EMBASE Cardiac Update AutoAlert: EPICORE Cardiac Surgery Blogger2

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

<2>
Accession Number
2014825263
Title
Coronary artery aneurysm: A review.
Source
World Journal of Cardiology. 13(9) (pp 446-455), 2021. Date of
Publication: 26 Sep 2021.
Author
Matta A.G.; Yaacoub N.; Nader V.; Moussallem N.; Carrie D.; Roncalli J.
Institution
(Matta, Nader) Department of Cardiology, Toulouse University Hospital,
Rangueil, Toulouse 31400, France
(Matta, Yaacoub) Faculty of Medicine, Holy Spirit University of Kaslik,
Jounieh 961, Lebanon
(Nader) Faculty of Pharmacy, Lebanese University, Hadath 961, Lebanon
(Moussallem) Division of Cardiology, Faculty of Medicine, Holy Spirit
University of Kaslik, Jounieh 961, Lebanon
(Carrie) Department of Cardiology, University Hospital Rangueil, Toulouse
31059, France
(Roncalli) Department of Cardiology, University Hospital of Toulouse,
Institute Cardiomet, Toulouse 31400, France
Publisher
Baishideng Publishing Group Inc
Abstract
Coronary artery aneurysm (CAA) is a clinical entity defined by a focal
enlargement of the coronary artery exceeding the 1.5-fold diameter of the
adjacent normal segment. Atherosclerosis is the main cause in adults and
Kawasaki disease in children. CAA is a silent progressive disorder
incidentally detected by coronary angiography, but it may end with fatal
complications such as rupture, compression of adjacent cardiopulmonary
structures, thrombus formation and distal embolization. The
pathophysiological mechanisms are not well understood. Atherosclerosis,
proteolytic imbalance and inflammatory reaction are involved in aneurysmal
formation. Data from previously published studies are scarce and
controversial, thereby the management of CAA is individualized depending
on clinical presentation, CAA characteristics, patient profile and
physician experience. Multiple therapeutic approaches including medical
treatment, covered stent angioplasty, coil insertion and surgery were
described. Herein, we provide an up-to-date systematic review on the
pathophysiology, complications and management of CAA.<br/>Copyright &#xa9;
The Author(s) 2021. Published by Basihideng Publishing Group Inc. All
rights reserved.

<3>
Accession Number
2014825032
Title
Prophylactic effect of Amiodarone and in combination with Vitamin C in
reducing atrial fibrillation after coronary artery bypass.
Source
European Journal of Translational Myology. 31(3) (no pagination), 2021.
Article Number: 8981. Date of Publication: 2021.
Author
Kamali A.; Yavari S.; Yazdi B.; Rostami A.
Institution
(Kamali, Yazdi) Department of Anesthesiology and Critical Care, Arak
University of Medical Sciences, Arak, Iran, Islamic Republic of
(Yavari, Rostami) Department of Cardiovascular Surgery, Arak University of
Medical Science, Arak, Iran, Islamic Republic of
Publisher
Page Press Publications
Abstract
Atrial fibrillation (AF) is the most common arrhythmia following cardiac
surgery, leading to hemodynamic impairment and increased mortality and
morbidity after coronary artery bypass grafting (CABG) and increases
hospitalization. Due to the antioxidant and anti-inflammatory effects of
vitamin C as well as the antiarrhythmic effect of amiodarone in reducing
the incidence of atrial fibrillation after coronary artery bypass
grafting, we decided to compare and evaluate the prophylactic effect of
amiodarone alone and in combination with vitamin C in controlling this
complication. In this double-blind clinical trial, patients were divided
into two equal groups of amiodarone (300 mg amiodarone bolus during 20-30
minutes) and amiodarone + vitamin C (150 mg amiodarone and 2g vitamin C
combination). Each group included 42 patients. All data were analyzed by
SPSS 19 software and statistical tests of ANOVA, Chi-square and Repeated
Measure. There was a significant difference between the two groups of
amiodarone and amiodarone+vitamin C (p-value = 0.01) and the mean
incidence of AF in the amiodarone +vitamin C group was significantly lower
than that of amiodarone alone. Other arrhythmias were also lower in the
amiodarone +vitamin C group than in the amiodarone group alone. The use
offibrillation after CABG compared with prophylactic amiodarone alone, but
did not have a significant effect on decreasing ICU stay(discharge) and
duration of hospitalization.<br/>Copyright &#xa9; 2021 PAGEPress
Publications. All rights reserved.

<4>
Accession Number
636860390
Title
Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in
Adults With Congenital Heart Disease: A Systematic Review and
Meta-Analysis.
Source
Journal of the American Heart Association. 10(24) (pp e022909), 2021. Date
of Publication: 21 Dec 2021.
Author
Van den Eynde J.; Callahan C.P.; Lo Rito M.; Hussein N.; Carvajal H.;
Guariento A.; Ruhparwar A.; Weymann A.; Budts W.; Gewillig M.; Sa M.P.;
Kutty S.
Institution
(Van den Eynde, Kutty) Helen B. Taussig Heart CenterThe Johns Hopkins
Hospital and School of Medicine Baltimore MD
(Van den Eynde) Department of Cardiovascular Sciences Department of
Cardiovascular Diseases KU Leuven, University Hospitals Leuven Leuven
Belgium
(Callahan, Guariento) Division of Cardiovascular Surgery The Hospital for
Sick Children Toronto Canada
(Lo Rito) Department of Congenital Cardiac Surgery IRCCS Policlinico San
Donato San Donato Milanese Italy
(Hussein) Department of Congenital Cardiac Surgery Yorkshire Heart
CentreLeeds General Infirmary England United Kingdom
(Carvajal) Section of Pediatric Cardiothoracic Surgery Department of
Surgery Washington University School of Medicine in St. Louis/St. Louis
Children's Hospital Saint Louis MO
(Ruhparwar, Weymann) Department of Thoracic and Cardiovascular Surgery
West German Heart and Vascular Center Essen University Hospital of
EssenUniversity Duisburg-Essen Essen Germany
(Budts) Department of Cardiovascular Sciences Congenital and Structural
Cardiology Catholic University Leuven, University Hospitals Leuven Leuven
Belgium
(Gewillig) Pediatric Cardiology University Hospitals Leuven Leuven Belgium
(Sa) Department of Cardiac Surgery Lankenau Heart InstituteMain Line
Health Wynnewood PA
(Sa) Department of Cardiac Surgery Research Lankenau Institute for Medical
ResearchMain Line Health Wynnewood PA
Publisher
NLM (Medline)
Abstract
Background Tricuspid regurgitation (TR) is a common finding in adults with
congenital heart disease referred for pulmonary valve replacement (PVR).
However, indications for combined valve surgery remain controversial. This
study aimed to evaluate early results of concomitant tricuspid valve
intervention (TVI) at the time of PVR. Methods and Results Observational
studies comparing TVI+PVR and isolated PVR were identified by a systematic
search of published research. Random-effects meta-analysis was performed,
comparing outcomes between the 2 groups. Six studies involving 749
patients (TVI+PVR, 278 patients; PVR, 471 patients) met the eligibility
criteria. In the pooled analysis, both TVI+PVR and PVR reduced TR grade,
pulmonary regurgitation grade, right ventricular end-diastolic volume, and
right ventricular end-systolic volumes. TVI+PVR, but not PVR, was
associated with a decrease in tricuspid valve annulus size (mean
difference, -6.43 mm, 95% CI, -10.59 to -2.27; P=0.010). Furthermore,
TVI+PVR was associated with a larger reduction in TR grade compared with
PVR (mean difference, -0.40; 95% CI, -0.75 to -0.05; P=0.031). No evidence
could be established for an effect of either treatment on right
ventricular ejection fraction or echocardiographic assessment of right
ventricular dilatation and dysfunction. There was no evidence for a
difference in hospital mortality or reoperation for TR. Conclusions While
both strategies are effective in reducing TR and right ventricular
volumes, routine TVI+PVR can reduce TR grade to a larger extent than
isolated PVR. Further studies are needed to identify the subgroups of
patients who might benefit most from combined valve surgery.

<5>
Accession Number
636718219
Title
Transfusion thresholds for guiding red blood cell transfusion.
Source
Cochrane Database of Systematic Reviews. 2021(12) (no pagination), 2021.
Article Number: CD002042. Date of Publication: 21 Dec 2021.
Author
Carson J.L.; Stanworth S.J.; Dennis J.A.; Trivella M.; Roubinian N.;
Fergusson D.A.; Triulzi D.; Doree C.; Hebert P.C.
Institution
(Carson) Division of General Internal Medicine, Rutgers Robert Wood
Johnson Medical School, New Brunswick, NJ, United States
(Stanworth) John Radcliffe Hospital, Oxford University Hospitals NHS
Foundation Trust, Oxford, United Kingdom
(Stanworth) Radcliffe Department of Medicine, NIHR Oxford Biomedical
Research Centre, University of Oxford, Oxford, United Kingdom
(Stanworth, Doree) Systematic Review Initiative, NHS Blood and Transplant,
Oxford, United Kingdom
(Dennis) Cochrane Injuries Group, London School of Hygiene & Tropical
Medicine, London, United Kingdom
(Trivella) Department of Cardiovascular Medicine, University of Oxford,
Oxford, United Kingdom
(Roubinian) Kaiser Permanente Division of Research Northern California,
Oakland, CA, United States
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Canada
(Triulzi) The Institute for Transfusion Medicine, University of
Pittsburgh, Pittsburgh, PA, United States
(Hebert) Centre for Research, University of Montreal Hospital Research
Centre, Montreal, Canada
Publisher
John Wiley and Sons Ltd
Abstract
Background: The optimal haemoglobin threshold for use of red blood cell
(RBC) transfusions in anaemic patients remains an active field of
research. Blood is a scarce resource, and in some countries, transfusions
are less safe than in others because of inadequate testing for viral
pathogens. If a liberal transfusion policy does not improve clinical
outcomes, or if it is equivalent, then adopting a more restrictive
approach could be recognised as the standard of care. <br/>Objective(s):
The aim of this review update was to compare 30-day mortality and other
clinical outcomes for participants randomised to restrictive versus
liberal red blood cell (RBC) transfusion thresholds (triggers) for all
clinical conditions. The restrictive transfusion threshold uses a lower
haemoglobin concentration as a threshold for transfusion (most commonly,
7.0 g/dL to 8.0 g/dL), and the liberal transfusion threshold uses a higher
haemoglobin concentration as a threshold for transfusion (most commonly,
9.0 g/dL to 10.0 g/dL). <br/>Search Method(s): We identified trials
through updated searches: CENTRAL (2020, Issue 11), MEDLINE (1946 to
November 2020), Embase (1974 to November 2020), Transfusion Evidence
Library (1950 to November 2020), Web of Science Conference Proceedings
Citation Index (1990 to November 2020), and trial registries (November
2020). We checked the reference lists of other published reviews and
relevant papers to identify additional trials. We were aware of one trial
identified in earlier searching that was in the process of being published
(in February 2021), and we were able to include it before this review was
finalised. <br/>Selection Criteria: We included randomised trials of
surgical or medical participants that recruited adults or children, or
both. We excluded studies that focused on neonates. Eligible trials
assigned intervention groups on the basis of different transfusion
schedules or thresholds or 'triggers'. These thresholds would be defined
by a haemoglobin (Hb) or haematocrit (Hct) concentration below which an
RBC transfusion would be administered; the haemoglobin concentration
remains the most commonly applied marker of the need for RBC transfusion
in clinical practice. We included trials in which investigators had
allocated participants to higher thresholds or more liberal transfusion
strategies compared to more restrictive ones, which might include no
transfusion. As in previous versions of this review, we did not exclude
unregistered trials published after 2010 (as per the policy of the
Cochrane Injuries Group, 2015), however, we did conduct analyses to
consider the differential impact of results of trials for which
prospective registration could not be confirmed. <br/>Data Collection and
Analysis: We identified trials for inclusion and extracted data using
Cochrane methods. We pooled risk ratios of clinical outcomes across trials
using a random-effects model. Two review authors independently extracted
data and assessed risk of bias. We conducted predefined analyses by
clinical subgroups. We defined participants randomly allocated to the
lower transfusion threshold as being in the 'restrictive transfusion'
group and those randomly allocated to the higher transfusion threshold as
being in the 'liberal transfusion' group. <br/>Main Result(s): A total of
48 trials, involving data from 21,433 participants (at baseline), across a
range of clinical contexts (e.g. orthopaedic, cardiac, or vascular
surgery; critical care; acute blood loss (including gastrointestinal
bleeding); acute coronary syndrome; cancer; leukaemia; haematological
malignancies), met the eligibility criteria. The haemoglobin concentration
used to define the restrictive transfusion group in most trials (36) was
between 7.0 g/dL and 8.0 g/dL. Most trials included only adults; three
trials focused on children. The included studies were generally at low
risk of bias for key domains including allocation concealment and
incomplete outcome data. Restrictive transfusion strategies reduced the
risk of receiving at least one RBC transfusion by 41% across a broad range
of clinical contexts (risk ratio (RR) 0.59, 95% confidence interval (CI)
0.53 to 0.66; 42 studies, 20,057 participants; high-quality evidence),
with a large amount of heterogeneity between trials (I2 = 96%). Overall,
restrictive transfusion strategies did not increase or decrease the risk
of 30-day mortality compared with liberal transfusion strategies (RR 0.99,
95% CI 0.86 to 1.15; 31 studies, 16,729 participants; I2 = 30%;
moderate-quality evidence) or any of the other outcomes assessed (i.e.
cardiac events (low-quality evidence), myocardial infarction, stroke,
thromboembolism (all high-quality evidence)). High-quality evidence shows
that the liberal transfusion threshold did not affect the risk of
infection (pneumonia, wound infection, or bacteraemia).
Transfusion-specific reactions are uncommon and were inconsistently
reported within trials. We noted less certainty in the strength of
evidence to support the safety of restrictive transfusion thresholds for
the following predefined clinical subgroups: myocardial infarction,
vascular surgery, haematological malignancies, and chronic bone-marrow
disorders. Authors' conclusions: Transfusion at a restrictive haemoglobin
concentration decreased the proportion of people exposed to RBC
transfusion by 41% across a broad range of clinical contexts. Across all
trials, no evidence suggests that a restrictive transfusion strategy
impacted 30-day mortality, mortality at other time points, or morbidity
(i.e. cardiac events, myocardial infarction, stroke, pneumonia,
thromboembolism, infection) compared with a liberal transfusion strategy.
Despite including 17 more randomised trials (and 8846 participants), data
remain insufficient to inform the safety of transfusion policies in
important and selected clinical contexts, such as myocardial infarction,
chronic cardiovascular disease, neurological injury or traumatic brain
injury, stroke, thrombocytopenia, and cancer or haematological
malignancies, including chronic bone marrow failure. Further work is
needed to improve our understanding of outcomes other than mortality. Most
trials compared only two separate thresholds for haemoglobin
concentration, which may not identify the actual optimal threshold for
transfusion in a particular patient. Haemoglobin concentration may not be
the most informative marker of the need for transfusion in individual
patients with different degrees of physiological adaptation to anaemia.
Notwithstanding these issues, overall findings provide good evidence that
transfusions with allogeneic RBCs can be avoided in most patients with
haemoglobin thresholds between the range of 7.0 g/dL and 8.0 g/dL. Some
patient subgroups might benefit from RBCs to maintain higher haemoglobin
concentrations; research efforts should focus on these clinical
contexts.<br/>Copyright &#xa9; 2021 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<6>
Accession Number
2016482663
Title
Impact of new-onset versus pre-existing atrial fibrillation on outcomes
after transcatheter aortic valve replacement/implantation.
Source
IJC Heart and Vasculature. 38 (no pagination), 2022. Article Number:
100910. Date of Publication: February 2022.
Author
Nso N.; Emmanuel K.; Nassar M.; Bhangal R.; Enoru S.; Iluyomade A.; Marmur
J.D.; Ilonze O.J.; Thambidorai S.; Ayinde H.
Institution
(Nso, Nassar, Bhangal) Department of Medicine, Icahn School of Medicine at
Mount Sinai/NYC H+H/Queens, NY, United States
(Emmanuel) Department of Medicine, University of Pittsburgh, Medical
Center Pinnacle, PA, United States
(Enoru, Marmur) Department of Cardiovascular Disease, SUNY Downstate
Health Science University, NY, United States
(Iluyomade) Division of Cardiovascular Disease, University of Miami Miller
School of Medicine, Miami, FL, United States
(Ilonze) Department of Cardiovascular Disease, Indiana University School
of Medicine, IN, United States
(Thambidorai) Division of Cardiac Electrophysiology, HCA Medical City
Program, Fort Wort, TX, United States
(Ayinde) Division of Clinical Cardiac Electrophysiology, Novant Health
Heart & Vascular Institute, Charlotte, NC, United States
Publisher
Elsevier Ireland Ltd
Abstract
Patients with aortic stenosis who undergo transcatheter aortic valve
replacement/transcatheter aortic valve implantation (TAVR/TAVI) experience
a high incidence of pre-existing atrial fibrillation (pre-AF) and
new-onset atrial fibrillation (NOAF) post-operatively. This systematic
review and meta-analysis aimed to update current evidence concerning the
incidence of 30-day mortality, stroke, acute kidney injury (AKI), length
of stay (LOS), and early/late bleeding in patients with NOAF or pre-AF who
undergo TAVR/TAVI. PubMed, Google Scholar, JSTOR, Cochrane Library, and
Web of Science were searched for studies published between January 2012
and December 2020 reporting the association between NOAF/pre-AF and
clinical complications after TAVR/TAVI. A total of 15 studies including
158,220 adult patients with TAVI/TAVR and NOAF or pre-AF were identified.
Compared to patients in sinus rhythm, patients who developed NOAF had a
higher risk of 30-day mortality, AKI, early bleeding events, extended LOS,
and stroke after TAVR/TAVI (odds ratio [OR]: 3.18 [95% confidence interval
[CI] 1.58, 6.40]) (OR: 3.83 [95% CI 1.18, 12.42]) (OR: 1.70 [95% CI 1.05,
2.74]) (OR: 13.96 [95% CI, 6.41, 30.40]) (OR: 2.51 [95% CI 1.59, 3.97],
respectively). Compared to patients in sinus rhythm, patients with pre-AF
had a higher risk of AKI and early bleeding episodes after TAVR/TAVI (OR:
2.43 [95% CI 1.10, 5.35]) (OR: 17.41 [95% CI 6.49, 46.68], respectively).
Atrial fibrillation is associated with a higher risk of all primary and
secondary outcomes. Specifically, NOAF but not pre-AF is associated with a
higher risk of 30-day mortality, stroke, and extended LOS after
TAVR/TAVI.<br/>Copyright &#xa9; 2021

<7>
Accession Number
2016458033
Title
Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in
Patients with Acute Decompensated Aortic Stenosis: Systematic Review and
Meta-Analysis.
Source
Journal of Interventional Cardiology. 2021 (no pagination), 2021. Article
Number: 7230063. Date of Publication: 2021.
Author
Shao R.; Li J.; Qu T.; Fu X.; Liao Y.; Chen M.
Institution
(Shao, Li, Chen) Laboratory of Heart Valve Disease, West China Hospital,
Sichuan University, Chengdu, China
(Shao, Fu) Department of Cardiology, West China Hospital, Sichuan
University, Chengdu, China
(Qu) West China School of Medicine, Sichuan University, Chengdu, China
(Liao, Chen) Department of Clinical Research Management, West China
Hospital, Sichuan University, Chengdu, China
Publisher
Hindawi Limited
Abstract
Introduction. The aim of this systematic review and meta-analysis was to
investigate the efficacy and safety of emergent transcatheter aortic valve
implantation (TAVI) in patients with decompensated aortic stenosis (AS) by
comparing the clinical outcomes with the patients who had received the
elective TAVI. Methods. By searching PubMed, EMBASE, and Cochrane
databases, we obtained the studies comparing the clinical outcomes of
emergent TAVI and elective TAVI. Finally, 14 studies were included.
Results. A total of 14 eligible articles with 73,484 patients were
included in this meta-analysis. Emergent TAVI was associated with a higher
mortality during hospitalization (HR 2.09, 95% CI [1.39 to 3.14]), 30 days
(HR 2.29, 95% CI [1.69 to 3.10]), and 1 year (HR 1.96, 95% CI [1.55 to
2.49]). Consistently, the incidence of acute kidney injury (AKI) (RR 2.48,
95% CI [1.85 to 3.32]), dialysis (RR 2.37, 95% CI [1.95 to 2.88]),
bleeding (RR 1.62, 95% CI [1.27 to 2.08]), major bleeding (RR 1.05, 95% CI
[1.00 to 1.10]), and 30-day rehospitalization (RR 1.30, 95% CI [1.07,
1.58]) were more common in patients receiving emergent TAVI. No
statistical differences were found in the occurrence rate of vascular
complications (RR 1.11, 95% CI [0.90, 1.36]), major vascular complications
(RR 1.14, 95% CI [0.52, 2.52]), permanent pacemaker (PPM) placement (RR
1.05, 95% CI [0.99, 1.11]), cerebrovascular events (RR 1.11, 95% CI [0.98,
1.25]), moderate to severe paravalvular leakage (PVL) (RR 1.23, 95% [CI
0.94 to 1.61]), and device success (RR 0.99, 95% CI [0.97, 1.01]).
Conclusion. Emergent TAVI is associated with some postoperative
complications and increased mortality compared with elective TAVI.
Emergent TAVI should be implemented cautiously and
individually.<br/>Copyright &#xa9; 2021 Ruochen Shao et al.

<8>
[Use Link to view the full text]
Accession Number
2016474125
Title
Left Main Disease What Is the Correct Approach to Revascularization?.
Source
Cardiology in Review. 26(5) (pp 219-229), 2018. Date of Publication: 01
Sep 2018.
Author
Rab T.; King S.B.
Institution
(Rab, King) Division of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Percutaneous coronary intervention of the left main coronary artery has
evolved through registries and meta analyses, supported by results from
the EXCEL [Everolimus-Eluting Stents (EES) or Bypass Surgery for Left Main
Coronary Artery Disease] and NOBLE (Percutaneous Coronary Angioplasty
versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left
Main Stenosis) trials as an acceptable alternative to coronary artery
bypass grafting in patients with low and intermediate Syntax scores.
Advances in stenting strategies and the availability of larger diameter
drug-eluting stents improve patient safety and optimize procedural and
patient outcomes.<br/>Copyright &#xa9; 2018 Wolters Kluwer Health, Inc.
All rights reserved.

<9>
Accession Number
2014436894
Title
Evaluating treatment-specific post-discharge quality-of-life and
cost-effectiveness of TAVR and SAVR: Current practice & future directions.
Source
IJC Heart and Vasculature. 36 (no pagination), 2021. Article Number:
100864. Date of Publication: October 2021.
Author
Fliegner M.A.; Sukul D.; Thompson M.P.; Shah N.J.; Soroushmehr R.;
McCullough J.S.; Likosky D.S.
Institution
(Fliegner, Thompson, Likosky) Department of Cardiac Surgery, Michigan
Medicine, University of Michigan, Ann Arbor, MI, United States
(Sukul) Division of Cardiovascular Medicine, Department of General
Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor,
MI, United States
(Shah) Department of Anesthesiology, Michigan Medicine, University of
Michigan, Ann Arbor, MI, United States
(Soroushmehr) Department of Computational Medicine and Bioinformatics,
University of Michigan, Ann Arbor, MI, United States
(McCullough) Department of Health Management and Policy, School of Public
Health, University of Michigan., Ann Arbor, MI, United States
Publisher
Elsevier Ireland Ltd
Abstract
Background: Aortic stenosis is a prevalent valvular heart disease that is
treated primarily by surgical aortic valve replacement (SAVR) or
transcatheter aortic valve replacement (TAVR), which are common treatments
for addressing symptoms secondary to valvular heart disease. This
narrative review article focuses on the existing literature comparing
recovery and cost-effectiveness for SAVR and TAVR. <br/>Method(s): Major
databases were searched for relevant literature discussing HRQOL and
cost-effectiveness of TAVR and SAVR. We also searched for studies
analyzing the use of wearable devices to monitor post-discharge recovery
patterns. <br/>Result(s): The literature focusing on quality-of-life
following TAVR and SAVR has been limited primarily to single-center
observational studies and randomized controlled trials. Studies focused on
TAVR report consistent and rapid improvement relative to baseline status.
Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to
document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with
the benefits leveling off following 1 year. TF-TAVR is economically
favorable relative to SAVR, with estimated incremental cost-effectiveness
ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not
been reported to be advantageous from an HRQOL or cost-effectiveness
perspective. <br/>Conclusion(s): While real-world experiences are less
described, large-scale trials have advanced our understanding of recovery
and cost-effectiveness of aortic valve replacement treatment strategies.
Future work should focus on scalable wearable device technology, such as
smartwatches and heart-rate monitors, to facilitate real-world evaluation
of TAVR and SAVR to support clinical decision-making and outcomes
ascertainment.<br/>Copyright &#xa9; 2021 The Authors

<10>
Accession Number
2014717037
Title
Valve endocarditis, to repair or not to repair, is that really the
question?.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Di Mauro M.; Bonalumi G.; Calafiore A.M.; Lorusso R.
Institution
(Di Mauro, Lorusso) Cardio-Thoracic Surgery Unit, Heart and Vascular
Centre, Maastricht University Medical Centre (MUMC), Maastricht,
Netherlands
(Bonalumi) Department of Cardiac Surgery, Centro Cardiologico Monzino,
Milan, Italy
(Calafiore) Division of Cardiac Surgery A, Henry Dunant Hospital, Athens,
Greece
Publisher
John Wiley and Sons Inc
Abstract
The meta-analysis by He et al. has the worth to cover, as much as
possible, a gap of scientific evidence were conducting a randomized trial
appears very complex for ethical and logistical reasons. The authors
concluded that mitral valve repair (MVP) provides better-pooled results,
both early and late, with respect to mitral valve replacement. However,
the superiority of MVP is driven by some single large cohort studies where
surgeons had wide experience in the field of MVP for infective
endocarditis. This finding is also confirmed by other studies. But if
mitral repair produces such a better short- and long-term survival than
replacement, why are there no clear indications from consensus and
guidelines pushing surgeons toward the pursuit of a reconstructive
procedure at almost any cost? We wonder to repair or not to repair, is
that really the question? The AATS consensus suggests repairing "whenever
possible" but without providing more specific indications. If the two
primary goals of surgery are total removal of infected tissues and
reconstruction of cardiac morphology, including repair or replacement of
the affected valve(s), probably MVP should be performed in case of less
extensive tissue detriment by the infection. In more wide valve
involvement, MVP may be the choice but only in very expert hands and in
Centers with a very large volumes of valve repairing. This decision
cannot, therefore, be the result of the choice of an individual but must
derive from a careful multidisciplinary discussion to be held in an
EndoTeam.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC

<11>
Accession Number
636921924
Title
Efficacy and safety of coronary computed tomography angiography in
patients with a high clinical likelihood of obstructive coronary artery
disease.
Source
Kardiologia polska. (no pagination), 2021. Date of Publication: 19 Dec
2021.
Author
Rudzinski P.N.; Kruk M.; Demkow M.; Oleksiak A.; Schoepf J.U.; Mach M.;
Dzielinska Z.; Pregowski J.; Witkowski A.; Ruzyllo W.; Kepka C.
Institution
(Rudzinski) National Institute of Cardiology, Warszawa, Poland
(Kruk, Demkow, Oleksiak, Dzielinska, Pregowski, Witkowski, Ruzyllo, Kepka)
National Institute of Cardiology, Warszawa, Poland
(Schoepf) Division of Cardiovascular Imaging, Department of Radiology and
Radiological Science, Medical University of South Carolina, SC,
Charleston, United States
(Schoepf) Division of Cardiology, Department of Medicine, Medical
University of South Carolina, SC, Charleston, United States
(Mach) Division of Cardiac Surgery, Department of Surgery, Vienna General
Hospital, Vienna, Austria
Publisher
NLM (Medline)
Abstract
BACKGROUND: The CAT-CAD trial showed that coronary computed tomography
angiography (CTA) in patients with a high prevalence of coronary artery
disease (CAD) and indications for invasive coronary angiography (ICA)
reduces the number of patients undergoing ICA by two thirds and nearly
eradicates non-actionable ICAs. However, the long-term benefits of this
non-invasive strategy remain unknown. AIMS: To evaluate the long-term
efficacy and safety of a non-invasive strategy employing coronary CTA vs.
ICA as the first-line imaging test in stable patients with a high clinical
likelihood of obstructive CAD. <br/>METHOD(S): The long-term outcomes were
evaluated during 36 months following randomization and included the
efficacy outcome, analyzed as the composite of major adverse
cardiovascular events (MACE): all-cause death, acute coronary syndrome,
unplanned coronary revascularization, urgent hospitalization for
cardiovascular reason, stroke, and the safety outcome, analyzed as a
cumulative incidence of serious adverse events. <br/>RESULT(S): 120
participants with a mean age of 60.6 (7.9) years (female, 35.0%) were
randomized with an allocation ratio of 1:1 to coronary CTA and direct ICA
as the first-line anatomical test for suspected obstructive CAD. There
were no significant differences between both diagnostic strategies neither
in terms of the long-term efficacy (MACE occurrence: 15.5% in coronary CTA
group vs. 16.7% in ICA group; log-rank P = 0.89) nor the long-term safety
(cumulative number of serious adverse events: respectively 36 vs. 38; P =
0.79). <br/>CONCLUSION(S): Long-term follow-up of the randomized CAT-CAD
trial confirms that the strategy employing coronary CTA is an effective
and safe, non-invasive, outpatient-based alternative to ICA for patients
with a high clinical likelihood of obstructive CAD.

<12>
Accession Number
636916479
Title
Five-year outcomes in trials comparing transcatheter aortic valve
implantation versus surgical aortic valve replacement: a pooled
meta-analysis of reconstructed time-to-event data.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2021.
Date of Publication: 16 Dec 2021.
Author
Barili F.; Freemantle N.; Musumeci F.; Martin B.; Anselmi A.; Rinaldi M.;
Kaul S.; Rodriguez-Roda J.; Di Mauro M.; Folliguet T.; Verhoye J.-P.;
Sousa-Uva M.; Parolari A.
Institution
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
(Barili) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, MA, Boston, United States
(Freemantle) Institute of Clinical Trials and Methodology, University
College London, London, United Kingdom
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Martin) Department of Research and Third Mission Area, University of
Turin, Turin, Italy
(Anselmi, Verhoye) Division of Thoracic and Cardiovascular Surgery,
Pontchaillou University Hospital, Rennes, France
(Rinaldi) Department of Cardiac Surgery, AOU "Citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Kaul) Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles,
CA, USA
(Rodriguez-Roda) Department of Cardiac Surgery, Ramon y Cajal University
Hospital, Madrid, Spain
(Di Mauro) Cardiothoracic and Vascular Department, Maastricht University
Medical Center, Maastricht, Netherlands
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Sousa-Uva) Department of Cardiothoracic Surgery, Hospital de Santa Crux,
Carnaxide, Portugal
(Parolari) Universitary Cardiac Surgery Unit, IRCCS Policlinico S. Donato,
Italy
(Parolari) Department of Biomedical Sciences for Health, University of
Milan, Milan, Italy
Publisher
NLM (Medline)
Abstract
OBJECTIVES: The incidence of outcomes in trials comparing transcatheter
aortic valve implantation (TAVI) and surgical aortic valve replacement
(SAVR) is expected to be different in the short and long term. We planned
a meta-analysis of reconstructed time-to-event data from trials comparing
TAVI and SAVR to evaluate their time-varying effects on outcomes.
<br/>METHOD(S): We performed a systematic review of the literature from
January 2007 through September 2021 on Medline, Embase, the Cochrane
Central Register of Controlled Trials and specialistic websites, including
randomized trials with allocation to TAVI or SAVR that reported at least
1-year follow-up and that graphed Kaplan-Meier curves of end points. The
comparisons were done with grouped frailty Cox models in a landmark
framework and fully parametric models. <br/>RESULT(S): Seven trials were
included (7770 participants). TAVI showed a lower incidence of the
composite of death or stroke in the first 6 months [risk-stratified hazard
ratio (HR) 0.66, 95% confidence interval (CI) 0.56-0.77, P-value <0.001],
with an HR reversal after 24 months favouring SAVR (risk-stratified HR
1.25; 95% CI 1.08-1.46; P-value 0.003). These outcomes were confirmed for
all-cause death (risk-stratified HR after 24 months 1.18; 95% CI
1.03-1.35; P-value 0.01). TAVI was also associated with an increased
incidence of rehospitalization after 6 months (risk-stratified HR 1.42;
95% CI 1.06-1.91; P-value 0.018) that got worse after 24 months
(risk-stratified HR 1.67; 95% CI 1.24-2.24; P-value <0.001).
<br/>CONCLUSION(S): Although it could appear that there is no difference
between TAVI and SAVR in the 5-year cumulative results, TAVI shows a
strong protective effect in the short term that runs out after 1 year.
TAVI becomes a risk factor for all-cause mortality and the composite end
point after 24 months and for rehospitalization after 6
months.<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.

<13>
Accession Number
2014571986
Title
Double Jeopardy: Prematurity and Congenital Heart Disease-What's Known and
Why It's Important.
Source
World Journal for Pediatric and Congenital Heart Surgery. 13(1) (pp
65-71), 2022. Date of Publication: January 2022.
Author
Costello J.M.; Kim F.; Polin R.; Krishnamurthy G.
Institution
(Costello) Department of Pediatrics, Medical University of South Carolina,
Charleston, SC, United States
(Kim, Polin, Krishnamurthy) Department of Pediatrics, Columbia University
Irving Medical Center, New York, NY, United States
Publisher
SAGE Publications Inc.
Abstract
This article is based on a composite of talks presented during the Double
Jeopardy: Prematurity and Congenital Heart Disease Plenary Session at
NeoHeart 2020, a global virtual conference. Prematurity and low weight
remain significant risk factors for mortality after neonatal cardiac
surgery despite a steady increase in survival. Newer and lower weight
thresholds for operability are constantly generated as surgeons gather
proficiency, technical mastery, and experience in performing complex
procedures on extremely small infants. The relationship between birth
weight and survival after cardiac surgery is nonlinear with 2 kilograms
(kg) being an inflection point below which marked decline in survival
occurs. The prevalence of congenital heart disease (CHD) in premature
infants is more than twice that in term born infants. Increased risk of
preterm birth in infants with CHD is most commonly due to spontaneous
preterm birth and remains poorly understood. Advances in
Neonatal-Perinatal medicine have led to a marked improvement in survival
of neonates born prematurely over the last several decades. However, the
risk of severe morbidities including retinopathy of prematurity,
intraventricular hemorrhage, bronchopulmonary dysplasia and necrotizing
enterocolitis remains significant in extremely low birth weight infants.
Premature infants with CHD are at a greater risk of prematurity related
morbidities than premature infants without CHD. Interventions that have
been successful in decreasing the risk of these morbidities are
addressed.<br/>Copyright &#xa9; The Author(s) 2021.

