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<1>
Accession Number
2018185576
Title
Protective effect of sacubitril/valsartan in patients with acute
myocardial infarction: A meta-analysis.
Source
Experimental and Therapeutic Medicine. 23(6) (no pagination), 2022.
Article Number: 11333. Date of Publication: June 2022.
Author
Liu S.; Yin B.; Wu B.; Fan Z.
Institution
(Liu, Yin, Wu) Department of Physical Examination, 904th Hospital of Joint
Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical
University, Wuxi, Jiangsu 214000, China
(Fan) Department of Cardiology, The First College of Clinical Medical
Sciences, China Three Gorges University, Yichang, Hubei 443000, China
Publisher
Spandidos Publications
Abstract
To evaluate the effects and safety of sacubitril/ valsartan in patients
with acute myocardial infarction (AMI), a total of four databases,
including PubMed, Cochrane Library, Embase and Web of Science, and the
ClinicalTrials. gov website were searched. Using a combination of medical
subject headings and entry terms, the final search was performed in July
2021. A manual search of cross-references from the original articles was
also conducted. The meta-analysis was subsequently performed with Revman
5.3 software and a total of four studies comprising 586 patients were
included. The results disclosed a significant reduction in major adverse
cardiovascular and cerebrovascular events (MACCEs) [odds ratio (OR), 0.47;
95% confidence interval (CI), 0.30-0.73; P=0.0007], readmission (OR, 0.45;
95% CI, 0.29-0.71; P=0.0006), incidence of acute heart failure (AHF) (OR,
0.45; 95% CI, 0.28-0.71; P=0.0007) and N-terminal pro B-type natriuretic
peptide [standardized mean difference (SMD), -0.88; 95% CI, -1.55-(-0.21);
P=0.01] in the sacubitril/ valsartan group compared with that in the
control group, and a random effects model was used to pool these data. No
significant differences were identified in the incidence of hypotension
(OR, 2.91; 95% CI, 0.55-15.51; P=0.21), adverse events (OR, 2.19; 95% CI,
0.42-11.37; P=0.35), left ventricular ejection fraction (mean difference,
1.96; 95% CI, -0.84-4.76; P=0.17) or soluble suppression of
tumorigenesis-2 (SMD, -0.45; 95% CI, -1.62-0.71; P=0.45) according to the
random effects model. In conclusion, the present meta-analysis revealed
that sacubitril/ valsartan was able to effectively reduce the incidence of
MACCEs, readmission and AHF in patients with AMI after revascularization
without any obvious adverse events. Copyright © 2022 Spandidos
Publications. All rights reserved.

<2>
Accession Number
637880009
Title
CT or Invasive Coronary Angiography in Stable Chest Pain.
Source
New England Journal of Medicine. 386(17) (pp 1591-1602), 2022. Date of
Publication: 28 Apr 2022.
Author
Maurovich-Horvat P.; Bosserdt M.; Kofoed K.F.; Rieckmann N.; Benedek T.;
Donnelly P.; Rodriguez-Palomares J.; Erglis A.; Stechovsky C.; Sakalyte
G.; Adic N.C.; Gutberlet M.; Dodd J.D.; Diez I.; Davis G.; Zimmermann E.;
Kepka C.; Vidakovic R.; Francone M.; Ilnicka-Suckiel M.; Plank F.; Knuuti
J.; Faria R.; Schroder S.; Berry C.; Saba L.; Ruzsics B.; Kubiak C.;
Gutierrez-Ibarluzea I.; Hansen K.S.; Muller-Nordhorn J.; Merkely B.;
Knudsen A.D.; Benedek I.; Orr C.; Valente F.X.; Zvaigzne L.; Suchanek V.;
Zajanckauskiene L.; Adic F.; Woinke M.; Hensey M.; Lecumberri I.; Thwaite
E.; Laule M.; Kruk M.; Neskovic A.N.; Mancone M.; Kusmierz D.; Feuchtner
G.; Pietila M.; Ribeiro V.G.; Drosch T.; Delles C.; Matta G.; Fisher M.;
Szilveszter B.; Larsen L.; Ratiu M.; Kelly S.; del Blanco B.G.; Rubio A.;
Drobni Z.D.; Jurlander B.; Rodean I.; Regan S.; Calabria H.C.; Boussoussou
M.; Engstrom T.; Hodas R.; Napp A.E.; Haase R.; Feger S.; Serna-Higuita
L.M.; Neumann K.; Dreger H.; Rief M.; Wieske V.; Estrella M.; Martus P.;
Dewey M.
Institution
(Maurovich-Horvat, Merkely, Szilveszter, Drobni, Boussoussou) The Heart
and Vascular Center, Semmelweis University, Budapest, Hungary
(Maurovich-Horvat) The Department of Radiology, Medical Imaging Center,
Semmelweis University, Budapest, Hungary
(Bosserdt, Zimmermann, Napp, Haase, Feger, Rief, Wieske, Estrella, Dewey)
The Department of Radiology, Charite-Universitatsmedizin Berlin, Berlin,
Germany
(Laule, Dreger) The Department of Cardiology and Angiology,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Rieckmann, Muller-Nordhorn) The Institute of Public Health,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Neumann) The Institute of Biometry and Clinical Epidemiology,
Charite-Universitatsmedizin Berlin, Berlin, Germany
(Dreger, Dewey) Freie Universitat Berlin, Humboldt-Universitat zu Berlin,
DZHK (German Center for Cardiovascular Research), Partner Site Berlin,
Berlin, Germany
(Dewey) Berlin Institute of Health, Berlin University Alliance, Berlin,
Germany
(Gutberlet) The Department of Radiology, University of Leipzig Heart
Center, Leipzig, Germany
(Woinke) The Department of Cardiology, University of Leipzig Heart Center,
Leipzig, Germany
(Schroder, Drosch) The Department of Cardiology, Alb Fils Kliniken,
Goppingen, Germany
(Muller-Nordhorn) The Bavarian Cancer Registry, Bavarian Health and Food
Safety Authority, Munich, Germany
(Serna-Higuita, Martus) The Department of Clinical Epidemiology and
Applied Biostatistics, Universitatsklinikum Tubingen, Tubingen, Germany
(Kofoed, Knudsen, Engstrom) The Department of Cardiology, Rigshospitalet,
Denmark
(Kofoed, Knudsen) The Department of Radiology, Rigshospitalet, Denmark
(Kofoed, Knudsen, Larsen, Jurlander, Engstrom) The Department of Clinical
Medicine, Faculty of Health and Medical Sciences, University of
Copenhagen, Copenhagen, Denmark
(Hansen) The Department of Public Health, Section for Health Services
Research, University of Copenhagen, Copenhagen, Denmark
(Larsen) The Department of Cardiology, Herlev-Gentofte Hospital, Hellerup,
Denmark
(Jurlander) The Department of Cardiology, Nordsjaellands Hospital,
Hillerod, Denmark
(Benedek, Hodas) The Department of Internal Medicine, Clinic of
Cardiology, Targu Mures, Romania
(Ratiu) The Department of Radiology and Medical Imaging, Targu Mures,
Romania
(Benedek) George Emil Palade University of Medicine, Pharmacy, Science,
and Technology, County Clinical Emergency Hospital Targu Mures, Targu
Mures, Romania
(Benedek, Rodean) The Center of Advanced Research in Multimodality Cardiac
Imaging, CardioMed Medical Center, Targu Mures, Romania
(Donnelly, Orr, Kelly, Regan) The Department of Cardiology, Southeastern
Health and Social Care Trust, Belfast, United Kingdom
(Davis) The Department of Cardiology, Aintree University Hospital,
Liverpool, United Kingdom
(Thwaite) The Department of Radiology, Aintree University Hospital,
Liverpool, United Kingdom
(Ruzsics, Fisher) The Department of Cardiology, Royal Liverpool University
Hospital, The Institute for Cardiovascular Medicine and Science, Liverpool
Heart and Chest Hospital, Liverpool, United Kingdom
(Fisher) The Faculty of Health and Life Sciences, University of Liverpool,
Liverpool, United Kingdom
(Davis) Edge Hill University, Ormskirk, United Kingdom
(Berry, Delles) The Institute of Cardiovascular and Medical Sciences,
University of Glasgow, Glasgow, United Kingdom
(Berry) Golden Jubilee National Hospital, Clydebank, United Kingdom
(Rodriguez-Palomares, Valente, del Blanco) The Department of Cardiology,
Hospital Universitario Vall d'Hebron, Institut de Recerca, Universitat
Autonoma de Barcelona, Barcelona, Spain
(Calabria) The Department of Radiology, Hospital Universitario Vall
d'Hebron, Institut de Recerca, Universitat Autonoma de Barcelona,
Barcelona, Spain
(Rodriguez-Palomares, Valente, del Blanco) Centro de Investigacion
Biomedica en Red, Madrid, Spain
(Diez, Rubio) The Department of Cardiology, Basurto Hospital, Bilbao,
Spain
(Lecumberri) The Department of Radiology, Basurto Hospital, Bilbao, Spain
(Gutierrez-Ibarluzea) Basque Foundation for Health Innovation and
Research, Barakaldo, Spain
(Gutierrez-Ibarluzea) The Basque Office for Health Technology Assessment,
Vitoria-Gasteiz, Spain
(Erglis) The Department of Cardiology, Paul Stradins Clinical University
Hospital, Riga, Latvia
(Zvaigzne) The Department of Radiology, Paul Stradins Clinical University
Hospital, Riga, Latvia
(Erglis) The University of Latvia, Riga, Latvia
(Stechovsky) The Department of Cardiology, Motol University Hospital,
Prague, Czechia
(Suchanek) The Department of Imaging Methods, Motol University Hospital,
Prague, Czechia
(Sakalyte, Zajanckauskiene) The Department of Cardiology, Medical Academy,
Lithuanian University of Health Sciences, Kaunas, Lithuania
(Sakalyte, Zajanckauskiene) The Department of Cardiology, Hospital of
Lithuanian University of Health Sciences, Kaunas, Lithuania
(Adic, Adic) The Faculty of Medicine, University of Novi Sad, Serbia
(Adic, Adic) The Department of Cardiology, Institute for Cardiovascular
Diseases of Vojvodina, Novi Sad, Serbia
(Vidakovic, Neskovic) The Department of Cardiology, Internal Medicine
Clinic, Clinical Hospital Center Zemun, The Faculty of Medicine,
University of Belgrade, Belgrade, Serbia
(Dodd) The Department of Radiology, St. Vincent's University Hospital,
Dublin, Ireland
(Hensey) The Department of Cardiology, St. Vincent's University Hospital,
Dublin, Ireland
(Dodd) School of Medicine, University College Dublin, Dublin, Ireland
(Kepka, Kruk) The National Institute of Cardiology, Warsaw, Poland
(Ilnicka-Suckiel) The Department of Cardiology, Provincial Specialist
Hospital in Wroclaw, Wroclaw, Poland
(Kusmierz) The Department of Radiology, Provincial Specialist Hospital in
Wroclaw, Wroclaw, Poland
(Mancone) The Department of Clinical Internal, Anesthesiologic, and
Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
(Francone) The Department of Biomedical Sciences, Humanitas University,
IRCCS Humanitas Research Hospital, Milan, Italy
(Saba) The Department of Radiology, University of Cagliari, Cagliari,
Italy
(Matta) The Department of Radiology, Azienda Ospedaliera Brotzu, Cagliari,
Italy
(Plank) The Department of Internal Medicine III, Innsbruck Medical
University, Innsbruck, Austria
(Plank) The Department of Cardiology, Innsbruck Medical University,
Innsbruck, Austria
(Feuchtner) The Department of Radiology, Innsbruck Medical University,
Innsbruck, Austria
(Knuuti) The Turku PET Center, Turku, Finland
(Pietila) Heart Center Turku University Hospital, University of Turku,
Turku, Finland
(Pietila) The Administrative Center, Health Care District of Southwestern
Finland, Turku, Finland
(Faria, Ribeiro) The Department of Cardiology, Centro Hospitalar de Vila
Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
(Kubiak) The European Clinical Research Infrastructure Network-European
Research Infrastructure Consortium, Paris, France
Publisher
Massachussetts Medical Society
Abstract
BACKGROUND In the diagnosis of obstructive coronary artery disease (CAD),
computed tomography (CT) is an accurate, noninvasive alternative to
invasive coronary angiography (ICA). However, the comparative
effectiveness of CT and ICA in the management of CAD to reduce the
frequency of major adverse cardiovascular events is uncertain. METHODS We
conducted a pragmatic, randomized trial comparing CT with ICA as initial
diagnostic imaging strategies for guiding the treatment of patients with
stable chest pain who had an intermediate pretest probability of
obstructive CAD and were referred for ICA at one of 26 European centers.
The primary outcome was major adverse cardiovascular events
(cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke)
over 3.5 years. Key secondary outcomes were procedure-related
complications and angina pectoris. RESULTS Among 3561 patients (56.2% of
whom were women), follow-up was complete for 3523 (98.9%). Major adverse
cardiovascular events occurred in 38 of 1808 patients (2.1%) in the CT
group and in 52 of 1753 (3.0%) in the ICA group (hazard ratio, 0.70; 95%
confidence interval [CI], 0.46 to 1.07; P=0.10). Major procedure-related
complications occurred in 9 patients (0.5%) in the CT group and in 33
(1.9%) in the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina
during the final 4 weeks of follow-up was reported in 8.8% of the patients
in the CT group and in 7.5% of those in the ICA group (odds ratio, 1.17;
95% CI, 0.92 to 1.48). CONCLUSIONS Among patients referred for ICA because
of stable chest pain and intermediate pretest probability of CAD, the risk
of major adverse cardiovascular events was similar in the CT group and the
ICA group. The frequency of major procedure-related complications was
lower with an initial CT strategy. Copyright © 2022 Massachusetts
Medical Society.

<3>
Accession Number
2017451980
Title
Treatment of Coronary De Novo Lesions by a Sirolimus- or Paclitaxel-Coated
Balloon.
Source
JACC: Cardiovascular Interventions. 15(7) (pp 770-779), 2022. Date of
Publication: 11 Apr 2022.
Author
Ahmad W.A.W.; Nuruddin A.A.; Abdul Kader M.A.S.K.; Ong T.K.; Liew H.B.;
Ali R.M.; Mahmood Zuhdi A.S.; Ismail M.D.; Yusof A.K.M.; Schwenke C.;
Kutschera M.; Scheller B.
Institution
(Ahmad, Mahmood Zuhdi, Ismail) Department of Medicine, University Malaya
Medical Center, Kuala Lumpur, Malaysia
(Nuruddin, Yusof) Cardiology Department, National Heart Institute
Malaysia, Kuala Lumpur, Malaysia
(Abdul Kader) Cardiology Department, Hospital Pulau Pinang, George Town,
Malaysia
(Ong) Cardiology Department, Sarawak Heart Centre, Kota Samarahan,
Malaysia
(Liew) Cardiology Department and Clinical Research Center, Queen Elizabeth
Hospital II, Kota Kinabalu, Malaysia
(Ali) Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
(Schwenke) SCO: SSiS, Berlin, Germany
(Kutschera) Experimental Radiology, Charite Universitatsmedizin, Berlin,
Germany
(Scheller) Clinical and Experimental Interventional Cardiology, University
of Saarland, Homburg/Saar, Germany
Publisher
Elsevier Inc.
Abstract
Objectives: The aim of this randomized controlled trial was to investigate
a novel sirolimus-coated balloon (SCB) compared with the best investigated
paclitaxel-coated balloon (PCB). Background(s): There is increasing
clinical evidence for the treatment of coronary de novo disease using
drug-coated balloons. However, it is unclear whether paclitaxel remains
the drug of choice or if sirolimus is an alternative, in analogy to
drug-eluting stents. Method(s): Seventy patients with coronary de
novo lesions were enrolled in a randomized, multicenter trial to compare a
novel SCB (SeQuent SCB, B. Braun Melsungen; 4 mug/mm2) with a
PCB (SeQuent Please, B. Braun Melsungen; 3 mug/mm2). The
primary endpoint was angiographic late lumen loss (LLL) at 6 months.
Secondary endpoints included major adverse cardiovascular events and
individual clinical endpoints such as cardiac death, target lesion
myocardial infarction, clinically driven target lesion revascularization,
and binary restenosis. Result(s): Quantitative coronary angiography
revealed no differences in baseline parameters. After 6 months, in-segment
LLL was 0.01 +/- 0.33 mm in the PCB group versus 0.10 +/- 0.32 mm in the
SCB group. The mean difference between SCB and PCB was 0.08 (95% CI: -0.07
to 0.24). Noninferiority at a predefined margin of 0.35 was shown.
However, negative LLL was more frequent in the PCB group (60% of lesions
vs 32% in the SCB group; P = 0.019). Major adverse cardiovascular events
up to 12 months also did not differ between the groups.
 Conclusion(s): This first-in-human comparison of a novel SCB with a
crystalline coating showed similar angiographic outcomes in the treatment
of coronary de novo disease compared with a clinically proven PCB.
However, late luminal enlargement was more frequently observed after PCB
treatment. (Treatment of Coronary De-Novo Stenosis by a Sirolimus Coated
Balloon or a Paclitaxel Coated Balloon Catheter Malaysia [SCBDNMAL];
NCT04017364) Copyright © 2022 American College of Cardiology
Foundation

<4>
Accession Number
2017404087
Title
Prognostic Value of Creatine Phosphate and Inflammatory Markers for Mitral
Valve Replacement: A Systematic Review and Meta-Analysis.
Source
Applied Bionics and Biomechanics. 2022 (no pagination), 2022. Article
Number: 1132452. Date of Publication: 2022.
Author
Zhu Y.; Zou C.; Zhang J.; Chen L.; Jia Y.
Institution
(Zhu, Jia) Department of Cardiac Surgery, Shandong Provincial Hospital,
Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021,
China
(Zhu, Zou, Zhang, Chen, Jia) Department of Cardiac Surgery, Shandong
Provincial Hospital Affiliated to Shandong First Medical University,
Jinan, Shandong 250021, China
Publisher
Hindawi Limited
Abstract
Purpose. The prognosis of mitral valve replacement is an important
clinical issue and may produce unexpected mortality rates if not properly
addressed. The postoperative examination results have important prognostic
implications. This study was designed to determine the prognostic value of
phosphocreatine and inflammatory markers after mitral valve replacement.
Method. Comparison and analysis of the data obtained using SPSS software.
The computer retrieved PubMed, Science Citation Index (SCI), Embase, VIP,
CNKI, CBM, and Wanfang database and manually retrieved randomized
controlled trials (RCTs) published at home and abroad on the central
muscle protection role of creatine phosphate in heart valve replacement,
and the search period was established until February 2018. Two random
literature reviewers independently screened the literature and extracted
data, using Review Manager (RevMan) (Computer program), version 5.3 (The
Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, 2014).
RevMan software version 5.0 assesses the risk of bias for inclusion in
studies. The software performs a meta-analysis of the obtained data.
Results. Ten RCTs with a total of 464 participants were enrolled. The
meta-analysis results showed that (1) elevated creatine kinase levels
often predict a better prognosis after mitral valve replacement (RR=1.36,
95% CI: 1.22 to 1.52, P<0.00001), (2) the creatine kinase isoenzyme level
in the venous blood of the phosphocreatine group after 24 h of aortic
blocking was significantly lower than that in the control group
(SMD=-2.90, 95% CI: -5.19 to -0.60, P=0.01), and (3) Troponin I levels
were significantly lower in the intravenous creatine group than in the
control group 24 h after opening of the aortic block (SMD=-1.49, 95% CI:
-2.02 to -0.97,P<0.00001). Conclusions. Creatine phosphate and
inflammatory factor have good predictive value for the prognosis of mitral
valve replacement. Copyright © 2022 Yanhui Zhu et al.

<5>
Accession Number
2014405350
Title
Association between leukoreduced red blood cell transfusions and
hospital-acquired infections in critically ill children: A secondary
analysis of the TRIPICU study.
Source
Vox Sanguinis. 117(4) (pp 545-552), 2022. Date of Publication: April 2022.
Author
Flatman L.K.; Fergusson D.A.; Lacroix J.; Ducruet T.; Papenburg J.;
Fontela P.S.
Institution
(Flatman, Papenburg, Fontela) Department of Epidemiology, Biostatistics
and Occupational Health, McGill University, Montreal, Canada
(Fergusson) Clinical Epidemiology Program, Ottawa Hospital Research
Institute, Ottawa, Canada
(Fergusson) Department of Medicine, University of Ottawa, Ottawa, Canada
(Lacroix) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, Universite de Montreal, Montreal, Canada
(Ducruet) Unite de Recherche Clinique Appliquee, Universite de Montreal,
Centre de Recherche, CHU Sainte-Justine, Montreal, Canada
(Papenburg) Division of Pediatric Infectious Diseases, Department of
Pediatrics, McGill University, Montreal, Canada
(Fontela) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, McGill University, Montreal, Canada
Publisher
John Wiley and Sons Inc
Abstract
Background and Objectives: Hospital-acquired infections (HAIs) are an
important problem in critically ill children. Studies show associations
between the transfusion of non-leukoreduced red blood cell units (RBC) and
increased HAI incidence rates (IRs). We hypothesize that transfusing
pre-storage leukoreduced RBC is also associated with increased HAI IR. We
aim to evaluate the associations between (1) a leukoreduced RBC
restrictive transfusion strategy and HAI IR, (2) leukoreduced RBC
transfusions and HAI IR, and (3) the number or volume of leukoreduced RBC
transfusions and HAI IR in critically ill children. Material(s) and
Method(s): This post hoc secondary analysis of the "Transfusion
Requirement in Paediatric Intensive Care Units" (TRIPICU) randomized
controlled trial (637 patients) used quasi-Poisson multivariable
regression models to estimate HAI incidence rate ratios (IRRs) and 95%
confidence intervals (CI). Result(s): A restrictive transfusion
strategy yielded an IRR of 0.88 (95% CI 0.67, 1.16). The association
between transfusing leukoreduced RBCs (IRR 1.25; 95% CI 0.73, 2.13) and
HAI IR was not statistically significant. However, we observed significant
associations between patients who received >20 cc/kg volume of
leukoreduced RBC transfusions (IRR 2.14; 95% CI 1.15, 3.99) and >=3
leukoreduced RBC transfusions (IRR 2.40; 95% CI 1.15, 4.99) and HAI IR.
 Conclusion(s): Exposing critically ill children to >20 cc/kg or >=3
leukoreduced RBC transfusions were associated with higher HAI IR,
suggesting dose-response patterns. Copyright © 2021 International
Society of Blood Transfusion.

<6>
[Use Link to view the full text]
Accession Number
635358659
Title
Effect of Denosumab or Alendronic Acid on the Progression of Aortic
Stenosis: A Double-Blind Randomized Controlled Trial.
Source
Circulation. 143(25) (pp 2418-2427), 2021. Date of Publication: 22 Jun
2021.
Author
Pawade T.A.; Doris M.K.; Bing R.; White A.C.; Forsyth L.; Evans E.; Graham
C.; Williams M.C.; Van Beek E.J.R.; Fletcher A.; Adamson P.D.; Andrews
J.P.M.; Cartlidge T.R.G.; Jenkins W.S.A.; Syed M.; Fujisawa T.; Lucatelli
C.; Fraser W.; Ralston S.H.; Boon N.; Prendergast B.; Newby D.E.; Dweck
M.R.
Institution
(Pawade, Doris, Bing, White, Williams, Adamson, Andrews, Cartlidge,
Jenkins, Syed, Fujisawa, Boon, Newby, Dweck) British Heart Foundation
Centre for Cardiovascular Science, University of Edinburgh, 47 Little
France Crescent, Edinburgh EH16 4TJ, United Kingdom
(Forsyth) Edinburgh Clinical Trials Unit, University of Edinburgh, United
Kingdom
(Evans, Graham) Edinburgh Clinical Research Facility, University of
Edinburgh, United Kingdom
(Van Beek, Fletcher, Lucatelli) Edinburgh Imaging, University of
Edinburgh, United Kingdom
(Ralston) Institute of Genetics and Molecular Medicine, University of
Edinburgh, United Kingdom
(Adamson) Christchurch Heart Institute, University of Otago, New Zealand
(Fraser) Norwich Medical School, University of East Anglia, United Kingdom
(Prendergast) King's College London, United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Valvular calcification is central to the pathogenesis and
progression of aortic stenosis, with preclinical and observational studies
suggesting that bone turnover and osteoblastic differentiation of valvular
interstitial cells are important contributory mechanisms. We aimed to
establish whether inhibition of these pathways with denosumab or
alendronic acid could reduce disease progression in aortic stenosis.
 Method(s): In a single-center, parallel group, double-blind
randomized controlled trial, patients >50 years of age with calcific
aortic stenosis (peak aortic jet velocity >2.5 m/s) were randomized
2:1:2:1 to denosumab (60 mg every 6 months), placebo injection, alendronic
acid (70 mg once weekly), or placebo capsule. Participants underwent
serial assessments with Doppler echocardiography, computed tomography
aortic valve calcium scoring, and 18F-sodium fluoride positron
emission tomography and computed tomography. The primary end point was the
calculated 24-month change in aortic valve calcium score. Result(s):
A total of 150 patients (mean age, 72+/-8 years; 21% women) with calcific
aortic stenosis (peak aortic jet velocity, 3.36 m/s [2.93-3.82 m/s];
aortic valve calcium score, 1152 AU [655-2065 AU]) were randomized and
received the allocated trial intervention: denosumab (n=49), alendronic
acid (n=51), and placebo (injection n=25, capsule n=25; pooled for
analysis). Serum C-terminal telopeptide, a measure of bone turnover,
halved from baseline to 6 months with denosumab (0.23 [0.18-0.33 microg/L]
to 0.11 microg/L [0.08-0.17 microg/L]) and alendronic acid (0.20
[0.14-0.28 microg/L] to 0.09 microg/L [0.08-0.13 microg/L]) but was
unchanged with placebo (0.23 [0.17-0.30 microg/L] to 0.26 microg/L
[0.16-0.31 microg/L]). There were no differences in 24-month change in
aortic valve calcium score between denosumab and placebo (343 [198-804 AU]
versus 354 AU [76-675 AU]; P=0.41) or alendronic acid and placebo (326
[138-813 AU] versus 354 AU [76-675 AU]; P=0.49). Similarly, there were no
differences in change in peak aortic jet velocity or 18F-sodium
fluoride aortic valve uptake. Conclusion(s): Neither denosumab nor
alendronic acid affected progression of aortic valve calcification in
patients with calcific aortic stenosis. Alternative pathways and
mechanisms need to be explored to identify disease-modifying therapies for
the growing population of patients with this potentially fatal condition.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier:
NCT02132026. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<7>
Accession Number
2017039819
Title
Outcomes of heart transplantation in cardiac amyloidosis: an updated
systematic review.
Source
Heart Failure Reviews. (no pagination), 2022. Date of Publication: 2022.
Author
Lakhdar S.; Buttar C.; Nassar M.; Ciobanu C.; Patel R.; Munira M.S.
Institution
(Lakhdar, Nassar) Department of Medicine, Icahn School of Medicine at
Mount Sinai/NYC H+H/Queens, 82-68 164th St. Queens, New York, NY 11432,
United States
(Buttar) Department of Cardiology, Ochsner Medical Center, New Orleans,
LA, United States
(Ciobanu) St. Barnabas Hospital/Albert Einstein College of Medicine, New
York, NY, United States
(Patel, Munira) Division of Cardiology, Icahn School of Medicine at Mount
Sinai/NYC H+H/Queens, New York, NY, United States
(Munira) Division of Cardiology, Icahn School of Medicine at Mount Sinai,
New York, NY, United States
Publisher
Springer
Abstract
Cardiac amyloidosis is one of the most common infiltrative
cardiomyopathies that is characterized by the extracellular deposition of
misfolded fibrillar protein. Several studies have previously found that
patients with amyloid in the past have performed poorly after heart
transplantation. Recent advancements in treatments have been made that
have significantly improved outcomes in these patients. The study aimed to
evaluate the outcomes of heart transplantation in cardiac amyloidosis. We
systematically searched EMBASE, PubMed/MEDLINE, and Cochrane Library
databases on 30 December 2021 following the Preferred Reporting Items for
Systematic Reviews and Meta-analyses (PRISMA) guidelines. We identified 22
studies that examined 42,951 patients with cardiac amyloidosis of which
only 1,329 patients underwent isolated heart transplantation. Seven
studies reported individual patient data. The results of 123 patients have
been pooled for analysis. There were 70 male patients, 45 female patients,
and eight patients who did not report their gender. Among the types of
amyloids, 63 (51%) patients were found to have light chain amyloidosis
(AL) and 33 (27%) patients had transthyretin amyloidosis (ATTR). Only 41
patients (33.3%) reported a monoclonal component. There were 30 patients
with AL that underwent autologous hematopoietic stem cell transplant
(ASCT). The mean survival of 24 out of 30 patients was 4.33 years. In
addition, the reported data include 13 patients requiring intra-aortic
balloon pump (IABP), six with cardiac resynchronization therapy (CRT), and
four with implantable cardioverter defibrillator (ICD). With the current
advancements in treatments in combination with a multidisciplinary
approach and careful patient selection, patients undergoing heart
transplantation for amyloidosis may have encouraging results in the
current era. Further studies will be needed to evaluate the outcomes of
heart transplantation in amyloidosis patients now that several advances
have been made in the field. Copyright © 2022, The Author(s),
under exclusive licence to Springer Science+Business Media, LLC, part of
Springer Nature.

<8>
Accession Number
2014160216
Title
Rationale and design of the Dapagliflozin after Transcatheter Aortic Valve
Implantation (DapaTAVI) randomized trial.
Source
European Journal of Heart Failure. 24(3) (pp 581-588), 2022. Date of
Publication: March 2022.
Author
Amat-Santos I.J.; Sanchez-Luna J.P.; Abu-Assi E.; Cruz-Gonzalez I.;
Nombela-Franco L.; Munoz-Garci A.J.; Blas S.G.; de la Torre Hernandez
J.M.; Romaguera R.; Sanchez-Recalde A.; Diez-Gil J.L.; Lopez-Otero D.;
Gheorge L.; Ibanez B.; Iniguez-Romo A.; Raposeiras-Roubin S.; Munoz-Garcia
E.; Sanz-Sanchez J.; Pereiro-Montes D.; Gutierrez-Barri A.;
Salgado-Fernandez J.; Veiga-Fernandez G.; Ojeda S.; Tirado G.; Sanchis J.;
Baladron-Zorita C.; Cordoba-Soriano J.G.; Vilalta V.; del Amo F.N.;
Molina-Navarro E.; Peral-Disdier V.; Ruiz-Quevedo V.; Ojeda F.B.; Alonso
J.A.B.; Abellas M.; Moris C.; Diaz-Fernandez J.F.; Blanco-Mata R.;
Regueiro A.; Fernandez-Diaz J.A.; Lezcano J.S.-R.; Garcia B.;
Arzamendi-Aizpurua D.; Feltes G.; Cuellas C.; Bordes P.; Jimenez-Britez
G.D.; Sarnago-Cebada F.; Gil-Ortega M.V.; Borrero J.C.; Reyes R.M.; Alonso
Briales J.H.; Alcaide J.; Lopez-Ledesma B.; Ten Morro F.; Sanchez-Lacuesta
E.; SanMartin-Pena J.C.; Lopez-Pais J.; Calle G.; Flores-Rios X.;
Mendez-Eirin E.; Nunez M.S.; Alvarez M.P.; de Lezo J.S.; Nunez-Gil I.;
Bonanad-Lozano C.; Nunez-Villota J.; Minana-Escriva G.; Valero-Picher E.;
Gonzalez-D'Gregorio J.; Fernandez-Cisnal A.; Santos S.; Arana J.R.D.;
Barrero A.; Sanz-Patino E.; Mazuecos J.J.; Gallardo-Lopez A.;
Carrillo-Suarez X.; Grau E.F.; Fernandez-Nofrerias E.; Lozano A.P.;
Alvarez M.L.; Franco-Pelaez J.A.; Talavera S.G.; Molina-Jimenez M.;
Morcuende-Gonzalez A.; Millan-Segovia R.; Pascual-Sastre M.;
Maristany-Daudert J.; Ramallal-Martinez R.; Sanchez-Elvira G.;
Bazal-Chacon P.; Bowden G.Y.; de la Fuente Perdomo B.; Loureiro R.E.;
Gonzalez-Ferreiro R.; Melendo-Viu M.; Ocampo-Miguez J.; Cobas-Paz R.;
Queija B.C.; Rioboo-Leston L.; Cespon-Fernandez M.; Dominguez-Erquicia P.;
Ledo-Pineiro A.; Camacho-Freire S.; Astorga-Burgo J.C.; Cepas P.L.; de
Miguel J.A.D.; Gracia M.C.F.; Ferreira I.; Calago A.; Palma R.;
Asmarats-Serra L.; Lopez-Benito M.; Garcia-Fernandez A.G.;
Fernandez-Vazquez F.; de Prado A.P.; Mainar V.; Ruiz-Nodar J.M.;
Valencia-Martin J.; Pineda-Rocamora J.; Torres-Mezcua F.J.; Quiles-Granado
J.M.; Lozano-Palencia T.; Sandin-Rollan M.; Ajo-Ferrer R.; Ajo-Ferrer M.;
Gonzalez-Trevilla A.A.; Gomez-Blazquez I.T.; Garcia-Tejada J.;
Huertas-Nieto S.; Maneiro-Melon N.M.; Olazabal-Valiente A.P.; Alfonso F.
Institution
(Amat-Santos, Sanchez-Luna, Munoz-Garci, Lopez-Otero, Ibanez) CIBERCV,
Madrid, Spain
(Amat-Santos, Sanchez-Luna) Cardiology Department, Hospital Clinico
Universitario, Valladolid, Spain
(Abu-Assi, Melendo-Viu, Iniguez-Romo, Raposeiras-Roubin) Department of
Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
(Cruz-Gonzalez) Cardiology Department, Hospital Clinico Universitario,
Salamanca, Spain
(Nombela-Franco) Cardiology Department, Hospital Clinico San Carlos,
Madrid, Spain
(Munoz-Garci) Cardiology Department, Hospital Virgen de la Victoria,
Malaga, Spain
(Blas) Cardiology Department, Hospital Clinico Universitario, Valencia,
Spain
(de la Torre Hernandez) Cardiology Department, Hospital Universitario
Marques de Valdecilla, Santander, Spain
(Romaguera) Cardiology Department, Hospital Universitario de Bellvitge,
Barcelona, Spain
(Sanchez-Recalde) Cardiology Department, Hospital Universitario Ramon y
Cajal, Madrid, Spain
(Diez-Gil) Cardiology Department, Hospital Universitario La Fe, Valencia,
Spain
(Lopez-Otero) Cardiology Department, Hospital Clinico Universitario de
Santiago de Compostela, Madrid, Spain
(Gheorge) Cardiology Department, Hospital Universitario Puerta del Mar,
Cadiz, Spain
(Ibanez) IIS-Department of Cardiology, Hospital Fundacion Jimenez Diaz,
Madrid, Spain
(Ibanez, Raposeiras-Roubin) Centro Nacional de Investigaciones
Cardiovasculares (CNIC), Madrid, Spain
Publisher
John Wiley and Sons Ltd
Abstract
Aims: Despite aortic stenosis (AS) relief, patients undergoing
transcatheter aortic valve implantation (TAVI) are at increased risk of
developing heart failure (HF) within first months of intervention.
Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to
reduce the risk of HF hospitalization in individuals with diabetes
mellitus, reduced left ventricular ejection fraction and chronic kidney
disease. However, the effect of SGLT-2 inhibitors on outcomes after TAVI
is unknown. The Dapagliflozin after Transcatheter Aortic Valve
Implantation (DapaTAVI) trial is designed to assess the clinical benefit
and safety of the SGLT-2 inhibitor dapagliflozin in patients undergoing
TAVI. Method(s): DapaTAVI is an independent pragmatic, controlled,
prospective, randomized, open-label blinded endpoint, multicentre trial
conducted in Spain, evaluating the effect of dapagliflozin 10 mg/day on
the risk of death and worsening HF in patients with severe AS undergoing
TAVI. Candidate patients should have prior history of HF admission plus
>=1 of the following criteria: (i) diabetes mellitus, (ii) left
ventricular ejection fraction <=40%, or (iii) estimated glomerular
filtration rate between 25 and 75 ml/min/1.73 m2. A total of
1020 patients will be randomized (1:1) to dapagliflozin vs. no
dapagliflozin. Key secondary outcomes include: (i) incidence rate of
individual components of the primary outcome; (ii) cardiovascular
mortality; (iii) the composite of HF hospitalization or cardiovascular
death; and (iv) total number of HF rehospitalizations. Conclusion(s):
DapaTAVI will determine the efficacy and safety of dapagliflozin in a
broad spectrum of frail patients after AS relief by TAVI. Copyright
© 2021 European Society of Cardiology.

