EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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<1>
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. <br/>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. <br/>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). <br/>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.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<2>
Accession Number
2015507120
Title
Meta-Analysis Evaluating High-Sensitivity Cardiac Troponin T Kinetics
after Coronary Artery Bypass Grafting in Relation to the Current
Definitions of Myocardial Infarction.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Heuts S.; Denessen E.J.S.; Daemen J.H.T.; Vroemen W.H.M.; Sels J.-W.;
Segers P.; Bekers O.; van 't Hof A.W.J.; Maessen J.G.; van der Horst
I.C.C.; Mingels A.M.A.
Institution
(Heuts, Segers, Maessen) Department of Cardiothoracic Surgery
(Denessen, Vroemen, Bekers, Mingels) Department of Central Diagnostic
Laboratory
(Sels, van der Horst) Department of Intensive Care Medicine, and
(Sels, van 't Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
(Denessen, Bekers, van 't Hof, Maessen, van der Horst, Mingels)
Cardiovascular Research Institute Maastricht (CARIM), Maastricht
University, Maastricht, Netherlands
(Daemen) Department of Surgery, and
(van 't Hof) Department of Cardiology, Zuyderland Medical Center, Heerlen,
Netherlands
Publisher
Elsevier Inc.
Abstract
Various definitions of myocardial infarction type 5 after coronary artery
bypass grafting (CABG) have been proposed (myocardial infarction [MI-5],
also known as peri-procedural MI), using different biomarkers and
different and arbitrary cut-off values. This meta-analysis aims to
determine the expected release of high-sensitivity cardiac troponin T
(hs-cTnT) after CABG in general and after uncomplicated surgery and
off-pump CABG in particular. A systematic search was applied to 3
databases. Studies on CABG as a single intervention and reporting on
postoperative hs-cTnT concentrations on at least 2 different time points
were included. All data on hs-cTnT concentrations were extracted, and mean
concentrations at various points in time were stratified. Eventually, 15
studies were included, encompassing 2,646 patients. Preoperative hs-cTnT
was 17 ng/L (95% confidence interval [CI] 13 to 20 ng/L). Hs-cTnT peaked
at 6 to 8 hours postoperatively (628 ng/L, 95% CI 400 to 856 ng/L; 45x
upper reference limit [URL]) and was still increased after 48 hours. In
addition, peak hs-cTnT concentration was 614 ng/L (95% CI 282 to 947 ng/L)
in patients with a definite uncomplicated postoperative course (i.e.,
without MI). For patients after off-pump CABG compared to on-pump CABG,
the mean peak hs-cTnT concentration was 186 ng/L (95% CI 172 to 200 ng/L,
13 x URL) versus 629 ng/L (95% CI 529 to 726 ng/L, 45 x URL),
respectively. In conclusion, postoperative hs-cTnT concentrations surpass
most of the currently defined cut-off values for MI-5, even in perceived
uncomplicated surgery, suggesting thorough reassessment. Hs-cTnT release
differences following on-pump CABG versus off-pump CABG were observed,
implying the need for different cut-off values for different surgical
strategies.<br/>Copyright &#xa9; 2021 The Author(s)

<3>
Accession Number
2015506449
Title
Inconsistent Methodology as a Barrier to Meaningful Research Outputs From
Studies of Atrial Fibrillation After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Campbell N.G.; Wollborn J.; Fields K.G.; Lip G.Y.H.; Ruetzler K.;
Muehlschlegel J.D.; O'Brien B.
Institution
(Campbell) Division of Cardiovascular Sciences, University of Manchester,
Manchester Academic Health Science Centre, Manchester, United Kingdom
(Wollborn, Fields, Muehlschlegel) Department of Anesthesiology,
Perioperative and Pain Medicine, Brigham, and Women's Hospital, Harvard
Medical School, Boston, MA, United States
(Lip) Liverpool Centre for Cardiovascular Science, University of Liverpool
and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
(Lip) Department of Clinical Medicine, Aalborg University, Aalborg,
Denmark
(Ruetzler) Anesthesiology Institute, Departments of Outcomes Research and
General Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
(Ruetzler, O'Brien) Outcomes Research Consortium, Cleveland, OH, United
States
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, German Heart Center Berlin, Berlin, Germany
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Charite Universitatsmedizin, Berlin, Germany
(O'Brien) Department of Perioperative Medicine, St. Bartholomew's
Hospital, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Atrial fibrillation after cardiac surgery (AFACS) is a serious
postoperative complication. There is significant research interest in this
field but also relevant heterogeneity in reported AFACS definitions and
approaches used for its identification. Few data exist on the extent of
this variation in clinical studies. The authors reviewed the literature
since 2001 and included manuscripts reporting outcomes of AFACS in adults.
They excluded smaller studies and studies in which patients did not
undergo a sternotomy. The documented protocol in each manuscript was
analyzed according to six different categories to determine how AFACS was
defined, which techniques were used to identify it, and the inclusion
and/or exclusion criteria. They also noted when a category was not
described in the documented protocol. The authors identified 302 studies,
of which 92 were included. Sixty-two percent of studies were randomized
controlled trials. There was significant heterogeneity in the manuscripts,
including the exclusion of patients with preoperative AF, the definition
and duration of AF needed to meet the primary endpoint, the type of
screening approach (continuous, episodic, or opportunistic), the duration
of monitoring during the study period in days, the diagnosis with
predefined electrocardiogram criteria, and the requirement for independent
confirmation by study investigators. Furthermore, the definitions of these
criteria frequently were not described. Consistent reporting standards for
AFACS research are needed to advance scientific progress in the field. The
authors here propose pragmatic standards for trial design and reporting
standards. These include adequate sample size estimation, a clear
definition of the AFACS endpoints, and a protocol for AFACS
detection.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<4>
Accession Number
2014241792
Title
Safety and efficacy of cerebral embolic protection devices in patients
undergoing transcatheter aortic valve replacement: a meta-analysis of
in-hospital outcomes.
Source
Cardiovascular Intervention and Therapeutics. (no pagination), 2021. Date
of Publication: 2021.
Author
Shimamura J.; Kuno T.; Malik A.; Yokoyama Y.; Gupta R.; Ahmad H.;
Briasoulis A.
Institution
(Shimamura) Division of Cardiac Surgery, Sunnybrook Health Sciences
Centre, Toronto, ON, Canada
(Kuno) Department of Cardiology, Montefiore Medical Center, Albert
Einstein Medical College, Bronx, NY, United States
(Malik) Department of Cardiology, Westchester Medical Center and New York
Medical College, Valhalla, NY, United States
(Yokoyama) Department of Surgery, Easton Hospital, Easton, PA, United
States
(Gupta) Department of Cardiology, Lehigh Valley Heart Institute, Lehigh
Valley Health Network, Allentown, PA, United States
(Ahmad) Division of Cardiology, Westchester Medical Center, Valhalla, NY,
United States
(Briasoulis) Section of Heart Failure and Transplant, Division of
Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200
Hawkins Dr, Iowa City, IA 52242, United States
Publisher
Springer Japan
Abstract
The evidence regarding the impact of cerebral embolic protection devices
(EPDs) on outcomes following transcatheter aortic valve replacement (TAVR)
is limited. The objective of this study was to evaluate in-hospital
outcomes with the use of cerebral EPDs in TAVR. We performed a
comprehensive EMBASE and PUBMED search to investigate randomized control
studies or propensity score-matched retrospective studies which assessed
patients undergoing TAVR with or without EPD up to April 2021. Endpoints
of interest were in-hospital mortality, stroke, acute kidney injury,
pacemaker implantation, major bleeding, vascular complication, length of
stay. Ten studies involving 173,002 patients with EPD (n = 16,898, 9.8%)
and those without (n = 156,104, 90.2%) fulfilled the inclusion criteria.
The use of EPD was associated with significantly lower risk of in-hospital
stroke (odds ratio [95% confidential interval]: 0.64 [0.46; 0.89]), but
similar rate of in-hospital mortality (odds ratio [95% confidential
interval]: 0.75 [0.54; 1.05]). No differences were observed in acute
kidney injury, pacemaker implantation, major bleeding, vascular
complication, length of stay. EPD during TAVR was associated with lower
in-hospital stroke but did not affect procedural complications and length
of stay.<br/>Copyright &#xa9; 2021, Japanese Association of Cardiovascular
Intervention and Therapeutics.

<5>
Accession Number
636730062
Title
Comparison of rehabilitation outcomes for transcatheter versus surgical
aortic valve replacement as redo procedure in patients with previous
cardiac surgery: Evidence based on 11 observational studies.
Source
Medicine. 100(45) (pp e27657), 2021. Date of Publication: 12 Nov 2021.
Author
Wang G.; Li X.; Zhang Z.; Dong J.
Institution
(Wang, Dong) Rehabilitation Division Treatment Department, Wang Jing
Hospital of China Academy of Chinese Medical Science, Beijing, China
(Li) Department of Vascular Surgery, Wang Jing Hospital of China Academy
of Chinese Medical Science, Beijing, China
(Zhang) Department of Spinal Surgery, Wang Jing Hospital of China Academy
of Chinese Medical Science, Beijing, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Currently, the number of severe aortic stenosis (AS) patients
with a history of prior cardiac surgery (PCS) has increased. Both
transcatheter aortic valve replacement (TAVR) and traditional surgical
aortic valve replacement (sAVR) are effective therapy for AS. However, PCS
increases the risk of adverse outcomes in patients undergoing aortic valve
replacement. Thus, this meta-analysis was designed to comparatively
evaluate the impact of PCS on clinical outcomes between TAVR and sAVR.
<br/>METHOD(S): A systematic search of PubMed, Embase, Cochrane Library,
and Web of Science up to February 1, 2021 was conducted for relevant
studies that comparing TAVR and sAVR for severe AS patients with a history
of PCS. The primary outcome was the non-inferiority of TAVR and sAVR in
mortality. The secondary outcomes were the other clinical outcomes. Two
reviewers assessed trial quality and extracted the data independently. All
statistical analyses were performed using the standard statistical
procedures provided in Review Manager 5.2. <br/>RESULT(S): A total of 11
studies including 8852 patients were identified. The pooled results
indicated that there was no difference in 30-day, and 1-year all-cause
mortality between TAVR and sAVR. No significant difference was also
observed in total follow-up and cardiovascular mortality between TAVR and
sAVR. However, subgroup analysis revealed significantly higher 1-year
all-cause mortality (OR 1.92; 95% CI 1.05-3.52; P = .04) and total
follow-up mortality (OR 2.28; 95% CI 1.09-4.77; P = .03) in TAVR than sAVR
for patients with a history of coronary artery bypass graft, aortic valve
replacement, and mitral valve reconstruction. In addition, TAVR
experienced higher pacemaker implantation than sAVR. However, compared
with sAVR, TAVR experienced shorter length of stay (MD -3.18 days; 95% CI
-4.78 to -1.57 days) and procedural time (MD -172.01 minutes; 95% CI
-251.15 to -92.88) respectively. TAVR also lead to much less bleeding than
sAVR. <br/>CONCLUSION(S): Our analysis shows that TAVR as a redo procedure
was equal to sAVR in mortality for severe AS patients with PCS, especially
coronary artery bypass graft. We agree the advantage of TAVR as a redo
procedure for patients with a history of PCS. Patients receiving TAVR
experienced rapid recovery, shorter operation time and less bleeding,
without increasing short and long term mortality.<br/>Copyright &#xa9;
2021 the Author(s). Published by Wolters Kluwer Health, Inc.

<6>
Accession Number
636728737
Title
Systematic review and meta-analysis on perioperative intervention to
prevent postoperative atelectasis complications after thoracic surgery.
Source
Annals of palliative medicine. 10(10) (pp 10726-10734), 2021. Date of
Publication: 01 Jan 2021.
Author
Zhao Y.; Zheng R.; Xiang W.; Ning D.; Li Z.
Institution
(Zhao, Xiang, Ning, Li) Department of Thoracic Surgery, Affiliated
Hospital of North Sichuan Medical College, China
(Zheng) Affiliated Hospital of North Sichuan Medical College, Department
of Integrated Western and Chinese Colorectal and Anal Surgery, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In clinical general thoracic surgery, the prevalence of
atelectasis is relatively high. Perioperative interventions can affect the
probability of patients with atelectasis after surgery. Therefore, the
incidence of perioperative intervention to prevent atelectasis after
thoracic surgery was discussed using meta-analysis in this study.
<br/>METHOD(S): The articles were searched in the English database PubMed
and Chinese databases including China National Knowledge Infrastructure
(CNKI), VIP, and China Journal Full-text Database (CJFD). The duration for
publication time of the articles was from the database inception to March
2021, and the articles were required to be randomized controlled trials
(RCTs) using interventions [such as changing the dose of general
anesthesia, continuous positive end expiratory pressure (PEEP),
non-invasive pressure support ventilation, and physical therapy] after
thoracic surgery (such as pulmonary lobectomy, sternum surgery, and lung
cancer surgery) for the treatment of atelectasis. The software RevMan 5.3
provided by the Cochrane Collaboration was used for meta-analysis.
<br/>RESULT(S): A total of 5 articles were obtained, including 375 cases
in the control group and 268 cases in the intervention treatment group. A
meta-analysis was performed on the included articles, combined effect
model analysis results showed that compared with the control group, the
use of PEEP during mechanical ventilation can significantly reduce the
incidence of atelectasis [odds ratio (OR) =0.46; 95% confidence interval
(CI): 0.31-0.67; Z=3.94; P<0.0001]. DISCUSSION: Perioperative intervention
was more effective for postoperative atelectasis and other complications.

<7>
Accession Number
636725823
Title
Effects of short-term bisoprolol on perioperative myocardial injury in
patients undergoing non-cardiac surgery: a randomized control study.
Source
Scientific reports. 11(1) (pp 22006), 2021. Date of Publication: 10 Nov
2021.
Author
Wongcharoen W.; Chotayaporn T.; Chutikhongchalermroj K.; Tantraworasin A.;
Saeteng S.; Arworn S.; Rerkasem K.; Phrommintikul A.
Institution
(Wongcharoen, Chotayaporn, Chutikhongchalermroj, Phrommintikul) Division
of Cardiology, Department of Internal Medicine, Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand
(Tantraworasin, Saeteng) Division of Thoracic Surgery, Department of
Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Arworn, Rerkasem) Division of Vascular Surgery, Department of Surgery,
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
(Rerkasem) Environmental Occupational Health Sciences and Non Communicable
Diseases Center of Excellence, Research Institute of Health Sciences,
Chiang Mai University, Chiang Mai, Thailand
(Phrommintikul) Center for Medical Excellence, Faculty of Medicine, Chiang
Mai University, Chiang Mai, Thailand
Publisher
NLM (Medline)
Abstract
The protective role of preoperative beta-blocker in patients undergoing
non-cardiac surgery is unknown. We aimed to evaluate the effects of
beta-blocker on perioperative myocardial injury in patients undergoing
non-cardiac surgery. We consecutively enrolled 112 patients undergoing
non-cardiac surgery. They were randomly allocated to receive bisoprolol or
placebo given at least 2 days preoperatively and continued until 30 days
after surgery. The primary outcome was incidence of perioperative
myocardial injury defined by a rise of high-sensitive troponin-T (hs-TnT)
more than 99th percentile of upper reference limit or a rise of hs-TnT
more than 20% if baseline level is abnormal. Baseline characteristics were
comparable between bisoprolol and placebo in randomized cohort Mean age
was 62.5+/-11.8 years and 76 (67.8%) of 112 patients were male. Among 112
patients, 49 (43.8%) underwent vascular surgery and 63 (56.2%) underwent
thoracic surgery. The median duration of assigned treatment prior to
surgery was 4 days (2-6 days). We did not demonstrate the significant
difference in the incidence of perioperative myocardial injury [52.6% (30
of 57 patients) vs. 49.1% (27 of 55 patients), P=0.706]. In addition, the
incidence of intraoperative hypotension was higher in bisoprolol group
than placebo group in patients undergoing non-cardiac surgery [70.2% (40
of 57 patients) vs. 47.3% (26 of 55 patients), P=0.017]. We demonstrated
that there was no statistically significant difference in perioperative
myocardial injury observed between patients receiving bisoprolol and
placebo who had undergone non-cardiac surgery.<br/>Copyright &#xa9; 2021.
The Author(s).

<8>
Accession Number
2016077360
Title
Rationale and design of the safe and timely antithrombotic removal -
ticagrelor (STAR-T) trial: A prospective, multi-center, double-blind,
randomized controlled trial evaluating reductions in postoperative
bleeding with intraoperative removal of ticagrelor by the drugsorbTM-ATR
device in patients undergoing cardiothoracic surgery within 48 hours from
last ticagrelor dose.
Source
American Heart Journal. 245 (pp 19-28), 2022. Date of Publication: March
2022.
Author
Gibson C.M.; Mack M.J.; Lee V.T.; Schneider D.J.; Sellke F.W.; Ohman E.M.;
Thourani V.H.; Doros G.; Kroger H.; Cutlip D.E.; Deliargyris E.N.
Institution
(Gibson, Doros, Cutlip) The Baim Institute and Harvard Medical School,
Boston, MA, United States
(Mack) Baylor Scott & White Health, Baylor Scott & White Research
Institute, Dallas, TX, United States
(Lee, Kroger, Deliargyris) CytoSorbents Inc, Princeton, NJ, United States
(Schneider) Department of Medicine and Cardiovascular Research Institute,
University of Vermont, Burlington, VT, United States
(Sellke) Division of Cardiothoracic Surgery, Alpert Medical School of
Brown University, Providence, RI, United States
(Ohman) Duke Clinical Research Institute, Duke Program for Advanced
Coronary Disease, Duke University Medical Center, Durham, NC, United
States
(Thourani) Department of Cardiovascular Surgery, Marcus Valve Center,
Piedmont Heart Institute, Atlanta, GA, United States
(Doros) Boston University School of Public Health, Boston, MA, United
States
Publisher
Elsevier Inc.
Abstract
Background: Ticagrelor is often administered to patients with acute
coronary syndromes. However, when these patients require urgent or
emergent cardiothoracic (CT) surgery the presence of ticagrelor
significantly increases surgical bleeding. The goal of the current trial
is to evaluate the effectiveness and safety of the DrugSorb-ATR
hemoadsorption device for the intraoperative removal of ticagrelor to
reduce postoperative bleeding in the above patient population. The Safe
and Timely Antithrombotic Removal - Ticagrelor (STAR-T) Trial is a
multi-center, double-blind, randomized, controlled trial enrolling
patients who require cardiothoracic surgery on cardiopulmonary bypass
(CPB) within 48 hours of last ticagrelor dose. <br/>Method(s): Subjects
will be randomized 1:1 to receive either the DrugSorb-ATR device or an
identical sham device during CPB. The study will enroll up to 120 subjects
at 20 U.S centers, and the primary outcome is the composite of fatal
perioperative bleeding, moderate/severe/massive bleeding according to the
Universal Definition of Perioperative Bleeding in Cardiac Surgery (UDPB),
and 24 hours chest tube drainage. The components of the composite are
hierarchically ranked according to clinical significance and the primary
analysis will utilize the Win Ratio method. Percent change in ticagrelor
levels before and after CPB (drug removal) will be the key secondary
endpoint. An independent Clinical Events Committee will adjudicate all
clinical endpoints including safety endpoints relating to postoperative
thrombotic events. Subjects will be followed through 30 days after the
index operation. <br/>Conclusion(s): The results from STAR-T, if positive,
will potentially support FDA market approval for DrugSorb-ATR, and provide
a solution to an important unmet clinical need.<br/>Copyright &#xa9; 2021
The Author(s)

<9>
Accession Number
2016088230
Title
The role of electrophysiology study in risk stratification of cardiac
sarcoidosis patients: Meta-analyses and systemic review.
Source
International Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Adhaduk M.; Paudel B.; Liu K.; Ashwath M.; Giudici M.
Institution
(Adhaduk, Paudel, Liu, Ashwath, Giudici) The University of Iowa, United
States
Publisher
Elsevier Ireland Ltd
Abstract
Background: The utility of an electrophysiologic study (EPS) in the risk
stratification of cardiac sarcoidosis (CS) patients is not clear. We
conducted a systemic review and meta-analysis to evaluate the utility of
EPS in the risk stratification of CS patients. <br/>Method(s): We searched
PubMed, Embase, and Scopus databases from their inception to 12/4/2020
with search terms "Cardiac sarcoidosis" And "Electrophysiological studies
OR ablation". The first and second authors reviewed all the studies. We
extracted the data of positive and negative EPS, and outcomes defined as
ventricular arrhythmias, implantable cardioverter defibrillator therapy,
death, left ventricular assist device placement, or heart transplantation.
Risk of bias assessment was done by the Quality Assessment of Diagnostic
Accuracy Studies-2 tool. Subgroup analysis of patients with left
ventricular ejection fraction (LVEF) >35%, and probable CS, no prior
ventricular tachycardia (VT) and LVEF >35% were performed. <br/>Result(s):
We found 544 articles after removing duplicates. A total of 52 full
articles were reviewed, and eight studies were included in the
meta-analysis. The pooled sensitivity and specificity (95% confidence
interval) of EPS in predicting clinical outcomes were 0.70 (0.51-0.85) and
0.93 (0.85-0.97), respectively. Subgroup analysis of patients with LVEF
>35% resulted in pooled sensitivity of 0.63 (0.29-0.88) and pooled
specificity of 0.97 (0.92-0.99), and subgroup analysis of patients with
probable CS, no prior VT, and LVEF >35% resulted in pooled sensitivity of
0.71 (0.33-0.93) and pooled specificity of 0.96 (0.88-0.99) in predicting
adverse clinical outcomes. <br/>Conclusion(s): EPS is an effective risk
stratification tool in patients with CS across all subgroups with high
sensitivity and specificity.<br/>Copyright &#xa9; 2021 Elsevier B.V.

<10>
Accession Number
636733731
Title
24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk.
Source
The New England journal of medicine. (no pagination), 2021. Date of
Publication: 13 Nov 2021.
Author
Ma Y.; He F.J.; Sun Q.; Yuan C.; Kieneker L.M.; Curhan G.C.; MacGregor
G.A.; Bakker S.J.L.; Campbell N.R.C.; Wang M.; Rimm E.B.; Manson J.E.;
Willett W.C.; Hofman A.; Gansevoort R.T.; Cook N.R.; Hu F.B.
Institution
(Ma, He, Sun, Yuan, Kieneker, Curhan, MacGregor, Bakker, Campbell, Wang,
Rimm, Manson, Willett, Hofman, Gansevoort, Cook, Hu) From the Departments
of Epidemiology (Y.M., Q.S., G.C.C., M.W., E.B.R., J.E.M., W.C.W., A.H.,
N.R.C., F.B.H.) and Nutrition (Q.S., C.Y., E.B.R., W.C.W., F.B.H.),
Harvard T.H. Chan School of Public Health, and the Channing Division of
Network Medicine, the Department of Medicine (Q.S., G.C.C., E.B.R.,
J.E.M., W.C.W., F.B.H.), Renal Division, the Department of Medicine
(G.C.C.), and the Division of Preventive Medicine (J.E.M., N.R.C.),
Brigham and Women's Hospital and Harvard Medical School - all in Boston;
the Wolfson Institute of Population Health, St. Bartholomew's Hospital and
the London School of Medicine and Dentistry, Queen Mary University of
London, London (F.J.H., G.A.M.); the Department of Nephrology, University
of Groningen, University Medical Center Groningen, Groningen, the
Netherlands (L.M.K., S.J.L.B., R.T.G.); and the Departments of Medicine,
Community Health Sciences, and Physiology and Pharmacology, O'Brien
Institute of Public Health and Libin Cardiovascular Institute of Alberta,
University of Calgary, Calgary, AB, Canada (N.R.C.C.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The relation between sodium intake and cardiovascular disease
remains controversial, owing in part to inaccurate assessment of sodium
intake. Assessing 24-hour urinary excretion over a period of multiple days
is considered to be an accurate method. <br/>METHOD(S): We included
individual-participant data from six prospective cohorts of generally
healthy adults; sodium and potassium excretion was assessed with the use
of at least two 24-hour urine samples per participant. The primary outcome
was a cardiovascular event (coronary revascularization or fatal or
nonfatal myocardial infarction or stroke). We analyzed each cohort using
consistent methods and combined the results using a random-effects
meta-analysis. <br/>RESULT(S): Among 10,709 participants, who had a mean
(+/-SD) age of 51.5+/-12.6 years and of whom 54.2% were women, 571
cardiovascular events were ascertained during a median study follow-up of
8.8 years (incidence rate, 5.9 per 1000 person-years). The median 24-hour
urinary sodium excretion was 3270 mg (10th to 90th percentile, 2099 to
4899). Higher sodium excretion, lower potassium excretion, and a higher
sodium-to-potassium ratio were all associated with a higher cardiovascular
risk in analyses that were controlled for confounding factors (P<=0.005
for all comparisons). In analyses that compared quartile 4 of the urinary
biomarker (highest) with quartile 1 (lowest), the hazard ratios were 1.60
(95% confidence interval [CI], 1.19 to 2.14) for sodium excretion, 0.69
(95% CI, 0.51 to 0.91) for potassium excretion, and 1.62 (95% CI, 1.25 to
2.10) for the sodium-to-potassium ratio. Each daily increment of 1000 mg
in sodium excretion was associated with an 18% increase in cardiovascular
risk (hazard ratio, 1.18; 95% CI, 1.08 to 1.29), and each daily increment
of 1000 mg in potassium excretion was associated with an 18% decrease in
risk (hazard ratio, 0.82; 95% CI, 0.72 to 0.94). <br/>CONCLUSION(S):
Higher sodium and lower potassium intakes, as measured in multiple 24-hour
urine samples, were associated in a dose-response manner with a higher
cardiovascular risk. These findings may support reducing sodium intake and
increasing potassium intake from current levels. (Funded by the American
Heart Association and the National Institutes of Health.).<br/>Copyright
&#xa9; 2021 Massachusetts Medical Society.

