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<1>
Accession Number
2014158266
Title
Sugammadex, neostigmine and postoperative pulmonary complications: an
international randomised feasibility and pilot trial.
Source
Pilot and Feasibility Studies. 7(1) (no pagination), 2021. Article Number:
200. Date of Publication: December 2021.
Author
Leslie K.; Chan M.T.V.; Darvall J.N.; De Silva A.P.; Braat S.; Devlin
N.J.; Peyton P.J.; Radnor J.; Lam C.K.M.; Sidiropoulos S.; Story D.A.
Institution
(Leslie, Darvall, Peyton, Sidiropoulos, Story) Department of Critical
Care, Melbourne Medical School, University of Melbourne, Melbourne,
Australia
(Leslie, Darvall) Department of Anaesthesia and Pain Management, Royal
Melbourne Hospital, Melbourne, Australia
(Chan) Department of Anaesthesia and Intensive Care, Chinese University of
Hong Kong, The Prince of Wales Hospital, Hong Kong
(De Silva, Braat) Centre for Epidemiology and Biostatistics, Melbourne
School of Population and Global Health, University of Melbourne,
Melbourne, Australia
(De Silva, Braat) Methods and Implementation Support for Clinical and
Health (MISCH) Research Hub, Faculty of Medicine, Dentistry and Health
Sciences, University of Melbourne, Melbourne, Australia
(Devlin) Health Economics Unit, Melbourne School of Population and Global
Health, Melbourne, Australia
(Peyton, Sidiropoulos, Story) Department of Anaesthesia, Austin Health,
Melbourne, Australia
(Radnor) Department of Anaesthesia and Pain Management, Northeast Health
Wangaratta, Wangaratta, Australia
(Lam) Department of Anaesthesia and Operating Room Services, Tuen Mun
Hospital, Hong Kong
Publisher
BioMed Central Ltd
Abstract
Background: Sugammadex reduces residual neuromuscular blockade after
anaesthesia, potentially preventing postoperative pulmonary complications.
However, definitive evidence is lacking. We therefore conducted a
feasibility and pilot trial for a large randomised controlled trial of
sugammadex, neostigmine, and postoperative pulmonary complications.
 Method(s): Patients aged >=40 years having elective or expedited
abdominal or intrathoracic surgery were recruited in Australia and Hong
Kong. Perioperative care was at the discretion of clinicians, except for
the use of rocuronium and/or vecuronium for neuromuscular blockade and the
randomised intervention (sugammadex or neostigmine) for reversal.
Feasibility measurements included recruitment, crossover, acceptability,
completeness, and workload. Trial coordinator feedback was systematically
sought. Patient-reported quality of life was measured using the EQ-5D-5L
score. The primary pilot outcome was the incidence of new pulmonary
complications up to hospital discharge (or postoperative day 7 if still in
hospital). Result(s): Among 150 eligible patients, 120 consented to
participate (recruitment rate 80%, 95% confidence interval [CI] 73 to
86%). The randomised intervention was administered without crossover to
115 of 117 patients who received reversal (98%, 95% CI 94 to 100%). The
protocol was acceptable or highly acceptable to the anaesthetist in 108 of
116 cases (93%, 95% CI 87 to 97%; missing = 4). Four patients of the 120
patients were lost to follow-up at 3 months (3.3%, 95% CI 0.9 to 8.3%).
Case report forms were complete at 3 months for all remaining patients.
The median time to complete trial processes was 3.5 h (range 2.5-4.5 h).
Trial coordinators reported no barriers to trial processes. Patients were
aged 64 (standard deviation 11) years, 70 (58%) were male and 50 (42%)
were female, and planned surgeries were thoracic (23 [19%]), upper
abdominal (41 [34%]), and lower abdominal (56 [47%]). The primary outcome
was observed in 5 (8.5%) of the 59 sugammadex patients and 5 (8.2%) of the
61 neostigmine patients (odds ratio 1.02, 95% CI 0.28 to 3.67).
 Conclusion(s): A large international randomised controlled trial of
sugammadex, neostigmine and postoperative pulmonary complications in adult
patients having abdominal and intrathoracic surgery, including collection
of cost-effectiveness evidence for Health Technology Appraisal, is
feasible. Trial registration: Prospectively registered at the Australian
and New Zealand Clinical Trials Registry (ACTRN12620001313921) on December
7, 2020.
www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380645&isReview=t
rue. Copyright © 2021, The Author(s).

<2>
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

<3>
Accession Number
2015437205
Title
Differential Effects of Newer-Generation Ultrathin-Strut Versus
Thicker-Strut Drug-Eluting Stents in Chronic and Acute Coronary Syndromes.
Source
JACC: Cardiovascular Interventions. 14(22) (pp 2461-2473), 2021. Date of
Publication: 22 Nov 2021.
Author
Iglesias J.F.; Degrauwe S.; Cimci M.; Chatelain Q.; Roffi M.; Windecker
S.; Pilgrim T.
Institution
(Iglesias, Degrauwe, Cimci, Chatelain, Roffi) Department of Cardiology,
Geneva University Hospitals, Geneva, Switzerland
(Windecker, Pilgrim) Department of Cardiology, Inselspital, University of
Bern, Bern University Hospital, Bern, Switzerland
Publisher
Elsevier Inc.
Abstract
Objectives: The authors sought to compare the differential effects of
ultrathin-strut and thicker-strut drug-eluting stents (DES) in patients
with chronic (CCS) versus acute (ACS) coronary syndromes.
 Background(s): Newest-generation ultrathin-strut DES reduce target
lesion failure (TLF) compared with thicker-strut second-generation DES in
patients undergoing percutaneous coronary intervention. Method(s):
PubMed, Embase, and Cochrane Central Register of Controlled Trials were
searched for randomized controlled trials comparing newer-generation
ultrathin-strut (<70 mum) versus thicker-strut (>=70 mum) DES. Patients
were divided based on baseline clinical presentation (CCS versus ACS). The
primary endpoint was TLF, a composite of cardiac death, target vessel
myocardial infarction, or clinically indicated target lesion
revascularization (TLR). Result(s): A total of 22,766 patients from
16 randomized controlled trials were included, of which 9 trials reported
TLF rates in ACS patients. At a mean follow-up of 12.2 months, the risk of
TLF was lower among patients treated with ultrathin-strut compared with
thicker-strut DES (risk ratio [RR]: 0.85; 95% CI: 0.75-0.95; P = 0.006).
The difference was driven by a lower risk of clinically-indicated TLR (RR:
0.75; 95% CI: 0.63-0.89; P < 0.001) among patients treated with
ultrathin-strut DES. The treatment effect was consistent between patients
presenting with CCS and ACS (relative RR: 0.97; 95% CI: 0.73-1.31; P for
interaction = 0.854). In patients with ST-segment elevation myocardial
infarction, TLF risk was lower among those treated with ultrathin-
compared with thicker-strut DES (RR: 0.74; 95% CI: 0.54-0.99; P = 0.049).
 Conclusion(s): Ultrathin-strut DES reduce the risk of TLF compared
with thicker-strut second-generation DES in patients undergoing
percutaneous coronary intervention, a difference caused by a lower risk of
ischemia-driven TLR. The treatment effect was consistent among patients
with CCS and ACS. Copyright © 2021 The Authors

<4>
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. 63(1) (pp 60-68), 2022. Date of
Publication: 01 Feb 2022.
Author
Machado R.J.; Saraiva F.A.; Mancio J.; Sousa P.; Cerqueira R.J.; Barros
A.S.; Lourenco A.P.; Leite-Moreira A.F.
Institution
(Machado, Saraiva, Mancio, Sousa, Barros) Department of Surgery and
Physiology and Cardiovascular Research, Development Center, Faculty of
Medicine, University of Porto, Porto, Portugal
(Mancio) Department of Intensive Care and Perioperative Medicine, Royal
Brompton and Harefield & Guys and St. Thomas NHS Foundation Trust,
London, UK
(Cerqueira, Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao
University Hospital, Porto, Portugal
(Lourenco) Department of Anesthesiology, Sao Joao University Hospital,
Porto, Portugal
(Leite-Moreira) Department of Surgery and Physiology and Cardiovascular
Research, Development Center, Faculty of Medicine, University of Porto,
Porto, Portugal
Publisher
NLM (Medline)
Abstract
INTRODUCTION: 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 re-revascularization. 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.

<5>
[Use Link to view the full text]
Accession Number
636712761
Title
Remote Ischemic Preconditioning Reduces Acute Kidney Injury After Cardiac
Surgery: A Systematic Review and Meta-analysis of Randomized Controlled
Trials.
Source
Anesthesia and analgesia. 134(3) (pp 592-605), 2022. Date of Publication:
01 Mar 2022.
Author
Long Y.-Q.; Feng X.-M.; Shan X.-S.; Chen Q.-C.; Xia Z.; Ji F.-H.; Liu H.;
Peng K.
Institution
(Long, Shan, Chen, Ji, Peng) From the Department of Anesthesiology, First
Affiliated Hospital of Soochow University, Suzhou, China
(Feng) Department of Anesthesiology, University of Utah Health, Salt Lake
City, UT, United States
(Feng) Transitional Residency Program, Intermountain Medical Center,
Murray, UT, United States
(Xia, Liu) Department of Anesthesiology and Pain Medicine, University of
California Davis Health, Sacramento, CA, Mexico
Publisher
NLM (Medline)
Abstract
BACKGROUND: Results from previous studies evaluating the effects of remote
ischemic preconditioning (RIPC) on morbidity and mortality after cardiac
surgery are inconsistent. This meta-analysis of randomized controlled
trials (RCTs) aims to determine whether RIPC improves cardiac and renal
outcomes in adults undergoing cardiac surgery. METHOD(S): PubMed,
EMBASE, and Cochrane Library were comprehensively searched to identify
RCTs comparing RIPC with control in cardiac surgery. The coprimary
outcomes were the incidence of postoperative myocardial infarction (MI)
and the incidence of postoperative acute kidney injury (AKI).
Meta-analyses were performed using a random-effect model. Subgroup
analyses were conducted according to volatile only anesthesia versus
propofol anesthesia with or without volatiles, high-risk patients versus
non-high-risk patients, and Acute Kidney Injury Network (AKIN) or Kidney
Disease Improving Global Outcomes (KDIGO) criteria versus other criteria
for AKI diagnosis. RESULT(S): A total of 79 RCTs with 10,814 patients
were included. While the incidence of postoperative MI did not differ
between the RIPC and control groups (8.2% vs 9.7%; risk ratio [RR] = 0.87,
95% confidence interval [CI], 0.76-1.01, P = .07, I2 = 0%), RIPC
significantly reduced the incidence of postoperative AKI (22% vs 24.4%; RR
= 0.86, 95% CI, 0.77-0.97, P = .01, I2 = 34%). The subgroup analyses
showed that RIPC was associated with a reduced incidence of MI in
non-high-risk patients, and that RIPC was associated with a reduced
incidence of AKI in volatile only anesthesia, in non-high-risk patients,
and in the studies using AKIN or KDIGO criteria for AKI diagnosis.
 CONCLUSION(S): This meta-analysis demonstrates that RIPC reduces the
incidence of AKI after cardiac surgery. This renoprotective effect of RIPC
is mainly evident during volatile only anesthesia, in non-high-risk
patients, and when AKIN or KDIGO criteria used for AKI
diagnosis. Copyright © 2021 International Anesthesia Research
Society.

<6>
Accession Number
635973528
Title
Beta-Blocker Landiolol Hydrochloride in Preventing Atrial Fibrillation
Following Cardiothoracic Surgery: A Systematic Review and Meta-Analysis.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 28(1) (pp
18-31), 2022. Date of Publication: 20 Feb 2022.
Author
Hao J.; Zhou J.; Xu W.; Chen C.; Zhang J.; Peng H.; Liu L.
Institution
(Hao, Zhou, Chen, Zhang, Peng, Liu) Department of Thoracic Surgery, West
China Hospital, Sichuan University, Chengdu, China
(Hao, Zhou, Xu, Chen) West China School of Medicine, Sichuan University,
Chengdu, China
(Zhang) Department of Thoracic Surgery, Chest Oncology Institute, West
China Hospital, Sichuan University, Chengdu, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The purpose of this article was to assess the benefit of
perioperative administration of the intravenous beta-blocker landiolol
hydrochloride in preventing atrial fibrillation (AF) after cardiothoracic
surgery. METHOD(S): We performed a systematic search in PubMed, Web
of Science, CNKI, and OVID to identify randomized controlled trials (RCTs)
and cohorts up to January 2021. Data regarding postoperative atrial
fibrillation (POAF) and safety outcomes were extracted. Odds ratios (ORs)
with 95% confidence intervals (CIs) were determined using the
Mantel-Haenszel method. Meanwhile, subgroup analyses were conducted
according to surgery type including lung cancer surgery, esophageal cancer
surgery, and cardiac surgery. RESULT(S): Seventeen eligible articles
involving 1349 patients within 13 RCTs and four cohorts were included in
our meta-analysis. Compared with control group, landiolol administration
was associated with a significant reduction of the occurrence of AF after
cardiothoracic surgery (OR = 0.32, 95% CI 0.23-0.43, P <0.00001). In
addition, the results demonstrated that perioperative administration of
landiolol hydrochloride minimized the occurrence of postoperative
complications (OR = 0.48, 95% CI 0.33-0.70, P = 0.0002). Funnel plots
indicated no obvious publication bias. CONCLUSION(S): Considering
this analysis, landiolol was effective in the prevention of AF after
cardiothoracic surgery and did not increase the risk of major
postoperative complications.

<7>
Accession Number
635782311
Title
Evidence and Challenges in Left Atrial Appendage Management.
Source
Annals of thoracic and cardiovascular surgery : official journal of the
Association of Thoracic and Cardiovascular Surgeons of Asia. 28(1) (pp
1-17), 2022. Date of Publication: 20 Feb 2022.
Author
Yamamoto T.; Endo D.; Matsushita S.; Shimada A.; Nakanishi K.; Asai T.;
Amano A.
Institution
(Yamamoto, Endo, Matsushita, Shimada, Nakanishi, Asai, Amano) Department
of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
Publisher
NLM (Medline)
Abstract
This review aimed to discuss the anatomical properties of the left atrial
appendage (LAA), its relationship with atrial fibrillation (AF),
effectiveness of LAA occlusion (LAAO), techniques, and new devices used to
perform this procedure. An electronic search was performed to identify
studies, in the English language, on LAA management. Searches were
performed on PubMed Central, Scopus, and Medline from the dates of
database inception to February 2020. For the assessed papers, data were
extracted from the reviewed text, tables, and figures, by two independent
authors. Anticoagulant therapy for patients with AF has proven beneficial
and is highly recommended, but it is challenging for many patients to
maintain optimal treatment. Surgery is the most cost-effective option;
surgical methods include simple LAA resection, thoracoscopic surgery, and
catheter treatment. Each procedure has its advantages and disadvantages,
and many prospective studies have been conducted to evaluate various
treatment methods. In managing the LAA, dissection of the LAA, such as
changes in its shape and size due to remodeling during AF, changes in
autonomic nerve function, and thrombosis, must be understood anatomically
and physiologically. We believe that early treatment intervention for the
LAA should be considered particularly in cases of recurrent AF.

<8>
Accession Number
635563068
Title
Effectiveness of endovascular versus open surgical repair for thoracic
aortic aneurysm: a systematic review and meta-analysis.
Source
The Journal of cardiovascular surgery. 63(1) (pp 25-36), 2022. Date of
Publication: 01 Feb 2022.
Author
Mahboub-Ahari A.; Sadeghi-Ghyassi F.; Heidari F.
Institution
(Mahboub-Ahari) Tabriz Health Services Management Research Center, School
of Management and Medical Informatics, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Mahboub-Ahari, Sadeghi-Ghyassi) Research Center for Evidence-Based
Medicine: a JBI Center of Excellence, Tabriz University of Medical
Sciences, Tabriz, Iran, Islamic Republic of
(Heidari) Research Center for Evidence-Based Medicine: a JBI Center of
Excellence, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic
Republic of
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Since the approval, the thoracic endovascular aortic repair
(TEVAR) is widely used for the repair of thoracic aortic aneurysm.
However, the long-term mortality and re-intervention rates compared to
open surgical repair (OSR) are unclear. We aimed to compare the
effectiveness of TEVAR with OSR specifically for thoracic aortic
aneurysms. EVIDENCE ACQUISITION: We conducted a comprehensive search in
MEDLINE, PubMed, EMBASE, CINAHL, PROSPERO, Centre for Reviews and
Dissemination, and the Cochrane Library up to November 2020. The main
outcomes were early mortality, mid-to-long-term survival, and
re-intervention. The quality of the evidence was assessed using the GRADE
methodology. All analyses were performed using RevMan with the random
effect model and Comprehensive Meta-Analysis software. EVIDENCE SYNTHESIS:
One systematic review and 15 individual studies were included. Pooled
analysis showed that 30-day mortality, stroke, renal failure, and
pulmonary complications were significantly lower in TEVAR versus open
surgery. The pooled rate of re-intervention significantly favored the OSR.
The long-term survival and mortality favored TEVAR and OSR in one and two
studies, respectively, but was non-significant in seven analyzes.
 CONCLUSION(S): Early clinical outcomes including the 30-day
mortality, stroke, renal failure, and pulmonary complications
significantly favored the TEVAR. However, the mid-to-long-term
re-intervention rate favored the OSR and long-term survival was
inconsistent among the studies. The quality of evidence was very low. More
studies with longer follow-ups are needed. The use of TEVAR should be
decided by taking into account other factors including patient
characteristics and preferences, cost, and surgeon expertise.

<9>
[Use Link to view the full text]
Accession Number
2016887625
Title
A Systematic Review and Meta-analysis of Randomized Controlled Trials
Comparing Intraoperative Red Blood Cell Transfusion Strategies.
Source
Annals of Surgery. 275(3) (pp 456-466), 2022. Date of Publication: 01 Mar
2022.
Author
Lenet T.; Baker L.; Park L.; Vered M.; Zahrai A.; Shorr R.; Davis A.;
McIsaac D.I.; Tinmouth A.; Fergusson D.A.; Martel G.
Institution
(Lenet, Baker, Park, Vered, Zahrai, Fergusson, Martel) Department of
Surgery, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
(Lenet, Baker, Tinmouth, Fergusson) Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
(Shorr, Davis) Library Services, Ottawa Hospital, Ottawa, ON, Canada
(McIsaac) Department of Anesthesiology, Ottawa Hospital, University of
Ottawa, Ottawa, ON, Canada
(McIsaac, Tinmouth, Fergusson, Martel) Department of Medicine, Ottawa
Hospital, University of Ottawa, Ottawa, ON, Canada
(Tinmouth, Fergusson) Canadian Blood Services, Ottawa, ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Objective:The objective of this work was to carry out a meta-analysis of
RCTs comparing intraoperative RBC transfusion strategies to determine
their impact on postoperative morbidity, mortality, and blood product
use.Summary of Background Data:RBC transfusions are common in surgery and
associated with widespread variability despite adjustment for casemix.
Evidence-based recommendations guiding RBC transfusion in the operative
setting are limited. Method(s):The search strategy was adapted from a
previous Cochrane Review. Electronic databases were searched from January
2016 to February 2021. Included studies from the previous Cochrane Review
were considered for eligibility from before 2016. RCTs comparing
intraoperative transfusion strategies were considered for inclusion.
Co-primary outcomes were 30-day mortality and morbidity. Secondary
outcomes included intraoperative and perioperative RBC transfusion.
Meta-analysis was carried out using random-effects models.
 Result(s):Fourteen trials (8641 patients) were included. One cardiac
surgery trial accounted for 56% of patients. There was no difference in
30-day mortality [relative risk (RR) 0.96, 95% confidence interval (CI)
0.71-1.29] and pooled postoperative morbidity among the studied outcomes
when comparing restrictive and liberal protocols. Two trials reported
worse composite outcomes with restrictive triggers. Intraoperative (RR
0.53, 95% CI 0.43-0.64) and perioperative (RR 0.70, 95% CI 0.62-0.79)
blood transfusions were significantly lower in the restrictive group
compared to the liberal group. Conclusion(s):Intraoperative
restrictive transfusion strategies decreased perioperative transfusions
without added postoperative morbidity and mortality in 12/14 trials. Two
trials reported worse outcomes. Given trial design and generalizability
limitations, uncertainty remains regarding the safety of broad application
of restrictive transfusion triggers in the operating room. Trials
specifically designed to address intraoperative transfusions are urgently
needed. Copyright © 2022 Lippincott Williams and Wilkins. All
rights reserved.

<10>
Accession Number
2016922421
Title
Effect of retrograde autologous priming on lactate and hemoglobin levels
of adult patients undergoing coronary artery bypass grafting.
Source
Anaesthesia, Pain and Intensive Care. 26(1) (pp 20-24), 2022. Date of
Publication: 01 Feb 2022.
Author
Naseer M.; Feroze R.; Akram M.A.; Fakhar-E-Fayaz
Institution
(Naseer, Akram, Fakhar-E-Fayaz) Department of Cardiac Anesthesia &
Intensive Care, Army Cardiac Center, Combined Military Hospital, Lahore,
Pakistan
(Feroze) Department of Anesthesiology & Intensive Care, Combined Military
Hospital Lahore Medical & Dental College, Lahore, Pakistan
Publisher
Faculty of Anaesthesia, Pain and Intensive Care, AFMS
Abstract
Background: Reduced hemoglobin, excessive transfusions and raised lactate
levels are important determinants of patient outcome after cardiopulmonary
bypass. Many strategies have been studied for optimum management of these
parameters. In this study, we evaluated the impact of retrograde
autologous priming (RAP) method on hemoglobin and lactate levels in
patients undergoing coronary artery bypass grafting (CABG) on
cardiopulmonary bypass. Methodology: This prospective randomized
controlled trial was conducted at Army Cardiac Centre, CMH, Lahore, from
January 01, 2021 to June 30, 2021. After approval of institutional ethical
committee and taking informed consent from patients, 272 patients
undergoing CABG were enrolled. Patients with ages less than 18 y, LVEF <=
20%, emergency operations, repeat operations, valvular or combined
procedures, recent myocardial infarction, with preoperative lactate levels
of more than 2 mmol/L and Hb of less than 9 gm/dL and other preoperative
systemic diseases or infection were excluded. Patients were divided into
two groups. Group A received conventional priming of bypass circuit with
ringer lactate, and Group B received RAP with patient's own blood. Hb and
lactate levels were measured in arterial blood gases before induction and
upon weaning from bypass. Result(s): The demographic features of both
groups were identical, Group A patients had significantly high levels of
lactate (3.76 +/- 0.81 vs. 2.64 +/- 0.47 mmol/L, P < 0.01). Hb levels of
patients in RAP (RAP) (Group B) were significantly better (9 +/- 0.31 vs.
7.9 +/- 0.39 gm/dL, P < 0.01) than Group A. Conclusion(s): Our study
concludes that when compared with crystalloid priming, retrograde
autologous priming technique is associated with reduced lactate levels and
better hemoglobin levels after cardiopulmonary bypass in patients
undergoing coronary artery bypass grafting. Copyright © 2022
Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights
reserved.

<11>
Accession Number
2016891569
Title
Efficacy and safety of low-dose colchicine in patients with coronary
disease: a systematic review and meta-analysis of randomized trials.
Source
European Heart Journal. 42(28) (pp 2765-2775), 2021. Date of Publication:
21 Jul 2021.
Author
Fiolet A.T.L.; Opstal T.S.J.; Mosterd A.; Eikelboom J.W.; Jolly S.S.;
Keech A.C.; Kelly P.; Tong D.C.; Layland J.; Nidorf S.M.; Thompson P.L.;
Budgeon C.; Tijssen J.G.P.; Cornel J.H.
Institution
(Fiolet) Department of Cardiology, University Medical Centre Utrecht,
Utrecht, Netherlands
(Fiolet, Mosterd, Cornel) Dutch Network for Cardiovascular Research (WCN),
Utrecht, Netherlands
(Opstal, Cornel) Department of Cardiology, Northwest Clinics, Alkmaar,
Netherlands
(Opstal, Cornel) Department of Cardiology, Radboud University Medical
Centre, Nijmegen, Netherlands
(Mosterd) Department of Cardiology, Meander Medical Centre, Amersfoort,
Netherlands
(Mosterd) Julius Centre for Health Sciences and Primary Care, Utrecht
University Medical Centre, Utrecht, Netherlands
(Eikelboom) Department of Medicine, McMaster University, Hamilton, ON,
Canada
(Jolly) Division of Cardiology, Department of Medicine, Population Health
Research Institute, McMaster University, Hamilton, ON, Canada
(Keech) Sydney Medical School, National Health and Medical Research
Council (NHMRC) Clinical Trials Centre, University of Sydney, Australia
(Kelly) Mater University and Health Research Board (HRB) Stroke Clinical
Trials Network Ireland, University College Dublin, Ireland
(Tong, Layland) Cardiology, Department of Medicine, Peninsula Health,
Peninsula Clinical School, Central Clinical School, Monash University,
VIC, Australia
(Tong, Layland) Department of Cardiology, St. Vincent's Hospital,
Melbourne, VIC, Australia
(Layland) Peninsula Clinical School, Central Clinical School, Monash
University, VIC, Australia
(Nidorf, Thompson) Heart and Vascular Research Institute of Western
Australia, Perth, Australia
(Nidorf) GenesisCare Western Australia, Perth, Australia
(Thompson) Sir Charles Gairdner Hospital, Perth, Australia
(Thompson, Budgeon) School of Population and Global Health, University of
Western Australia, Perth, Australia
(Tijssen) Department of Cardiology, Amsterdam University Medical Centre,
Amsterdam, Netherlands
(Tijssen) Cardialysis BV, Rotterdam, Netherlands
Publisher
Oxford University Press
Abstract
Aims Recent randomized trials demonstrated a benefit of low-dose
colchicine added to guideline-based treatment in patients with recent
myocardial infarction or chronic coronary disease. We performed a
systematic review and meta-analysis to obtain best estimates of the
effects of colchicine on major adverse cardiovascular events (MACE).
Methods and results We searched the literature for randomized clinical
trials of long-term colchicine in patients with atherosclerosis published
up to 1 September 2020. The primary efficacy endpoint was MACE, the
composite of myocardial infarction, stroke, or cardiovascular death. We
combined the results of five trials that included 11 816 patients. The
primary endpoint occurred in 578 patients. Colchicine reduced the risk for
the primary endpoint by 25% [relative risk (RR) 0.75, 95% confidence
interval (CI) 0.61-0.92; P = 0.005], myocardial infarction by 22% (RR
0.78, 95% CI 0.64-0.94; P = 0.010), stroke by 46% (RR 0.54, 95% CI
0.34-0.86; P = 0.009), and coronary revascularization by 23% (RR 0.77, 95%
CI 0.66-0.90; P < 0.001). We observed no difference in all-cause death (RR
1.08, 95% CI 0.71-1.62; P = 0.73), with a lower incidence of
cardiovascular death (RR 0.82, 95% CI 0.55-1.23; P = 0.34) counterbalanced
by a higher incidence of non-cardiovascular death (RR 1.38, 95% CI
0.99-1.92; P = 0.060). Conclusion Our meta-analysis indicates that
low-dose colchicine reduced the risk of MACE as well as that of myocardial
infarction, stroke, and the need for coronary revascularization in a broad
spectrum of patients with coronary disease. There was no difference in
all-cause mortality and fewer cardiovascular deaths were counterbalanced
by more non-cardiovascular deaths. Copyright Published on behalf of
the European Society of Cardiology. All rights reserved. © The
Author(s) 2021.

<12>
Accession Number
2015104354
Title
Evaluating the efficacy and safety of calcium channel blockers as
adjunctive analgesics to opioid therapy: a literature review.
Source
Journal of Pharmacy Practice and Research. (no pagination), 2022. Date of
Publication: 2022.
Author
Reinert J.P.; Tiemann A.R.; Barlow M.L.; Veronin M.A.
Institution
(Reinert, Tiemann, Barlow, Veronin) Ben and Maytee Fisch College of
Pharmacy, The University of Texas at Tyler, Tyler, TX, United States
(Reinert) Bon Secours Mercy Health St Vincent Medical Center, Toledo, OH,
United States
Publisher
John Wiley and Sons Inc
Abstract
Calcium channel blockers have been postulated as opioid adjuncts, due to
their complementary mechanism of action, which may reduce pain signal
transduction. The purpose of this study was to conduct a literature review
regarding the safety and efficacy of calcium channel blockers alongside
opioids in pain management. From August 2020 to January 2021, PubMed,
Scopus, and ProQuest were searched using the following terminology:
calcium channel blocker OR verapamil OR diltiazem OR amlodipine OR
nicardipine OR nimodipine OR nifedipine AND analgesia. Studies included
were those with adult human subjects that had reported efficacy and safety
outcomes for calcium channel blocker use as opioid adjuncts. Exclusion
criteria for the analysis were articles including pregnant patients, those
not readily translatable to English and those detailing the use of calcium
channel blockers for an alternative diagnosis or indication. Ten studies
were included in this review. Five were randomised controlled trials, one
involving verapamil, one addressing diltiazem, one including nifedipine
and three examining nimodipine. A sixth clinical trial involving
verapamil, diltiazem and nimodipine was reviewed. The seventh and final
clinical trial included nimodipine or nifedipine use during aorto-coronary
bypass surgery. One conclusive study addressed nimodipine's use in cancer
patients treated with morphine and the other nifedipine's morphine adjunct
potential postoperatively. Currently, there is insufficient data to
support the use of calcium channel blockers as adjuncts to opioid therapy
in pain management. When compared, the studies came to varying conclusions
and demonstrated conflicting data indicating the need for more research
regarding this topic. Copyright © 2022 The Society of Hospital
Pharmacists of Australia.

<13>
Accession Number
2014996387
Title
Evaluation of Citation Inaccuracies in Surgical Literature by Journal
Type, Study Design, and Level of Evidence: Towards Safeguarding the
Peer-Review Process.
Source
American Surgeon. (no pagination), 2022. Date of Publication: 2022.
Author
Sauder M.; Newsome K.; Zagales I.; Autrey C.; Das S.; Ang D.; Elkbuli A.
Institution
(Sauder, Das) NSU NOVA Southeastern University, Dr Kiran, C. Patel College
of Allopathic Medicine, Fort Lauderdale, FL, United States
(Newsome, Zagales, Autrey) Florida International University, Miami, FL,
United States
(Ang, Elkbuli) Departments of Surgery and Surgical Education, Orlando
Regional Medical Center, Orlando, FL, United States
(Ang) University of Central Florida, Ocala, FL, United States
Publisher
SAGE Publications Inc.
Abstract
Background: Accurate citation practices are key to furthering knowledge in
an efficient and valid manner. The aim of this study is to investigate the
prevalence of citation inaccuracies in original research from the
top-ranked surgical journals and to evaluate the impact level of evidence
has on citation inaccuracy. Method(s): A retrospective study
evaluating the citation accuracy of the top 10 ranked surgical journals
using the SJCR indicators. For each year between 2015 and 2020, the top 10
cited studies were selected, totaling 60 studies from each journal. From
each individual study, 10 citations were randomly selected and evaluated
for accuracy. Categories of inaccuracy included fact not found, study not
found, contradictory conclusion, citation of a citation, and inaccurate
population. Result(s): A total of 5973 citations were evaluated for
accuracy. Of all the citations analyzed, 15.2% of them had an inaccuracy.
There was no statistically significant difference in citations inaccuracy
rates among the years studied (P =.38) or study level of evidence (P
=.21). Annals of Surgery, Plastic and Reconstructive Surgery and Annals of
Surgical Oncology had significantly more citation inaccuracies than other
journals evaluated (P <.05). JAMA Surgery, The Journal of Endovascular
Therapy and The Journal of Thoracic and Cardiovascular Surgery had
significantly fewer citation inaccuracies. Conclusion(s): Although
84.8% of citations from 2015-2020 were determined to be accurate, citation
inaccuracies continue to be prevalent throughout highly-ranked surgical
literature. There were no significant differences identified in citation
inaccuracy rates between the years evaluated or based on study level of
evidence. Copyright © The Author(s) 2022.

<14>
Accession Number
2014996366
Title
Goal-directed perfusion for reducing acute kidney injury in cardiac
surgery: A systematic review and meta-analysis.
Source
Perfusion (United Kingdom). (no pagination), 2022. Date of Publication:
2022.
Author
Gao P.; Liu J.; Zhang P.; Bai L.; Jin Y.; Li Y.
Institution
(Gao, Liu, Zhang, Bai, Jin, Li) Department of Cardiopulmonary Bypass,
Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union
Medical College and Chinese Academy of Medical Sciences, Beijing, China
Publisher
SAGE Publications Ltd
Abstract
Background: Acute kidney injury (AKI) is a common complication following
cardiopulmonary bypass (CPB) which can affect morbidity and mortality.
Goal-directed perfusion (GDP) intended to avoid the nadir oxygen delivery
index below the critical value is associated with reduced postoperative
AKI. However, current studies suggested that GDP can only decrease the
incidence of AKI stage 1 but showed no effects on AKI stages 2-3 and
mortality. The objective of the present meta-analysis is to deter the
effects of GDP on postoperative AKI in any stage and mortality following
cardiac surgery. Method(s): MEDLINE, Embase, and the Cochrane Library
were searched to identify all clinical trials comparing GDP with control
(standard care) during cardiopulmonary bypass conducting in adults
undergoing cardiac surgery. The primary outcome was postoperative acute
kidney injury. Secondary outcomes included postoperative mortality and
length of ICU stay. Data synthesis was obtained by using risk ratio with
95% confidence interval by a random-effects model. Result(s): From
1094 potential studies, 3 trials enrolling 777 patients were included.
Meta-analysis suggested the GDP strategy based on DO<inf>2</inf>i reduced
postoperative AKI compared with standard CPB management (RR = 0.52; 95%
CI: 0.38-0.70; p <.0001), especially in AKI stage I (RR = 0.47; 95% CI:
0.33-0.66; p <.0001). But the GDP strategy did not reduce the incidence of
severe AKI (stages 2-3) and postoperative mortality. Conclusion(s):
The GDP strategy based on DO<inf>2</inf>i during CPB obviously reduces AKI
stage 1 and thus reduces overall AKI incidence. But it shows no effects on
severe AKI (stages 2-3) and mortality. Copyright © The Author(s)
2022.

<15>
Accession Number
637301978
Title
Clinical, Microbiological, and Imaging Characteristics of Infective
Endocarditis in Latin America: A Systematic Review.
Source
International journal of infectious diseases : IJID : official publication
of the International Society for Infectious Diseases. (no pagination),
2022. Date of Publication: 15 Feb 2022.
Author
Urina-Jassir M.; Jaimes-Reyes M.A.; Martinez-Vernaza S.; Quiroga-Vergara
C.; Urina-Triana M.
Institution
(Urina-Jassir) Colombia. Full postal address: Carrera 50 # 80 - 216 Office
201, Barranquilla, Atlantico, Colombia
(Jaimes-Reyes) Colombia. Full postal address: Carrera 50 # 80 - 216 Office
201, Barranquilla, Atlantico, Colombia
(Martinez-Vernaza) Unidad de Infectologia, Hospital Universitario San
Ignacio, Bogota D.C. ,Colombia. Full postal address: Calle 41 #13-06 Piso
2, Colombia
(Quiroga-Vergara) Unidad de Infectologia, Hospital Universitario San
Ignacio, Bogota D.C. ,Colombia. Full postal address: Calle 41 #13-06 Piso
2, Colombia
(Urina-Triana) Fundacion del Caribe para la Investigacion Biomedica,
Barranquilla, Atlantico, Colombia. Full postal address: Carrera 50 # 80 -
216 Office 201, Barranquilla, Atlantico, Colombia; Facultad de Ciencias de
la Salud, Universidad Simon Bolivar, Barranquilla, Atlantico, Colombia.
Full postal address: Carrera 59 # 59 - 65, Barranquilla, Atlantico,
Colombia. Electronic address: murina1@unisimonbolivar.edu.co
Publisher
NLM (Medline)
Abstract
OBJECTIVE: We aimed to describe the clinical, microbiological, and imaging
characteristics of patients with infective endocarditis (IE) in studies
from Latin America (LATAM). METHOD(S): A systematic search through
PubMed, EMBASE, LILACS, and SciELO from inception until February 2021 was
conducted. We included observational studies that assessed adults with IE
from LATAM and reported data on clinical, microbiological or imaging
characteristics. Data were independently extracted by two authors and the
risk of bias was evaluated by study design with its respective tool.
Findings were summarized using descriptive statistics. RESULT(S):
Forty-four studies were included. Most cases were male (68.5%), had a
predisposing condition including valve disease (24.3%) or a prosthetic
valve (23.4%). Clinical manifestations included fever (83.9%), malaise
(63.2%), or heart murmur (57.7%). 36.4% and 27.1% developed heart failure
or embolism, respectively. Blood cultures were negative in 23.9% and S.
aureus (18.6%) and viridans group streptococci (17.8%) were the most
common isolates. Most cases were native-IE (67.3%) affecting mainly
left-sided valves. Echocardiographic findings included vegetations (84.3%)
and regurgitation (75.9%). In-hospital mortality was 25.1%.
 CONCLUSION(S): This is the first systematic review evaluating the
characteristics of IE in LATAM patients. A lack of multicenter studies
reflects on the need for these studies in LATAM. Copyright ©
2022. Published by Elsevier Ltd.

