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<1>
Accession Number
636912019
Title
Efficacy and Safety of Aspirin for Primary Cardiovascular Risk Prevention
in Younger and Older Age: An Updated Systematic Review and Meta-analysis
of 173,810 Subjects from 21 Randomized Studies.
Source
Thrombosis and Haemostasis. 122(3) (pp 445-455), 2022. Date of
Publication: 01 Mar 2022.
Author
Calderone D.; Greco A.; Ingala S.; Agnello F.; Franchina G.; Scalia L.;
Buccheri S.; Capodanno D.
Institution
(Calderone, Greco, Ingala, Agnello, Franchina, Scalia, Capodanno) Division
of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico -
San Marco, University of Catania, Catania, Italy
(Buccheri) Department of Medical Sciences, Uppsala University, Uppsala,
Sweden
(Buccheri) Uppsala Clinical Research Center, Uppsala University, Uppsala,
Sweden
Publisher
Georg Thieme Verlag
Abstract
Aims The efficacy and safety of aspirin for primary cardiovascular disease
(CVD) prevention is controversial. The aim of this study was to
investigate the efficacy and safety of aspirin in subjects with no overt
CVD, with a focus on age as a treatment modifier. Methods and Results
Randomized trials comparing aspirin use versus no aspirin use or placebo
were included. The primary efficacy outcome was all-cause death. The
primary safety outcome was major bleeding. Secondary ischemic and bleeding
outcomes were explored. Subgroup analyses were conducted to investigate
the consistency of the effect sizes in studies including younger and older
individuals, using a cut-off of 65 years. A total of 21 randomized trials
including 173,810 individuals at a mean follow-up of 5.3 years were
included. Compared with control, aspirin did not reduce significantly the
risk of all-cause death (risk ratio: 0.96; 95% confidence interval:
0.92-1.00, p = 0.057). Major adverse cardiovascular events were
significantly reduced by 11%, paralleled by significant reductions in
myocardial infarction and transient ischemic attack. Major bleeding,
intracranial hemorrhage, and gastrointestinal bleeding were significantly
increased by aspirin. There was a significant age interaction for death (p
for interaction = 0.007), with aspirin showing a statistically significant
7% relative benefit on all-cause death in studies including younger
patients. Conclusion The use of aspirin in subjects with no overt CVD was
associated with a neutral effect on all-cause death and a modest lower
risk of major cardiovascular events at the price of an increased risk in
major bleeding. The benefit of aspirin might be more pronounced in younger
individuals. Copyright © 2022 Georg Thieme Verlag. All rights
reserved.

<2>
Accession Number
2014125979
Title
Anesthetic Considerations in Pediatric Patients With Acute Decompensated
Heart Failure.
Source
Seminars in Cardiothoracic and Vascular Anesthesia. 26(1) (pp 41-53),
2022. Date of Publication: March 2022.
Author
Sebastian R.; Ullah S.; Motta P.; Das B.; Zabala L.
Institution
(Sebastian, Ullah, Zabala) Department of Anesthesiology and Pain
Management, University of Texas Southwestern, Dallas, TX, United States
(Sebastian, Ullah, Zabala) Children's Medical Center of Dallas,
Anesthesiology and Pain Management, Dallas, TX, United States
(Motta) Perioperative and Pain Medicine, Baylor College of Medicine,
Houston, TX, United States
(Motta) Texas Children's Hospital, Arthur S. Keats Division of Pediatric
Cardiovascular Anesthesiology, Houston, TX, United States
(Das) Department of Pediatrics, Department of Pediatric Cardiology, Baylor
College of Medicine, Austin, TX, United States
(Das) Texas Children's Hospital Austin Specialty Center, Austin, TX,
United States
Publisher
SAGE Publications Inc.
Abstract
Acute decompensated heart failure (ADHF) in pediatrics is a significant
cause for morbidity and mortality in children. Congenital heart disease
and cardiomyopathy are the leading etiologies of ADHF. It is common for
these children to undergo diagnostic, therapeutic, or surgical procedure
under anesthesia, which may be associated with significant morbidity and
mortality. The importance of preanesthetic multidisciplinary planning with
all involved teams, including anesthesia, cardiology, intensive care,
perfusion, and cardiac surgery, cannot be emphasized enough. In order to
safely manage these patients, it is imperative for the anesthesiologist to
understand the complex pathophysiological interactions between
cardiopulmonary systems and anesthesia during these procedures. This
review discusses the etiology, pathophysiology, clinical manifestations,
and perioperative management of these patients. Copyright © The
Author(s) 2021.

<3>
[Use Link to view the full text]
Accession Number
2015776678
Title
The effect of the nursing care based on the roy adaptation model on the
level of the quality of life and fatigue in the patients undergoing
coronary artery bypass graft surgery.
Source
Critical Care Nursing Quarterly. 45(1) (pp 35-41), 2022. Date of
Publication: 01 Jan 2022.
Author
Esmaili M.; Salehi-Tali S.; Mazaheri E.; Hasanpour-Dehkordi A.; Kheiri S.
Institution
(Esmaili) Student Research Committee, School of Nursing and Midwifery,
Shahrekord University of Medical Sciences, Shahrekord, Iran, Islamic
Republic of
(Salehi-Tali) Department of Nursing, School of Nursing and Midwifery,
Shahrekord University of Medical Sciences, Shahrekord, Iran, Islamic
Republic of
(Mazaheri) Health Information Technology Research Center, Student Research
Committee, Department of Medical Library and Information Sciences, School
of Management and Medical Information Sciences, Isfahan University of
Medical Sciences, Isfahan, Iran, Islamic Republic of
(Hasanpour-Dehkordi) School of Allied Medical Sciences, Shahrekord
University of Medical Sciences, Shahrekord, Iran, Islamic Republic of
(Kheiri) Modeling in Health Research Center, Faculty of Health, Shahrekord
University of Medical Sciences, Shahrekord, Iran, Islamic Republic of
Publisher
Lippincott Williams and Wilkins
Abstract
This article reports the findings of a study designed to investigate the
effectiveness of the Roy Adaptation Model, as it relates to improvements
in nursing care outcomes for patients undergoing coronary bypass graft
surgery. Results revealed that the implementation of a training program
based on this model enhanced staff education and led to decreases in the
level of fatigue and improved the quality of life for this group of
patients. Copyright © 2022 Wolters Kluwer Health, Inc. All rights
reserved.

<4>
Accession Number
2015842002
Title
AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen
in the Acute Care Setting.
Source
Respiratory Care. 67(1) (pp 115-128), 2022. Date of Publication: 01 Jan
2022.
Author
Piraino T.; Madden M.; Roberts K.J.; Lamberti J.; Ginier E.; Strickland
S.L.
Institution
(Piraino) St. Michael's Hospital, Toronto, ON, Canada
(Madden) VERO Biotech, Atlanta, GA, United States
(Roberts) Hospital of the University of Pennsylvania, Philadelphia, PA,
United States
(Lamberti) Inova Fairfax Hospital, Department of Medicine, Fairfax, VA,
United States
(Ginier) Taubman Health Sciences Library, University of Michigan, Ann
Arbor, MI, United States
(Strickland) American Epilepsy Society, Chicago, IL, United States
(Strickland) Rush University, Chicago, IL, United States
Publisher
American Association for Respiratory Care
Abstract
Providing supplemental oxygen to hospitalized adults is a frequent
practice and can be administered via a variety of devices. Oxygen therapy
has evolved over the years, and clinicians should follow evidence-based
practices to provide maximum benefit and avoid harm. This systematic
review and subsequent clinical practice guidelines were developed to
answer questions about oxygenation targets, monitoring, early initiation
of high-flow oxygen (HFO), benefits of HFO compared to conventional oxygen
therapy, and humidification of supplemental oxygen. Using a modification
of the RAND/UCLA Appropriateness Method, 7 recommendations were developed
to guide the delivery of supplemental oxygen to hospitalized adults: (1)
aim for S<inf>pO2</inf> range of 94-98% for most hospitalized patients
(88- 92% for those with COPD), (2) the same S<inf>pO2</inf> range of
94-98% for critically ill patients, (3) promote early initiation of HFO,
(4) consider HFO to avoid escalation to noninvasive ventilation, (5)
consider HFO immediately postextubation to avoid re-intubation, (6) either
HFO or conventional oxygen therapy may be used with patients who are
immunocompromised, and (7) consider humidification for supplemental oxygen
when flows > 4L/minareused. Copyright © 2022 Daedalus
Enterprises.

<5>
Accession Number
2015865219
Title
Effect of Thoracic Paravertebral Nerve Block on Blood Coagulation in
Patients After Thoracoscopic Lobectomy: A Prospective Randomized
Controlled Clinical Trial.
Source
Journal of Pain Research. 15 (pp 633-641), 2022. Date of Publication:
2022.
Author
Yuan B.; Liu D.; Zhu Z.; Hao Y.; He K.; Deng S.
Institution
(Yuan, Liu, Zhu, Hao, He, Deng) Department of Anesthesiology, The First
Affiliated Hospital of Chongqing Medical University, Chongqing, China
Publisher
Dove Medical Press Ltd
Abstract
Purpose: Ultrasound-guided thoracic paravertebral block (TPVB) has become
increasingly popular for postoperative analgesia after thoracic surgery.
We designed this prospective, randomized, double-blind, placebo-controlled
trial to investigate the effect of TPVB on blood coagulation in patients
after thoracoscopic lobectomy. Patients and Methods: Sixty patients
scheduled for thoracoscopic lobectomy were randomly allocated to two
groups. Patients underwent ultrasound-guided TPVB with 0.33% ropivacaine
(T group) or 0.9% saline (C group) at the end of the surgery under general
anesthesia. Patient-controlled intravenous analgesia (PCIA) was
administered for both group after the surgery. The primary outcome was the
thromboelastogram (TEG) parameters before anesthesia (T0), at the end of
operation (T1) and in 1 day (T2) and 2 days (T3) after the operation, the
second outcomes were the analgesic effect and the amount of intraoperative
opioid consumption, operation time, infusion volume, blood loss and urine
volume. Result(s): The visual analog scale (VAS) scores in group T
were lower than group C (P < 0.05). In group T, compared with T0, the R
value at T1 and T2 is significantly reduced, and the K value at T1 were
significantly shortened, the alpha-angle and MA value at T1 were
significantly increased (P < 0.05). In group C, compared with T0, the R
value and K value were significantly shortened, the alpha-angle and MA
value were significantly increased at all postoperative time points (P <
0.05). Compared with group C at the same time point, the R and K values of
group T were significantly longer, and the alpha-angle and MA values were
significantly reduced at T2 and T3 points, with statistically significant
differences (P<0.05). Conclusion(s): TPVB is beneficial to improve
postoperative hypercoagulability and promote postoperative rehabilitation
of patients after thoracoscopic lobectomy. Copyright © 2022 Yuan
et al.

<6>
Accession Number
2017224723
Title
Acute haemothorax and pleuropulmonary blastoma: Two extremely rare
complications of extralobar pulmonary sequestration.
Source
Journal of Pediatric Surgery Case Reports. 80 (no pagination), 2022.
Article Number: 102238. Date of Publication: May 2022.
Author
Preziosi A.; Morandi A.; Galbiati F.; Scanagatta P.; Chiaravalli S.;
Fagnani A.M.; Di Cesare A.; Macchini F.; Leva E.
Institution
(Preziosi, Morandi, Galbiati, Fagnani, Di Cesare, Macchini, Leva)
Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale
Maggiore Policlinico, Milan, Italy
(Scanagatta) Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale
dei Tumori, Milan, Italy
(Chiaravalli) Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale
dei Tumori, Milan, Italy
Publisher
Elsevier Inc.
Abstract
Extralobar bronchopulmonary sequestration (eBPS) is a congenital lung
malformation characterized by non-functional lung tissue with no
connection with the bronchial tree, receiving systemic blood supply and
covered by its own visceral pleura. It is mostly asymptomatic, however it
can rarely get complicated with infections and neoplastic degeneration.
Its management is still debated: many authors suggest observation for
asymptomatic cases and intervention only in case of symptoms, others
advocate surgery even in asymptomatic patients. Pleuropulmonary blastoma
(PPB) is a rare malignant sarcomatous neoplasm, representing the most
common primary lung malignancy in children. Typically, PPB is associated
with congenital pulmonary airway malformation (CPAM). eBPS is rarely
associated with PPB. We report a case of a previously healthy
three-year-old boy presented to our emergency room with massive hemothorax
after a low-energy chest trauma. Imaging revealed active thoracic bleeding
by an anomalous artery arising from the celiac tripod, and an irregular
mass in the lower right hemithorax. After performing biopsy, pathologic
examination revealed a PPB. The patient underwent four cycles of
chemotherapy before surgery. The operative findings revealed a right
supradiaphragmatic extralobar mass, with no communication with the
bronchial tree, strictly adherent to the right middle lobe. After mass
excision, histological analysis confirmed the diagnosis of PPB type 2. The
patient underwent postoperative chemotherapy. No recurrence nor metastasis
were noted during the current follow-up. DICER-1 research revealed
biallelic mutation on the tumor and on the surrounding normal tissue. We
reviewed the literature concerning PPB and BPS. Based on these data, we
would recommend intervention even in case of asymptomatic
eBPS. Copyright © 2022 The Authors

<7>
Accession Number
2017181764
Title
effectiveness of endovascular versus open surgical repair for thoracic
aortic aneurysm: a systematic review and meta-analysis.
Source
Journal of Cardiovascular Surgery. 63(1) (pp 25-36), 2022. Date of
Publication: February 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, Heidari) Research Center for
evidence-Based Medicine, JBi Center of excellence, Tabriz university of
Medical sciences, Tabriz, Iran, Islamic Republic of
Publisher
Edizioni Minerva Medica
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. Copyright © 2022 Edizioni Minerva Medica. All rights
reserved.

<8>
Accession Number
2017181751
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
Journal of Cardiovascular Surgery. 63(1) (pp 60-68), 2022. Date of
Publication: February 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, Barros, Leite-Moreira) 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,
United Kingdom
(Cerqueira, Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao
University Hospital, Porto, Portugal
(Lourenco) Department of Anesthesiology, Sao Joao University Hospital,
Porto, Portugal
Publisher
Edizioni Minerva Medica
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). EVIDENCEACQUISITION:
Aliterature 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
CABGstrategy for these patients. Copyright © 2022 Edizioni
Minerva Medica. All rights reserved.

<9>
Accession Number
2017141668
Title
Patient-reported quality of life after stand-alone and concomitant
arrhythmia surgery: a systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 34(3) (pp 339-348), 2022.
Date of Publication: 01 Mar 2022.
Author
Maesen B.; Van Der Heijden C.A.J.; Bidar E.; Vos R.; Athanasiou T.;
Maessen J.G.
Institution
(Maesen, Van Der Heijden, Bidar, Maessen) Department of Cardiothoracic
Surgery, Maastricht University, Medical Centre, Postbus 5800, Maastricht
6202 AZ, Netherlands
(Maesen, Bidar, Maessen) Cardiovascular Research Institute Maastricht,
Maastricht, Netherlands
(Vos) Department of Methodology and Statistics, Maastricht University,
Maastricht, Netherlands
(Athanasiou) Department of Cardiothoracic Surgery, Imperial College
London, St Mary's Hospital, London, United Kingdom
Publisher
Oxford University Press
Abstract
OBJECTIVES: Patient-reported quality of life (QOL) has become an important
endpoint for arrhythmia surgery for atrial fibrillation (AF). While
studies specifically evaluating the effect of arrhythmia surgery on QOL
are scarce, we aimed to summarize current evidence of QOL following
concomitant and stand-alone arrhythmia surgery for AF. METHOD(S): All
studies reporting on QOL using questionnaires from patients undergoing
arrhythmia surgery for AF, both stand-alone and concomitant, were included
in this systematic review. A meta-analysis was performed on inter-study
heterogeneity of changes in QOL on 9 of 12 included studies that used the
Short-Form 36 tool and meta-regression based on rhythm outcome after 1
year was executed. Finally, differences in QOL following stand-alone
arrhythmia surgery and concomitant procedures were evaluated.
 RESULT(S): Overall, QOL scores improved 1 year after surgical
ablation for AF evaluated by several questionnaires. In stand-alone
arrhythmia procedures, meta-regression showed significant improvements in
those who were in sinus rhythm compared to those in AF after 1 year. This
association between an improved QOL and the procedural effectiveness was
also suggested in concomitant procedures. However, when comparing QOL of
patients undergoing cardiac surgery with and without add-on surgical
ablation for AF, only the variable 'physical role' demonstrated a
significant improvement. CONCLUSION(S): In patients with AF, QOL
improves after both stand-alone and concomitant arrhythmia surgery. In the
concomitant group, this improvement can be attributed to both the cardiac
procedure itself as well as the add-on arrhythmia surgery. However, both
in stand-alone and concomitant procedures, the improvement in QOL seems to
be related to the effectiveness of the procedure to maintain sinus rhythm
after 12 months. Copyright © The Author(s) 2021.

<10>
Accession Number
2017163255
Title
Outcomes of quantitative flow ratio-based percutaneous coronary
intervention in an all-comers study.
Source
EuroIntervention. 17(15) (pp 1240-1251), 2022. Date of Publication:
February 2022.
Author
Zhang R.; Dou K.; Guan C.; Zou T.; Zhang M.; Yuan S.; Qiao Z.; Xie L.; Sun
Z.; Song L.; Qiao S.; Stone G.W.; Xu B.
Institution
(Zhang, Dou, Yuan, Qiao) State Key Laboratory of Cardiovascular Disease,
Beijing, China
(Zhang, Dou, Yuan, Qiao, Song, Qiao) Department of Cardiology, Fu Wai
Hospital, National Center for Cardiovascular Diseases, Chinese Academy of
Medical Sciences and Peking Union Medical College, Beijing, China
(Guan, Zou, Xie, Sun, Xu) Catheterization Laboratories, Fu Wai Hospital,
National Center for Cardiovascular Diseases, Chinese Academy of Medical
Sciences, Peking Union Medical College, Beijing, China
(Zhang) CCRF (Beijing) Inc, Beijing, China
(Qiao, Xu) National Clinical Research Center for Cardiovascular Diseases,
Beijing, China
(Stone) Clinical Trials Center, Cardiovascular Research Foundation, New
York, NY, 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: Quantitative flow ratio (QFR) is a novel angiography-based
physiological index for fast computation of fractional flow reserve
without the use of a pressure wire or induction of hyperaemia.
 Aim(s): We sought to investigate the prevalence and prognostic
implications of achieving physiologyconsistent percutaneous coronary
intervention (PCI) according to the baseline angiographic QFR in an
allcomers cohort. Method(s): QFR was retrospectively analysed from
the angiograms of 1,391 patients enrolled in the randomised PANDA III
trial. Patients in whom all functionally ischaemic vessels (baseline QFR
<=0.80) were treated and in whom all non-ischaemic vessels (baseline QFR
>0.80) were deferred were termed as having had QFR-consistent treatment;
otherwise, they were termed as having had QFR-inconsistent treatment. The
major outcome was two-year major adverse cardiac events (MACE; a composite
of all-cause death, all myocardial infarction (MI), or any
ischaemia-driven revascularisation). Result(s): Overall, 814 (58.5%)
patients had QFR-consistent PCI, while 577 (41.5%) patients received
QFRinconsistent PCI. Patients with QFR-consistent versus those with
QFR-inconsistent treatment had a lower risk of two-year MACE (8.4% vs
14.7%; hazard ratio [HR] 0.56, 95% confidence interval [CI]: 0.41-0.78).
After adjusting for differences in baseline covariates, two-year rates of
MACE remained significantly lower in the QFR-consistent group (8.8% vs
13.6%; adjusted HR 0.64, 95% CI: 0.44-0.93), due mainly to reduced
ischaemia-driven revascularisation (2.9% vs 8.0%; adjusted HR 0.35, 95%
CI: 0.20-0.60). Conclusion(s): In this post hoc analysis of an
all-comers PCI trial, approximately 60% of patients were treated in
accordance with what the QFR measurement would have recommended, the
achievement of which was associated with improved two-year clinical
outcomes. Copyright © Europa Digital & Publishing 2022.

<11>
Accession Number
2015839549
Title
Role of Dexmedetomidine in Early POCD in Patients Undergoing Thoracic
Surgery.
Source
BioMed Research International. 2021 (no pagination), 2021. Article Number:
8652028. Date of Publication: 2021.
Author
Ran J.; Bai X.; Wang R.; Li X.
Institution
(Ran, Bai, Wang, Li) Department of Anesthesiology, West China Hospital,
Sichuan University and the Research Units of West China (2018RU012),
Chinese Academy of Medical Sciences, China
Publisher
Hindawi Limited
Abstract
Importance. Postoperative cognitive dysfunction (POCD) occurs in 6%-53% of
elderly patients receiving major surgery and is related to longer hospital
stays, increased hospital costs, and 1-year mortality. An increasing
number of studies suggest that using dexmedetomidine (Dex) in critical
care units is associated with reduced incidence of delirium. However,
perioperative use of Dex for the prevention of POCD has not been well
studied. Objective. To evaluate whether a low-dose perioperative infusion
of Dex reduces early POCD. Design. This study was a double-blind,
randomized, placebo-controlled trial that randomly assigned patients to
Dex or saline placebo infused during surgery and patient-controlled
intravenous analgesia (PCIA) infusion. Patients were assessed for
postoperative cognitive decline. Interventions. Dex was infused at a
loading dose of 0.5 mug/kg intravenously (15 min after entering the
operation room) followed by a continuous infusion at a rate of 0.5
mug/kg/h until one-lung ventilation or artificial pneumothorax ended.
Patients in the Dex group received regular PCIA pump with additional dose
of Dex (200 mug). Results. In total, 126 patients were randomized, and 102
patients were involved in the result analysis. The incidence of POCD was
36.54% (19/52) in the Dex group and 32.00% (16/50) in the normal saline
(NS) group, with no statistic difference. No significant difference was
observed between the two groups in terms of Telephone Interview for
Cognitive Status-Modified (TICS-m) scores at different times. However, the
TICS-m score at 7 days after surgery was significantly lower than that at
30 days in 102 patients (32.93+/-0.42 vs. 33.92+/-0.47, P=0.03). The
visual analogue scale scores in the Dex group were significantly lower
than those in the NS group 1 day postoperation at rest and activity (2.00
[1.00-3.00] vs. 3.00 [2.00-4.00], P<0.01; 4.00 [3.00-5.00] vs. 5.00
[4.00-6.00], P<0.05, respectively). Patients receiving Dex or NS had no
statistical difference in activities of daily living (ADLs) scores at 7
and 30 days after surgery, but the ADL score at 30 days after surgery
showed a significant reduction compared with that at 7 days (P<0.01).
Patients in the Dex group had a shorter hospital length of stay
(15.26+/-3.77 vs. 17.69+/-5.09, P=0.02) and less expenses
(52458.71+/-10649.30 vs. 57269.03+/-9269.98, P=0.04) than those in the NS
group. Conclusions. Low-dose Dex in the perioperative period did not
reduce the incidence of early POCD in thoracic surgery. However, it
relieved postoperative pain, decreased the hospitalization expenses, and
shortened the length of stay. Copyright © 2021 Jiao Ran et al.

<12>
Accession Number
2015895710
Title
Subclinical Leaflet Thrombosis After Transcatheter Aortic Valve
Replacement: A Meta-Analysis.
Source
JACC: Cardiovascular Interventions. 14(24) (pp 2643-2656), 2021. Date of
Publication: 27 Dec 2021.
Author
Bogyi M.; Schernthaner R.E.; Loewe C.; Gager G.M.; Dizdarevic A.M.;
Kronberger C.; Postula M.; Legutko J.; Velagapudi P.; Hengstenberg C.;
Siller-Matula J.M.
Institution
(Bogyi, Gager, Dizdarevic, Kronberger, Hengstenberg, Siller-Matula)
Department of Internal Medicine II, Division of Cardiology, Medical
University of Vienna, Vienna, Austria
(Schernthaner, Loewe) Division of Cardiovascular and Interventional
Radiology, Department of Biomedical Imaging and Image-Guided Therapy,
Medical University of Vienna, Vienna, Austria
(Gager) Department of Clinical Pharmacology, Medical University of Vienna,
Vienna, Austria
(Postula, Siller-Matula) Department of Experimental and Clinical
Pharmacology, Medical University of Warsaw, Center for Preclinical
Research and Technology CEPT, Warsaw, Poland
(Legutko) Jagiellonian University Medical College, Faculty of Medicine,
Institute of Cardiology, Department of Interventional Cardiology, John
Paul II Hospital, Krakow, Poland
(Velagapudi) Division of Cardiovascular Medicine, University of Nebraska
Medical Center, Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
This meta-analysis and systematic review was performed to evaluate the
clinical relevance of subclinical leaflet thrombosis (SLT) following
transcatheter aortic valve replacement. PubMed, Web of Science, and
CENTRAL were searched for eligible randomized and nonrandomized studies
until November 2020. Risk ratios (RRs) or odds ratios and 95% CIs were
calculated, using a random-effects model. Overall, 25 studies were
eligible for the analysis and comprised a total of 11,098 patients. The
median incidence of SLT was 6% at a median follow-up of 30 days. Use of
intra-annular valves was associated with 2-fold greater risk for the
development of SLT compared with use of supra-annular valves. There was no
difference in the risk for SLT (RR: 0.97; 95% CI: 0.72-1.29; P = 0.83)
between single-antiplatelet therapy (SAPT) and dual-antiplatelet therapy
(DAPT), whereas oral anticoagulation (OAC) was associated with a 58%
relative risk reduction for SLT (RR: 0.42; 95% CI: 0.29-0.61; P < 0.00001)
compared with SAPT and DAPT. In patients with diagnosed leaflet thrombosis
at follow-up, the risk for stroke or transient ischemic attack was
increased by 2.6-fold (RR: 2.56; 95% CI: 1.60-4.09; P < 0.00001) compared
with patients without leaflet thrombosis. In patients diagnosed with SLT,
the odds of SLT resolution increased by 99% after switch from antiplatelet
agents to OAC (odds ratio: 0.01; 95% CI: 0.00-0.06; P < 0.00001). To
summarize, indication-based use of OAC after transcatheter aortic valve
replacement is associated with a lower risk for SLT compared with SAPT and
DAPT. Switching to OAC seems to be effective for SLT resolution. As SLT
increased the odds of stroke or transient ischemic attack in the included
population, further studies are needed to investigate whether screening
tests for SLT and appropriate antithrombotic therapy improve long-term
valve functionality and clinical prognosis. Copyright © 2021
American College of Cardiology Foundation

<13>
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. 52(1) (pp 7-18), 2022. Date of
Publication: February 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.

<14>
Accession Number
2014054850
Title
Efficacy and safety of direct oral anticoagulants versus vitamin K
antagonist for portal vein thrombosis in cirrhosis: A systematic review
and meta-analysis.
Source
Digestive and Liver Disease. 54(1) (pp 56-62), 2022. Date of Publication:
January 2022.
Author
Koh J.H.; Liew Z.H.; Ng G.K.; Liu H.T.; Tam Y.C.; De Gottardi A.; Wong
Y.J.
Institution
(Koh, Liu) Yong Loo Lin School of Medicine, National University of
Singapore, Singapore
(Liew, Ng, Wong) Department of Gastroenterology & Hepatology, Changi
General Hospital, Singapore
(Tam) Medical Board, Education Resource Centre, Singapore General
Hospital, Singapore
(De Gottardi) Gastroenterology and Hepatology, Ente Ospedaliero Cantonale,
Lugano, Switzerland
(De Gottardi) Facolta di Scienze Biomediche, Universita della Svizzera
Italiana, Lugano, Switzerland
(Wong) Duke-NUS Medicine Academic Clinical Program, SingHealth, Singapore
Publisher
Elsevier B.V.
Abstract
Introduction and aim: Portal vein thrombosis (PVT) is associated with a
higher risk of liver-related complications. Recent guidelines recommend
direct-acting anticoagulants (DOAC) in patients with cirrhosis and
non-tumoral PVT. However, data on the efficacy and safety of DOAC in these
patients remain limited. We aim to investigate the efficacy and safety of
DOAC compared to vitamin K antagonists (VKA) to treat non-tumoral PVT in
patients with cirrhosis. Method(s): We performed a systematic search
of six electronic databases using MeSH term and free text. We selected all
studies comparing the use of DOACs with vitamin K antagonist to treat PVT
in cirrhosis. The primary outcome was PVT recanalization. Secondary
outcomes were and PVT progression, major bleeding, variceal bleeding and
death. Result(s): From 944 citations, we included 552 subjects from a
total of 11 studies (10 observational and 1 randomized trial) that
fulfilled the inclusion criteria. We found that DOAC were associated with
a higher pooled rate of PVT recanalization (RR = 1.67, 95%CI: 1.02, 2.74,
I2 = 79%) and lower pooled risk of PVT progression (RR = 0.14,
95%CI: 0.03-0.57, I2 = 0%). The pooled risk of major bleeding
(RR = 0.29, 95%CI: 0.08-1.01, I2 = 0%), variceal bleeding (RR =
1.29, 95%CI: 0.64-2.59, I2 = 0%) and death (RR = 0.31, 95%CI:
0.01-9.578, I2 = 80%) was similar between DOAC and VKA.
 Conclusion(s): For the treatment of PVT in patients with cirrhosis,
the bleeding risk was comparable between DOAC and VKA. However, DOAC were
associated with a higher pooled rate of PVT recanalization. Dedicated
randomized studies are needed to confirm these findings. Copyright
© 2021

<15>
Accession Number
2015146759
Title
Risk of Pneumothorax Requiring Pleural Drainage after Drainless VATS
Pulmonary Wedge Resection: A Systematic Review and Meta-Analysis.
Source
Innovations: Technology and Techniques in Cardiothoracic and Vascular
Surgery. 17(1) (pp 14-24), 2022. Date of Publication: January 2022.
Author
Laven I.E.W.G.; Daemen J.H.T.; Janssen N.; Franssen A.J.P.M.; Gronenschild
M.H.M.; Hulsewe K.W.E.; Vissers Y.L.J.; de Loos E.R.
Institution
(Laven, Daemen, Janssen, Franssen, Hulsewe, Vissers, de Loos) Department
of Surgery, Division of General Thoracic Surgery, Zuyderland Medical
Center, Heerlen, Netherlands
(Gronenschild) Department of Respiratory Medicine, Zuyderland Medical
Center, Heerlen, Netherlands
Publisher
SAGE Publications Ltd
Abstract
Objective: Omitting pleural drainage after video-assisted thoracic surgery
(VATS) for pulmonary wedge resections has been shown to be a safe approach
to enhance recovery. However, major concerns remain regarding the risk of
postoperative pneumothoraces requiring surgical interventions. Therefore,
our objective was to provide conclusive evidence whether chest tube
omission after VATS wedge resection is safe and does not increase the risk
of pneumothoraces requiring pleural drainage. Method(s): Five
scientific databases were searched. Studies comparing patients with (CT
group) and without chest tube drainage (NCT group) after VATS wedge
resection were evaluated. Outcomes included radiographically diagnosed
pneumothoraces and pneumothoraces requiring pleural drainage,
postoperative complications, hospitalization, and pain scores.
 Result(s): Overall, 9 studies (3 randomized controlled trials) were
included (N = 928). Meta-analysis showed significantly more
radiographically diagnosed pneumothoraces in the NCT group (risk ratio
[RR] = 2.58, 95% confidence interval [CI]: 1.56 to 4.29, P < 0.001; I
2 = 0%). However, no significant differences were found in
postoperative pneumothoraces requiring pleural drainage (RR = 1.72, 95%
CI: 0.63 to 4.74, P = 0.29; I2 = 0%) or complications (RR =
0.77, 95% CI: 0.39 to 1.52, P = 0.46; I 2 = 0%). Furthermore,
the NCT group showed significantly shorter hospitalization (mean
difference = -1.26, 95% CI: -1.56 to -0.95, P < 0.001) with high
heterogeneity (I 2 = 58%, P = 0.02), and lower pain scores on
postoperative day 1 (standard mean difference [SMD] = -0.98, 95% CI: -1.71
to -0.25, P = 0.009; I 2 = 92%) and postoperative day 2 (SMD =
-1.28, 95% CI: -2.55 to -0.01, P = 0.05; I 2 = 96%) compared
with the CT group. Conclusion(s): VATS wedge resection without
routine chest tube placement is suggested as a safe and less invasive
approach in selected patients that does not increase the risk of a
pneumothorax requiring pleural drainage. Copyright © The
Author(s) 2022.

<16>
Accession Number
637413410
Title
Smoking Status and Type 2 Diabetes, and Cardiovascular Disease: A
Comprehensive Analysis of Shared Genetic Etiology and Causal Relationship.
Source
Frontiers in Endocrinology. 13 (no pagination), 2022. Article Number:
809445. Date of Publication: 18 Feb 2022.
Author
Chi Y.; Wang X.; Jia J.; Huang T.
Institution
(Chi, Wang, Jia) Department of Biostatistics, School of Public Health,
Peking University, Beijing, China
(Jia) Center for Statistical Science, Peking University, Beijing, China
(Huang) Department of Epidemiology & Biostatistics, School of Public
Health, Peking University, Beijing, China
(Huang) Department of Global Health, School of Public Health, Peking
University, Beijing, China
(Huang) Key Laboratory of Molecular Cardiovascular Sciences (Peking
University), Ministry of Education, Beijing, China
Publisher
Frontiers Media S.A.
Abstract
Objective: This study aimed to explore shared genetic etiology and the
causality between smoking status and type 2 diabetes (T2D), cardiovascular
diseases (CVDs), and related metabolic traits. Method(s): Using
summary statistics from publicly available genome-wide association studies
(GWASs), we estimated genetic correlations between smoking status and T2D,
6 major CVDs, and 8 related metabolic traits with linkage disequilibrium
score regression (LDSC) analysis; identified shared genetic loci with
large-scale genome-wide cross-trait meta-analysis; explored potential
shared biological mechanisms with a series of post-GWAS analyses; and
determined causality with Mendelian randomization (MR). Result(s): We
found significant positive genetic associations with smoking status for
T2D (Rg = 0.170, p = 9.39 x 10-22), coronary artery disease
(CAD) (Rg = 0.234, p = 1.96 x 10-27), myocardial infarction
(MI) (Rg = 0.226, p = 1.08 x 10-17), and heart failure (HF) (Rg
= 0.276, p = 8.43 x 10-20). Cross-trait meta-analysis and
transcriptome-wide association analysis of smoking status identified 210
loci (32 novel loci) and 354 gene-tissue pairs jointly associated with
T2D, 63 loci (12 novel loci) and 37 gene-tissue pairs with CAD, 38 loci (6
novel loci) and 17 gene-tissue pairs with MI, and 28 loci (3 novel loci)
and one gene-tissue pair with HF. The shared loci were enriched in the
exo-/endocrine, cardiovascular, nervous, digestive, and genital systems.
Furthermore, we observed that smoking status was causally related to a
higher risk of T2D (beta = 0.385, p = 3.31 x 10-3), CAD (beta =
0.670, p = 7.86 x 10-11), MI (beta = 0.725, p = 2.32 x
10-9), and HF (beta = 0.520, p = 1.53 x 10-6).
 Conclusion(s): Our findings provide strong evidence on shared genetic
etiology and causal associations between smoking status and T2D, CAD, MI,
and HF, underscoring the potential shared biological mechanisms underlying
the link between smoking and T2D and CVDs. This work opens up a new way of
more effective and timely prevention of smoking-related T2D and
CVDs. Copyright © 2022 Chi, Wang, Jia and Huang.

<17>
Accession Number
637387653
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) (no pagination), 2022. Article Number: e055755. 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
BMJ Publishing Group
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 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. Results 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 ©

<18>
Accession Number
2014600509
Title
Heart valve surgery and the obesity paradox: A systematic review.
Source
Clinical Obesity. 12(2) (no pagination), 2022. Article Number: e12506.
Date of Publication: April 2022.
Author
EL-Andari R.; Bozso S.J.; Kang J.J.H.; Bedard A.M.A.; Adams C.; Wang W.;
Nagendran J.
Institution
(EL-Andari) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(Bozso, Kang, Wang, Nagendran) Division of Cardiac Surgery, Department of
Surgery, University of Alberta, Edmonton, AB, Canada
(Bedard) Department of Biological Sciences, Faculty of Science, University
of Alberta, Edmonton, AB, Canada
(Adams) Section of Cardiac Surgery, Department of Cardiac Sciences, Libin
Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB,
Canada
Publisher
John Wiley and Sons Inc
Abstract
Obesity has been associated with increased incidence of comorbidities and
shorter life expectancy, and it has generally been assumed that patients
with obesity should have inferior outcomes after surgery. Previous
literature has often demonstrated equivalent or even improved rates of
mortality after cardiac surgery when compared to their lower-weight
counterparts, coined the obesity paradox. Herein, we aim to review the
literature investigating the impact of obesity on surgical valve
interventions. PubMed and Embase were systematically searched for articles
published from 1 January 2000 to 15 October 2021. A total of 1315 articles
comparing differences in outcomes between patients of varying body mass
index (BMI) undergoing valve interventions were reviewed and 25 were
included in this study. Patients with higher BMI demonstrated equivalent
or reduced rates of postoperative myocardial infarction, stroke,
reoperation rates, acute kidney injury, dialysis and bleeding. Two studies
identified increased rates of deep sternal wound infection in patients
with higher BMI, although the majority of studies found no significant
difference in deep sternal wound infection rates. The obesity paradox has
described counterintuitive outcomes predominantly in coronary artery
bypass grafting and transcatheter aortic valve replacement. Recent
literature has identified similar trends in other heart valve
interventions. While the obesity paradox has been well characterized, its
causes are yet to be identified. Further study is essential in order to
identify the causes of the obesity paradox so patients of all body sizes
can receive optimal care. Copyright © 2021 World Obesity
Federation.

<19>
Accession Number
2006080385
Title
Percutaneous coronary intervention versus coronary artery bypass graft for
left main coronary artery disease: A meta-analysis.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(1) (pp 94-105.e15),
2022. Date of Publication: January 2022.
Author
Gallo M.; Blitzer D.; Laforgia P.L.; Doulamis I.P.; Perrin N.; Bortolussi
G.; Guariento A.; Putzu A.
Institution
(Gallo) Department of Cardiac Surgery, Cardiocentro Ticino, Lugano,
Switzerland
(Blitzer) Department of Surgery, New York Presbyterian Hospital, Columbia
University, New York, NY, United States
(Laforgia) Department of Cardiology, Maasstad Ziekenhuis, Rotterdam,
Netherlands
(Doulamis, Guariento) Department of Cardiac Surgery, Boston Children's
Hospital, Harvard Medical School, Boston, MA, United States
(Perrin) Department of Cardiology, Geneva University Hospitals, Geneva,
Switzerland
(Bortolussi) Department of Cardiac Surgery, IRCCS Policlinico San Donato,
Milan, Italy
(Putzu) Division of Anesthesiology, Department of Anesthesiology,
Pharmacology, Intensive Care, and Emergency Medicine, Geneva University
Hospitals, Geneva, Switzerland
Publisher
Elsevier Inc.
Abstract
Background: The optimal revascularization strategy for patients with left
main coronary artery disease is still controversial. This is systematic
review and meta-analysis aims to evaluate the outcomes of percutaneous
coronary intervention (PCI) with drug-eluting stents compared with
coronary artery bypass graft (CABG) for LM disease. Method(s): Online
electronic databases were systematically reviewed until January 2020 for
randomized trials comparing PCI with drug-eluting stents and CABG. Primary
outcomes were: all-cause mortality, myocardial infarction (MI), stroke,
and repeated revascularization. Secondary outcomes included periprocedural
and nonperiprocedural MI. The period of follow-up included 30 days, 1
year, and 5 years. Odds ratio and 95% confidence interval were calculated
with a fixed-effects model. Result(s): A total of 4595 patients (5
randomized trials) with left main coronary artery disease were included.
At 30 days and 1 year, PCI was associated with lower incidence of stroke,
higher repeated revascularization, and similar odds of mortality and MI
compared with CABG. At 5 years, PCI was associated with higher rates of MI
(odds ratio, 1.43; 95% confidence interval, 1.13-1.79; P =.003) and repeat
revascularization (odds ratio, 1.89; 95% CI, 1.58-2.26; P <.001) than
CABG. PCI was associated with lower periprocedural MI at 30 days, whereas
at 5 years PCI was associated with higher nonperiprocedural MI (odds
ratio, 2.32; 95% confidence interval, 1.62-3.31; P <.001). Mortality and
stroke rate did not differ at 5-year follow-up. Conclusion(s):
Patients with left main coronary artery disease treated with either PCI or
CABG do not show significant difference in early or 5-year mortality.
Although CABG was associated with higher stroke rates at 30 days and 1
year, PCI was associated with an increase in MI and need for repeat
revascularization at 5 years. Copyright © 2020 The American
Association for Thoracic Surgery

<20>
Accession Number
2011267283
Title
Graft Patency of a Second Conduit for Coronary Artery Bypass Surgery: A
Network Meta-Analysis of Randomized Controlled Trials.
Source
Seminars in Thoracic and Cardiovascular Surgery. 34(1) (pp 102-109), 2022.
Date of Publication: Spring 2022.
Author
Yokoyama Y.; Takagi H.; Kuno T.
Institution
(Yokoyama, Kuno) Department of Surgery, St. Luke's University Health
Network, Mount Sinai Beth Israel, Fountain Hill, PA, United States
(Kuno) Department of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Takagi) Department of Medicine, Icahn School of Medicine at Mount Sinai,
New York, New York City
Publisher
W.B. Saunders
Abstract
It has been well documented that the use of the left internal thoracic
artery (LITA) to graft the left anterior descending (LAD) artery has a
significant benefit in coronary artery bypass graft (CABG) surgery.
However, what graft is the best as a second conduit to complement LITA-LAD
anastomosis remains uncertain. We thus conducted a network meta-analysis
of RCTs to compare graft patency of the radial artery (RA), the right
internal thoracic artery (RITA), the right gastroepiploic artery (RGEA),
conventional saphenous vein (C-SVG), and no-touch saphenous vein (NT-SVG)
as a second conduit in CABG. MEDLINE and EMBASE were searched through
August 31, 2020 to identify randomized controlled trials (RCTs) that
investigated graft patency of a second conduit in CABG. From each study,
we extracted the incidence rate ratios of the outcome. A total of 13 RCTs
were identified, including 3728 patients and 2773 angiographic results.
The graft failure rates were significantly lower in NT-SVG and RA compared
to C-SVG and RGEA. There was no significant difference among the other
comparisons. A sensitivity analysis restricting trials with >=3 years
angiographic follow-up time showed the graft failure rates were
significantly lower in NT-SVG and RA compared to C-SVG and RGEA, and a
sensitivity analysis restricting trials with >=5 years angiographic
follow-up time showed the graft failure rates were significantly lower in
NT-SVG and RA compared to C-SVG. In a network meta-analysis of the updated
outcomes from RCTs, NT-SVG and RA have better graft patency compared to
C-SVG and RGEA. Copyright © 2021 Elsevier Inc.

<21>
Accession Number
2013859482
Title
TAVR and Dialysis Are a Challenging Combination. A Case Report and
Systematic Review of Literature.
Source
Structural Heart. 5(6) (pp 549-555), 2021. Date of Publication: 2021.
Author
Iadanza A.; Antenore A.; Biancofiore A.; Contorni F.; Biagioni G.; Bellan
C.; Davoli G.; Fineschi M.
Institution
(Iadanza, Fineschi) Department of Cardiovascular Diseases, Azienda
Ospedaliera Universitaria Senese, Siena, Italy
(Antenore, Biancofiore, Contorni, Biagioni) Department of Medical
Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
(Bellan) Department of Medical Biotechnologies, Institute of Pathological
Anatomy, University of Siena, Siena, Italy
(Davoli) Department of Cardiovascular Diseases, Azienda Ospedaliera
Universitaria Senese, Siena, Italy
Publisher
Taylor and Francis Ltd.
Abstract
Advanced chronic kidney disease (CKD) is associated with poor outcomes in
patients undergoing surgical aortic valve replacement, while its
prognostic role in transcatheter aortic valve replacement (TAVR) remains
unclear. Advanced CKD was defined according to estimated glomerular
filtration rate (eGFR): 15-29 mL/min/1.73 m2 (Stage 4-CKD G5),
<15 mL/min/1.73 m2 (Stage 5-CKD G5), and CKD G5D if the patient
is on hemodialysis. End-stage renal disease (ESRD) increases the risk of
developing heart valve disease, mainly aortic stenosis. Nonetheless, ESRD
is also known to carry a very high surgical risk, and all the main scoring
systems (i.e., STS, Euroscore II) developed to assess prognosis in
patients undergoing cardiac surgery take into account this risk factor.
Transcatheter aortic valve replacement (TAVR) appears to be a feasible
alternative to surgical valve replacement (SAVR), but the initial trials
testing this approach systematically excluded patients on dialysis.
Several observational studies have been recently conducted among patients
with severely impaired renal function and all found a worse prognosis in
both the short and long term. We present a case report in which a
successful TAVR procedure was performed due to severe symptomatic aortic
stenosis in a subject with severe nephropathy. The patient in chronic
dialysis developed an early degeneration of aortic bioprosthesis Medtronic
CoreValve, which required surgical replacement with a mechanical
valve. Copyright © 2021 Cardiovascular Research Foundation.