<11>
Accession Number
636722208
Title
Incidence and prognosis of COVID-19 amongst heart transplant recipients: a
systematic review and meta-analysis.
Source
European journal of preventive cardiology. (no pagination), 2021. Date of
Publication: 10 Nov 2021.
Author
Ahmed F.; Abid M.; Maniya T.; Usman M.S.; Fudim M.
Institution
(Ahmed, Abid) Department of Medicine, Dow University of Health Sciences,
Mission Rd, Karachi 74200, Pakistan
(Maniya) Department of Medicine, Ziauddin University, Shahrah-e-Ghalib Rd,
Block 6 Clifton, Karachi 74200, Pakistan
(Usman) Department of Medicine, University of Mississippi Medical Center,
MS 39216, 2500 North State Street, Jackson, United States
(Fudim) Division of Cardiology, Duke University Medical Center, 2301 Ervin
Rd, Durham, United States
(Fudim) Duke Clinical Research Institute, Durham, United States
Publisher
NLM (Medline)

<12>
Accession Number
636452724
Title
Effect of dexmedetomidine on postoperative delirium in patients undergoing
brain tumour resections: Study protocol of a randomised controlled trial.
Source
BMJ Open. 11(11) (no pagination), 2021. Article Number: e051584. Date of
Publication: 10 Nov 2021.
Author
Wang D.; Li R.; Li S.; Wang J.; Zeng M.; Dong J.; Liu X.; Lin N.; Peng Y.
Institution
(Wang, Li, Li, Wang, Zeng, Dong, Liu, Lin, Peng) Department of
Anesthesiology, Beijing Tiantan Hospital, Beijing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Postoperative delirium (POD) is a common complication. The
incidence of POD is about 25% in non-cardiac surgery and ranges from 10%
to 30% in neurological procedures. A lot of trials show that
dexmedetomidine might help to reduce the incidence of delirium in patients
undergoing non-cardiac surgery. However, the impact of dexmedetomidine on
POD for patients undergoing craniotomy and tumour resections remains
unclear. Methods and analysis The study is a prospective, single-centre,
randomised, double-blinded, paralleled-group controlled trial. Patients
undergoing elective frontotemporal tumour resections will be randomly
assigned to the dexmedetomidine group and the control group. After
endotracheal intubation, patients in the dexmedetomidine group will be
administered with a loading dose of dexmedetomidine 0.6 mug/kg in 10 min
followed by continuous infusion at a rate of 0.4 mug/kg/hour until the
start of dural closure. In the control group, patients will receive the
identical volume of normal saline in the same setting. The primary outcome
will be the cumulative incidence of POD within 5 days. The delirium
assessment will be performed by using the confusion assessment method in
the first 5 consecutive days after surgery. Secondary outcomes include the
pain severity assessed by Numerical Rating Scale pain score, quality of
postoperative sleep assessed by the Richards Campbell sleep questionnaire
and postoperative quality of recovery from anaesthesia by the
Postoperative Quality Recovery Scale. Ethics and dissemination The
protocol (V.1.0, 10 November 2020) has been approved by the Ethics Review
Committee of the Chinese Clinical Trial Registry (number
ChiECRCT-20200436). The findings of the study will be disseminated in a
peer-reviewed journal and at a scientific conference. Trial registration
number NCT04674241.<br/>Copyright &#xa9; Author(s) (or their employer(s))
2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<13>
Accession Number
2012859511
Title
Effect of intrapartum oxygen on the rate of cesarean delivery: a
meta-analysis.
Source
American Journal of Obstetrics and Gynecology MFM. 3(4) (no pagination),
2021. Article Number: 100374. Date of Publication: July 2021.
Author
Burd J.; Quist-Nelson J.; Moors S.; Raghuraman N.; Aly H.; Berghella V.
Institution
(Burd) Department of Obstetrics and Gynecology, Thomas Jefferson
University Hospital, Philadelphia, PA, United States
(Quist-Nelson, Berghella) Division of Maternal-Fetal Medicine, Department
of Obstetrics and Gynecology, Thomas Jefferson University Hospital,
Philadelphia, PA, United States
(Moors) Department of Obstetrics and Gynecology, St. Antonius Hospital,
Utrecht, Netherlands
(Raghuraman) Department of Obstetrics and Gynecology, Washington
University School of Medicine in St. Louis, St. Louis, MO, United States
(Aly) Department of Neonatology, Cleveland Clinic Children's Hospital,
Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
OBJECTIVE: This study aimed to determine if maternal intrapartum
administration of oxygen altered the rate of cesarean delivery compared
with room air. DATA SOURCES: This study was a systematic review and
meta-analysis of randomized controlled trials. Searches were performed in
MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central
Register of Controlled Trials using a combination of key words related to
"pregnant patients," "labor," "oxygen," "fetus," "newborn," and pregnancy
outcomes from database inception until April 2020. The study was
registered in PROSPERO (registration number CRD42020162110). STUDY
ELIGIBILITY CRITERIA: The inclusion criteria were randomized controlled
trials of maternal administration of oxygen compared with room air in
labor. The exclusion criteria were quasi-randomized trials and oxygen
administered for planned cesarean deliveries. The primary outcome was the
rate of cesarean delivery. Secondary maternal and neonatal outcomes,
including cord gas values, were analyzed. <br/>METHOD(S): The Cochrane
Handbook guidelines were used to assess bias in trials. To calculate the
relative risk or mean differences with confidence intervals, a
random-effects model was employed. Subgroup analyses were performed for
women who received oxygen for nonreassuring fetal heart rate monitoring or
prophylactically. <br/>RESULT(S): Five randomized controlled trials,
including 768 women, were included in the meta-analysis, 3 using
prophylactic oxygen and 2 using oxygen for nonreassuring fetal heart rate
monitoring. The risk of bias was generally considered low. There was no
statistically significant difference in the rate of cesarean delivery
between patients administered oxygen and patients provided room air (16 of
365 [4.4%] vs 11 of 379 [2.9%]; risk ratio 1.5; 95% confidence interval,
0.7-3.3). In addition, there were no statistically significant differencs
in the rates of cesarean delivery for nonreassuring fetal heart rate
monitoring, operative vaginal deliveries, Apgar scores of <7, neonatal
intensive care unit admissions, or cord blood gas values. There were no
statistically significant difference when analyzing oxygen for
nonreassuring fetal heart rate monitoring alone or prophylactic oxygen
alone. Data regarding FHT is mixed, with one study suggesting an
improvement and three suggesting no change. <br/>CONCLUSION(S): Maternal
intrapartum oxygen administration was not associated with any differences
in the rate of cesarean delivery or any secondary outcomes compared with
room air overall and in the subgroups of therapeutic (for nonreassuring
fetal heart rate monitoring) or prophylactic administration in this
meta-analysis. Large randomized controlled trials are necessary to further
examine any possible benefits or harms of oxygen administration in labor,
particularly for nonreassuring fetal heart rate monitoring.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<14>
Accession Number
2013622969
Title
Dextran-based priming solution during cardiopulmonary bypass attenuates
renal tubular injury-A secondary analysis of randomized controlled trial
in adult cardiac surgery patients.
Source
Acta Anaesthesiologica Scandinavica. 66(1) (pp 40-47), 2022. Date of
Publication: January 2022.
Author
Kolsrud O.; Barbu M.; Dellgren G.; Bjork K.; Corderfeldt A.; Thoren A.;
Jeppsson A.; Ricksten S.-E.
Institution
(Kolsrud, Dellgren, Bjork, Corderfeldt, Jeppsson) Cardiothoracic Surgery,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Kolsrud, Barbu, Dellgren, Jeppsson, Ricksten) Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden
(Barbu) Department of Cardiology, Karlskrona Hospital, Karlskrona, Sweden
(Dellgren) Transplant Institute, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Thoren, Ricksten) Departments of Cardiothoracic Anesthesiology and
Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
John Wiley and Sons Inc
Abstract
Background: Acute kidney injury (AKI) is a well-known complication after
cardiac surgery and cardiopulmonary bypass (CPB). In the present secondary
analysis of a blinded randomized controlled trial, we evaluated the
effects of a colloid-based versus a conventional crystalloid-based prime
on tubular injury and postoperative renal function in patients undergoing
cardiac surgery with CPB. <br/>Method(s): Eighty-four adult patients
undergoing cardiac surgery with CPB were randomized to receive either a
crystalloid- or colloid- (dextran 40) based CPB priming solution. The
crystalloid solution was based on Ringer-Acetate plus mannitol. The
tubular injury biomarker, N-acetyl-b-D-glucosaminidase (NAG), serum
creatinine and diuresis were measured before, during and after CPB. The
incidence of AKI was assessed according to the KDIGO criteria.
<br/>Result(s): The urinary-NAG/urinary-creatinine ratio rose in both
groups during and after CPB, with a more pronounced increase in the
crystalloid group (p =.038). One hour after CPB, the
urinary-NAG/urinary-creatinine ratio was 88% higher in the crystalloid
group (4.7 +/- 6.3 vs. 2.5 +/- 2.7, p =.045). Patients that received the
dextran 40-based priming solution had a significantly lower intraoperative
diuresis (p <.001) compared to the crystalloid group. The incidence of AKI
was 18% in the colloid and 22% in the crystalloid group (p =.66).
Postoperative serum creatinine did not differ between groups.
<br/>Conclusion(s): In patients undergoing cardiac surgery with CPB,
colloid-based priming solution (dextran 40) induced less renal tubular
injury compared to a crystalloid-based priming solution. Whether a
colloid-based priming solution will improve renal outcome in high-risk
cardiac surgery, or not, needs to be evaluated in future studies on higher
risk cardiac surgery patients.<br/>Copyright &#xa9; 2021 Acta
Anaesthesiologica Scandinavica Foundation

<15>
Accession Number
2015811384
Title
Individualised or liberal red blood cell transfusion after cardiac
surgery: a randomised controlled trial.
Source
British Journal of Anaesthesia. 128(1) (pp 37-44), 2022. Date of
Publication: January 2022.
Author
Fischer M.-O.; Guinot P.-G.; Debroczi S.; Huette P.; Beyls C.; Babatasi
G.; Bafi K.; Guilbart M.; Caus T.; Lorne E.; Dupont H.; Hanouz J.-L.;
Diouf M.; Abou-Arab O.
Institution
(Fischer, Debroczi, Bafi, Hanouz) Normandy University, UNICAEN, CHU de
Caen Normandie, Service d'Anesthesie Reanimation, Caen, France
(Guinot) Department of Anesthesiology and Critical Care Medicine, Dijon
University Hospital, Dijon, France
(Huette, Beyls, Guilbart, Dupont, Abou-Arab) Department of Anesthesiology
and Critical Care Medicine, Amiens Picardy University Hospital, Amiens,
France
(Babatasi) Normandy University, UNICAEN, CHU de Caen Normandie, Department
of Cardiac Surgery, Caen, France
(Caus) Department of Cardiac Surgery, Amiens University Hospital, Amiens
Picardy University Hospital, Amiens, France
(Lorne) Department of Anesthesiology and Critical Care Medicine, Clinique
du Millenaire, Montpellier, France
(Diouf) Department of Biostatistics, Amiens Picardy University Hospital,
Amiens, France
Publisher
Elsevier Ltd
Abstract
Background: Current practice guidelines for red blood cell (RBC)
transfusion in ICUs are based on haemoglobin threshold, without
consideration of oxygen delivery or consumption. We aimed to evaluate an
individual physiological threshold-guided by central venous oxygen
saturation ScvO<inf>2</inf>. <br/>Method(s): In a randomised study in two
French academic hospitals, 164 patients who were admitted to ICU after
cardiac surgery with postoperative haemoglobin <9 g dl^-1 were
randomised to receive a transfusion with one unit of RBCs (haemoglobin
group) or transfusion only if the ScvO<inf>2</inf> was <70%
(individualised group). The primary outcome was the number of subjects
receiving at least one unit of RBCs. The secondary composite outcome was
acute kidney injury, stroke, myocardial infarction, acute heart failure,
mesenteric ischaemia, or in-hospital mortality. One- and 6-month mortality
were evaluated during follow-up. <br/>Result(s): The primary outcome was
observed for 80 of 80 subjects (100%) in the haemoglobin group and in 61
of 77 patients (79%) in the individualised group (absolute risk -21%
[-32.0; -14.0]; P<0.001). There was no significant difference in the
secondary outcome between the two groups. Follow-up showed a
non-significant difference in mortality at 1 and 6 months.
<br/>Conclusion(s): An individualised strategy based on an central venous
oxygen saturation threshold of 70% allows for a more restrictive red blood
cell transfusion strategy with no incidence on postoperative morbidity or
6-month mortality. Clinical trial registration: NCT02963883.<br/>Copyright
&#xa9; 2021 British Journal of Anaesthesia

<16>
Accession Number
2015811369
Title
Targeted temperature management in cardiac surgery: a systematic review
and meta-analysis on postoperative cognitive outcomes.
Source
British Journal of Anaesthesia. 128(1) (pp 11-25), 2022. Date of
Publication: January 2022.
Author
Linassi F.; Maran E.; De Laurenzis A.; Tellaroli P.; Kreuzer M.; Schneider
G.; Navalesi P.; Carron M.
Institution
(Linassi, Maran, De Laurenzis, Navalesi, Carron) Department of Medicine,
Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
(Linassi, Kreuzer, Schneider) Department of Anaesthesiology and Intensive
Care, Klinikum rechts der Isar, Technical University of Munich, School of
Medicine, Munich, Germany
(Tellaroli) Department of Developmental Psychology and Socialisation,
University of Padova, Padova, Italy
Publisher
Elsevier Ltd
Abstract
Background: Postoperative cognitive decline occurs commonly after cardiac
surgery. The available literature is inconclusive on the role of
intraoperative causal or protective factors. <br/>Method(s): We
systematically reviewed studies evaluating delayed neurocognitive recovery
(DNR), postoperative neurocognitive disorder (NCD), stroke, and the
mortality rates among patients undergoing hypothermic or normothermic
cardiopulmonary bypass (CPB). We further performed a subgroup analysis for
age, surgery type (coronary artery bypass grafting [CABG], valve surgery,
or combined), and the mean arterial blood pressure (MAP) during CPB, and
conducted a proportion meta-analysis after calculation of single
proportions and confidence intervals (CIs). <br/>Result(s): We included a
total of 58 studies with 9609 patients in our analysis. Among these, 1906
of 4010 patients (47.5%) had DNR, and 2071 of 7160 (28.9%) had
postoperative NCD. Ninety of 4625 patients (2.0%) had a stroke, and 174 of
7589 (2.3%) died. There was no statistically significant relationship
between the considered variables and DNR, NCD, stroke, and mortality. In
the subgroup analysis comparing hypothermic with normothermic CPB, we
found higher NCD rates after combined surgery; for normothermic CPB cases
only, the rates of DNR and NCD were lower after combined surgery compared
with CABG surgery. A MAP >70 mm Hg compared with MAP=50-70 mm Hg during
CPB was associated with a lower rate of DNR. <br/>Conclusion(s):
Temperature, MAP during cardiopulmonary bypass age, and surgery type were
not associated with neurocognitive disorders, stroke, and mortality in
cardiac surgery. Normothermic cardiopulmonary bypass, particularly when
performed with MAP >70 mm Hg, may reduce the risk of postoperative
neurocognitive decline after cardiac surgery. PROSPERO registration
number: CRD42019140844.<br/>Copyright &#xa9; 2021 British Journal of
Anaesthesia

<17>
Accession Number
2015670935
Title
Anticoagulation therapy in patients with post-operative atrial
fibrillation: Systematic review with meta-analysis.
Source
Vascular Pharmacology. 142 (no pagination), 2022. Article Number: 106929.
Date of Publication: February 2022.
Author
Neves I.A.; Magalhaes A.; Lima da Silva G.; Almeida A.G.; Borges M.; Costa
J.; Ferreira J.J.; Pinto F.J.; Caldeira D.
Institution
(Neves) Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
(Magalhaes, Lima da Silva, Almeida, Pinto, Caldeira) Centro Cardiovascular
da Universidade de Lisboa, CAML, Faculdade de Medicina da Universidade de
Lisboa, Portugal
(Magalhaes, Lima da Silva, Almeida, Pinto, Caldeira) Cardiology
Department, Hospital Santa Maria - Centro Hospitalar Universitario Lisboa
Norte (CHULN), Lisbon, Portugal
(Borges, Costa, Ferreira, Caldeira) Laboratory of Clinical Pharmacology
and Therapeutics, Faculty of Medicine, Universidade de Lisboa, Lisbon,
Portugal
(Borges, Costa, Ferreira) Instituto de Medicina Molecular Joao Lobo
Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
(Ferreira) CNS - Neurological Senior Campus, Torres Vedras, Portugal
Publisher
Elsevier Inc.
Abstract
Background: Post-operative atrial fibrillation (POAF) is a relevant
complication after surgery. Several studies have shown that POAF has
important consequences for long-term morbidity and mortality, by
increasing the risk of thromboembolic events. However, the use of oral
anticoagulation (OAC) is not well established in this context.
<br/>Method(s): We searched MEDLINE, CENTRAL, PsycInfo and Web of Science
for clinical trials and observational studies evaluating anticoagulation
vs. no anticoagulation in patients with POAF (after cardiac or non-cardiac
surgery). Data were screened and extracted by two independent reviewers.
We performed a random- effects model to estimate the pooled odds ratio
(OR) with 95% Confidence Intervals (CI), and heterogeneity was evaluated
by I² statistics. The outcomes of interest were all-cause
mortality, thromboembolic events, and bleeding events. <br/>Result(s):
Overall, 10 observational retrospective studies were included: 5 studies
with 203,946 cardiac surgery POAF patients, and 5 studies with 29,566
patients with POAF after non-cardiac surgery. In cardiac surgery POAF, the
OAC use was associated with lower risk of thromboembolic events (OR 0.68;
95%CI 0.47-0.96, I² = 31%; 4 studies) and the bleeding risk was
significantly increased (OR 4.30; 95%CI 3.69 to 5.02, 1 study). In
non-cardiac surgery POAF, OAC did not significantly reduce the risk of
thromboembolic events (OR 0.71, 95%CI 0.33-1.15; I² = 79%; 5
studies) but was associated with increased risk of bleeding (OR 1.20,
95%CI 1.10-1.32, I² = 0%; 3 studies). Mortality was not
significantly reduced in both cardiac and non-cardiac surgery POAF.
<br/>Conclusion(s): Oral anticoagulation was associated with a lower risk
of thromboembolic events in patients with POAF following cardiac surgery
but not in non-cardiac surgery. Bleeding risk was increased in both
settings. The confidence on pooled results is at most low, and further
data, namely randomized controlled trials are necessary to derive robust
conclusions.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<18>
Accession Number
2015508193
Title
Impact of High-Frequency Oscillatory Ventilation Combined With Volume
Guarantee on Lung Inflammatory Response in Infants With Acute Respiratory
Distress Syndrome After Congenital Heart Surgery: A Randomized Controlled
Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Zheng Y.-R.; Xie W.-P.; Liu J.-F.; Wu H.-L.; Xu N.; Huang S.-T.; Cao H.;
Chen Q.
Institution
(Zheng, Xie, Liu, Wu, Xu, Huang, Cao, Chen) Department of Cardiac Surgery,
Fujian branch of Shanghai Children's Medical Center, Fuzhou, China
(Zheng, Xie, Liu, Wu, Xu, Huang, Cao, Chen) Fujian Children's Hospital,
Fuzhou, China
(Zheng, Xie, Liu, Wu, Xu, Huang, Cao, Chen) Fujian Maternity and Child
Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou,
China
(Zheng, Xie, Liu, Wu, Xu, Huang, Cao, Chen) Fujian Key Laboratory of Women
and Children's Critical Diseases Research, Fujian Maternity and Child
Health Hospital, Fuzhou, China
Publisher
W.B. Saunders
Abstract
Objectives: Congenital heart disease (CHD) after cardiopulmonary bypass
can cause systemic inflammation, and its degree is closely related to the
incidence of acute respiratory distress syndrome (ARDS). The purpose of
this study was to determine the effectiveness of high-frequency
oscillatory ventilation (HFOV) combined with volume guarantee (VG) in
reducing systemic inflammation in infants with ARDS after cardiopulmonary
bypass for congenital heart surgery. <br/>Design(s): A randomized
controlled trial. <br/>Setting(s): Single-center study in a tertiary
teaching hospital. <br/>Participant(s): A total of 58 infants with ARDS
after congenital heart surgery were eligible and were randomized to the
HFOV (n = 29) or the HFOV-VG (n = 29) between January 2020 and January
2021. <br/>Intervention(s): Tracheal aspirate samples for the measurement
of interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha)
were obtained on days one, two, and three of HFOV or HFOV-VG ventilation.
<br/>Measurements and Main Results: The authors found a significantly
increasing trend in the HFOV group mean values of IL-6, IL-8, and
TNF-alpha (p < 0.05 on days two and three v day one), and IL-6, IL-8, and
TNF-alpha levels were significantly higher on day three in the HFOV group
versus the HFOV+VG group (p < 0.05). In addition, the incidences of
hypocapnia and hypercapnia in infants supported with HFOV-VG were
significantly lower (p < 0.05). Furthermore, the postoperative mechanical
ventilation duration in the HFOV-VG group also was shorter than that in
the HFOV group (p < 0.05). <br/>Conclusion(s): Compared with HFOV alone,
HFOV-VG reduced proinflammatory systemic reactions after congenital
cardiac surgery, decreased the incidences of hypercapnia and hypocapnia,
and shortened the postoperative mechanical ventilation
duration.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<19>
Accession Number
636106514
Title
Effect of changes in inspired oxygen fraction on oxygen delivery during
cardiac surgery: a substudy of the CARROT trial.
Source
Scientific reports. 11(1) (pp 17862), 2021. Date of Publication: 09 Sep
2021.
Author
Nam K.; Kim H.-B.; Kwak Y.-L.; Jeong Y.H.; Ju J.-W.; Bae J.; Lee S.; Cho
Y.J.; Shim J.-K.; Jeon Y.
Institution
(Nam, Jeong, Ju, Bae, Lee, Cho, Jeon) Department of Anesthesiology and
Pain Medicine, Seoul National University Hospital, Seoul National
University College of Medicine, Seoul 03080, South Korea
(Kim, Kwak, Shim) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, Seoul 03722, South Korea
Publisher
NLM (Medline)
Abstract
When hemoglobin (Hb) is fully saturated with oxygen, the additional gain
in oxygen delivery (DO2) achieved by increasing the fraction of inspired
oxygen (FiO2) is often considered clinically insignificant. In this study,
we evaluated the change in DO2, interrogated by mixed venous oxygen
saturation (SvO2), in response to a change in FiO2 of 0.5 during cardiac
surgery. When patients were hemodynamically stable, FiO2 was alternated
between 0.5 and 1.0 in on-pump cardiac surgery patients (pilot study), and
between 0.3 and 0.8 in off-pump coronary artery bypass grafting patients
(substudy of the CARROT trial). After the patient had stabilized, a blood
gas analysis was performed to measure SvO2. The observed change in SvO2
(DELTASvO2) was compared to the expected DELTASvO2 calculated using Fick's
equation. A total 106 changes in FiO2 (two changes per patient; total 53
patients; on-pump, n=36; off-pump, n=17) were finally analyzed. While Hb
saturation remained near 100% (on-pump, 100%; off-pump, mean [SD]=98.1%
[1.5] when FiO2 was 0.3 and 99.9% [0.2] when FiO2 was 0.8), SvO2 changed
significantly as FiO2 was changed (the first and second changes in
on-pump, 7.7%p [3.8] and 7.6%p [3.5], respectively; off-pump, 7.9%p [4.9]
and 6.2%p [3.9]; all P<0.001). As a total, regardless of the surgery type,
the observed DELTASvO2 after the FiO2 change of 0.5 was>=5%p in 82 (77.4%)
changes and>=10%p in 31 (29.2%) changes (mean [SD], 7.5%p [3.9]). Hb
concentration was not correlated with the observed DELTASvO2 (the first
changes, r=-0.06, P=0.677; the second changes, r=-0.21, P=0.138). The mean
(SD) residual DELTASvO2 (observed-expected DELTASvO2) was 0%p (4).
Residual DELTASvO2 was more than 5%p in 14 (13.2%) changes and exceeded
10%p in 2 (1.9%) changes. Residual DELTASvO2 was greater in patients with
chronic kidney disease than in those without (median [IQR], 5%p [0 to 7]
vs. 0%p [-3 to 2]; P=0.049). DO2, interrogated by SvO2, may increase to a
clinically significant degree as FiO2 is increased during cardiac surgery,
and the increase of SvO2 is not related to Hb concentration. SvO2
increases more than expected in patients with chronic kidney disease.
Increasing FiO2 can be used to increase DO2 during cardiac
surgery.<br/>Copyright &#xa9; 2021. The Author(s).

<20>
Accession Number
635279260
Title
Aortic valve function post-replacement of severe aortic stenosis by
transcatheter procedure versus surgery: a systematic review and
metanalysis.
Source
Scientific reports. 11(1) (pp 11975), 2021. Date of Publication: 07 Jun
2021.
Author
Abi Khalil C.; Ignatiuk B.; Erdem G.; Chemaitelly H.; Barilli F.;
El-Shazly M.; Al Suwaidi J.; Aboulsoud S.; Kofler M.; Stastny L.; Jneid
H.; Bonaros N.
Institution
(Abi Khalil) Research Department, Weill Cornell Medicine-Qatar, Doha,
Qatar
(Abi Khalil) Joan and Sanford I. Weill Department of Medicine, Weill
Cornell Medicine, NY, United States
(Abi Khalil) Department of Health Policy, London School of Economics,
London, United Kingdom
(Ignatiuk, Erdem, Bonaros) Department of Health Policy, London School of
Economics, London, United Kingdom
(Ignatiuk) Ospedali Riuniti Padova Sud IT, Monselice, Italy
(Erdem) Istanbul Kent University, Istanbul, Turkey
(Chemaitelly, El-Shazly, Al Suwaidi) Research Department, Weill Cornell
Medicine-Qatar, Doha, Qatar
(Barilli) Department of CardioVascular Surgery, S. Croce e Carle Hospital,
Cuneo, Italy
(El-Shazly) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic, OH, United States
(Aboulsoud, Kofler) Department of Internal Medicine, Faculty of Medicine,
Cairo University, Cairo, Egypt
(Stastny, Bonaros) Department of Cardiac Surgery, Medical University of
Innsbruck, Innsbruck, Austria
(Jneid) Michael E. DeBakey VA Medical Center, Baylor College of Medicine,
Houston, United States
Publisher
NLM (Medline)
Abstract
Transcatheter aortic valve replacement (TAVR) has shown to reduce
mortality compared to surgical aortic valve replacement (sAVR). However,
it is unknown which procedure is associated with better post-procedural
valvular function. We conducted a meta-analysis of randomized clinical
trials that compared TAVR to sAVR for at least 2 years. The primary
outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary
outcomes were post-procedural and 2-year: effective orifice area (EOA),
paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL).
We identified 6 trials with a total of 7022 participants with severe
aortic stenosis. TAVR was associated with 37% (95% CI [0.51-0.78) mean RR
reduction of post-procedural PPM, a decrease that was not affected by the
surgical risk at inclusion, neither by the transcatheter heart valve
system. Postprocedural changes in gradient and EOA were also in favor of
TAVR as there was a pooled mean difference decrease of 0.56 (95% CI
[0.73-0.38]) in gradient and an increase of 0.47 (95% CI [0.38-0.56]) in
EOA. Additionally, self-expandable valves were associated with a higher
decrease in gradient than balloon ones (beta=0.38; 95% CI [0.12-0.64]).
However, TAVR was associated with a higher risk of moderate/severe PVL
(pooled RR: 9.54, 95% CI [5.53-16.46]). All results were sustainable at 2
years.

<21>
Accession Number
635232751
Title
The Effect of the Neuman Systems Model on Anxiety in Patients Undergoing
Coronary Artery Bypass Graft: A Randomized Controlled Trial.
Source
The journal of nursing research : JNR. 29(4) (pp e162), 2021. Date of
Publication: 02 Jun 2021.
Author
Akhlaghi E.; Babaei S.; Mardani A.; Eskandari F.
Institution
(Akhlaghi) Doctoral Candidate, School of Nursing and Midwifery, Iran
University of Medical Sciences, RN, Tehran, Iran, Islamic Republic of
(Babaei) Nursing and Midwifery Care Research Center, Faculty of Nursing
and Midwifery, Isfahan University of Medical Science, RN, Isfahan, Iran,
Islamic Republic of
(Mardani) Doctoral Candidate, Nursing Care Research Center, School of
Nursing and Midwifery, Iran University of Medical Sciences, RN, Tehran,
Iran, Islamic Republic of
(Eskandari) PhD, RN, Support Worker, Psychiatric/Mental Health Nursing,
Mental Health Community Making Life Better, Sydney, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Coronary artery bypass graft (CABG) surgery is the most
commonly used surgical procedure for patients with coronary artery
disease. Anxiety is a significant psychological problem associated with
CABG surgery that may reduce related treatment outcomes. PURPOSE: This
study was designed to investigate the effect on anxiety of applying the
Neuman Systems Model in patients awaiting and undergoing CABG surgery.
<br/>METHOD(S): A single-blind, parallel-group randomized controlled trial
was conducted on patients scheduled to receive coronary artery bypass
surgery in an urban area of Iran. Seventy participants were enrolled using
a convenience sampling method and randomly assigned to either the
intervention group (n = 35) or the control group (n = 35). Participants in
the intervention group received intervention in accordance with the Neuman
Systems Model format, including meetings held at three levels of
prevention. Patients' anxiety was measured using the State Anxiety
Inventory before the intervention, immediately after the intervention, and
at discharge time. The chi-square test, Fisher's exact test, independent
sample t test, one-way repeated measures analysis of variance test, and
Fisher's least significant difference were used to analyze the data.
<br/>RESULT(S): No significant difference was found between the mean
anxiety scores of the two groups before the intervention (p = .48, t =
0.71). However, the mean anxiety score of the intervention group was
significantly lower than that of the control group immediately after the
intervention (p = .008, t = 2.73) and at discharge time (p = .007, t =
2.77). <br/>CONCLUSION(S): The Neuman-based program is an effective and
low-cost intervention that may be applied to reduce anxiety in patients
awaiting and undergoing CABG surgery. This program may be a good guide in
providing healthcare services.<br/>Copyright &#xa9; 2021 The Authors.
Published by Wolters Kluwer Health, Inc.