<16>
Accession Number
2015124708
Title
Effect of Levosimendan Treatment in Pediatric Patients With Cardiac
Dysfunction: An Update of a Systematic Review and Meta-Analysis of
Randomized Controlled Trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 657-664),
2022. Date of Publication: March 2022.
Author
Silvetti S.; Belletti A.; Bianzina S.; Momeni M.
Institution
(Silvetti, Bianzina) Neonatal and Pediatric Intensive Care Unit,
Department of Critical Care and Perinatal Medicine, IRCCS Istituto
Giannina Gaslini, Genova, Italy
(Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele
Scientific Institute, Milan, Italy
(Momeni) Department of Anesthesiology, Cliniques Universitaires Saint Luc,
Universite Catholique de Louvain, Institut de Recherche Experimentale et
Clinique (IREC), Brussels, Belgium
Publisher
W.B. Saunders
Abstract
Levosimendan increasingly has been used to treat heart failure and cardiac
dysfunction in pediatric patients. Currently, there is only limited
evidence that this drug positively affects outcomes. The authors' aim was
to investigate the effects of levosimendan on hemodynamic parameters and
outcomes in pediatric patients in all clinical settings. The study design
was a systematic review of randomized and nonrandomized studies.
Randomized clinical trials (RCTs) were included in a meta-analysis. The
primary outcome of the meta-analysis was the effect of levosimendan on
central venous oxygen saturation (ScvO<inf>2</inf>) and lactate values as
surrogate markers of low-cardiac-output syndrome. The study setting was
any acute care setting. Study participants were pediatric patients (age
<18 years) receiving levosimendan, and the intervention was levosimendan
versus any control treatment. The authors identified 44 studies published
from 2004 to 2020, including a total of 1,131 pediatric patients. Nine
studies (enrolling 547 patients) were RCTs, all performed in a pediatric
cardiac surgery setting. Three RCTs were judged to carry a low risk of
bias. In the RCTs, levosimendan administration was associated with a
significant improvement of ScvO<inf>2</inf> (p = 0.03) and a trend toward
lower postoperative lactate levels (p = 0.08). No differences could be
found for secondary outcomes. Levosimendan use in pediatric patients is
not associated with major side effects and may lead to hemodynamic
improvement after cardiac surgery. However, its impact on major clinical
outcomes remains to be determined. Overall, the quality of evidence for
levosimendan use in pediatric patients is low, and further high-quality
RCTs are needed. Copyright © 2021 Elsevier Inc.

<17>
Accession Number
2013142657
Title
Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery
Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A
Randomized Controlled Study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 677-683),
2022. Date of Publication: March 2022.
Author
Abdelbaser I.; Mageed N.A.; Elmorsy M.M.; Elfayoumy S.I.
Institution
(Abdelbaser, Mageed, Elmorsy) Department of Anesthesia and Surgical
Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
(Elfayoumy) Department of Anesthesia and Surgical Intensive Care, Faculty
of Medicine, Portsaid University, Portsaid, Egypt
Publisher
W.B. Saunders
Abstract
Objective: The objective of the present study was to compare
ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery
catheterization in neonates and infants undergoing cardiac surgery.
 Design(s): A single-center, prospective, randomized, single-blinded,
controlled study. Setting(s): This study was conducted in the
operating room and intensive care unit of the division of cardiac surgery,
Mansoura University Children's Hospital, Egypt. Participant(s):
Ninety neonates and infants undergoing elective cardiac surgery were
enrolled in this study and randomly allocated to ultrasound-guided LAX and
SAX groups. Intervention(s): Ultrasound-guided femoral artery
catheterization was done using either LAX (in-plane) or SAX (out-of-plane)
technique. Measurements and Main Results: The primary outcome measure
was the rate of a successful first puncture. The secondary outcome
measures were the rates of mechanical complications, failure rate, time to
a successful first, second, and third puncture, total time of
catheterization, and imaging time. The first puncture success rate was
significantly higher (p = 0.048) in the LAX group (34 of 41, 82.9%) than
in the SAX group (25 of 41, 60.9%). The mean time to a successful first
puncture was significantly shorter (p < 0.001) in the LAX group (153.1 +/-
30.1 seconds) than in the SAX group (227.2 +/- 48.8 seconds). The total
catheterization time was significantly shorter in the LAX group than in
the SAX group. There was no significant difference in the rate of
complication. Conclusion(s): With a single experienced operator
performing the ultrasound-guided femoral artery cannulation, the LAX
technique resulted in a higher first puncture success rate and shorter
time to cannulation than the SAX technique. Copyright © 2021
Elsevier Inc.

<18>
Accession Number
2014167155
Title
Personalizing the decision of dabigatran versus warfarin in atrial
fibrillation: A secondary analysis of the Randomized Evaluation of
Long-term anticoagulation therapY (RE-LY) trial.
Source
PLoS ONE. 16(8 August) (no pagination), 2021. Article Number: e0256338.
Date of Publication: August 2021.
Author
Reinhardt S.W.; Desai N.R.; Tang Y.; Jones P.G.; Ader J.; Spertus J.A.
Institution
(Reinhardt, Desai) Section of Cardiovascular Medicine, Department of
Internal Medicine, Yale School of Medicine, New Haven, CT, United States
(Desai) Center for Outcomes Research and Evaluation, Yale-New Haven
Hospital, New Haven, CT, United States
(Tang, Jones, Spertus) Saint Luke's Mid America Heart Institute, Kansas
City, MO, United States
(Ader) Yale School of Medicine, New Haven, CT, United States
(Spertus) Section of Cardiovascular Disease, Department of
InternalMedicine, University of Missouri-Kansas City, Kansas City, MO,
United States
(Ader) Department of Neurology, Columbia University Medical Center, New
York, NY, United States
Publisher
Public Library of Science
Abstract
Background The RE-LY (Randomized Evaluation of Long-Term Anticoagulation
Therapy) trial demonstrated that higher-risk patients with atrial
fibrillation had lower rates of stroke or systemic embolism and a similar
rate of major bleeding, on average, when treated with dabigatran 150mg
compared to warfarin. Since population-level averages may not apply to
individual patients, estimating the heterogeneity of treatment effect can
improve application of RE-LY in clinical practice. Methods and results For
18040 patients randomized in RE-LY, we used patient-level data to develop
multivariable models to predict the risk for stroke or systemic embolism
and for major bleeding including all three treatment groups (dabigatran
110mg, dabigatran 150mg, and warfarin) over a median follow up of 2.0
years. The mean predicted absolute risk reduction (ARR) for
stroke/systemic embolism with dabigatran 150mg compared to warfarin was
1.32% (range 11.6% lower to 3.30% higher risk). The mean predicted ARR for
bleeding was 0.41% (range 8.93% lower to 63.4% higher risk). Patients with
increased stroke/systemic embolism risk included those with prior
stroke/TIA (OR 2.01), diabetics on warfarin (OR 2.00), and older patients
on dabigatran 150mg (OR 1.68 for every 10-year increase). Major bleeding
risk was higher in patients on aspirin (OR 1.25), with a history of
diabetes (OR 1.34) or prior stroke/TIA (OR 1.22), those with heart failure
on dabigatran 110mg (OR 1.52), older patients on either dabigatran 110mg
or 150mg (OR 1.57 and 1.93, respectively, for each 10-year increase), and
heavier patients on dabigatran 110mg or 150mg; patients in a region
outside the United States and Canada and with better renal function had
lower bleeding risk. Conclusions There is substantial heterogeneity in the
benefits and risks of dabigatran relative to warfarin among patients with
atrial fibrillation. Using individualized estimates may enable shared
decision making and facilitate more appropriate use of dabigatran; as
such, it should be prospectively tested. Copyright: © 2021
Reinhardt et al. This is an open access article distributed under the
terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.

<19>
Accession Number
2014156935
Title
Sex-Specific Outcomes of Transcatheter Mitral-Valve Repair and Medical
Therapy for Mitral Regurgitation in Heart Failure.
Source
JACC: Heart Failure. 9(9) (pp 674-683), 2021. Date of Publication:
September 2021.
Author
Kosmidou I.; Lindenfeld J.; Abraham W.T.; Rinaldi M.J.; Kapadia S.R.;
Rajagopal V.; Sarembock I.J.; Brieke A.; Gaba P.; Rogers J.H.; Shahim B.;
Redfors B.; Zhang Z.; Mack M.J.; Stone G.W.
Institution
(Kosmidou, Gaba, Redfors) NewYork-Presbyterian Hospital/Columbia
University Irving Medical Center, New York, NY, United States
(Kosmidou, Shahim, Redfors, Zhang, Stone) Clinical Trials Center,
Cardiovascular Research Foundation, New York, NY, United States
(Lindenfeld) Advanced Heart Failure and Cardiac Transplantation Section,
Vanderbilt Heart and Vascular Institute, Nashville, TN, United States
(Abraham) Division of Cardiovascular Medicine, The Ohio State University,
Columbus, OH, United States
(Rinaldi) Sanger Heart & Vascular Institute/Atrium Health, Charlotte, NC,
United States
(Kapadia) Cleveland Clinic, Cleveland, OH, United States
(Rajagopal) Piedmont Hospital, Atlanta, GA, United States
(Sarembock) The Christ Hospital and Lindner Clinical Research Center,
Cincinnati, OH, United States
(Brieke) University Of Colorado Hospital, Aurora, CO, United States
(Rogers) UC Davis Medical Center, Davis, CA, United States
(Redfors) Department of Cardiology, Sahlgrenska University Hospital,
Gothenburg, Sweden
(Mack) Baylor Scott & White Health, Plano, TX, United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Objectives: This study sought to assess the sex-specific outcomes in
patients with heart failure (HF) with 3+ and 4+ secondary mitral
regurgitation (SMR) treated with transcatheter mitral valve repair (TMVr)
plus guideline-directed medical therapy (GDMT) versus GDMT alone in the
COAPT trial. Background(s): The impact of sex in patients with HF and
severe SMR treated with TMVr with the MitraClip compared with GDMT alone
is unknown. Method(s): Patients were randomized 1:1 to TMVr versus
GDMT alone. Two-year outcomes were examined according to sex.
 Result(s): Among 614 patients, 221 (36.0%) were women. Women were
younger than men and had fewer comorbidities, but reduced quality of life
and functional capacity at baseline. In a joint frailty model accounting
for the competing risk of death, the 2-year cumulative incidence of the
primary endpoint of all HF hospitalizations (HFH) was higher in men
compared with women treated with GDMT alone. However, the relative
reduction in HFHs with TMVr was greater in men (HR: 0.43; 95% CI:
0.34-0.54) than women (HR: 0.78; 95% CI: 0.57-1.05)
(P<inf>interaction</inf> = 0.002). A significant interaction between TMVr
versus GDMT alone treatment and time was present for all HFHs in women
(HR: 0.57; 95% CI: 0.39-0.84, and HR: 1.39; 95% CI: 0.83-2.33 between 0-1
year and 1-2 years after randomization, respectively,
P<inf>interaction</inf> = 0.007) but not in men (HR: 0.48; 95% CI:
0.36-0.64, and HR: 0.33; 95% CI: 0.21-0.51; P<inf>interaction</inf> =
0.16). Female sex was independently associated with a lower adjusted risk
of death at 2 years (HR: 0.64; 95% CI: 0.46-0.90; P = 0.011). TMVr
consistently reduced 2-year mortality compared with GDMT alone,
irrespective of sex (P<inf>interaction</inf> = 0.99). Conclusion(s):
In the COAPT trial, TMVr with the MitraClip resulted in improved clinical
outcomes compared with GDMT alone, irrespective of sex. However, the
impact of TMVr in reducing HFH was less pronounced in women compared with
men beyond the first year after treatment. (Cardiovascular Outcomes
Assessment of the MitraClip Percutaneous Therapy for Heart Failure
Patients With Functional Mitral Regurgitation [The COAPT Tria] [COAPT];
NCT01626079) Copyright © 2021 American College of Cardiology
Foundation

<20>
Accession Number
2016891603
Title
Cardiac mortality in patients randomised to elective coronary
revascularisation plus medical therapy or medical therapy alone: a
systematic review and meta-analysis.
Source
European Heart Journal. 42(45) (pp 4638-4651), 2021. Date of Publication:
01 Dec 2021.
Author
Navarese E.P.; Lansky A.J.; Kereiakes D.J.; Kubica J.; Gurbel P.A.; Gorog
D.A.; Valgimigli M.; Curzen N.; Kandzari D.E.; Bonaca M.P.; Brouwer M.;
Uminska J.; Jaguszewski M.J.; Raggi P.; Waksman R.; Leon M.B.; Wijns W.;
Andreotti F.
Institution
(Navarese, Kubica) Interventional Cardiology and Cardiovascular Medicine
Research, Department of Cardiology and Internal Medicine, Nicolaus
Copernicus University, Bydgoszcz, Poland
(Navarese, Raggi) Faculty of Medicine, University of Alberta, Edmonton,
Canada
(Navarese, Kubica) SIRIO MEDICINE, research network, Poland
(Lansky) Yale University School of Medicine, New Haven, CT, United States
(Kereiakes) Christ Hospital, Lindner Research Center, Cincinnati, OH,
United States
(Gurbel) Sinai Center for Thrombosis Research and Drug Development, Sinai
Hospital of Baltimore, Baltimore, MD, United States
(Gorog) Faculty of Medicine, National Heart and Lung Institute, Imperial
College, London, United Kingdom
(Gorog) Cardiology Department, East and North Hertfordshire NHS Trust,
Stevenage, United Kingdom
(Valgimigli) Department of Cardiology, Inselspital Universitatsspital,
Bern, Switzerland
(Curzen) University Hospital Southampton NHS Foundation Trust,
Southampton, United Kingdom
(Curzen) University of Southampton, Southampton, United Kingdom
(Kandzari) Department of Interventional Cardiology, Piedmont Heart
Institute, Atlanta, GA, United States
(Bonaca) CPC Clinical Research, University of Colorado School of Medicine,
United States
(Brouwer) Department of Cardiology, Radboud University Medical Centre,
Nijmegen, Netherlands
(Uminska) Department of Geriatrics, Nicolaus Copernicus University,
Bydgoszcz, Poland
(Jaguszewski) Department of Cardiology, Medical University of Gdansk,
Gdansk, Poland
(Waksman) Section of Interventional Cardiology, MedStar Washington
Hospital Center, Washington, DC, United States
(Leon) Division of Cardiovascular Medicine, Columbia University Irving
Medical Center, New York, NY, United States
(Leon) Cardiovascular Research Foundation, New York, NY, United States
(Wijns) Lambe Institute for Translational Medicine and Curam, National
University of Ireland Galway, Saolta University Healthcare Group, Galway,
Ireland
(Andreotti) Direzione Scientifica, Fondazione Policlinico Universitario
Gemelli IRCCS, Rome, Italy
(Andreotti) Cardiovascular Medicine, Catholic University Medical School,
Rome, Italy
Publisher
Oxford University Press
Abstract
Aims The value of elective coronary revascularisation plus medical therapy
over medical therapy alone in managing stable patients with coronary
artery disease is debated. We reviewed all trials comparing the two
strategies in this population. Methods and results From inception through
November 2020, MEDLINE, EMBASE, Google Scholar, and other databases were
searched for randomised trials comparing revascularisation against medical
therapy alone in clinically stable coronary artery disease patients.
Treatment effects were measured by rate ratios (RRs) with 95% confidence
intervals, using random-effects models. Cardiac mortality was the
pre-specified primary endpoint. Spontaneous myocardial infarction (MI) and
its association with cardiac mortality were secondary endpoints. Further
endpoints included all-cause mortality, any MI, and stroke. Longest
follow-up data were abstracted. The study is registered with PROSPERO
(CRD42021225598). Twenty-five trials involving 19 806 patients (10 023
randomised to revascularisation plus medical therapy and 9783 to medical
therapy alone) were included. Compared with medical therapy alone,
revascularisation yielded a lower risk of cardiac death [RR 0.79
(0.67-0.93), P < 0.01] and spontaneous MI [RR 0.74 (0.64-0.86), P < 0.01].
By meta-regression, the cardiac death risk reduction after
revascularisation, compared with medical therapy alone, was linearly
associated with follow-up duration [RR per 4-year follow-up: 0.81
(0.69-0.96), P = 0.008], spontaneous MI absolute difference (P = 0.01) and
percentage of multivessel disease at baseline (P = 0.004). Trial
sequential and sensitivity analyses confirmed the reliability of the
cardiac mortality findings. All-cause mortality [0.94 (0.87-1.01), P =
0.11], any MI (P = 0.14), and stroke risk (P = 0.30) did not differ
significantly between strategies. Conclusion In stable coronary artery
disease patients, randomisation to elective coronary revascularisation
plus medical therapy led to reduced cardiac mortality compared with
medical therapy alone. The cardiac survival benefit after
revascularisation improved with longer follow-up times and was associated
with fewer spontaneous MIs. Copyright © The Author(s) 2021.
Published by Oxford University Press on behalf of the European Society of
Cardiology.

<21>
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.

<22>
Accession Number
2010586256
Title
Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a
Systematic Review andMeta-Analysis.
Source
Archives of Academic Emergency Medicine. 8(1) (pp e61), 2020. Date of
Publication: January 2020.
Author
Sadeghi R.; Babahajian A.; Sarveazad A.; Kachoueian N.; Bahardoust M.
Institution
(Sadeghi) Department of cardiovascular Medicine, School of Medicine,
Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Sadeghi) Cardiovascular Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran, Islamic Republic of
(Babahajian) Liver and Digestive Research Center, Research Institute for
Health Development, Kurdistan University of Medical Sciences, Sanandaj,
Iran, Islamic Republic of
(Sarveazad, Bahardoust) Colorectal Research Center, Iran University
ofMedical Sciences, Tehran, Iran, Islamic Republic of
(Sarveazad) Nursing Care Research center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Kachoueian) Department of Cardiac Surgery, School of Medicine, Shahid
Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Bahardoust) Department of Epidemiology, School of Public Health, Iran
University ofMedical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Shaheed Beheshti University of Medical Sciences and Health Services
Abstract
Introduction: Currently, the basis of acute coronary syndrome (ACS)
therapy is dual antiplatelet therapy (DAPT) with Aspirin as a nonsteroidal
anti-inflammatory drug and clopidogrel as adenosine diphosphate receptor
antagonists. Therefore, the aim of the present systematic review is to
answer that should DAPT with Aspirin and clopidogrel be continued until
coronary artery bypass grafting (CABG) in patients who have ACS?Methods:
The search for relevant studies in the present meta-analysis is based on
three approaches: A) systematic searches in electronic databases, B)
manual searches in Google and Google Scholar, and C) screening of
bibliography of related original and review articles. The endpoints
included mortality rate, myocardial infarction (MI), cerebrovascular
accident (CVA), reoperation, re-exploration, other cardiac events, renal
failure, length of ICU and hospital stay, chest tube drainage and blood
product transfusion after CABG. Result(s): After the initial
screening, 41 articles were studied in detail, and finally the data of 15
studies were included in the meta-analysis. DAPT before CABG in patients
with ACS does not increase the rate of mortality, CVA, renal failure, MI,
and other cardiac events, but increases reoperation, re-exploration,
length of ICU, and hospital stay. Chest tube drainage and blood product
transfusion rate significantly increased in the DAPT group compared to the
control group (non-antiplatelet or Aspirin alone). Increase in chest tube
drainage and blood product transfusion rate indicates an increase in
bleeding, so increase in reoperation, re-exploration to control bleeding,
and, subsequently, increase in the length of ICU and hospital stay are
expected. Conclusion(s): DAPT with Aspirin and clopidogrel before
CABG in patients with ACS does not increase the rate of mortality, CVA,
renal failure, MI, and other cardiac events despite more bleedings, and it
may be suggested before CABG for better graft patency. Copyright
© 2020, Archives of Academic Emergency Medicine. All Rights Reserved.

<23>
[Use Link to view the full text]
Accession Number
2010671704
Title
Perioperative Spinal Cord Ischemia After Cardiac Surgery Not Involving the
Aorta: A Review of the Literature.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 776-784),
2022. Date of Publication: March 2022.
Author
Wanat-Hawthorne A.; Akorede R.; Floyd T.
Institution
(Wanat-Hawthorne, Akorede, Floyd) Department of Anesthesiology and Pain
Management, UT Southwestern, Dallas, TX
Publisher
W.B. Saunders
Abstract
Spinal cord ischemia (SCI) associated with aortic surgery is
well-described; however, SCI after cardiac surgery not involving the aorta
is an unusual and underappreciated phenomenon. The authors reviewed the
literature and found 54 case reports of perioperative spinal cord ischemia
in nonaortic surgery. The severity of its implications is evidenced by the
fact that 14 patients died, 22 had no recovery, and seven had only partial
recovery. Various types of cardiac surgery have reported this complication
including coronary artery bypass grafting (CABG), off-pump CABG, valve
surgeries, combination valve and CABG surgeries, and transcatheter aortic
valve procedures. Patient comorbidities, such as high blood pressure,
hypercholesterolemia, diabetes, and peripheral vascular disease, also may
play a role in the development of this adverse outcome. The authors review
the literature to define further possible mechanisms, surgical techniques,
and patient factors that could contribute to the risk of perioperative SCI
after cardiac surgery. Copyright © 2020 Elsevier Inc.

<24>
Accession Number
637029656
Title
Addition of topical airway anaesthesia to conventional induction
techniques to reduce haemodynamic instability during the induction period
in patients undergoing cardiac surgery: Protocol for a randomised
controlled study.
Source
BMJ Open. 12(1) (no pagination), 2022. Article Number: e053337. Date of
Publication: 25 Jan 2022.
Author
Chen T.T.; Lv M.; Wang J.H.; Wei C.S.; Gu C.P.; Wang Y.L.
Institution
(Chen, Lv, Wang, Wei, Gu, Wang) Department of Anesthesiology, First
Affiliated Hospital of Shandong First Medical University, Shandong,
Ji'nan, China
(Chen) Shandong First Medical University, Shandong, Ji'nan, China
Publisher
BMJ Publishing Group
Abstract
Introduction The aim of this prospective study is to evaluate the effects
of combining topical airway anaesthesia with intravenous induction on
haemodynamic variables during the induction period in patients undergoing
cardiac surgery. Methods and analysis This randomised, double-blind,
controlled, parallel-group, superiority study from 1 March 2021 to 31
December 2021 will include 96 participants scheduled for cardiac surgery.
Participants will be screened into three blocks (ASA II, ASA III, ASA IV)
according to the American Society of Anesthesiologists (ASA) grade and
then randomly allocated into two groups within the block in a 1:1 ratio.
Concealment of allocation will be maintained using opaque, sealed
envelopes generated by a nurse according to a computer-generated
randomisation schedule. In addition to general intravenous anaesthetics,
participants will receive supraglottic and subglottic topical anaesthesia.
Changes in arterial blood pressure and heart rate in both groups will be
recorded by an independent investigator at the start of anaesthesia
induction until the skin incision. If vasopressors are used during this
period, the frequency, dosage and types of vasopressors will be recorded.
The incidence and severity of participants' postoperative hoarseness and
sore throat will also be assessed. Ethics and dissemination This study was
approved by the Ethics Committee of Qianfoshan Hospital of Shandong
Province (registration number: YXLL-KY-2021(003)). The results will be
disseminated through a peer-reviewed publication and in conferences or
congresses. Trial registration number NCT04744480. Copyright ©
Author(s) (or their employer(s)) 2022.

<25>
Accession Number
2014071889
Title
Maintenance of Serum Potassium Levels >=3.6 mEq/L Versus >=4.5 mEq/L After
Isolated Elective Coronary Artery Bypass Grafting and the Incidence of
New-Onset Atrial Fibrillation: Pilot and Feasibility Study Results.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 847-854),
2022. Date of Publication: March 2022.
Author
Campbell N.G.; Allen E.; Montgomery H.; Aron J.; Canter R.R.; Dodd M.;
Sanders J.; Sturgess J.; Elbourne D.; O'Brien B.
Institution
(Campbell) Division of Cardiovascular Sciences, School of Medical
Sciences, Manchester Academic Health Science Centre, University of
Manchester, Manchester, United Kingdom
(Campbell) Wythenshawe Hospital, Manchester University Foundation NHS
Trust, Manchester, United Kingdom
(Allen, Canter, Dodd, Sturgess, Elbourne) Clinical Trials Unit, London
School of Hygiene & Tropical Medicine, London, United Kingdom
(Montgomery) UCL Division of Medicine and Institute for Sport, Exercise,
and Health, London, United Kingdom
(Aron) St. George's Hospital, London, United Kingdom
(Sanders, O'Brien) St. Bartholomew's Hospital, Barts Health NHS Trust,
West Smithfield, London, United Kingdom
(O'Brien) German Heart Center, Department of Cardiac Anesthesiology and
Intensive Care Medicine, Berlin, Germany
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Charite Berlin, Berlin, Germany
(O'Brien) Outcomes Research Consortium, Cleveland, OH
Publisher
W.B. Saunders
Abstract
Objective: Serum potassium levels frequently are maintained at high levels
(>=4.5 mEq/L) to prevent atrial fibrillation after cardiac surgery
(AFACS), with limited evidence. Before undertaking a noninferiority
randomized controlled trial to investigate the noninferiority of
maintaining levels >=3.6 mEq/L compared with this strategy, the authors
wanted to assess the feasibility, acceptability, and safety of recruiting
for such a trial. Design(s): Pilot and feasibility study of full
trial protocol. Setting(s): Two university tertiary-care hospitals.
 Participant(s): A total of 160 individuals undergoing first-time
elective isolated coronary artery bypass grafting. Intervention(s):
Randomization (1:1) to protocols aiming to maintain serum potassium at
either >=3.6 mEq/L or >=4.5 mEq/L after arrival in the postoperative care
facility and for 120 hours or until discharge from the hospital or AFACS
occurred, whichever happened first. Measurements and Main Results:
Primary outcomes: (1) whether it was possible to recruit and randomize 160
patients for six months (estimated 20% of those eligible); (2) maintaining
supplementation protocol violation rate <=10% (defined as potassium
supplementation being inappropriately administered or withheld according
to treatment allocation after a serum potassium measurement); and (3)
retaining 28-day follow-up rates >=90% after surgery. Between August 2017
and April 2018, 723 patients were screened and 160 (22%) were recruited.
Potassium protocol violation rate = 9.8%. Follow-up rate at 28 days =
94.3%. Data on planned outcomes for the full trial also were collected.
 Conclusion(s): It is feasible to recruit and randomize patients to a
study assessing the impact of maintaining serum potassium concentrations
at either >=3.6 mEq/L or >=4.5 mEq/L on the incidence of
AFACS. Copyright © 2021

<26>
Accession Number
2013510238
Title
Postoperative 20% albumin vs standard care and acute kidney injury after
high-risk cardiac surgery (ALBICS): study protocol for a randomised trial.
Source
Trials. 22(1) (no pagination), 2021. Article Number: 558. Date of
Publication: December 2021.
Author
Balachandran M.; Banneheke P.; Pakavakis A.; Al-Bassam W.; Sarode V.;
Rowland M.; Shehabi Y.
Institution
(Balachandran, Banneheke) School of Clinical Sciences at Monash Health,
Monash University, Clayton, VIC, Australia
(Pakavakis, Al-Bassam, Shehabi) Intensive Care Services, School of
Clinical Sciences at Monash Health, Monash University, Clayton, VIC,
Australia
(Sarode) Intensive Care Services, Cabrini Health, Malvern, VIC, Australia
(Sarode) Cabrini Monash University Department of Medicine, Monash
University, Malvern, VIC, Australia
(Rowland) Department of Cardiothoracic Surgery, Barwon Health, Geelong,
VIC, Australia
(Shehabi) University of New South Wales, Prince of Wales Clinical School
of Medicine, Randwick, NSW, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Acute kidney injury (AKI) is a common complication of cardiac
surgery. Factors such as cardiopulmonary bypass, aortic cross-clamping and
surgical stress may precipitate renal hypoperfusion and ischaemia,
inflammation and oxidative stress are associated with development of AKI.
Albumin's pharmacological properties and widespread availability have the
potential to mitigate these factors. However, the effect of albumin on
cardiac surgery-associated AKI is unknown. Objective(s): To evaluate
the impact of postoperative 20% albumin infusion on kidney function after
high-risk cardiac surgery. Method(s): We designed an open-label,
multicentre, randomised controlled trial-the ALBICS study (ALBumin
Infusion and acute kidney injury following Cardiac Surgery). A total of
590 patients undergoing high-risk cardiac surgery (combined procedure or
estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73
m2) will be enrolled into the study and randomly allocated to
receive a postoperative 20% albumin infusion or standard care in a 1:1
ratio, stratified by centre and baseline renal function. The study fluid
will be administered upon arrival in intensive care for 15 h. Patients
will be followed up until 28 days after surgery or until discharge from
the hospital. The primary outcome is the proportion of patients who
develop AKI in both groups. Secondary outcomes to be measured are
proportions of AKI stage II and III, 28-day mortality, mechanical
ventilation time and length of stay in intensive care and hospital.
 Conclusion(s): This trial aims to determine if a postoperative
infusion of concentrated albumin reduces the risk of AKI following
high-risk cardiac surgery. Trial registration: Australian New Zealand
Clinical Trials Registry ACTRN12619001355167. Registered on 03 October
2019-retrospectively registered.
https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378383.Copyright © 2021, The Author(s).

<27>
Accession Number
2016795362
Title
Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac
Surgery: JACC Review Topic of the Week.
Source
Journal of the American College of Cardiology. 79(7) (pp 682-694), 2022.
Date of Publication: 22 Feb 2022.
Author
Zafeiropoulos S.; Doundoulakis I.; Farmakis I.T.; Miyara S.; Giannis D.;
Giannakoulas G.; Tsiachris D.; Mitra R.; Skipitaris N.T.; Mountantonakis
S.E.; Stavrakis S.; Zanos S.
Institution
(Zafeiropoulos, Miyara) Elmezzi Graduate School of Molecular Medicine,
Northwell Health, Manhasset, NY, United States
(Zafeiropoulos, Miyara, Giannis, Zanos) Feinstein Institutes for Medical
Research at Northwell Health, Manhasset, NY, United States
(Doundoulakis) Department of Cardiology, 424 General Military Training
Hospital, Thessaloniki, Greece
(Doundoulakis, Tsiachris) Athens Heart Center, Athens Medical Center,
Athens, Greece
(Farmakis, Giannakoulas) Department of Cardiology, AHEPA University
Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
(Mitra) Division of Electrophysiology, Department of Cardiology, North
Shore University Hospital, Northwell Health, Manhasset, NY, United States
(Skipitaris, Mountantonakis) Department of Cardiology, Lenox Hill
Hospital, Northwell Health, New York City, New York, United States
(Stavrakis) Heart Rhythm Institute, University of Oklahoma Health Sciences
Center, Oklahoma City, OK, United States
Publisher
Elsevier Inc.
Abstract
Autonomic neuromodulation therapies (ANMTs) (ie, ganglionated plexus
ablation, epicardial injections for temporary neurotoxicity, low-level
vagus nerve stimulation [LL-VNS], stellate ganglion block, baroreceptor
stimulation, spinal cord stimulation, and renal nerve denervation)
constitute an emerging therapeutic approach for arrhythmias. Very little
is known about ANMTs' preventive potential for postoperative atrial
fibrillation (POAF) after cardiac surgery. The purpose of this review is
to summarize and critically appraise the currently available evidence.
Herein, the authors conducted a systematic review of 922 articles that
yielded 7 randomized controlled trials. In the meta-analysis, ANMTs
reduced POAF incidence (OR: 0.37; 95% CI: 0.25 to 0.55) and burden (mean
difference [MD]: -3.51 hours; 95% CI: -6.64 to -0.38 hours), length of
stay (MD: -0.82 days; 95% CI: -1.59 to -0.04 days), and interleukin-6 (MD:
-79.92 pg/mL; 95% CI: -151.12 to -8.33 pg/mL), mainly attributed to LL-VNS
and epicardial injections. Moving forward, these findings establish a base
for future larger and comparative trials with ANMTs, to optimize and
expand their use. Copyright © 2022 American College of Cardiology
Foundation

<28>
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. 53(3) (pp 1108-1113), 2022. Date of Publication: March 2022.
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, Hebei, Cangzhou 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

<29>
Accession Number
2015090564
Title
Variable definitions and treatment approaches for atrial functional mitral
regurgitation: A scoping review of the literature.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Amabile A.; Fereydooni S.; Mori M.; Hameed I.; Jung J.; Krane M.; Geirsson
A.
Institution
(Amabile, Fereydooni, Mori, Hameed, Jung, Krane, Geirsson) Division of
Cardiac Surgery, Department of Surgery, Yale School of Medicine, New
Haven, CT, United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: Atrial functional mitral regurgitation (AFMR) is a subtype of
functional mitral regurgitation due to longstanding atrial fibrillation
(AF) or heart failure with preserved ejection fraction. The variation in
AFMR' definition and the common mode of treatment described in the
literature remain unknown. Method(s): We performed a scoping review
of studies that surgically treated AFMR to characterize the existing
variability in the definition of AFMR, the type of operations performed
for AFMR valvulopathy, and the treatment for the chronic AF. We searched
Medline, EMBASE, Cochrane Library, Scopus, and Web of Science since their
inceptions for studies of patients affected by AFMR and surgically treated
for their valvulopathy. Result(s): Twelve studies (n = 494 patients)
met eligibility criteria. All studies excluded patients with signs of left
ventricular (LV) dysfunction, but the way additional parameters were used
to define AFMR at a more granular level varied across studies: nine
studies (75%) used the presence of AF to define their AFMR cohorts, with
five (41.2%) requiring a history of AF of >1 year; additionally, the
threshold values for the LV ejection fraction differed (45%-55%). Isolated
mitral annuloplasty was performed in 96.2% of patients. Broad variability
was detected in the proportion of patients undergoing the Cox-Maze
procedure (range, 17.8%-79.5%), pulmonary vein isolation (0.0%-66.7%), and
left atrial appendage ligation (0.0%-100.0%). Conclusion(s): AFMR
remains variably defined in surgical studies, making comparisons across
studies difficult. Mitral annuloplasty was most commonly performed. The
proportion of AFMR patients undergoing concomitant procedures for AF
varied substantially. Copyright © 2022 Wiley Periodicals LLC.

<30>
Accession Number
2015089834
Title
Rejection surveillance in pediatric heart transplant recipients: Critical
reflection on the role of frequent and long-term routine surveillance
endomyocardial biopsies and comprehensive review of non-invasive rejection
screening tools.
Source
Pediatric Transplantation. (no pagination), 2022. Date of Publication:
2022.
Author
Power A.; Baez Hernandez N.; Dipchand A.I.
Institution
(Power, Baez Hernandez) Department of Pediatrics, UT Southwestern Medical
Center and Children's Medical Center, Dallas, TX, United States
(Dipchand) Department of Pediatrics, University of Toronto, Hospital for
Sick Children, Toronto, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background: Despite significant medical advances in the field of pediatric
heart transplantation (HT), acute rejection remains an important cause of
morbidity and mortality. Endomyocardial biopsy (EMB) remains the
gold-standard method for diagnosing rejection but is an invasive,
expensive, and stressful process. Given the potential adverse consequences
of rejection, routine post-transplant rejection surveillance protocols
incorporating EMB are widely employed to detect asymptomatic rejection.
Each center employs their own specific routine rejection surveillance
protocol, with no consensus on the optimal approach and with high
inter-center variability. The utility of high-frequency and long-term
routine surveillance biopsies (RSB) in pediatric HT has been called into
question. Method(s): Sources for this comprehensive review were
primarily identified through searches in biomedical databases including
MEDLINE and Embase. Result(s): The available literature suggests that
the diagnostic yield of RSB is low beyond the first year post-HT and that
a reduction in RSB intensity from high-frequency to low-frequency can be
done safely with no impact on early and mid-term survival. Though there
are emerging non-invasive methods of detecting asymptomatic rejection, the
evidence is not yet strong enough for any test to replace EMB.
 Conclusion(s): Overall, pediatric HT centers in North America should
likely be doing fewer RSB than are currently performed. Risk factors for
rejection should be considered when designing the optimal rejection
surveillance strategy. Noninvasive testing including emerging biomarkers
may have a complementary role to aid in safely reducing the need for
RSB. Copyright © 2022 Wiley Periodicals LLC.

