Center
Leipzig at University of Leipzig, Leipzig, Germany
(Hambrecht) Bremer Institute for Heart and Circulation Research, Klinikum
Links der Weser, Bremen, Germany
(Meincke) The Department of Cardiology, Asklepios Klinik St. Georg,
Hamburg, Germany
(Laeis, Lanz) Daiichi Sankyo Europe, Munich, Germany
(Veltkamp) The Department of Neurology, Alfried Krupp Krankenhaus, Essen,
Germany
(Veltkamp) The Department of Neurology, University Hospital Heidelberg,
Heidelberg, Germany
(Mehran, Dangas) Zena and Michael A. Wiener Cardiovascular Institute,
Mount Sinai Hospital, New York, United States
(Lopez-Otero) The Department of Cardiology, Centro de Investigacion
Biomedica en Red Enfermedades Cardiovasculares, Hospital Clinico
Universitario de Santiago de Compostela, Santiago de Compostela, Spain
(Nombela-Franco) The Cardiovascular Institute, Hospital Clinico San
Carlos, Instituto de Investigacion Sanitaria San Carlos, Madrid, Spain
(Moreno) The Department of Cardiology, University Hospital la Paz, Madrid,
Spain
(Zamorano) The Department of Cardiology, University Hospital Ramon y
Cajal, Madrid, Spain
(Shawl) The Department of Cardiology, Washington Adventist Hospital,
Takoma Park, MD, United States
(Yamamoto) The Department of Cardiology, Toyohashi Heart Center,
Toyohashi, Japan
(Watanabe) The Department of Cardiology, Teikyo University School of
Medicine, Tokyo, Japan
(Hayashida) The Department of Cardiology, Keio University School of
Medicine, Tokyo, Japan
(Saito) The Division of Cardiology and Catheterization Laboratories,
Shonan Kamakura General Hospital, Kamakura, Japan
(Vranckx) The Department of Cardiology, Jessa Hospital, Hasselt, Belgium
(Rodes-Cabau) Quebec Heart and Lung Institute, Laval University, Quebec,
QC, Canada
(Ohlmann) The Division of Cardiovascular Medicine, University Hospital of
Strasbourg, Strasbourg, France
(Capranzano) The Division of Cardiology, Policlinico Hospital, University
of Catania, Catania, Italy
(Kim) The Department of Internal Medicine, Cardiovascular Center, Seoul
National University Hospital, Seoul, South Korea
(Pilgrim) The Department of Cardiology, University of Bern, Bern,
Switzerland
(Valgimigli) Cardiocentro Ticino Institute, Department of Biomedical
Sciences, University of Italian Switzerland, Lugano, Switzerland
(Anderson) The Department of Cardiology, University Hospital of Wales,
Cardiff, United Kingdom
(Veltkamp) The Division of Brain Sciences, Imperial College London,
London, United Kingdom
(Baber) The Cardiology Section, University of Oklahoma Health Sciences
Center, Oklahoma City, United States
(Dangas) National and Kapodistrian University of Athens, School of
Medicine, Athens, Greece
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND The role of direct oral anticoagulants as compared with vitamin
K antagonists for atrial fibrillation after successful transcatheter
aortic-valve replacement (TAVR) has not been well studied. METHODS We
conducted a multicenter, prospective, randomized, open-label,
adjudicator-masked trial comparing edoxaban with vitamin K antagonists in
patients with prevalent or incident atrial fibrillation as the indication
for oral anticoagulation after successful TAVR. The primary efficacy
outcome was a composite of adverse events consisting of death from any
cause, myocardial infarction, ischemic stroke, systemic thromboembolism,
valve thrombosis, or major bleeding. The primary safety outcome was major
bleeding. On the basis of a hierarchical testing plan, the primary
efficacy and safety outcomes were tested sequentially for noninferiority,
with noninferiority of edoxaban established if the upper boundary of the
95% confidence interval for the hazard ratio did not exceed 1.38.
Superiority testing of edoxaban for efficacy would follow if
noninferiority and superiority were established for major bleeding.
RESULTS A total of 1426 patients were enrolled (713 in each group). The
mean age of the patients was 82.1 years, and 47.5% of the patients were
women. Almost all the patients had atrial fibrillation before TAVR. The
rate of the composite primary efficacy outcome was 17.3 per 100
person-years in the edoxaban group and 16.5 per 100 person-years in the
vitamin K antagonist group (hazard ratio, 1.05; 95% confidence interval
[CI], 0.85 to 1.31; P = 0.01 for noninferiority). Rates of major bleeding
were 9.7 per 100 person-years and 7.0 per 100 person-years, respectively
(hazard ratio, 1.40; 95% CI, 1.03 to 1.91; P = 0.93 for noninferiority);
the difference between groups was mainly due to more gastrointestinal
bleeding with edoxaban. Rates of death from any cause or stroke were 10.0
per 100 person-years in the edoxaban group and 11.7 per 100 person-years
in the vitamin K antagonist group (hazard ratio, 0.85; 95% CI, 0.66 to
1.11). CONCLUSIONS In patients with mainly prevalent atrial fibrillation
who underwent successful TAVR, edoxaban was noninferior to vitamin K
antagonists as determined by a hazard ratio margin of 38% for a composite
primary outcome of adverse clinical events. The incidence of major
bleeding was higher with edoxaban than with vitamin K antagonists.
 Copyright © 2021 Massachusetts Medical Society.

<78>
Accession Number
2014814923
Title
Surgical techniques for the treatment of anomalous origin of right
coronary artery from the left sinus: A comparative review.
Source
Journal of the American Heart Association. 10(22) (no pagination), 2021.
Article Number: e022377. Date of Publication: 16 Nov 2021.
Author
Gharibeh L.; Rahmouni K.; Hong S.J.; Crean A.M.; Grau J.B.
Institution
(Gharibeh, Grau) Division of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Gharibeh, Rahmouni) Department of Biochemistry, Microbiology and
Immunology, University of Ottawa, Ottawa, ON, Canada
(Crean) Division of Cardiology, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(Hong, Grau) Division of Cardiothoracic Surgery, The Valley Hospital,
Ridgewood, NJ, United States
Publisher
American Heart Association Inc.
Abstract
The anomalous aortic origin of the right coronary artery (AAORCA) from the
left sinus is a congenital anomaly affecting both the origin and course of
the right coronary artery. AAORCA is nowadays easily and increasingly
recognized by several cardiac imaging modalities. In most cases, patients
remain asymptomatic; however, in some, and especially in young athletes,
symptoms start to appear following exertion. A literature review was
conducted on the surgical management of AAORCA by searching the Pubmed and
Google Scholar databases. The inclusion criteria included manuscripts
reporting surgical outcomes of AAORCA for >=1 of the 3 techniques of
interest (unroofing, reimplantation, and coronary artery bypass grafting)
and manuscripts written in English and that were published between 2010
and 2020. The surgical management of AAORCA can be done through several
techniques, most commonly the unroofing of the intramural segment of the
AAORCA, the reimplantation of the native right coronary artery onto the
right sinus of the aortic root, and coronary artery bypass grafting with
either arterial or venous graft conduits with or without ligation of the
proximal right coronary artery. Superiority of one surgical technique has
not yet been formally proven because of the rare nature of this condition
and the lack of any prospective randomized controlled trial or robust
prospective observational studies. Copyright © 2021 The Authors.

<79>
Accession Number
2014804483
Title
Computed tomography imaging assessment of the effect of vancomycin paste
on poststernotomy healing.
Source
International Journal of General Medicine. 14 (pp 9287-9296), 2021. Date
of Publication: 2021.
Author
Basha M.A.A.; Shemais D.S.; Abdelwahed E.S.; Elfwakhry R.M.; Zeid A.F.;
Abdalla A.A.E.-H.M.; Aly S.A.; Abdelrahman D.S.; Elshenawy A.A.; Mansour
W.; Elbanna K.A.A.; El Tahlawi M.; Elnahal N.
Institution
(Basha, Elfwakhry, Zeid, Abdalla) Department of Radiodiagnosis, Faculty of
Human Medicine, Zagazig University, Zagazig, Egypt
(Shemais, Abdelwahed, Elnahal) Department of Cardiothoracic Surgery,
Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
(Aly, Abdelrahman) Department of Radiodiagnosis, Faculty of Human
Medicine, Benha University, Benha, Egypt
(Elshenawy) Department of Surgical Oncology, Faculty of Human Medicine,
Aswan University, Aswan, Egypt
(Mansour) Department of Chest Medicine, Faculty of Human Medicine, Zagazig
University, Zagazig, Egypt
(Elbanna) Department of Internal Medicine, Faculty of Human Medicine,
Zagazig University, Zagazig, Egypt
(El Tahlawi) Department of Cardiology, Faculty of Human Medicine, Zagazig
University, Zagazig, Egypt
Publisher
Dove Medical Press Ltd
Abstract
Purpose: To assess vancomycin paste effect on poststernotomy healing in
high-risk coronary artery bypass grafting (CABG) patients compared to bone
wax using the 6-point computed tomography (CT) score. Additionally
assessed the reliability of this score and its relationship to the
occurrence of infection. Patients and Methods: A prospective
comparative analysis included 126 high-risk CABG patients. The patients
were randomly assigned into bone wax or vancomycin paste for sternal
haemostasis. All patients were submitted to CT examinations 6-months
postoperative. Two radiologists independently reviewed all CT scans to
assess sternal healing using the 6-point CT score. The CT healing score of
the two groups was compared. The kappa statistics were used to calculate
the inter-reader agreement (IRA) of the 6-point CT score. Result(s):
The final analysis included 61 patients in each group. The main CT score
for sternal healing was 3.9+/-0.4 in the vancomycin group and 3.3+/-0.8 in
the bone wax group. Patients in the vancomycin group had a higher
statistically significant improvement in CT healing score than those in
the bone wax group (p<0.001). There was no statistically significant
relationship (p = 0.79) between the occurrence of infection and the
6-point CT score in the vancomycin group. The overall IRA of the 6-point
CT score was good in two groups (kappa = 0.79 in the vancomycin group and
= 0.78 in the bone wax group). Conclusion(s): Vancomycin paste had a
better CT healing score and can be used as a sternal haemostatic material
instead of bone wax. The 6-point CT healing score is a reliable diagnostic
tool for evaluating sternal healing. Copyright © 2021 Basha et
al.