<14>
Accession Number
2016417219
Title
A multi-center, international, randomized, 2-year, parallel-group study to
assess the superiority of IVUS-guided PCI versus qualitative angio-guided
PCI in unprotected left main coronary artery (ULMCA) disease: Study
protocol for OPTIMAL trial.
Source
PLoS ONE. 17(1 January) (no pagination), 2022. Article Number: e0260770.
Date of Publication: January 2022.
Author
de Maria G.L.; Testa L.; de la Torre Hernandez J.M.; Terentes-Printzios
D.; Emfietzoglou M.; Scarsini R.; Bedogni F.; Spitzer E.; Banning A.
Institution
(de Maria, Terentes-Printzios, Emfietzoglou, Scarsini, Banning) Heart
Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS
Foundation Trust, Oxford, United Kingdom
(Testa, Bedogni) Coronary Revascularisation Unit, IRCCS Policlinico S.
Donato, San Donato Milanese, Milan, Italy
(de la Torre Hernandez) Cardiology Department, Hospital Universitario
Marques de Valdecilla, IDIVAL, Santander, Spain
(Spitzer) European Cardiovascular Research Institute, Rotterdam,
Netherlands
(Spitzer) Department of Cardiology, Thoraxcenter, Erasmus Medical Centre,
Rotterdam, Netherlands
Publisher
Public Library of Science
Abstract
Background Percutaneous coronary intervention (PCI) is used increasingly
for revascularization of unprotected left main coronary artery (LMCA)
disease. Observational studies and subgroup analyses from clinical trials,
have suggested a possible benefit from the use of intravascular ultrasound
(IVUS) guidance when performing unprotected LMCA PCI. However, the value
of imaging with IVUS has never been proven in an appropriately powered
randomized clinical trial. The OPtimizaTIon of Left MAin PCI With
IntravascuLar Ultrasound (OPTIMAL) trial has been designed to establish
whether IVUS-guided PCI optimization on LMCA is associated with superior
clinical outcomes when compared with standard qualitative
angiography-guided PCI. Methods The OPTIMAL trial is a randomized,
multicenter, international study designed to enroll a total of 800
patients undergoing PCI for unprotected LMCA disease. Patients will be
randomized in a 1:1 fashion to IVUS-guided PCI versus angiogram-guided
PCI. In patients allocated to the angiogram-guided arm, use of IVUS is
discouraged, unless there are safety concerns. In patients allocated to
the IVUS guidance arm, pre-procedural IVUS assessment is highly
recommended, whilst post-procedural IVUS assessment is mandatory to
confirm appropriate stenting result and/or to guide stent result
optimization, according to predefined criteria. Patients will be followed
up to 2 years after the index procedure. The primary outcome measure is
the Academic Research Consortium (ARC) patient-oriented composite endpoint
(PoCE) which includes all-cause death, any stroke, any myocardial
infarction and any repeat revascularization at 2 years follow-up.
Discussion The OPTIMAL trial aims to provide definitive evidence about the
clinical impact of IVUS-guidance during PCI to an unprotected LMCA. It is
anticipated by the investigators, that an IVUS-guided strategy will be
associated with less clinical events compared to a strategy guided by
angiogram alone.<br/>Copyright &#xa9; 2022 De Maria et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<15>
Accession Number
2016352466
Title
Efficacy of psychological interventions on clinical outcomes of coronary
artery disease: Systematic review and meta-analysis.
Source
Journal of Psychosomatic Research. 153 (no pagination), 2022. Article
Number: 110710. Date of Publication: February 2022.
Author
Magan I.; Jurado-Barba R.; Casado L.; Barnum H.; Jeon A.; Hernandez A.V.;
Bueno H.
Institution
(Magan, Jurado-Barba, Casado) Department of Psychology, Facultad de Salud,
Universidad Camilo Jose Cela, Madrid, Spain
(Jurado-Barba, Bueno) Instituto de Investigacion Biomedica del Hospital 12
de Octubre (Imas12), Madrid, Spain
(Barnum, Jeon, Hernandez) Health Outcomes, Policy, and Evidence Synthesis
(HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT,
United States
(Hernandez) Vicerrectorado de Investigacion, Universidad San Ignacio de
Loyola (USIL), Lima, Peru
(Bueno) Department of Cardiology, Hospital Universitario 12 de Octubre,
Madrid, Spain
(Bueno) Multidisciplinary Translational Cardiovascular Research Group,
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
(Bueno) Centro de Investigacion Biomedica en Red Enfermedades
Cardiovasculares (CIBERCV), Madrid, Spain
Publisher
Elsevier Inc.
Abstract
Objectives: Psychological factors influence clinical outcomes in patients
with coronary artery disease (CAD). Therefore, psychological interventions
(PIs) may have beneficial effects in these patients. We evaluated the
efficacy of PIs based on cognitive-behavioral therapy (CBT) and positive
psychology therapy (PPT) on clinical and laboratory outcomes in CAD.
<br/>Method(s): Randomized controlled trials evaluating CBT or PPT in CAD
patients published until May 2020 were systematically reviewed and
analyzed. Primary outcomes were all-cause mortality, cardiovascular
mortality, any cardiovascular event, myocardial infarction (MI), stroke,
coronary revascularization, angina, and readmission. Random effects
meta-analyses using the inverse variance method were performed. Effects
were expressed as risk ratios (RR) or standardized mean difference (SMD)
with 95% confidence intervals (CIs). <br/>Result(s): Twenty-five trials
were included (n = 8119); 22 evaluating the effects of multi-component CBT
(n = 7909), and three PPT (n = 210). Thirteen RCTs were at high risk of
bias due to limitations in randomization or blinding. Compared with
control groups any cardiovascular event (RR 0.82; 0.70 to 0.97; 5
studies), MI (RR 0.72; 0.52 to 0.98; 9 studies), and angina duration and
intensity (SMD -0.64; -0.98 to -0.30; 4 studies; and -0.64; -1.17 to
-0.11; 2 trials) were significantly reduced with PIs at the end of
follow-up. PIs had no effect on other primary outcomes, laboratory or
anthropometrical results and presented a moderate to high heterogeneity.
<br/>Conclusion(s): CBT- and PPT-based PIs reduce the risk of
cardiovascular events, MI and angina in patients with CAD. Future research
should assess the individual role of CBT and PPT in CAD
populations.<br/>Copyright &#xa9; 2021

<16>
Accession Number
2013803073
Title
The effects of acute kidney injury in a multicenter cohort of high-risk
surgical patients.
Source
Renal Failure. 43(1) (pp 1338-1348), 2021. Date of Publication: 2021.
Author
Katayama H.T.; Gomes B.C.; Lobo S.M.A.; Chaves R.C.D.F.; Correa T.D.;
Assuncao M.S.C.; Serpa Neto A.; Malbouisson L.M.S.a.; Silva-Jr J.M.
Institution
(Katayama, Malbouisson, Silva-Jr) Faculdade de Medicina, Hospital das
Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
(Gomes) Universidade Federal do Parana, Curitiba, Brazil
(Lobo) Faculdade de Medicina de Sao Jose do Rio Preto, Hospital de Base,
Sao Jose do Rio Preto, Brazil
(Chaves, Correa, Assuncao, Serpa Neto, Silva-Jr) Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
Publisher
Taylor and Francis Ltd.
Abstract
Background and objectives: Patients who develop post-operative acute
kidney injury (AKI) have a poor prognosis, especially when undergoing
high-risk surgery. Therefore, the objective of this study was to evaluate
the outcome of patients with AKI acquired after non-cardiac surgery and
the possible risk factors for this complication. <br/>Method(s): A
multicenter, prospective cohort study with patients admitted to intensive
care units (ICUs) after non-cardiac surgery was conducted to assess
whether they developed AKI. The patients who developed AKI were then
compared to non-AKI patients. <br/>Result(s): A total of 29 ICUs
participated, of which 904 high-risk surgical patients were involved in
the study. The occurrence of AKI in the post-operative period was 15.8%,
and the mortality rate of post-operative AKI patients at 28 days was
27.6%. AKI was strongly associated with 28-day mortality (OR = 2.91; 95%
CI 1.51-5.62; p = 0.001), and a higher length of ICU and hospital stay (p
< 0.001). Independent factors for the risk of developing AKI were
pre-operative anemia (OR = 7.01; 95% CI 1.69-29.07), elective surgery (OR
= 0.45; 95% CI 0.21-0.97), SAPS 3 (OR = 1.04; 95% CI 1.02-1.06),
post-operative vasopressor use (OR = 2.47; 95% CI 1.34-4.55),
post-operative infection (OR = 8.82; 95% CI 2.43-32.05) and the need for
reoperation (OR= 7.15; 95% CI 2.58-19.79). <br/>Conclusion(s): AKI was
associated with the risk of death in surgical patients and those with
anemia before surgery, who had a higher SAPS 3, needed a post-operative
vasopressor, or had a post-operative infection or needed reoperation were
more likely to develop AKI post-operatively.<br/>Copyright &#xa9; 2021 The
Author(s). Published by Informa UK Limited, trading as Taylor & Francis
Group.

<17>
Accession Number
2014713865
Title
Outcomes After Transcatheter Aortic Valve Replacement in Bicuspid Versus
Tricuspid Anatomy: A Systematic Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14(19) (pp 2144-2155), 2021. Date of
Publication: 11 Oct 2021.
Author
Montalto C.; Sticchi A.; Crimi G.; Laricchia A.; Khokhar A.A.; Giannini
F.; Reimers B.; Colombo A.; Latib A.; Waksman R.; Mangieri A.
Institution
(Montalto) Department of Molecular Medicine, University of Pavia, Pavia,
Italy
(Montalto) Oxford Heart Center, Oxford University Hospital NHS Trust,
Oxford, United Kingdom
(Sticchi) Centro per la Lotta Contro l'Infarto Foundation, Rome, Italy
(Sticchi) Unicamillus, Saint Camillus International University of Health
Sciences, Rome, Italy
(Crimi) Cardio-Thoraco-Vascular Department, IRCCS Ospedale Policlinico San
Martino, Genova, Italy
(Laricchia, Khokhar, Giannini) GVM Care and Research, Maria Cecilia
Hospital, Cotignola, Italy
(Reimers, Colombo, Mangieri) Department of Biomedical Sciences, Humanitas
University, Pieve Emanuele, Milan, Italy
(Reimers, Colombo, Mangieri) Cardio Center, Humanitas Research Hospital
IRCCS, Rozzano, Milan, Italy
(Latib) Montefiore Medical Center, New York, NY, United States
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare the feasibility, safety,
and clinical outcomes of transcatheter aortic valve replacement (TAVR) in
bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) stenosis.
<br/>Background(s): At present, limited observational data exist
supporting TAVR in the context of bicuspid anatomy. <br/>Method(s):
Primary endpoints were 1-year survival and device success. Secondary
endpoints included moderate to severe paravalvular leak (PVL) and a
composite endpoint of periprocedural complications; incidence rates of
individual procedural endpoints were also explored individually.
<br/>Result(s): In the main analysis, 17 studies and 181,433 patients
undergoing TAVR were included, of whom 6,669 (0.27%) had BAV. A secondary
analysis of 7,071 matched subjects with similar baseline characteristics
was also performed. Device success and 1-year survival rates were similar
between subjects with BAV and those with TAV (97% vs 94% [P = 0.55] and
91.3% vs 90.8% [P = 0.22], respectively). In patients with BAV, a trend
toward a higher risk for periprocedural complications was observed in our
main analysis (risk ratio [RR]: 1.12; 95% CI: 0.99-1.27; P = 0.07) but not
in the matched population secondary analysis (RR: 1.00; 95% CI: 0.81-1.24;
P = 0.99). The risk for moderate to severe PVL was higher in subjects with
BAV (RR: 1.42; 95% CI: 1.29-1.58; P < 0.0001) as well as the incidence of
cerebral ischemic events (2.4% vs 1.6%; P = 0.015) and of annular rupture
(0.3% vs 0.02%; P = 0.014) in matched subjects. <br/>Conclusion(s): TAVR
is a feasible option among selected patients with BAV anatomy, but the
higher rates of moderate to severe PVL, annular rupture, and cerebral
ischemic events observed in the BAV group warrant caution and further
evidence.<br/>Copyright &#xa9; 2021 American College of Cardiology
Foundation

<18>
Accession Number
2014934849
Title
Optimal duration of dual antiplatelet therapy followed by monotherapy in
diabetic patients after percutaneous coronary intervention with
drugeluting stent implantation: A Bayesian network metaanalysis.
Source
Polish Archives of Internal Medicine. 131(9) (pp 781-789), 2021. Date of
Publication: 30 Sep 2021.
Author
An K.; Guo P.; Qiu S.; Zhu W.; Cao W.; Shi J.; Wang S.
Institution
(An, Qiu, Zhu, Cao, Shi, Wang) Department of Endocrinology, Affiliated
Zhongda Hospital of Southeast University, No. 87 DingJiaQiao Road, Nanjing
210009, China
(An, Qiu, Zhu, Cao, Shi) Medical School of Southeast University, Nanjing,
China
(Guo) Changlu Street Community Health Service Center, Nanjing, China
Publisher
Medycyna Praktyczna Cholerzyn
Abstract
INTRODUCTION The standard 12-month dual antiplatelet therapy (DAPT)
following percutaneous coro- nary intervention (PCI) with drug-eluting
stent (DES) implantation that is recommended for the general population
may not be suitable for patients with diabetes. OBJECTIVES The study aimed
to evaluate the efficacy and safety of short-term (<=3 months),
medium-term (6 months), standard-term (12 months), and extended-term (>12
months) DAPT in diabetic patients with DES implantation and to compare the
outcomes of DAPT discontinuation followed by monotherapy with aspirin
versus a P2Y<inf>12</inf> receptor inhibitor. PATIENTS AND METHODS
Randomized controlled trials published up to October 10, 2020 were
searched in the PubMed, Web of Science, Embase, Cochrane Library, and
ClinicalTrials.gov databases. A Bayes- ian network meta-analysis with a
random-effects model was performed. A total of 18 randomized trials
involving 20 536 patients with diabetes were included. RESULTS The network
analysis showed that short-term DAPT was the most optimal in terms of re-
ducing the primary endpoint and was superior to extended-term DAPT (odds
ratio [OR], 0.48; 95% CI, 0.25-0.85). Standard-term DAPT was also
associated with a reduced primary endpoint in comparison with
extended-term DAPT (OR, 0.56; 95% CI, 0.32-0.90). There was no noticeable
difference with respect to the primary endpoint between short-term DAPT
followed by monotherapy with aspirin and a P2Y<inf>12</inf> inhibitor. No
significant differences were observed in secondary endpoints, including
all-cause mortality, cardiac mortality, myocardial infarction, stroke,
target vessel revascularization, definite or probable stent thrombosis,
and major bleeding event. CONCLUSIONS Short-term DAPT, as compared with
extended-term therapy, was associated with a re- duced primary endpoint in
patients with diabetes after PCI with DES implantation.<br/>Copyright by
the Author(s), 2021

<19>
Accession Number
2015987644
Title
Prehabilitation in adult patients undergoing surgery: an umbrella review
of systematic reviews.
Source
British Journal of Anaesthesia. 128(2) (pp 244-257), 2022. Date of
Publication: February 2022.
Author
McIsaac D.I.; Gill M.; Boland L.; Hutton B.; Branje K.; Shaw J.;
Grudzinski A.L.; Barone N.; Gillis C.; Akhtar S.; Atkins M.; Aucoin S.;
Auer R.; Basualdo-Hammond C.; Beaule P.; Brindle M.; Bittner H.; Bryson
G.; Carli F.; Eskander A.; Fata P.; Fergusson D.; Fiore J.; Forster A.;
Gillam M.; Gramlich L.; Holroyd-Leduc J.; Jackson T.; Jacobsohn E.;
Khadaroo R.; Lalu M.; Love C.; Martel G.; McCartney C.; McKeen D.;
Meliambro A.; Moloo H.; Moore R.; Muscedere J.; Nantel J.; Poitras S.;
Scheede-Bergdahl C.; Taljaard M.; Wallace T.; Wijeysundera D.
Institution
(McIsaac, Hutton, Branje, Shaw, Grudzinski) Department of Anesthesiology
and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
(McIsaac, Branje, Shaw) Clinical Epidemiology Program, Ottawa Hospital
Research Institute, Ottawa, ON, Canada
(McIsaac, Hutton) School of Epidemiology and Public Health, University of
Ottawa, Ottawa, ON, Canada
(Gill) Patient and Community Engagement Research Program, University of
Calgary, Calgary, AB, Canada
(Boland) Centre for Practice-Changing Research, Ottawa Hospital Research
Institute, Ottawa, ON, Canada
(Barone) Department of Medicine, McGill University, Montreal, QC, Canada
(Gillis) Department of Anesthesia, McGill University, Montreal, QC, Canada
(Akhtar) Yale University, School of Medicine, New Haven, United States
(Atkins, Basualdo-Hammond, Gillam, Holroyd-Leduc, Moore) Alberta Health
Services, Edmonton, Canada
(Aucoin, Bryson, McCartney) The Ottawa Hospital, Department of
Anesthesiology and Pain Medicine, Ottawa, Canada
(Auer, Moloo) The Ottawa Hospital, Department of Surgery, Ottawa, Canada
(Beaule) University of Ottawa, Department of Surgery, Ottawa, Canada
(Bittner, Love) The Ottawa Hospital, Ottawa, Canada
(Brindle) The University of Calgary, Calgary, Canada
(Carli) McGill University, Department of Anesthesiology, Montreal, Canada
(Eskander) Sunnybrook Hospital, Toronto, Canada
(Fata, Fiore) McGill University, Division of General Surgery, Montreal,
Canada
(Fergusson, Forster, Lalu, Martel, Taljaard) Ottawa Hospital Research
Institute, Clinical Epidemiology Program, Ottawa, Canada
(Gramlich) University of Alberta, Edmonton, Canada
(Jackson) University Health Network, Toronto, Canada
(Jacobsohn) University of Manitoba, Faculty of Medicine, Winnipeg, Canada
(Khadaroo) University of Alberta, Department of Surgery, Edmonton, Canada
(McKeen) Memorial University of Newfoundland, St. John's, Canada
(Meliambro) Carleton University, Ottawa, Canada
(Muscedere) Kingston General Hospital, Department of Critical Care,
Kingston, Canada
(Nantel, Poitras) University of Ottawa, Faculty of Health Sciences,
Ottawa, Canada
(Scheede-Bergdahl) Montreal General Hospital, Department of
Anesthesiology, Montreal, Canada
(Wallace) University of British Columbia, Department of Surgery, Kamloops,
Canada
(Wijeysundera) St. Michael's Hospital, Department of Anesthesia, Toronto,
Canada
Publisher
Elsevier Ltd
Abstract
Background: The certainty that prehabilitation improves postoperative
outcomes is not clear. The objective of this umbrella review (i.e.
systematic review of systematic reviews) was to synthesise and evaluate
evidence for prehabilitation in improving health, experience, or cost
outcomes. <br/>Method(s): We performed an umbrella review of
prehabilitation systematic reviews. MEDLINE, Embase, Cochrane, Cumulative
Index to Nursing and Allied Health Literature, PsycINFO, Joanna Briggs
Institute's database, and Web of Science were searched (inception to
October 20, 2020). We included all systematic reviews of elective, adult
patients undergoing surgery and exposed to a prehabilitation intervention,
where health, experience, or cost outcomes were reported. Evidence
certainty was assessed using Grading of Recommendations Assessment,
Development and Evaluation. Primary syntheses of any prehabilitation were
stratified by surgery type. <br/>Result(s): From 1412 titles, 55
systematic reviews were included. For patients with cancer undergoing
surgery who participate in any prehabilitation, moderate certainty
evidence supports improvements in functional recovery. Low to very low
certainty evidence supports reductions in complications (mixed,
cardiovascular, and cancer surgery), non-home discharge (orthopaedic
surgery), and length of stay (mixed, cardiovascular, and cancer surgery).
There was low to very low certainty evidence that exercise prehabilitation
reduces the risk of complications, non-home discharge, and length of stay.
There was low to very low certainty evidence that nutritional
prehabilitation reduces risk of complications, mortality, and length of
stay. <br/>Conclusion(s): Low certainty evidence suggests that
prehabilitation may improve postoperative outcomes. Future low risk of
bias, randomised trials, synthesised using recommended standards, are
required to inform practice. Optimal patient selection, intervention
design, and intervention duration must also be determined.<br/>Copyright
&#xa9; 2021 British Journal of Anaesthesia

<20>
Accession Number
2016163662
Title
The effect of dexmedetomidine on myocardial ischemia/reperfusion injury in
patients undergoing cardiac surgery with cardiopulmonary bypass: A
meta-analysis.
Source
European Review for Medical and Pharmacological Sciences. 25(23) (pp
7409-7417), 2021. Date of Publication: 2021.
Author
ZHANG G.-R.; PENG C.-M.; LIU Z.-Z.; LENG Y.-F.
Institution
(ZHANG, LIU, LENG) Department of First Clinical Medical College, Lanzhou
University, Lanzhou, China
(PENG) Department of Basic Medicine, Qinghai Institute of Health Sciences,
Xining, China
(LENG) Department of Anesthesiology, the First Hospital of Lanzhou
University, Lanzhou, China
Publisher
Verduci Editore s.r.l
Abstract
OBJECTIVE: The purpose of this study was to evaluate the effect of
dexmedetomidine administration on myocardial ischemia/ reperfusion (I/R)
injury in patients undergoing cardiac surgery with cardiopulmonary bypass
(CPB). MATERIALS AND METHODS: Online databases including PubMed, the
Cochrane Library, Web of Science, Medline, and EMBASE were searched for
clinical trials that investigated the application of dexmedetomidine in
CPB patients prior to May 2021. A total of 17 studies involving 866
patients were included in this study. <br/>RESULT(S): The result of the
meta-analysis showed that there was a significant difference in serum
creatinine-kinase-MB (CK-MB) between the dexmedetomidine group and the
control group at the end of the operation and 24 h after the operation.
Compared to the control group, cardiac troponin I (cTn-I) concentration in
the dexmedetomidine group was significantly decreased at the end of the
operation, 24 h after the operation, and 48 h after the operation. There
was also a significant difference between the dexmedetomidine group and
the control group in the length of a patient's ICU stay.
<br/>CONCLUSION(S): Dexmedetomidine can reduce CK-MB and cTn-I
concentrations and shorten the length of ICU stays for patients undergoing
cardiac surgery with CPB. It can also provide myocardial protection from
I/R injury.<br/>Copyright &#xa9; 2021 Verduci Editore s.r.l. All rights
reserved.

<21>
Accession Number
2014656457
Title
Cardiac transplantation after heparin-induced thrombocytopenia: A
systematic review.
Source
Clinical Transplantation. (no pagination), 2021. Date of Publication:
2021.
Author
Jimenez D.C.; Warner E.D.; Ahmad D.; Rosen J.L.; Al-Rawas N.; Morris R.J.;
Alvarez R.; Rame J.E.; Entwistle J.W.; Massey H.T.; Tchantchaleishvili V.
Institution
(Jimenez, Warner, Ahmad, Rosen, Morris, Entwistle, Massey,
Tchantchaleishvili) Division of Cardiac Surgery, Thomas Jefferson
University, Philadelphia, PA, United States
(Al-Rawas) Department of Anesthesiology, Thomas Jefferson University,
Philadelphia, PA, United States
(Alvarez, Rame) Division of Cardiology, Thomas Jefferson University,
Philadelphia, PA, United States
Publisher
John Wiley and Sons Inc
Abstract
Purpose: Heparin-induced thrombocytopenia (HIT) presents a unique
challenge in patients requiring orthotopic heart transplantation (OHT). We
sought to pool the existing evidence in a systematic review.
<br/>Method(s): Electronic search was performed to identify all relevant
studies on OHT in patients with HIT. Patient-level data for 33 patients
from 21 studies were extracted for statistical analysis. <br/>Result(s):
Median patient age was 51 [IQR 41, 55] years, with 75.8% (25/33) males.
All patients had a clinical diagnosis of HIT, and anti-PF4/Heparin
antibodies were positive in 87.9% (29/33). Median lowest reported platelet
count was 46 x 10⁹/L [27.2, 73.5]. Intraoperatively, 61%
(20/33) of patients were given unfractionated heparin (UFH), while 39%
(13/33) were given alternative anticoagulants. The alternative agent
subgroup required more antifibrinolytics [54% (7/13) vs 10% (2/20), P
=.02] and clotting factors [69.2% (9/13) vs 15.0% (3/20), P <.01].
Perioperative thrombosis occurred more [53.8% (7/13) vs 0% (0/20, P <.01)
in alternate agent subgroup. More patients in the alternate agent subgroup
required post-operative transfusions [54% (7/13) vs 0% (0/20), P <.01].
Thirty-day mortality of 15.2% (5/33) was comparable between the subgroups.
<br/>Conclusion(s): Heparin use during OHT may be associated with less
adverse effects compared to use of other anticoagulants with no difference
in 30-day mortality.<br/>Copyright &#xa9; 2021 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd.

<22>
Accession Number
2015972717
Title
The perioperative management of small animals with previously implanted
pacemakers undergoing anaesthesia.
Source
Veterinary Anaesthesia and Analgesia. (no pagination), 2021. Date of
Publication: 2021.
Author
de Carellan Mateo A.G.; Casamian-Sorrosal D.
Institution
(de Carellan Mateo) Anaesthesia and Analgesia Service, Teaching Veterinary
Hospital, Department of Animal Medicine and Surgery, School of Veterinary
Science, Catholic University of Valencia, Valencia, Spain
(Casamian-Sorrosal) Cardiology and Interventional Cardiology Service,
Teaching Veterinary Hospital, Department of Animal Medicine and Surgery,
School of Veterinary Science, Catholic University of Valencia, Valencia,
Spain
Publisher
Association of Veterinary Anaesthetists and American College of Veterinary
Anesthesia and Analgesia
Abstract
Objective: There is little information in the veterinary literature about
the perioperative management of small animal patients with previously
implanted pacemakers undergoing elective or emergency non-cardiac
procedures. The purpose of this article is to review the current
literature with regard to human patients, with previously implanted
pacemakers, undergoing general anaesthesia. Using this and the current
information on pacemakers and anaesthesia in dogs and cats, we provide
recommendations for small animal patients in this situation. Databases
used: Google Scholar, PubMed and CAB Abstracts using and interlinking and
narrowing the search terms: "dog", "cat", "small animals", "anaesthesia",
"pacemaker", "perioperative", "transvenous pacing", "temporary pacing".
Scientific reports and human and small animal studies from the reference
lists of the retrieved papers were reviewed. In addition, related human
and veterinary cardiology and anaesthesia textbooks were also included to
create a narrative review of the subject. <br/>Conclusion(s): The best
perioperative care for these animals comes from a multidisciplinary
approach involving the anaesthetist, cardiologist, surgeon and intensive
care unit team. When such an approach is not feasible, the anaesthetist
should be familiar with pacemaker technology and how to avoid
perioperative complications such as electromagnetic interference, lead
damage and reprogramming of the device. The preanaesthetic assessment
should be thorough. Information regarding the indication for pacemaker
placement, complications during the procedure, location, type and
programming of the pacemaker should be readily available. The anaesthetic
management of these veterinary patients aims to preserve cardiovascular
function while avoiding hypotension, and backup pacing should be available
during the perioperative period. Further prospective studies are needed to
describe the best perioperative care in small animals with a previously
implanted pacemaker.<br/>Copyright &#xa9; 2021 Association of Veterinary
Anaesthetists and American College of Veterinary Anesthesia and Analgesia

<23>
Accession Number
2016000501
Title
Patient and caregiver preferences and prioritized outcomes for cardiac
surgery: A scoping review and consultation workshop.
Source
Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Oravec N.; Arora R.C.; Bjorklund B.; Gregora A.; Monnin C.; Dave M.G.;
Duhamel T.A.; Kent D.E.; Schultz A.S.H.; Chudyk A.M.
Institution
(Oravec, Arora) Section of Cardiac Surgery, Department of Surgery, Max
Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
(Arora, Dave, Kent) Department of Cardiac Sciences, St Boniface General
Hospital, Winnipeg, MB, Canada
(Bjorklund, Gregora) Enhanced Recovery Protocols for Cardiac Surgery
Patient Researcher Group, St Boniface General Hospital, Winnipeg, MB,
Canada
(Monnin) Neil John Maclean Health Sciences Library, University of
Manitoba, Winnipeg, MB, Canada
(Dave, Duhamel) Faculty of Kinesiology and Recreation Management,
University of Manitoba, Winnipeg, MB, Canada
(Duhamel) Institute of Cardiovascular Sciences, St Boniface General
Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
(Schultz, Chudyk) Rady Faculty of Health Sciences, College of Nursing,
University of Manitoba, Winnipeg, MB, Canada
(Schultz, Chudyk) Health Services & Structural Determinants of Health
Research Group, St Boniface General Hospital Albrechtsen Research Centre,
Winnipeg, MB, Canada
Publisher
Elsevier Inc.
Abstract
Objective(s): In light of the absence of patient and caregiver input in
Enhanced Recovery After Surgery Cardiac Surgery guideline development, we
conducted a scoping review to identify patient and caregiver preferences
and prioritized outcomes related to perioperative care in cardiac surgery
and its lifelong impact. <br/>Method(s): Five electronic databases were
searched to retrieve studies investigating patient or caregiver
preferences and prioritized outcomes. Information was charted in duplicate
and analyzed using descriptive statistics or thematic analysis. A patient
and caregiver consultation workshop validated scoping review findings and
solicited novel preferences and outcomes. <br/>Result(s): Of the 5292
articles retrieved, 43 met inclusion criteria. Most were from Europe (n =
19, 44%) or North America (n = 15, 35%) and qualitative and quantitative
designs were represented in equal proportions. Fifty-two methods were used
to obtain stakeholder preferences and prioritized outcomes, the majority
being qualitative in nature (n = 32, 61%). Based on the collective
preferences of 3772 patients and caregivers from the review and 17 from
the consultation workshop, a total of 108 patient preferences, 32
caregiver preferences, and 19 prioritized outcomes were identified. The
most commonly identified theme was "information and education." Improved
quality of life was the most common patient-prioritized outcome, and all
caregiver-prioritized outcomes were derived from the consultation
workshop. <br/>Conclusion(s): Patient and caregiver preferences overlap
with Enhanced Recovery After Surgery Cardiac Surgery recommendations
targeting preoperative risk reduction strategies, prehabilitation, patient
engagement technology, and intra- and postoperative strategies to reduce
discomfort. To support clinical practice, future research should
investigate associations with key surgical outcomes.<br/>Copyright &#xa9;
2021 The American Association for Thoracic Surgery

<24>
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).

<25>
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).

<26>
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

<27>
Accession Number
636897672
Title
Network meta-analysis of randomized controlled trials of eicosapentaenoic
acid for cardiovascular events reduction.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Yokoyama Y.; Kuno T.; Morita S.; Takagi H.; Briasoulis A.; Latib A.;
Heffron S.; Bangalore S.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Randomized clinical trials (RCTs) investigating the impact of
omega-3-fatty acid supplementation on cardiovascular events have largely
shown no benefit. A recent RCT suggested benefit from an eicosapentaenoic
acid (EPA)-only supplement. However, there is debate about the benign
nature of the placebo in this trial. <br/>Method(s): MEDLINE and EMBASE
were searched through May, 2021 to identify RCTs that investigated
cardiovascular outcomes with omega-3-fatty acid formulations (EPA,
decosahexanoic acid (DHA) or the combination) versus placebo or standard
care of controls. Outcomes of interest were cardiovascular death,
myocardial infarction, stroke, coronary revascularization, and all-cause
death. <br/>Result(s): Our analysis included 17 RCTs that enrolled a total
of 141,009 patients randomized to EPA (n =13,655), EPA+DHA (n =56,908),
mineral oil placebo (n =5,338), corn oil placebo (n =8,876), olive oil
placebo (n =41,009) and controls (no placebo oil; n =15,223). Rates of
cardiovascular death, myocardial infarction and stroke were significantly
lower in those receiving EPA compared to those receiving mineral oil, but
were not different from rates in those receiving other oils or standard of
care controls. Rates of coronary revascularization were significantly
lower in those receiving EPA than in those receiving either EPA+DHA,
mineral oil, corn oil, or olive oil placebo, but not standard of care
controls. All-cause death was similar among all groups.
<br/>Conclusion(s): Our analyses demonstrate that although EPA
supplementation lowers risk of coronary revascularization more than other
oils, there is no benefit relative to standard of care. Further, EPA
reduces the risk of cardiovascular events only in comparison to mineral
oil and not when compared with other placebo oils or to standard of care.
Any benefit of EPA-only supplementation in improving cardiovascular
outcomes is not currently generalizable outside of select studies
incorporating mineral oil placebo.

<28>
[Use Link to view the full text]
Accession Number
636897336
Title
Sodium intake and risk of cardiovascular disease: A pooled analysis of
individual data from six cohort studies with multiple 24-hour urine
collections.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Ma Y.; He F.J.; Sun Q.; Yuan C.; Kieneker L.M.; Curhan G.C.; MacGregor
G.A.; Bakker S.J.; Campbell N.; Wang M.; Rimm E.B.; Manson J.; Willett W.;
Hofman A.; Gansevoort R.T.; Cook N.R.; Hu F.B.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The relationship between sodium intake and cardiovascular
disease (CVD) remains controversial, in part, due to inaccurate assessment
of sodium intake. 24-hour urinary excretion over multiple days is
considered the optimal method. <br/>Method(s): We included individual
participant data from 6 prospective cohorts among generally healthy adults
with sodium and potassium excretion assessed by at least two 24-hour urine
collections. Out of 10,709 participants (54% women; mean [SD] age, 51.5
[12.6] years), 571 incident CVD events (including myocardial infarction,
coronary revascularization, and stroke) were ascertained during a median
follow-up of 8.8 years. We analyzed each cohort using consistent methods
and combined the results using random-effects meta-analysis.
<br/>Result(s): Median 24-hour urinary sodium excretion (10th -90th
percentile) was 3,270 (2,099-4,899) mg. Higher sodium excretion, lower
potassium excretion and higher sodium-to-potassium ratio were all
associated with higher risk of CVD events after controlling for
confounding factors (all P values for trend<=0.02); there was no evidence
of nonlinearity. The hazard ratio [HR] comparing top with bottom quartiles
was 1.67 [95% confidence interval [CI]: 1.21-2.30] for sodium, 0.77
[0.57-1.02] for potassium and 1.72 [1.27-2.32] for sodium-to-potassium
ratio. Each 1,000 mg/d increment in sodium excretion was associated with
an 18% increase in CVD risk (95%CI: 5%-32%) and each 1,000 mg/d increment
in potassium excretion was associated with 18% lower risk (95%CI: 6%-28%).
<br/>Conclusion(s): Higher sodium and lower potassium intakes, measured in
multiple 24-hour urine samples, were associated with higher risk of CVD in
a dose-response manner. These findings support current recommendations to
reduce sodium and increase potassium intakes.