<22>
Accession Number
2016086328
Title
Incidence of Post-Transplant Lymphoproliferative Disease: A Systematic
Literature Review.
Source
Blood. Conference: 63rd ASH Annual Meeting. Atlanta United States.
138(Supplement 1) (pp 4564), 2021. Date of Publication: 23 Nov 2021.
Author
Thirumalai D.; Watson C.; Xun P.; Sadetsky N.; Schaible K.; Barlev A.
Institution
(Thirumalai, Xun) Atara Biotherapeutics, Thousand Oaks, CA, United States
(Watson, Sadetsky, Barlev) Atara Biotherapeutics, South San Francisco, CA,
United States
(Schaible) Evidera, Waltham, MA, United States
Publisher
Elsevier B.V.
Abstract
Introduction: Post-transplant lymphoproliferative disease (PTLD) is an
ultra-rare lymphoma following allogeneic hematopoietic stem cell
transplant (HCT) or solid organ transplant (SOT). Incidence of PTLD varies
over time after transplant with majority of cases occurring within the
first year (yr) after HCT (Garcia-Cadenas, Eur J Haematol. 2019). In the
SOT setting, PTLD can occur up to 30 yrs post-transplant and is largely
dependent on the transplanted organ, the type and degree of
immunosuppression, and transplant recipient characteristics (Dierickx, N
Eng J Med. 2018; Trappe, J Clin Oncol. 2017). Published literature reports
wide ranges of epidemiological estimates due to variation in the follow-up
time, transplant type and sample size. We conducted a systematic
literature review (SLR) to summarize the incidence of PTLD to better
understand the reasons for such variation. <br/>Method(s): A SLR on the
burden of PTLD was conducted in accordance with the Preferred Reporting
Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines with
the scope defined in terms of Population, Intervention Comparators,
Outcomes and Study design (PICOS) criteria. Pertinent literature on
epidemiology of PTLD published between January 2010 to February 2020 and
relevant conference abstracts published between January 2018 to February
2020 were identified. Comprehensive literature searches were performed
using the Ovid platform to identify articles indexed in PubMed, Embase,
PsycINFO, and the National Health Service Economic Evaluation Database.
Study designs were limited to population/registry-based studies,
observational cohort studies (prospective/retrospective), and
cross-sectional studies. Studies reporting incidence of PTLD were limited
to those with at least 1000 total transplant recipients. All titles and
abstracts were reviewed by two independent researchers with any
discrepancies resolved by a third researcher. Incidence estimates were
calculated by data extractors when it was not directly reported in the
literature. <br/>Result(s): A total of 177 studies reporting
epidemiological data on PTLD were identified using pre-specified SLR
criteria. Most of the studies (n=150) were retrospective in design.
Incidence was reported in 114 studies. Majority of the studies reported
cumulative incidence (CI) over specified times such as 5-yr or 10-yr
incidence or proportion of patients (pts) with PTLD out of a sample of
transplanted pts. In the HCT setting, only CI was reported; twelve studies
reported CI ranging from 0.1% among 15094 pts receiving autologous HCT
over a 19-yr period to 4% in a cohort of 1021 pts receiving allogeneic HCT
over a 16-yr period. A total of 100 studies reported incidence of PTLD in
SOT pts which was highly influenced by the study population, EBV status at
the time of transplant and follow-up time. Of these, 12 reported incidence
rates ranging from 24 EBV negative PTLD cases per 100,000 person-years
(PY) within 1-5 yrs post-transplant to 3460 PTLD cases per 100,000 PY at
20 yrs post-transplant. Eighty studies reported CI, 19 of which reported
CI for various timepoints. In a group of 23171 heart transplant pts CI was
1% during a median follow-up of 4.3 yrs, while in a subgroup of four
pediatric multi-organ transplant recipients followed from 2003 to 2011 CI
was 25%. Across studies, CI at 1-yr post-transplant ranged from 0.1% to
4.9% and 5-yr CI ranged from 0.7% to 12.1% in select group of transplant
pts. Twenty-four studies reported CI by transplant organ type ranging from
0.2% in kidney transplant pts within the first year to 12.1% in lung
transplant pts over 7.5 yrs, with higher estimates reported in studies
with smaller sample sizes. <br/>Conclusion(s): Our SLR shows large
variation in the reported incidence of PTLD due to heterogeneity in the
methodology and the study populations in both HCT and SOT settings.
Published literature lacks the granularity to correctly interpret the
incidence of PTLD in the general transplant population. Thus, additional
methods and data considerations such as population type (HCT/SOT
transplants, adult/pediatric pts, etc.), representativeness (single
institutional data/multi-center/country level registry), unit of
measurement of risk (CI/incidence rate, etc.), type of study
(retrospective/prospective), length of follow-up, sample size, trends in
transplant and treatment landscape over time are needed to ensure accuracy
in the estimation of incidence of PTLD. Disclosures: Thirumalai: Atara
Biotherapeutics: Current Employment. Watson: Atara Biotherapeutics:
Current Employment, Current holder of individual stocks in a
privately-held company. Xun: Atara Biotherapeutics: Current Employment.
Sadetsky: Atara Biotherapeutics: Current Employment. Schaible: Evidera:
Current Employment. Barlev: Atara Biotherapeutics: Current
Employment.<br/>Copyright &#xa9; 2021 American Society of Hematology

<23>
Accession Number
636714767
Title
Renal and hepatic function of patients with severe tricuspid regurgitation
undergoing inferior caval valve implantation.
Source
Scientific reports. 11(1) (pp 21800), 2021. Date of Publication: 08 Nov
2021.
Author
Hewing B.; Mattig I.; Knebel F.; Stangl V.; Laule M.; Stangl K.; Dreger H.
Institution
(Hewing, Mattig, Knebel, Stangl, Laule, Stangl, Dreger) Corporate Member
of Freie Universitat Berlin and Humboldt-Universitat Zu Berlin,
Medizinische Klinik Mit Schwerpunkt Kardiologie und Angiologie,
Charite-Universitatsmedizin Berlin ,Campus Charite Mitte ,Chariteplatz 1,
Berlin 10117, Germany
(Hewing, Knebel, Laule) Berlin Institute of Health,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Hewing, Knebel, Stangl, Stangl, Dreger) DZHK (German Centre for
Cardiovascular Research), Partner Site, Berlin, Germany
(Hewing) Department of Cardiology III-Adult Congenital and Valvular Heart
Disease, University Hospital Muenster, Muenster, Germany
Publisher
NLM (Medline)
Abstract
Due to progressive abdominal-venous congestion severe tricuspid
regurgitation (TR) is a common cause of cardiorenal and cardiohepatic
syndrome. We initiated the TRICAVAL study to compare interventional valve
implantation into the inferior vena cava (CAVI) versus optimal medical
therapy (OMT) in severe TR. In the present subanalysis, we aimed to
evaluate the effects of CAVI on clinical signs of congestion, renal and
hepatic function. TRICAVAL was an investigator-initiated, randomized
trial. Twenty-eight patients with severe TR were randomized to OMT or CAVI
using an Edwards Sapien XT valve. Probands who completed the 3-month
follow-up (CAVI [n=8], OMT [n=10]) were evaluated by medical history,
clinical examination, and laboratory testing at baseline, 3 and 12 months.
After 3 months, the CAVI group exhibited a significant reduction of body
weight (from 80.7 [69.0-87.7] kg to 75.5 [63.8-84.6] kg, p<0.05) and
abdominal circumference (from 101.5+/-13.8 cm to 96.3+/-15.4 cm, p<=0.01)
and a trend to lower doses of diuretics compared to OMT. Renal and hepatic
function parameters did not change significantly. Within a short-term
follow-up, CAVI led to an improvement of clinical signs of venous
congestion and a non-significant reduction of diuretic doses compared to
OMT.<br/>Copyright &#xa9; 2021. The Author(s).

<24>
Accession Number
636716000
Title
Contemporary trends in the level of evidence in general thoracic surgery
clinical research.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 09 Nov 2021.
Author
Choe S.-I.; Ben-Avi R.; Begum H.; Pearce K.; Mehta M.; Agzarian J.; Finley
C.J.; Hanna W.C.; Farrokhyar F.; Shargall Y.
Institution
(Choe, Ben-Avi, Begum, Pearce, Mehta, Agzarian, Finley, Hanna, Farrokhyar,
Shargall) Department of Surgery, Division of Thoracic Surgery, McMaster
University, ON, Hamilton, Canada
(Farrokhyar) Department of Health Research Methods, McMaster University,
ON, Hamilton, Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The large volume of scientific publications and the increasing
emphasis on high-quality evidence for clinical decision-making present
daily challenges to all clinicians, including thoracic surgeons. The
objective of this study was to evaluate the contemporary trend in the
level of evidence (LOE) for thoracic surgery clinical research.
<br/>METHOD(S): All clinical research articles published between January
2010 and December 2017 in 3 major general thoracic surgery journals were
reviewed. Five authors independently reviewed the abstracts of each
publication and assigned a LOE to each of them using the 2011 Oxford
Centre for Evidence-Based Medicine classification scheme. Data extracted
from eligible abstracts included study type, study size, country of
primary author and type of study designs. Three auditing processes were
conducted to establish working definitions and the process was validated
with a research methodologist and 2 senior thoracic surgeons. Intra-class
correlation coefficient was calculated to assess inter-rater agreement.
Chi-square test and Spearman correlation analysis were then used to
compare the LOE between journals and by year of publication.
<br/>RESULT(S): Of 2028 publications reviewed and scored, 29 (1.4%) were
graded level I, 75 (3.7%) were graded level II, 471 (23.2%) were graded
level III, 1420 (70.2%) were graded level IV and 33 (1.6%) were graded
level V (lowest level). Most publications (94.9%) were of lower-level
evidence (III-V). There was an overall increasing trend in the lower LOE
(P < 0.001). Inter-rater reliability was substantial with 95.5% (95%,
confidence interval: 0.95-0.96) level of agreement between reviewers.
<br/>CONCLUSION(S): General thoracic surgery literature consists mostly of
lower LOE studies. The number of lower levels of evidence is dominating
the recent publications, potentially indicating a need to increase the
commitment to produce and disseminate higher-level evidence in general
thoracic surgery.<br/>Copyright &#xa9; The Author(s) 2021. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<25>
Accession Number
2015435213
Title
Prevalence of preoperative cognitive impairment in older surgical
patients.: A systematic review and meta-analysis.
Source
Journal of Clinical Anesthesia. 76 (no pagination), 2022. Article Number:
110574. Date of Publication: February 2022.
Author
Kapoor P.; Chen L.; Saripella A.; Waseem R.; Nagappa M.; Wong J.; Riazi
S.; Gold D.; Tang-Wai D.F.; Suen C.; Englesakis M.; Norman R.; Sinha S.K.;
Chung F.
Institution
(Kapoor, Chen, Saripella, Waseem, Wong, Riazi, Suen, Chung) Department of
Anesthesiology and Pain Medicine, Toronto Western Hospital, University
Health Network, University of Toronto, Toronto, ON, Canada
(Nagappa) Department of Anesthesia & Perioperative Medicine, Western
University, London, ON, Canada
(Wong) Department of Anesthesiology and Pain Medicine, Women's College
Hospital, Toronto, ON, Canada
(Gold) Department of Psychiatry, University of Toronto, Toronto, ON,
Canada
(Tang-Wai) Division of Neurology, Department of Medicine, University of
Toronto, Toronto, ON, Canada
(Englesakis) Library & Information Services, University Health Network,
Toronto, ON, Canada
(Norman, Sinha) Division of Geriatric Medicine, Department of Medicine,
University of Toronto, Toronto, ON, Canada
Publisher
Elsevier Inc.
Abstract
Study objective: Older surgical patients with cognitive impairment are at
an increased risk for adverse perioperative outcomes, however the
prevalence of preoperative cognitive impairment is not well-established
within this population. The purpose of this review is to determine the
pooled prevalence of preoperative cognitive impairment in older surgical
patients. <br/>Design(s): Systematic review and meta-analysis.
<br/>Setting(s): MEDLINE (Ovid), PubMed (non-MEDLINE records only),
Embase, Cochrane Central, Cochrane Database of Systematic Reviews,
PsycINFO, and EMCare Nursing for relevant articles from 1946 to April
2021. <br/>Patient(s): Patients aged >=60 years old undergoing surgery,
and preoperative cognitive impairment assessed by validated cognitive
assessment tools. <br/>Intervention(s): Preoperative assessment.
Measurements: Primary outcomes were the pooled prevalence of preoperative
cognitive impairment in older patients undergoing either elective (cardiac
or non-cardiac) or emergency surgery. <br/>Main Result(s): Forty-eight
studies (n = 42,498) were included. In elective non-cardiac surgeries, the
pooled prevalence of unrecognized cognitive impairment was 37.0% (95%
confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and
diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among
11,676 patients. Within the elective non-cardiac surgery category,
elective orthopedic surgery was analyzed. In this subcategory, the pooled
prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%,
49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0%
(95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the
unrecognized cognitive impairment prevalence across 588 patients was 26.0%
(95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive
impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389
patients. <br/>Conclusion(s): A substantial number of surgical patients
had unrecognized cognitive impairment. In elective non-cardiac and
emergency surgeries, the pooled prevalence of unrecognized cognitive
impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants
more attention for risk assessment and stratification.<br/>Copyright
&#xa9; 2021 Elsevier Inc.

<26>
Accession Number
636447082
Title
Cardiogenic Shock after Acute Myocardial Infarction: A Review.
Source
JAMA - Journal of the American Medical Association. 326(18) (pp
1840-1850), 2021. Date of Publication: 09 Nov 2021.
Author
Samsky M.D.; Morrow D.A.; Proudfoot A.G.; Hochman J.S.; Thiele H.; Rao
S.V.
Institution
(Samsky, Rao) Duke Clinical Research Institute, Duke University, School of
Medicine, Durham, NC, United States
(Morrow) TIMI Study Group, Cardiovascular Division, Brigham and Women's
Hospital, Harvard Medical School, Boston, MA, United States
(Proudfoot) Perioperative Medicine Department, Barts Heart Centre, St
Bartholomew's Hospital, London, United Kingdom
(Proudfoot) Clinic for Anesthesiology and Intensive Care,
Charite-Universitatsmedizin Berlin Corporate Member of Free, University
Berlin, Humboldt University, Berlin, Germany
(Proudfoot) Department of Anaesthesiology and Intensive Care, German Heart
Centre, Berlin, Germany
(Hochman) Cardiovascular Clinical Research Center, Division of Cardiology,
Department of Medicine, NYU Grossman School of Medicine, New York, NY,
United States
(Thiele) Department of Internal Medicine/Cardiology, Leipzig Heart
Institute, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
Publisher
American Medical Association
Abstract
Importance: Cardiogenic shock affects between 40000 and 50000 people in
the US per year and is the leading cause of in-hospital mortality
following acute myocardial infarction. Observations: Thirty-day mortality
for patients with cardiogenic shock due to myocardial infarction is
approximately 40%, and 1-year mortality approaches 50%. Immediate
revascularization of the infarct-related coronary artery remains the only
treatment for cardiogenic shock associated with acute myocardial
infarction supported by randomized clinical trials. The Percutaneous
Coronary Intervention Strategies with Acute Myocardial Infarction and
Cardiogenic Shock (CULPRIT-SHOCK) clinical trial demonstrated a reduction
in the primary outcome of 30-day death or kidney replacement therapy; 158
of 344 patients (45.9%) in the culprit lesion revascularization-only group
compared with 189 of 341 patients (55.4%) in the multivessel percutaneous
coronary intervention group (relative risk, 0.83 [95% CI, 0.71-0.96]; P
=.01). Despite a lack of randomized trials demonstrating benefit,
percutaneous mechanical circulatory support devices are frequently used to
manage cardiogenic shock following acute myocardial infarction.
<br/>Conclusions and Relevance: Cardiogenic shock occurs in up to 10% of
patients immediately following acute myocardial infarction and is
associated with mortality rates of nearly 40% at 30 days and 50% at 1
year. Current evidence and clinical practice guidelines support immediate
revascularization of the infarct-related coronary artery as the primary
therapy for cardiogenic shock following acute myocardial
infarction..<br/>Copyright &#xa9; 2021 American Medical Association. All
rights reserved.

<27>
Accession Number
2015527063
Title
Data quality of longitudinally collected patient-reported outcomes after
thoracic surgery: Comparison of paper- And web-based assessments.
Source
Journal of Medical Internet Research. 23(11) (no pagination), 2021.
Article Number: e28915. Date of Publication: November 2021.
Author
Yu H.; Yu Q.; Nie Y.; Xu W.; Pu Y.; Dai W.; Wei X.; Shi Q.
Institution
(Yu, Yu, Xu, Pu, Shi) School of Public Health and Management, Chongqing
Medical University, Chonqqing, China
(Nie, Shi) State Key Laboratory of Ultrasound in Medicine and Engineering,
College of Biomedical Engineering, Chongqing Medical University,
Chongqing, China
(Dai, Wei, Shi) Department of Thoracic Surgery, Sichuan Cancer Hospital
and Institute, Sichuan Cancer Center, School of Medicine, University of
Electronic Science and Technology of China, Sichuan, Chengdu, China
Publisher
JMIR Publications Inc.
Abstract
Background: High-frequency patient-reported outcome (PRO) assessments are
used to measure patients' symptoms after surgery for surgical research;
however, the quality of those longitudinal PRO data has seldom been
discussed. <br/>Objective(s): The aim of this study was to determine data
quality-influencing factors and to profile error trajectories of data
longitudinally collected via paper-and-pencil (P&P) or web-based
assessment (electronic PRO [ePRO]) after thoracic surgery. <br/>Method(s):
We extracted longitudinal PRO data with 678 patients scheduled for lung
surgery from an observational study (n=512) and a randomized clinical
trial (n=166) on the evaluation of different perioperative care
strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung
Cancer Module and single-item Quality of Life Scale before surgery and
then daily after surgery until discharge or up to 14 days of
hospitalization. Patient compliance and data error were identified and
compared between P&P and ePRO. Generalized estimating equations model and
2-piecewise model were used to describe trajectories of error incidence
over time and to identify the risk factors. <br/>Result(s): Among 678
patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P
assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of
patients had at least one error, including (1) missing items (64.69%,
1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3)
selection of multiple options (3.02%, 50/1654), (4) missing patient
signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%,
24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who
completed ePRO had fewer errors than those who completed P&P assessments
(ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P<.001). Compared with
ePRO patients, those using P&P were older, less educated, and sicker.
Common risk factors of having errors were a lower education level (P&P:
Odds ratio [OR] 1.39, 95% CI 1.20-1.62; P<.001; ePRO: OR 1.82, 95% CI
1.22-2.72; P=.003), treated in a provincial hospital (P&P: OR 3.34, 95% CI
2.10-5.33; P<.001; ePRO: OR 4.73, 95% CI 2.18-10.25; P<.001), and with
severe disease (P&P: OR 1.63, 95% CI 1.33-1.99; P<.001; ePRO: OR 2.70, 95%
CI 1.53-4.75; P<.001). Errors peaked on postoperative day (POD) 1 for P&P,
and on POD 2 for ePRO. <br/>Conclusion(s): It is possible to improve data
quality of longitudinally collected PRO through ePRO, compared with P&P.
However, ePRO-related sampling bias needs to be considered when designing
clinical research using longitudinal PROs as major outcomes.<br/>Copyright
&#xa9; 2021 Journal of Medical Internet Research. All rights reserved.

<28>
Accession Number
2015427957
Title
Progress of research in postoperative cognitive dysfunction in cardiac
surgery patients: A review article.
Source
International Journal of Surgery. 95 (no pagination), 2021. Article
Number: 106163. Date of Publication: November 2021.
Author
Bhushan S.; Li Y.; Huang X.; Cheng H.; Gao K.; Xiao Z.
Institution
(Bhushan, Li, Cheng, Gao, Xiao) Department of Cardiothoracic Surgery,
Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
(Huang) Department of Anesthesiology, West China Hospital of Medicine,
Sichuan University, Sichuan 610017, China
Publisher
Elsevier Ltd
Abstract
Background: Postoperative cognitive dysfunction (POCD) is a common
complication of central nervous system in middle-aged and elderly patients
after cardiac surgery. The purpose of this study was to review the
progress in diagnosis, pathogenesis and risk factors and control strategy
of POCD. <br/>Method(s): A systematic literature search was conducted
using Pubmed and EMBASE, using the Mesh terms and key words "POCD",
"diagnostic criteria", "pathogenesis", "influencing factors" and
"prevention strategies". Studies were retained for review after meeting
strict inclusion criteria that included only prospective studies
evaluating risk factors for POCD in patients who had elective cardiac
surgery. Diagnosis of POCD needed to be confirmed using the Diagnostic and
Statistical Manual of Montreal Cognitive Assessment (MoCA) Scale and other
criteria. <br/>Result(s): "Twenty two articles were selected for
inclusion. The incidence of POCD across the studies ranged from 9% to 54%.
Multiple factors have been associated with the pathogenesis and increased
risk of POCD, including neuroinflammation, dysfunction of cholinergic
system, abnormal protein function (beta-amyloid), old age, anesthetic,
surgical and other factors." <br/>Conclusion(s): POCD is a common
complication after cardiac surgery in elderly. The highest POCD incidence
was observed after open aortic, TAVI and CABG surgery. Age, cognitive
function, depression, CPB and anesthetic use are leading risk factors.
Further research is needed in determining interventions that will be
effective in preventing and treating POCD in cardiac surgical
setting.<br/>Copyright &#xa9; 2021 IJS Publishing Group Ltd

<29>
Accession Number
635867223
Title
Comparative effectiveness of metoprolol, ivabradine, and its combination
in the management of inappropriate sinus tachycardia in coronary artery
bypass graft patients.
Source
Indian Journal of Pharmacology. 53(4) (pp 264-269), 2021. Date of
Publication: July-August 2021.
Author
Bhatt P.; Bhavsar N.; Naik D.; Shah D.
Institution
(Bhatt, Bhavsar, Naik, Shah) Cardiovascular and Thoracic Surgery,
Department Care Institute of Medical Sciences, 12B, Riddhi Siddhi
Bungalows, Gujarat, Ahmedabad 380 015, India
Publisher
Wolters Kluwer Medknow Publications
Abstract
BACKGROUND: Inappropriate sinus tachycardia (IST) is an arrhythmic
complication observed after coronary artery bypass graft (CABG) surgery
which left untreated, commonly increases chances of postoperative stroke.
The primary study objective was comparing effectiveness of beta
blocker-metoprolol; a specific I<inf>f</inf>blocker-ivabradine and its
combination in patients who develop IST as a complication following CABG.
MATERIALS AND METHODS: An open-labeled, investigator initiated, clinical
study was conducted on 150 patients who developed IST (heart rate [HR]
>100 beats/min) following elective CABG surgery. The patients were
randomized into three treatment groups. Group I-received ivabradine (5
mg), Group II-metoprolol (25 mg), and Group III-ivabradine (5 mg) and
metoprolol (25 mg). Treatment was given orally, twice a day for 7 days in
all the three groups postoperatively. Primary endpoints were comparative
effectiveness in HR and blood pressure reduction following treatment.
<br/>RESULT(S): IST was diagnosed by an electrocardiogram (12-lead)
considering morphological features of P-wave and with 32% increase from
baseline HR in all the three groups. Compared to IST arrthymic rate, HR
was reduced in all groups following respective treatment (P = 0.05).
Reduction in HR was significant (P < 0.05) in combination group followed
by ivabradine which was significantly greater than metoprolol treated
group. None of the treatments clinically changed the systolic, diastolic
and mean blood pressure till discharge. No surgery/treatment-related
complications were observed in any groups. <br/>CONCLUSION(S): Ivabradine
stands as a pharmacological option for controlling HR and rhythm without
associated side effects in postoperative CABG patients with
IST.<br/>Copyright &#xa9; 2021 Wolters Kluwer Medknow Publications. All
rights reserved.