<80>
Accession Number
2015895710
Title
Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve
Replacement: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14(24) (pp 2643-2656), 2021. Date of
Publication: 27 Dec 2021.
Author
Bogyi M.; Schernthaner R.E.; Loewe C.; Gager G.M.; Dizdarevic A.M.;
Kronberger C.; Postula M.; Legutko J.; Velagapudi P.; Hengstenberg C.;
Siller-Matula J.M.
Institution
(Bogyi, Gager, Dizdarevic, Kronberger, Hengstenberg, Siller-Matula)
Department of Internal Medicine II, Division of Cardiology, Medical
University of Vienna, Vienna, Austria
(Schernthaner, Loewe) Division of Cardiovascular and Interventional
Radiology, Department of Biomedical Imaging and Image-Guided Therapy,
Medical University of Vienna, Vienna, Austria
(Gager) Department of Clinical Pharmacology, Medical University of Vienna,
Vienna, Austria
(Postula, Siller-Matula) Department of Experimental and Clinical
Pharmacology, Medical University of Warsaw, Center for Preclinical
Research and Technology CEPT, Warsaw, Poland
(Legutko) Jagiellonian University Medical College, Faculty of Medicine,
Institute of Cardiology, Department of Interventional Cardiology, John
Paul II Hospital, Krakow, Poland
(Velagapudi) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
This meta-analysis and systematic review was performed to evaluate the
clinical relevance of subclinical leaflet thrombosis (SLT) following
transcatheter aortic valve replacement. PubMed, Web of Science, and
CENTRAL were searched for eligible randomized and nonrandomized studies
until November 2020. Risk ratios (RRs) or odds ratios and 95% CIs were
calculated, using a random-effects model. Overall, 25 studies were
eligible for the analysis and comprised a total of 11,098 patients. The
median incidence of SLT was 6% at a median follow-up of 30 days. Use of
intra-annular valves was associated with 2-fold greater risk for the
development of SLT compared with use of supra-annular valves. There was no
difference in the risk for SLT (RR: 0.97; 95% CI: 0.72-1.29; P = 0.83)
between single-antiplatelet therapy (SAPT) and dual-antiplatelet therapy
(DAPT), whereas oral anticoagulation (OAC) was associated with a 58%
relative risk reduction for SLT (RR: 0.42; 95% CI: 0.29-0.61; P < 0.00001)
compared with SAPT and DAPT. In patients with diagnosed leaflet thrombosis
at follow-up, the risk for stroke or transient ischemic attack was
increased by 2.6-fold (RR: 2.56; 95% CI: 1.60-4.09; P < 0.00001) compared
with patients without leaflet thrombosis. In patients diagnosed with SLT,
the odds of SLT resolution increased by 99% after switch from antiplatelet
agents to OAC (odds ratio: 0.01; 95% CI: 0.00-0.06; P < 0.00001). To
summarize, indication-based use of OAC after transcatheter aortic valve
replacement is associated with a lower risk for SLT compared with SAPT and
DAPT. Switching to OAC seems to be effective for SLT resolution. As SLT
increased the odds of stroke or transient ischemic attack in the included
population, further studies are needed to investigate whether screening
tests for SLT and appropriate antithrombotic therapy improve long-term
valve functionality and clinical prognosis. Copyright © 2021
American College of Cardiology Foundation

<81>
Accession Number
2014419930
Title
Effect of physical manipulation pulmonary rehabilitation on lung cancer
patients after thoracoscopic lobectomy.
Source
Thoracic Cancer. (no pagination), 2021. Date of Publication: 2021.
Author
Zhou T.; Sun C.
Institution
(Zhou) Thoracic surgery Department, Beijing Hospital, National Center of
Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, Beijing, China
(Sun) Nursing Department, Beijing Hospital, National Center of
Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical
Sciences, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Background: To introduce a new postoperative pulmonary rehabilitation
program named physical manipulation pulmonary rehabilitation (PMPR) and to
explore the effect of perioperative management, including PMPR, on
patients with non-small cell lung cancer (NSCLC) after thoracoscopic
lobectomy. Method(s): A randomized controlled trial was conducted
between April and June 2021 at the Department of Thoracic Surgery, Beijing
Hospital. Adult patients with NSCLC who had undergone thoracoscopic
lobectomy were allocated to the treatment and control groups using a
random number table. The treatment group received both conventional
pulmonary rehabilitation (CVPR) and 14 days of PMPR after surgery; the
control group patients received CVPR only. PMPR included relaxing and
exercising the intercostal muscles, thoracic costal joint and abdominal
breathing muscles. Pulmonary function tests and the 6-min walk test were
conducted preoperatively and 7, 14, 21 and 28 days postoperatively. The
postoperative length of hospital stay, chest tube retention time and
postoperative pulmonary complications were recorded. The baseline data,
pulmonary function parameters and prognosis were compared with t- and
chi-square tests between the two groups. Result(s): A total of 86
patients were enrolled, and 44 patients were allocated to the treatment
group. There were no significant differences in the baseline data for age,
sex, body mass index, basic disease, surgical plan or preoperative
pulmonary function between the two groups (all p > 0.05). The peak
expiratory flow of patients in the treatment group was higher than that of
those in the control group 21 days after surgery (316 +/- 95 vs. 272 +/-
103 l/min, respectively, p = 0.043), and forced expiratory volume in the
first second on day 28 after surgery was greater than that in the control
group (2.1 +/- 0.2 vs. 1.9 +/- 0.3 L, respectively, p < 0.001). There were
no significant differences in forced vital capacity or 6-min walk test
scores (both p > 0.05). There were no significant differences in the
incidences of pneumonia and atelectasis between the two groups (both p >
0.05). The postoperative length of hospital stay (3.3 +/- 1.3 vs. 3.9 +/-
1.5 days, p = 0.043) and chest tube retention time (66 +/- 30 vs. 81 +/-
35 h, p = 0.036) in the treatment group were shorter than those in the
control group. Conclusion(s): We determined that PMPR could improve
early lung function in patients with NSCLC after thoracoscopic lobectomy,
and that chest tube retention time and length of hospital stay were
shortened. Copyright © 2021 The Authors. Thoracic Cancer
published by China Lung Oncology Group and John Wiley & Sons Australia,
Ltd.

<82>
Accession Number
2013030334
Title
Does erector spinae plane block result in improved postoperative analgesia
and enhanced recovery in adult patients after cardiac surgery?.
Source
Interactive Cardiovascular and Thoracic Surgery. 32(6) (pp 873-877), 2021.
Date of Publication: 01 Jun 2021.
Author
Misra S.; Awal S.
Institution
(Misra) Department of Anesthesiology and Critical Care, All India
Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
(Awal) Department of Anaesthesia and Critical Care Medicine, Institute of
Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
Publisher
Oxford University Press
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was whether erector spinae
plane block (ESPB) resulted in improved postoperative analgesia and
enhanced recovery in adult cardiac surgical patients. A total of 333
papers were found using the reported search of which, 7 papers represented
the best evidence to answer the clinical question. The authors, journal,
date and country of publication, patient groups studied, study type,
relevant outcomes and results of these papers are tabulated. The cardiac
surgical procedures included off-pump coronary artery bypass surgery (1
study), mitral/tricuspid valve repair (1 study), robotic minimally
invasive coronary artery bypass surgery (1 study) and other cardiac
surgeries (4 studies). ESPB was compared to intravenous analgesia (5
studies), thoracic epidural analgesia (1 study) and serratus anterior
plane block and paravertebral block (1 study). With ESPB, there was
significant improvement in postoperative pain scores (4 studies),
decreased opioid requirement/rescue analgesia (3 studies), increased
duration of analgesia (1 study), decreased time to extubation (3 studies),
less increase in postoperative Troponin T (1 study), earlier ambulation (2
studies), earlier oral intake (1 study), earlier chest drain removal (1
study), better patient satisfaction (1 study), reduced adverse events (1
study) and decreased intensive care unit stay (3 studies). We conclude
that ESPB may be associated with improved postoperative analgesia and
enhanced recovery after adult cardiac surgery based on the available
evidence. However, there is a need for better quality randomized
controlled trials to consolidate these findings. Copyright © 2021
Oxford University Press. All rights reserved.