<31>
Accession Number
2014928015
Title
Surgical Treatment of Primary Cardiac Tumors in Children Systematic Review
and Meta-analysis.
Source
Pediatric Cardiology. 43(2) (pp 251-266), 2022. Date of Publication:
February 2022.
Author
Svobodov A.A.; Glushko L.A.; Ergashov A.Y.
Institution
(Svobodov, Glushko, Ergashov) Bakoulev Scientific Center for
Cardiovascular Surgery Moskva, Rublevskoe shosse 135, Moscow 121552,
Russian Federation
Publisher
Springer
Abstract
This systematic review sought to investigate the current evidence
regarding surgical management of primary cardiac tumors in children.
Twenty-four studies were deemed eligible, reporting on 713 pediatric
patients. Cumulative 30-day mortality rate was 5.5% and 7.5% after
surgery. It was revealed a statistically lower mortality rate in the group
of patients below 1 year of age, justifying a more aggressive surgical
approach for primary cardiac tumors, except for rhabdomyoma that can
regress spontaneously. Copyright © 2022, The Author(s), under
exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<32>
Accession Number
2014908310
Title
Long-term impact of permanent cardiac pacing after surgical aortic valve
replacement: systematic review and meta-analysis.
Source
Expert Review of Cardiovascular Therapy. 20(1) (pp 81-86), 2022. Date of
Publication: 2022.
Author
Servito M.; Khoury W.; Payne D.; Baranchuk A.; El-Diasty M.
Institution
(Servito, Khoury) Faculty of Medicine, Queen's University, Kingston, ON,
Canada
(Payne, El-Diasty) Division of Cardiac Surgery, Kingston Health Sciences
Centre, Kingston, ON, Canada
(Baranchuk) Division of Cardiology, Kingston Health Sciences Centre,
Kingston, ON, Canada
Publisher
Taylor and Francis Ltd.
Abstract
Objectives: Permanent pacemaker (PPM) implantation after surgical aortic
valve (SAVR) is associated with short- and long-term complications.
However, the impact of PPM implantation on long-term mortality has not
been fully established. The aim of this meta-analysis was to determine
whether PPM post-SAVR increases the risk of mortality. Method(s): We
searched Cochrane, MEDLINE, and EMBASE from inception to December 2020 for
studies comparing mortality between patients who received PPM post-SAVR
and those who did not. Random effects meta-analysis was performed to
determine the effect of PPM on early and late mortality. The effect sizes
were reported as hazard ratio (HR) with 95% confidence intervals.
 Result(s): Three studies met criteria, which yielded a total of 9,105
patients. The most common indication was post-operative complete
atrioventricular block. While there was no difference in early mortality
between the PPM and no PPM groups (RR 1.19; 95%CI 0.20-7.08; I2
= 23%), PPM implantation was shown to significantly increase late
mortality (RR 1.49; 95%CI 1.25-1.77; I2 = 0%).
 Conclusion(s): The need for permanent pacemaker after surgically
isolated aortic valve replacement is associated with increased risk of
long-term mortality. This warrants further exploration on the effect of
PPM on long-term mortality in patients receiving sutureless prostheses or
transcatheter aortic valve implants. Abbreviations PPM Permanent
PacemakerSAVR Surgical Aortic Valve Replacement. Copyright © 2022
Informa UK Limited, trading as Taylor & Francis Group.

<33>
Accession Number
2014876338
Title
Epidemiology of infective endocarditis: novel aspects in the twenty-first
century.
Source
Expert Review of Cardiovascular Therapy. 20(1) (pp 45-54), 2022. Date of
Publication: 2022.
Author
Arshad V.; Talha K.M.; Baddour L.M.
Institution
(Arshad, Talha) Division of Infectious Diseases, Department of Medicine,
Mayo Clinic College of Medicine and Science, Rochester, MN, United States
(Baddour) Department of Cardiovascular Disease, Mayo Clinic School of
Medicine and Science, Rochester, MN, United States
(Baddour) Division of Infectious Diseases, Department of Medicine, Mayo
Clinic School of Medicine and Science, Rochester, MN, United States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: The epidemiology of infective endocarditis (IE) in this
millennium has changed with emergence of new risk factors and reemergence
of others. This, coupled with modifications in national guidelines in the
setting of a pandemic, prompted an address of the topic. Areas covered:
Our goal is to provide a contemporary review of IE epidemiology
considering changing incidence of rheumatic heart disease (RHD), cardiac
device implantation, and injection drug use (IDU), with SARS-CoV-2
pandemic as the backdrop. Method(s): PubMed and Google Scholar were
used to identify studies of interest. Expert opinion: Our experience over
the past two decades verifies the notion that there is not one 'textbook'
profile of IE. Multiple factors have dramatically impacted IE
epidemiology, and these factors differ, based, in part on geography. RHD
has declined in many areas of the world, whereas implanted cardiovascular
devices-related IE has grown exponentially. Perhaps the most influential,
at least in areas of the United States, is injection drug use complicating
the opioid epidemic. Healthy younger individuals contracting a potentially
life-threatening infection has been tragic. In the past year,
epidemiological changes due to the COVID-19 pandemic have also occurred.
No doubt, changes will characterize IE in the future and serial review of
the topic is warranted. Copyright © 2022 Informa UK Limited,
trading as Taylor & Francis Group.

<34>
Accession Number
2014799221
Title
The Efficacy of Corticosteroids, NSAIDs, and Colchicine in the Treatment
of Pediatric Postoperative Pericardial Effusion.
Source
Pediatric Cardiology. 43(2) (pp 279-289), 2022. Date of Publication:
February 2022.
Author
Somani N.; Breur H.
Institution
(Somani, Breur) Department of Pediatric Cardiology, University Medical
Center Utrecht, Lundlaan 6, Utrecht 3584 EA, Netherlands
Publisher
Springer
Abstract
The objective of this study is to investigate and compare the efficacy of
corticosteroids, NSAIDs, and colchicine in treating postoperative
pericardial effusion (PPE) following cardiac surgery in the pediatric
setting, on the basis of available literature. To investigate and compare
the efficacy of corticosteroids, NSAIDs, and colchicine in treating
postoperative pericardial effusion (PPE) following cardiac surgery in the
pediatric setting, on the basis of available literature. A systematic
review was conducted by carrying out a database search in PubMed on April
20th, 2021. An English language filter was added, but no time restrictions
were applied. Lack of pediatric literature prompted a broadening of the
search to include adult literature. One pediatric and four adult studies
were included, but the pediatric evidence was not found to be of
satisfactory quality, and the findings of adult literature could not be
readily generalized to the pediatric setting. No well-founded conclusions
could be drawn regarding the efficacy of corticosteroids, NSAIDs, or
colchicine in treating PPE, as a striking lack of evidence for their
efficacy in the pediatric setting were revealed. A knowledge gap was found
in the literature, indicating a need for good-quality randomized
controlled trials to bridge this gap. Copyright © 2022, The
Author(s).

<35>
Accession Number
2014741083
Title
Morbidity and mortality in patients managed with high compared with low
blood pressure targets during on-pump cardiac surgery: a systematic review
and meta-analysis of randomized controlled trials.
Source
Canadian Journal of Anesthesia. 69(3) (pp 374-386), 2022. Date of
Publication: March 2022.
Author
McEwen C.C.; Amir T.; Qiu Y.; Young J.; Kennedy K.; Grocott H.P.; Kashani
H.; Mazer D.; Brudney S.; Kavosh M.; Jacobsohn E.; Vedel A.; Wang E.;
Whitlock R.P.; Belley-Cote E.P.; Spence J.
Institution
(McEwen) Department of Surgery (Cardiac Surgery), McMaster University,
Hamilton, ON, Canada
(Amir, Qiu, Wang) Faculty of Health Sciences, McMaster University,
Hamilton, ON, Canada
(Young) Health Sciences Library, McMaster University, Hamilton, ON, Canada
(Kennedy) Department of Health Research Methods, Evaluation, and Impact,
McMaster University, Hamilton, ON, Canada
(Grocott, Kashani, Kavosh) Department of Anesthesia and Perioperative
Medicine, University of Manitoba, Winnipeg, MB, Canada
(Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St.
Michael's Hospital, Toronto, ON, Canada
(Mazer) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, ON, Canada
(Brudney, Jacobsohn) Departments of Medicine (Critical Care) and
Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg,
MB, Canada
(Vedel) Department of Cardiothoracic Anesthesiology, Copenhagen University
Hospital, Copenhagen, Denmark
(Whitlock) Departments of Surgery (Cardiac Surgery) and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
(Whitlock, Belley-Cote, Spence) Perioperative Research Division,
Population Health Research Institute, Hamilton, ON, Canada
(Belley-Cote) Departments of Medicine (Cardiology and Critical Care) and
Health Research Methods, Evaluation, and Impact, McMaster University,
Hamilton, ON, Canada
(Spence) Departments of Anesthesia and Critical Care and Health Research
Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada
Publisher
Springer
Abstract
Purpose: Many believe that blood pressure management during cardiac
surgery is associated with postoperative outcomes. We conducted a
systematic review and meta-analysis of randomized controlled trials (RCTs)
to determine the impact of high compared with low intraoperative blood
pressure targets on postoperative morbidity and mortality in adults
undergoing cardiac surgery on cardiopulmonary bypass (CPB). Our primary
objective was to inform the design of a future large RCT. Source: We
searched MEDLINE, EMBASE, Web of Science, CINAHL, and CENTRAL for RCTs
comparing high with low intraoperative blood pressure targets in adult
patients undergoing any cardiac surgical procedure on CPB. We screened
reference lists, grey literature, and conference proceedings. Principal
findings: We included eight RCTs (N =1,116 participants); all examined the
effect of blood pressure management only during the CPB. Trial definitions
of high compared with low blood pressure varied and, in some, there was a
discrepancy between the target and achieved mean arterial pressure. We
observed no difference in delirium, cognitive decline, stroke, acute
kidney injury, or mortality between high and low blood pressure targets
(very-low to low quality evidence). Higher blood pressure targets may have
increased the risk of requiring a blood transfusion (three trials; n = 456
participants; relative risk, 1.4; 95% confidence interval, 1.1 to 1.9; P =
0.01; moderate quality evidence) but this finding was based on a small
number of trials. Conclusion(s): Individual trial definitions of high
and low blood pressure targets varied, limiting inferences. The effect of
high (compared with low) blood pressure targets on other morbidity and
mortality after cardiac surgery remains unclear because of limitations
with the body of existing evidence. Research to determine the optimal
management of blood pressure during cardiac surgery is required. Study
registration: PROSPERO (CRD42020177376); registered: 5 July
2020. Copyright © 2022, Canadian Anesthesiologists' Society.

<36>
[Use Link to view the full text]
Accession Number
2016744591
Title
The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of
Acute Kidney Injury Following Congenital Heart Surgery in Infants: A
Randomized Clinical Trial.
Source
Pediatric Critical Care Medicine. 20(10) (pp 947-956), 2019. Date of
Publication: 01 Oct 2019.
Author
Thorlacius E.M.; Suominen P.K.; Wahlander H.; Keski-Nisula J.; Vistnes M.;
Ricksten S.-E.; Synnergren M.; Romlin B.S.; Castellheim A.
Institution
(Thorlacius, Ricksten, Romlin, Castellheim) Department of Anesthesiology
and Intensive Care Medicine, Sahlgrenska Academy, University of
Gothenburg, Queen Silvia Children's Hospital, Sahlgrenska University
Hospital, Gothenburg, Sweden
(Suominen, Keski-Nisula) Department of Anesthesia and Intensive Care,
Children's Hospital, Helsinki University Central Hospital, Helsinki,
Finland
(Wahlander) Department of Pediatric Cardiology, Sahlgrenska Academy,
University of Gothenburg, Queen Silvia Children's Hospital, Sahlgrenska
University Hospital, Gothenburg, Sweden
(Vistnes) Department of Internal Medicine, Diakonhjemmet Hospital,
Institute for Experimental Medical Research, Oslo University Hospital,
University of Oslo, Oslo, Norway
(Synnergren) Department of Pediatric Thoracic Surgery, Queen Silvia
Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Publisher
Lippincott Williams and Wilkins
Abstract
Objectives: It has been shown that, in contrast to other inotropic agents,
levosimendan improves glomerular filtration rate after adult cardiac
surgery. The aim of this study was to investigate the efficacy of
levosimendan, compared with milrinone, in preventing acute kidney
dysfunction in infants after open-heart surgery with cardiopulmonary
bypass. Design(s): Two-center, double-blinded, prospective,
randomized clinical trial. Setting(s): The study was performed in two
tertiary pediatric centers, one in Sweden (Gothenburg) and one in Finland
(Helsinki). Patient(s): Infants between 1 and 12 months old,
diagnosed with Tetralogy of Fallot, complete atrioventricular septal
defect or nonrestrictive ventricular septal defect, undergoing total
corrective cardiac surgery with cardiopulmonary bypass.
 Intervention(s): Seventy-two infants were randomized to receive a
perioperative infusion of levosimendan (0.1 microg/kg/min) or milrinone
(0.4 microg/kg/min). The infusion was initiated at the start of
cardiopulmonary bypass and continued for 26 hours. Measurements and
Main Results: The primary outcome variable was the absolute value of serum
creatinine data on postoperative day 1. Secondary outcomes included the
following: 1) acute kidney injury according to the serum creatinine
criteria of the Kidney Diseases: Improving Global Outcomes; 2) acute
kidney injury with serum creatinine corrected for fluid balance; 3) plasma
neutrophil gelatinase-associated lipocalin; 4) cystatin C; 5) urea; 6)
lactate; 7) hemodynamic variables; 8) use of diuretics in the PICU; 9)
need of dialysis; 10) length of ventilator therapy; and 11) length of PICU
stays. There was no significant difference in postoperative serum
creatinine between the treatment groups over time (p = 0.65). The
occurrence rate of acute kidney injury within 48 hours was 46.9% in the
levosimendan group and 39.5% in the milrinone group (p = 0.70). There were
no significant differences in other secondary outcome variables between
the groups. Conclusion(s): Levosimendan compared with milrinone did
not reduce the occurrence rate of acute kidney injury in infants after
total corrective heart surgery for atrioventricular septal defect,
ventricular septal defect, or Tetralogy of Fallot. Copyright ©
2019 by the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies

<37>
Accession Number
637288223
Title
Diagnostic features, management and prognosis of type 2 myocardial
infarction compared to type 1 myocardial infarction: a systematic review
and meta-analysis.
Source
BMJ open. 12(2) (pp e055755), 2022. Date of Publication: 17 Feb 2022.
Author
White K.; Kinarivala M.; Scott I.
Institution
(White, Kinarivala, Scott) Internal Medicine and Clinical Epidemiology,
Princess Alexandra Hospital, Woolloongabba, QLD, Australia
(White, Scott) School of Clinical Medicine, University of Queensland,
Brisbane, QLD, Australia
Publisher
NLM (Medline)
Abstract
IMPORTANCE: Distinguishing type 2 (T2MI) from type 1 myocardial infarction
(T1MI) in clinical practice can be difficult, and the management and
prognosis for T2MI remain uncertain. OBJECTIVE(S): To compare
precipitating factors, risk factors, investigations, management and
outcomes for T2MI and T1MI. DATA SOURCES: Medline and Embase databases as
well as reference list of recent articles were searched January 2009 to
December 2020 for term 'type 2 myocardial infarction'. STUDY SELECTION:
Studies were included if they used a universal definition of MI and
reported quantitative data on at least one variable of interest. DATA
EXTRACTION AND SYNTHESIS: Data were pooled using random-effect
meta-analysis. Risk of bias was assessed using Newcastle-Ottawa quality
assessment tool. Preferred Reporting Items for Systematic Reviews and
Meta-analyses guidelines were followed. All review stages were conducted
by two reviewers. MAIN OUTCOMES AND MEASURES: Risk factors, presenting
symptoms, cardiac investigations such as troponin and angiogram,
management and outcomes such as mortality. RESULT(S): 40 cohort
studies comprising 98 930 patients with T1MI and 13 803 patients with T2MI
were included. Compared with T1MI, patients with T2MI were: more likely to
have pre-existing chronic kidney disease (OR 1.87; 95% CI 1.53 to 2.28)
and chronic heart failure (OR 2.35; 95% CI 1.82 to 3.03), less likely to
present with typical cardiac symptoms of chest pain (OR 0.19; 95% CI 0.13
to 0.26) and more likely to present with dyspnoea (OR 2.64; 95% CI 1.86 to
3.74); more likely to demonstrate non-specific ST-T wave changes on ECG
(OR 2.62; 95% CI 1.81 to 3.79) and less likely to show ST elevation (OR
0.22; 95% CI 0.17 to 0.28); less likely to undergo coronary angiography
(OR 0.09; 95% CI 0.06 to 0.12) and percutaneous coronary intervention (OR
0.06; 95% CI 0.04 to 0.10) or receive cardioprotective medications, such
as statins (OR 0.25; 95% CI 0.16 to 0.38) and beta-blockers (OR 0.45; 95%
CI 0.33 to 0.63). T2MI had greater risk of all cause 1-year mortality (OR
3.11; 95% CI 1.91 to 5.08), with no differences in short-term mortality
(OR 1.34; 95% CI 0.63 to 2.85). CONCLUSION AND RELEVANCE: This review has
identified clinical, management and survival differences between T2MI and
T1MI with greater precision and scope than previously reported.
Differential use of coronary revascularisation and cardioprotective
medications highlight ongoing uncertainty of their utility in T2MI
compared with T1MI. Copyright © Author(s) (or their employer(s))
2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<38>
[Use Link to view the full text]
Accession Number
2016817985
Title
Saphenous vein harvesting techniques for coronary artery bypass grafting:
A systematic review and meta-analysis.
Source
Coronary Artery Disease. 33(2) (pp 128-136), 2022. Date of Publication: 01
Mar 2022.
Author
Vuong N.L.; Elfaituri M.K.; Eldoadoa M.; Karimzadeh S.; Mokhtar M.A.; Eid
P.S.; Nam N.H.; Mostafa M.R.; Radwan I.; Zaki M.M.M.; Al Khudari R.;
Kassem M.; Huy N.T.
Institution
(Vuong) Department of Cardiovascular and Thoracic Surgery, Faculty of
Medicine
(Vuong) Department of Medical Statistics and Informatics, Faculty of
Public Health, University of Medicine, Pharmacy at Ho Chi Minh City, Ho
Chi Minh City, Vietnam
(Elfaituri, Eldoadoa, Karimzadeh, Mokhtar, Eid, Nam, Mostafa, Radwan,
Zaki, Al Khudari, Kassem) Online Research Club, School of Tropical
Medicine and Global Health, Nagasaki University, Nagasaki, Japan
(Elfaituri) Faculty of Medicine, University of Tripoli, Tripoli, Libyan
Arab Jamahiriya
(Eldoadoa) Milton Keynes University Hospital, Milton Keynes, United
Kingdom
(Karimzadeh) School of Medicine, Sabzevar University of Medical Sciences,
Sabzevar, Iran, Islamic Republic of
(Mokhtar) Faculty of Medicine, Sohag University, Sohag, Egypt
(Eid, Radwan) Faculty of Medicine, Ain Shams University, Cairo, Egypt
(Nam) Division of Hepato-Biliary-Pancreatic Surgery and Transplantation,
Department of Surgery, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
(Mostafa) School of Medicine, Tanta University, Tanta, Egypt
(Zaki) Faculty of Clinical Pharmacy, Fayoum University, Fayoum, Egypt
(Al Khudari) Pediatric Department, Children's University Hospital,
Damascus University, Damascus, Syrian Arab Republic
(Kassem) Department of Medical Oncology, Ohio State University, Wexner
Medical Center, Columbus, OH, United States
(Huy) School of Tropical Medicine and Global Health, Nagasaki University,
1-12-4 Sakamoto, Nagasaki 852-8523, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
The great saphenous vein (GSV) graft remains a frequently used conduit for
coronary artery bypass graft (CABG) surgery. The optimal technique for GSV
harvesting has been the subject of on-going controversy. We therefore
sought to conduct a systematic review and meta-analysis of all available
GSV harvesting techniques in CABG. A systematic search of 12 electronic
databases was performed to identify all randomized controlled trials
(RCTs) of any GSV harvesting technique, including conventional vein
harvesting (CVH), no-touch, standard bridging technique (SBT) and
endoscopic vein harvesting (EVH) techniques. We investigated safety and
long-term efficacy outcomes. All outcomes were analyzed using the
frequentist network meta-analysis. A total of 6480 patients from 34 RCTs
were included. For safety outcomes, EVH reduced 91% and 77% risk of wound
infection compared to no-touch and CVH, respectively. EVH and SBT also
significantly reduced the risk of sensibility disorder and postoperative
pain. The techniques were not significantly different regarding long-term
efficacy outcomes, including mortality, myocardial infarction and graft
patency. For GSV harvesting for CABG, EVH techniques are the most
favorable, but in case of using an open technique, no-touch is more
recommended than CVH. More effective and safer procedures should be
investigated for GSV harvesting in CABG. Copyright © 2022
Lippincott Williams and Wilkins. All rights reserved.

<39>
Accession Number
2016799940
Title
Myocardial viability testing: All STICHed up, or about to be REVIVED?.
Source
European Heart Journal. 43(2) (pp 118-126a), 2022. Date of Publication: 07
Jan 2022.
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
Oxford University Press
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 © 2021
The Author(s) 2021. Published by Oxford University Press on behalf of the
European Society of Cardiology.

<40>
Accession Number
2016799921
Title
Sex differences in outcomes after coronary artery bypass grafting: A
pooled analysis of individual patient data.
Source
European Heart Journal. 43(1) (pp 18-28), 2022. Date of Publication: 01
Jan 2022.
Author
Gaudino M.; Di Franco A.; Alexander J.H.; Bakaeen F.; Egorova N.;
Kurlansky P.; Boening A.; Chikwe J.; Demetres M.; Devereaux P.J.; Diegeler
A.; Dimagli A.; Flather M.; Hameed I.; Lamy A.; Lawton J.S.; Reents W.;
Robinson N.B.; Audisio K.; Rahouma M.; Serruys P.W.; Hara H.; Taggart
D.P.; Girardi L.N.; Fremes S.E.; Benedetto U.
Institution
(Gaudino, Di Franco, Hameed, Robinson, Audisio, Rahouma, Girardi)
Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East
68th Street, New York, NY 10065, United States
(Alexander) Department of Medicine, Division of Cardiology, Duke Clinical
Research Institute, 40 Duke Medicine Cir, Durham, NC 27710, United States
(Bakaeen) Department of Thoracic and Cardiovascular Surgery, Cleveland
Clinic, Carnegie Ave, Cleveland, OH 44103, United States
(Egorova) Department of Population Health Science and Policy, Icahn School
of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029,
United States
(Kurlansky) Department of Surgery, Center for Innovation and Outcomes
Research, Columbia University Medical Center, 622 W 168th St, New York, NY
10032, United States
(Boening) Department of Cardiovascular Surgery, Justus-Liebig University
Giesen, Ludwigstrase 23, Giesen 35390, Germany
(Chikwe) Department of Cardiac Surgery, Smidt Heart Institute,
Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA
90048, United States
(Demetres) Samuel J. Wood Library and C.V. Starr Biomedical Information
Center, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065,
United States
(Devereaux, Lamy) Population Health Research Institute, McMaster
University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
(Diegeler, Reents) Department Cardiac Surgery, Cardiovascular Center Bad
Neustadt/Saale, Von-Guttenberg-Strase 11, Saale 97616, Germany
(Dimagli, Benedetto) Bristol Heart Institute, University of Bristol,
Terrell St, Bristol BS2 8ED, United Kingdom
(Flather) Research and Development Unit, Norfolk and Norwich University
Hospitals NHS Foundation Trust, Colney Ln, Norwich NR4 7UY, United Kingdom
(Lawton) Division of Cardiac Surgery, Department of Surgery, Johns Hopkins
University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United
States
(Serruys, Hara) Department of Cardiology, National University of Ireland,
University Rd, Galway, Ireland
(Taggart) Nuffield Department of Surgical Sciences, John Radcliffe
Hospital, University of Oxford, Oxford OX1 2JD, United Kingdom
(Fremes) Schulich Heart Centre Sunnybrook Health Sciences Centre,
University of Toronto, Hospital Road, Toronto, ON M4N 3M5, Canada
Publisher
Oxford University Press
Abstract
Aims: Data suggest that women have worse outcomes than men after coronary
artery bypass grafting (CABG), but results have been inconsistent across
studies. Due to the large differences in baseline characteristics between
sexes, suboptimal risk adjustment due to low-quality data may be the
reason for the observed differences. To overcome this limitation, we
undertook a systematic review and pooled analysis of high-quality
individual patient data from large CABG trials to compare the adjusted
outcomes of women and men. Methods and Results: The primary outcome
was a composite of all-cause mortality, myocardial infarction (MI),
stroke, and repeat revascularization (major adverse cardiac and
cerebrovascular events, MACCE). The secondary outcome was all-cause
mortality. Multivariable mixed-effect Cox regression was used. Four trials
involving 13 193 patients (10 479 males; 2714 females) were included. Over
5 years of follow-up, women had a significantly higher risk of MACCE
[adjusted hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.21;
P = 0.004] but similar mortality (adjusted HR 1.03, 95% CI 0.94-1.14; P =
0.51) compared to men. Women had higher incidence of MI (adjusted HR 1.30,
95% CI 1.11-1.52) and repeat revascularization (adjusted HR 1.22, 95% CI
1.04-1.43) but not stroke (adjusted HR 1.17, 95% CI 0.90-1.52). The
difference in MACCE between sexes was not significant in patients 75 years
and older. The use of off-pump surgery and multiple arterial grafting did
not modify the difference between sexes. Conclusion(s): Women have
worse outcomes than men in the first 5 years after CABG. This difference
is not significant in patients aged over 75 years and is not affected by
the surgical technique. Copyright © 2021 Published on behalf of
the European Society of Cardiology. All rights reserved.

<41>
Accession Number
2016915801
Title
Geographical variations in left main coronary artery revascularisation: A
prespecified analysis of the EXCEL trial.
Source
EuroIntervention. 17(13) (pp 1081-1090), 2022. Date of Publication:
January 2022.
Author
Myat A.; Hildick-Smith D.; De Belder A.J.; Trivedi U.; Crowley A.; Morice
M.-C.; Kandzari D.E.; Lembo N.J.; Morris Brown W.; Serruys P.W.; Kappetein
A.P.; Sabik J.F.; Stone G.W.
Institution
(Myat, Hildick-Smith, De Belder, Trivedi) Sussex Cardiac Centre, Brighton
and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
(Myat) Division of Clinical and Experimental Medicine, Brighton and Sussex
Medical School, Brighton, United Kingdom
(Crowley, Lembo, Stone) Clinical Trials Center, Cardiovascular Research
Foundation, New York, NY, United States
(Morice) Hopital Prive Jacques Cartier, Ramsay Generale de Sante, Massy,
France
(Kandzari, Morris Brown) Piedmont Heart Institute, Atlanta, GA, United
States
(Lembo) NewYork-Presbyterian Hospital, Columbia University Medical Center,
New York, NY, United States
(Serruys) Department of Cardiology, National University of Ireland Galway
(NUIG), Galway, Ireland
(Serruys) Department of Cardiology, Imperial College London, London,
United Kingdom
(Kappetein) Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
(Sabik) Department of Surgery, UH Cleveland Medical Center, Cleveland, OH,
United States
(Stone) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
Publisher
Europa Group
Abstract
Background: The EXCEL trial reported similar five-year rates of the
primary composite outcome of death, myocardial infarction (MI), or stroke
after percutaneous coronary intervention (PCI) compared with coronary
artery bypass grafting (CABG) for treatment of obstructive left main
coronary artery disease (LMCAD). Aim(s): We sought to determine
whether these outcomes remained consistent regardless of geography of
enrolment. Method(s): We performed a prespecified subgroup analysis
based on regional enrolment. Result(s): Among 1,905 patients
randomised to PCI (n=948) or CABG (n=957), 1,075 (56.4%) were recruited at
52 European Union (EU) centres, and 752 (39.5%) were recruited at 67 North
American (NA) centres. EU versus NA patients varied according to numerous
baseline demographics, anatomy, pharmacotherapy and procedural
characteristics. Nonetheless, the relative rates of the primary endpoint
after PCI versus CABG were consistent across EU versus NA centres at 30
days and 5 years. However, NA participants had substantially higher late
rates of ischaemia-driven revascularisation (IDR) after PCI, driven
predominantly by the need for greater target vessel and lesion
revascularisation. This culminated in a significant difference in the
relative risk of the secondary composite outcome of death, MI, stroke, or
IDR at 5 years (pinteraction=0.02). Conclusion(s): In the EXCEL
trial, the relative risks for the 30-day and five-year primary composite
outcome of death, MI or stroke after PCI versus CABG were consistent
irrespective of geography. However, five-year rates of IDR after PCI were
significantly higher in NA centres, a finding the Heart Team and patients
should consider when making treatment decisions. ClinicalTrials.gov
identifier: NCT01205776 Copyright © 2022 Europa Group. All Rights
Reserved.

<42>
Accession Number
2016948571
Title
Triiodothyronine Supplementation in Infants Undergoing Cardiopulmonary
Bypass: A Randomized Controlled Trial.
Source
Seminars in Thoracic and Cardiovascular Surgery. (no pagination), 2022.
Date of Publication: 2022.
Author
Portman M.A.; Slee A.E.; Roth S.J.; Radman M.; Olson A.K.; Mainwaring
R.D.; Kamerkar A.; Nuri M.; Hastings L.
Institution
(Portman, Radman, Olson) Seattle Children's Research Institute and
Department of Pediatrics, University of Washington, Seattle, WA, United
States
(Slee) New Arch Consulting, Seattle, WA, United States
(Roth) Department of Cardiology and Critical Care, Lucile Packard
Children's Hospital, Palo Alto, California, United States
(Mainwaring) Department of Cardiothoracic Surgery, Lucile Packard
Children's Hospital, Palo Alto, California, United States
(Kamerkar) Department of Critical Care, Los Angeles Children's Hospital,
Los Angeles, California, United States
(Nuri) Division of Cardiothoracic Surgery at Children's Hospital of
Philadelphia, Philadelphia, Pennsylvania, United States
(Hastings) Levine Children's Hospital, Scope Anesthesia, Charlotte, North
Carolina, United States
Publisher
W.B. Saunders
Abstract
Cardiopulmonary bypass (CPB) profoundly suppresses circulating thyroid
hormone levels in infants. We performed a multicenter randomized placebo
controlled trial to determine if triiodothyronine (T3) supplementation
improves reduces time to extubation (TTE) in infants after CPB. Infants (n
= 220) undergoing cardiac surgery with CPB and stratified into 2 age
cohorts: <=30 days and >30 days to <152 days were randomization to receive
either intravenous triiodothyronine or placebo bolus followed by study
drug infusion until extubated or at 48 hours, whichever preceded. T3 did
not significantly alter the primary endpoint, TTE (hazard ratio for chance
of extubation (1.08, 95% CI: 0.82-1.43, P = 0.575) in the entire
randomized population with censoring at 21 days. T3 showed no significant
effect on TTE (HR 0.82, 95% CI:0.55-1.23, P = 0.341) in the younger
subgroup or in the older (HR 1.38, 95% CI:0.95-2.2, P = 0.095). T3 also
did not significantly impact TTE during the first 48 hours while T3 levels
were maintained (HR 1.371, 95% CI:0.942-1.95, P = 0.099) No significant
differences occurred for arrhythmias or other sentinel adverse events in
the entire cohort or in the subgroups. This trial showed no significant
benefit on TTE in the entire cohort. T3 supplementation appears safe as it
did not cause an increase in adverse events. The study implementation and
analysis were complicated by marked variability in surgical risk, although
risk categories were balanced between treatment groups. Copyright
© 2022 Elsevier Inc.

<43>
Accession Number
2015094045
Title
Serum biomarkers of brain injury after uncomplicated cardiac surgery:
Secondary analysis from a randomized trial.
Source
Acta Anaesthesiologica Scandinavica. (no pagination), 2022. Date of
Publication: 2022.
Author
Barbu M.; Jonsson K.; Zetterberg H.; Blennow K.; Kolsrud O.; Ricksten
S.-E.; Dellgren G.; Bjork K.; Jeppsson A.
Institution
(Barbu, Dellgren, Jeppsson) Department of Molecular and Clinical Medicine,
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
(Barbu) Department of Cardiology, Blekinge Hospital, Karlskrona, Sweden
(Jonsson, Kolsrud, Dellgren, Bjork, Jeppsson) Department of Cardiothoracic
Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
(Zetterberg, Blennow) Clinical Neurochemistry Laboratory, Sahlgrenska
University Hospital, Molndal, Sweden
(Zetterberg, Blennow) Department of Psychiatry and Neurochemistry,
Institute of Neuroscience and Physiology, Sahlgrenska Academy, University
of Gothenburg, Molndal, Sweden
(Zetterberg) Department of Neurodegenerative Disease, UCL Institute of
Neurology, London, United Kingdom
(Zetterberg) UK Dementia Research Institute at UCL, London, United Kingdom
(Ricksten) Department of Cardiothoracic Anesthesia and Intensive Care,
Sahlgrenska University Hospital, Gothenburg, Sweden
(Ricksten) Department of Anesthesiology and Intensive Care, Institute of
Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
Publisher
John Wiley and Sons Inc
Abstract
Background: Postoperative cognitive dysfunction is common after cardiac
surgery. Postoperative measurements of brain injury biomarkers may
identify brain damage and predict cognitive dysfunction. We describe the
release patterns of five brain injury markers in serum and plasma after
uncomplicated cardiac surgery. Method(s): Sixty-one elective cardiac
surgery patients were randomized to undergo surgery with either a
dextran-based prime or a crystalloid prime. Blood samples were taken
immediately before surgery, and 2 and 24 h after surgery. Concentrations
of the brain injury biomarkers S100B, glial fibrillary acidic protein
(GFAP), tau, neurofilament light (NfL) and neuron-specific enolase (NSE))
and the blood-brain barrier injury marker beta-trace protein were
analyzed. Concentrations of brain injury biomarkers were correlated to
patients' age, operation time, and degree of hemolysis. Result(s): No
significant difference in brain injury biomarkers was observed between the
prime groups. All brain injury biomarkers increased significantly after
surgery (tau +456% (25th-75th percentile 327%-702%), NfL +57% (28%-87%),
S100B +1145% (783%-2158%), GFAP +17% (-3%-43%), NSE +168% (106%-228%),
while beta-trace protein was reduced (-11% (-17-3%). Tau, S100B, and NSE
peaked at 2h, NfL and GFAP at 24 h. Postoperative concentrations of brain
injury markers correlated to age, operation time, and/or hemolysis.
 Conclusion(s): Uncomplicated cardiac surgery with cardiopulmonary
bypass is associated with an increase in serum/plasma levels of all the
studied injury markers, without signs of blood-brain barrier injury. The
biomarkers differ markedly in their levels of release and time course.
Further investigations are required to study associations between
perioperative release of biomarkers, postoperative cognitive function and
clinical outcome. Copyright © 2022 The Authors. Acta
Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on
behalf of Acta Anaesthesiologica Scandinavica Foundation.