<9>
[Use Link to view the full text]
Accession Number
634780675
Title
A Comparison of the Required Bronchial Cuff Volume Obtained by 2 Cuff
Inflation Methods, Capnogram Waveform-Guided Versus Pressure-Guided: A
Prospective Randomized Controlled Study.
Source
Anesthesia and Analgesia. 132(3) (pp 827-835), 2021. Date of Publication:
01 Mar 2021.
Author
Yamada Y.; Tanabe K.; Nagase K.; Ishihara T.; Iida H.
Institution
(Yamada, Tanabe, Nagase, Iida) Department of Anesthesiology and Pain
Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu
501-1194, Japan
(Ishihara) Gifu University Hospital Innovative and Clinical Research
Promotion Center, Gifu University, Gifu, Japan
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Double-lumen endobronchial tubes (DLTs) are used for one-lung
ventilation (OLV) during thoracic surgery. Overinflation into the
bronchial cuff causes damage to the tracheobronchial mucosa, whereas
underinflation leads to an incomplete collapse of the nonventilated lung
or incomplete ventilation of the ventilated lung. However, how to
determine the appropriate bronchial cuff volume and pressure during OLV is
unclear. The objective of this study is to compare the required bronchial
cuff volume for lung separation obtained by 2 different cuff inflation
methods under closed- and open-chest conditions. METHOD(S): A total
of 64 patients scheduled to undergo elective thoracic surgery requiring
OLV were recruited. Left DLTs were used for both right- and left-sided
surgery. The patients were randomly assigned to 1 of 2 inflation-type
groups to estimate the bronchial cuff volume. In the capnogram
waveform-guided bronchial cuff inflation group (capno group, n = 27), the
bronchial cuff was inflated until a capnometer sampling gas containing
CO2from the nonventilated lung displayed a flat line. The
corresponding bronchial cuff volume and pressure were then recorded. In
the pressure-guided bronchial cuff inflation group (pressure group, n =
29), the bronchial cuff was inflated by a cuff inflator to a pressure of
20 cm H2O. Lung separation was confirmed when a flat line of a
capnometer was observed after gas sampling from the nonventilated lung.
 RESULT(S): Under closed-chest conditions, the bronchial cuff sealing
volume for the capno group was significantly lower than that for the
pressure group (mean [standard deviation {SD}], 1.00 [0.65] mL vs 1.44
[0.59] mL, mean difference, -0.44; 97.5% confidence interval [CI], -0.78
to -0.11; P =.010). Under open-chest conditions, the bronchial cuff
sealing volume for the capno group was also significantly lower than that
for the pressure group (mean [SD], 0.65 [0.66] mL vs 1.22 [0.45] mL, mean
difference, -0.58; 97.5% CI, -0.88 to -0.27; P <.001). CONCLUSION(S):
The lowest cuff volume providing an air-tight bronchial seal was obtained
by the capnogram waveform-guided bronchial cuff inflation method. Since
the cuff volume required to achieve an air-tight seal decreases after
opening the chest, readjustment of the bronchial cuff volume to prevent
bronchial cuff damage to the tracheobronchial mucosa after opening the
chest may be advisable. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<10>
Accession Number
633654983
Title
Retrograde Autologous Priming in Cardiac Surgery: Results From a
Systematic Review and Meta-analysis.
Source
Anesthesia and Analgesia. 132(1) (pp 100-107), 2021. Date of Publication:
01 Jan 2021.
Author
Hensley N.B.; Gyi R.; Zorrilla-Vaca A.; Choi C.W.; Lawton J.S.; Brown
C.H.; Frank S.M.; Grant M.C.; Cho B.C.
Institution
(Hensley, Frank, Grant) Department of Anesthesiology/Critical Care
Medicine, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287,
United States
(Gyi, Brown, Cho) Department of Anesthesiology/Critical Care Medicine,
Johns Hopkins University, School of Medicine, Baltimore, MD, United States
(Zorrilla-Vaca) Universidad del Valle School of Medicine Cali, Colombia
(Choi, Lawton) Division of Cardiac Surgery, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Retrograde autologous priming (RAP) before cardiopulmonary
bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a
systematic review of the literature to examine the impact of RAP on
perioperative allogeneic red cell transfusions in cardiac surgical
patients. METHOD(S): This study involved a systematic review and
meta-analysis of randomized controlled trials (RCTs) and observational
studies evaluating the use of RAP in cardiac surgery involving CPB. The
primary outcome was intraoperative allogeneic red cell transfusion.
Secondary outcomes included whole hospital allogeneic transfusions and
adverse events such as acute kidney injury (AKI) and stroke.
 RESULT(S): A total of 11 RCTs (n = 1337 patients) were included,
comparing RAP patients (n = 674) to control (n = 663). In addition, 10
observational studies (n = 2327) were included, comparing RAP patients (n
= 1257) to control (n = 1070). Overall, RAP was associated with a
significantly reduced incidence of intraoperative red cell transfusion (n
= 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI],
0.22-0.55, P <.001) compared to controls. This effect was seen among RCTs
(n = 10 studies; OR = 0.19; 95% CI, 0.08-0.45, P <.001) and observational
studies (n = 8 studies; OR = 0.66; 95% CI, 0.50-0.87, P =.004) in
isolation. RAP was also associated with a significantly reduced incidence
of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI,
0.19-0.41, P <.001). Among the studies that reported AKI and stroke
outcomes, there was no statistically significant increased odds of AKI or
stroke in either RAP or control patients. CONCLUSION(S): Based on the
pooled results of the available literature, RAP is associated with a
significant reduction in intraoperative and whole hospital allogeneic red
cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical
patients and thus, lessen transfusions. Additional high-quality
prospective studies are necessary to determine the ideal priming volume
necessary to confer the greatest benefit without incurring organ injury
(Anesth Analg 2021;132:100?7). Copyright © 2020 International
Anesthesia Research Society

<11>
[Use Link to view the full text]
Accession Number
632915588
Title
A Single Prophylactic Dose of Ondansetron Given at Cessation of
Postoperative Propofol Sedation Decreases Postoperative Nausea and
Vomiting in Cardiac Surgery Patients: A Randomized Controlled Trial.
Source
Anesthesia and Analgesia. 131(4) (pp 1164-1172), 2020. Date of
Publication: 01 Oct 2020.
Author
Wang E.H.Z.; Sunderland S.; Edwards N.Y.; Chima N.S.; Yarnold C.H.;
Schwarz S.K.W.; Coley M.A.
Institution
(Wang) Pharmacy Department, St Paul's Hospital, Providence Health Care,
Vancouver, BC, Canada
(Wang) Faculty Of Pharmaceutical Sciences, The University Of British
Columbia, Vancouver, BC, Canada
(Sunderland, Chima, Yarnold, Schwarz, Coley) Department Of Anesthesiology,
Pharmacology & Therapeutics, The University Of British Columbia,
Vancouver, BC, Canada
(Edwards, Yarnold, Schwarz, Coley) Department Of Anesthesia, St Paul's
Hospital, Providence Health Care, Vancouver, BC, Canada
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common
occurrence after cardiac surgery. However, in contrast to other surgical
populations, routine PONV prophylaxis is not a standard of care in cardiac
surgery. We hypothesized that routine administration of a single
prophylactic dose of ondansetron (4 mg) at the time of stopping
postoperative propofol sedation before extubation in the cardiac surgery
intensive care unit would decrease the incidence of PONV. METHOD(S):
With institutional human ethics board approval and written informed
consent, we conducted a randomized controlled trial in patients >=19 years
of age with no history of PONV undergoing elective or urgent cardiac
surgery procedures requiring cardiopulmonary bypass. The primary outcome
was the incidence of PONV in the first 24 hours postextubation, compared
by the chi2 test. Secondary outcomes included the incidence and times to
first dose of rescue antiemetic treatment administration, the incidence of
headaches, and the incidence of ventricular arrhythmias. RESULT(S):
PONV within the first 24 hours postextubation occurred in 33 of 77
patients (43%) in the ondansetron group versus 50 of 82 patients (61%) in
the placebo group (relative risk, 0.70 [95% confidence interval {CI},
0.51-0.95]; absolute risk difference,-18% [95% CI,-33 to-2]; number needed
to treat, 5.5 [95% CI, 3.0-58.4]; chi2 test, P =.022). Kaplan-Meier
"survival"analysis of the times to first rescue antiemetic treatment
administration over 24 hours indicated that patients in the ondansetron
group fared better than those in the placebo group (log-rank [Mantel-Cox]
test; P =.028). Overall, 32 of 77 patients (42%) in the ondansetron group
received rescue antiemetic treatment over the first 24 hours
postextubation versus 47 of 82 patients (57%) in the placebo group
(relative risk, 0.73 [95% CI, 0.52-1.00]; absolute risk difference,-16%
[95% CI,-31 to 1]); P =.047. There were no significant differences between
the groups in the incidence of postoperative headache (ondansetron group,
5 of 77 patients [6%] versus placebo group, 4 of 82 patients [5%]; Fisher
exact test; P =.740) or ventricular arrhythmias (ondansetron group, 2 of
77 patients [3%] versus placebo group, 4 of 82 patients [5%]; P =.68).
 CONCLUSION(S): These findings support the routine administration of
ondansetron prophylaxis at the time of discontinuation of postoperative
propofol sedation before extubation in patients following cardiac surgery.
Further research is warranted to optimize PONV prophylaxis in cardiac
surgery patients. Copyright © 2020 International Anesthesia
Research Society.

<12>
[Use Link to view the full text]
Accession Number
632914311
Title
A Comprehensive Update on Aspirin Management During Noncardiac Surgery.
Source
Anesthesia and Analgesia. 131(4) (pp 1111-1123), 2020. Date of
Publication: 01 Oct 2020.
Author
Gerstein N.S.; Albrechtsen C.L.; Mercado N.; Cigarroa J.E.; Schulman P.M.
Institution
(Gerstein) Department Of Anesthesiology And Critical Care Medicine,
University Of New Mexico, School Of Medicine, Albuquerque, NM, United
States
(Albrechtsen) L. Burrell College Of Osteopathic Medicine, Las Cruces, NM,
United States
(Mercado) Division Of Cardiology, Department Of Internal Medicine,
University Of New Mexico, School Of Medicine, Albuquerque, NM, United
States
(Cigarroa) Division Of Cardiology, Knight Cardiovascular Institute, Oregon
Health & Science University, Portland, OR, United States
(Schulman) Department Of Anesthesiology And Perioperative Medicine, Oregon
Health & Science University, Portland, OR, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Aspirin is considered critical lifelong therapy for patients with
established cardiovascular (CV) disease (including coronary artery,
cerebrovascular, and peripheral arterial diseases) and is consequently one
of the most widely used medications worldwide. However, the indications
for aspirin use continue to evolve and recent trials question its efficacy
for primary prevention. Although one third of patients undergoing
noncardiac surgery and at risk for a major adverse CV event receive
aspirin perioperatively, uncertainty still exists about how aspirin should
be optimally managed in this context, and significant practice variability
remains. Recent trials suggest that the risks of continuing aspirin during
the perioperative period outweigh the benefits in many cases, but data on
patients with high CV risk remain limited. We performed a comprehensive
PubMed and Medline literature search using the following keywords:
aspirin, aspirin withdrawal, perioperative, coronary artery disease,
cerebrovascular disease, peripheral artery disease, and CV disease; we
manually reviewed all relevant citations for inclusion. Patients taking
aspirin for the primary prevention of CV disease should likely discontinue
it during the perioperative period, especially when there is a high risk
of bleeding. Patients with established CV disease but without a coronary
stent should likely continue aspirin during the perioperative period
unless undergoing closed-space surgery. Patients with a history of
coronary stenting also likely need aspirin continuation throughout the
perioperative period for nonclosed space procedures. Perioperative
clinicians need to balance the risks of ceasing aspirin before surgery
against its continuation during the perioperative interval using a
patient-specific strategy. The guidance on decision-making with regard to
perioperative aspirin cessation or continuation using currently available
clinical data from studies in high-risk patients along with nonclinical
aspirin studies is conflicting and does not enable a simplified or unified
answer. However, pertinent guidelines on CV disease management provide a
basic framework for aspirin management, and large trial findings provide
some insight into the safety of perioperative aspirin cessation in some
contexts, although uncertainty on perioperative aspirin still exists. This
review provides an evidence-based update on perioperative aspirin
management in patients undergoing noncardiac surgery with a focus on
recommendations for perioperative clinicians on continuing versus holding
aspirin during this context. Copyright © 2020 International
Anesthesia Research Society.

<13>
Accession Number
2018169728
Title
HF-567-03 ARRHYTHMIC EVENTS IN PATIENTS WITH CARDIOGENIC SHOCK ON
INOTROPIC SUPPORT: RESULTS OF THE DOREMI RANDOMIZED TRIAL.
Source
Heart Rhythm. Conference: Heart Rhythm 2022. San Francisco United States.
19(5 Supplement) (pp S74), 2022. Date of Publication: May 2022.
Author
Ramirez F.D.; Jung R.; Di Santo P.; rebecca mathew; Simard T.; Parlow S.;
Weng W.; Abdel-Razek O.; Malhotra N.; Cheung M.; Hutson J.; Marbach J.;
Thibert M.; Fernando S.; Nery P.B.; Nair G.M.; Russo J.; Hibbert B.
Publisher
Elsevier B.V.
Abstract
Background: Inotropic support is widely used in the management of
cardiogenic shock (CS) to improve cardiac output and organ perfusion.
 Objective(s): To characterize the incidence and clinical relevance of
arrhythmic events in patients with CS on inotropic support managed by
medical teams blinded to the inotrope being used. Method(s): Patients
with CS enrolled in the DObutamine compaREd to MIlrinone (DOREMI) trial
were analyzed. Patients with and without arrhythmic events (defined as
arrhythmias requiring intervention or sustained ventricular arrhythmias)
were compared to (1) identify factors associated with their occurrence and
(2) examine their association with in-hospital outcomes. Result(s):
Ninety-five patients (49.5%) had arrhythmic events, occurring equally with
dobutamine and milrinone (P=0.665). A history of atrial fibrillation and
need for vasopressor support at inotrope initiation were positively
associated with arrhythmic events whereas predominant right ventricular
dysfunction and previous myocardial infarction were negatively associated
with them. Atrial arrhythmic events were associated with the need for
mechanical circulatory support or cardiac transplantation (RR 3.64, 95% CI
1.35-9.83) and both intensive care unit and hospital lengths of stay (6
[IQR 4-10] vs. 4 [3-7], P=0.029, and 17 [10-31] vs. 13 [5-21] days,
P=0.010, respectively). Ventricular arrhythmic events were associated with
the trial's primary composite outcome (RR 1.88, 95% CI 1.35-2.60),
including all-cause mortality (RR 1.73, 95% CI 1.09-2.75), initiation of
renal replacement therapy (RR 2.86, 95% CI 1.29-6.36), and need for
mechanical circulatory support or cardiac transplantation (RR 4.85, 95% CI
1.46-16.16). Conclusion(s): Clinically relevant arrhythmic events
occur in half of patients with CS treated with dobutamine or milrinone and
are associated with poor clinical outcomes. Ventricular arrhythmic events
are most strongly associated with adverse outcomes, including a 73%
increase in all-cause in-hospital mortality. Clinical factors available at
the time of inotrope initiation may help identify patients most at risk of
arrhythmic events. Given the purported proarrhythmic effects of inotropic
agents, their role in the management of patients with CS warrants critical
and rigorous appraisal. Copyright © 2022

<14>
Accession Number
2018169574
Title
PO-678-01 INVASIVE ELECTROPHYSIOLOGIC TESTING PARAMETERS TO PREDICT
ATRIOVENTRICULAR BLOCK AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: A
META-ANALYSIS.
Source
Heart Rhythm. Conference: Heart Rhythm 2022. San Francisco United States.
19(5 Supplement) (pp S349-S350), 2022. Date of Publication: May 2022.
Author
Siontis K.C.; Balla A.K.; Cha Y.-M.; Siontis G.C.M.
Publisher
Elsevier B.V.
Abstract
Background: Atrioventricular block (AVB) and permanent pacemaker (PPM)
implantation is an often anticipated complication of transcatheter aortic
valve replacement (TAVR), especially with self-expandable valves. The role
of invasive electrophysiologic (EP) testing parameters in predicting
post-TAVR AVB is unclear. Objective(s): We sought to perform a
systematic review of the literature and meta-analysis of associations of
invasive EP parameters with post-TAVR AVB. Method(s): We searched the
literature (2011-2021) for studies reporting on the prognostic value of
peri-TAVR EP testing to identify patients requiring PPM implant after
TAVR. Using random-effects meta-analysis methods, we performed
quantitative synthesis of the associations between key EP parameters
before TAVR (AH interval, HV interval, HV >70 msec, delta AH, delta HV,
Wenckebach cycle length) and post-TAVR AVB. Among patients without
immediate post-TAVR AVB, the same parameters were also examined after TAVR
to predict subsequent AVB. Summary odds ratios (OR) and 95% confidence
intervals (CI) were calculated. Result(s): A total of 16 studies with
1,197 patients (mean 75 patients per study) were included in
meta-analyses. Six studies included only self-expandable TAVR, one study
included only balloon-expandable TAVR, while 9 studies included both. In
11 studies, EP testing was performed both before and after TAVR, while in
5 studies it was only performed after TAVR. Timing of post-TAVR EP testing
ranged from immediately post-valve deployment to 7 days later. In
meta-analyses, HV interval >70 msec pre-TAVR (OR 2.53, 95% CI 1.11-5.81,
p=0.04) and the absolute value of the HV interval post-TAVR (OR 1.11, 95%
CI 1.07-1.15, p=0.001; per 1 msec increase) were significantly associated
with post-TAVR AVB. Conclusion(s): AV conduction system parameters
determined by invasive EP testing before and after TAVR can help risk
stratify patients for TAVR-induced AVB. [Formula presented] Copyright
© 2022

<15>
Accession Number
2018169460
Title
PO-670-06 EFFICACY AND SAFETY OF LEFT ATRIAL APPENDAGE OCCLUSION DURING
CARDIAC SURGERY TO PREVENT STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Source
Heart Rhythm. Conference: Heart Rhythm 2022. San Francisco United States.
19(5 Supplement) (pp S322), 2022. Date of Publication: May 2022.
Author
Tugade R.E.; David B.J.; Tolentino C.S.
Publisher
Elsevier B.V.
Abstract
Background: Stroke remains one of the significant causes of morbidity and
mortality after cardiac surgery. One stroke occurrence is postoperative
atrial fibrillation (pAF), with an incidence ranging between 20% and 40%.
PAF predisposes to the formation of atrial thrombus. Most thrombus
formations observed in the left atrial appendage (LAA) have triggered
significant interest as a potential therapeutic target. Current guidelines
recommend the administration of direct oral anticoagulants (DOACs) as the
preferred therapy to prevent stroke in patients with atrial fibrillation
with a CHA<inf>2</inf>DS<inf>2</inf>-VASc of >= 2. However, despite the
benefits of anticoagulants, these cannot be offered in all patients who
are poor candidates for long-term oral anticoagulation due to the high
risk of bleeding, drug compliance, and tolerance. There is limited data on
LAA occlusion during cardiac surgery in stroke prevention.
 Objective(s): This study aims to determine whether concomitant LAAO
can be effective and safe option in preventing ischemic stroke in patients
with atrial fibrillation undergoing cardiac surgery. Method(s): A
comprehensive and relevant search of randomized controlled trials, cohort,
and case-control study design was conducted. Outcome measures for ischemic
stroke events, all-cause mortality, and pAF were extracted and analyzed
using a random-effects model via Review Manager V5.4. Result(s): A
total of 12 studies were included, with 18,982 subjects being analyzed.
There were 9,473 patients who underwent Left atrial appendage occlusion
(LAAO) with ischemic stroke events of 231 compared with 9,509 patients who
underwent non - Left atrial appendage occlusion (non-LAAO) with events of
371. Concomitant LAAO showed a significant difference in ischemic event
rate (RR 0.65 [95%CI:0.55-0.77], p<0.00001, I2=0%, moderate
certainty of evidence) and all-cause mortality (RR 0.74 [95%CI:0.57-0.97],
p=0.03, I2=68%, moderate certainty of evidence). In regards to
pAF, there was no difference between the 2 groups (RR 1.08
[95%CI:0.95-1.22], p=0.24, I2=72%, very low certainty of
evidence). Conclusion(s): Concomitant LAAO was more effective in
preventing ischemic stroke events and all-cause mortality with overall
moderate certainty of evidence. However, postoperative atrial fibrillation
has similar rates between LAAO and non-LAAO. Copyright © 2022

<16>
Accession Number
2018169183
Title
PO-715-07 CORRELATIONS BETWEEN BIOMARKERS AND ENDOMYSIAL FIBROSIS IN LEFT
AND RIGHT ATRIA OF PATIENTS UNDERGOING CARDIAC SURGERY.
Source
Heart Rhythm. Conference: Heart Rhythm 2022. San Francisco United States.
19(5 Supplement) (pp S495), 2022. Date of Publication: May 2022.
Author
Gilbers M.D.; Kawczynski M.; Winters J.; Isaacs A.; Bidar E.; Zeemering
S.; Van Gelder I.C.; Crijns H.J.G.M.; Verheule S.; Stoll M.; Schotten U.
Publisher
Elsevier B.V.
Abstract
Background: Atrial fibrosis is a key feature of structural remodelling and
plays a pivotal role in the substrate for AF. Endomysial fibrosis may be
more disruptive for conduction than the overall presence of fibrosis in
cardiac tissue. Formation of endomysial fibrosis is a reactive process
that often occurs in the absence of myocyte death and has been linked to
stretch and pressure overload. However, the underlying pathophysiological
mechanisms are yet to be elucidated. Objective(s): To analyze
correlations between tissue biomarkers and endomysial fibrosis in the left
and right atrium. Method(s): Histological staining with Wheat Germ
Agglutinin of left and right atrial appendage samples from 156 patients
included in the RACE V - Tissue Bank Project (https://clinicaltrials.gov
identifier NCT03124576) was performed and analysed. Multivariate
regression analyses were adjusted for age, gender, left ventricular
function, and a preoperative history of atrial fibrillation.
 Result(s): Univariate correlations were significant for the majority
of the biomarker panel in left atria (Figure 1). Endomysial fibrosis was
significantly associated with both paroxysmal (beta [95% C.I.] = 0.84
[0.385 - 1.295], p = 0.000) and persistent AF (beta [95% C.I.] = 0.1.239
[0.784 - 1.694], p = 0.000). Associations between endomysial fibrosis in
the left atrium and an increase in Bone Morphogenic Protein - 10 (BPM-10,
beta [95% C.I.] = 0.28 [0.14 - 0.81], p = 0.006) and dickkopf-related
protein 3 (DKK3, beta [95% C.I.] = 0.19 [0.00 - 0.03], p = 0.047) in left
atrial tissue remained significant after multivariate analysis (Figure 2).
Right atrial fibrosis, however, was not significantly associated with
changes in any of the biomarkers from our panel after multivariate
analysis. Conclusion(s): The biomarkers DKK3 (involved in fibroblast
differentiation and hypertrophic remodelling) and BMP-10 (known to be
associated with Pitx2 and predictive for AF recurrence) could potentially
provide additional insight into ongoing cardiac remodelling processes and
may improve diagnosis and understanding of AF. Interestingly, both
biomarkers are also associated with heart failure, however, when adjusted
for left ventricular function, both biomarkers where still significant.
[Formula presented] [Formula presented] Copyright © 2022

<17>
Accession Number
2018169182
Title
PO-654-03 POSTERIOR PERICARDIOTOMY TO PREVENT POST-OPERATIVE ATRIAL
FIBRILLATION AFTER CARDIAC SURGERY.
Source
Heart Rhythm. Conference: Heart Rhythm 2022. San Francisco United States.
19(5 Supplement) (pp S258-S259), 2022. Date of Publication: May 2022.
Author
Bhardwaj R.; Turagam M.K.; Shah K.B.; Contractor T.; Mandapati R.;
Lakkireddy D.R.; Garg J.
Publisher
Elsevier B.V.
Abstract
Background: Postoperative atrial fibrillation (POAF) is a common
complication following cardiac surgery. Posterior pericardiotomy (PP) is a
simple surgical method that reduces the risk of POAF because it allows
drainage of pericardial fluid into the left pleural space, reducing the
incidence of pericardial effusion that may trigger POAF.
 Objective(s): We aimed to investigate the potential beneficial
effects of PP in reducing POAF in patients undergoing cardiac surgery.
 Method(s): We searched for Medline, Embase, Elsevier, PubMed and
Google Scholar literature to identify randomized controlled trials (RCT)
that had reported outcomes in adults patients post-cardiac surgery
undergoing PP. Primary outcome was reduction in the POAF post-cardiac
surgery following PP. Result(s): Eleven RCTs with 2396 patients (1195
in PP group and 1201 in control) were included in the analysis. There was
a significant reduction in POAF after cardiac surgery in PP group compared
to control group (RR 0.46, 95%CI 0.34-0.63). PP also effectively reduced
atrial arrhythmia (RR 0.51, 95% CI 0.32-0.82), early pericardial effusion
(RR 0.35, 95% CI 0.22-0.56), late pericardial effusion (RR 0.08, 95% CI
0.03-0.20) and pericardial tamponade (RR 0.24, 95% CI 0.11-0.53) while
increasing the incidence of pleural effusion (RR 1.39, 95% 1.07-1.80). No
significant differences were observed for pulmonary complications,
inotropic support, surgical revision for bleeding, use of intra-aortic
balloon pump, or all-cause mortality between the two groups.
 Conclusion(s): PP may be safe, and effective therapeutic strategy in
preventing POAF after cardiac surgery in adult patients. [Formula
presented] Copyright © 2022

<18>
Accession Number
638054155
Title
PATIENT-REPORTED OUTCOMES PROJECT IN CARDIOVASCULAR SURGERY: SYSTEMATIC
REVIEW.
Source
Irish Journal of Medical Science. Conference: 2021 UCD School of Medicine
Summer Student Research Awards, SSRA 2021. Dublin Ireland. 191(SUPPL 1)
(pp S45-S46), 2022. Date of Publication: April 2022.
Author
Al-Ghabari M.; Michl K.; Ahmed; Bele S.; Santana M.; Gregory A.
Institution
(Al-Ghabari) UCD School of Medicine, University College Dublin, Belfield,
Dublin 4, Ireland
(Michl, Bele, Santana) Cumming School of Medicine, Department of
Anesthesiology,Perioperative and PainMedicine, University of Calgary,
Calgary, AB, Canada
(Ahmed, Gregory) Libin Cardiovascular Institute, University of Calgary,
Foothills Medical Centre, Calgary, AB, Canada
Publisher
Springer
Abstract
Perioperative cardiac surgical care has begun to shift focus away from
outcomes such as mortality,major morbidity and length of stay (LOS) as
there is an increasing focus towards patient-centered careand high-value
health care. The emergence of these outcome measures to cardiac surgery
are vital inallowing us to understand and improve outcomes that are
important to patients (physical, emotional,psychological, social) which
can be used by providers to improve care beyond traditional methods.We are
conducting a systematic review to assess the use of patient-reported
outcome measures(PROMs) and patient-reported experience measures (PREMs)
in the perioperative period for adultpatients undergoing open-heart
surgery. PROMs and PREMs are metrics that capture information thatcomes
directly from the patient.We systematically search the following
electronic databases: CINAHL, MEDLINE, PsycInfo andEMBASE databases
followed by screening the retrieved articles using Covidence. Data
regardingPROM and PREM usage has been extracted from selected studies
describing the types ofPROMs/ PREMs, appropriate use of measures, timing
of measurements, description of scoringfunctions, relation to outcomes
(mortality, morbidity and LOS) and quality assessment of studies willbe
conducted.Although PROMs/PREMs are being used, often the measures used are
unvalidated or only portions ofvalidated PROMs/PREMs are being used which
is inappropriate when looking at effectivePROM/PREM usage.While the use of
PROMs/PREMs have been shown to improve patient outcomes and
experiences,their use with relation to perioperative cardiac surgical care
needs to be more standardized and robustto be beneficial to inform
value-based healthcare.

<19>
[Use Link to view the full text]
Accession Number
372617470
Title
Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the
treatment of proximal humeral fractures in elderly patients.
Source
Journal of Bone and Joint Surgery. 95(22) (pp 2050-2055), 2013. Date of
Publication: 20 Nov 2013.
Author
Cuff D.J.; Pupello D.R.
Institution
(Cuff, Pupello) Suncoast Orthopaedic Surgery and Sports Medicine,
Foundation for Orthopaedic Research and Education, Tampa, FL, United
States
(Cuff) Suncoast Orthopaedic Surgery and Sports Medicine, 836 Sunset Lake
Boulevard, Venice, FL 34292, United States
(Pupello) Foundation for Orthopaedic Research and Education, 13020 North
Telecom Parkway, Tampa, FL 33637, United States
Publisher
Journal of Bone and Joint Surgery Inc.
Abstract
Background: Treatment of complex three and four-part proximal humeral
fractures with hemiarthroplasty in elderly patients has yielded mixed
clinical results. Reverse shoulder arthroplasty has emerged as a treatment
option for comminuted proximal humeral fractures for these patients. The
purpose of the study was to perform a prospective evaluation of patient
outcomes comparing hemiarthroplasty and reverse shoulder arthroplasty for
the treatment of comminuted proximal humeral fractures in elderly
patients. Method(s): Fifty-three consecutive elderly patients
(average age, 74.4 years) underwent an arthroplasty for a complex proximal
humeral fracture. Indications for arthroplasty were four-part fractures,
three-part fractures with severe comminution of the greater tuberosity,
and fractures that involved an articular split of the humeral head.
Twenty-six patients underwent hemiarthroplasty (the HA group), followed by
twenty-seven patients who underwent reverse shoulder arthroplasty (the RSA
group). A total of forty-seven patients (twenty-three in the HA group and
twenty-four in the RSA group) were available for follow-up at a minimum of
two years. Result(s): Final average outcome scores were lower in the
HA group than in the RSA group (American Shoulder and Elbow Surgeons
[ASES] score of 62 versus 77 [p = 0.0001] and Simple Shoulder Test [SST]
of 5.8 versus 7.4 [p = 0.0062]), and patient-reported satisfaction was
lower in the HA group than in the RSA group (61% versus 91%; p = 0.038).
Radiographic healing of the tuberosities occurred in 61% of the patients
in the HA group compared with 83% of the patients in the RSA group (p =
0.17). Forward elevation of the arm was higher in the RSA group
(139degree) than in the HA group (100degree) (p = 0.0002), but no
significant differences were observed for shoulder external rotation or
internal rotation. Complication rates in both groups were similar. Three
patients (13%) in the HA group elected revision to reverse shoulder
arthroplasty because of failed tuberosity healing and resultant shoulder
pseudoparesis. Conclusion(s): In this series, reverse shoulder
arthroplasty resulted in better clinical outcomes and a similar
complication rate compared with hemiarthroplasty for the treatment of
comminuted proximal humeral fractures in the elderly. Level of
Evidence: Therapeutic Level II. See Instructions for Authors for a
complete description of levels of evidence.

<20>
Accession Number
633324119
Title
Use of dornase alfa in the paediatric intensive care unit: current
literature and a national cross-sectional survey.
Source
European Journal of Hospital Pharmacy. 29(3) (pp 123-128), 2022. Date of
Publication: 01 May 2022.
Author
Den Hollander B.; Linssen R.S.N.; Cortjens B.; Van Etten-Jamaludin F.S.;
Van Woensel J.B.M.; Bem R.A.
Institution
(Den Hollander, Linssen, Cortjens, Van Woensel, Bem) Pediatric Intensive
Care Unit, Emma Children's Hospital, Amsterdam UMC, Location Amc,
Amsterdam, Netherlands
(Van Etten-Jamaludin) Research Support, Medical Library, Amsterdam Umc
Location AMC, North Holland, Amsterdam, Netherlands
Publisher
BMJ Publishing Group
Abstract
Objectives Airway mucus obstruction is a major challenge in children
admitted to the paediatric intensive care unit (PICU). We aimed to
evaluate the evidence and contemporary use of the mucolytic medication
dornase alfa for non-cystic fibrosis conditions in the PICU. Methods (1)
We performed a systematic review with searches in PubMed, EMBASE, and the
Cochrane Library. Study selection: for quality assessment and data
synthesis, we included only randomised controlled trials (RCTs) that
compared dornase alfa to standard care or placebo in critically-ill
paediatric patients (<18 years of age) in the PICU. However,
non-randomised controlled studies and case series are also discussed. Data
extraction: data were extracted independently by multiple reviewers using
data extraction forms. The primary outcome was duration of mechanical
ventilation. Data synthesis: The GRADE approach was used for quality
assessment. No meta-analysis could be performed. (2) A national
cross-sectional survey among all seven PICUs in the Netherlands was also
performed. Results The systematic review yielded only one RCT, comparing
dornase alfa with normal saline in children after cardiac surgery. In this
study, dornase alfa led to a reduction in duration of mechanical
ventilation by approximately 1 day (36% reduction). In addition, we found
nine retrospective observational and case studies. The survey revealed
high current use of dornase alfa in Dutch PICUs: 42% of the respondents
reported prescribing dornase alfa at least once every week. Only 4% of the
respondents reported having access to a local PICU dornase alfa protocol.
Conclusions The off-label use of dornase alfa in the PICU is frequent
without strong evidence or local protocols, highlighting the need for
further research on the effectiveness of this mucolytic
agent. Copyright © Author(s) (or their employer(s)) 2022. Re-use
permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<21>
Accession Number
2006156290
Title
Subxiphoid versus intercostal video-assisted thoracic surgery for lung
resection: a meta-analysis.
Source
Minimally Invasive Therapy and Allied Technologies. 31(3) (pp 359-369),
2022. Date of Publication: 2022.
Author
Mei L.-X.; Wang Y.-Y.; Chen Y.; Dai L.; Chen M.-W.
Institution
(Mei, Wang, Chen, Dai, Chen) Department of Cardiothoracic Surgery, the
First Affiliated Hospital of GuangXi Medical University, Nanning, China
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: To systematically evaluate the safety and advantages of
subxiphoid approach video-assisted thoracic surgery (SA-VATS) compared
with intercostal approach video-assisted thoracic surgery (IA-VATS) for
lung resection, we conducted a meta-analysis of the current literature.
 Material(s) and Method(s): The literature search was conducted in
PubMed, Web of Science, Cochrane Library, Embase, and China National
Knowledge Infrastructure. RevMan 5.3 software was used to perform this
meta-analysis. Result(s): Eleven studies involving 934 patients were
included. Compared with patients in the IA-VATS group, those in the
SA-VATS group had lower pain scores on the day of the operation and at 24
h, 48 h and 72 h after the operation (p <.001) and suffered from less
postoperative paraesthesia at the first, third and sixth months after the
operation (p <.001). Moreover, there was no statistically significant
difference between the two groups regarding postoperative complications,
intraoperative blood loss, length of hospital stay, drainage amount, or
chest tube duration. However, SA-VATS had a longer operative time (p
<.001). Conclusion(s): SA-VATS is a safe surgical technique and has
superior postoperative outcomes over IA-VATS for lung resection in terms
of acute postoperative pain and chronic postoperative
paraesthesia. Copyright © 2020 Society of Medical Innovation and
Technology.

<22>
Accession Number
2018101418
Title
Determinants of Percutaneous Coronary Intervention and Coronary Artery
Bypass Grafting: A Systematic Review and Meta-analysis.
Source
Journal of Clinical and Diagnostic Research. 16(5) (pp PE01-PE05), 2022.
Date of Publication: May 2022.
Author
Bhaskaran P.; Sanal T.S.; Bhaskaran I.P.; Anastasiou N.
Institution
(Bhaskaran) Department of Cardiothoracic Surgery, Imperial College,
London, United Kingdom
(Sanal) Department of Biostatistics, Jothydev's Diabetes Hospital and
Research Centre, Kerala, Trivandrum, India
(Bhaskaran) Department of Cardiovascular Surgery, Imperial College,
London, United Kingdom
(Anastasiou) Department of Thoracic Surgery, General Oncology Hospital,
Agioi Anaragyroi, Athens, Greece
Publisher
Journal of Clinical and Diagnostic Research
Abstract
Introduction: Coronary Artery Bypass Graft (CABG) surgery has potential
benefits for patients with Coronary Artery Disease (CAD). The consensus
associated with Percutaneous Coronary Intervention (PCI) and CABG was in
terms of clinical outcomes, type of vessel disease, repeat
revascularization, stroke, myocardial infarction, and heart failure.
Hence, a comparison of PCI versus CABG is becoming important to identify
patients who would benefit from PCI and CABG. Aim(s): This review was
conducted to identify the pathophysiological determinants of PCI and CABG.
 Material(s) and Method(s): In the present systematic review, Medline
(PubMed), EMBASE, ProQuest, and the Cochrane database were searched, by
using the key words "PCI" OR "percutaneous coronary intervention" AND
"CABG" OR "coronary artery bypass grafting". The searches were restricted
from January 2009 to June 2021, with studies published in the English
language. Comparative studies of CABG versus PCI with stent placement were
the inclusion criteria. For meta-analysis Mantel-Haenszel Odds Ratio
(MHOR) with its 95% Confidence Interval (CI), Mean Difference (MD) with
its 95 % CI were computed. Result(s): Overall, 408 titles or
abstracts were identified from the initial search, of which full
manuscripts of 93 studies were retrieved, in the first phase. Later, 71
studies were excluded. Of the remaining 22 studies, 19 were subjected to
meta-analysis. This review contributes a sample size of 17,053. Mean age
of the study population of PCI group was 66.15+/-10.71 years and in CABG
group it was 66.16+/-9.43 years. PCI was performed among patients with
higher ejection fraction (MD=2.13; 95% CI=1.75 to 2.52) or higher Synergy
between percutaneous coronary intervention with Taxus and coronary artery
bypass surgery (SYNTAX) score score (MD=-3.43; 95% CI=-3.98 to -2.87).
CABG was considered for the patients with a higher Euro score (MD=0.28;
95% CI=0.2 to 0.35). conclusion: The ejection fraction, SYNTAX score, euro
score, type of vessel disease, chronic kidney disease, and diabetes are
the determinants of PCI and CABG. Copyright © 2022 Journal of
Clinical and Diagnostic Research. All rights reserved.