<83>
Accession Number
2012392088
Title
Effects of levosimendan on renal blood flow and glomerular filtration in
patients with acute kidney injury after cardiac surgery: a double blind,
randomized placebo-controlled study.
Source
Critical Care. 25(1) (no pagination), 2021. Article Number: 207. Date of
Publication: December 2021.
Author
Tholen M.; Ricksten S.-E.; Lannemyr L.
Institution
(Tholen, Ricksten, Lannemyr) Department of Anesthesiology and Intensive
Care Medicine At the Sahlgrenska Academy, University of Gothenburg and
Section for Cardiothoracic Anesthesia and Intensive Care, Sahlgrenska
University Hospital, Bla Straket 7, 5th Floor, Gothenburg 413 45, Sweden
Publisher
BioMed Central Ltd
Abstract
Background: Acute kidney injury (AKI) is a common and serious complication
after cardiac surgery, and current strategies aimed at treating AKI have
proven ineffective. Levosimendan, an inodilatating agent, has been shown
to increase renal blood flow and glomerular filtration rate in
uncomplicated postoperative patients and in patients with the cardiorenal
syndrome. We hypothesized that levosimendan through its specific effects
on renal vasculature, a preferential vasodilating effect on preglomerular
resistance vessels, could improve renal function in AKI-patients with who
did not have clinical indication for inotropic support. Method(s): In
this single-center, double-blind, randomized controlled study, adult
patients with postoperative AKI within 2 days after cardiac surgery, who
were hemodynamically stable with a central venous oxygen saturation
(ScvO<inf>2</inf>) >= 60% without inotropic support were eligible for
inclusion. After randomization, study drug infusions, levosimendan (n =
16) or placebo (n = 13) were given for 5 h. A bolus infusion of
levosimendan (12 microg/kg), were given for 30 min followed by 0.1
microg/kg/min for 5 h. Renal blood flow and glomerular filtration rate
were measured using infusion clearance of para-aminohippuric acid and a
filtration marker, respectively. As a safety issue, norepinephrine was
administered to maintain mean arterial pressure between 70-80 mmHg.
Intra-group differences were tested by Mann-Whitney U-tests, and a linear
mixed model was used to test time and group interaction. Result(s):
Twenty-nine patients completed the study. At inclusion, the mean serum
creatinine was higher in the patients randomized to levosimendan (148 +/-
29 vs 127 +/- 22 micromol/L, p = 0.030), and the estimated GFR was lower
(46 +/- 12 vs 57 +/- 11 ml/min/1.73 m2, p = 0.025).
Levosimendan induced a significantly (p = 0.011) more pronounced increase
in renal blood flow (15%) compared placebo (3%) and a more pronounced
decrease in renal vascular resistance (- 18% vs. - 4%, respectively, p =
0.043). There was a trend for a minor increase in glomerular filtration
rate with levosimendan (4.5%, p = 0.079), which did differ significantly
from the placebo group (p = 0.440). The mean norepinephrine dose was
increased by 82% in the levosimedan group and decreased by 29% in the
placebo group (p = 0.012). Conclusion(s): In hemodynamically stable
patients with AKI after cardiac surgery, levosimendan increases renal
blood flow through renal vasodilatation. Trial registration NCT02531724,
prospectly registered on 08/20/2015.
https://clinicaltrials.gov/ct2/show/NCT02531724?cond=AKI&cntry=SE&age=1&dr
aw=2&rank=1 Copyright © 2021, The Author(s).

<84>
Accession Number
2012216143
Title
Impact of Body Composition Indices on Ten-year Mortality After
Revascularization of Complex Coronary Artery Disease (From the Syntax
Extended Survival Trial).
Source
American Journal of Cardiology. 151 (pp 30-38), 2021. Date of Publication:
15 Jul 2021.
Author
Ono M.; Kawashima H.; Hara H.; O'Leary N.; Gao C.; Wang R.; Takahashi K.;
Wykrzykowska J.J.; Piek J.J.; Mack M.J.; Holmes D.R.; Morice M.-C.; Head
S.J.; Kappetein A.P.; Thuijs D.J.F.M.; Noack T.; Friedrich M.W.;
Davierwala P.M.; McEvoy J.W.; Onuma Y.; Serruys P.W.
Institution
(Ono, Kawashima, Hara, Takahashi, Wykrzykowska, Piek) Department of
Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam,
Netherlands
(Ono, Kawashima, Hara, O'Leary, Gao, Wang, McEvoy, Onuma, Serruys)
Department of Cardiology, National University of Ireland, Galway (NUIG),
Galway, Ireland
(Gao, Wang) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
(Mack) Department of Cardiothoracic Surgery, Baylor University Medical
Center, Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Departement of Cardiologie, Hopital prive Jacques Cartier,
Generale de Sante Massy, France
(Head, Kappetein, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(Noack, Friedrich, Davierwala) University Department of Cardiac Surgery,
Heart Centre Leipzig, Leipzig, Germany
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Elsevier Inc.
Abstract
Numerous studies have demonstrated a paradoxical association between
higher baseline body mass index (BMI) and lower long-term mortality risk
after coronary revascularization, known as the "obesity paradox", possibly
relying on the single use of BMI. The current study is a post-hoc analysis
of the SYNTAX Extended Survival (SYNTAXES) trial, which is the extended
follow-up of the SYNTAX trial comparing percutaneous coronary intervention
(PCI) versus coronary artery bypass graft (CABG) in patients with
left-main coronary artery disease (LMCAD) or three-vessel disease (3VD).
Patients were stratified according to baseline BMI and/or waist
circumference (WC). Out of 1,800 patients, 1,799 (99.9%) and 1,587 (88.2%)
had available baseline BMI and WC data, respectively. Of those, 1,327
(73.8%) patients had High BMI (>=25 kg/m2), whereas 705 (44.4%)
patients had High WC (>102 cm for men or >88 cm for women). When
stratified by both BMI and WC, 10-year mortality risk was significantly
higher in patients with Low BMI/Low WC (adjusted hazard ratio [HR]: 1.65;
95% confidence interval [CI]: 1.09 to 2.51), Low BMI/ High WC (adjusted
HR: 2.74; 95% CI: 1.12 to 6.69), or High BMI/High WC (adjusted HR: 1.59;
95% CI: 1.11 to 2.27) compared to those with High BMI/Low WC. In
conclusion, the "obesity paradox" following coronary revascularization
would be driven by low long-term mortality risk of the High BMI/Low WC
group. Body composition should be assessed by the combination of BMI and
WC in the appropriate evaluation of the long-term risk of obesity in
patients with LMCAD or 3VD. Copyright © 2021 The Author(s)

<85>
Accession Number
2011044277
Title
Systematic approach of mitral valve interventions in the setting of mitral
annular calcification: A step forward in improving outcomes.
Source
Journal of Cardiac Surgery. 36(7) (pp 2421-2422), 2021. Date of
Publication: July 2021.
Author
Mendoza C.E.; Celli D.
Institution
(Mendoza) Division of Cardiovascular Disease, Jackson Memorial Hospital,
Miami, FL, United States
(Celli) Department of Internal Medicine, University of Miami Miller School
of Medicine/Jackson Memorial Hospital, Miami, FL, United States
Publisher
John Wiley and Sons Inc

<86>
Accession Number
2007553197
Title
Development and internal validation of a predictive model of cognitive
decline 36 months following elective surgery.
Source
Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring.
13(1) (no pagination), 2021. Article Number: e12201. Date of Publication:
2021.
Author
Jones R.N.; Tommet D.; Steingrimsson J.; Racine A.M.; Fong T.G.; Gou Y.;
Hshieh T.T.; Metzger E.D.; Schmitt E.M.; Tabloski P.A.; Travison T.G.;
Vasunilashorn S.M.; Abdeen A.; Earp B.; Kunze L.; Lange J.; Vlassakov K.;
Dickerson B.C.; Marcantonio E.R.; Inouye S.K.
Institution
(Jones, Tommet) Department of Psychiatry and Human Behavior, Brown
University Warren Alpert Medical School, Providence, RI, United States
(Jones) Department of Neurology, Brown University Warren Alpert Medical
School, Providence, RI, United States
(Steingrimsson) Department of Biostatistics, Brown University School of
Public Health, Providence, RI, United States
(Racine, Fong, Gou, Schmitt, Travison, Marcantonio, Inouye) Biogen Inc,
Cambridge, MA, United States
(Fong, Hshieh, Metzger, Travison, Vasunilashorn, Abdeen, Earp, Kunze,
Lange, Vlassakov, Marcantonio, Inouye) Harvard Medical School, Boston, MA,
United States
(Fong) Department of Neurology, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Hshieh, Vasunilashorn, Marcantonio, Inouye) Department of Medicine, Beth
Israel Deaconess Medical Center, Boston, MA, United States
(Metzger) Department of Psychiatry, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Tabloski) William F Connell School of Nursing at Boston College, Boston,
MA, United States
(Abdeen) Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center, Boston, MA, United States
(Earp, Lange) Department of Orthopedic Surgery, Brigham and Women's
Hospital, Boston, MA, United States
(Kunze) Department of Anesthesia, Beth Israel Deaconess Medical Center,
Boston, MA, United States
(Vlassakov) Department of Anesthesia, Brigham and Women's Hospital,
Boston, MA, United States
(Dickerson) Department of Neurology and Massachusetts Alzheimer's Disease
Research Center, Massachusetts General Hospital, Boston, MA, United States
Publisher
John Wiley and Sons Inc
Abstract
Introduction: Our goal was to determine if features of surgical patients,
easily obtained from the medical chart or brief interview, could be used
to predict those likely to experience more rapid cognitive decline
following surgery. Method(s): We analyzed data from an observational
study of 560 older adults (>=70 years) without dementia undergoing major
elective non-cardiac surgery. Cognitive decline was measured using change
in a global composite over 2 to 36 months following surgery. Predictive
features were identified as variables readily obtained from chart review
or a brief patient assessment. We developed predictive models for
cognitive decline (slope) and predicting dichotomized cognitive decline at
a clinically determined cut. Result(s): In a hold-out testing set,
the regularized regression predictive model achieved a root mean squared
error (RMSE) of 0.146 and a model r-square (R2 ) of .31.
Prediction of "rapid" decliners as a group achieved an area under the
curve (AUC) of .75. Conclusion(s): Some of our models could predict
persons with increased risk for accelerated cognitive decline with greater
accuracy than relying upon chance, and this result might be useful for
stratification of surgical patients for inclusion in future clinical
trials. Copyright © 2021 The Authors.

