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<1>
Accession Number
2013509813
Title
Persistent Pain After Cardiac Surgery: Prevention and Management.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 25(4) (pp 289-300),
2021. Date of Publication: December 2021.
Author
Krakowski J.C.; Hallman M.J.; Smeltz A.M.
Institution
(Krakowski, Hallman, Smeltz) University of North Carolina at Chapel Hill,
NC, United States
Publisher
SAGE Publications Inc.
Abstract
Persistent postoperative pain (PPP) after cardiac surgery is a significant
complication that negatively affects patient quality of life and increases
health care system burden. However, there are no standards or guidelines
to inform how to mitigate these effects. Therefore, in this review, we
will discuss strategies to prevent and manage PPP after cardiac surgery.
Adequate perioperative analgesia may prove instrumental in the prevention
of PPP. Although opioids have historically been the primary analgesic
approach to cardiac surgery, an opioid-sparing strategy may prove
advantageous in reducing side effects, avoiding secondary hyperalgesia,
and decreasing risk of PPP. Implementing a multimodal analgesic plan using
alternative medications and regional anesthetic techniques may offer
superior efficacy while reducing adverse effects. Copyright © The
Author(s) 2021.

<2>
Accession Number
2013281926
Title
Comparison of dopamine versus norepinephrine in circulatory shock after
cardiac surgery: A randomized controlled trial.
Source
Journal of Cardiac Surgery. 36(10) (pp 3711-3718), 2021. Date of
Publication: October 2021.
Author
Lim J.Y.; Park S.J.; Kim H.J.; Choo S.J.; Chung C.H.; Lee J.W.; Park
D.-W.; Kim J.B.
Institution
(Lim) Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's
Hospital, College of Medicine, The Catholic University of Korea, Seoul,
South Korea
(Park, Kim, Choo, Chung, Lee, Kim) Department of Thoracic and
Cardiovascular Surgery, Asan Medical Center, University of Ulsan College
of Medicine, Seoul, South Korea
(Kim) Department of Thoracic and Cardiovascular Surgery, Anam Hospital,
University of Korea College of Medicine, Seoul, South Korea
(Park) Department of Cardiology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim of the Study: Although dopamine and norepinephrine are
recommended as first-line agents in the treatment of shock, it is unclear
which is the optimal vasoactive inotropic agent (VIA) to manage
postcardiotomy circulatory shock. This single-center, randomized clinical
trial aimed to investigate the efficacy and safety of dopamine versus
norepinephrine in postcardiotomy circulatory shock. Method(s): We
randomly assigned the patients with postcardiotomy circulatory shock to
receive either dopamine or norepinephrine. When shock persisted despite
the dose of 20 mug/kg/min of dopamine or the dose of 0.2 mug/kg/min of
norepinephrine, epinephrine or vasopressin could be added. The primary
endpoint was new-onset tachyarrhythmic event during drug infusion.
Secondary endpoints included requirement of additional VIAs, postoperative
complications, and all-cause mortality within 30 days of drug initiation.
 Result(s): At the planned interim analysis of 100 patients, the
boundary for the benefit of norepinephrine has been crossed, and the study
was stopped early. Excluding two patients withdrawing a consent, 48
patients were assigned to dopamine and 50 patients to norepinephrine.
New-onset tachyarrhythmic event occurred in 12 (25%) patients in the
dopamine and one (2%) patient in the norepinephrine group (p =.009). The
requirement for additional VIAs was more common in the dopamine group (p
<.001). Other secondary endpoints were similar between groups.
 Conclusion(s): Despite the limited study subjects with early
determination, in patients with postcardiotomy circulatory shock, dopamine
as a first-line vasopressor was associated with higher tachyarrhythmic
events and greater need for additional VIAs compared with
norepinephrine. Copyright © 2021 Wiley Periodicals LLC

<3>
Accession Number
2014407381
Title
Mitral valve paravalvular leaks: Comprehensive review of literature.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Janmohamed I.K.; Mishra V.; Geragotellis A.; Sherif M.; Harky A.
Institution
(Janmohamed) Faculty of Medicine and Health, University of Leeds School of
Medicine, Leeds, United Kingdom
(Mishra) St. George's University of London Medical School, Tooting,
London, United Kingdom
(Geragotellis) Faculty of Health Sciences, Observatory, University of Cape
Town School of Medicine, Cape Town, South Africa
(Sherif) Department of Cardiothoracic, Northern General Hospital,
Sheffield, United Kingdom
(Harky) Department of Cardiac Surgery, Liverpool Heart and Chest Hospital,
Liverpool, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Background: Mitral paravalvular leaks (mPVL) are a recognized complication
for patients with mitral valve prostheses. Although clinically
insignificant for many patients, it may pose life-threatening haemolysis
and regurgitation-induced heart failure, and so clinicians should have a
high index of suspicion in the presence of new symptoms. Aim(s): This
review discusses the pathogenesis, clinical features, diagnosis, imaging
and treatment of mPVLs. Method(s): A comprehensive literature search
was performed using PubMed, EMBASE, Cochrane database, Google Scholar and
Ovid. Search terms used included "mitral valve paravalvular leak,"
"transthoracic echocardiography," "2D transoesophageal echocardiography,"
"3D transoesophageal echocardiography," "cardiac computed tomography,"
(CT) "cardiac magnetic resonance imaging," "intracardiac
echocardiography," "cinefluoroscopy," "fluoroscopy," and "percutaneous
closure.". Result(s): All patients with mPVLs should undergo regular
full evaluation, including patient history, physical examination,
laboratory work-up, imaging, and referral, if necessary. Echocardiography
is fundamental to the diagnosis, and is augmented with cardiac magnetic
resonance imaging, cardiac computerized tomography and fluoroscopy for
further characterization and procedural planning amongst the structural
heart team. Conclusion(s): The prevalence of mPVL is expected to
increase proportionally to the growing number of surgical and
transcatheter valve replacements conducted in the ageing population.
Multimodal imaging is instrumental in guiding diagnostic and therapeutic
strategies when managing mPVLs. Advances in imaging and capabilities of
transcather devices will prompt growing uptake of percutaneous treatment
over conventional, higher-risk surgery for mPVL management. Copyright
© 2021 Wiley Periodicals LLC

<4>
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. (no pagination), 2021. Date of
Publication: 2021.
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. Copyright © 2021 Elsevier Inc.

<5>
Accession Number
2015687216
Title
Meta-Analysis of Nonrandomized Studies to Assess the Optimal Timing of
Coronary Artery Bypass Grafting After Acute Myocardial Infarction.
Source
American Journal of Cardiology. (no pagination), 2021. Date of
Publication: 2021.
Author
Weigel F.; Nudy M.; Krakowski G.; Ahmed M.; Foy A.
Institution
(Weigel, Ahmed) Department of Internal Medicine
(Nudy, Krakowski, Foy) Division of Cardiology, Penn State Milton S.
Hershey Medical Center, Hershey, PA, United States
Publisher
Elsevier Inc.
Abstract
The optimal timing of coronary artery bypass grafting (CABG) in patients
after an acute myocardial infarction (MI) is unknown. We performed a
systematic review and meta-analysis of studies comparing mortality rates
in patients who underwent CABG at different time intervals after acute MI.
Bias assessments were completed for each study, and summary of proportions
of all-cause mortality were calculated based on CABG at various time
intervals after MI. A total of 22 retrospective studies, which included a
total of 137,373 patients were identified. The average proportion of
patients who died when CABG was performed within 6 hours of MI was 12.7%,
within 6 to 24 hours of MI was 10.9%, within 1 day of MI was 9.8%, any
time after 1 day of MI was 3.0%, within 7 days of MI was 5.9%, and any
time after 7 days of MI was 2.7%. Interstudy heterogeneity, assessed using
I2 values, showed significant heterogeneity in death rates
within subgroups. Only 1 study accounted for immortal time bias, and there
was a serious risk of selection bias in all other studies. Confounding was
found to be a serious risk for bias in 55% of studies because of a lack of
accounting for type of MI, MI severity, or other verified cardiac risk
factors. The current publications comparing timing of CABG after MI is at
serious risk of bias because of patient selection and confounding, with
heterogeneity in both study populations and intervention time
intervals. Copyright © 2021 Elsevier Inc.

<6>
Accession Number
635203837
Title
Normal saline and lung recruitment with paediatric endotracheal suction
(NARES): A pilot, factorial, randomised controlled trial.
Source
Australian critical care : official journal of the Confederation of
Australian Critical Care Nurses. 34(6) (pp 530-538), 2021. Date of
Publication: 01 Nov 2021.
Author
Schults J.A.; Cooke M.; Long D.; Schibler A.; Ware R.S.; Charles K.; Irwin
A.; Mitchell M.L.
Institution
(Schults, Long) Paediatric Intensive Care Unit, Queensland Children's
Hospital, South Brisbane, Queensland, Australia; Menzies Health Institute
Queensland, School of Nursing and Midwifery, Griffith University,
Queensland, Australia; Paediatric Critical Care Research Group, Centre for
Children's Health Research, The University of Queensland, South Brisbane,
Queensland, Australia
(Cooke, Charles) Menzies Health Institute Queensland, School of Nursing
and Midwifery, Griffith University, QLD, Australia
(Schibler) Paediatric Intensive Care Unit, Queensland Children's Hospital,
South Brisbane, Queensland, Australia; Paediatric Critical Care Research
Group, Centre for Children's Health Research, The University of
Queensland, South Brisbane, Queensland, Australia
(Ware) Menzies Health Institute Queensland, Griffith University, Nathan,
QLD, Australia
(Irwin) UQ Centre for Clinical Research, The University of Queensland,
Australia; Infection Management and Prevention Service, Queensland
Children's Hospital, South Brisbane, Queensland, Australia
(Mitchell) Menzies Health Institute Queensland, School of Nursing and
Midwifery, Griffith University, Queensland, Australia; Intensive Care
Unit, Princess Alexandra Hospital, Queensland, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND/OBJECTIVE: Endotracheal suction is one of the most common and
harmful procuedres performed on mechanically ventilated children. The aim
of the study was to establish the feasibility of a randomised controlled
trial (RCT) examining the effectiveness of normal saline instillation
(NSI) and a positive end-expiratory pressure recruitment manoeuvre (RM)
with endotracheal suction in the paediatric intensive care unit.
 METHOD(S): Pilot 2 x 2 factorial RCT. The study was conducted at a
36-bed tertiary paediatric intensive care unit in Australia. Fifty-eight
children aged less than 16 years undergoing tracheal intubation and
invasive mechanical ventilation. (i) NSI or no NSI and (ii) RM or no RM
with endotracheal suction . The primary outcome was feasibility; secondary
outcomes were ventilator-associated pneumonia (VAP), change in
end-expiratory lung volume assessed by electrical impedance tomography,
dynamic compliance, and oxygen saturation-to-fraction of inspired oxygen
(SpO2/FiO2) ratio. RESULTS/FINDINGS: Recruitment, retention, and missing
data feasibility criteria were achieved. Eligibility and protocol
adherence criteria were not achieved, with 818 patients eligible and 58
enrolled; cardiac surgery was the primary reason for exclusion.
Approximately 30% of patients had at least one episode of nonadherence.
Children who received NSI had a reduced incidence of VAP; however, this
did not reach statistical significance (incidence rate ratio = 0.12, 95%
confidence interval = 0.01-1.10; p = 0.06). NSI was associated with a
significantly reduced SpO2/FiO2 ratio up to 10 min after suction. RMs were
not associated with a reduced VAP incidence (incidence rate ratio = 0.31,
95% confidence interval = 0.05-1.88), but did significantly improve
end-expiratory lung volume at 2 and 5 min after suction, dynamic
compliance, and SpO2/FiO2 ratio. CONCLUSION(S): RMs provided
short-term improvements in end-expiratory lung volume and oxygenation. NSI
with suction led to a reduced incidence of VAP; however, a definitive RCT
is needed to test statistical differences. A RCT of study interventions is
worthwhile and may be feasible with protocol modifications including the
widening of participant eligibility. Copyright © 2021 Australian
College of Critical Care Nurses Ltd. All rights reserved.

<7>
Accession Number
2016325917
Title
Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement.
Source
US Cardiology Review. 15 (no pagination), 2021. Article Number: A2. Date
of Publication: 2021.
Author
Payabyab E.C.; Elbaum L.S.; Sharma N.; George I.; Mick S.L.
Institution
(Payabyab, Mick) Department of Cardiothoracic Surgery, Weill Cornell
Medicine, New York City, NY, United States
(Elbaum, Sharma) Division of Cardiology, Department of Medicine, Weill
Cornell Medical College, NewYork-Presbyterian Hospital, New York City, NY,
United States
(George) NewYork-Presbyterian Hospital, Columbia University Medical
Center, New York City, NY, United States
Publisher
Radcliffe Medical Media
Abstract
Transcatheter aortic valve replacement (TAVR) has become a widely adopted
treatment modality for severe aortic stenosis. Transfemoral access is the
approach of choice; however, approximately 25% of patients undergoing TAVR
also have concomitant peripheral arterial disease. The recent advent of
intravascular lithotripsy has enabled preservation of transfemoral access
in some patients; although, a proportion still require alternative,
non-femoral access. Alternative access sites can be broadly categorized
into transthoracic and peripheral, facilitated by surgical or percutaneous
techniques. In this review, the technical details and clinical outcomes of
various TAVR accesses are discussed. Initially, transthoracic approaches
were most common, but recently, the trend has been toward alternative
peripheral access due to superior outcomes. Although there are no
randomized data to support all the alternative access sites, the
experiences reported provide available options for a large portion of
patients to be candidates for TAVR. The intervention site should be
selected by a multidisciplinary heart team based on patient anatomical
factors and institutional expertise. Copyright © 2021 Radcliffe
Group Ltd. All rights reserved.

<8>
Accession Number
2014601407
Title
Ultrasound-guided erector spinae plane catheter versus video-assisted
paravertebral catheter placement in minimally invasive thoracic surgery:
comparing continuous infusion analgesic techniques on early quality of
recovery, respiratory function and chronic persistent surgical pain: study
protocol for a double-blinded randomised controlled trial.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 965. Date of
Publication: December 2021.
Author
Moorthy A.; Eochagain A.N.; Dempsey E.; Buggy D.
Institution
(Moorthy, Buggy) Division of Anaesthesiology & Perioperative Medicine,
Mater University Hospital, Dublin, Ireland
(Eochagain, Dempsey) Department of Anaesthesia and Critical Care, St
James's University Hospital, Dublin, Ireland
Publisher
BioMed Central Ltd
Abstract
Background: Compared to conventional thoracotomy, minimally invasive
thoracic surgery (MITS) can reduce postoperative pain, reduce tissue
trauma and contribute to better recovery. However, it still causes
significant acute postoperative pain. Truncal regional anaesthesia
techniques such as paravertebral and erector spinae blocks have shown to
contribute to postoperative analgesia after MITS. Satisfactory placement
of an ultrasound-guided thoracic paravertebral catheter can be technically
challenging compared to an ultrasound-guided erector spinae catheter.
However, in MITS, an opportunity arises for directly visualised placement
of a paravertebral catheter by the surgeon under thoracoscopic guidance.
Alongside with thoracic epidural, a paravertebral block is considered the
"gold standard" of thoracic regional analgesic techniques. To the best of
our knowledge, there are no randomised controlled trials comparing
surgeon-administered paravertebral catheter and anaesthesiologist-assisted
erector spinae catheter for MITS in terms of patient-centred outcomes such
as quality of recovery. Method(s): This trial will be a prospective,
double-blinded randomised controlled trial. A total of 80 eligible
patients will be randomly assigned to receive either an
anaesthesiologist-assisted ultrasound-guided erector spinae catheter or a
surgeon-assisted video-assisted paravertebral catheter, in a 1:1 ratio
following induction of general anaesthesia for minimally assisted thoracic
surgery. Both groups will receive the same standardised analgesia protocol
for both intra- and postoperative periods. The primary outcome is defined
as Quality of Recovery (QoR-15) score between the two groups at 24 h
postoperative. Secondary outcomes include assessment of chronic persistent
surgical pain (CPSP) at 3 months postoperative using the Brief Pain
Inventory (BPI) Short Form and Short Form McGill (SF-15) questionnaires,
assessment of postoperative pulmonary function, area under the curve for
Verbal Rating Score for pain at rest and on deep inspiration versus time
over 48 h, total opioid consumption over 48 h, QoR-15 at 48 h, and
postoperative complications and morbidity as measured by the Comprehensive
Complication Index. Discussion(s): Despite surgical advancements in
thoracic surgery, severe acute postoperative pain following MITS is still
prevailing. This study will provide recommendations about the efficacy of
an anaesthesia-administered ultrasound-guided erector spinae catheter or
surgeon-administered, video-assisted paravertebral catheter techniques for
early quality of recovery following MITS. Trial registration:
ClinicalTrials.govNCT04729712. Registered on 28 January 2021. All items
from the World Health Organization Trial Registration Data Set have been
included. Copyright © 2021, The Author(s).

<9>
Accession Number
2016192616
Title
EFFECT of INTRAOPERATIVE DEXMEDETOMIDINE on RENAL FUNCTION in PATIENTS
UNDERGOING CARDIOPULMONARY BYPASS GRAFT SURGERY under CARDIOPULMONARY
BYPASS.
Source
Bulletin of Pharmaceutical Sciences. Assiut. 44(2) (pp 467-476), 2021.
Date of Publication: December 2021.
Author
Jannati M.; Shahbazi S.; Lotfi H.R.
Institution
(Jannati) Cardiovascular Surgery Ward, Namazee Hospital, Shiraz University
of Medical Sciences, Shiraz, Iran, Islamic Republic of
(Shahbazi) Department of Anaesthesiology, Shiraz University of Medical
Sciences, Shiraz, Iran, Islamic Republic of
(Lotfi) Shiraz University of Medical Sciences, Shiraz, Iran, Islamic
Republic of
Publisher
Assiut University
Abstract
Acute kidney injury (AKI) post-cardiac surgeries happens as a prompt
deterioration in renal function subsequent to cardiac surgery including
cardiopulmonary bypass graft surgery (CABG). This study is aimed to
evaluate the effect of intraoperative dexmedetomidine on renal function in
patients undergoing CABG by using cardiopulmonary bypass (CPB). Methods.
This Double-blinded randomized clinical trial study was performed on 58
patients who were candidates for CABG in Namazi Hospital of Shiraz. In the
dexmedetomidine group, dexmedetomidine infusion at a dose of 0.5 mug/kg/h
without a loading dose, and in the control group placebo was initiated.
After the end of surgery and ICU admission and on days 2 and 3
postoperatively, serum BUN, Cr, and eGFR levels, also urine output,
Inotrope usage, and packed red blood cells (PRBC) consumption were
recorded. SPSS software 24 was used for data analysis. Results. No
significant differences were observed in any of the steps in serum
creatinine levels between the two groups (P > 0.05). A significant
difference in serum BUN levels was observed between the two groups except
for the third day (P <0.05). Heterogeneity was seen in preoperative BUN in
the two groups. There was no significant difference between the mean of
eGFR in the dexmedetomidine and control groups over time (P >0.05). There
was a significant difference between the mean urine output in the two
groups only on the second day (P = 0.04). There was no significant
difference in PRBC intake and inotrope usage between the two groups (P >
0.05). Conclusion. The findings of this study indicate that
dexmedetomidine does not affect the renal function of patients undergoing
coronary artery bypass graft surgery. According to the findings,
dexmedetomidine can increase the urine output of patients during surgery.
However, it has no positive effect on the postoperative
period. Copyright © 2021 Assiut University. All rights reserved.

<10>
Accession Number
2016165010
Title
Comparison of invasive blood pressure monitoring versus normal
non-invasive blood pressure monitoring in ST-elevation myocardial
infarction patients with percutaneous coronary intervention.
Source
Injury. (no pagination), 2021. Date of Publication: 2021.
Author
Jiang Y.; Liu J.; Peng W.; Wang A.; Guo L.; Xu Z.
Institution
(Jiang, Liu, Peng, Wang, Guo, Xu) Department 2 of Cardiology, Cangzhou
Central Hospital, No. 16 Xinhua Road, Cangzhou, Hebei 061000, China
Publisher
Elsevier Ltd
Abstract
Background: Hypotension post percutaneous coronary intervention (PCI)
causes stent thrombosis and reduced coronary perfusion, which aggravate
myocardial ischemia and lead to patient death. Therefore, the accuracy and
timeliness of blood pressure monitoring (BPM) are crucial for the nursing
of patients post PCI. However, it is still controversial whether invasive
blood pressure monitoring (IBPM) or non-invasive blood pressure monitoring
(NIBPM) should be used for patients post PCI, and the magnitude of their
assistance for patients' recovery remains unclear. Method(s): A
randomized controlled trial was performed in this study. 126 ST-segment
elevation myocardial infarction (STEMI) patients post PCI were recruited
and randomly divided into two groups (NIBPM group n = 63; IBPM group n =
63). Result(s): Clinical characteristics and physiological outcomes
of participants received different BPM methods were collected and analyzed
to compare the effects of these two methods on the nursing of PCI
patients. Compared to NIBPM group, IBPM assisted to shorten the time of
myocardial ischemia, promote coronary reperfusion, reduce the occurrence
of cardiovascular disease and other complications, and ultimately reduce
the mortality of patients post PCI. Conclusion(s): The application of
IBPM contributed to reduce the occurrence of complications, shorten the
time of vascular reperfusion, and guide treatment of clinicians in
time. Copyright © 2021 Elsevier Ltd

<11>
Accession Number
2016167402
Title
Prevention and Reversal of Frailty in Heart Failure.
Source
Circulation Journal. 86(1) (pp 14-22), 2022. Date of Publication: 2022.
Author
Aili S.R.; Villanueva J.E.; Joshi Y.; Emmanuel S.; Macdonald P.
Institution
(Aili, Emmanuel) Faculty of Medicine, University of Notre Dame, Sydney,
NSW, Australia
(Joshi, Emmanuel) Heart Transplant Unit, St Vincent's Hospital, Sydney,
NSW, Australia
(Villanueva) Victor Chang Cardiac Research Institute, Sydney, NSW,
Australia
(Macdonald) Faculty of Medicine, University of New South Wales, Sydney,
NSW, Australia
Publisher
Japanese Circulation Society
Abstract
Background: Frailty is prevalent in patients with heart failure (HF) and
associated with increased morbidity and mortality. Hence, there has been
increased interest in the reversibility of frailty following treatment
with medication or surgery. This systematic review aimed to assess the
reversibility of frailty in patients with HF before and after surgical
interventions aimed at treating the underlying cause of HF. It also aimed
to assess the efficacy of cardiac rehabilitation and prehabilitation in
reversing or preventing frailty in patients with HF. Methods and
Results: Searches of PubMed, MEDLINE and Academic Search Ultimate
identified studies with HF patients undergoing interventions to reverse
frailty. Titles, abstracts and full texts were screened for eligibility
based on the PRISMA guidelines and using predefined inclusion/exclusion
criteria in relation to participants, intervention, control, outcome and
study design. In total, 14 studies were included: 3 assessed the effect of
surgery, 7 assessed the effect of rehabilitation programs, 2 assessed the
effect of a prehabilitation program and 2 assessed the effect of program
interruptions on HF patients. Conclusion(s): Overall, it was found
that frailty is at least partially reversible and potentially preventable
in patients with HF. Interruption of rehabilitation programs resulted in
deterioration of the frailty status. Future research should focus on the
role of prehabilitation in mitigating frailty prior to surgical
intervention. Copyright © 2022 Japanese Circulation Society. All
rights reserved.

<12>
Accession Number
2010560475
Title
Incidence and recurrence of new-onset atrial fibrillation detected during
hospitalization for non-cardiac surgery: a systematic review and
meta-analysis.
Source
Canadian Journal of Anesthesia. 68(7) (pp 1045-1056), 2021. Date of
Publication: July 2021.
Author
McIntyre W.F.; Vadakken M.E.; Rai A.S.; Thach T.; Syed W.; Um K.J.;
Ibrahim O.; Dalmia S.; Bhatnagar A.; Mendoza P.A.; Benz A.P.; Bangdiwala
S.I.; Spence J.; McClure G.R.; Huynh J.T.; Zhang T.; Inami T.; Conen D.;
Devereaux P.J.; Whitlock R.P.; Healey J.S.; Belley-Cote E.P.
Institution
(McIntyre, Vadakken, Rai, Bhatnagar, Benz, Bangdiwala, Spence, Zhang,
Conen, Devereaux, Whitlock, Healey, Belley-Cote) Population Health
Research Institute, McMaster University, Hamilton, ON, Canada
(McIntyre, Um, Ibrahim, Dalmia, Spence, Huynh, Conen, Devereaux, Whitlock,
Healey, Belley-Cote) Department of Medicine, McMaster University,
Hamilton, ON, Canada
(McIntyre, Mendoza, Benz, Bangdiwala, Spence, Conen, Devereaux, Healey)
Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada
(Thach, Syed) Faculty of Health Sciences, McMaster University, Hamilton,
ON, Canada
(McClure, Whitlock) Department of Surgery, McMaster University, Hamilton,
ON, Canada
(Inami) Department of Cardiovascular Medicine, Nippon Medical School,
Tokyo, Japan
Publisher
Springer
Abstract
Purpose: This systematic review aimed to summarize reports of the
incidence and long-term recurrence of new-onset atrial fibrillation (AF)
associated with non-cardiac surgery. Sources: We searched CENTRAL, MEDLINE
and EMBASE from inception to November 2019. We included studies that
reported on the incidence of new-onset perioperative AF during
hospitalization for non-cardiac surgery and/or AF recurrence in such
patients following discharge. Reviewers screened articles and abstracted
data independently and in duplicate. We assessed study quality by
appraising methodology for collecting AF history, incident AF during
hospitalization, and AF recurrence after discharge. Principal findings:
From 39,233 citations screened, 346 studies that enrolled a total of
5,829,758 patients met eligibility criteria. Only 27 studies used
prospective, continuous inpatient electrocardiographic (ECG) monitoring to
detect incident AF. Overall, the incidence of postoperative AF during
hospitalization ranged from 0.004 to 50.3%, with a median [interquartile
range] of 8.7 [3.8-15.0]%. Atrial fibrillation incidence varied with type
of surgery. Prospective studies using continuous ECG monitoring reported
significantly higher incidences of AF than those that did not (13.9% vs
1.9%, respectively; P < 0.001). A total of 13 studies (25,726 patients)
with follow-up up to 5.4 years reported on AF recurrence following
hospital discharge; only one study used a prospective systematic
monitoring protocol. Recurrence rates ranged from 0 to 37.3%.
 Conclusion(s): Rates of AF incidence first detected following
non-cardiac surgery and long-term AF recurrence vary markedly. Differences
in the intensity of ECG monitoring and type of surgery may account for
this variation. Trial registration: PROSPERO (CRD42017068055); registered
1 September 2017. Copyright © 2021, Canadian Anesthesiologists'
Society.

<13>
Accession Number
2006921751
Title
Systematic review and meta-analysis of short-term outcomes with
drug-coated balloons vs. stenting in acute myocardial infarction.
Source
Cardiovascular Intervention and Therapeutics. 36(4) (pp 481-489), 2021.
Date of Publication: October 2021.
Author
Megaly M.; Buda K.G.; Xenogiannis I.; Vemmou E.; Nikolakopoulos I.; Saad
M.; Rinfret S.; Abbott J.D.; Aronow H.D.; Garcia S.; Pershad A.; Burke
M.N.; Brilakis E.S.
Institution
(Megaly, Pershad) Division of Cardiology, Banner University Medical
Center-UA College of Medicine, Phoenix, AZ, United States
(Buda) Division of Internal Medicine, Hennepin Healthcare, Minneapolis,
MN, United States
(Xenogiannis, Vemmou, Nikolakopoulos, Garcia, Burke, Brilakis) Minneapolis
Heart Institute and Minneapolis Heart Institute Foundation, Abbott
Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN 55407,
United States
(Saad, Abbott, Aronow) Division of Cardiology, The Warren Alpert School of
Medicine at Brown University Providence, Providence, RI, United States
(Rinfret) Division of Cardiology, McGill University Health Centre,
Montreal, QC, Canada
Publisher
Springer Japan
Abstract
The role of drug-coated balloons (DCBs) in patients with acute myocardial
infarction (AMI) remains controversial. We performed a meta-analysis of
all published studies comparing the outcomes of DCBs vs. stenting in AMI
patients. Four studies with 497 patients (534 lesions) were included
(three randomized controlled trials and one observational study). During a
mean follow-up of 9 months (range 6-12 months), DCBs were associated with
similar risk of major adverse cardiovascular events (5% vs. 4.4%; OR 1.24,
95% CI: [0.34, 4.51], p = 0.74, I2 = 35%), all-cause mortality
(0.02% vs. 0.04%; OR 077, 95% CI: [0.15, 3.91], p = 0.75, I2 =
25%), cardiac death (0.01% vs. 0.02%; OR 0.64, 95% CI: [0.16, 2.64], p =
0.54), myocardial infarction (0% vs. 1.4%; OR 0.18, 95% CI: [0.01, 3.56],
p = 0.26), and target lesion revascularization (3.7% vs. 2%; OR 1.74, 95%
CI: [0.42, 7.13], p = 0.44, I2 = 17%) compared with stenting.
During a mean follow-up of 7 months (range 6-9 months), DCBs had similar
late lumen loss compared with stenting (mean difference 0.04 mm, 95% CI [-
0.21-0.28], p = 0.77, I2 = 92%). In patients with AMI, there
was no statistical difference in the incidence of clinical and
angiographic outcomes between AMI patients treated with DCB and DES.
Larger studies with longer-term follow-up are needed to assess the
clinical utility of DCBs in this setting. Copyright © 2020,
Japanese Association of Cardiovascular Intervention and Therapeutics.