<29>
Accession Number
636897209
Title
New-onset atrial fibrillation after transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Ryan T.; Jinah R.; Grindal A.; Pandey A.; Vadakken M.; Jaffer I.; Healey
J.S.; Belley-cote E.P.; McIntyre W.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: New-onset atrial fibrillation (NOAF) is a common complication
after transcatheter aortic valve replacement (TAVR), though estimates of
the precise incidence are variable. We sought to quantify the incidence of
NOAF after TAVR, explore the associated outcomes and identify predictors
for this complication. <br/>Method(s): Using a broad strategy, we searched
Medline, EMBASE and the Cochrane database from 2015-2020 for articles that
reported any outcomes of TAVR. We extracted data for studies published
prior to 2015 from a previous systematic review (22 studies in total).
Reviewers performed screening and data extraction in duplicate. We pooled
data using a random effects model with MantelHaenszel weighting.
<br/>Result(s): We identified 183 studies with 296,986 total participants
that reported NOAF from 2008 to 2020. The pooled incidence of NOAF after
TAVR was 9.9% (95%CI 8.1-12%). NOAF after TAVR was associated with longer
index hospitalization (MD 2.66 days, 95% CI 1.05-4.27), higher risk of
stroke (RR 1.65, 95% CI 1.09-2.5) and 30-day mortality (RR 1.76, 95%CI
1.12-2.76). NOAF after TAVR was also associated with increased risk of
major or life-threatening bleeding (RR 1.60, 95%CI 1.39-1.84) and new
permanent pacemaker implantation (RR 1.12, 95%CI 1.05-1.18). Risk factors
for the development of NOAF after TAVR included trans-apical access,
pulmonary hypertension, chronic kidney disease, peripheral vascular
disease, and severe mitral regurgitation. <br/>Conclusion(s): NOAF is
common after TAVR and associated with a longer hospital stay, a higher
risk of stroke, major bleeding, mortality and permanent pacemaker
implantation. Whether this risk is modifiable requires further study.

<30>
[Use Link to view the full text]
Accession Number
636897097
Title
Quality assessment of transcatheter aortic valve replacement meta
analysis: Is it worth reading?.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Sattar Y.; Song D.; Riasat M.; Singh G.; Shah R.; Elgendy I.Y.; Mehmood
A.; Mir T.; Zghouzi M.; Ullah W.; Alam M.; Khan A.; Alraies M.C.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Multiple meta-analyses have been performed since
Transcatheter Aortic Valve Replacement (TAVR) and quality of the rapidly
publishing data on TAVR is debatable. <br/>Method(s): Descriptive
statistics was performed on pooled samples of quality assessment
statistics including heterogeneity I2, Q-statistics , Tau, and Cochrane.
An approach to high heterogeneity was reviewed in this meta-analysis to
review the quality of content published online. We reported total n,
average numbers and percentages. Continuous data with normal distribution
was reported as mean with standard deviation (SD). <br/>Result(s): A total
of 231 meta-analyses done on TAVR were included in our study. The total of
1365 outcomes were reported in all of the meta-analyses. The total
outcomes with heterogeneity I2< 75% and I2 >75% were 1125 and 244
respectively. The average number of outcomes with I2 <75% was 5, while the
outcomes with I2>75% was 1.19. Tau, H statistics, and Cochrane statistics
were reported for 79, 1 and 42 outcomes respectively. The subgrouping was
performed in 87 outcomes. The mean number of subgroups was 1 +/- SD 0.06,
Odds ratios, relative risk and standard mean difference were used as an
effect size in 93, 63, and 36 studies respectively. The random effect
model, fixed effect model, or combine models were used in 180, 67, and 53
outcomes respectively. Sensitivity analysis was performed in 109 outcomes.
Meta-regression was performed in 55 outcomes with an average of 0.27
studies. 46 outcomes were able to report I2<75% after meta regression, and
subgroup analysis. Trend (n) of outcomes with heterogeneity I2>75% across
different studies is shown in figure 1. <br/>Conclusion(s): TAVR
heterogeneity was high in up to 18% of meta analysis outcomes in all meta
analysis performed. Meta regression was performed in 22% with high
heterogeneity, and 18% of the outcomes were able to fix the high
heterogeneity in the data.

<31>
Accession Number
636897001
Title
Impact of sex on outcomes after cardiac surgery: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Dixon L.K.; Di Tommaso E.; Dimagli A.; Sinha S.; Sandhu M.; Angelini G.;
Umberto B.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Despite advances in cardiac surgery, there is evidence from
observational studies which suggests that females have poorer
post-operative outcomes than males. This study is the first to review sex
related outcomes following both coronary artery bypass graft (CABG) and
valve surgery with or without combined CABG. Hypothesis: Females have
worse outcomes following cardiac surgery than males. <br/>Method(s): We
identified 30 primary research articles reporting either short-term
mortality (inhospital/30 day), long-term mortality, post-operative stroke,
sternal wound infection and postoperative myocardial infarction (MI) in
both sexes following CABG and valve surgery with or without combined CABG
Reported adjusted odds/hazard ratio were pooled using an inverse variance
model. <br/>Result(s): Females were at higher risk of short-term mortality
(odds ratio (OR) 1.40; 95% confidence interval (CI) 1.32-1.49;
I²=79%) and post-operative stroke (OR 1.2; CI 1.07-1.34;
I²=90%) when compared to males. There was no increased risk in
long-term mortality (OR 1.04; 95% CI: 0.93- 1.16; I²=82%),
post-operative MI (OR 1.22; 95%CI: 0.89-1.67; I²=60%) or deep
sternal wound infection (OR 0.92; 95%CI: 0.65-1.03, I²=87%). No
evidence of publication bias or small study effect was found.
<br/>Conclusion(s): Females are at a greater risk of short-term mortality
and post-operative stroke than males following CABG and valve surgery with
or without combined CABG. However long-term mortality is equivalent in
both sexes.

<32>
[Use Link to view the full text]
Accession Number
636896655
Title
Perioperative interventions for prevention of postoperative atrial
fibrillation after cardiac surgery: A systematic review and network
meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Li Z.; Zeng Z.; Yuan S.; Zhang X.; Zheng Z.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
complication of cardiac surgery, which increases the risk of stroke and
death, the length of hospital stays, and costs. Guidelines recommendations
on the use of beta-blockers (BBs) have only a modest influence on overall
rates of POAF. The key clinical outcomes such as stroke and death have not
been improved. The best approach to prophylaxis remains obscure.
<br/>Method(s): We used Bayesian network meta-analysis to synthesize
evidences from randomized controlled trials (RCTs) that compared
interventions for POAF prophylaxis. The primary outcomes were incidence of
POAF hypotension and bradycardia. <br/>Result(s): We included 262 RCTs
with 52636 participants (age > 18, undergoing CABG, valvular or combined
surgery), in which 14 different interventions were investigated. For the
incidence of POAF, sotalol, amiodarone, BBs, posterior pericardiotomy,
atrial pacing, magnesium, polyunsaturated fatty acids, colchicine,
glucocorticoid and statin had positive results compared to placebo with
statistical significance. The best three therapeutics were sotalol (OR
0.29, 95% CI 0.21-0.41; probability of being best 84.6%), amiodarone (OR
0.39, 95% CI 0.31-0.48) and BBs (OR 0.39, 95% CI 0.31-0.49). For safety,
BBs (OR 4.09, 95% CI 2.10-7.96), magnesium (OR 2.51, 95% CI 1.09-5.76) and
sotalol (OR 2.07, 95% CI 1.06-4.05) were associated with higher incidence
of hypotension. Sotalol (OR 2.80, 95% CI 1.66-4.74) and amiodarone (OR
2.27, 95% CI 1.66-3.10) were associated with higher incidence of
bradycardia. For secondary outcomes, no significant effect on all-cause or
cardiovascular mortality was observed. Amiodarone was the only
intervention that reduced stroke rate (OR 0.57, 95% CI 0.34-0.96).
<br/>Conclusion(s): Sotalol appeared to be superior in efficiency compared
with others. BBs do not work as well as we expected with the highest
incidence of hypotension.Further studies are required to define the better
interventions.

<33>
Accession Number
636896558
Title
Cardiothoracic surgery research articles supported by national institutes
of health grant funding exhibit enhanced scholarly impact.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Wang H.; Bajaj S.; Williams K.M.; Woo Y.; Boyd J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: National Institutes of Health (NIH) grants are an essential
funding source for cardiothoracic (CT) surgeon-scientists. The association
between NIH funding and an article's research impact, however, has not
been explored. We hypothesized that CT surgery research articles supported
by NIH funding exhibit enhanced scholarly impact. <br/>Method(s): Research
records and NIH funding history for all CT surgery faculty (n=992) at
accredited United States CT surgery training institutions in 2018 were
obtained using Scopus and Grantome, respectively. Using the NIH iCite
database, all articles published by these surgeons were classified as
either basic science research (BSR, iCite animal or molecular/cellular
score >0) or clinical research (CR, iCite animal and molecular/cellular
score = 0). The relative citation ratio (RCR), an NIH-validated
field-normalized metric of scholarly impact, was calculated for each
article, where RCR 1.00 indicates equal impact as other NIH-funded
articles in the same field, and RCR 2.00 indicates twice the impact. Data
are presented as median [interquartile range] and analyzed using the
Mann-Whitney test. <br/>Result(s): A total of 37,402 unique articles were
identified, including 9,469 supported by NIH funding and 27,933 without
NIH funding. CT surgery research articles with NIH funding exhibit a
significantly greater median RCR than those without NIH funding (1.08
[0.53-2.19] vs 0.75 [0.28-1.72], p<0.0001, Figure 1A). Among BSR articles,
NIH-funded papers have a significantly greater median RCR (0.93
[0.47-1.88] vs 0.62 [0.26-1.33], p<0.0001, Figure 1B). Similarly, among CR
articles, NIH-funded papers also exhibit a significantly greater median
RCR (1.34 [0.66-2.60] vs 0.79 [0.28-1.80], p<0.0001, Figure 1C).
<br/>Conclusion(s): At single-article resolution, CT surgery research
publications supported by NIH grant funding exhibit enhanced scholarly
impact and compare favorably in median RCR versus other NIHfunded
biomedical research.

<34>
Accession Number
636896557
Title
Association between baseline lipoprotein(A) and five-year outcomes in
patients underwent coronary artery bypass grafting: A post-hoc analysis of
DACAB trial.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Yu Q.; Zhou Y.; Zhang W.; Zhao Q.; Zhu Y.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Serum lipoprotein(a) [Lp(a)] is genetically determined and
has been proposed to be associated with coronary artery lesion severity
and clinical outcomes in coronary artery disease (CAD). But some
researches suggested heterogeneous effects and marked variations of Lp(a)
level between ethnic groups. The aim of this study was to investigate the
impact of baseline Lp(a) on fiveyear clinical outcomes in Chinese
population who underwent coronary artery bypass grafting (CABG).
<br/>Method(s): We performed a post-hoc analysis of the DACAB trial
(NCT02201771), in which patients aged 18 to 80 years, male or female,
underwent primary, isolated and elective CABG, were randomly assigned to
receive different antiplatelet treatments. Serum Lp(a) was obtained and
analyzed in 270/272 patients of one single center. The primary outcome was
major adverse cardiovascular events (MACE). MACE-5 included all-cause
death, myocardial infarction, stroke, repeated revascularization and
rehospitalization for unstable angina, and MACE-3 included cardiovascular
death, myocardial infarction, and stroke. The mean follow-up reached
59.4+/-9.4 months. <br/>Result(s): The baseline characteristics were
generally comparable. High Lp(a) level was identified in 71 (26.3%)
(cut-off >=30mg/dL) and 33 (12.2%) (cut-off >=50mg/dL) patients,
respectively. During 5- year follow-up, MACE-5 reported in high and low
Lp(a) group were 34.2% vs 28.8% when the cut-off value was 30mg/dL (hazard
ratio [HR], 1.11; 95% CI, 0.69-1.78, p=0.66). While the cut-off value was
50mg/dL, MACE-5 reported in high and low Lp(a) group were 39.4% vs 28.9%
(HR, 1.32; 95% CI, 0.73-2.38, p=0.36). Similar results were observed in
MACE-3 (Cut-off value 30mg/dL: 24.2% vs 21.9%, HR 1.08, p=0.78; Cut-off
value 50mg/dL: 27.3% vs 21.8%, HR 1.24, p=0.56). No statistical
significant difference was achieved between the two groups.
<br/>Conclusion(s): In this single center post-hoc analysis, baseline
Lp(a) level >=30mg/dL or >=50mg/dL had no statistical significant
association with 5-year MACE in post-CABG Chinese population. But higher
baseline Lp(a) levels seem to be associated with more MACE in longer
follow-up. Larger sample size from multicenter are needed to confirm our
findings.

<35>
Accession Number
636896325
Title
De novo atypical atrial flutters: Locations, mechanisms, and long term
outcomes post ablation.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Zaidi A.; Kirzner J.; Liu C.F.; Cheung J.W.; Thomas G.; Ip J.E.; Lerman
B.B.; Markowitz S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Atypical atrial flutter (aAFL) has been described in the
absence of prior atrial interventions, but prognosis for these patients
after catheter ablation is poorly defined. This study was designed to
define characteristics and ablation outcomes in patients with de novo
aAFL. <br/>Method(s): Patients with non-CTI flutter, without prior
ablation or cardiac surgery, were identified from an institutional
database. Clinical, mapping, ablation, and follow up data were compared to
an equally sized group of randomly selected patients with typical flutter
(tAFL). <br/>Result(s): The 35 patients with aAFL had 45 mapped non-CTI
flutters. aAFL patients had similar age, gender, cardiovascular
comorbidities, and LA size compared to tAFL, except aAFL patients had
higher LVEF (54 +/- 12 vs 46 +/- 19%, p=0.04). Cycle length of aAFL was
longer (268 [IQR 231, 310] vs 230 [220, 250] msec, p=0.0006). aAFL
localized to the RA in 16, LA in 28, and biatrial in 1. Mechanisms were
macroreentry in 23 (8 RA, 15 LA) and localized reentry in 22 (8 RA, 14
LA). Areas of scar predominated in the lateral/posterior RA (N=9),
anterior LA (N=14), and posterior LA (N=6). Most common LA circuits were
perimitral reentry (N=8) and roof dependent (N=8), including dual loop
reentry. Localized reentry occurred most commonly in the anterior LA (N=7)
or involved the pulmonary veins (N=4). Ablation was acutely successful for
41/45 aAFLs (91%) and for all tAFL. After median follow-up of 33 [6.6, 55]
mo, atrial arrhythmias recurred in 23/34 aAFL patients (68%) and 24/35
tAFL patients (69%); those with aAFL had earlier recurrences (1.9 [0.43,
11] vs 19 [2.3, 36] mo, p=0.01). First recurrences after aAFL ablation
were more likely to be AFL rather than AF (83% vs 17%) whereas tAFL
patients were more likely to recur with AF (24% AFL vs 76% AF, p<0.0001).
<br/>Conclusion(s): Patients with de novo aAFL tend to have spontaneous
scar, commonly in the lateral/posterior RA and anterior LA, consistent
with an atrial myopathy. Ablation can be accomplished with high acute
success, but recurrent atrial arrhythmias are common, most re-presenting
with atrial tachycardias. Future studies should clarify if a
substrate-based approach or adjunctive antiarrhythmic drugs would result
in better long term outcomes.

<36>
Accession Number
636895933
Title
Impact of new-onset atrial fibrillation (NOAF) versus pre-existing atrial
fibrillation on outcomes after transcatheter aortic valve
replacement/implantation (TAVR/TAVI).
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Nso N.; Emmanuel K.; Iluyomade A.; Ayinde H.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Aortic stenosis patients who undergo Transcatheter Aortic
Valve Replacement/Transcatheter Aortic Valve Implantation (TAVR/TAVI)
experience a high incidence of pre-existing atrial fibrillation and
new-onset atrial fibrillation (NOAF) post-operatively. We aim to update
current evidence concerning the incidence of 30-day mortality, stroke,
acute kidney injury, length of stay, and early/late bleeding in TAVR/TAVI
with NOAF or pre-existing atrial fibrillation (preAF). <br/>Method(s): We
searched Pubmed, Google Scholar, JSTOR, Cochrane Library and Web of
Science for studies published between January 2012 and December 2020 that
reported the association between NOAF/preAF and clinical complications
after TAVR/TAVI. Relevant studies were included in our systematic review
and meta-analysis. Our primary clinical outcomes included 30-day
mortality, stroke, early bleeding, and late bleeding. The secondary
clinical outcomes included acute kidney injury and extended length of
stay. <br/>Result(s): We included 15 studies based on 158,220 TAVI/TAVR
adult patients (>18 years of age) with NOAF or preAF. Compared to patients
in sinus rhythm, TAVR/TAVI patients who developed NOAF had higher risk of
30-day mortality, acute kidney injury, early bleeding events, extended
length of stay and stroke (OR: 3.18 [95% CI 1.58, 6.40]) (OR: 3.83 [95% CI
1.18, 12.42]) (OR: 1.70 [95% CI 1.05, 2.74]) (OR: 13.96 [95% CI, 6.41,
30.40]) (OR: 2.51 [95% CI 1.59, 3.97], respectively). Compared to patients
in sinus rhythm, TAVR/TAVI patients with pre-AF had higher risk of acute
kidney injury and early bleeding episodes (OR: 2.43 [95% CI 1.10, 5.35])
(OR: 17.41 [95% CI 6.49, 46.68], respectively). Pre-AF was not associated
with an increase in 30-day mortality, late bleeding, stroke, and length of
stay after TAVR/TAVI. <br/>Conclusion(s): The findings of our
meta-analysis showed that atrial fibrillation (AF) was associated with
higher risk of all primary and secondary outcomes. Specifically, NOAF but
not pre-AF was associated with higher risk of 30-day mortality, stroke,
and extended length of stay in TAVR/TAVI patients.

<37>
[Use Link to view the full text]
Accession Number
636895886
Title
Novel oral anticoagulants versus vitamin k antagonists in patients with
atrial fibrillation and bioprosthetic valve replacement: A systematic
review and meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Memon M.; Amin E.; Siddiqui A.A.; Eisha W.; Asma F.; Khan M.; Minhas A.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Vitamin K antagonists (VKAs) such as warfarin are
traditionally prescribed in patients with atrial fibrillation (AF) and
bioprosthetic valves (BPVs) to prevent thromboembolic events. However,
various studies have proposed novel oral anticoagulants (NOACs) as an
effective and safer option to use. Therefore, we conducted a systematic
review and meta-analysis to compare their relative efficacy and safety
profiles. <br/>Method(s): Pubmed, Cochrane Central, and Embase were
searched up until May 15, 2021 for randomized clinical trials (RCTs) and
observational studies determining efficacy and safety of NOACs or VKAs in
AF patients who had undergone BPV replacement. Outcomes of interest were:
stroke or systemic embolism (SSE), major bleeding, all-cause mortality,
and intracranial hemorrhage (ICH). Subgroup analysis by study design (RCT
and observational) was performed. Summary estimates were reported as
random effects risk ratios (RRs) with 95% confidence intervals (CIs).
<br/>Result(s): A total of 12 studies (4 RCTs and 8 observational) with
6436 patients (mean age 72.1 years; 51.4% males) were included in the
analysis. In comparison to VKAs, NOACs demonstrated a significant
reduction in ICH (RR 0.41 [95% CI 0.25,0.67]; p=0.0003; I²= 0%)
and major bleeding (RR 0.63 [95% CI 0.53,0.74]; p<0.00001; I²=
0%) at a mean duration follow up of 23.8 months. However, no difference
was observed in risk of SSE (RR 0.77 [95% CI 0.50,1.19]; p=0.23;
I²= 53%) and all-cause mortality (RR 0.98 [95% CI 0.78,1.22];
p=0.84; I²= 15%). Observational studies and RCTs did not
significantly differ across all outcomes in the subgroup analysis.
<br/>Conclusion(s): This meta-analysis suggests that NOACs are effective
at reducing risk of ICH and major bleeding in AF patients with BPVs in
contrast to VKAs. Future large-scale RCTs can aid in corroborating the
legitimacy of these results. (Figure Presented).

<38>
[Use Link to view the full text]
Accession Number
636895854
Title
Meta-analysis on left atrial appendage closure for atrial fibrillation
during cardiac surgery.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Prasad R.M.; Saleh Y.; Al-Abcha A.; Salam M.F.F.; Abdelkarim O.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The current guidelines indicate that left atrial appendage
(LAA) excision or exclusion during cardiac surgery has a class IIA
recommendation for atrial fibrillation. However, the short- and long-term
side effects are not well reported or defined. Methods/Results: We
conducted a meta-analysis of all studies that compared LAA exclusion
during cardiac surgery in patients with AF compared to a placebo arm. Five
randomized controlled trials (RCTs) and 23 observational studies were
included with a total of 540,111 patients. In regards to postoperative
stroke/embolic events, the LAA exclusion group had a significantly
decreased risk (risk ratio [RR] 0.75; 95% confidence interval [CI] 0.64 to
0.87; p=0.0002, I2=0%). This significantly reduced risk of stroke/embolic
events for the LAAC arm was also seen in both the perioperative period (RR
0.82, 95% CI 0.69 to 0.96, p=0.01, I2=41%) and when follow-up was greater
than two years (RR 0.70, 95% CI 0.57 to 0.85, p=0.0003, I2=39%). In terms
of all-cause mortality, there was no significant difference for the LAA
exclusion group in the early perioperative period (RR 0.84, 95% CI 0.56 to
1.28, p=0.42, I2=85%); however, it was significant after a follow-up of
greater than two years (RR 0.81, 95% CI 0.68 to 0.97, p=0.02, I2=79%).
<br/>Conclusion(s): This meta-analysis illustrates a significantly
decreased risk of postoperative stroke/embolic events in the perioperative
period and after a follow-up period greater than two years. Although the
early postoperative all-cause mortality did not show a significant
difference between the two groups, there was a significant decreased risk
in the LAA excision group after a follow-up duration of two years. (Figure
Presented).

<39>
[Use Link to view the full text]
Accession Number
636895807
Title
Cerebral embolic protection during transcatheter aortic valve
implantation: Updated systemic review and metaanalysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Zahid S.; Ubaid A.; Khan M.A.; Din M.T.U.; Muhammadzai H.Z.U.; Khan M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: In patient undergoing transcatheter aortic valve
implantation (TAVI), stroke remains a potentially devastating complication
associated with significant morbidity and mortality. Hypothesis: To reduce
the risk of stroke, cerebral protection devices (CPD) were developed to
prevent debris from embolizing to the brain during TAVI. The data on the
safety and efficacy of cerebral protection devices (CPD) remains limited.
<br/>Method(s): We performed a systemic review and meta-analysis to
determine the safety and efficacy of CPD in TAVI. The MEDLINE (PubMed,
Ovid) and Cochrane databases were queried with various combinations of
medical subject headings to identify relevant articles. Statistical
analysis was performed using a random-effects model to calculate
unadjusted odds ratio (OR). <br/>Result(s): Using a pooled analysis, CPD
was associated with a significant reduction in major adverse
cardiovascular events (MACE) (OR 0.69, 95% CI 0.50-0.96, p=0.03) and
stroke (OR 0.61, 95% CI 0.42-0.90, p=0.08) in patients undergoing TAVI.
Similarly, on MRI volume per lesion were lower for patients with CPD use
(SMD -0.79 [-1.30,-0.28], p<0.01). No significant difference were observed
in mortality (OR 0.97, 95% CI 0.60-1.55, p=0.88), acute kidney injury (OR
0.75, 95% CI 0.42-1.37, p=0.68), bleeding (OR 0.93, 95% CI 0.52-1.65,
p=0.80) or vascular complications (OR 0.90, 95% CI 0.62-1.31, p=0.6) for
patients undergoing TAVI with CPD. <br/>Conclusion(s): In conclusion, CPD
device use in TAVI is associated with a reduction of MACE and stroke
compared with patients undergoing TAVI without CPD.

<40>
[Use Link to view the full text]
Accession Number
636895765
Title
Novel oral anticoagulants versus Vitamin K antagonists in patients with
atrial fibrillation after transcatheter aortic valve replacement: A
systematic review and meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Memon M.; Siddiqui A.A.; Amin E.; Shaikh F.N.; Khan M.; Doukky R.;
Krasuski R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The efficacy and safety of novel oral anticoagulants (NOACs)
compared to the current guidelinerecommended vitamin K antagonists (VKAs)
in atrial fibrillation (AF) patients undergoing transcatheter aortic valve
replacement (TAVR) has not been well established. We pooled evidence from
all available studies to assess the risks and benefits of this drug class.
<br/>Method(s): We queried electronic databases (MEDLINE, Scopus, and
Cochrane central) up until 15 May 2021 for studies comparing NOACs to VKAs
in AF patients th undergoing TAVR. Results from studies were presented as
risk ratios (RR) with 95% confidence intervals (CI) and pooled using a
random-effects model. Subgroup analysis by study design and
meta-regression analysis were performed to explore heterogeneity.
<br/>Result(s): A total of 12 studies (4 RCTs and 8 retrospective
observational) containing 13,815 patients (mean age 81.1 years; 50.1% men)
were identified and included in the analysis. Pooled analysis revealed no
significant difference between NOACs and VKAs in terms of stroke or
systemic embolism (RR 0.83; p=0.34), major bleeding (RR 0.84; p=0.30),
intracranial hemorrhage (RR 0.72; p=0.60), all-cause mortality (RR 0.71;
p=0.15), and myocardial infarction (RR 1.34; p=0.32) at a mean length of
follow-up of 15.1 months. RCTs and observational studies did not
significantly differ across outcomes on subgroup analysis. Meta-regression
analysis found heterogeneity in all-cause mortality to be significantly
explained by percentage of males (coefficient: 0.049, p=0.007), mean age
(coefficient: 0.221, p<0.001), and CHA2DS2-VASc score (coefficient:
-1.657, p<0.001). <br/>Conclusion(s): This meta-analysis suggests that
outcomes with NOACs do not significantly differ compared to VKAs following
TAVR in patients with AF. Future RCTs may help provide a clearer answer.

<41>
[Use Link to view the full text]
Accession Number
636895701
Title
Agatston aortic valve calcium score and the prediction of transcatheter
aortic valve replacement complications: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Saleh Y.; Al-abcha A.; Faza N.N.; Little S.H.; Chang S.M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Aortic valve calcium score (AVCS) is used to determine
aortic stenosis severity, but whether it affects transcatheter aortic
valve replacement (TAVR) complications is not well studied.
<br/>Method(s): We conducted a literature search in PubMed using the key
words "Aortic valve", "Calcium score", "Aortic stenosis", "Computed
tomography"," Calcification", "Calcium", "TAVR", "TAVI", "Outcomes",
"Complications" up to December, 31 , 2020. Several studies assessed the
different factors affecting TAVR outcomes, of these, AVCS was usually
found to be one of them. Only a few studies investigated the effect of
AVCS on TAVR outcomes. We included studies classifying their patient
cohort into high and low AVCS. These studies used the Agatston AVCS
derived from non-contrast computed tomography (CT) in patients with native
aortic valves and they investigated the TAVR outcomes in both groups.
<br/>Result(s): Three studies were included in our metaanalysis with a
total number of 1839 patients. Our pooled analysis showed a similar risk
of 30-day mortality (low AVCS 2% vs high AVCS 2.5%, P=0.63), Permanent
pacemaker implantation (low AVCS 13.3 % vs high AVCS 11.9 %, P=0.73),
Stroke (low AVCS 2.54% vs high AVCS 2.3%, P=0.69), and Major vascular
complications (low AVCS 7.3% vs high AVCS 5.5%, P=0.60).
<br/>Conclusion(s): The severity of Aortic valve calcification calculated
by the Agatston AVCS had no impact on 30-day mortality, stroke, major
vascular complications, or the need for a permanent pacemaker after TAVR
is performed.

<42>
Accession Number
636895528
Title
The effect of diabetes on cardiovascular events after coronary artery
bypass grafting versus drug-eluting stents for left main coronary artery
disease: A meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
D'Entremont M.-A.; Yagi R.; Salia S.J.; Zhang S.; Shaban L.; Bene-Alhasan
Y.; Papatheodorou S.; Couture E.L.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimal method of coronary revascularization for diabetes
mellitus (DM) patients with left main coronary artery disease (LMCAD) is
controversial in the drug-eluting stent (DES) era. We performed a
systematic review and meta-analysis comparing DES-based percutaneous
coronary intervention (PCI) to coronary artery bypass grafting (CABG) for
LMCAD in DM patients and tested for potential effect measure modification
(EMM) by diabetes on major adverse cardiovascular and cerebrovascular
events (MACCE).Methods and Results: We included all randomized controlled
trials (RCTs) and observational studies comparing CABG to DES-based PCI
including DM patients with LMCAD published up to March 1, 2021. We
completed separate random-effects meta-analyses for four RCTs (4,356
patients, mean follow-up of 4.9 years) and six observational studies
(9,360 patients, mean follow-up of 5.2 years). DM and non-DM patients were
at increased risk of the composite endpoint of all-cause mortality,
myocardial infarction, stroke, and unplanned revascularization when
comparing CABG to DES-based PCI (p-value for interaction = 0.70) (Figure
1, DM =1, Non-DM =0). In observational studies, there was no difference
between DES-based PCI and CABG for all-cause mortality in patients with DM
(Figure 2). <br/>Conclusion(s): DES-based PCI was associated with an
increased risk of MACCE compared to CABG in LMCAD patients irrespectively
of DM status. We did not observe significant EMM by DM status. Considering
these data, heart teams could consider DM as one of the many components in
the clinical decision-making process, but not as a primary deciding factor
between DES and CABG for LMCAD.

<43>
Accession Number
636895461
Title
Improving the ability to assess and detect delirium in postoperative
cardiac surgery patients.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Ellis M.F.; Civale R.; Farrell D.; Simon J.; Mangodt L.; Awuku M.; Corbitt
S.; Thomas T.; Granger B.B.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Delirium is common in cardiac intensive care units due to
illness related stress, polypharmacy, interventions, excessive light and
noise, disorientation and sleep disruption. Delirium assessment is poor
due to limited nursing knowledge and the lack of integrated features in
electronic health platforms (EHR) to support accurate assessment and
documentation. Hypothesis: We hypothesized that education on use of the
Confusion Assessment Method for the ICU (CAM-ICU) and enhanced features in
the EHR would improve the ability to detect delirium in our CTICU.
<br/>Method(s): We conducted a QI intervention using a PDSA approach and
pre-post evaluation design. In the Planning phase audited 100 randomly
selected charts to determine baseline documentation of delirium. We
conducted a survey of nurses' knowledge of delirium and documentation
criteria and identified a knowledge deficit. In the Do phase, a
multi-stage educational initiative was used to address delirium awareness,
knowledge, and CAM-ICU documentation competency. Enhancements in the EHR
were made to enable accurate assessment, documentation and scoring using
embedded logic. Post-intervention audits (n=100) were performed.
<br/>Result(s): Survey respondents (n=64) averaged 31 years old (SD 1.4)
and had 6 years nursing experience on average (median=3, range <1-40).
Nurses believed patients with delirium had longer ICU LOS and worse
outcomes and patients would benefit from screening. Most lacked training
in delirium screening (88.1%, n=58). Baseline documentation of at least
one assessment of delirium was 44% (n=44) and post-intervention was 100%
(p<0.001). Accuracy of CAM-ICU assessments at baseline was challenging to
determine due to a single field (YES/NO/UTA) in the EHR, however,
positivity of pre-intervention assessments was 1% (n=1) and
post-intervention at least 1 positive CAM score was recorded in 33% (n=33)
of patients (p<0.001). <br/>Conclusion(s): Findings suggest that a
multi-stage educational intervention paired with EHR integrated scoring
logic improves awareness, knowledge and documentation accuracy for
delirium in the ICU, which may improve patient safety and ICU outcomes.
Better assessment and documentation may improve patient safety and ICU
outcomes.

<44>
[Use Link to view the full text]
Accession Number
636895410
Title
Genetic cardiomyopathy heart transplant outcomes.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
John S.; Hong K.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Data evaluating heart transplant (HT) outcomes in patients
with genetic cardiomyopathies is limited. Cardiac features are prominent
in these genetic disorders, resulting in progressive heart failure that
may be lethal without cardiac transplantation. However, no single center
has accumulated enough experience to investigate post-HT outcomes for
these rare cardiomyopathies. The primary aim of this review is to
synthesize literature investigating if HT is a viable treatment option for
genetic cardiomyopathies including Duchene Muscular dystrophy (DMD),
Becker's (BMD), Limb-Girdle (LGMD), Emery Dreifuss (EDMD); mitochondrial
disorders, Friederich's ataxia (FA), Barth's disorder and fatty acid
oxidation disorders (FAOD). <br/>Method(s): We performed a systematic
literature search of PubMed, EMBASE, and Google Scholar identifying
studies reporting HT outcomes published up to June 2021. <br/>Result(s): A
total of 42 articles were selected for review with 118 patients reported.
Patient data with age at HT, gender distribution, mean follow-up, reported
survival data, and post-operative outcomes are reported in Table 1.
Patients with DMD, BMD, LGMD, and EDMD had HT during the second and third
decade of life and were reported to have favorable survival outcomes at
one and five years. In FA, 11 patients underwent cardiac transplantation
at mean age 21.2 years with reported survival of 100% at one and five
years. Patients with Barth syndrome received HT at younger ages with mean
age 1.6 years. Mortality in these patients as well as mitochondrial
disorders were low even with longer reported follow-up time. Cardiac
transplants in FAOD were rare with one female receiving HT at the age of
27 months and was reported to be complication-free after 12 years.
<br/>Conclusion(s): This review suggests that post-transplantation
outcomes in genetic cardiomyopathy patients with multisystem involvement
are generally favorable, with high survival and few postoperative
complications.

<45>
Accession Number
636895385
Title
Meta-meta-analysis of outcomes of valve-in-valve TAVI compared to
redo-savr.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Altamimi A.; Khan N.; K Aedma S.; Raol K.; Raheem A.; Jain S.; Madireddy
S.; Ali N.; Rabbani R.; Rakholiya J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Redo-Surgical valve replacement (Redo-SAVR) is the gold
standard treatment for failed degenerated bioprosthetic valves. Recently
approved less invasive Valve-In-Valve Transcatheter Aortic Valve
Implantation (ViV-TAVI) procedure is becoming more popular but with
limited evidence of its safety and efficacy compared to redo-SAVR.
Hypothesis: We aimed to conduct the meta-meta analysis to evaluate the
outcomes of ViV-TAVI compared to redo-SAVR. <br/>Method(s): We conducted a
systematic search of meta-analysis studies assessing outcomes of ViV-TAVR
vs redo-SAVR using PubMed search engine and following PRISMA guidelines
from inception to May 2021. A meta-meta-analysis was performed by
obtaining a pooled odds ratio, 95% confidence interval (95%CI) using
random-effects models to analyze outcomes of 30-day all-cause mortality
and procedural mortality. <br/>Result(s): Nine meta-analysis studies were
included. We found that there was a significantly lower odds of 30-day
all-cause mortality (pooled OR:0.60; 95%CI:0.53-0.68; p<0.00001) with 0%
heterogeneity (I2= 0%;p=0.53) in the ViV-TAVI compared to redo-SAVR. We
also found a reduced risk of procedural mortality with ViV-TAVI compared
to redo-SAVR (pooled OR:0.52; 95%CI:0.27-0.98; p=0.04) with 0%
heterogeneity (I2= 0%;p=0.69) (Figure). <br/>Conclusion(s): ViV-TAVI is
significantly associated with reduced risk of 30-day all-cause mortality,
and procedural mortality compared to redo-SAVR. Our meta-metaanalysis
supports that minimally invasive ViV-TAVI is a safe and better procedure
for degenerated bioprosthetic valves in high-risk candidates.