<23>
[Use Link to view the full text]
Accession Number
2018089382
Title
Vitamin K2 and D in Patients with Aortic Valve Calcification: A Randomized
Double-Blinded Clinical Trial.
Source
Circulation. 145(18) (pp 1387-1397), 2022. Date of Publication: 03 May
2022.
Author
Diederichsen A.C.P.; Lindholt J.S.; Moller S.; Ovrehus K.A.; Auscher So.;
Lambrechtsen J.; Hosbond S.E.; Alan D.H.; Urbonaviciene G.; Becker So.W.;
Fredgart M.H.; Hasific S.; Folkestad L.; Gerke O.; Rasmussen L.M.; Moller
J.E.; Mickley H.; Dahl J.S.
Institution
(Diederichsen, Ovrehus, Fredgart, Hasific, Mickley, Dahl) Department of
Cardiology, Odense University Hospital, J.B. Winslows Vej 4, Odense 5000,
Denmark
(Lindholt) Department of Cardiothoracic and Vascular Surgery, Odense
University Hospital, Denmark
(Moller) Open Patient Data Explorative Network, Odense University
Hospital, Denmark
(Folkestad) Department of Endocrinology, Odense University Hospital,
Denmark
(Gerke) Department of Nuclear Medicine, Odense University Hospital,
Denmark
(Rasmussen) Department of Clinical Biochemistry and Pharmacology, Odense
University Hospital, Denmark
(Auscher, Lambrechtsen) Department of Cardiology, Svendborg Hospital,
Denmark
(Hosbond, Alan) Department of Cardiology, Lillebaelt Hospital, Vejle,
Denmark
(Urbonaviciene, Becker) Department of Cardiology, Regional Hospital
Central Jutland, Silkeborg, Denmark
(Moller) Department of Cardiology, Copenhagen University Hospital, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Menaquinone-7 (MK-7), also known as vitamin K2, is a cofactor
for the carboxylation of proteins involved in the inhibition of arterial
calcification and has been suggested to reduce the progression rate of
aortic valve calcification (AVC) in patients with aortic stenosis.
 Method(s): In a randomized, double-blind, multicenter trial, men from
the community with an AVC score >300 arbitrary units (AU) on cardiac
noncontrast computer tomography were randomized to daily treatment with
tablet 720 microg MK-7 plus 25 microg vitamin D or matching placebo for 24
months. The primary outcome was the change in AVC score. Selected
secondary outcomes included change in aortic valve area and peak aortic
jet velocity on echocardiography, heart valve surgery, change in aortic
and coronary artery calcification, and change in dp-ucMGP
(dephosphorylated-undercarboxylated matrix Gla-protein). Safety outcomes
included all-cause death and cardiovascular events. Result(s): From
February 1, 2018, to March 21, 2019, 365 men were randomized. Mean age was
71.0 (+/-4.4) years. The mean (95% CI) increase in AVC score was 275 AU
(95% CI, 225-326 AU) and 292 AU (95% CI, 246-338 AU) in the intervention
and placebo groups, respectively. The mean difference on AVC progression
was 17 AU (95% CI, -86 to 53 AU; P=0.64). The mean change in aortic valve
area was 0.02 cm2(95% CI, -0.09 to 0.12 cm2; P=0.78)
and in peak aortic jet velocity was 0.04 m/s (95% CI, -0.11 to 0.02 m/s;
P=0.21). The progression in aortic and coronary artery calcification score
was not significantly different between patients treated with MK-7 plus
vitamin D and patients receiving placebo. There was no difference in the
rate of heart valve surgery (1 versus 2 patients; P=0.99), all-cause death
(1 versus 4 patients; P=0.37), or cardiovascular events (10 versus 10
patients; P=0.99). Compared with patients in the placebo arm, a
significant reduction in dp-ucMGP was observed with MK-7 plus vitamin D
(-212 pmol/L versus 45 pmol/L; P<0.001). Conclusion(s): In elderly
men with an AVC score >300 AU, 2 years MK-7 plus vitamin D supplementation
did not influence AVC progression. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03243890. Copyright © 2022 Lippincott Williams and Wilkins.
All rights reserved.

<24>
Accession Number
2017451115
Title
Design and baseline characteristics of participants in the COcoa
Supplement and Multivitamin Outcomes Study (COSMOS).
Source
Contemporary Clinical Trials. 116 (no pagination), 2022. Article Number:
106728. Date of Publication: May 2022.
Author
Rist P.M.; Sesso H.D.; Johnson L.G.; Aragaki A.K.; Wang L.; Rautiainen S.;
Hazra A.; Tobias D.K.; LeBoff M.S.; Schroeter H.; Friedenberg G.; Copeland
T.; Clar A.; Tinker L.F.; Hunt R.P.; Bassuk S.S.; Sarkissian A.; Smith
D.C.; Pereira E.; Carrick W.R.; Wion E.S.; Schoenberg J.; Anderson G.L.;
Manson J.E.
Institution
(Rist, Sesso, Hazra, Tobias, Friedenberg, Copeland, Clar, Bassuk,
Sarkissian, Smith, Pereira, Manson) Division of Preventive Medicine,
Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
United States
(Rist, Sesso, Manson) Department of Epidemiology, Harvard T.H. Chan School
of Public Health, Boston, MA, United States
(Johnson, Aragaki, Tinker, Hunt, Carrick, Wion, Schoenberg, Anderson)
Division of Public Health Sciences, Fred Hutchinson Cancer Research
Center, Seattle, WA, United States
(Wang) Epidemiology, Janssen Research & Development, LLC, Titusville, NJ,
United States
(Rautiainen) Department of Global Public Health, Karolinska Institute,
Stockholm, Sweden
(LeBoff) Division of Endocrinology, Diabetes and Hypertension, Brigham and
Women's Hospital and Harvard Medical School, Boston, MA, United States
(Schroeter) Mars Inc., 6885 Elm St, McLean, VA 22101, United States
Publisher
Elsevier Inc.
Abstract
Background Cocoa extract and multivitamins have been proposed to reduce
the risk of cardiovascular disease (CVD) and cancer, respectively.
However, few randomized clinical trials have tested their long-term
effects on these outcomes. Methods The COcoa Supplement and Multivitamin
Outcomes Study (COSMOS) is a randomized, double-blind, placebo-controlled,
2 x 2 factorial trial of a cocoa extract supplement and a multivitamin
supplement to reduce the risk of CVD and cancer. Here we describe the
pragmatic, hybrid design of the trial and baseline characteristics of the
trial participants. Results The nationwide study population includes
21,442 U.S. women aged >=65 years and men aged >=60 years without baseline
myocardial infarction (MI), stroke, or a recent (within the past 2 years)
cancer diagnosis. Participants were randomized in a 2 x 2 factorial design
to one of four groups: (1) cocoa extract (containing 500 mg/d flavanols,
including 80 mg (-)-epicatechin) and a multivitamin (Centrum
Silver©); (2) cocoa extract and multivitamin placebo; (3)
multivitamin and cocoa extract placebo; or (4) both placebos.
Randomization successfully distributed baseline demographic, clinical,
behavioral, and dietary characteristics across treatment groups. Baseline
biospecimens were collected from 6867 participants, with at least one
follow-up biospecimen from 2142 participants. The primary outcome for the
cocoa extract intervention is total CVD (a composite of MI, stroke,
cardiovascular mortality, coronary revascularization, unstable angina
requiring hospitalization, carotid artery surgery, and peripheral artery
surgery); the primary outcome for the multivitamin intervention is total
invasive cancer. Conclusion COSMOS will provide important information on
the health effects of cocoa extract and multivitamin supplementation in
older U.S. adults. Clinical Trials Registration: clinicaltrials.gov
#NCT02422745 Copyright © 2022 Elsevier Inc.

<25>
Accession Number
2018228944
Title
Doxycycline can reduce glycocalyx shedding by inhibiting matrix
metalloproteinases in patients undergoing cardiopulmonary bypass: A
randomized controlled trial.
Source
Microvascular Research. 142 (no pagination), 2022. Article Number: 104381.
Date of Publication: July 2022.
Author
Gao W.; Fang F.; Xia T.J.; Zhang Y.; Sun J.; Wu Q.; Wang W.
Institution
(Gao, Sun, Wu, Wang) Department of Anaesthesiology, The First Affiliated
Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou, China
(Fang) Department of Anaesthesiology, Zhejiang University School of
Medicine First Affiliated Hospital, Zhejiang Province, Hangzhou, China
(Xia) Department of Anaesthesiology, The Ohio State University College of
Medicine, Columbus, OH, United States
(Zhang) Department of the Operating Room, The First Affiliated Hospital of
Wenzhou Medical University, Zhejiang Province, Wenzhou, China
Publisher
Academic Press Inc.
Abstract
Background: Cardiopulmonary bypass (CPB) leads to shedding of the
glycocalyx of endothelial cells, resulting in a series of complications
such as tissue edema and coagulatory and microcirculatory dysfunctions.
Matrix metalloproteinases (MMPs) can cause glycocalyx shedding in a
variety of pathological processes, but their role in the process of CPB is
still unclear. We hypothesized that the MMPs inhibitor doxycycline would
reduce glycocalyx shedding by inhibiting MMPs during CPB. Method(s):
Thirty-six patients were randomized to receive either 100 mg oral
doxycycline (an MMPs inhibitor) or a matching placebo pill twice a day for
three days before CPB. The primary outcome was the concentration of plasma
syndecan-1. Secondary outcomes included heparan sulphate, MMP-2, MMP-9,
ratio of urinary albumin to creatinine, and short-term clinical outcomes.
In order to further prove that MMPs in plasma caused the glycocalyx
shedding, human umbilical vein endothelial cells were cultured with plasma
obtained from cardiac surgery patients before or after CPB (with or
without MMPs inhibitor GM6001). The change in glycocalyx content was
detected by immunofluorescence. Result(s): CPB resulted in an
increase of MMPs and shedding of the glycocalyx. Plasma syndecan-1 was
higher in the control group than in the doxycycline group (median
difference:15.04 mug/L; 95% CI: 9.14-20.94 mug/L; P < 0.001). Similar to
syndecan-1, plasma heparan sulphate, MMP-2, and MMP-9 concentrations in
the doxycycline group were significantly lower than those in the control
group during CPB. Doxycycline was also correlated with a reduction in the
ratio of urinary albumin to creatinine and improved the short-term
clinical outcomes of patients. Endothelial cells cultured with plasma from
patients after CPB showed significant shedding of syndecan-1 and heparan
sulphate (post-CPB group vs pre-CPB group, P < 0.001). GM6001 was shown to
reduce shedding of syndecan-1 and heparan sulphate by inhibiting MMPs
(post-CPB + GM6001 group vs post-CPB group, P < 0.001).
 Conclusion(s): Doxycycline can reduce glycocalyx shedding by
inhibiting MMPs during CPB. Copyright © 2022 Elsevier Inc.

<26>
Accession Number
2016693209
Title
Vaptans for oedematous and hyponatraemic disorders in childhood: A
systematic literature review.
Source
British Journal of Clinical Pharmacology. (no pagination), 2022. Date of
Publication: 2022.
Author
Piffer A.; Bianchetti M.G.; Leoni-Foglia C.; Simonetti G.D.; Milani G.P.;
Lava S.A.G.
Institution
(Piffer, Leoni-Foglia, Simonetti) Pediatric Institute of Southern
Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
(Bianchetti) Family Medicine, Faculty of Biomedical Sciences, Universita
della Svizzera Italiana, Lugano, Switzerland
(Bianchetti, Simonetti) Faculty of Biomedical Sciences, Universita della
Svizzera Italiana, Lugano, Switzerland
(Milani) Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore
Policlinico, Milan, Italy
(Milani) Department of Clinical Sciences and Community Health, Universita
degli Studi di Milano, Milan, Italy
(Lava) Pediatric Cardiology Unit, Department of Pediatrics, Centre
Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne,
Switzerland
(Lava) Heart Failure and Transplantation, Department of Pediatric
Cardiology, Great Ormond Street Hospital, London, United Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Aims: The aim of this study was to systematically review the use of
vaptans (nonpeptide vasopressin receptor antagonists) in children.
 Method(s): Through a database search (Web of Science, the National
Library of Medicine, Excerpta Medica), we identified case series and case
reports and extracted clinical and laboratory data. Result(s):
Twenty-six articles, published since 2008, reported on 226 patients. Among
115 children with hyponatraemic (n = 63) and oedematous disorders (n =
52), a 48 hour course of tolvaptan with an initial dose of 0.38 +/- 0.27
mg/kg was administered in 106 cases, while intravenous conivaptan was
reported in nine cases. An increase (P <.02) in urine output was shown in
both oedematous (from 3.2 +/- 2.0 to 5.3 +/- 6.7 mL/kg/day) and
hyponatraemic (from 3.0 +/- 1.5 to 4.4 +/- 2.3 mL/kg/day) patients. In
these latter, sodium increased from 125 +/- 6 to 133 +/- 6 mmol/L (P
<.0001). The increase in sodium level correlated with its basal value, but
not with the administered vaptan dose. Among 111 children undergoing
cardiac surgery, after tolvaptan 0.21 +/- 0.01 mg/kg/day, mostly combined
with conventional diuretics, an increase in diuresis by 41 +/- 4% was seen
within 24 hours (P <.0001). Similarly, a single add-on dose of tolvaptan
0.45 mg/kg allowed a reduced additional intravenous furosemide
administration (0.26 +/- 0.23 vs 0.62 +/- 0.48 mg/kg, P <.005). Side
effects were rarely reported, and included excessive thirst and xerostomia
in seven, skin rash in one and elevated aminotransferases in one
patient(s). Conclusion(s): Vaptans appear to be safe for oedematous
and hyponatraemic disorders also in children. Although they increase
diuresis and natraemia, no superiority to traditional diuretics and sodium
supplements has been demonstrated. Reported side effects are rare and
non-serious. Copyright © 2022 British Pharmacological Society.

<27>
Accession Number
2015002102
Title
Colchicine may become a new cornerstone therapy for coronary artery
disease: a meta-analysis of randomized controlled trials.
Source
Clinical Rheumatology. (no pagination), 2022. Date of Publication: 2022.
Author
Zhang H.; Chen Y.; Li M.; Luo W.; Liu Y.; Fu Y.; Xia H.; Xu C.; Jiang Y.;
Wu Y.
Institution
(Chen, Zhang, Chen, Li, Luo, Liu, Fu, Xia, Xu, Wu) Department of
Cardiovascular Medicine, Donghu District, The Second Affiliated Hospital
of Nanchang University, No. 1, Minde Road, Jiangxi, Nanchang 330006, China
(Jiang) Department of Cardiovascular Medicine, Donghu District, The First
Affiliated Hospital of Nanchang University, No. 17, Yongzhengwai Road,
Jiangxi, Nanchang 330006, China
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose: Colchicine is an ancient anti-inflammatory drug. In recent years,
an increasing number of studies have shown that colchicine improves the
prognosis of patients with coronary artery disease (CAD), while other
studies have reported the opposite. The aim of this study was to evaluate
the relative efficacy and safety of colchicine in treating CAD.
 Method(s): PubMed, EMBASE, the Cochrane Library, and
ClinicalTrials.gov were searched from inception to 20 October 2020 for
randomized controlled trials (RCTs) comparing colchicine and placebo in
patients with CAD. The primary outcomes were the primary composite
outcomes of cardiovascular death, myocardial infarction (MI), ischemic
stroke, or ischemia-driven coronary revascularization after colchicine
administration. The secondary outcomes were cardiovascular death, death
from any cause, noncardiac death, MI, ischemic stroke, coronary
revascularization, gastrointestinal (GI) symptoms, and the different
effects of colchicine in acute and chronic CAD. We assessed the pooled
odds ratio (OR) of all-cause and cardiovascular mortality for CAD in
fixed-effects models, the pooled risk ratio (RR) of the primary composite
outcomes, MI, ischemic stroke, and ischemia-driven coronary
revascularization in fixed-effects models and the pooled RR of GI symptoms
in random-effects models. The Cochrane risk of bias tool was used to
assess the risk of bias in the included RCTs. Finding(s): Eleven of
the 894 identified studies (n = 12,899 patients) were included (6501
subjects in the colchicine group; 6389 subjects in the control group). The
colchicine group had significantly lower pooled RRs of the primary
composite outcomes (0.73, 95% confidence interval (CI) 0.64-0.84, P <
0.0001), MI (0.77, 95% CI 0.64-0.92, P = 0.004), ischemic stroke (0.47,
95% CI 0.30-0.76, P = 0.002), and ischemia-driven coronary
revascularization (0.77, 95% CI 0.66-0.89, P = 0.0007), while the pooled
RR of adverse GI events (2.15 95% CI 1.40-3.31, P = 0.0005) was
significantly higher. Colchicine had a lower pooled RR of ischemic stroke
(0.28, 95% CI 0.12-0.65, P = 0.003) for patients with acute compared with
chronic CAD. Implications: Colchicine treatment significantly decreased
the risk of primary cardiovascular composite outcomes, MI, ischemic
stroke, and ischemia-driven coronary revascularization in CAD patients but
increased adverse GI events. There was no significant difference in
all-cause mortality, cardiovascular mortality, and non-cardiovascular
death between the colchicine and control groups. Colchicine performs
better in acute CAD patients with ischemic stroke than chronic CAD
patients. Colchicine might be a new treatment for patients with
CAD. Copyright © 2022, International League of Associations for
Rheumatology (ILAR).

<28>
Accession Number
638041858
Title
Stroke volume variation for predicting responsiveness to fluid therapy in
patients undergoing cardiac and thoracic surgery: a systematic review and
meta-analysis.
Source
BMJ open. 12(5) (pp e051112), 2022. Date of Publication: 18 May 2022.
Author
Huan S.; Dai J.; Song S.; Zhu G.; Ji Y.; Yin G.
Institution
(Huan, Dai, Song, Zhu, Yin) Department of Anesthesiology, Nanjing Second
Hospital, Nanjing, Jiangsu, China
(Huan, Ji, Yin) Nanjing Hospital Affiliated to Nanjing University of
Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
(Ji) Department of Critical Medicine, Second Hospital of Nanjing, Nanjing,
Jiangsu, China
(Yin) College of Public Health, Nanjing Medical University, Nanjing,
Jiangsu, China
Publisher
NLM (Medline)
Abstract
OBJECTIVE: To evaluate the reliability of stroke volume variation (SVV)
for predicting responsiveness to fluid therapy in patients undergoing
cardiac and thoracic surgery. DESIGN: Systematic review and meta-analysis.
DATA SOURCES: PubMed, EMBASE, Cochrane Library, Web of Science up to 9
August 2020. METHOD(S): Quality of included studies were assessed
with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We
conducted subgroup analysis according to different anaesthesia and
surgical methods with Stata V.14.0, Review Manager V.5.3 and R V.3.6.3. We
used random-effects model to pool sensitivity, specificity and diagnostic
odds ratio with 95%CI. The area under the curve (AUC) of receiver
operating characteristic was calculated. RESULT(S): Among the 20
relevant studies, 7 were conducted during thoracic surgery, 8 were
conducted during cardiac surgery and the remaining 5 were conducted in
intensive critical unit (ICU) after cardiac surgery. Data from 854
patients accepting mechanical ventilation were included in our systematic
review. The pooled sensitivity and specificity were 0.73 (95% CI: 0.59 to
0.83) and 0.62 (95% CI: 0.46 to 0.76) in the thoracic surgery group, 0.71
(95% CI: 0.65 to 0.77) and 0.76 (95% CI: 0.69 to 0.82) in the cardiac
surgery group, 0.85 (95% CI: 0.60 to 0.96) and 0.85 (95% CI: 0.74 to 0.92)
in cardiac ICU group. The AUC was 0.73 (95% CI: 0.69 to 0.77), 0.80 (95%
CI: 0.77 to 0.83) and 0.88 (95% CI: 0.86 to 0.92), respectively. Results
of subgroup of FloTrac/Vigileo system (AUC=0.80, Youden index=0.38) and
large tidal volume (AUC=0.81, Youden index=0.48) in thoracic surgery,
colloid (AUC=0.85, Youden index=0.55) and postoperation (AUC=0.85, Youden
index=0.63) in cardiac surgery, passive leg raising (AUC=0.90, Youden
index=0.72) in cardiac ICU were reliable. CONCLUSION(S): SVV had good
predictive performance in cardiac surgery or ICU after cardiac surgery and
had moderate predictive performance in thoracic surgery. Nevertheless,
technical and clinical variables may affect the predictive value
potentially. Copyright © Author(s) (or their employer(s)) 2022.
Re-use permitted under CC BY-NC. No commercial re-use. See rights and
permissions. Published by BMJ.

<29>
[Use Link to view the full text]
Accession Number
635476134
Title
Prevention of Cardiac Surgery-Associated Acute Kidney Injury by
Implementing the KDIGO Guidelines in High-Risk Patients Identified by
Biomarkers: The PrevAKI-Multicenter Randomized Controlled Trial.
Source
Anesthesia and Analgesia. 133(2) (pp 292-302), 2021. Date of Publication:
01 Aug 2021.
Author
Zarbock A.; Kullmar M.; Ostermann M.; Lucchese G.; Baig K.; Cennamo A.;
Rajani R.; McCorkell S.; Arndt C.; Wulf H.; Irqsusi M.; Monaco F.; Di
Prima A.L.; Garcia Alvarez M.; Italiano S.; Miralles Bagan J.; Kunst G.;
Nair S.; L'Acqua C.; Hoste E.; Vandenberghe W.; Honore P.M.; Kellum J.A.;
Forni L.G.; Grieshaber P.; Massoth C.; Weiss R.; Gerss J.; Wempe C.;
Meersch M.
Institution
(Zarbock, Kullmar, Massoth, Weiss, Wempe, Meersch) Department of
Anesthesiology Intensive Care and Pain Medicine, University Hospital
Munster, Albert-Schweitzer-Campus 1, Munster 48149, Germany
(Ostermann, Lucchese, Baig, Cennamo, Rajani, McCorkell) Department of
Critical Care, Guy's & St Thomas' National Health Service Foundation
Hospital, London, United Kingdom
(Arndt, Wulf) Department of Anesthesiology and Intensive Care Medicine,
United Kingdom
(Irqsusi) Department of Cardiac Surgery, University Hospital Marburg,
Marburg, Germany
(Monaco, Di Prima) Department of Anesthesia and Intensive Care, Istituto
di Ricovero e Cura A Carattere Scientifico San Raffaele Scientific
Institute, Milan, Italy
(Garcia Alvarez, Italiano, Miralles Bagan) Department of Anesthesiology,
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
(Kunst, Nair) Department of Anesthetics, King's College Hospital, Denmark
Hill, London, United Kingdom
(L'Acqua) Department of Anesthesia and Critical Care, Centro Cardiologico
Monzino Istituto di Ricovero e Cura A Carattere Scientifico, Milan, Italy
(Hoste, Vandenberghe) Department of Intensive Care Medicine, University
Hospital Gent, Gent, Belgium
(Honore) Department of Intensive Care, CHU Brugmann University Hospital,
Brussels, Belgium
(Kellum) Center for Critical Care Nephrology, Department of Critical Care
Medicine, University of Pittsburgh, Pittsburgh, PA, United States
(Forni) Department of Intensive Care Medicine, Royal Surrey County
Hospital & Faculty of Health Sciences, University of Surrey, Guildford,
United Kingdom
(Grieshaber) Department of Cardiac Surgery, University Hospital Giessen,
Giessen, Germany
(Gerss) Institute of Biostatistics and Clinical Research, University of
Munster, Munster, Germany
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Prospective, single-center trials have shown that the
implementation of the Kidney Disease: Improving Global Outcomes (KDIGO)
recommendations in high-risk patients significantly reduced the
development of acute kidney injury (AKI) after surgery. We sought to
evaluate the feasibility of implementing a bundle of supportive measures
based on the KDIGO guideline in high-risk patients undergoing cardiac
surgery in a multicenter setting in preparation for a large definitive
trial. METHOD(S): In this multicenter, multinational, randomized
controlled trial, we examined the adherence to the KDIGO bundle consisting
of optimization of volume status and hemodynamics, functional hemodynamic
monitoring, avoidance of nephrotoxic drugs, and prevention of
hyperglycemia in high-risk patients identified by the urinary biomarkers
tissue inhibitor of metalloproteinases-2 [TIMP-2] and insulin growth
factor-binding protein 7 [IGFBP7] after cardiac surgery. The primary end
point was the adherence to the bundle protocol and was evaluated by the
percentage of compliant patients with a 95% confidence interval (CI)
according to Clopper-Pearson. Secondary end points included the
development and severity of AKI. RESULT(S): In total, 278 patients
were included in the final analysis. In the intervention group, 65.4% of
patients received the complete bundle as compared to 4.2% in the control
group (absolute risk reduction [ARR] 61.2 [95% CI, 52.6-69.9]; P <.001).
AKI rates were statistically not different in both groups (46.3%
intervention versus 41.5% control group; ARR -4.8% [95% CI, -16.4 to 6.9];
P =.423). However, the occurrence of moderate and severe AKI was
significantly lower in the intervention group as compared to the control
group (14.0% vs 23.9%; ARR 10.0% [95% CI, 0.9-19.1]; P =.034). There were
no significant effects on other specified secondary outcomes.
 CONCLUSION(S): Implementation of a KDIGO-derived treatment bundle is
feasible in a multinational setting. Furthermore, moderate to severe AKI
was significantly reduced in the intervention group. Copyright ©
2021 Lippincott Williams and Wilkins. All rights reserved.

<30>
[Use Link to view the full text]
Accession Number
635468146
Title
Neuromuscular and Clinical Recovery in Thoracic Surgical Patients Reversed
with Neostigmine or Sugammadex.
Source
Anesthesia and Analgesia. 133(2) (pp 435-444), 2021. Date of Publication:
01 Aug 2021.
Author
Murphy G.S.; Avram M.J.; Greenberg S.B.; Bilimoria S.; Benson J.; Maher
C.E.; Teister K.J.; Szokol J.W.
Institution
(Murphy, Greenberg, Bilimoria, Benson, Maher, Teister, Szokol) Department
of Anesthesiology, NorthShore University HealthSystem, 2650 Ridge Ave,
Evanston, IL 60201, United States
(Avram) Department of Anesthesiology, Northwestern University Feinberg
School of Medicine, Chicago, IL, United States
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Patients undergoing thoracoscopic procedures may be at
high-risk for incomplete neuromuscular recovery and associated
complications. The aim of this clinical investigation was to assess the
incidence of postoperative residual neuromuscular blockade in adult
thoracic surgical patients administered neostigmine or sugammadex when
optimal dosing and reversal strategies for these agents were used. The
effect of choice of reversal agent on hypoxemic events and signs and
symptoms of muscle weakness were also determined. Additionally, operative
conditions in each group were graded by surgeons performing the
procedures. METHOD(S): Two hundred patients undergoing thoracoscopic
surgical procedures were enrolled in this nonrandomized controlled trial.
One hundred consecutive patients maintained at moderate levels of
neuromuscular blockade were reversed with neostigmine (neostigmine group)
followed by 100 consecutive patients given sugammadex to antagonize deeper
levels of neuromuscular blockade (sugammadex group). Anesthetic and
neuromuscular management were standardized. Surgeons rated operative
conditions at the conclusion of the procedure on a 4-point scale (grade 1
= excellent to grade 4 = poor). Train-of-four ratios were measured
immediately before extubation and at PACU admission (primary outcomes).
Postoperatively, patients were assessed for adverse respiratory events and
11 signs and 16 symptoms of muscle weakness. RESULT(S): The 2 groups
were similar in intraoperative management characteristics. The percentage
of patients with residual neuromuscular blockade, defined as a normalized
train-of-four ratio <0.9, was significantly greater in the neostigmine
group than the sugammadex group at both tracheal extubation (80% vs 6%,
respectively, P <.0001) and PACU admission (61% vs 1%, respectively, P
<.0001). Patients in the neostigmine group had less optimal operative
conditions (median score 2 [good] versus 1 [excellent] in the sugammadex
group; P <.0001), and more symptoms of muscle weakness were present in
these subjects (median number [interquartile range] 4 [1-8] vs 1 [0-2] in
the sugammadex group, P <.0001). No differences between groups in adverse
airway events were observed. CONCLUSION(S): Despite the application
of strategies documented to reduce the risk of residual neuromuscular
blockade, a high percentage of thoracoscopic patients whose neuromuscular
blockade was reversed with neostigmine were admitted to the PACU with
clinical evidence of residual paralysis. In contrast, muscle weakness was
rarely observed in patients whose neuromuscular blockade was antagonized
with sugammadex. Copyright © 2021 Lippincott Williams and
Wilkins. All rights reserved.

<31>
[Use Link to view the full text]
Accession Number
633761759
Title
Comparison of Self-Expanding Bioprostheses for Transcatheter Aortic Valve
Replacement in Patients with Symptomatic Severe Aortic Stenosis: SCOPE 2
Randomized Clinical Trial.
Source
Circulation. 142(25) (pp 2431-2442), 2020. Date of Publication: 22 Dec
2020.
Author
Tamburino C.; Bleiziffer S.; Thiele H.; Scholtz S.; Hildick-Smith D.;
Cunnington M.; Wolf A.; Barbanti M.; Tchetche D.; Garot P.; Pagnotta P.;
Gilard M.; Bedogni F.; Van Belle E.; Vasa-Nicotera M.; Chieffo A.; Deutsch
O.; Kempfert J.; Sondergaard L.; Butter C.; Trillo-Nouche R.; Lotfi S.;
Mollmann H.; Joner M.; Abdel-Wahab M.; Bogaerts K.; Hengstenberg C.;
Capodanno D.
Institution
(Tamburino, Capodanno) Department of General Surgery and Medical-Surgical
Subspecialties, University of Catania, Catania 95124, Italy
(Bleiziffer) Department of Cardiothoracic Surgery, Heart and Diabetes
Center Northrhein-Westfalia, Bad Oeynhausen, Germany
(Scholtz) Department of Interventional Cardiology, Heart and Diabetes
Center Northrhein-Westfalia, Bad Oeynhausen, Germany
(Thiele, Abdel-Wahab) Department of Cardiology, Heart Center Leipzig,
University Leipzig, Germany
(Hildick-Smith) Department of Cardiology, Brighton and Sussex University
Hospitals National Health Service Trust, Brighton, United Kingdom
(Cunnington) Department of Cardiology, Leeds General Infirmary, Leeds
Teaching Hospitals National Health Service Trust, United Kingdom
(Wolf) Department of Cardiology, Elisabeth Hospital Essen, Germany
(Barbanti) Department of Cardio-Thoracic-Vascular Diseases and
Transplantations, Azienda Ospedaliero-Universitaria Policlinico G.
Rodolico-San Marco, Catania, Italy
(Tchetche) Groupe CardioVasculaire Interventionnel, Clinique Pasteur,
Toulouse, France
(Garot) Hopital Prive Jacques Cartier, Institut Cardio-vasculaire
Paris-Sud, Ramsay-Sante, Massy, France
(Pagnotta) Department of Cardiovascular Medicine, Humanitas Clinical and
Research Center, Milano, Italy
(Gilard) Department of Cardiology, Brest University Hospital, France
(Bedogni) Cardiology Department, Istituti di Ricovero e Cura A Carattere
Scientifico Policlinico San Donato, Milano, Italy
(Van Belle) Department of Cardiology, University Hospital, Lille, France
(Vasa-Nicotera) Department of Cardiology, Goethe University Hospital
Frankfurt, Frankfurt am Main, Germany
(Chieffo) Interventional Cardiology Unit, Istituti di Ricovero e Cura A
Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
(Deutsch) Department of Cardiovascular Surgery, German Heart Centre
Munich, Germany
(Kempfert) Deutsches Herzzentrum Berlin, Charite Universitatsmedizin,
Berlin, Germany
(Sondergaard) The Heart Center-Rigshospitalet, Copenhagen, Denmark
(Butter) Department of Cardiology, Heart Center Brandenburg in Bernau and
Brandenburg Medical School, Germany
(Trillo-Nouche) Servicio de Cardiologia, Complejo Hospitalario
Universitario de Santiago de Compostela, Spain
(Lotfi) Department of Cardiovascular Surgery, University Hospital RWTH
Aachen, Germany
(Mollmann) Department of Cardiology, St Johannes Hospital, Dortmund,
Germany
(Joner) Klinik fur Herz und Kreislauferkrankungen, Deutsches Herzzentrum
Munchen, Munich, Germany
(Bogaerts) Department of Public Health and Primary Care, I-BioStat, KU
Leuven, Belgium
(Bogaerts) I-BioStat, Universiteit Hasselt, Belgium
(Hengstenberg) Department of Internal Medicine II, Medical University of
Vienna, Austria
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Few randomized trials have compared bioprostheses for
transcatheter aortic valve replacement, and no trials have compared
bioprostheses with supra-annular design. The SCOPE 2 trial (Safety and
Efficacy Comparison of Two TAVI Systems in a Prospective Randomized
Evaluation 2) was designed to compare the clinical outcomes of the ACURATE
neo and CoreValve Evolut bioprostheses for transcatheter aortic valve
replacement. Method(s): SCOPE 2 was a randomized trial performed at
23 centers in 6 countries between April 2017 and April 2019. Patients >=75
years old with an indication for transfemoral transcatheter aortic valve
replacement as agreed by the heart team were randomly assigned to receive
treatment with either the ACURATE neo (n=398) or the CoreValve Evolut
bioprostheses (n=398). The primary end point, powered for noninferiority
of the ACURATE neo bioprosthesis, was all-cause death or stroke at 1 year.
The key secondary end point, powered for superiority of the ACURATE neo
bioprosthesis, was new permanent pacemaker implantation at 30 days.
 Result(s): Among 796 randomized patients (mean age, 83.2+/-4.3 years;
mean Society of Thoracic Surgeons Predicted Risk of Mortality score,
4.6+/-2.9%), clinical follow-up information was available for 778 (98%)
patients. Within 1 year, the primary end point occurred in 15.8% of
patients in the ACURATE neo group and in 13.9% of patients in the
CoreValve Evolut group (absolute risk difference, 1.8%, upper 1-sided 95%
confidence limit, 6.1%; P=0.0549 for noninferiority). The 30-day rates of
new permanent pacemaker implantation were 10.5% in the ACURATE neo group
and 18.0% in the CoreValve Evolut group (absolute risk difference, -7.5%
[95% CI, -12.4 to -2.60]; P=0.0027). No significant differences were
observed in the components of the primary end point. Cardiac death at 30
days (2.8% versus 0.8%; P=0.03) and 1 year (8.4% versus 3.9%; P=0.01), and
moderate or severe aortic regurgitation at 30 days (10% versus 3%;
P=0.002) were significantly increased in the ACURATE neo group.
 Conclusion(s): Transfemoral transcatheter aortic valve replacement
with the self-expanding ACURATE neo did not meet noninferiority compared
with the self-expanding CoreValve Evolut in terms of all-cause death or
stroke at 1 year, and it was associated with a lower incidence of new
permanent pacemaker implantation. In secondary analyses, the ACURATE neo
was associated with more moderate or severe aortic regurgitation at 30
days and cardiac death at 30 days and 1 year. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03192813. Copyright © 2020 Lippincott Williams and Wilkins.
All rights reserved.

<32>
Accession Number
2018255876
Title
Effect of glutamate infusion on NT-proBNP after coronary artery bypass
grafting in highrisk patients (GLUTAMICS II): A randomized controlled
trial.
Source
PLoS Medicine. 19(5) (no pagination), 2022. Article Number: e1003997. Date
of Publication: May 2022.
Author
Holm J.; Ferrari G.; Holmgren A.; Vanky F.; Friberg O.; Vidlund M.;
Svedjeholm R.
Institution
(Holm, Vanky, Svedjeholm) Department of Thoracic and Vascular Surgery,
Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular
Medicine, Linkoping University, Linkoping, Sweden
(Ferrari, Friberg, Vidlund) Department of Cardiothoracic and Vascular
Surgery, Faculty of Medicine and Health, Health Care Research Center,
Orebro University, Orebro, Sweden
(Holmgren) Heart Center and Department of Public Health and Clinical
Medicine, Umea University, Umea, Sweden
(Vidlund) Department of Cardiothoracic Surgery, Sahlgrenska University
Hospital, Gothenburg, Sweden
Publisher
Public Library of Science
Abstract
Background AAUnim:
Palleaansdechounmfiramnthdaattaallshueagdgiensgtletvhealtsagrluertaepmreas
teencteadncoernrheactnlyc:e recovery of myocardial metabolism and function
after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP)
reflects myocardial dysfunction after coronary artery bypass surgery
(CABG). We investigated whether glutamate infusion can reduce rises of
NT-proBNP in moderate- to high-risk patients after CABG. Methods and
findings A prospective, randomized, double-blind study enrolled patients
from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4
academic cardiac surgery centers in Sweden. Patients underwent CABG +/-
valve procedure and had left ventricular ejection fraction <=0.30 or
EuroSCORE II >=3.0. Intravenous infusion of 0.125 M L-glutamic acid or
saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the
aortic cross-clamp, then continued for another 150 minutes. Patients,
staff, and investigators were blinded to the treatment. The primary
endpoint was the difference between preoperative and day-3 postoperative
NT-proBNP levels. Analysis was intention to treat. We studied 303 patients
(age 74 +/- 7 years; females 26%, diabetes 47%), 148 receiving glutamate
group and 155 controls. There was no significant difference in the primary
endpoint associated with glutamate administration (5,390 +/- 5,396 ng/L
versus 6,452 +/- 5,215 ng/ L; p = 0.086). One patient died <=30 days in
the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12).
No adverse events linked to glutamate were observed. A significant
interaction between glutamate and diabetes was found (p = 0.03). Among
patients without diabetes the primary endpoint (mean 4,503 +/- 4,846 ng/L
versus 6,824 +/-5,671 ng/L; p = 0.007), and the incidence of acute kidney
injury (11% versus 29%; p = 0.005) was reduced in the glutamate group.
These associations remained significant after adjusting for differences in
baseline data. The main limitations of the study are: (i) it relies on a
surrogate marker for heart failure; and (ii) the proportion of patients
with diabetes had almost doubled compared to the cohort used for the
sample size estimation. Conclusions Infusion of glutamate did not
significantly reduce postoperative rises of NT-proBNP. Diverging results
in patients with and without diabetes agree with previous observations and
suggest that the concept of enhancing postischemic myocardial recovery
with glutamate merits further evaluation. Copyright © 2022 Holm
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.