<87>
Accession Number
2007496649
Title
Management of intraoperative mechanical ventilation to prevent
postoperative complications after general anesthesia: A narrative review.
Source
Journal of Clinical Medicine. 10(12) (no pagination), 2021. Article
Number: 2656. Date of Publication: 02 Jun 2021.
Author
Fogagnolo A.; Montanaro F.; Al-husinat L.; Turrini C.; Rauseo M.;
Mirabella L.; Ragazzi R.; Ottaviani I.; Cinnella G.; Volta C.A.; Spadaro
S.
Institution
(Fogagnolo, Montanaro, Turrini, Ragazzi, Ottaviani, Volta, Spadaro)
Department of Translation Medicine and for Romagna, Section of Anesthesia
and Intensive Care, University of Ferrara, Ferrara 44121, Italy
(Al-husinat) Department of Clinical Sciences, Faculty of Medicine, Yarmouk
University, Irbid 21163, Jordan
(Rauseo, Mirabella, Cinnella) Department of Anesthesia and Intensive Care,
University of Foggia, Foggia 71122, Italy
Publisher
MDPI
Abstract
Mechanical ventilation (MV) is still necessary in many surgical
procedures; nonetheless, intraoperative MV is not free from harmful
effects. Protective ventilation strategies, which include the combination
of low tidal volume and adequate positive end expiratory pressure (PEEP)
levels, are usually adopted to minimize the ventilation-induced lung
injury and to avoid post-operative pulmonary complications (PPCs). Even
so, volutrauma and atelectrauma may co-exist at different levels of tidal
volume and PEEP, and therefore, the physiological response to the MV
settings should be monitored in each patient. A personalized perioperative
approach is gaining relevance in the field of intraoperative MV; in
particular, many efforts have been made to individualize PEEP, giving more
emphasis on physiological and functional status to the whole body. In this
review, we summarized the latest findings about the optimization of PEEP
and intraoperative MV in different surgical settings. Starting from a
physiological point of view, we described how to approach the
individualized MV and monitor the effects of MV on lung
function. Copyright © 2021 by the authors. Licensee MDPI, Basel,
Switzerland.

<88>
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. Copyright © Author(s) (or their employer(s))
2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<89>
Accession Number
635298532
Title
Hypothermia versus normothermia after out-of-hospital cardiac arrest.
Source
New England Journal of Medicine. 384(24) (pp 2283-2294), 2021. Date of
Publication: 17 Jun 2021.
Author
Dankiewicz J.; Cronberg T.; Lilja G.; Jakobsen J.C.; Levin H.; Ullen S.;
Rylander C.; Wise M.P.; Oddo M.; Cariou A.; Belohlavek J.; Hovdenes J.;
Saxena M.; Kirkegaard H.; Young P.J.; Pelosi P.; Storm C.; Taccone F.S.;
Joannidis M.; Callaway C.; Eastwood G.M.; Morgan M.P.G.; Nordberg P.;
Erlinge D.; Nichol A.D.; Chew M.S.; Hollenberg J.; Thomas M.; Bewley J.;
Sweet K.; Grejs A.M.; Christensen S.; Haenggi M.; Levis A.; Lundin A.;
During J.; Schmidbauer S.; Keeble T.R.; Karamasis G.V.; Schrag C.;
Faessler E.; Smid O.; Otahal M.; Maggiorini M.; Wendel Garcia P.D.;
Jaubert P.; Cole J.M.; Solar M.; Borgquist O.; Leithner C.; Abed-Maillard
S.; Navarra L.; Annborn M.; Unden J.; Brunetti I.; Awad A.; McGuigan P.;
Olsen R.B.; Cassina T.; Vignon P.; Langeland H.; Lange T.; Friberg H.;
Nielsen N.
Institution
(Dankiewicz, Erlinge) Department of Clinical Sciences Lund, Sections of
Cardiology, Lund University and Clinical Studies Sweden - Forum South,
Skane University Hospital, Lund, Sweden
(Cronberg, Lilja) Neurology (T. Cronberg, G.L.), Lund University and
Clinical Studies Sweden - Forum South, Skane University Hospital, Lund,
Sweden
(Levin, Borgquist) Anesthesiology and Intensive Care, Lund University and
Clinical Studies Sweden - Forum South, Skane University Hospital, Lund,
Sweden
(Ullen) Skane University Hospital Lund, Lund University and Clinical
Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden
(During, Schmidbauer, Friberg) Department of Clinical Sciences Lund,
Section of Anesthesia and Intensive Care, Skane University Hospital Malmo,
Malmo, Sweden
(Annborn, Nielsen) Department of Clinical Sciences Lund, Sections of
Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg,
Sweden
(Nielsen) Clinical Sciences Helsingborg, Helsingborg Hospital,
Helsingborg, Sweden
(Unden) Department of Clinical Sciences Lund, Section of Anesthesiology
and Intensive Care Lund, Hallands Hospital, Halmstad, Sweden
(Rylander, Lundin) Department of Anesthesiology and Intensive Care
Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University
of Gothenburg, Gothenburg, Sweden
(Nordberg, Hollenberg, Awad) Department of Clinical Science and Education,
Center for Resuscitation Science, Karolinska Institutet, Sodersjukhuset,
Stockholm, Sweden
(Chew) Department of Anesthesiology, Intensive Care, and Acute Medicine,
Linkoping University, Linkoping, Sweden
(Jakobsen) Copenhagen Trial Unit, Center for Clinical Intervention
Research, Copenhagen University Hospital, University of Copenhagen,
Copenhagen, Denmark
(Lange) Section of Biostatistics, Faculty of Health and Medical Sciences,
University of Copenhagen, Copenhagen, Denmark
(Jakobsen) Department of Regional Health Research, Faculty of Health
Sciences, University of Southern Denmark, Odense, Denmark
(Kirkegaard) Research Center for Emergency Medicine, Department of
Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
(Grejs, Christensen) Department of Intensive Care, Aarhus University
Hospital, Aarhus, Denmark
(Wise, Morgan, Cole) Adult Critical Care, University Hospital of Wales,
Cardiff, United Kingdom
(Thomas, Bewley, Sweet) Department of Intensive Care, Bristol Royal
Infirmary, Bristol, United Kingdom
(Keeble, Karamasis) Essex Cardiothoracic Centre, Basildon, United Kingdom
(Keeble, Karamasis) Anglia Ruskin University School of Medicine,
Chelmsford, Essex, United Kingdom
(McGuigan) Department of Anesthesiology and Intensive Care, Royal Victoria
Hospital, Belfast, United Kingdom
(Oddo, Abed-Maillard) Neuroscience Critical Care Research Group, Adult
Intensive Care Medicine Service, Centre Hospitalier Universitaire
Vaudois-Lausanne University Hospital, University of Lausanne, Lausanne,
Switzerland
(Haenggi) Departments of Intensive Care Medicine, Bern University
Hospital, University of Bern, Bern, Switzerland
(Levis) Anesthesiology and Pain Medicine, Inselspital, Bern University
Hospital, University of Bern, Bern, Switzerland
(Schrag, Faessler) Intensive Care Department, Kantonsspital St. Gallen,
St. Gallen, Switzerland
(Maggiorini, Wendel Garcia) Institute of Intensive Care Medicine,
University Hospital Zurich, Zurich, Switzerland
(Cassina) Cardiac Anesthesia and Intensive Care Department, Instituto
Cardiocentro Ticino, Lugano, Switzerland
(Cariou, Jaubert) Descartes University of Paris, Cochin University
Hospital, Paris, France
(Vignon) Medical-Surgical Intensive Care Unit, Dupuytren Teaching
Hospital, Limoges, France
(Belohlavek, Smid) 2nd Department of Medicine, General University Hospital
and First Faculty of Medicine, Charles University, Prague, Czechia
(Otahal) Department of Anesthesiology and Intensive Care Medicine, General
University Hospital and First Faculty of Medicine, Charles University,
Prague, Czechia
(Solar) 1st Department of Internal Medicine-Cardioangiology, University
Hospital Hradec Kralove, Faculty of Medicine, Charles University, Hradec
Kralove, Czechia
(Hovdenes) Department of Anesthesiology, Division of Emergencies and
Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Olsen) Department of Anesthesiology, Sorlandet Hospital, Arendal, Norway
(Langeland) Department of Anesthesiology and Intensive Care Medicine, St.
Olav's University Hospital, Department of Circulation and Medical Imaging,
Faculty of Medicine and Health Sciences, Norwegian University of Science
and Technology, Trondheim, Norway
(Saxena) Division of Critical Care and Trauma, George Institute for Global
Health, Bankstown-Lidcombe Hospital, South Western Sydney Local Health
District, Sydney, Australia
(Eastwood) Australian and New Zealand Intensive Care Research Centre,
School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia
(Nichol) Department of Intensive Care, Alfred Health, Monash University,
Melbourne, Australia
(Young, Navarra) Medical Research Institute of New Zealand, Intensive Care
Unit, Wellington Hospital, Wellington, New Zealand
(Pelosi) Departments of Surgical Sciences and Integrated Diagnostics,
University of Genoa, Genoa, Italy
(Pelosi, Brunetti) Anesthesiology and Intensive Care, San Martino
Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of
Genoa, Genoa, Italy
(Storm) Department of Nephrology and Medical Intensive Care, Charite
Universitatzmedizin, Berlin, Germany
(Leithner) Klinik und Hochschulambulanz fur Neurologie, Charite
Universitatzmedizin, Berlin, Germany
(Taccone) Department of Intensive Care, Erasme University Hospital,
Universite Libre de Bruxelles, Brussels, Belgium
(Joannidis) Division of Intensive Care and Emergency Medicine, Department
of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
(Callaway) Department of Emergency Medicine, University of Pittsburgh,
Pittsburgh, United States
(Nichol) University College Dublin Clinical Research Centre, St. Vincent's
University Hospital, Dublin, Ireland
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND Targeted temperature management is recommended for patients
after cardiac arrest, but the supporting evidence is of low certainty.
METHODS In an open-label trial with blinded assessment of outcomes, we
randomly assigned 1900 adults with coma who had had an out-of-hospital
cardiac arrest of presumed cardiac or unknown cause to undergo targeted
hypothermia at 33degreeC, followed by controlled rewarming, or targeted
normothermia with early treatment of fever (body temperature,
>=37.8degreeC). The primary outcome was death from any cause at 6 months.
Secondary outcomes included functional outcome at 6 months as assessed
with the modified Rankin scale. Prespecified subgroups were defined
according to sex, age, initial cardiac rhythm, time to return of
spontaneous circulation, and presence or absence of shock on admission.
Prespecified adverse events were pneumonia, sepsis, bleeding, arrhythmia
resulting in hemodynamic compromise, and skin complications related to the
temperature management device. RESULTS A total of 1850 patients were
evaluated for the primary outcome. At 6 months, 465 of 925 patients (50%)
in the hypothermia group had died, as compared with 446 of 925 (48%) in
the normothermia group (relative risk with hypothermia, 1.04; 95%
confidence interval [CI], 0.94 to 1.14; P = 0.37). Of the 1747 patients in
whom the functional outcome was assessed, 488 of 881 (55%) in the
hypothermia group had moderately severe disability or worse (modified
Rankin scale score >=4), as compared with 479 of 866 (55%) in the
normothermia group (relative risk with hypothermia, 1.00; 95% CI, 0.92 to
1.09). Outcomes were consistent in the prespecified subgroups. Arrhythmia
resulting in hemodynamic compromise was more common in the hypothermia
group than in the normothermia group (24% vs. 17%, P<0.001). The incidence
of other adverse events did not differ significantly between the two
groups. CONCLUSIONS In patients with coma after out-of-hospital cardiac
arrest, targeted hypothermia did not lead to a lower incidence of death by
6 months than targeted normothermia. (Funded by the Swedish Research
Council and others; TTM2 ClinicalTrials.gov number,
NCT02908308.). Copyright © 2021 Massachusetts Medical Society.