<14>
Accession Number
2013342741
Title
Comparison between intraoperative bleeding score and ROTEM measurements to
assess coagulopathy during major pediatric surgery.
Source
Transfusion and Apheresis Science. 60(5) (no pagination), 2021. Article
Number: 103191. Date of Publication: October 2021.
Author
Restin T.; Schmugge M.; Cushing M.M.; Haas T.
Institution
(Restin) Newborn Research Zurich, Department of Neonatology, University
hospital Zurich, Zurich, Switzerland
(Restin) Institute of Physiology, Zurich Center for Integrative Human
Physiology, University of Zurich, Zurich, Switzerland
(Schmugge) Department of Hematology, Zurich University Children's
Hospital, Zurich, Switzerland
(Schmugge, Haas) Children's Research Center, University Children's
Hospital of Zurich, Zurich, Switzerland
(Cushing) Department of Pathology and Laboratory Medicine, Weill Cornell
Medical College, New York, NY, United States
(Haas) Department of Anesthesia, Zurich University Children's Hospital,
Zurich, Switzerland
Publisher
Elsevier Ltd
Abstract
Purpose: Intraoperative bleeding should be regularly assessed visually to
guide coagulation management. Whereas viscoelastic testing with ROTEM
measurement has been proven to be useful in detecting coagulopathies, the
visual assessment is not standardized. This study therefore aims to
compare a standardized visual assessment with ROTEM results.
 Method(s): A 5-point bleeding score was created and applied in a
recently published randomized controlled trial in major pediatric
non-cardiac surgery. This score assesses overall bleeding tendency and the
occurrence of diffuse bleeding, aqueous bleeding, bleeding outside the
operative field, and the ability to control bleeding. Validity of this
score was tested by post hoc comparison to the results of simultaneously
performed ROTEM measurements. Result(s): Signs of coagulopathic
bleeding were assessed at 183 time points. Mild to moderate bleeding
intensity was judged at 103 time points, in 42 % abnormal ROTEM traces
were obtained simultaneously. When severe bleeding was scored, abnormal
ROTEM values occurred in 58 %, and FIBTEM-values were significantly lower
than in the "no bleeding group". Altogether, the correlation between
bleeding score and ROTEM measurements was not significant.
 Conclusion(s): The standardized visual assessment did not correlate
well with ROTEM measurements, suggesting that it is not useful to detect
coagulopathy. Trial registry number: ClinicalTrials.gov identifier No.
NCT01487837. Copyright © 2021

<15>
Accession Number
2013291906
Title
Effects of WeChat follow-up management of infants who underwent
ventricular septal defect repair on parents' disease knowledge and quality
of life: A prospective randomized controlled study.
Source
Journal of Cardiac Surgery. 36(10) (pp 3690-3697), 2021. Date of
Publication: October 2021.
Author
Xie W.-P.; Liu J.-F.; Lei Y.-Q.; Cao H.; Chen Q.
Institution
(Xie, Liu, Lei, Cao, Chen) Department of Cardiac Surgery, Fujian Branch of
Shanghai Children's Medical Center, Fuzhou, China
(Xie, Liu, Lei, Cao, Chen) Department of Cardiac Surgery, Fujian
Children's Hospital, Fuzhou, China
(Xie, Liu, Lei, Cao, Chen) Department of Cardiac Surgery, Fujian Maternity
and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Xie, Liu, Lei, Cao, Chen) Fujian Key Laboratory of Women and Children's
Critical Diseases Research, Fujian Maternity and Child Health Hospital,
Fuzhou, China
Publisher
John Wiley and Sons Inc
Abstract
Objective: To investigate the effect of WeChat follow-up management of
infants who underwent ventricular septal defect (VSD) repair on parents'
disease knowledge and quality of life. Method(s): Participants were
randomly assigned to an intervention group (n = 40) or a control group (n
= 40). The intervention group was followed up with WeChat, while the
control group was followed up using a traditional method. The disease
knowledge, mental state, and quality of life of the two groups of parents
were analyzed and compared. Result(s): During the 3-month follow-up
period, the PedSQL (PedsQL family impact module) results showed that the
overall score in the intervention group was significantly higher than that
in the control group. The parents in the intervention group were better at
managing "emotion control," "worry," and "family communication" than those
in the control group. The results of the LKQCHD (Leuven congenital heart
disease knowledge questionnaire) showed that the parents in the
intervention group had a higher mastery of "basic knowledge and treatment
of congenital heart disease," "related complications," and "postoperative
rehabilitation" than those in the control group. Conclusion(s):
Knowledge education and psychological counseling for parents of children
who underwent VSD repair through WeChat follow-up management can
effectively improve parents' knowledge, relieve their anxiety and sadness,
and improve their quality of life. Copyright © 2021 Wiley
Periodicals LLC

<16>
Accession Number
2016097234
Title
Ultrasound-guided parasternal blocks: techniques, clinical indications and
future prospects.
Source
Minerva Anestesiologica. 87(12) (pp 1338-1346), 2021. Date of Publication:
December 2021.
Author
Sepolvere G.; Coppolino F.; Tedesco M.; Cristiano L.
Institution
(Sepolvere, Cristiano) Department of Anesthesia and Cardiac Surgery
Intensive Care Unit, San Michele Hospital, Maddaloni, Caserta, Italy
(Coppolino) Department of Woman, Child and General and Specialized
Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
(Tedesco) Department of Anesthesia and Intensive Care Unit and Pain
Therapy, Mater Dei Hospital, Bari, Italy
Publisher
Edizioni Minerva Medica
Abstract
Fascial plane blocks represent anesthetic procedures performed to manage
perioperative and chronic pain. Recently, many fascial blocks techniques
have been described increasing their field of applications. They offer
anesthetic and analgesic efficacy, easy of execution and low risk of
complications. The newest techniques recently described are the ultrasound
parasternal blocks (US-PSB) which provide analgesia to the antero-medial
chest wall. In particular, the antero-medial chest wall blocks are
performed to provide analgesia and anesthesia in several and different
surgeries such as median sternotomy, breast surgery, implantable
cardioverter-defibrillator implantation and in the management of acute and
chronic pain. The nervous target for these blocks is represented by the
anterior branches of the intercostal nerves which enter the intercostal
(ICM) and pectoralis major (PMM) muscles innervating the antero-medial
region of chest wall, the main cause of poststernotomy pain. Local
anesthetic is injected deep to PMM and superficial to the ICM or between
the internal thoracic muscle (IIM) and transversus thoracis muscle (TTM).
So, essentially these blocks may be described as superficial or deep
parasternal-intercostal plane blocks, based on where the target nerves are
hunted. Even if they all provide analgesia to the antero-medial chest
wall, the anatomical injection site represents the main peculiarity that
differentiates these techniques. To date, a common nomenclature for
antero-medial chest wall blocks or parasternal-intercostal plane blocks is
not yet well defined and a standardized nomenclature is needed to ensure
an adequate communication among anesthesiologists. Copyright ©
2021 EDIZIONI MINERVA MEDICA

<17>
[Use Link to view the full text]
Accession Number
2016121796
Title
Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during
Noncardiac Surgery.
Source
Anesthesiology. 136(1) (pp 127-137), 2022. Date of Publication: 01 Jan
2022.
Author
Reiterer C.; Kabon B.; Halvorson S.; Sessler D.I.; Mascha E.J.; Kurz A.;
Maheshwari K.; Kot M.; Kopyeva T.; Naylor A.; Podolyak A.; Yang D.;
Fleischmann E.; Zotti O.M.; Obradovic M.; Luf F.; Muehlbacher J.; Sljivic
S.; Bayoumi A.; Marschalek C.; Eredics K.; Taschner A.
Institution
(Reiterer, Kabon) Department of Anesthesia, General Intensive Care
Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
(Halvorson, Mascha) Departments of Quantitative Health Sciences and
Outcomes Research, Cleveland Clinic, Cleveland, OH, United States
(Sessler, Kurz) Departments of Outcomes Research and General
Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH,
United States
(Kurz) Department of Anesthesia, Emergency and General Intensive Care
Medicine, Medical University of Graz, Graz, Austria
(Reiterer, Kabon) Outcomes Research Consortium, Cleveland, OH, United
States
(Halvorson, Maheshwari, Kot, Kopyeva, Naylor, Podolyak, Yang) Cleveland
Clinic, Cleveland, OH, United States
(Fleischmann, Zotti, Obradovic, Luf, Muehlbacher, Sljivic, Bayoumi,
Marschalek, Eredics, Taschner) Medical University of Vienna, Vienna,
Austria
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Colloids are thought to sustain blood pressure and cardiac
index better than crystalloids. However, the relative effects of
intraoperative hydroxyethyl starch and crystalloid administration on the
cardiac index and blood pressure remain unclear. This study therefore
tested in this subanalysis of a previously published large randomized
trial the hypothesis that intraoperative goal-directed colloid
administration increases the cardiac index more than goal-directed
crystalloid administration. Further, the effects of crystalloid and
colloid boluses on blood pressure were evaluated. Method(s): This
planned subanalysis of a previous trial analyzed data from 973 patients,
of whom 480 were randomized to colloids and 493 were randomized to
crystalloids. Fluid administration was guided by esophageal Doppler. The
primary outcome was the time-weighted average cardiac index during surgery
between the colloid and crystalloid group. The secondary outcomes were the
cardiac index just after bolus administration, time elapsed between
boluses, and the average real variability during surgery. The study
recorded cardiac index, corrected flow time, and blood pressure at 10-min
intervals, as well as before and after each bolus. Result(s):
Time-weighted average of cardiac index over the duration of anesthesia was
only slightly greater in patients given colloid than crystalloid, with the
difference being just 0.20 l . min-1. m-2(95% CI,
0.11 to 0.29; P < 0.001). However, the hazard for needing additional
boluses was lower after colloid administration (hazard ratio [95% CI],
0.60 [0.55 to 0.66]; P < 0.001) in a frailty time-to-event model
accounting for within-subject correlation. The median [quartiles] number
of boluses per patient was 4 [2, 6] for colloids and 6 [3, 8] for
crystalloids, with a median difference (95% CI) of -1.5 (-2 to -1; P <
0.001). The average real mean arterial pressure variability did not differ
significantly between the groups (difference in means [95% CI] of -0.03
(-0.07 to 0.02) mmHg, P = 0.229). Conclusion(s): There were not
clinically meaningful differences in the cardiac index or mean pressure
variability in patients given goal-directed colloid and crystalloids. As
might be expected from longer intravascular dwell time, the interval
between boluses was longer with colloids. However, on a case basis, the
number of boluses differed only slightly. Colloids do not appear to
provide substantial hemodynamic benefit. Copyright © 2022
Lippincott Williams and Wilkins. All rights reserved.

<18>
Accession Number
2014276871
Title
Surgical ablation in rheumatic heart disease-Uncharted territory.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Leviner D.B.; Sharoni E.
Institution
(Leviner, Sharoni) Department of Cardiothoracic Surgery, Carmel Medical
Center, Haifa, Israel
(Leviner, Sharoni) Technion-Israel Institute of Technology, Faculty of
Medicine, Haifa, Israel
Publisher
John Wiley and Sons Inc
Abstract
Background: Atrial fibrillation is a common arrhythmia with a large impact
on society and on patients. Rheumatic valve disease is still prevalent in
low- and medium-income countries. Performing surgical ablation during
surgery for mitral valve disease has been shown to restore sinus rhythm in
most patients. Aims, Material(s) and Method(s): In this issue of the
Journal of Cardiac Surgery, Ma et al., publish a meta-analysis of surgical
ablation in patients with rheumatic heart disease (RHD). Result(s):
They found no difference in short-term outcomes with a higher incidence of
restoration to sinus rhythm. In mid- to long-term follow-up, there was no
difference in mortality with a signal towards more permanent pacemaker
implantation. Discussion and Conclusion(s): Despite some inherent
limitations and some methodological flows, this meta-analysis has
important insights and is valuable for surgeons taking care of patients
with RHD. Copyright © 2021 Wiley Periodicals LLC

<19>
Accession Number
2014261122
Title
Robot-assisted thoracic surgery versus video-assisted thoracic surgery for
treatment of patients with thymoma: A systematic review and meta-analysis.
Source
Thoracic Cancer. (no pagination), 2021. Date of Publication: 2021.
Author
Shen C.; Li J.; Che G.
Institution
(Shen, Li, Li, Che) Department of Thoracic Surgery, West-China Hospital,
Sichuan University, Chengdu, China
Publisher
John Wiley and Sons Inc
Abstract
Background: Surgical resection of the thymus is indicated in the presence
of primary thymic diseases such as thymoma. Video-assisted thoracoscopic
surgery (VATS) and robot-assisted thoracic surgery (RATS) offer a
minimally invasive approach to thymectomy. However, there is no clear
conclusion whether RATS can achieve an equal or even better surgical
effect when compared with VATS in treatment of thymoma. We performed this
meta-analysis to explore and compare the outcomes of RATS versus VATS for
thymectomy in patients with thymoma. Method(s): PubMed, Cochrane
Library, EMBASE, China National Knowledge Infrastructure (CNKI), Medline,
and Web of Science databases were searched for full-text literature
citations. The quality of the articles was evaluated using the
Newcastle-Ottawa Scale and the data analyzed using Review Manager 5.3
software. Fixed or random effect models were applied according to
heterogeneity. Subgroup analysis was conducted. Result(s): A total of
11 studies with 1418 patients, of whom 688 patients were in the RATS group
and 730 in the VATS group, were involved in the analysis. Compared with
VATS, RATS was associated with less blood loss in operation, lower volume
of drainage, fewer postoperative pleural drainage days, shorter
postoperative hospital stay, and fewer postoperative complications. There
was no significant difference in operative time and patients with or
without myasthenia gravis between the two groups. Conclusion(s): RATS
has more advantages over VATS, indicating that RATS is better than VATS in
terms of postoperative recovery. We look forward to more large-sample,
high-quality randomized controlled studies published in the
future. Copyright © 2021 The Authors. Thoracic Cancer published
by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

<20>
Accession Number
2015689015
Title
Percutaneous mitral valve repair in severe secondary mitral regurgitation:
Analysis of index hospitalization and economic evaluation based on the
MITRA-FR trial.
Source
Archives of Cardiovascular Diseases. 114(12) (pp 805-813), 2021. Date of
Publication: December 2021.
Author
Capelle A.; Obadia J.-F.; Iung B.; Messika-Zeitoun D.; Vahanian A.; Guerin
P.; Lefevre T.; Bonnet G.; Donal E.; Leurent G.; Trochu J.-N.; Armoiry X.
Institution
(Capelle) Pharmacy department, CHU de Saint-Etienne, Saint-Etienne, France
(Obadia) Service de cardiologie interventionnelle, hospices civils de
Lyon, hopital cardiovasculaire Louis-Pradel, Lyon, France
(Iung, Vahanian) Inserm 1148, universite de Paris, hopital Bichat, AP-HP,
Paris, France
(Messika-Zeitoun) Division of Cardiology, University of Ottawa Heart
Institute, Ottawa, Canada
(Guerin, Trochu) Inserm, institut du Thorax, CNRS, CHU de Nantes,
universite Nantes, Nantes, France
(Lefevre) Institut Jacques-Cartier, Massy, France
(Bonnet) Inserm-UMR 626, service de cardiologie interventionnelle,
Assistance Publique-Hopitaux de Marseille, CHU de Timone, Aix-Marseille
universite, Marseille 13385, France
(Donal) Inserm, LTSI-UMR 1099, universite Rennes, CHU de Rennes, Rennes,
France
(Leurent) Inserm, LTSI-UMR 1099, Department of Cardiology, CHU de Rennes,
universite Rennes 1, Rennes, France
(Armoiry) UMR CNRS 5510 MATEIS, Pharmacy Department, School of Pharmacy
(ISPB), University of Lyon, Edouard-Herriot Hospital, Lyon, France
(Armoiry) Warwick Medical School, University of Warwick, Coventry, United
Kingdom
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Percutaneous mitral valve repair (pMVR) is reimbursed in
France for severe secondary mitral regurgitation (SMR), but French data
regarding the hospitalization index stay are lacking. Aim(s): Our
objectives were to describe the index hospitalization stay and to evaluate
the cost of hospital stay for pMVR used in SMR. Method(s): A
secondary evaluation based on patients who were randomized to the
intervention group of the MITRA-FR study was undertaken. The economic
evaluation was conducted according to the French hospital perspective.
Medical resource use was estimated using specific data collected from
patients enrolled in the MITRA-FR study and non-specific data from
national statistics. Result(s): The population was represented by 144
patients who underwent pMVR at 33 French centres. There was a mean +/-
standard deviation of 7.9 +/- 1.5 hospital staff during procedures. The
mean procedure duration was 154 +/- 68 minutes and increased with the
number of implanted clips. Median total length of stay was 8 days. The
occurrence of a serious adverse event was not associated with an increased
risk of admission to the critical care unit, but was associated with an
increased length of stay. The mean total cost was 28,025 +/- 3424 , which
includes 21,547 for the cost of medical devices used during pMVR and 6478
+/- 3424 for other costs. Conclusion(s): The cost of pMVR is
substantial for patients with SMR, which advocates for further efforts to
identify the patients with SMR who are likely to derive a clear clinical
benefit from the procedure. Copyright © 2021 Elsevier Masson SAS

<21>
Accession Number
2015688804
Title
Myocardial injury after major noncardiac surgery: A secondary analysis of
a randomized controlled trial.
Source
Surgery (United States). (no pagination), 2021. Date of Publication:
2021.
Author
Ellenberger C.; Schorer R.; Diaper J.; Jeleff A.; Luise S.; Hagermann A.;
Licker M.
Institution
(Ellenberger, Schorer, Diaper, Jeleff, Luise, Hagermann, Licker)
Department of Anesthesiology, Pharmacology, Intensive Care, and Emergency
Medicine, University Hospital of Geneva, Switzerland
(Ellenberger, Licker) Faculty of Medicine, University of Geneva,
Switzerland
Publisher
Elsevier Inc.
Abstract
Background: Myocardial injury after noncardiac surgery frequently occurs
and may influence survival. The aims of this study were to examine the
association between myocardial injury after noncardiac surgery and patient
and procedural factors as well as its impact on postoperative clinical
outcome. Method(s): A retrospective analysis was conducted from data
collected in adults enrolled in a randomized trial in elective major open
abdominal surgery. Preoperative patient characteristics, intraoperative
hemodynamic changes, and postoperative adverse events were analyzed, and
Kaplan-Meier curves were built for postoperative survival probability.
After adjustment for baseline patient and procedural characteristics, the
effect of myocardial injury after noncardiac surgery on postoperative
outcomes was analyzed in a propensity score matched cohort.
 Result(s): Among 394 patients, myocardial injury after noncardiac
surgery was reported in 109 (27.7%) and was associated with a higher
cardiovascular risk profile, prolonged surgery (333 +/- 111 min vs 295 +/-
134 min, P = .010), greater need for transfusions (41.3% vs 19.3%, P <
.001), higher incidence of major adverse cardiac events (22.9% vs 6.7%, P
< .001), pulmonary complications (31.2% vs 17.9%, P = .004), acute kidney
injury (30.3% vs 18.2%, P = .009), and systemic inflammatory syndrome
(28.4% vs 13.0%, P < .001). After propensity score matching, the operative
time and the need for blood transfusion remained higher among myocardial
injury after noncardiac surgery patients who experienced more frequent
major adverse cardiac events and acute kidney injury. In both the entire
and matched cohorts, survival up to 30 months after surgery was determined
mainly by the presence of cancer. Conclusion(s): The burden of
cardiovascular disease and operative stress surgery is predictive of
myocardial injury after noncardiac surgery and, in turn, with a higher
incidence of cardiac adverse events, whereas the presence of cancer is
associated with poor survival in patients undergoing major open abdominal
surgery. Further studies are needed to determine whether myocardial injury
after noncardiac surgery can be prevented by better control of the
patient's cardiovascular condition and implementation of less invasive of
surgical procedures. Copyright © 2021 The Author(s)

<22>
Accession Number
2015656918
Title
Left atrial appendage closure during cardiac surgery for atrial
fibrillation: A meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Prasad R.M.; Saleh Y.; Al-Abcha A.; Abdelkarim O.; Abdelfattah O.M.;
Abdelnabi M.; Almaghraby A.; Elwany M.; DeBruyn E.; Abela G.S.
Institution
(Prasad, Al-Abcha) Department of Internal Medicine, Michigan State
University, East Lansing, MI, United States
(Saleh, Abdelkarim) Department of Cardiology, Houston Methodist DeBakey
Heart & Vascular Center, Houston, TX, United States
(Saleh, Abdelkarim, Almaghraby, Elwany) Department of Cardiology,
Alexandria University, Alexandria, Egypt
(Abdelfattah) Department of Internal Medicine, Morristown Medical Center,
Atlantic Health System, Morristown, NJ, United States
(DeBruyn) College of Medicine, University of Illinois, Chicago, IL, United
States
(Abela) Department of Cardiology, Michigan State University, East Lansing,
MI, United States
(Abdelnabi) Internal Medicine Department, Texas Tech University Health
Science Center, Lubbock, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: Left atrial appendage closure (LAAC) during cardiac surgery in
atrial fibrillation (AF) patients has been investigated in multiple
studies with variable safety and efficacy results. Method(s): A
comprehensive review was performed of all studies comparing LAAC and
placebo arm during cardiac surgery in AF patients. A random-effect model
was used to calculate risk ratios, mean differences, and 95% confidence
intervals. Result(s): Five randomized controlled trials and 22
observational studies were included with a total of 540,111 patients. The
LAAC group had significantly decreased postoperative stroke/embolic events
as compared to the no LAAC group with all cardiac surgeries (3.74% vs
4.88%, p = 0.0002), isolated valvular surgery (1.95% vs 4.48%, p = 0.002).
However, CABG insignificantly favored the LAAC group for stroke/embolic
events (6.72% vs 8.30%, p = 0.07). There was no difference between both
groups in all-cause mortality in the perioperative period (p = 0.42), but
was significantly lower in the LAAC arm after two years (14.1% vs 18.3%, p
= 0.02). There was no difference in major bleeding, all-cause
rehospitalizations, or cross-clamp time between both groups (p = 0.53 and
p = 0.45). The bypass and the cross-clamp time were longer in the LAAC
group (4 and 9 min, respectively). Conclusion(s): In AF patients,
LAAC during cardiac surgery had a decreased risk of stroke and long-term
all-cause mortality. Additionally, there was no difference in major
bleeding, all-cause rehospitalizations, or cross-clamp time. Copyright
© 2021

<23>
Accession Number
636486391
Title
Assessment of Pretreatment with Oral P2Y12 Inhibitors and Cardiovascular
and Bleeding Outcomes in Patients with Non-ST Elevation Acute Coronary
Syndromes: A Systematic Review and Meta-analysis.
Source
JAMA Network Open. 4(11) (no pagination), 2021. Article Number: e2134322.
Date of Publication: 19 Nov 2021.
Author
Dawson L.P.; Chen D.; Dagan M.; Bloom J.; Taylor A.; Duffy S.J.; Shaw J.;
Lefkovits J.; Stub D.
Institution
(Dawson, Lefkovits) Department of Cardiology, Royal Melbourne Hospital,
Melbourne, VIC, Australia
(Dawson, Chen, Bloom, Taylor, Duffy, Shaw, Lefkovits, Stub) Department of
Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC,
Australia
(Dawson, Dagan, Bloom, Taylor, Duffy, Shaw, Stub) Department of
Cardiology, Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004,
Australia
(Bloom, Duffy, Shaw, Stub) Baker Institute, Melbourne, VIC, Australia
Publisher
American Medical Association
Abstract
Importance: The practice of pretreatment with oral P2Y12 inhibitors in
non-ST elevation acute coronary syndromes (NSTEACS) remains common;
however, its association with improved cardiovascular outcomes is unclear.
 Objective(s): To assess the association between oral P2Y12 inhibitor
pretreatment and cardiovascular and bleeding outcomes in patients with
NSTEACS. Data Sources: On March 20, 2021, PubMed, MEDLINE, Embase,
Scopus, Web of Science, Science Direct, clinicaltrials.gov, and the
Cochrane Central Register for Controlled Trials were searched from
database inception. Study Selection: Randomized clinical trials of
patients with NSTEACS randomized to either oral P2Y12 inhibitor
pretreatment (defined as prior to angiography) or no pretreatment (defined
as following angiography, once coronary anatomy was known) among patients
undergoing an invasive strategy. Data Extraction and Synthesis: This study
followed Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines. Data on publication year, sample size, clinical
characteristics, revascularization strategy, P2Y12 inhibitor type and
dosage, time from pretreatment to angiography, and end point data were
independently extracted by 2 authors. A random-effects model was used,
including stratification by (1) P2Y12 inhibitor type, (2)
revascularization strategy, and (3) access site. Main Outcomes and
Measures: The primary end point was 30-day major adverse cardiac events
(MACEs). Secondary end points were 30-day myocardial infarction (MI) and
cardiovascular death. The primary safety end point was 30-day major
bleeding (defined according to individual studies). Result(s): A
total of 7 trials randomizing 13226 patients to either pretreatment (6603
patients) or no pretreatment (6623 patients) were included. The mean age
of patients was 64 years and 3598 (27.2%) were female individuals.
Indication for P2Y12 inhibitors was non-ST elevation myocardial infarction
in 7430 patients (61.7%), radial access was used in 4295 (32.6%), and
10945 (82.8%) underwent percutaneous coronary intervention. Pretreatment
was not associated with a reduction in 30-day MACE (odds ratio [OR], 0.95;
95% CI, 0.78-1.15; I2= 28%), 30-day MI (OR, 0.90; 95% CI,
0.72-1.12; I2= 19%), or 30-day cardiovascular death (OR, 0.79;
95% CI, 0.49-1.27; I2= 0%). The risk of 30-day major bleeding
was increased among patients who underwent pretreatment (OR, 1.51; 95% CI,
1.16-1.97; I2= 41%). The number needed to harm to bring about 1
major bleeding event with oral P2Y12 inhibitor pretreatment was 63
patients. Conclusions and Relevance: In this study, pretreatment with
oral P2Y12 inhibitors among patients with NSTEACS prior to angiography,
compared with treatment once coronary anatomy is known, was associated
with increased bleeding risk and no difference in cardiovascular outcomes.
Routine pretreatment with oral P2Y12 inhibitors in patients with NSTEACS
receiving an early invasive strategy is not supported by this
study.. Copyright © 2021 American Medical Association. All rights
reserved.

<24>
Accession Number
2005380404
Title
New technology for the use of inhaled nitric oxide to protect the heart
and lungs during operations with cardiopulmonary bypass.
Source
Sovremennye Tehnologii v Medicine. 12(5) (pp 28-34), 2020. Date of
Publication: 2020.
Author
Pichugin V.V.; Seyfetdinov I.R.; Ryazanov M.V.; Domnin S.E.; Gamzaev A.B.;
Chiginev V.A.; Bober V.V.; Medvedev A.P.
Institution
(Pichugin, Seyfetdinov, Domnin, Bober) Department of Anesthesiology,
Resuscitation, Emergency Medical Aid, Privolzhsky Research Medical
University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod 603005,
Russian Federation
(Ryazanov, Chiginev, Medvedev) Department of Hospital Surgery named after
B.A. Korolyov, Privolzhsky Research Medical University, 10/1 Minin and
Pozharsky Square, Nizhny Novgorod 603005, Russian Federation
(Gamzaev) Department of X-ray Endovascular Diagnostics, Treatment,
Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square,
Nizhny Novgorod 603005, Russian Federation
Publisher
Privolzhsky Research Medical University
Abstract
The aim of the study was to evaluate the effectiveness of a new technology
for the use of inhaled nitric oxide (NO) for the heart and lung protection
during operations with cardiopulmonary bypass (SPB). Materials and
Methods. The study included 90 patients who underwent heart valve surgery
and combined procedures under CPB and pharmacological cardioplegia. Three
groups were created: group 1 (control, n=30); group 2 (n=30) - NO
inhalation (20 ppm) was conducted traditionally, that is, before and after
CPB; group 3 (n=30) - NO inhalation was performed using a new technology -
during the entire operation, with pulmonary artery perfusion and lung
ventilation performed during CPB. Troponin I (cTn I) level, changes in the
pulmonary function parameters, and clinical indicators were studied.
Results. Statistically significant lower levels of postoperative cTn I
were registered in the patients of groups 2 and 3, at the same time, the
levels were significantly lower in group 3 compared to group 2. The
patients in group 1 (standardized anesthesia protocol) demonstrated an
increase in the alveolar-arterial oxygen difference, an increase in
intrapulmonary shunting, a decrease in blood oxygenation, and static lung
compliance after SPB. In both cases, NO inhalation retained the values of
lung compliance and pulmonary oxygenating function after CPB, and in the
patients of group 3, it also significantly reduced intrapulmonary shunting
and alveolar-arterial difference after CPB. NO inhalation allowed a
statistically significant decrease in the incidence of pulmonary
dysfunction, acute respiratory failure, as well as the time of respiratory
support in the ICU. Conclusion. The developed technology for the use of
inhaled NO in surgery with CPB provides a clinically marked protective
effect on the heart and lungs. The effectiveness of the protective action
of NO depends on the duration of its administration and is most pronounced
when used during the entire operation, including CPB time. Copyright
© 2020, Privolzhsky Research Medical University. All rights reserved.

<25>
Accession Number
2013026302
Title
Biomarkers of Cerebral Injury for Prediction of Postoperative Cognitive
Dysfunction in Patients Undergoing Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(1) (pp 125-132),
2022. Date of Publication: January 2022.
Author
Wiberg S.; Holmgaard F.; Zetterberg H.; Nilsson J.-C.; Kjaergaard J.;
Wanscher M.; Langkilde A.R.; Hassager C.; Rasmussen L.S.; Blennow K.;
Vedel A.G.
Institution
(Wiberg, Kjaergaard, Hassager) Department of Cardiology, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark
(Holmgaard, Nilsson, Wanscher, Vedel) Department of Cardiothoracic
Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
(Zetterberg, Blennow) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the
University of Gothenburg, Molndal, Sweden
(Zetterberg, Blennow) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Zetterberg) Department of Neurodegenerative Disease, UCL Institute of
Neurology, London, United Kingdom
(Zetterberg) UK Dementia Research Institute at UCL, London, United Kingdom
(Langkilde) Department of Radiology, Rigshospitalet, University of
Copenhagen, Copenhagen, Denmark
(Hassager, Rasmussen) Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
(Rasmussen) Department of Anesthesia, Center of Head and Orthopedics,
Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Publisher
W.B. Saunders
Abstract
Objectives: To assess the ability of the biomarkers neuron-specific
enolase (NSE), tau, neurofilament light chain (NFL), and glial fibrillary
acidic protein (GFAP) to predict postoperative cognitive dysfunction
(POCD) at discharge in patients who underwent cardiac surgery.
 Design(s): Post hoc analyses (with tests being prespecified before
data analyses) from a randomized clinical trial. Setting(s):
Single-center study from a primary heart center in Denmark.
 Participant(s): Adult patients undergoing elective or subacute
on-pump coronary artery bypass grafting and/or aortic valve replacement.
 Intervention(s): Blood was collected before induction of anesthesia,
after 24 hours, after 48 hours, and at discharge from the surgical ward.
The International Study of Postoperative Cognitive Dysfunction test
battery was applied to diagnose POCD at discharge and after three months.
Linear mixed models of covariance were used to assess whether repeated
measurements of biomarker levels were associated with POCD. Receiver
operating characteristic (ROC) curves were applied to assess the
predictive value of each biomarker measurement for POCD. Measurements
and Main Results: A total of 168 patients had biomarkers measured at
baseline, and 47 (28%) fulfilled the POCD criteria at discharge. Patients
with POCD at discharge had significantly higher levels of tau (p = 0.02)
and GFAP (p = 0.01) from baseline to discharge. The biomarker measurements
achieving the highest area under the ROC curve for prediction of POCD at
discharge were NFL measured at discharge (AUC, 0.64; 95% confidence
interval [CI], 0.54-0.73), GFAP measured 48 hours after induction (AUC,
0.64; 95% CI, 0.55-0.73), and GFAP measured at discharge (AUC, 0.64; 95%
CI, 0.54-0.74), corresponding to a moderate predictive ability.
 Conclusion(s): Postoperative serum levels of tau and GFAP were
significantly elevated in cardiac surgery patients with POCD at discharge,
however, the biomarkers achieved only modest predictive abilities for POCD
at discharge. Postoperative levels of NSE were not associated with POCD at
discharge. Copyright © 2021 Elsevier Inc.

<26>
Accession Number
2011471721
Title
Impact of COVID-19 infection on the cardiovascular system: An
evidence-based analysis of risk factors and outcomes.
Source
Best Practice and Research: Clinical Anaesthesiology. 35(3) (pp 437-448),
2021. Date of Publication: October 2021.
Author
Kaye A.D.; Spence A.L.; Mayerle M.; Sardana N.; Clay C.M.; Eng M.R.; Luedi
M.M.; Carroll Turpin M.A.; Urman R.D.; Cornett E.M.
Institution
(Kaye) Department of Anesthesiology and Pharmacology, Toxicology, and
Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA
71103, United States
(Spence) Department of Pharmaceutical Sciences, Regis University School of
Pharmacy, Denver, CO 80221, United States
(Mayerle) Regis University School of Pharmacy, Denver, CO 80221, United
States
(Sardana) Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln W,
Piscataway, NJ 08854, United States
(Clay) LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103,
United States
(Eng) Department of Anesthesiology, LSU Health Sciences Center, 1542
Tulane Avenue, New Orleans, LA 70112, United States
(Luedi) Bern University Hospital Inselspital, University of Bern, Bern,
Switzerland
(Carroll Turpin) Department of Biomedical Sciences, College of Medicine,
University of Houston, Health 2 Building, Room 8037, United States
(Urman) Department of Anesthesiology, Perioperative and Pain Medicine,
Harvard Medical School, Brigham and Women's Hospital, 75 Francis St,
Boston, MA 02115, United States
(Cornett) Department of Anesthesiology, LSU Health Shreveport, 1501 Kings
Highway, Shreveport, LA 71103, United States
Publisher
Bailliere Tindall Ltd
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known
as COVID-19, emerged in late 2019 in Wuhan, China. The World Health
Organization declared the virus a pandemic on March 11, 2020. Disease
progression from COVID-19 infection has shown significant symptom
manifestations within organ systems beyond the respiratory system. The
literature has shown increasing evidence of cardiovascular involvement
during disease course and an associated increase in mortality among
infected patients. Although the understanding of this novel virus is
continually evolving, it is currently proposed that the mechanism by which
the SARS-CoV-2 virus contributes to cardiovascular manifestations involves
the ACE2 transmembrane protein. The protein ACE2 is highly expressed in
blood vessel pericytes, and infection can result in microvascular
dysfunction and subsequent acute coronary syndromes. Complications
involving the cardiovascular system include myocardial infarction,
arrhythmias, shock, and heart failure. In this evidence-based review, we
discuss risk factors of cardiovascular involvement in COVID-19 infection,
pathophysiology of COVID-19-related cardiovascular infection, and injury,
COVID-19 effects on the cardiovascular system and corresponding
treatments, and hematologic effects of COVID-19 and COVID-19 in heart
transplant patients. Clinicians managing COVID-19 patients should
appreciate the potential cardiovascular effects related to the disease
process. Copyright © 2021 Elsevier Ltd

<27>
Accession Number
2013667755
Title
Stenting deferral in primary percutaneous coronary intervention: exploring
benefits and suitable interval in heavy thrombus burden.
Source
Egyptian Heart Journal. 73(1) (no pagination), 2021. Article Number: 78.
Date of Publication: December 2021.
Author
Magdy A.M.; Demitry S.R.; Hasan-Ali H.; Zaky M.; Abd El-Hady M.; Abdel
Ghany M.
Institution
(Magdy, Abd El-Hady) Cardiovascular Medicine, National Heart Institute,
Cairo, Egypt
(Demitry, Hasan-Ali, Zaky, Abdel Ghany) Cardiovascular Medicine, Faculty
of Medicine, Assiut University, Asyut, Egypt
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Deferred stenting, despite being successful in early studies,
showed no benefit in recent trials. However, these trials were testing
routine deferral; not in patients with heavy thrombus burden.
 Result(s): This is a prospective, Randomized Clinical Trial that
included 150 patients who presented with STEMI, patients were allocated
into three equal groups after the coronary angiography +/- primary
intervention and before stenting of the culprit lesion; group (A) included
50 patients with early deferral of stenting, group (B) included 50
patients with late deferral and group (C) included 50 patients with
immediate stenting. No-reflow was significantly higher in group C, while
Final TIMI flow grade 3 and MBG grade 3 were significantly higher in group
A and B than group C; p = 0.019 and < 0.001 respectively, with no
significant difference between groups A and B, only the thrombus
resolution in group B was significantly higher than group A; p < 0.001.
Finally, 6-months, over-all MACE was significantly higher in group C
(34.7% vs. 14.6% and 16.3%, p = 0.029). Conclusion(s): Stent deferral
was proved to be better than immediate stenting after recanalization of
IRA, in achieving TIMI III flow, reducing risk of 6 months MACE, and
restoration of myocardial function in a subset of STEMI patients
presenting with large thrombus burden. While, no significant difference
was found between both deferral times in final TIMI flow, or clinical
outcomes. Copyright © 2021, The Author(s).