<44>
Accession Number
2015070855
Title
Minimally invasive mitral valve surgery versus conventional sternotomy
mitral valve surgery: A systematic review and meta-analysis of 119
studies.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Eqbal A.J.; Gupta S.; Basha A.; Qiu Y.; Wu N.; Rega F.; Chu F.V.;
Belley-Cote E.P.; Whitlock R.P.
Institution
(Eqbal, Gupta, Chu, Whitlock) Division of Cardiac Surgery, McMaster
University, Hamilton, ON, Canada
(Basha) Libin Cardiovascular Institute, University of Calgary, Calgary,
AB, Canada
(Qiu) Michael G. DeGroote School of Medicine, McMaster University,
Hamilton, ON, Canada
(Wu) Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
(Rega) Department of Cardiac Surgery, Universitair Ziekenhuis Leuven,
Leuven, Belgium
(Belley-Cote) Division of Cardiology, McMaster University, Hamilton, ON,
Canada
(Belley-Cote, Whitlock) Population Health Research Institute, McMaster
University, Hamilton, ON, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background and Aim of the Study: Whether minimally invasive mitral valve
surgery (MMVS) leads to better outcomes remains unclear. We conducted a
systematic review and meta-analysis comparing various MMVS approaches with
conventional sternotomy. Method(s): We searched Cochrane CENTRAL,
MEDLINE, EMBASE, ClinicalTrials. gov, and the ISRCTN Register for studies
comparing minimally invasive approach (thoracotomy, port access, partial
sternotomy, or robotic) with median sternotomy for mitral valve surgery.
We performed title and abstract, full-text screening, and data extraction
independently and in duplicate. We pooled data using random effect models.
Quality assessment was performed using validated tools. Certainty of
evidence was established using the GRADE framework. Result(s): One
hundred and nineteen studies (n = 38,106) met eligibility criteria: eight
randomized controlled trials (RCTs) and 111 observational studies. MMVS
was associated with fewer days in hospital (RCT: MD: -2.2 days, 95% CI,
[-3.7 to -0.8]; observational: MD: -2.4 days, 95% CI, [-2.7 to -2.1]).
Observational studies suggested that MMVS reduced transfusion requirements
with fewer units transfused per patient (MD: -1.2; 95% CI, [-1.6 to -0.9])
and fewer patients transfused (RR, 0.7; 95% CI, [0.6-0.7]). Observational
data also suggested lower mortality with MMVS (RR, 0.6; 95% CI, [0.5-0.7],
p <.001, I2 = 0%), but this was not corroborated by RCT data.
The risk of postoperative mitral regurgitation (>=2+ or requiring
re-intervention) did not differ between the two groups.
 Conclusion(s): MMVS may be associated with shorter length of hospital
stay with no significant difference in short-term morbidity and mortality.
There is a paucity of high-quality data on the long-term outcomes of MMVS
when compared with conventional sternotomy. Copyright © 2022
Wiley Periodicals LLC

<45>
Accession Number
637286141
Title
Bibliometric Analysis of 50 Most Cited Articles Comparing Lobectomy with
Sublobar Resection.
Source
Thoracic and Cardiovascular Surgeon. (no pagination), 2022. Date of
Publication: 2022.
Author
Tekneci A.K.; Ozgur G.K.; Akcam T.I.; Cagirici U.
Institution
(Tekneci, Ozgur, Akcam, Cagirici) Department of Thoracic Surgery, Faculty
of Medicine, Ege University, Izmir 35100, Turkey
Publisher
Georg Thieme Verlag
Abstract
Background Recent years have seen an increase in the number of studies of
the sublobar resection approach in non-small cell lung cancer (NSCLC)
surgery. The purpose of this bibliometric analysis is to assess the
significance and impact of articles comparing sublobar resection and
lobectomy in NSCLC surgery. Material and Methods The Web of Science
database was searched to identify studies comparing sublobar resection and
lobectomy in NSCLC surgery published between 2005 and 2020 (accessed:
September 11, 2020). The 50 most cited articles were analyzed by years,
countries, authors, authors' affiliations, journals, journals' addresses,
and impact factors. Results The bibliometric analysis revealed that the
most cited article had 443 citations, while the total number of citations
of all articles was 2,820. The mean number of citations, in turn, was 56.4
+/- 75.62 (1-443) times. The highest number of publications over the past
15 years was in 2016, with eight articles. The Annals of Thoracic Surgery
(n = 10; 20%) had the highest number of publications on the list. The
articles included in the present study were mostly (n = 35, 70%) published
in U.S. journals. While multiple subject matters and analyses were
presented by many studies, survival was the topic of greatest interest,
with 37 (74%) studies. Conclusion This study revealed that interest in
studies comparing sublobar resection with lobectomy has increased in
recent years. It also presents both quantitative and qualitative analyses
of the most cited articles in the literature on this topic. Therefore, it
can serve as a guide for researchers. Copyright © 2022 Georg
Thieme Verlag. All rights reserved.

<46>
Accession Number
637280981
Title
Development and validation of a nomogram model for pneumonia after redo
cardiac surgery.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). (no pagination),
2022. Date of Publication: 16 Feb 2022.
Author
Wang D.; Li Y.; Sheng W.; Wang H.; Le S.; Huang X.; Du X.
Institution
(Wang) Department of Cardiovascular Surgery Department of Emergency
General Surgery, Union Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, China
Publisher
NLM (Medline)
Abstract
AIMS: Postoperative pneumonia (POP) after redo cardiac surgery is
prevalent, associated with poor outcome. The aim of this study was to
identify independent risk factors for POP after redo cardiac surgery and
to develop and validate a prediction model. METHOD(S): Adults
undergoing redo cardiac surgery from 2016 to 2019 were identified in a
single-institution database. Using a 2 : 1 ratio, the patients were
randomly divided into training and validation sets. Univariate and
multivariate analyses were applied to identify independent predictors for
POP in the training set. A nomogram model was constructed for clinical
utility and was validated in the validation set. RESULT(S): POP
developed in 72 of the 376 patients (19.1%). Four independent risk factors
were identified, including age, chronic obstructive pulmonary disease,
serum creatinine level and intraoperative blood transfusion volume. A
nomogram based on the four predictors was constructed, with good
discrimination in both the training (c-index: 0.86) and validation sets
(c-index: 0.78). The model was well calibrated, with a Hosmer-Lemeshow
chi2-value of 7.31 (P = 0.50) in the training set and 7.41 (P = 0.49) in
the validation set. The calibration was also good by visual inspection.
The decision and clinical impact curves of the nomogram indicated good
clinical utility. Three risk intervals were identified based on the
nomogram for better risk stratification. CONCLUSION(S): We developed
and validated a nomogram model for POP after redo cardiac surgery. The
model may have good clinical utility in risk evaluation and individualized
treatment to reduce adverse events.Graphical abstract Incidence, risk
factor, and outcomes of postoperative pneumonia after redo cardiac
surgery: http://links.lww.com/JCM/A445. Copyright © 2022 Italian
Federation of Cardiology. All rights reserved.

<47>
Accession Number
624628505
Title
Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary
Intervention in ST-Segment Elevation Myocardial Infarction:
ATLANTIC-Morphine.
Source
American Journal of Cardiovascular Drugs. 19(2) (pp 173-183), 2019. Date
of Publication: 08 Apr 2019.
Author
Lapostolle F.; van't Hof A.W.; Hamm C.W.; Stibbe O.; Ecollan P.; Collet
J.-P.; Silvain J.; Lassen J.F.; Bolognese L.; Cantor W.J.; Cequier A.;
Chettibi M.; Goodman S.G.; Hammett C.J.; Huber K.; Janzon M.; Merkely B.;
Storey R.F.; ten Berg J.; Zeymer U.; Licour M.; Tsatsaris A.; Montalescot
G.; Bougherbal R.; Bouafia M.T.; Nibouche D.; Moklati A.; Benalia A.; Kaid
O.; Krim M.; Hammett C.; Garraby P.; Jayasinghe R.; Rashford S.; Neunteufl
T.; Brussee H.; Alber H.; Weidinger F.; Brunner M.; Sipoetz J.; Prause G.;
Baubin M.; Sebald D.; Vijayaraghavan R.; Bata I.; Lavoie A.; Ravkilde J.;
Jensen L.O.; Christensen A.M.; Toftegaard M.; Kohler D.; Ducrocq G.;
Danchin N.; Henry P.; Livarek B.; Berthier R.; Hovasse T.; Garot P.; Payot
L.; Benamer H.; Esteve J.B.; Elhadad S.; Teiger E.; Bonnet J.L.; Paganelli
F.; Cottin Y.; Schiele F.; Thuaire C.; Cayla G.; Coste P.; Ohlmann P.;
Cudraz E.B.; Lantelme P.; Perret T.; Tron C.; De Labriolle A.; Aptecar E.;
Beliard O.; Varenne O.; Mahmoud R.E.; Filippi-Codaccioni E.; Angoulvant
D.; Peycher P.; Poitrineau O.; Tabone X.; Broche C.; Lambert Y.; Briole
N.; Beruben A.; Porcher N.; Auffray J.-P.; Freysz M.; Depardieu F.; Poubel
D.; De La Cousaye J.-E.; Bartier J.-C.; Jardel B.; Boulanger B.; Labourel
H.; Soulat L.-C.; Julie V.; Thicoipe M.; Capel O.; Carli P.; Tazarourte
K.; Alcouffe F.; Aboucaya D.; Aubert G.; Kierzek G.; Cahun-Giraud S.; Hamm
C.; Dengler T.; Prondzinsky R.; Biever P.M.; Schafer A.; Seyfarth M.;
Lemke B.; Werner G.; Nef H.; Steiger H.; Leschke M.; Munzel T.; Orto
M.C.D.; Loges C.; Schinke M.; Koberne F.; Reiffen H.P.; Tiroch K.; Wierich
D.; Kneussel M.; Little S.; Sauer H.; Laufenberg-Feldmann R.; Ungi I.;
Horvath I.; Edes I.; Martai I.; Berti S.; Chiarella F.; Calabria P.;
Fineschi M.; Galvani M.; Valgimigli M.; Moretti L.; Tespili M.; Mando M.;
Bermano F.; Biagioni R.; Fabbri A.; Ricciardelli A.; Petroni M.R.;
Vatteroni U.R.; Palumbo F.; Willems F.F.; mafragi A.A.; Heestermans
T.A.A.C.M.; Van Eck M.J.; Heutz W.M.J.M.; Meppelder H.H.; Jong A.R.-D.;
Van de Pas H.; Fillat A.C.; Tenas M.S.; Ferrer J.M.; Penaranda A.S.;
Ferrer J.A.; Del Blanco B.G.; Guardiola F.M.; Nodar J.M.R.; Romo A.I.;
Gonzalez N.V.; Nouche R.T.; De La Llera L.D.; Garcia J.M.H.; Rivero-Crespo
F.; Hernandez F.H.; Gomez J.L.Z.; Farega X.J.; Fernandez G.A.; Toboso
J.L.; Carrasco M.; Barreiro V.; Vazquez J.A.I.; del Mar Ruiz Montero M.;
Ortiz F.R.; Escudero G.G.; Ingelmo V.S.-B.; Garcia A.L.; Oldgren J.;
Calais F.; Kastberg R.; Bergsten P.-A.; Blomberg H.; Thorn K.; Skoog G.;
Zaman A.; Gerber R.; Ryding A.; Spence M.; Swanson N.; Been M.; Grosser
K.; Schofield P.; Mackin D.; Fell P.; Foster T.Q.T.; McManus D.; Carson A.
Institution
(Lapostolle) SAMU 93 - UF Recherche-Enseignement-Qualite, Universite Paris
13, Sorbonne Paris Cite, Inserm U942, Hopital Avicenne, 125, rue de
Stalingrad, Bobigny 93009, France
(van't Hof) Department of Cardiology, Isala Clinics, Zwolle, Netherlands
(Hamm) Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad
Nauheim, Germany
(Stibbe) Service Medical d'Urgence, Brigade de Sapeurs-Pompiers de Paris,
Paris, France
(Ecollan, Collet, Silvain, Montalescot) Sorbonne Universite, ACTION Study
Group, Hopital Pitie-Salpetriere (AP-HP), 47 boul de l'Hopital, Paris
75013, France
(Lassen) Department of Cardiology B, Aarhus University Hospital, Skejby,
Aarhus N, Denmark
(Heutz) Regionale Ambulance Voor ziening Gelderland-Midden, Arnhem,
Netherlands
(Bolognese) Cardiovascular and Neurological Department, Azienda
Ospedaliera Arezzo, Arezzo, Italy
(Cantor) Southlake Regional Health Centre, University of Toronto,
Newmarket, ON, Canada
(Cequier) Heart Disease Institute, Hospital Universitario de Bellvitge,
University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
(Chettibi) Centre Hospito-universitaire Frantz Fanon, Blida, Algeria
(Goodman) Division of Cardiology, Canadian Heart Research Centre, St
Michael's Hospital, University of Toronto, Toronto, Canada
(Hammett) Department of Cardiology, Royal Brisbane and Women's Hospital,
Brisbane, QLD, Australia
(Huber) 3rd Department of Medicine, Cardiology and Intensive Care
Medicine, Wilhelminenhospital, Sigmund Freud University, Medical School,
Vienna, Austria
(Janzon) Department of Cardiology and Department of Medical and Health
Sciences, Linkoping University, Linkoping, Sweden
(Merkely) Heart and Vascular Center, Semmelweis University, Budapest,
Hungary
(Storey) Department of Infection, Immunity and Cardiovascular Disease,
University of Sheffield, Sheffield, United Kingdom
(ten Berg) Department of Cardiology, St Antonius Hospital Nieuwegein,
Nieuwegein, Netherlands
(Zeymer) Klinikum Ludwigshafen and Institut fur Herzinfarktforschung
Ludwigshafen, Ludwigshafen, Germany
(Licour, Tsatsaris) AstraZeneca, Rueil Malmaison, France
(van't Hof) Department of Cardiology, Maastricht University Medical
Center, Maastricht, Netherlands
Publisher
Adis
Abstract
Background: Morphine adversely impacts the action of oral adenosine
diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial
infarction (STEMI) patients, and is possibly associated with differing
patient characteristics. This retrospective analysis investigated whether
interaction between morphine use and pre-percutaneous coronary
intervention (pre-PCI) ST-segment elevation resolution in STEMI patients
in the ATLANTIC study was associated with differences in patient
characteristics and management. Method(s): ATLANTIC was an
international, multicenter, randomized study of treatment in the acute
ambulance/hospital setting where STEMI patients received ticagrelor 180 mg
+/- morphine. Patient characteristics, cardiovascular history, risk
factors, management, and outcomes were recorded. Result(s): Opioids
(97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were
no significant differences in age, sex or cardiovascular history, but more
morphine-treated patients had anterior myocardial infarction and left-main
disease. Time from chest pain to electrocardiogram and ticagrelor loading
was shorter with morphine (both p = 0.01) but not total ischemic time.
Morphine-treated patients more frequently received glycoprotein IIb/IIIa
inhibitors (p = 0.002), thromboaspiration and stent implantation (both p <
0.001). No significant difference between the two groups was found
regarding pre-PCI >= 70% ST-segment elevation resolution, death,
myocardial infarction, stroke, urgent revascularization and definitive
acute stent thrombosis. More morphine-treated patients had an absence of
pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs.
79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p =
0.02). Conclusion(s): Morphine-treatment was associated with
increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more
bleeding. Judicious morphine use is advised with non-opioid analgesics
preferred for non-severe acute pain. Trial Registration:
clinicaltrials.gov identifier: NCT01347580. Copyright © 2018,
Springer Nature Switzerland AG.

<48>
Accession Number
637134860
Title
Evaluation of low-dose colchicine in patients with cardiopulmonary bypass:
Study protocol for a randomised controlled trial.
Source
BMJ Open. 12(2) (no pagination), 2022. Article Number: e050577. Date of
Publication: 01 Feb 2022.
Author
Zhang H.; Han X.; Pan T.; Zhang H.-T.; Zhong K.; Li Z.-S.; Jiang X.; Pan
J.; Wang D.-J.
Institution
(Zhang, Pan, Zhang, Li, Jiang, Wang) Department of Cardio-Thoracic
Surgery, Nanjing Drum Tower Hospital, Chinese Academy of Medical Sciences,
Peking Union Medical College, Graduate School of Peking, Union Medical
College, Beijing, China
(Han) Department of Epidemiology, Harvard University, T H Chan School of
Public Health, Boston, MA, United States
(Han) Program in Genetic Epidemiology and Statistical Genetics, Harvard
University, T H Chan School of Public Health, Boston, MA, United States
(Pan, Pan, Wang) Department of Cardio-Thoracic Surgery, Nanjing Drum Tower
Hospital, The Affiliated Hospital, Nanjing University Medical School,
Nanjing University Medical School, Affiliated Nanjing Drum Tower Hospital,
Jiangsu, Nanjing, China
(Zhong) Department of Cardio-Thoracic Surgery, Nanjing Drum Tower
Hospital, Nanjing Medical University, Nanjing Medical University, Jiangsu,
Nanjing, China
Publisher
BMJ Publishing Group
Abstract
Introduction Inflammation and myocardial damage caused by cardiovascular
surgery with cardiopulmonary bypass (CPB) have been shown to be the major
contributors to postoperative morbidity and mortality. Colchicine can
reduce myocardial ischaemia-reperfusion injury in patients with chronic
coronary artery disease. However, there is a lack of evidence whether
colchicine could reduce myocardial injury after cardiovascular surgery. In
this study, we aim to evaluate the effect of low-dose colchicine on
myocardial protection during perioperative period in patients who undergo
cardiovascular surgery with CPB. Methods and analysis In this randomised
controlled trial, a total of 132 patients will be recruited from the
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital.
Patients will be randomised into the colchicine treatment group and
control group with a ratio of 1:1. Patients in the colchicine treatment
group will receive 0.5 mg of colchicine daily for 3 days before surgery
and 0.5 mg of colchicine daily for 5 days after surgery. Patients in the
control group will receive placebo instead of colchicine for the same
schedule. Level of postoperative myocardial injury will be assessed as the
primary outcome. The secondary outcomes are biomarker levels for
myocardial injury (such as creatine kinase-MB, cardiac troponin I,
myohaemoglobin, type B natriuretic peptide, D-dimer) and inflammatory
response markers (white blood cell, procalcitonin, interleukin-6, C
reactive protein) for 5 consecutive days after surgery and poor
postoperative outcomes. Ethics and dissemination This study has been
approved by Medical Ethics Committee of Affiliated Nanjing Drum Tower
Hospital, Nanjing University Medical College (approval number:
2020-293-01). Study results will be disseminated through publication in an
open access journal. Trial registration number
ChiCTR2000040129. Copyright © 2022 BMJ Publishing Group. All
rights reserved.

<49>
Accession Number
637058308
Title
Association of Antihypertensives That Stimulate vs Inhibit Types 2 and 4
Angiotensin II Receptors with Cognitive Impairment.
Source
JAMA Network Open. 5(1) (pp E2145319), 2022. Date of Publication: 28 Jan
2022.
Author
Marcum Z.A.; Cohen J.B.; Zhang C.; Derington C.G.; Greene T.H.; Ghazi L.;
Herrick J.S.; King J.B.; Cheung A.K.; Bryan N.; Supiano M.A.; Sonnen J.A.;
Weintraub W.S.; Williamson J.; Pajewski N.M.; Bress A.P.
Institution
(Marcum) Department of Pharmacy, School of Pharmacy, University of
Washington, 1959 NE Pacific St, Box 357630, Seattle, WA 98102, United
States
(Cohen) Renal-Electrolyte and Hypertension Division, Department of
Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, United States
(Cohen) Department of Biostatistics Epidemiology, and Informatics,
Perelman School of Medicine, University of Pennsylvania, Philadelphia,
United States
(Zhang, Derington, Greene, Herrick, King, Bress) Division of Health System
Innovation and Research, Department of Population Health Sciences,
University of Utah, School of Medicine, Salt Lake City, United States
(Ghazi) Clinical and Translational Research Accelerator, Yale University,
School of Medicine, New Haven, CT, United States
(Herrick, King, Cheung, Bress) George E. Wahlen Department of Veterans,
Affairs Medical Center, Salt Lake City, UT, United States
(King) Institute for Health Research, Kaiser Permanente Colorado, Aurora,
United States
(Cheung, Bress) Department of Internal Medicine, University of Utah,
School of Medicine, Salt Lake City, United States
(Bryan) Department of Radiology, Perelman School of Medicine, University
of Pennsylvania, Philadelphia, United States
(Supiano) Division of Geriatrics, University of Utah, School of Medicine,
Salt Lake City, United States
(Sonnen) Department of Pathology and Neurology and Neurosurgery, McGill
University, School of Medicine, Montreal, QC, Canada
(Weintraub) MedStar Health Research Institute, Georgetown University,
Washington, DC, United States
(Williamson) Section on Gerontology and Geriatric Medicine, Wake Forest
School of Medicine, Winston-Salem, NC, United States
(Pajewski) Department of Biostatistics and Data Science, Wake Forest
School of Medicine, Winston-Salem, NC, United States
Publisher
American Medical Association
Abstract
Importance: Use of antihypertensive medications that stimulate type 2 and
4 angiotensin II receptors, compared with those that do not stimulate
these receptors, has been associated with a lower risk of dementia.
However, this association with cognitive outcomes in hypertension trials,
with blood pressure levels in the range of current guidelines, has not
been evaluated. Objective(s): To examine the association between use
of exclusively antihypertensive medication regimens that stimulate vs
inhibit type 2 and 4 angiotensin II receptors on mild cognitive impairment
(MCI) or dementia. Design, Setting, and Participant(s): This cohort
study is a secondary analysis (April 2011 to July 2018) of participants in
the randomized Systolic Blood Pressure Intervention Trial (SPRINT), which
recruited individuals 50 years or older with hypertension and increased
cardiovascular risk but without a history of diabetes, stroke, or
dementia. Data analysis was conducted from March 16 to July 6, 2021.
Exposures: Prevalent use of angiotensin II receptor type 2 and
4-stimulating or -inhibiting antihypertensive medication regimens at the
6-month study visit. Main Outcomes and Measures: The primary outcome
was a composite of adjudicated amnestic MCI or probable dementia.
 Result(s): Of the 8685 SPRINT participants who were prevalent users
of antihypertensive medication regimens at the 6-month study visit (mean
[SD] age, 67.7 [11.2] years; 5586 [64.3%] male; and 935 [10.8%] Hispanic,
2605 [30.0%] non-Hispanic Black, 4983 [57.4%] non-Hispanic White, and 162
[1.9%] who responded as other race or ethnicity), 2644 (30.4%) were users
of exclusively stimulating, 1536 (17.7%) inhibiting, and 4505 (51.9%)
mixed antihypertensive medication regimens. During a median of 4.8 years
of follow-up (95% CI, 4.7-4.8 years), there were 45 vs 59 cases per 1000
person-years of amnestic MCI or probable dementia among prevalent users of
regimens that contained exclusively stimulating vs inhibiting
antihypertensive medications (hazard ratio [HR], 0.76; 95% CI, 0.66-0.87).
When comparing stimulating-only vs inhibiting-only users, amnestic MCI
occurred at rates of 40 vs 54 cases per 1000 person-years (HR, 0.74; 95%
CI, 0.64-0.87) and probable dementia at rates of 8 vs 10 cases per 1000
person-years (HR, 0.80; 95% CI, 0.57-1.14). Negative control outcome
analyses suggested the presence of residual confounding. Conclusions
and Relevance: In this secondary analysis of SPRINT, prevalent users of
regimens that contain exclusively antihypertensive medications that
stimulate vs inhibit type 2 and 4 angiotensin II receptors had lower rates
of incident cognitive impairment. Residual confounding cannot be ruled
out. If these results are replicated in randomized clinical trials,
certain antihypertensive medications could be prioritized to prevent
cognitive decline. Copyright © 2022 EDP Sciences. All rights
reserved.

<50>
Accession Number
636989528
Title
Corticocortical paired associative stimulation for treating motor
dysfunction after stroke: Study protocol for a randomised sham-controlled
double-blind clinical trial.
Source
BMJ Open. 12(1) (no pagination), 2022. Article Number: e053991. Date of
Publication: 13 Jan 2022.
Author
Duan Y.-J.; Hua X.-Y.; Zheng M.-X.; Wu J.-J.; Xing X.-X.; Li Y.-L.; Xu
J.-G.
Institution
(Duan, Xing, Li, Xu) School of Rehabilitation Science, Shanghai University
of Traditional Chinese Medicine, Shanghai, China
(Hua, Zheng, Wu, Xu) Yueyang Hospital of Integrated Traditional Chinese
Medicine and Western Medicine, Shanghai University of Traditional Chinese
Medicine, Shanghai, China
Publisher
BMJ Publishing Group
Abstract
Introduction Stroke survivors can have a high disability rate with low
quality of daily life, resulting in a heavy burden on family and society.
Transcranial magnetic stimulation has been widely applied to brain injury
repair, neurological disease treatment, cognition and emotion regulation
and so on. However, there is still much to be desired in the theories of
using these neuromodulation techniques to treat stroke-caused hemiplegia.
It is generally recognised that synaptic plasticity is an important basis
for functional repair after brain injury. This study protocol aims to
examine the corticocortical paired associative stimulation (ccPAS) for
inducing synaptic plasticity to rescue the paralysed after stroke. Methods
and analysis The current study is designed as a 14-week double-blind
randomised sham-controlled clinical trial, composed of 2-week intervention
and 12-week follow-up. For the study, 42 patients who had a stroke aged
40-70 will be recruited, who are randomly assigned either to the ccPAS
intervention group, or to the control group at a 1:1 ratio, hence an equal
number each. In the intervention group, ccPAS is practised in conjunction
with the conventional rehabilitation treatment, and in the control group,
the conventional rehabilitation treatment is administered with sham
stimulation. A total of 10 interventions will be made, 5 times a week for
2 weeks. The same assessors are supposed to evaluate the participants'
motor function at four time points of the baseline (before 10
interventions), treatment ending (after 10 interventions), and two
intervals of follow-up (1 and 3 months later, respectively). The
Fugl-Meyer Assessment Upper Extremity is used for the primary outcomes.
The secondary outcomes include changes in the assessment of Action
Research Arm Test (ARAT), Modified Barthel Index (MBI),
electroencephalogram (EEG) and functional MRI data. The adverse events are
to be recorded throughout the study. Ethics and dissemination This study
was approved by the Medical Ethics Committee of Yueyang Hospital. All
ethical work was performed in accordance with the Helsinki declaration.
Written informed consent was obtained from all individual participants
included in the study. Study findings will be disseminated in the printed
media. Trial registration number Chinese Clinical Trial Registry:
ChiCTR2000036685. Copyright © Author(s) (or their employer(s))
2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights
and permissions. Published by BMJ.

<51>
Accession Number
636989169
Title
Effect of perioperative levosimendan administration on postoperative
N-terminal pro-B-type natriuretic peptide concentration in patients with
increased cardiovascular risk factors undergoing non-cardiac surgery:
Protocol for the double-blind, randomised, placebo-controlled IMPROVE
trial.
Source
BMJ Open. 12(1) (no pagination), 2022. Article Number: e058216. Date of
Publication: 21 Jan 2022.
Author
Reiterer C.; Kabon B.; Taschner A.; Adamowitsch N.; Graf A.; Fraunschiel
M.; Horvath K.; Kuhrn M.; Clement T.; Treskatsch S.; Berger C.;
Fleischmann E.
Institution
(Reiterer, Fleischmann) Department of Anesthesia, Intensive Care Medicine
and Pain Medicine, Outcome Research Consortium, Cleveland, OH, United
States
(Kabon, Taschner, Adamowitsch, Horvath, Kuhrn, Clement, Fleischmann)
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine,
Medical University of Vienna, Wien, Austria
(Graf) Center for Medical Statistics, Informatics and Intelligent Systems,
Medical University of Vienna, Wien, Austria
(Fraunschiel) ITSC - IT Systems and Communications, Medical University of
Vienna, Wien, Austria
(Treskatsch, Berger) Department of Anesthesiology and Intensive Care
Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
Publisher
BMJ Publishing Group
Abstract
Introduction Elevated N-terminal pro-brain natriuretic peptide
(NT-pro-BNP) after non-cardiac surgery is a strong predictor for
cardiovascular complications and reflects increased myocardial strain.
NT-pro-BNP concentrations significantly rise after non-cardiac surgery
within the first 3 days. Levosimendan is a potent inotropic drug that
increases calcium sensitivity to cardiac myocytes, which results in
improved cardiac contractility that last for approximately 7 days. Thus,
we will test the effect of a pre-emptive perioperative administration of
levosimendan on postoperative NT-pro-BNP concentration as compared with
the administration of a placebo in patients undergoing moderate-risk to
high-risk major abdominal surgery. Methods and analysis We will conduct a
double-blinded prospective randomised trial at the Medical University of
Vienna, Vienna, Austria (and potentially a second centre in Germany),
including 230 patients at-risk for cardiovascular complications undergoing
moderate- to high-risk major abdominal surgery. Patients will be randomly
assigned to receive a single dose of 12.5 mg levosimendan versus placebo
after induction of anaesthesia. The primary outcome will be the
postoperative maximum NT-pro-BNP concentration between both group within
the first three postoperative days. Our secondary outcomes will be the
incidence of myocardial ischaemia, myocardial injury after non-cardiac
surgery and a composite of myocardial infarction and death within 30 days
and 1 year after surgery between both groups. Our further secondary
outcome will be stratification of NT-pro-BNP values according to
previously thresholds to predict mortality of myocardial infarction after
surgery. Ethics and dissemination The study was approved by the Ethics
Committee of the Medical University of Vienna on 14 July 2020 (EK
2187/2019). Written informed consent will be obtained from all patients a
day before surgery. Results of this study will be submitted for
publication in a peer-reviewed journal. Trial registration number
NCT04329624. Copyright © Author(s) (or their employer(s)) 2022.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<52>
Accession Number
2015124711
Title
A Tale of Two Centrifugal-Flow Ventricular Assist Devices As Bridge to
Heart Transplant.
Source
Annals of Thoracic Surgery. 113(3) (pp 757-762), 2022. Date of
Publication: March 2022.
Author
Alwair H.; Whitehouse K.; Slaughter M.S.; Trivedi J.R.
Institution
(Alwair, Whitehouse, Slaughter, Trivedi) Department of Cardiovascular and
Thoracic Surgery, University of Louisville School of Medicine, Kentucky,
Louisville
Publisher
Elsevier Inc.
Abstract
Background: Use of continuous-flow left ventricular assist devices (LVAD)
has increased over the years as a bridge to transplant. The HeartWare HVAD
(Medtronic, Minneapolis, MN) and HeartMate III (HM3, Abbott, Abbott Park,
IL) are currently approved centrifugal-flow devices used for bridge to
transplant. We sought to evaluate outcomes of the patients listed and who
received a transplant after receiving these 2 devices. Method(s): The
United Network of Organ Sharing thoracic transplant database was queried
after August 23, 2017, until December 2018 to identify patients aged older
than 18 years listed for heart transplant and supported by the HVAD or
HM3. Patient characteristics were evaluated at the time of listing and
transplant. The primary study end point was 1-year mortality after LVAD
implantation. Nonparametric tests were used to evaluate the device groups.
 Result(s): Of 569 patients listed for heart transplant during the
study period, 226 had HM3 and 343 had HVAD. The HM3 group had more men
(82% vs 74%, P =.02), patients with diabetes (38% vs 29%, P =.02), and the
body mass index was higher (28 vs 27 kg/m2, P =.04) at listing.
Between the HM3 and HVAD groups, the 1-year mortality was 20% vs 17%,
respectively (log-rank P =.28; Figure 1), and the posttransplant survival
at 1 year was 97% and 94%, respectively (P =.1). Conclusion(s): In a
relatively well-matched group of patients listed for heart transplant with
a centrifugal-flow LVAD, the 6-month and 1-year mortality on the waiting
list as well as after transplant were not statistically different.
Additional real-world experience or a randomized trial would be needed to
determine whether one LVAD is superior. Copyright © 2022 The
Society of Thoracic Surgeons

<53>
Accession Number
2014824563
Title
Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With
Chronic Kidney Disease.
Source
Annals of Thoracic Surgery. 113(2) (pp 554-562), 2022. Date of
Publication: February 2022.
Author
Sandner S.E.; Schunkert H.; Kastrati A.; Milojevic M.; Boning A.; Zimpfer
D.; Zellmer S.; Wiedemann D.; Laufer G.; von Scheidt M.
Institution
(Sandner, Zimpfer, Wiedemann, Laufer) Department of Cardiac Surgery,
Medical University of Vienna, Vienna, Austria
(Schunkert, Kastrati, Zellmer, von Scheidt) German Heart Center Munich,
Technical University of Munich, Munich, Germany
(Schunkert, Kastrati, Zellmer, von Scheidt) German Center for
Cardiovascular Research, Munich Heart Alliance, Munich, Germany
(Milojevic) Department of Cardiothoracic Surgery, Erasmus University
Medical Center, Rotterdam, Netherlands
(Milojevic) Department of Cardiac Surgery and Cardiovascular Research,
Dedinje Cardiovascular Institute, Belgrade, Serbia
(Boning) Department of Cardiovascular Surgery, University Hospital
Giessen, Giessen, Germany
Publisher
Elsevier Inc.
Abstract
Background: The optimal antiplatelet therapy for patients with chronic
kidney disease (CKD) undergoing coronary artery bypass graft surgery
remains unknown. Method(s): This post hoc analysis of the Ticagrelor
in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety
of ticagrelor vs aspirin in patients with and patients without CKD. The
primary endpoint was major adverse cardiac and cerebrovascular events
(MACCE), namely, the composite of cardiovascular death, stroke, myocardial
infarction, or revascularization at 1 year after coronary artery bypass
graft surgery. Secondary endpoints included individual components of the
primary endpoint, all-cause death, and major bleeding. Result(s):
Chronic kidney disease was present in 276 of 1843 randomized patients
(15%). Patients with CKD vs patients without CKD had higher 1-year rates
of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval
[CI], 1.12 to 2.39; P =.01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95%
CI, 1.03 to 3.28; P =.04). The 1-year rate of MACCE was increased with
ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95%
CI, 1.08 to 4.30; P =.03), but not in patients without CKD (8.5% vs 8.1%,
HR 1.05; 95% CI, 0.74 to 1.49; P =.79; P<inf>interaction</inf> =.067).
There was no difference in the 1-year rate of major bleeding with
ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI,
0.52 to 3.97; P =.48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95%
CI, 0.64 to 2.01; P =.65). Conclusion(s): Among patients with CKD and
coronary artery bypass graft surgery, those who received ticagrelor had a
higher incidence of MACCE but a similar incidence of major bleeding
compared with those who received aspirin. Copyright © 2022 The
Society of Thoracic Surgeons

<54>
Accession Number
2013718101
Title
10-Year Results of Mitral Repair and Coronary Bypass for Ischemic
Regurgitation: A Randomized Trial.
Source
Annals of Thoracic Surgery. 113(3) (pp 816-822), 2022. Date of
Publication: March 2022.
Author
Fattouch K.; Dioguardi P.; Guccione F.; Nogara A.; Salardino M.;
Sampognaro R.; Bacarella D.; Moscarelli M.
Institution
(Fattouch, Dioguardi, Guccione, Nogara, Salardino, Sampognaro, Bacarella,
Moscarelli) GVM Care & Research, Department of Cardiovascular Surgery,
Maria Eleonora Hospital, Palermo, Italy
(Fattouch, Moscarelli) GVM Care & Research, Department of Cardiovascular
Surgery, Maria Cecilia Hospital, Cotignola, Italy
Publisher
Elsevier Inc.
Abstract
Background: The decision to treat moderate ischemic mitral regurgitation
(IMR) at the time of coronary artery bypass surgery (CABG) remains
controversial. We previously conducted a prospective randomized trial that
showed a benefit of adding restricted annuloplasty to bypass surgery
(CABG-Ring group) in terms of IMR grade, New York Heart Association
classification, and left ventricle reverse remodeling. Here, we present
the long-term (>10 years) follow-up data from this randomized trial.
 Method(s): The original trial arms accounted for 54 patients in the
CABG-alone and 48 in the CABG-Ring group; patients were re-contacted for
follow-up to obtain relevant clinical and echocardiographic information.
 Result(s): The mean follow-up was 160.4 +/- 45.5 months. Survival
probabilities in the CABG-alone and CABG-Ring groups were 96% vs 93% at 3
years, 85% vs 89% at 6 years, 79% vs 85% at 9 years, 77% vs 83% at 12
years, and 72% vs 80% at 15 years, respectively (P = .18) Freedom from at
least moderate IMR or reintervention at last follow-up was also higher in
the CABG-Ring group (P < .001). Compared with the CABG-alone group, the
CABG-Ring group had a higher degree of left ventricular reverse remodeling
(54.7 +/- 6.9 mm vs 51.6 +/- 6 mm, respectively; P = .03), lower New York
Heart Association class (P < .001), and a lower rate of rehospitalization
(P = .002). Conclusion(s): Long-term follow-up data from our
randomized trial further support the utility of performing restricted
annuloplasty at the time of CABG to prevent further progression of IMR,
mitral reintervention, and left ventricle remodeling. Untreated IMR was
associated with significantly higher New York Heart Association class and
rehospitalization. Copyright © 2022 The Society of Thoracic
Surgeons

<55>
Accession Number
2016828092
Title
Comparison of Balloon-Blowing Exercise and Incentive Spirometry after
Thoracotomy.
Source
Pakistan Journal of Medical and Health Sciences. 16(1) (pp 486-489), 2022.
Date of Publication: January 2022.
Author
Ghani H.M.; Obaid S.; Bhatti Z.M.; Razzaq M.; Niaz A.; Waris S.
Institution
(Ghani, Razzaq) Bakhtawar Amin College of Rehabilitation Sciences BAMDC,
Multan, Pakistan
(Obaid) Riphah International University-, Islamabad, Pakistan
(Bhatti) Principal Bakhtawar Amin College of Rehabilitation Sciences
BAMDC, Multan, Pakistan
(Razzaq) Abasyn University, Islamabad Campus, Pakistan
(Niaz) College of Rehabilitation Sciences BAMDC, Multan, Pakistan
(Waris) University of Management and Technology, Sialkot Campus, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Objective: The objective of this study is to compare effect of balloon
blowing exercise & incentive spirometer on Chest expansion, Improvement in
lung volumes and capacities, Level of dyspnoea, and on Improvement in
progression of walk in post-thoracotomy stable patients. Study
Design: Randomized Controlled Trial Place and Duration of Study: Study was
conducted in thoracic surgical ICU of Gulab Devi Hospital, Lahore for the
period of 6 months from September 2018 - February 2019. Patients and
Methods: The sample size was calculated through Open Epi, and it was 48.
24 subjects were assigned to control group A and 24 to experimental group
B through non-purposive random sampling technique. Data was collected at
base line, 3rd and 5th day after exercise therapy on above stated outcome
measures, by using Tape Measure, Digital Spirometer, RPE Scale and
Pedometer respectively, from non-critical postthoracotomy patients.
Control Group-A performed routine respiratory physiotherapy + incentive
spirometry and Experimental Group- B performed routine respiratory
physiotherapy + balloon blowing exercise. Result(s): BBE + routine
respiratory physiotherapy was found equally effective on mentioned outcome
measure as Incentive Spirometry + routine respiratory physiotherapy in
stated patients. (P >0.05) Conclusion(s): Based upon statistical
analysis, it can be concluded that incentive spirometer can be replaced
with balloon-blowing exercise with conventional/routine respiratory
physiotherapy in thoracotomy patients who have lung surgeries, to overcome
post-op pulmonary complications or to achieve the same outcomes as that of
incentive spirometer. Copyright © 2022 Lahore Medical And Dental
College. All rights reserved.