<46>
[Use Link to view the full text]
Accession Number
636895306
Title
Doacs use in very elderly AF patients after tavr confers significant risk
of thromboembolic events.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Cerrud-Rodriguez R.C.; Wiley K.A.; Castillero I.; Goodwin A.; Saralidze
T.; Villablanca P.A.; Gonzalez M.; Terre J.; Wiley J.; Di Biase L.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: To assess the efficacy and safety of direct oral
anticoagulants (DOACs) versus vitamin K antagonists (VKA) in very elderly
patients with atrial fibrillation (AF) undergoing transcatheter aortic
valve replacement (TAVR). Two efficacy outcomes were used: all-cause
mortality and thromboembolic events (defined as stroke and/or transient
ischemic attack and/or systemic embolism and/or valve thromboses) and one
safety outcome: life-threatening or major bleeding events. There is a
discrepancy between the results of previous studies on the appropriate
anticoagulation regimen in patients with AF with CHA DS Vasc score>=2
undergoing TAVRMethods: A systematic review of Medline, Cochrane, and
Embase was done to find all studies in which the previously described
outcomes in AF patients undergoing TAVR were compared according to their
use of DOACs vs. VKA. <br/>Result(s): Six studies with a total 3,631
participants, mean follow-up 19+/-9.4 months (male: 30.3%, mean ages were
82.8+/-1.1 years and 82.2+/-1.5 years for the DOAC and the VKA groups,
respectively) were included in our analysis. No significant differences
were found between the DOAC and VKA group in all-cause mortality (Risk
Ratio [RR] 1.06, 95% Confidence Interval [CI] 0.84-1.35) or
life-threatening or major bleeding events (RR 1.02, 95% CI 0.83-1.25). A
significant increase in risk of thromboembolic events was found in the
DOAC group (RR 1.23, 95% CI 1.05-1.44). <br/>Conclusion(s): VKA should be
preferred over DOACs in very elderly patients with AF who undergo TAVR,
given the significantly increased risk in thromboembolic events seen with
DOACs and the lack of significant difference in all-cause mortality and
bleeding. RCTs are needed to confirm or refute our findings.

<47>
[Use Link to view the full text]
Accession Number
636895304
Title
Meta-analysis of direct oral anticoagulants versus vitamin k antagonists
in patients with atrial fibrillation and bioprosthetic valves.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Yokoyama Y.; Briasoulis A.; Ueyama H.; Mori M.; Iwagami M.; Misumida N.;
Takagi H.; Kuno T.
Publisher
Lippincott Williams and Wilkins
Abstract
Objective: The optimal anticoagulation strategy for patients with
bioprosthetic valves and atrial fibrillation remain uncertain. Thus, we
conducted a meta-analysis using updated evidence comparing direct
anticoagulants (DOAC) and vitamin K antagonist (VKA) in patients with
bioprosthetic valves and atrial fibrillation. <br/>Method(s): MEDLINE and
EMBASE were searched through March, 2021 to identify randomized control
trials (RCT) and observational studies that investigated the outcomes of
DOAC and VKA in patients with bioprosthetic valves and atrial
fibrillation. The outcomes of interest were all-cause death, major
bleeding, and stroke or systemic embolism. <br/>Result(s): Our analysis
included 4 RCTs and 6 observational studies which enrolled a total of
6,405 patients with bioprosthetic valves and atrial fibrillation assigned
to the DOAC group (n =2,142) and VKA (n =4,263). Pooled analysis
demonstrated the similar rates of all-cause death (HR [95% confidence
interval [CI]] =0.90 [0.77-1.05]; P =0.18; I²=0%)between the
DOAC and VKA groups. However, the rates of major bleeding were
significantly lower in the DOAC group compared to the VKA group (HR [95%
CI] =0.66 [0.48-0.89]; P =0.006; I²=0%) (Figure), while the
rates of stroke or systemic embolism were similar (HR [95% CI] =0.72
[0.44-1.17]; P =0.18; I²=39%). <br/>Conclusion(s): DOAC was
associated with lower rates of major bleeding without increasing the risk
of stroke or systemic embolism or all-cause death compared to VKA in
patients with bioprosthetic valves and atrial fibrillation.

<48>
Accession Number
636895230
Title
Clinical outcomes of fractional flow reserve (FFR) versus instantaneous
wave-free ratio (IFR) versus coronary angiography (CAG) guided
cardiovascular procedures, including pci (percutaneous coronary
intervention) and cabg (coronary artery bypass grafting): A systematic
review and meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Nso N.; Choudhary K.; Enoru S.; Marmur J.D.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Recent evidence from two systematic reviews and meta-analysis
advocates the superiority of fractional flow reserve (FFR) and
instantaneous wave-free ratio (iFR) guided PCI (percutaneous coronary
intervention) and CABG (Coronary Artery Bypass Grafting) in improving the
clinical outcomes of CAD (coronary artery disease) patients. We aimed to
expand this evidence and comparatively analyze the efficacy/safety of
FFR-guided, iFR-oriented, and CAG (coronary angiography)-guided PCI/CABG.
<br/>Method(s): We utilized PRISMA (Preferred Reporting Items for
Systematic Reviews and Meta-Analyses) framework and extracted randomized
controlled trials/ observational (retrospective/prospective studies)
concerning FFR/iFR/CAG-guided PCI/CABG on 05/27/2021. We explored JSTOR,
PubMed/Medline, Cochrane Library, EMBASE, Google Scholar, CINAHL, and
Scopus to identify and track the articles of interest published from
January 2005 until December 2020. We constructed forest plots and funnel
plots to investigate several clinical endpoints related to
FFR/iFR/CAG-oriented cardiovascular interventions. <br/>Result(s): The
meta-analysis results indicated higher potential of FFR-guided PCI/CABG to
minimize all-cause mortality (OR: 0.73, 95% CI 0.56, 0.94) (p=0.01),
cardiovascular death (OR: 0.73, 95% CI 0.43, 1.24) (p=0.25),
hospitalization (for heart failure, unstable angina, or chest pain) (OR:
0.73, 95% CI 0.42, 1.27), MACE (OR: 0.65, 95% CI 0.51, 0.82) (p=0.0005),
bleeding (OR: 0.72, 95% CI 0.24, 2.09), MI (OR: 0.85, 95% CI 0.73, 0.99),
and unplanned revascularization (OR: 0.61, 95% CI 0.40, 0.94) (p=0.03)
compared to CAG-guided cardiovascular procedures. The results also proved
non-inferiority of iFR-guided PCI/CABG to FFR-guided PCI/CABG (OR: 0.66,
95% CI 0.40, 1.11) (OR: 1.03, 95% CI 0.84, 1.27) (OR: 0.42, 95% CI 0.11,
1.62) (OR: 0.55, 95% CI 0.15, 2.05). <br/>Conclusion(s): The findings of
this systematic review/meta-analysis increase the scope of replacing
CAG-guided PCI/CABG with FFR/iFR-guided procedures to improve patient
outcomes. Future studies should strengthen current evidence concerning
FFR/iFR-guided cardiovascular interventions to enhance their utilization
across wider subsets of patients with coronary artery disease.

<49>
Accession Number
636895214
Title
Comparison of clinical outcomes in transcatheter aortic valve replacement
with edwards sapien 3 versus evolut series: A systematic review and
meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Krishan S.; Akhtar K.H.; Ijaz S.H.; Jafry A.; Yalamanchili S.; Nasir Y.M.;
Akhtar H.H.; Dani S.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The third generation transcatheter heart valve system aimed
to improve the safety of transcatheter aortic valve replacement (TAVR). We
performed systematic review and meta-analysis to compare clinical outcomes
after TAVR with Edwards Sapien 3 (ES3) and Evolut series (MER).
<br/>Method(s): A systematic search was conducted by 2 independent
researchers in MEDLINE and EMBASE for studies comparing clinical outcomes
after TAVR with ES3 and MER. 1 randomized controlled trial and 11
observational studies met the inclusion criteria. Mantel-Haenszel odds
ratios were calculated, and for heterogeneity I statistics were reported.
<br/>Result(s): 12 studies with total 7,749 patients were included for
final analysis. ES3 and MER were implanted in 4,333 and 3,416 patients
respectively. ES3 showed statistically significant decrease in permanent
pacemaker implantation at 30-days (OR: 0.60; 95% CI: 0.52-0.70; p< 0.05).
Furthermore, TAVR with ES3 showed non-statistically significant trend
towards decreased all-cause mortality at 30 days (OR: 0.73; 95% CI:
0.51-1.02; p=0.07), and stroke at 30 days (OR: 0.55; 95% CI: 0.27-1.10;
p=0.09). Cardiovascular mortality (OR: 1.03; 95% CI: 0.50-2.15; p=0.93),
and acute kidney injury (OR: 1.08; 95% CI: 0.83-1.41; p=0.56) did not show
statistically significant difference. <br/>Conclusion(s): While ES3 and
MER had similar clinical outcomes, patients undergoing TAVR with ES3 had
statistically significant decrease in permanent pacemaker implantation and
hence may be favored in patients with pre-existing conduction system
disease.

<50>
Accession Number
636895208
Title
Long-term outcomes of CABG versus medical therapy: A systematic review and
meta-analysis of 34350 patients with ischemic heart diseases.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Nso N.; Emmanuel K.; Nassar M.; Zirkiyeva M.; Choudhary K.; Enoru S.;
Rizzo V.; Munira M.S.; Marmur J.; Radparvar F.
Publisher
Lippincott Williams and Wilkins
Abstract
Background/Aim: Medical therapy (MT) and coronary artery bypass graft
(CABG) are valuable treatment options for patients with ischemic heart
diseases (IHD). However, their negative outcomes in the long-term are
poorly investigated. Therefore, we conducted this meta-analysis to
determine the long-term effects of both interventions. <br/>Method(s):
Till Nov 27, 2020, nine databases were searched for original articles
investigating MT versus CABG in patients with IHD. Primary outcomes
included mortality, survival, revascularization/additional treatment,
event-free survival (incidence of cardiovascular (CV) mortality,
myocardial infarction (MI), or refractory angina), cerebrovascular
accidents (CVA), and acute MI. Secondary outcomes included imaging
findings, such as left ventricular ejection fraction (LVEF). Cochrane's
revised tool (Version II) and ROBINS-I tool were used to assess the risk
of bias of randomized and non-randomized intervention studies,
respectively. <br/>Result(s): Fifteen studies were included in the
systematic review, while twelve studies (34350 patients) were analyzed.
CABG was associated with a significant reduction in all-cause mortality
(OR=0.61; 95%CI: 0.45-0.83) and significant improvement in survival
(OR=2.45; 95%CI: 1.61-3.73). The risk of acute MI (OR=0.44; 95%CI:
0.23-0.85) and the need for revascularization/additional treatment were
significantly lower in the CABG group. No significant differences were
noted as regards CV mortality (OR=0.64; 95%CI: 0.34- 1.17), CVA (OR=1.45;
95%CI: 0.56-3.75), event-free survival (OR=0.86; 95%CI: 0.22-3.39), and
LVEF (OR=-0.21; 95%CI: -1.48-1.6). Eleven studies had low risk, and four
studies had a high risk of bias. <br/>Conclusion(s): Compared to medical
therapy alone, CABG offers better long-term outcomes in terms of fewer
mortality rates, higher survival rates, and limited need for
revascularization or additional treatment.

<51>
[Use Link to view the full text]
Accession Number
636895172
Title
Optimal anticoagulation use in patients undergoing transcatheter mitral
valve replacement a quest for more data.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Vashistha K.; Tobaa A.; Elhamdani A.; Khalif A.; Doyle M.; Khalil R.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Multiple studies have demonstrated an increased risk of valve
thrombosis in patients with mitral valve prostheses. Data to guide
decision-making in regards to the choice of anticoagulation agent and
duration of the therapy is lacking. We present our single-center
experience with oral anticoagulation use in patients undergoing
transcatheter mitral valve replacement (TMVR). <br/>Method(s): 32 patients
underwent the TMVR procedure at our center from 1/1/2017 to 12/31/2020.
Data points on baseline characteristics, STSPROM, functional status (NYHA
and KCCQ), baseline laboratory values, echocardiographic parameters
(including LVEF, MV area, gradient, grading of MS, and MR was collected.
We analyzed patterns of anticoagulation therapy including the type of
agent, duration of therapy, and complications occurring related to
anticoagulation use. <br/>Result(s): Our registry included 32 patients
that underwent TMVR. 70.5 % were females, 96.8 % Caucasian with a mean
NYHA class of 3.25. STS-PROM of 6.25 (5.56-9.43) and KCCQ score of 38.04
(SD 19.9). Out of 32 patients, 31 had retrievable data. Vitamin K
antagonist (VKA) was used in 60 % (18), apixaban in 26.6 % (8),
rivaroxaban in 16.6 % (3), and no anticoagulation was used in 0.03 % (1)
of patients.74 % (22) of the patients were on anticoagulation at the time
of TMVR for another indication. 33.3% (6) of patients on VKA suffered a
complication such as gastrointestinal/genitourinary bleed, while 54.45%
(6) of patients on DOAC reported similar complications.
<br/>Conclusion(s): The choice of anticoagulant and optimal duration of
anticoagulation in patients undergoing TMVR remains a gap in our evidence
base. We present our single-center experience of anticoagulant use in this
patient population. Further randomized studies are needed to address this
knowledge gap.

<52>
Accession Number
636895155
Title
Transcatheter edge-to-edge mitral repair versus surgery in medicare
patients.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Chikwe J.; Roach A.; Egorova N.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: The optimal therapy for patients with primary mitral
regurgitation eligible for transcatheter mitral edge-to-edge repair (TEER)
and surgery is not known. This study compared mid-term outcomes of TEER
and mitral surgery for primary mitral regurgitation. <br/>Method(s):
Centers for Medicare and Medicaid data was used to identify 158,931 adults
who underwent mitral repair (42.9%, n=68,166) or TEER (14.5%, n=23,008)
between July 2012 and June 2019. Patients undergoing mitral replacement
(42.6%, n=67,757), previous mitral intervention (3.1%, n=4877), secondary,
rheumatic or infectious etiology (26.3%, n=41,821), coronary or valve
surgery (22.2%, n=35,438), and urgent procedures (15.6%, n=24,768) were
excluded, and 4550 propensity matched patient pairs created. The primary
outcome was 3-year survival. Stroke and mitral re-intervention were
compared using competing risk analysis, with a landmark analysis of new
atrial fibrillation (AF) after 30- days. <br/>Result(s): In the overall
cohort patients undergoing TEER were older, with worse comorbidity and
frailty than patients undergoing surgery. In propensity matched patients
mean age was 77.3 vs. 76.4 years (P=NS) and frailty score was 0.2 vs. 0.19
(P=NS). Three-year mortality after surgery was 14% (standard error (SE)
0.02) versus 34% (standard error (SE) 0.03) after TEER (p<0.0001)
(Figure). In competing risk analysis at three years stroke rates were
similar (hazard ratio (HR) 1.07, 95% confidence interval (CI) 0.80-1.45),
mitral reintervention was less common (HR 0.26, 95% CI 0.20-0.34); new AF
was significantly less common (HR 0.82, 95% CI 0.7-0.96) after surgical
repair compared to TEER. <br/>Conclusion(s): In propensity matched
patients with primary mitral regurgitation surgical mitral repair was
associated with superior survival, freedom from new AF and mitral
re-intervention. This treatment difference, which may be due to selection
bias, should be evaluated in randomized trials.

<53>
Accession Number
636895144
Title
Speckle tracking echocardiography changes in patients who developed atrial
fibrillation post coronary artery bypass grafting.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Renjithlal S.L.M.; Barssoum K.; Chowdhury M.; Hassib M.; Shankar A.;
Biswas S.; Kumar A.; Victor V.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Postoperative atrial fibrillation (POAF) is seen in around
30% of patients after coronary artery bypass grafting (CABG). It is
associated with increased risk for stroke, heart failure, in-hospital
mortality and hospital readmission. Prediction of POAF could help
institute preventive and early treatment strategies. <br/>Method(s): We
queried PubMed, Ovid Medline, and Cochrane databases for key words 'atrial
speckle tracking" and/or "reservoir strain" and/or "post-operative atrial
fibrillation". We included studies that included patients in normal sinus
rhythm before CABG and compared reservoir strain and/or peak atrial
longitudinal strain (PALS) between patients who developed POAF and those
who did not. Continuous data (LA strain) was pooled as a mean difference
comparing patients who developed POAF versus patients who did not. We used
the inverse variance method with the Restricted Maximum likelihood
estimator of Tau2, for random effect analysis. We used Q and I2 statistics
to calculate the heterogeneity. <br/>Result(s): Six observational studies
met our inclusion criteria with a total of 338 patients, of which 91
patients developed POAF. Left atrial reservoir strain was significantly
reduced in patients who developed POAF as compared with those who did not
develop POAF, mean difference(MD), 95% confidence interval(CI):
-13.97(-15.00-12.93), I2= 53%, , P <0.00001, Figure 1. <br/>Conclusion(s):
Atrial reservoir strain was significantly reduced in patients who
developed POAF as compared to those who remained in sinus rhythm. Atrial
reservoir strain can be potentially used to identify patients at risk of
POAF. More data is needed for further validation of this finding.

<54>
Accession Number
636895110
Title
A real-world comparison of percutaneous coronary intervention vs coronary
artery bypass in patients with chronic total occlusion.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Khan M.; Din M.T.U.; Roomi S.; Ullah W.; Virani S.S.; Hamzeh I.; Khalid
M.; Birnbaum Y.; Alam M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: There is a paucity of data comparing percutaneous coronary
intervention (PCI) and coronary artery bypass grafting (CABG) in patients
with chronic total occlusion (CTO) of the coronary arteries.
<br/>Method(s): The National Inpatient Sample (NIS) database was queried
to identify all CTO related hospitalizations from 2002-2018. Patients
undergoing PCI were compared with those having CABG for CTO using
CochranMantel-Haenszel statistics to determine unadjusted odds ratios
(OR). A propensity matched analysis (PSM) was used to determine adjusted
OR for major in-hospital outcomes. <br/>Result(s): A total of 404,563
patients with CTO were included in the analysis. Of these, 20,841 (5.6%)
patients underwent CABG whereas 383,722 (94.8%) underwent PCI. Patients in
the PCI group had a higher percentage of chronic obstructive pulmonary
disease, diabetes, coagulopathy, obesity and renal failure. On an
unadjusted analysis, the primary outcome of in-hospital mortality was
comparable between the two groups. The odds of stroke, acute kidney
injury, sepsis, major bleeding and need for IABP were higher with CABG,
whereas the odds of cardiopulmonary arrest and coronary artery dissection
were higher with PCI. On a propensity adjusted analysis, PCI was
associated with a higher mortality and comparable rate of major bleeding
and sepsis compared to CABG (Table). CABG, however, had a higher
hospitalization cost ($ 156113.03 vs. $ 103078.48, p=<0.0001), and a mean
length of stay (8.93 vs. 4.82 days, p=<0.0001) as compared to PCI.
<br/>Conclusion(s): Our findings show that CABG has a lower inpatient
mortality for CTO as compared to PCI, however it is associated with
increased risk of complications, higher cost and increased length of
hospitalization, highlighting the need for randomized data on the subject.

<55>
Accession Number
636895051
Title
Improvements in disease-specific and generic quality of life after
coronary artery bypass grafting surgery: A meta-analysis of randomized
trials.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Creber R.M.M.; Dimagli A.; Spadaccio C.; Myers A.; Moscarelli M.; Demetres
M.; Fremes S.E.; Gaudino M.F.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: We conducted a systematic review and meta-analysis to evaluate
the short and longterm effects of coronary artery bypass grafting (CABG)
on disease-specific and generic quality of life (QOL) and a quantitative
comparison from before surgery to up to five years after surgery across
contemporary randomized clinical trials. <br/>Method(s): We searched four
databases from 2010-2020 to identify all randomized clinical trials that
included the measurement of QOL in patients undergoing CABG. The QOL
assessments included the primary outcome, Seattle Angina Questionnaire
(SAQ), and secondary outcomes included Short Form Health Surveys (SF-36
Physical Component (PC) and Mental Component (MC)) and EQ-5D. A
random-effects model with an inverse variance method to pool the means and
the weighted mean differences was used. We used meta-regression to assess
the effects of covariates (sex, age, diabetes, and trial publication date)
on changes in QOL over time. <br/>Result(s): A total of 2,533 studies were
screened and 17 full-text studies were included in the metaanalysis. There
were significantly higher scores at 1-year postoperatively for the SAQ-AF,
SAQQOL, SF-36 PC, and EQ-5D (Figure). The weighted mean differences from
before surgery to the 1-year after was 24 (95% CI: 21.6-26.4) for the SAQ
AF; 31 (95% CI: 27.5-34.6) for the SAQ QOL; 9.8 (95% CI: 7.1-12.8) for the
SF-36 PC; and 0.1 (95% CI: 0.03-0.2) for the EQ-5D. The SF-36 MC did not
improve significantly. In the meta-regression, mean age was associated
with higher SAQ AF scores at five years and SAQ QOL scores at one year.
There was no evidence of publication bias or small study effect.
<br/>Conclusion(s): CABG is associated with short and long-term
improvements for both disease-specific QOL and generic QOL, with the
largest improvement in angina frequency from before surgery to 1-year.

<56>
Accession Number
636894938
Title
Costs of endoscopic vs open vein harvesting for coronary artery bypass
grafting: Insights from the regroup trial.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Wagner T.; Hattler B.; Stock E.; Biswas K.; Bhatt D.; Bakaeen F.; Zenati
M.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Endoscopic Vein Harvesting (EVH) provides comparable rates
in major adverse cardiac events to Open Vein Harvest (OVH) based on the
intermediate-term results of the REGROUP Trial. Value based purchasing
places more pressure to examine whether minimally invasive techniques,
e.g., EVH, yield intended or unintended economic effects. The objective of
this study was to compare health care costs between participants
randomized to EVH or OVH during coronary artery bypass graft (CABG)
surgery in the REGROUP trial. Hypothesis: We hypothesized that EVH would
result in lower discharge and follow-up costs compared to the traditional
OVH. <br/>Method(s): Department of Veterans Affairs Cooperative Studies
Program #588 (Clinicaltrials. gov NCT01850082) randomized 1150
participants (574 OVH, 576 EVH) at 16 VA medical centers. We linked
participants to VA administrative data in VA's Corporate Data Warehouse
and extracted activity-based cost data starting with the index surgery. We
analyzed discharge costs for the index surgery as well as follow-up costs
in 30-day periods for EVH vs. OVH, comparing results from different
statistical models to test for robustness. All costs were standardized to
2020 US dollars. <br/>Result(s): The unadjusted average cost for CABG
patients with EVH and OVH was $76,607 (SD $43,883) and $75,368 (SD
$45,900), respectively; the costs include both facility and provider
costs. Despite the skewed variation in costs, there were no significant
differences in discharge costs and high-cost patients were equally likely
in both groups. We also found no significant differences in follow-up
costs; the average follow-up period was 33 months (maximum follow-up was
85 months). The results were highly robust to the statistical model.
<br/>Conclusion(s): Endoscopic harvesting was not associated with a
reduction in costs for the index CABG surgery or follow-up care, nor was
it associated with increased costs through unintended events. Therefore,
the choice to provide endoscopic harvesting should be based on surgeon and
patient preferences.

<57>
[Use Link to view the full text]
Accession Number
636894919
Title
The use of direct oral anticoagulation therapy in transcatheter aortic
valve implantation in patients with concurrent indications for
anticoagulation; a systematic review and metaanalysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
El Iskandarani M.; Al Tamari A.; Khalid M.; Paul T.K.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: The optimal antithrombotic regimen in patients after
transcatheter aortic valve implantation (TAVI) in the setting of
concurrent indication for anticoagulation remains unclear. Recently
multiple studies have investigated the role of direct oral anticoagulation
therapy (DOAC) in comparison to Vitamin K antagonist (VKA) in this
category of patients. Therefore, we conducted a systematic review and
meta-analysis to evaluate the efficacy and safety of this
approachHypothesis: DOAC is a safe and effective alternative
anticoagulation therapy in TAVI patientsMethods: Unrestricted search of
the PubMed, EMBASE, and Cochrane databases from inception till June 1,
2021, for studies comparing DOAC with VKA in TAVR patients with concurrent
indication for anticoagulation. Relevant data were extracted and analyzed
using Revman 5.3 software. Relative Risk (RR) and 95% Confidence interval
(CI) were calculated using the random-effects model. <br/>Result(s): A
total of 8 studies (7 Observational, and 1 Randomized clinical trial) were
included examining 4,158 TAVI patients (1,500 DOAC vs 2,658 VKA). There
was no difference between DOAC and VKA in terms of all-cause mortality RR
0.89 (95% CI 0.65-1.21), all-bleeding events RR 0.90 (95% CI 0.76-1.07),
and stroke risk RR 1.42 (95% CI 0.96-2.11). <br/>Conclusion(s): DOAC is
probably non-inferior to VKA in TAVI patients with concurrent indications
for anticoagulation therapy. Further studies are needed to validate our
findings.

<58>
[Use Link to view the full text]
Accession Number
636894902
Title
Single versus dual antiplatelet post transcatheter aortic valve
replacement: An updated meta-analysis.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Khalid M.; El Iskandarani M.; Yar A.; Tahir A.; Tahir S.; Helton T.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Perioperative use of dual antiplatelet therapy (DAPT) after
transcatheter aortic valve replacement (TAVR) remains controversial. This
meta-analysis compares the safety and efficacy of single anti-antiplatelet
therapy (SAPT) versus DAPT after TAVR in patients with no indications for
long-term anticoagulation. Hypothesis: The use of SAPT is safe and
efficacious in TAVR patients. <br/>Method(s): Electronic databases were
queried for randomized controlled trials (RCTs) and observational studies
matching the inclusion criteria. The safety endpoints included bleeding
and major vascular complications. The efficacy outcomes included
myocardial infarction (MI), stroke, short and long-term all-cause
mortality. The ratio risk ratio (RR) with 95% confidence interval (CI) was
computed using a random-effect model. <br/>Result(s): A total of 4 RCTs
and 2 observational studies (n=1,417) were included in the final analysis.
There were decreased rates of bleeding (life-threatening or major) (RR:
0.44; CI: 0.31-0.63) with aspirin only therapy. However, there was no
difference of MI (RR: 0.73; CI: 0.28-1.87), stroke (RR: 0.92; CI:
0.55-1.54), major vascular complications (RR: 0.61; CI: 0.35-1.07),
short-term mortality (>30 days) (RR: 0.82; CI: 0.45-1.49), and long-term
mortality (>30 days) (RR: 1.13; CI: 0.73-1.76). <br/>Conclusion(s): This
analysis showed lower rates of bleeding and composite of
bleeding/thromboembolic events with aspirin only compared to dual
antiplatelet amongst patients that underwent TAVR for aortic stenosis.

<59>
Accession Number
636894751
Title
Clinical predictive models for cardiovascular disease should adjust for
race, ethnicity and social determinants of health to inform more equitable
interventions: Findings from a targeted review.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Snowdon J.L.; Scheufele E.L.; Pritts J.; Le P.-T.; Zhang X.; Dankwa-Mullan
I.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Clinical models of cardiovascular disease (CVD) that
incorporate relevant predictors can provide powerful insights into the
complex, inter-related mechanisms of CVD pathophysiology, risk for adverse
outcomes, and correlations with social determinants of health (SDoH) to
inform practice guidelines and targeted interventions. Despite the growing
body of evidence demonstrating the role of race, ethnicity and SDoH on CVD
outcomes, limited evidence exists about incorporating these factors into
models. Hypothesis: We assessed the hypotheses that clinical predictive
studies on CVD risk, outcomes, prognosis and treatment interventions: (1)
do not fully examine race, ethnicity and SDoH factors, and (2) may not
leverage adequate data sources fully representative of a population of
interest or may lack the decisional context to ensure robustness. These
are critical limitations that could lead to inaccurate predictions,
perpetuating bias and ultimately health and racial inequities.
<br/>Method(s): This targeted literature review yielded 533 potentially
relevant PubMed articles (2018- 2019) after duplicate removal. Article
titles and abstracts were reviewed for eligibility where 375 met the
exclusion criteria (age <18 years old, outside North America, no clinical
outcomes, language non-English) and were removed. The remaining 158
potentially relevant articles were screened and 116 met the criteria for
exclusion (e.g. stroke, heart transplant). After screening, 42 citations
were identified for full-text screening, of which 35 articles met criteria
for inclusion. <br/>Result(s): Studies employed advanced statistical and
machine learning methods to predict CVD risk (10/29%), mortality (19/54%),
survival (7/20%), complication (10/29%), disease progression (6/17%),
functional outcomes (4/11%) and disposition (2/6%). Most studies
incorporated sex (34/97%), co-morbid conditions (32/91%), and behavioral
risk factor (28/80%) variables. Race/ethnicity (23/66%) and SDoH variables
(e.g. education (3/9%)) were less frequently observed. <br/>Conclusion(s):
In conclusion, clinical risk and predictive models often do not adjust for
or consider race, ethnicity and SDoH to improve model accuracy to inform
more equitable interventions and decision-making.

<60>
Accession Number
636894424
Title
Renal and cardiac effects of remote ischemic preconditioning in children
undergoing cardiopulmonary bypass surgery.
Source
Circulation. Conference: American Hearts Association's 2021 Scientific
Sessions. Boston, MA United States. 144(SUPPL 1) (no pagination), 2021.
Date of Publication: November 2021.
Author
Law Y.M.; Hsu C.; Katz R.; Hingorani S.; Mcmullan D.; Richards M.;
Jeffries H.; Tian R.; Himmelfarb J.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Children undergoing cardiac surgery are at risk for AKI and
cardiac dysfunction affecting outcome. Improved surgical techniques and
post-operative care allow better outcomes in complex repairs and at-risk
patients. Opportunity exists in further protecting multiple end organ
function with remote ischemic preconditioning (RIPC) given promising but
mixed data in adults and children. Hypothesis: A non-invasive technique of
inducing reversible lower extremity ischemia with inflation of pressure
cuff lessens renal and myocardial injury. <br/>Method(s): A single center
randomized, placebo controlled, double blinded trial of RIPC in children
undergoing cardiac surgery of RACHS-1 category 2 or greater. RIPC was
performed in the operating room after anesthesia and before sternotomy.
Pre-specified end points are change in creatinine, eGFR, development of
AKI, B-type natriuretic peptide and Troponin I at 6, 12, 24, 48, 72 hours
post separation from bypass. Secondary end points included select clinical
outcomes. <br/>Result(s): There were 45 in the RIPC and 39 patients in the
control group: age was 3.5 and 3.8 years, respectively; 57 patients below
1 year of age; 35 patients below 1 month of age. There was no difference
between groups in creatinine, cystatin C, eGFR at each time points. There
was a trend for a larger rate of decrease, especially for cystatin C
(p=0.042) in the RIPC group but the magnitude was small. AKI was observed
in 21 (54%) of control and 16 (36%) of RIPC group (p=0.094). Adjusting for
baseline creatinine, the odds ratio for AKI in in RIPC compared to control
group was 0.31 (p=0.037). Adjusted for clinical characteristics, the odds
ratio was 0.34 (p=0.056). Peak troponin occurred at 6 hrs. Compared to
control, the RIPC group had a lower troponin at 6 hrs (p=0.140). However,
no difference in other analyses of troponin and B-type natriuretic
peptides between the groups. Length of stay, all-cause mortality, systolic
function by echocardiography and composite clinical end points of advanced
renal and heart failure were not different between groups.
<br/>Conclusion(s): There is suggestion of RIPC delivering renal
protection in an at-risk pediatric population. Additional larger, higher
risk population studies will be required to fully determine its efficacy.

<61>
Accession Number
2016431629
Title
Guideline No. 417: Prevention of Venous Thromboembolic Disease in
Gynaecological Surgery.
Source
Journal of Obstetrics and Gynaecology Canada. 44(1) (pp 82-96.e1), 2022.
Date of Publication: January 2022.
Author
Tafler K.; Kuriya A.; Gervais N.; Leyland N.
Institution
(Tafler, Gervais, Leyland) HamiltonONCanada
(Kuriya) OakvilleONCanada
Publisher
Elsevier Inc.
Abstract
Objective: The primary objective of this clinical practice guideline is to
provide gynaecologists with an algorithm and evidence to guide the use of
thromboprophylaxis in gynaecological surgery. Target Population: All
patients undergoing gynaecological surgery for benign or malignant
indications. Benefits, Harms, and Costs: The implementation of this
guideline will benefit patients undergoing gynaecological surgery and
provide physicians with a standard algorithm for the use of perioperative
thromboprophylaxis. Evidence: The following search terms were entered into
MEDLINE, Google Scholar, and Cochrane in 2017 and 2018: VTE, PE, DVT,
thromboprophylaxis, gynaecological surgery, heparin, graduated compression
stocking, intermittent pneumatic stocking, obesity, pediatrics, minimally
invasive surgery, heparin induced thrombocytopenia, regional anesthesia).
Articles included were randomized controlled trials, meta-analyses,
systematic reviews, and observational studies. Additional publications
were identified from the reference lists of these articles. There were no
date limits, but search results were limited to English language articles
only. Searches were updated and incorporated into the guideline up to
September 2018. Validation methods: The authors rated the quality of
evidence and strength of recommendations using the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) approach.
See online Appendix A (Tables A1 for definitions and A2 for
interpretations of strong and weak recommendations). Intended Users:
Gynaecologists and other members of the surgical team. RECOMMENDATIONS
(GRADE ratings in parentheses): 1 The risk of venous thromboembolism
should be considered pre-operatively and a standard approach to
prophylaxis should be encouraged through standardized order sets where
available (strong, moderate). A team approach is encouraged in difficult
cases. 2 Patients should be counselled about the risk of venous
thromboembolism and informed discharge should include discussion of the
signs and symptoms of venous thromboembolism along with the recommended
course of action should these occur (strong, moderate). 3 Patients should
be encouraged to ambulate as soon as possible (within the first 24 h)
after surgery in order to decrease the risk of venous thromboembolism
(strong, moderate). 4 Intermittent compression stockings, when available,
are preferred to graduated compression stockings (strong, moderate). 5
Either low-molecular-weight heparin or low-dose unfractionated heparin is
recommended as the first choice for pharmacological thromboprophylaxis in
most cases (strong, high). 6 For patients undergoing gynaecological
surgery for benign disease, postoperative low-dose unfractionated heparin
should be administered every 12 hours (twice daily) (strong, moderate).
For patients undergoing gynaecological surgery for malignant disease,
postoperative low-dose unfractionated should be administered every 8 hours
(3 times a day) (strong, moderate). 7 If patients with renal dysfunction
require pharmacological thromboprophylaxis, low-dose unfractionated
heparin is recommended (strong, high). The use of low-molecular-weight
heparin or fondaparinux is not recommended when creatinine clearance is
<30 mL/min (strong, high). 8 For patients at high risk for venous
thromboembolism and using low-molecular-weight heparin or low-dose
unfractionated heparin for thromboprophylaxis, continued dosing for 4
weeks postoperatively is recommended (strong, moderate). 9 In general,
patients already on low-dose aspirin for primary or secondary
cardiovascular prevention should discontinue it 5-7 days prior to surgery,
and restart once hemostasis is guaranteed. Patients on antiplatelet
therapy with recent cardiac stenting, coronary artery bypass graft, or
other significant cardiovascular disease may continue these agents after
consulting with the appropriate specialist for operative planning (strong,
low). 10 Thromboprophylaxis should be implemented based on the
pre-operative risk assessment as described in this guideline. For most
patients, mechanical prophylaxis is recommended with or without
pharmacotherapy based on risks and anticipated benefits (strong,
moderate). 11 When patients are both at high risk of venous
thromboembolism and at high risk for major bleeding complications, a team
approach including consultation with the department of medicine is
recommended (strong, moderate). There may be benefits to combining
intermittent pneumatic compression and graduated compression stockings in
this population (conditional, low). 12 For patients at high risk of venous
thromboembolism and with contraindication to heparins, the use of
fondaparinux and mechanical prophylaxis can be used (strong, moderate).
Increased surveillance for bleeding complications is recommended when
fondaparinux is used for thromboprophylaxis (strong, moderate). 13
Awareness of the risk of venous thromboembolism should be extended to
pediatric and adolescent patients and a team approach to venous
thromboembolism prophylaxis, involving a pediatrician and/or pediatric
hematologist, is recommended for patients at high risk (strong, low). 14
Dose adjustment of pharmacologic thromboprophylaxis is recommended for
patients with a BMI >40 kg/m² (strong, moderate). 15 There is
no indication for stopping hormone replacement therapy preoperatively, and
it is not necessary to stop oral contraceptives preoperatively in patients
who are at low risk for venous thromboembolism (strong, moderate). 16
Preoperative consultation with anesthesia is recommended when
pharmacologic thromboprophylaxis is indicated and regional anesthesia is
being considered (strong, very low).<br/>Copyright &#xa9; 2021

<62>
Accession Number
2014686337
Title
Dexmedetomidine versus propofol in reducing atrial fibrillation after
cardiac surgery.
Source
Egyptian Journal of Anaesthesia. 38(1) (pp 72-77), 2022. Date of
Publication: 2022.
Author
Abdallah O.; Salem M.I.; Gomaa M.
Institution
(Abdallah) Department of Anesthesia, General Organization for Teaching
Hospitals and Institutes, Damanhur, Egypt
(Salem) Department of Cardiothoracic Surgery, Port Said University, Port
Said, Egypt
(Gomaa) Department of Anesthesia and Surgical Intensive Care, Alexandria
University, Alexandria, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: Atrial fibrillation is a common complication associated with
cardiac surgery after cardiopulmonary bypass with a deleterious effect on
morbidity and mortality. The current study aimed to compare between
dexmedetomidine and propofol in reducing atrial fibrillation after cardiac
surgery. <br/>Design(s): A randomized prospective cohort study.
<br/>Setting(s): Conducted in Alexandria main university hospital.
<br/>Participant(s): 98 patients of either sex ASA II physical status aged
40-60 years. <br/>Intervention(s): All patients were subjected to either
propofol or dexmedetomidine infusion after cardiac surgery according to
the assigned group. <br/>Measurements and Main Results: The patients were
divided into two groups where first group received dexmedetomidine
infusion as postoperative sedation and the second group received propofol
infusion. Both groups were assessed for incidence of atrial fibrillation,
hypotension and length of intensive care stay. Incidence with atrial
fibrillation was 0.9% in dexmedetomidine group vs. 13% in propofol group
(P = 0.001) and intensive care stay was prolonged in propofol group 4.6
+/- 1.2 day vs. 2.7 +/- 1 for dexmedetomidine group (P = 0.002). There was
no statistically significant difference between both groups regarding
blood pressure or heart rate. <br/>Conclusion(s): The use of
dexmedetomidine for sedation after cardiac surgery was associated with a
lower incidence of atrial fibrillation and hence decreased the duration of
intensive care stay.<br/>Copyright &#xa9; 2022 The Author(s). Published by
Informa UK Limited, trading as Taylor & Francis Group.