<22>
Accession Number
2012853506
Title
Pedicled or skeletonized bilateral internal mammary artery harvesting - a
meta- analysis and trial sequential analysis.
Source
Expert Review of Cardiovascular Therapy. 19(7) (pp 647-654), 2021. Date of
Publication: 2021.
Author
Iddawela S.; Mellor S.L.; Zahra S.A.; Khare Y.; Harky A.
Institution
(Iddawela) Department of General Surgery, University Hospitals Birmingham,
Birmingham, United Kingdom
(Mellor) College of Medical and Dental Sciences, University of Birmingham,
Birmingham, United Kingdom
(Zahra, Khare) Department of Medicine, St George's, University of London,
London, United Kingdom
(Harky) Department of Cardio-thoracic Surgery, Liverpool Heart and Chest
Hospital, Liverpool, United Kingdom
(Harky) Faculty of Life Sciences, University of Liverpool, Liverpool,
United Kingdom
Publisher
Taylor and Francis Ltd.
Abstract
Objective: There is varying evidence on the role of skeletonization of
internal mammary artery in reducing the risk of sternal wound infections
and ischemia following bilateral internal mammary artery grafting.
Post-operative clinical outcomes of skeletonized bilateral internal
mammary artery versus pedicled bilateral internal mammary artery
harvesting in patients undergoing coronary artery bypass surgery were
compared. Method(s): A comprehensive electronic search was conducted
using MEDLINE, Scopus, EMBASE, Cochrane database and Google Scholar from
inception until 15 June 2020. All studies directly comparing skeletonized
and pedicled bilateral internal mammary artery harvesting were included.
Meta-analysis and trial sequential analysis were conducted.
 Result(s): Nine studies (one randomized controlled trial and eight
observational studies) consisting of 3649 patients (2050 patients with
skeletonized bilateral internal mammary artery grafting and 1599 patients
with pedicled bilateral internal mammary artery grafting) were included.
Pooled effects analysis and trial sequential analysis reported
significantly lower risk of sternal wound infection with skeletonized
bilateral internal mammary artery harvesting (OR 0.27, 95% CI 0.20-0.51, p
< 0.00001). Conclusion(s): Skeletonization reduces the risk of
sternal wound infections by preserving vasculature as much as possible.
This facilitates its use in patients at high risk of sternal wound
infection. Copyright © 2021 Informa UK Limited, trading as Taylor
& Francis Group.

<23>
Accession Number
2007249490
Title
First-line ablation of ventricular tachycardia in ischemic cardiomyopathy:
stratification of outcomes by left ventricular function.
Source
Journal of Interventional Cardiac Electrophysiology. 62(2) (pp 391-400),
2021. Date of Publication: November 2021.
Author
Briceno D.F.; Romero J.; Patel K.; Liaqat W.; Zhang X.-D.; Alviz I.; Yang
R.; Rodriguez D.; Lakkireddy D.; Rocca D.D.; Tarantino N.; Gopinathannair
R.; Natale A.; Di Biase L.
Institution
(Briceno, Romero, Patel, Liaqat, Zhang, Alviz, Yang, Rodriguez, Tarantino,
Di Biase) Montefiore-Einstein Center for Heart and Vascular Care,
Montefiore Medical Center, Albert Einstein College of Medicine, 111 East
210th Street, Bronx, NY 10467, United States
(Yang) Division of Cardiology, Department of Medicine, Henan Provincial
People's Hospital, Zhengzhou, China
(Lakkireddy, Gopinathannair) Kansas City Heart Rhythm Institute, Overland
Park, KS, United States
(Rocca, Natale, Di Biase) Texas Cardiac Arrhythmia Institute, St. David's
Medical Center, Austin, TX, United States
Publisher
Springer
Abstract
Purpose: First-line catheter ablation of ventricular
tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic
cardiomyopathy (ICM) has been associated with improved outcomes; however,
most benefit seems to be in patients with moderately depressed left
ventricular ejection fraction (LVEF). Herein, outcomes were stratified
based on LVEF. Method(s): A meta-analysis of randomized controlled
trials (RCTs) evaluating first-line ablation versus medical therapy in
patients with VT and ICM was performed. Risk estimates and 95% confidence
intervals (CI) were measured. Result(s): Four RCTs with a total of
505 patients (mean age 66 +/- 9 years, 89% male, 80% with previous
revascularization) were included. Mean LVEF was 35 +/- 8%. At a mean
follow-up of 24 +/- 9 months, a significant benefit in survival-free from
appropriate implantable cardioverter-defibrillator (ICD) therapies was
observed in all patients undergoing first-line catheter ablation compared
with medical management (RR 0.70, 95% CI 0.56-0.86). In patients with
moderately depressed LVEF (> 30-50%), first-line VT ablation was
associated with a statistically significant reduction in the composite
endpoint of survival free from VT/VF and appropriate ICD therapies (HR
0.52, 95% CI 0.36-0.76), whereas there was no difference in patients with
severely depressed LVEF (<=30%) (HR 0.56, 95% CI 0.24-1.32). Funnel plots
did not show asymmetry suggesting lack of bias. Conclusion(s):
Patients with ICM and VT undergoing first-line ablation have a
significantly lower rate of appropriate ICD therapies without a mortality
difference compared with patients receiving an initial approach based on
medical therapy. The beneficial effect of a first-line ablation approach
was only observed in patients with moderately depressed LVEF (>
30-50%). Copyright © 2020, Springer Science+Business Media, LLC,
part of Springer Nature.

<24>
Accession Number
2010850248
Title
Lumbosacral subdural hematoma associated with cranial subdural hematoma
and craniocerebral surgery: Three cases and a systemic literature review.
Source
Neurochirurgie. 67(5) (pp 470-478), 2021. Date of Publication: September
2021.
Author
Yokota H.; Wajima D.; Ida Y.
Institution
(Yokota, Wajima, Ida) Department of Neurosurgery, Nabari City Hospital,
1-178 Yurigaoka Nishi, Nabari, Mie 518-0481, Japan
Publisher
Elsevier Masson s.r.l.
Abstract
Objective: The authors aim to focus on lumbosacral subdural hematoma (SDH)
associated with cranial subdural hematoma and craniocerebral surgery,
which has been rarely reported. Material(s) and Method(s): They
present 3 cases of lumbosacral SDH, including 2 associated with cranial
chronic SDH and 1 following craniotomy for neck clipping of cerebral
aneurysm. Using a PubMed search, they also provide a systemic literature
review to summarize pathogenesis, treatment and outcome. Result(s):
All cases presented with bilateral radiating leg pain, and recovered
completely by conservative managements. Predisposing factors were trauma,
anticoagulant therapy and brain atrophy. Literature review revealed 54
such cases, in which 28 cases associated with cranial SDH and 26 cases
associated with craniocerebral surgery. In both group, main symptoms were
low back and radiating leg pain, and sensorimotor deficits. Regardless of
treatments, conservatively or surgically, outcome was favorable. Migration
of cranial hematoma is most supported pathogenesis, while intracranial
hypotension due to cerebrospinal fluid overdrainage procedures may also be
a contributing factor for cases associated with craniocerebral surgery.
 Conclusion(s): Lumbosacral SDH should be considered in patients
present with unexpected low back and radiating leg pains associated with
cranial SDH and craniocerebral surgery. Conservative treatment would be
reasonable for cases with mild symptoms as the first treatment of
choice. Copyright © 2021 Elsevier Masson SAS

<25>
Accession Number
2012931076
Title
Coronary revascularisation in patients with chronic kidney disease and
end-stage renal disease: A meta-analysis.
Source
International Journal of Clinical Practice. 75(11) (no pagination), 2021.
Article Number: e14506. Date of Publication: November 2021.
Author
Li X.; Xiao F.; Zhang S.
Institution
(Li, Xiao, Zhang) Department of Cardiac Surgery, Peking University First
Hospital, Beijing, China
Publisher
John Wiley and Sons Inc
Abstract
Objectives: To compare coronary artery bypass grafting (CABG) and
percutaneous coronary intervention (PCI) for revascularising coronary
arteries in patients with chronic kidney disease (CKD) and end-stage renal
disease (ESRD). CKD is described as a continuous decrease in the
glomerular filtration rate or abnormalities in kidney structure or
function. Method(s): PubMed, Cochrane Library and Embase databases
were searched for studies on the revascularisation of coronary arteries in
patients with CKD and ESRD. Result(s): Since no randomised controlled
trials (RCTs) have addressed this issue so far, 31 observational studies
involving 74 805 patients were included in this meta-analysis. Compared
with PCI, patients undergoing CABG have significantly higher early
mortality (CKD: RR = 1.62, 95% CI: 1.17-2.25, pheterogeneity = 0.476,
I2 = 0; ESRD: RR = 1.99, 95% CI: 1.46-2.71, pheterogeneity =
0.001, I2 = 66.9%). Patients with ESRD undergoing CABG have
significantly lower all-cause mortality (RR = 0.95, 95% CI: 0.93-0.96,
pheterogeneity < 0.001, I2 = 82.9%) and cardiac mortality (RR =
0.73, 95% CI: 0.58-0.92, pheterogeneity = 0.908, I2 = 0). The
long-term risk of repeat revascularisation (CKD: RR = 0.24, 95% CI:
0.19-0.30, pheterogeneity = 0.489, I2 = 0; ESRD: RR = 0.23, 95%
CI: 0.15-0.34, pheterogeneity = 0.012, I2 = 54.4%) and
myocardial infarction (CKD: RR =.57, 95% CI: 0.38-0.85, pheterogeneity =
0.025, I2 = 49.9%; ESRD: RR = 0.42, 95% CI: 0.40-0.44,
pheterogeneity = 0.49, I2 = 0) remained significantly higher in
the PCI group. Conclusion(s): Patients with ESRD, but not CKD, who
underwent CABG had significantly lower all-cause mortality and cardiac
mortality. However, CABG was associated with an increased risk of early
mortality in patients with CKD or ESRD. Adequately powered, contemporary,
prospective RCTs are needed to define the optimal revascularisation
strategy for patients with CKD and ESRD. Copyright © 2021 The
Authors. International Journal of Clinical Practice published by John
Wiley & Sons Ltd.

<26>
Accession Number
2013237238
Title
Efficacy and safety of cerebral embolic protection systems during
transcatheter aortic valve replacement: a review of current clinical
findings.
Source
Expert Review of Cardiovascular Therapy. 19(8) (pp 725-737), 2021. Date of
Publication: 2021.
Author
Sato Y.; Kawakami R.; Sakamoto A.; Cornelissen A.; Mori M.; Kawai K.;
Ghosh S.; Romero M.E.; Kolodgie F.D.; Virmani R.; Finn A.V.
Institution
(Sato, Kawakami, Sakamoto, Cornelissen, Mori, Kawai, Ghosh, Romero,
Kolodgie, Virmani, Finn) CVPath Institute, Gaithersburg, MD, United States
(Finn) University of Maryland, School of Medicine, Baltimore, MD, United
States
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Cerebrovascular events are one of the most serious
consequences after transcatheter aortic valve replacement (TAVR). More
than half of the cerebrovascular events following TAVR are due to
procedure-related emboli. Embolic protection devices (EPDs) have the
potential to decrease cerebrovascular events during TAVR procedure.
However, randomized controlled trials (RCTs) have not conclusively
determined if EPDs are effective, likely because of small number of
patients enrolled. However, meta-analyses and propensity-matched analyses
from large registries have shown efficacy and suggest the importance of
EPDs in prevention of stroke during TAVR and perhaps other structural
heart procedures. Areas covered: This review will focus on clinical and
histopathologic studies examining the efficacy, safety, and
histopathologic device capture findings in the presence and absence of
EPDs during TAVR procedures. Expert opinion: Clinical studies have not
conclusively determined the efficacy of EPDs. Current ongoing large-scale
RCT (PROTECTED TAVR [NCT04149535]) has the potential to prove their
efficacy. Histopathological evaluation of debris captured by EPDs
contributes to our understanding of the mechanisms of TAVR
procedure-related embolic events and suggests the importance of preventing
cerebral embolization of debris released during this and other structural
heart procedures. Copyright © 2021 Informa UK Limited, trading as
Taylor & Francis Group.

<27>
Accession Number
2015133671
Title
Using telemedicine to improve the quality of life of parents of infants
with CHD surgery after discharge.
Source
International Journal for Quality in Health Care. 33(3) (no pagination),
2021. Article Number: mzab133. Date of Publication: 2021.
Author
Zhang Q.-L.; Lei Y.-Q.; Liu J.-F.; Cao H.; Chen Q.
Institution
(Zhang, Lei, Liu, Cao, Chen) Department of Cardiac Surgery, Fujian Branch
of Shanghai Children's Medical Center, No.966 of Hengyu Road, Fuzhou,
Fujian 350014, China Fujian Children's Hospital, No.966 of Hengyu Road,
Fuzhou, Fujian 350014, China Fujian Maternity and Child Health Hospital,
Affiliated Hospital of Fujian Medical University, No.18 of Danshan Road,
Fuzhou, Fujian 350001, China Fujian Key Laboratory of Women and Children's
Critical Diseases Research, Fujian Maternity and Child Health Hospital,
No.18 of Danshan Road, Fuzhou, Fujian 350001, China
Publisher
Oxford University Press
Abstract
Objective: The purpose of this study was to investigate the effect of
using telemedicine to improve the quality of life of parents of infants
with congenital heart disease (CHD) surgery after discharge.
 Method(s): A prospective randomized controlled study was conducted in
a provincial hospital in China from November 2020 to April 2021 to compare
the quality of life of parents of infants with CHD surgery after discharge
between the WeChat follow-up group and the outpatient follow-up group. A
total of 84 patients (42 in each group) and 168 parents (84 in each group)
participated in this study. Result(s): One month after discharge, the
Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)
scores of parents in the intervention group were significantly lower than
those in the control group (P < 0.05). Compared with the SAS and SDS
scores at discharge, the scores of parents in the intervention group were
significantly lower at 1 month after discharge (P < 0.05), while the
scores of parents in the control group were similar at 1 month after
discharge (P > 0.05). At discharge, in both the intervention group and the
control group, the SAS and SDS scores of the mothers were higher than
those of the fathers (P < 0.05). One month after discharge, in the control
group, the SAS and SDS scores of the mothers were higher than those of the
fathers (P < 0.05). One month after discharge, in the intervention group,
the SAS and SDS scores of the mothers were similar to those of the fathers
(P > 0.05). The comparison of the SAS and SDS scores of parents with
different education levels showed that in both the intervention group and
control group, the lower the parents' educational levels, the higher their
SAS and SDS scores (P < 0.05). One month after discharge, in the control
group, the lower the parents' education levels, the higher their SAS and
SDS scores (P < 0.05). One month after discharge, in the intervention
group, the SAS and SDS scores were similar among parents with different
educational levels. The results of the World Health Organization Quality
of Life Brief scale showed that the scores of the physiological,
psychological, social and environmental fields at 1 month after discharge
in the intervention group were significantly higher than those in the
control group (P < 0.05). Conclusion(s): Providing health education
and medical support to the parents of infants with CHD surgery after
discharge via telemedicine can effectively relieve parents' anxiety and
depression and improve their quality of life. Copyright © 2021
The Author(s) 2021. Published by Oxford University Press on behalf of
International Society for Quality in Health Care. All rights reserved.

<28>
Accession Number
2015131610
Title
Propofol pharmacokinetics and pharmacodynamics-a perspective in minimally
invasive extracorporeal circulation.
Source
Interactive Cardiovascular and Thoracic Surgery. 33(4) (pp 625-627), 2021.
Date of Publication: 01 Oct 2021.
Author
Condello I.; Santarpino G.; Fiore F.; Di Bari N.; Speziale G.; Moscarelli
M.; Nasso G.
Institution
(Condello, Santarpino, Fiore, Speziale, Moscarelli, Nasso) Department of
Cardiac Surgery, Anthea Hospital, Gvm Care and Research, Bari, Italy
(Santarpino) Paracelsus Medical University, Nuremberg, Germany
(Santarpino) Cardiac Surgery Unit, Department of Experimental and Clinical
Medicine, "magna Graecia", University of Catanzaro, Italy
(Di Bari) Division of Cardiac Surgery, Dipartimento di Emergenza e
Trapianti di Organo (D.E.T.O.), University of Bari, Bari, Italy
Publisher
Oxford University Press
Abstract
There is limited evidence as to the pharmacokinetic changes expected in
adults with extracorporeal technologies. Drugs may be taken up by various
components of the cardiopulmonary bypass circuit itself. Issues include
the increased volume of the circuit leading to haemodilution; the
sequestration of lipophilic drugs within the circuit tubing; and the
absorption of proteins, especially albumin, onto the circuit, which can
result in increased free drug. However, in this context, the aspect of
pharmacokinetics and pharmacodynamics during minimally invasive
extracorporeal circulation has not been described and evidenced by
scientific studies. In this single-centre control study of 60 patients
undergoing isolated coronary artery bypass grafting, we present the
results focused on postoperative albumin values and intraoperative
propofol dosages in patients undergoing surgery with minimally invasive (n
= 30) versus conventional extracorporeal circulation (n = 30). In the
minimally invasive extracorporeal circulation group, a lower propofol
dosage titrated to a bispectral index of 40-45 was used during coronary
artery bypass grafting, and an improvement of postoperative concentration
of serum albumin was observed compared to the conventional extracorporeal
circulation group. Copyright © The Author(s) 2021. Published by
Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<29>
Accession Number
2015131593
Title
A pooled analysis of pacemaker implantation after Perceval sutureless
aortic valve replacement.
Source
Interactive Cardiovascular and Thoracic Surgery. 33(4) (pp 501-509), 2021.
Date of Publication: 01 Oct 2021.
Author
Moscarelli M.; Santarpino G.; Athanasiou T.; Mastroroberto P.; Fattouch
K.; Nasso G.; Speziale G.
Institution
(Moscarelli, Nasso, Speziale) Department of Cardiovascular Surgery, Anthea
Hospital, Gvm Care and Research, Bari, Italy
(Moscarelli, Athanasiou) Imperial College, Nhli, Hammersmith Hospital,
London, United Kingdom
(Santarpino, Mastroroberto) Department of Clinical and Experimental
Medicine, Magna Graecia University, Catanzaro, Italy
(Santarpino) Department of Cardiac Surgery, Paracelsus Medical University,
Nuremberg, Germany
(Fattouch) Department of Cardiovascular Surgery, Maria Eleonora Hospital,
Gvm Care and Research, Palermo, Italy
Publisher
Oxford University Press
Abstract
OBJECTIVES: We performed a literature meta-analysis to estimate the rate
of pacemaker implantation after Perceval sutureless aortic valve
replacement. METHOD(S): Pertinent articles were identified from the
PubMed, Google Scholar, Ovid MEDLINE and Ovid EMBASE databases. Eligible
studies reported the de novo incidence of postoperative pacemaker
implantation after Perceval valve surgery. Among 394 articles retrieved,
26 studies including 9492 patients met the inclusion criteria.
 RESULT(S): The pooled event rate for postoperative pacemaker
implantation was 7% [95% confidence interval (CI) 6-9%]; however,
significant heterogeneity was observed across studies. In a sub-analysis,
there was no difference between the rates of pacemaker implantation
calculated from multicentre and registry studies (8 studies, 6845
patients; 7%, 95% CI 5-10%) and single-centre studies (18 studies, 2647
patients; 7%, 95% CI 5-9%; P = 0.75). Implantation rates were similar in
high-volume studies (16 studies, 9121 patients; 7%, 95% CI 5-8%) than in
low-volume studies (10 studies, 371 patients; pooled rate: 7%, 95% CI
4-14%; P = 0.5). Postoperative pacemaker implantation rates tended to
decrease over time. CONCLUSION(S): With a pooled event rate of 7%,
postoperative pacemaker implantation remains an important limitation of
Perceval sutureless valve surgery, although we observed a degree of
variability across included studies. The resultant findings provide a
useful estimate for physicians and patients and can serve as a benchmark
for future comparative studies. Copyright © 2021 The Author(s).
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<30>
Accession Number
634739748
Title
Withholding vs. Continuing Angiotensin-Converting Enzyme Inhibitors or
Angiotensin Receptor Blockers Before Non-cardiac Surgery in Older
Patients: Study Protocol for a Multicenter Randomized Controlled Trial.
Source
Frontiers in Medicine. 8 (no pagination), 2021. Article Number: 654700.
Date of Publication: 30 Mar 2021.
Author
Yang Y.-F.; Zhu Y.-J.; Long Y.-Q.; Liu H.-Y.; Shan X.-S.; Feng X.-M.; Peng
K.; Ji F.-H.
Institution
(Yang, Zhu, Long, Liu, Shan, Peng, Ji) 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
Publisher
Frontiers Media S.A.
Abstract
Background: Older hypertensive adults are at increased risk for
postoperative morbidity and mortality. As first line antihypertensive drug
therapy, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin
receptor blockers (ARBs) have many beneficial effects. However, the use of
ACEIs/ARBs in the perioperative period remains controversial. This study
aims to determine the effects of withholding vs. continuing ACEIs/ARBs
before non-cardiac surgery on perioperative hypotension and postoperative
outcomes in older patients. Method(s): In this multicenter,
randomized, double-blind, placebo-controlled trial, a total of 2036
patients aged 60-80 years undergoing non-cardiac surgical procedures will
be randomly assigned, in a 1:1 ratio, to receive oral ACEIs/ARBs (the
ACEIs/ARBs continued group) or inactive placebos (the ACEIs/ARBs withheld
group) on the morning of surgery. For both groups, the ACEIs/ARBs will be
continued from the first postoperative day. The primary outcome measure is
the incidence of perioperative hypotensive events, defined as mean blood
pressure (MBP) < 65 mmHg or >=30% reduction in MBP from baseline during
surgery and in a post-anesthesia care unit. The secondary outcomes include
duration of perioperative hypotension, intraoperative use of fluids and
vasopressors, hypotensive events within postoperative 3 days, and
perioperative neurocognitive disorders, major adverse cardiocerebral
events (a composite outcome of stroke, coma, myocardial infarction, heart
block, and cardiac arrest), and mortality within 30 days after surgery.
 Discussion(s): The results of this trial will offer an evidence-based
perioperative ACEIs/ARBs therapy for older hypertensive adults undergoing
non-cardiac surgery. Study Registration: This study is approved by the
Medical Ethics Committee of The First Affiliated Hospital of Soochow
University (Approval No. 2020-077-1) and by the institutional ethics
review board of each participating center. This protocol is registered at
the Chinese Clinical Trials Registry (ChiCTR2000039376). ©
Copyright © 2021 Yang, Zhu, Long, Liu, Shan, Feng, Peng and Ji.

<31>
Accession Number
634019146
Title
Effect of Prolonged Hypothermic Cardiopulmonary Bypass, Heparin, and
Protamine on Platelet: A Small-Group Study.
Source
Thoracic and Cardiovascular Surgeon. 69(8) (pp 719-722), 2021. Date of
Publication: 01 Dec 2021.
Author
Epstein D.; Vishnepolsky A.; Bolotin G.; Atweh N.; Bonstein L.; Lehavi A.
Institution
(Epstein) Department of Internal Medicine B, Rambam Health Care Campus,
Haifa, Israel
(Vishnepolsky, Lehavi) Department of Anesthesiology, Rambam Health Care
Campus, Haifa, Israel
(Bolotin) Department of Cardiac Surgery, Rambam Health Care Campus, Haifa,
Israel
(Bolotin, Bonstein, Lehavi) Ruth and Bruce Rappaport Faculty of Medicine,
Technion - Israel Institute of Technology, Haifa, Israel
(Atweh, Bonstein) Blood Bank and Platelet Immunology Laboratories, Rambam
Health Care Campus, Haifa, Israel
Publisher
Georg Thieme Verlag
Abstract
Cardiopulmonary bypass (CPB) is associated with platelet dysfunction (PD),
an important cause of postoperative bleeding. The etiology of PD is not
completely understood. We mapped the platelets' function during CPB to
determine the etiology of PD. Platelets activation, measured by procaspase
activating compound-1 and P-selectin expression (CD62P), after activation
by adenosine diphosphate and thrombin receptor activator peptide, were
decreased by protamine. Changes during CPB were insignificant.
Platelet-leukocyte aggregation was increased by CPB but not by protamine.
Platelet apoptosis marker, annexin V, was increased by protamine. Changes
during CPB were insignificant. Our findings demonstrate that protamine
given after CPB plays a central role in PD and count
decrease. Copyright © 2021 American Medical Association. All
rights reserved.

<32>
Accession Number
2005621634
Title
Anticoagulation in Patients with Aortic Stenosis and Atrial Fibrillation.
Source
Structural Heart. (no pagination), 2020. Date of Publication: 2020.
Author
Chugh Y.; Patel K.; Maraboto Gonzalez C.A.; Li D.; Gossl M.
Institution
(Chugh) Mount Sinai St Luke's and West Hospital, New York, United States
(Patel) Montefiore Medical Center, Bronx, NY, United States
(Maraboto Gonzalez) Tulane Medical Center, New Orleans, LA, United States
(Li) Vanderbilt University Medical Center, Nashville, TN, United States
(Gossl) Valve Science Center at the Minneapolis Heart Institute
Foundation, Abbott Northwestern Hospital, Minneapolis, MN, United States
Publisher
Bellwether Publishing, Ltd.
Abstract
There is a rising prevalence of patients with coexisting valvular heart
disease (VHD) and atrial fibrillation (AF). Anti-coagulating these
patients is often a clinical challenge, as they pose a greater bleeding
risk on treatment than patients without VHD, and a greater risk of stroke
or systemic embolism if anticoagulation is withheld. Patients with aortic
stenosis (AS), in particular, have the highest rates of stroke and
bleeding risk amongst VHD subtypes. Data comparing direct oral
anticoagulants (DOAC) to Warfarin in patients with various VHD subtypes
and AF is limited. Available post-hoc analysis have shown that Rivaroxaban
maybe associated with more major bleeding when used in patients with AS,
mitral regurgitation (MR) or aortic regurgitation (AR), but similar rates
of stroke or systemic embolism compared to Warfarin. Apixaban was found to
have comparable outcomes with Warfarin in patients with AS, MR or AR.
Although Dabigatran and Edoxaban have similar safety and efficacy profiles
to Warfarin in VHD patients, there is no available outcome data by valve
disease subtype, particularly AS, which is the focus of our review.
Further well-powered randomized trials evaluating various oral
anticoagulant regimens are needed for the growing population of patients
with AS and AF. Copyright © 2020, © 2020 Cardiovascular
Research Foundation.

<33>
Accession Number
2017308580
Title
CLINICAL CHARACTERISTICS, EVALUATION AND OUTCOMES OF CHYLOPERICARDIUM: A
SYSTEMATIC REVIEW.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 1352), 2022. Date of
Publication: 08 Mar 2022.
Author
Verma B.; Kumar A.; Verma N.; Agrawal A.; Yesilyaprak A.; Furqan M.;
Mahalwar G.; Raeisi-Giglou P.; Schleicher M.; Nasser M.; Wang T.; Klein
A.L.
Institution
(Verma, Kumar, Verma, Agrawal, Yesilyaprak, Furqan, Mahalwar,
Raeisi-Giglou, Schleicher, Nasser, Wang, Klein) MetroHealth, Cleveland,
OH, United States
(Verma, Kumar, Verma, Agrawal, Yesilyaprak, Furqan, Mahalwar,
Raeisi-Giglou, Schleicher, Nasser, Wang, Klein) Cleveland Clinic,
Cleveland, OH, United States
Publisher
Elsevier Inc.
Abstract
Background Chylopericardium (CPE) is a rare disease of the pericardium. We
conducted a systematic review to understand its clinical characteristics,
management, and after-discharge outcomes. Methods We systematically
identified published cases of CPE from inception until May
27th, 2021 for pooled analysis of clinical, diagnostic and
outcome data. Results A total of 95 articles with 98 patients were
identified. Demographics demonstrated male predominance (55%) with a mean
age of 37.4+14.7 years. Time to diagnosis from symptom onset was 4.8 [4.5,
14] days. Concomitant cardiac tamponade was seen in 38%. Initial treatment
included conservative management (66%), however to identify the leakage
site lymphangiography was performed in 59% and 32% progressed towards
surgical intervention (thoracic duct ligation). During median follow-up of
180 [90, 377] days, CPE recurred in 16%, requiring re-intervention i.e
pericardiocentesis or pericardial window in 6% and re-hospitalization in
10%. 6% cases experienced death predominately due to
non-cardiac/underlying co-morbidities. Conclusion CPE tends to present in
younger patients, concomitantly with cardiac tamponade and may fail
medical management requiring surgical intervention. Although overall
mortality is low, associated morbidities warrant closer follow-up for
re-intervention or hospitalization after index discharge. [Formula
presented] Copyright © 2022 American College of Cardiology
Foundation

<34>
Accession Number
2017307712
Title
INCIDENCE AND PROGNOSIS OF WORSENING RENAL FUNCTION IN PATIENTS WITH HEART
FAILURE AND SECONDARY MITRAL REGURGITATION: THE COAPT TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 1696), 2022. Date of
Publication: 08 Mar 2022.
Author
Kong J.; Zaroff J.G.; Ambrosy A.P.; Ku I.; Mishell J.M.; Kotinkaduwa L.;
Redfors B.; Beohar N.; Ailawadi G.; Lindenfeld J.; Abraham W.T.; Mack
M.J.; Stone G.W.
Institution
(Kong, Zaroff, Ambrosy, Ku, Mishell, Kotinkaduwa, Redfors, Beohar,
Ailawadi, Lindenfeld, Abraham, Mack, Stone) Kaiser Permanente Northern
California, San Francisco, CA, United States
(Kong, Zaroff, Ambrosy, Ku, Mishell, Kotinkaduwa, Redfors, Beohar,
Ailawadi, Lindenfeld, Abraham, Mack, Stone) Cardiovascular Research
Foundation, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background Acute kidney injury (AKI) is a known complication of
transcatheter mitral valve repair (TMVr) and has been associated with a
poor prognosis. However, AKI may be transient and the implications of
persistent worsening renal function (WRF) after TMVr are unknown. Methods
In the COAPT trial, 614 patients with heart failure and severe secondary
mitral regurgitation (MR) were randomized to TMVr with the MitraClip plus
guideline-directed medical therapy (GDMT) vs. GDMT alone. WRF was defined
as a serum creatinine increase >=1.5x or >=0.3 mg/dL from baseline that
persisted to day 30 or requiring renal replacement therapy. Predictors of
WRF and its association with subsequent death and all-cause
hospitalization were assessed. Results WRF occurred in 11.3% of patients
(TMVr 9.7% vs GDMT alone 13.1%, p=0.23). Patients with WRF had more
co-morbidities and lower estimated creatinine clearance at baseline
(44+/-17 vs 53+/-28 mL/min, p=0.02). After adjusting for confounders, WRF
was independently associated with death (HR 1.66 [1.07, 2.59], p=0.025)
but not hospitalization (HR 1.42 [0.99, 2.05], p=0.057) between 30 days to
2 years. There were no interactions between WRF and treatment with TMVr
for death (p<inf>int</inf>=0.53) or hospitalization (p<inf>int</inf>=0.83)
(Figure). Conclusion Among patients with HF and severe secondary MR, WRF
at 30 days occurred in 11% of patients and was not more frequent after
TMVr than GDMT alone. Although associated with greater mortality, WRF did
not modify the benefit of TMVr on clinical outcomes. [Formula
presented] Copyright © 2022 American College of Cardiology
Foundation

<35>
Accession Number
2017307396
Title
OUTCOMES OF CARDIAC SURGERY WITH LEFT ATRIAL APPENDAGE OCCLUSION VERSUS NO
OCCLUSION, DIRECT ORAL ANTICOAGULANTS, AND VITAMIN K ANTAGONISTS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 87), 2022. Date of
Publication: 08 Mar 2022.
Author
Nso N.; Nassar M.; Lakhdar S.; Shaukat T.; Guzman L.; Bhangal R.; Alshamam
M.; Rizzo V.V.; Munira M.S.; Radparvar F.; Thambidorai S.
Institution
(Nso, Nassar, Lakhdar, Shaukat, Guzman, Bhangal, Alshamam, Rizzo, Munira,
Radparvar, Thambidorai) Icahn School of Medicine at Mount Sinai (NYC
H+H/Queens), Jamaica, NY, United States
(Nso, Nassar, Lakhdar, Shaukat, Guzman, Bhangal, Alshamam, Rizzo, Munira,
Radparvar, Thambidorai) HCA Medical City of Fort Worth, Fort Worth, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: Left atrial appendage occlusion (LAAO) is being used
increasingly in the setting of atrial fibrillation but has been associated
with procedural complications. This systematic review and meta-analysis
compared the outcomes of LAAO with those of no LAAO and use of direct oral
anticoagulants (DOACs) and vitamin K antagonists (VKAs) Methods: We
utilized PRISMA (Preferred Reporting Items for Systematic Reviews and
Meta-Analysis) guidelines to perform this systematic review and
meta-analysis. A literature search was undertaken for relevant studies
published between January 1, 2003 and August 15, 2021. Primary clinical
outcomes were all-cause mortality, embolic events, and stroke. Secondary
clinical outcomes included major adverse cardiac events (MACE),
postoperative atrial fibrillation, postoperative complications,
reoperation for bleeding, and major bleeding. Result(s): There was a
statistically significant 34% reduction in incidence of embolic events
(odds ratio [OR] 0.66, 95% confidence interval [CI] 0.57-0.77, p<0.001)
and a significant 42% reduction in risk of MACE (OR 0.58, 95% CI
0.38-0.88, p=0.01) in patients who underwent LAAO and a 28% higher risk of
postoperative complications in those who did not (OR 1.28, 95% CI
1.15-1.42, p<0.001). There was a significant reduction (33%) in major
bleeding episodes in the LAAO group compared with the DOAC group (OR 0.67,
95% CI 0.47-0.96, p=0.03). Conclusion(s): LAAO is a safe option
because of its potential to reduce embolic events, MACE, and postoperative
complications in patients undergoing cardiac surgery for atrial
fibrillation. However, complete replacement of DOACs and warfarin therapy
with LAAO is unlikely despite its superiority in terms of minimizing major
bleeding episodes in patients on oral anticoagulation
therapies. Copyright © 2022 American College of Cardiology
Foundation

<36>
Accession Number
2017307170
Title
PERCUTANEOUS INTERVENTION OR BYPASS GRAFT FOR LEFT MAIN CORONARY ARTERY
DISEASE WITH LOW EJECTION FRACTION - A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 941), 2022. Date of
Publication: 08 Mar 2022.
Author
Ullah W.; Mene-Afejuku T.O.; Zahidullah H.; Zahid S.; Abedin M.S.U.;
Mehreen R.; Pasha A.; Minhas A.M.K.; Khan M.Z.; Fischman D.L.
Institution
(Ullah, Mene-Afejuku, Zahidullah, Zahid, Abedin, Mehreen, Pasha, Minhas,
Khan, Fischman) Thomas Jefferson University Hospital, Philadelphia, PA,
United States
Publisher
Elsevier Inc.
Abstract
Background: The safety and efficacy of percutaneous coronary intervention
(PCI) versus coronary artery bypass grafting (CABG) for stable left main
coronary artery disease (LMCAD) in patients with low ejection fraction
(EF) (<50%) remains controversial. Method(s): Digital databases were
searched to compare the major adverse cardiovascular and cerebrovascular
events (MACE) and it's components. A random-effect model was used to
compute an unadjusted odds ratio (OR) Results: A total of 7 studies
comprising 3590 patients were included. On pooled analysis, there was no
significant difference in the odds of MACE (OR 1.36, 95% CI 0.93-1.99,
P=12), MI (OR 1.45, 95% CI 0.80-2.62, P=0.32), stroke (OR 0.39, 95% CI
0.15-1.05, P=0.06) and all-cause mortality (OR 1.14, 95% CI 0.64-2.03,
P=0.66) between patients undergoing PCI vs. CABG for LMCAD with reduced
EF. PCI was associated with a higher rate of need for repeat
revascularization compared to CABG (OR, 1.97; 95% CI, 1.35-2.88;
P=0.0005). A stratified analysis based on follow up duration and study
design followed the pooled findings with a few exceptions. In contrast to
overall odds, the risk of MACE and mortality was lower in the PCI-arm at
30 days, while the 1- and 2-year rate of MACE favored CABG
 Conclusion(s): PCI might serve as a reasonable alternative to CABG
for patients with LMCAD and low EF due to a similar rate of major adverse
cardiovascular events and its components [Formula presented] Copyright
© 2022 American College of Cardiology Foundation

<37>
Accession Number
2017305074
Title
CLINICAL OUTCOME OF REVASCULARIZATION DEGREE WITH PERCUTANEOUS CORONARY
INTERVENTION (PCI) PRIOR TO TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR):
A COMPREHENSIVE META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 725), 2022. Date of
Publication: 08 Mar 2022.
Author
Ghanem F.H.; Altibi A.; Al-Taweel O.; Jbara M.H.; Alshami M.; Rahmouni H.
Institution
(Ghanem, Altibi, Al-Taweel, Jbara, Alshami, Rahmouni) East Tennessee State
University, Johnson City, TN, United States
(Ghanem, Altibi, Al-Taweel, Jbara, Alshami, Rahmouni) Oregon Health &
Science University, Portland, OR, United States
Publisher
Elsevier Inc.
Abstract
Background: Active Coronary Artery Disease (CAD) is a common finding
before TAVR, the clinical outcome of revascularization degree pre-TAVR
remains controversial. Method(s): We searched the literature to
identify studies reporting on patients with significant CAD undergoing PCI
prior to TAVR. We identified studies reporting on the status of
revascularization with PCI: (i) complete revascularization, and (ii)
incomplete revascularization. Random-effects meta-analyses with the
inverse variance method were used to estimate the effect size.
 Result(s): A total of 10 studies reporting on a total of 2494
patients who underwent either CR (n= 770) or IR (n= 1724). The pooled
30-day all-cause mortality was 2.7% in CR group versus 7.5% in IR group.
IR was associated with a decreased risk of 30-day mortality (OR= 0.31, 95%
CI: 0.17-0.58, p-value < 0.01). To the contrary, the pooled 12-month
all-cause mortality was 24.4% in CR group versus 12.5% in IR group. IR was
associated with an increased risk of 12-month mortality (OR 2.37, 95% CI:
1.36-4.14, p-value < 0.01). Conclusion(s): In CAD patient population
undergoing TAVI for severe AS, incomplete revascularization was associated
with an improvement in short-term mortality. However, it was associated
with an increased risk for long-term mortality. [Formula
presented] Copyright © 2022 American College of Cardiology
Foundation

<38>
Accession Number
2017305031
Title
HIGHER ODDS OF LONG-TERM ALL-CAUSE MORTALITY WITH PERSISTENT PULMONARY
HYPERTENSION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 718), 2022. Date of
Publication: 08 Mar 2022.
Author
Sachdeva S.; Khandait H.; Bhandari J.; Naik S.; Hashem A.; Sukaina M.;
Desai R.; Vyas A.; Jain A.
Institution
(Sachdeva, Khandait, Bhandari, Naik, Hashem, Sukaina, Desai, Vyas, Jain)
Mercy Catholic Medical Center, Darby, PA, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) has been
accepted as a treatment modality of choice for patients with severe aortic
stenosis (AS) with high surgical risk. Present risk model for estimating
the risk of failure to recover does not include persistent pulmonary
hypertension status after TAVR, and, therefore we aimed to evaluate the
same. Method(s): We systematically searched PubMed, Google Scholar,
and SCOPUS and identified studies reporting outcomes in patients with
persistent pulmonary hypertension after TAVR on long-term followup. We
used a random-effects model for pooled relative risk of long term
all-cause mortality between patients who had had pulmonary hypertension
after TAVR vs those who did not. I2 statistics and leave-one-out methods
were used for heterogeneity and sensitivity analysis, respectively.
 Result(s): After initial electronic search (102 articles), 7 studies
(n=2789, 49.31% males, mean age 80.991+/-2.528 years) were included in the
final analysis. Pooled and sensitivity analysis both demonstrated higher
odds of long-term all-cause mortality in patients with persistent
pulmonary hypertension after TAVR than those with improved pulmonary
hypertension after the procedure (HR 2.799, 95% CI: 2.068-3.789, p=<0.001,
I2= 25.51%). Conclusion(s): Persistent pulmonary hypertension after
TAVR bears poor prognosis in terms of higher odds of long term all-cause
mortality, and, therefore needs prospective validation for incorporation
into future risk models. [Formula presented] Copyright © 2022
American College of Cardiology Foundation

<39>
Accession Number
2017304931
Title
OUTCOMES OF EMERGENCY TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR): AN
UPDATED META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 709), 2022. Date of
Publication: 08 Mar 2022.
Author
Ismayl M.; Balakrishna A.M.; Pajjuru V.S.K.; Thandra A.; Smer A.M.
Institution
(Ismayl, Balakrishna, Pajjuru, Thandra, Smer) Creighton University School
of Medicine, Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
Background: With the increased expertise in performance of transcatheter
aortic valve replacement (TAVR) since its approval, it has also emerged as
a rescue therapy in patients with cardiogenic shock (CS) from
decompensated severe aortic stenosis. However, prior randomized control
trials evaluating TAVR outcomes were elective and selectively excluded
hemodynamically unstable patients requiring ionotropic support. Therefore,
we aim to assess the outcomes of emergency TAVR in patients with CS.
 Method(s): We searched PubMed, Cochrane Central, and EMBASE for
studies on outcomes of emergency TAVR, especially in cardiogenic shock.
Primary outcomes included in-hospital and 30-day mortality rates.
Secondary outcomes included device success rate, need for mechanical
circulatory support (MCS), major bleeding, major vascular complications,
myocardial infarction (MI), heart block, need for pacemaker, stroke, acute
kidney injury (AKI), and need for dialysis. Result(s): We included 6
studies with 25,370 patients in the meta-analysis. Mean age was 79 years
and 48.1% were males. On average, the in-hospital and 30-day mortality
rates were 9.5% (95% confidence interval [CI]: 3.1-25.3) and 13.1% (95%
CI: 4.7-31.6) for emergency TAVR, respectively. Refer to table 1 for
secondary outcomes. Conclusion(s): TAVR in the setting of CS has high
mortality rates which is mainly driven by pre-procedural shock. Emergency
TAVR can still be considered as a reasonable approach in selected
patients. [Formula presented] Copyright © 2022 American College
of Cardiology Foundation

<40>
Accession Number
2017304740
Title
PREDICTORS OF HEART FAILURE HOSPITALIZATION AFTER TRANSCATHETER AORTIC
VALVE IMPLANTATION: A META ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 696), 2022. Date of
Publication: 08 Mar 2022.
Author
Khandait H.; Sachdeva S.; Bhandari J.; Fichadiya H.; Yasmin F.; Desai R.;
Vyas A.; Jain A.; Badheka A.
Institution
(Khandait, Sachdeva, Bhandari, Fichadiya, Yasmin, Desai, Vyas, Jain,
Badheka) Trinitas Regional Medical Center, Elizabeth, NJ, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcutaneous aortic valve implantation (TAVI) has
transformed the management of Aortic Stenosis (AS) and is increasingly
being used for intermediate and low-risk AS. This study analyzes the risk
factors for heart failure (HF) hospitalization post-TAVI. Method(s):
A systematic literature search of PUBMED, Google Scholar, and SCOPUS
databases was performed to identify studies reporting heart failure
hospitalization after TAVI. Data on the relative risk (RR) with a 95%
confidence interval were collected and pooled to compute the RR using
random-effects models. Result(s): Total nine studies were included
with 5407 patients undergoing TAVI with a median follow-up for one year.
The mean age was 82.78 +/- 24.91 and 44.57% were males. Major factors
evaluated for HF hospitalization were age, gender, comorbidities such as
hypertension, atrial fibrillation (AF), chronic pulmonary disease
including COPD, history of myocardial infarction, baseline LVEF before the
procedure, NYHA symptom class, society of thoracic surgeons (STS) score,
and a few others. The presence of diabetes mellitus, chronic kidney
disease (CKD), atrial fibrillation, chronic pulmonary disease, and a high
STS score were predictive of HF hospitalization after TAVI (Figure 1).
 Conclusion(s): Patients with diabetes mellitus, AF, CKD, chronic
pulmonary disease, and a high STS score are at increased risk of heart
failure hospitalization post-TAVI, whereas LVEF <50% and NYHA symptoms do
not predict hospitalization. [Formula presented] Copyright © 2022
American College of Cardiology Foundation