<28>
Accession Number
2014503161
Title
ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter
aortic VAlve implantaTION): A Randomized Clinical Trial.
Source
JACC: Cardiovascular Interventions. 14(18) (pp 1965-1974), 2021. Date of
Publication: 27 Sep 2021.
Author
Patterson T.; Clayton T.; Dodd M.; Khawaja Z.; Morice M.C.; Wilson K.; Kim
W.-K.; Meneveau N.; Hambrecht R.; Byrne J.; Carrie D.; Fraser D.; Roberts
D.H.; Doshi S.N.; Zaman A.; Banning A.P.; Eltchaninoff H.; Le Breton H.;
Smith D.; Cox I.; Frank D.; Gershlick A.; de Belder M.; Thomas M.;
Hildick-Smith D.; Prendergast B.; Redwood S.; Pocock S.; Wang D.; Irague
F.
Institution
(Patterson, Wilson, Prendergast, Redwood) Cardiovascular Department, St
Thomas' Hospital, Kings College London, London, United Kingdom
(Clayton, Dodd) Department of Medical Statistics, London School of Hygiene
and Tropical Medicine, London, United Kingdom
(Khawaja) Cardiology Department, Lewisham and Greenwich NHS Foundation
Trust, United Kingdom
(Morice) Institut Cardiovasculaire Paris Sud, Massy, France
(Morice) Cardiovascular European Research Center, Massy, France
(Kim) Cardiology Department, Kerckhoff-Klinik Bad Nauheim Abteilung
Kardiologie, Bad Nauheim, Germany
(Meneveau) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(Meneveau) EA3920, University of Burgundy Franche-Comte, Besancon, France
(Hambrecht) Cardiology Department, Klinikum Links der Weser GmbH, Bremen,
Germany
(Byrne) Cardiothoracic Department, King's College Hospital, London, United
Kingdom
(Carrie) Cardiology Department, Hopital Rangueil, Centre Hospitalier
Universitaire de Toulouse, Toulouse, France
(Fraser) Cardiology Department, Manchester Royal Infirmary, Manchester,
United Kingdom
(Roberts) Lancashire Cardiac Centre, Blackpool Victoria Hospital NHS
Trust, Blackpool, United Kingdom
(Doshi) Cardiology Department, Queen Elizabeth Hospital, Birmingham,
United Kingdom
(Zaman) Cardiology Department, Newcastle upon Tyne Hospitals NHS
Foundation Trust of the Freeman Hospital, Newcastle, United Kingdom
(Banning) Department of Cardiology, John Radcliffe Hospital, Oxford,
United Kingdom
(Eltchaninoff) Cardiology Department, Hopital Charles-Nicolle, Centre
Hospitalier Universitaire de Rouen, Rouen, France
(Le Breton) Service de Cardiologie, Hopital Pontchaillou, Centre
Hospitalier Universitaire de Rennes, Rennes, France
(Smith) Cardiology Department, Morriston Hospital, Swansea, United Kingdom
(Cox) Cardiology Department, Derriford Hospital, Plymouth, United Kingdom
(Frank) Cardiology Department, Oberarzt Facharzt fur Innere Medizin und
Kardiologie, Kiel, Germany
(Gershlick) Department of Cardiovascular Sciences, Glenfield Hospital,
University of Leicester, Leicester, United Kingdom
(de Belder) Cardiology Department, Barts Heart Centre, London, United
Kingdom
(Thomas) Edwards Lifesciences, Irvine, CA, United States
(Hildick-Smith) Sussex Cardiac Centre, Brighton and Sussex University
Hospitals, Brighton, United Kingdom
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to determine if percutaneous coronary
intervention (PCI) prior to transcatheter aortic valve replacement (TAVR)
in patients with significant coronary artery disease would produce
noninferior clinical results when compared with no PCI (control arm).
 Background(s): PCI in patients undergoing TAVR is not without risk,
and there are no randomized data to inform clinical practice.
 Method(s): Patients with severe symptomatic aortic stenosis and
significant coronary artery disease with Canadian Cardiovascular Society
class <=2 angina were randomly assigned to receive PCI or no PCI prior to
TAVR. The primary endpoint was a composite of all-cause death or
rehospitalization at 1 year. Noninferiority testing (prespecified margin
of 7.5%) was performed in the intention-to-treat population.
 Result(s): At 17 centers, 235 patients underwent randomization. At 1
year, the primary composite endpoint occurred in 48 (41.5%) of the PCI arm
and 47 (44.0%) of the no-PCI arm. The requirement for noninferiority was
not met (difference: -2.5%; 1-sided upper 95% confidence limit: 8.5%;
1-sided noninferiority test P = 0.067). On analysis of the as-treated
population, the difference was -3.7% (1-sided upper 95% confidence limit:
7.5%; P = 0.050). Mortality was 16 (13.4%) in the PCI arm and 14 (12.1%)
in the no-PCI arm. At 1 year, there was no evidence of a difference in the
rates of stroke, myocardial infarction, or acute kidney injury, with
higher rates of any bleed in the PCI arm (P = 0.021). Conclusion(s):
Observed rates of death and rehospitalization at 1 year were similar
between PCI and no PCI prior to TAVR; however, the noninferiority margin
was not met, and PCI resulted in a higher incidence of bleeding.
(Assessing the Effects of Stenting in Significant Coronary Artery Disease
Prior to Transcatheter Aortic Valve Implantation;
ISRCTN75836930) Copyright © 2021 American College of Cardiology
Foundation

<29>
Accession Number
2014501808
Title
5-Year Outcomes Comparing Surgical Versus Transcatheter Aortic Valve
Replacement in Patients With Chronic Kidney Disease.
Source
JACC: Cardiovascular Interventions. 14(18) (pp 1995-2005), 2021. Date of
Publication: 27 Sep 2021.
Author
Garcia S.; Cubeddu R.J.; Hahn R.T.; Ternacle J.; Kapadia S.R.; Kodali
S.K.; Thourani V.H.; Jaber W.A.; Asher C.R.; Elmariah S.; Makkar R.; Webb
J.G.; Herrmann H.C.; Lu M.; Devireddy C.M.; Malaisrie S.C.; Smith C.R.;
Mack M.J.; Sorajja P.; Cavalcante J.L.; Goessl M.; Shroff G.R.; Leon M.B.;
Pibarot P.
Institution
(Garcia, Sorajja, Cavalcante, Goessl) Minneapolis Heart Institute, Abbott
Northwestern Hospital, Minneapolis, MN, United States
(Garcia, Sorajja, Cavalcante, Goessl) Valve Science Center, Minneapolis
Heart Institute Foundation, Minneapolis, MN, United States
(Cubeddu) NCH Healthcare System, Naples, FL, United States
(Hahn, Smith, Leon) Cardiovascular Research Foundation, New York, NY,
United States
(Hahn, Kodali, Smith, Leon) Division of Cardiology, Columbia University
Medical Center/NewYork-Presbyterian Hospital, New York, NY, United States
(Ternacle, Pibarot) Institut Universitaire de Cardiologie et de
Pneumologie de Quebec/Quebec Heart & Lung Institute, Laval University,
Quebec, Quebec, Canada
(Kapadia) Department of Cardiovascular Medicine, Heart, Vascular, and
Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
(Thourani) Department of Cardiovascular Surgery, Marcus Heart and Vascular
Center, Piedmont Heart and Vascular Institute, Atlanta, GA, United States
(Jaber) Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH,
United States
(Asher) Department of Cardiovascular Medicine, Heart and Vascular
Institute, Cleveland Clinic Weston, Weston, FL, United States
(Elmariah) Massachusetts General Hospital, Boston, MA, United States
(Makkar) Cedars-Sinai Heart Institute, Los Angeles, CA, United States
(Webb) St. Paul's Hospital, Vancouver, BC, Canada
(Herrmann) Department of Cardiology, Hospital of the University of
Pennsylvania, Philadelphia, PA, United States
(Lu) Edwards Lifesciences, Irvine, CA, United States
(Devireddy) Department of Cardiology, Emory University School of Medicine,
Atlanta, GA, United States
(Malaisrie) Department of Cardiac Surgery, Northwestern University
Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago,
IL, United States
(Mack) Department of Cardiothoracic Surgery, Baylor Scott & White Health,
Plano, TX, United States
(Shroff) Hennepin Healthcare and University of Minnesota Medical School,
Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare 5-year cardiovascular,
renal, and bioprosthetic valve durability outcomes in patients with severe
aortic stenosis (AS) and chronic kidney disease (CKD) undergoing
transcatheter aortic valve replacement (TAVR) or surgical aortic valve
replacement (SAVR). Background(s): Patients with severe AS and CKD
undergoing TAVR or SAVR are a challenging, understudied clinical subset.
 Method(s): Intermediate-risk patients with moderate to severe CKD
(estimated glomerular filtration rate <60 mL/min/m2) from the
PARTNER (Placement of Aortic Transcatheter Valve) 2A trial (patients
randomly assigned to SAPIEN XT TAVR or SAVR) and SAPIEN 3 Intermediate
Risk Registry were pooled. The composite primary outcome of death, stroke,
rehospitalization, and new hemodialysis was evaluated using Cox regression
analysis. Patients with and without perioperative acute kidney injury
(AKI) were followed through 5 years. A core laboratory-adjudicated
analysis of structural valve deterioration and bioprosthetic valve failure
was also performed. Result(s): The study population included 1,045
TAVR patients (512 SAPIEN XT, 533 SAPIEN 3) and 479 SAVR patients. At 5
years, SAVR was better than SAPIEN XT TAVR (52.8% vs 68.0%; P = 0.04) but
similar to SAPIEN 3 TAVR (52.8% vs 58.7%; P = 0.89). Perioperative AKI was
more common after SAVR than TAVR (26.3% vs 10.3%; P < 0.001) and was
independently associated with long-term outcomes. Compared with SAVR,
bioprosthetic valve failure and stage 2 or 3 structural valve
deterioration were significantly greater for SAPIEN XT TAVR (P < 0.05) but
not for SAPIEN 3 TAVR. Conclusion(s): In intermediate-risk patients
with AS and CKD, SAPIEN 3 TAVR and SAVR were associated with a similar
risk for the primary endpoint at 5 years. AKI was more common after SAVR
than TAVR, and SAPIEN 3 valve durability was comparable with that of
surgical bioprostheses. Copyright © 2021 American College of
Cardiology Foundation

<30>
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.
 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. 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. 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. Copyright © 2020
Taylor & Francis Group, LLC.

<31>
Accession Number
2014246820
Title
Urgent transcatheter aortic valve implantation in an all-comer population:
a single-centre experience.
Source
BMC Cardiovascular Disorders. 21(1) (no pagination), 2021. Article Number:
550. Date of Publication: December 2021.
Author
Lux A.; Veenstra L.F.; Kats S.; Dohmen W.; Maessen J.G.; van 't Hof
A.W.J.; Maesen B.
Institution
(Lux, Veenstra, van 't Hof) Department of Cardiology, Maastricht
University Medical Center+, Maastricht, Netherlands
(Veenstra, Kats, Maessen, Maesen) Department of Cardiothoracic Surgery,
Maastricht University Medical Center+, Maastricht, Netherlands
(Maessen, van 't Hof, Maesen) Cardiovascular Reasearch Institute
Maastricht University, Maastricht, Netherlands
(Lux, van 't Hof) Department of Cardiology, Zuyderland Medical Centrum,
Heerlen, Netherlands
(Dohmen) Business Information Management, Maastricht University Medical
Center+, Maastricht, Netherlands
Publisher
BioMed Central Ltd
Abstract
Background: When compared with older reports of untreated symptomatic
aortic valve stenosis (AoS), urgent transcatheter aortic valve
implantation (u-TAVI) seems to improve mortality rates. We performed a
single centre, retrospective cohort analysis to characterize our u-TAVI
population and to identify potential predictors of worse outcomes.
 Method(s): We performed a retrospective analysis of 631 consecutive
TAVI patients between 2013 and 2018. Of these patients, 53 were
categorized as u-TAVI. Data was collected from the local electronic
database. Result(s): Urgent patients had more often a severely
decreased left ventricular ejection fraction (LVEF < 30%) and increased
creatinine levels (115.5 [88-147] vs 94.5 [78-116] mmol/l; p = 0.001).
Urgent patients were hospitalised for 18 [10-28] days before and
discharged 6 [4-9] days after the implantation. The incidence of
peri-procedural complications and apical implantations was comparable
among the study groups. Urgent patients had higher in-hospital (11.3% vs
3.1%; p = 0.011) and 1-year mortality rates (28.2% vs 8.5%, p < 0.001). An
increased risk of one-year mortality was associated with urgency (HR 3.5;
p < 0.001), apical access (HR 1.9; p = 0.016) and cerebrovascular
complications (HR 4.3; p = 0.002). Within the urgent group, the length of
pre-hospital admission was the only significant predictor of 1-year
mortality (HR 1.037/day; p = 0.003). Conclusion(s): Compared to
elective procedures, u-TAVI led to increased mortality and comparable
complication rates. This detrimental effect is most likely related to the
length of pre-procedural hospitalisation of urgent patients. Copyright
© 2021, The Author(s).

<32>
Accession Number
2015978516
Title
Percutaneous coronary intervention with drug-eluting stents versus
coronary artery bypass grafting in left main coronary artery disease: an
individual patient data meta-analysis.
Source
The Lancet. 398(10318) (pp 2247-2257), 2021. Date of Publication: 18 Dec
2021.
Author
Sabatine M.S.; Bergmark B.A.; Murphy S.A.; O'Gara P.T.; Smith P.K.;
Serruys P.W.; Kappetein A.P.; Park S.-J.; Park D.-W.; Christiansen E.H.;
Holm N.R.; Nielsen P.H.; Stone G.W.; Sabik J.F.; Braunwald E.
Institution
(Sabatine, Bergmark, Murphy, Braunwald) Thrombolysis in Myocardial
Infarction Study Group, Brigham and Women's Hospital and Harvard Medical
School, Boston, MA, United States
(Sabatine, Bergmark, Murphy, O'Gara, Braunwald) Division of Cardiovascular
Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston,
MA, United States
(Smith) Department of Surgery (Cardiothoracic), Duke University School of
Medicine, Duke Clinical Research Institute, Durham, NC, United States
(Serruys) Department of Cardiology, National University of Ireland Galway,
Galway, Ireland
(Serruys) National Heart and Lung Institute, Imperial College London,
London, UK, United Kingdom
(Kappetein) Department of Cardiothoracic Surgery, Erasmus University
Medical Centre, Rotterdam, Netherlands
(Kappetein) Medtronic, Maastricht, Netherlands
(Park, Park) Department of Cardiology, Asan Medical Center, Seoul, South
Korea
(Christiansen, Holm) Department of Cardiology, Aarhus University Hospital,
Aarhus, Denmark
(Nielsen) Department of Cardiothoracic and Vascular Surgery, Aarhus
University Hospital, Aarhus, Denmark
(Stone) The Zena and Michael A Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Stone) Cardiovascular Research Foundation, New York, NY, United States
(Sabik) Department of Surgery, University Hospitals Cleveland Medical
Center, Cleveland, OH, United States
Publisher
Elsevier B.V.
Abstract
Background: The optimal revascularisation strategy for patients with left
main coronary artery disease is uncertain. We therefore aimed to evaluate
long-term outcomes for patients treated with percutaneous coronary
intervention (PCI) with drug-eluting stents versus coronary artery bypass
grafting (CABG). Method(s): In this individual patient data
meta-analysis, we searched MEDLINE, Embase, and the Cochrane database
using the search terms "left main", "percutaneous coronary intervention"
or "stent", and "coronary artery bypass graft*" to identify randomised
controlled trials (RCTs) published in English between database inception
and Aug 31, 2021, comparing PCI with drug-eluting stents with CABG in
patients with left main coronary artery disease that had at least 5 years
of patient follow-up for all-cause mortality. Two authors (MSS and BAB)
identified studies meeting the criteria. The primary endpoint was 5-year
all-cause mortality. Secondary endpoints were cardiovascular death,
spontaneous myocardial infarction, procedural myocardial infarction,
stroke, and repeat revascularisation. We used a one-stage approach; event
rates were calculated by use of the Kaplan-Meier method and treatment
group comparisons were made by use of a Cox frailty model, with trial as a
random effect. In Bayesian analyses, the probabilities of absolute risk
differences in the primary endpoint between PCI and CABG being more than
0.0%, and at least 1.0%, 2.5%, or 5.0%, were calculated. Finding(s):
Our literature search yielded 1599 results, of which four RCTs-SYNTAX,
PRECOMBAT, NOBLE, and EXCEL-meeting our inclusion criteria were included
in our meta-analysis. 4394 patients, with a median SYNTAX score of 25.0
(IQR 18.0-31.0), were randomly assigned to PCI (n=2197) or CABG (n=2197).
The Kaplan-Meier estimate of 5-year all-cause death was 11.2% (95% CI
9.9-12.6) with PCI and 10.2% (9.0-11.6) with CABG (hazard ratio 1.10, 95%
CI 0.91-1.32; p=0.33), resulting in a non-statistically significant
absolute risk difference of 0.9% (95% CI -0.9 to 2.8). In Bayesian
analyses, there was an 85.7% probability that death at 5 years was greater
with PCI than with CABG; this difference was more likely than not less
than 1.0% (<0.2% per year). The numerical difference in mortality was
comprised more of non-cardiovascular than cardiovascular death.
Spontaneous myocardial infarction (6.2%, 95% CI 5.2-7.3 vs 2.6%, 2.0-3.4;
hazard ratio [HR] 2.35, 95% CI 1.71-3.23; p<0.0001) and repeat
revascularisation (18.3%, 16.7-20.0 vs 10.7%, 9.4-12.1; HR 1.78,
1.51-2.10; p<0.0001) were more common with PCI than with CABG. Differences
in procedural myocardial infarction between strategies depended on the
definition used. Overall, there was no difference in the risk of stroke
between PCI (2.7%, 2.0-3.5) and CABG (3.1%, 2.4-3.9; HR 0.84, 0.59-1.21;
p=0.36), but the risk was lower with PCI in the first year after
randomisation (HR 0.37, 0.19-0.69). Interpretation(s): Among patients
with left main coronary artery disease and, largely, low or intermediate
coronary anatomical complexity, there was no statistically significant
difference in 5-year all-cause death between PCI and CABG, although a
Bayesian approach suggested a difference probably exists (more likely than
not <0.2% per year) favouring CABG. There were trade-offs in terms of the
risk of myocardial infarction, stroke, and revascularisation. A heart team
approach to communicate expected outcome differences might be useful to
assist patients in reaching a treatment decision. Funding(s): No
external funding. Copyright © 2021 Elsevier Ltd

<33>
Accession Number
2015626119
Title
Polycythaemia Vera and Coronary Artery Bypass Graft Surgery: A Systematic
Review of the Literature.
Source
Heart Lung and Circulation. (no pagination), 2021. Date of Publication:
2021.
Author
Janmohamed I.K.; Sondh R.S.; Ahmed H.; Afzal M.B.; Tyson N.; Harky A.
Institution
(Janmohamed) University of Leeds, Faculty of Health and Medicine, Leeds,
United Kingdom
(Sondh) St George's Hospital Medical School, University of London, London,
UK, United Kingdom
(Ahmed, Afzal) Imperial College London, Department of Medicine, London,
UK, United Kingdom
(Tyson) Nottingham University Hospitals, Department of Cardiac Surgery,
UK, United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, UK, United Kingdom
Publisher
Elsevier Ltd
Abstract
Objectives: Polycythaemia vera (PV) is a condition that may potentially
put patients undergoing cardiac surgery at an increased risk of bleeding
and thrombosis; however, there is currently a paucity of literature
regarding the management of these patients. We aim to examine the
literature in this systematic review to indicate the interventions that
may be considered to minimise complications. Method(s): We conducted
a literature search using keywords and MeSH terms to identify articles
discussing PV and cardiac surgery. The studies were identified and
qualitatively analysed using the Preferred Reporting Items for Systematic
Reviews and Meta-analysis (PRISMA) protocol. Result(s): In total, 10
case reports representing 11 patients were identified for this systematic
review and were included in qualitative analysis. 63.6% of patients had
preoperative intermittent phlebotomy, and the majority of patients
received postoperative therapy that involved one antiplatelet and one
anticoagulant. Generous perioperative fluid management, phlebotomy,
preservation of core body temperature, early extubation, monitoring of
myocardial ischaemia, infarction and vascular events, intense chest
physiotherapy and patient mobilisation are important to consider to reduce
the risk of complications arising from surgery. Conclusion(s): These
considerations should be systematically discussed in a multidisciplinary
team, where the acute surgical need can be balanced appropriately against
the risk of haemorrhage and thrombosis. Copyright © 2021
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
(ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

<34>
Accession Number
2015437870
Title
Transcatheter Versus Surgical Aortic Valve Replacement in Patients With
Complex Coronary Artery Disease.
Source
JACC: Cardiovascular Interventions. 14(22) (pp 2490-2499), 2021. Date of
Publication: 22 Nov 2021.
Author
Alperi A.; Mohammadi S.; Campelo-Parada F.; Munoz-Garcia E.;
Nombela-Franco L.; Faroux L.; Veiga G.; Serra V.; Fischer Q.; Pascual I.;
Asmarats L.; Gutierrez E.; Regueiro A.; Vilalta V.; Ribeiro H.B.; Matta
A.; Munoz-Garcia A.; Armijo G.; Metz D.; De la Torre Hernandez J.M.;
Rodenas-Alesina E.; Urena M.; Moris C.; Arzamendi D.; Perez-Fuentes P.;
Fernandez-Nofrerias E.; Campanha-Borges D.C.; Mesnier J.; Voisine P.;
Dumont E.; Kalavrouziotis D.; Rodes-Cabau J.
Institution
(Alperi, Mohammadi, Mesnier, Voisine, Dumont, Kalavrouziotis, Rodes-Cabau)
Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
(Campelo-Parada, Matta) Rangueil University Hospital, Toulouse, France
(Munoz-Garcia, Munoz-Garcia) Hospital Universitario Virgen de la Victoria,
Malaga, Spain
(Nombela-Franco, Armijo) Cardiovascular Institute, Hospital Clinico San
Carlos, IdISSC, Madrid, Spain
(Faroux, Metz) Reims University Hospital, Reims, France
(Veiga, De la Torre Hernandez) Hospital Marques de Valdecilla, Santander,
Spain
(Serra, Rodenas-Alesina) Hospital Universitari Vall d'Hebron, Barcelona,
Spain
(Fischer, Urena) Assistance Publique-Hopitaux de Paris, Bichat Hospital,
Paris, France
(Pascual, Moris) Hospital Universitario Central de Asturias, Oviedo, Spain
(Asmarats, Arzamendi) Hospital Santa Creu i Sant Pau, Barcelona, Spain
(Gutierrez) Hospital Gregorio Maranon, Madrid, Spain
(Regueiro, Perez-Fuentes, Rodes-Cabau) Hospital Clinic de Barcelona,
Barcelona, Spain
(Vilalta, Fernandez-Nofrerias) Hospital Germans Trias i Pujol, Badalona,
Spain
(Ribeiro, Campanha-Borges) Instituto do Coracao (InCor), Heart Institute,
University of Sao Paulo, Sao Paulo, Brazil
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this study was to compare, in a cohort of patients
with complex coronary artery disease (CAD) and severe aortic stenosis
(AS), the clinical outcomes associated with transfemoral transcatheter
aortic valve replacement (TAVR) (plus percutaneous coronary intervention
[PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary
artery bypass grafting [CABG]). Background(s): Patients with complex
CAD were excluded from the main randomized trials comparing TAVR with
SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such
patients. Method(s): A multicenter study was conducted including
consecutive patients with severe AS and complex CAD (SYNTAX [Synergy
Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left
main disease). A 1:1 propensity-matched analysis was performed to account
for unbalanced covariates. The rates of major adverse cardiac and
cerebrovascular events (MACCE), including all-cause mortality,
nonprocedural myocardial infarction, need for new coronary
revascularization, and stroke, were evaluated. Result(s): A total of
800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral
TAVR + PCI) were included, and after propensity matching, a total of 156
pairs of patients were generated. After a median follow-up period of 3
years (interquartile range: 1-6 years), there were no significant
differences between groups for MACCE (HR for transfemoral TAVR vs SAVR:
1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI:
0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and
stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new
coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI:
1.73-16.7). Conclusion(s): In patients with severe AS and complex
CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of
MACCE after a median follow-up period of 3 years, but TAVR + PCI
recipients exhibited a higher risk for repeat coronary revascularization.
Future trials are warranted. Copyright © 2021 American College of
Cardiology Foundation

<35>
Accession Number
2011986310
Title
Post-Cardiac Surgery Pancreatitis And Associated Outcomes: A Systemic
Review And Meta-Analysis.
Source
Gastroenterology. Conference: DDW 2021. Virtual, Online. 160(6 Supplement)
(pp S-292-S-293), 2021. Date of Publication: May 2021.
Author
Shah I.; Mehta H.; Bhurwal A.; Kandasamy C.; Ahmed A.; Sheth S.G.;
Freedman S.D.
Publisher
W.B. Saunders
Abstract
Introduction: Acute Pancreatitis (Ap) Has Been Identified As A
Postoperative Complication In Patients Undergoing Cardiac Surgery. Several
Mechanisms Such As Low Cardiac Output, Intra-Aortic Balloon Pump Usage,
Use Of Vasopressors And Prolonged Cardiopulmonary Bypass Time May Result
In Vascular Injury To The Pancreas. The Aim Of Our Study Was To Identify
The Incidence Of Post-Cardiac Surgery Ap In The Published Literature And
Its Impact On Systemic Complications And Mortality. Method(s): Three
Independent Reviewers Performed A Comprehensive Review Of All Original
Articles Published From Inception To September 2020, Describing The
Occurrence Of Post Operative Pancreatitis Among Patients Undergoing
Cardiac Surgeries. Primary Outcomes Were Incidence Of Ap, Necrotizing
Pancreatitis And Pancreatitis-Associated Multi-Organ Failure Among These
Patients. Secondary Outcome Was Mortality Rate Among These Patients With
Ap Compared To Those Post-Cardiac Surgery Patients Who Did Not Develop Ap
(Control Group). All Meta-Analysis Tests Were 2-Tailed Utilizing Cma
Software. Probability Of Publication Bias Was Assessed Using Funnel Plots
And With Egger'S Test. Result(s): A Total Of 15 Studies Described The
Incidence Of Ap As A Post-Operative Complication Among Patients Undergoing
Cardiac Surgeries. The Pooled Incidence Rate Of Ap Was 5.0% (95% Ci
1.7-13.9; I2 =98) And Rate Of Necrotizing Pancreatitis Was 30.1% (95% Ci
6.9-71.5; I 2 =83) (Figure-1). Three Studies Reported Multi-Organ Failure
Associated With Ap With An Overall Pooled Organ Failure Rate Of 36.2% (95%
Ci 12.9-68.6; I2 =70.97) (Figure-2). A Total Of Five Studies Reported
Mortality Among Patients With Post-Cardiac Surgery Ap. The Incidence Of Ap
Among Post-Cardiac Surgery Patients Significantly Increased The Odds Of
Mortality Compared To Those Who Did Not Develop Ap, With An Odds Ratio Of
7.90 (95% Ci 4.7-13.24, P<0.0001; I2 =0) (Figure-2). There Was No
Publication Bias Based On The Funnel Plot. Egger'S Test Confirmed The Same
(P=0.91). Conclusion(s): This Systemic Review And Meta-Analysis
Indicates A High Incidence Of Post-Cardiac Surgery Pancreatitis And
Associated High Morbidity And Mortality. Almost One Third Of Patients With
Pancreatitis Progressed To Necrotizing Pancreatitis And One Third Of These
Patients Developed Multi-Organ Failure. A High Index Of Suspicion Is
Warranted To Identify Pancreatitis As A Rare But Fatal Complication In
Patients Undergoing Cardiac Surgeries. (Figure Presented) Pooled Incidence
Rate Of Acute Pancreatitis And Necrotizing Pancreatitis Among Post-Cardiac
Surgery Patients (Figure Presented) Pooled Organ Failure Rate And
Mortality Rate Among Patients With Post-Cardiac Surgery
Pancreatiti Copyright © 2021 AGA Institute

<36>
Accession Number
636769924
Title
Optimal medical therapy in patients with stable coronary artery disease in
Poland in comparison to other countries worldwide. The ISCHEMIA Trial
experience.
Source
Kardiologia Polska. Conference: 25th International Congress of the Polish
Cardiac Society. Online. 79(SUPPL 1) (pp 15-16), 2021. Date of
Publication: 2021.
Author
Pracon R.; Demkow M.; Anthopolos R.; Mazurek T.; Drozdz J.; Witkowski A.;
Gajos G.; Roik M.; Pruszczyk P.; Loboz-Grudzien K.; Lesiak M.; Reczuch K.;
Kalarus Z.; Henzel J.; Kryczka K.; Kaczmarska-Dyrda E.; Jonik S.; Maksym
J.; Krekora J.; Celinska-Spodar M.; Jaroch J.; Lanocha M.; Szulik M.;
Ruzyllo W.; Szwed H.; Zabrze C.S.
Institution
(Pracon, Demkow) Klinika Choroby Wiencowej i Strukturalnych Chorob Serca,
Narodowy Instytut Kardiologii, Warszawa, Poland
(Anthopolos) NYU Grossman School of Medicine, New York, United States
(Mazurek) I Katedra i Klinika Kardiologii Warszawskiego Uniwersytetu
Medycznego, Warszawa, Poland
(Drozdz) II Klinika Kardiologii, Katedra Kardiologii, Kardiochirurgii i
Chorob Naczyn, UM w Lodzi, Lodz, Poland
(Witkowski) Klinika Kardiologii i Angiologii Interwencyjnej, Narodowy
Instytut Kardiologii, Warszawa, Poland
(Gajos) Department of Coronary Disease and Heart Failure, Faculty of
Medicine, Jagiellonian University Medical College, Krakow, Poland
(Roik) Department of Coronary Disease and Heart Failure, Faculty of
Medicine, Krakow, Poland
(Pruszczyk) Klinika Chorob Wewnetrznych i Kardiologii z Centrum
Diagnostyki i Leczenia Zylnej Choroby Zakrzepowo-Zatorowej, Warszawski
Uniwersytet Medyczny, Warszawa, Poland
(Loboz-Grudzien) Dolnoslaski Szpital Specjalistyczny im. T. Marciniaka,
Oddzial Kardiologi, Wroclaw, Poland
(Lesiak) I Klinika Kardiologii, Uniwersytet Medyczny im. Karola
Marcinkowskiego, Poznan, Poland
(Reczuch) Katedra Chorob Serca, Uniwersytet Medyczny we Wroclawiu,
Wroclaw, Poland
(Kalarus) Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii,
Slaskie Centrum Chorob Serca, Zabrze, Poland
(Henzel, Kryczka) Klinika Choroby Wiencowej i Strukturalnych Chorob-Serca,
Narodowy Instytut Kardiologii, Warszawa, Poland
(Kaczmarska-Dyrda) Klinika Choroby Wiencowej i Strukturalnych Chorob
Serca, Instytut Kardiologii, Warszawa, Poland
(Jonik, Maksym) I Katedra i Klinika Kardiologii Warszawskiego
Uniwersytetu-Medycznego, Warszawa, Poland
(Krekora) II Klinika Kardiologii Katedry Kardiologii, Kardiochirurgii i
Chorob Naczyn, Centralny Szpital Kliniczny Uniwersytetu Medycznego, Lodz,
Poland
(Celinska-Spodar, Ruzyllo, Szwed, Zabrze) Narodowy Instytut Kardiologii,
Warszawa, Poland
(Jaroch) Dolnoslaski Szpital Specjalistyczny im. T. Marciniaka, Oddzial
Kardiologii, Wroclaw, Poland
(Lanocha) I Katedra i Klinika Kardiologii, Uniwersytet Medyczny im. Karola
Marcinkowskiego, Poznan, Poland
(Szulik) Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii,
Oddzial Kliniczny Kardiologii Slaskiego Uniwersytetu Medycznego, Slaskie
Centrum, Poland
Publisher
Via Medica
Abstract
INTRODUCTION The ISCHEMIA Trial showed similar outcomes of initial
conservative vs invasive approach to stable coronary artery disease, with
optimal medical therapy (OMT) remaining the cornerstone of treatment. To
describe OMT goal attainment among ISCHEMIA participants in Poland
compared to other countries. MATERIAL AND METHODS Among 5179 trial
participants 333 were randomized in Poland. The median follow-up duration
was 3.2 years with the following OMT targets: not-smoking, high-intensity
statin therapy, low-density lipoprotein cholesterol (LDL-C) <70 mg/dl,
systolic blood pressure (SBP) <140 mm Hg, antiplatelet agent therapy, and
angiotensin converting enzyme inhibitory/ /angiotensin II receptor
blockers (ACE-I/ARB), beta-blocker therapy if indicated. RESULTS Compared
to other countries worldwide, at randomization participants in Poland were
older (67 [62, 75] yrs vs 65 [58, 71] yrs; P <0.005), more often female
(30% vs 22%; P <0.005), with longer angina duration (3 [1, 9] yrs vs 1 [0,
3] yrs; P <0.001), more prior myocardial infarctions (32% vs 18%; P
<0.005) and coronary revascularization procedures (percutaneous coronary
intervention: 40% vs 19%; coronary artery bypass grafting: 11% vs 3%; P
<0.001). Number of OMT goal attainment increased from baseline to last
follow-up (5 [4, 6] vs 6 [5, 6]; P <0.0001) in Poland and other countries
alike (P = 0.89, and P = 0.14, respectively). In Poland, significant
improvements were achieved regarding high-intensity statin therapy (27% vs
50%), LDL-C <70mg/dl (29% vs 65%), and SBP <140 mm Hg (63% vs 81%); P
<0.001; whereas not-smoking (89% vs 89%), antiplatelet (91% vs 88%),
ACE-I/ARB (91% vs 93%), and beta-blocker therapy (89% vs 91%) remained
similarly high. CONCLUSIONS With regular surveillance and concurrent
medical therapy, high OMT goal attainment was achievable among ISCHEMIA
participants in Poland relative to other countries. There is still room
for improvement in lipids and blood pressure management.