<33>
Accession Number
2018224699
Title
Comparison of Intra- and postoperative effectiveness of erector spinae
plane block and patient controlled analgesia in patients undergoing
coronary artery bypass grafting surgery.
Source
American Journal of Translational Research. 14(4) (pp 2469-2479), 2022.
Date of Publication: 2022.
Author
Ogur L.; Akesen S.; Goren S.; Kan I.I.; Mogol E.B.; Gurbet A.
Institution
(Ogur) Department of Anesthesiology and Reanimation, Bingol Public
Hospital, Bingol 12000, Turkey
(Akesen, Goren, Mogol, Gurbet) Department of Anesthesiology and
Reanimation, Bursa Uludag University, Faculty of Medicine, Bursa 16059,
Turkey
(Kan) Department of Cardiovascular Surgery, Bursa Uludag University,
Faculty of Medicine, Bursa 16059, Turkey
Publisher
E-Century Publishing Corporation
Abstract
The aim of our study was to compare bilateral erector spinae plane block
(ESPB) efficacy on pain management with patient controlled analgesia (PCA)
during the perioperative period in patients scheduled for coronary artery
bypass grafting (CABG). After ethics committee approval (2019-7/31 dated
09.04.2019) from the Bursa Uludag University Medical Trials Ethics
Committee, (https://uludag.edu.tr/buuetikkurulu) ASA II-III, 50 patients
aged between 18-80 years were included. They were randomly divided into
two groups, ESPB (n=25) and control (n=25). In the preoperative period,
bilateral ESPB with ultrasonography was applied to both groups with 0.25%
bupivacaine (0.5 ml/kg) + dexamethasone (8 mg) or saline, respectively.
PCA prepared with morphine was given to all patients postoperatively.
Perioperative opioid use, extubation times, coughing/resting Visual Analog
Scale (VAS) scores, duration for first PCA bolus dose requirement, rescue
analgesia needs, mobilization times, and opioid side effects were
evaluated. In the ESPB group, compared to the control group,
intraoperative fentanyl consumption was lower (P=0.001). During the
postoperative period; extubation time was shorter, the need for initial
PCA was much later, morphine consumption and need for rescue analgesia was
less (P=0.001; P<0.001; P<0.001; P=0.009, respectively). The postoperative
VAS scores were lower for each measurement period (P<0.05). Opioid-related
side effects were more common in the control group (P=0.040). First
mobilization time in ESPB group was earlier (P<0.001). As a result, ESPB
has a significant analgesic effect in CABG patients. It was concluded that
bilateral ESPB reduces opioid requirement compared to intravenous morphine
PCA alone and provides better pain management and more comfortable
recovery. Copyright © 2022 E-Century Publishing Corporation. All
rights reserved.

<34>
Accession Number
2018224472
Title
Single coronary artery originating from right sinus. Role of MDCT and a
review of literature.
Source
Monaldi Archives for Chest Disease. 92(2) (no pagination), 2022. Article
Number: 1915. Date of Publication: 2022.
Author
Pergola V.; Cabrelle G.; Barbiero G.; Dellino C.M.; Reffo E.; Di Salvo G.;
Motta R.
Institution
(Pergola, Dellino) Department of Cardiac, Thoracic and Vascular Sciences
and Public Health, University of Padua, Italy
(Cabrelle, Barbiero, Motta) Department of Medicine, Institute of
Radiology, University of Padua, Italy
(Reffo, Di Salvo) Department of Women's and Children's Health, University
of Padua, Italy
Publisher
Page Press Publications
Abstract
Single coronary artery (SCA) from the right sinus is the rarest coronary
anomaly. We describe 2 cases: 1 with SCA type-1RI; 2 with SCA type-2RII-A.
Appropriate and successful treatment (CABG in case-1; PTCA in case-2) was
chosen relying on accurate morphological description provided by MDCT, in
order to recognize all the possible mechanisms of myocardial
ischemia. Copyright © 2022 PAGEPress Publications. All rights
reserved.

<35>
Accession Number
2017089141
Title
P ostoperative but not preoperative depression is associated with
cognitive impairment after cardiac surgery: exploratory analysis of data
from a randomized trial.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 157. Date
of Publication: December 2022.
Author
Lewis C.; Dokucu M.E.; Brown C.H.; Balmert L.; Srdanovic N.; Madhan A.S.;
Samra S.S.; Csernansky J.; Grafman J.; Hogue C.W.
Institution
(Lewis, Hogue) Department of Anesthesiology, The Bluhm Cardiovascular
Institute, Northwestern University Feinberg School of Medicine, 251 East
Huron St, Feinberg 5-704, Chicago, IL 60611, United States
(Dokucu, Csernansky) Department of Psychiatry, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
(Brown) Department of Anesthesiology & Critical Care Medicine, The Johns
Hopkins University School of Medicine, Baltimore, MD, United States
(Balmert, Srdanovic) Department of Preventative Medicine, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
(Madhan, Samra) Medical Student, Northwestern University Feinberg School
of Medicine, Chicago, IL, United States
(Grafman) Department of Physical Medicine & Rehabilitation, Neurology,
Cognitive Neurology and Alzheimer's Center, Department of Psychiatry,
Northwestern University Feinberg School of Medicine, Weinberg College of
Arts and Sciences, Northwestern University, Chicago, IL, United States
Publisher
BioMed Central Ltd
Abstract
Background: In this study we hypothesize that depression is associated
with perioperative neurocognitive dysfunction and altered quality of life
one month after surgery. Method(s): Data were obtained as part of a
study evaluating cerebral autoregulation monitoring for targeting arterial
pressure during cardiopulmonary bypass. Neuropsychological testing was
performed before surgery and one month postoperatively. Testing included
the Beck Depression Inventory, a depression symptoms questionnaire (0-63
scale), as well as anxiety and quality of life assessments. Depression was
defined as a Beck Depression Inventory score > 13. Result(s): Beck
Depression data were available from 320 patients of whom cognitive domain
endpoints were available from 88-98% at baseline and 69-79% after surgery.
This range in end-points data was due to variability in the availability
of each neuropsychological test results between patients. Depression was
present in 50 (15.6%) patients before surgery and in 43 (13.4%) after
surgery. Baseline depression was not associated with postoperative
domain-specific neurocognitive function compared with non-depressed
patients. Those with depression one month after surgery, though, had
poorer performance on tests of attention (p = 0.017), memory (p = 0.049),
verbal fluency (p = 0.010), processing speed (p = 0.017), and fine motor
speed (p = 0.014). Postoperative neurocognitive dysfunction as a composite
outcome occurred in 33.3% versus 14.5% of patients with and without
postoperative depression (p = 0.040). Baseline depression was associated
with higher anxiety and lower self-ratings on several quality of life
domains, these measures were generally more adversely affected by
depression one month after surgery. Conclusion(s): The results of
this exploratory analysis suggests that preoperative depression is not
associated with perioperative neurocognitive dysfunction, but depression
after cardiac surgery may be associated with impairment in in several
cognitive domains, a higher frequency of the composite neurocognitive
outcome, and altered quality of life. Trial Registration:
www.clinicaltrials.gov, NCT00981474 (parent study). Copyright ©
2022, The Author(s).

<36>
Accession Number
2016817094
Title
Prior percutaneous coronary intervention and outcomes in patients after
coronary artery bypass grafting: a meta-analysis of 308,284 patients.
Source
Therapeutic Advances in Chronic Disease. 13 (no pagination), 2022. Date of
Publication: 2022.
Author
Zhang H.; Zhao Z.; Yao J.; Zhao J.; Hou T.; Wang M.; Xu Y.; Wang B.; Niu
G.; Sui Y.; Song G.; Wu Y.
Institution
(Zhang, Zhao, Yao, Zhao, Wang, Xu, Wang, Niu, Sui) Department of
Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
(Hou) Department of Cardiology, Cixian People's Hospital, Han Dan City,
China
(Song) Interventional Center of Valvular Heart Disease, Beijing Anzhen
Hospital, Capital Medical University, Beijing Institute of Heart, Lung,
and Blood Vessel Diseases, Anzhen road 2, Chaoyang District, Beijing
100029, China
(Wu) Department of Cardiology, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Road, 167, Xicheng District, Beijing
100037, China
Publisher
SAGE Publications Ltd
Abstract
Background: The association between prior percutaneous coronary
intervention (PCI) and prognosis after coronary artery bypass grafting
(CABG) remains uncertain. We aimed to evaluate the aforementioned
association in a meta-analysis. Method(s): PubMed, Cochrane's
Library, and Embase databases were searched for potential studies. A
random-effects model was used for the meta-analysis. Meta-regression was
performed to evaluate the influence of study characteristics on the
outcomes. Result(s): Thirty-six follow-up studies with 308,284
patients were included, and 40,892 (13.3%) patients had prior PCI. Pooled
results showed that prior PCI was associated with higher risks of early
(in-hospital or within 1 month) all-cause mortality [odds ratio (OR):
1.26, 95% confidence interval (CI): 1.11-1.44, p = 0.003; I2 =
64%] and major adverse cardiovascular events (MACEs; OR: 1.36, 95% CI:
1.12-1.66, p = 0.002, I2 = 79%), but not with late (follow-up
durations from 1 to 13 years) mortality (OR: 1.03, 95% CI: 0.95-1.13, p =
0.44, I2 = 46%) or MACEs (OR: 1.03, 95% CI: 0.97-1.09, p =
0.38, I2 = 0%). Meta-regression showed that the study
characteristics of patient number, age, sex, diabetic status, and
proportion of patients with prior PCI did not affect the outcomes.
Sensitivity analyses limited to multivariate studies excluding patients
with acute PCI failure showed similar results (early mortality, OR: 1.25,
p = 0.003; early MACE, OR: 1.50, p = 0.001; late mortality, OR: 1.03, p =
0.70). Conclusion(s): The current evidence, mostly from retrospective
observational studies, suggests that prior PCI is related to poor early
clinical outcomes, but not to late clinical outcomes, after
CABG. Copyright © The Author(s), 2022.

<37>
Accession Number
2018196260
Title
Segmentation Algorithm-Based Safety Analysis of Cardiac Computed
Tomography Angiography to Evaluate Doctor-Nurse-Patient Integrated Nursing
Management for Cardiac Interventional Surgery.
Source
Computational and Mathematical Methods in Medicine. 2022 (no pagination),
2022. Article Number: 2148566. Date of Publication: 2022.
Author
Zhang A.; Chen Q.
Institution
(Zhang) Intervention Section, South Hospital Of Chenzhou First People's
Hospital, Hunan, Chenzhou 423000, China
(Chen) Operation Room, South Hospital Of Chenzhou First People's Hospital,
Hunan, Chenzhou 423000, China
Publisher
Hindawi Limited
Abstract
To deeply analyze the influences of doctor-nurse-patient integrated
nursing management on cardiac interventional surgery, 120 patients with
coronary heart disease undergoing cardiac interventional therapy were
selected as the subjects and randomly divided into two groups, 60 cases in
each group. The experimental group used the doctor-nurse-patient
integrated nursing, while the control group adopted the routine nursing.
The Hessian matrix enhanced filter segmentation algorithm was used to
process the cardiac computed tomography angiography (CTA) images of
patients to assess the algorithm performance and the safety of nursing
methods. The results showed that the Jaccard, Dice, sensitivity, and
specificity of cardiac CTA images of patients with coronary heart disease
processed by Hessian matrix enhanced filter segmentation algorithm were
0.86, 0.93, 0.94, and 0.95, respectively; the disease self-management
ability score and quality of life score of patients in the experimental
group after nursing intervention were significantly better than those
before nursing intervention, with significant differences (P<0.05). The
number of cases with adverse vascular events in the experimental group was
3 cases, which was obviously lower than that in the control group (15
cases). The diagnostic accuracy of the two groups of patients after
segmentation algorithm processing was 0.87 and 0.88, respectively, which
was apparently superior than the diagnostic accuracy of conventional CTA
(0.58 and 0.61). In summary, cardiac CTA evaluation of
doctor-nurse-patient integrated nursing management cardiac interventional
surgery based on segmentation algorithm had good safety and was worthy of
further promotion in clinical cardiac interventional surgery.
 Copyright © 2022 Aiqiong Zhang and Qiuxiang Chen.

<38>
Accession Number
2018179203
Title
Editorial comments on 'Effects of ischaemic postconditioning in aortic
valve replacement: a multicenter randomized controlled trial'.
Source
European Journal of Cardio-thoracic Surgery. 61(5) (pp 1153-1154), 2022.
Date of Publication: 01 May 2022.
Author
Podesser B.K.; Kiss A.
Institution
(Podesser, Kiss) Ludwig Boltzmann Institute for Cardiovascular Research,
Center for Biomedical Research and Translational Surgery, Medical
University of Vienna, Wahringer Gurtel 18-20, Vienna 1090, Austria
(Podesser) Department of Cardiac Surgery, University Hospital St. Poelten,
Poelten, Austria
Publisher
European Association for Cardio-Thoracic Surgery

<39>
Accession Number
2018179202
Title
Effects of ischaemic postconditioning in aortic valve replacement: a
multicenter randomized controlled trial.
Source
European Journal of Cardio-thoracic Surgery. 61(5) (pp 1144-1152), 2022.
Date of Publication: 01 May 2022.
Author
Kaljusto M.-L.; Bautin A.; Jakobsen O.; Wilimski R.; Brunborg C.; Wennemo
M.; Karpova L.; Nergaard Aas K.; Arendarczyk A.; Landsverk S.A.; Galagudza
M.; Naesheim T.; Czub P.; Gordeev M.; Vaage J.
Institution
(Kaljusto) Department of Cardiothoracic Surgery, Oslo University Hospital,
Kirkeveien 166, Nydalen, Oslo 0424, Norway
(Bautin) Research Division of Anesthesiology and Intensive Care, Almazov
National Medical Research Centre, Saint Petersburg, Russian Federation
(Jakobsen, Nergaard Aas, Naesheim) Department of Thoracic and
Cardiovascular Surgery, University Hospital of North Norway, Tromso,
Norway
(Wilimski, Arendarczyk, Czub) Department of Cardiac Surgery, Medical
University of Warsaw, Warsaw, Poland
(Brunborg) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Oslo, Norway
(Wennemo, Landsverk) Department of Anesthesiology, Oslo University
Hospital, Oslo, Norway
(Karpova) Department of Anesthesiology, Almazov National Medical Research
Centre, Saint Petersburg, Russian Federation
(Galagudza) Institute of Experimental Medicine, Almazov National Medical
Research Centre, Saint Petersburg, Russian Federation
(Gordeev) Research Division of Cardiothoracic Surgery, Almazov National
Medical Research Centre, Saint Petersburg, Russian Federation
(Vaage) Institute of Clinical Medicine, University of Oslo, Oslo, Norway
(Vaage) Section of Physiology, Department of Molecular Medicine, Institute
of Basic Medical Sciences, University of Oslo, Oslo, Norway
(Vaage) Division of Emergencies and Critical Care, Department of Research
& Development, Oslo University Hospital, Oslo, Norway
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The effect of ischaemic postconditioning (IPost) on
postcardioplegic cardiac function is not known. We hypothesized that IPost
was cardioprotective in adult patients undergoing elective aortic valve
replacement. METHOD(S): In a multicentre, prospective, randomized
trial, patients (n = 209) were randomized to either a standard operation
(controls) or postconditioning. Immediately before the cross-clamp was
released, patients in the postconditioning group underwent 3 cycles of
flow/non-flow (2 min each) of normothermic blood via the antegrade
cardioplegia line. The primary end point was cardiac index. Secondary end
points included additional haemodynamic measurements, biomarkers of
cardiomyocyte injury, renal function parameters, intra- and postoperative
arrhythmias and use of inotropic agents. RESULT(S): There was no
significant difference between the groups regarding cardiac index [mean
between-group difference, 95% confidence interval (CI), 0.11 (-0.1 to
0.3), P = 0.27]. Postconditioning had no effect on other haemodynamic
parametres. There was no between-group difference regarding troponin T or
creatine kinase MB. Postconditioning reduced the relative risk for
arrhythmias by 45% (P = 0.03) when postoperative atrial fibrillation and
intraoperative ventricular fibrillation were combined. There were no
differences in patients with/without diabetes, patients above/below 70
years of age or between the centres. However, after postconditioning, the
cardiac index [95% CI, 0.46 (0.2-0.7), P = 0.001], cardiac output (P <
0.001), mean arterial pressure (P < 0.001) and left ventricular stroke
work index (P < 0.001) were higher in males compared to females.
 CONCLUSION(S): IPost had no overall cardioprotective effects in
patients undergoing aortic valve replacement but improved postoperative
cardiac performance in men compared to women. Copyright © 2021
The Author(s) 2021. Published by Oxford University Press on behalf of the
European Association for Cardio-Thoracic Surgery. All rights reserved.

<40>
Accession Number
2016601258
Title
The use of FEIBA for refractory bleeding in cardiac surgery - a systematic
review.
Source
Expert Review of Cardiovascular Therapy. (no pagination), 2022. Date of
Publication: 2022.
Author
Khoury W.; Servito M.; Wang L.; Baranchuk A.; Callum J.; Payne D.;
El-Diasty M.
Institution
(Khoury, Servito) School of Medicine, Queen's University, Kingston, ON,
Canada
(Wang) Department of Anesthesiology, Queen's University, Kingston, ON,
Canada
(Baranchuk) Division of Cardiology, Queen's University, Kingston, ON,
Canada
(Callum) Department of Pathology and Molecular Medicine, Queen's
University, Kingston, ON, Canada
(Payne, El-Diasty) Division of Cardiac Surgery, Queen's University,
Kingston, ON, Canada
Publisher
Taylor and Francis Ltd.
Abstract
Introduction: Significant blood loss during cardiac surgery is associated
with a dramatic increase in morbidity and mortality. Factor Eight
Inhibitor Bypassing Activity (FEIBA), a hemostatic bypassing agent mainly
used in hemophiliac patients, has also been used for intractable bleeding
during cardiac surgical procedures in non-hemophiliac patients. However,
concerns exist that its use may be linked to increased incidence of
perioperative adverse effects including thrombotic complications. Areas
covered: A systematic literature search was performed on MEDLINE, EMBASE,
and the Cochrane Central Register of Controlled Trials databases for all
studies that reported the administration of FEIBA for treatment of
bleeding during adult cardiac surgery in non-hemophiliac patients. After
selecting the title and abstracts, two authors assessed the methodological
quality of the full-text articles prior to final inclusion in the
manuscript. Expert opinion: The safety profile of FEIBA was determined
through an aggregate count of adverse events. Major complications included
renal failure, re-operation for unresolved bleeding, postoperative
mortality, and thromboembolic events. Overall, there is insufficient
robust evidence to make a definitive conclusion about the safety or
efficacy of using of FEIBA as a hemostatic agent in the setting of cardiac
surgery. Copyright © 2022 Informa UK Limited, trading as Taylor &
Francis Group.

<41>
Accession Number
2016907901
Title
What is the role of septal myectomy in aortic stenosis?.
Source
Revista Portuguesa de Cardiologia. 41(4) (pp 341-346), 2022. Date of
Publication: April 2022.
Author
Magro P.L.; Sousa Uva M.
Institution
(Magro, Sousa Uva) Department of Cardio-thoracic Surgery, Hospital de
Santa Cruz, Carnaxide, Portugal
Publisher
Sociedade Portuguesa de Cardiologia
Abstract
Asymmetric basal septal hypertrophy is present in 10% of patients with
hemodynamic significant aortic valve stenosis. From the surgeon's
standpoint, it represents a dilemma as it may be implicated in suboptimal
short and long-term results after aortic valve replacement (AVR), but also
heighten unwarranted complications at the time of surgical correction. To
provide insight about the usefulness and safety of concomitant septal
myectomy in this setting, we performed a literature review searching
Medline from its inception to November 2020 using the Pubmed interface.
Only five low evidence retrospective analyses, comprising a total of <200
patients undergoing AVR with concomitant septal myectomy, were found in
the literature. In summary, routine myectomy, in the presence of suspected
or directly visualized asymmetric septal hypertrophy on echocardiogram
during AVR, seems to be a safe procedure, with all authors reporting a low
rate or absence of complications. Overall, myectomy in this setting is
associated with superior echocardiographic results concerning surrogates
of LV remodelling (LVM; LVM index; LVM/height) and diastolic function
(E/E'), suggesting some benefit for hemodynamic outcomes. However, to what
extent hemodynamic improvement is exclusively attributable to myectomy is
uncertain, as is, the clinical significance of such an improvement, with
similar short and mid-term survival rates being reported. Copyright
© 2022 Sociedade Portuguesa de Cardiologia

<42>
Accession Number
2016767862
Title
Pragmatic Tips for Improving the Modern Outcomes of Coronary Artery Bypass
Operations.
Source
Journal of Tehran University Heart Center. 17(1) (pp 1-6), 2022. Date of
Publication: 2022.
Author
Marzban M.; Benharash P.
Institution
(Marzban, Benharash) Cardiovascular Outcomes Research Laboratories
(CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at
UCLA, Los Angeles, CA, United States
Publisher
Tehran Heart Center

<43>
Accession Number
2016382954
Title
Evaluating the Impact of Cardiopulmonary Bypass Priming Fluids on Bleeding
After Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 36(6) (pp 1584-1594),
2022. Date of Publication: June 2022.
Author
Siemens K.; Donnelly P.; Hunt B.J.; Carter M.J.; Murdoch I.A.; Tibby S.M.
Institution
(Siemens, Donnelly, Carter, Murdoch, Tibby) PICU Evelina London Children's
Hospital, St Thomas' Hospital, London, United Kingdom
(Hunt, Tibby) Haematology, St Thomas' Hospital, London, United Kingdom
Publisher
W.B. Saunders
Abstract
Objectives: Cardiopulmonary bypass (CPB) predisposes young children to
coagulopathy. The authors evaluated possible effects of CPB priming fluids
on perioperative bleeding in pediatric cardiac surgery. Design(s):
Meta-analysis and systematic review of previously published studies.
 Setting(s): Each study was conducted in a surgical center or
intensive care unit. Participant(s): Studies investigating patients
<18 years without underlying hematologic disorders were included.
 Intervention(s): The authors evaluated randomized controlled trials
(RCTs) published between 1980 and 2020 on MEDLINE, EMBASE, PubMed, and
CENTRAL databases. The primary outcome was postoperative bleeding;
secondary endpoints included blood product transfusion, mortality, and
safety. Measurements and Main Results: Twenty eligible RCTs were
analyzed, with a total of 1,550 patients and a median of 66 patients per
study (range 20-200). The most frequently assessed intervention was adding
fresh frozen plasma (FFP) to the prime (8/20), followed by albumin (5/20),
artificial colloids (5/20), and blood-based priming solutions (3/20). Ten
studies with 771 patients evaluated blood loss at 24 hours in mL/kg and
were included in a meta-analysis. Most of them investigated the addition
of FFP to the priming fluid (7/10). No significant difference was found
between intervention and control groups, with a mean difference of -0.13
(-2.61 to 2.34), p = 0.92, I2 = 69%. Further study endpoints
were described but their reporting was too heterogeneous to be
quantitatively analyzed. Conclusion(s): This systematic review of
current evidence did not show an effect of different CPB priming solutions
on 24-hour blood loss. The analysis was limited by heterogeneity within
the dataset regarding population, type of intervention, dosing, and the
chosen comparator, compromising any conclusions. Copyright © 2021
Elsevier Inc.

<44>
Accession Number
2017791338
Title
Thoracoscopic Versus Open Lobectomy After Induction Therapy for Nonsmall
Cell Lung Cancer: New Study Results and Meta-analysis.
Source
Journal of Surgical Research. 276 (pp 416-432), 2022. Date of Publication:
August 2022.
Author
Hireche K.; Canaud L.; Lounes Y.; Aouinti S.; Molinari N.; Alric P.
Institution
(Hireche, Canaud, Lounes, Alric) Department of Thoracic and Vascular
Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
(Hireche, Canaud, Lounes, Alric) PhyMedExp, University of Montpellier,
INSERM, CNRS, Montpellier, France
(Aouinti, Molinari) IDESP, INSERM, University of Montpellier, CHU
Montpellier, Montpellier, France
Publisher
Academic Press Inc.
Abstract
Introduction: The use of video-assisted thoracoscopic surgery (VATS)
lobectomy has become a mainstay of modern thoracic surgery practice and
the technique of choice for resection of early-stage lung cancers.
However, the benefits of VATS following induction therapy are yet to be
clarified. This study aims to assess whether VATS lobectomy achieves
similar perioperative and oncologic outcomes compared to thoracotomy for
nonsmall cell lung cancer after induction therapy. Method(s): We
retrospectively reviewed the outcomes of 72 patients who underwent lung
lobectomy after induction therapy in our institution from January 2017 to
January 2020. Subsequently, we carried out a comprehensive literature
search and pooled our results with available data from previously
published studies to perform a meta-analysis. Result(s): VATS was
associated with reduced intraoperative blood loss (P = 0.05) and less
perioperative complications (P = 0.04) in our local institution. The
meta-analysis comprised nine studies. A total of 943 patients underwent
VATS and 2827 patients underwent open lobectomy. VATS was associated with
significant shorter surgery duration (P < 0.0001), shorter chest-tube
drainage duration (P < 0.0001), and shorter hospital stays (P < 0.0001).
Furthermore, there was significantly less perioperative complications (P =
0.006) and less intraoperative blood loss (P = 0.036) in the VATS group.
However, there were no significant differences in 3-y overall survival and
3-y disease-free survival rates. Conclusion(s): In some selected
patients undergoing induction therapy, VATS lobectomy could achieve
equivalent perioperative outcomes to thoracotomy but evidence is lacking
on oncologic outcomes. Further trials with a focus on oncologic outcomes
and longer follow-up are required. Copyright © 2022 Elsevier Inc.

<45>
Accession Number
2017578666
Title
Meta-Analysis of Percutaneous Coronary Intervention Versus Coronary Artery
Bypass Grafting for Left Main Narrowing.
Source
American Journal of Cardiology. 173 (pp 39-47), 2022. Date of Publication:
15 Jun 2022.
Author
Chew N.W.S.; Ng C.-H.; Kong G.; Lee K.-S.; Tan D.J.H.; Lim O.Z.-H.; Chin
Y.H.; Tai B.C.; Gu T.; Park S.-J.; Park D.-W.; Morice M.-C.; Kofidis T.;
Yip J.W.L.; Loh P.-H.; Chan K.-H.; Low A.F.; Lee C.-H.; Yeo T.-C.; Tan
H.-C.; Chan M.Y.
Institution
(Chew, Yip, Loh, Chan, Low, Lee, Yeo, Tan, Chan) Department of Cardiology,
National University Heart Centre, National University Health System,
Singapore
(Ng, Kong, Tan, Lim, Chin, Kofidis, Yip, Loh, Chan, Low, Lee, Yeo, Tan,
Chan) Yong Loo Lin School of Medicine, National University of Singapore,
Singapore
(Lee) Bristol Medical School, University of Bristol, Bristol, United
Kingdom
(Tai, Gu) Biostatistics & Modelling Domain, Saw Swee Hock School of Public
Health, National University of Singapore
(Park, Park) Division of Cardiology, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, South Korea
(Morice) Cardiovascular European Research Center, Massy, France
(Kofidis) Department of Cardiac, Thoracic, Vascular Surgery, National
University Heart Centre, Singapore
Publisher
Elsevier Inc.
Abstract
Randomized controlled trials (RCTs) comparing percutaneous coronary
intervention (PCI) with drug-eluting stents and coronary artery bypass
grafting (CABG) for patients with left main coronary artery disease
(LMCAD) have reported conflicting results. We performed a systematic
review up to May 23, 2021, and 1-stage reconstructed individual patient
data meta-analysis (IPDMA) to compare outcomes between both groups. The
primary outcome was 10-year all-cause mortality. Secondary outcomes
included myocardial infarction (MI), stroke, and unplanned
revascularization at 5 years. We performed individual patient data
meta-analysis using published Kaplan-Meier curves to provide individual
data points in coordinates and numbers at risk were used to increase the
calibration accuracy of the reconstructed data. Shared frailty model or,
when proportionality assumptions were not met, a restricted mean survival
time model were fitted to compare outcomes between treatment groups. Of
583 articles retrieved, 5 RCTs were included. A total of 4,595 patients
from these 5 RCTs were randomly assigned to PCI (n = 2,297) or CABG (n =
2,298). The cumulative 10-year all-cause mortality after PCI and CABG was
12.0% versus 10.6%, respectively (hazard ratio [HR] 1.093, 95% confidence
interval [CI] 0.925 to 1.292; p = 0.296). PCI conferred similar time-to-MI
(restricted mean survival time ratio 1.006, 95% CI 0.992 to 1.021,
p=0.391) and stroke (restricted mean survival time ratio 1.005, 95% CI
0.998 to 1.013, p = 0.133) at 5 years. Unplanned revascularization was
more frequent after PCI than CABG (HR 1.807, 95% CI 1.524 to 2.144, p
<0.001) at 5 years. This meta-analysis using reconstructed
participant-level time-to-event data showed no statistically significant
difference in cumulative 10-year all-cause mortality between PCI versus
CABG in the treatment of LMCAD. Copyright © 2022 Elsevier Inc.

<46>
Accession Number
2016986751
Title
Predictors of health-related quality of life after cardiac surgery: a
systematic review.
Source
Health and Quality of Life Outcomes. 20(1) (no pagination), 2022. Article
Number: 79. Date of Publication: December 2022.
Author
Sanders J.; Bowden T.; Woolfe-Loftus N.; Sekhon M.; Aitken L.M.
Institution
(Sanders, Woolfe-Loftus) St Bartholomew's Hospital, Barts Health NHS
Trust, West Smithfield, London EC1A 7DN, United Kingdom
(Sanders) William Harvey Research Institute, Charterhouse Square, Queen
Mary University of London, London EC1M 6BQ, United Kingdom
(Bowden, Sekhon, Aitken) School of Health Sciences, City, University of
London, London EC1V 0HB, United Kingdom
(Aitken) School of Nursing and Midwifery, Griffith University, Nathan, QLD
4111, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Health-related quality of life (HRQoL) is important in
determining surgical success, particularly from the patients' perspective.
 Aim(s): To identify predictors for HRQoL outcome after cardiac
surgery in order to identify potentially modifiable factors where
interventions to improve patient outcomes could be targeted.
 Method(s): Electronic databases (including MEDLINE, CINAHL, Embase)
were searched between January 2001 and December 2020 for studies
determining predictors of HRQoL (using a recognised and validated tool) in
adult patients undergoing cardiac surgery. Data extraction and quality
assessments were undertaken and data was summarised using descriptive
statistics and narrative synthesis, as appropriate. Result(s):
Overall, 3924 papers were screened with 41 papers included in the review.
Considerable methodological heterogeneity between studies was observed.
Most were single-centre (75.6%) prospective observational studies (73.2%)
conducted in patients undergoing coronary artery bypass graft (CABG) (n =
51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent
predictors (62 pre-operative, five intra-operative and 36 post-operative)
were identified, where 34 (33.0%) were reported in more than one study.
Potential pre-operative modifiable predictors include alcohol use,
BMI/weight, depression, pre-operative quality of life and smoking while in
the post-operative period pain and strategies to reduce post-operative
complications and intensive care and hospital length of stay are potential
therapeutic targets. Conclusion(s): Despite a lack of consistency
across studies, several potentially modifiable predictors were identified
that could be targeted in interventions to improve patient or treatment
outcomes. This may contribute to delivering more person-centred care
involving shared decision-making to improve patient HRQoL after cardiac
surgery. Copyright © 2022, The Author(s).

<47>
Accession Number
2015743730
Title
Sublingual Sufentanil in Pain Management After Pulmonary Resection: A
Randomized Prospective Study.
Source
Annals of Thoracic Surgery. 113(6) (pp 1867-1872), 2022. Date of
Publication: June 2022.
Author
Lomangino I.; Berni A.; Lloret Madrid A.; Terzi S.; Melan L.; Cannone G.;
Rebusso A.; Zuin A.; Dell'Amore A.; Rea F.
Institution
(Lomangino, Berni, Lloret Madrid, Terzi, Melan, Cannone, Rebusso, Zuin,
Dell'Amore, Rea) Thoracic Surgery Unit, Department of Cardiac, Thoracic
and Vascular Sciences, and Public Health, University of Padova, Padova,
Italy
Publisher
Elsevier Inc.
Abstract
Background: Successful postoperative pain management after major lung
resection surgery is mostly achieved through intravenous administration of
analgesic drugs. This study explored the use of sublingual sufentanil
cartridges (Zalviso) as a noninvasive alternative to postoperative
analgesia. Method(s): From July 2019 to April 2020, patients who
underwent major thoracoscopic lung resection surgery were randomly
allocated to receive either intravenous pain management, or
patient-controlled analgesia by the Zalviso system. Pain assessment scores
were collected for a 72-hour time window, and requests for additional
medication due to insufficient pain control were recorded. Result(s):
Of the 80 patients enlisted, 40 were assigned to the Zalviso group and 40
to the control group. The groups were not statistically different from
each other. The difference in the mean pain scores reported was
statistically significant in the first 24 hours in favor of the Zalviso
group (P = .046), and the need for additional pain medication was
significantly higher in the control group (P = .004). Conclusion(s):
Patient-controlled analgesia using sublingual sufentanil cartridges can
provide effective pain relief for patients undergoing video-assisted
thoracic surgery and can reduce the need for additional medication,
offering a noninvasive alternative to traditional intravenous
therapy. Copyright © 2022 The Society of Thoracic Surgeons

<48>
Accession Number
638020564
Title
Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve
Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A
Randomized Clinical Trial.
Source
JAMA. 327(19) (pp 1875-1887), 2022. Date of Publication: 17 May 2022.
Author
Toff W.D.; Hildick-Smith D.; Kovac J.; Mullen M.J.; Wendler O.; Mansouri
A.; Rombach I.; Abrams K.R.; Conroy S.P.; Flather M.D.; Gray A.M.;
MacCarthy P.; Monaghan M.J.; Prendergast B.; Ray S.; Young C.P.; Crossman
D.C.; Cleland J.G.F.; de Belder M.A.; Ludman P.F.; Jones S.; Densem C.G.;
Tsui S.; Kuduvalli M.; Mills J.D.; Banning A.P.; Sayeed R.; Hasan R.;
Fraser D.G.W.; Trivedi U.; Davies S.W.; Duncan A.; Curzen N.; Ohri S.K.;
Malkin C.J.; Kaul P.; Muir D.F.; Owens W.A.; Uren N.G.; Pessotto R.;
Kennon S.; Awad W.I.; Khogali S.S.; Matuszewski M.; Edwards R.J.; Ramesh
B.C.; Dalby M.; Raja S.G.; Mariscalco G.; Lloyd C.; Cox I.D.; Redwood
S.R.; Gunning M.G.; Ridley P.D.
Institution
(Toff, Kovac, Mariscalco) Department of Cardiovascular Sciences,
University of Leicester, Leicester, United Kingdom
(Toff, Kovac, Mariscalco) National Institute for Health Research Leicester
Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
(Hildick-Smith, Trivedi) Sussex Cardiac Centre, Brighton and Sussex
University Hospitals NHS Trust, Brighton, United Kingdom
(Mullen) Institute of Cardiovascular Science, University College London,
London, United Kingdom
(Wendler) Department of Cardiothoracic Surgery, King's College Hospital
NHS Foundation Trust, London, United Kingdom
(Mansouri, Rombach) Oxford Clinical Trials Research Unit, Nuffield
Department of Orthopedics, Musculoskeletal Sciences, University of Oxford,
Rheumatology, Oxford, United Kingdom
(Abrams) Centre for Health Economics, University of York, York, United
Kingdom
(Abrams) Department of Statistics, University of Warwick, Coventry, United
Kingdom
(Abrams, Conroy) Department of Health Sciences, University of Leicester,
Leicester, United Kingdom
(Flather) Norwich Medical School, University of East Anglia, Norwich,
United Kingdom
(Gray) Health Economics Research Centre, Nuffield Department of Population
Health, University of Oxford, Oxford, United Kingdom
(MacCarthy, Monaghan) Department of Cardiology, King's College Hospital
NHS Foundation Trust, London, United Kingdom
(Prendergast) Department of Cardiology, St Thomas' Hospital, London,
United Kingdom
(Ray) Department of Cardiology, Manchester University NHS Foundation
Trust, Manchester, United Kingdom
(Young) Department of Cardiothoracic Surgery, St Thomas' Hospital, London,
United Kingdom
(Crossman) School of Medicine, University of St Andrews, Fife, United
Kingdom
(Cleland) Robertson Centre for Biostatistics and Glasgow Clinical Trials
Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow,
United Kingdom
(de Belder) National Institute for Cardiovascular Outcomes Research, Barts
Health NHS Trust, London, United Kingdom
(Ludman) Institute of Cardiovascular Sciences, Birmingham University,
Birmingham, United Kingdom
(Jones) Surgical Intervention Trials Unit, Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, United Kingdom
(Densem) Department of Cardiology, Royal Papworth Hospital, Cambridge,
United Kingdom
(Tsui) Department of Cardiothoracic Surgery, Royal Papworth Hospital,
Cambridge, United Kingdom
(Kuduvalli) Department of Cardiothoracic Surgery, Liverpool Heart and
Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
(Mills) Department of Cardiology, Liverpool Heart and Chest Hospital NHS
Foundation Trust, Liverpool, United Kingdom
(Banning) Department of Cardiology, John Radcliffe Hospital, Oxford
University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Sayeed) Department of Cardiothoracic Surgery, John Radcliffe Hospital,
Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
(Hasan) Department of Cardiothoracic Surgery, Manchester University NHS
Foundation Trust, Manchester, United Kingdom
(Fraser) Department of Cardiovascular Medicine, University of Manchester,
Manchester, United Kingdom
(Davies, Duncan) Cardiac Department, Royal Brompton Hospital, Royal
Brompton and Harefield NHS Foundation Trust, London, United Kingdom
(Curzen, Ohri) Wessex Cardiothoracic Centre, University Hospital
Southampton, Southampton, United Kingdom
(Malkin) Department of Cardiology, Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
(Kaul) Department of Cardiac Surgery, Leeds Teaching Hospitals NHS Trust,
Leeds, United Kingdom
(Muir) Department of Cardiology, James Cook University Hospital, South
Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
(Owens) Department of Cardiothoracic Surgery, James Cook University
Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United
Kingdom
(Uren, Pessotto) Edinburgh Heart Centre, Royal Infirmary of Edinburgh,
Edinburgh, United Kingdom
(Kennon, Awad) Barts Heart Centre, Barts Health NHS Trust, London, United
Kingdom
(Khogali, Matuszewski) Heart and Lung Centre, New Cross Hospital,
Wolverhampton, United Kingdom
(Edwards, Ramesh) Cardiothoracic Department, Newcastle upon Tyne
Hospitals, Newcastle upon Tyne, United Kingdom
(Dalby) Department of Cardiology, Harefield Hospital, Royal Brompton and
Harefield NHS Foundation Trust, London, United Kingdom
(Raja) Department of Cardiac Surgery, Harefield Hospital, Royal Brompton
and Harefield NHS Foundation Trust, London, United Kingdom
(Lloyd) Department of Cardiothoracic Surgery, Derriford Hospital,
Plymouth, United Kingdom
(Cox) Department of Cardiology, Derriford Hospital, Plymouth, United
Kingdom
(Redwood) Cardiovascular Division, King's College London, British Heart
Foundation Centre of Research Excellence, Rayne Institute, St Thomas'
Hospital, London, United Kingdom
(Gunning) Cardiology Department, Royal Stoke University Hospital,
Stoke-on-Trent, United Kingdom
(Ridley) Department of Cardiothoracic Surgery, Royal Stoke University
Hospital, Stoke-on-Trent, United Kingdom
Publisher
NLM (Medline)
Abstract
Importance: Transcatheter aortic valve implantation (TAVI) is a less
invasive alternative to surgical aortic valve replacement and is the
treatment of choice for patients at high operative risk. The role of TAVI
in patients at lower risk is unclear. Objective(s): To determine
whether TAVI is noninferior to surgery in patients at moderately increased
operative risk. Design, Setting, and Participant(s): In this
randomized clinical trial conducted at 34 UK centers, 913 patients aged 70
years or older with severe, symptomatic aortic stenosis and moderately
increased operative risk due to age or comorbidity were enrolled between
April 2014 and April 2018 and followed up through April 2019.
 Intervention(s): TAVI using any valve with a CE mark (indicating
conformity of the valve with all legal and safety requirements for sale
throughout the European Economic Area) and any access route (n=458) or
surgical aortic valve replacement (surgery; n=455). Main Outcomes and
Measures: The primary outcome was all-cause mortality at 1 year. The
primary hypothesis was that TAVI was noninferior to surgery, with a
noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI
for the absolute between-group difference in mortality. There were 36
secondary outcomes (30 reported herein), including duration of hospital
stay, major bleeding events, vascular complications, conduction
disturbance requiring pacemaker implantation, and aortic regurgitation.
 Result(s): Among 913 patients randomized (median age, 81 years [IQR,
78 to 84 years]; 424 [46%] were female; median Society of Thoracic
Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%)
completed follow-up and were included in the noninferiority analysis. At 1
year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%)
in the surgery group, with an adjusted absolute risk difference of -2.0%
(1-sided 97.5% CI, - to 1.2%; P<.001 for noninferiority). Of 30
prespecified secondary outcomes reported herein, 24 showed no significant
difference at 1 year. TAVI was associated with significantly shorter
postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8
days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were
significantly fewer major bleeding events after TAVI compared with surgery
(7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI,
0.24 to 0.45]) but significantly more vascular complications (10.3% vs
2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances
requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95%
CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%)
aortic regurgitation (adjusted odds ratio for mild, moderate, or severe
[no instance of severe reported] aortic regurgitation combined vs none,
4.89 [95% CI, 3.08 to 7.75]). Conclusions and Relevance: Among
patients aged 70 years or older with severe, symptomatic aortic stenosis
and moderately increased operative risk, TAVI was noninferior to surgery
with respect to all-cause mortality at 1 year. Trial Registration:
isrctn.com Identifier: ISRCTN57819173.