<90>
Accession Number
2014525141
Title
Non-invasive imaging software to assess the functional significance of
coronary Stenoses: A systematic review and economic evaluation.
Source
Health Technology Assessment. 25(56) (pp i-229), 2021. Date of
Publication: 2021.
Author
Duarte A.; Llewellyn A.; Walker R.; Schmitt L.; Wright K.; Walker S.;
Rothery C.; Simmonds M.
Institution
(Duarte, Schmitt, Walker, Rothery) Centre for Health Economics, University
of York, York, United Kingdom
(Llewellyn, Walker, Wright, Simmonds) Centre for Reviews and
Dissemination, University of York, York, United Kingdom
Publisher
NIHR Journals Library
Abstract
Background: QAngioXA 3D/QFR(three-dimensional/quantitative flow ratio)
imaging software (Medis Medical Imaging Systems BV, Leiden, the
Netherlands) and CAAS vFFR (vessel fractional flow reserve) imaging
software (Pie Medical Imaging BV, Maastricht, the Netherlands) are
non-invasive technologies to assess the functional significance of
coronary stenoses, which can be alternatives to invasive fractional flow
reserve assessment. Objective(s): The objectives were to determine
the clinical effectiveness and cost-effectiveness of QAngio XA 3D/QFR and
CAAS vFFR. Method(s): We performed a systematic review of all
evidence on QAngio XA 3D/QFR and CAAS vFFR, including diagnostic accuracy,
clinical effectiveness, implementation and economic analyses.We searched
MEDLINE and other databases to January 2020 for studies where either
technology was used and compared with fractional flow reserve in patients
with intermediate stenosis. The risk of bias was assessed with quality
assessment of diagnostic accuracy studies. Meta-analyses of diagnostic
accuracy were performed. Clinical and implementation outcomes were
synthesised narratively. A simulation study investigated the clinical
impact of using QAngio XA 3D/QFR.We developed a de novo decision-analytic
model to estimate the cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR
relative to invasive fractional flow reserve or invasive coronary
angiography alone. Scenario analyses were undertaken to explore the
robustness of the results to variation in the sources of data used to
populate the model and alternative assumptions. Result(s):
Thirty-nine studies (5440 patients) of QAngio XA 3D/QFR and three studies
(500 patients) of CAAS vFFR were included. QAngio XA 3D/QFR had good
diagnostic accuracy to predict functionally significant fractional flow
reserve (<= 0.80 cut-off point); contrast-flow quantitative flow ratio had
a sensitivity of 85% (95% confidence interval 78% to 90%) and a
specificity of 91% (95% confidence interval 85% to 95%). A total of 95% of
quantitative flow ratio measurements were within 0.14 of the fractional
flow reserve. Data on the diagnostic accuracy of CAAS vFFR were limited
and a full meta-analysis was not feasible. There were very few data on
clinical and implementation outcomes. The simulation found that
quantitative flow ratio slightly increased the revascularisation rate when
compared with fractional flow reserve, from 40.2% to 42.0%. Quantitative
flow ratio and fractional flow reserve resulted in similar numbers of
subsequent coronary events. The base-case cost-effectiveness results
showed that the test strategy with the highest net benefit was invasive
coronary angiography with confirmatory fractional flow reserve. The next
best strategies were QAngio XA 3D/QFR and CAAS vFFR (without fractional
flow reserve). However, the difference in net benefit between this best
strategy and the next best was small, ranging from 0.007 to 0.012
quality-adjusted life-years (or equivalently 140-240) per patient
diagnosed at a cost-effectiveness threshold of 20,000 per quality-adjusted
life-year. Limitation(s): Diagnostic accuracy evidence on CAAS vFFR,
and evidence on the clinical impact of QAngio XA 3D/QFR, were limited.
 Conclusion(s): Quantitative flow ratio as measured by QAngio XA
3D/QFR has good agreement and diagnostic accuracy compared with fractional
flow reserve and is preferable to standard invasive coronary angiography
alone. It appears to have very similar cost-effectiveness to fractional
flow reserve and, therefore, pending further evidence on general clinical
benefits and specific subgroups, could be a reasonable alternative. The
clinical effectiveness and cost-effectiveness of CAAS vFFR are uncertain.
Randomised controlled trial evidence evaluating the effect of quantitative
flow ratio on clinical and patient-centred outcomes is
needed. Copyright © 2021, NIHR Journals Library. All rights
reserved.

<91>
Accession Number
2014313005
Title
Comparison of high-flow nasal cannula (hfnc) and conventional oxygen
therapy in obese patients undergoing cardiac surgery: A systematic review
and meta-analysis.
Source
In Vivo. 35(5) (pp 2521-2529), 2021. Date of Publication: October 2021.
Author
WANG Y.; ZHU J.; WANG X.; LIU N.; YANG Q.; LUAN G.; MA X.; LIU J.
Institution
(WANG, ZHU, WANG, YANG, LUAN, MA, LIU) Zhaoyuan Renmin Hospital, Yantai,
China
(LIU) Weihai Municipal Hospital, Weihai, China
Publisher
International Institute of Anticancer Research
Abstract
Background/Aim: High-flow nasal cannula (HFNC), a new method for
postoperative oxygenation, has increasingly received attention during
postoperative care. However, its importance for obese patients undergoing
cardiac surgery remains controversial. This systematic review and
meta-analysis compared and evaluated HFNC and conventional oxygen therapy
(COT) in this patient group. Material(s) and Method(s): Literature
was retrieved by searching eight public databases. Randomized controlled
trials (RCTs) were selected. RevMan 5.3 was used to analyze the results
and any potential bias. The primary outcome included atelectasis score at
24 h postoperatively. The secondary outcomes included PaO2/FiO2 (ratio),
dyspnea score at 24 h postoperatively, intensive care unit (ICU) length of
stay, and reintubation. Result(s): The search strategy yielded 382
studies after duplicates were removed. Finally, 3 RCTs with a total of 526
patients were included in the present study. Compared with COT, there was
no significant difference in atelectasis score, dyspnea score,
reintubation, and ICU length of stay. Conclusion(s): For obese
patients undergoing cardiac surgery, postoperative use of HFNC can
maintain patient's oxygenation. Additional clinical studies are needed to
investigate the role of HFNC in this patient group. Copyright ©
2021 International Institute of Anticancer Research. All rights reserved.