<63>
Accession Number
2016458597
Title
Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and
Serological Parameters in Congenital Heart Surgery.
Source
Journal of Healthcare Engineering. 2021 (no pagination), 2021. Article
Number: 4650291. Date of Publication: 2021.
Author
Qin Z.; Xu Y.
Institution
(Qin) Surgical Anesthesia Center, TaiKang Tongji (Wuhan) Hospital, Hubei,
Wuhan 430000, China
(Xu) Department of Anesthesiology, Wuhan Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Hubei, Wuhan
430030, China
Publisher
Hindawi Limited
Abstract
In this study, we have investigated feasibility of remifentanil and
sufentanil anesthesia in children with congenital heart disease surgery
and its effects on cardiac function and serological parameters. For this
purpose, a retrospective study was conducted on 120 children with
congenital heart disease who underwent repair of ventricular septum or
atrial septum in our hospital, specifically from January 2016 to January
2018, and 60 patients in each group were randomly divided into the control
and treatment groups, respectively. The control group was anesthetized
with sufentanil, and the treatment group was anesthetized with
remifentanil. The heart function, serological indexes, and adverse
reactions were observed and compared. We have observed that there was no
significant difference in HR levels between these groups (P>0.05), but SDP
and DBP values of the two groups were decreased after anesthetic induction
(P<0.05). ACH, cortisol, and lactic acid in the treatment group were
significantly lower than those in the control group, and the difference
was statistically significant (P<0.05). The incidence of bradycardia,
nausea and vomiting, hypotension, muscle rigidity, and respiratory
depression in the treatment group was 16.67% lower than that in the
control group (P<0.05). Remifentanil has less influence on hemodynamics
and a better analgesic effect than fentanyl in inhibiting stress response
in congenital heart surgery, which provides reference and basis for
children congenital heart surgery. <br/>Copyright &#xa9; 2021 Zhigang Qin
and Younian Xu.

<64>
Accession Number
2016427814
Title
A systematic review of the evidence supporting post-operative
antithrombotic use following cardiopulmonary bypass in children with CHD.
Source
Cardiology in the Young. (no pagination), 2022. Date of Publication:
2022.
Author
Thompson E.J.; Foote H.P.; Li J.S.; Rotta A.T.; Goldenberg N.A.; Hornik
C.P.
Institution
(Thompson, Foote, Li, Rotta, Hornik) Department of Pediatrics, Duke
University, School of Medicine, Durham, NC, United States
(Li, Hornik) Duke Clinical Research Institute, Duke University, School of
Medicine, Durham, NC, United States
(Goldenberg) Department of Pediatrics and Medicine, Division of
Hematology, Johns Hopkins University, School of Medicine, Baltimore, MD,
United States
(Goldenberg) Institute for Clinical and Translational Research, Cancer and
Blood Disorders Institute, Heart Institute, Johns Hopkins All Children's
Hospital, St. Petersburg, FL, United States
Publisher
Cambridge University Press
Abstract
Objectives: To determine the optimal antithrombotic agent choice, timing
of initiation, dosing and duration of therapy for paediatric patients
undergoing cardiac surgery with cardiopulmonary bypass. <br/>Method(s): We
used PubMed and EMBASE to systematically review the existing literature of
clinical trials involving antithrombotics following cardiac surgery from
2000 to 2020 in children 0-18 years. Studies were assessed by two
reviewers to ensure they met eligibility criteria. <br/>Result(s): We
identified 10 studies in 1929 children across three medications classes:
vitamin K antagonists, cyclooxygenase inhibitors and indirect thrombin
inhibitors. Four studies were retrospective, five were prospective
observational cohorts (one of which used historical controls) and one was
a prospective, randomised, placebo-controlled, double-blind trial. All
included were single-centre studies. Eight studies used surrogate
biomarkers and two used clinical endpoints as the primary endpoint. There
was substantive variability in response to antithrombotics in the
immediate post-operative period. Studies of warfarin and aspirin showed
that laboratory monitoring levels were frequently out of therapeutic range
(variably defined), and findings were mixed on the association of these
derangements with bleeding or thrombotic events. Heparin was found to be
safe at low doses, but breakthrough thromboembolic events were common.
<br/>Conclusion(s): There are few paediatric prospective randomised
clinical trials evaluating antithrombotic therapeutics post-cardiac
surgery; most studies have been observational and seldom employed clinical
endpoints. Standardised, validated endpoints and pragmatic trial designs
may allow investigators to determine the optimal drug, timing of
initiation, dosing and duration to improve outcomes by limiting
post-operative morbidity and mortality related to bleeding or thrombotic
events.<br/>Copyright &#xa9; The Author(s), 2022. Published by Cambridge
University Press

<65>
Accession Number
2014718407
Title
Rapid deployment technology versus conventional sutured bioprostheses in
aortic valve replacement.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Salmasi M.Y.; Ramaraju S.; Haq I.; B. Mohamed R.A.; Khan T.; Oezalp F.;
Asimakopoulos G.; Raja S.G.
Institution
(Salmasi, Ramaraju, Haq) Department of Surgery, Imperial College London,
United Kingdom
(Salmasi, B. Mohamed, Khan, Oezalp, Asimakopoulos, Raja) Department of
Cardiac Surgery, Royal Brompton and Harefield Trust, London, United
Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Despite the benefits of rapid deployment aortic valve
prostheses (RDAVR), conventional sutured valves (cAVR) are more commonly
used in the treatment for aortic stenosis. Given the paucity of randomized
studies, this study aimed to synthesize available data to compare both
treatment options. <br/>Method(s): A systematic search of Pubmed, OVID,
and MEDLINE was conducted to retrieve comparative studies for RDAVR versus
cAVR in the treatment of aortic stenosis. Out of 1773 returned titles, 35
papers were used in the final analysis, including 1 randomized study, 1
registry study, 6 propensity-matched studies, and 28 observational
studies, incorporating a total of 10,381 participants (RDAVR n = 3686;
cAVR n = 6310). <br/>Result(s): Random-effects meta-analysis found no
difference between the two treatment groups in terms of operative
mortality, stroke, or bleeding (p >.05). The RDAVR group had reduced
cardiopulmonary bypass (standardized mean difference [SMD]: -1.28, 95%
confidence interval [CI]: [-1.35, -1.20], p <.001) and cross-clamp times
(SMD: -1.05, 95% CI: [-1.12, -0.98], p <.001). Length of stay in the
intensive care unit was also shorter in the RDAVR group (SMD: -0.385, 95%
CI: [-0.679, -0.092], p =.010). The risk of pacemaker insertion was higher
for RDAVR (odds ratio [OR]: 2.41, 95% CI: [1.92, 3.01], p <.001) as was
the risk of paravalvular leak (PVL) at midterm follow-up (OR: 2.52, 95%
CI: [1.32, 4.79], p =.005). Effective orifice area and transvalvular
gradient were more favorable in RDAVR patients (p >.05).
<br/>Conclusion(s): Despite the benefits of RDAVR in terms of reduced
operative time and enhanced recovery, the risk of pacemaker insertion and
midterm PVL remains a significant cause for concern.<br/>Copyright &#xa9;
2022 The Authors. Journal of Cardiac Surgery published by Wiley
Periodicals LLC.

<66>
Accession Number
2014717012
Title
Are outcomes in congenital cardiac surgery better than ever?.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Holcomb R.M.; Undar A.
Institution
(Holcomb, Undar) Penn State Hershey Pediatric Cardiovascular Research
Center, Departments of Pediatrics, Penn State College of Medicine, Penn
State Health Children's Hospital, Hershey, PA, United States
(Holcomb) Surgery, Penn State College of Medicine, Penn State Health
Children's Hospital, Hershey, PA, United States
(Undar) Biomedical Engineering, Penn State College of Medicine, Penn State
Health Children's Hospital, Hershey, PA, United States
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim of the Study: Congenital heart disease is the most
common congenital defect among infants born in the United States. Within
the first year of life, 1 in 4 of these infants will need surgery. Only
one generation removed from an overall mortality of 14%, many changes have
been introduced into the field. Have these changes measurably improved
outcomes?. <br/>Method(s): The literature search was conducted through
PubMed MEDLINE and Google Scholar from inception to October 31, 2021.
Ultimately, 78 publications were chosen for inclusion. <br/>Result(s): The
outcome of overall mortality has experienced continuous improvements in
the modern era of the specialty despite the performance of more
technically demanding surgeries on patients with complex comorbidities.
This modality does not account for case-mix, however. In turn, clinical
outcomes have not been consistent from center to center. Furthermore,
variation in practice between institutions has also been documented. A
recurring theme in the literature is a movement toward standardization and
universalization. Examples include mortality risk-stratification that has
allowed direct comparison of outcomes between programs and improved
definitions of morbidities which provide an enhanced framework for
diagnosis and management. <br/>Conclusion(s): Overall mortality is now
below 3%, which suggests that more patients are surviving their
interventions than in any previous era in congenital cardiac surgery.
Focus has transitioned from survival to improving the quality of life in
the survivors by decreasing the incidence of morbidity and associated
long-term effects. With the transformation toward standardization and
interinstitutional collaboration, future advancements are
expected.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC

<67>
Accession Number
636724015
Title
Association between Antimicrobial Prophylaxis with Double-Dose Cefuroxime
and Surgical Site Infections in Patients Weighing 80 kg or More.
Source
JAMA Network Open. 4(12) (no pagination), 2021. Article Number: e2138926.
Date of Publication: 15 Dec 2021.
Author
Sommerstein R.; Atkinson A.; Kuster S.P.; Vuichard-Gysin D.; Harbarth S.;
Troillet N.; Widmer A.F.
Institution
(Sommerstein, Atkinson) Department of Infectious Diseases, Bern University
Hospital, University of Bern, Bern, Switzerland
(Sommerstein, Vuichard-Gysin, Harbarth, Troillet, Widmer) Swissnoso,
National Center for Infection Control, Bern, Switzerland
(Sommerstein) Department of Health Sciences and Medicine, University of
Lucerne, Lucerne, Switzerland
(Kuster) University of Zurich, Zurich, Switzerland
(Vuichard-Gysin) Infectious Diseases, Cantonal Hospital Thurgau,
Switzerland
(Harbarth) Infection Control Program, Geneva University Hospitals, Faculty
of Medicine, Geneva, Switzerland
(Troillet) Service of Infectious Diseases, Central Institute, Valais
Hospitals, Sion, Switzerland
(Widmer) Department of Infectious Diseases, University Hospital Basel,
Basel, Switzerland
Publisher
American Medical Association
Abstract
Importance: Many guidelines recommend a weight-adopted dose increase of
cefuroxime for surgical antimicrobial prophylaxis (SAP). However, the
evidence that this approach is associated with lower rates of surgical
site infection (SSI) is limited. <br/>Objective(s): To assess whether
double-dose cefuroxime SAP was associated with a decreased SSI rate in
patients weighing at least 80 kg. <br/>Design, Setting, and
Participant(s): This cohort study included adult patients (>18 years)
weighing at least 80 kg who underwent 9 major surgical procedures with a
cefuroxime SAP administration from the Swissnoso SSI surveillance system
between January 2015 and December 2019 at 142 Swiss hospitals. The
follow-up was 30 days for all surgical procedures and 1 year for
implant-related operations. Exposures: Cefuroxime SAP dose (1.5 vs 3.0 g).
<br/>Main Outcomes and Measures: Overall SSI. A mixed-effects logistic
regression adjusted for institutional, epidemiological, and perioperative
variables was applied. Results were stratified by weight categories as
well as by wound contamination classes. <br/>Result(s): Of 41076 eligible
patients, 37640 were included, with 22625 (60.1%) men and a median (IQR)
age of 61.9 (49.9-71.1) years. The outcome SSI was met by 1203 patients
(3.2%). Double-dose cefuroxime was administered to 13246 patients (35.2%)
and was not significantly associated with a lower SSI rate (adjusted odds
ratio [aOR], 0.89; 95% CI, 0.78-1.02; P =.10). After stratification by
weight category, double-dose SAP vs single-dose SAP was associated with
lower SSI rates among 16605 patients weighing at least 80 to less than 90
kg (aOR, 0.76; 95% CI, 0.61-0.97; P =.02) but not in the other weight
categories (>=90 to <100 kg, 10342 patients: aOR, 1.12; 95% CI, 0.87-1.47;
P =.37; >=100 to <120 kg, 8099 patients: aOR, 0.99; 95% CI, 0.76-1.30; P
=.96; >=120 kg, 2594 patients: aOR, 0.65; 95% CI, 0.42-1.04; P =.06).
After stratification by contamination class, double-dose SAP was
associated with lower SSI rates among 1946 patients with contaminated
wounds (aOR, 0.49; 95% CI, 0.30-0.84; P =.008) but not those with clean
wounds (25680 patients; aOR, 0.92; 95% CI, 0.76-1.12; P =.44) or
clean-contaminated wounds (10014 patients; aOR, 0.90; 95% CI, 0.73-1.12; P
=.37) compared with a single dose. <br/>Conclusions and Relevance: In this
study, double-dose SAP with cefuroxime for patients weighing at least 80
kg was not consistently associated with a lower SSI rate..<br/>Copyright
&#xa9; 2021 American Medical Association. All rights reserved.

<68>
Accession Number
2014242358
Title
Predictors for the risk of permanent pacemaker implantation after
transcatheter aortic valve replacement: A systematic review and
meta-analysis.
Source
Journal of Cardiac Surgery. 37(2) (pp 377-405), 2022. Date of Publication:
February 2022.
Author
Wang T.; Ou A.; Xia P.; Tian J.; Wang H.; Cheng Z.
Institution
(Wang, Xia, Tian) Department of Cardiovascular Medicine, The Fourth
Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
(Ou) Department of Radiology, Shengjing Hospital of China Medical
University, Shenyang, Liaoning, China
(Wang) Department of Emergency Medicine, The First Affiliated Hospital of
Lanzhou Medical University, Lanzhou, China
(Cheng) Department of Cardiac Surgery, West China Hospital, Sichuan
University, Chengdu, Sichuan, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is a less
invasive treatment than surgery for severe aortic stenosis. However, its
use is restricted by the fact that many patients eventually require
permanent pacemaker implantation (PPMI). This meta-analysis was performed
to identify predictors of post-TAVR PPMI. <br/>Method(s): The PubMed,
Embase, Web of Science, and Cochrane Library databases were systematically
searched. Relevant studies that met the inclusion criteria were included
in the pooling analysis after quality assessment. <br/>Result(s): After
pooling 67 studies on post-TAVR PPMI risk in 97,294 patients,
balloon-expandable valve use was negatively correlated with PPMI risk
compared with self-expandable valve (SEV) use (odds ratio [OR]: 0.44, 95%
confidence interval [CI]: 0.37-0.53). Meta-regression analysis revealed
that history of coronary artery bypass grafting and higher Society of
Thoracic Surgeons (STS) risk score increased the risk of PPMI with SEV
utilization. Patients with pre-existing cardiac conduction abnormalities
in 28 pooled studies also had a higher risk of PPMI (OR: 2.33, 95% CI:
1.90-2.86). Right bundle branch block (OR: 5.2, 95% CI: 4.37-6.18) and
first-degree atrioventricular block (OR: 1.97, 95% CI: 1.38-2.79) also
increased PPMI risk. Although the trans-femoral approach was positively
correlated with PPMI risk, the trans-apical pathway showed no statistical
difference to the trans-femoral pathway. The approach did not increase
PPMI risk in patients with STS scores >8. Patient-prosthesis mismatch did
not influence post-TAVR PPMI risk (OR: 0.88, 95% CI: 0.67-1.16). We also
analyzed implantation depth and found no difference between patients with
PPMI after TAVR and those without. <br/>Conclusion(s): SEV selection,
pre-existing cardiac conduction abnormality, and trans-femoral pathway
selection are positively correlated with PPMI after TAVR. Pre-existing
left bundle branch block, patient-prosthesis mismatch, and implantation
depth did not affect the risk of PPMI after TAVR.<br/>Copyright &#xa9;
2021 Wiley Periodicals LLC

<69>
Accession Number
2014159169
Title
Isolated tricuspid valve surgery-Repair versus replacement: A
meta-analysis.
Source
Journal of Cardiac Surgery. 37(2) (pp 329-335), 2022. Date of Publication:
February 2022.
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

<70>
Accession Number
2015243958
Title
Biomarkers-in-Cardiology 8 RE-VISITED-Consistent Safety of Early Discharge
with a Dual Marker Strategy Combining a Normal hs-cTnT with a Normal
Copeptin in Low-to-Intermediate Risk Patients with Suspected Acute
Coronary Syndrome-A Secondary Analysis of the Randomized
Biomarkers-in-Cardiology 8 Trial.
Source
Cells. 11(2) (no pagination), 2022. Article Number: 211. Date of
Publication: January-2 2022.
Author
Giannitsis E.; Garfias-Veitl T.; Slagman A.; Searle J.; Muller C.;
Blankenberg S.; Haehling S.V.; Katus H.A.; Hamm C.W.; Huber K.; Vollert
J.O.; Mockel M.
Institution
(Giannitsis, Katus) Medizinische Klinik III, Department of Cardiology,
Angiology and Pulmology, University Hospital of Heidelberg, Heidelberg
69120, Germany
(Garfias-Veitl, Haehling) Department of Cardiology and Pneumology,
University of Gottingen Medical Center, German Center for Cardiovascular
Research (DZHK), Partner site Gottingen, Gottingen 37075, Germany
(Slagman, Searle, Mockel) Department of Emergency Medicine Campus Mitte
and Virchow and Department of Cardiology, Charite-Universitatsmedizin,
Berlin 13353, Germany
(Muller) Cardiovascular Research Institute Basel (CRIB) and Department of
Cardiology, University Hospital Basel, University of Basel, Basel 4031,
Switzerland
(Blankenberg) Department of Cardiology, University Heart and Vascular
Centre Hamburg, Hamburg 20251, Germany
(Hamm) Department of Cardiology, University of Giessen, Campus Kerckhoff,
Bad Nauheim 61231, Germany
(Huber) 3rd Department of Internal Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Vienna 1060, Austria
(Vollert) BRAHMS GmbH Deutschland, Berlin 16761, Germany
Publisher
MDPI
Abstract
Regarding the management of suspected Non-ST-segment-elevation acute
coronary syndrome (ACS), the main Biomarker-in-Cardiology (BIC)-8
randomized controlled trial study had reported non-inferiority for the
incidence of major adverse cardiac events at 30 days in the Copeptin group
(dual marker strategy of copeptin and hs-cTnT at presentation) compared to
the standard process (serial hs-cTnT testing). However, in 349 (38.7%) of
the 902 patients, high-sensitivity cardiac troponin was not available for
the treating physicians. High sensitivity cardiac troponin T was
remeasured from thawed blood samples collected at baseline. This cohort
qualified for a re-analysis of the 30-day incidence rate of MACE (death,
survived cardiac death, acute myocardial infarction, re-hospitalization
for acute coronary syndrome, acute unplanned percutaneous coronary
intervention, coronary bypass grafting, or documented life-threatening
arrhythmias), or components of the primary endpoint including death or
death/MI. After re-measurement of troponin and exclusion of 9 patients
with insufficient blood sample volume, 893 patients qualified for
re-analysis. A total of 57 cases were detected with high sensitivity
cardiac troponin T >= 14 ng/L who had been classified as "troponin
negative" based on a conventional cardiac troponin T or I < 99th
percentile upper limit of normal. Major adverse cardiac events rates after
exclusion were noninferior in the Copeptin group compared to the standard
group (4.34% (95% confidence intervals 2.60-6.78%) vs. 4.27% (2.55-6.66%).
Rates were 53% lower in the per-protocol analysis (HR 0.47, 95% CI:
0.18-1.15, p = 0.09). No deaths occurred within 30 days in the discharged
low risk patients of the Copeptin group. Copeptin combined with high
sensitivity cardiac troponin is useful for risk stratification and allows
early discharge of low-to-intermediate risk patients with suspected acute
coronary syndrome is as safe as a re-testing strategy at 3 h or
later.<br/>Copyright &#xa9; 2022 by the authors. Licensee MDPI, Basel,
Switzerland.

<71>
[Use Link to view the full text]
Accession Number
2016329815
Title
The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine
Antiseptics for the Prevention of Infection in Clean Surgery: A Systematic
Review and Network Meta-analysis.
Source
Annals of Surgery. 274(6) (pp E481-E488), 2021. Date of Publication: 01
Dec 2021.
Author
Wade R.G.; Burr N.E.; Mccauley G.; Bourke G.; Efthimiou O.
Institution
(Wade, Mccauley, Bourke) Department of Plastic and Reconstructive Surgery,
Leeds Teaching Hospitals Trust, Leeds, United Kingdom
(Wade, Burr, Mccauley, Bourke, Efthimiou) Faculty of Medicine and Health
Sciences, University of Leeds, Leeds, United Kingdom
(Burr) Cancer Epidemiology Group, Institute of Cancer and Pathology and
Institute of Data Analytics, University of Leeds, United Kingdom
(Wade, Burr, Mccauley, Bourke, Efthimiou) Mid Yorkshire Hospitals NHS
Trust, Pinderfields General Hospital, Wakefield, United Kingdom
(Efthimiou) Institute of Social and Preventive Medicine, University of
Bern, Switzerland
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:There is uncertainty around preoperative skin antisepsis in
clean surgery. Network meta-analysis provides more precise estimates than
standard pairwise meta-analysis and can rank interventions by efficacy, to
better inform clinical decisions. <br/>Background(s):Infection is the most
common and costly complication of surgery. The relative efficacy of CHG
and PVI based skin antiseptics in clean surgery remains unclear.
<br/>Method(s):We searched for randomized or nonrandomized studies
comparing the effect of different preparations of CHG and PVI on the
dichotomous outcome of surgical site infection. We included studies of
adults undergoing clean surgery. We excluded studies concerning indwelling
vascular catheters, blood sampling, combination antiseptics or sequential
applications of different antiseptics. We performed a network
meta-analysis to estimate the relative efficacy of interventions using
relative risks (RR). <br/>Result(s):We included 17 studies comparing 5
antiseptics in 14,593 individuals. The overall rate of surgical site
infection was 3%. Alcoholic CHG 4%-5% was ranked as the most effective
antiseptic as it halved the risk of surgical site infection when compared
to aqueous PVI [RR 0.49 (95% confidence interval 0.24, 1.02)] and also to
alcoholic PVI, although uncertainty was larger [RR 0.51 (95% confidence
interval 0.21, 1.27)]. Adverse events related to antiseptic application
were only observed with patients exposed to PVI.
<br/>Conclusion(s):Alcoholic formulations of 4%-5% CHG seem to be safe and
twice as effective as PVI (alcoholic or aqueous solutions) in preventing
infection after clean surgery in adults. Our findings concur with the
literature on contaminated and clean-contaminated surgery, and endorse
guidelines worldwide which advocate the use of alcoholic CHG for
preoperative skin antisepsis.Registration:PROSPERO ID
CRD42018113001.<br/>Copyright &#xa9; 2020 The Author(s). Published by
Wolters Kluwer Health, Inc

<72>
Accession Number
2007164350
Title
Treatment options for ischemic mitral regurgitation: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(2) (pp 607-622.e14),
2022. Date of Publication: February 2022.
Author
Nappi F.; Antoniou G.A.; Nenna A.; Michler R.; Benedetto U.; Avtaar Singh
S.S.; Gambardella I.C.; Chello M.
Institution
(Nappi) Department of Cardiac Surgery, Centre Cardiologique du Nord de
Saint-Denis, Paris, France
(Antoniou) Department of Vascular and Endovascular Surgery, The Royal
Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, United
Kingdom
(Antoniou) Division of Cardiovascular Sciences, School of Medical
Sciences, University of Manchester, Manchester, United Kingdom
(Nenna, Chello) Department of Cardiovascular Surgery, University Campus
Bio-Medico of Rome, Rome, Italy
(Michler) Department of Surgery and Cardiothoracic and Vascular Surgery,
Montefiore Medical Center, Albert Einstein College of Medicine, New York,
NY, United States
(Benedetto) Department of Cardiothoracic Surgery, Bristol Heart Institute,
University of Bristol, Bristol, United Kingdom
(Avtaar Singh) Department of Cardiac Surgery, Golden Jubilee National
Hospital, Glasgow, United Kingdom
(Gambardella) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Treatment of ischemic mitral regurgitation (IMR) is in
evolution, as percutaneous procedures and complex surgical repair have
been recently investigated in randomized clinical trials and matched
studies. This study aims to review and compare the current treatment
options for IMR. <br/>Method(s): A comprehensive literature search was
conducted using electronic databases. The primary outcome was all-cause
long-term mortality. The secondary outcomes were perioperative mortality,
unplanned rehospitalization, reoperation, and composite end points as
defined in the original articles. <br/>Result(s): A total of 12 articles
met the inclusion criteria and were included in the final meta-analysis.
The MitraClip procedure did not confer a significant benefit in mortality
and repeated hospitalization compared with medical therapy alone. In
patients with moderate IMR, the adjunct of mitral procedure over coronary
artery bypass graft is not associated with clinical improvements. When
evaluating mitral valve (MV) replacement versus repair, hospital mortality
was greater among patients undergoing replacement (odds ratio [OR], 1.91;
P = .009), but both reoperation and readmission rates were lower (OR,
0.60, P = .05; and OR, 0.45, P < .02, respectively). Comparing restrictive
annuloplasty alone with adjunctive subvalvular repair, subvalvular
procedures resulted in fewer readmissions (OR, 0.50; P = .06) and adverse
composite end points (P = .009). <br/>Conclusion(s): MitraClip procedure
is not associated with improved outcomes compared with medical therapy. MV
replacement is associated with increased early mortality but reduced
reoperation rate and readmission rate compared with MV repair using
annuloplasty in moderate-to-severe IMR. Despite no significant benefit in
isolated outcomes comparing annular and adjunct subvalvular procedures,
the adjunct of subvalvular procedures reduces the risk of major
postoperative adverse events.<br/>Copyright &#xa9; 2020 The American
Association for Thoracic Surgery

<73>
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.

<74>
Accession Number
636641506
Title
Preoperative Sucrosomial Iron Supplementation Increases Haemoglobin and
Reduces Transfusion Requirements in Elective Heart Surgery Patients: A
Prospective Randomized Study.
Source
Surgical technology international. 39 (pp 321-328), 2021. Date of
Publication: 28 Oct 2021.
Author
Pierelli L.; De Rosa A.; Falco M.; Papi E.; Rondinelli M.B.; Turani F.;
Weltert L.
Institution
(Pierelli) Dipartimento di Medicina Sperimentale, Sapienza University,
Rome, Italy
(Pierelli, De Rosa, Rondinelli) Transfusion Medicine, San Camillo
Forlanini Hospital, Rome, Italy
(Falco, Papi) Department of Anesthesiology, European Hospital, Rome, Italy
(Papi, Turani) Department of Anesthesiology, Aurelia Hospital, Rome, Italy
(Papi, Weltert) San Camillus International University for Health Sciences,
Rome, Italy
Publisher
NLM (Medline)
Abstract
BACKGROUND: Low preoperative haemoglobin is frequently observed in heart
surgery patients and is associated with a significant decrease in
haemoglobin between post-operative days 2 and 3, known as haemoglobin
drift. Overall, these patients tend to receive many RBC transfusions.
Since iron homeostasis is often impaired in these patients, restoration of
iron availability might override iron-restricted erythropoiesis. However,
reduced tolerance to oral iron salts has limited this strategy to
intravenous iron administration. STUDY DESIGN AND METHODS: The purpose of
this study was to assess whether preoperative supplementation with oral
sucrosomial iron, a new iron-delivery technology with improved tolerance
and bioavailability, might be an effective strategy for this patient
population. One thousand consecutive patients were randomized and received
either a one-month course of sucrosomial iron (60 mg/day) or no treatment
prior to elective heart surgery at a single high-volume centre
(ClinicalTrials.gov NCT03560687). Primary end-points were haemoglobin
concentration on the day of hospital admittance and number of blood
transfusions. Secondary end-points were haemoglobin drift, tolerance of
treatment and cost-effectiveness of sucrosomial iron administration.
<br/>RESULT(S): Baseline haemoglobin in the treatment group was higher (by
0.67 g/dL; p<0.001) than that in the control group. The percentage of
patients in the treatment group who required transfusion (35.4%) was half
that in the control group (64.6%). The average number of transfused units
per operation was 0.95 vs. 2.03 in the treatment and control groups,
respectively. Haemoglobin drift was substantially similar in the two
groups, and the tolerability of treatment was excellent (98%). The overall
cost of treatment was 156 Euros less in the treatment group, expressed as
a raw cost of transfusion. <br/>CONCLUSION(S): In elective heart surgery,
routine preoperative sucrosomial iron administration seems to be a safe,
well-tolerated and cost-effective strategy to increase preoperative
haemoglobin and reduce the need for allogeneic blood transfusions.

<75>
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.

<76>
Accession Number
634418356
Title
Comparison of coronary artery bypass graft versus drug-eluting stents in
dialysis patients: an updated systemic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 22(4) (pp 285-296),
2021. Date of Publication: 01 Apr 2021.
Author
Prasitlumkum N.; Cheungpasitporn W.; Sato R.; Thangjui S.; Thongprayoon
C.; Kewcharoen J.; Bathini T.; Vallabhajosyula S.; Ratanapo S.;
Chokesuwattanaskul R.
Institution
(Prasitlumkum) Department of Cardiology, University of California
Riverside, Riverside, CA, United States
(Cheungpasitporn) Department of Internal Medicine, University of
Mississippi Medical Center, Jackson, MS, United States
(Sato) Department of Critical Care Medicine, Respiratory Institute,
Cleveland Clinic, OH, United States
(Thangjui) Department of Internal Medicine, Basset Healthcare Network,
Cooperstown, NY, United States
(Thongprayoon) Department of Medicine, Mayo Clinic, Rochester, MN
(Kewcharoen) Department of Medicine, University of Hawaii, Honolulu, HI,
United States
(Bathini) Department of Internal Medicine, University of Arizona, Tucson,
AZ, United States
(Vallabhajosyula) Section of Interventional Cardiology, Division of
Cardiovascular Medicine, Department of Medicine, Emory University School
of Medicine, Atlanta, United States
(Ratanapo) Department of Cardiovascular Medicine, Phramongkutklao Hospital
(Chokesuwattanaskul) Faculty of Medicine, King Chulalongkorn Memorial
Hospital, Chulalongkorn University, Bangkok, Thailand
Publisher
NLM (Medline)
Abstract
INTRODUCTION: As percutaneous coronary intervention (PCI) technologies
have been far improved, we hence conducted an updated systemic review and
meta-analysis to determine the comparability between coronary artery
bypass graft (CABG) and PCI with drug-eluting stent (DES) in ESRD
patients. <br/>METHOD(S): We comprehensively searched the databases of
MEDLINE, EMBASE, PUBMED and the Cochrane from inception to January 2020.
Included studies were published observational studies that compared the
risk of cardiovascular outcomes among dialysis patients with CABG and DES.
Data from each study were combined using the random-effects, generic
inverse variance method of DerSimonian and Laird to calculate risk ratios
and 95% confidence intervals. Subgroup analyses and meta-regression were
performed to explore heterogeneity. <br/>RESULT(S): Thirteen studies were
included in this analysis, involving total 56 422 (CABG 21 740 and PCI 34
682). Compared with DES, our study demonstrated CABG had higher 30-day
mortality [odds ratio (OR) 3.85, P = 0.009] but lower cardiac mortality
(OR 0.78, P < 0.001), myocardial infarction (OR 0.5, P < 0.001) and repeat
revascularization (OR 0.35, P < 0.001). No statistical differences were
found between CABG and DES for long-term mortality (OR 0.92, P = 0.055),
composite outcomes (OR 0.88, P = 0.112) and stroke (OR 1.49, P = 0.457).
Meta-regression suggested diabetes and the presence of left main coronary
artery disease as an effect modifier of long-term mortality.
<br/>CONCLUSION(S): PCI with DES shared similar long-term mortality,
composite outcomes and stroke outcomes to CABG among dialysis patients but
still was associated with an improved 30-day survival. However, CABG had
better rates of myocardial infarction, repeat revascularization and
cardiac mortality.<br/>Copyright &#xa9; 2021 Italian Federation of
Cardiology - I.F.C. All rights reserved.