<49>
Accession Number
638016455
Title
Surgical Timing in Patients With Infective Endocarditis and With
Intracranial Hemorrhage: A Systematic Review and Meta-Analysis.
Source
Journal of the American Heart Association. 11(10) (pp e024401), 2022. Date
of Publication: 17 May 2022.
Author
Musleh R.; Schlattmann P.; Caldonazo T.; Kirov H.; Witte O.W.; Doenst T.;
Gunther A.; Diab M.
Institution
(Musleh, Witte, Gunther) Department of Neurology Jena University
HospitalFriedrich-Schiller-University Jena Jena Germany, Germany
(Schlattmann) Department of Medical Statistics Computer Science and Data
Science Jena University HospitalFriedrich-Schiller University Jena Jena
Germany, Germany
(Caldonazo, Kirov, Doenst, Diab) Department of Cardiothoracic Surgery Jena
University HospitalFriedrich-Schiller-University Jena Jena Germany,
Germany
Publisher
NLM (Medline)
Abstract
Background Intracranial hemorrhage (ICH) is one of the main causes for
lack of surgery in patients with infective endocarditis (IE), despite the
presence of surgical indications. We aimed to evaluate the impact of early
surgery in patients with IE and with ICH on postoperative neurological
deterioration and all-cause mortality and to elucidate the risk of 30-day
mortality in patients who were denied surgery. Methods and Results Three
libraries (MEDLINE, EMBASE, and Cochrane Library) were assessed. The
primary outcome was all-cause mortality, and the secondary outcome was
neurological deterioration. Inverse variance method and random model were
performed. We identified 16 studies including 355 patients. Nine studies
examined the impact of surgical timing (early versus late) and were
included in the meta-analysis. Only one study examined the fate of
patients with IE and with ICH who were treated conservatively despite
having an indication for cardiac surgery, showing higher mortality rates
than those who underwent surgery (11.8% versus 2.5%). We found no
significant association between early surgery, regardless of its
definition, and a higher mortality (odds ratio [OR], 1.69; 95% CI,
0.95-3.02). Early surgery was associated with higher risk for neurological
deterioration (OR, 2.00; 95% CI, 1.10-3.65). Conclusions Cardiac surgery
for IE within 30 days of ICH was not associated with higher mortality, but
with an increased rate of neurological deterioration. The 30-day mortality
in patients with IE and with ICH who were denied surgery has not yet been
sufficiently investigated. This patient group should be analyzed in future
studies in more detail.

<50>
Accession Number
2018179176
Title
Contemporary trends in the level of evidence in general thoracic surgery
clinical research.
Source
European Journal of Cardio-thoracic Surgery. 61(5) (pp 1012-1019), 2022.
Date of Publication: 01 May 2022.
Author
Choe S.-I.; Ben-Avi R.; Begum H.; Pearce K.; Mehta M.; Agzarian J.; Finley
C.J.; Hanna W.C.; Farrokhyar F.; Shargall Y.
Institution
(Choe, Ben-Avi, Begum, Pearce, Mehta, Agzarian, Finley, Hanna, Farrokhyar,
Shargall) Department of Surgery, Division of Thoracic Surgery, McMaster
University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East,
Hamilton, ON L8N 4A6, Canada
(Farrokhyar) Department of Health Research Methods, Evidence and Impact,
McMaster University, Hamilton, ON, Canada
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The large volume of scientific publications and the increasing
emphasis on high-quality evidence for clinical decision-making present
daily challenges to all clinicians, including thoracic surgeons. The
objective of this study was to evaluate the contemporary trend in the
level of evidence (LOE) for thoracic surgery clinical research.
 METHOD(S): All clinical research articles published between January
2010 and December 2017 in 3 major general thoracic surgery journals were
reviewed. Five authors independently reviewed the abstracts of each
publication and assigned a LOE to each of them using the 2011 Oxford
Centre for Evidence-Based Medicine classification scheme. Data extracted
from eligible abstracts included study type, study size, country of
primary author and type of study designs. Three auditing processes were
conducted to establish working definitions and the process was validated
with a research methodologist and 2 senior thoracic surgeons. Intra-class
correlation coefficient was calculated to assess inter-rater agreement.
Chi-square test and Spearman correlation analysis were then used to
compare the LOE between journals and by year of publication.
 RESULT(S): Of 2028 publications reviewed and scored, 29 (1.4%) were
graded level I, 75 (3.7%) were graded level II, 471 (23.2%) were graded
level III, 1420 (70.2%) were graded level IV and 33 (1.6%) were graded
level V (lowest level). Most publications (94.9%) were of lower-level
evidence (III-V). There was an overall increasing trend in the lower LOE
(P < 0.001). Inter-rater reliability was substantial with 95.5% (95%,
confidence interval: 0.95-0.96) level of agreement between reviewers.
 CONCLUSION(S): General thoracic surgery literature consists mostly of
lower LOE studies. The number of lower levels of evidence is dominating
the recent publications, potentially indicating a need to increase the
commitment to produce and disseminate higher-level evidence in general
thoracic surgery. Copyright © 2021 The Author(s) 2021. Published
by Oxford University Press on behalf of the European Association for
Cardio-Thoracic Surgery. All rights reserved.

<51>
Accession Number
2018179218
Title
Five-year outcomes in trials comparing transcatheter aortic valve
implantation versus surgical aortic valve replacement: a pooled
meta-analysis of reconstructed time-to-event data.
Source
European Journal of Cardio-thoracic Surgery. 61(5) (pp 977-987), 2022.
Date of Publication: 01 May 2022.
Author
Barili F.; Freemantle N.; Musumeci F.; Martin B.; Anselmi A.; Rinaldi M.;
Kaul S.; Rodriguez-Roda J.; Di Mauro M.; Folliguet T.; Verhoye J.-P.;
Sousa-Uva M.; Parolari A.
Institution
(Barili) Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
(Barili) Department of Epidemiology, Harvard T.H. Chan School of Public
Health, 677 Huntington Ave, Boston, MA 02115, United States
(Freemantle) Institute of Clinical Trials and Methodology, University
College London, London, United Kingdom
(Musumeci) Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, S. Camillo-Forlanini Hospital, Rome, Italy
(Martin) Department of Research and Third Mission Area, University of
Turin, Turin, Italy
(Anselmi, Verhoye) Division of Thoracic and Cardiovascular Surgery,
Pontchaillou University Hospital, Rennes, France
(Rinaldi) Department of Cardiac Surgery, Aou "citta della Salute e della
Scienza di Torino", University of Turin, Turin, Italy
(Kaul) Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles,
CA, United States
(Rodriguez-Roda) Department of Cardiac Surgery, Ramon y Cajal University
Hospital, Madrid, Spain
(Di Mauro) Cardiothoracic and Vascular Department, Maastricht University
Medical Center, Maastricht, Netherlands
(Folliguet) Department of Cardiac Surgery, Hopital Henri Mondor, Paris,
France
(Sousa-Uva) Department of Cardiothoracic Surgery, Hospital de Santa Crux,
Carnaxide, Portugal
(Parolari) Universitary Cardiac Surgery Unit, Irccs Policlinico S. Donato,
Italy
(Parolari) Department of Biomedical Sciences for Health, University of
Milan, Milan, Italy
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: The incidence of outcomes in trials comparing transcatheter
aortic valve implantation (TAVI) and surgical aortic valve replacement
(SAVR) is expected to be different in the short and long term. We planned
a meta-analysis of reconstructed time-to-event data from trials comparing
TAVI and SAVR to evaluate their time-varying effects on outcomes.
 METHOD(S): We performed a systematic review of the literature from
January 2007 through September 2021 on Medline, Embase, the Cochrane
Central Register of Controlled Trials and specialistic websites, including
randomized trials with allocation to TAVI or SAVR that reported at least
1-year follow-up and that graphed Kaplan-Meier curves of end points. The
comparisons were done with grouped frailty Cox models in a landmark
framework and fully parametric models. RESULT(S): Seven trials were
included (7770 participants). TAVI showed a lower incidence of the
composite of death or stroke in the first 6 months [risk-stratified hazard
ratio (HR) 0.66, 95% confidence interval (CI) 0.56-0.77, P-value <0.001],
with an HR reversal after 24 months favouring SAVR (risk-stratified HR
1.25; 95% CI 1.08-1.46; P-value 0.003). These outcomes were confirmed for
all-cause death (risk-stratified HR after 24 months 1.18; 95% CI
1.03-1.35; P-value 0.01). TAVI was also associated with an increased
incidence of rehospitalization after 6 months (risk-stratified HR 1.42;
95% CI 1.06-1.91; P-value 0.018) that got worse after 24 months
(risk-stratified HR 1.67; 95% CI 1.24-2.24; P-value <0.001).
 CONCLUSION(S): Although it could appear that there is no difference
between TAVI and SAVR in the 5-year cumulative results, TAVI shows a
strong protective effect in the short term that runs out after 1 year.
TAVI becomes a risk factor for all-cause mortality and the composite end
point after 24 months and for rehospitalization after 6 months.
 Copyright © 2021 The Author(s) 2021. Published by Oxford
University Press on behalf of the European Association for Cardio-Thoracic
Surgery. All rights reserved.

<52>
Accession Number
2018179217
Title
Transcatheter aortic valve replacement for structural degeneration of
previously implanted transcatheter valves (TAVR-in-TAVR): a systematic
review.
Source
European Journal of Cardio-thoracic Surgery. 61(5) (pp 967-976), 2022.
Date of Publication: 01 May 2022.
Author
Gallo M.; Fovino L.N.; Blitzer D.; Doulamis I.P.; Guariento A.; Salvador
L.; Tagliari A.P.; Ferrari E.
Institution
(Gallo, Ferrari) Department of Cardiac Surgery, Cardiocentro Ticino
Institute, Via Tesserete 48, Lugano 6900, Switzerland
(Gallo, Salvador) Department of Cardiac Surgery, San Bortolo Hospital,
Vicenza, Italy
(Fovino) Department of Cardiology, University of Padova, Padova, Italy
(Blitzer) Department of Surgery, New York Presbyterian Hospital, Columbia
University, New York, NY, United States
(Doulamis) Department of Cardiac Surgery, Boston Children's Hospital,
Harvard Medical School, Boston, MA, United States
(Guariento) Department of Cardiovascular Surgery, Labatt Family Heart
Centre, The Hospital for Sick Children, University of Toronto, Toronto,
ON, Canada
(Tagliari) Postgraduate Program in Health Sciences: Cardiology and
Cardiovascular Sciences, Universidade Federal Do Rio Grande Dosul, Porto
Alegre, Brazil
(Ferrari) University of Zurich, Zurich, Switzerland
Publisher
European Association for Cardio-Thoracic Surgery
Abstract
OBJECTIVES: Transcatheter aortic valve replacement (TAVR) represents a
valid treatment for patients with aortic valve stenosis and high or
intermediate surgical risk. However, biological transcatheter valves can
also experience a structural degeneration after years, and a redo-TAVR
procedure (TAVR-in-TAVR) can be a valid option. We revised the current
available literature for indications, procedural and technical details and
outcome on TAVR-in-TAVR procedures for degenerated TAVR valves.
 METHOD(S): A systematic search was conducted in the public medical
database for scientific articles on TAVR-in-TAVR procedures for
degenerated transcatheter valves. Data on demographics, indications, first
and second transcatheter valve type and size, mortality, complications and
follow-up were extracted and analysed. RESULT(S): A total of 13
studies (1 multicentre, 3 case series, 9 case reports) were included in
this review, with a total amount of 160 patients treated with TAVR-in-TAVR
procedures for transcatheter valve failure. The mean age was 74.8 +/- 7.8
with 84 males (52.8%). The mean elapsed time from the first TAVR procedure
was 58.1 +/- 23.4 months. Main indication for TAVR-in-TAVR was pure
stenosis (38.4%, with mean gradient of 44.5 +/- 18.5 mmHg), regurgitation
(31.4%), mixed stenosis and regurgitation (29.5%) and leaflet thrombosis
(8.8%). Procedural success rate was 86.8%, with second TAVR valve
malposition occurred in 4 cases (2.5%). The hospital mortality rate was
1.25% (2/160). Post-procedural echocardiographic control showed moderate
regurgitation in 5.6% of patients (9/160) and residual transvalvular mean
gradient >=20 mmHg in 5% of cases. Postoperative complications included
major vascular complications (8.7%), new pacemaker implantation (8.7%),
acute kidney failure (3.7%), stroke (0.6%) and coronary obstruction
(0.6%). The mean follow-up time was 6 +/- 5.6 months with 1
non-cardiovascular death reported. CONCLUSION(S): TAVR-in-TAVR
represents a valid alternative to standard surgery for the treatment of
degenerated transcatheter valves in high-risk patients. Despite these
promising results, further studies are required to assess durability and
haemodynamic performances of the second TAVR valve. Copyright ©
2021 The Author(s) 2021. Published by Oxford University Press on behalf of
the European Association for Cardio-Thoracic Surgery. All rights reserved.

<53>
Accession Number
2018121398
Title
Evaluation of a Clinical Decision Support System for the most
evidence-based approach to managing perioperative anticoagulation.
Source
Journal of Clinical Anesthesia. 80 (no pagination), 2022. Article Number:
110877. Date of Publication: September 2022.
Author
Buchner L.-M.; Park E.J.; Bendz P.; Englert A.; von der Groeben C.; Vo L.;
Schmitt E.; Zacharowski K.; Borm P.; Stauber D.; Bingold T.; Booke M.;
Gerth M.; Greim C.-A.; Mersmann J.; Muellenbach R.M.; Mutlak H.; Ott B.;
Pape A.; Sander M.; Tessmann R.; Welte M.; Wermelt J.; Wulf H.;
Choorapoikayil S.; Fullenbach C.; Meybohm P.
Institution
(Buchner, Park, von der Groeben, Vo, Schmitt, Zacharowski, Choorapoikayil,
Fullenbach, Meybohm) Department of Anaesthesiology, Intensive Care
Medicine and Pain Therapy, Goethe University, University Hospital
Frankfurt, Frankfurt am Main, Germany
(Bendz, Englert, Meybohm) Department of Anaesthesiology, Intensive Care,
Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg,
Germany
(Borm, Stauber) Borm Bruckmeier Verlag GmbH, Munich, Germany
(Bingold) Department of Anaesthesiology, Helios Dr. Horst Schmidt Hospital
Wiesbaden, Wiesbaden, Germany
(Booke) Department of Anaesthesiology, Hospital Bad Soden, Bad Soden,
Germany
(Gerth) Department of Anaesthesiology, University Hospital Mainz, Mainz,
Germany
(Greim) Department of Anaesthesiology, Hospital Fulda, Fulda, Germany
(Mersmann) Department of Anaesthesiology, Hochtaunus Hospital Bad Homburg,
Bad Homburg, Germany
(Muellenbach) Department of Anaesthesiology, Hospital Kassel, Kassel,
Germany
(Mutlak) Department of Anaesthesiology, Sanaklinikum Offenbach, Offenbach,
Germany
(Ott) Department of Anaesthesiology, BG Unfallklinik Murnau, Murnau,
Germany
(Pape) Department of Anaesthesiology, Sankt Katharinen Hospital Frankfurt,
Frankfurt, Germany
(Sander) Department of Anaesthesiology, University Hospital Giesen,
Germany
(Tesmann) Department of Anaesthesiology, BG Unfallklinik Frankfurt,
Frankfurt, Germany
(Welte) Department of Anaesthesiology, Hospital Darmstadt, Darmstadt,
Germany
(Wermelt) Department of Anaesthesiology, Burgerhospital Frankfurt,
Frankfurt, Germany
(Wulf) Department of Anaesthesiology, University Hospital Marburg,
Marburg, Germany
Publisher
Elsevier Inc.
Abstract
Study objective: We explored the feasibility of a Clinical Decision
Support System (CDSS) to guide evidence-based perioperative
anticoagulation. Design(s): Prospective randomised clinical
management simulation multicentre study. Setting(s): Five University
and 11 general hospitals in Germany. Participant(s): We enrolled
physicians (anaesthesiologist (n = 73), trauma surgeons (n = 2), unknown
(n = 1)) with different professional experience. Intervention(s): A
CDSS based on a multiple-choice test was developed and validated at the
University Hospital of Frankfurt (phase-I). The CDSS comprised European
guidelines for the management of anticoagulation in cardiology,
cardio-thoracic, non-cardio-thoracic surgery and anaesthesiology. Phase-II
compared the efficiency of physicians in identifying evidence-based
approach of managing perioperative anticoagulation. In total 168
physicians were randomised to CDSS (PERI-KOAG) or CONTROL. Measurements:
Overall mean score and association of processing time and professional
experience were analysed. The multiple-choice test consists of 11 cases
and two correct answers per question were required to gain 100% success
rate (=22 points). Main Result(s): In total 76 physicians completed
the questionnaire (n = 42 PERI-KOAG; n = 34 CONTROL; attrition rate 54%).
Overall mean score (max. 100% = 22 points) was significantly higher in
PERI-KOAG compared to CONTROL (82 +/- 15% vs. 70 +/- 10%; 18 +/- 3 vs. 15
+/- 2 points; P = 0.0003). A longer processing time is associated with
significantly increased overall mean scores in PERI-KOAG (>=33 min. 89 +/-
10% (20 +/- 2 points) vs. <33 min. 73 +/- 15% (16 +/- 3 points), P =
0.0005) but not in CONTROL (>=33 min. 74 +/- 13% (16 +/- 3 points) vs. <33
min. 69 +/- 9% (15 +/- 2 points), P = 0.11). Within PERI-KOAG, there is a
tendency towards higher results within the more experienced group (>5
years), but no significant difference to less (<=5 years) experienced
colleagues (87 +/- 10% (19 +/- 2 points) vs. 78 +/- 17% (17 +/- 4 points),
P = 0.08). However, an association between professional experience and
success rate in CONTROL has not been shown (71 +/- 8% vs. 70 +/- 13%, 16
+/- 2 vs. 15 +/- 3 points; P = 0.66). Conclusion(s): CDSS
significantly improved the identification of evidence-based treatment
approaches. A precise usage of CDSS is mandatory to maximise
efficiency. Copyright © 2022 Elsevier Inc.

<54>
Accession Number
2018222019
Title
Standardized Aortic Valve Neocuspidization for Treatment of Aortic Valve
Diseases.
Source
Annals of Thoracic Surgery. (no pagination), 2022. Date of Publication:
2022.
Author
Amabile A.; Krane M.; Dufendach K.; Baird C.W.; Ganjoo N.; Eckstein F.S.;
Albertini A.; Gruber P.J.; Mumtaz M.A.; Bacha E.A.; Benedetto U.; Chikwe
J.; Geirsson A.; Holfeld J.; Iida Y.; Lange R.; Morell V.O.; Chu D.
Institution
(Amabile, Krane, Geirsson) Division of Cardiac Surgery, Department of
Surgery, Yale University School of Medicine, New Haven, Connecticut,
United States
(Dufendach, Ganjoo, Morell, Chu) Division of Cardiac Surgery, Department
of Cardiothoracic Surgery, University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States
(Mumtaz, Morell, Chu) University of Pittsburgh Medical Center Heart and
Vascular Institute, Pittsburgh, PA, United States
(Baird) Department of Cardiac Surgery, Boston Children's Hospital, Harvard
Medical School, Boston, Massachusetts, United States
(Eckstein) Department of Cardiac Surgery, University Hospital Basel,
University of Basel, Switzerland
(Albertini) Cardiovascular Surgery Department, Maria Cecilia Hospital GVM
Care and Research, Cotignola, Revenna, Italy
(Gruber, Bacha) Division of Cardiac, Thoracic, and Vascular Surgery,
Section of Pediatric and Congenital Heart Surgery, Columbia University
Medical Center/New York-Presbyterian Hospital, New York, New York, United
States
(Benedetto) Department of Cardiac Surgery, University Chieti-Pescara,
Chieti, Italy
(Chikwe) Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt
Heart Institute, Los Angeles, California, United States
(Holfeld) Department of Cardiac Surgery, Innsbruck Medical University,
Innsbruck, Austria
(Iida) Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu
Hospital, Yokohama, Japan
(Lange) Department of Cardiovascular Surgery, German Heart Center, Munich,
Germany
Publisher
Elsevier Inc.
Abstract
Background: Aortic valve replacement is the traditional surgical treatment
for aortic valve diseases, yet standardized aortic valve neocuspidization
(AVNeo) is a promising alternative that is gaining popularity. The purpose
of this article is to review the available published literature of AVNeo
using glutaraldehyde-treated autologous pericardium, also known as the
Ozaki procedure, including indications, outcomes, potential benefits, and
modes of failure for the reconstructed valve. Method(s): A
comprehensive literature search was performed using keywords related to
aortic valve repair, AVNeo, or Ozaki procedure. All articles describing
performance of AVNeo were reviewed. Result(s): Reported early
mortality after AVNeo varies from 0% to 5.88%. The largest cohort of
patients in the literature includes 850 patients with an inhospital
mortality rate of 1.88%. Cumulative incidence of aortic valve reoperation
was 4.2% in the largest series. Reoperation was uncommon and mainly due to
infective endocarditis or degeneration of the reconstructed valve (most
commonly due to aortic valve regurgitation, rather than stenosis).
 Conclusion(s): Aortic valve neocuspidization is a versatile and
standardized alternative to aortic valve replacement with a biological
prosthesis. Early to midterm outcomes from a number of centers are
excellent and demonstrate the safety and durability of the procedure.
Long-term outcomes and clinical trial data are necessary to determine
which patients benefit the most from this procedure. Copyright ©
2022 The Society of Thoracic Surgeons

<55>
Accession Number
2018221832
Title
Effect of Intraoperative Phrenic Nerve Infiltration on Postoperative
Ipsilateral Shoulder Pain After Thoracic Surgeries: A Systematic Review
and Meta-Analysis of Randomized Controlled Studies.
Source
Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2022.
Date of Publication: 2022.
Author
Hung Y.-A.; Sun C.-K.; Chiang M.-H.; Chen J.-Y.; Ko C.-C.; Chen C.-C.;
Chen Y.; Teng I.-C.; Hung K.-C.
Institution
(Hung) Department of Anesthesiology, Taichung Veterans General Hospital,
Taichung City, Taiwan (Republic of China)
(Sun) Department of Emergency Medicine, E-Da Hospital, Kaohsiung city,
Taiwan (Republic of China)
(Sun) College of Medicine, I-Shou University, Kaohsiung city, Taiwan
(Republic of China)
(Chiang) Department of Anesthesiology, Shin Huey Shin Hospital, Kaohsiung,
Taiwan (Republic of China)
(Chen) Division of Nephrology, Department of Internal Medicine, Chi Mei
Medical Center, Tainan, Taiwan (Republic of China)
(Chen) Department of Health and Nutrition, ChiaNai University of Pharmacy
and Science, Tainan City, Taiwan (Republic of China)
(Ko) Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
(Republic of China)
(Chen) Department of Anesthesiology, Kaohsiung Chang Gung Memorial
Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
(Republic of China)
(Chen) Department of Cardiovascular and Thoracic Surgery, Kaohsiung Chang
Gung Memorial Hospital and Chang Gung University College of Medicine,
Kaohsiung, Taiwan (Republic of China)
(Ko, Teng, Hung) Department of Anesthesiology, Chi Mei Medical Center,
Tainan, Taiwan (Republic of China)
Publisher
W.B. Saunders
Abstract
Objectives: This meta-analysis was aimed at investigating the
effectiveness and safety of phrenic nerve infiltration (PNI) against
ipsilateral shoulder pain (ISP) after thoracic surgery. Design(s): A
systematic review and meta-analysis of randomized controlled trials
(RCTs). Setting(s): Operating room. Participant(s): Patients
undergoing thoracic surgery. Intervention(s): PNI. Measurements
and Main Results: MEDLINE, Cochrane Library, and EMBASE databases were
searched from inception through December 2021. The primary outcome was the
overall incidence of ISP, with secondary outcomes including incidence and
severity of ISP at postoperative 6, 24, and 48 hours. Six RCTs involving
482 patients undergoing thoracic surgery were included. Pooled results
found a significantly lower incidence of overall ISP in patients with PNI
(ie, 23.6%) compared to those without (ie, 53.2%; risk ratio: 0.46, 95%
confidence interval: 0.34-0.61; I2 = 19%; 6 RCTs; n = 474;
certainty of evidence = high). At postoperative 6, 24, and 48 hours, there
was also a significantly lower incidence of ISP in the PNI group than in
the control group (certainty of evidence for all outcomes = high).
Besides, the severity of ISP was lower in the PNI group at 6 (certainty of
evidence = moderate) and 24 hours (certainty of evidence = high), with
insufficient data for analysis at 48 hours because of only 1 trial.
 Conclusion(s): This meta-analysis showed that PNI not only reduced
the incidence but also improved the severity of ipsilateral shoulder pain
after thoracic surgery with a prophylactic effect lasting up to 48 hours.
The limited number of included studies warrants further research to
support these findings. Copyright © 2022 Elsevier Inc.

<56>
Accession Number
2018221562
Title
Editorial conflicts of interest related to the management of stable
ischemic heart disease.
Source
International Journal of Cardiology. (no pagination), 2022. Date of
Publication: 2022.
Author
Ferrell M.C.; Garrett E.P.; Tomlin A.; Wayant C.; Vassar M.
Institution
(Ferrell, Garrett, Vassar) Office of Medical Student Research, Oklahoma
State University Center for Health Sciences, Tulsa, OK, United States
(Tomlin) Department of Internal Medicine, Oklahoma State University
Medical Center, Tulsa, OK, United States
(Wayant) Department of Internal Medicine, Baylor College of Medicine,
Houston, TX, United States
(Vassar) Department of Psychiatry and Behavioral Sciences, Oklahoma State
University Center for Health Sciences, Tulsa, OK, United States
Publisher
Elsevier Ireland Ltd
Abstract
Objective: Our study examines the association between the favorability of
percutaneous coronary intervention (PCI) and/or coronary artery bypass
surgery (CABG) and the presence of conflicts of interest (COIs) among
authors. Method(s): We used the "Citing Articles" tool on the New
England Journal of Medicine website to identify editorials on the use of
PCI/CABG for stable ischemic heart disease. Authors were rated as
"supportive," "neutral," or "critical" of these interventions based on the
content of their editorials. COIs for each author were identified using
past publications found on Scopus, PubMed, or a general internet search.
 Result(s): A total of 606 articles were identified, and data were
extracted from 56 of them. Among the 149 authors, 64 (43.0%) had a COI. Of
these 64 authors, 19 (29.7%) disclosed their COI, while 45 (70.3%) did
not. Overall, among authors with a COI, there was no association between
disclosed and undisclosed COIs and the authors' view of PCI/CABG
[chi2 (2, N = 64) = 1.63, p = .44]. If an author was associated
with Medtronic, Abbott, or Boston Scientific, they were more likely to
favor PCI/CABG if they had an undisclosed COI relative to authors who
disclosed COIs [chi2 (1, N = 31) = 5.04, p = .025]. Authors
publishing in a cardiology journal were more likely to view PCI/CABG
favorably relative to those publishing in a general medicine journal
[chi2 (2, N = 62) = 7.17, p = .028]. Conclusion(s):
Editors should adopt policies to counteract the unbalancing effects that
COIs have on medical opinions and evidence. Copyright © 2022
Elsevier B.V.

<57>
Accession Number
2018221467
Title
A clinical profile of infective endocarditis in patients with recent
COVID-19: A systematic review.
Source
American Journal of the Medical Sciences. (no pagination), 2022. Date of
Publication: 2022.
Author
Quintero-Martinez J.A.; Hindy J.-R.; Mahmood M.; Gerberi D.J.; DeSimone
D.C.; Baddour L.M.
Institution
(Quintero-Martinez, Hindy, Mahmood, DeSimone, Baddour) Division of
Infectious Diseases, Departments of Medicine and Cardiovascular Diseases,
Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester,
MN 55905, United States
(Gerberi) Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, United States
Publisher
Elsevier B.V.
Abstract
Background: Coronavirus disease 2019 (COVID-19) can progress to
cardiovascular complications which are linked to higher in-hospital
mortality rates. Infective endocarditis (IE) can develop in patients with
recent COVID-19 infections, however, characterization of IE following
COVID-19 infection has been lacking. To better characterize this disease,
we performed a systematic review with descriptive analysis of the clinical
features and outcomes of these patients. Method(s): Our search was
conducted in 8 databases for all published reports of probable or definite
IE in patients with a prior COVID-19 confirmed diagnosis. After ensuring
an appropriate inclusion of the articles, we extracted data related to
clinical characteristics, modified duke criteria, microbiology, outcomes,
and procedures. Result(s): Searches generated a total of 323
published reports, and 20 articles met our inclusion criteria. The mean
age of patients was 52.2 +/- 16.9 years and 76.2% were males.
Staphylococcus aureus was isolated in 8 (38.1%) patients, Enterococcus
faecalis in 3 patients (14.3%) and Streptococcus mitis/oralis in 2 (9.5%)
patients. The mean time interval between COVID-19 and IE diagnoses was
16.7 +/- 15 days. Six (28.6%) patients required critical care due to IE, 7
patients (33.3%) underwent IE-related cardiac surgery and 5 patients
(23.8%) died during their IE hospitalization. Conclusion(s): Our
systematic review provides a profile of clinical features and outcomes of
patients with a prior COVID-19 infection diagnosis who subsequently
developed IE. Due to the ongoing COVID-19 pandemic, it is essential that
clinicians appreciate the possibility of IE as a unique complication of
COVID-19 infection. Copyright © 2022 Southern Society for
Clinical Investigation

<58>
Accession Number
2005782448
Title
Renal function and coronary bypass surgery in patients with ischemic heart
failure.
Source
Journal of Thoracic and Cardiovascular Surgery. 163(2) (pp 663-672.e3),
2022. Date of Publication: February 2022.
Author
Doenst T.; Haddad H.; Stebbins A.; Hill J.A.; Velazquez E.J.; Lee K.L.;
Rouleau J.L.; Sopko G.; Farsky P.S.; Al-Khalidi H.R.; Jeemon P.; Szwed H.;
Tan R.-S.; Bigalli D.R.; Kosevic D.; Benke K.; Kalil R.A.K.; Jasinski M.;
Smith P.K.; Chua Y.L.
Institution
(Doenst) Department of Cardiothoracic Surgery, Jena University Hospital,
Friedrich-Schiller-University of Jena, Jena, Germany
(Haddad) Department of Medicine, College of Medicine, University of
Saskatchewan, Saskatoon, Saskatchewan, Canada
(Stebbins) Duke Clinical Research Institute, Durham, NC
(Hill) Division of Cardiovascular Medicine, Department of Medicine,
University of Florida, Malcom Randal VAMC, Gainesville, Fla, United States
(Velazquez) Section of Cardiovascular Medicine, Department of Internal
Medicine, Yale School of Medicine, New Haven, Conn
(Lee, Al-Khalidi) Department of Biostatistics and Bioinformatics, Duke
University School of Medicine, Duke Clinical Research Institute, Durham,
NC
(Rouleau) Montreal Heart Institute, University of Montreal, Montreal,
Quebec, Canada
(Sopko) Division of Cardiovascular Sciences, National Heart, Lung, and
Blood Institute, National Institutes of Health, Bethesda, Md
(Farsky) Department of Cardiology, Instituto Dante Pazzanese de
Cardiologia, Sao Paulo, Brazil
(Farsky) Department of Cardiology, Hospital Israelita Albert Einstein, Sao
Paulo, Brazil
(Jeemon) Epidemiology, Sree Chitra Tirunal Institute for Medical Sciences
and Technology, Kerala, India
(Szwed) Department of Coronary Artery Disease, Institute of Cardiology,
Warsaw, Poland
(Tan) Department of Cardiology, National Heart Centre Singapore, Singapore
(Bigalli) Department of Cardiac Surgery, CICU, Montevideo, Uruguay
(Kosevic) Department of Cardiology, Dedinje Cardiovascular Institute,
Belgrade, Serbia
(Benke) Heart and Vascular Centre, Semmelweis University, Budapest,
Hungary
(Kalil) Postgraduate Program, Instituto de Cardiologia/FUC and UFCSPA,
Porto Alegre, Brazil
(Jasinski) Department of Cardiac Surgery, Wroclaw Medical University,
Wroclaw, Poland
(Smith) Department of Surgery (Cardiothoracic), Duke University School of
Medicine, Duke Clinical Research Institute, Durham, NC
(Chua) Department of Cardiothoracic Surgery, National Heart Centre
Singapore, Singapore
Publisher
Elsevier Inc.
Abstract
Objective: Chronic kidney disease is a known risk factor in cardiovascular
disease, but its influence on treatment effect of bypass surgery remains
unclear. We assessed the influence of chronic kidney disease on 10-year
mortality and cardiovascular outcomes in patients with ischemic heart
failure treated with medical therapy (medical treatment) with or without
coronary artery bypass grafting. Method(s): We calculated the
baseline estimated glomerular filtration rate (Chronic Kidney Disease
Epidemiology Collaboration formula, chronic kidney disease stages 1-5)
from 1209 patients randomized to medical treatment or coronary artery
bypass grafting in the Surgical Treatment for IsChemic Heart failure trial
and assessed its effect on outcome. Result(s): In the overall
Surgical Treatment for IsChemic Heart failure cohort, patients with
chronic kidney disease stages 3 to 5 were older than those with stages 1
and 2 (66-71 years vs 54-59 years) and had more comorbidities.
Multivariable modeling revealed an inverse association between estimated
glomerular filtration rate and risk of death, cardiovascular death, or
cardiovascular rehospitalization (all P < .001, but not for stroke, P =
.697). Baseline characteristics of the 2 treatment arms were equal for
each chronic kidney disease stage. There were significant improvements in
death or cardiovascular rehospitalization with coronary artery bypass
grafting (stage 1: hazard ratio, 0.71; confidence interval, 0.53-0.96, P =
.02; stage 2: hazard ratio, 0.71; confidence interval, 0.59-0.84, P <
.0001; stage 3: hazard ratio, 0.76; confidence interval, 0.53-0.96, P =
.03). These data were inconclusive in stages 4 and 5 for insufficient
patient numbers (N = 28). There was no significant interaction of
estimated glomerular filtration rate with the treatment effect of coronary
artery bypass grafting (P = .25 for death and P = .54 for death or
cardiovascular rehospitalization). Conclusion(s): Chronic kidney
disease is an independent risk factor for mortality in patients with
ischemic heart failure with or without coronary artery bypass grafting.
However, mild to moderate chronic kidney disease does not appear to
influence long-term treatment effects of coronary artery bypass
grafting. Copyright © 2020 The American Association for Thoracic
Surgery

<59>
[Use Link to view the full text]
Accession Number
2017899974
Title
Outcomes With Intermediate Left Main Disease: Analysis From the ISCHEMIA
Trial.
Source
Circulation: Cardiovascular Interventions. 15(4) (pp E010925), 2022. Date
of Publication: 01 Apr 2022.
Author
Bangalore S.; Spertus J.A.; Stevens S.R.; Jones P.G.; Mancini G.B.J.;
Leipsic J.; Reynolds H.R.; Budoff M.J.; Hague C.J.; Min J.K.; Boden W.E.;
O'Brien S.M.; Harrington R.A.; Berger J.S.; Senior R.; Peteiro J.; Pandit
N.; Bershtein L.; De Belder M.A.; Szwed H.; Doerr R.; Monti L.; Alfakih
K.; Hochman J.S.; Maron D.J.
Institution
(Bangalore, Reynolds, Berger, Hochman) Department of Medicine, New York
University Grossman School of Medicine, 550 First Ave, New York, NY 10016,
United States
(Spertus) Department(s) of Biomedical and Health Informatics, Umkc School
of Medicine, Kansas City, MO, United States
(Stevens, O'Brien) Department of Biostatistics and Bioinformatics, Duke
Clinical Research Institute, Durham, NC, United States
(Jones) Department of Cardiology, Saint Luke's Mid America Heart
Institute/UMKC, Kansas City, MO, United States
(Mancini) Division of Cardiology, Centre for Cardiovascular Innovation,
University of British Columbia, Vancouver, Canada
(Leipsic, Hague) Department of Radiology, Centre for Cardiovascular
Innovation, University of British Columbia, Vancouver, Canada
(Budoff) Division of Cardiology, Lundquist Institute, Torrance, CA, United
States
(Min) Cleerly, Inc, New York, NY, United States
(Boden) Department of Medicine, Va New England Healthcare System, Boston,
MA, United States
(Harrington, Maron) Department of Medicine, Stanford University, CA,
United States
(Senior) Department of Medicine, Northwick Park Hospital-Royal Brompton
Hospital, London, United Kingdom
(Peteiro) Department of Cardiology, Chuac, Universidad de A Coruna,
CIBER-CV, A Coruna, Spain
(Pandit) Department of Cardiology, Ram Manohar Lohia Hospital, Delhi,
India
(Bershtein) Department of Cardiology, North-Western State Medical
University I.I. Mechnikov, Saint Petersburg, Russian Federation
(De Belder) Department of Cardiology, The James Cook University Hospital,
Middlesbrough, United Kingdom
(Szwed) Department of Cardiology, National Institute of Cardiology,
Warsaw, Poland
(Doerr) Department of Cardiology, Praxislinik Herz und Gefaesse, Dresden,
Germany
(Monti) Department of Radiology, Istituto Clinico Humanitas, Rozzano,
Milano, Italy
(Alfakih) Department of Cardiology, King's College Hospital, London,
United Kingdom
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Patients with significant (>=50%) left main disease (LMD) have
a high risk of cardiovascular events, and guidelines recommend
revascularization to improve survival. However, the impact of intermediate
LMD (stenosis, 25%-49%) on outcomes is unclear. Method(s): Randomized
ISCHEMIA (International Study of Comparative Health Effectiveness With
Medical and Invasive Approaches) participants who underwent coronary
computed tomography angiography at baseline were categorized into those
with (25%-49%) and without (<25%) intermediate LMD. The primary outcome
was a composite of cardiovascular mortality, myocardial infarction (MI),
or hospitalization for unstable angina, heart failure, or resuscitated
cardiac arrest. The primary quality of life outcome was the Seattle Angina
Questionnaire summary score. Result(s): Among the 3699 participants
who satisfied the inclusion criteria, 962 (26%) had intermediate LMD.
Among invasive strategy participants with intermediate LMD on coronary
computed tomography angiography, 49 (7.0%) had significant (>=50%
stenosis) left main stenosis on invasive angiography. Patients with
intermediate LMD had a higher risk of cardiovascular events in the
unadjusted but not in the fully adjusted model compared with those without
intermediate LMD. An invasive strategy increased procedural MI and
decreased nonprocedural MI with no significant difference for other
outcomes including the primary end point. There was no meaningful
heterogeneity of treatment effect based on intermediate LMD status except
for nonprocedural MI for which there was a greater absolute reduction with
invasive management in the intermediate LMD group (-6.4% versus -2.0%;
Pinteraction=0.049). The invasive strategy improved angina-related quality
of life and the benefit was durable throughout follow-up without
significant heterogeneity based on intermediate LMD status.
 Conclusion(s): In the ISCHEMIA trial, there was no meaningful
heterogeneity of treatment benefit from an invasive strategy regardless of
intermediate LMD status except for a greater absolute risk reduction in
nonprocedural MI with invasive management in those with intermediate LMD.
An invasive strategy increased procedural MI, reduced nonprocedural MI,
and improved angina-related quality of life. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT01471522. Copyright © 2022 Lippincott Williams and Wilkins.
All rights reserved.