<92>
Accession Number
2014181974
Title
Frailty Assessment in Heart Failure and Ventricular Assist Device
Populations: A Review from the United States.
Source
Heart and Lung. 50(6) (pp 941-952), 2021. Date of Publication: 01 Nov
2021.
Author
Schroeder S.E.; Pozehl B.J.; Alonso W.W.
Institution
(Schroeder) College of Nursing, University of Nebraska Medical Center,
Omaha, Nebraska, 985330 Nebraska Medical Center Omaha, NE USA, 68198-5330;
Division of Mechanical Circulatory Support, Bryan Heart, Lincoln, NE, 1600
South 48th Street, Suite 600, Lincoln, NE 68506, United States
(Pozehl, Alonso) College of Nursing, University of Nebraska Medical
Center, Omaha, Nebraska; 985330 Nebraska Medical Center Omaha, NE
68198-5330, United States
Publisher
Mosby Inc.
Abstract
Importance: Post-operative risk is increased with frail individuals
undergoing cardiac surgery. Yet, there is no consensus for frailty
assessment prior to durable left ventricular assist device (dLVAD)
evaluation. Objective(s): The objectives of this integrative review
were to describe frailty measures, examine psychometrics of measures used,
and identify variables related to frailty in heart failure with reduced
ejection fraction (HFrEF) and dLVAD populations. Design, Setting,
Participants: PubMed, CINAHL, and Embase databases were searched for terms
related to frailty, HFrEF and dLVAD that met inclusion criteria.
 Result(s): Fourteen articles met inclusion criteria. Frailty was
inconsistently defined. The Fried Phenotype Criteria was the most widely
used approach to measurement. Validity was reported in all articles.
Variables related to frailty included readmissions, higher mortality and
increased adverse events. Conclusion(s): There was variability in
frailty definition and frailty measurement across studies. Further
research in HFrEF and dLVAD populations is needed for frailty
evaluation. Copyright © 2021 Elsevier Inc.

<93>
Accession Number
2014160216
Title
Rationale and design of the Dapagliflozin after Transcatheter Aortic Valve
Implantation (DapaTAVI) randomized trial.
Source
European Journal of Heart Failure. (no pagination), 2021. Date of
Publication: 2021.
Author
Amat-Santos I.J.; Sanchez-Luna J.P.; Abu-Assi E.; Melendo-Viu M.;
Cruz-Gonzalez I.; Nombela-Franco L.; Munoz-Garci A.J.; Blas S.G.; de la
Torre Hernandez J.M.; Romaguera R.; Sanchez-Recalde A.; Diez-Gil J.L.;
Lopez-Otero D.; Gheorge L.; Ibanez B.; Iniguez-Romo A.; Raposeiras-Roubin
S.
Institution
(Amat-Santos, Sanchez-Luna, Munoz-Garci, Lopez-Otero, Ibanez) CIBERCV,
Madrid, Spain
(Amat-Santos, Sanchez-Luna) Cardiology Department, Hospital Clinico
Universitario, Valladolid, Spain
(Abu-Assi, Melendo-Viu, Iniguez-Romo, Raposeiras-Roubin) Department of
Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
(Cruz-Gonzalez) Cardiology Department, Hospital Clinico Universitario,
Salamanca, Spain
(Nombela-Franco) Cardiology Department, Hospital Clinico San Carlos,
Madrid, Spain
(Munoz-Garci) Cardiology Department, Hospital Virgen de la Victoria,
Malaga, Spain
(Blas) Cardiology Department, Hospital Clinico Universitario, Valencia,
Spain
(de la Torre Hernandez) Cardiology Department, Hospital Universitario
Marques de Valdecilla, Santander, Spain
(Romaguera) Cardiology Department, Hospital Universitario de Bellvitge,
Barcelona, Spain
(Sanchez-Recalde) Cardiology Department, Hospital Universitario Ramon y
Cajal, Madrid, Spain
(Diez-Gil) Cardiology Department, Hospital Universitario La Fe, Valencia,
Spain
(Lopez-Otero) Cardiology Department, Hospital Clinico Universitario de
Santiago de Compostela, Madrid, Spain
(Gheorge) Cardiology Department, Hospital Universitario Puerta del Mar,
Cadiz, Spain
(Ibanez) IIS-Department of Cardiology, Hospital Fundacion Jimenez Diaz,
Madrid, Spain
(Ibanez, Raposeiras-Roubin) Centro Nacional de Investigaciones
Cardiovasculares (CNIC), Madrid, Spain
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Despite aortic stenosis (AS) relief, patients undergoing
transcatheter aortic valve implantation (TAVI) are at increased risk of
developing heart failure (HF) within first months of intervention.
Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to
reduce the risk of HF hospitalization in individuals with diabetes
mellitus, reduced left ventricular ejection fraction and chronic kidney
disease. However, the effect of SGLT-2 inhibitors on outcomes after TAVI
is unknown. The Dapagliflozin after Transcatheter Aortic Valve
Implantation (DapaTAVI) trial is designed to assess the clinical benefit
and safety of the SGLT-2 inhibitor dapagliflozin in patients undergoing
TAVI. Method(s): DapaTAVI is an independent pragmatic, controlled,
prospective, randomized, open-label blinded endpoint, multicentre trial
conducted in Spain, evaluating the effect of dapagliflozin 10 mg/day on
the risk of death and worsening HF in patients with severe AS undergoing
TAVI. Candidate patients should have prior history of HF admission plus
>=1 of the following criteria: (i) diabetes mellitus, (ii) left
ventricular ejection fraction <=40%, or (iii) estimated glomerular
filtration rate between 25 and 75 ml/min/1.73 m2. A total of
1020 patients will be randomized (1:1) to dapagliflozin vs. no
dapagliflozin. Key secondary outcomes include: (i) incidence rate of
individual components of the primary outcome; (ii) cardiovascular
mortality; (iii) the composite of HF hospitalization or cardiovascular
death; and (iv) total number of HF rehospitalizations. Conclusion(s):
DapaTAVI will determine the efficacy and safety of dapagliflozin in a
broad spectrum of frail patients after AS relief by TAVI. Copyright
© 2021 European Society of Cardiology