<56>
Accession Number
2016828049
Title
Comparison of Phase 1 Cardiac Rehabilitation with and without Lower Limb
Paddling Effects in Post-CABG Patients.
Source
Pakistan Journal of Medical and Health Sciences. 16(1) (pp 342-345), 2022.
Date of Publication: January 2022.
Author
Hamid M.F.; Nazar Q.-U.-A.; Akash N.K.A.; Khalid Z.; Ali M.S.; Farooqi A.;
Arslan H.R.M.
Institution
(Hamid, Nazar, Khalid, Ali, Farooqi, Arslan) Department of Allied & Health
Sciences, University of South Asia Cantt Campus, Lahore, Pakistan
(Akash) Life Special School, Karachi, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Objective: To compare the effectiveness of Phase 1 cardiac rehabilitation
with lower limb paddling, with phase 1 cardiac rehabilitation without
lower limb paddling. Study Design: Randomized clinical Trail Place
and Duration of Study: Department of Cardiology, Rawal General and Dental
Hospital Islamabad from 1st January 2020 to 31st December 2020.
Methodology: Fifty four patients, 27 in each group were determined using
general self-efficacy before intervention readings. Inclusion was made on
post elective Sternotomy surgery, post extubation, both genders, age
between 35 and 60 years, body mass index (BMI) between 20 and 30 kg/m2,
hemodynamic stability, absence of arrhythmias. Result(s): The mean
SF-36 at day 1 was 37.74+/-1.45 and at Day 7 was 90.42+/-11.8 in
experimental group and 37.22+/-1.45 at Day 1 and 76.81+/-2.58 at day 7 for
control group respectively. The mean FIM at day 1 was 31.48+/-5.07 and on
day 7 it was 109.03+/-5.97 in experimental group compared to 33.66+/-5.34
on day 1, and 82.44+/-13.35 on day 7 for controls. The mean for
self-efficacy at day 1 was 19.11+/-2.5 and at day 7 it was 62.59+/-3.17 in
experimental compared to 21.11+/-3.59 on day 1, and 61.74+/-6.32 on day 7
in the controls. The mean EF was same at day 1 and day 7, in experimental
group it was 53.11+/-4.8 whereas for control group it was 53.85+/-3.76 one
day 1 and day 7. The mean ABGs at day 1 were 7.41+/-0.05 and at Day 7 it
was 7.42+/-0.04 in experimental group whereas in the controls it was
7.39+/-0.39 at Day 1 and 7.44+/-0.01 at day 7. Conclusion(s): Phase 1
cardiac rehabilitation with and without paddling have similar effects
according to ABGs and Ejection fraction. However, the quality of life was
found significantly improved using paddling intervention during Phase 1
Cardiac rehabilitation compared to those without paddling. Hence it is
implied that it is safe to incorporate paddling with phase 1 cardiac
rehabilitation in post CABG patients. Copyright © 2022 Lahore
Medical And Dental College. All rights reserved.

<57>
Accession Number
2016809282
Title
Influence of preoperative frailty on quality of life after cardiac
surgery: Protocol for a systematic review and meta-analysis.
Source
PLoS ONE. 17(2 February) (no pagination), 2022. Article Number: e0262742.
Date of Publication: February 2022.
Author
Bezzina K.; Fehlmann C.A.; Guo M.H.; Visintini S.M.; Rubens F.D.; Wells
G.A.; Mazzola R.; McGuinty C.; Huang A.; Khoury L.; Boczar K.E.
Institution
(Bezzina, Huang, Khoury) Division of Geriatric Medicine, The Ottawa
Hospital, Ottawa, ON, Canada
(Fehlmann, Wells, Mazzola, Boczar) School of Epidemiology and Public
Health, University of Ottawa, Ottawa, ON, Canada
(Fehlmann, Huang) Ottawa Hospital Research Institute, Ottawa, ON, Canada
(Fehlmann) Division of Emergency Medicine, Geneva University Hospitals,
Geneva, Switzerland
(Guo, Rubens) Department of Cardiac Surgery, University of Ottawa Heart
Institute, Ottawa, ON, Canada
(Visintini) Berkman Library, University of Ottawa Heart Institute, Ottawa,
ON, Canada
(Wells) Research Methods Centre, University of Ottawa Heart Institute,
Ottawa, ON, Canada
(McGuinty, Boczar) University of Ottawa Heart Institute, Ottawa, ON,
Canada
Publisher
Public Library of Science
Abstract
Background Frailty has emerged as an important prognostic marker of
adverse outcomes after cardiac surgery, but evidence regarding its ability
to predict quality of life after cardiac surgery is currently lacking.
Whether frail patients derive the same quality of life benefit after
cardiac surgery as patients without frailty remains unclear. Methods This
systematic review will include interventional studies (RCT and others) and
observational studies evaluating the effect of preoperative frailty on
quality-of-life outcomes after cardiac surgery amongst patients 65 years
and older. Studies will be retrieved from major databases including the
Cochrane Central Register of Controlled Trials, Embase, and Medline. The
primary exposure will be frailty status, independent of the tool used. The
primary outcome will be change in quality of life, independent of the tool
used. Secondary outcomes will include readmission during the year
following the index intervention, discharge to a long-term care facility
and living in a long-term care facility at one year. Screening, inclusion,
data extraction and quality assessment will be performed independently by
two reviewers. Meta-analysis based on the random-effects model will be
conducted to compare the outcomes between frail and non-frail patients.
The evidential quality of the findings will be assessed with the GRADE
profiler. Conclusion The findings of this systematic review will be
important to clinicians, patients and health policy-makers regarding the
use of preoperative frailty as a screening and assessment tool before
cardiac surgery. Copyright: © 2022 Bezzina et al. This is an open
access article distributed under the terms of the Creative Commons
Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are
credited.

<58>
Accession Number
2016802330
Title
Ticagrelor Monotherapy After 3-Month Dual Antiplatelet Therapy in Acute
Coronary Syndrome by High Bleeding Risk: The Subanalysis From the TICO
Trial.
Source
Korean Circulation Journal. 52 (no pagination), 2022. Article Number:
:e19. Date of Publication: January 2022.
Author
Lee Y.-J.; Suh Y.; Kim J.-S.; Cho Y.-H.; Yun K.H.; Kim Y.H.; Cho J.Y.; Her
A.-Y.; Cho S.; Jeon D.W.; Yoo S.-Y.; Cho D.-K.; Hong B.-K.; Kwon H.; Hong
S.-J.; Ahn C.-M.; Shin D.-H.; Nam C.-M.; Kim B.-K.; Ko Y.-G.; Choi D.;
Hong M.-K.; Jang Y.
Institution
(Lee, Kim, Hong, Ahn, Shin, Kim, Ko, Choi, Hong) Division of Cardiology,
Severance Cardiovascular Hospital, Yonsei University College of Medicine,
Seoul, South Korea
(Suh, Cho) Division of Cardiology, Department of Internal Medicine,
Myongji Hospital, Hanyang University College of Medicine, Goyang, South
Korea
(Yun, Cho) Division of Cardiology, Wonkwang University Hospital, Iksan,
South Korea
(Kim, Her) Division of Cardiology, Kangwon National University School of
Medicine, Chuncheon, South Korea
(Cho) Division of Cardiology, Dankook University Hospital, Dankook
University College of Medicine, Cheonan, South Korea
(Jeon) Division of Cardiology, National Health Insurance Service Ilsan
Hospital, Goyang, South Korea
(Yoo) Division of Cardiology, Gangneung Asan Hospital, University of Ulsan
College of Medicine, Gangneung, South Korea
(Cho) Division of Cardiology, Yongin Severance Hospital, Yonsei University
College of Medicine, Yongin, South Korea
(Hong, Kwon) Division of Cardiology, Gangnam Severance Hospital, Yonsei
University College of Medicine, Seoul, South Korea
(Nam) Department of Preventive Medicine and Biostatistics, Yonsei
University College of Medicine, Seoul, South Korea
(Jang) Division of Cardiology, CHA Bundang Medical Center, CHA University
College of Medicine, Seongnam, South Korea
Publisher
Korean Society of Circulation
Abstract
Background and Objectives: Identifying patients with high bleeding risk
(HBR) is important when making decisions for antiplatelet therapy
strategy. This study evaluated the impact of ticagrelor monotherapy after
3-month dual antiplatelet therapy (DAPT) according to HBR in acute
coronary syndrome (ACS) patients treated with drug eluting stents (DESs).
 Method(s): In this post-hoc analysis of the TICO trial, HBR was
defined by 2 approaches: meeting Academic Research Consortium for HBR
(ARC-HBR) criteria or Predicting Bleeding Complications in Patients
Undergoing Stent Implantation and Subsequent DAPT (PRECISE-DAPT) score
>=25. The primary outcome was a 3-12 months net adverse clinical event
(composite of major bleeding and adverse cardiac and cerebrovascular
events). Result(s): Of the 2,980 patients without adverse events
during the first 3 months after DES implantation, 453 (15.2%) were HBR by
ARC-HBR criteria and 504 (16.9%) were HBR by PRECISE-DAPT score. The
primary outcome rate was higher in HBR versus non-HBR patients (by ARC-HBR
criteria: hazard ratio [HR], 2.87; 95% confidence interval [CI],
1.76-4.69; p<0.001; by PRECISE-DAPT score: HR, 3.09; 95% CI, 1.92-4.98;
p<0.001). Ticagrelor monotherapy after 3-month DAPT was associated with
lower primary outcome rate than ticagrelor-based 12-month DAPT regardless
of HBR by ARC-HBR criteria, with similar magnitudes of therapy effect for
HBR and non-HBR patients (p-interaction=0.400). Results were consistent by
PRECISE-DAPT score (p-interaction=0.178). Conclusion(s): In ACS
patients treated with DESs, ticagrelor monotherapy after 3-month DAPT was
associated with lower rate of adverse clinical outcomes regardless of HBR,
with similar magnitudes of therapy effect between HBR and
non-HBR. Copyright © 2022. The Korean Society of Cardiology This
is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License
(https://creativecommons.org/licenses/by-nc/4.0) which permits
unrestricted noncommercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

<59>
[Use Link to view the full text]
Accession Number
2016779907
Title
A Systematic Review and Pooled Prevalence of Delirium in Critically Ill
Children.
Source
Critical Care Medicine. 50(2) (pp 317-328), 2022. Date of Publication: 01
Feb 2022.
Author
Semple D.; Howlett M.M.; Strawbridge J.D.; Breatnach C.V.; Hayden J.C.
Institution
(Semple, Howlett) Pharmacy Department, Children's Health Ireland Crumlin,
Dublin, Ireland
(Semple, Howlett, Strawbridge, Hayden) School of Pharmacy and Biomolecular
Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
(Breatnach) Department of Intensive Care, Children's Health Ireland
Crumlin, Dublin, Ireland
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: Pediatric delirium is a neuropsychiatric disorder with
disrupted cerebral functioning due to underlying disease and/or critical
care treatment. Pediatric delirium can be classified as hypoactive,
hyperactive, and mixed. This systematic review was conducted to estimate
the pooled prevalence of pediatric delirium using validated assessment
tools in children (Cornell Assessment of Pediatric Delirium, Pediatric
Confusion Assessment Method for the ICU, PreSchool Confusion Assessment
Method for the ICU, Pediatric Confusion Assessment Method for the ICU
Severity Scale, and Sophia Observation Withdrawal Symptoms Pediatric
Delirium scale), identify modifiable and nonmodifiable risk factors, and
explore the association of pediatric delirium with clinical outcomes. DATA
SOURCES: A systematic search of PubMed, EMBASE, and CINAHL databases was
undertaken for full articles pertaining to pediatric delirium prevalence.
STUDY SELECTION: No language or date barriers were set. Studies were
included where the following eligibility criteria were met: study design
aimed to estimate pediatric delirium prevalence arising from treatment in
the intensive care setting, using a validated tool. Only randomized
controlled trials, cross-sectional studies, or cohort studies allowing an
estimate of the prevalence of pediatric delirium were included. DATA
EXTRACTION: Data were extracted by the primary researcher (D.S.) and
accuracy checked by coauthors. DATA SYNTHESIS: A narrative synthesis and
pooled prevalence meta-analysis were undertaken. CONCLUSION(S):
Pediatric delirium, as determined by the Cornell Assessment of Pediatric
Delirium score, is estimated to occur in 34% of critical care admissions.
Eight of 11 studies reporting on subtype identified hypoactive delirium as
most prevalent (46-81%) with each of the three remaining reporting either
hyperactive (44%), mixed (57%), or equal percentages of hypoactive and
mixed delirium (43%) as most prevalent. The development of pediatric
delirium is associated with cumulative doses of benzodiazepines, opioids,
the number of sedative classes used, deep sedation, and cardiothoracic
surgery. Increased time mechanically ventilated, length of stay,
mortality, healthcare costs, and associations with decreased quality of
life after discharge were also found. Multi-institutional and longitudinal
studies are required to better determine the natural history, true
prevalence, long-term outcomes, management strategies, and financial
implications of pediatric delirium. Copyright © 2021 by the
Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All
Rights Reserved.

<60>
Accession Number
2016537144
Title
Prevalence of Malnutrition in Children with Congenital Heart Disease: A
Systematic Review and Meta-Analysis.
Source
Journal of Pediatrics. 242 (pp 39-47.e4), 2022. Date of Publication: March
2022.
Author
Diao J.; Chen L.; Wei J.; Shu J.; Li Y.; Li J.; Zhang S.; Wang T.; Qin J.
Institution
(Diao, Chen, Wei, Shu, Li, Li, Zhang, Wang, Qin) Department of
Epidemiology and Health Statistics, Xiangya School of Public Health,
Central South University, Hunan, China
(Wang, Qin) National Health Council Key Laboratory of Birth Defect for
Research and Prevention, Hunan Provincial Maternal and Child Health Care
Hospital, Changsha, Hunan, China
(Qin) Guangdong Cardiovascular Institute, Guangdong Provincial People's
Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong,
China
Publisher
Elsevier Inc.
Abstract
Objective: To evaluate the global prevalence of malnutrition in children
with congenital heart disease (CHD). Study design: A systematic review and
meta-analysis were performed. Web of Science, PubMed, Embase, Wanfang
Database, China National Knowledge Infrastructure, and China Biology
Medicine disc databases were searched for studies published through April
2021. Random-effect model meta-analyses were performed to derive the
pooled the prevalence of preoperative underweight, stunting, and wasting
in children with CHD. Time-trend analyses of postoperative malnutrition
prevalence were undertaken. Subgroup and sensitivity analyses were
conducted to explore sources of heterogeneity. Egger test and funnel plots
were used to explore public bias. Result(s): A total of 39 studies
were included in this meta-analysis. The pooled estimates of preoperative
malnutrition in children with CHD were 27.4% (95% CI, 21.7-34.0) for
underweight, 24.4% (95% CI, 19.5-30.0) for stunting, and 24.8% (95% CI,
19.3-31.3) for wasting. Catch-up growth was found in the postoperative
period among some children. Different continents were identified as
heterogeneity moderators by subgroup analyses. Conclusion(s):
Children with CHD have a high prevalence of preoperative malnutrition and
some show catch-up growth postoperatively. These data can be used as
benchmarks in efforts to improve the nutritional status of children with
CHD. Copyright © 2021 Elsevier Inc.

<61>
Accession Number
2015885807
Title
Dexmedetomidine Use in Intensive Care Unit Sedation and Postoperative
Recovery in Elderly Patients Post-Cardiac Surgery (DIRECT).
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 880-892),
2022. Date of Publication: March 2022.
Author
Chitnis S.; Mullane D.; Brohan J.; Noronha A.; Paje H.; Grey R.; Bhalla
R.K.; Sidhu J.; Klein R.
Institution
(Chitnis, Mullane, Brohan, Grey, Klein) Department of Anesthesiology and
Perioperative Care, Vancouver General and UBC Hospitals, Vancouver, BC,
Canada
(Chitnis) Department of Anaesthesia and Pain Medicine, Fiona Stanley
Hospital, Murdoch, Perth, WA, Australia
(Brohan) Department of Anaesthesia, Cork University Hospital, Wilton,
Cork, Ireland
(Noronha, Paje) Vancouver Coastal Health, Vancouver, BC, Canada
(Bhalla) Neuropsychology Service, Vancouver General Hospital, 899 W 12th
Avenue, Vancouver, BC V5Z 1M9, Canada
(Bhalla) Division of Psychiatry, University of British Columbia,
Vancouver, BC V6T 1Z4, Canada
(Sidhu) Department of Psychiatry, Vancouver General Hospital, Vancouver,
BC, Canada
Publisher
W.B. Saunders
Abstract
Objective: This study examined recovery, delirium, and neurocognitive
outcome in elderly patients receiving dexmedetomidine or propofol sedation
after undergoing cardiac surgery. Design(s): Open-label randomized
trial. Setting(s): Single center. Participant(s): A total of 70
patients older than 75 years without English language limitations and Mini
Mental State Examination scores >20. Intervention(s): Patients
received either propofol (group P) or dexmedetomidine (group D)
postoperatively until normothermic and hemodynamically stable.
 Measurements and Main Results: Quality of recovery (QoR) was measured
by the QoR-40 questionnaire on postoperative day (POD) three. Secondary
outcomes were incidence and duration of delirium, time to extubation,
length of hospital stay, hospital mortality rate, postoperative quality of
life (QoL; measured by SF-36 performed at baseline and six months
postoperatively), and neurocognitive disorder (measured by Minnesota
Cognitive Acuity Screen [MCAS] performed at baseline, POD5, and six months
postoperatively). A total of sixty-seven patients completed the trial.
There was no significant difference in QoR-40 scores (95% confidence
interval [CI], -7.6081-to-10.9781; p = 1.000), incidence of delirium
(group P, 42%; group D, 24%; p = 0.191), mean hospital stay (95% CI,
-5.4838-to-1.5444; p = 0.297), mean time to extubation (95% CI,
-19.2513-to-7.5561; p = 0.866), or mean duration of delirium (95% CI,
-4.3065-to-1.067; p = 0.206) between groups. No patients died in the
hospital. There were no significant differences in changes in SF-36 or
MCAS scores over time between groups. There was a decline in MCAS score
from preoperatively to POD5 in group P (95% CI, -8.95725-to- -2.61775; p =
0.0005), which was greater than that observed in group D.
 Conclusion(s): The authors' findings demonstrated that the use of
dexmedetomidine compared with propofol in elderly patients undergoing
cardiac surgery was unlikely to improve QoR/postoperative QoL. Although
the study was underpowered to detect secondary outcomes, the results
suggested no reductions in delirium, time to extubation, and hospital
stay, but a potential decrease in delayed neurocognitive
recovery. Copyright © 2021

<62>
Accession Number
2016504240
Title
Consensus Statement: Hemostasis Trial Outcomes in Cardiac Surgery and
Mechanical Support.
Source
Annals of Thoracic Surgery. 113(3) (pp 1026-1035), 2022. Date of
Publication: March 2022.
Author
Levy J.H.; Faraoni D.; Almond C.S.; Baumann-Kreuziger L.; Bembea M.M.;
Connors J.M.; Dalton H.J.; Davies R.; Dumont L.J.; Griselli M.; Karkouti
K.; Massicotte M.P.; Teruya J.; Thiagarajan R.R.; Spinella P.C.; Steiner
M.E.
Institution
(Levy) Division Cardiothoracic Anesthesiology and Critical Care,
Departments of Anesthesiology and Surgery (Cardiothoracic), Duke
University School of Medicine, North Carolina, Durham
(Faraoni) Division of Cardiac Anesthesia, Department of Anesthesia and
Pain Medicine, The Hospital for Sick Children, University of Toronto,
Toronto, Ontario, Canada
(Almond) Heart Failure Service, Cardiac Anticoagulation Service, Lucile
Packard Children's Hospital Stanford, Stanford University School of
Medicine, California, Palo Alto
(Baumann-Kreuziger) Blood Research Institute, Versiti, Medical College of
Wisconsin, Milwaukee, WI, United States
(Bembea) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University School of Medicine, Maryland, Baltimore
(Connors) Hematology Division, Department of Medicine, Brigham and Women's
Hospital, Harvard Medical School, Massachusetts, Boston
(Dalton) INOVA Heart and Vascular Institute; Department of Pediatrics,
INOVA Fairfax Medical Center, Falls Church, VA, United States
(Davies) Department of Cardiovascular and Thoracic Surgery, University of
Texas Southwestern Medical Center and Children's Health, Texas, Dallas
(Dumont) Vitalant Research Institute, Colorado, Denver
(Dumont) Department of Pathology, University of Colorado Medical School,
Colorado, Denver
(Dumont) Department of Pathology and Laboratory Medicine, Geisel School of
Medicine at Dartmouth, New Hampshire, Lebanon
(Griselli) Division of Pediatric Cardiovascular Surgery, University of
Minnesota, Minneapolis, MN, United States
(Karkouti) Department of Anesthesiology and Pain Medicine, University of
Toronto, Toronto, Ontario, Canada
(Massicotte) Division of Cardiology, Department of Pediatrics, University
of Alberta, Edmonton, AB, Canada
(Teruya) Division of Transfusion Medicine and Coagulation, Department of
Pathology and Immunology, Pediatrics and Medicine, Texan Children's
Hospital, Baylor College of Medicine, Texas, Houston
(Thiagarajan) Cardiac Intensive Care Unit, Boston Children's Hospital,
Department of Pediatrics, Harvard Medical School, Massachusetts, Boston
(Spinella) Division of Critical Care, Department of Pediatrics, Washington
University School of Medicine, Missouri, St Louis
(Steiner) Divisions of Hematology and Critical Care, Department of
Pediatrics, University of Minnesota, Minneapolis, MN, United States
Publisher
Elsevier Inc.
Abstract
Background: Research evaluating hemostatic agents for the treatment of
clinically significant bleeding has been hampered by inconsistency and
lack of standardized primary clinical trial outcomes. Clinical trials of
hemostatic agents in both cardiac surgery and mechanical circulatory
support, such as extracorporeal membrane oxygenation and ventricular
assist devices, are examples of studies that lack implementation of
universally accepted outcomes. Method(s): A subgroup of experts
convened by the National Heart, Lung, and Blood Institute and the US
Department of Defense developed consensus recommendations for primary
outcomes in cardiac surgery and mechanical circulatory support.
 Result(s): For cardiac surgery the primary efficacy endpoint of total
allogeneic blood products (units vs mL/kg for pediatric patients)
administered intraoperatively and postoperatively through day 5 or
hospital discharge is recommended. For mechanical circulatory support
outside the perioperative period the recommended primary outcome for
extracorporeal membrane oxygenation is a 5-point ordinal score of
thrombosis and bleeding severity adapted from the Common Terminology
Criteria for Adverse Events version 5.0. The recommended primary endpoint
for ventricular assist device is freedom from disabling stroke (Common
Terminology Criteria for Adverse Events AE >= grade 3) through day 180.
 Conclusion(s): The proposed composite risk scores could impact the
design of upcoming clinical trials and enable comparability of future
investigations. Harmonizing and disseminating global consensus definitions
and management guidelines can also reduce patient heterogeneity that would
confound standardized primary outcomes in future research. Copyright
© 2022 The Society of Thoracic Surgeons

<63>
Accession Number
2015399902
Title
Relationship between Post-traumatic Stress Disorder and subsequent
myocardial infarction: a systematic review and meta-analysis.
Source
Journal of Affective Disorders. 297 (pp 525-535), 2022. Date of
Publication: 15 Jan 2022.
Author
Jacquet-Smailovic M.; Brennsthul M.-J.; Denis I.; Kirche A.; Tarquinio C.
Institution
(Jacquet-Smailovic) Centre Hospitalier du Pays d'Avesnes, Route de
Haut-Lieu, Avesnes-sur-Helpe 59363, France
(Jacquet-Smailovic, Brennsthul, Denis, Kirche, Tarquinio, Tarquinio)
Universite de Lorraine, Departement de psychologie de la sante,
APEMAC/EPSAM UE 4360, Ile du Saulcy, Metz 57000, France
Publisher
Elsevier B.V.
Abstract
Background: Each year, nearly 790.000 new cases of myocardial infarction
(MI) are recorded in the United States. Better knowledge of the modifiable
risk factors for this cardiovascular disease remains a major public health
issue. In this perspective, the aim of this systematic review and
meta-analysis was to estimate the relationship between post-traumatic
stress disorder (PTSD) and risk of subsequent myocardial infarction (MI).
 Method(s): A systematic review using PRISMA (Preferred Reporting
Items for Systematic reviews and Meta-Analysis) guidelines was performed
by searching four bibliographic databases (PubMed/Medline, PsycINFO,
Science Direct and Proquest Dissertations and Theses). Result(s): A
total of 14 articles were included. Nine of these included depression as a
covariate. Among 13 studies (N = 848.903), the pooled HR for the magnitude
of the relationship between PTSD and MI was 1.49 (95% CI 1.31-1.69) before
adjustment for depression. The pooled HR estimate for the 9
depression-adjusted estimates (N = 814.441) was 1.32 (95% CI 1.12-1.56).
 Limitation(s): These results should be considered with caution
because there is high heterogeneity between studies and possible
publication bias; thus, further research is required to support these
results. Conclusion(s): Further research is still needed to identify
in more precise terms the mediating factors involved in the direct
association between PTSD and the subsequent occurrence of ischemic heart
disease. Copyright © 2021 Elsevier B.V.

<64>
Accession Number
2012015301
Title
Pulmonary Valve Replacement in Tetralogy of Fallot: An Updated
Meta-Analysis.
Source
Annals of Thoracic Surgery. 113(3) (pp 1036-1046), 2022. Date of
Publication: March 2022.
Author
Van den Eynde J.; Sa M.P.B.O.; Vervoort D.; Roever L.; Meyns B.; Budts W.;
Gewillig M.; Ruhparwar A.; Zhigalov K.; Weymann A.
Institution
(Van den Eynde, Meyns) Unit of Cardiac Surgery, Department of
Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
(Sa) Division of Cardiovascular Surgery of Pronto Socorro Cardiologico de
Pernambuco, PROCAPE, University of Pernambuco, Pernambuco, Recife, Brazil
(Vervoort) Johns Hopkins Bloomberg School of Public Health, Maryland,
Baltimore
(Roever) Department of Clinical Research, Federal University of
Uberlandia, Minas Gerais, Uberlandia, Brazil
(Budts) Congenital and Structural Cardiology University Hospitals Leuven
and Department of Cardiovascular Sciences, Catholic University Leuven,
Leuven, Belgium
(Gewillig) Pediatric Cardiology, University Hospitals Leuven, Leuven,
Belgium
(Ruhparwar, Zhigalov, Weymann) Department of Thoracic and Cardiovascular
Surgery, West German Heart and Vascular Center, Essen, Germany
Publisher
Elsevier Inc.
Abstract
Background: The benefits of pulmonary valve replacement (PVR) for
pulmonary insufficiency in patients with repaired tetralogy of Fallot are
still incompletely understood, and optimal timing remains challenging.
 Method(s): We systematically reviewed databases (PubMed/MEDLINE,
Embase, Cochrane Central Register of Controlled Trials /Cochrane
Controlled Trials Register, ClinicalTrials.gov, Scientific Electronic
Library Online, Literatura Latino Americana em Ciencias da Saude, and
Google Scholar) and reference lists of relevant articles for studies about
PVR in repaired tetralogy of Fallot patients that reported any of the
following outcomes: mortality and redo PVR rates, right ventricular (RV)
and left ventricular measures, QRS duration, cardiopulmonary exercise test
results, or brain natriuretic peptide. In addition to calculating the
pooled treatment effects using a random-effects meta-analysis, we
evaluated the effect of preoperative measures on PVR outcomes using
meta-regressions. Result(s): Eighty-four studies involving 7544
patients met the eligibility criteria. Pooled mortality at 30 days, 5
years, and 10 years after PVR was 0.87% (63 of 7253 patients, 80 studies),
2.7% (132 of 4952 patients, 37 studies), and 6.2% (510 of 2765 patients,
15 studies), respectively. Pooled 5- and 10-year redo PVR rates were 3.7%
(141 of 3755 patients, 23 studies) and 16.8% (172 of 3035 patients, 16
studies), respectively. The results of the previous meta-analysis could be
confirmed. In addition, we demonstrated that after PVR (1) QRS duration,
cardiopulmonary exercise test results, and RV and left ventricular
measures longitudinal strain do not significantly change; (2) brain
natriuretic peptide decreases; and (3) greater indexed RV end-diastolic
and end-systolic volumes are associated with lower chances of RV volume
normalization after PVR. Conclusion(s): This updated meta-analysis
provides evidence about the benefits of PVR. Copyright © 2022 The
Society of Thoracic Surgeons

<65>
Accession Number
2014701083
Title
Fixed-dose combination therapies with and without aspirin for primary
prevention of cardiovascular disease: an individual participant data
meta-analysis.
Source
The Lancet. 398(10306) (pp 1133-1146), 2021. Date of Publication: 25 Sep
2021.
Author
Joseph P.; Roshandel G.; Gao P.; Pais P.; Lonn E.; Xavier D.; Avezum A.;
Zhu J.; Liu L.; Sliwa K.; Gamra H.; Bangdiwala S.I.; Teo K.; Diaz R.; Dans
A.; Lopez-Jaramillo P.; Prabhakaran D.; Castellano J.M.; Fuster V.;
Rodgers A.; Huffman M.D.; Bosch J.; Dagenais G.R.; Malekzadeh R.; Yusuf S.
Institution
(Joseph, Gao, Lonn, Bangdiwala, Teo, Bosch, Yusuf) Population Health
Research Institute, Hamilton Health Sciences and McMaster University,
Hamilton, ON, Canada
(Roshandel) Golestan Research Center of Gastroenterology and Hepatology,
Golestan University of Medical Sciences, Gorgan, Iran, Islamic Republic of
(Roshandel) Digestive Oncology Research Center, Digestive Disease Research
Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Pais, Xavier) St John's Research Institute, Bangalore, India
(Xavier) St John's Medical College, Bangalore, India
(Avezum) International Research Center, Hospital Alemao Oswaldo Cruz, Sao
Paulo, Brazil
(Zhu, Liu) Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
(Sliwa) Cape Heart Institute, Department of Medicine and Cardiology,
University of Cape Town, Cape Town, South Africa
(Gamra) Fattouma Bourguiba University Hospital and University of Monastir,
Monastir, Tunisia
(Diaz) Estudios Clinicos Latino America, Instituto Cardiovascular de
Rosario, Rosario, Argentina
(Dans) University of the Philippines, Manila, Philippines
(Lopez-Jaramillo) Universidad de Santander, Instituto Masira, Facultad de
Ciencias de la Salud, Bucaramanga, Colombia
(Prabhakaran) Public Health Foundation of India, Haryana, India
(Castellano) Centro Nacional de Investigaciones Cardiovasculares,
Instituto de Salud Carlos III, Madrid, Spain
(Castellano) Centro Integral de Enfermedades Cardiovasculares, Hospital
Universitario Monteprincipe, Grupo HM Hospitales, Madrid, Spain
(Fuster) Zena and Michael A Wiener Cardiovascular Institute, Icahn School
of Medicine at Mount Sinai, New York, United States
(Rodgers, Huffman) The George Institute for Global Health, Sydney, NSW,
Australia
(Huffman) Northwestern University Feinberg School of Medicine, Chicago,
IL, United States
(Dagenais) Universite Laval, Institut Universitaire de Cardiologie et de
Pneumologie de Quebec, Quebec, QC, Canada
(Malekzadeh) Digestive Disease Research Institute, Shariati Hospital,
Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Elsevier B.V.
Abstract
Background: In randomised controlled trials, fixed-dose combination
treatments (or polypills) have been shown to reduce a composite of
cardiovascular disease outcomes in primary prevention. However, whether or
not aspirin should be included, effects on specific outcomes, and effects
in key subgroups are unknown. Method(s): We did an individual
participant data meta-analysis of large randomised controlled trials (each
with >=1000 participants and >=2 years of follow-up) of a fixed-dose
combination treatment strategy versus control in a primary cardiovascular
disease prevention population. We included trials that evaluated a
fixed-dose combination strategy of at least two blood pressure lowering
agents plus a statin (with or without aspirin), compared with a control
strategy (either placebo or usual care). The primary outcome was time to
first occurrence of a composite of cardiovascular death, myocardial
infarction, stroke, or arterial revascularisation. Additional outcomes
included individual cardiovascular outcomes and death from any cause.
Outcomes were also evaluated in groups stratified by the inclusion of
aspirin in the fixed-dose treatment strategy, and effect sizes were
estimated in prespecified subgroups based on risk factors. Kaplan-Meier
survival curves and Cox proportional hazard regression models were used to
compare strategies. Finding(s): Three large randomised trials were
included in the analysis (TIPS-3, HOPE-3, and PolyIran), with a total of
18 162 participants. Mean age was 63.0 years (SD 7.1), and 9038 (49.8%)
participants were female. Estimated 10-year cardiovascular disease risk
for the population was 17.7% (8.7). During a median follow-up of 5 years,
the primary outcome occurred in 276 (3.0%) participants in the fixed-dose
combination strategy group compared with 445 (4.9%) in the control group
(hazard ratio 0.62, 95% CI 0.53-0.73, p<0.0001). Reductions were also
observed for the separate components of the primary outcome: myocardial
infarction (0.52, 0.38-0.70), revascularisation (0.54, 0.36-0.80), stroke
(0.59, 0.45-0.78), and cardiovascular death (0.65, 0.52-0.81). Significant
reductions in the primary outcome and its components were observed in the
analyses of fixed-dose combination strategies with and without aspirin,
with greater reductions for strategies including aspirin. Treatment
effects were similar at different lipid and blood pressure levels, and in
the presence or absence of diabetes, smoking, or obesity. Gastrointestinal
bleeding was uncommon but slightly more frequent in the fixed-dose
combination strategy with aspirin group versus control (19 [0.4%] vs 11
[0.2%], p=0.15). The frequencies of haemorrhagic stroke (10 [0.2%] vs 15
[0.3%]), fatal bleeding (two [<0.1%] vs four [0.1%]), and peptic ulcer
disease (32 [0.7%] vs 34 [0.8%]) were low and did not differ significantly
between groups. Dizziness was more common with fixed-dose combination
treatment (1060 [11.7%] vs 834 [9.2%], p<0.0001). Interpretation(s):
Fixed-dose combination treatment strategies substantially reduce
cardiovascular disease, myocardial infarction, stroke, revascularisation,
and cardiovascular death in primary cardiovascular disease prevention.
These benefits are consistent irrespective of cardiometabolic risk
factors. Funding(s): Population Health Research
Institute. Copyright © 2021 Elsevier Ltd

<66>
Accession Number
635319371
Title
Safety and Efficacy of Different Antithrombotic Strategies after
Transcatheter Aortic Valve Implantation: A Network Meta-Analysis.
Source
Thrombosis and Haemostasis. 122(2) (pp 216-225), 2022. Article Number:
210095. Date of Publication: 01 Feb 2022.
Author
Navarese E.P.; Grisafi L.; Spinoni E.G.; Mennuni M.G.; Rognoni A.;
Ratajczak J.; Podhajski P.; Koni E.; Kubica J.; Patti G.
Institution
(Navarese, Kubica) Department of Cardiology and Internal Medicine,
Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
(Grisafi, Spinoni, Patti) Department of Translational Medicine, University
of Eastern Piedmont, Via Solaroli 17, Novara, Italy
(Grisafi, Spinoni, Mennuni, Rognoni, Patti) Department of Thoracic, Heart
and Vascular Diseases, Maggiore della Carita Hospital, Novara, Italy
(Ratajczak) Department of Health Promotion, Nicolaus Copernicus
University, Bydgoszcz, Poland
(Ratajczak, Podhajski) Department of Cardiology and Internal Medicine,
Nicolaus Copernicus University, Bydgoszcz, Poland
(Koni) Department of Interventional Cardiology, Santa Corona Hospital,
Pietra Ligure, Italy
Publisher
Georg Thieme Verlag
Abstract
Background The optimal pharmacological therapy after transcatheter aortic
valve implantation (TAVI) remains uncertain. We compared efficacy and
safety of various antiplatelet and anticoagulant approaches after TAVI by
a network meta-analysis. Methods A total of 14 studies (both observational
and randomized) were considered, with 24,119 patients included. Primary
safety endpoint was the incidence of any bleeding complications during
follow-up. Secondary safety endpoint was major bleeding. Efficacy
endpoints were stroke, myocardial infarction, and cardiovascular
mortality. A frequentist network meta-analysis was conducted with a
random-effects model. The following strategies were compared: dual
antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), oral
anticoagulation (OAC), and OAC + SAPT. The mean follow-up was 15 months.
Results In comparison to DAPT, SAPT was associated with a 44% risk
reduction of any bleeding (odds ratio [OR]: 0.56 [95% confidence interval,
CI: 0.39-0.80]). SAPT was ranked as the safest strategy for the prevention
of any bleeding (p -score: 0.704), followed by OAC alone (p -score: 0.476)
and DAPT (p -score: 0.437). Consistent results were observed for major
bleeding. The incidence of cardiovascular death and secondary ischemic
endpoints did not differ among the tested antithrombotic approaches. In
patients with indication for long-term anticoagulation, OAC alone showed
similar rates of stroke (OR: 0.92 [95% CI: 0.41-2.05], p = 0.83) and
reduced occurrence of any bleeding (OR: 0.49 [95% CI: 0.37-0.66], p <
0.01) versus OAC + SAPT. Conclusion The present network meta-analysis
supports after TAVI the use of SAPT in patients without indication for OAC
and OAC alone in those needing long-term anticoagulation. Copyright
© 2022 American Institute of Physics Inc.. All rights reserved.