<30>
Accession Number
2014470926
Title
The Chinese consensus for surgical treatment of traumatic rib fractures
2021 (C-STTRF 2021).
Source
Chinese Journal of Traumatology - English Edition. 24(6) (pp 311-319),
2021. Date of Publication: November 2021.
Author
Kong L.-W.; Huang G.-B.; Yi Y.-F.; Du D.-Y.; Bai X.-J.; Cheng L.-M.; Cui
S.-S.; Du G.-L.; Deng J.; Dai J.-G.; Dang X.-B.; Fu X.-B.; Fu Y.; Ge B.;
Gao J.-M.; Hou L.-J.; Hu P.-Y.; Hou Z.-Y.; Jiang B.-G.; Jiang J.-X.; Jia
Y.-F.; Jing J.-H.; Li C.-M.; Lv D.-C.; Liu G.-D.; Liang G.-Y.; Lian H.-K.;
Li K.-N.; Li L.; Liu L.-M.; Lin Y.-D.; Li Z.-F.; Liu Z.-M.; Shao B.; Shen
Y.; Tao N.; Tang P.-F.; Tan Q.-Y.; Hu P.; Wang C.; Wu C.; Wang D.-L.; Wang
G.; Wang H.-D.; Wu J.-L.; Wu Q.-C.; Wang R.-W.; Wang T.-B.; Wu X.; Wang
Z.-G.; Xu F.; Xiao R.-J.; Xiao Y.-B.; Yu A.-Y.; Yu B.; Yang J.; Yang
X.-F.; Zhu D.-B.; Zeng J.; Zhou J.-H.; Zhang L.-Y.; Zhao X.-J.; Zhong
Y.-F.
Institution
(Kong, Du) Department of Cardiothoracic Surgery, Chongqing Emergency
Medical Center, Chongqing University Central Hospital, Chongqing 400014,
China
(Huang, Du) Department of Trauma Surgery, Chongqing Emergency Medical
Center, Chongqing University Central Hospital, Chongqing 400014, China
(Yi) Department of Cardiothoracic Surgery, Xiamen University Affiliated
Southeast Hospital, Zhangzhou, Fujian Province 363000, China
(Bai, Li) Tongji Hospital, Tongji Medical College, Huazhong University of
Science and Technology
(Cheng) Tongji Hospital, Tongji University School of Medicine
(Cui) China-Japan Union Hospital of Jilin University
(Kong, Huang, Du, Gao, Hu, Zhao) Chongqing Emergency Medical Center,
Chongqing University Central Hospital
(Du, Dang) Shanxi Province People's Hospital
(Deng) Affiliated Hospital of Guizhou Medical University
(Dai) Xinqiao Hospital, Army Military Medical University
(Fu, Tang) General Hospital of People's Liberation Army
(Fu) The Second Hospital, University of South China
(Ge) The Fourth People's Hospital of Guiyang
(Hou) Changzheng Hospital, Second Military Medical University
(Hu) Tiantai People's Hospital of Zhejiang Province
(Hou) The Third Hospital of Hebei Medical University
(Jiang) Peking University People's Hospital, National Center for Trauma
Medicine
(Jiang, Liu, Tan, Wang, Wang, Zhou) Army Medical Center of People's
Liberation Army
(Jia, Wang) The Second Affiliated Hospital of Inner Mongolia Medical
University
(Jing) The Second Hospital of Anhui Medical University
(Li) Jilin Central Hospital
(Lv) First Affiliated Hospital of Dalian Medical University
(Liu) Editorial Department of Chinese Journal of Trauma
(Liang) Guizhou Medical University
(Lian) Zhengzhou Central Hospital Affiliated to Zhengzhou University
(Li) Affiliated Hospital of Chengdu University
(Li) Editorial Department of Chinese Journal of Traumatology(English
Edition)
(Lin) West China Hospital of Sichuan University
(Liu) Shanghai Oriental Hospital of Tongji University
(Shao) The First People's Hospital of Kunming
(Shen, Yang) The First Affiliated Hospital, School of Medicine, Zhejiang
University
(Tao) Suining Central Hospital, Sichuan Province
(Wang) The First Affiliated Hospital of Hainan Medical University
(Wu) Children's Hospital of Chongqing Medical University
(Wang, Yu) Affiliated Hospital of Zunyi Medical University
(Wang, Wu, Yu) Southern Hospital of Southern Medical University
(Wang) Southwest Hospital of Army Medical University
(Wu) Union Shenzhen Hospital, Huazhong University of Science and
Technology
(Wu) The First Affiliated Hospital of Chongqing Medical University
(Xu) The First Affiliated Hospital of Soochow University
(Xiao) People's Hospital of Xingyi City, Guizhou Province
(Xiao) Xinqiao Hospital of Army Medical University
(Yang) Chongqing Emergency Medical Center, Central Hospital of Chongqing
University
(Yi) Xiamen University Affiliated Southeast Hospital
(Zhu) The Affiliated Hospital of Nantong University
(Zeng) Sichuan Provincial People's Hospital
(Zhang) Daping Hospital, Army Military Medical University
(Zhong) Chongqing University Three Gorges Hospital)
Publisher
Elsevier B.V.
Abstract
Rib fracture is the most common injury in chest trauma. Most of patients
with rib fractures were treated conservatively, but up to 50% of patients,
especially those with combined injury such as flail chest, presented
chronic pain or chest wall deformities, and more than 30% had long-term
disabilities, unable to retain a full-time job. In the past two decades,
surgery for rib fractures has achieving good outcomes. However, in clinic,
there are still some problems including inconsistency in surgical
indications and quality control in medical services. Before the year of
2018, there were 3 guidelines on the management of regional traumatic rib
fractures were published at home and abroad, focusing on the guidance of
the overall treatment decisions and plans; another clinical guideline
about the surgical treatment of rib fractures lacks recent related
progress in surgical treatment of rib fractures. The Chinese Society of
Traumatology, Chinese Medical Association, and the Chinese College of
Trauma Surgeons, Chinese Medical Doctor Association organized experts from
cardiothoracic surgery, trauma surgery, acute care surgery, orthopedics
and other disciplines to participate together, following the principle of
evidence-based medicine and in line with the scientific nature and
practicality, formulated the Chinese consensus for surgical treatment of
traumatic rib fractures (STTRF 2021). This expert consensus put forward
some clear, applicable, and graded recommendations from seven aspects:
preoperative imaging evaluation, surgical indications, timing of surgery,
surgical methods, rib fracture sites for surgical fixation, internal
fixation method and material selection, treatment of combined injuries in
rib fractures, in order to provide guidance and reference for surgical
treatment of traumatic rib fractures.<br/>Copyright &#xa9; 2021 Chinese
Medical Association

<31>
Accession Number
2015029858
Title
Influence of deep neuromuscular blockade on perioperative stress response
in patients undergoing robot-assisted gastrectomy: A prospective
double-blinded randomized-controlled trial.
Source
Journal of Personalized Medicine. 11(12) (no pagination), 2021. Article
Number: 1308. Date of Publication: December 2021.
Author
Kim M.H.; Kim N.Y.; Yoo Y.C.; Kong H.J.; Lee H.S.; Jo A.; Bai S.J.
Institution
(Kim, Jo) Department of Anesthesiology and Pain Medicine, Anesthesia and
Pain Research Institute, Yonsei University College of Medicine, Gangnam
Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, South Korea
(Kim, Yoo, Kong, Bai) Department of Anesthesiology and Pain Medicine,
Anesthesia and Pain Research Institute, Yonsei University College of
Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
(Lee) Department of Research Affairs, Biostatistics Collaboration Unit,
Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul
03722, South Korea
Publisher
MDPI
Abstract
Attenuating the intraoperative stress response is crucial; however, the
effect of neuromus-cular blockade (NMB) on surgical stress is not
completely understood. We aimed to investigate the effects of NMB on the
perioperative stress response during robot-assisted gastrectomy. Patients
were assigned to the deep or moderate NMB group. Serum cortisol,
prolactin, and interleukin-6 (IL-6) levels and natural killer (NK) cell
percentage were measured before anesthesia induction, 90 min after
pneumoperitoneum, operation end (OP<inf>End</inf>), and postoperative day
1. Additionally, C-reactive protein (CRP) and albumin levels were
estimated. Additionally, intraoperative heart rate variability was
evaluated. The deep NMB group showed significantly lower levels of
low-frequency/high-frequency (HF) ratio at OP<inf>End</inf> compared to
the moderate NMB group (1.4 +/- 0.2 vs. 2.2 +/- 0.3, respectively;
Bon-ferroni corrected p = 0.039). Furthermore, HF power in the deep NMB
group was significantly higher at OP<inf>End</inf> than that in the
moderate NMB group (45.2 +/- 3.6 vs. 33.8 +/- 4.0, respectively;
Bonferroni corrected p = 0.044). However, no significant differences in
cortisol, prolactin, IL-6, CRP, and albumin levels and NK cell percentage
were found between the two groups. The degree of NMB may have similar
effects on stress-related biological markers in patients undergoing
robot-assisted gastrectomy.<br/>Copyright &#xa9; 2021 by the authors.
Licensee MDPI, Basel, Switzerland.

<32>
Accession Number
2014217288
Title
Restrictive versus liberal transfusion in patients with diabetes
undergoing cardiac surgery: An open-label, randomized, blinded outcome
evaluation trial.
Source
Diabetes, Obesity and Metabolism. (no pagination), 2021. Date of
Publication: 2021.
Author
Mistry N.; Shehata N.; Carmona P.; Bolliger D.; Hu R.; Carrier F.M.;
Alphonsus C.S.; Tseng E.E.; Royse A.G.; Royse C.; Filipescu D.; Mehta C.;
Saha T.; Villar J.C.; Gregory A.J.; Wijeysundera D.N.; Thorpe K.E.; Juni
P.; Hare G.M.T.; Ko D.T.; Verma S.; Mazer C.D.
Institution
(Mistry) Department of Anesthesia, St. Michael's Hospital, Institute of
Medical Sciences, University of Toronto, Toronto, ON, Canada
(Shehata) Division of Hematology, Departments of Medicine, Laboratory
Medicine and Pathobiology, Institute of Health Policy Management and
Evaluation, University of Toronto, Mount Sinai Hospital, Toronto, ON,
Canada
(Carmona) Department of Anesthesia and Critical Care, Hospital
Universitari and Politecnic La Fe, Valencia, Spain
(Bolliger) Clinic for Anaesthesia, Intermediate Care, Prehospital
Emergency Medicine and Pain Therapy, University Hospital Basel, Basel,
Switzerland
(Hu) Department of Anesthesia, Austin Hospital, Melbourne, VIC, Australia
(Carrier) Department of Anesthesiology & Department of Medicine, Critical
Care Division, Centre hospitalier de l'Universite de Montreal, Montreal,
QC, Canada
(Carrier) Carrefour de l'innovation et sante des populations, Centre de
recherche du CHUM, Montreal, QC, Canada
(Alphonsus) Department of Anaesthesia and Perioperative Medicine, Groote
Schuur Hospital and Faculty of Health Sciences, University of Cape Town,
Cape Town, South Africa
(Tseng) Division of Adult Cardiothoracic Surgery, Department of Surgery,
University of California San Francisco and San Francisco VA Medical
Center, San Francisco, CA, United States
(Royse, Royse) Department of Surgery, The Royal Melbourne Hospital,
Parkville, VIC, Australia
(Royse, Royse) Department of Surgery, The University of Melbourne,
Melbourne, VIC, Australia
(Royse) Outcomes Research Consortium, The Cleveland Clinic, Cleveland, OH,
United States
(Filipescu) Department of Cardiac Anaesthesia and Intensive Care Medicine,
Emergency Institute for Cardiovascular Diseases, Carol Davila University
of Medicine and Pharmacy, Bucharest, Romania
(Mehta) Department of Cardiac Anaesthesia, Epic Hospital, Ahmedabad, India
(Saha) Department of Anesthesiology and Perioperative Medicine, Kingston
General Hospital, Kingston, ON, Canada
(Villar) Fundacion Cardioinfantil-Instituto de Cardiologia, Bogota,
Colombia
(Villar) Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia
(Gregory) Department of Anesthesiology, Perioperative and Pain Medicine,
Libin Cardiovascular Institute, Cumming School of Medicine, University of
Calgary, Calgary, AB, Canada
(Wijeysundera) Department of Anesthesia, St. Michael's Hospital, Li Ka
Shing Knowledge Institute, Institute of Health Policy, Management and
Evaluation, University of Toronto, Toronto, ON, Canada
(Thorpe) Applied Health Research Centre, Li Ka Shing Knowledge Institute
of St. Michael's Hospital, Dalla Lana School of Public Health, University
of Toronto, Toronto, ON, Canada
(Juni) Applied Health Research Centre, Li Ka Shing Knowledge Institute of
St. Michael's Hospital, Department of Medicine, University of Toronto,
Toronto, ON, Canada
(Hare) Department of Anesthesia, St. Michael's Hospital, Li Ka Shing
Knowledge Institute, Department of Physiology, University of Toronto,
Toronto, ON, Canada
(Ko) Division of Cardiology, Schulich Heart Centre, Sunnybrook Health
Sciences Centre, Institute of Health Policy, Management and Evaluation
University of Toronto, ICES, Toronto, ON, Canada
(Verma) Division of Cardiac Surgery, St. Michael's Hospital, Li Ka Shing
Knowledge Institute, Department of Surgery, Department of Pharmacology and
Toxicology, University of Toronto, Toronto, ON, Canada
(Mazer) Department of Anesthesia, St. Michael's Hospital, Li Ka Shing
Knowledge Institute, Institute of Medical Sciences, Department of
Physiology, University of Toronto, Toronto, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Aim: To characterize the association between diabetes and transfusion and
clinical outcomes in cardiac surgery, and to evaluate whether restrictive
transfusion thresholds are harmful in these patients. <br/>Material(s) and
Method(s): The multinational, open-label, randomized controlled TRICS-III
trial assessed a restrictive transfusion strategy (haemoglobin [Hb]
transfusion threshold <75 g/L) compared with a liberal strategy (Hb <95
g/L for operating room or intensive care unit; or <85 g/L for ward) in
patients undergoing cardiac surgery on cardiopulmonary bypass with a
moderate-to-high risk of death (EuroSCORE >=6). Diabetes status was
collected preoperatively. The primary composite outcome was all-cause
death, stroke, myocardial infarction, and new-onset renal failure
requiring dialysis at 6 months. Secondary outcomes included components of
the composite outcome at 6 months, and transfusion and clinical outcomes
at 28 days. <br/>Result(s): Of the 5092 patients analysed, 1396 (27.4%)
had diabetes (restrictive, n = 679; liberal, n = 717). Patients with
diabetes had more cardiovascular disease than patients without diabetes.
Neither the presence of diabetes (OR [95% CI] 1.10 [0.93-1.31]) nor the
restrictive strategy increased the risk for the primary composite outcome
(diabetes OR [95% CI] 1.04 [0.68-1.59] vs. no diabetes OR 1.02
[0.85-1.22]; P<inf>interaction</inf> =.92). In patients with versus
without diabetes, a restrictive transfusion strategy was more effective at
reducing red blood cell transfusion (diabetes OR [95% CI] 0.28
[0.21-0.36]; no diabetes OR [95% CI] 0.40 [0.35-0.47];
P<inf>interaction</inf> =.04). <br/>Conclusion(s): The presence of
diabetes did not modify the effect of a restrictive transfusion strategy
on the primary composite outcome, but improved its efficacy on red cell
transfusion. Restrictive transfusion triggers are safe and effective in
patients with diabetes undergoing cardiac surgery.<br/>Copyright &#xa9;
2021 John Wiley & Sons Ltd.

<33>
Accession Number
2014159169
Title
Isolated tricuspid valve surgery-Repair versus replacement: A
meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Sarris-Michopoulos P.; Macias A.E.; Sarris-Michopoulos C.; Woodhouse P.;
Buitrago D.; Salerno T.A.; Magarakis M.
Institution
(Sarris-Michopoulos) University of Miami Miller School of Medicine, Miami,
FL, United States
(Macias) Department of Surgery, Jackson Memorial Hospital, University of
Miami Miller School of Medicine, Miami, FL, United States
(Sarris-Michopoulos) Department of Economics, University of Georgia,
Athens, GA, United States
(Woodhouse) Department of Surgery, Vanderbilt University School of
Medicine, Vanderbilt University Medical Center, Nashville, Vanderbilt,
United States
(Buitrago) Department of Surgery, Division of Cardiothoracic Surgery,
University of Miami Miller School of Medicine, Jackson Memorial Hospital,
Miami, FL, United States
(Salerno, Magarakis) Department of Surgery, Division of Cardiothoracic
Surgery, Jackson Memorial Hospital, University of Miami Miller School of
Medicine, Miami, FL, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: There is a paucity of data on outcomes after isolated tricuspid
valve surgery. This meta-analysis aims to compile available data on
isolated tricuspid valve surgery and compare isolated tricuspid valve
repair (iTVr) with isolated tricuspid valve replacement (iTVR) to
elucidate outcomes after tricuspid valve surgery. <br/>Method(s): A
literature search of 6 databases was performed. The primary outcomes was
30-day mortality. Secondary outcomes were early stroke, post-op pacemaker
placement, and tricuspid reoperation within 5 years. Publication bias was
explored using the funnel plot. <br/>Result(s): Ten retrospective studies
involving 1407 patients (iTVr group = 779 patients and iTVR group = 628
patients) were included. A cumulative analysis demonstrated a significant
difference favoring iTVr for 30-day mortality (odds ratio [OR]: 10 studies
[95% confidence interval [CI]]: 0.34 [0.18-0.66]); 4.7% versus 12.6%, for
iTVr and iTVR, respectively. Post-op pacemaker placement favored iTVr (OR:
6 studies [95% CI]: 0.37 [0.18-0.77]). Although stroke rates and TV
reoperation favored iTVr, they did not reach statistical significance. No
publication bias was identified. <br/>Conclusion(s): This meta-analysis
demonstrates that iTVr has better 30-day mortality and fewer permanent
pacemaker placements. Etiology and severity of TR, as well as careful
patient selection remain the most important factors for optimal
outcomes.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC.

<34>
Accession Number
634366539
Title
Biventricular function in exercise during autonomic (thoracic epidural)
block.
Source
European journal of applied physiology. 121(5) (pp 1405-1418), 2021. Date
of Publication: 01 May 2021.
Author
Wink J.; Steendijk P.; Tsonaka R.; de Wilde R.B.P.; Friedericy H.J.; Braun
J.; Veering B.T.; Aarts L.P.H.J.; Wouters P.F.
Institution
(Wink, Friedericy, Veering, Aarts) Department of Anesthesiology, Leiden
University Medical Center, P.O. Box 9600, Leiden 2300 RC, Netherlands
(Steendijk) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Tsonaka) Department of Biomedical Data Sciences, Medical Statistics
Section, Leiden University Medical Center, Leiden, Netherlands
(de Wilde) Department of Intensive Care, Leiden University Medical Center,
Leiden, Netherlands
(Braun) Department of Cardio-Thoracic Surgery, Leiden University Medical
Center, Leiden, Netherlands
(Wouters) Department of Anesthesia, University Hospitals Ghent, Ghent,
Belgium
Publisher
NLM (Medline)
Abstract
BACKGROUND: Blockade of cardiac sympathetic fibers by thoracic epidural
anesthesia (TEA) was previously shown to reduce right and left ventricular
systolic function and effective pulmonary arterial elastance. At
conditions of constant paced heart rate, cardiac output and systemic
hemodynamics were unchanged. In this study, we further investigated the
effect of cardiac sympathicolysis during physical stress and increased
oxygen demand. <br/>METHOD(S): In a cross-over design, 12 patients
scheduled to undergo thoracic surgery performed dynamic ergometric
exercise tests with and without TEA. Hemodynamics were monitored and
biventricular function was measured by transthoracic two-dimensional and
M-mode echocardiography, pulsed wave Doppler and tissue Doppler imaging.
<br/>RESULT(S): TEA attenuated systolic RV function (TV S': -21%, P<0.001)
and LV function (MV S': -14%, P=0.025), but biventricular diastolic
function was not affected. HR (-11%, P<0.001), SVI (-15%, P=0.006), CI
(-21%, P<0.001) and MAP (-12%, P<0.001) were decreased during TEA, but SVR
was not affected. Exercise resulted in significant augmentation of
systolic and diastolic biventricular function. During exercise HR, SVI, CI
and MAP increased (respectively, +86%, +19%, +124% and +17%, all P<0.001),
whereas SVR decreased (-49%, P<0.001). No significant interactions between
exercise and TEA were found, except for RPP (P=0.024) and MV E DT
(P=0.035). <br/>CONCLUSION(S): Cardiac sympathetic blockade by TEA reduced
LV and RV systolic function but did not significantly blunt
exercise-induced increases in LV and RV function. These data indicate that
additional mechanisms besides those controlled by the cardiac sympathetic
nervous system are involved in the regulation of cardiac function during
dynamic exercise. Trial registration Clinical trial registration:
Nederlands Trial Register, NTR 4880
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4880 .

<35>
Accession Number
636356899
Title
Dyslipidemia and aortic valve disease.
Source
Current opinion in lipidology. 32(6) (pp 349-354), 2021. Date of
Publication: 01 Dec 2021.
Author
Mata P.; Alonso R.; Perez de Isla L.; Badimon L.
Institution
(Mata, Alonso, Perez de Isla, Badimon) Fundacion Hipercolesterolemia
Familiar, Madrid, Spain
(Alonso) Center for Advanced Metabolic Medicine and Nutrition, Santiago,
Chile
(Perez de Isla) Cardiology Department, Hospital Clinico San Carlos,
IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
(Badimon) Cardiovascular Program - ICCC, Institut de Recerca del Hospital
Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
Publisher
NLM (Medline)
Abstract
PURPOSE OF REVIEW: Degenerative aortic stenosis (AS) is one of the most
prevalent heart valve diseases in the adult population. The understanding
of AS pathophysiology and involved risk factors have recently undergone a
great advance, with low-density lipoprotein cholesterol (LDL-C),
lipoprotein (a) [Lp(a)] and other clinical conditions taking on a relevant
role. Although little is known about the prevention of AS, we can
progressively find more evidence of the possible use of drugs to control
risk factors as tools that may delay the progression to severe AS and
aortic valve replacement. RECENT FINDINGS: Several factors have shown to
be solid predictors of the development of AS. Mendelian randomization and
observational studies on risk factors specifically lipid factors, such as
hypercholesterolemia, Lp(a), proprotein convertase subtilisin/kexin type 9
and hypertension have provided meaningful new information. The SAFEHEART
study has significantly contributed to define the role of LDL-C and Lp(a)
in AS. SUMMARY: In this review we discuss the interrelationship of
dyslipidemia, especially hypercholesterolemia and Lp(a) in the development
and prognosis of valvular AS. New imaging tools may contribute to its
early detection. Future studies with proprotein convertase
subtilisin/kexin type 9 inhibitors and specific therapies to lower Lp(a)
might contribute to delay AS development.<br/>Copyright &#xa9; 2021
Wolters Kluwer Health, Inc. All rights reserved.

<36>
Accession Number
2016087599
Title
Management Strategies in Persons with Inherited Hemophilia Requiring
Antithrombotic Therapy: A Scoping Review.
Source
Blood. Conference: 63rd ASH Annual Meeting. Atlanta United States.
138(Supplement 1) (pp 3191), 2021. Date of Publication: 23 Nov 2021.
Author
Uminski K.; Xu Y.; Zahrai A.; Hodgson A.; Duffett L.; Tinmouth A.; Khalife
R.
Institution
(Uminski, Xu, Duffett, Tinmouth, Khalife) Department of Medicine, The
Ottawa Hospital, University of Ottawa, Ottawa, Canada
(Zahrai, Hodgson) University of Ottawa, Ottawa, Canada
(Duffett, Tinmouth, Khalife) Ottawa Hospital Research Institute, Ottawa,
Canada
Publisher
Elsevier B.V.
Abstract
Background: Cardiovascular disorders (CVD) and venous thromboembolism
(VTE) are increasingly reported in people with hemophilia (PWH) whose life
expectancy has improved dramatically over the past decades. While
management of thrombotic events among PWH requires navigating the delicate
balance between recurrent ischemic events and hemorrhage, current
practices are highly variable and largely informed by expert opinion.
<br/>Objective(s): We sought to examine and summarize what is known about
the management, practice variation and outcomes of PWH requiring
antithrombotic therapy (ATT) for cardiovascular disorders (CVD) or venous
thromboembolism (VTE). We also aimed to identify current knowledge and
practice gaps in the management of CVD and VTE in PWH. <br/>Method(s): We
conducted a scoping review guided by Arksey and O'Malley (2002), and Levac
et al.'s (2010) methodological frameworks. We also adhered to the
Preferred Reporting Items for Systematic reviews and Meta-Analyses
extension for Scoping Reviews (PRISMA-ScR). A search strategy, developed
iteratively in collaboration with a medical librarian, was performed on
MEDLINE, EMBASE, and Scopus from inception to May 3, 2021. Studies of any
design, published in English or French, in full-text or abstract, were
included if they reported on more than two patients with inherited
hemophilia A or B requiring ATT for CVD or VTE. Following eligibility
assessment in duplicate, data from each study was charted by two
independent reviewers to report the type of research designs, population,
geographical location, interventions, and outcomes. Conflicts were
resolved by consensus. We conducted a descriptive analysis and narrative
synthesis to identify common themes and knowledge gaps. <br/>Result(s): We
screened 3929 articles and selected 38 studies for inclusion (23 full-text
and 15 abstracts). Published studies were largely retrospective (28/38,
73.7%), single center (25/38, 65.8%), and from Europe (25/38, 65.8%). A
total of 567 patients with hemophilia A or B were reported. Common
indications for ATT use included: coronary artery disease (26/38, 68.4%),
including a history of percutaneous coronary intervention or coronary
artery bypass procedures (14/38, 36.8%), atrial fibrillation (13/38,
34.2%), VTE treatment or prevention (10/38, 26.3%), cerebrovascular
disease (9/38, 23.7%) and valvular heart disease (7/38, 18.4%). ATT
included single antiplatelet therapy (28/38, 73.7%), heparins (21/38,
55.3%), dual antiplatelet therapy (19/38, 50%), vitamin K antagonists
(10/38, 26.3%), and direct oral anticoagulants (5/38, 13.2%). The use of
hemostatic therapies, either on-demand or prophylactically, was reported
in 36 studies (94.7%). Clotting factors concentrates were used in 35
studies (92.1%). Other agents included desmopressin (2/38, 5.2%) and
emicizumab (1/38, 2.6%). Only 19 studies (50%) reported target factor
levels (peak and/or trough) while on ATT. Outcomes related to bleeding
while on ATT were described in 36 studies (94.7%). Bleeding events
resulting in a change in hemostatic regimen occurred in 9 studies (25%),
while bleeding resulting in a change or discontinuation of ATT occurred in
10 studies (27.8%). In 10 studies (26.3%), no pathologic bleeding was
observed in PWH on ATT. Four key themes were generated iteratively to
describe the observed wide practice variation in the management of PWH
requiring ATT: (1) Deviation from established and evolving CVD/VTE-related
standards of care; (2) Difficulty weighing competing bleeding and
thrombotic risks; (3) Advocacy for individualized strategies and
multidisciplinary care; and (4) Absence of high-quality and long-term data
for PWH. Discussion and <br/>Conclusion(s): Our scoping review highlights
unmet needs in the management of an aging population of PWH with
increasing prevalence of CVD and VTE. Management patterns are inconsistent
and diverge from those of non-hemophilic patients. Current literature
provides limited information on key issues such as hemostatic regimen,
target factor levels, bleeding events and long-term outcomes. Prospective,
clinically actionable data are needed to inform optimal and evidence-based
management strategies of CVD and VTE in PWH. Higher quality data should
culminate in much needed guidelines co-produced with patient partners and
medical experts in hemophilia, CVD, and VTE. Disclosures: Khalife: Pfizer
Canada: Honoraria, Research Funding; Canadian Hemophilia Society: Research
Funding.<br/>Copyright &#xa9; 2021 American Society of Hematology

<37>
Accession Number
2014571984
Title
Short- and Mid-Term Autograft Outcomes Following the Reinforced Ross
Operation.
Source
World Journal for Pediatric and Congenital Heart Surgery. 13(1) (pp
38-45), 2022. Date of Publication: January 2022.
Author
Leeds H.; Ashfaq A.; McGrath L.; Dewey E.N.; Ungerleider R.M.; Shen I.;
Muralidaran A.
Institution
(Leeds, Dewey) Department of Pediatrics, Oregon Health Science University,
Portland, OR, United States
(Ashfaq) Heart Institute, Johns Hopkins All Children's Hospital, St
Petersburg, FL, United States
(McGrath) Section of Adult Congenital Heart Disease, Oregon Health Science
University, Portland, OR, United States
(Ungerleider) Institute for Integrated Life Skills, LLC, Bermuda Run, NC,
United States
(Shen, Muralidaran) Section of Pediatric and Congenital Cardiac Surgery,
Doernbecher Children's Hospital, Oregon Health Science University,
Portland, OR, United States
Publisher
SAGE Publications Inc.
Abstract
Background: The Ross operation for aortic valve replacement continues to
be a controversial option because of concerns related to late autograft
dilation and progressive neo-aortic insufficiency. In 2005, the reinforced
Ross procedure was described at our institution to address this problem.
We aim to analyze the short and mid-term outcomes following this
procedure. <br/>Method(s): This is a retrospective study of patients who
underwent the reinforced Ross operation between 2004 and 2019. A
comprehensive chart review was performed. Echocardiograms were
independently reviewed by an adult congenital cardiologist. The time to
reintervention was evaluated with a Kaplan-Meier curve. Analysis was
conducted in JMP 15.1 (SAS Inc., Cary, NC). <br/>Result(s): Twenty-five
patients underwent the reinforced Ross operation. Twenty-three patients
(92%) had bicuspid aortic valve and the most common indication for surgery
was a combination of aortic insufficiency and stenosis (n = 18, 72%). The
mean follow-up was 6.1 +/- 5.0 years. All patients were alive at the time
of follow-up. Six patients (24%), from early in our experience, required
subsequent aortic reintervention. Median time to reintervention was 41.8
months (0-81.5 months). Sixteen (64%) patients had less than moderate
aortic insufficiency at last follow-up. Additionally, average aortic root
measurements remained unchanged. <br/>Conclusion(s): The reinforced Ross
technique was initially proposed as a way to mitigate aortic root dilation
seen in the traditional Ross procedure. Our experience suggests an
associated learning curve with the majority of aortic reinterventions
occurring within the first few years following surgery. Continued
follow-up is warranted to assess its long-term durability and
functionality.<br/>Copyright &#xa9; The Author(s) 2021.

<38>
Accession Number
2015979833
Title
Clinical and Cardiovascular Characteristics of Patients Suffering
ST-Segment Elevation Myocardial Infarction After Covid-19: A Systematic
Review and Meta-Analysis.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
101045. Date of Publication: 2021.
Author
Gharibzadeh A.; Shahsanaei F.; Rahimi Petrudi N.
Institution
(Gharibzadeh) Assistant Professor of Cardiology, School of Medicine,
Cardiovascular Research Center, Shahid Mohammadi Hospital, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
(Shahsanaei) Interventional Cardiologist, Hypertension Research center,
Cardiovascular Research Institute, Isfahan University Of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Rahimi Petrudi) Resident Of Cardiology, School of Medicine,
Cardiovascular Research Center, Shahid Mohammadi Hospital, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
ST-segment elevation myocardial infarction (STEMI) is one of the fatal
complications following Covid-19. We aimed to systematically assess the
clinical sequels as well as cardiovascular findings in patients suffering
STEMI following Covid-19.The manuscripts databases including PubMed, Web
of knowledge (ISI), SCOPUS, Embase, and Google Scholar were deeply
searched by the two reviewers using the relevant keywords related to the
issue considered in the current review. Of 88 studies initially reviewed,
9 articles were included in final assessment. Nine articles including 447
patients with Covid-19 were included in the study. In terms of
electrocardiographic findings, anterior lead involvement was reported in
12% - 61.6% of cases, inferior lead in 28.2% - 75% and lateral involvement
in 7.7% - 100% of cases. The prevalence of LBBB was in the range of 10.7%
- 61.6% of cases. In terms of echocardiographic findings, a decrease in
left ventricular ejection fraction was reported in 60% - 88% of patients.
Wall motion abnormality was also observed in 60% - 82.1% of patients. In
terms of angiographic findings, the multi-vessel disease was reported in
17.9% - 69% of cases. Also, 24% - 83% of cases needed to revascularization
procedures. Cardiac arrest was also reported in 3.1% - 28.2% of cases.
Based on the meta-analysis performed on the mortality of patients with
STEMI in the field of Covid-19, the pooled prevalence of mortality was
estimated at 25.2% (95%CI:17.5%-34.8%). Mortality and adverse consequences
of STEMI in patients with Covid-19 are far higher than in the general
population. Therefore, in-hospital cardiovascular tracking and monitoring
of Covid-19 patients with potential cardiovascular disorders is necessary
to achieve a more favorable outcome.<br/>Copyright &#xa9; 2021 Elsevier
Inc.