<37>
Accession Number
636769380
Title
Minimally invasive versus conventional approach for mitral valve surgery.
Source
QJM. Conference: 40th Annual Ain Shams Medical Conference. Online.
113(SUPPL 1) (pp i36), 2020. Date of Publication: March 2020.
Author
ElKerdany A.B.; Elghanam M.A.; Gamal M.A.; Abdelmoneim T.M.E.
Institution
(ElKerdany, Elghanam, Gamal, Abdelmoneim) Faculty of Medicine, Ain Shams
University, Egypt
Publisher
Oxford University Press
Abstract
Introduction: Full median sternotomy has been well established as a
standard approach for all types of open heart surgery for many years.
Although well established, the full sternotomy incision has been
frequently criticized for its length, post operative pain and possible
complications. Minimally invasive mitral valve surgery can be an appealing
feasible alternative to the conventional full sternotomy approach with low
perioperative morbidity and short-term mortality. We here made
meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in
patients with mitral valve disease. Methods A systematic review of studies
comparing perioperative outcomes of MIMVS versus CMVS in patients with
mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane
Collaboration) was employed to analyze the results. The outcomes of
interest are mortality, cerebrovascular accidents, wound infection,
reexploration due to bleeding, and LVEF assessment post-surgery. Results
12 studies involving 10279 patients were included in the meta-analysis.
The 30-day mortality was significantly decreased with MIMVS; 1.6% in the
MIMVS group and 2.9% in the group treated through a conventional
sternotomy. Cerebrovascular events were significantly decreased with
MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients
treated via a conventional sternotomy. Wound infections, reexploration due
to bleeding, and LVEF did not differ significantly between both groups.
Conclusion The perioperative outcome is more or less similar for minimally
invasive mitral valve surgery and conventional mitral valve surgery
performed via median sternotomy. Given balance in outcomes, MIMVS is at
least as safe as the standard approach and can be considered a routine and
standard approach for mitral valve surgery.

<38>
Accession Number
636769116
Title
Effect of oral gabapentin premedication on post-operative pain in
pediatric patient undergoing adenotonsillectomy.
Source
QJM. Conference: 40th Annual Ain Shams Medical Conference. Online.
113(SUPPL 1) (pp i9), 2020. Date of Publication: March 2020.
Author
Bassiony M.A.; Elserwi H.B.; Abdelnaiem M.A.; Elrazzaz M.H.S.M.
Institution
(Bassiony, Elserwi, Abdelnaiem, Elrazzaz) Anesthesia Department, Faculty
of Medicine, Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
Background: Tonsillectomy is one of the most common surgical procedures
performed in otorhinolaryngology. Postoperative pain following
tonsillectomy, which is especially aggravated by swallowing, can lead to
various complications, such as impairment of food intake, possible
dehydration, sleep disturbance and increased risk of secondary hemorrhage.
 Objective(s): The current study aims to evaluate the effectiveness of
oral Gabapentin in decreasing the postoperative pain in pediatric patient
undergoing tonsillectomy in the first 0,2,12 24 hours post-operative.
 Patients and Methods: Type of study: Prospective randomized control
study, study setting: Ain Shams university hospitals, Study period: 3
months from December 2018 to February 2019, Patients were divided randomly
into two groups, each group consists of 25 patients: Group A: Patients in
this group received oral Gabapentin dose according to body weight
(20mg/kg) at 0,2,12,24hrs post operative, Group B: Patients in this group
received oral paracetamol as analgesics (10-15mg/kg every 12hours).
 Result(s): The mean age of our study population was around7.2in group
A and 7.08 in group B years. This study showed no statisticaly
significance differance between group A and B regarding age. The mean body
weight of the study was around27.79 for group A and 28.68 for group B.This
study showed no statisticaly significance differance between group A and B
regarding body weight. The mean HR of group A was lower than group B mean
HR. The study shows statistically highly significant reduction of group A
post operative heart rate compared to group B. The mean blood pressure of
group A was lower than group B mean blood pressure. The study shows
statistically highly significant reduction of group A postoperative blood
pressure compared to group B. The median VAS score of group A was lower
then group B. This study showed statisticaly significance reduction of VAS
pain score post operative in group A compared to group B. The median
analgesic rescue doses of group A was 2 and for group B was 3.5 so there
was a statisticaly significance increase in rescue analgesia use in group
B compared with group A.

<39>
Accession Number
636769054
Title
Minimally invasive versus conventional mitral valve surgery comparison of
early outcomes.
Source
QJM. Conference: 40th Annual Ain Shams Medical Conference. Online.
113(SUPPL 1) (pp i50-i51), 2020. Date of Publication: March 2020.
Author
Mohamed M.A.; Elsayegh T.M.; Elbawab H.Y.; Elnahas Y.M.; Omar A.H.
Institution
(Mohamed, Elsayegh, Elbawab, Elnahas, Omar) Cardiothoracic Surgery,
Faculty of Medicine, Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
The mitral valve has been traditionally approached through a median
sternotomy. However, mitral valve surgery could be performed using smaller
incisions including the right minithoracotomy. This study was a
case-control non randomized conducted on 60 patients. All patients had
isolated mitral valve disease for mitral valve surgery, 30 of them were
operated through right anterolateral minithoracotomy and the others
through full median sternotomy to study the effects of minimally invasive
mitral valve surgery through right anterolateral minithoracotomy on
morbidity and mortality compared with conventional mitral surgery. Medico
legal concent was taken from all the patients in this study. All the
patients completed the study and there was no mortality among the
patients. There was no statistically significant difference as regards the
demograohic data, NYHA score and the preoperative echocardiographic
findings. Regarding intraoperative comparison, there was statistically
significant difference in the cross-clamp time, total bypass time & total
operation time. This difference may be due to the new experiences in this
MIMVS and the lack of instrumentation that narrow the field of MIMVS. The
length of the incision was highly significantly lesser in the minimally
invasive group than the full sternotomy group. There was significant
difference in the intensive care parameters. The blood loss and the blood
transfusion required were lesser in the minimally invasive group. But the
ventilation hours and ICU stay was nearly the same in both groups. There
was highly significantly less postoperative pain in the minimally invasive
group than in the stenotomy group. Total hospital stay was nearly the same
in both groups. Minimally invasive mitral valve surgery is a safe
alternative to a conventional approach and is associated with less
morbidity especially with expert surgeon in simple mitral valve surgery.

<40>
Accession Number
636769039
Title
Custodiol for myocardial protection and preservation.
Source
QJM. Conference: 40th Annual Ain Shams Medical Conference. Online.
113(SUPPL 1) (pp i50), 2020. Date of Publication: March 2020.
Author
Gobran M.A.; Elkerdany A.B.; Elnahhas Y.; Omar A.H.
Institution
(Gobran, Elkerdany, Elnahhas, Omar) Cardiothoracic Surgery Unit, Faculty
of Medicine, Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
Introduction: Custodiol cardioplegia is attractive for minimally invasive
cardiac surgery, as a single dose provides a long period of myocardial
protection. Despite widespread use in Europe, there is little data
confirming its efficacy compared with conventional (blood or crystalloid)
cardioplegia. There is similar enthusiasm for its use in organ
preservation for transplant, but also a lack of data. This systematic
review aimed to assess the evidence for the efficacy of Custodiol in
myocardial protection and as a preservation solution in heart transplant.
 Method(s): Electronic searches were performed of six databases from
inception to October 2013. Reviewers independently identified studies that
compared Custodiol with conventional cardioplegia (blood or extracellular
crystalloid) in adult patients for meta-analysis; large case series that
reported results using Custodiol were analyzed. Next, we identified
studies that compared Custodiol with other organ preservation solutions
for organ preservation in heart transplant. Result(s): Fourteen
studies compared Custodiol with conventional cardioplegia for myocardial
protection in adult cardiac surgery. No difference was identified in
mortality; there was a trend for increased incidence of ventricular
fibrillation in the Custodiol group that did not reach statistical
significance. No difference was identified in studies that compared
Custodiol with other solutions for heart transplant. Conclusion(s):
Despite widespread clinical use, the evidence supporting the superiority
of Custodiol over other solutions for myocardial protection or organ
preservation is limited. Large randomised trials are required.

<41>
Accession Number
636769014
Title
Conscious sedation with local anesthesia versus general anesthesia for
patients undergoing transcatheter aortic valve implantation.
Source
QJM. Conference: 40th Annual Ain Shams Medical Conference. Online.
113(SUPPL 1) (pp i26-i27), 2020. Date of Publication: March 2020.
Author
Abdelhafez O.S.M.; Abdou A.M.H.; Ismail A.E.A.; Aboseif E.M.K.; Kamaly
A.M.
Institution
(Abdelhafez, Abdou, Ismail, Aboseif, Kamaly) Department of
Anesthesiology,Intensive Care and Algology, Ain Shams University, Egypt
Publisher
Oxford University Press
Abstract
Background: Transcatheter Aortic Valve Implantation (TAVI) procedure is
being performed under general anesthesia (GA), conscious sedation
associated with local anesthesia (CSLA) and local anesthesia alone. There
have been limited studies to determine which plan of anesthesia is
associated with better results. Aim(s): We aimed in this study to
assess the role of CSLA in outcome, complications, mortality and to assess
quality of life in immediate post-procedural period (ICU and hospital
stay). Methodology: After approval of ethical committee, seventy cases of
moderate to severe aortic stenosis planned for TAVI were randomized into
two groups. Group-GA: received general anesthesia and Group-CSLA: received
conscious sedation combined with local anesthesia. We measured
intraoperative hemodynamic changes, pH, PaO<inf>2</inf>, PaCO<inf>2</inf>,
need for inotropic support and need for blood products. Post-operative
variables were need for inotropic support, prolonged respiratory support,
need for renal dialysis, and incidence of stroke, heart block, aortic
regurge as well as mortality. Result(s): The CSLA group showed more
incidence of respiratory acidosis with increase in PaCO<inf>2</inf>
(p=0.024), less decrease in mean arterial blood pressure (p=0.028), less
need for inotropic support both intraoperative (p=0.001) and
post-operative (p=0.005). The CSLA patients showed less hospital length of
stay (LOS) (p=0.006) and less prolonged respiratory support more than 24h
(p=0.001) compared to the GA group patients. However, there was no
significant difference between the two groups as regards need for blood
products (p=0.587) and incidence of complications in the form of renal
failure (p=0.113), heart block (p=0.756), aortic regurge (paravalvular
leak) (p=0.168) and mortality (p=0.238). There was no incidence of stroke
in either group. Conclusion(s): CSLA for TAVI patients in the current
study showed better intraoperative hemodynamic stability, less need for
inotropic support whether intaoperative or postoperative and less hospital
LOS despite the presence of mild acceptable respiratory acidosis. So we
can recommend to consider CSLA in such patients.

<42>
Accession Number
636768980
Title
Comparison of short term outcomes of de vega repair versus ring
annuloplasty in cases of functional tricuspid regurgitation.
Source
QJM. Conference: 40th Annual Ain Shams Medical Conference. Online.
113(SUPPL 1) (pp i49), 2020. Date of Publication: March 2020.
Author
Ibrahim M.A.; Saber W.A.; Abdelhamid H.A.; Mansour S.A.; Mostafa M.G.
Institution
(Ibrahim, Saber, Abdelhamid, Mansour, Mostafa) Cardio-Thoracic Surgery
Publisher
Oxford University Press
Abstract
Background: functional tricuspid valve regurgitation (FTR) is a common
problem accompanying left-sided heart lesions e.g. mitral stenosis. FTR is
a serious disease which affects survival and quality of life if left
untreated. Many techniques can be used to repair the tricuspid valve (TV),
but the optimal method for repair is still controversial. The aim of our
study is to compare ring annuloplasty and De Vega repair of TV as regard
effectiveness and durability. Patients and Methods: sixty patients
who are candidate for mitral valve (MV) replacement and TV repair were
randomized into two groups, 30 patients each. Group (A) underwent ring
annuloplasty, and group (B) underwent De Vega repair of TV. Patients from
both groups were followed up after the operation for one year.
 Result(s): Ring annuloplasty was more effective as the mean grade of
TR in this group (1.6+/-1.2) was significantly lower than that in De Vega
group (2.2+/-1.0), p value 0.041. After one year of follow up, no
significant increase was present in the mean grade of TR in the ring
annuloplasty group. However, grade of TR increased significantly in the De
Vega group from 2.2 to 2.6, p value < 0.001. Conclusion(s): Ring
annuloplasty provides more effective and durable reduction of FTR compared
to De Vega repair of TV.

<43>
Accession Number
2016185540
Title
Design and Rationale of a Phase 2 Study of NeurOtoxin (Botulinum Toxin
Type A) for the PreVention of Post-Operative Atrial Fibrillation - The
NOVA Study.
Source
American Heart Journal. 245 (pp 51-59), 2022. Date of Publication: March
2022.
Author
Piccini J.P.; Ahlsson A.; Dorian P.; Gillinov M.A.; Kowey P.R.; Mack M.J.;
Milano C.A.; Perrault L.P.; Steinberg J.S.; Waldron N.H.; Adams L.M.;
Bharucha D.B.; Brin M.F.; Ferguson W.G.; Benussi S.
Institution
(Piccini, Waldron) Duke Clinical Research Institute / Duke University
Medical Center, Durham, NC, United States
(Ahlsson) Karolinska University Hospital, Sweden
(Dorian) St. Michael's Hospital, Canada
(Gillinov) Cleveland Clinic
(Kowey) Lankenau Heart Institute
(Mack) Baylor University Medical Center
(Milano) Duke University Medical Center
(Perrault) Montreal Heart Institute, Canada
(Steinberg) University of Rochester School of Medicine & Dentistry
(Adams) AbbVie Inc.
(Bharucha) AbbVie Inc.
(Brin) XXX
(Ferguson) AbbVie Inc.
(Benussi) University of Brescia, Italy
Publisher
Elsevier Inc.
Abstract
Background: : Post-operative AF (POAF) is the most common complication
following cardiac surgery, occurring in 30% to 60% of patients undergoing
bypass and/or valve surgery. POAF is associated with longer intensive care
unit/hospital stays, increased healthcare utilization, and increased
morbidity and mortality. Injection of botulinum toxin type A into the
epicardial fat pads resulted in reduction of AF in animal models, and in
two clinical studies of cardiac surgery patients, without new safety
observations. Method(s): : The objective of NOVA is to assess the use
of AGN-151607 (botulinum toxin type A) for prevention of POAF in cardiac
surgery patients. This randomized, multi-site, placebo-controlled trial
will study one-time injections of AGN-151607 125 U (25 U / fat pad) and
250 U (50 U / fat pad) or placebo during cardiac surgery in ~330
participants. Primary endpoint: % of patients with continuous AF >= 30 s.
Secondary endpoints include several measures of AF frequency, duration,
and burden. Additional endpoints include clinically important tachycardia
during AF, time to AF termination, and healthcare utilization. Primary and
secondary efficacy endpoints will be assessed using continuous ECG
monitoring for 30 days following surgery. All patients will be followed
for up to 1 year for safety. Conclusion(s): : The NOVA Study will
test the hypothesis that injections of AGN-151607 will reduce the
incidence of POAF and associated resource utilization. If demonstrated to
be safe and effective, the availability of a one-time therapy for the
prevention of POAF would represent an important treatment option for
patients undergoing cardiac surgery. Copyright © 2021 Elsevier
Inc.

<44>
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. 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.
 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. Copyright © 2021 Verduci Editore s.r.l. All rights
reserved.

<45>
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. 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. 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. 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. 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. Copyright © 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.

<46>
Accession Number
636762233
Title
A systematic review and meta-analysis of randomized controlled studies
comparing off-pump versus on-pump coronary artery bypass grafting in the
elderly.
Source
The Journal of cardiovascular surgery. (no pagination), 2021. Date of
Publication: 18 Nov 2021.
Author
Machado R.J.; Saraiva F.A.; Mancio J.; Sousa P.; Cerqueira R.J.; Barros
A.S.; Lourenco A.P.; Leite-Moreira A.F.
Institution
(Machado, Saraiva, Sousa, Barros) Surgery and Physiology Department and
Cardiovascular Research & Development Centre, Faculty of Medicine,
University of Porto, Porto, Portugal
(Mancio) Intensive Care and Perioperative Medicine Department, Royal
Brompton and Harefield & Guys and St. Thomas NHS Foundation Trust,
London, UK
(Cerqueira, Leite-Moreira) Cardiothoracic Surgery Department, Centro
Hospitalar Universitario Sao Joao, Porto, Portugal
(Lourenco) Anaesthesiology Department, Centro Hospitalar Universitario Sao
Joao, Porto, Portugal
(Leite-Moreira) Surgery and Physiology Department and Cardiovascular
Research & Development Centre, Faculty of Medicine, University of
Porto, Porto, Portugal - amoreira@med.up.pt
Publisher
NLM (Medline)
Abstract
AIM: Comparison of short and mid-term outcomes between off-pump CABG
(OPCAB) and on-pump CABG (ONCAB) in patients older than 65 throughout a
meta-analysis of randomized clinical trials (RCTs). EVIDENCE ACQUISITION:
A literature search was conducted using 3 databases. RCTs reporting
mortality outcomes of OPCAB versus ONCAB among the elderly were included.
Data on myocardial infarction, stroke, re-revascularization, renal failure
and composite endpoints after CABG were also collected. Random effects
models were used to compute statistical combined measures and 95%
confidence intervals (CI). EVIDENCE SYNTHESIS: Five RCTs encompassing 6221
patients were included (3105 OPCAB and 3116 ONCAB). There were no
significant differences on mid-term mortality (pooled HR: 1.02, 95%CI:
0.89-1.17, p=0.80) and composite endpoint incidence (pooled HR: 0.98,
95%CI: 0.88-1.09, p=0.72) between OPCAB and ONCAB. At 30-day, there were
no differences in mortality, myocardial infarction, stroke and renal
complications. The need for early re-revascularization was significantly
higher in OPCAB (pooled OR: 3.22, 95%CI: 1.28-8.09, p=0.01), with a higher
percentage of incomplete revascularization being reported for OPCAB in
trials included in this pooled result (34% in OPCAB vs 29% in ONCAB,
p<0.01). CONCLUSION(S): Data from RCTs in elderly patients showed
that OPCAB and ONCAB provide similar mid-term results. OPCAB was
associated with a higher risk of early rerevascularization. As CABG on the
elderly is still insufficiently explored, further RCTs, specifically
designed targeting this population, are needed to establish a better CABG
strategy for these patients.

<47>
Accession Number
636761823
Title
Results of concomitant cryoablation for atrial fibrillation during mitral
valve surgery.
Source
Interactive cardiovascular and thoracic surgery. (no pagination), 2021.
Date of Publication: 13 Nov 2021.
Author
Bogachev-Prokophiev A.; Sharifulin R.; Karadzha A.; Zheleznev S.;
Afanasyev A.; Ovcharov M.; Pivkin A.; Zalesov A.; Budagaev S.; Ivantsov
S.; Chernyavsky A.
Institution
(Bogachev-Prokophiev, Sharifulin, Karadzha, Zheleznev, Afanasyev,
Ovcharov, Pivkin, Zalesov, Budagaev, Ivantsov) Department of Heart Valve
Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk,
Russian Federation
(Ivantsov) Department of Congenital Heart Disease, E. Meshalkin National
Medical Research Centre, Novosibirsk, Russian Federation
(Chernyavsky) Department of Aortic and Coronary Artery Surgery, E.
Meshalkin National Medical Research Centre, Novosibirsk, Russian
Federation
Publisher
NLM (Medline)
Abstract
OBJECTIVES: Concomitant atrial fibrillation ablation during mitral valve
(MV) surgery using radio frequency energy sources has been reported
previously with excellent outcomes. However, data regarding the
effectiveness of concomitant cryoablation remain limited. This study aimed
to assess the efficacy of concomitant cryoablation in patients scheduled
for MV surgery. METHOD(S): Between 2012 and 2020, 242 adult patients
who underwent MV surgery and concomitant cryoablation were included. Data
on rhythm, medication status and clinical events were assessed at 3, 6 and
12 months, then annually thereafter. RESULT(S): Early mortality was
0.4%. The mean follow-up period duration was 43.9 months. The survival
rates at 1, 3 and 5 years were 97.3%, 94.3% and 87.7%, respectively. The
rates of freedom from atrial arrhythmia paroxysms at 1, 3 and 5 years were
79.0%, 64.0% and 60.5%, respectively. Atrial arrhythmia recurrence was
associated with isolated left atrial lesion set (P = 0.038), large right
atrial size (P = 0.002), lower surgeon experience (P = 0.003) and atrial
fibrillation paroxysms in the early postoperative period (P = 0.002).
 CONCLUSION(S): Concomitant cryoablation during MV surgery is a safe
and reproducible technique. The procedure provides acceptable freedom from
atrial arrhythmias recurrences during long-term follow-up. The biatrial
lesion set has advantages over the left atrium pattern in terms of atrial
arrhythmias freedom. Surgeon experience significantly influences atrial
fibrillation ablation success. Randomized trials are needed to compare
radiofrequency and cryoablation. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery.

<48>
Accession Number
636761748
Title
Myocardial viability testing: all STICHed up, or about to be REVIVED?.
Source
European heart journal. (no pagination), 2021. Date of Publication: 13
Nov 2021.
Author
Ryan M.; Morgan H.; Chiribiri A.; Nagel E.; Cleland J.; Perera D.
Institution
(Ryan, Morgan, Perera) School of Cardiovascular Medicine and Sciences,
King's College London, Westminster Bridge Road, London SE1 7EH, United
Kingdom
(Chiribiri) School of Biomedical Engineering and Imaging Sciences, King's
College London, Westminster Bridge Road, London SE1 7EH, United Kingdom
(Nagel) Institute for Experimental and Translational Cardiovascular
Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital
Frankfurt, Frankfurt am Main, Germany
(Cleland) Robertson Centre for Biostatistics, University of Glasgow,
University Avenue, Glasgow G12 8QQ, United Kingdom
Publisher
NLM (Medline)
Abstract
Patients with ischaemic left ventricular dysfunction frequently undergo
myocardial viability testing. The historical model presumes that those who
have extensive areas of dysfunctional-yet-viable myocardium derive
particular benefit from revascularization, whilst those without extensive
viability do not. These suppositions rely on the theory of hibernation and
are based on data of low quality: taking a dogmatic approach may therefore
lead to patients being refused appropriate, prognostically important
treatment. Recent data from a sub-study of the randomized STICH trial
challenges these historical concepts, as the volume of viable myocardium
failed to predict the effectiveness of coronary artery bypass grafting.
Should the Heart Team now abandon viability testing, or are new paradigms
needed in the way we interpret viability? This state-of-the-art review
critically examines the evidence base for viability testing, focusing in
particular on the presumed interactions between viability, functional
recovery, revascularization and prognosis which underly the traditional
model. We consider whether viability should relate solely to dysfunctional
myocardium or be considered more broadly and explore wider uses of
viability testingoutside of revascularization decision-making. Finally, we
look forward to ongoing and future randomized trials, which will shape
evidence-based clinical practice in the future. Copyright © The
Author(s) 2021. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<49>
Accession Number
636760393
Title
Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease: A
Systematic Review and Meta-analysis.
Source
European heart journal. Quality of care & clinical outcomes. (no
pagination), 2021. Date of Publication: 12 Nov 2021.
Author
Guddeti R.R.; Gill G.S.; Garcia-Garcia H.M.; Alla V.M.
Institution
(Guddeti, Gill, Alla) Division of Cardiovascular Diseases, Creighton
University School of Medicine, Omaha, NE
(Guddeti) Division of Cardiovascular Diseases, Minneapolis Heart
Institute, MN, Minneapolis, United States
(Garcia-Garcia) Department of Medicine, Georgetown University, DC, WA
(Garcia-Garcia) Division of Cardiovascular Medicine, MedStar Washington
Hospital Center, DC, WA
Publisher
NLM (Medline)
Abstract
BACKGROUND: Utilization of transcatheter aortic valve replacement (TAVR)
has expanded from high-risk patients to intermediate and select low-risk
candidates with severe aortic stenosis (AS). TAVR is currently not
indicated for patients with aortic insufficiency, and its outcomes in
mixed aortic valve disease (MAVD) are unclear. METHOD(S): A
systematic search of PubMed, Medline, CINHAL and Cochrane databases was
performed to identify studies comparing TAVR outcomes in patients with AS
vs. MAVD. Primary outcomes included 30-day and late all-cause mortality,
and paravalvular regurgitation (PVR). Secondary outcomes were major
bleeding, vascular complications, device implantation success, permanent
pacemaker and stroke. Pooled odds ratios (OR) and 95% confidence intervals
(CIs) were calculated using Der Simonian-Laird random-effects model.
 RESULT(S): Six observational studies with 58,879 patients were
included in the analysis. There was no significant difference in 30-day
all-cause mortality (OR 1.03 [95% CI 0.92-1.15]; p = 0.63), however, MAVD
group had higher odds of moderate to severe PVR (1.81 [1.41-2.31];
p<0.01). MAVD patients had lower odds of device implantation success (0.60
[0.40-0.91]; p = 0.02) while other secondary outcomes were similar in the
two groups. CONCLUSION(S): TAVR in MAVD is associated with increased
odds of paravalvular regurgitation and lower odds of device implantation
success when compared to severe aortic stenosis. Copyright © The
Author(s) 2021. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<50>
Accession Number
2016104951
Title
Geographic barriers to children's surgical care: A systematic review of
existing evidence.
Source
Journal of Pediatric Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Buss R.; SenthilKumar G.; Bouchard M.; Bowder A.; Marquart J.;
Cooke-Barber J.; Vore E.; Beals D.; Raval M.; Rich B.S.; Goldstein S.; Van
Arendonk K.
Institution
(Buss, SenthilKumar, Bowder, Marquart, Van Arendonk) Division of Pediatric
Surgery, Department of Surgery, Medical College of Wisconsin, 999 North
92nd StreetSuite CCC 320, Milwaukee, WI 53226, United States
(Bouchard, Raval, Goldstein) Division of Pediatric Surgery, Ann and Robert
H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave. Chicago, IL
60611, United States
(Cooke-Barber) Division of Pediatric General and Thoracic Surgery,
Cincinnati Children's Hospital, 3333 Burnet Ave. ML 2023, Cincinnati, OH
45229, United States
(Vore, Beals) Department of Surgery, Marshall University Medical Center,
1600 Medical Center DriveSuite 2500, Huntington, WV 25701, United States
(Rich) Division of Pediatric Surgery, Cohen Children's Medical Center, 450
Lakeville Rd, North New Hyde Park, NY 11042, United States
Publisher
W.B. Saunders
Abstract
Background: Ensuring that children have access to timely and appropriate
surgical care is a vital component of comprehensive pediatric care. This
study systematically reviews the existing evidence related to geographic
barriers in children's surgery. Method(s): Medline and Scopus
databases were searched for any English language studies that examined
associations between geographic burden (rural residence or distance to
care) and a quantifiable outcome within pediatric surgical subspecialties.
Two independent reviewers extracted data from each study. Result(s):
From 6331 studies screened, 22 studies met inclusion criteria. Most
studies were retrospective analyses and conducted in the U.S. or Canada
(14 and three studies, respectively); five were conducted outside North
America. In transplant surgery (seven studies), greater distance from a
transplant center was associated with higher waitlist mortality prior to
kidney and liver transplantation, although graft outcomes were generally
similar. In congenital cardiac surgery (five studies), greater travel was
associated with higher neonatal mortality and older age at surgery but not
with post-operative outcomes. In general surgery (eight studies), rural
residence was associated with increased rates of perforated appendicitis,
higher frequency of negative appendectomy, and increased length of stay
after appendectomy. In orthopedic surgery (one study), rurality was
associated with decreased post-operative satisfaction. No evidence for
disparate outcomes based upon distance or rurality was identified in
neurosurgery (one study). Conclusion(s): Substantial evidence
suggests that geographic barriers impact the receipt of surgical care
among children, particularly with regard to transplantation, congenital
cardiac surgery, and appendicitis. Copyright © 2021

<51>
Accession Number
2014600509
Title
Heart valve surgery and the obesity paradox: A systematic review.
Source
Clinical Obesity. (no pagination), 2021. Date of Publication: 2021.
Author
EL-Andari R.; Bozso S.J.; Kang J.J.H.; Bedard A.M.A.; Adams C.; Wang W.;
Nagendran J.
Institution
(EL-Andari) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(Bozso, Kang, Wang, Nagendran) Division of Cardiac Surgery, Department of
Surgery, University of Alberta, Edmonton, AB, Canada
(Bedard) Department of Biological Sciences, Faculty of Science, University
of Alberta, Edmonton, AB, Canada
(Adams) Section of Cardiac Surgery, Department of Cardiac Sciences, Libin
Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB,
Canada
Publisher
John Wiley and Sons Inc
Abstract
Obesity has been associated with increased incidence of comorbidities and
shorter life expectancy, and it has generally been assumed that patients
with obesity should have inferior outcomes after surgery. Previous
literature has often demonstrated equivalent or even improved rates of
mortality after cardiac surgery when compared to their lower-weight
counterparts, coined the obesity paradox. Herein, we aim to review the
literature investigating the impact of obesity on surgical valve
interventions. PubMed and Embase were systematically searched for articles
published from 1 January 2000 to 15 October 2021. A total of 1315 articles
comparing differences in outcomes between patients of varying body mass
index (BMI) undergoing valve interventions were reviewed and 25 were
included in this study. Patients with higher BMI demonstrated equivalent
or reduced rates of postoperative myocardial infarction, stroke,
reoperation rates, acute kidney injury, dialysis and bleeding. Two studies
identified increased rates of deep sternal wound infection in patients
with higher BMI, although the majority of studies found no significant
difference in deep sternal wound infection rates. The obesity paradox has
described counterintuitive outcomes predominantly in coronary artery
bypass grafting and transcatheter aortic valve replacement. Recent
literature has identified similar trends in other heart valve
interventions. While the obesity paradox has been well characterized, its
causes are yet to be identified. Further study is essential in order to
identify the causes of the obesity paradox so patients of all body sizes
can receive optimal care. Copyright © 2021 World Obesity
Federation.