<60>
Accession Number
2017817157
Title
Very long-term follow-up of patients with coronary bifurcation lesions
treated with bioresorbable scaffolds.
Source
Kardiologia Polska. 80(3) (pp 307-314), 2022. Date of Publication: 2022.
Author
Iwanczyk S.; Araszkiewicz A.; Grygier M.; Klotzka A.; Pyda M.; Skorupski
W.; Mitkowski P.; Lanocha M.; Grajek S.; Drewnicki A.; Mularek-Kubzdela
T.; Lesiak M.
Institution
(Iwanczyk, Araszkiewicz, Grygier, Klotzka, Pyda, Skorupski, Mitkowski,
Lanocha, Grajek, Drewnicki, Mularek-Kubzdela, Lesiak) 1st Department of
Cardiology, Poznan University of Medical Sciences, Poznan, Poland
Publisher
Via Medica
Abstract
Backgrounds: The data concerning the use of bioresorbable vascular
scaffolds (BVS) in coronary bifurcation lesions are limited. Aim(s):
The objective of the study was to evaluate the early and very long-term
clinical outcomes of bifurcation stenting with ABSORB BVS. Method(s):
One hundred consecutive patients with coronary bifurcation lesions treated
with BVS were included. A total of 124 BVS were implanted. Provisional
side branch stenting was performed in 66 patients, distal main stenting in
14 patients, systematic T stenting in 2, and T with minimal protrusion
(TAP) in 5 patients. Side branch ostial stenting was performed in
additional 12 patients. Result(s): The procedural success was
achieved in 98% of patients. In long-term follow-up, the rate of cardiac
death was 4.0%, target vessel myocardial infarction was 5.0%, and target
vessel revascularization (TVR) was 11%. The cumulative incidence of
definite/probable scaffold thrombosis (ST) was 2% at long-term follow-up.
Comparison with the historical drug-eluting stents (DES) group revealed
higher mortality and major adverse cardiac events rate in the ABSORB
group. Conclusion(s): Stenting of coronary bifurcation lesions of
low-to-moderate complexity with BVS was feasible with good acute
performance and acceptable results. However, the risk of death and major
adverse cardiovascular events was higher as compared with
DES. Copyright by the Author(s), 2022.

<61>
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).

<62>
Accession Number
2015574576
Title
Timing of Permanent Pacemaker Placement for Complete Post-operative Heart
Block: Is It Worth the Wait?.
Source
Current Treatment Options in Pediatrics. 8(2) (pp 38-48), 2022. Date of
Publication: June 2022.
Author
Czosek R.J.; Baskar S.
Institution
(Czosek, Baskar) The Heart Institute, Cincinnati Children's Hospital
Medical Center, Cincinnati, OH, United States
Publisher
Springer Science and Business Media Deutschland GmbH
Abstract
Purpose of Review: Post-operative complete/high-grade heart block (HB) is
a relatively common complication during repair of congenital heart disease
(CHD) and is associated with significant morbidity. The decision on how
long to wait for recovery of conduction after surgery before implanting a
permanent pacemaker has historically been driven by the likelihood of
early recovery of conduction, though debate continues about proper timing.
Recent Findings: Recent data has demonstrated little improvement in the
incidence of post-operative HB over the past three decades. Newer data has
provided lesion-specific risk assessment for HB with some ability to
predict which patients will have early return of conduction based on
operation type and patient characteristics, though not with the clarity
needed to influence implant timing recommendations. Some have advocated
for earlier device implant based on cost; however, given the long-term
sequelae associated with pacemakers, cost concerns have not affected
implant timing recommendations. The advent of new methods for mapping the
conduction system prior to or during a high-risk operation offers
potential for decreasing the incidence of post-surgical HB but are not yet
available for routine clinical use. Summary: Post-operative HB
continues to be a common complication. The timing of when to implant a
permanent pacing system post-operatively continues to be a difficult
decision primarily driven by the probability of early return of
conduction. While there has been little improvement in the incidence of HB
and only minimal improvement in our prediction of early recurrence, there
are exciting potential pre-operative and operative methods that may help
prevent HB and obviate the need for permanent pacing. Further research is
needed in lesion-specific prediction modeling for return of conduction, as
is improved methodology to assist surgeons in avoiding AV nodal damage
during surgery. Copyright © 2022, The Author(s), under exclusive
licence to Springer Nature Switzerland AG.

<63>
[Use Link to view the full text]
Accession Number
2014810081
Title
Myocardial Function in Secondary Mitral Regurgitation: A Challenging
Relationship.
Source
Circulation: Cardiovascular Imaging. 14(9) (pp E013350), 2021. Date of
Publication: 01 Sep 2021.
Author
Lavall D.; Stobe S.
Institution
(Lavall, Stobe) Universitatsklinikum Leipzig, Klinik und Poliklinik fur
Kardiologie, Germany
Publisher
Lippincott Williams and Wilkins

<64>
[Use Link to view the full text]
Accession Number
635311349
Title
Five-Year Clinical and Quality of Life Outcomes From the CoreValve US
Pivotal Extreme Risk Trial.
Source
Circulation: Cardiovascular Interventions. 14(6) (pp E010258), 2021. Date
of Publication: 01 Jun 2021.
Author
Arnold S.V.; Petrossian G.; Reardon M.J.; Kleiman N.S.; Yakubov S.J.; Wang
K.; Hermiller J.; Harrison J.K.; Deeb G.M.; Huang J.; Cohen D.J.
Institution
(Arnold, Wang) Saint Luke's Mid America Heart Institute, Kansas City, MO,
United States
(Arnold) Department Of Medicine, University Of Missouri, Kansas City,
United States
(Petrossian, Cohen) Saint Francis Hospital, Roslyn, NY, United States
(Cohen) Clinical Trials Center, Cardiovascular Research Foundation, NY,
United States
(Reardon, Kleiman) Houston Methodist DeBakey Heart And Vascular Center,
Houston, TX, United States
(Yakubov) Riverside Methodist Hospital, Columbus, OH, United States
(Hermiller) St Vincent's Medical Center, Indianapolis, IN, United States
(Harrison) Department Of Medicine, Duke University Medical Center, Durham,
NC, United States
(Deeb) Department Of Surgery, University Of Michigan Medical Center, Ann
Arbor, MI, United States
(Huang) Medtronic, Minneapolis, MN, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Older adults with comorbidities who are at extreme risk for
surgical aortic valve replacement may be appropriate candidates for
transcatheter aortic valve replacement (TAVR). We present the 5-year
clinical, echocardiographic, and health status outcomes of such patients
treated with CoreValve self-expanding supra-annular TAVR. Method(s):
The CoreValve US Extreme Risk Pivotal Trial was a prospective,
nonrandomized, single-arm clinical trial of TAVR at 41 sites in the United
States. The primary outcome was all-cause mortality or major stroke.
Secondary outcomes included echocardiographic parameters and
patient-reported health status, assessed with the Kansas City
Cardiomyopathy Questionnaire. Result(s): Between February 2011 and
August 2012, 639 patients with severe aortic stenosis at extreme surgical
risk underwent attempted TAVR (mean age 82.8+/-8.4 years, 53% women, mean
Society of Thoracic Surgeons Predicted Risk of Mortality 10.4+/-5.6%, 77%
iliofemoral access). The 5-year Kaplan-Meier rate of death or major stroke
was 72.6% ([95% CI, 68.4%-76.7%]; death 71.6%, major stroke 11.5%), with
no significant differences according to access site. Among patients who
survived 5 years, mean transvalvular gradient was 7.5+/-5.9 mm Hg, and
3.1% had moderate or severe aortic regurgitation. Health status measures
improved significantly by 1 month after TAVR through 1 year (mean change
in Kansas City Cardiomyopathy Questionnaire-Overall Summary score 24.8
points [95% CI, 22.4-27.2]). Beyond 1 year, the Kansas City Cardiomyopathy
Questionnaire-Overall Summary score decreased gradually but remained
significantly improved from pre-TAVR through 5 years of follow-up among
surviving patients (mean change from baseline, 14.3 points [95% CI,
10.7-17.9]). Conclusion(s): Patients with severe aortic stenosis at
extreme surgical risk who are treated with self-expanding supra-annular
TAVR have high 5-year mortality. However, the short-term benefits of TAVR
in terms of valve hemodynamics and quality of life are mostly preserved
among surviving patients at 5 years, thereby supporting the continued use
of TAVR in these challenging patients. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT01240902. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<65>
[Use Link to view the full text]
Accession Number
635080166
Title
Radiofrequency Versus Cryoballoon Catheter Ablation for Paroxysmal Atrial
Fibrillation: Durability of Pulmonary Vein Isolation and Effect on Atrial
Fibrillation Burden: The RACE-AF Randomized Controlled Trial.
Source
Circulation: Arrhythmia and Electrophysiology. 14(5) (pp E009573), 2021.
Date of Publication: 01 May 2021.
Author
Sorensen S.K.; Johannessen A.; Worck R.; Hansen M.L.; Hansen J.
Institution
(Sorensen, Johannessen, Worck, Hansen, Hansen) Copenhagen University
Hospital Gentofte, Gentofte Hospitalsvej 1 Hellerup, Denmark
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Recurrent paroxysmal atrial fibrillation (AF) after catheter
ablation is presumably caused by failure to achieve durable pulmonary vein
isolation (PVI). The primary methods of PVI are radiofrequency catheter
ablation (RF) and cryoballoon catheter ablation (CRYO), but these methods
have not been directly compared with respect to PVI durability and the
effect thereof on AF burden (% of time in AF). Method(s):
Accordingly, we performed a randomized trial including 98 patients (68%
male, 61 [55-67] years) with paroxysmal AF assigned 1:1 to PVI by
contact-force sensing, irrigated radiofrequency catheter, or
second-generation cryoballoon catheter. Implantable cardiac monitors were
inserted >=1 month before PVI for assessment of AF burden and recurrence,
and all patients, irrespective of AF recurrence, underwent a second
procedure 4 to 6 months after PVI to determine PVI durability.
 Result(s): In the second procedure, 152 out of 199 (76%) pulmonary
veins (PVs) were found durably isolated after RF and 161 out of 200 (81%)
after CRYO (P=0.32), corresponding to durable isolation of all veins in
47% of patients in both groups (P=1.0). Median AF burden before PVI was
5.4% (interquartile range, 0.5%-13.0%) versus 4.0% (0.6%-18.1%), RF versus
CRYO (P=0.71), and reduced to 0.0% (0.0%-0.1%) and 0.0% (0.0%-0.5%),
respectively (P=0.58)-a reduction of 99.9% (92.9%-100.0%) and 99.3%
(85.9%-100.0%; P=0.36). AF burden after PVI significantly correlated to
the number of durably isolated PVs (P<0.01), but 9 out of 45 (20%)
patients with durable isolation of all veins had recurrence of AF within 4
to 6 months after PVI (excluding a 3-month blanking period).
 Conclusion(s): PVI by RF and CRYO produce similar moderate to high
PVI durability. Both treatments lead to marked reductions in AF burden,
which is related to the number of durably isolated PVs. However, for
one-fifth of paroxysmal AF patients, complete and durable PVI was not
sufficient to prevent even short-term AF recurrence. Registration: URL:
https://www.clinicaltrials.gov; Unique identifier:
NCT03805555. Copyright © 2021 Lippincott Williams and Wilkins.
All rights reserved.

<66>
Accession Number
2014888696
Title
Hemopericardium in the Setting of Direct Oral Anticoagulant Use: An
Updated Systematic Review.
Source
Cardiovascular Revascularization Medicine. 39 (pp 73-83), 2022. Date of
Publication: June 2022.
Author
Sheikh A.B.; Shah I.; Sagheer S.; Javed N.; Minhas A.M.K.; Lopez E.D.;
Parikh C.; Shekhar R.
Institution
(Sheikh, Shah, Lopez) University of New Mexico Health Sciences Center,
Department of Internal Medicine, Albuquerque, NM, United States
(Sagheer) Division of Cardiology, University of New Mexico Health Sciences
Center, Albuquerque, NM, United States
(Javed) Shifa College of Medicine, Shifa Tameer-e-Millat University,
Islamabad, Pakistan
(Minhas) Forrest General Hospital, Department of Internal Medicine,
Hattiesburg, United States
(Parikh) Pramukh Swami Medical College, Department of Internal Medicine,
Gujarat, Karamsad, India
(Shekhar) Division of Hospital Medicine, University of New Mexico School
of Medicine, Department of Internal Medicine, Albuquerque, NM, United
States
Publisher
Elsevier Inc.
Abstract
Background: Spontaneous hemopericardium, associated with direct oral
anticoagulant (DOAC) use, is one of the uncommon complications with high
morbidity that has not been extensively studied We aimed to determine
demographic characteristics, clinical features, lab evaluation,
management, and outcomes of the studies focusing on hemopericardium as a
DOAC use. Method(s): PubMed, Web of Science, Google Scholar, and
CINAHL databases were searched for relevant articles using MeSH key-words
and imported into referencing/review software. The data regarding
demographics, clinical characteristics, cardiac investigations, and
management were analyzed in IBM Statistics SPSS 21. t-Test and Chi-square
test were used. A P score of <0.05 was considered statistically
significant. Result(s): After literature search, a total of 41
articles were selected for analysis. The mean age of the patients was
70.09 +/- 11.06 years (p < 0.05); the majority of them were males (58.5%).
Most of the patients presented with shortness of breath (75.2%) and had
more than 3 co-morbid conditions (43.9%). The most frequently used
anticoagulant was rivaroxaban (15/41; 36.6%); the common indication being
arrhythmia (78.0%). CYP4503A4/P-Gp inhibitors (22.2%) were commonly used
by the patients. Majority of the cases had a favorable outcome (95.1%).
Pericardial tamponade was noted in 31/41 cases. Pericardiocentesis was
performed in 37/41 cases. Conclusion(s): Hemopericardium from DOAC
use has a favorable outcome but requires urgent pericardiocentesis.
However, long term mortality, monitoring of DOAC activity, and drug-drug
interactions have not been widely studied. Copyright © 2021
Elsevier Inc.

<67>
Accession Number
637988984
Title
Does Dexmedetomidine Reduce the Risk of Atrial Fibrillation and Stroke
After Adult Cardiac Surgery? A Systematic Review and Meta-analysis of
Randomized Controlled Trials.
Source
Anatolian journal of cardiology. 26(5) (pp 354-365), 2022. Date of
Publication: 01 May 2022.
Author
Jing C.; Lin L.; Zhou T.; Li Y.L.; Fu L.; Gao M.Q.
Institution
(Jing, Lin, Zhou, Gao) Department of Intensive Care Unit, Beijing Shijitan
Hospital, Capital Medical University, Beijing, China
(Li, Fu) Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen,
Guangdong, China
Publisher
NLM (Medline)
Abstract
BACKGROUND: Postoperative atrial fibrillation is a common consequence of
cardiac sur-gery with increased stroke complications and mortality.
Although dexmedetomidine is thought to prevent postoperative atrial
fibrillation and stroke because of its sympa-tholytic and
anti-inflammatory properties, data from different studies show the effect
of dexmedetomidine on postoperative atrial fibrillation and stroke
uncertain in adult patients with cardiac surgery. METHOD(S): A
database including EMBASE, PubMed, and Cochrane CENTRAL was searched for
randomized controlled trials comparing dexmedetomidine with placebo or
other anesthetic drugs in adult cardiac surgery. The primary outcome was
the incidence of postoperative atrial fibrillation. The secondary outcomes
were the incidence of postop-erative stroke, mechanical ventilation
duration, intensive care unit length of stay, hospi-tal length of stay,
and mortality. RESULT(S): Eighteen trials with a total of 2933
patients were enrolled in the meta-analyses. Compared with controls,
dexmedetomidine significantly reduced the incidence of post-operative
atrial fibrillation [odds ratio, 0.82; 95% CI, 0.69-0.98; P = .03]. There
was no sig-nificant difference between groups in stroke (odds ratio, 1.36;
95% CI, 0.59-3.16; P = .47), mechanical ventilation duration [weighted
mean difference, -0.17; 95% CI, -0.35 to 0.14;P=.39], intensive care unit
length of stay (weighted mean difference, -0.03; 95% CI,-0.93 to 0.87; P =
.95), hospital length of stay (weighted mean difference, -0.04; 95%
CI,-0.40 to 0.32; P = .83) and mortality (odds ratio, 0.72; 95% CI,
0.32-1.60; P = .42). CONCLUSION(S): Perioperative dexmedetomidine
reduced the incidence of postoperative atrial fibrillation in adult
patients undergoing cardiac surgery. But there was no signifi-cant
difference in the incidence of stroke, mechanical ventilation duration,
intensive care unit length of stay, hospital length of stay, and
mortality.

<68>
[Use Link to view the full text]
Accession Number
635359153
Title
Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A
Scientific Statement From the American Heart Association.
Source
Circulation. 143(25) (pp E1088-E1114), 2021. Date of Publication: 22 Jun
2021.
Author
Shroff G.R.; Bangalore S.; Bhave N.M.; Chang T.I.; Garcia S.; Mathew R.O.;
Rangaswami J.; Ternacle J.; Thourani V.H.; Pibarot P.
Publisher
Lippincott Williams and Wilkins
Abstract
Aortic stenosis with concomitant chronic kidney disease (CKD) represents a
clinical challenge. Aortic stenosis is more prevalent and progresses more
rapidly and unpredictably in CKD, and the presence of CKD is associated
with worse short-term and long-term outcomes after aortic valve
replacement. Because patients with advanced CKD and end-stage kidney
disease have been excluded from randomized trials, clinicians need to make
complex management decisions in this population that are based on
retrospective and observational evidence. This statement summarizes the
epidemiological and pathophysiological characteristics of aortic stenosis
in the context of CKD, evaluates the nuances and prognostic information
provided by noninvasive cardiovascular imaging with echocardiography and
advanced imaging techniques, and outlines the special risks in this
population. Furthermore, this statement provides a critical review of the
existing literature pertaining to clinical outcomes of surgical versus
transcatheter aortic valve replacement in this high-risk population to
help guide clinical decision making in the choice of aortic valve
replacement and specific prosthesis. Finally, this statement provides an
approach to the perioperative management of these patients, with special
attention to a multidisciplinary heart-kidney collaborative team-based
approach. Copyright © 2021 Lippincott Williams and Wilkins. All
rights reserved.

<69>
[Use Link to view the full text]
Accession Number
634780040
Title
Closure of Iatrogenic Atrial Septal Defect after Transcatheter Mitral
Valve Repair: The Randomized MITHRAS Trial.
Source
Circulation. 143(3) (pp 292-294), 2021. Date of Publication: 19 Jan 2021.
Author
Lurz P.; Unterhuber M.; Rommel K.-P.; Kresoja K.-P.; Kister T.; Besler C.;
Fengler K.; Sandri M.; Daehnert I.; Thiele H.; Von Roeder M.; Blazek S.
Institution
(Lurz, Unterhuber, Rommel, Kresoja, Kister, Besler, Fengler, Sandri,
Thiele, Von Roeder, Blazek) Department of Internal Medicine/Cardiology,
Heart Center Leipzig, Leipzig University, Germany
(Daehnert) Department of Pediatric Cardiology, Heart Center Leipzig,
Leipzig University, Germany
(Lurz, Thiele) Leipzig Heart Institute, Germany
Publisher
Lippincott Williams and Wilkins

<70>
Accession Number
634773631
Title
Myocardial Ischemia in the Management of Chronic Coronary Artery Disease:
Past and Present.
Source
Circulation: Cardiovascular Imaging. 14(1) (pp E011615), 2021. Date of
Publication: 01 Jan 2021.
Author
Gibbons R.J.
Institution
(Gibbons) Department of Cardiovascular Medicine, Mayo Clinic, Rochester,
MN, United States
Publisher
Lippincott Williams and Wilkins
Abstract
For many years, stress-induced myocardial ischemia has been considered
important in the management of chronic coronary artery disease. Early
evidence focused on the exercise ECG and the Duke treadmill score. In the
1970s, randomized clinical trials, which compared coronary artery bypass
surgery to medical therapy, enrolled patients who were very different from
contemporary practice and had inconsistent results. Surgery appeared to be
of greatest benefit in high-risk patients defined by anatomy (such as left
main disease) or stress-induced ischemia. However, randomized clinical
trials of revascularization versus contemporary medical therapy over the
past 20 years have been surprisingly negative. Nuclear cardiology
substudies from these trials reported inconsistent results. Two
observational studies from a single-center provided the best evidence for
the use of stress-induced ischemia to identify patients who were most
likely to benefit from revascularization. The recently completed ISCHEMIA
trial (International Study of Comparative Health Effectiveness With
Medical and Invasive Approaches) was designed to test the hypothesis that
revascularization would improve outcomes in patients with moderate-severe
ischemia on stress testing. Unfortunately, 14.2% of the randomized
patients had either mild or no ischemia on core lab review. Nearly
one-quarter of the patients were randomized on the basis of an exercise
ECG without imaging. The negative results of the trial reflect the
long-term population decline in coronary artery disease and abnormal
stress tests, as well as improvements in patient outcome due to optimal
medical therapy. Topics requiring further research are presented. The
implications of the trial for the use of both stress imaging and coronary
computed tomography angiography in clinical practice are
examined. Copyright © 2021 Lippincott Williams and Wilkins. All
rights reserved.

<71>
Accession Number
632852588
Title
Diagnosis of Infective Endocarditis by Subtype Using
18F-Fluorodeoxyglucose Positron Emission Tomography/Computed
Tomography: A Contemporary Meta-Analysis.
Source
Circulation: Cardiovascular Imaging. 13(6) (pp E010600), 2020. Date of
Publication: 01 Jun 2020.
Author
Wang T.K.M.; Sanchez-Nadales A.; Igbinomwanhia E.; Cremer P.; Griffin B.;
Xu B.
Institution
(Wang, Cremer, Griffin, Xu) Section of Cardiovascular Imaging, Robert and
Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold
Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic,
Cleveland, OH 44195, United States
(Sanchez-Nadales, Igbinomwanhia) Department of Medicine, Advocate Illinois
Masonic Medical Center, Chicago, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background Infective endocarditis (IE) remains a difficult to diagnose
condition associated with high mortality.
18F-fluorodeoxyglucose positron emission tomography/computed
tomography (18F-FDG PET/CT) has recently emerged as another IE
imaging modality, although diagnostic accuracy varies across observational
studies and types of IE. This meta-analysis assessed the diagnostic
performance of 18F-FDG PET/CT for IE and its subtypes. Methods
We searched Pubmed, Cochrane, and Embase from January 1980 to September
2019 for studies reporting both sensitivity and specificity of
18F-FDG PET/CT for IE. Meta-Disc 1.4 was used to pool data for
all cases of IE and its subgroups of native valve IE, prosthetic valve IE,
and cardiac implantable electronic devices IE. Results We screened 2566
records from the search, assessed 52 full-text articles, and included 26
studies totaling 1358 patients (509 IE cases). Pooled sensitivity and
specificity (95% CI, inconsistency I-square statistic) were 0.74
(0.70-0.77, 71.5%) and 0.88 (0.86-0.91, 78.5%) for all cases of
endocarditis. Corresponding parameters for native valve IE were
sensitivity 0.31 (0.21-0.41, 29.4%) and specificity 0.98 (0.95-0.99,
34.4%); for prosthetic valve IE: sensitivity 0.86 (0.81-0.89, 60.0%) and
specificity 0.84 (0.79-0.88, 75.2%); and for cardiac implantable
electronic devices IE: sensitivity 0.72 (0.61-0.81, 76.2%) and specificity
0.83 (0.75-0.89, 83.6%). Pooled sensitivities and specificities were
higher for the 17 studies since 2015 than the 9 studies published before
2015. Conclusions 18F-FDG PET/CT had high specificity for all
IE subtypes; however, sensitivity was markedly lower for native valve IE
than prosthetic valve IE and cardiac implantable electronic devices IE. It
is, therefore, a useful adjunct modality for assessing endocarditis,
especially in the challenging scenarios of prosthetic valve IE and cardiac
implantable electronic devices IE, with improving performance over time,
related to advances in 18F-FDG PET/CT techniques. Copyright
© 2020 Lippincott Williams and Wilkins. All rights reserved.

<72>
Accession Number
2018185409
Title
Multiple versus single arterial grafting in the elderly: a meta-analysis
of randomized controlled trials and propensity score studies.
Source
Journal of Cardiovascular Surgery. 63(2) (pp 169-178), 2022. Date of
Publication: April 2022.
Author
Saraiva F.A.; Moreira R.; Cerqueira R.J.; Mancio J.; Barros A.S.; Lourenco
A.P.; Leite-Moreira A.F.
Institution
(Saraiva, Moreira, Cerqueira, Mancio, Barros, Lourenco, Leite-Moreira)
Department of Surgery and Physiology, Cardiovascular Research and
Development Center, Faculty of Medicine, University of Porto, Porto,
Portugal
(Cerqueira, Leite-Moreira) Department of Cardiothoracic Surgery, Sao Joao
University Hospital, Porto, Portugal
(Mancio) St. Bartholomew's Hospital, Bart's Health NHSTrust, London,
United Kingdom
(Lourenco) Department of Anesthesiology, Sao Joao University Hospital,
Porto, Portugal
Publisher
Edizioni Minerva Medica
Abstract
INTRODUCTION: The benefit of adding a second arterial conduit is still
controversial, mainly in specific subgroups. We conducted a meta-analysis
of randomized controlled trials (RCTs) and propensity score (PS) studies
comparing survival and early results in elderly patients who underwent
coronary artery bypass grafting (CABG) with multiple (MAG) versus single
arterial grafting (SAG). EVIDENCE ACQUISITION: MEDLINE, Web of Science and
Cochrane Library were used to find relevant literature (1960-April 2020).
Survival at a >=1-year follow-up and early outcomes were evaluated.
Outcomes were collected from matched samples or PS adjusted analysis:
hazard ratio (HR) along with their variance, frequencies or odds ratios.
Random effect models were used to compute combined statistical measures
and 95% confidence intervals (CI) through generic inverse variance method
(time-to-event) or Mantel-Haenszel method (binary events).
EVIDENCESYNTHESIS: Eleven PScohorts and 1 RCT comprising >18,800 patients
older than 70 (>6200 MAGand >12,500 SAG) were included in this
meta-analysis. MAGwas associated with lower long-term mortality (pooled
HR: 0.81, 95% CI: 0.72-0.91, P<0.01, I2=64%) in the absence of higher risk
of early mortality (pooled OR: 0.74, 95% CI: 0.44 to 1.25, P=0.27, I2=0%).
In a meta-regression, MAGsurvival advantage was more pronounced in studies
with a higher MAG usage rate (beta=-0.0052, P=0.021). CONCLUSION(S):
Current evidence suggests that advanced age should not limit MAG's use
considering its benefits in long-term survival. Of note, an individualized
patient selection for this approach is warranted. Copyright ©
2022 Edizioni Minerva Medica. All rights reserved.

<73>
Accession Number
2017987408
Title
Exercise Training in Patients with Heart Failure: From Pathophysiology to
Exercise Prescription.
Source
Reviews in Cardiovascular Medicine. 23(4) (no pagination), 2022. Article
Number: 144. Date of Publication: 2022.
Author
Cuomo G.; Lorenzo A.D.; Tramontano A.; Iannone F.P.; D'Angelo A.; Pezzella
R.; Testa C.; Parlato A.; Merone P.; Pacileo M.; D'Andrea A.; Cudemo G.;
Venturini E.; Iannuzzo G.; Vigorito C.; Giallauria F.
Institution
(Cuomo, Lorenzo, Tramontano, Iannone, D'Angelo, Pezzella, Testa, Parlato,
Merone, Cudemo, Vigorito, Giallauria) Department of Translational Medical
Sciences, "Federico II" University of Naples, Naples 80131, Italy
(Pacileo, D'Andrea) Division of Cardiology, UTIC, "Umberto I" Hospital,
Nocera Inferiore (ASL Salerno), SA, Nocera Inferiore 84014, Italy
(Venturini) Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest,
Cecina Civil Hospital, LI Cecina 57023, Italy
(Iannuzzo) Department of Clinical Medicine and Surgery, "Federico II"
University of Naples, Naples 80131, Italy
Publisher
IMR Press Limited
Abstract
Heart failure (HF) is a chronic, progressive, and inexorable syndrome
affecting worldwide billion of patients (equally distributed among men and
women), with prevalence estimate of 1-3% in developed countries. HF leads
to enormous direct and indirect costs, and because of ageing population,
the total number of HF patients keep rising, approximately 10% in patients
>65 years old. Exercise training (ET) is widely recognized as an
evidence-based adjunct treatment modality for patients with HF, and
growing evidence is emerging among elderly patients with HF. We used
relevant data from literature search (PubMed, Medline, EMBASE)
highlighting the epidemiology of HF; focusing on central and peripheral
mechanisms underlying the beneficial effect of ET in HF patients; and on
frail HF elderly patients undergoing ET. Since many Countries ordered a
lockdown in early stages pandemic trying to limit infections, COVID-19
pandemic, and its limitation to exercise-based cardiac rehabilitation
operativity was also discussed. ET exerts both central and peripheral
adaptations that clinically translate into anti-remodeling effects,
increased functional capacity and reduced morbidity and mortality.
Ideally, ET programs should be prescribed in a patient-tailored approach,
particularly in frail elderly patients with HF. In conclusion, given the
complexity of HF syndrome, combining, and tailoring different ET
modalities is mandatory. A procedural algorithm according to patient's
baseline clinical characteristics [i.e., functional capacity, comorbidity,
frailty status (muscle strength, balance, usual daily activities, hearing
and vision impairment, sarcopenia, and inability to actively exercise),
logistics, individual preferences and goals] has been proposed. Increasing
long-term adherence and reaching the frailest patients are challenging
goals for future initiatives in the field. Copyright © 2022 The
Author(s).

<74>
[Use Link to view the full text]
Accession Number
2018105939
Title
Mitral valve surgery with extensive annular calcification: Review of
surgical techniques and postoperative complications.
Source
Journal of Cardiovascular Medicine. 23(5) (pp 285-289), 2022. Date of
Publication: 01 May 2022.
Author
Baudo M.; Petruccelli R.D.; Muneretto C.
Institution
(Baudo, Petruccelli, Muneretto) Cardiac Surgery Department, Spedali Civili
di Brescia, University of Brescia, Piazza Spedali Civili, 1, Brescia
25123, Italy
Publisher
Lippincott Williams and Wilkins
Abstract
Mitral annular calcification (MAC) represents an important risk factor in
mitral valve (MV) surgery. Despite several procedures having been
described, no surgical treatment of choice has been established so far:
whether a decalcification should be systematically carried out, or if the
MV should be preferentially repaired rather than replaced. A review of the
literature on patients undergoing MV surgery associated with MAC was
performed. Studies were excluded if dealing with endovascular procedures
or emergency surgery for associated endocarditis. Case reports were also
not considered in the final analysis. The literature search identified
1429 potentially eligible studies, and 25 papers were eventually included.
Several surgical techniques were described to approach this challenging
condition. During MV surgery, the presence of MAC favors the occurrence of
suboptimal intraoperative outcomes. MAC-related complications such as
atrioventricular groove rupture, cerebrovascular accident, new permanent
pacemaker implantation, intraoperative conversion from valve repair to
replacement and mortality were analyzed.MV surgery in the presence of MAC
considerably impacts the postoperative outcomes in terms of morbidity and
mortality. A great variability of surgical techniques is reported,
suggesting the need for standardization of the approach. Copyright
© 2022 Lippincott Williams and Wilkins. All rights reserved.