<77>
Accession Number
634412619
Title
The diagnostic accuracy of procalcitonin in infectious patients after
cardiac surgery: a systematic review and meta-analysis.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 22(4) (pp 305-312),
2021. Date of Publication: 01 Apr 2021.
Author
Li Q.; Zheng S.; Zhou P.Y.; Xiao Z.; Wang R.; Li J.
Institution
(Li, Zheng, Zhou, Xiao, Wang) Department of the Cardiovascular Surgery
(Li) School of Nursing, Southern Medical University, Guangzhou, China
Publisher
NLM (Medline)
Abstract
Cardiac surgery with cardiopulmonary bypass (CPB) induces an acute
inflammatory response that may lead to a systemic inflammatory response
syndrome. The interest in procalcitonin (PCT) in the diagnosis of
bacterial infection in patients after cardiac surgery remains less
defined. The aim of this meta-analysis is to prospectively examine the
discriminatory power of PCT as markers of infection in hospitalized
patients with after cardiac surgery. The bivariate generalized nonlinear
mixed-effect model and the hierarchical summary receiver operating
characteristic model were used to estimate the pooled sensitivity,
specificity and summary receiver operating characteristic curve. The
pooled sensitivity and specificity were 0.81 (95% CI 0.75-0.87) and 0.78
(95% CI 0.73-0.83), respectively. The pooled positive likelihood ratio,
and negative likelihood ratio of PCT were 3.74 (95% CI 2.98-4.69) and 0.24
(95% CI 0.17-0.32), respectively. The pooled area under the summary
receiver operating characteristic curve of PCT using the HSROC method was
0.87 (95% CI 0.84- 0.90). This study indicated that PCT is a promising
marker for the diagnosis of sepsis for those patients who undergo cardiac
surgery.<br/>Copyright &#xa9; 2020 Italian Federation of Cardiology -
I.F.C. All rights reserved.

<78>
Accession Number
2000975905
Title
Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult
Cardiac Surgical Patients: A Randomized Controlled Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 33(2) (pp 368-375),
2019. Date of Publication: February 2019.
Author
Krishna S.N.; Chauhan S.; Bhoi D.; Kaushal B.; Hasija S.; Sangdup T.;
Bisoi A.K.
Institution
(Krishna, Chauhan, Kaushal, Hasija) Department of Cardiac Anesthesiology,
Cardio and Neurosciences Center, All India Institute of Medical Sciences,
New Delhi, India
(Bhoi) Department of Anesthesiology, Pain Medicine and Critical Care, All
India Institute of Medical Sciences, New Delhi, India
(Sangdup, Bisoi) Department of Cardiothoracic and Vascular Surgery, Cardio
and Neurosciences Center, All India Institute of Medical Sciences, New
Delhi, India
Publisher
W.B. Saunders
Abstract
Objectives: To examine the analgesic efficacy of bilateral erector spinae
plane (ESP) block compared with conventional treatment for pain after
cardiac surgery in adult patients. <br/>Design(s): A prospective,
randomized, controlled, single-blinded study. <br/>Setting(s):
Single-center tertiary teaching hospital. <br/>Participant(s): One hundred
and six adult patients undergoing elective cardiac surgery with
cardiopulmonary bypass. <br/>Intervention(s): Patients were randomized
into 2 groups. Patients in group 1 (ESP block group, n = 53) received
ultrasound-guided bilateral ESP block with 3 mg/kg of 0.375% ropivacaine
before anesthesia induction at the T6 transverse process level. Patients
in group 2 (paracetamol and tramadol group, n = 53) received paracetamol
(1 gm every 6 hours) and tramadol (50 mg every 8 hours) intravenously in
the postoperative period. The primary study outcome was to evaluate pain
at rest using an 11-point numeric rating scale (NRS). Mann-Whitney U test
was used for comparing NRS scores. <br/>Measurements and Main Results: The
postoperative pain level after extubation and duration of analgesia during
which NRS was < 4 of 10 was compared between the groups. The median pain
score at rest after extubation in group 1 was 0 of 10 until hour 6, 3 of
10 at hour 8, and 4 of 10 at hours 10 and 12 postextubation. These were
significantly less in comparison with group 2 (p = 0.0001). Patients in
group 1 had a significantly higher mean duration of analgesia (8.98 +/-
0.14 hours), during which NRS was < 4 of 10, compared with group 2 (4.60
+/- 0.12 hours) (p = 0.0001). <br/>Conclusion(s): ESP block safely
provided significantly better pain relief at rest for longer duration as
compared to intravenous paracetamol and tramadol.<br/>Copyright &#xa9;
2018 Elsevier Inc.

<79>
Accession Number
2007490831
Title
Posture Dependent Hypoxia Following Lobectomy: The Achilles Tendon of the
Lung Surgeon?.
Source
Journal of Investigative Surgery. 35(1) (pp 180-185), 2022. Date of
Publication: 2022.
Author
Krassas A.; Tzifa A.; Boulia S.; Iliadis K.
Institution
(Krassas, Iliadis) Thoracic Surgery Department, "HYGEIA" Hospital, Athens,
Greece
(Tzifa) Congenital Heart Disease Department, "MITERA" Hospital, Athens,
Greece
(Tzifa) Department of Imaging Sciences, King's College, London, United
Kingdom
(Boulia) Pulmonology Department, "EVANGELISMOS" Hospital, Athens, Greece
Publisher
Taylor and Francis Ltd.
Abstract
Background: Platypnoea-Orthodeoxia Syndrome is an uncommon phenomenon
characterized by dyspnea/arterial desaturation in the standing position,
resolving in recumbency. Some patients present with Platypnoea-Orthodeoxia
Syndrome in the early-or-late post-operative period after major lung
resection (lobectomy/pneumonectomy). The main cause of
Platypnoea-Orthodeoxia Syndrome is an intracardiac anomaly (Patent Foramen
Ovalis/Atrial Septal Defect) leading to right-to-left shunt.
<br/>Objective(s): To identify the causes of post-lobectomy
Platypnoea-Orthodeoxia Syndrome, and the possible pathophysiologic
mechanism. Methods A Pubmed database-EMBASE systematic review was
performed in order to find all reports, reporting the occurrence of
dyspnea/hypoxemia after lobectomy. <br/>Result(s): 8 studies were found
concerning ten patients during the period from 1983-2019.There was 6
male/4 female. The mean age was 62 years. All patients underwent resection
of the right lung. The time-interval between the operation and the
Platypnoea-Orthodeoxia Syndrome was from 2 days to 3 years. A Patent
Foramen Ovalis was present in 90% and in 10% an Atrial Septal Defect was
diagnosed. The mean Right Atrial Pressure was 7.5 mmHg, the mean Left
Atrial Pressure was 6.6 mmHg and the mean Pulmonary artery pressure was
18.5 mmHg. The mean size of the interatrial communication was 1.62 cm. The
inter-atrial communication was closed by open-chest surgical procedure in
3 cases (30%) and in 7 patients (70%) a percutaneous transcatheter device
was implanted. <br/>Conclusion(s): Platypnoea-Orthodeoxia Syndrome after
lobectomy is a rare cause of post-operative dyspnea/hypoxia. It is the
result of right-to-left shunt via an interatrial communication.
Mediastinal relocation, stretching of the atrial septum and aortic root
dilatation are among the functional elements necessary for the
Platypnoea-Orthodeoxia Syndrome manifestation.<br/>Copyright &#xa9; 2020
Taylor & Francis Group, LLC.

<80>
Accession Number
2013959776
Title
Adhesion barriers in cardiac surgery: A systematic review of efficacy.
Source
Journal of Cardiac Surgery. 37(1) (pp 176-185), 2022. Date of Publication:
January 2022.
Author
Head W.T.; Paladugu N.; Kwon J.H.; Gerry B.; Hill M.A.; Brennan E.A.;
Kavarana M.N.; Rajab T.K.
Institution
(Head, Paladugu, Kwon, Gerry, Hill, Kavarana, Rajab) Department of
Surgery, Medical University of South Carolina, Charleston, SC, United
States
(Brennan) Department of Research & Education Services (Libraries), Medical
University of South Carolina, Charleston, SC, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Postoperative pericardial adhesions have been associated with
increased morbidity, mortality, and surgical difficulty. Barriers exist to
limit adhesion formation, yet little is known about their use in cardiac
surgery. The study presented here provides the first major systematic
review of adhesion barriers in cardiac surgery. <br/>Method(s): Scopus and
PubMed were assessed on November 20, 2020. Inclusion criteria were
clinical studies on human subjects, and exclusion criteria were studies
not published in English and case reports. Risk of bias was evaluated with
the Cochrane Risk of Bias Tool. Barrier efficacy data was assessed with
Excel and GraphPad Prism 5. <br/>Result(s): Twenty-five studies were
identified with a total of 13 barriers and 2928 patients.
Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier
(13 studies, 67% of patients) with adhesion formation rate of 37.31% and
standardized tenacity score of 26.50. Several barriers had improved
efficacy. In particular, Cova CARD had a standardized tenacity score of
15.00. <br/>Conclusion(s): Overall, the data varied considerably in terms
of study design and reporting bias. The amount of data was also limited
for the non-PTFE studies. PTFE has historically been effective in
preventing adhesions. More recent barriers may be superior, yet the
current data is nonconfirmatory. No ideal adhesion barrier currently
exists, and future barriers must focus on the requirements unique to
operating in and around the heart.<br/>Copyright &#xa9; 2021 Wiley
Periodicals LLC

<81>
Accession Number
2015769494
Title
A Scoping Review of Alternative Anticoagulation Strategies for
Hemodialysis Patients with a Mechanical Heart Valve.
Source
American Journal of Nephrology. 52(10-11) (pp 861-870), 2021. Date of
Publication: 01 Dec 2021.
Author
Thomson B.K.A.; Pilkey N.G.; Monteith B.; Holden R.M.
Institution
(Thomson) Bloomberg School of Public Health, Johns Hopkins University,
Baltimore, MD, United States
(Thomson, Pilkey, Holden) Division of Nephrology, Department of Medicine,
Queen's University, Kingston, ON, Canada
(Monteith) Division of Hematology, Department of Medicine, Queen's
University, Kingston, ON, Canada
Publisher
S. Karger AG
Abstract
Introduction: Patients with end-stage renal disease (ESRD) have high rates
of cardiac valvulopathy but can develop contraindications for vitamin K
antagonist (VKA) therapy. We explored the evidence for alternative
anticoagulation strategies in patients with ESRD with a contraindication
for VKA therapy. <br/>Method(s): A scoping review was completed, searching
MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of
Science, and Conference abstracts from inception to March 30, 2021. The
study population was patients with ESRD who were on VKA therapy and
developed a contraindication to VKA therapy use. All data regarding
studies, patient characteristics, anticoagulation strategy, and clinical
outcomes were summarized. <br/>Result(s): Twenty-three articles met
inclusion criteria. These articles included 57 patients. Contraindications
to VKA therapy included calcific uremic arteriolopathy (CUA) (n = 55) and
warfarin-induced skin necrosis (n = 2). All studies were either case
reports or case series. There were 10 anticoagulation strategies
identified. Continuation of VKA therapy was associated with increased
death and decreased rates of CUA resolution (80.0% and 10.0%,
respectively), compared to apixaban (24.0% and 70.8%), subcutaneous (SC)
low-molecular-weight heparin (LMWH) (14.3%, 85.7%), and SC unfractionated
heparin (0.0%, 100.0%). While only 5 patient cases were reported with
mechanical heart valves, SC LMWH use has been reported in this context
with good outcomes. <br/>Conclusion(s): In patients with ESRD who develop
a contraindication to VKA therapy, several alternative anticoagulation
strategies have been reported with superior outcomes to VKA continuation.
While outcomes appear superior to continuation of VKA therapy, more data
are required before definitive recommendations can be made for the patient
with ESRD and a mechanical heart valve.<br/>Copyright &#xa9; 2021 S.
Karger AG, Basel.

<82>
Accession Number
2016158441
Title
Comparing the Effects of Gamification and Teach-Back Training Methods on
Adherence to a Therapeutic Regimen in Patients after Coronary Artery
Bypass Graft Surgery: Randomized Clinical Trial.
Source
Journal of Medical Internet Research. 23(12) (no pagination), 2021.
Article Number: e22557. Date of Publication: December 2021.
Author
Ghorbani B.; Jackson A.C.; Noorchenarboo M.; Mandegar M.H.; Sharifi F.;
Mirmoghtadaie Z.; Bahramnezhad F.
Institution
(Ghorbani) School of Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Jackson) Australian Centre for Heart Health, Melbourne, Australia
(Jackson) Faculty of Health, Deakin University, Geelong, Australia
(Jackson) Centre on Behavioural Health, Hong Kong University, Hong Kong
(Noorchenarboo) Tehran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
(Mandegar) Department of Cardiac Surgery, Shariati Hospital, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Sharifi) Elderly Health Research Center, Endocrinology and Metabolism
Population Sciences Research Institute, Tehran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Mirmoghtadaie) Shaheed Beheshti University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Bahramnezhad) School of Nursing & Midwifery, Nursing and Midwifery Care
Research Center, Spiritual Health Group, Research Center of Quran, Hadith
and Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
Publisher
JMIR Publications Inc.
Abstract
Background: Patients undergoing coronary artery bypass graft surgery
(CABGS) may fail to adhere to their treatment regimen for many reasons.
Among these, one of the most important reasons for nonadherence is the
inadequate training of such patients or training using inappropriate
methods. <br/>Objective(s): This study aimed to compare the effect of
gamification and teach-back training methods on adherence to a therapeutic
regimen in patients after CABGS. <br/>Method(s): This randomized clinical
trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in
2019. Training was provided to the teach-back group individually. In the
gamification group, an app developed for the purpose was installed on each
patient's smartphone, with training given via this device. The control
group received usual care, or routine training. Adherence to the
therapeutic regimen was assessed using a questionnaire on adherence to a
therapeutic regimen (physical activity and dietary regimen) and an
adherence scale as a pretest and a 1-month posttest. <br/>Result(s):
One-way analysis of variance (ANOVA) for comparing the mean scores of
teach-back and gamification training methods showed that the mean
normalized scores for the dietary regimen (P<.001, F=71.80), movement
regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before
and after intervention were significantly different between the
teach-back, gamification, and control groups. In addition, the results of
the Dunnett test showed that the teach-back and gamification groups were
significantly different from the control group in all three treatment
regimen methods. There was no statistically significant difference in
adherence to the therapeutic regimen between the teach-back and control
groups. <br/>Conclusion(s): Based on the results of this study, the use of
teach-back and gamification training approaches may be suggested for
patients after CABGS to facilitate adherence to the therapeutic
regimen.<br/>Copyright &#xa9; Banafsheh Ghorbani, Alun C Jackson, Mohammad
Noorchenarboo, Mohammad H Mandegar, Farshad Sharifi, Zohrehsadat
Mirmoghtadaie, Fatemeh Bahramnezhad. Originally published in the Journal
of Medical Internet Research (https://www.jmir.org),10.12.2021. This is an
open-access article distributed under the terms of the Creative Commons
Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in the Journal of Medical
Internet Research, is properly cited. The complete bibliographic
information, a link to the original publication on https://www.jmir.org/,
as well as this copyright and license information must be included.

<83>
Accession Number
636718230
Title
Beneficial Effects of a Short Course of Physical Prehabilitation on
Neurophysiological Functioning and Neurovascular Biomarkers in Patients
Undergoing Coronary Artery Bypass Grafting.
Source
Frontiers in Aging Neuroscience. 13 (no pagination), 2021. Article Number:
699259. Date of Publication: 10 Dec 2021.
Author
Trubnikova O.A.; Tarasova I.V.; Moskin E.G.; Kupriyanova D.S.; Argunova
Y.A.; Pomeshkina S.A.; Gruzdeva O.V.; Barbarash O.L.
Institution
(Trubnikova, Tarasova, Moskin, Kupriyanova, Argunova, Pomeshkina,
Gruzdeva, Barbarash) Research Institute for Complex Issues of
Cardiovascular Diseases, Kemerovo, Russian Federation
Publisher
Frontiers Media S.A.
Abstract
This study aimed to evaluate the effects of a short course of physical
prehabilitation on neurophysiological functioning and markers of the
neurovascular unit in patients undergoing coronary artery bypass grafting
(CABG). We performed a prospective randomized study involving 97 male CABG
patients aged 45-70 years, 47 of whom underwent a 5-7-day preoperative
course of aerobic physical training (PhT). Both groups of patients were
comparable with respect to baseline clinical and anamnestic
characteristics. An extended neuropsychological and
electroencephalographic (EEG) study was performed before surgery and at
7-10 days after CABG. Markers of the neurovascular unit [S100beta,
neuron-specific enolase (NSE), and brain-derived neurotrophic factor
(BDNF)] were examined as metabolic correlations of early postoperative
cognitive dysfunction (POCD) at three time points: before surgery, within
the first 24 h after surgery, and 7-10 days after CABG. POCD developed in
58% of patients who underwent preoperative PhT, and in 79.5% of patients
who did not undergo training, 7-10 days after CABG. Patients without
prehabilitation demonstrated a higher percentage of theta1 power increase
in the relative change values as compared to the PhT patients (p = 0.015).
The short preoperative course of PhT was associated with low plasma
S100beta concentration, but high BDNF levels in the postoperative period.
Patients who underwent a short preoperative course of PhT had better
cognitive and electrical cortical activity indicators. Markers of the
neurovascular unit indicated lower perioperative brain injury after CABG
in those who underwent training. A short course of PhT before CABG can
decrease the brain's susceptibility to ischemia and reduce the severity of
cognitive impairments in cardiac surgery patients. Electrical brain
activity indicators and neurovascular markers, such as S100beta and BDNF,
can be informative for the effectiveness of cardiac rehabilitation
programs.<br/>Copyright &#xa9; 2021 Trubnikova, Tarasova, Moskin,
Kupriyanova, Argunova, Pomeshkina, Gruzdeva and Barbarash.

<84>
Accession Number
2013093820
Title
Lack of Cost-Effectiveness of Preoperative Erythropoiesis-Stimulating
Agents and/or Iron Therapy in Anaemic, Elective Surgery Patients: A
Systematic Review and Updated Analysis.
Source
PharmacoEconomics. 39(10) (pp 1123-1139), 2021. Date of Publication:
October 2021.
Author
Avau B.; Van Remoortel H.; Laermans J.; Bekkering G.; Fergusson D.;
Georgsen J.; Manzini P.M.; Ozier Y.; De Buck E.; Compernolle V.;
Vandekerckhove P.
Institution
(Avau, Van Remoortel, Laermans, De Buck) Centre for Evidence-Based
Practice (CEBaP), Belgian Red Cross, Motstraat 42, Mechelen 2800, Belgium
(Bekkering) Center for Evidence-Based Medicine, Leuven, Belgium
(Bekkering) Cochrane Belgium, Leuven, Belgium
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Canada
(Fergusson) Department of Medicine, University of Ottawa, Ottawa, Canada
(Fergusson) Canadian Blood Services, Ottawa, Canada
(Georgsen) South Danish Transfusion Service, Odense University Hospital,
Odense, Denmark
(Manzini) SC Banca del Sangue Servizio di Immunoematologia, University
Hospital Citta della Salute e della Scienza di Torino, Torino, Italy
(Ozier) University Hospital of Brest, Brest, France
(De Buck, Vandekerckhove) Department of Public Health and Primary Care,
Faculty of Medicine, KU Leuven, Leuven, Belgium
(Compernolle) Blood Services, Belgian Red Cross, Mechelen, Belgium
(Compernolle) Faculty of Medicine and Health Sciences, Ghent University,
Ghent, Belgium
(Vandekerckhove) Belgian Red Cross, Mechelen, Belgium
Publisher
Adis
Abstract
Objectives: For anaemic elective surgery patients, current clinical
practice guidelines weakly recommend the routine use of iron, but not
erythrocyte-stimulating agents (ESAs), except for short-acting ESAs in
major orthopaedic surgery. This recommendation is, however, not based on
any cost-effectiveness studies. The aim of this research was to (1)
systematically review the literature regarding cost effectiveness of
preoperative iron and/or ESAs in anaemic, elective surgery patients and
(2) update existing economic evaluations (EEs) with recent data.
<br/>Method(s): Eight databases and registries were searched for EEs and
randomized controlled trials (RCTs) reporting cost-effectiveness data on
November 11, 2020. Data were extracted, narratively synthesized and
critically appraised using the Philips reporting checklist. Pre-existing
full EEs were updated with effectiveness data from a recent systematic
review and current cost data. Incremental cost-effectiveness ratios were
expressed as cost per (quality-adjusted) life-year [(QA)LY] gained.
<br/>Result(s): Only five studies (4 EEs and 1 RCT) were included, one on
intravenous iron and four on ESAs + oral iron. The EE on intravenous iron
only had an in-hospital time horizon. Therefore, cost effectiveness of
preoperative iron remains uncertain. The three EEs on ESAs had a lifetime
time horizon, but reported cost per (QA)LY gained of 20-65 million (GBP or
CAD). Updating these analyses with current data confirmed ESAs to have a
cost per (QA)LY gained of 3.5-120 million (GBP or CAD).
<br/>Conclusion(s): Cost effectiveness of preoperative iron is unproven,
whereas routine preoperative ESA therapy cannot be considered cost
effective in elective surgery, based on the limited available data. Future
guidelines should reflect these findings.<br/>Copyright &#xa9; 2021, The
Author(s).

<85>
Accession Number
2014702870
Title
Effect of Coronary CTA on Chronic Total Occlusion Percutaneous Coronary
Intervention: A Randomized Trial.
Source
JACC: Cardiovascular Imaging. 14(10) (pp 1993-2004), 2021. Date of
Publication: October 2021.
Author
Hong S.-J.; Kim B.-K.; Cho I.; Kim H.-Y.; Rha S.-W.; Lee S.-H.; Park S.M.;
Kim Y.H.; Chang H.-J.; Ahn C.-M.; Kim J.-S.; Ko Y.-G.; Choi D.; Hong
M.-K.; Jang Y.
Institution
(Hong, Kim, Cho, Chang, Ahn, Kim, Ko, Choi, Hong, Jang) Severance
Cardiovascular Hospital, Yonsei University College of Medicine, Seoul,
South Korea
(Kim) Catholic University St. Mary's Hospital, Bucheon, South Korea
(Rha) Korea University Guro Hospital, Seoul, South Korea
(Lee) Wonju Severance Christian Hospital, Yonsei University Wonju College
of Medicine, Wonju, South Korea
(Park) Nowon Eulji Medical Center, Eulji University College of Medicine,
Seoul, South Korea
(Kim) Kangwon National University School of Medicine, Chuncheon, South
Korea
Publisher
Elsevier Inc.
Abstract
Objectives: The purpose of this study was to test whether the success rate
of percutaneous coronary intervention (PCI) for chronic total occlusion
(CTO) increased with pre-procedural coronary computed tomography
angiography (CTA). <br/>Background(s): Coronary CTA provides valuable
information before and during CTO-PCI. However, there are no randomized
data that explore whether coronary CTA increases its success rate.
<br/>Method(s): In this multicenter, randomized trial, a total of 400
patients with CTO were randomized to receive PCI with pre-procedural
coronary CTA (coronary CTA-guided group; n = 200) or without coronary CTA
(angiography-guided group; n = 200) between January 2014 and September
2019. The primary endpoint was the successful recanalization rate, a final
TIMI (Thrombolysis In Myocardial Infarction) grade >=2, and <=30% residual
stenosis on the final angiogram. <br/>Result(s): A total of 10 operators
performed PCI. Successful recanalization was achieved in 187 patients
(93.5%) in the coronary CTA-guided group and in 168 patients (84.0%) in
the angiography-guided group (absolute difference, 9.5% [95% confidence
interval: 3.4% to 15.6%]; p = 0.003). When comparing the success rates
according to the Multicenter CTO Registry of Japan score (J-CTO), the
coronary CTA guidance was favored over the angiography-guidance in the
subset of J-CTO >=2 versus in the subset of J-CTO <2 (p interaction =
0.035). Coronary perforations occurred in 2 (1%) and 8 patients (4%) in
the coronary CTA- and angiography-guided groups, respectively (p = 0.055).
Periprocedural myocardial infarction was not observed in the coronary
CTA-guided group, whereas it occurred in 4 patients (2%) in the
angiography-guided group (p = 0.123). Total procedure and fluoroscopic
times were not different. There were no differences between the groups in
the occurrences of cardiac death, target vessel-related myocardial
infarction, or target-vessel revascularization at 1 year.
<br/>Conclusion(s): Pre-procedural coronary CTA-guidance for CTO resulted
in higher success rates with numerically fewer immediate periprocedural
complications such as coronary perforations or periprocedural myocardial
infarction than angiography guidance. Higher success rates were more
prominently observed in patients with CTO who had a high J-CTO score than
those who did not. (Role of CT Scan for the Successful Recanalization of
Chronic Total Occlusion; a Randomized Comparison Between 3D CT-guided PCI
vs. Conventional Treatment [CT-CTO Trial]; NCT02037698)<br/>Copyright
&#xa9; 2021 American College of Cardiology Foundation

<86>
Accession Number
2014746627
Title
Comparison of Efficacy and Safety of Recombinant Human Prourokinase and
Alteplase in the Treatment of STEMI and Analysis of Influencing Factors of
Efficacy.
Source
Evidence-based Complementary and Alternative Medicine. 2021 (no
pagination), 2021. Article Number: 6702965. Date of Publication: 2021.
Author
Liu Y.; Yang Y.; Li Y.; Peng X.
Institution
(Liu, Peng) Affiliated Nanhua Hospital, Department of Cardiology, Hengyang
Medical School, University of South China, Hunan, Hengyang 421001, China
(Yang) Affiliated Nanhua Hospital, Department of Recovery from Anesthesia,
Hengyang Medical School, University of South China, Hunan, Hengyang
421001, China
(Li) Affiliated Nanhua Hospital, Department of Nursing Teaching and
Research, Hengyang Medical School, University of South China, Hunan,
Hengyang 421001, China
Publisher
Hindawi Limited
Abstract
Objective. To compare the efficacy and safety of recombinant human
prourokinase (rhPro-UK) and alteplase for thrombolytic therapy in acute
ST-segment elevation myocardial infarction (STEMI) and to analyze the
related factors affecting efficacy. Methods. From January 2017 to December
2019, 100 patients diagnosed with STEMI were selected and randomly divided
into the control group (n = 50) and the observation group (n = 50). Based
on conventional treatments, the control group was treated with alteplase,
and the observation group was treated with rhPro-UK, and both were treated
for 7 days. After treatment, the vascular recanalization, left ventricular
end-systolic diameter (LVESD), left ventricular end-diastolic diameter
(LVEDD), and left ventricular ejection fraction (LVEF) were compared. The
bleeding and major adverse cardiovascular events (MACE) were recorded in
both groups. According to the patient's vascular recanalization, it was
divided into two subgroups: recanalization group and occlusion group.
Multiple logistic regression models were used to analyze the related
factors that affect the efficacy. Results. The recanalization rate of the
observation group (96.00%) was higher than that of the control group
(84.00%) (P<0.05). After treatment, LVDs and LVEDD in both groups were
lower than those before treatment, and LVEF was higher than that before
treatment. The LVDs and LVEDD in the observation group were lower than
those in the control group, and the LVEF was higher than that in the
control group (P<0.05). The incidence of bleeding in the observation group
(2.00%) was lower than that in the control group (12.00%), and the
incidence of MACE (4.00%) was lower than that in the control group
(16.00%) (P<0.05). Univariate analysis showed that age, smoking history,
diabetes history, myocardial infarction history, infarct location, and
intravenous thrombolysis time were related to the efficacy after treatment
(P<0.05). Multivariate logistic analysis showed that age, history of
diabetes, vascular infarction site, and venous thrombolysis time were
independent influencing factors after treatment (P<0.05). Conclusion. Both
rhPro-UK and alteplase thrombolytic therapy can effectively recanalize
blood vessels and improve the cardiac function of patients with STEMI.
However, rhPro-UK has better effect than alteplase and is safer and worth
promoting. The curative effect is related to age, diabetes history,
vascular infarction site, and venous thrombolysis time.<br/>Copyright
&#xa9; 2021 Yizhou Liu et al.

<87>
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. 4(1) (pp 85-96), 2022. Date of Publication: January 2022.
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, Ontario, Canada
(Wang, Devereaux, Whitlock, McIntyre, Healey, Belley-Cote, Lamy, Conen)
Population Health Research Institute, McMaster University, Hamilton,
Ontario, Canada
(Wang, Devereaux, Whitlock, McIntyre, Healey, Lamy, Conen) Department of
Health Research Methods, Evidence & Impact, McMaster University, Hamilton,
Ontario, 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, Ontario, Canada
(Birchenough) Faculty of Health Sciences, McMaster University, Hamilton,
Ontario, Canada
(Whitlock, Lamy) Department of Surgery, McMaster University, Hamilton,
Ontario, 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

<88>
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. 349 (pp 55-61), 2022. Date of
Publication: 15 Feb 2022.
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.

<89>
[Use Link to view the full text]
Accession Number
636748585
Title
Virtual reality and hypnosis for anxiety and pain management in intensive
care units: A prospective randomised trial among cardiac surgery patients.
Source
European journal of anaesthesiology. 39(1) (pp 58-66), 2022. Date of
Publication: 01 Jan 2022.
Author
Rousseaux F.; Dardenne N.; Massion P.B.; Ledoux D.; Bicego A.; Donneau
A.-F.; Faymonville M.-E.; Nyssen A.-S.; Vanhaudenhuyse A.
Institution
(Rousseaux) From the Laboratory of Cognitive Ergonomics and Work
Intervention, University of Liege, ULiege (B32), Quartier Agora - Place
des Orateurs (FR, AB, ASN), Algology Department, University Hospital of
Liege, CHU Sart Tilman, Domaine Universitaire du Sart Tilman (MEF, AV),
Sensation & Perception Research Group, GIGA Consciousness, University of
Liege, GIGA (B34) (FR, AB, MEF, ASN, AV), Intensive Care Units, University
Hospital of Liege (B35) (PBM, DL), Public Health Department,
Biostatistics, University of Liege, CHU (B35) (ND, AFD) and Anesthesia &
Intensive care, GIGA Consciousness, University of Liege, GIGA (B34),
Quartier Hopital - Avenue de l'Hopital, Liege, Belgium (DL)
Publisher
NLM (Medline)
Abstract
BACKGROUND: Virtual reality and hypnosis are little studied in complex
contexts, such as intensive care, where patients need significant physical
and psychological assistance. <br/>OBJECTIVE(S): To compare and combine
hypnosis and virtual reality benefits on anxiety and pain on patients
before and after cardiac surgery. DESIGN: Prospective randomised
controlled clinical trial. SETTING: The study was conducted in the
University Hospital of Liege (Belgium) from October 2018 to January 2020.
PATIENTS: One hundred patients (66 +/- 11.5 years; 24 women, 76 men) were
included. Participants were adults undergoing cardiac surgery. Exclusion
criteria: psychiatric diseases, claustrophobia, acrophobia, hearing loss,
visual impairment, extreme fatigue, confusion surgery cancelled.
INTERVENTIONS: Patients were randomly assigned to four arms (control;
hypnosis; virtual reality; virtual reality hypnosis) and had 20 min of one
of the techniques the day before and the day after surgery. MAIN OUTCOMES
MEASURES: Anxiety, pain, fatigue, relaxation, physiological parameters,
and opioid use were evaluated before and after each session.
<br/>RESULT(S): The main results did not show any significant differences
between the groups. In all groups, anxiety decreased and pain increased
from baseline to the postoperative day. Relaxation increased in all groups
in the pre-operative (P < 0.0001) and postoperative period (P = 0.03).
There were no significant differences for fatigue, physiological measures,
or opioid use. <br/>CONCLUSION(S): As there were no significant
differences between groups for the measured variables, we cannot affirm
that one technique is better than another. Additional studies are required
to compare and evaluate the cost-effectiveness of these techniques for
critical care patients and caregivers. TRIAL REGISTRATION:
ClinicalTrials.gov: NCT03820700.
https://clinicaltrials.gov/ct2/show/NCT03820700. Retrospectively
registered on 29 January 2019.<br/>Copyright &#xa9; 2021 The Author(s).
Published by Wolters Kluwer Health, Inc. on behalf of the European Society
of Anaesthesiology and Intensive Care.