<67>
Accession Number
636681291
Title
Outcomes of a Delirium Prevention Program in Older Persons after Elective
Surgery: A Stepped-Wedge Cluster Randomized Clinical Trial.
Source
JAMA Surgery. 157(2) (pp E216370), 2022. Date of Publication: February
2022.
Author
Deeken F.; Sanchez A.; Rapp M.A.; Denkinger M.; Brefka S.; Spank J.; Bruns
C.; Von Arnim C.A.F.; Kuster O.C.; Conzelmann L.O.; Metz B.R.; Maurer C.;
Skrobik Y.; Forkavets O.; Eschweiler G.W.; Thomas C.
Institution
(Deeken, Sanchez, Rapp) Department of Social and Preventive Medicine,
University of Potsdam, Potsdam, Germany
(Rapp) Social and Preventive Medicine, Department of Sports and Health
Sciences, Intrafaculty Unit of Cognitive Sciences, Faculty of Human
Science, Faculty of Health Sciences Brandenburg, Research Area Services
Research and E-Health, University of Potsdam, Potsdam, Germany
(Denkinger, Brefka) Agaplesion Bethesda Clinic Ulm, Institute for
Geriatric Research, Ulm University, Geriatric Center Ulm, Ulm, Germany
(Brefka) Department of Cardiothoracic and Vascular Surgery, Ulm University
Hospital, Ulm, Germany
(Spank, Bruns, Thomas) Department of Geriatric Psychiatry and
Psychotherapy, Klinikum Stuttgart, Krankenhaus Bad Cannstatt,
Priessnitzweg 24, Stuttgart 70374, Germany
(Von Arnim) Division of Geriatrics, University Medical Center Goettingen,
Gottingen, Germany
(Von Arnim, Kuster, Forkavets) Department of Neurology, University
Hospital Ulm, Ulm, Germany
(Conzelmann) Helios Clinic for Cardiac Surgery Karlsruhe, Karlsruhe,
Germany
(Metz) Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe,
Karlsruhe, Germany
(Maurer) Center for Geriatrics and Gerontology, Medical Center University
of Freiburg, Freiburg, Germany
(Skrobik) Department of Medicine, McGill University, Montreal, QC, Canada
(Forkavets, Eschweiler) Geriatric Center, The University Hospital
Tubingen, Tubingen, Germany
(Eschweiler, Thomas) Department of Psychiatry and Psychotherapy,
University Hospital of Tubingen, Tubingen, Germany
Publisher
American Medical Association
Abstract
Importance: Delirium significantly worsens elective surgery outcomes and
costs. Delirium risk is highest in elderly populations, whose surgical
health care resource consumption (50%) exceeds their demographic
proportion (15% to 18%) in high-resource countries. Effective
nonpharmacologic delirium prevention could safely improve care in these
vulnerable patients, but data from procedure-specific studies are
insufficiently compelling to drive changes in practice. Delirium
prevention approaches applicable to different surgical settings remain
unexplored. Objective(s): To examine whether a multifaceted
prevention intervention is effective in reducing postoperative delirium
incidence and prevalence after various major surgical procedures.
 Design, Setting, and Participant(s): This stepped-wedge cluster
randomized trial recruited 1470 patients 70 years and older undergoing
elective orthopedic, general, or cardiac surgery from November 2017 to
April 2019 from 5 German tertiary medical centers. Data were analyzed from
December 2019 to July 2021. Intervention(s): First, structured
delirium education was provided to clinical caregivers at each site. Then,
the study delirium prevention team assessed patient delirium risk factors
and symptoms daily. Prevention was tailored to individual patient needs
and could include: cognitive, motor, and sensory stimulation; meal
companionship; accompaniment during diagnostic procedures; stress
relaxation; and sleep promotion. Main Outcomes and Measures:
Postoperative delirium incidence and duration. Result(s): Of 1470
included patients, 763 (51.9%) were male, and the median (IQR) age was 77
(74-81) years. Overall, the intervention reduced postoperative delirium
incidence (odds ratio, 0.87; 95% CI, 0.77-0.98; P =.02) and percentage of
days with delirium (intervention, 5.3%; control, 6.9%; P =.03). The effect
was significant in patients undergoing orthopedic or abdominal surgery
(odds ratio, 0.59; 95% CI, 0.35-0.99; P =.047) but not cardiac surgery
(odds ratio, 1.18; 95% CI, 0.70-1.99; P =.54). Conclusions and
Relevance: This multifaceted multidisciplinary prevention intervention
reduced postoperative delirium occurrence and days with delirium in older
patients undergoing different elective surgical procedures but not cardiac
procedures. These results suggest implementing this delirium prevention
program will improve care and outcomes in older patients undergoing
elective general and orthopedic procedures.. Copyright © 2022
American Medical Association. All rights reserved.

<68>
Accession Number
2011279407
Title
An umbrella review of systematic reviews and meta-analyses of
observational investigations of obstructive sleep apnea and health
outcomes.
Source
Sleep and Breathing. 26(1) (pp 167-188), 2022. Date of Publication: March
2022.
Author
Chen W.; Li Y.; Guo L.; Zhang C.; Tang S.
Institution
(Chen, Li, Guo, Zhang, Tang) Department of Gastroenterology, The First
Affiliated Hospital, Jinan University, Guangzhou, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: The previous analysis of systematic reviews and meta-analyses
have illustrated that obstructive sleep apnea (OSA) is correlated with
multiple health outcomes. In the present research, our main aim was to
execute an umbrella review to assess the available evidence for the
associations between OSA and health outcomes. Method(s): Herein, a
meta-analysis of previous observational investigations that have reported
associations between OSA and health outcomes in all human populations and
settings was performed. We used these studies to execute an umbrella
review of available meta-analyses and systematic reviews. Result(s):
Sixty-six articles comprising 136 unique outcomes were enrolled in this
analysis. Of the 136 unique outcomes, 111 unique outcomes had significant
associations (p < 0.05). Only 7 outcomes (coronary revascularization after
PCI, postoperative respiratory failure, steatosis, alaninetrans aminase
(ALT) elevation, metabolic syndrome (MS), psoriasis, and Parkinson's
disease) had a high quality of evidence. Twenty-four outcomes had a
moderate quality of evidence, and the remaining 80 outcomes had a weak
quality of evidence. Sixty-nine outcomes exhibited significant
heterogeneity. Twenty-five outcomes exhibited publication bias.
Sixty-three (95%) studies showed critically low methodological quality.
 Conclusion(s): Among the 66 meta-analyses exploring 136 unique
outcomes, only 7 statistically significant outcomes were rated as high
quality of evidence. OSA may correlate with an increased risk of coronary
revascularization after PCI, postoperative respiratory failure, steatosis,
ALT elevation, MS, psoriasis, and Parkinson's disease. Copyright
© 2021, The Author(s).

<69>
Accession Number
2016940544
Title
The effect of delirium preventive measures on the occurrence of
postoperative cognitive dysfunction in older adults undergoing
cardiovascular surgery. The DelPOCD randomised controlled trial.
Source
Journal of Clinical Anesthesia. 78 (no pagination), 2022. Article Number:
110686. Date of Publication: June 2022.
Author
Olotu C.; Ascone L.; Wiede J.; Manthey J.; Kuehn S.; Scherwath A.;
Kiefmann R.
Institution
(Olotu, Wiede, Manthey, Kiefmann) Department of Anaesthesiology,
University Medical Centre Hamburg, Germany
(Ascone) Department of Psychiatry and Psychotherapy, University Medical
Centre Hamburg, Germany
(Kuehn, Scherwath) Institute of Medical Psychology, University Medical
Centre Hamburg, Germany
(Scherwath) Department of Stem Cell Transplantation, University Medical
Centre Hamburg, Germany
Publisher
Elsevier Inc.
Abstract
Study objective: This trial examines the effect of delirium preventive
measures on the incidence of postoperative cognitive dysfunction in older
adults. Design(s): In a randomised approach, a delirium prevention
and a standard care group were compared regarding manifestation of
postoperative cognitive dysfunction at seven days, three and twelve months
postoperatively (primary outcome). To correct for practice effects and
age-depended cognitive decline, a control group of age-matched healthy
subjects was included. Setting(s): The trial was conducted at the
University Medical Centre Hamburg between 2014 and 2018, data assessment
took place in the Anaesthesia Outpatient Clinic and on the surgical ward.
 Patient(s): A total of 609 patients >=60 years scheduled for
cardiovascular surgery were enrolled, allocated treatment was received by
284 patients in the delirium prevention and 274 patients in the standard
care group. Intervention(s): The intervention consisted of a delirium
prevention bundle including reorientation measures, sleeping aids and
early mobilisation. Measurements: Cognitive functions were assessed via
neuropsychological testing of attention, executive functions including
word fluency, and verbal memory utilizing a computerised test of
attentional performance, the trail making test, the digit span subtest
from the Wechsler Adult Intelligence Scale-IV, the verbal learning and
memory test, and the Regensburg Word Fluency Test. Assessments were
performed preoperatively and at three time points postoperatively (one
week, three months and 12 months). Main Result(s): Postoperative
cognitive dysfunction was defined as a clinically meaningful decline in at
least two out of nine chosen test parameters compared to the preoperative
level (reliable change index <= - 1.96). The rates of postoperative
cognitive dysfunction were 25.9% (delirium prevention group, n = 284) vs.
28.1% (standard care group, n = 274) [X2(1,n = 433) = 0.245;p =
0.621] at postoperative day seven and declined to 7.8% vs. 6.8%
[X2(1,n = 219) = 0.081;p = 0.775] and 1.3% vs. 5.6% (p = 0.215,
Fisher's exact test) at three and 12 months following surgery,
respectively. The postoperative delirium rates did not differ between the
two groups (delirium prevention group: 13.4% vs. standard care group:
17.3%). Attentional performance was impaired shortly after surgery,
whereas verbal delayed recall was most frequently affected over the whole
postoperative period. Conclusion(s): These findings suggest that an
intervention combining specific measures extracted from established
postoperative delirium prevention programs did not reduce the rate of
postoperative cognitive dysfunction in older adults. Copyright ©
2022 Elsevier Inc.

<70>
Accession Number
2016939828
Title
2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve
Replacement in Low-Risk Patients.
Source
Journal of the American College of Cardiology. 79(9) (pp 882-896), 2022.
Date of Publication: 08 Mar 2022.
Author
Forrest J.K.; Deeb G.M.; Yakubov S.J.; Rovin J.D.; Mumtaz M.; Gada H.;
O'Hair D.; Bajwa T.; Sorajja P.; Heiser J.C.; Merhi W.; Mangi A.; Spriggs
D.J.; Kleiman N.S.; Chetcuti S.J.; Teirstein P.S.; Zorn G.L.; Tadros P.;
Tchetche D.; Resar J.R.; Walton A.; Gleason T.G.; Ramlawi B.; Iskander A.;
Caputo R.; Oh J.K.; Huang J.; Reardon M.J.
Institution
(Forrest, Mangi) Department of Internal Medicine (Cardiology), Yale
University School of Medicine, New Haven, CT, United States
(Forrest, Mangi) Department of Surgery (Cardiac Surgery), Yale University
School of Medicine, New Haven, CT, United States
(Deeb, Chetcuti) Department of Interventional Cardiology, University of
Michigan Hospitals, Ann Arbor, MI, United States
(Deeb, Chetcuti) Department of Cardiovascular Surgery, University of
Michigan Hospitals, Ann Arbor, MI, United States
(Yakubov) Department of Interventional Cardiology, Riverside
Methodist-OhioHealth, Columbus, OH, United States
(Rovin, Spriggs) Department of Cardiac Surgery, Morton Plant Hospital,
Clearwater, FL, United States
(Mumtaz, Gada) Department of Interventional Cardiology, University of
Pittsburgh Medical Center Pinnacle, Wormleyburg, PA, United States
(Mumtaz, Gada) Department of Cardiovascular and Thoracic Surgery,
University of Pittsburgh Medical Center Pinnacle, Wormleyburg, PA, United
States
(O'Hair, Bajwa) Department of Interventional Cardiology, Aurora St. Luke's
Medical Center, Milwaukee, WI, United States
(O'Hair, Bajwa) Department of Cardiovascular Surgery, Aurora St. Luke's
Medical Center, Milwaukee, WI, United States
(Sorajja) Department of Interventional Cardiology, Minneapolis Heart
Institute-Abbott Northwestern Hospital, Minneapolis, MN, United States
(Heiser, Merhi) Department of Interventional Cardiology, Spectrum Health,
Grand Rapids, MI, United States
(Heiser, Merhi) Department of Cardiothoracic Surgery, Spectrum Health,
Grand Rapids, MI, United States
(Kleiman, Reardon) Department of Interventional Cardiology, Houston
Methodist-DeBakey Heart and Vascular Center, Houston, TX, United States
(Kleiman, Reardon) Department of Cardiothoracic Surgery, Houston
Methodist-DeBakey Heart and Vascular Center, Houston, TX, United States
(Teirstein) Department of Interventional Cardiology, Scripps Clinic, La
Jolla, CA, United States
(Zorn, Tadros) Department of Interventional Cardiology, University of
Kansas, Kansas City, KS, United States
(Zorn, Tadros) Department of Cardiac Surgery, University of Kansas, Kansas
City, KS, United States
(Tchetche) Department of Interventional Cardiology, Clinique Pasteur,
Toulouse, France
(Resar) Department of Interventional Cardiology, Johns Hopkins Hospital,
Baltimore, MD, United States
(Walton) Department of Interventional Cardiology, Alfred Hospital,
Melbourne, VIC, Australia
(Gleason) Department of Cardiac Surgery, University of Pittsburgh Medical
Center, Pittsburgh, PA, United States
(Ramlawi) Department of Cardiovascular Surgery, Valley Health System,
Winchester, Virginia, United States
(Iskander, Caputo) Department of Interventional Cardiology, Saint Joseph's
Hospital Health Center, Syracuse, NY, United States
(Iskander, Caputo) Department of Cardiovascular Surgery, Saint Joseph's
Hospital Health Center, Syracuse, NY, United States
(Oh) Division of Cardiovascular Ultrasound, Mayo Clinic, Rochester, MN,
United States
(Huang) Department of Statistics, Medtronic, Minneapolis, MN, United
States
Publisher
Elsevier Inc.
Abstract
Background: The Evolut Low Risk Trial (Medtronic Evolut Transcatheter
Aortic Valve Replacement in Low Risk Patients) showed that transcatheter
aortic valve replacement (TAVR) with a supra-annular, self-expanding valve
was noninferior to surgery for the primary endpoint of all-cause mortality
or disabling stroke at 2 years. This finding was based on a Bayesian
analysis performed after 850 patients had reached 1 year of follow-up.
 Objective(s): The goal of this study was to report the full 2-year
clinical and echocardiographic outcomes for patients enrolled in the
Evolut Low Risk Trial. Method(s): A total of 1,414 low-surgical risk
patients with severe aortic stenosis were randomized to receive TAVR or
surgical AVR. An independent clinical events committee adjudicated adverse
events, and a central echocardiographic core laboratory assessed
hemodynamic endpoints. Result(s): An attempted implant was performed
in 730 TAVR and 684 surgical patients from March 2016 to May 2019. The
Kaplan-Meier rates for the complete 2-year primary endpoint of death or
disabling stroke were 4.3% in the TAVR group and 6.3% in the surgery group
(P = 0.084). These rates were comparable to the interim Bayesian rates of
5.3% with TAVR and 6.7% with surgery (difference: -1.4%; 95% Bayesian
credible interval: -4.9% to 2.1%). All-cause mortality rates were 3.5% vs
4.4% (P = 0.366), and disabling stroke rates were 1.5% vs 2.7% (P =
0.119), respectively. Between years 1 and 2, there was no convergence of
the primary outcome curves. Conclusion(s): The complete 2-year
follow-up from the Evolut Low Risk Trial found that TAVR is noninferior to
surgery for the primary endpoint of all-cause mortality or disabling
stroke, with event rates that were slightly better than those predicted by
using the Bayesian analysis. (Medtronic Evolut Transcatheter Aortic Valve
Replacement in Low Risk Patients [Evolut Low Risk Trial];
NCT02701283) Copyright © 2022

<71>
Accession Number
2016907949
Title
Non-invasive Imaging in the Evaluation of Cardiac Allograft Vasculopathy
in Heart Transplantation: A Systematic Review.
Source
Current Problems in Cardiology. (no pagination), 2022. Article Number:
101103. Date of Publication: 2022.
Author
Ajluni S.C.; Mously H.; Chami T.; Hajjari J.; Stout A.; Zacharias M.;
ElAmm C.; Wilson D.; Janus S.E.; Al-Kindi S.G.
Institution
(Ajluni, Hajjari) Department of Medicine, University Hospitals, Cleveland,
OH, United States
(Mously, Zacharias, ElAmm, Wilson, Janus, Al-Kindi) Harrington Heart and
Vascular Institute, University Hospitals and School of Medicine, Case
Western Reserve University, Cleveland, OH, United States
(Chami) Minneapolis Heart Institute, Minneapolis, MN, United States
(Stout) Core Library, University Hospitals Cleveland Medical Center,
Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Cardiac allograft vasculopathy (CAV) is the leading cause of long-term
graft dysfunction in patients with heart transplantation and is linked
with significant morbidity and mortality. Currently, the gold standard for
diagnosing CAV is coronary imaging with intravascular ultrasound during
traditional invasive coronary angiography. Invasive imaging, however,
carries increased procedural risk and expense to patients in addition to
requiring an experienced interventionalist. With the improvements in
non-invasive cardiac imaging modalities such as transthoracic
echocardiography, computed tomography, magnetic resonance imaging and
positron emission tomography, an alternative non-invasive imaging approach
for the early detection of CAV may be feasible. In this systematic review,
we explored the literature to investigate the utility of non-invasive
imaging in diagnosis of CAV in >3000 patients across 49 studies. We also
discuss the strengths and weaknesses for each imaging modality. Overall,
all 4 imaging modalities show good to excellent accuracy for identifying
CAV with significant variations across studies. Majority of the studies
compared non-invasive imaging with invasive coronary angiography without
intravascular imaging. In summary, non-invasive imaging modalities offer
an alternative approach to invasive coronary imaging for CAV. Future
studies should investigate longitudinal non-invasive protocols in low-risk
patients after heart transplantation. Copyright © 2022 Elsevier
Inc.

<72>
Accession Number
637271005
Title
Mortality prediction of mitral valve replacement surgery by machine
learning.
Source
Research in Cardiovascular Medicine. 10(4) (pp 106-111), 2021. Date of
Publication: October-December 2021.
Author
Hosseininezhad M.; Langarizadeh M.; Hosseini S.
Institution
(Hosseininezhad, Langarizadeh) Department of Health Information
Management, School of Health Management and Information Sciences, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Heart Valve Disease Research Center, Rajaie Cardiovascular
Medical and Research Center, Iran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
Publisher
Wolters Kluwer Medknow Publications
Abstract
Background: Mitral valve replacement procedure has increased in the Iran
over the last years. For optimization of the results, as the other
procedure, it needs statistical evaluation of the results, and then a
system for the prediction of outcome. Hence, in this study, we generate a
machine learning (ML)-based model to predict in-hospital mortality after
isolated mitral valve replacement (IMVR). Material(s) and Method(s):
The patients who underwent IMVR from February 2005 to August 2016 were
identified in a single tertiary heart hospital. Data were retrospectively
gathered including baseline characteristics, echocardiographic and
surgical features, and patient's outcome. Prediction models for
in-hospital mortality were obtained using five supervised ML classifiers
including: logistic regression (LR), linear discriminant analysis (LDA),
support-vector machine (SVM), K-nearest neighbors (KNN), and multilayer
perceptron (MLP). Result(s): A total of 1200 IMVRs were analyzed in
our study. The study population was randomly divided into a training set
(n = 840) and a testing set (n = 360). The overall in-hospital mortality
was 4.2%. LR model had the best discrimination for 22 variables in
predicting mortality after IMVR, with area under the receiver-operating
curve (AUC), specificity, and sensitivity of 0.68, 0.73, and 0.58,
respectively. A LDA model had an (AUC) of 0.73, compared to 0.56 for SVM,
0.51 for KNN, and 0.5 for MLP. Conclusion(s): We developed a robust
ML-derived model to predict in-hospital mortality in patients undergoing
IMVR. This model is promising for decision-making and deserves further
clinical validation. Copyright © 2021 Wolters Kluwer Medknow
Publications. All rights reserved.

<73>
[Use Link to view the full text]
Accession Number
2016817980
Title
A meta-analysis of optimal medical therapy with or without percutaneous
coronary intervention in patients with stable coronary artery disease.
Source
Coronary Artery Disease. 33(2) (pp 91-97), 2022. Date of Publication: 01
Mar 2022.
Author
Shah R.; Nayyar M.; Le F.K.; Labroo A.; Nasr A.; Rashid A.; Davis D.A.;
Weintraub W.S.; Boden W.E.
Institution
(Shah, Nayyar) Department of Medicine, University of Tennessee, School of
Medicine, Section of Cardiovascular Medicine, 1030 Jefferson Avenue,
Memphis, TN 38104, United States
(Shah, Le, Labroo, Davis) Department of Cardiology, Gulf Coast Medical
Center, Alabama University of Osteopathic Medicine, Panama City, FL,
United States
(Nasr) Department of Biology, University of Memphis, Memphis, TN, United
States
(Rashid) Department of Cardiology, University of Tennessee, Jackson, TN,
United States
(Weintraub) Department of Medicine, MedStar Washington Hospital Center,
Washington, DC, United States
(Boden) Department of Medicine, Veterans Affairs (VA) New England
Healthcare System, Boston University, United States
(Boden) Department of Medicine, Boston University, School of Medicine,
Boston, MA, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background Whether percutaneous coronary intervention (PCI) improves
clinical outcomes in patients with chronic angina and stable coronary
artery disease (CAD) has been a continuing area of investigation for more
than two decades. The recently reported results of the International Study
of Comparative Health Effectiveness with Medical and Invasive Approaches,
the largest prospective trial of optimal medical therapy (OMT) with or
without myocardial revascularization, provides a unique opportunity to
determine whether there is an incremental benefit of revascularization in
stable CAD patients. Methods Scientific databases and websites were
searched to find randomized clinical trials (RCTs). Pooled risk ratios
were calculated using the random-effects model. Results Data from 10 RCTs
comprising 12 125 patients showed that PCI, when added to OMT, were not
associated with lower all-cause mortality (risk ratios, 0.96; 95% CI,
0.87-1.08), cardiovascular mortality (risk ratios, 0.91; 95% CI,
0.79-1.05) or myocardial infarction (MI) (risk ratios, 0.90; 95% CI,
0.78-1.04) as compared with OMT alone. However, OMT+PCI was associated
with improved anginal symptoms and a lower risk for revascularization
(risk ratios, 0.52; 95% CI, 0.37-0.75). Conclusions In patient with
chronic stable CAD (without left main disease or reduced ejection
fraction), PCI in addition to OMT did not improve mortality or MI compared
to OMT alone. However, this strategy is associated with a lower rate of
revascularization and improved anginal symptoms. Copyright © 2022
Lippincott Williams and Wilkins. All rights reserved.

<74>
Accession Number
2016799943
Title
Effects of initial invasive vs. initial conservative treatment strategies
on recurrent and total cardiovascular events in the ISCHEMIA trial.
Source
European Heart Journal. 43(2) (pp 148-149A), 2022. Date of Publication: 07
Jan 2022.
Author
Lopez-Sendon J.L.; Cyr D.D.; Mark D.B.; Bangalore S.; Huang Z.; White
H.D.; Alexander K.P.; Li J.; Nair R.G.; Demkow M.; Peteiro J.; Wander
G.S.; Demchenko E.A.; Gamma R.; Gadkari M.; Poh K.K.; Nageh T.; Stone
P.H.; Keltai M.; Sidhu M.; Newman J.D.; Boden W.E.; Reynolds H.R.;
Chaitman B.R.; Hochman J.S.; Maron D.J.; O'Brien S.M.
Institution
(Lopez-Sendon) Cardiology department, Hospital Universitario La Paz,
Idipaz, UAM, CIBER-CV, Paseo de la Castellana 261, Madrid 28046, Spain
(Cyr, Mark, Huang, Alexander, Li, O'Brien) Duke Clinical Research
Institute, Duke University, 300 W. Morgan Street, Durham, NC, United
States
(Bangalore, Newman, Reynolds, Hochman) NYU Grossman School of Medicine,
530 First Avenue, New York, NY, United States
(White) Auckland City Hospital Green Lane Cardiovascular Services,
University of Auckland, 2 Park Road, Grafton, Auckland 1023, New Zealand
(Nair) Government Medical College, 48/584, Subhag Sastrinagar, Kerala,
Thiruvananthapuram 695002, India
(Demkow) Department of Coronary and Structural Heart Diseases, National
Institute of Cardiology, Alpejska 42, Warsaw 04-628, Poland
(Peteiro) CHUAC, Universidad de A Coruna, CIBER-CV, As Xubias, 84, A
Coruna 15006, Spain
(Wander) Dayanand Medical College & Hospital, Civil Lines, Tagore Nagar,
Punjab, Ludhiana 141001, India
(Demchenko) Almazov National Medical Research Centre, Ulitsa Akkuratova,
2, Saint-Petersburg 197341, Russian Federation
(Gamma) Broomfield Hospital, Court Rd, Broomfield, Chelmsford CM1 7ET,
United Kingdom
(Gadkari) Kem Hospital Maharashtra, 489, Mudaliar Rd, Rasta Peth,
Maharashtra, Pune 411011, India
(Poh) National University Heart Center Singapore, Singapore, Singapore
(Poh) Yong Loo Lin School of Medicine, National University of Singapore,
10 Medical Dr, Singapore, Singapore
(Nageh) Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea,
Southend-on-Sea, Southend SS0 0RY, United Kingdom
(Stone) Brigham and Women's Hospital, 75 Francis St, Boston, MA, United
States
(Keltai) Semmelweis University, Ulloi ut 26, Budapest 1085, Hungary
(Sidhu) Albany Medical College, 47 New Scotland Avenue, Physicians
Pavilion, Albany, NY 12208, United States
(Boden) VA New England Healthcare System, Boston University School of
Medicine, 150 South Huntington Avenue, Boston, MA, United States
(Chaitman) St Louis University School of Medicine, Center for
Comprehensive Cardiovascular Care, 1034 S. Brentwood Blvd., St. Louis, MO,
United States
(Maron) Department of Medicine, Stanford University, 300 Pasteur Drive,
Falk CVRC 265, Stanford, CA 94305-5406, United States
Publisher
Oxford University Press
Abstract
Aims: The International Study of Comparative Health Effectiveness with
Medical and Invasive Approaches (ISCHEMIA) trial prespecified an analysis
to determine whether accounting for recurrent cardiovascular events in
addition to first events modified understanding of the treatment effects.
 Methods and Results: Patients with stable coronary artery disease
(CAD) and moderate or severe ischaemia on stress testing were randomized
to either initial invasive (INV) or initial conservative (CON) management.
The primary outcome was a composite of cardiovascular death, myocardial
infarction (MI), and hospitalization for unstable angina, heart failure,
or cardiac arrest. The Ghosh-Lin method was used to estimate mean
cumulative incidence of total events with death as a competing risk. The
5179 ISCHEMIA patients experienced 670 index events (318 INV, 352 CON) and
203 recurrent events (102 INV, 101 CON). A single primary event was
observed in 9.8% of INV and 10.8% of CON patients while >=2 primary events
were observed in 2.5% and 2.8%, respectively. Patients with recurrent
events were older; had more frequent hypertension, diabetes, prior MI, or
cerebrovascular disease; and had more multivessel CAD. The average number
of primary endpoint events per 100 patients over 4 years was 18.2 in INV
[95% confidence interval (CI) 15.8-20.9] and 19.7 in CON (95% CI
17.5-22.2), difference -1.5 (95% CI -5.0 to 2.0, P = 0.398). Comparable
results were obtained when all-cause death was substituted for
cardiovascular death and when stroke was added as an event.
 Conclusion(s): In stable CAD patients with moderate or severe
myocardial ischaemia enrolled in ISCHEMIA, an initial INV treatment
strategy did not prevent either net recurrent events or net total events
more effectively than an initial CON strategy. Copyright © 2022
Oxford University Press. All rights reserved.

<75>
Accession Number
2015686283
Title
Patients with intracardiac masses: 12-year observation from a tertiary
referral hospital.
Source
Annals of Clinical and Analytical Medicine. 12(12) (pp 1362-1366), 2021.
Date of Publication: 2021.
Author
Tasbulak O.; Guler A.; Duran M.; Sahin A.A.; Uygur B.; Bulut U.; Avci Y.;
Demir A.R.; Kahraman S.; Aydin U.; Erturk M.
Institution
(Tasbulak, Guler, Uygur, Bulut, Avci, Demir, Kahraman, Erturk) Department
of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic
and Cardiovascular Surgery Training and Research Hospital, Istanbul,
Turkey
(Duran) Department of Cardiology, University of Health Sciences, Konya
Training and Research Hospital, Konya, Turkey
(Sahin) Department of Cardiology, School of Medicine, Istinye University,
Istanbul, Turkey
(Aydin) Department of Cardiovascular Surgery, University of Health
Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training
and Research Hospital, Istanbul, Turkey
Publisher
Derman Medical Publishing
Abstract
Aim: Intracardiac masses are extremely rare and challenging to manage. Due
to the rarity of the disease and the absence of data from large randomized
clinical trials, recommendations for the diagnosis and management of
intracardiac masses are still derived from expert opinion and
observational cohort studies. In this study we aim to describe the
epidemiological features, clinical characteristics, and prevalence of
intracardiac masses. Material(s) and Method(s): The records of 133
patients aged >18 who underwent open surgery due to confirmed intracardiac
masses were investigated retrospectively. Demographic and clinical
characteristics of the patients, the indication for the procedure, and
postoperative outcomes were retrospectively analyzed. For isolated
intracardiac masses, the mass location, final histopathologic diagnosis,
concomitant clinical conditions, and preferred surgical approach were
analyzed. Result(s): The most common histopathologic diagnosis was
atrial myxoma (n=62, 46.6%), followed by cardiac thrombus (n=33, 24.8%),
and the most common location of the intracardiac masses was the left
interatrial septum (n=48, 36.1%). The composite of all-cause mortality was
the most common early outcome (n=11, 8.3%) while tumor-related mortality
was the most common late outcome (n=15, 11.3%). Discussion(s): Our
data show that intracardiac masses have diverse etiology and various
clinical manifestations, and they often require cardiac surgery. In order
to prevent complications, careful assessment and optimal timing of surgery
is mandatory. Copyright © 2021, Derman Medical Publishing. All
rights reserved.

<76>
Accession Number
2015686159
Title
A case report of peripartum cardiomyopathy with a review of literature.
Source
Annals of Clinical and Analytical Medicine. 10(2) (pp 253-256), 2019. Date
of Publication: 2019.
Author
Isguder C.K.; Pektas M.K.; Basol N.
Institution
(Isguder) Department of Obstetrics and Gynecology, School of Medicine
Istanbul, Istanbul University, Istanbul, Turkey
(Pektas) Department of Obstetrics and Gynecology, Afyon Kocatepe
University Hospital, Afyonkarahisar, Turkey
(Basol) Department of Emergency Medicine, School of Medicine,
Gaziosmanpasa University, Tokat, Turkey
Publisher
Derman Medical Publishing
Abstract
Peripartum cardiomyopathy (PPCM) is a severe form of idiopathic dilated
cardiomyopathy, which appears either in the last month of pregnancy or
during the five months following delivery. This clinical entity leads to
left ventricular dysfunction and eventually cardiac insufficiency. Left
ventricle functions recover spontaneously in some patients with PPCM while
left ventricular dysfunction persists to cause an indication for cardiac
transplantation in some patients. This case report aims to increase the
awareness of obstetricians about PPCM by describing an affected
patient. Copyright © 2019, Derman Medical Publishing. All rights
reserved.

<77>
Accession Number
637263513
Title
Preoperative risk assessment tools for morbidity after cardiac surgery: a
systematic review.
Source
European journal of cardiovascular nursing : journal of the Working Group
on Cardiovascular Nursing of the European Society of Cardiology. (no
pagination), 2022. Date of Publication: 16 Feb 2022.
Author
Sanders J.; Makariou N.; Tocock A.; Magboo R.; Thomas A.; Aitken L.M.
Institution
(Sanders) St Bartholomew's Hospital, Barts Health NHS Trust, West
Smithfield, London EC1A 7DN, UK
(Sanders, Magboo, Thomas) William Harvey Research Institute, Queen Mary
University of London, Charterhouse Square, London, United Kingdom
(Makariou) Barts and the London Medical School, Queen Mary University of
London, Charterhouse Square, London, United Kingdom
(Tocock) Knowledge and Library Services, St Bartholomew's Hospital, Barts
Health NHS Trust, West Smithfield, London, UK
(Magboo, Thomas) Critical Care, St Bartholomew's Hospital, Barts Health
NHS Trust, West Smithfield, London, UK
(Aitken) School of Health Sciences, City, University of London,
Northampton Square, London, UK
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative morbidity places considerable burden on health
and resources. Thus, strategies to identify, predict, and reduce
postoperative morbidity are needed. AIMS: To identify and explore existing
preoperative risk assessment tools for morbidity after cardiac surgery.
 METHOD(S): Electronic databases (including MEDLINE, CINAHL, and
Embase) were searched to December 2020 for preoperative risk assessment
models for morbidity after adult cardiac surgery. Models exploring one
isolated postoperative morbidity and those in patients having heart
transplantation or congenital surgery were excluded. Data extraction and
quality assessments were undertaken by two authors. RESULT(S): From
2251 identified papers, 22 models were found. The majority (54.5%) were
developed in the USA or Canada, defined morbidity outcome within the
in-hospital period (90.9%), and focused on major morbidity. Considerable
variation in morbidity definition was identified, with morbidity incidence
between 4.3% and 52%. The majority (45.5%) defined morbidity and mortality
separately but combined them to develop one model, while seven studies
(33.3%) constructed a morbidity-specific model. Models contained between 5
and 50 variables. Commonly included variables were age, emergency surgery,
left ventricular dysfunction, and reoperation/previous cardiac surgery,
although definition differences across studies were observed. All models
demonstrated at least reasonable discriminatory power [area under the
receiver operating curve (0.61-0.82)]. CONCLUSION(S): Despite the
methodological heterogeneity across models, all demonstrated at least
reasonable discriminatory power and could be implemented depending on
local preferences. Future strategies to identify, predict, and reduce
morbidity after cardiac surgery should consider the ageing population and
those with minor and/or multiple complex morbidities. Copyright
Published on behalf of the European Society of Cardiology. All rights
reserved. © The Author(s) 2022. For permissions, please email:
journals.permissions@oup.com.