<52>
Accession Number
2015568740
Title
Association between perioperative hypotension and postoperative delirium
and atrial fibrillation after cardiac surgery: A post-hoc analysis of the
DECADE trial.
Source
Journal of Clinical Anesthesia. 76 (no pagination), 2022. Article Number:
110584. Date of Publication: February 2022.
Author
Wang J.; Mao G.; Malackany N.; Marciniak D.; Donaldson C.; Wakefield B.;
Hassan M.; Ruetzler K.; Sessler D.I.; Turan A.
Institution
(Wang, Mao, Hassan, Ruetzler, Sessler, Turan) Department of Outcomes
Research, Cleveland Clinic, Cleveland, OH, United States
(Malackany, Marciniak, Donaldson, Wakefield) Department of Cardiovascular
Anesthesiology, Cleveland Clinic, Cleveland, OH, United States
(Ruetzler, Turan) Department of General Anesthesiology, Cleveland Clinic,
Cleveland, OH, United States
(Mao) Department of Quantitative Health Sciences, Cleveland Clinic,
Cleveland, OH, United States
(Wang) Department of Anesthesiology, Shanghai Ninth People's Hospital,
Shanghai JiaoTong University School of Medicine, Shanghai, China
Publisher
Elsevier Inc.
Abstract
Study objective: To test the hypotheses that in adults having cardiac
surgery with cardio-pulmonary bypass, perioperative hypotension increases
the risk of delirium and atrial fibrillation during the initial five
postoperative days. Design(s): Sub-analysis of the DECADE
multi-center randomized trial. Setting(s): Patients who had cardiac
surgery with cardiopulmonary bypass at the Cleveland Clinic.
 Intervention(s): In the underlying trial, patients were randomly
assigned 1:1 to dexmedetomidine or normal saline placebo. Measurements:
Intraoperative mean arterial pressures were recorded at 1-min intervals
from arterial catheters or at 1-5-min intervals oscillometrically.
Postoperative blood pressures were recorded every half-hour or more often.
The co-primary outcomes were atrial fibrillation and delirium occurring
between intensive care unit admission and the earlier of postoperative day
5 or hospital discharge. Delirium was assessed twice daily during the
initial 5 postoperative days while patients remained hospitalized with the
Confusion Assessment Method for the intensive care unit. Assessments were
made by trained research fellows who were blinded to the dexmedetomidine
administration. Main Result(s): There was no significant association
between intraoperative hypotension and delirium, with an adjusted odds
ratio of 0.94 (95% CI: 0.81, 1.09; P = 0.419) for a doubling in AUC of
mean arterial pressure (MAP) <60 mmHg. An increase in intraoperative AUC
of MAP <60 mmHg was not significantly associated with the odds of atrial
fibrillation (adjusted odds ratio = 0.99; 95% CI: 0.87, 1.11; P = 0.819).
Postoperative MAP <70 mmHg per hour 1.14 (97.5% CI: 1.04,1.26; P = 0.002)
and MAP <80 mmHg per hour 1.05 (97.5%: 1.01, 1.10; P = 0.010) were
significantly associated with atrial fibrillation. Conclusion(s): In
patients having cardiac surgery with cardio-pulmonary bypass, neither
intraoperative nor postoperative hypotension were associated with
delirium. Postoperative hypotension was associated with atrial
fibrillation, although intraoperative hypotension was not. Copyright
© 2021 Elsevier Inc.

<53>
Accession Number
2015850561
Title
Role of stent oversizing in patients undergoing primary percutaneous
coronary intervention. An open-labeled randomized controlled trial.
Source
Minerva Cardiology and Angiology. 69(5) (pp 513-521), 2021. Date of
Publication: October 2021.
Author
BANIFATEMEH S.A.; SADEGHIPOUR P.; ALEMZADEH-ANSARI M.J.; FAKHRABADI A.A.;
ZOLFAGHARI F.; ZAHEDMEHR A.; MOHEBBI B.; KIANI R.; SHAKERIAN F.;
RASHIDINEJAD A.; HOSSEINI Z.; FIROUZI A.
Institution
(BANIFATEMEH, SADEGHIPOUR, ALEMZADEH-ANSARI, FAKHRABADI, ZOLFAGHARI,
ZAHEDMEHR, MOHEBBI, KIANI, SHAKERIAN, RASHIDINEJAD, HOSSEINI, FIROUZI)
Cardiovascular Intervention Research Center, Rajaie Cardiovascular,
Medical, and Research, Center, Iran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(BANIFATEMEH) Department of Cardiovascular Medicine, Rasoul-e-Akram
Hospital, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(SADEGHIPOUR) Clinical Trial Center, Rajaie Cardiovascular, Medical, and
Research Center, Iran University of Medical Sciences, Tehran, Iran,
Islamic Republic of
Publisher
Edizioni Minerva Medica
Abstract
BACKGROUND: In patients with ST-segment-elevation myocardial infarction
(STEMI), primary percutaneous coronary intervention (PPCI) is the
treatment of choice. Stent undersizing might occur due to catecholamine
release and coronary spasm. Although routine oversizing has been promising
in several investigations, it has never been tested in randomized clinical
trials. In this single-center open-label randomized clinical trial, we
evaluated the role of stent oversizing in PPCI. METHOD(S): Candidates
for PPCIwere randomly divided into oversized and non-oversized groups. In
the oversized group, the stent was oversized by 10% according to the mean
lumen diameter, retrieved from the quantitative coronary analysis. Primary
composite endpoints were defined as the occurrence of complete total
ST-segment (STR)resolution and postprocedural thrombolysis in myocardial
infarction (TIMI) flow grade III. RESULT(S): The study population was
comprised of 122 patients, allocated to the oversized group (N.=61) and
the non-oversized group (N.=61). There was no significant difference
between the 2 groups regarding the final TIMI flow grade. Complete STRwas
marginally more favorable in the non-oversized group (56.05+/-55.12 vs.
64.64+/-23.28; P=0.056). The troponin ratio, CK-MB ratio, and 6-month
follow-up outcome - defined as target lesion revascularization, heart
failure, and cardiovascular death - were comparable between the 2 groups.
 CONCLUSION(S): Our study showed that routine oversizing in patients
undergoing PPCI had no benefit regarding ST-segment resolution and the
final TIMI flow, as well as hard cardiac events, during the
follow-up. Copyright © 2021 Edizioni Minerva Medica. All right
reserved.

<54>
Accession Number
2015810754
Title
Posterior left pericardiotomy for the prevention of atrial fibrillation
after cardiac surgery: an adaptive, single-centre, single-blind,
randomised, controlled trial.
Source
The Lancet. 398(10316) (pp 2075-2083), 2021. Date of Publication: 04 Dec
2021.
Author
Gaudino M.; Sanna T.; Ballman K.V.; Robinson N.B.; Hameed I.; Audisio K.;
Rahouma M.; Di Franco A.; Soletti G.J.; Lau C.; Rong L.Q.; Massetti M.;
Gillinov M.; Ad N.; Voisine P.; DiMaio J.M.; Chikwe J.; Fremes S.E.; Crea
F.; Puskas J.D.; Girardi L.
Institution
(Gaudino, Robinson, Hameed, Audisio, Rahouma, Di Franco, Soletti, Lau,
Girardi) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New
York, NY, United States
(Rong) Department of Anesthesiology, Weill Cornell Medicine, New York, NY,
United States
(Sanna, Massetti, Crea) Department of Cardiovascular Medicine, Fondazione
Policlinico Universitario A Gemelli IRCCS, Rome, Italy
(Sanna, Massetti, Crea) Department of Cardiovascular and Pulmonary
Sciences, Catholic University of the Sacred Heart, Rome, Italy
(Ballman) Alliance Statistics and Data Center, Weill Medical College of
Cornell University, New York, NY, United States
(Gillinov) Department of Thoracic and Cardiovascular Surgery, Heart and
Vascular Institute, Cleveland Clinic, Cleveland, OH, United States
(Ad) Division of Cardiothoracic Surgery, Washington Adventist Hospital and
University of Maryland, Tacoma Park, MD, United States
(Voisine) Division of Cardiac Surgery, Department of Cardiology, Institut
Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec
City, QC, Canada
(DiMaio) Department of Cardiothoracic Surgery, Baylor Scott & White The
Heart Hospital, Plano, TX, United States
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA, United States
(Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre,
University of Toronto, Toronto, ON, Canada
(Puskas) Department of Cardiovascular Surgery, Mount Sinai Morningside,
New York, NY, United States
Publisher
Elsevier B.V.
Abstract
Background: Atrial fibrillation is the most common complication after
cardiac surgery and is associated with extended in-hospital stay and
increased adverse outcomes, including death and stroke. Pericardial
effusion is common after cardiac surgery and can trigger atrial
fibrillation. We tested the hypothesis that posterior left pericardiotomy,
a surgical manoeuvre that drains the pericardial space into the left
pleural cavity, might reduce the incidence of atrial fibrillation after
cardiac surgery. Method(s): In this adaptive, randomised, controlled
trial, we recruited adult patients (aged >=18 years) undergoing elective
interventions on the coronary arteries, aortic valve, or ascending aorta,
or a combination of these, performed by members of the Department of
Cardiothoracic Surgery from Weill Cornell Medicine at the New York
Presbyterian Hospital in New York, NY, USA. Patients were eligible if they
had no history of atrial fibrillation or other arrhythmias or
contraindications to the experimental intervention. Eligible patients were
randomly assigned (1:1), stratified by CHA<inf>2</inf>DS<inf>2</inf>-VASc
score and using a mixed-block randomisation approach (block sizes of 4, 6,
and 8), to posterior left pericardiotomy or no intervention. Patients and
assessors were blinded to treatment assignment. Patients were followed up
until 30 days after hospital discharge. The primary outcome was the
incidence of atrial fibrillation during postoperative in-hospital stay,
which was assessed in the intention-to-treat (ITT) population. Safety was
assessed in the as-treated population. This study is registered with
ClinicalTrials.gov, NCT02875405, and is now complete. Finding(s):
Between Sept 18, 2017, and Aug 2, 2021, 3601 patients were screened and
420 were included and randomly assigned to the posterior left
pericardiotomy group (n=212) or the no intervention group (n=208; ITT
population). The median age was 61.0 years (IQR 53.0-70.0), 102 (24%)
patients were female, and 318 (76%) were male, with a median
CHA<inf>2</inf>DS<inf>2</inf>-VASc score of 2.0 (IQR 1.0-3.0). The two
groups were balanced with respect to clinical and surgical
characteristics. No patients were lost to follow-up and data completeness
was 100%. Three patients in the posterior left pericardiotomy group did
not receive the intervention. In the ITT population, the incidence of
postoperative atrial fibrillation was significantly lower in the posterior
left pericardiotomy group than in the no intervention group (37 [17%] of
212 vs 66 [32%] of 208 [p=0.0007]; odds ratio adjusted for the
stratification variable 0.44 [95% CI 0.27-0.70; p=0.0005]). Two (1%) of
209 patients in the posterior left pericardiotomy group and one (<1%) of
211 in the no intervention group died within 30 days after hospital
discharge. The incidence of postoperative pericardial effusion was lower
in the posterior left pericardiotomy group than in the no intervention
group (26 [12%] of 209 vs 45 [21%] of 211; relative risk 0.58 [95% CI
0.37-0.91]). Postoperative major adverse events occurred in six (3%)
patients in the posterior left pericardiotomy group and in four (2%) in
the no intervention group. No posterior left pericardiotomy related
complications were seen. Interpretation(s): Posterior left
pericardiotomy is highly effective in reducing the incidence of atrial
fibrillation after surgery on the coronary arteries, aortic valve, or
ascending aorta, or a combination of these without additional risk of
postoperative complications. Funding(s): None Copyright ©
2021 Elsevier Ltd

<55>
Accession Number
2014735920
Title
Surgical strategies for cardiac perforation after catheter ablation or
electrophysiology study: A systemic review.
Source
International Heart Journal. 62(6) (pp 1257-1264), 2021. Date of
Publication: 2021.
Author
Wu S.-J.; Fan Y.-F.; Chien C.-Y.
Institution
(Wu, Fan, Chien) Division of Cardiovascular Surgery, Departments of
Surgery, MacKay Memorial Hospital, Taipei, Taiwan (Republic of China)
Publisher
International Heart Journal Association
Abstract
Catheter ablation is a treatment modality which has been increasingly used
for cardiac arrhythmias. How-ever, it is not complication-free, and
cardiac perforation is one of its most life-threatening complications. As
surgery is usually not the first-line treatment for this emergent episode,
there were only very few sporadic surgical reports in the literature. This
systemic review primarily aims to collect different surgical approaches
for catheter-induced cardiac perforation to help surgeons manage this kind
of uncommon and critical patients. Of the 452 initially screened articles,
22 studies (38 patients) were included in the systemic review. Of all the
included patients, 84% (32/38) were found to have pericardial effusion
acutely following catheter-related proce-dures, and 16% (6/38) experienced
delayed-onset episodes. Regarding the surgical procedures, four patients
underwent removal of clots only, eight patients underwent suture repair of
the left ventricle (LV), nine patients underwent suture repair of the
right ventricle (RV), five patients underwent suture repair of the LA, and
four patients underwent sutureless repair of the LV and pulmonary vein (LV
1, RV 1, pulmonary vein 1). In addition to repair of perforation sites,
the concomitant combined procedures included repair of intercostal vessels
(compli-cation of pericardiocentesis) for one patient, cryoablation for
two patients, and maze procedure for one patient. For cardiac perforation
following catheter ablation or electrophysiology study, although the
majority of the patients are treated with pericardiocentesis and medical
management at first, cardiovascular surgeons have to pre-pare to take over
if the bleeding is persistent or if the cardiac tamponade is not
relieved. Copyright © 2021, International Heart Journal
Association. All rights reserved.

<56>
Accession Number
2014735918
Title
Active versus conventional side branch protection strategy for coronary
bifurcation lesions a systematic review and meta-analysis.
Source
International Heart Journal. 62(6) (pp 1241-1248), 2021. Date of
Publication: 2021.
Author
Qin Q.; Zheng B.; Liu J.; Zhang B.; Chen M.; Li J.; Huo Y.
Institution
(Qin, Zheng, Liu, Zhang, Chen, Li, Huo) Department of Cardiology,
Institute of Cardiovascular Disease, Peking University First Hospital,
Beijing, China
Publisher
International Heart Journal Association
Abstract
The side branch (SB) provisional stenting strategy is currently the
recommended approach for most coronary bifurcation lesions. However, this
strategy may result in SB deterioration, which is associated with an
increased incidence of periprocedural myocardial infarction (PMI) and may
adversely affect the long-term progno-sis. Various techniques for SB
protection (SB-P) have been developed to reduce SB occlusion and improve
the clinical prognosis. This meta-analysis was performed to compare the
outcomes of an active SB-P strategy of jailed balloon technique,
balloon-stent kissing technique, and jailed Corsair technique versus the
conventional SB-P strategy based on jailed wire technique. This
meta-analysis included 5 studies (4 randomized and 1 observational)
involving a total of 1,174 patients in whom the active and conventional
SB-P strategies were compared. Fixed-and random-effects models were used
to calculate summary risk ratios (RRs). The risk of SB occlusion was
significantly lower in active SB-P strategy [RR 0.47, 95% confidence
interval (CI) 0.30-0.73 in fixed-effect model; RR 0.52, 95% CI 0.31-0.87
in random-effect model]. The risk of PMI was similar between the two
strategies (RR 0.63, 95% CI 0.30-1.33 in fixed-effect model; RR 0.71,
95%CI 0.20-2.48 in random-effect model). The rate of long-term major
adverse cardiovascular events was similar between the groups (RR 0.48, 95%
CI 0.15-1.48 in fixed-effect model; RR 0.49, 95% CI 0.16-1.52 in
random-effect model). The active SB-P strategy in coronary bifurcation
lesions is associated with reduced SB deterioration, but it does not
decrease PMI or improve the long-term prognosis. Copyright ©
2021, International Heart Journal Association. All rights reserved.

<57>
Accession Number
2014217742
Title
What is Standard Dose of Rivaroxaban in Elderly Asian Patients with Atrial
Fibrillation: 20ms versus. 15mg?.
Source
Clinical and Applied Thrombosis/Hemostasis. 27 (no pagination), 2021. Date
of Publication: 2021.
Author
Kim S.S.; Lee K.H.; Yoon N.S.; Park H.W.; Cho J.G.
Institution
(Kim) Chosun University Hospital, Gwangju, South Korea
(Lee, Yoon, Park, Cho) The Heart Center of Chonnam, National University
Hospital, Gwangju, South Korea
(Lee, Yoon, Park, Cho) Chonnam National University Medical School,
Gwangju, South Korea
Publisher
SAGE Publications Inc.
Abstract
Although there is no age criterion for rivaroxaban dose reduction, elderly
patients with atrial fibrillation (AF) are often prescribed an off-label
reduced dose. We aimed to evaluate whether age is a necessary criterion
for rivaroxaban dose reduction in Korean patients with AF. Among 2208
patients who prescribed warfarin or rivaroxaban, 552 patients over 75
years without renal dysfunction (creatinine clearance >50 mL/min) were
compared based on propensity score matching. The rivaroxaban group was
further divided into a 20 mg (R20; on-label) and a 15 mg (R15; off-label).
Primary net clinical benefit (NCB) was defined as the composite of stroke,
systemic embolism, major bleeding, and all-cause mortality. Secondary NCB
was defined as the composite of stroke, systemic embolism, and major
bleeding. Patients were followed for 1 year, or until the first outcome
occurrence. Both rivaroxaban groups had comparable efficacy compared with
warfarin. However, both R20 (0.9% vs 7.4%, p =.014) and R15 (2.3% vs 7.4%,
p =.018) had a significant reduction in major bleeding. There were no
differences in efficacy or safety outcomes between R20 and R15. R20 had
significantly reduced primary (hazard ratio [HR] 0.33, 95% confidence
interval [CI]: 0.12-0.93) and secondary (HR 0.31, 95% CI: 0.10-0.93) NCBs
compared with warfarin. However, primary and secondary NCBs were not
reduced in R15. In real-world practice with elderly patients with AF,
off-label rivaroxaban dose reduction to 15 mg conferred no benefits.
Therefore, guideline-adherent rivaroxaban 20 mg is favorable in elderly
Korean patients with AF. Copyright © The Author(s) 2021.

<58>
Accession Number
2013950065
Title
Annual reports on hypertension research 2020.
Source
Hypertension Research. 45(1) (pp 15-31), 2022. Date of Publication:
January 2022.
Author
Mogi M.; Higashi Y.; Bokuda K.; Ichihara A.; Nagata D.; Tanaka A.; Node
K.; Nozato Y.; Yamamoto K.; Sugimoto K.; Shibata H.; Hoshide S.; Nishizawa
H.; Kario K.
Institution
(Mogi) Deparment of Pharmacology, Ehime University Graduate School of
Medicine, Tohon, Ehime, Japan
(Higashi) Department of Cardiovascular Regeneration and Medicine, Research
Institute for Radiation Biology and Medicine, Hiroshima University,
Hiroshima, Hiroshima, Japan
(Higashi) Divivsion of Regeneration and Medicine, Medical Center for
Translational and Clinical Research, Hiroshima University Hospital,
Hiroshima, Hiroshima, Japan
(Bokuda, Ichihara) Department of Endocrinology and Hypertension, Tokyo
Women's Medical University, Shinjuku, Tokyo, Japan
(Nagata) Division of Nephrology, Department of Medicine, Jichi Medical
University School of Medicine, Shimotsuke, Tochigi, Japan
(Tanaka, Node) Department of Cardiovascular Medicine, Saga University,
Saga, Saga, Japan
(Nozato, Yamamoto) Department of Geriatric and General Medicine, Osaka
University Graduate School of Medicine, Suita, Osaka, Japan
(Sugimoto) General and Geriatric Medicine, Kawasaki Medical University,
Okayama, Okayama, Japan
(Shibata) Department of Endocrinology, Metabolism, Rheumatology and
Nephrology, Faculty of Medicine, Oita University, Yufu, Oita, Japan
(Hoshide, Kario) Division of Cardiovascular Medicine, Department of
Medicine, Jichi Medical University School of Medicine, Shimotsuke,
Tochigi, Japan
(Nishizawa) Department of Metabolic Medicine, Osaka University Graduate
School of Medicine, Suita, Osaka, Japan
Publisher
Springer Nature
Abstract
In 2020, 199 papers were published in Hypertension Research. Many
excellent papers have contributed to progress in research on hypertension.
Here, our editorial members have summarized eleven topics from published
work and discussed current topics in depth. We hope you enjoy our special
feature, Annual Reports on Hypertension Research. Copyright ©
2021, The Author(s), under exclusive licence to The Japanese Society of
Hypertension.

<59>
Accession Number
2013940774
Title
Urinary albumin-to-creatinine ratio and the risk of first stroke in
Chinese hypertensive patients treated with angiotensin-converting enzyme
inhibitors.
Source
Hypertension Research. 45(1) (pp 116-124), 2022. Date of Publication:
January 2022.
Author
He P.; Yang Y.; Tian J.; Yang M.; Lin Z.; Li H.; Liu M.; Zhou C.; Zhang
Z.; Li Y.; Zhang Y.; Li J.; Huo Y.; Xu X.; Qin X.; Liang M.
Institution
(He, Yang, Tian, Yang, Lin, Li, Zhang, Liu, Zhou, Zhang, Li, Xu, Qin,
Liang) Division of Nephrology, Nanfang Hospital, Southern Medical
University; National Clinical Research Center for Kidney Disease; State
Key Laboratory of Organ Failure Research; Guangdong Provincial Institute
of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure
Research, Guangdong Provincial Clinical Research Center for Kidney
Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory,
Guangzhou 510515, China
(Zhang, Li, Huo) Department of Cardiology, Peking University First
Hospital, Beijing 100034, China
(Xu) Beijing Advanced Innovation Center for Food Nutrition and Human
Health, College of Food Science and Nutritional Engineering, China
Agricultural University, Beijing 100083, China
Publisher
Springer Nature
Abstract
We aimed to evaluate the relationship of the albumin-to-creatinine ratio
(ACR) with the risk of first stroke and examine possible effect modifiers
in hypertensive patients. A total of 11,632 hypertensive participants with
urinary ACR measurements and without a history of stroke from the China
Stroke Primary Prevention Trial (CSPPT) were included in this analysis.
The primary outcome was first stroke. Over a median follow-up of 4.4
years, 728 first strokes were identified, of which 633 were ischemic, 89
were hemorrhagic, and 6 were uncertain types. Overall, there was a
significant positive association between natural log-transformed ACR and
the risk of first stroke (HR, 1.11; 95% CI: 1.03-1.20) and first ischemic
stroke (HR, 1.12; 95% CI: 1.03-1.22). Consistently, participants with ACR
>= 10 mg/g had a significantly higher risk of first stroke (HR, 1.26; 95%
CI: 1.06-1.50) and first ischemic stroke (HR, 1.33; 95% CI: 1.10-1.59)
than those with ACR < 10 mg/g. Moreover, the association of ACR with first
stroke was significantly stronger in participants with higher total
homocysteine (tHcy) levels (<10 versus >= 10 mumol/L; P for interaction =
0.044). However, there was no significant association between ACR and
first hemorrhagic stroke (per natural log [ACR] increment: HR, 1.02; 95%
CI: 0.82-1.27). In summary, hypertensive patients with ACR >= 10 mg/g had
a significantly increased risk of first stroke or first ischemic stroke.
This positive association was more pronounced among participants with
higher tHcy levels. Copyright © 2021, The Author(s), under
exclusive licence to The Japanese Society of Hypertension.

<60>
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. Copyright © The Author(s) 2021.

<61>
Accession Number
636607224
Title
Early Thymectomy Is Associated With Long-Term Impairment of the Immune
System: A Systematic Review.
Source
Frontiers in Immunology. 12 (no pagination), 2021. Article Number: 774780.
Date of Publication: 25 Nov 2021.
Author
Cavalcanti N.V.; Palmeira P.; Jatene M.B.; de Barros Dorna M.;
Carneiro-Sampaio M.
Institution
(Cavalcanti, de Barros Dorna, Carneiro-Sampaio) Children's Hospital,
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo (HC-FMUSP), Sao Paulo, Brazil
(Palmeira, Carneiro-Sampaio) Laboratory of Clinical Investigation LIM-36,
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo (HC-FMUSP), Sao Paulo, Brazil
(Jatene) Pediatric Cardiovascular Surgery Department, Heart Institute,
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao
Paulo (HC-FMUSP), Sao Paulo, Brazil
Publisher
Frontiers Media S.A.
Abstract
Background and Aims: Congenital heart diseases (CHDs) are diagnosed in
approximately 9 in 1,000 newborns, and early cardiac corrective surgery
often requires partial or complete thymectomy. As the long-term effect of
early thymectomy on the subsequent development of the immune system in
humans has not been completely elucidated, the present study aimed to
evaluate the effects of thymus removal on the functional capacity of the
immune system after different periods. Method(s): A systematic review
of the literature was performed using MEDLINE, EMBASE, LILACS and Scopus.
The inclusion criteria were original studies that analyzed any component
of the immune system in patients with CHD who had undergone thymectomy
during cardiac surgery in the first years of life. The results were
evaluated for the quality of evidence. Result(s): Twenty-three
studies were selected and showed that patients who underwent a thymectomy
in the first years of life tended to exhibit important alterations in the
T cell compartment, such as fewer total T cells, CD4+, CD8+, naive and
CD31+ T cells, lower TRECs, decreased diversity of the TCR repertoire and
higher peripheral proliferation (increased Ki-67 expression) than
controls. However, the numbers of memory T cells and Treg cells differed
across the selected studies. Conclusion(s): Early thymectomy, either
partial or complete, may be associated with a reduction in many T cell
subpopulations and TCR diversity, and these alterations may persist during
long-term follow-up. Alternative solutions should be studied, either in
the operative technique with partial preservation of the thymus or through
the autograft of fragments of the gland. Systematic Review Registration:
Prospero [157188]. Copyright © 2021 Cavalcanti, Palmeira, Jatene,
de Barros Dorna and Carneiro-Sampaio.

<62>
Accession Number
636573325
Title
Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic
Review.
Source
Frontiers in Neurology. 12 (no pagination), 2021. Article Number: 732176.
Date of Publication: 16 Nov 2021.
Author
Longhitano Y.; Iannuzzi F.; Bonatti G.; Zanza C.; Messina A.; Godoy D.;
Dabrowski W.; Xiuyun L.; Czosnyka M.; Pelosi P.; Badenes R.; Robba C.
Institution
(Longhitano) Department of Anesthesiology and Critical Care, AO St.
Antonio, Biagio and Cesare Arrigo, Alessandria, Italy
(Iannuzzi, Pelosi, Robba) Department of Surgical Sciences and Integrated
Diagnostics (DISC), University of Genoa, Genoa, Italy
(Bonatti) Anesthesia and Intensive Care, Gaslini Hospital, Genova, Italy
(Zanza) Foundation of "Nuovo Ospedale Alba-Bra" and Department of
Emergency Medicine, Anesthesia and Critical Care Division, Michele and
Pietro Ferrero Hospital, Verduno, Italy
(Messina) Humanitas Clinical and Research Center - IRCCS, Milan, Italy
(Messina) Department of Biomedical Sciences, Humanitas University, Milan,
Italy
(Godoy) Neurointensive Care Unit, Sanatorio Pasteur, 2 Intensive Care
Unit, Hospital Carlos Malbran, Catamarca, Argentina
(Dabrowski) Anesthesia and Intensive Care, University of Lublin, Lublin,
Poland
(Xiuyun) Department of Anesthesiology & Critical Care Medicine, John
Hopkins University, Baltimore, MD, United States
(Czosnyka) Brain Physics Laboratory, Department of Clinical Neurosciences,
University of Cambridge, Cambridge, United Kingdom
(Pelosi, Robba) Anesthesia and Critical Care, San Martino Policlinico
Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
(Badenes) Department of Anesthesiology and Surgical-Trauma Intensive Care,
Hospital Clinic Universitari de Valencia, Department of Surgery,
University of Valencia, Valencia, Spain
Publisher
Frontiers Media S.A.
Abstract
Introduction: Cerebral autoregulation (CA) plays a fundamental role in the
maintenance of adequate cerebral blood flow (CBF). CA monitoring, through
direct and indirect techniques, may guide an appropriate therapeutic
approach aimed at improving CBF and reducing neurological complications;
so far, the role of CA has been investigated mainly in brain-injured
patients. The aim of this study is to investigate the role of CA in
non-brain injured patients. Method(s): A systematic consultation of
literature was carried out. Search terms included: "CA and sepsis," "CA
and surgery," and "CA and non-brain injury." Results: Our research
individualized 294 studies and after screening, 22 studies were analyzed
in this study. Studies were divided in three groups: CA in sepsis and
septic shock, CA during surgery, and CA in the pediatric population.
Studies in sepsis and intraoperative setting highlighted a relationship
between the incidence of sepsis-associated delirium and impaired CA. The
most investigated setting in the pediatric population is cardiac surgery,
but the role and measurement of CA need to be further elucidated.
 Conclusion(s): In non-brain injured patients, impaired CA may result
in cognitive dysfunction, neurological damage, worst outcome, and
increased mortality. Monitoring CA might be a useful tool for the bedside
optimization and individualization of the clinical management in this
group of patients. Copyright © 2021 Longhitano, Iannuzzi,
Bonatti, Zanza, Messina, Godoy, Dabrowski, Xiuyun, Czosnyka, Pelosi,
Badenes and Robba.

<63>
Accession Number
2013092853
Title
Diagnostic accuracy of prospectively gated, 128-slice or greater CTCA at
high heart rates: a systematic review and meta-analysis.
Source
Journal of Medical Radiation Sciences. 68(4) (pp 435-445), 2021. Date of
Publication: December 2021.
Author
Mander G.T.W.; Dobeli K.; Steffensen C.; Munn Z.
Institution
(Mander) Toowoomba Hospital, Darling Downs Health, Queensland Health,
Toowoomba, QLD, Australia
(Mander, Steffensen, Munn) Faculty of Health Sciences, Joanna Briggs
Institute, University of Adelaide, Adelaide, SA, Australia
(Dobeli) Royal Brisbane and Women's Hospital, Metro North Hospital and
Health Service, Queensland Health, Herston, QLD, Australia
(Steffensen) Philips Australia and New Zealand, Brisbane, QLD, Australia
Publisher
John Wiley and Sons Ltd
Abstract
Introduction: Prospectively gated 64-slice CT coronary angiography (CTCA)
may be contraindicated for heart rates (HRs) over 65 beats per minute
(bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically
provide 128 or more slices and superior temporal resolution compared with
older models; consequently, diagnostic accuracy for current technology
prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of
this systematic review was to investigate the diagnostic accuracy of CTCA
using 128-slice or greater CT technology when compared with conventional
coronary angiography for patients with HRs >65 bpm. Method(s): A
systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as
well as unpublished databases, sources and reference lists. Titles and
abstracts were screened by two independent reviewers. Full-text screening
was then performed. Studies that determined diagnostic accuracy of
coronary artery stenosis in adult patients with high heart rates utilising
prospectively gated 128 detector or greater scanners were included.
Studies that were included in the review underwent critical appraisal
using the QUADAS-2 tool. Result(s): Ten studies were included in the
systematic review, with nine of these included in a diagnostic test
accuracy meta-analysis, including six of which reported data at the
patient level. Meta-analysis indicated very high pooled sensitivity 100%
(95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI
0.69, 0.88). Conclusion(s): Prospectively gated CT coronary
angiography may be justifiable at heart rates above 65 bpm if performed on
a 128-slice or greater CT unit. Caution regarding the implication of a
positive result is recommended due to reduced specificity. Further
evidence is required before consideration of a new higher heart
threshold. Copyright © 2021 The Authors. Journal of Medical
Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf
of Australian Society of Medical Imaging and Radiation Therapy and New
Zealand Institute of Medical Radiation Technology

<64>
Accession Number
2012315216
Title
Impact of chronic kidney disease on hemoglobin among patients with
peripheral artery disease treated with P2Y<inf>12</inf> inhibitors:
Insights from the EUCLID trial.
Source
Vascular Medicine (United Kingdom). 26(6) (pp 608-612), 2021. Date of
Publication: December 2021.
Author
Hsia J.; Kavanagh S.T.; Hopley C.W.; Baumgartner I.; Berger J.S.; Fowkes
G.R.; Jones W.S.; Mahaffey K.W.; Norgren L.; Patel M.R.; Rockhold F.;
Blomster J.; Katona B.G.; Hiatt W.R.; Bonaca M.P.
Institution
(Hsia, Kavanagh, Hiatt, Bonaca) CPC Clinical Research, Aurora, CO, United
States
(Hsia, Hiatt, Bonaca) Department of Medicine, University of Colorado
School of Medicine, Aurora, CO, United States
(Hopley) Department of Medicine, Geisel School of Medicine at Dartmouth,
Dartmouth Hitchcock Medical Center, Hanover, NH, United States
(Baumgartner) Department of Angiology, Inselspital, Bern, Switzerland
(Berger) Departments of Medicine and Surgery, New York University School
of Medicine, New York, NY, United States
(Fowkes) Centre for Population Health Sciences, University of Edinburgh,
Edinburgh, United Kingdom
(Jones, Patel, Rockhold) Duke Clinical Research Institute, Duke
University, Durham, NC, United States
(Mahaffey) Stanford University School of Medicine, Palo Alto, CA, United
States
(Norgren) Faculty of Medicine and Health, Orebro University Hospital,
Orebro, Sweden
(Blomster, Katona) AstraZeneca LP, Gothenburg, Sweden
(Blomster, Katona) GaithersburgMDUnited States
Publisher
SAGE Publications Ltd
Abstract
Patients with chronic kidney disease may develop new or more severe anemia
when treated with antiplatelet agents due to blood loss in conjunction
with impaired erythropoiesis. Because anemia independently predicts limb
amputation and mortality among patients with peripheral artery disease
(PAD), we evaluated the relationship between estimated glomerular
filtration rate (eGFR) and hemoglobin (Hb) levels in the EUCLID trial in
which patients with symptomatic PAD were randomized to ticagrelor or
clopidogrel. At baseline, 9025, 1870, and 1000 patients had eGFR 60,
45-59, and < 45 mL/min/1.73 m2, respectively. The mean fall in
Hb during the trial was 0.46 +/- 1.68 g/dL and did not differ by baseline
eGFR category, although Hb fall 10% was more frequent among patients with
lower eGFR (p for trend < 0.0001). On-study treatment with iron,
erythropoiesis-stimulating agents, and/or red blood cell transfusion was
reported for 479 (5.3%), 165 (8.8%), and 129 (12.9%) patients in the three
eGFR categories, respectively (p for trend < 0.0001). After adjustment for
baseline and post-randomization effects, those not receiving anemia
treatment had a smaller reduction in Hb from baseline than those receiving
anemia treatment (p < 0.0001). Other determinants of Hb reduction included
absence of on-study myocardial infarction, coronary or peripheral
revascularization, residence outside North America, male sex, and baseline
eGFR. We conclude that among patients with PAD treated with
P2Y<inf>12</inf> inhibitors, lower baseline eGFR was associated with a
greater reduction in Hb. ClinicalTrials.gov Identifier:
NCT01732822 Copyright © The Author(s) 2021.