<41>
Accession Number
2017304686
Title
PREDICTION OF PERIOPERATIVE MAJOR ADVERSE CARDIOVASCULAR AND
CEREBROVASCULAR EVENTS (MACCE) USING AUTOMATED MACHINE LEARNING (AUTOML)
ALGORITHMS WITH GOOGLE AUTOML TABLES (GAMLT) USING THE AMERICAN COLLEGE OF
SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (ACS NSQIP)
DATABASE.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 2052), 2022. Date of
Publication: 08 Mar 2022.
Author
Thangirala A.; Aphinyanaphongs Y.; Kan K.; Talmor N.; Smilowitz N.R.
Institution
(Thangirala, Aphinyanaphongs, Kan, Talmor, Smilowitz) New York University
Langone Health, New York, NY, United States
Publisher
Elsevier Inc.
Abstract
Background: Risk calculators to predict perioperative major adverse
cardiovascular and cerebrovascular events (MACCE) often rely on logistic
regression (LR) analysis. Automated machine learning (AutoML) processes
regularly outperform regular machine learning (ML) and LR methods for
predictive accuracy. Commercial AutoML systems have not yet been applied
to predict perioperative MACCE after non-cardiac and cardiac surgeries.
 Method(s): We used a commercial AutoML system, Google AutoML Tables
(GAMLT), to predict perioperative MACCE in the 2019 ACS NSQIP database.
MACCE was defined as death, myocardial infarction, cardiac arrest, or
stroke. Default AutoML settings were used, with 80% of cases randomly
selected for training, 10% for validation, and 10% for testing. Global
feature importance was determined through the Shapley method. Two models
were generated: Model 1 included 81 pre-operative features; Model 2
included the top 21 features from Model 1 and was independently validated
with 2016-2018 NSQIP data. Result(s): Model 1 yielded an area under
the receiver operating characteristic (AUROC) of 0.934 in the 2019 ACS
NSQIP dataset. Model 2, an ensemble of 25 feedforward neural net models,
yielded an AUROC of 0.914-0.920 for MACCE in 2016-2019 (Figure).
 Conclusion(s): Compared to existing risk calculators, GAMLT-derived
models offered novel feature detection and comparable predictive
performance for MACCE. AutoML analyses should be considered for risk
estimation of perioperative MACCE. [Formula presented] Copyright
© 2022 American College of Cardiology Foundation

<42>
Accession Number
2017304125
Title
MATERNAL AND FETAL OUTCOME OF PREGNANCY IN WOMEN WITH D TRANSPOSITION
(D-TGA) OF THE GREAT ARTERIES AFTER ATRIAL AND ARTERIAL SWITCH OPERATIONS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 1963), 2022. Date of
Publication: 08 Mar 2022.
Author
Pizula J.; Devera J.; Ng T.M.H.; Mehra A.O.; Elkayam U.
Institution
(Pizula, Devera, Ng, Mehra, Elkayam) University of Southern California,
Los Angeles, CA, United States
Publisher
Elsevier Inc.
Abstract
Background: Pregnancy in women with D-TGA is listed as Class III in the
Modified World Health Organization (WHO) classification of maternal
cardiovascular risk predicting high morbidity and mortality. This
prediction is based on limited data from small retrospective studies. We
sought to evaluate maternal and fetal outcomes of pregnancy in women with
D-TGA and compare those with atrial switch operation (ATSO) and arterial
switch operation (ASO). Method(s): A systematic review of published
studies in English between 2005 and 2021 examining the outcomes of
pregnancy in women with D-TGA. Result(s): 610 pregnancies in 409
women were reviewed. 490 pregnancies were reported with ATSO and 120 with
ASO. Most patients in both groups were in NYHA functional class I-II
before pregnancy. Approximately half of the patients with ATSO had mild to
moderate dysfunction of the systemic ventricle and mild to moderate
tricuspid regurgitation. Maternal and fetal outcomes are shown in the
table. Conclusion(s): WHO classification overestimates the maternal
risk of pregnancy in women with D-TGA. Most of such patients tolerate
pregnancy well. Rate of mortality was low; heart failure and arrhythmias
were the most common maternal complications with a numerically but not
significantly higher incidence in women with ATSO. In contrast rate of
fetal complications including premature delivery were normal in women with
ASO but significantly increased in women with ATSO. [Formula
presented] Copyright © 2022 American College of Cardiology
Foundation

<43>
Accession Number
2017303953
Title
RHYTHM VERSUS RATE CONTROL IN PATIENTS WITH POSTOPERATIVE ATRIAL
FIBRILLATION FOLLOWING CARDIAC SURGERY: A SYSTEMATIC REVIEW AND
META-ANALYSIS.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 44), 2022. Date of
Publication: 08 Mar 2022.
Author
Ahmed M.; Belley-Cote E.; Qiu Y.; Belesiotis P.; Tao B.; Wolf A.; Kaur H.;
Ibrahim A.; Healey J.S.; Conen D.; Devereaux P.J.; Whitlock R.; McIntyre
W.F.
Institution
(Ahmed, Belley-Cote, Qiu, Belesiotis, Tao, Wolf, Kaur, Ibrahim, Healey,
Conen, Devereaux, Whitlock, McIntyre) McMaster University, Hamilton,
Canada
Publisher
Elsevier Inc.
Abstract
Background: Postoperative atrial fibrillation (POAF) is the most common
complication after cardiac surgery and is associated with morbidity and
mortality. Whether these patients should be treated with rhythm or rate
control is unclear. Method(s): We searched MEDLINE, Embase and
CENTRAL to July 2021. We included randomized controlled trials (RCTs) that
compared rhythm to rate control in cardiac surgery patients who developed
POAF. We abstracted data and assessed the risk of bias in each study
independently and in duplicate. We used a random-effects model to combine
data and rated the quality of evidence using the GRADE framework.
 Result(s): From 6,408 citations, we identified 8 RCTs testing 10
different rhythm control regimens and including a total of 990 patients.
Length of follow-up was 24 h in 2 trials, 48 h in 1 trial, 1 week in 3
trials and >1 month in 2 trials. Drugs used for rhythm control included
amiodarone in 4 trials, class III anti-arrhythmics in 1 trial, class I
anti-arrhythmics in 4 trials and either a class I or III anti-arrhythmic
in 1 trial. We identified risk of methodological bias related to blinding
in 6 of 8 trials. Compared to rate control, rhythm control was not
associated with a difference in length of stay (MD [mean difference] -0.80
days; 95% CI -2.95-1.35, I2 = 97%), mortality (risk ratio [RR]
1.60; 95%CI 0.73-3.50, I2 = 0%), AF recurrence up to 1 week (RR
1.09; 95%CI 0.64-1.86, I2=54%), AF recurrence up to 1 month (RR
0.94; 95%CI 0.5-1.76, I2=0%), nor AF recurrence up to 3 months
(RR 0.96; 95%CI 0.27-3.37, I2=0%). We judged the quality of
evidence to be low due to risk of bias and inconsistency or imprecision.
 Conclusion(s): Currently available evidence does not favour either
rhythm or rate control for patients with new-onset AF following cardiac
surgery. Existing evidence, however, has important limitations and this
topic requires further study. Copyright © 2022 American College
of Cardiology Foundation

<44>
Accession Number
2017302527
Title
THE ROLE OF TRANSCATHETER AORTIC VALVE REPLACEMENT IN LOW-FLOW,
LOW-GRADIENT AORTIC STENOSIS: INSIGHTS FROM THE EVOLUT LOW RISK TRIAL.
Source
Journal of the American College of Cardiology. Conference: ACC 22.
Washington, DC United States. 79(9 Supplement) (pp 653), 2022. Date of
Publication: 08 Mar 2022.
Author
Anwaruddin S.; Forrest J.K.; Gada H.; Mumtaz M.A.; Huang J.; Maini B.S.;
Oh J.K.; Ito S.; Kleiman N.S.; Reardon M.J.
Institution
(Anwaruddin, Forrest, Gada, Mumtaz, Huang, Maini, Oh, Ito, Kleiman,
Reardon) Saint Vincent Hospital, Worcester, MA, United States
(Anwaruddin, Forrest, Gada, Mumtaz, Huang, Maini, Oh, Ito, Kleiman,
Reardon) Houston Methodist DeBakey Heart and Vascular Center, Houston, TX,
United States
Publisher
Elsevier Inc.
Abstract
Background: Paradoxical low-flow, low-gradient (pLFLG) aortic stenosis
(AS) represents 5-20% of AS patients and is associated with worse outcomes
compared with high-gradient AS. However, there is conflicting data
regarding the role of TAVR in patients with pLFLG-AS. This study aims to
evaluate the benefit of TAVR and SAVR in pLFLG-AS patients.
 Method(s): The Evolut Low Risk trial was a randomized trial in which
TAVR and SAVR were compared in patients with a surgical mortality risk of
<3%. Of 1414 as treated patients, 50 TAVR and 39 SAVR patients were
identified as pLFLG-AS by Echo Core Lab (mean gradient <40 mmHg AND peak
velocity <4 m/s AND AVA <=1.0 cm2 AND SVi <=35 ml/m2
AND LVEF >=50%), while 6 TAVR and 6 SAVR patients were identified as
classical LFLG (LVEF <50%). Result(s): Baseline characteristics were
similar among TAVR and SAVR patients with pLFLG-AS. There were no
significant differences in mortality between the groups at 30 days, 1 year
and 2 years. At 2 years, mean gradient and peak velocity were
significantly lower after TAVR, while dimensionless velocity index and LV
end-diastolic diameter were higher. Using the KCCQ overall score, each
group had a statistically significant increase in quality of life
longitudinally. Furthermore, TAVR patients showed reduced symptoms of
heart failure resulting in an improved NYHA functional class compared to
SAVR. Conclusion(s): TAVR patients with pLFLG-AS appear to derive a
greater degree of clinical, functional and hemodynamic benefit from the
procedure than SAVR patients. [Formula presented] Copyright ©
2022 American College of Cardiology Foundation

<45>
Accession Number
635256264
Title
A Comparative Effectiveness Systematic Review and Meta-analysis of Drugs
for the Prophylaxis of Junctional Ectopic Tachycardia.
Source
Current cardiology reviews. 18(1) (pp 101-111), 2022. Date of Publication:
2022.
Author
Mendel B.; Christianto C.; Setiawan M.; Prakoso R.; Siagian S.N.
Institution
(Mendel, Christianto, Setiawan) Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
(Prakoso, Siagian) Pediatric Cardiology and Congenital Heart Defect
Division, Department of Cardiology and Vascular Medicine, National
Cardiovascular Center Harapan Kita, Jakarta, Indonesia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Junctional Ectopic Tachycardia (JET) is an arrhythmia
originating from the AV junction, which may occur following congenital
heart surgery, especially when the intervention is near the
atrioventricular junction. OBJECTIVE(S): The aim of this systematic
review and meta-analysis is to compare the effectiveness of amiodarone,
dexmedetomidine, and magnesium in preventing JET following congenital
heart surgery. METHOD(S): This meta-analysis was conducted according
to the Preferred Reporting Items for Systematic Review and Meta-Analysis
(PRISMA) statement, where 11 electronic databases were searched from the
date of inception to August 2020. The incidence of JET was calculated with
the relative risk of 95% Confidence Interval (CI). Quality assessment of
the included studies was assessed using the Consolidated Standards of
Reporting Trials (CONSORT) 2010 statement. RESULT(S): Eleven studies
met the predetermined inclusion criteria and were included in this
meta-analysis. Amiodarone, dexmedetomidine, and magnesium significantly
reduced the incidence of postoperative JET [Amiodarone: risk ratio 0.34;
I2= 0%; Z=3.66 (P=0.0002); 95% CI 0.19-0.60. Dexmedetomidine: risk ratio
0.34; I2= 0%; Z=4.77 (P<0.00001); 95% CI 0.21-0.52. Magnesium: risk ratio
0.50; I2= 24%; Z=5.08 (P<0.00001); 95% CI 0.39-0.66]. CONCLUSION(S):
All three drugs have shown promising results in reducing the incidence of
JET. Our systematic review found that dexmedetomidine is better in
reducing the length of ICU stays as well as mortality. In addition,
dexmedetomidine also has the least pronounced side effects among the
three. However, it should be noted that this conclusion was derived from
studies with small sample sizes. Therefore, dexmedetomidine may be
considered as the drug of choice for preventing JET. Copyright©
Bentham Science Publishers; For any queries, please email at
epub@benthamscience.net.

<46>
Accession Number
2015360070
Title
A Randomized Pilot Trial Assessing the Role of Human Fibrinogen
Concentrate in Decreasing Cryoprecipitate Use and Blood Loss in Infants
Undergoing Cardiopulmonary Bypass.
Source
Pediatric Cardiology. (no pagination), 2022. Date of Publication: 2022.
Author
Tirotta C.F.; Lagueruela R.G.; Gupta A.; Salyakina D.; Aguero D.; Ojito
J.; Kubes K.; Hannan R.; Burke R.P.
Institution
(Tirotta, Lagueruela, Aguero, Ojito, Kubes, Hannan, Burke) The Heart
Program, Nicklaus Children's Hospital, Miami, FL, United States
(Gupta, Salyakina) Nicklaus Children's Health System Research Institute,
Miami, FL, United States
(Tirotta, Lagueruela) Dept. Anesthesiology, The Heart Program, Nicklaus
Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, United States
Publisher
Springer
Abstract
The objective of this study was to determine whether treatment with human
fibrinogen concentrate decreases the need for component blood therapy and
blood loss in neonate and infant patients undergoing cardiopulmonary
bypass. Pediatric patients (N = 30) undergoing elective cardiac surgery
were randomized to receive human fibrinogen concentrate or placebo
following cardiopulmonary bypass termination. The primary endpoint was the
amount of cryoprecipitate administered. Secondary endpoints included
estimated blood loss during the 24 h post-surgery; perioperative blood
product transfusion; effects of fibrinogen infusion on global hemostasis,
measured by laboratory testing and rotational thromboelastometry; and
adverse events. No clinically significant differences were identified in
baseline characteristics between groups. A significantly lower volume of
cryoprecipitate was administered to the treatment group during the
perioperative period [median (interquartile range) 0.0 (0.0-0.0) cc/kg vs
12.0 (8.2-14.3) cc/kg; P < 0.0001] versus placebo. No difference was
observed between treatment groups in blood loss, laboratory coagulation
tests, use of other blood components, or incidence of adverse events.
FIBTEM amplitude of maximum clot firmness values was significantly higher
among patients treated with human fibrinogen concentrate versus placebo (P
<= 0.0001). No significant differences were observed in post-drug HEPTEM,
INTEM, and EXTEM results. Human fibrinogen concentrate (70 mg/kg)
administered after the termination of cardiopulmonary bypass reduced the
need for transfusion with cryoprecipitate in a neonate and infant patient
population. ClinicalTrials.gov identifier: NCT02822599. Copyright
© 2022, The Author(s).

<47>
Accession Number
2010284492
Title
Vasoplegia in patients following ventricular assist device explant and
heart transplantation.
Source
Perfusion (United Kingdom). 37(2) (pp 152-161), 2022. Date of Publication:
March 2022.
Author
Emmanuel S.; Pearman M.; Jansz P.; Hayward C.S.
Institution
(Emmanuel, Pearman, Jansz, Hayward) St Vincent's Hospital, Sydney, NSW,
Australia
(Emmanuel, Jansz, Hayward) School of Medicine, University of New South
Wales, Sydney, NSW, Australia
(Emmanuel, Pearman, Jansz) School of Medicine, University of Notre Dame,
Sydney, NSW, Australia
(Emmanuel, Jansz, Hayward) The Victor Chang Cardiac Research Institute,
Sydney, NSW, Australia
Publisher
SAGE Publications Ltd
Abstract
Background: Vasoplegia has been shown to be associated with increased
morbidity and mortality in patients undergoing cardiac surgery. It has
been previously stated that low pulsatile states as seen with current left
ventricular assist devices (LVADs) may contribute to vasoplegia post
LVAD-explant and heart transplant. We sought to examine the literature
regarding vasoplegia in the post-operative setting for patients undergoing
LVAD explant and heart transplant. Method(s): A literature review was
conducted to firstly define vasoplegia in the setting of LVAD patients,
and secondly to better understand the relationship between vasoplegia and
LVAD explantation in the postoperative heart transplant patient cohort. A
keyword search of 'vasoplegia' OR 'vasoplegic' AND 'transplant' was used.
Search engines used were PubMed, Cochrane Library, ClinicalTrials.gov,
Ovid, Scopus and grey literature. Result(s): 17 studies met the
selection criteria for review. Three key themes emerged from the
literature. Firstly, there is limited consensus regarding the definition
of vasoplegia. Secondly, patients with LVADs experienced higher rates of
vasoplegia following heart transplant than their counterparts and thirdly,
increased cardiopulmonary bypass time was associated with a higher rate of
vasoplegia. Conclusion(s): Vasoplegia is not clearly defined in the
literature as it pertains to the LVAD patient cohort. Patients bridged
with LVADs appear to have higher rates of vasoplegia, however the
aetiology of this is unclear and may be associated with continuous flow
physiology or prolonged cardiopulmonary bypass time. A universal
definition will aid in risk stratification, early recognition and
management. Copyright © The Author(s) 2021.

<48>
Accession Number
2010217649
Title
Enhanced recovery after cardiac surgery and its impact on outcomes: A
systematic review.
Source
Perfusion (United Kingdom). 37(2) (pp 162-174), 2022. Date of Publication:
March 2022.
Author
Zhang Y.; Chong J.H.; Harky A.
Institution
(Zhang) The London School of Medicine and Dentistry, London, United
Kingdom
(Chong) GKT School of Medical Education, King's College London, London,
United Kingdom
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool, United Kingdom
(Harky) Department of Integrative Biology, Faculty of Life Science,
University of Liverpool, Liverpool, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Harky) Department of Cardiac Surgery, Alder Hey Children Hospital,
Liverpool, United Kingdom
Publisher
SAGE Publications Ltd
Abstract
Background and Aim: Enhanced Recovery After Surgery (ERAS) protocols are a
series of perioperative interventions well-established in improving the
care and outcomes of patients. With recent emergence of studies on its
implementation in cardiac surgery, this paper represents the first
systematic review on current evidence of ERAS efficacy in this field.
 Method(s): Two reviewers independently searched through Pubmed,
Cochrane, Google Scholar, Web of Science, Embase and Scopus. Comparative
studies with controls that described the implementation of ERAS in all
types of cardiac operations from 2001 to 2020 were included. Data
extracted included patient demographics, components of ERAS protocol
described, types of cardiac surgery, and postoperative outcomes.
 Result(s): In the final analysis, nine studies were included, of
which there were one randomized controlled trial (RCT), one
quasi-experiment and seven retrospective/prospective studies. Significant
improvement in hospital and ICU length of stay, as well as reduction in
postoperative opioid consumption were demonstrated. No increase in
postoperative complications were reported. Conclusion(s): ERAS in
cardiac surgery has shown to be potentially safe and effective in
improving certain postoperative outcomes. However, the evidence is limited
by the lack of high-quality RCTs. We also found the lack of practice of
class 1 recommended interventions set forth by the ERAS Cardiac Society.
Furthermore, majority of studies only evaluated the immediate
postoperative outcomes of patients, and not the long-term outcomes. RCTs
that fully implement measures recommended by the ERAS Cardiac Society,
with assessments on both immediate and long-term outcomes, are
warranted. Copyright © The Author(s) 2021.

<49>
Accession Number
2015982964
Title
Spectral Entropy Monitoring Accelerates the Emergence from Sevoflurane
Anesthesia in Thoracic Surgery: A Randomized Controlled Trial.
Source
Journal of Clinical Medicine. 11(6) (no pagination), 2022. Article Number:
1631. Date of Publication: March-2 2022.
Author
Chen J.-T.; Wu Y.-M.; Tiong T.-Y.; Cata J.P.; Kuo K.-T.; Li C.-C.; Liu
H.-Y.; Cherng Y.-G.; Wu H.-L.; Tai Y.-H.
Institution
(Chen, Wu, Li, Liu, Cherng, Tai) Department of Anesthesiology, Shuang Ho
Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
(Republic of China)
(Chen, Wu, Li, Liu, Cherng, Tai) Department of Anesthesiology, School of
Medicine, College of Medicine, Taipei Medical University, Taipei 11031,
Taiwan (Republic of China)
(Tiong, Kuo) Division of Thoracic Surgery, Department of Surgery, Shuang
Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
(Republic of China)
(Tiong, Kuo) Division of Thoracic Surgery, Department of Surgery, School
of Medicine, College of Medicine, Taipei Medical University, Taipei 11031,
Taiwan (Republic of China)
(Cata) Department of Anesthesiology and Perioperative Medicine, The
University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit
409, Houston, TX 77030, United States
(Wu) Department of Anesthesiology, Taipei Veterans General Hospital,
Taipei 11217, Taiwan (Republic of China)
(Wu) School of Medicine, National Yang Ming Chiao Tung University, Taipei
11221, Taiwan (Republic of China)
Publisher
MDPI
Abstract
The clinical efficacy of spectral entropy monitoring in improving
postoperative recovery remains unclear. This trial aimed to investigate
the impact of M-Entropy (GE Healthcare, Helsinki, Finland) guidance on
emergence from anesthesia and postoperative delirium in thoracic surgery.
Adult patients undergoing video-assisted thoracoscopic surgery for lung
resection at a medical center were randomly allocated into the M-Entropy
guidance group (n = 39) and the control group (n = 37). In the M-Entropy
guidance group, sevoflurane anesthesia was titrated to maintain response
and state entropy values between 40 and 60 intraoperatively. In the
control group, the dosing of sevoflurane was adjusted based on clinical
judgment and vital signs. The primary outcome was time to spontaneous eye
opening. M-Entropy guidance significantly reduced the time proportion of
deep anesthesia (entropy value <40) during surgery, mean difference:
-21.5% (95% confidence interval (CI): -32.7 to -10.3) for response entropy
and -24.2% (-36.3 to -12.2) for state entropy. M-Entropy guidance
significantly shortened time to spontaneous eye opening compared to
clinical signs, mean difference: -154 s (95% CI: -259 to -49). In
addition, patients of the M-Entropy group had a lower rate of emergence
agitation (absolute risk reduction: 0.166, 95% CI: 0.005-0.328) and
delirium (0.245, 0.093-0.396) at the postanesthesia care unit.
M-Entropy-guided anesthesia hastened awakening and potentially prevented
emergence agitation and delirium after thoracic surgery. These results may
provide an implication for facilitating postoperative recovery and
reducing the complications associated with delayed emergence and
delirium. Copyright © 2022 by the authors. Licensee MDPI, Basel,
Switzerland.

<50>
Accession Number
2015211515
Title
Plasmalyte-A Based del Nido Cardioplegia Versus Plain Ringer Based del
Nido Cardioplegia: Double-Blind Randomized Trial.
Source
World Journal for Pediatric and Congenital Heart Surgery. 13(2) (pp
187-195), 2022. Date of Publication: March 2022.
Author
Talwar S.; Harshavardhan N.; Kapoor P.M.; Makhija N.; Rajashekar P.;
Sreenivas V.; Upadhyay A.D.; Sahu M.K.; Choudhary S.K.
Institution
(Talwar, Harshavardhan, Sahu, Choudhary) All India Institute of Medical
Sciences Cardio-Thoracic Sciences Centre, New Delhi, India
(Kapoor, Makhija, Rajashekar, Sreenivas, Upadhyay) All India Institute of
Medical Sciences, New Delhi, India
Publisher
SAGE Publications Inc.
Abstract
Background: In this prospective randomized controlled trial, we compared
the standard del Nido cardioplegia solution (SDN) with the modified del
Nido cardioplegia solution (MDN) in which the base solution was the plain
Ringer solution. Method(s): A total of 80 patients aged < 12 years
undergoing intracardiac repair of Tetralogy of Fallot were randomized into
SDN (n = 39) or MDN (n = 41) groups. The primary outcome was a change in
cardiac index (CI). Secondary outcomes were ventricular arrhythmias after
the release of aortic-cross clamp, postoperative inotropic score (IS),
time to peripheral rewarming, duration of mechanical ventilation,
intensive care unit (ICU) length of stay, and hospital length of stay, and
electron microscopic differences between the 2 groups. Cardiac Troponin-I,
inflammatory markers tumor necrosis factor-alpha (TNF-alpha), and
interleukin-L (IL-6) were measured. Result(s): Applying the
noninferiority confidence interval approach, the difference between the
changes in CI between the 2 groups was -0.093 L/min/m2 (95% CI: -0.46-0.27
L/min/m2) which was within the noninferiority threshold of -0.5 indicating
that CI was similar in both SDN and MDN. Ventricular arrhythmias postclamp
release (P =.91), IS (P =.09), duration of mechanical ventilation (P
=.27), ICU length of stay (P =.50), hospital length of stay (P =.57), IL-6
(P =.19), TNF-alpha (P =.17), Troponin-I (P =.15), electron microscopy
changes (P >.05) were not different between groups. Conclusion(s):
MDN was shown to be noninferior to the SDN cardioplegia in terms of
preservation of cardiac index. In addition, other metrics indicative of
myocardial protection were similar between groups. In developing nations
where SDN is not available or is expensive, MDN cardioplegia is an
acceptable alternative. Copyright © The Author(s) 2022.

<51>
Accession Number
637530364
Title
Sex-Related Differences in Postoperative Outcomes After Transcatheter
Aortic Valve Replacement: A Systematic Review and Meta-analysis.
Source
Cardiology in review. (no pagination), 2022. Date of Publication: 15 Mar
2022.
Author
Bozso S.J.; El-Andari R.; Kang J.J.; Eckstein J.; Nagendran J.
Institution
(Bozso, Kang, Nagendran) Division of Cardiac Surgery, Department of
Surgery, University of Alberta, Edmonton, AB, Canada
(El-Andari) Faculty of Medicine and Dentistry, University of Alberta,
Edmonton, AB, Canada
(Eckstein) Division of Cardiology, Royal University Hospital, Saskatoon,
SK, Canada
Publisher
NLM (Medline)
Abstract
Aortic stenosis (AS) is the most common valvular disease of the heart and
is increasing in prevalence. Previous literature has found inferior
outcomes for females undergoing surgical aortic valve replacement (SAVR),
while recent investigations have found equivalent or superior outcomes for
females undergoing transcatheter aortic valve replacement (TAVR). PubMed
and Medline were systematically searched for articles published from
January 1st 2010 to April 30th 2021 for retrospective and prospective
studies comparing outcomes between males and females undergoing TAVR.
1,180 titles and abstracts were screened and 28 were included in this
review. Risk of bias was assessed using questions derived from the
ROBINS-I tool and previous literature. The data were compiled and analyzed
using the RevMan 5.4 software. The results of this review confirm the
previously published literature and have found rates of acute kidney
injury (p=0.05) and postoperative pacemaker insertion (p<0.00001) favoring
females, and in-hospital mortality (p=0.04), stroke (p<0.00001), bleeding
complications (p<0.00001), and vascular complications (p<0.00001) favoring
males. The previously published literature has demonstrated consistently
inferior outcomes for females undergoing heart valve surgery when compared
to males. However, contemporary literature investigating sex differences
after TAVR has found comparable outcomes for females. While the
postoperative outcomes after SAVR and TAVR are well established, the
causal factors are still unidentified. Future studies utilizing matching
based on preoperative characteristics and follow-up including collection
of postoperative ventricular remodeling and prosthetic valve performance
data will aid in elucidating the causal factors impacting outcomes for
males and females after TAVR. Copyright © 2022 Wolters Kluwer
Health, Inc. Unauthorized reproduction of this article is prohibited.

<52>
Accession Number
635811916
Title
Efficacy and Safety of Tranexamic Acid for the Control of Surgical
Bleeding in Patients Under Liposuction.
Source
Aesthetic plastic surgery. 46(1) (pp 258-264), 2022. Date of Publication:
01 Feb 2022.
Author
Rodriguez-Garcia F.A.; Sanchez-Pena M.A.; de Andrea G.T.;
Villarreal-Salgado J.L.; Alvarez-Trejo H.J.; Medina-Quintana V.M.;
Garcia-Valenzuela S.E.; Morfin-Meza K.E.; Fierro-Rodriguez D.A.;
Dorado-Hernandez E.; Bonilla-Catalan P.V.; Ramos-Maciel J.; Romero-Algara
E.; Jimenez-Pavon K.E.; Torres-Salazar Q.L.
Institution
(Rodriguez-Garcia, Villarreal-Salgado, Alvarez-Trejo, Medina-Quintana,
Garcia-Valenzuela, Morfin-Meza, Fierro-Rodriguez, Dorado-Hernandez,
Bonilla-Catalan, Ramos-Maciel, Romero-Algara, Jimenez-Pavon) Instituto de
Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital
Regional "Dr. Valentin Gomez Farias", Av. Soledad Orozco 203, El Capullo,
45100, Zapopan, Guadalajara, Jalisco, Mexico
(Sanchez-Pena, de Andrea) Hospital INNOVARE, Av. Verona 7412, Zapopan,
Jalisco, Mexico
(Torres-Salazar) Universidad Juarez del Estado de Durango, Calle Paloma
No.806, Colonia Fatima, Durango 34060, Mexico
Publisher
NLM (Medline)
Abstract
Liposuction remains one of the most frequently performed cosmetic surgical
procedures and its popularity is increasing every year. However, since its
inception, justified concerns regarding patient safety have placed limits
on the volume of fat that can be aspirated, influenced by hemodynamic
fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is
an antifibrinolytic agent that competitively inhibits the conversion of
plasminogen to plasmin, thus preventing the binding and degradation of
fibrin. Despite the existence of evidence of the effectiveness of TXA in
orthopedic and cardiac surgeries, there is little evidence of its use in
liposuction. The objective of this study was to evaluate the efficacy and
safety of tranexamic acid in the control of surgical bleeding in patients
undergoing liposuction, through a prospective, open, randomized and
controlled clinical trial. Two groups of 25 participants each were formed
to whom the application of TXA in a tumescent solution prior to
liposuction or liposuction with the traditional technique was randomly
assigned. The results showed a decrease in blood loss reflected by the
differences in the final hematocrit values, as well as decrease in the
same per aspirated volume (p = 0.003). No adverse events were found
related with the TXA application and no blood transfusions were required
in this group, in contrast to the control group where the need for blood
transfusion was present in 20% of the intervened participants. LEVEL OF
EVIDENCE II: This journal requires that authors assign a level of evidence
to each article. For a full description of these Evidence-Based Medicine
ratings, please refer to the Table of Contents or the online Instructions
to Authors www.springer.com/00266. Copyright © 2021. Springer
Science+Business Media, LLC, part of Springer Nature and International
Society of Aesthetic Plastic Surgery.

<53>
Accession Number
2016980609
Title
The Art and Science of Mentorship in Cardiothoracic Surgery: A Systematic
Review of the Literature.
Source
Annals of Thoracic Surgery. 113(4) (pp 1093-1100), 2022. Date of
Publication: April 2022.
Author
Odell D.D.; Edwards M.; Fuller S.; Loor G.; Antonoff M.B.
Institution
(Odell) Department of Surgery, Northwestern University Feinberg School of
Medicine, Illinois, Chicago
(Edwards) Department of Surgery, St. Joseph's Medical Center, Ann Arbor,
MI, United States
(Fuller) Division of Cardiothoracic Surgery, Children's Hospital of
Philadelphia, Pennsylvania, Philadelphia
(Loor) Department of Surgery, Baylor College of Medicine, Texas, Houston
(Antonoff) Department of Thoracic and Cardiovascular Surgery, University
of Texas MD Anderson Cancer Center, Texas, Houston
Publisher
Elsevier Inc.
Abstract
Background: As academic cardiothoracic surgeons focus on producing a new
generation of successful surgeon leaders, mentorship has emerged as one of
the most important variables influencing professional and personal success
and satisfaction. This review explores the literature to determine the
benefits, qualities, and features of the mentor relationship.
 Method(s): A comprehensive review was performed in February 2020 of
Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and the
SCOPUS Database using "'mentor"' as a primary search term. The titles and
abstracts of these publications were then reviewed by 2 of the authors to
identify relevant sources addressing topics related to mentorship in
cardiothoracic surgery and also to identify 4 specific areas of focus: (1)
the value of mentorship, (2) the skills needed to be an effective mentor,
(3) effective approaches for identifying and receiving mentorship, and (4)
the unique considerations associated with mentorship for traditionally
underrepresented populations in surgery. Result(s): Of 16,469
articles reviewed, 167 relevant manuscripts were identified, and 62 were
included. Conclusion(s): There is undeniable value in mentorship when
navigating a career in cardiothoracic surgery. By sharing the most
significant features and skills of both ideal mentors and mentees, this
review hoped to provide a framework to improve the quality of mentorship
from both sides. Copyright © 2022 The Society of Thoracic
Surgeons

<54>
Accession Number
2015208076
Title
Low Dose of Methylprednisolone for Pain and Immune Function After Thoracic
Surgery.
Source
Annals of Thoracic Surgery. 113(4) (pp 1325-1332), 2022. Date of
Publication: April 2022.
Author
Li X.; Song B.; Teng X.; Li Y.; Yang Y.; Zhu J.
Institution
(Li, Song, Teng, Li, Yang, Zhu) Department of Anesthesiology, Shengjing
Hospital of China Medical University, Liaoning, Shenyang, China
(Song) Department of Anesthesiology, Beijing Friendship Hospital of
Capital Medical University, Beijing, China
Publisher
Elsevier Inc.
Abstract
Background: This study evaluated the effects of single low-dose
preoperative methylprednisolone (MP) on the immunologic function and
postoperative pain of patients undergoing elective video-assisted
thoracoscopic surgery under general anesthesia. Method(s): The study
randomly assigned 81 patients who underwent elective video-assisted
thoracoscopic surgery to the MP group or the control group. The
T-lymphocyte subsets of CD3+, CD4+, and
CD8+, and the CD4+/CD8+ ratio at
T<inf>0</inf> (before anesthesia), T<inf>1</inf> (after operation), and
T<inf>2</inf> (24 hours after operation) were recorded. Also recorded were
postoperative rest and cough pain scores and postoperative adverse effects
and surgery complications. Result(s): Compared with T<inf>0</inf>,
the levels of CD3+ and CD4+ subsets and
CD4+/CD8+ were significantly decreased, and the
level of CD8+ was increased after surgery in both groups. There
was no significant difference in the variation of CD3+,
CD4+, CD8+, and CD4+/CD8+
between the MP group and the control group. The rest and cough pain of
patients in the MP group was significantly lower compared with the control
group at 2, 4, 6, and 24 hours after surgery. The incidences of nausea and
vomiting and dizziness were also significantly higher in the control group
than those in the MP group. Conclusion(s): A preoperative single low
dose of MP (1 mg/kg) had no effect on immune function but had effective
analgesic effects and could reduce the incidence of dizziness and
postoperative nausea and vomiting. Copyright © 2022 The Society
of Thoracic Surgeons

<55>
Accession Number
2017229878
Title
Surgical aortic valve replacement versus conservative treatment in
asymptomatic severe aortic stenosis: An updated systematic review and
meta-analysis.
Source
Cardiovascular Revascularization Medicine. (no pagination), 2022. Date of
Publication: 2022.
Author
Ismayl M.; Machanahalli Balakrishna A.; Abusnina W.; Thandra A.; Walters
R.W.; Alugubelli N.R.; Yackley S.; Betts L.; Smer A.; Goldsweig A.M.;
Dahal K.
Institution
(Ismayl, Machanahalli Balakrishna, Yackley, Betts) Department of Medicine,
Creighton University School of Medicine, Omaha, NE, United States
(Abusnina, Thandra, Alugubelli, Smer, Dahal) Department of Medicine,
Division of Cardiology, Creighton University School of Medicine, Omaha,
NE, United States
(Walters) Department of Medicine, Division of Clinical Research and
Evaluative Sciences, Creighton University School of Medicine, Omaha, NE,
United States
(Goldsweig) Department of Medicine, Division of Cardiovascular Medicine,
University of Nebraska Medical Center, Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
Background: While aortic valve replacement (AVR) is indicated for
symptomatic severe aortic stenosis (AS), the appropriate management of
asymptomatic severe AS remains unclear. We conducted an updated
meta-analysis to compare the outcomes of surgical AVR (SAVR) versus
conservative treatment in patients with asymptomatic severe AS.
 Method(s): We searched PubMed, EMBASE, Cochrane, clinicaltrials.gov,
and Google Scholar for studies comparing outcomes of SAVR versus
conservative treatment in asymptomatic severe AS. Risk ratios (RRs) and
95% confidence intervals (CIs) were calculated for each individual study.
Outcomes included all-cause mortality, cardiovascular and
non-cardiovascular mortality, 30-day operative mortality, sudden cardiac
death (SCD), heart failure hospitalization (HFH), myocardial infarction
(MI), and stroke. Result(s): A total of 8 studies with 2685 patients
were included. The mean age was above 60 years, and the median follow-up
duration was 4 years. Compared to conservative treatment, SAVR was
associated with significantly lower all-cause mortality (RR 0.39; 95% CI
0.23-0.64) and HFH rates (RR 0.18; 95% CI 0.05-0.71). There were no
significant differences in cardiovascular mortality (RR 0.24; 95% CI
0.03-1.67), non-cardiovascular mortality (RR 0.49; 95% CI 0.23-1.03),
30-day operative mortality (RR 0.48; 95% CI 0.10-2.32), SCD (RR 0.37; 95%
CI 0.05-2.89), MI (RR 0.48; 95% CI 0.04-5.52), and stroke rates (RR 1.20;
95% CI 0.35-4.11) between the two strategies. Conclusion(s): In
patients with asymptomatic severe AS, SAVR is associated with
significantly lower all-cause mortality and HFH compared to conservative
treatment. While SAVR is a promising option for asymptomatic severe AS,
most studies were observational and nonrandomized; randomized trials are
needed to establish a clear benefit. Copyright © 2022 Elsevier
Inc.

<56>
Accession Number
2016536933
Title
Heart transplantation in systemic lupus erythematosus: A case report and
meta-analysis.
Source
Heart and Lung. 52 (pp 174-181), 2022. Date of Publication: 01 Mar 2022.
Author
Chapa J.J.; Ilonze O.J.; Guglin M.E.; Rao R.A.
Institution
(Chapa) Indiana University School of Medicine, Department of Medicine
(Ilonze, Guglin, Rao) Indiana University School of Medicine, Department of
Medicine, Division of Cardiology
Publisher
Elsevier Inc.
Abstract
Cardiac involvement in Systemic Lupus Erythematosus can present as end
stage heart failure necessitating orthotopic heart transplantation. Most
transplant centers regard Lupus as a contraindication to transplant due to
risk of disease recurrence in the transplanted organ. Limited reports of
heart transplant in Lupus exist in the literature. Herein, we aim to
report on the successful transplant and long-term survival of a
24-year-old woman with Lupus and biventricular heart failure. Given the
rarity of transplant in Lupus, we also conducted a meta-analysis of
reported cases in the literature to assess post-transplant outcomes and
evaluate immunosuppression strategies. Our case underlines the feasibility
of transplant in Lupus patients, outlines a detailed immunosuppression
strategy and favorable long-term outcome to guide centers contemplating
such transplants. The long-term survival of our patient, together with
review of the thirteen previously described cases, supports that
orthotopic heart transplantation can be considered in select patients with
Systemic Lupus Erythematosus. Copyright © 2022 Elsevier Inc.

<57>
Accession Number
2015318072
Title
Left main coronary artery compression by dilated pulmonary artery in
pulmonary arterial hypertension: a systematic review and meta-analysis.
Source
Clinical Research in Cardiology. (no pagination), 2022. Date of
Publication: 2022.
Author
Badea R.; Dorobantu D.M.; Sharabiani M.T.A.; Predescu L.M.; Coman I.M.;
Ginghina C.
Institution
(Badea, Predescu, Coman, Ginghina) Cardiology Department, Carol Davila
University of Medicine and Pharmacy, Soseaua Fundeni nr. 258, Bucharest,
Romania
(Dorobantu) Children's Health and Exercise Research Centre (CHERC),
University of Exeter, Exeter, United Kingdom
(Dorobantu) School of Population Health Sciences, University of Bristol,
Bristol, United Kingdom
(Sharabiani) Department of Primary Care and Public Health, School of
Public Health, Imperial College of London, London, United Kingdom
(Predescu, Coman, Ginghina) Cardiology Department, Prof. Dr. C. C. Iliescu
Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objective: Pulmonary arterial hypertension (PAH) can lead to left main
coronary artery compression (LMCo), but data on the impact, screening and
treatment are limited. A meta-analysis of LMCo cases could fill the
knowledge gaps in this topic. Method(s): Electronic databases were
searched for all LMCo/PAH studies, abstracts and case reports including
pulmonary artery (PA) size. Restricted maximum likelihood meta-analysis
was used to evaluate LMCo-associated factors. Specificity, sensitivity and
accuracy of PA size thresholds for diagnosis of LMCo were calculated.
Treatment options and outcomes were summarized. Result(s): A total of
five case-control cohorts and 64 case reports/series (196 LMCo and 438
controls) were included. LMCo cases had higher PA diameter (Hedge's g 1.46
[1.09; 1.82]), PA/aorta ratio (Hedge's g 1.1 [0.64; 1.55]) and probability
of CHD (log odds-ratio 1.22 [0.54; 1.9]) compared to non-LMCo, but not PA
pressure or vascular resistance. A 40 mm cut-off for the PA diameter had
balanced sensitivity (80.5%), specificity (79%) and accuracy (79.7%) for
LMCo diagnosis, while a value of 44 mm had higher accuracy (81.7%), higher
specificity (91.5%) but lower sensitivity (71.9%). Pooled mortality after
non-conservative treatment (n = 150, predominantly stenting) was 2.7% at
up to 22 months of mean follow-up, with 83% survivors having no angina at
follow-up. Conclusion(s): PA diameter, PA/aorta ratio and CHD are
associated with LMCo, while hemodynamic parameters are not. Data from this
study support that a PA diameter cut-off between 40 and 44 mm can offer
optimal accuracy for LMCo screening. Preferred treatment was coronary
stenting, associated with low mid-term mortality and symptom relief.
Graphical abstract: Diagnosis and management of left main coronary artery
compression (LMCo) in patients with pulmonary arterial hypertension (PAH).
[Figure not available: see fulltext.]. Copyright © 2022, The
Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

<58>
Accession Number
636664079
Title
Sublingual microcirculatory alterations during the immediate and early
postoperative period: A systematic review and meta-analysis.
Source
Clinical hemorheology and microcirculation. 80(3) (pp 253-265), 2022. Date
of Publication: 2022.
Author
Chalkias A.; Papagiannakis N.; Mavrovounis G.; Kolonia K.; Mermiri M.;
Pantazopoulos I.; Laou E.; Arnaoutoglou E.
Institution
(Chalkias, Kolonia, Mermiri, Laou, Arnaoutoglou) Department of
Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa,
Greece
(Chalkias) Outcomes Research Consortium, Cleveland, OH, USA
(Papagiannakis) First Department of Neurology, National and Kapodistrian
University of Athens, Medical School, Athens, Greece
(Mavrovounis, Pantazopoulos) Department of Emergency Medicine, Faculty of
Medicine, University of Thessaly, Larisa, Greece
Publisher
NLM (Medline)
Abstract
BACKGROUND: The incidence of postoperative microcirculatory flow
alterations and their effect on outcome have not been studied extensively.
 OBJECTIVE(S): This systematic review and meta-analysis were designed
to investigate the presence of sublingual microcirculatory flow
alterations during the immediate and early postoperative period and their
correlation with complications and survival. METHOD(S): A systematic
search of PubMed, Scopus, Embase, PubMed Central, and Google Scholar was
conducted for relevant articles from January 2000 to March 2021.
Eligibility criteria were randomized controlled and non-randomized trials.
Case reports, case series, review papers, animal studies and non-English
literature were excluded. The primary outcome was the assessment of
sublingual microcirculatory alterations during the immediate and early
postoperative period in adult patients undergoing surgery. Risk of bias
was assessed with the Ottawa-Newcastle scale. Standard meta-analysis
methods (random-effects models) were used to assess the difference in
microcirculation variables. RESULT(S): Thirteen studies were
included. No statistically significant difference was found between
preoperative and postoperative total vessel density (p = 0.084;
Standardized Mean Difference (SMD): -0.029; 95%CI: -0.31 to 0.26; I2 =
22.55%). Perfused vessel density significantly decreased postoperatively
(p = 0.035; SMD: 0.344; 95%CI: 0.02 to 0.66; I2 = 65.66%), while perfused
boundary region significantly increased postoperatively (p = 0.031; SMD:
-0.415; 95%CI: -0.79 to -0.03; I2 = 37.21%). Microvascular flow index
significantly decreased postoperatively (p = 0.028; SMD: 0.587; 95%CI:
0.06 to 1.11; I2 = 86.09%), while no statistically significant difference
was found between preoperative and postoperative proportion of perfused
vessels (p = 0.089; SMD: 0.53; 95%CI: -0.08 to 1.14; I2 = 70.71%). The
results of the non-cardiac surgery post-hoc analysis were comparable
except that no statistically significant difference in perfused vessel
density was found (p = 0.69; SMD: 0.07; 95%CI: -0.26 to 0.39; I2 = 0%).
LIMITATIONS: The included studies investigate heterogeneous groups of
surgical patients. There were no randomized controlled trials.
 CONCLUSION(S): Significant sublingual microcirculatory flow
alterations are present during the immediate and early postoperative
period. Further research is required to estimate the correlation of
sublingual microcirculatory flow impairment with complications and
survival.