<94>
Accession Number
2014028092
Title
Acute Changes in Myocardial Expression of Heat Shock Proteins and
Apoptotic Response Following Blood, delNido, or Custodiol Cardioplegia in
Infants Undergoing Open-Heart Surgery.
Source
Pediatric Cardiology. (no pagination), 2021. Date of Publication: 2021.
Author
Yayla-Tuncer E.; Sengelen A.; Tan-Recep B.Z.; Savluk O.F.; Yilmaz A.A.;
Ceyran H.; Onay-Ucar E.
Institution
(Yayla-Tuncer, Tan-Recep, Yilmaz, Ceyran) Pediatric Cardiovascular Surgery
Clinic, Kartal Kosuyolu High Specialization Training and Research
Hospital, Health Sciences University, Denizer Road No:2,
Cevizli-Kartal/Istanbul 34846, Turkey
(Sengelen) Department of Molecular Biology and Genetics, Institute of
Graduate Studies in Sciences, Istanbul University, Istanbul, Turkey
(Savluk) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High
Specialization Training and Research Hospital, Health Sciences University,
Istanbul, Turkey
(Onay-Ucar) Department of Molecular Biology and Genetics, Faculty of
Science, Istanbul University, Balabanaga, Sehzadebasi Road, Vezneciler,
Istanbul 34134, Turkey
(Tan-Recep) Pediatric Cardiovascular Surgery Clinic, Konya City Hospital,
Health Sciences University, Konya, Turkey
Publisher
Springer
Abstract
Stress caused by cardioplegic ischemic arrest was shown to alter the
expression levels of heat shock proteins (Hsp), but little is known about
their effects, particularly on pediatric hearts. This study aimed to
investigate whether myocardial cellular stress and apoptotic response
changes due to different cardioplegia (CP) solutions during
cardiopulmonary bypass (CPB) in infants and to determine their influence
on surgical/clinical outcomes. Therefore, twenty-seven infants for
surgical closure of ventricular septal defect were randomly assigned to a
CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol
(CCP). Hsp levels and apoptosis were determined by immunoblotting in
cardiac tissue from the right atrium before and after CP, and their
correlations with cardiac parameters were evaluated. No significant change
was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased
significantly in the BCP-group but increased markedly in the CCP-group.
Decreased Hsp60 and increased Hsp70 expression were detected in
dNCP-group. Importantly, apoptosis was not observed in dNCP- and
CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were
determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury
marker, was markedly lower in the BCP- and dNCP-groups than CCP.
Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated
with aortic cross-clamp time, total perfusion time, and cTn-I release. Our
findings show that dNCP provides the most effective myocardial
preservation in pediatric open-heart surgery and indicate that an increase
in Hsp70 expression may be associated with a cardioprotective effect,
while an increase in Hsp60 and Hsp90 levels may be an indicator of
myocardial damage during CPB. Copyright © 2021, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<95>
Accession Number
636227076
Title
Comparison of plasma concentrations of levobupivacaine with and without
epinephrine for thoracic paravertebral block: A randomised trial.
Source
Anaesthesia, critical care & pain medicine. 40(5) (pp 100952), 2021. Date
of Publication: 01 Oct 2021.
Author
Yamazaki A.; Fujii K.; Aratani Y.; Kuriyama T.; Kawamata T.
Institution
(Yamazaki, Fujii, Aratani, Kuriyama, Kawamata) Department of
Anaesthesiology, Wakayama Medical University School of Medicine, 811-1
Kimiidera, Wakayama 641-8509, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Thoracic paravertebral block (TPVB) is effective for analgesia
for unilateral thoracic surgery. However, since the paravertebral space is
highly vascular, injection of local anaesthetics into the paravertebral
space may induce systemic local anaesthetic toxicity. We examined the
effect of addition of epinephrine to paravertebral levobupivacaine on its
plasma concentration. METHOD(S): In a randomised single blind trial,
twenty-four male patients who were scheduled to undergo elective
unilateral pulmonary lobectomy or segmentectomy under general anaesthesia
combined with TPVB were enrolled in this study. They were randomly divided
into two groups: one group received a single bolus thoracic paravertebral
injection of 1mg/kg of 0.25% levobupivacaine with 5mug/mL epinephrine and
the other group received a single bolus thoracic paravertebral injection
of 1mg/kg of 0.25% levobupivacaine alone. Arterial blood samples were
obtained for plasma levobupivacaine assay after injection. The peak plasma
concentration (Cmax) and the time to peak plasma concentration (Tmax), for
levobupivacaine were calculated. RESULT(S): There were no significant
differences in patients' characteristics between the two groups. The mean
arterial Cmax values of levobupivacaine were 0.48+/-0.11mug/mL with
epinephrine and 0.71+/-0.31mug/mL without epinephrine (P=0.041). The mean
arterial Tmax values of levobupivacaine were 46.0+/-35.6min with
epinephrine and 12.0+/-7.2min without epinephrine (P=0.005).
 CONCLUSION(S): The addition of 5-mug/mL epinephrine to a single bolus
thoracic paravertebral injection of 1-mg/kg levobupivacaine significantly
decreased Cmax and delayed Tmax of levobupivacaine. The addition of
epinephrine to levobupivacaine may be a useful strategy to reduce systemic
levobupivacaine toxicity. CLINICAL TRIAL REGISTRATION NUMBER: UMIN
000021942. Copyright © 2021 The Author(s). Published by Elsevier
Masson SAS.. All rights reserved.

<96>
Accession Number
2015219584
Title
Effect of Benson and progressive muscle relaxation techniques on sleep
quality after coronary artery bypass graft: A randomized controlled trial.
Source
Complementary Therapies in Medicine. 63 (no pagination), 2021. Article
Number: 102784. Date of Publication: December 2021.
Author
Bagheri H.; Moradi-Mohammadi F.; Khosravi A.; Ameri M.; Khajeh M.; Chan
S.W.-C.; Abbasinia M.; Mardani A.
Institution
(Bagheri, Ameri, Khajeh) School of Nursing and Midwifery, Shahroud
University of Medical Sciences, Shahroud, Iran, Islamic Republic of
(Moradi-Mohammadi) ICU department, Shahid Beheshti Hospital, Shahid
Beheshti Boulevard, Azadegan Square, Qom, Iran, Islamic Republic of
(Khosravi) School of Public Health, Shahroud University of Medical
Sciences, Shahroud, Iran, Islamic Republic of
(Chan) Tung Wah College, Hong Kong
(Abbasinia) Nursing faculty, Qom University of Medical Sciences, Qom,
Iran, Islamic Republic of
(Mardani) Nursing Care Research Center, Department of Medical Surgical
Nursing, School of Nursing and Midwifery, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
Publisher
Churchill Livingstone
Abstract
Objective: This study aimed to investigate the effect of Benson relaxation
(BR) and progressive muscle relaxation (PMR) techniques on the sleep
quality of patients undergoing coronary artery bypass graft (CABG)
surgery. Method(s): This study was a three-arm, parallel, randomized
controlled trial. 120 patients who underwent CABG surgery at two academic
hospitals in an urban area of Iran were randomly allocated into three
groups (40 per group): the BR, PMR, and control groups. Patients in the BR
and the PMR groups performed relevant exercises twice a day for four
weeks. Sleep quality was measured before and immediately after the
intervention using Pittsburgh Sleep Quality Index. Result(s):
Within-group comparison in the BR (t = 3.51, p = 0.001) and the PMR (t =
4.58, p < 0.001) group showed that the overall sleep quality showed a
significant improvement after the intervention when compared to baseline.
The between-group comparison showed that both the BR and PMR groups showed
significant improvements in subjective sleep quality (F = 3.75, p = 0.02),
habitual sleep efficiency (F = 4.81, p = 0.01), and overall sleep quality
(F = 5.53, p = 005) when compared to the control group after the
intervention. However, no statistically significant differences were
identified among the three study groups in terms of sleep latency, sleep
duration, sleep disturbances, sleeping medication, and daytime dysfunction
after the intervention (p > 0.05). Conclusion(s): The study showed
that a four-week program of both PMR and BR can be effective in the
overall improvement of sleep quality in patients following CABG. Further
research is required to replicate the findings of the present
study. Copyright © 2021 The Authors

<97>
Accession Number
2012315216
Title
Impact of chronic kidney disease on hemoglobin among patients with
peripheral artery disease treated with P2Y<inf>12</inf> inhibitors:
Insights from the EUCLID trial.
Source
Vascular Medicine (United Kingdom). 26(6) (pp 608-612), 2021. Date of
Publication: December 2021.
Author
Hsia J.; Kavanagh S.T.; Hopley C.W.; Baumgartner I.; Berger J.S.; Fowkes
G.R.; Jones W.S.; Mahaffey K.W.; Norgren L.; Patel M.R.; Rockhold F.;
Blomster J.; Katona B.G.; Hiatt W.R.; Bonaca M.P.
Institution
(Hsia, Kavanagh, Hiatt, Bonaca) CPC Clinical Research, Aurora, CO, United
States
(Hsia, Hiatt, Bonaca) Department of Medicine, University of Colorado
School of Medicine, Aurora, CO, United States
(Hopley) Department of Medicine, Geisel School of Medicine at Dartmouth,
Dartmouth Hitchcock Medical Center, Hanover, NH, United States
(Baumgartner) Department of Angiology, Inselspital, Bern, Switzerland
(Berger) Departments of Medicine and Surgery, New York University School
of Medicine, New York, NY, United States
(Fowkes) Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Jones, Patel, Rockhold) Duke Clinical Research Institute, Duke
University, Durham, NC, United States
(Mahaffey) Stanford University School of Medicine, Palo Alto, CA, United
States
(Norgren) Faculty of Medicine and Health, Orebro University Hospital,
Orebro, Sweden
(Blomster, Katona) AstraZeneca LP, Gothenburg, Sweden
(Blomster, Katona) GaithersburgMDUnited States
Publisher
SAGE Publications Ltd
Abstract
Patients with chronic kidney disease may develop new or more severe anemia
when treated with antiplatelet agents due to blood loss in conjunction
with impaired erythropoiesis. Because anemia independently predicts limb
amputation and mortality among patients with peripheral artery disease
(PAD), we evaluated the relationship between estimated glomerular
filtration rate (eGFR) and hemoglobin (Hb) levels in the EUCLID trial in
which patients with symptomatic PAD were randomized to ticagrelor or
clopidogrel. At baseline, 9025, 1870, and 1000 patients had eGFR 60,
45-59, and < 45 mL/min/1.73 m2, respectively. The mean fall in
Hb during the trial was 0.46 +/- 1.68 g/dL and did not differ by baseline
eGFR category, although Hb fall 10% was more frequent among patients with
lower eGFR (p for trend < 0.0001). On-study treatment with iron,
erythropoiesis-stimulating agents, and/or red blood cell transfusion was
reported for 479 (5.3%), 165 (8.8%), and 129 (12.9%) patients in the three
eGFR categories, respectively (p for trend < 0.0001). After adjustment for
baseline and post-randomization effects, those not receiving anemia
treatment had a smaller reduction in Hb from baseline than those receiving
anemia treatment (p < 0.0001). Other determinants of Hb reduction included
absence of on-study myocardial infarction, coronary or peripheral
revascularization, residence outside North America, male sex, and baseline
eGFR. We conclude that among patients with PAD treated with
P2Y<inf>12</inf> inhibitors, lower baseline eGFR was associated with a
greater reduction in Hb. ClinicalTrials.gov Identifier:
NCT01732822 Copyright © The Author(s) 2021.