<65>
Accession Number
2015913481
Title
Comparison of Preoperative Surgical Risk Estimated by Thoracic Surgeons vs
a Standardized Surgical Risk Prediction Tool.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2021.
Date of Publication: 2021.
Author
Dyas A.R.; Colborn K.L.; Bronsert M.R.; Henderson W.G.; Mason N.J.;
Rozeboom P.D.; Pradhan N.; Lambert-Kerzner A.; Meguid R.A.
Institution
(Dyas, Colborn, Bronsert, Henderson, Mason, Rozeboom, Pradhan,
Lambert-Kerzner, Meguid) Surgical Outcomes and Applied Research Program,
Department of Surgery, University of Colorado School of Medicine, Aurora,
CO, United States
(Bronsert, Henderson, Lambert-Kerzner, Meguid) Adult and Child Center for
Health Outcomes Research and Delivery Science, University of Colorado
School of Medicine, Aurora, CO, United States
(Colborn, Henderson) Department of Biostatistics and Informatics, Colorado
School of Public Health, Aurora, CO, United States
Publisher
W.B. Saunders
Abstract
Considerable variability exists between surgeons' assessments of a
patient's individual preoperative surgical risk. Surgical risk calculators
are not routinely used despite their validation. We sought to compare
thoracic surgeons' prediction of patients' risk of postoperative adverse
outcomes vs a surgical risk calculator, the Surgical Risk Preoperative
Assessment System (SURPAS). We developed vignettes from 30 randomly
selected patients who underwent thoracic surgery in the American College
of Surgeons' National Surgical Quality Improvement Program database.
Twelve thoracic surgeons estimated patients' preoperative risks of
postoperative morbidity and mortality. These were compared to SURPAS
estimates of the same vignettes. C-indices and Brier scores were
calculated for the surgeons' and SURPAS estimates. Agreement between
surgeon estimates was examined using intraclass correlation coefficients
(ICCs). Surgeons estimated higher morbidity risk compared to SURPAS for
low-risk patients (ASA classes 1-2, 11.5% vs 5.1%, P <= 0.001) and lower
morbidity risk compared to SURPAS for high-risk patients (ASA class 5,
37.6% vs 69.8%, P < 0.001). This trend also occurred in high-risk patients
for mortality (ASA 5, 11.1% vs 44.3%, P < 0.001). C-indices for SURPAS vs
surgeons were 0.84 vs 0.76 (P = 0.3) for morbidity and 0.98 vs 0.85 (P =
0.001) for mortality. Brier scores for SURPAS vs surgeons were 0.1579 vs
0.1986 for morbidity (P = 0.03) and 0.0409 vs 0.0543 for mortality (P =
0.006). ICCs showed that surgeons had moderate risk agreement for
morbidity (ICC = 0.654) and mortality (ICC = 0.507). Thoracic surgeons and
patients could benefit from using a surgical risk calculator to better
estimate patients' surgical risks during the informed consent
process. Copyright © 2021 Elsevier Inc.

<66>
Accession Number
633446002
Title
Response to the Comment on "Long-term and Temporal Outcomes of
Transcatheter Versus Surgical Aortic-valve Replacement in Severe Aortic
Stenosis: A Meta-analysis".
Source
Annals of surgery. 274(6) (pp e837-e838), 2021. Date of Publication: 01
Dec 2021.
Author
Zhang X.-L.; Zhang X.-W.; Xu W.; Xu B.
Institution
(Zhang) Department of Endocrinology, Affiliated Drum Tower Hospital,
Nanjing University School of Medicine, Nanjing, China
(Xu, Xu) Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing
University School of Medicine, Nanjing, China
Publisher
NLM (Medline)

<67>
Accession Number
2014808201
Title
Outcomes of peri-operative glucocorticosteroid use in major pancreatic
resections: a systematic review.
Source
HPB. 23(12) (pp 1789-1798), 2021. Date of Publication: December 2021.
Author
Kuan L.L.; Dennison A.R.; Garcea G.
Institution
(Kuan, Dennison, Garcea) Department of Hepatobiliary and Pancreatic
Surgery, University Hospitals of Leicester NHS Trust, Leicester, United
Kingdom
(Kuan) Discipline of Surgery, The University of Adelaide, The Queen
Elizabeth Hospital, Adelaide, South Australia, Australia
Publisher
Elsevier B.V.
Abstract
Background: There is increasing evidence that peri-operative
glucocorticosteroid can ameliorate the systemic response following major
surgery. Preliminary evidence suggests peri-operative usage of
glucocorticosteroid may decrease post-operative complications. These
positive associations have been observed in a range of different
operations including intra-abdominal, thoracic, cardiac, and orthopaedic
surgery. This review aims to investigate the impact of peri-operative
glucocorticosteroid in major pancreatic resections. Method(s): A
systematic review based on a search in Medline and Embase databases was
performed. PRISMA guidelines for systematic reviews were followed.
 Result(s): A total of five studies were analysed; three randomised
controlled trials and two retrospective cohort studies. The total patient
population was 1042. The glucocorticosteroids used were intravenous
hydrocortisone or dexamethasone. Three studies reported significantly
lower morbidity in the peri-operative glucocorticosteroid group. The
number needed to treat to prevent one major complication with
hydrocortisone is four patients. Two studies demonstrated that
dexamethasone was associated with a statistically significantly improved
median overall survival in pancreatic cancer. Conclusion(s): This is
the first systematic review conducted to investigate the significance of
peri-operative glucocorticosteroid in patients undergoing pancreatic
resection. This review shows a correlation of positive outcomes with the
administration of glucocorticosteroid in the peri-operative setting
following a major pancreatic resection. More randomised clinical trials
are required to confirm if this is a true effect, as it would have
significant implications. Copyright © 2021

<68>
Accession Number
2015373884
Title
Cost comparison between transcatheter aortic valve implantation and
surgical valve replacement using individual data in a Spanish public
hospital.
Source
Cirugia Cardiovascular. 28(6) (pp 317-324), 2021. Date of Publication: 01
Nov 2021.
Author
Areces S.; Hernandez-Vaquero D.; Avanzas P.; Garcia-Aranda F.J.; Silva J.;
Moris C.
Institution
(Areces, Hernandez-Vaquero, Avanzas, Garcia-Aranda, Silva, Moris) Area del
Corazon, Hospital Universitario Central de Asturias, Oviedo, Spain
(Areces, Hernandez-Vaquero, Avanzas, Silva, Moris) Universidad de Oviedo,
Oviedo, Spain
Publisher
Sociedad Espanola de Cirugia Cardiovascular y Endovascular (SECCE)
Abstract
Background: Transcatheter aortic valve implantation has revolutionized the
management of aortic stenosis and is currently an alternative to surgical
aortic valve replacement. Some studies have found costs of percutaneous
procedure to be greater than those of surgical replacement. However, these
published studies are based on pooled data from clinical registries. The
objective of the present study was to compare costs of both treatments
during the hospital phase in a Spanish public hospital. Method(s): A
hospital phase cost study consisted of patients diagnosed and treated with
aortic stenosis in a Spanish tertiary hospital between 1st January 2019
and 29th February 2020. An individual analysis was conducted in relation
to real costs pertaining to materials, staffing and hospital stay. Several
baseline characteristics were controlled for. Result(s): Mean costs
per patient from procedure through to discharge were 26,684.1 in the
percutaneous group and 14,939.5 in the surgical group (p < 0.001).
Independent of comorbidities, the cost of transcatheter aortic valve
implantation was, on average, 8636.6 greater than that of surgical aortic
valve replacement (95% CI 6086.3-11,186.9; p < 0.001). Conclusion(s):
Aortic stenosis treatment costs in hospital phase were greater when
percutaneous option was used in comparison to surgery. Copyright
© 2021 Sociedad Espanola de Cirugia Cardiovascular y Endovascular

<69>
Accession Number
2014217421
Title
Radial versus femoral secondary access for transcatheter aortic valve
replacement: A systematic review and meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Das T.M.; Shin J.; Czarny M.J.; Nanavati J.; Resar J.R.; Hasan R.K.
Institution
(Das, Shin) Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
(Czarny, Resar, Hasan) Department of Medicine, Division of Cardiology,
Johns Hopkins University School of Medicine, Baltimore, MD, United States
(Nanavati) Welch Medical Library, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: We aimed to evaluate the risk of procedural complications
after TAVR using secondary radial access (RA) versus femoral access (FA)
through a systematic review and meta-analysis of the published literature.
 Background(s): Transcatheter aortic valve replacement (TAVR) entails
both large-bore arterial access for device delivery and secondary arterial
access for hemodynamic and imaging assessments. It is unknown whether RA
versus FA for this secondary access reduces the risk of procedural
complications. Method(s): We searched PubMed, Embase, the Cochrane
Library, and Web of Science for observational studies comparing TAVR
procedural complications in RA versus FA. Event rates were compared via
weighted summary odds ratios using the Mantel-Haenszel method.
 Result(s): Six manuscripts encompassing 6132 patients were included.
Meta-analysis showed that RA reduced the risk of major vascular
complications (OR 0.58, 95% CI 0.43-0.77, p < 0.001, I2 0%) and
major/life-threatening bleeding (OR 0.46, 95% CI 0.36-0.59, p < 0.001,
I2 0%) as compared to FA for secondary TAVR access. We also
observed a reduction 30-day mortality (OR 0.55, 95% CI 0.38-0.79, p =
0.001, I2 0%), acute kidney injury (OR 0.45, 95% CI 0.34-0.60,
p < 0.001, I2 0%), and stroke and transient ischemic attack (OR
0.43, 95% CI 0.27-0.67, p < 0.001, I2 0%). Conclusion(s):
RA reduced the risk of major vascular and bleeding complications when
compared to FA for secondary access in TAVR. RA is associated with reduced
risk of other adverse outcomes including mortality, but these associations
may be related to selection bias and confounding given the observational
study designs. Copyright © 2021 Wiley Periodicals LLC.

<70>
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. 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. 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. 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. Copyright © 2021 S.
Karger AG, Basel.

<71>
Accession Number
631752946
Title
Improvement in Health-Related Quality of Life After Total Ankle
Arthroplasty Compares Well With Other Successful Orthopaedic and
Nonorthopaedic Procedures.
Source
Foot & ankle specialist. 14(5) (pp 427-437), 2021. Date of Publication: 01
Oct 2021.
Author
Lachman J.R.; Green C.L.; Adams S.B.; Nunley J.A.; DeOrio J.K.; Easley
M.E.
Institution
(Lachman, Green, Adams, Nunley, DeOrio, Easley) St Luke's University
Health Network, Quakertown, Pennsylvania (JRL), United States
(Lachman, Green, Adams, Nunley, DeOrio, Easley) Duke University Department
of Biostatistics and Bioinformatics, Durham, North Carolina (CLG), United
States
(Lachman, Green, Adams, Nunley, DeOrio, Easley) Duke University School of
Medicine, North Carolina (SBA, Durham
Publisher
NLM (Medline)
Abstract
Background. Ankle arthritis is a major cause of disability. Orthopaedic
literature suggests improvement in health-related quality of life (HRQOL)
after total ankle arthroplasty (TAA). This has not been compared with
improvements observed in successful orthopaedic and nonorthopaedic
procedures, including anterior cervical discectomy/fusion (ACDF), total
knee arthroplasty (TKA), coronary artery bypass grafting (CABG), and
orthotopic liver transplant (OLT). We hypothesize that the effects after
TAA are comparable to several successful surgical procedures. Methods. 500
consecutive TAA patients were included and grouped with 2 other large
series. Short Form-36 (SF36) were collected at standardized intervals. A
systematic literature review identified studies comparing preoperative and
postoperative SF36 physical (PCS) and mental component summary (MCS)
scores. Using meta-analyses, we pooled the data for each procedure to
compare with the TAA group. Results. Patients in all cohorts had
preoperative SF36 MCS and PCS scores that were significantly lower than
that in the general population. Improvements in HRQOL after TAA were not
statistically different from improvements reported in PCS and MCS after
ACDF, TKA, and OLT. However, improvement in PCS after TAA was better than
that observed after CABG. Conclusions. Disability with ankle arthritis is
severe. Disability associated with cervical disc disease, knee arthrosis,
coronary artery disease, and liver failure is also severe, with surgical
intervention providing major improvements in HRQOL postoperatively. The
improvement in HRQOL after TAA did not differ statistically from ACDF,
TKA, CABG, and OLT. Our investigation suggests that the HRQOL benefits of
TAA meet benchmarks set by some of modern medicine's best.Levels of
Evidence: Level III: Systematic review.

<72>
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.
 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. 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.
 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. Copyright © 2021 International Anesthesia Research
Society.

<73>
Accession Number
2014199640
Title
Comparison of the analgesic effect of ultrasound-guided paravertebral
block and ultrasound-guided retrolaminar block in Uniportal video-assisted
Thoracoscopic surgery: a prospective, randomized study.
Source
BMC Cancer. 21(1) (no pagination), 2021. Article Number: 1229. Date of
Publication: December 2021.
Author
Wang Q.; Wei S.; Li S.; Yu J.; Zhang G.; Ni C.; Sun L.; Zheng H.
Institution
(Wang, Wei, Li, Yu, Zhang, Ni, Zheng) Department of Anesthesiology,
National Cancer Center/National Clinical Research Center for Cancer/Cancer
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, No. 17, Panjiayuannanli, Chaoyang District, Beijing 100021, China
(Sun) Department of Anesthesiology, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Shenzhen 518116, China
Publisher
BioMed Central Ltd
Abstract
Background: The optimal modality for postoperative analgesia after
uniportal video-assisted thoracoscopic surgery (UVATS) for the treatment
of lung cancer has not yet been determined. Both ultrasound-guided
paravertebral block (PVB) and retrolaminar block (RLB) have been reported
to be successful in providing analgesia after UVATS. However, which block
technique provides superior analgesia after UVATS is still unclear. This
randomized study was designed to compare the postoperative analgesic
effects and adverse events associated with ultrasound-guided PVB and RLB
after UVATS. Method(s): Sixty patients with lung cancer were
randomized to undergo ultrasound-guided PVB (group P) or ultrasound-guided
RLB (group R). In group P, 30 mL of 0.5% ropivacaine was injected at the
T3 and T5 levels via ultrasound-guided PVB (15 mL at each level on the
operative side). In group R, 30 mL of 0.5% ropivacaine was injected at the
T3 and T5 levels via ultrasound-guided RLB (15 mL at each level on the
operative side). The primary outcome was the numerical rating scale (NRS)
score within 48 h after surgery. The secondary outcomes were total
postoperative sufentanil consumption, time to first analgesic request and
adverse events. Result(s): At 3, 6, 12, 24, 36 and 48 h
postoperatively, the NRS score at rest in group P was lower than that in
group R (p < 0.05). At 3, 6, 12, 24 and 36 h postoperatively, the NRS
score while coughing in group P was lower than that in group R (p < 0.05).
The total postoperative sufentanil consumption in group P was
significantly lower than that in group R (p < 0.001). Additionally, the
time to first analgesic request was longer in group R than in group P (p <
0.0001). The incidence of nausea in group R was higher than that in group
P (p < 0.05). Conclusion(s): In patients with lung cancer undergoing
UVATS, ultrasound-guided PVB with 0.5% ropivacaine provides better
analgesia and results in less nausea than ultrasound-guided RLB. Compared
with ultrasound-guided RLB, ultrasound-guided PVB seems to be a better
technique for analgesia in UVATS. Trial registration: The name of this
study is the Effect And Mechanism Of Ultrasound-guided Multimodal Regional
Nerve Block On Acute And Chronic Pain After Thoracic Surgery. This study
was registered in the Chinese Clinical Trial Registry (ChiCTR2100044060).
The date of registration was March 9, 2021. Copyright © 2021, The
Author(s).

<74>
Accession Number
636750725
Title
The role of physical activity in the quality of life and sedentary
behaviour of children and adolescents.
Source
BMC Proceedings. Conference: International Conference Novelties in Sport
Sciences. Novi Sad Serbia. 15(SUPPL 14) (no pagination), 2021. Date of
Publication: March - November 2021.
Author
Korovljev D.; Todorovic N.; Stajer V.; Maksimovic N.; Ostojic S.
Institution
(Korovljev, Todorovic, Stajer, Maksimovic, Ostojic) Applied Bioenergetics
Lab, Faculty of Sport and Physical Education, University of Novi Sad, Novi
Sad, Serbia
(Ostojic) Faculty of Health Sciences, University of Pecs, Pecs, Hungary
Publisher
BioMed Central Ltd
Abstract
Background Numerous studies have shown that more physical activity and
less time spent in a sedentary lifestyle are associated with the overall
better health-related quality of life (HRQOL) in children and adolescents.
To date, very few studies have been conducted that synthesize the link
between physical activity, sedentary behaviour, and quality of
life-related to health in children and adolescents. The objective of this
study was to review the associations between physical activity, sedentary
behaviours, and HRQOL in children and adolescents aged < 19 in a general
and clinical population. Methods The research was conducted by reviewing
all available relevant scientific articles within the PubMed database.
Initially, we found 108 articles, including clinical trials and randomized
clinical trials in English for the period 2016 to 2021. Further analyses
identified 6 studies that evaluated the connection between physical
activity (PA), sedentary behaviour (SB), and health-related quality of
life (HRQOL) in children and adolescents aged < 19 years in a general and
clinical population. After a more detailed analysis of initial studies,
the research was reduced to three studies, and three studies were excluded
from further analysis: one describing the research protocol (e.g., no
research data), one that did not meet the criteria for HRQOL, and another
concerning the cost analysis. PUBMED search employed the following
keywords: "health-related quality of life," "sedentary behaviour,"
"physical activity," "children," and "adolescent." Results The results of
our analysis are depicted in Table 1. The studies involved a total sample
of 62 children and adolescents aged < 19 years, and HRQOL was monitored
after different types of health interventions in children with chronic
conditions, including cerebral palsy, cystic fibrosis, and heart
transplantation. Moola et al. [1] designed a study to assess the
feasibility of theoretically informed 8-week counselling intervention
through parents in increasing habitual physical activity and quality of
life of children and adolescents with CF (n=13, age 8-18 y). The
intervention was found to be feasible and acceptable with good
recruitment, retention, adherence, and acceptability. There have also been
positive trends in terms of increased PA, reduced sedentary time, and
improvements in most dimensions of HRQOL comparing the period before the
intervention with the period after the intervention, suggesting that
counselling is feasible for the CF community. Another interesting study
[2] evaluated motivational and behaviour change therapy intervention to
increase PA and HRQOL through meaningful participation in children with
cerebral palsy in an 8-week exercise program (n=18 men; aged 8-12). The
results of the study showed that there were no statistically significant
effects after the intervention in the HPA indicators, but there was an
increase in the MPA values. A recent study by Chen et al. [3] recruited
children and adolescents aged 8-19, who had a heart transplant a year ago,
who had confirmation from their cardiologist, and a caregiver or adult at
home during exercise, especially for persons under 14 years of age. The
intervention consisted of daily application of the diet and exercises
three times during the week via video conference. This study confirmed
that this type of intervention through diet and exercise was applicable,
which had a positive effect on improving VO2max and physical functioning,
a surrogate marker of HRQOL. Conclusions According to studies included in
our analysis, health interventions that promote active lifestyles for
children and adolescents may contribute to improve health-related quality
of life. One of the limiting factors is certainly the small number of
sample participants. It can be concluded that health-related quality of
life in children and adolescents, whether healthy or with chronic
conditions, can be improved with the help of designed long-term health
interventions and studies involving the use of dosed habitual and moderate
physical activity, as well as the adoption of healthy diets and the
reduction of SB. Future research is certainly needed to expand studies and
longitudinal links between physical activity, sedentary behaviour, and
health-related quality of life in children and adolescents.

<75>
Accession Number
2016115655
Title
Misdiagnosis of aortic dissection: A systematic review of the literature.
Source
American Journal of Emergency Medicine. 53 (pp 16-22), 2022. Date of
Publication: March 2022.
Author
Lovatt S.; Wong C.W.; Schwarz K.; Borovac J.A.; Lo T.; Gunning M.; Phan
T.; Patwala A.; Barker D.; Mallen C.D.; Kwok C.S.
Institution
(Lovatt, Wong, Lo, Gunning, Phan, Patwala, Barker, Kwok) Department of
Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United
Kingdom
(Schwarz) Karl Landsteiner University of Health Sciences, Department of
Internal Medicine 3, University Hospital St. Polten, Krems, Austria
(Borovac) Clinic for Heart and Cardiovascular Diseases, University
Hospital of Split, Split, Croatia
(Mallen, Kwok) School of Medicine, Keele University, Stoke-on-Trent,
United Kingdom
Publisher
W.B. Saunders
Abstract
Background: Aortic dissection is a rare but potentially catastrophic
condition. Misdiagnosis of aortic dissection is not uncommon as symptoms
can overlap with other diagnoses. Objective(s): We conducted a
systematic review to better understand the factors contributing to
incorrect diagnosis of this condition. Method(s): We searched MEDLINE
and EMBASE for studies that evaluated the misdiagnosis of aortic
dissection. The rate of misdiagnosis was pooled and results were
narratively synthesized. Result(s): A total of 12 studies with were
included with 1663 patients. The overall rate of misdiagnosis of aortic
dissection was 33.8%. The proportion of patients presenting with chest
pain, back pain and syncope were 67.5%, 24.8% and 6.8% respectively. The
proportion of patients with pre-existing hypertension was 55.4%, 30.5%
were smokers while the proportion of patients with coronary artery
disease, previous cardiovascular surgery or surgical trauma and Marfan
syndrome was 14.7%, 5.8%, and 3.7%, respectively. Factors related to
misdiagnosis included the presence of symptoms and features associated
with other diseases (such as acute coronary syndrome, stroke and pulmonary
embolism), the absence of typical features (such as widened mediastinum on
chest X-ray) or concurrent conditions such congestive heart failure.
Factors associated with more accurate diagnosis included more
comprehensive history taking and increased use of imaging.
 Conclusion(s): Misdiagnosis in patients with an eventual diagnosis of
aortic dissection affects 1 in 3 patients. Clinicians should consider
aortic dissection as differential diagnosis in patients with chest pain,
back pain and syncope. Imaging should be used early to make the diagnosis
when aortic dissection is suspected. Copyright © 2021

<76>
Accession Number
636719662
Title
Safety of Normothermic Cardiopulmonary Bypass in Pediatric Cardiac
Surgery: A System Review and Meta-Analysis.
Source
Frontiers in Pediatrics. 9 (no pagination), 2021. Article Number: 757551.
Date of Publication: 14 Dec 2021.
Author
Xiong T.; Pu L.; Ma Y.-F.; Zhu Y.-L.; Cui X.; Li H.; Zhan X.; Li Y.-X.
Institution
(Xiong, Pu, Ma, Zhu, Cui, Li, Zhan, Li) Department of Cardiac Surgery,
Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical
University, Kunming, China
(Pu, Cui, Li, Zhan, Li) Cardiovascular Surgery, Institution of Yunnan,
Kunming, China
Publisher
Frontiers Media S.A.
Abstract
Objectives: Hypothermic cardiopulmonary bypass (HCPB) has been used
successfully in cardiac surgery for more than half a century, although
adverse effects have been reported with its use. Many studies on
temperature management during CPB published to date have shown that
normothermic CPB (NCPB) provides more benefits to children undergoing
cardiac surgery. The present meta-analysis investigated the effect of NCPB
on clinical outcomes based on results of randomized controlled trials and
observational studies on pediatric cardiac surgery. Method(s):
Databases such as PubMed, EMBASE, Cochrane Central Register of Controlled
Trials, and Clinical Trials.gov were searched from inception to May 2021
to identify relevant studies published in English. Result(s): The
present meta-analysis included 13 studies characterizing a total of 837
pediatric patients. The random effects model exhibited that the NCPB group
had reduced revision for postoperative bleeding [odds ratio (OR): 0.11;
95% confidence interval (CI): 0.01-0.89; I2 = 0%, P = 0.04],
serum lactate 2-4 h after CPB (mean difference: -0.60; 95% CI: -1.09 to
-0.11; I2 = 82%, P = 0.02), serum creatinemia 24 h after CPB
(mean difference: -2.73; 95% CI: -5.06 to -0.39; I2 = 83%, P =
0.02), serum creatinemia 48 h after CPB (mean difference: -2.08; 95% CI:
-2.78 to -1.39; I2 = 0%, P < 0.05), CPB time (mean difference:
-19.10, 95% CI: -32.03 to -6.18; I2 = 96%, P = 0.04), and major
adverse events (OR: 0.37; 95% CI: 0.15-0.93; Z = 2.12, P = 0.03) after
simple congenital surgery compared with the HCPB group.
 Conclusion(s): NCPB is as safe as HCPB in pediatric congenital heart
surgery. Moreover, NCPB provides more advantages than HCPB in simple
congenital heart surgery. Copyright © 2021 Xiong, Pu, Ma, Zhu,
Cui, Li, Zhan and Li.

<77>
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. Copyright © 2021 Trubnikova, Tarasova, Moskin,
Kupriyanova, Argunova, Pomeshkina, Gruzdeva and Barbarash.

<78>
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. 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). 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. 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. 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. 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. Copyright © 2021 The Cochrane Collaboration. Published
by John Wiley & Sons, Ltd.

<79>
Accession Number
2016141013
Title
Selection of the best of 2021 in structural interventional cardiology.
Source
REC: CardioClinics. (no pagination), 2021. Date of Publication: 2021.
Author
Romaguera R.; Ojeda S.; Cruz-Gonzalez I.; Moreno R.
Institution
(Romaguera) Servicio de Cardiologia, Hospital de Bellvitge-IDIBELL,
Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Ojeda) Servicio de Cardiologia, Hospital Universitario Reina
Sofia-IMIBIC, Universidad de Cordoba, Cordoba, Spain
(Cruz-Gonzalez) Departamento de Cardiologia, Hospital Clinico de
Salamanca, Salamanca, Spain
(Moreno) Servicio de Cardiologia, Hospital Universitario La Paz-IDIPAZ,
Madrid, Spain
(Moreno) Centro de Investigacion Biomedica en Red Enfermedades
Cardiovaculares (CIBERCV), Spain
Publisher
Elsevier Espana S.L.U
Abstract
This article is a systematic review of the most relevant articles on
aortic, mitral, tricuspid or atrial appendage intervention from September
15, 2020 to September 15, 2021 indexed in Medline and Scopus, as well as
abstracts of randomized clinical trials or large multicenter prospective
registries presented at the most relevant conferences. Copyright
© 2021 Sociedad Espanola de Cardiologia

<80>
Accession Number
2016140820
Title
Effect of Cyclosporine on Cytokine Production in Elective Coronary Artery
Bypass Grafting: A Sub-Analysis of the CiPRICS (Cyclosporine to Protect
Renal Function in Cardiac Surgery) Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2021.
Date of Publication: 2021.
Author
Grins E.; Ederoth P.; Bjursten H.; Dardashti A.; Bronden B.; Metzsch C.;
Erdling A.; Nozohoor S.; Mokhtari A.; Hansson M.J.; Elmer E.; Algotsson
L.; Shrestha N.M.; Jovinge S.
Institution
(Grins, Ederoth, Dardashti, Bronden, Metzsch, Erdling, Algotsson)
Department of Cardiothoracic Anesthesia and Intensive Care, Department of
Clinical Sciences, Lund University, Skane University Hospital, Lund,
Sweden
(Bjursten, Nozohoor, Mokhtari) Department of Cardiothoracic Surgery,
Department of Clinical Sciences Lund University, Skane University
Hospital, Lund, Sweden
(Hansson, Elmer) Mitochondrial Medicine, Department of Clinical Sciences
Lund, Lund University, Lund, Sweden
(Shrestha, Jovinge) DeVos Cardiovascular Research Program, Fredrik Meijer
Heart and Vascular Institute Spectrum Health/Van Andel Institute, Grand
Rapids, MI, United States
(Jovinge) Cardiovascular Institute, Stanford University, Palo Alto, CA,
United States
Publisher
W.B. Saunders
Abstract
Objectives: The augmented inflammatory response to cardiac surgery is a
recognized cause of postoperative acute kidney injury. The present study
aimed to investigate the effects of preoperative cyclosporine treatment on
cytokine production and delineate factors associated with postoperative
kidney impairment. Design(s): A randomized, double-blind,
placebo-controlled, single-center study. Setting(s): At a tertiary
care, university hospital. Participant(s): Patients eligible for
elective coronary artery bypass grafting surgery; 67 patients were
enrolled. Intervention(s): Patients were randomized to receive 2.5
mg/kg cyclosporine or placebo before surgery. Cytokine levels were
measured after the induction of anesthesia and 4 hours after the end of
cardiopulmonary bypass. Measurements and Main Results:
Tissue-aggressive (interleukin [IL]-1beta, macrophage inflammatory protein
[MIP]-1beta, granulocyte colony-stimulating factor [G-CSF], IL-6, IL-8,
IL-17, MCP-1), as well tissue-lenient (IL-4) cytokines, were significantly
elevated in response to surgery. Changes in cytokine levels were not
affected by cyclosporine pretreatment. Conclusion(s): Elective
coronary artery bypass grafting surgery with cardiopulmonary bypass
triggers cytokine activation. This activation was not impacted by
preoperative cyclosporine treatment. Copyright © 2021 Elsevier
Inc.

<81>
Accession Number
2016140587
Title
Network meta-analysis comparing the short and long-term outcomes of
alternative access for transcatheter aortic valve replacement.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2021. Date of
Publication: 2021.
Author
Ranka S.; Lahan S.; Chhatriwalla A.K.; Allen K.B.; Chiang M.; O'Neill B.;
Verma S.; Wang D.D.; Lee J.; Frisoli T.; Eng M.; Bagur R.; O'Neill W.;
Villablanca P.
Institution
(Ranka) Department of Cardiovascular Medicine, University of Kansas
Medical Center, Kansas City, KS, United States
(Lahan) Division of Cardiovascular Prevention & Wellness, Department of
Cardiology, Houston Methodist, Houston, TX, United States
(Chhatriwalla, Allen) Department of Cardiothoracic Surgery, Saint Luke's
Mid America Heart Institute and University of Missouri-Kansas City, Kansas
City, MO, United States
(Chiang, O'Neill, Wang, Lee, Frisoli, O'Neill, Villablanca) Department of
Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI,
United States
(Verma) Department of Family Medicine, Henry Ford Allegiance Health,
Jackson, MI, United States
(Eng) Department of Cardiology, Banner University Medical Center, Phoenix,
AZ, United States
(Bagur) Division of Cardiology, Department of Medicine, London Health
Sciences Centre, Western University, London, ON, Canada
Publisher
Elsevier Inc.
Abstract
Background: Several studies have pair-wise compared access sites for
transcatheter aortic valve replacement (TAVR) but pooled estimate of
overall comparative efficacy and safety outcomes are not well known. We
sought to compare short- and long-term outcomes following various
alternative access routes for TAVR. Method(s): Thirty-four studies
with a pooled sample size of 32,756 patients were selected by searching
PubMed and Cochrane library databases from inception through 11th June
2021 for patients undergoing TAVR via 1 of 6 different access sites:
Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC),
Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted
to conduct a frequentist network meta-analysis with a random-effects model
using TF access as a reference group. Result(s): Compared with TF,
both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI
(1.84-2.46)] were associated with an increased risk of 30-day mortality.
No significant difference was observed for stroke, myocardial infarction,
major bleeding, conversion to open surgery, and major adverse
cardiovascular or cerebrovascular events at 30 days between different
accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI,
0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF.
The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)]
and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. Conclusion(s):
Non-thoracic alternative access site utilization for TAVR implantation
(TC, TSA and TCV) is associated with outcomes similar to conventional TF
access. Thoracic TAVR access (TAO and TA) translates into increased short
and long-term mortality. Copyright © 2021 Elsevier Inc.