<59>
Accession Number
637465852
Title
Treatment With Icosapent Ethyl to Reduce Ischemic Events in Patients With
Prior Percutaneous Coronary Intervention: Insights From REDUCE-IT PCI.
Source
Journal of the American Heart Association. 11(6) (pp e022937), 2022. Date
of Publication: 15 Mar 2022.
Author
Peterson B.E.; Bhatt D.L.; Steg P.G.; Miller M.; Brinton E.A.; Jacobson
T.A.; Ketchum S.B.; Juliano R.A.; Jiao L.; Doyle R.T.; Granowitz C.;
Gibson C.M.; Pinto D.; Giugliano R.P.; Budoff M.J.; Tardif J.-C.; Verma
S.; Ballantyne C.M.
Institution
(Peterson, Bhatt, Giugliano) Brigham and Women's Hospital Heart and
Vascular Center Harvard Medical School Boston MA
(Steg) Universite de ParisAP-HP (Assistance Publique-Hopitaux de
Paris)Hopital BichatFACT (French Alliance for Cardiovascular Trials)INSERM
U-1148 Paris France, France
(Miller) Department of Medicine University of Maryland School of Medicine
Baltimore MD
(Brinton) Utah Lipid Center Salt Lake City UT
(Jacobson) Department of Medicine Office of Health Promotion and Disease
Prevention Emory University School of Medicine Atlanta GA
(Ketchum, Juliano, Jiao, Doyle, Granowitz) Amarin Pharma, Inc. (Amarin)
Bridgewater NJ
(Gibson, Pinto) Baim Clinical Research Institute Boston MA
(Budoff) David Geffen School of Medicine Lundquist Institute Torrance CA
(Tardif) Montreal Heart InstituteUniversite de Montreal Quebec Canada,
Canada
(Verma) Division of Cardiac Surgery St Michael's HospitalUniversity of
Toronto Ontario Canada, Canada
(Ballantyne) Department of Medicine Baylor College of MedicineCenter for
Cardiovascular Disease PreventionMethodist DeBakey Heart and Vascular
Center Houston TX
Publisher
NLM (Medline)
Abstract
Background Patients who undergo percutaneous coronary intervention (PCI)
are at increased risk for recurrent cardiovascular events despite
aggressive medical therapy. Methods and Results This post hoc analysis
focused on the subset of patients with prior PCI enrolled in REDUCE-IT
(Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention
Trial), a multicenter, randomized, double-blind, placebo-controlled trial
of icosapent ethyl versus placebo. Icosapent ethyl was added to statins in
patients with low-density lipoprotein cholesterol <100 mg/dL and fasting
triglycerides 135-499 mg/dL. The primary end point was a composite of
cardiovascular death, nonfatal myocardial infarction, nonfatal stroke,
coronary revascularization, or unstable angina requiring hospitalization.
There were 8179 patients randomized in REDUCE-IT followed for a median of
4.9 years, and 3408 (41.7%) of them had a prior PCI with a median
follow-up of 4.8 years. These patients were randomized a median of 2.9
years (11 days to 30.7 years) after PCI. Among patients treated with
icosapent ethyl versus placebo, there was a 34% reduction in the primary
composite end point (hazard ratio [HR], 0.66; 95% CI, 0.58-0.76; P<0.001;
number needed to treat4.8 years=12) and a 34% reduction in the key
secondary composite end point of cardiovascular death, nonfatal myocardial
infarction, or nonfatal stroke (HR, 0.66; 95% CI, 0.56-0.79; P<0.001;
NNT4.8 years=19) versus placebo. Similarly, large reductions occurred in
total coronary revascularizations and revascularization subtypes. There
was also a 39% reduction in total events (rate ratio, 0.61; 95% CI,
0.52-0.72; P<0.001). Conclusions Among patients treated with statins with
elevated triglycerides and a history of prior PCI, icosapent ethyl
substantially reduced the risk of recurrent events during an average of ~5
years of follow-up with a number needed to treat of only 12. Registration
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01492361.

<60>
[Use Link to view the full text]
Accession Number
637359650
Title
Effect of Evolocumab in Patients With Prior Percutaneous Coronary
Intervention.
Source
Circulation. Cardiovascular interventions. 15(3) (pp e011382), 2022. Date
of Publication: 01 Mar 2022.
Author
Furtado R.H.M.; Fagundes A.A.; Oyama K.; Zelniker T.A.; Tang M.; Kuder
J.F.; Murphy S.A.; Hamer A.; Wang H.; Keech A.C.; Giugliano R.P.; Sabatine
M.S.; Bergmark B.A.
Institution
(Furtado) Academic Research Organization, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Furtado) Instituto do Coracao (InCor), Hospital das Clinicas da Faculdade
de Medicina, Universidade de Sao Paulo, Brazil
(Furtado, Fagundes, Oyama, Zelniker, Tang, Kuder, Murphy, Giugliano,
Sabatine, Bergmark) Thrombolysis in Myocardial Infarction (TIMI) Study
Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
(R.H.M.F., A.A.F., K.O., T.A.Z., M.T., J.F.K., S.AM., R.P.G., M.S.S.,
B.A.B.)
(Oyama) Department of Cardiovascular Medicine, Tohoku University Graduate
School of Medicine, Japan (K.O.), Sendai, Japan
(Zelniker) Division of Cardiology, Vienna General Hospital and Medical
University of Vienna, Austria
(Hamer) Cardiol Therapeutics, ON, Oakville, United States
(Wang) Amgen' Thousand Oaks' CA (H.W.)
(Keech) National Health and Medical Research Council Clinical Trials
Centre, Sydney Medical School, University of Sydney, Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Patients with prior percutaneous coronary intervention (PCI)
are at high residual risk for multiple types of coronary events within and
beyond the stented lesion. This risk might be mitigated by more intensive
LDL-C (low-density lipoprotein cholesterol)-lowering beyond just with
statin therapy. METHOD(S): FOURIER (Further Cardiovascular Outcomes
Research With PCSK9 Inhibition in Subjects With Elevated Risk) randomized
27 564 patients with stable atherosclerotic disease on statin to the PCSK9
(proprotein convertase subtilisin-kexin type 9) inhibitor evolocumab or
placebo with a median follow-up of 2.2 years. The end points of interest
were major adverse cardiovascular events (MACE; a composite of
cardiovascular death, myocardial infarction, stroke, unstable angina or
coronary revascularization), and major coronary events (a composite of
coronary heart death, myocardial infarction, or coronary
revascularization). We compared the risk of MACE and the magnitude of
relative and absolute risk reductions with evolocumab in patients with and
without prior PCI. RESULT(S): Seventeen thousand seventy-three
patients had prior PCI. In the placebo arm, those with prior PCI had
higher rates of MACE (13.2% versus 8.3%; hazard ratio [HR]adj 1.61 [95%
CI, 1.42-1.84]; P<0.0001) and major coronary events (11.5% versus 6.0%;
HRadj, 1.72 [95% CI, 1.49-1.99]; P<0.0001). Relative risk reductions with
evolocumab were similar in patients with and without prior PCI (MACE: HR,
0.84 [0.77-0.91] versus HR, 0.88 [0.77-1.01]; Pinteraction 0.51; major
coronary events: HR, 0.82 [0.75-0.90] versus HR, 0.88 [0.75-1.04];
Pinteraction 0.42). Absolute risk reductions for MACE were 2.0% versus
0.9% (Pinteraction 0.14) and for major coronary events 2.0% versus 0.7%
(Pinteraction 0.045). In those with prior PCI, the effect of evolocumab on
coronary revascularization (HR, 0.76 [0.69-0.85]) was directionally
consistent across types of revascularization procedures: coronary artery
bypass grafting (HR, 0.71 [0.54-0.94]); any PCI (HR, 0.77 [0.69-0.86]);
PCI for de novo lesions (HR, 0.76 [0.66-0.88]); and PCI for stent failure
or graft lesions (HR, 0.76 [0.63-0.91]). CONCLUSION(S): Evolocumab
reduces the risk of MACE in patients with prior PCI including the risk of
coronary revascularization, with directionally consistent effects across
several types of revascularization procedures, including coronary artery
bypass grafting and PCI for stent or graft failure. REGISTRATION: URL:
https://www. CLINICALTRIALS: gov; Unique identifier: NCT01764633.

<61>
Accession Number
2014028092
Title
Acute Changes in Myocardial Expression of Heat Shock Proteins and
Apoptotic Response Following Blood, delNido, or Custodiol Cardioplegia in
Infants Undergoing Open-Heart Surgery.
Source
Pediatric Cardiology. 43(3) (pp 567-579), 2022. Date of Publication: March
2022.
Author
Yayla-Tuncer E.; Sengelen A.; Tan-Recep B.Z.; Savluk O.F.; Yilmaz A.A.;
Ceyran H.; Onay-Ucar E.
Institution
(Yayla-Tuncer, Tan-Recep, Yilmaz, Ceyran) Pediatric Cardiovascular Surgery
Clinic, Kartal Kosuyolu High Specialization Training and Research
Hospital, Health Sciences University, Denizer Road No:2,
Cevizli-Kartal/Istanbul 34846, Turkey
(Sengelen) Department of Molecular Biology and Genetics, Institute of
Graduate Studies in Sciences, Istanbul University, Istanbul, Turkey
(Savluk) Anesthesiology and Reanimation Clinic, Kartal Kosuyolu High
Specialization Training and Research Hospital, Health Sciences University,
Istanbul, Turkey
(Onay-Ucar) Department of Molecular Biology and Genetics, Faculty of
Science, Istanbul University, Balabanaga, Sehzadebasi Road, Vezneciler,
Istanbul 34134, Turkey
(Tan-Recep) Pediatric Cardiovascular Surgery Clinic, Konya City Hospital,
Health Sciences University, Konya, Turkey
Publisher
Springer
Abstract
Stress caused by cardioplegic ischemic arrest was shown to alter the
expression levels of heat shock proteins (Hsp), but little is known about
their effects, particularly on pediatric hearts. This study aimed to
investigate whether myocardial cellular stress and apoptotic response
changes due to different cardioplegia (CP) solutions during
cardiopulmonary bypass (CPB) in infants and to determine their influence
on surgical/clinical outcomes. Therefore, twenty-seven infants for
surgical closure of ventricular septal defect were randomly assigned to a
CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol
(CCP). Hsp levels and apoptosis were determined by immunoblotting in
cardiac tissue from the right atrium before and after CP, and their
correlations with cardiac parameters were evaluated. No significant change
was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased
significantly in the BCP-group but increased markedly in the CCP-group.
Decreased Hsp60 and increased Hsp70 expression were detected in
dNCP-group. Importantly, apoptosis was not observed in dNCP- and
CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were
determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury
marker, was markedly lower in the BCP- and dNCP-groups than CCP.
Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated
with aortic cross-clamp time, total perfusion time, and cTn-I release. Our
findings show that dNCP provides the most effective myocardial
preservation in pediatric open-heart surgery and indicate that an increase
in Hsp70 expression may be associated with a cardioprotective effect,
while an increase in Hsp60 and Hsp90 levels may be an indicator of
myocardial damage during CPB. Copyright © 2021, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<62>
Accession Number
2017231015
Title
Outcomes with revascularization and medical therapy in patients with
coronary disease and chronic kidney disease: A meta-analysis.
Source
Atherosclerosis. (no pagination), 2022. Date of Publication: 2022.
Author
Leszek A.; Poli L.; Zbinden S.; Godoy L.C.; Reny J.-L.; Farkouh M.E.;
Charytan D.M.; Mavrakanas T.A.
Institution
(Leszek, Poli, Zbinden, Reny) Department of Medicine, Geneva University
Hospitals and Faculty of Medicine, Geneva, Switzerland
(Godoy, Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, ON, Canada
(Godoy) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
(Charytan) Department of Medicine, New York University Langone Medical
Center & New York University Grossman School of Medicine, New York, NY,
United States
(Mavrakanas) Department of Medicine, McGill University Health Centre,
Montreal, QC, Canada
(Mavrakanas) Research Institute of the McGill University Health Centre,
Montreal, QC, Canada
Publisher
Elsevier Ireland Ltd
Abstract
Background and aims: Chronic kidney disease (CKD) confers a high risk for
poor cardiovascular outcomes. We conducted a systematic review and
meta-analysis to estimate the effects of revascularization as the initial
management strategy compared with medical therapy among patients with CKD
and coronary artery disease. Method(s): A Medline/PubMed literature
research was conducted to identify randomized studies comparing early
coronary revascularization with optimal medical therapy or medical therapy
alone in patients with CKD (estimated glomerular filtration rate <60
mL/min/1.73 m2 or maintenance dialysis). The primary outcome
was myocardial infarction. The secondary outcomes were all-cause mortality
or progression to kidney failure. The risk ratio (RR) was estimated using
a random-effects model. Result(s): Eleven randomized trials were
included (3422 patients). Revascularization was associated with lower
incidence of myocardial infarction compared with medical therapy in
patients with CKD: RR 0.71 (95% confidence interval [CI] 0.54-0.94;
p=0.02). This result was mainly driven from a significantly lower
incidence of myocardial infarction with early revascularization among
patients with stable coronary artery disease: RR 0.59; 95% CI 0.37-0.93. A
similar incidence of all-cause mortality was observed with both treatment
strategies: RR 0.88 (95% CI 0.72-1.08; p=0.22). A trend towards lower
incidence of all-cause mortality was observed with revascularization in
the subgroup of patients presenting with NSTE-ACS: RR 0.73 (95% CI
0.51-1.04; p=0.08) but not among patients with stable coronary disease.
There was no difference in progression to kidney failure between the two
strategies. Conclusion(s): Coronary revascularization may be superior
to medical therapy among patients with CKD and coronary
disease. Copyright © 2022

<63>
Accession Number
637473319
Title
Benefits and harms of direct oral anticoagulation and low molecular weight
heparin for thromboprophylaxis in patients undergoing non-cardiac surgery:
systematic review and network meta-analysis of randomised trials.
Source
BMJ (Clinical research ed.). 376 (pp e066785), 2022. Date of Publication:
09 Mar 2022.
Author
Marcucci M.; Etxeandia-Ikobaltzeta I.; Yang S.; Germini F.; Gupta S.;
Agarwal A.; Ventresca M.; Tang S.; Morgano G.P.; Wang M.; Ahmed M.M.;
Neumann I.; Izcovich A.; Criniti J.; Popoff F.; Devereaux P.J.; Dahm P.;
Anderson D.; Lavikainen L.I.; Tikkinen K.A.O.; Guyatt G.H.; Schunemann
H.J.; Violette P.D.
Institution
(Marcucci) Department of Health Research Methods, Evidence, McMaster
University, ON, and Impact, Hamilton, Canada
(Marcucci, Germini, Agarwal, Ahmed, Devereaux, Guyatt) Department of
Medicine, McMaster University, ON, Hamilton, Canada
(Marcucci, Devereaux) Population Health Research Institute, ON, Hamilton,
Canada
(Etxeandia-Ikobaltzeta, Germini, Ventresca, Morgano, Devereaux, Guyatt,
Schunemann, Violette) Department of Health Research Methods, Evidence,
McMaster University, ON, and Impact, Hamilton, Canada
(Yang) Department of Anaesthesia, Jewish General Hospital, QC, Montreal,
Canada
(Gupta) Department of Medicine, Kingston Health Sciences Centre, Queen's
University, ON, Kingston, Canada
(Agarwal) Department of Medicine, University of Toronto, ON, Toronto,
Canada
(Tang) Department of Epidemiology, Nanjing Medical University, Nanjing,
China
(Wang) Department of Science, McMaster University, ON, Hamilton, Canada
(Wang) Department of Mathematics, University of Waterloo, ON, Waterloo,
Canada
(Neumann) Department of Internal Medicine, Santiago de Chile, Pontificia
Universidad Catolica de Chile, Chile
(Izcovich, Criniti, Popoff) Department of Internal Medicine, Hospital
Aleman, Buenos Aires, Argentina
(Dahm) Minneapolis Veterans Affair Health Care System, Urology Section,
MN, Minneapolis, United States
(Dahm) University of Minnesota, Department of Urology, MN, Minneapolis,
United States
(Anderson) Faculty of Medicine, Dalhousie University, NS, Halifax, Canada
(Lavikainen) Faculty of Medicine, University of Helsinki, Helsinki,
Finland
(Tikkinen) Department of Urology, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
(Tikkinen) Department of Surgery, South Karelian Central Hospital,
Lappeenranta, Finland
(Schunemann) Michael DeGroote Cochrane Canada Centre-Department of
Medicine, McMaster University, ON, Hamilton, Canada
(Violette) Department of Surgery, McMaster University, ON, Hamilton,
Canada
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To systematically compare the effect of direct oral
anticoagulants and low molecular weight heparin for thromboprophylaxis on
the benefits and harms to patients undergoing non-cardiac surgery. DESIGN:
Systematic review and network meta-analysis of randomised controlled
trials. DATA SOURCES: Medline, Embase, and the Cochrane Central Register
of Controlled Trials (CENTRAL), up to August 2021. REVIEW METHODS:
Randomised controlled trials in adults undergoing non-cardiac surgery were
selected, comparing low molecular weight heparin (prophylactic (low) or
higher dose) with direct oral anticoagulants or with no active treatment.
Main outcomes were symptomatic venous thromboembolism, symptomatic
pulmonary embolism, and major bleeding. Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for
network meta-analyses. Abstracts and full texts were screened
independently in duplicate. Data were abstracted on study participants,
interventions, and outcomes, and risk of bias was assessed independently
in duplicate. Frequentist network meta-analysis with multivariate random
effects models provided odds ratios with 95% confidence intervals, and
GRADE (grading of recommendations, assessment, development, and
evaluation) assessments indicated the certainty of the evidence.
 RESULT(S): 68 randomised controlled trials were included (51
orthopaedic, 10 general, four gynaecological, two thoracic, and one
urological surgery), involving 45445 patients. Low dose (odds ratio 0.33,
95% confidence interval 0.16 to 0.67) and high dose (0.19, 0.07 to 0.54)
low molecular weight heparin, and direct oral anticoagulants (0.17, 0.07
to 0.41) reduced symptomatic venous thromboembolism compared with no
active treatment, with absolute risk differences of 1-100 per 1000
patients, depending on baseline risks (certainty of evidence, moderate to
high). None of the active agents reduced symptomatic pulmonary embolism
(certainty of evidence, low to moderate). Direct oral anticoagulants and
low molecular weight heparin were associated with a 2-3-fold increase in
the odds of major bleeding compared with no active treatment (certainty of
evidence, moderate to high), with absolute risk differences as high as 50
per 1000 in patients at high risk. Compared with low dose low molecular
weight heparin, high dose low molecular weight heparin did not reduce
symptomatic venous thromboembolism (0.57, 0.26 to 1.27) but increased
major bleeding (1.87, 1.06 to 3.31); direct oral anticoagulants reduced
symptomatic venous thromboembolism (0.53, 0.32 to 0.89) and did not
increase major bleeding (1.23, 0.89 to 1.69). CONCLUSION(S): Direct
oral anticoagulants and low molecular weight heparin reduced venous
thromboembolism compared with no active treatment but probably increased
major bleeding to a similar extent. Direct oral anticoagulants probably
prevent symptomatic venous thromboembolism to a greater extent than
prophylactic low molecular weight heparin. SYSTEMATIC REVIEW REGISTRATION:
PROSPERO CRD42018106181. Copyright © Author(s) (or their
employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use.
See rights and permissions. Published by BMJ.

<64>
[Use Link to view the full text]
Accession Number
637084158
Title
Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Medicine in
Ischemic Cardiomyopathy: The STICH Randomized Clinical Trial.
Source
Circulation. 145(11) (pp 819-828), 2022. Date of Publication: 15 Mar 2022.
Author
Chew D.S.; Cowper P.A.; Al-Khalidi H.; Anstrom K.J.; Daniels M.R.;
Davidson-Ray L.; Li Y.; Michler R.E.; Panza J.A.; Pina I.L.; Rouleau J.L.;
Velazquez E.J.; Mark D.B.
Institution
(Chew, Cowper, Al-Khalidi, Anstrom, Daniels, Davidson-Ray, Li, Mark) Duke
Clinical Research Institute (D.S.C., P.A.C., H.A., K.J.A., M.R.D.,
L.D.-R., Y.L., D.B.M.), Duke University, Durham, NC
(Chew) Department of Cardiac Sciences, Libin Cardiovascular Institute
(D.S.C.), University of Calgary, AB, Canada
(Chew) O'Brien Institute for Public Health (D.S.C.), University of
Calgary, AB, Canada
(Al-Khalidi, Anstrom) Department of Biostatistics and Bioinformatics
(H.A., Duke University, Durham
(Michler) Department of Cardiothoracic and Vascular Surgery, Montefiore
Medical Center, Bronx, United States
(Panza) Department of Cardiology, Westchester Medical Center, Westchester
Medical Center Health Network, Valhalla, United States
(Pina) Department of Medicine, Wayne State University, Detroit, United
States
(Rouleau) Institut de Cardiologie de Montreal, Universite de Montreal
(Velazquez) Section of Cardiovascular Medicine, Yale School of Medicine,
CT (E.J.V.), New Haven, United States
(Mark) Division of Cardiology, Department of Medicine, Duke University
Medical Center, Durham
Publisher
NLM (Medline)
Abstract
BACKGROUND: The STICH Randomized Clinical Trial (Surgical Treatment for
Ischemic Heart Failure) demonstrated that coronary artery bypass grafting
(CABG) reduced all-cause mortality rates out to 10 years compared with
medical therapy alone (MED) in patients with ischemic cardiomyopathy and
reduced left ventricular function (ejection fraction <=35%). We examined
the economic implications of these results. METHOD(S): We used a
decision-analytic patient-level simulation model to estimate the lifetime
costs and benefits of CABG and MED using patient-level resource use and
clinical data collected in the STICH trial. Patient-level costs were
calculated by applying externally derived US cost weights to resource use
counts during trial follow-up. A 3% discount rate was applied to both
future costs and benefits. The primary outcome was the incremental
cost-effectiveness ratio assessed from the US health care sector
perspective. RESULT(S): For the CABG arm, we estimated 6.53
quality-adjusted life-years (95% CI, 5.70-7.53) and a lifetime cost of
$140059 (95% CI, $106401 to $180992). For the MED arm, the corresponding
estimates were 5.52 (95% CI, 5.06-6.09) quality-adjusted life-years and
$74894 lifetime cost (95% CI, $58372 to $93541). The incremental
cost-effectiveness ratio for CABG compared with MED was $63989 per
quality-adjusted life-year gained. At a societal willingness-to-pay
threshold of $100000 per quality-adjusted life-year gained, CABG was found
to be economically favorable compared with MED in 87% of microsimulations.
 CONCLUSION(S): In the STICH trial, in patients with ischemic
cardiomyopathy and reduced left ventricular function, CABG was
economically attractive relative to MED at current benchmarks for value in
the United States. REGISTRATION: URL: https://www. CLINICALTRIALS: gov;
Unique identifier: NCT00023595.

<65>
[Use Link to view the full text]
Accession Number
637066488
Title
Revascularization strategies in patients with diabetes and stable ischemic
heart disease: a systematic review and meta-analysis of randomized trials.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 23(4) (pp 242-246),
2022. Date of Publication: 01 Apr 2022.
Author
Noguchi M.; Ueyama H.; Fujisaki T.; Takagi H.; Kuno T.
Institution
(Noguchi) Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical
Center, Urayasu, Japan
(Ueyama, Kuno) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Beth Israel, Israel
(Fujisaki) Department of Medicine, Icahn School of Medicine at Mount
Sinai, Mount Sinai Morningside and West, NY, United States
(Takagi) Division of Cardiovascular Surgery, Shizuoka Medical Center,
Shizuoka, Japan
(Kuno) Division of Cardiology, Montefiore Medical Center, Albert Einstein
College of Medicine, NY, United States
Publisher
NLM (Medline)
Abstract
AIMS: The optimal treatment strategy comparing invasive revascularization
versus optimal medical therapy (OMT) in patients with diabetes mellitus
(DM) and stable ischemic heart disease (SIHD) still remains unclear. We
aimed to investigate clinical outcomes of invasive revascularization
(percutaneous coronary intervention, coronary artery bypass grafting or
both) versus OMT in patients with DM and SIHD from updated published
randomised-controlled trials (RCTs). METHOD(S): We conducted a
comprehensive literature search through PubMed and EMBASE to investigate
the effect of revascularization versus OMT for patients with DM and SIHD.
The studies were limited to RCTs or their subgroup data for a
meta-analysis. The outcomes of interest were major adverse cardiovascular
events (MACE) in patients with DM and SIHD. RESULT(S): Our search
identified subgroup data with DM of four RCTs including a total of 5742
patients with SIHD. Our results showed that invasive revascularization was
not associated with a decreased risk of MACE when compared to OMT [hazard
ratio (95% confidence interval): 0.95 (0.85-1.05), P = 0.31; I2 = 0%].
 CONCLUSION(S): Invasive revascularization was not associated with a
decreased risk of MACE when compared with OMT. Copyright © 2021
Italian Federation of Cardiology - I.F.C. All rights reserved.

<66>
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Accession Number
636937011
Title
Rationale and design of the effects of EMpagliflozin on left ventricular
DIAstolic function in diabetes (EmDia) study.
Source
Journal of cardiovascular medicine (Hagerstown, Md.). 23(3) (pp 191-197),
2022. Date of Publication: 01 Mar 2022.
Author
Junger C.; Prochaska J.H.; Gori T.; Schulz A.; Binder H.; Daiber A.; Koeck
T.; Rapp S.; Lackner K.J.; Munzel T.; Wild P.S.
Institution
(Junger, Prochaska, Schulz, Koeck, Rapp, Wild) Preventive Cardiology and
Preventive Medicine, Department of Cardiology
(Junger) Department of Psychosomatic Medicine and Psychotherapy,
University Medical Center of the Johannes Gutenberg-University Mainz
(Junger, Prochaska, Gori, Daiber, Koeck, Lackner, Munzel, Wild) German
Center for Cardiovascular Research (DZHK), Partner Site Rhine Main,
Germany
(Prochaska, Wild) Center for Thrombosis and Hemostasis (CTH)
(Gori, Daiber, Munzel) Department of Cardiology, University Medical Center
of the Johannes Gutenberg-University Mainz, Mainz, Germany
(Binder) Institute of Medical Biometry and Statistics, University of
Freiburg, Freiburg, Germany
(Lackner) Institute for Clinical Chemistry and Laboratory Medicine,
University Medical Center of the Johannes Gutenberg-University Mainz,
Mainz, Germany
Publisher
NLM (Medline)
Abstract
BACKGROUND: Data of the EMPA-REG OUTCOME study have demonstrated a
beneficial effect of the sodium-glucose cotransporter 2 inhibitor
empagliflozin on cardiovascular outcome in patients with type 2 diabetes.
The reduction in cardiovascular mortality and hospitalization due to heart
failure might be in part explained by the direct effects of empagliflozin
on cardiac diastolic function. The EmDia trial investigates the short-term
effects of empagliflozin compared to placebo on the left ventricular E/E'
ratio as a surrogate of left ventricular diastolic function.
 METHOD(S): EmDia is a single-center, randomized, double-blind,
two-arm, placebo-controlled, parallel group study of phase IV. Individuals
with diabetes mellitus type 2 (T2DM) are randomized 1:1 to receive
empagliflozin 10 mg per day or a placebo for 12 weeks. The main inclusion
criteria are diagnosed as T2DM with stable glucose-lowering and/or dietary
treatment, elevated HbA1c level (6.5-10.0% if receiving glucose-lowering
therapy, or 6.5-9.0% if drug-naive), and diastolic cardiac dysfunction
with left ventricular E/E'>=8. The primary end point is the difference of
the change in the E/E' ratio by treatment groups after 12 weeks. Secondary
end points include assessment of the effect of empagliflozin on left
ventricular systolic function, measures of vascular structure and
function, as well as humoral cardiovascular biomarkers (i.e. brain
natriuretic peptide, troponin, C-reactive protein). In addition, the
multidimensional biodatabase enables explorative analyses of molecular
biomarkers to gain insights into possible mechanisms of the effects of
empagliflozin on human health in a systems medicine-oriented, multiomics
approach. CONCLUSION(S): By evaluating the short-term effect of
empagliflozin with a comprehensive biobanking program, the EmDia Study
offers an opportunity to primarily assess the effects on diastolic
function but also to examine effects on clinical and molecular
cardiovascular traits. TRIAL REGISTRATION: ClinicalTrials.gov;
NCT02932436. Registration date, 2016/10/13. Copyright © 2021
Italian Federation of Cardiology - I.F.C. All rights reserved.

<67>
Accession Number
637495812
Title
Risk Factors for Acute Kidney Injury Requiring Renal Replacement Therapy
after Orthotopic Heart Transplantation in Patients with Preserved Renal
Function.
Source
Thoracic and Cardiovascular Surgeon. Conference: 51st Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2022.
Online. 70(SUPPL 1) (no pagination), 2022. Date of Publication: January
2022.
Author
Mpembele R.; Roth S.; Stroda A.; Buse G.L.; Westenfeld R.; Tudorache I.;
Aubin H.; Akhyari P.; Lichtenberg A.; Huhn R.; Boeken U.
Institution
(Mpembele, Roth, Stroda, Buse, Westenfeld, Tudorache, Aubin, Akhyari,
Lichtenberg, Huhn, Boeken) University Hospital Duesseldorf, Dasseldorf,
Germany
Publisher
Georg Thieme Verlag
Abstract
Background:Acute kidney injury (AKI) requiring renal replacement therapy
(RRT) is a serious complication after orthotopic heart transplantation
(HTX),In patients with preexisting impaired renal function, postoperative
AKI is not surprising,However, even in patients with preserved renal
function, AKI requiring RRT is frequent,Therefore, this study aimed to
identify risk factors associated with postoperative AKI requiring RRT
after HTX in this sub-cohort,Method:This retrospective cohort study
included patients >=18 years who underwent HTX at the University Hospital
Duesseldorf, Germany, from 2010 to 2021,Preserved renal function was
defined as preoperative creatinine-based glomerular filtration rate >=60
mL/min,The association between all available patient-A nd
procedure-related factors with postoperative AKI requiring RRT within 72
hours after HTX was assessed in univariate logistic regression
models,Based on systematic literature research, most suitable significant
variables were included into multivariate logistic regression,Results:A
total of 206 patients were screened for this study,Thirteen patients had
hemodialysis prior to HTX and 86 patients had baseline GFR<60 mL/min,Based
on the inclusion and exclusion criteria, 107 patients remained for
statistical analysis (mean age: 52+/-12 years, 78.5% male, 45.8% AKI
requiring RRT),After univariate analysis, use of extracorporeal membrane
oxygenation, postoperative infection, levosimendan therapy, duration of
norepinephrine (NE) therapy, and maximum daily increase in tacrolimus
plasma levels were included into multivariate analysis,Duration of NE
therapy and maximum daily increase in tacrolimus plasma levels remained as
independent significant risk factors (NE: OR 1.01, 95% CI:
1.00-1.02,p=0.005; increase in tacrolimus plasma level: OR 1.18, 95% CI:
1.01-1.37,p=0.036),In addition, there was a nonsignificant trend for
VA-ECMO due to primary graft dysfunction after HTX (OR: 4.54, 95% CI:
0.96-21.43;p=0.056),Conclusion:This retrospective cohort study identified
prolonged NE therapy and maximum daily increase in tacrolimus plasma
levels as risk factors for AKI requiring RRT in HTX patients with
preserved renal function,These results are clinically relevant and new
therapeutic approaches for HTX patients are urgently needed,In this
context, the role of calcineurin inhibitor free induction therapy or
extended release tacrolimus should be investigated.

<68>
Accession Number
637495706
Title
Cardiac Patient Education Goes Digital: From Paper-Based Methods and
3D-Printed Modelsto Virtual Reality.
Source
Thoracic and Cardiovascular Surgeon. Conference: 51st Annual Meeting of
the German Society for Thoracic and Cardiovascular Surgery, DGTHG 2022.
Online. 70(SUPPL 1) (no pagination), 2022. Date of Publication: January
2022.
Author
Grab M.; Hundertmark F.; Grefen L.; Konig F.; Fairchild M.; Hagl C.;
Thierfelder N.
Institution
(Grab, Hundertmark, Grefen, Konig, Hagl, Thierfelder) Ludwig-Maximilian
University of Munich, Manchen, Germany
(Fairchild) Vr-on GmbH, Manchen, Germany
Publisher
Georg Thieme Verlag
Abstract
Background: Cardiac surgery represents one of the most intrusive surgical
procedures in a patient's life. Due to theseverity, many patients suffer
from postoperative mental health issues. Therefore, the aim of this study
was to employdigital models during the pre-surgical education, focusing on
their impact on patient's anxiety. Method(s): To create standardized
digital models for CABG, SAVR and TAA procedures anonymized patient
CT-datasets werecollected retrospectively. These digital models were
surface modified in a 3D-modeling software and subsequently insertedinto a
multi-user virtual reality (VR) platform or 3D printed. Presurgical
patient education was conducted with patientsadmitted to our cardiac
surgery department. Patients were randomly divided into three groups for
different patienteducation methods based on conventional paper sheets,
3D-printed models, and VR models. Presurgical consultation withthe paper
sheet was treated as a control. Education quality and impact on patient
anxiety was determined by aquestionnaire combining customized questions
with the standardized State-Trait Anxiety Inventory. A cardiac
surgeonconducted pre-surgical consultation and questionnaires were filled
out before and after. Result(s): Three representative VR scenes were
created for some of the most common procedures in cardiac surgery.
Patientand physician, using two cordless VR headsets were able to freely
move around the education model inside a medical-styleVR room. The
physician was able to cycle through different steps of the procedure,
while highlighting and scaling importantstructures. Forty patients were
included in classic paper sheet, 3D-printed model and VR-model education
groups,respectively. Questionnaires revealed an increase in procedural
understanding for all three groups, with the 3D-printedmodel and VR model
groups additionally showing an increase in anatomical and spatial
awareness. Anxiety levels decreasedfor patients educated with all
education methods. Patients educated with 3D-printed and VR models
expressed higherconfidence in the procedure and surgical team. Ten
patients in the VR-model group experienced nausea or struggled withthe VR
controls and were excluded from the study. Conclusion(s): It was
possible to create a VR-based patient education platform for the most
common cardiac surgicalprocedures. The patients overall satisfaction with
the 3D-models be it physical or digital, was very high making
anintegration into everyday clinical practice feasible.

<69>
Accession Number
637495230
Title
Eligibility criteria perpetuate disparities in enrollment and
participation in pancreatic cancer clinical trials.
Source
Cancer Epidemiology Biomarkers and Prevention. Conference: 14th AACR
Conference on the Science of Cancer Health Disparities in Racial/Ethnic
Minorities and the Medically Underserved. Virtual. 31(1 SUPPL) (no
pagination), 2022. Date of Publication: January 2022.
Author
Riner A.N.; Girma S.; Skoro N.; Gal T.S.; Herremans K.M.; Mukhopadhyay N.;
Vudatha V.; Raman S.; George T.; Trevino J.G.
Publisher
American Association for Cancer Research Inc.
Abstract
Introduction: Clinical trials determine efficacy and safety of cancer
therapeutics and set the standard of care. Inequitable representation of
participants leaves gaps in our knowledge, limits opportunities to
investigational therapeutics and subsequently perpetuates disparities in
survivorship. Clinical trial eligibility criteria have been postulated to
differentially impact certain racial/ethnic groups which have higher
prevalence of infectious and chronic diseases. We aimed to determine the
impact of eligibility criteria on disparities in pancreatic cancer
clinical trial candidacy. Method(s): Common eligibility criteria for
Phase 2 and 3 pancreatic cancer trials listed in clinicaltrials.gov were
compiled for simulation of a clinical trial screening process. Patients
with pancreatic ductal adenocarcinoma who sought care at VCU Massey Cancer
Center (Richmond, VA) from 2010-2019 were included. Clinical variables
pertaining to eligibility criteria were obtained from billing codes and
discrete values in the medical record. Inclusion/exclusion criteria were
applied to determine overall eligibility and for individual criterion.
Chi-squared tests were utilized to identify statistically significant
differences in patient eligibility between racial groups. Result(s):
A total of 676 patients with pancreatic cancer were identified, with Black
(42%) and White (52%) patients comprising the majority of the patient
population. Black patients were significantly more likely than White
patients to be deemed ineligible based on Creatinine (6.08% vs 2.27%, p =
0.036), HIV (3.136% vs 0.286%, p = 0.01), Hepatitis B (1.742% vs 0%, p =
0.043), and Hepatitis C (9.06 vs 3.43%, p = 0.005). Black patients were
also more likely to be ineligible based on Albumin (12.45% vs 7.47%, p =
0.076), history of coronary stenting in the past 6 months (1.39% vs 0%, p
= 0.087), and uncontrolled diabetes (8.96% vs 6.07%, p = 0.244), although
differences in these criteria did not achieve statistical significance at
5% level. History of prior cancer treatment was the only variable that
excluded less Black patients than White patients (9.06% vs 14.0%, p =
0.072) and was attributable to more White patients initiating neoadjuvant
chemotherapy for their pancreatic cancer prior to seeking care at VCU.
After applying all criteria, Black patients were more likely to be
ineligible for participation compared to White patients (42.0% vs 33.3%, p
= 0.039). Conclusion(s): Standard pancreatic cancer clinical trial
eligibility criteria differentially exclude Black patients from
participating in clinical trials. These criteria perpetuate racial
disparities, limit generalizability to real world clinical scenarios, and
are often not medically justifiable. Alternative eligibility criteria can
improve representation of diverse participants, provide more equitable
access to investigational therapeutics and reduce disparities in
survivorship, without compromising patient safety or study results.