<39>
Accession Number
2015979180
Title
A clinical and cost-effectiveness analysis of the HeartMate 3 left
ventricular assist device for transplant-ineligible patients: A United
Kingdom perspective.
Source
Journal of Heart and Lung Transplantation. (no pagination), 2021. Date of
Publication: 2021.
Author
Lim H.S.; Shaw S.; Carter A.W.; Jayawardana S.; Mossialos E.; Mehra M.R.
Institution
(Lim) University Hospital Birmingham NHS Foundation Trust, Birmingham,
United Kingdom
(Shaw) Manchester University NHS Foundation Trust, Manchester, United
Kingdom
(Carter, Jayawardana, Mossialos) London School of Economics, London,
United Kingdom
(Mehra) Brigham and Women's Hospital Heart and Vascular Center and Harvard
Medical School, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: The clinical and cost-effectiveness of left ventricular assist
device (LVAD) therapy for patients with advanced heart failure (HF) who
are ineligible for heart transplantation is debated in the UK. This study
develops an indirect comparison between the fully magnetically levitated
HeartMate 3 (HM 3) LVAD and medical therapy (MT) to evaluate expected
clinical and cost-effectiveness in the UK National Health Service (NHS)
context. <br/>Method(s): We performed an economic analysis comparing the
HM3 pump against the HeartMate II LVAD (MOMENTUM 3), and then another
analysis comparing MT with the first- and second-generation HeartMate XVE
pump LVAD and HeartMate II LVAD for the same patient population (REMATCH
and ROADMAP, respectively). By bridging those 2 analyses, an indirect
comparison between HM3 and MT in the form of a network meta-analysis was
developed. A literature search was performed to select the most
appropriate pair of studies for this purpose. Outcomes were adjusted to
produce Kaplan-Meier curves for the cost-effectiveness evaluation by using
a decision-analytic model. Data were extrapolated linearly over a 5-year
time horizon. Uncertainty and additional scenarios were addressed by
one-way and probabilistic sensitivity analysis. Local costs and health
utility were used from England, thereby representing the UK context.
<br/>Result(s): The incremental cost-effectiveness ratio (ICER) for LVAD
vs MT in transplant ineligible patients with advanced HF was estimated to
be 47,361 per quality-adjusted life year gained, with a 97.1% probability
of being cost-effective at 50,000. In a subgroup of patients who are
inotropic therapy dependent (INTERMACS 1-3 severity profile), the ICER was
45,616, while for a population with less-ill ambulatory HF (INTERMACS
profile 4-7) the ICER changed to 64,051. <br/>Conclusion(s): This study
provides evidence that HM3 LVAD therapy in advanced HF patients ineligible
for heart transplantation may be cost-effective compared to MT in the NHS
UK-England context. The ICER is lowest for patients dependent on inotropic
support, but exceeds the willingness to pay threshold of 50,000 in
ambulatory noninotropic therapy dependent advanced HF
patients.<br/>Copyright &#xa9; 2021 The Authors

<40>
Accession Number
636712761
Title
Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac
Surgery: A Systematic Review and Meta-analysis of Randomized Controlled
Trials.
Source
Anesthesia and analgesia. (no pagination), 2021. Date of Publication: 05
Nov 2021.
Author
Long Y.-Q.; Feng X.-M.; Shan X.-S.; Chen Q.-C.; Xia Z.; Ji F.-H.; Liu H.;
Peng K.
Institution
(Long, Shan, Chen, Ji, Peng) From the Department of Anesthesiology, First
Affiliated Hospital of Soochow University, Suzhou, China
(Feng) Department of Anesthesiology, University of Utah Health, Salt Lake
City, UT, United States
(Feng) Transitional Residency Program, Intermountain Medical Center,
Murray, UT, United States
(Xia, Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health, Sacramento, CA, Mexico
Publisher
NLM (Medline)
Abstract
BACKGROUND: Results from previous studies evaluating the effects of remote
ischemic preconditioning (RIPC) on morbidity and mortality after cardiac
surgery are inconsistent. This meta-analysis of randomized controlled
trials (RCTs) aims to determine whether RIPC improves cardiac and renal
outcomes in adults undergoing cardiac surgery. <br/>METHOD(S): PubMed,
EMBASE, and Cochrane Library were comprehensively searched to identify
RCTs comparing RIPC with control in cardiac surgery. The coprimary
outcomes were the incidence of postoperative myocardial infarction (MI)
and the incidence of postoperative acute kidney injury (AKI).
Meta-analyses were performed using a random-effect model. Subgroup
analyses were conducted according to volatile only anesthesia versus
propofol anesthesia with or without volatiles, high-risk patients versus
non-high-risk patients, and Acute Kidney Injury Network (AKIN) or Kidney
Disease Improving Global Outcomes (KDIGO) criteria versus other criteria
for AKI diagnosis. <br/>RESULT(S): A total of 79 RCTs with 10,814 patients
were included. While the incidence of postoperative MI did not differ
between the RIPC and control groups (8.2% vs 9.7%; risk ratio [RR] = 0.87,
95% confidence interval [CI], 0.76-1.01, P = .07, I2 = 0%), RIPC
significantly reduced the incidence of postoperative AKI (22% vs 24.4%; RR
= 0.86, 95% CI, 0.77-0.97, P = .01, I2 = 34%). The subgroup analyses
showed that RIPC was associated with a reduced incidence of MI in
non-high-risk patients, and that RIPC was associated with a reduced
incidence of AKI in volatile only anesthesia, in non-high-risk patients,
and in the studies using AKIN or KDIGO criteria for AKI diagnosis.
<br/>CONCLUSION(S): This meta-analysis demonstrates that RIPC reduces the
incidence of AKI after cardiac surgery. This renoprotective effect of RIPC
is mainly evident during volatile only anesthesia, in non-high-risk
patients, and when AKIN or KDIGO criteria used for AKI
diagnosis.<br/>Copyright &#xa9; 2021, the American Society of
Anesthesiologists. All Rights Reserved.

<41>
Accession Number
636442218
Title
Assessment of Discrepancies between Follow-up Infarct Volume and 90-Day
Outcomes among Patients with Ischemic Stroke Who Received Endovascular
Therapy.
Source
JAMA Network Open. 4(11) (no pagination), 2021. Article Number: e2132376.
Date of Publication: 04 Nov 2021.
Author
Ganesh A.; Ospel J.M.; Menon B.K.; Demchuk A.M.; McTaggart R.A.; Nogueira
R.G.; Poppe A.Y.; Almekhlafi M.A.; Hanel R.A.; Thomalla G.; Holmin S.;
Puetz V.; Van Adel B.A.; Tarpley J.W.; Tymianski M.; Hill M.D.; Goyal M.
Institution
(Ganesh, Menon, Demchuk, Almekhlafi, Hill, Goyal) Calgary Stroke Program,
Department of Clinical Neurosciences, University of Calgary, Calgary, AB,
Canada
(Ospel) Department of Radiology, University Hospital Basel, University of
Basel, Basel, Switzerland
(Menon, Almekhlafi, Hill, Goyal) Seaman Family MR Research Centre,
Department of Radiology, University of Calgary, Foothills Medical Centre,
1403 29 St NW, Calgary, AB T2N 2T9, Canada
(Menon, Almekhlafi, Hill, Goyal) Department of Community Health Sciences,
University of Calgary, Calgary, AB, Canada
(Menon, Demchuk, Almekhlafi, Hill) Hotchkiss Brain Institute, University
of Calgary, Calgary, AB, Canada
(McTaggart) Departments of Diagnostic Imaging, Neurology, and
Neurosurgery, Warren Alpert Medical School, Brown University, Providence,
RI, United States
(Nogueira) Departments of Neurology, Neurosurgery, and Radiology, Emory
University, School of Medicine, Atlanta, GA, United States
(Nogueira) Neuroendovascular Service, Marcus Stroke and Neuroscience
Center, Grady Memorial Hospital, Atlanta, GA, United States
(Poppe) Department of Neurosciences, Centre Hospitalier, L'Universite de
Montreal (CHUM), Universite de Montreal, Montreal, QC, Canada
(Hanel) Lyerly Neurosurgery, Baptist Hospital, Jacksonville, FL, United
States
(Thomalla) Departments of Neurology and Neuroradiology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany
(Holmin) Department of Clinical Neuroscience, Karolinska Institutet,
Departments of Neuroradiology and Neurology, Karolinska University
Hospital, Stockholm, Sweden
(Puetz) Dresden Neurovascular Center, Department of Neurology, University
Hospital Carl Gustav Carus, Technische Universitat Dresden, Dresden,
Germany
(Van Adel) McMaster University, Hamilton, ON, Canada
(Tarpley) Providence Little Company of Mary Medical Center, Providence
Saint John's Health Center, Pacific Neuroscience Institute, Torrance, CA,
United States
(Tymianski) Division of Neurosurgery and Neurovascular Therapeutics
Program, University Health Network, Departments of Surgery and Physiology,
University of Toronto, Toronto Western Hospital, Research Institute,
Toronto, Canada
(Tymianski) NoNO Inc, Toronto, ON, Canada
(Hill) Department of Medicine, University of Calgary, Cumming School of
Medicine, Calgary, AB, Canada
Publisher
American Medical Association
Abstract
Importance: Some patients have poor outcomes despite small infarcts after
endovascular therapy (EVT), while others with large infarcts do well.
Understanding why these discrepancies occur may help to optimize EVT
outcomes. <br/>Objective(s): To validate exploratory findings from the
Endovascular Treatment for Small Core and Anterior Circulation Proximal
Occlusion with Emphasis on Minimizing CT to Recanalization Times (ESCAPE)
trial regarding pretreatment, treatment-related, and posttreatment factors
associated with discrepancies between follow-up infarct volume (FIV) and
90-day functional outcome. <br/>Design, Setting, and Participant(s): This
cohort study is a post hoc analysis of the Safety and Efficacy of
Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke
(ESCAPE-NA1) trial, a double-blind, randomized, placebo-controlled,
international, multicenter trial conducted from March 2017 to August 2019.
Patients who participated in ESCAPE-NA1 and had available 90-day modified
Rankin Scale (mRS) scores and 24-hour to 48-hour posttreatment follow-up
parenchymal imaging were included. Exposures: Small FIV (volume <=25th
percentile) and large FIV (volume >=75th percentile) on 24-hour computed
tomography/magnetic resonance imaging. Baseline factors, outcomes,
treatments, and poststroke serious adverse events (SAEs) were compared
between discrepant cases (ie, patients with 90-day mRS score >=3 despite
small FIV or those with mRS scores <=2 despite large FIV) and
nondiscrepant cases. <br/>Main Outcomes and Measures: Area under the curve
(AUC) and goodness of fit of prespecified logistic models, including
pretreatment (eg, age, cancer, vascular risk factors) and
treatment-related and posttreatment (eg, SAEs) factors, were compared with
stepwise regression-derived models for ability to identify small FIV with
higher mRS score and large FIV with lower mRS score. <br/>Result(s): Among
1091 patients (median [IQR] age, 70.8 [60.8-79.8] years; 549 [49.7%]
women; median [IQR] FIV, 24.9 mL [6.6-92.2 mL]), 42 of 287 patients
(14.6%) with FIV of 7 mL or less (ie, <=25th percentile) had an mRS score
of at least 3; 65 of 275 patients (23.6%) with FIV of 92 mL or greater
(ie, >=75th percentile) had an mRS score of 2 or less. Prespecified models
of pretreatment factors (ie, age, cancer, vascular risk factors)
associated with low FIV and higher mRS score performed similarly to models
selected by stepwise regression (AUC, 0.92 [95% CI, 0.89-0.95] vs 0.93
[95% CI, 0.90-0.95]; P =.42). SAEs, specifically infarct in new territory,
recurrent stroke, pneumonia, and congestive heart failure, were associated
with low FIV and higher mRS scores; stepwise models also identified
24-hour hemoglobin as treatment-related/posttreatment factor (AUC, 0.92
[95% CI, 0.90-0.95] vs 0.94 [95% CI, 0.91-0.96]; P =.14). Younger age was
associated with high FIV and lower mRS score; stepwise models identified
absence of diabetes and higher baseline hemoglobin as additional
pretreatment factors (AUC, 0.76 [95% CI, 0.70-0.82] vs 0.77 [95% CI,
0.71-0.83]; P =.82). Absence of SAEs, especially stroke progression,
symptomatic intracerebral hemorrhage, and pneumonia, was associated with
high FIV and lower mRS score2; stepwise models also identified 24-hour
hemoglobin level, glucose, and diastolic blood pressure as posttreatment
factors associated with discrepant cases (AUC, 0.80 [95% CI, 0.74-0.87] vs
0.79 [95% CI, 0.72-0.86]; P =.92). <br/>Conclusions and Relevance: In this
study, discrepancies between functional outcome and post-EVT infarct
volume were associated with differences in pretreatment factors, such as
age and comorbidities, and posttreatment complications related to index
stroke evolution, secondary prevention, and quality of stroke unit care.
Besides preventing such complications, optimization of blood pressure,
glucose levels, and hemoglobin levels are potentially modifiable factors
meriting further study..<br/>Copyright &#xa9; 2021 American Medical
Association. All rights reserved.

<42>
Accession Number
636395921
Title
Efficacy of a glucagon-like peptide-1 agonist and restrictive versus
liberal oxygen supply in patients undergoing coronary artery bypass
grafting or aortic valve replacement: Study protocol for a 2-by-2
factorial designed, randomised clinical trial.
Source
BMJ Open. 11(11) (no pagination), 2021. Article Number: e052340. Date of
Publication: 05 Nov 2021.
Author
Wiberg S.; Kjaergaard J.; Mogelvang R.; Moller C.H.; Kandler K.; Ravn H.;
Hassager C.; Kober L.; Nilsson J.C.
Institution
(Wiberg, Kjaergaard, Mogelvang, Hassager, Kober) Department of Cardiology,
Rigshospitalet, Copenhagen, Denmark
(Moller, Kandler) Department of Cardiothoracic Surgery, Rigshospitalet,
Copenhagen, Denmark
(Ravn, Nilsson) Department of Cardiothoracic Anesthesiology,
Rigshospitalet, Copenhagen, Denmark
Publisher
BMJ Publishing Group
Abstract
Introduction Coronary artery bypass grafting (CABG) and/or aortic valve
replacement (AVR) are associated with risk of death, as well as brain,
heart and kidney injury. Glucagon-like peptide-1 (GLP-1) analogues are
approved for treatment of type 2 diabetes, and GLP-1 analogues have been
suggested to have potential organ-protective and anti-inflammatory
effects. During cardiopulmonary bypass (CPB), consensus on the optimal
fraction of oxygen is lacking. The objective of this study is to determine
the efficacy of the GLP-1-analogue exenatide versus placebo and
restrictive oxygenation (50% fractional inspired oxygen, FiO2) versus
liberal oxygenation (100% FiO2) in patients undergoing open heart surgery.
Methods and analysis A randomised, placebo-controlled, double blind (for
the exenatide intervention)/single blind (for the oxygenation strategy),
2x2 factorial designed single-centre trial on adult patients undergoing
elective or subacute CABG and/or surgical AVR. Patients will be randomised
in a 1:1 and 1:1 ratio to a 6-hour and 15 min infusion of 17.4 mug of
exenatide or placebo during CPB and to a FiO2 of 50% or 100% during and
after weaning from CPB. Patients will be followed until 12 months after
inclusion of the last participant. The primary composite endpoint consists
of time to first event of death, renal failure requiring renal replacement
therapy, hospitalisation for stroke or heart failure. In addition, the
trial will include predefined sub-studies applying more advanced measures
of cardiac- A nd pulmonary dysfunction, renal dysfunction and cerebral
dysfunction. The trial is event driven and aims at 323 primary endpoints
with a projected inclusion of 1400 patients. Ethics and dissemination
Eligible patients will provide informed, written consent prior to
randomisation. The trial is approved by the local ethics committee and is
conducted in accordance with Danish legislation and the Declaration of
Helsinki. The results will be presented in peer-reviewed
journals.<br/>Copyright &#xa9; 2021 Author(s). Published by BMJ.

<43>
Accession Number
616834912
Title
Intraoperative dexamethasone does not increase the risk of postoperative
wound infection: A propensity score-matched post hoc analysis of the
ENIGMA-II trial (EnDEX).
Source
British Journal of Anaesthesia. 118(2) (pp 190-199), 2017. Date of
Publication: 01 Feb 2017.
Author
Corcoran T.; Kasza J.; Short T.G.; O'Loughlin E.; Chan M.; Leslie K.;
Forbes A.; Paech M.; Myles P.; Wallace S.; Galagher W.; Farrington C.;
Ditoro A.; Peyton P.; Baulch S.; Sidiropoulos S.; Bulach R.; Bryant D.;
Mitteregger V.; Bolsin S.; Osborne C.; McRae R.; Backstrom M.; Cotter R.;
March S.; Silbert B.; Said S.; Halliwell R.; Cope J.; Fahlbusch D.; Crump
D.; Thompson G.; Jefferies A.; McCulloch T.; Reeves M.; Buckley N.; Tidyl
T.; Schricker T.; Lattermann R.; Iannuzzi D.; Beattie S.; Carroll J.;
Jacka M.; Bryden C.; Badner N.; Tsang M.; Cheng B.; Fong A.; Chu L.; Koo
E.; Mohd N.; Ming L.E.; Yin Wang C.; Campbell D.; McAllister D.; Walker
S.; Olliff S.; Kennedy R.; Eldawlatly A.; Alzahrani T.; Chua N.; Haller
G.; Pichon I.; Sneyd R.; McMillan H.; Parkinson I.; Rousseau G.; Brennan
A.; Balaji P.; Cupitt J.; Nightingale J.; Kunst G.; Dickinson M.; Saran
T.; Subramaniam B.; Banner-Godspeed V.; Sessler D.; Liu J.; Kurz A.;
Hesler B.; Fu A.; Egan C.; Fiffick A.; Hutcherson M.; Turan A.; Naylor A.;
Obal D.; Cooke E.
Institution
(Corcoran, Paech) Department of Anaesthesia and Pain Medicine, Royal Perth
Hospital, Perth, WA, Australia
(Corcoran, O'Loughlin, Paech) School of Medicine and Pharmacology,
University of Western Australia, Perth, WA, Australia
(Corcoran) Western Australia Health Department, Perth, WA, Australia
(Corcoran, Kasza, Leslie, Forbes, Myles) Department of Epidemiology and
Preventive Medicine, Monash University, Melbourne, VIC, Australia
(Short) Department of Anaesthesia, Auckland City Hospital, Park Road,
Grafton, Auckland, New Zealand
(O'Loughlin) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Perth, WA, Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Hong Kong Special Administrative Region, Hong Kong
(Leslie) Department of Anaesthesia and Pain Management, Royal Melbourne
Hospital, Melbourne, VIC, Australia
(Leslie) Anaesthesia Perioperative and Pain Medicine Unit, Department of
Pharmacology and Therapeutics, University of Melbourne, Melbourne, VIC,
Australia
(Myles) Department of Anaesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Wallace, Galagher, Farrington, Ditoro) AustinAustralia
(Peyton, Baulch, Sidiropoulos) DandenongAustralia
(Bulach, Bryant) Fremantle, Australia
(O'Loughlin, Mitteregger) Geelong Hospital, Australia
(Bolsin, Osborne) Monash Medical Centre, Australia
(McRae, Backstrom) Royal Melbourne Hospital, Australia
(Leslie, Cotter) Royal Perth Hospital, Australia
(Paech, March) St Vincent's Hospital, Australia
(Silbert, Said) Westmead Hospital, Australia
(Halliwell, Cope) Calvary WakefieldAustralia
(Fahlbusch, Crump) Peter MacCallum Cancer Centre, Australia
(Thompson) Western Hospital, Australia
(Jefferies) Royal Prince Alfred, Australia
(McCulloch) North West Regional Hosptial, Australia
(Reeves) McMaster University, Canada
(Buckley, Tidyl) Royal Victoria Hospital, Canada
(Schricker, Lattermann, Iannuzzi) Toronto General Hospital, Canada
(Beattie, Carroll) University of Alberta Hospital, Canada
(Jacka, Bryden) London Health Sciences, Canada
(Badner) Prince of Wales, Hong Kong
(Chan) ANZCA Trials Group Member, Hong Kong
(Tsang) Tuen Mun Hospital, Hong Kong
(Cheng, Fong) ACM Fong, Hong Kong
(Chu, Koo) Nethersole Eastern Hospital, Hong Kong
(Mohd, Ming) Hospital Kuala Lumpur, Malaysia
(Yin Wang) Malaya Medical Centre, Malaysia
(Campbell, McAllister) Auckland Hospital, New Zealand
(Walker, Olliff) Middlemore Hospital, New Zealand
(Kennedy) Christchurch Hospital, New Zealand
(Eldawlatly, Alzahrani) King Saud University Hospital, Saudi Arabia
(Chua) Tan Tock Seng Hospital, Singapore
(Haller, Pichon) Geneva University Hospital, Switzerland
(Sneyd, McMillan) Plymouth NHS Trust, France
(Parkinson) Royal Lancaster Infirmary, United Kingdom
(Rousseau) North Devon District Hospital, United Kingdom
(Brennan) Bradford Teaching Hospital, United Kingdom
(Balaji) Hull Royal Infirmary, United Kingdom
(Cupitt) Blackpool Victoria Hospital, United Kingdom
(Nightingale) Portsmouth Hospital, United Kingdom
(Kunst) King's College Hospital, United Kingdom
(Dickinson) Royal Surrey County Hospital, United Kingdom
(Saran) University Hospitals, Coventry and Warwickshire, United Kingdom
(Subramaniam, Banner-Godspeed) Beth Israel Deaconess Medical Center,
United States
(Sessler, Liu, Kurz, Hesler, Fu, Egan, Fiffick, Hutcherson, Turan, Naylor)
Cleveland Clinic, United States
(Obal, Cooke) Louisville Medical Centre, United States
Publisher
Elsevier Ltd
Abstract
Background. In a post hoc analysis of the ENIGMA-II trial, we sought to
determine whether intraoperative dexamethasone was associated with adverse
safety outcomes. Methods. Inverse probability weighting with estimated
propensity scores was used to determine the association of dexamethasone
administration with postoperative infection, quality of recovery, and
adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects
enrolled in ENIGMA-II. Results. Dexamethasone was administered to 2178
(40%) of the 5499 subjects included in this analysis and was not
associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity
score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI)
0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242
(7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30;
P=0.59], quality of recovery score [median 14, interquartile range (IQR)
12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the
postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0
(1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main
trial. Dexamethasone administration was associated with a decrease in
fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74;
P<0.001] and shorter lengths of stay in hospital [propensity
score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001].
Neither diabetes mellitus nor surgical wound contamination status altered
these outcomes. Conclusion. Dexamethasone administration to high-risk
non-cardiac surgical patients did not increase the risk of postoperative
wound infection or other adverse events up to day 30, and appears to be
safe in patients either with or without diabetes mellitus. Clinical trial
registration. NCT00430989.<br/>Copyright &#xa9; 2017 The Author.

<44>
Accession Number
636571752
Title
Post-thymectomy myasthenia gravis: A case report and systematic review of
literature.
Source
BMJ Case Reports. 14(12) (no pagination), 2021. Article Number: e246005.
Date of Publication: 02 Dec 2021.
Author
Gurowich L.; Yiin G.; Maxwell A.; Rice A.
Institution
(Gurowich) General Surgery, Taunton and Somerset Nhs Foundation Trust,
Taunton, United Kingdom
(Gurowich, Yiin, Maxwell) Neurology, Swindon and Marlborough Nhs Trust,
Swindon, United Kingdom
(Rice) Histopathology, Royal Brompton Hospital, London, United Kingdom
Publisher
BMJ Publishing Group
Abstract
Myasthenia gravis (MG) is an autoimmune condition affecting the
neuromuscular junction characterised by weakness and fatiguability,
carrying a high morbidity if treatment is delayed. A clear association
with thymoma has led to management with thymectomy as a common practice,
but MG presenting post-thymectomy has rarely been reported. We present a
case of an 82-year-old woman developing fatigue, ptosis and dysarthria 3
months after thymectomy. After a clinical diagnosis of MG was made, she
responded well to prompt treatment with prednisolone and pyridostigmine.
Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came
back positive. Our systematic review reveals that post-thymectomy MG can
be categorised as early-onset or late-onset form with differing aetiology,
and demonstrated correlation between preoperative anti-AChR titres and
post-thymectomy MG. The postulated mechanisms for post-thymectomy MG
centre around long-lasting peripheral autoantibodies. Clinicians should
actively look for MG symptoms in thymoma patients and measure anti-AChR
preoperatively to aid prognostication.<br/>Copyright &#xa9; BMJ Publishing
Group Limited 2021. No commercial re-use. See rights and permissions.
Published by BMJ.