<82>
Accession Number
636748753
Title
Efficacy and safety of aprotinin in paediatric cardiac surgery: A
systematic review and meta-analysis.
Source
European journal of anaesthesiology. (no pagination), 2021. Date of
Publication: 15 Nov 2021.
Author
Atasever A.G.; Eerens M.; Van den Eynde R.; Faraoni D.; Rex S.
Institution
(Atasever) From the Department of Anaesthesiology, University Hospitals of
the KU Leuven, Herestraat, Leuven, Belgium (AGA, ME, RVdE, SR). Arthur S.
Keats Division of Paediatric Cardiovascular Anesthesia. Department of
Anesthesiology, Peri-operative and Pain Medicine, Texas Children's
Hospital, Baylor College of Medicine, Houston, TX, USA (DF). And
Department of Cardiovascular Sciences, KU Leuven, Herestraat, Leuven,
Belgium (SR)
Publisher
NLM (Medline)
Abstract
BACKGROUND: The relicensing of aprotinin in Europe and Canada has
stimulated discussions on its usefulness in paediatric cardiac surgery.
 OBJECTIVE(S): To systematically evaluate the available evidence on
the efficacy and safety of aprotinin in paediatric cardiac surgery.
DESIGN: Systematic review of all randomised and observational studies
comparing aprotinin with tranexamic acid, epsilon aminocaproic acid,
placebo or no drug in paediatric cardiac surgery. Meta-analyses were
performed on efficacy and safety outcomes. DATA SOURCES: PubMed, Cochrane
Central Register of Controlled Trials, Web of Science and Embase were
searched from January 2000 to March 2021. ELIGIBILITY CRITERIA: Studies
that enrolled children under 18 years undergoing cardiac surgery with
cardiopulmonary bypass. RESULT(S): Thirty-two studies enrolling a
total of 63 894 paediatric cardiac procedures were included. Aprotinin
significantly reduced total blood loss [mean difference -4.70 ml kg-1, 95%
confidence interval (CI), -7.88 to -1.53; P = 0.004], postoperative
transfusion requirements and the incidence of surgical re-exploration for
bleeding [odds ratio (OR) 0.74, 95% CI, 0.56 to 0.97; P = 0.03]. Aprotinin
had no effects on 30-day mortality (OR 1.02, 95% CI, 0.93 to 1.11; P =
0.73) and on other safety outcomes, except for the incidence of renal
replacement therapy (RRT), which was significantly increased in patients
given aprotinin (OR 1.29, 95% CI, 1.08 to 1.54; P = 0.006). Findings from
observational and randomised controlled trials did not largely differ. A
sub-group analysis in neonates showed that aprotinin significantly reduced
packed red blood cell transfusions and the incidence of postoperative
surgical re-exploration for bleeding and/or tamponade. When compared with
lysine analogues, aprotinin was more effective at reducing bleeding and
transfusion without increasing the risk of side effects.
 CONCLUSION(S): This meta-analysis suggests that aprotinin is
effective and well tolerated in paediatric cardiac surgery. Given the
large heterogeneity of the results and the risk of selection bias in
observational studies, large randomised controlled trials are
warranted. Copyright © 2021 European Society of Anaesthesiology.

<83>
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. (no pagination), 2021. Date of
Publication: 15 Nov 2021.
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. 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.
 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. 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. Copyright © 2021 European Society
of Anaesthesiology.

<84>
Accession Number
636744223
Title
Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic
SeveRe Aortic Stenosis: The AVATAR Trial.
Source
Circulation. (no pagination), 2021. Date of Publication: 13 Nov 2021.
Author
Banovic M.; Putnik S.; Penicka M.; Doros G.; Deja M.A.; Kockova R.; Kotrc
M.; Glaveckaite S.; Gasparovic H.; Pavlovic N.; Velicki L.; Salizzoni S.;
Wojakowski W.; Van Camp G.; Nikolic S.D.; Iung B.; Bartunek J.
Institution
(Banovic) Belgrade Medical School, University of Belgrade, Serbia;
Cardiology Department, University Clinical Center of Serbia, Belgrade,
Serbia
(Putnik) Belgrade Medical School, University of Belgrade, Serbia;
Cardiac-Surgery Department, University Clinical Center of Serbia,
Belgrade, Serbia
(Penicka, Van Camp, Bartunek) Cardiovascular Center, OLV Hospital, Aalst,
Belgium
(Doros) Boston University School of Public Health, Department of
Biostatistics, MA, Boston
(Deja) Department of Cardiac Surgery, Medical University of Silesia,
Katowice, Poland
(Kockova, Kotrc) Department of Cardiology, Institute for Clinical and
Experimental Medicine, Prague, Czechia
(Glaveckaite) Clinic of Cardiac and Vascular Diseases, Institute of
Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius,
Lithuania
(Gasparovic) Department of Cardiac Surgery, University of Zagreb School of
Medicine and University Hospital Center Zagreb, Zagreb, Croatia
(Pavlovic) University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
(Velicki) Faculty of Medicine, University of Novi Sad, Serbia and
Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Novi
Sad, Serbia
(Salizzoni) Cardiovascular and Thoracic Department, Citta della Salute e
della Scienza Hospital and University of Turin, Italy
(Wojakowski) Division of Cardiology and Structural Heart Diseases, Medical
University of Silesia, Katowice, Poland
(Nikolic) CorDynamix, Redwood City, CA
(Iung) Cardiology Department, Bichat Hospital APHP and Universite de
Paris, France
Publisher
NLM (Medline)
Abstract
Background: Surgical aortic valve replacement (SAVR) represents a class I
indication in symptomatic patients with severe aortic stenosis (AS).
However, indications for early SAVR in asymptomatic patients with severe
AS and normal left ventricular function remain debated. Method(s):
The Aortic Valve replAcemenT versus conservative treatment in Asymptomatic
seveRe aortic stenosis (AVATAR) trial is an investigator-initiated
international prospective randomized controlled trial that evaluated the
safety and efficacy of early SAVR in the treatment of asymptomatic
patients with severe AS, according to common criteria (valve area <=1 cm2
with aortic jet velocity >4 m/s or a mean trans-aortic gradient >=40 mm
Hg), and with normal LV function. Negative exercise testing was mandatory
for inclusion. The primary hypothesis was that early SAVR would reduce the
primary composite endpoint of all-cause death, acute myocardial
infarction, stroke or unplanned hospitalization for heart failure, as
compared to a conservative strategy according to guidelines. The trial was
designed as event-driven to reach a minimum of 35 prespecified events. The
study was performed in 9 centers in 7 European countries. Result(s):
Between June 2015 and September 2020, 157 patients (mean age 67 years, 57
% men) were randomly allocated to early surgery (n=78) or conservative
treatment (n=79). Follow-up was completed in May 2021. Overall median
follow-up was 32 months: 28 months in the early surgery group and 35
months in the conservative treatment group. There was a total of 39
events, 13 in early surgery and 26 in conservative treatment group. In the
early surgery group, 72 patients (92.3 %) underwent SAVR with operative
mortality of 1.4 %. In an intention-to-treat analysis, patients randomized
to early surgery had a significantly lower incidence of primary composite
endpoint than those in the conservative arm (HR 0.46, 95 % CI 0.23-0.90,
p=0.02). There was no statistical difference in secondary endpoints,
including all-cause mortality, first heart failure hospitalizations, major
bleeding or thromboembolic complications, but trends were consistent with
the primary outcome. Conclusion(s): In asymptomatic patients with
severe AS, early surgery reduced a primary composite of all-cause death,
acute myocardial infarction, stroke or unplanned hospitalization for heart
failure compared with conservative treatment. This randomized trial
provides preliminary support for early SAVR once AS becomes severe,
regardless of symptoms.

<85>
Accession Number
2014243765
Title
Effectiveness of interventions for prevention of common infections in
people who use opioids: a protocol for a systematic review of systematic
reviews.
Source
Systematic Reviews. 10(1) (no pagination), 2021. Article Number: 298. Date
of Publication: December 2021.
Author
Kudrina I.; Puzhko S.; Filion K.B.; Gore G.; Paraskevopoulos E.; Windle
S.; Martel M.O.; Eisenberg M.J.
Institution
(Kudrina, Puzhko, Paraskevopoulos) Department of Family Medicine, Faculty
of Medicine and Health Sciences, McGill University, 5858 Chemin de la
Cote-des-Neiges, Suite 300, Montreal, QC H3S 1Z1, Canada
(Kudrina, Martel) Department of Anesthesia, Faculty of Medicine and Health
Sciences, McGill University, 1650 Cedar Ave., Montreal, QC H3G 1A4, Canada
(Filion, Windle, Eisenberg) Department of Epidemiology, Biostatistics and
Occupational Health, Faculty of Medicine and Health Sciences, McGill
University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC H3A 1A2,
Canada
(Filion, Eisenberg) Lady Davis Institute for Medical Research, Jewish
General Hospital, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC
H3T 1E2, Canada
(Filion) Department of Medicine, Faculty of Medicine and Health Sciences,
McGill University Health Center, McGill University, 1001 Decarie
Boulevard, Suite D05-2212, Montreal, QC H4A3JI, Canada
(Gore) Schulich Library of Physical Sciences, Life Sciences, and
Engineering, McGill University, 3459 rue McTavish, Montreal, QC H3A OC9,
Canada
(Paraskevopoulos) Queensway Carleton Hospital, 3045 Baseline Rd, Ottawa,
ON K2H 8P4, Canada
(Martel) Faculty of Dentistry, McGill University, 2001 Avenue McGill
College, Suite 500, Montreal, QC H3A 1G1, Canada
(Eisenberg) Department of Medicine, Faculty of Medicine and Health
Sciences, McGill University, 3605 de la Montagne, Montreal, Qc H3G 2M1,
Canada
(Eisenberg) Division of Cardiology, Jewish General Hospital, 3755 Chemin
de la Cote-Sainte-Catherine, Montreal, QC H3T 1E2, Canada
Publisher
BioMed Central Ltd
Abstract
Background: The North American opioid crisis is driven by opioid-related
mortality and morbidity, including opioid use-associated infections
(OUAIs), resulting in a substantial burden for society. Users of legal and
illegal opioids are at an increased risk of OUAIs compared to individuals
not using opioids. As reported for hepatitis C virus (HCV), human
immunodeficiency virus (HIV), bacterial, fungal, and other infections,
OUAIs transmission and acquisition risks may be modifiable. Several
systematic reviews (SRs) synthetized data regarding interventions to
prevent infections in persons using drugs (e.g., opioid substitution
therapy, needle and syringes exchange programs, psycho-social
interventions); however, their conclusions varied. Therefore, SR of
published SRs is needed to synthesize the highest level of evidence on the
scope and effectiveness of interventions to prevent OUAIs in people using
opioids legally or illegally. Method(s): We will comprehensively
search for SRs in the PubMed, Embase, PsycINFO, Cochrane Database of
Systematic Reviews, Epistemonikos, and Google Scholar databases from
inception to November 2020. Data selection and extraction for each SR will
be performed independently by two researchers, with disagreements resolved
by consensus. All SRs regarding interventions with evaluated effectiveness
to prevent OUAI in legal and/or illegal opioid users will be eligible.
Risk of bias assessment will be performed using the AMSTAR2 tool. The
results will be qualitatively synthesized, and a typology of
interventions' effectiveness with a statement on the strength of evidence
for each category will be created. Discussion(s): Our pilot search of
PubMed resulted in 379 SRs analyzing the effectiveness of interventions to
prevent HCV and HIV in persons who inject different types of drugs,
including opioids. Of these 379 SRs, 8 evaluated primary studies where
participants used opioids and would therefore be eligible for inclusion.
The search results thus justify the application of SR of SRs approach.
Comprehensive data on the scope and effectiveness of existing
interventions to prevent OUAIs will help policy-makers to plan and
implement preventive interventions and will assist clinicians in the
guidance for their patients using opioids. Systematic review registration:
Registered in PROSPERO on 30 July 2020 (#195929). Copyright ©
2021, The Author(s).

<86>
Accession Number
636423877
Title
Blockade of IL-6/IL-6R Signaling Attenuates Acute Antibody-Mediated
Rejection in a Mouse Cardiac Transplantation Model.
Source
Frontiers in Immunology. 12 (no pagination), 2021. Article Number: 778359.
Date of Publication: 28 Oct 2021.
Author
Ma M.; Li X.; Deng G.; Zhang Y.; Yang Z.; Han F.; Huang Z.; Fang Y.; Liao
T.; Sun Q.
Institution
(Ma, Deng, Yang, Han, Huang) Organ Transplantation Research Institute,
Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong,
China
(Sun, Zhang, Liao, Sun) Department of Kidney Transplantation, Guangdong
Provincial People's Hospital, Guangdong Academy of Medical Sciences,
Guangzhou, Guangdong, China
(Li) Department of Obstetrics and Gynecology, Third Affiliated Hospital of
Sun Yat-sen University, Guangzhou, Guangdong, China
(Fang) Department of Urology, Third Affiliated Hospital of Sun Yat-sen
University, Guangzhou, Guangdong, China
Publisher
Frontiers Media S.A.
Abstract
Acute antibody-mediated rejection (AAMR) is an important cause of cardiac
allograft dysfunction, and more effective strategies need to be explored
to improve allograft prognosis. Interleukin (IL)-6/IL-6R signaling plays a
key role in the activation of immune cells including B cells, T cells and
macrophages, which participate in the progression of AAMR. In this study,
we investigated the effect of IL-6/IL-6R signaling blockade on the
prevention of AAMR in a mouse model. We established a mouse model of AAMR
for cardiac transplantation via presensitization of skin grafts and
addition of cyclosporin A, and sequentially analyzed its features.
Tocilizumab, anti-IL-6R antibody, and recipient IL-6 knockout were used to
block IL-6/IL-6R signaling. We demonstrated that blockade of IL-6/IL-6R
signaling significantly attenuated allograft injury and improved survival.
Further mechanistic research revealed that signaling blockade decreased B
cells in circulation, spleens, and allografts, thus inhibiting
donor-specific antibody production and complement activation. Moreover,
macrophage, T cell, and pro-inflammatory cytokine infiltration in
allografts was also reduced. Collectively, we provided a highly practical
mouse model of AAMR and demonstrated that blockade of IL-6/IL-6R signaling
markedly alleviated AAMR, which is expected to provide a superior option
for the treatment of AAMR in clinic. © Copyright © 2021 Ma,
Sun, Li, Deng, Zhang, Yang, Han, Huang, Fang, Liao and Sun.

<87>
Accession Number
2015691154
Title
Effect of nursing intervention based on Maslow's hierarchy of needs in
patients with coronary heart disease interventional surgery.
Source
World Journal of Clinical Cases. 9(33) (pp 10189-10197), 2021. Date of
Publication: 26 Nov 2021.
Author
Xu J.-X.; Wu L.-X.; Jiang W.; Fan G.-H.
Institution
(Xu, Wu, Jiang, Fan) Department of Nursing, First Affiliated Hospital of
Qiqihar Medical College, Qiqihar, Heilongjiang Province 161000, China
Publisher
Baishideng Publishing Group Inc
Abstract
BACKGROUND It is very important to provide effective nursing programs to
regulate the physical and mental state of patients and to improve
treatment compliance after interven-tional surgery for coronary heart
disease (CHD).AIM To explore the effect of a nursing intervention based on
Maslow's hierarchy of needs theory on patients with CHD undergoing
percutaneous coronary inter-vention.METHODS Ninety-four patients with CHD
undergoing interventional surgery in our hospital from January 2020 to
February 2021 were randomly divided into a research group (n = 47) and a
control group (n = 47). The control group received routine nursing, and
the research group received a nursing intervention based on Maslow's
hierarchy of needs theory. The scores of self-efficacy, negative emotion
[de-pression (SDS), anxiety (SAS)], intervention compliance (standardized
medication, moderate exercise, healthy diet, and regular review), and
nursing satisfaction were calculated before and after intervention for the
two groups.RESULTS Before intervention, there was no significant
difference in the scores of disease general management self-efficacy,
disease management self-efficacy, and total self-efficacy between the two
groups (P = 0.795, 0.479, and 0.659, respectively). After intervention,
these three scores in the research group were higher than those in the
control group (P < 0.001). Before intervention, there was no significant
difference in the scores of SAS and SDS between the two groups (P = 0.149
and 0.347, respectively). After intervention, the scores of SAS and SDS in
the research group were lower than those in the control group (P < 0.001).
The standardized drug use rate (97.87%), moderate exercise rate (97.87%),
healthy diet rate (95.74%),and regular reexamination rate (97.87%) in the
research group were higher than those in the control group (85.11%,
82.98%, 80.85%, and 87.23%, respectively) (P = 0.027, 0.014, 0.025, and
0.049, respectively). Nursing job satisfaction in the research group
(93.62%) was higher than that in the control group (78.72%) (P = 0.036).
CONCLUSION A nursing program based on Maslow's hierarchy of needs theory
can effectively alleviate negative emotion, enhance self-efficacy and
intervention compliance, and ensure that the patients are highly satisfied
with the nursing work. Copyright © The Author(s) 2021. Published
by Baishideng Publishing Group Inc. All rights reserved.

<88>
Accession Number
2013622882
Title
Efficacy of adding dexmedetomidine as adjuvant with bupivacaine in
ultrasound-guided erector spinae plane block for post thoracotomy pain:
Randomized controlled study: Dexmedetomidine as adjuvant in ESPB for PTP.
Source
Egyptian Journal of Anaesthesia. 37(1) (pp 425-431), 2021. Date of
Publication: 2021.
Author
Elshal M.M.; Gamal R.M.; Ahmed A.M.; Gouda N.M.; Abdelhaq M.M.
Institution
(Elshal, Gamal, Ahmed) Anesthesia and Pain Relief, National Cancer
Institute, Cairo University, Cairo, Egypt
(Gouda, Abdelhaq) Anesthesia, Surgical ICU and Pain Management, Faculty of
Medicine, Cairo University, Cairo, Egypt
Publisher
Taylor and Francis Ltd.
Abstract
Background: Poor management of postoperative pain results in physiological
and psychological side effects with higher morbidity. Erector spinae plane
block (ESPB) has shown efficacy in controlling pain in many surgeries.
Dexmedetomidine has improved the quality of analgesia in many regional
techniques. This study aimed to assess the analgesic outcome of adding
dexmedetomidine to bupivacaine in ultrasound (US) guided ESPB for
perioperative analgesia for thoracic cancer surgeries. Patients and
Methods: In this randomized controlled, double-blind study, 42 patients
aged 18-65 years, ASA (American Society of Anesthesiologists) physical
status II, scheduled for thoracotomy for cancer surgeries under general
anesthesia were included. Patients were allocated into two equal groups:
group 1 (ESPB by 28 ml bupivacaine 0.25% + 2 mL saline) and group 2 (ESPB
28 ml bupivacaine 0.25% + 2 mL dexmedetomidine 0.5 microg/kg). Blocks were
performed before anesthesia induction. Result(s): Group 2 consumed
lower intraoperative fentanyl and postoperative morphine and had a lower
pain score at rest and cough compared to group 1. Group 2 had prolonged
time to first request of rescue analgesia compared to group 1.
Postoperative nausea and vomiting, and sedation were comparable between
both groups. No block-related complications were observed.
 Conclusion(s): Adding dexmedetomidine to bupivacaine in US-guided
ESPB provided more effective and safe analgesia in
thoracotomy. Copyright © 2021 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis Group.

<89>
Accession Number
2007658702
Title
NGS of micrornas involved in cardioprotection induced by sevoflurane
compared to propofol in myocardial revascularization surgery: The
ACDHUVV-16 clinical trial.
Source
Current Medicinal Chemistry. 28(20) (pp 4074-4086), 2021. Date of
Publication: 2021.
Author
Guerrero Orriach J.L.; Escalona Belmonte J.J.; Aliaga M.R.; Fernandez
A.R.; Rodriguez Capitan M.J.; Munoz G.Q.; Ponferrada A.R.; Torres J.A.;
Santiago-Fernandez C.; Gonzalez E.M.; Navarro M.R.; Bautista R.; Maldonado
J.G.; Garrido-Sanchez L.; Manas J.C.
Institution
(Guerrero Orriach, Escalona Belmonte, Aliaga, Fernandez, Rodriguez
Capitan, Munoz, Ponferrada, Navarro, Manas) Department of
Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Malaga,
Spain
(Guerrero Orriach, Escalona Belmonte, Aliaga, Fernandez, Rodriguez
Capitan, Munoz, Ponferrada, Santiago-Fernandez, Navarro, Garrido-Sanchez,
Manas) Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga,
Spain
(Torres, Santiago-Fernandez, Garrido-Sanchez) Unidad de Gestion Clinica de
Endocrino-logia y Nutricion, Hospital Universitario Virgen de la Victoria,
Malaga, Spain
(Gonzalez) Department of Anesthesia, Hospital Universitario, Sanitas La
Moraleja, Spain
(Bautista, Maldonado) Genomic and Ultrasecuenciation. Supercomputacion y
Bioinnovacion Center, Malaga University, Malaga, Spain
(Garrido-Sanchez) CIBER Fisiopatologia de la Obesidad y
Nu-tricion-CIBEROBN, Instituto de Salud, Carlos III, Spain
Publisher
Bentham Science Publishers
Abstract
Background: Numerous studies have demonstrated that halogenated agents
elicit myocardial conditioning effects when administered perioperatively
in cardiac surgery. Recent evidence has been pub-lished on the benefits of
maintaining exposure to halogenated agents during the early postoperative
pe-riod. The enzymatic mechanisms by which this beneficial effect is
exerted were explained recently. Objective(s): Our study was
performed to investigate whether this phenomenon is mediated by either the
activation or suppression of miRNAs targeted by halogenated anesthetics.
 Method(s): A double-blind, two-stage trial was conducted. The results
of the first stage of the trial are pre-sented in this paper. The sample
was composed of patients undergoing off-pump myocardial revasculari-zation
surgery. Patients were randomized to receive either sevoflurane [S] or
propofol [P] during the in-traoperative and early postoperative period
(during the first six hours after the intervention). Hemodynam-ics (heart
rate, blood pressure, central venous pressure, cardiac index, systolic
volume index, LVEF) and myocardial enzymes (troponin I) were monitored at
six hour intervals during the first 48 hours. In the first stage of the
trial, blood was drawn for gene sequencing from eight patients (four per
group) at baseline and at 24 h. In the second stage of the study, a qPCR
analysis was performed of the miRNAs identified as significant by gene
sequencing. Levels of cardioprotective enzymes (serine/threonine protein
kinase (Akt), tumor necrosis factor alpha (TNFalpha), extracellular
regulated protein kinase (ERK 1/2), and caspase 3) were measured to assess
their role in myocardial conditioning pathways. The purpose was to
identify the miRNAs that play a major role in myocardial conditioning
induced by halogenated agents. Concentrations of cardioprotective enzymes
were higher in patients who received sevoflurane than the patients who
were administered propofol. Result(s): NGS differences were observed
between baseline and 24-h values in the two study groups. In group P,
miRNA 197-3p was overexpressed, whereas miRNAs 4443 and 1294, 708-3p were
underex-pressed. In group S, miRNAs 615-3p, 4466, 29, 937-3p, 636, 197-3P,
184, 4685, 296-3p, 147b, 3199, 6815, 1294 and 3176 were underexpressed;
whereas 708-3p was overexpressed. qPCR showed significant variations in
miRNAs 197-3p, 4443, 708-3p and 1294 in the P group, and in miRNAs 937-3p,
636, 197-3p, 296-3p and 708-3p in the S group. Conclusion(s): In the
P Group, changes in the expression of some miRNAs were associated with
lower concentrations of the enzymes involved in myocardial pre-and
postconditioning. In contrast, in Group S, variations in miRNAs were
associated with the activation of mediators of anesthetic-induced pre-and
post-conditioning, a reduction in cell apoptosis, and a decrease in
caspase and TnBF alpha concentrations. Changes in these miRNAs were
associated with better prognosis in patients with ischemic heart disease.
The main limitation of this study will be overcome in the second stage of
the trial, where the specific role of each miRNA will be
determined. Copyright © 2021 Bentham Science Publishers.

<90>
Accession Number
2007563566
Title
A systematic review on durability and structural valve deterioration in
TAVR and surgical AVR.
Source
Acta Cardiologica. 76(9) (pp 921-932), 2021. Date of Publication: 2021.
Author
Okutucu S.; Niazi A.K.; Oliveira D.; Fatihoglu S.G.; Oto A.
Institution
(Okutucu, Oto) Department of Cardiology, Memorial Ankara Hospital, Ankara,
Turkey
(Niazi) Department of Cardiovascular Surgery, Shalamar Medical & Dental
College, Lahore, Pakistan
(Oliveira) Department of Cardiology, Federal University of Pernambuco,
Recife, Brazil
(Fatihoglu) Department of Cardiology, Iskenderun State Hospital, Hatay,
Turkey
Publisher
Taylor and Francis Ltd.
Abstract
Mechanical valves and bioprosthetic heart valves are widely used for
aortic valve replacement (AVR). Mechanical valves are associated with risk
of bleeding because of oral anticoagulation, while the durability and
structural valve deterioration (SVD) represent the main limitation of the
bioprosthetic heart valves. The implantation of bioprosthetic heart valves
is increasing precipitously due aging population, and the widespread use
of transcatheter aortic valve replacement (TAVR). TAVR has become the
standard treatment for intermediate or high surgical risk patients and a
reasonable alternative to surgery for low risk patients with symptomatic
severe aortic stenosis. Moreover, TAVR is increasingly being used for
younger and lower-risk patients with longer life expectancy; therefore it
is important to ensure the valve durability for long-term transcatheter
aortic valves. Although the results of mid-term durability of the
transcatheter heart valves are encouraging, their long-term durability
remains largely unknown. This review summarises the definitions,
mechanisms, risk factors and assessment of SVD; overviews available data
on surgical bioprosthetic and transcatheter heart valves
durability. Copyright © 2020 Belgian Society of Cardiology.

<91>
Accession Number
636611041
Title
Transcatheter aortic valve implantation versus surgical aortic valve
replacement in patients with severe aortic stenosis: A systematic review
and meta-Analysis.
Source
BMJ Open. 11(12) (no pagination), 2021. Article Number: e054222. Date of
Publication: 06 Dec 2021.
Author
Swift S.L.; Puehler T.; Misso K.; Lang S.H.; Forbes C.; Kleijnen J.;
Danner M.; Kuhn C.; Haneya A.; Seoudy H.; Cremer J.; Frey N.; Lutter G.;
Wolff R.; Scheibler F.; Wehkamp K.; Frank D.
Institution
(Swift, Misso, Lang, Forbes, Kleijnen, Wolff) Kleijnen Systematic Reviews
Ltd, York, United Kingdom
(Puehler, Haneya, Cremer, Lutter) Department of Cardiac and Vascular
Surgery, Universitatsklinikum Schleswig-Holstein, Kiel, Germany
(Puehler, Kuhn, Seoudy, Lutter, Frank) German Centre for Cardiovascular
Research, Kiel, Germany
(Danner, Scheibler) National Competency Center for Shared Decision Making,
Universitatsklinikum Schleswig-Holstein, Kiel, Germany
(Kuhn, Seoudy, Frank) Department of Cardiology and Angiology,
Universitatsklinikum Schleswig-Holstein, Kiel, Germany
(Frey) Department of Cardiology, Angiology, and Pneumology, University
Hospital Heidelberg, Heidelberg, Germany
(Wehkamp) Department of Internal Medicinei, Universitatsklinikum
Schleswig-Holstein, Kiel, Germany
Publisher
BMJ Publishing Group
Abstract
Objectives Patients undergoing surgery for severe aortic stenosis (SAS)
can be treated with either transcatheter aortic valve implantation (TAVI)
or surgical aortic valve replacement (SAVR). The choice of procedure
depends on several factors, including the clinical judgement of the heart
team and patient preferences, which are captured by actively informing and
involving patients in a process of shared decision making (SDM). We
synthesised the most up-To-date and accessible evidence on the benefits
and risks that may be associated with TAVI versus SAVR to support SDM in
this highly personalised decision-making process. Design Systematic review
and meta-Analysis. Data sources MEDLINE (Ovid), Embase (Ovid) and the
Cochrane Central Register of Controlled Trials (CENTRAL; Wiley) were
searched from January 2000 to August 2020 with no language restrictions.
Reference lists of included studies were searched to identify additional
studies. Eligibility criteria Randomised controlled trials (RCTs) that
compared TAVI versus SAVR in patients with SAS and reported on all-cause
or cardiovascular mortality, length of stay in intensive care unit or
hospital, valve durability, rehospitalisation/reintervention, stroke (any
stroke or major/disabling stroke), myocardial infarction, major vascular
complications, major bleeding, permanent pacemaker (PPM) implantation,
new-onset or worsening atrial fibrillation (NOW-AF), endocarditis, acute
kidney injury (AKI), recovery time or pain were included. Data extraction
and synthesis Two independent reviewers were involved in data extraction
and risk of bias (ROB) assessment using the Cochrane tool (one reviewer
extracted/assessed the data, and the second reviewer checked it).
Dichotomous data were pooled using the Mantel-Haenszel method with
random-effects to generate a risk ratio (RR) with 95% CI. Continuous data
were pooled using the inverse-variance method with random-effects and
expressed as a mean difference (MD) with 95% CI. Heterogeneity was
assessed using the I 2 statistic. Results 8969 records were retrieved and
nine RCTs (61 records) were ultimately included (n=8818 participants). Two
RCTs recruited high-risk patients, two RCTs recruited intermediate-risk
patients, two RCTs recruited low-risk patients, one RCT recruited
high-risk (>=70 years) or any-risk (>=80 years) patients; and two RCTs
recruited all-risk or a operable' patients. While there was no overall
change in the risk of dying from any cause (30 day: RR 0.89, 95% CI 0.65
to 1.22; <=1 year: RR 0.90, 95% CI 0.79 to 1.03; 5 years: RR 1.09, 95% CI
0.98 to 1.22), cardiovascular mortality (30 day: RR 1.03, 95% CI 0.77 to
1.39; <=1 year: RR 0.90, 95% CI 0.76 to 1.06; 2 years: RR 0.96, 95% CI
0.83 to 1.12), or any type of stroke (30 day: RR 0.83, 95% CI 0.61 to
1.14;<=1 year: RR 0.94, 95% CI 0.72 to 1.23; 5 years: RR 1.07, 95% CI 0.88
to 1.30), the risk of several clinical outcomes was significantly
decreased (major bleeding, AKI, NOW-AF) or significantly increased (major
vascular complications, PPM implantation) for TAVI vs SAVR. TAVI was
associated with a significantly shorter hospital stay vs SAVR (MD-3.08
days, 95% CI-4.86 to-1.29; 4 RCTs, n=2758 participants). Subgroup analysis
generally favoured TAVI patients receiving implantation via the
transfemoral (TF) route (vs non-TF); receiving a balloon-expandable (vs
self-expanding) valve; and those at low-intermediate risk (vs high risk).
All RCTs were rated at high ROB, predominantly due to lack of blinding and
selective reporting. Conclusions No overall change in the risk of death
from any cause or cardiovascular mortality was identified but 95% CIs were
often wide, indicating uncertainty. TAVI may reduce the risk of certain
side effects while SAVR may reduce the risk of others. Most long-Term
(5-year) results are limited to older patients at high surgical risk (ie,
early trials), therefore more data are required for low risk populations.
Ultimately, neither surgical technique was considered dominant, and these
results suggest that every patient with SAS should be individually engaged
in SDM to make evidence-based, personalised decisions around their care
based on the various benefits and risks associated with each treatment.
PROSPERO registration number CRD42019138171. Copyright © 2021 BMJ
Publishing Group. All rights reserved.