<75>
Accession Number
2016767860
Title
Effects of Iron Sucrose and Erythropoietin on Transfusion Requirements
inPatientswithPreoperative IronDeficiency Anemia Undergoing on-Pump
Coronary Artery Bypass Graft.
Source
Journal of Tehran University Heart Center. 17(1) (pp 7-14), 2022. Date of
Publication: 2022.
Author
Jafari S.; Talasaz A.H.; Salehiomran A.; Ariannejad H.; Jalali A.
Institution
(Jafari) Cardiovascular Diseases Research Center, Birjand University of
Medical Sciences, Birjand, Iran, Islamic Republic of
(Jafari) Department of Clinical Pharmacy, School of Pharmacy, Birjand
University of Medical Sciences, Birjand, Iran, Islamic Republic of
(Talasaz) Department of Clinical Pharmacy, School of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Talasaz, Salehiomran, Ariannejad, Jalali) Tehran Heart Center, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
Publisher
Tehran Heart Center
Abstract
Background: Preoperative anemia is an independent risk factor for higher
rates of blood transfusion in cardiac surgery. This study aimed to
evaluate the effects of intravenous iron sucrose and erythropoietin on
transfusion requirements in patients with preoperative iron deficiency
anemia (IDA) undergoing on-pump coronary artery bypass graft (CABG)
surgery. Method(s): In this open-label, randomized clinical trial,
patients with preoperative IDA who were candidates for on-pump CABG were
randomized into intervention (iron plus erythropoietin) or control groups.
Iron sucrose was administered as a 200 mg intravenous dose and
erythropoietin as a 100 IU/kg bolus 1 to 2 days before surgery. The
primary outcome was the amount of blood transfusion during the first 4
postoperative days. Result(s): The study population consisted of 114
patients. The mean age was 64.11+/-8.18 years in the intervention group
and 63.35+/-8.70 years in the control group. Twenty-seven patients (47.4%)
in the intervention group and 25 (43.9%) in the control group were males.
The number of red blood cell units transfused per patient exhibited a
significant fall in the intervention group compared with the control group
(P<0.001). The ferritin level showed a significant rise in the
intervention group on postoperative day 7 (P=0.027). The length of stay in
the intensive care unit and the hospital was significantly lower in the
intervention arm (P=0.041 and P=0.006, respectively). No adverse events
were reported in both groups. Conclusion(s): The use of
erythropoietin and iron sucrose 1 to 2 days before surgery significantly
decreased the need for blood transfusion in patients with IDA undergoing
CABG without any significant adverse events. Copyright © 2022
Tehran University of Medical Sciences. Published by Tehran University of
Medical Sciences.

<76>
Accession Number
2016884138
Title
Meta-Analysis Investigating the Efficacy and Safety of the MANTA Versus
ProGlide Vascular Closure Devices After Transcatheter Aortic Valve
Implantation.
Source
American Journal of Cardiology. 169 (pp 151-154), 2022. Date of
Publication: 15 Apr 2022.
Author
Al-Abcha A.; Saleh Y.; Halboni A.; Wang E.; Salam M.F.; Abela G.
Institution
(Al-Abcha, Wang, Salam) Department of Internal Medicine, Michigan State
University, East Lansing, MI, United States
(Saleh) Department of Cardiology, Houston Methodist DeBakey Heart &
Vascular Center, Houston, Texas, United States
(Saleh) Department of Cardiology, Alexandria University, Alexandria, Egypt
(Halboni) Department of Internal Medicine, Wayne State University/Detroit
Medical Center, Detroit, MI, United States
(Abela) Department of Cardiology, Michigan State University, East Lansing,
MI, United States
Publisher
Elsevier Inc.

<77>
Accession Number
2016884135
Title
Meta-Analysis Comparing Direct Oral Anticoagulants Versus Vitamin K
Antagonists in Patients With Atrial Fibrillation Who Underwent
Bioprosthetic Valve Replacement.
Source
American Journal of Cardiology. 169 (pp 148-149), 2022. Date of
Publication: 15 Apr 2022.
Author
Shaikh S.; Mohamed M.M.G.; Osman M.; Kheiri B.
Institution
(Shaikh, Mohamed) Internal Medicine Department, SSM Health St. Mary's
Hospital-St. Louis, Missouri, St Louis
(Osman, Kheiri) Knight Cardiovascular Institute, Oregon Health & Science
University, Oregon, Portland
Publisher
Elsevier Inc.

<78>
Accession Number
2016797563
Title
Erector Spinae Plane Block for Children Undergoing Cardiac Surgeries via
Sternotomy: A Randomized Controlled Trial.
Source
Anesthesiology and Pain Medicine. 12(2) (no pagination), 2022. Article
Number: e123723. Date of Publication: Apr 2022.
Author
Gado A.A.; Alsadek W.M.; Ali H.; Ismail A.A.
Institution
(Gado, Alsadek, Ali, Ismail) Anesthesia Department, Faculty of Medicine,
Cairo University, Giza, Egypt
Publisher
Kowsar Medical Institute
Abstract
Background: Ineffective management of postoperative pain following
pediatric cardiac surgeries adversely affects a patient's postoperative
course. The erector spinae plane (ESP) block has been described in the
literature regarding perioperative pain manage-ment. We hypothesized that
bilateral ESP blocks in pediatric patients would decrease intraoperative
fentanyl consumption, reduce the need for postoperative morphine
consumption, and improve pain scores. Objective(s): The aim of this
double-blinded randomized controlled trial was to assess the efficacy and
safety of bilateral ESP blocks in pediatric patients undergoing cardiac
surgeries through a median sternotomy. Method(s): The study involved
98 children aged 6 months to 7 years who were American Society of
Anesthesiologists (ASA) II and III and scheduled for cardiac surgery
through a median sternotomy. Patients were divided randomly into 2 groups:
the ES group (n = 50) who received bilateral ultrasound-guided ESP blocks,
and the N group (n = 48) who received no block. The primary outcome was
the total dose of administered fentanyl intraoperatively. Secondary
outcomes included morphine consumption in the first 24 hours
postoperatively; the length of time before the first need for
postoperative analgesia; and FLACC (face, legs, activity, consolability,
and cry) scores at the first and second hours postoperatively and every 4
hours, with readings taken for a period of 24 hours. Result(s): There
were statistically significantly higher levels of administered fentanyl
intraoperatively (6.7 +/- 3 vs 4.3 +/- 1.9 microg.kg-1) and
postoperative morphine consumption (0.5 +/- 0.2 vs 0.4 +/- 0.2
mg.kg-1) in the N group compared with the ES group (P < 0.001).
Moreover, the timing of the first rescue analgesia was significantly
delayed in the ES group compared with the N group (231.6 +/- 104.5 vs
108.8 +/- 47.8 minutes). Conclusion(s): Bilateral ultrasound-guided
ESP blocks can be used to reduce perioperative opioid consumption in
pediatric patients undergoing cardiac surgery through a sternotomy. It
also can be used to decrease postoperative pain scores. Copyright
© 2022, Author(s).

<79>
Accession Number
2016796356
Title
Possible effects of melatonin on reperfusion injury following coronary
artery bypass graft surgery.
Source
ARYA Atherosclerosis. 18(1) (no pagination), 2022. Article Number: 2208.
Date of Publication: January 2022.
Author
Hajhossein-Talasaz A.; Ghaeli P.; Salehiomran A.; Dianatkhah M.
Institution
(Hajhossein-Talasaz) Department of Clinical Pharmacy, School of Pharmacy
AND Tehran Heart Center, Tehran University of Medical Sciences, Tehran,
Iran, Islamic Republic of
(Dianatkhah) Department of Clinical Pharmacy, School of Pharmacy AND
Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
(Ghaeli) Department of Clinical Pharmacy, School of Pharmacy, Tehran
University of Medical Sciences, Tehran, Iran, Islamic Republic of
(Salehiomran) Tehran Heart Center, Tehran University of Medical Sciences,
Tehran, Iran, Islamic Republic of
(Dianatkhah) Isfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,
Islamic Republic of
Publisher
Isfahan University of Medical Sciences(IUMS)
Abstract
BACKGROUND: Although coronary artery bypass graft (CABG) surgery has been
reported to be one of the most effective internentions in terms of
myocardial salvage, reperfusion itself can cause additional damage to the
myocardium. Since there is strong evidence that free radicals are the
principal offender in ischemia-reperfusion (I/R) injury, it has been
suggested that treatment with antioxidant agents can be protective.
Investigations have shown that melatonin secretion is partially disturbed
in CABG patients. The aim of this study was to evaluate the protective
effect of melatonin as an antioxidant agent on I/R injury. METHOD(S):
164 elective CABG candidates participated in this randomized clinical
trial during the preoperative period. The candidates were randomized to
receive 3 mg of melatonin tablets (physiologic dose) from 3 days before
surgery until the day of discharge. Cardiac biomarkers [troponin and
creatine kinase myocardial band (CKMB)] were assessed once before surgery
(24 hours before surgery), and 8 and 24 hours after surgery.
 RESULT(S): Finally, 130 patients, 65 (50%) patients in the melatonin
group and 65 (50%) in the control arm finished our study. Mean age of
melatonin and control groups was 59.90 +/- 9.59 and 60.80 +/- 8.00 years,
respectively; moreover, 47 (72.30%) in melatonin and 45 (69.23%) in
control group were men. No significant difference was seen in baseline
cardiac biomarkers between two groups (P > 0.05). In both groups, cardiac
biomarkers (CKMB and troponin) elevated after surgery in comparison to
their preoperative values. There was no statistically significant
difference between the control and melatonin groups regarding the 8-hour
and 24-hour troponin and CKMB when adjusted for interacting factors (P >
0.05). CONCLUSION(S): Although physiological concentration of
melatonin is protective against I/R injury, substitution of endogenous
melatonin with the oral supplement which creates physiologic concentration
may not prevent I/R injury. In order to have antioxidant effect,
pharmacologic doses of melatonin should be employed. Copyright ©
2022, Isfahan University of Medical Sciences(IUMS). All rights reserved.

<80>
Accession Number
2016019099
Title
Cost Analysis From a Randomized Comparison of Immediate Versus Delayed
Angiography After Cardiac Arrest.
Source
Journal of the American Heart Association. 11(5) (no pagination), 2022.
Article Number: e022238. Date of Publication: 01 Mar 2022.
Author
Camaro C.; Bonnes J.L.; Adang E.M.; Spoormans E.M.; Janssens G.N.; van der
Hoeven N.W.; Jewbali L.S.; Dubois E.A.; Meuwissen M.; Rijpstra T.A.;
Bosker H.A.; Blans M.J.; Bleeker G.B.; Baak R.; Vlachojannis G.J.;
Eikemans B.J.; van der Harst P.; van der Horst I.C.; Voskuil M.; van der
Heijden J.J.; Beishuizen B.; Stoel M.; van der Hoeven H.; Henriques J.P.;
Vlaar A.P.; Vink M.A.; van den Bogaard B.; Heestermans T.A.; de Ruijter
W.; Delnoij T.S.; Crijns H.J.; Jessurun G.A.; Oemrawsingh P.V.; Gosselink
M.T.; Plomp K.; Magro M.; Elbers P.W.; van de Ven P.M.; Lemkes J.S.; van
Royen N.
Institution
(Camaro, Bonnes, van Royen) Department of Cardiology, Radboud University
Medical Center, Nijmegen, Netherlands
(Adang) Department of Health Evidence, Radboudumc Technology Center for
Health Economics, Nijmegen, Netherlands
(Spoormans, Janssens, van der Hoeven, Lemkes, van Royen) Department of
Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam,
Netherlands
(Jewbali, Dubois) Department of Cardiology and Intensive Care Medicine,
Erasmus Medical Centre, Rotterdam, Netherlands
(Meuwissen) Department of Cardiology, Amphia Hospital, Breda, Netherlands
(Rijpstra) Department of Intensive Care Medicine, Amphia Hospital, Breda,
Netherlands
(Bosker) Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands
(Blans) Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem,
Netherlands
(Bleeker) Department of Cardiology, HAGA Hospital, Den Haag, Netherlands
(Baak) Department of Intensive Care Medicine, HAGA Hospital, Den Haag,
Netherlands
(Vlachojannis) Department of Cardiology, Maasstad Hospital Rotterdam and
University Medical Centre Utrecht, Utrecht, Netherlands
(Eikemans) Department of Intensive Care Medicine, Maasstad Hospital,
Rotterdam, Netherlands
(van der Harst) Department of Cardiology, University Medical Center
Groningen, Groningen, Netherlands
(van der Harst) Department of Cardiology, University Medical Centre
Utrecht, Utrecht, Netherlands
(van der Horst) Department of Critical Care, University Medical Center
Groningen, Groningen, Netherlands
(van der Horst) Department of Critical Care, Maastricht University Medical
Center+, Maastricht, Netherlands
(van der Horst, Delnoij) Department of Intensive Care Medicine, Maastricht
University Medical Center+, Maastricht, Netherlands
(Voskuil) Department of Cardiology, University Medical Center Utrecht,
Utrecht, Netherlands
(van der Heijden) Department of Intensive Care Medicine, University
Medical Center Utrecht, Utrecht, Netherlands
(Beishuizen) Department of Intensive Care Medicine, Medisch Spectrum
Twente, Enschede, Netherlands
(Stoel) Department of Cardiology, Medisch Spectrum Twente, Enschede,
Netherlands
(van der Hoeven) Department of Intensive Care Medicine, Radboud University
Medical Center, Nijmegen, Netherlands
(Henriques) Department of Cardiology, Amsterdam University Medical Center,
Amsterdam, Netherlands
(Vlaar) Department of Intensive Care Medicine, Amsterdam University
Medical Center, Amsterdam, Netherlands
(Vink) Department of Cardiology, OLVG, Amsterdam, Netherlands
(van den Bogaard) Department of Intensive Care Medicine, OLVG, Amsterdam,
Netherlands
(Heestermans) Department of Cardiology, Noord West Ziekenhuisgroep,
Alkmaar, Netherlands
(de Ruijter) Department of Intensive Care Medicine, Noord West
Ziekenhuisgroep, Alkmaar, Netherlands
(Delnoij, Crijns) Department of Cardiology, Maastricht University Medical
Center+, Maastricht, Netherlands
(Jessurun) Department of Cardiology, Scheper Hospital, Emmen, Netherlands
(Oemrawsingh) Department of Cardiology, Haaglanden Medical Center, Den
Haag, Netherlands
(Gosselink) Department of Cardiology, Isala Hospital, Zwolle, Netherlands
(Plomp) Department of Cardiology, Tergooi Hospital, Blaricum, Netherlands
(Magro) Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg,
Netherlands
(Elbers) Department of Intensive Care Medicine, Amsterdam University
Medical Center, location VUmc, Amsterdam, Netherlands
(van de Ven) Department of Epidemiology and Data Science, Amsterdam
University, Amsterdam, Netherlands
Publisher
American Heart Association Inc.
Abstract
BACKGROUND: In patients with out-of-hospital cardiac arrest without
ST-segment elevation, immediate coronary angiography did not improve
clinical outcomes when compared with delayed angiography in the COACT
(Coronary Angiography After Cardiac Arrest) trial. Whether 1 of the 2
strategies has benefits in terms of health care resource use and costs is
currently unknown. We assess the health care resource use and costs in
patients with out-of-hospital cardiac arrest. METHODS AND RESULTS: A total
of 538 patients were randomly assigned to a strategy of either immediate
or delayed coronary angiography. Detailed health care resource use and
cost-prices were collected from the initial hospital episode. A
generalized linear model and a gamma distribution were performed. Generic
quality of life was measured with the RAND-36 and collected at 12-month
follow-up. Overall total mean costs were similar between both groups (EUR
33 575+/-19 612 versus EUR 33 880+/-21 044; P=0.86). Generalized linear
model: (beta, 0.991; 95% CI, 0.894-1.099; P=0.86). Mean procedural costs
(coronary angiography and percutaneous coronary intervention, coronary
artery bypass graft) were higher in the immediate angiography group (EUR
4384+/-3447 versus EUR 3028+/-4220; P<0.001). Costs concerning intensive
care unit and ward stay did not show any significant difference. The
RAND-36 questionnaire did not differ between both groups.
 CONCLUSION(S): The mean total costs between patients with
out-of-hospital cardiac arrest randomly assigned to an immediate
angiography or a delayed invasive strategy were similar during the initial
hospital stay. With respect to the higher invasive procedure costs in the
immediate group, a strategy awaiting neurological recovery followed by
coronary angiography and planned revascularization may be
considered. Copyright © 2022 The Authors. Published on behalf of
the American Heart Association, Inc.

<81>
Accession Number
2016816683
Title
Preclosure of large bore venous access sites in patients undergoing
transcatheter mitral replacement and repair.
Source
Catheterization and Cardiovascular Interventions. (no pagination), 2022.
Date of Publication: 2022.
Author
Mohammed M.; Nona P.; Abou Asala E.; Chiang M.; Lemor A.; O'Neill B.;
Frisoli T.; Lee J.; Wang D.D.; O'Neill W.W.; Eng M.; Villablanca P.A.
Institution
(Mohammed, Abou Asala) Department of Medicine, Henry Ford Hospital,
Detroit, MI, United States
(Nona, Chiang, Lemor, O'Neill, Frisoli, Lee, Wang, O'Neill, Eng,
Villablanca) Center for Structural Heart Disease, Henry Ford Hospital,
Detroit, MI, United States
Publisher
John Wiley and Sons Inc
Abstract
Objective: We aim to report on the efficacy and safety of large bore
venous access (LBVA) preclosure with PercloseTM (Abbott Vascular Devices)
suture-mediated device use following transcatheter edge-to-edge (TEER) and
replacement (TMVR). Background(s): Patients requiring TEER and TMVR
require LBVA. Clinical outcome data on the use of suture-mediated devices
for LBVA site closure are limited. Method(s): Between 2012 and 2019,
354 consecutive high-risk patients with mitral valvular heart disease
underwent TEER (n = 287) with MitraClip and TMVR (n = 67) with Edwards
Sapien Valves. Patients had LBVA with 24 or 16 French sheaths. All
patients underwent preclosure of LBVA except for one that underwent manual
hemostasis. Result(s): There were no closure device failures. None of
the cases required surgical repair of the access site following venous
preclosure. Two cases had large hematomas (>6 cm) following Perclose in
each group. Six cases had small hematomas (<6 cm and >2 cm) with three in
each group. There was one major bleeding using Mitral Valve Academic
Research Consortium 2 definition (retroperitoneal bleed from arterial
puncture) unrelated to the venous closure. Transfusion related to vascular
access complication was required in five cases. There were two immediate
acute deep venous thromboses postprocedure; one of which occurred after
preclosure. There were no arteriovenous malformations, pseudoaneurysms, or
access site infections reported following Perclose. Conclusion(s): In
this large sample size analysis, Proglide preclosure technique is a
feasible and safe alternative approach to achieving hemostasis after
removal of LBVA sheaths in patients undergoing TEER and TMVR. Randomized
trials are needed to compare the different modalities of
hemostasis. Copyright © 2022 Wiley Periodicals LLC.

<82>
Accession Number
638033222
Title
Apixaban vs. standard of care after transcatheter aortic valve
implantation: the ATLANTIS trial.
Source
European heart journal. (no pagination), 2022. Date of Publication: 18
May 2022.
Author
Collet J.-P.; Van Belle E.; Thiele H.; Berti S.; Lhermusier T.; Manigold
T.; Neumann F.-J.; Gilard M.; Attias D.; Beygui F.; Cequier A.; Alfonso
F.; Aubry P.; Baronnet F.; Ederhy S.; El Kasty M.; Kerneis M.; Barthelemy
O.; Lefevre T.; Leprince P.; Redheuil A.; Henry P.; Portal J.-J.; Vicaut
E.; Montalescot G.
Institution
(Collet, Kerneis, Barthelemy, Montalescot) Sorbonne Universite, ACTION
Group, INSERM UMRS 1166, Hopital Pitie-Salpetriere (AP-HP), Institut de
Cardiologie, Paris 75013, France
(Van Belle) Pole Cardiovasculaire et Pulmonaire, ACTION Group, Inserm
U1011, Institut Pasteur de Lille, EGID, Universite de Lille, CHU Lille,
Lille, France
(Thiele) Department of Internal Medicine/Cardiology, Heart Center Leipzig
at University of Leipzig and Leipzig, Leipzig, Germany
(Berti) Fondazione Toscana G. Monasterio, Ospedale del Cuore G, Massa,
Italy
(Lhermusier) Hopital de Rangueil, Federation de Cardiologie, Pole
Cardio-vasculaire et Metabolique, Toulouse, France
(Manigold) Hopital Guillaume et Rene Laennec, Unite Hemodynamique et
Cardiovasculaire Interventionnel, Nantes, France
(Neumann) University Heart Centre Freiburg Bad Krozingen, Division of
Cardiology and Angiology II, Bad Krozingen, Germany
(Gilard) CHU Brest, Departement de Cardiologie, Brest, France
(Attias) Centre Cardiologique du Nord, Saint Denis, France
(Beygui) CHU de la Cote de Nacre, Departement de Cardiologie, Caen, France
(Cequier) Hospital Universitario de Bellvitge, University of Barcelona,
Heart Disease Institute, L'Hospitalet de Llobregat, Barcelona, Spain
(Alfonso) Hospital Universitario de la Princesa, Department of Cardiology,
Madrid, Spain
(Aubry) Centre Hospitalier Bichat, Departement de Cardiologie, Paris,
France
(Baronnet) Hopital La Pitie-Salpetriere (AP-HP), Unite Intensif de
Neurologie Vasculaire, Paris, France
(Ederhy) Hopital Saint-Antoine (AP-HP), ACTION Group, Service de
Cardiologie, Paris, France
(El Kasty) Hopital de Jossigny, ACTION Group, Service de Cardiologie,
Jossigny, France
(Lefevre) Hopital Prive Jacques Cartier, Institut Cardiovasculaire Paris
Sud, Massy, France
(Leprince) Institut de Cardiologie, Chirurgie Cardiaque, Paris, France
(Redheuil) Laboratoire Imagerie Biomedicale (LIB), ICAN, ACTION Group,
Hopital Pitie-Salpetriere (AP-HP), Institut de Cardiologie, Sorbonne
Universite, Paris, France
(Henry) Hopital Lariboisiere (AP-HP), Service de Cardiologie, Universite
de Paris, Paris, France
(Portal, Vicaut) Unite de Recherche Clinique Lariboisiere St Louis, ACTION
Group, Paris, France
Publisher
NLM (Medline)
Abstract
AIMS: The respective roles of oral anticoagulation or antiplatelet therapy
following transcatheter aortic valve implantation (TAVI) remain debated.
ATLANTIS is an international, randomized, open-label, superiority trial
comparing apixaban to the standard of care. METHODS AND RESULTS: After
successful TAVI, 1500 patients were randomized (1:1) to receive apixaban 5
mg (2.5 mg if impaired renal function or concomitant antiplatelet therapy)
(n=749) twice daily, or standard of care (n=751). Randomization was
stratified by the need for chronic anticoagulation therapy.
Standard-of-care patients received a vitamin K antagonist (VKA) (Stratum
1) or antiplatelet therapy (Stratum 2) if there was an indication for
anticoagulation or not, respectively. The primary endpoint was the
composite of death, myocardial infarction, stroke or transient ischaemic
attack, systemic embolism, intracardiac or bioprosthesis thrombosis, deep
vein thrombosis or pulmonary embolism, and life-threatening, disabling, or
major bleeding over 1-year follow-up. The primary safety endpoint was
major, disabling, or life-threatening bleeding. The primary outcome
occurred in 138 (18.4%) and 151 (20.1%) patients receiving apixaban or
standard of care, respectively [hazard ratio (HR) 0.92; 95% confidence
interval (CI) 0.73-1.16] and there was no evidence of interaction between
treatment and stratum (Pinteraction=0.57). The primary safety endpoint was
similar in both groups (HR 1.02; 95% CI 0.72-1.44). In Stratum 1 (n=451),
an exploratory analysis showed no difference for all endpoints between
apixaban and VKA. In Stratum 2 (n=1049), the primary outcome and primary
safety endpoint did not differ, but obstructive valve thrombosis was
reduced with apixaban vs. antiplatelet therapy (HR 0.19; 95% CI
0.08-0.46), while a signal of higher non-cardiovascular mortality was
observed with apixaban. CONCLUSION(S): After TAVI, apixaban was not
superior to the standard of care, irrespective of an indication for oral
anticoagulation. Copyright © The Author(s) 2022. Published by
Oxford University Press on behalf of European Society of Cardiology. All
rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.

<83>
Accession Number
638032859
Title
Statin and Post-Cardiac Surgery Atrial Fibrillation Prevention: Systematic
Review and Meta-analysis.
Source
Journal of cardiovascular pharmacology. (no pagination), 2022. Date of
Publication: 11 May 2022.
Author
Oliveri F.; Bongiorno A.; Compagnoni S.; Fasolino A.; Gentile F.R.; Pepe
A.; Tua L.
Institution
(Oliveri) Department of Molecular Medicine, University of Pavia, Pavia,
Italy
Publisher
NLM (Medline)
Abstract
ABSTRACT: Postoperative atrial fibrillation (POAF) is a frequently
reported post-cardiac surgery complication leading to increased
in-hospital and long-term mortality rates. Many randomized controlled
trials (RCTs) have recently suggested using statins to protect against
POAF. Therefore, we performed a systematic literature search and
meta-analysis in electronic databases for eligible studies published
between January 2006 and January 2022. Principal inclusion criteria were:
RCTs study design; statin-naive patients; total study participants >= 50
units; statin pretreatment started no more than 21 days before cardiac
surgery. In the primary analysis, statin pretreatment reduced the
incidence of POAF compared to placebo. Analyzing different molecules,
atorvastatin was associated with lower incidence of POAF but rosuvastatin
was not. We therefore performed a sensitivity analysis excluding RCTs
affected by significant risk of biases. Thus, studies whose participants
were >= 199 were those eligible for the secondary analysis. No
statistically significant difference between statin pre-treatment and
placebo (OR 0.87; 95% CI: 0.71-1.07, p= 0.18), as well as for atorvastatin
(OR 0.88; 95% CI: 0.61-1.28; p=0.48; I2= 84%) and rosuvastatin (OR 0.87;
95% CI: 0.68-1.12, p= 0.29) was observed. To conclude, statin pretreatment
before cardiac surgery is not associated with a significant reduction in
POAF occurrence. Copyright © 2022 Wolters Kluwer Health, Inc. All
rights reserved.

<84>
Accession Number
638019702
Title
Intravenous iron supplement for iron deficiency in patients with severe
aortic stenosis scheduled for TAVI Results of the IIISAS randomised trial.
Source
European journal of heart failure. (no pagination), 2022. Date of
Publication: 17 May 2022.
Author
Kvaslerud A.B.; Bardan S.; Andresen K.; Klove S.F.; Fagerland M.W.;
Edvardsen T.; Gullestad L.; Broch K.
Institution
(Kvaslerud, Bardan, Andresen, Edvardsen, Gullestad, Broch) Faculty of
Medicine, University of Oslo, Oslo, Norway
(Kvaslerud, Andresen, Klove, Edvardsen, Gullestad, Broch) Department of
Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
(Kvaslerud, Gullestad, Broch) KG Jebsen Center for Cardiac Research and
Center for Heart Failure Research, University of Oslo, Oslo, Norway
(Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research
Support Services, Oslo University Hospital, Oslo, Norway
Publisher
NLM (Medline)
Abstract
AIMS: The aim of this trial was to evaluate whether intravenous iron could
provide benefit beyond transcatheter aortic valve implantation (TAVI) in
iron deficient patients with severe aortic stenosis. METHODS AND RESULTS:
In this randomised, placebo-controlled, double-blinded, single-centre
trial, we enrolled patients with severe aortic stenosis and iron
deficiency (defined as ferritin <100 mug/L, or 100-299 mug/L with a
transferrin saturation <20 %) who were evaluated for TAVI. Patients were
randomly assigned (1:1) to receive i.v. ferric derisomaltose or placebo
approximately three months before TAVI. The primary endpoint was the
between-group, baseline-adjusted six-minute walk distance measured three
months after TAVI. Secondary outcomes included quality of life, iron
stores, handgrip strength, NYHA class, and safety. Between January 2020
and September 2021, we randomised 74 patients to ferric derisomaltose and
75 patients to placebo. The modified intention-to-treat population
comprised the 104 patients who completed the six-minute walk test at
baseline and three months after successful TAVI. Iron stores were restored
in 76 % of the patients allocated to iron and 13 % of the patients
allocated to placebo (p <0.001). There was no difference in the
baseline-adjusted six-minute walk distance between the two treatment arms
(p = 0.82). The number of serious adverse events, quality of life,
handgrip strength, and NYHA class did not differ between the treatment
arms. CONCLUSION(S): Treatment with intravenous iron did not provide
clinical benefit beyond TAVI in iron deficient patients with severe aortic
stenosis. Copyright This article is protected by copyright. All rights
reserved.

<85>
Accession Number
2014648675
Title
Assessment of glycaemic status in adult hospital patients for the
detection of undiagnosed diabetes mellitus: A systematic review.
Source
Diabetic Medicine. 39(4) (no pagination), 2022. Article Number: e14777.
Date of Publication: April 2022.
Author
Thornton-Swan T.D.; Armitage L.C.; Curtis A.M.; Farmer A.J.
Institution
(Thornton-Swan, Armitage, Farmer) Exeter College, University of Oxford,
Oxford, United Kingdom
(Thornton-Swan, Curtis) Clinical Medical School, University of Oxford,
Oxford, United Kingdom
(Armitage, Farmer) Nuffield Department of Primary Care Health Sciences,
University of Oxford, Oxford, United Kingdom
(Curtis) Green Templeton College, University of Oxford, Oxford, United
Kingdom
Publisher
John Wiley and Sons Inc
Abstract
Aim: In-hospital blood glucose testing is commonplace, particularly in
acute care. In-hospital screening for hyperglycaemia may present a
valuable opportunity for early diabetes diagnosis by identifying at-risk
individuals. This systematic review investigates the extent to which
random blood glucose testing in acute and inpatient hospital settings
predicts undiagnosed diabetes. Method(s): Two databases were
systematically searched for studies in which adult patients received an
in-hospital random blood glucose test, followed by a diagnostic HbA1c
test. The primary outcome was the proportion of hyperglycaemic individuals
diagnosed with diabetes by HbA1c. Result(s): A total of 3245 unique
citations were identified, and 12 were eligible for inclusion. Ten
different blood glucose thresholds, ranging from 5.5 to 11.1 mmol/L, were
used to detect hyperglycaemia, indicating that there is no consistent
clinical definition for hyperglycaemia. The proportion of participants
with hyperglycaemia in each study ranged from 3.3% to 62.1%, with a median
(Q<inf>1</inf>, Q<inf>3</inf>) of 34.5% (5.95%, 61.1%). The proportion of
hyperglycaemic participants found to have a diabetes-range HbA1c varied
from 4.1% to 90%, with a median (Q<inf>1</inf>, Q<inf>3</inf>) of 18.9%
(11.5%, 61.1%). Meta-analysis was not possible due to substantial
heterogeneity between study protocols. Conclusion(s): All studies
consistently identified a proportion of hyperglycaemic hospital patients
as having a diabetes-range HbA1c, showing that in-hospital blood glucose
screening can facilitate diabetes diagnosis. The proportion of
hyperglycaemic participants with undiagnosed diabetes varied
substantially, indicating a need for further research and consistency in
defining in-hospital hyperglycaemia. This may aid the development of a
standardised screening protocol to identify people with possible
undiagnosed diabetes. Copyright © 2021 The Authors. Diabetic
Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

<86>
Accession Number
2017969089
Title
Protective effect of sacubitril/valsartan in patients with acute
myocardial infarction: A meta-analysis.
Source
Experimental and Therapeutic Medicine. 23(6) (no pagination), 2022.
Article Number: 406. Date of Publication: June 2022.
Author
Liu S.; Yin B.; Wu B.; Fan Z.
Institution
(Liu, Yin, Wu) Department of Physical Examination, 904th Hospital of Joint
Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical
University, Jiangsu, Wuxi 214000, China
(Fan) Department of Cardiology, The First College of Clinical Medical
Sciences, China Three Gorges University, Hubei, Yichang 443000, China
Publisher
Spandidos Publications
Abstract
To evaluate the effects and safety of sacubi- tril/valsartan in patients
with acute myocardial infarction (AMI), a total of four databases,
including PubMed, Cochrane Library, Embase and Web of Science, and the
ClinicalTrials. gov website were searched. Using a combination of medical
subject headings and entry terms, the final search was performed in July
2021. A manual search of cross-refer- ences from the original articles was
also conducted. The meta-analysis was subsequently performed with Revman
5.3 software and a total of four studies comprising 586 patients were
included. The results disclosed a significant reduction in major adverse
cardiovascular and cerebrovascular events (MACCEs) [odds ratio (OR), 0.47;
95% confidence interval (CI), 0.30-0.73; P=0.0007], readmission (OR, 0.45;
95% CI, 0.29-0.71; P=0.0006), incidence of acute heart failure (AHF) (OR,
0.45; 95% CI, 0.28-0.71; P=0.0007) and N-terminal pro B-type natriuretic
peptide [standardized mean difference (SMD), -0.88; 95% CI, -1.55-(-0.21);
P=0.01] in the sacubi- tril/valsartan group compared with that in the
control group, and a random effects model was used to pool these data. No
significant differences were identified in the incidence of hypo- tension
(OR, 2.91; 95% CI, 0.55-15.51; P=0.21), adverse events (OR, 2.19; 95% CI,
0.42-11.37; P=0.35), left ventricular ejection fraction (mean difference,
1.96; 95% CI, -0.84-4.76; P=0.17) or soluble suppression of
tumorigenesis-2 (SMD, -0.45; 95% CI, -1.62-0.71; P=0.45) according to the
random effects model. Copyright © 2022 Spandidos Publications.
All rights reserved.

<87>
Accession Number
2017904214
Title
Development of a protocol for conducting a randomized control trial on
effects of artificial intelligence on nutritional status of children post
cardiac surgery.
Source
Journal of the Pakistan Medical Association. 72(5) (pp 908-911), 2022.
Date of Publication: May 2022.
Author
Zahid M.; Sughra U.
Institution
(Zahid, Sughra) Al Shifa Trust Eye Hospital, School of Public Health,
Rawalpindi, Pakistan
Publisher
Pakistan Medical Association
Abstract
Objectives: To assess the effect of diet-related mobile application based
on artificial intelligence on the nutritional status of children
post-cardiac surgery, and to compare their diet-related problems with
their counterparts having the usual diet. Method(s): The two-arm
double-blind randomised controlled trial will be conducted at a tertiary
care hospital in Rawalpindi, Pakistan, over an expected duration of 6
months from March to August 2021. Intervention group A will be given a
diet-related mobile application based on artificial intelligence, while
usual-care group B will be handed a pamphlet with instructions related to
post-operative diet on discharge. Result(s): The findings will
improve perception about the influence of artificial intelligence on
nutritional status of children post-cardiac surgery. If proven to be
effective, this mobile application can be used in other hospitals.
 Conclusion(s): The study protocol will give an indication that
whether diet-related mobile application can contribute to improving the
nutritional status of children post-cardiac surgery. As the pandemic has
forced people to minimise hospital visits, this is the right time to
evaluate the utility of such an application. Copyright © 2022
Pakistan Medical Association. All rights reserved.

<88>
[Use Link to view the full text]
Accession Number
2016531207
Title
Plasma and Platelet Transfusions Strategies in Neonates and Children
Undergoing Cardiac Surgery With Cardiopulmonary Bypass or Neonates and
Children Supported by Extracorporeal Membrane Oxygenation: From the
Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.
Source
Pediatric Critical Care Medicine. 23 (pp E25-E36), 2022. Date of
Publication: 01 Jan 2022.
Author
Cholette J.M.; Muszynski J.A.; Ibla J.C.; Emani S.; Steiner M.E.; Vogel
A.M.; Parker R.I.; Nellis M.E.; Bembea M.M.
Institution
(Cholette) Department of Pediatrics, University of Rochester, Golisano
Children's Hospital, Rochester, NY, United States
(Muszynski) Department of Pediatrics, Division of Critical Care Medicine,
Nationwide Children's Hospital, Columbus, OH, United States
(Ibla) Division of Cardiac Anesthesia, Department of Anesthesiology,
Critical Care and Pain Medicine, Boston Children's Hospital, Harvard
Medical School, Boston, MA, United States
(Emani) Department of Cardiac Surgery, Boston Children's Hospital, Boston,
MA, United States
(Steiner) Divisions of Critical Care and Hematology, Department of
Pediatrics, University of Minnesota, Masonic Children's Hospital,
Minneapolis, MN, United States
(Vogel) Division of Pediatric Surgery, Department of Surgery, Texas
Children's Hospital, Baylor College of Medicine, Houston, TX, United
States
(Parker) Department of Pediatrics, Hematology/Oncology, Renaissance School
of Medicine, SUNY at Stony Brook, Stony Brook, NY, United States
(Nellis) Division of Pediatric Critical Care Medicine, Department of
Pediatrics, NY Presbyterian Hospital, Weill Cornell Medicine, New York,
NY, United States
(Bembea) Department of Anesthesiology and Critical Care Medicine, Johns
Hopkins University, School of Medicine, Baltimore, MD, United States
Publisher
Lippincott Williams and Wilkins
Abstract
OBJECTIVES: To present the recommendations and consensus statements with
supporting literature for plasma and platelet transfusions in critically
ill neonates and children undergoing cardiac surgery with cardiopulmonary
bypass or supported by extracorporeal membrane oxygenation from the
Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.
DESIGN: Systematic review and consensus conference of international,
multidisciplinary experts in platelet and plasma transfusion management of
critically ill children. SETTING: Not applicable. PATIENTS: Critically ill
neonates and children following cardiopulmonary bypass or supported by
extracorporeal membrane oxygenation. INTERVENTIONS: None. MEASUREMENTS AND
MAIN RESULTS: A panel of nine experts developed evidence-based and, when
evidence was insufficient, expert-based statements for plasma and platelet
transfusions in critically ill neonates and children following
cardiopulmonary bypass or supported by extracorporeal membrane
oxygenation. These statements were reviewed and ratified by the 29
Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding
experts. A systematic review was conducted using MEDLINE, EMBASE, and
Cochrane Library databases, from inception to December 2020. Consensus was
obtained using the Research and Development/University of California, Los
Angeles Appropriateness Method. Results were summarized using the Grading
of Recommendations Assessment, Development, and Evaluation method. We
developed one good practice statement, two recommendations, and three
expert consensus statements. CONCLUSION(S): Whereas viscoelastic
testing and transfusion algorithms may be considered, in general, evidence
informing indications for plasma and platelet transfusions in neonatal and
pediatric patients undergoing cardiac surgery with cardiopulmonary bypass
or those requiring extracorporeal membrane oxygenation support is
lacking. Copyright © 2022 by the Society of Critical Care
Medicine and the World Federation of Pediatric Intensive and Critical Care
Societies

<89>
Accession Number
2016102219
Title
Direct oral anticoagulation in atrial fibrillation and heart valve
surgery-a meta-analysis and systematic review.
Source
Therapeutic Advances in Cardiovascular Disease. 16 (no pagination), 2022.
Date of Publication: 2022.
Author
Gerfer S.; Djordjevic I.; Eghbalzadeh K.; Mader N.; Wahlers T.; Kuhn E.
Institution
(Gerfer) Department of Cardiothoracic Surgery, Heart Center, University
Hospital of Cologne, Kerpener Strase 62, Cologne 50937, Germany
(Djordjevic, Eghbalzadeh, Mader, Wahlers, Kuhn) Department of
Cardiothoracic Surgery, Heart Center, University Hospital of Cologne,
Cologne, Germany
Publisher
SAGE Publications Ltd
Abstract
Aims: Oral anticoagulation with direct oral anticoagulants (DOAC) could
provide an alternative to vitamin K antagonists (VKA) for patients with
atrial fibrillation (AF) undergoing bioprosthetic heart valve replacement
or valve repair. Methods and Results: The aim of this meta-analysis
was to review the safety and efficacy of DOAC in patients with surgical
implanted bioprosthetic heart valves or valve repairs and AF including
data from six clinical trials with a total of 1,857 patients. The efficacy
and safety data of DOAC and VKA were pooled to perform random-effects
meta-analyses using the Mantel-Haenszel method with pooled risk ratios
(RR) and 95% confidence interval (CI). A trial sequential analysis (TSA)
was performed to assess statistical robustness. Death caused by
cardiovascular cause or thromboembolic events were comparable (RR 0.67,
95% CI: 0.42-1.08; p = 0.10) as DOAC significantly reduced the risk for
major bleeding (RR 0.55, 95% CI: 0.35-0.88; p = 0.01) and thromboembolic
stroke or systemic embolism rates (RR 0.54, 95% CI: 0.32-0.90; p = 0.02).
Rates for intracranial bleeding and hemorrhagic stroke (RR 0.27, 95% CI:
0.07-0.99; p = 0.05) show a trend toward fewer events in the DOAC group.
Outcomes for major or minor bleeding events and all-cause mortality were
comparable for DOAC and VKA. Conclusion(s): Cumulative data analysis
reveals that DOAC may provide an effective and safe alternative to VKA in
patients with AF after surgically implanted bioprosthetic heart valves or
repair with AF. Within a relatively heterogeneous study population, this
meta-analysis shows a risk reduction of major bleedings and thromboembolic
stroke or systemic embolisms for DOAC. Copyright © The Author(s),
2022.