<90>
Accession Number
2007302182
Title
Autograft remodeling after the Ross procedure by cardiovascular magnetic
resonance imaging: Aortic stenosis versus insufficiency.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(2) (pp 578-587.e1),
2022. Date of Publication: February 2022.
Author
Lenoir M.; Emmott A.; Bouhout I.; Poirier N.; Tousch M.; El-Hamamsy I.;
Mongeon F.-P.
Institution
(Lenoir, Emmott, Bouhout, Poirier, Tousch, El-Hamamsy) Department of
Surgery, Montreal Heart Institute, Universite de Montreal, Montreal,
Quebec, Canada
(El-Hamamsy) Division of Cardiac Surgery, Sacre-Coeur Hospital, Universite
de Montreal, Montreal, Quebec, Canada
(Poirier) Division of Cardiac Surgery, Sainte-Justine University Hospital
Center, Universite de Montreal, Montreal, Quebec, Canada
(Mongeon) Divison of Noninvasive Cardiology, Department of Specialized
Medicine, Montreal Heart Institute, Universite de Montreal, Montreal,
Quebec, Canada
Publisher
Elsevier Inc.
Abstract
Background: Studies suggest that patients undergoing the Ross procedure
for aortic insufficiency are at greater risk of autograft dilatation than
those with aortic stenosis. By using a tailored Ross technique to mitigate
autograft dilatation in patients with aortic insufficiency, we aimed to
compare the biomechanical and morphologic remodeling of the autograft at 1
year between patients with aortic insufficiency and patients with aortic
stenosis. <br/>Method(s): A total of 210 patients underwent a Ross
procedure (2011-2016). Of those, 86 patients (mean age 43 +/- 13 years;
32% were female) completed preoperative and postoperative cardiovascular
magnetic resonance imaging. A total of 71 studies were suitable for
analysis: 41 patients with aortic stenosis and 30 patients with aortic
insufficiency. Nine healthy adults were used as controls. Autograft root
dimensions, individual sinus volumes, and distensibility were measured
using cardiovascular magnetic resonance. <br/>Result(s): At 1 year, there
was no difference in autograft root dimensions between patients with
aortic stenosis (mean annulus 25.1 +/- 3.1 mm and sinus diameters 35 +/-
4.1 mm) and patients with aortic insufficiency (26.6 +/- 3 mm and 37.1 +/-
3.5 mm; P =.12 and.06, respectively). Relative sinus of Valsalva volumes
were symmetrical in the aortic stenosis (right 34.8% +/- 4%, left 33.7%
+/- 3.5%, noncoronary 31.4% +/- 3.2%) and aortic insufficiency groups
(34.8% +/- 3.9%, 33.8% +/- 2.8%, 31.3% +/- 3.7%, P =.85,.92, and.82), and
similar to those of healthy adults. Aortic root distensibility was reduced
in both groups compared with healthy adults (P =.003), but was similar
between aortic stenosis (3.12 +/- 1.58 x 10^-3 mm
Hg^-1) and aortic insufficiency (3.04 +/- 1.15 x 10^-3
mm Hg^-1; P =.9). <br/>Conclusion(s): Using a tailored
technique, there were no differences in the morphologic or biomechanical
remodeling of the autograft root 1 year after the Ross procedure between
patients with aortic stenosis and patients with aortic insufficiency.
However, autograft roots are stiffer than native aortic
roots.<br/>Copyright &#xa9; 2020 The American Association for Thoracic
Surgery

<91>
Accession Number
636379653
Title
Exercise-based cardiac rehabilitation for coronary heart disease.
Source
Cochrane Database of Systematic Reviews. 2021(11) (no pagination), 2021.
Article Number: CD001800. Date of Publication: 06 Nov 2021.
Author
Dibben G.; Faulkner J.; Oldridge N.; Rees K.; Thompson D.R.; Zwisler
A.-D.; Taylor R.S.
Institution
(Dibben) MRC/CSO Social and Public Health Sciences Unit, Institute of
Health and Well Being, University of Glasgow, Glasgow, United Kingdom
(Faulkner) Faculty Health and Wellbeing, School of Sport, Health and
Community, University of Winchester, Winchester, United Kingdom
(Oldridge) College of Health Sciences, University of Wisconsin-Milwaukee,
Milwaukee, WI, United States
(Rees) Division of Health Sciences, Warwick Medical School, University of
Warwick, Coventry, United Kingdom
(Thompson) School of Nursing and Midwifery, Queen's University Belfast,
Belfast, United Kingdom
(Zwisler) REHPA, The Danish Knowledge Centre for Rehabilitation and
Palliative Care, Odense University Hospital, Nyborg, Denmark
(Zwisler) Department of Clinical Research, University of Southern Denmark,
Odense, Denmark
(Taylor) MRC/CSO Social and Public Health Sciences Unit & Robertson Centre
for Biostatistics, Institute of Health and Well Being, University of
Glasgow, Glasgow, United Kingdom
(Taylor) National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
Publisher
John Wiley and Sons Ltd
Abstract
Background: Coronary heart disease (CHD) is the most common cause of death
globally. However, with falling CHD mortality rates, an increasing number
of people living with CHD may need support to manage their symptoms and
prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the
health and outcomes of people with CHD. This is an update of a Cochrane
Review previously published in 2016. <br/>Objective(s): To assess the
clinical effectiveness and cost-effectiveness of exercise-based CR
(exercise training alone or in combination with psychosocial or
educational interventions) compared with 'no exercise' control, on
mortality, morbidity and health-related quality of life (HRQoL) in people
with CHD. <br/>Search Method(s): We updated searches from the previous
Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other
databases in September 2020. We also searched two clinical trials
registers in June 2021. <br/>Selection Criteria: We included randomised
controlled trials (RCTs) of exercise-based interventions with at least six
months' follow-up, compared with 'no exercise' control. The study
population comprised adult men and women who have had a myocardial
infarction (MI), coronary artery bypass graft (CABG) or percutaneous
coronary intervention (PCI), or have angina pectoris, or coronary artery
disease. <br/>Data Collection and Analysis: We screened all identified
references, extracted data and assessed risk of bias according to Cochrane
methods. We stratified meta-analysis by duration of follow-up: short-term
(6 to 12 months); medium-term (> 12 to 36 months); and long-term (> 3
years), and used meta-regression to explore potential treatment effect
modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most
common follow-up time point). <br/>Main Result(s): This review included 85
trials which randomised 23,430 people with CHD. This latest update
identified 22 new trials (7795 participants). The population included
predominantly post-MI and post-revascularisation patients, with a mean age
ranging from 47 to 77 years. In the last decade, the median percentage of
women with CHD has increased from 11% to 17%, but females still account
for a similarly small percentage of participants recruited overall (<
15%). Twenty-one of the included trials were performed in low- and
middle-income countries (LMICs). Overall trial reporting was poor,
although there was evidence of an improvement in quality over the last
decade. The median longest follow-up time was 12 months (range 6 months to
19 years). At short-term follow-up (6 to 12 months), exercise-based CR
likely results in a slight reduction in all-cause mortality (risk ratio
(RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate
certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to
0.93; 22 trials; number needed to treat for an additional beneficial
outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large
reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14
trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence).
Exercise-based CR likely results in little to no difference in risk of
cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials;
moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20
trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19;
13 trials; moderate certainty evidence) up to 12 months' follow-up. We are
uncertain about the effects of exercise-based CR on cardiovascular
hospitalisation, with a wide confidence interval including considerable
benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty
evidence). There was evidence of substantial heterogeneity across trials
for cardiovascular hospitalisations (I² = 53%), and of small
study bias for all-cause hospitalisation, but not for all other outcomes.
At medium-term follow-up, although there may be little to no difference in
all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR
1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35;
6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause
hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large
reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to
0.93; 5 trials). Evidence is uncertain for difference in risk of
cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials).
At long-term follow-up, although there may be little to no difference in
all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may
result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI
0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials).
Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials),
and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed
benefits in outcomes were independent of CHD case mix, type of CR,
exercise dose, follow-up length, publication year, CR setting, study
location, sample size or risk of bias. There was evidence that
exercise-based CR may slightly increase HRQoL across several subscales
(SF-36 mental component, physical functioning, physical performance,
general health, vitality, social functioning and mental health scores) up
to 12 months' follow-up; however, these may not be clinically important
differences. The eight trial-based economic evaluation studies showed
exercise-based CR to be a potentially cost-effective use of resources in
terms of gain in quality-adjusted life years (QALYs). Authors'
conclusions: This updated Cochrane Review supports the conclusions of the
previous version, that exercise-based CR provides important benefits to
people with CHD, including reduced risk of MI, a likely small reduction in
all-cause mortality, and a large reduction in all-cause hospitalisation,
along with associated healthcare costs, and improved HRQoL up to 12
months' follow-up. Over longer-term follow-up, benefits may include
reductions in cardiovascular mortality and MI. In the last decade, trials
were more likely to include females, and be undertaken in LMICs,
increasing the generalisability of findings. Well-designed,
adequately-reported RCTs of CR in people with CHD more representative of
usual clinical practice are still needed. Trials should explicitly report
clinical outcomes, including mortality and hospital admissions, and
include validated HRQoL outcome measures, especially over longer-term
follow-up, and assess costs and cost-effectiveness.<br/>Copyright &#xa9;
2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

<92>
Accession Number
636627805
Title
The Effect of Normal Saline Injection Volumes on the Optic Nerve Sheath
Diameter during Thoracic Epidural Analgesia.
Source
Pain physician. 24(7) (pp E1007-E1013), 2021. Date of Publication: 01 Nov
2021.
Author
Hong J.; Kim J.S.; Lee Y.H.
Institution
(Hong) Department of Anesthesiology and Pain Medicine, Keimyung University
School of Medicine, South Korea
(Kim, Lee) Department of Anesthesiology and Pain Medicine, Keimyung
University DongSan Hospital, Keimyung University School of Medicine,
Daegu, South Korea
Publisher
NLM (Medline)
Abstract
BACKGROUND: Saline or local anesthetic injection into the epidural space
increases intracranial pressure (ICP), at least transiently. Measurement
of the optic nerve sheath diameter (ONSD) using ocular ultrasonography is
one of the noninvasive methods for ICP assessment. <br/>OBJECTIVE(S): The
purpose of this study is to investigate the effects of the different
volume on the ONSD and cerebral oxygen saturation (rSO2) during thoracic
epidural saline injection under awake conditions. STUDY DESIGN:
Prospective randomized, controlled trial. SETTING: An interventional pain
management practice in South Korea. <br/>METHOD(S): This study included 71
patients receiving thoracic epidural catheterization for pain management,
following upper abdominal or thoracic surgery. Following successful
epidural space confirmation, patients were randomly allocated to receive 5
mL (5 mL group), 10 mL (10 mL group), and 20 mL (20 mL group) of epidural
normal saline. Transorbital sonography was performed to measure the ONSD.
This was measured at 3 mm posterior to the optic nerve head. An rSO2 was
measured using cerebral oximeter sensors. <br/>RESULT(S): All 3 groups
showed significant increases of ONSD from 10 minutes to 40 minutes as
compared to baseline (before procedure). Among the 3 groups, the 20 mL
group demonstrated the most significantly increased ONSD, as compared to
the 5 mL and 10 mL groups. At the 20 minute and 40 minute time points, the
ONSD showed a volume-dependent increase (P = 0.0005, P = 0.014). All 3
groups showed the rSO2 to be distributed between 60~70% without any
statistical difference. LIMITATIONS: We could not determine the returning
point of the normalized ONSD value. <br/>CONCLUSION(S): Twenty milliliters
of normal saline epidural injection resulted in a significant increase of
ONSD, as compared to the 5 mL and 10 mL groups. Our results also indicate
that an increase of ONSD occurs in accordance with the injected volume of
normal saline.

<93>
[Use Link to view the full text]
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.

<94>
[Use Link to view the full text]
Accession Number
636189630
Title
Urinary Neutrophil Gelatinase-Associated Lipocalin/Hepcidin-25 Ratio for
Early Identification of Patients at Risk for Renal Replacement Therapy
After Cardiac Surgery: A Substudy of the BICARBONATE Trial.
Source
Anesthesia and analgesia. 133(6) (pp 1510-1519), 2021. Date of
Publication: 01 Dec 2021.
Author
Elitok S.; Kuppe H.; Devarajan P.; Bellomo R.; Isermann B.; Westphal S.;
Kube J.; Albert C.; Ernst M.; Kropf S.; Haase-Fielitz A.; Haase M.
Institution
(Elitok, Ernst) From the Department of Nephrology and Endocrinology, Ernst
von Bergmann Hospital Potsdam, Potsdam, Germany
(Kuppe) Institute of Cardiac Thoracic Vascular Anesthesia and Intensive
Care Medicine, German Heart Center Berlin & Charite-University Medicine
Berlin, Berlin, Germany
(Devarajan) Department of Nephrology and Hypertension, Cincinnati
Children's Hospital, Cincinnati, OH, United States
(Bellomo) Department of Intensive Care, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Bellomo) Department of Intensive Care, Austin Health, Heidelberg, VIC,
Australia
(Bellomo) Department of Integrated Critical Care, Center for Integrated
Critical Care, University of Melbourne, Melbourne, VIC, Australia
(Isermann) Department of Laboratory Medicine, Institute of Laboratory
Medicine, Clinical Chemistry, Molecular Diagnostic, Leipzig University
Hospital, Leipzig, Germany
(Westphal) Department of Laboratory Medicine, Institute of Laboratory
Medicine, Tertiary Hospital Dessau, Germany
(Kube, Haase) Department of Anesthesiology and Intensive Care, Leisnig,
Germany
(Albert) Diaverum Renal Care Center, Potsdam, Germany
(Albert) Medical Faculty, University Clinic for Cardiology and Angiology
(Ernst, Haase) Medical Faculty
(Kropf) Medical Faculty, Institute for Biometrics and Medical Informatics,
Otto von-Guericke-University Magdeburg, Magdeburg, Germany
(Haase-Fielitz) Brandenburg Medical School Theodor Fontane, Neuruppin,
Germany
(Haase-Fielitz) Faculty of Health Sciences Brandenburg, Potsdam, Germany
(Haase-Fielitz) Institute of Integrated Health Care Systems Research &
Social Medicine, Otto von-Guericke-University Magdeburg, Magdeburg,
Germany
(Haase-Fielitz) Department of Cardiology, Brandenburg Heart Center,
Immanuel Hospital, Bernau, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Acute kidney injury requiring renal replacement therapy
(AKI-RRT) is strongly associated with mortality after cardiac surgery;
however, options for early identification of patients at high risk for
AKI-RRT are extremely limited. Early after cardiac surgery, the predictive
ability for AKI-RRT even of one of the most extensively evaluated novel
urinary biomarkers, neutrophil gelatinase-associated lipocalin (NGAL),
appears to be only moderate. We aimed to determine whether the
NGAL/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of
hepcidin-25) early after surgery may compare favorably to NGAL for
identification of high-risk patients after cardiac surgery.
<br/>METHOD(S): This is a prospective substudy of the BICARBONATE trial, a
multicenter parallel-randomized controlled trial comparing perioperative
bicarbonate infusion for AKI prevention to usual patient care. At a
tertiary referral center, 198 patients at increased kidney risk undergoing
cardiac surgery with cardiopulmonary bypass were included into the present
study. The primary outcome measure was defined as AKI-RRT. Secondary
outcomes were in-hospital mortality and long-term mortality. We compared
area under the curve of the receiver operating characteristic (AUC-ROC) of
urinary NGAL with that of the urinary NGAL/hepcidin-25 ratio within 60
minutes after end of surgery. We compared adjusted AUC and performed
cross-validated reclassification statistics of the (logarithmic) urinary
NGAL/hepcidin-25 ratio adjusted to Cleveland risk score/EuroScore,
cross-clamp time, age, volume of packed red blood cells, and (logarithmic)
urinary NGAL concentration. The association of the NGAL/hepcidin-25 ratio
with long-term patient survival was assessed using Cox proportional hazard
regression analysis adjusting for EuroScore, aortic cross-clamp time,
packed red blood cells and urinary NGAL. <br/>RESULT(S): Patients with
AKI-RRT (n = 13) had 13.7-times higher NGAL and 3.3-times lower
hepcidin-25 concentrations resulting in 46.9-times higher NGAL/hepcidin-25
ratio early after surgery compared to patients without AKI-RRT. The
NGAL/hepcidin-25 ratio had higher AUC-ROC compared with NGAL for risk of
AKI-RRT and in-hospital mortality (unadjusted AUC-ROC difference 0.087,
95% confidence interval [CI], 0.036-0.138, P < .001; 0.082, 95% CI,
0.018-0.146, P = .012). For AKI-RRT, the NGAL/hepcidin-25 ratio increased
adjusted category-free net reclassification improvement (cfNRI; 0.952, 95%
CI, 0.437-1.468; P < .001) and integrated discrimination improvement (IDI;
0.040, 95% CI, 0.008-0.073; P = .016) but not AUC difference. For
in-hospital mortality, the ratio improved AUC of the reference model (AUC
difference 0.056, 95% CI, 0.003-0.108; P = .037) and cfNRI but not IDI.
The urinary NGAL/hepcidin-25 ratio remained significantly associated with
long-term mortality after adjusting for the model covariates.
<br/>CONCLUSION(S): The urinary NGAL/hepcidin-25 ratio appears to early
identify high-risk patients and outperform NGAL after cardiac surgery.
Confirmation of our findings in other cardiac surgery centers is now
needed.<br/>Copyright &#xa9; 2021 International Anesthesia Research
Society.

<95>
Accession Number
2016441335
Title
FLOW-CONTROLLED VS PRESSURE-CONTROLLED VENTILATION IN CARDIAC SURGERY WITH
CARDIOPULMONARY BYPASS: A PROSPECTIVE, RANDOMIZED CLINICAL TRIAL.
Source
Chest. Conference: CHEST Congress 2022. Bologna Italy. 161(1 Supplement)
(pp A29), 2022. Date of Publication: January 2022.
Author
SPRAIDER P.; ABRAM J.; PUTZER G.; GLODNY B.; MARTINI J.
Institution
(SPRAIDER, ABRAM, PUTZER, MARTINI) Medical University Innsbruck,
Department Of Anaesthesiology And Intensive Care Medicine, Innsbruck,
Austria
(GLODNY) Medical University Innsbruck, Department Of Radiology, Innsbruck,
Austria
Publisher
Elsevier Inc.
Abstract
TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: Flow-controlled
ventilation (FCV) ensures a continuous gas flow during inspiration and
expiration, whereas latter one is a unique feature in artificial
ventilation and has shown to improve lung aeration in preclinical trials.
Aim of this trial was to compare FCV to current standard of
pressure-controlled ventilation (PCV) in patients undergoing cardiac
surgery in terms of gas exchange parameters. <br/>METHOD(S): In a
randomized, single-center, controlled trial patients scheduled for on-pump
open chest cardiac surgery were randomized to either FCV or PCV.
Ventilation was performed per-protocol for the duration of surgery until
intensive care unit admission. The primary endpoint was oxygenation 15
minutes after intraoperative chest closure. <br/>RESULT(S): Among 54
randomized patients 50 were included into final analysis (mean age 70.0
years, 38 (76%) men). The primary endpoint oxygenation, assessed by
paO<inf>2</inf>/FiO<inf>2</inf> after intraoperative chest closure was
significantly higher in the FCV group (n=24) compared to the control group
(PCV n=26) (356 vs 309, MD 46 (95% CI 3 to 90); p=0.038). Additionally,
required respiratory minute volume to obtain similar levels of normocapnia
was significantly lower in the FCV group (4.0 vs. 6.1 l min^-1,
MD -2.0 (95% CI -2.5 to -1.5); p<0.001), which indicates improved carbon
dioxide elimination. <br/>CONCLUSION(S): In patients undergoing cardiac
surgery flow-controlled ventilation improved gas exchange parameters in
terms of oxygenation and carbon dioxide removal compared to standard of
pressure-controlled ventilation. CLINICAL IMPLICATIONS: Flow-controlled
ventilation may represent a treatment option in patients undergoing
cardiac surgery as a high-risk procedure for the development of
postoperative pulmonary complication. DISCLOSURE: Nothing to declare.
KEYWORD: flow-controlled ventilation<br/>Copyright &#xa9; 2021 American
College of Chest Physicians

<96>
Accession Number
2016441219
Title
USE OF CRYOANALGESIA IN PATIENTS AFTER THORACIC SURGERY.
Source
Chest. Conference: CHEST Congress 2022. Bologna Italy. 161(1 Supplement)
(pp A48), 2022. Date of Publication: January 2022.
Author
KURFIRST V.; MOKRACEK A.; KRBEC J.
Institution
(KURFIRST, MOKRACEK, KRBEC) Hospital of Ceske Budejovice, Department Of
Cardiac And Thoracic Surgery, Ceske Budejovice, Czechia
Publisher
Elsevier Inc.
Abstract
TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: To compare the
postoperative analgesic effect of the use of cryoablation of intercostal
nerves in the area of thoracotomy with classical epidural analgesia.
<br/>METHOD(S): Patients indicated for lung / thoracic surgery from a
thoracotomy approach were included in the study. The preoperative
examination included a standard set of examinations needed before surgery.
Patients were randomized into 2 arms: 1) Patients who underwent
cryoanalgesia of intercostal nerves as part of postoperative pain
management 2) Patients who underwent epidural analgesia as part of
postoperative pain management. <br/>RESULT(S): A total of 20 patients were
included in the study. The comparison of the two groups was as follows:
patients after cryoanalgesia had less postoperative pain as assessed by
the VAS scale (3.5 vs. 4.2), less analgesic consumption and the same
respiratory function compared to the group of patients after epidural
analgesia. <br/>CONCLUSION(S): Cryoanalgesia can be used as an alternative
to epidural analgesia in patients undergoing lung surgery from a
thoracotomy approach. CLINICAL IMPLICATIONS: Cryoanalgesia can be used as
an alternative to epidural analgesia in patients undergoing lung surgery
from a thoracotomy approach. DISCLOSURE: Nothing to declare. KEYWORD:
Thoracotomy<br/>Copyright &#xa9; 2021 American College of Chest Physicians

<97>
Accession Number
2016441182
Title
PATIENTS' SATISFACTION WITH LOCAL OR GENERAL ANAESTHESIA IN VIDEO-ASSISTED
THORACOSCOPIC SURGERY: RESULTS OF THE RANDOMIZED CONTROLLED PASSAT TRIAL.
Source
Chest. Conference: CHEST Congress 2022. Bologna Italy. 161(1 Supplement)
(pp A32), 2022. Date of Publication: January 2022.
Author
GALETIN T.; ECKERMANN C.; KRAJA O.; GEERS T.; MERRES J.; KOSSE N.;
KORYLLOS A.; STOELBEN E.
Institution
(GALETIN, ECKERMANN, KRAJA, GEERS, MERRES, KOSSE, KORYLLOS, STOELBEN)
Lung-Clinic Cologne-Merheim, Thoracic Surgery, Cologne, Germany
Publisher
Elsevier Inc.
Abstract
TYPE: Abstract TOPIC: Cardiothoracic Surgery PURPOSE: VATS in local
anaesthesia and analgosedation (LA) is advantageous over general
anaesthesia and one-lung-ventilation (GA) regarding cardiopulmonary,
inflammatory and neurocognitive consequences for the patient. However, the
impact of anaesthesia on patient satisfaction remains unclear. We report
the results of PASSAT, the first randomised-controlled trial using valid
methods to investigate satisfaction. <br/>METHOD(S): Patients presenting
for VATS for pleural disorders or wedge resections were randomised to LA
(intervention group) or GA (control group). The primary endpoint was
patient satisfaction according to psychometrically validated
questionnaires; secondary endpoints were physicians' satisfaction,
capnometry, complication rates, cost-effectiveness. Registry-ID
DRKS00013661. <br/>RESULT(S): Fifty (LA) und 56 (GA) patients completed
the trial. Patient satisfaction with anaesthesiologic care was 2.4 vs. 2.6
(p=0.2), with general perioperative care 2.2 vs. 2.3 (p=0.8), with
recovery after surgery 2.1 vs. 1.9 (p=0.2; 3-point-Likert-scales).
Patient's overall satisfaction with anaesthesia was 8.9 vs. 8.8 (p=0.7),
surgeon's satisfaction with feasibility 7.6 vs 9.4 (p<0.01),
anaesthetist's satisfaction with feasibility 7.3 vs. 9.0 (p<0.01;
10-point-scales each); operation time 35 vs. 34min (p=0.7),
pCO<inf>2</inf> 30min after surgery 44 vs. 44mmHg (p=0.9), pain-NRS on
5^th day 0.7 vs. 1.3 (p=0.2), postoperative delirium 2% vs. 4%
(p=1), complication rate 0% vs. 4% (p=0.5), length of stay 3.9 vs. 6.0
days (p<0.01). <br/>CONCLUSION(S): Patients are as satisfied with LA as
with GA, but their anaesthesiologists and surgeons are not. LA is at least
as safe as GA, but is correlated with significantly shorter length of
stay. CLINICAL IMPLICATIONS: Considering its pathophysiologic benefits and
its equivalent contentment, more efforts should be taken to re-establish
VATS in LA. DISCLOSURE: Nothing to declare. KEYWORD: VATS<br/>Copyright
&#xa9; 2021 American College of Chest Physicians

<98>
Accession Number
2016417055
Title
Machine learning methods for perioperative anesthetic management in
cardiac surgery patients: a scoping review.
Source
Journal of Thoracic Disease. 13(12) (pp 6976-6993), 2021. Date of
Publication: December 2021.
Author
Rellum S.R.; Schuurmans J.; van der Ven W.H.; Eberl S.; Driessen A.H.G.;
Vlaar A.P.J.; Veelo D.P.
Institution
(Rellum, Schuurmans, van der Ven, Eberl, Veelo) Department of
Anesthesiology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
(Rellum, Schuurmans, van der Ven, Vlaar) Department of Intensive Care,
Amsterdam UMC, Location AMC, Amsterdam, Netherlands
(Driessen) Department of Cardiothoracic Surgery, Heart Center, Amsterdam
UMC, Location AMC, Amsterdam, Netherlands
Publisher
AME Publishing Company
Abstract
Background: Machine learning (ML) is developing fast with promising
prospects within medicine and already has several applications in
perioperative care. We conducted a scoping review to examine the extent
and potential limitations of ML implementation in perioperative anesthetic
care, specifically in cardiac surgery patients. <br/>Method(s): We mapped
the current literature by searching three databases: MEDLINE (Ovid),
EMBASE (Ovid), and Cochrane Library. Articles were eligible if they
reported on perioperative ML use in the field of cardiac surgery with
relevance to anesthetic practices. Data on the applicability of ML and
comparability to conventional statistical methods were extracted.
<br/>Result(s): Forty-six articles on ML relevant to the work of the
anesthesiologist in cardiac surgery were identified. Three main categories
emerged: (I) event and risk prediction, (II) hemodynamic monitoring, and
(III) automation of echocardiography. Prediction models based on ML tend
to behave similarly to conventional statistical methods. Using dynamic
hemodynamic or ultrasound data in ML models, however, shifts the potential
to promising results. <br/>Conclusion(s): ML in cardiac surgery is
increasingly used in perioperative anesthetic management. The majority is
used for prediction purposes similar to conventional clinical scores.
Remarkable ML model performances are achieved when using real-time dynamic
parameters. However, beneficial clinical outcomes of ML integration have
yet to be determined. Nonetheless, the first steps introducing ML in
perioperative anesthetic care for cardiac surgery have been
taken.<br/>Copyright &#xa9; Journal of Thoracic Disease. All rights
reserved.

<99>
Accession Number
2005782448
Title
Renal function and coronary bypass surgery in patients with ischemic heart
failure.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(2) (pp 663-672.e3),
2022. Date of Publication: February 2022.
Author
Doenst T.; Haddad H.; Stebbins A.; Hill J.A.; Velazquez E.J.; Lee K.L.;
Rouleau J.L.; Sopko G.; Farsky P.S.; Al-Khalidi H.R.; Jeemon P.; Szwed H.;
Tan R.-S.; Bigalli D.R.; Kosevic D.; Benke K.; Kalil R.A.K.; Jasinski M.;
Smith P.K.; Chua Y.L.
Institution
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich-Schiller-University of Jena, Jena, Germany
(Haddad) Department of Medicine, College of Medicine, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
(Stebbins) Duke Clinical Research Institute, Durham, NC
(Hill) Division of Cardiovascular Medicine, Department of Medicine,
University of Florida, Malcom Randal VAMC, Gainesville, Fla, United States
(Velazquez) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale School of Medicine, New Haven, Conn
(Lee, Al-Khalidi) Department of Biostatistics and Bioinformatics, Duke
University School of Medicine, Duke Clinical Research Institute, Durham,
NC
(Rouleau) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, Md
(Farsky) Department of Cardiology, Instituto Dante Pazzanese de
Cardiologia, Sao Paulo, Brazil
(Farsky) Department of Cardiology, Hospital Israelita Albert Einstein, Sao
Paulo, Brazil
(Jeemon) Epidemiology, Sree Chitra Tirunal Institute for Medical Sciences
and Technology, Kerala, India
(Szwed) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Tan) Department of Cardiology, National Heart Centre Singapore, Singapore
(Bigalli) Department of Cardiac Surgery, CICU, Montevideo, Uruguay
(Kosevic) Department of Cardiology, Dedinje Cardiovascular Institute,
Belgrade, Serbia
(Benke) Heart and Vascular Centre, Semmelweis University, Budapest,
Hungary
(Kalil) Postgraduate Program, Instituto de Cardiologia/FUC and UFCSPA,
Porto Alegre, Brazil
(Jasinski) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Smith) Department of Surgery (Cardiothoracic), Duke University School of
Medicine, Duke Clinical Research Institute, Durham, NC
(Chua) Department of Cardiothoracic Surgery, National Heart Centre
Singapore, Singapore
Publisher
Elsevier Inc.
Abstract
Objective: Chronic kidney disease is a known risk factor in cardiovascular
disease, but its influence on treatment effect of bypass surgery remains
unclear. We assessed the influence of chronic kidney disease on 10-year
mortality and cardiovascular outcomes in patients with ischemic heart
failure treated with medical therapy (medical treatment) with or without
coronary artery bypass grafting. <br/>Method(s): We calculated the
baseline estimated glomerular filtration rate (Chronic Kidney Disease
Epidemiology Collaboration formula, chronic kidney disease stages 1-5)
from 1209 patients randomized to medical treatment or coronary artery
bypass grafting in the Surgical Treatment for IsChemic Heart failure trial
and assessed its effect on outcome. <br/>Result(s): In the overall
Surgical Treatment for IsChemic Heart failure cohort, patients with
chronic kidney disease stages 3 to 5 were older than those with stages 1
and 2 (66-71 years vs 54-59 years) and had more comorbidities.
Multivariable modeling revealed an inverse association between estimated
glomerular filtration rate and risk of death, cardiovascular death, or
cardiovascular rehospitalization (all P < .001, but not for stroke, P =
.697). Baseline characteristics of the 2 treatment arms were equal for
each chronic kidney disease stage. There were significant improvements in
death or cardiovascular rehospitalization with coronary artery bypass
grafting (stage 1: hazard ratio, 0.71; confidence interval, 0.53-0.96, P =
.02; stage 2: hazard ratio, 0.71; confidence interval, 0.59-0.84, P <
.0001; stage 3: hazard ratio, 0.76; confidence interval, 0.53-0.96, P =
.03). These data were inconclusive in stages 4 and 5 for insufficient
patient numbers (N = 28). There was no significant interaction of
estimated glomerular filtration rate with the treatment effect of coronary
artery bypass grafting (P = .25 for death and P = .54 for death or
cardiovascular rehospitalization). <br/>Conclusion(s): Chronic kidney
disease is an independent risk factor for mortality in patients with
ischemic heart failure with or without coronary artery bypass grafting.
However, mild to moderate chronic kidney disease does not appear to
influence long-term treatment effects of coronary artery bypass
grafting.<br/>Copyright &#xa9; 2020 The American Association for Thoracic
Surgery

<100>
Accession Number
2016374784
Title
10-Year All-Cause Mortality Following Percutaneous or Surgical
Revascularization in Patients With Heavy Calcification.
Source
JACC: Cardiovascular Interventions. 15(2) (pp 193-204), 2022. Date of
Publication: 24 Jan 2022.
Author
Kawashima H.; Serruys P.W.; Hara H.; Ono M.; Gao C.; Wang R.; Garg S.;
Sharif F.; de Winter R.J.; Mack M.J.; Holmes D.R.; Morice M.-C.; Kappetein
A.P.; Thuijs D.J.F.M.; Milojevic M.; Noack T.; Mohr F.-W.; Davierwala
P.M.; Onuma Y.
Institution
(Kawashima, Serruys, Hara, Ono, Gao, Wang, Sharif, Onuma) Department of
Cardiology, National University of Ireland, Galway, Galway, Ireland
(Kawashima, Hara, Ono, de Winter) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Serruys) National Heart and Lung Institute, Imperial College London,
London, United Kingdom
(Gao, Wang) Department of Cardiology, Radboud University, Nijmegen,
Netherlands
(Garg) Department of Cardiology, Royal Blackburn Hospital, Blackburn,
United Kingdom
(Mack) Baylor Scott & White Health, Dallas, Texas, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, Minnesota, United States
(Morice) Departement of Cardiologie, Hopital prive Jacques Cartier,
Generale de Sante Massy, Massy, France
(Kappetein, Thuijs, Milojevic) Department of Cardiothoracic Surgery,
Erasmus University Medical Centre, Rotterdam, Netherlands
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Noack, Mohr) University Department of Cardiac Surgery, Heart Centre
Leipzig, Leipzig, Germany
(Davierwala) Division of Cardiovascular Surgery, Peter Munk Cardiac
Centre, Toronto General Hospital, University Health Network, Toronto,
Ontario, Canada
(Davierwala) Department of Surgery, University of Toronto, Toronto, Canada
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to assess 10-year all-cause
mortality in patients with heavily calcified lesions (HCLs) undergoing
percutaneous coronary intervention (PCI) or coronary artery bypass
grafting (CABG). <br/>Background(s): Limited data are available on very
long term outcomes in patients with HCLs according to the mode of
revascularization. <br/>Method(s): This substudy of the SYNTAXES (Synergy
Between PCI With Taxus and Cardiac Surgery Extended Survival) study
assessed 10-year all-cause mortality according to the presence of HCLs
within lesions with >50% diameter stenosis and identified during the
calculation of the anatomical SYNTAX (Synergy Between PCI With Taxus and
Cardiac Surgery) score among 1,800 patients with the 3-vessel disease
and/or left main disease randomized to PCI or CABG in the SYNTAX trial.
Patients with HCLs were further stratified according to disease type
(3-vessel disease or left main disease) and assigned treatment (PCI or
CABG). <br/>Result(s): The 532 patients with >=1 HCL had a higher crude
mortality rate at 10 years than those without (36.4% vs 22.3%; HR: 1.79;
95% CI: 1.49-2.16; P < 0.001). After adjustment, an HCL remained an
independent predictor of 10-year mortality (HR: 1.36; 95% CI: 1.09-1.69; P
= 0.006). There was a significant interaction in mortality between
treatment effect (PCI and CABG) and the presence or absence of HCLs
(P<inf>interaction</inf> = 0.005). In patients without HCLs, mortality was
significantly higher after PCI than after CABG (26.0% vs 18.8%; HR: 1.44;
95% CI: 0.97-1.41; P = 0.003), whereas in those with HCLs, there was no
significant difference (34.0% vs 39.0%; HR: 0.85; 95% CI: 0.64-1.13; P =
0.264). <br/>Conclusion(s): At 10 years, the presence of an HCL was an
independent predictor of mortality, with a similar prognosis following PCI
or CABG. Whether HCLs require special consideration when deciding the mode
of revascularization beyond their current contribution to the anatomical
SYNTAX score deserves further evaluation. (Synergy Between PCI With TAXUS
and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES], NCT03417050;
SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass
Surgery for the Treatment of Narrowed Arteries [SYNTAX],
NCT00114972)<br/>Copyright &#xa9; 2022 American College of Cardiology
Foundation

<101>
Accession Number
2014851609
Title
Giant cell arteritis: A case report and review of literature.
Source
Radiology Case Reports. 16(12) (pp 3734-3738), 2021. Date of Publication:
December 2021.
Author
Crain M.A.; Lakhani D.A.; Winkler L.; Adelanwa A.; Kim C.
Institution
(Crain) West Virginia University School of Medicine, Morgantown, WV,
United States
(Lakhani, Winkler, Kim) Department of Radiology, West Virginia University,
1 Medical Center Drive, Morgantown, WV 26506, United States
(Adelanwa) Department of Pathology, Ruby Memorial Hospital, West Virginia
University, Morgantown, WV, United States
Publisher
Elsevier Inc.
Abstract
Giant cell arteritis, the most common form of vasculitis in the elderly,
is characterized by granulomatous inflammation of arteries, which can lead
to serious, life-threatening conditions including aortic aneurysms,
ruptures, and dissections as well as blindness. Since GCA can be treated
by immunosuppressant therapy, such as corticosteroids, early diagnosis and
treatment may reduce the risk of serious disability and morbidity. While
temporal artery biopsy is considered the gold standard to diagnosis giant
cell arteritis, it is intrusive with inherent risks as well as unreliable
due to tissue sampling. Imaging studies, such as computerized tomography,
are nonintrusive and have been shown to identify vasculitis including
giant cell arteritis. We present a case of a 72-year-old male patient who
was diagnosed with giant cell arteritis by temporal artery biopsy during
surgery for aortic aneurysm and coronary artery bypass graft. Computerized
tomography imaging studies, prior to the surgery and biopsy, were
suggestive of vasculitis. This case serves to emphasize the beneficial
role of imaging studies to assess vasculitis, including giant cell
arteritis, that can be done prior to the progressive development of more
serious debilitating and potentially fatal pathology.<br/>Copyright &#xa9;
2021