<70>
Accession Number
2016889117
Title
CRT-700.19 Five-Year Outcomes of Transcatheter Versus Surgical Aortic
Valve Replacement in Low- to Intermediate-Risk Patients.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S59), 2022. Date of Publication: 28 Feb 2022.
Author
Nasir U.; Waheed T.A.; Choxi R.; Sundhu M.; Ahuja K.R.
Institution
(Nasir, Waheed, Choxi, Sundhu, Ahuja) Reading Hospital - Tower Health,
Reading, PA, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an alternate
to surgical aortic valve replacement (SAVR) in patients with aortic
stenosis (AS). In patients with low to intermediate surgical risk, while
SAVR remains the procedure of choice, TAVR has shown promising results.
 Objective(s): This meta-analysis of randomized controlled trials
(RCTs) compared the outcomes of TAVR versus SAVR in low to intermediate
surgical risk candidates at five year follow up. Method(s):
Electronic databases were searched from inception to November 4, 2021.
RCTs comparing TAVR versus SAVR in low to intermediate-risk patients
(Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score
<8%) were included. Primary outcome was all-cause mortality at 5 years.
Random-effects models were used to calculate pooled odds ratio (OR) and
corresponding 95% confidence intervals (CI) Results: The meta-analysis
included 4 RCTs that randomized 4722 patients (2411 to TAVR and 2311 to
SAVR). Patients had a mean age of 89.9 and mean STS score of 5.1 in TAVR
versus 5.2 in SAVR. All-cause mortality at five years was lower in SAVR
compared to TAVR (OR 1.16; 95% CI: 1.01-1.34, I2=21%, P=0.28).
There was no difference in the risk of any stroke at five years (OR 0.98;
95% CI: 0.74-1.31. I2=58%, P=0.07). The need for valve
reintervention at five years was higher in TAVR (OR 2.50; 95% CI:
1.55-4.03, I2=0%, P=0.55). There was no difference in the
composite outcome of death or disabling stroke, endocarditis, or
cardiovascular mortality. Conclusion(s): The findings of this
meta-analysis show encouraging results of TAVR at five year follow up with
non-inferiority of TAVR for cardiovascular mortality, death, or disabling
stroke. While there is inferiority of TAVR in all-cause mortality, the
difference between the two groups is minimal. [Formula
presented] Copyright © 2022

<71>
Accession Number
2016889106
Title
CRT-700.28 Clinical Outcomes of MANTA vs Suture-Based Closure Devices
After TAVR: An Updated Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S62), 2022. Date of Publication: 28 Feb 2022.
Author
Vasudev R.; Guragai N.; Doshi R.; Kumar A.; Shariff M.; Majmundar M.;
Doshi P.; Altabaqchali S.; Virk H.; Bikkina M.; Shamoon F.; Pasala T.
Institution
(Vasudev, Altabaqchali, Pasala) Hackensack University Medical Center,
Hackensack, NJ, United States
(Guragai, Doshi) St Joseph University Medical Center, Paterson, NJ, United
States
(Kumar) Cleveland Clinic Akron General Hospital, Akron, OH, United States
(Shariff) Mayo Clinic, Rochester, MN, United States
(Majmundar) Maimonides Medical Center, Brooklyn, NY, United States
(Doshi) Ramaiah Medical College, Bangaluru, India
(Virk, Bikkina, Shamoon) St Joseph's University Medical Center, Paterson,
NJ, United States
Publisher
Elsevier Inc.
Abstract
Background: There have been a recently published randomized control trial
showing better results with suture-based vascular closure device (VCD)
than plug-based VCD in patient undergoing transfemoral trans catheter
aortic valve replacement (TAVR). The learning curve for MANTA device is
steep while learning curve for suture-based VCD is shallow as the devices
are quite different. In this meta-analysis, we have compared suture-based
vs plug-based VCDs using most up-to-date studies. Suture-based VCD
included ProGlide and Prostar XL. Method(s): We performed
meta-analysis of all published studies (Using PubMed and EMBASE) reporting
the clinical outcome of MANTA (plug-based) vs suture-based VCD in
transfemoral TAVR patients. Primary outcome was a combination of major and
minor bleeding. Result(s): We included nine studies with a total of
2865 patients (MANTA n= 1631, suture-based n= 1234). There was no
significant difference in primary outcome when using MANTA as opposed to
suture-based VCD (RR 1.54 [0.83-2.86]I2 = 69 %) (Panel A).
There was no difference in major life threatening bleeding (RR 1.01
[0.61-1.67] I2= 32%) (Panel B), vascular complications (RR 1.42
[0.63-3.23] I2=58%) (Panel C), pseudo aneurysm (RR 1.46
[0.18-11.87] I2= 43%) (Panel D), dissection (RR 1.08
[0.54-2.15] I2=0%) (Panel E), VCD failure (RR 1.71 [0.96-3.04]
I2= 0%) (Panel F). Conclusion(s): In this transfemoral
TAVR population, there was no significant difference in safety or efficacy
when using MANTA as compared to suture-based VCD. There was significant
heterogeneity in our primary outcome and these results needs to be
confirmed with upcoming RCTs in patients with significantly higher burden
of calcification. There was very frequent use of secondary VCDs in
suture-based VCD group which is not possible when using MANTA. [Formula
presented] Copyright © 2022

<72>
Accession Number
2016889090
Title
CRT-700.40 Self-Expandable Versus Balloon-Expandable Valve in Low Risk
TAVR Patients: 30-Day Outcomes of LRT Substudy.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S67), 2022. Date of Publication: 28 Feb 2022.
Author
Bhogal S.; Torguson R.; Gordon P.; Ehsan A.; Wilson S.R.; Levitt R.;
Parikh P.; Bilfinger T.; Hanna N.; Buchbinder M.; Asch F.M.; Weissman G.;
Ben-Dor I.; Shults C.C.; Ali S.; Shea C.; Zhang C.; Garcia-Garcia H.M.;
Satler L.F.; Waksman R.; Rogers T.
Institution
(Bhogal, Ben-Dor, Ali, Shea, Zhang, Garcia-Garcia, Satler, Waksman,
Rogers) Section of Interventional Cardiology, MedStar Washington Hospital
Center, Washington, DC, United States
(Torguson) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, New York, NY, United States
(Gordon) Division of Cardiology, Miriam Hospital, Providence, RI, United
States
(Ehsan) Division of Cardiothoracic Surgery, Lifespan Cardiovascular
Institute, Providence, RI, United States
(Wilson) Department of Cardiology, North Shore University Hospital,
Manhasset, NY, United States
(Levitt) Department of Cardiology, HCA Virginia Health System, Richmond,
VA, United States
(Parikh) Department of Medicine, Stony Brook Hospital, Stony Brook, NY,
United States
(Bilfinger) Department of Surgery, Stony Brook Hospital, Stony Brook, NY,
United States
(Hanna) St. John Heart Institute Cardiovascular Consultants, St. John
Health System, Tulsa, OK, United States
(Buchbinder) Foundation for Cardiovascular Medicine, Stanford University,
Stanford, CA, United States
(Asch) MedStar Health Research Institute, MedStar Washington Hospital
Center, Washington, DC, United States
(Weissman) Department of Cardiology, MedStar Washington Hospital Center,
Washington, DC, United States
(Shults) Department of Cardiac Surgery, MedStar Washington Hospital
Center, Washington, DC, United States
Publisher
Elsevier Inc.
Abstract
Background: To date, there is no direct comparison of patients implanted
with balloon-expandable (BE) or self-expandable (SE) valves in the
low-risk population. Method(s): The LRT 1.0 and 2.0 trials were
prospective, investigator-initiated, multicenter studies in low-risk
patients. The current study is a post hoc analysis of combined data from
both the LRT 1.0 and 2.0 trials studying BE and SE transcatheter heart
valves. Result(s): A total of 294 patients received a BE valve
(Edwards Sapien 3) and 102 patients received an SE valve (Medtronic
CoreValve, Evolut R, Evolut PRO). The 30-day clinical outcomes were
similar across both groups except for stroke (4.9% vs. 0.7%, p=0.014) and
permanent pacemaker implantation (PPM) rate (17.8% vs. 5.8%,p<0.001),
which was higher in the SE cohort than in the BE cohort (Figure 1). No
difference was observed in terms of paravalvular leak (>= moderate)
between the groups (0% vs. 1.5%, p=0.577); however, SE patients had larger
aortic valve area (1.92+/-0.43 cm2 vs. 1.69+/-0.45
cm2; p<0.001) and lower mean gradient (8.93+/-3.53 mmHg vs.
13.41+/-4.73 mmHg; p<0.001) compared to BE patients. The rate of
subclinical leaflet thrombosis was significantly lower in SE patients
(5.6% vs. 13.8%; p=0.038) than in BE patients. Limitation(s): The key
limitation of our study is lack of randomization. The choice of valve use
was left at operators discretion, which may introduce the risk of serious
bias (as an example, patients with more left ventricular outflow tract
calcium receiving SE, which imparts higher risk of PPM and stroke that is
patient-dependent rather than valve-dependent). Conclusion(s): SE
valves are associated with better hemodynamics and lesser leaflet
thrombosis in this non-randomized study, but with increased rates of
stroke and PPM at 30 days; however, this could be due to patient-dependent
factors not fully evaluated in this study. [Formula
presented] Copyright © 2022

<73>
Accession Number
2016889000
Title
CRT-700.36 Outcomes of Aortic Valve Replacement Versus Conservative
Treatment in Asymptomatic Severe Aortic Stenosis: An Updated
Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S65), 2022. Date of Publication: 28 Feb 2022.
Author
Ismayl M.; Balakrishna A.M.; Abusnina W.; Thandra A.; Smer A.; Dahal K.
Institution
(Ismayl, Balakrishna, Abusnina, Thandra, Smer, Dahal) Creighton University
School of Medicine, Omaha, NE, United States
Publisher
Elsevier Inc.
Abstract
Background: The current American College of Cardiology/American Heart
Association guidelines recommend conservative treatment for patients with
isolated asymptomatic severe aortic stenosis (AS). We conducted an updated
meta-analysis to compare the outcomes of early aortic valve replacement
(AVR) versus conservative treatment in patients with asymptomatic severe
AS. Method(s): We searched PubMed, Cochrane Central Register of
Clinical Trials, EMBASE, and (inception through October 2021) for studies
comparing outcomes of early AVR versus conservative treatment in patients
with asymptomatic severe AS. We used random-effect model to calculate risk
ratio (RR) with 95% confidence interval (CI). Our main outcomes included
all-cause mortality, cardiac and non-cardiac mortality, sudden cardiac
death (SCD), myocardial infarction (MI), stroke, and heart failure
hospitalization (HFH). Result(s): A total of 12 studies (2 randomized
and 10 observational studies) with 5,245 patients were included. Compared
to conservative treatment in patients with asymptomatic severe AS, AVR was
associated with significantly lower all-cause mortality (RR: 0.38; 95% CI:
0.30-0.48; p<0.01), cardiac mortality (RR: 0.34; 95% CI: 0.26-0.45;
p<0.01), non-cardiac mortality (RR: 0.40; 95% CI: 0.31-0.50; p<0.01), SCD
(RR: 0.44; 95% CI: 0.26-0.75; p<0.01), and HFH rates (RR: 0.17; 95% CI:
0.10-0.31; p<0.01). There was no significant difference between both
groups in MI (RR: 1.08; 95% CI: 0.20-5.73; p=0.93) and stroke rates (RR:
0.85; 95% CI 0.43-1.65; p=0.62). Conclusion(s): In patients with
asymptomatic severe AS, AVR is associated with significantly lower
mortality and HFH rates compared to conservative treatment. This
meta-analysis supports early AVR in all patients with severe AS,
regardless of symptoms. [Formula presented] Copyright © 2022

<74>
Accession Number
2016888929
Title
CRT-300.18 The Efficacy and Safety of Manta Versus ProGlide Vascular
Closure Devices After Transcatheter Aortic Valve Replacement.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S37), 2022. Date of Publication: 28 Feb 2022.
Author
Saleh Y.; Abdelkarim O.; Al-Abcha A.
Institution
(Saleh, Abdelkarim) Houston Methodist Hospital, Houston, TX, United States
(Al-Abcha) Michigan State University, East Lansing, MI, United States
Publisher
Elsevier Inc.
Abstract
Background: Several vascular closure devices (VCDs) including Manta and
ProGlide are utilized after transcatheter aortic valve replacement. Data
comparing the plug-based Manta to the suture-based ProGlide are limited.
 Method(s): We conducted a meta-analysis of all studies that evaluated
clinical outcomes of the Manta VCD compared to ProGlide VCD in
transcatheter aortic valve replacement. The primary outcome was device
failure. Secondary outcomes included major vascular complications, minor
vascular complications, major bleeding, and minor bleeding events.
 Result(s): We included two randomized clinical trials (RCT), and four
observational studies with a total of 1,565 patients. The rate of device
failure was similar in the MANTA arm when compared to the ProGlide arm (7%
vs 10%, respectively). There were no differences in all major or minor
vascular complications between the Manta and the ProGlide VCDs. The rate
of major and minor bleeding was also similar between the two arms.
 Conclusion(s): In the transcatheter aortic valve replacement
population, the safety profile and efficacy of the plug-based MANTA VCD is
similar to the suture-based VCDs ProGlide. [Formula
presented] Copyright © 2022

<75>
Accession Number
2016888917
Title
CRT-700.02 Bicuspid Transcatheter Aortic Valve Replacement (TAVR): The
Texas Tech Experience.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S55), 2022. Date of Publication: 28 Feb 2022.
Author
Galvan B.; Holder K.G.; Ramon M.; Mittal N.; Boeger B.; Ansari M.M.
Institution
(Galvan, Holder, Ramon, Mittal, Boeger, Ansari) Texas Tech University
Health Sciences Center, Lubbock, TX, United States
Publisher
Elsevier Inc.
Abstract
Background: In the last 15 years, transcatheter aortic valve replacement
(TAVR) has become an increasingly viable alternative to open surgery for
aortic valve repair in patients with aortic valve stenosis who have high
perioperative risk factors. To date, most randomized control trials of
TAVR have excluded patients with stenosed bicuspid valves. Bicuspid aortic
valves (BAV) are found in up to2% of the population and 25% of patients
over 80 years of age who require aortic valve replacement. Method(s):
A retrospective case series was conducted over TAVR procedure outcomes in
high-risk patients including those with bi-cuspid aortic valves. This
study analyzes clinical features and outcomes of TAVR at a tertiary
referral center and academic teaching hospital that took place between
2015 and 2021. ANOVA was then run with multiple pairwise comparisons using
independent sample t-tests. Result(s): Out of all patients who
underwent TAVR at this center, seven patients had a congenital bicuspid
aortic valve. The average age of these patients was 72 years and they have
an average STS score was 5.42. These patients all had at least one
comorbidity and averaged 3comorbidities each which include HTN, HLD, DM,
PAD, CVA, AFib, CHF, or CAD. Only one patient experienced a 3 month
postoperative complication. Conclusion(s): While data on TAVR
outcomes in bicuspid aortic valve stenosis is limited, this small study
suggests that TAVR may be a viable alternative to open surgery in this
treatment group. Randomized control trials are needed to adequately assess
TAVR's efficacy and risks, but in the meantime, TAVR may be considered by
experienced physicians willing to treat high-risk patients with stenosed
bicuspid valves as seen in our experience. Copyright © 2022

<76>
Accession Number
2016888911
Title
CRT-100.75 Impact of FFR Evaluation in Patients With Multivessel Coronary
Artery Disease Undergoing Coronary Artery Revascularization: A Systematic
Review and Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S20), 2022. Date of Publication: 28 Feb 2022.
Author
Sanz-Sanchez J.; Kumar S.; Sole J.M.; Diez Gil J.L.; Garcia-Garcia H.M.
Institution
(Sanz-Sanchez, Sole, Diez Gil) Hospital Universitario y Politecnico La Fe,
Valencia, Spain
(Kumar, Garcia-Garcia) MedStar Washington Hospital, Washington, DC, United
States
Publisher
Elsevier Inc.
Abstract
Background: Fractional flow reserve (FFR)-guided percutaneous coronary
intervention (PCI) is the recommended revascularization strategy in
patients presenting with multivessel coronary artery disease (CAD) by
current guidelines. However, recently published studies comparing
FFR-guided PCI with non-physiology-guided revascularization strategies
(i.e., angiography-guided, coronary artery bypass grafting) have reported
conflicting results. Method(s): PubMed and Embase databases were
searched for randomized clinical trials comparing FFR-guided PCI with
non-physiology-guided revascularization strategies in patients with
multivessel CAD. Data were pooled by meta-analysis using a random-effects
model. Result(s): Four studies (FAME, FLOWER-MI, FUTURE, and FAME 3)
enrolling 4,595 patients were included. No differences between FFR-guided
PCI and non-physiology-guided coronary revascularization were found in
patients with multivessel CAD in terms of major adverse cardiovascular
events (MACE; odds ratio [OR] 1.08, 95% confidence interval [CI]
0.73-1.62, I2=75.5%), all-cause mortality (OR 1.25, 95% CI
0.68-2.28, I2=44.4%), myocardial infarction (OR 1.1, 95% CI
0.70-1.73, I2=61.3%), and repeat revascularization (OR 1.04,
95% CI 0.68-1.59, I2=68%) (Figure 1). Conclusion(s): Among
patients with multivessel CAD, FFR-guided PCI as compared to
non-physiology-guided revascularization was not associated with a risk
reduction in any clinical outcome. Panel A) MACE, B) all-cause mortality,
C) myocardial infarction, D) repeat revascularization [Formula
presented] Copyright © 2022

<77>
Accession Number
2016888905
Title
CRT-700.24 Comparison of Various Transcatheter Aortic Valves for Aortic
Stenosis - A Network Meta-Analysis of Randomized Controlled Trials.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S61), 2022. Date of Publication: 28 Feb 2022.
Author
Hiltner E.P.; Shah M.; Schwabe-Warf D.; Haik B.; Hakeem A.; Russo M.;
Sethi A.
Institution
(Hiltner, Schwabe-Warf, Haik, Hakeem, Russo, Sethi) Robert Wood Johnson
University Hospital, New Brunswick, NJ, United States
(Shah) St. Peter's University Hospital, New Brunswick, NJ, United States
Publisher
Elsevier Inc.
Abstract
Background: Transcatheter aortic valve replacement (TAVR) is an
established treatment for many patients with severe aortic stenosis,
however there is limited data comparing available TAVR valves. Our aim was
to compare available valves using direct and indirect evidence from
randomized controlled trials (RCTs) for patients with severe symptomatic
native aortic valve stenosis. Method(s): We performed a systematic
search of electronic databases for RCTs comparing a TAVR valve to a valve
or surgery. A Bayesian network meta-analysis was performed to compile
evidence from both direct and indirect comparisons at 30 days and at one
year. The outcomes which met the convergence and consistency criteria were
reported. Result(s): Eleven studies with 10,307 patients eligible for
TAVR met the criteria and were included. Self-expanding valve CoreValve
type (SEV_C) was associated with higher risk of pacemaker (PPM)
implantation and use of >=1 valve, SEV Accurate type (SEV_A) was
associated with higher risk of >= moderate aortic regurgitation (AR) and
death at 30 days, and mechanically expandable valve (MEV) was associated
with lower risk of >= moderate AR at 30 days but higher risk of PPM
implantation at 30 days and 1 year compared to balloon expandable valve
(BEV) (Figure). SEV_C and MEV were associated with higher PPM implantation
rates compared BEV at 1 year. There was no difference among the valves in
stroke at 30 days and 1 year. Conclusion(s): BEV was superior on one
or more outcomes of PPM implantation, >= 1 valve implantation, and >=
moderate AR compared to other valves except the higher rate >= moderate AR
compared to MEV at 30 days. At one year, BEV was associated with lower
odds of PPM implantation compared to SEV_C and MEV but not different on
other end points. More RCTs comparing available TAVR devices are needed.
[Formula presented] Copyright © 2022

<78>
Accession Number
2016888889
Title
CRT-600.03 Ultrathin Bioresorbable-Polymer Sirolimus-Eluting Stents Versus
Thin Durable-Polymer Everolimus-Eluting Stents in Patients Undergoing
Coronary Revascularization: Final Five-Year Outcomes From the Randomized
BIOFLOW-V Trial.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S51), 2022. Date of Publication: 28 Feb 2022.
Author
Kandzari D.E.; Koolen J.J.; Doros G.; Garcia-Garcia H.M.; Bennett J.;
Roguin A.; Gharib E.G.; Cutlip D.E.; Waksman R.
Institution
(Kandzari) Piedmont Heart Institute, Atlanta, GA, United States
(Koolen) Catharina Hospital, Eindhoven, Netherlands
(Doros) Department of Biostatistics and Epidemiology, Boston University
School of Public Health, Baim Institute for Clinical Research, Boston, MA,
United States
(Garcia-Garcia, Waksman) MedStar Cardiovascular Research Network, MedStar
Washington Hospital Center, Washington, DC, United States
(Bennett) Department of Cardiovascular Medicine, University Hospitals
Leuven, Leuven, Belgium
(Roguin) Department of Cardiology, Hillel Yaffe Medical Center, Hadera,
Israel
(Gharib) Charleston Area Medical Center, Charleston, WV, United States
(Cutlip) Beth Israel Deaconess Medical Center, Baim Institute for Clinical
Research, Boston, MA, United States
Publisher
Elsevier Inc.
Abstract
Background: Randomized clinical trials have demonstrated the superiority
of ultrathin-strut drug-eluting stents (DES) compared with alternative
stent designs. Whether these differences persist over late-term follow-up
is uncertain. Method(s): BIOFLOW-V (ClinicalTrials.gov NCT02389946)
was an international, 2:1 randomized trial comparing an ultrathin-strut
(60 mum) bioresorbable-polymer sirolimus-eluting stent (BP SES) with a
thin-strut (81 mum) durable-polymer everolimus-eluting stent (DP EES)
regarding the primary endpoint of 12-month target lesion failure (TLF).
Prespecified outcomes through the study duration of 5 years were assessed.
 Result(s): Among 1,334 patients randomized to treatment with BP SES
(884 patients) or DP EES (450 patients), the 5-year rate of TLF was 13.2%
(104/787) for BP SES and 16.5% (66/399) for DP EES (p=0.14).
Revascularization with BP SES was associated with significantly lower
target vessel myocardial infarction (TV-MI; 7.3% [56/765] versus 11.5%
[45/391], p=0.02) and numerically lower clinically driven target lesion
revascularization (CD-TLR; 6.3% [48/761] versus 8.3% [32/388], p=0.22).
Cardiac death rates were 2.7% (21/774) for BP SES versus 2.0% (8/392) for
DP EES (p=0.56). At 5 years, very late definite/probable stent thrombosis
was significantly lower for BP SES versus DP EES (0.13% [1/753] for BP SES
versus 1.04% [4/384] for DP EES [p=0.047]). Conclusion(s): In a
large, randomized trial, TLF and the individual outcomes of cardiac death
and CD-TLR at 5-year follow-up were lower, but not statistically
different, among patients treated with BP SES versus DP EES. Both TV-MI
and very late definite/probable stent thrombosis were significantly lower
among patients treated with BP SES. The study demonstrates the excellent
long-term safety and clinical performance of this ultrathin BP SES in a
complex patient population undergoing percutaneous coronary
intervention. Copyright © 2022

<79>
Accession Number
2016888785
Title
CRT-700.61 Pre-Procedural Tricuspid Regurgitation in TMVr: Patient-Centric
Outcomes.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S74), 2022. Date of Publication: 28 Feb 2022.
Author
Dave P.; Milden J.; Abunassar J.; Abuzeid W.
Institution
(Dave, Milden, Abunassar, Abuzeid) Queen's University, Kingston, ON,
Canada
Publisher
Elsevier Inc.
Abstract
Background: Severe TR and MR often co-exist in patients. Transcatheter
mitral valve repair (TMVr) is an option in the management of severe MR.
Studies have not yet clearly identified the role of baseline TR in
prognostication of TMVr patients. We assessed the impact of pre-procedural
TR on patient-centric outcomes such as mortality, need for Heart Failure
Hospitalization (HFH), or need for re-intervention. Method(s): Three
databases on the Ovid platform (Ovid MEDLINE, EMBASE, EBM reviews) were
searched until October 2021. A random-effects model was used to estimate
the pooled odds ratio across the included studies. Result(s): A total
of 924 articles were identified, of which 9 articles were included based
on pre-specified inclusion criteria. A total of 5259 patients undergoing
TMVr from 2010 to 2018 were included in analysis. 20% of patients were
identified as having moderate/severe TR at baseline. Moderate/severe TR at
baseline was associated with increased 12 month mortality as compared to
mild TR at baseline, Figure 1A (OR: 2.59, [95%CI 2.12, 3.17] p<0.001). HFH
were included in 5 studies, showing no statistically significant
association with moderate/severe TR at baseline, Figure 1B (OR: 1.81,
[95%CI 0.96, 3.42] p=0.07). 4 studies commented on re-intervention rates
including repeat TMVr or surgery, showing no statistically significant
association with moderate/severe TR at baseline, Figure 1C (OR: 0.70,
[95%CI 0.38, 1.27] p=0.24). Conclusion(s): Moderate or severe
pre-procedural TR is associated with increased mortality compared to mild
TR at 12 months in patients undergoing TMVr. There is a signal towards
increased HFH post TMVr with worse pre-procedural TR however more studies
need to be done to delineate this. Data regarding re-intervention rates
remains limited and is also an area requiring further investigation.
[Formula presented] Copyright © 2022

<80>
Accession Number
2016888784
Title
CRT-700.35 Early Aortic Valve Replacement Versus Conservative Management
in Asymptomatic Severe Aortic Stenosis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S65), 2022. Date of Publication: 28 Feb 2022.
Author
Nasir U.; Qasim M.
Institution
(Nasir) Reading Hospital - Tower Health, Reading, PA, United States
(Qasim) Indiana University Hospital, Bloomington, IN, United States
Publisher
Elsevier Inc.
Abstract
Background: Aortic stenosis continues to grow as one of the leading causes
of valvular heart disease. Severe but asymptomatic aortic stenosis (AS) is
a perplexing entity without clear consensus of opinion on management. In
this study, we examined the total weight of early aortic valve replacement
(AVR) versus conservative management. Method(s): Electronic databases
were searched from inception through November 18, 2021. Comparative
studies of early AVR versus conservative management in asymptomatic severe
aortic stenosis patients were included. Random-effects models were used to
calculate pooled odds ratio (OR) with corresponding 95% confidence
interval (CI) Results: Ten observational studies (OS) and two randomized
controlled trials (RCTs) including a total of 4460 patients, 1436 in the
early AVR and 3024 in the conservative management arm were analyzed. Early
AVR was associated with lower all-cause mortality (OR: 0.27; 95% CI:
0.19-0.38; I2=67%; P<0.00001), and lower cardiovascular
mortality (OR: 0.30; 95% CI: 0.13-0.72; I2=60%; P=0.04)
compared to conservative management. Subgroup analysis for RCTs only
showed no difference in cardiovascular mortality. Conclusion(s): This
meta-analysis adds further evidence for the benefits of early AVR in
patients with asymptomatic severe AS. Due to the paucity of RCT's, further
studies are needed to better compare early AVR and conservative
management. [Formula presented] Copyright © 2022

<81>
Accession Number
2016888769
Title
CRT-700.11 Comparison of Transfemoral Versus Subclavian/Axillary Access in
Transcatheter Aortic Valve Replacement: A Systematic Review and
Meta-Analysis.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S57-S58), 2022. Date of Publication: 28 Feb 2022.
Author
Abusnina W.; Ismayl M.; Balakrishna A.M.; Latif A.; Mostafa M.R.; Ben-Dor
I.; Dahal K.
Institution
(Abusnina, Ismayl, Balakrishna, Latif, Dahal) Creighton University, Omaha,
NE, United States
(Mostafa) Rochester Regional/Unity Hospital, Rochester, NY, United States
(Ben-Dor) MedStar Washington Hospital Center, Washington DC, DC, United
States
Publisher
Elsevier Inc.
Abstract
Introduction: The transfemoral (TF) approach is the gold-standard approach
for transcatheter aortic valve replacement (TAVR). In cases of iliofemoral
arterial disease, the TF approach is avoided and alternative approaches
are needed. We conducted a meta-analysis to compare the outcomes of TF
versus subclavian/axillary access (SCA) in patients undergoing TAVR.
 Method(s): We searched PubMed, Cochrane Central Register of Clinical
Trials, EMBASE, and (inception through October 2021) for studies comparing
outcomes of TF versus SCA in patients undergoing TAVR. We used
random-effect model to calculate risk ratio (RR) with 95% confidence
interval (CI). Our main outcomes included short and 30-day mortality,
1-year mortality, bleeding, and stroke. Result(s): A total of 20
studies with 69,746 patients were included. Compared to TF access,
patients undergoing TAVR via SCA access had significantly higher risk of
1-year mortality (RR: 0.82; 95% CI: 0.69-0.96; p=0.02), bleeding (RR:
0.73; 95% CI: 0.54-0.99; P=0.05), and stroke rates (RR: 0.62; 95% CI:
0.41-0.94; p=0.02).There was no significant difference between the two
groups in 30-day mortality (RR: 0.91; 95% CI: 0.60-1.40; P=0.68) (Figure).
 Conclusion(s): In patients undergoing TAVR, SCA is associated with
significantly higher 1-year mortality, bleeding, and stroke rates compared
to TF access. The TF approach remains the preferred option for TAVR;
however, the SCA is also a feasible option in patients who cannot undergo
TF access. [Formula presented] Copyright © 2022

<82>
Accession Number
2016888716
Title
CRT-700.09 Early Outcomes and Peri-Procedural Complications of
Transcatheter Aortic Valve Replacement in Patients With Previous Coronary
Artery Bypass Graft Surgery.
Source
JACC: Cardiovascular Interventions. Conference: CRT 2022, Cardiovascular
Research Technologies. Washington, DC United States. 15(4 Supplement) (pp
S56-S57), 2022. Date of Publication: 28 Feb 2022.
Author
Balakrishna A.M.; Ismayl M.; Abusnina W.; Srinivasamurthy R.; Butt D.N.;
Butt K.N.; Gowda R.; Dahal K.
Institution
(Balakrishna, Ismayl, Abusnina, Butt, Butt, Dahal) Creighton University
School of Medicine, Omaha, NE, United States
(Srinivasamurthy) Saint Louis University School of Medicine, St. Louis,
MO, United States
(Gowda) Icahn School of Medicine at Mount Sinai, New York, NY, United
States
Publisher
Elsevier Inc.
Abstract
Background: Patients who underwent a previous coronary artery bypass graft
(CABG) surgery are at increased peri-operative risk when undergoing a redo
cardiac operation such as Transcatheter Aortic Valve Replacement (TAVR).
Recent studies have showed no risk difference in 30-day mortality and
conflicting data with respect to periprocedural complications. We
performed a systematic review and meta-analysis to compare the early
outcomes and peri-procedural complications of TAVR in patients with or
without previous CABG. Method(s): A search was made in the PubMed and
Cochrane databases using the search terms "TAVR" and "CABG". The major
outcomes were 30-day mortality and peri-procedural complications. We used
random effects model to perform statistical analyses. Result(s): A
total of 9 studies (6441 patients) were included, of which 6 studies
reported 30-day mortality. Compared to patients without previous CABG,
patients with previous CABG undergoing TAVR had no difference in terms of
risk of 30-day mortality (RR: 0.67; 95% CI: 0.36-1.25; p = 0.21),
Periprocedural mortality (RR: 0.78; 95% CI: 0.38-1.60; p = 0.49), Stroke
(RR: 0.76; 95% CI: 0.54-1.07; p = 0.12), AKI (RR: 0.98; 95% CI: 0.71-1.36;
p = 0.92), Cardiac tamponade (RR: 0.82; 95% CI: 0.26-2.58; p = 0.74),
Aortic regurgitation (RR: 0.79; 95% CI: 0.63-1.00; p = 0.05). Patients
with previous CABG had lower risk of Vascular complications (RR: 0.76; 95%
CI: 0.62-0.95; p = 0.01), Bleeding (RR: 0.67; 95% CI: 0.53-0.86; p =
0.001), and higher risk of MI (RR: 1.98; 95% CI: 1.17-3.34; p = 0.01) and
Pacemaker implantation (RR: 1.19; 95% CI: 1.03-1.39; p = 0.02).
 Conclusion(s): Patients with or without previous CABG undergoing TAVR
had mostly similar outcomes with exception of vascular complications,
bleeding, MI, and pacemaker implantation. These factors should be
considered while planning for TAVR in such patients. [Formula
presented] Copyright © 2022

<83>
Accession Number
2016112362
Title
Impact of transcatheter aortic valve implantations on temporal trend in
pacemaker implantations over the last decade using the French National
Healthcare database.
Source
Archives of Cardiovascular Diseases Supplements. Conference: JESFC 2022.
Paris France. 14(1) (pp 78), 2022. Date of Publication: January 2022.
Author
Panh L.; Jacob S.; Van Rothem J.; Lapeyre-Mestre M.; Marijon E.; Boveda S.
Institution
(Panh, Van Rothem, Boveda) Cardiology, heart rhythm management, clinique
Pasteur, Toulouse, France
(Jacob) Epidemiology, IRSN, PSE-SANTE, Fontenay-aux-Roses, France
(Lapeyre-Mestre) INSERM, UMR 1295 CERPOP, universite Toulouse III,
Toulouse, France
(Lapeyre-Mestre) Clinical pharmacology, Toulouse university hospital,
Toulouse, France
(Marijon) Cardiac electrophysiology, European Georges-Pompidou hospital,
Paris, France
(Marijon) Centre de recherche cardiovasculaire, INSERM Paris, Paris,
France
Publisher
Elsevier Masson s.r.l.
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has emerged in
2010's for high-risk patients. Permanent pacemaker implantation (PPMI) is
a common complication after TAVI procedure. There are no data on the
eventual impact of TAVI on PPMI temporal trends, at a nationwide scale.
 Purpose(s): First, to evaluate whether PPMI have increased in France
during the period 2008-2018, and secondly to evaluate the extent to which
those post-TAVI PPMI could explain such potential increase.
 Method(s): We used the Echantillon Generaliste de Beneficiaires
(EGB), the 1/97th randomly selected sample of the French healthcare
database to identify patients with PPMI and TAVI performed between 2008
and 2018. The number of observed PPMI, O, in the period 2013-2018 (TAVI
period) was compared with the expected number of PPMI, E, calculated by
using 2008-2012 (pre-TAVI period) incidence rates. We computed the
standardized incidence ratio (SIR) of the observed number of PPMI to the
expected number of PPMI (O/E), with 95% confidence intervals (CIs). We
evaluated the contribution of post-TAVI PPMI in the overall number of
excess cases of PPMI (O-E) for the period 2013-2018. Result(s): The
EGB included more than 500,000 individuals each year with an increasing
part of octogenarians (> 80 years) (4.7% in 2008; 5.9% in 2018). By
removing the effect of age, the PPMI annual rate remained stable, except
for octogenarians: 546 in 2008 to 676 per 100,000 inhabitants in 2018,
especially after 2012 with a significant SIR = 1.06 (95% CI: 1.01-1.12).
In this group of octogenarians, 72% of the increase appeared to be related
to post-TAVI PPMI. Conclusion(s): Between 2008 and 2018 in France,
the incidence of PPMI significantly increased only among octogenarians.
Post-TAVI PPMI could explain more than 70% of this increase. Copyright
© 2021

<84>
Accession Number
2015211271
Title
THE EFFECT OF GOAL-DIRECTED FLUID THERAPY ON THE OCCUR OF ACUTE KIDNEY
INJURY IN PATIENTS UNDERGONE CARDIAC SURGERY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference:
EACTAIC-ICCVA 2021 Joint Virtual Congress. Virtual, Online. 35(Supplement
1) (pp S11), 2021. Date of Publication: October 2021.
Author
Ozdemir I.; Ozturk T.; Senarslan D.A.; Yildirim F.N.
Institution
(Ozdemir, Ozturk) Celal Bayar University Medicine Faculty, Department of
Anesthesiology and Reanimation, Manisa, Turkey
(Senarslan, Yildirim) Celal Bayar University Medicine Faculty, Department
of Cardiovascular Surgery, Manisa, Turkey
Publisher
W.B. Saunders
Abstract
Introduction: The rate of acute kidney injury (AKI) after open heart
surgery is between 3.1% and 42%. Nephrotoxins, ischemia and reperfusion,
venous congestion, inflammation, oxidative stress and genetics have been
implicated in the development of AKI. 1 The primary aim of this study was
to investigate the effect of goal-directed fluid therapy in the
perioperative period on the development of AKI in the early period in
patients undergoing cardiac surgery. The secondary aim was to determine
the independent risk factors for the development of AKI. [Formula
presented] Methods: Coronary artery by-pass greft (CABG) and valvuler
heart disease patients undergoing open heart surgery were randomly divided
into two groups according to their perioperative fluid management: Group
Control (Group C, n=30): Fluid management was performed with the
traditional monitoring method. Group Study (Group S, n=30): Applied with
transesophageal doppler and transthoracic doppler fluid management. It was
aimed to keep the hemodynamics of the patients at normal values.2 Clinical
and haemodynamic data were recorded at preoperative baseline (t1),
postoperative 4th hour (t2), 24th hour (t3) and 48th hour (t4). Serum
creatinine, GFR, Cystatin-C and KIM-1 values obtained at the same time
intervals as indicators of AKI. Akut kidney injury was defined by KDIGO
clasifications. Two independent groups were compared statistically with
appropriate parametric and non-parametric tests. The development of
postoperative AKI was investigated by "Forward Stepwise Binary Logistic
Regression" analysis. Result(s): Postoperative fluid requirement was
significantly lower in the study group (p=0.002). Postoperative total
balance was significantly more negative in the study group than in the
control group (p<0.0001). ERT requirement was significantly lower in the
study group compared to the control group (intraoperative, p=0.02;
postoperative, p=0.002). Cystatin-C was significantly lower in the study
group at the postoperative 24th and 48th hours. (respectively, p<0.04,
p<0.02) (Fig.1). AKI development rates were similar between the groups
(p>0.05). In the study group, only age (r=0.60, p=0.02) and only
intraoperative urine output in the control group (r=1.1;p=0.02) were
determined as independent risk factors for the development of AKI. When
all cases were evaluated, the Cystatin-C level at the postoperative 4th
hour (r=0.03; p=0.02), intraoperative noradrenalin requirement (r=0.74;
p=0.04) and Euroscore (r=0.61, p=0.04) parameters were independent risk
factors. Discussion(s): The incidence of AKI development after
cardiac surgery was not different between groups. Cystatin-C in Group S
patients were significantly lower at the postoperative 24th and 48th
hours. Cystatin-C clearence was affected more earlier than creatinine
clearence in patients with AKI. Fluid and ERT requirements were less in
Group S than Group C and the hospital stay was significantly shorter than
the control group. Copyright © 2021

<85>
Accession Number
2015211244
Title
A COMPARISON OF ISOLATION AND SPONTANEOUS VENTILATION FOR LUNG MANAGEMENT
DURING THORACIC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference:
EACTAIC-ICCVA 2021 Joint Virtual Congress. Virtual, Online. 35(Supplement
1) (pp S8-S9), 2021. Date of Publication: October 2021.
Author
Wilson E.; Alston P.
Institution
(Wilson, Alston) University of Edinburgh - School of Medicine and
Veterinary Medicine, Edinburgh, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: General anaesthesia, mechanical ventilation with lung
isolation using a double-lumen endobronchial tube or bronchial blocker,
has been the standard for lung management during thoracic surgery for over
80 years. However, there has been increasing popularity for avoiding lung
isolation and maintaining spontaneous ventilation for video assisted
thoracoscopic surgery (VATS) both with patients conscious using regional
anaesthesia and unconscious using general anaesthesia. Many benefits of
spontaneous ventilation over the traditional approach have been proposed.
We hypothesised that spontaneous ventilation would be significantly more
efficient that lung isolation for thoracic surgery. The primary aim of
this study was to compare the duration of hospital stay in patients
undergoing thoracic surgery with lung isolation or spontaneous ventilation
for lung management. Secondary aims were the durations of anaesthesia,
global in-operating room duration and overall hospital cost.
 Method(s): Systematic search of PubMed, OVID/Embase and Google
Scholar from January 2000 - October 2020 was conducted using predetermined
inclusion criteria. Bias was assessed using the Cochrane screening method.
Each lung management technique was segmented into randomised controlled
trials (RCTs) and observational studies and analysed both separately and
together. Meta-analysis using the Cochrane RevMan5 software was conducted
and findings summarised as forest plots. Mean and 95% confidence intervals
were compared alongside assessment of probability and heterogeneity.
 Result(s): The literature search identified 649 studies, of which
only 23 fulfilled the entry criteria, and these included a total of 2,564
patients. The duration of hospital stay was significantly shorter for
spontaneous ventilation than lung isolation (mean: -0.78 days; 95% CI 1.17
- 0.38) in all studies and in RCTs (mean: -0.88 days; 95% CI 1.1 - 0.65).
The duration of anaesthesia was significantly shorter in spontaneous
ventilation for all studies (mean: -10.87 minutes; 95% CI 9.3 - 12.43) and
for RCTs (mean: -13.19 minutes; 95% CI 11.18 - 15.2). Similarly, global in
operating room duration was shorter using spontaneous ventilation for all
studies (mean: -33.31 minutes; 95% CI 23.57 - 43.04) and for RCTs (mean:
-31.77 minutes; 95% CI 28.49 - 35.05). No statistically significant
difference was found between hospital cost for the two techniques but when
only RCTs were analysed, spontaneous ventilation was associated with a
lower cost (mean: 990; 95% CI 760-1220). Discussion(s): When compared
to the traditional technique of lung isolation under general anaesthesia
for thoracic surgery, techniques using spontaneous ventilation either
under regional or general anaesthesia, were associated with shorter
durations of hospital stay and anaesthesia as well as time spent in the
operating room. In addition, hospital costs may also be less expensive
using spontaneous ventilation. Copyright © 2021

<86>
Accession Number
2015211240
Title
EFFECTS OF ULTRASOUND-GUIDED BILATERAL THORACIC PARAVERTEBRAL NERVE BLOCK
COMBINED WITH GENERAL ANESTHESIA ON BRIDGING VASCULAR FLOW IN OFF-PUMP
CORONARY ARTERY BYPASS GRAFTING: A SINGLE-CENTER RANDOMIZED CONTROLLED
STUDY.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference:
EACTAIC-ICCVA 2021 Joint Virtual Congress. Virtual, Online. 35(Supplement
1) (pp S29-S30), 2021. Date of Publication: October 2021.
Author
Xu H.; Lin H.
Institution
(Xu, Lin) Central China Fuwai Hospital-Department of Anesthesiology,
Zhengzhou, Henan, China
Publisher
W.B. Saunders
Abstract
Introduction: To investigate the effect of bilateral thoracic
paravertebral nerve block(BTPVB)combined with general anesthesia on
bridging vascular flow in OPCABG. Method(s): Fifty patients were
randomly divided into two groups randomly:BTPVB combined with general
anesthesia group (T group,n=20) and general anesthesia group (G
group,n=30). Before anesthesia induction, the patients in group T
underwent bilateral thoracic paravertebral space puncture through T4-5
space. The experimental dose of 1% lidocaine 5 ml was injected on both
sides, and the first dose of 0.375% ropivacaine 15 ml was given 2 minutes
later.Primary Outcome Measures: Immediate flow and pulse index of bridge
vessels were recorded in both groups. Secondary Outcome Measures: Dosages
of intraoperative anesthetic drugs were recorded in both groups. After the
placement of the floating catheter (T1), after the sternotomy (T2), after
the completion of anastomosis of all bridging vessels (T3), and before the
exit of the chamber (T4), HR MAP, CVP, MPAP, CCO, SVRI and PVRI were
recorded. Result(s): The level of pain block after BTPVB in T group
was 5.1 and 0.6 segments, as shown and G group, and CVP at T3 and T4 in T
group SVRI and PVRI were significantly decreased (P<0.05), and CCO was
significantly increased (P<0.05). Compared with group G, the incidence of
tachycardia in the operation center in group T was significantly decreased
(P<0.05), the incidence of hypotension and the use rate of noradrenaline
were significantly increased (P<0.05), and the intraoperative sufentanil
in group T was significantly decreased (P<0.05).Compared with group G,
after OPCABG, the blood flow of the lima-lad bridge in group T was
significantly increased (P<0.05), and the vascular pulse index of the
bridge was significantly decreased (P<0.05). Discussion(s): BTPVB
combined with general anesthesia has obvious analgesic effect
significantly increased the vascular flow of the left internal thoracic
artery bridge and decreased the vascular pulse index of the left internal
thoracic artery bridge after OPCABG. Copyright © 2021

<87>
Accession Number
2015211223
Title
PERIOPERATIVE ANTIBIOTIC PROPHYLAXIS IN CARDIAC SURGERY. WHAT SHOULD WE
KNOW?.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference:
EACTAIC-ICCVA 2021 Joint Virtual Congress. Virtual, Online. 35(Supplement
1) (pp S31-S32), 2021. Date of Publication: October 2021.
Author
Palau Marti C.; Pascual De La Fuente F.; Mateo Rodriguez E.M.; Moliner
Velazquez S.; Granell Gil M.; De Andres Ibanez J.; Gil Alvarova O.
Institution
(Palau Marti, Pascual De La Fuente, Mateo Rodriguez, Moliner Velazquez,
Granell Gil, De Andres Ibanez, Gil Alvarova) Consorcio Hospital General
Universitario de Valencia, Valencia, Spain
Publisher
W.B. Saunders
Abstract
Introduction: Perioperative antibiotic prophylaxis has proved to reduce
the number of postoperative infections. In cardiac surgery, the infections
in the surgical site are found to be around 0.4-4%. The most common
bacterias causing surgical site infections in cardiac surgery are
gram-positive. Our aim in to guide the reader in the decision of choosing
the most adequate Perioperative Antibiotic Prophylaxis in each patient
according to their characteristics and their environment. Method(s):
The most recent bibliography was reviewed searching the most common
antibiotics used in perioperative Antibiotic Prophylaxis in cardiac
surgery. A bibliographic search was carried out in the PubMed-MEDLINE
database. A peer review was performed and a total of 4 references of more
than 30 were selected. Result(s): There is no difference in the
Surgical Site Infections between the use of 1st generation of
Cephalosporin or Glycopeptides such as Vancomycin or Teicoplanin. On the
other hand, 1st generation of Cephalosporin reduces the incidence of
infections produced by Staphylococcus. Nevertheless, Glycopeptides are
better at avoiding infection produced by Staphylococcus and Enterococcus
resistant than Cephalosporin. Discussion(s): Choosing Perioperative
Antibiotic Prophylaxis must be individualized according to the bacterial
flora in the environment, the different characteristics of the patients,
and the type of cardiac surgery. Also, a high incidence of Staphylococcus
Aureus methicillin-resistant must receive prophylaxis with Vancomycin and
a second antibiotic should be considered. Copyright © 2021

<88>
Accession Number
2015211217
Title
ANATOMICAL INNERVATION AND PHARMACOLOGY OF INTERFASCIAL PLANE REGIONAL
ANALGESIA FOR THORACIC SURGERY AND TRAUMA.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference:
EACTAIC-ICCVA 2021 Joint Virtual Congress. Virtual, Online. 35(Supplement
1) (pp S20), 2021. Date of Publication: October 2021.
Author
Preston C.; Howland-Jackson B.; Kileen T.; Rowbotham E.; Ou R.; O'connor
A.; Soe-Paing J.; Jarrott R.; Crosbie H.; Aza N.; Alston P.
Institution
(Preston, Howland-Jackson, Kileen, Rowbotham, Ou, O'connor, Soe-Paing,
Jarrott, Crosbie, Aza) University of Edinburgh Medical School, Edinburgh,
United Kingdom
(Alston) Royal Infirmary Edinburgh - Department of Anaesthesia, Critical
Care and Pain Medicine, Edinburgh, United Kingdom
Publisher
W.B. Saunders
Abstract
Introduction: Opioid analgesia for thoracic surgery and trauma may be
associated with adverse effects including respiratory depression, cough
suppression and diminished consciousness. These adverse effects can be
minimised using interfascial plane regional analgesia such as the erector
spinae and serratus anterior plane blocks (ESPB and SAPB) as first
described by Forero and colleagues and Blanco and colleagues,
respectively.1,2 This systematic review aims to evaluate the anatomical
evidence underlying innervation and dermatomal distribution of these two
regional analgesic techniques. Additionally, the pharmacokinetics of ESPB
and SAPB were compared. [Formula presented] Methods: Google Scholar,
DiscoverEd, and PubMed were searched using key words: ESPB, SAPB, nerve
block, local anaesthetic systemic toxicity, dermatomal spread,
pharmacokinetics. Result(s): The search yielded 39 papers
investigating anatomical and pharmacokinetic evidence of which 11 were
identified as relevant (Table 1). Table 1 found as an attachment
Pharmacokinetic Results: The most commonly used local anaesthetic was
bupivacaine and the use of adjuvants was infrequent. As proposed by Luftig
and colleagues,3 a larger volume of a weaker concentration appears to
reduce the chance of local anaesthetic systemic toxicity. Anatomical
spread is dependent upon the dose and site of injection. Techniques can be
easily taught and reproduced. Discussion(s): The anatomical and
pharmacokinetic evidence supports use of both techniques for thoracic
regional analgesia with ESPB spreading more caudally than SAPB. However,
there is anatomical variance between patients in the spread of each block.
Pharmacokinetic evidence supports the use of low-concentration,
high-volume local anaesthetic for optimal efficacy and limited
toxicity. Copyright © 2021