<45>
Accession Number
2015313335
Title
Management of acute aortic syndromes from initial presentation to
definitive treatment.
Source
American Journal of Emergency Medicine. 51 (pp 108-113), 2022. Date of
Publication: January 2022.
Author
Mehta C.K.; Son A.Y.; Chia M.C.; Budd A.N.; Allen B.D.; Vassallo P.; Hoel
A.W.; Brady W.J.; Nable J.V.
Institution
(Mehta, Son) Division of Cardiac Surgery, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Chia, Hoel) Division of Vascular Surgery, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Budd) Department of Anesthesiology, Northwestern Medicine, Chicago, IL,
United States
(Allen) Department of Radiology, Northwestern Medicine, Chicago, IL,
United States
(Vassallo) Division of Cardiology, Bluhm Cardiovascular Institute,
Northwestern Medicine, Chicago, IL, United States
(Brady) Departments of Emergency Medicine and Internal Medicine,
University of Virginia, Charlottesville, VA, United States
(Nable) Department of Emergency Medicine, MedStar Georgetown University
Hospital, Washington D.C., United States
Publisher
W.B. Saunders
Abstract
Background: Acute aortic syndromes comprise a spectrum of diseases
including aortic dissection, intramural hematoma, and penetrating
atherosclerotic ulcers. Early diagnosis, rapid intervention, and
multidisciplinary team care are vital to efficiently manage time-sensitive
aortic emergencies, mobilize appropriate resources, and optimize clinical
outcomes. <br/>Objective(s): This comprehensive review outlines the
multidisciplinary team approach from initial presentation to definitive
interventional treatment and post-operative care. <br/>Discussion(s):
Acute aortic syndromes can be life-threatening and require prompt
diagnosis and aggressive initiation of blood pressure and pain control to
prevent subsequent complications. Early time to diagnosis and intervention
are associated with improved outcomes. <br/>Conclusion(s): A
multidisciplinary team can help promptly diagnose and manage aortic
syndromes.<br/>Copyright &#xa9; 2021

<46>
Accession Number
2014866892
Title
Perioperative Care Standards in Cardiac Surgery Patients Aiming at
Enhancing Recovery: A Nationwide Survey in the Netherlands and Belgium.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(1) (pp 109-117),
2022. Date of Publication: January 2022.
Author
Damstra J.; Geerts B.F.; Rex S.; Vlaar A.P.J.; Driessen A.H.G.; Engelman
D.T.; Klautz R.J.M.; Eberl S.
Institution
(Damstra, Eberl) Department of Anesthesiology, Amsterdam UMC, Location
AMC, Netherlands
(Rex) Department of Anesthesiology, University Hospital Leuven, Belgium;
and Department of Cardiovascular Sciences, KU Leuven, Belgium
(Vlaar) Department of Intensive Care, Amsterdam UMC, Location AMC,
Netherlands
(Driessen, Klautz) Department of Cardiothoracic Surgery, Amsterdam UMC,
location AMC, Netherlands
(Engelman) Heart and Vascular Program, Baystate Health, Springfield and
University of Massachusetts Medical School-Baystate, Springfield, MA,
United States
(Geerts) Department for Intensive Care, Spaarne Gasthuis, Haarlem,
Netherlands
Publisher
W.B. Saunders
Abstract
Objective: The aim of this survey was to describe existing perioperative
care standards and best practices in the Netherlands and Belgium.
<br/>Design(s): An online survey was followed up by an in-depth personal
interview. The main outcomes were the existing standards of perioperative
care for patients undergoing cardiac surgery. <br/>Setting(s): The online
survey and subsequent interviews were targeted to one representative in
the intensive care unit (ICU), cardiac surgery, and anesthesiology
department from each cardiac surgical center in the Netherlands and
Belgium. <br/>Participant(s): A representative intensive care physician,
cardiac surgeon, and cardiac anesthesiologist. <br/>Intervention(s): None.
<br/>Measurements and Main Results: The response rate was 60% (71% for the
Netherlands, and 44% in Belgium). Agreement across centers was found for
discontinuation of proton-pump inhibitors (80%) and avoiding intra- and
postoperative (92%) nonsteroidal antiinflammatory drugs. Additionally, 98%
of respondents stated that physiotherapy should be started immediately in
the ICU. Major divergence was found for elements such as the
discontinuation of angiotensin-converting enzyme inhibitors (55%) or the
postoperative use of chest support vests (44%). <br/>Conclusion(s): The
authors demonstrated a wide range of different local protocols. Strategies
differed among disciplines, hospitals, and countries. This emphasized the
need for the implementation of a more universal protocol to further reduce
variance and improve recovery practices. This nationwide survey was the
first of its kind simultaneously studying best practices for cardiac
surgery through the entire care pathway at the advent of Enhanced Recovery
After Surgery (ERAS) Cardiac implementation. A multinational randomized
controlled trial to test the implementation of an evidence-based ERAS
Cardiac protocol is the next step to pave the way for further outcome
improvements in this high-risk population.<br/>Copyright &#xa9; 2021
Elsevier Inc.

<47>
Accession Number
2015465631
Title
Letter regarding "RenalGuard system and conventional hydration for
preventing contrast-associated acute kidney injury in patients undergoing
cardiac interventional procedures: A systematic review and meta-analysis".
Source
International Journal of Cardiology. 346 (pp 18), 2022. Date of
Publication: 01 Jan 2022.
Author
Huang Z.; Mo M.; Huang H.
Institution
(Huang, Huang) Department of Cardiovascular Thoracic Surgery, the Third
Affiliated Hospital of Guangxi Medical University: Nanning Second People's
Hospital, Nanning, China
(Mo) Geriatric Department of Endocrinology, the First Affiliated Hospital
of Guangxi Medical University, Nanning, China
Publisher
Elsevier Ireland Ltd

<48>
Accession Number
2015744277
Title
Clinical features of Danon disease and insights gained from LAMP-2
deficiency models.
Source
Trends in Cardiovascular Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Zhai Y.; Miao J.; Peng Y.; Wang Y.; Dong J.; Zhao X.
Institution
(Zhai, Peng, Dong, Zhao) Centre for Cardiovascular Diseases, Henan Key
Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated
Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
(Miao) Academy of Medical Sciences, Zhengzhou University, Zhengzhou, P.R.
China;Department of Science and Technology, Henan University of Chinese
Medicine, Zhengzhou, Henan, China
(Miao, Wang) Sino-British Research Center for Molecular Oncology, National
Center for the International Research in Cell and Gene Therapy, School of
Basic Sciences, Academy of Medical Sciences, Zhengzhou University,
Zhengzhou, Henan, China
(Wang) Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary
University of London, London, UK, United Kingdom
(Dong) Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Publisher
Elsevier Inc.
Abstract
Danon disease (DD) is an X-linked multisystem disorder with clinical
features characterized by the triad of hypertrophic cardiomyopathy,
skeletal muscle weakness, and mental retardation. Cardiac involvement can
be fatal in the absence of an effective treatment option such as heart
transplantation. Molecular studies have proved that LAMP-2 protein
deficiency, mainly LAMP-2B isoform, resulting from LAMP2 gene mutation, is
the culprit for DD. Autophagy impairment due to LAMP-2 deficiency mediated
the accumulation of abnormal autophagic vacuoles in cells. While it is not
ideal for mimicking DD phenotypes in humans, the emergence of
LAMP-2-deficient animal models and induced pluripotent stem cells from DD
patients provided powerful tools for exploring DD mechanism. In both in
vitro and in vivo studies, much evidence has demonstrated that
mitochondria dysfunction and fragmentation can result in DD pathology.
Fundamental research contributes to the therapeutic transformation. By
targeting the molecular core, several potential therapies have
demonstrated promising results in partial phenotypes improvement. Among
them, gene therapies anticipate inaugurate a class of symptom control and
prevention drugs as their in vivo effects are promising, and one clinical
trial is currently underway.<br/>Copyright &#xa9; 2021

<49>
Accession Number
636689530
Title
PROSE: Prospective Randomized Trial of the On-X Mechanical Prosthesis and
the St Jude Medical Mechanical Prosthesis Evaluation : Part 1(Patient
Dynamics): Preoperative demographics and preoperative and operative risk
factors.
Source
Journal of cardiothoracic surgery. 16(1) (pp 323), 2021. Date of
Publication: 03 Nov 2021.
Author
Jamieson W.R.E.; Ely J.L.; Brink J.; Pennel T.; Bannon P.; Patel J.; Kumar
Gupta R.; Mohan Rao P.S.; Agrawal D.; Wiklund L.; Kappetein A.P.;
Haaverstad R.; Geisner T.; Doenst T.; Schlensak C.; Nair S.; Brown C.;
Siepe M.; Damiano R.J.; Langlois Y.; Cherian K.M.; Azar H.; Chen J.C.;
Bavaria J.E.; Fedoruk L.M.; Munfakh N.A.; Sridhar V.; Scholz P.M.; Pfeffer
T.A.; Ye J.
Institution
(Jamieson, Ye) Vancouver Coastal Health Research Institute, University of
British Columbia, Vancouver, Canada
(Ely) Heart of the Matter CV Consulting, Austin, United States
(Brink, Pennel) University of Cape Town, Cape Town, South Africa
(Bannon) University of Sydney, Sydney, Australia
(Patel) SuratIndia
(Kumar Gupta) Dayanand Medical College, Punjab, India
(Mohan Rao) Sri Jayadeva Institute of Cardiovascular Sciences, Bengaluru,
India
(Agrawal) Banaras Hindu University, Varanasi, India
(Wiklund) Sahlgrenska University Hospital, Gothenburg, Sweden
(Kappetein) Erasmus University Rotterdam, Rotterdam, Netherlands
(Haaverstad, Geisner) Haukeland University Hospital, Bergen, Norway
(Doenst) University Hospital Jena, Jena, Germany
(Schlensak) University Hospital Tuebingen, Freiburg, Germany
(Nair) Apollo Hospital Chennai, Chennai, India
(Brown) Horizon New Brunswick Heart Center, St. John, Canada
(Siepe) University Heart Center Freiburg, Freiburg, Germany
(Damiano, Munfakh) Washington University School of Medicine, St. Louis,
United States
(Langlois) Jewish General Hospital, Montreal, Canada
(Cherian) Frontier Lifeline Hospitals, Chennai, India
(Azar) Sentara Norfolk General Hospital, Norfolk, United Kingdom
(Chen) Kaiser Permanente Hospital, Honolulu, United States
(Bavaria) University of Pennsylvania, Philadelphia, United States
(Fedoruk) Victoria Heart Institute, VIC, Canada
(Sridhar) Apollo Mulitspecialty Hospitals, Madurai, India
(Scholz) Robert Wood Johnson School of Medicine, NB, United States
(Pfeffer) Southern California Permanente Medical Group, Los Angeles,
United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The PROSE trial purpose is to investigate whether the
incidence of thromboembolic-related complications is reduced with a
current generation mechanical prosthesis (On-X Life Technologies/CryoLife
Inc.-On-X) compared with a previous generation mechanical prosthesis (St
Jude Medical-SJM). The primary purpose of the initial report is to
document the preoperative demographics, and the preoperative and operative
risk factors by individual prosthesis and by Western and Developing
populations. <br/>METHOD(S): The PROSE study was conducted in 28 worldwide
centres and incorporated 855 subjects randomized between 2003 and 2016.
The study enrollment was discontinued on August 31, 2016. The preoperative
demographics incorporated age, gender, functional class, etiology,
prosthetic degeneration, primary rhythm, primary valve lesion, weight,
height, BSA and BMI. The preoperative and operative evaluation
incorporated 24 risk factors. <br/>RESULT(S): The total patient population
(855) incorporated On-X population (462) and the St Jude Medical
population (393). There was no significant difference of any of the
preoperative demographics between the On-X and SJM groups. The
preoperative and operative risk factors evaluation showed there was no
significant difference between the On-X and St Jude Medical populations.
The preoperative and operative risk factors by valve position (aortic and
mitral) also documented no differentiation. The dominant preoperative
demographics of the Western world population were older age, male gender,
sinus rhythm, aortic stenosis, congenital aortic lesion, and mitral
regurgitation. The dominant demographics of the Developing world
population were rheumatic etiology, atrial fibrillation, aortic
regurgitation, mixed aortic lesions, mitral stenosis and mixed mitral
lesions. The Developing world group had only one significant risk factor,
congestive heart failure. The majority of the preoperative and operative
risk factors were significant in the Western world population.
<br/>CONCLUSION(S): The preoperative demographics do not differentiate the
prostheses but do differentiate the Western and Developing world
populations. The preoperative and operative risk factors do not
differentiate the prostheses BUT do differentiate the Western and
Developing world populations.<br/>Copyright &#xa9; 2021. The Author(s).

<50>
Accession Number
2013859482
Title
TAVR and Dialysis Are a Challenging Combination. A Case Report and
Systematic Review of Literature.
Source
Structural Heart. 5(6) (pp 549-555), 2021. Date of Publication: 2021.
Author
Iadanza A.; Antenore A.; Biancofiore A.; Contorni F.; Biagioni G.; Bellan
C.; Davoli G.; Fineschi M.
Institution
(Iadanza, Fineschi) Department of Cardiovascular Diseases, Azienda
Ospedaliera Universitaria Senese, Siena, Italy
(Antenore, Biancofiore, Contorni, Biagioni) Department of Medical
Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
(Bellan) Department of Medical Biotechnologies, Institute of Pathological
Anatomy, University of Siena, Siena, Italy
(Davoli) Department of Cardiovascular Diseases, Azienda Ospedaliera
Universitaria Senese, Siena, Italy
Publisher
Taylor and Francis Ltd.
Abstract
Advanced chronic kidney disease (CKD) is associated with poor outcomes in
patients undergoing surgical aortic valve replacement, while its
prognostic role in transcatheter aortic valve replacement (TAVR) remains
unclear. Advanced CKD was defined according to estimated glomerular
filtration rate (eGFR): 15-29 mL/min/1.73 m² (Stage 4-CKD G5),
<15 mL/min/1.73 m² (Stage 5-CKD G5), and CKD G5D if the patient
is on hemodialysis. End-stage renal disease (ESRD) increases the risk of
developing heart valve disease, mainly aortic stenosis. Nonetheless, ESRD
is also known to carry a very high surgical risk, and all the main scoring
systems (i.e., STS, Euroscore II) developed to assess prognosis in
patients undergoing cardiac surgery take into account this risk factor.
Transcatheter aortic valve replacement (TAVR) appears to be a feasible
alternative to surgical valve replacement (SAVR), but the initial trials
testing this approach systematically excluded patients on dialysis.
Several observational studies have been recently conducted among patients
with severely impaired renal function and all found a worse prognosis in
both the short and long term. We present a case report in which a
successful TAVR procedure was performed due to severe symptomatic aortic
stenosis in a subject with severe nephropathy. The patient in chronic
dialysis developed an early degeneration of aortic bioprosthesis Medtronic
CoreValve, which required surgical replacement with a mechanical
valve.<br/>Copyright &#xa9; 2021 Cardiovascular Research Foundation.

<51>
Accession Number
635238935
Title
The international ENIGMA-II substudy on postoperative cognitive disorders
(ISEP).
Source
Scientific reports. 11(1) (pp 11631), 2021. Date of Publication: 02 Jun
2021.
Author
Haller G.; Chan M.T.V.; Combescure C.; Lopez U.; Pichon I.; Licker M.;
Fournier R.; Myles P.
Institution
(Haller, Pichon, Licker, Fournier) Division of Anesthesiology, Department
of Acute Care Medicine, Geneva University Hospitals and Faculty of
Medicine, University of Geneva, Geneve 14 1211, Switzerland
(Haller) Health Services Management and Research Unit, Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC,
Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative
Region, New Territories, Shatin, China
(Combescure) Division of Clinical Epidemiology, Department of Health and
Community Medicine, University Hospitals of Geneva and Faculty of
Medicine, University of Geneva, Geneva, Switzerland
(Lopez) Unit of Neuropsychology and Logopedics, Department of Medicine,
Cantonal Hospital of Fribourg, Fribourg, Switzerland
(Myles) Department of Anesthesiology and Perioperative Medicine, Alfred
Hospital and Monash University, Melbourne, VIC, Australia
Publisher
NLM (Medline)
Abstract
There is a large controversy as to whether nitrous oxide (N2O) added to
the anaesthetic gas mixture is harmful or harmless for postoperative
cognitive function recovery. We performed a nested study in the ENIGMA-II
trial and compared postoperative neurocognitive recovery of patients
randomly receiving N2O (70%) or Air (70%) in 30% O2 during anesthesia. We
included adults having non cardiac surgery. We compared recovery scores
for episodic memory, decision making/processing speed and executive
functions measured with the computerised Cambridge Neuropsychological Test
Automated Battery (CANTAB). Assessments were performed at baseline, seven
and ninety days. At first interim analysis, following recruitment of 140
participants, the trial was suspended. We found that the mean (95%CI)
changes of scores for episodic memory were in the Pocock futility
boundaries. Decision making/processing speed did not differ either between
groups (P>0.182). But for executive functions at seven days, the mean
number (95% CI) of problems successfully solved and the number of correct
box choices made was higher in the N2O group, P=0.029. N2O with the
limitations of an interim analysis appears to have no harmful effect on
cognitive functions (memory/processing speed). It may improve the early
recovery process of executive functions. This preliminary finding warrants
further investigations.

<52>
Accession Number
636699122
Title
Fractional Flow Reserve to Guide Treatment of Patients With Multivessel
Coronary Artery Disease.
Source
Journal of the American College of Cardiology. 78(19) (pp 1875-1885),
2021. Date of Publication: 09 Nov 2021.
Author
Rioufol G.; Derimay F.; Roubille F.; Perret T.; Motreff P.; Angoulvant D.;
Cottin Y.; Meunier L.; Cetran L.; Cayla G.; Harbaoui B.; Wiedemann J.-Y.;
Van Belle E.; Pouillot C.; Noirclerc N.; Morelle J.-F.; Soto F.-X.;
Caussin C.; Bertrand B.; Lefevre T.; Dupouy P.; Lesault P.-F.; Albert F.;
Barthelemy O.; Koning R.; Leborgne L.; Barnay P.; Chapon P.; Armero S.;
Lafont A.; Piot C.; Amaz C.; Vaz B.; Benyahya L.; Varillon Y.; Ovize M.;
Mewton N.; Finet G.
Institution
(Rioufol, Derimay, Finet) Hopital Cardiologique et Pneumologique Louis
Pradel, Hospices Civils de Lyon, Bron, France
(Roubille) Hopital Arnaud de Villeneuve, Montpellier, France
(Perret) Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
(Motreff) Hopital Gabriel Montpied, Clermont-Ferrand, France
(Angoulvant) Hopital Trousseau, CHRU de Tours, Universite de Tours, Tours,
France
(Cottin) Hopital du Bocage Central, Dijon, France
(Meunier) Centre Hospitalier de La Rochelle, La Rochelle, France
(Cetran) Hopital Cardiologique, Centre Hospitalo-Universitaire de
Bordeaux, Universite de Bordeaux, Bordeaux, France
(Cayla) Service de cardiologie, Hopital Caremeau, Universite de
Montpellier, Nimes, France
(Harbaoui) Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon,
France
(Wiedemann) Centre Hospitalier de Mulhouse, Mulhouse, France
(Van Belle) Hopital Cardiologique Calmette, Lille, France
(Pouillot) Clinique Sainte Clotilde, La Reunion, France
(Noirclerc) Centre Hospitalier Annecy-Genevois, Annecy, France
(Morelle) Clinique Saint Martin, Caen, France
(Soto) Centre Hospitalier d'Auxerre, Auxerre, France
(Caussin) Institut Mutualiste de Montsouris, Paris, France
(Bertrand) Hopital Michallon, Grenoble, France
(Lefevre) Institut Hospitalier Jacques Cartier, Massy, France
(Dupouy) Clinique Les Fontaines, Melun, France
(Lesault) Hopital Prive de l'Estuaire, Le Havre, France
(Albert) Centre Hospitalier General, Chartres, France
(Barthelemy) Hopital de La Pitie-Salpetriere, Assistance Publique-Hopitaux
de Paris, Paris, France
(Koning) Clinique Saint Hilaire, Rouen, France
(Leborgne) Centre Hospitalier Amiens-Picardie, Hopital Sud, Amiens, France
(Barnay) Hopital Henri Duffaut, Avignon, France
(Chapon) Centre Hospitalier de Valence, Valence, France
(Armero) Hopital Europeen, Marseille, France
(Lafont) Hopital Europeen George Pompidou, Assistance Publique-Hopitaux de
Paris, Paris, France
(Piot) Clinique Le Millenaire, Montpellier, France
(Amaz, Vaz, Benyahya, Varillon, Ovize, Mewton) Centre d'investigation
clinique de Lyon, INSERM 1407, Hopital Cardiologique et Pneumologique
Louis Pradel, Hospices Civils de Lyon, Bron, France
Publisher
NLM (Medline)
Abstract
BACKGROUND: There is limited evidence that fractional flow reserve (FFR)
is effective in guiding therapeutic strategy in multivessel coronary
artery disease (CAD) beyond prespecified percutaneous coronary
intervention or coronary graft surgery candidates. <br/>OBJECTIVE(S): The
FUTURE (FUnctional Testing Underlying coronary REvascularization) trial
aimed to evaluate whether a treatment strategy based on FFR was superior
to a traditional strategy without FFR in the treatment of multivessel CAD.
<br/>METHOD(S): The FUTURE trial is a prospective, randomized, open-label
superiority trial. Multivessel CAD candidates were randomly assigned (1:1)
to treatment strategy based on FFR in all stenotic (>=50%) coronary
arteries or to a traditional strategy without FFR. In the FFR group,
revascularization (percutaneous coronary intervention or surgery) was
indicated for FFR <=0.80 lesions. The primary endpoint was a composite of
major adverse cardiac or cerebrovascular events at 1 year. <br/>RESULT(S):
The trial was stopped prematurely by the data safety and monitoring board
after a safety analysis and 927 patients were enrolled. At 1-year
follow-up, by intention to treat, there were no significant differences in
major adverse cardiac or cerebrovascular events rates between groups
(14.6% in the FFR group vs 14.4% in the control group; hazard ratio: 0.97;
95% confidence interval: 0.69-1.36; P = 0.85). The difference in all-cause
mortality was nonsignificant, 3.7% in the FFR group versus 1.5% in the
control group (hazard ratio: 2.34; 95% confidence interval: 0.97-5.18; P =
0.06), and this was confirmed with a 24 months' extended follow-up. FFR
significantly reduced the proportion of revascularized patients, with more
patients referred to exclusively medical treatment (P = 0.02).
<br/>CONCLUSION(S): In patients with multivessel CAD, we did not find
evidence that an FFR-guided treatment strategy reduced the risk of
ischemic cardiovascular events or death at 1-year follow-up. (Functional
Testing Underlying Coronary Revascularisation; NCT01881555).<br/>Copyright
&#xa9; 2021 American College of Cardiology Foundation. Published by
Elsevier Inc. All rights reserved.

<53>
Accession Number
2016016189
Title
A systematic review supporting the Society for Vascular Surgery Guidelines
on the management of carotid artery disease.
Source
Journal of Vascular Surgery. 75(1 Supplement) (pp 99S-108S.e42), 2022.
Date of Publication: January 2022.
Author
Hasan B.; Farah M.; Nayfeh T.; Amin M.; Malandris K.; Abd-Rabu R.; Shah
S.; Rajjoub R.; Seisa M.O.; Saadi S.; Hassett L.; Prokop L.J.; AbuRahma
A.F.; Murad M.H.
Institution
(Hasan, Farah, Nayfeh, Amin, Malandris, Abd-Rabu, Shah, Rajjoub, Seisa,
Saadi, Murad) Evidence-Based Practice Research Program, Mayo Clinic,
Rochester, Minn, United States
(Hasan, Farah, Nayfeh, Amin, Malandris, Abd-Rabu, Shah, Rajjoub, Seisa,
Saadi, Murad) Robert D. and Patricia E. Kern Center for the Science of
Health Care Delivery, Mayo Clinic, Rochester, Minn, United States
(Hassett, Prokop) Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn,
United States
(AbuRahma) Department of Surgery, West Virginia University, Charleston,
WV, United States
Publisher
Elsevier Inc.
Abstract
Background: To support the development of guidelines on the management of
carotid disease, a writing committee from the Society for Vascular Surgery
has commissioned this systematic review. <br/>Method(s): We searched
multiple data bases for studies addressing five questions: medical
management vs carotid revascularization (CEA) in asymptomatic patients,
CEA vs carotid artery stenting (CAS) in symptomatic low surgical risk
patients, the optimal timing of revascularization after acute stroke,
screening high-risk patients for carotid disease, and the optimal sequence
of interventions in patients with combined coronary and carotid disease.
Studies were selected and appraised by pairs of independent reviewers.
Meta-analyses were performed when feasible. <br/>Result(s): Medical
management compared with carotid interventions in asymptomatic patients
was associated with better early outcome during the first 30 days.
However, CEA was associated with significantly lower long-term rate of
stroke/death at 5 years. In symptomatic low-risk surgical patients, CEA
was associated with a lower risk of stroke, but a significant increase in
myocardial infarction compared with CAS during the first 30 days. When the
long-term outcome of transfemoral CAS vs CEA in symptomatic patients were
examined using preplanned pooled analysis of individual patient data from
four randomized trials, the risk of death or stroke within 120 days of the
index procedure was 5.5% for CEA and 8.7% for CAS, which lends support
that, over the long term, CEA has a superior outcome compared with
transfemoral CAS. When managing acute stroke, the comparison of CEA during
the first 48 hours to that between day 2 and day 14 did not reveal a
statistically significant difference on outcomes during the first 30 days.
Registry data show good results with CEA performed in the first week, but
not within the first 48 hours. A single risk factor, aside from peripheral
artery disease, was associated with low carotid screening yield. Multiple
risk factors greatly increase the yield of screening. Evidence on the
timing of interventions in patients with combined carotid and coronary
disease was sparse and imprecise. Patients without carotid symptoms, who
had the carotid intervention first, compared with a combined carotid
intervention and coronary artery bypass grafting, had better outcomes.
<br/>Conclusion(s): This updated evidence summary supports the Society for
Vascular Surgery clinical practice guidelines for commonly raised clinical
scenarios. CEA was superior to medical therapy in the long-term prevention
of stroke/death over medical therapy. CEA was also superior to
transfemoral CAS in minimizing long-term stroke/death for symptomatic low
risk surgical patients. CEA should optimally be performed between 2 and 14
days from the onset of acute stroke. Having multiple risk factors
increases the value of carotid screening.<br/>Copyright &#xa9; 2021
Society for Vascular Surgery

<54>
Accession Number
2016064757
Title
Postoperative Transfusion Guidelines in Aneurysmal Cerebral Subarachnoid
Hemorrhage: A Systematic Review and Critical Summary of Available
Evidence.
Source
World Neurosurgery. (no pagination), 2021. Date of Publication: 2021.
Author
Mofor P.; Oduguwa E.; Tao J.; Barrie U.; Kenfack Y.J.; Montgomery E.;
Edukugho D.; Rail B.; Hicks W.H.; Pernik M.N.; Adeyemo E.; Caruso J.; El
Ahmadieh T.Y.; Bagley C.A.; De Oliveira Sillero R.; Aoun S.G.
Institution
(Mofor, Oduguwa, Tao, Barrie, Kenfack, Montgomery, Rail, Hicks, Pernik,
Adeyemo, Caruso, Bagley, De Oliveira Sillero, Aoun) Department of
Neurological Surgery, University of Texas Southwestern Medical Center,
Dallas, TX, United States
(Edukugho) Department of Neurological Surgery, Boonshoft School of
Medicine, Wright State University, Dayton, OH, United States
(El Ahmadieh) Department of Neurological Surgery, Memorial Sloan Kettering
Cancer Center, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objective: Surgical management of aneurysmal subarachnoid hemorrhage (SAH)
often involves red blood cell (RBC) transfusion, which increases the risk
of postoperative complications. RBC transfusion guidelines report on
chronically critically ill patients and may not apply to patients with
SAH. Our study aims to synthesize the evidence to recommend RBC
transfusion thresholds among adult patients with SAH undergoing surgery.
<br/>Method(s): A systematic review was conducted using PubMed, Google
Scholar, and Web of Science electronic databases according to the PRISMA
(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
guidelines to critically assess primary articles discussing RBC
transfusion thresholds and describe complications secondary to RBC
transfusion in adult patients with SAH in the perioperative period.
<br/>Result(s): Sixteen articles meeting our search strategy were
reviewed. Patients with SAH who received blood transfusion were older,
female, had World Federation of Neurosurgical Societies grade IV-V and
modified Fisher grade 3-4 scores, and presented with more comorbidities
such as hypertension, diabetes, and cardiovascular and pulmonary diseases.
In addition, transfusion was associated with multiple postoperative
complications, including higher rates of vasospasms, surgical site
infections, cardiovascular and respiratory complications, increased
postoperative length of stay, and 30-day mortality. Analysis of transfused
patients showed that a higher hemoglobin (>10 g/dL) goal after SAH was
safe and that patients may benefit from a higher whole hospital stay
hemoglobin nadir, as shown by a reduction in risk of cerebral vasospasm
and improvement in clinical outcomes (level B class II).
<br/>Conclusion(s): Among patients with SAH, the benefits of reducing
cerebral ischemia and anemia are shown to outweigh the risks of
transfusion-related complications.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<55>
Accession Number
2016031416
Title
Short-term and Long-term Risk of Stroke in Patients With Perioperative
Atrial Fibrillation After Cardiac Surgery: Systematic Review and
Meta-analysis.
Source
CJC Open. (no pagination), 2021. Date of Publication: 2021.
Author
Wang M.K.; Meyre P.B.; Heo R.; Devereaux P.J.; Birchenough L.; Whitlock
R.; McIntyre W.F.; Peter Chen Y.C.; Ali M.Z.; Biancari F.; Butt J.H.;
Healey J.S.; Belley-Cote E.P.; Lamy A.; Conen D.
Institution
(Wang, Devereaux, McIntyre, Healey, Belley-Cote, Conen) Department of
Medicine, McMaster University, Hamilton, ON, Canada
(Wang, Devereaux, Whitlock, McIntyre, Healey, Belley-Cote, Lamy, Conen)
Population Health Research Institute, McMaster University, Hamilton, ON,
Canada
(Wang, Devereaux, Whitlock, McIntyre, Healey, Lamy, Conen) Department of
Health Research Methods, Evidence & Impact, McMaster University, Hamilton,
ON, Canada
(Meyre) Division of Cardiology and Basel Cardiovascular Research
Institute, Basel University Hospital, Basel, Switzerland
(Heo) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Birchenough) Faculty of Health Sciences, McMaster University, Hamilton,
ON, Canada
(Whitlock, Lamy) Department of Surgery, McMaster University, Hamilton, ON,
Canada
(Peter Chen) Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
(Ali) School of Medicine, Royal College of Surgeons in Ireland, Dublin,
Ireland
(Biancari) Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
(Butt) Department of Cardiology, Rigshopitalet, Copenhagen University
Hospital, Copenhagen, Denmark
Publisher
Elsevier Inc.
Abstract
Background: Perioperative atrial fibrillation (POAF) after cardiac surgery
has been associated with an increased risk of stroke in some studies.
However, the exact magnitude of this association during short-term and
long-term follow-up remains unclear. <br/>Method(s): We searched PubMed,
Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for
the time period from database inception to October 2020. We included
observational studies with >= 100 patients that reported data on
short-term or long-term stroke risk in patients with and without POAF
after cardiac surgery. Data were pooled using random-effects models. We
reported summary risk ratios (RRs) for studies reporting multivariable
adjusted results and calculated absolute risk differences (ARDs) with 95%
confidence intervals (CIs). <br/>Result(s): A total of 55 studies with
540,209 patients were included. POAF was associated with both an increased
relative risk (RR 1.69; 95% CI, 1.41-2.03; I² = 82%; 9 studies)
and absolute risk of short-term stroke (4.5% vs 2.5%; ARD 2.0%; 95% CI,
1.28-2.89). POAF was associated with an increased relative risk (RR 1.20;
95% CI, 1.12-1.29; I² = 16%; 10 studies) and absolute risk of
long-term stroke (1.06 vs 0.88 per 100 patient-years; ARD 0.18 per 100
patient-years; 95% CI, 0.07-0.26). Sensitivity analyses of high-quality
studies and studies reporting either ischemic or embolic strokes yielded
similar findings. <br/>Conclusion(s): POAF after cardiac surgery was
associated with an increased risk of both short-term and long-term stroke.
However, the long-term stroke ARD was small, and whether these patients
will benefit from long-term oral anticoagulation therapy is
unclear.<br/>Copyright &#xa9; 2021 The Authors