<90>
Accession Number
2017819978
Title
Initiation of acid suppression therapy for laryngomalacia.
Source
American Journal of Otolaryngology - Head and Neck Medicine and Surgery.
43(3) (no pagination), 2022. Article Number: 103434. Date of Publication:
01 May 2022.
Author
Dang S.; McCoy J.L.; Shaffer A.D.; Tobey A.B.J.; Dohar J.E.; Simons J.P.;
Maguire R.C.; Padia R.
Institution
(Dang, Tobey, Dohar, Simons, Maguire, Padia) Department of Otolaryngology,
University of Pittsburgh Medical Center, Pittsburgh, PA, United States
(McCoy, Shaffer, Tobey, Dohar, Simons, Maguire, Padia) Division of
Pediatric Otolaryngology, UPMC Children's Hospital of Pittsburgh,
Pittsburgh, PA, United States
Publisher
W.B. Saunders
Abstract
Objective: Evidence supporting the use of acid suppression therapy (AST)
for laryngomalacia (LM) is limited. The objective of this study was to
determine if outpatient-initiated AST for LM was associated with symptom
improvement, weight gain, and/or avoidance of surgery. Method(s): A
retrospective cohort was reviewed at a tertiary-care children's hospital.
Patients were included if they were diagnosed with LM at <=6 months of
age, seen in an outpatient otolaryngology clinic between 2012 and 2018,
and started on AST. Primary outcomes were improvement of airway and
dysphagia symptoms, weight gain, and need for surgery. Severity was
assessed by symptom severity. Result(s): Of 2693 patients reviewed,
199 met inclusion criteria. Median age of diagnosis was 4 weeks (range:
0-29 weeks). LM was classified as mild/moderate (71.4%) and severe (28.6%)
based on symptom severity. Severity on flexible fiberoptic laryngoscopy
(FFL) was not associated with clinical severity. Weight percentile, airway
symptoms, and dysphagia symptoms improved within the cohort. In total,
26.1% underwent supraglottoplasty (SGP). In multivariate analysis, only
severe LM on FFL was predictive of SGP (OR: 7.28, 95%CI: 1.91-27.67, p
=.004). Conclusion(s): Clinical symptom severity did not predict
response to AST raising the question of utility of AST in LM. Severity of
LM based on FFL, not clinical severity, was associated with decision to
pursue SGP. Prospective randomized trials are needed to better understand
the role of AST in LM. Level of Evidence: Level 3. Copyright
© 2022

<91>
Accession Number
2017684273
Title
Endovascular therapeutic hypothermia adjunctive to percutaneous coronary
intervention in acute myocardial infarction: realistic simulation as a
game changer.
Source
Reviews in Cardiovascular Medicine. 23(3) (no pagination), 2022. Article
Number: 104. Date of Publication: March 2022.
Author
Dallan L.A.P.; Dae M.; Giannetti N.S.; Polastri T.F.; Lima M.K.F.;
Rochitte C.E.; Hajjar L.A.; Martin C.Y.B.S.; Lima F.G.; Nicolau J.C.; de
Oliveira M.T.; Dallan L.A.O.; da Silva E.E.R.; Filho R.K.; Abizaid A.;
Neto P.A.L.; Timerman S.
Institution
(Dallan, Giannetti, Polastri, Lima, Rochitte, Hajjar, Martin, Lima,
Nicolau, de Oliveira, Dallan, da Silva, Filho, Abizaid, Neto, Timerman)
Department of Cardiology, InCor - Heart Institute, School of Medicine,
University of Sao Paulo, Sao Paulo 05403-900, Brazil
(Dallan) Harrington Heart & Vascular Institute, University Hospitals
Cleveland Medical Center, Case Western Reserve University, School of
Medicine, Cleveland, OH 44106, United States
(Dae) Department of Radiology, University of California, San Francisco, CA
94143, United States
Publisher
IMR Press Limited
Abstract
Background: Endovascular therapeutic hypothermia (ETH) reduces the damage
by ischemia/reperfusion cell syndrome in cardiac arrest and has been
studied as an adjuvant therapy to percutaneous coronary intervention (PCI)
in ST-elevation myocardial infarction (STEMI). New available advanced
technology allows cooling much faster, but there is paucity of resources
for training to avoid delays in door-to-balloon time (DTB) due to ETH and
subsequently coronary reperfusion, which would derail the procedure. The
aim of the study was to describe the process for the development of a
simulation, training & educational protocol for the multidisciplinary team
to perform optimized ETH as an adjunctive therapy for STEMI. Methods
and Results: We developed an optimized simulation protocol using modern
mannequins in different realistic scenarios for the treatment of patients
undergoing ETH adjunctive to PCI for STEMIs starting from the emergency
room, through the CathLab, and to the intensive care unit (ICU) using the
Proteus Endovascular System (Zoll Circulation IncTM, San Jose, CA, USA).
The primary endpoint was door-to-balloon (DTB) time. We successfully
trained 361 multidisciplinary professionals in realistic simulation using
modern mannequins and sham situations in divisions of the hospital where
real patients would be treated. The focus of simulation and training was
logistical optimization and educational debriefing with strategies to
reduce waste of time in patient's transportation from different
departments, and avoiding excessive rewarming during transfer. Afterwards,
the EHT protocol was successfully validated in a trial randomizing 50
patients for 18 minutes cooling before coronary recanalization at the
target temperature of 32 +/- 1.0 C or PCI-only. A total of 35 patients
underwent ETH (85.7% [30/35] in 90 +/- 15 minutes), without delays in the
mean door-to-balloon time for primary PCI when compared to 15 control
group patients (92.1 minutes versus 87 minutes, respectively p = 0.509).
 Conclusion(s): Realistic simulation, intensive training and
educational debriefing for the multidisciplinary team propitiated feasible
endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI
in STEMI. Copyright: © 2022 The Author(s).

<92>
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.

<93>
Accession Number
2016754854
Title
Comparative Evaluation of the Incidence of Postoperative Pulmonary
Complications After Minimally Invasive Valve Surgery vs. Full Sternotomy:
A Systematic Review and Meta-Analysis of Randomized Controlled Trials and
Propensity Score-Matched Studies.
Source
Frontiers in Cardiovascular Medicine. 8 (no pagination), 2021. Article
Number: 724178. Date of Publication: 2021.
Author
Mohamed M.A.; Ding S.; Ali Shah S.Z.; Li R.; Dirie N.I.; Cheng C.; Wei X.
Institution
(Mohamed, Ding, Cheng, Wei) Division of Cardiothoracic and Vascular
Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of
Science and Technology, Wuhan, China
(Ali Shah, Li) Department of Rehabilitation Medicine, Tongji Hospital,
Tongji Medical College, Huazhong University of Science and Technology,
Wuhan, China
(Dirie) Division of Urology, Tongji Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Publisher
Frontiers Media S.A.
Abstract
Background: Postoperative pulmonary complications remain a leading cause
of increased morbidity, mortality, longer hospital stays, and increased
costs after cardiac surgery; therefore, our study aims to analyze whether
minimally invasive valve surgery (MIVS) for both aortic and mitral valves
can improve pulmonary function and reduce the incidence of postoperative
pulmonary complications when compared with the full median sternotomy (FS)
approach. Method(s): A comprehensive systematic literature research
was performed for studies comparing MIVS and FS up to February 2021.
Randomized controlled trials (RCTs) and propensity score-matching (PSM)
studies comparing early respiratory function and pulmonary complications
after MIVS and FS were extracted and analyzed. Secondary outcomes included
intra-and postoperative outcomes. Result(s): A total of 10,194
patients from 30 studies (6 RCTs and 24 PSM studies) were analyzed. Early
mortality differed significantly between the groups (MIVS 1.2 vs. FS 1.9%;
p = 0.005). Compared with FS, MIVS significantly lowered the incidence of
postoperative pulmonary complications (odds ratio 0.79, 95% confidence
interval [0.67, 0.93]; p = 0.004) and improved early postoperative
respiratory function status (mean difference -24.83 [-29.90, -19.76]; p <
0.00001). Blood transfusion amount was significantly lower after MIVS (p <
0.02), whereas cardiopulmonary bypass time and aortic cross-clamp time
were significantly longer after MIVS (p < 0.00001). Conclusion(s):
Our study showed that minimally invasive valve surgery decreases the
incidence of postoperative pulmonary complications and improves
postoperative respiratory function status. Copyright © 2021
Mohamed, Ding, Ali Shah, Li, Dirie, Cheng and Wei.

<94>
Accession Number
2016863036
Title
Intraoperative low tidal volume ventilation and the risk of ICD-10 coded
delirium and the use for antipsychotic medications.
Source
BMC Anesthesiology. 22(1) (no pagination), 2022. Article Number: 149. Date
of Publication: December 2022.
Author
Karalapillai D.; Weinberg L.; Neto A.S.; Peyton P.J.; Ellard L.; Hu R.;
Pearce B.; Tan C.; Story D.; O'Donnell M.; Hamilton P.; Oughton C.;
Galtieri J.; Appu S.; Wilson A.; Eastwood G.; Bellomo R.; Jones D.A.
Institution
(Karalapillai, Weinberg, Peyton, Ellard, Hu, Pearce, Tan, Story,
O'Donnell, Hamilton, Oughton, Galtieri) Department of Anaesthesia, Austin
Hospital, Melbourne, VIC, Australia
(Karalapillai, Neto, Wilson, Eastwood, Bellomo, Jones) Department of
Intensive Care, Austin Hospital, Melbourne, VIC, Australia
(Karalapillai, Neto, Peyton, Ellard, Hu, Pearce, Tan, Story, Bellomo)
Department of Critical Care, The University of Melbourne, Melbourne, VIC,
Australia
(Weinberg, Ellard, Hu, Pearce, Tan, Jones) Department of Surgery,
University of Melbourne, Melbourne, VIC, Australia
(Neto, Bellomo, Jones) Australian and New Zealand Intensive Care Research
Centre, School of Public Health and Preventive Medicine, Monash
University, Melbourne, VIC, Australia
(Neto, Bellomo) Data Analytics Research and Evaluation (DARE) Centre,
University of Melbourne, Melbourne, VIC, Australia
(Neto) Department of Critical Care Medicine, Hospital Israelita Albert
Einstein, Sao Paulo, Brazil
(Appu) Department of Surgery, Austin Hospital, Melbourne, VIC, Australia
Publisher
BioMed Central Ltd
Abstract
Background: Low tidal volume (V<inf>T</inf>) ventilation and its
associated increase in arterial carbon dioxide (PaCO<inf>2</inf>) may
affect postoperative neurologic function. We aimed to test the hypothesis
that intraoperative low V<inf>T</inf> ventilation affect the incidence of
postoperative ICD-10 coded delirium and/or the need for antipsychotic
medications. Method(s): This is a post-hoc analysis of a large
randomized controlled trial evaluating low vs. conventional V<inf>T</inf>
ventilation during major non-cardiothoracic, non-intracranial surgery. The
primary outcome was the incidence of ICD-10 delirium and/or the use of
antipsychotic medications during hospital stay, and the absolute
difference with its 95% confidence interval (CI) was calculated.
 Result(s): We studied 1206 patients (median age of 64 [55-72] years,
59.0% males, median ARISCAT of 26 [19-37], and 47.6% of ASA 3). ICD-10
coded delirium and /or antipsychotic medication use was diagnosed in 11.2%
with similar incidence between low and conventional V<inf>T</inf>
ventilation (11.1% vs. 11.3%; absolute difference, -0.24 [95%CI, -3.82 to
3.32]; p = 0.894). There was no interaction between allocation group and
type of surgery. Conclusion(s): In adult patients undergoing major
surgery, low V<inf>T</inf> ventilation was not associated with increased
risk of ICD-10 delirium and/or the use of antipsychotic medications during
hospital stay. Trial registration: ANZCTR Identifier:
ACTRN12614000790640. Copyright © 2022, The Author(s).

<95>
Accession Number
2015575433
Title
Predictors of permanent pacemaker insertion after mitral valve
replacement: A systematic review.
Source
PACE - Pacing and Clinical Electrophysiology. 45(5) (pp 681-687), 2022.
Date of Publication: May 2022.
Author
Ghauri H.; Iqbal R.; Ahmed S.; Ashraf A.; Khan M.S.Q.; Malik J.; Zaidi
S.M.J.; Almas T.
Institution
(Ghauri, Malik) Department of Cardiology, Rawalpindi Institute of
Cardiology, Rawalpindi, Pakistan
(Iqbal) Department of Cardiology, Wah Medical College, Wah, Pakistan
(Ahmed) Department of Cardiology, DHQ Hospital, Chakwal, Pakistan
(Ashraf) Department of Medicine, Military Hospital, Rawalpindi, Pakistan
(Khan) Department of Cardiology, Armed Forces Institute of Cardiology,
Rawalpindi, Pakistan
(Zaidi) Department of Medicine, Rawalpindi Medical University, Rawalpindi,
Pakistan
(Almas) Department of Medicine, Royal College of Surgeons in Ireland,
Dublin, Ireland
Publisher
John Wiley and Sons Inc
Abstract
As the established surgical mitral valve replacement (MVR) expands toward
various contemporary techniques and access routes, the predictors and
burden of procedure-related complications including the need for permanent
pacemaker (PPM) implantation need to be identified. Digital databases were
searched systematically to identify studies reporting the incidence of PPM
implantation after MVR. Detailed study and patient-level baseline
characteristics including the type of study, sample size, follow-up,
number of post-MVR PPM implantations, age, gender, and baseline ECG
abnormalities were abstracted. A total of 12 studies, recruiting 37,124
patients were included in the final analysis. Overall, 2820 (7.6%)
patients required a PPM with the net rate ranging from 1.7% to 10.96%.
Post-MVR atrioventricular (AV) block was the most commonly observed
indication for PPM, followed by sinoatrial (SA) node dysfunction, and
bradycardia. Age, male gender, pre-existing comorbid conditions, prior
CABG, history of arrhythmias or using antiarrhythmic drugs, atrial
fibrillation ablation, and double valve replacement were predictors of PPM
implantation post-MVR. Age, male gender, comorbid conditions like diabetes
and renal impairment, prior CABG, double valve replacement, and
antiarrhythmic drugs served as positive predictors of PPM implantation in
patients undergoing MVR. Copyright © 2022 Wiley Periodicals LLC.

<96>
Accession Number
635787580
Title
Incidence and Clinical Significance of Worsening Tricuspid Regurgitation
Following Surgical or Transcatheter Aortic Valve Replacement: Analysis
From the PARTNER IIA Trial.
Source
Circulation: Cardiovascular Interventions. 14(8) (pp E010437), 2021. Date
of Publication: 01 Aug 2021.
Author
Cremer P.C.; Wang T.K.M.; Rodriguez L.L.; Lindman B.R.; Zhang Y.; Zajarias
A.; Hahn R.T.; Lerakis S.; Malaisrie S.C.; Douglas P.S.; Pibarot P.;
Svensson L.G.; Kapadia S.; Leon M.B.; Jaber W.A.
Institution
(Cremer, Wang, Rodriguez, Jaber) Section of Cardiovascular Imaging,
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic
Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United
States
(Lindman) Structural Heart and Valve Center, Vanderbilt University Medical
Center, Nashville, TN, United States
(Zhang, Hahn, Leon) Cardiovascular Research Foundation, NY, United States
(Zajarias) Washington University School of Medicine, St. Louis, MO, United
States
(Zajarias) Structural Heart and Valve Center, NewYork-Presbyterian
Hospital, Columbia University Medical Center, NY, United States
(Lerakis) The Zena and Michael A. Wiener Cardiovascular Institute, Icahn
School of Medicine at Mount Sinai, NY, United States
(Malaisrie) Division of Cardiac Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, IL, United States
(Douglas) Duke Clinical Research Institute and Duke University Medical
Center, Durham, NC, United States
(Pibarot) Department of Medicine, Universite Laval, Quebec, QC, Canada
(Svensson, Kapadia) Department of Thoracic and Cardiovascular Surgery,
Heart and Vascular Institute, Cleveland Clinic, OH, United States
(Cremer, Wang, Rodriguez, Jaber) 1Department of Cardiovascular Medicine,
Cleveland Clinic, OH, United States
Publisher
Lippincott Williams and Wilkins
Abstract
Background: Aortic valve replacement (AVR) is recommended for severe
symptomatic aortic stenosis. However, the incidence of worsening tricuspid
regurgitation (TR) following transcatheter compared with surgical AVR
(TAVR, SAVR), and the impact of worsening TR on outcomes, is ill-defined.
Accordingly, among patients randomized to TAVR or SAVR, we describe the
differential incidence of worsening TR and its association with survival.
 Method(s): From the PARTNER IIA trial (Placement of Aortic
Transcatheter Valves IIA), 1334 patients were included with baseline and
30-day postprocedure core-lab echocardiograms. Worsening TR was defined as
deterioration of >=1 grade from baseline to 30 days. Outcomes included
cardiovascular and all-cause death between 30 days and 2 years.
Multivariable logistic regression was performed to identify associations
with worsening TR; survival analyses were performed to assess associations
with mortality. Result(s): Worsening TR occurred in 17.3% (125/721)
of TAVR and 27.0% (165/611) of SAVR patients. On multivariable analysis,
SAVR (odds ratio, 2.09 [95% CI, 1.40-3.11]), female sex (odds ratio, 2.22
[95% CI, 1.44-3.42]), atrial fibrillation (odds ratio, 1.61 [95% CI,
1.03-2.51]), and right ventricular enlargement (odds ratio, 2.25 [95% CI,
1.17-4.31]) were associated with worsening TR. Cardiovascular and
all-cause death occurred in 9.0% (26/290) and 17.9% (52/290) of patients
with worsening TR, compared with 4.8% (50/1042) and 10.9% (114/1042)
without worsening TR, respectively. In patients with worsening TR,
cardiovascular and all-cause death were similar in TAVR compared with
SAVR, (hazard ratio, 1.09 [95% CI, 0.55-2.16]) and (hazard ratio, 1.07
[95% CI, 0.62-1.87]), respectively. After adjustment, worsening TR was
independently associated with cardiovascular (hazard ratio, 3.62 [95% CI,
2.08-6.29]) and all-cause death (hazard ratio, 2.11 [95% CI, 1.37-3.27]).
 Conclusion(s): Worsening TR is associated with female sex, atrial
fibrillation, right ventricular enlargement, and SAVR. Regardless of mode
of AVR, worsening TR is similarly associated with a poor prognosis. Future
studies should focus on whether preventing or treating worsening TR
improves outcomes. Registration: URL: https://www.clinicaltrials.gov;
Unique identifier: NCT01314313. Copyright © 2021 Lippincott
Williams and Wilkins. All rights reserved.

<97>
Accession Number
2016768632
Title
Performance of a new single-use bronchoscope versus a marketed single-use
comparator: a bench study.
Source
BMC Pulmonary Medicine. 22(1) (no pagination), 2022. Article Number: 189.
Date of Publication: December 2022.
Author
Lamb C.R.; Yavarovich E.; Kang V.; Servais E.L.; Sheehan L.B.; Shadchehr
S.; Weldon J.; Rousseau M.J.; Tirrell G.P.
Institution
(Lamb, Yavarovich, Kang, Shadchehr) Division of Pulmonary and Critical
Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road,
Burlington, MA 01805, United States
(Servais) Division of Thoracic Surgery, Lahey Hospital and Medical Center,
Burlington, MA, United States
(Sheehan) Division of Anesthesiology, Lahey Hospital and Medical Center,
Burlington, MA, United States
(Lamb, Sheehan, Shadchehr) Department of Medicine, Tufts Medical Center,
Boston, United States
(Weldon, Rousseau, Tirrell) Boston Scientific Corporation, Marlborough,
MA, United States
Publisher
BioMed Central Ltd
Abstract
Background: Single-use flexible bronchoscopes eliminate cross
contamination from reusable bronchoscopes and are cost-effective in a
number of clinical settings. The present bench study aimed to compare the
performance of a new single-use bronchoscope (Boston Scientific EXALT
Model B) to a marketed single-use comparator (Ambu aScope 4), each in
slim, regular and large diameters. Method(s): Three bronchoscopy
tasks were performed: water suction and visualization, "mucus" mass
(synthetic mucoid mixture) suctioned in 30 s, and "mucus" plug (thicker
mucoid mixture) suction. Suction ability, task completion times, and
subjective ratings of visualization and overall performance on a scale of
one to 10 (best) were compared. All bronchoscopy tasks were completed by
15 physicians representing diversity in specialization including
pulmonary, interventional pulmonary, critical care, anesthesia, and
thoracic surgery. Each physician utilized the six bronchoscope versions
with block randomization by bronchoscope and task. Result(s):
Aspirated mean mass of "mucus" using EXALT Model B Regular was comparable
to that for an aScope 4 Large (41.8 +/- 8.3 g vs. 41.5 +/- 5.7 g
respectively, p = 0.914). In comparisons of scopes with the same outer
diameter, the aspirated mean mass by weight of water and "mucus" was
significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for
all three diameters). Mean ratings for visualization attributes were
significantly better for EXALT Model B compared to aScope 4 (p-value range
0.001-0.029). Conclusion(s): A new single-use bronchoscope provided
strong suction capability and visualization compared to same-diameter
marketed single-use comparators in a bench model simulation. Copyright
© 2022, The Author(s).

<98>
Accession Number
2018123914
Title
Impact of preprocedural biological markers on 10-year mortality in the
SYNTAXES trial.
Source
EuroIntervention. 17(18) (pp 1477-1487), 2022. Date of Publication: April
2022.
Author
Hara H.; Kawashima H.; Ono M.; Takahashi K.; Mack M.J.; Holmes D.R.;
Morice M.-C.; Davierwala P.M.; Mohr F.W.; Thuijs D.J.F.M.; Kappetein A.P.;
O'Leary N.; van Klaveren D.; Onuma Y.; Serruys P.W.
Institution
(Hara, Kawashima, Ono, Takahashi) Department of Cardiology, Academic
Medical Center, University of Amsterdam, Amsterdam, Netherlands
(Hara, Kawashima, Ono, Onuma, Serruys) Department of Cardiology, National
University of Ireland, Galway (NUIG), Galway, Ireland
(Mack) Department of Cardiothoracic Surgery, Baylor Scott & White Health,
Dallas, TX, United States
(Holmes) Department of Cardiovascular Diseases and Internal Medicine, Mayo
Clinic, Rochester, MN, United States
(Morice) Unite de Cardiologie, Hopital Prive Jacques Cartier, Generale de
Sante Massy, Massy, France
(Davierwala, Mohr) University Department of Cardiac Surgery, Heart Centre
Leipzig, Leipzig, Germany
(Thuijs, Kappetein) Department of Cardiothoracic Surgery, Erasmus
University Medical Centre, Rotterdam, Netherlands
(O'Leary) Health Research Board Clinical Research Facility, Department of
Medicine, NUIG, Galway, Ireland
(van Klaveren) Department of Public Health, Center for Medical Decision
Making, Erasmus MC, Rotterdam, Netherlands
(van Klaveren) Predictive Analytics and Comparative Effectiveness Center,
Institute for Clinical Research and Health Policy Studies, Tufts Medical
Center, Boston, MA, United States
(Serruys) NHLI, Imperial College London, London, United Kingdom
Publisher
Europa Group
Abstract
Background: Creatinine clearance (CrCl) is an independent determinant of
mortality in predictive models of revascularisation outcomes for complex
coronary artery disease. Aim(s): This study aimed to investigate the
impact of preprocedural biological markers on 10-year mortality following
coronary revascularisation. Method(s): The SYNTAX Extended Survival
(SYNTAXES) study evaluated the 10-year vital status followup of 1,800
patients with de novo three-vessel (3VD) and/or left main coronary artery
disease (LMCAD) randomised to include percutaneous or surgical coronary
revascularisation. The associations between mortality and preprocedural
C-reactive protein (CRP), haemoglobin, HbA1c, CrCl, fasting triglycerides,
low-density lipoprotein cholesterol, and high-density lipoprotein
cholesterol were analysed. Result(s): Out of 1,800 patients, 460
patients died before the 10-year follow-up. CRP, HbA1c and CrCl with
threshold values of >=2 mg/L, >=6% (42 mmol/mol) and <60 ml/min,
respectively, were associated with 10-year all-cause death (adjusted
hazard ratio [95% confidence interval]: 1.35 [1.01-1.82], 1.51
[1.16-1.95], and 1.46 [1.07-2.00], respectively). There was no significant
interaction between the biological markers on all-cause mortality and the
type of revascularisation. Preprocedural lipid markers were not
significantly associated with 10-year all-cause death, but the non-use of
statins was a determinant factor of worse prognosis (adjusted hazard ratio
[95% confidence interval]: 1.68 [1.26-2.25]). Conclusion(s):
Preprocedural biomarkers, such as CRP and HbA1c, are associated with
long-term mortality post revascularisation, regardless of the
revascularisation technique. Conventional lipidic biomarkers associated
with high-risk of cardiovascular events seem to be effectively mitigated
by the long-term use of statins, whereas the non-use of statins was a
factor of a worse prognosis, emphasising the importance of pharmacological
treatment. Copyright © Europa Digital & Publishing 2022. All
rights reserved.

<99>
Accession Number
2018123909
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. 17(18) (pp 1467-1476), 2022. Date of Publication: April
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) Hopital Prive du Confluent, Nantes, France
(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
Europa Group
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). Aim(s): 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 for 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. Copyright ©
Europa Digital & Publishing 2022. All rights reserved.

<100>
Accession Number
2018121337
Title
Chlorhexidine Gluconate for Perioperative Skin Cleansing to Reduce
Surgical Site Infection and Bacterial Colonization: A Randomized
Controlled Trial.
Source
Mediterranean Journal of Infection, Microbes and Antimicrobials. 11 (no
pagination), 2022. Article Number: 15. Date of Publication: 2022.
Author
Yilmaz A.; Ates S.; Aysun K.
Institution
(Yilmaz) Institute of Health Sciences, Maltepe University, Istanbul,
Turkey
(Ates, Ates) Maltepe University Faculty of Nursing, Istanbul, Turkey
(Aysun) Sureyyapasa Chest Diseases and Thoracic Surgery Training and
Research Hospital, Clinic of Thoracic Surgery, Istanbul, Turkey
Publisher
Galenos Publishing House
Abstract
Introduction: This study aimed to define the role of chlorhexidine
gluconate (CG) in preoperatively skin cleansing and surgical site
infection (SSI) and bacterial colonization reduction. Material(s) and
Method(s): This study was conducted in a public hospital on 120 patients,
of whom 61 consisted the intervention group and 59 in the control group.
The intervention group used bath gel that contains CG and the control
group used bath gels/soap without any antiseptics. Using a swab, samples
from the surgical site were taken from all patients before and after bath.
Surgical sites were inspected in terms of redness, edema, or fluid
drainage daily during their hospital stay, as well as at the 10th and 30th
days after discharge. Fever, heart rate, and blood pressure were also
followed closely. This data was recorded and statistically analyzed.
 Result(s): Infection was detected in 3.3% (n=120) of participants. In
the control group, 6.8% were infected. Infection was not observed in the
intervention group. Five bacteria were analyzed in terms of the effect of
CG use on bacterial colonization and it was found that only
Coagulase-Negative Staphylococci (CNS) growth was decreased with the use
of CG. This decrease was found to be statistically significant.
 Conclusion(s): Our results suggest that cleansing the skin with CG
before thoracic surgery may be beneficial in preventing SSI and reducing
CNS colonization. Copyright © 2022 Mediterranean Journal of
Infection, Microbes and Antimicrobials.All right reserved.

<101>
Accession Number
638019248
Title
Custodiol-N versus Custodiol: a prospective randomized double-blind
multicenter phase III trial in patients undergoing elective coronary
bypass surgery.
Source
European journal of cardio-thoracic surgery : official journal of the
European Association for Cardio-thoracic Surgery. (no pagination), 2022.
Date of Publication: 17 May 2022.
Author
Szabo G.; Brlecic P.; Loganathan S.; Wagner F.; Rastan A.; Doenst T.;
Karck M.; Veres G.
Institution
(Szabo, Brlecic, Loganathan, Karck, Veres) Department of Cardiac Surgery,
University of Heidelberg, Heidelberg 69120, Germany
(Szabo, Loganathan, Veres) Department of Cardiac Surgery, University of
Halle, Halle (Saale) 06120, Germany
(Wagner) Department of Cardiac Surgery, University of Hamburg, Hamburg
20251, Germany
(Rastan) Cardiac Surgery, Heart Center Rotenburg 36199, Germany
(Doenst) Department of Cardiac Surgery, University of Jena, Jena 07747,
Germany
Publisher
NLM (Medline)
Abstract
OBJECTIVE: HTK-Solution (Custodiol) is a well-established cardioplegic and
organ preservation solution. We currently developed a novel HTK-based
solution, Custodiol-N, which includes iron chelators to reduce oxidative
injury, as well as L-arginine, to improve endothelial function. In this
first in-human study, Custodiol-N compared to Custodiol in patients
undergoing elective coronary artery bypass surgery. The aim of this
comparison was to evaluate the safety and ability of Custodiol-N to
protect cardiac tissue. METHOD(S): The study was designed as a
prospective randomized double-blind non-inferiority trial. Primary
end-point was area under the curve (AUC) of creatine kinase MB (CK-MB)
within the first 24h after surgery. Secondary end-points included peak
CK-MB and troponin-T and AUC of troponin-T release, cardiac index,
cumulative catecholamine dose, ICU-stay and mortality. All values in the
abstract are given as mean +/- SD, p<0.05 was considered statistically
significant. RESULT(S): Early termination of the trial was performed
per protocol as the primary non-inferiority end-point was reached after
inclusion of 101 patients. CK-MB AUC (878 +/- 549 vs 779 +/- 439h* U/l,
non-inferiority p<0.001, Custodiol vs Custodiol-N) and troponin-T AUC
(12990 +/- 8347 vs 13498 +/- 6513h*pg/ml, noninferiority p<0.001,
Custodiol vs Custodiol-N) were similar in both groups. Although the trial
was designed for non-inferiority, peak CK-MB (52 +/- 40 vs. 42 +/- 28U/l,
superiority p<0.03, Custodiol vs Custodiol-N) was significantly lower in
the Custodiol-N group. CONCLUSION(S): This study shows that
Custodiol-N is safe and provides similar cardiac protection as the
established HTK-Custodiol solution. Significantly reduced peak CK-MB
levels in the Custodiol-N group in the full analysis set may implicate a
beneficial effect on ischaemia/reperfusion injury in the setting of
coronary bypass surgery. Copyright © The Author(s) 2022.
Published by Oxford University Press on behalf of the European Association
for Cardio-Thoracic Surgery. All rights reserved.

<102>
Accession Number
638015216
Title
Obesity paradox and cardiovascular diseases.
Source
Current cardiology reviews. (no pagination), 2022. Date of Publication:
14 May 2022.
Author
Ganna I.; Anna S.
Institution
(Ganna, Anna) Complex Risk Reduction of Chronic Non-communicable Diseases
L.T. Malaya National Therapy Institute of the National Academy of Medical
Sciences of Ukraine, Ukraine
Publisher
NLM (Medline)
Abstract
The present review summaries data describing the relationship between
obesity and cardiovascular outcomes. Links between obesity and chronic
coronary syndromes, acute coronary syndromes, coronary revascularization,
ischemic stroke, heart failure, hypertension and atrial fibrillation were
evaluated. Data from epidemiological studies, prospective studies with
lifestyle modification or medical therapy, and results of the
meta-analysis were evaluated. The majority of publications report the
presence of an 'obesity paradox'. According to this, overweight or obese
patients with cardiovascular conditions have a better prognosis than
patients with normal weight or underweight. At the same time, no
information about comorbidities, concomitant medication, or other causes
of low weight was not given in the majority of studies. Moreover, weight
reduction as a result of medical intervention leads to improvement of the
prognosis and patients' quality of life. This analysis of the literature
suggests that the 'obesity paradox' may not be an isolated medical
phenomenon, but rather a corollary of the interpretation of the
epidemiological data, and that medically-supervised weight loss should
remain a key factor in recuing cardiovascular complications in obese
people. Copyright© Bentham Science Publishers; For any queries,
please email at epub@benthamscience.net.

<103>
Accession Number
638002515
Title
Fractional flow reserve versus angiography alone in guiding myocardial
revascularisation: a systematic review and meta-analysis of randomised
trials.
Source
Heart (British Cardiac Society). (no pagination), 2022. Date of
Publication: 13 May 2022.
Author
Elbadawi A.; Sedhom R.; Dang A.T.; Gad M.M.; Rahman F.; Brilakis E.S.;
Elgendy I.Y.; Jneid H.
Institution
(Elbadawi, Rahman, Jneid) Cardiology, Baylor College of Medicine, Houston,
TX, United States
(Sedhom) Internal Medicine, Albert Einstein Medical Center, Philadelphia,
PA, United States
(Dang) Internal Medicine, University of Texas Medical Branch at Galveston,
Galveston, TX, United States
(Gad) Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH,
United States
(Brilakis) Cardiology, Minneapolis Heart Institute and Minneapolis Heart
Institute Foundation, Minneapolis, MN, United States
(Elgendy) Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
Publisher
NLM (Medline)
Abstract
BACKGROUND: Randomised trials evaluating the efficacy and safety of
fractional flow reserve (FFR)-guided versus angiography-guided
revascularisation among patients with obstructive coronary artery disease
(CAD) have yielded mixed results. AIMS: To examine the comparative
efficacy and safety of FFR-guided versus angiography-guided
revascularisation among patients with obstructive CAD. METHOD(S): An
electronic search of MEDLINE, SCOPUS and Cochrane databases without
language restrictions was performed through November 2021 for randomised
controlled trials that evaluated the outcomes of FFR-guided versus
angiography-guided revascularisation. The primary outcome was major
adverse cardiac events (MACE). Data were pooled using a random-effects
model. RESULT(S): The final analysis included seven trials with 5094
patients. The weighted mean follow-up duration was 38 months. Compared
with angiography guidance, FFR guidance was associated with fewer number
of stents during revascularisation (standardised mean difference=-0.80;
95% CI -1.33 to -0.27), but no difference in total hospital cost. There
was no difference between FFR-guided and angiography-guided
revascularisation in long-term MACE (13.6% vs 13.9%; risk ratio (RR) 0.97,
95% CI 0.85 to 1.11). Meta-regression analyses did not reveal any evidence
of effect modification for MACE with acute coronary syndrome (p=0.36),
proportion of three-vessel disease (p=0.88) or left main disease (p=0.50).
There were no differences between FFR-guided and angiography-guided
revascularisation in the outcomes all-cause mortality (RR 1.16, 95% CI
0.80 to 1.68), cardiovascular mortality (RR 1.27, 95% CI 0.50 to 3.26),
repeat revascularisation (RR 0.99, 95% CI 0.81 to 1.21), recurrent
myocardial infarction (RR 0.92, 95% CI 0.74 to 1.14) or stent thrombosis
(RR 0.61, 95% CI 0.31 to 1.21). CONCLUSION(S): Among patients with
obstructive CAD, FFR-guided revascularisation did not reduce the risk of
long-term adverse cardiac events or the individual outcomes. However,
FFR-guided revascularisation was associated with fewer number of stents.
PROSPERO REGISTRATION NUMBER: CRD42021291596. Copyright ©
Author(s) (or their employer(s)) 2022. No commercial re-use. See rights
and permissions. Published by BMJ.

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