<78>
Accession Number
637262851
Title
Association of Annual N-Terminal Pro-Brain Natriuretic Peptide
Measurements With Clinical Events in Patients With Asymptomatic Nonsevere
Aortic Stenosis: A Post Hoc Substudy of the SEAS Trial.
Source
JAMA cardiology. (no pagination), 2022. Date of Publication: 16 Feb 2022.
Author
Hadziselimovic E.; Greve A.M.; Sajadieh A.; Olsen M.H.; Kesaniemi Y.A.;
Nienaber C.A.; Ray S.G.; Rossebo A.B.; Willenheimer R.; Wachtell K.;
Nielsen O.W.
Institution
(Hadziselimovic, Sajadieh, Nielsen) Department of Cardiology, Bispebjerg
University Hospital, Copenhagen, Denmark
(Greve) Department of Clinical Biochemistry 3011, Rigshospitalet,
Copenhagen, Denmark
(Sajadieh, Nielsen) Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
(Olsen) Department of Cardiology, Holbaek Hospital, Denmark
(Olsen) Department of Regional Health Research, University of Southern
Denmark, Odense, Denmark
(Kesaniemi) Research Unit of Internal Medicine, Medical Research Center
Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
(Nienaber) Royal Brompton and Harefield NHS Foundation Trust, Imperial
College, London, United Kingdom
(Ray) Manchester Academic Health Sciences Centre, Manchester, United
Kingdom
(Rossebo) Department of Cardiology, Oslo University Hospital, Ulleval,
Oslo, Norway
(Willenheimer) Lund University, Heart Health Group, Malmo, Sweden
(Wachtell) Department of Cardiology, Oslo University Hospital,
Rikshospitalet, Oslo, Norway
Publisher
NLM (Medline)
Abstract
Importance: Recent studies have questioned the presumed low-risk status of
patients with asymptomatic nonsevere aortic stenosis (AS). Whether annual
N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements are
useful for risk assessment is unknown. Objective(s): To assess the
association of annual NT-proBNP measurements with clinical outcomes in
patients with nonsevere AS. Design, Setting, and Participant(s):
Analysis of annual NT-proBNP concentrations in the multicenter,
double-blind Simvastatin and Ezetimibe in Aortic Stenosis (SEAS)
randomized clinical trial was performed. SEAS was conducted from January
6, 2003, to April 1, 2008. Blood samples were analyzed in 2016, and data
analysis was performed from February 10 to October 10, 2021. SEAS included
1873 patients with asymptomatic AS not requiring statin therapy with
transaortic maximal flow velocity from 2.5 to 4.0 m/s and preserved
ejection fraction. This substudy included 1644 patients (87.8%) with
available blood samples at baseline and year 1. Exposures: Increased age-
and sex-adjusted NT-proBNP concentrations at year 1 and a 1.5-fold or
greater relative NT-proBNP concentration change from baseline to year 1.
Moderate AS was defined as baseline maximal flow velocity greater than or
equal to 3.0 m/s. Main Outcomes and Measures: Aortic valve events
(AVEs), which are a composite of aortic valve replacement, cardiovascular
death, or incident heart failure due to AS progression, were noted.
Landmark analyses from year 1 examined the association of NT-proBNP
concentrations with outcomes. Result(s): Among 1644 patients, 996
were men (60.6%); mean (SD) age was 67.5 (9.7) years. Adjusted NT-proBNP
concentrations were within the reference range (normal) in 1228 of 1594
patients (77.0%) with NT-proBNP values available at baseline and in 1164
of 1644 patients (70.8%) at year 1. During the next 2 years of follow-up,
the AVE rates per 100 patient-years for normal vs increased adjusted
NT-proBNP levels at year 1 were 1.39 (95% CI, 0.86-2.23) vs 7.05 (95% CI,
4.60-10.81) for patients with mild AS (P<.01), and 10.38 (95% CI,
8.56-12.59) vs 26.20 (95% CI, 22.03-31.15) for those with moderate AS
(P<.01). Corresponding all-cause mortality rates were 1.05 (95% CI,
0.61-1.81) vs 4.17 (95% CI, 2.42-7.19) for patients with mild AS (P<.01),
and 1.60 (95% CI, 0.99-2.57) vs 4.78 (95% CI, 3.32-6.87) for those with
moderate AS (P<.01). In multivariable Cox proportional hazards regression
models, the combination of a 1-year increased adjusted NT-proBNP level and
1.5-fold or greater NT-proBNP level change from baseline was associated
with the highest AVE rates in both patients with mild AS (hazard ratio,
8.12; 95% CI, 3.53-18.66; P<.001) and those with moderate AS (hazard
ratio, 4.05; 95% CI, 2.84-5.77; P<.001). Conclusions and Relevance:
The findings of this study suggest that normal NT-proBNP concentrations at
1-year follow-up are associated with low AVE and all-cause mortality rates
in patients with asymptomatic nonsevere AS. Conversely, an increased
1-year NT-proBNP level combined with a 50% or greater increase from
baseline may be associated with high AVE rates. Trial Registration:
ClinicalTrials.gov Identifier: NCT00092677.

<79>
Accession Number
637262131
Title
Meta-Analysis Comparing Direct Oral Anticoagulants Versus Vitamin K
Antagonists in Patients With Atrial Fibrillation Who Underwent
Bioprosthetic Valve Replacement.
Source
The American journal of cardiology. (no pagination), 2022. Date of
Publication: 12 Feb 2022.
Author
Shaikh S.; Mohamed M.M.G.; Osman M.; Kheiri B.
Institution
(Shaikh, Mohamed) Internal Medicine Department, SSM Health St. Mary's
Hospital-St. Louis, St Louis, MO, United States
(Osman, Kheiri) Knight Cardiovascular Institute, Oregon Health & Science
University, Portland, Oregon
Publisher
NLM (Medline)

<80>
Accession Number
637262077
Title
Meta-Analysis Investigating the Efficacy and Safety of the MANTA Versus
ProGlide Vascular Closure Devices After Transcatheter Aortic Valve
Implantation.
Source
The American journal of cardiology. (no pagination), 2022. Date of
Publication: 12 Feb 2022.
Author
Al-Abcha A.; Saleh Y.; Halboni A.; Wang E.; Salam M.F.; Abela G.
Institution
(Al-Abcha, Wang, Salam) Department of Internal Medicine, Michigan State
University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist DeBakey Heart &
Vascular Center, Houston, Texas; Department of Cardiology, Alexandria
University, Alexandria, Egypt. Electronic address: alabchaa@msu.edu
(Halboni) Department of Internal Medicine, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Abela) Department of Cardiology, Michigan State University, East Lansing,
MI, United States
Publisher
NLM (Medline)

<81>
Accession Number
637261222
Title
Effects of positive end-expiratory pressure on pulmonary atelectasis after
paediatric laparoscopic surgery as assessed by ultrasound: A randomised
controlled study.
Source
Anaesthesia, critical care & pain medicine. (pp 101034), 2022. Date of
Publication: 12 Feb 2022.
Author
Lee H.-M.; Min J.Y.; Lee J.-R.; Lee M.H.; Byon H.-J.
Institution
(Lee) Department of Anaesthesiology and Pain Medicine, Yonsei University
College of Medicine, Yongin Severance Hospital, 363,
Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, Gyeonggi-do, 169995,
Republic of Korea; Anaesthesia and Pain Research Institute, Yonsei
University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722
Republic of Korea
(Min) Department of Anaesthesiology and Pain Medicine, Catholic University
College of Medicine, Eunpyeong St. Mary's Hospital, Seoul 03312 Republic
of Korea 1021
(Lee, Lee) Anaesthesia and Pain Research Institute, Yonsei University
College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of
Korea; Department of Anaesthesiology and Pain Medicine, Yonsei University
College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of
Korea
(Byon) Anaesthesia and Pain Research Institute, Yonsei University College
of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea;
Department of Anaesthesiology and Pain Medicine, Yonsei University College
of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722 Republic of Korea.
Electronic address: JINOBEN@yuhs.ac
Publisher
NLM (Medline)
Abstract
INTRODUCTION: Positive end-expiratory pressure (PEEP) following alveolar
recruitment manoeuvre (RM) can effectively prevent anaesthesia-induced
atelectasis in children. We aimed to evaluate the individual effect of
PEEP following RM on atelectasis at the end of laparoscopic surgery in
infants and small children. METHOD(S): Children undergoing
laparoscopic inguinal hernia repair aged 5 weeks to 2 years were randomly
allocated to either the PEEP or control group. A progressive RM was
performed after intubation in all cases. The PEEP group received PEEP of 5
cmH2O until the end of mechanical ventilation, while the control group did
not receive any PEEP. Lung ultrasonography was performed to compare the
number of atelectatic regions between the two groups after anaesthesia
induction, after RM, and at the end of surgery in 12 thoracic regions.
 RESULT(S): Overall, 432 ultrasonographic images were acquired from 36
children. At the end of surgery, the number of atelectatic regions (median
[interquartile range]) was significantly lower in the PEEP group compared
to the control group (2.0 [1.0 - 3.0] versus 4.0 [3.0 - 4.0] out of 12
regions, respectively; p= 0.02). While no difference was observed between
the number of atelectatic regions after induction and at the end of
surgery in the control group (p= 0.30), a decrease was observed in the
PEEP group (3.0 [2.0 - 4.0] to 2.0 [1.0 - 3.0], respectively; p= 0.02).
 CONCLUSION(S): RM followed by a PEEP of 5 cmH2O can effectively
reduce the regions of pulmonary atelectasis at the end of laparoscopic
surgery in infants and small children. Copyright © 2022.
Published by Elsevier Masson SAS.

<82>
Accession Number
2013610079
Title
Effect of nurse led education on anxiety level among coronary artery
bypass grafting pre-operative patients.
Source
Journal of the Pakistan Medical Association. 71(1 B) (pp 238-242), 2021.
Date of Publication: January 2021.
Author
Ali A.; Masih S.; Rabbi F.; Rasheed A.
Institution
(Ali, Masih) Institute of Nursing, Dow University of Health Sciences,
Karachi, Pakistan
(Rabbi) National Institute of Cardiovascular Diseases, Karachi, Pakistan
(Rasheed) Department of Research, Dow University of Health Sciences,
Karachi, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objective: The objective of this study was to identify the effect of
nurse-led pre-operative education in minimizing the level of anxiety among
patients waiting for Coronary Artery Bypass Grafting. Method(s): This
experimental study was accomplished at National Institute of
Cardiovascular Diseases. Out of 136, there were 80 patients identified
with the presence of anxiety using AKUADS 4 to 6 weeks before CABG. Data
were collected by the primary researcher from July 2016 to December 2016.
Patients with anxiety were divided into experimental and non-experimental
groups. After pre-operative education to the experimental group, patients
from both groups were re-assessed for anxiety level one week before CABG.
 Result(s): Data were assessed through non-parametric Wilcoxon sign
ranked and Mann Whitney tests. It was found that anxiety reduced
significantly in post-assessment among experimental group participants. No
significant difference was found for pre-anxiety assessment between
experimental and non-experimental groups. It was noted that post
assessment anxiety differed significantly between experimental and
non-experimental groups. Conclusion(s): Pre-operative education was
found effective to decrease level of anxiety among patients waiting for
CABG. There was no significant difference between pre and post assessment
among patients from non-experimental group. Copyright © 2021
Pakistan Medical Association. All rights reserved.

<83>
Accession Number
2013610073
Title
Surgery re-imagined: The digital revolution.
Source
Journal of the Pakistan Medical Association. 71(1 B) (pp 184-185), 2021.
Date of Publication: January 2021.
Author
Rizvi I.
Institution
(Rizvi) Mid-Atlantic Permanente Medical Group, Virginia, United States
Publisher
Pakistan Medical Association
Abstract
Anaesthesia and asepsis made surgery humane and safe in the latter half of
the nineteenth century. The twentieth century brought laparoscopy,
open-heart surgery, organ transplant and surgical staplers, amongst other
advances. Today, the digital revolution is ushering in a new era in
surgery. While some contend that this might serve to further dehumanize
medicine, there is no denying that the smart deployment of technology can
improve surgical safety and precision as well as improve the well-being of
those it serves. Copyright © 2021 Pakistan Medical Association.
All rights reserved.

<84>
Accession Number
2011115966
Title
Association between frailty and postoperative delirium: a meta-analysis of
cohort study.
Source
Aging Clinical and Experimental Research. 34(1) (pp 25-37), 2022. Date of
Publication: January 2022.
Author
Fu D.; Tan X.; Zhang M.; Chen L.; Yang J.
Institution
(Fu, Zhang, Chen, Yang) Intensive Care Unit, Chongqing General Hospital,
University of Chinese Academy of Sciences, No. 118 Xingguang Avenue,
Liangjiang New Area, Chongqing 400010, China
(Tan) Department of Urology, Chongqing University Central Hospital,
Chongqing 400010, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Background: Frailty has been suggested as a possible risk factor for
postoperative delirium (POD). However, results of previous studies were
not consistent. We performed a meta-analysis of cohort study to evaluate
the above association. Method(s): Relevant studies were obtained via
systematic search of PubMed, Embase, SCOPUS, and Web of Science databases.
Only studies with multivariate analysis were included. A random-effect
model incorporating the potential heterogeneity was used to combine the
results. Result(s): Fifteen cohort studies including 3250 adult
patients who underwent surgery were included, and the prevalence of
frailty was 27.1% (880/3250) before surgeries. Overall, POD occurred in
513 patients (15.8%). Pooled results showed that frailty was associated
with a higher risk of POD (adjusted odds ratio [OR]: 3.23, 95% confidence
interval [CI]: 2.56-4.07, P < 0.001) without significant heterogeneity (P
for Cochrane's Q test = 0.25, I2 = 18%). Subgroup analyses
showed a more remarkable association between frailty and POD in
prospective cohort studies (OR: 3.64, 95% CI: 2.95-4.49, P < 0.001) than
that in retrospective cohort studies (OR: 2.32, 95% CI: 1.60-3.35, P <
0.001; P for subgroup difference = 0.04). Moreover, the association was
not affected by country of the study, age group of the patient, elective
or emergency surgeries, cardiac and non-cardiac surgeries, evaluation
instruments for frailty, diagnostic methods for POD, or quality score of
the study (P for subgroup difference all > 0.05). Conclusion(s):
Frailty may be associated with a higher risk of POD in adult
population. Copyright © 2021, The Author(s), under exclusive
licence to Springer Nature Switzerland AG.

<85>
Accession Number
2015506449
Title
Inconsistent Methodology as a Barrier to Meaningful Research Outputs From
Studies of Atrial Fibrillation After Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 739-745),
2022. Date of Publication: March 2022.
Author
Campbell N.G.; Wollborn J.; Fields K.G.; Lip G.Y.H.; Ruetzler K.;
Muehlschlegel J.D.; O'Brien B.
Institution
(Campbell) Division of Cardiovascular Sciences, University of Manchester,
Manchester Academic Health Science Centre, Manchester, United Kingdom
(Wollborn, Fields, Muehlschlegel) Department of Anesthesiology,
Perioperative and Pain Medicine, Brigham, and Women's Hospital, Harvard
Medical School, Boston, MA
(Lip) Liverpool Centre for Cardiovascular Science, University of Liverpool
and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
(Lip) Department of Clinical Medicine, Aalborg University, Aalborg,
Denmark
(Ruetzler) Anesthesiology Institute, Departments of Outcomes Research and
General Anesthesiology, Cleveland Clinic, Cleveland, OH
(Ruetzler, O'Brien) Outcomes Research Consortium, Cleveland, OH
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, German Heart Center Berlin, Berlin, Germany
(O'Brien) Department of Cardiac Anesthesiology and Intensive Care
Medicine, Charite Universitatsmedizin, Berlin, Germany
(O'Brien) Department of Perioperative Medicine, St. Bartholomew's
Hospital, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Atrial fibrillation after cardiac surgery (AFACS) is a serious
postoperative complication. There is significant research interest in this
field but also relevant heterogeneity in reported AFACS definitions and
approaches used for its identification. Few data exist on the extent of
this variation in clinical studies. The authors reviewed the literature
since 2001 and included manuscripts reporting outcomes of AFACS in adults.
They excluded smaller studies and studies in which patients did not
undergo a sternotomy. The documented protocol in each manuscript was
analyzed according to six different categories to determine how AFACS was
defined, which techniques were used to identify it, and the inclusion
and/or exclusion criteria. They also noted when a category was not
described in the documented protocol. The authors identified 302 studies,
of which 92 were included. Sixty-two percent of studies were randomized
controlled trials. There was significant heterogeneity in the manuscripts,
including the exclusion of patients with preoperative AF, the definition
and duration of AF needed to meet the primary endpoint, the type of
screening approach (continuous, episodic, or opportunistic), the duration
of monitoring during the study period in days, the diagnosis with
predefined electrocardiogram criteria, and the requirement for independent
confirmation by study investigators. Furthermore, the definitions of these
criteria frequently were not described. Consistent reporting standards for
AFACS research are needed to advance scientific progress in the field. The
authors here propose pragmatic standards for trial design and reporting
standards. These include adequate sample size estimation, a clear
definition of the AFACS endpoints, and a protocol for AFACS
detection. Copyright © 2021 Elsevier Inc.

<86>
Accession Number
2014271561
Title
Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation
Following Cardiac Surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(3) (pp 807-814),
2022. Date of Publication: March 2022.
Author
Pierik R.; Zeillemaker-Hoekstra M.; Scheeren T.W.L.; Erasmus M.E.; Luijckx
G.-J.R.; Rienstra M.; Uyttenboogaart M.; Nijsten M.; van den Bergh W.M.
Institution
(Pierik, Nijsten, van den Bergh) Department of Critical Care, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Zeillemaker-Hoekstra, Scheeren) Department of Anesthesiology, University
Medical Center Groningen, University of Groningen, Groningen, Netherlands
(Erasmus) Department of Cardiac Surgery, University Medical Center
Groningen, University of Groningen, Groningen, Netherlands
(Luijckx, Uyttenboogaart) Department of Neurology, University Medical
Center Groningen, University of Groningen, Groningen, Netherlands
(Rienstra) Department of Cardiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Publisher
W.B. Saunders
Abstract
Objective: The authors aimed to study the association between
postoperative atrial fibrillation (POAF) and thromboembolic stroke and to
determine risk factors for thromboembolic stroke after cardiac surgery.
 Design(s): The authors performed a secondary analysis from a
randomized controlled trial (GRIP-COMPASS). The patients with
thromboembolic stroke were compared with those without thromboembolic
stroke, and the difference in the incidence of POAF between these groups
was assessed. Odds ratios (OR) were calculated using logistic regression
analyses. Brain imaging was studied for the occurrence of thromboembolic
stroke during hospital admission, and POAF was monitored for seven days.
To assess which characteristics were associated with occurrence of
thromboembolic stroke, stepwise backward regression analysis was
performed. Participant(s): All adult consecutive cardiac surgery
patients admitted postoperatively to the intensive care unit.
 Setting(s): Academic tertiary care medical center.
 Intervention(s): None. Measurements and Main Results: Of the 910
patients included in this study, 26 patients (2.9%) had a thromboembolic
stroke during hospital admission. The incidence of POAF during the first
seven days after cardiac surgery in those with thromboembolic stroke was
65%, compared with 39% in those without thromboembolic stroke: adjusted OR
3.01 (95% confidence interval, 1.13-8.00). POAF, a history of peripheral
vascular disease, a higher EuroSCORE, and a longer duration of surgery
were associated with thromboembolic stroke. Conclusion(s): POAF
within seven days after cardiac surgery was associated with a three-fold
increased risk for a thromboembolic stroke during hospital admission.
Expeditious treatment of POAF may, therefore, reduce early stroke risk
after cardiac surgery. Copyright © 2021 The Authors

<87>
Accession Number
2016352199
Title
Comparison between Saphenous Vein Graft and Radial Artery Graft in
Coronary Artery Bypass Grafting.
Source
Pakistan Journal of Medical and Health Sciences. 15(12) (pp 3378-3380),
2021. Date of Publication: December 2021.
Author
Salman M.; Rahim S.S.; Khan A.K.; Pannu F.Y.; Ahmed B.; Iqbal S.; Afshan
S.; Shafqat A.
Institution
(Salman, Rahim, Khan) SR Cardiac Surgery, Punjab Institute of Cardiology,
Lahore, Pakistan
(Pannu, Ahmed) SR, Cardiology Department, Mayo hospital Lahore, Pakistan
(Iqbal) SR Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
(Afshan, Shafqat) Punjab Institute of Cardiology, Lahore, Pakistan
Publisher
Lahore Medical And Dental College
Abstract
Background: To bypass the obstruction in native coronary arteries both
arterial and venous grafts are used. Inspite of having radial artery graft
as a favored second conduit for bypass, venous grafts are more frequently
used. Objective(s): To compare the CT angiography patency findings of
radial artery graft vs. saphenous vein graft 3 months postoperatively.
 Study Design: Randomized controlled trial. Setting(s): The study
was conductedat the Department of Cardiac Surgery, Mayo Hospital, Lahore.
Data Collection: All patients fulfilling theinclusioncriteria were
recruited. A written informed consentwastaken. The non-dominant arm was
used almostexclusively forharvesting the radial artery in those patients
who have positive modified Allen`s test as a pedicle by atraumatic
"no-touch" technique. After heparanization, it was immersed in diluted
solution (Inj. verapamil hydrochloride 5mg + Inj. nitroglycerin 2.5mg +
Inj. heparin 500 IU + Inj. ringer lactate 300 ml with Inj. 8.4% NaHCO3 0.9
m1). All the patients in the study received LIMA to LAD and were done on
pump. After that the patients were dividedinto2 groups namely Group I and
Group II by computer generated method. In Group I, the patient received
the radial artery as a second graft to a coronary having more than 90%
stenosis. The third or fourth graft if required is saphenous vein graft.
The group II had SVG as second, third or fourth grafts, one of the venous
grafts were to a coronary having more than 90% stenosis. Result(s):
Average age of all (n=62) patients was 38.82+/-9.93 years. Average age in
Group-I & II patients was 39.09+/-9.49 & 38.54+/-10.50 years respectively.
Among patients 47% were male and 53% were female patients. In Group-I, 12
(38.7%) of the patients were male, and 19 (67.3%) were female, whereas in
Group-II, 17 (54.8%) of the patients were male, and 14 (45.8%) were
female. In Group-I 1(3.2%) patient and in Group-II 3(9.7%) patients died
(p=0.301). Insignificant difference was seen for cardiac arrhythmias i.e.
Group-I:16.1% vs. Group-II: 19.4%, p=0.740. Myocardial infarction in
Group-A 5(16.1%) patients and in Group-B 7(22.6%) (p=0.520). In Group-A,
30(96.8%) patients and in Group-B, 28(90.3%) patients showed patency of
artery after coronary artery bypass grafting(P>0.05). Conclusion(s):
We discovered no significant difference in the patency of both radial
artery and saphenous vein grafts on 3 months postoperative CT angiography
and clinical outcomes in terms of perioperative mortality, MI, and cardiac
arrhythmias in patients who underwent CABG in this study. Copyright
© 2021 Lahore Medical And Dental College. All rights reserved.

<88>
Accession Number
2015370461
Title
Multidisciplinary approach for repair of a large ventral thoracic
meningocele in neurofibromatosis-1; a systematic review of the literature
and case report.
Source
Clinical Neurology and Neurosurgery. 210 (no pagination), 2021. Article
Number: 106996. Date of Publication: November 2021.
Author
Lehner K.; Lubelski D.; Witham T.; Luciano M.; Tuffaha S.; Yang R.; Yang
S.; Belzberg A.
Institution
(Lehner, Lubelski, Witham, Luciano, Belzberg) Department of Neurosurgery,
Johns Hopkins University School of Medicine, Baltimore, MD, United States
(Tuffaha, Yang, Belzberg) Department of Plastic Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, United States
(Yang) Department of Thoracic Surgery, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
Publisher
Elsevier B.V.
Abstract
Thoracic meningoceles and dural ectasia are less commonly recognized
manifestations of neurofibromatosis 1 (NF1). Rarely, large thoracic
meningoceles may become compressive and lead to respiratory compromise
secondary to lung compression. Surgical goals aim to increase lung
aeration through decreasing the size of the meningocele through shunting,
excision or repair of the meningocele, and varying degrees of dural tube
reconstruction. There is no agreement on the best approach for large,
symptomatic meningoceles. Here, we discuss the case of a 41-year-old woman
with NF1 who presented with dyspnea and enlargement of a large, 19 cm
thoracic meningocele. A multidisciplinary team of thoracic, plastic, and
neurological surgery participated in the operation to excise the
meningocele and reconstruct the dural tube without the need for subsequent
shunting of spinal fluid. We also systematically review the literature on
thoracic meningoceles in NF1 to understand the optimal treatment of this
pathology. Copyright © 2021 Elsevier B.V.

<89>
Accession Number
2010778688
Title
Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric
surgery in terms of complications and efficacy?.
Source
Langenbeck's Archives of Surgery. 406(5) (pp 1363-1377), 2021. Date of
Publication: August 2021.
Author
Balint I.B.; Csaszar F.; Somodi K.; Ternyik L.; Biro A.; Kaposztas Z.
Institution
(Balint) Department of Surgery and Vascular Surgery, Zala County Saint
Rafael Hospital, H-8900 Zrinyi Miklos street 1., Zalaegerszeg, Hungary
(Csaszar) Doctoral School of Neurosciences, University of Pecs, Pecs,
Hungary
(Somodi, Ternyik, Biro, Kaposztas) Department of Surgery, Somogy County
Kaposi Mor Teaching Hospital, Kaposvar, Hungary
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Based on recent scientific evidence, bariatric surgery is more
effective in the management of morbid obesity and related comorbidities
than conservative therapy. Pylorus preserving surgical procedures (PPBS)
such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal
bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical
techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical
method in the inventory of metabolism focused manual interventions that
excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures
without the risk of surgical intervention. The aim of this article is to
summarize and compare differences between safety-related features and
weight loss outcomes of DJBL and PPBS. Method(s): A literature search
was conducted in the PubMed database. Records of DJBL-related adverse
events (AEs), occurrence of PPBS-related complications and reintervention
rates were collected. Mean weight, mean body mass index (BMI), percent of
excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI
value alterations were recorded for weight loss outcomes. Result(s):
A total of 11 publications on DJBL and 6 publications on PPBS were
included, involving 800 and 1462 patients, respectively. The baseline
characteristics of the patients were matched. Comparison of DJBL-related
AEs and PPBS-related severe complications showed an almost equal risk
(risk difference (RD): -0.03 and confidence interval (CI): -0.27 to 0.21),
despite higher rates among patients having received endoscopic treatment.
Overall AE and complication rates classified by Clavien-Dindo showed that
PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25,
CI: 0.01-0.49). Reintervention rates were more favourable in the PPBS
group, without significant differences in risk (RD: -0.03, CI: -0.27 to
0.20). However, PPBS seemed more efficient regarding weight loss outcomes
at 1-year follow-up according to raw data, while meta-analysis did not
reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74-1.59
for BMI changes). Conclusion(s): Only limited conclusions can be made
based on our findings. PPBS was superior to DJBL with regard to safety
outcomes (GRADE IIB), which failed to support the authors' hypothesis.
Surgical procedures showed lower complication rates than the incidence of
DJBL-related AEs, although it should be emphasized that the low number of
PPBS-related mild to moderate complications reported could be the result
of incomplete data recording from the analysed publications. Weight loss
outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted
into the upper gastrointestinal tract for 6 to 12 months, it seems a
promising additional method in the inventory of metabolic
interventions. Copyright © 2021, The Author(s).

<90>
Accession Number
2007879922
Title
Prognostic effect of the syntax score on 10-year outcomes after left main
coronary artery revascularization in a randomized population: Insights
from the extended precombat trial.
Source
Journal of the American Heart Association. 10(14) (no pagination), 2021.
Article Number: e020359. Date of Publication: 20 Jul 2021.
Author
Lee J.; Ahn J.-M.; Kim J.H.; Jeong Y.J.; Hyun J.; Yang Y.; Lee J.S.; Park
H.; Kang D.-Y.; Lee P.H.; Park D.-W.; Park S.-J.
Institution
(Lee, Ahn, Jeong, Hyun, Yang, Park, Kang, Lee, Park, Park) Department of
Cardiology, Center for Medical Research and Information, Asan Medical
Center, University of Ulsan College of Medicine, Seoul, South Korea
(Lee) Division of Clinical Epidemiology and Biostatistics, Center for
Medical Research and Information, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, South Korea
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: The long-term prognostic effect of the SYNTAX (Synergy Between
Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score
(SS) after percutaneous coronary intervention (PCI) or coronary artery
bypass graft (CABG) for left main coronary artery disease is
controversial. METHODS AND RESULTS: In the PRECOMBAT (Premier of
Randomized Comparison of Bypass Surgery Versus Angioplasty Using
Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery
Disease) trial, 600 patients with left main coronary artery disease were
randomized to undergo PCI with drug-eluting stents (n=300) or CABG
(n=300). We compared 10-year outcomes after PCI and CABG according to SS
categories and evaluated the predictive value of SS in each
revascularization arm. The primary outcome was a major adverse cardiac or
cerebrovascular event (composite of death, myocardial infarction, stroke,
or ischemia-driven target-vessel revascularization) at 10 years. Among 566
patients with valid SS measurement at baseline, 240 (42.4%) had low SS,
200 (35.3%) had intermediate SS, and 126 (22.3%) had high SS. The 10-year
rates of major adverse cardiac or cerebrovascular events were not
significantly different between PCI and CABG in low (21.6% versus 22.2%,
P=0.97), intermediate (31.8% versus 22.2%; P=0.13), and high SS (46.2%
versus 35.7%; P=0.31) (P-for-interaction=0.46). There were no significant
interactions between SS categories and revascularization modalities for
death (P=0.92); composite of death, myocardial infarction, or stroke
(P=0.87); and target-vessel revascularization (P=0.06). Higher SS
categories were associated with higher risks for major adverse cardiac or
cerebrovascular events in the PCI arm but not in the CABG arm.
 CONCLUSION(S): Ten-year clinical outcomes between PCI and CABG were
not significantly different according to the SS. The SS was predictive of
major adverse cardiac or cerebrovascular events after PCI but not after
CABG. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique
identifier: NCT03871127. Copyright © 2021 The Authors.

<91>
Accession Number
2004278459
Title
Emerging microRNA biomarkers for acute kidney injury in acute
decompensated heart failure.
Source
Heart Failure Reviews. 26(5) (pp 1203-1217), 2021. Date of Publication:
September 2021.
Author
Templeton E.M.; Cameron V.A.; Pickering J.W.; Richards A.M.; Pilbrow A.P.
Institution
(Templeton, Cameron, Pickering, Richards, Pilbrow) Christchurch Heart
Institute, Department of Medicine, University of Otago-Christchurch,
Christchurch, New Zealand
(Richards) Cardiovascular Research Institute, National University of
Singapore, Singapore, Singapore
(Pilbrow) Christchurch Heart Institute, University of Otago-Christchurch,
PO Box 4345, Christchurch 8140, New Zealand
Publisher
Springer
Abstract
Acute decompensated heart failure (ADHF) is associated with a high
incidence of acute kidney injury (AKI), an abrupt loss of kidney function
associated with a near doubling of mortality at 1 year. In addition to the
direct threat acute HF itself poses to kidney function, the beneficial
effects of commonly prescribed HF treatments must be weighed against their
potentially adverse effects on glomerular perfusion. Consequently, there
is an urgent need to identify early markers for AKI in ADHF to facilitate
timely implementation of supportive measures to minimize kidney damage and
improve outcomes. The recent recognition of the diagnostic potential of
circulating microRNAs presents the potential to address this gap if
microRNAs specific for AKI can be identified in serial plasma, serum
and/or urine samples from well-phenotyped cohorts of ADHF patients,
including a proportion with AKI. This review summarizes emerging
circulating diagnostic and prognostic microRNA biomarkers (serum, plasma
or urine) in HF and AKI. Copyright © 2020, Springer
Science+Business Media, LLC, part of Springer Nature.

<92>
Accession Number
2004239861
Title
Phenotypes of hypertrophic cardiomyopathy: genetics, clinics, and modular
imaging.
Source
Heart Failure Reviews. 26(5) (pp 1023-1036), 2021. Date of Publication:
September 2021.
Author
Muresan I.D.; Agoston-Coldea L.
Institution
(Muresan, Agoston-Coldea) 2nd Department of Internal Medicine, Iuliu
Hatieganu University of Medicine and Pharmacy, 2-4 Clinicilor, Cluj-Napoca
400006, Romania
Publisher
Springer
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common cardiovascular
disease with genetic transmission, characterized by the hypertrophy of any
segment of the left ventricle (LV), not totally explained by improper
loading conditions, with LV systolic function preserved, increased, or
reduced. The histopathological mechanism involved in HCM refers to the
primary injury of the myocardium, as follows: disorganized array of
myocytes, extracellular matrix modification, microvascular dysfunction,
with subsequent appearance of myocardial fibrosis. Multiple sarcomere
proteins mutations are responsible for HCM, but two of them are involved
in 70% of the cases of HCM: beta-myosin heavy chain (MYH7) and
myosin-binding protein C (MYBPC3). The development of new genetic
techniques involving genome editing is promising to discover a gene
therapy for patients with HCM. Clinical presentation may differ from
asymptomatic to sudden cardiac death (SCD), the last one targeting younger
adults. In this case, the diagnosis and evaluation of SCD risk factors is
extremely important. The common method of diagnosis is transthoracic
echocardiography, but cardiac magnetic resonance (CMR) imaging represents
"gold standard" in the evaluation of HCM patients. Treatment includes
pharmacological therapy, surgery, alcohol ablation, and not least SCD
prevention. Copyright © 2020, Springer Science+Business Media,
LLC, part of Springer Nature.

<93>
Accession Number
2014057689
Title
Proximal junctional kyphosis in pediatric spinal deformity surgery: a
systematic review and critical analysis.
Source
Spine Deformity. 10(2) (pp 257-266), 2022. Date of Publication: March
2022.
Author
Erkilinc M.; Baldwin K.D.; Pasha S.; Mistovich R.J.
Institution
(Erkilinc, Mistovich) Division of Pediatric Orthopaedic Surgery, Rainbow
Babies and Children's Hospital, University Hospitals Cleveland Medical
Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States
(Baldwin, Pasha) Department of Orthopaedic Surgery, Children's Hospital of
Philadelphia, Philadelphia, PA, United States
(Mistovich) Case Western Reserve University School of Medicine, Cleveland,
United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Proximal junctional kyphosis (PJK) is a commonly encountered
clinical and radiographic phenomenon after pediatric and adolescent spinal
deformity surgery that may lead to post-operative deformity, pain, and
dissatisfaction. Understanding the risk factors of PJK can be useful for
pre-operative informed consent as well as to identify any potential
preventative strategies. Method(s): We performed a systematic review
and critical analysis following the PRISMA statement in July 2019 by
searching the PubMed, Scopus, and Embase databases, including all prior
published studies. We included articles with data on PJK in patients with
operative pediatric and adolescent scoliosis and those that detailed risk
factors and/or preventative strategies for PJK. Levels of evidence were
determined based on consensus. Findings were summarized and grades of
recommendation were assigned by consensus. This study was registered in
the PROSPERO database; 202,457. Result(s): Six hundred and thirty
five studies were identified. Thirty-seven studies met criteria for
inclusion into the analysis. No studies including neuromuscular scoliosis
met inclusion criteria. No findings had Grade A evidence. There were 4
findings found to contribute to PJK with Grade B evidence in EOS: higher
number of distractions, disruption of posterior elements, greater sagittal
plane correction. There was no difference in incidence noted between
etiology of the curvature. Five findings with Grade B evidence were found
to contribute to PJK in AIS populations: higher pre-operative thoracic
kyphosis, higher pre-operative lumbar lordosis, longer fusion constructs,
greater sagittal plane correction, and posterior versus anterior fusion
constructs. Conclusion(s): Greater sagittal plane correction has
Grade B evidence as a risk factor for PJK in both EOS and AIS populations.
In EOS patients, an increased number of distractions and posterior element
disruption are Grade B risk factors. In AIS patients, longer fusion
constructs, higher pre-operative thoracic kyphosis and lumbar lordosis,
and posterior (as opposed to anterior) constructs also contributed to PJK
with Grade B evidence. These findings can guide informed consent and
surgical management, and provide the foundation for future
studies. Copyright © 2021, Scoliosis Research Society.