<56>
Accession Number
636701154
Title
Comparison of a Pure Plug-Based versus a Primary Suture-Based Vascular
Closure Device Strategy for Transfemoral Transcatheter Aortic Valve
Replacement: The CHOICE-CLOSURE Randomized Clinical Trial.
Source
Circulation. (no pagination), 2021. Date of Publication: 05 Nov 2021.
Author
Abdel-Wahab M.; Hartung P.; Dumpies O.; Obradovic D.; Wilde J.; Majunke
N.; Boekstegers P.; Muller R.; Seyfarth M.; Vorpahl M.; Kiefer P.; Noack
T.; Leontyev S.; Sandri M.; Rotta Detto Loria J.; Kitamura M.; Borger
M.A.; Funkat A.-K.; Hohenstein S.; Desch S.; Holzhey D.; Thiele H.
Institution
(Abdel-Wahab, Hartung, Dumpies, Obradovic, Wilde, Majunke, Sandri, Rotta
Detto Loria, Kitamura, Desch, Desch, Thiele) Department of Cardiology,
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
(Boekstegers) Department of Cardiology, Helios Klinikum Siegburg,
Siegburg, Germany; Witten Herdecke University, Witten, Germany
(Muller) Department of Cardiology, Helios Klinikum Siegburg, Siegburg,
Germany
(Seyfarth, Vorpahl) Witten Herdecke University, Witten, Germany;
Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal,
Germany
(Kiefer, Noack, Leontyev, Borger) University Department of Cardiac
Surgery, Heart Center Leipzig, Leipzig, Germany
(Funkat, Hohenstein) Leipzig Heart Institute, Leipzig, Germany
(Holzhey) Witten Herdecke University, Witten, Germany; University
Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany;
Department of Cardiac Surgery, Helios University Hospital Wuppertal,
Wuppertal, Germany
Publisher
NLM (Medline)
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
established treatment option for patients with severe symptomatic aortic
stenosis (AS), and is most commonly performed through the transfemoral
access route. Percutaneous access site closure can be achieved using
dedicated plug-based or suture-based vascular closure device (VCD)
strategies, but randomized comparative studies are scarce. <br/>Method(s):
The CHOICE-CLOSURE (Randomized Comparison of CatHeter-based Strategies fOr
Interventional ACcess SitE CLOSURE during Transfemoral Transcatheter
Aortic Valve Implantation) trial is an investigator-initiated, multicenter
study, in which patients undergoing transfemoral TAVR were randomly
assigned to vascular access site closure using either a pure plug-based
technique (MANTA, Teleflex, Wayne, Pennsylvania) with no additional VCDs
or a primary suture-based technique (ProGlide, Abbott Vascular, Abbott
Park, Illinois) potentially complemented by a small-plug. The primary
endpoint consisted of access-site or access-related major and minor
vascular complications during index hospitalization, defined according to
the Valve Academic Research Consortium-2 criteria. Secondary endpoints
included the rate of access-site or access-related bleeding, VCD failure,
and time to hemostasis Results: A total of 516 patients were included and
randomized. The mean age of the study population was 80.5+/-6.1 years,
55.4% were male, 7.6% of patients had peripheral vascular disease, and the
mean Society of Thoracic Surgeons score was 4.1+/-2.9%. The primary
endpoint occurred in 19.4% (50/258) of the pure plug-based group and 12.0%
(31/258) of the primary suture-based group (relative risk [RR]: 1.61, 95%
confidence interval [CI]: 1.07-2.44, p=0.029). Access-site or
access-related bleeding occurred in 11.6% vs. 7.4% (RR: 1.58, 95%CI:
0.91-2.73, p=0.133) and device failure in 4.7% vs. 5.4% (RR: 0.86, 95%CI:
0.40-1.82, p=0.841) in the respective groups. Time to hemostasis was
significantly shorter in the pure plug-based group (80 [32, 180] vs. 240
[174, 316] seconds, p<0.001). <br/>Conclusion(s): Among patients treated
with transfemoral TAVR, a pure plug-based vascular closure technique using
the MANTA VCD is associated with a higher rate of access-site or
access-related vascular complications but a shorter time to hemostasis
compared to a primary suture-based technique using the ProGlide VCD.

<57>
Accession Number
636691280
Title
N-Acetylcysteine's Renoprotective Effect in Cardiac Surgery: A Systematic
Review and Meta-Analysis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. (no
pagination), 2021. Date of Publication: 03 Nov 2021.
Author
Tan Y.K.; Luo H.; Kang G.S.; Teoh K.L.; Kofidis T.
Institution
(Tan) Department of Cardiac Surgery, Yong Loo Lin School of Medicine,
Singapore
(Luo, Kang, Teoh, Kofidis) Department of Cardiac Thoracic & Vascular
Surgery, National University Heart Centre, Singapore
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To examine N-acetylcysteine's (NAC's) renoprotective effect in
adult cardiac surgeryMethods: PubMed, Ovid Medline, and Embase were
searched for randomized controlled trials published between January 1990
and May 2021 that investigated the effect of NAC in preventing acute
kidney injury (AKI) in patients undergoing cardiac surgery. The inclusion
criterion was studies that assessed the effect of NAC in comparison to
placebo by measuring the incidence of AKI. <br/>RESULT(S): Overall
meta-analytic estimates of all 10 included trials showed that NAC did not
have a significant effect (odds ratio [OR]: 0.84, 95% confidence interval
[CI]: 0.64-1.10) on AKI. Further subgroup analysis did not show a
significant benefit of NAC in preventing AKI. <br/>CONCLUSION(S): This
meta-analysis suggests that NAC does not have a significant effect in
reducing the incidence of AKI. However, there is notable heterogeneity
among the included studies that could possibly account for the
non-significant effect observed. It is worth noting that only one trial
administered NAC high dosages perioperatively, and it is the only included
trial to show a significant benefit in reducing the incidence of AKI (OR:
0.30, 95% CI: 0.11-0.81). Further studies on this dosage and duration of
administration should be conducted to best elucidate the effect of
administering NAC.

<58>
Accession Number
636689666
Title
Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass
Surgery.
Source
The New England journal of medicine. (no pagination), 2021. Date of
Publication: 04 Nov 2021.
Author
Fearon W.F.; Zimmermann F.M.; De Bruyne B.; Piroth Z.; van Straten A.H.M.;
Szekely L.; Davidavicius G.; Kalinauskas G.; Mansour S.; Kharbanda R.;
Ostlund-Papadogeorgos N.; Aminian A.; Oldroyd K.G.; Al-Attar N.; Jagic N.;
Dambrink J.-H.E.; Kala P.; Angeras O.; MacCarthy P.; Wendler O.; Casselman
F.; Witt N.; Mavromatis K.; Miner S.E.S.; Sarma J.; Engstrom T.;
Christiansen E.H.; Tonino P.A.L.; Reardon M.J.; Lu D.; Ding V.Y.;
Kobayashi Y.; Hlatky M.A.; Mahaffey K.W.; Desai M.; Woo Y.J.; Yeung A.C.;
Pijls N.H.J.
Institution
(Fearon, Zimmermann, De Bruyne, Piroth, van Straten, Szekely,
Davidavicius, Kalinauskas, Mansour, Kharbanda, Ostlund-Papadogeorgos,
Aminian, Oldroyd, Al-Attar, Jagic, Dambrink, Kala, Angeras, MacCarthy,
Wendler, Casselman, Witt, Mavromatis, Miner, Sarma, Engstrom,
Christiansen, Tonino, Reardon, Lu, Ding, Kobayashi, Hlatky, Mahaffey,
Desai, Woo, Yeung, Pijls) From the Division of Cardiovascular Medicine and
Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the
Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of
Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford
University, and the Stanford Center for Clinical Research, Department of
Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and
the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in
California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T.,
N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the
Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre
Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in
Belgium; Lausanne University Center Hospital, Lausanne, Switzerland
(B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary
(Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of
Clinical Medicine, Vilnius University, and Vilnius University Hospital
Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de
l'Universite de Montreal, Montreal (S.M.)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with three-vessel coronary artery disease have been
found to have better outcomes with coronary-artery bypass grafting (CABG)
than with percutaneous coronary intervention (PCI), but studies in which
PCI is guided by measurement of fractional flow reserve (FFR) have been
lacking. <br/>METHOD(S): In this multicenter, international,
noninferiority trial, patients with three-vessel coronary artery disease
were randomly assigned to undergo CABG or FFR-guided PCI with
current-generation zotarolimus-eluting stents. The primary end point was
the occurrence within 1 year of a major adverse cardiac or cerebrovascular
event, defined as death from any cause, myocardial infarction, stroke, or
repeat revascularization. Noninferiority of FFR-guided PCI to CABG was
prespecified as an upper boundary of less than 1.65 for the 95% confidence
interval of the hazard ratio. Secondary end points included a composite of
death, myocardial infarction, or stroke; safety was also assessed.
<br/>RESULT(S): A total of 1500 patients underwent randomization at 48
centers. Patients assigned to undergo PCI received a mean (+/-SD) of
3.7+/-1.9 stents, and those assigned to undergo CABG received 3.4+/-1.0
distal anastomoses. The 1-year incidence of the composite primary end
point was 10.6% among patients randomly assigned to undergo FFR-guided PCI
and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95%
confidence interval [CI], 1.1 to 2.2), findings that were not consistent
with noninferiority of FFR-guided PCI (P=0.35 for noninferiority). The
incidence of death, myocardial infarction, or stroke was 7.3% in the
FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95%
CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute
kidney injury were higher in the CABG group than in the FFR-guided PCI
group. <br/>CONCLUSION(S): In patients with three-vessel coronary artery
disease, FFR-guided PCI was not found to be noninferior to CABG with
respect to the incidence of a composite of death, myocardial infarction,
stroke, or repeat revascularization at 1 year. (Funded by Medtronic and
Abbott Vascular; FAME 3 ClinicalTrials.gov number,
NCT02100722.).<br/>Copyright &#xa9; 2021 Massachusetts Medical Society.

<59>
Accession Number
636682518
Title
Pyoderma Gangrenosum after Cardiac Surgery.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2021. Date of
Publication: 2021.
Author
Petrov A.; Kappert U.; Schmidt T.; Matschke K.E.; Wilbring M.
Institution
(Petrov, Kappert, Matschke, Wilbring) Department of Cardiac Surgery,
University Heart Center Dresden, Fetscherstrasse 76, Dresden 01307,
Germany
(Schmidt) Department of Cardiac Anesthesiology, University Heart Center
Dresden, Dresden, Germany
Publisher
Georg Thieme Verlag
Abstract
Background Pyoderma gangrenosum after cardiac surgery is a rare,
noninfectious ulcerating skin disease mimicking sternal wound infection.
Methods A systematic search of literature for pyoderma gangrenosum
complicating cases of cardiac surgery was conducted between September 1985
and September 2020 on PubMed and Cochrane databases. A systematic review
and detailed overview of clinical presentation, diagnostic, treatment, and
outcome is provided. Results A total of 15 studies enclosing 15 patients
suffering from pyoderma gangrenosum following cardiac surgery were
identified. Onset of symptoms was observed after a median of 5 days.
Patients were predominantly male (81.3%) with a median age of 64 years.
Typical clinical presentation mimicked sternal site infection, mainly by
means of mediastinitis. Specific signs were rapid progression,
erythematous to violaceous color of the wound border, accompanied by
unspecific symptoms including fever, malaise, and severe pain.
Additionally, pathergy (development of ulcers at the sites of minor
cutaneous trauma) was reported frequently. Biopsy is mandatory with a
cutaneous neutrophilic inflammation confirming the diagnosis. Initial
treatment mostly (75.0% of reported cases) was misled, addressing
suspicion of surgical site infection. After correct diagnosis, the
treatment was switched to an immunosuppressive therapy. Full sternal wound
closure took between 5 weeks and 5 months. Reported case mortality was
12.5% in actually low-risk surgeries. Conclusion Despite pyoderma
gangrenosum has typical signs, it remains an exclusion diagnosis. The
treatment is completely opposite to the main differential diagnosis-the
typical surgical site infection. Knowledge about diagnosis and treatment
is essential in the context of avoiding fatal mistreatment.<br/>Copyright
&#xa9; 2021 American Medical Association. All rights reserved.

<60>
Accession Number
636681291
Title
Outcomes of a Delirium Prevention Program in Older Persons after Elective
Surgery: A Stepped-Wedge Cluster Randomized Clinical Trial.
Source
JAMA Surgery. (no pagination), 2021. Date of Publication: 2021.
Author
Deeken F.; Sanchez A.; Rapp M.A.; Denkinger M.; Brefka S.; Spank J.; Bruns
C.; Von Arnim C.A.F.; Kuster O.C.; Conzelmann L.O.; Metz B.R.; Maurer C.;
Skrobik Y.; Forkavets O.; Eschweiler G.W.; Thomas C.
Institution
(Deeken, Sanchez, Rapp) Department of Social and Preventive Medicine,
University of Potsdam, Potsdam, Germany
(Rapp) Social and Preventive Medicine, Department of Sports and Health
Sciences, Intrafaculty Unit of Cognitive Sciences, Faculty of Human
Science, Faculty of Health Sciences Brandenburg, Research Area Services
Research and E-Health, University of Potsdam, Potsdam, Germany
(Denkinger, Brefka) Agaplesion Bethesda Clinic Ulm, Institute for
Geriatric Research, Ulm University, Geriatric Center Ulm, Ulm, Germany
(Brefka) Department of Cardiothoracic and Vascular Surgery, Ulm University
Hospital, Ulm, Germany
(Spank, Bruns, Thomas) Department of Geriatric Psychiatry and
Psychotherapy, Klinikum Stuttgart, Krankenhaus Bad Cannstatt,
Priessnitzweg 24, Stuttgart 70374, Germany
(Von Arnim) Division of Geriatrics, University Medical Center Goettingen,
Gottingen, Germany
(Von Arnim, Kuster, Forkavets) Department of Neurology, University
Hospital Ulm, Ulm, Germany
(Conzelmann) Helios Clinic for Cardiac Surgery Karlsruhe, Karlsruhe,
Germany
(Metz) Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe,
Karlsruhe, Germany
(Maurer) Center for Geriatrics and Gerontology, Medical Center University
of Freiburg, Freiburg, Germany
(Skrobik) Department of Medicine, McGill University, Montreal, QC, Canada
(Forkavets, Eschweiler) Geriatric Center, University Hospital Tubingen,
Tubingen, Germany
(Eschweiler, Thomas) Department of Psychiatry and Psychotherapy,
University Hospital of Tubingen, Tubingen, Germany
Publisher
American Medical Association
Abstract
Importance: Delirium significantly worsens elective surgery outcomes and
costs. Delirium risk is highest in elderly populations, whose surgical
health care resource consumption (50%) exceeds their demographic
proportion (15% to 18%) in high-resource countries. Effective
nonpharmacologic delirium prevention could safely improve care in these
vulnerable patients, but data from procedure-specific studies are
insufficiently compelling to drive changes in practice. Delirium
prevention approaches applicable to different surgical settings remain
unexplored. <br/>Objective(s): To examine whether a multifaceted
prevention intervention is effective in reducing postoperative delirium
incidence and prevalence after various major surgical procedures.
<br/>Design, Setting, and Participant(s): This stepped-wedge cluster
randomized trial recruited 1470 patients 70 years and older undergoing
elective orthopedic, general, or cardiac surgery from November 2017 to
April 2019 from 5 German tertiary medical centers. Data were analyzed from
December 2019 to July 2021. <br/>Intervention(s): First, structured
delirium education was provided to clinical caregivers at each site. Then,
the study delirium prevention team assessed patient delirium risk factors
and symptoms daily. Prevention was tailored to individual patient needs
and could include: cognitive, motor, and sensory stimulation; meal
companionship; accompaniment during diagnostic procedures; stress
relaxation; and sleep promotion. <br/>Main Outcomes and Measures:
Postoperative delirium incidence and duration. <br/>Result(s): Of 1470
included patients, 763 (51.9%) were male, and the median (IQR) age was 77
(74-81) years. Overall, the intervention reduced postoperative delirium
incidence (odds ratio, 0.87; 95% CI, 0.77-0.98; P =.02) and percentage of
days with delirium (intervention, 5.3%; control, 6.9%; P =.03). The effect
was significant in patients undergoing orthopedic or abdominal surgery
(odds ratio, 0.59; 95% CI, 0.35-0.99; P =.047) but not cardiac surgery
(odds ratio, 1.18; 95% CI, 0.70-1.99; P =.54). <br/>Conclusions and
Relevance: This multifaceted multidisciplinary prevention intervention
reduced postoperative delirium occurrence and days with delirium in older
patients undergoing different elective surgical procedures but not cardiac
procedures. These results suggest implementing this delirium prevention
program will improve care and outcomes in older patients undergoing
elective general and orthopedic procedures.<br/>Copyright &#xa9; 2021
American Medical Association. All rights reserved.

<61>
Accession Number
636681128
Title
Scientific Publishing Differences between Sexes in Cardiology, Cardiac,
and General Surgery.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2021. Date of
Publication: 2021.
Author
Farber G.; Alscher L.; Heyne E.; Doenst T.; Schwarzer M.
Institution
(Farber, Alscher, Heyne, Doenst, Schwarzer) Department of Cardiothoracic
Surgery, Jena University Hospital, Thuringen, Jena 07747, Germany
Publisher
Georg Thieme Verlag
Abstract
Background Research and scientific publications are important for the
advancement of science but also for the individual career development.
While women have become the majority of students in medicine we do not
know about female presence and scientific activity in cardiac surgery. We
thus aimed to compare scientific output of women and men in German
University departments of cardiac surgery with cardiology departments
focusing on the same organ and surgical departments not addressing the
heart (general surgery) of 34 universities in Germany. Methods Personnel
working at University departments was identified on the institutions
internet homepage in 2014. Publications in 2011 to 2013 on PubMed were
identified. Author and manuscript characteristics were determined. Results
A lower proportion of women were working in cardiac surgery (25%) compared
with cardiology (35%) and general (32%) surgery independent of executive
function or academic degree. Scientifically active women published fewer
manuscripts per capita than men both, in total and as first author.
Additionally, the mean and the cumulated journal impact factor of the
journals chosen was lower for women compared with men in cardiology but
not in cardiac and general surgery. Conclusion We conclude that the
differences in scientific activity between women and men are more
pronounced in cardiology compared with general and cardiac surgery,
indicating that a higher proportion of women in a field does not result in
reduced differences between sexes. The low number of women together with
the lower number of manuscripts in cardiac surgery may render the
appointment of women as directors challenging.<br/>Copyright &#xa9; 2021
American Medical Association. All rights reserved.

<62>
Accession Number
2015474460
Title
A clinical trial comparing complete revascularization at the time of
primary percutaneous coronary intervention versus during the index
hospital admission in patients with multi-vessel coronary artery disease
and ST-elevation myocardial infarction uncomplicated by cardiogenic shock.
Source
Anatolian Journal of Cardiology. 25(11) (pp 781-788), 2021. Date of
Publication: November 2021.
Author
Nichita-Brendea M.T.; Popescu M.I.; Popa V.; Carmen P.C.D.
Institution
(Nichita-Brendea, Popescu, Popa, Carmen) Department of Cardiology,
Emergency Clinical County Hospital, Oradea, Romania
(Popescu, Carmen) Department of Medical Disciplines, Faculty of Medicine
and Pharmacology, University of Oradea, Oradea, Romania
Publisher
Turkish Society of Cardiology
Abstract
Objective: In this study, we aimed to compare major adverse cardiac and
cerebrovascular events (MACCE), defined as a composite of death, stroke,
myocardial infarction and symptom-induced revascularization, and mortality
within one year of randomization between two strategies; complete
revascularization including non-culprit lesions percutaneous coronary
intervention (PCI) during primary PCI (PPCI) versus complete
revascularization during the same hospital admission in patients with
multi-vascular coronary artery disease (MVD) presenting with ST-elevation
myocardial infarction (STEMI) uncomplicated by cardiogenic shock.
<br/>Method(s): We randomized in a 1:1 manner 100 patients with MVD and
STEMI uncomplicated by cardiogenic shock who had undergone successful
culprit-lesion PCI to either a strategy of complete revascularization with
PCI of angiographically significant non-culprit lesions in the index PPCI
procedure or to a strategy of complete revascularization during a second
procedure that took place during the same hospital admission.
<br/>Result(s): The first primary outcome was death within a timeframe of
one year and the second a composite of MACCE within a year following
complete revascularization. Of the total number of patients monitored, 4%
in each of the two groups was associated with the first primary outcome
(p=0.984) and the second primary outcome in 6% (p=0.970). There was no
statistical difference between outcomes in the two groups.
<br/>Conclusion(s): Among patients with MVD and STEMI uncomplicated by
cardiogenic shock, there was no difference regarding outcomes when using a
strategy of complete revascularization of non-culprit lesions during PPCI
or the same hospital admission.<br/>&#xa9;Copyright 2021 by Turkish
Society of Cardiology

<63>
Accession Number
2014459740
Title
Application effect of dexmedetomidine combined with flurbiprofen axetil
and flurbiprofen axetil monotherapy in radical operation of lung cancer
and evaluation of the immune function.
Source
Journal of B.U.ON.. 26(4) (pp 1432-1439), 2021. Date of Publication: July
2021.
Author
Zong S.; Du J.; Chen Y.; Tao H.
Institution
(Zong, Du, Chen, Tao) Department of Anesthesiology, Tengzhou Central
People's Hospital, Tengzhou, China
Publisher
Zerbinis Publications
Abstract
Purpose: To explore the effect of dexmedetomidine combined with
flurbiprofen axetil on postoperative analgesia and immune function in
patients with lung cancer after radical operation. <br/>Method(s): 60 lung
cancer patients undergoing open chest radical surgery were selected and
randomly divided into D & F Group (dexmedetomidine combined with
flurbiprofen axetil) and F Group (flurbiprofen axetil), with 30 cases in
each group. Before induction of general anesthesia, Group F was
administered intravenous flurbiprofen axetil, and in D & F group,
dexmedetomidine and erfuorbiprofen axetil were injected. <br/>Result(s):
At T2 (intubation) and T3 (extubation), map and HR in D & F group were
significantly lower than those in F group (p<0.05). The extubation quality
score of D & F group was significantly lower than that of F group
(p<0.05). At 6 h and 12 h after operation, visual analogue scale (VAS)
score and Bruggrmann comfort scale (BCS) score of D & F group were
significantly lower than that of F group (p<0.05). The dosage of
sufentanil and the times of pressing analgesia pump in group D & F were
significantly less than those in group F (p<0.05). NK cells, CD3 + T cells
and CD4 + / CD8 + in the D & F group were significantly higher than those
in F group at 12h, 24h, 48 h and 1 week after operation (p<0.05).
<br/>Conclusion(s): Flurbiprofen axetil can improve postoperative pain,
but combined with dexmedetomidine better effect, postoperative comfort and
immune function of patients were significantly improved.<br/>Copyright
&#xa9; 2021 Zerbinis Publications. All rights reserved.

<64>
Accession Number
2014395482
Title
Site vs. core laboratory variability in computed tomographic
angiography-derived SYNTAX scores in the SYNTAX III trial.
Source
European Heart Journal Cardiovascular Imaging. 22(9) (pp 1063-1071), 2021.
Date of Publication: 01 Sep 2021.
Author
Katagiri Y.; Andreini D.; Miyazaki Y.; Takahashi K.; Komiyama H.; Mushtaq
S.; Sonck J.; Schoors D.; Maisano F.; Kaufman P.A.; Leal I.; Lindeboom W.;
Piek J.J.; Wykrzykowska J.J.; Morel M.-A.; Bartorelli A.L.; Onuma Y.;
Serruys P.W.
Institution
(Katagiri, Takahashi, Komiyama, Piek, Wykrzykowska) Department of Clinical
and Experimental Cardiology, Amsterdam UMC, Meibergdreef 9, Amsterdam 1105
AZ, Netherlands
(Andreini, Mushtaq, Bartorelli) Centro Cardiologico Monzino, University of
Milano, Via Carlo Parea, 4, Milano 20138, Italy
(Andreini) Department of Clinical Sciences and Community Health,
Cardiovascular Section, University of Milan, Via della Commenda 19, Milano
20122, Italy
(Miyazaki) Department of Cardiology, Thoraxcenter, Erasmus Medical Center,
Doctor Molewaterplein 40, Rotterdam 3015 GD, Netherlands
(Sonck) Department of Cardiology, Cardiovascular Center Aalst, OLV
Hospital, Moorselbaan 164, Aalst 9300, Belgium
(Sonck) Department of Advanced Biomedical Sciences, Federico II University
of Naples, Corso Umberto I 40, Napoli 80138, Italy
(Schoors) Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije
Universiteit Brussel, Laarbeeklaan 101, Brussel, Jette 1090, Belgium
(Maisano) Department of Cardiovascular Surgery, University Hospital
Zurich, Ramistrasse 100, Zurich 8091, Switzerland
(Kaufman) Department of Nuclear Medicine, University Hospital Zurich,
Ramistrasse 100, Zurich 8091, Switzerland
(Leal, Lindeboom, Morel) Cardialysis BV, Westblaak 98, Rotterdam 3012 KM,
Netherlands
(Bartorelli) Department of Biomedical and Clinical Sciences "luigi Sacco",
University of Milan, Via Festa del Perdono, 7, MI, Milano 20122, Italy
(Onuma, Serruys) Department of Cardiology, National University of Ireland,
Galway (NUIG), University Road, Galway H91 TK33, Ireland
(Serruys) Department of Cardiology, Royal Brompton and Harefield
Hospitals, Imperial College of London, Kensington, London SW7 2AZ, United
Kingdom
Publisher
Oxford University Press
Abstract
Aims: To investigate the variability between site and core laboratory (CL)
calculation of the anatomical SYNTAX score (SS) based on coronary computed
tomography angiography (CTA) alone and functional SS based on coronary CTA
and fractional flow reserve derived from computed tomography (FFRCT) in
the SYNTAX III trial. <br/>Methods and Results: The SYNTAX III trial was a
multicentre, international study that included 223 patients with
three-vessel disease with or without left main involvement. Functional SS
was computed by subtracting non-flow limiting stenoses (FFRCT > 0.80) from
anatomical SS. SS was combined with clinical information to generate the
SYNTAX score II (SS II) that provides treatment recommendations. The mean
anatomical SS based on coronary CTA alone was 33.4 +/- 12.7 by sites and
37.1 +/- 13.4 by CL (P < 0.001). The mean functional SS based on coronary
CTA and FFRCT was 30.5 +/- 13.0 by sites and 33.3 +/- 13.6 by CL (P <
0.001). The intraclass correlation coefficient was 0.49 [95% confidence
interval (CI) 0.37-0.59) in anatomical SS and 0.62 (95% CI 0.52-0.70) in
functional SS. The Cohen's kappa comparing treatment recommendation
between sites and CL was 0.68 (95% CI 0.58-0.78) based on anatomical SS
and 0.71 (95% CI 0.60-0.82) based on functional SS. <br/>Conclusion(s):
The mean anatomical SS derived from coronary CTA alone and functional SS
based on coronary CTA and FFRCT were higher when assessed by the CL than
by the sites themselves. However, substantial agreement in treatment
recommendation by SS II between sites and CL was demonstrated. Clinical
Trials.gov Identifier: NCT02385279.<br/>Copyright &#xa9; 2020 Published on
behalf of the European Society of Cardiology. All rights reserved.