<92>
Accession Number
635935478
Title
A comparative study of the efficacy of Glidescope versus Macintosh direct
laryngoscopy for intubation in pediatric patients undergoing cardiac
surgery.
Source
Saudi Journal of Anaesthesia. 15(4) (pp 419-423), 2021. Date of
Publication: October-December 2021.
Author
Zabani I.; AlHarbi M.; AlHassoun A.; Iqbal S.; Al Amoudi D.; AlOtaibi S.;
Saad H.
Institution
(Zabani, AlHarbi, AlHassoun, Iqbal, Al Amoudi, AlOtaibi, Saad) Department
of Anesthesiology, King Faisal Specialist Hospital and Research Center,
Jeddah, Saudi Arabia
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: The Glidescope is a novel, portable, reusable video
laryngoscope that has provided superior laryngeal visualization to
facilitate tracheal intubation, especially in the management of difficult
airways. In this study, we aimed to compare the efficacy of the Glidescope
(video-laryngoscope) against the Macintosh direct laryngoscope.
 Method(s): Fifty patients were randomly selected via simple
randomization using computer-generated random numbers, and sorted into two
groups of 25 patients: the Glidescope group and the Macintosh group. We
included pediatric patients undergoing cardiac surgery for the repair of
congenital heart disease. Those with suspected difficult intubation,
preterm babies with low body weight, and patients at risk of aspiration
were all excluded. Result(s): Patients' baseline demographic and
clinical characteristics were found to be comparable in the two groups.
The mean intubation time was 24.1 +/- 13.6 s in the Glidescope group, as
compared to 18.1 +/- 5.9 s in the Macintosh group. Blade insertion was
easy in 92% and 96% of the patients in the Glidescope and Macintosh
groups, respectively. Tracheal intubation was considered easy in 84% of
the Glidescope group, compared to 92% of the Macintosh group. There was a
statistically significant correlation between the ease of tracheal
intubation and the used intubation method (rho = -0.35; P = 0.014).
 Conclusion(s): Our findings indicate that the Glidescope can be used
as an efficient modality for obtaining successful intubations with no
complications. Ease of tracheal intubation was the only outcome that was
found to be affected by the used modality. Further investigations with
proper sample sizes are needed. Copyright © 2021 Saudi Journal of
Anesthesia Published by Wolters Kluwer - Medknow

<93>
Accession Number
2015648971
Title
The effects of eye masks on post-operative sleep quality and pain in
school-age children with CHD.
Source
Cardiology in the Young. (no pagination), 2021. Date of Publication:
2021.
Author
Dai W.-S.; Xie W.-P.; Liu J.-F.; Chen Q.; Cao H.
Institution
(Dai, Xie, Liu, Chen, Cao) Department of Cardiac Surgery, Fujian Branch,
Shanghai Children's Medical Center, Fuzhou, China
(Dai, Xie, Liu, Chen, Cao) Department of Cardiac Surgery, Fujian
Children's Hospital, Fuzhou, China
(Dai, Xie, Liu, Chen, Cao) Department of Cardiac Surgery, Fujian Maternity
and Child Health Hospital, Affiliated Hospital of Fujian Medical
University, Fuzhou, China
(Dai, Xie, Liu, Chen, Cao) Fujian Key Laboratory of Women and Children's
Critical Diseases Research, Fujian Maternity and Child Health Hospital,
Fuzhou, China
Publisher
Cambridge University Press
Abstract
Objective: This study aimed to explore the effects of eye masks on the
sleep quality and pain of school-age children with CHD after surgery.
 Method(s): Forty school-age children with CHD who underwent
open-heart surgery in the Cardiac Surgery Department of a provincial
hospital in China from January 2020 to December 2020 were selected. The
children were randomly divided into the experimental group (n = 20) and
the control group (n = 20). Children in the control group were given
routine sleep care, and the children in the experimental group were given
a sleep intervention with eye masks for three nights following the removal
of tracheal intubation. The Pittsburgh Sleep Quality Index was used to
evaluate the sleep quality of the children. The Children's Pain Behaviour
Scale was used to evaluate the pain of the children. Result(s): After
three nights of receiving the eye masks intervention, the sleep quality
scores of the children in the experimental group were significantly lower
than those of the control group, the difference was statistically
significant (p < 0.05) and the sleep quality of the children in the
experimental group was higher. The pain scores of the children in the
experimental group were significantly lower than those of the children in
the control group, the difference was statistically significant (p <
0.05), and the children in the experimental group suffered less
post-operative pain. Conclusion(s): Eye masks are a simple, safe and
economical intervention, that is beneficial for improving the
post-operative sleep quality and relieving post-operative pain in
school-age children with congenital heart disease. Copyright ©
The Author(s), 2021. Published by Cambridge University Press.

<94>
Accession Number
2015979833
Title
Clinical and Cardiovascular Characteristics of Patients Suffering
ST-Segment Elevation Myocardial Infarction After Covid-19: A Systematic
Review and Meta-Analysis.
Source
Current Problems in Cardiology. (no pagination), 2021. Article Number:
101045. Date of Publication: 2021.
Author
Gharibzadeh A.; Shahsanaei F.; Rahimi Petrudi N.
Institution
(Gharibzadeh) Assistant Professor of Cardiology, School of Medicine,
Cardiovascular Research Center, Shahid Mohammadi Hospital, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
(Shahsanaei) Interventional Cardiologist, Hypertension Research center,
Cardiovascular Research Institute, Isfahan University Of Medical Sciences,
Isfahan, Iran, Islamic Republic of
(Rahimi Petrudi) Resident Of Cardiology, School of Medicine,
Cardiovascular Research Center, Shahid Mohammadi Hospital, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran, Islamic Republic of
Publisher
Elsevier Inc.
Abstract
ST-segment elevation myocardial infarction (STEMI) is one of the fatal
complications following Covid-19. We aimed to systematically assess the
clinical sequels as well as cardiovascular findings in patients suffering
STEMI following Covid-19.The manuscripts databases including PubMed, Web
of knowledge (ISI), SCOPUS, Embase, and Google Scholar were deeply
searched by the two reviewers using the relevant keywords related to the
issue considered in the current review. Of 88 studies initially reviewed,
9 articles were included in final assessment. Nine articles including 447
patients with Covid-19 were included in the study. In terms of
electrocardiographic findings, anterior lead involvement was reported in
12% - 61.6% of cases, inferior lead in 28.2% - 75% and lateral involvement
in 7.7% - 100% of cases. The prevalence of LBBB was in the range of 10.7%
- 61.6% of cases. In terms of echocardiographic findings, a decrease in
left ventricular ejection fraction was reported in 60% - 88% of patients.
Wall motion abnormality was also observed in 60% - 82.1% of patients. In
terms of angiographic findings, the multi-vessel disease was reported in
17.9% - 69% of cases. Also, 24% - 83% of cases needed to revascularization
procedures. Cardiac arrest was also reported in 3.1% - 28.2% of cases.
Based on the meta-analysis performed on the mortality of patients with
STEMI in the field of Covid-19, the pooled prevalence of mortality was
estimated at 25.2% (95%CI:17.5%-34.8%). Mortality and adverse consequences
of STEMI in patients with Covid-19 are far higher than in the general
population. Therefore, in-hospital cardiovascular tracking and monitoring
of Covid-19 patients with potential cardiovascular disorders is necessary
to achieve a more favorable outcome. Copyright © 2021 Elsevier
Inc.

<95>
Accession Number
632267170
Title
The Impact of Robotic-Assisted Surgery on Team Performance: A Systematic
Mixed Studies Review.
Source
Human factors. 63(8) (pp 1352-1379), 2021. Date of Publication: 01 Dec
2021.
Author
Gillespie B.M.; Gillespie J.; Boorman R.J.; Granqvist K.; Stranne J.;
Erichsen-Andersson A.
Institution
(Gillespie, Boorman) School of Nursing & Midwifery & Menzies Institute of
Health, Brisbane, Australia
(Gillespie) Gold Coast Hospital and Health Service, Australia
(Gillespie) Services Australia, Brisbane, Australia
(Granqvist, Erichsen-Andersson) Institute of Health & Caring Sciences,
University of Gothenburg, Sweden
(Stranne) Sahlgrenska University Hospital, Gothenburg, Sweden
(Stranne) 3570University of Gothenburg, Sweden
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The aim of this study is to describe the impact of
robotic-assisted surgery on team performance in the operating room.
BACKGROUND: The introduction of surgical robots has improved the technical
performance of surgical procedures but has also contributed to unexpected
interactions in surgical teams, leading to new types of errors.
 METHOD(S): A systematic literature search of Cumulative Index to
Nursing and Allied Health Literature, PubMed, ProQuest, Cochrane, Web of
Science, PsycINFO, and Scopus databases using key words and MeSH terms was
conducted. Screening identified studies employing qualitative and
quantitative methods published between January 2000 and September 2019.
Two reviewers independently appraised the methodological quality of the
articles using the Mixed Methods Appraisal Tool (2018). Discussions were
held among authors to examine quality scores of the studies and emergent
themes, and agreement was reached through consensus. Themes were derived
using inductive content analysis. RESULT(S): Combined searches
identified 1,065 citations. Of these, 19 articles, 16 quantitative and 3
qualitative, were included. Robotic-assisted surgeries included urology,
gynecology, cardiac, and general procedures involving surgeons,
anesthetists, nurses, and technicians. Three themes emerged: Negotiating
the altered physical environs and adapting team communications to manage
task and technology; managing the robotic system to optimize workflow
efficiency; and technical proficiency depends on experience, team
familiarity, and case complexity. CONCLUSION(S): Inclusion of a robot
as a team member adds further complexity to the work of surgery.
APPLICATION: These review findings will inform training programs
specifically designed to optimize teamwork, workflow efficiency, and
learning needs.

<96>
Accession Number
636728737
Title
Systematic review and meta-analysis on perioperative intervention to
prevent postoperative atelectasis complications after thoracic surgery.
Source
Annals of palliative medicine. 10(10) (pp 10726-10734), 2021. Date of
Publication: 01 Jan 2021.
Author
Zhao Y.; Zheng R.; Xiang W.; Ning D.; Li Z.
Institution
(Zhao, Xiang, Ning, Li) Department of Thoracic Surgery, Affiliated
Hospital of North Sichuan Medical College, China
(Zheng) Affiliated Hospital of North Sichuan Medical College, Department
of Integrated Western and Chinese Colorectal and Anal Surgery, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: In clinical general thoracic surgery, the prevalence of
atelectasis is relatively high. Perioperative interventions can affect the
probability of patients with atelectasis after surgery. Therefore, the
incidence of perioperative intervention to prevent atelectasis after
thoracic surgery was discussed using meta-analysis in this study.
 METHOD(S): The articles were searched in the English database PubMed
and Chinese databases including China National Knowledge Infrastructure
(CNKI), VIP, and China Journal Full-text Database (CJFD). The duration for
publication time of the articles was from the database inception to March
2021, and the articles were required to be randomized controlled trials
(RCTs) using interventions [such as changing the dose of general
anesthesia, continuous positive end expiratory pressure (PEEP),
non-invasive pressure support ventilation, and physical therapy] after
thoracic surgery (such as pulmonary lobectomy, sternum surgery, and lung
cancer surgery) for the treatment of atelectasis. The software RevMan 5.3
provided by the Cochrane Collaboration was used for meta-analysis.
 RESULT(S): A total of 5 articles were obtained, including 375 cases
in the control group and 268 cases in the intervention treatment group. A
meta-analysis was performed on the included articles, combined effect
model analysis results showed that compared with the control group, the
use of PEEP during mechanical ventilation can significantly reduce the
incidence of atelectasis [odds ratio (OR) =0.46; 95% confidence interval
(CI): 0.31-0.67; Z=3.94; P<0.0001]. DISCUSSION: Perioperative intervention
was more effective for postoperative atelectasis and other complications.

<97>
Accession Number
2013963525
Title
Effects of single versus dual antiplatelet therapy on the adverse events
after transcatheter aortic valve implantation: A meta-analysis.
Source
Clinical Cardiology. 44(12) (pp 1718-1728), 2021. Date of Publication:
December 2021.
Author
Yu S.; Zhang S.; Yao C.; Liu J.
Institution
(Yu, Zhang, Yao, Liu) Heart Center, Affiliated Zhongshan Hospital of
Dalian University, Dalian, China
Publisher
John Wiley and Sons Inc
Abstract
Dual antiplatelet therapy (DAPT) was currently recommended for
transcatheter aortic valve implantation (TAVI) postoperative management in
clinical application. However, POPular-TAVI trial showed DAPT increased
the incidence of adverse events compared to single antiplatelet therapy
(SAPT). Herein, we performed a meta-analysis to investigate the effect of
SAPT versus DAPT on the adverse events after TAVI. Eleven studies were
available from PubMed, Embase, Cochrane Library, and Web of Science from
inception to April 1, 2021. The pooled effect size was presented as
relative risk (RR) with 95% confidence intervals (CIs). The sensitivity
analysis was used to assess the stability of analysis results, and Begg's
test was applied to evaluate the publication bias. The Cochran Q test and
the I2 statistic were used to evaluate the heterogeneity, and
the source of heterogeneity was explored by meta-regression. A total of
4804 patients were obtained, with 2257 in SAPT group and 2547 in DAPT
group. Compared to the DAPT, SAPT was associated with the decreased risk
of all-cause bleeding (RR: 0.51, 95% CI: 0.44-0.61), major bleeding (RR:
0.53, 95% CI: 0.32-0.86), and minor bleeding (RR: 0.58, 95% CI:
0.34-0.98). There were no significant differences in mortality and
myocardial infarction events, stroke events, and acute kidney injury
between the two groups. SAPT was superior to DAPT in decreasing all-cause
bleeding, major bleeding, and minor bleeding, suggesting that SAPT could
be preferentially recommended for TAVI postoperative management in most
patients without another indication for DAPT and oral
anticoagulation. Copyright © 2021 The Authors. Clinical
Cardiology published by Wiley Periodicals LLC.

<98>
Accession Number
636467151
Title
Assessment of Intercostal Nerve Block Analgesia for Thoracic Surgery: A
Systematic Review and Meta-analysis.
Source
JAMA Network Open. (no pagination), 2021. Article Number: e2133394. Date
of Publication: 2021.
Author
Guerra-Londono C.E.; Privorotskiy A.; Cozowicz C.; Hicklen R.S.;
Memtsoudis S.G.; Mariano E.R.; Cata J.P.
Institution
(Guerra-Londono, Cata) Department of Anesthesiology and Perioperative
Medicine, MD Anderson Cancer Center, University of Texas, 1515 Holcombe
Blvd, Houston, TX 77030, United States
(Privorotskiy) Eastern Virginia Medical School, Norfolk, United States
(Cozowicz) Department of Anesthesiology, Perioperative Medicine and
Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
(Hicklen) Research Medical Library, MD Anderson Cancer Center, University
of Texas, Houston, United States
(Memtsoudis) Department of Anesthesia, Hospital for Special Surgery, New
York, NY, United States
(Mariano) Department of Anesthesia, School of Medicine, Stanford
University, Stanford, CA, United States
(Cata) Anesthesiology and Surgical Oncology Research Group, Houston, TX,
United States
Publisher
American Medical Association
Abstract
Importance: The use of intercostal nerve block (ICNB) analgesia with local
anesthesia is common in thoracic surgery. However, the benefits and safety
of ICNB among adult patients undergoing surgery is unknown.
 Objective(s): To evaluate the analgesic benefits and safety of ICNB
among adults undergoing thoracic surgery. Data Sources: A systematic
search was performed in Ovid MEDLINE, Ovid Embase, Scopus, and the
Cochrane Library databases using terms for ICNB and thoracic surgery
(including thoracic surgery, thoracoscopy, thoracotomy, nerve block,
intercostal nerves). The search and results were not limited by date, with
the last search conducted on July 24, 2020. Study Selection: Selected
studies were experimental or observational and included adult patients
undergoing cardiothoracic surgery in which ICNB was administered with
local anesthesia via single injection, continuous infusion, or a
combination of both techniques in at least 1 group of patients. For
comparison with ICNB, studies that examined systemic analgesia and
different forms of regional analgesia (such as thoracic epidural analgesia
[TEA], paravertebral block [PVB], and other techniques) were included.
These criteria were applied independently by 2 authors, and discrepancies
were resolved by consensus. A total of 694 records were selected for
screening. Data Extraction and Synthesis: This study followed the
Preferred Reporting Items for Systematic Reviews and Meta-analyses
(PRISMA) reporting guideline. Data including patient characteristics, type
of surgery, intervention analgesia, comparison analgesia, and primary and
secondary outcomes were extracted independently by 3 authors. Synthesis
was performed using a fixed-effects model. Main Outcomes and
Measures: The coprimary outcomes were postoperative pain intensity
(measured as the worst static or dynamic pain using a validated 10-point
scale, with 0 indicating no pain and 10 indicating severe pain) and opioid
consumption (measured in morphine milligram equivalents [MMEs]) at
prespecified intervals (0-6 hours, 7-24 hours, 25-48 hours, 49-72 hours,
and >72 hours). Clinically relevant analgesia was defined as a 1-point or
greater difference in pain intensity score at any interval. Secondary
outcomes included 30-day postoperative complications and pulmonary
function. Result(s): Of 694 records screened, 608 were excluded based
on prespecified exclusion criteria. The remaining 86 full-text articles
were assessed for eligibility, and 20 of those articles were excluded. All
of the 66 remaining studies (5184 patients; mean [SD] age, 53.9 [10.2]
years; approximately 59% men and 41% women) were included in the
qualitative analysis, and 59 studies (3325 patients) that provided data
for at least 1 outcome were included in the quantitative meta-analysis.
Experimental studies had a high risk of bias in multiple domains,
including allocation concealment, blinding of participants and personnel,
and blinding of outcome assessors. Marked differences (eg, crossover
studies, timing of the intervention [intraoperative vs postoperative],
blinding, and type of control group) were observed in the design and
implementation of studies. The use of ICNB vs systemic analgesia was
associated with lower static pain (0-6 hours after surgery: mean score
difference, -1.40 points [95% CI, -1.46 to -1.33 points]; 7-24 hours after
surgery: mean score difference, -1.27 points [95% CI, -1.40 to -1.13
points]) and lower dynamic pain (0-6 hours after surgery: mean score
difference, -1.66 points [95% CI, -1.90 to -1.41 points]; 7-24 hours after
surgery: mean score difference, -1.43 points [95% CI, -1.70 to -1.17
points]). Intercostal nerve block analgesia was noninferior to TEA (mean
score difference in worst dynamic panic at 7-24 hours after surgery: 0.79
points; 95% CI, 0.28-1.29 points) and marginally inferior to PVB (mean
score difference in worst dynamic pain at 7-24 hours after surgery: 1.29
points; 95% CI, 1.16 to 1.41 points). The largest opioid-sparing effect of
ICNB vs systemic analgesia occurred at 48 hours after surgery (mean
difference, -10.97 MMEs; 95% CI, -12.92 to -9.02 MMEs). The use of ICNB
was associated with higher MME values compared with TEA (eg, 48 hours
after surgery: mean difference, 48.31 MMEs; 95% CI, 36.11-60.52 MMEs) and
PVB (eg, 48 hours after surgery: mean difference, 3.87 MMEs; 95% CI,
2.59-5.15 MMEs). Conclusions and Relevance: In this study,
single-injection ICNB was associated with a reduction in pain during the
first 24 hours after thoracic surgery and was clinically noninferior to
TEA or PVB. Intercostal nerve block analgesia had opioid-sparing effects;
however, TEA and PVB were associated with larger decreases in
postoperative MMEs, suggesting that ICNB may be most beneficial for cases
in which TEA and PVB are not indicated. Copyright © 2021 American
Medical Association. All rights reserved.

<99>
Accession Number
2014308080
Title
Ultrafiltration and cardiopulmonary bypass associated acute kidney injury:
A systematic review and meta-analysis.
Source
Clinical Cardiology. 44(12) (pp 1700-1708), 2021. Date of Publication:
December 2021.
Author
Kandil O.A.; Motawea K.R.; Darling E.; Riley J.B.; Shah J.; Elashhat
M.A.M.; Searles B.; Aiash H.
Institution
(Kandil, Motawea) Faculty of Medicine, Alexandria University, Alexandria,
Egypt
(Darling, Riley, Searles, Aiash) Department of Cardiovascular Perfusion,
State University of New York Upstate Medical University, Syracuse, NY,
United States
(Shah) Medical Research Center, Kateb University, Kabul, Afghanistan
(Elashhat) Aswan Heart Center (Magdy Yacoub Foundation), Aswan
Governorate, Aswan, Egypt
(Aiash) Department of Family Medicine, Faculty of Medicine, Suez Canal
University, Ismailia, Egypt
(Aiash) Department of Surgery, State University of New York Upstate
Medical University, Syracuse, NY, United States
Publisher
John Wiley and Sons Inc
Abstract
Background: Cardiopulmonary bypass is known to raise the risk of acute
kidney injury (AKI). Previous studies have identified numerous risk
factors of cardiopulmonary bypass including the possible impact of
perioperative ultrafiltration. However, the association between
ultrafiltration (UF) and AKI remains conflicting. Thus, we conducted a
meta-analysis to further examine the relationship between UF and AKI.
Hypothesis: Ultrafiltration during cardiac surgery increases the risk of
developping Acute kidney Injury. Method(s): We searched PubMed, Web
of Science, EBSCO, and SCOPUS through July 2021. The RevMan (version 5.4)
software was used to calculate the pooled risk ratios (RRs) and mean
differences along with their associated confidence intervals (95% CI).
 Result(s): We identified 12 studies with a total of 8005 patients.
There was no statistically significant difference in the incidence of AKI
between the group who underwent UF and the control group who did not (RR =
0.90, 95% CI = 0.64-1). Subgroup analysis on patients with previous renal
insufficiency also yielded nonsignificant difference (RR = 0.84, 95% CI =
0.53 -1.33, p =.47). Subgroup analysis based on volume of ultrafiltrate
removed (> or <2900 ml) was not significant and did not increase the AKI
risk as predicted (RR = 0.82, 95% CI = 0.63 -1.07, p =.15). We also did
subgroup analysis according to the type of UF and again no significant
difference in AKI incidence between UF groups and controls was observed in
either the conventional ultrafiltration (CUF), modified ultrafiltration
(MUF), zero-balanced ultrafiltration (ZBUF), or combined MUF and CUF
subgroups. Conclusion(s): UF in cardiac surgery is not associated
with increased AKI incidence and may be safely used even in baseline
chronic injury patients. Copyright © 2021 The Authors. Clinical
Cardiology published by Wiley Periodicals LLC.

<100>
Accession Number
2014243457
Title
Radial versus femoral access in patients with coronary artery bypass
surgery: Frequentist and Bayesian meta-analysis.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2021.
Date of Publication: 2021.
Author
Nikolakopoulos I.; Vemmou E.; Xenogiannis I.; Karacsonyi J.; Rao S.V.;
Romagnoli E.; Tsigkas G.; Milkas A.; Velagapudi P.; Alaswad K.; Rangan
B.V.; Garcia S.; Burke M.N.; Brilakis E.S.
Institution
(Nikolakopoulos, Vemmou, Xenogiannis, Karacsonyi, Rangan, Garcia, Burke,
Brilakis) Minneapolis Heart Institute and Minneapolis Heart Institute
Foundation, Abbott Northwestern Hospital, Minneapolis, MN, United States
(Rao) Duke Clinical Research Institute, Durham, NC, United States
(Romagnoli) Department of Cardiovascular and Thoracic Sciences, Institute
of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS,
Universita Cattolica del Sacro Cuore, Rome, Italy
(Tsigkas) Department of Cardiology, University of Patras Medical School,
Patras, Greece
(Milkas) Acute Cardiac Care Unit, Athens Naval and Veterans Hospital,
Athens, Greece
(Velagapudi) University of Nebraska Medical Center, Omaha, NE, United
States
(Alaswad) Department of Cardiology, Henry Ford Hospital, Detroit, MI,
United States
Publisher
John Wiley and Sons Inc
Abstract
Background: The optimal access site for cardiac catheterization in
patients with prior coronary artery bypass surgery (CABG) continues to be
debated. Method(s): We performed a random effects frequentist and
Bayesian meta-analysis of 4 randomized trials and 18 observational
studies, including 60,192 patients with prior CABG (27,236 in the radial
group; 32,956 in the femoral group) that underwent cardiac
catheterization. Outcomes included (1) access-site complications, (2)
crossover to a different vascular access, (3) procedure time, and (4)
contrast volume. Mean differences (MD) and 95% confidence interval (CI)
were calculated for continuous outcomes and odds ratios (OR) and 95% CI
for binary outcomes. Result(s): Among randomized trials, crossover
(OR: 7.63; 95% CI: 2.04, 28.51; p = 0.003) was higher in the radial group,
while access site complications (OR: 0.96; 95% CI: 0.34, 2.87; p = 0.94)
and contrast volume (MD: 15.08; 95% CI: -10.19, 40.35; p = 0.24) were
similar. Among observational studies, crossover rates were higher (OR:
5.09; 95% CI: 2.43, 10.65; p < 0.001), while access site complication
rates (OR: 0.52; 95% CI: 0.30, 0.89; p = 0.02) and contrast volume (MD:
-7.52; 95% CI: -13.14, -1.90 ml; p = 0.009) were lower in the radial
group. Bayesian analysis suggested that the odds of a difference existing
between radial and femoral are small for all endpoints except crossover to
another access site. Conclusion(s): In a frequentist and Bayesian
meta-analysis of patients with prior CABG undergoing coronary
catheterization, radial access was associated with lower incidence of
vascular access complications and lower contrast volume but also higher
crossover rate. Copyright © 2021 Wiley Periodicals LLC.

<101>
Accession Number
2014242360
Title
Shedding some light on tricuspid intervention.
Source
Journal of Cardiac Surgery. (no pagination), 2021. Date of Publication:
2021.
Author
Fattouch K.; Moscarelli M.
Institution
(Fattouch) Dicronis, Department of Cardiovascular Surgery, University of
Palermo, Palermo, Italy
(Moscarelli) Department of Cardiac Surgery, GVM Care and Research, Anthea
Hospital, Bari, Italy
Publisher
John Wiley and Sons Inc
Abstract
Background: More than 1.6 million Americans have at least moderate to
severe valvular tricuspid regurgitation, yet fewer than 8000 tricuspid
valve operations are performed annually in the USA. The undertreatment for
isolated tricuspid regurgitation might be related to the fact that in the
past years no clear guidelines on 'how' and 'when' to treat tricuspid
regurgitation were issued. Aim(s): Sarris-Michopoulos and colleagues
carried out a meta-analysis with the aim to investigate the role of
tricuspid valve repair versus tricuspid valve replacement in patients with
isolated tricuspid valve regurgitation. Material(s) and Method(s):
Outcomes of patients with first-time surgery for isolated tricuspid valve
regurgitation without previous left-sided valve surgery were reviewed. Ten
studies were included with a total of 1407 patients. Result(s):
Authors concluded that patients who underwent tricuspid valve repair
showed less 30-days mortality than replacement along with a reduced need
for post-operaitve permanent pacemaker implantation rate.
 Discussion(s): Decision on whether to treat or not tricuspid valve is
demanding, particularly in the context of the newest percutaneous
technologies. Before intervention, careful evaluation of both tricuspid
valve and right ventricle must be performed. Nevertheless, intervention,
should not be deferred when clinically indicated. Conclusion(s): The
findings form this meta-analysis suggest that reparative surgery, perhaps
in an early stage, may be beneficial in selected cohort of
patients. Copyright © 2021 Wiley Periodicals LLC

<102>
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. (no pagination), 2021. Date of Publication:
2021.
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. 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. 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. 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. Copyright ©
2021 Wiley Periodicals LLC

<103>
Accession Number
2014198948
Title
Effect of routine preoperative screening for aortic calcifications using
noncontrast computed tomography on stroke rate in cardiac surgery: the
randomized controlled CRICKET study.
Source
European Radiology. (no pagination), 2021. Date of Publication: 2021.
Author
Knol W.G.; Simon J.; Den Harder A.M.; Bekker M.W.A.; Suyker W.J.L.; de
Heer L.M.; de Jong P.A.; Leiner T.; Merkely B.; Polos M.; Krestin G.P.;
Boersma E.; Koudstaal P.J.; Maurovich-Horvat P.; Bogers A.J.J.C.; Budde
R.P.J.
Institution
(Knol, Bekker, Bogers) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Knol, Krestin, Budde) Department of Radiology and Nuclear Medicine,
Erasmus University Medical Center, PO BOX 2040, Rotterdam ND-547, 3000-CA,
Netherlands
(Simon, Merkely, Maurovich-Horvat) Department of Cardiology, Heart and
Vascular Center, Semmelweis University, Budapest, Hungary
(Den Harder, de Jong, Leiner) Department of Radiology, University Medical
Center Utrecht and Utrecht University, Utrecht, Netherlands
(Suyker, de Heer) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Polos) Department of Cardiovascular Surgery, Heart and Vascular Center,
Semmelweis University, Budapest, Hungary
(Boersma) Department of Clinical Epidemiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Koudstaal) Department of Neurology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Maurovich-Horvat) Department of Radiology, Medical Imaging Centre,
Semmelweis University, Budapest, Hungary
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: To evaluate if routine screening for aortic calcification
using unenhanced CT lowers the risk of stroke and alters the surgical
approach in patients undergoing general cardiac surgery compared with
standard of care (SoC). Method(s): In this prospective, multicenter,
randomized controlled trial, adult patients scheduled for cardiac surgery
from September 2014 to October 2019 were randomized 1:1 into two groups:
SoC alone, including chest radiography, vs. SoC plus preoperative
noncontrast CT. The primary endpoint was in-hospital perioperative stroke.
Secondary endpoints were preoperative change of the surgical approach,
in-hospital mortality, and postoperative delirium. The trial was halted
halfway for expected futility, as the conditional power analysis showed a
chance < 1% of finding the hypothesized effect. Result(s): A total of
862 patients were evaluated (SoC-group: 433 patients (66 +/- 11 years;
74.1% male) vs. SoC + CT-group: 429 patients (66 +/- 10 years; 69.9%
male)). The perioperative stroke rate (SoC + CT: 2.1%, 9/429 vs. SoC:
1.2%, 5/433, p = 0.27) and rate of changed surgical approach (SoC + CT:
4.0% (17/429) vs. SoC: 2.8% (12/433, p = 0.35) did not differ between
groups. In-hospital mortality and postoperative delirium were comparable
between groups. In the SoC + CT group, aortic calcification was observed
on CT in the ascending aorta in 28% (108/380) and in the aortic arch in
70% (265/379). Conclusion(s): Preoperative noncontrast CT in cardiac
surgery candidates did not influence the surgical approach nor the
incidence of perioperative stroke compared with standard of care. Aortic
calcification is a frequent finding on the CT scan in these patients but
results in major surgical alterations to prevent stroke in only few
patients. Key Points: * Aortic calcification is a frequent finding on
noncontrast computed tomography prior to cardiac surgery. * Routine use of
noncontrast computed tomography does not often lead to a change of the
surgical approach, when compared to standard of care. * No effect was
observed on perioperative stroke after cardiac surgery when using routine
noncontrast computed tomography screening on top of standard of
care. Copyright © 2021, The Author(s).

<104>
Accession Number
634355114
Title
Association of intraoperative hypotension with postoperative morbidity and
mortality: systematic review and meta-analysis.
Source
BJS open. 5(1) (no pagination), 2021. Date of Publication: 08 Jan 2021.
Author
Wijnberge M.; Schenk J.; Bulle E.; Vlaar A.P.; Maheshwari K.; Hollmann
M.W.; Binnekade J.M.; Geerts B.F.; Veelo D.P.
Institution
(Wijnberge, Schenk, Bulle, Hollmann, Geerts, Veelo) Department of
Anaesthesiology, Amsterdam University Medical Centre, Amsterdam,
Netherlands
(Wijnberge, Bulle, Vlaar, Binnekade) Department of Intensive Care,
Amsterdam University Medical Centre, Amsterdam, Netherlands
(Wijnberge, Vlaar, Hollmann) Laboratory of Experimental Intensive Care and
Anaesthesiology, Amsterdam University Medical Centre, Amsterdam,
Netherlands
(Maheshwari) Department of General Anaesthesiology, Outcomes Research,
Cleveland Clinic, Cleveland, OH, United States
Publisher
NLM (Medline)
Abstract
BACKGROUND: Intraoperative hypotension, with varying definitions in
literature, may be associated with postoperative complications. The aim of
this meta-analysis was to assess the association of intraoperative
hypotension with postoperative morbidity and mortality. METHOD(S):
MEDLINE, Embase and Cochrane databases were searched for studies published
between January 1990 and August 2018. The primary endpoints were
postoperative overall morbidity and mortality. Secondary endpoints were
postoperative cardiac outcomes, acute kidney injury, stroke, delirium,
surgical outcomes and combined outcomes. Subgroup analyses, sensitivity
analyses and a meta-regression were performed to test the robustness of
the results and to explore heterogeneity. RESULT(S): The search
identified 2931 studies, of which 29 were included in the meta-analysis,
consisting of 130 862 patients. Intraoperative hypotension was associated
with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent
confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84).
In the secondary analyses, intraoperative hypotension was associated with
cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR
2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of
88 per cent. When hypotension severity, outcome severity and study
population variables were added to the meta-regression, heterogeneity was
reduced to 50 per cent. CONCLUSION(S): Intraoperative hypotension
during non-cardiac surgery is associated with postoperative cardiac and
renal morbidity, and mortality. A universally accepted standard definition
of hypotension would facilitate further research into this
topic. Copyright © The Author(s) 2021. Published by Oxford
University Press on behalf of BJS Society Ltd.

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