<89>
Accession Number
2015211159
Title
INFLUENCE OF RESPIRATORY SUPPORT STRATEGY DURING CARDIOPULMONARY BYPASS ON
LUNGS OXYGENATING FUNCTION.
Source
Journal of Cardiothoracic and Vascular Anesthesia. Conference:
EACTAIC-ICCVA 2021 Joint Virtual Congress. Virtual, Online. 35(Supplement
1) (pp S4), 2021. Date of Publication: October 2021.
Author
Kirillov A.; Yavorovskiy A.; Mandel I.; Vyzhigina M.; Komarov R.; Nogtev
P.; Bagdasarov P.; Khalikova E.; Podolskiy Y.; Panov A.; Kazakova S.;
Kasim T.
Institution
(Kirillov, Yavorovskiy, Mandel, Vyzhigina, Komarov, Nogtev, Bagdasarov,
Khalikova, Podolskiy, Panov, Kazakova, Kasim) I.M. Sechenov First Moscow
State Medical University (Sechenov University), Moscow, Russian Federation
Publisher
W.B. Saunders
Abstract
Introduction: There are high incidence of pulmonary complications and
acute respiratory failure (3,2-28,6%)1 after cardiac surgery with
cardiopulmonary bypass. The study aimed to evaluate the effectiveness of
various tactics of respiratory support during cardiopulmonary bypass (CPB)
for the prevention of postoperative pulmonary complications.
 Method(s): This is a prospective, randomized, controlled clinical
study in parallel groups. The study was approved by a local ethics
committee. Informed consent was obligatory for all participants. Sixty
patients were divided into two groups. In group 1 we provided a continuous
positive airway pressure (CPAP) of +5 cm H2O during CPB. In group 2
patients underwent mechanical ventilation with reduced volume (volume
control (VC) mode, tidal volume 3 ml / kg of ideal body weight) and
respiratory rate of 6 breathes per minute with positive end-expiratory
pressure + 5 cm H2O. The primary end-point of the study was the value of
the partial pressure of oxygen in arterial blood to oxygen fraction in
inhaled gas mixture ratio (paO2/FiO2) at different stages of perioperative
management: T1 (after the beginning of mechanical ventilation, T2 (before
the CPB), T3 (after CPB), T4 (at the end of the surgery), T5 (upon
admission to the ICU), T6 and T7 (6 and 12 hours after surgery,
respectively). Secondary end-points were the common lung complications
rate (pneumonia, pleural effusion, atelectasis, pneumothorax), the
frequency of recruitment maneuvers during the mechanical ventilation, the
need for non-invasive ventilation after extubation, the frequency of
re-intubation of the trachea. Statistical analysis was carried out in SPSS
for Mac v19 (IBM, Inc, USA). Data were presented as mean (+/-standard
deviation) or number (percent). A comparison of the quantitative
characteristics was performed using the Mann Whitney U-test. Fisher's
exact test was used for the incidence of complications between groups. A p
value of less than 0.05 was considered statistically significant.
 Result(s): The results are presented in Tables 1 and 2. [Formula
presented] The paO2/FiO2 in the VC group was higher than in the CPAP group
at stages T3 and T5. The frequency of recruiting maneuvers in the VC group
was lower than in the CPAP group. There was a lower incidence of
atelectasis in the VC group than in the CPAP group (Table 2). The
low-volume lung ventilation during the CPB is beneficial for oxygenating
function of the lungs in comparison with CPAP respiratory support.
 Discussion(s): The low-volume lung ventilation during the CPB is
beneficial for oxygenating function of the lungs in comparison with CPAP
respiratory support. Copyright © 2021

<90>
Accession Number
2015170361
Title
JUST TRAC IT! TRANSITIONING RESPONSIBLY TO ADULT CARE USING SMART PHONE
TECHNOLOGY.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S31-S32), 2021. Date of Publication: October 2021.
Author
Han A.; Gingrich J.; Yaskina M.; Rankin K.; Martin-Feeney D.S.; Mackie A.
Institution
(Han, Gingrich, Yaskina, Rankin, Martin-Feeney, Mackie) TorontoONCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Many adolescents living with heart disease face challenges
when transitioning from pediatric to adult care. There is little evidence
on how use of smartphone technology influences transition readiness. Just
TRAC it! is a method of using existing features on a smartphone, including
the Notes, Calendar, and Contacts apps, as a way for adolescents and
adults to manage their health. We aimed to investigate the impact of
nurse-led teaching with vs. without Just TRAC it! on self-management
skills in this population. METHODS AND RESULTS: We conducted a randomized
clinical trial of 16-18 year olds with congenital heart disease (CHD) or
acquired heart disease requiring surgery. Participants were randomly
allocated 1:1 to either usual care (control; 1-hour education session) or
the smartphone intervention (1-hour education session including Just TRAC
it!). The primary outcome was change in TRANSITION-Q score between
baseline, 3 and 6 months. Secondary outcomes were frequency of use and
perceived usefulness of Just TRAC it! at 3 and 6 months post intervention.
Analysis was intention to treat. We enrolled 68 patients (41% female, mean
age 17.3 years). Cardiac diagnosis was simple CHD (34%), moderate CHD
(49%), complex CHD (13%), and acquired heart disease (4%). Sixty-eight
percent had previous cardiac surgery and 26% had a previous cardiac
catheterization. TRANSITION-Q scores were similar at baseline and
increased over time in both groups (Figure) but were not significantly
different between groups at 6 months. On average, TRANSITION-Q score at 6
months were 0.9 points higher than at 3 months (95% CI 0.1-1.7). Each
additional point at the baseline score brought, on average, a 0.7 point
increase in TRANSITION-Q score (95% CI 0.5-0.9) each at 3 months and at 6
months. Perceived usefulness of Just TRAC it! is summarized (Table).
Ninety-seven percent of participants indicated they would recommend Just
TRAC it! to others at 3 months and 100% at 6 months. CONCLUSION(S):
Nurse-led transition teaching with vs. without Just TRAC it! improved
transition readiness based on TRANSITION-Q scores over time, with no
significant difference between groups. The majority of participants found
Just TRAC it! useful, with the camera, calendar and notes apps reported as
the most useful. Participants had a positive reception to Just TRAC it!
and would recommend it to others. Longer follow-up is needed to assess how
smartphone technology is used by young adults to facilitate their entry
into the adult healthcare system. Copyright © 2021

<91>
Accession Number
2015170354
Title
BALLOON VALVULOPLASTY VERSUS SURGICAL VALVOTOMY FOR CONGENITAL AORTIC
STENOSIS: SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S25-S26), 2021. Date of Publication: October 2021.
Author
Alraddadi H.; Amir T.; Barron D.; Honjo O.
Institution
(Alraddadi, Amir, Barron, Honjo) HamiltonONCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: The debate between the best therapeutic approach to congenital
aortic stenosis is ongoing. Multiple studies have attempted to answer this
question without reaching a definitive conclusion. McCrindle et al
performed the landmark analysis of the congenital heart surgeon database
and they showed equivalent results in the outcome between surgical aortic
valvotomy (SAV) versus balloon aortic valvuloplasty (BAV). Given similar
outcomes, many centers preferentially perform BAV due to its minimally
invasive nature and faster recovery. Some more recent single-center
studies have shown better outcomes with surgical valvotomy; however, their
results were attributed to the use of contemporary superior surgical
techniques. In this study, we perform a contemporary systematic review and
meta-analysis to compare the effects of BAV and SAV on patient morbidity
and mortality. METHODS AND RESULTS: We searched MEDLINE and EMBASE from
inception to March 2021 for studies comparing balloon aortic valvuloplasty
versus surgical commissurotomy for critical congenital AS in patients
younger than 18. We performed title and abstract screening, full-text
assessment, risk of bias assessment using the CLARITY tool, and data
collection independently and in duplicate. We pooled data using the
random-effects model and Mantel-Haensel statistical method. We evaluated
the overall quality of evidence using the GRADE framework. From a total of
439 studies imported for screening, 12 studies (1214 participants) were
included that compared outcomes for balloon aortic valvuloplasty and
surgical commissurotomy in the pediatric population. Mortality at 30-day
and at longest follow-up was not statistically significant between the two
groups (RR 0.66 95% CI [0.34, 1.27] and 0.74 95% CI [0.35, 1.56].
Reintervention favoured surgical repair at the longest follow-up but did
not reach statistical significance (RR 1.11 95% CI [0.89, 1.38]).
Postprocedural aortic insufficiency was more common after balloon
valvotomy but failed to reach statistical significance (RR: 1.5 95% CI
0.99 - 2.99). CONCLUSION(S): In pediatric patients with congenital
AS, surgical commissurotomy did not offer additional advantages over
balloon valvotomy. There was a trend toward an increase in post-procedural
AI and an increased rate of reintervention with balloon valvotomy.
However, the quality of evidence is very low. An appropriately powered
large study is required to adequately address the risks and benefits of
the two interventions. Copyright © 2021

<92>
Accession Number
2015170349
Title
LONG TERM OUTCOMES OF THE RESYNCHRONIZATION-DEFIBRILLATION IN AMBULATORY
HEART FAILURE TRIAL (RAFT) IN ATLANTIC CANADA.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S50), 2021. Date of Publication: October 2021.
Author
Mokhtar A.; Sapp J.
Institution
(Mokhtar, Sapp) HalifaxNSCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: The RAFT trial randomized patients with NYHA II or III heart
failure on optimal medical therapy with EF <= 30% and widened QRS duration
to implantation with cardiac resynchronization defibrillator (CRT-D) or
defibrillator alone (ICD) and demonstrated a reduction in HF
hospitalization and overall mortality with CRT-D over mean follow-up of
3.3 years. The longer-term effects of CRT are less certain. METHODS AND
RESULTS: A chart review of patients who participated in the RAFT trial in
Atlantic Canada was performed. Patients from NB, PEI and NS were followed
up based on the following composite primary outcome: Any death, heart
failure hospitalization, heart transplant and ventricular assist device
(VAD) implant in selected patients with complete data available. Secondary
outcomes included individual components of the primary outcome, along with
cardiovascular death (Death from HF, CAD or arrhythmia). Among 131
patients enrolled (80.7% male, mean age = 65.3y) 66 were randomized to
CRT-D and 63 patients to ICD. Follow-up was available for 104 patients (51
in CRT-D and 53 in ICD subgroup). The mean period to the primary endpoint
was 11.3 (11.2-14.7). The primary outcome at the end of follow-up occurred
in 35 (66.8%) patients in the CRT-D subgroup and 41(77.3%) in the ICD
subgroup (HR 0.57, 95% CI= 0.35 - 0.91, p = 0.019). Cardiovascular death
was the main driver of the primary outcome (39.2% vs 56.5%, HR= 0.54, 95
CI- 0.030 - 0.94, p=0.031). There was no significant difference in HF
hospitalization between both groups. CONCLUSION(S): The effect of CRT
on mortality and HF hospitalization observed during the randomized RAFT
trial persisted during long-term follow-up. A national, multicentre
follow-up, long-term study of the RAFT trial is currently
underway. Copyright © 2021

<93>
Accession Number
2015170335
Title
AORTIC VALVE REPAIR DECREASES RISKS OF VALVE-RELATED EVENTS IN AORTIC
INSUFFICIENCY AT 10 YEARS A PROPENSITY SCORE-MATCHED ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S99), 2021. Date of Publication: October 2021.
Author
Jabagi H.; Chan V.; Ruel M.; Mesana T.; Boodhwani M.
Institution
(Jabagi, Chan, Ruel, Mesana, Boodhwani) OttawaONCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Aortic valve repair (AVr) has emerged as a feasible and
effective alternative to replacement (AVR) in patients with aortic
insufficiency (AI), however, little data exists comparing outcomes. Thus,
the objective of this study was to compare early and long-term valve
related complications between AVr and AVR in the treatment of AI. METHODS
AND RESULTS: Single centre, retrospective study of all patients (n=417)
undergoing AVr (n=264) or AVR (n=153) for primary AI. Propensity-matching
using a 1:1 greedy matching algorithm identified 140 patients using six
covariates (age, gender, LV function, LV size, presence of aortopathy, and
urgency of operation) for comparison. The primary outcome was a composite
of all valve-related events (VRE), including: endocarditis, myocardial
infarction (MI), stroke, transient ischemic attack (TIA),
thromboembolisms, bleeding, and aortic valve (AV) reoperation. VRE were
defined as per published guidelines. Survival and freedom from VRE were
reported using the Kaplan-Meier method. Propensity-matching identified 70
well matched pairs with no major differences in baseline demographics,
comorbidities, or AI severity (p=0.57). Perioperative outcomes showed no
significant differences in VRE (AVR 8 vs AVr 7, p=0.78) or mortality (AVR
3 vs AVr 1, p=0.62). Event-free survival from the primary outcome at
10-years was significantly better after AVr than after AVR (82% vs 68%,
p=0.024), with no significant differences in 10-year overall survival
between groups (82% vs 72%, p=0.29). No significant differences in AI
severity (p=0.07) or reoperation rate (p=0.44) were detected between
groups. CONCLUSION(S): This study demonstrated a lower long-term risk
of VRE with repair compared to replacement, with low mortality and
comparable durability. Further prospective randomized control trials are
necessary to formally compare outcomes and determine
superiority. Copyright © 2021

<94>
Accession Number
2015170302
Title
PILOT STUDY OF PERCUTANEOUS TEMPORARY DIAPHRAGM PACING WIRES IN CARDIAC
SURGERY PATIENTS AT RISK OF PROLONGED MECHANICAL VENTILATION DURING THE
COVID-19 PANDEMIC.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S112-S113), 2021. Date of Publication: October 2021.
Author
Jarrett C.; Onders R.; Pelletier M.; Abu-Omar Y.; Baeza C.; Elgudin Y.;
Markowitz A.; Ruda Vega P.; Sabik J.
Institution
(Jarrett, Onders, Pelletier, Abu-Omar, Baeza, Elgudin, Markowitz, Ruda
Vega, Sabik) ClevelandOHUnited States
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Prolonged mechanical ventilation (PMV) after cardiac surgery
occurs in 12% of patients, and significantly increases morbidity and
mortality. Diaphragm pacing (DP) decreases ventilation times by 64% in
other patient groups. We investigated the feasibility and outcomes of DP
in urgent cardiac surgeries to decrease ventilator burden during the
COVID-19 pandemic. METHODS AND RESULTS: This pilot study is an open-label
FDA (IDE# G170294) prospective trial of temporary DP electrode use in high
risk cardiac surgery patients (ClinicalTrials.gov Identifier-NCT04309123).
Prior to sternotomy closure, the pleural space is opened, two electrodes
(Figure 1) are placed in each diaphragm muscle, and the wires are tunneled
percutaneously. The electrodes record diaphragm burst electromyography
(dEMG) continuously for the first 24 hours and then once daily (Figure 2).
In PMV patients (MV>24 hours), DP is initiated to prevent diaphragm
atrophy and ventilator induced diaphragm dysfunction. The primary outcome
was incidence of serious device related adverse events. The secondary
outcome was time on MV. From 4/2/20-6/25/20, 44 patients were consented,
32 were implanted, and 12 were not. PMV was required in 10 patients
implanted and 4 not implanted. There were no serious adverse events
related to DP electrode implantation, all stimulated patients had improved
ventilation and diaphragm function, and all electrodes were removed
successfully. Criteria that best predicted PMV were: IABP, history of TIA
or CVA, COPD, LVEF < 20%, and prior open-heart surgery. Using these
criteria, the median time on mechanical ventilation in the first 120 hours
was 35.7% versus 80.0% for the stimulated and non-stimulated groups,
respectively. CONCLUSION(S): Temporary DP electrode placement during
cardiac surgery is feasible and safe. DP improved diaphragm function and
ventilation, and increased the likelihood of extubation by 48 hours. These
results provide a catalyst for a prospective randomized controlled trial
to decrease the MV burden in an enhanced recovery after surgery (ERAS)
protocol. Copyright © 2021

<95>
Accession Number
2015170298
Title
ENHANCEMENT OF STERNAL CLOSURE WITH NOVEL HARDENING BONE PUTTY ACCELERATES
POST-OPERATIVE RECOVERY.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S109), 2021. Date of Publication: October 2021.
Author
Vasanthan V.; Fatehi Hassanabad A.; Kang S.; Ramadan D.; Holloway D.;
Adams C.; Ahsan M.; Fedak P.
Institution
(Vasanthan, Fatehi Hassanabad, Kang, Ramadan, Holloway, Adams, Ahsan,
Fedak) CalgaryABCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Regaining and maintaining sternal stability is key to
recovering from cardiac surgery and resuming normal life.
MontageTM (ABYRX, Irvington, NY, USA) is a settable, resorbable
putty that adheres to bleeding bone and achieves rigid sternal fixation
following application (Image). We evaluated feasibility, safety, and
efficacy of enhanced sternal closure (ESC) with a novel bone putty to
accelerate post-operative functional recovery in patients receiving median
sternotomy. METHODS AND RESULTS: A single-center, single-blinded
(participant only), randomized controlled trial was performed
(NCT03365843). Consenting patients for elective cardiac surgery via
sternotomy received sternal closure using either 8-10 cc of bone putty
with wire cerclage (ESC) or wire cerclage alone (control). To date, 32
patients with ESC and 25 control patients reached 6 weeks with 100%
follow-up. Student t-test and Fischer's exact test analyzed continuous
(mean +/- SEM) and categorical variables (Table). Both groups had similar
BMI. There were no device-related safety concerns. The ESC group had a
shorter time to discharge. Bedside spirometry was used when COVID-19
restrictions allowed. At 5 days or discharge, more patients with ESC
recovered to 60% of their baseline FVC (22/28 patients vs 11/23 patients;
p=0.04; ESC vs Control). A Likert-type 11-point scale quantified
incisional, chest wall, and back pain/discomfort. The ESC group had less
incisional pain while resting and at post-operative day 5 or discharge;
while breathing at day 5 or discharge; while sleeping at day 5 or
discharge and 2 weeks; and while walking at day 5 or discharge. The ESC
group had less chest wall pain at day 3 and day 5 or discharge; and less
back pain at day 3 and day 5 or discharge. Standardized patient-reported
outcomes measures assessed health-related quality of life (EQ-5D index)
and physical disability (Health Assessment Questionnaire). ESC improved
physical functional recovery with a lower HAQ Index at day 5 or discharge,
2 weeks, and 4 weeks. More patients with ESC recovered to baseline HAQ at
2 weeks and 4 weeks. ESC increased EQ-5D Index scores for quality of life
at day 5 or discharge, 2 weeks, and 4 weeks. More patients with ESC
recovered to baseline EQ-5D Index by 5 days or discharge.
 CONCLUSION(S): Enhanced sternal closure with a novel hardening bone
putty for rigid fixation accelerates patient recovery. ESC improved
ventilatory recovery, reduced pain, and accelerated recovery to baseline
function and quality of life. Earlier hospital discharge with ESC may
provide substantial cost benefits for the healthcare system. Copyright
© 2021

<96>
Accession Number
2015163455
Title
SUBSTANTIAL CARDIOVASCULAR RISK REDUCTION WITH ICOSAPENT ETHYL REGARDLESS
OF DIABETES STATUS OR BMI: REDUCE-IT BMI.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S87-S88), 2021. Date of Publication: October 2021.
Author
Bhatt D.; Brinton E.; Miller M.; Steg P.; Jacobson T.; Ketchum S.; Juliano
R.; Jiao L.; Doyle R.; Granowitz C.; Busch R.; Tardif J.; Ballantyne C.
Institution
(Bhatt, Brinton, Miller, Steg, Jacobson, Ketchum, Juliano, Jiao, Doyle,
Granowitz, Busch, Tardif, Ballantyne) BostonMAUnited States
Publisher
Elsevier Inc.
Abstract
BACKGROUND: REDUCE-IT, a multinational, double-blind trial, randomized
8179 statin-treated patients with controlled low density lipoprotein
cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to
icosapent ethyl (IPE) 4 grams daily or placebo. IPE reduced the primary
(CV death, myocardial infarction [MI], stroke, coronary revascularization,
hospitalization for unstable angina) and key secondary (CV death, MI,
stroke) endpoints 25% and 26%, respectively (each p < 0.000001). At
baseline, median body mass index (BMI) was 30.8 kg/m2, and 58.5% of
REDUCE-IT patients had diabetes mellitus (DM). In patients with DM, the
primary and key secondary endpoints were reduced 23% and 30%, respectively
(each p<=0.00005). METHODS AND RESULTS: We evaluated if BMI modulated CV
risk reduction with IPE in patients with or without DM. In the full
cohort, similar CV risk reduction was observed across the prespecified
endpoint testing hierarchy (interaction p=ns for all), and relative safety
between treatment groups was generally consistent. In persons with or
without DM, similar reductions in the primary endpoint were observed
across BMI categories (Figure), with similar findings in the key secondary
endpoint (interaction p=ns for all). CONCLUSION(S): The significant
cardiovascular risk reduction provided by IPE 4g/day is consistent across
BMI in patients with and without DM. Copyright © 2021

<97>
Accession Number
2015163423
Title
DEVELOPMENT OF SHARED DECISION MAKING TRAINING MODULE FOR PATIENTS FACING
PREFERENCE-SENSITIVE DECISIONS REGARDING MAJOR SURGICAL PROCEDURES.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S40), 2021. Date of Publication: October 2021.
Author
Hirsch E.; Gainer R.; Roy S.; Hirsch G.
Institution
(Hirsch, Gainer, Roy, Hirsch) HalifaxNSCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: In our NSQIP participating center, patient experience measures
demonstrate that 25% of patients over 65 years of age regret the decision
for cardiac surgery, demonstrating a mismatch of expectations and
outcomes. Studies of surgical decision-making demonstrate poor decisional
quality, especially patient comprehension and expression of preferences.
Shared decision making (SDM), a formalized approach wherein patients are
educated about the risks, benefits to treatment options, and supported to
share personal preferences, has been shown to improve comprehension,
reduce decisional conflict, and better align patient expectations with
outcome, however, multiple systematic reviews have demonstrated almost no
sustained uptake of this approach in surgery. The goal of this study is to
implement SDM with relevant training aimed at the surgical team with a
pre-post design that measures effectiveness through Option 5 scoring of
informed consent interactions. METHODS AND RESULTS: Five focus groups with
patients (n=2) and health care providers (HCPs) (n=3) were carried out to
determine barriers and facilitators of SDM and learning preferences for
HCPs. Thematic analysis of focus groups demonstrated barriers to SDM (lack
of time during surgeon-patient interaction; authoritative imbalance
between patients and clinicians; and deficits in patient comprehension);
and identified HCP training preferences (synchronous short events with
relevant examples). SDM training was developed in light of the findings.
Common barriers and facilitators to SDM identified in the groups were used
to develop communication and logistical strategies included in the
training. HCP learning preferences identified in provider groups were used
to inform the format and presentation style of the training to improve
participant engagement. Pre-intervention informed consent discussions were
audio-recorded and analyzed using Option 5 methodology which comprises a 5
item measure of SDM used to assess the extent to which clinicians involve
patients in the decision-making process. OPTION-5 scoring (n=40)
demonstrated low decisional quality (average score 27/100) with almost no
perceptible elicitation or incorporation of patient preferences during
consent discussions. Following the training of surgeons and
multidisciplinary team members, 40 more informed consent discussions will
be audio-recorded and evaluated using the OPTION-5 scoring metric. Scores
before and after training will be compared by item to determine change in
informed consent discussion quality. CONCLUSION(S): Informed consent
in surgery is lacking in SDM approaches. Barriers have been identified and
SDM training has been developed with a team-based approach in mind. The
effect of the training intervention on surgical consent discussion quality
will be measured using OPTION-5 and if successful broader implementation
will be carried out. Canadian Frailty Network Copyright © 2021

<98>
Accession Number
2015162362
Title
POST-OPERATIVE PAIN AND ANALGESIC USE FOR CARDIAC SURGERY WITH MEDIAN
STERNOTOMY.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S107-S108), 2021. Date of Publication: October 2021.
Author
Hassan S.; Stambulic T.; King M.; Norman P.; Payne D.; Derry K.; El Diasty
M.
Institution
(Hassan, Stambulic, King, Norman, Payne, Derry, El Diasty)
KingstonONCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Inadequate pain control after median sternotomy leads to
reduced mobilization, increased respiratory complications, and longer
hospital stays. Typically, post-operative pain is controlled by opioid
analgesics that may have significant respiratory and gastrointestinal side
effects. Parasternal intercostal neuraxial block (PSB) has emerged as part
of a multimodal strategy to control pain after median sternotomy. However,
the effect of this intervention on post-op pain and analgesic use has not
been fully established. METHODS AND RESULTS: We conducted a meta-analysis
to assess the effect of PSB on post-op pain and analgesic use in adult
cardiac surgery patients undergoing median sternotomy. PubMed, Embase,
Google Scholar and the Cochrane database were searched with the following
search strategy: ((post-operative pain) or (pain relief) OR (analgesics)
or (analgesia) or (nerve block) or (regional block) or (local block) or
(regional anesthesia) or (local anesthetic) or (parasternal block) and
(sternotomy)) and (humans[filter]). Inclusion criteria were: cardiac
surgery, median sternotomy, age>18 and parasternal block (continuous and
single dose), and exclusion criteria were: non-cardiac surgery,
non-parasternal nerve blocks, use of NSAIDS in parasternal infusion.
Quality assessment was performed by 3 independent reviewers via the
Cochrane risk of bias assessment tool. Of 1165 total citations, 16 were
found to be relevant. These were all double blinded RCTs: 7 RCTs with a
total of 2223 patients reported post-op pain scores in an extractable
format and 11 RCTs (N=2155) reported post-op analgesia use after PSB
(Table 1). For post-op analgesia use, morphine equivalent doses were
calculated for all studies and post-op pain scores were standardized to a
10-point visual analog scale for comparison between studies; both these
were reported as total opioid use or cumulative score ranging from 24h to
72h post-op. All data analyses were run using a random effects model,
using a restricted maximum likelihood estimation, analyzing standardized
mean differences with 95% CI's. For studies which only reported median and
IQR, standard deviation was estimated by IQR/1.35. Following median
sternotomy both post-op pain (SMD -0.49 [-0.92,-0.06]) and post-op
morphine equivalent use (SMD -1.68 [-3.11, -0.25]) were significantly less
in the PSB group (Fig. 1). CONCLUSION(S): A parasternal nerve block
strategy significantly reduces post-op pain and opioid analgesic use.
While there was heterogeneity between the RCTs in the amount, type of
anesthetic and the use of single vs continuous dosing and the type of
control used (Table 1), our analysis suggests that PSB is effective in
reducing post-op pain in cardiac surgery patients. Copyright ©
2021

<99>
Accession Number
2015162359
Title
THE LONG-TERM IMPACT OF PERMANENT CARDIAC PACING AFTER SURGICAL AORTIC
VALVE REPLACEMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Canadian Journal of Cardiology. Conference: 74th Annual Meeting of the
Canadian Cardiovascular Society. Virtual, Online. 37(10 Supplement) (pp
S101-S102), 2021. Date of Publication: October 2021.
Author
Servito M.; Khoury W.; Baranchuk A.; El Diasty M.
Institution
(Servito, Khoury, Baranchuk, El Diasty) KingstonONCanada
Publisher
Elsevier Inc.
Abstract
BACKGROUND: Permanent pacemaker (PPM) implantation after isolated surgical
aortic valve is associated with short- and long-term complications.
However, the impact of PPM implantation on long-term mortality has not
been fully established. While some studies have demonstrated no effect,
others have suggested that PPM reduces long-term survival. Therefore, our
objective was to determine whether PPM post-SAVR increases the risk of
mortality by performing a systematic review and meta-analysis. METHODS AND
RESULTS: We searched MEDLINE and EMBASE from inception to December 2020
for studies comparing mortality between post-SAVR patients who received
PPM and those who did not. Studies were excluded, if they enrolled
pediatric patients, if patients underwent other concomitant cardiac
surgical procedure, and if transcatheter, sutureless, or rapid deployment
valvular prosthesis were used. Random effects meta-analysis was performed
using the restricted maximum likelihood estimator with Hartung-Knapp
adjustment. The effect sizes were reported as relative risk (RR) with 95%
confidence intervals. The analyses were performed using the metaprop and
metafor packages for R version 3.01. The literature search yielded a total
of 1,903 articles - of which 30 underwent full text review. Three articles
met the inclusion and exclusion criteria, thus yielding a total of 9,105
patients. Two out of the three articles reported the hazard ratio adjusted
for multiple covariates. The articles had at least 5 years of follow-up,
and the pooled age was similar between the PPM (72 [95%CI 68-76] years)
group and no PPM group (74 [95%CI 68-76] years). There was no difference
between the groups in the number of men (PPM: 59% vs no PPM: 63%, p=0.90),
patients with diabetes (PPM: 30% vs no PPM: 24%, p=0.31), hypertension
(PPM: 72% vs no PPM: 68%, p=0.28), and atrial fibrillation (PPM: 21% vs no
PPM: 13%, p=0.06). 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%). However, PPM
implantation was associated with higher late mortality (RR 1.49; 95%CI
1.25-1.77; I2=0%) compared to the no PPM group. CONCLUSION(S): While
PPM post-SAVR does not increase early mortality, PPM independently
increases the risk of mortality in the long-term. With the widespread
adoption of innovative techniques like transcatheter and rapid
deployment/sutureless valves that are known to be associated with high PPM
rates, it becomes very important to observe for any excess long-term
mortality that might be related to PPM implantation after these
techniques. Copyright © 2021

<100>
Accession Number
2013572851
Title
Incidence, Predictors And Outcomes Of Halt In Patients With Bioprosthetic
Valve Replacement.
Source
Journal of Cardiovascular Computed Tomography. Conference: 16th Annual
Scientific Meeting of the Society of Cardiovascular Computed Tomography.
Virtual, Online. 15(4 Supplement) (pp S56-S57), 2021. Date of Publication:
01 Jul 2021.
Author
Arunachalam K.; Naung Htay Y.; Shah P.; Nidamanuri K.; Hegde V.
Institution
(Arunachalam, Naung Htay, Shah, Nidamanuri, Hegde) Aultman Hospital,
Canton, OH, United States
Publisher
Elsevier Inc.
Abstract
Introduction: Incidence, predictors and outcomes of Hypo-Attenuated
Leaflet Thickening (HALT) recognized by cardiac CT or Multi Detector
Computed tomography (MDCT) in bio-prosthetic valves is not clearly
reported. Management and long term course of HALT is also uncertain.
 Method(s): Adults greater than 18 years with either surgical or
Transcatheter bio-prosthetic valve replacement who were studied utilizing
cardiac CT and MDCT were included in the study. Two independent
investigators conducted systematic review as per PRISMA guidelines using
keywords "HALT" or "Hypo-attenuated Leaflet Thickening" AND "Cardiac CT"
or "MDCT" in database such as Pubmed, Embase, Web of Science. Continuous
variables are reported as numbers and percentages. Result(s): We
identified total of 19 studies that met our inclusion and exclusion
criteria. Surgical aortic valve replacement was studied in 5 studies,
Transcatheter aortic valve replacement was evaluated in 17 studies and
only one study involved surgical bio-prosthetic mitral valve replacement.
Of the 3775 patients with median follow-up of 12 months, 663 (17.6%)
patients were found to have HALT. Reduced leaflet motion was detected
using MDCT on 303 (45.7%) patients. Baseline characteristics in patients
with HALT were males 483 (73%), Coronary Artery disease 336(51%),
Hypertension 616 (93%), Atrial fibrillation 224 (34%). 30 (4.5%) patients
were found to have stroke or Transient Ischemic Attack (TIA), 24 (3.6%)
patients were found to have Congestive heart failure (CHF). Mortality
occurred in 24 (3.6%) patients. HALT spontaneously resolved in 84 (12.7%)
patients. Major predictors for HALT were lack of oral anticoagulation,
Valve size greater than 28 mm, Male gender and BMI>more than 30.
 Conclusion(s): This is the first systematic review on HALT involving
both surgical and transcatheter heart valve replacements. Our systematic
review revealed incidence of HALT is frequently common but not
significantly associated with stroke or TIA, CHF, or death. Copyright
© 2021

<101>
Accession Number
2010941762
Title
PVP is Effective and Safe to Restore Valve Function, Best Suitable for
Early Stages of Pressure-induced Valve Decompensation.
Source
Journal of Vascular Surgery: Venous and Lymphatic Disorders. Conference:
2021 American Venous Forum Annual Meeting. Virtual, Online. 9(2) (pp 551),
2021. Date of Publication: March 2021.
Author
Ragg C.
Institution
(Ragg) Angioclinic Vein Centers Germany, Berlin, Germany
Publisher
Elsevier Inc.
Abstract
PVP is effective and safe to restore valve function, best suitable for
early stages of pressure-induced valve decompensation. FVP for hemodynamic
purposes showed feasibility, effectivity and safety, very promising to
create novel "no-cut" vein sparing modalities. SVP adjunctive to
endovenous ablation significantly improved post-treatment comfort.
Hyaluronan, due to its approved biocompatibility and low-risk placement,
will be mandatory. All modalities are now waiting for the manufacturers to
provide reasonable products. Background(s): As vein insufficiency
frequently goes along with focal or segmental dilatation, the idea to
adjust the diameters of such veins or valve zones by injection of
perivenous biocompatible gel was established 2013. Although there are lots
of medical bulking agents like dextranomer, cellulose derivatives or even
acrylates, the best choice for use in phlebology seemed to be cross-linked
hyaluronan. There are currently three pilot studies: (1) percutaneous
valvuloplasty (PVP), aiming at restoration of local valve function; (2)
focal venoplasty (FVP), aiming at diameter reduction to modify
hemodynamics, and (3) segmental venoplasty (SVP) to reduce diameters as an
adjunct to endoluminal procedures. Method(s): PVP was studied in 38
patients (24 female; 14 male; 25-56 years; GSM valves, diameter 7.0-12.2
mm), using a 24 mg/L prototype hyaluronan. FVP was evaluated in 22
patients (13 female; 9 male; 26-69 years) for reflux reduction in GSV,
SSV, or tributary insufficiency (also 24 mg/L). SVP was investigated in 40
cases (23 female; 17 male; 41-72 years) with GSV or SSV insufficiency >8
mm in diameter adjunctive to Biomatrix sclerofoam (Venartis), using a less
viscous and less durable hyaluronan (16 mg/L; half-life of 8 weeks). For
this collective, target segments were split and randomized versus NaCl
0.09%. Result(s): PVP established orthograde flow in 37/38 cases
(97.4%). With FVP, 18/22 cases were successful (81.8%) in obtaining
alternate (n = 10) or orthograde flow (n = 8), correlating well with
clinical improvement. In both applications, medical benefit was unchanged
at 6 months follow-up. With SVP, technical success (>50% lumen reduction)
was obtained in all cases (40/40). In all hyaluronan compressed segments,
there was no postinterventional pain or discomfort (follow-up 8 weeks),
compared to 36/40 (90%) of saline covered segments. All hyaluronan
applications were without adverse reactions. Conclusion(s): PVP is
effective and safe to restore valve function and is best suitable for
early stages of pressure-induced valve decompensation. FVP for hemodynamic
purposes showed feasibility, effectivity and safety, very promising to
create novel "no-cut" vein sparing modalities. SVP adjunctive to
endovenous ablation significantly improved post-treatment comfort.
Hyaluronan, due to its approved biocompatibility and low-risk placement,
will be mandatory. All modalities are now waiting for the manufacturers to
provide reasonable products. Copyright © 2020

<102>
Accession Number
2017144379
Title
A comparison of the analgesic efficacy of serratus anterior plane block
vs. paravertebral nerve block for video-assisted thoracic surgery: a
randomized controlled trial.
Source
Wideochirurgia I Inne Techniki Maloinwazyjne. 17(1) (pp 134-142), 2022.
Date of Publication: 2022.
Author
Zhang Y.; Fu Z.; Fang T.; Wang K.; Liu Z.; Li H.; Jiang W.; Cao X.
Institution
(Zhang, Fu, Fang, Wang, Liu, Li, Jiang, Cao) Department of Anesthesiology,
The First Hospital of China Medical University, Liaoning, Shenyang, China
Publisher
Termedia Publishing House Ltd.
Abstract
Introduction: Patients who undergo video-assisted thoracic surgery (VATS)
frequently experience moderate to severe postoperative pain. Serratus
anterior plane block (SAPB) is a relatively novel technique that can block
the lateral cutaneous branches of the intercostal nerves as well as the
long thoracic nerve. Aim(s): To evaluate the analgesic efficiency of
deep serratus plane block (DSPB) and superficial serratus anterior plane
block (SSPB) as well as paravertebral nerve block (PVB) in patients
undergoing VATS. Material(s) and Method(s): A total of 74 patients
aged 16-80 undergoing VATS were randomized to receive either DSPB or SSPB
as well as PVB. Ultrasound (US) guided DSPB or SSPB as well as PVB was
performed preoperatively on the patients according to their groups. All
patients were provided with patient-controlled intravenous analgesia
(PCIA) for postoperative analgesia. The primary outcomes were the levels
of postoperative pain at rest and on coughing evaluated by the visual
analog scale (VAS), and intraoperative and postoperative opioid
consumption. The secondary outcomes included PCIA pressing times, side
effects and satisfaction with analgesia, duration of nerve block,
intraoperative hemodynamic changes and vasoactive drug dosage.
 Result(s): No significant differences of VAS score were found. During
the operation, PVB reduced consumption of opioids (27.23 +/-5.10 mg)
compared to DSPB (31.20 +/-3.80 mg) and SSPB (32.61 +/-5.28 mg). The
effective pressing times of PCIA in the SSPB group (0.18 +/-0.65) were
significantly lower compared to the PVB group (1.09 +/-1.50) at 12 h
postoperatively. Accordingly, SSPB also reduced the dosage of PCIA (26.55
+/-4.72 ml) compared to PVB (31.45 +/-7.60 ml). Time of the PVB procedure
was longer (11.14 +/-1.66 min) than DSPB (5.68 +/-1.10 min) and SSPB (4.77
+/-1.04 min). Conclusion(s): DSPB and SSPB are easy to perform and
can serve as a promising alternative technique to PVB that may offer
comparable analgesic effectiveness for patients undergoing
VATS. Copyright © 2022 Termedia Publishing House Ltd.. All rights
reserved.

<103>
[Use Link to view the full text]
Accession Number
2017207366
Title
Prophylactic Penehyclidine Inhalation for Prevention of Postoperative
Pulmonary Complications in High-risk Patients: A Double-blind Randomized
Trial.
Source
Anesthesiology. 136(4) (pp 551-566), 2022. Date of Publication: 01 Apr
2022.
Author
Yan T.; Liang X.-Q.; Wang G.-J.; Wang T.; Li W.-O.; Liu Y.; Wu L.-Y.; Yu
K.-Y.; Zhu S.-N.; Wang D.-X.; Sessler D.I.
Institution
(Yan, Liang, Wang, Wang, Li, Liu, Wu, Wang) The Departments of
Anesthesiology and Critical Care Medicine, Peking University First
Hospital, Beijing, China
(Yu) Respiratory and Critical Care Medicine, Peking University First
Hospital, Beijing, China
(Zhu) Biostatistics, Peking University First Hospital, Beijing, China
(Wang) The Department of Anesthesiology, Aerospace Central Hospital,
Peking University Aerospace School of Clinical Medicine, Beijing, China
(Li) The Department of Anesthesiology, Plastic Surgery Hospital, Chinese
Academy of Medical Science, Peking Union Medical College, Beijing, China
(Liu) The Department of Anesthesiology, Beijing Fangshan Liangxiang
Hospital, Beijing, China
(Wu) The Department of Anesthesiology, Beijing Ditan Hospital, Capital
Medical University, Beijing, China
(Sessler) The Outcomes Research Consortium, Cleveland, OH, United States
(Sessler) The Department of Outcomes Research, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Postoperative pulmonary complications are common. Aging and
respiratory disease provoke airway hyperresponsiveness, high-risk surgery
induces diaphragmatic dysfunction, and general anesthesia contributes to
atelectasis and peripheral airway injury. This study therefore tested the
hypothesis that inhalation of penehyclidine, a long-acting muscarinic
antagonist, reduces the incidence of pulmonary complications in high-risk
patients over the initial 30 postoperative days. Method(s): This
single-center double-blind trial enrolled 864 patients age over 50 yr who
were scheduled for major upper-abdominal or noncardiac thoracic surgery
lasting 2 h or more and who had an Assess Respiratory Risk in Surgical
Patients in Catalonia score of 45 or higher. The patients were randomly
assigned to placebo or prophylactic penehyclidine inhalation from the
night before surgery through postoperative day 2 at 12-h intervals. The
primary outcome was the incidence of a composite of pulmonary
complications within 30 postoperative days, including respiratory
infection, respiratory failure, pleural effusion, atelectasis,
pneumothorax, bronchospasm, and aspiration pneumonitis. Result(s): A
total of 826 patients (mean age, 64 yr; 63% male) were included in the
intention-to-treat analysis. A composite of pulmonary complications was
less common in patients assigned to penehyclidine (18.9% [79 of 417]) than
those receiving the placebo (26.4% [108 of 409]; relative risk, 0.72; 95%
CI, 0.56 to 0.93; P = 0.010; number needed to treat, 13). Bronchospasm was
less common in penehyclidine than placebo patients: 1.4% (6 of 417) versus
4.4% (18 of 409; relative risk, 0.327; 95% CI, 0.131 to 0.82; P = 0.011).
None of the other individual pulmonary complications differed
significantly. Peak airway pressures greater than 40 cm H<inf>2</inf>O
were also less common in patients given penehyclidine: 1.9% (8 of 432)
versus 4.9% (21 of 432; relative risk, 0.381; 95% CI, 0.171 to 0.85; P =
0.014). The incidence of other adverse events, including dry mouth and
delirium, that were potentially related to penehyclidine inhalation did
not differ between the groups. Conclusion(s): In high-risk patients
having major upper-abdominal or noncardiac thoracic surgery, prophylactic
penehyclidine inhalation reduced the incidence of pulmonary complications
without provoking complications. Copyright © 2022 Lippincott
Williams and Wilkins. All rights reserved.

<104>
[Use Link to view the full text]
Accession Number
2017207272
Title
Effect of Dexmedetomidine on Tachyarrhythmias after Cardiac Surgery: A
Systematic Review and Meta-Analysis.
Source
Journal of Cardiovascular Pharmacology. 79(3) (pp 315-324), 2022. Date of
Publication: 08 Mar 2022.
Author
Wang W.; Liu J.; Ye H.; Wang M.; Wang T.
Institution
(Wang) Department of Anesthesiology, Jining No. 1 People's Hospital,
Shandong, Jining, China
(Liu) Department of Emergency, Jining No. 1 People's Hospital, Shandong,
Jining, China
(Ye) Department of Anesthesiology, Sishui County Hospital, Jining,
Shandong, China
(Wang) Department of Anesthesiology, Qingdao Municipal Hospital Group,
Shandong, Qingdao, China
(Wang) Department of Anesthesiology, The Second Affiliated Hospital of
Hainan Medical University, Hainan, Haikou, China
Publisher
Lippincott Williams and Wilkins
Abstract
Tachyarrhythmias after cardiac surgery is a common occurrence in clinical
practice, which can be life threatening. We searched 6 databases,
including Embase, PubMed, Cochrane, CNKI, Wanfang, and Sinomed, to
evaluate the effect of dexmedetomidine on tachyarrhythmias after adult
cardiac surgery. The primary end point was the number of patients with
atrial fibrillation (AF) after cardiac surgery. The secondary end points
included the number of patients with supraventricular tachycardia or with
ventricular tachycardia or with ventricular fibrillation or with
myocardial infarction or deceased patients, the duration of mechanical
ventilation, the intensive care unit stay, hospital stay, and the number
of patients with bradycardia and those with hypotension. Among the 1388
retrieved studies, 18 studies (n = 3171 participants) met our inclusion
criteria. Dexmedetomidine reduced the incidence of AF by 17% [relative
risk (RR) = 0.83; 95% confidence interval (CI), 0.73-0.93; P = 0.002].
Through subgroup analysis, we found that when the maintenance dose of
dexmedetomidine was >0.7 microg.kg-1.h-1, the effect
of preventing AF was obvious (RR = 0.58; 95%CI 0.43-0.78; P = 0.0003).
Dexmedetomidine also reduced the incidence of supraventricular tachycardia
by approximately 70% (RR = 0.29; 95% CI, 0.11-0.77; P = 0.01) and the
incidence of ventricular tachycardia by approximately 80% (RR = 0.23; 95%
CI, 0.08-0.63; P = 0.004) but had no effect on ventricular fibrillation
(RR = 1.02; 95% CI, 0.14-7.31; P = 0.99). The major side effect of
dexmedetomidine was bradycardia. Dexmedetomidine can reduce the incidence
of AF (especially high dosages), supraventricular tachycardia, and
ventricular tachycardia after cardiac surgery in adults, but it does not
affect the occurrence of ventricular fibrillation. Copyright ©
2022 Lippincott Williams and Wilkins. All rights reserved.