<102>
Accession Number
2014286064
Title
Calcium administration In patients undergoing CardiAc suRgery under
cardiopulmonary bypasS (ICARUS trial): Rationale and design of a
randomized controlled trial.
Source
Contemporary Clinical Trials Communications. 23 (no pagination), 2021.
Article Number: 100835. Date of Publication: September 2021.
Author
Lomivorotov V.; Ponomarev D.; Boboshko V.; Shmyrev V.; Ismoilov S.;
Efremov S.; Kamenshchikov N.; Akselrod B.; Pasyuga V.; Urusov D.; Ovezov
A.; Evdokimov M.; Turchaninov A.; Bogachev-Prokofiev A.; Bukamal N.; Afifi
S.; Belletti A.; Bellomo R.; Landoni G.
Institution
(Lomivorotov, Ponomarev, Boboshko, Shmyrev, Ismoilov, Bogachev-Prokofiev)
E. Meshalkin National Medical Research Centre, Novosibirsk, Russian
Federation
(Lomivorotov) Novosibirsk State University, Novosibirsk, Russian
Federation
(Efremov) Saint Petersburg State University Hospital, Saint Petersburg,
Russian Federation
(Kamenshchikov) Sardiology Research Institute, Tomsk National Research
Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
(Akselrod) Petrovsky National Research Centre of Surgery, Moscow, Russian
Federation
(Pasyuga) Federal Center for Cardiovascular Surgery, Astrakhan, Russian
Federation
(Urusov) District Clinical Hospital, Khanty-Mansiysk, Russian Federation
(Ovezov) Moscow Regional Research and Clinical Institute (MONIKI), Moscow,
Russian Federation
(Evdokimov) Federal Center for Cardiovascular Surgery, Penza, Russian
Federation
(Turchaninov) Federal Center for Cardiovascular Surgery, Chelyabinsk,
Russian Federation
(Bukamal) Sh. Mohammed Bin Khalifa Bin Sulman Al-Khalifa Cardiac Center,
Awali, Bahrain
(Afifi) King Abdullah Medical City, Makkah, Saudi Arabia
(Belletti, Landoni) IRCCS San Raffaele Scientific Institute, Milan, Italy
(Bellomo) The University of Melbourne, Melbourne, Australia
(Landoni) Vita-Salute San Raffaele University, Milan, Italy
Publisher
Elsevier Inc.
Abstract
Introduction: Weaning from cardiopulmonary bypass (CPB) is a critical step
of any cardiac surgical procedure and often requires pharmacologic
intervention. Calcium ions are pivotal elements for the
excitation-contraction coupling process of cardiac myocytes. Thus, calcium
administration might be helpful during weaning from CPB. <br/>Method(s):
We describe a multicenter, placebo-controlled, double blind randomized
clinical trial to assess the effect of calcium chloride on the need for
inotropic support among adult patients during weaning from CPB. The
experimental group (409 patients) will receive 15 mg/kg of calcium
chloride. The control group (409 patients) will receive an equivalent
volume of 0.9% sodium chloride. Both drugs will be administered
intravenously as a bolus at the beginning of weaning from CPB.
<br/>Result(s): The primary outcome will be the need for inotropic support
between termination of CPB and completion of surgery. Secondary outcomes
will be: duration of inotropic support, vasoactive-inotropic score 30 min
after transfer to intensive care unit and on postoperative day 1, plasma
alpha-amylase on postoperative day 1, plasma Ca²⁺ concentration
immediately before and 10-15 min after calcium chloride administration,
non-fatal myocardial infarction, blood loss on postoperative day 1, need
for transfusion of red blood cells, signs of myocardial ischemia on
electrocardiogram after arrival to intensive care unit, all-cause
mortality at 30 days or during hospital stay if this is longer than 30
days. <br/>Discussion(s): This trial is designed to assess whether
intravenous calcium chloride administration could reduce the need for
inotropic support after cardiopulmonary bypass weaning among adults
undergoing cardiac surgery.<br/>Copyright &#xa9; 2021 The Authors

<103>
Accession Number
2016417054
Title
Artificial intelligence in thoracic surgery: a narrative review.
Source
Journal of Thoracic Disease. 13(12) (pp 6963-6975), 2021. Date of
Publication: December 2021.
Author
Bellini V.; Valente M.; Rio P.D.; Bignami E.
Institution
(Bellini, Bignami) Anesthesiology, Critical Care and Pain Medicine
Division, Department of Medicine and Surgery, University of Parma, Parma,
Italy
(Valente, Rio) General Surgery Unit, Department of Medicine and Surgery,
University of Parma, Parma, Italy
Publisher
AME Publishing Company
Abstract
Objective: The aim of this article is to review the current applications
of artificial intelligence in thoracic surgery, from diagnosis and
pulmonary disease management, to preoperative risk-assessment, surgical
planning, and outcomes prediction. <br/>Background(s): Artificial
intelligence implementation in healthcare settings is rapidly growing,
though its widespread use in clinical practice is still limited. The
employment of machine learning algorithms in thoracic surgery is
wide-ranging, including all steps of the clinical pathway. <br/>Method(s):
We performed a narrative review of the literature on Scopus, PubMed and
Cochrane databases, including all the relevant studies published in the
last ten years, until March 2021. <br/>Conclusion(s): Machine learning
methods are promising encouraging results throughout the key issues of
thoracic surgery, both clinical, organizational, and educational.
Artificial intelligence-based technologies showed remarkable efficacy to
improve the perioperative evaluation of the patient, to assist the
decision-making process, to enhance the surgical performance, and to
optimize the operating room scheduling. Still, some concern remains about
data supply, protection, and transparency, thus further studies and
specific consensus guidelines are needed to validate these technologies
for daily common practice.<br/>Copyright &#xa9; Journal of Thoracic
Disease. All rights reserved.

<104>
Accession Number
2016417049
Title
Bridge to transplantation from mechanical circulatory support: a narrative
review.
Source
Journal of Thoracic Disease. 13(12) (pp 6911-6923), 2021. Date of
Publication: December 2021.
Author
Zhou A.L.; Etchill E.W.; Giuliano K.A.; Shou B.L.; Sharma K.; Choi C.W.;
Kilic A.
Institution
(Zhou, Shou) Johns Hopkins School of Medicine, Baltimore, MD, United
States
(Etchill, Giuliano, Choi, Kilic) Division of Cardiac Surgery, Department
of Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
(Sharma) Division of Cardiology, Johns Hopkins School of Medicine,
Baltimore, MD, United States
Publisher
AME Publishing Company
Abstract
Objective: To highlight recent developments in the utilization of
mechanical circulatory support (MCS) devices as bridge-to-transplant
strategies and to discuss trends in MCS use following the changes to the
United Network for Organ Sharing (UNOS) heart allocation system.
<br/>Background(s): MCS devices have played an increasingly important role
in the treatment of heart failure patients. Over the past several years,
technological advancements have led to new developments in MCS devices and
expanding indications for MCS use. In October of 2018, the UNOS heart
allocation policy was revised to prioritize higher-urgency patients,
including those supported with temporary MCS devices. Since then, changes
in trends of MCS utilization have been observed. <br/>Method(s): Articles
from the PubMed database regarding the use of MCS devices as
bridge-to-transplant strategies were reviewed. <br/>Conclusion(s): Over
the past decade, utilization of temporary MCS devices, which include the
intraaortic balloon pump (IABP), percutaneous ventricular assist devices
(pVADs), and extracorporeal membrane oxygenation (ECMO), has become
increasingly common. Recent advancements in MCS include the development of
pVADs that can fully unload the left ventricle (LV) as well as devices
designed to provide right-sided support. Technological advancements in
durable left ventricular assist devices (LVADs) have also led to improved
outcomes both on the device and following heart transplantation. Following
the 2018 UNOS heart allocation policy revision, the utilization of
temporary MCS in advanced heart failure patients has further increased and
the proportion of patients bridged directly from a temporary MCS device
has exponentially risen. However, following the start of the COVID-19
pandemic, the trends have reversed, with a decrease in the percentage of
patients bridged from a temporary MCS device. As long-term data following
the allocation policy revision becomes available, future studies should
investigate how trends in MCS use for patients with advanced heart failure
continue to evolve.<br/>Copyright &#xa9; Journal of Thoracic Disease. All
rights reserved.

<105>
Accession Number
2016416422
Title
Aortic Valve Replacement for Patients with Heyde Syndrome: A Literature
Review.
Source
Chinese Medical Sciences Journal. 36(4) (pp 307-315), 2021. Date of
Publication: December 2021.
Author
Li H.; Lin P.; Yao Y.
Institution
(Li) Department of Anesthesiology, The First Hospital of Hebei Medical
University, Shijiazhuang 050000, China
(Lin) Department of Anesthesiology, Fujian Medical University Affiliated
First Quanzhou Hospital, Quanzhou 362000, China
(Yao) Department of Anesthesiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking
Union Medical College, Beijing 100037, China
Publisher
Elsevier Ltd
Abstract
Objective: To explore the characteristics and clinical outcomes of
patients with Heyde syndrome (HS) who undergo aortic valve replacement
(AVR). <br/>Method(s): Electronic databases including PubMed, Embase,
Ovid, WANFANG, VIP and CNKI were searched to identify all case reports of
HS patients undergoing AVR surgery, using different combinations of search
terms "Heyde syndrome", "gastrointestinal bleeding", "aortic stenosis",
and "surgery". Three authors independently extracted the clinical data
including the patients' characteristics, aortic stenosis severity,
gastrointestinal bleeding sites, surgical treatments and prognosis.
<br/>Result(s): Finally, 46 case reports with SS patients aging from 46 to
87 years, were determined eligible and included. Of them, 1 patient had
mild aortic stenosis, 1 had moderate aortic stenosis, 42 had severe aortic
stenosis, and 11 were not mentioned. Gastrointestinal bleeding was
detected in colon (n⁼8), jejunum (n=6), ileum (n=4), cecum
(n=3), duodenal (n⁼3) and multiple sites (n⁼8). No
specific bleeding site was identified in 23 patients. Preoperative
hemoglobin level ranged from 43 to 117 g/L. All but one of 16 patients
showed decreased level of high molecule weight von Willebrand factor. Of
the 55 patients, 43 underwent AVR, and 12 received transcatheter AVR.
Aortic valves of 14 cases were replaced by mechanical valves, and 33 cases
by biological valves. All patients recovered well during the follow-up,
except 5 patients. One patient who had perivalvular leakage and
gastrointestinal bleeding after AVR underwent the second AVR. Two patients
had recurrent gastrointestinal bleeding. Two patients died of
hfe-threatening acute subdural hematoma and multiple organ failure,
respectively. <br/>Conclusion(s): HS is a rare syndrome characterized by
aortic stenosis and gastrointestinal bleeding. AVR is an effective
treatment for HS.<br/>Copyright &#xa9; 2021 Chinese Academy Medical
Sciences

<106>
Accession Number
2016430309
Title
Comparative Early and Long Term Results of Mitral Valve Surgery between
Right Mini Thoracotomy and Full Sternotomy Approach.
Source
Journal of the Medical Association of Thailand. 104(12) (pp S133-S139),
2021. Date of Publication: December 2021.
Author
Chaiyaroj S.; Lertsitthichai P.
Institution
(Chaiyaroj) Cardiovascular Thoracic Surgery Unit, Department of Surgery,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok,
Thailand
(Lertsitthichai) Department of Surgery, Faculty of Medicine Ramathibodi
Hospital, Mahidol University, Bangkok, Thailand
Publisher
Medical Association of Thailand
Abstract
Background: Conventional mitral valve surgery (MVS) requires median
sternotomy. Right mini thoracotomy (RMT) MVS is an alternative non
sternotomy approach aiming for less bleeding, pain reduction, rapid
recovery, cosmetic satisfaction, safety and effectiveness of the
procedure. <br/>Objective(s): To report early and late clinical results
comparing RMT versus full sternotomy (FS) MVS. <br/>Material(s) and
Method(s): 574 consecutive patients underwent MVS were prospectively non
randomized reviewed during January 2002 to October 2018. There were 241 in
FS group and 241 in RMT group by age and Euro II score matching. Baseline
characteristics were compared. Early and late clinical outcomes of 30 days
mortality, reoperation for bleeding, stroke, prolonged ventilation, renal
failure, permanent pacemaker, and echocardiographic hemodynamic
performance were assessed and compared between two groups. All patient
follow-up to December 2020. <br/>Result(s): Similar results were found
between RMT and FS MVS groups including age 58.8+13.6, 57.2+14.2, p=0.2,
new AF 5 (2%), 4 (1.7%), p=1.0), except for more degenerative valve
pathology (79%, 50%, p<0.001). There were more re operation for bleeding 2
(0.8%), 1 (0.3%), p=0.9, less aortic cross clamp time (107+37.3,
115.4+36.4, p=0.017), less cardiopulmonary bypass time (157.6+51.2,
171.3+53.4, p=0.005), less bleeding and blood transfusion requirement in
the RMT group. Early clinical results of 30 days mortality, stroke, renal
failure, new pacemaker, and hemodynamic performance at one month, three to
six month, and one year were comparable in both groups. Mean follow-up
(year) was 5.2+2.5 (RMT) and 10.2+4.0 (FS). Survival probability and
freedom from MACCE at ten years in RMT and FS group were 94.05%, 95.44%
and 99.5%, 90.46%, p<0.001, respectively. <br/>Conclusion(s): RMT approach
for MVS is associated with cosmetic satisfaction, less bleeding, similar
effective hemodynamic performance and non-inferiority early and late
clinical results to FS approach.<br/>Copyright &#xa9; JOURNAL OF THE
MEDICAL ASSOCIATION OF THAILAND<br/> 2021

<107>
Accession Number
2014711499
Title
Stress exercise haemodynamic performance and opening reserve of a stented
bovine pericardial aortic valve bioprosthesis.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Porterie J.; Salaun E.; Ternacle J.; Clavel M.-A.; Dagenais F.
Institution
(Porterie, Dagenais) Department of Cardiac Surgery, Heart and Lung
University Institute, Quebec City, QC, Canada
(Salaun, Ternacle, Clavel) Department of Clinical Research, Heart and Lung
University Institute, Quebec City, QC, Canada
(Salaun, Clavel) Department of Medicine, Faculty of Medicine, Laval
University, Quebec City, QC, Canada
(Ternacle) Department of Cardiology, Hopital Cardiologique Haut-Leveque,
CHU de Bordeaux, France
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Despite unusual high rates of patient-prosthesis mismatch
(PPM), excellent midterm clinical outcomes have been reported after
surgical aortic valve replacement (SAVR) with the AvalusTM bioprosthetic
valve (Medtronic). To elucidate this "PPM conundrum," the Avalus valve
haemodynamics were assessed during exercise testing. <br/>Method(s): Of
the 148 patients who had undergone SAVR with the Avalus valve at our
institution, 30 were randomly selected among those in whom stress test was
deemed feasible and underwent a resting transthoracic echocardiography
immediately followed by exercise echocardiography. Severe PPM was defined
as indexed effective orifice area (iEOA) (Formula presented.) 0.65
cm²/m² and moderate PPM as iEOA (Formula presented.)
0.65 and (Formula presented.) 0.85 cm²/m². Measured
PPM was determined with the use of the measured iEOA at rest or stress,
while the estimated PPM was based on the estimated iEOA, derived from the
mean EOA reported for each valve size in the manufacturer chart.
<br/>Result(s): Measured EOA significantly increased from rest to peak
exercise in all PPM groups (p <.05) and the rates of moderate and severe
measured PPM decreased from 40% and 20% to 27% and 0%, respectively. The
patients with low-flow state (flow < 250 ml/s) had significantly lower
measured rest EOA (p =.03). On the basis of the estimated iEOA, there was
no severe PPM and 19 patients had moderate PPM (63.3%), with a
significantly lower opening reserve than the patients without estimated
PPM (p =.04). The estimated iEOA was more reliably correlated to the
measured iEOA at maximal stress than the measured iEOA at rest, especially
in patients with a low-flow state. <br/>Conclusion(s): This study supports
the concept of an opening reserve of the Avalus valve to explain the PPM
conundrum and promotes the use of exercise Doppler-echocardiography to
complete the assessment of mismatch, especially in patients with a
low-flow state. Published estimated EOA seems reliable to predict the
haemodynamic performance of the Avalus valve, whether the flow conditions
at rest.<br/>Copyright &#xa9; 2022 Wiley Periodicals LLC

<108>
Accession Number
2016448775
Title
Coronary Stenting: Reflections on a 35-Year Journey.
Source
Canadian Journal of Cardiology. (no pagination), 2022. Date of
Publication: 2022.
Author
Strauss B.H.; Tanguay J.-F.; Picard F.; Doucet S.; Morice M.-C.;
Elbaz-Greener G.
Institution
(Strauss, Elbaz-Greener) Schulich Heart Program, Sunnybrook Health
Sciences Centre, Toronto, Ontario, Canada
(Strauss) University of Toronto, Toronto, Ontario, Canada
(Tanguay, Doucet) Montreal Heart Institute, University of Montreal,
Montreal, Quebec, Canada
(Picard) Cardiology Department, Assistance Publique-Hopitaux de Paris,
Hopital Cochin, Paris, France
(Morice) Department of Cardiology, Institut Hospitalier Jacques Cartier,
Ramsay Generale de Sante, Massy, France
(Elbaz-Greener) Department of Cardiology Hadassah Medical Center, Faculty
of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
Publisher
Elsevier Inc.
Abstract
Stenting was introduced as a therapy for coronary artery disease 35 years
ago, and is currently the most commonly performed minimally invasive
procedure globally. Percutaneous coronary revascularization, initially
with plain old balloon angioplasty and later with stenting, has
dramatically affected the outcomes of acute myocardial infarction and
acute coronary syndromes. Coronary stenting is probably the most
intensively studied therapy in medicine on the basis of the number of
randomized clinical trials for a broad range of indications. Continuous
improvements in stent materials, design, and coatings concurrent with
procedural innovations have truly been awe-inspiring. The story of
stenting is replete with high points and some low points, such as the
initial experience with stent thrombosis and restenosis, and the more
recent disappointment with bioabsorbable scaffolds. History has shown
rapid growth of stent use with expansion of indications followed by
contraction of some uses in response to clinical trial evidence in support
of bypass surgery or medical therapy. In this review we trace the
constantly evolving story of the coronary stent from the earliest
experience until the present time. Undoubtedly, future iterations of stent
design and materials will continue to move the stent story
forward.<br/>Copyright &#xa9; 2021 Canadian Cardiovascular Society

<109>
Accession Number
2013963717
Title
Slow gait speed is associated with worse postoperative outcomes in cardiac
surgery: A systematic review and meta-analysis.
Source
Journal of Cardiac Surgery. 37(1) (pp 197-204), 2022. Date of Publication:
January 2022.
Author
Chang J.; Nathalie J.; Nguyenhuy M.; Xu R.; Virk S.A.; Saxena A.
Institution
(Chang) The Royal Melbourne Hospital, Parkville, VIC, Australia
(Nathalie) St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
(Nguyenhuy) Western Hospital, Footscray, VIC, Australia
(Xu) The University of Melbourne, Parkville, VIC, Australia
(Virk) Department of Cardiology, Concord Repatriation General Hospital,
Concord West, NSW, Australia
(Saxena) Department of Cardiothoracic Surgery and Transplantation, Fiona
Stanley Hospital, Murdoch, WA, Australia
Publisher
John Wiley and Sons Inc
Abstract
Background: Frailty is associated with poorer outcomes in cardiac surgery,
but the heterogeneity in frailty assessment tools makes it difficult to
ascertain its true impact in cardiac surgery. Slow gait speed is a simple,
validated, and reliable marker of frailty. We performed a systematic
review and meta-analysis to examine the effect of slow gait speed on
postoperative cardiac surgical patients. <br/>Method(s): PubMED, MEDLINE,
and EMBASE databases were searched from January 2000 to August 2021 for
studies comparing slow gait speed and "normal" gait speed. Primary outcome
was in-hospital mortality. Secondary outcomes were composite mortality and
major morbidity, AKI, stroke, deep sternal wound infection, prolonged
ventilation, discharge to a healthcare facility, and ICU length of stay.
<br/>Result(s): There were seven eligible studies with 36,697 patients.
Slow gait speed was associated with increased likelihood of in-hospital
mortality (risk ratio [RR]: 2.32; 95% confidence interval [CI]:
1.87-2.87). Additionally, they were more likely to suffer from composite
mortality and major morbidity (RR: 1.52; 95% CI: 1.38-1.66), AKI (RR:
2.81; 95% CI: 1.44-5.49), deep sternal wound infection (RR: 1.77; 95% CI:
1.59-1.98), prolonged ventilation >24 h (RR: 1.97; 95% CI: 1.48-2.63),
reoperation (RR: 1.38; 95% CI: 1.05-1.82), institutional discharge (RR:
2.08; 95% CI: 1.61-2.69), and longer ICU length of stay (MD: 21.69; 95%
CI: 17.32-26.05). <br/>Conclusion(s): Slow gait speed is associated with
poorer outcomes in cardiac surgery. Frail patients are twofold more likely
to die during hospital admission than nonfrail counterparts and are at an
increased risk of developing various perioperative
complications.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<110>
Accession Number
2014068463
Title
Safety and efficacy of concomitant ablation for atrial fibrillation in
rheumatic mitral valve surgery: A meta-analysis.
Source
Journal of Cardiac Surgery. 37(2) (pp 361-373), 2022. Date of Publication:
February 2022.
Author
Ma J.; Wei P.; Yan Q.; Liu J.; Yao X.; Chen Z.; Zhuang J.; Guo H.-M.
Institution
(Ma, Wei, Liu, Chen, Zhuang, Guo) Department of Cardiovascular Surgery,
Guangdong Provincial Key Laboratory of South China Structural Heart
Disease, Guangdong Provincial People's Hospital, Guangdong Cardiovascular
Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
(Yan, Yao) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese
Academy of Medical Sciences, Shenzhen, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: This review aimed to evaluate the safety and efficacy of
concomitant surgical ablation (SA) for patients with atrial fibrillation
(AF) undergoing rheumatic mitral valve (MV) surgery. <br/>Method(s): A
systematic search of relevant studies focusing on SA for patients with AF
undergoing rheumatic MV surgery was performed. The primary outcomes
included mortality, efficacy, and complications. <br/>Result(s): Four
randomized controlled trials (RCTs) and four observational studies
covering 1931 patients met the inclusion criteria. In RCTs, no significant
differences in reoperation for bleeding, low cardiac output syndrome,
thromboembolic events, and early (risk ratio [RR], 2.07; 95% confidence
intervals [CI], 0.37-11.40; p =.41) and midterm all-cause death (RR, 1.07;
95% CI, 0.40-2.88; p =.89) were noted between the SA group and the
nonablation group. These results were similar to those obtained from
observational studies. However, ablation was associated with a higher
incidence of permanent pacemaker implantation (RR, 2.44; 95% CI,
1.15-5.18; p =.02) in observational studies but not in RCTs (RR, 2.03; 95%
CI, 0.19-21.26; p =.56). Furthermore, additional SA was significantly more
effective in sinus rhythm (SR) restoration than MV surgery alone at
discharge and at the 12-month and 3-year follow-ups. <br/>Conclusion(s):
Concomitant SA during rheumatic MV surgery does not increase perioperative
adverse events. In addition, SA promotes considerable restoration of SR.
Although some evidence exists that permanent pacemaker implantation is
more common after ablation, not all studies support this
notion.<br/>Copyright &#xa9; 2021 Wiley Periodicals LLC

<111>
Accession Number
2016193440
Title
Mortality after bleeding versus myocardial infarction in coronary artery
disease: A systematic review and meta-analysis.
Source
EuroIntervention. 17(7) (pp 550-560), 2021. Date of Publication: September
2021.
Author
Piccolo R.; Oliva A.; Avvedimento M.; Franzone A.; Windecker S.;
Valgimigli M.; Esposito G.; Juni P.
Institution
(Piccolo, Oliva, Avvedimento, Franzone, Esposito) Department of Advanced
Biomedical Sciences, University of Naples Federico II, Naples, Italy
(Windecker, Valgimigli) Department of Cardiology, Bern University
Hospital, University of Bern, Bern, Switzerland
(Juni) Applied Health Research Centre of the Li Ka Shing Knowledge
Institute, Department of Medicine, St Michael's Hospital, University of
Toronto, Toronto, ON, Canada
Publisher
Europa Group
Abstract
Background: Bleeding is the principal safety concern of antithrombotic
therapy and occurs frequently among patients with coronary artery disease
(CAD). <br/>Aim(s): We aimed to evaluate the prognostic impact of bleeding
on mortality compared with that of myocardial infarction (MI) in patients
with CAD. <br/>Method(s): We searched Medline and Embase for studies that
included patients with CAD and that reported both the association between
the occurrence of bleeding and mortality, and between the occurrence of MI
and mortality within the same population. Adjusted hazard ratios (HRs) for
mortality associated with bleeding and MI were extracted and ratios of
hazard ratios (rHRs) were pooled by using inverse variance weighted random
effects meta-analyses. Early events included periprocedural or within
30-day events after revascularisation or acute coronary syndrome (ACS).
Late events included spontaneous or beyond 30-day events after
revascularisation or ACS. <br/>Result(s): A total of 141,059 patients were
included across 16 studies; 128,660 (91%) underwent percutaneous coronary
intervention. Major bleeding increased the risk of mortality to the same
extent as MI (rHRsbleedingvsMI 1.10, 95% CI: 0.71-1.71, p=0.668). Early
bleeding was associated with a higher risk of mortality than early MI
(rHRsbleedingvsMI 1.46, 95% CI: 1.13-1.89, p=0.004), although this finding
was not present when only randomised trials were included. Late bleeding
was prognostically comparable to late MI (rHRsbleedingvsMI 1.14, 95% CI:
0.87-1.49, p=0.358). <br/>Conclusion(s): Compared with MI, major and late
bleeding is associated with a similar increase in mortality, whereas early
bleeding might have a stronger association with mortality.<br/>Copyright
&#xa9; Europa Digital & Publishing 2021. All rights reserved.

<112>
Accession Number
2015687437
Title
Meta-Analysis of New-Onset Atrial Fibrillation Versus No History of Atrial
Fibrillation in Patients With Noncardiac Critical Care Illness.
Source
American Journal of Cardiology. 164 (pp 57-63), 2022. Date of Publication:
01 Feb 2022.
Author
Shah K.B.; Saado J.; Kerwin M.; Mazimba S.; Kwon Y.; Mangrum J.M.; Salerno
M.; Haines D.E.; Mehta N.K.
Institution
(Shah, Haines, Mehta) Department of Cardiovascular Medicine, Beaumont
Hospital, Oakland University William Beaumont School of Medicine, Royal
Oak, MI, United States
(Saado) Department of Internal Medicine, Virginia Commonwealth University,
Richmond, VA, United States
(Kerwin) Division of Internal Medicine
(Mazimba, Mangrum, Salerno, Mehta) Division of Cardiovascular Medicine,
University of Virginia, Charlottesville, VA, United States
(Kwon) Division of Cardiovascular Medicine and Critical care medicine,
Harborview Medical Center, University of Washington Medical Center,
Seattle, WA, United States
Publisher
Elsevier Inc.
Abstract
The incidence of new-onset secondary atrial fibrillation (NOSAF) is as
high as 44% in noncardiac critical illness. A systematic review and
meta-analysis were performed to evaluate the impact of NOSAF, compared
with history of prior atrial fibrillation (AF) and no history of AF in
noncardiac critically ill patients. Patients undergoing cardiothoracic
surgery were excluded. NOSAF incidence, intensive care unit (ICU)/hospital
length of stay (LOS), and mortality outcomes were analyzed. Of 2,360
studies reviewed, 19 studies met inclusion criteria (n = 306,805
patients). NOSAF compared with no history of AF was associated with
increased in-hospital mortality (risk ratio [RR] 2.06, 95% confidence
interval [CI] 1.76 to 2.41, p <0.001), longer ICU LOS (standardized
difference in means [SMD] 0.66, 95% CI 0.41 to 0.91, p <0.001), longer
hospital LOS (SMD 0.31, 95% CI 0.07 to 0.56, p = 0.001) and increased risk
of long-term (>1 year) mortality (RR 1.76, 95% CI 1.29 to 2.40, p <0.001).
NOSAF compared with previous AF was also associated with higher
in-hospital mortality (RR 1.29, 95% CI 1.12 to 1.49, p <0.001), longer ICU
LOS (SMD 0.37, 95% CI 0.03 to 0.70, p = 0.03) but no difference
in-hospital LOS (SMD -0.18, 95% CI -0.66 to 0.31, p = 0.47). In
conclusion, NOSAF, in the setting of noncardiac critical illness is
associated with increased in-hospital mortality compared with no history
of AF and previous AF. NOSAF (vs no history of AF) is also associated with
increased long-term mortality.<br/>Copyright &#xa9; 2021 Elsevier Inc.

<113>
Accession Number
635108025
Title
Cardiac mortality in patients randomised to elective coronary
revascularisation plus medical therapy or medical therapy alone: a
systematic review and meta-analysis.
Source
European heart journal. 42(45) (pp 4638-4651), 2021. Date of Publication:
01 Dec 2021.
Author
Navarese E.P.; Lansky A.J.; Kereiakes D.J.; Kubica J.; Gurbel P.A.; Gorog
D.A.; Valgimigli M.; Curzen N.; Kandzari D.E.; Bonaca M.P.; Brouwer M.;
Uminska J.; Jaguszewski M.J.; Raggi P.; Waksman R.; Leon M.B.; Wijns W.;
Andreotti F.
Institution
(Navarese, Kubica) Interventional Cardiology and Cardiovascular Medicine
Research, Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Navarese, Raggi) Faculty of Medicine, University of Alberta, Edmonton,
Canada
(Navarese, Kubica) SIRIO MEDICINE research network, Poland
(Lansky) Yale University School of Medicine, CT, New Haven, United States
(Kereiakes) Christ Hospital and Lindner Research Center, Cincinnati, OH,
USA
(Gurbel) Sinai Center for Thrombosis Research and Drug Development, Sinai
Hospital of Baltimore, MD, Baltimore, United States
(Gorog) Faculty of Medicine, National Heart and Lung Institute, Imperial
College, London, United Kingdom
(Gorog) Cardiology Department, East and North Hertfordshire NHS Trust,
Stevenage, United Kingdom
(Valgimigli) Department of Cardiology, Inselspital Universitatsspital,
Bern, Switzerland
(Curzen) University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Curzen) University of Southampton, Southampton, United Kingdom
(Kandzari) Department of Interventional Cardiology, Piedmont Heart
Institute, Atlanta, United States
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
United States
(Brouwer) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Uminska) Department of Geriatrics, Nicolaus Copernicus University,
Bydgoszcz, Poland
(Jaguszewski) 1st Department of Cardiology, Medical University of Gdansk,
Gdansk, Poland
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, DC, WA, United States
(Leon) Division of Cardiovascular Medicine, Columbia University Irving
Medical Center, NY, NY, United States
(Leon) Cardiovascular Research Foundation, NY, NY, United States
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland Galway and Saolta University Healthcare Group,
Galway, Ireland
(Andreotti) Direzione Scientifica, Fondazione Policlinico Universitario
Gemelli IRCCS, Rome, Italy
(Andreotti) Cardiovascular Medicine, Catholic University Medical School,
Rome, Italy
Publisher
NLM (Medline)
Abstract
AIMS: The value of elective coronary revascularisation plus medical
therapy over medical therapy alone in managing stable patients with
coronary artery disease is debated. We reviewed all trials comparing the
two strategies in this population. METHODS AND RESULTS: From inception
through November 2020, MEDLINE, EMBASE, Google Scholar, and other
databases were searched for randomised trials comparing revascularisation
against medical therapy alone in clinically stable coronary artery disease
patients. Treatment effects were measured by rate ratios (RRs) with 95%
confidence intervals, using random-effects models. Cardiac mortality was
the pre-specified primary endpoint. Spontaneous myocardial infarction (MI)
and its association with cardiac mortality were secondary endpoints.
Further endpoints included all-cause mortality, any MI, and stroke.
Longest follow-up data were abstracted. The study is registered with
PROSPERO (CRD42021225598). Twenty-five trials involving 19 806 patients
(10 023 randomised to revascularisation plus medical therapy and 9783 to
medical therapy alone) were included. Compared with medical therapy alone,
revascularisation yielded a lower risk of cardiac death [RR 0.79
(0.67-0.93), P<0.01] and spontaneous MI [RR 0.74 (0.64-0.86), P<0.01]. By
meta-regression, the cardiac death risk reduction after revascularisation,
compared with medical therapy alone, was linearly associated with
follow-up duration [RR per 4-year follow-up: 0.81 (0.69-0.96), P=0.008],
spontaneous MI absolute difference (P=0.01) and percentage of multivessel
disease at baseline (P=0.004). Trial sequential and sensitivity analyses
confirmed the reliability of the cardiac mortality findings. All-cause
mortality [0.94 (0.87-1.01), P=0.11], any MI (P=0.14), and stroke risk
(P=0.30) did not differ significantly between strategies.
<br/>CONCLUSION(S): In stable coronary artery disease patients,
randomisation to elective coronary revascularisation plus medical therapy
led to reduced cardiac mortality compared with medical therapy alone. The
cardiac survival benefit after revascularisation improved with longer
follow-up times and was associated with fewer spontaneous
MIs.<br/>Copyright &#xa9; The Author(s) 2021. Published by Oxford
University Press on behalf of the European Society of Cardiology.

<114>
Accession Number
636881517
Title
Impact of Chronic Kidney Disease on the Prognosis of Transcatheter Aortic
Valve Replacement in Patients with Aortic Stenosis: a Meta-Analysis of
133624 Patients.
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: 10 Dec 2021.
Author
Wang J.; Liu S.; Han X.; Chen Y.; Chen H.; Dong S.; Song B.
Institution
(Wang, Han, Chen, Chen) First Clinical Medical College of Lanzhou
University, Lanzhou University, Lanzhou, China
(Liu, Dong, Song) Department of Cardiovascular Surgery, First Hospital of
Lanzhou University, Lanzhou, China
Publisher
NLM (Medline)
Abstract
PURPOSE: The impact of chronic kidney disease (CKD) on the prognosis of
transcatheter aortic valve replacement (TAVR) remains unclear. The purpose
of this meta-analysis was to assess the impact of CKD and different stages
of CKD on prognosis in patients undergoing TAVR. <br/>METHOD(S): As of
June 2020, we performed a comprehensive literature search on relevant
studies using PubMed, Embase, Cochrane Library, and Web of Science.
Subsequently, we pooled the risk ratio (RR) of individual studies via
random effects to analyze heterogeneity, quality assessment, and
publication bias. <br/>RESULT(S): A total of 20 studies, involving 133624
patients, were eligible for analysis. Patients with CKD had higher
all-cause mortality at 30 days (RR: 1.39, 95% confidence interval [CI]:
1.31-1.47, P <0.001), 1 year (RR: 1.36, 95% CI: 1.24-1.49, P <0.001), and
2 years (RR: 1.2, 95% CI: 1.05-1.38, P = 0.009) of follow-up. Moreover,
they also had higher acute kidney injury (AKI) (RR: 1.38, 95% CI:
1.16-1.63, P <0.001) and bleeding (RR: 1.33, 95% CI: 1.18-1.50, P <0.001)
at 30 days. CKD3 alone also increased all-cause mortality at follow-ups.
Risk of all-cause mortality increased with severity of CKD for stages 3,
4, and 5 at follow-up. <br/>CONCLUSION(S): Patients with CKD are at an
increased risk of all-cause mortality, AKI, and bleeding events after
TAVR. Moreover, the mortality risk rises with increasing severity of CKD.