<98>
Accession Number
636573325
Title
Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic
Review.
Source
Frontiers in Neurology. 12 (no pagination), 2021. Article Number: 732176.
Date of Publication: 16 Nov 2021.
Author
Longhitano Y.; Iannuzzi F.; Bonatti G.; Zanza C.; Messina A.; Godoy D.;
Dabrowski W.; Xiuyun L.; Czosnyka M.; Pelosi P.; Badenes R.; Robba C.
Institution
(Longhitano) Department of Anesthesiology and Critical Care, AO St.
Antonio, Biagio and Cesare Arrigo, Alessandria, Italy
(Iannuzzi, Pelosi, Robba) Department of Surgical Sciences and Integrated
Diagnostics (DISC), University of Genoa, Genoa, Italy
(Bonatti) Anesthesia and Intensive Care, Gaslini Hospital, Genova, Italy
(Zanza) Foundation of "Nuovo Ospedale Alba-Bra" and Department of
Emergency Medicine, Anesthesia and Critical Care Division, Michele and
Pietro Ferrero Hospital, Verduno, Italy
(Messina) Humanitas Clinical and Research Center - IRCCS, Milan, Italy
(Messina) Department of Biomedical Sciences, Humanitas University, Milan,
Italy
(Godoy) Neurointensive Care Unit, Sanatorio Pasteur, 2 Intensive Care
Unit, Hospital Carlos Malbran, Catamarca, Argentina
(Dabrowski) Anesthesia and Intensive Care, University of Lublin, Lublin,
Poland
(Xiuyun) Department of Anesthesiology & Critical Care Medicine, John
Hopkins University, Baltimore, MD, United States
(Czosnyka) Brain Physics Laboratory, Department of Clinical Neurosciences,
University of Cambridge, Cambridge, United Kingdom
(Pelosi, Robba) Anesthesia and Critical Care, San Martino Policlinico
Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
(Badenes) Department of Anesthesiology and Surgical-Trauma Intensive Care,
Hospital Clinic Universitari de Valencia, Department of Surgery,
University of Valencia, Valencia, Spain
Publisher
Frontiers Media S.A.
Abstract
Introduction: Cerebral autoregulation (CA) plays a fundamental role in the
maintenance of adequate cerebral blood flow (CBF). CA monitoring, through
direct and indirect techniques, may guide an appropriate therapeutic
approach aimed at improving CBF and reducing neurological complications;
so far, the role of CA has been investigated mainly in brain-injured
patients. The aim of this study is to investigate the role of CA in
non-brain injured patients. Method(s): A systematic consultation of
literature was carried out. Search terms included: "CA and sepsis," "CA
and surgery," and "CA and non-brain injury." Results: Our research
individualized 294 studies and after screening, 22 studies were analyzed
in this study. Studies were divided in three groups: CA in sepsis and
septic shock, CA during surgery, and CA in the pediatric population.
Studies in sepsis and intraoperative setting highlighted a relationship
between the incidence of sepsis-associated delirium and impaired CA. The
most investigated setting in the pediatric population is cardiac surgery,
but the role and measurement of CA need to be further elucidated.
 Conclusion(s): In non-brain injured patients, impaired CA may result
in cognitive dysfunction, neurological damage, worst outcome, and
increased mortality. Monitoring CA might be a useful tool for the bedside
optimization and individualization of the clinical management in this
group of patients. Copyright © 2021 Longhitano, Iannuzzi,
Bonatti, Zanza, Messina, Godoy, Dabrowski, Xiuyun, Czosnyka, Pelosi,
Badenes and Robba.

<99>
Accession Number
2015885807
Title
Dexmedetomidine Use in Intensive Care Unit Sedation and Postoperative
Recovery in Elderly Patients Post-Cardiac Surgery (DIRECT).
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Chitnis S.; Mullane D.; Brohan J.; Noronha A.; Paje H.; Grey R.; Bhalla
R.K.; Sidhu J.; Klein R.
Institution
(Chitnis, Mullane, Brohan, Grey, Klein) Department of Anesthesiology and
Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, BC,
Canada
(Chitnis) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Murdoch, Perth, Western Australia, Australia
(Brohan) Department of Anaesthesia, Cork University Hospital, Wilton,
Cork, Ireland
(Noronha, Paje) Vancouver Coastal Health, Vancouver, BC, Canada
(Bhalla) Neuropsychology Service, Vancouver General Hospital, 899 W 12th
Avenue, Vancouver, BC V5Z 1M9, Canada
(Bhalla) Division of Psychiatry, University of British Columbia,
Vancouver, BC V6T 1Z4, Canada
(Sidhu) Department of Psychiatry, Vancouver General Hospital, Vancouver,
BC, Canada
Publisher
W.B. Saunders
Abstract
Objective: This study examined recovery, delirium, and neurocognitive
outcome in elderly patients receiving dexmedetomidine or propofol sedation
after undergoing cardiac surgery. Design(s): Open-label randomized
trial. Setting(s): Single center. Participant(s): A total of 70
patients older than 75 years without English language limitations and Mini
Mental State Examination scores >20. Intervention(s): Patients
received either propofol (group P) or dexmedetomidine (group D)
postoperatively until normothermic and hemodynamically stable.
 Measurements and Main Results: Quality of recovery (QoR) was measured
by the QoR-40 questionnaire on postoperative day (POD) three. Secondary
outcomes were incidence and duration of delirium, time to extubation,
length of hospital stay, hospital mortality rate, postoperative quality of
life (QoL; measured by SF-36 performed at baseline and six months
postoperatively), and neurocognitive disorder (measured by Minnesota
Cognitive Acuity Screen [MCAS] performed at baseline, POD5, and six months
postoperatively). A total of sixty-seven patients completed the trial.
There was no significant difference in QoR-40 scores (95% confidence
interval [CI], -7.6081-to-10.9781; p = 1.000), incidence of delirium
(group P, 42%; group D, 24%; p = 0.191), mean hospital stay (95% CI,
-5.4838-to-1.5444; p = 0.297), mean time to extubation (95% CI,
-19.2513-to-7.5561; p = 0.866), or mean duration of delirium (95% CI,
-4.3065-to-1.067; p = 0.206) between groups. No patients died in the
hospital. There were no significant differences in changes in SF-36 or
MCAS scores over time between groups. There was a decline in MCAS score
from preoperatively to POD5 in group P (95% CI, -8.95725-to- -2.61775; p =
0.0005), which was greater than that observed in group D.
 Conclusion(s): The authors' findings demonstrated that the use of
dexmedetomidine compared with propofol in elderly patients undergoing
cardiac surgery was unlikely to improve QoR/postoperative QoL. Although
the study was underpowered to detect secondary outcomes, the results
suggested no reductions in delirium, time to extubation, and hospital
stay, but a potential decrease in delayed neurocognitive
recovery. Copyright © 2021

<100>
Accession Number
636599203
Title
Design and Rationale of a Phase 2 Study of NeurOtoxin (Botulinum Toxin
Type A) for the PreVention of Post-Operative Atrial Fibrillation - The
NOVA Study.
Source
American heart journal. (no pagination), 2021. Date of Publication: 20
Oct 2021.
Author
Piccini J.P.; Ahlsson A.; Dorian P.; Gillinov M.A.; Kowey P.R.; Mack M.J.;
Milano C.A.; Perrault L.P.; Steinberg J.S.; Waldron N.H.; Adams L.M.;
Bharucha D.B.; Brin M.F.; Ferguson W.G.; Benussi S.
Institution
(Piccini, Waldron) Duke Clinical Research Institute/ Duke University
Medical Center, United States
(Ahlsson) Karolinska University Hospital, Sweden
(Dorian) St. Michael's Hospital, Canada
(Gillinov) Cleveland Clinic, United States
(Kowey) Lankenau Heart Institute, United States
(Mack) Baylor University Medical Center, United States
(Milano) Duke University Medical Center, United States
(Perrault) Montreal Heart Institute, Canada
(Steinberg) University of Rochester School of Medicine & Dentistry, United
States
(Adams, Bharucha, Brin, Ferguson) XXX
(Benussi) University of Brescia, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Post-operative AF (POAF) is the most common complication
following cardiac surgery, occurring in 30% to 60% of patients undergoing
bypass and/or valve surgery. POAF is associated with longer intensive care
unit/hospital stays, increased healthcare utilization, and increased
morbidity and mortality. Injection of botulinum toxin type A into the
epicardial fat pads resulted in reduction of AF in animal models, and in 2
clinical studies of cardiac surgery patients, without new safety
observations. METHOD(S): The objective of NOVA is to assess the use
of AGN-151607 (botulinum toxin type A) for prevention of POAF in cardiac
surgery patients. This randomized, multi-site, placebo-controlled trial
will study one-time injections of AGN-151607 125 U (25 U / fat pad) and
250 U (50 U / fat pad) or placebo during cardiac surgery in ~330
participants. Primary endpoint: % of patients with continuous AF >= 30 s.
Secondary endpoints include several measures of AF frequency, duration,
and burden. Additional endpoints include clinically important tachycardia
during AF, time to AF termination, and healthcare utilization. Primary and
secondary efficacy endpoints will be assessed using continuous ECG
monitoring for 30 days following surgery. All patients will be followed
for up to 1 year for safety. CONCLUSION(S): The NOVA Study will test
the hypothesis that injections of AGN-151607 will reduce the incidence of
POAF and associated resource utilization. If demonstrated to be safe and
effective, the availability of a one-time therapy for the prevention of
POAF would represent an important treatment option for patients undergoing
cardiac surgery. Copyright © 2021. Published by Elsevier Inc.

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