<65>
Accession Number
636679785
Title
Limb Remote Ischemic Preconditioning Applied During Sevoflurane Anesthesia
Does Not Protect the Lungs in Patients Undergoing Adult Heart Valve
Surgery.
Source
The heart surgery forum. 24(5) (pp E916-E924), 2021. Date of Publication:
21 Oct 2021.
Author
Li T.; Zeng Q.-S.; She S.-Z.
Institution
(Li) Department of Anesthesiology, First Affiliated Hospital of Nanchang
University, Nanchang, Jiangxi, China
(Zeng) Department of Anesthesiology, Guangdong General Hospital,
Guangzhou, Guangdong, China
(She) Department of Anesthesiology, Guangzhou First People's Hospital,
Guangzhou, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Two consistent overall cell protective preconditioning
treatments should provide more protection. We hypothesized that limb
remote ischemic preconditioning (RIPC, second preconditioning stimulus)
applied during sevoflurane inhalation (first preconditioning stimulus)
would provide more protection to the lungs of patients undergoing adult
heart valve surgery. <br/>METHOD(S): In this randomized,
placebo-controlled, double-blind trial, 50 patients were assigned to the
RIPC group or the placebo group (1:1). Patients in the RIPC group received
three 5-min cycles of 300 mmHg cuff inflation/deflation of the left-side
lower limb before aortic cross-clamping. Anesthesia consisted of opioids
and propofol for induction and sevoflurane for maintenance. The primary
end point was comparison of the postoperative arterial-alveolar oxygen
tension ratio (a/A ratio) between groups. Secondary end points included
comparisons of pulmonary variables, postoperative morbidity and mortality
and regional and systemic inflammatory cytokines between groups.
<br/>RESULT(S): In the RIPC group, the a/A ratio and other pulmonary
variables exhibited no significant differences throughout the study period
compared with the placebo group. No significant differences in either
plasma or bronchoalveolar lavage levels of TNF- alpha were noted between
the groups at 10 min after anesthetic induction and 1 h after cross-clamp
release. The percentage of neutrophils at 12 h postoperation was
significantly increased in the RIPC group compared with the placebo group
(91.34+/-0.00 vs. 89.42+/-0.10, P = 0.023). <br/>CONCLUSION(S): Limb RIPC
applied during sevoflurane anesthesia did not provide additional
significant pulmonary protection following adult valvular cardiac surgery.

<66>
Accession Number
636670089
Title
Cost-effectiveness analysis of cardiac versus non-cardiac surgery on
cardiovascular-disease population.
Source
Clinical Trials. Conference: 42nd Annual Meeting Society for Clinical
Trials, SCT 2021. Virtual. 18(SUPPL 5) (pp 91-92), 2021. Date of
Publication: 2021.
Author
Yuan F.; Lamy A.; Tong W.; Bangdiwala S.I.
Institution
(Yuan, Lamy, Tong, Bangdiwala) McMaster University
Publisher
SAGE Publications Ltd
Abstract
Background: Cardiovascular diseases are becoming a bigger and bigger
burden for an aging population. As the diseases progress, this population
requires various surgical services. These services are increasingly
expensive in a healthcare system. Therefore, to help with optimally
allocating resources and government policymaking, it is desired to analyze
the cost-effectiveness of various surgical services. This is especially
meaningful to ''advance rigorous and ethical trials in this field in the
Pandemic Era.'' Objectives: To understand the long-term economic
implication of various surgical services on cardiovasculardisease
population through a life-time cost-effectiveness analysis.
<br/>Method(s): This case-control study investigated cardiac and
non-cardiac surgeries based on participants from three international
surgical trials. These trials originally studied various interventions on
patients who had cardiovascular diseases and required various surgeries.
There were 12,252 participants undertook cardiac surgery from the Coronary
Artery Bypass Surgery Off or On Pump Revascularization Study and Steroids
In caRdiac Surgery Trial trials. There were 10,010 noncardiac surgery
participants from the Perioperative Ischemic Evaluation 2 trial. The
evaluation was based on incremental cost-effectiveness ratio. These costs
were included cardiac surgeries, non-cardiac surgeries and three health
states (myocardial infarct, stroke, and new renal failure). Canadian
public payer's perspective was adopted and translated into US dollars. A
time horizon of life-time was applied. A cohort-level aggregated Markov
model was used with a cycle length of 30 days in the analysis. There were
five health states included event-free, myocardial infarct, stroke, new
renal failure, and death. Death was an absorbing state. For other states,
participants could stay in their current state or transmit to any other
states. <br/>Result(s): The mean ages were 67.6 years old for participants
undertaken cardiac surgery and 68.5 years old for those undertaken
non-cardiac surgery. The Markov model started from randomization and ran
exhaustively till every participant was projected to die in the model. The
mean cost per non-cardiac surgery patient was estimated to be US$9206 and
mean survival was 2.18 quality-adjusted life year gained. The mean cost
per cardiac surgery participants was estimated as US$22,245 and such
patients survived 3.09 quality-adjusted-life year on average. Compared
with a non-cardiac surgery patient, a cardiac surgery one spent US$13,038
more and survived 0.91 quality-adjusted-life year longer on average. An
incremental cost-effectiveness ratio was estimated as US$14,274 per
quality-adjusted-life year gained. Being lower than US$50,000 per
qualityadjusted- life year gained, this qualified the cardiac surgeries as
treatments with ''better outcomes at lower cost'' according to the
American College of Cardiology/ American Heart Association guideline.
<br/>Conclusion(s): For participants who have a medical history of
cardiovascular diseases and a Canadian perspective, cardiac surgeries have
high value to improve patients' cardiovascular health. This analysis
needed to adjust for potential confounding factors.

<67>
Accession Number
2016016295
Title
Society for Vascular Surgery clinical practice guidelines for management
of extracranial cerebrovascular disease.
Source
Journal of Vascular Surgery. 75(1 Supplement) (pp 4S-22S), 2022. Date of
Publication: January 2022.
Author
AbuRahma A.F.; Avgerinos E.D.; Chang R.W.; Darling R.C.; Duncan A.A.;
Forbes T.L.; Malas M.B.; Murad M.H.; Perler B.A.; Powell R.J.; Rockman
C.B.; Zhou W.
Institution
(AbuRahma) Department of Surgery, West Virginia University-Charleston
Division, Charleston, WVa
(Avgerinos) Division of Vascular Surgery, Univeristy of Pittsburgh School
of Medicine, UPMC Heart & Vascular Institute, Pittsburgh, Pa, United
States
(Chang) Vascular Surgery, Permanente Medical Group, San Francisco, Calif,
United States
(Darling) Division of Vascular Surgery, Albany Med Vascular, Albany, NY,
United States
(Duncan) Division of Vascular & Endovascular Surgery, University of
Western Ontario, London, ON, Canada
(Forbes) Vascular Surgery, University of Toronto, Toronto, ON, Canada
(Malas) Vascular & Endovascular Surgery, University of California San
Diego, La Jolla, Calif, United States
(Murad) Mayo Clinic Evidence-based Practice Center, Rochester, Minn,
United States
(Perler) Division of Vascular Surgery & Endovascular Therapy, Johns
Hopkins, Baltimore, Md, United States
(Powell) Vascular Surgery, Dartmouth-Hitchcock, Lebanon, NH, United States
(Rockman) Division of Vascular Surgery, New York University Langone, New
York, NY, United States
(Zhou) Division of Vascular Surgery, University of Arizona, Tucson, Ariz,
United States
Publisher
Elsevier Inc.
Abstract
Management of carotid bifurcation stenosis in stroke prevention has been
the subject of extensive investigations, including multiple randomized
controlled trials. The proper treatment of patients with carotid
bifurcation disease is of major interest to vascular surgeons and other
vascular specialists. In 2011, the Society for Vascular Surgery published
guidelines for the treatment of carotid artery disease. At the time,
several randomized trials, comparing carotid endarterectomy (CEA) and
carotid artery stenting (CAS), were reported. Since the 2011 guidelines,
several studies and a few systematic reviews comparing CEA and CAS have
been reported, and the role of medical management has been reemphasized.
In the present publication, we have updated and expanded on the 2011
guidelines with specific emphasis on five areas: (1) is CEA recommended
over maximal medical therapy for low-risk patients; (2) is CEA recommended
over transfemoral CAS for low surgical risk patients with symptomatic
carotid artery stenosis of >50%; (3) the timing of carotid intervention
for patients presenting with acute stroke; (4) screening for carotid
artery stenosis in asymptomatic patients; and (5) the optimal sequence of
intervention for patients with combined carotid and coronary artery
disease. A separate implementation document will address other important
clinical issues in extracranial cerebrovascular disease. Recommendations
are made using the GRADE (grades of recommendation assessment,
development, and evaluation) approach, as was used for other Society for
Vascular Surgery guidelines. The committee recommends CEA as the
first-line treatment for symptomatic low-risk surgical patients with
stenosis of 50% to 99% and asymptomatic patients with stenosis of 70% to
99%. The perioperative risk of stroke and death in asymptomatic patients
must be <3% to ensure benefit for the patient. In patients with recent
stable stroke (modified Rankin scale score, 0-2), carotid
revascularization is considered appropriate for symptomatic patients with
>50% stenosis and should be performed as soon as the patient is
neurologically stable after 48 hours but definitely <14 days after symptom
onset. In the general population, screening for clinically asymptomatic
carotid artery stenosis in patients without cerebrovascular symptoms or
significant risk factors for carotid artery disease is not recommended. In
selected asymptomatic patients with an increased risk of carotid stenosis,
we suggest screening for clinically asymptomatic carotid artery stenosis
as long as the patients would potentially be fit for and willing to
consider carotid intervention if significant stenosis is discovered. For
patients with symptomatic carotid stenosis of 50% to 99%, who require both
CEA and coronary artery bypass grafting, we suggest CEA before, or
concomitant with, coronary artery bypass grafting to potentially reduce
the risk of stroke and stroke/death. The sequencing of the intervention
depends on the clinical presentation and institutional
experience.<br/>Copyright &#xa9; 2021 Society for Vascular Surgery

<68>
Accession Number
636657374
Title
Nomogram Models to Predict Postoperative Hyperlactatemia in Patients
Undergoing Elective Cardiac Surgery.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 763931.
Date of Publication: 02 Dec 2021.
Author
Wang D.; Wang S.; Wu J.; Le S.; Xie F.; Li X.; Wang H.; Huang X.; Du X.;
Zhang A.
Institution
(Wang, Le, Wang, Huang, Du) Department of Cardiovascular Surgery, Union
Hospital, Tongji Medical College, Huazhong University of Science and
Technology, Wuhan, China
(Wang) Department of Emergency Medicine, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
(Wu) Key Laboratory for Molecular Diagnosis of Hubei Province, The Central
Hospital of Wuhan, Tongji Medical College, Huazhong University of Science
and Technology, Wuhan, China
(Xie) Department of Cardiovascular Surgery, First Affiliated Hospital of
Zhengzhou University, Zhengzhou, China
(Li) Department of Nursing, Huaihe Hospital of Henan University, Kaifeng,
China
(Zhang) Department of Cardiology, The Central Hospital of Wuhan, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan,
China
Publisher
Frontiers Media S.A.
Abstract
Objectives: Postoperative hyperlactatemia (POHL) is common in patients
undergoing cardiac surgery and is associated with poor outcomes. The
purpose of this study was to develop and validate two predictive models
for POHL in patients undergoing elective cardiac surgery (ECS).
<br/>Method(s): We conducted a multicenter retrospective study enrolling
13,454 adult patients who underwent ECS. All patients involved in the
analysis were randomly assigned to a training set and a validation set.
Univariate and multivariate analyses were performed to identify risk
factors for POHL in the training cohort. Based on these independent
predictors, the nomograms were constructed to predict the probability of
POHL and were validated in the validation cohort. <br/>Result(s): A total
of 1,430 patients (10.6%) developed POHL after ECS. Age, preoperative left
ventricular ejection fraction, renal insufficiency, cardiac surgery
history, intraoperative red blood cell transfusion, and cardiopulmonary
bypass time were independent predictors and were used to construct a full
nomogram. The second nomogram was constructed comprising only the
preoperative factors. Both models showed good predictive ability,
calibration, and clinical utility. According to the predicted
probabilities, four risk groups were defined as very low risk (<0.05), low
risk (0.05-0.1), medium risk (0.1-0.3), and high risk groups (>0.3),
corresponding to scores of <= 180 points, 181-202 points, 203-239 points,
and >239 points on the full nomogram, respectively. <br/>Conclusion(s): We
developed and validated two nomogram models to predict POHL in patients
undergoing ECS. The nomograms may have clinical utility in risk
estimation, risk stratification, and targeted interventions.<br/>Copyright
&#xa9; 2021 Wang, Wang, Wu, Le, Xie, Li, Wang, Huang, Du and Zhang.

<69>
Accession Number
2014495140
Title
Feasibility and effectiveness of prone position ventilation technique for
postoperative acute lung injury in infants with congenital heart disease:
study protocol for a prospective randomized study.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 929. Date of
Publication: December 2021.
Author
Xu Y.-L.; Mi Y.-P.; Zhu M.-X.; Ren Y.-H.; Gong W.-J.; Fu W.-J.; Wang
H.-M.; Ye L.; Wang Y.; Zhou X.-Y.; Chen Y.; Chen Y.-Y.; Gu L.-Q.; Gu Y.;
Jia B.; Hu J.; Hu X.-J.
Institution
(Xu, Mi, Zhu, Ren, Gong, Fu, Wang, Ye, Wang, Zhou, Chen, Chen, Gu, Gu,
Jia, Hu, Hu) Children's Hospital of Fudan University, 399 Wanyuan Road,
Minhang District, Shanghai, China
Publisher
BioMed Central Ltd
Abstract
Background: Prone position ventilation is a widely used lung protection
ventilation strategy. The strategy is more convenient to implement in
children compared to adults. Due to the precise mechanism of improving
oxygenation function, development of pediatric prone ventilation
technology has been largely focused on children with acute respiratory
distress syndrome. There is a paucity of high-quality studies
investigating the effects of prone position ventilation after pediatric
cardiac surgery. The purpose of this study is to evaluate the feasibility
and effectiveness of prone position ventilation in infants who develop
postoperative acute lung injury after surgery for congenital heart
disease. <br/>Method(s): A single-center, randomized controlled trial of
pediatric patients with acute lung injury after surgery for congenital
heart disease who will receive prone position ventilation or usual care
(control group). A total of 68 children will be enrolled according to the
inclusion criteria. The main outcome measures will be lung compliance and
oxygenation index. The secondary outcomes will be duration of mechanical
ventilation, length of stay in cardiac intensive care unit, reintubation
rate, and complication rate. <br/>Discussion(s): This study will
investigate the feasibility and effectiveness of prone position
ventilation techniques in children who develop postoperative acute lung
injury after surgery for congenital heart disease. The results may help
inform strategies to improve airway management after surgery for
congenital heart disease. Trial registration: ClinicalTrials.gov
NCT04607993. Initially registered on 29 October 2020.<br/>Copyright &#xa9;
2021, The Author(s).

<70>
Accession Number
2014493517
Title
Long-term hospital-based secondary prevention of coronary artery disease:
a randomized controlled trial.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
600. Date of Publication: December 2021.
Author
Kaldal A.; Tonstad S.; Jortveit J.
Institution
(Kaldal) Department of Research, Sorlandet Hospital HF, Lundsiden, Box
416, Kristiansand S 4604, Norway
(Tonstad) Department of Endocrinology, Obesity and Preventive Medicine,
Section of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
(Jortveit) Department of Cardiology, Sorlandet Hospital Arendal, Arendal,
Norway
Publisher
BioMed Central Ltd
Abstract
Background and aims: Despite established guidelines on secondary
prevention of cardiovascular disease, practical implementation of
treatment targets is deficient even in high-income countries. This study
compared long-term hospital-based treatment with follow-up at primary
health care regarding new cardiovascular events and achievement of
treatment targets. <br/>Method(s): This randomized controlled trial at
Sorlandet Hospital, Norway 2007-2021 included patients hospitalized due to
myocardial infarction (n = 760) or after scheduled percutaneous coronary
intervention (PCI) (n = 677) or coronary artery bypass grafting (n = 103).
Patients were randomized to hospital-based secondary preventive care with
consultations 2 weeks, 3 months, 6 months and 1 year after the index event
and annually for up to 5 years, or follow-up at primary health care. Final
data was collected after 10 years and hazard ratios were calculated using
Cox regression analyses. <br/>Result(s): Composite endpoint-free survival
due to a lower rate of PCI improved in patients with hospital-based
follow-up (n = 788) compared to patients followed-up at primary health
care (n = 752) (HR 0.80, 95% CI 0.66-0.96; p = 0.02) but all-cause
mortality was not reduced (HR 0.96, 95% CI 0.59-1.56; p = 0.86). At 1
year, LDL-cholesterol (2.1 [SD 0.7] versus 2.3 [SD 0.8] mmol/l; p < 0.001)
and systolic blood pressure (132 [SD 16] versus 142 [SD 20] mm/Hg; p <
0.001) were lower in the hospital-based group, and the differences
remained significant during the first 5 years. Other secondary preventive
measures (smoking cessation, physical activity, body weight, glucose
control, drug adherence) did not differ. <br/>Conclusion(s): Long-term
hospital-based secondary preventive follow-up improved composite
endpoint-free survival, but not mortality. Substantial risk factors
remained unaddressed. The beneficial effects on blood pressure and
LDL-cholesterol disappeared after annual consultations ceased. Trial
registration: The study is registered in ClinicalTrials.gov (NCT00679237)
May 16, 2008.<br/>Copyright &#xa9; 2021, The Author(s).

<71>
Accession Number
2014496019
Title
The effect of pulsatile versus non-pulsatile flow during cardiopulmonary
bypass on cerebral oxygenation: A randomized trial.
Source
Asian Cardiovascular and Thoracic Annals. (no pagination), 2021. Date of
Publication: 2021.
Author
Moosaeifar S.; Mousavizadeh M.; Najafi Ghezeljeh T.; Hosseinian A.; Babaee
T.; Hosseini S.; Mestres C.A.
Institution
(Moosaeifar) Department of Critical Care Nursing and Midwifery, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Mousavizadeh, Hosseinian, Babaee, Hosseini) Heart Valve disease Research
Center, Rajaie Cardiovascular, Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Najafi Ghezeljeh) Center for Nursing Care Research, Department of
Critical Care Nursing and Midwifery, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Mestres) Department of Cardiac Surgery, University Hospital Zurich,
Zurich, Switzerland
Publisher
SAGE Publications Inc.
Abstract
Background: The present study aims to compare regional oxygen supply
determined by Near-Infrared Spectroscopy in the course of pulsatile
perfusion with non-pulsatile perfusion during cardiopulmonary bypass in
patients undergoing valvular heart surgery. <br/>Method(s): In this
prospective randomized single-blinded trial, we enrolled adult subjects
aged 18-65 years scheduled for elective valvular heart repair/replacement
surgery with non-stenotic carotid arteries, employing a consecutive
sampling method. Eligible patients were then randomly assigned in a 1:1
ratio to pulsatile or non-pulsatile perfusion during aortic cross-clamp.
The primary outcome was regional cerebral oxygenation monitored by
Near-Infrared Spectroscopy in each group. <br/>Result(s): Seventy patients
were randomly assigned, and each group comprised 35 patients. Mean age was
46.8 and 46.5 years in pulsatile and non-pulsatile groups, respectively.
There were no significant between-group differences in regional cerebral
oxygen saturation at different time points of cardiopulmonary bypass
(p-value for analysis of variance repeated measures: 0.923 and 0.223 for
left and right hemispheres, respectively). Moreover, no significant
differences in regional cerebral oxygen saturation levels from baseline
between pulsatile and non-pulsatile groups at all desired time points for
the left (p = 0.51) and right (p = 0.22) hemispheres of the brain were
detected. <br/>Conclusion(s): Pulsatile perfusion during cardiopulmonary
bypass does not offer superior regional cerebral oxygenation measured by
Near-Infrared Spectroscopy than non-pulsatile perfusion during
cardiopulmonary bypass. Nonetheless, the efficacy of pulsatile flow in the
subgroup of patients in whom cerebral blood flow is impaired due to
carotid artery stenosis needs to be explored and evaluated by this method
in future studies.<br/>Copyright &#xa9; The Author(s) 2021.

<72>
Accession Number
636675130
Title
Postnatal outcome in patients with aortic stenosis undergoing fetal aortic
valvuloplasty: systematic review and meta-analysis.
Source
Ultrasound in obstetrics & gynecology : the official journal of the
International Society of Ultrasound in Obstetrics and Gynecology. (no
pagination), 2021. Date of Publication: 02 Nov 2021.
Author
Vorisek C.N.; Zurakowski D.; Tamayo A.; Axt-Fliedner R.; Siepmann T.;
Friehs I.
Institution
(Vorisek, Tamayo, Siepmann, Friehs) Dresden International University,
Division of Health Care Sciences, Dresden, Germany
(Vorisek) Berlin Institute of Health at Charite - Universitaetsmedizin
Berlin, Germany
(Zurakowski) Department of Anesthesiology, Perioperative and Pain
Medicine, Boston Children's Hospital, Department of Anesthesia, Harvard
Medical School, Boston, MA
(Tamayo) Max Rady Faculty of Health Sciences, University of Manitoba,
Winnipeg, Canada
(Axt-Fliedner) Justus-Liebig-University Giessen, Germany
(Siepmann) University Hospital Carl Gustav Carus Dresden, Dresden, Germany
(Friehs) Harvard Medical School, Boston Children's Hospital, Boston,
United States
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Fetal aortic valvuloplasty (FAV) became a treatment option for
critical fetal aortic stenosis (AS) with the goal to preserve
biventricular circulation (BVC). To date, it is unclear how many patients
undergoing FAV achieve a BVC. Therefore, the goal of this systematic
review/meta-analysis is to investigate the type of postnatal circulation
following FAV. <br/>METHOD(S): The methodology published by the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
statement was applied. A systematic search on peri- and postnatal outcome
in patients with AS following FAV was performed using MEDLINE, EMBASE, Web
of Science and Cochrane Library. All literature was assessed by reading
abstracts, excluding duplicates, and if suitable, full text articles were
obtained and included. We reviewed publications from 2000 to 2020
including at least 12 months of follow-up. Review papers, comments, books,
editorials and case reports were excluded. The primary endpoint was type
of postnatal circulation. Additional assessed outcomes included fetal
death, live birth, neonatal death (NND), termination of pregnancy (TOP)
and technical success of FAV procedure. The quality of articles was
assessed using the Critical Appraisal Skills Programme tool (CASP
checklist). To estimate the overall proportion of each endpoint,
meta-analysis of proportions was employed using a random-effects model.
<br/>RESULT(S): An electronic search identified 579 studies, of which
seven were considered eligible for analysis. A total of 266 fetuses
underwent FAV with a follow-up ranging from 12 months to 13.2years. There
were no maternal deaths and only one FAV related maternal complication.
Hydrops was present in 25 (9%) patients. Pooled prevalence of BV and UV
among all live-born patients were 46% (95% CI: 39.2, 52.4) and 44 %, (95%
CI: 33.9, 53.8), respectively. Pooled prevalence of each secondary outcome
was, technical successful procedures (82%; 95% CI: 74.3, 87.9), fetal
deaths (16%; 95% CI: 11.2-22.4), TOP (6 %; 95% CI: 2.0-15.5), live-births
(79 %; 95% CI: 66.5, 87.4), NND (9%; 95% CI 4.7, 15.5), comfort care (4%;
95% CI: 1.9, 8.4), late death (10%; 95% CI: 3.6, 26.1). Pooled prevalence
for BV and UV among live-born patients that underwent technical successful
procedures were 52% (95% CI: 44.7, 59.1) and 39.8 % (95% CI: 29.7, 50.9),
respectively. <br/>CONCLUSION(S): This study showed a BVC rate of 46%
among live-born patients with AS undergoing FAV. Bias might be introduced
due to the lack of randomized clinical trials and BVC rate improved to 52%
when subjects underwent a technically successful FAV. However, currently,
data does not suggest a true benefit after FAV towards BVC. This article
is protected by copyright. All rights reserved.

<73>
Accession Number
636672351
Title
Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during
Noncardiac Surgery.
Source
Anesthesiology. (no pagination), 2021. Date of Publication: 01 Nov 2021.
Author
Reiterer C.; Kabon B.; Halvorson S.; Sessler D.I.; Mascha E.J.; Kurz A.
Publisher
NLM (Medline)
Abstract
BACKGROUND: Colloids are thought to sustain blood pressure and cardiac
index better than crystalloids. However, the relative effects of
intraoperative hydroxyethyl starch and crystalloid administration on the
cardiac index and blood pressure remain unclear. This study therefore
tested in this subanalysis of a previously published large randomized
trial the hypothesis that intraoperative goal-directed colloid
administration increases the cardiac index more than goal-directed
crystalloid administration. Further, the effects of crystalloid and
colloid boluses on blood pressure were evaluated. <br/>METHOD(S): This
planned subanalysis of a previous trial analyzed data from 973 patients,
of whom 480 were randomized to colloids and 493 were randomized to
crystalloids. Fluid administration was guided by esophageal Doppler. The
primary outcome was the time-weighted average cardiac index during surgery
between the colloid and crystalloid group. The secondary outcomes were the
cardiac index just after bolus administration, time elapsed between
boluses, and the average real variability during surgery. The study
recorded cardiac index, corrected flow time, and blood pressure at 10-min
intervals, as well as before and after each bolus. <br/>RESULT(S):
Time-weighted average of cardiac index over the duration of anesthesia was
only slightly greater in patients given colloid than crystalloid, with the
difference being just 0.20 l . min-1 . m-2 (95% CI, 0.11 to 0.29; P <
0.001). However, the hazard for needing additional boluses was lower after
colloid administration (hazard ratio [95% CI], 0.60 [0.55 to 0.66]; P <
0.001) in a frailty time-to-event model accounting for within-subject
correlation. The median [quartiles] number of boluses per patient was 4
[2, 6] for colloids and 6 [3, 8] for crystalloids, with a median
difference (95% CI) of -1.5 (-2 to -1; P < 0.001). The average real mean
arterial pressure variability did not differ significantly between the
groups (difference in means [95% CI] of -0.03 (-0.07 to 0.02) mmHg, P =
0.229). <br/>CONCLUSION(S): There were not clinically meaningful
differences in the cardiac index or mean pressure variability in patients
given goal-directed colloid and crystalloids. As might be expected from
longer intravascular dwell time, the interval between boluses was longer
with colloids. However, on a case basis, the number of boluses differed
only slightly. Colloids do not appear to provide substantial hemodynamic
benefit.<br/>Copyright &#xa9; 2021, the American Society of
Anesthesiologists. All Rights Reserved.