<105>
Accession Number
2015924381
Title
Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve with
Aortic Stenosis: a Meta-Analysis and Trial Sequential Analysis.
Source
Brazilian Journal of Cardiovascular Surgery. 37(1) (pp 88-98), 2022. Date
of Publication: 2022.
Author
Chan J.S.K.; Singh S.; Eriksen P.; Tsui L.H.; Harky A.
Institution
(Chan) Division of Cardiology, Department of Medicine and Therapeutics,
Prince of Wales Hospital, Shatin, New Territories, Hong Kong
(Chan, Singh) Faculty of Medicine, The Chinese University of Hong Kong,
Shatin, New Territories, Hong Kong
(Eriksen) School of Medicine, University of Liverpool, Liverpool, United
Kingdom
(Tsui) Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong
Kong
(Harky) Department of Cardiothoracic Surgery, Liverpool Heart and Chest
Hospital, United Kingdom
(Harky) Liverpool Centre for Cardiovascular Science, University of
Liverpool and Liverpool Heart and Chest Hospital, United Kingdom
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Objectives: Bicuspid aortic valve (BAV) is an important aetiology of
aortic stenosis and the use of transcatheter aortic valve implantation
(TAVI) has not been fully explored in this cohort. This systematic review
and meta-analysis compared the outcomes of TAVI in stenotic BAV against
tricuspid aortic valve (TAV). Method(s): An electronic literature
search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify
all studies comparing TAVI in stenotic BAV versus TAV. Only studies
comparing TAVI in BAV versus TAV were included, without any limit on the
study date. Primary endpoints were 30-day and 1-year mortality, while
secondary endpoints were postoperative rates of stroke, acute kidney
injury (AKI), and permanent pacemaker (PPM) requirement. A trial
sequential analysis (TSA) was performed for all endpoints to understand
their significance. Result(s): Thirteen studies met the inclusion
criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger
(76.8+/-7.43 years vs. 78.5+/-7.12 years, P=0.02), had a higher
trans-aortic valve gradient (P=0.02), and larger ascending aortic
diameters (P<0.0001). No significant difference was shown for primary
(30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary
endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM
requirement [P=0.86]). The BAV group had a higher rate of significant
postoperative aortic regurgitation (P=0.002). TSA showed that there was
sufficient evidence to conclude the lack of difference in PPM
requirements, and 30-day and 1-year mortality between the two cohorts.
 Conclusion(s): TAVI gives satisfactory outcomes for treating stenotic
BAV and should be considered clinically. Copyright © 2022,
Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.

<106>
Accession Number
2015924375
Title
Surviving the Struggle of COVID-19: Practical Recommendations for
Pediatric/Adult Cardiology and Cardiac Surgical Programs in
Resource-Limited Settings: a Review.
Source
Brazilian Journal of Cardiovascular Surgery. 37(1) (pp 99-109), 2022. Date
of Publication: 2022.
Author
Pilarczyk K.; Nina V.; Boshkov L.; Ferdman B.; Farkas E.A.; Burnham N.;
Cifuentes R.; Ntogwiachu D.; Marath A.
Institution
(Pilarczyk) RobinAid Foundation, Hamburg, Germany
(Pilarczyk) Department for Intensive Care, imland Klinik Rendsburg,
Rendsburg, Germany
(Nina) Department for Cardiothoracic Surgery, Universidade Federal do
Maranhao, Maranhao, Sao Luis, Brazil
(Nina, Marath) Cardiostart International, Tampa, United States
(Boshkov) Division of Hematology, Department of Medicine, Oregon Health &
Science University, Portland, OR, United States
(Ferdman) Pediatric Cardiology, CardioStart International, Tampa, FL,
United States
(Farkas) School of Medicine, Indiana University, Indianapolis, IN, United
States
(Burnham) Children's Hospital Canada, Vancouver, Canada
(Cifuentes) Division of Thoracic Transplantation and Mechanical
Circulatory Support, Department of Surgery, Miller School of Medicine,
University of Miami, Miami, FL, United States
(Ntogwiachu) African Federation of Critical Care Nurses, South Africa
Publisher
Sociedade Brasileira de Cirurgia Cardiovascular
Abstract
Introduction: The primary aim of this systematic review is to provide
perioperative strategies to help restore or preserve cardiovascular
services under threat from financial and personnel constraints imposed by
the coronavirus disease 2019 (COVID-19) pandemic. Method(s): The
Medical Literature Analysis and Retrieval System Online, Excerpta Medica
dataBASE, Cochrane Central Register of Controlled Trials/CCTR, and Google
Scholar were systematically searched using the search terms "(cardiac OR
cardiology OR cardiothoracic OR surgery) AND (COVID-19 or coronavirus OR
SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)".
Additionally, the webpages of relevant medical societies, including the
World Federation Society of Anesthesiologists, the Cardiothoracic Surgery
Network, and the Society of Thoracic Surgeons, were screened for relevant
information. Result(s): Whereas cardiac surgery and cardiology
practices were reduced by 50-75% during the pandemic, mortality of
patients with COVID-19 increased significantly. Healthcare workers are
among those at high risk of infection with COVID-19. Conclusion(s):
Hospitals must provide maximum protective equipment and training on how to
use it to healthcare workers for their mutual protection. Triage
management of patients - which accounts for patient's clinical status and
risk-factor profile relatable to which services are available during the
COVID-19 pandemic - is recommended. A strict reorganization of the
hospital resources including preoperative, intraoperative, and
postoperative detailed protective measures is necessary to reduce
probability of vector contamination, to protect patients and the
cardiovascular teams, and to permit safe resumption of cardiological and
cardiac surgical activity. Copyright © 2022, Sociedade Brasileira
de Cirurgia Cardiovascular. All rights reserved.

<107>
Accession Number
2017149407
Title
Transcatheter aortic valve replacement in mixed aortic valve disease: A
systematic review and meta-analysis.
Source
European Heart Journal - Quality of Care and Clinical Outcomes. 8(2) (pp
169-176), 2022. Date of Publication: 01 Mar 2022.
Author
Guddeti R.R.; Gill G.S.; Garcia-Garcia H.M.; Alla V.M.
Institution
(Guddeti, Gill, Alla) Division of Cardiovascular Diseases, Creighton
University School of Medicine, Omaha, NE 68154, United States
(Guddeti) Division of Cardiovascular Diseases, Minneapolis Heart
Institute, Minneapolis, MN 55407, United States
(Garcia-Garcia) Department of Medicine, Georgetown University, Washington,
DC 20057, United States
(Garcia-Garcia) Division of Cardiovascular Medicine, MedStar Washington
Hospital Center, Washington, DC 20010, United States
Publisher
Oxford University Press
Abstract
Background: Utilization of transcatheter aortic valve replacement (TAVR)
has expanded from high-risk patients to intermediate- A nd select low-risk
candidates with severe aortic stenosis (AS). TAVR is currently not
indicated for patients with aortic insufficiency, and its outcomes in
mixed aortic valve disease (MAVD) are unclear. Method(s): A
systematic search of PubMed, Medline, CINHAL, and Cochrane databases was
performed to identify studies comparing TAVR outcomes in patients with AS
vs. MAVD. Primary outcomes included 30-day and late all-cause mortality,
and paravalvular regurgitation (PVR). Secondary outcomes were major
bleeding, vascular complications, device implantation success, permanent
pacemaker, and stroke. Pooled odds ratios (OR) and 95% confidence
intervals (CIs) were calculated using Der Simonian-Laird random-effects
model. Result(s): Six observational studies with 58 879 patients were
included in the analysis. There was no significant difference in 30-day
all-cause mortality [OR 1.03 (95% CI 0.92-1.15); P = 0.63], however, MAVD
group had higher odds of moderate-to-severe PVR [1.81 (1.41-2.31); P <
0.01]. MAVD patients had lower odds of device implantation success [0.60
(0.40-0.91); P = 0.02] while other secondary outcomes were similar in the
two groups. Conclusion(s): TAVR in MAVD is associated with increased
odds of paravalvular regurgitation and lower odds of device implantation
success when compared to severe aortic stenosis. Copyright © 2021
The Author(s). Published by Oxford University Press on behalf of the
European Society of Cardiology.

<108>
Accession Number
2017234200
Title
Stroke events after transcatheter aortic valve implantation: Temporal
relationships and affected brain regions.
Source
American Heart Journal. 247 (pp 112-122), 2022. Date of Publication: May
2022.
Author
Linder M.; Higgen F.L.; Voigtlander L.; Weimann J.; Ludwig S.; Waldschmidt
L.; Focke C.; Bhadra O.D.; Grundmann D.; Demal T.J.; von Zastrow A.;
Schafer A.; Schirmer J.; Reichenspurner H.; Blankenberg S.; Westermann D.;
Schofer N.; Conradi L.; Thomalla G.; Seiffert M.
Institution
(Linder, Voigtlander, Weimann, Ludwig, Waldschmidt, Focke, Grundmann, von
Zastrow, Blankenberg, Westermann, Schofer, Seiffert) Department of
Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
(Higgen, Thomalla) Department of Neurology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
(Bhadra, Demal, Schafer, Schirmer, Reichenspurner, Conradi) Department of
Cardiovascular Surgery, University Heart & Vascular Center Hamburg,
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
(Voigtlander, Blankenberg, Westermann, Seiffert) German Center for
Cardiovascular Research (DZHK), Partner Site Hamburg/Lubeck/Kiel, Germany
Publisher
Elsevier Inc.
Abstract
Background: Despite continuous improvements in transcatheter aortic valve
implantation (TAVI), periprocedural strokes remain a devastating
complication. Randomized controlled trials failed to demonstrate a
reduction in clinically apparent strokes or mortality after TAVI due to
cerebral embolic protection (CEP). To identify potential targets of CEP
strategies during TAVI, we evaluated affected brain regions, and temporal
patterns of stroke onset in a routine clinical sample. Methods and
Results: A total of 3,164 consecutive patients treated with TAVI from 2008
to 2019 at a single center were screened for cerebrovascular events.
Affected cerebral regions were determined according to clinical symptoms
and brain imaging. Rates of disabling stroke and non-disabling stroke at
30 days were 2.2% and 1.4%, respectively. The frequency of all strokes
decreased from 5.0% to 3.0% over time (P = .012). Patients with impaired
left-ventricular function (OR 2.19), increased CHA2DS2-VASc (OR 1.39) and
moderate/severe spontaneous echo contrast (OR 3.60) had a higher stroke
risk. Acute symptom onset occurred during TAVI (19.4%), within 24 hours
(40.3%) or later (25.0%); 98.3% of strokes were of ischemic origin. In
intraprocedural strokes, 53.2% of lesions were found in locations
considered protected by current CEP devices, and 37.5% of patients with
intraprocedural strokes were exclusively affected in these areas. Baseline
or procedural parameters were not associated with embolic distribution
patterns. Conclusion(s): Most strokes occurred early after TAVI - but
not necessarily during the procedure - and affected multiple brain regions
only partially protected by current CEP devices. Efficient prevention of
cerebrovascular events may require strategies beyond the TAVI procedure to
minimize stroke risk and additional randomized controlled trials will be
required to clarify the role of CEP in efficient stroke prevention during
TAVI. Copyright © 2022 Elsevier Inc.

<109>
Accession Number
2017198517
Title
Sex-Specific Difference in Outcomes after Transcatheter Mitral Valve
Repair with MitraClip Implantation: A Systematic Review and Meta-Analysis.
Source
Journal of Interventional Cardiology. 2022 (no pagination), 2022. Article
Number: 5488654. Date of Publication: 2022.
Author
Sun F.; Liu H.; Zhang Q.; Zhou J.; Zhan H.; Lu F.
Institution
(Sun, Zhou, Zhan, Lu) Department of Cardiovascular Surgery, Hospital of
Zhengzhou University, Zhengzhou, China
(Liu) Department of Emergency, The First Affiliated Hospital of Zhengzhou
University, Zhengzhou Zzu.edu.cn, China
(Zhang) Department of Endovascular Surgery, Hospital of Zhengzhou
University, Zhengzhou, China
Publisher
Hindawi Limited
Abstract
Background. Implantation of the MitraClip is a safe and effective therapy
for mitral valve repair in patients ineligible for surgery or at high risk
of adverse surgical outcomes. However, only limited information is
available concerning sex differences in transcatheter mitral valve repair.
We therefore sought to conduct a comprehensive meta-analysis of studies
that investigated differences between men and women in outcomes following
MitraClip implantation. Methods. The PubMed and Embase databases were
searched until November 2019 for studies reporting outcomes after
MitraClip implantation in women versus men. Outcomes included all-cause
mortality and major complications at 30 days and one year of follow-up.
Results. Six studies (n = 1,109 women; n = 1,743 men) were analyzed. At 30
days, women had a similar risk of postoperative complications, such as
stroke, major bleeding, and pericardium effusion, without differences in
all-cause mortality, procedure success, or MitraClip usage. At one year,
the all-cause mortality, the reduction of mitral regurgitation, and the
risk of rehospitalization for heart failure were also comparable between
male and female patients. Conclusion. Gender disparity was not found in
complications or prognosis of patients undergoing MitraClip implantation.
This study suggests that gender should not be considered as a critical
factor in the selection of patients as candidates for MitraClip
implantation of concern during follow-up. Copyright © 2022
Fuqiang Sun et al.

<110>
Accession Number
2017160570
Title
Effect of remote ischaemic preconditioning on mortality and morbidity
after non-cardiac surgery: Meta-analysis.
Source
BJS Open. 5(2) (no pagination), 2021. Article Number: zraa026. Date of
Publication: 01 Mar 2021.
Author
Wahlstrom K.L.; Bjerrum E.; Gogenur I.; Burcharth J.; Ekeloef S.
Institution
(Wahlstrom, Bjerrum, Gogenur, Burcharth, Ekeloef) Department of Surgery,
Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
Publisher
Oxford University Press
Abstract
Background: Remote ischaemic preconditioning (RIPC) has been shown to have
a protective role on vital organs exposed to reperfusion injury. The aim
of this systematic review was to evaluate the effects of non-invasive RIPC
on clinical and biochemical outcomes in patients undergoing non-cardiac
surgery Methods: A systematic literature search of PubMed, EMBASE, Scopus,
and Cochrane databases was carried out in February 2020. RCTs
investigating the effect of non-invasive RIPC in adults undergoing
non-cardiac surgery were included. Meta-analyses and trial sequential
analyses (TSAs) were performed on cardiovascular events, acute kidney
injury, and short- and long-term mortality. Result(s): Some 43 RCTs
including 3660 patients were included. The surgical areas comprised
orthopaedic, vascular, abdominal, pulmonary, neurological, and urological
surgery. Meta-analysis showed RIPC to be associated with fewer
cardiovascular events in non-cardiac surgery (13 trials, 1968 patients,
421 events; odds ratio (OR) 0.68, 95 per cent c.i. 0.47 to 0.96; P=0.03).
Meta-analyses of the effect of RIPC on acute kidney injury (12 trials,
1208 patients, 211 events; OR 1.14, 0.78 to 1.69; P=0.50; I2 = 9 per
cent), short-term mortality (7 trials, 1239 patients, 65 events; OR 0.65,
0.37 to 1.12; P=0.12; I2 = 0 per cent), and long-term mortality (4 trials,
1167 patients, 9 events; OR 0.67, 0.18 to 2.55; P=0.56; I2 = 0 per cent)
showed no significant differences for RIPC compared with standard
perioperative care in non-cardiac surgery. However, TSAs showed that the
required information sizes have not yet been reached. Conclusion(s):
Application of RIPC to non-cardiac surgery might reduce cardiovascular
events, but not acute kidney injury or all-cause mortality, but currently
available data are inadequate to confirm or reject an assumed intervention
effect. Copyright © 2020 The Author(s).

<111>
[Use Link to view the full text]
Accession Number
2017127088
Title
Diabetes and multivessel disease: coronary artery bypass grafting remains
king.
Source
Current Opinion in Cardiology. 33(5) (pp 551-557), 2018. Date of
Publication: 01 Sep 2018.
Author
Godoy L.C.; Rao V.; Farkouh M.E.
Institution
(Godoy, Farkouh) Peter Munk Cardiac Centre, Heart and Stroke Richard Lewar
Centre, University of Toronto, Toronto, Canada
(Godoy) Instituto do Coracao (InCor), Faculdade de Medicina FMUSP,
Universidade de Sao Paulo, SP, Sao Paulo, Brazil
(Rao) Peter Munk Cardiac Centre, Toronto General Research Institute,
Division of Cardiovascular Surgery, Toronto General Hospital, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review Review the recently published scientific evidence to
support the decision-making process of revascularization strategy in
patients with diabetes mellitus (DM) and multivessel coronary artery
disease (MVD). Recent findings Recently published observational analyses
have proven the superiority of coronary artery bypass grafting (CABG) in
patients presenting with other comorbidities together with DM, such as
renal disease or heart failure. Summary Significant challenges and
controversies surrounded the choice of the appropriate revascularization
method in patients with DM and MVD over the last decades. FREEDOM trial
was the first adequately powered randomized study to directly compare
percutaneous coronary intervention (PCI) versus CABG in the DM population,
showing the superiority of CABG in the long-term follow-up. Subsequently,
other studies confirmed that CABG is also preferable over PCI in diabetic
patients with particular comorbidities, such as renal failure and left
ventricular dysfunction, and also in patients with type 1 DM and in the
setting of an early acute coronary syndrome. Finally, in 2018, an
individual level data meta-analysis reported an expressive reduction in
all-cause mortality when comparing CABG versus PCI in patients with DM and
MVD enrolled in the most recent clinical trials (hazard ratio 1.44, 95%
confidence interval 1.20-1.74, P1/40.0001). Copyright © 2018
Wolters Kluwer Health, Inc. All rights reserved

<112>
[Use Link to view the full text]
Accession Number
2017127084
Title
What is the state of hybrid coronary revascularization in 2018?.
Source
Current Opinion in Cardiology. 33(5) (pp 540-545), 2018. Date of
Publication: 01 Sep 2018.
Author
Yanagawa B.; Hong K.; Cheema A.; Bagai A.; Verma S.
Institution
(Yanagawa, Hong, Verma) Division of Cardiac Surgery, St Michael's
Hospital, Toronto, ON, Canada
(Cheema, Bagai) Division of Cardiology, St Michael's Hospital, Toronto,
ON, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose of review Hybrid coronary revascularization (HCR) combines
minimally invasive surgical bypass with percutaneous coronary intervention
(PCI) using drug-eluting stents, the goal being to leverage the strengths
of each approach. Here we provide an update on HCR from the past 12
months. Recent findings HCR represents a minority of surgical
revascularization cases from a small number of highly experienced surgical
centers. Most single-center observational series show no differences in
major cardiovascular outcomes comparing HCR and coronary artery bypass
graft (CABG) or HCR and PCI. The 5-year results of the first randomized
study comparing HCR to CABG reported no difference in all-cause mortality,
myocardial infarction, and repeat revascularization. Comparing HCR with
multivessel PCI, a large, prospective observational study reported no
difference in risk-adjusted major adverse cardiovascular events at 12
months. The Hybrid Coronary Revascularization Trial is an international,
multicenter, randomized controlled trial to compare HCR versus PCI for
patients with proximal left anterior descending disease or left main
disease. This trial is currently recruiting patients. Summary HCR is a
potentially attractive alternative to both surgical revascularization and
multivessel PCI when performed in experienced centers for highly selected
patients. The results of a large, multicenter, prospective trial will
provide greater clarity on the clinical role and optimal coronary anatomy
for this third revascularization option. Copyright © 2018
Lippincott Williams and Wilkins. All rights reserved.

<113>
Accession Number
2017140048
Title
The Cox-maze IV procedure in its second decade: Still the gold standard?.
Source
European Journal of Cardio-thoracic Surgery. 53(1) (pp I19-I25), 2018.
Date of Publication: 01 Jan 2018.
Author
Ruaengsri C.; Schill M.R.; Khiabani A.J.; Schuessler R.B.; Melby S.J.;
Damiano R.J.
Institution
(Ruaengsri, Schill, Khiabani, Schuessler, Melby, Damiano) Department of
Surgery, Division of Cardiothoracic Surgery, Washington University, School
of Medicine, Barnes Jewish Hospital, St. Louis, MO, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and the
treatment options include medical treatment and catheter-based or surgical
interventions. AF is a major cause of stroke, and its prevalence is
increasing. The surgical treatment of AF has been revolutionized over the
past 2 decades through surgical innovation and improvements in endoscopic
imaging, ablation technology and surgical instrumentation. The Cox-maze
(CM) procedure, which was developed by James Cox and introduced clinically
in 1987, is a procedure in which multiple incisions are created in both
the left and the right atria to eliminate AF while allowing the sinus
impulse to reach the atrioventricular node. This procedure became the gold
standard for the surgical treatment of AF. Its latest iteration is termed
the CMIV and was introduced in 2002. The CM IV replaced the previous
cutand- sew method (CM III) by replacing most of the incisions with a
combination of bipolar radiofrequency and cryoablation. The use of
ablation technologies, made the CM IV technically easier, faster and more
amenable to minimally invasive approaches. The aims of this article are to
review the indications and preoperative planning for the CM IV, to
describe the operative technique and to review the literature including
comparisons of the CMIV with the previous cut-and-sewmethod. Finally, this
review explores future directions for the surgical treatment of patients
with AF. Copyright © The Author 2018.

<114>
Accession Number
2017140010
Title
Re: Preoperative intra-aortic counterpulsation in high-risk patients
undergoing cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
European Journal of Cardio-thoracic Surgery. 51(1) (pp 193-194), 2017.
Date of Publication: 01 Jan 2017.
Author
Yang S.S.
Institution
(Yang) Department of Anesthesia, McGill University, Montreal, QC, Canada
Publisher
European Association for Cardio-Thoracic Surgery

<115>
Accession Number
2017140157
Title
Hypothermia and cerebral protection strategies in aortic arch surgery: a
comparative effectiveness analysis from the STS Adult Cardiac Surgery
Database.
Source
European Journal of Cardio-thoracic Surgery. 52(3) (pp 492-498), 2017.
Date of Publication: 01 Sep 2017.
Author
Englum B.R.; He X.; Gulack B.C.; Ganapathi A.M.; Mathew J.P.; Brennan
J.M.; Reece T.B.; Keeling W.B.; Leshnower B.G.; Chen E.P.; Jacobs J.P.;
Thourani V.H.; Hughes G.C.
Institution
(Englum, Gulack, Ganapathi, Hughes) Department of Surgery, Duke University
Medical Center, Durham, NC, United States
(Englum, He, Gulack, Brennan) Duke Clinical Research Institute, Durham,
NC, United States
(Mathew) Department of Anesthesiology, Duke University Medical Center,
Durham, NC, United States
(Reece) Department of Surgery, University of Colorado, Aurora, CO, United
States
(Keeling, Leshnower, Chen, Thourani) Department of Surgery, Emory
University School of Medicine, Atlanta, GA, United States
(Jacobs) Division of Cardiovascular Surgery, Johns Hopkins University, St.
Petersburg, FL, United States
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Hypothermic circulatory arrest is essential to aortic arch
surgery, although consensus regarding optimal cerebral protection strategy
remains lacking. We evaluated the current use and comparative
effectiveness of hypothermia/cerebral perfusion (CP) strategies in aortic
arch surgery. METHOD(S): Using the Society of Thoracic Surgeons
Database, cases of aortic arch surgery with hypothermic circulatory arrest
from 2011 to 2014 were categorized by hypothermia strategy-deep/profound
(D/P; <_20C), low-moderate (L-M; 20.1-24C), and
high-moderate (H-M; 24.1-28C)-and CP strategy-no CP, antegrade
(ACP), retrograde (RCP) or both ACP/RCP. After adjusting for potential
confounders, strategies were compared by composite end-point (operative
mortality or neurologic complication). RESULT(S): Of the 12 521
aortic arch repairs with hypothermic circulatory arrest, the most common
combined strategies were straight D/P without CP (25%), D/P + RCP (16%)
and D/P + ACP (14%). Overall rates of the primary end-point, operative
mortality and stroke were 23%, 12% and 8%, respectively. Among the 7 most
common strategies, the 2 not utilizing CP (straight D/P and straight L-M)
appeared inferior, associated with significantly higher risk of the
composite end-point (odds ratio: 1.6; P < 0.01); there was no significant
difference in composite outcome between the remaining strategies (D/P +
ACP, D/P + RCP, L-M + ACP, L-M + RCP and H-M + ACP). CONCLUSION(S):
In a comparative effectiveness study of cerebral protection strategies for
aortic arch repair, strategies without adjunctive CP, including the most
commonly utilized strategy of straight D/P hypothermia, appeared inferior
to those utilizing CP. There was no clearly superior strategy among
remaining techniques, and randomized trials are needed to define best
practice. Copyright © The Author 2017. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<116>
Accession Number
2017140152
Title
Prevention of surgical site sternal infections in cardiac surgery: a
two-centre prospective randomized controlled study.
Source
European Journal of Cardio-thoracic Surgery. 51(1) (pp 67-72), 2017. Date
of Publication: 01 Jan 2017.
Author
Schimmer C.; Gross J.; Ramm E.; Morfeld B.-C.; Hoffmann G.; Panholzer B.;
Hedderich J.; Leyh R.; Cremer J.; Petzina R.
Institution
(Schimmer, Morfeld, Leyh) Department of Cardiothoracic and Thoracic
Vascular Surgery, University Hospital Wurzburg, Wurzburg, Germany
(Gross, Ramm, Hoffmann, Panholzer, Cremer, Petzina) Department of
Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus
Kiel, Kiel, Germany
(Hedderich) Institute of Medical Informatics and Statistics, University
Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Surgical site infection (SSI) of the sternum is a devastating
complication in cardiac surgery. The aim of this prospective randomized
controlled two-centre clinical study was to compare the use of a
gentamicin-collagen sponge (Genta-Coll resorb) and of a
cyanoacrylate-based microbial skin sealant (InteguSeal) on the SSI rate of
the sternum. METHOD(S): We analysed data from 996 consecutive
patients following isolated coronary artery bypass grafting between 2012
and 2014. The patients were randomized into three groups: standard group
(S-group), Genta-Coll group (G-group) and InteguSeal group (I-group). The
primary study end-point was to analyse the incidence of superficial and
deep sternal SSI. The secondary study end-point was to determine
independent risk factors for an increased SSI rate. RESULT(S): Of the
996 patients investigated, 332 patients were in S-group, 336 patients in
G-group and 328 patients in I-group. The mean age was 67.7 +/- 9.4 years,
18.6% were women and the overall SSI rate was 6.2% with 2.2% deep sternal
wound infections. SSI rates were 8.3% (S-group), 5.4% (G-group) and 4.9%
(I-group) (P 0.16). Multiple regression analysis demonstrated a
preoperative body mass index (BMI) of >30 kg/m2 (P 0.047),
re-thoracotomy for postoperative bleeding (P < 0.001) and sternum
instability (P < 0.001) as independent predictors for an increased SSI
rate. CONCLUSION(S): The application of InteguSeal or Genta-Coll
resorb had no significant influence on the incidence of the sternal SSI
rate in 996 consecutive cardiac surgery patients but demonstrated a trend
towards a benefit from using these prophylactic approaches. Multiple
regression analysis demonstrated a preoperative BMI of >30
kg/m2, re-thoracotomy for bleeding and sternum instability as
independent predictors for an increased sternal SSI rate. Copyright
© The Author 2016. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<117>
Accession Number
2017140060
Title
Early, dedicated follow-up and treatment of pleural effusions enhance the
recovery rate after open cardiac surgery: Results from a randomized,
clinical trial.
Source
European Journal of Cardio-thoracic Surgery. 51(1) (pp 58-66), 2017. Date
of Publication: 01 Jan 2017.
Author
Hansen L.S.; Hjortdal V.E.; Jakobsen C.-J.; Heiberg J.; Maagaard M.; Sloth
E.
Institution
(Hansen, Hjortdal, Jakobsen, Heiberg, Maagaard, Sloth) Aarhus University
Hospital, Aarhus N, Denmark
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Recent studies conclude that cardiac surgery patients are
prone to both mortality and morbidity in the weeks after discharge.
Complications such as pleural and pericardial effusions may influence
physical recovery due to symptoms such as dyspnoea, chest pain and
fatigue. Dedicated follow-up and timely treatment of postoperative
complications are suggested. METHOD(S): A randomized, controlled
intervention trial including 76 patients, in the ratio of 1 : 1. Patients
scheduled for elective on-pump coronary artery bypass grafting and/or
aortic valve replacement were eligible for inclusion. Patients were
randomized to either standard postoperative care or complementary
follow-up visits with clinical examinations, focused chest sonography and
protocol-driven thoracentesis if applicable. Primary outcomes were the
mean change in walking distance, peak expiratory flow and EuroQOL from
baseline to 30 days after surgery. RESULT(S): The mean difference in
walking distance after 30 days was 15% (65 +/- 22 m) between groups, P =
0.017. No differences were found in the peak expiratory flow or EuroQOL.
In patients with pleural effusion, walking distance improved by 22% after
thoracentesis (81 +/- 42 m), P < 0.0001, and peak expiratory flow improved
by 26% (1.1 +/- 1.2 l/min), P < 0.001. CONCLUSION(S): Supplemental
dedicated follow-up and treatment of postoperative effusions enhance
recovery by 15% compared with standard care, measured by improvement in
the walking distance 1 month after cardiac surgery. Copyright ©
The Author 2016.

<118>
Accession Number
2017140030
Title
Techniques and standards in intraoperative graft verification by transit
time flow measurement after coronary artery bypass graft surgery: A
critical review.
Source
European Journal of Cardio-thoracic Surgery. 51(1) (pp 26-33), 2017. Date
of Publication: 01 Jan 2017.
Author
Niclauss L.
Institution
(Niclauss) Department of Cardiovascular Surgery, University Hospital of
Lausanne (CHUV), Lausanne, Switzerland
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
Transit time flow measurement (TTFM) is a quality control tool for
intraoperative graft evaluation in coronary artery bypass graft (CABG)
surgery. A critical review of the literature available using TTFM in CABG
surgery is the focus of this article. The main objectives will be to
detail precise parameters for flow evaluation, to show limitations of TTFM
and to prove its predictive impact on postoperative graft failure rate.
Publications listed in the PubMed database were reviewed, searching for
intraoperative graft verification in coronary surgery by TTFM, with
postoperative imaging follow-up (FU) modality and with a special focus on
publications released after European guidelines from 2010. Nine included
publications revealed an overall graft failure rate of ~12%. Mean graft
flow had a positive predictive value in the largest study, and cut-offs,
of at least 20 ml/min for internal mammary artery (IMA) grafts, therein
partially confirming guidelines, and 30-40 ml/min for saphenous venous
grafts (SVGs) were proposed. An explicit correlation between graft flow,
patency rate and severity of coronary stenosis, by indicating the
fractional flow reserve, was found for IMA grafts. Increased pulsatility
index and increased systolic reverse flow probably predict worse outcome
and may help identifying competitive flow. Diastolic filling, rarely
indicated, could not be confirmed as the predictive marker. No significant
correlation of TTFM and graft failure rate for radial and other arterial
grafts could be found, partially due to the small number of these types of
grafts analysed. Larger target vessels and lower postoperative CK-MB
levels may predict better graft patency rates. Low sensitivity for TTFM to
reliably detect graft failure is certainly a major issue, as found in
randomized analyses. However, methodical limitations and varying threshold
values for TTFM render a general consensus difficult. Influence of
quantity (vessel territory distribution) and quality (myocardial scar) of
the graft perfusion area, on TTFM and FU outcome, was not included by
anyone and should be part of future research. TTFM is probably not the
tool of choice to detect progressive late graft failure of SVG.
Peroperative TTFM values should be correlated with one type of conduit,
differentiating between early and late graft failure (by applying a
uniform, appropriated definition), to precise and confirm threshold
values. Copyright © The Author 2016.

<119>
Accession Number
2017140054
Title
A pilot prospective randomized, controlled trial comparing LigaSureTM
tissue fusion technology with the ForceTriadTM energy platform to the
electrosurgical pencil on rates of atrial fibrillation after pulmonary
lobectomy and mediastinal lymphadenectomy.
Source
European Journal of Cardio-thoracic Surgery. 47(1) (pp E13-E18), 2015.
Date of Publication: 01 Jan 2015.
Author
Martucci N.; Tracey M.; Rocca A.L.; Manna C.L.; De Luca G.; Rocco G.
Institution
(Martucci, Tracey, Rocca, Manna, De Luca, Rocco) Division of Thoracic
Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale
Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The use of bipolar sealing devices during pulmonary resection
is particularly useful in thoracoscopic surgery. Theoretically, a bipolar
device, which contains the current in a smaller area and completes the
current cycle only through the tissue between the electrodes, may reduce
the proportion of patients experiencing atrial fibrillation compared with
monopolar devices such as the electrosurgical pencil using which the
current completes the cycle through the patient. We investigated the
impact of the LigaSureTM (LS) tissue fusion technology with the
ForceTriadTM energy platform device on the incidence of postoperative
atrial fibrillation and on the reduction of postoperative chest tube
output and hospital length of stay after open pulmonary lobectomy.
 METHOD(S): A pilot prospective randomized, controlled trial comparing
LS tissue fusion technology with the ForceTriadTM energy platform to the
conventional electrosurgical pencil. Overall, 146 patients with resectable
lung cancer were recruited at the Division of Thoracic Surgery of the
Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, between January 2011
and July 2013. Of these, 119 candidates to open lobectomy for
non-small-cell lung cancer were randomized to either LS tissue fusion
technology with the ForceTriadTM energy platform (LS: 57 patients) or
standard haemostatic procedure (standard treatment, ST: 62 patients) for
hilar and mediastinal nodal dissection. The primary end-point was to
compare the incidence of postoperative atrial fibrillation of LS compared
with ST. The secondary end-point was to compare the efficacy of LS
compared with ST in terms of total chest tube drainage, daily chest tube
drainage and chest tube duration. RESULT(S): There was no
statistically significant difference between LS and ST in terms of
postoperative atrial fibrillation (P = 0.31). However, LS was associated
to significant reduction of duration of both mediastinal nodal dissection
(P = 0.017) and the cumulative chest tube drainage (P = 0.025).
 CONCLUSION(S): The incidence of atrial fibrillation with LS tissue
fusion technology with the ForceTriadTM energy platform is not reduced as
compared with conventional electrosurgical pencil. However, the use of LS
during mediastinal nodal dissection is associated to shorter duration of
lymphadenectomy and duration of chest tube drainage. Copyright ©
The Author 2014.

<120>
Accession Number
2017212854
Title
Preoperative Iron Supplementation in Pediatric Cardiac Surgical Patients:
A Preliminary Single-Center Experience.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Otsuka Y.; Naraine N.; Switzer T.; Faraoni D.
Institution
(Otsuka, Switzer) Division of Cardiac Anesthesia, Department of
Anesthesiology and Pain Medicine, The Hospital for Sick Children,
University of Toronto, Toronto, ON, Canada
(Naraine) Transfusion Medicine, Department of Pediatric Laboratory
Medicine, The Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada
(Faraoni) Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia,
Department of Anesthesiology, Perioperative and Pain Medicine, Texas
Children's Hospital, Baylor College of Medicine, Boston, MA, United States
Publisher
W.B. Saunders
Abstract
Objective: To assess preoperative hemoglobin and perioperative red blood
cell transfusion in children undergoing cardiac surgery after the
implementation of a preoperative patient blood management (PBM) clinic
with oral iron supplementation. Design(s): A retrospective analysis.
 Setting(s): A single tertiary hospital. Participant(s): Patients
who underwent cardiac surgery with cardiopulmonary bypass at the Hospital
for Sick Children (Toronto, Canada) during a 12-month period before and
following the implementation of a preoperative PBM clinic. Patients
younger than 3 months of age, or who were admitted to the cardiac
intensive care unit preoperatively, were excluded because they were not
systematically assessed by the PBM clinic. Intervention(s): None.
 Measurements and Main Results: A total of 296 patients were included
in the authors' analysis. After adjustment for confounding factors (age at
surgery, preoperative oxygen saturation, type of congenital heart disease,
surgery type), they found that preoperative hemoglobin levels were
significantly higher in children treated with iron supplementation (n =
201) compared to historic controls (n = 95) (13.9 [12.8-15.1] g/dL v 12.9
[11.7-15.0] g/dL, adjusted p = 0.001). The exposure rate to red blood cell
transfusion (50% v 61%, adjusted p = 0.930) was not significantly
different between groups. However, the volumes of allogeneic red blood
cells (1.4 (0.0-14.0) mL/kg v 12.5 (0.0-23.0) mL/kg, adjusted p = 0.004)
and autologous blood (11.0 (6.8-17.0) v 17.0 (11.0-31.0), adjusted p <
0.001) transfused were significantly reduced in children treated with iron
supplementation. Conclusion(s): Preoperative iron supplementation led
to an increase in preoperative hemoglobin levels. The exact prevalence of
iron deficiency and the effect of iron supplementation on perioperative
allogeneic blood transfusion and long-term outcomes should be studied in a
prospective randomized study. Copyright © 2021 Elsevier Inc.

<121>
Accession Number
637431594
Title
Effects of exercise-based prehabilitation in children undergoing elective
surgeries: A systematic review.
Source
F1000Research. 10 (no pagination), 2022. Article Number: 1262. Date of
Publication: 2022.
Author
Samuel S.; Noronha J.; Singh V.P.; Prabhu H.S.
Institution
(Noronha) Department of Physiotherapy, Kasturba Medical College, Manipal
Academy of Higher Education, Mangalore, Manipal, India
(Samuel) Department of Physiotherapy, Kasturba Medical College, Manipal
Academy of Higher Education, Mangalore, Manipal, India
(Singh) Department of Physiotherapy, Kasturba Medical College Mangalore,
Manipal Academy of Higher Education, Manipal, India
(Prabhu) Department of Surgery, Kasturba Medical College, Manipal Academy
of Higher Education, Mangalore, Manipal, India
Publisher
F1000 Research Ltd
Abstract
Background: Prehabilitation is a therapeutic strategy involving
preoperative physical exercises, nutritional support, and stress and
anxiety reduction. This approach has been gaining popularity and has been
seeing effective results in adults in terms of improving pre and
postoperative outcomes. The purpose of this review was to summarise the
evidence about the effects of exercise-based prehabilitation programs on
various outcome measures in children post elective surgeries.
 Method(s): PubMed, Scopus, Web of Science, PEDro, CINAHL/EBSCO and
EMBASE electronic databases were searched from inception to June 2021.
Based on the inclusion criteria, titles and abstracts were independently
screened by the authors. After that, a data extraction table of the
selected studies which included the participants, type, and details of
exercise intervention, outcome measures and results were analysed after
which the quality assessment of the studies was done. Result(s): The
search yielded 2219 articles of which three articles fulfilled the
inclusion criteria with two studies being randomized controlled trials and
one being a quasi-experimental pre-post type of study. One randomized
controlled trial was on the effects of exercise-based prehabilitation in
reducing pulmonary complications post cardiac surgeries in children and
the other two studies were on the effects of prehabilitation on functional
capacity & pulmonary function. All the three articles found that
exercise-based prehabilitation had a positive effect on children's
post-surgery. Conclusion(s): Although there is a paucity of
evidence-based literature, we conclude based on the existing literature
retrieved by our review that exercise-based prehabilitation improves
postoperative outcomes and helps in reducing postoperative complications
in children undergoing various surgeries. Copyright © 2022
Noronha J et al.

<122>
Accession Number
2015259011
Title
Reported definitions of intraoperative hypotension in adults undergoing
non-cardiac surgery under general anaesthesia: a review.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 69. Date
of Publication: December 2022.
Author
Weinberg L.; Li S.Y.; Louis M.; Karp J.; Poci N.; Carp B.S.; Miles L.F.;
Tully P.; Hahn R.; Karalapillai D.; Lee D.-K.
Institution
(Weinberg, Li, Louis, Karp, Poci, Carp, Miles, Tully, Karalapillai)
Department of Anaesthesia, Austin Hospital, Austin Health, 145 Studley
Road, Heidelberg, Melbourne, VIC 3084, Australia
(Weinberg, Miles, Karalapillai) Department of Critical Care, The
University of Melbourne, Melbourne, Australia
(Weinberg) Department of Surgery, Austin Health, The University of
Melbourne, Melbourne, Australia
(Hahn) Karolinska Institute at Danderyd's Hospital (KIDS), Stockholm,
Sweden
(Hahn) Department of Research, Sodertalje Hospital, Sodertalje, Sweden
(Lee) Department of Anesthesiology and Pain Medicine, Dongguk University
Ilsan Hospital, Goyang, South Korea
Publisher
BioMed Central Ltd
Abstract
Background: Intraoperative hypotension (IOH) during non-cardiac surgery is
common and associated with major adverse kidney, neurological and cardiac
events and even death. Given that IOH is a modifiable risk factor for the
mitigation of postoperative complications, it is imperative to generate a
precise definition for IOH to facilitate strategies for avoiding or
treating its occurrence. Moreover, a universal and consensus definition of
IOH may also facilitate the application of novel and emerging therapeutic
interventions in treating IOH. We conducted a review to systematically
record the reported definitions of intraoperative hypotension in adults
undergoing non-cardiac surgery under general anaesthesia. Method(s):
In accordance with Cochrane guidelines, we searched three online databases
(OVID [Medline], Embase and Cochrane Library) for all studies published
from 1 January 2000 to 6 September 2020. We evaluated the number of
studies that reported the absolute or relative threshold values for
defining blood pressure. Secondary aims included evaluation of the
threshold values for defining IOH, the methodology for accounting for the
severity of hypotension, whether the type of surgical procedure influenced
the definition of IOH, and whether a study whose definition of IOH aligned
with the Perioperative Quality Initiative-3 workgroup (POQI) consensus
statement for defining was more likely to be associated with determining
an adverse postoperative outcome. Result(s): A total of 318 studies
were included in the final qualitative synthesis. Most studies (n = 249;
78.3%) used an absolute threshold to define hypotension; 150 (60.5%)
reported SBP, 117 (47.2%) reported MAP, and 12 (4.8%) reported diastolic
blood pressure (DBP). 126 (39.6%) used a relative threshold to define
hypotension. Of the included studies, 153 (48.1%) did not include any
duration variable in their definition of hypotension. Among the selected
318 studies 148 (46.5%) studies defined IOH according to the POQI
statement. When studies used a "relative blood pressure change" to define
IOH, there was a weaker association in detecting adverse postoperative
outcomes compared to studies who reported "absolute blood pressure change"
(chi2(2) = 10.508, P = 0.005, Cramer's V = 0.182). When studies
used the POQI statement definition of hypotension or defined IOH by values
higher than the POQI statement definition there were statistical
differences observed between IOH and adverse postoperative outcomes
(chi2(1) = 6.581, P = 0.037, Cramer's V = 0.144). When both the
duration of IOH or the numbers of hypotensive epochs were evaluated, we
observed a significantly stronger relationship between the definition of
IOH use the development of adverse postoperative outcomes.
(chi2(1) = 4.860, P = 0.027, Cramer's V = 0.124).
 Conclusion(s): Most studies defined IOH by absolute or relative
changes from baseline values. There are substantial inconsistencies in how
IOH was reported. Further, definitions differed across different surgical
specialities. Our findings further suggest that IOH should be defined
using the absolute values stated in the POQI statement i.e., MAP < 60-70
mmHg or SBP < 100 mmHg. Finally, the number of hypotensive epochs or
time-weighted duration of IOH should also be reported. Copyright
© 2022, The Author(s).