<94>
Accession Number
2005726487
Title
Influence of lipoproteins and antiplatelet agents on vein graft patency 1
year after coronary artery bypass grafting.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(3) (pp 1030-1039.e4),
2022. Date of Publication: March 2022.
Author
Zhu J.; Zhu Y.; Zhang M.; Xue Q.; Hu J.; Liu H.; Wang R.; Wang X.; Zhao Q.
Institution
(Zhu, Zhu, Zhao) Department of Cardiovascular Surgery, Ruijin Hospital
Shanghai Jiao Tong University School of Medicine, Shanghai, China
(Zhang) Department of Cancer Control and Prevention, Shanghai Municipal
Center for Disease Control and Prevention, Shanghai, China
(Xue) Department of Cardiovascular Surgery, Changhai Hospital of Shanghai,
Shanghai, China
(Hu) Department of Cardiovascular Surgery, Fuwai Central China
Cardiovascular Hospital, Zhengzhou, China
(Liu) Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao
Tong University School of Medicine, Shanghai, China
(Wang) Department of Cardiovascular Surgery, Nanjing First Hospital,
Nanjing, China
(Wang) Department of Cardiovascular Surgery, Jiangsu Province Hospital,
Nanjing, China
Publisher
Elsevier Inc.
Abstract
Objective: It remains unclear whether aggressive low-density lipoprotein
cholesterol (LDL-C) management (<1.8 mmol/L) can slow the process of vein
graft stenosis. This study aimed to explore the impact of baseline LDL-C
levels on vein graft patency in patients on ticagrelor with or without
aspirin 1 year after coronary artery bypass grafting (CABG).
 Method(s): This was a post hoc analysis of the DACAB (Different
Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery)
trial (NCT02201771), a randomized controlled trial (ticagrelor + aspirin
or ticagrelor vs aspirin) of patients undergoing CABG in China. The study
subjects were stratified as LDL-low (baseline LDL-C <1.8 mmol/L, 148
patients with 430 vein grafts) versus LDL-high (baseline LDL-C >=1.8
mmol/L, 352 patients with 1030 vein grafts). The primary outcome was the
1-year vein graft patency (Fitzgibbon grade A) assessed by coronary
computed tomographic angiography or coronary angiography. Result(s):
Baseline/1-year LDL-C were 1.4/1.6 and 2.6/2.4 mmol/L in the LDL-low and
LDL-high subgroups, respectively. Regardless of antiplatelet regimen, no
significant inter-subgroup difference was observed for 1-year graft
patency (LDL-low: 83.8% [359/430 grafts]; LDL-high: 82.3% [848/1030
grafts]; adjusted OR for non-patency [OR<inf>adj</inf>], 0.96; 95%
confidence interval [CI], 0.62-1.50, P = .857). For both subgroups, the
1-year graft patency rates were greater with ticagrelor + aspirin versus
aspirin (LDL-low: OR<inf>adj</inf>, 0.41; 95% CI, 0.17-0.97; LDL-high:
OR<inf>adj</inf>, 0.38; 95% CI, 0.20-0.71; inter P = .679).
 Conclusion(s): In general, baseline LDL-C is not associated with
1-year vein graft patency after CABG. Regardless of the baseline LDL-C
levels, ticagrelor + aspirin was superior to aspirin alone in maintaining
vein graft patency. The primary factor causing early vein graft disease
might not be atherosclerosis but thrombosis. Copyright © 2020 The
American Association for Thoracic Surgery

<95>
Accession Number
2016884193
Title
Effect of Volatile Anesthetics on Myocardial Infarction After Coronary
Artery Surgery: A Post Hoc Analysis of a Randomized Trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Zangrillo A.; Lomivorotov V.V.; Pasyuga V.V.; Belletti A.; Gazivoda G.;
Monaco F.; Nigro Neto C.; Likhvantsev V.V.; Bradic N.; Lozovskiy A.; Lei
C.; Bukamal N.A.R.; Silva F.S.; Bautin A.E.; Ma J.; Yong C.Y.; Carollo C.;
Kunstyr J.; Wang C.Y.; Grigoryev E.V.; Riha H.; Wang C.; El-Tahan M.R.;
Scandroglio A.M.; Mansor M.; Lembo R.; Ponomarev D.N.; Bezerra F.J.L.;
Ruggeri L.; Chernyavskiy A.M.; Xu J.; Tarasov D.G.; Navalesi P.;
Yavorovskiy A.; Bove T.; Kuzovlev A.; Hajjar L.A.; Landoni G.
Institution
(Zangrillo, Belletti, Monaco, Scandroglio, Lembo, Ruggeri, Landoni)
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific
Institute, Milan, Italy
(Zangrillo, Landoni) School of Medicine, Vita-Salute San Raffaele
University, Milan, Italy
(Lomivorotov, Ponomarev, Chernyavskiy) Department of Anesthesiology and
Intensive Care, E. Meshalkin National Medical Research Center,
Novosibirsk, Russian Federation
(Lomivorotov) Department of Anesthesiology and Intensive Care, Novosibirsk
State University, Novosibirsk, Russian Federation
(Pasyuga) Department of Anesthesiology and Intensive Care, Federal Center
for Cardiovascular Surgery Astrakhan, Astrakhan, Russian Federation
(Gazivoda) Department of Anaesthesia and Intensive Care, Cardiovascular
Institute Dedinje, Belgrade, Serbia
(Nigro Neto, Bezerra) Anesthesia Section, Department of Cardiovascular
Surgery, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
(Likhvantsev) Department of Anesthesiology and Intensive Care, First
Moscow State Medical University, Moscow, Russian Federation
(Likhvantsev, Kuzovlev) V. Negovsky Reanimatology Research Institute,
Moscow, Russian Federation
(Bradic) Department of Cardiovascular Anesthesiology and Intensive Care
Medicine, Clinical Department of Anesthesiology, Resuscitation and
Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia
(Bradic) Department of Biomedical Sciences, University North, Varazdin,
Croatia
(Lozovskiy) Department of Anesthesia and Intensive Care, Ural Institute of
Cardiology, Ekaterinburg, Russian Federation
(Lei) Department of Anesthesiology and Perioperative Medicine, Xijing
Hospital, Shaanxi, Xi'an, China
(Bukamal) Cardiothoracic ICU and Anesthesia Department, Mohammed Bin
Khalifa Cardiac Center, Riffa, Bahrain
(Silva) Department of Anaesthesiology, Hospital de Santa Maria, Lisboa,
Portugal
(Bautin) Laboratory for Anesthesiology and Intensive Care, Almazov
National Medical Research Center, Saint Petersburg, Russian Federation
(Ma, Wang) Center for Anesthesiology, Beijing Anzhen Hospital, Capital
Medical University, Beijing, China
(Yong) Department of Anaesthesiology and Intensive Care, Hospital Pulau
Pinang, Pulau Pinang, Malaysia
(Carollo, Navalesi) Institute of Anesthesia and Intensive Care, Padua
University Hospital, Padua, Italy
(Kunstyr) Department of Anesthesiology and Intensive Care, First Faculty
of Medicine Charles University and General University Hospital, Prague,
Czechia
(Wang, Mansor) Department of Anaesthesiology, Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia
(Grigoryev) Intensive Care Unit, Scientific Research Institute for Complex
Issues of Cardiovascular Diseases, Kemerovo, Russian Federation
(Riha) Cardiothoracic Anesthesiology and Intensive Care Medicine,
Department of Anesthesiology and Intensive Care Medicine, Institute for
Clinical and Experimental Medicine, Prague, Czechia
(El-Tahan) Department of Anesthesiology, Imam Abdulrahman Bin Faisal
University, Dammam, Saudi Arabia
(Xu) Department of Anesthesiology, The Second Xiangya Hospital of Central
South University, Changsha, China
(Tarasov) Department of Cardiac Surgery, Federal Center for Cardiovascular
Surgery Astrakhan, Astrakhan, Russian Federation
(Navalesi) Department of Medicine, University of Padua, Padua, Italy
(Yavorovskiy) Federal Research and Clinical Center of Resuscitation and
Rehabilitation, Moscow, Russian Federation
(Bove) Department of Medicine (DAME), University of Udine, Udine, Italy
(Bove) Department of Anesthesia and Intensive Care Medicine, ASUFC
University-Hospital of Central Friuli, Udine, Italy
(Hajjar) Department of Cardiopneumology, Instituto do Coracao,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Hajjar) Intensive Care Unit, Hospital SirioLibanes, Sao Paulo, Brazil
Publisher
W.B. Saunders
Abstract
Objective: To investigate the effect of volatile anesthetics on the rates
of postoperative myocardial infarction (MI) and cardiac death after
coronary artery bypass graft (CABG). Design(s): A post hoc analysis
of a randomized trial. Setting(s): Cardiac surgical operating rooms.
 Participant(s): Patients undergoing elective, isolated CABG.
 Intervention(s): Patients were randomized to receive a volatile
anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous
anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI
requiring high-dose inotropic support or prolonged intensive care unit
stay) occurring within 48 hours from surgery. The secondary outcome was
1-year death due to cardiac causes. Measurements and Main Results: A
total of 5,400 patients were enrolled between April 2014 and September
2017 (2,709 patients randomized to the volatile anesthetics group and
2,691 to TIVA). The mean age was 62 +/- 8.4 years, and the median baseline
ejection fraction was 57% (50-67), without differences between the 2
groups. Patients in the volatile group had a lower incidence of MI with
hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v
27 of 2,501 [1.1%] in the TIVA group; p = 0.038) and as-treated analyses
(16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p = 0.039),
but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of
2,667 [1.0%] in the TIVA group; p = 0.10). Overall, deaths due to cardiac
causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668
[1.5%] than in the TIVA group; p = 0.03). Conclusion(s): An
anesthetic regimen, including volatile agents, may be associated with a
lower rate of postoperative MI with hemodynamic complication in patients
undergoing CABG. Furthermore, it may reduce long-term cardiac
mortality. Copyright © 2022 Elsevier Inc.

<96>
Accession Number
637202326
Title
Coronary Revascularization Versus Optimal Medical Therapy in Renal
Transplant Candidates With Coronary Artery Disease: A Systematic Review
and Meta-Analysis.
Source
Journal of the American Heart Association. 11(4) (pp e023548), 2022. Date
of Publication: 15 Feb 2022.
Author
Siddiqui M.U.; Junarta J.; Marhefka G.D.
Institution
(Siddiqui, Junarta) Department of Medicine Thomas Jefferson University
Hospitals Philadelphia PA
(Marhefka) Jefferson Heart Institute Thomas Jefferson University Hospitals
Philadelphia PA
Publisher
NLM (Medline)
Abstract
Background Coronary artery disease (CAD) is highly prevalent in patients
with chronic kidney disease and is a common cause of mortality in
end-stage renal disease. Thus, patients with end-stage renal disease are
routinely screened for CAD before renal transplantation. The usefulness of
revascularization before transplantation remains unclear. We hypothesize
that there is no difference in all-cause and cardiovascular mortality in
waitlisted renal transplant candidates with CAD who underwent
revascularization versus those treated with optimal medical therapy before
transplantation. Methods and Results This meta-analysis was reported
according to the Preferred Reporting Items for Systematic Review and
Meta-Analyses guidelines. MEDLINE, Scopus, and Cochrane Central Register
of Controlled Trials were systematically searched to identify relevant
studies. Risk of bias was assessed using the modified Newcastle-Ottawa
Scale and Cochrane risk of bias tool. The primary outcome of interest was
all-cause mortality. Eight studies comprising 945 patients were included
(36% women, mean age 56 years). There was no difference in all-cause
mortality (risk ratio [RR], 1.16 [95% CI, 0.63-2.12), cardiovascular
mortality (RR, 0.75 [95% CI, 0.29-1.89]), or major adverse cardiovascular
events (RR, 0.78 [95% CI, 0.30-2.07]) when comparing renal transplant
candidates with CAD who underwent revascularization versus those who were
on optimal medical therapy before renal transplant. Conclusions This
meta-analysis demonstrates that revascularization is not superior to
optimal medical therapy in reducing all-cause mortality, cardiovascular
mortality, or major adverse cardiovascular events in waitlisted kidney
transplant candidates with CAD who eventually underwent kidney
transplantation.

<97>
Accession Number
637231417
Title
The effects of preoperative supplementation with a combination of
beta-hydroxy-beta-methylbutyrate, arginine, and glutamine on inflammatory
and hematological markers of patients with heart surgery: a randomized
controlled trial.
Source
BMC surgery. 22(1) (pp 51), 2022. Date of Publication: 11 Feb 2022.
Author
Norouzi M.; Nadjarzadeh A.; Maleki M.; Khayyatzadeh S.S.; Hosseini S.;
Yaseri M.; Fattahi H.
Institution
(Norouzi) Department of Nutrition, International Campus of Shahid Sadoughi
University of Medical Science, Yazd, Iran, Islamic Republic of
(Norouzi, Nadjarzadeh, Khayyatzadeh) Nutrition and Food Security Research
Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,
Islamic Republic of
(Nadjarzadeh, Khayyatzadeh) Department of Nutrition, School of Public
Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran,
Islamic Republic of
(Maleki) Rajaie Cardiovascular Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Hosseini) Heart Valve Disease Research Center, Shahid Rajaie
Cardiovascular Medical and Research Center, Iran University of Medical
Sciences, Tehran, Iran, Islamic Republic of
(Yaseri) Department of Epidemiology and Biostatistics, Tehran University
of Medical Science, Tehran, Iran, Islamic Republic of
(Fattahi) Cardiovascular Medical and Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiac surgery is associated with a widespread inflammatory
response, by an additional release of free radicals. Due to the importance
of these patient's nutritional status, the present study was designed to
evaluate the effectiveness of supplementation with a combination of
glutamine, beta-hydroxy-beta-methylbutyrate (HMB) and arginine in patients
undergoing to the heart surgery. METHOD(S): The experiment was
performed in 1 month (30 days) before cardiac surgery. patients were asked
to take 2 sachets of Heallagen (a combination of 7 g L-arginine, 7 g
L-glutamine, and 1.5 g daily HMB) or placebo with identical appearance and
taste (maltodextrin) with 120 cc of water. Clinical and biochemical
factors were evaluated in the baseline and end of the study.
 RESULT(S): Totally, 60 preoperative patients (30 interventions and 30
placeboes) with a mean age of 53.13+/-14.35 years participated in the
study. Subjects in Heallagen group had a lower serum levels of
interleukin-6 (P=0.023), erythrocyte sedimentation rate (P<0.01), high
sensitivity C-reactive protein (P<0.01), and lymphocyte number (P=0.007)
compared to the placebo, at end of the study. CONCLUSION(S): In the
patients undergoing heart surgery, Heallagen significantly improved some
of the inflammatory factors and hematological parameters. These results
need to be confirmed in a larger trial. TRIAL REGISTRATION: The protocol
of the study was registered in the IRCT.ir with registration no.
IRCT20120913010826N31 at 13/10/2020. Copyright © 2022. The
Author(s).

<98>
Accession Number
636664333
Title
Effect of Positive Expiratory Pressure Therapy on Lung Volumes and Health
Outcomes in Adults With Chest Trauma: A Systematic Review and
Meta-Analysis.
Source
Physical therapy. 102(1) (no pagination), 2022. Date of Publication: 01
Jan 2022.
Author
Saliba K.A.; Blackstock F.; McCarren B.; Tang C.Y.
Institution
(Saliba, Blackstock, Tang) Physiotherapy Department, School of Health
Sciences, Western Sydney University, NSW, Australia
Publisher
NLM (Medline)
Abstract
OBJECTIVE: The purposes of this study were to evaluate the effect of
positive expiratory pressure (PEP) therapy on lung volumes and health
outcomes in adults with chest trauma and to investigate any adverse
effects and optimal dosages leading to the greatest positive impact on
lung volumes and recovery. METHOD(S): Data sources were
MEDLINE/PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database,
CINAHL, Open Access Thesis/Dissertations, EBSCO Open Dissertations, and
OpenSIGLE/Open Grey. Randomized controlled trials investigating PEP
therapy compared with usual care or other physical therapist interventions
were included. Participants were>18 years old and who were admitted to the
hospital with any form of chest trauma, including lung or cardiac surgery,
blunt chest trauma, and rib fractures. Methodological quality was assessed
using the Physiotherapy Evidence Database Scale, and the level of evidence
was downgraded using the Grading of Recommendations Assessment,
Development and Evaluation approach. RESULT(S): Eleven studies
involving 661 participants met inclusion eligibility. There was very
low-level evidence that PEP improved forced vital capacity (standardized
mean difference=-0.50; 95% CI=-0.79 to -0.21), forced expiratory volume in
1 second (standardized mean difference =-0.38; 95% CI=-0.62 to -0.13), and
reduced the incidence of pneumonia (relative risk=0.16; 95% CI=0.03 to
0.85). Respiratory muscle strength also significantly improved in all 3
studies reporting this outcome. There was very low-level evidence that PEP
did not improve other lung function measures, arterial blood gases,
atelectasis, or hospital length of stay. Both PEP devices and dosages
varied among the studies, and no adverse events were reported.
 CONCLUSION(S): PEP therapy is a safe intervention with very low-level
evidence showing improvements in forced vital capacity, forced expiratory
volume in 1 second, respiratory muscle strength, and incidence of
pneumonia. It does not improve arterial blood gases, atelectasis, or
hospital length of stay. Because the evidence is very low level, more
rigorous physiological and dose-response studies are required to
understand the true impact of PEP on the lungs after chest trauma. IMPACT:
There is currently no strong evidence for physical therapists to routinely
use PEP devices following chest trauma. However, there is no evidence of
adverse events; therefore, in specific clinical situations, PEP therapy
may be considered. Copyright © The Author(s) 2022. Published by
Oxford University Press on behalf of the American Physical Therapy
Association. All rights reserved. For permissions, please email:
journals.permissions@oup.com.

<99>
Accession Number
2016866246
Title
The effect of preoperative chest physiotherapy on oxygenation and lung
function in cardiac surgery patients: a randomized controlled study.
Source
Annals of Saudi Medicine. 42(1) (pp 8-16), 2022. Date of Publication:
January 2022.
Author
Shahood H.; Pakai A.; Rudolf K.; Bory E.; Szilagyi N.; Sandor A.; Zsofia
V.
Institution
(Shahood, Pakai, Zsofia) Doctoral School of Health Sciences, University of
Pecs Medical School, Pecs, Hungary
(Rudolf, Bory, Szilagyi, Sandor, Zsofia) Heart Institute Medical School,
University of Pecs Medical School, Pecs, Hungary
Publisher
King Faisal Specialist Hospital and Research Centre
Abstract
BACKGROUND: Postoperative pulmonary complications in patients who undergo
open heart surgery are serious life-threatening conditions. Few studies
have investigated the potentially beneficial effects of preoperative
physiotherapy in patients undergoing cardiac surgery. OBJECTIVE(S):
Assess the effects of preoperative chest physiotherapy on oxygenation and
lung function in patients undergoing open heart surgery. DESIGN:
Randomized, controlled. SETTING: University hospital. PATIENTS AND
METHODS: Patients with planned open heart surgery were randomly allocated
into an intervention group of patients who underwent a preoperative home
chest physiotherapy program for one week in addition to the traditional
postoperative program and a control group who underwent only the
traditional postoperative program. Lung function was assessed daily from
the day before surgery until the seventh postoperative day. MAIN OUTCOME
MEASURES: Differences in measures of respiratory function and oxygen
saturation. Length of postoperative hospital stay was a secondary outcome.
SAMPLE SIZE: 100 patients (46 in intervention group, 54 in control group).
 RESULT(S): Postoperative improvements in lung function and oxygen
saturation in the intervention group were statistically significant
compared with the control group. The intervention group also had a
statistically significant shorter hospital stay (P<.01).
 CONCLUSION(S): Preoperative chest physiotherapy is effective in
improving respiratory function following open heart surgery. LIMITATIONS:
Relatively small number of patients. Copyright © 2022, Annals of
Saudi Medicine, Saudi Arabia.

<100>
Accession Number
2016799927
Title
Ten-year all-cause death after percutaneous or surgical revascularization
in diabetic patients with complex coronary artery disease.
Source
European Heart Journal. 43(1) (pp 56-67), 2022. Date of Publication: 01
Jan 2022.
Author
Wang R.; Serruys P.W.; Gao C.; Hara H.; Takahashi K.; Ono M.; Kawashima
H.; O'leary N.; Holmes D.R.; Witkowski A.; Curzen N.; Burzotta F.; James
S.; Van Geuns R.-J.; Kappetein A.P.; Morel M.-A.; Head S.J.; Thuijs
D.J.F.M.; Davierwala P.M.; O'Brien T.; Fuster V.; Garg S.; Onuma Y.
Institution
(Wang, Gao) Department of Cardiology, Xijing Hospital, Changle West Road
127, Xi'an 710032, China
(Wang, Serruys, Gao, Hara, Ono, Kawashima, O'leary, Morel, Onuma)
Department of Cardiology, National University of Ireland, Galway (NUIG),
University Road, Galway H91 TK33, Ireland
(Wang, Gao, Van Geuns) Department of Cardiology, Radboud University
Medical Center, Geert Grooteplein Zuid 8, Nijmegen 6525 GA, Netherlands
(Serruys) Department of Cardiology, Imperial College London, Exhibition
Rd, London SW7 2BX, United Kingdom
(Hara, Takahashi, Ono, Kawashima) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105
AZ, Netherlands
(Holmes) Department of Cardiology, Mayo ClinicSchool of Medicine, 200
First St. SW, Rochester, MN 55905, United States
(Witkowski) Department of Interventional Cardiology and Angiology,
National Institute of Cardiology, ul. Alpejska 42, Warsaw 04-628, Poland
(Curzen) Cardiology Department, University Hospital Southampton, Coxford
Rd, Southampton SO16 5YA, United Kingdom
(Burzotta) Institute of Cardiology, Catholic University of the Sacred
Heart, Largo F. Vito 1, Rome 00168, Italy
(James) Department of Medical Sciences, Cardiology and Uppsala Clinical
Research Center, Uppsala University, Dag Hammarskjolds vag 14B SE-752 37,
Uppsala, Sweden
(Kappetein, Head, Thuijs) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Dr Molewaterplein 40, Rotterdam 3015 GE,
Netherlands
(Davierwala) Department of Cardiac Surgery, Heart Centre Leipzig,
Strumpelstrasse 39, Leipzig 4289, Germany
(O'Brien) Regenerative Medicine Institute, CURAM, National University of
Ireland, Galway (NUIG), University Road, Galway H91 TK33, Ireland
(Fuster) Division of Cardiology, Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicina at Mount Sinai School, 1 Gustave L.
Levy Place, New York, NY 10029-5674, United States
(Garg) Department of Cardiology, East Lancashire Hospitals NHS Trust,
Haslingden Rd, Blackburn, Lancashire BB2 3HH, United Kingdom
Publisher
Oxford University Press
Abstract
Aims: The aim of this article was to compare rates of all-cause death at
10 years following coronary artery bypass grafting (CABG) or percutaneous
coronary intervention (PCI) in patients with or without diabetes.
 Methods and Results: The SYNTAXES study evaluated up to 10-year
survival of 1800 patients with three-vessel disease (3VD) and/or left main
coronary artery disease (LMCAD) randomized to receive either PCI or CABG
in the SYNTAX trial. Ten-year all-cause death according to diabetic status
and revascularization strategy was examined. In diabetics (n = 452), the
risk of mortality was numerically higher with PCI compared with CABG at 5
years [19.6% vs. 13.3%, hazard ratio (HR): 1.53, 95% confidence interval
(CI): 0.96, 2.43, P = 0.075], with the opposite seen between 5 and 10
years (PCI vs. CABG: 20.8% vs. 24.4%, HR: 0.82, 95% CI: 0.52, 1.27, P =
0.366). Irrespective of diabetic status, there was no significant
difference in all-cause death at 10 years between patients receiving PCI
or CABG, the absolute treatment difference was 1.9% in diabetics (PCI vs.
CABG: 36.4% vs. 34.5%, difference: 1.9%, 95% CI: -7.6%, 11.1%, P = 0.551).
Among insulin-treated patients (n = 182), all-cause death at 10 years was
numerically higher with PCI (47.9% vs. 39.6%, difference: 8.2%, 95% CI:
-6.5%, 22.5%, P = 0.227). Conclusion(s): The treatment effects of PCI
vs. CABG on all-cause death at 10 years in patients with 3VD and/or LMCAD
were similar irrespective of the presence of diabetes. There may, however,
be a survival benefit with CABG in patients with insulin-treated diabetes.
The association between revascularization strategy and very long-term
ischaemic and safety outcomes for patients with diabetes needs further
investigation in dedicated trials. Copyright © 2022 Oxford
University Press. All rights reserved.

<101>
Accession Number
2016891405
Title
Effect of trimetazidine on the functional capacity of ischemic heart
disease patients not suitable for revascularization: Metaanalysis of
randomized controlled trials.
Source
PLoS ONE. 17(2 February) (no pagination), 2022. Article Number: e0263932.
Date of Publication: February 2022.
Author
Ajabnoor A.; Mukhtar A.
Institution
(Ajabnoor) Faculty of Pharmacy, Department of Pharmacy Practice, King
Abdulaziz University, Jeddah, Saudi Arabia
(Mukhtar) Pharmaceutical Care Division, King Faisal Specialist Hospital
and Research Center, Jeddah, Saudi Arabia
Publisher
Public Library of Science
Abstract
Objective To explore the effect of adding trimetazidine to other
anti-anginal drugs on the functional capacity of ischemic heart disease
(IHD) patients not suitable for revascularization when compared to
first-line antianginal drugs alone. Methods MEDLINE and EMBASE databases
were searched for English-language peer-reviewed randomized controlled
trials (RCTs) comparing trimetazidine with first-line antianginal drugs
alone or with placebo in IHD patients not suitable for revascularization
and were included in this review. Quality of studies were assessed using
the Cochrane collaboration "risk of bias"tool. Results Six RCTs, three
were crossover studies. A total of 312 participants were included in this
review. Overall quality of studies was moderate. Two studies found
improvement in the 6- minute walking test (6-MWT) [standardized mean
differences (SMD) 1.75; 95% CI 1.35 to 2.14; p <0.001], and two trials
found improvement in the Canadian cardiovascular society (CCS) grading of
angina class (SMD -1.37; 95% CI -1.89 to -0.84) in the trimetazidine
group. Three of the better-quality trials found no increase in total
exercise duration (TED) (SMD 0.34; 95% CI -0.10 to 0.78; p < 0.13).
Significant heterogeneity was identified among trials describing outcomes
for the New York Heart Association (NYHA) functional classification and
left ventricular ejection fraction (LVEF %). Conclusion Trimetazidine
improve walking time and angina severity in IHD patients not suitable for
revascularization. Due to the inconsistency of available evidence, RCTs
targeting IHD patients with "no option"to undergo coronary
revascularization is required to clarify this review question.
 Copyright © 2022 Ajabnoor, Mukhtar. This is an open access
article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original author and source are credited.

<102>
Accession Number
2016896887
Title
Effect of evolocumab on acute arterial events across all vascular
territories: Results from the FOURIER trial.
Source
European Heart Journal. 42(47) (pp 4821-4829), 2021. Date of Publication:
14 Dec 2021.
Author
Oyama K.; Giugliano R.P.; Tang M.; Bonaca M.P.; Saver J.L.; Murphy S.A.;
Ruzza A.; Keech A.C.; Sever P.S.; Sabatine M.S.; Bergmark B.A.
Institution
(Oyama, Giugliano, Tang, Murphy, Sabatine, Bergmark) TIMI Study Group,
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard
Medical School, 60 Fenwood Road, Suite 7022, Boston, MA 02115, United
States
(Oyama) Department of Cardiovascular Medicine, Tohoku University, Graduate
School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
(Bonaca) CPC Clinical Research, Department of Medicine, University of
Colorado Anschutz, School of Medicine, 2115 N. Scranton St., Suite 2040,
Aurora, CO 80045, United States
(Saver) Department of Neurology, Comprehensive Stroke Center, David Geffen
School of Medicine at UCLA, 710 Westwood Plaza, Los Angeles, CA 90095,
United States
(Ruzza) Amgen, 1 Amgen Center Drive, Thousand Oaks, CA 91320, United
States
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Medical Foundation
Building, Level 6, 92-94 Parramatta Road, Camperdown, NSW 2050, Australia
(Sever) International Centre for Circulatory Health, National Heart and
Lung Institute, Imperial College London, 59 North Wharf Road, London W2
1LA, United Kingdom
Publisher
Oxford University Press
Abstract
Aims We assessed the impact of the proprotein convertase subtilisin-kexin
type 9 (PCSK9) inhibitor evolocumab on acute arterial events across all
vascular territories, including coronary, cerebrovascular, and peripheral
vascular beds, in patients with established atherosclerotic cardiovascular
disease (ASCVD). Methods In the FOURIER trial, 27 564 patients with stable
ASCVD on statin therapy were randomly assigned to evolocumab and results
or placebo. Acute arterial events were a composite of acute coronary
(coronary heart disease death, myocardial infarction, or urgent coronary
revascularization), cerebrovascular (ischaemic stroke, transient ischaemic
attack, or urgent cerebral revascularization), or peripheral vascular
(acute limb ischaemia, major amputation, or urgent peripheral
revascularization) events. Of the 2210 first acute arterial events, 74%
were coronary, 22% were cerebrovascular, and 4% were peripheral vascular.
Evolocumab reduced first acute arterial events by 19% (hazard ratio [HR]
0.81 [95% confidence interval 0.74-0.88]; P < 0.001), with significant
individual reductions in acute coronary (HR 0.83 [0.75-0.91]),
cerebrovascular (HR 0.77 [0.65-0.92]), and peripheral vascular (HR 0.58
[0.38-0.88]) events. There were 3437 total events (first plus recurrent),
with evolocumab reducing total events by 24% (incidence rate ratio 0.76
[0.69-0.85]). The magnitude of reduction in acute arterial events with
evolocumab numerically increased over time, with a 16% reduction (HR 0.84
[0.75-0.95]) in the first year followed by a 24% reduction (HR 0.76
[0.67-0.85]) thereafter. Conclusion The addition of the PCSK9 inhibitor
evolocumab to statin therapy reduced acute arterial events across all
vascular territories with a robust effect over time, indicating a
pan-vascular impact of aggressive lipid-lowering therapy on these acute
and clinically meaningful events. Copyright © The Author(s) 2021.

<103>
Accession Number
2015027752
Title
Impact of left ventricle outflow tract calcification on the outcomes of
transcatheter aortic valve implantation: A study-level meta-analysis.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Sa M.P.; Van den Eynde J.; Malin J.H.; Torregrossa G.; Sicouri S.; Ramlawi
B.
Institution
(Sa, Torregrossa, Ramlawi) Department of Cardiothoracic Surgery, Lankenau
Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA,
United States
(Sa, Torregrossa, Sicouri, Ramlawi) Department of Cardiothoracic Surgery
Research, Lankenau Institute for Medical Research, Wynnewood, PA, United
States
(Van den Eynde) Department of Cardiovascular Sciences, KU Leuven, Leuven,
Belgium
(Van den Eynde) Helen B. Taussig Heart Center, The Johns Hopkins Hospital
and School of Medicine, Baltimore, MD, United States
(Malin) Philadelphia College of Osteopathic Medicine, Bala Cynwyd, PA,
United States
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To assess the impact of left ventricle outflow tract
calcification (LVOT) on the outcomes of transcatheter aortic valve
implantation (TAVI). Method(s): Meta-analysis including studies
published by October 2021. Primary endpoints were operative and 1-year
mortality. The secondary endpoints were stroke, myocardial infarction,
paravalvular leakage (PVL), new permanent pacemaker implantation (PPI),
aortic annulus/root rupture. Result(s): Nine studies met our
eligibility criteria, including a total of 4459 patients (1330 patients
with significant LVOT calcification and 3129 patients without significant
LVOT calcification). Pooled risk of operative death was higher in the
group with significant LVOT calcification (odds ratio [OR]: 2.28; 95%
confidence interval [CI]: 1.33-3.91; p <.001). Worse 1-year survival was
observed in the group with LVOT calcification (hazard ratio 1.53, 95% CI:
1.26-1.87, p <.001). Patients with significant LVOT calcification had
higher risk of stroke (OR: 1.83; 95% CI: 1.08-3.09; p =.032), myocardial
infarction (OR: 1.74; 95% CI: 1.08-2.80; p =.034), PVL (OR: 1.88; 95% CI:
1.09-3.22; p =.028) and aortic annulus/root rupture (OR: 7.48; 95% CI:
3.58-15.65; p =.002). We did not observe a statistically significant
difference in the pooled results for new PPI between the groups (OR: 1.19;
95% CI: 0.79-1.80; p =.337). Conclusion(s): The presence of
significant LVOT calcification increases the risk of periprocedural and
1-year mortality, stroke, myocardial infarction, PVL and aortic
annulus/root rupture after TAVI. Self-expandable valves may be a
preferrable option in this scenario. Structural heart surgeons and
interventional cardiologists should consider this factor when referring
patients for TAVI and technical aspects (such as the type of transcatheter
heart valve to be deployed or the use of pre-/post-dilatation) should be
factored in. Copyright © 2022 Wiley Periodicals LLC.

<104>
Accession Number
2014997155
Title
Peripheral access size evaluation in transfemoral transcatheter aortic
valve replacement.
Source
Journal of Cardiac Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Hameed I.; Oakley C.T.; Hameed N.U.F.; Jiang Y.; Naeem N.; Morsi M.; Ahmed
A.; Amabile A.; Hirji S.; Truong Q.A.; Gaudino M.; Kaneko T.; Salemi A.
Institution
(Hameed, Amabile) Division of Cardiothoracic Surgery, Department of
Surgery, Yale School of Medicine, New Haven, CT, United States
(Oakley, Hameed, Jiang, Naeem, Morsi, Ahmed, Gaudino) Department of
Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY,
United States
(Hirji) Department of Surgery, Brigham and Women's Hospital, Boston, MA,
United States
(Truong) Department of Radiology, Weill Cornell Medical College, New York,
NY, United States
(Kaneko) Division of Cardiac Surgery, Brigham and Women's Hospital,
Boston, MA, United States
(Salemi) Department of Cardiothoracic Surgery, Robert Wood
Johnson/Barnabas Health, West Orange, NJ, United States
Publisher
John Wiley and Sons Inc
Abstract
Background/Aim: Peripheral access vessel dimensions in the general patient
population screened for transcatheter aortic valve replacement (TAVR) can
offer insight into the indications for pre-TAVR computed tomography
angiography (CTA) assessment. We seek to determine peripheral access
vessel sizes in patients screened for TAVR and association with patient
characteristics. Material(s) and Method(s): All patients with severe,
symptomatic aortic stenosis screened for TAVR at a high-volume center from
April 2012 to March 2019 were retrospectively reviewed. For each patient,
contrast-enhanced CTA was used to determine the minimal luminal diameters
(MLDs) of the transfemoral access vessels, as measured between the
inguinal ligament and the deep femoral artery for the femoral artery, and
proximal to the inguinal ligament for the external and common iliac
arteries, respectively. Paired and independent samples t-tests were used
to compare means and regression analyses were performed to determine
factors associated with MLD. Result(s): A total of 1049 screened
patients were included of which 826 (78.7%) underwent TAVR and 551 (52.5%)
were male. The mean age was 80.6 (+/-9.6) years and the mean body mass
index (BMI) was 26.7 (+/-5.9) kg/m2. About 152 (14.5%) had
peripheral vascular disease and 153 (14.6%) had chronic kidney disease.
The mean (+/-2 standard deviations) MLDs of the right and left femoral
arteries were 7.73 mm (4.68-10.78) and 7.68 mm (4.63-10.72), respectively.
Male sex and BMI were associated with larger average femoral MLD while
hyperlipidemia, hypertension, smoking, peripheral vascular disease, and
coronary artery disease were inversely associated. Conclusion(s):
Most patients screened for TAVR have minimum peripheral access vessel
sizes exceeding the recommended minimum access route diameters of modern
transcatheter heart valves. As sheath sizes decrease, clinicians must
carefully judge patient individual risk factors to determine whether a
pre-TAVR CTA assessing peripheral access vessel dimensions and anatomical
contraindications is indicated. Larger studies and randomized controlled
trials are required to compare the outcomes of TAVR with and without
preoperative CTA. Copyright © 2022 Wiley Periodicals LLC

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