<123>
Accession Number
2015244264
Title
The effect of continuous intercostal nerve block vs. single shot on
analgesic outcomes and hospital stays in minimally invasive direct
coronary artery bypass surgery: a retrospective cohort study.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 64. Date
of Publication: December 2022.
Author
Yao Y.; Xu M.
Institution
(Yao, Xu) Department of Anesthesiology, Peking University Third Hospital,
Beijing, China
Publisher
BioMed Central Ltd
Abstract
Background: Minimally invasive direct coronary artery bypass (MIDCAB)
grafting surgery is accompanied by severe pain. Although continuous
intercostal nerve block (CINB) has become one of the multimodal analgesic
techniques in single port thoracoscopic surgery, its effects on MIDCAB are
unclear. The purpose of this study was to compare the effects of CINB and
single shot on analgesic outcomes and hospital stays in patients
undergoing MIDCAB in a real-world setting. Method(s): A retrospective
cohort study was carried out at Peking University Third Hospital, China.
Two hundred and sixteen patients undergoing MIDCAB were divided into two
groups: a CINB group and a single block (SI) group. The primary outcome
was postoperative maximal visual analog scale (VAS); secondary outcomes
included the number of patients with maximal VAS <= 3, the demand for and
consumed doses of pethidine and tramadol, and the length of intensive care
unit (ICU) and hospital stays. The above data and the area under the VAS
curve in the 70 h after extubation for the two subgroups (No. of grafts =
1) were also compared. Result(s): The maximum VAS was lower in the
CINB group, and there were more cases with maximum VAS <= 3 in the CINB
group: CINB 52 (40%) vs. SI 17 (20%), P = 0.002. The percentage of cases
requiring tramadol and pethidine was less in CINB, P = 0.001. Among all
patients, drug doses were significantly lower in the CINB group [tramadol:
CINB 0 (0-100) mg vs. SI 100 (0-225) mg, P = 0.0001; pethidine: CINB 0
(0-25) mg vs. SI 25 (0-50) mg, P = 0.0004]. Further subgroup analysis
showed that the area under the VAS curve in CINB was smaller: 28.05 in
CINB vs. 30.41 in SI, P = 0.002. Finally, the length of ICU stay was
shorter in CINB than in SI: 20.5 (11.3-26.0) h vs. 22.0 (19.0-45.0) h, P =
0.011. Conclusion(s): CINB is associated with decreased demand for
rescue analgesics and shorter length of ICU stay when compared to single
shot intercostal nerve block. Additional randomized controlled trial (RCT)
is needed to support these findings. Copyright © 2022, The
Author(s).

<124>
Accession Number
2015219445
Title
A randomized non-inferiority study of low-dose and standard-dose
ticagrelor after intervention for acute coronary syndrome: study protocol
for the TIGER STUDY.
Source
Trials. 23(1) (no pagination), 2022. Article Number: 203. Date of
Publication: December 2022.
Author
Pang Y.; Ma M.; Xia J.; Wang D.; YanChen; Ye J.; Jia Z.; Wu S.; Yang J.;
Hou L.
Institution
(Pang, Ma, Xia, Wang, Hou) The Department of Cardiology, Institute of
Cardiovascular Diseases, Tongren Hospital, Shanghai Jiao Tong University
School of Medicine, Shanghai 200336, China
(YanChen) The Department of Cardiology, Taishan People's Hospital,
Guangdong 529000, China
(Ye) The Department of Cardiology, Ningbo Fourth Hospital, Zhejiang
315700, China
(Jia) The Department of Cardiology, Southwestern Lu hospital, Shandong
252300, China
(Wu) Biostatistics Office of Clinical Research Center, Shanghai Ninth
People's Hospital, Shanghai Jiao Tong University School of Medicine,
Shanghai 200011, China
(Yang) The Department of Cardiology, Yanzhou Branch of Affiliated Hospital
of Jining Medical University, Shandong 272199, China
Publisher
BioMed Central Ltd
Abstract
Background: Current guidelines recommend that patients with acute coronary
syndrome (ACS) who have successfully undergone percutaneous coronary
intervention (PCI) should continue to use dual antiplatelet therapy (DAPT)
for 12 months. The long-term use of standard-dose dual antiplatelet
therapy will increase the risk of bleeding. An optimized antiplatelet
strategy that can prevent ischemic events and reduce the risk of bleeding
remains to be explored. Method(s): The study is a prospective,
multicenter, randomized, open-label, controlled study involving 2090
patients from six clinical centers in China. Through the interactive web
response system (IWRS), ACS patients undergoing successful PCI will be
randomly divided into the low-dose ticagrelor group or the normal-dose
ticagrelor group, after taking 100 mg aspirin and 90 mg ticagrelor bid for
1 week. The primary endpoint is a composite of cardiovascular death,
non-fatal myocardial infarction, stent thrombosis, repeat
revascularization, and stroke. The secondary endpoints are bleeding events
of grade 2 or higher according to Bleeding Academic Research Consortium
[BARC] criteria, cardiovascular death, acute myocardium infarction, and
coronary revascularization at 1 year. Discussion(s): Recent studies
have confirmed that 90 mg ticagrelor alone can safely and effectively
reduce bleeding without increasing ischemic events of patients with ACS
after PCI. Compared with standard-dose DAPT, whether low-dose ticagrelor
combined with aspirin can ensure the anti-ischemic effect while reducing
the bleeding risk remains unclear in Chinese patients. The TIGER study
will be the first large-scale, multicenter study to compare the efficacy
and safety of low-dose and standard-dose ticagrelor combined with aspirin
in ACS patients 1 week after successful PCI. Trial registration:
Clinicaltrials.gov NCT04255602. Registered on 5 February
2020. Copyright © 2022, The Author(s).

<125>
Accession Number
2015211858
Title
Safety and efficacy of anti-inflammatory therapy in patients with coronary
artery disease: a systematic review and meta-analysis.
Source
BMC Cardiovascular Disorders. 22(1) (no pagination), 2022. Article Number:
84. Date of Publication: December 2022.
Author
Niu Y.; Bai N.; Ma Y.; Zhong P.-Y.; Shang Y.-S.; Wang Z.-L.
Institution
(Niu, Bai, Ma, Zhong, Shang) The First Clinical Medical College of Lanzhou
University, Lanzhou, China
(Wang) Department of Cardiology, The First Hospital of Lanzhou University,
No. 1, Donggang West Road, Chengguan District, Gansu, Lanzhou 730000,
China
Publisher
BioMed Central Ltd
Abstract
Background: The inflammation hypothesis of atherosclerosis has been put
forward for more than 20 years. Although many animal experiments have
suggested that anti-inflammatory therapy can inhibit the atherosclerotic
process, the efficacy of anti-inflammatory therapy for patients with
coronary artery disease (CAD) is still controversial. Therefore, this
study aims to evaluate the safety and efficacy of anti-inflammatory drugs
in patients with CAD. Method(s): We conducted this systematic review
and meta-analysis of randomized controlled trials by searching PubMed,
EMBASE, web of science, and Cochrane Library database. The primary outcome
was a composite outcome of cardiovascular death, myocardial infarction
(MI), or stroke. The secondary outcomes included individual MI, coronary
revascularization, cardiovascular death, all-cause death, and stroke. The
relative risk (RR) and 95% confidence intervals (CI) for outcome events
were calculated by the fixed effects model, and trial sequential analysis
was applied to assess the results. Result(s): A total of ten
randomized controlled trials and 60,782 patients with CAD was included.
Compared with patients receiving placebo, anti-inflammatory therapy
significantly reduced the incidence of the primary outcome in patients
with CAD (RR 0.93, 0.89-0.98, P = 0.007). In addition, the
anti-inflammatory therapy can also reduce the risk of MI (RR 0.90,
0.84-0.96, P = 0.002) and coronary revascularization (RR 0.74, 0.66-0.84,
P < 0.00001) remarkably. However, there was no significant difference in
the incidence of cardiovascular death (RR 0.94, 0.86-1.02, P = 0.14),
all-cause death (RR 1.00, 0.94-1.07, P = 0.98) and stroke (RR 0.96,
0.85-1.09, P = 0.51) between two groups. Conclusion(s):
Anti-inflammatory therapy can reduce the incidence of the primary outcome
in patients with CAD, especially the risk of MI and coronary
revascularization. However, anti-inflammatory therapy increases the risk
of infection. (Registered by PROSPERO, CRD 420212291032). Copyright
© 2022, The Author(s).

<126>
Accession Number
2011552231
Title
Prospective multicenter registry of hybrid coronary artery
revascularization combined with non-saphenous vein graft surgical bypass
and percutaneous coronary intervention using everolimus eluting metallic
stents (PRIDE-METAL study).
Source
Cardiovascular Intervention and Therapeutics. 37(2) (pp 304-311), 2022.
Date of Publication: April 2022.
Author
Watanabe Y.; Fujita T.; Doi H.; Tobaru T.; Takanashi S.; Kinoshita Y.;
Okawa Y.; Fuku Y.; Komiya T.; Tsujita K.; Fukui T.; Shimokawa T.; Kozuma
K.
Institution
(Watanabe, Kozuma) Department of Cardiology, Teikyo University School of
Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
(Fujita) Department of Cardiovascular Medicine, Sapporo Cardiovascular
Clinic, Sapporo Heart Center, Sapporo, Japan
(Doi) Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic,
Sapporo Heart Center, Sapporo, Japan
(Tobaru) Department of Cardiology, Sakakibara Heart Institute, Tokyo,
Japan
(Takanashi) Department of Cardiovascular Surgery, Sakakibara Heart
Institute, Tokyo, Japan
(Kinoshita) Department of Cardiology, Toyohashi Heart Center, Toyohashi,
Japan
(Okawa) Department of Cardiovascular Surgery, Toyohashi Heart Center,
Toyohashi, Japan
(Fuku) Department of Cardiovascular Medicine, Kurashiki Central Hospital,
Kurashiki, Japan
(Komiya) Department of Cardiovascular Surgery, Kurashiki Central Hospital,
Kurashiki, Japan
(Tsujita) Department of Cardiovascular Medicine, Graduate School of
Medical Sciences, Kumamoto University, Kumamoto, Japan
(Fukui) Department of Cardiovascular Surgery, Graduate School of Medicine
Sciences, Kumamoto University, Kumamoto, Japan
(Shimokawa) Department of Cardiovascular Surgery, Teikyo University School
of Medicine, Tokyo, Japan
Publisher
Springer Japan
Abstract
The concept of hybrid coronary revascularization (HCR) combines the
advantages of coronary artery bypass grafting (CABG) and percutaneous
coronary intervention (PCI) to improve the treatment of patients with
complex multivessel disease. This study aimed to investigate a 1-year
clinical follow-up of a prospective multicenter registry of HCR combined
with non-saphenous vein graft surgical bypass and PCI using
everolimus-eluting metallic stents (the PRIDE-METAL study). From June 2016
to June 2018, a total of 54 patients with multivessel coronary disease
from six Japanese institutes were enrolled in this study. The primary
endpoint of the study was the occurrence of major adverse cardiovascular
event (MACE; all-cause death, myocardial infarction, stroke, and repeat
revascularization) at 1 year. Three patients declined before complete HCR,
and two patients were lost by the 1-year follow-up. All-cause mortality at
30 days and at 1 year was 0% and 4.1%, respectively. The rates of
myocardial infarction, repeat revascularization, stroke, and MACE were 0%
at 30 days, and 0%, 2.0%, 2.0%, and 8.2% at 1-year follow-up,
respectively. No occlusion of arterial bypass graft at the 30-day
follow-up was observed, and was observed in 1.7% at the 1-year follow-up.
HCR was safe and feasible and associated with a low risk of MACE at the
1-year follow-up. Further validation in multicenter and randomized studies
is needed. Copyright © 2021, Japanese Association of
Cardiovascular Intervention and Therapeutics.

<127>
Accession Number
637507990
Title
Veno-Arterial Partial Pressure of Carbon Dioxide Difference as a Metric of
Systemic Oxygen Delivery: Insights from a Correlative Meta-Analysis.
Source
Journal of Pediatric Intensive Care. (no pagination), 2022. Date of
Publication: 2022.
Author
Loomba R.S.; Farias J.S.; Savorgnan F.; Acosta S.; Flores S.; Villarreal
E.G.
Institution
(Loomba) Division of Cardiology, Advocate Children's Hospital, Chicago,
IL, United States
(Loomba) Department of Pediatrics, Chicago Medical School, Rosalind
Franklin University of Medicine and Science, Chicago, IL, United States
(Farias, Villarreal) Section of Critical Care Medicine and Cardiology,
Texas Children's Hospital, Houston, TX, United States
(Savorgnan, Acosta, Flores) Department of Pediatrics, Baylor College of
Medicine, Houston, TX, United States
(Savorgnan, Acosta, Flores) Tecnologico de Monterrey, School of Medicine
and Health Sciences, Nuevo Leon, Monterrey, Mexico
Publisher
Georg Thieme Verlag
Abstract
The assessment of cardiac output and adequacy of systemic oxygen delivery
in children after cardiac surgery require the use of an aggregate of
hemodynamic monitors and blood tests. There are previously published data
regarding the utility of the veno-arterial partial pressure of carbon
dioxide difference (AVDco2) to help with this. This study pooled data on
the correlation of AVDco2 with other metrics of cardiac output and
systemic oxygen delivery such as arteriovenous oxygen saturation
difference, venous saturation, and serum lactate. A systematic review of
the literature was done to identify studies analyzing the correlation of
AVDco2 with other hemodynamic and laboratory values. Data were extracted,
and correlation coefficients were pooled for each specific comparison to
create a point estimate for the overall correlation. A total of four
studies with 350 patients and 809 paired blood gases were pooled. Adequate
data were available to assess the correlation of AVDco2 with arteriovenous
oxygen saturation difference, venous saturation, and serum lactate. There
was a significant, moderate correlation with arteriovenous oxygen
saturation difference and venous saturation. A significant, weak
correlation with serum lactate was found. The AVDco2 has significant,
moderate correlations with other metrics of the adequacy of systemic
oxygen delivery such as arteriovenous oxygen saturation difference and
venous saturation. There was a significant but only weak correlation with
serum lactate. AVDco2 may be complementary to assess the adequacy of
cardiac output and systemic oxygen delivery. Copyright © 2022
Hogrefe Publishing GmbH. All rights reserved.

<128>
Accession Number
637499363
Title
Bioabsorbable polymer drug-eluting stents with 4-month dual antiplatelet
therapy versus durable polymer drug-eluting stents with 12-month dual
antiplatelet therapy in patients with left main coronary artery disease:
the IDEAL-LM randomised trial.
Source
EuroIntervention : journal of EuroPCR in collaboration with the Working
Group on Interventional Cardiology of the European Society of Cardiology.
(no pagination), 2022. Date of Publication: 14 Mar 2022.
Author
van Geuns R.-J.; Chun-Chin C.; McEntegart M.B.; Merkulov E.; Kretov E.;
Lesiak M.; O'Kane P.; Hanratty C.G.; Bressollette E.; Silvestri M.;
Wlodarczak A.; Barragan P.; Anderson R.; Protopopov A.; Peace A.; Menown
I.; Rocchiccioli P.; Onuma Y.; Oldroyd K.G.
Institution
(van Geuns) Department of Cardiology, Radboud University Medical Center,
Nijmegen, Netherlands
(van Geuns, Chun-Chin, Onuma) Department of Cardiology, Thorax Center,
Erasmus Medical Center, Rotterdam, Netherlands
(Chun-Chin) Division of Cardiology, Department of Internal Medicine,
Taipei Veterans General Hospital, Taipei, Taiwan (Republic of China)
(McEntegart, Rocchiccioli, Oldroyd) Golden Jubilee National Hospital,
Glasgow, United Kingdom
(Merkulov) Russian Cardiology Research Center, Moscow, Russian Federation
(Kretov) E.N. Meshalkin National Medical Research Center, Novosibirsk,
Russian Federation
(Lesiak) 1st Department of Cardiology, Poznan University of Medical
Sciences, Poznan, Poland
(O'Kane) Department of Cardiology, Royal Bournemouth Hospital,
Bournemouth, United Kingdom
(Hanratty) Belfast Health and Social Care Trust, Belfast, United Kingdom
(Bressollette) NantesFrance
(Silvestri) Clinique Axium, Aix-en-Provence, France
(Wlodarczak) Department of Cardiology, Miedziowe Centrum Zdrowia S.A.,
Lubin, Poland
(Barragan) Department of Cardiology, Polyclinique les Fleurs, Ollioules,
France
(Anderson) University Hospital of Wales, Cardiff, United Kingdom
(Protopopov) Krasnoyarsk Regional Vascular Centre, Krasnoyarsk, Russian
Federation
(Peace) Altnagelvin Hospital, Londonderry, United Kingdom
(Menown) Craigavon Area Hospital, Craigavon, United Kingdom
(Onuma) Cardialysis B.V., Rotterdam, Netherlands
Publisher
NLM (Medline)
Abstract
BACKGROUND: Improvements in drug-eluting stent design have led to a
reduced frequency of repeat revascularisation and new biodegradable
polymer coatings may allow a shorter duration of dual-antiplatelet therapy
(DAPT) after percutaneous coronary intervention (PCI). AIMS: The Improved
Drug-Eluting stent for All-comers Left Main (IDEAL-LM) study aims to
investigate long-term clinical outcomes after implantation of a
biodegradable polymer platinum-chromium everolimus-eluting stent
(BP-PtCr-EES) followed by 4 months DAPT compared to a durable polymer
cobalt-chromium everolimus-eluting stent (DP-CoCr-EES) followed by 12
months DAPT in patients undergoing PCI of unprotected left main coronary
artery (LMCA) disease. METHOD(S): This is a multicentre randomised
clinical trial study in patients with an indication for coronary artery
revascularisation who have been accepted for PCI of LMCA disease after
Heart Team consultation. Patients were randomly assigned in a 1:1 ratio to
receive either the BP-PtCr-EES or the DP-CoCr-EES. The primary endpoint
was a non-inferiority comparison of the rate of major adverse
cardiovascular events (MACE), defined as all-cause death, myocardial
infarction, or ischaemia-driven target vessel revascularisation at 2
years. RESULT(S): Between December 2014 and October 2016, 818
patients (410 BP-PtCr-EES and 408 DP-CoCr-EES) were enrolled at 29 centres
in Europe. At 2 years, the primary endpoint of MACE occurred in 59
patients (14.6%) in the BP-PtCr-EES group and 45 patients (11.4%) in the
DP-CoCr-EES group; 1-sided upper 95% confidence interval (CI) 7.18%;
p=0.04 for non-inferiority; p=0.17 for superiority. The secondary endpoint
event of BARC 3 or 5 bleeding occurred in 11 patients (2.7%) in the
BP-PtCr-EES group and 2 patients (0.5%) in the DP-CoCr-EES group (p=0.02).
 CONCLUSION(S): In patients undergoing PCI of LMCA disease, after two
years of follow-up, the use of a BP-PtCr-EES with 4 months of DAPT was
non-inferior to a DP-CoCr-EES with 12 months of DAPT with respect to the
composite endpoint of all-cause death, myocardial infarction or
ischaemia-driven target vessel revascularisation.

<129>
Accession Number
637496800
Title
Effectiveness of music during cardiac catheterization on children's pain,
fear, anxiety and vital signs: A randomized, blind controlled trial.
Source
Journal of pediatric nursing. (no pagination), 2022. Date of Publication:
09 Mar 2022.
Author
Karakul A.; Akgul E.A.; Yaliniz R.; Mese T.
Institution
(Karakul) Tarsus University, Faculty of Health Sciences, Department of
Nursing, Mersin, Turkey
(Akgul) Izmir Katip Celebi University, Faculty of Health Sciences,
Department of Pediatric Nursing, Izmir, Turkey
(Yaliniz, Mese) Dr. Behcet Uz Child Diseases and Surgery Teaching and
Research Hospital, Department of Pediatric Cardiology, Izmir, Turkey
Publisher
NLM (Medline)
Abstract
PURPOSE: This study aims to examine the effectiveness of music during
pediatric cardiac catheterization procedure on children's pain, fear,
anxiety and vital signs. DESIGN AND METHODS: This randomized, blind
controlled study was conducted with the guidelines of Consolidated
Standards of Reporting Trials (CONSORT). The sample of children was
allocated to the Control Group, the Classic Music Group, and the
Self-Selected Group. Pain, fear, and anxiety levels were measured before
and after the pediatric cardiac catheterization procedure. Vital signs
were measured before, during, and after the pediatric cardiac
catheterization procedure. RESULT(S): There was no significant
difference between the groups in terms of demographic status, pain, fear,
or anxiety levels and vital signs before the procedure. In post pediatric
cardiac catheterization measurement in the recovery phase, pain, fear
levels, anxiety levels, heart rate, systolic and diastolic blood pressure
of children in the musical intervention groups were lower than the control
group. No statistical difference was found in terms of pain, fear and
anxiety levels of the children in groups Classic and Self-Selected.
CONCLUSION AND PRACTICE IMPLICATIONS: The result of this research reveals
that musical intervention applied during the pediatric cardiac
catheterization procedure in children affects the reduction of pain, fear
and anxiety levels and stabilization of vital signs. This intervention
could be an effective nonpharmacological method to improve outcomes.Nurses
can improve children's comfort by using musical interventions. CLINICAL
REGISTRATION: This study was registered at the U.S. National Library of
Medicine Clinical Trials (code: NCT04316754). Copyright © 2022
Elsevier Inc. All rights reserved.

<130>
Accession Number
637490760
Title
Delivery, barriers, and enablers to patient participation in inpatient
cardiac rehabilitation following cardiac surgery: An integrative review.
Source
Australian critical care : official journal of the Confederation of
Australian Critical Care Nurses. (no pagination), 2022. Date of
Publication: 08 Mar 2022.
Author
Nasrawi D.; Latimer S.; Massey D.; Gillespie B.M.
Institution
(Nasrawi) School of Nursing and Midwifery, Griffith University, Logan
Campus Meadowbrook QLD, Australia; School of Health and Human Sciences,
Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga QLD
4225, Australia
(Latimer) School of Nursing and Midwifery, Griffith University, Logan
Campus Meadowbrook QLD, Australia; Nursing and Midwifery Education and
Research Unit, Gold Coast Hospital and Health Service, Southport, QLD,
Australia; NHMRC Centre of Research Excellence in Wiser Wounds, Menzies
Health Institute QLD, School of Nursing and Midwifery, Griffith
University, Southport QLD 4222, Australia
(Massey) School of Health and Human Sciences, Southern Cross University,
Gold Coast Airport, Terminal Dr, Australia
(Gillespie) Nursing and Midwifery Education and Research Unit, Gold Coast
Hospital and Health Service, Southport, QLD, Australia; NHMRC Centre of
Research Excellence in Wiser Wounds, Menzies Health Institute QLD, School
of Nursing and Midwifery, Griffith University, Southport QLD 4222,
Australia
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiovascular disease is the leading cause of death
worldwide. Cardiac surgery is the main treatment followed by inpatient
cardiac rehabilitation (ICR) to prepare patients for recovery. AIM: The
aim of this study was to describe the delivery, barriers, and enablers to
patient participation in ICR programs after cardiac surgery.
 METHOD(S): This integrative review was guided by Whittemore and
Knafl's methodology. This process included database searches, data
evaluation, data integration, and presentation of results. Searched
databases included Medline, CINAHL Complete, PsycINFO, Cochrane Library,
and Web of Science. Publications dates included 2000 to 2021. Studies
included Phase 1/inpatient phase cardiac rehabilitation following cardiac
surgery. The Mixed Method Appraisal Tool (2018) was used to assess the
quality of the included studies. Inductive content analysis was used to
analyse the textual data. RESULT(S): Using the inclusion and the
exclusion criteria, 607 articles were screened. Five articles were
included in this review, and they were appraised. Categories comprised of
the following: i) ICR programs using a multidisciplinary approach
beginning in the early postoperative stage; ii) ICR programs including
multicomponents that were delivered through an individualised approach;
and iii) enablers and barriers to patient participation to ICR. The
enablers included religious faith and family support, whereas inconsistent
pathways of cardiac rehabilitation referrals and detachment from patients'
experiences and needs were barriers to participation in ICR.
 CONCLUSION(S): In some instances, ICR programs were delivered using
individualised approaches, but this is an area that needs improvement. A
multidisciplinary team including nurses should be involved in the ICR
phase after cardiac surgery to provide holistic care and enhance patients'
preparedness to participate in subsequent phases of rehabilitation. Only
five relevant articles addressing the delivery of inpatient cardiac
rehabilitation were identified in this specific topic area. Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by
Elsevier Ltd. All rights reserved.

<131>
Accession Number
637484579
Title
CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR).
Source
RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der
Nuklearmedizin. (no pagination), 2022. Date of Publication: 10 Mar 2022.
Author
Heiser L.; Gohmann R.F.; Noack T.; Renatus K.; Lurz P.; Thiele H.; Seitz
P.; Gutberlet M.
Institution
(Heiser, Gohmann, Renatus, Seitz, Gutberlet) Department of Diagnostic and
Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
(Noack) Department of Cardiac Surgery, Heart Center Leipzig, University of
Leipzig, Leipzig, Germany
(Renatus, Thiele, Gutberlet) Medical Faculty, University of Leipzig,
Leipzig, Germany
(Lurz, Thiele) Department of Cardiology, Heart Center Leipzig, University
of Leipzig, Leipzig, Germany
(Lurz, Thiele, Gutberlet) Leipzig Heart Institute, Leipzig, Germany
Publisher
NLM (Medline)

<132>
Accession Number
637483333
Title
Neuromuscular electrical stimulation after cardiovascular surgery
mitigates muscle weakness in older individuals with diabetes.
Source
Annals of physical and rehabilitation medicine. (pp 101659), 2022. Date
of Publication: 07 Mar 2022.
Author
Takino K.; Kameshima M.; Asai C.; Kawamura I.; Tomita S.; Sato H.;
Hirakawa A.; Yamada S.
Institution
(Takino) Department of Cardiac Rehabilitation, Gifu Heart Center. 4-14-4,
Yabuta-minami, Gifu, Japan; Program in Physical and Occupational Therapy,
Nagoya University Graduate School of Medicine
(Kameshima) Department of Cardiac Rehabilitation, Nagoya Heart Center.
1-1-11, Nagoya, Japan
(Asai) Department of Cardiac Rehabilitation, Toyohashi Heart Center. 1-21,
Oyamacho, Japan
(Kawamura) Department of Cardiology, Gifu Heart Center. 4-14-4, Gifu,
Japan
(Tomita) Department of Cardiovascular Surgery, Gifu Heart Center. 4-14-4,
Gifu, Japan
(Sato, Hirakawa) Division of Biostatistics and Data Science, Clinical
Research Center. Tokyo Medical and Dental University Hospital of Medicine,
Bunkyo-ku, 1-5-45 Yushima, Tokyo, Japan
(Yamada) Department of Integrated Health Sciences, Nagoya University
Graduate School of Medicine 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan
Publisher
NLM (Medline)
Abstract
BACKGROUND: Cardiovascular surgery leads to postsurgical muscle weakness,
probably because of muscle proteolysis and peripheral nerve dysfunction,
which are augmented by aging and diabetes mellitus. OBJECTIVE(S): We
examined the effect of neuromuscular electrical stimulation (NMES) on
postsurgical muscle weakness in older individuals with diabetes mellitus.
 METHOD(S): We conducted a multicentre, randomized, controlled trial,
and screened consecutive patients with diabetes who underwent
cardiovascular surgery for eligibility (age >= 65 years). Those included
were randomly assigned to the NMES or the sham group. The primary outcome
was the percent change in isometric knee extension strength (%DELTAIKES)
from preoperative to postoperative day 7. Secondary outcomes were the
percent change in usual (%DELTAUWS), maximum walking speed (%DELTAMWS),
and grip strength (%DELTAGS). A statistician who was blinded to group
allocation used intention-to-treat analysis (student t test).
 RESULT(S): Of 1151 participants screened for eligibility, 180 (NMES,
n=90; sham, n=90) were included in the primary analysis. %DELTAIKES was
significantly lower in the NMES than sham group (NMES: mean -2%, 95%
confidence interval [CI] -6 to 1; sham: -13%, 95% CI -17 to -9, p <
0.001). Among the secondary outcomes, %DELTAMWS was significantly lower
and %DELTAUWS and %DELTAGS were lower, although not significantly, in the
NMES than sham group. CONCLUSION(S): A short course of NMES (< 1
week) mitigated postsurgical muscle weakness and functional decline in
older persons with diabetes mellitus. NMES could be recommended as a part
of postsurgical rehabilitation in older people with diabetes mellitus,
especially those with a low functional reserve. Copyright © 2022.
Published by Elsevier Masson SAS.

<133>
Accession Number
637483261
Title
High-Sensitivity Cardiac Troponin and the Diagnosis of Myocardial
Infarction in Patients with Renal Impairment.
Source
Kidney international. (no pagination), 2022. Date of Publication: 07 Mar
2022.
Author
Gallacher P.J.; Miller-Hodges E.; Shah A.S.V.; Farrah T.E.; Halbesma N.;
Blackmur J.P.; Chapman A.R.; Adamson P.D.; Anand A.; Strachan F.E.; Ferry
A.V.; Lee K.K.; Berry C.; Findlay I.; Cruickshank A.; Reid A.; Gray A.;
Collinson P.O.; Apple F.S.; McAllister D.A.; Maguire D.; Fox K.A.A.;
Keerie C.; Weir C.J.; Newby D.E.; Mills N.L.; Dhaun N.
Institution
(Gallacher, Shah, Blackmur, Chapman, Anand, Strachan, Ferry, Lee, Fox,
Newby) BHF Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, United Kingdom
(Miller-Hodges, Farrah, Dhaun) BHF Centre for Cardiovascular Science,
University of Edinburgh, Edinburgh, UK; Department of Renal Medicine,
Royal Infirmary of Edinburgh, Edinburgh, UK
(Halbesma) Usher Institute, University of Edinburgh, Edinburgh, United
Kingdom
(Adamson) BHF Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, UK; Christchurch Heart Institute, University of Otago,
Christchurch, NZ
(Berry) Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, United Kingdom
(Findlay) Department of Cardiology, Royal Alexandra Hospital, Paisley,
United Kingdom
(Cruickshank, Reid) Department of Biochemistry, Queen Elizabeth University
Hospital, Glasgow, United Kingdom
(Gray) Emergency Medicine Research Group Edinburgh, Royal Infirmary of
Edinburgh, Edinburgh, United Kingdom
(Collinson) Departments of Clinical Blood Sciences and Cardiology,
University Hospitals NHS Trust and St George's University of London, St
George's, London, United Kingdom
(Apple) Department of Laboratory Medicine and Pathology, Hennepin
Healthcare/Hennepin County Medical Center & University of Minnesota, MN,
Minneapolis, United States
(McAllister) Institute of Health and Wellbeing, University of Glasgow,
Glasgow, United Kingdom
(Maguire) Emergency Medicine Department, Glasgow Royal Infirmary, Glasgow,
United Kingdom
(Keerie, Weir) Usher Institute, University of Edinburgh, Edinburgh, UK;
Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
(Mills) BHF Centre for Cardiovascular Science, University of Edinburgh,
Edinburgh, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
Publisher
NLM (Medline)
Abstract
The benefit and utility of high-sensitivity cardiac troponin (hs-cTn) in
the diagnosis of myocardial infarction in patients with kidney impairment
is unclear. Here, we describe implementation of hs-cTnI testing on the
diagnosis, management, and outcomes of myocardial infarction in patients
with and without kidney impairment. Consecutive patients with suspected
acute coronary syndrome enrolled in a stepped-wedge, cluster-randomized
controlled trial were included in this pre-specified secondary analysis.
Kidney impairment was defined as an eGFR under 60mL/min/1.73m2. The index
diagnosis and primary outcome of type 1 and type 4b myocardial infarction
or cardiovascular death at one year were compared in patients with and
without kidney impairment following implementation of hs-cTnI assay with
99th centile sex-specific diagnostic thresholds. Serum creatinine
concentrations were available in 46,927 patients (mean age 61years; 47%
women), of whom 9,080 (19%) had kidney impairment. hs-cTnIs were over 99th
centile in 46% and 16% of patients with and without kidney impairment.
Implementation increased the diagnosis of type 1 infarction from 12.4% to
17.8%, and from 7.5% to 9.4% in patients with and without kidney
impairment (both significant). Patients with kidney impairment and type 1
myocardial infarction were less likely to undergo coronary
revascularisation (26% versus 53%) or receive dual anti-platelets (40%
versus 68%) than those without kidney impairment, and this did not change
post-implementation. In patients with hs-cTnI above the 99th centile, the
primary outcome occurred twice as often in those with kidney impairment
compared to those without (24% versus 12%, hazard ratio 1.53, 95%
confidence interval 1.31 to 1.78). Thus, hs-cTnI testing increased the
identification of myocardial injury and infarction but failed to address
disparities in management and outcomes between those with and without
kidney impairment. Copyright © 2022. Published by Elsevier Inc.

<134>
Accession Number
2014305346
Title
Revascularization of vertebrobasilar tandem occlusions: a meta-analysis.
Source
Neuroradiology. 64(4) (pp 637-645), 2022. Date of Publication: April 2022.
Author
Mahmoud M.N.; Zaitoun M.M.A.; Abdalla M.A.
Institution
(Mahmoud) Department of Neurosurgery, Faculty of Medicine, Menoufia
University, Menoufia, Shebin El-kom, Egypt
(Zaitoun) Department of Radiology, Faculty of Human Medicine, Zagazig
University, Zagazig, Egypt
(Abdalla) Neurosurgery Department, St George's University Hospital,
Blackshaw Road, London, United Kingdom
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: To investigate the difference in mechanical thrombectomy (MT)
outcomes between vertebrobasilar tandem occlusion (VBTO) and isolated
basilar artery (BA) occlusion (non-VBTO) and the difference in rates of
successful recanalization between the clean-road and dirty-road pathways,
in VBTO. Method(s): We conducted a meta-analysis after searching
PubMed, EMBASE, and Google Scholar databases as of April 2021. We only
included adult patients who underwent MT to treat acute ischemic stroke
(AIS) due to VBTO, and the following outcomes should be reported:
successful recanalization, functional outcome at 90 days, and symptomatic
intracerebral hemorrhage (sICH). The main effect size measures were odds
ratio and risk difference, and the software used was RevMan 5.4.
 Result(s): The analysis included 81 VBTO and 324 non-VBTO patients
(seven studies). We found no significant difference regarding 3 m
functional independence [4 studies: OR = 1.71 (95% CI, 0.54, 5.43),
I2 = 75%], 3 m mortality [4 studies: OR = 1.62 (95% CI, 0.62,
4.25), I2 = 66%], sICH [4 studies: OR = 1.71 (95% CI, 0.67,
4.39), I2 = 0%], and successful recanalization [3 studies: OR =
0.81 (95% CI, 0.12, 5.57), I2 = 80%]. A subgroup analysis of
118 VBTO patients (five studies) showed no significant difference in
successful recanalization between clean-road and dirty-road pathways [RD =
0.07 (95% CI, - 0.09, 0.24), I2 = 40%]. Conclusion(s): The
results of this meta-analysis support the use of MT for AIS patients with
VBTO. In VBTO patients, none of the clean-road or dirty-road pathways
proved to be superior to the other. Copyright © 2021, The
Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part
of Springer Nature.

<135>
Accession Number
2015844431
Title
Prognostic Impact of Red Cell Distribution Width on the Development of
Contrast-Induced Nephropathy, Major Adverse Cardiac Events, and Mortality
in Coronary Artery Disease Patients Undergoing Percutaneous Coronary
Intervention.
Source
Current Cardiology Reviews. 17(6) (no pagination), 2021. Article Number:
e051121191160. Date of Publication: November 2021.
Author
Latif A.; Ahsan M.J.; Lateef N.; Kapoor V.; Fazeel H.M.; Razzaq F.;
Iftikhar A.; Ashfaq M.Z.; Anwer F.; Mirza M.; Kabach A.
Institution
(Latif, Ahsan, Lateef, Kapoor, Ashfaq, Mirza, Kabach) Department of
Internal Medicine, Creighton University Medical Center, Omaha, NE 7500,
United States
(Fazeel, Razzaq) Department of Internal Medicine, Pakistan Institute of
Medicine, Islamabad, Pakistan
(Iftikhar) Department of Internal Medicine, University of Arizona, Tucson,
AZ, United States
(Anwer) Department of Hematology and Oncology, Cleveland Clinic,
Cleveland, OH, United States
Publisher
Bentham Science Publishers
Abstract
Red cell distribution width (RDW) serves as an independent predictor
towards the prognosis of coronary artery disease (CAD) in patients
undergoing percutaneous coronary intervention (PCI). A systematic search
of databases such as PubMed, Embase, Web of Science, and Cochrane library
was performed on October 10th, 2019, to elaborate the
relationship between RDW and in hospital and long term follow up,
all-cause and cardiovascular mortality, major adverse cardiac events
(MACE) and development of contrast-induced nephropathy (CIN) in patients
with CAD undergoing PCI. Twenty-one studies qualified this strict
selection criterion (number of patients = 56,425): one study was
prospective, and the rest were retrospective cohorts. Our analysis showed
that patients undergoing PCI with high RDW had a significantly higher risk
of in-hospital all-cause mortality (OR 2.41), long-term all-cause
mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16), and
odds of developing CIN (OR: 1.42) when compared to the patients with low
RDW. Therefore, incorporating RDW in the predictive models for the
development of CIN, MACE, and mortality can help in triage to improve the
outcomes in coronary artery disease patients who undergo
PCI. Copyright © 2021 Bentham Science Publishers.

<136>
Accession Number
2014262927
Title
Postoperative analgesic effects of paravertebral block versus erector
spinae plane block for thoracic and breast surgery: A meta-analysis.
Source
PLoS ONE. 16(8 August) (no pagination), 2021. Article Number: e0256611.
Date of Publication: August 2021.
Author
Xiong C.; Han C.; Zhao D.; Peng W.; Xu D.; Lan Z.
Institution
(Xiong, Zhao, Peng, Xu, Lan) Department of Anesthesiology, Affiliated
Jinhua Hospital, Zhejiang University School of Medicine, Zhejiang, Jinhua,
China
(Han) Department of Rehabilitation, Jinhua Maternal and Child Health Care
Hospital, Zhejiang, Jinhua, China
Publisher
Public Library of Science
Abstract
Background Paravertebral block (PVB) is the most recognized regional
anesthesia technique after thoracic epidural anesthesia for postoperative
analgesia in thoracic and breast surgery. Erector spinae plane block
(ESPB) is a recently discovered blocking technique, and it has evidenced
excellent postoperative analgesia for breast and thoracic surgery with
fewer adverse reactions. However, there are controversies about the
postoperative analgesic effects of the two analgesic techniques. Objective
To assess the analgesic effects of PVB versus ESPB in postoperative
thoracic and breast surgery. Methods We systematically searched PubMed,
Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up
to April 5, 2021. The primary outcome was postoperative pain scores.
Secondary outcomes included: opioid consumption, additional analgesia,
postoperative nausea and vomiting (PONV) 24 hours post-operation, and the
time required for completing block procedure. This study was registered in
PROSPERO, number CRD42021246160. Results After screening relevant,
full-text articles, ten randomized controlled trials (RCTs) that met the
inclusion criteria were retrieved for this meta-analysis. Six studies
involved thoracic surgery patients, and four included breast surgery
patients. Thoracic surgery studies included all of the outcomes involved
in this meta-analysis while breast surgery did not report pain scores at
movement and additional analgesia in 24 hours post-operation. For thoracic
surgery, PVB resulted in significant reduction in the following pain
scores: 0-1 hours (MD = -0.79, 95% CI: -1.54 to -0.03, P = 0.04), 4-6
hours (MD = -0.31, 95% CI: -0.57 to -0.05, P = 0.02), and 24 hours (MD =
-0.42, 95% CI: -0.81 to -0.02, P = 0.04) at rest; significant reduction in
pain scores at 4-6 hours (MD = -0.47, 95% CI: -0.93 to -0.01, P = 0.04),
8-12 hours (MD = -1.09, 95% CI: -2.13 to -0.04, P = 0.04), and 24 hours
(MD = -0.31, 95% CI: -0.57 to -0.06, P = 0.01) at movement. Moreover, the
opioid consumption at 24 hours post-operation (MD = -2.74, 95% CI: -5.41
to -0.07, P = 0.04) and the incidence of additional analgesia in 24 hours
of the postoperative course (RR: 0.53, 95% CI: 0.29 to 0.97, P = 0.04)
were significantly lower in the PVB group than in the ESPB group for
thoracic surgery. However, no significant differences were found in pain
scores at rest at various time points postoperatively, and opioid
consumption at 24 hours post-operation for breast surgery. The time
required for completing block procedure was longer in the PVB group than
in the ESPB group for thoracic and breast surgery, and the incidence of
PONV between the two groups showed no significant difference. Conclusion
The postoperative analgesic effects of PVB versus ESPB are distinguished
by the surgical site. For thoracic surgery, the postoperative analgesic
effect of PVB is better than that of ESPB. For breast surgery, the
postoperative analgesic effects of PVB and ESPB are similar. Copyright
© 2021 Xiong 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.

<137>
Accession Number
2014198948
Title
Effect of routine preoperative screening for aortic calcifications using
noncontrast computed tomography on stroke rate in cardiac surgery: the
randomized controlled CRICKET study.
Source
European Radiology. 32(4) (pp 2611-2619), 2022. Date of Publication: April
2022.
Author
Knol W.G.; Simon J.; Den Harder A.M.; Bekker M.W.A.; Suyker W.J.L.; de
Heer L.M.; de Jong P.A.; Leiner T.; Merkely B.; Polos M.; Krestin G.P.;
Boersma E.; Koudstaal P.J.; Maurovich-Horvat P.; Bogers A.J.J.C.; Budde
R.P.J.
Institution
(Knol, Bekker, Bogers) Department of Cardiothoracic Surgery, Erasmus
University Medical Center, Rotterdam, Netherlands
(Knol, Krestin, Budde) Department of Radiology and Nuclear Medicine,
Erasmus University Medical Center, PO BOX 2040, Rotterdam ND-547, 3000-CA,
Netherlands
(Simon, Merkely, Maurovich-Horvat) Department of Cardiology, Heart and
Vascular Center, Semmelweis University, Budapest, Hungary
(Den Harder, de Jong, Leiner) Department of Radiology, University Medical
Center Utrecht and Utrecht University, Utrecht, Netherlands
(Suyker, de Heer) Department of Cardiothoracic Surgery, University Medical
Center Utrecht, Utrecht, Netherlands
(Polos) Department of Cardiovascular Surgery, Heart and Vascular Center,
Semmelweis University, Budapest, Hungary
(Boersma) Department of Clinical Epidemiology, Erasmus University Medical
Center, Rotterdam, Netherlands
(Koudstaal) Department of Neurology, Erasmus University Medical Center,
Rotterdam, Netherlands
(Maurovich-Horvat) Department of Radiology, Medical Imaging Centre,
Semmelweis University, Budapest, Hungary
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Objectives: To evaluate if routine screening for aortic calcification
using unenhanced CT lowers the risk of stroke and alters the surgical
approach in patients undergoing general cardiac surgery compared with
standard of care (SoC). Method(s): In this prospective, multicenter,
randomized controlled trial, adult patients scheduled for cardiac surgery
from September 2014 to October 2019 were randomized 1:1 into two groups:
SoC alone, including chest radiography, vs. SoC plus preoperative
noncontrast CT. The primary endpoint was in-hospital perioperative stroke.
Secondary endpoints were preoperative change of the surgical approach,
in-hospital mortality, and postoperative delirium. The trial was halted
halfway for expected futility, as the conditional power analysis showed a
chance < 1% of finding the hypothesized effect. Result(s): A total of
862 patients were evaluated (SoC-group: 433 patients (66 +/- 11 years;
74.1% male) vs. SoC + CT-group: 429 patients (66 +/- 10 years; 69.9%
male)). The perioperative stroke rate (SoC + CT: 2.1%, 9/429 vs. SoC:
1.2%, 5/433, p = 0.27) and rate of changed surgical approach (SoC + CT:
4.0% (17/429) vs. SoC: 2.8% (12/433, p = 0.35) did not differ between
groups. In-hospital mortality and postoperative delirium were comparable
between groups. In the SoC + CT group, aortic calcification was observed
on CT in the ascending aorta in 28% (108/380) and in the aortic arch in
70% (265/379). Conclusion(s): Preoperative noncontrast CT in cardiac
surgery candidates did not influence the surgical approach nor the
incidence of perioperative stroke compared with standard of care. Aortic
calcification is a frequent finding on the CT scan in these patients but
results in major surgical alterations to prevent stroke in only few
patients. Key Points: * Aortic calcification is a frequent finding on
noncontrast computed tomography prior to cardiac surgery. * Routine use of
noncontrast computed tomography does not often lead to a change of the
surgical approach, when compared to standard of care. * No effect was
observed on perioperative stroke after cardiac surgery when using routine
noncontrast computed tomography screening on top of standard of
care. Copyright © 2021, The Author(s).

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